Inhoudsopgave
Histologie van lever....................................................................................................................................... 3
Anatomie.................................................................................................................................................... 3
4 lobben................................................................................................................................................3
8 segmenten (volgens Couinaud)........................................................................................................ 3
Histologie................................................................................................................................................... 4
Lobulus van Kiernan.............................................................................................................................4
Acinus van Rappaport.......................................................................................................................... 4
Portale lobulus......................................................................................................................................5
Architectuur van de lever........................................................................................................................... 6
Portaveld.............................................................................................................................................. 6
Leverparenchym...................................................................................................................................6
Lymfeafvoer..........................................................................................................................................7
Sinusoïden................................................................................................................................................. 8
Sinusoïdale endotheelcellen................................................................................................................ 8
Kupffer cellen (1876)............................................................................................................................ 8
Stellaire cellen (1876)...........................................................................................................................9
Intrasinusoïdale lymfocyten................................................................................................................10
Extracellulaire matrix................................................................................................................................ 10
Leverpathologie.................................................................................................................................. 11
Leverpathologie........................................................................................................................................12
Alcohol................................................................................................................................................13
Levercirrose........................................................................................................................................15
Complicaties.......................................................................................................................................16
Histologie van galblaas............................................................................................................................... 17
Gal............................................................................................................................................................17
Galwegsysteem........................................................................................................................................17
Galcanaliculus.................................................................................................................................... 18
Kanaal van Hering = galductulus....................................................................................................... 18
Galductus........................................................................................................................................... 19
Galblaas............................................................................................................................................. 19
Extrahepatisch systeem..................................................................................................................... 20
Histologie van de gastro-intestinale tractus............................................................................................. 22
Mondholte................................................................................................................................................ 22
Lippen.................................................................................................................................................22
Tanden................................................................................................................................................22
Gingiva = tandvlees............................................................................................................................23
Tong....................................................................................................................................................24
Mond.................................................................................................................................................. 25
Pharynx.............................................................................................................................................. 25
Gastro-intestinale tractus......................................................................................................................... 26
Mucosa...............................................................................................................................................26
Submucosa........................................................................................................................................ 26
Muscularis propria.............................................................................................................................. 27
1
, Serosa/adventitia................................................................................................................................27
Bezenuwing........................................................................................................................................27
Onderdelen.........................................................................................................................................28
Slokdarm.................................................................................................................................................. 28
Mucosa...............................................................................................................................................29
Submucosa........................................................................................................................................ 29
Muscularis propria.............................................................................................................................. 29
(Dys)functie........................................................................................................................................ 30
