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Gastrointestinal > 11. Functions of the Liver II > Flashcards

11. Functions of the Liver II Flashcards

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1
Q

how is the LIVER’S BLOOD SUPPLY

A

DUAL BLOOD SUPPLY

  • from HEPATIC PORTAL VEIN and HEPATIC ARTERIES
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2
Q

How much of the BLOOD SUPPLY comes from HEPATIC PORTAL VEIN

A

75%

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3
Q

HEPATIC PORTAL VEIN carries VENOUS BLOOD FROM..

A

SPLEEN and GI TRACT (intestines etc)

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4
Q

PARENCHYMAL CELLS (related to function) of liver

A

HEPATOCYTES (80%)

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5
Q

NON-PARENCHYMAL CELLS of Liver

A

KUPPFER, ENDOTHELIAL, SINUSOIDAL
(6.5%)

BIPOTENTIAL STEM CELLS - OVALOCYTES (from Hepatocytes and Cholangiocytes)

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6
Q

LIVER FUNCTIONS

A

SYNTHESIS
BREAKDOWN
STORAGE
IMMUNE SYSTEM

etc

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7
Q

BILE COLOUR

A

GREEN/YELLOWISH BROWN

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8
Q

where is BILE STORED and CONCENTRATED

A

in GALLBLADDER

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9
Q

BILE is DISCHARGED to the..

A

DUODENUM

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10
Q

GALLBLADDER BILE COMPOSITION

A

97% WATER
0.7% BILE SALTS
0.2% RUBIN

0.51% FATS (CHOLESTEROL, FATTY ACIDSM LECITHIN)

INORGANIC SALTS

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11
Q

how much of GALLBLADDER BILE is WATER

A

97%

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12
Q

how much of GALLBLADDER BILE is BILE SALTS

A

0.7%

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13
Q

how much of GALLBLADDER BILE is BILIRUBIN

A

0.2%

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14
Q

how much of GALLBLADDER BILE is FATS (CHOLESTEROL/FATTY ACIDS/LECITHIN)

A

0.51%

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15
Q

SYNTHESIS of BILE ACIDS is a major route of … METABOLISM

A

CHOLESTEROL METABOLISM

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16
Q

how much CHOLESTEROL does the BODY PRODUCE PER DAY
and how much of it is used for BILE ACID SYNTHESIS

A

800 MG/DAY CHOLESTEROL

  • 400-600 MG used for BILE ACID SYNTHESIS
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17
Q

How much BILE ACIDS do we SECRETE into Intestines PER DAY

A

12-18 G

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18
Q

how much of BILE ACIDS is REABSORBED by TRANPORT in ILEUM and RECYCLED (ENTEROHEPATIC CIRCULATION)

A

95%

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19
Q

what is BILIRUBIN

A

YELLOW BREAKDOWN PRODUCT of HAEM METABOLISM (RBC breakdown)

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20
Q

what is the name of the PIGMENT from BILIRUBIN that gives FAECES its BROWN COLOUR

A

STERCOBILIN

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21
Q

if bile can’t flow into the duodenum ie jaundice it is filtered by KIDNEYS and BILIRUBIN gives URINE a DARK COLOUR by which PIGMENT:

A

UROBILIN

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22
Q

BILIRUBIN has what structure

A

TETRAPYROLE
/ PORPHYRINS in haem

  • 4 RINGS
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23
Q

what is BILIRUBIN CONJUGATED WITH

A

GLUCORONIC ACID

(by GLUCORONIDATION)

