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Liver of a sheep: (1) right lobe, (2) left lobe, (3) caudate lobe, (4) quadrate lobe, (5) hepatic artery and portal vein, (6) hepatic lymph nodes, (7) gall bladder.
Latin Liverus Livernian
Gray's subject #250 1188
Artery hepatic artery
Vein hepatic vein, portal vein
Nerve celiac ganglia, vagus<ref>Physiology at MCG 6/6ch2/s6ch2_30</ref>
Precursor foregut
MeSH Liver

The liver is an organ in living beings, including humans. It plays a major role in metabolism and has a number of functions in the body including glycogen storage, plasma protein synthesis, and drug detoxification. This organ also is the largest gland in the human body. It produces bile, which is important in digestion. It performs and regulates a wide variety of high-volume biochemical reactions requiring specialized tissues. Medical terms related to the liver often start in hepato- or hepatic from the Greek word for liver, hepar.


[edit] Anatomy

Image:Liver inferior.jpg
View from below

The adult human liver normally weighs between 1.3 - 3.0 kilograms, and is a soft, pinkish-brown "boomerang shaped" organ. It is the second largest organ (the largest organ being the skin) and the largest gland within the human body. Its anatomical position in the body is immediately under the diaphragm on the right side of the upper abdomen. The liver lies on the right of the stomach and makes a kind of bed for the gallbladder (which stores bile).

The liver is supplied by two main blood vessels on its right lobe: the hepatic artery and the portal vein. The hepatic artery normally comes off the celiac trunk. The portal vein brings venous blood from the spleen, pancreas, and small intestines, so that the liver can process the nutrients and byproducts of food digestion. The hepatic veins drain directly into the inferior vena cava.

The bile produced in the liver is collected in bile canaliculi, which merge to form bile ducts. These eventually drain into the right and left hepatic ducts, which in turn merge to form the common hepatic duct. The cystic duct (from the gallbladder) joins with the common hepatic duct to form the common bile duct. Bile can either drain directly into the duodenum via the common bile duct or be temporarily stored in the gallbladder via the cystic duct. The common bile duct and the pancreatic duct enter the duodenum together at the ampulla of Vater. The branchings of the bile ducts resemble those of a tree, and indeed the term "biliary tree" is commonly used in this setting.

The liver is among the few internal human organs capable of natural regeneration of lost tissue; as little as 25% of remaining liver can regenerate into a whole liver again. This is predominantly due to the hepatocytes acting as unipotential stem cells (i.e. a single hepatocyte can divide into two hepatocyte daughter cells). There is also some evidence of bipotential stem cells, called oval cells, which can differentiate into either hepatocytes or cholangiocytes (cells that line the bile ducts).

[edit] Surface anatomy

Image:Liver superior.jpg
The liver is the largest internal organ of the human body.

Apart from a patch where it connects to the diaphragm, the liver is covered entirely by visceral peritoneum, a thin, double-layered membrane that reduces friction against other organs. The peritoneum folds back on itself to form the falciform ligament and the right and left triangular ligaments. These "ligaments" are in no way related to the true anatomic ligaments in joints, and have essentially no functional importance, but they are easily recognizable surface landmarks. Traditional gross anatomy divided the liver into four lobes based on surface features.

The falciform ligament is visible on the front (anterior side) of the liver. This divides the liver into a left anatomical lobe, and a right anatomical lobe.

If the liver is flipped over, to look at it from behind (the visceral surface), there are two additional lobes between the right and left. These are the caudate lobe (the more superior), and below this the quadrate lobe.

From behind, the lobes are divided up by the ligamentum venosum and ligamentum teres (anything left of these is the left lobe), the transverse fissure (or porta hepatis) divides the caudate from the quadrate lobe, and the right sagittal fossa, which the inferior vena cava runs over, separates these two lobes from the right lobe.

[edit] Functional anatomy

For purposes such as advanced liver surgery, it is crucial to understand the fundamental importance of the liver on the blood supply and biliary drainage system. The central area where the common bile duct, portal vein, and hepatic artery enter the liver is the hilum or "porta hepatis". The duct, vein, and artery divide into left and right branches, and the portions of the liver supplied by these branches constitute the functional left and right lobes. The functional lobes are separated by a plane joining the gallbladder fossa to the inferior vena cava. In the widely used Couinaud or "French" system, the functional lobes are further divided into a total of eight segments based on secondary and tertiary branching of the blood supply. The segments corresponding to the surface anatomical lobes are as follows:

Lobe Couinaud segments
Caudate 1
Left 2, 3
Quadrate 4
Right 5, 6, 7, 8

[edit] Physiology

The various functions of the liver are carried out by the liver cells or hepatocytes.

Currently, there is no artificial organ or device capable of emulating all the functions of the liver. Some functions can be emulated by liver dialysis, an experimental treatment for liver failure.

[edit] Diseases of the liver

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.

There are also many pediatric liver disease, including biliary atresia, alpha-1 antitrypsin deficiency, alagille syndrome, and progressive familial intrahepatic cholestasis, to name but a few.

A number of liver function tests are available to test the proper function of the liver. These test for the presence of enzymes in blood that are normally most abundant in liver tissue, metabolites or products.

[edit] Liver transplantation

Human liver transplant was first performed by Thomas Starzl in USA and Roy Calne in England in 1963 and 1965 respectively. 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, autoimmune hepatitis, and many others. Less commonly, liver transplantation is done for fulminant hepatic failure, in which liver failure occurs over days to weeks. Liver allografts for transplant usually come from non-living 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 and used to replace the entire liver of the recipient. This was first performed in 1989 for pediatric liver transplantation. Only 20% 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% 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 have been at least 2 donor deaths out of the first several hundred cases. A recent publication has addressed the problem of donor mortality, and at least 14 cases have been found. ([1]) The risk of postoperative complications (and death) is far greater in right sided hepatectomy than left sided operations

[edit] Development

The liver develops as an endodermal outpocketing of the foregut called the hepatic diverticulum. Its initial blood supply is primarily from the vitelline veins that drain blood from the yolk sac. The superior part of the hepatic diverticulum gives rise to the hepatocytes and bile ducts, while the inferior part becomes the gallbladder and its associated cystic duct.

