Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
62 Cards in this Set
- Front
- Back
|
What are the portal systems of blood flow within the body?
|
Liver
Pineal gland |
|
|
Where does the liver receive its blood supply?
|
Pancreas
Intestines |
|
|
What is the pattern of blood flow within the liver?
|
Blood comes in via the hepatic artery, portal vein
Blood mixes between the two Exits via the central vein of a liver acinus |
|
|
What is the direction of bile flow within the liver?
|
Away from the central vein to the outside of the acini
|
|
|
What's the blood supply to the liver?
|
80% portal
20% hepatic artery |
|
|
What are functional consequences of right heart failure? Hepatic vein obstruction
|
Liver ischemia
|
|
|
What are the consequences of hepatic artery obstruction?
|
It's possible that the liver could survive, if it were a more chronic process
The dual blood supply can help you out here. HOWEVER the bile duct receives all of its vasculature from the cystic artery coming off the hepatic artery, which means that it will have severe problems. |
|
|
What happens in Budd-Chiari syndrome?
|
Obstruction of the hepatic veins by clots
Dilated upstream sinusoids Hemorrhage, ischemia around the central vein |
|
|
What is the structure of endothelial cells in the liver?
|
Fenestrated; allow the hepatocytes to poke through.
This means that hepatocytes can take up both large and small particles |
|
|
What are kupffer cells?
|
Tissue macrophages in the liver
|
|
|
What is the function of the kupffer cells?
|
Filtering the liver of bacteria, endotoxins
|
|
|
What is the function of the ito cells?
|
Fat, fat-soluble storage cells
ex. vitamin A |
|
|
What do Ito cells do in chronic inflammation?
|
Converts to a myofibroblast
Forms collagen, ECM These guys are responsible for the cirrhotic material in liver cirrhosis |
|
|
Where does glucose metabolism take place?
|
Liver
|
|
|
Where are lipids produced in the body?
|
LIver
From glucose during a fed state |
|
|
Where does glycogen storage take place?
|
Liver
|
|
|
Where does gluconeogenesis take place?
|
Liver
|
|
|
What happens in acute liver failure?
|
Hypoglycemia-->rapid neuronal death
|
|
|
What types of metabolism take place in the liver?
|
Glycogen synthesis
Fat synthesis Gluconeogenesis Amino acid breakdown Protein synthesis Urea synthesis |
|
|
What types of lipoproteins are secreted by the liver?
|
HDL
VLDL |
|
|
What is the place that cholesterol is disposed?
|
Liver
|
|
|
What is the cause of fatty liver?
|
Increasing input of fatty acids into the liver
Blocking of the excretion of fat from the liver |
|
|
What are the input causes of fatty liver?
|
Excess calories
|
|
|
What are causes of adipose tissue releasing fatty acids when not in a fasting state?
|
Insulin deficiency
Insulin resistance |
|
|
What are the proteins synthesized by the liver?
|
Lipoproteins
Albumin Clotting factors Anti-proteases Fibrinogen Complement factors Ceruloplasmin Transferrin |
|
|
What protein defects happen in liver disease?
|
Albumin
Clotting factors Fibrinogen |
|
|
What are the consequences of lowered albumin levels?
|
Decreased plasma oncotic pressure/edema
Decreased binding of hydrophobic compounds |
|
|
What are the consequences of decreased clotting factors?
|
Decreased factors II, VII, IX , X
Increased bleeding |
|
|
What are the consequences of decreased fibrinogen?
|
Decreased fibrin formation in clotting
|
|
|
What happens in alpha1-anti trypsin deficiency?
|
If it's gone, you get problems with the lungs-->emphysema
It's an anti-protease. |
|
|
Where is alpha1-anti-trypsin created?
|
In the liver
|
|
|
Where does VLDL synthesis take place?
|
ER: synthesis
SER: addition of the lipids to the proteins Secreted through the golgi |
|
|
What cells are most likely to become necrotic in the liver? Why?
