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Liver Flashcards

1
Q

what are the functions of the liver

A

hormone production, digestion, storage, immune (Kupffer cells) and synthetic functions

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2
Q

what proteins does the liver produce

A

plasma proteins, clotting factors (except VWF) and compliment proteins

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3
Q

what hormone does the liver metabolise

A

oestrogen

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4
Q

where is the liver found in the abdomen

A

in the right upper quadrant (right hypochondriac)

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5
Q

what is the importance of albumin

A

it maintains oncotic pressure in the vasculature as well as being a carrier protein of unconjugated bilirubin and other hydrophobic molecules

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6
Q

how are faulty proteins degraded

A

ubiquitin or lysosomal degradation

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7
Q

what is ubiquitin dependent protein degradation

A

ubiquitin in the cell cytoplasm binds to defective proteins. this signals to proteases that the protein needs to be broken down

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8
Q

what is lysosomal protein degradation

A

occurs in the reticuloendothelial system in the liver. sinusoidal endothelial cells remove proteins from the blood into a lysosome. Kupffer cells then phagocytose protein in a phagolysosome

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9
Q

what two processes occur in amino acid catabolism

A

transamination and oxidative deamination

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10
Q

what occurs in transamination of amino acids

A

where alpha ketoglutarate readily accepts an amine group from alanine. this forms glutamate and pyruvate (to gluconeogenesis or aerobic respiration)

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11
Q

what occurs in oxidative deamination of amino acids

A

after transamination the glutamate is hydrolysed to form alpha ketoglutarate and ammonia (NH3). the NH3 is then removed via the urea cycle to be excreted

Glutamate plus water - alpha ketoglutarate and ammonia

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12
Q

what enzyme is involved in oxidative deamination

A

glutamate dehydrogenase

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13
Q

what is negative nitrogen balance

A

catabolism, where there is more nitrogen out then in

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14
Q

what is positive nitrogen balance

A

anabolism - more nitrogen in then out

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15
Q

briefly describe the urea cycle starting with citrulline

A

citrulline joins with NH3 to form arginine. Arginase converts arginine to ornithine, urea is made as a biproduct. ornithine joins with NH3 and CO2 to form citrulline

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16
Q

what is the biproduct of the urea cycle

A

Urea

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17
Q

what happens if there is a build up of ammonia in the body

A

it is neurotoxic, it can cross the blood brain barrier and deplete alpha ketoglutarate impairing aerobic respiration

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18
Q

what is the glucose alanine cycle

A

relationship between muscles and liver so that all muscle energy can go towards contraction and not towards gluconeogenesis

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19
Q

describe the glucose alanine cycle

A
  1. reverse transamination in the muscles converts glutamine and pyruvate to alanine and alpha ketoglutarate
  2. alanine is transported to liver
  3. in liver transamination occurs and alanine plus alpha ketoglutarate becomes pyruvate and glutamate
  4. glutamate is oxidatively deaminated
  5. pyruvate is converted to glucose via gluconeogenesis
  6. glucose back to muscles
  7. glucose made into pyruvate and cycle starts again
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20
Q

what is the main source of lipids in the diet

A

Triglycerides

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21
Q

what is the main functions of lipid in the body

A

energy reserve (fatty acid beta oxidation), shock absorbent, cell membrane components, hormones and metabolism

