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GI / Hepatology > 1 - Anatomy & Histology of the Liver > Flashcards

1 - Anatomy & Histology of the Liver Flashcards

(73 cards)

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1
Q

Normal Liver Mass

A

1500g

Largest organ

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2
Q

Normal Portal Pressure

A

5 - 10 mm Hg

Low pressure

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3
Q

Hepatocytes - Do they all do the same thing?

A

No!!!!

They have functional heterogeneity

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4
Q

Liver’s borders

A

Right 5th rib
Left 6th rib
Right 9th rib

Feel it below the 9th rib and it’s HUGE!!!!!!

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5
Q

Contents of the portal vein

A

Collection of venous blood from spleen, splenic vein, SMA, IMA

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6
Q

Portal Hypertension

A

Obstruction to portal vein flow causing pressure to increase above 10mm Hg

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7
Q

Post-Hepatic Hypertension

A

Rarest kind of portal HTN

Congenital webs of the IVC

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8
Q

Intra-Hepatic Hypertension

A

Most common type of portal HTN

Cirrhosis
Other types of pathology

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9
Q

Pre-Hepatic Hypertension

A

Thrombosis blocking entry to the portal vein

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10
Q

How many lobes?

A

2!

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11
Q

Components of the liver

A

2 Lobes
Glisson’s Capsule (smooth! IT IS SMOOTH!!)
Falciform Ligament

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12
Q

Real divisions of the liver

A

8 Segments
4 on the left, 4 on the right
Each has its own vascular and biliary pedacle

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13
Q

Two sources of blood for the liver

A

Celiac Trunk > Hepatic Artery > Left & Right Lobes

Splenic Vein + IMA + SMA > Portal Vein

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14
Q

Biliary Tree

A

Bile conducted from ducts inside into common hepatic duct which meets with cystic duct to join the GI tract

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15
Q

Lobule

A

One functional unit of hepatocytes.
Central vein in the center
Arterial flow at the periphery
No connective tissue divisions between lobules the way pigs do!!!

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16
Q

Central veins

A

Marked by venous endothelium

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17
Q

Portal tracts

A

Collagen tracts that carry 3 tubes:

Bile duct
Artery
Vein

Can fibrose in pathways leading to other portal tracts when inflammation fucks that shit up

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18
Q

Blood path through a lobule

A

Portal tracts at periphery
Contents flow through sinudoids in the periportal regions
Undergo hella changes
Enter central veins to go back to the heart.

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19
Q

Bile Cannaliculi

A

Collect bile, interanastomose and form the canal of herring, which drains into the individual bile ducts that drain into the hilum and the common bile duct.

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20
Q

Where do the progenitor (stem) cells in the liver live?

A

The Canal of Herring

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21
Q

Description of Lobule

A

Radiating Cords
Nicely organized
Once Cell Thick (so nicely bathed)

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22
Q

Central Veins

A

Anastomose into Hepatic Veins (R & L)

