THE PPT CONTAIN WHOLE CHAPTER OF LIVER FOR FIRST YEAR OF MBBS BAMS BHMS

1. LIVER
By : Aditi Sharma

2. INTRODUCTION
• Functional Anatomy of Liver
• Blood supply to Liver
• Secretion of Bile
• Properties and composition of Bile
• Function of Liver
• Applied physiology

3. FUNCTIONAL ANATOMY OF LIVER
• Largest exocrine gland in the body.
• Weight 1.2- 1.5 kg
• It develops from Endoderm.
• It is located in Upper & right side of abdominal cavity, below diaphragm.
• Liver is dual organ having both secretory and excretory functions.
• It is made up of left and right lobe ( hepatic lobe). Where Left lobe is smaller
than right lobe.
• Both the lobes are separated from each other by falciform ligament.

4. STRUCTURE
• Liver made up of hepatic lobe ,,and each hepatic lobes consists of Hepatic
lobules.
HEPATIC LOBULES :
• Hepatic lobules are the structural and functional unit of Liver.
• 50,000 to 100,000 Lobules present in the liver.
• These are arranged in honey comb like structure.
• These are made up of hepatic cells known as Hepatocytes.
Note: characteristics feature of mammalian liver:
• Hepatic Lobules are covered By Thin fibrous connective tissue sheath known
as Glission’s capsule.

5. HEPATIC PLATE :
• Hepatocytes are radially arrange in columns, which
forms Hepatic plate Or Hepatic cord.
• Made up of two columns of cell.
BILE CANALICULI :
• It runs In b/w the two layers of hepatic cells in each
Cord / plate.
• Bile is secreted by Hepatic cells and Emptied into
Bile canaliculi.
Sinusoids :
• It is a cavity/ space b/w two Hepatic plate.
• It is lined by endothelial cells.
• Special macrophage cell present know as kupffer cells.( Phagocytic cell).

6. PORTAL TRIAD

8. BLOOD SUPPLY TO LIVER
• Liver receives the maximum blood supply of about 1500mL/min.
• It receives blood from two sources ,namely,,
1. Hepatic artery
2. Hepatic portal vein

10. Portal vein blood :
• It is rich in monosaccharides & amino acid.
• It also contains bile salts, bilirubin and GI Hormone.
• Carries deoxygenated blood ( having low oxygen content)
Enterohepatic circulation :
Flow of blood from intestine to liver through portal vein is known as
Enterohepatic circulation.
Hepatic veins :
Waste products and CO2 synthesis by Hepatocytes are discharge into
Sinusoids .
Sinusoids drains them into central veins .
Central veins unite to form bigger vein, which ultimately forms Right & left
Hepatic veins ,which opens into Inferior vena cava.

12. SECRETION OF BILE
Bile is secreted by Hepatocytes .
• Initially bile secreted by Hepatocytes contain large quantity of Bile acid, bile
pigments, cholesterol, lecithin,& fatty acid.
• From hepatocytes, bile released into bile canaliculi.
Bile canaliculi --- passes to small ducts--- Hepatic ducts--- finally reaches Common
Hepatic ducts
From common Hepatic bile duct , Bile is Diverted either directly into intestine or into gall bladder.
Sodium , bicarbonate, water Added to bile When it passes through ducts.
Addition of these substances increases total quantity of Bile.

13. PROPERTIES OF BILE
• Volume : 800 – 1200 mL/day
• Nature : Alkaline ( basic)
• Ph : 8 – 8.6
• Specific gravity : 1.010 – 1.011
• Colour : Golden yellow or greenish shade

14. COMPOSITION OF BILE

15. FUNCTIONS OF LIVER
1. Secretion and synthesis of Bile
2. Carbohydrates Metabolism
• Main centre for carbohydrates metabolismis Liver.
• Glycogenesis
• Glycogenolysis
• Gluconeogenesis
• Gluconeogenesis
the main stored food – glycogen.
3. Metabolic function
• Liver is organ where Maximum Metabolic reactions occur.
4. Deamination and urea formation
orinithine cycle / urea cycle occur in liver

16. 5. Storage function
Substance like glycogen , amino acid, Folic acid , Vitamin B12,, VitA,vitD &
some small amount of fats and ions like ca2+ , cobalt,..
Liver is good source of iron.
6. Synthesis of plasma proteins
All plasma proteins except gama globulin.
_ prothrombin & fibrinogen And clotting factors are also formed.
_ produce thrombopoietin – leads to production of thrombocytes.
7. Synthesis of heparin ( natural anticoagulant )
8. Haemopoiesis / Hemopoietic function
in embryonic stage RBC & WBC are formed by liver.
9. Purification of blood
Due to presence of kupffer cells ( phagocytic cell)

17. 10. Excretory functions
Excretes cholesterol, bile pigment, heavy metals ( Pb, As,Bi,etc.) , Toxins,
Bacteria and viruses Through bile.
11. Heat production
Liver is the organ where Maximum heat is produced because of metabolic
reactions.
12. Haemolytic Function
Senile RBCs after lifespan of 120 days are destroyed by Reticuloendothelial
cells ( kupffer cells) Of Liver.
13. Inactivation of Hormones and Drugs
Liver catabolize the Hormone Such as growth hormone, Parathormone,
Cortisol ,insulin, glucagon, estrogen.
_ Also inactivates the drugs , particularly fat soluble drugs.
_ Fat soluble drugs converts into water soluble Substance which are excreted
through bile or urine.

