Liver Physio, Bile Physio, Gallbladder Disease

Question 1

liver blood supply

Answer 1

portal v. (75%)

hepatic a. (25%)

Question 2

portal v. carries blood from

Answer 2

entire capillary system of stomach, spleen, pancreas, intestine

Question 3

primary functions of the liver

Answer 3

• bile production and excretion
• excretion of bilirubin, CHL, hormones, drugs
• metabolism of fats, proteins, carbs
• enzyme activation
• storage of glycogen, vitamins, minerals
• synth plasma proteins
• blood detox

Question 4

In the liver, what maintains tissue fluid homeostasis via collecting xs tissue fluid and returning it to venous circulation?

Answer 4

lymphatic vascular system

Question 5

plasma components are filtered through liver sinusoidal endothelial cells into the _________, and are regarded as the source of _________.

Answer 5

space of Disse

lymphatic fluid

Question 6

ascites fluid

Answer 6

lymph, inc when pressure in sinusoids inc much above normal

Question 7

major organic compounds prod by liver, found in bile

Answer 7

• bile acids
• phospholipids (lecithins)
• CHL
• Bile Pigments

Question 8

T/F

Bilirubin is prod by the liver

Answer 8

F

Question 9

things stored in liver

Answer 9

• glucose
• fat-soluble vitamins (A, D, E, K), folate, B12
• Fe, Cu

Question 10

liver can synthesis __ of 20 essential aa

Answer 10

11

Question 11

liver prod most of circulating plasma proteins EXCEPT

Answer 11

Ig, Hb

Question 12

most abundant protein in plasma

Answer 12

albumin

Question 13

Fe absorption

Answer 13

duodenum

upper jejunum

Question 14

liver stores enough iron to last

Answer 14

2-3 years

Question 15

major site of clearance of circulating lipoproteins

Answer 15

liver

catabolized in hepatocytes

Question 16

SI production of ammonia

Answer 16

aa breakdown

Question 17

large bowel production of ammonia

Answer 17

bacterial breakdown of aa and urea

Question 18

ammonia effect on CNS

Answer 18

serious negative effects that disrupt metabolism and function of protective glial cells (astrocytes)

Question 19

liver is the only organ in which complete ______ cycle is found

Answer 19

urea

only organ that can NH3 –> non-toxic urea

Question 20

Higher first-pass effect,

Answer 20

less active drug getting into systemic circulation after oral admin

Question 21

drug metabolism

Answer 21

intro hydrophilic functionalities onto drug molecule to make it less lipophilic (promote excretion from body)

Question 22

phase I metabolism of drugs

Answer 22

intro functional group (like hyroxyl) –> activates or inactivates –> more hydrophilic/susceptible to excretion

Question 23

phase II metabolism of drugs

Answer 23

conjugates glucuronic acid, sulfates, glutathione, aa to the drug

inc molecule weight, inactive/more susceptible to excretion

Question 24

bilirubin

Answer 24

prod from degradation of Hb (normal senescence)

Question 25

unconjugated bilirubin is carried through the blood by

Answer 25

albumin

Question 26

enzyme responsible for conjugating bilirubin in the liver

Answer 26

UDP glucuronosyltransferase

Question 27

primary bile acids

Answer 27

cholic and chenodeoxycholic bile acids synthesized in liver from CHL, modified in gut by bacteria to form secondary bile acids

Question 28

secondary bile acids

Answer 28

deoxycholic and lithocholic acid conjugated w/ glycine or taurine, considered to be func equiv to primary bile acids

Question 29

______ facilitate the digestive action of pancreatic lipase on triglycerides forming fatty acid chains and monoglycerides that can easily diffuse into the enterocyte.

Answer 29

Micelles (bile acid + fat droplet)

Question 30

percentage of bile salt pool lost each day to excretion

Answer 30

15-30%

Question 31

bulk of fat digestion is where, via which enzyme

Answer 31

SI, pancreatic lipase

Question 32

pancreatic lipase

Answer 32

SI hydrolyzes TGs to monoglycerides and free FAs

Question 33

absorption of bile acids from ___ ileum req 2 methods:

Answer 33

distal ileum req 1. Na dependent symporter 2. diffusion across cell membranes using hydrophobic surface of bile acid to fuse w/ lipid of cell memb

Question 34

effect of ingestion of food on bile flow

Answer 34

eating --> contraction of GB (CCK and neural stim), relax of sphincter of Oddi

Question 35

process of concentrating gb bile

Answer 35

as [ions] in interstitial space inc, H2O flows out of bile following ion gradient passively

Question 36

causes of gallstones

Answer 36

1. too much absorption of water from bile 2. too much absorption of bile acids from bile 3. too much CHL in bile 2. inflamm of epithelium

Question 37

~70% gallstones are formed from

Answer 37

CHL

Question 38

3 important components of bile

Answer 38

CHL bile salts phospholipids (90% lecithin)

Question 39

bile acids are secreted into bile after conjugation in liver with

Answer 39

taurine | glycine

Question 40

major risk fx for devel of gallstones

Answer 40

- age - female sex - pregnancy - obesity - rapid weight loss - very low calorie diet - surgical therapy of morbid obesity - hypertriglyceridemia - terminal ileal resection - gallbladder stasis - DM - total parenteral nutrition - postvagotomy - spinal cord injury - reduced physical activity (men) - cirrhosis

Question 41

meds that inc risk of gallstone development

Answer 41

estrogen, OCP clofibrate cefraiaxone octreotide or somatostatinoma

Question 42

genetic risk fx for gallstone development

Answer 42

Native Americans | -Pima Indians, chileans

Question 43

anemias that inc risk of gallstone formation

Answer 43

- sickle-cell | - hereditary spherocytosis

Question 44

composition of gallstones

Answer 44

bilirubin pignments CHL Ca salts

Question 45

__% of gallstones are heavily calcified

Answer 45

15% | most of these are pigment stones

Question 46

brown pigment stones

Answer 46

bacteria or parasites calcium salts of unconjugated bilirubin asians

Question 47

black pigment stones

Answer 47

unconjugated bilirubin + mucin glycoproteins chronic hemolysis, cirrhosis

Question 48

biliary colic

Answer 48

episodic RUQ pain - radiates to back or R shoulder - jaundice - WBC and diff - LFTs - amylase and lipase

Question 49

choledocholithiasis

Answer 49

gallstones obstruct part of bile duct can lead to cholangitis (EMERGENCY! -->sepsis/shock)

Question 50

gallstone ileus

Answer 50

gallbladder forms a fistula w/ digestive tract pts w/ longstanding gallstone disease stones pass into bowel and can block gut at level of ligament of treitz or ileocecal valve tx: surgery

Question 51

gallstone imaging

Answer 51

abd US, CT, MRI | HIDA, ERCP, EUS

Question 52

HIDA

Answer 52

injects radioactive tracer --> taken up by the liver --> excreted by hepatocytes into the biliary tree --> passes into the gb through the cystic duct. If cystic duct is obstructed by inflammation or a stone (as in acute cholecystitis), tracer will not enter the gb and the gb will not be visualized.