Liver
Liver | |
---|---|
hepatic portal vein | |
Nerve | Celiac ganglia and vagus nerve[1] |
Identifiers | |
Latin | jecur, iecur |
Greek | hepar (ἧπαρ) root hepat- (ἡπατ-) |
MeSH | D008099 |
TA98 | A05.8.01.001 |
TA2 | 3023 |
FMA | 7197 |
Anatomical terminology] |
The liver is a major
The liver is also an
It is not known how to compensate for the absence of liver function in the long term, although
Structure
The liver is a dark reddish brown, wedge-shaped
The liver is connected to two large
Hepatic lobules are the functional units of the liver. Each lobule is made up of millions of
Gross anatomy
Terminology related to the liver often starts in hepat- from ἡπατο-, from the Greek word for liver.[13]
Lobes
The liver is
The
Other anatomical landmarks include the
Surfaces
On the diaphragmatic surface, apart from a triangular bare area where it connects to the diaphragm, the liver is covered by a thin, double-layered membrane, the peritoneum, that helps to reduce friction against other organs.[18] This surface covers the convex shape of the two lobes where it accommodates the shape of the diaphragm. The peritoneum folds back on itself to form the falciform ligament and the right and left triangular ligaments.[19]
These peritoneal ligaments are not related to the anatomic ligaments in joints, and the right and left triangular ligaments have no known functional importance, though they serve as surface landmarks.[19] The falciform ligament functions to attach the liver to the posterior portion of the anterior body wall.
The visceral surface or inferior surface is uneven and concave. It is covered in peritoneum apart from where it attaches the gallbladder and the porta hepatis.[18] The fossa of gallbladder lies to the right of the quadrate lobe, occupied by the gallbladder with its cystic duct close to the right end of porta hepatis.
Impressions
Several impressions on the surface of the liver accommodate the various adjacent structures and organs. Underneath the right lobe and to the right of the gallbladder fossa are two impressions, one behind the other and separated by a ridge. The one in front is a shallow colic impression, formed by the
The suprarenal impression is a small, triangular, depressed area on the liver. It is located close to the right of the fossa, between the bare area and the caudate lobe, and immediately above the renal impression. The greater part of the suprarenal impression is devoid of peritoneum and it lodges the right suprarenal gland.[21]
Medial to the renal impression is a third and slightly marked impression, lying between it and the neck of the gall bladder. This is caused by the descending portion of the duodenum, and is known as the duodenal impression.[21]
The inferior surface of the left lobe of the liver presents behind and to the left of the gastric impression.
Microscopic anatomy
Microscopically, each liver lobe is seen to be made up of
Histology, the study of microscopic anatomy, shows two major types of liver cell: parenchymal cells and nonparenchymal cells. About 70–85% of the liver volume is occupied by parenchymal hepatocytes. Nonparenchymal cells constitute 40% of the total number of liver cells but only 6.5% of its volume.[25] The liver sinusoids are lined with two types of cell, sinusoidal endothelial cells, and phagocytic Kupffer cells.[26] Hepatic stellate cells are nonparenchymal cells found in the perisinusoidal space, between a sinusoid and a hepatocyte.[25] Additionally, intrahepatic
-
Microscopic anatomy of the liver
-
Types of capillaries–sinusoid on right
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3D medical animation still shot depicting parts of liver
Functional anatomy
The central area or
The hilum of the liver is described in terms of three plates that contain the bile ducts and blood vessels. The contents of the whole plate system are surrounded by a sheath.[27] The three plates are the hilar plate, the cystic plate and the umbilical plate and the plate system is the site of the many anatomical variations to be found in the liver.[27]
Couinaud classification system
In the widely used Couinaud system, the functional lobes are further divided into a total of eight subsegments based on a transverse plane through the bifurcation of the main portal vein.[28] The caudate lobe is a separate structure that receives blood flow from both the right- and left-sided vascular branches.[29][30] The Couinaud classification divides the liver into eight functionally independent liver segments. Each segment has its own vascular inflow, outflow and biliary drainage. In the centre of each segment are branches of the portal vein, hepatic artery, and bile duct. In the periphery of each segment is vascular outflow through the hepatic veins.[31] The classification system uses the vascular supply in the liver to separate the functional units (numbered I to VIII) with unit 1, the caudate lobe, receiving its supply from both the right and the left branches of the portal vein. It contains one or more hepatic veins which drain directly into the inferior vena cava.[28] The remainder of the units (II to VIII) are numbered in a clockwise fashion:[31]
Gene and protein expression
About 20,000 protein coding genes are expressed in human cells and 60% of these genes are expressed in a normal, adult liver.
