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Anaesthetic FRCA Primary - Teaching Days > AWABS - Liver Physiology > Flashcards

AWABS - Liver Physiology Flashcards

1
Q

Liver anatomy

A

1.5-2 kg
Right and Left lobes divided by falciform ligament

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2
Q

Blood flow received by liver

A

25% of cardiac output
1.5 L blood flow per minute

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3
Q

Blood supply of liver

A

25% Hepatic artery (oxygen rich)
75% Hepatic portal vein (nutrient rich)

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4
Q

Splanchnic circulation

A
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5
Q

Functional divisions of liver

A
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6
Q

Factors which increase hepatic blood flow

A

Supine position
Ingestion of food
Hypercapnia
Acute hepatitis
P450 enzyme inducers

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7
Q

Factors which reduce hepatic blood flow

A

Upright position
PEEP / IPPV (reduced venous return)
Cirrhosis
Hypocarbia

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8
Q

Functional units of the liver

A

Hepatic lobules
Hexagonal
Arranged around central vein which connects to hepatic veins
Cords of hepatocytes radiate out
At each corner is the portal triad

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9
Q

Sinusoids

A
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10
Q

Metabolic units of liver

A
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11
Q

Functions of the liver

A

Synthesis
Metabolism
Storage
Catabolism and excretion
Immunological / Haematological
Reservoir

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12
Q

Substances synthesised by liver

A

Proteins
Fats
Bile

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13
Q

Substances metabolised by the liver

A

Glucose homeostasis and other absorbed nutrients

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14
Q

Substances stored by liver

A

Glycogen
Vitamins
Iron
Copper

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15
Q

Substances catabolised / excreted by liver

A

Drugs
Urea
Bilirubin

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16
Q

Reservoir function of liver

A

450+ mls of blood

17
Q

Albumin synthesis rate by liver

A

200 mg/kg/day

18
Q

Some examples of proteins synthesised by liver

A

Albumin
Clotting factors (all except factor 8 produced in liver)
Acute phase proteins inc CRP

19
Q

Drug handling by liver

A

All substances absorbed in gut pass through liver via portal vein into the systemic circulation (1st pass)

Many also re-presented from systemic circulation (2nd pass)

Once drugs reach hepatocyte they are metabolised by SER

20
Q

Phase 1 reactions

A

Alteration if molecular structure
Involves oxidation or reduction
Resulting compounds are more polar or water soluble
Cytochrome P450 are main players in phase 1 metabolism

21
Q

What happens to metabolites after phase 1 reactions occur

A

After phase 1 the compound is either:
- Sufficiently water soluble and excreted
- Able to go into phase 2 metabolism
- Toxic and require further metabolism
- Bioactivated

22
Q

Phase 2 reactions

A

Attachment of ionised groups to the drug

23
Q

Methods of alterations in phase 1 and 2 reactions

A

Anaesthetic FRCA Primary - Teaching Days (64 decks)

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