The Liver, Biliary System, and Pancreas Chapter 16 The Liver, Biliary System, and Pancreas

Structure & Function of the Liver The liver is the largest organ in the body Located beneath the diaphragm in the upper right abdomen

The Liver and Biliary System Fig. 16.1

Structure & Function of the Liver The liver has a double blood supply About ¾ of blood flow comes from the: This vessel drains the : The blood in this vessel is: All other blood comes from the: The blood from these two vessels mixes as it flows through the liver and eventually flows into the inferior vena cava

Structure & Function of the Liver The liver has a double blood supply

Structure & Function of the Liver Functions of the liver: Metabolism of: ingested carbohydrates, protein, and fat These substances are delivered to the liver by the: Synthesis of substances, including plasma proteins (albumin) and blood clotting proteins Storage of vitamin B12 and other materials Detoxification and excretion of various substances

Bile: Formation & Excretion Bile pigment is a product of the: Causes: Iron from the hemoglobin of old RBC’s is reused to make new hemoglobin Iron free heme pigment forms: This will be conjugated and added to bile

Bile: Composition & Properties Bile is an aqueous solution containing: Bile salts function as: Bile is secreted continually from the liver into ducts that carry bile to the gallbladder. The gallbladder: During digestion the gallbladder: Review the ducts that carry bile to the gallbladder & duodenum on the next slide

Biliary Duct System

Causes and Effects of Liver Injury Fig. 16-5

Viral Hepatitis A type of liver injury caused by viruses and characterized by inflammation of the liver cells Clinical manifestations are variable and correlate with the degree of liver cell injury and associated inflammation The outcome depends primarily on which virus caused the infection

Hepatitis A (HAV) Most benign Spread by fecal-oral contact Transmission is by: Incubation period: Symptoms are: There are no: Never leads to: Inactivated hepatitis-A vaccine is available Recommended for:

Hepatitis B (HBV) Spread by contact with: HBV is not excreted in stool!!! Transmission doesn’t occur due to: Positive mother can: People with an increased risk are: Incubation period: About 10% of people become chronic carriers and may develop chronic hepatitis which causes: Vaccination is included in the childhood vaccination schedule

Hepatitis C (HCV) Spread same way as HBV Incubation period: Causes a more serious infection than HBV: Most HCV infected individuals become: Frequently causing: No available:

Hepatitis Hepatitis D (HDV) Hepatitis E (HEV) Can only infect those already infected with: Most U.S. cases involve: Hepatitis E (HEV) Transmitted by fecal-oral route Commonly due to:

Hepatitis Outcomes

Fatty Liver Fat accumulates in liver secondary to injury In the U.S. the most common cause is: May be caused by: Impaired liver function but injury is still reversible

Fatty Liver

Alcoholic Liver Disease Refers to a group of structural and functional changes in the liver resulting from excessive alcohol consumption Severity depends on amount and duration of alcohol consumption 3 stages of progression Alcoholic fatty liver: Alcoholic hepatitis: Alcoholic cirrhosis:

Cirrhosis Diffuse scarring of the liver from any cause Two most common causes: Less common causes: Normal liver cells are replaced with: Leads to 2 major issues:

Cirrhosis Impaired liver function from scarring can lead to: Portal Hypertension occurs because: Fluid leaks from the capillaries & collects in the abdominal cavity which is called: Anastomoses form between portal and systemic veins Blood is shunted away from: Esophageal veins become distended called:

Advanced hepatic cirrhosis illustrating elevated nodules of liver tissue surrounded by depressed areas of scar tissue. Exterior of liver. Fig 16-12

Ascites Fig 16-14

Liver Diseases Cirrhosis Complications of severe cirrhosis: Varicosities

Cirrhosis Hepatic encephalopathy is deterioration of brain function characterized by: Results from:

Cholelithiasis Formation of: Develop whenever: Process can take: Gallstones that remain in the gallbladder: If a stone passes into & blocks a biliary duct it causes: Cystic duct obstruction: Common duct obstruction: Treatment:

Cholelithiasis

Cholelithiasis Fig. 16-20

Tumors of the Liver & Gallbladder Primary tumors are uncommon. Chronic carriers of: Liver is a common site of metastatic carcinoma Spread from: Tumor cells carried in the blood and delivered to the liver via:

Jaundice Yellow discoloration of skin and sclera (whites of eyes) from: Causes of jaundice Hemolytic jaundice: Hepatocellular jaundice: Obstructive jaundice:

Jaundice

The Pancreas: Structure & Function Functions as an exocrine gland (digestion) and an endocrine gland Exocrine tissue secretes alkaline pancreatic juice with digestive enzymes that break down: Secretes into:

Duct System of Pancreas

The Pancreas: Structure & Function Endocrine tissue of the pancreas is found in found in small clusters of cells called: Secretes directly into: Each islet is composed of different types of cells Alpha cells: Beta cells: Delta cells:

Pancreatitis Acute Pancreatitis is caused by the escape of: Leads to: If pancreatic blood vessels are damaged: Usually due to pancreatic duct obstruction Two factors predispose: Excessive amounts of alcohol: Gallstones:

Pancreatitis Chronic Pancreatitis results from: Each episode of pancreatitis destroys pancreatic tissue which is replaced by: As pancreatic tissue is destroyed, the affected person: If islets of Langerhans cells are destroyed it may lead to:

Cystic fibrosis A hereditary disease transmitted as an autosomal recessive trait (discussed in Ch7) Occurs in 1 in 3000 “white” people Caused by the mutation of gene which regulates the movement of salt & water in & out of epithelial cells Electrolyte and water secretion is deficient in mucus production causing: Mucus obstructs: Leads to: Sweat contains: Respiratory treatments, antibiotics, postural drainage, chest-clapping, and meds are used to treat Average life expectancy is about 35 years old

Diabetes Mellitus Very common and important metabolic disease resulting in hyperglycemia which is: Two major types: Type 1 and Type 2

Type 1 Diabetes Mellitus Is an autoimmune disease in which the immune system destroys the: leads to the reduction or absence of: Often follows a viral infection that destroys the pancreatic islets Complication Diabetic ketosis

Type 2 Diabetes Mellitus Insulin secretion is: Tissues are: Cause is not completely understood but seems to be related to: Weight reduction:

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