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BRS > Hepatobiliary system > Flashcards

Hepatobiliary system Flashcards

1
Q

What blood vessels supply the liver?

A

Hepatic artery and portal vein.

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2
Q

What vessels leave the liver?

A

3x hepatic veins and common bile duct.

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3
Q

How many segments make up the liver?

A

8.

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4
Q

What is a hepatic lobule?

A

Hexagonal structural unit of liver tissue.

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5
Q

Describe the structure of a hepatic lobule?

A

Each corner consists of a portal triad. Centre of liver lobule is the central vein. Within the lobule you have rows of hepatocytes.

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6
Q

What are hepatocytes facing?

A

Bile canaliculi and hepatic sinusoids.

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7
Q

What makes up the portal triad?

A

Branch of hepatic artery. Branch of portal vein. Bile duct.

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8
Q

What is the function of the branch of hepatic artery that arrives at the portal triad?

A

Bring oxygen rich blood to the liver.

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9
Q

What is the function of the branch of portal vein that arrives at the portal triad?

A

To bring nutrients, bacteria and toxins from GI tract and waste products from spleen.

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10
Q

Where does bile produced by hepatocytes drain into?

A

Bile canaliculi.

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11
Q

What is the functional unit of the liver?

A

Hepatic acinus.

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12
Q

What does the hepatic acinus consist of?

A

Two adjacent 1/6th hepatic lobules. Share 2 portal triads.

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13
Q

Where does blood enter the hepatic acinus from?

A

Portal triads.

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14
Q

Where does blood drain from the hepatic acinus?

A

Central veins.

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15
Q

Why do hepatocytes in hepatic acinus zone 1 receive the most oxygen but also has the greatest toxin risk?

A

Receive early exposure to blood contents as closest to portal triad.

High oxygen from branch of hepatic artery but also toxins from branch of portal vein.

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16
Q

How many hepatic acinus zones are there?

A

3.

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17
Q

Which hepatic acinus zone has the greatest oxygen exposure but also greatest toxin risk?

A

Zone 1.

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18
Q

Which hepatic acinus zone has the lowest oxygen exposure but also lowest toxin risk?

A

Zone 3.

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19
Q

Structure of sinusoidal endothelial cells?

A

No basement membrane, discontinuous.

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20
Q

What does the structure of sinusoidal endothelial cells allow?

A

Allows lipids and large molecules to move to and from hepatocytes.

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21
Q

What cells are attached to the sinusoidal endothelial cells?

A

Kupffer cells.

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22
Q

What are kupffer cells?

A

Sinusoidal macrophage cells.

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23
Q

What do kupffer cells do?

A

Eliminate and detoxify substances arriving to the liver from portal circulation.

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24
Q

Where are hepatic stellate cells located?

A

Space of disse (space in between sinusoid and hepatocytes).

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25
Q

What do hepatic stellate cells do?

A

Exist in dormant state. Store vitamin A in liver cytosolic droplets.

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26
Q

What activates hepatic stellate cells and what occurs once activated?

A

Activated in response to liver damage. Once activated they act as fibroblasts and deposit collagen in ECM.

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27
Q

What shape are hepatocytes?

A

Cubical.

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28
Q

Role of hepatocytes?

A

Synthesis of compounds and drug metabolism (detoxification).

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29
Q

Role of cholangiocytes?

A

Secrete bicarbonate and water into bile.

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30
Q

What is a key protein to check for liver function?

A

Serum albumin.

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31
Q

What enzymes are key for production of non essential amino acids?

A

Transaminases.

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32
Q

What does transamination of alanine and alpha keto glutarate give you?

A

Pyruvate and glutamate (non essential amino acid).

33
Q

How are amino acids from muscle converted to glucose via the glucose alanine cycle?

A

Glutamate from muscle breakdown. Glutamate undergoes transamination with pyruvate in the muscle cell to produce alanine. Alanine moves to liver where along with alpha keto glutarate undergoes transamination again to produce glutamate and pyruvate. Pyruvate converted to glucose. Glutamate undergoes deamination.

34
Q

What process occurs in the liver and converts fatty acids to acetyl CoA?

A

Beta oxidation.

35
Q

How are lipoproteins synthesised in the liver?

A

Uptake of glucose. Glucose converted to pyruvate which is converted to acetyl CoA. Acetyl CoA converted to cholesterol and fatty acids. Fatty acids added to glycerol to produce triacylglycerol. Triacylglycerol + cholesterol + apoprotein + phospholipids = lipoprotein.

36
Q

What are the fat soluble vitamins?

