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liver a p Flashcards

1
Q

factors involved in liver regeneration

A

hepatocyte growth factor

epidermal growth factor

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2
Q

4 lobes of liver

A

left
right
caudate
quadrate

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3
Q

right and left liver lobes separated by this:

A

falciform ligament

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4
Q

A layer of connective tissue (_____) surrounds the liver and forms a sheath around hepatic artery, portal vein, and bile ducts within it

A

Glisson’s capsule

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5
Q

based on vascular supply, liver divides into how many lobes

A

8

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6
Q

Functional unit of liver

A

lobule

50k - 100k

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7
Q

liver blood flow per minute

A

1350 ml/min

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8
Q

liver % of cardiac output

A

25%

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9
Q

% of O2 extracted from each, hepatic artery and portal vein

A

50% from each

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10
Q

Receives blood from stomach, pancreas, spleen, large and small intestines via these major vein

A 
Inferior and superior mesenteric veins
Splenic vein
Left and right gastric veins
Cystic vein
Paraumbilical vein
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11
Q

Blood from heart (hepatic)

A 
aorta
arteries
arterioles
capillaries in gut
venules 
veins
portal vein
venules in liver
capillaries in liver
venules 
vena cava
To heart
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12
Q

Main functions of zone 1 cells

A

detoxification and secretion

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13
Q

normal hepatic arteriole pressure

A

35 mmHg

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14
Q

normal portal vein pressure

A

8-10 mmHg

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15
Q

hepatic vein pressure

A

0 mmHg

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16
Q

intrinsic liver regulation of BP

A

hepatic arterial autoregulation
hepatic arterial buffer system (reciprocity)
metabolic control

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17
Q

extrinsic liver regulation of BP

A

neuronal

hormonal

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18
Q

no autoregulation here

A

hepatic portal blood flow (pressure dependent)

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19
Q

hepatic artery neuronal receptors

A

alpha 1
alpha 2
beta 2

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20
Q

portal vein neuronal receptors

A

ONLY alpha

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21
Q

relax hepatic smooth muscle (extrinsic fx)

blocks effects of vasocontriction in hep artery

A

glucagon

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22
Q

increased splanchnic artrerial resistance

decreased portal venous resistance (tx portal HTN)

A

vasopressin

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23
Q

fxs of liver

A 
Blood reservoir
Carbohydrate metabolism
-Gluconeogenesis
-Glycogenolysis
-Glycogenesis
Protein synthesis
-Albumin
-Thrombopoietin 
Amino acid synthesis
Protein metabolism
Bile production
Lipid metabolism
-Lipogenesis
-Cholesterol synthesis
Coagulation factor synthesis
-Factors 1, 2, 5, 7, 9, 10, 11
Insulin clearance
Drug metabolism and/or transformation
Bilirubin metabolism
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24
Q

primary energy source for many of body’s cells and preferred source for the brain

A

glucose

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25
Q

Four main functions of liver in CHO metabolism

A

Glycogen storage
Conversion of galactose and fructose to glucose
Gluconeogenesis
Formation of compounds form products of CHO metabolism

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26
Q

order of nutrient preference for energy

A
  1. carbs (90% used for ATP)
  2. fats
  3. proteins
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27
Q

primary monosaccharide going back to tissue cells

A

glucose

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28
Q

renal gluconeogenesis happens here

A

proximal tubule

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29
Q

renal glucose uptake here

A

distal medullary segment (CO2 converted to lactate here)

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30
Q

Required ATP and NAD+ for energy

A

Required: 2 ATP & NAD+
Yield: 4 ATP + 2 NADH + 2 Pyruvate molecules
Net: 2 ATP

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31
Q

% of plasma proteins are liver derived

A

90%

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32
Q

amino acids: how much formed from liver vs obtained in diet

A

liver - 20

diet - 10

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33
Q

liver proteins examples

A 
procoagulants
hormones
cytokines
chemokines
transport proteins
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34
Q

most abundant, 15% of total protein production

A

albumin

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35
Q

most cells can use fatty acids for energy except

A

RBC (no mitochondria)

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36
Q

brain can utilize these from fat metabolism during starvation

A

ketone bodies (but brain not happy)

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37
Q

most important function of cholesterol

A

form:
cell structure (specialized)
organelle membranes

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38
Q

80% of nonmembranous cholesterol

A

converted to BILE SALTS

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39
Q

cause high cholesterol

A

saturated fats (diet)
low insulin
low thyroid

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40
Q

bile composition

A 
Bile acids (50%)
Cholesterol (4%)
Phospholipids, (40%)
Bile pigments (bilirubin) (2%)
Ions (electrolytes)
Water
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41
Q

all coag factors produced by liver except

A

8

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42
Q

liver - endocrine synthesis (3)

