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Monday, March 9, 2015

Bionics



From Wikipedia, the free encyclopedia

Robot behaviour (bottom) modeled after that of a cockroach (top) and a gecko (middle).

Bionics (also known as bionical creativity engineering) is the application of biological methods and systems found in nature to the study and design of engineering systems and modern technology.[citation needed]

The word bionic was coined by Jack E. Steele in 1958, possibly originating from the technical term bion (pronounced BEE-on; from Ancient Greek: βίος), meaning 'unit of life' and the suffix -ic, meaning 'like' or 'in the manner of', hence 'like life'. Some dictionaries, however, explain the word as being formed as a portmanteau from biology and electronics. It was popularized by the 1970s television series The Six Million Dollar Man and The Bionic Woman, which were based upon the novel Cyborg by Martin Caidin, which was influenced by Steele's work, and feature humans given superhuman powers by electromechanical implants

The transfer of technology between lifeforms and manufactures is, according to proponents of bionic technology, desirable because evolutionary pressure typically forces living organisms, including fauna and flora, to become highly optimized and efficient. A classical example is the development of dirt- and water-repellent paint (coating) from the observation that the surface of the lotus flower plant is practically unsticky for anything (the lotus effect).[citation needed].

Ekso Bionics is currently developing and manufacturing intelligently powered exoskeleton bionic devices that can be strapped on as wearable robots to enhance the strength, mobility, and endurance of soldiers and paraplegics.

The term "biomimetic" is preferred when reference is made to chemical reactions.[citation needed] In that domain, biomimetic chemistry refers to reactions that, in nature, involve biological macromolecules (for example, enzymes or nucleic acids) whose chemistry can be replicated using much smaller molecules in vitro.

Examples of bionics in engineering include the hulls of boats imitating the thick skin of dolphins; sonar, radar, and medical ultrasound imaging imitating the echolocation of bats.

In the field of computer science, the study of bionics has produced artificial neurons, artificial neural networks,[1] and swarm intelligence. Evolutionary computation was also motivated by bionics ideas but it took the idea further by simulating evolution in silico and producing well-optimized solutions that had never appeared in nature.

It is estimated by Julian Vincent, professor of biomimetics at the University of Bath's department of mechanical engineering Biomimetics group, that "at present there is only a 12% overlap between biology and technology in terms of the mechanisms used".[2]

History

The name biomimetics was coined by Otto Schmitt in the 1950s. The term bionics was coined by Jack E. Steele in 1958 while working at the Aeronautics Division House at Wright-Patterson Air Force Base in Dayton, Ohio. However, terms like biomimicry or biomimetics are more preferred in the technology world in efforts to avoid confusion between the medical term bionics. Coincidentally, Martin Caidin used the word for his 1972 novel Cyborg, which inspired the series The Six Million Dollar Man. Caidin was a long-time aviation industry writer before turning to fiction full-time.

Methods


Velcro was inspired by the tiny hooks found on the surface of burs.

Often, the study of bionics emphasizes implementing a function found in nature rather than just imitating biological structures. For example, in computer science, cybernetics tries to model the feedback and control mechanisms that are inherent in intelligent behavior, while artificial intelligence tries to model the intelligent function regardless of the particular way it can be achieved.

The conscious copying of examples and mechanisms from natural organisms and ecologies is a form of applied case-based reasoning, treating nature itself as a database of solutions that already work. Proponents argue that the selective pressure placed on all natural life forms minimizes and removes failures.

Although almost all engineering could be said to be a form of biomimicry, the modern origins of this field are usually attributed to Buckminster Fuller and its later codification as a house or field of study to Janine Benyus.

Roughly, we can distinguish three biological levels in the fauna or flora, after which technology can be modeled:

