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Serous cells
o usually pyramidal in shape, with a broad base
o narrow apical surface with short, irregular microvilli
o rounded nuclei with basophilic cytoplasm
o usually form a spherical mass of cells called acinus or
alveolus with a small lumen at the center
Mucous cells
o cuboidal to columnar in shape
o nuclei are oval and pressed towards the base of the cells
due to presence of mucous in the cytoplasm
o often organized as tubules, consisting of cylindrical arrays
of secretory cells surrounding a lumen
Objectives:
Enumerate the major salivary glands and classify each based on the nature of its secretion.
State the important anatomic relationships, surfaces and peritoneal attachments of the liver.
Differentiate between classical and functional divisions of the liver.
Describe the circulation of blood within the liver.
Describe the intrahepatic biliary flow.
Enumerate the sites of portocaval anastomoses and explain the clinical significance of such.
Describe the innervation, blood supply, and lymphatic drainage of the liver.
Describe the location of the gallbladder and its anatomic relations.
Describe the innervation, blood supply and lymphatic drainage of the gallbladder.
Identify parts of the extrahepatic biliary system.
State the relations between the CBD and pancreatic duct as they open into the 2 nd portion of the duodenum.
Describe the pancreas and its location, as well as its parts and noting important anatomic relations.
I. SALIVARY GLANDS
A. FUNCTIONS
C.
Intercalated ducts
o Where secretory end pieces empty into
o Lined by simple cuboidal epithelial cells, with
presence of striations
o Empty into or join to form striated ducts
Page 1 of 11
Striated ducts
o Characterized by radial striations that extend to form
the bases of the cells to the level of the central nuclei
Radial striations plasma membrane infoldings
with elongated mitochondria that are aligned
parallel to the infolded membranes
o Cells are columnar in shape
o Striated ducts of each lobule converge and drain into
interlobular or excretory ducts located in the CT
septae separating the lobules; initially lined with
pseudostratified or stratified cuboidal epithelium,
distally lined with stratified columnar epithelium
o Myoepithelial cells present in basal lamina of
glands or ducts which function to propel secretions
upon contraction
Histology
o Morphology: Compound tubulo-alveolar gland or
branched tubulo-acinar gland
o Nature of secretion: purely serous
o White structures are fat cells
o Basophilic cytoplasm
o Rounded nucleus at base
o High in Alpha amylase and proline-rich proteins, which are
antimicrobial and have calcium-binding property
o Parotid glands may become acutely inflamed as a result of
retrograde bacterial infection from the mouth via the
parotid duct
o May also become infected via the bloodstream, as in
mumps
E.
Arterial supply
- External carotid artery (ECA) and its superficial
terminal branches (Superficial temporal and maxillary
aa.)
Venous drainage
- Retromandibular v.
Lymphatic drainage
- Parotid and Deep cervical nodes
Nerve supply
o Parasympathetic: Secretomotor supply from the
glossopharyngeal nerve (via the tympanic branch, the
Lesser Petrosal nerve, the Otic ganglion, and the
Auriculotemporal nerve)
o Sympathetic: Plexus around ECA
I.
Parotid Glands
Gross
o Largest of the salivary glands
o Wedge-shaped
o Situated below the external auditory meatus
o Lies in a deep hollow behind the ramus of the mandible, and
in front of the sternocleidomastoid muscle
o Secretes 25% of total saliva
o Stensens/Parotid duct emerges from the anterior border of
the gland, runs toward the lateral surface of the masseter
muscle, pierces the buccinator muscle, opens opposite the
nd
upper 2 molar tooth, into the parotid papilla of the oral
cavity
II.
