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20-September-2008 09:29:06 - Liver This article or section includes a list of references or external links, but its sources remain unclear because it lacks in-text citations. You can improve this article by introducing more precise citations where appropriate. June 2008 Liver Liver of a sheep: 1 right lobe, 2 left lobe, 3 caudate lobe, 4 quadrate lobe, 5 hepatic artery and portal vein, 6 hepatic lymph nodes, 7 gall bladder. Anterior view of the position of the liver red in the human abdomen. Latin hepar Gray's subject #250 1188 Artery hepatic artery Vein hepatic vein, hepatic portal vein Nerve celiac ganglia, vagus1 Precursor foregut MeSH Liver The liver is the largest internal organ in the human body and is present in vertebrates and some other animals. The liver is necessary for survival; a human can only last up to 24 hours without liver function. It plays a major role in metabolism and has a number of functions in the body, including glycogen storage, decomposition of red blood cells, plasma protein synthesis, and detoxification. The liver is also the largest gland in the human body. It lies below the diaphragm in the thoracic region of the abdomen. It produces bile, an alkaline compound which aids in digestion, via the emulsification of lipids. It also performs and regulates a wide variety of high-volume biochemical reactions requiring very specialized tissues.2 Medical terms related to the liver often start in hepato- or hepatic from the Greek word for liver, hÄ“par ήπαÏ?.3 Contents 1 Anatomy 1.1 Flow of blood 1.2 Flow of bile 1.3 Regeneration 1.4 Traditional Surface anatomy 1.4.1 Peritoneal ligaments 1.4.2 Lobes 1.5 Modern Functional anatomy 2 Physiology 3 Diseases of the liver 4 Liver transplantation 5 Development 5.1 Fetal blood supply 6 Liver as food 7 Cultural allusions 8 See also 9 Further reading 10 References 11 Gallery 12 External links Anatomy The adult human liver normally weighs between 1.4 - 1.6 kilograms 3.1 - 3.5 pounds,4 and it is a soft, pinkish-brown, triangular organ. Averaging about the size of an American football in adults, it is both the largest internal organ and the largest gland in the human body. It is located on the right side of the upper abdomen below the diaphragm anatomy. The liver lies to the right of the stomach and overlies the gallbladder. Flow of blood The splenic vein joins the inferior mesenteric vein, which then together join the superior mesenteric vein to form the hepatic portal vein, bringing venous blood from the spleen, pancreas, stomach, small intestine, and large intestine, so that the liver can process the nutrients and by-products of food digestion. The hepatic veins of the blood can be from other branches such as the superior mesenteric artery. Both the portal venules the hepatic arterioles enter approximately one million identical lobules acini, likened to and changes in the size of chylomicrons lipoproteins of dietary origin brought about by the quantity types of food fats.clarify Approximately 60% to 80% of the blood flow to the liver is from the portal venous system, and 1/4 is from the hepatic artery Flow of bile The bile produced in the liver is collected in bile canaliculi, which merge to form bile ducts. These eventually drain into the right and left hepatic ducts, which in turn merge to form the common hepatic duct. The cystic duct from the gallbladder joins with the common hepatic duct to form the common bile duct. Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored in the gallbladder via the cystic duct. The common bile duct and the pancreatic duct enter the duodenum together at the ampulla of Vater. The branchings of the bile ducts resemble those of a tree, and indeed the term biliary tree is commonly used in this setting. The Biliary Tree. The Biliary Tree. Regeneration The liver is among the few internal human organs capable of natural regeneration of lost tissue; as little as 25% of remaining liver can regenerate into a whole liver again. This is predominantly due to the hepatocytes reentering the cell cycle i.e. the hepatocytes go from the quiescent G0 phase to the G1 phase and undergo mitosis. There is also some evidence of bipotential stem cells, called ovalocyte o´vÉ™-lo-sÄ«t, which exist in the Canals of Hering. These cells can differentiate into either hepatocytes or cholangiocytes