Liver & Gallbladder: Functions, Anatomy, Disorders

LIVER & GALL BLADDER
©2021 DR ROHIT BHASKAR PT HTTPS://WWW.PT-PEDIA.COM/

OBJECTIVES
❖Liver
❖ Physiological anatomy
❖ Hepatic biliary system
❖ Functions of liver
❖ Bile
❖Gall bladder
❖ Applied aspects.

LIVER – PHYSIOLOGICAL ANATOMY
■ Largest gland
■ Wt – 1500 gm
■ Anatomically – lobes – 2
■ Right & left
■ Each part has blood supply from hepatic
artery, portal vein & own venous & biliary
drainage.

STRUCTURAL CHARACTERISTICS
■
■
■
■
Structural & functional units –
hepatic lobules – about 1 lac
Each lobules has hepatocytes in columns
Between columns present bile canaliculi
Hapatocytes tunneled by blood sinusoids
which drains into central vein.

STRUCTURAL CHARACTERISTICS
■
■
■
■
Sinusoids lined by
endothelial cells, along with
Kupffer cells in between.
At periphery of each lobule
present portal triad.
Contains – portal vein,
hepatic artery & bile duct.
Acinus – is structural unit of
liver.

ZONES OF ACINUS
■ Zone 1 – central portion of
acinus immediately
surrounding terminal hepatic
arteriole & portal venule
■ Zone 2 – between zone 1 & 3
■ Zone 3 – most peripheral
part, most susceptible to
anoxic injury.

HEPATIC CIRCULATION
■ Hepatic artery – branch of ciliac trunk (20-
25%)
■ Portal vein – collects from mesenteric &
splenic vascular bed ( 75-80%)
■ Hepatic vein – sinusoids drain into central
vein, all central veins joins to form right &
left hepatic veins which drains into inferior
venacava.

HEPATIC BILIARY SYSTEM
■ Intra hepatic Biliary
system – bile secreted by
hepatic cells into canaliculi
which form hexagonal
network around liver cells
■ At periphery canaliculi
becomes continuous with
intralobular ductules –
joins together to form
hepatic duct

EXTRA HEPATIC BILIARY APPARATUS
■ Gall Bladder –
pear shaped sac
beneath liver, 30-50
ml capacity, stores
bile
■ Extra hepatic
ducts.
■ Hepatic duct
■ Cystic duct
■ Common bile duct.

EXTRA HEPATIC DUCTS
■ Hepatic duct – right
& left hepatic ducts
from 2 sides joins to
bile common hepatic
duct (4 cm)
■ Cystic duct (4cm)
– connects neck of
gall bladder to
common hepatic
duct to form CBD

EXTRA HEPATIC DUCTS
■ Common bile duct
(8 cm)
■ Joins pancreatic duct
to form common
hepatopancreatic duct
(Ampulla ofVater)
■ Opens into 2ndpart
of duodenum at
major duodenal
papilla.
■ Surrounded by sphincter
of Oddi.

FUNCTIONS OF LIVER
■
■
Secretory function
Metabolic function
■
■
■
Carbohydreate
Fat
Protein
■
■
■
■
■
Detoxicating and protective function.
Storage function
Excretory function
Synthesis function
Miscellaneous function.

SECRETORY FUNCTION
■ Liver – exocrine gland
■ Secrete bile for digestion and absorption of
fats.

METABOLIC FUNCTION
■ Carbohydrate –
■ Glycogenesis
■ Glycogenolysis
■ Gluconeogenesis.
■ Alcohol metabolism
■ Fats – degradation & synthesis of fats
■ Proteins – Deamination, urea formation.

DETOXICATING AND PROTECTIVE FUNCTION
■ Kupffer cells –
removes bacteria &
cleansing action
■ Detoxify drugs by
oxidation, hydrolysis,
reduction &
conjugation.

STORAGE FUNCTION
■ Glucose ( in the form of Glycogen),Vit B12,Vit A
■ Blood iron buffer & iron storage medium in the
form of ferritin & hemosiderin.

EXCRETORY FUNCTION
■ Exogenous dyes like bromsulpthalein & rose
Bengal dye are excreted.