Submandibular/Submaxillary glands
Gross
o Partly below the mandible
o Seen in the submandibular triangle
Histology
o Whartons Duct
o branched tubuloacinar gland, both mucous and serous,
predominantly serous with basophilic cytoplasm
o secretes lyzozyme
o goes along with the tongue and empties into the
sublingual caruncle
Page 2 of 11
Lymphatic drainage
- Submandibular and Deep cervical nodes
Nerve supply
o Parasympathetic: Secretomotor supply is from the facial
nerve via the chorda tympani & the submandibular
ganglion (Superior Salivary nucleus of CN VII) (increases
secretions)
o Sympathetic: Plexus around facial and lingual a. (Decreases
secretion)
III.
Lymphatic drainage
- Retromandibular and Deep cervical nodes
Nerve supply
o Parasympathetic: secretomotor supply is from the
facial nerve via the chorda tympani & the
submandibular ganglion (Superior Salivary nucleus of
CN VII)
o Sympathetic: Plexus around facial and lingual a.
Sublingual glands
Gross
o Smallest
o Seen on the floor of mouth, beneath mucus membrane,
close to the midline
o 8-20 sublingual ducts which empty into sublingual folds
but a few may open into the sublingual caruncle
o Secretes 5% of the total saliva
II. LIVER
-
Histology
o branched tubulo-acinar gland formed of serous and
mucous cells
o mucous cells more predominant
o serous cells are present almost exclusively on demilunes
of mucous tubules
o Histologically lung-like appearance
Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado
A. FUNCTIONS
Page 3 of 11
C.
Falciform Ligament
o attaches the liver to the anterior wall of the abdominal
cavity up to the level of the diaphragm
o its free edge forms the ligamentum teres
o passes on to the anterior and then the superior surfaces
of the liver then splits into 2 layers
right layer: forms the upper layer of the coronary
ligament; free margin forms the right triangular
ligament
left layer: forms the upper layer of the left
triangular ligament
Coronary ligament: has an upper and lower layer which
encloses an area of the liver devoid of peritoneum known as
the bare area; attaches the right lobe of the liver to the
diaphragm
Right triangular ligament: V-shaped fold of peritoneum
formed by the right extremity of the coronary ligament;
connects the posterior surface of the right lobe of the liver to
the diaphragm
Left triangular ligament: attaches the left lobe of the liver to
the diaphragm; communicate with appendix fibrosa at the left
tip of liver
Areas devoid of Peritoneum
o Bare area
o Area proximal to the inferior vena cava
o Gallbladder in contact with liver bed
o Portahepatis
Lobes
Classical
Right Lobe:
subdivided into
quadrate and caudate
Left lobe
Functional
Left Lobe: including
quadrate and
caudate lobes
Right lobe
Lobes of liver
o Right lobe
larger than the left lobe
blood supply of functional right lobe: right hepatic artery
venous and lymphatic drainage: right hepatic vein and
hepatic duct
o Left lobe
extends to left hypochondrium
th
reaches the upper border of the 6 rib
blood supply: left hepatic artery
venous and lymphatic drainage: left hepatic vein and
hepatic duct
o Quadrate lobe
lower portion of the classical right lobe
o Caudate lobe
upper portion of the classical right lobe
*refer to appendix for summarized table
Page 4 of 11
Retroperitoneal anastomosis
o veins of ascending colon, descending colon, duodenum,
pancreas and liver (portal) with renal, lumbar and phrenic
veins (systemic)
o retroperitoneal varicose portocaval anastomosis
G. LYMPHATIC DRAINAGE
E.
F.
PORTOCAVAL ANASTOMOSES
Esophageal
o Esophageal branches of left gastric (portal) with
rd
esophageal veins draining middle 3 of esophagus
(systemic)
o Esophageal varicosities: esophageal hemorrhage : most
dangerous complication of the portal HPN
Rectal
o Superior rectal veins (portal) with middle and inferior
rectal veins (systemic)
o Superior rectal veins (portal) with middle and inferior
rectal veins (systemic)
o Hemorrhoidal piles: swollen/inflamed vascular structures
in the anal canal
Para-umbilical
o Paraumbilical veins(portal) with superficial veins of
anterior abdominal wall (systemic)
o Caput Medusae: distended and engorged paraumbilical
veins radiating from the umbilicus
Group 17|Esguerra, Eslao, Esling, Espelimbergo, Esternon, Estevanez, Estrada, Estrellado
H. NERVE SUPPLY
The nerves of the liver are derived from the hepatic plexus
which accompanies the branch of the hepatic artery and
hepatic portal vein.
o hepatic plexus
Sympathetic fibers from celiac plexus
Parasympathetic fibers from the anterior vagal trunk
I.
