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Cholesistitis

Cholesistitis

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Published by Albertus Cristanto

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Published by: Albertus Cristanto on Oct 13, 2010
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06/09/2013

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PENYAKIT PADA SEL HEPAR CHOLESISTITISDISUSUN OLEH:
Kelompok 05Kevin Jonathan (0810063)Bonita Fransiska R. (0810094)Febby V. (0810098)Stefanus Bambang (0810144)Dea Tantiara B. (0810130)Christina Melissa S. (0810134)Yunita Indah Dewi (0810138)Azarel Jimmy (0810152)Easter Taruli V. (0810219)T. M. Randy (0810231)TUTOR :dr. Susy
FAKULTAS KEDOKTERAN
 
UNIVERSITAS KRISTEN MARANATHABANDUNG ± 2009
 
Sistem Duktus Biliaris
The duct system for the passage of bile extends from the liver, connects with the gallbladder, andempties into the descending part of the duodenum. The coalescence of ducts begins in the liver  parenchyma and continues until the right and left hepatic ducts are formed. These drain therespective lobes of the liver.The two hepatic ducts combine to form the common hepatic duct, which runs, near the liver,with the hepatic artery proper and portal vein in the free margin of the lesser omentum.As the common hepatic duct continues to descend, it is joined by the cystic duct from thegallbladder. This completes the formation of the bile duct. At this point, the bile duct lies to theright of the hepatic artery proper and usually to the right of, and anterior to, the portal vein in thefree margin of the lesser omentum. The omental foramen is posterior to these structures at this point.The bile duct continues to descend, passing posteriorly to the superior part of the duodenum before joining with the pancreatic duct to enter the descending part of the duodenum at the major duodenal papilla
Normal histology-Gallbladder
Has mucosa, muscularis propria and serosa on free surface; no muscularis mucosa or submucosais present
Mucosa
: variable branching folds, more prominent if gallbladder not distended
Surface epithelium
: composed of single layer of uniform, tall columnar cells with basal nuclei,indistinct nucleoli, pale cytoplasm due to sulfomucins; also pencil cells (small, darkly stainingcolumnar cells), inconspicuous basal epithelial cells, T lymphocytes; no goblet cells,myoepithelial cells or melanocytes; neck region has tubuloalveolar mucus glands that secretesulfo-, sialo- and neutral mucin and contain neuroendocrine cells; true glands are not presentoutside the neck 
Lamina propria
: loose connective tissue with blood vessels, lymphatics, occasional chronicinflammatory cells (IgA secreting plasma cells), no neutrophils
Muscular layer:
circular, longitudinal and oblique smooth muscle fibers without distinct layers,resembles muscularis mucosa; adjacent to lamina propria without an intervening submucosa
Adventitia
: perimuscular connective tissue composed of collagen, elastic tissue, fat, vessels,lymphatics, nerves, paraganglia
Peritoneum:
lines gallbladder that is not directly attached to liver, is continuous with that of liver 
 
Aberrant bile ducts (ducts of Lushka):
present in 10% of cholecystectomy specimens, often buried in gallbladder wall adjacent to liver, may contain collar of fibrous tissue, maycommunicate with intrahepatic bile ducts
Rokitansky-Aschoff sinuses:
outpouchings of gallbladder mucosa that penetrate into musclewall; may be acquired herniations
Larger accessory bile ducts
: join with cystic or hepatic ducts, may be present withingallbladder bed
Mucin-secreting accessory glands
: prominent near terminus of common bile duct
FISIOLOGI SISTEM HEPATOBILIER 
Salah satu dari berbagai fungsi hati adalah mengeluarkan empedu, normalnya anatara 600 ± 1000ml/hari.Dua fungsi penting dari empedu :1.
 
P
encernaan dan absorpsi lemak.Hal ini dikarenakan asam empedu dalam empedu melakukan dua hal :-
 
Membantu mengemulsikan partikel-partikel lemak yang besar dari makanan menjadi partikel-partikel kecil.-
 
Membantu absorpsi produk akhir lemak yang telah dicerna melalui membranemukosa intestinal.2.
 
Mengeluarkan beberapa produk buangan yang penting dari darah.Hal ini terutama meliputi bilirubin dan kelebihan kolesterol.
SEKRESI EMPEDU
Empedu disekresikan oleh sel-sel fungsional utama hati, yaitu sel hepatosit. Sekresi inimengandung sejumlah besar asam empedu, kolesterol, dan zat-zat organic lainnya. Kemudianempedu disekresikan ke dalam kanalikuli biliaris kecil yang terletak di antara sel-sel hati.Selanjutnya mengalir menuju septa interlobularis, tempat kanalikuli mengeluarkan empedu kedalam duktus biliaris terminal dan kemudian secara progresif masuk ke duktus yang lebih besar,akhirnya mencapai duktus hepatikus dan duktus biliaris komunis. Dari sini empedu langsungdikeluarkan ke dalam duodenum atau dialihkan dalam hitungan menit sampai beberapa jammelalui duktus sistikus ke dalam kandung empedu.Dalam perjalanannya melalui duktus-duktus biliaris, bagian kedua dari sekresi hati ditambahkanke dalam sekresi empedu yang pertama. Sekresi tambahan ini berupa larutan ion-ion Natriumdan Bikarbonat encer yang disekresikan oleh sel-sel epitel sekretoris yang mengelilingi duktusdan duktulus. Fungsinya adalah untuk menetralkan asam yang dikeluarkan dari lambung keduodenum.

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