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Chapter 28

After studying this chapter, you should be able to:

• Describe the major functions of the liver with respect to metabolism, detoxification, and excretion of hydrophobic substances.
• Understand the functional anatomy of the liver and the relative arrangements of hepatocytes, cholangiocytes, endothelial cells, and Kupffer cells.
• Define the characteristics of the hepatic circulation and its role in subserving the liver's functions.
• Identify the plasma proteins that are synthesized by the liver.
• Describe the formation of bile, its constituents, and its role in the excretion of cholesterol and bilirubin.
• Outline the mechanisms by which the liver contributes to whole body ammonia homeostasis and the consequences of the failure of these mechanisms, particularly for brain function.
• Identify the mechanisms that permit normal functioning of the gallbladder and the basis of gallstone disease.

The liver is the largest gland in the body. It is essential for life because it conducts a vast array of biochemical and metabolic functions, including ridding the body of substances that would otherwise be injurious if allowed to accumulate, and excreting drug metabolites. It is also the first port of call for most nutrients absorbed across the gut wall, supplies most of the plasma proteins, and synthesizes the bile that optimizes the absorption of fats as well as serving as an excretory fluid. The liver and associated biliary system have therefore evolved an array of structural and physiologic features that underpin this broad range of critical functions.

### Functional Anatomy

An important function of the liver is to serve as a filter between the blood coming from the gastrointestinal tract and the blood in the rest of the body. Blood from the intestines and other viscera reach the liver via the portal vein. This blood percolates in sinusoids between plates of hepatic cells and eventually drains into the hepatic veins, which enter the inferior vena cava. During its passage through the hepatic plates, it is extensively modified chemically. Bile is formed on the other side at each plate. The bile passes to the intestine via the hepatic duct (Figure 28–1).

###### Figure 28–1

Schematic anatomy of the liver. Top: Organization of the liver. CV, central vein. PS, portal space containing branches of bile duct (green), portal vein (blue), and hepatic artery (red). Bottom: Arrangement of plates of liver cells, sinusoids, and bile ducts in a liver lobule, showing centripetal flow of blood in sinusoids to central vein and centrifugal flow of bile in bile canaliculi to bile ducts. (Redrawn and modified from Ham AW: Textbook of Histology, 5th ed. Philadelphia: JB Lippincott Co., 1965.)

In each hepatic lobule, the plates of hepatic cells are usually only one cell thick. Large gaps occur between the endothelial cells, and plasma is in intimate contact with the cells (Figure 28–2). Hepatic artery blood also enters the ...

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