Liver and Gallbladder Phys and Path again Flashcards
what receives portal blood that drains the stomach, small intestine, large intestine, pancreas, and spleen?
the liver
what is in the liver that represent up to 80% of the mononuclear phagocyte system?
Kupffer cells
what are the four lobes of the liver?
right, left, quadrate, and caudate
what are the important ligaments of the liver?
- coronary ligaments
- falciform ligament
- round ligament
- ligamentum venosum
what anchors the liver to the diaphragm
coronary ligaments
what ligament separates right and left lobe
falciform ligament
what is the ligament found on free border of falciform ligament separates quadrate and left lobe
round ligament (ligamentum teres)
what connects the liver to the umbilicus
round ligament (ligamentum teres)
what ligament separates the caudate and left lobe
ligamentum venosum
what separates the caudate and right lobe
gallbladder
the liver receives oxygenated blood from the ?
hepatic artery
the liver receives deoxygenated, nutrient-rich blood from the ?
hepatic portal vein
what is the opening for the 3 main things entering the liver called? (hepatic artery, portal vein, common hepatic duct)
Porta hepatis
what are the 3 main components of the liver
- hepatocytes
- bile canaliculi/cholangiocytes
- hepatic sinusoids
what are the major functional cells in the liver
hepatocytes
what are hepatocytes arranged into ?
hepatic laminae
what are hepatic laminae
“Plates” of hepatocytes, bordered by endothelial-lined vascular spaces (hepatic sinusoids)
what are bile canaliculi
Small ducts found between hepatic laminae that collect bile
what is the central vein
- drains hepatic sinusoids
- empties into hepatic vein
what does the portal triad contain?
- bile duct
- arteriole branch of hepatic artery
- venule branch of portal vein
what is the capillary system specific to the liver?
hepatic sinusoids
what separates the hepatocytes and sinusoids?
space of disse
what is the area where blood from the portal vein and hepatic artery mix and then converge and drain into central vein
hepatic sinusoids
where are hepatic stellate cells found?
space of disse
hepatic stellate cells are normally…
in a quiescent state
the hepatic stellate cells become active when…
there is damage
what does hepatic stellate cells do?
secrete collagen and extracellular matrix in response to damage -> scar tissue formation
what is the resident macrophage of the liver
Kupffers cells
what is the function of kupffers cells
phagocytose old RBC’s, hemoglobin, particulate matter, cellular debris, microorganisms
Hepatocytes, bile duct system and hepatic sinusoids can be organized into functional units called
hepatic acinus
hepatocytes are arranged in ? zones around short axis
3 zones
○ Zone 1 – most O2
○ Zone 2
○ Zone 3 – least O2
Hepatocyte function differs based on ? within hepatic acinus
zones
what is the liver functions
- Biotransformation & degradation
- Bilirubin conjugation
- Storage & synthesis of nutrients
- Bile production
why does the liver process lipophilic chemicals into polar, water-soluble metabolites?
easier to excrete into bile when hydrophilic
what are the 4 major steps of biotransformation and degradation of the liver
- Hepatocyte imports the compounds from blood across it’s basolateral membrane
- Hepatocyte transport material within the cell
- Hepatocyte may chemically modify/ degrade products intracellularly
- Hepatocyte excretes the molecule into bile across its apical membrane
what are the 2 phases of hepatocyte chemically modifying and degrading products intracellularly
- Phase I – oxidation or reduction reactions typically catalyzed by P-450 cytochromes enzymes (aka CYP450)
- Phase II – conjugation
what is an inducer of many CYP450 enzymes
Hypericum perforatum (St. John’s Wort)
what can transport a wide variety of conjugated drugs and bilirubin either into bile or blood
ATP-binding Casette
Senescent erythrocytes are phagocytosed by macrophages & heme will be degraded into ? & released into the blood
○ Unconjugated ? will be carried to the liver bound to ?
Bilirubin
bilirubin
albumin
Bacteria in the terminal ileum and colon converts some of the conjugated bilirubin back into bilirubin. Then, this bilirubin will be converted to ? and some will then be converted to ?
urobilinogen
stercobilin
what is the main pigment of feces
stercobilin
bile production by the liver serves 2 functions:
- elimination of exogenous and endogenous waste products
- promotes digestion and absorption of lipids from the intestines
Bile is synthesized initial from ? in the liver
cholesterol
what is the process called when ileum and colon bile can be dehydroxylated by bacteria and reabsorbed
Enterohepatic circulation
what is the bile flow pathway
hepatocyte -> bile canaliculi -> bile ductules -> bile ducts -> common hepatic duct -> cystic duct -> common bile duct -> duodenum
what is the small, pear shaped organ on inferior aspect of liver
gallbladder
what is continuous with the cystic duct?
gallbladder
what are the layers of the gallbladder
- mucosa
- muscularis
- serosa
what is the function of the gallbladder
Storage of bile that is secreted continuously by hepatocytes until it’s needed in the duodenum
When food digestion begins in upper GI tract, the gallbladder begins to ?
empty
Emptying occurs with ?
rhythmical contractions of gallbladder wall also requires simultaneous relaxation of the sphincter of Oddi
what is cirrhosis
Diffuse remodeling of the liver into parenchymal nodules surrounded by fibrous bands and variable degree of vascular shunting
what are the leading causes of cirrhosis
- Chronic hepatitis B,
- chronic hepatitis C,
- Nonalcoholic fatty liver disease
- Alcoholic liver disease
what are the symptoms of cirrhosis
- Many are asymptomatic until most advanced stages of disease
- Symptoms are often non-specific:
○ Anorexia, weight loss, weakness
cirrhosis is reversible but will often progress to ?
liver failure
what is the most common biliary tract disease
cholelithiasis (gallstones)
what are the 2 main types of gallstones
- cholesterol stones
- pigment stones
what is the pathogenesis of cholesterol stones
Cholesterol concentrations exceed the solubilizing capacity of bile (supersaturation)
-> cholesterol can no longer remain dispersed and nucleates into solid cholesterol monohydrate crystals
cholelithiasis can progression into?
acute cholecystitis
what results in jaundice and icterus?
elevated bilirubin
what is jaundice
yellow discolouration of the skin
what is icterus
yellow discolouration of the sclera
the etiology of jaundice can be divided into :
- Pre-hepatic causes
- Intra-hepatic causes
- Post-hepatic causes
pre-hepatic causes mean
excessive extrahepatic production of bilirubin
intra-hepatic causes mean
reduced hepatocute uptake, impaired conjugation, decreased heptocellular excretion
post-hepatic causes mean
impaired bile flow