Development
After migration of hepatoblasts into the septum transversum mesenchyme, the hepatic architecture begins to be established, with liver sinusoids and bile canaliculi appearing. The liver bud separates into the lobes. The left
At birth, the liver comprises roughly 4% of body weight and weighs on average about 120 g (4 oz). Over the course of further development, it will increase to 1.4–1.6 kg (3.1–3.5 lb) but will only take up 2.5–3.5% of body weight.[38]
Hepatosomatic index (HSI) is the ratio of liver weight to body weight.[39]
Fetal blood supply
In the growing fetus, a major source of blood to the liver is the umbilical vein, which supplies nutrients to the growing fetus. The umbilical vein enters the abdomen at the umbilicus and passes upward along the free margin of the falciform ligament of the liver to the inferior surface of the liver. There, it joins with the left branch of the portal vein. The ductus venosus carries blood from the left portal vein to the left hepatic vein and then to the inferior vena cava, allowing placental blood to bypass the liver. In the fetus, the liver does not perform the normal digestive processes and filtration of the infant liver because nutrients are received directly from the mother via the
Unlike eutherian mammals, in marsupials the liver remains haematopoietic well after birth.[40][41][42][43]
Functions
The various functions of the liver are carried out by the liver cells or hepatocytes. The liver is thought to be responsible for up to 500 separate functions, usually in combination with other systems and organs. Currently, no
Blood supply
The liver receives a dual blood supply from the hepatic portal vein and hepatic arteries. The hepatic portal vein delivers around 75% of the liver's blood supply and carries venous blood drained from the spleen, gastrointestinal tract, and its associated organs. The hepatic arteries supply arterial blood to the liver, accounting for the remaining quarter of its blood flow. Oxygen is provided from both sources; about half of the liver's oxygen demand is met by the hepatic portal vein, and half is met by the hepatic arteries.[44] The hepatic artery also has both alpha- and beta-adrenergic receptors; therefore, flow through the artery is controlled, in part, by the splanchnic nerves of the autonomic nervous system.
Blood flows through the liver sinusoids and empties into the central vein of each lobule. The central veins coalesce into hepatic veins, which leave the liver and drain into the inferior vena cava.[45]
Biliary flow
The
Bile either drains directly into the duodenum via the common bile duct, or is temporarily stored in the gallbladder via the cystic duct. The common bile duct and the pancreatic duct enter the second part of the duodenum together at the hepatopancreatic ampulla, also known as the ampulla of Vater.
Metabolism
The liver plays a major role in carbohydrate, protein, amino acid, and lipid metabolism.
Carbohydrate metabolism
The liver performs several roles in carbohydrate metabolism.
- The liver synthesizes and stores around 100g of glycogen via glycogenesis, the formation of glycogen from glucose.
