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GI Final > 4 Hepatobiliary Function > Flashcards

4 Hepatobiliary Function Flashcards

1
Q

Main functions of the liver

A

Bile production and secretion

Metabolism of carbs, proteins, and lipids

Bilirubin production and excretion

Detoxification of substances

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2
Q

Three metabolic functions of the liver

A

Carbohydrate metabolism

Protein metabolism

Lipid metabolism

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3
Q

Carbohydrate metabolism of the liver includes ______, release of ______, and storage of glucose as ______.

A

Gluconeogenesis

Glucose

Glycogen

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4
Q

Protein metabolism of liver includes synthesis of ______ amino acids

Modification of _____ for use in biosynthetic pathways for carbohydrate

Synthesis of plasma proteins including _____ and _____

Conversion of ammonia to _____

A

Nonessential

Amino acids

Albumin and clotting factors

Urea

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5
Q

Lipid metabolism of the liver includes synthesis of _____, ______, and _____, and fatty acid oxidation.

A

Lipoproteins

Cholesterol

Pospholipids

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6
Q

The more blood vessels in parallel, the _____ the resistance.

The more in series, the _____ the resistance.

A

Lower

Greater

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7
Q

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

Most common causes is ____.

A

Cirrhosis

Alcohol abuse

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8
Q

Alcohol abuse leads to an accumulation of _____ in hepatocytes.

_____ is a fatty liver with inflammation, leading to scarring of the liver and cirrhosis.

A

Fat

Steatohepatitis

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9
Q

Chronic disease that causes the bile ducts in the liver to become inflamed, damaged, and eventually lost

A

Primary biliary cirrhosis

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10
Q

What is one of the most common causes of portal hypertension?

Why?

A

Cirrhosis

Liver cirrhosis is caused by fibrosis of the liver-> increases resistance to portal blood flow -> portal hypertension

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11
Q

Clinical consequences of portal hypertension due to liver cirrhosis

A

Hepatic encephalopathy

Esophageal varies

Splenomegaly

Caput medusae (ascites)

Hemorrhoids

Testicular atrophy (less testosterone)

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12
Q

Composition of bile

A

Bile salts

Bile pigments

Cholesterol

Phospholipids (lecithin)

Ions

Water

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13
Q

Function of bile

A

Vehicle for elimination of substances from the body

Solubilizes lipids that are normally insoluble

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14
Q

How does the parasympathetic innervation of the _____ nerve affect bile secretion?

What opposes this innervation?

A

Vagus nerve

Increases bile flow

Includes contraction of the gallbladder

Sympathetics

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15
Q

This hormone is the primary regulator of bile secretion.

What does it stimulate?

Other hormones and fx

A

CCK

Gallbladder contraction directly
Relax the sphincter of Oddi

Gastrin
Secretin stimulates liver ductal secretion (antagonize CCK actions)
Pancreatic polypeptide and somatostatin (decrease gallbladder contractility)

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16
Q

Primary bile acids are synthesized in _____ by ____.

Secondary bile acids are synthesized in _____ by _____.

Secondary acids are _____ in the liver and form bile salts.

Bile salts form _____.

A

Hepatocytes; 7 alpha-hydroxylase

Small intestine; 7 alpha-dehydroxylase

Conjugated

Micelles

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17
Q

Cirrhosis liver leading to portal hypertension causes _____ albumin production-> ______ oncotic pressure and ____ hydrostatic pressure.

Also causes ______ aldosterone and Na reabsorption in the kidney

A

Decreased

Decreased

Increased

Increased

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18
Q

Enterohepatic circulation plays a role in the biliary system by ____.

Regulated by what two hormones?

A

It recycles bile acids to decrease the amount need to be synthesized (90% of bile acids delivered recycled to portal blood; the rest excreted in feces)

CCK and secretin

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19
Q

Some bile is lost in ____.

This changes the amount of bile ____.

A

Feces

Synthesis

20
Q

Bile is secreted across what kind of membrane?

By what cells?

A

Canalicular (have active and passive secretions)

Ductile cells

21
Q

Bile salt transporters:
into the hepatocyes

Into canaliculi

Into enterocytes

Exiting enterocytes

A

NTCP: Na dependent transport protein
OATPs: organic anion transport protein

BSEP: bile salt excretory pump
MRP2: multidrug resistance protein 2

ASBT: apical Na dependent bile acid transporter

OSTalpha/beta: organic solution transporter

22
Q

Increased bile secretion ____ the rate of return

Cholesterol 7 alpha-hydroxylase is inhibited by ____ (negative feedback).

A

Increases

Bile salts

23
Q

How does ileal resection affect enterohepatic circulation?

A

Increases bile salt synthesis levels by 10 fold

Because not longer able to reabsorb bile into the portal blood through the enterocytes in the ileum

24
Q

What does secretin stimulate during bile acid secretion?

A

HCO3 and water secretion form ductile cells

Increase volume, increases pH, decreases bile salt concentration

25
Q

What does it meant to be bile acid-dependent and independent?

