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Organ Systems II > SS-L Lecture > Flashcards

SS-L Lecture Flashcards

0
Q

What suspends the liver between the stomach & anterior abdominal wall?

A

Peritoneum via two peritoneal ligaments

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1
Q

What is the largest gland in the body?

A

Liver

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2
Q

What are the two peritoneal ligaments which suspend the liver b/w the stomach & anterior abdominal wall?

A
  1. Lesser omentum: b/w liver & stomach, contains hepatic blood vessels & bile ducts
  2. Falciform ligament: b/w liver & anterior abdominal wall; visceral peritoneum covers liver except bare area, top of liver attached to diaphragm & surrounded by coronal ligament
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3
Q

What are the lobes of the liver & how are they determined?

A

Right, left, quadrate & caudate

Demarcated by blood vessels & ligaments however, do not represent internal organization

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4
Q

Ligamentum teres is a vestige of what?

A

Umbilical cord carrying blood from placenta to fetus

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5
Q

What is the porta hepatis?

A

‘hilum’ of the liver containing bile ducts, hepatic artery & portal vein

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6
Q

The liver receives what percentage of CO?

A

29%

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7
Q

What are the 5 fxns of the liver?

A
  1. macrophages (kupffer cells) consume colonic bacteria
  2. metabolizes 3 major components of food
    - CHO: stores as glycogen or secretes into circulation through gluconeogenesis
    - lipids: synthesizes lipoproteins, cholesterol & phospholipids; oxidizes FAs; converts CHOs & proteins into fat
    - proteins: synthesizes plasma proteins; forms urea
  3. stores vitamins & iron
  4. detoxifies drugs, hormones, etc
  5. secretes bile
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8
Q

What are the 4 blood pathways in the liver?

A
  1. hepatic artery: brings oxygenated blood from the aorta via the celiac artery
  2. portal vein: brings nutrient-filled, deoxygenated blood from the gastric, splenic & mesenteric veins
  3. sinusoids: lined w/hepatocytes that detoxify, metabolize, store iron & vitamins, etc
  4. hepatic veins: brings blood out of superior aspect of liver into the IVC
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9
Q

What is the arrangement w/in the liver? (of the cells)

A

classic lobule, hexagonal

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10
Q

What is the functional unit of the liver? What do they contain?

A
  • liver lobule

- triads; they contain the hepatic artery, portal vein & bile duct; central vein lies in the middle

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11
Q

What is the more functional unit of the liver?

A

Acinus

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12
Q

Hepatocyte efficiency depends on what? What are the differences between the different zones?

A
  • proximity to blood supply; from hepatic and portal vessels out
  • zone 1 receives highest concentration of oxygen & nutrients
  • zone 3 receives least oxygen & nutrients, but is the primary site of alcohol & drug detoxification; susceptible to hypoxia & toxic damage
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13
Q

In terms of lymphatics, what is the structure which contains plasma & what space does this plasma flow into?

A
  • plasma flows from sinusoids into space of Disse
  • space of Disse b/w hepatocytes & endothelium of sinusoids
  • lymph sent via channels to IVC or thoracic duct
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14
Q

How does Portal Hypertension happen?

A

-back pressure of blood into portal circulation due to flow obstruction: varicosities in portal-caval anastamoses (hemorrhoids, caput medusae & esophageal varices)

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15
Q

What are ascites?

A
  • build of fluid into peritoneal cavity surrounding the liver due to an increase in portal hypertension–> increase in lymph flow into space of Disse–> lymph seeps through visceral layer of peritoneum= fluid build up
  • drop in blood volume stimulates renal salt & H2O retention until blood volume is restored
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16
Q

Bile is secreted from what through what and towards what?

A

Bile is secreted from hepatocytes through the canaliculi towards the bile ducts

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17
Q

What are the constituents of bile?

A
  • bile acids
  • phospholipids
  • cholesterol
  • bicarbonate (from bile ducts & hepatocytes to neutralize stomach acid)
  • bile pigments (bilirubin)
  • melatonin (antioxidant to protect mucosa against damage)
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18
Q

The right and left hepatic ducts are for outflow from where?

A

bile outflow from the liver

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19
Q

The Common Hepatic Duct is what structurally?

A

junction of R and L hepatic ducts

20
Q

The Cystic Duct is for outflow from where?

A

outflow from gall bladder

21
Q

The Common Bile Duct is for outflow of what?

A

outflow of bile from gall bladder & liver

22
Q

The Hepatopancreatic Ampulla is what structurally?

A

the junction of bile and pancreatic ducts

23
Q

The main pancreatic duct is for outflow from where?

A

outflow from the pancreas

24
Q

The Major Duodenal Papilla is for secretions of what into where?

