Digestive system part 4 (pancreas, liver and gall bladder) english

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1. By – SURESH KUMAR ( Nursing Tutor ) TO WATCH THIS SLIDE WITH VOICE EXPALINATION AS VIDEO PLEASE VISIT MY YOUTUBE CHANNEL “MY STUDENT SUPPORT SYSTEM”

2. Digestive System. The digestive system is also known as the gastrointestinal system or the alimentary canal or GIT. This vast system is approximately 10 m long. It travels the length of the body from the mouth through the thoracic, abdominal and pelvic cavities, where it ends at the anus. We are covering it in multiple lectures. Today we are going to discuss the anatomy and physiology of accessary organs of GIT that are pancreas, liver and gall bladder.

3. Pancreas The pancreas is a pale grey gland weighing about 60 grams. It is about 12 to 15 cm long and is situated in the epigastric and left hypochondriac regions of the abdominal cavity. It consists of a head, body and tail

4. Pancreas The head lies in the curve of the duodenum , the body behind the stomach and the tail lies in front of the left kidney and just reaches the spleen . The abdominal aorta and the inferior vena cava lie behind the gland. The pancreas is both as : Exocrine gland and E ndocrine gland.

5. Exocrine Pancreas This consists of a large number of lobules made up of small acini , the walls of which consist of secretory cells. Each lobule is drained by a tiny duct and these unite eventually to form the pancreatic duct , which extends the whole length of the gland and opens into the duodenum. Just before entering the duodenum the pancreatic duct joins the common bile duct to form the hepatopancreatic ampulla . The function of the exocrine pancreas is to produce pancreatic juice containing enzymes that digest carbohydrates, proteins and fats

6. Endocrine Pancreas T here are groups of specialised cells called the pancreatic islets (islets of Langerhans). These islets are distributed throughout the gland. The islets have no ducts so the hormones diffuse directly into the blood. The endocrine pancreas secretes the hormones insulin and glucagon , which are principally concerned with control of blood glucose levels

7. Liver The liver is the largest gland in the body, weighing between 1 and 2.3 kg. It is situated in the upper part of the abdominal cavity occupying the greater part of the right hypochondriac region, part of the epigastric region and extending into the left hypochondriac region. Its upper and anterior surfaces are smooth and curved to fit the under surface of the diaphragm. its posterior surface is irregular in outline

8. Liver The liver is enclosed in a thin inelastic capsule and incompletely covered by a layer of peritoneum . Folds of peritoneum form supporting ligaments attaching the liver to the inferior surface of the diaphragm. It is held in position partly by these ligaments and partly by the pressure of the organs in the abdominal cavity. The liver has four lobes. The two most obvious are the large right lobe and the smaller, wedge shaped, left lobe . The other two, the caudate and quadrate lobes, are areas on the posterior surface

9. Liver

10. Liver The portal fissure- This is the name given to the region on the posterior surface of the liver where various structures enter and leave the gland. The portal vein enters, carrying blood from the stomach, spleen, pancreas and the small and large intestines. The hepatic artery enters, carrying arterial blood. It is a branch from the coeliac artery, which is a branch from the abdominal aorta .

11. Liver Nerve fibres , sympathetic and parasympathetic, enter here. The right and left hepatic ducts leave, carrying bile from the liver to the gall bladder. Lymph vessels leave the liver, draining some lymph to abdominal and some to thoracic nodes.

12. Liver The falciform ligament extends from the undersurface of the diaphragm between the two principal lobes of the liver to the superior surface of the liver , helping to suspend the liver in the abdominal cavity . In the free border of the falciform ligament is the ligamentum teres (round ligament), a remnant of the umbilical vein of the fetus

13. Structure of Liver The lobes of the liver are made up of tiny functional units, called lobules , which are just visible to the naked eye. Liver lobules are hexagonal in outline and are formed by cubical-shaped cells, the hepatocytes , arranged in pairs of columns radiating from a central vein.

14. Structure of Liver Blood drains from the sinusoids into central or centrilobular veins . These then join with veins from other lobules, forming larger veins, until eventually they become the hepatic veins, which leave the liver and empty into the inferior vena cava.

15. Structure of Liver One of the functions of the liver is to secrete bile . Bile canaliculi run between the columns of liver cells. The canaliculi join up to form larger bile canals until eventually they form the right and left hepatic ducts , which drain bile from the liver.

