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Anatomy Exam 2 > Liver > Flashcards

Liver Flashcards

1
Q

Where is the liver located?

A

URQ, beneath diaphragm and behind lower ribs

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2
Q

How much does the liver weigh?

A 
1500 g (3 lbs, size of football)
-aka LARGEST internal organ
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3
Q

What is the major function of the liver?

A

Excretion of waste products from the bloodstream by excretion into bile
-detoxification by splenic blood

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4
Q

What are the 3 basic functions of the liver?

A

1) Metabolic- processing of dietary AAs, carbs, lipids and vitamins; synthesis of plasma proteins; synthesis of bile
2) Secretory
3) Vascular

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5
Q

What is the function of the hepatic artery?

A

Provides 20-30% of O2-RICH blood supply to liver

-Liver is a vascular organ

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6
Q

What is the function of the portal vein?

A

Provides 70-80% of NUTRIENT-RICH (O2-poor) blood supply to liver
-Drains from the digestive tract via the splenic vein and superior mesentric vein

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7
Q

What are the lobes of the liver?

A

4 lobes: RT (largest lobe), LT, quadrate and caudate lobes

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8
Q

How is the liver connected to the diaphragm and abdominal walls?

A

5 ligaments: Falciform ligament, Teres ligament, Coronary ligament, RT and LT triangular ligaments

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9
Q

What is unique to the liver?

A

Only human organ with self-regeneration; only have to donate a small piece

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10
Q

What are Kuppfer cells?

A

Phagocytic cells of the liver that ingest toxins and waste products of metabolism

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11
Q

What are sinusoids?

A

Fenestrated vessels (porous), wider than capillaries; lined w/ endothelial cells

  • Allow for mixing of O2-rich blood from hepatic artery and nutrient-rich blood from portal vein
  • Do all the work
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12
Q

The liver has Kuppfer cells and ___ cells.

A

Fat storing

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13
Q

How do blood and bile flow to and from the liver?

A

In OPPOSITE directions

  • Blood flow: deoxygenated blood from stomach or small intestine -> hepatic portal vein -> venules -> sinusoids -> central vein -> hepatic vein -> vena cava
  • Bile flow: bile produced in hepatocytes -> secreted into canaliculi -> bile ductules -> common duct -> gallbladder -> bile duct -> small intestine
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14
Q

What is the liver role in nutrient storage?

A

Hepatocytes absorb and store excess nutrients in the blood

-Glucose (stored as glycogen), iron, retinol (vitamin A), calciferol (vitamin D)

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15
Q

How are erythrocytes broken down in liver?

A

Hemoglobin is absorbed by phagocytosis by Kuppfer cells in the liver; Hb split into:

1) Heme groups -> iron is removed from a heme leaving a substance called bilirubin (bile pigment)
2) Globins -> hydrolyzed to AAs and returned to blood

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16
Q

What happens if hemoglobin is not absorbed by Kuppfer cells?

A

Too much iron -> buildup causes toxicity of liver -> Hemochromotosis

17
Q

What is the life span of a normal, healthy RBC?

A

120 days

18
Q

What does glucagon do?

A

Raises blood sugar by stimulating the breakdown of glycogen

19
Q

Where are plasma proteins synthesized?

A

In the rER of hepatocytes

20
Q

What are the 3 main types of plasma proteins synthesized by the liver?

A

Albumin, globulin, fibrinogen

21
Q

What happens if you have less synthesis of plasma proteins?

A

Hypoalbuminemia-> Third spacing of fluid (this happens in liver disease) -> Peripheral edema (poor quality of life, increased chance of infection because of tapping of fluid and peritonitis)

22
Q

If less plasma proteins are synthesized in liver disease, how should a patient’s medication be altered?

A

Patient should be given a lower dose to avoid toxicity
-Medications are active when they are “free floating” through the blood, they are inactivated when they are bound to plasma proteins (less plasma proteins -> more free floating)

23
Q

Where is cholesterol made?

A

In hepatocytes in the liver

24
Q

What is cholesterol the precursor for?

A

Steroid hormones made by the testis, ovaries or adrenal gland (progestins, glucocortoids, androgens, estrogens, mineralocortoids); also Vitamin D

25
Q

What is associated with decreased liver function?

A

Decreased adrenal function

26
Q

What is cirrhosis?

A

Replacement of liver tissue with fibrosis (scar tissue) and regenerative nodules (lumps that occur due to attempted repair of damaged tissue)
-symptoms typically show up 20-30 years later

27
Q

What are the most common causes of cirrhosis?

A

Alcoholism, hepatitis (especially B & C; C causes liver cancer), biliary (fatty liver disease)

28
Q

What is the most common complication of cirrhosis?

A

Ascites- fluid retention in abdominal cavity (often caused by hypoalbuminemia)

29
Q

What is hepatic encephalopathy?

A

AMS caused by buildup of toxins in blood (ammonia) that liver is unable to filter, can cause seizures and death
-aka organic brain syndrome (OBS)

30
Q

What is alcohol dehydrogenase?

A

The enzyme used to breakdown alcohol; responsible for tolerance but does not change BAC

31
Q

What bleeding problems are associated with cirrhosis?

A

1) Vascular problem: portal vein cannot dump blood into vena cava -> backs up into venous end -> surrounding veins swell -> varicose veins and esophageal varices
2) Hematologic: clotting factor

32
Q

What are some PE findings consistent with liver dysfunction?

A

1) Hepatomegaly - enlarged liver
2) Ascites - needs about 1500 mL to be detected
3) Fetor hepaticus - musty breath odor from increased dimethyl sulfides
4) Jaundice
5) Muehrcke’s lines - paired horizontal bands separated by normal color in nails (due to hypoalbuminemia)
6) Terry’s nails - proximal 2/3 nail plate white, distal 1/3 read (due to hypoalbuminemia)
7) Clubbing - angle between nail plate and proximal nail fold >180 degrees
8) Dupuytren’s contacture - thickening and shortening of palmar fascia -> flexion deformities of fingers

33
Q

What are spider angiomas?

A

Vascular lesions that blanche when you press them

-result due to an increase in estradiol (in 1/3 of patients with liver dysfunction)

34
Q

What is the cause of palmar erythema?

A

Increased estrogen seen in liver dysfunction

35
Q

What is a gynecomastia and what causes it?

A

Non-cancerous lesion caused by increase in estradiol

-seen in 2/3 of pts with liver dysfunction

36
Q

What are other features of liver dysfunction?

A
  • Spider angioma/spider nevi
  • Palmar erythema
  • Gynecomastia
  • Hypogonadism
37
Q

What is portal hypertension?

A

Increased hepatic vascular resistance (due to scarring and fibrosis/cirrhosis)

38
Q

What are some effects of portal hypertension?

A
  • Splenomegaly
  • Esophageal varices
  • Caput medusae
  • Cruveilheir-Baumgarten murmur
39
Q

What is a Cruveilheir-Baumgarten murmur?

A

Abdominal wall bruit and palpable thrill/venous hum heard in epigastric area, due to collateral collections formed between portal system and the remnant of the umbilical vein
-secondary to portal hypertension

Anatomy Exam 2 (5 decks)

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