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 ANATOMI
HEPATOBILIER
HEPAR
 HEPAR
Kelenjar paling besar 1,5 kg = 2-2.5% berat
tubuh. (anak sampai 5%)
Bentuk seperti piramida alasnya di kanan
dan puncaknya di ujung kiri
Konsistensi lunak seperti selai
Dibungkus oleh Capsula Glisson (tunica fibrosa
hepatis)
 Fungsi Hepar
1. Produksi dan sekresi empedu saluran
cerna dan fakor pembekuan
2. Berperan pada metabolisme lemak, KH, dan
protein
3. Sebagai filter dari darah untuk kuman dan
zat-zat toksik
4. Tempat menyimpan vitamin dan ferritin
 LETAK HEPAR
Dibawah diaphragma,
pada regio:
hypochondriaca kanan,
bagian atas regio
epigastrica dan dapat
mencapai regio
hypochondriaca kiri
Tergantung pada:
Distensi alat sekitar
Gerak diaphragma
Posisi tubuh (lebih rendah
saat berdiri dan inspirasi)
 LETAK HEPAR
Batas atas
Garis horizontal via
articulatio xiphisternalis
Ke kiri pinggir bawah
iga 5, berakhir pada sela
iga 5 dekat apex cordis
8-9 cm kiri garis tengah
Ke kanan sedikit naik ke
atas iga 5 pada linea
medioclavicularis kanan
 LETAK HEPAR
Batas bawah (ditentukan
dengan perkusi)
Garis miring mulai pada
sela iga 5 kiri pada linea
medioclavicularis
memotong arcus costarum
kiri (ujung rawan iga 8) lalu
menyilang garis tengah
pada/sedikit di atas bidang
transpyloricum ke kanan
memotong arcus costarum
kanan (rawan iga 9)
hepar berada di belakang
iga
 FIKSASI HEPAR

Terutama oleh ligamentum falciforme hepar, v.cava

inferior dan tekanan intraabdominal
 PERMUKAAN HEPAR
Facies diaphragmatica
facies anterior, superior,
lateral, dan posterior
Facies visceralis ke arah
alat-alat viscera abdomen

