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DIG: Biweekly 1 > Williams- Physiology of Liver and Biliary Tract > Flashcards

Williams- Physiology of Liver and Biliary Tract Flashcards

1
Q

divides segment 2 and 3 from the 4th segment in the L liver

A

falciform ligament

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2
Q

____liver composed of segments 5-8

A

R

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3
Q

_____ liver is composed of segments 2,3, and 4

A

L

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4
Q

where is segment I (caudate lobe)

A

in b/t the two lobes

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5
Q

fibrous capsule that surrounds liver

A

Glisson’s capsule

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6
Q

oxygenated blood flows in from the______

A

hepatic artery

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7
Q

nutrient rich blood flows in from the ______

A

portal vein

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8
Q

cell of the liver

A

hepatocyte

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9
Q

more than one hepatocyte

A

lobule

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10
Q

confluence of the portal venule and hepatic venule

A

sinusoid

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11
Q

b/t hepatocyte and sinusoid (basolateral surface)

A

Space of Disse

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12
Q

_______ is secreted into apical/canalicular space

A

bile

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13
Q

sinusoids are on what surface

A

basolateral

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14
Q

bile flows in what direction to blood

A

opposite

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15
Q

bile flowing away from central vein toward portal triad

A

choleresis

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16
Q

slowing of bile flow (can be due to injury to hepatocyte)

A

cholestasis

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17
Q

____ flows from portal vein and hepatic artery toward central vein (becoming a sinusoid)

A

blood

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18
Q

what view of liver

A

hepatic lobule

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19
Q

what view of the liver

A

Acinar view

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20
Q

zone 1 of liver

A

periportal (most oxygenated)

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21
Q

zone that is nearest to portal triad

A

periportal (zone 1)

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22
Q

zone 2 of liver

A

intermediate

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23
Q

zone 3 of liver

A

centrilobular (least oxygenated)

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24
Q

which zone is 1st affected by ischemia

A

centrilobular zone (zone 3)

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25
Q

what view of liver

A

acinar view

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26
Q

what makes up the portal triad

A

hepatic artery
portal vein
bile duct

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27
Q

structures that lie within hepatoduodenal ligament

A

hepatic a.
portal vein
bile duct

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28
Q

triangle of Calot borders

A

Superior: The inferior surface of the liver
Inferior: The cystic duct
Medial: The common hepatic duct

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29
Q

cystic duct and common hepatic duct join to form what

A

common bile duct

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30
Q

main area cell death occurs in the liver due to ischemic injury

A

centrilobular (zone 3)

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31
Q

drug toxicity injures what zone

A

zone 3

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32
Q

Hepatitis C injures what zone

A

Zone 1 (periportal)

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33
Q

filtration
digestion
metabolism/detoxification
protein synthesis
storage of vitamin, minerals, energy

A

main functions of the liver

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34
Q

enzymes located in cytosol of hepatocyte; if elevated in the serum, means injury to hepatocyte

A

AST/ALT

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35
Q

enzyme located on canalicular surface of hepatocyte; if elevated in serum, means bile duct in distress

A

GGT and Alk Phos

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36
Q

2 labs that can tell us about liver function

A

Albumin
INR

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37
Q

what enzymes that pertain to the liver don’t just belong to the liver

A

AST/ALT

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38
Q

what does it mean if transaminases are elevated (AST/ALT)

A

hepatocellular injury

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39
Q

phase 1 of hepatic detoxification

A

CYP450 alters parent molecule

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40
Q

phase 2 of hepatic detoxification

A

synthesis drug conjugates (make water soluble)

41
Q

phase 3 of hepatic detoxification

A

excrete molecule or conjugate into bile

42
Q

major enzymes involved in drug metabolism and mainly act on the liver (speed up metabolism of drugs)

A

P450 Cytochromes

43
Q

another key enzyme in body (liver) that metabolizes drugs, etc

A

CYP3A4/3A5

44
Q

drugs come to liver through ____

A

central vein

45
Q

____ and _____are CYP450 and CYP3A4 enzyme inducers (helps speed up metabolism)

A

Rifampin and St. John’s Wort

46
Q

Phenytoin/carbamazepine

A

CYP450 inducers

47
Q

Na+/valproate

A

CYP450 inhibitors

48
Q

3 main CYP3A4/3A5 enzyme inducers (speed up metabolism of drugs)

A

Rifampin
carbamazepine
St. John’s Wort

49
Q

inhibitors of CYP3A4/3A5

A

antibiotics, anti-virals, and anti-fungals

50
Q

grapefruit juice
wild cherry
chamomile
licorice

A

CYP3A4 inhibitors (allow for drug to be available longer in body)

51
Q

conjugation of drug or parent molecule requires what 2 enzymes

A

Glucuronyl transferase
Glutathione transferase

52
Q

MDR1, MRP2, and BSEP, MDR3 proteins are located where help secrete drugs/conjugates into bile

