Hepatic/GI Flashcards
What are the fat soluble vitamins?
A, D, E, K
What clotting factors are produced by the liver?
All except VWF, factor 3, 4, and 8
Where is bile produced?
Liver
Where is bile stored?
Gallbladder
What is bilirubin?
The end product of hemoglobin metabolism or destruction of aged RBCs. Gives bile it’s green color and jaundice it’s yellow color
Is unconjugated bilirubin water or fat soluble?
Fat soluble. Conjugation makes a molecule water soluble, bioinactive, and ready for excretion
Where is conjugated bilirubin excreted?
Into bile
What are the clotting factors that depend on adequate vitamin K?
Factor 2, 7, 9, 10, and prothrombin
Connection between bile production and alterations in bleeding?
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
Which way does bile flow?
In the opposite direction of blood in the liver
Liver damage does what to platelet count?
Bone marrow depression and decreased thrombopoietin leads to decreased platelet production
Where are platelets stored?
The spleen
Connection between liver failure and a certain blood syndrome?
Liver failure -> Portal HTN -> splenomegaly -> inc. platelet consumption -> thrombocytopenia
What drugs induce the cytochrome P450 system?
Barbiturates, ethanol, phenytoin, rifampin, carbamazepine
What are the 2 phases of reactions in hepatic metabolism?
Phase 1: Modification and Phase 2: Conjugation
3 types of Phase 1 reactions (modification) you should know?
- Oxidation (remove electron)
- Reduction (add electron)
- Hydrolysis (add water to split a compound apart, usually an ester)
3 anatomic structures that make up the portal tract?
Hepatic artery, portal vein, bile duct
Function of Space of Disse?
Structure in the liver that facilitates removal of excess fluid through the lymphatic system
Zones 1-3…. what’s important to know?
Zone 1 is closest to oxygen rich blood, zone 3 is furthest and therefore most susceptible to ischemia
Normal portal vein pressure?
3-5 mmHg
Normal gradient between portal vein pressure and hepatic vein pressure?
<5 mmHg
Kupffer cells…
macrophages in liver that line the sinusoids
Stellate cells…
remove foreign substances from the blood and trap bacteria
Portal HTN is defined as elevation above…
5 mmHg
What is deamination? Why is it significant?
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
What structure drains the gallbladder?
Common bile duct
What structure controls the common bile duct secretion into the duodenum?
Major duodenal papilla
Ampulla of Vater
Structure that is the union between the common bile duct and the pancreatic duct
Asterixis
Neuro symptoms following liver disease. Hand/wrist flapping tremor caused by hepatic encephalopathy when ammonia crosses the BBB due to liver damage
What is formed in the liver that you may not expect?
1/2 of all lymph fluid
