Biliary Secretion: Hepatobiliary Function Flashcards
T/F: Liver failure can result in hypoalbuminemia which may lead to edema
True
The following are clinical manifestations that can result from cirrhosis. Which of them is due to lack of urea processing?
A. Acites
B. Portal Hypertension
C. Bruising
D. Hepatic Encephalopathy
Hepatic Encephalopathy
The following are clinical manifestations that can result from cirrhosis. Which of them is due to lack of albumin and decreased oncotic pressure?
A. Acites
B. Portal Hypertension
C. Bruising
D. Hepatic Encephalopathy
Acites
The following are clinical manifestations that can result from cirrhosis. Which of them is due to lack of coagulation factors?
A. Acites
B. Portal Hypertension
C. Bruising
D. Hepatic Encephalopathy
Bruising
The following are clinical manifestations that can result from cirrhosis. Which of them is due to a fibrotic liver? This one can also cause caput medusae and esophageal varices.
A. Acites
B. Portal Hypertension
C. Bruising
D. Hepatic Encephalopathy
Portal Hypertension
What is the name of the chronic liver disease where normal cells are damaged and replaced by scar tissue?
What is the most common cause of this disease?
Cirrhosis
Excessive alcohol consumption
Which of the following most likely results due to excessive alcohol consumption and eventually leads to steatohepatitis? Bonus: What is Steatohepatits?
A. Accumulation of unconjugated bilirubin
B. Accumulation of fat in hepatocytes
C. Accumulation of urea in systemic circulation
D. None of the above
Accumulation of fat in hepatocytes
Steatohepatitis is a fatty liver accompanied by inflammation that leads to scarring and cirrhosis
Cirrhosis can cause portal hypertension because hypertension develops when there is resistance to portal blood flow. Associated with Portal Hypertension are changes to venous circulation that can lead to what 2 things?
Describe them both with extra emphasis on location
Esophageal Varices: the inferior end of the esophagus is a swollen connection between systemic and portal systems
Caput Medusae: around the umbilicus is a swollen connection between systemic and portal systems
Which of the following decreases hepatic urea cycle metabolism, and leads to the accumulation of ammonia in the systemic circulation as seen in Hepatic Encephalopathy?
A. Cirrhosis only
B. Portosystemic Shunting only
C. Both Portosystemic shunting and Cirrhosis
D. None of the above
Both Portosystemic shunting and Cirrhosis
Which of the following is the second most abundant in the composition of bile acids?
A. Bile Salt
B. Bile pigment (e.g. bilirubin)
C. Cholesterol
D. Phospholipid (e.g. lecithin)
Phospholipid (eg, lecithin)
T/F: The function of bile is it’s a vehicle for the elimination of substances from the body and it solves the insolubility problem of lipids
True
Which of the following accurately represents the relative amount of the four bile acids found in the body from greatest to least?
A. Cholic acid> Deoxycholic acid > Chenodeoxycholic acid > lithocholic acid
B. Lithocholic acid > deoxycholic acid > chenodeoxycholic acid > cholic acid
C. Cholic acid > Chenodeoxycholic acid > Deoxycholic acid > Lithocholic acid
D. Chenodeoxycholic acid > cholic acid : lithocholic acid > deoxycholic acid
Cholic acid > Chenodeoxycholic acid > Deoxycholic acid > Lithocholic acid
Which of the following is the location of most secondary bile acids?
A. Hepatocytes
B. Small Intestine
C. Liver
D. Kidney
Small Intestine
Which of the following is the location of conjugation of bile acids to bile salts
A. Hepatocytes
B. Small Intestine
C. Liver
D. Kidney
Liver or Hepatocytes is correct
Which of the following is the location for the emulsification and digestion of fats?
A. Liver
B. Gallbladder
C. Deuodenum
D. Ileum
E. Jejunum
Deuodenum
Which of the following is the location for the active absorption of bile acids?
A. Liver
B. Gallbladder
C. Deuodenum
D. Ileum
E. Jejunum
Ileum
Which of the following is the location for micelle formation and fat absorption?
