Porth's Essentials of Pathophysiology, 4e

30 C h a p t e r

The Liver and Hepatobiliary System Physiologic Functions of the Liver Metabolic Functions Bile Formation and Flow Bilirubin Formation and Jaundice Cholestasis Tests of Hepatobiliary Function Disorders of Hepatic and Biliary Function Hepatitis Viral Hepatitis Autoimmune Hepatitis Acute Fulminant Hepatitis Intrahepatic Biliary Disorders Primary Biliary Cirrhosis Secondary Biliary Cirrhosis Drug- and Alcohol-Induced Liver Disease Drug Metabolism Drug-Induced Liver Disease Alcohol Metabolism Alcohol-Induced Liver Disease Nonalcoholic Fatty Liver Disease Hepatic Syndromes Cirrhosis Portal Hypertension Liver Failure Cancer of the Liver Primary Liver Cancers Metastatic Tumors Disorders of the Hepatobiliary System and Exocrine Pancreas Disorders of the Hepatobiliary System Cholelithiasis Acute Cholecystitis Chronic Cholecystitis Diagnosis and Treatment of Gallbladder Disease Choledocholithiasis and Cholangitis Cancer of the Gallbladder Disorders of the Exocrine Pancreas Acute Pancreatitis Chronic Pancreatitis Cancer of the Pancreas

Disorders of Hepatobiliary and Exocrine

Pancreas Function

T

he liver, the gallbladder, and the pancreas are clas- sified as accessory organs of the gastrointestinal tract. The liver produces and the gallbladder stores and concentrates bile that is involved in the digestion of fats. The liver also plays an important role in the uptake, storage, and distribution of both nutrients and vitamins; it synthesizes most of the body’s circulating plasma proteins; and it degrades and eliminates drugs and toxins. The exocrine pancreas secretes enzymes that are involved in the digestion of carbohydrates, lipids, and proteins, This chapter is divided into two parts: the first focuses on functions and disorders of the liver, and the second on disorders of the gallbladder, biliary tract, and pancreas. The liver is the largest visceral organ in the body, weigh- ing approximately 1.5 kg (3.3 lb) in the adult. 1,2 It is located immediately under the diaphragm in the upper right and partially in the upper left quadrants of the abdominal cavity, protected by the rib cage (Fig. 30-1). Anatomically, the liver is divided by deep grooves into two large lobes (the right and left lobes) and two smaller lobes (the caudate and quadrate lobes). Each lobe is divided into numerous lobules by small blood vessels and fibrous strands that form a supporting framework for them. The liver is enclosed in a capsule of fibrous connective tissue ( Glisson capsule ); a serous covering (visceral peritoneum) surrounds the capsule, except where the liver adheres to the diaphragm. The liver is unique among the abdominal organs in having a dual blood supply consisting of a venous (por- tal) supply through the hepatic portal vein and an arterial The Liver and Hepatobiliary System

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