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GASTRO > 5: Pancreas & Liver > Flashcards

5: Pancreas & Liver Flashcards

1
Q

Where does the stomach empty chyme into?

A

Duodenum

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2
Q

What are the key properties of chyme? (3 things)

A
  1. Acidic
  2. Hypertonic
  3. Partly digested
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3
Q

How is the acidity of chyme corrected?

A

By HCO3- secreted from pancreas + liver + duodenal mucosa

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4
Q

How is the hypertonicity of chyme corrected?

A

By osmotic movement of water into duodenum across wall

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5
Q

How is the digestion of the partly digested chyme completed?

A

By enzymes from pancreas

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6
Q

What are the 2 components of Bile?

A
  1. Bile Acid dependant
  2. Bile Acid independant
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7
Q

What are the Bile Acid Dependant components secreted by?

A

Hepatocytes

Secreted into canaliculi (of bone)

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8
Q

What are the Bile Acid Dependant components?

A
  1. Bile acids (cholic acid)
  2. Cholesterol
  3. Bile pigments (bilirubin)
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9
Q

What are the Bile Acid Independant components secreted from?

A

Cells lining intra-hepatic bile ducts

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10
Q

What are the Bile Acid Independant components?

A

Alkaline juice (HCO3-)

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11
Q

What is the basic functional unit of the liver?

A

Lobule surrounding a central vein

  • Vein drains blood from liver → systemic veins
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12
Q

How does blood flow through a hepatic lobule?

A
  1. Blood from Hepatic Portal Vein + Hepatic Vein → Enters sinusoids @ periphery of lube
  2. Blood flows through sinusoids (lined by hepatocytes) → Central Vein
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13
Q

What is the duodenum response to gastric emptying? (3 steps)

A
  1. Duodenum secretes Cholecystokinin (CKK)
  2. CKK stimulates gall bladder contraction
  3. This ejects concentrated bile acids with enzymes from pancreas
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14
Q

What is the pancreas and liver response to gastric emptying?

A

Alkali released rom pancreas and liver in response to secretin

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15
Q

Where does the Pancreas + Bile ducts release their bile acids through?

A

Through Ampula of Vater into small intestine

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16
Q

What happens to blood returning from digestive tract? (3 steps)

A
  1. Blood enters Hepatic Portal Blood
  2. Hepatocytes actively take up bile acids
  3. Hepatocytes re-secrete bile acids into canaliculi
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17
Q

What happens to bile acids in between meals?

A

Returned to liver → secreted into canaliculi → stored in gall bladder until needed

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18
Q

How is bile acid concentrated in the gall bladder?

A

Salt and water transported across gall bladder epithelium → reduces volume

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19
Q

What does concentrated bile acids increase the risk of?

A

Gall stones

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20
Q

What are the symptoms of gall stones?

A

Usually asymptomatic

BUT if they move into neck of gall bladder / biliary tree → very painful biliary colic / obstruction

Followed by:

  • Inflammation (cholecystitis)
  • Gall bladder infection
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21
Q

When is the pain for gall stones worse?

A

After eating because Cholecystokinin (CKK) causes gall bladder to contract

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22
Q

What are the exocrine pancreas secretions? (2 things)

A
  1. Alkaline juice (HCO3-)
  2. Enzymes:
  • Proteases
  • Amylases
  • Lipases
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23
Q

What is the mechanism of alkaline juice secretion (HCO3-)?

A
  1. Na-K ATPase pump sets up Na+ concentration gradient
  2. H+ ions exported from Duct Cell → ECF using Na+ gradient
  3. H+ ions combine with HCO3- → H2O + CO2 → taken up into Duct Cell
  4. H2O + CO2 → reform HCO3 + H+ inside Duct Cell
  5. HCO3+ exported into Duct Lumen
  6. H+ recycled → carrys more HCO3+ from ECF to lumen
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24
Q

What is Secretin?

A

Hormone that stimulates secretion of:

