liver, gallbladder & pancreas- 15

Question 1

papilla

Answer 1

common orifice of the duodenum that the liver and pancreas excretory ducts empty into

Question 2

bile

Answer 2

excretory product of the liver
transported via hepatic bile ducts

• greatly facilitates digestion of fats including fat soluble vitamins A, D, E, K
  if there is interference with production/excretion of bile, digestion of fats is greatly impaired

Question 3

gallbladder

Answer 3

resevoir that stores bile on its way to the duodenum

Question 4

cystic duct

Answer 4

connects gallbladder to bile ducts

Question 5

common bile duct

Answer 5

drains cystic ducts to the papilla of Vater

Question 6

excretory process of the pancreas

Answer 6

a fluid rich in enzymes that digest food once they are delivered to the small intestine

Question 7

largest glandular organ in the body

Answer 7

liver

Question 8

portal veins

Answer 8

carry blood from abdominal organs to the liver

Question 9

hepatocytes

Answer 9

=parenchymal cells of the liver, filter the blood before transported back to the heart via the hepatic vein

Question 10

bulk of liver composed of:

Answer 10

hepatocytes, large epithelial cells, arranged in lobules that carry out many essential metabolic functions.

Question 11

sinusoids

Answer 11

separate hepatocytes

channel for blood from the portal vein to percolate to the central vein

Question 12

kupffer cells

Answer 12

mononuclear phagocytic cells within the simusoids

phagocytose particulate matter present in the blood

Question 13

canaliculi

Answer 13

tiny
between cell membranes of adjacent hepatocytes
carry bile produced by the hepatocytes to the portal area, where they empty into epithelial-lined bile ducts

Question 14

portal triad

Answer 14

branches of the hepatic artery
portal vein
bile ducts

blood flows into the liver through the hepatic artery and portal vein and filters into the sinusoids.
here, hepatocytes and kupffer cells remove waste products and nutrients.
waste products are metabolized by the hepatocytes.
the metabolites may be returned to the blood, stored in the hepatocytes, or converted to components of bile and excreted into bile canaliculi. bile is carried through the canaliculi back to the portal areas for excretion via the bile ducts, while the blood itself drains into central (or hepatic) veins and eventually gets carried to the inferior vena cava and back to the heart.

Question 15

metabolic functions of the liver

Answer 15

1: production of bile salts
2: excretion of bilirubin
3: metabolism of nitrogenous substances
4: production of serum proteins
5: detoxification of drugs and poisons

Question 16

bile salts

Answer 16

compose bile

bipolar molecules derived from cholesterol that aggregate into spherical masses or micelles

Question 17

micelles

Answer 17

solubilize lipids in the aqueous environment of the digestive tract
prevent cholesterol from crystallizing and emulsify or dissolve dietary lipids so that they are more easily digested by lipases in the GI tract.

Question 18

bilirubin

Answer 18

breakdown product of hemoglobin

present in excess is imparts a yellow color or jaundice to the skin, eyes and internal organs

Question 19

urea nitrogen

Answer 19

metabolic product of hepatocytes

breakdown of dead cells produces nitrogenous products such as ammonia. liver converts these nitrogenous products to urea nitrogen and returns it to the bloodstream to be excreted by the kidney

• severe liver failure results in accumulation of ammonia in the blood
• severe kidney failure results in accumulation of urea nitrogen in the blood

Question 20

cytochrome p450 (CYP)

Answer 20

enzyme that catalyzes the first step in the clearance of many drugs

Question 21

implications for the manner in which toxins are cleared from the liver:

Answer 21

1: individual variation -unpredictable
2: co-administration of drugs that are cleared by the same enzyme system
3: if enzyme clearance system is impaired.

Question 22

albumin

Answer 22

serum protein
maintains osmotic pressure and can carry non-soluble molecules such as unconjugated bilirubin in the blood

*altered albumin levlsmay indicate underlying liver injury

Question 23

clotting factors

Answer 23

protein produced by the liver
part of the coagulation cascade

*pts with severe liver disease have problems with blood clotting and prolonged bleeding times

Question 24

pancreas

Answer 24

exocrine and endocrine functions

long, narrow glandular organ lying horizontally in the midabdomen behind the peritoneum

Question 25

pancreatic duct

Answer 25

runs the length of the pancreas and empties into the duodenum after going the bile duct

Question 26

acini

Answer 26

glands that make the bulk of the pancreas
secrete digestive enzymes into the pancreatic duct.
when activated by intestinal juices, these enzymes digest carbs, fats and proteins

*amylase, lipase, and trypsin
pancreatic enzymes can be replaced nutritionally

Question 27

islets of langerhans

Answer 27

clusters of endocrine cells scattered among the pancreatic glands
-produce insulin and other hormones

Question 28

most common problem affecting accessory digestive organs

Answer 28

gallstones

Question 29

gallstones

Answer 29

usually asymptomatic but can produce serious complications such as obstruction of bile flow from migration of stones into common bile duct.
20-40% of americans
1-4% symptomatic a year

tx: surgical removal of gallbladder or cholecystectomy

Question 30

hepatitis

Answer 30

inflammation of the liver
most common liver disease

caused by infection, autoimmune diseases, drug reactions, alcohol and obesity

• some forms are acute and resolve- hepatitis A
• some forms are reversible if the offending agent is identified and avoided-alcohol and drug induced
• many are irreversible or not detected until serious injury to liver already occurred

Question 31

cirrhosis

Answer 31

long standing inflammation leading to substantial loss of hepatocytes and severe scarring of the liver

more common cause=alcohol and hepatitis C
not reversible- results in liver failure

Question 32

hepatocellular carcinoma

Answer 32

most common primary neoplasm of the liver

tends to arise in cirrhotic livers

Question 33

most common reasons for liver transplant

Answer 33

cirrhosis
hepatitis C

**livers 2nd most transplanted organ after kidney

Question 34

jaundice

Answer 34

most obvious sign of liver disaese
manifests first in sclerae
can be caused by increased hemoglobin breakdown, liver disease, or bile duct obstruction

Question 35

biliary colic

Answer 35

severe right upper quadrant and flank pain cause by acute cholecytitis or obstruction of the biliary ductal system by stones

*pain caused by pancreatitis is usually in the upper abdomen and radiates to the back

Question 36

signs and symptoms

Answer 36

jaundice
biliary colic
abdomen & back pain
unintentional weight loss
steatorrhea
hepatomegaly

Question 37

steatorrhea

Answer 37

passage of greasy, smelly stools that often float in toilet water
indicates malabsorption of fats

Question 38

hepatomegaly

Answer 38

=increase in liver size
can be palpated in the lower left quadrant just inferior to the rib cage

particularly prominent in alcoholic fatty liver and metastatic disease

Question 39

routine tests to check the status of the liver:

Answer 39

bilirubin-elevated

total protein - low serum protein

albumin- low levels-chronic liver disease

aspartate aminotransfersase (AST)-elevated w/ liver necrosis (hepatitis)

alkaline phosphatase-elevated w/ bile obstruction

blood coagulation tests- PT deficiency

enzymes produced by pancreas can be measured in serum-elevated amylase and lipase indicate acute pancreatic injury bc these leak into blood