The liver is a major metabolic organ exclusively found in , which performs many essential biological functions such as detoxification of the organism, and the synthesis of various proteins and various other Biochemistry necessary for digestion and growth. In , it is located in the right upper quadrant of the abdomen, below the diaphragm and mostly shielded by the lower right rib cage. Its other metabolic roles include carbohydrate metabolism, the production of a number of , conversion and storage of nutrients such as glucose and glycogen, and the decomposition of red blood cells. Anatomical and medical terminology often use the prefix hepat- from ἡπατο-, from the Greek language word for liver, such as hepatology, and hepatitis.
The liver is also an accessory digestive organ that produces bile, an alkaline fluid containing cholesterol and , which emulsifies and aids the breakdown of dietary fat. The gallbladder, a small hollow pouch that sits just under the right lobe of liver, stores and concentrates the bile produced by the liver, which is later excreted to the duodenum to help with digestion.
It is not known how to compensate for the absence of liver function in the long term, although liver dialysis techniques can be used in the short term. Artificial livers have not been developed to promote long-term replacement in the absence of the liver. , liver transplantation is the only option for complete liver failure.
The liver is connected to two large : the hepatic artery and the portal vein. The hepatic artery carries oxygen-rich blood from the aorta via the celiac trunk, whereas the portal vein carries blood rich in digested nutrients from the entire gastrointestinal tract and also from the spleen and pancreas. These blood vessels subdivide into small capillaries known as , which then lead to hepatic lobules.
Hepatic lobules are the functional units of the liver. Each lobule is made up of millions of , which are the basic metabolic cells. The lobules are held together by a fine, dense, irregular, connective tissue layer extending from the fibrous capsule covering the entire liver known as Glisson's capsule after British doctor Francis Glisson. This tissue extends into the structure of the liver by accompanying the blood vessels, ducts, and nerves at the hepatic hilum. The whole surface of the liver, except for the bare area, is covered in a Serous membrane coat derived from the peritoneum, and this firmly adheres to the inner Glisson's capsule.
The falciform ligament makes a superficial division of the liver into a left and right lobe. From below, the two additional lobes are located between the right and left lobes, one in front of the other. A line can be imagined running from the left of the vena cava and all the way forward to divide the liver and gallbladder into two halves.
Other anatomical landmarks include the ligamentum venosum and the round ligament of the liver, which further divide the left side of the liver in two sections. An important anatomical landmark, the porta hepatis, divides this left portion into four segments, which can be numbered starting at the caudate lobe as I in an anticlockwise manner. From this parietal view, seven segments can be seen, because the eighth segment is only visible in the visceral view.
These peritoneal ligaments are not related to the anatomic ligaments in joints, and the right and left triangular ligaments have no known functional importance, though they serve as surface landmarks. The falciform ligament functions to attach the liver to the posterior portion of the anterior body wall.
The visceral surface or inferior surface is uneven and concave. It is covered in peritoneum apart from where it attaches the gallbladder and the porta hepatis. The fossa of gallbladder lies to the right of the quadrate lobe, occupied by the gallbladder with its cystic duct close to the right end of porta hepatis.
The suprarenal impression is a small, triangular, depressed area on the liver. It is located close to the right of the fossa, between the bare area and the caudate lobe, and immediately above the renal impression. The greater part of the suprarenal impression is devoid of peritoneum and it lodges the right suprarenal gland.
Medial to the renal impression is a third and slightly marked impression, lying between it and the neck of the gall bladder. This is caused by the descending portion of the duodenum, and is known as the duodenal impression.
The inferior surface of the left lobe of the liver presents behind and to the left of the gastric impression. This is moulded over the upper front surface of the stomach, and to the right of this is a rounded eminence, the tuber omentale, which fits into the concavity of the lesser curvature of the stomach and lies in front of the anterior layer of the lesser omentum.
Histology, the study of microscopic anatomy, shows two major types of liver cell: cells and nonparenchymal cells. About 70–85% of the liver volume is occupied by parenchymal hepatocytes. Nonparenchymal cells constitute 40% of the total number of liver cells but only 6.5% of its volume. The are lined with two types of cell, sinusoidal endothelial cells, and phagocyte .
The hilum of the liver is described in terms of three plates that contain the and blood vessels. The contents of the whole plate system are surrounded by a sheath. The three plates are the hilar plate, the cystic plate and the umbilical plate and the plate system is the site of the many anatomical variations to be found in the liver.