A. Liver
B. Gallbladder
C. Deuodenum
D. Ileum
E. Jejunum
Jejunum
What substance is secreted when chyme reaches the small intestines to both stimulate the contraction of the gallbladder and relax the Sphincter of Oddi?
A. Gastrin
B. CCK
C. Secretin
D. Somatostatin
CCK
Once in the the bile canaliculi, the bile is secreted by ductal cells in response to what?
A. Osmotic effects of cation transport
B. Osmotic effects of anion transport
C. Combines effects of secretin and CCK
D. Effects of secretin only
Osmotic effects of anion transport
Bile secretion occurs via 2 mechanisms. What are those two mechanisms? Indicate which one is true for almost all bile secretion?
1. Bile acid dependent
- most common
2. Bile acid-independent or ductular secretion: via Secretin
What substance stimulates the secretion of HCO3 and H2O frin the ductile cells that causes an increase in bile volume, [HCO3], and thus pH? Bonus: what happens to the concentration of bile salts?
A. Gastrin
B. CCK
C. Secretin
D. Somatostatin
Secretin
bile salt concentration decreases
T/F: Secretion of bile acids is accompanied by the passive movement of cations into the canaliculi, which makes them more positive
True
T/F: Canalicular bile is a primarily an ultrafiltrate of plasma
True
Which of the following accuretly describes what occurs during the interdigestive period?
A. Gallbladder is contracting
B. Sphincter of Oddi is closed
C. CCK is released
D. All of the above
Sphincter of Oddi is closed
Interdigestive period:
- relaxed gallbladder and closed sphincter of Oddi to allow bile to fill gallbladder
Upon eating
CCK is released and gallbladder contracts, and sphincter opens to let bile flow out and help with digestion and absorption
Bile salts are recirculated to the liver via the Enterohepatic circulation. To get there, bile salts are first transported from the ileum into portal blood via what transport mechanism?
A. Na+-Taurocholate Co-transport Polypeptide (NTCP)
B. Organic Anion Transport protein (OATP)
C. Na+-bile salt co-transporter
D. A and B
Na+-bile salt co-transporter
Bile salts are recirculated to the liver via the Enterohepatic circulation. To get across the hepatocytes basolateral membrane and into the liver what sodium dependent tranporter is used?
A. Na+-Taurocholate Co-transport Polypeptide (NTCP)
B. Organic Anion Transport protein (OATP)
C. Na+-bile salt co-transporter
D. ASBT
E. BSEP and MRP2
Na+-Taurocholate Co-transport Polypeptide (NTCP)
Bile salts are recirculated to the liver via the Enterohepatic circulation. To get across the hepatocytes basolateral membrane and into the liver what sodium independent tranporter is used?
A. Na+-Taurocholate Co-transport Polypeptide (NTCP)
B. Organic Anion Transport protein (OATP)
C. Na+-bile salt co-transporter
D. ASBT
E. BSEP and MRP2
Organic Anion Transport protein (OATP)
Which of the following transports are used to recollect excreted bile acid and and take it back up into the enterocyte?
A. Na+-Taurocholate Co-transport Polypeptide (NTCP)
B. Organic Anion Transport protein (OATP)
C. Na+-bile salt co-transporter
D. ASBT
E. BSEP and MRP2
D. ASBT
Apical Sodium Dependent Bile Acid Transport
- no sodium would cause trouble
After the bile acid is taken into the hepatocyte by ASBT transport, how is it then released back into portal circulation?
A. Na+-Taurocholate Co-transport Polypeptide (NTCP)
B. Organic Anion Transport protein (OATP)
C. Organic Solute Transporter Alpha and Beta (OSTa-OSTB)
D. ASBT
E. BSEP and MRP2
Organic Solute Transporter Alpha and Beta (OSTa-OSTB)
Which of the following transporters are found in the hepatocyte along the bile canaliculi and allow bile acid to be secreted out?
After the bile acid is taken into the hepatocyte by ASBT transport, how is it then released back into portal circulation?