BILIARY TRACT
Bile
o produced by hepatocytes
o golden yellow or greenish yellow
o alkaline water containing sodium bicarbonate, bile salts,
bile pigments, cholesterol, lecithin and mucin
o aids in the breaking down of fats
o stored and concentrated (thru absorption of water and
salts) in the gallbladder when digestion is not take place
o first collected by the bile cannaliculi or bile capillaries
between hepatocytes
nd
Common bile duct drains into 2 part of the duodenum at the
ampulla of vater.
J. LIVER HISTOLOGY
i.
STRUCTURAL ORGANIZATION
STROMA
o Glissons Capsule: thin connective tissue
o Thicker at hilum
o Vessels and ducts covered with connective tissue all the
way to termination/origin
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PARENCHYMA
o
Organized plated of hepatocytes:
80% liver cell population
1-2 spherical nuclei with nucleoli
Acidophilic cytoplasm with basophilic bodies
Numerous microvilli
Organelles:
- Rough ER - sites for synthesis of plasma proteins
(albumin, fibrinogen, prothrombin and lipoprotein)
- Smooth ER important in CHO metabolism, bile
formation, catabolism of drugs and other toxic
substances; also site of VLDL synthesis
- Golgi complexes important in concentrating and
packaging secretory products
- Mitochondria energy production
- Lysosomes for turnover and degradation of
organelles
- Peroxisomes oxidative metabolism of lipids, purines
& alcohol; participate in cholesterol and bile acid
synthesis
Bile canaliculus
- tubular space between two abutted hepatocytes,
which forms a complex of anastomosing network
- Empties from the canals of Hering to preductules of
cholangioles into bile ductules which then end in the
into bile ducts in the portal spaces
- Bile ducts gradually enlarge and fuse to form the right
and left hepatic ducts, which subsequently leave the
liver as the common hepatic duct
- Bile flow opposite of blood flow: center to periphery
SINUSOIDAL CAPILLARIES
o Sinusoids
o Vascular channels between plates of hepatocytes that are
lined by fenestrated endothelium
o Contain Kupffer cells: macrophages that belong to the
mononuclear phagocyte system that metabolize aged
RBCs, digest hemoglobin, secrete proteins related to
immunological processes and destroy bacteria (later sent
to space of Disse)
ii.
BLOOD SUPPLY
Portal Vein
o supply 80% of blood flow
o nutrient-rich but oxygen-poor
o from abdominal viscera
o branches into portal venules to the portal spaces
o Portal Venules
o branch distributing venules that run around the
periphery of each lobule and lead into the sinusoids as
inlet venules
o sinusoids: run radially, converging in the center to form
central or centrolobular venule
o central venules converge into sublobular veins to form
large hepatic veins, which drains -> inferior vena cava
HEPATIC LOBULE
Functional units of the liver
Composed of hepatocytes arranged into polyhedral structures
Each lobule has three to six portal areas at its periphery and a
venule in the center (central vein)
The portal zones at the corners consist of connective tissue in
which the PORTAL TRIAD are embedded; portal triad consists
of venule (from portal vein), arteriole (from the hepatic
artery), and a branch of the bile duct (duct of cuboidal
epithelium)
A. PARTS
FUNDUS: wide, blunt end that projects from the inferior lobe of
th
the liver at the right 9 costal cartilage
BODY: main portion that contacts the liver, transverse colon, and
superior part of the duodenum
NECK: narrow, tapering end, opposite the fundus; directs to the
portahepatis and joins the cystic duct
INFUNDIBULUM/HARTMANNS POUCH: funnel shaped cavity
located close to the neck
B. CYSTIC DUCT
Figure 11. Liver acinus
Liver Regeneration
Has extraordinary capacity for regeneration
Controlled by chalones
o Self-regulating
o Compensatory hyperplasia a process in which the
remaining healthy hepatocytes begin to divide continuing
until the original mass of tissue is restored
Liver cirrhosis
o Continuous or repeated damage to hepatocytes over a
long period of time by various agents such as ethanol,
drugs or other chemicals, hepatitis virus (B,C, or D),
parasites and autoimmune liver disease
o Formation of disorganized hepatocytes
o Causes liver failure, and is usually fatal
III. GALLBLADDER
-
Lies in the fossa for the gallbladder at the visceral surface of the
liver, located at the junction of the left and right lobe
Pear-shaped sac
Can hold 30-50mL of bile
Stores and concentrates bile
C.