SYNTHESIS FUNCTION
■ Plasma proteins – albumin & α & β globulin
■ Coagulation factors I,V,VII, IX & X
■ Enzymes – alkaline phosphatase. SGPT, SGOT
■ Removes ammonia to synthesize urea
■ Cholesterol.

MISCELLANEOUS FUNCTION
■ Reservoir of blood – about 650 ml
■ Erythropioiesis
■ Hormone metabolism
■ Inactivation of insulin, glucagon, vasopressin
■ Reduction & conjugation of oestrogen,
testosterone, cortisol, aldosterone.
■ Destruction of RBC
■ Thermal regulation.

BILE
■ Digestive juice formed
in liver.
■ Hepatocytes to bile
canaliculi
■ Common hepatic duct
■ Cystic duct
■ Common bile duct

FORMATION OF BILE

COMPOSITION OF BILE
■
■
■
Bile formed in hepatocytes & released into canaliculi.
Its an alkaline juice comprised of
Water & solids (organic/inorganic)
■ Organic – bile salts, pigments, cholesterol, lecithin, FA, alkaline
phosphatase
■ Inorganic – Na+, K+, Ca+, HCO3- & Cl-

COMPOSITION OF BILE
■ Bile salts
■ Bile pigments
■ Phospholipids
■ Cholesterol
■ Electrolytes.

FORMATION OF BILE SALTS
■ Bile salts
■ Formation

FUNCTIONS OF BILE SALTS
■ Emulsification of fats
■ Acceleration of action of pancreatic lipase
■ Micelle formation
■ Absorption of fat soluble vitamins
■ Cholerectic action- formation of bile
■ Cholesterol kept in soluble form in gall
bladder
■ Intestinal motility.

ENTEROHEPATIC CIRCULATION OF BILE SALTS

BILE PIGMENTS
■ Mainly Bilirubin & Biliverdin
■ From metabolite of hemoglobin.

OTHER CONTENTS
■ Phospholipids – Primarily Lecithins.
■ Cholesterol – by product of bile salts synthesis.
■ Normal level in bile – 60-170 mg/dl
■ Electrolytes
■ Cl- & HCO3- mainly.

FUNCTIONS OF GALL BLADDER (RECSS)
■ Regulates equalization of pressure in biliary
system
■ Effect on pH of bile
■ Concentration of bile – becomes thicker,
viscous & darker
■ Storage of bile – 30-50 ml
■ Secretion of mucous

FUNCTIONS OF BILE MADE-(LPC)2
■
■
■
■
■
■
■
■
■
■
Digestive function - FATS
Absorptive function – fats &Vit
Excretory function – heavy metals, toxins , bacteria, lecithin
Laxative action – GIT motility
Protective action – Natural detergent.
Cholerectic action – secretion of bile.
Maintenance of pH of gastrointestinal tract.
Prevention of gall stone formation
Lubricating function.
Cholegogue function – Increases release of bile from gall bladder.

REGULATION OF BILE
■ Regulation of biliary
secretion
■ Regulation of release
of bile from gall
bladder.

REGULATION OF BILIARY SECRETION
■ Regulation of bile Indepedent fraction of biliary
secretion
■ Regulation of bile depedentr fraction of biliary
secretion

REGULATION OF BILE INDEPEDENT
FRACTION OF BILIARY SECRETION
■ Its amount of fluid containing water &
electrolytes.
■ Controlled by secretin & vagal stimulation.
■ Secretin – produces watery secretion rich in
HCO3 – via cAMP.
■ Vagovagal reflex – initiated during intestinal
phase of digestion through Ach.

REGULATION OF BILE DEPEDENT
FRACTION OF BILIARY SECRETION
■ Quantity of bile salts by liver.
■ Directly proportional amount of bile salts
reabsorbed from portal circulation.
■ Cholerectics enhances bile salts secretion by
hepatocytes.

REGULATION OF RELEASE OF BILE FROM
GALL BLADDER.
■ Filling of gall bladder – controlled by
pressure gradient.
■ During interdigestive period as sphincter of oddi
closed bile goes to gall bladder & pressure rises to 7
cm of H2O
■ Emptying of gall bladder – during digestive
period as sphincter of oddi relaxed pressure in
gall bladder rises to 20 cm of H2O bile enters
to duodenum.

