Hepatobiliary physiology

Dr Nyongesa, Bsc, MBCHB, PGD, MSc,

MBCHB 2 year 2024
Course outline
• Anatomy and histology
• Function
Anatomical location
• Largest internal organ

• Weighs about 1500g

• Highly vascular, takes 25% of CO

• Metabolically active filter

 Divisions
Lobes:
• 4 lobes: right, ;left, quadrate, and
caudate

Segments
• Based on branching pattern of
hepatic artery, portal vein and
bile ducts
• 8 Counard segments
• Important for planning for surgery
Vasculature
Supply:
• Portal vein:
• About 1050mls/min
• Supplies 70% of blood, 40% of oxygen
• Pressure : 9mmhg
• Hepatic artery:
• 300mls/min
• 30% of blood, 60% of oxygen
• Blood percolates in the sinusoids
• Sinusoidal blood flows into terminal hepatic venules before emptying into hepatic
veins
• Liver acts as blood reservoir
• About ½ of total lymph emanates from liver
Histology
Liver acinus
• Functional unit of liver
• About 100,000 acini
• Globular array of hepatocytes
around portal tract
• Portal tract:
Portal triad
Components: 3 parenchymal zones:
• Bile ductule • Periportal/Zone I
• Intermediate: Zone II
• Terminal portal vein • Perivenular: Zone III
• Hepatic arteriole
• Also has nerve fibres and small
lymphatics

• At periphery: central veins drain

away
Sinusoids
Network of vascular spaces
sandwiched between hepatocyte
plates.
• Has different cell types:
• Endothelial cells:
• Are fenestrated, and lack
basement membrane
• Barrier between blood and
hepatocytes: Filter substances
• Engaged in endocytosis
• Secrete bioactive compounds s.a
PGE2, NO
Cells along sinusoids
• Kuppfer cells
• Largest population of macrophages
• More abundant in periportal zone
• Phagocytose senescent RBCs
• Clear endotoxins from portal blood
• Act as APCs
• Ingest and kills tumor cells and
pathogens
• Produce cytokines
Pit cells
• Large granular non B- and non-T cells
• Kill tumor cells and cells infected
with viruses
Stellate cells/cells of Ito:
• Site of fat metabolism and storage of
Vitamin A
• Have role in hepatic regeneration
• Produce extracellular matrix proteins
• Can transform into myofibroblasts
Hepatocytes
• Are polyhedral in shape

• 25% are bi-nucleated

• Arranged in liver cell plates

• Exhibit microenvironment diversity

Nutrient metabolism
Carbohydrates: Protein metabolism
• Storage of glycogen • Deamination
• Converts galactose and fructose into
glucose • Urea formation
• Gluconeogenesis • Plasma protein formation
• Formation of intermediate compounds • Interconversions of AA
Fat metabolism
• Oxidation of fatty acids
• Synthesis of cholesterol, phospholipids
and lipoproteins
Biliary function
• Degradation of xenobiotic
compounds
• Bile formation
• Bile from bile canaliculi drains
into intralobular bile ducts
• From there into interlobular
ducts into right and left hepatic
ducts
• Cholangiocytes line walls of
biliary tress
Bilirubin
metabolism
Regulation of liver mass
• Partial hepatectomy leads to enlargement of remaining tissue to
restore it to normal size

• Involves hepatocyte growth factors produced by mesenchymal cells

Assessment of liver function
• Aminotransferases

• Alkaline phosphatase

• Bilirubin

• Serum proteins
Concept check
Application questions
1. Excessive alcohol intake raises AST (2-5 times) more than ALT because of the following reason
a. Increased pyridoxal 5 phosphate for AST synthesis
b. Increased mitochondrial release of AST
c. Blockage of bile canaculi
d. Toxicity to circulating RBCs
2. Coagulation disorders occur in advanced liver cirrhosis because of
a. Increased synthesis of vitamin K dependant factors
b. Increased production of thrombopoetin hormone
c. Hyperfunctioning of platelets
d. Hypersplenism leading to low platelet levels
3. Concerning the liver acinus
a. Periportal zone receives nutrient poor blood
b. Perivenular zone is at more risk of anoxia
c. Blood and bile flow in same direction
d. The portal tract has hepatic venule in addition to bile ductile and hepatic arteriole
4. Correctly matched
a. Endothelial cells: Secrete NO
b. Pit cells: Storage of Vitamin A
c. Stellate cells: Kill tumor cells
d. Kuppfer cells: Hepatic regeneration
5. Biliary structure and metabolism of bilirubin: Incorrect statement
a. Elevation of serum conjugated bilirubin points to intra or extrahepatic
biliary obstruction
b. Cholangiocytes line wall of gall bladder
c. CCK relaxes the Sphincter of Oddi
d. Biliverdin circulates in blood bound to albumin