Gastro Final lccw

What 2 glands are accessory glands?

liver and gallbladder

what produces bile to go to the duodenum?

liver

how many lobes does the liver have?

4

-right, left, caudate, and quadrate

the falciform ligament is a mesentery that attaches the liver to the ant abdominal wall T/F?

True

the round ligament of the liver is a remnant of what vein?

fetal umbilical v.

what is the bare area of the liver?

a. area not covered by visceral peritoneum

b. top of liver surrounding the bare area

c. lobe beside the gallbladder

d. lobe at dorsal end of liver

area not covered by visceral peritoneum

what is the coronal ligament?

a. area not covered by visceral peritoneum

b. top of liver surrounding the bare area

c. lobe beside the gallbladder

d. lobe at dorsal end of liver

b. top of liver surrounding the bare area

where is the quadrate lobe?

a. area not covered by visceral peritoneum

b. top of liver surrounding the bare area

c. lobe beside the gallbladder

d. lobe at dorsal end of liver

c. lobe beside the gallbladder

where is the caudate lobe?

a. area not covered by visceral peritoneum

b. top of liver surrounding the bare area

c. lobe beside the gallbladder

d. lobe at dorsal end of liver

d. lobe at dorsal end of liver

which two ducts come together to form the common bile duct?

a. left hepatic and right hepatic duct

b. cystic duct and common hepatic duct

c. common hepatic duct and left hepatic duct

b. cystic duct and common hepatic duct

the liver is formed of liver lobules which contain plates of hepatocytes within them T/F?

True

what is the portal triad of the liver made up of?

hepatic a, v, and bile duct (and lymph ducts)

between the plates of hepatocytes there are liver sinusoids, blood travels through here to the______

a. hepatic v.

b. IVC

c. central vein

c. central vein

liver has only oxygenated blood going through it T/F?

False,

has oxygenated and deoxygenated blood

blood travels from the central vein to hepatic vv to the _____

IVC

what are Kupffer cells?

macrophages (remove bacteria and dead blood cells) that live in the liver and engulf bacteria and toxins and help w/ detoxification process

where are the Kupffer cells found?

walls of the sinusoids

what's an aka for bile canaliculi?

canal of Hering

how many functional zones does the liver have, and which zone has the best supply of oxygenated blood?

-3 zones

-zone 1 has best supply of oxygenated blood and zone 3 the poorest supply

What are the functions of zone 1 of the liver?

a. glycogen syn, glycogenolysis; protein metabolism and formation of plasma portions; cojugation of certain drugs

b. shared function

c. glycogen storage of lipid and pigment formation and metabolism of certain drugs

a. glycogen syn, glycogenolysis; protein metabolism and formation of plasma portions; cojugation of certain drugs

What are the functions of zone 3 of the liver?

a. glycogen syn, glycogenolysis; protein metabolism and formation of plasma portions; cojugation of certain drugs

b. shared function

c. glycogen storage of lipid and pigment formation, and metabolism of certain drugs

c. glycogen storage of lipid and pigment formation, and metabolism of certain drugs

What are the functions of zone 2 of the liver?

a. glycogen syn, glycogenolysis; protein metabolism and formation of plasma portions; cojugation of certain drugs

b. shared function

c. glycogen storage of lipid and pigment formation and metabolism of certain drugs

b. shared functions

What is bile made up of?

- a yellow alkaline soln

-bile salts

-pigments

-cholesterol

-fat

-lecithin

what is the role of bile?

-emulsifies fats

-increases surface area for digestion, and allows fat to be suspended in chyme soln to get ride of waste

where are bile salts reabsorbed at?

a. stomach

b. ileum

c. transverse colon

b. ileum- by the enterohepatic circulation

what do bile salts facilitate absorption of?

a. fat and protein

b. protein and cholesterol

c. fat and cholesterol

c. fat and cholesterol

how much bile does the liver produce per day?

500-1000ml/day

the gallbladder is a thin walled muscular sac T/F?

True

where is bile stored after produced by the liver that is not needed immediately?

a. ileum

b. gallbladder

c. cecum

gallbladder

the hepatic portal vein brings blood to the liver from what?

gut, spleen, and pancreas

blood leaves the liver via the______

hepatic veins--->IVC

The liver can regenerate via hepatocytes replicating, but this process is severely impaired by what types of conditions?

-fibrosis

-inflammation

-viral infections

what are the 8 functions of the liver?

