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Gastro-intestinal System > Liver and Pancreas Physiology and Disease > Flashcards

Liver and Pancreas Physiology and Disease Flashcards

1
Q

Which areas of the abdominal does the liver reside in?

A

Right hypochondrium

Epigastric

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2
Q

What do we call the 2 liver surfaces?

A

Diaphragmatic

Visceral

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3
Q

What is contained within the falciform ligament?

A

Remnant of umbilical vein

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4
Q

What is the role of the coronary and triangular ligaments of the liver?

A

Attach superior liver to the diaphragm

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5
Q

Which ligaments are contained in the lesser omentum?

A

Hepatoduodenal

Hepatogastric

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6
Q

Name the hepatic recesses and state where they are

A

Subphrenic spaces (left and right) - between diaphragm and liver
Subhepatic space - between liver inferior surface and transverse colon
Morison’s pouch - between liver and the right kidney

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7
Q

What is the deepest part of the peritoneal cavity when supine?

A

Morison’s pouch

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8
Q

What do we call the fibrous layer covering the liver?

A

Glisson’s capsule

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9
Q

What divides the liver into right and left lobes?

A

Falciform ligament

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10
Q

Where are the accessory lobes of the liver?

A

Visceral surface
Caudate - between the IVC and a fossa produced by ligamentum venosum
Quadrate - between gall bladder and fossa produced by ligamentum teres

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11
Q

What lies between the caudate and quadrate lobes?

A

Deep fissure - porta hepatis

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12
Q

What provides the dual blood supply to the liver?

A

Hepatic artery proper (from coeliac trunk)

Hepatic portal vein (from small intestine)

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13
Q

What is the dominant blood supply to the liver parenchyma?

A

Hepatic portal vein

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14
Q

How is the parenchyma of the liver innervated?

A

Hepatic plexus:
SNS - coeliac plexus
PNS - vagus nerve

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15
Q

What innervates the Glisson’s capsule?

A

Branches of the liver intercostal nerves

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16
Q

What kind of pain occurs with distension of the liver capsule?

A

Sharp

Well localised

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17
Q

Does the duodenum add or remove water to the gut lumen?

A

Adds (from ECF)

For dilution because chyme so hypertonic

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18
Q

What is the osmotic status of chyme when it leaves the duodenum?

A

Isotonic

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19
Q

What percentage of the pancreas is exocrine?

A

90%

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20
Q

Which basic parts of the pancreas produce the different exocrine parts?

A

Acinus - produces enzymes
Centroacinar - aqueous component
Duct - modifies secretion

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21
Q

What happens to pancreatic secretions if the flow is faster?

A

More HCO3- ions

More alkaline

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22
Q

Describe the neuronal control of the pancreas

A

SNS - inhibits secretions

PNS - vagus stimulates secretions

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23
Q

What stimulates the acinus to produce enzymes?

A

Vagus nerve

CCK

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24
Q

What stimulates the release of CCK in the duodenum?

A

Detection of hypertonicity, small peptides and fats in the duodenum

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25
Q

What enzymes are released from the pancreas?

A

Amylases and lipase
Proteases - trypsin, chymotrypsin, elastase, carboxypeptidases
(Proteases as zymogens)

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26
Q

What are zymogen granules?

A

Membrane bound

Contain inactive precursor of an enzyme

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27
Q

Pancreatic enzymes in the blood indicate …

A

Pancreatic damage

Pancreatitis

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28
Q

How high can the rate of mortality in pancreatitis be?

A

50%

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29
Q

What is the role of pancreatic duct cells?

A

Produce aqueous component - isotonic solution
Secrete HCO3- stimulated by secretin
HCO3- pumped into lumen therefore H+ moves into blood
(Transient lowering of pH of blood leaving the pancreas)

30
Q

What are the roles of the liver?

A

Energy metabolism - glycogen storage
Detoxification
Plasma protein production
Bile production

31
Q

How many hepatic veins attach the liver to the IVC?

A

3

32
Q

How much bile is secreted per day?

A

250ml - 1 litre

33
Q

Describe hepatocytes

A

Chief functional cell of liver
Very active at producing proteins/lipids for export
Contain lots of glycogen

34
Q

What is the structural unit of the liver and describe?

A 
Lobule 
Contains many hepatocytes in radiating branches
Central vein 
Hexagonal 
Portal triads at each corner
35
Q

What is the functional unit of the liver and describe?

A

Acinus
Diamond shaped - from one central vein to another in an adjacent lobule (long axis)
One portal triad to another - short axis
3 zones

36
Q

Which zones of the acinus of the liver are most at risk?

A

Zone 1 - receives highest blood supply so most at risk of toxic damage
Zone 3 - receives lowest blood supply so most at risk of hypoxic damage

37
Q

Which veins all drain together to make the hepatic portal vein?

A 
Splenic vein
Superior mesenteric vein 
Inferior mesenteric vein
Gastric veins
Cystic vein
38
Q

What are the 2 component types of bile?

A

Bile acid dependent - bile acids and pigments

Bile acid independent - alkaline solution

39
Q

What are the 2 primary bile acids?

A

Cholic acid

Chenodeoxycholic acid

40
Q

What are bile salts?

