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GI > Physiology and Pharmacology of the Liver > Flashcards

Physiology and Pharmacology of the Liver Flashcards

1
Q

Functions of Liver?

A
  • Carb metabolism
  • Fat metabolism
  • Protein metabolism
  • Degradation fro insulin, steroid, glucagon & ADH
  • Activation of Vit D to hydroxyvitamin D2
  • Storage Vit A, B12, E, D + K, copper, iron, glycogen
  • Coagulation
  • Synthesis of plasma proteins
  • Protective
  • Detoxification
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2
Q

Examples of carb etabolism?

A

Gluconeogenesis
Glycogenolysis
Glycogenesis
Glycolysis

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3
Q

What is gluconeogenesis?

A

Producing glucose form amino acids

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4
Q

What is glycogenolysis?

A

Release glucose as required

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5
Q

Glycogenesis?

A

To store polymerised glucose as glycogen

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6
Q

Glycolysis?

A

Form pyruvate, thence lactat or acetyl Co-A

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7
Q

What is involved in fat metabolism?

A
  • Processing of chlyomicron remenants
  • Synthesis of lipoproteins & cholesterol
  • Ketogenesis (starvation)
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8
Q

What is involved in protein metabolism?

A
  • Trans and de-amination of amino acids
  • Convert ammonia to urea
  • Synthesis of plasma proteins
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9
Q

When is bile secreted?

A

Between meals

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10
Q

Where is bile stored?

A

Stored and concentrated in gall-bladder

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11
Q

What happens in regards to bile during a meal?

A

Chyme in duodenum stimulates the GB smooth muscle to contract via CCK

  • Sphincter of Oddi opens
  • Bile spurts into duodenum via cystic and common bile ducts
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12
Q

What does bile consist of?

A

Cholic and chenodeoxycholic acids

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13
Q

What is cholelthiasis?

A

Concentration of bile in gall bladder caused by resorption of water- producing a supersaturated solution that is unstable
Cholesterol may crystallise and over time produce gall stones

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14
Q

What is the best treatment for symptomatic gall stones?

A

Laparoscopic cholecystectomy

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15
Q

What is given to patients with impaired GB function with small-medium sized radiolucent stones? And the drugs adverse affect?

A

Ursodeoxycholic acid

Diarrhoea

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16
Q

What does atropine or GTN relieve?

A

Biliary spasm

17
Q

Bile acid sequesterants?

A

Colesevalam
Colestipol
Colestyramine

18
Q

What do bile acid sequesterants do?

A

Bind to bile acids preventing reabsorption

Lower plasma cholesterol indirectly

19
Q

What are bile acid sequesterants used for? And what are their adverse affects/limitations?

A

Used in hyperlipidaemia, cholestatic jaundice and bile acid diarrhoea

-Unpalatable, Causes diarrhoea, reduced absorption of fat soluble vitamins

20
Q

Where does Phase 1 of drug metabolism occur?

A

Right Liver

21
Q

3 processes in phase 1 of drug metabolism?

A

Oxidation
Reduction
Hydrolysis

22
Q

What is the effect of drug metabolism phase 1?

A

Makes drug more polar

Adds chemically reactive group permitting conjugation

23
Q

Where does phase 2 of drug metabolism occur?

A

Left liver

24
Q

What happens in phase 2 of drug metabolism?

A 
Conjugation
An endogenous compound is added increasing polarity
Then excreted (some drugs excreted unchanged and don't go through the phases)
25
Q

What does drug metabolism do?

A

Acts to convert patent drugs to more polar metabolites that are not readily reabsorbed by kidney facilitating excretion

26
Q

What is CYP450? What does it stand for? What does it do?

A

Cytochrome P450
Metabolizing enzyme in liver
Paracetamol and other drugs mess this up so liver can’t metabolise (do it’s job)

27
Q

What does not occur in severe hepatic failure?

What condition is this known as?

A

Detoxification of NH3 to urea

Hepatic encephalopathy

28
Q

What effect does a lack of detoxification of NH3 to urea have?

A

Blood NH3 levels rise

Resulting in coma

29
Q

What do you use in hepatic encephalopathy?

A

Lactulose

Converts ammonia to ammonium which is not absorbed/digested in SI

30
Q

Examples of plasma protein secretions?

A

Albumin
Alpha globulins
Beta globulins

31
Q

What do alpha globulins do?

A

Transport lipoproteins, lipids, hormones and bilirubin

32
Q

What do beta globulins do?

A

Transferrin (transports Fe3+, store bound to ferritin)

Fibrinogen (inactive from of fibrin, clotting blood)

33
Q

What is albumin?

A

Most abundant plasma protein

Small, negatively charged, water soluble, liver synthesizes about 14g/day

34
Q

What do lipoproteins do?

A

Transport dietary fats + synthesized fats. Only liver can metabolise and excrete cholesterol

35
Q

What vitamins does the liver store and for how long?

A

Vitamin A- 10 months
Vitamin D- 3 weeks
Vit B12- Few years

36
Q

What does cholesterol synthesis require?

A

C atoms-Acetyl Co-A
Reducing power-NADPH
Energy- ATP

37
Q

What is the role of HMG-CoA reductase?

A

Catalyiss irreversible form of mevalonic acid
Rate limiting enzyme
Statins target this to lower cholesterol

38
Q

Products form cholesterol?

A

Vitamin D- Regulates calcium + phosphorous metabolism
Steroid hormones- Corticosteroids, androgens, estrogens
Bile salts-Main metabolic product of cholesterol

GI (15 decks)

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