SISTEM HEPATOBILIAR

dr. Anung Putri Illahika

Departemen Anatomi
FK UMM
HEPAR
Letak : Pada regio hipochondrium dextra dan epigastrium, intra peritoneum.

Pembagian :1. Lobus dextra 3. Lobus quadratus

2. Lobus sinistra 4. Lobus caudatus

Fixatie Hepar :
1.Pars affixa hepatis/bare area of the liver
2.Ligamentum falciforme hepatis
3.Ligamentum teres hepatis
4.Omentum minus ( ligamentum hepatogastrica dan ligamentum hepatoduodenale)

Permukaan hepar :
1. Facies diafragmatica terdapat :
- facies ventrale : terdapat struktur lig.faciforme, lig. teres hepatis
- facies cranialis : terdapat struktur pars.affixa hepatis,ligament coronaria Ant/Pst dan
triangulare Dex/Snt
- facies dorsalis : terdpt.struktur Vena Cava inferior + impres. oesopagus.
2. Facies visceralis (caudalis) terdapat :
- Lobus caudatus, lobus quadratus, Vesica felea pd fossa vesica felea
- Porta hepatis/hillus hepar terdpt : a.hepatica, v.porta, dt hepaticus
Lanjutan, facies visceralis hapatis terdapat :
- Tuber omentalis hepatis
- Ligament falciforme, teres hepar
- Ligament venosum Arantii
- Impressio : colica dextra, renalis dextra, gastrica duodenalis

Vascularisasi Hepar :
1. Nutritive:- aliran darah a. hepatica propria cab.a.hepatica communis
2. Fungsionil :- v. porta hepatica menerima darah vena dari organ abdomen
Fungsi Hepar:
1. Excocrin : menghasilkan empedu ikut mencernakan lemak
2. Endokrin ikut metabolime glucosa
3. Menghasilkan albumin/plasma hemoglobin
4. Metabolisme kh, lemak, protein
5. Detoksikasi racun-racun yg terserap dari usus

PORTAL SYSTEMIC ANASTOMOSE : Hubungan aliran darah vena

1. Gastro – oesophagical (v.coronaria ventriculi-plexus venosus
oesophagicus)
2. Ano – rectal (v.haemorhoid sup/medius –v.haemorhoid inferior)
3. Para – umbilical (v.para umbilicalis –v.epigastrica superior/inferior)
4. Retro – peritonial (v.sekitar renal –vv.dinding dorsal abdomen )
 HEPAR
• Fissura sagitalis sinistra
– 1a. Lig.venosum
• Lobus Hepatis – 1b. Lig. teres hepatis 
Obliterasi V.umbilicalis, dan
D Lig.falciforme hepatis 
Ca 2a membungkus/menggantung lig.teres
1a
3 • Fissura sagitalis dextra
S D s.s.
– 2a. V.cava caudalis
1b Q 2b – 2b. Vesica fellea
V • Porta Hepatis (3) :
Lobus sinister – Ventral : Ductus Hepaticus
Lobus dexter : – Tengah : Arteria Hepatica propria
Lobus dexter s.s. – Dorsal : Vena Porta
Lobus centralis :
Lobus caudatus
Lobus quadratus
Segments
 Anatomy
• Eight segments, based on arterial and
portal venous inflow.
• Segment 1 is the caudate lobe of the
liver.
• Segments 2-4 are segments of the left
lobe resected during left hepatic
lobectomy.
• Segments 5-8 are segments of the
right lobe resected during right hepatic
lobectomy.
14
15
 Functions of the Liver
• Bile production
– Salts emulsify fats, contain pigments as bilirubin
• Storage
– Glycogen, fat, vitamins, copper and iron
• Nutrient interconversion
• Detoxification
– Hepatocytes remove ammonia and convert to urea
• Phagocytosis
– Kupffer cells phagocytize worn-out and dying red and white blood
cells, some bacteria
• Synthesis
– Albumins, fibrinogen, globulins, heparin, clotting factors
VE S I C A F ELL E A ( GALL BLADDER ) ( Kandung Empedu )

Letak :
Intra peritoneum, Tepi inferior hepar dengan garis mid clavicular dextra

Pembagian :
- fundus - ductus cysticus (terdapat valvula spiralis)
- collum - corpus

