Week 3: accessory organs (PHYS) Flashcards
What does the hepatic portal vein do
its rich in nutrients from the intestine, it carries toxins for liver to filter (vein so it carries things UP from intestine)
what does the hepatic artery do
it carries oxygen rich blood from heart to liver
which macrophage cells live in the liver and clean the blood
Kupffer
how does the liver break down protein
the liver breaks protein down into Amino acids, which have nitrogen
its then turned into ammonia which is lowkey toxic so liver turns it into urea which gets transported to the kidneys and excreted into the urine
how is fat broken down in the liver
fatty things need bile to be absorbed, it then turns into fatty acids and glycerol
what is an important protein that the liver processes
albumin, this is the protein that maintains oncotic pressure and keeps equilibrium of water in interstitial fluid and plasma fluid
what would happen to drugs if there was low albumin in the blood
certain things like drugs, lipids and hormones are albumin bound so they need albumin to be transported around, if there was low albumin they would just float around and probably become toxic
how does the liver process oral medication
remember first pass metabolism
which hormones does the liver store and excrete
aldosterone, estrogen, testosterone
what is vitamin K, why is it important
its a very important clotting factor, its fat soluble so you need liver and bile to process and store it (bad liver= issues with clotting )
what even is bilirubin
macrophages in the spleen and liver break down old red blood cells, causing bilirubin as a byproduct
its also a key component of bile
what is the difference between conjugated and unconjugated bilirubin
conjugated (direct) is when bilirubin has been processed by the liver and is now water soluble
unconjugated is when bilirubin is fat soluble and has not been processed by the liver yet (also called indirect/free bilirubin)
what is sterocobilinogen
basically bilirubin that has been converted by bacteria and makes stool brown
what colour would stool be if there was an issue with the processing of billirubin
clay colour
what does bile do
basically gets rid of fat/fat soluble things and also gets rid of old red blood cells (important note for bilirubin and jaundice topics)
what is hyperbilirubinemia
jaundice
what’s pre hepatic jaundice
results from increase in bilirubin before reaching liver, it is an overproduction of unconjugated bilirubin so it actually has nothing to do with liver function, and more with increased load
what are the two main conditions that cause pre hepatic jaundice
babies with incompatible blood types to their mother (haemolytic jaundice of the newborn) and blood transfusion errors (wrong blood type
what is hepatic jaundice
liver dysfunction, results from livers inability to take up conjugate and excrete bilirubin
how does a diseased liver result in elevated conjugated and unconjugated jaundice
- hepatocytes struggle to conjugate bilirubin
- conjugated bilirubin will leak from cells and into circulation
what liver diseases will cause hepatic jaundice
hepatitis and cirrhosis
what will urine look like with hepatic jaundice
it will be dark in colour
what is the primary thing that causes posthepatic jaundice
failure of bile to reach the duodenum, usually from cholestasis (which is obstruction of bile flow to the liver)
what is an intrahepatic (inside the liver) cause of post hepatic jaundice
swelling or fibrosis of liver and bile ducts
what is an extra hepatic (outside the liver) cause of post hepatic jaundice
common bile duct stone, gall stone, pancreatic cancer
what is viral hepatitis
widespread inflammation and infection of the liver tissue, results in liver cell necrosis and inflammation which can obstruct the flow of bile
whats the difference between Hep A, B, and C (transmission)
A: fecal oral contamination (not v harmful)
B: blood, bodily fluids (unprotected sex), mother to child
C: Blood-Blood and sex (the worst one)
What are the three main clinical manifestations of viral hepatitis
- upper right quadrant pain (liver enlargement due to inflammation
- general symptoms like fatigue, arthralgia, malaise, anorexia, fever
- jaundice: inflamation and necrosis changes the structure of the liver and can obstruct the flow of bile causing blockage
which type(s) of hepatitis can cause chronic infection
B and C
what is NAFLD and why is it bad
accumulation of fat in the liver cells that can turn into NASH which is bad and irreversible
what happens to cause toxic and drug induced hepatitis
- the liver filters substances
- when the liver breaks down the toxins, it creates byproducts that can damage the liver
- liver regenerates, but if it does to much of this it can cause scarring and inflammation
describe liver cirrhosis and how it causes damage in the liver
