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I&I WC2 > Hepatology - Fundamentals > Flashcards

Hepatology - Fundamentals Flashcards

1
Q

What are the three main functions of the liver?

A
  1. Metabolism
  2. Synthesis & storage
  3. Detoxification
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2
Q

What are the three most important metabolic processes of the liver?

A
  1. Gluconeogenesis
  2. Glycogenesis
  3. Fatty acid oxidation & storage
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3
Q

What are important detoxification processes performed by the liver? (2)

A
  1. Removal of toxic byproducts & medications
  2. Removal of bacteria from the blood
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4
Q

True or false: the liver is the most important organ when it comes to clearing bacteria from the blood

A

False: the spleen is more important

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5
Q

What are products synthesized by the liver? (5)

A
  1. Non-essential amino acids
  2. Clotting factors, albumin & immunological factors
  3. Cholesterol & lipoproteins
  4. Phospholipids
  5. Bile
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6
Q

Which nutrients are stored in the liver?

A
  1. Fat-soluble vitamins
  2. Minerals
  3. Sugar
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7
Q

What is the function of lipoproteins?

A

Transport of lipids throughout the body

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8
Q

Why is the synthesis of phospholipids by the liver of vital importance?

A

These are needed in the cell membranes of all body cells

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9
Q

What are the functions of bile? (2)

A
  1. Excretion of byproducts such as cholesterol & haem
  2. Digestion of fat & absorption of fat-soluble vitamins
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10
Q

In which form is cholesterol excreted in bile?

A

Bile salts

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11
Q

In which form is haem excreted in bile?

A

(Conjugated) bilirubin

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12
Q

Which vitamins are stored in the liver? What why are these vitamins explicitly stored in the liver?

A

A, D, E & K
All fat-soluble vitamins

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13
Q

How do nutrients enter the liver?

A

Via the portal vein

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14
Q

What is the primary immunological function of the liver?

A

Production of clotting factors, complement & other immunolgical proteins for systemic immunity

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15
Q

What is the secondary immunological function of the liver?

A

Local defence against gut-derived pathogens, bacterial products & food toxins

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16
Q

What is the blood supply of the liver? What are the characteristics of the blood in each of these vessels?

A
  1. Portal vein = nutrient-rich, oxygen-poor
  2. Hepatic artery = nutrient-poor, oxygen-rich
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17
Q

What is the drainage system from the liver?

A

Central veins drain on the hepatic vein, which drains on the v. cava inferior

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18
Q

What is a liver lobulus?

A

Anatomical subdivision, consisting of sheets of hepatocytes bordered by 3-6 portal triads, draining into one central vein

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19
Q

Which structures can be found in a portal triad?

A
  1. Portal vein
  2. Hepatic artery
  3. Bile duct
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20
Q

How does blood flow from the portal triad to the central vein?

A

Via sinusoids

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21
Q

Which cells can be found in the sinusoids of the liver? (2)

A
  1. Liver sinusoidal epithelial cells (LSECs)
  2. Kupffer cells
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22
Q

True or false: hepatocytes directly contact the full blood flowing through the sinusoids

A

False: LSECs keep larger particles in the sinusoids, but smaller particles & fluid are able to pass through and directly contact the hepatocytes

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23
Q

What are the three most important groups of immunological factors synthesized by the liver? (3)

A
  1. Complement proteins
  2. Soluble pattern recognition receptors (sPRRs)
  3. Acute phase proteins
24
Q

What are acute phase proteins? (definition)

A

Proteins that dramatically increase in concentration during the acute phase response during infections

