231499122 fisiologi hati dan kandung empedu

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FISIOLOGI HATI KANDUNG EMPEDU

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Page 1: 231499122 Fisiologi Hati Dan Kandung Empedu

FISIOLOGI

• HATI

• KANDUNG EMPEDU

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ANATOMI-FISIOLOGIANATOMI-FISIOLOGI(LOBULUS)(LOBULUS)

1. SEL HEPATOSIT (RADIER)2. VENA SENTRALIS3. KANALIKULI4. SINUSOID5. SEL KUPFFER6. SPACE OF DISSE

• V.PORTA SINUSOID V.HEPATKA

• KANALIKULI DUKTUS BILIARIS

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A. FUNCTION OF THE HEPATIC VASCULARE SYSTEM

• Blood flow through the liver• 1450 ml/min (29% COP)

1100 ml : from the portal vein350 ml : from hepatic artery.

• The pressure of portal vein : 9 mmHg• The pressure in the hepatic vein : 0 mmHg• Chirrosis of the liver (alkoholic, carbon tetachloride,

virus diseases, infections in the bile duct) : blockage of the portal system

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Reservoir function of the liver

• 450 ml can be stored in the hepatic vein and hepatic sinuses.

• 0,5 to 1 liter : high pressure in the right atrium

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High hepatic vascular pressures causing fluid transudation into the abdominal cavity from the liver and portal capillaries ASCITES

BLOCKAGE OF PORTAL FLOW ALSO CAUSES ASCITES, BUT IS LESSBicause the collateral vascular channel develop rapidly from the portal veins to the systemic veins.

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Blood cleansing function of the liver

Hepatic macrophage system (kupffer cells, the large macrophage that line the hepatic sinuses) can cleanse blood (sach as many bacteria from the intestines)

Kupffer cells also phagocytize old red and white cells and bacteria.

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B. B. METABOLIC FUNCTION METABOLIC FUNCTION OF OF THE LIVERTHE LIVER

CARBOHYDRATE METABOLISMMaintains normal blood glucose level (glukostat)

• Convert glucose to glycogen and glycogen to glucose

• Convert amino acids, lactic acid, fructose and galactose to glucose

• Convert glucose to triglycerides

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Glocose balance

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B. B. METABOLIC FUNCTION METABOLIC FUNCTION OF OF THE LIVERTHE LIVER

LIPID METABOLISM• Stores triglycerides• Convert fatty acids to acetyl co A

than to ketone bodies• Syntheizes lipoproteins• synthesizes which is used to

make bile salt

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B. METABOLIC FUNCTION OF THE LIVER

PROTEIN METABOLISM• Remove NH2 (deaminates) amino

acids which can than be used to form ATP or convert to fats or carbohydrate

• Convert toxic NH3 to the less toxic urea than excreted in urine

• Synthesizes plasma protein (albumin, globulin, fibrinogen, protrombin, lipoprotein)

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Metabolic pathways of the absoeptive state

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Metabolic pathways of the post absoeptive state

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Cholesterol balance

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C. ENDOCRINE FUNCTION

• Secrete IGF I and somatomedin in response to growth hormone

• Forms T3 from T4• Secrete angiotensinogen• Activation of vitamin D• Secrete erytropoitin (15 %)

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D. DETOXIFICATION FUNCTION

Removal of drugs, hormons etc :• Detoxifies drugs : sulfonamides, penicillin,

erytromicin• Altered or excreted hormones : thyroxine,

steroid hormons (estrogen, cortisol, aldosteron)

• Detoxifies products of metabolism• Detoxifies forigns chemicals

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E. OTHERS FUNCTION / EXCRETION

STORAGE : glycogen, fats, vitamins A, B12, D, E, K, copper and Fe (combined with protein called ferritin)

