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Digestion > GI 3B- Physiology of the Liver > Flashcards

GI 3B- Physiology of the Liver Flashcards

1
Q

What lipids are incorporated in chylomicrons and LDL?

A

FFAs

Cholesterol

Phospholipids

TAGs

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1
Q

Why would a patient suffering from liver failure exhibit:

Jaundice?

Uncontrollable bleeding?

Fatty liver?

A

Jaundice: No bile synthesis results in hyperbilirubemia

Uncontrolled bleeding: No clotting factors are synthesized (125 7-12)

Fatty liver: Fat droplets accumulate because LDL cannot be formed/secreted due to lack of essential surface proteins

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1
Q

A “lipid panel” of a liver failure patient will exhibit what with respect to the following:

Albumin

Total protein

Prothrombin Time

A

Decreased albumin

Decreased total protein

Increased PT time

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1
Q

In what patients is intrahepatic jaundice seen? What will the bilirubin of the lipid panel look like?

A

Any liver problem/disease(alcoholics, hepatitis, Guille-Baire’s)

Increased unconjugated

Increased conjugated

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2
Q

What is the function of fibrinogen?

A

Participates in blood clotting

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2
Q

What are the 4 organic constituents of bile?

A

Bile salts (~50%)

Phospholipids (~40%)

Cholesterol (~4%)

Bile pigments such as bilirubin (~2%)

*Also contains some electrolyes and water that is secreted by cells lining the bile ducts*

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2
Q

Vitamin D activation occurs first in the _______, which adds a _______ group on the 25th carbon. It then is shuttled to the ______ which then adds a ______ group to the 1st carbon

A

Liver

Hydroxal

Kidney

Hydroxal

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2
Q

How is free bilirubin transported in the blood?

A

Attached to albumin

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3
Q

A build-up of UREA in the blood can lead to a state called ________ or _______, in which high levels of urea become toxic to a variety of tissues. This is a symptom of renal disease/failure.

A

Azotemia

Uremia

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4
Q

__________ reactions are designed to make metabolites more polar or hydrophilic.

A

Conjugation

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5
Q

What clotting factors are syntehsized in the liver?

A

Factors I, II, V, VII, VIII, IX, X, XI, XII

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6
Q

In what patients is prehepatic jaundice seen? What is prehepatic jaundice also called? What will the bilirubin of the lipid panel look like?

A

Sickle cell anemia

Hemolytic jaundice

Increased uncojugated bilirubin

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7
Q

An important enzyme in liver hepatocytes required for endogenous cholesterol synthesis is ____________ reductase

A

HMG-CoA

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8
Q

How many days until our Christmas break?

A

16!!! Respect the chain

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9
Q

What percentage of albumins, fibrinogens and globulins are formed in the liver?

A

100% of albumins and fibrinogens

50-80% of globulins (the other 20-50% are formed by lymphoid tissues. They are gamma globulins which are antibodies)

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10
Q

What is the only way that the body can eliminate excess cholesterol?

A

Via bile

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11
Q

In step 1 of bile synthesis, hepatocytes actively secrete bile into the bile ______ or ______.

A

Canals

Canaliculi

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12
Q

In addition to protein deanimation what is the other second function of AST & ALT?

A

Used to synthesize non-essential amino acids in liver hepatocytes

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12
Q

There are the 2 types of bilirubin? What are their characteristics

A

Free/Unconjugated/Indirect (Not water soluble. It must be transported by bilirubin to make it water soluble)

Conjugated/Direct (Has a glucuronic acid attached making it extremely water soluble)

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14
Q

If CP450 is induced, will drug metabolism increase or decrease?

A

Increased

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15
Q

The formation of bile occurs in _____ discrete steps.

A

3

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16
Q

The liver degrade ALL of the steroid hormones as well as ____ and _____ which are hormones of the thyroid

A

T3

T4

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16
Q

What are 4 common endogenous substrates added to drug metabolites during Phase II drug metabolism? Which of the 3 is the most common?

