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Jemima Flash Cards > Liver > Flashcards

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
Q

what is the energy reserve of lipids

A

100,000kcal

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26
Q

what are the different type of lipoproteins

A

HDLs, LDLs, VLDLs, IDLs

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27
Q

what are HDLs

A

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

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28
Q

what are LDLs

A

low density lipoproteins - ‘bad’

these are synthesised in the plasma and have low protein to lipid ratio. they deposit cholesterol in the cells

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29
Q

what are VLDLs

A

they carry triglycerides to adipose tissue

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30
Q

what are IDLs

A

these are VLDL intermediates and are converted into LDLs

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31
Q

what are the three types of beta oxidation of fatty acids

A

peroxisomal, mitochondrial and CYP4a ER oxidation

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32
Q

what are xenobiotics

A

foreign substances that are absorbed but not metabolized

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33
Q

what are the two phases in detoxification

A

phase 1 oxidation and phase 2 glucuronidation biotransformation

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34
Q

what happens in phase 1 biotransformation of xenobiotics

A

oxidation - hydrolysis or reduction. this is when an OH group is added onto the molecule which makes the drug more hydrophilic

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35
Q

what catalyzes phase 1 oxidation reaction (detoxification)

A

CYP450 enzyme (microsomal enzyme)

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36
Q

what happens in phase 2 biotransformation of xenobiotics

A

glucuronidation - conjugation reaction. you conjugate the drug to a hydrophilic molecule, most commonly glucuronic acid.

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37
Q

what enzyme catalyzes type 2 glucuronidation reaction in detoxification

A

non microsomal enzymes, most commonly UGT

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38
Q

what happens during alcohol detoxification

A

alcohol is converted to acetaldehyde (by alcohol dehydrogenase)
acetaldehyde is converted to acetate (by acetaldehyde dehydrogenase)

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39
Q

What does bile contain

A

bile salts, cholesterol, xenobiotics, electrolytes (HC3-), phospholipids and bilirubin

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40
Q

what is the basic anatomy of the liver

A

the portal triad is found at the vertices of the hepatic lobules which is hexagonally arranged around the central portal vein

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41
Q

what is contained in the portal triad

A

central vein, artery and bile duct

42
Q

what is found in the hepatoduodenal ligament of the lesser omentum

A

the portal triad

43
Q

describe the path of bile from hepatocytes to duodenum

A

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
Q

what is the bile duct opening into the duodenum called

A

the ampulla of Vata (surrounded by the sphincter of oddi)

45
Q

how much of the bile is absorbed back into the ileum

A

95%

46
Q

why is bile stored in the gall bladder

A

for concentration and storage

47
Q

what initiates gall bladder contraction

A

CCK

48
Q

where is bile reabsorbed

A

in the terminal ileum

49
Q

what transporter is bile absorbed through

A

NA+ Bile acid symporters (ASBT)

50
Q

what degrades old erythrocytes

A

macrophages

51
Q

what is released when RBC are broken down

A

haem and globin

52
Q

what happens during bilirubin metabolism up to excretion in the bile

A

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
Q

what happens in bilirubin metabolism after its been excreted in bile

A

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
Q

what happens to the urobilogen that is reabsorbed

A

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
Q

Bacterial enzyme hydrolysis in the gut produces what compound which is excreted in faeces

A

Stercobilinogen

56
Q

What structure is situated within the duodenal loop

A

Pancreas

57
Q

how much bile does the gall bladder store

A

up to 50 mls

58
Q

what is the entero-pancreatic reflex mediated by

A

the parasympathetic system

59
Q

what are causes of obstructive jaundice

A

hepatitis, cirrhosis, gallstones, pancreatic carcinoma

60
Q

what is the structure in the middle of the hepatic lobule

A

central vein

61
Q

Obstructive jaundice is commonly caused by gall stones within what structure

A

Common bile duct

62
Q

how much of the cardiac output goes to the hepatic blood supply

A

25%

63
Q

how many segments is the liver divided into

A

8 segments

64
Q

What causes an increased serum unconjugated (free) bilirubin and increased faecal urobilinogen

