Liver and friends Flashcards
give 3 purposes of the aqueous (HCO3- rich) secretion by the parcreas
buffer the duodenum against acid entering it from the stomach and providing a suitable pH for the action of enzymes in the intestine, the low pH also stops the action of pepsin from the stomach
what electrolytes’ concentrations are relatively constant in the pancreatic juices?
Na+ and k+
in a high flow rate, is the pancreatic juice high in Hco3- or cl-?
HCO3-
what blood vessel does the pancreas mainly receive its blood supply from?
the splenic artery
which bud of the pancreas is the one that rotates in its development to fuse with the other
the ventral bud
Santorini’s duct forms what duct of the pancreas and is it part of the ventral or dorsal bud to start with?
the accessory duct. the dorsal bud
at what week in utero do the ventral and dorsal buds of the pancreas form?
week 5
what is the common bile duct a fusion of?
the pancreatic duct and bile duct
what type of muscle surrounds the sphincter of Oddie?
circular smooth muscle
is the minor papilla above or below the major papilla?
above
what is the main exocrine tissue of the pancreas called?
the acinar tissue
histologically, is the pancreatic endocrine or exocrine tissue usually lighter in colour?
endocrine
what cells in the pancreas produce and secrete the enzymes eg trypsinogen? so do they appear darker or lighter histologically due to them being protein rich?
the acinar cells. they appear darker
what cells of the pancreas secrete bicarbonate?
the centro-acinar cells
what does simulation of the bicarbonate-releasing duct cell of the pancreas result in an increase of?
intracellular cyclic AMP.
what 2 things does the increase in cAMP in the duct cells of the pancreas cause?
- movement of tubulovesicles that contain H+ pumps to move to the basolateral membrane
- dis-aggregation and activation of CFTR
what moves out of the basolateral membrane of the pancreatic duct cell and via what?
H+ via the H+ pumps that were contained in tubulovescicles by active transport
what ion is exchanged for HCO3- at the apical membrane of the duct cell of the pancreas via CFTR
cl-
what enzyme catalyses the formation of h2co3 and vice versa from carbon dioxide and water in the pancreas duct cell
carbonic anhydrase
other than providing hco3- substrate for the transport out via the apical membrane what is another benefit of forming h2co3 within the duct cell of the pancreas
maintaining a concentration gradient for the continuous movement of water and carbon dioxide into the duct cell
what hormone stimualtes Hco3- secretion in the pancreas?
secretin
what hormone stimulates enzymatic production and secretion in the pancreas and is produced in the duodenum?
CCK
what paracrine agent is produced in the pancretic islets, by delta cells and stops exocrine secretion by the pancreas?
somatostatin
what receptors do CCK and gastrin bind to in the pancreas to stimulate exocrine secretion
CCK A receptors
what receptors do secretin and VIP bind to in the pancreas
VIP receptors
what 2 enzymes can activate all other zymogens once in the intestine
trypsin and enterokinase
what is the zymogen equivalent of elastase
proelastase
what is the zyogen to carboxypeptidase
pro-carboxypeptidase
what cells is enterokinase in? what type of enzyme is it?
enterocytes. a proteolytic enzyme
what 2 enzymes are already secreted in the active form from the pancreas?
amylase and lipase
other than the intestinal phase that causes secretions from the pancreas to increase what 2 stimuli from the gastric and cephalic phase also cause increased pancreatic secretion?
vagal cholinegics from the cephalic phase and stimulation of the G cells of the stomach to produce gastrin by the vagus nerve and the gastrin causes the acinar cells to release enzymes and the duct cells to secret electrolytes, this is the gastric phase
what sort of stimuli mediate the gastric phase?
swallowing of food and hypoglycaemia
what is involved in the intestinal phase to cause secretion of bicarbonate from the duct cells
increased acidity, fatty acids and amino acids in the duodenum stimulates the S cells of the stomach to secrete secretin and the secretion of CCK by enteroendocrine cells (specifically L cells) and so the duct and acinar cells are stimulated to release enzymes and bicarbonate and water
what are the 2 surfaces of the liver
diaphragmatic and visceral
what are the 2 recesses on the diaphragmatic surface of the liver
subphrenic recess and hepatorenal recess (between the liver and the right kidney and suprarenal gland
what is the left triangular ligament of the liver formed of
the falciform ligament and ligamentum venosum
what does the falciform ligament attach the liver to?
the anterior abdominal wall (the diaphragm)
what is at the colic impression of the liver?
the right hepatic flexure of the colon (start of the transverse colon
what is the portal triad within and what does it contain?
the porta hepatis, the portal vein, hepatic artery and bile duct
the porta hepatis is mainly thought of an entry point to the liver but what is it an exit point for?
the hepatic ducts
where is the gastric impression on the liver and what impression is right to it?
the top of the liver on the left (so the left lobe of the liver), the oesophageal impression is right of it
is the caudate or quadrate lobe above?
caudate
what is the right triangular ligament composed of and what is between here?
the anterior and posterior coronary ligaments. the bare area
what ligament connects the liver to he stomach and has muscle in it?
hepatogastric ligament
what 4 ligaments connect the liver to the diaphragm?
