liver Flashcards
what is liver inflammation often due to
obesity
pathway to cirrhosis
- progressive fibrosis
- portal hypertension
- deterioration of liver §
what is the body largest internal organ
liver
where is the liver situated
right hypochondrium
how many segments
8
what does each segment have
portal pedicle
what two vessels enter the liver
- hepatic artery
- portal vein
what is the hepatic artery
branch of the coeliac axis
what does the portal vein do
drain most of the GI tract and the spleen
where does blood go after it leaves the sinusoids
- enter branches of the hepatic vein
2. enters inferior vena cava
what is special about the caudate lobe
- receives independent blood supply from portal vein and hepatic artery
- drains directly into inferior vena cava
do sinusoids have a basement membrane
no
what are Kupffer cells
phagocytic cells
what is the subendothelial space between the sinusoids and hepatocytes
space of Disse
what do stellate cells store
retinoids in their resting state
what happens to stellate cells when activated
are contractile and regulate sinusoidal blood flow
what do stellate cells generate
collagen eventually leading to cirrhosis
what do bile canaliculi form
a network between the hepatocytes
where do the hepatic ducts join
at the porta hepatis
what does the cystic duct connect
the gall bladder to the lower end of the common hepatic duct
where does the gall bladder lie
under the right lobe of the liver
what does the gall bladder do
stores and concentrated hepatic bile
where does the bile duct and pancreatic duct open into
second part of duodenum
what does the liver synthesise
- all circulating proteins
- all coagulation factors
- complement system
what does the liver control
the rate of gluconeogenesis
functions of albumin
- maintain intravascular oncotic pressure
- transport water-insoluble substances such as bilirubin, hormones, fatty acids and drugs
examples of coagulation factors
- fibrinogen
- prothrombin
- antithrombin
what does the liver store
- large amounts of certain proteins and minerals
- glycogen
how are amino acids degraded
by transamination and oxidative deamination
what does oxidative deamination of amino acid produce
ammonia
what is ammonia converted to
urea
where is urea excreted
kidneys
what organ controls glucose homeostasis
liver
what is glycogenolysis
glycogen breakdown
what is gluconeogenesis
synthesis of new glucose
what are the sources of gluconeogenesis
- lactate
- pyruvate
- amino acids
- glycerol
where is glycerol from
lipolysis of fat
what is used in prolonged starvation as a source of fuel
- ketone bodies
- fatty acids
are fats soluble in water
no
how are fats transported
by lipoproteins
what organ metabolises lipoproteins
liver
where are triglycerides from
dietary origin
where is most cholesterol synthesised from
acetyl-CoA
what does bile consist of
- water
- electrolytes
- bile acids
- cholesterol
- phospholipids
- conjugated bilirubin
what does bile formation require
uptake of bile acids
what does bile acid receptor farnesoid X do
block bile acid formation from cholesterol
what are water channels
aquaporins
where are bile acids excreted to
into bile and pass via the common bile duct into the duodenum
what are the 2 primary bile acids
- cholic acid
- chenodeoxycholic acid
what do I cells of duodenum secrete
cholecystokinin
what does cholecystokinin do
stimulate contraction of gall bladder and relax sphincter of Oddi this allows bile to enter the duodenum
what does bile acids act as
detergents - lipid solubilisation
what do bile acids form in aqueous solution
micelles
how is bilirubin produced
from breakdown of mature red cells by Kupffer cells in the liver
what is bilverdin formed from
haem and reduced to form bilirubin
how is bilirubin transported
bound to albumin
is conjugated bilirubin water soluble
yes
what is bilirubin reduced to
urobilinogen
where is the main site of drug metabolism
liver
what are viral markers good for diagnosing
Hep A, B, C, D, E
what is serum iron and ferritin used to diagnose
haemochromatosis
what is serum copper used for
Wilson’s disease
what is anti-nuclear cytoplasmic antibodies used for
primary sclerosing cholangitis
what are markers of liver fibrosis used for
NAFLD
hepatitis C
what is serum albumin useful for
determining severity of liver disease
is bilirubin mostly conjugated or unconjugated
unconjugated
what is prothrombin time a marker of
synthetic function
when is genetic analysis done
- haemochromatosis
- alpha1-antitrypsin deficiency
what do dipsticks test sense
bilirubin and urobilinogen
what is ultrasound useful for
- extraheptic obstruction
- assessing jaundice
- assessment of hepatomegaly
- assessing hepatic parenchyma
- cirrhosis
- lymph node enlargement
what does fatty infiltration look like on ultrasound
bright appearance
what does CT provide guidance for
biopsy
what does X-ray for
- gallstones
- air in biliary tree
- pancreatic calcification
- calcification of gall bladder
what is upper GI endoscopy used for
diagnosis and treatment of varices, peptic ulcers
what does ERCP outline
biliary and pancreatic ducts
what is skin like in haemochromatosis
slate-grey appearance
what does splenomegaly occur with
portal hypertension