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22
Q

what is the energy reserve of blood glucose

A

40kcal

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23
Q

what is the energy reserve of glycogen

A

600kcal

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24
Q

what is the energy reserve of muscle protein

A

30,000kcal

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25
what is the energy reserve of lipids
100,000kcal
26
what are the different type of lipoproteins
HDLs, LDLs, VLDLs, IDLs
27
what are HDLs
high density lipoproteins - 'good'. these are synthesized in the liver and have the highest protein to lipid ratio. they help to remove cholesterol from plasma
28
what are LDLs
low density lipoproteins - 'bad' | these are synthesised in the plasma and have low protein to lipid ratio. they deposit cholesterol in the cells
29
what are VLDLs
they carry triglycerides to adipose tissue
30
what are IDLs
these are VLDL intermediates and are converted into LDLs
31
what are the three types of beta oxidation of fatty acids
peroxisomal, mitochondrial and CYP4a ER oxidation
32
what are xenobiotics
foreign substances that are absorbed but not metabolized
33
what are the two phases in detoxification
phase 1 oxidation and phase 2 glucuronidation biotransformation
34
what happens in phase 1 biotransformation of xenobiotics
oxidation - hydrolysis or reduction. this is when an OH group is added onto the molecule which makes the drug more hydrophilic
35
what catalyzes phase 1 oxidation reaction (detoxification)
CYP450 enzyme (microsomal enzyme)
36
what happens in phase 2 biotransformation of xenobiotics
glucuronidation - conjugation reaction. you conjugate the drug to a hydrophilic molecule, most commonly glucuronic acid.
37
what enzyme catalyzes type 2 glucuronidation reaction in detoxification
non microsomal enzymes, most commonly UGT
38
what happens during alcohol detoxification
alcohol is converted to acetaldehyde (by alcohol dehydrogenase) acetaldehyde is converted to acetate (by acetaldehyde dehydrogenase)
39
What does bile contain
bile salts, cholesterol, xenobiotics, electrolytes (HC3-), phospholipids and bilirubin
40
what is the basic anatomy of the liver
the portal triad is found at the vertices of the hepatic lobules which is hexagonally arranged around the central portal vein
41
what is contained in the portal triad
central vein, artery and bile duct
42
what is found in the hepatoduodenal ligament of the lesser omentum
the portal triad
43
describe the path of bile from hepatocytes to duodenum
bile drains into bile canaliculi, these drain into ductules. these then drain into the right and left hepatic ducts. these will then converge to form the hepatic duct. the hepatic duct then joins the cystic duct (from gall bladder) which then becomes the common bile duct. this joins the pancreatic duct and enters the duodenum through the sphincter of oddi
44
what is the bile duct opening into the duodenum called
the ampulla of Vata (surrounded by the sphincter of oddi)
45
how much of the bile is absorbed back into the ileum
95%
46
why is bile stored in the gall bladder
for concentration and storage
47
what initiates gall bladder contraction
CCK
48
where is bile reabsorbed
in the terminal ileum
49
what transporter is bile absorbed through
NA+ Bile acid symporters (ASBT)
50
what degrades old erythrocytes
macrophages
51
what is released when RBC are broken down
haem and globin
52
what happens during bilirubin metabolism up to excretion in the bile
haem is broken down into iron and unconjugated bilirubin. unconjugated bilirubin is transported in the blood attached to albumin to the liver. in the liver it is conjugated to glucuronic acid making it water soluble
53
what happens in bilirubin metabolism after its been excreted in bile
in the ileum the conjugated bilirubin is converted by intestinal bacteria to urobilogen. about 10-15% is reabsorbed and the rest is further oxidised by bacteria into stercobilin (brown pigment)
54
what happens to the urobilogen that is reabsorbed
5% will go to entero-hepatic cycle and is secreted into bile again. the rest is transported to the kidneys and made into urobilin which gives urine its yellow colour
55
Bacterial enzyme hydrolysis in the gut produces what compound which is excreted in faeces
Stercobilinogen
56
What structure is situated within the duodenal loop
Pancreas
57
how much bile does the gall bladder store
up to 50 mls
58
what is the entero-pancreatic reflex mediated by
the parasympathetic system
59
what are causes of obstructive jaundice
hepatitis, cirrhosis, gallstones, pancreatic carcinoma
60
what is the structure in the middle of the hepatic lobule
central vein
61
Obstructive jaundice is commonly caused by gall stones within what structure
Common bile duct
62
how much of the cardiac output goes to the hepatic blood supply
25%
63
how many segments is the liver divided into
