The Liver and Billary System

Question 1

The liver has 2 blood supplies via the ______________ and ___________

Answer 1

Hepatic Portal Vein and Hepatic Artery

Question 2

The microscopic units of the liver are _________ that are centred around a __________ with radiating cords of ________ with ___________ at the periphery

Answer 2

Liver Lobules
Central Vein
Hepatocytes
Portal Tracts

Question 3

What are the functions of the liver:

Answer 3

• Metabolism of ingested CHO’s, proteins and fats delivered from the portal vein
• Synthesis of plasma proteins and proteins involved in blood coagulation
• Storage of Iron, Vitamin B-12
• Detoxification and excretion through bile

Question 4

Bile is an aqueous solution composed of:

Answer 4

Conjugated bilirubin
Bile salts
Lecithin
Cholesterol
Minerals

Question 5

Bile flows in the ________ direction of the blood. It drains into ___________ and then into larger ducts that become the ______________. Bile is __________ and ________ in the gall bladder.

Answer 5

Opposite
Bile Canaliculi
Common Hepatic Duct
Concentrated and Stored

Question 6

What causes Liver Injury?

Answer 6

Alcohol
Drugs
Chemicals/Toxins
Infections especially viral ones
Obstruction
Autoimmune disorders

Question 7

What are the major types of Liver cell injury?

Answer 7

Fatty Change
Necrosis
Cirrhosis

Question 8

What is Fatty change?

Answer 8

Accumulation of fat in the hepatocyte, it is usually reversible

Question 9

What is Necrosis of liver?

Answer 9

Death of liver cells, remaining liver cells can regrow if death is only focal

Question 10

What is Cirrhosis?

Answer 10

Diffuse fibrosis with regeneration nodules, it is irreversible

Question 11

What is Hepatic Steatosis and what causes it?

Answer 11

Fatty Liver disease, An injury which disrupts normal fat metabolism in the liver leading to the accumulation of fat globules in hepatocytes

Question 12

What what are common causes of Hepatic Steatosis?

Answer 12

• Excess alcohol use
• Solvents like Carbon Tetrachloride
• Protein malnutrition
• Anoxia
• Reye’s Syndrome

Question 13

Briefly describe Alcoholic liver disease:

Answer 13

1. Reversible fatty liver disease if you stop drinking
2. Progresses to Alcoholic Hepatitis which causes degenerative changes and inflammation
3. Progresses to Alcoholic Cirrhosis which is irreversible due to diffuse scarring

Question 14

Common viruses that affect the liver are:

Answer 14

Hep A
Hep B
Hep C

Question 15

All hepatitis viruses cause liver cell _______ and/or _______ and __________.

Answer 15

Injury

Necrosis and Inflammation

Question 16

Summarise Hep A:

Answer 16

• Transmitted person to person by water and faecal contaminated food
• Short incubation and infectivity period
• No carrier status
• Usually acute and short illness
• Vaccine is available

Question 17

Summarise Hep B:

Answer 17

• Transmitted by blood and body fluids
• 10% become chronic carriers and are infectious
• Has a carrier status, they may develop liver disease
• Preventative Vaccine is available
• Treated with HBV Ig after exposure

Question 18

Summarise Hep C:

Answer 18

• Transmitted by blood and body fluids
• Large proportion become chronic carriers and are infectious
• No vaccine available
• No HCV Ig treatment available

Question 19

Cholelithiasis (Gallstones) occur in __ to __% of the population. They are composed of __________________ most often _________.

Answer 19

10-20%
Bile Constituents
Cholesterol

Question 20

When do gallstones form?

Answer 20

When cholesterol content is present in a supersaturated solution

Question 21

Who is most at risk for gallstones

Answer 21

Fair Fat Fertile Females in their Forties and Fifties

Question 22

What are the symptoms of gallstones?

Answer 22

Usually assymptomatic unless they pass into the cystic or common bile ducts

Question 23

What complications can arise from gallstones?

Answer 23

Inflammation of the gall bladder, Cholecystitis
Rupture of the gall bladder with perforation
Obstruction of the common bile duct which may cause pancreatitis