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GIGU > Hepatobiliary Function > Flashcards

Hepatobiliary Function Flashcards

1
Q

Main functions of the liver?

A

Bile production and secretion
Metabolism
Bilirubin production and secretion
Detoxification of substances

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2
Q

What does the liver convert to urea?

A

Ammonia

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3
Q

Liver failure can result in _______ that results in edema

A

Hypoalbuminemia

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4
Q

The portal vein brings nutrient rich blood to the liver from what sources?

A 
Colon
Small intestine
Pancreas
Stomach
Spleen
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5
Q

Cirrhosis

A

Chronic liver disease where liver cells are damaged and replaced with scar tissue

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6
Q

What is the most common cause of cirrhosis?

A

Excessive alcohol consumption

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7
Q

Excessive alcohol consumption causes what to accumulate in the hepatocytes?

A

Fat

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8
Q

If fat is deposited in hepatocytes, what can it lead to?

A

Steatohepatitis - fatty liver that leads to inflammation, scarring and cirrhosis

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9
Q

Excessive alcohol consumption causes fat to deposit in the liver cells. What can this ultimately result in?

A

Cirrhosis - damage of liver cells and formation of scar tissue

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10
Q

What can cause portal hypertension?

A

Cirrhosis

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11
Q

Portal hypertension

A

Resistance to portal blood flow

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12
Q

2 signs that portal hypertension is present

A
  1. Esophageal varices

2. Caput medusae

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13
Q

Esophageal varices

A

Swollen connections between systemic and portal systems at inferior end of esophagus - seen with portal hypertension, resistance to blood flow

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14
Q

Caput medusae

A

Swollen connections between systemic and portal systems around umbilicus - seen with portal hypertension, resistance to blood flow

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15
Q

What can lead to hepatic encephalopathy?

A

Liver dysfunction

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16
Q

Cirrhosis or portal hypertension can result in a ______ hepatic urea cycle

A

DECREASED

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17
Q

If the urea cycle is not occurring, what is building up in the systemic blood?

A

Ammonia

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18
Q

Accumulation of ammonia can do what?

A

It crosses the blood brain barrier and ALTERS BRAIN FUNCTION

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19
Q

Main things that bile is composed of?

A

Cholesterol
Bile acids and bile salts
Phospholipids
Ions and water

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20
Q

Bile makes lipids?

A

Soluble

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21
Q

Once concentrated bile is released from the liver, what stimuli can cause absorption of ions and water to it to dilute it and increase the volume?

A

Secretin

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22
Q

What stimuli causes gallbladder contraction and sphincter of oddi relaxation to successfully secrete bile into the duodenum in response to food?

A

CCK

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23
Q

Where are bile acids absorbed for reuse?

A

Ileum

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24
Q

The recycled bile acids are actively secreted into?

A

Bile canaliculi along with the newly synthesized bile acids

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25
Q

What 2 stimuli stimulate bile secretion?

A
  1. Bile acids drive bile formation

2. Secretin (small portion)

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26
Q

As the liver secretes bile acids, it is accompanied by?

A

Passive movement of cations (+)

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27
Q

Secretin stimulates bile excretion from?

A

Ductile cells

28
Q

Secretin activates the release of what from ductile cells into the bile?

A

HCO3-
Water
Na+

29
Q

Describe what happens with bile secretion during the interdigestive period while you are not eating

A

The gallbladder is filling and is relaxed

The sphincter of Oddi into the duodenum is contracted and closed

30
Q

Describe what happens with bile secretion during eating

A

CCK mediates:

  • gallbladder contraction to empty contents
  • Relaxation and opening of the sphincter of Oddi to allow bile into the duodenum
31
Q

Bile salts are sent from the ileum into _____ to go back to the liver for reuse

A

Portal blood (enterohepatic circulation)

32
Q

Hepatocytes uptake bile salts across the basolateral membrane using what 2 transporters?

A
  1. NTCP - Na+ dependent

2. OATP - Na+ independent

33
Q

What transporter on the enterocyte in the ileum absorbs bile acids?

A

ASBT - with Na+

34
Q

What transporter on the enterocyte in the ileum sends bile acids into enterohepatic circulation?

A

OSTalpha-OSTbeta

35
Q

The hepatocytes use what 2 transporters to absorb bile acids from the portal circulation?

A

NTCP and OATP

36
Q

What 2 transporters use ATP to help pump bile acids back into the bile canaliculi?

37
Q

7alpha - hydroxylase is inhibited by?

A

Bile salts

- As they return via portal circulation to the liver, they inhibit their own formation!

38
Q

Red blood cell (RBC) breakdown in the bloodstream creates?

A

Bilirubin-Albumin complex

39
Q

Bilirubin is then sent to the liver for uptake. What enzyme is required to convert bilirubin to its conjugated form?

A

UDP-glucuronyltransferase

40
Q

If a neonate has some jaundice right after birth, why could that be?

A

UDP-glucuronyltransferase takes some time to develop
OR
Bilirubin production is high due to fetal RBCs breaking down

41
Q

If the liver cannot take bilirubin to its conjugated form, what will result?

A

UNconjugated hyperbilirubinemia

42
Q

If the liver can take bilirubin to its conjugated form, where does it send it?

A

Into the bile to go to the small intestine

43
Q

As conjugated bilirubin is sent into the small intestine, what is it changed to in the colon?

A

Urobilin and stercobilin

44
Q

What gives stool its dark color?

A

Urobilin and stercobilin (conjugated bilirubin break down in the colon)

45
Q

Direct bilirubin

A

Conjugated

46
Q

Indirect bilirubin

A

UNconjugated

47
Q

Jaundice is due to?

A

Hyperbilirubinemia

48
Q

Hemolytic anemia

A

Increased RBC breakdown = increased UNCONJUGATED bilirubin

49
Q

Neonatal jaundice has increased?

A

UNCONJUGATED bilirubin

50
Q

Gilbert’s syndrome has increased?

A

UNCONJUGATED bilirubin

51
Q

Crigler - Najjar syndrome has increased?

A

UNCONJUGATED bilirubin

52
Q

Dubin - Johnson has increased?

A

Conjugated bilirubin

53
Q

Rotor’s syndrome has increased?

A

Conjugated bilirubin

54
Q

If there is a buildup of conjugated bilirubin, what is the problem?

A

The liver can convert bilirubin to it’s conjugated form but cannot excrete it into the bile

55
Q

Primary therapy for neonates with UNconjugated hyperbilirubinemia?

A

Phototherapy

56
Q

Phototherapy should be used if total serum bilirubin is above?

57
Q

2 things that can cause gallstones?

A
  1. Excess pigment of bilirubin breakdown

2. Excess cholesterol

58
Q

Excess pigment of bilirubin breakdown can be seen with what disease?

A

Hemolytic anemia

59
Q

Obstruction of cystic duct, intermittent pain

A

Cholecystitis

60
Q

Gallstone occluding common bile duct

A

Choledocholithiasis

61
Q

Choledocholithiasis can result in what symptoms?

A

Jaundice and Hyperbilirubinemia

62
Q

Cholangitis

A

Infection of bile duct

63
Q

Hepatocyte injury levels of ALT or AST

64
Q

Bile duct injury lab value

A

Increased alkaline phosphatase

65
Q

Albumin levels fall as?

A

Liver function declines, such as cirrhosis

66
Q

PT levels increase as the liver decreases?

A

Production of clotting factors

GIGU (29 decks)

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