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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
Which stores more glycogen: liver or skeletal muscle?
Skeletal muscle store more glycogen because there is more skuh-lee-tulls than liver in the body.
19
What are the key enzymes required for deamination? What are the 2 specific examples?
aminotransferases (transaminases) AST & ALT
20
What is hemachromotosis?
The liver stores too much iron. Resulting in bronzing color (bad sun tan)
21
Cholic acid and chenodeoxycholic acids are ________ bile acids.
Primary
22
In what states would ketogenesis occur?
In fasting states or this guy
23
Bile has what 2 important functions?
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
A "lipid panel" of a liver failure patient will exhibit what with respect to the following: ALT AST Bilirubin
Elevated ALT Elevated AST Elevated bilirubin
25
Steps 1 & 2 of bile synthesis produce _____ ml/day of "\_\_\_\_\_\_" bile
~900 hepatic
26
What are 4 common causes of elevated BUN?
Impaired renal function Increased protein intake/catabolism GI bleeding (due to intestinal flora creating nitrogenous waste) Dehydration
27
The gall bladder concentrates the key remaining solutes (bile salts, biliruin, cholesterol & lecithin) by ____ to ____ fold.
10 to 20
28
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)
Ferritin Apoferritin
29
In what patients is physiological jaundice seen? What will the bilirubin of the lipid panel look like?
Newborns Increased unconjugated
30
A portion of the primary bile acids are then converted by intestinal bacteria into 2 secondary bile acids called _________ acid and _______ acid.
Deoxycholic Lithocholic
32
What is the site of amino acid degradation (deamination) in the body?
Liver
32
What is the most common phospholipid found in bile? What is an important charicteristic about phospholipids?
Lecithin They are also amphipathic
33
The liver typically stores \_\_\_\_\_% of its weight as glycogen.
8
34
What are high blood levels of ALT & AST indicative of?
Liver disease
34
The liver stores large quantities of what 3 vitamins?
A B12 D
36
What is the ultimate fate of the bile/ bile acids?
Eliminated as a waste product
38
What are the shared functions of albumin & globulin?
Transport of thyroid, adrenocortical, gonadal and other hormones. Acting as carriers for metals, ions, fatty acids, amino acids, bilirubin, enzymes and drugs.
39
What is CYP2D6?
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
What is uremia? What is it indicative of?
A build-up of urea in the blood that is toxic to tissues. Indicative of renal failure/disease
42
What is azotemia? What is it indicative of?
A build-up of urea in the blood that is toxic to tissues. Indicative of renal failure/disease
43
What are the 3 major types of plasma proteins?
Albumin Globulin Fibrinogen
43
What are the two goals of drug metabolism?
Make them less active Make them more soluble so that they can be readilly excreted into urine or bile.
44
What occurs in Phase II drug metabolism?
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
What occurs in Phase I of drug metabolism?
Cytochrome P450 enzymes will either break down the drug and either drug metabolite with modified activity or an inactive drug metabolite is formed
47
When the free bilirubin is released by albumin in the liver, hepatocytes perform what 3 functions?
Uptake of bilirubin from circulation Conjugation of bilirubin Excretion of bilirubin into bile
48
What are the 2 exclusive functions of albumin?
Exertion of oncotic pressure across capillary walls preventing edema supplying ~15% of buffering capacity
50
The liver conjugates bile acids with the glycine or taurine to form bile salts. This makes them ________ at duodenal pH
Amphiphatic
51
Is cytochrome P450 a phase I or phase II enzyme?
Phase I
52
During meals, the bile that reaches the duodenum is a mixture of _______ hepatic bile and ______ gall bladder bile
Diluted Concentrated
54
What are the amine groups cleaved from amino acids converted into _______ and then that is converted into \_\_\_\_\_\_?
Ammonia Urea
55
What is the major way that cholesterol is broken down in the liver? How much cholesterol is used per day to create it?
Bile acids 500 mg
56
If Cytochome P450 is inhibited, will drug metabolism will increase or decrease?
Decrease. In the words of Dr. Cottam, if you don't know that then you should just leave dental school
57
What time is it?
59
What contributes ions and water into bile?
Epithelial cells lining the bile ducts
60
What is happening on Dec 19th?
Loupes DAY
61
In what patients is posthepatic jaundice seen? What is another name for posthepatic jaundice? What will the bilirubin of the lipid panel look like?
Gallstones or pancreatic cancer Obstructive jaundice Increase conjugated No change/slight increase to unconjugated
62
What is the function of gamma-globulins?
Participates in immune responses
63
Who doesn't want to make toys?
This guy
64
What glucose metabolism pathways does the liver perform?
Glycogenolysis Glycogenesis Gluconeogenesis
65
What is bilirubin?
The waste product of hemoglobin degredation. Specifically it is the degraded heme portion.
67
In serious liver disease, AMMONIA can often accumulate in the blood & lead to a state called hepatic _______ or hepatic \_\_\_\_\_\_\_\_\_\_.
Coma Encephalopathy
68
Where are drugs metabolized? What is the most important enzymatic pathways?
Liver Cytochrom P450
69
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.
1/2 gall bladder
71
What do hepatocytes add to free/unconjugated/indirect bilirubin to make it conjugated/direct? What is the enzyme required?
glucuronic acid glucuronyl transferase
72
What are 2 waste products commonly found in bile?
Lipophilic drugs/metabolites Antigen-antibody complexes
73
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
cholangiocytes
74
A "lipid panel" of a liver failure patient will exhibit what with respect to the following: Alkaline phosphatase Gamma-glutamyl transferase Lactate-dehydrogenase
These are non-specific enzymes that are multifactoral. They are not used for detecting liver damage

Digestion (16 decks)

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