Jack's Jaundice Flashcards
Where is the superior pancreaticcoduodenal artery derived from?
The gastroduodenal which is in turn derived from the coeliac trunk
What is a portal triad?
Bile duct, portal vein and hepatic artery found on the edge of each hexagonal liver lobule
What colour do serous glands stain?
Darkly
Where do large hepatic veins drain to?
The portion of the vena cava that indents onto the liver
What are bile salts synthesised from?
Cholesterol
Where is the inferior pancreaticcoduodenal artery derived from?
The superior mesenteric artery
What spaces bound the liver above and below?
Sub-phrenic above and hepato-renal below
Which BAC will impair gag reflex causing choking on own vomit?
0.2
How is hepatitis B transmitted?
Bodily fluid eg sexual intercourse, sharing needles, tattoos, blood contact
Which immunoglobulin is indicative of a past infection?
IgG
How are fatty acids absorbed in the small intestine?
Bile salts form a micelle around them, in the sER fat droplets are then formed, then packaged into apoproteins in the Golgi, chylomicrons and VLDLs bud off and exit cell via exocytosis from basal membrane passing to capillaries
Where does the cystic artery arise from?
The right branch of the hepatic artery
What do the left and right leaflets of the coronary ligament form anteriorly and posteriorly?
Anteriorly the left and right leaflets of the coronary ligaments form the falciform ligament and posteriorly they form the lesser omentum
What is the half life of albumin?
14 days
Which hormone controls bile flow?
Cholecystokinin (CCK)
What is gynecomastia?
Hormone build up as liver cannot break them down causing female like characteristics in males ie breasts
What kind of autonomic innervation does the pancreas have?
Sympathetic
How is ethanol broken down into CO2 and H2O?
1) broken down into acetaldehyde by cytochrome P450 and alcohol dehydrogenase and catalase
2) converted to acetate by acetaldehyde dehydrogenase
3) acetate broken down to CO2 and H2O
Which lobe of the liver has a tail?
The caudate lobe
How and where does saliva become hypotonic?
The Na+ pumps in the striated duct reabsorb Na+ and Cl- and replace them with K+ and HCO3- so saliva is hypotonic
What is the normal range for bilirubin?
3-17 micro mols
Where does the liver get 75% of it’s blood supply from?
Deoxygenated blood from the entire GI tract via the portal vein comes to be detoxified.
How does the gall bladder concentrate bile?
Using Na+K+ATPase pumps to reabsorb water in the same way as in the kidney
What are the symptoms of viral hepatitis?
Malaise, fever, headache, jaundice, dark urine, clay coloured faeces,
What is the porta hepatis?
Point of entry and exit for the hepatic portal vein, left and right hepatic arteries and left and right hepatic bile ducts.
Where are dorsal pancreatic artery and arteria pancreatica magna derived from?
Splenic artery
Which virus causes hepatitis?
Adenovirus hepatitis
Which BAC may cause coma and even be fatal due to respiratory arrest?
0.4
Where does the tail of the pancreas lie?
To the hilum of the spleen
Describe how the common bile duct is formed.
From union of cystic duct and common hepatic duct (from union of right and left hepatic ducts)
Where does the body of the pancreas lie?
Crossing the aorta
Where does the upper surface of the liver lie?
Beneath the diaphragm approximately to the level of the level of the xiphisternal joint
How does methanol poisoning cause CNS toxicity?
Formation of formic acid which disturbs neuronal mitochondrial function and causes acidosis
Define parotid, submandibular and sublingual glands with regards to serous or mucosal secretions.
Parotid: serous
Sublingual: mucus
Submandibular: mixed
Why may liver failure lead to malnutrition?
Glucose intolerance, alterations in amino acid metabolism, decreased bile acids so can’t absorb fat, no appetite due to ascites, hyper metabolism from hormone imbalance, increased resting energy expenditure, increased pro inflammatory cytokines
What is apocrine secretion?
Membrane bound and vesicle release
Which BAC will causes motor impairment and lack of physical control?
0.13-015
Where do chylomicrons carry fat to and from?
From gut to liver
What are the junctions of anterior and posterior leaflets of the coronary ligaments called?
Left and right triangular ligaments
What kind of secretions do serous glands secrete?
Watery secretions
Where do HDLs carry fat to and from?
From tissues to liver
Which five ligaments connect the liver to the diaphragm?
Membranous falciform, coronary, right and left triangular ligaments and the fibrous round ligament
What are the symptoms of foetal alcohol syndrome?
Dysmorphic facial features, growth deficiency, CNS impairment affecting learning and behaviour, decreased brain size
Which lobe of liver is largest?
Right as it contains caudate and quadrate lobes
How do mucus glands stain?
Pale staining
Where is the liver in contact with the diaphragm?
At its bare area which is devoid of peritoneum
Which strains of hepatitis cause chronic infection and which don’t?
B, C, D cause chronic infection
A and E don’t
Where is the fundus of the pancreas located?
Where the linea semilunaris meets the costal margin
Where do VLDLs carry fat to and from?
From liver to adipocyte and muscle
What is the endocrine function of the pancreas?
Hormonal regulation of blood glucose levels
Which artery supplies the gall bladder?
Cystic artery
How is bile production stimulated?
Acidic chyme entering duodenum, secretin secretion into blood, free fatty acids stimulate CCK release causing gall bladder contraction
Which arteries supply the pancreas?
