Hepatic 1 Flashcards
what are the overall functions of the liver?
- removes toxic byproducts of certain medications
- metabolizes or breaks down nutrients from food to produce energy
- helps your body fight infection by removing bacteria from the blood
- produces substances that regulate blood clotting
- produces bile which is needed to digest fat and absorb vitamins A, D, E and K
- produces most proteins needed by the body
- prevents shortages of nutrients by storing vitamins, minerals, and sugar
how big is the liver?
2.5-3 lbs
largest organ in the body
what is the basic functional unit of the liver
- lobule
- cylindrical shape
- several mm long and 0.8-2 mm wide
how many lobules are in the liver
50,000-100,000
what are the basic structures of a liver lobule (9)?
- portal vein
- sinusoids
- central vein
- hepatic artery
- bile canaliculi and bile duct (“capillaries” that transport bile)
- space of disse and lymphatic duct
- hepatic cellular plates
- kuppfer cells (macrophages in liver)
- interlobular septa
Space of Disse
space around the endothelial cells; plasma goes through large gaps of endothelial cells and into this space; eventually drains into lymphatics
what is the portal triad?
-portal vein
-hepatic artery
-bile duct
these are the components of a typical portal canal
celiac trunk artery
- important for hepatic blood flow
- gives rise to hepatic artery so supplies blood to liver
where does the liver receive blood flow from?
- the portal vein and the hepatic artery
- both supply about 50% of the liver’s O2 requirement
SvO2 of portal vein
85%
SaO2 of hepatic artery
98-100%
what is normal hepatic blood flow?
1500 mL/min
about 25-30% of CO
how much hepatic blood flow comes from portal vein and hepatic artery respectively?
- portal vein - 1100 mL (75%)
- hepatic artery - 400 mL (25%)
what is the avg portal vein pressure?
9 mmHg
resistance to blood flow through the liver
- portal vein pressure on avg is 9 mmHg
- pressure in hepatic vein leaving liver and entering IVC normally averages 0 mmHg
- small pressure difference demonstrates that resistance to flow in hepatic sinusoids is VERY low
- resistance MUST be low given than 1500 mL of blood flows through the liver each minute
- calculate resistance using ohm’s law
how long does it take for blood to traverse from the portal vein to the central vein?
- 8 to 9 seconds
- promotes sufficient time for the blood to be in contact with the hepatocytes and kupffer cells
what is hepatic arterial blood flow dependent on?
- autoregulation
- metabolic demand
- constriction and dilation dependent on local conditions
what is hepatic portal vein blood flow dependent on?
-blood flow to the GI tract and the spleen
Liver blood flow compensation
- change in blood flow from one source will produce a reciprocal (but somewhat limited) compensatory change in the blood flow from the other source
- decrease in hepatic arterial blood flow produces an increase in portal venous blood flow
cirrhosis and hepatic blood flow
- cirrhosis greatly increases the resistance to blood flow
- destruction of the liver parnechymal cells results in replacement with fibrous tissue that contracts around the blood vessels (bridging fibrosis)
- bridging fibrosis = fibrotic tissue bridges across sinusoids and cuts them off
- greatly impedes portal vein blood flow
most common cause of cirrhosis
alcoholism
other common causes of cirrhosis
- viral hepatitis
- obstruction of bile ducts
- infection in the bile ducts
- ingestion of poisons (carbon tetrachloride - formerly used in dry cleaning)
- non-alcoholic fatty liver disease
fatty liver
- deposits of fat cause liver enlargement
- strict abstinence can lead to a full recovery
liver fibrosis
- scar tissue forms
- recovery is possible but scar tissue remains