Pancreas and liver

The Liver and Gallbladder

Describe the histologic anatomy of

the liver.

State the role of bile in digestion.

Describe the role of the

gallbladder.

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The liver and gallbladder are accessory organs
associated with the small intestine.
The liver, one of the body’s most important organs,
has many metabolic and regulatory roles.
However, its digestive system function is to produce
bile for export to the duodenum.
Bile is a fat emulsifier that breaks down fats into tiny
particles to make them more readily digestible.
Although the liver also processes nutrient-laden
venous blood delivered to it from the digestive organs,
this is a metabolic rather than a digestive role.
The gallbladder is chiefly a storage organ for bile.

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The liver has four primary lobes: The largest, the right lobe, is visible on all
liver surfaces and separated from the smaller left lobe by a deep fissure . The
posteriormost caudate lobe and the quadrate lobe, which lies inferior to the
left lobe, are visible in an inferior view of the liver.

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 Gross Anatomy of the Liver
The ruddy, blood-rich liver is the largest gland in the
body, weighing about 1.4 kg (3 lb) in the average adult.

 Shaped like a wedge, it occupies most of the right

hypochondriac and epigastric regions, extending farther
to the right of the body midline than to the left.

 Located under the diaphragm, the liver lies almost

entirely within the rib cage, which provides some
protection.

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A mesentery, the falciform ligament, separates the
right and left lobes anteriorly and suspends the liver
from the diaphragm and anterior abdominal wall.

Running along the inferior edge of the falciform

ligament is the round ligament, or ligamentum
teres (“round”), a fibrous remnant of the fetal
umbilical vein.

Except for the superiormost liver area (the bare

area), which touches the diaphragm, the entire liver is
enclosed by the visceral peritoneum.

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As we mentioned earlier, a ventral mesentery, the
lesser omentum, anchors the liver to the lesser
curvature of the stomach.

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 Blood suply for the liver and gallbladder.
The hepatic artery and the hepatic portal vein, which enter
the liver at the porta hepatis (“gateway to the liver”), and the
common hepatic duct, which runs inferiorly from the liver, all
travel through the lesser omentum to reach their destinations.

The gallbladder rests in a recess on the inferior surface of the

right liver lobe. The gallbladder is supplied by the cystic
artery, which usually arises from the right hepatic artery.

The cystic veins drain the gallbladder.

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  The liver receives blood from two sources.
 From the hepatic artery it obtains
oxygenated blood, and from the hepatic
portal vein it receives deoxygenated blood
containing newly absorbed nutrients,
drugs, and possibly microbes and toxins
from the gastrointestinal tract.
 Branches of both the hepatic artery and
the hepatic portal vein carry blood into
hepatic sinusoids, where oxygen, most of
the nutrients, and certain toxic substances
are taken up by the hepatocytes.
 Products manufactured by the
hepatocytes and nutrients needed by
other cells are secreted back into the
blood, which then drains into the central
vein and eventually passes into a hepatic
vein.

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 Nerve suply for the liver and gallbladder.
The nerve supply to the liver consists of
parasympathetic innervation from the vagus (X)
nerves and sympathetic innervation from the greater
splanchnic nerves through the celiac ganglia.

The nerves to the gallbladder include branches from

the celiac plexus and the vagus (X) nerve.

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 Functions of the Liver and Gallbladder
Hepatocytes continuously secrete 800–1000 mL
(about 1 qt) of bile per day.

Bile salts, which are sodium salts and potassium

salts of bile acids (mostly cholic acid and
chenodeoxycholic acid), play roles in
(1) emulsification, the breakdown of large lipid
globules into a suspension of droplets about 1 μm in
diameter, and
(2) the absorption of digested lipids.

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Between meals, bile flows into the gallbladder for
storage because the sphincter of the hepatopancreatic
ampulla or sphincter of Oddi closes off the entrance
to the duodenum.

The sphincter surrounds the hepatopancreatic

ampulla.

After a meal, several neural and hormonal stimuli

promote the production and release of bile.

Parasympathetic impulses along the vagus (X) nerve

fibers can stimulate the liver to increase bile production
to more than twice the baseline rate.

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Fatty acids and amino acids in chyme entering the
duodenum stimulate some duodenal enteroendocrine
cells to secrete the hormone cholecystokinin (CCK)
into the blood.

CCK causes contraction of the walls of the gallbladder,

which squeezes stored bile out of the gallbladder into
the cystic duct and through the common bile duct.

CCK also causes relaxation of the sphincter of the

hepatopancreatic ampulla, which allows bile to flow
into the duodenum.

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In addition to secreting bile, the liver performs
many other vital functions:
• Carbohydrate metabolism.

The liver is especially important in maintaining a

normal blood glucose level. When blood glucose is
low, the liver can break down glycogen to glucose and
release glucose into the bloodstream.

When blood glucose is high, as occurs just after eating

a meal, the liver converts glucose to glycogen and
triglycerides for storage.

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Lipid metabolism.
 Hepatocytes store some triglycerides; break down fatty acids to
generate ATP; synthesize lipoproteins (HDLs, LDLs, VLDLs), which
transport fatty acids, triglycerides, and cholesterol to and from body
cells; synthesize cholesterol; and use cholesterol to make bile salts.

Protein metabolism.
 Hepatocytes deaminate 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.

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 Processing of drugs and hormones.
 The liver can detoxify substances such as alcohol or secrete drugs such
as penicillin, erythromycin, and sulfonamides into bile. It can also
inactivate hormones such as thyroid hormones, estrogens, and
aldosterone.

 Excretion of bilirubin.
 Bilirubin, derived from the heme of aged 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.

