CONTENT

ON
STRUCTURE
AND
FUNCTION OF LIVER

SUBMITTED TO, SUBMITTED BY;

Madam Mitali Adhikary Ishika Roy
Senior Lecturer MSc Nursing 1year student
College of Nursing College of Nursing
Medical College and Hospital Medical College and Hospital
DEFINITION:-
The liver is a large, solid, gland situated in the right upper quadrant of the abdominal cavity. In the living subject, the
liver is reddish brown in colour, soft in consistency, and very friable. It weighs about 1600 g in males and about 1300
g in females.

LOCATION:-
The liver occupies the whole of the right hypo-chondrium, the greater part of the epigastrium, and extends into the left
hypochondrium. Most of the liver is covered by ribs and costal cartilages, Its upper and anterior surfaces are smooth
and curved to fit the under surface of the diaphragm; its posterior surface is irregular in outline.

ORGANS ASSOCIATED WITH THE LIVER:-

 Superiorly and anteriorly – diaphragm and anterior abdominal wall
 Inferiorly– stomach, bile ducts, duodenum, hepatic flexure of the colon, right kidney and adrenal gland
 Posteriorly – esophagus, inferior vena cava, aorta, gallbladder, vertebral column and diaphragm
 Laterally– lower ribs and diaphragm.

The liver is enclosed in a thin inelastic capsule and incompletely covered by a layer of peritoneum. Folds of
peritoneum form supporting ligaments that attach 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.

STRUCTURE:-
ANTERIOR SURFACE:-
The liver is divided into right and left lobes by the attachment of the falciform ligament anteriorly and superiorly;
1) The right lobe is much larger than the left lobe, and forms five sixth of the liver. It contributes to all the five
surfaces of the liver, and presents the caudate and quadrate lobes.
 The caudate lobe is situated on the posterior surface.
 The quadrate lobe is situated on the inferior surface, and is rectangular in shape.
2) The left lobe of the liver is much smaller than the right lobe and forms only one-sixth of the liver. It is flattened
from above downwards.

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 branches from
the abdominal aorta.
 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 lymph to abdominal and thoracic nodes.
Each liver lobe contains thousands of functional units called lobules separates from each other by connective tissues.
This lobules are generally five or six sided structure. Individual lobule unit varies in diameter about 0.8 – 2.0 mm
across.
The individual liver cell accords hepatocytes. In individual lobules hepatocytes are arranged around a central vein.
Hepatocytes are arranged in a row two cell thick. This two rows of cells are known as Hepatic cellular plates.
Between hepatic cellular plates there are blood capillaries known as sinusoids. A liver sinusoid is a type
of capillary known as a sinusoid capillary, or discontinuous capillary having discontinuous endothelium that serves as
a location for mixing of the oxygen-rich blood from the hepatic artery and the nutrient-rich blood from the portal
vein. In corners of lobules there are portal triads. Portal triads are consists of three major tubes, braches of hepatic
artery carry oxygenated blood to the hepatocytes while branches from portal veins carry nutrient rich blood from
small intestine, the bile duct carries bile products away from the hepatocytes to the larger ducts and gallbladder.

BLOOD SUPPLY:-
The liver receives a dual blood supply from the hepatic portal vein and hepatic arteries. The hepatic portal vein
delivers around 75% of the liver's blood supply, and carries venous blood drained from the spleen, gastrointestinal
tract and its associated organs. The hepatic arteries supply arterial blood to the liver, accounting for the remaining
quarter of it blood flow. As the blood coming from hepatic portal veins is poorly oxygenated so the oxygen demand
of liver is met by the blood from hepatic arteries.
Blood drains from the sinusoids into central or centrilobular veins. These then merge 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.

NERVE SUPPLY:-
The liver receives its nerve supply from the hepatic plexus which contains both sympathetic and parasympathetic or
vagal fibres. Nerves also reach the liver through its various peritoneal ligaments.

BILE PRODUCTION:-
Liver can be identified as an exocrine gland because it produces about 500 ml of bile everyday. Bile secreted from
liver by right and left hepatic ducts which merged to make common bile duct. It is the cystic duct that transports bile
from common hepatic duct to gallbladder and in gallbladder the bile is stored and concentrated and the cystic duct
again carries the concentrated bile from gallbladder to common bile duct. The common bile duct communicate with
the pancreatic duct before it drains in to the duodenum. It brings bile and pancreatic juice together into the duodenum
by the hepato-pancreatic sphincter or the sphincter of oddi.

FUNCTIONS:-
The liver is an extremely active organ, which has many important functions that are described below.
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.
Fat metabolism:-
Stored fat can be converted to a form in which it can be used by the tissues to provide energy.
Protein metabolism:-
Deamination of amino acids
• Removes the nitrogenous portion from amino acids that are not required for the formation of new protein; urea is
formed from this nitrogenous portion and is excreted in urine.
• Breaks down nucleic acids to form uric acid, which is excreted in the urine.
Transamination
Removes the nitrogenous portion of amino acids and attaches it to other carbohydrate molecules forming new non-
essential amino acids.
Synthesis of plasma proteins
These are formed from amino acids and include albumins, globulins and blood clotting factors.
Breakdown of erythrocytes and defence against microbes:-
This is carried out by phagocytic hepatic macrophages (Kupffer cells) in the sinusoids although breakdown of red
blood cells also takes place in the spleen and bone marrow.
Detoxification of drugs and toxic substances:-
These include ethanol (alcohol), waste products and microbial toxins. Some drugs are extensively inactivated by the
liver and are not very effective when given by mouth (orally), e.g. glyceryl trinitrate.
Inactivation of hormones:-
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 consequently produces a great deal of
heat. It is the main heat-producing organ of the body.
Secretion of bile:-
The hepatocytes synthesise the constituents of bile from the mixed arterial and venous blood in the sinusoids. These
include bile salts, bile pigments and cholesterol.
Storage:-
Stored substances include: • glycogen (see p. 315) • fat-soluble vitamins: A, D, E, K • iron, copper • some water-
soluble vitamins, e.g. vitamin B12.
Composition of bile:-
Between 500 and 1000 mL of bile is secreted by the liver daily. Bile consists of:
• Water
• Mineral salts
• Mucus
• Bile pigments, mainly bilirubin
• Bile salts
• Cholesterol.
Functions of bile:-

 Fat digestion
 Excretion of bilirubin