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Pathophys II MHM - Exam 1 > GI Module 4 > Flashcards

GI Module 4 Flashcards

1
Q

What connective tissue does the liver consist of?

A
  • Falciform ligament

- Glisson’s capsule

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2
Q

What is Glisson’s capsule?

A
  • Connective tissue that surrounds the liver

- Invaginates at hilum of liver

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3
Q

What is the functional unit of the liver?

A

Liver lobule

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4
Q

What is a liver lobule?

A
  • Functional unit
  • Hexagonal arrangement of hepatocytes and microvasculature
  • Central vein
  • Portal triad at each outer corner of hexagon
  • Microvasculature consists of sinusoids and bile canaliculi
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5
Q

What is a portal triad?

A
  • Outer corner of hexagon in liver lobule

- Consists of hepatic artery, portal vein, bile duct

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6
Q

What is the biliary pathway?

A

Bile canaliculi - terminal bile ducts - R/L hepatic ducts - common hepatic duct

  • Then cystic duct - gallbladder
  • And common bile duct - pancreatic duct - duodenum
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7
Q

Hepatic circulation generally consists of:

A
  • Afferent pathways to liver (portal and arterial)
  • Sinusoids
  • Efferent pathway from liver
  • Lymphatic circulation
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8
Q

Where does the hepatic portal vein receive blood from?

A

GI tract, spleen, pancreas

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9
Q

What is the hepatic portal anastomosis?

A
  • Collateral venous circulation w/numerous veins of abdominopelvic region
  • Consists of: gastroesophageal vein, rectal, paraumbilical, portorenal
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10
Q

Describe portal hypertension

A
  • Portal circulation is congested and reverses blood flow toward portal anastomoses
  • Occurs when cirrhosis develops
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11
Q

Where does the hepatic artery originate from and what does it do?

A
  • Originates from celiac trunk
  • Delivers oxygenated blood to liver
  • Approx 25% of blood flow to liver
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12
Q

What is the hepatic artery’s relationship with portal HTN?

A

Blood flow to liver from hepatic artery is NOT impaired

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13
Q

What is the function of sinusoids?

A
  • Act as capillary bed for hepatocytes
  • Receives blood from 2 of 3 portal triad vessels
  • Merges nutrient rich and O2 rich blood
  • Exposes hepatocytes to blood flow
  • Drains into central vein
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14
Q

General structure of sinusoid/hepatocyte interface

A
  • Kupffer cells
  • Fenestrated endothelium
  • Space of Disse
  • Microvilli of hepatocyte
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15
Q

Describe Kupffer cells including location and function

A
  • Monocyte/macrophage origin
  • Located along surface of endothelium
  • Serves as early defense against liver injury (phagocytic removal, RBC degradation)
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16
Q

Describe fenestrated endothelium

A
  • Large holes in endothelial lining of sinusoid vessel
  • Allows nutrients/lipids to travel through and flow to microvilli of hepatocyte
  • Pinocytosis function to actively transport molecules as well
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17
Q

What are stellate cells? Function and location?

A
  • Located in Disse Space of sinusoids
  • Stores Vit A
  • Produces/secretes hepatic GF for liver regeneration
18
Q

What happens to stellate cells in some sort of pathology?

A
  • Transform into fibroblastic function (produce collagen) and myoblastic function (contractile)
  • Role in fibrosis
19
Q

What are pit cells? Location and function?

A
  • Aka granular lymphocytes (NK cells)
  • Located surface of endothelium in sinusoids
  • Front line immune defense
  • Some role in liver regeneration too
20
Q

Which organ produces the largest amount of lymph fluid in the body?

A

Liver (approx 20% of total)

21
Q

What are the two regional zones of hepatocytes in liver lobule?

A
  • Periportal hepatocytes
  • Centrilobular hepatocytes
  • Sometimes a 3rd zone mid-way between is identified
22
Q

Describe periportal hepatocytes

A
  • Part of liver lobule circulation
  • First to receive blood
  • First to regenerate
  • Last to experience necrosis
23
Q

Describe centrilobular hepatocytes

A
  • Part of liver lobule circulation
  • Last to receive blood
  • Susceptible to ischemia/necrosis
  • Region of drug metabolism
24
Q

What is the region of drug metabolism in the liver?

A

Centrilobular hepatocytes

25
Q

How does the liver function in drug metabolism?

A
  • Serves as intermediate step

- Converts drugs from hydrophobic to hydrophilic to allow excretion

26
Q

What is gluconeogenesis?

A

Production of glucose from non-carb source (fatty acids, AAs, lactate)

27
Q

What is the rate limiting step of gluconeogenesis?

A
  • Amt of available substrate

- NOT liver enzymes

28
Q

How does the liver function in fat metabolism?

A

Removes FFA and lipoproteins from plasma

29
Q

Lipoproteins in order from largest to smallest in size:

A
  1. Chylomicrons
  2. VLDL
  3. LDL
  4. HDL
30
Q

Lipoproteins by function

A
  1. Chylomicrons - transport TGs
  2. VLDL - transport TGs to periphery
  3. LDL - transport cholesterol to peripheral tissue
  4. HDL - remove cholesterol from periphery to liver
31
Q

Bile fluid contains:

A
  • Bile acids
  • Phospholipids
  • Cholesterol
  • Other things via micelle complex
32
Q

Function of bile

A
  • Assist in intestinal fat digestion

- Excretion of hydrophobic substances

33
Q

Bile pathway during fasting

A
  • 75% flows into gallbladder to be concentrated

- 25% continues on and flows into duodenum

34
Q

Bile pathway during feeding

A
  • Gallbladder contracts via CCK and vagal stimuli

- Bile reaches duodenum and enters enterohepatic circulation

35
Q

What is bilirubin?

A

Byproduct of RBC breakdown

-Heme is broken down into biliverdin which is broken down into bilirubin

36
Q

How is RBC broken down?

A
  • Hemoglobin is exposed
  • Globin broken down to AAs
  • Heme broken into iron and biliverdin
37
Q

Is bilirubin fat or water soluble?

A

Fat soluble so it travels to liver to be conjugated for excretion

38
Q

What is urobilinogen?

A
  • Bilirubin in the intestine that is converted by bacteria
  • Remains in colon to be excreted in stool (80%)
  • 20% is reabsorbed into bloodstream
39
Q

What is jaundice?

A
  • Hyperbilirubinemia
  • Yellowing of skin and membranes
  • Sign of disease that affects bilirubin metabolism
40
Q

What is pre-hepatic jaundice?

A
  • Location of pathology is “before” bilirubin is conjugated by the hepatocytes
  • RBC breakdown, genetic diseases, kidney
41
Q

What is post-hepatic jaundice?

A
  • Pathology located “after” bilirubin is conjugated and secreted
  • Impaired transport to GI tract
  • Gallstones or pancreatic obstruction
  • Pale stools, dark urine
42
Q

What are the different types of gallstones?

A
  • Cholesterol (MC, yellowish/green)

- Pigment (black or brown)

Pathophys II MHM - Exam 1 (9 decks)

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