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24
Q

what does BILE FORM to AID LIPID DIGESTION

A

MICELLES

  • Increase SA to digest lipids
  • MOVE LIPIDS near BRUSH BORDER for FAT ABSORPTION
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25
FUNCTIONS of MICELLES
- AID LIPID DIGESTION and ABSORPTION (move near brush borders) - ELIMINATE CHOLESTEROL - DRIVES BILE FLOW - EMULSIFY FAT SOLUBLE VITAMINS (D,E,A,K) to HELP ABSORPTION - REDUCE BACTERIAL FLORA in SMALL INTESTINE and BILIARY TRACT
26
where can MICELLES REDUCE BACTERIAL FLORA
in SMALL INTESTINES and BILIARY TRACT
27
BILE ACIDS also have HORMONAL ACTIONS (METABOLIC) which function through 2 RECEPTORS:
- FARNESOID X RECEPTOR (NR1H4) activates signalling molecules in liver and intestines - G-PROTEIN COUPLED BILE ACID RECEPTOR / TGR5
28
FARSENOID X RECEPTOR (NR1H4) ACTIVATES SIGNALLING MOLECULES in LIVER and INTESTINES involved in...
- TRIGLYCERIDE and GLUCOSE METABOLISM - LIVER GROWTH
29
G-PROTEIN COUPLED BILE ACID RECEPTOR / TGR5 has what FUNCTIONS
METABOLIC, ENDOCRINE, NEUROLOGICAL functions
30
which bile acid RECEPTOR is involved in TRIGLYCERIDE and GLUCOSE METABOLISM
FARSENOID X RECEPTOR (NR1H4)
31
which bile acid RECEPTOR is used for METABOLIC, ENDOCRINE & NEUROLOGICAL FUNCTIONS
G-PROTEIN COUPLED BILE ACID RECEPTOR, TGR5
32
WHERE are PRIMARY BILE ACIDS SYNTHESISED
LIVER
33
WHERE are SECONDARY BILE ACIDS SYNTHESISED
COLON as a result of BACTERIAL ACTIONS - PRIMARY bile acids are PARTIALLY HYDROXYLATED
34
PRIMARY BILE ACIDS:
- CHOLIC ACID - CHENODEOXYCHOLIC ACID
35
PRIMARY BILE ACIDS FORMED VIA..
CYTOCHROME P450 Mediated OXIDATION of CHOLESTEROL
36
What is the RATE-LIMITING STEP in the SYNTHESIS of PRIMARY BILE ACIDS (cholesterol oxidation)
ADDITION of HYDROXYL GROUP of 7TH POSITION of the steroid nucleus by ENZYME CHOLESTEROL 7 ALPHA-HYDROXYLASE
37
CHOLESTEREOL 7 ALPHA HYDROXYLASE ENZYME is DOWN-REGULATED by...
CHOLIC ACID
38
CHOLESTEREOL 7 ALPHA HYDROXYLASE ENZYME is UP-REGULATED by...
CHOLESTEROL
39
CHOLESTEREOL 7 ALPHA HYDROXYLASE ENZYME is INHIBITED by...
Actions of the ILEAL Hormone: FGF 15/19
40
what happens to PRIMARY BILE ACIDS to form SECONDARY BILE ACIDS
PARTIAL HYDROXYLATION - GLYCINE and TAURINE GROUPS REMOVED
41
PRIMARY CHOLIC ACID becomes SECONDARY BILE ACID:
DEOXYCHOLIC ACID
42
PRIMARY CHENODEOXYCHOLIC ACID becomes SECONDARY BILE ACID:
LITHOCOLIC ACID
43
what happens in ENTERO-HEPATIC CIRCULATION
all BILE ACIDS and 95% of BILE is REABSORBED from TERMINAL ILEUM and RECYCLED by the Liver
44
BILE ACIDS can BIND to some other PROTEINS such as..
NAPE-PLD
45
BILE ACIDS GENERATE BIOACTIVE...
LIPID AMIDES eg. Cannabinoid Anandamide
46
BILE ACID ROLES in PYSIOLOGICAL PATHWAYS
- STRESS and PAIN RESPONSES - APPETITE - LIFESPAN
47
NAPE-BLD (binds bile acids) orchestrates a DIRECT CROSS-TALK Between..
LIPID AMIDE SIGNALS and BILE ACID PHYSIOLOGY
48
as SURFACTANTS or DETERGENTS, BILE ACIDS are potentially ... to cells
TOXIC
49
what INHIBITS BILE ACID SYNTHESIS when LEVELS are too HIGH
ACTIVATION of FXR in the liver - activation by bile acids during absorption in the intestine -> INCREASES TRANSCRIPTION and SYNTHESIS of FGF19 (which inhibits bile synthesis)
50
Name of the SPHINCTER before the Ampulla that controls flow of BILE and PANCREATIC JUICE INTO DUODENUM
SPHINCTER OF ODDI (SOD)
51
how is BILE and PANCREATIC JUICE flow ALLOWED into the DUODENUM (via ampulla)
by GALLBLADDER CONTRACTION and RELAXATION of the SPHINCTER OF ODDI
52
what STIMULATE GALLBLADDER CONTRACTION (which relaxes sphincter of oddi)
- ACID FROM STOMAC INTO DUODENUM - CCK - SECRETIN - Increases HCO3- / H2O (help relax SOD)
53
BILE from GALLBLADDER comes to/from COMMON BILE DUCT VIA.. (joins with common hepatic duct)
CYSTIC DUCT
54
CLINICAL problems that can be caused by BILE ACIDS
- HYPERLIPIDAEMIA - CHOLESTASIS (excess blockage) - GALLSTONES - BILE ACID DIARRHOEA - COLON CANCER (from deoxycholic acid conc.)
55
JAUNDICE (YELLOW SCLERA or SKIN) is from..
HYPERBILIRUBINAEMIA - EXCESS BILIRUBIN in BLOOD
56
When does JAUNDICE become apparent
when SERUM BILIRUBIN is 2-3X Upper limit of NORMAL
57
how are blood LEVELS in PREHEPATIC JAUNDICE
RAISED BILIRUBIN ONLY
58
how are blood LEVELS in HEPATIC JAUNDICE
RAISED BILIRUBIN RAISED AST RAISED ALT
59
how are blood LEVELS in POST HEPATIC JAUNDICE (ie in bile duct)
RAISED BILIRUBIN RAISED ALP (alkaline phosphatase) RAISED GGT (gamma GT)
60
JAUNDICE INVESTIGATION
History and Examination Urine Dip prehepatic: Haemolysis Hepatic: Ultrasound - not dilated ducts Liver Screen Post Hepatic: Ultrasound - Dilated ducts
61
CAUSES OF JAUNDICE
POST HEPATIC JAUNDICE CONJUGATED HYPERBILIRUBINAEMIA - bilirubin detectable in Urine - blockage of floe of bile to duodenum in bile LUMEN: STONES, TUMOUR in WALL of LUMEN: STRICTURE, PSC COMPRESSION on the LUMEN: PANCREATIC CANCER, HILAR LYMPHADENOPATHY

Gastrointestinal (19 decks)

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