A

Glucuronic acid (Glucuronidation is the most common & most important)

Acetyl-CoA

Glutathione

Amino acids

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17
Q

Why would a patient suffering from liver failure exhibit:

Impaired drug metabolism?

Edema?

Osteomalacia?

Hypoglycemia?

A

Impaired drug metabo: No Phase I & II enzymes produced (especially CP450)

Edema: No plasma proteins therefore no PIc pressure

Osteomalacia: Inactivated vitamin D.

Hypoglycemia: No glycogen storage or gluconeogenesis

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18
Q

Which stores more glycogen: liver or skeletal muscle?

A

Skeletal muscle store more glycogen because there is more skuh-lee-tulls than liver in the body.

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19
Q

What are the key enzymes required for deamination? What are the 2 specific examples?

A

aminotransferases (transaminases)

AST & ALT

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20
Q

What is hemachromotosis?

A

The liver stores too much iron. Resulting in bronzing color (bad sun tan)

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21
Q

Cholic acid and chenodeoxycholic acids are ________ bile acids.

A

Primary

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22
Q

In what states would ketogenesis occur?

A

In fasting states or this guy

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23
Q

Bile has what 2 important functions?

A

Bile provides the sole excretory route for many solutes that are not excreted by the kidneys.

Secreted bile salts & lecithink are required for normal lipid digestion and absorption in the small intestine.

24
Q

A “lipid panel” of a liver failure patient will exhibit what with respect to the following:

ALT

AST

Bilirubin

A

Elevated ALT

Elevated AST

Elevated bilirubin

25
Q

Steps 1 & 2 of bile synthesis produce _____ ml/day of “______” bile

A

~900

hepatic

26
Q

What are 4 common causes of elevated BUN?

A

Impaired renal function

Increased protein intake/catabolism

GI bleeding (due to intestinal flora creating nitrogenous waste)

Dehydration

27
Q

The gall bladder concentrates the key remaining solutes (bile salts, biliruin, cholesterol & lecithin) by ____ to ____ fold.

A

10 to 20

28
Q

Iron is stored in the liver as _________. What is the protein that binds to it in the liver? (Not to be confussied with transferrin in the blood)

A

Ferritin

Apoferritin

29
Q

In what patients is physiological jaundice seen? What will the bilirubin of the lipid panel look like?

A

Newborns

Increased unconjugated

30
Q

A portion of the primary bile acids are then converted by intestinal bacteria into 2 secondary bile acids called _________ acid and _______ acid.

A

Deoxycholic

Lithocholic

32
Q

What is the site of amino acid degradation (deamination) in the body?

A

Liver

32
Q

What is the most common phospholipid found in bile? What is an important charicteristic about phospholipids?

A

Lecithin

They are also amphipathic

33
Q

The liver typically stores _____% of its weight as glycogen.

A

8

34
Q

What are high blood levels of ALT & AST indicative of?

A

Liver disease

34
Q

The liver stores large quantities of what 3 vitamins?

A

A

B12

D

36
Q

What is the ultimate fate of the bile/ bile acids?

A

Eliminated as a waste product

38
Q

What are the shared functions of albumin & globulin?

A

Transport of thyroid, adrenocortical, gonadal and other hormones.

Acting as carriers for metals, ions, fatty acids, amino acids, bilirubin, enzymes and drugs.

39
Q

What is CYP2D6?

A

A specific Cytochrome P450 gene.

Designated by the letters CYP followed by an Arabic numeral, a letter and another Arabic numeral. The last 3 are specific to the gene

40
Q

What is uremia? What is it indicative of?

A

A build-up of urea in the blood that is toxic to tissues. Indicative of renal failure/disease

42
Q

What is azotemia? What is it indicative of?

A

A build-up of urea in the blood that is toxic to tissues. Indicative of renal failure/disease

43
Q

What are the 3 major types of plasma proteins?

