Anatomy and Physiology of the liver

The liver is the largest internal organ in the body. It weighs approximately 3 pounds in an adult. It is

located in the right upper quadrant of the abdomen just below the diaphragm. The liver is the only

human organ that is capable of self-regeneration. The liver is divided into a large right lobe and a smaller

left lobe.

The falciform ligament divides the two lobes of the liver. Each lobe is further divided into lobules that

are approximately 2 mm high and 1 mm in circumference. These hepatic lobules are the functioning

units of the liver. Each of the approximately 1 million lobules consists of a hexagonal row of hepatic cells

called hepatocytes. The hepatocytes secrete bile into the bile channels and also perform a variety of

metabolic functions. Between each row of hepatocytes are small cavities called sinusoids. Each sinusoid

is lined with Kupffer cells, phagocytic cells that remove amino acids, nutrients, sugar, old red blood cells,

bacteria and debris from the blood that flows through the sinusoids. The main functions of the sinusoids

are to destroy old or defective red blood cells, to remove bacteria and foreign particles from the blood,

and to detoxify toxins and other harmful substances. Approximately 1500 ml of blood enters the liver

each minute, making it one of the most vascular organs in the body. 75 % of the blood flowing to the

liver comes through the hepatic portal vein; the remaining 25% is oxygenated blood that is carried by

the hepatic artery. The blood from the portal vein that contains substances absorbed by the stomach

and intestines goes to the liver via portal vein. Then, portal blood passed through the hepatic lobules

where nutrients and toxins are absorbed, excreted or converted. Once passed through the sinusoids, the

filtered blood enters the collecting branch of the central vein, and finally leaves the liver via the hepatic

vein going to the inferior vena cava.

Functions of the liver:

The liver's main job is to filter the blood coming from the hepatic vein and artery, before passing

it to the rest of the body. The liver regulates most chemical levels in the blood. All the blood leaving the

stomach and intestines passes through the liver. The liver also regulates the amount of glucose, amino

acids and fats in the blood and responsible in releasing waste products to intestines and kidneys for

elimination.

During carbohydrate metabolism the liver regulates the level of glucose in the blood. When the

liver detected high blood glucose level, the insulin converts the excess glucose to glycogen for storage in

the liver in the process called glycogenesis. In case the liver detected a low blood glucose level,

glucagon converts this glycogen back to glucose in the process of glycogenolysis, to maintain the blood

glucose level.

In Fat metabolism, the liver receives fats in the form of fatty acids and glycerol and regulates the

amount of these substances in the blood before releasing to the body system. Excess fatty acids and

glycerol are converted to triglycerides and stored in lipocytes.

In protein metabolism, the liver receives protein in the form of amino acids. Excess amino acids

are deaminated, the nitrogenous part is converted to ammonia and then to urea a water soluble

substance inorder to be excreted by the kidneys.

Bilirubin is the main bile pigment that is formed from the breakdown of heme in red blood cells.

The broken down heme travels to the liver, where it is secreted into the bile by the liver .When the

reticuloendothelial system breaks down old red blood cells, bilirubin is one of the waste products. This

"free bilirubin", is in a lipid-soluble form that must be made water-soluble to be excreted. The free, or

unconjugated, bilirubin is carried by albumin to the liver, where it is converted or conjugated and made

water soluble. Once it is conjugated into a water-soluble form, bilirubin can be excreted in the urine. An

enzyme, glucuronyl transferase, is necessary for the conjugation of bilirubin.

During alcohol ingestion the liver enzyme alcohol dehydrogenase breaks down alcohol to water

and carbon dioxide. However the liver can only break down limited amount of alcohol, approximately

10-20 ml per hour.