Spring Selected Topics Unit 1-Lecture 4

Front 1

What usually causes Hirschsprungs disease

Back 1

improper innervation or ganglionic activity of the enteric nervous system of the colon

Front 2

How big is the liver and how much blood flow does it get

Back 2

4-5 lbs.
about 1/3 of CO- 1400-1500ml/min

Front 3

What is a buffer to all the blood that flows from the abdominal organs

Back 3

liver

Front 4

Where does the liver receive blood from

Back 4

Portal vein
Hepatic artery

Front 5

The main source that venous blood from all the abdominal organs flows through what vein

Back 5

Portal vein (1100-1200ml)

Front 6

What branchs off the aorta and flows into the liver

Back 6

hepatic artery (300-400ml/min)

Front 7

The liver has access to all products absorbed from the intestines except what

Back 7

lipids- they are removed by lymphatic system and dumped into the blood before making it to the liver

Front 8

what is the functional unit of the liver

Back 8

liver lobules- 50,000-100,000 of them

Front 9

what are liver lobules composed of

Back 9

circular shape composed of many hepatic cellular plates

Front 10

What are sinusoids?

Back 10

space between the hepatic cellular plates where portal venules and arteries drain into

Front 11

What lies between the adjacent cells of the hepatic cellular plate

Back 11

bile canaliculi

Front 12

the bile from the bile canaliculi drains, collected and stored where

Back 12

drains into the bile ducts, collected in the hepatic duct and is stored in the gallbladder

Front 13

Each liver lobule is construced around a central vein that drains into where

Back 13

into a common vein- into the hepatic vein- into the inferior vena cava

Front 14

Hepatic cells are continously exposed to what

Back 14

portal venous blood

Front 15

How permeable are the capillaries around the liver

Back 15

the most permeable in the body- lots of protein are able to leak into lymphatic vessels

Front 16

Sinusoids are lined by what 4 types of cells

Back 16

Typical endothelial cells
Hepatic parenchymal cells
mast cells
Kupffer cells

Front 17

What are the functional cells of the liver

Back 17

hepatic parenchymal cells- most predominant cell in the hepatic plate

Front 18

What do the mast cells do

Back 18

release histamine and heparin (natural anticoagulant)

Front 19

What are Kupffer cells

Back 19

large phagocytic cell to get rid of bacteria, cleanses the blood

Front 20

What are the narrow tissue spaces between the hepatic cells and the endothelial cells

Back 20

Spaces of Disse

Front 21

Half of the total lymph flow in the body comes from where

Back 21

liver

Front 22

What do the spaces of disse connect to

Back 22

lymphatic vessels which picks up all the extra fluid and protiens that leak out of the sinusoids

Front 23

What are the main functions of the liver

Back 23

metabolic conversion(carbs, fats, protiens) and storage
synthesis and secretion
filter and detoxify

Front 24

What happens if blood glucose levels stay too high

Back 24

the glucose causes an increase in osmotic concentration in teh blood- pulls fluid out of the cells adn dehydrates the ICF volume
Glucose spills out into the urin to increase osmotic concentration- can cause osmotic diuresis and dehydration

Front 25

What happens if BG levels stay too low

Back 25

will see a decrease in function of several tissues that require glucose for normal operation -brain, RBC, retina

Front 26

What organ helps maintain blood glucose levels

Back 26

liver

Front 27

What does the liver do to glucose, fructose, and galactose

Back 27

processes it- converts fructose and galactose to glucose and stores any extra as glycogen

Front 28

what is the only organ that can use galactose

Back 28

liver- converts it to glucose

Front 29

How much glycogen can the liver store

Back 29

up to 8% of its weight

Front 30

What does the liver do when the body needs glucose

Back 30

slowly breaks down the glycogen to glucose

Front 31

What happens to glucose after the body doesnt need any more and the liver is at is storage capacity

Back 31

the glucose is converted to triglycerides and stored in adipose tissue

Front 32

What is gluconeogenesis

Back 32

formation of glucose from something other than glucose sources (fats, proteins) when glucose is needed

Front 33

How do fats get to the liver

Back 33

from the lymphatic system

Front 34

what is the process where the liver clips 2 carbons from a fatty acid and what does it form

Back 34

Beta oxidation
forms Acetyl CoA

Front 35

What is the compound that is fed into the Kreb cycle and burned for energy

Back 35

Acetyl Coenzyme A

Front 36

What happens if too much fat is take in and not able to be burned off

Back 36

too much Acetyl CoA is produced- so two of these molecules combine together and form acetoacetic acid

Front 37

What happens to acetoacetic acid after it is formed

Back 37

usually taken up into teh adipose tissue, turned back into triglycerides and stored as fat

Front 38

what happens if we have too much acetoacetic acid

Back 38

can lead to acidosis- esp in diabetics- leading to DKA- reason for acetone breath

Front 39

Where is cholesterol synthesized

Back 39

in the liver 95% of it where it is stored or sent out to other tissues as needed

Front 40

What are two components of the cell membrane that is synthesized in the liver

Back 40

cholesterol
phospolipids

Front 41

What is cholesterol converted to

Back 41

bile salts and acids

Front 42

What is the main acid that cholesterol is converted into

Back 42

cholic acid- secreted as part of bile

Front 43

what happens to the bile salts and bile pigments

Back 43

salts are reabsorbed
pigments are not

Front 44

how many amino acids form proteins and how many are considered essential

Back 44

20
10- have to get from dietary intake

Front 45

How does the liver get proteins

Back 45

in the form of amino acids and synthesizes proteins

Front 46

what is the main plasma protein

Back 46

albumin

Front 47

what are the proteins that are not syntesized by the liver

Back 47

Gamma globulin- they are synthesized by the immune system

Front 48

The liver producdes all blood clotting factors except what

Back 48

calcium

Front 49

liver can convert proteins into what

Back 49

fat and glucose

Front 50

what is the removal of the amine group from amino acids and what happens to the remaining compound