A

Almost all bile formation is driven by bile acids

Small portion of bile is stimulated by secretin

26
Q

What happens to bile secretion between meals?

What happens when food is ingested and what mediates this?

A

Gallbladder fills with bile and relaxes
Sphincter of Oddi is closed

Contraction of gallbladder
Relaxation of sphincter of Oddi—mediated by CCK

27
Q

Bilirubin is made from hemoglobin from RBC-> bilirubin combines with ____ and goes to the liver-> bilirubin is ____ in the liver by ______ enzyme-> some conjugated bilirubin is excreted in the ____-> the rest goes to the small intestine where it is converted into urobilin and stercobilin to make _____.

A

Albumin

Conjugated

UDP-glucuronyl transferase

Urine (yellow because of conjugated bilirubin or bilirubin glucuronide)

Dark colored stools (feces)

28
Q

What is jaundice a sign of?

How do you measure jaundice?

Direct vs indirect?

A

Hyperbilirubinemia

Measure total serum bilirubin to see levels of direct (conjugated) and indirect (unconjugated) bilirubin

29
Q

Form of anemia due to hemolysis of RBC

Increased ____ bilirubin.

A

Hemolytic anemia

Unconjugated bilirubin

30
Q

Increased unconjugated bilirubin in blood during the 1st week of life

What causes it?

A

Neonatal jaundice

Elevated bilirubin production due to breakdown of fetal erythrocytes

Low activity of UDP glucuronyl transferase

31
Q

Gilbert’s syndrome has increased levels of _____ bilirubin in the blood.

Appears during adolescence because has episodes of _____ brought on by stress.

Caused by mutation in gene coding for ____.

Mild; ____ of people have no signs or symptoms

A

Unconjugated bilirubin

Hyperbilirubinemia

UDP glucuronyltransferase

30%

32
Q

Crigler-Najjar Syndrome has increased levels of ____ bilirubin in the blood.

Mutation in gene coding for ____.

Type 1 is ____.

Type 2 is ____.

A

Unconjugated

UDP glucuronyltransferase

Very severe

Less severe

33
Q

____ is a form of brain damage caused by the accumulation of unconjugated bilirubin and develops in the 1st year.

Symptoms of cerebral palsy, sensory neural hearing loss, and gaze abnormalities.

Due to untreated _____ with a build up of ____ bilirubin?

A

Kernicterus

Crigler-Najjar Syndrome Type 1

Unconjugated

34
Q

What treats type 2 crigler-najjar syndrome?

How?

Can it help type 1?

A

Phenobarbitol

Helps conjugate the bilirubin

NO

35
Q

What treats type 1 crigler-najjar syndrome?

A

Phototherapy up to 12 hr/day

Heme oxygenate inhibitors

Oral calcium phosphate

Carbonate

Liver transplant

36
Q

Dublin-Johnson syndrome has increased levels of ____ bilirubin.

Why?

Mutation in ____.

Liver has a ____ pigmentation.

A

Conjugated bilirubin

Defect in the ability of hepatocytes to secrete conjugated bilirubin in bile

MRP2

Black

37
Q

Rotor Syndrome has a buildup of _____ bilirubin but most is _____.

Mutation in genes ____.

A

Unconjugated and conjugated

Conjugated

OATP1B1 and OATP1B3

38
Q

Phototherapy is the main treatment in babies with ____.

How?

A

Unconjugated hyperbilirubinemia

Isomerization that changes trans-bilirubin into water-soluble cis-bilirubin isomer

39
Q

Bile duct obstruction (stones) causes an increase in ____ bilirubin.

Small stones blocking the cystic duct cause ____.

A

Conjugated bilirubin

Acute cholecystitis

40
Q

Causes of gallstones

A

Too much absorption of water and bile acids from bile

Too much cholesterol in bile

Inflammation of epithelium

41
Q

Liver enzymes can modify drugs and toxins to make them ____.

This allows excretion of theses substances through _____.

Phase 1 processed by _____.

Phase 2 includes ____ with glucoronide, sulfate, AA, or glutathione

A

Water-soluble

Bile or urine

P450 enzymes

Conjugation

42
Q

Liver function tests measure what liver enzymes?

A

Serum aminotransferases: ALT and AST

Alkaline phosphatase

43
Q

Elevated aminotransferases mean what?

Elevated alkaline phosphatases mean what?

A

Hepatocytes injury

Cholestasis

44
Q

Measures the liver’s ability to detoxify metabolites and transport organic anions into bile

A

Bilirubin function test

45
Q

Low levels of _____ mean severe impairment in liver function/hepatocyte function like during cirrhosis.

Why?

A

Albumin (hypoalbuminemia)

Because albumin is synthesized in the liver

46
Q

Increases as the ability of cirrhotic liver to synthesize clotting factors decreases

Reflects the degree of hepatic synthetic dysfunction

A

Prothrombin time/INR

GI Final (11 decks)

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