FISIOLOGI SISTEM HEPATOBILIER PANKREAS

Fasilitator : Hanna Goenawan, M.Kes, AIFO,Ph.D.

Presentan :

Adriel Benedict (ORT) Redi Rulandari (BU)

Rio Aditya (ORT) M. Sangaji Ramadhan (URO)

Wirda Yunita (BA) Ambara Rakhmadi (BS)

Maria Mediatrix Ohoiwirin (BU) Piter Pical (THT-KL)

 HEPAR

•Hepar adalah organ

metabolic terbesar dalam
tubuh manusia “pabrik
biokimia tubuh”.
•Hepar berperan dalam
system pencernaan-->
sekresi garam empedu
yang membantu
pencernaan dan dan
penyerapan lemak.
 FUNGSI UTAMA HEPAR

FUNGSI UMUM FUNGSI KHUSUS

Metabolisme karbohidrat Konversi glukosa menjadi glikogen, atau glikogen jadi glukosa dan dari non karbohidrat
ke glukosa

Metabolisme lipid Oksidasi asam lemak: sintesis lipoprotein, posfolipid dan kolesterol: konversi Karbohidrat
dan protein ke lemak

Metabolisme protein Deaminasi asam amino: sintesis urea, protein darah, interkonversi asam amino

Penyimpanan Glukosa, vitamin A, D, dan B12 dan besi

Filter darah Membuang sel darah merah yang rusak dan benda asing dengan fagositosis

Detoksifikasi Mengubah komposisi zat-zat toksis

Sekresi Sekresi empedu

 METABOLISME BILIRUBIN

Penghancuran Eritrosit oleh sel Penghancuran Eritroid di

retikuloendotelial limpa dan sumsum tulang

Hemoglobin
Globin PRA
HEPATIK
Hem
Hem Oksigenase

Biliverdin
Biliverdin Reduktase

Unconjugated Bilirubin-Albumin
 Masuk ke hepar

Ambilan
Unconjugated Bilirubin
Dilepaskan dari Albumin
Glukuronosil
INTRA
Transferase
HEPATIK
Bilirubin Diglukuronida
Konjugasi
(conjugated bilirubin,larut di air)

Ekskresi Ekskresi Melalui Empedu

Dibawa Ke usus
Bakteri Usus POST
HEPATIC
Urobilinogen
 Urobilinogen

Diekskresi Sebagian Kecil

Dalam Feses Diserap Kembali oleh
Usus

Strekobilin
Vena Porta POST
HEPATIK

Dieksresikan Lagi Sebagian Kecil

dalam empedu Mencapai ginjal

Eksresi lewat Urin

GALLBLADDER & BILE
DUCT
 GALLBLADDER FUNCTION

• The gallbladder, the bile ducts, and the sphincter of Oddi act
together to store and regulate the flow of bile.
• Gallbladder’s capacity is 40-50 mL
• The main function of the gallbladder is to concentrate and store
hepatic bile and to deliver bile into the duodenum in response to a
meal
 SPHINCTER OF
ODDI

• Size: 4-6mm
• - Regulates flow of bile (and
pancreatic juice) into the duodenum,
prevents the regurgitation of
duodenal contents into the biliary tree,
and diverts bile into the gallbladder
 ABSORPTION AND SECRETION

• In the fasting state, approximately 80% of the bile secreted by the liver is stored in the gallbladder

• Rapidly absorbs sodium, chloride, and water

• e epithelial cells of the gallbladder secrete two important products into the gallbladder lumen: glycoproteins and hydrogen ions.

• The mucosal glands in the infundibulum and the neck of the gallbladder secrete mucus glycoproteins that are believed to protect the
mucosa from the lytic action of bile and to facilitate the passage of bile through the cystic duct.

This mucus makes up the colorless “white bile” seen in hydrops of the gallbladder resulting from cystic duct obstruction.

• The transport of hydrogen ions by the gallbladder epithelium leads to a decrease in the gallbladder bile pH.

• The gallbladder secrets mucus at about 20 mL/h

 MOTOR ACTIVITY

• Gallbladder filling is facilitated by tonic contraction of the

sphincter of Oddicreates a pressure gradient between the bile
ducts and the gallbladder
• Gallbladder empties 50% to 70% of its contents within 30 to 40
minutes. Over the following 60 to 90 minutes, the gallbladder
gradually refills
• In fasting: gallbladder repeatedly empties
small volumes of bile into the duodenum by
hormone motilin by rhythmic contractions
that exchange concentrated bile with dilute
bile
• In meal: gallbladder empties by a
coordinated motor response of gallbladder
contraction and sphincter of Oddi
relaxationdelivering into the duodenum
concentrated bile required for digestion
 NEUROHORMONAL
REGULATION

• The vagus nerve stimulates contraction of the gallbladder

• Splanchnic sympathetic stimulation is inhibitory to its motor activity
• Vasoactive intestinal polypeptide inhibits contraction and causes
gallbladder relaxation.
• CCK (hormone cholecystokinin) acts directly on smooth muscle
receptors of the gallbladder and stimulates gallbladder contraction.
It also relaxes the terminal bile duct, the sphincter of Oddi, and
the duodenum. CCK stimulation of the gallbladder and the biliary
tree also is mediated by cholinergic vagal neurons.
 BILE FORMATION AND
COMPOSITION

