DLA 12; lecture 17+18

Question 1

porta hepatis of the liver?

Answer 1

contains the hepatic A, portal vein, and hepatic ducts

Question 2

what does a classic hepatic lobule look like histologically

Answer 2

has a central portal vein

shape of a hexagon; all points of the hexagon are portal areas

hepatocytes:
have at least one centrally located nucleus
foamy cytoplasm

Question 3

hepatocyte surfaces of the classic lobule?

Answer 3

1. adjacent
   form small, tunnel like canaliculi
   used for movement of bile
2. basal surface
   adjacent to the sinusoids
   has contact with space of disse

Question 4

Kupffer cell

Answer 4

found in the liver
derived from monocytes

phagocytic cells; immune function

Question 5

peri-sinusoidal space of disse

Answer 5

functions to exchange material between the blood and the hepatocytes

have Ito cells:
used for fat storage and vitamin A storage
modified pericytes

Question 6

functional lobule of liver

Answer 6

triangular region

have three points which are the portal veins

portal area in the middle of triangle

Question 7

bile canaliculi and canals of herring

Answer 7

BC receive bile from the liver and convey that bile to the canals of herring

COH are surrounded by cholangiocytes (these sense changes in bile flow)

Question 8

Liver acinus of rappaport

Answer 8

a functional lobulation based on blood flow

divided into 3 zones:

zone 1:
first to be exposed by blood

zone 3:
last to be exposed to blood
first to be ischemic

Question 9

CHF and liver

Answer 9

Zone 3 of the acinus is the first to be impacted by this condition due to decreased blood output which deprives this area of the liver of oxygen

Question 10

fatty liver disease

Answer 10

associated with chronic alcohol intake and metabolic syndrome

increased lipid droplets, thus hepatomegaly

reversible!

Question 11

liver cirrhosis

Answer 11

diffuse liver damage

have collagen deposition due to ito cells
blood restriction
have nodular appearance

not reversible

Question 12

gallbladder constriction?

Answer 12

facilitated by CCK

Question 13

histology of gallbladder

Answer 13

simple columnar epithelium

have false lumens
mucosal folds

have sinuses of Rokitansky Aschoff:
invaginations of the mucosa into the deeper layers

Question 14

regulation of pancreatic secretion

Answer 14

CCK:
induces the acinar cells to release proenzymes

secretin:
induces the intercalated ducts to secrete large amounts of alkaline fluid; neutralize chyme

sympathetics: regulate blood flow
parasympathetics: stimulate activity of acinar cells and centroacinar cells

Question 15

Acute pancreatitis

Answer 15

inflammation of the pancreas

most likely due to gallstones or alcohol abuse

can have a gallstone blockage in the pancreatic duct which could lead to this inflammation

Question 16

cystic fibrosis and the pancreas

Answer 16

can lead to obstructions in the pancreatic duct due to thickness

also malabsorption

Question 17

hormone sensitive lipase

Answer 17

fatty acids in TAG’s are released as free fatty acids by this enzyme

inhibited by insulin

low levels and insulin and epinephrine stimulate this enzyme

Question 18

role of epinephrine and breaking down TAGs

Answer 18

activates PKA

PKA is going to phosphorylate HS lipase

stimulates hydrolysis of the TAG into glycerol and FFA

Question 19

tissues that use FFA’s?

Answer 19

liver and muscle (skeletal and cardiac)

brain and RBC’s DO NOT use FFA’s

Question 20

activation of the Fatty acid?

Answer 20

the fatty acid is converted into fatty acyl CoA by fatty acid CoA synthetase (thiokinase)

needs two high energy bonds

Question 21

transport of the fatty acid into the mito?

Answer 21

CPT-1 will take acyl CoA and carnitine and form acyl carnitine (move acyl group)

translocase will then take acyl carnitine and move it into the inner membrane space

CPT-II will remove the acyl group from the carnitine and produce acyl CoA again

carnitine will go back to the intermembrane space

Question 22

reactions of beta oxidation

Answer 22

1. oxidation (need FAD)
2. addition of water
3. oxidation (need NAD)
4. cleavage

two C’s at a time
Acetyl CoA is produced for the TCA cycle

Question 23

Acyl CoA dehydrogenase

Answer 23

Needs FAD

converts fatty acyl CoA to enoyl CoA

Question 24

LCAD, MCAD, SCAD?

Answer 24

LCAD:
long chain acyl Co-A
used for 16-C chains

MCAD:
medium chain acyl CoA
used for 10-C chains

SCAD:
short chain acyl CoA
used for 6-C chains

Question 25

systemic fatty acid oxidation disorders

Answer 25

MCAD deficiency
carnitine deficiency
CPT-1 deficiency

have hypoglycemia (no gluconeogenesis) 
hypoketosis 

BC LESS acetyl coA

Question 26

myopathic fatty acid oxidation disorders

Answer 26

muscles

cramps during low intensity exercise 
high blood lactate 
elevated Ck-MM's 
lipid droplets in muscle 
myoglobinuria

Question 27

MCAD deficiency

Answer 27

hypoglycemia after fasting or after illness

low glucose
Fatty acids are elevated
ketone bodies are low

autosomal recessive
be found between 6-24 months old

medium chain acyl carnitines in urine
dicarboxylic acids in urine

Question 28

Carnitine deficiency

Answer 28

systemic:
early age of presentation
hypoglycemia
hypoketosis

myopathic:
muscle weakness and cardiomyopathy
elevated CK-MM
lipid droplets in muscle

Question 29

CPT-I deficiency

Answer 29

hypoglycemia and hypoketosis

affects liver isoform

Question 30

CPT-II deficiency

Answer 30

cardiomyopathy and muscle weakness 
lipid deposits 
myoglobinuria
high CK-MM 
affects muscle isoform

Question 31

Jamaican vomiting sickness

Answer 31

eating unripe ackee fruit

contains hypoglycin A which inhibits MCAD

thus hypoglycemia due to less gluconeogenesis and lack of beta oxidation
vomiting

medium chain acyl carnitines found in urine

Question 32

oxidation of odd chain fatty acids

Answer 32

propionyl CoA is converted to methylmalonyl CoA
by propionyl CoA carboxylase (needs biotin)

methylmalonyl CoA is converted to succinyl CoA
by Methylmalonyl CoA mutase (need B12)

can enter TCA cycle