The Physiology of Hepatobiliary

System
Ahmad Fariz Malvi Zamzam Zein | Dept. of Internal Medicine | FM UGJ – Waled Hospital
The scope of theme

• Liver & its function

• The role of liver in the metabolism of carbohydrates, protein, and lipid

• Gallbladder & its function

Liver & its functions
Liver: the functions

• Metabolic function • Heat production

• Secretion of bile • Hemopoietic function

• Excretory function • Hemolytic function

• Storage function • Inactivation of hormones and

drugs
• Synthetic function
• Defensive & detoxification
function
 Liver: secretion of bile

• Histology of hepatic
lobules
Liver: secretion of bile

• Hepatocyte  secretes initial bile>>> bile acid, bile

pigments, cholesterol, lecithin, & fatty acids 
canaliculi

• Hepatic ducts  common hepatic duct  bile is

diverted directly into the intestine or into
gallbladder
Liver: secretion of bile

• Epithelial cells of the

ducts  Na, HCO3, H2O

• The bile is stored in

gallbladder  △ quality &
quantity due to absorption
of >>> H2O & electrolyte
(exc Ca & K)  volume ↓,
conc bile salts, pigments,
chol, fatty acid, & lecithin
↑, pH ↓, specific gravity ↑,
mucin is added
Liver: secretion of bile

• Aorta  O2-rich blood  hepatic artery (porta of the

liver)  portal triads  hepatic sinusoid to supply
hepatocytes in the hepatic chords with O2

• Intestines  nutrient-rich & deO2 blood  hepatic

portal vein (porta of the liver)  portal triads  hepatic
sinusoids to supply hepatocytes nutrients

• Substances + waste products + CO2  sinusoids

drain  central vein of the lobule  hepatic vein 
IVC

• Bile secretion
Formation of bile • Histology of hepatic lobules
salts
 Functions of bile (bile salts)

Functions Mechanisms
Emulsifications of Fat + bile salt  detergent action 
fats digestable by lipolytic enzymes
Absorption of fats Fats + bile salts  micelle  absorbable
Choleretic action Bile salt stimulates bile secretion from liver
Cholagogue action Bile salt  CCK  GB contraction  bile
release
Laxative agent Bile salt stimulate peristaltic movements of
intestine
Prevention of Bile salt + chol + lecithin  solution
gallstone formation
Control of bile
secretion and
release
Control of bile secretion and release

Category Chemical factors

Choleretics Acetylcholine
(substrates increase the secretion of bile from Secretin
liver) Cholecystokinin
Acid chime in intestine
Bile salt
Cholagogues Bile salt
(agents increase the bile release into intestine Calcium
by contracting gallbladder through stimulating Fatty acid
CCK) Amino acid
Inorganic acid
Hydrocholeretic Hydrochloric acid
(substances cause the secretion of bile from
liver, with large amount of water & less amount
of solid)
Liver: excretion of bile pigments
Liver: storage of nutrients

Hepatocytes:

• can remove sugar from the blood and store it in the form of glycogen.

• Store lipids, vitamins (A, B12, D, E, & K), Copper, & Iron.

This storage function:

• Short-term

• Fluctuates in size during the day

Liver: synthetic function

Liver:

• Produces glucose by gluconeogenesis

• Synthesizes all plasma proteins and other proteins (except immunoglobulins)

such as clotting factors, complement factors, & hormone-binding proteins.

• Synthesizes steroids, somatomedin, & heparin.

Liver: heat production

Mechanisms:

- Metabolic reactions in the liver 

enormous amount of heat is produced

- Cold exposure  FA from hepatic VLDL is

extracted by brown adipose tissue (BAT)
:
- adrenergic stimulation  hepatic
gluconeogenesis  glucose for BAT
thermogenesis
- Activate HNF⍺ in liver  ↑ FA oxidation &
production of acylcarnitines (fuel BAT
metabolism)

Liver is the organ where maximum heat is

produced
Liver: hemopoietic function

Hepatocytes:

• Produces the blood cell (fetus ~ hepatic stage)

• Stores vitamin B12  erythropoiesis

• Stores iron  Hb synthesis

• Produces thrombopoietin  promotes production of thrombocyte

Liver: hemolytic function

Kupffer cells  destroy the senile RBC after lifespan of 120 days
Liver: inactivation of hormones and drugs

Liver:

- catabolizes the hormones (GH, parathormone, cortisol insulin, glucagon, &

estrogen).

- Inactivates the drugs, esp fat-soluble

Liver: defensive & detoxification function

Immune cell & parenchymal cell in the liver produce a variety of soluble mediators 
important role in the maintenance of immune homeostasis, host defense, tissue repair,,
or fibrosis.

Kupffer cell ~ important defense of the body

- Foreign bodies (bacteria, Ag) are swallowed & digested by Kupffer cells by means of
phagocytosis

- Kupffer cell  IL & TNF  activate the immune system

Detoxification occurs in 2 ways:

- Total destruction of the substances by means of metabolic degradation

- Conversion of toxic substances into non toxic materials by means of conjugation with
glucuronic acid or sulfates.
Gallbladder & its function
 Gallbladder: its function

• Storage of bile

• Concentration of bile

• Alteration of bile pH

• Secretion of mucin

• Maintenance of pressure in biliary

system
The role of liver in carbohydrate
metabolism
Digestion of carbohydrates
The scheme of
carbohydrate
metabolism
Digestion of protein
The scheme of
protein metabolism
Digestion of lipid
The scheme of lipid
metabolism
Interconversion of nutrient molecules in
carbohydrate metabolism
Absorptive state
Postabsorptive state
References

• Seeley’s Anatomy & Physiology, 11th ed. NY, McGraw-Hill Education. 2017

• Essentials of Medical Physiology. 6th ed. New Delhi, Jaypee Brothers Medical
Publishers. 2012.

• Gastrointestinal Physiology. 8th ed. PA, Elsevier Mosby. 2014.

• Abumrad NA. Cell Metabolism. 2017;26:454-5.

THANK YOU