FISIOLOGI

• HATI

• KANDUNG EMPEDU
 ANATOMI-FISIOLOGI
(LOBULUS)
1. SEL HEPATOSIT (RADIER)
2. VENA SENTRALIS
3. KANALIKULI
4. SINUSOID
5. SEL KUPFFER
6. SPACE OF DISSE

• V.PORTA SINUSOID V.HEPATKA

• KANALIKULI DUKTUS BILIARIS

A. FUNCTION OF THE HEPATIC VASCULARE
SYSTEM
• Blood flow through the liver
• 1450 ml/min (29% COP)
1100 ml : from the portal vein
350 ml : from hepatic artery.
• The pressure of portal vein : 9 mmHg
• The pressure in the hepatic vein : 0 mmHg
• Chirrosis of the liver (alkoholic, carbon yetachloride,
virus diseases, infectious in the bile duct) :
blockage of the portal system
 Reservoir function of the liver
• 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
causing fluid transudation into the
abdominal cavity from the liver and
portal capillaries ASCITES
BLOCKAGE OF PORTAL FLOW ALSO
CAUSES ASCITES, BUT IS LESS
Bicause the collateral vascular channel
develop rapidly from the portal veins to the
systemic veins.
Blood cleansing function of the 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.
 B. METABOLIC FUNCTION OF THE
LIVER
CARBOHYDRATE METABOLISM
Maintains 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. METABOLIC FUNCTION OF THE
LIVER
LIPID METABOLISM
• Stores triglycerides
• Convert fatty acids to acetyl co A than to
ketone bodies
• Syntheizes lipoproteins
• synthesizes which is used to make bile
salt
 B. METABOLIC FUNCTION OF THE
LIVER
PROTEIN METABOLISM
• Remove NH2 (deaminates) amini 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 FUNCTION
• Secrete IGF I and somatomedin in response to
growth hormone
• Forms T3 from T4
• Secrete angiotensinogen
• Activation of vitamin D
• Secrete erytropoitin (15 %)
D. DETOXIFICATION FUNCTION

Removal of drugs, hormons etc :

• Detoxifies drugs : sulfonamides, penicillin,
erytromicin
• Altered or excreted hormones : thyroxine,
steroid hormons (estrogen, cortisol,
aldosteron)
• Detoxifies products of metabolism
• Detoxifies forigns chemicals
E. OTHERS FUNCTION / EXCRETION

STORAGE :
glycogen, fats, vitamins A, B12, D, E, K, copper and
Fe (combined with protein called ferritin)

DIGESTIVE FUNCTIONS
• Secrete bile, righ in HCO3
• synthesizes bile salt from cholesterol
• synthesizes bile pigments from haem of
haemoglobin
• Excretes plasma cholesterol and lecithin
RELATION OF THE LIVER TO BLOOD COAGULATION

• 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 BILE
• 500 – 1000 ml/day
• Synthesize 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 canaliculi
hepatic ducts GALL BLADER
 BILIARY 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
 COMPOTITION OF BILE (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)
• Bile pigments :
bilirubin and biliverdin (two principal bile
pigments), formed from hemoglobin
responsible for the golden yellowcolor of the
bile
Uroblin, metabolized from bilirubin by
intestinal bacteria. Responsible for the brown
color of the stool
If Bilirubin is not secretet by the liver,
producyng jaundice.
 COMPOTITION OF BILE (3)
• Phospholipids (prymarily lecithisn)
solubized by the bile salt micelles
• Cholesterol
is important of bile, bicause it is one of
the few ways in wich choleterol
regulation
• electrolytes
 FUNCTION OF THE BILE
• Digestion and absoption of fat
help to emulsify of the large fat particle
aid to absorption of fat through the
intestinal mucosal membrane
• Exretion of several important waste
products from the blood (bilirubin) and
ecsesses of cholesterol
 ENTEROHEPATIC CIRCULATION

• 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
 CILINICAL 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 dirrhea, bile salt inhibit
water and Na absorption
 GALLBLADDER
• FUNCTION :
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 contruction
vagal stimulation during cephalic ang gastric
phase
 BILIRUBIN METABOLISM
• Formation of bilirubin
is 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 JAUNDICE

• INCREASED DESTRUCTION OF RED BLOOD

CELLS (HEMOLITIC JAUNDICE)
• OBSTRUCTIONOF THE BILE DUCT OR DAMAGE
TO THE LIVER SELLS (OBSTRUCTIVE JAUNDICE)