Hepatic/GI

Question 1

What are the fat soluble vitamins?

Answer 1

A, D, E, K

Question 2

What clotting factors are produced by the liver?

Answer 2

All except VWF, factor 3, 4, and 8

Question 3

Where is bile produced?

Answer 3

Liver

Question 4

Where is bile stored?

Answer 4

Gallbladder

Question 5

What is bilirubin?

Answer 5

The end product of hemoglobin metabolism or destruction of aged RBCs. Gives bile it’s green color and jaundice it’s yellow color

Question 6

Is unconjugated bilirubin water or fat soluble?

Answer 6

Fat soluble. Conjugation makes a molecule water soluble, bioinactive, and ready for excretion

Question 7

Where is conjugated bilirubin excreted?

Answer 7

Into bile

Question 8

What are the clotting factors that depend on adequate vitamin K?

Answer 8

Factor 2, 7, 9, 10, and prothrombin

Question 9

Connection between bile production and alterations in bleeding?

Answer 9

Bile salts needed to reabsorb fat. Vitamin K is fat soluble. In liver disease, bile production is reduced (bc liver produces bile). Which leads to decreased vit K absorption, which leads to decreased ability to clot, which leads to coagulopathy

Question 10

Which way does bile flow?

Answer 10

In the opposite direction of blood in the liver

Question 11

Liver damage does what to platelet count?

Answer 11

Bone marrow depression and decreased thrombopoietin leads to decreased platelet production

Question 12

Where are platelets stored?

Answer 12

The spleen

Question 13

Connection between liver failure and a certain blood syndrome?

Answer 13

Liver failure -> Portal HTN -> splenomegaly -> inc. platelet consumption -> thrombocytopenia

Question 14

What drugs induce the cytochrome P450 system?

Answer 14

Barbiturates, ethanol, phenytoin, rifampin, carbamazepine

Question 15

What are the 2 phases of reactions in hepatic metabolism?

Answer 15

Phase 1: Modification and Phase 2: Conjugation

Question 16

3 types of Phase 1 reactions (modification) you should know?

Answer 16

1. Oxidation (remove electron)
2. Reduction (add electron)
3. Hydrolysis (add water to split a compound apart, usually an ester)

Question 17

3 anatomic structures that make up the portal tract?

Answer 17

Hepatic artery, portal vein, bile duct

Question 18

Function of Space of Disse?

Answer 18

Structure in the liver that facilitates removal of excess fluid through the lymphatic system

Question 19

Zones 1-3…. what’s important to know?

Answer 19

Zone 1 is closest to oxygen rich blood, zone 3 is furthest and therefore most susceptible to ischemia

Question 20

Normal portal vein pressure?

Answer 20

3-5 mmHg

Question 21

Normal gradient between portal vein pressure and hepatic vein pressure?

Answer 21

<5 mmHg

Question 22

Kupffer cells…

Answer 22

macrophages in liver that line the sinusoids

Question 23

Stellate cells…

Answer 23

remove foreign substances from the blood and trap bacteria

Question 24

Portal HTN is defined as elevation above…

Answer 24

5 mmHg

Question 25

What is deamination? Why is it significant?

Answer 25

The removal of ammonia from amino acids to create CHO. The ammonia is converted to urea by the liver and urea is excreted by the kidneys

Question 26

What structure drains the gallbladder?

Answer 26

Common bile duct

Question 27

What structure controls the common bile duct secretion into the duodenum?

Answer 27

Major duodenal papilla

Question 28

Ampulla of Vater

Answer 28

Structure that is the union between the common bile duct and the pancreatic duct

Question 29

Asterixis

Answer 29

Neuro symptoms following liver disease. Hand/wrist flapping tremor caused by hepatic encephalopathy when ammonia crosses the BBB due to liver damage

Question 30

What is formed in the liver that you may not expect?

Answer 30

1/2 of all lymph fluid