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Fisiologi

Sistem Pencernaan
Hati dan pankreas

Learning Objective
1. Explain the functions of liver.
2. Explain the functions of gallblader.
3. Explain the functions of pancreas.

Liver
Largest internal organ
Receives major blood supply from hepatic portal vein
Brings venous blood rich in nutrients from digestive tract

Hepatocytes
Livers cells
Capable of regeneration

Liver

Liver

Functions
1. Metabolic regulation
1.
2.
3.
4.
5.
6.
7.

Carbohydrate metabolism
Lipid metabolism
Amino acid metabolism
removal of waste products
Vitamin storage
Mineral storage
Drug inactivation

Liver

Functions
2. Hematological regulation
1.
2.
3.
4.
5.
6.

Phagocytosis and antigen presentation


synthesis of plasma proteins
removal of circulating hormones
removal of antibodies
removal or storage of toxins
synthesis and secretion of bile

Liver

Functions
3. Circulatory regulation
4. Growth regulation

Typical albumin distribution in a healthy 70 kg adult


58%
total body albumin
pool about 3.5
5.0 g/kgBW (250
300 g for a healthy
70 kg adult).

Synthesis:

42%

Hidrostatic P,
Fenestrae,
trans endotel

lymphatic drainage

Insulin
GH
Feeding

J. P. Nicholson et al. Br. J. Anaesth. 2000;85:599-610

Skin
41%
Muscle
40%
Gut
7%
Liver
3%
Subcutaneous, etc. 9%

Gallbladder
Attached to surface of the liver
Bile pouch that stores bile
Ducts
Hepatic Duct
Cystic Duct
Common Bile Duct

Gallbladder
Function:

Bile storage
Bile modification
Bicarbonate secretion

Bile compasition

Water
Bilirubin
Ion
Cholesterol
Bile salt

Bile Secretion
Necessary for digestion and absorption of lipids in small
intestine
Mixture of bile salts, bile pigments, and cholesterol
Bile salts emulsify lipids to prepare them for digestion
Solubilize products of lipid digestion in packets called
micelles

Bile Secretion and Recycling


1.
2.
3.
4.

Produced and secreted by liver


Stored in gallbladder
Ejected into small intestine when gallbladder contracts
After lipids absorbed, bile salts are recirculated to liver via
enterohepatic circulation

Absorption of bile salts from ileum into portal circulation


Delivery back to liver

5. Extraction of bile salts from the portal blood by hepatocytes

Bile Secretion and Recycling

Pancreas
Exocrine and Endocrine Gland
1. ExocrineAcinar Cells

Secretes essential digestive enzymes through pancreatic duct into


duodenum

2. EndocrineIslets of Langerhans

Secretes insulin and glucagon into blood stream

Pancreas

Pancreas

Pancreatic Secretion
Exocrine pancreas secretes ~1 L/day into duodenum
Fluid consists of HCO3- and enzymes
HCO3- neutralizes H+ delivered to duodenum from stomach
Enzymatic portion digests carbohydrates, proteins, and lipids into
absorbable molecules

Structure of Pancreatic Exocrine Glands


Comprises ~90% of pancreas

Rest of pancreatic tissue is endocrine pancreas and blood vessels

Acinar Cells

Line blind end of branching duct system


Secrete enzymatic portion

Ductal Cells

Line the ducts


Secrete aqueous HCO3- component

HCO3- Secretion

Apical membrane of ductal cells contains a Cl --HCO3exchanger


Basolateral membrane contains Na+-K+ ATPase and a Na+-H+
exchanger
1. CO2 and H2O combine in cells to form H+ and HCO32. HCO3- is secreted into pancreatic juice by Cl--HCO3exchanger
3. H+ is transported into blood by Na+-H+ exchanger

Absorption of H+ causes acidification of pancreatic venous blood

Regulation of Pancreatic Secretion


Acinar cells (enzymatic secretion)
Receptors for CCK and muscarinic receptors for ACh
CCK is most important stimulant
I cells secrete CCK in presence of amino acids and fatty acids in intestinal
lumen

ACh also stimulates enzyme secretion

Ductal cells (aqueous secretion of HCO3-)


Receptors for CCK, ACh, and secretin
Secretin (from S cells of duodenum) is major stimulant
Secreted in response to H+ in intestine

Effects of secretin are potentiated by both CCK and ACh

Pancreatic Endocrine

Alpha cells produce glucagon


Beta cells produce insulin
Delta cells produce somatostatin
Gamma cells produce Pancreatic polypeptide

Somatostatin
Kadar somatostatin
plasma meningkat dari
112 mjd 182 pmol/l
setelah makan