After migration of hepatoblasts into the septum transversum mesenchyme, the hepatic architecture begins to be established, with liver sinusoids and bile canaliculi appearing. The liver bud separates into the lobes. The left umbilical vein becomes the ductus venosus and the right vitelline vein becomes the portal vein. The expanding liver bud is colonized by hematopoietic cells. The bipotential hepatoblasts begin differentiating into Cholangiocyte and hepatocytes. The biliary epithelial cells differentiate from hepatoblasts around portal veins, first producing a monolayer, and then a bilayer of cuboidal cells. In ductal plate, focal dilations emerge at points in the bilayer, become surrounded by portal mesenchyme, and undergo tubulogenesis into intrahepatic bile ducts. Hepatoblasts not adjacent to portal veins instead differentiate into hepatocytes and arrange into cords lined by sinusoidal epithelial cells and bile canaliculi. Once hepatoblasts are specified into hepatocytes and undergo further expansion, they begin acquiring the functions of a mature hepatocyte, and eventually mature hepatocytes appear as highly polarized epithelial cells with abundant glycogen accumulation. In the adult liver, hepatocytes are not equivalent, with position along the portocentrovenular axis within a liver lobule dictating expression of metabolic genes involved in drug metabolism, carbohydrate metabolism, ammonia detoxification, and bile production and secretion. WNT/β-catenin has now been identified to be playing a key role in this phenomenon.
At birth, the liver comprises roughly 4% of body weight and weighs on average about . Over the course of further development, it will increase to but will only take up 2.5–3.5% of body weight.
Hepatosomatic index (HSI) is the ratio of liver weight to body weight.
Unlike eutherian mammals, in marsupials the liver remains haematopoietic well after birth.
Blood flows through the liver sinusoids and empties into the central vein of each lobule. The central veins coalesce into hepatic veins, which leave the liver and drain into the inferior vena cava.
Bile either drains directly into the duodenum via the common bile duct, or is temporarily stored in the gallbladder via the cystic duct. The common bile duct and the pancreatic duct enter the second part of the duodenum together at the hepatopancreatic ampulla, also known as the ampulla of Vater.
The most common chronic liver disease is nonalcoholic fatty liver disease, which affects an estimated one-third of the world population.
Hepatitis is a common condition of inflammation of the liver. The most usual cause of this is viral hepatitis, and the most common of these infections are hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E. Some of these infections are sexually transmitted. Inflammation can also be caused by other viruses in the family Herpesviridae such as the herpes simplex virus. Chronic (rather than acute) infection with hepatitis B virus or hepatitis C virus is the main cause of liver cancer. Hepatitis A, B, and C Center: Symptoms, Causes, Tests, Transmission, and Treatments . Webmd.com (2005-08-19). Retrieved on 2016-05-10. Globally, about 248 million individuals are chronically infected with hepatitis B (with 843,724 in the U.S.), and 142 million are chronically infected with hepatitis C (with 2.7 million in the U.S.). Globally there are about 114 million and 20 million cases of hepatitis A and hepatitis E respectively, but these generally resolve and do not become chronic. Hepatitis D virus is a "satellite" of hepatitis B virus (it can only infect in the presence of hepatitis B), and co-infects nearly 20 million people with hepatitis B, globally.
Hepatic encephalopathy is caused by an accumulation of toxins in the bloodstream that are normally removed by the liver. This condition can result in coma and can prove fatal. Budd–Chiari syndrome is a condition caused by blockage of the hepatic veins (including thrombosis) that drain the liver. It presents with the classical triad of abdominal pain, ascites and liver enlargement. 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.
Other disorders caused by excessive alcohol consumption are grouped under alcoholic liver diseases and these include alcoholic hepatitis, fatty liver, and cirrhosis. Factors contributing to the development of alcoholic liver diseases are not only the quantity and frequency of alcohol consumption, but can also include gender, genetics, and liver insult. Liver damage can also be hepatotoxicity, particularly paracetamol and drugs used to treat cancer. A rupture of the liver can be caused by a liver shot used in combat sports.
Primary biliary cholangitis is an autoimmune disease of the liver. It is marked by slow progressive destruction of the small of the liver, with the intralobular ducts (Canals of Hering) affected early in the disease. When these ducts are damaged, bile and other toxins build up in the liver (cholestasis) and over time damages the liver tissue in combination with ongoing immune related damage. This can lead to scarring (fibrosis) and cirrhosis. Cirrhosis increases the resistance to blood flow in the liver, and can result in portal hypertension. Congested anastomoses between the portal venous system and the systemic circulation, can be a subsequent condition.
