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18 Cards in this Set

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Describe the blood supply to the liver: also, how does it leave?
Liver is 80% from the portal system (including nutrient-rich, o2 poor, old broken RBC's, enzymes from the intestines

Hepatic Artery = 80% this is o2 rich, nutrient poor.

these merge together to form the hepatic sinusoids - so all hepatocytes receive a mixture of oxygenated/deoxygenated blood.

blood leaves via the hepatic vein
describe a liver lobule:
stacks of cells, generally arranged in a hexagon. each stack has between it sinusoids. at each of the 6 points, there should be portal triad (aka portal canal): a portal vein, a hepatic artery, and a bile duct.

the portal vein and hepatic artery anastamose and become the sinusoids, with blood flowing toward a CENTRAL VEIN, which drains downward into a larger vein which later becomes the hepatic vein.

each lobule has 6 feeding triads.
do hepatocytes regenerate?
yes! they live only about 5 months.
describe the relationship between a hepatocyte and an adjacent sinusoid:
a hepatocyte should have two sides facing a sinusoid for huge amount of passing blood flow.

also note that the side facing a sinusoid has the SPACE of DISSE, AKA PERI-Sinusoidal Space. It's full of microvili which increase the surface area and allow better trading of stuff.
what bile duct is found at triads?
interlobar duct
sinusoids - what kind of capillaries are they? describe. what cells do we expect to see?
they're discontinuous - have lots of gaps in their endothelium. large fenistrae.

blood cells are common - as are KUPEFFER CELLS (macrophages)
what is expected to be found in the space of disse (perisinusoidal space)? as in, what cell type?
Ito cells (stellate) - these normally store Vitamin A.

Note that they can become myofibroblasts and secrete collagen, making a fibrotic liver.
describing lobules - what different ways are they, and what do they tell us?
can divide lobules up into:

the classic lobule: this is our traditional hexagon, with six triads surround it, with blood flowing from the triads to the central vein and bile flowing toward the triad.

Portal Lobule: This forms a triangle around a single triad, using 3 central veins as ends.

Liver Acinus: This forms a ring around 2 central veins and the two triads between them.
the portal lobule: what's it good for describing?
bile movement.
the liver acinus - what's it good for describing?
great at talking about blood supply. this is where you have zone 1 (closest to the shared border), zone 2 (mid way), and zone 3 (furthest from the border, closest to the opposite ventral veins).
In the liver acinus, zones 1 and 2 and 3: what happens in them? where is blood supply loss seen first?
zone 1 gets the best blood flow, zone 3 gets the worst. So, zone 3 is the first to show ischemia when blood supply goes down.
what does bile do?
helps emulsify fats.

also, detoxifies bilirubin.
what's the order of bile ducts? what is the one in the triad?
start with caniculus: between hepatocytes, moving toward triad.

just before arriving at triad, get INTRAHEPATIC

traveling in the triad, get INTERLOBULAR

then get R/L hepatic ducts, them hepatic bile duct.
how can you identify a canniculus?
see a tube going between hepatocytes (not in the sinusoids), probably that.
galbladder: what does it look like?
when empty, seriously tortuous mucosa.
what are the big white things in gallbladders?
Rokitansky-Ashcoft sinuses - these are invaginated mucosa. can lead to gallstones.
pancreas: what's an exocrine unit? what do you often see in the cells?
40-50 cells. these are acinar cells, which line a lumen (which itself is lined by centroacinar cells).

see zymogen granules in the apical sides of the pyrmidal-shaped acinar cells, ready for release into the exocrine ducts.
how is the pancreas hormonally controlled? what about nerves?
Secretin, made by the duodenum, tells the pancreas to release all sorts of fluid with lots of HCO3- in it (to balance acids), but not a lot of enzyme.


CCK secretion tells the pancreas to dump in pro-enzymes)

nerves: sympathetics control the blood flow, parasympathetics control the release of things from the acinar/centroacinar cells.