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GI Final > Hepatobiliary Function > Flashcards

Hepatobiliary Function Flashcards

1
Q

What two mechanisms stimulate bile secretion?

A
  1. Bile acid - dependent (MAJOR)

Movement of cations into the canaliculus

(canalicular bile is an ultrafiltrate of plasma)

  1. Secretin (Bile acid - independent)
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2
Q

What causes gallstones (cholelithiasis)?

A

Excess of either bilirubin or cholesterol breakdown

Too much absorption of water or bile acids or cholesterol in bile.

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3
Q

What are the functions of the liver?

A
  1. Detoxifies drugs/toxins
  2. Bile production/secretion
  3. Metabolizes carbs, proteins, lipids
  4. Bilirubin production/excretion
  5. Recieves absorbed nutrients
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4
Q
A
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5
Q

What is the most common cause of cirrhosis? This leads to what?

A

Excessive alcohol intake

Leads to fatty liver (steatohepatitis)

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6
Q

What 2 diseases have increased conjugated bilirubin?

A
  1. Dubin Johnson
  2. Gilberts

(Dustin Golub)

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7
Q

If the ileum is resected and enterohepatic circulation is interrupted what happens?

A

Bile synthesis will be way higher than normal

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8
Q

When a patient has liver failure, what symptom can they exhibit?

A

Edema from hypoalbumnemia

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9
Q

When the function of the liver (ammonia –> urea) is damaged via cirrhosis & portosystemic shunting this leads to what?

A

Hepatic encephalopathy

Urea cycle impairment –> Increased ammonia in systemic circulation —> Damage brain

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10
Q

What is cirrhosis?

A

Chronic liver disease where normal liver cells are damaged and replaced by scar tissue.

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11
Q

What is the enzyme that turns bilirubin into its conjugated form?

A

UDP glucuronyl transferase

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12
Q

What % of bile acids are excreted into feces? This means?

A

5%

This means that 90% of bile acids are recycled via portal blood and only 5% of bile needs to be synthesized by the liver.

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13
Q

Decreased albumin means?

A

Severe impairment of hepatocyte function

Ex. cirrhosis

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14
Q

Bile salts are recirculated to the liver via _______.

A

Enterohepatic circulation

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15
Q

What 2 changes are associated w/ portal hypertension?

A
  1. Esohageal varices ( veins get swollen between systemic + portal systems @ inferior end of esophagus)
  2. Caput medusae (swollen connections between systemic + portal systems around umbilicus)
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16
Q

What is the cause of physiologic neonatal jaundice?

A

Increased RBC destruction

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17
Q

What is a symptom of Crigler-Najjar syndrome Type 1?

A

Kernicterus: brain damage caused by accumulation of unconjugated bilirubin

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18
Q

What mutation causes Dubin Johnson?

A

MRP2

Liver is black

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19
Q

Somatostatin, atropine, cimetidine, and omeprazole do what to gastric secretion?

A

Decrease it

20
Q

List the compostion (+ %’s of bile)

A

50% = bile salts

40% = phospholipids

Rest = cholesterol, bile pigments (bilirubin), ions, h20

21
Q

If there is a lot of bile return and no need for synthesis what hormone is inhibited?

A

cholesterol 7 alpha - hydroxylase

22
Q

Elevated alkaline phosphatase means?

A

Bile duct injury (ex. gallstones)

23
Q

PT (prothromibin time) liver test means?

A

Reflects the degree of hepatic synthetic dysfunction

As PT increases chirrhosis in the liver is getting worse

Higher the PT the worse off you are

24
Q

Remember the liver sees all drugs or toxic substances first through “first pass metabolism”

A
25
Q

What membrane are bile salts actively secreted across?

A

The canalicular membrane

26
Q

What can cirrhosis cause? (besides steatohepatitis)

A

Portal hypertension (resistance to portal blood flow from scarring)

27
Q

What increases saliva secretion?

What decreses saliva secretion?

A

PNS

Sleep, dehydration, atropine

28
Q

When you are not eating is bile released?

A

No

29
Q

What 3 diseases have increased unconjugated bilirubin?

A
  1. Crigler Najar Syndrome
  2. Physiologic Juandice
  3. Hemolytic Anemia

(Cunts pull hair)

30
Q

Gastrin, ACh, and histamine do what to gastric secretin?

A

Increase it

31
Q

What is the primary treatment in neonates w/ unconjugated hyperbilirubinemia?

A

Phototherapy makes bilirubin soluble

32
Q

Bilirubin is made in the body when the hemoglobin protein in old red blood cells is broken down.

A
33
Q

What syndrome has both increased conjugated and unconjugated bilirubin?

A

Rotors Syndrome

(Majority = conjugated)

34
Q

Hemolytic anemia results in _________ and is from what?

A

Increased unconjugated bilirubin

Due to hemolysis.

35
Q

What mutations cause Rotor Syndrome?

A

OATP1B1 and OATP1B3 which transport bilirubin

36
Q

What are the metabolic functions of the liver?

A

carbs –> gluconeogenesis, store + release glucose

proteins –> synthesize non - AA’s + plasma proteins and convert ammonia to urea

lipids –> fatty acid oxidation, synthesis of phospholipids, cholesterol

37
Q

List the steps of bile secretion + absorption

A
  1. Sinthesis + secretion of bile salts
  2. Bile salts are stored + concentrated in the gallbladder
  3. CCK - induced gallbladder contraction + sphincter of Oddi relaxation
  4. Absorption of bile salts into the portal circulation
  5. Delivery of bile slats to the liver
38
Q

What mutation causes Gilbert syndome?

A

UDP glucuronyltransferase

39
Q

What is jaundice a sign of?

A

Hyperbilirubinemia

40
Q

What is the function of bile?

A

To emulsify fat

It makes lipids soluble (via micelles) so that they can be eliminated from the body

41
Q

What does bilirubin test measure?

A

Livers ability to detoxify metabolities and transport organic acids into bile

42
Q

Enterohepatic Circulation

A
43
Q

In enterohepatic circulation, what 2 systems transport bile salts across the basolateral membrane of hepatocytes?

A
  1. NTCP

(Na+ - dependent transport protein, sodium taurocholate cotransporting polypeptide)

  1. OATPs

(Na+ - independent transport protein, organic anaion transport proteins)

44
Q

What mutation causes Crigler - Najjar syndrome?

A

UDP gluccuronyltransferase

Type 1: NO function

Type 2: Partial function

45
Q

Elevated aminotransferase (AST/ALT) means?

A

liver damage

GI Final (12 decks)

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