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Surgery- Liver, Spleen and Pancreas > Gall-bladder and Liver physiology > Flashcards

Gall-bladder and Liver physiology Flashcards

1
Q

Which lobe of the liver is the gall bladder associated with?

A

The gall bladder is found on the visceral surface of the liver, and is associated with the Quadrate lobe.

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2
Q

Explain the surface anatomy/ positioning of the gall bladder in relation to the MCL.

A

The fundus of the gall bladder is found in the Right- MCL inferior to the 9th costal cartilage.
Note that the fundus of the gall bladder is found lower than the anteroinferior border of the liver.

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3
Q

What is the function of the gall bladder?

A

The gall bladder is a 50ml reservoir of bile

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4
Q

What is the innervation of the gall bladder

A

Autonomic nervous system

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5
Q

What is the blood supply of gall bladder?

A 
Coeliac trunk 
Common hepatic artery 
Hepatic artery proper 
Right hepatic artery 
Cystic artery
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6
Q

What is the venous drainage of the gall bladder?

A

Cystic vein

Portal vein

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7
Q

True or false:

- Conjugated bilirubin is normally found in urine.

A

False

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8
Q

True or false

- Bile contains digestive enzymes.

A

False

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9
Q

What are substances stimulating bile secretion called?

A

Choloretics

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10
Q

What are the contents of bile?

A

Bile salts
Bile pigment
Cholesterol
Steroid hormone

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11
Q

What are the 2 main components in bile salt formation?

A

Cholesterol

Amino acids.

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12
Q

Name 4 functions of bile acids:

A
  1. Involved in digestion and absorption of fat.
  2. Regulate their own synthesis from cholesterol, by hepatocytes
  3. Function as choleretics (Substances stimulating bile secretion)
  4. May increase colon motility/ laxative.
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13
Q

Name the 2 primary bile acids (sterols synthesized from cholesterol):

A
  1. Cholic Acid

2. Chenodeoxycholic acid.

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14
Q

Name 2 secondary bile acids (conjugated amino acids):

A

Glycine

Taurine

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15
Q

Primary bile acids are conjugated into secondary bile acids.
Use this to describe the formation of bile salts

A

Cholic acid and chenodeoxycholic acid are sterols synthesized by hepatocytes from cholesterol.
They are then conjugated into amino acids Glycine and Taurine to form soluble glycocholic acid and taurocholic acid.
Glycocholic acid and taurocholic acid are secreted and react with Na+ or K+ to produce bile salts.

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16
Q

Name the 3 intermediates that bile salts must consist of:

A

Primary bile acids: cholic acid and Chenodeoxycholic acid
Secondary bile acids: Glycine and taurine
Na+ or K+

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17
Q

Name 4 functions of bile acids

A
  1. Increase colon motility/ laxative
  2. Fat metabolism (Absorption and digestion of fat)
  3. Regulate their own synthesis from cholesterol by hepatocytes
  4. Function as choleretics.
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18
Q

What portion of primary acids are converted into secondary bile acids but intestinal bacteria?

A

25%

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19
Q

Name the 2 primary bile pigments and mention, what compound are they derivatives of?

A

Bilirubin
Billiverden
Both of which are a derivatives of haemoglobin

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20
Q

What plasma protein is bilirubin bound to, in blood?

A

Albumin

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21
Q

Name 2 other compounds that bile pigments are derived from:

A

Myoglobin

Cytochromes

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22
Q

Name the carrier of bile pigments in the liver:

A

Glucuronic acid

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23
Q

What is jaundice?

A

Jaundice is medical condition in which there is excessive bile production, ineffective bile excretion or obstruction of the bile duct leading to a build up bilirubin the body.
As a result, the skin, sclera and mucous membranes develop a yellow appearance

24
Q

What enzyme catalyzes conjugation within hepatocytes

A

Glucuronyl transferase

25
Q

What is the cause for neonatal jaundice?

A

There’s is impaired glucuronide formation due to transferase deficiency

26
Q

Which drug increases bile duct pressure?

A

Morphine

27
Q

Which drug stimulates glucuronyl transferase activity?

A

Phenobarb

28
Q

What is bilirubin broken down into in the intestines causing brown discoloration of faeces?

