Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Physiology > Exam 3 – Dr. Sullivant Hepatic Physiology > Flashcards

Exam 3 – Dr. Sullivant Hepatic Physiology Flashcards

1
Q

What is ascites?

A

Fluid accumulation in peritoneal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the different types of ascites?

A

Transudate
Modified transudate
Exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is icterus?

A

Elevated bilirubin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is cirrhosis?

A

Condition in which normal cells are replaced by scar tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is portal hypertension?

A

Hypertension in the portal vein and its branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is metabolism?

A

Sum of all anabolic and catabolic reactions as it related to use of all nutrients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the functions of the liver?

A 
Filtering and storage of blood
Metabolism of CHOs, proteins, and fats
Metabolism of hormones, drugs, and toxins
Formation of cholesterol and bile
Storages of vitamins and iron
Production of coagulation factors
Production of plasma proteins
Lymph formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the liver lobule?

A

Basic functional unit of the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where do most of the liver functions occur?

A

In the lobules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where does the liver make lymph?

A

In the sinusoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where does the major supply to the liver come from?

A

Portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do hepatocytes do?

A

Clean and detoxify blood to make sure it does not go into systemic circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens once everything that goes to the liver gets cleaned up?

A

It moves to the central vein where it is released to the jugular vein, the heart, and then goes through it all again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Look at liver anatomy

A

Look at liver anatomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the liver anatomy

A

Largest internal organ
2-5% total body weight
Receives 30% of cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How many lobes does the liver consist of? What are they?

A 
6
Right and left medial 
Right and left lateral
Quadrate
Caudate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are venous sinusoids lined by?

A

Endothelial cells with large pores to allow movement of plasma proteins
Large Kupffer cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are Kupffer cells?

A

Macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe Kupffer cells

A

Keeps less than 1% of GI bacteria from entering systemic circulation
Defense mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What percentage of lymph in the body is made in the liver?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do sinusoidal endothelial cells do in the lymph formation the liver?

A

Leak fluids and proteins into “space of Disse”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What happens if lymph leaks out into the body?

A

There is a protein concentration of 6g/dl (slightly less than plasma protein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does increased sinusoidal pressure cause?

A

Increase in lymph production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What happens if the liver is losing a lot of lymph?

A

Any disease of the liver can occur, especially chronic disease such as fibrosis and cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What happens once sinusoidal pressure rises enough?

A

The liver sweats lymph which leads to ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does the liver have a high capacitance for?

A

Lymph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What can lymph cause the liver volume to do?

A

Increase by 1 liter or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What can the liver perform for blood?

A

Vast storage

Extramedullary hematopoiesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is extramedullary hematopoiesis?

A

Making blood cells outside of the bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When can the liver make blood cells?

A

Cytokine stimulation

Hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the blood flow break down of the liver?

A

20% from hepatic artery

80% from portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the oxygen supply breakdown of the liver?

A

50% from hepatic artery

50% from portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What do portosystemic shunts do?

A

Shunting of blood from portal circulation to systemic circulation without passing through the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the types of portosystemic shunts?

A

Congenital

Acquired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does an extrahepatic shunt do?

A

Goes around the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What does an intrahepatic shunt do?

A

Go through the liver, but it is not the correct path

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What makes up the portal vein?

A

Spleen
Pancreas
GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Look at blood flow picture

A

Look at blood flow picture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are congenital shunts?

A

Intrahepatic or extrahepatic anomalous vessels that does not allow the blood to take a normal course through the liver

40
Q

What is an examples of a congenital shunt?

A

Portocaval shunt: portal vein empties directly into caudal vena cava

41
Q

What are consequences of congenital shunts?

A

Impaired liver development
Liver dysfunction
Liver failure
End stage cirrhosis without repair

42
Q

What does impaired liver development cause?

A

Stunted growth

43
Q

What does liver dysfunction cause?

A

Build up of toxins, especially ammonia

Poor ability to metabolize anesthetics/sedatives

44
Q

What is the pressure in portal vein?

A

9 mmHg

45
Q

What is the pressure in the hepatic vein leading to the vena cava?

A

0 mmHg

46
Q

Why is the 0 mmHg pressure in the hepatic vein good?

A

It is the perfect low pressure gradient to get blood from the intestines and spleen, throughout the liver, into vena cava and back into the right atrium

47
Q

What can ascites do?

A

It can leak from the portal vessels or from the liver tissue itself

48
Q

What are causes of portal hypertension?

A

Cirrhosis
Severe infection
Chronic biliary tract obstructions
Portal vein thrombosis

49
Q

What are the consequences of portal hypertension?

A

Gastrointestinal edema/ulceration
Severe GI signs and protein loss
Ascites
Acquired portosystemic shunts

50
Q

What does cirrhosis cause?

A

Fibrous tissue to contract around blood vessels

51
Q

Describe acquired shunts

A

Multiple tortuous vessels outside of the liver develop due to high pressure in the liver (acts as a relief valve for portal vasculature)
All throughout abdomen
Often near the kidney
Worsens liver function

52
Q

What are causes of congestion?

A

Right sided congestive heart failure
Heartworm disease
Congenital diseases
Cor pulmonale

53
Q

What are the consequences of congestion?

A

Gastrointestinal edema/ulceration
Severe GI signs and protein loss
Ascites

54
Q

How can ascites happen in liver disease?

A

Obstruction of lymph flow/congestion (right sided heart failure)
Portal hypertension (increases resistance to blood flow through the liver)
Increased sinusoidal pressure in the liver
Hypoalbuminemia

55
Q

How is the liver forgiving?