CYSTIC ARTERY
o Supplies the gallbladder and the cystic duct
o Arises from the Right Hepatic Artery in the
Cystohepatic Triangle of Calot (the triangle between
the common hepatic duct, cystic duct and visceral
surface of the liver/free edge)
CYSTIC VEINS
o Drains the neck of the gallbladder and cystic duct
Page 7 of 11
D. NERVE SUPPLY
E.
GALLBLADDER HISTOLOGY
MUCOSA:
o Simple columnar epithelium with microvilli
o Tubuloacinar glands (mucous glands are present only in the
neck)
o Absence muscularis mucosa
o Lining epithelia with prominent mitochondria, microvilli and
intercellular spaces; indicative of absorptive cells (bile
concentration achieved through water absorption)
Absence of muscularis mucosa
Muscular Layer
o Discontinuous
o Inner layer: longitudinally oriented; outer layer:
diagonally oriented
Presence of Serosal layer
Rokitansky-Aschoff Sinuses: pseudodiverticula
True Ducts of Luschka: aberrant vestigial bile ducts
F.
Supraduodenal
Retroduodenal
Infraduodenal
Intraduodenal
IV. PANCREAS
-
A. RELATIONS
Anteriorly (from (R) to (L)):
- Transverse colon
- Attachment of the transverse mesocolon
- Lesser sac
- Stomach
- Spleen
Posteriorly (from (R) to (L)):
- Bile duct
- Portal vein
- Splenic vein
- Inferior Vena Cava
- Aorta
- Origin of Superior Mesenteric Artery
- Left Psoas muscle
- Left suprarenal gland
B. PARTS
Page 8 of 11
C.
HEAD
o Disc shaped and lies within the concavity of the duodenum
o A part of the head extend to the left behind the superior
mesenteric vessels and is called the uncinate process (or
lingula of the pancreas)
o It rests posteriorly on the IVC, right renal artery and vein,
and left renal vein.
o The bile duct lies in a groove on the postero-superior
surface of the head or is embedded in its substance
NECK
o Constricted portion of the pancreas and connects the head
of the body
o Lies in front of the beginning of the portal vein and the
origin of the superior mesenteric artery from the aorta
BODY
o Runs upward to the left across the midline
o Lies to the left of the superior mesenteric vessels, passing
over the aorta and L2 vertebra.
o Sometimes triangular in cross section
o Lies in the epigastric area
o Comes in contact with hilum of spleen
TAIL
o Anterior to the left kidney and passes forward in the
splenicorenal ligament
o Comes in contact with the hilum of the spleen
D. ARTERIAL SUPPLY
PANCREATIC DUCTS
Sphincter of Oddi
o Circular muscles fibers which surround the Ampulla of
Vater and the terminal segments of the main pancreatic
duct and common bile duct
o Functions to contract the Ampulla of Vater to prevent the
throw of bile during the basal state
o Prevents reflux
o Presence of food relaxes the sphincter, allowing bile to
flow into the duodenum
o Without food, the sphincter is contracted
E. VENOUS DRAINAGE
Page 9 of 11
F.
