The liver, gallbladder, and bile ducts make up the hepatobiliary tract. The liver is composed of lobules containing hepatocytes and receives blood from both the hepatic artery and portal vein. Bile produced by the liver is stored in the gallbladder and secreted through bile ducts. The liver has an incredible ability to regenerate even after losing 75% of its tissue. Liver damage progresses from inflammation to fibrosis to cirrhosis as regeneration is unable to keep up with injury over time. Common causes of hepatitis that can damage the liver include viral infections and toxins. Blood tests of liver enzymes and bilirubin can indicate liver injury and function.

1. Physiology of Gastric Acid Secretion
Liver Function
Basicsof

3. The hepatobiliary
tract(biliary system)
refers to the liver, gall
bladder and bile
ducts, and how they
work together to make,
store and secrete bile.
Bile consists of water,
electrolytes, bile acids,
cholesterol,
phospholipids and
conjugated bilirubin.
PARTS OF THE
HEPATOBILIARY
TRACT

4. LIVER LOBULE: Functional unit
• The liver is made up of four sections called lobes, each in turn made up of lobules. The lobules contain
the liver cells or hepatocytes that do the work of the liver
• At the center of each lobule is a central vein, and at each angle are portal triads which have branches
of the hepatic interlobular artery, portal (interlobular) vein, and interlobular bile duct system

5. PORTAL TRIAD
• There are several blood vessels that
carry blood to and from the liver.
• These include the main (hepatic)
artery, that carries oxygen-rich
blood to the liver from the heart and
the portal vein, which carries
oxygen-poor blood from the
intestines.
• The blood that comes from the
portal vein carries a range of
substances, including nutrients and
toxic substances.
• The liver filters out these substances
and sends blood on to the heart via
the hepatic vein

7. Liver and Property of Regeneration
• One of the most incredible facts about the liver is that it is self-healing, just like your skin
• This remarkable feature of the liver is called as regeneration
• As much as 75% of the liver can be lost, and it can still grow new tissue and expand to its
original size within several weeks
• The liver can regenerate after either surgical removal or after chemical injury
• However if the damage to the liver has been long-term, it may not be reversible and over
time it will lose its capacity to regenerate

8. Stages of Liver Damage
• In response to the infection, the body's immune system attacks the liver, causing
inflammation (hepatitis)
• If the hepatitis is severe or goes on for a long period of time, hardened fibers can develop in
the liver, a condition called fibrosis
• Over time, more and more normal liver tissue can be replaced by hardened scar tissue, which
can obstruct the normal flow of blood through the liver and seriously affect its structure and
ability to function properly: This is called cirrhosis

9. Stages of Liver Damage

10. Liver Damage
INFECTION / INJURY
COMPENSATED LIVER DISEASE DECOMPENSATED LIVER DISEASE
Regeneration of damaged hepatocytes
and liver functions restored
• Damage greater than regeneration
• Excessive scar tissue( fibrosis)
• Liver starts failing and cannot
function properly
• End stage liver disease

11. Hepatitis
The word hepatitis comes from the
Ancient Greek word hepar meaning 'liver',
and the Latin itis meaning inflammation.
Hepatitis = Inflammation of the liver

12. Common Causes of Hepatitis
A number of agents can
cause hepatitis including
infectious diseases,
chemical poisons, drugs
and alcohol.

13. Signs and Symptoms of Liver Disease
Could be
Jaundice

14. Liver function tests (LFTs)
• Group of blood tests that detect inflammation and damage to the liver
• Test the functional status of the liver
• These tests include prothrombin time (PT/INR), total albumin (proteins),
bilirubin (direct and indirect), and others.
• Liver enzymes - transaminases (AST or SGOT and ALT or SGPT) are useful
biomarkers of liver injury in a patient

15. LFTs: Liver enzymes
• Alanine transaminase (ALT)/ Aspartate aminotransferase (AST): Large amounts of ALT
occur in liver cells. When the liver is injured or inflamed (as in hepatitis), the blood level of
ALT usually rises.
• AST another enzyme usually found inside liver cells. When a blood test detects high levels of
this enzyme in the blood it usually means the liver is injured in some way. However AST can
also be released if heart or skeletal muscle is damaged.
• For this reason ALT is usually considered to be more specifically related to liver
problems
• Normal values range from 5-45 IU/L
• However in Hepatitis B /C patients : upper limit of normal (ULN) or max normal value is 30
in males and 19 in females
• Other enzymes tested include Gamma-glutamyl transpeptidase (GGT) and alkaline
phosphatase (ALP)

16. LFTs: Total protein
• This measures albumin and all other proteins in blood
• Albumin- is a protein made specifically by the liver
• It is the main constituent of total protein
• Albumin levels are decreased in chronic liver disease, such as cirrhosis

17. LFTs: Bilirubin
• This chemical gives bile its yellow/green colour.
• A high level of bilirubin in your blood will make you jaundiced ('yellow').
Bilirubin is made from haemoglobin in red blood cells that is released when
the red blood cells break down.
• Liver cells take in bilirubin, bind it to albumin and convert it to 'conjugated'
bilirubin
• A raised blood level of “conjugated' bilirubin” occurs in various liver and
bile duct conditions.
E.g. gallstone, or by a tumour in the pancreas, hepatitis, liver injury, or long-term
alcohol abuse

18. LFTs: Prothrombin time
• Blood clotting factors are needed for blood to clot (coagulation).
Prothrombin, or factor II, is one of the clotting factors made by the liver.
• An abnormal or increased prothrombin time is often caused by liver disease

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