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GI System Final I > Liver and Gallbladder Function - Lopez > Flashcards

Liver and Gallbladder Function - Lopez Flashcards

1
Q

Function of liver

A

bile production and secretion, metabolism of carb/protein/lipid, bilirubin production, detoxification

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2
Q

Carb metabolism by liver

A

gluconeogenesis, storage of glucose as glycogen, release of glucose

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3
Q

Protein metabolism by liver (4)

A

synthesize nonessential amino acids, modify amino acids, synthesize plasma protein, convert ammonia to urea

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4
Q

Liver failure can result in…

A

hypoalbuminemia –> edema

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5
Q

Lipid metabolism by liver

A

fatty acid oxidation, synthesis of lipoproteins, cholesterol, and phospholipids

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6
Q

Majority of bile is….

A

bile salts

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7
Q

Where is bile produced and secreted

A

liver

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8
Q

Cirrhosis

A

chronic liver disease where normal liver cells are damaged and replaced by scar tissue

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9
Q

How can cirrhosis occur

A

excessive alcohol intake

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10
Q

Why does alcohol lead to cirrhosis

A

alcohol abuse causes accumulation of fat in hepatocytes causing fatty liver and steatohepatitis

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11
Q

Steatohepatitis

A

fatty liver with inflammation leading to scarring

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12
Q

Relative amounts of the four bile acids

A

cholic acid > chemodeoxycholic acid > deoxycholic acid > lithocholic acid

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13
Q

Location of primary bile acids

A

hepatocytes

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14
Q

Location of secondary bile acids

A

lumen of small intestine

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15
Q

Location of bile salt conjugation

A

liver

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16
Q

Bile salt structure

A

amphiphathic

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17
Q

Role of bile salts

A

emulsify lipids and form micelles

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18
Q

Phospholipid structure

A

amphipathic molecules but not soluble in H2O

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19
Q

How are micelles formed?

A

bile salts solubilize phospholipids

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20
Q

Cholesterol structure

A

weakly polar molecule on interior micelle

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21
Q

Most important bile pigment

A

bilirubin

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22
Q

T/F Bile pigments play a major rile in micellar formation

A

F- do not take part in micellar formation

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23
Q

What is the predominant cation of bile

A

Na+

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24
Q

Predominant anion of bile

A

Cl- and HCO3-

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25
Q

What does the behavior of bile salts depends on…

A

bile salt concentration

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26
Q

Decreased concentration of bile salts

A

no aggregation of bile salts

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27
Q

Increased concentration of bile salts

A

increased concentration of micelle formation

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28
Q

Critical micellar concentration

A

hydrophobic portion of bile salt, phospholipds, and fatty acids interact in interior of micelles

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29
Q

5 components of biliary system

A

liver, gallbladder and bile duct, duodenum, ileum, portal circulation

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30
Q

What is secreted into the bile canaliculi

A

the returning bile salts

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31
Q

What secretes canalicular bile

A

ductule cells in response to osmotic effects of anion transport

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32
Q

What happens via enterohepatic circulation

A

bile salts are recirculated to the liver

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33
Q

3 steps of enterohepatic circulation

A

1bile salts transported from ileum to portal blood 2. bile salts back to liver 3. Synthesis of bile salts to replace amount that was lost

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34
Q

What membrane do the bile salts get taken up through

A

basolateral membrane of hepatocytes

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35
Q

2 systems of bile salt uptake by liver

A

1Na+ dependent transport protein, sodium taurocholate cotransporting polypeptide, 2. Na+ independent transport protein, organic anion transport protein

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36
Q

Ileal transport process

A

highly efficient at carrying bile acids to portal blood

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37
Q

Effect of increase in bile secretion on returning rate of bile acids

A

increase bile acid to liver via portal blood

38
Q

What is inhibited by bile salts

A

cholesterol 7a-hydroxylase

39
Q

Secretin effect on bile salts

A

stimulates HCO3 secretion and H2O from ductile cells cause an increase in bile formation and decrease in bile salt concentration

40
Q

Secretion of bile acids in relation to cations

A

accompanied by passive movement of cations into conaliculus

41
Q

What is canalicular bile

A

ultrafiltrate of plasma

42
Q

Bile flow between periods of digestion: gallbladder

A

relaxed gallbladder, sphincter of Oddi closed

43
Q

Interdigestive period

A

between periods of digestion

44
Q

CCK mediated when…

A

eating

45
Q

CCK function on gallbladder

A

contraction of gallbladder and relaxation of sphincter of Oddi

46
Q

UDP glucuronyl transferase

A

synthesized slowly after birth

- can potentially cause jaundice

47
Q

Conjugated bilirubin is called..