Batasnya di depan
margo anterior
Batasnya di belakang
facies posterior

Ligamentum falciforme
hepatis membagi hepar
lobus kanan dan kiri
 FACIES DIAPHRAGMA HEPATIS
Cembung sesuai permuakaan bawah
diaphragma, terpisah dari diaphragma oleh
recessus subphrenicus
Hubungan-hubungan:
Facies anterior iga2, proc.xiphoideus dan
dinding depan abdomen
Facies lateral diaphragma & iga 7-11
Facies superior lekukan impressio cardiaca
Facies posterior vertebra T10-11, area nuda
 FACIES VISCERALIS HEPATIS
Menghadap ke bawah agak ke kiri belakang
Bentuk huruf H dengan sisi kanan dan kiri dan
porta hepatis di tengah :
Sisi kiri fissura ligamenti teretis hepatis di depan,
fissura ligamenti venosi di belakang
Sisi kanan fossa vesica fellea di depan, fossa venae
cavae inferioris di belakang
Porta hepatis lekukan dalam, 5 cm antara lobus
caudatus dan quadratus tempat masuk keluat
v.porta hepatis, arteria hepatica, ductus
hepaticus, saraf dan saluran limfe
 FACIES VISCERALIS HEPATIS
Bagian belakang lobus kiri impressio
esophagea
Lobus kiri : impressio gastrica (fundus dan bagian
atas corpus gastrica)
Kiri dari fissura lig. Venosi tuber omentale ~
curvatura minor gastrica
Lobus kiri, quadratus dan lobus kanan
impressio duodenalis (pylorus + pars
sup.duodeni)
Kanan dari vesica fellea impressio colica ~
flexura coli dextra
 FACIES VISCERALIS HEPATIS
Dorsal dari impressio colica impressio renalis ~ ren
dexter dan di belakangnya lagi impressio
suprarenalis
Pada facies visceralis ada porta hepatis, lekuk
sagittalis kanan dan kiri terpisah dari lobus dexter:
Lobus quadratus dan lobus caudatus
(fungsional keduanya lobus kiri)
Lobus caudatus dibatasi oleh fissura ligamenti venosi,
porta hepatis, fossa v.cava inf.
Mempunyai tonjolan : processus caudatus dan
papillaris
 FACIES VISCERALIS HEPATIS
Lobus quadratus dibatasi oleh
Fissura ligamenti teretis hepatis, porta
hepatis, fossa vesica felleae
Antara lobuli ada canalis portalis berisi
triad portal :
a.hepatica propia, vena porta hepatis, dan
ductus choledocus
 Pembuluh darah hepar
70% dari arteri hepaticae
30% dari v.porta hepatis
Hepar terdiri dari lobuli dengan pusatnya pada
venae centrales hepatis -> ke venae hepaticae
-> v.cava inferior
 Pembuluh limfe hepar
Sebagian besar -> nl. Hepatici -> nl. Coeliaci ->
ductus thoracicus
 Persarafan hepar
Dari sistem simpatis (plexus coeliacus),
parasimpatik (n.vagus), dan sensoris
(n.phrenicus) -> melalui plexus hepaticus,
sebagian besar melalui plexus coeliacus
 Saluran eksresi hepar
Dari sel hepar -> canaliculi -> ductus hepaticus
interlobularis -> ductus hepaticus dexter et
sinister -> ductus hepaticus communis (4cm)
ke bawah di antara lapisan omentum minus ->
bersatu dengan ductus cysticus dengan sudut
tajam -> membentuk ductus choledocus
(common bile duct) -> berjalan ke bawah pada
pinggir kanan omentum minus (triad portal)
bersama a.hepatica propia di kirinya dan
v.porta hepatica di belakangnya
 Peritoneum hepar
Hampir seluruhnya diliputi capsula fibrosa
(peritoneum) kecuali suatu daerah pada facies
posterior -> area nuda hepatis (bare area)
Peritoneum viscerale berasal dari
mesohepaticum ventrale -> ikut membentuk
omentum minus dan lig. Falciforme hepatis
Omentum minus : dari porta hepatis ke curvatura
minor gastrica dan awal pars superior duodeni.
Ujung kanannya membungkus triad portal.
 Lig.falciforme hepatis -> 2 lapis peritoneum
menghubungkan hepar dengan diaphragma +
dinding depan abdomen
Pada pinggir bebas ya terdapat lig.teres
hepatis (round ligament of liver) -> sisa
v.umbilicalis yang telah menutup
Beberapa venae kecil vv.paraumbilicales masih
mempunyai hubungan dengan sistem vena
porta hepatis
 Lig.falciforme hepatis dari facies anterior hepar ->
ke atas ke facies superior dan visceralis
membentuk lig.coronarium hepatis
Lig.coronarium sisi kiri ke ujung kiri membentuk
lig.triangulare sinistrum
Lig.coronarium yang kanan lapisan depan dan
belakang memisahkan diri meninggalkan daerah
bebas peritoneum (area nuda hepatis) -> ke
ujung bersatu lagi membentuk lig.triangulare
dextrum
 Aspek klinis hepar
Tempat penyebaran kanker dari alat2 melalui
v.porta hepatis
Sering terjadi cirrhosis hepatis -> terjadi
bendungan pada vena porta hepatis dengan
akibat2nya
Abses hepar (e.c amuba) -> penyebaran melalui
alitan darah dari disentri amuba di rectum
Abses subphrenica (e.c. ruptura appendicitis,
perforasi ulcus duodeni/empedu) -> sisi kanan
Vesica Fellea
 Merupakan bagian alat eksresi
hepar, berfungsi sebagai
tempat penampungan cairan
empedu -> absorpsi air ->
concentrated
Bentuknya seperti buah pir,
panjang 8 cm, lebar 3 cm dan
isinya 30-60 cc
Terletak di fossa vesica fellea
hepatis antara lobus quadratus
lobus kanan
Ujungnya: fundus menonjol
melewati pinggir depan hepar -
> hubungan langsung dengan
dinding depan abdomen (rawan
iga 9 kanan)
Diliputi oleh peritoneum
 Bagian2 : fundus, corpus, collum -> ke ductus
cysticus
 Fundus vesica fellea:
Proyeksinya pada perpotongan linea semilunaris
kanan arcus costarum (rawan iga 9 pada linea
medioclavicularis) atau perpotongan linea
axilloumbilicalis arcus costarum ( semuanya dari
sisi kanan)
Hubungan dengan permukaan depan abdomen
dan dengan pars superior duodeni, juga dengan
awal colon transversum -> pada kadaver warna
kehijauan
 Corpus vesica felleae:
-> permukaan visceralis hepar menghadap ke atas,
kiri, dorsal
Berhubungan dengan pars superior duodeni dan colon
transversum

