55999640 fisiologi hati dan kandung empedu
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FISIOLOGIFISIOLOGI
HATI
KANDUNG EMPEDU
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ANATOMI-FISIOLOGIANATOMI-FISIOLOGI
(LOBULUS)(LOBULUS)1. SEL HEPATOSIT (RADIER)
2. VENA SENTRALIS
3. KANALIKULI
4. SINUSOID
5. SEL KUPFFER
6. SPACE OF DISSE
V.PORTA SINUSOID V.HEPATKA
KANALIKULI DUKTUS BILIARIS
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A.A. FUNCTION OF THE HEPATICFUNCTION OF THE HEPATICVASCULARE SYSTEMVASCULARE SYSTEM
A.A. FUNCTION OF THE HEPATICFUNCTION OF THE HEPATIC
VASCULARE SYSTEMVASCULARE SYSTEMBlood flow through the liver 1450 ml/min (29% COP)
1100 ml : from the portal vein
350 ml : from hepatic artery
!he pre""#re of portal vein : 9 mm$
!he pre""#re in the hepatic vein : 0 mm$Chirro"i" of the liver (al&oholic' caron tetachlorie'
vir! "i!#$!#!' infectio#" in the ile #ct) :loc&ae of the portal "y"tem
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Reservoir function of the liverReservoir function of the liver
450 ml can e "tore in the hepatic vein an
hepatic "in#"e"
0'5 to 1 liter : hih pre""#re in the riht
atri#m
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High hepatic vascular pressuresHigh hepatic vascular pressures
causing fluid transudation into thecausing fluid transudation into theabdominal cavity from the liver andabdominal cavity from the liver and
portal capillariesportal capillaries ASCITESASCITES
BLOCKAGE OF PORTAL FLOWALSO CAUSES ASCITES, BUT ISLESS
Bicause the c!!ate"a! #ascu!a"cha$$e! %e#e!& "a&i%!' " the&"ta! #ei$s t the s'steic#ei$s*
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Blood cleansing funcion ofBlood cleansing funcion of
!e li"e#!e li"e#
Blood cleansing funcion ofBlood cleansing funcion of
!e li"e#!e li"e#
Hepatic macrophage system (kupffer
cells, the large macrophage thatline the hepatic sinuses) can cleanseblood (sach as many bacteria from
the intestines)Kupffer cells also phagocytize old redand white cells and bacteria.
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B.B. METABOLIC FUNCTIONMETABOLIC FUNCTION
OF THE LIVEROF THE LIVER
B.B. METABOLIC FUNCTIONMETABOLIC FUNCTION
OF THE LIVEROF THE LIVER ARBOHYDRATE METABOLISM
Maintains normal blood glucose
level glu!ostat"
onvert glucose to gl#cogen and
gl#cogen to glucose
onvert amino acids$ lactic acid$
%ructose and galactose to glucose
onvert glucose to trigl#cerides
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B.B. METABOLIC FUNCTIONMETABOLIC FUNCTION
OF THE LIVEROF THE LIVER
B.B. METABOLIC FUNCTIONMETABOLIC FUNCTION
OF THE LIVEROF THE LIVERLIPID METABOLISM
Stores triglycerides
Convert fatty acids to acetyl co A thanto ketone bodies
Syntheizes lipoproteins
synthesizes which is used to make bilesalt
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B.B. METABOLIC FUNCTIONMETABOLIC FUNCTION
OF THE LIVEROF THE LIVER
B.B. METABOLIC FUNCTIONMETABOLIC FUNCTION
OF THE LIVEROF THE LIVERPROTEIN METABOLISMRemove NH2 (deaminates) amini aids
!"i" an t"an #e $sed to %o&m ATP o&onve&t to %ats o& ao"'d&ateonve&t toi NH* to t"e +ess toi $&ea
t"an e&eted in $&ine
S'nt"esi,es -+asma -&otein (a+#$min./+o#$+in. %i#&ino/en. -&ot&om#in.+i-o-&otein)
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C. E!"CRIE #$CTI"C. E!"CRIE #$CTI"
Sec"ete IGF I a$% sate%i$i$ "es&$se t +"th h"$e
F"s T " T.
