Liver and Pancreas

Question 1

What are the 2 portions of the pancreas?

Answer 1

Endocrine and exocrine

Question 2

Why is the pancreas described as a dual purpose gland?

Answer 2

It has 2 portions with different functions: endocrine and exocrine

Question 3

Describe the endocrine portion of the pancreas

Answer 3

• Only 1% of the pancreas is endocrine
• Islets of Langerhans
• Produces hormones: beta cells produce insulin, alpha cells produce glucagon and delta cells produce somatostatin

Question 4

Describe the exocrine portion of the pancreas

Answer 4

• 99% of the pancreas is exocrine
• Produces digestive enzymes (acinus)
• Bicarbonate ions (ducts)

Question 5

What are some of the digestive enzymes produced by the exocrine portion of the pancreas?

Answer 5

Amylase, lipase, trypsin, chymotrypsin, nucleases

Question 6

Which portion of the pancreas secretes bicarbonate ions and what is the function of these ions?

Answer 6

• Exocrine portion

- Bicarbonate neutralises gastric acid; it is a buffer, maintains optimum pH

Question 7

What does insulin do?

Answer 7

Decreases blood sugar

Question 8

What does glucagon do?

Answer 8

Increases blood sugar

Question 9

What does somatostatin do?

Answer 9

Inhibits gastrin secretion and reduces muscle contraction

Question 10

What are the 4 regions of the pancreas?

Answer 10

Head, neck, body, tail

Question 11

Which organ is the pancreas posterior to?

Answer 11

The stomach

Question 12

The pancreas starts as 2 organs which then fuse in utero. What can happen if they don’t fuse together?

Answer 12

End up with 2 openings into the duodenum e.g. the major papilla and the minor papilla

Question 13

What do alpha cells, beta cells and delta cells release in the pancreas? (endocrine portion)

Answer 13

Alpha cells: glucagon (15%)
Beta cells: insulin (80%)
Delta cells: somatostatin (5%)

Question 14

What do acinar cells in the pancreas do?

Answer 14

Produce and transport enzymes that are passed onto the duodenum where they assist in the digestion of food

Question 15

Which part of the pancreas does cystic fibrosis affect?

Answer 15

• Exocrine portion

Question 16

What are the clinical features of cystic fibrosis?

Answer 16

• Abnormal, thick secretions
• Damage to lungs, liver and pancreas
• Destruction of primarily exocrine pancreas (reduced digestive function, malabsorption, steatorrhea)
• Can affect the salivary glands (thick secretions can cause dry mouth)
• Can cause infertility

Question 17

What is steatorrhea?

Answer 17

Excretion of abnormal quantities of fat

Question 18

What can CF patients be given to help with impaired pancreas function?

Answer 18

Pancreatic supplements to provide the missing enzymes

Question 19

Which parts of the pancreas does pancreatic cancer typically affect?

Answer 19

The head and neck

Blocks the duct and the sphincter

Question 20

What is blockage of the bile duct termed?

Answer 20

Biliary obstruction

Question 21

What can biliary obstruction cause?

Answer 21

• Biliary obstruction is blockage of the bile duct

- Can cause obstructive jaundice - yellowness of the skin, bile is redirected to the blood

Question 22

Why is pancreatic cancer a very dangerous form of cancer?

Answer 22

• It can cause early metastasis

- It cannot be operated on (worst prognosis of all cancers) because the pancreas might start to self-digest

Question 23

Define metastasis

Answer 23

Cancer cells break off from original tumour and migrate in the bloodstream or lymph and form a secondary tumour away from the original site

Question 24

What is the liver?

Answer 24

A large lobed glandular organ in the abdomen involved in metabolic processes

Question 25

Where is the liver located?

Answer 25

Under the rib cage - extends all the way from left to right

Question 26

What are the functions of the liver?

Answer 26

- Involved in metabolism: material absorbed from G.I. tract, storage of glycogen, release of glucose - Protein synthesis - Inactivation of hormones, drugs - Excretion of waste - Produces bile

Question 27

Where is bile produced?

