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BRS Y1 > Week 9- Hepatobiliary System > Flashcards

Week 9- Hepatobiliary System Flashcards

1
Q

Where is the liver situated?

A

Underneath the right pec

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2
Q

What is found right on top of the liver?

A

The diaphragm

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3
Q

What is the name of the ligament that divides the left lobe of the liver from the right? Where is it found

A

Falciform ligament. It is found going from the left side of inferior vena cava to the gallbladder fossa

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4
Q

What does the inflow of blood supply of the liver consist of?

A 
Hepatic artery (25%)
Portal vein (75%)
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5
Q

What does the outflow of blood supply of the liver consist of?

A

Bile

3 hepatic veins

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6
Q

What 2 ducts join to form the bile duct?

A

Common left and common right hepatic duct

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7
Q

What is the point of the common right and left hepatic ducts joining called?

A

Hyloconfluence/hylum

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8
Q

What is the duct where the gall bladder comes off the liver called?

A

Cystic duct

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9
Q

What is the section of the bile duct between the hyloconfluence and cystic duct called?

A

Common hepatic duct

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10
Q

What is the section of the bile duct after the cystic duct called?

A

Common bile duct

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11
Q

What are the 3 hepatic veins called?

A

Right, middle and left hepatic veins

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12
Q

What does the right hepatic vein split the right side of the liver into?

A

Anterior (right medial) and posterior (right lateral)

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13
Q

How many segments does the liver have?

A

8

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14
Q

What is segment 1 of the liver sandwiched between?

A

Inferior vena cava and portal vein

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15
Q

What does the left hepatic vein split the left side of the liver into?

A

Left medial and left lateral

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16
Q

What goes in and out of each liver segment?

A

Portal vein and hepatic artery going in

Bile duct coming out

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17
Q

What does a hepatic lobule look like?

A

Hexagonal structure, each corner has a portal triad and centre has a central vein

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18
Q

What do portal triads of hepatic lobules link with?

A

3 adjacent lobules

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19
Q

What is the role of a central vein in a hepatic lobule?

A

To collect blood from hepatic sinusoids to deliver it to hepatic veins and into the systemic venous system

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20
Q

What 2 sides do hepatocytes contain?

A

Sinusoid facing side

Bile canaliculi facing side

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21
Q

Where are hepatocytes in hepatic lobules found?

A

In the lobules

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22
Q

What is the role of the hepatic artery?

A

Brings oxygen rich blood into the liver to support hepatocytes high energy demands

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23
Q

What is the role of the portal vein?

A

Hepatocytes process nutrients, detoxify blood and excrete waste, takes away mixed venous blood from GI tract and spleen

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24
Q

Where does bile produced by hepatocytes drain to?

A

Bile canaliculi

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25
Q

Describe a hepatic acinus

A

It is a functional unit consisting of 2 adjacent 1/6 hepatic lobules (looks like a diamond shape) that share 2 portal triads and extend into hepatic lobules as far as the central vein

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26
Q

How many zones is the hepatic acinus split into?

A

3

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27
Q

Describe the 3 zones of the hepatic acinus

A

Zone 1- Receives blood most so highest 02 and toxin risk
Zone 2- Less blood, lower o2 and toxin risk
Zone 3- Least blood, lowest o2 and toxin risk- where central vein is

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28
Q

If a person was in a car accident and bleeding out, which zone of the hepatic acinus would suffer most first and why?

A

Zone 3 as it has the lowest blood supply and oxygen

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29
Q

Describe sinusoidal endothelial cells

A

No basement membrane
Fenestrated (discontinuous epithelium)
Allow lipids and large molecules to move to and from the hepatocyte

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30
Q

Describe Kuppfer cells

A

Sinusoidal macrophage cells
Attached to endothelial cells
Carry out phagocytosis (detoxification)

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31
Q

Describe hepatic stellate cells

A

Exist in dormant state
Store vit A in liver cytosolic droplets
When activated act as fibroblasts and cause scarring (cirrhosis)
Proliferate, chemotatic and deposit ECM

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32
Q

Describe hepatocytes

A

80% of liver mass
Main working cell
Synthesise albumin, clotting factors and bile salts
Metabolise drugs

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33
Q

What do hepatocytes receive nutrients from?

A

Sinusoids

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34
Q

What are the 3 main categories of functions of the liver?

