Chapter 18 Liver and Gallbladder

Transcription

1 Chapter 18 Liver and Gallbladder 解剖學科徐淑媛

2 本堂重點 1. Liver : functions & histology 2. Gallbladder

3 Physiology Liver Produce circulating plasma proteins Vitamin Iron Degradation Metabolism Bile manufacture (exocrine) Endocrine-like functions

4 Physiology Liver Produce circulating plasma proteins -- albumins : regulating plasma volume -- lipoproteins : VLDL transport TG to other organs -- glycoproteins : carrier -- prothrombin & fibrinogen : blood clotting -- globulins : plasma volume & carrier proteins Vitamins -- vitamin A : hepatic stellate cells; retinol-binding protein (RBP) -- vitamin D : calcium & phosphate metabolism -- convert vitamin D 3 to 25-hydroxycholecalciferol (circulating form) then be activated in kidney -- vitamin K : synthesis of clotting factors

5 Physiology Liver Iron -- synthesis most proteins involved in iron transport and metabolism -- long term storage site of iron Degradation -- proteins, drugs & toxins -- oxidation (ser + mitochodria) conjugation (more water soluble) Metabolism -- glucose : storage or energy supply -- lipid : fatty acids; produce ketone bodies cholesterol synthesis & uptake from blood (for synthesis of bile salts, VLDLs ) -- protein : formation of urea; synthesis of nonessential amino acids

6 Physiology Liver Bile manufacture (exocrine) (Table 18.1) -- contain conjugated & degraded waste to intestine for disposal -- bind metabolite to aid absorption in intestine Endocrine-like functions -- convert vitamin D -- thyroxine deiodination (T 4 T 3 ) -- modify the action of growth hormone -- degrade insulin & glucagon (with kidney)

7 Structural organization Glisson s fibrous capsule parenchyma: plates of hepatocytes stroma : connective tissue with abundant reticular fibers Fig. 18.1

8 Structural organization Glisson s fibrous capsule parenchyma: plates of hepatocytes stroma : connective tissue with abundant reticular fibers From Wheater s: Functional Histology

9 Structural organization parenchyma: plates of hepatocytes sinusoids stroma : portal area (triad) contain brs. of hepatic artery, portal vein, bile duct Fig Plate 65 p. 655

10 Structural organization parenchyma: plates of hepatocytes sinusoids stroma : portal area (triad) contain brs. of hepatic artery, portal vein, bile duct Fig Plate 66 p. 657

11 Structural organization Glisson s fibrous capsule parenchyma: plates of hepatocytes stroma : connective tissue with abundant reticular fibers From Wheater s: Functional Histology

12 Blood supply Dual blood supply : hepatic artery (25%) & hapatic portal vein (75%) -- nutrients & toxic materials from intestines -- blood cells & breakdown products from spleen -- endocrine secretions From Moore : Clinically Oriented Anatomy

13 Blood supply Dual blood supply : hepatic artery (25%) & hapatic portal vein (75%) hepatic portal vein & hepatic artery sinusoid central vein (terminal hepatic venule) hepatic veins inferior vena cava From Moore : Clinically Oriented Anatomy Fig. 18.2

14 stroma : portal area (triad) contain brs. of hepatic artery, portal vein, bile duct From Moore : Clinically Oriented Anatomy From Netter : Atlas of human anatomy

15 stroma : portal area (triad) contain brs. of hepatic artery, portal vein, bile duct Fig From Wheater s: Functional Histology Plate 65, p.655

16 From Wheater s: Functional Histology

17 Plate 65 p.655 Fig Plate 66, p. 657

18 From Marieb & Mallet: Human Anatomy

19 classical lobule portal lobule liver acinus Liver Liver lobules Fig. 18.4, 18.5 From Gartner : Color Atlas of Histology

20 Liver lobules classical liver lobule -- 1 central vein + 3 portal areas (portal canals) Fig. 18.3, 18.4

21 Liver lobules classical liver lobule -- 1 central vein + 3 portal areas (portal canals) Fig From Wheater s: Functional Histology

22 Liver lobules portal lobule : exocrine function -- 1 portal area + 3 central veins Fig Fig. 18.6

23 Liver lobules portal lobule : exocrine function -- 1 portal area + 3 central veins From Netter : Atlas of human anatomy

24 Liver lobules liver acinus : functional interpretation -- 2 central veins + 2 portal areas -- zone 1, 2 & 3 Fig From Wheater s: Functional Histology

