协和基础医学院-肝胆生理(考试部分仅限于中文幻灯)
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肝胆生理
协和基础医学院生理系
二、胆汁 (bile)
（一）性质
➢ 浓稠、味苦、有色液体。 800～1000ml/day
➢ 肝胆汁—金黄色、枯棕 色，弱碱性，pH 7.4
➢ 胆囊胆汁—黄绿色、弱 酸性，pH 6.8
➢ 持续分泌、间歇排放，不 含消化酶。
（二）成分和作用
1. 胆盐 (bile salt)
Liver- Functions
• Vascular functions, including formation of lymph and the hepatic phagocytic system.
• Metabolic achievements in control of synthesis and utilization of carbohydrates, lipids and proteins.
返回肝脏的胆盐 有刺激肝胆汁分泌的 作用。
2. 胆固醇： 体内脂肪的代谢产物，也具有乳化功能.
胆盐、胆固醇和卵磷脂的适当比例是维持胆固醇成溶 解状态的必要条件。若胆固醇↑→胆石症。
3. 胆色素 是血红蛋白的降解产物.
胆红素是临床上判定黄疸的重要依据，也是肝功 能的重要指标。
（三）胆汁分泌和排放的调节
Excretory Functions:
The principal excretory product of the liver is bile, an aqueous mixture of
•conjugated bilirubin, •bile acids, phospholipids, •cholesterol •electrolytes. Bile not only provides a repository for the products of heme catabolism but is also vital for fat absorption in the small intestine.
Blood Supply
• Incoming blood-
• 25% of cardiac output—arrives via the Portal vein it is 60% to 70% of hepatic blood flow
• 30% to 40% from hepatic artery through the hilum, the "gateway" of the liver (porta hepatis).
Micro architecture
• Classically, the liver has been divided into 1- to 2-mm diameter hexagonal lobules
• Lobule oriented around terminal hepatic veins tributaries
➢促脂肪消化：乳化脂肪、增加酶作用面积; ➢促脂肪吸收：与脂肪形成水溶性复合物; ➢促脂溶性维生素（A、D、E、K）吸收; ➢促胆汁的自身分泌：肠 - 肝循环。
The Secretion of Canalicular Bile Is Active and Isotonic
胆盐进入小肠后， 约 95% 被 回 肠 末 端 黏 膜吸收，通过门V又回 到肝脏，再成为合成胆 汁的原料，然后胆汁又 分泌入肠，这一过程称 为胆盐的肠肝循环。
• It performs an astonishingly large number of tasks that impact all body systems:
– catabolizing dietary amino acids , carbohydrates, lipids, and vitamins; – synthesizing and secreting serum proteins; – detoxifying the endogenous waste products and xenobiotics and
• Outgoing Blood- collected into ramifications of
the hepatic vein, which exits by the "back door" of the liver into the closely apposed inferior vena cava.
glycogenolysis and gluconeogenesis.
Synthetic functions
Most serum proteins, including •Albumin •Blood coagulation factors •Complement, •Acute phase reactants • binding proteins for iron, copper, and vitamin A
Plasma Proteins synthesized
Storage Functions
The liver is an important storage site for •Glycogen, •Triglycerides, •Iron, copper, •Lipid-soluble vitamins.
• Portal tracts are at periphery of lobule • Hepatocytes present at
– Centrilobular around central vein (Hepatic – Periportal near the portal tract
Hepatic Parenchyma-1
excrete into bile. – secreting bile
• The liver is vulnerable to a wide variety of metabolic, toxic, microbial, and circulatory insults
• It has tremendous regeneration capacity
• Hepatocytes in the intermediate zone II and pericentral hepatocytes located near the terminal hepatic venule (zone III ) are exposed to progressively lower concentrations of nutrients and oxygen.
• There are scattered fat-containing perisinusoidal stellate cells in the space of Disse. They stellate cells play a role in metabolism of vitamin A and are transformed into collagen-producing myofibroblasts in inflammation
• Secretory and excretory functions, particularly with respect to the synthesis of secretion of bile.
Metabolic Functions of Liver
The liver is the central organ of • glucose homeostasis, • maintaining blood glucose levels by
• These blood vessels subdivide in the liver repeatedly, terminating in very small capillaries.