|
Central vein cells
They get less and less oxygen |
|
|
What cells perform the albumin synthesis? P450 functions?
|
Albumin: Portal cells
P450s: near the central veins |
|
|
What cells are likely to be hit by toxins? Why?
|
The pericentral cells
These are the ones that perform most of the detoxification |
|
|
What are the function of bile salts?
|
Breakdown fats in the digestive tract
Get rid of lipophilic compounds: bilirubin, drugs, etc. |
|
|
What cells synthesize bile?
|
Hepatocytes
|
|
|
Where is bile modified? What occurs?
|
Bile ducts, gall bladder
Addition of HCO3, helps with the neutralization of gastric acid |
|
|
What are the functions of bile?
|
Get rid of:
Cholesterol Bilirubin Copper Drugs, toxins, xenobiotics Transports bile acids to the intestine to aid in fat absorption |
|
|
What are bile acids?
|
Organic acids synthesized in the liver from cholesterol that are conjugated to AAs
|
|
|
Where are bile acids secreted?
|
Into bile
|
|
|
What are the functions of bile acids?
|
Fat digestion/absorption
|
|
|
Where are bile acids reabsorbed?
|
Distal ileum; returned to liver via the portal vein
|
|
|
How does bile acid synthesis take place? What's the starting compound?
|
Hydroxylation of cholesterol
Addition of a carboxylic acid Addition of an amino acid |
|
|
How is cholesterol secreted from the liver?
|
Conversion to a bile acid, addition to a micelle
|
|
|
What's the effect of bile acids in the colon?
|
Increasing the amount of water retained in the colon --> prevention of constipation
|
|
|
What's the effect of loss of the terminal ileum on bile acid physiology?
|
You cut out some of the absorption-->secretory diarrhea
You then have lots of bile acid loss, which then causes problems with fat reabsorption, which then causes steatorrhea |
|
|
What's the effect of cholestyramine on bile acid physiology?
|
Removes bile acids from the entereohepatic circulation by binding them to the drug, which is a resin
The liver then has to convert more cholesterol to bile acids, which has the net effect of removing cholesterol from the body |
|
|
What are the side effects of cholestyramine?
|
Constipation
|
|
|
What is billirubin?
|
Porphyrin ring from RBCs
|
|
|
How is billirubin secreted?
|
1. RBC breakdown
2. Travels unconjugated by albumin to the liver. 3. Conjugated to a sugar (glucuronide)within the SER of the liver to make it more water soluble 4. Excreted via an ATP dependent pump from the liver 5. Conjugation to glutathione |
|
|
How do neonates get jaundiced?
|
Poor billirubin conjugating systems
|
|
|
What populations are more likely to be jaundiced?
|
Premature infants
|
|
|
What is the effect of unconjugated billirubin on the brain?
|
Permanent brain damage
|
|
|
How is brain damage prevented by billirubin?
|
Phototherapy!
Blue light on the kids gets makes the billirubin become more water soluble, which makes it able to be removed from the circulation |
|
|
What happens in Crigler-Najjar syndrome?
|
Lots of unconjugated billirubin due to the fact that the enzymes necessary to conjugate are mutated/absent
|
|
|
What happens in Gilbert's syndrome?
|
A mild syndrome that causes increased billirubin
Benign |
|
|
What are some syndromes that cause problems with the organic anion transporter in the liver? What are the consequences?
|
dubin-Johnson, Rostor's syndrome
You get yellow eyes, but not too many other problems |
|
|
What's the rate limiting stem in billirubin handling?
|
Excretion into the bile
|
|
|
What are the ways that drugs are handled in the liver?
|
1. Oxidative reactions via the P450s
2. Conjugation reactions to glutathione, AAs, etc. |
|
|
How is Prometheus relevant to the GI system?
|
The liver regenerates!
|
|
|
What are functional consequences of large amounts of liver resection/necrosis?
|
Hypoglycemia
Poor blood clotting Cholestasis, jaundice Increased blood ammonia Decreased drug disposition Abnormal lipid metabolism |
