Porth's Essentials of Pathophysiology, 4e

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Disorders of Hepatobiliary and Exocrine Pancreas Function

C h a p t e r 3 0

Diaphragm

Liver

Gallbladder

Spleen

Hepatic duct

Cystic duct

Common bile duct Ampulla of Vater

Tail of the pancreas

Sphincter of Oddi Duodenum

Pancreatic duct

Head of the pancreas

FIGURE 30-1. The liver and biliary system, including the gallbladder and bile ducts.

supply through the hepatic artery. Approximately 300 mL of blood per minute enters the liver through the hepatic artery; another 1050 mL/min enters by way of the valveless portal vein. 1 The venous blood delivered by the hepatic portal vein comes from the digestive tract and major abdominal organs, including the pancreas and spleen (Fig. 30-2). The portal blood supply carries

nutrient and toxic materials absorbed in the intestine, blood cells and their breakdown products from the spleen, and insulin and glucagon from the pancreas. Although the blood from the portal vein is incompletely saturated with oxygen, it supplies approximately 60% to 70% of the oxygen needs of the liver. The venous outflow from the liver is carried by the valveless hepatic

Inferior vena cava

Hepatic veins

Coronary (gastric)

Short gastric

Left gastroepiploic

Cystic Pyloric Portal Superior mesenteric

Splenic

Right gastroepiploic

Pancreatic

Inferior mesenteric

FIGURE 30-2. The portal circulation. Blood from the gastrointestinal tract, spleen, and pancreas travels to the liver through the portal vein before moving into the vena cava for return to the heart.