16. Functions of Liver Carbohydrate metabolism The liver has an important role in maintaining plasma glucose levels. After a meal when levels rise, glucose is converted to glycogen for storage under the influence of the hormone insulin. Later, when glucose levels fall, the hormone glucagon stimulates conversion of glycogen into glucose again, keeping levels within the normal range

17. Functions of Liver Fat metabolism Hepatocytes store some triglycerides; break down fatty acids to generate ATP; synthesize lipoproteins, which transport fatty acids, triglycerides, and cholesterol to and from body cells; synthesize cholesterol; and use cholesterol to make bile salts

18. Functions of Liver Protein metabolism- Hepatocytes deaminate (remove the amino group, NH2, from) amino acids so that the amino acids can be used for ATP production or converted to carbohydrates or fats. The resulting toxic ammonia (NH3) is then converted into the much less toxic urea, which is excreted in urine . Hepatocytes also synthesize most plasma proteins, such as alpha and beta globulins, albumin, prothrombin , and fibrinogen.

19. Functions of Liver Processing of drugs and hormones. The liver can detoxify substances such as alcohol and excrete drugs such as penicillin, erythromycin , and sulfonamides into bile. It can also chemically alter or excrete thyroid hormones and steroid hormones such as estrogens and aldosterone.

20. Functions of Liver Excretion of bilirubin. Bilirubin, derived from the heme of aged/dead red blood cells, is absorbed by the liver from the blood and secreted into bile. Most of the bilirubin in bile is metabolized in the small intestine by bacteria and eliminated in feces.

21. Functions of Liver Synthesis of bile salts- Bile salts are used in the small intestinefor the emulsification and absorption of lipids . Storage - In addition to glycogen, the liver is a prime storage site for certain vitamins (A, B12, D, E, and K) and minerals (iron and copper), which are released from the liver when needed elsewhere in the body.

22. Functions of Liver Inactivation of hormones- hormones are inactivated/regulated by liver. These include insulin, glucagon, cortisol, aldosterone, thyroid and sex hormones. Production of heat- The liver uses a considerable amount of energy, has a high metabolic rate and produces a great deal of heat. It is the main heat-producing organ of the body.

23. Functions of Liver Phagocytosis- The stellate reticuloendothelial ( Kupffer ) cells of the liver phagocytize aged red blood cells, white blood cells, and some bacteria. Activation of vitamin D- The skin, liver, and kidneys participate in synthesizing the active form of vitamin D.

24. Bile juice Between 500 and 1000 ml of bile are secreted by the liver daily. Bile consists of: Water, mineral salts, mucus, bile pigments, mainly bilirubin, bile salts, which are derived from the primary bile acids, cholic acid and chenodeoxycholic acid cholesterol.

25. Bile juice The principal bile pigment is bilirubin. The phagocytosis of aged red blood cells liberates iron, globin, and bilirubin ( derived from heme ) . The iron and globin are recycled; the bilirubin is secreted into the bile and is eventually broken down in the intestine. One of its breakdown products— stercobilin —gives feces their normal brown color . A small amount is reabsorbed and excreted in urine as urobilinogen

26. Bile juice Bile is partially an excretory product and partially a digestive secretion . Bile salts, which are sodium salts and potassium salts of bile acids (mostly chenodeoxycholic acid and cholic acid ), play a role in emulsification, the breakdown of large lipid globules into a suspension of small lipid globules

27. Gall bladder The gall bladder is a pear-shaped sac attached to the posterior surface of the liver by connective tissue . It has a fundus or expanded end, a body or main part and a neck, which is continuous with the cystic duct.

28. Gall bladder The wall of the gall bladder has the same layers of tissue as those described in the basic structure of the alimentary canal, with some modifications. Peritoneum- This covers only the inferior surface because the upper surface of the gall bladder is in direct contact with the liver Muscle layer- There is an additional layer of oblique muscle fibres . Mucous membrane- This displays small rugae when the gall bladder is empty that disappear when it is distended with bile .

29. Bile ducts to and from Gall bladder The right and left hepatic ducts join to form the common hepatic duct just outside the portal fissure . The hepatic duct passes downwards for about 3 cm where it is joined by the cystic duct from the gall bladder. The cystic and hepatic ducts merge forming the common bile duct , which passes downwards behind the head of the pancreas. This is joined by the main pancreatic duct at the hepatopancreatic ampulla and the opening into the duodenum, at the duodenal papilla, is controlled by the hepatopancreatic sphincter (of Oddi ). The common bile duct is about 7.5 cm long and has a diameter of about 6 mm.

30. Functions of Gall bladder Functions include : R eservoir for bile- concentration of the bile by up to 10- or 15-fold, by absorption of water through the walls of the gall bladder R elease of stored bile- When the muscle wall of the gall bladder contracts, bile passes through the bile ducts to the duodenum . Contraction is stimulated by: the hormone cholecystokinin (CCK), secreted by the duodenum the presence of fat and acid chyme in the duodenum. Relaxation of the hepatopancreatic sphincter (of Oddi ) is caused by CCK and is a reflex response to contraction of the gall bladder.

31. By – SURESH KUMAR ( Nursing Tutor )