Maag........................................................................................................................................................ 31
Mucosa...............................................................................................................................................32
Celtypes............................................................................................................................................. 34
Bescherming tegen maagzuur........................................................................................................... 35
Gastritis.............................................................................................................................................. 36
Dunne darm............................................................................................................................................. 37
Mucosa...............................................................................................................................................38
Submucosa........................................................................................................................................ 41
3 delen van de dunne darm................................................................................................................42
Coeliakie.............................................................................................................................................43
Dikke darm............................................................................................................................................... 43
Mucosa...............................................................................................................................................44
Appendix............................................................................................................................................ 45
Rectum............................................................................................................................................... 46
Acute zelf-limiterende colitis = infectieuze colitis............................................................................... 46
Examenvragen......................................................................................................................................... 47
Histologie van de spijsverteringsklieren................................................................................................... 48
Spijsverteringsklieren............................................................................................................................... 48
Speekselklieren........................................................................................................................................48
Tubuloalveolaire klieren..................................................................................................................... 48
Acini....................................................................................................................................................49
Afvoergangen..................................................................................................................................... 50
Speeksel.............................................................................................................................................52
Pancreas.................................................................................................................................................. 53
Afvoersysteem....................................................................................................................................53
Sereuze exocriene klier......................................................................................................................54
Endocriene klier..................................................................................................................................54
Dubbele bloedvoorziening..................................................................................................................55
Pathologie: acute pancreatitis............................................................................................................ 56
Pathologie: chronische pancreatitis....................................................................................................57
2
,Histologie van lever
Anatomie
● grootste klier van het lichaam
● grootste parenchymateus abdominaal orgaan: 1200-1500 g
● locatie: van rechter fossa hypochondriaca tot fossa epigastrica
● vrijwel volledig omgeven door peritoneum
vorm
● pyramide: basis thv rechter flank, top thv linker flank
● beweegt met de ademhaling en houding
oppervlakken
● diafragmatisch oppervlak: in de koepel van het diafragma
● visceraal oppervlak
○ in contact met diverse organen: maag, dunne darm, galblaas …
○ porta hepatis (hilus): bloedvaten gaan lever binnen en galwegen treden naar buiten
4 lobben
→ scheidt de bloedvoorziening en galafvoer
rechter lob (grootste): gescheiden van linker lob door …
● ventraal: ligamentum falciforme
● interior/posterior: ligamentum teres en ligamentum venosum
linker lob: bevat 2 lobus
● lobus caudatus: tegen vena porta
● lobus quadratus: tegen galblaas
8 segmenten (volgens Couinaud)
● verdeeld op basis van bloedtoevoer
● segment 2-8: anterior
● segment 1 = lobus caudatus
⇒ voordeel: kleinere resercties (segmentectomies)
3
, Histologie
classificatie op basis van de morfologische of functionele architectuur
● morfologie
○ lobulus van Kiernan (1)
● functie
○ acinus van Rappaport (3)
○ portale lobulus (2)
Lobulus van Kiernan
6-hoekige structuur
● centraal: terminale hepatische venule = vena centrilobularis
● hoeken: portale tractus = portavelden
vaatmarker (CD34)(rechts): vena centrilobularis beter in beeld brengen
→ zowel portavelden als vena centrilobularis kleuren bruin aan
praktijk
● biopt: de lobulus is een grote structuur die enkel kan gezien worden bij
biopten in een resectiestuk van 2 op 1 cm
● leverpunctiecilinder: cilinder van 2 cm lang met 2 mm diameter, waardoor
de lobulus niet zichtbaar is
Acinus van Rappaport
functionele eenheid op basis van dubbele bloedvoorziening
● a. hepatica (25%)
● v. portae (75%)
⇒ belangrijke structurele eenheid ter beoordeling van het leverbiopt
portaveld (v. portae + a. hepatica) → sinusoïde → v. centrolobularis → hepatische venen → v. cava inferior
4
, Lobulus vs. acinus
lobulus van Kiernan: 6-hoekig
acinus van Rappapport: ovale structuur met 3 verschillende zones
● zone 1: periportaal
● zone 2
● zone 3: centrilobulair
3 zones
functies van de lever zijn zonaal verdeeld
● bloed transporteren van portavelden naar sinusoïden
● uitwisseling van voedingsstoffen (opnemen) en afvalstoffen (afvoeren)
● uitwisseling van O2
opbouw: centraal liggen hepatocyten die begrensd worden door …
● bloedbaan: v. portae → sinusoïden → v. hepaticae
● canaliculus: kleine galkanaaltjes
zone 1 (periportaal)
● β-oxidatie
● ketogenese, gluconeogenese, glycogenolyse
● conjugatie van galzouten
zone 3 (centrilobulair)
● biotransformatie
● glycogenese, glycolyse
● vetdepositie
voorbeeld: cardiovasculaire shock → minder bloedvoorziening naar de lever → vooral schade thv zone 3
● oorzaak: gebieden waar de O2-concentratie in normale omstandigheden al laag is worden het eerst
aangetast
● centrilobulaire schade (bleke zones) rond vena centrolobularis
○ leverparenchym rond portaveld blijft bewaard
Portale lobulus
3-hoekige functionele eenheid op basis van transport van gal in de galwegen (tegengesteld aan bloed)
● bloed: portavelden → vena centrolobularis
● gal: van leverparenchym (hepatocyten) → galwegen in portavelden
