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Gastrointestinal > 11. Functions of the Liver II > Flashcards

11. Functions of the Liver II Flashcards

1
Q

how is the LIVER’S BLOOD SUPPLY

A

DUAL BLOOD SUPPLY

  • from HEPATIC PORTAL VEIN and HEPATIC ARTERIES
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2
Q

How much of the BLOOD SUPPLY comes from HEPATIC PORTAL VEIN

A

75%

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3
Q

HEPATIC PORTAL VEIN carries VENOUS BLOOD FROM..

A

SPLEEN and GI TRACT (intestines etc)

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4
Q

PARENCHYMAL CELLS (related to function) of liver

A

HEPATOCYTES (80%)

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5
Q

NON-PARENCHYMAL CELLS of Liver

A

KUPPFER, ENDOTHELIAL, SINUSOIDAL
(6.5%)

BIPOTENTIAL STEM CELLS - OVALOCYTES (from Hepatocytes and Cholangiocytes)

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6
Q

LIVER FUNCTIONS

A

SYNTHESIS
BREAKDOWN
STORAGE
IMMUNE SYSTEM

etc

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7
Q

BILE COLOUR

A

GREEN/YELLOWISH BROWN

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8
Q

where is BILE STORED and CONCENTRATED

A

in GALLBLADDER

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9
Q

BILE is DISCHARGED to the..

A

DUODENUM

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10
Q

GALLBLADDER BILE COMPOSITION

A

97% WATER
0.7% BILE SALTS
0.2% RUBIN

0.51% FATS (CHOLESTEROL, FATTY ACIDSM LECITHIN)

INORGANIC SALTS

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11
Q

how much of GALLBLADDER BILE is WATER

A

97%

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12
Q

how much of GALLBLADDER BILE is BILE SALTS

A

0.7%

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13
Q

how much of GALLBLADDER BILE is BILIRUBIN

A

0.2%

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14
Q

how much of GALLBLADDER BILE is FATS (CHOLESTEROL/FATTY ACIDS/LECITHIN)

A

0.51%

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15
Q

SYNTHESIS of BILE ACIDS is a major route of … METABOLISM

A

CHOLESTEROL METABOLISM

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16
Q

how much CHOLESTEROL does the BODY PRODUCE PER DAY
and how much of it is used for BILE ACID SYNTHESIS

A

800 MG/DAY CHOLESTEROL

  • 400-600 MG used for BILE ACID SYNTHESIS
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17
Q

How much BILE ACIDS do we SECRETE into Intestines PER DAY

A

12-18 G

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18
Q

how much of BILE ACIDS is REABSORBED by TRANPORT in ILEUM and RECYCLED (ENTEROHEPATIC CIRCULATION)

A

95%

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19
Q

what is BILIRUBIN

A

YELLOW BREAKDOWN PRODUCT of HAEM METABOLISM (RBC breakdown)

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20
Q

what is the name of the PIGMENT from BILIRUBIN that gives FAECES its BROWN COLOUR

A

STERCOBILIN

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21
Q

if bile can’t flow into the duodenum ie jaundice it is filtered by KIDNEYS and BILIRUBIN gives URINE a DARK COLOUR by which PIGMENT:

A

UROBILIN

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22
Q

BILIRUBIN has what structure

A

TETRAPYROLE
/ PORPHYRINS in haem

  • 4 RINGS
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23
Q

what is BILIRUBIN CONJUGATED WITH

A

GLUCORONIC ACID

(by GLUCORONIDATION)

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24
Q

what does BILE FORM to AID LIPID DIGESTION

A

MICELLES

  • Increase SA to digest lipids
  • MOVE LIPIDS near BRUSH BORDER for FAT ABSORPTION
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25
Q

FUNCTIONS of MICELLES

A
  • AID LIPID DIGESTION and ABSORPTION (move near brush borders)
  • ELIMINATE CHOLESTEROL
  • DRIVES BILE FLOW
  • EMULSIFY FAT SOLUBLE VITAMINS (D,E,A,K) to HELP ABSORPTION
  • REDUCE BACTERIAL FLORA in SMALL INTESTINE and BILIARY TRACT
26
Q

where can MICELLES REDUCE BACTERIAL FLORA

A

in SMALL INTESTINES and BILIARY TRACT

27
Q

BILE ACIDS also have HORMONAL ACTIONS (METABOLIC) which function through 2 RECEPTORS:

A
  • FARNESOID X RECEPTOR (NR1H4)
    activates signalling molecules in liver and intestines
  • G-PROTEIN COUPLED BILE ACID RECEPTOR / TGR5
28
Q

FARSENOID X RECEPTOR (NR1H4) ACTIVATES SIGNALLING MOLECULES in LIVER and INTESTINES involved in…

A
  • TRIGLYCERIDE and GLUCOSE METABOLISM
  • LIVER GROWTH
29
Q

G-PROTEIN COUPLED BILE ACID RECEPTOR / TGR5 has what FUNCTIONS

A

METABOLIC, ENDOCRINE, NEUROLOGICAL functions

30
Q

which bile acid RECEPTOR is involved in TRIGLYCERIDE and GLUCOSE METABOLISM

A

FARSENOID X RECEPTOR (NR1H4)

31
Q

which bile acid RECEPTOR is used for METABOLIC, ENDOCRINE & NEUROLOGICAL FUNCTIONS

A

G-PROTEIN COUPLED BILE ACID RECEPTOR, TGR5

32
Q

WHERE are PRIMARY BILE ACIDS SYNTHESISED

33
Q

WHERE are SECONDARY BILE ACIDS SYNTHESISED

A

COLON as a result of BACTERIAL ACTIONS

  • PRIMARY bile acids are PARTIALLY HYDROXYLATED
34
Q

PRIMARY BILE ACIDS:

A
  • CHOLIC ACID
  • CHENODEOXYCHOLIC ACID
35
Q

PRIMARY BILE ACIDS FORMED VIA..

