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HEPATOBILIARY & PANCREATIC

PHYSIOLOGY
Theresa Rubi Nadala, FPCP, FPSG,
FPSDE

01.11.11

OUTLINE OF TOPICS
Topics
I. PANCREAS
a. Pancreatic Digestive Enzymes
b. Regulation of Pancreatic Secretion
c. Multiplicative Effect of Different
Stimuli
d. Phases of Pancreatic Secretion
e. Secretin Effect
II. HEPATOBILIARY TRACT
a. Physiologic Anatomy of Biliary
Secretion
b. Storage & Concentration of Bile in
Gallbladder
c. Gallbladder Contraction & Emptying
d. Synthesis of Bile Salts in the
Hepatocytes
e. Action of Bile Salts in Intestinal Tract
f. Enterohepatic Circulation of Bile
Salts
g. The Liver
h. Normal Hepatic Function
i. Metabolic Functions of the Liver
j. Jaundice

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PANCREAS
Lies parallel to and beneath the
stomach
Large compound gland with most of its
structure similar to that of the salivary
glands
PANCREATIC ACINUS
o Basic unit of the pancreas
PANCREATIC SECRETION
PANCREATIC ACINUS
Acinar Cells

PANCREATIC DIGESTIVE ENZYMES

Secreted by pancreatic ductules
Capable of digesting Proteins, Fats,
Carbohydrates
A.) PROTEOLYTIC ENZYMES
Important enzymes
o Trypsin
o Chymotrypsin
o Carboxypolypeptidas
Proteins
Trypsin &
Chymotrypsin
Peptides

Starches, Glycogen
(not cellulose)
Pancreatic amylase

PANCREATIC DUCTULES

Disaccharides

secrete

DUODENUM
through the Papilla of Vater,
surrounded by Sphincter of Oddi

Transcribed by Group : 4

destruction of near
Nuclease blood vessels (ex: acute
pancreatitis)

B.) ENZYME THAT DIGESTS

CARBOHYDRATES
Pancreatic Amylase

Pancreatic Digestive Enzymes

PANCREATIC DUCT
Pancreatic Digestive Enzymes
+
Sodium Bicarbonate + H2O

Carboxypolypeptidase
Amino Acids
Less important proteolytic enzymes
o Elastase
can promote
o

secrete

Sodium Bicarbonate + H2O

Stimulus for pancreatic secretion

o Chyme in the upper small
intestine (duodenum & upper
jejunum)

Trisaccharides

C.) LIPOLYTIC ENZYMES

Pancreatic Lipase
o Marker for pancreatic
destruction
o Neutral Fat
hydrolysis

Fatty Acid + Monoglycerides

Cholesterol Esterase
o Hydrolysis of esterified
cholesterol
Phospholipase

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Phospholipid Fatty Acids

PANCREAS
Inactive Proenzyme
Trypsinogen

INTESTINES
Active Enzyme

enterokinase
intestinal mucosa

AutoTrypsin
catalytically

Food in small intestine

Chymotrypsinogen
Chymotrypsin

SECRETIN
o Secreted by S cells of
duodenal and jejunal mucosa
o When highly acidic food enters
the small intestine

Procarboxypolypeptidase
Carboxypolypeptidase
TRYPSIN INHIBITOR
o Secreted simultaneously by the
acini
o Prevents premature activation
of trypsin
o Overwhelmed in acute
pancreatitis
Pancreatic Secretion
o Can rise to 145 meq/L (5x
greater than plasma levels)

CCK

Secretin
Absorbed in blood
PANCREAS

Pancreatic Secretions
In the pancreas:
Acetylcholine &
Secretin
CCK
Ductal epithelium
Acinar cells
NaHCO3
Digestive
Fluid
enzyme
Fluid
1 L/day secreted fluid volume

MULTIPLICATIVE EFFECT OF THE

DIFFERENT STIMULI
Total secretion is greater than the sum
of the individual secretions caused by
each stimulus separately
PHASES OF PANCREATIC SECRETION

Phase
Cephalic
Secretion of isosmotic sodium bicarbonate solution
by the pancreatic ductules and ducts

REGULATION OF PANCREATIC SECRETION

Basic stimuli that cause pancreatic secretion
(after food has entered duodenum)
ACETYLCHOLINE
o From parasympathetic vagus
nerve and others
CHOLECYSTOKININ
o Secreted by I cells of
duodenal and jejunal mucosa
o Released when food enters the
small intestine
o Enhance CCK secretion

Proteoses

Peptones

Long chain of fatty

acids

Transcribed by Group : 4

Gastric

Intestinal

Phenome
non
Acetylcholi
ne
released
from vagal
nerve
endings
Acetylcholi
ne
released
from vagal
nerve
endings
CCK
released
secretion

Result
Enzyme
secretion
(stored in
acini)

% Total
Secreti
on
20

Enzyme
secretion
(stored in
acini)

5-10

Enzyme
secretion

NaHCO3
Fluid

70

SECRETIN EFFECT

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HCl (from stomach)+ NaHCO3

NaCl + H2CO3

Gall Bladder
Stimulated by Bile Salts

SECRETORY EPITHELIAL
CELLS LINING DUCTULES
AND DUCTS
(Na+, HCO3)

