Oleh : dr.

Flori Puspa Humani

Pembimbing : dr. Anbiar Manjar,Sp.B-KBD

 Introduction
 Exocrine Pancreas
 GIP, Glucose, & Insulin Secretion
 Pancreatic Juice Composition
 Cellular Basis of Secretion
 Secretion and Phases of Digestion
 Liver
 Bile Secretion
 Gall Bladder Function
 Enzymes are produced and secreted in
excess.
 However, nutrition problems will arise
if production of pancreatic enzymes
falls by as little as 10%, or if outflow of
pancreatic juice is obstructed.
Figure 15-25

The exocrine cells in the pancreas play a central role in the

production of digestive enzymes; the endocrine functions of the
pancreas will be discussed at length in Chapter 16.
 Acinar cells secrete proteins into lumen; water & salts follow from
blood by a paracellular route.
Ductal cells modify secretions of the Acinar cells – add HCO3-
Acinar Cells
Respond to CCK, VIP, GRP & Acetylcholine
Na+ K+

Ductule Cells
Respond to Secretin
Cl- HCO3- & Acetylcholine
 Secretin stimulates HCO3- secretion in the
pancreatic ducts when S cells detect that acid is
present in the duodenum.

Barrett, Fig. 4-
5

Also see Fig. 4-

7 for secretion
mechanism

Secretin Receptors are Densely Expressed on Pancreatic Ductular Cells in Humans.

 Notes:
Both calcium and cAMP
are important, but
increasing calcium is
more significant than
cAMP.

It is not yet clear whether

Secretin modulates
secretion from acinar
cells in humans, although
it does so in rats. Secretin
receptors may be present
Barrett, Fig. 4-7 on some subpopulations
of acinar cells.
INDUCTION OF FLUID SECRETION
IN PANCREATIC ACINAR CELLS
PANCREATIC SECRETION
IN THE INTESTINAL PHASE
 Bile is produced in the liver
 Bile is stored in the gallbladder.
 Bile is secreted into the small
intestine.
 Bile salts are absorbed in the
small intestine and recycled.
 Figure 15-29

Bile formation by cells in the liver includes 6 components:

bile salts, lecithin, bicarbonate ions, cholesterol, bile
pigments, and trace metals.
The bile is funneled into the gallbladder and then delivered
into the duodenum upon stimulation from CCK.
Figure 15-31

Cholecystokinin (CCK)
stimulates the
gallbladder, which
responds by
contracting and
delivering more
bile to the duodenum
through the sphincter
of Oddi, which relaxes
(opens) in response to
CCK.

CCK is secreted by
the intestinal mucosa
(“I cells”).
Bile Acid Structure

Primary bile acids are

synthesized in the
liver.

Secondary bile acids

are produced in the
colon by bacterial
enzymes
(ursodeoxycholic acid
is used as cholesterol-
lowering drug).
Figure 15-30

Up to 95% of the
cholesterol-based bile
salts are “recycled” by
reabsorption along
the intestine.
Mechanism of bile concentration by gallbladder epithelium

Fig. 12-3
Neurohormonal control of gallbladder contraction and biliary secretion.

Fig. 12-1
 Deposition of cholesterol or bilirubin in the
gallbladder or in common biliary duct. Cholesterol
stones are the common type in Western countries.
 About 1/3 of patients will get episodes of pain in the
epigastric region.
 Treatment is cholecystectomy (gall bladder removal)
or sometimes endoscopic approaches to remove
stones from common biliary duct or sphincter of
Oddi.
 Consequence of gall baldder removal is inability to
concentrate bile, which affects fat absorption, and
fatty meals may need to be avoided.
 Liver: Bile Production
 Enterohepatic circulation - recycling
 Gallbladder: Bile Concentration and controls release
 CCK is a major regulator
Summary of Factors that regulate CCK release:

Fig. 4-3
Barrett, Fig. 4-2