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GI / Hepatology > 1 - Anatomy & Histology of the Liver > Flashcards

1 - Anatomy & Histology of the Liver Flashcards

1
Q

Normal Liver Mass

A

1500g

Largest organ

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2
Q

Normal Portal Pressure

A

5 - 10 mm Hg

Low pressure

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3
Q

Hepatocytes - Do they all do the same thing?

A

No!!!!

They have functional heterogeneity

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4
Q

Liver’s borders

A

Right 5th rib
Left 6th rib
Right 9th rib

Feel it below the 9th rib and it’s HUGE!!!!!!

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5
Q

Contents of the portal vein

A

Collection of venous blood from spleen, splenic vein, SMA, IMA

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6
Q

Portal Hypertension

A

Obstruction to portal vein flow causing pressure to increase above 10mm Hg

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7
Q

Post-Hepatic Hypertension

A

Rarest kind of portal HTN

Congenital webs of the IVC

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8
Q

Intra-Hepatic Hypertension

A

Most common type of portal HTN

Cirrhosis
Other types of pathology

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9
Q

Pre-Hepatic Hypertension

A

Thrombosis blocking entry to the portal vein

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10
Q

How many lobes?

A

2!

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11
Q

Components of the liver

A

2 Lobes
Glisson’s Capsule (smooth! IT IS SMOOTH!!)
Falciform Ligament

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12
Q

Real divisions of the liver

A

8 Segments
4 on the left, 4 on the right
Each has its own vascular and biliary pedacle

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13
Q

Two sources of blood for the liver

A

Celiac Trunk > Hepatic Artery > Left & Right Lobes

Splenic Vein + IMA + SMA > Portal Vein

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14
Q

Biliary Tree

A

Bile conducted from ducts inside into common hepatic duct which meets with cystic duct to join the GI tract

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15
Q

Lobule

A

One functional unit of hepatocytes.
Central vein in the center
Arterial flow at the periphery
No connective tissue divisions between lobules the way pigs do!!!

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16
Q

Central veins

A

Marked by venous endothelium

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17
Q

Portal tracts

A

Collagen tracts that carry 3 tubes:

Bile duct
Artery
Vein

Can fibrose in pathways leading to other portal tracts when inflammation fucks that shit up

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18
Q

Blood path through a lobule

A

Portal tracts at periphery
Contents flow through sinudoids in the periportal regions
Undergo hella changes
Enter central veins to go back to the heart.

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19
Q

Bile Cannaliculi

A

Collect bile, interanastomose and form the canal of herring, which drains into the individual bile ducts that drain into the hilum and the common bile duct.

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20
Q

Where do the progenitor (stem) cells in the liver live?

A

The Canal of Herring

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21
Q

Description of Lobule

A

Radiating Cords
Nicely organized
Once Cell Thick (so nicely bathed)

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22
Q

Central Veins

A

Anastomose into Hepatic Veins (R & L)

Exit to IVC

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23
Q

Portal Tract on Histo

A

Nothing but collagen, fibroblasts and triad of structures

Inflammatory

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24
Q

Bile Duct

A

Tube of cuboidal epithelium

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25
Q

Limiting Plate

A

The hepatocytes at the edge of the Portal Tract

Chronic Hepatitis - Lymphocytes and inflammatory cells can infiltrate this structure and cause fibrosis

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26
Q

Mixing of Portal Venous and Hepatic Arterial Blood

A

Hepatic artery branches give off small twigs which empty arterial (oxygenated) blood into the periportal sinusoids directly outside the portal tract connective tissue

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27
Q

Chronic Hepatitis

A

Ground Glass Inclusions

Lymphocytes and other inflammatory cells cross limiting plate

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28
Q

Space of Disse

A

Type III Collagen

Discontinuous Array

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29
Q

Least oxygenated hepatocytes

A

Right around the central vein

They die quickly because they receive the least-oxygenated blood

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30
Q

Lipofuscin Pigment

A

Phagolysosomes with “Wear & Tear” cell debris
Brown Pigment Junk

Appears in Heart, Liver, and Adrenal. Myocytes particularly.
See it first in the hepatocytes surrounding central veins

31
Q

Areas from Portal Tract to Central Vein

A

Periportal
Midzonal
Centrilobular

Each is about 7 cells wide
~22 hepatocytes from portal tract to central vein

32
Q

Periportal Area - Zone 1

A 
Best oxygen
Oxygen tension is 65mm Hg
Area where chronic hepatitis is most active
Gluconeogenesis
Bile Salt Synthesis
33
Q

Centrilobular Area - Zone 3

A 
Oxygen tension is 35 mm Hg
Furthest from oxygen
Most vulnerable to shock/ischemia
Contains drug metabolizing enzymes
Cytochrome p450s
Area where alcohol is metabolized
34
Q

Acinar Zones

A

Another interpretation of
Zone 1 - Best perfusion
Zone 2 - Midzonal
Zone 3 - Centrilobular

