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LIVER. Gallbladder

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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LIVER. Gallbladder

  1. 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
    This chapter continues the presentation of the pathology of the digestive system. According to traditions, a number of diseases of the liver and biliary tract, despite their infectious etiology, are considered not in chapter 14, devoted to infections, but here. The same applies to diabetes mellitus, a description of which, for reasons of expediency, is included in this
  3. 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.
  4. 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
  5. Nutrition for diabetes with diseases of the liver and gall bladder
    Nutrition in the treatment of this disease should improve metabolic processes that are disturbed by diabetes and diseases of the liver and gall bladder. Products that improve liver function, enhance bile secretion, and help normalize intestinal activity are introduced into the diet of a diabetic. Foods that impede liver function are excluded from nutrition. It is recommended to include milk and
  6. Diseases of the liver, gallbladder and pancreas
  7. Nutrition for exacerbation of liver inflammation and acute gallbladder inflammation
    Nutrition is recommended for patients with acute cholecystitis and hepatitis, chronic cholecystitis and hepatitis, liver cirrhosis with moderate liver failure, cholelithiasis, as well as with simultaneous damage to the liver and biliary tract, stomach and intestines. Food is cooked in water or steamed, wiped. Excluded foods that enhance fermentation and rotting in
  8. Recommended products for exacerbation of liver inflammation and acute gallbladder inflammation
    Recommended: yesterday’s wheat bread; soups are prepared on a mucous broth with mashed cereals, vegetables or on vegetable broths with finely chopped vegetables - potatoes, carrots, zucchini, pumpkin, boiled cereals - rice, semolina, oatmeal, noodles, and egg-milk mixture can be added to soups, which is prepared mix raw eggs with an equal volume of milk, and season
  9. Nutrition for patients with mild diabetes mellitus with liver and gall bladder diseases with normal body weight receiving sugar-lowering drugs (diet for 2500 calories)
    PRODUCT SET FOR DAY Black bread 300 g. Potatoes 100 g. Vegetables 800 g. Buckwheat, oat or pearl barley 50 g. Meat (category II beef or chicken) 160 g. Meat broth 300 g. Egg white 2 pieces. Fat-free cottage cheese 200 g. Milk 600 g. Kefir or yogurt 200 g. Butter 25 g. Vegetable oil 25 g. Diet sausage 50 g. Sugar 20 g. EXAMPLES MENU DAY
  10. 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
  11. 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.
  12. 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
  13. Features of the gallbladder
    The gall bladder is located under the right lobe of the liver and has a fusiform shape, its length reaches 3 cm. It acquires a typical pear-shaped form by 7 months, by 2 years reaches the edge of the liver. The main function of the gallbladder is the accumulation and secretion of hepatic bile. The bile of a child is different in composition from the bile of an adult. It has few bile acids, cholesterol, salts, a lot
  14. Cholecystitis (inflammation of the gallbladder)
    Causes: As a rule, the presence of stones in the gallbladder or its ducts. Pathological thickening of bile as a result of a viral infection, errors in diet, abnormal structure of the gallbladder, overweight, prolonged stressful situation, diseases of the gastrointestinal tract and liver. Symptoms Pain in the upper right abdomen, fever, fat intolerance, may be temporary
  15. Gallstones
    Causes Impaired metabolism in the liver (bile is oversaturated with cholesterol). Overweight women get sick more often. One of the reasons is a sedentary lifestyle combined with errors in the diet (excess fat, fried, spicy and smoked foods, alcohol). In complex cases, cancer of the biliary tract and gall bladder can occur. Symptoms Soreness on palpation in the right
  16. 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.
  17. 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
  18. 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
  19. Diseases of the liver and biliary tract in newborns
    The earliest manifestation of most diseases of the liver and biliary tract is cholestasis syndrome. Depending on the level of damage to the hepatobiliary system, it is customary to distinguish diseases manifesting with extrahepatic and intrahepatic cholestasis. Diseases of the hepatobiliary system, manifested by extrahepatic cholestasis The causes of extrahepatic cholestasis in newborns can be: • Atresia
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