Examples

  • Velcro is the most famous example of biomimetics. In 1948, the Swiss engineer George de Mestral was cleaning his dog of burrs picked up on a walk when he realized how the hooks of the burrs clung to the fur.
  • The horn-shaped, saw-tooth design for lumberjack blades used at the turn of the 19th century to cut down trees when it was still done by hand was modeled after observations of a wood-burrowing beetle. It revolutionized the industry because the blades worked so much faster at felling trees.
  • Cat's eye reflectors were invented by Percy Shaw in 1935 after studying the mechanism of cat eyes. He had found that cats had a system of reflecting cells, known as tapetum lucidum, which was capable of reflecting the tiniest bit of light.
  • Leonardo da Vinci's flying machines and ships are early examples of drawing from nature in engineering.
  • Resilin is a replacement for rubber that has been created by studying the material also found in arthropods.
  • Julian Vincent drew from the study of pinecones when he developed in 2004 "smart" clothing that adapts to changing temperatures. "I wanted a nonliving system which would respond to changes in moisture by changing shape", he said. "There are several such systems in plants, but most are very small — the pinecone is the largest and therefore the easiest to work on". Pinecones respond to higher humidity by opening their scales (to disperse their seeds). The "smart" fabric does the same thing, opening up when the wearer is warm and sweating, and shutting tight when cold.
  • "Morphing aircraft wings" that change shape according to the speed and duration of flight were designed in 2004 by biomimetic scientists from Penn State University. The morphing wings were inspired by different bird species that have differently shaped wings according to the speed at which they fly. In order to change the shape and underlying structure of the aircraft wings, the researchers needed to make the overlying skin also be able to change, which their design does by covering the wings with fish-inspired scales that could slide over each other. In some respects this is a refinement of the swing-wing design.

Lotus leaf surface, rendered: microscopic view
  • Some paints and roof tiles have been engineered to be self-cleaning by copying the mechanism from the Nelumbo lotus.[3]
  • Cholesteric liquid crystals (CLCs) are the thin-film material often used to fabricate fish tank thermometers or mood rings, that change color with temperature changes. They change color because their molecules are arranged in a helical or chiral arrangement and with temperature the pitch of that helical structure changes, reflecting different wavelengths of light. Chiral Photonics, Inc. has abstracted the self-assembled structure of the organic CLCs to produce analogous optical devices using tiny lengths of inorganic, twisted glass fiber.
  • The wing structure of the blue morpho butterfly was studied and the way it reflects light was mimicked to create an RFID tag that can be read through water and on metal.[4]
  • The wing structure of butterflies has also inspired the creation of new nanosensors to detect explosives.[5]
  • Technoecosystems or 'EcoCyborg' systems involve the coupling of natural ecological processes to technological ones which mimic ecological functions. This results in the creation of a self-regulating hybrid system.[6] Research into this field was initiated by Howard T. Odum,[7] who perceived the structure and emergy dynamics of ecosystems as being analogous to energy flow between components of an electrical circuit.
  • Medical adhesives involving glue and tiny nano-hairs are being developed based on the physical structures found in the feet of geckos.
  • Computer viruses also show troubling similarities with biological viruses in their way to curb program-oriented information towards self-reproduction and dissemination.
  • The cooling system of the Eastgate Centre building, in Harare was modeled after a termite mound to achieve very efficient passive cooling.
  • Adhesive which allows mussels to stick to rocks, piers and boat hulls inspired bioadhesive gel for blood vessels.[8]
  • Through the field of bionics, new aircraft designs with far greater agility and other advantages may be created. This has been described by Geoff Spedding and Anders Hedenström in an article in Journal of Experimental Biology. Similar statements were also made by John Videler and Eize Stamhuis in their book Avian Flight [9] and in the article they present in Science about LEVs.[10] John Videler and Eize Stamhuis have since worked out real-life improvements to airplane wings, using bionics research. This research in bionics may also be used to create more efficient helicopters or miniature UAVs. This latter was stated by Bret Tobalske in an article in Science about Hummingbirds.[11] Bret Tobalske has thus now started work on creating these miniature UAVs which may be used for espionage. UC Berkeley as well as ESA have finally also been working in a similar direction and created the Robofly [12] (a miniature UAV) and the Entomopter (a UAV which can walk, crawl and fly).[13]

Specific uses of the term

In medicine

Bionics is a term which refers to the flow of concepts from biology to engineering and vice versa. Hence, there are two slightly different points of view regarding the meaning of the word.

In medicine, bionics means the replacement or enhancement of organs or other body parts by mechanical versions. Bionic implants differ from mere prostheses by mimicking the original function very closely, or even surpassing it.

Bionics' German equivalent, Bionik, always adheres to the broader meaning, in that it tries to develop engineering solutions from biological models. This approach is motivated by the fact that biological solutions will usually be optimized by evolutionary forces.

While the technologies that make bionic implants possible are still in a very early stage, a few bionic items already exist, the best known being the cochlear implant, a device for deaf people. By 2004 fully functional artificial hearts were developed. Significant further progress is expected to take place with the advent of nanotechnologies. A well-known example of a proposed nanodevice is a respirocyte, an artificial red cell, designed (though not built yet) by Robert Freitas.

Kwabena Boahen from Ghana was a professor in the Department of Bioengineering at the University of Pennsylvania. During his eight years at Penn, he developed a silicon retina that was able to process images in the same manner as a living retina. He confirmed the results by comparing the electrical signals from his silicon retina to the electrical signals produced by a salamander eye while the two retinas were looking at the same image.