- When needed, the liver releases glucose into the blood by performing glycogenolysis, the breakdown of glycogen into glucose.[46]
- The liver is also responsible for gluconeogenesis, which is the synthesis of glucose from certain amino acids, lactate, or glycerol. Adipose and liver cells produce glycerol by breakdown of fat, which the liver uses for gluconeogenesis.[46]
- Liver also does glyconeogenesis which is synthesis of glycogen from lactic acid.[47]
Protein metabolism
The liver is responsible for the mainstay of protein
Lipid metabolism
The liver plays several roles in
Breakdown
The liver is responsible for the breakdown of insulin and other hormones. The liver breaks down bilirubin via glucuronidation, facilitating its excretion into bile. The liver is responsible for the breakdown and excretion of many waste products. It plays a key role in breaking down or modifying toxic substances (e.g.,
Blood reservoir
Because the liver is an expandable organ, large quantities of blood can be stored in its blood vessels. Its normal blood volume, including both that in the hepatic veins and that in the hepatic sinuses, is about 450 milliliters, or almost 10 percent of the body's total blood volume. When high pressure in the right atrium causes backpressure in the liver, the liver expands, and 0.5 to 1 liter of extra blood is occasionally stored in the hepatic veins and sinuses. This occurs especially in cardiac failure with peripheral congestion. Thus, in effect, the liver is a large, expandable, venous organ capable of acting as a valuable blood reservoir in times of excess blood volume and capable of supplying extra blood in times of diminished blood volume.[51]
Lymph production
Because the pores in the hepatic sinusoids are very permeable and allow ready passage of both fluid and proteins into the perisinusoidal space, the lymph draining from the liver usually has a protein concentration of about 6 g/dl, which is only slightly less than the protein concentration of plasma. Also, the high permeability of the liver sinusoid epithelium allows large quantities of lymph to form. Therefore, about half of all the lymph formed in the body under resting conditions arises in the liver.
Other
- The liver stores a multitude of substances, including vitamin A (1–2 years' supply), vitamin D (1–4 months' supply),[52] vitamin B12 (3–5 years' supply),[53] vitamin K, vitamin E, iron, copper, zinc, cobalt, molybdenum, etc.
- Haemopoiesis - The formation of blood cells is called haemopoiesis. In embryonic stage RBC and WBC are formed by liver. In the first trimester fetus, the liver is the main site of red blood cell production. By the 32nd week of gestation, the bone marrow has almost completely taken over that task.[54]
- The liver helps in the purification of blood. The Kupffer cells of liver are phagocytic cells, helps in phagocytosis of dead blood cells and bacteria from the blood.[55]
- The liver is responsible for immunological effects – the mononuclear phagocyte system of the liver contains many immunologically active cells, acting as a 'sieve' for antigens carried to it via the portal system.
- The liver produces albumin, the most abundant protein in blood serum. It is essential in the maintenance of oncotic pressure, and acts as a transport for fatty acids and steroid hormones.
- The liver synthesizes angiotensinogen, a hormone that is responsible for raising the blood pressure when activated by renin, an enzyme that is released when the kidney senses low blood pressure.
- The liver produces the enzyme catalase to break down hydrogen peroxide, a toxic oxidising agent, into water and oxygen.
Clinical significance
Disease
The liver is a vital organ and supports almost every other organ in the body. Because of its strategic location and multidimensional functions, the liver is prone to many diseases.[56] The bare area of the liver is a site that is vulnerable to the passing of infection from the abdominal cavity to the thoracic cavity. Liver diseases may be diagnosed by liver function tests–blood tests that can identify various markers. For example, acute-phase reactants are produced by the liver in response to injury or inflammation.
The most common chronic liver disease is
Other disorders caused by excessive alcohol consumption are grouped under
Primary biliary cholangitis is an autoimmune disease of the liver.[65][66] It is marked by slow progressive destruction of the small bile ducts of the liver, with the intralobular ducts (Canals of Hering) affected early in the disease.[67] When these ducts are damaged, bile and other toxins build up in the liver (cholestasis) and over time damages the liver tissue in combination with ongoing immune related damage. This can lead to scarring (fibrosis) and cirrhosis. Cirrhosis increases the resistance to blood flow in the liver, and can result in portal hypertension. Congested anastomoses between the portal venous system and the systemic circulation, can be a subsequent condition.
There are also many pediatric liver diseases, including
Symptoms
The classic symptoms of liver damage include the following:
- Pale stools occur when stercobilin, a brown pigment, is absent from the stool. Stercobilin is derived from bilirubin metabolites produced in the liver.
- Dark urine occurs when bilirubin mixes with urine
- Jaundice (yellow skin and/or whites of the eyes) This is where bilirubin deposits in skin, causing an intense itch. Itching is the most common complaint by people who have liver failure. Often this itch cannot be relieved by drugs.