Collum vesica felleae:

Sempit, lengkungan S, menyempit waktu beralih
menjadi ductus cysticus
Pada batasnya kadang2 ada kantong kecil Hartmann's
pouch (ampulla/infundibulum of gallbladder)
Collum untuk patokan menentukan letak foramen
omentalis -> tepat di sebelah kirinya
 Ductus cysticus
Panjang 2-4 cm

Mucosa ada lipatan spiralis :

Plica spiralis ductus cystici (valvula Heisteri) ->
berfungsi mempertahankan lumen tetap terbuka

Ductus berjalan ke bawah sedikit posterior, kiri

pada pinggir omentum minus -> bersatu dengan
ductus hepaticus communis -> ductus choledocus
(common bile duct)
 Ductus choledochus
Panjang 8-10 cm, lebar 0.5-0.6 cm
Berada di antara lapisan omentum minus pada
pinggir kanannya bersama a.hepatica propia dan
v.porta hepatis -> triad portal
Selanjutnya berjalan di belakang pars superior
duodeni di sebelah, bisa juga menembus masa
caput pankreas -> bersatu dengan ductus
pankreaticus membentuk ampulla
hepatopancreatica -> bermuara oblique ke sisi
medial pars descendens duodeni pada papilla
duodeni major
 Pada ujung ductus choledochus ada m.sphincter
ductus choledochi (Boyden's sphincter)
Dengan kontraksi otot ini -> empedu tidak bisa
lewat -> balik ke dalam vesica fellea -> disimpan
sementara
Pada papilla duodeni major juga ada m.sphincter
ampullae hepatopancreaticae (sphincter oddi) ->
mengatur pengeluaran cairan empedu dan
pancreas
 Pembuluh darah vesica fellea
-> A.cystica (cabang a.hepatica dextra)
Ductus choledocus -> cabang2 dari
aa.pancreaticoduodenalis superior, hepatica
dan cystica
Vena cystica -> cabang kanan v.porta hepatis
Vena dari ductus choledochus -> sebagian
masuk ke hepar, sebagian ke
v.pancreaticoduodenalis superior ->
v..mesenterica superior
 Pembulauh limfe vesica fellea
Nl.cysticus -> nl.hepatici -> nl.coeliaci
 Persarafan vesica fellea
Berasaal dari plexus celiacus (simpatis), nervus
vagus (parasimpatis), dan nervus phrenicus
kanan (sensoris)
 Aspek klinis
Batu empedu (cholelithiasis) -> bisa menyumbat di
dekat sphincter ampullae hepatopancreaticae
Jika tersumbat di ductus cysticus -> nyeri yang hebat
(colic cysticus) di sekitar epigastrium. Waktu VF
relaksasi batu masuk kembali ke VF -> nyeri
berkurang/hilang
Jika tetap tersumbat -> radang (cholecystitis) -> nyeri di
regio hypochondriaca kanan yang menjalar ke pundak
kanan (reffered pain)
Jika sumbatan total (bisa juga karena kanker pada
papila duodeni major) -> icterus. Variasi : ductus
hepaticus accessorius
Pankreas
 Termasuk kelenjar
pencernaan, warnanya
kelabu, panjangnya 12-
15 cm beratnya 90
gram
Kelenjar eksokrin ->
ductus pancreaticus
Kelenjar endokrin ->
pulau2 langerhans ->
hormon glucagon dan
insulin langsung ke
dalam darah
 Letaknya melintang menyilang garis tengah
dari caput (dikelilingi duodenum) -> cauda ke
kiri atas pada splen-> regio umbilicalis,
epigastrica, dan hypochondriaca kiri
 Letaknya retroperitonealis pada bagiam
belakang abdomen dorsal dari peritoneum
parietale, bursa omentalis -> ikut membentuk
"stomach bed"
 Bagian2 pancreas: 4C -> caput, collum, corpus,
dan cauda
 Caput pancreas
Mempunyai tonjolan ke kiri atas dibelakang vasa
mesenterica superior -> proc.uncinatus
Hubungan2:
Atas -> pars sup duodeni
Kanan -> pars desc duodeni &
aa.pancreaticoduodenalis sup
Bawah kiri -> pars inf & asc duodeni
Belakang -> crus dextrum diaphragma, v.cava inf, vasa
renalis kanan & v.renalis kiri
Depan -> disilang oleh colon transversum & kelokan
jejunum
 Collum pancreas
Hanya 2 cm, ke kanan menyatu dengan bagian
atas kiri caput pancreas dan ke kiri dengan
corpus pancreas
Pada collum ada lekukan untuk tempat vasa
mesenterica superior
Ke atas berhubungan dengan pylorus di
belakangnya terdapat persatuan v.splenica
dan v.mesenterica superior membentuk
v.porta hepatis
 Corpus pancreas
Bentuknya seperti prisma sisi tiga ->
3 facies: ant, post, inf
3 margo: sup, ant, post