Answer 27

In the liver

Question 28

Where is bile stored and concentrated?

Answer 28

In the gallbladder

Question 29

What are the 4 lobes of the liver?

Answer 29

Right, left, quadrate and caudate

Question 30

What do liver cells (hepatocytes) produce?

Answer 30

Bile

Question 31

What does bile contain?

Answer 31

- Lipid emulsifiers (bile salts) | - Waste products including bile pigments (bilirubin)

Question 32

What is the purpose of the ductus venosus in the foetus?

Answer 32

The ductus venosus shunts a portion of umbilical vein blood directly to the inferior vena cava. It allows oxygenated blood from the placenta to bypass the liver.

Question 33

Where does bile travel to after it is produced in the liver?

Answer 33

Travels down the left and right hepatic ducts, to the common hepatic duct and into the gallbladder

Question 34

What effect does cholecystokinin (CCK) on the gall bladder?

Answer 34

When CCK is released it will act on the gallbladder which will release bile into the bile duct that feeds into the duodenum

Question 35

Which technique can be used to visualise any blockages in the liver/gallbladder/duodenum pathway?

Answer 35

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Question 36

What are the 2 sources of blood for the liver?

Answer 36

Hepatic artery and hepatic portal vein

Question 37

Where does the hepatic artery come from?

Answer 37

The coeliac trunk branched from the aorta

Question 38

Where does the hepatic portal vein come from?

Answer 38

Drains abdominal unpaired organs | Almost all material absorbed by the G.I.T. enters the HPV

Question 39

Which vein drains abdominal unpaired organs into the liver?

Answer 39

Hepatic portal vein

Question 40

Which veins drain the gut?

Answer 40

Superior and inferior mesenteric veins and splenic vein -> hepatic portal vein

Question 41

What is the portal triad?

Answer 41

- Component of a hepatic lobule | - Consists of the hepatic portal vein, hepatic artery and bile canaliculus

Question 42

Which direction do efferents from the liver move?

Answer 42

Towards the central vein (hepatic artery and hepatic portal vein) Exception is bile: drains to the bile duct through the bile canaliculus

Question 43

Where do sinusoids drain?

Answer 43

Hepatic vein/central vein

Question 44

What are sinusoids?

Answer 44

- Channels/blood vessels that receive blood from the hepatic artery and the hepatic portal vein (blood from both sources - hepatic artery and hepatic portal vein - mingle in the sinusoids) - Sinusoids drain into the central vein

Question 45

What are Kupffer cells?

Answer 45

- Phagocytic cells found within sinusoids endothelium | - Important filtering function, remove and process antigens that arrive from the G.I. tract or systemic circulation

Question 46

Which cells are phagocytic ells that are found within the sinusoids endothelium?

Answer 46

Kupffer cells

Question 47

What is the function of Kupffer cells?

Answer 47

- Filtering function | - Remove and process antigens that arrive from the G.I. tract or the systemic circulation

Question 48

What is hepatomegaly?

Answer 48

- Enlargement of the liver

Question 49

What is cirrhosis?

Answer 49

- Chronic disease of the liver - Characterised by degeneration of cells, inflammation and thickening of tissue/scar tissue - Typically a result of alcoholism or hepititis infection

Question 50

What can cause liver cirrhosis?

Answer 50

Alcoholism | Hepititis

Question 51

What does viral hepititis cause?

Answer 51

Inflammation of the liver

Question 52

What is obstructive jaundice?

Answer 52

Jaundice resulting from blockage of the bile ducts or abnormal retention of bile in the liver

Question 53

What can blockage of bile ducts result in?

Answer 53

Obstructive jaundice

Question 54

What is hepatic carcinoma?

Answer 54

- A cancer arising from liver cells (hepatocytes)

Question 55

What is a primary risk factor for liver cancer?

Answer 55

Liver damage manifested by cirrhosis (scarring)