cells that line the bile ducts. Traditional Surface anatomy Peritoneal ligaments Apart from a patch where it connects to the diaphragm, the liver is covered entirely by visceral peritoneum, a thin, double-layered membrane that reduces friction against other organs. The peritoneum folds back on itself to form the falciform ligament and the right and left triangular ligaments. These ligaments are in no way related to the true anatomic ligaments in joints, and have essentially no functional importance, but they are easily recognizable surface landmarks. Lobes Traditional gross anatomy divided the liver into four lobes based on surface features. The falciform ligament is visible on the front anterior side of the liver. This divides the liver into a left anatomical lobe, and a right anatomical lobe. If the liver flipped over, to look at it from behind the visceral surface, there are two additional lobes between the right and left. These are the caudate lobe the more superior, and below this the quadrate lobe. From behind, the lobes are divided up by the ligamentum venosum and ligamentum teres anything left of these is the left lobe, the transverse fissure or porta hepatis divides the caudate from the quadrate lobe, and the right sagittal fossa, which the inferior vena cava runs over, separates these two lobes from the right lobe. Each of the lobes is made up of lobules, a vein goes from the centre of each lobule which then joins to the hepatic vein to carry blood out from the liver. On the surface of the lobules there are ducts, veins and arteries that carry fluids to and from them. Modern Functional anatomy The central area where the common bile duct, hepatic portal vein, and hepatic artery enter is the hilum or porta hepatis. The duct, vein, and artery divide into left and right branches, and the portions of the liver supplied by these branches constitute the functional left and right lobes. The liver performs over 500 jobs, and produces over 1,000 essential enzymes. The functional lobes are separated by a plane joining the gallbladder fossa to the inferior vena cava. This separates the liver into the true right and left lobes. The middle hepatic vein also demarcates the true right and left lobes. The right lobe is further divided into an anterior and posterior segment by the right hepatic vein. The left lobe is divided into the medial and lateral segments by the left hepatic vein. The fissure for the ligamentum teres the ligamentum teres becomes the falciform ligament also separates the medial and lateral segments. The medial segment is what used to be called the quadrate lobe. In the widely used Couinaud or French 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. The caudate lobe is a separate structure which receives blood flow from both the right- and left-sided vascular branches.56 The subsegments corresponding to the anatomical lobes are as follows: Segment Couinaud segments Caudate 1 Lateral 2, 3 Medial 4a, 4b Right 5, 6, 7, 8 or lobe in the Caudate's case. Each number in the list corresponds to one in the table. Caudate Superior subsegment of the lateral segment Inferior subsegment of the lateral segment Superior subsegment of the medial segment Inferior subsegment of the medial segment Inferior subsegment of the anterior segment Inferior subsegment of the posterior segment Superior subsegment of the posterior segment Superior subsegment of the anterior segment Physiology The various functions of the liver are carried out by the liver cells or hepatocytes. The liver produces and excretes bile a greenish liquid required for emulsifying fats. Some of the bile drains directly into the duodenum, and some is stored in the gallbladder. The liver performs several roles in carbohydrate metabolism: Gluconeogenesis the synthesis of glucose from certain amino acids, lactate or glycerol Glycogenolysis the breakdown of glycogen into glucose muscle tissues can also do this Glycogenesis the formation of glycogen from glucose The breakdown of insulin and other hormones The liver is responsible for the mainstay of protein metabolism. For instance, the liver can convert lactic acid to alanine. The liver also performs several roles in lipid metabolism: Cholesterol synthesis Lipogenesis, the production of triglycerides fats. The liver produces coagulation factors I fibrinogen, II prothrombin, V, VII, IX, X and XI, as well as protein C, protein S and antithrombin. The liver breaks down haemoglobin, creating metabolites that are added to bile as pigment bilirubin and biliverdin. The liver breaks down toxic substances and most medicinal products in a process called drug metabolism. This sometimes results in toxication, when the metabolite is more toxic than its precursor. The liver converts ammonia to urea. The liver stores a multitude of substances, including glucose in the form of glycogen, vitamin B12, iron, and copper. 