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Physio II > Exam 4- Pancreas, Liver, Gallbladder > Flashcards

Exam 4- Pancreas, Liver, Gallbladder Flashcards

1
Q

Is the pancreas more of an exocrine or endocrine organ?

A

Exocrine (90%)

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2
Q

How is the exocrine pancreas organized?

A

Organized like salivary ducts, secretions from acinar and duct cells

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3
Q

What are the 2 major functions of pancreatic juice?

A

Neutralize acids from stomach (via bicarb) and provide enzymes for digestion of food

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4
Q

What 3 enzymes are secreted from the pancreas?

A

Amylase, lipase, protease

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5
Q

What is the optimal pH for most intestinal enzymes?

A

7

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6
Q

What type of cells secrete the enzymatic component of pancreatic juice?

A

Acinar cells

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7
Q

What 2 types of cells secret the aqeous fraction of pancreative juice via ATP?

A

Ductal cells and centriacinar cells

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8
Q

What cells remove Cl and add HCO3 to pancreatic juice?

A

Ductal cells

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9
Q

What is the relationship between the composition of pancreatic juice and the pancreatic flow rate?

A

As flow rate increases, concentration of HCO3- increases at the expense of Cl- (Na+ and K+ similar to plasma)

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10
Q

Does the cephalic or gastric phase have a greater effect on enzyme secretion?

A

Gastric (only 20% of enzymes secreted during cephalic phase)

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11
Q

What stimulates the pancrease during the cephalic phase?

A

PNS → ACh → ductal cells

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12
Q

What mediates pancreatic stimulation in the gastric phase?

A

Gastric distention and gastrin

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13
Q

The cephalic phase contributes what percentage of aqueous secretion during pancreatic stimulation?

A

10-15% of max

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14
Q

What is the most important phase of pancreatic stimulation as it controls 80% of the pancreatic secretion?

A

Intestinal phase

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15
Q

During the gastric phase, is pancreatic stimulation under nueronal or hormonal control?

A

Hormonal (CCK, secretin)

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16
Q

H+ in the duodenum stimulates what in the intestinal phase of pancreatic stimulation?

A

S cells- Secretin

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17
Q

Fat and peptides in the duodenal chyme stimulate what in the intestinal phase of pancreatic stimulation?

A

I cells- CCK

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18
Q

CCK travel to the pancrease via cirulatory system to stimulate what?

A

Acinar cells → increased enzyme secretion (smaller effect on aqueous secretion)

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19
Q

Stimulation of the ductal cells by H+ results in increased production of what?

A

Aqeuous component of pancreatic juice

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20
Q

What is “nature’s antacid”?

A

Secretin (only mildly stimulates enzyme secretion)

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21
Q

What enhances (“potentiates”) the secretion of CCK leading to increased enzyme production/ secretion?

A

Vagus nerve stimulation/ ACh

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22
Q

What enhances (“potentiates”) the secretion of Secretin leading to increased production/ secretion of aqueous secretion?

A

ACh and CCK

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23
Q

What organ is responsible for regulation of vascular volume, digestion/absorption of fats/ cholesterol, detoxification, synthesis of plasma proteins?

A

Liver

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24
Q

Once bile is secreted into the small intestine from the gallbladder, it aids in what? (3)

A

Fat emulsification/ digestion, transport/ elimination of cholesterol, fat absorption

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25
Q

Liver receives blood from what 2 sources?

A

Hepatic portal system and hepatic artery

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26
Q

What drains blood from the stomach, spleen, intestines and pancreas and carries absorbed food molecules to the liver for processing?

A

Heaptic portal system: portal vein (70% of liver’s blood) → hepatic vein → IVC

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27
Q

What supplies liver with oxygenated blood?

A

Hepatic artery (30% liver’s blood supply)

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28
Q

What is the fundamental unit of the liver and what are its 2 components?

A

Lobules; CV (central vein) and PS (portal space)

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29
Q

What part of the lobule contains the hepatic portal vein, hepatic artery and bile duct?

A

Portal space (PS)

30
Q

How does blood travel from the hepatic portal vein (PS) to the central vein in a lobule?

A

Via sinusoids

31
Q

What structure in the lobule is separate from the sinusoids (via tight junctions) and allows for passage of bile into the central vein?

A

Bile canaliculi

32
Q

Which cells in the lobule are phagocytic?

A

Kupffer cells

33
Q

The sinusoidal endothelium in the lobule has what making it permeable to proteins?

A

Large fenestrations

34
Q

GI → portal vein → sinusoids → central vein → vena cava is hight or low reistance?

A

Low resistance

35
Q

Materials entering the canaliculi must pass through what structure first?