A

canalicular surface

53
Q

______is located where and helps facilitate passage of drug conjugate into sinusoidal circulation

A

MRP3

54
Q

3 phases of liver detoxification

A
  1. alter parent molecule (CYP450)
  2. conjugation (make water soluble)
  3. secrete into bile
55
Q

bilirubin that is not water soluble and cant be measured

A

indirect bilirubin

56
Q

water soluble bilirubin and can be measured

A

direct bilirubin

57
Q

step 1 of bilirubin metabolism

A

hemeprotein from old RBC’s enters macrophages

58
Q

step 2 and 3 in bilirubin metabolism

A

breakdown of heme into biliverdin (green), then biliverdin into unconjugated bilirubin in macrophage

59
Q

step 4 in bilirubin metabolism

A

unconjugated bilirubin attaches to buddy albumin and is carried into liver

60
Q

until step ____ is complete, bilirubin remains unconjugated

A

step 4

61
Q

what happens at the end of step 4 of bilirubin metabolism

A

bilirubin is conjugated (made water-soluble)

62
Q

how is heme broken down to biliverden

A

heme oxygenase

63
Q

how is biliverden broken down to bilirubin

A

biliverdin reductase

64
Q

step 1-4 of bilirubin metabolism

A

unconjugated bilirubin

65
Q

2 enzymes used in phase 2 of liver detoxification and presents bilirubin for conjugation

A

glucuronic acid
glutathione-S-transferase

66
Q

reduces efflux of bilirubin back into serum and presents bilirubin for conjugation

A

glutathione-S-transferase

67
Q

rate limiting step in bilirubin metabolism

A

UGT1A1 (UDPGT) conjugates bilirubin

68
Q

bilirubin + glucuronic acid=

A

conjugated bilirubin

69
Q

step 5 of bilirubin metabolism

A

conjugated bilirubin now secreted into bile duct and intestines

70
Q

how is conjugated bilirubin transported into bile

A

by active transport of MRP2

71
Q

step 6 of bilirubin metabolism

A

bile drains into duodenum and bacteria can reduce bilirubin to urobilinogen

72
Q

what happens to most of the bilirubin

A

gets excreted out through poop

73
Q

upper limit of normal conjugated bilirubin (direct bilirubin)

A

0.3 mg/dL

74
Q

gene that produces an enzyme that attaches glucuronic acid to bilirubin for conjugation

A

UGT1A1

75
Q

what to do if serum bilirubin is 4.2 mg/dL

A

FRACTIONATE (indirect and direct)

76
Q

indirect hyperbilirubinemia (unconjugated): TB<5 mg/dL

A

Gilbert syndrome

77
Q

insufficient UGT1A1 seen with this syndrome

A

Gilbert Syndrome

78
Q

pt w/ an elevated total and indirect bilirubin in serum from CMP labs performed fasting for an unrelated issue

A

Gilbert Syndrome

79
Q

what to do with total bilirubin

A

fractionate it

80
Q

complete loss of UGT1A1 (no conjugation); infants will die

A

Type I Crigler Najjar syndrome

81
Q

significantly reduced UGT1A1

A

type II Crigler Najjar syndrome

82
Q

to Rx type II Crigler Najjar syndrome

A

phenobarbital (increases enzyme)

83
Q

defect in MRP2
liver is black
80% of urine coproporphyrin is isomer 1

A

Dubin-Johnson syndrome

84
Q

defect in OATP1B1 and OATP1B3
mixed conjugated and unconjugated hyperbilirubinemia
urine coproporhyrin

A

Rotor Syndrome

85
Q

Dubin-Johnson syndrome and Rotor’s syndrome both have impaired canalicular export of what

A

conjugated bilirubin

86
Q

2 main bile acids

A

CA and CDCA

87
Q

what synthesizes bile acids

A

cholesterol

88
Q

rate limiting enzyme of bile acid metabolism

A

CYP7A1

89
Q

how are bile acids made stronger

A

conjugated with glycine or taurine

90
Q

functions in lipid digestion and absorption

A

bile acids

91
Q

need ______ to absorb fat soluble vitamins

A

bile acids

92
Q

also used for anti-microbial defense

A

bile acids

93
Q

contains bile acids and other molecules

A

bile

94
Q

flow of bile

A

choleresis

95
Q

during fasting state, bile acids concentrate where

A

gallbladder

96
Q

after a meal, _____ will relax sphincter of Oddi and stimulate gallbladder contraction and bile will move into small intestine

A

CCK

97
Q

facilitates fat absorption and delivers lipids to mucosa surface

A

micelles

98
Q

slowing of bile movement

A

cholestasis

DIG: Biweekly 1 (11 decks)

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