There are also many pediatric liver diseases, including biliary atresia, alpha-1 antitrypsin deficiency, alagille syndrome, progressive familial intrahepatic cholestasis, Langerhans cell histiocytosis and hepatic hemangioma a benign tumour the most common type of liver tumour, thought to be congenital. A genetic disorder causing multiple cysts to form in the liver tissue, usually in later life, and usually asymptomatic, is polycystic liver disease. Diseases that interfere with liver function will lead to derangement of these processes. However, the liver has a great capacity to regenerate and has a large reserve capacity. In most cases, the liver only produces symptoms after extensive damage.
Hepatomegaly refers to an enlarged liver and can be due to many causes. It can be palpated in a liver span measurement.
Consuming caffeine regularly may help safeguard individuals from Cirrhosis. Additionally, it has been shown to slow the advancement of liver disease in those already affected, lower the risk of liver fibrosis, and provide a protective benefit against liver cancer for moderate coffee drinkers. A 2017 study revealed that the positive effects of caffeine on the liver were evident regardless of the coffee preparation method.
Sometimes a liver biopsy will be necessary, and a tissue sample is taken through a needle inserted into the skin just below the rib cage. This procedure may be helped by a sonographer providing ultrasound guidance to an interventional radiologist.
This is predominantly due to the re-entering the cell cycle. That is, the hepatocytes go from the quiescent G0 phase to the G1 phase and undergo mitosis. This process is activated by the p75 receptors. There is also some evidence of bipotential , called hepatic oval cells or ovalocytes (not to be confused with oval red blood cells of ovalocytosis), which are thought to reside in the canals of Hering. These cells can differentiate into either or . Cholangiocytes are the epithelial cells of the . They are cuboidal epithelium in the small interlobular bile ducts, but become columnar and mucus secreting in larger bile ducts approaching the porta hepatis and the extrahepatic ducts. Research is being carried out on the use of stem cells for the generation of an artificial organ.
Scientific and medical works about liver regeneration often refer to the Greek Titan Prometheus who was chained to a rock in the Caucasus where, each day, his liver was devoured by an eagle, only to grow back each night. The myth suggests the Ancient Greece may have known about the liver's remarkable capacity for self-repair.An argument for the ancient Greek’s knowing about liver regeneration is provided by Counterarguments are provided by and by
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, and autoimmune hepatitis. Less commonly, liver transplantation is done for fulminant hepatic failure, in which liver failure occurs rapidly over a period of days or weeks.
Liver for transplant usually come from 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 (hepatectomy) and used to replace the entire liver of the recipient. This was first performed in 1989 for pediatric liver transplantation. Only 20 percent 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 percent 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 were at least two donor deaths out of the first several hundred cases. A 2006 publication addressed the problem of donor mortality and found at least fourteen cases. The risk of postoperative complications (and death) is far greater in right-sided operations than that in left-sided operations.
With the recent advances of noninvasive 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 multidetector 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 operations.
In Plato, and in later physiology, the liver was thought to be the seat of the darkest emotions (specifically wrath, jealousy and greed) which drive men to action. The Talmud (tractate Berakhot 61b) refers to the liver as the seat of anger, with the gallbladder counteracting this. The Persian language, Urdu, and Hindi languages (جگر or जिगर or ) refer to the liver in figurative speech to indicate courage and strong feelings, or "their best"; e.g., "This Mecca has thrown to you the pieces of its liver!". The Great Battle Of Badar (Yaum-E-Furqan) . Shawuniversitymosque.org (2006-07-08). Retrieved 2013-03-19. The term , literally "the strength (power) of my liver", is a term of endearment in Urdu. In Persian slang, is used as an adjective for any object which is desirable, especially women. In the Zulu language, the word for liver (isibindi) is the same as the word for courage. In English the term 'lily-livered' is used to indicate cowardice from the medieval belief that the liver was the seat of courage.
Spanish hígados also means "courage".
However the secondary meaning of Basque gibel is "indolence".