25 lobules Liver liver acinus : functional interpretation -- 2 central veins + 2 portal areas -- zone 1, 2 & 3 Fig p. 634

26 classical lobule portal lobule liver acinus Liver Liver lobules Fig. 18.4, 18.5 From Gartner : Color Atlas of Histology

27 Structural organization parenchyma: plates of hepatocytes sinusoids stroma : portal area (triad) contain brs. of hepatic artery, portal vein, bile duct perisinusoidal space Plate 65 p. 655

28 Hepatic sinusoids discontinuous endothelium with large fenestrae & gaps Kupffer cells (stellate sinusoidal macrophage) -- form part of sinusoidal lining -- final breakdown of RBC fragments Liver Plate 66, p.657

29 Hepatic sinusoids Liver discontinuous endothelium with large fenestrae & gaps Kupffer cells (stellate sinusoidal macrophage) -- form part of sinusoidal lining -- final breakdown of RBC fragments From Wheater s: Functional Histology From Basic Histology: Text & Atlas

30 Perisinusoidal Space (space of Disse) -- exchange between bloodstream & hepatocytes (microvilli) -- islets of blood-forming cells in fetal liver Plate 66, p.657 Fig

31 Perisinusoidal Space (space of Disse) -- exchange between bloodstream & hepatocytes (microvilli) -- islets of blood-forming cells in fetal liver Fig Fig From Wheater s: Functional Histology

32 Perisinusoidal Space (space of Disse) -- hepatic stellate cell (Ito cell) -- storage site of hepatic vitamin A in lipid droplets -- may differentiate into myofibroblast-like cells such as in liver cirrhosis liver fibrosis & portal hypertension Fig Fig. 18.7

33 Structural organization parenchyma: plates of hepatocytes sinusoids stroma : portal area (triad) contain brs. of hepatic artery, portal vein, bile duct perisinusoidal space From Marieb & Mallet: Human Anatomy Plate 65 p. 655

34 Hepatocyte polyhedral shape single (75%) or two (25%) nuclei; most are tetraploid (4n) abundance of rer, mitochondria, Golgi complexes, & lysosomes (iron storage) lipid droplets (VLDL) & glycogen peroxisomes : detoxification & oxidation of lipid ser : degradation of drug & detoxification; synthesis of cholesterol From Wheater s: Functional Histology Fig

35 Hepatocyte polyhedral shape : 2 surfaces face space of Disse, the others face neighboring hepatocytes & bile canaliculi From Marieb & Mallet: Human Anatomy Fig

36 Biliary tree bile canaliculi canal of Hering intrahepatic ductule interlobular bile duct (portal triad) right & left hepatic ducts common hepatic duct From Netter : Atlas of human anatomy

37 Biliary tree -- bile canaliculi formed by apposed grooves in the surface of adjacent hepatocytes From Basic Histology: Text & Atlas Fig

38 Biliary tree bile canaliculi canal of Hering intrahepatic ductule interlobular bile duct (portal triad) right & left hepatic ducts common hepatic duct From Wheater s: Functional Histology Fig From Netter : Atlas of human anatomy

39 Biliary tree canal of Hering -- lined with hepatocytes and cholangiocytes -- a reservoir of liver progenitor cells Fig From Netter : Atlas of human anatomy

40 Biliary tree bile canaliculi canal of Hering intrahepatic ductule interlobular bile duct (portal triad) right & left hepatic ducts common hepatic duct From Netter : Atlas of human anatomy From Wheater s: Functional Histology

41 Bile functions of the bile -- absorption of fat -- excretion of cholesterol, bilirubin, iron and copper bile salts, cholesterol, water, electrolytes are reabsorbed from gut back to liver bilirubin glucuronide (end product of hemoglobin) excreted in feces From Fox: Human Physiology

42 Gallbladder Fig. 18.1

43 Gallbladder store, concentrate & release bile responded to CCK & Ach mucosa, muscularis externa, & serosa or adventitia From Wheater s: Functional Histology Fig

44 Gallbladder simple tall columnar epithelium -- microvilli, junctional complexes, mitochondria, & lateral plications Plate 67, p. 659 Fig

45 Gallbladder lamina propria: rich in fenestrated capillaries & small venules (water absorption) no muscularis mucosae & submucosa muscularis externa; serosa/adventitia Plate 67 p. 659

46 Gallbladder Rokitansky-Aschoff sinuses : pathologic changes -- deep diverticula of mucosa From Wheater s: Functional Histology Fig

47 Digestive System III - Liver and Gallbladder 1. Liver : functions & histology 2. Gallbladder