In 2007 the Scottish company Touch Bionics launched the first commercially available bionic hand, named "i-Limb Hand". According to the firm, by May 2010 it has been fitted to more than 1,200 patients worldwide.[14]

The Nichi-In group is working on bimomimicking scaffolds in tissue engineering, stem cells and regenerative medicine have given a detailed classification on biomimetics in medicine.[15]

Politics

A political form of biomimicry is bioregional democracy, wherein political borders conform to natural ecoregions rather than human cultures or the outcomes of prior conflicts.

Critics of these approaches often argue that ecological selection itself is a poor model of minimizing manufacturing complexity or conflict, and that the free market relies on conscious cooperation, agreement, and standards as much as on efficiency – more analogous to sexual selection. Charles Darwin himself contended that both were balanced in natural selection – although his contemporaries often avoided frank talk about sex, or any suggestion that free market success was based on persuasion, not value.

Advocates, especially in the anti-globalization movement, argue that the mating-like processes of standardization, financing and marketing, are already examples of runaway evolution – rendering a system that appeals to the consumer but which is inefficient at use of energy and raw materials. Biomimicry, they argue, is an effective strategy to restore basic efficiency.

Biomimicry is also the second principle of Natural Capitalism.

Other uses

Business biomimetics is the latest development in the application of biomimetics. Specifically it applies principles and practice from biological systems to business strategy, process, organisation design and strategic thinking. It has been successfully used by a range of industries in FMCG, defence, central government, packaging and business services. Based on the work by Phil Richardson at the University of Bath[16] the approach was launched at the House of Lords in May 2009.

In a more specific meaning, it is a creativity technique that tries to use biological prototypes to get ideas for engineering solutions. This approach is motivated by the fact that biological organisms and their organs have been well optimized by evolution. In chemistry, a biomimetic synthesis is a chemical synthesis inspired by biochemical processes.

Another, more recent meaning of the term bionics refers to merging organism and machine. This approach results in a hybrid system combining biological and engineering parts, which can also be referred as a cybernetic organism (cyborg). Practical realization of this was demonstrated in Kevin Warwick's implant experiments bringing about ultrasound input via his own nervous system.

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Liver



From Wikipedia, the free encyclopedia

Liver
Anatomy Abdomen Tiesworks.jpg
Human liver shown in abdomen
Details
Latin Jecur, iecur
Greek Hepar (ἧπαρm)
root hepat- (ἡπατ-)
Precursor Foregut
System Digestive system
hepatic artery
Hepatic vein and hepatic portal vein
Celiac ganglia and vagus nerve[1]
Identifiers
Gray's p.1188
MeSH A03.620
TA A05.8.01.001
FMA 7197
Anatomical terminology

The liver is a vital organ of vertebrates and some other animals. In the human it is located in the upper right quadrant of the abdomen, below the diaphragm. The liver has a wide range of functions, including detoxification of various metabolites, protein synthesis, and the production of biochemicals necessary for digestion. There is currently no way to compensate for the absence of liver function in the long term, although liver dialysis techniques can be used in the short term.

The liver is a gland and plays a major role in metabolism with numerous functions in the human body, including regulation of glycogen storage, decomposition of red blood cells, plasma protein synthesis, hormone production, and detoxification. It is an accessory digestive gland and produces bile, an alkaline compound which aids in digestion via the emulsification of lipids. The liver's highly specialized tissue consisting of mostly hepatocytes regulates a wide variety of high-volume biochemical reactions, including the synthesis and breakdown of small and complex molecules, many of which are necessary for normal vital functions.[2] Estimates regarding the organ's total number of functions vary, but textbooks generally cite it being around 500.[3]

Terminology related to the liver often starts in hepar- or hepat- from the Greek word for liver, hēpar (ἧπαρ, root hepat-, ἡπατ-).[4][5]

Structure


Capillaries, sinusoid on right

The liver is a reddish brown triangular organ with four lobes of unequal size and shape. A human liver normally weighs 1.44–1.66 kg (3.2–3.7 lb).[6] It is both the largest internal organ and the largest gland in the human body. Located in the right upper quadrant of the abdominal cavity, it rests just below the diaphragm, to the right of the stomach and overlying the gallbladder. It is connected to two large blood vessels, the hepatic artery and the portal vein. The hepatic artery carries oxygen-rich blood from the aorta, whereas the portal vein carries blood rich in digested nutrients from the entire gastrointestinal tract and also from the spleen and pancreas. These blood vessels subdivide into small capillaries known as liver sinusoids, which then lead to a lobule. Lobules are the functional units of the liver and each lobule is made up of millions of hepatic cells (hepatocytes) which are the basic metabolic cells.

