GI 4

Question 1

What are Glisson’s capsule?

Answer 1

Dense outer lining of liver
coated by visceral peritoneum (mesothelium)
Continuous with portal canal

Question 2

Describe the classic hepatic lobule

Answer 2

Central vein (terminal hepatic venule)
Portal canals - at outer angles - artery, vein, duct
Sinusoidal capillaries (cells literally bathed in blood)

Question 3

What’s the space of mall

Answer 3

Space between peripeheral plates and triad (artery, vein, duct)

Where lymph originates

Question 4

What’s the portal triad?

Answer 4

Portal vein, artery, and bile duct in portal canal

Question 5

Tell me about liver blood supply

Answer 5

Dual blood flow

75% comes from portal vein
25% comes from hepatic artery proper

Question 6

What are Kupffer cells?

Answer 6

In sinusoids
Cleanses blood
“bite” red blood cells

Question 7

Sinusoids of liver

Answer 7

Discontinuous endothelium
Discontinuous basal lamina - for rapid transfer of materials

Kupffer cells reside there

Question 8

Perisinusoidal Space (of disse)

Answer 8

Contains Hepatic stellate cell (perisinusoidal cell)
- lots of lipid droplets, Vitamin A, not much activity usually

Between epithelium and membrane of hepatocyte
Microvilli extend into there to more rapidly exchange material

Question 9

Portal Lobule

Answer 9

Exocrine (bile) territory draining into bile duct

This was the triangle from 3 adjacent central veins; the cells there dump the bile into the one central portal canal

Question 10

Hepatic Acinus (of Rappaport)

Answer 10

Diamond shape between 2 adjacent hepatic lobules, contains zones 1, 2, and 3

Question 11

Primary Lobule, (liver lobule)

Answer 11

Like a slice of pie
Pie-sliced area of hepatic lobule
Extends from central vein to 2 sides, including portal triad

Question 12

Zone 1

Answer 12

Higher O2 concentration
Regenerative capacity

Fatty-acid oxidation, glucose-liberating enzymes

Question 13

Zone 3

Answer 13

Fatty-acid synthesizing enzymes
Detox occurs here
- Acetaminophen toxicity causes necrosis here first
Glycolysis enzymes

First to necrose

Question 14

Functions of liver

Answer 14

Detox (in SR)
Glycogen metabolism
Protein synthesis
Bile acid synthesis
Bilirubin conjugation and secretion

Question 15

Gilbery syndrome

Answer 15

Bilirubin conjugation reduced

causes insanity, mental retardation, and possible death around age 28

Question 16

Crigler-Najjar syndrome

Answer 16

Bilirubin conjugation decreased (type II)
 or none (type I - fatal)

Question 17

Dubin-Johnson Syndrome

Answer 17

Decreased secretion of conjugated bilirubin, due to absence of MDR-2 canalicular transport protein

pneumonic - Mr. DJ

Question 18

What happens in fatty liver changes/alcohol cirrhosis?

Answer 18

Perisinusoidal cell (hepatic stellate cell) goes crazy

Gets provoked, becomes synthetic - lays down collagen (“and contractility”?)

Question 19

What is the bile canaliculus?

Answer 19

first collecting structure for bile

No ductal cells - simply lined by plasma membrane of hepatocytes

Question 20

Outline the flow of bile

Answer 20

Secreted into bile canaliculus (apical lumen of hepatocytes)

Flows down to a duct - Canal of Herring
- lined simply by ductalar cells

Goes into bile ducts (in portal triads) - simple cuboidal

Hepatic ducts - simple columnar epithelium

Question 21

Where are hepatic stem cells located?

Answer 21

In the canal of herring

Question 22

Layers of the gallbladder (3)

Answer 22

Mucosa
Muscularis
CT layer of serosa/adventitia
adventitia - between gallbladder and liver
serosa - faces peritoneal cavity
Gallbladder cancer metastasizes where there is no serosa (no epithelial lining)

Question 23

Rokitansky-Aschoff Sinuses

Answer 23

Normal - extend through muscularis in gall bladder

Originate in mucosa

Question 24

Cholesterolosis

Answer 24

Macrophages loaded with cholesterol

Question 25

Which cells of the pancreas are endocrine and which are exocrine?

Answer 25

Endocrine - islets of Langerhans

Exocrine - acinar cells

Question 26

What do pancreatic duct cells secrete?

Answer 26

Water

Ions of which HCO3- are important in neutralizing chyme

Question 27

What are two primary causes of acute pancreatitis?

Answer 27

Alcohol and gallstones

Digestive enzymes stored in inactive form in acinar cells; injuring acinar cells causes premature activation of these enzymes

Question 28

What happens if the bile canaliculus is damaged?

Answer 28

Damage to bile canaliculus can cause increase in alkaline phosphatase