A

angiotensinogen
thrombopoietin
insulin-like GF

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43
Q

liver-endocrine INACTIVATES these:

A

aldosterone
estrogen
androgens
ADH

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44
Q

iron stored in liver

A

ferritin (releases iron to circ when needed)

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45
Q

how is ferritin formed in liver

A

liver protein (apoprotein/transferrin) + iron

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46
Q

50% of current drugs metabolized by this CYP

A

3A4

3A5

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47
Q

meaning of 1st number, 2nd letter, last number (after CYP)

A

1 #: genetic family
2.L: genetic subfamily
3 #: specific gene or isozyme

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48
Q

other sites of metabolism (besides liver)

A 
brain
kidney
skin
heart
lungs
plasma
GI
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49
Q

liver zone with highest CYP amnt

A

3

50
Q

zone most susceptible to toxin damage

A

1

51
Q

oxidation: changes made to molecule/electrons

A

add O2 to molecule
loss electrons (H+)
“OIL RIG”

52
Q

reduction: changes made to molecule/electrons

A

gain electron

“OIL RIG”

53
Q

biologic activity of Phase II reactions

A

very little/none

54
Q

enzyme inducing drugs

A 
Phenytoin
Smoke from cigarettes or marijuana
Isoniazid (TB abx)
St. John’s Wart
Alcohol
Charbroiled foods
Phenobarbital
Carbamazepine (tegritol)
Garlic supplements
55
Q

tegretol (inducer) + estradiol =

A

pregnancy

56
Q

flagyl (inhibitor) + warfarin

A

bleeding

57
Q

high ER drugs

A 
Propofol
Amitriptyline
Labetalol
Lidocaine
Meperidine
Metoprolol
Morphine
Propranolol
Ranitidine
58
Q

low ER drugs

A 
Acetaminophen
Aspirin
Diazepam 
Digitoxin
Ethanol
Phenobarbital
Phenytoin
Valproic acid
Warfarin
59
Q

zero order drugs

A 
P's and WHEATS
Phenytoin & Phenylbutazone 
Warfarin
Heparin
Ethanol
Alcohol
Theophylline, tolbutamide
Salicylates
60
Q

labs for cholestasis

A

Bilirubin
ALP
GGT
“chole BAG”

61
Q

labs for synthetic function

A 
albumin
protein
PT/INR
cholesterol
plasma cholinesterase
62
Q

AST > ALT indicative of

A

alcohol
drugs
cirrhosis

63
Q

ALT and AST > 1000 indicative of

A

ischemic or viral hepatitis

acetaminophen ingestion

64
Q

ALP&raquo_space; GGT indicative of

A

bone disease

pregnancy

65
Q

GGT&raquo_space; ALP indicative of

A

alcohol

medications

66
Q

albumin t1/2

A

2-3 weeks

67
Q

coagulation factor w/ shortest t 1/2

A

7 (4 hours)

68
Q

prothrombin t 1/2

A

72 hours

69
Q

normal total bilirubin

A

0.3 - 1.9

70
Q

direct (conjugated) bili normal value

A

0 - 0.3

71
Q

serum bilirubin in jaundice

A

> 3 - 4 mg/dL

72
Q

most common cause of jaundice postop

A

hemolysis

73
Q

MELD score for inc risk for M&M perioperatively

A

> 14

74
Q 
- What disease?
AST>ALT
elevated Bili 
elevated INR
tender hepatomegaly
low grade fever
slow recovery
A

acute alcoholic hepatitis

75
Q

causes of cirrhosis

A 
alcohol abuse
biliary obstr
hemochromatosis (Fe2-Fe3)
right HF
Wilsons (no ATP7b -> Cu high)
NASH
Alpha 1 - antitrypsin def
76
Q

1 cause of cirrhosis :/

A

alcohol abuse

77
Q

alcohol oxidizes (steals electrons) to this in liver

A

acetaldehyde

78
Q

oxidation of lipids is called this

A

lipid peroxidation

79
Q

alcoholic cirrhosis begins infiltration of this

A

fatty infiltration

80
Q

precursor to cirrhosis (bolded note)

A

inflammation (alcoholic hepatitis)

reversed by cessation

81
Q

dx for NASH

A

elevated LFT

liver bx

82
Q

portal HTN collaterals develop into

A

esophagus

anterior abdominal wall and rectum

83
Q

the point where portal veins meet systemic veins – porta (liver) caval (vena cava)