- swelling of the ankles and feet occurs because the liver fails to make albumin.
- Excessive fatigue occurs from a mineralsand vitamins.
- Bruising and easy bleeding are other features of liver disease. The liver makes clotting factors, substances which help prevent bleeding. When liver damage occurs, these factors are no longer present and severe bleeding can occur.[68]
- Pain in the upper right quadrant can result from the stretching of Glisson's capsule in conditions of hepatitis and pre-eclampsia.
Diagnosis
The diagnosis of liver disease is made by liver function tests, groups of blood tests, that can readily show the extent of liver damage. If infection is suspected, then other serological tests will be carried out. A physical examination of the liver can only reveal its size and any tenderness, and some form of imaging such as an ultrasound or CT scan may also be needed.
Sometimes a liver biopsy will be necessary, and a tissue sample is taken through a needle inserted into the skin just below the rib cage. This procedure may be helped by a sonographer providing ultrasound guidance to an interventional radiologist.[69]
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Axial CT image showing anomalous hepatic veins coursing on the liver's subcapsular anterior surface[70]
-
Maximum intensity projection (MIP) CT image as viewed anteriorly showing the anomalous hepatic veins coursing on the anterior surface of the liver
-
Lateral MIP view in the same patient as previous image
-
A CT scan in which the liver and portal vein are shown
Liver regeneration
The liver is the only human internal organ capable of natural
This is predominantly due to the
Scientific and medical works about liver regeneration often refer to the Greek
Liver transplantation
Human liver transplants were first performed by Thomas Starzl in the United States and Roy Calne in Cambridge, England in 1963 and 1967, respectively.
Liver
More recently,[when?] adult-to-adult liver transplantation has been done using the donor's right hepatic lobe, which amounts to 60 percent of the liver. Due to the ability of the liver to regenerate, both the donor and recipient end up with normal liver function if all goes well. This procedure is more controversial, as it entails performing a much larger operation on the donor, and indeed there were at least two donor deaths out of the first several hundred cases. A 2006 publication addressed the problem of donor mortality and found at least fourteen cases.[78] The risk of postoperative complications (and death) is far greater in right-sided operations than that in left-sided operations.
With the recent advances of noninvasive imaging, living liver donors usually have to undergo imaging examinations for liver anatomy to decide if the anatomy is feasible for donation. The evaluation is usually performed by multidetector row
-
MDCT image. Arterial anatomy contraindicated for liver donation
-
MDCT image. Portal venous anatomy contraindicated for liver donation
-
MDCT image. 3D image created by MDCT can clearly visualize the liver, measure the liver volume, and plan the dissection plane to facilitate the liver transplantation procedure.
-
Phase contrast CT image. Contrast is perfusing the right liver but not the left due to a left portal vein thrombus.
Society and culture
Some cultures regard the liver as the seat of the
In Plato, and in later physiology, the liver was thought to be the seat of the darkest emotions (specifically wrath, jealousy and greed) which drive men to action.[80] The Talmud (tractate Berakhot 61b) refers to the liver as the seat of anger, with the gallbladder counteracting this. The Persian, Urdu, and Hindi languages (جگر or जिगर or jigar) refer to the liver in figurative speech to indicate courage and strong feelings, or "their best"; e.g., "This Mecca has thrown to you the pieces of its liver!".[81] The term jan e jigar, literally "the strength (power) of my liver", is a term of endearment in Urdu. In Persian slang, jigar is used as an adjective for any object which is desirable, especially women. In the Zulu language, the word for liver (isibindi) is the same as the word for courage. In English the term 'lily-livered' is used to indicate cowardice from the medieval belief that the liver was the seat of courage. Spanish hígados also means "courage".[82] However the secondary meaning of Basque gibel is "indolence".[83]
In biblical Hebrew, the word for liver, כבד (Kauved, stemmed KBD or KVD, similar to Arabic الكبد), also means heavy and is used to describe the rich ("heavy" with possessions) and honor (presumably for the same reason). In the Book of Lamentations (2:11) it is used to describe the physiological responses to sadness by "my liver spilled to earth" along with the flow of tears and the overturning in bitterness of the intestines.