Saluran Empedu : dari hepar --duodenum

1. Ductus Hepaticus : dari lobus hepar dext/sint
2. Ductus Hepaticus Common : gabungan 2 duct hepaticus
3. Ductus cysticus: dari collum visica felea
4. Ductus Choledocus : bertemunya ductus cysticus dengan duct. Hept.common
5. Bergabungnya duct.choledochus dengan ductus pancreaticus mayor masuk ke
duodenum

Vascularisasi :
A. cystica cabang dari a. hepatica
V. Cystica menuju V.hepstica

Fungsi :
1. menyimpan empedu
2. mengentalkan empedu konsentretet
Blood and Bile Flow
 Enterohepatic Circulation

• Merupakan sirkulasi
dari lever dan
intestine
• Bilirubin dikeluarkan
ke usus dan
diabsorbsi,
kemudian kembali
lagi ke hepar
• Sebagian akan
dikeluarkan melalui
feces

18­58
Bilirubin Production & Metabolism:

stercobilin
Etiology Of Jaundice:

Impaired of
Increase of
Clearance
production
Portal Hypertension
 Physical
• Signs of portosystemic collateral
formation.
• Dilated veins in abdominal wall
• Caput medusa
• Rectal hemorrhoids
• Ascites
• Umbilical hernia
 Signs of Liver Disease
• Ascites
• Jaundice
• Palmar erythema
• Asterixis
• Testicular atrophy, gynecomastia
• Muscle wasting, Dupuytren
contracture
• Splenomegaly
Caput Medusa
 Tractus Hepatobiliaris
10
1 P 11
5
7 9
1 2 3 4 6 8 D
H
VF

H : Hepar VF : Vesica Fellea P : Pancreas D: Duodenum

1. D. hepaticus 2. D. hepaticus communis 3. D. cysticus
4. D. choledochus 5. D.Pancreaticus major 6. D. hepato-
pancreaticus
7. Ampulla ( hepato-pancreaticus ) vateri 8. Sphincter Oddii
9. Papilla duodenalis major vateri 10. Ductus pancreaticus minor
11. Papilla duodenalis minor
Regulation of Bile Release

1 Acidic, fatty chyme

entering duodenum causes
release of cholecystokinin
and secretin from
duodenal wall
enteroendocrine cells

Figure 23.25
Regulation of Bile Release

1 Acidic, fatty chyme

entering duodenum causes
release of cholecystokinin
and secretin from
duodenal wall
enteroendocrine cells

2 Cholecystokinin
and secretin enter the
bloodstream

Figure 23.25
Regulation of Bile Release
3 Bile salts
and secretin
transported via
bloodstream
stimulate liver
to produce bile
more rapidly

1 Acidic, fatty chyme

entering duodenum causes
release of cholecystokinin
and secretin from
duodenal wall
enteroendocrine cells

2 Cholecystokinin
and secretin enter the
bloodstream

Figure 23.25
Regulation of Bile Release
4 Vagal stimulation causes
weak contractions of
gallbladder
3 Bile salts
and secretin
transported via
bloodstream
stimulate liver
to produce bile
more rapidly

1 Acidic, fatty chyme

entering duodenum causes
release of cholecystokinin
and secretin from
duodenal wall
enteroendocrine cells

2 Cholecystokinin
and secretin enter the
bloodstream

Figure 23.25
Regulation of Bile Release
4 Vagal stimulation causes
weak contractions of
gallbladder
3 Bile salts
and secretin
transported via
5 Cholecystokinin bloodstream
(via bloodstream) stimulate liver
causes gallbladder to produce bile
to contract and more rapidly
hepatopancreatic
sphincter to relax;
bile enters
duodenum

1 Acidic, fatty chyme

entering duodenum causes
release of cholecystokinin
and secretin from
duodenal wall
enteroendocrine cells

2 Cholecystokinin
and secretin enter the
bloodstream

Figure 23.25
Regulation of Bile Release
4 Vagal stimulation causes
weak contractions of
gallbladder
3 Bile salts
and secretin
transported via
5 Cholecystokinin bloodstream
(via bloodstream) stimulate liver
causes gallbladder to produce bile
to contract and more rapidly
hepatopancreatic
sphincter to relax;
bile enters
duodenum

1 Acidic, fatty chyme

entering duodenum causes
release of cholecystokinin
and secretin from
duodenal wall
enteroendocrine cells

2 Cholecystokinin
and secretin enter the
bloodstream

6 Bile salts reabsorbed into blood

Figure 23.25