RELEASE OF BILE CONTROLLED BY
■ Hormones – CCK
■ Fats & protein digestion products stimulate
secretion of CCK which causes contraction of gall
bladder & relxation of sphincter of oddi.
■ Neural
■ Vagal stimulation during gastric phase of digestion
causes contraction of gall bladder.
■ Cholegogue – Substances causing
contraction of gall bladder.

APPLIEDASPECTS
■ Disorders of liver and
gall bladder
■ Jaundice or icterus.
■ Cirrhosis of liver
■ Viral hepatitis
■ Cholecystitis – Gall
bladder inflammation.

JAUNDICE OR ICTERUS
■ Yellowish
discolouration of skin
& mucous membrane
due to raised bilirubin
in blood.
■ Normal value – 0.3-
1 mg/dl
■ Jaundice > 2 mg/dl

TYPES OF JAUNDICE
■ Haemolytic – prehepatic
■ Hepatocellular – Hepatic
■ Obstructive – post hepatic

CIRRHOSIS OF LIVER
■ Irreversible chronic
damage to liver with
extensive fibrosis &
regenerative nodule
formation.

VIRAL HEPATITIS
 Odema
 Haemorrhagic disorders
 Muscle weakness, tremors, convulsions Hepatomegaly, ascites
 Steatorrhoea Anaemia,jaundice
 Raised SGPT, SGOT, Blood urea
■
■
■
Cause – hepatitis virus – A,B,C,D,E,F & G
Hepatitis B hepatitis Most common
Clinical features

GALL STONE
■ Cholelithiasis – gall stone
formation.
■ Types
■ Cholesterol stone – 80-85%
■
■ Due to precipitation of
cholesterol
Radioluscent – cannot seen.
■ Pigment stones – Ca
bilirubinate stones
■ 15-20 %, Radiopoaque.

LIVER FUNCTIONTESTS
■ Tests to assess Secretory functions of liver
■ Tests to assess Metabolic functions of liver.
■ Tests to assess Synthesis of function of liver.
■ Tests to assess Detoxication function of liver.
■ Tests to assess Hepatic cellular integrity.
■ Miscellaneous tests

TESTSTO ASSESS SECRETORY
FUNCTIONS OF LIVER
■ Serum bilirubin –
■ Total serum bilirubin – 0.3-1 mg/dl
■ Conjugated bilirubin – 0.1-0.3 mg/dl
■ Unconjugated bilirubin – 0.2-0.7 mg/dl
■ Urine bilirubin & bile salts
■ Urine urobilinogen > 4mg/dl
■ Faecal stercobilinogen - > 20-25 mg/dl
■ Faecal fat level - > 5-6 %

TESTSTO ASSESS METABOLIC
FUNCTIONS OF LIVER
■ Galactose tolerance tests
■ Blood glucose level < 70-90 mg/dl
■ Blood & urine amino acid levels > 30-65
mg/dl
■ Lipid Profile
■ Increase – plasma NEFA & FFA & Ketone bodies
■ Decrease – serum cholesterol, serumTG, Serum
PL, total lipids.

TESTSTO ASSESS SYNTHESIS OF
FUNCTION OF LIVER
■ Estimation of plasma proteins –
Hypoalbuminemia & reversal of A:G ratio
■ Serum liver enzymes level – raised
Transaminase & alkaline phosphatase
■ Blood urea - < 20-40 mg/dl
■ Blood ammonia - > 20-80 mg/dl
■ Coagulation factors – II,V,VII, IX & X
decreases.

TESTSTO ASSESS DETOXICATION
FUNCTION OF LIVER
■ Bromsulphthalein excretion test.
■ Rate of removal of BSP from blood depends on
functional efficiency of liver & rate of hepatic blood
flow.

TESTSTO ASSESS HEPATIC
CELLULAR INTEGRITY
■ USG – to detect
cirrhosis of liver, fatty
liver, abcesses, cysts,
tumours, gall stones &
dilatation of biliary
system.
■ CT scan

TESTSTO ASSESS HEPATIC
CELLULAR INTEGRITY
■ Radionucleotide imaging
– Technetium (99mTc)
■ Liver biopsy
■ FNAC
■ Cholecystography
■ Other tests –
■ Percutaneous choleangiography
■ Portal venography
■ Endoscopic retrograde cholagiography

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Liver & Gallbladder: Functions, Anatomy, Disorders

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