CO2
H2O
Blood

Interlobar Septa

Expired by the lungs

End result:
o Neutralization of acid
o Peptic activity in duodenum
o Appropriate pH (2.0-8.0) for
action of pancreatic enzymes

Terminal Bile Ducts

Cystic Duct

Duodenum

Gall Bladder
Stimulated by Secretin

STORAGE & CONCENTRATION OF BILE IN

GALLBLADDER
Maximum volume of bile: 30-60 ml
Gallbladder concentrates bile 5-20
folds
Na actively transported across
gallbladder mucosa (Cl- & H2O follows)
leaving:
o Bile salts (most abundant)
o Cholesterol
o Lecithin
o Bilirubin
if in excessive amounts,
these can precipitate to form
gallstones
Regulation of pancreatic secretion

HEPATOBILIARY TRACT

Important functions of bile

o Fat digestion and absorption
o Means for excretion of blood
waste products

Bilirubin

Cholesterol

PHYSIOLOGIC ANATOMY OF BILIARY

SECRETION
HEPATOCYTE SECRETION
(bile acids, cholesterol, organic constituents)
Bile Canaliculus
Interlobar Septa
Terminal Bile Ducts
Cystic Duct

Duodenum

Transcribed by Group : 4

Formation of Gallstones

GALLBLADDER CONTRACTION AND

EMPTYING
Phase
Cephalic

Phenome
non
Slight

Result
Acetylcholi

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Contract
ion

Gastric

Intestin
al

smell,
taste of
food
stimulate
vagus
nerve
Stomach
distention
vagus
nerve
further
stimulated
Food (fat)
in
duodenum

Up to 18x

ne
secretion

Secreted in bile
Portal Blood
Intestines

Acetylcholi
ne
secretion

CCK
secretion

94% absorbed
in ileum
6% lost in feces
transport)

(diffusion/active

SYNTHESIS OF BILE SALTS IN THE

HEPATOCYTES
Cholesterol
Cholic acid / Chenodeoxycholic Acid
conjugated
Glycine
Taurine
Glycoconjugated
Tauroconjugated
Bile Acids
Acids

Bile

Liver cells synthesize 6g of bile salts

daily
ACTION OF BILE SALTS IN INTESTINAL
TRACT
Detergent/Emulsifying Action
o Increase surface tension of fat
particles
Absorption of fats:
Fatty Acids, Monoglycerides,
Cholesterol, Lipids

Liver secretion & gallbladder emptying

Formation of Micelles
Ferried to mucosa
Absorbed into the blood
***in absence of bile salts: 40% of lipids are
lost in feces
ENTEROHEPATIC CIRCULATION OF BILE
SALTS
Means of bile salt conservation
Bile salts in liver

Transcribed by Group : 4

Basic structure of a liver lobule, showing the liver

cellular plates, the blood vessels, the bile-collecting
system, and the lymph flow system composed of the
spaces of Disse and the interlobular lymphatics.

THE LIVER
Function as:
o Blood reservoir

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450 ml (10% of bodys

total blood volume)
Lymph Source

Supplies of all lymph

formed in the body
Blood cleanser

Via Kupffer cells

(hepatic macrophage
system)

NORMAL HEPATIC FUNCTION

D.) CLEARANCE & DETOXIFICATION

A.) GLUCOSE REGULATION

E.) EXCRETION

B.) STORAGE

C.) SYNTHESIS

METABOLIC FUNCTIONS OF THE LIVER

Carbohydrate, Fat, Protein metabolism
Miscellaneous functions:
o Storage site for vitamins
o Storage for iron
o Formation of blood coagulation
factors
o Removal or excretion of drugs,
homones, others
a.) Liver as Storage site for Vitamins
VITAMI
STORED SUPPLY
N
GOOD FOR
A
10 months

Transcribed by Group : 4

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D
B12

3-4 months
1 year

b.) Liver as storage site for Iron

Hepatocyte
APOFERRITIN
Excess Iron

Reversibly combines
with iron (Ferritin)

Released in Circulation

Conjugated with glucuronic acid in the liver

Gall Bladder

Kidneys

Intestines
Group NYAKIS! 11
FLOM.ron.BLE.jay.JUD.baki.JING.chin.KAR.dalt

c.) Formation of Blood Coagulation

Factors
Fibrinogen
Accelerator Globulin
Prothrombin
Factor VII
Vitamin K
Factor IX
Dependent
Factor X
d.) Removal or excretion of:
Drugs
Hormones
o Thyroxine, Cortisol, Estrogen
Calcium

JAUNDICE
Yellowish tint to the body tissues (skin,
sclerae, deep tissue) caused by large
quantities of bilirubin in the
extracellular fluid greater than 3x the
normal level
Causes of jaundice:
o Prehepatic

RBC destruction
(hemolytic jaundice)

Unconjugated
bilirubin
o Hepatic

Liver cell damage

o Posthepatic

Normal bilirubin
production but cannot
pass from bile ducts to
intestine

Conjugated Bilirubin

Bilirubin Formation and Excretion:

Senescent RBCs destroyed by RE cells in the

spleen
Unconjugated Bilirubin (B1) released to
bloodstream
Uptake of B1 by the liver

Transcribed by Group : 4

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