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. The liver is responsible for immunological effects- the reticuloendothelial 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 major osmolar component of blood serum. Currently, there is no artificial organ or device capable of emulating all the functions of the liver. Some functions can be emulated by liver dialysis, an experimental treatment for liver failure. Diseases of the liver Main article: Liver disease Many diseases of the liver are accompanied by jaundice caused by increased levels of bilirubin in the system. The bilirubin results from the breakup of the hemoglobin of dead red blood cells; normally, the liver removes bilirubin from the blood and excretes it through bile. There are also many pediatric liver diseases, including biliary atresia, alpha-1 antitrypsin deficiency, alagille syndrome, progressive familial intrahepatic cholestasis, and Langerhans cell histiocytosis to name but a few. Liver transplantation Main article: Liver transplantation Human liver transplant was first performed by Thomas Starzl in USA and Roy Calne in Cambridge, England in 1963 and 1965 respectively. Liver transplantation is the only option for those with irreversible liver failure. Most transplants are done for chronic liver diseases leading to cirrhosis, such as chronic hepatitis C, alcoholism, autoimmune hepatitis, and many others. Less commonly, liver transplantation is done for fulminant hepatic failure, in which liver failure occurs over days to weeks. Liver allografts for transplant usually come from non-living donors who have died from fatal brain injury. Living donor liver transplantation is a technique in which a portion of a living person's liver is removed and used to replace the entire liver of the recipient. This was first performed in 1989 for pediatric liver transplantation. Only 20% of an adult's liver Couinaud segments 2 and 3 is needed to serve as a liver allograft for an infant or small child. More recently, adult-to-adult liver transplantation has been done using the donor's right hepatic lobe which amounts to 60% 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 have been at least 2 donor deaths out of the first several hundred cases. A recent publication has addressed the problem of donor mortality, and at least 14 cases have been found.7 The risk of postoperative complications and death is far greater in right sided hepatectomy than left sided operations. With the recent advances of non-invasive 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 multi-detector row computed tomography MDCT and magnetic resonance imaging MRI. MDCT is good in vascular anatomy and volumetry. MRI is used for biliary tree anatomy. Donors with very unusual vascular anatomy, which makes them unsuitable for donation, could be screened out to avoid unnecessary operation. 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. Development 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 develops throughout normal gestation, and does not perform the normal filtration of the infant liver. The liver does not perform digestive processes because the fetus does not consume meals directly, but receives nourishment from the mother via the placenta. The fetal liver releases some blood stem cells that migrate to the fetal thymus, so initially the lymphocytes, called T-cells, are created from fetal liver stem cells. Once the fetus is delivered, the formation of blood stem cells in infants shifts to the red bone marrow. After birth, the umbilical vein and ductus venosus are completely obliterated two to five days postpartum; the former becomes the ligamentum teres and the latter becomes the ligamentum venosum. In the disease state of cirrhosis and portal hypertension, the umbilical vein can open up again. Liver as food Pork liver Nutritional value per 100 g 3.5 oz Energy 130 kcal 560 kJ Carbohydrates 2.5 g Fat 3.7 g Protein 21 g Vitamin A equiv. 