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Histology - Exam 3 > Liver and Pancreas > Flashcards

Liver and Pancreas Flashcards

1
Q

liver functions

A
  • gluconeogenesis
  • detoxification
  • storage
  • produce plasma proteins
  • bile production
  • transfer of IgA into bile canaliculi
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2
Q

gluconeogenesis

A

converts aa’s and lipids into glucose

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3
Q

what detox does the liver do?

A

microsomal mixed-function oxidase enzyme system catalyzes methylation, oxidation, or conjugation of drugs, toxins, chemicals

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4
Q

what is stored in the liver?

A
  • glycogen
  • triglycerides
  • vitamin A
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5
Q

what plasma proteins are produced in the liver?

A
  • fibrinogen
  • prothrombin
  • albumin
  • urea
  • acute phase proteins
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6
Q

endocrine vs. exocrine secretions of liver

A

endo: plasma proteins, acute phase proteins
exo: bile

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7
Q

in what organelle is bile made?

A

sER

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8
Q

describe liver circulation/blood supply

A
  • afferent vessels: 20-30% hepatic artery, 70-80% portal vein
  • efferent vessels: central vein
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9
Q

what subdivides liver into lobes and lobules?

A

Glisson’s capsule - fibroconnective tissue capsule

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10
Q

liver composition/cells

A

hepatocytes (parenchymal cells) arranged in anastamosing and branching plates

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11
Q

contents of hepatocytes

A
  • abundant rER and sER
  • many lysosomes
  • PEROXISOMES
  • many mitochondria
  • glycogen deposits
  • lipid droplets
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12
Q

classic liver lobule

A

hexagonal arrangement of hepatocyte plates around a central vein

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13
Q

nucleus of liver cells

A
  • can be binucleate w/ large nuclei

- can be polyploid

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14
Q

do liver cells divide?

A

yes - if part of liver removed

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15
Q

contents of portal canal

A
  • portal vein
  • hepatic artery
  • bile duct
  • sometimes lymphatics
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16
Q

direction of blood flow vs. bile flow in liver

A

blood: from vessels in portal area through liver sinusoids to empty in central vein
bile: from liver cells out into bile duct in portal area

(opposite directions)

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17
Q

sinusoids

A

discontinuous endothelial (large fenestrations) lined spaces located in b/w plates of hepatocytes

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18
Q

Kupffer cells

A

fixed phagocytic cells in the monocyte lineage

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19
Q

location of Kupffer cells

A

sinusoids

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20
Q

subendothelial space b/w the hepatocytes and the sinusoid endothelium?

A

space of Disse

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21
Q

portal lobule

A
  • centered on a portal area
  • defined by 3 adjacent central veins
  • triangle defines flow of bile into bile duct
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22
Q

hepatic acinus of Rappaport/ liver acinus

A
  • centered on a portal area
  • defined by 2 adjacent central veins
  • defines metabolic gradient from periportal area to the drainage zone (3 zones)
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23
Q

zone 1 of liver acinus

A
  • high O2 area

- oxidative functions: cholesterol synthesis, gluconeogenesis, plasma proteins

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24
Q

zone 2 of liver acinus

A

intermediate region

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25
Q

zone 3 of liver acinus

A
  • low O2 area
  • hepatocytes here involved in detox
  • susceptible to hypoxia
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26
Q

functions of space of Disse

A

exchange materials b/w blood and hepatocytes

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27
Q

contents of space of Disse

A
  • reticular fibers
  • hepatic stellate cells/ ells of Ito (fat storing)
  • microvilli of hepatocytes
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28
Q

function of hepatic stellate cells

A
  • vitamin A storage and metabolism

- produces collagen during disease in response to cytokines from Kupffer cells in space of Disse

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29
Q

bile canaliculi

A

intercellular spaces b/w the hepatocytes

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30
Q

pathway of bile flow

A

secreted by hepatocytes -> bile canaliculi -> cholangioles -> canals of Hering -> bile ducts in portal areas -> hepatic duct -> cystic duct

