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$" 8h8: cng chIa Cn u%ng g+ th+ cho u%ng vig ga3actos< vZi 5ii"3 nIZc r4i nO" ngh` 1 cau B 3y nIZc tiu sau 5h ("Ju Q) v sau vh "Ju 51 P+nh thI.ng "Ju Q xgRN; "Ju 5 Q;gRN1 6ng I.ng th@i ra r<ong vh /h,ng qua vgRN * Chuyn ho lipid: - N*i =uy nht c ra "Ht nh[ tI*ng ho Ni8i= r4i h8 th] qua con I.ng >C or 0ch huyDt v' gan v I7c 0iDn 6i trong gan; chuyn ho tZi ", /hc 1 cK thoi ho c)a aci= 0o trong gans Sc<ty3 CoS ch` ch?a Q s8 nh- ac<ty3 CoS 0E %t chy trong chu tr+nh Kr<0 cung c8 NN cho gan s =]ng1 9h!n 3Zn Sc<ty3 CoS s cc cht C<tonic s ", /hc s =]ng1 ai ", cc th C<tonic chuyn ho tr@ 3i h Sc<ty3 CoS r4i %t chy hon ton to thnh C5 v n5 v NN - P+nh thI.ng {| cc cht C<tonic trong "u th8 /hi nhEn Bi hay Pn u u {| cc cht c<tonic tCng cao v th@i ra nIZc tiu1 - 2an t6ng h78 c Sci= 0o /, "nh 0Ong ", "\ " gan t6ng h78 rt "nh g3uc<ri=; 8hos8hati=; 3i8o8rot<in1 uc 0i$t 8hos8hati= v 3i8rot<in c gan t6ng h78 3 ch) yDu1 - Khi gan 0E t6n thI*ng s thiDu cc cht hIZng "\ nhI: cho3in; "<thionin; isnoito31 cK t6ng h78 8hos8hati= /, ) t6ng h78 3i8o8rot<in; trig3yc<ri= /, c vHn chuyn tZi cc t6 ch?c s gan 0E ? "\ 3:u ngy =Jn Dn T* gan1 - Cc cht hIZng "\ cB tc =]ng 06 gan trGn c* chD tCng cI.ng sK t6ng h78 8hos8hati= 0 3 3<cithin vHn chuyn 0Zt trig3yc<ri= ra /hpi gan3" cho nhu ", gan I7c h4i 8h]c1 - 2an Bng vai trA quan trng trong t6ng h78 Cho3<st<ro3; qtr t6ng h78 cho3<st<ro3 - gan "nh h*n nhi'u so vZi - thHn; thI7ng thHn; rut non; e6i1 uc 0i$t cho3<st<ro3 <st<r oe "u ch` c t6ng h78 - gan1 s c Enh tf 3$ cho3<st<ro3 <st<r R Cho3<st<ro3 ton th:n trong huyDt tI*ng =Jn Dn nh gi CN gan1 P } xr; Khi gan t6n thI*ng ir1 - 2an 3 n*i t6ng h78 3i8o8rot<in1 n!u hDt kNXN; nXN =o gan t6ng h78 vHn chuyn cho3<st<ro3 v trig3yc<ri= t# gan tZi cc t6 ch?c /hc1 U nXN vHn chuyn cho3<st<ro3 t# t0 ngoi vi v' gan r4i o th@i qua #ng rut U kiG" gan virut nXN huyDt thanh th8 s R 3i8o8rot<in rt cao1 * Chuyn ho protein: - N*i t6ng h78 8<8ti= w 8rot<in rt 3Zn =o gan v huyDt tI*ng1 - 6ng h78 ton 0 S30u"in< oe huyDt tI*ng; to 8 3Kc /<o cho "u; vHn chuyn aci= 0o; 0i3iru0in v "t s% /i" 3oi1 - on 0 <rritin c gan t6ng h78 =K trL sat1