5
Histologie van lever....................................................................................................................................... 3
Anatomie.................................................................................................................................................... 3
4 lobben................................................................................................................................................3
8 segmenten (volgens Couinaud)........................................................................................................ 3
Histologie................................................................................................................................................... 4
Lobulus van Kiernan.............................................................................................................................4
Acinus van Rappaport.......................................................................................................................... 4
Portale lobulus......................................................................................................................................5
Architectuur van de lever........................................................................................................................... 6
Portaveld.............................................................................................................................................. 6
Leverparenchym...................................................................................................................................6
Lymfeafvoer..........................................................................................................................................7
Sinusoïden................................................................................................................................................. 8
Sinusoïdale endotheelcellen................................................................................................................ 8
Kupffer cellen (1876)............................................................................................................................ 8
Stellaire cellen (1876)...........................................................................................................................9
Intrasinusoïdale lymfocyten................................................................................................................10
Extracellulaire matrix................................................................................................................................ 10
Leverpathologie.................................................................................................................................. 11
Leverpathologie........................................................................................................................................12
Alcohol................................................................................................................................................13
Levercirrose........................................................................................................................................15
Complicaties.......................................................................................................................................16
Histologie van galblaas............................................................................................................................... 17
Gal............................................................................................................................................................17
Galwegsysteem........................................................................................................................................17
Galcanaliculus.................................................................................................................................... 18
Kanaal van Hering = galductulus....................................................................................................... 18
Galductus........................................................................................................................................... 19
Galblaas............................................................................................................................................. 19
Extrahepatisch systeem..................................................................................................................... 20
Histologie van de gastro-intestinale tractus............................................................................................. 22
Mondholte................................................................................................................................................ 22
Lippen.................................................................................................................................................22
Tanden................................................................................................................................................22
Gingiva = tandvlees............................................................................................................................23
Tong....................................................................................................................................................24
Mond.................................................................................................................................................. 25
Pharynx.............................................................................................................................................. 25
Gastro-intestinale tractus......................................................................................................................... 26
Mucosa...............................................................................................................................................26
Submucosa........................................................................................................................................ 26
Muscularis propria.............................................................................................................................. 27
1
, Serosa/adventitia................................................................................................................................27
Bezenuwing........................................................................................................................................27
Onderdelen.........................................................................................................................................28
Slokdarm.................................................................................................................................................. 28
Mucosa...............................................................................................................................................29
Submucosa........................................................................................................................................ 29
Muscularis propria.............................................................................................................................. 29
(Dys)functie........................................................................................................................................ 30
