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The liver (hepar) is the largest gland of the human body (Fig. 78). Its mass is about 1500 g. It performs several main functions: digestive, forms a protein, neutralizes, hematopoietic, carries out metabolism, etc.
The liver is located in the right hypochondrium and in the epigastrium. In shape, it resembles a wedge, has an upper and lower surface. The upper (diaphragmatic) surface is convex, adjacent to the lower surface of the diaphragm; the lower (visceral) is directed down and to the underlying organs. It is concave, contains grooves and depressions from adjacent internal organs. The upper and lower surfaces, connecting, form the lower sharp and posterior obtuse edges. On the visceral surface of the liver there are three grooves: one frontal and two sagittal; also distinguish the right and left lobes. The right and left sagittal grooves are connected by a deep transverse groove, which is called the portal of the liver. On the visceral surface of the liver, the right, left, square and tail lobes are isolated. On the diaphragmatic surface, you can only consider the right and left lobes, separated by a crescent ligament of the liver.
Depressions from adjacent organs (heart, inferior vena cava, spine) are visible on the diaphragmatic surface, and impressions from the right kidney, adrenal gland, right bend of the colon and duodenum are visible on the visceral surface. The left lobe of the liver is in contact with the stomach and esophagus.
The peritoneum covers the liver from almost all sides, with the exception of the portal of the liver, posterior margin and transverse groove. In places where the peritoneum from the liver passes to the diaphragm, ligaments are formed that help to keep the liver in an appropriate position.
Under the peritoneum is a thin dense fibrous membrane; through the gate of the liver, it penetrates into the tissue of the organ, accompanies blood vessels and forms interlobular layers with them. Given the distribution of blood vessels and bile ducts, two lobes, five sectors and 8 segments are distinguished in the liver. The structure of the liver is a complex branched tubular gland, the excretory ducts of which are the bile ducts. The morphofunctional unit of the liver is the lobule of the liver. It has the shape of a prism, its dimensions in diameter are from 0.5 to 2.0 mm; in humans there are about 500,000.
Each lobule consists of connected liver plates, or “beams” in the form of double, radially directed rows of liver cells. In the center of each lobule is a central vein.
The inner ends of the liver plates are directed to the central vein, the outer ones to the periphery of the lobule. Inside each liver plate, between the two rows of liver cells, there is a bile duct (tubule), which gives rise to the biliary tract. In the center, the lobule ducts are closed, and on the periphery they flow into the interlobular bile ducts. The latter, combining, form larger ducts, and then the right and left hepatic ducts emerging from the corresponding lobes of the liver are formed. At the gate of the liver, they form a common hepatic duct 4–6 cm long. Then this duct connects to the cystic duct and a common bile duct forms, which flows into the duodenum.
The liver lies in the right hypochondrium and does not protrude beyond the costal arch. On the right, the lower edge of the right lobe intersects the costal arch at the level of the VIII rib. From the end of this rib, the lower edge of the right lobe, and then the left, crosses the epigastric region in the direction of the VI rib and ends along the midclavicular line. The upper border on the right along the midclavicular line corresponds to the V rib, on the left to the fifth to sixth intercostal space. In older people and women, the lower border of the liver is slightly lower than in young people and in men.
The gall bladder (vesica fellea, biliaris) is a container in which bile accumulates, its concentration due to the absorption of water. It is located in front of the right longitudinal groove of the liver, has a pear-shaped shape, holds about 40-60 ml of bile. It distinguishes between the bottom, body and neck. The neck of the gallbladder passes into the cystic duct, which connects to the common hepatic duct. The bottom of the gallbladder is in contact with the parietal peritoneum, and the body is in contact with the lower part of the stomach, duodenum and transverse colon.
The wall of the gallbladder consists of mucous membranes, muscle membranes and is covered with peritoneum. The mucous membrane in the neck and cystic duct forms a spiral fold; the muscle membrane consists of smooth muscle fibers.