A

Vitamins A,D,E,K

37
Q

What minerals/vitamins do hepatocytes store?

A

Vitamins B12, A,D,E,K. Iron and copper.

38
Q

What are the 2 phases of detoxification?

A

Modification and conjugation.

39
Q

What occurs in phase one of detoxification? What enzymes drives this phase?

A

Make molecule more hydrophillic. Cytochrome P450 enzymes.

40
Q

What occurs in phase two of detoxification?

A

Attach water soluble side chain to make less reactive.

41
Q

What are the bile pigments?

A

Bilirubin (yellow) and biliverden (green).

42
Q

What is excreted in bile?

A

Xenobiotics, cholesterol metabolites, alkaline phosphatase.

43
Q

What does bile help absorb?

A

Lipids and lipid soluble vitamins.

44
Q

How do cholangiocytes alter bile?

A

Raise pH. Bicarbonate and chloride actively pumped into bile by CFTR. Water drawn into bile by osmosis via paracellular junctions. Luminal glucose and organic acids reabsorbed.

45
Q

What surface of the hepatocyte are bile salt uptake channels located on?

A

Basolateral membrane (facing sinusoids).

46
Q

What surface of the hepatocyte are bile salt export channels located on?

A

Apical surface facing bile canaliculi.

47
Q

What bile salt uptake channels are present in hepatocytes?

A

organic anion transporting peptides (OATPs) and Na+ taurocholate-cotransporting polypeptide (NTCP).

48
Q

What bile salt export channels are present in hepatocytes?

A

Bile salt excretory pump (BSEP)
MDR (multi drug resistant) related proteins
MDR1 and MDR3

49
Q

What do MDR (multi drug resistant) related proteins like MRP2 and MRP3 export into bile?

A

Negatively charged metabolites.

50
Q

What do MDR1 channels export into bile?

A

Excretion of neutral and positive xenobiotics.

51
Q

What do MDR3 channels export into bile?

A

Phospatidylcholine.

52
Q

What are primary bile acids produced from?

A

Cholesterol.

53
Q

Where are primary bile acids produced?

A

Liver.

54
Q

What are the primary bile acids?

A

Cholic acid and chenodeoxycholic acid.

55
Q

Where does formation of secondary bile acids occur? What converts primary bile acids to secondary bile acids?

A

In colon by gut bacteria.

56
Q

What are the secondary bile acids?

A

Deoxycholic acid and lithocholic acid.

57
Q

What amino acids are bile salts normally conjugated to?

A

Glycine or taurine.

58
Q

Function of bile acids?

A

Reduce surface tension of fats. Emulsify fat

59
Q

What do bile acids form to in digestion of fat?

A

Micelles

60
Q

What in the micelles face out?

A

Hydrophilic domains.

61
Q

What in the micelles face in?

A

Hydrophobic domains.

62
Q

What molecules are located on the inside of micelles?

A

FFA’s and cholesterol.

63
Q

What kind of molecule are micelles?

A

Amphipathic.

64
Q

What hormone cause gall bladder to contract?

A

Cholecystokinin.

65
Q

What sphincter allows release of bile into duodenum?

A

Sphincter of oddi.

66
Q

Where are bile salts reabsorbed?

A

Terminal ileum.

67
Q

What reabsorbs bile salts?

A

Bile salt co transport Na K+ ATPase system.

68
Q

What secondary bile salt is excreted in stool?

A

Lithocolic acid.

69
Q

Functions of gallbladder?

A

Stores bile. Concentrates and acidifies bile.

70
Q

Free bilirubin (unconjugated) solubility?

A

Water insoluble.

71
Q

What is the main source of bilirubin?

A

Break down of erythrocytes.

72
Q

What transports free bilirubin in the blood?

A

Albumin.

73
Q

What happens when bilirubin from the blood arrives in the liver?

A

Conjugated with 2 molecules of UDP-glucuronate to produce bilirubin diglucuronide. Secreted across concentration gradient into biliary canaliculi where it makes its way to GI tract for excretion.

74
Q

Where is most bilirubin excreted? Where else is it excreted?

A

Mostly excreted in faeces. Small amount excreted by kidneys.

75
Q

What is bilirubin converted to before it is excreted?

A

Urobillin and stercobillin.

76
Q

What happens to bilirubin that is not excreted?

A

Enters enterohepatic circulation and goes back to liver.

77
Q

Prehepatic jaundice causes?

A

Too much erythrocyte turnover.

78
Q

Intrahepatic jaundice causes?

A

Acute and chronic liver damage.

79
Q

Posthepatic jaundice causes?

A

Gallstone, tumours.

BRS (52 decks)

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