A

Metabolic and catabolic
Secretory and excretory
Detoxification and immunological

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35
Q

Describe the Cori cycle

A

When glucose runs out lactate is produced, this is carried to the liver which converts it back into pyruvate and carries out gluconeogenesis so the muscle can be provided with more sugar

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36
Q

What is the name of the cycle that the liver is involved with to do with carbohydrate metabolism?

A

Cori cycle

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37
Q

Describe how the liver is involved with protein synthesis and state the main proteins it synthesises

A

Amino acids come from the diet (fed state) or the muscle (fasted state) and are joined up to make proteins in the liver, mainly plasma proteins (albumin), clotting factors and lipoproteins

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38
Q

What special amino acids does the liver produce?

A

Non essential amino acids (via transamination)

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39
Q

What can you look at via blood tests to get an indication of how their liver is doing?

A

Albumin levels

ALT/AST (transaminases that help produce non essential amino acids)

40
Q

Why is it difficult for the muscle to utilise amino acids to produce glucose for energy? How does it get over this problem?

A

Conversion of amino acids to pyruvate requires lots of energy
Removal of nitrogen as urea requires lots of energy
Transfers the problem to the liver as the glucose alanine cycle

41
Q

Describe the glucose alanine cycle

A

In the muscle cells alanine is formed from glutamate and pyruvate via alanine transaminase
Alanine shuttles along alpha ketoglutarate to liver
Alanine is converted back to pyruvate and glutamate producing energy
In liver glutamate is converted to urea which goes to blood
and pyruvate is converted to glucose which goes to the muscle for glycolysis

42
Q

When is fat synthesised in the liver?

A

When glycogen stores are full

43
Q

Describe how the liver metabolises triglycerides

A

In adipose tissue they are converted to fatty acids and carried to the liver where they are converted to acetyl coA via beta oxidation. This can then enter the TCA cycle and produce energy

44
Q

How does the liver metabolise triglycerides if you want to outsource the energy source?

A

Fatty acids are converted to 2 acetyl coA via beta oxidation in the liver, these combine with one more acetyl coA and form acetoacetate which can be transported to other tissues

45
Q

Describe how lipoproteins are synthesised in the liver

A

Glucose in the liver is converted either directly to glycerol or via pyruvate into acetyl coA which can then be made into fatty acids or cholestrol.
Glycerol and 2 fatty acids combine to form triacylglycerol these together with apoproteins, phospholipids and cholesterol combine to form lipoproteins

46
Q

What is components in the liver are required to produce lipoproteins?

A

Triacylglycerol (from glycerol and fatty acids)
Apoproteins
Phospholipids
Cholesterol

47
Q

Which lipoproteins does the liver produce

A

HDL

VLDL

48
Q

What does the liver store? State what the most important thing it stores is

A

Fat soluble vitamins (A,D,E,K, K is most important as stores are small whereas others last 6-12 months)
Iron (stored as ferritin)
Copper

49
Q

How does the liver carry out detoxification?

A 
Uses P450 enzymes
Phase 1 (modification)- makes it more hydrophilic
Phase 2 (conjugation)- attaches a water soluble side chain to make it less reactive
50
Q

What is the name of the muscle where the common bile duct and pancreatic ducts join?

A

Sphincter of oddi

51
Q

Where does the common bile duct come out into the duodenum?

A

At the ampulla

52
Q

What is the other name for bile salts?

A

Bile acid

53
Q

What colour is bile?

A

Different colours depending on whats in it usually yellow or green

54
Q

What are uses of bile?

A

Helps w cholesterol homeostasis
Absorption of lipids and lipid soluble vitamins
Excretion of xenobiotics/drugs, cholesterol metabolites, adrenocortical/steroid hormones and alkaline phosphotase

55
Q

How much bile is produced daily?

A

500ml

56
Q

What pigments are present in bile and what colours do they make bile?

A

Bilirubin- yellow

Biliverdin- green

57
Q

What 2 cell types secrete bile and what % of total bile do they secrete?

A

Hepatocytes (60%)

Cholangiocytes (40%)

58
Q

In bile production what is the main function of hepatocytes?

A

Primary secretion of bile (which reflects serum concentrations)

59
Q

In bile production what is the main function of cholangiocytes?

A

Secondary modification ie alteration of pH, luminal glucose and organic acids absorbed, HCO3- and Cl- secreted into bile via CFTR, IgA exocytosed

60
Q

What performs the excretion of bile salts and toxins?