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31
Q

canals of Hering

A

small bile ductules at the edge of liver lobules

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32
Q

functions of bile

A
  • excretion of cholesterol, phospholipids, bile salts, conjugated bilirubin, electrolytes
  • absorption of fat and fat soluble vitamins
  • IgA transport to intestine
  • excretion of drugs and heavy metals
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33
Q

reabsorption of bile

A

90% recirculated - reabsorbed in ileum -> venous blood from ileum -> portal vein -> liver sinusoids -> hepatocytes extract bile acids -> transported across hepatocytes -> resecreted into canaliculi

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34
Q

pathway of IgA production to secretion

A

plasma cells in intestinal mucosa -> enters circulatory system and goes to liver -> IgA complexed w/ secretory component -> released into bile

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35
Q

how are bile components transported into canaliculi?

A

ATPases in plasma membrane

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36
Q

MDR1 and MDR2

A

multidrug resistance transporters

  • MDR1: transports cholesterol
  • MDR2: transports phospholipids
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37
Q

MOAT

A

multispecific organ anionic transporter - transports glutathione conjugates

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38
Q

BAT

A

biliary acid transporter - transports bile salts

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39
Q

what does a genetic defect in MDR2 cause?

A

focal hepatic necrosis and bile ductule proliferation

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40
Q

function of spleen macrophages

A

removal of old RBCs

41
Q

what happens to the heme from digested RBCs?

A

converted to bilirubin -> released in blood -> conjugated w/ albumin -> enters hepatocyte -> complexed to ligandin -> sER releases free bilirubin in cytosol -> glucoronic acid added to form conjugated bilirubin -> secreted into bile

42
Q

hepatitis

A

inflammation of liver - commonly from viruses or toxic materials

43
Q

hepA

A
  • infectious

- fecal oral route

44
Q

hepB

A
  • serum hepatitis

- transferred by blood and blood products

45
Q

hepC

A
  • hepatocellular carcinoma

- transfusion related

46
Q

cirrhosis

A

degeneration and fibrosis - damaged hepatocytes

47
Q

what can cause cirrhosis?

A
  • poisoning
  • chronic alcohol use
  • bile duct obstruction
48
Q

what often accompanies long term alcohol consumption?

A

steatosis - fatty liver

49
Q

jaundice

A
  • excess bilirubin in blood

- bile pigment in skin and sclera of eye

50
Q

what can cause jaundice?

A
  • liver dysfunction
  • obstructed bile passages
  • excess RBC destruction (hemolytic jaundice)
51
Q

CHF

A

increased central venous pressure causes liver to engorge w/ blood (enlarged)

52
Q

portal hypertension

A

obstructed blood flow - leads to fluid accumulation in peritoneal cavity (ascites)

53
Q

what is often associated with portal hypertension?

A

cirrhosis

54
Q

what frequently obstructs bile outflow from liver?

A

pancreatic carcinoma

55
Q

what can result in hyperbilirubinemia?

A

hemolytic disease such as erythroblastosis fetalis

56
Q

erythroblastosis fetalis

A

blood group incompatibility b/w mother and fetus

57
Q

why is free bilirubin bad?

A

toxic to brain

58
Q

how is alcohol metabolized?

A

ADH or mixed-function oxidase (MFO)

59
Q

what does the ADH system produce?

A

acetaldehyde and excess H+

60
Q

what does the MFO system produce?

A

acetaldehyde and ROS - causes lipid peroxidation

61
Q

how does chronic liver disease lead to fibrosis?

A

viral/alcohol/bacterial toxins -> proinflammatory cytokines released from Kupffer cells -> induces hepatic stellate cells to transform to myofibroblasts -> produce collagen

62
Q

how does fibrosis affect the liver?

A

restricts portal venous blood flow

63
Q

what is cholestasis and what causes it?

A

slow or stop of bile flow - caused by TNF-a

64
Q

function of gallbladder

A

stores bile and releases it into duodenum

65
Q

what causes the gallbladder to release it into duodenum?

