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41 Cards in this Set
- Front
- Back
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Whcih regions of the abdomen does the liver occupy |
- roght hypochondriac, epigastric region, and part of the left hypochondriac region |
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Name the 9 regions of the abdomen |
top: right hypochondriac, epigastric region, and left hypochondriac region middle: right lumbar region, umbilical region, left lumbar region bottom: right iliac, hypogastric, left iliac |
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Which ligament separates the right and left lobes of the liver? |
- falciform ligament |
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What are the 2 lobes on the posterior of the liver? |
- caudate and quadrate lobes |
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What do the falciform and right and left coronary ligaments do? |
- suspend the live in the abdominal cavity |
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What hepatic laminae? What is the name of the spaces between hepatocytes? What constitutes a portal triad? |
- The plates of liver cells that radiate from the centre of the liver lobule - sinusoids - bile duct, branch of the hepatic artery and branch of the hepatic vein |
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What are the name of the bile ducts which between hepatocytes? Describe the passage of bile from leaving hepatocytes to entering the gall bladder |
- bile canaliculi - hepatocytes>bile canaliculi>bile ductules>bile ducts>right and left hepatic ducts>common hepatic duct |
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What is the name of the capillaries found between hepatocytes? What cell types would you find there? |
- hepatic sinusoids - Kupfer cells |
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Describe the passage of blood from hepatic sinusiods to the right atrium of the heart |
- hepatic sinusoids>central vein>hepatic veins>inferior vena cava>right atrium |
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Describe hepatic lobules (3) |
-hexagonal shape with a central vein -hepatocytes and hepatic sinusoids radiate out from the centre -portal triads are located at corners of the hexagons |
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Describe a portal lobule (3) |
- triangular shape formed by three central veins - bile duct is central in the triangle - accentuates the function of bile secretion |
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Describe a portal acinus (3) |
- sideways oval spanning two lobules - the shortest diameter marks 2 portal triads, while the longest diameter marks 2 central veins |
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Describe the diffences between zones 1-3 in a portal acinus |
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The liver recieves blood from which 2 sources? What is the difference in the composition of the blood? |
- hepatic artery and hepatic vein - hepatic artery: oxygenated blood from the heart - hepatic portal vein: deoxygenated, nutrient-rich blood form the GI tract - but also potential toxins, bacteria and drugs |
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What enables distension of the gallbladder? What is its capacity? |
- rugae - 50ml |
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Describe the different passages that bile may flow to once it has left the liver, and why the routes may be different |
- right and left hepatic ducts - common hepatic duct - if food is present in the duodenum, the sphincter of Oddi is open - allowing it to flow into the duodenum through the common bile duct - if the duodenum is empty, the sphincter of Oddi will be closed - causing the bile to back up through the cystic duct into the gall bladder (for storage and concentration) |
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How does bile become concentrated in the gall bladder? |
- the mucous membrane of the gall bladder contains microvilli - they absorb water and inorganic salts, concentrating the bile by 5-18 times compared to the liver |
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Describe the arterial, venous and nerve supply to the gallbladder (3) |
- arterial supply: cystic artery - venous supply: portal vein - nerve: celiac plexus |
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What hormone causes contraction and the ejection of bile from the gall bladder? What stimulates the release of this hormone? Where is this hormone produced? |
- cholecystokinin - HCl, amino acids and fatty acids being released into the duodenum - upper regions of the small intestine |
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What is the function of bile salts (2)? What would happen in the abscence of bile salts? |
- emulsification and fatty acid absorption - no absorption of lipid soluble vitamins (A, D, E, K). No vitamin K leads to deficiency in clotting factors VII, IX, X and prothrombin |
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Name the 6 commonly used LFTs |
- bilirubin - albumin - aminotransferases: alanineaminotransferase (ALT) and aspartate aminotransferase (AST) - alkaline phosphatase - gamma glutamyl transferase - total protein |
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Why would you measure LFTs (5) |
- screening - investigate unexplained symptoms - investigate symptoms indicative of liver disease - pre-operative/baseline - monitor disease or treatment |
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What is the general function of aminotransferases? |
- involved in gluconeogenesis - transfer amino groups from aspartic acid (AST) and alanine (ALT) to produce oxaloacetic acid and pyruvic acid - respectively |