35
Q

Zone 1

A 
Chronic Hepatitis
NH3 Metabolism (OTC & CPS Enzymes
36
Q

Midzonal - Zone 2

A

Protein Synthesis

37
Q

Zone 3

A

Drug Metabolism
Ischemia/Shock
Glutamine Synthetase Enzyme

38
Q

Pit Cell

A

Natural Killer Cell
Tumor Surveillance

Tumor cells from GI tract come back in portal vein
Pit cells KILL THOSE BITCHES

39
Q

Kupffer Cell

A

Macrophages
Contain multiple pseudopodia
Lie in waiting along endothelial surfaces
Phagocytose microbes

40
Q

Endothelial Cells

A

Contain fenestrae in the sieve plate

Allow smallecules to move from Sinusoids into the Space of Disse

41
Q

Space of Disse

A

Contains scattered discontinuous Collagen III fibers
Contains Ito (Stellate) cells
No basement membrane
Low pressure system (Dependent on how tight or loose the endothelial cells are, or how tight or loose stellate cells are

42
Q

Stellate (Ito) Cells

A 
Chief fibrotic source for the liver
Stores vitamins
Lies in wait for liver damage
Releases collagen on damage
Have little triangular basophilic nuclei (like little hats) over a vacuole of Vitamin A (fat soluble)
43
Q

Canal of Hering

A

Bile canalliculi narrow to tubes lined by single cuboidal epithelium as they approach the bile ducts.
Progenitor cells live in that part
They can differentiate into whatever types of cells you need!!

44
Q

Overdose of Vitamin A

A

Hyperplasia in Space of Disse

45
Q

Endothelin and NO

A

Released in order to modify tension of endothelial cells and stellate cells

46
Q

Bile Pumps

A

There are different bile pumps in the canaliculi
Studying these will reveal new forms of jaundice

BSEP
FIC-1
OATP

47
Q

BSEP

A

Bile Salt Exporter Pump

Inhibited if you have septic shock from LPS

48
Q

FIC-1

A

Familial Intrahepatic Cholestasis-1

Causes of jaundice in the liver itself

49
Q

OATP

A

Organic anion transport pump

50
Q

Cholestasis

A

Impaired bile secretion

51
Q

Jaundice

A

Sallow yellow skin

Icteric sclera

52
Q

LFTs

A 
Liver Function Tests
Total Protein
Albumin
Globulin
Bilirubin Total
Bilirubin Direct (conjugated)
Bilirubin Indirect (unconjugated)
AST
ALT
Alk Phos
53
Q

Total Protein

A

6.7 - 8.6 g/dL

54
Q

Albumin

A

3.5 - 5.5 g/dL

55
Q

Globulin

A

2.0 - 3.5 g/dL

56
Q

When a hepatocyte dies, what is released?

A

AST/ALT

57
Q

Pressure on bile ducts and canaliculi?

A

Elevated Bilirubin/Direct bilirubin
Alk Phos goes up
GGT (gammaglutamyl transferase)
5’NT (5’ nucleotidase)

58
Q

Synthesis

A

Synthetic proteins
Total Protein
Albumin

59
Q

Synthesized in hepatocytes

A

Clotting Factors (I - II - V - VII - IX)
Albumin
Complement Proteins

60
Q

Largest grey thing on EM

A

Erythrocytes

61
Q

How does the liver regenerate?

A

Like medusa

62
Q

How often do hepatocytes divide?

A

Every 400 Days

63
Q

How many times can a hepatocyte divide?

A

70 Times

64
Q

Regeneration after injury

A

Cell Division (eg hepatitis)

65
Q

Severe Loss of tissue - Regeneration

A

From progenitor cells! (eg fulminant hepatitis)

66
Q

Cirrhosis

A

An example of ABNORMAL REGENERATION with abnormally thick liver-cell plates
Cords are no longer 1 cell thick, but 3 or 4 cells thick
Blood can’t squeeze through!! THAT SUXXXX
Portal fibrosis

67
Q

Embryonic origins of liver

A

Gut ectoderm

68
Q

Septum transversum

A

Primitive diaphragm running horizontally

Gut from narrow tube growing into connective tissue plate

69
Q

22 Days post-blastocyst

A

Foregut endoderm goes into septum transversum.

Vitelline veins go into sinusoids

70
Q

26 days post-blastocyst

A

Cystic Bud

Cystic duct & gall bladder

71
Q

7 - 8 weeks

A

Portal vein
Portal tract
Sinusoids
Liver cords (many cells thick)

72
Q

9 - 10 weeks

A

Bile duct plates (BDP) develop

Differentiation of periportal hepatocytes to bile duct epithelium (bile duct plate)

73
Q

23 weeks and later

A

Double-lined tube regresses, is remodeled, and disappears
One portion moves into the tract to become the intralobular bile duct
Some liver diseases affect this remodeling (Polycistic Liver Disease)

GI / Hepatology (28 decks)

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