A

Pre-hepatic cause of jaundice

65
Q

What is the cause of physiological jaundice of the newborn

A

Excess breakdown of foetal haemoglobin

66
Q

Microsomal enzyme uridine diphosphoglucoronosyl transferase (glucuronyl transferase) catalyses the formation of what

A

Conjugated bilirubin

67
Q

what cells are part of the reticuloendothelial system in the liver

A

kupffer cells

68
Q

Which compound is returned to the liver by the enterohepatic circulation

A

Urobilinogen

69
Q

what is the diaphragmatic surface of the liver

A

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
Q

what is the visceral surface of the liver

A

lies in contact with the right kidney, adrenal glands, coeliac flexure, transverse colon, duodenum, gallbladder, oesophagus, and stomach. covered with peritoneum

71
Q

what is the falciform ligament

A

it attaches to the anterior surface of the liver to the anterior abdominal wall

72
Q

what is the ligamentum teres

A

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
Q

what is the coronary ligament

A

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
Q

what are the triangular ligaments

A

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
Q

what is found within the lesser omentum

A

the hepatoduodenal ligament and the hepatogastric ligament

76
Q

what are the hepatic recesses

A

they are anatomical spaces between the liver and the surrounding structures

77
Q

where is the subphrenic space

A

it is between the diaphragm and the liver. it is divided into the left and right by the falciform ligament

78
Q

where is the subhepatic space

A

it is supracolic compartment located between the inferior surface of the liver and the transverse colon

79
Q

where is morisons pouch

A

it is the potential space between the visceral surface of the liver and the right kidney

80
Q

what are the lobes of the liver

A

right, left, caudate and quadrate

81
Q

where is the caudate lobe of the liver

A

located on the upper aspect of the visceral lobe

82
Q

were is the quadrate lobe found

A

the lower aspect of the visceral lobe

83
Q

what separates the caudate and quadrate lobe - the porta hepatis

A
84
Q

what is the microscopic view of the liver

A

the liver is arranged into lobules, with each being hexagonal and drained by a central duct. at the periphery is the portal triad

85
Q

what is found in the portal triad

A

hepatic artery, hepatic portal vein and the bile duct

86
Q

what is the vasculature of the liver

A

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
Q

what is the parenchyma of the liver supplied by

A

the hepatic plexus - sympathetic

the vagus nerve gives parasympathetic innervation

88
Q

what is glissons capsule innervated by

A

branches of the lower intercostal nerves

89
Q

What are the ligaments of the liver

A

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
Q

what are the 4 lobes of the liver

A

left, right, caudate and quadrate

91
Q

what is the area on the liver where there is no peritoneum

A

the bare area

92
Q

what two ligaments converge to make the triangular ligaments

A

right and left coronary ligaments

93
Q

where is the ligamentum found

A

on the posterior surface between the caudate lobe and the left lobe

94
Q

how many functional segments of the liver are the

A

8

95
Q

where is the first functional segment of the liver found

A

on the posterior surface

96
Q

what splits the right and the left liver lobes

A

the Cantlie line

97
Q

what connects the hepatic central vein to the portal triad

A

the sinusoids

98
Q

what proteins does the liver make

A

albumin, compliment proteins, clotting factors, insulin like growth factor, prothrombin, angiotensinogen, fibrinogen, transferrin, IGF binding protein

99
Q

what liver ligament is a remnant of the umbilical vein

A

the ligamentum teres

100
Q

are bile acids hydrophilic or hydrophobic

A

amphipathic - both

101
Q

what are the main types of bile acids

A

cholic acid, deoxycholic, lithocholic, ursodeoxycholic, chenodeoxycholic

Jemima Flash Cards (9 decks)

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