Synthesis of bile salts. Bile salts are used in the small intestine
for the emulsification and absorption of lipids, cholesterol,
phospholipids, and lipoproteins.

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 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.

Phagocytosis.
 The stellate reticuloendothelial (Kupffer) cells of the liver
phagocytize aged red blood cells and white blood cells and
some bacteria.

Activation of vitamin D.
 The skin, liver, and kidneys participate in synthesizing the
active form of vitamin D.

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 Composition of Bile
Bile is a yellow-green, alkaline solution containing bile
salts, bile pigments, cholesterol, triglycerides,
phospholipids (lecithin and others), and a variety of
electrolytes. Of these, only bile salts and phospholipids
aid the digestive process.

Bile salts, primarily cholic and chenodeoxycholic acids,

are cholesterol derivatives. Their role is to emulsify fats
—break them down into smaller pieces and distribute
them throughout the watery intestinal contents, just as
a dish detergent breaks up a pool of fat drippings in a
roasting pan.

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The chief bile pigment is bilirubin, a waste product of the
heme of hemoglobin formed during the breakdown of
worn-out erythrocytes.

The globin and iron parts of hemoglobin are saved and

recycled, but bilirubin is absorbed from the blood by liver
cells, excreted into bile, and metabolized in the small
intestine by resident bacteria.

One of its breakdown products, stercobilin , gives feces a

brown color. In the absence of bile, feces are gray-white
and have fatty streaks because essentially no fats are
digested or absorbed.

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 The Gallbladder
The gallbladder is a thin-walled green muscular sac about 10 cm
(4 inches) long.
The size of a kiwi fruit, it snuggles in a shallow fossa on the inferior
surface of the liver from which its rounded fundus protrudes.
The gallbladder stores bile that is not immediately needed for
digestion and concentrates it by absorbing some of its water and
ions.
When empty, its mucosa is thrown into honeycomblike folds
that, like the rugae of the stomach, allow the organ to expand as it
fills.
Its muscular wall contracts to expel bile into the cystic duct. From
there bile flows into the bile duct.
The gallbladder, like most of the liver, is covered by visceral
peritoneum.

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 PANCREAS
OBJECTIVES :
Describe the location and structure of the
pancreas.
Explain the role of the pancreas in digestion.

From the stomach, chyme passes into the small

intestine.
Chemical digestion in the small intestine depends
on activities of the pancreas, liver, and gallbladder.

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 Anatomy of the Pancreas
The pancreas, a retroperitoneal gland that is about 12–15 cm (5–6
in.) long and 2.5 cm (1 in.) thick, lies posterior to the greater
curvature of the stomach.
Along with the liver and gallbladder, it develops as an embryonic
epithelial outgrowth of the duodenum of the small intestine.
The pancreas consists of a head, a body, and a tail and is usually
connected to the duodenum by two ducts.
The head is the expanded portion of the organ near the curve of
the duodenum. Projecting from the lower portion of the head is
the hooklike uncinate process that arches behind the superior
mesenteric artery and vein, encircling them with pancreatic tissue.
Superior to and to the left of the head are the central body and
the tapering tail.

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Pancreatic secretions pass from the secreting cells into
small ducts that ultimately unite to form two larger
ducts that convey the secretions into the duodenum of
the small intestine.

The larger of the two ducts is called the pancreatic

duct (duct of Wirsung).

In most people, the pancreatic duct joins the common

bile duct from the liver and gallbladder and enters the
duodenum as a dilated common duct called the
hepatopancreatic ampulla ampulla of Vater.

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 The ampulla opens onto an
elevation of the duodenal
mucosa, the major
duodenal papilla, that lies
about 10 cm (4 in.) inferior
to the pyloric sphincter of
the stomach.
The smaller of the two
ducts, the accessory duct
(duct of Santorini), leads
from the pancreas and
empties into the duodenum
about 2.5 cm (1 in.) superior
to the hepatopancreatic
ampulla.

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 arterial supply
The arterial supply of the pancreas is from the
superior and inferior pancreaticoduodenal
arteries and from the splenic and superior
mesenteric arteries.

The veins, in general, correspond to the arteries.

Venous blood reaches the hepatic portal vein by

means of the splenic and superior mesenteric
veins.

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 Innervation
The nerves to the pancreas are autonomic nerves that
branch from the celiac and superior mesenteric
plexuses. Included are preganglionic vagal,
postganglionic sympathetic, and sensory fibers.
Parasympathetic vagal fibers are said to terminate at both
acinar (exocrine) and islet (endocrine) cells.
Although the innervation is presumed to influence enzyme
formation, pancreatic secretion is controlled largely by the
hormones secretin and cholecystokinin (CCK) released by
the small intestine.
The sympathetic fibers enter the islets and also end on
blood vessels; these fibers are vasomotor and accompanied
by sensory fibers, especially for pain.

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 Functions of the Pancreas
Each day the pancreas produces 1200–1500 mL
(about 1.2–1.5 qt) of pancreatic juice, a clear,
colorless liquid consisting mostly of water, some salts,
sodium bicarbonate, and several enzymes.

The sodium bicarbonate gives pancreatic juice a

slightly alkaline pH (7.1–8.2) that buffers acidic gastric
juice in chyme, stops the action of pepsin from the
stomach, and creates the proper pH for the action of
digestive enzymes in the small intestine.

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The enzymes in pancreatic juice include a
starchdigesting enzyme called pancreatic amylase;
several enzymes that digest proteins into peptides
called trypsin, chymotrypsin, carboxypeptidase
and elastase;

The principal triglyceride-digesting enzyme in

adults, called pancreatic lipase; and enzymes called
ribonuclease and deoxyribonuclease that digest
ribonucleic acid (RNA) and deoxyribonucleic acid
(DNA) into nucleotides.

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