fisiologi hati dan kandung empedu

FISIOLOGI FISIOLOGI

HATI

KANDUNG EMPEDU

Apa yang kita lakukan hari ini merupakan kunci sukses atau kunci kehancuran hari esok kita. Lakukanlah yang

terbaik untuk hari ini

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

A. A. FUNCTION OF THE HEPATIC FUNCTION OF THE HEPATIC VASCULARE SYSTEMVASCULARE SYSTEM

A. A. FUNCTION OF THE HEPATIC FUNCTION OF THE HEPATIC VASCULARE SYSTEMVASCULARE SYSTEM

Blood flow through the liver1450 ml/min (29% COP)

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

The pressure of portal vein : 9 mmHgThe pressure in the hepatic vein : 0 mmHgChirrosis of the liver (alkoholic, carbon

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

Reservoir function of the Reservoir function of the liverliver

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

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

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

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

Blood cleansing function of Blood cleansing function of the liverthe liver

Blood cleansing function of Blood cleansing function of the liverthe 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.

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.

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



LIPID METABOLISMStores triglyceridesConvert fatty acids to acetyl co A than to ketone bodies

Syntheizes lipoproteinssynthesizes which is used to make bile salt



PROTEIN METABOLISMRemove 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)

C. ENDOCRINE FUNCTIONC. ENDOCRINE FUNCTION

Secrete IGF I and somatomedin in response to growth hormone

Forms T3 from T4Secrete angiotensinogenActivation of vitamin DSecrete erytropoitin (15 %)

D. DETOXIFICATION FUNCTIOND. DETOXIFICATION FUNCTION

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

penicillin, erytromicinAltered or excreted hormones :

thyroxine, steroid hormons (estrogen, cortisol, aldosteron)

Detoxifies products of metabolismDetoxifies forigns chemicals

E. OTHERS FUNCTION / EXCRETIONE. OTHERS FUNCTION / EXCRETIONE. OTHERS FUNCTION / EXCRETIONE. OTHERS FUNCTION / EXCRETION

STORAGE :

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

DIGESTIVE FUNCTIONSSecrete bile, righ in HCO3synthesizes bile salt from cholesterolsynthesizes bile pigments from haem of

haemoglobinExcretes plasma cholesterol and lecithin

RELATION OF THE LIVER TO BLOOD RELATION OF THE LIVER TO BLOOD

COAGULATIONCOAGULATION

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

PRODUCTION OF BILEPRODUCTION OF BILE

500 – 1000 ml/daySynthesize 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

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

GALLBLADDERGALLBLADDERGALLBLADDERGALLBLADDERFUNCTION :

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 contractionvagal stimulation during cephalic and gastric phase

Regulation of bile entry into the small intestineRegulation of bile entry into the small intestine

COMPOTITION OF BILE COMPOTITION OF BILE (1)(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.

COMPOTITION OF BILE (2)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.



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

FUNCTION OF THE BILEFUNCTION OF THE BILEFUNCTION OF THE BILEFUNCTION OF THE BILE

Digestion and absoption of fathelp 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

ENTEROHEPATIC ENTEROHEPATIC CIRCULATIONCIRCULATION

ENTEROHEPATIC ENTEROHEPATIC CIRCULATIONCIRCULATION

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

Enterohepatic circulation of bile saltEnterohepatic circulation of bile salt

CILINICAL IMPLICATIONCILINICAL 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 diarrhea, bile salt inhibit water and Na absorption

BILIRUBIN METABOLISMBILIRUBIN METABOLISM

BILIRUBIN METABOLISMBILIRUBIN METABOLISM

Formation of bilirubinis 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.

THE COMMONE CAUSES THE COMMONE CAUSES JAUNDICEJAUNDICE

INCREASED DESTRUCTION OF RED BLOOD CELLS (HEMOLITIC JAUNDICE)

OBSTRUCTION OF THE BILE DUCT OR DAMAGE TO THE LIVER SELLS (OBSTRUCTIVE JAUNDICE)