Liver

Gross anatomy

General structure

Location

  • Location: under the diaphragm in the right upper abdomen.

Ligaments

Vasculature

Arteries
Veins
Lymphatics

As part of the liver's dual blood supply, the portal vein allows tissue to remain oxygenated and preserve function in the event of an obstructed hepatic artery.

Innervation

Distention of the capsule results in well-localized, sharp pain, as seen in ascites, inflammation, or hepatic cancer.

References:[1][2][3][4]

Microscopic anatomy


References:[1][5][3]

Function

Energy metabolism
Synthesis
Regulation
Storage
Detoxification and clearance/excretion
Fetal

Also see “parameters of hepatocellular damage”, “parameters of cholestasis”, and “parameters of hepatic synthesis” in liver function tests.

Breakdown of ethanol

Example of zero-order elimination: A constant amount of alcohol is metabolized per unit time (∼ 1 ounce of alcohol per hour).

  1. Oxidation of ethanol to acetaldehyde by alcohol dehydrogenase: competitive inhibition of alcohol dehydrogenase by fomepizole; treatment of methanol or ethylene glycol poisoning to prevent the formation of toxic metabolites [6]
  2. Oxidation of acetaldehyde to acetate by acetaldehyde dehydrogenase
  3. Ligation of acetate and coenzyme A to acetyl-CoA by thiokinase under ATP consumption

When large quantities of alcohol are consumed, acetaldehyde builds up faster than it can be metabolized by alcohol dehydrogenase. Excess acetaldehyde plays a major role in hangover symptoms.

FOMEpizole: For Overdosing on Methanol or Ethylene glycol!

It is DISgusting to drink alcohol when taking DISulfiram!

Consequences of excessive ethanol consumption

When ethanol is metabolized, there is an increase in the NADH/NAD+ ratio in the liver. Excessive ethanol consumption and consequently excess NADH result in:

References:[8][6][7]

Embryology

References:[9]

Clinical significance

References:[10][11]

  • 1. Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. Elsevier Health Sciences; 2016.
  • 2. Kumar V, Abbas AK, Aster JC. Robbins & Cotran Pathologic Basis of Disease. Philadelphia, PA: Elsevier Saunders; 2014.
  • 3. Chung KW, Chung HM. Gross Anatomy. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.
  • 4. Drake R, Vogl AW, Mitchell AWM. Gray's Anatomy for Students International Edition. Elsevier Health Sciences; 2009.
  • 5. Le T, Bhushan V,‎ Sochat M, Chavda Y, Zureick A. First Aid for the USMLE Step 1 2018. New York, NY: McGraw-Hill Medical; 2017.
  • 6. McMartin K, Jacobsen D, Hovda KE. Antidotes for poisoning by alcohols that form toxic metabolites. Br J Clin Pharmacol. 2016; 81(3): pp. 505–515. doi: 10.1111/bcp.12824.
  • 7. Goh ET, Morgan MY. Review article: pharmacotherapy for alcohol dependence - the why, the what and the wherefore. Aliment Pharmacol Ther. 2017; 45(7): pp. 865–882. doi: 10.1111/apt.13965.
  • 8. Hall JE. Guyton and Hall Textbook of Medical Physiology. Philadelphia, PA: Elsevier; 2016.
  • 9. Sadler TW. Langman's Medical Embryology. Philadelphia, PA: Wolters Kluwer Health; 2014.
  • 10. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. New York, NY: McGraw-Hill Education; 2015.
  • 11. Goljan EF. Rapid Review Pathology. Philadelphia, PA: Elsevier Saunders; 2018.
last updated 11/28/2019
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