A

CYTOCHROME P450 Mediated OXIDATION of CHOLESTEROL

36
Q

What is the RATE-LIMITING STEP in the SYNTHESIS of PRIMARY BILE ACIDS (cholesterol oxidation)

A

ADDITION of HYDROXYL GROUP of 7TH POSITION of the steroid nucleus
by ENZYME CHOLESTEROL 7 ALPHA-HYDROXYLASE

37
Q

CHOLESTEREOL 7 ALPHA HYDROXYLASE ENZYME is DOWN-REGULATED by…

A

CHOLIC ACID

38
Q

CHOLESTEREOL 7 ALPHA HYDROXYLASE ENZYME is UP-REGULATED by…

A

CHOLESTEROL

39
Q

CHOLESTEREOL 7 ALPHA HYDROXYLASE ENZYME is INHIBITED by…

A

Actions of the ILEAL Hormone: FGF 15/19

40
Q

what happens to PRIMARY BILE ACIDS to form SECONDARY BILE ACIDS

A

PARTIAL HYDROXYLATION

  • GLYCINE and TAURINE GROUPS REMOVED
41
Q

PRIMARY CHOLIC ACID becomes SECONDARY BILE ACID:

A

DEOXYCHOLIC ACID

42
Q

PRIMARY CHENODEOXYCHOLIC ACID becomes SECONDARY BILE ACID:

A

LITHOCOLIC ACID

43
Q

what happens in ENTERO-HEPATIC CIRCULATION

A

all BILE ACIDS and 95% of BILE is REABSORBED from TERMINAL ILEUM

and RECYCLED by the Liver

44
Q

BILE ACIDS can BIND to some other PROTEINS such as..

45
Q

BILE ACIDS GENERATE BIOACTIVE…

A

LIPID AMIDES

eg. Cannabinoid Anandamide

46
Q

BILE ACID ROLES in PYSIOLOGICAL PATHWAYS

A
  • STRESS and PAIN RESPONSES
  • APPETITE
  • LIFESPAN
47
Q

NAPE-BLD (binds bile acids) orchestrates a DIRECT CROSS-TALK Between..

A

LIPID AMIDE SIGNALS and BILE ACID PHYSIOLOGY

48
Q

as SURFACTANTS or DETERGENTS, BILE ACIDS are potentially … to cells

49
Q

what INHIBITS BILE ACID SYNTHESIS when LEVELS are too HIGH

A

ACTIVATION of FXR in the liver

  • activation by bile acids during absorption in the intestine
    -> INCREASES TRANSCRIPTION and SYNTHESIS of FGF19 (which inhibits bile synthesis)
50
Q

Name of the SPHINCTER before the Ampulla that controls flow of BILE and PANCREATIC JUICE INTO DUODENUM

A

SPHINCTER OF ODDI (SOD)

51
Q

how is BILE and PANCREATIC JUICE flow ALLOWED into the DUODENUM (via ampulla)

A

by GALLBLADDER CONTRACTION
and RELAXATION of the SPHINCTER OF ODDI

52
Q

what STIMULATE GALLBLADDER CONTRACTION (which relaxes sphincter of oddi)

A
  • ACID FROM STOMAC INTO DUODENUM
  • CCK
  • SECRETIN - Increases HCO3- / H2O (help relax SOD)
53
Q

BILE from GALLBLADDER comes to/from COMMON BILE DUCT VIA..
(joins with common hepatic duct)

A

CYSTIC DUCT

54
Q

CLINICAL problems that can be caused by BILE ACIDS

A
  • HYPERLIPIDAEMIA
  • CHOLESTASIS (excess blockage)
  • GALLSTONES
  • BILE ACID DIARRHOEA
  • COLON CANCER (from deoxycholic acid conc.)
55
Q

JAUNDICE (YELLOW SCLERA or SKIN) is from..

A

HYPERBILIRUBINAEMIA

  • EXCESS BILIRUBIN in BLOOD
56
Q

When does JAUNDICE become apparent

A

when SERUM BILIRUBIN is 2-3X Upper limit of NORMAL

57
Q

how are blood LEVELS in PREHEPATIC JAUNDICE

A

RAISED BILIRUBIN ONLY

58
Q

how are blood LEVELS in HEPATIC JAUNDICE

A

RAISED BILIRUBIN
RAISED AST
RAISED ALT

59
Q

how are blood LEVELS in POST HEPATIC JAUNDICE (ie in bile duct)

A

RAISED BILIRUBIN
RAISED ALP (alkaline phosphatase)
RAISED GGT (gamma GT)

60
Q

JAUNDICE INVESTIGATION

A

History and Examination

Urine Dip

prehepatic: Haemolysis

Hepatic: Ultrasound - not dilated ducts
Liver Screen
Post Hepatic: Ultrasound - Dilated ducts

61
Q

CAUSES OF JAUNDICE

A

POST HEPATIC JAUNDICE
CONJUGATED HYPERBILIRUBINAEMIA
- bilirubin detectable in Urine
- blockage of floe of bile to duodenum

in bile LUMEN: STONES, TUMOUR
in WALL of LUMEN: STRICTURE, PSC
COMPRESSION on the LUMEN: PANCREATIC CANCER, HILAR LYMPHADENOPATHY

Gastrointestinal (19 decks)

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