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2480: Liver
Pathophysiology of the Liver Hepatobiliary System (Week 6)
| Question | Answer |
|---|---|
| The liver is the _______ organ in the body. It weighs about ___lbs. It is divided into ___ lobes and had a ____blood supply. | largest; 3; 4; dual |
| The functional unit of the liver is the _____. | lobule |
| Describe sinusoids. | Capillaries located between the rows of hepatocytes and are lined with Kupffer cells. |
| Describe Kupffer cells. | Cells lining the sinusoids that carry out phagocytic activity. (removal of bacteria and toxins from the blood) |
| Describe hepatocytes. | Lines the central vein and sinusoids and secrete bile into the canaliculi which empties into the bile duct |
| Describe the hepatic artery. | 1 of 2 ways that blood is supplied to the liver; pumps 300mL/min; comes from celiac trunk; provides oxygen-rich blood to liver |
| Describe the portal vein. | 1 of 2 ways that blood is supplied to the liver; valveless vein that pumps 1050mL/min; comes from the stomach, intestines, pancreas, and the spleen; provides nutrient-rich blood to the liver |
| Describe the hepatic vein. | Collects filtered blood from the central veins and is pumped away from the liver towards the inferior vena cava; it is a valveless vein. |
| Describe lobules. | It is the functional portion of the liver, there are 50,000-100,000. The center is the central vein and is supplied by the portal vein & hepatic artery. |
| Describe sinusoids. | Channels between sheets of hepatocytes that go between the central vein and the hepatic triad; allowing blood to come in contact with hepatocytes and Kupffer cells |
| Describe hepatocytes. | Cells that line the sinusoids and secrete bile into the canaliculi. |
| Describe Kupffer cells. | Cells that line the sinusoids that carry out phagocytic activity; removal of bacteria and toxins from the blood |
| Describe the common bile duct. | Collects bile that was created by hepatocytes from the canaliculi and then to the left and right hepatic ducts. The r/l hepatic ducts drain into the common bile duct. The common bile duct joins w/the pancreatic duct to drain into the doudenum. |
| The pancreatic bile duct and the common bile duct join at the _________ before leading into the doudenum. | hepatopancreatic ampulla |
| _________ regulates the flow of bile into the doudenum. | sphinchter of Oddi |
| What is the liver's function in carbohydrate metabolism? | maintains glucose homeostasis by storing glycogen and releasing it when levels fall; converts galatose and fructose to glucose; converts amino acids and lactic acid into gluose; converts excess glucose into triglycerides for storage |
| What does the liver create for the blood? | it synthesizes albumin, fibrinogen, and the blood clotting factors |
| Describe the deamination of proteins. | the removal of an amino group (-NH2)from an amino acid, NH2 forms with a hydrogen ion to create NH3 (ammonia) which is toxic to the body; the goal of the deamination is to create a usable energy source |
| What is the liver's function in protecting the body against ammonia? | after deaminiation of proteins, the liver converts the amonia into urea which can be safely flow to the kidneys to be excreted as urine |
| What is the liver's role in fat metabolism? (4 roles) | formation of lipoproteins; conversion of carbohydrates and proteins into fat; synthesis, recycling, and elimination of cholesterol; formation of ketones from fatty acid |
| How does liver play a role in the metabolism of drugs? | phase 1: chemical modification or inactivation of a substancephase 2: conversion of lipid-soluble substances into water-soluble derivatives(important in metabolizing lipid-soluble substances) |
| What hormones are metabolized in the liver? If the liver isn't functioning properly, what manifestations would you expect of these? | sex hormones (gynecomastia in men, disturbances in gonadal function); glucocorticoids (increased cortisol levels-Cushing's); and aldosterone (signs of hyperaldosteronism- sodium retention and hypokalemia) |
| What function do bile salts have? | They are essential in for digestion of dietary fats and absorption of fats and fat-soluble vitamins from the intestine (Vit. A,D,E,and K) |