Facies anterior ditutupi oleh peritoneum dari

bursa omentalis -> ikut membentuk stomach
bed
 Cauda pancreas
Ujung paling kiri, setinggi vert T12 di atas
bidang transpyloricum
Berada di antara ke 2 lapisan lig.splenorenalis
(lienorenalis)
Berhubungan erat dengan a. dan v. lienalis
yang keluar masuk melalui hilum lienalis
Ujungnya terletak dekat hilum di bawah
impressio gastrica lienalis
 Ductus pancreaticus
Ada 2 saluran keluar :
ductus pancreaticus wirsungi (utama) dam
ductus pancreaticus accessorius Santorini (9% muara di
papilla duodeni minor)
Ductus pancreaticus mulai pada cauda terus ke corpus
sampai caput -> membelok ke bawah, mendekati
ductus choledocus -> bersatu -> membentuk ampulla
hepatopancreatica Vater -> bermuara miring ke dalam
pars descendens duodeni pada papilla duodeni major
Pada muaranya ada m.sphincter ampullae hepato-
pancreatici Oddi
 Pembuluh darah pancreas
Pancreas mendapat darah dari cabang2:
a. splenica (corpus & cauda)
aa. Pancreaticoduodenalis superior et inferior
(caput)
Vena dari pancreas dialirkan ke vena porta
hepatis, v. splenica, dan v. mesenterica
superior
 Pembuluh limfe pancreas
Mengikuti pembuluh darahnya
Sebagian besar -> ke nl. Pancreaticolienalis
sepanjang a. splenica dan sebagian kecil -> nl.
Pylorici (nl. Coeliaci, hepatici & mesenterici
superiores)
 Persarafan pancreas
Dari nervi vagi dan splanchnici
Untuk rasa nyeri -> nn. splanchnici
 Aspek klinis
Batu dari empedu yang menyumbat di ampulla
hepatopancreatica -> icterus
Aliran dari pancreas juga tersumbat atau reflux
cairan empedu ke ductus pamcreaticus ->
akibatnya terjadi pancreatitis
Kanker pancreas -> 90% ductular
adenocarcinoma (severe pain in the back is
frequently present), kalau mengenai colum dan
corpus -> sumbatan pada VCI. Metastase paling
dekat dengan liver
Lien
 Suatu alat sistem RES (reticuloendothelial
system) > tempat penyimpanan butir sel
darah merah dan trombosit.
Pada fetus membuat darah.
Juga dianggap sebagai jaringan limfoid
 Ukuran: panjang 12.5 cm, lebar 7.5 cm dan
tebalnya 3.5 cm
Beratnya 150 gram (variasi 50-250 gram)
Letak limpa bervariasi sesuai gerak
diaphragma, posisi tubuh dan perkembangan
alat sekitarnya
Hubungan dengan pleura + paru2 bervariasi
sesuai ritme pernafasan
 Letaknya miring pada regio hypochondriaca kiri di
belakang lambung dan di depan ren kiri
Sumbu pajangnya sepanjang iga 10 sejajar
dengan bagian dorsal iga 9,10, dan 11 terpisah
dari pleura
Ujung posterior 4 cm kiri garis tengah setinggi
vert T10 dan ujung anterior/inferior terletak tepat
di dorsal linea medioclavicularis
Margo anterior dan superiornya tajam (margo
acutus) dengan lekukan2 sisa lobulisasi fissura
lenalis sedang margo inferiornya tumpul
margo obtusus
 Lien diliputi oleh peritoneum viscerale,
berhubungan dengan curvatura major
ventriculi melalui lig. Gastrosplenicum/lienalis
dan dengan ren kiri melalui lig,splenorenale
(lienorenale)
Keduanya melekat pada hilum splenis
Lien mempunyai
2 ujung: extremitas anterior/inferior dan
posterior/superior
2 margo: margo superior dan inferior splenis
2 permukaan: facies visceralis dan diaphragmatica
 Facies diaphragmatica cembung menghadap
ke diaphragma terpisah dari pleura dan
pinggir bawah paru2
Facies visceralis mempunyai tonjolan hilum
splenis dan lekukan2:
Impressio gastrica dekat margo superior
Impressio renalis dekat margo inferior
Impressio pancreatis (hubungan erat dengan
hilum)
Impressio colica dekat extremitas inferior
