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Gastrointestinal system > Liver and pancreas exocrine function > Flashcards

Liver and pancreas exocrine function Flashcards

1
Q

Functions of liver

A 
T4 -> T3
Detoxification 
Production of cholesterol
Stores glycogen 
Stimulates gluconeogenesis from fatty acids and glycerol
Cytochrome P450
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2
Q

Vit K dependent sites

A

2,7,9,10

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3
Q

RBC breakdown

A
  • RBC → free Hb
  • Haem → biliverdin and iron
  • Globulin → amino acids
  • Biliverdin → bilirubin → conjugates bilirubin → bile → stercobilin or urobilin
  • Reabsorption of bile acid through enterohepatic circulation
  • Too much bilirubin → jaundice
  • Bilirubin is itchy
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4
Q

Bile acid secretion

A
  • Enters duodenum via sphincter of oddi
  • Traction of gall bladder pushed bile down and sphincter of oddi relaxes
  • Fat-containing food releases cholecystokinin causes gallbladder contraction and relaxation of sphincter
  • Secretin causes intra-hepatic secretion
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5
Q

Vitamins in liver

A
  • Vit B12, A and D stored in large amounts in liver

- Vit K and folate in small amounts

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6
Q

Hepcidin

A
  • Produced by liver when blood contains iron
  • Stops reabsorption of iron via ferroportin 1
  • Too much iron = haemochromatosis → cirrhosis of liver and failure
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7
Q

Causes of liver disease

A
  • Alcohol related liver disease - alcohol is short chain
  • Hepatitis B and C
  • NAFLD, NASH
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8
Q

Non-alcoholic fatty liver disease

A
  • Changes from simple steatosis to steatohepatitis and fibrosis
  • Associated with metabolic syndrome compartments
  • Exacerbates insulin resistance and increases cardiovascular risk
  • Related to lipids and lipotoxicity
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9
Q

Acites

A

Build up of fluid

  • Fluid build up in peritoneal cavity
  • Decreased albumin
  • Increased hydrostatic pressure
  • Aldosterone is not metabolised = splanchnic vasodilation
  • Drained by ascitic tap
  • No immune response from cirrhotic liver → peritonitis
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10
Q

Peritonitis

A

Bacterial infection in ascitic fluid

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11
Q

Hepatorenal syndrome

A

Leads to liver and kidney failure

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12
Q

Hepatopulmonary syndrome

A

Leads to oedema

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13
Q

How is bilirubin produced

A

RBC metabolism

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14
Q

Symptoms of liver failure

A
  • Ascites
  • Bleeding
  • Bruising
  • Jaundiced
  • Itchy
  • Confusion
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15
Q

Signs of chronic liver disease

A
  • Hands - erythema, clubbing
  • Eyes/skin - jaundice, loss of hair, bruising
  • Chest - gynaecomastia, spider naevi
  • Abdomen - hepatomegaly, splenomegaly, caput medusae
  • Legs - oedema
  • Lipid deposits = xanthelasma
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16
Q

Asterixis

A
  • Liver flap

- Seen in hyper-uraemia, t2 respiratory failure, electrolyte disturbance, phenytoin and barbituates

17
Q

Blood test for liver disease

A
  • LFTS - ALT, bilirubin, ALP, albumin, AST, gamma GT
  • Coagulation - PT /INR
  • FBC - Hb and platelets
18
Q

Imaging for liver disease

A
  • Texture of liver
  • Focal lesoins
  • Gall bladder
  • Portal vein - thrombus, flow rate, hypertension
  • Splenomegaly
  • Stiffness of liver
19
Q

Fibrocan

A

F4 = cirrhosis, F0/1 is no/mild fibrosis

20
Q

Management of liver disease

A
  • Treat decompensation
  • If ascitic, sule out peritonitis
  • Diuretics
  • Ascitic drain
  • Check INR and give INR
  • If bleed suspected, duodendoscopy and beta blocker
  • Lactulose/enemas
21
Q

Long-term management liver disease

A
  • Treat underlying cause
  • Alcohol cessation
  • Lactulose, rifaximin
  • Nutrition
  • Diuretics
  • B blockers
22
Q

Liver regeneration

A
  • Associated with signalling cascades - growth factors, cytokines, matrix remodelling
  • Liver restores any mass lost and adjusts its size to the organism
23
Q

TIPS

A
  • Trans-jugular intrahepatic portosystemic shunt
  • Development of oesophageal varices - can do a shunt to bypass liver and leads to hepatic encephalopathy (toxins to brain)
  • Shunt between hepatic vein and portal vein
24
Q

Pancreas

A
  • Digestive enzymes enter duodenum via sphincter of oddi
  • Endocrine: insulin, somatostatin, glucagon, pancreatic polypeptide, ghrelin
  • Exocrine: digestive enzymes, bicarbonate
  • Digestive enzymes from acinar cells
  • HCO3- from ductal cells
25
Q

Producing bicarbonate

A
  • SLC26A6 absorbs negative ions and exchanging for HCO3-
  • Neutralises stomach contents
  • Controlled by ACh (stimulates bicarbonate secretion)and vagus nerve
  • High level of water needed - transfers through passively between cells
  • Secretin drives expulsion of bicarbonate into duct
26
Q

Pancreatic acinar cells

A
  • Secrete digestive enzymes to small intestine via pancreatic duct
  • Zymogens are enzymes secreted in vesicles
  • Enzymes activated in small intestine aid breakdown of carbohydrates, fats, proteins
27
Q

Exocrine function of pancreas

A
  • Pancreatic enzymes secreted from acinar cells in response to secretin and CCK
  • Necessary for digestion of fat, protein and carbohydrate
  • Secreted from ductular cells to produce optimum pH for enzymes
28
Q

Carbohydrate digestion

A
  • Starch broken down
  • Enters duodenum
  • Starch acted on by amylase
  • Absorbed in epithelium cells
29
Q

Protein digestion

A
  • Broken into amino acids
  • Pepsinogen activated by acidic environment → smaller peptides
  • Peptides broken down by proteolytic enzymes
  • Trypsinogen, chymotrypsinogen and procarboxypeptidase
  • Intrinsic factor secreted from stomach binds to B12
  • No intrinsic factor = no B12
30
Q

Lipid digestion

A
  • Lipase from pancreas acts in conjunction of bile
  • Lipase → small particles → chylomicrons from micelles → thoracic duct or portal vein
  • Vagal nerve via ACh stimulates release of enzymes into acini
  • Secretin and cholecystokinin released due to acidic environment
  • Secretin causes pancreatic fluid to be made
  • Cholecystokinin causes enzyme secretion
31
Q

Sx pancreatic insufficiency

A
  • Pancreas is main source of lipase → insufficiency = unable to digest lipids
  • Loose, pale, greasy stools that float
  • Weight loss
  • Fatigue
  • Abdominal distension
  • Lack of vitamins
  • Amylase/proteolytic enzymes found elsewhere
32
Q

Treatment pancreatic insufficiency

A

Creon

Gastrointestinal system (27 decks)

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