hello and welcome to part one of chapter 14 on the liver this first part of the recording is probably going to be the longest of three parts that we will get to in this one we're going to cover the normal anatomy and physiology of the liver and then we'll talk about all the things that go wrong in in the other sections I mean all right so I'm going to Super simplify the liver I'm going to use some analogies and and let me just say I know several of you have told me how much you appreciate the analogies I really appreciate hearing that they help me in understanding and they help me in Remembering and organizing um information I will never test you on an analogy there's they're not perfect they're just a tool to help us understand things better um so I'm going to talk about um the liver and and different characteristics of what the liver does um but there's a lot of overlap and so please if if you find overlap and do not sweat it for a second thinking I don't know which is it filter or is it kitchen it doesn't matter um there's there's a lot of overlap in these functions okay so let's talk about the liver uh it is not a super sexy organ um so it that it's not the leading man kind of organ but it's a really exceptional character actor if you know what that is um it's the you know the one who gets the small part and again Community Theater it's sometimes the same person you know changing costumes and doing all these different jobs like they're the bailiff in this scene but then they're a prisoner in a different scene and um and I I feel like that's what the liver is doing oh my gosh it's this big brown lump right and it's just not super enticing but as we learn more and more about what the liver does it's really extraordinary how many different roles it plays and so as a way of trying to organize um our thoughts I I very uh roughly uh broke the activities of the liver into three main categories filter that is blood's going to go through the filter through the filter the blood's going to go through the liver and some stuff is going to be taken out kitchen this is a very broad category and by kitchen I mean some materials are going to come in there's some chemical reactions that are going to happen and then something different will be at the end some things will be um uh ready to use and other things will be now ready to get rid of you know um and then finally storage unit there are some items that reside in the liver for longer or shorter periods of time and we'll talk about those different things all right um to understand the filter and where some of the materials are coming from that are going through this organ we have to understand the blood supply and it it confuses everybody and it's usually explained badly so I'm going to try to explain it in a different way from how I usually see it explained and I'm going to show you a diagram that you've seen before when we were in the circulation chapter and we used this diagram to talk about the pulmonary circulation versus the systemic circulation remember it's the patient's right side of the heart um that the the blood's going to be right back it goes just out to the lungs and then comes back and then the blood that goes to the systemic circulation that has left the thorax that's coming out of the left side of the heart okay um what all of this has in common is that the blood leaves out of an artery it goes through a capillary bed and then returns to the heart in a vein and that's true in the pulmonary circuit and it's true in the systemic circuit blood leaves through an artery goes through some capillary bed somewhere and then gets recollected into a vein and back to the heart and that is true in the liver and it's true in the kidneys uh so there's artery Supply and there's vein recollection this is the part that's weird um people always focus on the liver being weird the liver is actually pretty normal what's weird is what the GI tract does it gets its blood supply you know it has arteries supplied from the heart um the blood goes through the capillary veins around um the the GI tract you know around the base of the esophagus the stomach the uh small intestine large intestine um and instead of just being recollected and going straight back to the heart that is the blood that gets into this other vein that then dumps into the liver that's why the liver has the two blood supplies it has the artery blood supply from the heart but then it also has this big amount of blood coming from the GI tract and that explains two things one it explains you know there's double blood supply um but the other thing it explains is how it can act as such an effective filter and remember last week when we talked about the GI tract we said this is the receiving department this is how you like pull things into the body well before that's going to be allowed into regular circulation we want to check that out as best we can before allowing it to go back to the heart and then circulate around the rest of the body and that's where the filter part comes in where the liver gets to take a you know first uh crack at everything that's coming in through the GI tract very very nice okay now on the next slide you're going to see the same diagram over on the right and then there's a whole lot of stuff over on the left and we'll walk through it slowly I lied um all right so here is uh the same diagram uh some basic anatomy uh the liver is in the upper right quadrant of the abdomen if it helps you at all I tell my you know General Anatomy students you know the the livers is being structure um I think it looks roughly like a lowercase R which is a student help me to remember that's on the right side of mostly on the right side of of the abdomen it's divided into these great big lobes uh but again you know just I don't know it's just not a very elegant looking uh organ um and then the lobes are further divided into lobules um and