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2 - Functional Development of the Liver

from SECTION I - PATHOPHYSIOLOGY OF PEDIATRIC LIVER DISEASE

Published online by Cambridge University Press:  18 December 2009

By
Frederick J. Suchy M.D.
Edited by
Frederick J. Suchy ,
Ronald J. Sokol  and
William F. Balistreri
Frederick J. Suchy M.D.
Affiliation:
Professor and Chair, Department of Pediatrics, Mount Sinai School of Medicine of New York University, New York, New York; Pediatrician-in-Chief, Department of Pediatrics, Mount Sinai Hospital, New York, New York
Frederick J. Suchy
Affiliation:
Mount Sinai School of Medicine, New York
Ronald J. Sokol
Affiliation:
University of Colorado, Denver
William F. Balistreri
Affiliation:
University of Cincinnati
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Summary

The liver attains its highest relative size at about 10% of fetal weight at the ninth week of gestation. Early in gestation the liver is the primary site for hematopoiesis. At 7 weeks of gestation, hematopoietic cells outnumber hepatocytes. Primitive hepatocytes are smaller than mature cells and are deficient in glycogen. As the fetus nears term, hepatocytes predominate and enlarge with expansion of the endoplasmic reticulum and accumulation of glycogen. Hepatic blood flow, plasma protein binding, and intrinsic clearance by the liver (reflected in the maximal enzymatic and transport capacity of the liver) also undergo significant postnatal maturation [1]. These changes correlate with an increased capacity for hepatic metabolism and detoxification. At birth the liver constitutes about 4% of body weight compared with 2% in the adult. Liver weight doubles by 12 months of age and increases threefold by 3 years of age.

The functional development of the liver that occurs in concert with growth requires a complicated orchestration of changes in hepatic enzymes and metabolic pathways that result in the mature capacity of the liver to undertake metabolism, biotransformation, and vectorial transport. Greengard [2] has established a paradigm for hepatic development based on a group of several hepatic enzymes studied in the rat and, less extensively, in humans. In one pattern of hepatic development, enzymatic activity is high in a fetus and falls during postnatal development. Examples would include thymidine kinase and ornithine decarboxylase [3].

Type
Chapter
Information
Liver Disease in Children , pp. 14 - 27
Publisher: Cambridge University Press
Print publication year: 2007

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  • Functional Development of the Liver
    • By Frederick J. Suchy, M.D., Professor and Chair, Department of Pediatrics, Mount Sinai School of Medicine of New York University, New York, New York; Pediatrician-in-Chief, Department of Pediatrics, Mount Sinai Hospital, New York, New York
  • Edited by Frederick J. Suchy, Mount Sinai School of Medicine, New York, Ronald J. Sokol, University of Colorado, Denver, William F. Balistreri, University of Cincinnati
  • Book: Liver Disease in Children
  • Online publication: 18 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547409.004
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  • Functional Development of the Liver
    • By Frederick J. Suchy, M.D., Professor and Chair, Department of Pediatrics, Mount Sinai School of Medicine of New York University, New York, New York; Pediatrician-in-Chief, Department of Pediatrics, Mount Sinai Hospital, New York, New York
  • Edited by Frederick J. Suchy, Mount Sinai School of Medicine, New York, Ronald J. Sokol, University of Colorado, Denver, William F. Balistreri, University of Cincinnati
  • Book: Liver Disease in Children
  • Online publication: 18 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547409.004
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  • Functional Development of the Liver
    • By Frederick J. Suchy, M.D., Professor and Chair, Department of Pediatrics, Mount Sinai School of Medicine of New York University, New York, New York; Pediatrician-in-Chief, Department of Pediatrics, Mount Sinai Hospital, New York, New York
  • Edited by Frederick J. Suchy, Mount Sinai School of Medicine, New York, Ronald J. Sokol, University of Colorado, Denver, William F. Balistreri, University of Cincinnati
  • Book: Liver Disease in Children
  • Online publication: 18 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547409.004
Available formats
×