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Digestive and Renal Sciences > Function of the Liver and Hepatobiliary System > Flashcards

Function of the Liver and Hepatobiliary System Flashcards

1
Q

What organs is the liver associated with?

A

Associated with the other abdominal organs and organs of the digestive system.

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2
Q

What is the liver?

A

Largest solid organ in the upper right quadrant and is composed of 2 lobes.

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3
Q

Where is the liver located?

A

In the upper right quadrant

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4
Q

What are some genetic variations of the livers anatomy?

A

Hereditary anatomical displacement,

accessory lobes

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5
Q

What internal factors are associated with gross liver anatomy?

A

Portal thrombosis, cardiac cirrhosis, fibrosis and atrophy

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6
Q

What external factors are associated with gross liver anatomy?

A

Impression effects

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7
Q

What suggests that a patient may have liver disease when presented with fatigue and weight loss?

A

Raised liver enzymes
Increased prothrombin time
reduced serum albumin

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8
Q

Where does bile drain into?

A

Hepatic bile drains directly into the duodenum to enable the digestion of fats.

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9
Q

How can the liver be functionally divided up?

A

Liver can be divided up into segments based upon the blood supply and bile drainage.

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10
Q

What is the lobule/acinus?

A

The functional units of the liver

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11
Q

What are the lobule/acinus composed of?

A

Plates of hepatocytes, sinusoidal channels, inlet and exit blood vessels and bile canaliculi.

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12
Q

Where does blood come from to the liver?

A

Portal vein - venous blood from the gut (75%)

Hepatic artery - arterial blood (25%)

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13
Q

What is the blood content of the liver and what is its passage through the liver?

A

Blood content makes up about 30% of the liver and up to 15% of total blood content.

Enters the liver
Mixes in the sinusoids
drains via hepatic veins into the IVC

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14
Q

How much blood enters the liver per min?

A

roughly 1.3L/min around 25% of cardiac output

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15
Q

What is the function of the connective tissue in the liver (liver stroma)?

A

For metabolic support and scaffolding.

Acts as a capsule to protect the liver and the biliary tree.

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16
Q

What is the connective tissue of the liver composed of?

A

ECM materials such as collagen etc.

Also made up of stellate cells, glycoproteins, integrins.

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17
Q

What happens to the structure of the lobule in a fibrotic liver?

A

The hexagonal architecture becomes disrupted and the patient will lose hepatocytes and have an increased build up of connective tissue.

18
Q

What are hepatocytes?

A

60-65% of liver tissue
100 billion cells
Large cells (due to their range of functions)
polarised polyhedral epithelial cells (meaning they have different functions across the plains of the cell)
low mitotic index
Secretions are located close to the sinusoids for early drainage.

19
Q

What are the functions of the hepatocytes?

A 
Protein secretion
Bile secretion
Storage
Metabolism
Detoxification and inactivation (drugs, alcohol)
20
Q

What is the biliary Epithelium?

A

Form collecting vessels of increasing size with the aim to seal in all the bile to prevent it leaking.
Also used in secretion of bile.

21
Q

What do the endothelial cells of the liver do?

A

Form a barrier tissue which acts as a filter lining the hepatic vasculature.
They protect the parenchyma from blood cells, bacteria and viruses.
Functions:
- Anti thrombogenic surface
- regulation of coagulation
- regulation of leukocyte traffic.

22
Q

What are Kupffer cells?

A

Hepatic macrophages located within the sinusoids
80% of all macrophages in the body
Involved in phagocytosis, regulation of the microcirculation, removal of endotoxin
Very active cells
Can produce cytokines, present antigens and stimulate immune responses

23
Q

What are stellate cells of the liver?

A

Star shaped cells with multiple membrane processes and branching structure.
Sit in the sinusoids
Store vitamins

24
Q

What are the digestive functions of the liver?

A

Carbohydrate and fat metabolism (can also be used to produce glycose)
Storage of vitamins and minerals

25
Q

What is the function of the liver for cholesterol synthesis?

A

Liver can synthesise cholesterol which is an essential component for cell membranes.
Also an important component of bile acids, steroids, hormones.

26
Q

What is the function of the liver in bile production?

A

About 0.5L if bile is produced a day by hepatocytes which isn’t enough so some of it is recycled to be reused when needed.
Bile is key for emulsification of fats.
Also for excretion of some substances which can’t be cleared by the kidney.

27
Q

What is the immune function of the liver?

A

Protection against pathogen arriving in blood.
Phagocytosis of old or dying cells
innate immune functions
induction of tolerance so the body ignores proteins that will not cause damage.

28
Q

How is Bilirubin produced?

A

Haem –(oxidised) –> to green Biliverdin –(biliverdin reductase)–> to bilirubin

29
Q

What is are the proportions of immune cells in the liver?

A

The liver selects the important immune cells to sit in zone 1 to prevent infection be pathogens.

30
Q

What are the detoxification and elimination functions of the liver?

A 
Urinary excretion (solubilisation of compounds)
Biliary excretion (lipophilic compounds)

Biotransformation of Drugs:
Phase 1 - Oxidation or reduction to make soluble (P450)
Phase 2 - Conjugation to make water soluble

Elimination of ammonia by-product of protein metabolism.

31
Q

What are the P450 enzymes?

A

enzymes used to metabolise potentially toxic compounds such as drugs and bilirubin.

32
Q

What are the useful proteins produced by the liver?

A 
Albumin (50%) of all plasma proteins
Fibronectin and components of the coagulation cascade
Plasminogen
Alpha -1 antitrypsin
Transferrin
Hepcidin
33
Q

What are the stages of liver damage?

A

Healthy liver
Fatty liver - deposits of fat lead to liver enlargement
Liver fibrosis - scar tissue forms
Liver Cirrhosis - Growth of connective tissue destroys liver cells

34
Q

What are the main causes of liver disease?

A

Alcohol abuse
Obesity - metabolic liver disease
Viral infection - Hepatitis C Virus (HCV)

35
Q

What is Hepatitis?

A

Liver inflammation (non-viral) caused by liver disease either acute or chronic.

36
Q

What can liver cirrhosis cause?

A

Leads to life threatening complications causing renal failure, varices in the oesophagus, ascites and spleen problems.

37
Q

What kind of liver tests can be done for diagnosis?

A

Bilirubin concentration
Blood tests
Liver enzyme concentrations
Biopsy

38
Q

What are the pathways that drive the development of fibrosis of the liver?

A

Damage - Virus/toxin/autoimmunity
Acute hepatitis
Chronic hepatitis
Liver Fibrosis

39
Q

What is liver cirrhosis?

A

Where the liver does not function properly due to long term damage caused by the main causes.

40
Q

What is liver fibrosis?

A

Formation of abnormally large scar tissue in the liver.

Digestive and Renal Sciences (26 decks)

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