Gross anatomy


The upper surface of the liver showing two lobes

Visceral surface showing four lobes

Gross anatomy traditionally divided the liver into two – a right and a left lobe, as viewed from the front (diaphragmatic) surface; but the underside (the visceral surface) shows it to be divided into four lobes and includes the caudate and quadrate lobes.

The falciform ligament is visible on the front of the liver and this divides the liver into a left and a much larger right lobe. From the visceral surface, the two additional lobes are located between the right and left lobes, one in front of the other. On the visceral surface a functional anatomy determines the organisation of the liver. A line can be visualised running from the left of the vena cava and all the way forward to divide the liver and gallbladder into two halves. This line is called Cantlie's line. Other anatomical landmarks exist, such as the ligamentum venosum and the round ligament of the liver (ligamentum teres) that further divide the left side of the liver in two sections. Now an important anatomical landmark, the transverse fissure of the liver divides this left portion of the liver into four segments which will be numbered starting at the caudate lobule as I in an anti-clock manner. From this visceral view we can see 7 segments because the 8th segment is only visible in the parietal view.

Surfaces

On the diaphragmatic surface, apart from a large triangular bare area, where it connects to the diaphragm, the liver is covered by a thin double-layered membrane, the peritoneum, that reduces friction against other organs. This surface covers the convex shape of the two lobes where it accommodates the shape of the diaphragm. The peritoneum folds back on itself to form the falciform ligament and the right and left triangular ligaments.

These "peritoneal ligaments" are not related to the true anatomic ligaments in joints, and the right and left triangular ligaments have no known functional importance, but they serve as recognizable surface landmarks. The falciform ligament however, does function to attach the liver to the posterior portion of the anterior body wall.

The visceral surface or inferior surface, is uneven and concave. It is covered in peritoneum apart from where it attaches the gallbladder and the porta hepatis.

Impressions


Impressions on liver (posterior view)

There are several impressions on the surface of the liver which accommodate the various adjacent structures and organs. Underneath the right lobe and to the right of the gallbladder fossa, are two impressions, one behind the other and separated by a ridge. The one in front is a shallow colic impression, formed by the hepatic flexure and the one behind is a deeper renal impression accommodating part of the right kidney and part of the suprarenal gland.

The suprarenal impression is a small triangular depressed area on the liver. It is located close to the right of the fossa between the bare area and the caudate lobe and immediately above the renal impression. The greater part of the suprarenal impression is devoid of peritoneum and it lodges the right suprarenal gland.

Medial to the renal impression is a third and slightly marked impression, lying between it and the neck of the gall-bladder. This is caused by the descending portion of the duodenum, and is known as the duodenal impression.

The inferior surface of the left lobe of the liver presents behind and to the left the gastric impression, moulded over the antero-superior surface of the stomach, and to the right of this a rounded eminence, the tuber omentale, which fits into the concavity of the lesser curvature of the stomach and lies in front of the anterior layer of the lesser omentum.

Microscopic anatomy


Liver structure showing cells

Histology, the study of microscopic anatomy shows two major types of cells of the liver: parenchymal and non-parenchymal cells. 80% of the liver volume is occupied by parenchymal cells commonly referred to as hepatocytes. Non-parenchymal cells constitute 40% of the total number of liver cells but only 6.5% of its volume. The liver sinusoids are lined with two types of cell, sinusoidal endothelial cells, and phagocytic Kupffer cells.[7] Hepatic stellate cells are some of the non-parenchymal cells are external to the sinusoid in the space of Disse.[8]
Basic structure of a lobule
Each of the lobes is seen to be made up of hepatic lobules; a vein goes from the centre, which then joins to the hepatic vein to carry blood out from the liver. On the surface of the lobules, there are ducts, veins and arteries that carry fluids to and from them. A distinctive component of a lobule is the portal triad.

