Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Liver & Gall bladder

Liver and Gall Bladder

  • Login to see the comments

Liver & Gall bladder

  1. 1. DR NILESH KATE MBBS,MD ASSOCIATE PROF ESIC MEDICAL COLLEGE, GULBARGA. DEPT. OF PHYSIOLOGY LIVER & GALL BLADDER.
  2. 2. OBJECTIVES.  Liver  Physiological anatomy  Hepatic biliary system  Functions of liver  Bile  Gall bladder  Applied aspects.
  3. 3. 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. Tuesday, September 18, 2018
  4. 4. 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. Tuesday, September 18, 2018
  5. 5. 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. Tuesday, September 18, 2018
  6. 6. 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. Tuesday, September 18, 2018
  7. 7. 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. Tuesday, September 18, 2018
  8. 8. 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 Tuesday, September 18, 2018
  9. 9. 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. Tuesday, September 18, 2018
  10. 10. 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 Tuesday, September 18, 2018
  11. 11. EXTRA HEPATIC DUCTS.  Common bile duct (8 cm)  Joins pancreatic duct to form common hepatopancreatic duct (Ampulla of Vater)  Opens into 2nd part of duodenum at major duodenal papilla.  Surrounded by sphincter of Oddi. Tuesday, September 18, 2018
  12. 12. FUNCTIONS OF LIVER  Secretory function  Metabolic function  Carbohydreate  Fat  Protein  Detoxicating and protective function.  Storage function  Excretory function  Synthesis function  Miscellaneous function. Tuesday, September 18, 2018
  13. 13. SECRETORY FUNCTION  Liver – exocrine gland  Secrete bile for digestion and absorption of fats. Tuesday, September 18, 2018
  14. 14. METABOLIC FUNCTION  Carbohydrate –  Glycogenesis  Glycogenolysis  Gluconeogenesis.  Alcohol metabolism  Fats – degradation & synthesis of fats  Proteins – Deamination, urea formation. Tuesday, September 18, 2018
  15. 15. DETOXICATING AND PROTECTIVE FUNCTION.  Kupffer cells – removes bacteria & cleansing action  Detoxify drugs by oxidation, hydrolysis, reduction & conjugation. Tuesday, September 18, 2018
  16. 16. STORAGE FUNCTION  Glucose ( in the form of Glycogen), Vit B12, Vit A  Blood iron buffer & iron storage medium in the form of ferritin & hemosiderin. Tuesday, September 18, 2018
  17. 17. EXCRETORY FUNCTION  Exogenous dyes like bromsulpthalein & rose Bengal dye are excreted. Tuesday, September 18, 2018
  18. 18. 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. Tuesday, September 18, 2018
  19. 19. 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. Tuesday, September 18, 2018
  20. 20. BILE  Digestive juice formed in liver.  Hepatocytes to bile canaliculi  Common hepatic duct  Cystic duct  Common bile duct Tuesday, September 18, 2018
  21. 21. FORMATION OF BILE Tuesday, September 18, 2018
  22. 22. 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- Tuesday, September 18, 2018
  23. 23. COMPOSITION OF BILE  Bile salts  Bile pigments  Phospholipids  Cholesterol  Electrolytes. Tuesday, September 18, 2018
  24. 24. FORMATION OF BILE SALTS  Bile salts  Formation Tuesday, September 18, 2018
  25. 25. 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. Tuesday, September 18, 2018
  26. 26. ENTEROHEPATIC CIRCULATION OF BILE SALTS Tuesday, September 18, 2018
  27. 27. BILE PIGMENTS  Mainly Bilirubin & Biliverdin  From metabolite of hemoglobin. Tuesday, September 18, 2018
  28. 28. OTHER CONTENTS  Phospholipids – Primarily Lecithins.  Cholesterol – by product of bile salts synthesis.  Normal level in bile – 60-170 mg/dl  Electrolytes  Cl- & HCO3- mainly. Tuesday, September 18, 2018
  29. 29. 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 Tuesday, September 18, 2018
  30. 30. 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. Tuesday, September 18, 2018
  31. 31. REGULATION OF BILE  Regulation of biliary secretion  Regulation of release of bile from gall bladder. Tuesday, September 18, 2018
  32. 32. REGULATION OF BILIARY SECRETION  Regulation of bile Indepedent fraction of biliary secretion  Regulation of bile depedentr fraction of biliary secretion Tuesday, September 18, 2018
  33. 33. 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. Tuesday, September 18, 2018
  34. 34. 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. Tuesday, September 18, 2018
  35. 35. 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. Tuesday, September 18, 2018
  36. 36. 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. Tuesday, September 18, 2018
  37. 37. APPLIED ASPECTS  Disorders of liver and gall bladder  Jaundice or icterus.  Cirrhosis of liver  Viral hepatitis  Cholecystitis – Gall bladder inflammation. Tuesday, September 18, 2018
  38. 38. 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 Tuesday, September 18, 2018
  39. 39. TYPES OF JAUNDICE  Haemolytic – prehepatic  Hepatocellular – Hepatic  Obstructive – post hepatic Tuesday, September 18, 2018
  40. 40. CIRRHOSIS OF LIVER  Irreversible chronic damage to liver with extensive fibrosis & regenerative nodule formation. Tuesday, September 18, 2018
  41. 41. VIRAL HEPATITIS  Cause – hepatitis virus – A,B,C,D,E,F & G  Hepatitis B hepatitis Most common  Clinical features  Odema  Haemorrhagic disorders  Muscle weakness, tremors, convulsions  Hepatomegaly, ascites  Steatorrhoea  Anaemia, jaundice  Raised SGPT, SGOT, Blood urea Tuesday, September 18, 2018
  42. 42. 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. Tuesday, September 18, 2018
  43. 43. LIVER FUNCTION TESTS  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 Tuesday, September 18, 2018
  44. 44. TESTS TO 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 % Tuesday, September 18, 2018
  45. 45. TESTS TO 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, serum TG, Serum PL, total lipids. Tuesday, September 18, 2018
  46. 46. TESTS TO 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. Tuesday, September 18, 2018
  47. 47. TESTS TO 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. Tuesday, September 18, 2018
  48. 48. TESTS TO ASSESS HEPATIC CELLULAR INTEGRITY.  USG – to detect cirrhosis of liver, fatty liver, abcesses, cysts, tumours, gall stones & dilatation of biliary system.  CT scan Tuesday, September 18, 2018
  49. 49. TESTS TO ASSESS HEPATIC CELLULAR INTEGRITY.  Radionucleotide imaging – Technetium (99m Tc)  Liver biopsy  FNAC  Cholecystography  Other tests –  Percutaneous choleangiography  Portal venography  Endoscopic retrograde cholagiography Tuesday, September 18, 2018
  50. 50. THANK YOU

×