Liver, Gallbladder, and Pancrease Flashcards
1
Q
What are the parts of the portal triad?
A
- Hepatic artery- brings in fresh blood
- hepatic portal vein- blood from GI tract
- bile duct- brings bile out of the liver
- lymphatics- bring lymph out of the liver towards portal triad
2
Q
How much of CO does liver get?
A
25%
80% enters liver from portal vein
20% from hepatic artery
3
Q
What is the function of the hepatocyte regarding glucose and protein?
A
- takes up glucose and stores it as glycogen, releases glucose between meals
- Takes up amino acids and synthesizes plasma proteins
- makes lipoproteins
- some protein is stored in the liver (reserve of one day’s worth of amino acids)
4
Q
What is the hepatocyte function regarding bile?
What is the function of bile?
A
- Liver makes bile
- bile salts are used to emulsify fats
- negatively charged after the Na+ or H+ is removed
- bile is modified cholesterol
- Bile is released into bile canaliculi then to bile duct, then to gallbladder, then to duodenum
- In duodenum bile helps digest fat by emulsifying
- bile is reabsorbed in ileum and it is brought back to liver
5
Q
What is hepatocyte function regarding bilirubin?
A
- Bilirubin comes from broken down heme
- Fe is recycled and porphyrin–>biliverdin–>bilirubin
- when unconjugated it is lipophilic; must be conjugated in liver so it can be excreted in kidney
- Hepatocytes attach a glucuronic acid, making it water soluble
- this is released into bile duct and into duodenum and out with feces
6
Q
What is fibrosis?
A
- inflammation: macrophages activate and stimulate fibroblasts to lay down collagen
- lots of collagen impairs blood flow through liver and liver function
7
Q
What laboratory test evaluates hepatocyte integrity?
A
- AST, ALT
- these are enzymes that are found within hepatocytes.
- they would only be found in the blood if the hepatocytes are dying (necrosis, not apoptosis)
- the higher the values, the more hepatocyte death that is occuring.
8
Q
What lab values indicate biliary tract integrity?
A
- Serum alkaline phosphatase (AP, ALP, ALKP) and GGT
- released if cells along the biliary tract are damaged
- found in cells lining bile ducts
- high numbers are indicative of bile duct damage
9
Q
What lab values indicate hepatocyte function?
A
- Serum bilirubin- liver’s ability to conjugate the bilirubin
- tests for total and conjugated
- total- conjugated = unconjugated
- Serum albumin- will not be made if liver is failing
- decreased albumin and decreased total protein = liver damage
- if all numbers are correct except albumin, might be a kidney problem
- INR (Prothrombin time)- measures clotting time
- liver makes clotting factors, if liver is failing, pt will have increased clotting time
- might be making clotting factors but not fibrinolytic factors (they would have more clotting)
- coagulopathy- either too much or too little
- Serum ammonia- liver deaminates amino acids and sticks them together to form urea
- if liver cannot do this, ammonia is released
10
Q
What is the MELD score?
A
- Model for End-stage Liver disease
- 3.8 * ln(bilirubin) + 11.2 * ln (INR) + 9.6 * ln (creatinine) + 6.43
- higher score = higher risk of mortality
11
Q
What are the consequences of liver disease?
A
- jaundice and cholestasis
- hypoalbuminemia
- hyperammonemia
- hypoglycemia
- fetor hepaticus- smell of death/feces in lung
- hypogonadism-liver clears hormones (estrogen builds, decreased release of LH & FSH)
- gynecomastia- steroid hormones are lipophilic, must be conjugated in liver to be able to excrete
- palmar erythema- red palms, blamed on estrogen
- spider angiomas- red dilated capilaries, blamed on estrogen
- weight loss
- muscle wasting
12
Q
What does hepatic portal hypertension cause?
A
- ascites
- esophageal varices
- hemorrhoids
- caput medusae
- splenomegaly
13
Q
What are the causes of jaundice?
A
- resulting in elevated unconjugated bili
- excess bilirubin production
- reduced hepatic uptake
- impaired conjugation
- resulting in elevated conjugated bili
- decreased hepatocellular excretion
- impaired bile flow
14
Q
Whats the problem with increased unconjugated bilirubin?
A
- it is insoluble in water and tightly bound to albumin, so it cannot be excreted by the kidney
- the fraction that is not bound to albumin will:
- diffuse into tissues (especially brain, causing brain damage)
- produce toxic injury
- may lead to severe neurological damage
15
Q
What is cholestasis?
What is biliary atresia?
A
- Cholestasis: The inability to move bile
- passage gets clogged, bile can’t go through and this buildup will damage the hepatocytes
- Biliary atresia: bile duct doesnt form all the way, results in liver failure, seen in young children.
16
Q
What are the causes of hyperbilirubinemia without liver damage?
A
- Gilbert’s syndrome
- Crigler-Najjar syndrome
- Dubin-Johnson Syndrome
- Benign Postoperative Intrahepatic cholestasis
- Progressive Familial Intrahepatic Cholestasis
17
Q
What is Gilbert’s syndrome?
A
- Mild defect in glucoronosyltransferase enzyme (UGT1A1)
- increase in unconjugated bilirubin (the only thing that is elevated)
- Common 5%-10%, but benign
18
Q
What is Crigler-Najjar syndrome?
A
- Severe defect in glucuronosyltransferase enzyme (UGT1A1)
- increase in unconjugated bilirubin
- rare, but a severe problem
- bilirubin can cause brain damage
19
Q
What is Dubin-Johnson Syndrome?
A
- Defect in protein needed to pump conjugated bilirubin into bile canaliculus
- increase in conjugated bilirubin
- rare and benign–liver is black!
- ** Joey didnt mention the sports thing, I was just looking at pictures of black livers and thought this was funny**
22
Q
What is the problem with cirrhosis? What does it cause?
A
- it impairs blood flow through the liver and causes hepatic portal hypertension, which causes:
- ascites
- portosystemic shunts
- esophageal varices
- hemorrhoids
- caput medusae
- splenomegaly
24
Q
What are the clinical manifestations of cirrhosis?
(chart)
A
29
Q
What is hepatic steatosis?
A
- Fatty liver disease- fat builds up inside hepatocytes, enlarges liver
- Usually caused by high alcohol intake, the hepatocytes will take up the alcohol (as fats?) faster than they can make the fats into lipoproteins
- Will see elevated AST, ALT and unconjugated bili, but all will return to normal after the binge drinking stops
30
Q
What are the different stages of alcoholic liver disease?
A
- hepatic steatosis (90-100%)
- alcoholic hepatitis (10-35%)
- Cirrhosis (8-20%)
36
Q
What are the four circulatory problems of the liver?
A
- Hepatic vein outflow obstruction
- impaired intrahepatic blood flow
- impaired blood flow into liver
- impaired hepatic artery flow
40
Q
What are the different types of stones?
A
cholesterol (front)
pigment (below)