  1. Pancreatic Juice
  2. Bile (from Liver)
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25
How and where is secretin released?
Duodenum In response to low pH
26
What facilitates the action of secretin?
Cholecystokinin (CKK)
27
What are the 2 types of pancreatic secretions?
1. Acinar 2. Duct
28
What are Acinar secretions of the pancreas stimulated by?
Cholecystokinin (CKK) (from APUD cells of duodenum in response to hypertonicity and fats)
29
What are the Duct secretions of the pancreas stimulated by?
Secretin (from duodenal cells in reponse to low pH)
30
What is Cholecystokinin (CKK) secreted in response to?
Gastric emptying CKK secreted by duodenum
31
What does Cholecystokinin (CCK) do?
Stimulates contraction of gall bladder muscles
32
Why are fats no digested until the duodenum?
Fat insoluble in water → aggregates into large globules So isn't affected by digestive enzymes
33
What happens to fats in the duodenum? (5 steps)
1. Bile acids enable fats to be incorporated into small **micelles** (fat in middle, polar component of bile acid on outside) 2. Micelles = large s.a for lipase action → F.A cleaved from glycerol 3. Micelles carry fats → "unstirred layer" next to mucosa → F.A diffuse into epithelial cells 4. F.A reconstituded → TAGs 5. TAGs expelled as chylomicrons
34
What do chylomicrons facilitate?
Facilitate transport of fat in lymphatic system from gut → systemic veins
35
What is the anatomy of the liver? (3 points)
1. 2 main lobes → each divided into 8 segments 2. Segments have 1000 hepatic lobules 3. Hepatic lobules connected to small ducts → larger ducts → Common Hepatic Duct
36
What does the Common Hepatic Duct transport? And via what?
Bile made by liver cells → gall bladder + duodeum Via Common Bile Duct
37
What are the functions of the liver? (3 steps)
1. Blood from Hepatic Portal Vein enters sinusoids (lined with hepatocytes) 2. Sinusoids drain into Central Vein 3. Bile secreted into Canaliculi
38
Where is the gall bladder located?
Under liver on RHS of abdomen
39
What is the function of the gall bladder?
Stores and concentrates bile produced by the liver
40
What causes Steatorrhoea?
Bile acids / pancreatic enzymes not secreted enough → fat in faeces
41
What are the characteristics of Steatorrhoea poo? (3 things)
1. Pale 2. Floats 3. Stinks
42
What causes Jaundice?
Normal: Bilirubin conjugated in liver → secreted in bile to be secreted in faeces Jaundice: Bilirubin NOT secreted → accumulates in blood → JAUNDICE
43
What is the pathophysiology of Cirrhosis?
Liver cell necrosis + nodular regeneration + fibrosis This causes: 1. Increased resistance to blood flow 2. Reduced liver function
44
What are the causes of Cirrhosis? (3 things)
1. Alcohol 2. alpha 1-antitrypsin deficiency 3. Hepatits B / C / autoimmune
45
What can be seen on investigation of Cirrhosis? (3 things)
1. High bilirubin 2. Low albumin 3. High ALT / AST ratio (enzymes in blood)
46
What are the 3 types of Jaundice?
1. Pre-Hepatic 2. Hepatic 3. Post-Hepatic
47
What is Pre-Hepatic Jaundice?
Excessive bilirubin production (Liver can't cope with excess)
48
What are the Bilirubin lab findings for Pre-Hepatic Jaundice? (2 things)
1. Unconjugated bilirubin 2. Hyperbilirubinaemia
49
What are the causes of Pre-Hepatic Jaundice? (3 things)
1. Hb abnormalities 2. Gilberts syndrome 3. Infections / Drugs
50
What is Hepatic Jaundice?
Reduced capacity to conjugate / excrete bilirubin
51
What are the Bilirubin lab findings for Hepatic Jaundice? (2 things)
1. Mixed unconjugated + conjugated bilirubin 2. Hyperbilirubinaemia
52
What are the causes of Hepatic Jaundice? (3 things)
1. Gilberts syndrome 2. ALCOHOL (Cirrhosis) 3. Hepatic Tumours
53
What is Post-Hepatic Jaundice?
Obstruction to biliary system
54
What are the Bilirubin lab findings of Post-Hepatic Jaundice? (4 things)
1. Conjugated bilirubin 2. Hyperbilirubinaemia 3. Bilirubin in urine (dark) 4. None in faeces (pale) (supposed to be in faeces innit)
55
What are the causes of Post-Hepatic Jaundice? (5 things)
Intra-Hepatic 1. Cirrhosis 2. Drugs Extra-Hepatic 3. Gall stones 4. Biliary stricture 5. Pancreatitis
56
What are the causes of Portal Hypertensions? (2 things)
1. Obstruction to Portal Vein: * Congenital / Thrombosis / Compression 2. Obstruction to flow within liver: * Cirrhosis
57
What does Portal Hypertension lead to? (3 things)
1. Ascites 2. Splenomegaly 3. Vessel dilation / rupture / ulceration / haemorrhage
58
How does Portal Hypertension lead to Ascites?
Fluid accum. in Peritoneal cavity → abd swelling
59
How does Portal Hypertension cause Splenomegaly?
Bc increased BP in spleen
60
How does Portal Hypertension cause Vessel dilation / rupture / ulceration / haemorrhage?
Increased BP → blood backs up through anastomoses
61
What are the complications of Gall Stones? (2 things)
1. Cholecystitis 2. Ascending Cholangitis
62
What is cholecystitis?
Inflammation of gall bladder
63
What does cholecystitis lead to? (4 things)
1. RUQ Pain + Fever 2. Increased WBC 3. Sepsis 4. Gall bladder mass RISG
64
What is ascending cholangitis?
Inflammation / infection of CBD (common bile duct) Bacteria ascend from CBD junction with duodenum
65
What are the signs and symptoms of Ascending Cholangitis? (3 things)
Charcots Triad: 1. RUQ Pain 2. Jaundice 3. Fever
66
What are the causes of Pancreatitis? (10 things)
GET SMASHED 1. Gall Stones 2. Ethanol 3. Trauma 4. Steroids 5. Mumps 6. AI 7. Scorpion bite 8. Hyperlipidaemia 9. ERCP / Iatrogenic (ERCP is a diagnostic procedure to examine liver) 10. Drugs
67
What are the signs and symptoms of Acute Pancreatitis? (4 things)
1. Haemorrhage / Oedema / Necrosis of Pancreas 2. Pain / vomiting / dehydration 3. High: AGA * Amylase * Gycaemia * ALP / Bilirubin ratio 4. Low calcium
68
What are the signs and symptoms of Chronic Pancreatitis? (4 things)
1. Fibrosis / Calcification of Pancreas 2. Malabsorption which causes: * Steatorrhoea * Low albumin * Weight loss 3. Jaundice

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