Sec"ete a$+ite$si$+e$
Acti#ati$ #itai$ /
Sec"ete e"'t"&iti$ (01 2)
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$% $ETO&IFICATION FUNCTION$% $ETO&IFICATION FUNCTION
*emoval of r#"' hormon" etc :
+eto,ifie" r#" : "#lfonamie"' penicillin'
erytromicin-ltere or e,crete hormone" : thyro,ine'
"teroi hormon" (e"troen' corti"ol'
alo"teron)+eto,ifie" pro#ct" of metaoli"m
+eto,ifie" forin" chemical"
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E% OTHERS FUNCTION ' E&CRETIONE% OTHERS FUNCTION ' E&CRETIONE% OTHERS FUNCTION ' E&CRETIONE% OTHERS FUNCTION ' E&CRETION
STORAGE :
%&'%#*+ ,$-!+ vi-$i*! A+ B12+ D+ E+ K+ //#r $*"F# (0i*#" i- /r-#i* $&" ,#rri-i*)
DIGESTIVE FUNCTIONS
S#r#-# 0i+ ri% i* HCO3
!'*-#!i#! 0i !$&- ,r !-#r&
!'*-#!i#! 0i /i%#*-! ,r $# , $#%&0i*
Er#-#! /&$!$ !-#r& $*" i-i*
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RELATION OF THE LIVER TO BLOO$RELATION OF THE LIVER TO BLOO$
COA(ULATIONCOA(ULATION
Liver %orm %ibrinogen$ &rotrombin$
accelerator globulin$ %a!tor 'II'it ( is re)uired b# t*e metabolic
&rocess o% t*e liver %or t*e %ormation
&rotrombin$ %a!tor 'II$ I+ and +
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%R"!$CTI" "# BI&E%R"!$CTI" "# BI&E
133 4 0333 !5%a'S'$thesi6e BILE SALT "
ch!este"! (c$7u+ate% ith+!'ci$e " tau"i$e)
C$#e"t 8AEM t BILE PIGMENTS(cu&!e% t +!uc"$ic aci%) "
9i!i"u9i$ +!uc"$i%e (BILE)/ischa"+e 9i!e i$t 9i!e ca$a!icu!i
he&atic %ucts GALL BLA/ER
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BILIAR: SECRETIONSBILIAR: SECRETIONS
Riquired for digestion and absorption offats and excretion of water insoluble
substaces sach as cholesterol and bilirubinFormed by hepatocytes (250-1100 mlday!"ecreted continously# stored in gallbladder
during interdigesti$e period%
Released into the duodenum duringdigesti$e periode# trigered the released of&&'
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COMPOTITION OF BILECOMPOTITION OF BILE
(0)(0)
COMPOTITION OF BILECOMPOTITION OF BILE
(0)(0)Bile acids;
(&"ia"' 9i!e aci%s)s'$thesi6e% "
ch!este"! a$% c$#e"te% " bilesalt9' the he&atc'tes, a$%
(sec$%a"' 9i!e aci%s)"e% 9'%ec$7u+ati$ a$% %eh'%"
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COMPOTITION OF BILECOMPOTITION OF BILE
(=)(=)Bile pigments;
bilirubin and biliverdin(t &"i$ci&a!
9i!e &i+e$ts), "e% "he+!9i$ "es&$si9!e " the+!%e$ 'e!!c!" the 9i!e
Uroblin, eta9!i6e% " 9i!i"u9i$9' i$testi$a! 9acte"ia* Res&$si9!e" the 9"$ c!" the st!
I Bi!i"u9i$ is $t sec"etet 9' the!i#e", &"%uc'$+jaundice*
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COMPOTITION OF BILECOMPOTITION OF BILE
()()
COMPOTITION OF BILECOMPOTITION OF BILE
()()Phospholipids(&"'a"i!'
!ecithis$)
s!u9i6e% 9' the 9i!e sa!t ice!!esCholesterol
is i&"ta$t 9i!e, 9icause it is
$e the e a's i$ ichch!ete"! "e+u!ati$
electrolytes
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#$CTI" "# THE BI&E#$CTI" "# THE BI&E#$CTI" "# THE BI&E#$CTI" "# THE BI&E
Digestion and absoption of fat
help to emulsify of the large fat
particleaid to absorption of fat through theintestinal mucosal membrane
Exretion of several important wasteproducts from the blood (bilirubin)and ecsesses of cholesterol
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ENTERO8EPATIC CIRCULATIONENTERO8EPATIC CIRCULATIONENTERO8EPATIC CIRCULATIONENTERO8EPATIC CIRCULATION
The ci"cu!ati$ 9i!e sa!t "the !i#e" t the sa!! i$testi$e
a$% 9ac> a+ai$*Necessa"', 9icause !iite% &!!
9i!e sa!t t he!& 9"ea>%$a$% a9s"&ti$ ats
?32 - ?12 a9s"9e% $!' i$the te"i$a! i!eu
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CILINICAL IMPLICATIONCILINICAL IMPLICATION
Any condition that disruptsenterohepatic circulation (ilealresection or small intestinal
diseases : sprue or Crohns diease)leads to malabsorption of fat and fatsoluble vitamins.
The clinical manivestation :steathorrea and nutritional defisiency.
Incrases in fecal losses of bile saltresults watery dirrhea, bile saltinhibit water and a absorption
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GALLBLADDERGALLBLADDERGALLBLADDERGALLBLADDER
FUNCTION :Storage : stores and concentratesduring interdigestive periode.
contraction: during digestive periode,
the gallbladder contracts, empetyingthe content into the duodenum
CONTO! :
"at and protein digestion productCC# gallbladder contruction
vagal stimulation during cephalic anggastric phase
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BILIRUBIN METABOLISMBILIRUBIN METABOLISM
Formation of bilirubin
is 'e++o!is" -i/ment %o&med as an end
-&od$t o% "emo/+o#in ata#o+ism0Jaundice
is 'e++o!in/ o% t"e s1in d$o to t"ea$m$+ation o% #i+i&$#in !it"in t"e tiss$es.
ma' &es$+t %&om eess -&od$tion o%#i+i&$#in. o& o#st&$tion o% t"e #i+e d$ts o&t"e +ive& e++s -&eventin/ t"e se&etion o%#i+i&$#in0
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THE COMMONE CAUSES )AUN$ICETHE COMMONE CAUSES )AUN$ICE
.C*-+ +!*C!.O O *+
OO+ C ($6O.!.C
7-+.C)O!*C!.OO !$ . +C! O*
+-6-8 !O !$ .*
(O!*C!. 7-+.C)