1: Physiology and pharmacology of the liver

Question 1

The liver is involved in the ___ of carbohydrates, fat and protein.

Answer 1

metabolism

Question 2

Where do gluconeogenesis, glycogenolysis, glycogenesis and the urea cycle take place?

among a million other processes

Answer 2

Liver

Question 3

Where are hormones degraded?

Answer 3

Liver

Question 4

Which hormone is converted from its inactive to active form in the liver?

Answer 4

Thyroxine to Triiodothyronine

(T4 > T3)

Question 5

Which vitamin is activated in the liver?

Answer 5

Vitamin D

Question 6

Which three types of molecules does the liver store?

Answer 6

Vitamins

Metal ions (e.g copper and ion)

Glycogen

Question 7

What is a protein marker of liver function?

Answer 7

Albumin

Question 8

Which molecules, involved in coagulation of blood, are synthesised in the liver?

Answer 8

Factors

Question 9

Albumin is a marker for ___ function.

Answer 9

liver

Question 10

What phagocytic cells are found in the liver and destroy debris and bacteria?

Answer 10

Kupffer cells

Question 11

The liver detoxifies substances found in the ___.

Give two examples.

Answer 11

blood

Drugs, alcohol

Question 12

Where is bile produced?

Where is bile stored?

Answer 12

Liver

Gall bladder

Question 13

Through which sphincter is bile released? Where does this sphincter lead?

Answer 13

Sphincter of Oddi

2nd part of the duodenum

Question 14

What event prompts the gall bladder’s smooth muscle to contract?

Which signal molecule is involved?

Which parasympathetic nerve is also involved?

Answer 14

Chyme in the duodenum

CCK

Vagus nerve

Question 15

Which signal molecule is released during a meal and prompts the Sphincter of Oddi to open?

Answer 15

CCK

Question 16

Bile is involved in the digestion and absorption of ___.

Answer 16

fat

Question 17

What component of bile can crystalise to form a gall stone?

Answer 17

Cholesterol

Question 18

Which antibody is found in bile?

Answer 18

IgA

Question 19

Which breakdown product of red blood cells is found in bile?

Excess amounts of this product in the blood cause ___.

Answer 19

Bilirubin

jaundice

Question 20

What is cholelithiasis?

Answer 20

Gall stones IN THE GALL BLADDER

Question 21

Where do gall stones most commonly appear?

Answer 21

Gall bladder

Common bile duct

Question 22

What is the most common pathology of the biliary tract?

Answer 22

Cholelithiasis

Question 23

What surgical technique is used to treat symptomatic cholelithiasis?

Answer 23

Laparoscopic cholecystectomy

keyhole surgery to remove the gall bladder.

Why not ERCP? because ERCP can only remove gall stones in the bile duct

Question 24

If cholelithiasis isn’t producing symptoms, how may it be treated (instead of cholecystectomy)?

Answer 24

Ursodeoxycholic acid (dissolves the stones)

Question 25

What is **biliary colic**?

Answer 25

**Colicky abdominal pain** caused by a gall stone blocking the bile duct

Question 26

Which drugs can be used to relieve pain caused by **biliary colic**?

Answer 26

**Atropine** **GTN**

Question 27

Which process **reabsorbs** 95% of the bile salts entering the terminal ileum from the duodenum?

Answer 27

**Enterohepatic recycling**

Question 28

If **bile salts** aren't reabsorbed by the terminal ileum and returned to the liver, how does the body synthesise it?

Answer 28

Using **cholesterol**

Question 29

Which drugs can be used to treat **hyperlipidaemia** and **cholestatic jaundice** by blocking bile salt reabsorption?

Answer 29

**Bile acid sequestrants**

Question 30

Name a bile acid sequestrant used to reduce cholesterol levels.

Answer 30

**Cole--** colesevelam, colestipol, colestyramine

Question 31

Colesevelam binds to ___ \_\_\_ in the terminal ileum, preventing their reabsorption and forcing the body to break down ___ to replenish it.

Answer 31

**bile salt** **cholesterol**

Question 32

What are the side effects of **bile acid sequestrants** e.g colesevelam?

Answer 32

**Vitamin deficiency** (bind to fat-soluble vitamins and block absorption) **GI side effects** (constipation, diarrhoea, pain, bloating) **Tastes awful**

Question 33

The liver usually converts ___ drugs to ___ metabolites. **(inactive , active)**

Answer 33

**active drugs** to **inactive metabolites**

Question 34

Which drug **gains** activity when it is metabolised by the liver?

Answer 34

**Codeine** turns into morphine.

Question 35

Sometimes, liver metabolism leaves the activity of a drug \_\_\_.

Answer 35

**unchanged**

Question 36

What tends to happen in **Phase I** of drug metabolism?

Answer 36

Some reaction to make it **more polar** (less active) e.g oxidation, reduction, hydrolysis

Question 37

What tends to happen in **Phase II** of drug metabolism?

Answer 37

A **functional group** is attached to the polar drug to render it even more polar

Question 38

What happens to a drug once it has been rendered polar by liver metabolism?

Answer 38

**Excretion**

Question 39

Which family of enzymes control **oxidation reactions** in Phase I of drug metabolism?

Answer 39

Cytochrome P540 monooxygenases | (**CYP** enzymes)

Question 40

\_\_\_ is a component of the R groups in many amino acids.

Answer 40

**Nitrogen**

Question 41

High levels of nitrogen is ___ to cells.

Answer 41

**toxic**

Question 42

\_\_\_\_ is detoxified by the liver to form \_\_\_, which is secreted in the urine.

Answer 42

**Ammonia** **urea**

Question 43

What disease occurs when the liver cannot detoxify ammonia to urea?

Answer 43

**Hepatic encephalopathy**

Question 44

What is the end stage of **hepatic encephalopathy**?

Answer 44

**Hepatic failure** **Coma** **Death**

Question 45

In **hepatic encephalopathy**, blood levels of ___ are high.

Answer 45

**ammonia**

Question 46

Ammonia is also produced by ___ in the gut.

Answer 46

**bacteria**

Question 47

Which drug is used to convert **ammonia** produced by bacteria into safe **ammonium**?

Answer 47

**Lactulose**

Question 48

Which drugs can be used to kill off ammonia-producing bacteria in hepatic encephalopathy?

Answer 48

**Antibiotics**