Anatomy and Physiology

of Hepatic – Biliary –
Pancreatic System

Michael D. Manglapus, RN, RM, MAN

 Hepatic System
Liver
• Approximately 3 lbs (1.37 kg) in an adult
• Is the largest organ in the body.
• Located directly beneath the diaphragm at
right epigastric region
• Has two lobes
divided by falciform
ligament, right lobe
larger than the left
lobe 2
• Able to repair itself and regenerate
damaged tissue to a certain extent

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 Liver
• Receives 1500 ml of
blood each minute
from:
– Hepatic artery =
provides about
one third of the
incoming blood
directly from the
heart

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 Liver
– Portal vein =
carries nutrient-
rich but poorly
oxygenated blood
directly from the
digestive tract.

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 Liver
• Lobules = functional unit of the liver
– Each lobule consists of hepatocytes (liver
cells)
• Sinusoids = are specialized capillaries found
only in the liver.
• Kupffer cells = carry out phagocytic activity
(removal of bacteria and toxins from the
blood)
• Nerve supply to the liver is from left vagus
and sympathetic celiac plexus.
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 Major Functions of the Liver:
1. Metabolic functions
A. Carbohydrate metabolism
• Glyconeogenesis = the process of the
liver to convert amino acids and fatty
acids to glucose
• Glycogenesis (glycogen synthesis) =
conversion of glucose to glycogen
• Glycogenolysis (glycogen hydrolysis) =
process of breaking down glycogen into
glucose
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Major Functions of the Liver:
B. Protein metabolism
• Conversion of NH3 (ammonia) to urea
C. Fat metabolism
• Synthesis of fatty acids from amino
acids and glucose
• Breakdown of triglycerides
D. Detoxification
• Inactivation of drugs and harmful
substances
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 Major Functions of the Liver:
E. Steroid metabolism
• Excretion of gonadal and adrenal
corticosteroid
2. Bile synthesis
– Bile production by hepatocytes.
– Bile excretion = bile excreted by liver
about 1 L/day

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 Major Functions of the Liver:
3. Storage
– Glucose in the form of glycogen
– Vit. A, D, E, K
4. Phagocytic system
– Breakdown of RBC, WBC, and bacteria
– Breakdown of hemoglobin to bilirubin

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 Bilirubin Metabolism:
• Bilirubin = is a waste product of the
breakdown of the hemoglobin molecule.

Aged RBC

Hemoglobin

Heme Globin
11
 Bilirubin Metabolism:

Bilirubin (insoluble) Amino acids

Attached to albumin New proteins

Unconjugated bilirubin (indirect bilirubin) - insoluble

Liver

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 Bilirubin Metabolism:
Unconjugated bilirubin combines with glocuronic
acid (glucoronide)

Conjugated bilirubin (direct bilirubin) – soluble

Excreted in the bile

Intestine (bilirubin reduced to urobilinogen and

stercobilinogen by intestinal bacteria)
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 Bilirubin Metabolism:

Stercobilinogen gives brown color to stool

Urobilinogen goes in systemic circulation

and excreted in urine

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 Bilirubin Disorders
• Jaundice = yellow pigmentation of the skin
and sclera
• Icterus = yellow coloration in the sclera of
the eye.
• Kernicterus = excessive accumulation of
bilirubin in the brain that causes brain
damage

15
 Bilirubin Disorders
• Crigler-Najjar disease = recessive
inherited disorder characterized by the
inability to conjugate bilirubin. Patients
display severe neurological impairments
and have a life expectancy of one year or
less.

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 Biliary Tract
• Is composed of gallbladder, common bile
duct, cystic duct, and hepatic duct which is
designed to drain bile.
• Gallbladder = is a pear-shaped sac
located below the liver
– Function:
• To concentrate and store bile.
• It can hold approximately 40 – 70 ml
of bile.
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 Biliary Tract
Gall bladder
• Is drained
by the cystic
duct.

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 Pancreas
• Is a long, thin glandular organ that is
essential for digestion and metabolism
• Two major types of cells:
– Exocrine cells
• Acini cells = produce pancreatic
enzymes 

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 Pancreas
– Endocrine cells
• Islets of Langerhans
–Alpha cells = produce glucagon
–Beta cells = produce insulin
–Delta cells = produce somatostatin

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 Diagnostic Tests
1. Liver Function Tests
(LFT)
– Albumin
– Total and direct bilirubin
– Alkaline phosphatase
– AST – aspartate
transaminase
– SGOT

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 Diagnostic Tests
– ALT – alanine transaminase
– GPT – glutamic pyruvate transaminase
– SGPT
– Liver biopsy = is used to procure a small
sample of liver tissue to diagnose liver
pathology.
– It is an invasive sterile procedure performed
under local anesthesia.

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 Diagnostic Tests
• Nursing responsibility:
– Explaining the procedure to the patient.
– Placing the patient on NPO for 12 hours prior
to biopsy
– Making sure prothrombin and hemoglobin
result are available

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 Diagnostic Tests
• Potential complications:
– Bleeding
– Puncture of the kidney or intestine
– Puncture of the lungs with subsequent
pneumothorax
– Puncture of the gallbladder
– Peritonitis

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 Diagnostic Tests
3. Endoscopic Retrograde
Cholangiopancreatography (ERCP) =
inspects the liver, gallbladder, and
pancreas visually and radiographically.
– A fiberoptic duodenoscope is inserted orally
under general anesthesia into the
duodenum.
– Radiographic dye is introduced to visualize
the liver, gallbladder, pancreas, and the
different ducts.
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 Diagnostic Tests
• Potential complications:
– Perforation of the stomach, duodenum and
other ducts
– Pancreatitis
– Anaphylactic reaction to the contrast dye
– Aspiration of gastric contents
– Reaction to anesthesia

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 Diagnostic Tests
• Nursing responsibilities:
– Checking the signed consent form
– Patent IV line
– X-rays are available
– NPO for 12 hours
– After the test:
• NPO until gag reflex returns

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