A

Stercobilin

29
Q

What is urobilin?

A

This is the remainder of the pigment that is reabsorbed and excreted by the kidneys

30
Q

What happens to bilirubin excretion in the case of hepatitis.

A

With hepatitis, excretion fails and jaundice results.

31
Q

Which duct connects the gall bladder to the common hepatic duct

A

The cystic duct.

32
Q

What epithelium in found lining the internal mucous membranes?

A

Simple columnar epithelium

33
Q

What is the main function of the gall bladder?

A

Store bile
During inter digestive periods, the sphincter of Odi closes.
Bile flows into a relaxed gall bladder
Mucosa reabsorbs water and electrolytes rapidly

34
Q

What hormone stimulates gall bladder contraction?

A

Cholescystokinin

35
Q

What are the 2 mechanisms that control gall bladder contraction?

A

Neurological

Chemical

36
Q

Name the 2 mechanisms that control gall bladder contraction?

A

Neurological:
- Stimulation of the vagus nerve causing the contraction of the gall bladder and relaxation of the sphincter

Chemical:
- when chyme reaches the upper small intestines, fatty acids and protein products stimulate the release of cholecystokinin
Cholecystokinin is a hormone that stimulates the contraction of the gall bladder

37
Q

What are the main components of gallstones ?

A

Calcium.

Bilirubinate.

38
Q

How do gallstones form?

A

If Billirubin glucuronide is deconjugated, the free billirubin combines with calcium to form calcium bilirubinate which is highly insoluble.

39
Q

What is hepatic regeneration?

A

Ability of the liver to regenerate is highly effective.

40
Q

True or False:

- Conjugated bilirubin is normally found in urine.

A

False.

41
Q

True or False:

- Intrahepatic cholestasis is an indication for surgery.

A

True

42
Q

True or False:

- Gall-stones can cause extra-hepatic cholestasis.

A

True.

43
Q

True or False:

- Gilbert syndrome produces ↑ed conjugated bilirubin.

A

True

44
Q

True or False:

- Obstructive jaundice produces dark stools.

A

False.

45
Q

True or False

- Obstructive jaundice is always extra-hepatic.

A

False.

46
Q

True or False

- Obstructive jaundice may result in cholangitis.

A

True

47
Q

True or False

- Hemolysis results in ↑ed unconjugated bilirubin.

A

True.

48
Q

True or False
- Hemolysis results in light stools
• intra-hepatic cholestasis may be related to hepatitis T

A

False

49
Q

True or False

- Intra-hepatic cholestasis may be related to hepatitis.

A

True.

50
Q

True or False:

- Intra-hepatic cholestasis may be related to hepatitis.

A

True.

51
Q

What is the embryological derivative of the falciform ligament?

A

Remnants of the ventral mesogastrium

52
Q

What is the embryological derivative of the ligamentum teres hepatis/ round ligament?

A

Obliterated umbilical vein

53
Q

What is the embryological derivative of the ligamentum venosum

A

Ductus venosus

54
Q

Name, in order, the structures needle will pierce in a liver biopsy:

A 
Skin. 
Fascia.
Intercostal space. 
Diaphragm.
Parietal peritoneum. 
Visceral peritoneum. 
Liver.
55
Q

Explain bile pigment formation:

A 
In the macrophage:
RBC death produces heme + globin+ iron
Heme converted to biliverdin and
Heme reduced to bilirubin
Bilirubin is water insoluble
Bilirubin binds to albumin which transports it to the liver

In the liver:
Bilirubin + glucuronic acid is conjugated to bile salts by glucoronyl transferase to mono- or diglucuronide
Which is transported via the biliary duct system through the duodenum
Into the small intestines deconjugated by β glucuronidase
And large intestines where bacterial oxidation occurs and it is excreted as stercobilinogen (in faeces)
The rest of the 2-5% urobilinogen is re-absorbed via the blood stream into the kidney
And then excreted as urobilin
20% into enterohepatic circulation

56
Q

What causes unconjugated bilirubinaemia?

A

Haemolysis
Gilbert’s syndrome
Criggler Najar Syndrome

Surgery- Liver, Spleen and Pancreas (10 decks)

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