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GOATED BRS > Hepatobilliary system > Flashcards

Hepatobilliary system Flashcards

1
Q

How many liver segments are there and how many are there per lobe

A

8, 4 each

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2
Q

1?

A

Right lobe

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3
Q

2?

A

Diaphragm

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4
Q

3?

A

Left lobe

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5
Q

4?

A

Falciform ligament

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6
Q

5?

A

Ligamentum teres

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7
Q

6?

A

Gallbladder

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8
Q

Describe the blood inflow and outflow of the liver

A

Inflow:
75% Hepatic portal vein
25% Hepatic artery

Outflow:
Bile
3x hepatic veins

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9
Q

What is the purpose of blood delivered by the hepatic artery and the hepatic portal vein?

A

HPV:Deliver digested products to the liver

HA: Deliver oxygenated blood for resp/met

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10
Q

Describe the morphology of a liver lobule, incl what is in every corner and what’s in the center

A

Hexagonal structural unit of liver tissue

Each corner consists of a portal triad
Links with 3x adjacent lobules

Centre of liver lobule is a central vein
Collects blood from hepatic sinusoids → hepatic veins → systemic venous system

Within lobule rows of hepatocytes
Each has sinusoid-facing side & bile canaliculi-facing side

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11
Q

What are the 3 vessels contained within a portal triad and what are their functions?

A

Branch of hepatic artery
Brings O2-rich blood into liver to support hepatocytes ↑ energy demands
Branch of portal vein
Mixed venous blood from GIT (nutrients, bacteria & toxins) and spleen (waste products)
Hepatocytes process nutrients, detoxify blood & excrete waste
Bile duct
Bile produced by hepatocytes drains into bile canaliculi
Coalesce with cholangiocyte-lined bile ducts around lobule perimeter

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12
Q

What is a hepatic acinus and what is contained within it

A

Functional unit of liver
Hard to define anatomically cf hepatic lobule

Consists of two adjacent 1/6th hepatic lobules
Share 2x portal triads
Extend into hepatic lobules as far as central vein

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13
Q

Outline the microfunction of a hepatic acinus, including the blood supply and drainage and the zone by zone O2 conc and risk of toxicity.

A

Blood into hepatic acinus via Point A (portal triad)
Blood drains out of hepatic acinus via Point B (central vein)
Hepatocytes near outer hepatic lobule(zone 1) receive early exposure to blood contents:
Good components (O2)
Bad components (toxins)
Acinus split into 3x regions
Zone 1 – O2 ↑, Toxin risk ↑
Zone 2 – O2 →, Toxin risk →
Zone 3 – O2 ↓, Toxin risk ↓

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14
Q

What nerve innervates the gall bladder

A

The vagus nerve

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15
Q

Give 3 unusual characteristics of a hepatic sinusoid endothelial cell

A

No basement membrane

Fenestrated (discontinuous endothelium)

Allow lipids & large molecule movement to and from hepatocytes

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16
Q

What is the role of kupffer cells

A

Hepatic Sinusoidal macrophage cells

Attached to endothelial cells

-Phagocystosis
Eliminate & detoxify substances arriving in liver from portal circulation

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17
Q

What is the role of hepatic stellate cells

A

(Ito; perisinusoidal)
Exist in dormant state
Store vit A in liver cytosolic droplets
Activated (fibroblasts) in response to liver damage
Proliferate, chemotactic & deposit collagen in ECM

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18
Q

What is the function and shape of a hepatocyte

A

80% of liver mass
Cubical
Synthesis e.g. albumin, clotting factors & bile salts
Drug metabolism
Receive nutrients & building blocks from sinusoids

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19
Q

What is the role of a hepatic cholangiocyte

A

Secrete HCO3- & H2O into bile

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20
Q

Give the 3 general functions of hepatocytes

A

Metabolic & catabolic functions:synthesis & utilization of carbohydrates, lipids and proteins.