6500 μg 722% Riboflavin Vit. B2 3 mg 200% Niacin Vit. B3 15 mg 100% Vitamin B6 0.7 mg 54% Folate Vit. B9 212 μg 53% Vitamin B12 26 μg 1083% Iron 23 mg 184% Sodium 87 mg 6% Beef and chicken liver are comparable. Percentages are relative to US recommendations for adults. Source: USDA Nutrient database Mammal and bird livers are commonly eaten as food by humans. Liver can be baked, broiled, or fried often served as liver and onions or eaten raw liver sashimi, but is perhaps most commonly made into spreads examples include liver pâté, foie gras, chopped liver, and leverpostej, or sausages such as Braunschweiger and liverwurst. Liver sausages may also be used as spreads. Animal livers are rich in iron and Vitamin A, and cod liver oil is commonly used as a dietary supplement. Very high doses of Vitamin A can be toxic; in 1913, Antarctic explorers Douglas Mawson and Xavier Mertz were both poisoned, the latter fatally, from eating husky liver. In the US, the USDA specifies 3000 μg per day as a tolerable upper limit, which amounts to about 50 g of raw pork liver, or 30-90 g of polar bear liver. 8 However, acute vitamin A poisoning is not likely to result from liver consumption, since it is present in a less toxic form than in many dietary supplements.9 Cultural allusions In Greek mythology, Prometheus was punished by the gods for revealing fire to humans by being chained to a rock where a vulture or an eagle would peck out his liver, which would regenerate overnight. Curiously, the liver is the only human internal organ that actually can regenerate itself to a significant extent; this characteristic may have already been known to the Greeks due to survived injuries in battle. The Talmud tractate Berakhot 61b refers to the liver as the seat of anger, with the gallbladder counteracting this. In Arabic, Persian and Urdu languages, the liver is used in figurative speech to refer to courage and strong feelings, or their best, e.g. This Mecca has thrown to you the pieces of its liver! 10 , The term jan e jigar literally a piece of my liver is a term of endearment in Urdu. The legend of Liver-Eating Johnson says that he would cut out and eat the liver of each man killed. In the motion picture The Message, Hind bint Utbah is implied or portrayed eating the liver of Hamza ibn 'Abd al-Muttalib during the Battle of Uhud. Inuit will not eat the liver of polar bears due to the fact a polar bear's liver contains so much Vitamin A as to be poisonous to humans or seals 11 See also Look up liver in Wiktionary, the free dictionary. Artificial liver Bile Bile canaliculus Hepatocyte Liver function tests Further reading The following are standard medical textbooks: Eugene R. Schiff, Michael F. Sorrell, Willis C. Maddrey, eds. Schiff's diseases of the liver, 9th ed. Philadelphia : Lippincott, Williams Wilkins, 2003. ISBN 0-7817-3007-4 Sheila Sherlock, James Dooley. Diseases of the liver and biliary system, 11th ed. Oxford, UK ; Malden, MA : Blackwell Science. 2002. ISBN 0-632-05582-0 David Zakim, Thomas D. Boyer. eds. Hepatology: a textbook of liver disease, 4th ed. Philadelphia: Saunders. 2003. ISBN 0-7216-9051-3 These are for the lay reader or patient: Sanjiv Chopra. The Liver Book: A Comprehensive Guide to Diagnosis, Treatment, and Recovery, Atria, 2002, ISBN 0-7434-0585-4 Melissa Palmer. Dr. Melissa Palmer's Guide to Hepatitis and Liver Disease: What You Need to Know, Avery Publishing Group; Revised ion May 24, 2004, ISBN 1-58333-188-3. her webpage. Howard J. Worman. The Liver Disorders Sourcebook, McGraw-Hill, 1999, ISBN 0-7373-0090-6. his Columbia University web site, Diseases of the liver References ^ Physiology at MCG 6/6ch2/s6ch2_30 ^ Maton, Anthea; Jean Hopkins, Charles William McLaughlin, Susan Johnson, Maryanna Quon Warner, David LaHart, Jill D. Wright 1993. Human Biology and Health. Englewood Cliffs, New Jersey, USA: Prentice Hall. ISBN 0-13-981176-1. ^ The Greek word ήπαÏ? was derived from hÄ“paomai ηπάομαι: to mend, to repair, hence hÄ“par actually means repairable, indicating that this organ can regenerate itself spontaneously in the case of lesion. ^ Robbins and Cotran Pathologic Basis of Disease, 7th ion, p. 878 ^ Three-dimensional Anatomy of the Couinaud Liver Segments - University of Iowa ^ Limitations and Pitfalls of Couinaud`s Segmentation of the Liver in Transaxial