welcome back welcome back welcome back to science all right so today we're going to be talking about the liver and the gallbladder the liver is the largest internal organ it is giant it is heavy and its colors reddish brown it is so vasculated um and if you're looking for a location it's going to be on your right side and it's going to be middle right and it's going to be in that right upper quadrant quite large so the liver has four lobes the right left the quadrate and caudate lobes so the largest is going to be the right lobe and you can see the right lobe that's going to be here here's the left lobe and if you go to the back you can see the quadrate lobe that's going to be here as well as the caudate which is going to be here cut it usually refers to the word tail and so we've seen that a few other times throughout Anatomy things like the Kata aquana of the nervous system at the end of the spinal cord all right so the lobes consist of small subparts called lobules and those lobules or lobules are going to have a lot of hepatocytes that are going to be there so they contain hepatocytes which are these liver cells that are going to be around a central vein and so we're going to look at the anatomy of it of this major vessel we have the bile duct we're going to have the hepatic vein and also the paddock portal artery as they're going to be involved in here so we're going to have the hepatic sinusoids that are going to form channels within the blood between the plates and the cells The Paddock artery of course arterials moving away from the heart so it's carrying this oxygen-rich Blood that's going to mix with the oxygen poor blood in this portal system so remember the hepatic portal system this is what it's looking at here so blood's going to form the sinusoids to the central veins and then to the hepatic veins bile is going to do its job and it's going to flow from the ductules of the paddock ducts to the hepatic common bile duct so here we can take a look at the gallbladder you can see its color very unique in the sense of in the body there's not a lot of green things but gallbladder is definitely green it's going to be filled with bile and you're going to see as it moves down you're going to see the cystic duct and it's going to empty into we have the right and left hepatic ducts and then we're going to move down to the bile duct that we're seeing here and we'll see continuation if you look at the anterior aspect of the liver you can see it dipping down but if you look at the posterior aspect this is inverted so this is flipped this like this to look at it you can see that it's quite large on the back by comparison to view on the front if you take a look at the cross section you can see what's going on with the sinusoids the duck duel the Ducks and that hepatic Triad all right so liver functions what does it do and a bigger question is what does it not do um it is such a vital part of your survival so let's go through some of the things that it does it's going to produce glycogen from glucose so let's say that you have a bunch of sugar in your diet your body specifically your liver is going to convert this to glycogen and this is going to be kind of putting that sugar on the shelf for us to use later if needed it can also break down glycogen to make glucose remember in those low glucose areas where hypoglycemic or body TAPS in the glycogen and our liver and muscle cells this is where we have that so it's going to both produce the glycogen from excessive amounts of glucose as well as break down glycogen to get glucose as needed it's going to oxidize fatty acids it's going to convert non-carbohydrates to glucose which is kind of magical that it can take something that's not a carbohydrate and make a carbohydrate from it it's going to synthetize synthesize other things like lipoproteins phospholipids cholesterol so you can imagine the cellular activity of things like the smooth endoplasmic reticulum heavily involved here so you have a bunch of smooth endoplasmic reticulum per um typical cell that's going to be in here and your liver these hepatocytes all right it can convert the excess carbohydrates and proteins into fats and we don't necessarily love this evolutionarily this is really handy for survival if we can have a backup energy Supply that's just hanging on us in these Saddles all right it can deaminate amino acids this is going to be breaking it down it's going to form urea synthesize plasma proteins it's going to convert amino acids into other amino acids so you have our essential amino acids this is going to take the essential amino acids and be able to convert into some of the non-acino essential amino acids essential means that we have to eat it to get it the non-essential amino acids are going to be derived from an existing amino acid and your liver is able to do that all right it's also going to store glycogen as we identify it but also it's going to store iron so it's going to have part of its coloration because of red blood cells as well as the amount of iron that's there we know that in a feverish type event our body is going to sequester iron it's going to pull it up in one of those storage areas it's going to be the liver it's also going to be a storage for vitamin A D and b12 so even though the taste of let's say beef litter liver chicken liver isn't necessarily appealing to a lot of people there's a lot of nutrients there and so it's a pretty good food for you if you're looking for something if you're low in different kinds of vitamins or iron it would be recommended to eat liver so try to find a