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patho summer test #1 > Gastrointestinal Module #2b > Flashcards

Gastrointestinal Module #2b Flashcards

1
Q

What does the Glisson capsule do in the liver?

A

Sounds liver and contains blood vessels, nerves and lymphatics

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2
Q

What happens when the glisson capsule distends?

A

Causes pain

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3
Q

What is the functional unit of the liver?

A

Lobule

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4
Q

How are hepatocytes arranged?

A

Radially around central vein

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5
Q

Where are capillaries (sinusoids) located in the liver?

A

Between heaptocytes

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6
Q

From whom do sinusoids (capillaries) receive blood from?

A

Hepatic Artery

Hepatic Portal Vein

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7
Q

Where do sinusoids (capillaries) drain?

A

Central vein –> hepatic veins and IVC

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8
Q

Where are bile canaliculi located?

A

Plates of hepatocytes

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9
Q

Where do the bile canaliculi drain?

A

Small bile ducts –> eventually make their way into common bile duct

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10
Q

What are the immune/defense cells that line the sinusoids?

A

Kupffer Cells

Stellate Cells

Pit Cells

Disse Space

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11
Q

What are kupffer cells?

A

Macrophage (phagocytic) cells that line the sinusoids

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12
Q

What is the function of the kupffer cells?

A

Phagocytic cells –> RBC breakdown (bilirubin production)

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13
Q

What is clinically important about kupffer cells?

A

Early response to liver injury/pathology

Responsible for early steps in alcoholic (ethanol) induced injury

1st step in cascade of events leading to fibrosis/cirrhosis

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14
Q

What are stellate cells and where are they located?

A

Contractile cells

Located in perisinusoidal space

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15
Q

When do stellate cells become activated?

A

During pathology –> usually store vitamin A when dormant

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16
Q

What is the function of stellate cells when they become activated?

A

Contraction/relaxation to regulate sinusoidal blood flow

Production of scar tissue (collagen –> fibrosis) in development of cirrhosis

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17
Q

What do pit cells do?

A

Produce interferon and other immune defense substances

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18
Q

Clinically what is the function of pit cells?

A

“First line of defense” against tumor formation

Cytotoxic effect on tumor cells

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19
Q

What is the Disse space?

A

Interstitial space between hepatocytes and sinusoids that drains into lymphatic vesels

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20
Q

Describe the general pathway of bile (start w/ production)

A

Produced in Liver

Secreted into duodenum

Excreted/reabsorbed

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21
Q

What is the pH of bile?

A

7.6 - 8.6

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22
Q

What is bile alkaline?

A

Helps to neutralize stomach acids in duodenum

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23
Q

Describe bile

A

Alkaline, yellow fluid that is made mostly of water

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24
Q

What are the organic compounds found in bile?

A

Bile Salts

Cholesterol

Bilirubin

Phospholipids

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25
Q

What is the major organic compound found in bile?

A

Bile Salts

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26
Q

What are bile salts?

A

Conjugated bile acids

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27
Q

What does bile do?

A

Emulsifying agent to assist in breakdown of fats for absorption in small intestine and formation of micelles

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28
Q

What is bilirubin?

A

Yellow pigment from RBC (heme portion) degradation

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29
Q

Where is bile secreted into initially?

A

Canaliculi

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30
Q

Where do canaliculi eventually drain into?

A

R/L hepatic duct –> common hepatic duct

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31
Q

How much bile will flow into the gall bladder during fasting?

A

75%

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32
Q

What happens to the 25% of bile that doesn’t flow into the gall bladder during fasting?

A

Continue on and flow into the duodenum via common bile duct

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33
Q

What happens to the gall bladder during feeding?

A

Contracts and releases stored bile

34
Q

What stimulates the gall bladder to contract during feeding?

A

CCK

Vagal stimuli

35
Q

What is the name of the sphincter that allows bile to flow during feeding?

A

Sphincter of Oddi

36
Q

What synthesizes primary bile acid?

A

Hepatocytes

37
Q

What stimulates bile acid production?

A

CCK

Secretin

38
Q

What is bile acid synthesized from?

A

Cholesterol

**major site of cholestserol metabolism

39
Q

What are bile acids converted into?

A

Bile salts (they’re water soluble)

40
Q

What do bile salts do in the duodenum?

A

Emulsify fat droplets –> physically arrange them into “micelles”

41
Q

What are micelles?

A

Clumps (aggregates) of bile salts, fat droplets, fat soluble vitamins, cholesterol and phospholipids

Form circle w/ hydrophilic-ends on outside

42
Q

What happens to bile in the ileum/colon?

A

90% = absorbed and transported back to liver

10% = continue to rectum and are excreted

43
Q

Where are RBCs broken down?

A

Spleen

Liver = Kupffer Cells

Throughout Vascular System

44
Q

How is hemoglobin divided during RBC break down?

A

Globin

Heme

45
Q

What is globin further broken down into?

A

Amino Acids

46
Q

What is heme further broken down into?

A

Iron –> stored in liver and recycled into new RBCs

Bilverdin –> further broken down into bilirubin –> released in plasma

47
Q

What happens to bilirubin in blood plasma?

A

Attaches to albumin

48
Q

In the blood plasma is bilirubin conjugated or unconjugated?

A

Unconjugated

49
Q

What happens to the unconjugated bilirubin?

A

Circulates through hepatocytes in liver and is conjugated –> can be secreted into duodenum or stored in gallbladder

50
Q

What happens to conjugated bilirubin in the duodenum?

