1. The Liver
Anatomy
 Right (middle hepatic vein) Left lobe
 Right – caudate & quadrate lobes
 Overall, 8 subdivisions separated by R, middle & L hepatic veins
 Each section has portal pedicle – individual resection
Blood flow:
Hepatic/Portal Vein
Portal Tracts
Sinusoids
Branches of Hepatic Veins (finally form 3)
IVC
 Lymph – formed in the perisinusoidal space collected in lymphatics in portal
tracts  eventually draining into hepatic ducts
 Acinus – functional liver unit. Made of parenchyma supplied by portal tracts
containing portal vein radicles, hepatic arterioles and bile ductules.
 Sinusoids – a small blood vessel without a continuous endothelium
(fenestrated) or basement membrane and has Kupffer cells (phagocytic).
They are separated by hepatocytes.
 Kupffer cells – secrete Ils, TNF, collagenase & lysosomal hydrolases
 Space of Disse – the subendothelial space between sinusoids and
hepatocytes. It contains a basement membrane matrix and stellate cells.
 Stellate cells – contain desmin. Are activated to myofibroblasts which
contract and regulate sinusoidal blood flow. Involved in fibrosis.
Blood Supply:
 Hepatic Artery – from celiac axis (25% blood flow
 Portal Vein – drains most of GI tract and spleen (75%
of blood flow)
 Enter via porta hepatis
Caudate Lobe blood:
Receives an independent supply
via the portal vein and hepatic
artery and drains directly into the
IVC

2. Liver Function:
Protein Metabolism
Synthesis & Storage:
 Makes all circulating proteins (except y-globulins) by receiving
amino acids from GI and muscles
 Plasma – 60-80g/L of protein – mainly in albumin, globulin and
fibrinogen
 Albumin – ½ life of 16-24 days and 10-12g produced per day.
Function is to 1. Maintain colloid osmotic pressure and 2. To
transport water-insoluble substances e.g. bilirubin, hormones, fatty
acids and drugs. Hypoalbuminaemia is seen in chronic liver
disease, malnutrition, hypercatabolic states (trauma & sepsis) &
where there is excessive loss (nephritic syndrome)
 Transport/carrier proteins are also formed : transferring,
caeruloplasmin
 Also synthesises fibrinogen, factors 5,7,9,10 and 13, proteins C & S
and antithrombin.
 Stores vitamin A, D & B12, and iron, haemosiderin and copper.
Nitrogen Excretion:
 Amino acids  ammonia urea
Carbohydrate Metabolism
Glucose homeostasis, by storing approx 80g of glycogen.
Lipid Metabolism
 Fats are insoluble in water so transported as lipoproteins.

3.  Formation of bile and bilirubin metabolism.
 Hormone and Drug Inactivation – catabolises insulin, glucagon, oestrogens,
growth hormone, glucocorticoids and parathyroid hormones
 Immunological Function – bacteria and other antigens are phagocytosed and
degraded by Kupffer cells.
Investigations
LFTS –
 serum albumin & bilirubin
 prothrombin time
Liver Biochemistry –
 serum aspartate and alanine aminotransferases –show hepatocellular damage
 serum alkaline phosphatise, y-glutamyl transpeptidase - cholestasis
 total protein