Liver Anatomy and Pathophysiology Lecture Notes

This set of flashcards covers vital vocabulary terms related to liver anatomy, function, pathology, and clinical management derived from the lecture notes.

Hepatic Dysfunction

Affects all body systems due to the liver's central metabolic role.

What are common etiologies of Hepatic dysfunction?

Viral Hepatitis (HBV/HCV). Obesity and insulin resistance. Toxic exposure (alcohol, medications). Neoplastic processes.

What are systemic consequences of hepatic dysfunction?

Metabolic dysregulation. Coagulation abnormalities. Portal hypertension. Encephalopathy.

What is the livers role in the body?

It’s the primary chemical factory, it regulate metabolism, storage and detoxification.

How does the liver process nutrients?

From GI tract via portal vein

How does the liver regulate metabolism?

Controls glucose homeostasis and metabolism of protein

How does the livers role regulate produce bile?

It manufactures and secrets bile for fat digestion and absorption.

How does the livers role regulate eliminate waste?

Takes out metabolic waste from blood and secrets it into the bile for excretion

What is the structural organization of the liver?

It has four lobes that are surrounded by connective tissues that extend throughout. It creates functional units called lobules.

What are hepaptocytes?

Primary functional liver cells

What are Kupffer cells?

Macrophages (WBC) that live inside the liver. They line the sinusoids in the liver. They are part of the reticuloendothelial system (RES - the network of cells responsible for filtering and removing harmful substances from the blood).

What are sinusoids?

Specialized blood vessels in the liver

What are Bile Canaliculi?

Microscopic channels that are formed by two adjacent hepatocytes (like a mini duct) that collects bile from the cells.

What is Glycogenesis?

The process of converting post-meal glucose into glycogen for storage in hepatocytes.

What is Glycogenolysis?

Glycogen being released and metabolized into glucose, which is released to maintain blood glucose levels.

What is glucogenesis?

The synthesis of glucose from amino acids or lactate during hypoglycemia. (Compensation).

How does ammonia get created in the body?

During glycogenesis the amino acids used can generate a byproduct of ammonia (TOXIC!) The liver will quickly metabolize to Urea and excrete it through urine. The liver will also deal with ammonia created by gut bacteria that entered through portal (intestinal through portal vein) blood.

What proteins are metabolized in the liver?

Almost all plasma proteins - Albumin, Alpha/beta globulins, Clotting factors. It requires vitamin K for prothrombin and clotting factor synthesis.

What role does the liver play in fat metabolism?

There fatty acids are broken down for energy and to produce ketone bodies. (Ketogenesis happens during starvation or uncontrolled diabetes when glucose is limited). It synthesizes cholesterol, lecithin, lipoproteins, complex lipids.

What role does the livers play play in storage of Vitamins and Iron?

It has a large reserve of Vitamin A, B, D & B-complex. Stores Iron and copper for metabolic needs.

Which drugs do the livers metabolize?

Barbiturates, opioids, sedatives, anesthetics, amphetamies.

How does the liver play a role in Bile?

Hepatocyte cells are constantly forming bile, from water, electrolytes, lecithin, fatty acids, cholesterol, bilirubin, bile salts.

What is the function of bile in the body?

Excretion of bilirubin an other fat soluble waste. Fat emulsification by bile salts.

When liver function tests (LFTs) are abnormal what should we ask the patient about?

Toxins, substances, meds and risky exposure

What general physical appearance are we looking for in a patient with abnormal liver function tests (LFTs)?

Pallor (chronic illness), Jaundice (on skin, mucosa, sclera-white of the eye), Scratches (from pruritus due to bile salt buildup).

What skin findings are we looking for in a patient with abnormal liver function tests (LFTs)?

Petechia & ecchymoses (bleeding tendency from impaired clotting). Spider angiomas (Vascular changes seen in liver disease).

What neurological assessment are we doing on a patient with abnormal LFTs?

Checking memory, recall, abstract thinking. Looking for tremors, weakness, slurred speech (can also indicate encephalopathy)

What key blood tests should be taken in a patient with abnormal liver function tests (LFTs)?

Bilirubin - asses liver cell injury & bile flow. Ammonia - gets elevated in liver failure. Clothing factors - made by liver if synthesis impaired will prolong bleeding. Lipids - in liver dysfunction they are altered.

What is the use of an abdominal examination of the liver?

To palpate abdomen and check liver size, surface and tenderness. Can be felt in RUQ will be firm, smooth, sharp edged wedge.

What are abnormalities that can be found through abdominal liver examination?

Hepatomegaly (enlarged), Irregular surface (fibrosis/mass), Tenderness (inflammation or congestion), Nodularity (classic of cirrhosis- scar tissues surrounding nodules)

What is a liver biopsy and when is it used?

Done by needle aspiration of a small liver tissue sample for a histological exam. Primary Indications - Evaluation of diffuse parenchymal disease, space occupying lesions, and unclear lab/clinical findings. Done Percutaneously (with ultrasound) or laparoscopically.

What are advanced diagnostic imaging that can be used to assess hepatic function?

Ultrasound (ultrasonography) - identifies liver and biliary abnormalities. CT/MRI - gives a detailed anatomy and lesion characterization.

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Portal Hypertension

Increased pressure throughout the portal venous system due to obstruction.

Ascites

Fluid accumulation in the peritoneal cavity, often a consequence of portal hypertension.

Hepatocellular Carcinoma (HCC)

The most common primary liver cancer and the second leading cause of cancer-related mortality worldwide.

Endoscopic Variceal Ligation

A procedure where a rubber band is applied to bleeding varices to stop hemorrhage.

Cirrhosis

Chronic liver disease characterized by fibrotic changes and loss of functional liver tissue.

Focal Nodular Hyperplasia (FNH)

A benign hepatocellular lesion that is usually asymptomatic and requires conservative management.

Metabolic Regulation

The liver controls glucose homeostasis and protein metabolism.

Hepatic Vein

Vein that drains blood from the liver to the inferior vena cava.

Viral Hepatitis

Inflammation of the liver due to viruses such as HBV and HCV.

Portal Vein

A blood vessel that carries nutrient-rich blood from the gastrointestinal tract to the liver.

Octreotide

A pharmacologic agent effective in decreasing variceal bleeding.

Bile Composition

Bile is formed by hepatocytes and consists of water, electrolytes, bile salts, and bilirubin.

Hematemesis

Vomiting of blood, often a symptom of esophageal varices.

Portal System

The vascular system that collects blood from the gastrointestinal tract and spleen to the liver.

Imaging Studies

Tests such as CT scans and ultrasounds used to diagnose liver conditions.

Ammonia Conversion

The liver converts toxic ammonia generated from amino acid metabolism into urea for renal excretion.

Surgical Resection

Surgical treatment for liver tumors when the tumor is confined to one lobe and liver function is adequate.

Echinococcal Liver Cysts

Cysts caused by the parasite Echinococcus, often asymptomatic until detected.

Fatty Liver Disease

A condition where lipid accumulates in hepatocytes, associated with obesity and diabetes.