Functional anatomy

Correspondence between anatomic lobes and Couinaud segments
Segment* Couinaud segments
Caudate 1
Lateral 2, 3
Medial 4a, 4b
Right 5, 6, 7, 8
* or lobe, in the case of the caudate lobe
Each number in the list corresponds to one in the table
1. Caudate
2. Superior subsegment of the lateral segment
3. Inferior subsegment of the lateral segment
4a. Superior subsegment of the medial segment
4b. Inferior subsegment of the medial segment
5. Inferior subsegment of the anterior segment
6. Inferior subsegment of the posterior segment
7. Superior subsegment of the posterior segment
8. Superior subsegment of the anterior segment
The central area where the common bile duct, hepatic portal vein, and the hepatic artery proper enter is the hilum known as the porta hepatis (gateway to the liver) or the transverse fissure of the liver. The duct, vein, and artery divide into left and right branches, and the areas of the liver supplied by these branches constitute the functional left and right lobes.

The functional lobes are separated by the imaginary plane, Cantlie's line joining the gallbladder fossa to the inferior vena cava. The plane separates the liver into the true right and left lobes. The middle hepatic vein also demarcates the true right and left lobes. The right lobe is further divided into an anterior and posterior segment by the right hepatic vein. The left lobe is divided into the medial and lateral segments by the left hepatic vein. The fissure for the round ligament of the liver (ligamentum teres) also separates the medial and lateral segments. The medial segment is also called the quadrate lobe. In the widely used Couinaud (or "French") system, the functional lobes are further divided into a total of eight subsegments based on a transverse plane through the bifurcation of the main portal vein. The caudate lobe is a separate structure which receives blood flow from both the right- and left-sided vascular branches.[9][10]

Development

Organogenesis, the development of the organs takes place from the third to the eighth week in human embryogenesis. The origins of the liver lie in both the ventral portion of the foregut endoderm (endoderm being one of the 3 embryonic germ cell layers) and the constituents of the adjacent septum transversum mesenchyme. In human embryo, the hepatic diverticulum is the tube of endoderm that extends out from the foregut into the surrounding mesenchyme. The mesenchyme of septum transversum induces this endoderm to proliferate, to branch, and to form the glandular epithelium of the liver. A portion of the hepatic diverticulum (that region closest to the digestive tube) continues to function as the drainage duct of the liver, and a branch from this duct produces the gallbladder.[11]
Besides signals from the septum transversum mesenchyme, fibroblast growth factor from the developing heart also contributes to hepatic competence, along with retinoic acid emanating from the lateral plate mesoderm. The hepatic endodermal cells undergo a morphological transition from columnar to pseudostratified resulting in thickening into the early liver bud. Their expansion forms a population of the bipotential hepatoblasts.[12] Hepatic stellate cells are derived from mesenchyme.[13]

After migration of hepatoblasts into the septum transversum mesenchyme, the hepatic architecture begins to be established, with liver sinusoids and bile canaliculi appearing. The liver bud separates into the lobes. The left umbilical vein becomes the ductus venosus and the right vitelline vein becomes the portal vein. The expanding liver bud is colonized by hematopoietic cells. The bipotential hepatoblasts begin differentiating into biliary epithelial cells and hepatocytes. The biliary epithelial cells differentiate from hepatoblasts around portal veins, first producing a monolayer, and then a bilayer of cuboidal cells. In ductal plate, focal dilations emerge at points in the bilayer, become surrounded by portal mesenchyme, and undergo tubulogenesis into intrahepatic bile ducts. Hepatoblasts not adjacent to portal veins instead differentiate into hepatocytes and arrange into cords lined by sinudoidal epithelial cells and bile canaliculi. Once hepatoblasts are specified into hepatocytes and undergo further expansion, they begin acquiring the functions of a mature hepatocyte, and eventually mature hepatocytes appear as highly polarized epithelial cells with abundant glycogen accumulation. In the adult liver, hepatocytes are not equivalent, with position along the portocentrovenular axis within a liver lobule dictating expression of metabolic genes involved in drug metabolism, carbohydrate metabolism, ammonia detoxification, and bile production and secretion. WNT/β-catenin has now been identified to be playing a key role in this phenomenon.[12]

Fetal blood supply

In the growing fetus, a major source of blood to the liver is the umbilical vein which supplies nutrients to the growing fetus. The umbilical vein enters the abdomen at the umbilicus, and passes upward along the free margin of the falciform ligament of the liver to the inferior surface of the liver. There it joins with the left branch of the portal vein. The ductus venosus carries blood from the left portal vein to the left hepatic vein and then to the inferior vena cava, allowing placental blood to bypass the liver.

In the fetus, the liver develops throughout normal gestation, and does not perform the normal filtration of the infant liver. The liver does not perform digestive processes because the fetus does not consume meals directly, but receives nourishment from the mother via the placenta. The fetal liver releases some blood stem cells that migrate to the fetal thymus, so initially the lymphocytes, called T-cells, are created from fetal liver stem cells. Once the fetus is delivered, the formation of blood stem cells in infants shifts to the red bone marrow.

