Anatomy and Physiology

Respiratory, Liver and Bladder

Melanie Shale

Beginners guide to the Liver and gall bladder

The largest gland in the body

The hepatic blood vessels enter the liver at the porta hepatis

The gallbladder
Bile leaves the liver via: Bile ducts, which fuse into the common hepatic duct The common hepatic duct, which fuses with the cystic duct These two ducts form the bile duct

Liver: Microscopic Anatomy

Hexagonal-shaped liver lobules are the structural and functional units of the liver
Composed of hepatocyte (liver cell) plates radiating outward from a central vein Portal triads are found at each of the six corners of each liver lobule

Portal triads consist of a bile duct and

Hepatic artery supplies oxygen-rich blood to the liver Hepatic portal vein carries venous blood with nutrients from digestive viscera

Liver lobes, liver lobules, hepatocytes and portal triads

What do hepatocytes do?

Hepatocytes functions include: Production of bile Processing blood borne nutrients Storage of fat-soluble vitamins Detoxification Secreted bile flows in canaliculi between hepatocytes toward the bile ducts in the portal triads Liver sinusoids enlarged, leaky capillaries located between hepatic plates Kupffer cells hepatic macrophages found in liver sinusoids

Composition of bile
A yellow-green, alkaline solution containing bile salts, bile pigments, cholesterol, fats, phospholipids, and electrolytes Bile salts are cholesterol derivatives that:
Emulsify fat Facilitate fat and cholesterol absorption Help solubilise fat and cholesterol

Enterohepatic circulation recycles bile salts The chief bile pigment is bilirubin, a waste product of haem

The gall bladder

Thin-walled, green muscular sac Stores and concentrates bile by absorbing its water and ions Releases bile via the cystic duct, which flows into the bile duct

Regulation of bile secretion

Acidic, fatty chyme causes the duodenum to release:

Cholecystokinin (CCK) and secretin into the bloodstream

Bile salts and secretin transported in blood stimulate the liver to produce bile Vagal stimulation causes weak contractions of the gallbladder Cholecystokinin causes:

The gallbladder to contract The hepatopancreatic sphincter to relax

As a result, bile enters the duodenum

http://www.execulink.com/~ekimmel/cck_0.htm

Production of bilirubin
The bilirubin in blood plasma is derived from the breakdown of haemoglobin. At the end of their 120 day life span, red cells are removed from the circulation by the spleen and the hb contained within them is broken down to its constituent parts: haem and globin. The haem part is converted to bilirubin.

Handling of bilirubin
As a waste product of haemoglobin breakdown and with no physiological functions, bilirubin must be removed from the body by the liver, in bile. The first phase in the process of bilirubin excretion is transport in blood plasma (bound to albumin) from the spleen, where it is produced, to the liver.

Conjugation
Bilirubin arriving at the liver is lipid soluble; for excretion in bile it must first be made water soluble. This is accomplished in the hepatocytes by joining (conjugation) with glucuronide acid The process of conjugation within hepatocytes is dependent on a key enzyme, uridine diphosphateglucuronosyltransferase (UPD-GT).

Bile excretion
Conjugated bilirubin is secreted from hepatocytes to the bile canaliculi of the liver and outwards in bile Bacterial action within the ileum and colon converts bilirubin to stercobilinogen. Finally stercobilin, the product of stercobilinogen oxidation, is excreted in faeces. A small amount of stercobilinogen is reabsorbed from the gastrointestinal tract back into the blood system and subsequently excreted in urine as urobilinogen.

The Bilirubin Pathway

The Urinary System

Ureters
Slender tubes that convey urine from the kidneys to the bladder Ureters enter the base of the bladder through the posterior wall
This closes their distal ends as bladder pressure increases and prevents backflow of urine into the ureters

Ureters
Ureters actively propel urine to the bladder via response to smooth muscle stretch Ureters have a trilayered wall
Transitional epithelial mucosa Smooth muscle muscularis Fibrous connective tissue adventitia

Cross-sectional view of the ureter wall

Lumen Adventitia Circular layer Longitudinal layer Transitional epithelium Lamina propria

Mucosa

Muscularis

Urinary Bladder
Smooth, muscular sac that stores urine The bladder is distensible and collapses when empty As urine accumulates, the bladder expands without significant rise in internal pressure It lies retroperitoneally on the pelvic floor posterior to the pubic symphysis Males prostate gland surrounds the neck inferiorly Females anterior to the vagina and uterus

Position and shape of a distended and an empty urinary bladder in an adult male
Umbilicus

Superior wall of distended bladder

Superior wall of empty bladder Pubic symphysis

Urinary Bladder
The bladder wall has three layers
Transitional epithelial mucosa A thick muscular layer A fibrous adventitia

Trigone triangular area outlined by the openings for the ureters and the urethra
Clinically important because infections tend to persist in this region

Urinary Bladder

Urethra
Muscular tube that:
Drains urine from the bladder

Sphincters keep the urethra closed when urine is not being passed
Internal urethral sphincter involuntary sphincter at the bladder-urethra junction External urethral sphincter voluntary sphincter surrounding the urethra as it passes through the urogenital diaphragm Levator ani muscle voluntary urethral sphincter

Urethra
The female urethra is tightly bound to the anterior vaginal wall Its external opening lies anterior to the vaginal opening and posterior to the clitoris The male urethra has three named regions Prostatic urethra runs within the prostate gland Membranous urethra runs through the urogenital diaphragm Spongy (penile) urethra passes through the penis and opens via the external urethral orifice

Urethra

Micturition (Voiding or Urination)

The act of emptying the bladder Distension of bladder walls initiates spinal reflexes that:
Stimulate contraction of the external urethral sphincter Inhibit the detrusor muscle and internal sphincter (temporarily)

Voiding reflexes:
Stimulate the detrusor muscle to contract Inhibit the internal and external sphincters

Neural Circuits Controlling Urine Storage

Neural Circuits Controlling Micturition

The Process of respiration

Drive from the CNS Neuromuscular Function

Mechanics of chest wall & pressure changes in lungs

Ventilation Transfer between alveolus and pulmonary capillary Carriage in blood stream Transfer from systemic capillary to tissue cell Use in tissue cells

Overview of the Respiratory System

Respiration
ventilation of lungs exchange of gases between
air and blood blood and tissue fluid

use of O2 in cellular metabolism

Organs of Respiratory System

Nose, pharynx, larynx, trachea, bronchi, lungs

Regions of Pharynx

Lower Respiratory Tract

Alveolar Blood Supply