In biblical Hebrew, the word for liver, כבד (, stemmed or , similar to Arabic الكبد), also means heavy and is used to describe the rich ("heavy" with possessions) and honor (presumably for the same reason). In the Book of Lamentations (2:11) it is used to describe the physiological responses to sadness by "my liver spilled to earth" along with the flow of tears and the overturning in bitterness of the intestines.כלו בדמעות עיני חמרמרו מעי נשפך לארץ כבדי על שבר בת עמי בעטף עולל ויונק ברחבות קריה "My eyes terminated with tears, my intestines overturned with bitterness, my liver spilled to the earth on the breaking of my nation's daughter when a suckling baby lies in the town squares" (Lamentations 2:11) this could be interpreted to be read as my honor spilled, or myself being spilled). On several occasions in the book of Psalms (most notably 16:9), the word is used to describe happiness in the liver, along with the heart (which beats rapidly) and the flesh (which appears red under the skin). Further usage as the self (similar to "your honor") is widely available throughout the old testament, sometimes compared to the breathing soul (Genesis 49:6, Psalms 7:6, etc.). An honorable hat was also referred to with this word (Job 19:9, etc.) and under that definition appears many times along with פאר - grandeur. Kavod - Honor (in Hebrew, Israeli Linguist Ruvik Rosenthal's website). Rosenthal hypothesized that the term's usage to describe heaviness comes perhaps from the liver being the heaviest of all body parts in some farm animals or in humans. These four meanings were used in preceding ancient Afro-Asiatic languages such as Akkadian and Ancient Egyptian preserved in classical Ethiopic Ge'ez language.See
Kabadu in Akkadian, (From online dictionary at Association Assyrophile de France organization website)
Anatomical and medical terminology often use the prefix hepat- from ἡπατο-, from the Greek language word for liver, such as hepatology, and hepatitis
Liver can be baked, boiled, broiled, fried, stir-fried, or eaten raw ( asbeh nayeh or sawda naye in Lebanese cuisine, or liver sashimi in Japanese cuisine). In many preparations, pieces of liver are combined with pieces of meat or kidneys, as in the various forms of Middle Eastern mixed grill (e.g. meurav Yerushalmi). Well-known examples include liver pâté, foie gras, chopped liver, and leverpastej. Liver , such as Braunschweiger and liverwurst, are also a valued meal. may also be used as spreads. A traditional delicacy, skilpadjies, is made of minced lamb's liver wrapped in netvet (caul fat), and grilled over an open fire. Traditionally, some fish livers were valued as food, especially the Common stingray liver. It was used to prepare delicacies, such as poached skate liver on toast in England, as well as the beignets de foie de raie and foie de raie en croute in French cuisine.
Cunnison's remarkable account of an apparently psychoactive mammal found its way from a somewhat obscure scientific paper into more mainstream literature through a conversation between W. James of the Institute of Social and Cultural Anthropology at the University of Oxford and specialist on the use of and intoxicants in society, and Richard Rudgley, who discussed it in a book on psychoactive drugs for general readers. He speculated that a hallucinogenic compound N,N-Dimethyltryptamine in the giraffe liver might account for the intoxicating properties claimed for umm nyolokh.
Cunnison, on the other hand, writing in 1958 found it hard to believe in the literal truth of the Humr's assertion that the drink was intoxicating:
The study of in general – including entheogens of animal origin (e.g. hallucinogenic fish and toad venom) – has, however, made considerable progress in the sixty-odd years since Cunnison's report; the idea that some intoxicating substance might reside in giraffe livers may no longer be as far-fetched as it seemed to Cunnison. However, to date, proof (or disproof) still waits on detailed analyses of the organ and the beverage made from it.
In neonatal marsupials, it is responsible for the production of blood cells.
An organ sometimes referred to as a liver is found associated with the digestive tract of the primitive chordate amphioxus. Although it performs many functions of a liver, it is not considered a "true" liver but rather a homolog of the vertebrate liver.
Gross anatomy
Lobes
Surfaces
Impressions
Microscopic anatomy
Functional anatomy
Couinaud classification system
Gene and protein expression
Development
Fetal blood supply
Functions
Blood supply
Biliary flow
Metabolism
Carbohydrate metabolism
Protein metabolism
Lipid metabolism
Breakdown
Blood reservoir
Lymph production
Other
Clinical significance
Disease
Symptoms
Diagnosis
Liver regeneration
Liver transplantation
Society and culture
Food
Giraffe liver
Arrow/bullet poison
Other animals
See also
Works cited
External links
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