HISTOLOGY OF DIGESTIVE

SYSTEM-(Part two)
LIVER ,GALL BLADDER&
PANCREAS.

NYANDA GAPI, MD 1
 The liver
 largest gland in the body, weighing about 1.5 kg.
 Located in the right hypochondriac and epigastric
region.
 Receives dual blood supply; portal vein(75%) and
hepatic artery(25%).

 At the portal hepatis, which is a slight depression

area, the connective tissue capsule enters the organ
along with portal vein, hepatic artery, bile duct,
nerves and lymphatic.

NYANDA GAPI, MD 2
 Cont..
 The hepatic arteries, and portal veins, which bring
nutrients and other compounds absorbed by the GI
tract to be processed and/or stored in the liver. They
branch into small vessels that supply the liver lobes and
pour blood into sinusoids.

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 Cont..
Functions of liver.
1.Synthesis of plasma proteins including albumin and
fibrinogen.

2.Synthesis of cholesterol.

3.Metabolism of lipid-soluble drugs and steroids.

4.Fat metabolism.

5.Glycogen storage and release.

6.Secretion of bile.
 Histologically the liver is made up of the parenchyma
(liver cells) and a stroma (connective tissue).
• The stroma of the liver is composed of connective
tissue which consists of three main parts as follows:
1. A thin connective tissue capsule that contains collagen
fibers and scatted fibroblasts.
2. Intrahepatic connective tissue, including the septae
that branch from the capsule.
3. Fine meshwork of reticular fibers around the sinusoids
and perisinusoidal space.

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 Cont..
 The parenchyma is composed primary of the liver cells
known as hepatocytes and their supporting cells
(kupffer cells and ito cells)

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 Structural organization of the
liver.
 The liver is covered by a thin fibroconnective tissue called
the Glisson’s capsule.
 The Glisson’s capsule sends thin connective tissue septae
into the substance/parenchyma of the liver to divide it
into lobes and lobules which assumes hexagonal shape .
 At the corners of these hexagonal units, there are portal
triads containing a bile ductule, arteriole and venule.
 The venule is usually the largest of the structures
containing blood.
 Cont..
 The liver parenchyma is made up of polyhedral hepatocytes
radially arranged from the central vein to the periphery in
each classic lobule. They are supported by an extensive
network of reticular fibers.
 The hepatic sinusoids, occupy the spaces between the
radially arranged plates of hepatocytes.

NOTE. Blood flows from the triads through the sinusoids, to

the central vein in the center of each classical lobule,
where as on the other hand, bile secretion is from the
hepatocytes to the bile ductules at periphery (portal triad).
 Cont..
 The endothelium of sinusoids is separated from the plates
of hepatocytes by a narrow perisinusoidal space, the space
of Disse.

 A population of phagocytic cells, called Kupffer cells,

adheres to the endothelium and extends processes through
its fenestrations into the space of Disse.

 The space of Disse also contains a few stellate fat-storing

cells (Ito cells) that contain many lipid droplets.
 Cont..
 There are minute Intrahepatic bile channels that are situated
between adjacent hepatocytes forming an anastomosing
network which is present on almost all of the surfaces of the
cells, except where the hepatocytes relate to the sinusoids.
They are called bile canaliculi/ bile capillaries.
 When the liver cells secrete bile they secrete it into bile
canaliculi.
 The bile canaliculi joins with short bile ductules known as canals
of Hering at the periphery of a hepatic lobule and drain into
the interlobular bile ducts of the portal triads.
 The interlobular bile ducts are lined by cuboidal epithelium
which continue into a system of progressively larger ducts that
converge to form the right and left hepatic bile ducts from the
corresponding lobes of the liver.
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Hepatocyte
Histological features of the liver.

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 Concept of Hepatic lobules.
• There are three ways of describing the structure of the
liver in terms of a functional unit.
– The classic lobule- Traditional way of description
– The portal lobule
– Liver/hepatic acinus

NYANDA GAPI, MD 16
 Classic lobules .
 Hexagonal shaped,
representing territory
tissues whose blood
flows from portal triads
to the single central vein.
 At the center of the
lobule is the central vein
and at the angles of the
hexagon are the portal
triads.Flow of blood is
centrapedal but bile and
lymph is centrifugal.
Classic lobule…

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 Portal lobule.
 Emphasizes the exocrine functions of the liver.