After birth, the umbilical vein and ductus venosus are completely obliterated in two to five days; the former becomes the ligamentum teres and the latter becomes the ligamentum venosum. In the disease state of cirrhosis and portal hypertension, the umbilical vein can open up again.

During childhood

At birth the liver comprises roughly 4% of body weight and is at average 120g. Over the course of development it will increase to 1,4–1,6 kg but will only take up 2.5–3.5% of body weight.[14]

Physiology

The various functions of the liver are carried out by the liver cells or hepatocytes. Currently, there is no artificial organ or device capable of emulating all the functions of the liver. Some functions can be emulated by liver dialysis, an experimental treatment for liver failure. The liver is thought to be responsible for up to 500 separate functions, usually in combination with other systems and organs.

Blood supply

The liver gets a dual blood supply from the hepatic portal vein and hepatic arteries. Supplying approximately 75% of the liver's blood supply, the hepatic portal vein carries venous blood drained from the spleen, gastrointestinal tract, and its associated organs. The hepatic arteries supply arterial blood to the liver, accounting for the remainder of its blood flow. Oxygen is provided from both sources; approximately half of the liver's oxygen demand is met by the hepatic portal vein, and half is met by the hepatic arteries.[15]

Blood flows through the liver sinusoids and empties into the central vein of each lobule. The central veins coalesce into hepatic veins, which leave the liver.
  • Axial CT image showing anomalous hepatic veins coursing on the subcapsular anterior surface of the liver.[16]
  • Maximum intensity projection (MIP) CT image as viewed anteriorly showing the anomalous hepatic veins coursing on the anterior surface of the liver
  • Lateral MIP view in the same patient
  • A CT scan in which the liver and portal vein are shown.

Biliary flow


Biliary tree

The term biliary tree is derived from the branches of the bile ducts. The bile produced in the liver is collected in bile canaliculi, which merge to form bile ducts. Within the liver, these ducts are called intrahepatic (within the liver) bile ducts, and once they exit the liver they are considered extrahepatic (outside the liver). The intrahepatic ducts eventually drain into the right and left hepatic ducts, which merge to form the common hepatic duct. The cystic duct from the gallbladder joins with the common hepatic duct to form the common bile duct.

Bile either drains directly into the duodenum via the common bile duct, or is temporarily stored in the gallbladder via the cystic duct. The common bile duct and the pancreatic duct enter the second part of the duodenum together at the ampulla of Vater.

Synthesis

Breakdown

Other functions

Relation to medicine and pharmacology

The oxidative capacity of the liver decreases with aging and therefore any medications that require oxidation (for instance, benzodiazepines) are more likely to accumulate to toxic levels. However, medications with shorter half-lives, such as lorazepam and oxazepam, are preferred in most cases when benzodiazepines are required in regards to geriatric medicine.

Clinical significance

Disease

Left lobe liver tumor

The liver supports almost every organ in the body and is vital for survival. Because of its strategic location and multidimensional functions, the liver is also prone to many diseases.[17]

Hepatitis is a common condition of inflammation of the liver. The most usual cause of this is viral, and the most common of these infections are hepatitis A B C D and E. Some of these infections are sexually transmitted. Inflammation can also be caused by other viruses in the Herpesviridae family such as the herpes simplex virus. Infection with hepatitis B virus or hepatitis C virus is the main cause of liver cancer.

Other disorders caused by excessive alcohol consumption are grouped under alcoholic liver diseases and these include alcoholic hepatitis, fatty liver, and cirrhosis. Liver damage can also be caused by drugs in particular paracetomol and drugs used to treat cancer.

Many diseases of the liver are accompanied by jaundice caused by increased levels of bilirubin in the system. The bilirubin results from the breakup of the hemoglobin of dead red blood cells; normally, the liver removes bilirubin from the blood and excretes it through bile.

There are also many pediatric liver diseases including biliary atresia, alpha-1 antitrypsin deficiency, alagille syndrome, progressive familial intrahepatic cholestasis, and Langerhans cell histiocytosis, to name but a few.

Diseases that interfere with liver function will lead to derangement of these processes. However, the liver has a great capacity to regenerate and has a large reserve capacity. In most cases, the liver only produces symptoms after extensive damage.

Liver diseases may be diagnosed by liver function tests, for example, by production of acute phase proteins.