Secretory& excretory functions:synthesis &secretion of proteins, bile and waste products.

Detoxification & immunological functions:breakdown of ingested pathogens & processing of drugs

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21
Q

Glycolysis def and where is occurs

A

Anaerobic conversion of glucose → lactate
- (RBCs, renal medulla & skeletal muscle)
Aerobic oxidation of glucose (CNS, heart,
- (Skeletal muscle, most organs)

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22
Q

Glycogenesis def and where it occurs

A

synthesis of glycogen from glucose
- (liver & muscle)

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23
Q

Glycogenolysis def

A

Breakdown of glycogen into glucose

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24
Q

Gluconeogenesis def

A

Production of glucose from non-sugar molecules
-Amino acids (glutamine) in liver & renal cortex
-Lactate (from anaerobic glycolysis in RBCs & muscles)
-Glycerol (from lipolysis)

25
Lipolysis def
Breakdown of triacylglycerols into FFAs and glycerol
26
Lipogenesis def
Synthesis of triacylglycerols
27
Outline the function of hepatocytes within carbohydrate met
Glucose from the liver is released, travels to muscle cell Undergoes glycolysis, forming pyruvate then lactate **Lactate travels to hepatocyte and is recycled by lactate dehydrogenase into pyruvate** ATP is used to power gluconeogenesis to reproduce glucose and restart the cycle
28
Outline the function of hepatocytes within protein synthesis
Amino acids (either from muscle cell in fasted state or diet in fed state) travel to hepatocyte They are turned into secreted proteins
29
Outline the function on hepatocytes within non-essential amino-acid synthesis
-All occurs in the liver Dietary alanine is processed into a-ketoglutarate Reversible reaction then forms glutamate and pyruvate via **transamination**
30
Which amino acids can be formed from a-ketoglutarate?
Glutamate, proline, arginine
31
Which amino acids can be formed from pyruvate?
Alanine, valine, leucine
32
Which amino acids can be formed from oxaloacetate?
Aspartate, methionine, lysine
33
What issue does the glucose alanine cycle solve?
For conversion of amino acids into glucose -Removal of nitrogen as urea -Conversion of pyruvate into glucose
34
Outline the glucose alanine cycle?
Glutamate/pyruvate is converted to alanine in muscle cell Alanine travels to the liver, is deaminated to produce urea as well as converted into pyruvate The pyruvate is converted into glucose in the liver and then transported to muscle to be respired
35
Outline hepatocytes role within fat metabolism
Triglycerides are converted to fatty acids They are transported to the liver B-oxidation converts them into acetyl CoA which enters the TCA cycle(Conversion to acetoacetate and then release as tissue energy source)
36
How are lipoproteins synthesised within hepatocytes?
Hepatic glucose is converted into pyruvate and glycerol, then acetyl CoA, then into cholesterol via HMG CoA-reductase The glycerol is converted into tri-acyl glycerol, apoproteins, phospholipids and cholesterol, which combine to form lipoproteins
37
What occurs to lipoproteins after synthesis?
HDL-Picks up excess cholesterol LDL-Transport cholesterol to tissues VLDL-Transport fatty acids to tissues(incl. muscle)
38
What do hepatocytes store?
**Storage of fat soluble vitamins (A,D,E,K)** Stores sufficient 6-12 month (except Vit K where store is small) Vit K essential blood clotting **Storage of iron as ferritin** Available for erythropoeisis **Vitamin B12** Copper(Excess Cu is Wilsons')
39
How do hepatocytes detoxify blood?
**P450 enzymes** Phase 1 (modification) – more hydrophilic Phase 2 (conjugation) – attach water soluble side chain to make less reactive
40
Outline the gross composition of bile
41
Give the 3 major functions of bile