basically the liver keeps taking hits, and its healing is disorganised causing liver regeneration that is different from its original liver structure. The liver then will get improper blood flow and become hypoxic and receive poor nutrition
what is compensated liver cirrhosis
when the liver is diseased but can still preform essential function
what is uncompensated liver cirrhosis
when liver dysfunction occurs and liver ends up failing
what is portal hypertension
structural changes in the liver (due to liver cirrhosis) leads to compressed and damaged veins, which affects blood flow
the hepatic portal vein will get clogged and get all backed up
how would portal hypertension show signs of bleeding and bruising
blood flows into the spleen causing splenomegaly, thrombocytopenia, and trapping of white blood cells
what is varicose
the body reroutes veins around the liver so that vein doesn’t burst like a balloon
where are the three common spots where varies are formed
esophagus, abdominal wall (gastric varices), and the rectum (hemmorrhodal varies)
what are some bad things about varicose
- there weak and rupture easily
- they carry things in blood that aren’t filtered which is bad
how would portal hypertension cause ascites
because it kicks in the RAAS which makes aldosterone
why does liver cirrhosis cause ascites
low serum albumin from damaged liver will mean that there is less oncotic pressure, causing fluid shift into the interstitial space
how does ascites and edema affect potassium
it causes hypokalaemia
what is the highest risk varices
Rectum because it can cause life threatening GI bleed
what is hepatic encephalopathy
Liver cirrhosis impacts the process of converting ammonia to urea, causes a build up in the blood which travels to brain
how does liver cirrhosis cause ammonia build up
- ammonia rich blood is bypassing liver due to rerouting of veins
- dysfunctional hepatocytes cannot convert ammonia to urea
what is fector hepaticus
bad breath from ammonia build up
how would a bad liver cause hypercoaguability and anemia?
- portal hypertension leads to splenomegaly (enlarged spleen), where WBC, WBC and platelets are trapped
bad liver also has trouble producing vitamin K
What is hepatorenal syndrome
sudden decrease in urinary output, increased usine osmolality (common cause of death)
what is cholelithiasis/ calculi
gall bladder stones
what causes calculi
too much cholesterol in the bile or too much billiruben
what are the risk factors for calculi
4 F
female
fertile (had multiple kids)
forty
fat
anything in the body that changes how we metabolise cholesterol can cause stones
what are the two types of acute cholecystitis
1) calculous: caused by stones
2) acauculous: caused by conditions where gal has trouble filling and emptying
why would cholecystitis produce fatty stools
because there is no bile being produced to break down fat in diet
where would pain be located in cholecystitis
upper right abdominal quadrant
what type of jaundice would occur in acute cholecystitis
post-hepatic jaundice because no bile to get rid of excess billirubin
what are the four pancreatic enzymes and their functions
trypsin: digestion of proteins
chymotrypsin: digestion of proteins
amylase: digestion of carbs
lipase: digestion of fats
what is the protective mechanism of the pancreatic enzymes
they remain inactive until they reach the duodenum so that they don’t eat Pancras
what is acute pancreatitis and how does it happen
it is acute inflammation of the pancreas, it is abnormal activation of the pancreatic enzymes which ends up in auto digestion of the Pancras
what are the two most common causes of pancreatitis
gall bladder stones and alcohol use
what is lipolysis
the enzyme lipase that causes fat necrosis of pancreatic cells
what is proteolysis
break down of proteins that can lead to thrombosis and gangrene
describe the clinical manifestations of acute pancreatitis
answer 5 if you have studied them
what is splenomegaly
thick spleen
what does a low INR indicate
the body takes less time to clot
what is urobilinogen
bilirubin in the urine, gives it the yellow colour
what is stercobilinogen
gives poop the brown colour, bilirubin being excreted through stool
which type of jaundice is characterised by elevated unconjugated bilirubin
pre hepatic
which type of jaundice is characterised by elevated conjugated and unconjugated bilirubin
hepatic jaundice
which type of jaundice is characterised by elevated conjugated bilirubin
post hepatic jaundice
what is an intrahepatic factors that causes post hepatic jaundice
swelling/blockage of liver and bile ducts
what is an extrahepatic cause of post hepatic jaundice
common bile duct stones, gall stones, pancreatic cancer
what are the main causes for ascites and edema in a liver cirrhosis patient
portal hypertension, low albumin, too much aldosterone
you’re caring for a patient with pancreatitis and their blood work shows that they have increased serum lipase and amylase, what does this indicate?
that there is cell death causing the enzymes to leak from the organ (bad)