| What role does the liver have in heat production? | The metabolism happening in the liver keeps you warm when you are sitting. |
| What are the tests of hepatobiliary function? | liver enzymes (ALT, AST); serum albumin, PT, serum bilirubin, ultrasonography, ERCP, CT/MRI |
| Describe ALT. | liver function test; it is an enzyme found primarily in the liver and is released when the liver cell is injured; elevated levels imply a liver disorder |
| Describe AST. | liver funtion test; it is an enzyme found mainly in the heart and liver, levels are high following an MI or if there is injury to the liver cells |
| Describe the function of prothrombin. | Produced by the liver and requires Vitamin K for synthesis. Prothrombin is converted to thrombin, essential in coagulation. |
| Describe GGT. | GGT is a enzyme found in the liver and kidney; may indicate liver damage (cirrhosis, alcoholism); more sensitive to liver dysfunction than ALP |
| Describe ALP. | LFT; ALP is an enzyme found in the liver and bone; increased level may imply liver damage (obstructive biliary disease, hepatitis) |
| Describe ultrasonography as a LFT. | It is able to see gallstones or obstruction |
| Describe ERCP. | endoscopic retrograde cholangio pancreatography; provides radiographic visualization of bile and pancreatic ducts; used to ID obstructions |
| Define icterus. | aka jaundice: a yellow discoloration of the skin, mucous membranes, and sclerae of the eyes caused by greater than normal amounts of bilirubin in the blood. |
| During jaundice, what causes pruritus? | Bile salts are released from the blood, making you itchy |
| During jaundice serum bilirubin levels are greater than ________________mg/dL. | 2-2.5 |
| What are the three different types of jaundice? | pre-hepatic, intra-hepatic, and post-hepatic |
| Describe pre-hepatic jaundice. What are the causes? | aka hemolytic jaundice; due to an increased breakdown of RBC's creating an increased amount of unconjugated bilirubin in the blood; r/t blood transfussions reactions, sickle cell crisis; common in newborns |
| Describe intra-hepatic jaundice. What are the causes? | aka hepatocellular jaundice; results from the liver's altered ability to take up bilirubin from the blood or to conjugate or excrete it; r/t hepatitis, cirrhosis, certain drugs, estrogen |
| Describe post-hepatic jaundice. What are the causes? | aka obstructive jaundice; due to decreased or obstructed flow of bile through the liver or biliary duct system; r/t gallstone, inflammation, pancreatic cancer |
| What are the hematologic manifestations of liver failure? | anemia, thrombocytopenia, coagulation defects, and leukopenia; patient will bruise easy, have hematuria, abnormal menstrual bleeding, vulnerable to GI bleeds |
| What are the endocrine disorders associated with liver failure? | women- menstrual irregularities, loss of libido, sterility; men- testicular atrophy, loss of libido, impotence, gynecomastia; increased aldosterone may lead to edema/ascites |
| What are the skin disoders associated with liver failure? | lesions on the upper half of the body, palmar erythma, clubbing (cirrhosis), jaundice (late manifestion) |
| Describe hepatorenal syndrome. | Funtional renal failure seen during the terminal stages of liver failure w/ascites; may contibute to hepatic encephalopathy. |
| Describe hepatic encephalopathy. | Neurotoxins accumulate in blood causes lack of mental awareness and can result in a terminal coma. NH3 is a thought cause. Assoc w/poor coordination, foul-smelling breath, & asterixis (uncontrollable flapping of the hands). |
| What are the liver failure treatments? | neomycin, lactulose, stop alcohol use, prevent infections, prevent protein breakdown, correct f/e imbalance, treat complications (hepatitis & cirrhosis), liver transplant |
| Describe neomycin. | Causes a decrease in bacterial flora, decreasing formation of ammonia |
| Describe lactulose. | Enhances intestinal excretion of ammonia, converts it to a form that is not absorbed by the blood and is released into the stool. |
| What is the reccomended diet for a patient going into liver failure? | High in calories (prevent hypoglycemia and catabolism) with a high carbohydrate content and moderate to low fat levels |
Created by:
erachuy23
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