**Cholesterol homeostasis** **Absorption of lipids & lipid soluble vitamins (A, D, E, & K)** **Excretion** of: xenobiotics/drugs cholesterol metabolites adrenocortical & other steroid hormones Alkaline phosphatase
42
What causes biles' colour?
Yellow-Bilirubin Green-Biliverdin
43
How much bile is produced per day and by what?
500mls/day 60% from hepatocytes 40% from cholangiocytes
44
Outline the primary/secondary secretion stages of bile and what happens in each of them
Primary-secretion **Bile secretions reflect serum concentrations Secretion of bile salts (acids), lipids & organic ions** Secondary-modification **Alteration of pH (alkaline electrolyte solution) H2O drawn into bile by osmosis via paracellular junctions Luminal glucose & organic acids reabsorbed HCO3- & Cl- actively secreted into bile by CFTR (Cystic Fibrosis Transmembrane Regulator) IgA exocytosed**
45
What are the proteins which are responsible for the biliary excretion of bile salts & toxins
Biliary transporters
46
What are the main importers(basolateral) in the bile tube?
Organic anion transporting peptide (OATPs) – bile salt uptake Na+ taurocholate-cotransporting polypeptide (NTCP) - bile salt uptake
47
What are the main exporters(apical) in the bile tube?
**Bile Salt Excretory Pump (BSEP)** – active transport of BAs into bile **MDR related proteins (MRP2 & MRP3)** – -vely charged metabolites **Products of multidrug resistance genes** MDR1 → excretion of neutral & +ve xenobiotics & cytotoxins MDR3 → phospatidylcholine
48
What is the key component of bile and what is it synthesised from?
Bile salts(acids) -Synthed from cholesterol
49
What are Na+ and K+ conjugated into in the liver?
Glycine and taurine
50
What are the 2 primary bile acids, where are they synthesised and what do they turn into and how?
**Cholic acid** --> Deoxycholic acid **Chenodeoxycholic acid** --> Lithocolic acid >Both are converted by gut bacteria
51
What are the 2 surfaces of micelles and give their properties
1x surface hydrophilic domains (hydroxyl & carboxyl) - faces OUT → dissolves in water 2nd surface hydrophobic domains (nucleus & methyl) faces IN → dissolves in fat
52
Outline the overall function of bile salts and enzymes in the digestion of lipids
1. Emulsification Bile salts and phospholipids form micelles around triglycerides 2. Enzyme action Lipase and Colipase break down the triglycerides into glycerol and FFAs
53
What is the sphincter of Oddi and when does it open/close?
Between meals Sphincter of Oddi closed → bile diverted into gall bladder for storage Eating → Sphincter of Oddi relaxes Gastric contents (FFAs, AAs > CHOs) enter duodenum causing release of cholecystokinin (CCK) CCK causes gall bladder to contract
54
What happens to bile salts after their role in absorption?
**95% bile salts reabsorbed from terminal ileum** By Na+/bile salt co-transport Na+-K+ ATPase system **5% converted to 2o bile acids in colon:** Deoxycholic acid absorbed 99% Lithocolic acid excreted in stool Absorbed B.salts back to liver & re-excreted in bile
55
Give 2 functions of the gall bladder in relation to bile
Stores ~50ml of bile -Concentrates and acidifies bile
56
How does the gall bladder contract?
CCK(Cholecystokinin) binds to **CCKA receptors & neuronal plexus of GB** wall (innervated by preganglionic parasympathetic fibres of vagus nerve)
57
Give the sources of bilirubin
75% BR from Hb (erythrocytes) breakdown 22% from catabolism of other haemoproteins 3% from ineffective BM erythropoiesis
58
How much bilirubin is excreted into bile daily and what is the percentage breakdown of where it ends up
200-250mg BR excreted into bile/day **85% excreted in faeces** BR→urobilinogen→stercobilinogen→stercobilin(brown) **15% enters enterohepatic circulation** BR→deconjugated→lipophilic form Urobilinogen Stercobilinogen 1% enters systemic circulation & excreted by kidneys
59
Outline some of the causes of jaundice

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