 Lien normal seluruhnya terletak di belakang
iga tidak teraba di bawah arcus costarum
Jika terjadi pembesara (splenomegali) lien
dapat melewati arcus costarum ditentukan
oleh garis schuffner dari arcus costarum
sampai umbilicus terus sampai SIAS
 Pembuluh darah limpa
Dari a.lienalis yang berjalan sepanjang pinggir
atas dan cauda pancreas terbagi dalam 5
cabang masuk ke dalam hilum splenicum
Venanya berjalan di belakang cauda + corpus
pancreas membentuk v.porta hepatis
bersama v. mesenterica superior
Vena lienalis menerima juga darah dari
v.mesenterica inferior
 Pembuluh limfe limpa
Dialirkan ke nl. Pancreaticolienalis pada facies
posterior pancreas dekat pinggir atasnya
 Persarafan limpa
Berasal dari plexus celiacus tersebar ke
a.lienalis (fungsi vasomotor)
 Aspek klinis limpa
Splenomegali pada malaria, demam tifoid,
bendungan portal (cirrhosis hati), dan
leukemia
Hubungan lien dengan pleura perlu
diperhatikan pada biopsi limpa
Cedera karena trauma dapat ruptura dan
perdarahan hebat shock perlu diangkat
(splenectomia)
 Splenomegali
Garis schuffner
Histologi hepatobilier
 Pancreas
The pancreas is a mixed exocrineendocrine
gland that produces digestive enzymes and
hormones
The enzymes are stored and released by cells
of the exocrine portion, arranged in acini.
The hormones are synthesized in clusters of
endocrine epithelial cells known as islets of
Langerhans
 The pancreas is made up of small clusters of
glandular epithelial cells.
About 99% of the clusters, called acini (AS-i-n),
constitute the exocrine portion of the organ
The cells within acini secrete a mixture of fluid
and digestive enzymes called pancreatic juice.
The remaining 1% of the clusters, called
pancreatic islets (I-lets) (islets of Langerhans),
form the endocrine portion of the pancreas.
These cells secrete the hormones glucagon,
insulin, somatostatin, and pancreatic polypeptide
Histology of the Liver and Gallbladder
Histologically, the liver is composed of several
components
1. Hepatocytes
2. Bile canaliculi
3. Hepatic sinusoids
 Hepatocytes
Hepatocytes are the major functional cells of the
liver and perform a wide array of metabolic,
secretory, and endocrine functions
Hepatocytes form complex three-dimensional
arrangements called hepatic laminae
The hepatic laminae are plates of hepatocytes
one
Cell thick bordered on either side by the
endothelial-lined vascular spaces called hepatic
sinusoids
 Grooves in the cell membranes between
neighboring hepatocytes provide spaces for
canaliculi into which the hepatocytes secrete
bile.
Bile, a yellow, brownish, or olive-green liquid
secreted by hepatocytes, serves as both an
excretory product and a digestive secretion.
 Bile canaliculi
These are small ducts between hepatocytes that
collect bile produced by the hepatocytes.
From bile canaliculi, bile passes into bile ductules
and then bile ducts.
The bile ducts merge and eventually form the
larger right and left hepatic ducts, which unite
and exit the liver as the common hepatic duct
The common hepatic duct joins the cystic duct
(cystic bladder) from the gallbladder to form the
common bile duct.
From here, bile enters the small intestine to
participate in digestion.
 Hepatic sinusoids
These are highly permeable blood capillaries
between rows of hepatocytes that receive
oxygenated blood from branches of the hepatic
artery and nutrient-rich deoxygenated blood
from branches of the hepatic portal vein.

