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1. By – SURESH KUMAR ( Nursing Tutor )
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2. Digestive System.
• The digestive system is also known as the gastrointestinal
system or the alimentary canal or GIT. This vast system is
approximately 10 m long. It travels the length of the body
from the mouth through the thoracic, abdominal and pelvic
cavities, where it ends at the anus. We are covering it in
multiple lectures. Today we are going to discuss the anatomy
and physiology of accessary organs of GIT that are
pancreas, liver and gall bladder.

3. Pancreas
• The pancreas is a pale grey
gland weighing about 60
grams. It is about 12 to 15 cm
long and is situated in the
epigastric and left
hypochondriac regions of the
abdominal cavity. It consists
of a head, body and tail

4. Pancreas
• The head lies in the curve of the duodenum, the body behind
the stomach and the tail lies in front of the left kidney and
just reaches the spleen. The abdominal aorta and the inferior
vena cava lie behind the gland. The pancreas is both as :
• Exocrine gland and
• Endocrine gland.

5. Exocrine Pancreas
• This consists of a large number of lobules made up of small acini, the
walls of which consist of secretory cells. Each lobule is drained by a
tiny duct and these unite eventually to form the pancreatic duct, which
extends the whole length of the gland and opens into the duodenum.
Just before entering the duodenum the pancreatic duct joins the common
bile duct to form the hepatopancreatic ampulla. The function of the
exocrine pancreas is to produce pancreatic juice containing enzymes that
digest carbohydrates, proteins and fats

6. Endocrine Pancreas
• There are groups of specialised cells called the
pancreatic islets (islets of Langerhans). These islets are
distributed throughout the gland. The islets have no
ducts so the hormones diffuse directly into the blood.
The endocrine pancreas secretes the hormones insulin
and glucagon, which are principally concerned with
control of blood glucose levels

7. Liver
• The liver is the largest gland in the body, weighing between 1
and 2.3 kg. It is situated in the upper part of the abdominal
cavity occupying the greater part of the right hypochondriac
region, part of the epigastric region and extending into the
left hypochondriac region. Its upper and anterior surfaces are
smooth and curved to fit the under surface of the diaphragm.
its posterior surface is irregular in outline

8. Liver
• The liver is enclosed in a thin inelastic capsule and incompletely
covered by a layer of peritoneum. Folds of peritoneum form
supporting ligaments attaching the liver to the inferior surface of
the diaphragm. It is held in position partly by these ligaments and
partly by the pressure of the organs in the abdominal cavity. The
liver has four lobes. The two most obvious are the large right lobe
and the smaller, wedge shaped, left lobe. The other two, the caudate
and quadrate lobes, are areas on the posterior surface

9. Liver
•

10. Liver
• The portal fissure- This is the name given to the region on the
posterior surface of the liver where various structures enter and
leave the gland.
• The portal vein enters, carrying blood from the stomach, spleen,
pancreas and the small and large intestines.
• The hepatic artery enters, carrying arterial blood. It is a branch from
the coeliac artery, which is a branch from the abdominal aorta.

11. Liver
• Nerve fibres, sympathetic and
parasympathetic, enter here.
• The right and left hepatic ducts leave,
carrying bile from the liver to the gall
bladder.
• Lymph vessels leave the liver, draining
some lymph to abdominal and some
to thoracic nodes.

12. Liver
• The falciform ligament extends from the undersurface
of the diaphragm between the two principal lobes of the
liver to the superior surface of the liver, helping to
suspend the liver in the abdominal cavity. In the free
border of the falciform ligament is the ligamentum
teres (round ligament), a remnant of the umbilical vein
of the fetus

13. Structure
of Liver
• The lobes of the liver are made up of
tiny functional units, called lobules,
which are just visible to the naked
eye. Liver lobules are hexagonal in
outline and are formed by cubical-
shaped cells, the hepatocytes, arranged
in pairs of columns radiating from a
central vein.

14. Structure
of Liver
• Blood drains from the sinusoids
into central or centrilobular veins.
These then join with veins from
other lobules, forming larger
veins, until eventually they
become the hepatic veins, which
leave the liver and empty into
the inferior vena cava.

15. Structure
of Liver
• One of the functions of the
liver is to secrete bile. Bile
canaliculi run between the
columns of liver cells. The
canaliculi join up to form larger
bile canals until eventually they
form the right and left hepatic ducts,
which drain bile from the liver.

16. Functions of Liver
• Carbohydrate metabolism
• The liver has an important role in maintaining plasma
glucose levels. After a meal when levels rise, glucose is
converted to glycogen for storage under the influence of
the hormone insulin. Later, when glucose levels fall, the
hormone glucagon stimulates conversion of glycogen
into glucose again, keeping levels within the normal range

17. Functions of Liver
• Fat metabolism
• Hepatocytes store some triglycerides; break down fatty
acids to generate ATP; synthesize lipoproteins, which
transport fatty acids, triglycerides, and cholesterol to and
from body cells; synthesize cholesterol; and use
cholesterol to make bile salts

18. Functions of Liver
• Protein metabolism- Hepatocytes deaminate (remove the
amino group, NH2, from) amino acids so that the amino
acids can be used for ATP production or converted to
carbohydrates or fats. The resulting toxic ammonia (NH3) is
then converted into the much less toxic urea, which is
excreted in urine. Hepatocytes also synthesize most plasma
proteins, such as alpha and beta globulins, albumin,
prothrombin, and fibrinogen.