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- LESSON 6 TOPIC. Diseases of the liver, gallbladder, bile ducts, and pancreas
Motivational characteristic of the topic. Knowledge of the pathological manifestations of diseases and syndromes of the hepato-cholecystic-pancreatic zone is necessary for the successful assimilation of this human suffering in clinical departments. In the practical work of the doctor, this knowledge is necessary for the clinical anatomical analysis of sectional cases and liver biopsies. The general purpose of the lesson. Learn by morphological characteristics
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- Liver, gall bladder and bile ducts
The liver of the newborn is relatively large, especially its left lobe, to which the spleen is adjacent. Cases of agenesis of the liver are rare, they are more often found to be underdeveloped. On the back or on the lower surface of the liver, you can sometimes see congenital notches, often located in the sagittal direction. If these depressions are significant, the liver is divided into additional lobes.
- Diseases of the liver and gall bladder
With the development of possibilities for diagnosing diseases of internal organs, it was found that liver disease (hepatopathy) is much more common than previously thought, and that many vague signs of disease are based on hepatosis. Due to the importance and variety of functions, the liver is endowed with a natural ability for high regeneration. Therefore arising under the influence of different
- Nutrition for diabetes with diseases of the liver and gall bladder
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- Diseases of the liver, gallbladder and pancreas
DISEASES OF THE LIVER, GALL BLADDER AND Pancreas
- Nutrition for exacerbation of liver inflammation and acute gallbladder inflammation
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- Gall bladder and bile ducts
As in many other organs and tissues, in the human liver, secretory processes are subordinated to a certain rhythm. Bile secretion prevails during the day, glycogen production prevails at night. The effect of a nightly decrease in the secretion of bile, which has a physiological basis, is enhanced even more with biliary dyskinesia (a violation of the coordinated work of the smooth muscles of the ducts and gallbladder, which has
- Diseases of the liver and biliary system. Hepatitis. Cirrhosis of the liver. Liver cancer. Cholelithiasis.
1. A 40-year-old woman complains of weakness, jaundice. A history of 2 months. before the disease - blood transfusion. An examination revealed an increase in the liver, an increase in the level of hepatic transaminases. Conclusion 1. liver steatosis 3. obstructive jaundice 2. Botkin’s disease 4. acute viral hepatitis 2. Viral hepatitis C is characterized by 1. high frequency of chronicity 2. parenteral transmission 3.
- Gall bladder (problems)
The gall bladder is a hollow organ that contains bile coming from the liver and prevents it from flowing into the intestine in between meals. During the digestion of food, the gallbladder opens and expels bile through the bile duct into the duodenum. Bile is necessary so that the intestines can absorb fats from food. Most common problem related
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- Cholecystitis (inflammation of the gallbladder)
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- Gall bladder cancer
Epidemiology. Gallbladder cancer accounts for 2-8% of all malignant tumors and in frequency it takes 5-6 place among digestive tumors. Ill men relate to women in a ratio of 1:14. 90% of patients older than 60 years. For 100 planned cholecystectomies for chronic calculous cholecystitis, there is a histological finding of 3 cases of cancer in situ of the gallbladder.
- Diseases of the biliary tract and gallbladder
Diseases of the biliary system are very common. Patients with this pathology in the general population are on average 2, and among women - almost 10 times more than patients with peptic ulcer disease. Among the numerous diseases of the biliary tract, it is advisable to single out mainly functional disorders (dyskinesias), inflammatory (cholecystitis), and metabolic (gallstone
- Diseases of the gallbladder and biliary tract in children
Questions for repetition: 1. Duodenal sounding and its assessment. 2. The main pain points in the disease of the gallbladder and biliary tract. Test questions: 1. Biliary dyskinesia. Concept. Etiopathogenesis. Classification. 2. Clinical and diagnostic criteria for biliary dyskinesia: 2.1. hypermotor type 2.2. hypomotor type 3. Treatment of dyskinesia
- Diseases of the liver and biliary tract in newborns
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