Hepatic sinusoids converge and deliver blood into

a central vein.
From central veins the blood flows into the
hepatic veins, drain into the inferior vena cava
 Blood flows toward a central vein, bile flows in
the opposite direction.
Also present in the hepatic sinusoids are fixed
phagocytes called stellate reticuloendothelial
(Kupffer) cells which destroy worn-out white
and red blood cells, bacteria, and other
foreign matter in the venous blood draining
from the gastrointestinal tract.
 Together, a bile duct, branch of the hepatic artery,
and branch of the hepatic vein are referred to as
a portal triad.
The hepatocytes, bile duct system, and hepatic
sinusoids can be organized into anatomical and
functional units in three different ways:
1. Hepatic lobule functional unit of the liver
2. Portal lobule exocrine function of the liver,
that is, bile secretion. The bile duct of a portal
triad is taken as the center of the portal lobule
3. Hepatic acinus
Hepatic acinus
 Hepatic acinus
Cells in zone 1 are closest to the branches of the portal
triad and the first to receive incoming oxygen, nutrients,
and toxins from incoming blood. The first to show
morphological changes following bile duct obstruction or
exposure to toxic substances.
Cells in zone 3 are farthest from branches of the portal triad
and are the last to show the effects of bile obstruction or
exposure to toxins, the first ones to show the effects of
impaired circulation, and the last ones to regenerate
Cells in zone 2 have structural and functional characteristics
intermediate between the cells in zones 1 and 3.
 Gallbladder
The mucosa of the gallbladder consists of
simple columnar epithelium arranged in rugae
resembling those of the stomach.
The wall of the gallbladder lacks a submucosa.
The middle, muscular coat of the wall consists
of smooth muscle fibers.
Contraction of the smooth muscle fibers
ejects the contents of the gallbladder into the
cystic duct.
 Fisiologi Liver
Liver functions include the following:
1. Secretion of bile salts, which aid fat digestion and absorption.
This is the only liver function directly related to digestion.
2. Metabolic processing of the major categories of nutrients
(carbohydrates, proteins, and lipids) after their absorption from
the digestive tract
3. Detoxifying or degrading body wastes and hormones, as well
as drugs and other foreign compounds
4. Synthesizing plasma proteins, including those needed for
blood clotting, those that transport steroid and thyroid
hormones and cholesterol in the blood, and angiotensinogen
important in the saltconserving reninangiotensinaldosterone
system
5. Storing glycogen, fats, iron, copper, and many vitamins
6. Activating vitamin D, which the liver does in
conjunction with the kidneys
7. Secreting the hormones thrombopoietin (stimulates
platelet production), hepcidin (inhibits iron uptake from
the intestine;), and insulin-like growth factor-I (stimulates
growth;)
8. Producing acute phase proteins important in
inflammation
9. Excreting cholesterol and bilirubin, the latter being a
breakdown product derived from the destruction of
worn-out red blood cells
10. Removing bacteria and worn-out red blood cells,
thanks to its resident macrophages
Bile is continuously secreted by the liver and is diverted
to the gallbladder between meals.

The liver continuously secretes bile, even between meals.