A

Albumin

Globulin

Fibrinogen

43
Q

What are the two goals of drug metabolism?

A

Make them less active

Make them more soluble so that they can be readilly excreted into urine or bile.

44
Q

What occurs in Phase II drug metabolism?

A

Conjugative enzymes add chemical groups to the drug metabolites to make it even more water soluble so that it can be excreted in the urine and bile

45
Q

What occurs in Phase I of drug metabolism?

A

Cytochrome P450 enzymes will either break down the drug and either drug metabolite with modified activity or an inactive drug metabolite is formed

47
Q

When the free bilirubin is released by albumin in the liver, hepatocytes perform what 3 functions?

A

Uptake of bilirubin from circulation

Conjugation of bilirubin

Excretion of bilirubin into bile

48
Q

What are the 2 exclusive functions of albumin?

A

Exertion of oncotic pressure across capillary walls preventing edema

supplying ~15% of buffering capacity

50
Q

The liver conjugates bile acids with the glycine or taurine to form bile salts. This makes them ________ at duodenal pH

A

Amphiphatic

51
Q

Is cytochrome P450 a phase I or phase II enzyme?

A

Phase I

52
Q

During meals, the bile that reaches the duodenum is a mixture of _______ hepatic bile and ______ gall bladder bile

A

Diluted

Concentrated

54
Q

What are the amine groups cleaved from amino acids converted into _______ and then that is converted into ______?

A

Ammonia

Urea

55
Q

What is the major way that cholesterol is broken down in the liver? How much cholesterol is used per day to create it?

A

Bile acids

500 mg

56
Q

If Cytochome P450 is inhibited, will drug metabolism will increase or decrease?

A

Decrease. In the words of Dr. Cottam, if you don’t know that then you should just leave dental school

57
Q

What time is it?

A
59
Q

What contributes ions and water into bile?

A

Epithelial cells lining the bile ducts

60
Q

What is happening on Dec 19th?

A

Loupes DAY

61
Q

In what patients is posthepatic jaundice seen? What is another name for posthepatic jaundice? What will the bilirubin of the lipid panel look like?

A

Gallstones or pancreatic cancer

Obstructive jaundice

Increase conjugated

No change/slight increase to unconjugated

62
Q

What is the function of gamma-globulins?

A

Participates in immune responses

63
Q

Who doesn’t want to make toys?

A

This guy

64
Q

What glucose metabolism pathways does the liver perform?

A

Glycogenolysis

Glycogenesis

Gluconeogenesis

65
Q

What is bilirubin?

A

The waste product of hemoglobin degredation. Specifically it is the degraded heme portion.

67
Q

In serious liver disease, AMMONIA can often accumulate in the blood & lead to a state called hepatic _______ or hepatic __________.

A

Coma

Encephalopathy

68
Q

Where are drugs metabolized? What is the most important enzymatic pathways?

A

Liver

Cytochrom P450

69
Q

In step 3 of bile synthesis:

Between meals, approximately _____ of the hepatic bile is diverted to the ______ ______. which stores bile and removes the salts and water.

A

1/2

gall bladder

71
Q

What do hepatocytes add to free/unconjugated/indirect bilirubin to make it conjugated/direct? What is the enzyme required?

A

glucuronic acid

glucuronyl transferase

72
Q

What are 2 waste products commonly found in bile?

A

Lipophilic drugs/metabolites

Antigen-antibody complexes

73
Q

In step 2 of bile synthesis, INTRAhepatic & EXTRAhepatic ducts not only transport bile but ______ cells, which line the ducts, also secrete a watery, HCO3 rich fluid

A

cholangiocytes

74
Q

A “lipid panel” of a liver failure patient will exhibit what with respect to the following:

Alkaline phosphatase

Gamma-glutamyl transferase

Lactate-dehydrogenase

A

These are non-specific enzymes that are multifactoral. They are not used for detecting liver damage

Digestion (16 decks)

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