724
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 and Hepatobiliary
System
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
T
Disorders of
Hepatobiliary
and Exocrine
Pancreas
Function
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
