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, infections 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
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
Glocose balance
Homeostatic blood glocose
level
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)
Metabolic pathways of the absoeptive state
Metabolic pathways of the post absoeptive state
Cholesterol balance
 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
Role of liver in clotting
 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)
Bileacids :
(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
Enterohepatic circulation of bile salts
Regulation of bile entry into the small intestine
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
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)
Summary of liver functions
Summary of liver functions
Summary of liver functions
Summary of liver functions
 Betapa sulitnya manusia
bersyukur atas nafas yang
masih berhembus. Namun
batapa mudahnya manusia
mengeluh hanya karena
kakinya menginjak kotoran