LYMPHATIC DRAINAGE
Pancreaticosplenic nodes
o Major lymph drainage
o Lie along the splenic artery
o Most vessels drain into these and some to the Pyloric lymph
nodes toward the celiac nodes or superiormesenteric nodes
o Lymph nodes are situated along the arteries that supply the
gland
o Very extensive thats why carcinoma spreads easily
(intermingle with other lymph nodes)
CLINICAL CORRELATION
Cancer of the head of pancreas often obstructs the bile duct
and/or hepatopancreatic ampulla resulting in the retention of bile
pigments, enlargement of the gallbladder, and obstructive
jaundice. It may also cause obstruction of hepatic portal and
inferior vena cava because it overlies these veins. Surgical
resection of the pancreas is futile because of its extensive
drainage in relation to its inaccessible lymph nodes and
metastasis to the liver occurs early, via hepatic portal vein. Life
expectancy for individuals afflicted with it usually is 2-3 months.
G. NERVE SUPPLY
Motor:
Majority
Decreases stimulation
Parasympathetic: Vagus n.
Stimulation
H. EXOCRINE FUNCTION
Composed of:
1. Pancreatic acini composed of several serous cells
2.Intercalated ducts merge to form larger interlobar ducts
lined with columnar epithelium
Secretes pancreatic juice rich in bicarbonate ions (HCO3-) and
digestive enzymes (Proteases, Lipases, Nucleases and amylases)
Most proteases are stored as zymogen (inactive form) granules
of acinar cells
Centroacinar cells- constitute the intraacinar portion of the
intercalated duct and are only found in the pancreatic acini
I.
ENDOCRINE FUNCTION
Composed of:
Islets of Langerhans compact spherical masses of
endocrine tissue embedded within the acinar exocrine tissue.
o numerous in the tail region of pancreas
o arranged in cords separated by a network of
fenestrated capillaries
Table 3. Types of Cells found in the Islets
Hormone
Hormone
Cell Type
Quantity
Produced
Function
~20%
Glucagon
Increases
Alpha Cells
blood glucose
content
~70%
Insulin
Decrease
Beta Cells
blood glucose
content
~5-10%
Somatostatin
Inhibits
release of
Delta Cells
other islet cell
hormones
Pancreatic
Rare
Pancreatic
Stimulates
Polypeptide
Polypeptide
activity of
Cells
gastric chief
cells
(F Cells)
Gallbladder
& Liver
Nerves derived
from celiac
plexus
(sympathetic),
vagus nerve
(parasympatheti
c), and right
phrenic nerve
(sensory)
T6-T9
Epigastric
region and
right
hypochondriac
region; may
cause pain on
posterior
thoracic wall or
right shoulder
owing to
diaphragmatic
irritation
Page 10 of 11
APPENDIX:
Anatomical term
Functional/surgical
term
Right lobe
Right (part of )the liver [Right portal lobe]
Left lobe
Left (part of )the liver [left portal
lobe]
Caudate lobe
Posterior part of
the liver
Right medial
division
Left medial
devisor
Left lateral
division
Posterior lateral
segment
SEGMENT VII
[posterior superior
area]
Right anterior lateral
segment
SEGMENT VI
[posterior inferior
area]
Posterior lateral
segment VIII
[anterior superior
area]
[Medial superior
area]
Left medial
segment
Anterior medial
segment V
[anterior inferior
area]
SEGMENT IV
[medial inferior
area= =quadrate
lobe]
Lateral
segment
SEGMENT II
[lateral
superior area]
Left lateral
anterior
segment
SEGMENT III
[lateral inferior
area]
Right
Left
caudate caudate
lobe
lobe
Posterior segment
I
Page 11 of 11