Symptoms

The classic symptoms of liver damage include the following:
  • Pale stools occur when stercobilin, a brown pigment, is absent from the stool. Stercobilin is derived from bilirubin metabolites produced in the liver.
  • Dark urine occurs when bilirubin mixes with urine
  • Jaundice (yellow skin and/or whites of the eyes) This is where bilirubin deposits in skin, causing an intense itch. Itching is the most common complaint by people who have liver failure. Often this itch cannot be relieved by drugs.
  • Swelling of the abdomen, ankles and feet occurs because the liver fails to make albumin.
  • Excessive fatigue occurs from a generalized loss of nutrients, minerals and vitamins.
  • Bruising and easy bleeding are other features of liver disease. The liver makes substances which help prevent bleeding. When liver damage occurs, these substances are no longer present and severe bleeding can occur.[18]

Diagnosis

The diagnosis of liver function is made by liver function tests, groups of blood tests, that can readily show the extent of liver damage. If infection is suspected, then other serological tests will be carried out. Sometimes, an ultrasound or a CT scan is needed to produce an image of the liver.

Physical examination of the liver can only reveal its size and any tenderness, and some form of imaging will also be needed.[19]

Biopsy / scan

Damage to the liver is sometimes determined with a biopsy, particularly when the cause of liver damage is unknown. In the 21st century they were largely replaced by high-resolution radiographic scans. The latter do not require ultrasound guidance, lab involvement, microscopic analysis, organ damage, pain, or patient sedation; and the results are available immediately on a computer screen.

In a biopsy, a needle is inserted into the skin just below the rib cage and a tissue sample obtained. The tissue is sent to the laboratory, where it is analyzed under a microscope. Sometimes, a radiologist may assist the physician performing a liver biopsy by providing ultrasound guidance.[20]

Liver regeneration

The liver is the only human internal organ capable of natural regeneration of lost tissue; as little as 25% of a liver can regenerate into a whole liver.[21] This is, however, not true regeneration but rather compensatory growth in mammals.[22] The lobes that are removed do not regrow and the growth of the liver is a restoration of function, not original form. This contrasts with true regeneration where both original function and form are restored. In lower species such as fish, the liver undergoes true regeneration by restoring both shape and size of the organ.[23] In liver, large areas of the tissues are formed but for the formation of new cells there must be sufficient amount of material so the circulation of the blood becomes more active.[24]
This is predominantly due to the hepatocytes re-entering the cell cycle. That is, the hepatocytes go from the quiescent G0 phase to the G1 phase and undergo mitosis. This process is activated by the p75 receptors.[25] There is also some evidence of bipotential stem cells, called hepatic oval cells or ovalocytes (not to be confused with oval red blood cells of ovalocytosis), which are thought to reside in the canals of Hering. These cells can differentiate into either hepatocytes or cholangiocytes, the latter being the cells that line the bile ducts.[citation needed]

Scientific and medical works about liver regeneration often refer to the Greek Titan Prometheus who was chained to a rock in the Caucasus where, each day, his liver was devoured by an eagle, only to grow back each night. The myth suggests the ancient Greeks knew about the liver’s remarkable capacity for self-repair, however, this claim is purely speculative.[26]

Liver transplantation

Human liver transplants were first performed by Thomas Starzl in the United States and Roy Calne in Cambridge, England in 1963 and 1965, respectively.

After resection of left lobe liver tumor

Liver transplantation is the only option for those with irreversible liver failure. Most transplants are done for chronic liver diseases leading to cirrhosis, such as chronic hepatitis C, alcoholism, autoimmune hepatitis, and many others. Less commonly, liver transplantation is done for fulminant hepatic failure, in which liver failure occurs over days to weeks.

Liver allografts for transplant usually come from donors who have died from fatal brain injury. Living donor liver transplantation is a technique in which a portion of a living person's liver is removed and used to replace the entire liver of the recipient. This was first performed in 1989 for pediatric liver transplantation. Only 20 percent of an adult's liver (Couinaud segments 2 and 3) is needed to serve as a liver allograft for an infant or small child.

More recently, adult-to-adult liver transplantation has been done using the donor's right hepatic lobe, which amounts to 60 percent of the liver. Due to the ability of the liver to regenerate, both the donor and recipient end up with normal liver function if all goes well. This procedure is more controversial, as it entails performing a much larger operation on the donor, and indeed there have been at least two donor deaths out of the first several hundred cases. A recent publication has addressed the problem of donor mortality, and at least 14 cases have been found.[27] The risk of postoperative complications (and death) is far greater in right-sided operations than that in left-sided operations.