A

Bacteria in intestines “deconjugate” it into urobilinogen

51
Q

What are the 3 pathways that urobilinogen can follow?

A

Reabsorbed into blood stream –> excreted in urine or recycled in liver

Remain in coon and excreted in stool

52
Q

What are normal values of urobilinogen in the urine?

A

0 - 4 mg/24 hrs

53
Q

What kind of jaundice is increased values of urobilinogen in the urine considered?

A

Pre-hepatic jaundice

54
Q

What is pre-hepatic jaundice caused by?

A

Hemolysis –> increased bilirubin production –> increased urobilinogen formation

55
Q

What kind of jaundice is decreased values of urobilinogen in the urine considered?

A

Post-hepatic jaundice

56
Q

What is post-hepatic jaundice caused by?

A

Obstruction –> blocks secretion of bile into intestine –> decreased urobilinogen formation

Less urobilinogen is reabsorbed into bloodstream for kidney to filter

57
Q

What would your stools look like with post-hepatic jaundice?

A

Pale

58
Q

What is jaundice (aka icterus)?

A

Bilirubin pigment causing yellow of skin (tissues) and conjunctival membranes

59
Q

Is jaundice a specific disease/pathology?

A

NO its a symptom/sign of disease/pathology affecting metabolism/excretion of bilirubin

60
Q

What are the 3 classifications of jaundice?

A

Pre-hepatic

Intra-hepatic

Post-hepatic

61
Q

What does it mean for jaundice to be “pre-hepatic”?

A

Pathology PRIOR to liver –> increased RBC breakdown)

62
Q

What are some diseases that would cause pre-hepatic jaundice?

A

Genetic diseases: Gilbert’s syndrome, sickle cell anemia, thalassemia

Kidney Disease

63
Q

What does it mean for jaundice to be “intra-hepatic”?

A

Pathology located w/in the liver –> liver’s ability to conjugate bilirubin is impaired

64
Q

What are some diseases that would cause intra-hepatic jaundice?

A

Cirrhosis

Hepatitis

Liver Toxicity

65
Q

What does it mean for jaundice to be “post-hepatic”?

A

Pathology located AFTER liver –> impaired transport of conjugated bilirubin to GI tract

66
Q

What are some diseases that would cause post-hepatic jaundice?

A

Gallstones

Pancreatic pathology that blocks to bile ducts

67
Q

Can you use lab tests to DDx between classifications of jaundice?

A

Yes BUT need “whole picture” assessment of all LFTs, urine and stool analysis

**each jaundice classification has different lab patterns

68
Q

What does serum bilirubin measure?

A

Both AMOUNT and TYPE of hyperbilirubinemia –> provide clues to jaundice classification

69
Q

How is total bilirubin measured?

A

Directly in blood

**all 3 types of jaundice can have elevated total bilirubin

70
Q

How is direct (conjugated) bilirubin measured?

A

Directly in blood

**elevated can indicate post or intra-hepatic pathology

71
Q

How is indirect (unconjugated) bilirubin measured?

A

Calculated from total/direct measurements

**if elevated can indicate pre or intra-hepatic pathology

72
Q

What serum enzymes can be measured when analyzing for jaundice?

A

Alkaline Phosphatase

AST

ALT

LDH

GGT

73
Q

What serum proteins can be measured when analyzing for jaundice?

A

Albumin

Globulins

A/G ratio

transferrin

AFP = alpha fetoprotein

74
Q

When looking @ urinalysis for jaundice what are you looking for?

A

Urobilinogen

Conjugated bilirubin

Color

75
Q

What would you expect urine and stool to look like with pre-hepatic pathology of jaundice?

A

Urine = elevated urobilinogen

Urine color = normal

Stool color = normal

76
Q

What would you expect blood tests to look like with pre-hepatic pathology of jaundice?

A

Blood: hyperbilirubinemia

Total bilirubin = elevated

Direct (conjugated) bilirubin = normal/potentially elevated (d/t increased production)

Indirect (unconjugated) bilirubin = elevated

77
Q

What would you expect urine and stools to look like with post-hepatic pathology of jaundice?

A

Urine = dark –> elevated conjugated bilirubin and decreased urobilinogen

Stool color = pale –> d/t decrease of urobilinogen

78
Q

What would you expect blood tests to look like with post-hepatic pathology of jaundice?

A

Blood = hyperbilirubinemia

Total bilirubin = elevated

Direct (conjugated) bilirubin = elevated –> d/t “congestive back up”

Indirect (unconjugated) = normal

79
Q

What would you expect to see in intra-hepatic jaundice pathology?

A

Decreased uptake –> d/t CHF, drug/meds

OR

Decreased conjugation in the liver –> neonatal (pysiological), liver dz (hepatitis, cirrhosis), hyperthyroidism

80
Q

What do you expect the labs to look like with intra-hepatic jaundice?

A

Elevated total bilirubin (d/t elevated conjugated bilirubin)

Elevated indirect (unconjugated) bilirubin (d/t congestive back up of indirect (unconjugated bilirubin in the blood stream)

Elevated direct (conjugated) bilirubin (d/t congestive hepatic “back-up”)

81
Q

What will urine and stool samples look like in intra-hepatic jaundice?

A

Urine: increased conjugated bilirubin; normal or low urobilinogen

Urine Color = dark

Stool color = normal (no decrease of urobilinogen in stools

patho summer test #1 (8 decks)

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