25
Which groups of proteins are seen as acute phase proteins? (6)
1. Antimicrobial peptides (AMPs) 2. Clotting factors (fibrinogen) 3. Proteinase factors 4. C-reactive protein (CRP) 5. Haptoglobin 6. Serum amyloid A (SAA)
26
What kind of protein is CRP?
C-reactive protein = soluble PRR, produced during the acute phase response
27
How is the acute phase response of the liver triggered?
IL-6 produced by macrophages at the site of infection
28
Why is it especially crucial that liver immunity is finely balanced between tolerance & immunity?
A lot of foreign compounds enter the body via the liver, which don't need to trigger an immune response
29
To which wanted (2) and unwanted (3) agents is the liver tolerant?
Wanted: 1. (Endo)toxins 2. Food antigens Unwanted: 1. HBV & HCV viruses 2. Plasmodium sporozoites 3. Tumour metastases
30
What is the most important endotoxin encounterd by the liver?
LPS
31
To which agents does the liver have immunity? (3)
1. HAV 2. Acute phase of HBV 3. Many bacterial species
32
What are the most important subsets of immune cells in the liver? (3)
1. Kupffer cells 2. LSECs 3. Dendritic cells
33
What kind of cell type are Kupffer cells?
Tissue-resident macrophages
34
How many % of body macrophages are Kupffer cells?
80%
35
What is the primary function of Kupffer cells?
Phagocytosis & degradation of particulate materials from blood
36
Which particulate materials are cleared from the blood by Kupffer cells? (3)
1. Dying cells 2. Aged erythrocytes 3. Pathogens
37
How do Kupffer cells phagocytose particulate matters?
They have a broad range of receptors to detect particulate matters in the blood
38
Which phagocytic receptors can be found on Kupffer cells? (5)
1. Scavenger receptors 2. FcγR and FcαR 3. Complement receptors 4. TLR3, -4 & -9 5. IgA-receptors
39
What is the function of TLRs in Kupffer cells?
Help switch Kupffer cells from tolerogenic to pro-inflammatory in case of pathogen invasion
40
What is the function of IgA-receptors on Kupffer cells?
Form a second line of defence in case of breach of the mucosal immune barrier
41
True or false: Kupffer cells are professional APCs
True
42
What is the role of Kupffer cells as APCs?
Low MHCII expression = moderate T-cell stimulatory capacity -> mainly tolerogenic
43
Which three tolerogenic mechanisms are employed by Kupffer cells?
1. Production of IL-10 & prostaglandins -> suppresses T-cell activation 2. Induction of Treg expansion 3. Scavenging of pathogenic epitopes
44
What is the primary function of LSECs?
Removal of waste products
45
Why are LSECs especially suited to remove waste products from the blood?
The slow blood flow in sinusoids facilitates detection & capture of pathogens, proteins & toxins
46
What is the main mechanism by which LSECs remove waste products from the blood?
Receptor-mediated endocytosis
47
Which receptors do LSECs express to facilitate receptor-mediated endocytosis? (2)
1. Scavenger receptors 2. Carbohydrate receptors
48
Which compounds are recognized by the scavenger receptors of LSECs? (3)
1. Modified LDL 2. Modified proteins 3. Denatured collagen
49
True or false: LSECs have a prominent role in liver immunity
False; they rarely stimulate the immune system
50
Through which mechanisms do LSECs have some role in liver immunity? (2)
1. Endocytosis 2. Antigen presentation
51
What are the tolerogenic mechanisms employed by LSECs? (3)
1. Production of anti-inflammatory factors 2. Suppression of CD8+ activation 3. Stimulation of Tregs through presentation on MHCII
52
Which anti-inflammatory factors do LSECs produce? (2)
1. TGF-β 2. IL-10
53
How do LSECs suppress CD8+ activation?
1. Cross-presentation on MHCI -> non-productive activation 2. Expression of PD-L1
54
How do liver DCs differ from systemic DCs?
They have tolerogenic properties
55
What is the specific tolerogenic property of liver-DCs?
IL-10 & IDO secretion upon TLR stimulation -> active induction of Tregs
56
True or false: liver DCs can have pro-inflammatory effects
True; stimulation of specific PRRs may cause them to switch to a more pro-inflammatory phenotype

I&I WC2 (25 decks)

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