Maag........................................................................................................................................................ 31
Mucosa...............................................................................................................................................32
Celtypes............................................................................................................................................. 34
Bescherming tegen maagzuur........................................................................................................... 35
Gastritis.............................................................................................................................................. 36
Dunne darm............................................................................................................................................. 37
Mucosa...............................................................................................................................................38
Submucosa........................................................................................................................................ 41
3 delen van de dunne darm................................................................................................................42
Coeliakie.............................................................................................................................................43
Dikke darm............................................................................................................................................... 43
Mucosa...............................................................................................................................................44
Appendix............................................................................................................................................ 45
Rectum............................................................................................................................................... 46
Acute zelf-limiterende colitis = infectieuze colitis............................................................................... 46
Examenvragen......................................................................................................................................... 47
Histologie van de spijsverteringsklieren................................................................................................... 48
Spijsverteringsklieren............................................................................................................................... 48
Speekselklieren........................................................................................................................................48
Tubuloalveolaire klieren..................................................................................................................... 48
Acini....................................................................................................................................................49
Afvoergangen..................................................................................................................................... 50
Speeksel.............................................................................................................................................52
Pancreas.................................................................................................................................................. 53
Afvoersysteem....................................................................................................................................53
Sereuze exocriene klier......................................................................................................................54
Endocriene klier..................................................................................................................................54
Dubbele bloedvoorziening..................................................................................................................55
Pathologie: acute pancreatitis............................................................................................................ 56
Pathologie: chronische pancreatitis....................................................................................................57
2
,Histologie van lever
Anatomie
● grootste klier van het lichaam
● grootste parenchymateus abdominaal orgaan: 1200-1500 g
● locatie: van rechter fossa hypochondriaca tot fossa epigastrica
● vrijwel volledig omgeven door peritoneum
vorm
● pyramide: basis thv rechter flank, top thv linker flank
● beweegt met de ademhaling en houding
oppervlakken
● diafragmatisch oppervlak: in de koepel van het diafragma
● visceraal oppervlak
○ in contact met diverse organen: maag, dunne darm, galblaas …
○ porta hepatis (hilus): bloedvaten gaan lever binnen en galwegen treden naar buiten
4 lobben
→ scheidt de bloedvoorziening en galafvoer
rechter lob (grootste): gescheiden van linker lob door …
● ventraal: ligamentum falciforme
● interior/posterior: ligamentum teres en ligamentum venosum
linker lob: bevat 2 lobus
● lobus caudatus: tegen vena porta
● lobus quadratus: tegen galblaas
8 segmenten (volgens Couinaud)
● verdeeld op basis van bloedtoevoer
● segment 2-8: anterior
● segment 1 = lobus caudatus
⇒ voordeel: kleinere resercties (segmentectomies)
3
, Histologie
classificatie op basis van de morfologische of functionele architectuur
● morfologie
○ lobulus van Kiernan (1)
● functie
○ acinus van Rappaport (3)
○ portale lobulus (2)
Lobulus van Kiernan
6-hoekige structuur
● centraal: terminale hepatische venule = vena centrilobularis
● hoeken: portale tractus = portavelden
vaatmarker (CD34)(rechts): vena centrilobularis beter in beeld brengen
→ zowel portavelden als vena centrilobularis kleuren bruin aan
praktijk
● biopt: de lobulus is een grote structuur die enkel kan gezien worden bij
biopten in een resectiestuk van 2 op 1 cm
● leverpunctiecilinder: cilinder van 2 cm lang met 2 mm diameter, waardoor
de lobulus niet zichtbaar is
Acinus van Rappaport
functionele eenheid op basis van dubbele bloedvoorziening
● a. hepatica (25%)
● v. portae (75%)
⇒ belangrijke structurele eenheid ter beoordeling van het leverbiopt
portaveld (v. portae + a. hepatica) → sinusoïde → v. centrolobularis → hepatische venen → v. cava inferior
4
, Lobulus vs. acinus
lobulus van Kiernan: 6-hoekig
acinus van Rappapport: ovale structuur met 3 verschillende zones
● zone 1: periportaal
● zone 2
● zone 3: centrilobulair
3 zones
functies van de lever zijn zonaal verdeeld
● bloed transporteren van portavelden naar sinusoïden
● uitwisseling van voedingsstoffen (opnemen) en afvalstoffen (afvoeren)
● uitwisseling van O2
opbouw: centraal liggen hepatocyten die begrensd worden door …
● bloedbaan: v. portae → sinusoïden → v. hepaticae
● canaliculus: kleine galkanaaltjes
zone 1 (periportaal)
● β-oxidatie
● ketogenese, gluconeogenese, glycogenolyse
● conjugatie van galzouten
zone 3 (centrilobulair)
● biotransformatie
● glycogenese, glycolyse
● vetdepositie
voorbeeld: cardiovasculaire shock → minder bloedvoorziening naar de lever → vooral schade thv zone 3
● oorzaak: gebieden waar de O2-concentratie in normale omstandigheden al laag is worden het eerst
aangetast
● centrilobulaire schade (bleke zones) rond vena centrolobularis
○ leverparenchym rond portaveld blijft bewaard
Portale lobulus
3-hoekige functionele eenheid op basis van transport van gal in de galwegen (tegengesteld aan bloed)
● bloed: portavelden → vena centrolobularis
● gal: van leverparenchym (hepatocyten) → galwegen in portavelden
5
