Liver Pathology

Normal Structure/Anatomy
• Largest organ of the body
• Weighting : 1400 – 1600gm (Male)
1200 – 1400gm (Female)
• 2 main anatomical lobes – Right and Left
• Right lobe – Inferior surface (Quadrate Lobe)
Posterior surface (Caudate Lobe)
Right & Left Lobes are separated by peritoneal folds like-
Falciform ligament – Anteriorly
Ligamentum Teres – Inferiorly
Ligamentum Venosum – Posteriorly
• On Inferior surface – Porta Hepatis
Acting like Hilum for Entry & Exit of all vessels
• Glisson’s Capsule – Connective tissue cover over porta hepatis
• Blood supply – Double supply by hepatic artery & portal vein
Both divides into branches to Right & Left part of porta hepatis
• Right & Left Hepatic Duct joins porta tp form common Hepatic Duct
• Venous Drainage – Right & Left Hepatic vein – Inferior Vena Cava
Biliary Tree
 Histology of Liver
• Hepatic Parenchyma has hexagonal classical lobule
• Centrally – Hepatic vein
• Periphery – 4 to 5 Triads with branches of Bile duct, Hepatic artery,
Portal vein
• Between these two passes the cords of hepatocytes & Sinusoids
• 3 Zones – i) Peripheral zone – nearer to peripheral triad
ii)Midzonal Area
iii)Centrilobular Area – Surrounds Central vein
 Bile & its Components
• Bile – Produced in liver
Stored in Gall Bladder
Secreted In Biliary Tracts in Duodenum
• Consists of Bilirubin, Biliary phospholipids, 1° & 2° Bile Salts
• 4 Steps of Bilirubin Metabolism –
i)Source : 80 – 85% from catabolism of Hb in RBC inside Bone Marrow
15 – 20% from non Hb containing pigments like
Myoglobin, Catalase, Cytochromes or ineffective
Erythropoesis
 Haem
Haem oxygenase
Biliverdin
Biliverdin reductase
Unconjugated Bilirubin

ii)Transport : From Macrophages, it is now released in form of

unconjugated Bilirubin to Plasma
-Tightly Bounded to Albumin in plasma
Disease – Kernicterus
• iii)Hepatic Phase :
a)Hepatic Uptake →Unconjugated Bilirubin + Albumin
enters Hepatocyte
→Dissociate in Albumin + Bilirubin which
binds cytoplasmic protein
b)Conjugation – Unconjugated Bilirubin (water insoluble &
↓ alcohol soluble)
Conjugated Bilirubin (water soluble)