8 segments
64
What causes an increased serum unconjugated (free) bilirubin and increased faecal urobilinogen
Pre-hepatic cause of jaundice
65
What is the cause of physiological jaundice of the newborn
Excess breakdown of foetal haemoglobin
66
Microsomal enzyme uridine diphosphoglucoronosyl transferase (glucuronyl transferase) catalyses the formation of what
Conjugated bilirubin
67
what cells are part of the reticuloendothelial system in the liver
kupffer cells
68
Which compound is returned to the liver by the enterohepatic circulation
Urobilinogen
69
what is the diaphragmatic surface of the liver
the anterior surface of the liver. the posterior bit of the diaphragmatic surface is not covered by visceral peritoneum and is in direct contact with the diaphragm
70
what is the visceral surface of the liver
lies in contact with the right kidney, adrenal glands, coeliac flexure, transverse colon, duodenum, gallbladder, oesophagus, and stomach. covered with peritoneum
71
what is the falciform ligament
it attaches to the anterior surface of the liver to the anterior abdominal wall
72
what is the ligamentum teres
The round ligament of the liver (or ligamentum teres, or ligamentum teres hepatis) is a ligament that forms part of the free edge of the falciform ligament of the liver. It connects the liver to the umbilicus. It is the remnant of the left umbilical vein.
73
what is the coronary ligament
it attaches the superior surface of the liver to the inferior surface of the diaphragm. the anterior and posterior folds unite to form the triangular ligaments
74
what are the triangular ligaments
the left is formed by the union of the anterior and posterior layers of the coronary ligament at the apex of the liver and attaches the left lobe of the liver to the diaphragm the right ligament is formed similarly adjacent to the bare area and attaches to the right lobe of the liver to the diaphragm
75
what is found within the lesser omentum
the hepatoduodenal ligament and the hepatogastric ligament
76
what are the hepatic recesses
they are anatomical spaces between the liver and the surrounding structures
77
where is the subphrenic space
it is between the diaphragm and the liver. it is divided into the left and right by the falciform ligament
78
where is the subhepatic space
it is supracolic compartment located between the inferior surface of the liver and the transverse colon
79
where is morisons pouch
it is the potential space between the visceral surface of the liver and the right kidney
80
what are the lobes of the liver
right, left, caudate and quadrate
81
where is the caudate lobe of the liver
located on the upper aspect of the visceral lobe
82
were is the quadrate lobe found
the lower aspect of the visceral lobe
83
what separates the caudate and quadrate lobe - the porta hepatis
84
what is the microscopic view of the liver
the liver is arranged into lobules, with each being hexagonal and drained by a central duct. at the periphery is the portal triad
85
what is found in the portal triad
hepatic artery, hepatic portal vein and the bile duct
86
what is the vasculature of the liver
dual supply with 25% of the livers blood coming from the hepatic artery proper which supplies the liver with arterial blood, (from coeliac trunk), and 75% from the livers blood supply comes from the hepatic portal vein
87
what is the parenchyma of the liver supplied by
the hepatic plexus - sympathetic | the vagus nerve gives parasympathetic innervation
88
what is glissons capsule innervated by
branches of the lower intercostal nerves
89
What are the ligaments of the liver
falciform ligament, ligamentum teres, anterior and posterior folds of the right and left coronary artery, right and left triangular ligament and the ligamentum venosum
90
what are the 4 lobes of the liver
left, right, caudate and quadrate
91
what is the area on the liver where there is no peritoneum
the bare area
92
what two ligaments converge to make the triangular ligaments
right and left coronary ligaments
93
where is the ligamentum found
on the posterior surface between the caudate lobe and the left lobe
94
how many functional segments of the liver are the
8
95
where is the first functional segment of the liver found
on the posterior surface
96
what splits the right and the left liver lobes
the Cantlie line
97
what connects the hepatic central vein to the portal triad
the sinusoids
98
what proteins does the liver make
albumin, compliment proteins, clotting factors, insulin like growth factor, prothrombin, angiotensinogen, fibrinogen, transferrin, IGF binding protein
99
what liver ligament is a remnant of the umbilical vein
the ligamentum teres
100
are bile acids hydrophilic or hydrophobic
amphipathic - both
101
what are the main types of bile acids
cholic acid, deoxycholic, lithocholic, ursodeoxycholic, chenodeoxycholic

Jemima Flash Cards (9 decks)

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