we'll go over these in a little bit more detail so you can understand how the blood flows and how it's um how the filtering happens so here's the blood supply issue the oxygenated blood like for all of the organs of the body oxygenated blood is coming from an artery coming from the heart um but in addition to that oxygenated blood um the liver is also getting a bunch of blood but this is the blood that's like could you check this for me before it goes to the rest of circulation um I'm never going to test you on exactly how much but some of you will be wondering this and so about a quarter of all the blood that comes through the liver about a quarter of it is coming straight from the heart and then three quarters of what's coming through is that you know scream this Blood before it gets to go out the rest of the body um that blood that's coming through this so-called portal vein system that is the name of this vessel um that is recollecting all of the blood from the GI tract and bringing it to the liver it's called portal vein I think of it as portage if you have a boat in a river and you have to go to a different River you have to pick up the boat and walk with it to the other River to continue your travels or from one Lake to another I don't know just it helps me to to think about okay this is that kind of blood it went through this capillary bed now it has to get recollected and then shut you know shuttled somewhere else and then it can go through another capillary bed foreign so that blood the portal blood um it's going to have a lot of nutrients from the gut the small intestine was doing all that absorption um and it's also recollecting blood from the pancreas and remember the pancreas um is going to be releasing insulin and glucagon at different times and so one of the first organs to get that signal is the liver that's what I mean by hormones from the pancreas so these two sources of blood they mix they're not pep separate in the in the liver and they they pass by the liver cells the hepatocytes and some immune cells because remember we are checking everything that just came in through the receiving department um that has its own immune cells but there's some more immune cells in the liver also checking um for anything that needs to be attacked and then uh I'll show you the central bank shortly all right so let's March through the filter kitchen and um storage unit and then we'll go into the this the different um reactions under each one in more detail but this is just a quick first pass through the information all right so filter we already mentioned the blood gets um try that again the liver gets blood directly from the GI tract from the receiving department and so it neutralizes toxins like alcohol and medications we don't think of them as toxins we think of them as medications that are useful but our body perceives them as foreign things that need to be metabolized and gotten rid of um and then it remember the the immune cells the macrophages and dendritic cells these are um part of the innate immunity and they're screening um for bacteria or toxins that might be coming through the body so that's filter then let's do kitchen there's a lot here uh so kitchen remember this means uh reactions chemical reactions that are going to be being done we're cooking we're changing things remember the three macromolecules we deal with the most are carbohydrates proteins and lipids and there's stuff happening with each of those categories the carbohydrate processing I'm going to save for a little bit later um what I'm talking about is the glucose that comes in and gets made into put together into glycogen but we'll cover that shortly then there's protein synthesis and a lot of it remember we've been talking throughout the semester about um let me just say it as an aside oh and it's made in the liver this is those proteins that we've been talking about albumin is the one that the liver makes the most um so it's a protein that is in the blood it's the most common protein in the blood but on top of that there are all the things that we've talked about before the clotting factors all the Roman numeral ones they're all made by the liver the complement proteins part of the immune defenses and eight defenses that's all made by the liver Alpha one antitrypsin we mentioned this when we were talking about emphysema and how this is the uh the Protein that's supposed to act against the enzymes that are breaking down the elastase that's that protein and there are others and we'll talk about the others as well I just wanted to give you a smattering of proteins that we've mentioned before okay so that's carbs proteins and now lipids uh yeah the liver can make cholesterol cholesterol you'll recall is that four ring structure it's a lipid meaning it doesn't dissolve well in water but it's the basis for making the steroid hormones for making vitamin D um and there was something else I wanted to mention about this oh um some people who have elevated cholesterol levels can try desperately to limit the cholesterol that they take in in their diet and they still have high cholesterol numbers and and it's because we we make the cholesterol our livers make the cholesterol for us and so we're finding that a lot of people's cholesterol numbers are related to what their livers are doing and then also uh the liver's the one that makes triglycerides when we have extra food we have extra fuel um the the liver detects and we can talk about the mechanism by which it detects that there's excess fuel there's excess energy and it says I'm going to store some of this for later so it makes triglycerides those are the Three fatty acid chains that gets stored up it gets stored away in adipose tissue thanks liver uh because yeah we'll use that later all right so those are the processing of the of those three macromolecules now let's talk about uh some waste molecules um and