A

Biliary transporters

61
Q

What are some of the main biliary transporters?

A

Bile sale excretory pump (BSEP)
MDR related proteins
Products of multidrug resistant genes

62
Q

What is bile synthesised from?

A

Cholesterol

63
Q

What are sodium and potassium salts of bile acids conjugated to?

A

Glycine and taurine

64
Q

What are the 2 primary bile acids synthesised in the liver?

A

Cholic acid

Chenodeoxycholic acid

65
Q

What are the 2 secondary bile acids produced from primary acids by gut bacteria?

A

Deoxcycholic acid

Lithocolic acid

66
Q

How do bile salts work?

A

Reduce the surface tension of fats

Emulsify fat prior to its digestion and absorption

67
Q

Describe a bile salt micelle

A

Hydrophilic exterior to dissolve in water

Hydrophobic interior dissolves in fat

68
Q

In a bile salt micelle where are FFAs and cholesterol found?

A

Inside

69
Q

What makes up a triglyceride?

A

Monoglyceride

2 fatty acids

70
Q

What coenzyme does lipase need to digest triglycerides?

A

Colipase

71
Q

What muscle plays a main role in regulating secretion vs storage of bile and how?

A

The sphincter of Oddi
Between meals it is closed and bile is diverted into the gall bladder for storage
When eating it relaxes

72
Q

What chemical causes the gallbladder to contract?

A

Cholecystikinin (CCK)

73
Q

What causes the release of CCK?

A

Gastric contents entering the duodenum

74
Q

Where are bile salts reabsorbed and how much?

A

95% in the terminal ileum

75
Q

What cotransporter is involved with reabsorbtion of bile salts?

A

Na+/bile co transporter

76
Q

What happens to the 5% of bile salts that arent reabsorbed?

A

They are converted to secondary bile acids in the colon- deoxycholic acid is reabsorbed and 99% os lithocolic acid is secreted in the stool

77
Q

Where do reabsorbed bile salts go?

A

To the liver where they can be re excreted

78
Q

What is the function of the gallbladder?

A

Stores bile (50ml)- concentrates and acidifies it

79
Q

What does CCK bind to on the gallbladder?

A

CCKa receptors

80
Q

What nerve fibres innervate the gallbladder?

A

Preganglionic parasympathetic fibres of the vagus nerve

81
Q

How essential is the gallbladder?

A

Not at all, you can easily live without it

82
Q

What is free bilirubin?

A

Indirect/unconjugated, water insoluble

83
Q

What is the main source of bilirubin?

A

75% from erythrocyte breakdown

84
Q

How does bilirubin circulate before it gets to the liver?

A

Bound to albumin

85
Q

How is bilirubin conjugated?

A

Via 2 molecules of UDP glucuronate to form bilirubin diglucuronide

86
Q

Via what transporter is bilirubin diglucuronide secreted into the biliary canaliculi?

A

cMOAT

87
Q

How much BR is secreted into bile daily?

A

200-250 mg

88
Q

What happens to BR?

A

85% excreted in faeces

15% enters enterohepatic circulation

89
Q

What compound makes poo brown?

A

Stercobilin

90
Q

What happens in obstructive jaundice and what is a visible sign of it?

A

No bile is secreted into the large intestine so no stercobilin is produced and poo is white

91
Q

What are causes of jaundice?

A 
Pre hepatic- producing a lot more bilirubin eg sickle cell patients break down RBCs a lot more 
Intrahepatic- liver isnt working properly, either not taking up much bilirubin, decreased conjugation or secretion or flow obstruction in the billary trees
Post hepatic (obstructive)- mechanical blockage
92
Q

What is biliary colic?

A

Stones in gallbladder try to get out but they cant

93
Q

What is cholecystitis?

A

When stones in the gallbladder get stuck in the cystic duct and cause infection

94
Q

What is cholangitis?

A

When the stone gets out of the gallbladder and gets stuck in the bile duct causing the bile to become infected

95
Q

What is ERCP?

A

A process by which gallstones are removed if they’re near the end of the biliary system by going in through the stomach and ampulla and up the bile duct

96
Q

What is PTC?

A

A process by which gallstones are removed if they’re near the top of the biliary system by going in through the abdomen and finding a hepatic duct

BRS Y1 (52 decks)

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