Dorsal pancreatic artery, arteria pancreatica magna, superior pancreaticcoduodenal artery and the inferior pancreaticoduodenal
Why may painless jaundice occur?
Obstruction of bile duct forcing bile into blood
Where does the lower border of the liver correspond to?
The right costal margin
Where does the neck of the pancreas lie?
On the right of the aorta
What is at the free edge of the lesser omentum?
Porta hepatis
What are the parts of the pancreas?
Head, neck, body, tail and uncinate process
What is the posterior surface of the kidney also known as?
The visceral surface as it comes into contact with other organs
What is in the bare area of the liver?
The vena cava is embedded in it and the coronary ligament surrounds it
What is the median survival from ascites onset?
2 years
What usually breaks paracetamol down? What happens in overdose?
P450 which becomes depleted if overused. If depleted quione bonds covalently to cell proteins and kills cells
How much bile can the gallbladder store?
50ml
Which co transporters are used to draw fluid out of bile and concentrate it?
Na+/Cl-
Which veins drain into portal vein ultimately?
Superior and middle rectal, superior and inferior mesenteric and short and left gastric
How is hepatitis A transmitted?
Faecal-oral, IV
What is the normal paracetamol pathway?
1) conjugation (coupling) with glucuronide sulphate into non toxic metabolites (90%) 2) metabolism by CYP450 isoforms into N-acetyl-p-benzquione-imine (NABQI) which is detoxified by glutathione at a normal dose
Why would there be hypoglycaemia in liver failure?
Insulin not being broken down
What is immune dependant cytoxicity?
An effector cell of the immune system lyses a target cell who’s cell surface antigen have been bound by specific antigens
What is merocrine secretion?
Via exocytosis
Which organs are in contact with the liver?
Stomach, duodenum, oesophagus, gallbladder, hepatic flexure of colon and right kidney
Which hepatic arteries supply quadrate and caudate lobes of the liver?
Left
What is the incubation period for hepatitis B?
6 weeks - 6 months
How is paracetamol overdose treated?
N-acetyl cysteine to detoxify NABQI
Which immunoglobulin is indicative of a recent infection?
IgA
What is the ligamentum venosum?
Runs inferiorly from lesser omentum and is a vestigal remnant of the foetal duct, ductus venosus.
Where does the liver get 25% of it’s blood supply from?
Oxygenated blood via the left and right hepatic arteries
What is icteric infection?
Infection resolved without any symptoms but the carrier state can result in cirrhosis and carcinoma of liver eventually
What causes the ‘Asian flush’ upon alcohol consumption?
Polymorphism in alcohol dehydrogenase 2 (ALDH2) allows acetaldehyde to reach high levels in blood causes flushing of face, headaches and increased risk of colon cancer
Where is the lesser omentum attached to the liver?
In the fissure for the ligamentum venosum
Which four anastomoses between systemic and portal circulation could be opened up in the event of blockage of the portal vein to divert blood flow?
- In the lower oesophagus
- In the anal canal
- via recanalisation of umbilical vein to anterior abdominal wall
- via anastomoses on the posterior abdominal wall
Where do LDLs carry fat to and from?
From liver to tissues
When is the liver palpable?
When hard and enlarged
What is a sinusoid?
A space where blood drains pat a row of hepatocytes
What are the three main pathologies of liver failure?
Ascites, jaundice and brain damage
What is the incubation period for hepatitis A?
3-5 weeks
What are bile pigments?
Break down products of haemoglobin- bilirubin and biliverdin
What is bilirubin bound to in the blood?
Albumin
How is ascites treated?
Aldesterone antagonist: spironolactone
How are bile salts recycled?
Actively absorbed in terminal iluem and returned to liver in the portal circulation
How is bile production stimulated by the nervous system?
Parasympathetic impulses via vagus
How is ascites caused?
Portal hypertension due to liver fibrosis causes back log of fluid in abdomen which leaks into tissues
What is ascites?
Accumulation of fluid in peritoneal cavity causing blood vessel prominence (medusas head) and bloating
What is the exocrine function of the pancreas?
Release of enzymes and salts
Where is the sphincter of Oddi?
Controlling bile and pancreatic juice entering the duodenum at the ampulla of Vater
What is the bioavailability of a drug?
The proportion of drug absorbed when it reaches the systemic circulation
What happens in paracetamol overdose?
Glucuronide pathway is saturated so NABQI pathway dominates and no glutathione to detoxify the toxic NABQI
Which immunoglobulin is present in saliva?
IgA
Where do the head and uncinate process of the pancreas lie?
In the C-shape of the duodenum
What is an enteric virus?
One which occupies the GI tract
Why there be additional bacterial infections in liver failure?
Loss of Kuffer cell function means bacterial challenge from gut, frequent gram negative infections, breed in ascites fluid
What is the Km for class 1 alcohol dehydrogenases?
0.05-3.4 mM
How is hepatitis B treated?
Drugs Lanividine, Adenfouir
What is the legal BAC for driving?
0.08
What are the three ducts in acinar glands?
Intercalated, striated and excretory
What is holocrine secretion?
Whole cells released ie sebaceous glands
What are the four lobes of the liver?
Left and right anteriorly, caudate and quadrate posteriorly
What are Kuffer cells?
The macrophages of the liver
