FISIOLOGI

HATI KANDUNG

EMPEDU

ANATOMI-FISIOLOGI (LOBULUS)
1.
2. 3. 4.

5.
6.

SEL HEPATOSIT (RADIER) VENA SENTRALIS KANALIKULI SINUSOID SEL KUPFFER SPACE OF DISSE V.PORTA
KANALIKULI

SINUSOID

V.HEPATKA

DUKTUS BILIARIS

A. FUNCTION OF THE HEPATIC

VASCULARE 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 yetachloride, 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 cleansing function of the 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 FUNCTION OF THE 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. METABOLIC FUNCTION OF THE 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. METABOLIC FUNCTION OF THE 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 FUNCTION / 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 OF BILE (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 OF BILE (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 THE 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 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 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 dirrhea, bile salt inhibit water and Na absorption

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)