Clinical Aspects, Gallbladder, Liver Flashcards
What are the two general causes of peptic ulcers?
insufficient protection from HCl and pepsin, helicobacter pylori
How could there be insufficient protection from HCl?
damaged mucous coat
too much HCl and pepsin
How long does it take for lumen to repair after damage?
1-2 months if the luminal activity is decreased
What are some examples of factors that delay healing of a peptic ulcer?
cigarette smoking, alcochol, caffiene, calcium, aspirin
What can aggravate an ulcer, but not cause it?
stress and spicy foods
What is the cause of gastroesophageal reflux?
stomach chyme backing up into the lower esophagus
What are some possible contributing factors to reflux?
chronic gastritis (inflammation of stomach lining) hiatal hernia pregnancy incompetent lower esophageal sphincter subluxations
What are some ways to reduce reflux?
keep a food diary of food, spices and drinks consumed along with reflux episodes
limit how much is eaten at one time
do not eat less than 3 hours before bed
What are some problem foods for reflux?
spices (pepper, garlic, onion, peppermint, cinnamon)
acidic foods (citrus, tomatoes)
acidic beverages (fruit juices, carbonated drinks, coffee, tea)
fatty foods
alcohol
What is Barrett’s Esophagus?
stratified squamous epithelium is replaced by mucus-secreting simple columnar epithelium in lower (proximal) esophagus. This is metaplasia due to a chronic problem.
Where is the gallbladder located?
inferior to the liver
What is the function of the gallbladder?
store bile (can hold ~70mL) concentrate bile
What is Hepatic Bile?
primary bile from the liver
What is Cystic Bile?
concentrated bile from gallbladder
What is bile release controlled by?
CCK and vagus nerve
What is the surface epithelium
simple columnar
What are some cell types within the surface epithelium of the gallbladder?
clear cells (cholangiocytes) few brush cells
What is the function of the clear cells? What do they have a lot of?
concentrate bile by absorbing water
many microvilli
What is the function of brush cells?
produce mucinogen
What is the lamina propria made of?
loose and very vascular CT
What does the neck of the lamina propria contain?
small mucous glands
What is the function of the lamina propria?
lubricate the narrow neck lumen
What is the muscularis musoca made of in the gallbladder?
nothing! it’s absent!
What is so significant about the submucosa of the gallbladder?
it’s absent!!
What is special about the muscularis externa?
it doesn’t have a normal patterns. it consists of a thin smooth muscle layer with a disorganized muscle arrangement
Does the gallbladder have serosa or adventita?
mostly serosa, but some adventitia where it attaches to the liver
What is the pancreas surrounded by?
a thin CT capsule
What creates lobules of the pancreas?
septa, they dive into the organ to create them
What is the endocrine pancreas?
Islets of langerhans (pancreatic islets) producing hormones
What is the exocrine pancreas?
serous acini producing digestive enzymes
What is the largest portion of the pancreas?
exocrine portion
What controls the secretion of the serous (pancreatic) acini?
CCK and acetylcholine from parasympathetic nerves
What do the pancreatic ducts secrete?
water and HCO3
What is the secretion of the pancreatic duct controlled by?
secretin and acetylcholine from parasympathetic nerves
What are some characteristics of pancreatic ducts?
centroacinar cells, centroacinar cells, collagen-rich CT wraps pancreatic ducts
Where are centroacinar cells of the pancreas located?
next to acinar cells
What do centroacinar cells of the pancreas do?
produce alkaline fluid with large quantities of bicarbonate ions which are released into the duodenum to buffer stomach chyme
What is the function of collagen rich CT of the pancreas?
provide extra protection from the possible leading of digestive enzymes
What else produces alkaline fluid in the pancreas?
cuboid cells
What is the largest gland in the body?
liver, has endocrine and exocrine functions
What are the general functions of the liver?
metabolism of lipids, carbs and proteins
production of blood proeins, factors and non-essential vitamins
detoxify blood
produce hepatic bile primarily (exocrine function)
store certain vitamins (A and B12)
What is the classic liver lobule?
hexagonal-shaped lobules are difficult to distinguish in humans due to the lack of CT between the lobules
What kind of cells are hepatocytes?
microvillated cuboidal cells possessing lateral bile canaliculi between adjecent hepatocytes
What is the function of the hepatocytes?
most general functions
What do the bile canaliculi collect?
bile
How does bile flow through a liver lobule?
bile moves from the hepatocytes toward the bile duct branch in the portal triad
What is the arrangement of hepatocytes in the liver?
in rows between hepatic sinusoids like spokes of a wheel
What are Kupffer cells?
stellate macrophages, resident macrophages that develop from monocytes
What is the function of Kupffer cells?
phagocytosis of debris and aged RBCs, act as an antigen presenting cell
What are Ito cells?
hepatic stellate cells
What is the function of Ito cells?
store lipids for immediate use, store vitamin A, produce collagen I, III, IV and growth factors
What are pit cells?
natural killer cells?
What are hepatic progenitor cells?
likely present and responsible for regenerative capabilities
What is the portal triad?
hepatic artery, portal vein, bile duct, (lymph vessels)
What are hepatic sinusoids?
dilated, fenestrated thin walled vessels found between the rows of hepatocytes; carry a mixture of venous and arterial blood
What is the ratio of venous to arterial blood in the hepatic sinusoids?
venous- 75%
arterial- 25%
What is the central vein?
fenestrated thin walled vessel that collects blood from hepatic sinusoids
What is the direction of blood flow within a liver lobule?
blood flows from the portal triad toward the central vein
What is the space of Disse (perisinusoidal space)?
space between hepatocytes and fenestrated hepatic sinusoids where blood can directly contact the microvilliated surfaces of the hepatocytes
Why is the blood flow slow in the perisinusoidal space?
so the cells can interact with the blood and its contents, this is why the liver can take over the job of the spleen in 24-48 hours
What is Glisson’s capsule?
dense irregular CT covered with serosa
What occurs after a splenectomy?
liver takes over blood filtration in 24-48 hours
