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GI II > Ketchum- Liver and gallbladder > Flashcards

Ketchum- Liver and gallbladder Flashcards

1
Q

What surrounds all four lobes of the liver

A

Glisson’s capsule- dense irregular CT

simple squamous epithelium

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2
Q

What runs through the porta hepatis

A

hepatic ducts, portal vein,hepatic artery

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3
Q

What is the distribution of blood supply to liver

A

20-25% of CO
75% from portal vein
25% from hepatic a

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4
Q

Where does blood exit liver

A

hepatic veins and enters IVC

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5
Q

What are the generalized functions of the liver

A 
take up digested nutrients
store and release compounds
synthesize
detox
bile formation and secretion
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6
Q

What nutrients does the liver take up

A

carbs, aa, lipids and vitamins

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7
Q

What does the liver store and release

A

glucose, triglycerids and vitamins

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8
Q

what does the liver synthesize

A

albumin, prothrombin, fibrinogen, a&b globulins, glucose, FA, triglycerides, cholesterol, phospholipids and lipoproteins

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9
Q

What does the liver detoxify

A

metabolites, drugs, xenobiotics, bacteria, immunoglobulin complexes, worn out cells and proteins

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10
Q

how much bile does the liver produce each day

A

750 ml/day

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11
Q

what extra functions does the liver have

A

sequesters IgA into bile, converts T4–>T3, embryonic hematopoesis, somatomedin production

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12
Q

What runs in the hepatic or portal triad

A

portal vein, hepatic a, bile ductule, lymph vessel

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13
Q

The lymph vessel in the hepatic triad comes from and goes wehre

A

derived from space of Disse and goes to periportal tissue space of mall

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14
Q

describe the protein content of lymph capillaries compaired to plasma

A

30%

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15
Q

Describe blood flow from portal vein

A

interlobar v-> interlobular v-> distributing (perilobular v)-> inlet venule –> sinusoids –> central v –>sublobular –>collecting v –>hepatic v–>IVC

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16
Q

describe blood flow from hepatic a

A

interlobar a –> interlobular a–>distributing a–> inlet a–> sinusoids–>central v–>sublobular v–>collecting v–>hepatic v–>IVC

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17
Q

What is a liver lobule

A

the polyhedral structure of hepatocytes

blood enters at periphery and percolates via sinusoids, leaves via central vein in the middle

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18
Q

describe the bile course in a liver lobule

A

bile travels counter-current and leaves at periphery of lobule

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19
Q

What is a muralium

A

the wall of cells(hepatocytes) that form liver lobule

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20
Q

What is the lifespan of a hepatocyte

A

150 days

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21
Q

describe the structure of hepatocytes

A

most cells mononuclear, many bi-nucleate cells, most 80% are polyploid (tetraploid, 4N)

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22
Q

how thick is the muralium in adults? infants?

A

2 cells thick in infants

1 cell thick by age 2

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23
Q

what are the 3 surfaces of a hepatocyte

A

sinusoidal, baso-lateral, bile canalicular

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24
Q

Describe the structure of sinusoids

A

the wall is discontinuous with supporting reticular fibers to facilitate blood access and no cells into space of Disse

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25
Q

What are examples of sinusoidal cells

A

Kupffer cells, endothelial cells, fibroblasts, lipocytes, hemtopoetic cells during fetal life

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26
Q

What stroma in the liver is altered in disease

A

the sinusoidal stroma in hepatic fibrosis, hepatic cirrhosis

Increase CT alters normal function

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27
Q

What are the 3 types of liver lobules

A 
classic lobule (endocrine nature)
portal lobule (exocrine nature)
portal acinus (based on metabolic donation)
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28
Q

Why is the structure of the classic liver lobule important for function

A

emphasizes endocrine function to secrete synthesized products into blood

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29
Q

Describe differences in the general shapes of liver lobules

A

classic- polygonal

portal - triangular

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30
Q

Why is the structure of the portal lobule important for function

A

triangular shape with portal canal in center and central v at peripheries
exocrine function to secrete synthesized products into duct (bile)

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31
Q

Describe structure of the portal acinus lobule

A

portal triads and central vv at periphery
metabolic activity (peripheral->central and central–>peripheral)
hepatic regeneration, development cirrhosis, centrolobular necrosis

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32
Q

Describe zone 1 in the portal acinus lobule

A

zone 1- periportal zone, receives blood with highest [ ] of nutrients/oxygen
last to die first to regenerate

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33
Q

Describe zone 2 of the portal acinus lobule

A

mid region, receives blood of intermediate “quality”

34
Q

Describe zone 3 of the portal acinus lobule

A

centrolobular
receives blood with lowest nutrient/oxygen content from zone 2
first cells to die in centrolobular necrosis

35
Q

The zonal differences of the portal acinus lobule reflect differences in what

A

carb metabolism, protein metabolism, lipid metabolism, drug metabolism

36
Q

In a partial hepatectomy what areas regenerate

A

hepatocytes of all zones regenerate

37
Q

how does the liver regenerate in hepatic cirrhosis

A

abnormal regeneration, cT elements don’t cooperate in regeneration
results in altered hepatic structure and compromised parenchymal function

38
Q

What is half life of mitochondria in hepatocytes

A

10.5 days

39
Q

How to mitochondria replicate and what is the function

A 
form by budding
function in oxidative phosphorylation, urea cycel, TCA cycle, lipid oxidation
40
Q

What is the function of lysosomes in hepatocytes

A

autophagy (internal structures)

heterophagy (external structures)

41
Q

Describe the internal environment of a lysosome

A

low pH 4-5
need for lysosomal enzymes maintained by ATP H pump
40-50 catabolic enzymes present