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What type of pathology do elevated ALT/AST suggest? Why are they not specific (give examples) Which is more specific: ALT or AST? |
- hepatocellular damage - the enzymes are found in various other oragn systems e.g. ardiacand skeletal muscle, kidneys, brain, pancreas, lungs, leukocytes andRBCs. Elevated ALT/AST can therefore be due to other diseaseprocesses e.g. muscle injury - ALTis more specific than AST as it is less active the liver i.e. morenoticeable when increased |
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Why does GGT have poor sensitivity (give examples)? What is elevated GGT indicative of? ? What is elevated GGT and ALP indicative of? What type of drugs can lead to false-postives? |
- same as for AST/ALT. Found in hepatobiliarytree; heart; kidneys; lungs; pancreas and seminal vesicles - recent alcohol consumption - biliary occlusion (cholestasis) - anti-seizure medications e.g. phenytoin,carbamazepine and barbiturates |
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What is the general function of ALPs? What is an elevation of ALP indicative of? |
- hydrolyse phosphateesters in alkaline solutions - bone disease |
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What type of pathology is elevated bilirubin indicative of? |
- hepatocellulardamage or choestasis |
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What is the main cause of portal hypertension? Which blood supply to the liver is most affected? |
- cirrhosis - portal vein (pumps at lower pressure) |
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What happens to the blood supply to liver in portal hypertension? What is this called? Why is this bad? |
- production of collateral vessels - portosystemic shunting - nutrient-rich blood increasingly bypasses the liver and instead goes to the systemic circulation |
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What are the 5 main causes of portal hypertension? Give examples for each. |
- prehepatic e.g. thrombosis in the portal vein, abdominal trauma or congential atresia (narrowing of the portal vein) - intrahepatic e.g. schistosomiais (parasitic worn infection), congenital hepatic fibrosis) and sarcoidosis (granulomas) - sinusoidal e.g. cirrhosis, polycystic liver disease, metastatic malignancies - intrahepatic post sinusoidal e.g. venoocclusive disease of the hepatic veins - post hepatic e.g. Budd-Chiari syndrome, and obstruction from hepatic vein to inferior ena cava |
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How does changes in blood pressure cause changes in blood composition? Give 4 symptoms of liver disease which relate to changes in blood pressure/blood composition. State briefly how they are caused? |
- leads to an imbalance in hydrostaticvs colloid osmotic pressure, causing dysregulation of lymphatic reabsorption - ascites (accumulation of fluid in the peritoneal cavity); splenomegaly; distension of the abdominal veins (caput medusae); varices (dilated blood vessels) |
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List 8 symptoms associated with hepatic insufficiency |
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List 6 diagnostic approaches for diagnosing portal hypertension/hepatic insufficiency and briefly state why they are useful. |
- most useful is an endoscopy to look for varices - portal venous pressure (not common though can confirm diagnosis and also be used to differentiate between different types e.g. pre-sinusoidal) - platelet count: indicative of hypersplenism - LFTs: clues to liver pathology - ultrasound: very useful. Shows several aspects of pathology e.g. splenomegaly, collateral vessels, thrombosis - CT and MRI: clots and vessel patency |
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List 4 ways you might manage a person with liver disease |
- monitor varices due to potential haemorrhage - lower blood pressure - salt restriction and diuretics - transjugular intrahepatic shunt |
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Describe a transjugular intrahepatic shunt (TIPS) |
- connectionis made between the portal vein and the hepatic vein and held openwith a stent. - This allows blood from the GI tract to reach the heartwhile bypassing the liver. - The main role of TIPS is to relieve thepressure which occurs with varices in the stomach or oesophagus, andtherefore reduce the risk of haemorrhage. |
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Describe bilirubin metabolism (essay answer) |
- begins with catabolisation of RBCs - macrophages in the spleen, bone marrow and liver (Kupfer cells) phagocytose RBCs. Haenoglobin is released which degrades into haem and globin. - globin is degraded into amino acids and re-used for erythropoiesis. Haem is degraded in macrophages to to biliverdin, by haem oxygenase. Biliverdin is then converted to unconjugated bilirubin and iron by biliverdin reductase. The iron is strored as ferritin or transported in blood bound to transferrin. - unconjugated bilirubin is lipid soluble and is therefore bound to albumin to be transported in blood. - unconjugated bilirubin travels to the liver where it is conjugated by glucoronic acid, making it water soluble. - conjugated bilirubin then travels to the gallblader and small and large intestines. In the ileum and large intestine conjugated is hydrolysed by bacteria, producing lipid-soluble urobilinogen. - 10-15% or urobilinogen is bound to albumin and reabsorbed into the blood, the rest is oxidised by bacteria into stercobilin and excreted. - of the 10-15% of urobilinogen bound to albumin, 5% will re-enter the entero-hepatic urobilinogen cycle. The remaining 5-10% will transported to the kidney, converted to urobilin, and excreted.
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