you could put this in with the filter category um so we take things uh from the blood the liver takes things from the blood like for example bilirubin and I'm going to remind you where Billy Rubin came from and I'll remind you on another slide too it's from the red blood cells uh that are getting recycled specifically the heme group after the iron's taken out we've got to re we've got to get rid of that Pain Group um and uh that's where the bilirubin comes from um and the liver takes care of that for us uh the other thing that it deals with for us is ammonia and that came from the breakdown of the amino acids those were amino acids are the subunits of proteins if we're not using the proteins to be proteins if we're using them for fuel we take that amino group off and that's got to go somewhere and if we don't do anything else with it it becomes ammonia the liver is looking out for us and so it combines a couple of ammonias together in some other things to make something called urea and we can pee that out and um the liver also processes medications drugs then there's some stuff that leaves the liver and um and leave circulation isn't uh yeah there's some stuff that leaves the liver let's put it that way um and that stuff that leaves the liver is known as bile bile is a mixture of recycling things that are useful they're going to be used and then they're going to get sent back to the liver and some trash that just needs to go out and so unlike where most communities have the separate bins for the trash and the recycling the liver just puts it all in one bin puts it out and then says to the intestines figure out something that's trash and some of that we're going to need back but take what you need and then you know get rid of the rest in the stool and what I'm talking about for recycling are the bile salts these are the things that are needed for breaking up the fats in the digestive system um and so they're necessary for fat digestion and absorption those things get used and recycled they go back to the liver and they can go back to the liver in the course of the same meal they can go through this trip a few times but then there's also some waste that's being released from the liver and that's going to get eliminated just in the stool it doesn't get reabsorbed and sent back to the liver just out in the poop and uh so we did um filter kitchen storage unit uh we're bringing you short-term storage and long-term storage short-term storage I'm talking about a few hours and this is where we do the carbohydrate processing so when we get monosaccharides from the digestive system from the GI tract you know it takes the starches and breaks them up into the individual glucoses and absorbs those and then that gets to the liver and the liver is going to store some of that stuff because we can't use all of the glucose all at once I mean some of our muscle cells and neurons and whatever are going to you know take some of the glucose out of circulation but there's too much glucose in circulation and we know glucose is damaging to the capillaries if it's left in the bloodstream for too long and so the liver puts it together and stores it as this molecule called glycogen and then a few hours later we haven't eaten but we need some an increase in our blood glucose and so the liver re-breaks down that glycogen and releases it back into the bloodstream and we'll we'll go about that we'll go through that in more detail later and that happens in the course of the uh several hours longer term we're talking about weeks and months um things can get um taken out of circulation and put in the liver and it can just stay there until it's needed examples of this minerals iron and copper vitamins we've talked about these two in particular B9 that's folate and b12 can also be stored in the living and there are others some things that can go wrong and again this is very high overview uh the liver can have infections um specifically viral infections we call them viral hepatitis and we'll talk about the three kinds that are the most common um the livers also susceptible to damage from alcohol kind of famous for that as well as other intake there's a condition called non-alcoholic fatty liver disease that is largely a disease of lifestyle that is a person's intake we'll talk a little bit about that but both of these can lead all the way to cirrhosis as can some of that hepatitis infections drug toxic drug toxicity most famously acetaminophen but other drugs can also create a problem for the liver and then some of these problems can progress all the way to hepatocellular cancer okay that's the big overview now let's get into a little bit more Anatomy uh we're looking at a smaller scale and looking at lobules they're mostly made of these General function uh cells of the liver called hepatocytes the lobules are roughly organized like this um there are some blood vessels around the outside of the lobule and so the blood comes in from the outside and then flows in towards the center um and what we're talking about here are the branches from the hepatic artery that's shown here in red because oxygenated blood and um portal vein this is the stuff that's coming from the GI tract and both of these blood supplies get mixed in the sinusoids sinusoids is a fancy name for a leaky capillaries that are in the liver and they're really leaky because they have actual holes in the cells called fenestration it doesn't matter the windows in the in the cells and stuff passes through easily remember we're talking about making proteins and and taking proteins out of circulation and putting things into circulation you need big holes for that because little holes like the ones in um the renal capillaries there's they're so small they're not supposed to let the proteins through the liver is all about processing protein so it needs bigger holes to get that stuff in and out and so that blood is