DIGESTIVE FUNCTIONS• Secrete bile, righ in HCO3• synthesizes bile salt from cholesterol• synthesizes bile pigments from haem of

haemoglobin• Excretes plasma cholesterol and lecithin

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RELATION OF THE LIVER TO BLOOD COAGULATION

• Liver form fibrinogen, protrombin, accelerator globulin, faktor VII

• Vit K is required by the metabolic process of the liver for the formation protrombin, faktor VII, IX and X

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Role of liver in clotting

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PRODUCTION OF BILEPRODUCTION OF BILE

• 500 – 1000 ml/day• Synthesize BILE SALT from

cholesterol (conjugated with glycine or taurine)

• Convert HAEM to BILE PIGMENTS (coupled to glucoronic acid) form bilirubin glucoronide (BILE)

• Discharge bile into bile canaliculihepatic ducts GALL BLADER

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BILIARY SECRETIONSBILIARY SECRETIONS• Riquired for digestion and absorption of

fats and excretion of water insoluble substaces sach as cholesterol and bilirubin

• Formed by hepatocytes (250-1100 ml/day)• Secreted continously, stored in gallbladder

during interdigestive period. • Released into the duodenum during

digestive periode, trigered the released of CCK

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COMPOTITION OF BILE (1)

• Bile acids : (primary bile acids) synthesized from cholesterol and converted form bile salt by the hepatocytes, and (secondary bile acids) formed by deconjugation and dehydroxylation of primary bile salt by intestinal bacteria.

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COMPOTITION OF BILE (2)

• Bile pigments :bilirubin and biliverdin (two principal bile pigments), formed from hemoglobin responsible for the golden yellowcolor of the bileUroblin, metabolized from bilirubin by intestinal bacteria. Responsible for the brown color of the stoolIf Bilirubin is not secretet by the liver, producyng jaundice.

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COMPOTITION OF BILE (3)

• Phospholipids (prymarily lecithisn) solubized by the bile salt micelles

• Cholesterolis important of bile, bicause it is one of the few ways in wich choleterol regulation

• electrolytes

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FUNCTION OF THE BILEFUNCTION OF THE BILEDigestion and absoption of fat

help to emulsify of the large fat particleaid to absorption of fat through the intestinal mucosal membrane

Exretion of several important waste products from the blood (bilirubin) and ecsesses of cholesterol

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ENTEROHEPATIC CIRCULATION

• The circulation of bile salt from the liver to the small intestine and back again.

• Necessary, bicause limited poll of bile salt to help breakdown and absorption fats

• 90% - 95% absorbed only in the terminal ileum

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Enterohepatic circulation of bile salts

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Regulation of bile entry into the small intestine

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CILINICAL IMPLICATION• Any condition that disrupts enterohepatic

circulation (ileal resection or small intestinal diseases : sprue or Crohn’s diease) leads to malabsorption of fat and fat soluble vitamins.

• The clinical manivestation : steathorrea and nutritional defisiency.

• Incrases in fecal losses of bile salt results watery dirrhea, bile salt inhibit water and Na absorption

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GALLBLADDER• FUNCTION :

Storage : stores and concentrates during interdigestive periode.contraction : during digestive periode, the gallbladder contracts, empetying the content into the duodenum

• CONTROL :fat and protein digestion product CCK gallbladder contructionvagal stimulation during cephalic ang gastric phase

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BILIRUBIN METABOLISM• Formation of bilirubin

is yellowish pigment formed as an end product of hemoglobin catabolism.

• Jaundice is yellowing of the skin duo to the accumulation of bilirubin within the tissues, may result from : excess production of bilirubin, or obstruction of the bile ducts or the liver cells preventing the secretion of bilirubin.

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THE COMMONE CAUSES JAUNDICE

• INCREASED DESTRUCTION OF RED BLOOD CELLS (HEMOLITIC JAUNDICE)

• OBSTRUCTIONOF THE BILE DUCT OR DAMAGE TO THE LIVER SELLS (OBSTRUCTIVE JAUNDICE)

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Summary of liver functions

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Summary of liver functions

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Summary of liver functions

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Summary of liver functions