These four meanings were used in preceding ancient
Food
Humans commonly eat the livers of mammals, fowl, and fish as food. Domestic pig, ox, lamb, calf, chicken, and goose livers are widely available from butchers and supermarkets. In the
Liver can be baked, boiled, broiled, fried, stir-fried, or eaten raw (asbeh nayeh or sawda naye in
Giraffe liver
The
- It is said that a person, once he has drunk umm nyolokh, will return to giraffe again and again. Humr, being Mahdists, are strict abstainers [from alcohol] and a Humrawi is never drunk (sakran) on liquor or beer. But he uses this word to describe the effects which umm nyolokh has upon him.[90]
Cunnison's remarkable account of an apparently psychoactive mammal found its way from a somewhat obscure scientific paper into more mainstream literature through a conversation between W. James of the Institute of Social and Cultural Anthropology at the University of Oxford and specialist on the use of hallucinogens and intoxicants in society, and R. Rudgley, who discussed it in a book on psychoactive drugs for general readers.[89] He speculated that a hallucinogenic compound N,N-Dimethyltryptamine in the giraffe liver might account for the intoxicating properties claimed for umm nyolokh.[89]
Cunnison, on the other hand, writing in 1958 found it hard to believe in the literal truth of the Humr's assertion that the drink was intoxicating:
- I can only assume that there is no intoxicating substance in the drink, and that the effect it produces is simply a matter of convention, although it may be brought about subconsciously.[90]
The study of entheogens in general – including entheogens of animal origin (e.g. hallucinogenic fish and toad venom) – has, however, made considerable progress in the sixty-odd years since Cunnison's report; the idea that some intoxicating substance might reside in giraffe livers may no longer be as far-fetched as it seemed to Cunnison. However, to date, proof (or disproof) still waits on detailed analyses of the organ and the beverage made from it.[89]
Arrow/bullet poison
Certain Tungusic peoples of northeast Asia formerly prepared a type of arrow poison from rotting animal livers, which was, in later times, also applied to bullets. Russian anthropologist S. M. Shirokogoroff wrote that:
- Formerly the using of poisoned arrows was common. For instance, among the Kumarčen, [a subgroup of the Oroqen] even in recent times, a poison was used which was prepared from decaying liver.
- [Note] This has been confirmed by the Kumarčen. I am not competent to judge as to the chemical conditions of production of poison which is not destroyed by the heat of explosion. However, the Tungus themselves compare this method [of poisoning ammunition] with the poisoning of arrows.[91]
Other animals
The liver is found in all vertebrates and is typically the largest internal organ. The internal structure of the liver is broadly similar in all vertebrates, though its form varies considerably in different species, and is largely determined by the shape and arrangement of the surrounding organs. Nonetheless, in most species, it is divided into right and left lobes; exceptions to this general rule include snakes, where the shape of the body necessitates a simple cigar-like form.[92]
In neonatal marsupials, it is responsible for the production of blood cells.[40][43][93][42]
An organ sometimes referred to as a liver is found associated with the digestive tract of the primitive chordate
See also
- Porphyria
- Johann Joseph Dömling (published Is the liver a purifying organ in 1798)
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(Bc, BN-s, R) cachaza, calme
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Works cited
- Dorland's illustrated medical dictionary (32nd ed.). Philadelphia, PA: Elsevier / Saunders. 2012. ISBN 978-1-4557-0985-4.
- Young, Barbara; O'Dowd, Geraldine; Woodford, Phillip (4 November 2013). Wheater's Functional Histology: A text and colour atlas (6th ed.). Philadelphia, PA: Elsevier. ISBN 978-0-7020-4747-3.
External links
- Liver at the Human Protein Atlas
- VIRTUAL Liver – online learning resource
- Liver enzymes
- Encyclopædia Britannica. Vol. 16 (11th ed.). 1911. pp. 801–803. with several diagrams. .
- Rizi, Farid (14 January 2022). "Beaver tail liver". Radiopaedia.org. .