passing through and it passes right by the hepatocytes and then gets recollected here in the central vein now bile is being made by these hepatocytes uh they're taking some stuff from the blood doing some kitchen reactions and then putting some stuff into the bile and so although the blood's flowing towards the center the biles actually flow flowing in the opposite direction it's being made um in by the hepatocytes and then it's being put into a duct that flows towards the outside that's not super important except um if you're an anatomy fan these the way these uh tubes run three tubes tend to run together a branch of the hepatic artery a branch of the portal vein and one of these bile ductules run together and they're referred to as the portal Triad okay point is blood supply passing by the cells going into the center bile being made and flowing out to the outside and then this is going to get recollected and passed along from the liver to the small intestine all right a little bit more histology close-up the hepatocytes these regular cells I love have shown like little brown bricks I mean I'm just like not sexy but oh my goodness when you get to know them they're fabulous uh yeah so they uh highly permeable capillaries um plates of hepatocytes and oh then there's lots of these uh immune cells macrophages and dendritic cells uh portal vein uh the arterial on the outside and where is it the bile duct the Triad your blood's flowing this way towards the central vein and biles flowing the other way all right this is not super important for you to know but I wanted to make this point and that is hepatocytes are not magic they're cells like every other cell they've got organelles like every other cell and so they do a lot of different reactions and kitchen work um but they do it the way other cells do it you know for so for example there's a abundant rough ER the rough endoplasmic reticulum you'll remember uh the rough part is because of the ribosomes stuck on the outside ribosomes are all about translation all about making proteins so lots and lots of rough ER in a Cell that's going to make lots and lots of protein albumin complement proteins all those different proteins get made in a cell and then that gets shipped out through exocytosis which you remember learning about earlier this semester there's also lots of smooth ER that's where a lot of the lipid metabolism reactions happen and then there are it's referred to as granules the storage Pockets um inside the cells for the glycogen and lipids that get made and then I have to sit around for a while either for a few hours or for months or years in in the case of the fat all right back to gross anatomy um the bile duct is what we're going to look at so the liver this big this is where I was saying it looks roughly like the lowercase R so you can remember it's on the right side mostly on the right side it does go all the way over to the left side um let's see so the the biles being made throughout the liver and it's getting recollected uh we're getting collected into this bile duct and here where it's going to empty into the small intestine this is the duodenum duodenum some people say um if we're not actively eating there's a a little sphincter there that that stays mostly closed and so this bile builds up here and can back into this gallbladder and so between meals we build up some bio and we save it for later until somebody you know until we eat something especially something that has some fat in it then that bile gets pumped out so that those bile salts can help emulsify and help break up those fat glovobules um this common bile duct um joins with a duct from the pancreas that's shown here a little bit better so the bile duct is here and then the pancreas is also making its digestive enzymes the proteases the lipases and the amylases and those digestive enzymes come together into the duodenum along with the bile salts uh the sphincter of ODI somebody's name um I have a I have a preferred name for it um the hepatos pancreatic duct it's just sorry that the hepatopancreatic sphincter um it it just is more descriptive of what it is Odie was the guy who first described it all right so let's talk about some kitchen functions the liver along with the pancreas plays a really important role in maintaining normal blood glucose levels this diagram is not from our textbook but I think it it nicely illustrates this point normal blood glucose levels are between 70 and 110 milligrams of glucose per deciliter um you probably all already know that um as blood glucose levels rise such as after we eat they don't have to even come out of this range they just have to be on the trajectory upward the pancreas is going to secrete some insulin and that insulin is a signal to cells that have receptors for insulin those cells are going to bring the glucose from the blood into the those cells and that means cells of the body the muscle cells the neuron they're going to bring glucose in but so are lots and lots of cells in the liver are going to bring lots of glucose in the cells um around the rest of the body are going to be using the glucose the liver is going to be storing some glucose for us but if it's stored it just as glucose that would draw so much water into the cells that it would be non-functional and so the glucoses are bound together to form glycogen that branching carbohydrate and between those two things um you know taking the glucose into the cells as individual glucoses and taking it in and forming it into glycogen the blood glucose levels drop and come back down into the normal range a few hours later we haven't eaten again but our blood glucose is coming down now um the the pancreas again is going to secrete a hormone but instead of insulin it's going to secrete something called glucagon glucagon like insulin it got into the bloodstream and all the cells get exposed to it but only the cells that