• Each capillary leads to a lobule.
Zonal Flow of Blood
• There is a radial orientation of the hepatocyte cords around the terminal hepatic vein.
• Hepatocytes exhibit variation in size, • Nuclei may vary in size, number, and ploidy,
Fra Baidu bibliotek
Periportal Hepatocytes Specialize In Oxidative Metabolism; Pericentral Hepatocytes Detoxify Drugs
• Periportal hepatocytes (zone I) are the most resistant to the effects of circulatory compromise, nutritional deficiency and other forms of cell injury and are the first to regenerate.
Circulation of liver
• Heptic artery carries oxygen-rich blood from the aorta .
• The portal vein carries blood containing digested food from the small intestine.
• The sinusoids are lined by fenestrated and discontinuous endothelial cells, which demarcate an extrasinusoidal space of Disse, into which protrude abundant microvilli of hepatocytes. Scattered Kupffer cells of the
1.神经调节
食物(蛋白分解产物＞脂肪酸＞糖) →条件与非条件反射（①纯神经机 制②迷走-促胃液素机制）→肝脏→ 胆汁分泌和排放。
2.体液调节 ① 缩胆囊素 ② 促胰液素 ③ 促胃液素 ④ 胆盐
Introduction
• The liver is the largest gland in the body, weighs 1400 to 1600 gm, representing 2.5% of body weight.
Liver Cell plates
Schematic liver
Sinusoid Diagramatic
FUNCTIONAL ANATOMY OF THE LIVER AND BILIARY TREE
Hepatic Lobule, Portal Lobule & Portal Acinus
particularly with advancing age. Uninucleate,
Hepatic Parenchyma-2
• Between the cords of hepatocytes are vascular sinusoids. Blood traverses the sinusoids and exits into the terminal hepatic vein through orifices of vein wall. Hepatocytes are bathed on 2 sides by well-mixed portal venous and hepatic arterial blood.
• The hepatic parenchyma is organized into cribiform (pierced with holes as in a sieve ), anastomosing sheets or "plates" of hepatocytes
• Hepatocytes immediately abutting the portal tract are referred to as the limiting plate, forming a rim around the mesenchyme of the portal tract.
协和基础医学院生理系
二、胆汁 (bile)
（一）性质
➢ 浓稠、味苦、有色液体。 800～1000ml/day
➢ 肝胆汁—金黄色、枯棕 色，弱碱性，pH 7.4
➢ 胆囊胆汁—黄绿色、弱 酸性，pH 6.8
➢ 持续分泌、间歇排放，不 含消化酶。
（二）成分和作用
1. 胆盐 (bile salt)
Liver- Functions
• Vascular functions, including formation of lymph and the hepatic phagocytic system.
• Metabolic achievements in control of synthesis and utilization of carbohydrates, lipids and proteins.
返回肝脏的胆盐 有刺激肝胆汁分泌的 作用。
2. 胆固醇： 体内脂肪的代谢产物，也具有乳化功能.
胆盐、胆固醇和卵磷脂的适当比例是维持胆固醇成溶 解状态的必要条件。若胆固醇↑→胆石症。
3. 胆色素 是血红蛋白的降解产物.
胆红素是临床上判定黄疸的重要依据，也是肝功 能的重要指标。
（三）胆汁分泌和排放的调节
Excretory Functions:
The principal excretory product of the liver is bile, an aqueous mixture of
•conjugated bilirubin, •bile acids, phospholipids, •cholesterol •electrolytes. Bile not only provides a repository for the products of heme catabolism but is also vital for fat absorption in the small intestine.
Blood Supply
• Incoming blood-
• 25% of cardiac output—arrives via the Portal vein it is 60% to 70% of hepatic blood flow
• 30% to 40% from hepatic artery through the hilum, the "gateway" of the liver (porta hepatis).