- 6 ch?c 3/ oe gan t6ng h78 Q8h!n g3o0u3in oe "u s tR=]ng ch%ng viG"; ch%ng =E ?ng1 Khi viG" gan; T* gan {| a30u"in gi@"; g3o0u3in tCng s SR2 gi@" - N h 88 i$n =i v 88 3Gn 0,ng: 2ross >ac3agan - N*i c nhi'u yDu t% tha" gia qtr ,ng "u nhI: i0rinog<n; 9rothro"0in; 9roac<3<in (yt% k); 9roconv<rtin (yt% k)1 Khi t6n thI*ng gan cc yDu t% ny gi@"; th.i gian =,ng "u /<o =i1 - N*i t6ng h78 nhi'u ln_y": U ransa"inas< SN RSc U 9hos8hatas< /i'" U NXn U S3=o3as< U Cho3in<st<ras< U C - N*i t6ng h78 v chuyn ho cc aci= a"in; 0 qtr /h cKc v trao 6i a"in c)a cc aci= a"in 1 Cu h! "#c ca gan: tr /h c g4" 5 c* chD : C% Enh - th@i tr# v 0iDn 6i ho hc b C* chD c% Enh th@i tr#: - >t s% cht /i" 3oi nhI "u%i 4ng; ch+ 11cc cht "u 111 vo c* th 0E gan giL 3i r4i th@i tr# nguyGn vn qua "Ht1 - Nghi$" 8h8 Pc9 (Pro"osu38ho8hta3<in) thC" =A CN gan1 P+nh thI.ng sau Q8 cAn 3i ir 1 cau v8 cAn 3i Qir1 rong tac "Ht v suy gan th+ ch` s% ny 'u cao1 b C* chD 0iDn 6i ho hc: 2an s =]ng nhi'u 8? ho hc /hc nhau G to thnh cc cht (t c h*n v o th@i ra ngoi1 Cc 8? ho hc (Ti ch nu tn p hoa hc) - Cc 8? to ur< t# NnV: - 9? 8h:n gi@i: n55 (Cata3as<)s n5 U - Kh c h ny=roTy3 ho: >i cu trMc nh:n th*" thnh 8h<no3 - Kh c h Ty ho: PiDn rI7u thnh aci= - Kh c h ><thy3 ho (8h6 0iDn) Sci= guani=oac<tic "<thy3 thnh Cr<atin - Kh ho h 3iGn h78: U NiGn h78 vZi g3ycin U NiGn h78 cu3eonic U NiGn h78 23ucuronic th+ nhi'u cht I7c o th@i nhI 8h<no3; a3co3 th*"; =s 8h<no3ic;1111to 0i3iru0in 3iGn h781 - Ngoi ra gan cong cB c* chD /h c nhI "- vAng; thuf 8h:n; /h "<thy3; to thnh s8 su3eocyanua1111 C:u Cc N thC" =o ch?c nCng gan Q1 nRC suy t0 gan - S30u"in< n ~ - f 3$ Cho3<st<ro3 lst<rR Cho - on 8h!n : ~ - i0rinog<n nuyDt tI*ng : ~

- f 3$ 9rothro"0in : ~ - Cc Nghi$" 8h8: Pc9; Sci= hi8u8uric v ga3actos< ni$u 'u U 51 nRC nuf P gan - ransa"inas< huyDt thanh Sc v SN - C huyDt thanh - NXN - S3=o3as< n - < n - Pi3iru0in 3iGn h78 v ton 8h:n v ti"g thy 0i3iru0in trong nIZc tiu - >u%i "Ht trong nIZc tiu: V1 nC viG" gan trong trung ", - 23o0u3in : - ui$n =i 8rot<in huyDt thanh : v g3o0u3in - 9? 