have receptors for it are going to respond and those cells are in the liver the liver's job at that point is now to break down that glycogen that it just made a few hours ago break it up and release those individual glucoses back into circulation so that brings the blood glucose back into the normal range and we can continue doing the work that we need to do with our sodium potassium pumps and then you know doing the make we've made ATP so we can continue functioning it's fantastic um so when we get to the endocrine chapter we'll talk some more about why does the liver have to spend so much time doing that um but that's a huge part of what the liver does every day is help us maintain normal blood glucose levels okay this is the the slide that's so busy okay so here's the the diagram I just showed you um and we're going to walk through this part slowly so there's some kitchen elements to this and there's some storage elements to this but it's basically the processing of the carbohydrates so after we eat the liver receives the the sugars that the the small intestine um took up mostly what we're talking about is glucose and as I said pancreas releases insulin the glucose gets stored temporarily as glycogen if there is a lot of glycogen um that's when the liver says oh you're not going to need this in the next few hours because I know about how much you exercise so I'm going to save this you know for next month in case we go through some kind of difficult period where we don't get to eat so I'm just going to put this together as a triglyceride and then we can put that in the adipose tissue and put that right on your thighs for you and you can use that later great okay but if the glucose is um just you know the normal amount of glucose that we usually use and the liver knows approximately how much you're going to need for the amount of work that we usually do then it just stores it as glycogen okay and then the between meals um and the blood glucose comes down the pancreas releases the glucagon and that's the signal to the liver to break down that glycogen and release the glucose back into circulation if um the glucose stores are low if the glycogen stores are low the liver can also do this other trick it can produce glucose from other molecules this is called gluconeogenesis um this is not desperation measures this is uh for example I mean it can be but it can also be uh somebody just doesn't need a lot of carbohydrates and they take more more of their calories in in the form of protein and lipids and fats um they can do this gluconeogenesis and that's how they can keep their blood glucose in the normal range even though they're not eating a lot of carbohydrates okay and it's just a normal liver function all right we're going to continue with kitchen uh work uh we already did carbs now we're going to go to proteins and you can guess that we're going to do lipids after this so proteins the liver is making lots and lots of proteins I've mentioned this before the plasma protein albumin the clotting factors that's what I mean by coagulation proteins the complement proteins part of immunity and carrier proteins like uh transferrin if we need to take iron from liver and take it out to the bone marrow from making hemoglobin whoops those are the kind of carrier proteins I'm talking about also things like uh angiotensinogen remember antiotensinogen is what we need to have already in circulation for the renin angiotensinaldosterone system to work renin cleaves the angiotensinogen to make Angiotensin one of those acute phase proteins oh inflammatory responses so um like C-reactive protein for example all of this stuff is being made by the liver and then uh we've got regarding protein urea is not a protein but it's a waste that we make um because we've been processing amino acids amino acids are the things that make up proteins um and so it's those amine groups when they get taken off you got to do something with them you got to get rid of them somehow and so instead of letting them become just ammonia which is really toxic to our to our tissues um the liver will put two ammonias and some other atoms together and make something called urea and that's how we can get rid of those amine groups and it the urea largely gets back into circulation and then gets eliminated by the kidneys and then finally the carbs the proteins now we're going to do lipids um and we'll do we'll talk about triglycerides I've mentioned this when we were talking about glucose triglycerides can be produced when we have excess glucose we have more intake than we're anticipating to have output our liver will make these fat molecules for us and then some of it can be stored in the liver itself and some of it can get shipped out to adipose tissue the liver as I mentioned can also make cholesterol and it can also create the kind of shipping vessels for um moving some cholesterols around high density lipoproteins and low density lipoproteins related to livers bile salts are not what did I just say related to lipids um bile salts are amphipathic that meant that they have uh the nonpolar side on one side and the polar side on the other um these are the molecules that are necessary for breaking up the fat globules in the small intestine um so they they get into the bile that bile gets into the digestive system and then they get used for breaking up fats but then they get uh taken up again in the ilium in the late part of the small intestine and then gets recycled back to the liver and the bile salts can actually do that trip a couple of times a couple of free times in the in the time it takes to eat a meal so yeah very efficient recycling system all right so here's a summary of all of this um the nutrients come in through the small intestine and they get broken these are the carbs of proteins and lipids so monosaccharides are the individual units of the sugars amino acids individual