Imaging - Prof. Dr. Holger Strunk ^ Bramstedt K 2006. Living liver donor mortality: where do we stand?. Am J Gastroenterol 101 4: 755-9. doi:10.1111/j.1572-0241.2006.00421.x. PMID 16494593. ^ A. Aggrawal, Death by Vitamin A ^ Myhre et al., Water-miscible, emulsified, and solid forms of retinol supplements are more toxic than oil-based preparations, Am. J. Clinical Nutrition, 78, 1152 2003 ^ THE GREAT BATTLE OF BADAR Yaum-e-Furqan ^ Man's best friend? - Student BMJ Gallery Accessory digestive system. Digestive organs. The liver and the veins in connection with it, of a human embryo, twenty-four or twenty-five days old, as seen from the ventral surface. Transverse section through the middle of the first lumbar vertebra, showing the relations of the pancreas. Front of abdomen, showing surface markings for liver, stomach, and great intestine Topography of thoracic and abdominal viscera. Portal triad View of the superior top surface from Gray's Anatomy 1918 View of the inferior bottom surface from Gray's Anatomy 1918 External links The external links in this article may not follow 's content policies or guidelines. Please improve this article by removing excessive or inappropriate external links. Wikimedia Commons has media related to: Liver electron microscopic images of the liver Dr. Jastrow's EM-atlas Elevated liver enzymes information Canadian Liver Foundation Official Website Liver Info: Youth-Oriented Website. Created by Liver Info Students' Association LISA, Official Chapter of Canadian Liver Foundation Children's Liver Association for Support Services, C.L.A.S.S. A large non-profit organization. An online Support Group full of resources, materials and stories; includes a Community Discussion Forum and Chat Room The American Liver Foundation American Association for the Study of Liver Diseases AASLD American Liver Society ALS WikiLiver - a wiki dedicated to the liver It's Dangerous to Ignore Your Liver - information provided by the American Liver Foundation The Liver and its Diseases - information at h2g2 Liver Families - an online support group for families whose lives have been affected by pediatric liver disease and transplant issues Children's Liver Disease Foundation - an organisation dedicated to fighting childhood liver disease and supporting affected families Liver Specialists of Texas: a site designed for patients with liver disease, located in Houston, Texas USA Autoimmune immune liver disease British Liver Trust - includes patient info oriented to British situations. v d e Anatomy of torso, digestive system: accessory digestive glands Liver by region: Left lobe Caudate lobe, Quadrate lobe Right lobe Transverse fissure of liver by function: Fibrous capsule of Glisson Hepatocyte Space of Disse Space of Mall Kupffer cell Liver sinusoid Ito cell Hepatic lobule Biliary tract Bile ducts intrahepatic: Bile canaliculus Canals of Hering Interlobular bile ducts Intrahepatic bile ducts Left and Right hepatic ducts extrahepatic: Common hepatic duct Cystic duct Common bile duct Gallbladder by region: Body Fundus Neck Pancreas by region: Tail Body Head Uncinate process by function: Islets of Langerhans Exocrine pancreas ducts: Pancreatic duct Accessory pancreatic duct Common Hepatopancreatic ampulla Sphincter of Oddi Retrieved from http://en..org/wiki/Liver Categories: Organs | Abdomen | Digestive system | Hepatology | Glands | OffalHidden categories: Articles lacking in-text citations | articles needing clarification | external links cleanup Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages العربية Aymar Bân-lâm-gú Bosanski БългарÑ?ки Català Чăвашла ÄŒesky Cymraeg Dansk Deutsch Þ‹Þ¨ÞˆÞ¬Þ€Þ¨Þ„Þ¦Þ?Þ° Eesti Ελληνικά Español Esperanto Euskara Français Gaeilge Gà idhlig Galego í•œêµì–´ हिनà¥?दी Hrvatski Ido Bahasa Indonesia Ã?slenska Italiano עברית Basa Jawa ქáƒ?რთული Kurdî / كوردی Latina LatvieÅ¡u Lietuvių Lingála Lumbaart Magyar МакедонÑ?ки മലയാളം Malti Bahasa Melayu NÄ?huatl Nederlands 日本語 ‪Norsk bokmÃ¥l‬ ‪Norsk nynorsk‬ Occitan Pangasinan Polski Português Română Runa Simi РуÑ?Ñ?кий Shqip Sicilianu Simple English SlovenÄ?ina SlovenÅ¡Ä?ina СрпÑ?ки / Srpski Srpskohrvatski / СрпÑ?кохрватÑ?ки Basa Sunda Suomi Svenska தமிழà¯? తెలà±?à°—à±? ไทย Tiếng Việt Тоҷикӣ Türkçe УкраїнÑ?ька اردو ייִדיש Zazaki ä¸æ–‡ This page was last modified on 15 August 2008, at 16:55
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