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4th Yr - CMS 1 > Liver 1 > Flashcards

Liver 1 Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

how does blood drain from the gut?

A
  • blood drains from the gut into the portal venous system (portal vein) towards the liver
    (Portal Vein- Hepatic vein- Vena Cava)
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2
Q

What is the significance of the blood flowing from the gut into the liver through the portal venous system?

A

Nutrient-rich blood from the gut flows into the liver, allowing hepatocytes to filter and metabolize drugs and nutrients, including vitamins, before releasing them into the systemic circulation.

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3
Q

what happens if liver becomes inflamed or fibroused ?

A

it can impede blood flow through it thru portal vein and can lead to portal hypertension (raised pressure in the portal venal system)

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4
Q

what happens if you have liver disease ,portal hypertension and oesophageal varices?

A

can cause severe bleeding

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5
Q

where does the liver sit?

A

right side but passes thru midline
directly underneath diaphragm

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6
Q

what is special about the liver ?

A

regenerates

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7
Q

describe the blood supply system

A
  1. portal venous system - blood from gut drains into liver
  2. hepatic artery - brings arterial blood in as its an active metabolic organ
  3. hepatic duct - draining bile out of liver into gull bladder and then into small intestines
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8
Q

What is the primary functional unit of the liver?

A

The liver’s primary functional unit is the hepatic lobule.

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9
Q

What is the structural component of the liver that plays a crucial role in detoxification and metabolism of nutrients and drugs?

A

hepatocytes

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10
Q

In addition to hepatocytes, what other cell type is present in the liver and is involved in immune responses and clearance of pathogens?

A

Kupffer cells, which are macrophages, are present in the liver and are involved in immune responses and clearance of pathogens.

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11
Q

What is the functional significance of the hepatic sinusoids in the liver lobule?

A

The hepatic sinusoids facilitate the exchange of substances between blood and hepatocytes, playing a crucial role in the liver’s metabolic and detoxification functions.

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12
Q

What is the primary function of bile salts produced by the liver?

A

allow the emulsification of fats in the diet, increasing the absorption of fat-soluble vitamins A, D, E, and K.

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13
Q

Where are bile salts stored, and when are they released?

A

Bile salts are stored in the gall bladder and are released in response to food (fatty meal) in the gastrointestinal tract.

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14
Q

What are the key functions of the liver related to detoxification and metabolism?

A

The liver filters and metabolizes microbes and toxins, as well as plays a crucial role in the metabolism of nutrients and drugs.

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15
Q
  • Describe the exocrine functions of the liver.
A

The exocrine functions of the liver include the excretion of bilirubin (a product of hemoglobin breakdown), bile salts (aiding in fat emulsification and absorption), and cholesterol (which is important for hormone and vitamin D synthesis).

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16
Q

What are some of the synthesis functions of the liver?

A

synthesis of clotting factors, antibodies, and albumin( stops blood from leaking out of tissues - if this does happen one can get oedema and lose BP)

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17
Q

Why is it essential for drugs to undergo metabolism in the liver?

A

to be deactivated or excreted from body

18
Q

What is the challenge with the solubility of most drugs?

A

Most drugs are insoluble in water but soluble in fat.

19
Q

Why is binding to plasma proteins crucial for drug metabolism and excretion?

A

l to prevent filtration by the glomerulus; these proteins are too large to be filtered, ensuring that drugs are retained in the vascular space.

20
Q

How does altering the structure of drugs contribute to their secretion?

A

makes them water-soluble, allowing for their excretion.

21
Q

Explain the process by which lipophilic free drugs can diffuse back from the tubule into the blood.

A

can diffuse back from the tubule into the blood because of their lipophilic nature, which allows them to pass through cell membranes.

22
Q

What is the objective of Phase 1 metabolism in drug metabolism?

A

make the molecule more polar or water soluble

23
Q

Name some processes involved in Phase 1 metabolism.

A

Hydrolysis
Reduction
Hydroxylation (involving Cytochrome P450)
Oxidation

24
Q

What is the goal of Phase 2 metabolism in drug metabolism?

A

make the molecule less active and more soluble.

25
Q

How is conjugation achieved in Phase 2 metabolism?

A

Conjugation involves attaching molecules like sulfate, glucuronate, and gluconate to the drug molecule, making it more soluble.

26
Q

Where can first pass metabolism occur in the body?

A
  • Liver
  • Lung
  • Gut
  • Other organs
27
Q

Define first pass metabolism

A

First pass metabolism refers to the metabolism of a drug during its initial passage through an organ, affecting the peak concentrations and activity of the drug in the body.

28
Q

provide examples of drugs affected by first pass metabolism.

A

Lignocaine
- Glyceryl trinitrate (GTN, requiring buccal or sublingual administration) - Denature
- Codeine (undergoing first pass metabolism to morphine) - more active

29
Q

what is cytochrome p450?

A

a group of enzymes that are coded by similar group of genes

30
Q

what role does erythromycin play in drug metabolism?

A

Inhibits p450: enhances activity of warfarin

31
Q

what role does miconazole play in drug metabolism?

A

Inhibits p450: enhances activity of warfarin

32
Q

what role does grapefruit play in drug metabolism?

A

Enhances p450: reduces activity of warfarin.

33
Q

What are the mechanical consequences of liver disease, as shown in the diagram?

A
  • Portal hypertension
  • Oesophageal varices
  • Ascites - fluid buildup in periotoneal cavitiy
34
Q

what are some signs and symptoms of liver disease

A
  1. Jaundice
  2. Finger clubbing - loss
  3. Dupuytren’s contracture
  4. Gynaecomasitaa - male breasts
  5. Sialosis - bilateral swelling of salivary glands - smooth
35
Q

How do you assess for liver disease?

A
  1. Derranged Liver Function Tests (LFTs)
  2. Impaired Clotting (INR)
36
Q

What are some causes of acute and chronic liver failure?

A
  1. Acute
    - Alcohol
    - Drugs eg. paracetamol
    - Infections- viral hep
  2. Chronic
    - Cirrhosis
    - Infections
    - Alcohol
37
Q

What is a key toxic intermediate in alcoholic liver disease?

A

acetylaldehyde - highly reactive
should be converted to acetate

38
Q

What is the consequence of acetaldehyde in alcoholic liver disease?

A

Acetaldehyde causes inflammation and death of hepatocytes in alcoholic liver disease.

39
Q

how is paracetamol metabolised, and which is the highly reactive and toxic agent?

A
40
Q

What are the common causes of hepatitis?

A

Common causes of hepatitis include:
Viral infections (A, B, C, E)
Malaria and other infections
Alcohol consumption
Drug-induced hepatitis
Exposure to toxins

41
Q

What are the symptoms of hepatitis, and what other condition do they overlap with?

A

Abdominal pain, especially in the right upper abdomen
Fever
Jaundice
Itchy skin
Dark urine (due to bilirubin)
Pale bowel motions (resulting from unabsorbed fat)

  1. These symptoms overlap with signs of gallbladder disease.
42
Q

Describe the following for viral hepatitis A,B,C,E
+ Route of infection
+ Risk Factors
+ Diagnosis
+ Vaccine available
+ Long term impact
+ Carrier state

A

4th Yr - CMS 1 (27 decks)

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