19. Functions of Liver
• Processing of drugs and hormones.
• The liver can detoxify substances such as alcohol and
excrete drugs such as penicillin, erythromycin, and
sulfonamides into bile. It can also chemically alter or
excrete thyroid hormones and steroid hormones such
as estrogens and aldosterone.

20. Functions of Liver
• Excretion of bilirubin.
• Bilirubin, derived from the heme of aged/dead red
blood cells, is absorbed by the liver from the blood
and secreted into bile. Most of the bilirubin in bile
is metabolized in the small intestine by bacteria and
eliminated in feces.

21. Functions of Liver
• Synthesis of bile salts- Bile salts are used in the small
intestinefor the emulsification and absorption of lipids.
• Storage-In addition to glycogen, the liver is a prime
storage site for certain vitamins (A, B12, D, E, and K)
and minerals (iron and copper), which are released from
the liver when needed elsewhere in the body.

22. Functions of Liver
• Inactivation of hormones- hormones are
inactivated/regulated by liver. These include insulin, glucagon,
cortisol, aldosterone, thyroid and sex hormones.
• Production of heat-The liver uses a considerable amount of
energy, has a high metabolic rate and produces a great deal of
heat. It is the main heat-producing organ of the body.

23. Functions of Liver
• Phagocytosis- The stellate reticuloendothelial
(Kupffer) cells of the liver phagocytize aged red
blood cells, white blood cells, and some bacteria.
• Activation of vitamin D- The skin, liver, and
kidneys participate in synthesizing the active form
of vitamin D.

24. Bile juice
• Between 500 and 1000 ml of bile are secreted by the
liver daily. Bile consists of:
• Water, mineral salts, mucus, bile pigments, mainly
bilirubin, bile salts, which are derived from the primary
bile acids, cholic acid and chenodeoxycholic acid
• cholesterol.

25. Bile juice
• The principal bile pigment is bilirubin. The phagocytosis of
aged red blood cells liberates iron, globin, and bilirubin
(derived from heme) . The iron and globin are recycled; the
bilirubin is secreted into the bile and is eventually broken
down in the intestine. One of its breakdown products—
stercobilin—gives feces their normal brown color. A small
amount is reabsorbed and excreted in urine as urobilinogen

26. Bile juice
• Bile is partially an excretory product and partially a
digestive secretion. Bile salts, which are sodium salts and
potassium salts of bile acids (mostly chenodeoxycholic
acid and cholic acid), play a role in emulsification, the
breakdown of large lipid globules into a suspension of
small lipid globules

27. Gall bladder
• The gall bladder is a pear-
shaped sac attached to the
posterior surface of the liver
by connective tissue. It has a
fundus or expanded end, a
body or main part and a neck,
which is continuous with the
cystic duct.

28. Gall bladder
The wall of the gall bladder has the same layers of tissue as those described in the
basic structure of the alimentary canal, with some modifications.
• Peritoneum-This covers only the inferior surface because the
upper surface of the gall bladder is in direct contact with the liver
• Muscle layer-There is an additional layer of oblique muscle fibres.
• Mucous membrane-This displays small rugae when the gall
bladder is empty that disappear when it is distended with bile.

29. Bile ducts
to and from Gall bladder
• The right and left hepatic ducts join to form the common hepatic duct just
outside the portal fissure. The hepatic duct passes downwards for about
3 cm where it is joined by the cystic duct from the gall bladder. The cystic
and hepatic ducts merge forming the common bile duct, which passes
downwards behind the head of the pancreas. This is joined by the main
pancreatic duct at the hepatopancreatic ampulla and the opening into
the duodenum, at the duodenal papilla, is controlled by the
hepatopancreatic sphincter (of Oddi). The common bile duct is about
7.5 cm long and has a diameter of about 6 mm.

30. Functions of
Gall bladder
• Functions include:
• Reservoir for bile- concentration of the bile by up to 10- or 15-fold, by absorption
of water through the walls of the gall bladder
• Release of stored bile- When the muscle wall of the gall bladder contracts, bile
passes through the bile ducts to the duodenum. Contraction is stimulated by: the
hormone cholecystokinin (CCK), secreted by the duodenum the presence of fat and
acid chyme in the duodenum.
• Relaxation of the hepatopancreatic sphincter (of Oddi) is caused by CCK and is a
reflex response to contraction of the gall bladder.

31. By – SURESH KUMAR ( Nursing Tutor )