Back 50

deamination- the remaining compound can then be broken down into fat or glucose

Front 51

What are tranaminase enzymes

Back 51

enzymes that remove the amine group

Front 52

what is the process of transamination

Back 52

changing one type of amino acid to another

Front 53

what does the liver do to the ammonia produced during deamination

Back 53

combines it with carbon dioxide to form urea and water

Front 54

what is urea

Back 54

the main by product of protein metabolism that is excreted into the urine

Front 55

who is not able to make the conversion of ammonia to urea

Back 55

pts with liver failure and cirrhosis- causes high ammonia levels that can be fatal

Front 56

How is the liver a inactivator and detoxifier

Back 56

CYP 450
glucoronyl transferase
breaks down drugs and toxins making them more water soluble to be excreted from the body

Front 57

what vitamins does the liver store and how much of it

Back 57

Vitamin A, D- one years worth
B12- 6-12 months worth
Vit k , E, and Iron

Front 58

What is vitamin K important for

Back 58

forming prothrombin

Front 59

How is lron stored

Back 59

as apoferritin

Front 60

apoferritin is converted to what

Back 60

transferrin and stored in the tissues

Front 61

What happens when the membranes of RBC's get weaker

Back 61

they rupture and release Hgb

Front 62

What is Hgb broken down into

Back 62

heme and globin

Front 63

What happens to globin after Hgb is broken down

Back 63

it is taken to the liver and is sent out to the bone marrow for the production of new hgb and rbc, or it can be broken down

Front 64

What enzyme is released from the liver to breakdown the heme compound

Back 64

hemeoxygenase

Front 65

What is heme broken down to

Back 65

CO and ferrous iron is released
biliveridin is what is left

Front 66

where does the ferrous iron go after it is released from heme

Back 66

to the bone marrow and used again or stored in the liver

Front 67

what converts biliveridin to bilirubin

Back 67

biliveridin reductase

Front 68

What happens for bilirubin to be able to be excreted in the bile

Back 68

bilirubin is insoluble so it is acted upon by glucuronyl transferase to form bilirubin glucuronide which is soluble and can be excreted

Front 69

what gives bile its yellow/green color

Back 69

bilirubin

Front 70

what happens when bilirubin is excreted into the small intestines with the bile

Back 70

it becomes urobilinogen

Front 71

what 2 things can happen to urobilinogen

Back 71

can stay in GI tract and acted upon by bacteria to form stercobilinogen (reduced) the oxidized by bacteria to become stercobilin to be excreted in stool
or Get absorbed from GI tract and taken to kidney to be oxidized to urobilin and excreted with urine

Front 72

what gives urin its yellow color

Back 72

urobilin

Front 73

What does stool look like if bile duct is blocked

Back 73

clay colored without teh stercobilin tha gives stool its brown color

Front 74

what happen if the liver has problems and cant get rid of bilirubin and biliveridin

Back 74

it starts to accumulate and causes jaundice

Front 75

what is normal bilirubin level

Back 75

0.5-1 mg%

Front 76

describe hemolytic jaundice

Back 76

greater destruction of RBC's than the liver can compensate for

Front 77

What is physiologic jaundice of the newborn

Back 77

Infant born with immature liver adn enzymes cant handle the bilirubin from the breakdown of fetal hgb

Front 78

How is jaundice of the newborn treated

Back 78

UV light to convert the bilirubin to a soluble compound that can be excreted

Front 79

What causes obstructive jaundice

Back 79

cholelithiasis

Front 80

What happens in hepatitis

Back 80

damages the parenchymal cells of liver so they cant convert the bilirubin- leads to accumulation/jaundice

Front 81

What happens in cirrhosis

Back 81

the liver plate cells die and are slowly replaced with scar tissue that accumulates fatty tissue and results in loss of liver function

Front 82

main causes of cirrhosis

Back 82

#1- alcoholism
hepatitis B, C

Front 83

treatment of cirrhosis

Back 83

liver transplant

Front 84

What events are associated with cirrhosis

Back 84

jaundice
portal htn
esophageal varices
ascites
feminized males
ammonia toxicityy
reduced blood clotting factors

Front 85

what is portal htn

Back 85

increased blood pressure in the portal veins bc the blood cant pass through the fatty tissue

Front 86

what causes esophageal varices

Back 86

portal htn- blood backs up from portal system and will eventually only be able to pass through the gastric vein to return to the vena cava- can cause esophageal hemorrhage

Front 87

What causes ascites

Back 87

collection of fluid in the abdomen that has weaped from the surface of the liver. due to sinusoids being so permeable to proteins and fluid cant pass through fatty tissue and liver cant make albumin to hold onto the fluid

Front 88

why to men become feminized in cirrhosis

Back 88

because the liver solublizes estrogen and secretes it causing increased levels

Front 89

What is an ancillary organ to the liver that stores and concentrates bile

Back 89

gallbladder

Front 90

how does the gallbladder concentrate bile

Back 90

it removes the salts and water

Front 91

How does the bile from the liver get to the gallbladder

Back 91

through the cystic duct

Front 92

What stimulates the liver and gallbladder to release bile

Back 92

CCK

Front 93

What happens to the bile salts and acids

Back 93

it is reabsorbed by the ileum and carried back to the liver

Front 94

What does choleolithiasis casuse

Back 94

blocks the duct from the gallbladder causing increased pressure and pain