the right and left coronary ligaments, and the right and left triangular ligaments
what divides the liver into right and left a. anatomical lobes b.functional lobes
a. falciform ligament b. fossae for the gallbladder and inferior vena cava
which lobe of the liver is anatomically smaller?
left
the quadrate and caudate lobes are anatomically part of which lobe of the liver?
right (right of falciform ligament)
is the quadrate or caudate lobe visible on the anterior part of the liver?
quadrate
what bounds the quadrate lobe of the liver anatomically
on the right by the fossa for the gallbladder and on the left by the ligamentum teres
the quadrate lobe is functionally part of which lobe?
left
the caudate lobe is functionally part of which lobe?
none. it is functionally distinct
what ligament of the liver also runs anteriorly as well as being superior?
falciform liament
what 3 organs is the blood draining into the portal vein from?
the stomach, intestines and spleen
from the liver, where does the blood go before draining into the inferior vena cava?
the hepatic vein
what is the blood supply to the gall bladder
cystic atery off right hepatic artery off the coeliac trunk
how would you describe the appearance of the mucosa within the gallbladder?
honeycomb
what name is given to the valve of the cystic duct before it gets into the common bile duct
spiral valve
what part of the gut does the liver derive from?
the foregut
how many veins do the hepatic veins divide into?
8
what artery is given off from the hepatic artery once the gastroduodenal artery has already been given off and what name is now given to the hepatic artery
the right gastric artery, hepatic artery proper
what does he pancreas lack that means that disease of it causes it to spread to adjacent viscera
a capsule
what vessels travel behind the neck of the pancreas but infront of the uncinate process?
the superior mesenteric artery and vein
what is another name for the ampulla of vater
the hepatopancreatic ampulla
what duct ends in the uncinate process of the pancreas?
the accessory duct
what is the superior pancreaticoduodenal artery a branch off? and the inferior pancreaticoduodenal artery?
a. the gastroduodenal artery that was off the common hepatic artery b. superior mesenteric artery
which one is more superior? the ligamentum teres or ligamentum venosum
ligamentum venosum
give 4 functions of the liver
as a storage organ, removes toxic compounds that were ingested or are metabolic products and targets them for secretion via the urine or via the bile, makes coagulation proteins, makes glycoproteins from proteins that it breaks down and oligosaccharides that it has
what cells make and secrete bile salts?
hepatocytes
what is the main way that bile is concentrated and which cells do this specifically?
by reabsorption of water, epithelial cells of the gallbladder
what are the 3 components of bile?
cholesterol, lecithin and bile acids
give 2 functions of bile
an emulsifier and to act as an excretory pathway for many steroid hormones (so via faeces)
what must be closed for the bile to enter the gall bladder via the hepatic ducts then the cystic duct from the liver?
the ampulla of vater
what causes the gallbladder to contract?
CCK
where does the gall bladder’s venous blood drain directly into
the liver sinusoids
what type of blood is in the siusoids
mixed hepatic and portal blood
the blood in the portal triad at the corner of each lobule runs in the opposite direction to what? that is in what structure?
bile, canaliculi
the kupffer cells line the endothelial cells pf what in the liver?
sinusoids
what cells produce the extracellular matrix in the space of disse in the liver?
stellate cells
what 3 types of junctions are between the cells of the canaliculi
gap junctions, desmosomes and tight junctions
what is in the canaliculi that pumps the bile towards the bile duct or ductule of the portal triad
actin filaments
what does the gallbladder do to enable its size to increase but not the pressure within it
adaptive relaxation
what is a grouped name given to lecithin and cholesterol
secondary bile salts
why is bile put into miscelles along with lecithin and cholesterol to be transported to the duodenum?
it’s a powerful detergent and can destroy cell membranes of route
what is secreted into the bile in the gallbladder to increase its viscosity?
mucin
what is the main way of concentrating the bile in the gall bladder
active absorption of electrolytes from the bile, so that the electrolyte concentration goes down and water follows by osmosis out of the bile
what is the only 2 electrolyte who’s concentration in the bile increases in the gallbladder?
HCO3- and ca2+
what is another name for obstructive jaundice? and where are the gallstones impacted?
deep jaundice or post hepatic duct. the common bile duct
define jaundice
a term used to describe the yellowing of the skin and sclera that is caused by a buildup of billirubin in the blood and the body’s tissues.
what are you malabsorbing as a result of gallstones leading to jaundice?
fat
what causes the calcification of gallstones
calcium
what is haemolytic anaemia? what type of jaundice does it cause?
an increased breakdown of red blood cells and so increased bilirubin is made by the body. prehepatic
what causes prehepatic jaundice and give 2 examples of conditions causing it
increased bilirubin in the blood before it has been transported to the liver. haemolytic anaemia and sickle cell anaemia
what causes intrahepatic jaundice and give 2 examples of coditions
disruption to bilirubin removal in the liver. cirrhosis and gillbert’s syndrome
what causes post-hepatic jaundice and give 2 examples of such conditions
prevents the bile and bilirubin in it from draining out of the gallbladder and into the digestive system. gallstones and tumour.
