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GI Final > 3 Hepatobiliary Function > Flashcards

3 Hepatobiliary Function Flashcards

1
Q

What are the main functions of the liver

A

Bile production
Metabolism of FA, Carbs, proteins
Bilirubin production
Detoxification

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2
Q

What is cirrhosis

A

Chronic liver disease in which normal liver cells are damaged and replaced by scar tissue (fibrosis)

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3
Q

What is the most commmon cause of cirrhosis

A

Excessive alcohol intake

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4
Q

Steatohepatitis is also known as

A

Fatty liver disease

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5
Q

What is the most common cause of portal hypertension

A

Cirrhosis

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6
Q

Where are primary bile acids synthesized

A

Hepatocytes

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7
Q

Secondary bile acids are made where

A

SI

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8
Q

Where are bile salts conjugated

A

Liver

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9
Q

What are the two primary bile acids

A

Cholic acid and chenodeoxycholic acid

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10
Q

What are the two secondary bile acids

A

Deoxycholic acid from cholic acid

Lithocholic acid from chenodeoxycholic acid

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11
Q

What is the most prevalent bile acids

A

Cholic > chenodeoxycholic > deoxycholic > lithocholic

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12
Q

What is the function of bile salts

A

Solubilizes lipids that are naturally insoluble

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13
Q

What is the primary hormonal regulator of bile secretion

A

Gallbladder contraction directly and relaxation of sphincter of oddi

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14
Q

What is the effect of the vagus on bile secretion

A

Increases bile flow, induces contraction of gallbladder

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15
Q

What transporters assist with bile salt uptake into hepatocytes

A

NTCP and OATPs

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16
Q

What are the bile salt transporters that move bile into canaliculi

A

BSEP and MRP2

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17
Q

What moves bile salts into enterocytes

A

ASBT

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18
Q

What moves bile salts out of enterocytes

A

OST α/β

19
Q

What enzyme makes bile salts

A

Cholesterol 7α hydroxylase

20
Q

Interruption of the enterohepatic circulation does what to bile acid synthesis

A

Can increase it by 10 fold

21
Q

What makes conjugated bilirubin

A

UDP glucuronyl transferase (responsible for infant jaundice)

22
Q

What are the hereditary defects in bilirubin metabolism

A

Gilbert’s syndrome
Dubin-Johnson syndrome
Rotor syndrome
Crigler-Najjar syndrome (Type 1 and 2)

23
Q

What is hemolytic anemia

A

Type of anemia which causes increased unconjugated bilirubin

24
Q

What are the 2 main causes of neonatal jaundice

A

Elevated bilirubin production due to breakdown of fetal erythrocytes

Low activity of UDP gluuronyl transferase

25
Q

What is Gilbert’s syndrome

A
  • increased levels of uncojugated bilirubin in the blood
  • usually recognized during adolescence
  • episodes are brought on by physiological stress
26
Q

What causes Gilbert’s syndrome

A

Mutation in gene that codes fro UDP glucuronyltransferase

27
Q

What causes Crigler-Najjar syndrome

A

Mutations in the gene that codes for UDP glucuronyltransferase

28
Q

CN1 or 2 is more severe

A

1

29
Q

What is a major symptom of CN1

A

Kernicterus (form of brain damage cause by the accumulation of unconjugated bilirubin)

30
Q

What are the treatments for CN1

A
  • phototherapy
  • heme oxygenase inhibitors
  • oral calcium phosphate and carbonate
  • liver transplantation
  • phenobarbitol (no response in CN1)
31
Q

What are the clinical symptoms of kernicterus

A
  • cerebral palsy
  • sensory nerual hearing loss
  • gaze abnormalities
32
Q

What distinguishes CN2

A

Less than 20% UPD glucuronyltransferase function

Less likely to develop kernicterus

33
Q

What is found in Dubin-Johnson syndrome

A
  • increased bilirubin w/o liver enzyme elevation
  • mutations in MRP2 (unable to secrete conjugated bilirubin)
  • liver has black pigmentation
34
Q

What is Rotor syndrome

A

Buildup of conjugated and unconjugated bilirubin but the majority is conjugated

35
Q

What mutation is responsible for Rotor syndrome

A

OATP1B1 and OATP1B3

36
Q

How does phototherapy work

A

Changes trans-bilirubin to cis-bilirubin

37
Q

What causes gallstones

A
  • too much absorption of water from bile
  • too much absorption of bile acids from bile
  • too much cholesterol in bile
  • inflammation of epithelium
38
Q

Modification of drugs by liver to their active form

A

First pass effect

39
Q

What are the liver enzymes

A

ALT and AST and alkaline phosphatase

40
Q

What does elevated aminotransferases suggest

A

Hepatocyte injury

41
Q

What does elevated alkaline phosphatase suggest

A

Cholestasis

42
Q

Bilirubin can be used to measure

A

The liver’s ability to detoxify metabolites and transport organic anions

43
Q

What is albumin used to measure

A

Severe impairment in liver function

44
Q

What is prothrombin time used to measure

A

Reflects the degree of hepatic synthetic dysfunction

PT increases as the liver is unable to synthesize clotting factors

GI Final (12 decks)

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