Cu Cc chc phn ca gan - Chuynv ho cc cht: (quan trng nht) - Kh c Ni sinh v ngoi sinh - u!

n hon: Chuyn "u t# h$ th%ng t&nh "ch ca sang h$ th%ng tu!n hon chung i'u ho th t(ch "u c)a c* th - ha" gia qu tr+nh ,ng "u v to "u - th.i /+ 0o thai1 Cu cc chc phn chuyn ho trong gan 2an 3u,n t4n ti 5 qu tr+nh: 6ng h78 - 9h:n 3y - 6ng h78: 9r; 23ycog<n; 8hos8hati=11111 - 9h:n 3y: >t s% 8h:n t 8h?c t8 thnh cc 8h:n t *n gi@n cung c8 cho cc c* quan /hc1 - 2an cAn cB ch?c nCng /h c cc cht ni sinh (=o c* th tiDt ra) v cht c ngoi sinh (0E nhiF" t# 0Gn ngoi vo)1 1.1.Chc phn to mt - >Ht I7c tiGt ra t# t0 gan; qua %ng =Jn "Ht v =K trL - tMi "Ht - Khi t6ng h78 "Ht I7c tiDt vo t trng c)a h$ tiGu ho (t trng)1 NIu 3I7ng hOng ngy 3 P Q3(tRngy v thay 6i th<o nhu c!u /h%i 3I7ng v t(nh cht c)a th?c Cn1 - hnh 8h!n c)a "Ht Sci= "Ht v "u%i "Ht * Acid mt: - Sci= "Ht I7c to thnh - gan t# cho3<st<ro3 0@n cht 3 =Jn Tut c)a aci= cho3anic: U Sci= 3itocho3ic (Sci= V hy=roTycho3anic) U Sci= Ch<no=<oTycho3ic (Sci= V-W hy=roTycho3anic) U Sci= X<oTycho3ic (Sci= V-Q5 hy=roTycho3anic) U Sci= Cho3ic (Sc= V-W-Q5 trihy=roTycho3anic) - Cc aci= "Ht /o t4n ti - =ng tK =o trong "Ht " chuYng /Dt h78 vZi g3ycin v t@uin to thnh "u%i "Ht1 Cc "u%i "Ht g4" 23ycocho3at natri v auroch3at Natri1 - >u%i "Ht Bng vai trA quan trng trong vi$c nh[ ho "\1 c =]ng nhL tI*ng ho "\ v+ nB cB 5 u Ia nIZc v /E nIZc1 Khi - trng thi nh[ tI*ng 0'n; "\ cB ) =i$n t(ch ^ <n_y" 3i8as< tiD8 TMc tc =]ng1 - P`nh thI-ng trong nIZc tiu /h,ng cB "u%i "Ht1 Khi tac "Ht th+ cB Tut hi$n trong nIZc tiu - rong viG" gan vng =a th+ "u%i "Ht tCng (t - rong vng =a tan huyDt /o thy sK tCng "u%i "Ht b cac t% "Ht: g4" Pi3iru0in; 0i3iv<c=in; uro0i3in; st<rco0i3in - Pi3`ru0in =o t0 3iGn vdng v t0 Kuee<r c)a gan sT t# thoi hB h<"og3o0in trong qtr tiGu huf h4ng c!u - gan1 - Pi3`ru0in c to ra - gan /Dt h78 vZi aci= g3ucuronic to thnh 0i3iru0in 3iGn h78 tan trong nIZc1 - P+nh thI.ng (1) huyDt thanh : Pi3ig =o h i;jRQii"3; Pi3i g Nh78 - =ng v$t1 - Pi3iru0in tCng trong "u - cc trI.ng h78: kng =a tan huyDt; tac "Ht; viG" gan virus1

