Human Physiology, 14th edition (2016)

640 Chapter 18

Detoxication of the Blood

The liver’s endothelial cells (lining the sinusoids), Kupffer cells,

and dendritic cells have pathogen recognition receptors that recog-

nize PAMPs (pathogen-associated molecular patterns; chapter 15,

section 15.1), enabling them to scavenge blood-borne bacteria.

The liver can also remove hormones, drugs, and other biologically

active molecules from the blood by (1) excretion of these com-

pounds in the bile as previously described; (2) phagocytosis by the

Kupffer cells that line the sinusoids; and (3) chemical alteration of

these molecules within the hepatocytes.

Ammonia, for example, is a very toxic molecule produced

by deamination of amino acids in the liver and by the action of

Liver

Common

bile duct

Bacteria

Gallbladder

Hepatic

portal vein

Urobilinogen

in feces

Bilirubin Urobilinogen

Kidney

Urobilinogen

in urine

General circulation

Vena cava

Small

intestine

Figure 18.23 The enterohepatic circulation of
urobilinogen. Bacteria in the intestine convert bilirubin (bile
pigment) into urobilinogen. Some of this pigment leaves the body in
the feces; some is absorbed by the intestine and is recycled through
the liver. A portion of the urobilinogen that is absorbed enters the
general circulation and is filtered by the kidneys into the urine.

CLINICAL APPLICATION

Jaundice is a yellow staining of the sclera of the eyes, mucous

membranes, and skin caused by elevated levels of blood

bilirubin ( hyperbilirubinemia ). This condition may result from

pre-hepatic, hepatic, or post-hepatic causes. Pre-hepatic

jaundice refers to an increase in free bilirubin due to increased

hemolysis of red blood cells, which provides more heme

groups for conversion into bilirubin. This can produce neona-

tal jaundice and physiological jaundice of the newborn, due to

rapid turnover of fetal red blood cells as previously described

(chapter 16, section 16.6). In adults, it may result from hemo-

lysis due to such conditions as malaria and sickle-cell anemia.

Hepatic jaundice, caused by hepatitis and cirrhosis, can raise

either free or conjugated bilirubin. Post-hepatic jaundice, or

obstructive jaundice, is due to a blockage in the drainage of

bile. Because conjugated bilirubin cannot be excreted, it rises

in the blood. The obstruction may result from a gallstone, pan-

creatic diseases, or stricture of the bile duct.

Clinical Investigation CLUES

George’s eyes appeared yellow when he went for an

abdominal ultrasound.

• How was the yellowing of his sclera produced?


• How would his ultrasound results explain the
  yellowing of George’s eyes?

Figure 18.24 Bile acids form micelles. ( a ) Cholic

acid, a bile acid. ( b ) A simplified representation of a bile acid,

emphasizing that part of the molecule is polar, but most is

nonpolar. ( c ) Bile acids in water aggregate to form associations

called micelles. Cholesterol and lecithin, being nonpolar, can

enter the micelles. The bile acids in the micelles serve to emulsify

triglycerides (fats and oils) in the chyme.

HO OH

OH

Cholic acid (a bile acid)

CH COOH

CH 3

CH 2 CH 2

Nonpolar

Simplified representation of bile acid

Micelle of bile acids

Polar

(a)

(b)

(c)