way that's palatable and if you like liver good for you maybe eat it more often all right so this configure size red blood cells and foreign substances they're going to be these macrophages that are going to be embedded in the endothelium and it's going to be able to do its job and these are permanized phagocytes that are going to consume things it's also going to remove toxins and as it removes toxins such as alcohol and certain drugs and a drug that we can mention here that is common so alcohol we would probably are familiar with over consumption alcohol alcoholism a lot of times you see correlations with people that have cirrhosis of the liver and this is where the liver itself breaks down and is replaced instead of with liver tissue it's going to be replaced with fatty tissue fatty tissue doesn't have the same actions of being able to do all the things that have been listed and so people that have cirrhosis oftentimes as the cirrhosis worsens and they can't cleanse their blood they either have to have some kind of a cyst system or ultimately uh cirrhosis can be fatal and oftentimes is so a drug that should be taken in moderation is Tylenol so any medication should be taking the moderation just to put that out there but if a person chronically takes Tylenol let's say that to go to to go to sleep you take Tylenol PM every night that is not a healthy choice and maybe you're a person that takes Tylenol to deal with just an a persistent pain that you're dealing with continued use of Tylenol and I'm not saying you're taking a little bit of Tylenol that that's okay that's just fine but I'm talking about people that are taking Tylenol every day they're at risk of developing cirrhosis as a result of that toxin that's entering into their liver all right so the liver itself can act as a blood Reservoir and we know that it's going to have a role in secreting bile so this is an overview of what we just talked about all right we're replacing a river a liver let's say the better so the liver is going to regenerate if you have 25 to 30 percent of your liver you can replace the liver that is damaged however if somebody has a cancer of the liver they only have weeks to months to live it is something you can't live without so a donor if you're not an organ donor please consider being an organ donor with organ donations people oftentimes are well let's put it this way there's only about 6 000 liver transplants per year and there are 16 000 liver transplants needed a year so ten thousand people die a year waiting on a liver and I don't know about you but if there's that chance that my liver could be given to somebody and they now have another chance at life and if you're thinking like I don't want to do that because that person dranked himself into that condition here's the thing that you probably didn't know and that is if you have cirrhosis of the liver due to Chronic alcoholism you're not eligible for a liver transplant in other words if you do this to yourself um you're not eligible to receive it and don't be mad at me this is not my decision um but this is my thought is the reason it's like this is that at some point they found that people that got a new liver didn't stop drinking and then they ruined a second liver and when there are other people that are waiting on that list um you get the idea that let's just give it to people that just have something that's going on that need our liver transplant so they're the extra Corporal liver assist device elab can temporary perform blood cleansing functions of the liver until the donor liver becomes available so the e-lad is going to be bioartificial there's an artificial component and a biological component so the artificial it's going to have a portion of cartridges that are going to be added to it that are going to allow for certain secretions but also the biological part of it's going to have human liver cells that are going to be in it that's going to be involved as well So the patient's blood plasma is passed through the Elan where toxins are removed and liver secretions are added and the plasma is then returned back to the patient so you think of some other types of devices that are going to be biofiltration devices this is in that realm of things categorically it's there all right let's talk about um the gallbladder in bile all right so bile is yellowish green in color and it's going to be secreted by the gallbladder so the components what is in bile you're gonna have water bile salts bile pigments cholesterol and electrolytes so bile salts are going to help with the emulsa emulsification of fat so fat breakdown and even forming them into Maya cells is going to be a big part of the purpose of bile so a person that has had a their gallbladder removed oftentimes they're taking medications to help with emulsification of fat if they don't take these medications oftentimes they can't break down the fat and as a result they're going to have a lot of that fat that's going to be passing through their GI system they're going to have a pretty consistent diarrhea in their life if they're eating a fatty diet so one of the ways that you can fix that medicate as needed and also reduce the fat intake that's another thing that you can do so only by all component that have a digestive function is going to be the emulsification of fat so the bile pigments bilirubin and Billy Bearden these are going to be derived from hemoglobin we'll talk about those in just a moment there's also going to be cholesterol we'll talk about that as well and electrolytes that's going to be involved when a person is jaundice