A

bile and pancreatic secretion into duodenum

25
Q

What are the functions of the gall bladder?

A

store & concentrate bile

26
Q

What is the purpose of the choledochal sphincter of Oddi?

A

creates back flow to fill the gall bladder

27
Q

What does the gall bladder release and into where?

A
  • bile into the duodenum
  • CCK released in response to fats, contracts GB wall
  • vagus n. increases bile flow & contracts GB
28
Q

What does CCK promote?

A
  • GB emptying
  • pancreatic secretion
  • gastric slowing
  • intestinal peristalsis
29
Q

What does secretin promote?

A

-promotes HCO3- secretion from bile ducts, pancreatic ducts & Brunner’s glands

30
Q

Gall stones are precipitates of what due to what?

A

precipitates of cholesterol due to:

  • excess absorption of water
  • excess secretion of cholesterol
  • inflammation of epithelium
  • stasis of gall bladder smooth muscle layer
  • **Main one from SSL: reduction in terminal ileum reabsorption of bile salts
31
Q

In regards to the triad of biliary lithogenicity, what do we want our bile salt vs cholesterol vs phosphatidylcholine concentrations to be (to avoid gall stones)?

A
  • bile salts high (above 70%)
  • cholesterol low (below 20%)
  • phosphatidylcholine high (above 80%)
32
Q

Bile is necessary for what?

A
  • digestion & absorption of lipids

- elimination of endogenous products (cholesterol, bile pigments, etc) and exogenous substances (drugs, heavy metals)

33
Q

What is the sequence of fat digestion?

A
  • lipases hydrolyze TGs into FFAs
  • digested FFAs transported into enterocytes via biliary micelles
  • FFA reconverted to TGs
  • TGs converted to chylomicrons
  • chylomicrons transported to the blood
34
Q

Bile emulsifies fat into what?

A

1 micrometer soluble droplets

35
Q

Pancreatic lipases do what to TGs?

A

-hydrolyze TGs to glycerides & FAs

36
Q

What does phospholipase A2 do?

A

hydrolyzes phospholipids

37
Q

What does cholesterol esterase do?

A

hydrolyzes cholesterol

38
Q

What is the structure of a micelle?

A

-bile acids, phospholipids & cholesterol form lipophilic center that emulsifies fats into a form digestible by lipases

39
Q

What is the sequence of bile acids to bile salts? Starting with synthesis

A
  • bile acids synthesized in the liver
  • conjugated in liver to taurine or glycine to form bile salts
  • deconjugaed in intestine to form bile acids
40
Q

What do phospholipids align with? What makes cholesterol soluble?

A
  • phospholipids align with bile acids

- cholesterol is solubilized by micelles

41
Q

Micelles transport & facilitate what? What can pass through the unstirred layer?

A
  • absorption of glycerides & FAs through mucosa

- LCFAs can pass through unstirred aqueous layer to reach enterocyte membrane

42
Q

What do micelles transport and to where? What happens to them there? How, in contrast, is cholesterol absorbed?

A
  • FAs & glycerides to enterocyte where they diffuse into cell
  • once inside the enterocyte, FAs & glycerides are re-synthesized into TGs
  • cholesterol is absorbed & processed in free form
43
Q

What is enterohepatic circulation?

A
  • bile acids & salts are recycled back to the liver
  • most reabsorption is active transport in the ileum (less passive transport from rest of intestine)
  • bile acids & salts are returned to the liver and reconjugated with taurine or glycine
44
Q

What do chylomicrons transport? What are they formed from & coated with? Where are they transported to? Where are they stored?

A
  • exogenous LCFAs into circulation
  • TGs, cholesterol & phospholipids & coated with apoproteins
  • transported into lacteals & thoracic duct
  • stored in liver & adipose tissue
45
Q

What happens to short/MCFAs?

A

-not converted to TGs–>transported directly into portal system of veins

46
Q

What are the lipoproteins? Where is each one made? What does it transport?

A
  • Chylomicrons: made in SI, transport fat into blood
  • VLDL: made in liver, transport TG from liver to organs
  • LDL: made in plasma, transport cholesterol esters from liver to organs or tissues (LDL cholesterol deposits in atherosclerosis)
  • HDL: made in plasma, transport cholesterol from peripheral tissues to liver
47
Q

Where is bilirubin derived from? What is it converted to and by what?

A
  • derived from hemoglobin
  • converted by colonic bacteria to urobilinogen, either: stercobilin= makes feces brown or excreted in urine= makes urine yellow
48
Q

What is jaundice?

A

-excess bilirubin due to increased hemolysis, liver damage or bile duct obstruction

Organ Systems II (2 decks)

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