With the recent advances of noninvasive imaging, living liver donors usually have to undergo imaging examinations for liver anatomy to decide if the anatomy is feasible for donation. The evaluation is usually performed by multidetector row computed tomography (MDCT) and magnetic resonance imaging (MRI). MDCT is good in vascular anatomy and volumetry. MRI is used for biliary tree anatomy. Donors with very unusual vascular anatomy, which makes them unsuitable for donation, could be screened out to avoid unnecessary operations.
  • MDCT image. Arterial anatomy contraindicated for liver donation
  • MDCT image. Portal venous anatomy contraindicated for liver donation
  • MDCT image. 3D image created by MDCT can clearly visualize the liver, measure the liver volume, and plan the dissection plane to facilitate the liver transplantation procedure.
  • Phase contrast CT image. Contrast is perfusing the right liver but not the left due to a left portal vein thrombus.

Society and culture

In Greek mythology, Prometheus was punished by the gods for revealing fire to humans, by being chained to a rock where a vulture (or an eagle) would peck out his liver, which would regenerate overnight. (The liver is the only human internal organ that actually can regenerate itself to a significant extent.) Many ancient peoples of the Near East and Mediterranean areas practiced a type of divination called haruspicy, where they tried to obtain information by examining the livers of sheep and other animals.

In Plato, and in later physiology, the liver was thought to be the seat of the darkest emotions (specifically wrath, jealousy and greed) which drive men to action.[28] The Talmud (tractate Berakhot 61b) refers to the liver as the seat of anger, with the gallbladder counteracting this.

The Persian, Urdu, and Hindi languages (جگر or जिगर or jigar) refer to the liver in figurative speech to indicate courage and strong feelings, or "their best"; e.g., "This Mecca has thrown to you the pieces of its liver!".[29] The term jan e jigar, literally "the strength (power) of my liver", is a term of endearment in Urdu. In Persian slang, jigar is used as an adjective for any object which is desirable, especially women. In the Zulu language, the word for liver (isibindi) is the same as the word for courage.

The legend of Liver-Eating Johnson says that he would cut out and eat the liver of each man killed after dinner.

In the motion picture The Message, Hind bint Utbah is implied or portrayed eating the liver of Hamza ibn ‘Abd al-Muttalib during the Battle of Uhud. Although there are narrations that suggest that Hind did "taste", rather than eat, the liver of Hamza, the authenticity of these narrations have to be questioned.

Food

The liver of mammals, fowl, and fish are commonly eaten as food by humans. Domestic pig, ox, lamb, calf, chicken, and goose livers are widely available from butchers and supermarkets.
Liver can be baked, boiled, broiled, fried, stir-fried, or eaten raw (asbeh nayeh or sawda naye in Lebanese cuisine, liver sashimi). In many preparations, pieces of liver are combined with pieces of meat or kidneys, like in the various forms of Middle Eastern mixed grill (e.g. meurav Yerushalmi). Liver is often made into spreads. Well-known examples include liver pâté, foie gras, chopped liver, and leverpastej. Liver sausages such as Braunschweiger and liverwurst are also a valued meal. Liver sausages may also be used as spreads. A traditional South African delicacy, namely Skilpadjies, is made of minced lamb's liver wrapped in netvet (caul fat), and grilled over an open fire.

Animal livers are rich in iron and vitamin A, and cod liver oil is commonly used as a dietary supplement. Traditionally, some fish livers were valued as food, especially the stingray liver. It was used to prepare delicacies, such as poached skate liver on toast in England, as well as the beignets de foie de raie and foie de raie en croute in French cuisine.[30]

Other animals


Sheep's liver

The liver is found in all vertebrates, and is typically the largest visceral (internal) organ. Its form varies considerably in different species, and is largely determined by the shape and arrangement of the surrounding organs. Nonetheless, in most species it is divided into right and left lobes; exceptions to this general rule include snakes, where the shape of the body necessitates a simple cigar-like form. The internal structure of the liver is broadly similar in all vertebrates.[31]

An organ sometimes referred to as a liver is found associated with the digestive tract of the primitive chordate Amphioxus. However, this is an enzyme secreting gland, not a metabolic organ, and it is unclear how truly homologous it is to the vertebrate liver.[31]

Additional images

  • Anterior view of the liver.
  • Inferior view of the liver.
  • Schematic posterior view of the liver.
  • View of the various organs and blood-vessels in proximity with liver.
  • Liver lifted to show gall bladder and stomach in situ.
  • Cross section showing the liver as the large brown mass in the left of the images, right of the individual.
  • Cross section of an inferior portion of the liver, showing gallbladder and various structures.
  • Human liver.Visceral surface of liver.
  • Human liver.Horizontal section to newborn

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