A

Bile acids that are conjugated with amino acids

Glycine and taurine

41
Q

Describe the structure and function of bile salts

A

Generally soluble at duodenal pH
Amphipathic molecules
Crucial for emulsification of dietary lipids
Form micelles with products of lipid breakdown
Moves fat into enterocytes and bile salts remain in gut
Reabsorbed at terminal ileum then go back to liver to be recycled

42
Q

What are the products of lipid digestion in the gut?

A

Cholesterol
Monoglycerides
Free fatty acids

43
Q

Inside cells, fat is re-esterified back to …

A

Triglycerides
Phospholipids
Cholesterol

44
Q

What are chylomicrons?

A

Reformed lipids packaged with apoproteins

45
Q

How do chylomicrons travel?

A

Exocytosis through basolateral membrane
Enter lymph capillaries - lacteals
Travel through lymphatic system
Re-enter vascular system at the thoracic duct

46
Q

What is the function of the gall bladder?

A

To store and concentrate bile

47
Q

Name the different types of gallstones we can get

A

Pigment stones - black
Cholesterol stones - yellow
Mixed stones - black and yellow

48
Q

What is the effect of CCK towards bile?

A

Stimulates gall bladder contraction

Relaxes sphincter of Oddi

49
Q

What is steatorrhoea?

A

Fat in the faeces
Pale, floating, foul smelling stool
If bile acids or pancreatic lipase are not secreted in adequate amounts

50
Q

Give some common symptoms/signs of liver disease

A 
Abnormal blood tests (LFTs)
Abdominal pain 
Nausea/vomiting 
Jaundice
Skin irritation 
Hepatomegaly
51
Q

Give some signs of very severe liver disease

A

Small, irregular liver
Bleeding/poor clotting
Oedema
Encephalopathy

52
Q

How do you get abdominal pain in liver diseases?

A

Inflamed liver/swelling
Surrounded by visceral peritoneum
Poorly localised visceral pain

53
Q

Why do you become nauseous in liver failure?

A

High number of toxins in the blood

Liver cannot detoxify as well

54
Q

Why can the skin become irritated in liver disease?

A

Bile salts deposited in the skin - itchy

55
Q

Why do you get hepatomegaly in liver disease?

A

Inflammation and swelling

Increased fat deposition

56
Q

How does ascites occur in liver failure?

A

Decreased albumin production
Decreased oncotic pressure of plasma
Fluid moves out of plasma
Also if portal hypertension - increased hydrostatic pressure in the portal system - fluid moves out

57
Q

How does encephalopathy occur in liver disease?

A 
Break down of the urea cycle 
Increase in ammonia 
Crosses in BBB 
Toxic to the brain 
Can lead to coma
58
Q

Describe the life cycle of bilirubin

A 
120 days in a RBC 
Bilirubin is the breakdown product of Hb
Joined with albumin to carry to liver
Conjugation 
Joined with bile salts and excess cholesterol 
Drains into biliary tree
Secreted into duodenum 
Bilirubin converted to urobilinogen which gives colour to faeces
Some bilirubin recycled to liver
59
Q

Describe pre-hepatic jaundice

A

Excess bilirubin load to the liver
Excessive RBC breakdown eg. Haemolytic anaemia
Liver cannot conjugate fast enough
Unconjugated bilirubin remains in blood

60
Q

Describe hepatic jaundice

A

Decreased rate of bilirubin conjugation
Injury/damage to liver or defects in conjugation
Some bilirubin remains insoluble

61
Q

Describe post-hepatic jaundice

A

Obstruction to bile drainage into duodenum
Conjugated but cannot leav ebiliary tree
Refluxes into circulation
No bilirubin in stool - pale, fatty, smelly steatorrhoea

62
Q

What are the tests for the true liver function?

A

Albumin

Clotting factors

63
Q

Briefly describe hepatitis

A 
Hepatocytes inflammation and breakdown 
Many causes:
Viral Hep
Autoimmune
Drugs eg. Alcohol, paracetamol 
Hereditary disorders
64
Q

How does chronic liver disease lead to cirrhosis?

A 
Inflammation of the liver
Ongoing liver cell damage/necrosis 
Nodular regeneration and fibrosis 
Architectural change to liver structure 
Increased resistance to blood flow
65
Q

Describe the symptoms of stones in the biliary tree

A

Nausea/vomiting
Abdominal pain
Jaundice
(Fever and right upper quadrant pain = cholecystitis)

66
Q

How do we tend to identify gall stones?

A

Ultrasound scan

67
Q

What are the most common causes of pancreatitis?

A

Gallstones

Alcohol

68
Q

What are the symptoms of pancreatitis?

A

Abdominal pain
Vomiting
Hypotension

69
Q

What is the treatment for pancreatitis?

A

Supportive
Analgesics
Lots of IV fluids

70
Q

What type of cancer is the majority of pancreatic cancers?

A

Ductal adenocarcinoma

71
Q

What are the symptoms of pancreatic cancer as it progresses?

A 
Obstructive jaundice
Pain (referred to back)
Weight loss
Vomiting 
Malabsorption 
Diabetes

Gastro-intestinal System (10 decks)

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