• The liver (hepatocytes) produces bile continuously and excretes it into the bile
canaliculi.
• Bile secretion serves two major roles:
- Excretion of toxins and normal cellular metabolites.
- Bile salts have a critical role in the absorption of most lipids
• 500 to 1000 mL of bile a day
• Bile contains electrolytes, bile salts (bile acids), electrolytes, cholesterol, lecithin
(phosphatidylcholine), bilirubin diglucuronide, steroid hormones, medications, and
bile pigments.
• Stimultion from:
- Neurogenic: Vagal stimulation ↑ secretion of bile >< splanchnic nerve stimulation ↓
bile flow
- Hydrochloric acid, partly digested proteins, and fatty acids in the duodenum stimulate
the release of secretin↑ bile production and bile flow
- Cholecystokinin (CCK), secreted by the intestinal mucosa, serves to induce biliary
tree secretion and gallbladder wall contractionexcretion of bile into the intestines.

• Bile flows from liverhepatic ductscommon hepatic ductcommon bile

ductduodenum.
With an intact sphincter of Oddi, bile flow is directed into the gallbladder
• In the intestines, about 80% of the conjugated bile acids are absorbed in the
terminal ileum. The remainder is dehydroxylated (deconjugated) by gut bacteria,
forming secondary bile acids deoxycholate and lithocholate. These are absorbed
in the colon, transported to the liver, conjugated, and secreted into the bile.
• Eventually, about 95% of the bile acid pool (unconjugated bile salts) is
reabsorbed from bile ducts. Conjugated bile salts enter the duodenum and are
reabsorbed from the terminal ileum by the Na+ symport carrier ISBT (=ileal
sodium bile acid cotransporter) and circulated back via the portal venous system
to the liver (enterohepatic circulation)
• 5% is excreted in the stool, leaving the relatively small amount of bile acids to
have maximum effect.
 PANCREAS

• The exocrine part of the pancreas

secretes 1–2 L of pancreatic juice
into the duodenum each day.
• The pancreatic juice contains
bicarbonate(HCO3–), which
neutralizes (pH 7–8) HCl- rich
chyme from the stomach, and
mostly inactive precursors of
digestive enzymes that break
down proteins, fats,
carbohydrates and other
substances in the small intestine.
FUNCTION

ENDOCRIN
EXOCRINE E
 EXOCRINE

• The bulk of the pancreas isan exocrine gland secreting

pancreatic fluid into duodenum after meal.
• The principal stimulant of pancreatic water and electrolyte
secretion (secretin)
• Secretin is synthesized in the S cells of the cript of
Lieberkuhn
• Release into the blood stream in the presence of luminal
acid and bile.
 BICARBONATE SECRETION

• Bicarbonate is formed from carbonic acid by enzyme

carbonic anhydrase
• Major stimulants : secretin, cholecystokine, gastrin,
Achetylcoline
• Major inhibitors: atropine, somatostatin, pancreatic
polypeptide
• Secretin released from the duodenal mucosa in response to
a duodenal luminal ph <3
 ENZYMES (TYPES &
SECRETION)

• Amylase
- Only digestive enzymes secreted by pancreas in active form
- Hydroliyzes starch and glycogen to glucose, maltase, maltotriose and dextrin.
• Lipase
- Emulsify and hydrolyze fat in the presence of bile salts.
• Protease
-Essential for protein digestion
- Sectreted as proenzymes require activation for proteolytic activity
- Duodenal enzymes enterokinase converts trypsinogen to trypsin
• Released from the acinar cells into the lumen of the acinus
and the transported into the duodenal lumen, where the
enzymes are activated.
 ENDOCRINE

• Principal function is to maintain glucose homeostasis

• Insulin and glucagon play a major role in glucose
homeostasis
• In addition endocrine pancreas secrete somatostatine,
pancreatic polypeptide, c peptide and amylin.
• Pancreatic polypeptide  release internally to self regulate
pancreas activity
• Amylin  release with insulin, contributes to glycemic
control
 PANCREATIC
HORMONES

• Islets of Langerhans in the pancreas play a

primary role in carbohydrate metabolism. Three
cell types (A, B, D) have been identified so far
• 25% are type A (cells that produce glucagon)
• 60% are B ( cells that synthesize insulin)
• 10% are D ( cells that secrete somatostatin
(SIH).
 INSULIN

• Sythesized in Beta cells

of the islets of the
Langerhans.
• Insulin and C peptides
are packaged in to
secretory granules and
released together in to
the cytoplasm
• Major stimulant : amino
acide, glucose, glucagon
• Major inhibitor:
somatostatin, amylin
 GLUCAGON

• Secreted by the Alpha cells of the islet of the Langerhans

• Major stimulants: Amino acid, cholinergic fiber,
• Major inhibitors: Glucose, insulin, somatostatin
• Main physiological role: Increase blood glucose level
through stimulation of glycogenolisis and gluconeogenesis
• Release is inhibited by hyperglicemia and stimulated by
hypoglycemia (Antagonist effect of insulin)
 SOMATOSTATIN

• Secreted by Delta cells of the islets of Langerhans

• Major stimulants: High fat, protein rich, high carbohydrate
meal
• Generalized inhibitory effect:
- Inhibits the release of growth hormones
- Inhibit the release of almost all peptide hormones
- Inhibit gastric, pancreatic and biliary secretion
• Used to treat both endo and exocrine disorders
THANK
YOU