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Block 1 - 1. Upper GIT & liver > Liver > Flashcards

Liver Flashcards

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1
Q

What is the blood supply to the liver?

A 
Hepatic portal vein (70%) &
Hepatic artery (30%)
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2
Q

What is the venous drainage of the liver?

A

Hepatic veins –> IVC

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3
Q

How many lobes and how many anatomical units are there in the liver?

A

4 lobes - left, right, caudrate, quadrate

8 anatomical units

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4
Q

What are lobules?

A

An arrangement of hepatocytes around a central vein, which drains to the hepatic vein.

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5
Q

What are sinusoids?

A

Vascular spaces, where blood from the portal vein & hepatic artery mix, which separate plates of the lobules.

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6
Q

What are the functional zones of the lobules?

A

Zone 1 periportal hepatocytes - (outer) - most oxygenated
Zone 2
Zone 3 pericentral hepatocytes - (inner) - least oxygenated

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7
Q

What is the Space of Disse?

A

The space between the plates of hepatocytes & sinusoid

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8
Q

What are the cell types in the liver?

A

Hepatocytes
Endothelial cells
Kupffer cells - specialised macrophages in vascular spaces.
Lipocytes (stellate cells) - in the space of disse - key for fibrosis

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9
Q

What are the 7 major functions of the liver?

A
  • Energy metabolism & substrate interconversion
  • Plasma protein synthesis
  • Drug metabolism & detoxification
  • Immune functions
  • Production, storage & excretion of bile
  • Cholesterol processing
  • Excretion of bilirubin
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10
Q

What is involved in energy metabolism?

A

Carbohydrate metabolism
Lipid metabolism
Protein metabolism

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11
Q

What plasma proteins are synthesised in the liver?

A

Albumin
Factors involved in haemostasis
Carriage proteins
Pro-hormones & apolipoproteins

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12
Q

What are the components of bile?

A 
Bile salts
Lecithin
HCO3- (bicarbonates)
Cholesterol
Bile pigments
Trace metals
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13
Q

How is bile synthesised?

A
  1. Bile salts synthesised from CH & converted into primary bile acids
  2. Taurine or glycine added to give conjugated bile salts
  3. These are exported by the bile canaliculus
  4. They are released into the S.I where they solubilise fats
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14
Q

How much of conjugated bile salts are recycled?

A

95% are recycled back to the liver by the enterohepatic circulation. (75% as intact bile salts, 25% deconjugated by bacteria & reconjugated in liver)
Other 5% lost in faeces.

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15
Q

What are the functions of bile salts?

A
  • Emulsification of dietary lipids
  • Elimination of CH
  • Prevention of CH precipitation in gall bladder
  • Facilitation of absorption of fat-soluble vitamins
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16
Q

How is bilirubin disposed of?

A
  1. Delivered to liver by albumin in blood
  2. Released from albumin & transported into hepatocytes
  3. Conjugated to glucuronic acid
  4. Bilirubin glucuronide is more soluble –> exported into bile to be exported from body
  5. In S.I, bilirubin broken down by bacterial proteases to form urobilinogen - 90% lost in faeces, 10% goes to kidney
17
Q

What are the clinical features seen in liver disease?

A

Filter failure - portal hypertension
Elimination failure - jaundice
Metabolic failure

18
Q

What are the tests of liver distress?

A

ALT/AST - hepatocyte damage

Alk phos/gamma GT - bile duct damage

19
Q

What are the true tests of liver function?

A 
Prothrombin time
Bilirubin (excretion)
Albumin
Urea/creatinine
pH
20
Q

What are the main causes of liver disease?

A

Alcohol
Fat
Virus
Iron

21
Q

What can fat in the liver cause?

A

Non-alcohol fatty liver disease (NAFLD)

Non-alcohol steatohepatitis (NASH)

22
Q

What are the relations of the liver?

A

Anterior: Diaphragm & anterior abdominal wall.
Posterior: R. kidney, hepatic flexure, duodenum, gall bladder, IVC, oesophagus, fundus of stomach

23
Q

What is the nerve supply to the liver?

A

Sympathetic nerve

Vagus nerve

24
Q

What is the lymphatic drainage of the liver?

A

Lymph nodes in the porta hepatis –> coeliac nodes

25
Q

What is the bare area?

A

An area at the top of the right lobe where there is no peritoneum

Block 1 - 1. Upper GIT & liver (4 decks)

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