A

portocaval anastomoses

84
Q

Three areas are susceptible to formation of varices as portal HTN increases

A

gut (esoph varicies)
butt (internal hemorrhoids)
caput (caput medusea)

85
Q

most common clinical manifestation of portal HTN

A

GI bleeding

86
Q

alcohol effects on NMDA receptors

A

inhibition (dec CNS excitation)

87
Q

Functions of spleen (3)

A

Filter and destroy damaged RBCs
Prevents infection (produces lymphocytes)
Stores RBCs and platelets

88
Q

CV manifestations of cirrhosis

A 
hyperdynamic (high CO)
low SVR
cardiomyopathy
pulm HTN
dec response to stress
diastolic dysfx
down regulated beta receptors
89
Q

EKG changes: eccentric LVH

A

tall R
Q wave
voluminous upright T wave

90
Q

only cure for hepatopulmonary syndrome

A

liver transplant

91
Q

features of hepatopulmonary syndrome

A

cyanosis
dyspnea
–platypnea (breathe better when flat)
–orthodoxia (desats with sitting/standing)

92
Q

diagnostic criteria for hepatopulm syndrome

A 
liver dz (portal HTN & cirrhosis)
alveolar-arterial O2 gradient > 15
---intrapulm R - L shunt
93
Q

pAO2 =

A

FiO2 (760 mm Hg – 47 mm Hg) – (paCO2/0.8)

94
Q

formula for normal age-dependent ALV-art shunt

A

age/4 + 4

95
Q

features of portopulm HTN

A

Fibrosis
PAP > 25 in presence of normal PCWP
RV overload and right heart failure
hepatic congestion

96
Q

Renal manifestations in cirrhosis: what syndrome do these describe?

  • -oliguria in prescence of renal failure
  • -renal artery constriction
A

hepatorenal syndrome

97
Q

definitive tx of hepatorenal syndrome

A

transplant

98
Q

hepatic encephalopathy caused by accumulation of these neurotoxins:

A

ammonia
fatty acids
serotonin
tryptophan

99
Q

of 3 most common causes of viral hepatitis (hep A, B, C) which one is most common of the 3 in US

A

C

100
Q

most common FORM of DRUG induced hepatitis

A

alcoholic hepatitis

101
Q

most common CAUSE of DRUG induced hepatitis

A

genetic predisposition

102
Q

most common cause of POST OP jaundice

A

hematoma resorption

RBC breakdown post transfusion

103
Q

most common complication of CIRRHOSIS

A

ascites

104
Q

HRS treatment: these vasoconstrict splanchnic

A

octreotide + midodrine + albumin 20%
ornipressin + albumin
terlipressin + albumin

105
Q

HRS treatment: these vasodilate renal arteries

A

misoprostol (cytotec)
adenosine - 1 antagonist (caffeine, theoph)
angiotensin II t1 antagonist (losartan)

106
Q

hepatopulmonary TRIAD

A

liver disease
arterial vasodilation
pulmonary vasodilation

107
Q

hepatotoxins contributing to encephalopathy

A

ammonia
fatty acids
mercaptans
manganese

108
Q

2 branches of vagus innervation to stomach

A 
right posterior (celiac) branch
left anterior (hepatic) branch
109
Q

endocrine secretion of stomach (2)

A

pepsinogen

serotonin

110
Q

mucus and gastrin (G-cells) secreted by

A

surface epithelial cells

mucous cells

111
Q

most of blood supply to stomach from which artery

A

celiac

112
Q

population most at risk for PUD

A

men 45-65

women > 55

113
Q

gastric mucosal acidosis common in this pt population

A

critically-ill
prolonged complex surgery
CABG

114
Q

milk-akali syndrome manifestations

A

skeletal muscle weakness

polyurea

115
Q

H2 antagonist utilizing P450 the least

A

famotidine

116
Q

15% of ulcerative colitis get acute fulminating incidence with these symptoms (3)

A

severe abd pain
profuse rectal bleed
high fever

117
Q

agents reducing LES

A 
caffeine
chocolate
alcohol
nicotine
fats
118
Q

gallstones composition

A

cholesterol
calcium biliruminate
mixture of cholesterol/bilirubin

119
Q

charcot’s triad

A

fever/chills
jaundice
upper quadrant pain

120
Q

enzymes responsible for acute pancreatitis

A

trypsin
enterokinase
bile acids

121
Q

spleen major vs minor roles

A

major: macrophage/immunoglobin M (white pulp)
minor: plt reservoir

122
Q

2 factors enhancing carcinoid syndrome

A
  1. direct tumor manipulation

2. beta-adrenergic stimulation

liver a&p (1 decks)

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