2ros - >ac3agan =I*ng t(nh v1 nC tac "Ht - uEnh 3I7ng Pi3`u0in 3iGn h78 huyDt thanh v ti"g 0i3iru0in nIZc tiu - Cho3<st<ro3 huyDt thanh: - 9hos8hatas< /i'" huyDt thanh : - >u%i "Ht trong huyDt thanh w nc tiu : - SN9; 22 : Cu $ ngh%a cc th&nh ph'n (rotein trong huy)t t*ng 9rot<in 3 cht hLu c* quan trng nht; cB h" 3I7ng cao nht trong huyDt tI*ng1 CB nhi'u 3oi 9ro: S30u"in<; g3o0u3in; ei0rinog<n;111n!u hDt cc 3oi 8ro 'u I7c t6ng h78 - gan v t6 ch?c 3iGn vdng1 - >t s% ch?c nCng ch(nh oe 9ro huyDt tI*ng 3: U Xuy tr+ 8 3Kc /<o- thz" thu1 U ha" gia h$ th%ng ,ng "u w ch%ng ,ng "u U Enh nhZt c)a "u; Bng vai trA quan trng trong huyDt ng U Xuy tr+ 9n vZi "Zi vai trA 3 Q h$ $" U kHn chuyn "t s% cht U P@o v$ c* th trong h$ th%ng "iFn =Ech U Ngu4n =K trL aci= a"in; 8ro oe c* th - 9ro ton 8h!n {| Wi-jigRN 1 POng 88 i$n =i s tch I7c t8: S30u"in; g3o0u3in; Q; 5; ; : U S30u"in: - ChiD" xr 8ro ton 8h!n - Xuy tr+ 8 3Kc /<ow thz" thu - h t?i iu ho nIZc trong c* th - kHn chuyn nhi'u cht /, tan trong nIZc nhI Pi3iru0in tK =o; aci= 0o; Q s% hor"on; thu%c - Rgian 0n huf W ngy S30u"in gi@" t6ng h78: P$nh gan; Bi or cuy =inh =I\ng S30u"in gi@" =o 0E o th@i: P$nh thHn: hHn hI; nhiF" "\; viG" thHn c8 U 23o0u3in:

23o0u3in Q : - ChiD" ;V r 9ro ton 8h!n - ha" gia cu to 3i8rot<in - 23yco8rot<in 23o0u3in 5: - ChiD" W;jr 9ro ton 8h!n - ha" gia cu to C<ru3o83as"in - Cng tronh thHn hI nhiF" "\ 23o0u3in : - ChiD" QQ;Wr 9ro ton 8h!n - ha" gia vHn chuyn sat - Cng trong viG" th8 /hZ8 23o0u3in : - ChiD" Qj;xr 9ro ton 8h!n - cinh ra cc /hng th nhI gS; g2; g>111 - Cng trong nhiD" /huzn U f 3$ SR2 : - P+nh thI.ng :h Q;V-5 - 2i@" : U 2i@" S30 =o cXX; tCng g3o0u3in =o nhiF" /huzn U * gan; viG" thHn c8 U i0rinog<n: - ChiD" 5-vgRN - ha" gia qtr ,ng "u - Cng trong thoi ho /hZ8; viG" 8h6i; nhiF" /huzn - 2i@" trong T* gan U 23yco8rot<in : g4" ga3actos<; "anos<; eructos<; ra"nos<; g3ucosa"in; ga3atosa"in; aci= nora"ic; aci= sia3ic1111 Cng 3Gn trong nhiF" /huzn nhI 3ao; viG" 8hD qu@n; viG" 8h6i; th8 /hZ8 c8; viG" c!u thHn; nC n; N>C ; u u111 U Ni8o8rot<in: (N9; 8r< -N9; N9): - P`nh thI.ng : R h 5;V -RU i;x - Ong trong vLa T* ng "ch; thHn hI nhiF" "\; viG" gan =o virus; u u; Po 8h+; tac rut U na8tog3o0in (n8): - kHn chuyn n0 - {n8| gi@" /hi: tan "u; viG" gan c8; thiDu "u c t(nh111 U ><ta33o8rot<in: - ranse<rrin - C<ru3o83as"in