A. Na+-Taurocholate Co-transport Polypeptide (NTCP)
B. Organic Anion Transport protein (OATP)
C. Organic Solute Transporter Alpha and Beta (OSTa-OSTB)
D. ASBT
E. BSEP and MRP2
BSEP and MRP2
- Bile Salt Excretory Pump*
- Multidrug Resistant Protein 2*
Under normal conditions, increased bile secretion increases the rate of return of bile acids to the liver. This return normally exerts a negative feedback control on synthesis specically inhibiting what major bile acid synthesis enzyme?
7alpha-hydroxylase
NOTE: Interuption of the enterohepatic circulation can cause a 10-fold increase in bile synthesis
Look at this
Cool
What two substances are responsible for gibing stool its dark color?
Urobilin and Stercobilin
Why is it that an ileal resection leads to decreased bile secretion?
We see less recycling of bile and more excretion of it. Excessive fecal loss of bile decreases the total pool of bile salt so even though bile synthesis is strongly stimulated, it cannot keep pace with the loss.
What enzyme is responsible for converting unconjugated bilirubin to conjugated bilirubin?
UDP glucoronyl Transferase
UDP GT
Which of the following decreases the amount of gastric secretion?
A. Gastrin
B. PNS stimulation
C. Chyme in the duodenum
D. Histamine
Chyme in the duodenum
Select all of the following syndromes where jaundice is seen due to amounts of unconjugated bilirubin and NOT conjugated bilirubin instead.
A. Gilbert’s Syndrome
B. Crigler-Najjar syndrome
C. Dubin Johnson syndrome
D. Rotor’s syndrome
E. Biliary tree obstruction
A. Gilbert’s Syndrome
B. Crigler-Najjar syndrome
NOTE: The rest are related to conjugated jaundice
Why does hemolytic anemia lead to increase in amount of unconjugated bilirubin?
Destruction of RBCs causes increased bilirubin production, and the demand can put the livers ability to conjugate bilirubin at capacity, resulting in an increase of unconjugated bilirubin
What are the 2 main causes of physiological neonatal jaundice, which is due to increased unconjugated bilirubin in the blood?
- Increased breakdown of fetal erythrocytes
- Low UDP Glucuronyl Transferase activity
Which of the following is associted with the development of Kernicterus, which is a form of brain famage caused by accumulation of unconjugated bilirubin in the brain?
A. Crigler-Najjar Type I
B. Crigler-Najjar Type II
C. Gilbert’s Syndrome
D. Dubin-Johnson syndrome
Crigler-Najjar Type I
Which of the following is true about Kernicterus?
A. Clinical features include cerebral palsy, sensorineural hearling loss, and gaze abnormalities
B. DEvelops during the 1st year postnatal
C. Associated with Type I Crigler-Najjar
D. All of the above are correct
All of the above are correct
T/F: Patients with Crigler-Najjar require phototherapy throughout their life and often it does not work well after age 4 due to thickened skin blocking the light
True
Look at this summary
Cool
What are 4 potential causes of Gallstones (Cholelithiasis)?
- too much water absorption from bile
- too much absorption of bile acids from bile
- too much cholesterol in bile
- inflammation of the epithelium
Look at this
Dope
T/F: Hypoalbuminemia is not specific for liver disease, but l=albumin levels do fall as the synthesis function of the liver declines
True
Prothrombin Time (PT) reflects the degree of hepatic synthetic dysfunction. Which of the following scenarios would cause PT to increase?
A. Ability of the cirrhotic liver to synthesize clotting factor increases
B. Ability of the cirrhotic liver to synthesize clotting factor decreases
Ability of the cirrhotic liver to synthesize clotting factor decreases
Which of the following is the primary result of hepatocyte injury?
A. Reduced aminotransferases
B. Elevated aminotransferases
C. Reduced alkaline phosphatase
D. Elevated alkaline phosphatase
Elevated aminotransferases
Which of the following is the primary result of bile duct injury?
A. Reduced aminotransferases
B. Elevated aminotransferases
C. Reduced alkaline phosphatase
D. Elevated alkaline phosphatase
Elevated alkaline phosphatase
