HEPATOBILIARY SYSTEM ANATOMY AND PHYSIOLOGY The liver is the second largest organ of the body, weighing 1200

to 1500 grams, or 4 -5% of body weight. It is located in the right upper abdominal quadrant, or the right hypochondriac and epigastric regions, behind the lower ribs. The falciform ligament divides the liver anatomically into two unequal lobes: right and left. Two additional smaller lobes, the quadrate and caudate lobes are more visible in cross section. Physiologically though, the division is equal, following the fossa for gall bladder and inferior vena cava. There is no evidence for difference in functions among the four anatomical lobes. The gall bladder is a saccular organ located posterior to the liver that functions to store bile. It has a mean capacity of 30-50 mL. Mucosal folds, called the spiral valves of Heister, maintain patency of the cystic duct to allow passage of bile. Presence of fats inthe duodenum stimulate the gall bladder to contract. The liver is histologically arranged into hexagonal lobules, which are primarily formed by hepatocytes, the livers specialized epithelial cells that make up 80% of the liver parenchyma. Each lobule is centered on a hepatic venule (central vein) and the hepatocytes are separated by sinusoids into hepatic cords. Portal triads are located on the edges of the hexagonal lobules, enclosed by connective tissues, and contain three important structures: a.Hepatic artery that bring 25% of the total blood into the liver b.Portal veins that carries the other 75% of portal blood from the lower digestive tract, and c.Bile ducts There are four types of cells that make up the liver. Hepatocytes make up the bulk of the liver parenchyma. Endothelial cells line the sinusoids and form fenestrations to control the entry of plasma solutes and keep out red blood cells. Kupffer cells are the livers macrophages that liewithin the sinusoidal vascular space. Lastly, stellate or Ito cells contain large fat droplets in their cytoplasm and form the storage of retinoids. They can transform into proliferative, fibrogenic,and contractile myofibroblasts upon proper stimulation.

Blood Supply To Liver The liver receives blood from two sources: oxygenated arterial blood from the hepatic artery,and portal blood draining from the lower GI via the portal vein. The two vessels drain intohepatic sinusoids and then flow towards the central vein. Small central veins come together toform three hepatic veins that return blood to the heart through the inferior vena cava. Blood Supply To Bile Ducts The right hepatic artery supplies the bile ducts by dividing into a rich capillary plexus that woulddrain into the sinusoids. Hepatocytes then act for the bidirectional exchange of compoundsbetween bile and blood. Biliary Flow Bile is synthesized and secreted by hepatocytes into the canaliculi. After which, bile flows into progressively larger ducts until bile reaches the duodenum via the greater duodenal papilla (of Vater):Terminal ductules (canals of Hering), surrounded by 3-6 ductal epithelial cells perilobular ducts interlobular bile ducts surrounding portal vein septal ducts lobar ducts 2 hepatic ducts common hepatic duct + cystic duct common bile duct +pancreatic duct ampulla of Vater