units that make up the proteins and the bits they use the different colors um so this is all color-coded um let's see that then there's one place where things are not passing through the blood and that's the bile that's made by the liver that's going to get passed into the small intestine along that bile duct but everything else gets passed between the liver and the blood just lovely all right some more kitchen stuff we're going to talk nitty-gritty about Billy Rubin I'm going to remind you of a red blood cell recycling that we looked at before when we were in the chapter on blood um we talked about how we recycle parts we the usable parts of the red blood cell get recycled and then what I'm talking about mostly is hemoglobin the here we go um we break up the hemoglobin the globin part that's the amino acids those get recycled the heme part is the problem we take the iron out of it because we want that iron um but then the part of the heme group it doesn't have the iron becomes the so-called unconjugated bilirubin and I showed you these pictures in the other chapter we talked about how if the unconjugated bilirubin gets uh put down in the dermis excuse me it's put down in the skin we have this jaundiced appearance kind of yellowing of the skin if it gets put down in the sclera then it's even more obvious that's referred to as ictarus this I'm not going to test you on I just wanted for those of you who are very detail-oriented to have a visual of this this is a heme group um there's the iron right in the middle of the heme group that gets taken out uh goes through a few Transformations and then this is the part that I can't use this for anything I just have to get rid of this somehow that's the bilirubin and the bilirubin has some color to it just explains why we see it in people's skin um so some terminology related to bilirubin um Billy Rubin is not really water soluble and so uh think about the spleen you know being in the spleen the red blood cells are getting broken up um and that uh bilirubin has to travel from the spleen to the liver and it's going to do it in the blood um so it kind of hitches a ride on the albumin that's already in the blood at this point we call it unconjugated bilirubin uh sometimes you'll see it on lab reports as indirect uh Billy Rubin so then the liver takes it up and um conjugates it to this other acid once it's conjugated it is uh easier to dissolve in the blood that's a conjugated bilirubin it's also known as direct bilirubin you may see it called that on lab reports um and so we can travel in the blood and uh comes out in the urine some of it comes out in the urine a lot of it a lot of the bilirubin um ends up in the Bible because there's so much of it it gives the bile this really I know it sounds crazy but this dark yellow going to green color um that's where that a lot of that color comes from all right so this is all right secretion defecate okay so it's getting into the intestines then some of it um gets processed um into these other molecules until finally it becomes stirco uh billin this is brown and it's because of the circle bill and the presence of this stuff that uh our our waste is brown colored so if somebody's having a problem with getting the bile from the liver into the small intestine one of the the signs of this is a pale the pale stool so cholestasis is what I'm talking about if there's some kind of blockage if it's not allowing the the file to get into the the intestinal tract and there's we're almost done um a little bit more uh filter and kitchen the drugs that come in through the oral route um they get processed and um they get metabolized there are different kinds of waste products if it's nonpolar that it's lipid soluble it's going to go out in the bile going out in the trash that way and that's going to be eliminated in the stool if it's polar if it's something can that can dissolve in water that's going to go into the plasma and then it gets excreted by the kidneys but the liver wants the stuff out of the body all right so this is why the difference between orally administered medications versus IB medications for orally administered medications things have to come in through the digestive system through GI tract that's going to get blood's going to get recollected into this portal vein that goes to the liver and the liver is going to get first crack at that blood and so it's going to have some metabolic enzymes that that work on those drugs so what we end up with what we end up with as effective circulating concentration of the drug depends on what the liver does with it it's the so-called first pass metabolism that's that blood that first got into the body the liver is going to try to neutralize a lot of that stuff and that's why with idb administered medications you bypass all of this and so action of the drugs is faster and um the less of it gets metabolized less of it gets broken down because it gets right into circulation without going through this portal vein and then this is the final slide we did a filter we did kitchen and now let's talk about storage things that get stored for the long term vitamins the fat soluble ones all of them a b e k um and then the water soluble ones are the primarily the two that we've talked about before the folate B9 and b12 these were the ones that um when a patient is low in these they end up um making red blood cells really slowly and so the end the red blood cells end up being really big macro acidic cells it's a kind of anemia and then the minerals that get stored are iron which we've talked about in some detail they're stored attached to ferritin hundreds of iron atoms get stored in ferritin and the liver also is responsible for making the proteins that transfer the iron from the liver to the bone marrow and that's the transferrin and then the other mineral that's stored here is copper that is the end of part one see you in part two