Exit to IVC

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23
Q

Portal Tract on Histo

A

Nothing but collagen, fibroblasts and triad of structures

Inflammatory

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24
Q

Bile Duct

A

Tube of cuboidal epithelium

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25
Limiting Plate
The hepatocytes at the edge of the Portal Tract | Chronic Hepatitis - Lymphocytes and inflammatory cells can infiltrate this structure and cause fibrosis
26
Mixing of Portal Venous and Hepatic Arterial Blood
Hepatic artery branches give off small twigs which empty arterial (oxygenated) blood into the periportal sinusoids directly outside the portal tract connective tissue
27
Chronic Hepatitis
Ground Glass Inclusions | Lymphocytes and other inflammatory cells cross limiting plate
28
Space of Disse
Type III Collagen | Discontinuous Array
29
Least oxygenated hepatocytes
Right around the central vein | They die quickly because they receive the least-oxygenated blood
30
Lipofuscin Pigment
Phagolysosomes with "Wear & Tear" cell debris Brown Pigment Junk Appears in Heart, Liver, and Adrenal. Myocytes particularly. See it first in the hepatocytes surrounding central veins
31
Areas from Portal Tract to Central Vein
Periportal Midzonal Centrilobular Each is about 7 cells wide ~22 hepatocytes from portal tract to central vein
32
Periportal Area - Zone 1
``` Best oxygen Oxygen tension is 65mm Hg Area where chronic hepatitis is most active Gluconeogenesis Bile Salt Synthesis ```
33
Centrilobular Area - Zone 3
``` Oxygen tension is 35 mm Hg Furthest from oxygen Most vulnerable to shock/ischemia Contains drug metabolizing enzymes Cytochrome p450s Area where alcohol is metabolized ```
34
Acinar Zones
Another interpretation of Zone 1 - Best perfusion Zone 2 - Midzonal Zone 3 - Centrilobular
35
Zone 1
``` Chronic Hepatitis NH3 Metabolism (OTC & CPS Enzymes ```
36
Midzonal - Zone 2
Protein Synthesis
37
Zone 3
Drug Metabolism Ischemia/Shock Glutamine Synthetase Enzyme
38
Pit Cell
Natural Killer Cell Tumor Surveillance Tumor cells from GI tract come back in portal vein Pit cells KILL THOSE BITCHES
39
Kupffer Cell
Macrophages Contain multiple pseudopodia Lie in waiting along endothelial surfaces Phagocytose microbes
40
Endothelial Cells
Contain fenestrae in the sieve plate | Allow smallecules to move from Sinusoids into the Space of Disse
41
Space of Disse
Contains scattered discontinuous Collagen III fibers Contains Ito (Stellate) cells No basement membrane Low pressure system (Dependent on how tight or loose the endothelial cells are, or how tight or loose stellate cells are
42
Stellate (Ito) Cells
``` Chief fibrotic source for the liver Stores vitamins Lies in wait for liver damage Releases collagen on damage Have little triangular basophilic nuclei (like little hats) over a vacuole of Vitamin A (fat soluble) ```
43
Canal of Hering
Bile canalliculi narrow to tubes lined by single cuboidal epithelium as they approach the bile ducts. Progenitor cells live in that part They can differentiate into whatever types of cells you need!!
44
Overdose of Vitamin A
Hyperplasia in Space of Disse
45
Endothelin and NO
Released in order to modify tension of endothelial cells and stellate cells
46
Bile Pumps
There are different bile pumps in the canaliculi Studying these will reveal new forms of jaundice BSEP FIC-1 OATP
47
BSEP
Bile Salt Exporter Pump | Inhibited if you have septic shock from LPS
48
FIC-1
Familial Intrahepatic Cholestasis-1 | Causes of jaundice in the liver itself
49
OATP
Organic anion transport pump
50
Cholestasis
Impaired bile secretion
51
Jaundice
Sallow yellow skin | Icteric sclera
52
LFTs
``` Liver Function Tests Total Protein Albumin Globulin Bilirubin Total Bilirubin Direct (conjugated) Bilirubin Indirect (unconjugated) AST ALT Alk Phos ```
53
Total Protein
6.7 - 8.6 g/dL
54
Albumin
3.5 - 5.5 g/dL
55
Globulin
2.0 - 3.5 g/dL
56
When a hepatocyte dies, what is released?
AST/ALT
57
Pressure on bile ducts and canaliculi?
Elevated Bilirubin/Direct bilirubin Alk Phos goes up GGT (gammaglutamyl transferase) 5'NT (5' nucleotidase)
58
Synthesis
Synthetic proteins Total Protein Albumin
59
Synthesized in hepatocytes
Clotting Factors (I - II - V - VII - IX) Albumin Complement Proteins
60
Largest grey thing on EM
Erythrocytes
61
How does the liver regenerate?
Like medusa
62
How often do hepatocytes divide?
Every 400 Days
63
How many times can a hepatocyte divide?
70 Times
64
Regeneration after injury
Cell Division (eg hepatitis)
65
Severe Loss of tissue - Regeneration
From progenitor cells! (eg fulminant hepatitis)
66
Cirrhosis
An example of ABNORMAL REGENERATION with abnormally thick liver-cell plates Cords are no longer 1 cell thick, but 3 or 4 cells thick Blood can't squeeze through!! THAT SUXXXX Portal fibrosis
67
Embryonic origins of liver
Gut ectoderm
68
Septum transversum
Primitive diaphragm running horizontally | Gut from narrow tube growing into connective tissue plate
69
22 Days post-blastocyst
Foregut endoderm goes into septum transversum. | Vitelline veins go into sinusoids
70
26 days post-blastocyst
Cystic Bud | Cystic duct & gall bladder
71
7 - 8 weeks
Portal vein Portal tract Sinusoids Liver cords (many cells thick)
72
9 - 10 weeks
Bile duct plates (BDP) develop | Differentiation of periportal hepatocytes to bile duct epithelium (bile duct plate)
73
23 weeks and later
Double-lined tube regresses, is remodeled, and disappears One portion moves into the tract to become the intralobular bile duct Some liver diseases affect this remodeling (Polycistic Liver Disease)

GI / Hepatology (28 decks)

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