there jaundice jaundice means yellowing and so this is going to be yelling of the skin the yellow the whites of the eye are going to be yellow as well as the mucous membranes if your bile duct does not work because it's blocked but so we have common bile duct here let's say that you have a blockage that's occurring here or maybe it's further down whether it's a cystic duct or the bile duct as those are going to be blocked you don't have the production of bile I feel like I'm on the wrong slide yes there we go all right so if you have that blockage then you can't have the function of bile ultimately so reasons that you could have that you could have damaged to block bile ducts you could have disease sclerosis of the liver hepatitis all of these things are going to contribute to why a person would be jaundice so let's take a look at hepatitis so hepatitis is viral viruses can't be treated with an antibiotic so a person that has hepatitis they can't just go get an antibiotic and be fixed they're different kinds of hepatitis there's going to be chronic and there's going to be acute and the severity is also going to vary as well some people have symptoms and some people don't so you can't necessarily think that this person is quote unquote clean and you're all right always treat all of this with that Universal precaution of treating every patient like they have hepatitis or HIV whatever it is bloodborne pathogen just protect yourself protect the patient all right so some forms of transmission are by contaminated food body fluids or objects contaminated with feces that contain the virus so hepatitis A B and C hepatitis A is going to be transmitted by contact with uh food or objects contaminated with feces containing the virus Hepatitis B is from body fluids containing the virus and hepatitis C is Through Blood contact half of all known hepatitis cases are from hepatitis C which is blood contact all right let's get back to our focus on the gallbladder the gallbladder is going to be this pear-shaped sac it's going to be on the posterior aspect of your liver we looked at it just a minute ago leading from the gallbladder we have the cystic duct it's its only entrance exit it's going to merge with the common bio hepatic duct that leads to the common violent all right when bile is secreted from this it's going to then eventually end up in the duodenum so duodenum is going to have the common bile duct that's going to be emptying into the hepatopancreatic and Pula that we looked at earlier when we looked at the pancreas so the hepatopancreatic sphincter that circular muscle is going to regulate the amount that's released by opening up loosening or tightening down occasionally you hear people talking about gallstones and so gall stones are going to a gallbladder normally concentrates bile salts bile pigments cholesterols sometimes that cholesterol is going to form into these large granulars granule pieces that are going to be like stones like rocks oftentimes getting as big as a pea gravel quite painful to pass some people say that having gallstones and kidney stones are very very very painful so the cause is by an excess concentration of bile too much cholesterol secreted by the liver or an inflammation of the gallbladder so the hormone classicin is going to stimulate the contraction of the gallbladder to have the release of bile so this is the ultimate thing that is causing the concentration to release that is the cck here gallstones and so by the release of that acidic chyme that has fat in it you're going to have the emulsification that's going to occur by the cck it's going to stimulate in the bloodstream it's going to stimulate the contraction of the gallbladder that's going to be into the cystic duct which is then going to join the common hepatic duct that goes into the bile duct that then is going to go through the hepato pancreatic duct that is regulated by the pancreatic sphincter and that's going to be released into the impula into the duodenum that is going to allow for the breakdown of those fats once again slow release of the gastric system allows for this feedback mechanism to have the thing that is going to treat that fatty material to be released all right so the function of bile salts this AIDS digestion through emulsification the breakdown the breakup of these large flat fat globules into smaller droplets like soapric detergent and the enzyme lipase is going to break down these lipids and it's going to ultimately form a mild cell myocell is going to be um an encompassing going around it to where it's going to have these nonpolar tails that are going to be around that fat piece or the polar heads this is going to allow for mobility and also absorption through fat soluble vitamins like a d e and K most of the bile salts that you make are going to be reabsorbed and retained and recycled again all right symptoms of gallbladder disease typically it's pain in the right upper quadrant back and right shoulder perhaps nausea and sweating it will occur so test to observe you have ultrasonography of the gallbladder or an x-ray using a cholesterogram gallstones can be found um in the gallbladder cystic duct hepatic ducts or common bile ducts so think of that rock-like piece that is in the gallbladder it can be in any of the pathways from there go so a cholecystectomy is the removal of the gallbladder and an endoscopy can be used to find stones or even remove them under certain conditions all right so this is the overview of the gallbladder all right guys the liver and gallbladder all right next let's get into small intensive