134129131 Fisiologi Hati Dan Kandung Empedu
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Transcript of 134129131 Fisiologi Hati Dan Kandung Empedu
FISIOLOGI FISIOLOGI
HATI
KANDUNG EMPEDU
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ANATOMI-FISIOLOGIANATOMI-FISIOLOGI(LOBULUS)(LOBULUS)
1. SEL HEPATOSIT (RADIER)2. VENA SENTRALIS3. KANALIKULI4. SINUSOID5. SEL KUPFFER6. SPACE OF DISSE
V.PORTA SINUSOID V.HEPATKA
KANALIKULI DUKTUS BILIARIS
A. A. FUNCTION OF THE HEPATIC FUNCTION OF THE HEPATIC VASCULARE SYSTEMVASCULARE SYSTEM
A. A. FUNCTION OF THE HEPATIC FUNCTION OF THE HEPATIC VASCULARE SYSTEMVASCULARE SYSTEM
Blood flow through the liver1450 ml/min (29% COP)
1100 ml : from the portal vein350 ml : from hepatic artery.
The pressure of portal vein : 9 mmHgThe pressure in the hepatic vein : 0 mmHgChirrosis of the liver (alkoholic, carbon
tetachloride, virus diseases, infectious in the bile duct) : blockage of the portal system
Reservoir function of the Reservoir function of the liverliver
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 High hepatic vascular pressures causing fluid transudation into the causing fluid transudation into the abdominal cavity from the liver and abdominal cavity from the liver and portal capillariesportal capillaries ASCITESASCITES
BLOCKAGE OF PORTAL FLOW ALSO CAUSES ASCITES, BUT IS LESSBicause the collateral vascular channel develop rapidly from the portal veins to the systemic veins.
Blood cleansing function of Blood cleansing function of the liverthe liver
Blood cleansing function of Blood cleansing function of the liverthe 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.
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. B. METABOLIC FUNCTION METABOLIC FUNCTION OF OF THE LIVERTHE LIVER
B. B. METABOLIC FUNCTION METABOLIC FUNCTION OF OF THE LIVERTHE LIVER
CARBOHYDRATE METABOLISMMaintains 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 FUNCTION METABOLIC FUNCTION OF OF THE LIVERTHE LIVER
B. B. METABOLIC FUNCTION METABOLIC FUNCTION OF OF THE LIVERTHE LIVER
LIPID METABOLISMStores triglyceridesConvert fatty acids to acetyl co A than to ketone bodies
Syntheizes lipoproteinssynthesizes which is used to make bile salt
B. B. METABOLIC FUNCTION METABOLIC FUNCTION OF OF THE LIVERTHE LIVER
B. B. METABOLIC FUNCTION METABOLIC FUNCTION OF OF THE LIVERTHE LIVER
PROTEIN METABOLISMRemove 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)
C. ENDOCRINE FUNCTIONC. ENDOCRINE FUNCTION
Secrete IGF I and somatomedin in response to growth hormone
Forms T3 from T4Secrete angiotensinogenActivation of vitamin DSecrete erytropoitin (15 %)
D. DETOXIFICATION FUNCTIOND. DETOXIFICATION FUNCTION
Removal of drugs, hormons etc :Detoxifies drugs : sulfonamides,
penicillin, erytromicinAltered or excreted hormones :
thyroxine, steroid hormons (estrogen, cortisol, aldosteron)
Detoxifies products of metabolismDetoxifies forigns chemicals
E. OTHERS FUNCTION / EXCRETIONE. OTHERS FUNCTION / EXCRETIONE. OTHERS FUNCTION / EXCRETIONE. OTHERS FUNCTION / EXCRETION
STORAGE :
glycogen, fats, vitamins A, B12, D, E, K, copper and Fe (combined with protein called ferritin)
DIGESTIVE FUNCTIONSSecrete bile, righ in HCO3synthesizes bile salt from cholesterolsynthesizes bile pigments from haem of
haemoglobinExcretes plasma cholesterol and lecithin
RELATION OF THE LIVER TO BLOOD RELATION OF THE LIVER TO BLOOD
COAGULATIONCOAGULATION
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 BILEPRODUCTION OF BILE
500 – 1000 ml/daySynthesize 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 canaliculihepatic ducts GALL
BLADER
BILIARY SECRETIONSBILIARY 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
GALLBLADDERGALLBLADDERGALLBLADDERGALLBLADDERFUNCTION :
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 contractionvagal stimulation during cephalic and gastric phase
Regulation of bile entry into the small intestineRegulation of bile entry into the small intestine
COMPOTITION OF BILE COMPOTITION OF BILE (1)(1)
COMPOTITION OF BILE COMPOTITION OF 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)COMPOTITION OF BILE (2)
Bile pigments :bilirubin and biliverdin (two principal bile pigments), formed from hemoglobin responsible for the golden yellowcolor of the bileUroblin, metabolized from bilirubin by intestinal bacteria. Responsible for the brown color of the stoolIf Bilirubin is not secretet by the liver, producyng jaundice.
COMPOTITION OF BILE COMPOTITION OF BILE (3)(3)
COMPOTITION OF BILE COMPOTITION OF BILE (3)(3)
Phospholipids (prymarily lecithisn) solubized by the bile salt micelles
Cholesterolis important of bile, bicause it is one of the few ways in wich choleterol regulation
electrolytes
FUNCTION OF THE BILEFUNCTION OF THE BILEFUNCTION OF THE BILEFUNCTION OF THE BILE
Digestion and absoption of fathelp to emulsify of the large fat particleaid 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 CIRCULATIONCIRCULATION
ENTEROHEPATIC ENTEROHEPATIC CIRCULATIONCIRCULATION
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 saltEnterohepatic circulation of bile salt
CILINICAL IMPLICATIONCILINICAL 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 diarrhea, bile salt inhibit water and Na absorption
BILIRUBIN METABOLISMBILIRUBIN METABOLISM
BILIRUBIN METABOLISMBILIRUBIN METABOLISM
Formation of bilirubinis 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 THE COMMONE CAUSES JAUNDICEJAUNDICE
INCREASED DESTRUCTION OF RED BLOOD CELLS (HEMOLITIC JAUNDICE)
OBSTRUCTION OF THE BILE DUCT OR DAMAGE TO THE LIVER SELLS (OBSTRUCTIVE JAUNDICE)