A

There are insults and then there is a repair process
Great ability to repair and regenerate
Transforming growth factor B can stop liver cell proliferation

56
Q

When the liver does not repair, what happens?

A

Insults turn into fibrosis which turns into cirrhosis

57
Q

What does the liver store?

A

Vitamins (A, D, B12)

Iron

58
Q

What is iron stored as?

A

Ferritin in hepatic cells by combining with the protein “apoferritin”
It is released from storage in times of need

59
Q

What is the livers role in coagulation?

A

Makes most of proteins needed in the process–fibrinogen, prothrombin, and clotting factors 2, 7,9, and 10

60
Q

Describe clotting factors 2, 7, 9, and 10

A

Vitamin K dependent

The liver activates vitamin K so that it can be used to make these factors

61
Q

What is the role of the liver in drug, hormone, and toxin metabolism?

A 
Detoxify/activate antibiotics
Excrete antibiotics into bile
Chemical alteration of hormones
Excrete hormones
Calcium excretion
62
Q

What is bilirubin?

A

Greenish, yellow pigment that is the major end product of hemoglobin degradation

63
Q

Where does bilirubin come from?

A

Old, sick, and tired RBCs that get phagocytosed by macrophages
Hgb is split into globin and heme which releases free iron and a substrate from which bilirubin will be formed

64
Q

What is biliverdin?

A

Free bilirubin released from macrophages into circulation

65
Q

What is the formation of bilirubin?

A

Senescent RBCs have Hgb which splits into iron and biliverdin by heme oxygenase. Biliverdin becomes bilirubin by biliverdin reductase

66
Q

What does free bilirubin do?

A

Joins albumin and is transported throughout the body

67
Q

What happens when the bilirubin/albumin combo reaches the liver?

A

They are absorbed through the hepatocyte membrane

68
Q

What happens to bilirubin inside the hepatocyte?

A

Conjugation with glucuronide, sulfate, and others (conjugated bilirubin)
It is excreted into bile canaliculi and then into intestines

69
Q

What is the fate of bilirubin?

A

Converted via bacteria to urobilinogen

70
Q

What happens to urobilinogen?

A

It is reabsorbed through intestinal mucosa back into blood
Most goes back to liver for re-excretion into gut and is oxidized to stercobilin
5% is excreted by kidneys and is oxidized to the urobilin

71
Q

Where is stercobilin excreted?

A

Feces

72
Q

Where is urobilin excreted?

A

Urine

73
Q

Look at bilirubin metabolism

A

Look at bilirubin metabolism

74
Q

What is increased bilirubin known as?

A

Hyperbilirubinemia, icertus, or jaundice

75
Q

What is the yellowish tint to body tissues due to?

A

Excessive build up of conjugated or unconjugated bilirubin

76
Q

What is the normal range of bilirubin? What is the range of bilirubin with jaundice?

A

0.2-0.6 mg/dl

2 mg/dl

77
Q

What occurs with hyperbilirubinemia?

A

Bilirubinuria, which is often the first sign of liver disease

78
Q

What can cause hyperbilirubinemia?

A

Hemolytic anemia
Liver failure/dysfunction
Obstruction of biliary tracts in the lover
Obstruction of posthepatic biliary system

79
Q

What happens with liver failure/dysfuction?

A

Bilirubin is not processed/conjugated properly by sick liver cells

80
Q

What happens with obstruction of biliary tracts in the liver?

A

Bilirubin can’t get out of the liver due to obstructed bile flow

81
Q

Where does obstruction of postheptaic biliary system?

A

Gallbladder
Common bile duct
Pancreas

82
Q

Describe hepatic metabolism

A

High rate of metabolism
Shares substrates with other organs
Processing and transportation to other organs

83
Q

What are manifestations of liver disease?

A 
Decreased albumin
Decreased glucose
Increased bilirubin
Decreased protein metabolism 
Increases ammonia
84
Q

What does decreased albumin cause?

A

Decreased colloidal osmotic pressure which leads to effusions and edema

85
Q

What does decreased protein metabolism cause?

A

Decreased urea

86
Q

What does increased ammonia cause?

A

Hepatic encephalopathy

87
Q

What are coagulopathies involved in the manifestations of liver disease?

A 
Increased prothrombin time
Increased partial thromboplastin
Platelet dysfunction
Decreased fibrinolysis
Excessive fibrinolysis
88
Q

What is alanine aminotransferase (ALT)?

A

Leakage enzyme made inside hepatocytes

Indicators of hepatic injury

89
Q

What is aspartate aminotransferase (AST)

A

Leakage enzyme made inside hepatocytes mitochondria

Indicators of hepatic injury

90
Q

What is alkaline phosphorase (ALP)?

A

Induced enzyme made in lining of bile caniliculi

Elevated with cholestasis

91
Q

What is gamma glutamyltranspeptidase (GGT)?

A

Induced enzymes made in lining of bile caniliculi
Excellent marker for hepatobiliary disease especially biliary tract disease
Elevated with cholestasis

92
Q

What do you look for on bloodwork?

A 
Increased bilirubin
Decreased albumin 
Decreased cholesterol
Decreased glucose
Decreased BUN
Increased ALT/AST
Increased ALP/GGT
93
Q

What can be done to test liver function?

A

Bile acid assay

Ammonia tolerance test

94
Q

What are the pros of bile acid assay?

A

Can do in practice

95
Q

What are the cons of bile acid assay?

A

Have to feed patient

Cannot rely on results if bilirubin is elevated

96
Q

What are the pros of ammonia tolerance test?

A

Can do if bilirubin is elevated

97
Q

What are the cons of ammonia tolerance test?

A

Not able to do in practice

Can cause hepatic encephalopathy/coma

Physiology (70 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions