Integrated histology and pathophysiology: hepatic and biliary

Question 1

Where do the hepatic veins drain into?

Answer 1

IVC

Question 2

What is Wilson’s disease?

Answer 2

Copper is not properly disposed of by the liver so it accumulates in other tissues causing Keyser-Fleischer ring in the eye and causing Parkinson’s diseaese by depositing in the basal ganglia

Question 3

What are some ways that the liver helps dispose of excess copper?

Answer 3

1. Billiary excretion of copper
2. Ceruloplasmin production

Defect in either of these mechanisms can cause Wilson’s disease. Excess copper in the liver can lead to Cirrhosis

Question 4

The liver is responsible for chylomicron destruction via which enzyme?

Answer 4

Endothelial lipoprotein lipase

Question 5

The liver is responsible for the production of all plasma proteins except for one. What is the exception?

Answer 5

y-globulins

Question 6

What are the two phases of liver detoxification?

Answer 6

PHASE 1:
oxidation
reduction
hydrolysis

PHASE 2:
conjugation

Question 7

What co-factor does phase 1 of liver detoxification require?

Answer 7

P-450

Question 8

What cells convert heme to bilirubin?

Answer 8

Macrophages in the liver

Question 9

What enzyme is required for the conversion of Heme to bilirubin?

Answer 9

Heme oxygenase

Question 10

During phase 2 of the elimination of bilirubin, what enzyme is required for its conjugation?

Answer 10

Glucuronyl transferase is required to conjugate bilirubin with glucuronic acid

Question 11

Where is bilirubin diglucuronide converted to Urobilinogen?

Answer 11

In the gut (flora)

Question 12

What gives urine its yellow color?

Answer 12

Urobilinogen

Question 13

What gives feces its brown color?

Answer 13

Stercobilin

Question 14

What are cholangiocytes?

Answer 14

They are the cuboidal epithelial cells of the bile duct.

Question 15

What do cholangiocytes secrete?

Answer 15

Water and bicarb

Question 16

How much of the bile is reabsorbed by the gut each day?

Answer 16

95%

Question 17

In the small intestines, what converts primary bile acids to secondary bile acids?

Answer 17

Bacterial enzymes

Question 18

How is bilirubin diglucuronide transported from the liver to the gut?

Answer 18

with the bile

Question 19

If bile is being reabsorbed, where does it go from the gut?

Answer 19

to the Portal vein and then to the hepatocyte

Question 20

True or False: Bile reabsorption from the gut into the portal vein is a carrier-mediated absorption.

Answer 20

FALSE: Bile reabsorption in the gut is Na dependent.

Question 21

True or False: Bile salt uptake and secretion from the hepatocyte is carrier-mediated.

Answer 21

TRUE

Question 22

Which part of the intestine allows for bile salt reabsorption into the portal vein?

Answer 22

Terminal ileum

Question 23

Which part of the intestines recieves bile salts from the liver?

Answer 23

Duodenum

Question 24

What type of transport is responsible for secretion of bile salts from the hepatocytes into the canaliculus? Is it active or passive

Answer 24

Carrier-mediated secretion (active)

Question 25

What type of transport is required for secretion of urea from the hepatocytes into the canaliculus?

Answer 25

Passive movement or urea

Question 26

Is bicarb secreted into the bile duct? If so, what cells are responsible?

Answer 26

Bicarb is secreted into the bile duct by cholangiocytes (which line the lumen of bile duct)

Question 27

What channel is responsible for pumping Cl- out of cholangiocytes and into the bile duct lumen?

Answer 27

CFTR

Question 28

How is bicarb secreted from cholangiocytes?

Answer 28

via a Cl-/bicarb anion exchanger (Cl- enters the cell from the bile duct lumen and bicarb exits the cell to join the bile)

Question 29

In an anion exchanger, does Cl- enter the cell or exit the cell?

Answer 29

Cl- enters the cell and bicarb exits the cell.

Question 30

TRUE or FALSE: Cl- and bicarb enter the cholangiocytes from the basal aspect with the help of Na/K pumps.

Answer 30

TRUE

Question 31

How does secretin affect bicarb secretion by the cholangiocyte?

Answer 31

increases secretion

Question 32

How does Glucagon affect bicarb secretion by the cholangiocytes?

Answer 32

increases secretion

Question 33

How does VIP affect bicarb secretion by the cholangiocytes?

Answer 33

increases secretion

Question 34

How does somatostatin affect bicarb secretion by the cholangiocytes?

Answer 34

decreases secretion

Question 35

What is Cholelithiasis?

Answer 35

gallstones: calcium bilirunibate

- symptoms determined by location of stones