The opening of the bile duct into the duodenum is guarded by
the sphincter of Oddi, which prevents bile from entering the
duodenum except during digestion of meals
When this sphincter is closed, bile secreted by the liver hits
the closed sphincter and is diverted back up into the
gallbladder.
Bile is subsequently stored and concentrated in the
gallbladder between meals.
Active transport of salt out of the gallbladder, with water
following osmotically, results in a 5 to 10 times greater
concentration of the organic constituents.
 After a meal, bile enters the duodenum as a
result of the combined effects of relaxation of
the sphincter of Oddi, gallbladder contraction,
and increased bile secretion by the liver.
Bile salts are recycled through the enterohepatic
circulation
 Bile contains several organic constituents, namely, bile
salts, cholesterol, lecithin (a phospholipid), and
bilirubin
Bile salts are derivatives of cholesterol. They are
actively secreted into the bile and eventually enter the
duodenum, along with the other biliary constituents.
Following their participation in fat digestion and
absorption, most bile salts are reabsorbed into the
blood by special active-transport mechanisms located
only in the terminal ileum enterohepatic circulation.
 Bile salts aid fat digestion through their detergent
action (emulsification) and facilitate fat absorption
by participating in the formation of micelles.
 Bile salts stimulate bile secretion;
CCK promotes gallbladder emptying
Any substance that increases bile secretion is
called a choleretic.
The most potent choleretic is bile salts
themselves
After bile salts participate in fat digestion and
absorption, they are reabsorbed and returned
by the enterohepatic circulation to the liver,
where they act as potent choleretics to
stimulate further bile secretion
 When chyme reaches the small intestine, the
presence especially of fat products in the
duodenal lumen triggers release of CCK.
This hormone stimulates contraction of the
gallbladder and relaxation of the sphincter of
Oddi, so bile is discharged into the duodenum
 Bilirubin is a waste product excreted
in the bile.
Bilirubin, the other major constituent of bile,
does not play a role in digestion but instead is
a waste product excreted in the bile.
Bilirubin is the primary bile pigment derived
from the breakdown of worn-out red blood
cells, which are removed from the blood by
the macrophages that line the liver sinusoids
and reside in other areas in the body.
 Bilirubin is the end product from degradation
of the heme (iron-containing) part of the
hemoglobin contained within these old red
blood cells
Bilirubin is a yellow pigment that gives bile its
color.
Within the intestinal tract, this pigment is
modified by bacterial enzymes, giving rise to
the characteristic brown color of feces
When bile secretion does not occur, as when
the bile duct is completely obstructed by a
gallstone, the feces are grayish white.
 A small amount of bilirubin is normally
reabsorbed by the intestine back into the blood,
and when it is eventually excreted in the urine, it
is largely responsible for the urines yellow color
If bilirubin is formed more rapidly than it can be
excreted, it accumulates in the body and causes
jaundice.
Patients with this condition appear yellowish,
with this color being seen most easily in the
whites of their eyes.
Jaundice can be brought about in three ways:
1. Prehepatic (the problem occurs before the liver), or
hemolytic, jaundice arises from excessive breakdown
(hemolysis) of red blood cells, which results in the liver
being presented with more bilirubin than it is capable of
excreting.

2. Hepatic (the problem is the liver) jaundice occurs

when the liver is diseased and cannot deal with even the
normal load of bilirubin.

3. Posthepatic (the problem occurs after the liver), or

obstructive, jaundice occurs when the bile duct is
obstructed, such as by a gallstone, so that bilirubin
cannot be eliminated in the feces
 Daftar pustaka
Sherwood L. Human Physiology from Cells to
Systems. 9th ed. Canada: Cengage Learning;
2016.
 CARBOHYDRATE METABOLISM
The oxidation of glucose to produce ATP is
also known as cellular respiration, and it
involves four sets of reactions: glycolysis, the
formation of acetyl coenzyme A, the Krebs
cycle, and the electron transport chain
LIPID METABOLISM
Protein Metabolism
 Daftar Pustaka
Tortora GJ, Derrickson B. Principles of
Anatomy & Physiology. 13th ed. United States
of America: John Wiley & Sons,Inc.; 2012.
 Sumber : Kapita Selekta
 FAKTOR RESIKO PENYAKIT
HEPATOBILIER
Major risk factors for liver disease that should be sought in the clinical history
include details of
alcohol use
medication use (including herbal compounds, birth control pills, and over-
the-counter medications)
personal habits
sexual activity
Travel
exposure to jaundiced or other high-risk persons,
injection drug use
Recent surgery
remote or recent transfusion of blood or blood products,
occupation
accidental exposure to blood or needlestick,
and familial history of liver disease
 Daftar Pustaka
Dennis K, Fauci A, Kasper D, Longo D, et al.
Harrisons Principles of Internal Medicine.
18th ed. United States of America: McGraw
Hill; 2012.