FISIOLOGI SISTEM

HEPATOBILIER PANKREAS

Caroline
Indra
Novyan
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
Fungsi Hati sebagai
Metabolisme Karbohidrat
 Metabolisme karbohidrat
Menyimpan glikogen
Mengubah galaktosa dan fruktosa menjadi
glukosa
Glukoneogenesis
Membentuk banyak senyawa kimia dari hasil
metabolisme karbohidrat
 Hati mengubah pentosa dan heksosa
yang diserap dari usus halus menjadi
glikogen  mekanisme glikogenesis
 Glikogen lalu ditimbun di dalam hati
dan dipecahkan menjadi glukosa 
proses glikogenolisis
 Hati mengubah glukosa melalui
heksosa monophosphat shunt dan
terbentuklah pentosa
Fungsi Hati sebagai
Metabolisme Lemak
 Asam lemak dipecah menjadi beberapa komponen:
 Senyawa 4 karbon  keton bodies
 Senyawa 2 karbon  active acetate (dipecah menjadi
asam lemak dan gliserol)
 Pembentukan sebagian besar lipoprotein
 Pembentukan sejumlah besar kolesterol dan
phospolipid
 Pengubahan sejumlah besar karbohidrat dan protein
menjadi lemak
 Hati merupakan tempat pembentukan utama, sintesis,
esterifikasi, dan ekskresi kolesterol
Fungsi Hati sebagai
Metabolisme Protein
 Metabolisme protein
Mensistesis berbagai macam protein
dari asam amino  deaminasi asam
amino
Pembentukan ureum untuk
mengeluarkan amonia dari cairan tubuh
Pembentukan protein plasma
Mensistesis gula dari asam lemak dan
asam amino
 Dengan proses transaminasi, hati
memproduksi asam amino dari bahan-
bahan non nitrogen
 Hati membentuk plasma albumin dan α-
globulin dan organ utama bagi produksi
urea
 Urea merupakan end product metabolisme
protein
Fungsi Hati sebagai Pembekuan
Darah
 Hepar mensintesis protein yang
membentuk sebagian besar zat-zat
untuk proses koagulasi darah
(fibrinogen, protrombin, globulin
akselerator, faktor VII, dll)
 Vitamin K dibutuhkan oleh proses
metabolisme hati untuk membentuk
protrombin dan faktor VII, IX dan X
Fungsi Hati sebagai Metabolisme
Vitamin

 Semua vitamin disimpan di dalam hati

khususnya vitamin A, D, E, K
Fungsi Hati sebagai Penyimpan
Besi
 Besi disimpan di hati dalam bentuk
ferritin.
 Bila besi banyak tersedia dalam cairan
tubuh, maka besi akan berikatan
dengan apoferritin membentuk ferritin
dan disimpan dalam bentuk ini di dalam
sel hati sampai diperlukan.
Fungsi Hati sebagai Detoksikasi

 Hati dapat mendetoksikasi/ekresi

berbagai obat-obat meliputi
sulfonamide, penisilin, ampisilin dan
eritromisin ke dalam empedu.
 Proses detoksikasi terjadi pada proses
oksidasi, reduksi, metilasi, esterifikasi
dan konjugasi terhadap berbagai
macam bahan seperti zat racun, obat
over dosis.
 Dengan cara yang sama, beberapa hormon
yang disekresi oleh kelenjar endokrin
dieksresikan atau dihambat secara kimia
oleh hati, meliputi tiroksin dan terutama
semua hormon steroid seperti estrogen,
kortisol, dan aldosteron
Fungsi Hati sebagai Fagositosis
dan Imunitas
 Sel kupfer merupakan saringan penting
bakteri, pigmen dan berbagai bahan
melalui proses fagositosis
 Sel kupfer juga ikut memproduksi α-
globulin sebagai imun livers mechanism.
Metabolisme Bilirubin
Penghancuran Eritrosit oleh Penghancuran Eritroid di
sel 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
• The liver (hepatocytes) produces bile continuously
and excretes it into the bile canaliculi.
• Bile secretion serves two major roles:
1. because the liver is a major site of
detoxification and cellular recycling, bile
transport allows excretion of toxins and normal
cellular metabolites.
2. bile salts have a critical role in the absorption
of most lipids
 Bile Formation and Composition
• 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.
 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
 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

• The 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.
Somatostatin and its analogues are potent
inhibitors of gallbladder contraction.
• 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.
Sphincter of Oddi
• 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
 Pancreas
FUNGSI

ENDOKRIN
EKSOKRIN

DIGESTIVE α CELL β CELL D CELL

ENZYME,HCO3
- GLUKAGON -. INSULIN
–
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.
Pancreatic secretions are similar to
saliva in
that they are produced in two stages:

(1) Cl– is secreted in the acini by active

secondary transport,
followed by passive transport of Na+ and
water . The electrolyte composition
of these primary secretions corresponds
to
that of plasma (!A1 and A2). Primary
pancreatic
secretions also contain digestive
proenzymes
and other proteins
(2) HCO3 is added to the primary
secretions (in exchange for Cl–) in the
secretory ducts; Na+ and water follow by passive
transport. As a result, the HCO3– concentration
of pancreatic juice rises to over
100 mmol/L, while the Cl– concentration falls
-Most of the pancreatic juice is
secreted during the digestive phase
 Pancreatic juice secretion is
controlled by
cholinergic (vagal) and hormonal
mechanisms
(CCK, secretin).

Fat in the chyme stimulates the

release of CCK,
which, in turn, increases the
(pro)enzyme content
of the pancreatic juice (!C ).

Trypsin in the small intestinal

lumen deactivates CCK release via
a feedback loop (!D).
• Pancreatic enzymes
are essential for
digestion.
They have a pH optimum
of 7–8. Insufficient
HCO3– secretion (e.g., in
cystic fibrosis) results in
inadequate
neutralization of chyme
and therefore in
Carbohydrate
catabolism.
-Amylase is secreted
in active form and
splits starch and
glycogen into maltose,
maltotriose and -limit
dextrin. These
products are further
digested by
enzymes of the
intestinal epithelium
Lipolysis.
Pancreatic lipase is the most
important enzyme for lipolysis.
It is secreted in its active form and
breaks triacylglycerol
to 2-monoacylglycerol and free fatty
acids.
Pancreatic lipase activity depends on
the presence of colipases
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).
Function. Pancreatic hormones
(1) ensure
that ingested food is stored as glycogen and fat
(insulin)

(2) mobilize energy reserves in response

to food deprivation, physical activity or
stress (glucagon and the non-pancreatic hormone
epinephrine)

(3) maintain the plasmaglucose concentration as

constant as possible

(4) promote growth.

TERIMA
KASIH