Anda di halaman 1dari 31

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-FISIOLOGI
(LOBULUS)

6.

SEL HEPATOSIT (RADIER)


VENA SENTRALIS
KANALIKULI
SINUSOID
SEL KUPFFER
SPACE OF DISSE

V.PORTA

KANALIKULI

1.
2.
3.
4.
5.

SINUSOID

V.HEPATKA

DUKTUS BILIARIS

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

Blood

flow through the liver


1450 ml/min (29% COP)
1100 ml : from the portal vein
350 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, infectious in the bile
duct)
: blockage of the portal system

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

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 LESS
Bicause the collateral vascular
channel develop rapidly from the
portal veins to the systemic veins.

Blood
Blood cleansing
cleansing function
function of
of
the
the liver
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.

B. METABOLIC
METABOLIC FUNCTION
FUNCTION OF
OF
B.
THE LIVER
LIVER
THE
CARBOHYDRATE METABOLISM
Maintains 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

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

B.
B. METABOLIC
METABOLIC FUNCTION
FUNCTION OF
OF
THE
THE LIVER
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)

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 %)

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

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

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

PRODUCTION 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 canaliculi
hepatic ducts
GALL BLADER

BILIARY 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

GALLBLADDER
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 contraction
vagal stimulation during cephalic and
gastric phase

Regulation of bile entry into the small intestine

COMPOTITION
COMPOTITION OF
OF BILE
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)


Bile

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

COMPOTITION
COMPOTITION OF
OF BILE
BILE
(3)
(3)

Phospholipids

(prymarily

lecithisn)
solubized by the bile salt
micelles
Cholesterol
is important of bile, bicause it is
one of the few ways in wich
choleterol regulation
electrolytes

FUNCTION OF
OF THE
THE BILE
BILE
FUNCTION
Digestion

and absoption of fat


help to emulsify of the large fat
particle
aid 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
CIRCULATION
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

Enterohepatic circulation of bile salt

CILINICAL IMPLICATION
Any

condition that disrupts


enterohepatic circulation (ileal
resection or small intestinal
diseases : sprue or Crohns 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 METABOLISM

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.

THE COMMONE CAUSES JAUNDICE


INCREASED DESTRUCTION OF

RED BLOOD CELLS (HEMOLITIC


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