42
Q

What endocrine R do lysosomes have in hepatocytes

A 
growth hormone
prolactin
insulin
glucagon
norepinephrine
43
Q

Examples of lysosomal diseases

A 
Tay Sachs(sphingolipidosis)
metachromatic leukodystrophy(sulfatidosis)
Type II glycogenosis
44
Q

What causes Tay Sachs

A

absence of B hexosaminidase A

degrades fatty gangliosides

45
Q

What causes metachromatic leukodystrophy

A

absence of aryisulfatase to cause accumulation of sulfated cerebrosides

46
Q

What causes type II glycogenosis

A

acid maltase is absent

47
Q

What proteins are synthesized in the rER of hepatocytes

A

albumin, prothrombin, fibrinogen

48
Q

Are the synthesized proteins in hepatocytes stored in secretion granules

A

no, secreted in small clear vesicles

49
Q

Where do hepatocytes make VLDL

A

synthesize VLDL and completely formed in sER

50
Q

What is the role of sER in hepatocytes

A

synthesis of cholesterol and phospholipids
esterification of FFA to triglycerides
dehaloginase converts T4-T3
biotransformation of durgs, metabolites and xenobiotics to detox
synthesis of cholic acid (conjugation with glycine and taurine to form bile acids)
Ca storage and release

51
Q

How do hepatocytes store glucose

A

polymeric storage form of glucose–>glycogen

glycogen rosettes are seen near sER– assoc with those enzymes

52
Q

Where is glycogen derived from in liver

A

gluconeogenesis in periportal area

glucose in perivenous area

53
Q

What are peroximsomes (microbodies) in hepatocytes

A

membrane bound bodies that produce uric acid and oxidize substrates using O2 and H2O2
also can do peroxisome biogenesis

54
Q

What substrates are used for oxidases in peroxisomes

A

lactate, urate, D-AA, polyamines

55
Q

What substances are used for per oxidation reaction in peroxisomes

A

alcohols, formate, nitrite, quinones

56
Q

How to peroxisomes regenerate

A

bud from previous peroxisomes

bud from rER

57
Q

What are the cytoskeletal elements of hepatocytes

A

microtubules, microfilaments, intermediate filaments

58
Q

What is the role of microtubules in hepatocytes

A

involved in vesicular transport

59
Q

What is the function of microfilaments in heptocytes

A

submembranous and pericanalicular location important for bile flow

60
Q

What is the function of intermediate filaments

A

submembranous and pericanalicular location found in mallory bodies and seen in hepatic diseases

61
Q

describe the endothelial cells of liver

A

fenestrated without diaphragms
no pericytes
basal lamina is indistinct with type IV collagen and laminin detectable

62
Q

What type of collagen is in a liver fibroblast

A

type III

63
Q

What is the function of Kupfffer cells

A

Fc and C’ R because phagocytose IC, bacteria and non-immune particulates
bind and degrade Hb to bilirubin

64
Q

How can Kupffer cells help spleen out

A

can assist in RBC degradation

65
Q

What are the Ito cells in liver

A

hepatic lipocytes (fat cells)

66
Q

What do Ito cells do

A

take up Vit A rapidly and store

take up lopiphylic and membranolytic molecules that damage lysosomes

67
Q

What compunds are found in bile

A 
electrolytes (Na, K, Ca, Mg, Cl, HCO3)
biles acids
cholesterol conjugates (cholic and deoxycholic)
phopholipids
bilirubin-glucuronide
68
Q

What are the intraheptic ducts of biliary channels?

extrahepatic?

A

intrahepatic–> bile canaliculus, terminal ductules, interlobular bile ducts
extrahepatic–>right & left hepatic ducts, proper hepatic duct, cystic duct, common bile duct

69
Q

What seals the bile canaliculi

A

zonula occludens & desmosomes

70
Q

where are the golgi and sER oriented to in biliary channel

A

towards bile canaliculus

71
Q

what are the terminal ductules of the biliary channels and describe them

A

transition from canaliculus to interlobular bile ducts
basal surface is attached to hepatocytes
have flat cuboidal epithelium
HCO3 secreting pinocytotic vesicles modify bile

72
Q

Describe characteristics of interlobular bile ducts

A

cuboidal to columnar epithelium
surrounded by elastic and collagen CT
surrounded by sm m at porta hepatis
seen in cholangiograms because narrow

73
Q

Where are the extrahepatic ducts and describe them

A

right, left, proper hepatic ducts
tall columnar cells with occasional mucous cells
mucosa, submucosa, muscularis, adventitia

74
Q

Describe structure of cystic duct

A

neck twists, throwing spiral fold into mucosa

75
Q

What is different about the common bile duct when compared to hepatic ducts

A

circumferential sm m sphincter present (sphincter of Boyden or choledochus)

76
Q

When the gallbladder is full what does it look like, empty?

A

full has even surface

empty has decussating folds or rugae

77
Q

Describe mucosa of gallbladder

A

simple columnar epithelium with microvilli
desmosomes
Rokintansky-Aschoff crypts (invaginations of surface epithelium)
mucus glands near neck

78
Q

Describe the lamina propria of gall bladder

A

thin layer dense irregular CT
numerous small blood vessels
numerous small lymph vessels
no muscularis mucosa

79
Q

Describe submucosa of gallbladder

A

no submucosa

80
Q

Describe the muscularis externa of gallbladder

A

tunica muscularis

smooth m layer with some collagen and elastic fibers

81
Q

describe serosa of gallbladder

A

thick layer dense irregular CT
abundant aa, vv and lymph
mesothelium covers underlying CT

82
Q

What are the secretory stimuli for gall bladder

A

from enteroendocrine cells: secretin(HCO3 and H2O) and CCK(contraction)

GI II (12 decks)

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