18. 14. Defensive function
_ Due to presence of reticuloendothelial cells,, it play imp. role in defence
mechanism.
• Foreign Bodies Like bacteria or antigens are swallowed & digested by
Reticuloendothelial cells Of Liver through phagocytosis.
• Reticuloendothelial cells also produce Substance like interleukins and Tumor
necrosis factor which activates the immune system Of body .
15. Detoxification Function
Hepatocytes are involved in Removal of toxic property of various harmful
substances.
Detoxification in liver occur in two ways :
• Total destruction of harmful Substances through metabolic degradation.
• Conversion of toxic substances into non toxic substances by means of
conjugation With glucuronic Acid or Sulfates .

19. APPLIED PHYSIOLOGY

20. JAUNDICE OR ICTERUS
• Derived from French word “jaune” Means “yellow” .
• Condition characterised by yellow colouration of skin , Mucous membrane &
deeper tissue Due to increased Billirubin Level in blood.
Normal serum Billirubin Level- 0.5 to 1.5 mg/dL .
In jaundice, Billirubin Level – more then 2mg/ dL .
Jaundice is classified into three types:
1. Prehepatic or Hemolytic jaundice
2. Hepatic or Hepatocellular jaundice
3. Posthepatic or Obstructive jaundice

21. PREHEPATIC JAUNDICE/ HEMOLYTIC
• Occur due To excessive destruction of RBCs.
• Results in increased blood Level Of Unconjugated (free) Billirubin.
• Excretory functions of Liver is normal .
• Quantity of Billirubin increase enormously.
• Unconjugated Billirubin is insoluble in water. Therefore not excreted in urine.
Therefore accumulates in blood resulting in jaundice.
• Formation of urobilinogen Also increase, results in it's excretion in urine .

22. CAUSES
• Conditions causes hemolytic Anemia can lead to hemolytic jaundice.
Common causes:
• Renal Disorders
• Hypersplenism
• Burns
• Infections such as malaria
• Haemoglobin Abnormalities like sickle cell Anemia or thalassemia.
• Drugs or chemical substance causing red cell damage.
• Auto immune disease

23. HEPATIC/HEPATOCELLULAR/CHOLESTATIC
JAUNDICE
• Occurs due to damage Of hepatic cells (Hepatocytes).
• This results in the Conjugated Billirubin from the liver Cannot be excreted &
Returns in the blood.
Causes :
• Infection by virus ( Infective jaundice),, Resulting in hepatitis ( Viral hepatitis)
• Alcoholic hepatitis
• Cirrhosis Of Liver
• Exposure to toxic Material.

24. POSTHEPATIC/OBSTRUCTIVE/ EXTRA
HEPATIC JAUNDICE
• Occurs due to obstruction of Bile flow at any level of billiary system.
• Bile cannot be excreted into small intestine .Therefore, Bile salts and pigment
enters into blood circulation.
• Results in more amount of Conjugated Billirubin in blood.
Causes:
• Gallstones
• Cancer of billiary system Or pancreas

26. HEPATITIS
• Hepatitis is liver damage caused by many agents.
• Characterised by swelling & Inadequate functioning of Liver.
• It may be acute or chronic. In severe condition,it May lead to liver failure
and death.
Causes & types:
1. Viral infection ( viral hepatitis)
2. Bacterial infection like leptospirosis &Q fever
3. Excessive consumption of alcohol
4. Excessive administration of drugs like paracetamol
5. Poisons Like carbon tetrachloride (CCl4) & Aflatoxin
6. Wilson Disease
7. Circulatory Insufficiency
8. Inheritance From mother during parturition

27. VIRAL HEPATITIS ( CAUSE BY VIRUS)
• Causes by two type of virus, hepatitis A & hepatitis B.
Causes Of viral hepatitis :
• By Intake of water & food Contaminated with Hepatitis virus.
• Sharing needles with infected person .
• Accidently prick By infected needle.
• Having Unprotected sex with infected person.
• Inheritance From mother during Parturition.
• Blood transfusion From infected donor.
NOTE: Hepatitis caused By Hepatitis B virus is more common & considered
More serious Because it may lead to cirrhosis & cancer of Liver.

28. FEATURES:
1. Fever
2. Nausea
3. Vomiting, diarrhoea & loss of appetite
4. Headache & Weakness
5. In addition, chronic Hepatitis is characterised by :
• Stomach pain
• Paleness of skin
• Dark coloured Urine & Pale stool
• Jaundice
• Personality changes

29. CIRRHOSIS OF LIVER
• It refers to Inflammation & Damage of Parenchyma of liver.
• It results in Degeneration of hepatic cells & Dysfunction of liver.
Causes :
1. Infection
2. Retension of Bile in liver due to obstruction of ducts of billiary system.
3. Enlargement of liver due to intoxication
4. Inflammation around Liver ( perihepatitis )
5. Infiltration of fats in Hepatic Cells.
Factors : 1. Fever ,nausea , vomiting
2. Jaundice
3.Increased heart rate & cardiac output
4.Portal hypertension
5.muscular weakness & Wasting Of muscle
6.Drowsiness
7. Lack of concentration & confused state of mind
8. Comma in advance stage

30. THANK YOU