[edit] Fetal blood supply

In the growing fetus, a major source of blood to the liver is the umbilical vein which supplies nutrients to the growing fetus. The umbilical vein enters the abdomen at the umbilicus, and passes upward along the free margin of the falciform ligament of the liver to the inferior surface of the liver. There it joins with the left branch of the portal vein. The ductus venosus carries blood from the left portal vein to the left hepatic vein and thence to the inferior vena cava, allowing placental blood to bypass the liver.

In the fetus, the liver is developing throughout normal gestation, and does not perform the normal filtration of the infant liver. The liver does not perform digestive processes because the fetus does not consume meals directly, but receives nourishment from the mother via the placenta. The fetal liver releases some blood stem cells that migrate to the fetal thymus, so initially the lymphocytes, called T-cells, are created from fetal liver stem cells. Once the fetus is delivered, the formation of blood stem cells in infants shifts to the red bone marrow.

After birth, the umbilical vein and ductus venosus are completely obliterated two to five days postpartum; the former becomes the ligamentum teres and the latter becomes the ligamentum venosum. In the disease state of cirrhosis and portal hypertension, the umbilical vein can open up again.

[edit] Liver as food

Pork liver
Nutritional value per 100 g
Energy 130 kcal   560 kJ
<tr><td>Vitamin A  6500 μg</td><td>722%</td></tr><tr><td>Riboflavin (Vit. B2)  3 mg  </td><td>200%</td></tr><tr><td>Niacin (Vit. B3)  15 mg  </td><td>100%</td></tr><tr><td>Vitamin B6  0.7 mg</td><td>54%</td></tr><tr><td>Folate (Vit. B9)  212 μg </td><td>53%</td></tr><tr><td>Vitamin B12  26 μg  </td><td>1083%</td></tr><tr><td>Iron  23 mg</td><td>184%</td></tr><tr><td>Sodium  87 mg</td><td>6%</td></tr>
Carbohydrates     2.5 g
Fat3.7 g
Protein 21 g
Beef and chicken liver are comparable.
Percentages are relative to US
recommendations for adults.
Source: USDA Nutrient database</td></tr></table>

Mammal and bird livers are commonly eaten as food: products include liver paté, Liverwurst, Braunschweiger, foie gras, chopped liver, leverpostej and liver sashimi.

Both animal and fish livers are rich in iron and Vitamin A and cod liver oil is commonly used as a supplement. Very high doses of Vitamin A can be toxic; Antarctic explorers Douglas Mawson and Xavier Mertz were both poisoned, the latter fatally, from eating husky liver. In the US, the USDA specifies 3000 μg per day as a tolerable upper limit, which amounts to about 50 g of raw pork liver or 3 g of polar-bear liver.<ref>A. Aggrawal, Death by Vitamin A</ref>, However, acute vitamin A poisoning is not likely to result from liver consumption, since it is present in a less toxic form than in many dietary supplements.<ref>Myhre et al., "Water-miscible, emulsified, and solid forms of retinol supplements are more toxic than oil-based preparations", Am. J. Clinical Nutrition, 78, 1152 (2003)</ref>

[edit] Cultural allusions

In Greek mythology, Prometheus was punished by the gods for revealing fire to humans by being chained to a rock where a vulture (or an eagle, Ethon) would peck out his liver, which would regenerate overnight. Curiously, the liver is the only human internal organ that actually can regenerate itself to a significant extent, a characteristic which may have already been known to the Greeks, possibly due to survived injuries in battle.

The Talmud (tractate Berakhot 61b) refers to the liver as the seat of anger, with the gallbladder counteracting this.

In Arabic and Persian language, the liver is used in figurative speech to refer to courage and strong feelings, or "their best," e.g. "This Mecca has thrown to you the pieces of its liver!" <ref></ref>

The legend of Liver-Eating Johnson says that he would cut out and eat the liver of each man killed.

In the motion picture The Message, Hind bint Utbah is implyed or portrayed eating the liver of Hamza ibn Abd-al-Muttalib during the Battle of Uhud.

It is well known that Inuit will not eat the liver of polar bears or seals <ref></ref>

[edit] Further reading

The following are standard medical textbooks:
  • Eugene R. Schiff, Michael F. Sorrell, Willis C. Maddrey, eds. Schiff's diseases of the liver, 9th ed. Philadelphia : Lippincott, Williams & Wilkins, 2003. ISBN 0-7817-3007-4
  • Sheila Sherlock, James Dooley. Diseases of the liver and biliary system, 11th ed. Oxford, UK ; Malden, MA : Blackwell Science. 2002. ISBN 0-632-05582-0
  • David Zakim, Thomas D. Boyer. eds. Hepatology: a textbook of liver disease, 4th ed. Philadelphia: Saunders. 2003. ISBN 0-7216-9051-3
These are for the lay reader or patient:

[edit] See also

Look up liver in Wiktionary, the free dictionary.

[edit] References


[edit] Additional images

[edit] External links

Wikimedia Commons has media related to:
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Pancreas (Tail, Body, Head, Islets of Langerhans) | Gallbladder | Liver

Bile ducts: (Bile canaliculus, Common hepatic duct, Cystic duct, Common bile duct) | Pancreatic duct | Hepatopancreatic ampulla


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