A

cholecystokinin

66
Q

lining of gallbladder mucosa

A
  • simple columner epithelium

- numerous microvilli on apical surface

67
Q

lamina propria of gallbladder

A

loose CT that blends w/ “submucosa”

68
Q

muscularis externa of gallbladder

A

thin fascicles of smooth muscle fibers

69
Q

what is the key feature to identify gallbladder?

A

diverticula of epithelium - outpocketings of the mucosa that form what appear to be epithelial lined cysts in the lamina propria (Rokitansky-Aschoff sinuses)

70
Q

adventitia and serosa of gallbladder

A

attached to liver: adventitia

most covered by serosa

71
Q

biliary calculi

A

gallstone concretions

72
Q

what is usual composition of gallstones?

A

cholesterol crystals - can also be from calcium salt of bile (calcium bilirubinate)

73
Q

where do you find gallstones?

A

gallbladder and bile duct

74
Q

how is the pancreas subdivided?

A

gland enclosed in a CT capsule - subdivides into lobules via septa

75
Q

endocrine vs. exocrine parts of pancreas

A

endo: islets of Langerhans
exo: digestive enzymes

76
Q

what type of stain is used to distinguish the cell types in the islets of Langerhans?

A

Mallory-Azan stain

77
Q

types of cells in islets of Langerhans and percent composition

A
  • alpha/A cells (15-20%)
  • beta/B cells (60-70%)
  • delta/D cels (5%)
  • epsilon cells (<1%)
  • PP/F cells (10%)
78
Q

A cell product

A

produce glucagon -> elevate blood glucose

79
Q

B cell product

A

produce insulin -> decrease blood glucose

80
Q

D cell product

A

produce somatostatin -> inhibits hormonal release of neighboring secretory cells

81
Q

what color do D cells stain?

A

blue

82
Q

epsilon cell product

A

produce ghrelin -> stimulates appetite

83
Q

PP/F cell product

A

produce pancreatic polypeptie -> inhibits release of exocrine pancreatic secretions

84
Q

arrangement/surroundings of endocrine cells of pancreas

A
  • surrounded by reticular fiber network

- located among acini of exocrine pancreas

85
Q

exocrine pancreas secretions

A
  • amylase, lipase, ribonuclease, deoxyribonuclease
  • trypsin, chymotrypsin, carboxypeptidase
  • enzyme poor alkaline fluid (bicarb)
86
Q

what are amylase/lipase/ribonulease/deoxyribonuclease secreted in response to?

A

cholecystokinin from intestinal enteroendocrine cells

87
Q

how are trypsin/chymotrypsin/carboxypeptidase secreted?

A

proenzyme form - must be activated in the intestine by more acidic environment

88
Q

what secretes the bicarbonate and in response to what?

A

intercalated duct cells - in response to secretin produced by intestinal enteroendocrine cells

89
Q

cells of intercalated ducts

A

centroacinar cells

90
Q

epithelium of intralobular ducts

A

cuboidal

91
Q

how can you identify interlobular ducts?

A

surrounded by large amount of CT

92
Q

T1DM

A

insulin dependent

  • sudden onset before age 20
  • low levels of plasma insulin
  • polydipsia, polyuria, polyphagia
93
Q

T2DM

A

non-insulin dependent

  • in overweight people over 40
  • may be normal insulin levels or impaired insulin release
  • decreased insulin receptors
  • faulty post-receptor signaling
94
Q

what is a significant component of insulin resistant diabetes?

A

muscle insulin resistance

95
Q

HIS

A

hepatic insulin resistance - due to faulty signaling through docking molecules (insulin receptor substrate- IRS) proteins that connect insulin receptor activation to downstream kinase cascades such as the PI3K and MAPK pathways

96
Q

what can also contribute to development of T2DM?

A

HIS

97
Q

pancreatitis

A

inflammation of pancreas - often due to gallstones

98
Q

acute necrotizing pancreatitis

A

proenzymes may be activated - digest pancreatic tissues

99
Q

what can cause acute necrotizing pancreatitis?

A
  • infection
  • gallstones
  • drugs
  • trauma

Histology - Exam 3 (12 decks)

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