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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
Q

How and where is secretin released?

A

Duodenum

In response to low pH

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26
Q

What facilitates the action of secretin?

A

Cholecystokinin (CKK)

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27
Q

What are the 2 types of pancreatic secretions?

A
  1. Acinar
  2. Duct
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28
Q

What are Acinar secretions of the pancreas stimulated by?

A

Cholecystokinin (CKK) (from APUD cells of duodenum in response to hypertonicity and fats)

29
Q

What are the Duct secretions of the pancreas stimulated by?

A

Secretin (from duodenal cells in reponse to low pH)

30
Q

What is Cholecystokinin (CKK) secreted in response to?

A

Gastric emptying

CKK secreted by duodenum

31
Q

What does Cholecystokinin (CCK) do?

A

Stimulates contraction of gall bladder muscles

32
Q

Why are fats no digested until the duodenum?

A

Fat insoluble in water → aggregates into large globules

So isn’t affected by digestive enzymes

33
Q

What happens to fats in the duodenum? (5 steps)

A
  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
Q

What do chylomicrons facilitate?

A

Facilitate transport of fat in lymphatic system from gut → systemic veins

35
Q

What is the anatomy of the liver? (3 points)

A
  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
Q

What does the Common Hepatic Duct transport?

And via what?

A

Bile made by liver cells → gall bladder + duodeum

Via Common Bile Duct

37
Q

What are the functions of the liver? (3 steps)

A
  1. Blood from Hepatic Portal Vein enters sinusoids (lined with hepatocytes)
  2. Sinusoids drain into Central Vein
  3. Bile secreted into Canaliculi
38
Q

Where is the gall bladder located?

A

Under liver on RHS of abdomen

39
Q

What is the function of the gall bladder?

A

Stores and concentrates bile produced by the liver

40
Q

What causes Steatorrhoea?

A

Bile acids / pancreatic enzymes not secreted enough → fat in faeces

41
Q

What are the characteristics of Steatorrhoea poo? (3 things)

A
  1. Pale
  2. Floats
  3. Stinks
42
Q

What causes Jaundice?

A

Normal: Bilirubin conjugated in liver → secreted in bile to be secreted in faeces

Jaundice: Bilirubin NOT secreted → accumulates in blood → JAUNDICE

43
Q

What is the pathophysiology of Cirrhosis?

A

Liver cell necrosis + nodular regeneration + fibrosis

This causes:

  1. Increased resistance to blood flow
  2. Reduced liver function
44
Q

What are the causes of Cirrhosis? (3 things)

A
  1. Alcohol
  2. alpha 1-antitrypsin deficiency
  3. Hepatits B / C / autoimmune
45
Q

What can be seen on investigation of Cirrhosis? (3 things)

A
  1. High bilirubin
  2. Low albumin
  3. High ALT / AST ratio (enzymes in blood)
46
Q

What are the 3 types of Jaundice?

A
  1. Pre-Hepatic
  2. Hepatic
  3. Post-Hepatic
47
Q

What is Pre-Hepatic Jaundice?

A

Excessive bilirubin production

(Liver can’t cope with excess)

48
Q

What are the Bilirubin lab findings for Pre-Hepatic Jaundice? (2 things)

A
  1. Unconjugated bilirubin
  2. Hyperbilirubinaemia
49
Q

What are the causes of Pre-Hepatic Jaundice? (3 things)

A
  1. Hb abnormalities
  2. Gilberts syndrome
  3. Infections / Drugs
50
Q

What is Hepatic Jaundice?

A

Reduced capacity to conjugate / excrete bilirubin

51
Q

What are the Bilirubin lab findings for Hepatic Jaundice? (2 things)

A
  1. Mixed unconjugated + conjugated bilirubin
  2. Hyperbilirubinaemia
52
Q

What are the causes of Hepatic Jaundice? (3 things)

A
  1. Gilberts syndrome
  2. ALCOHOL (Cirrhosis)
  3. Hepatic Tumours
53
Q

What is Post-Hepatic Jaundice?

A

Obstruction to biliary system

54
Q

What are the Bilirubin lab findings of Post-Hepatic Jaundice? (4 things)

A
  1. Conjugated bilirubin
  2. Hyperbilirubinaemia
  3. Bilirubin in urine (dark)
  4. None in faeces (pale) (supposed to be in faeces innit)
55
Q

What are the causes of Post-Hepatic Jaundice? (5 things)

A

Intra-Hepatic

  1. Cirrhosis
  2. Drugs

Extra-Hepatic

  1. Gall stones
  2. Biliary stricture
  3. Pancreatitis
56
Q

What are the causes of Portal Hypertensions? (2 things)

A
  1. Obstruction to Portal Vein:
    * Congenital / Thrombosis / Compression
  2. Obstruction to flow within liver:
    * Cirrhosis
57
Q

What does Portal Hypertension lead to? (3 things)

A
  1. Ascites
  2. Splenomegaly
  3. Vessel dilation / rupture / ulceration / haemorrhage
58
Q

How does Portal Hypertension lead to Ascites?

A

Fluid accum. in Peritoneal cavity → abd swelling

59
Q

How does Portal Hypertension cause Splenomegaly?

A

Bc increased BP in spleen

60
Q

How does Portal Hypertension cause Vessel dilation / rupture / ulceration / haemorrhage?

A

Increased BP → blood backs up through anastomoses

61
Q

What are the complications of Gall Stones? (2 things)

A
  1. Cholecystitis
  2. Ascending Cholangitis
62
Q

What is cholecystitis?

A

Inflammation of gall bladder

63
Q

What does cholecystitis lead to? (4 things)

A
  1. RUQ Pain + Fever
  2. Increased WBC
  3. Sepsis
  4. Gall bladder mass

RISG

64
Q

What is ascending cholangitis?

A

Inflammation / infection of CBD (common bile duct)

Bacteria ascend from CBD junction with duodenum

65
Q

What are the signs and symptoms of Ascending Cholangitis? (3 things)

A

Charcots Triad:

  1. RUQ Pain
  2. Jaundice
  3. Fever
66
Q

What are the causes of Pancreatitis? (10 things)

A

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
Q

What are the signs and symptoms of Acute Pancreatitis? (4 things)

A
  1. Haemorrhage / Oedema / Necrosis of Pancreas
  2. Pain / vomiting / dehydration
  3. High: AGA
  • Amylase
  • Gycaemia
  • ALP / Bilirubin ratio
  1. Low calcium
68
Q

What are the signs and symptoms of Chronic Pancreatitis? (4 things)

A
  1. Fibrosis / Calcification of Pancreas
  2. Malabsorption which causes:
  • Steatorrhoea
  • Low albumin
  • Weight loss
  1. Jaundice

GASTRO (10 decks)

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