A

bilirubin glucuronide

48
Q

What accounts for the urine’s yellow color

A

conjugated bilirubin

49
Q

What causes stool dark color

A

Urobilin and stercobilin

50
Q

Physiological neonatal jaundice

A

increase level on unconjugated bilirubin in blood during first week of life

51
Q

Two main causes of physiological neonatal jaundice

A

1bilirubin production is elevated 2. Low activity of UDP glucuronyl transferase

52
Q

Why would bilirubin be elevated

A

increased breakdown of fetal erythrocytes

53
Q

UDP glucuronyl transferase

A

enzyme responsible for binding bilirubin to glucuonic acid to mae bilirubin more soluble

54
Q

Jaundice

A

yellowing of skin beginning at face

55
Q

Crigler-Najjar syndromes

A

can’t conjugate bilirubin

56
Q

Gilbert’s syndrome

A

can’t uptake unconjugated bilirubin in liver

57
Q

Dubin-Johnson syndrome

A

can’t secrete conjugated bilirubin into bile

58
Q

Rotor syndrome

A

can’t secrete conjugated bilirubin into bile

same as Dubin-Johnson

59
Q

Hemolytic anemia

A

form of anemia due to hemoylsis

60
Q

Hemolytic anemia affect on bilirubin

A

increase bilirubin production

61
Q

T/F Hemolytic anemia is related to both unconjugated bilirubin and conjugated bilirubin

A

F- Hemolytic anemia is related to conjugated bilirubin

62
Q

Constitutional hepatic dysfunction/familial nonhemolytic jaundice

A

aka Gilbert’s syndrome

63
Q

Level of unconjugated bilirubin for Gilbert’s syndrome

A

increased in blood ( unconjugated hyperbilirubinemia)

64
Q

What causes Gilbert’s syndrome

A

mutation in gene that codes for UDP glucuronyl transferase

65
Q

Level of unconjugated bilirubin for Crigler-Najjar syndrome

A

increased in blood (unconjugated hyperbilirubinemia)

66
Q

Type I Crigler-Najjar syndrome

A

early in life

  • no function of UDP glucuronyl transferase
  • with kernicterus
67
Q

Kernicterus

A

form of brain damage caused by accumulation of unconjugated bilirubin in brain

68
Q

Babies with kernicterus

A

lethargic and weak muscle tone

69
Q

Type II Crigler-Najjar syndrome

A

starts later in life

  • less that 2-5 function of UDP glucuronyl transferase
  • less likely to develop ketnicterus
70
Q

Treatment for Crigler-Najjar

A
  • light treatment (phototherapy) but doesn’t work after the age of 4 due to thickening of skin
  • blood transfusions
  • oral calcium
71
Q

Treatment for only Type I CN

A

liver transplant

72
Q

Treatment for only Type II CN

A

phenobarbitol drug

73
Q

Level of unconjugated bilirubin for Dubin-Johnson syndrome

A

increase of unconjugated bilirubin IN SERUM without liver enzyme elevation

74
Q

Cause of Dubin-Johnson

A

defect in ability of hepatocytes to secrete conjugated biliruin

75
Q

Mutation in Dubin-Johnson

A

multidrug resistance protein 2 (MRP2)

76
Q

Function of MRP2

A

transport bilirubin out of liver cells into bile

77
Q

Staple sign of Dubin-Johnson

A

liver has black pigmentation

78
Q

Dubin-Johnson incidence rate

A

more common among iranian and moroccan jews living in Israel

79
Q

Rotor syndrome bilirubin levels

A

build up of both unconjugated con conjugated bilirubin in blood

80
Q

Gene associated with Rotor syndrome

A

abnormally short OATP1B1 and OATP1B3

81
Q

Function of OATP1B1 and OATP1B3

A

transport bilirubin from blood to liver to be cleared from body

82
Q

Liver appearance with Rotor syndrome

A

not pigmented

83
Q

How does phototherapy work

A

transformation of trans-bilirubin into cis-bilirubin allowing the newborn to excrete bilirubin in urine and stools

84
Q

Cholelithiasis

A

excess of pigmented bilirubin breakdown or cholesterol

85
Q

Choledocholithiasis

A

small gallstomes pass to biliary duct and get stuck leading to inflammation and crampy pain

86
Q

How can jaundice form from gallstone

A

if stone passes to common bile duct and obstructs it

87
Q

How can pancreatitis form from gallstone

A

if stone pass to entrance of duct at duodenum and obstruct pancreatic duct

88
Q

Gallstone ileus

A

stone pass into duodenum and obstruct it

89
Q

Phase I of drug metabolism by liver

A

cytochrome P450 enzyme oxidation

90
Q

Phase II of drug metabolism by liver

A

conjugation phase

GI System Final I (7 decks)

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