- Khi thiDu nht th.i ln_y" g3ycuronat transe<ras< gan th+ g:y vng =a sinh 3Y tr^ s* sinh1 - cac t, "Ht mro0i3in v ct<cco0i3in (c8 thoi ho c)a n<"og3o0in)1 NB I7c h8 th] qua "ng rut i vo >C c)a gan; "t 8h!n cAn 3i o th@i qua h$ tu!n hon r4i o th@i qua nIZc tiu1 - Khi viG" gan or suy gan @nh hI-ng tZi t(nh th" t01 cac t% "Ht v "u%i "Ht th" vo "u nhi'u h*n1 - Pi3iru0in trong "u tCng; sac t% "Ht v "u%i "Ht trong nIZc tiu =I*ng t(nh - rong tac "Ht th+ 8 3Kc %ng "Ht tCng; 0i3iru0in trKc tiD8 tCng; sac t% "Ht v "u%i "Ht trong nIZc tiu c[ng tCng cao1 - ct<rco0i3in (1) 8h:n gi@" =Jn Dn 8h:n 0c "u (c?t cA)1 b Cho3<st<ro3: -Cho3<st<ro3 /, tan trong nIZc; "u%i "Ht ngCn c@n sK /Dt t)a cho3<st<ro31 - Cho3<st<ro3 tiDt ra cong vZi "Ht v cong I7c ti h:8 thu - chu tr+nh gan rut1 Cho3<st<ro3 giu8 h8 thu 3i8i=1 - Khi tMi "Ht 0E viG"; ti ch, viG" to thnh /Dt t)a " ti :y h+nh thnh spi Cho3<st<ro3 chiD" ji-qir11 Q151 Ch?c 8hHn chuyn ho: - Chuyn ho g3uci= - Chuyn ho 3i8i= - Chuyn ho 8rot<in * Chuyn ho glucid: - 6ng h78 g3ycog<n =K trL cho c* th: U 2an cB /Rn t6ng h78 # g3ucos< v cc os< /hc; t# cc s8 chuyn ho trung gian /hc1 U C*: Ch` t6ng h78 c g3ycog<n t# g3ucos< U 6n thI*ng t0 gan s tNCn ga3actos< thnh g3ycog<n s uo B; 3" N9 ga3actos< 8ht hi$n t6n thI*ng ny1 - 9h:n 3y g3ycog<n: U huf 8h:n g3ycog<n =o <n_y" a"y3as< v >a3tas< (gi%ng tinh 0t trong 0 "y tiGu ho1) U 9hos8hory3 ho thuf 8h:n vZi sK tha" gia c)a 8hos8hory3as< cat ?t 3iGn /Dt Q-v g3ycosi= - 8h:n t g3ucos< nO" - !u chu%i to 2Q9 gi%ng t6 ch?c 1 U 2Q9 w 2x9 sy I7c tch 8hos8hat IZi tc =]ng c)a 8hos8hatas< g8 g3ucos<1 23ucos< th" qua "ng t0 vo "u1 9? /, Tzy ra - t6 ch?c1 - Ngoi ra gan cAn cB /Rn t6ng h78 t# cc os< /hc; t# cc aa; aci= 3actic; aci= 8yruvic v nhi'u cht /hc; /Rn ny /, cB - c*1 Ch(nh v+ /Rn chuyn ho g3uci= rt "nh v 8hong 8hM " gan tha" gia t(ch cKc vo sK i'u ho I.ng huyDt cong vZi cc yDu t% /hc nhI th!n /inh; hor"on; insu3in; a=r<na3in1 - P+nh thI.ng g3ucos< trong "u ji-Q5i"gRQii"31 U Khi {| g3ucos< } Q5i"gRQii"3 th+ gan ~ s@n Tut g3ucos< " tCng t6ng h78 g3ycog<n1 U Khi {| g3ucos< ji"gRQii"3 th+ gan tCng cI.ng 8h:n 3yg3ycog<n1

U u nh gi CN chuyn ho ny s N" N98 g:y tCng =g huyDt 1 CB nhi'u 88 3" nhIng N98 g:y 0i tiDt ga3actos< ni$u c =ong nhi'u h*n v ti$n =]ng h*n: Ng tac cu@ NR 8h8: 2a3actos< c gan chuyn thnh 23ucos< v g3ycog<n =K trL1 Khi gan 0E suy th+ t%c chuyn ho chH" h*n; I.ng huyDt sy cao h*n v th@i tr# ra ngoi qu nIZc tiu nhiu h*n1 Cch tiDn hnh nghi$" 8h8: cng chIa Cn u%ng g+ th+ cho u%ng vig ga3actos< vZi 5ii"3 nIZc r4i nO" ngh` 1 cau B 3y nIZc tiu sau 5h ("Ju Q) v sau vh "Ju 51 P+nh thI.ng "Ju Q xgRN; "Ju 5 Q;gRN1 6ng I.ng th@i ra r<ong vh /h,ng qua vgRN