1. bile syn and secretion

2. syn of lipoproteins

3. storage of carbs as glycogen

4. deamination of AA's

5. syn of proteins

6. vitamin storage

7. storage and transport of minerals

8. detoxification

VLDL transports the fats to _____

a. tissue

b. adipose

c. liver

b. adipose

LDL transports fats/lipids to _____

a. tissue

b. adipose

c. liver

a. tissue

HDL transports fats/lipids to ____

a. tissue

b. adipose

c. liver

c. liver for excretion or reutilization

90% of plasma proteins are produced by liver, what form are most of the proteins in?

albumin

What vitamins does the liver store?

Vit. A,D, E, K and B12

What mineral does the liver store?

stores Iron as ferritin

detoxification in the liver occurs with or w/o CYTP450, it metabolizes toxins (free radicals), and is also known as mixed fxn oxygenation T/F?

True

what are 2 fxns of bile?

-help emulsify big fat globules to smaller ones to help w/ absorption of digested fat

-a way to excrete waste products bilirubin and excess cholesterol

what secretes and forms bile?

hepatocytes

bile leaves the liver via the R/L hepatic duct T/F?

True

when bile is in the bile ducts w/in the liver it is mixed with a watery soln of Na and bicarbonate which is secreted by the epithelial cells and stimulated by _____

a. CCK

b. secretin

c. intrinsic factor

b. secretin

~30min after a meal the gallbladder begins to empty bile into the ______

duodenum

-duodenum contracts and the sphcinter of oddi relaxes

what is the most potent stimulus for bile leaving the gallbladder?

a. CCK

b. secretin

c. intrinsic factor

a. CCK

what synthesize bile salts?

hepatocytes

what are the fxns of bile salts?

-decrease surface tension of fat globule to allow for easier breakdown of fat

-for micelle to help with absorption of FA's, monoglycerides, cholesterol, and other lipids

most of the bile salts are recirculated/reabsorbed into the bile via enterohepatic circulation in the sm. intestine T/F?

True

what are 2 characteristics of cirrhosis?

1. bridging fibrosis septae-bands of fibrous scars linking portal tracts (sinusoids)/increase in fibrotic tissue

2. parenchymal nodules formed from injury/inflammation and fibrosis

what's the leading cause of cirrhosis?

alcoholic liver disease

what are 7 possible causes of cirrhosis going from most likely to rarest?

1. alcoholic liver disease

2. viral hep

3. biliary disease

4. cryptogenic cirrhosis (fatty liver)

5. primary hemochromatosis (abnormal storage of iron in liver)

6. Wilson disease (liver stores too much Cu, rare)

7. alpha-antitrypsin deficiency (rare)

what occurs in the liver for cirrhosis to develop?

-Space of Disse contain type I and III collagen (instead of Type IV normally) and are deposited in the lobule by activated stellate cells which creates new vascular channels

-shunts blood around the parnenchyma

what is cirrhosis classified as?

a progressive fibrosis and reorganization of the vascular architecture

what is the space of Disse in the liver?

an area that allows for communication between blood and hepatocytes

what does albumin do?

it's an osmotic regulator for our blood vessels

what is ascites?

a collection of plasma outside the blood vessels (b/c there's no albumin to retain it) and it accumulates in the abdominal spaces

what causes ascites and edema?

hyoalbuminemia

-b/c decreases osmotic BP

chronic fibrosis of the liver eventually causes a loss of fenestrations in the sinusoidal endothelial cells, which leads to a loss of exchange b/t the plasma and the hepatocytes T/F?

True

what is portal hypertension?

a. resistance of portal blood flow

b. yellow discoloration of the skin

c. fibrosis of the liver

a. resistance of the portal blood flow

what are 3 divisions of portal hypertension?

-prehepatic=obstructive thrombosis (clot) and stenosis (narrowing) of portal vein. Splenomegaly can also shunt a lot of blood into splenic v. (enlarged spleen will send more blood to the liver and will increase pressure in portal vein)

-intrahepatic=R sided heart failure

-posthepatic=caused by cirrhosis (most common)

what are 4 consequences of portal hypertension?

1. ascites

2. formation of portosystemic venous shunts (veins around umbilicus, esophagus)

3. congestive splenomegaly (spleen)

4. hepatic encephalopathy

acput medusae are enlarged veins around what the ______

a. esophagus

b. umbilicus

b. umbilicus

What is jaundice?

yellow discoloration of the skin and sclera due to retention of pigmented bilirubin

heme is oxidized by heme oxygenase to biliverdin, which is reduced to unconjugated bilirubin T/F?

