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The Liver and Bile Ducts
Mechanisms of Injury and Repair
Bacterial, Parasitic, and Helminthic Infections
Pathophysiology of Jaundice
Impaired Blood Flow Into the Liver
Impaired Blood Flow Through the Liver
The Liver and Bile Ducts
The normal adult liver weighs 1400 to 1600 gm. It has a dual blood supply, with the portal vein providing 60% to 70% of hepatic blood flow and the hepatic artery supplying the remaining 30% to 40%. The portal vein and the hepatic artery enter the inferior aspect of the liver through the hilum, or porta hepatis. Within the liver, the branches of the portal veins, hepatic arteries, and bile ducts travel in parallel within portal tracts, ramifying variably through 10 to 12 orders of branches.
The most common terminology used to describe the hepatic microarchitecture is based on the lobular model (
Fig. 16.1 ). This model divides the liver into lobules 1to 2-mm in diameter that are centered on a terminal tributary of the hepatic vein and demarcated by portal tracts at their periphery. These lobules are often drawn as hexagonal structures, though in humans the shapes are far more variable; nonetheless, it is a useful simplification. A second model divides the liver into triangular acini (see
Fig. 16.1 ) based on the position of hepatocytes relative to their blood supply. The hepatocytes in the vicinity of the terminal hepatic vein are called centrilobular; those near the portal tract are periportal. Division of the lobular parenchyma into zones is an important concept because each zone differs with respect to its metabolic activities and susceptibility to certain forms of hepatic injury.