FISIOLOGI

HATI

KANDUNG EMPEDU
 ANATOMI-FISIOLOGI
(LOBULUS)
1. SEL HEPATOSIT (RADIER)
2. VENA SENTRALIS
3. KANALIKULI
4. SINUSOID
5. SEL KUPFFER
6. SPACE OF DISSE

 V.PORTA SINUSOID V.HEPATKA

 KANALIKULI 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
Hepatic macrophage system
system (kupffer
(kupffer
cells, the
cells, the large
large macrophage
macrophage that
that
line the
line the hepatic
hepatic sinuses)
sinuses) can
can cleanse
cleanse
blood (sach
blood (sach as
as many
many bacteria
bacteria from
from
the intestines)
the intestines)
Kupffer cells
Kupffer cells also
also phagocytize
phagocytize old
old red
red
and white
and white cells
cells and
and bacteria.
bacteria.
B. METABOLIC
B. METABOLIC FUNCTION
FUNCTION
OF THE
OF THE LIVER
LIVER
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) amini 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
E. OTHERS FUNCTION
FUNCTION // EXCRETION
EXCRETION

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
 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
FUNCTION OF THE
THE BILE
BILE
 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
 CILINICAL IMPLICATION
 Any condition that disrupts
enterohepatic circulation (ileal
resection or small intestinal
diseases : sprue or Crohn’s 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 dirrhea, bile salt
inhibit water and Na absorption
 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 contruction
vagal stimulation during cephalic ang gastric
phase
 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)
 OBSTRUCTIONOF THE BILE DUCT OR
DAMAGE TO THE LIVER SELLS
(OBSTRUCTIVE JAUNDICE)