Micro architecture
• Classically, the liver has been divided into 1- to 2-mm diameter hexagonal lobules
• Lobule oriented around terminal hepatic veins tributaries
➢促脂肪消化：乳化脂肪、增加酶作用面积; ➢促脂肪吸收：与脂肪形成水溶性复合物; ➢促脂溶性维生素（A、D、E、K）吸收; ➢促胆汁的自身分泌：肠 - 肝循环。
The Secretion of Canalicular Bile Is Active and Isotonic
胆盐进入小肠后， 约 95% 被 回 肠 末 端 黏 膜吸收，通过门V又回 到肝脏，再成为合成胆 汁的原料，然后胆汁又 分泌入肠，这一过程称 为胆盐的肠肝循环。
• It performs an astonishingly large number of tasks that impact all body systems:
– catabolizing dietary amino acids , carbohydrates, lipids, and vitamins; – synthesizing and secreting serum proteins; – detoxifying the endogenous waste products and xenobiotics and
• Outgoing Blood- collected into ramifications of
the hepatic vein, which exits by the "back door" of the liver into the closely apposed inferior vena cava.
glycogenolysis and gluconeogenesis.
Synthetic functions
Most serum proteins, including •Albumin •Blood coagulation factors •Complement, •Acute phase reactants • binding proteins for iron, copper, and vitamin A
Plasma Proteins synthesized
Storage Functions
The liver is an important storage site for •Glycogen, •Triglycerides, •Iron, copper, •Lipid-soluble vitamins.
• Portal tracts are at periphery of lobule • Hepatocytes present at
– Centrilobular around central vein (Hepatic – Periportal near the portal tract
Hepatic Parenchyma-1
excrete into bile. – secreting bile
• The liver is vulnerable to a wide variety of metabolic, toxic, microbial, and circulatory insults
• It has tremendous regeneration capacity
• Hepatocytes in the intermediate zone II and pericentral hepatocytes located near the terminal hepatic venule (zone III ) are exposed to progressively lower concentrations of nutrients and oxygen.
• There are scattered fat-containing perisinusoidal stellate cells in the space of Disse. They stellate cells play a role in metabolism of vitamin A and are transformed into collagen-producing myofibroblasts in inflammation
• Secretory and excretory functions, particularly with respect to the synthesis of secretion of bile.
Metabolic Functions of Liver
The liver is the central organ of • glucose homeostasis, • maintaining blood glucose levels by
• These blood vessels subdivide in the liver repeatedly, terminating in very small capillaries.
• Each capillary leads to a lobule.
Zonal Flow of Blood
• There is a radial orientation of the hepatocyte cords around the terminal hepatic vein.
• Hepatocytes exhibit variation in size, • Nuclei may vary in size, number, and ploidy,
Fra Baidu bibliotek
Periportal Hepatocytes Specialize In Oxidative Metabolism; Pericentral Hepatocytes Detoxify Drugs
• Periportal hepatocytes (zone I) are the most resistant to the effects of circulatory compromise, nutritional deficiency and other forms of cell injury and are the first to regenerate.
Circulation of liver
• Heptic artery carries oxygen-rich blood from the aorta .
• The portal vein carries blood containing digested food from the small intestine.
• The sinusoids are lined by fenestrated and discontinuous endothelial cells, which demarcate an extrasinusoidal space of Disse, into which protrude abundant microvilli of hepatocytes. Scattered Kupffer cells of the
1.神经调节
食物(蛋白分解产物＞脂肪酸＞糖) →条件与非条件反射（①纯神经机 制②迷走-促胃液素机制）→肝脏→ 胆汁分泌和排放。
2.体液调节 ① 缩胆囊素 ② 促胰液素 ③ 促胃液素 ④ 胆盐
Introduction
• The liver is the largest gland in the body, weighs 1400 to 1600 gm, representing 2.5% of body weight.
Liver Cell plates
Schematic liver
Sinusoid Diagramatic
FUNCTIONAL ANATOMY OF THE LIVER AND BILIARY TREE
Hepatic Lobule, Portal Lobule & Portal Acinus
particularly with advancing age. Uninucleate,
Hepatic Parenchyma-2
• Between the cords of hepatocytes are vascular sinusoids. Blood traverses the sinusoids and exits into the terminal hepatic vein through orifices of vein wall. Hepatocytes are bathed on 2 sides by well-mixed portal venous and hepatic arterial blood.
• The hepatic parenchyma is organized into cribiform (pierced with holes as in a sieve ), anastomosing sheets or "plates" of hepatocytes
• Hepatocytes immediately abutting the portal tract are referred to as the limiting plate, forming a rim around the mesenchyme of the portal tract.