True

-bilirubin is derived from heme degradation

how does bilirubin produced outside the liver travel in the blood stream?

by attaching to serum albumin

when bilirubin gets into the liver it is conjugated w/ glucuronic acid to become less water soluble T/F?

False,

it becomes MORE water soluble once conjugated

where is the conjugated bilirubin excreted to from the liver?

biliary ducts as part of bile

intestinal bacteria convert bilirubin into _____

a. stercobilinogen

b. urobilinogen

c. stays the same

b. urobilinogen

onces bilirubin becomes urobilinogen it can either be converted to stercobilinogen (and passed out to feces) OR it can be reabsorbed by the intestine and transported to the kidney (and be passed out by urine as oxidized product urobilin) T/F?

True

large quantities of unconjugated bilirubin are found in the circulating plasma, which diffuse into tissues, like brain in infants and cause neurological defects T/F?

False,

SMALL quantities

what are normal levels serum bilirubin?

.3-1.2mg/dl

what are the levels of bilirubin when you have jaundice?

2-2.5mg/dl

what causes jaundice?

when equilibrium of production and excretion is disturbed by these mechanisms:

-excessive production of bilirubin

-reduced hepatocyte uptake

-impaired conjugation of bilirubin

-decreased hepatocellular excretion

-impaired bile flow

HAV incubation period is _____

a. 2-6 weeks

b. 4-26 weeks

a. 2-6 weeks

HBV incubation period is ____

a. 2-6 weeks

b. 4-26 weeks

b. 4-26 weeks

HAV and HEV are both fecal-oral (water borne) T/F?

True

HBV and HCV are both blood borne T/F?

True

what 3 hep viruses's are RNA virus?

HAV, HCV, and HDV

Which hep has a double stranded circular DNA molecule?

HBV

what has to happen to get a HDV superimposed infection?

have to have HBV first, then get HDV and this usually leads to chronic hepatitis

Which hep can be asymptomatic?

HBV

in HBV you can become a chronic carrier and most carriers are located in Africa T/F?

False,

Asia

what are major sources of contracting HBV?

-IV drug user (60%)

-sex (15%)

in HBV ___ % of infections lead to chronic liver disease?

a. 40%

b. 85%

c. 100%

b. 85%

HAV is benign, self-limiting disease,with a small nonenveloped single-stranded RNA picornavirus T/F?

True

if contract HDV and HBV at same time you will develop a mild infection and it will resolve itself, what is this called?

a. HDV superimposed

b. Coinfection

b. coinfection

If get HEV while pregnant you have a 1 in 5 chance of dying T/F?

True

HEV and HAV are both self-limiting infections T/F?

True

What 3 different liver diseases can present with chronic alcohol consumption?

1. hepatic steatosis (fatty liver)

2. alcoholic hepatitis (inflamed liver)

3. cirrhosis (nonreversible impairing of the liver)

Hepatic steatosis causes _____ to accumulate in the hepatocyte, causing the liver to soften and enlarge, and appear yellow and greasy

a. proteins

b. lipids

c. chocolate

b. lipids

Hepatic steatosis can be reversed if alcohol consumption is stopped T/F?

True

alcoholic hepatitis causes welling and necrosis of the _____

hepatocytes

What other characteristics present in alcoholic hepatitis?

1. mallory bodies

2. neutrophilic reaction-neutrophils permeate lobule

3. fibrosis-activation of stellate cells

alcoholic cirrhosis is irreversible, and will transform the liver into a brown shrunken and nonfatty organ weighing less than 1kg T/F?

True

what types of hepatic tumors are there?

1. benign neoplasms

2. malignant tumors

3. Hepatocellular carcinoma (malignant)

4. Cholangiocarcinoma (malignant cancer of the bile ducts)

hepatic benign neoplasms can reach up to ____cm in diameter, and have a vascular component but no portal tracts, and are pale in color

30cm

malignant tumors in the liver develop usually from other tumors and spread to the liver T/F?

True

Hepatocellular carcinoma are a primary malignant tumor, diffusely infiltrates, and can be caused by HCV and HBV T/F?

True

Hepatocellular carcinoma and benign neoplasms both show as a pale area on the liver T/F?

True