A

Hepatocyte

36
Q

What are the 4 amphipathic constituents of bile?

A

Bile salts (50%), phospholipids (40%), cholesterol, and bile pigments

37
Q

Bile acids and bile salts are synthsized by what and from what?

A

By hepatocytes from cholesterol

38
Q

Synthesis of new bile acids depends on what?

A

Amount of bile salts returned to liver via enterohepatic circulation

39
Q

The body pool of bile salts is tightly regulated at what amount?

A

2-4 grams

40
Q

Primary (hepatic origin) and secondary bile (bacterial origin) acids are conjugated with glycine and taurine to form what?

A

Bile salts

41
Q

What are deoxycholic acids and lithocholic acids?

A

Secondary bile acids

42
Q

At lower pH’s how does the activity of bile salts change?

A

More bile salts are dissociated at lower pH = more amphipathic activity

43
Q

What increases the ability of bile salts to solubilze cholesterol?

A

Phosphlidis

44
Q

Phospholipids makes up what % of bile?

A

20-40%

45
Q

Cholesterol makes up what % of bile?

A

4%

46
Q

What bile acid constituent does not undergo recirculation, is amphipathic (but not water-soluble) and is soluble in bile salts?

A

Phospholipids

47
Q

What is the most important bile pigment?

A

Bilirubin

48
Q

What bile acid constituent is from dietary and hepatic origin and is primary excreted (with the except of reabsorption of bile salts)?

A

Cholesterol

49
Q

Bilirubin is the precursor for what 2 things?

A

Urobilin (gives urine yellow color), stercoblin (gives feces brown color)

50
Q

Bile pigments are carried in blood bound to albumin and derived from what?

A

Porphyrins from senescent RBCs

51
Q

The liver removes bilirubin from blood and conjugates to what?

A

Glucuronic acid (more soluble)

52
Q

Jaundice is visually detectable buildup of what in the blood?

A

Bile pigments (bilirubin)

53
Q

What are the 3 general types of jaundice?

A

Prehepatic, hepatic, posthepatic

54
Q

What type of jaundice is due to excessive breakdown of RBCs (too much liver bilirubin for liver to excrete)?

A

Prehepatic (hemolytic)

55
Q

Hepatic jaundice is characterized by a diseased liver/ a liver unable to deal with the normal load of bilirubin. What conditions can lead to this? (2)

A

Cirrhosis, Gilbert’s syndome (deficiency of conjugating enzyme)

56
Q

A blockage of bile ducts either due to a gallstone or pancreatic CA will result in what?

A

Posthepatic jaundice (obstructive)

57
Q

How do bile salts aid in fat digestion? (2)

A

Emulsifying large fat droplets (detergent action) and forming small lipid aggregations (micelles)

58
Q

What process of fat digestion by bile salt results in small drops of fat?

A

Emulsification

59
Q

What is the benefit of emulsifying fat droplets?

A

Increases SA (↑ area available for attack by pancreatic lipase)

60
Q

What act as lipid shuttles and increased lipid solubility in chyme?

A

Micelles

61
Q

What does contraction of the sphincter of oddi prevent?

A

Bile flow into the duodenum

62
Q

What impact does CCK have one the gallbladder and sphincter of oddi during the digestive period? What does this result in?

A

Contracts galbladder, relaxes sphincter of oddi. Bile released from gallbladder and enters into duodenum

63
Q

Bile acid flowing to gallbladder, concentrated, and prevented from flowing into duodenum is part of what period of gallbladder emptying?

A

Interdigestive period

64
Q

Continuous bile duct secretion will occur so long as what hormone as present?

A

CCK

65
Q

Bile salts go through how many cycles of reuptake and re-secretion per day?

A

6-10

66
Q

How are bile salts reabsorbed in the ileum?

A

Via Na+ co-transporter

67
Q

What is the relationship between bile salt synthesis and bile salt reabsoprtion?

A

Inverse (bile salts inhibit cholesterol 7alpha-hydroxylase, which converts cholesterol into primary bile acids)

68
Q

85% of gallstones are made of what?

A

Cholesterol

69
Q

What 3 factors favor gallstone formation?

A

Bile stasis, suprsaturation of bile w/ cholesterol, nucleating factors

70
Q

What is the role of bacteria in gallstone formation?

A

Can initiate or perpetuate stone formation

71
Q

What imaging can ID gallstones?

A

US, CT w/ iodine contrast dyes

72
Q

How does the production of beta-glucuronidase by E.coli favor gallstone formation?

A

Deconjugates conjugated bile pigments

Physio II (14 decks)

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