 It is triangular in shape with central veins at the angles

of the triangle; and a portal area at the center of the
triangle.

 Its margins consist of imaginary lines drawn between

three central veins that are close to the portal triad.

 One portal lobule incorporates three classical lobules. It

emphasizes the flow of bile.
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 Liver acinus
 Diamond shaped lobule provides the best correlation
among blood perfusion, metabolic activity, and liver
pathology.

 The short axis of the acinar is defined by the terminal

branches of two opposing portal areas.

 The long axis is a line drawn between the two terminal

opposite central veins.
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 …liver acinus
 The acinus is roughly divided into zones that
correspond to distance from the arterial blood supply
- those hepatocytes closest to the arterioles (zone 1
below) are the best oxygenated, while those farthest
from the arterioles have the poorest supply of oxygen.

 This arrangement also means that cells in the center of

the acinus (again, zone 1) are the first to "see" and
potentially absorb blood-borne toxins absorbed into
portal blood from the small intestine.

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 Zone 1
– Cells in zone 1 are the first to receive both
nutrients and toxins in the blood.

– They are the last to die if circulation is impaired.

– They are the first to regenerate.

– Are the first to show changes following bile duct

occlusion (bile stasis)

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 Zone 2
– Has no sharp boundaries.

– But it morphologically and functionally

intermediate between zones 1 and 3.

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Zone 3
– Cells in this zone are the first to show signs of
ischemic necrosis (centrilobular necrosis)

– They are the last to react to toxins or bile duct

occlusion

– Are the first to show fat accumulation in metabolic

or drug- induced fatty livers

NYANDA GAPI, MD 33
 Kupffer cells
 Kupffer cells belongs to mononuclear phagocytic
system and are derived from monocytes that
originate from bone marrow.

 Kupffer cells probably phagocytize and break down

damaged or senile red blood cells that have not
captured by macrophages of spleen.

 This function increases and becomes essential after

splenectomy.

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 CLINICAL APPLICATION.
 Liver cirrhosis; fibrosis of the liver parenchyma and
connective tissues fill perisinusoid space interfering with
exchange of material between hepatocytes and
sinusoids.
 Fatty liver disease; hepatocytes accumulates
triglycerides with large lipid droplets. Alcoholism and
obesity are potential risk factors.
 Hepatitis; inflammation of liver parenchyma due to
infection , steatosis or alcoholism.
 Hepatocellular carcinoma; malignant condition of the
liver parenchyma.
 Extrahepatic biliary
apparatus
This consist of the gallbladder and
extrahepatic bile ducts

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 Gall bladder.
 Is an elongate, pear shaped. Distensible sac attached
to the posteroinferior surface of the liver with a
volume of up to 50ml.

 Is responsible for storage and concentration of bile

 It concentrates bile by absorbing water and selected

electrolytes from bile that reaches it from liver.

 It consists of Fundus, body and Neck

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 Gall bladder…
 Histologically the wall consist of outer
adventitia/serous coat, muscular layer and inner
mucosal layer

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 Gall bladder…
Inner mucous layer
The mucosal has numerous deep
mucosal folds, many of which
smoothes out when the organ is
distended
The epithelial lining consist of
simple columnar cells united by tight
junctions, have numerous microvilli
and many mitochondria
Below columnar cells is the lamina
propria of loose connective tissue.
NYANDA GAPI, MD 41
 Gall bladder…
Muscular coat
 Is made up of smooth muscles that show a random
arrangement ( fibers runs in different directions).

 Fibroelastic tissue are present in between muscle

fibers.

 Contractions of smooth muscle cells reduces volume

of gallbladder causing bile to flow into cystic duct .

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 Gall bladder…
Serous coat
 The outer coat completely surrounds the fundus but
covers only inferior surface and sides of other parts
of gall bladder

 In areas in contact with liver is missing and is being

replaced by fibrous coat or tunica adventitia

NYANDA GAPI, MD 44
 Bile ducts
 The bile ductules and bile ducts are lined by simple
cuboidal epithelium.

 The intrahepatic ducts lead to extrahepatic ducts

which are lined by simple columnar epithelial
surrounded by connective tissues and smooth
muscles.

 These unite to form the common bile duct.

NYANDA GAPI, MD 45
 Common bile duct.
 The common bile duct which is also lined by simple
columnar epithelium surrounded by connective
tissues (which contains tubule-alveolar mucous
glands) and smooth muscle cells.

 The sphincter of Oddi, a thickening of smooth

muscles of duodenal wall surrounds the opening of
both common bile duct and pancreatic duct.

 Note : The common bile duct, which is also lined by

simple columnar epithelium.
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 CLINICAL APPLICATION.

Cholelithiasis; formation of stones in the

gall bladder.

Cholecystitis; inflammation of the

gallbladder mucosa due to infection or
longstanding cholelithiasis. Can be acute or
chronic.
NYANDA GAPI, MD 48
 Pancreas
 The pancreas has both exocrine
and endocrine components.
 The exocrine component is a
serous gland that synthesizes and
secretes, into the duodenum,
enzymes that are essential for
digestion in the intestine.
 The endocrine component
synthesizes and secretes, into the
blood, insulin and glucagon,
hormones that regulate glucose
metabolism in the whole body.
NYANDA GAPI, MD 49
 Pancreas…
Microscopic features of the exocrine pancreas
It is a serous gland and is covered by thin areola tissue
that sends septae into the gland and divide it into lobes.

Each lobule is composed of spherical clusters of secretory

exocrine cells that form the pancreatic acini or secretory
end pieces. They constitute the large portion of pancreatic
parenchyma.

During physiological state secretion of exocrine pancreas

is enhanced by cholecystokinin.
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 The Exocrine Pancreas…
 The exocrine component consists of closely packed
secretory acini which drain into the main pancreatic duct.
Acinar cells, Centroacinar cells and Ductal cells constitute
exocrine portion.
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 Exocrine pancreas…
 The pancreas contains multiple ducts, but the main
pancreatic duct runs from the tail to the head of the
pancreas.
 There may be a smaller accessory pancreatic duct.
They join the common bile duct to empty into the
duodenum.
 The duct system of the exocrine pancreas system
begins in the acinus. These ducts are lines by simple
cuboidal epithelium.

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 Pancreas..
 The main pancreatic duct is lined by columnar and
goblet cells, it run longitudinally from the tail of the
pancreas to its head and empty into the duodenal lumen
at the ampulla of Vater.

 Accessory pancreatic duct drains the lower part of the

head of the gland and opens a short distance above the
main duct but sometimes communicate with the main
duct

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 Exocrine pancrease…
 The exocrine pancrease contains several zymogenic
granules filled with pancreatic enzymes in their
inactive forms;

 Question , Mention pancreatic enzymes and their

functions---------

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 Endocrine Pancreas…
 The endocrine tissue of the pancreas forms islets of
Langerhans of various sizes scattered throughout
the exocrine tissue

 Using special stains, three major cells are identified;

the alpha cells, beta, delta and PP cells.

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 Alpha cells and Beta cells.
 Alpha cells: These occupy the central part of the islets
and form 20% of the islet cells. These cells secrete
glucagon hormone which increases the blood level of
glucose.

 Beta cells: These occupy the peripheral part of the islets

and constitute 75% - 80% of the islet cells. These cells
secrete insulin hormone which allows utilization of
glucose by the body cells, as without insulin glucose will
not be utilized.
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 Delta cells & PP cells
 Delta cells :These occupy the central portion of the
islets and constitute 5% of the cell population. These
cells are said to secrete serotonin or pancreatic gastrin
& somatostatin.

 PP cells: These are very rare cells in man but are

demonstrated in guinea pigs and rats. They secrete a
pancreatic polypeptide which stimulates the chief
cells of the stomach to produce more pepsinogen.

NYANDA GAPI, MD 63
 CLINICAL APPLICATION.
 Pancreatic carcinoma; common malignant condition of the
pancreas arising from the duct cell in the head or any
region.

 Pancreatitis; proteolytic destruction of pancreatic

parenchyma due to several cause which affect the
pancreas causing release of proteolytic enzyme. It can be
acute or chronic.
 Diabetes mellitus; due to abnormal functions of beta cells
causing insufficiency insulin hormone. Then blood glucose
level will be higher than normal.
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