The liver in Health and Disease

Question 1

How does unconjugated bilirubin travel in the blood?

Answer 1

bound to albumin

Question 2

What is the bare area of the liver?

Answer 2

the surface not covered with peritoneum

Question 3

How many segments is the liver described as having?

Answer 3

8

Question 4

What two sources does the liver receive blood from?

Answer 4

hepatic portal vein - 75-80%

hepatic artery - 20-25%

Question 5

Describe the anatomy of the biliary tree

Answer 5

hepatocytes secrete bile into the bile canaliculi which drain into the small interlobular biliary ducts and then into large collecting ducts which merge to form left and right hepatic ducts

Question 6

What is the ampulla of Vater formed by?

Answer 6

the pancreatic and common bile duct uniting

Question 7

What part of the duodenum does the bile duct drain into?

Answer 7

2nd part

Question 8

What causes bile release?

Answer 8

presence of fatty acids in the lumen of the duodenum stimulate I cells to release cholecystokinin

CCK also stimulates pancreatic enzyme secretion and relaxed the sphincter of Oddi, allowing bile and pancreatic juice to enter the duodenum

Question 9

What cell type comprises the mucosa of the gall bladder?

Answer 9

simple columnar

Question 10

What is bilirubin conjugated with in the liver?

Answer 10

glucaronic acid

Question 11

What form of bilirubin is soluble?

Answer 11

conjugated bilirubin

Question 12

What are the three products of bilirubin diglucuronide when it is hydrolysed by bacteria in the gut?

Answer 12

urobilinogen

stercobilin

urobilin

Question 13

How is urobilinogen excreted?

Answer 13

by the kidneys

Question 14

What comprises a portal triad?

Answer 14

hepatic artery

portal vein

bile duct

Question 15

What is a liver acinus?

Answer 15

elliptical area divided into three zones

Zone 1 - nearest to vascular supply

Zone 2 - transitional zone

Zone 3 - less well oxygenated

Question 16

Which zone of the acinus will be most affected during ischaemia?

Answer 16

Zone 3

Question 17

What are the two types of fatty liver disease?

Answer 17

non-alcoholic - pregnancy, obesity, genetic predisposition, hyperlipidaemia

alcholic

Question 18

What drug can cause fibrosis of the liver?

Answer 18

methotrexate

Question 19

What type of drug can cause a cholestatic pattern on the liver?

Answer 19

antibiotics

Question 20

What drugs cause a neoplasm pattern on the liver?

Answer 20

steroids

Many synthetic androgenic steroids are capable of causing cholestatic liver injury and long term use of androgens is associated with development of liver tumors including hepatocellular carcinoma and hepatic adenoma.

Question 21

What kind of drugs cause a fatty injury on the liver?

Answer 21

antiepilectics

Question 22

Which part of the abdominal aorta supplies the liver and from which vetebrae level does the vessel emerge from the aorta?

Answer 22

coeliac trunk, T12

Question 23

How can cimetidine sometimes causes gynaecomastia in men?

Answer 23

Cimetidine, is a H2 receptor antagonist, the drug is a potent inhibitor of P450 and exhibits antiandrogenic effects, hence less testosterone is produced