Patho ch 30 combo set: Disorders of
Hepatobiliary and Exocrine Pancreas
Function. Updated Fall 2024/2025.
The Liver and Hepatobiliary System
Physiologic Functions of the Liver
Metabolic Functions
Bile Formation and Flow
Bilirubin Formation and Jaundice
Cholestasis
Tests of Hepatobiliary Function
Disorders of Hepatic and Biliary Function
Hepatitis
Viral Hepatitis
Autoimmune Hepatitis
Acute Fulminant Hepatitis
Intrahepatic Biliary Disorders
Primary Biliary Cirrhosis
Secondary Biliary Cirrhosis
Drug-and Alcohol-Induced Liver Disease
Drug Metabolism
Drug-Induced Liver Disease
Alcohol Metabolism
Alcohol-Induced Liver Disease
Nonalcoholic Fatty Liver Disease
Hepatic Syndromes
Cirrhosis
Portal Hypertension
Liver Failure
C a n c e r o f t h e Li v e r
Primary Liver Cancers
Metastatic Tumors
Disorders of the Hepatobiliary System and Exocrine Pancreas
Disorders of the Hepa tobilia ry System
Cholelithiasis
Acute Cholecystitis
Chronic Cholecystitis
Diagnosis and Treatment of Gallbladder Disease
Choledocholithiasis and Cholangitis
Cancer of the Gallbladder
Disorders of the Exocrine Pa ncrea s
,Acute Pancreatitis
Chronic Pancreatitis
Cancer of the Pancreas
SUMMARY CONCEPTS
■ The liver, which is the largest and most versatile organ in the body, is located between the
gastrointestinal tract and the systemic circulation. Venous blood from the intestine
flows through the liver before it is returned to the heart, allowing nutrients to be removed for processing
and storage, and bacteria and other foreign matter to be removed before the blood is returned to the
systemic circulation.
■ The main functions of the liver include synthesis of plasma proteins, maintenance of blood glucose
levels, regulation of circulating lipoprotein levels, and vitamin and mineral storage.The liver also plays an
essential role in the metabolism and elimination of harmful toxins and drugs, conversion of ammonia to
urea, and removal of bilirubin, a product of hemoglobin breakdown, from the blood.
■ Serum liver enzymes, especially alanine aminotransferase (ALT) and aspartate aminotransferase (AST),
are used to assess injury to liver cells; plasma proteins (e.g., serum albumin) and blood clotting factors
(prothrombin time) provide information related to the liver's synthetic capacity; and serum bilirubin,
serumγ-glutamyltransferase (GGT), and alkaline phosphatase (ALP) are used as measures of hepatic
excretory function.
SUMMARY CONCEPTS
The liver is subject to most of the disease processes that affect other body structures, such as infections,
autoimmune disorders, toxic injury, metabolic diseases, and neoplasms.
Hepatitis is characterized by inflammation of the liver. Viral hepatitis is caused by hepatitis viruses A, B,
C, D, and E, which differ in terms of mode of transmission, incubation period, mechanism, degree and
chronicity of liver damage, and ability to evolve to a carrier state. Autoimmune hepatitis involves the
immune destruction of hepatocytes causing inflammation.
Intrahepatic biliary diseases disrupt the flow of bile through the liver, causing cholestasis and biliary
cirrhosis. Causes of intrahepatic biliary diseases include primary biliary cirrhosis, primary sclerosing
cholangitis, and secondary biliary cirrhosis.
The liver, which is the major drug-metabolizing and detoxifying organ in the body, is subject to potential
damage from an enormous array of pharmaceutical and environmental chemicals. There are two types
of drug reactions: predictable, based on the drug's chemical structure and metabolites, and idiosyncratic,
based on individual characteristics of the person receiving the drug.
Cirrhosis represents the end stage of chronic liver disease in which much of the liver's functional tissue
has been replaced by fibrous tissue that disrupts venous blood flow predisposing to portal hypertension
and its complications, loss of liver cells, and eventual liver failure.
Portal hypertension is characterized by increased resistance to flow and increased pressure in the portal
venous system, the pathologic consequences of which include ascites, the formation of collateral bypass
channels (e.g., esophageal varices), and splenomegaly.
The manifestations of liver failure reflect the various functions of the liver, including hematologic
disorders, disruption of endocrine function, skin disorders, hepatorenal syndrome, and hepatic
encephalopathy.
There are two types of primary cancers of the liver. Hepatocellular cancer, the most common form, is
derived from hepatocytes and their precursors and is associated with conditions such as chronic
,hepatitis B and C infection and alcoholic cirrhosis. Cholangiocarcinoma, or bile duct cancer, arises from
the biliary epithelium, typically following long-standing inflammation of the bile ducts.
Liver
-largest single organ in the body
-weighs 3 pounds
-size of a football
-upper right part of abd behind lower ribs
-only organ that self regenerates
-if part is removed, remaining parts can grow back to original shape and size
-4 lobes- right, left, quadrate and caudate
-supplied with blood via portal vein and hepatic artery
-blood is carried away by hepatic vein
-connected to diaphragm and abd walls by five ligaments
Liver and Biliary System
-Sinusoids of liver are supplied by blood from the portal vein and the hepatic artery
-Hepatic cells can remove substances from the blood or can release things into the blood
-Lobules of liver are supplied with small tubular channels (bile canaliculi)
-Bile flows into canaliculi -> periphery of lobules -> larger ducts -> R/L hepatic ducts; hepatobiliary tree
-Pancreatic & common bile ducts empty into the ampulla of Vater (hepatopancreatic ampulla) whose
opening is protected by the sphincter of Oddi
Liver Sinusoids & Bile Canaliculi
-Blood from the hepatic portal vein and hepatic artery mix in sinusoids.
-Sinusoids empty into central veins, which send blood to the hepatic vein and inferior vena cava.
-Hepatic cells lie along the sinusoids, pick up chemicals from blood, modify blood's composition.
-Many sinusoids come together to empty into one vein.
-The section of the liver emptying into one vein is a lobule.
-At the back end of each hepatic cell, bile is released into bile canaliculi.
-Bile is carried to the bile duct and then to the gallbladder.
Portal Circulation
, The pathway of blood flow through the portal vein from the GI system to the liver.
liver function
has over 200 functions
- storage of nutrients
-breakdown of erythrocytes
-produces and secretes bile
-synthesis of plasma proteins
-synthesis of cholesterol
-metabolizes hormones and drugs
-synthesizes protein, glucose and clotting factors
-changes ammonia to urea
-converts fatty acids to ketones
1. produces bile (emulsify fats)
2. excretes bilirubin (byproduct of hemoglobin break down)
3. converts medications into a useful form (body can't absorb most meds as is must be converted by the
liver first)
4. creates carrier protein for hormones so that they can travel in the blood because they are not water
soluble the are lipid soluble
5. responsible to a large degree of metabolism in the body (brakes down fats and builds them back up
into what we need)
6. important role in energy storage of carbs and fats
7. helps detoxify the blood
very important!! cannot live to long without it!!
Metabolic Functions of the Liver
-Carbohydrate metabolism
-Protein synthesis & conversion of ammonia to urea
-Lipid metabolism
-Drug & hormone metabolism
-Bile production
-Bilirubin excretion
liver turns things into something useful
1. glucose--> glycogen so that it can be stored in the liver until it is needed
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