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Patho Summer Test #1 > Gastrointestinal Module #2b > Flashcards

Gastrointestinal Module #2b Flashcards

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1
Q

What does the Glisson capsule do in the liver?

A

Sounds liver and contains blood vessels, nerves and lymphatics

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2
Q

What happens when the glisson capsule distends?

A

Causes pain

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3
Q

What is the functional unit of the liver?

A

Lobule

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4
Q

How are hepatocytes arranged?

A

Radially around central vein

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5
Q

Where are capillaries (sinusoids) located in the liver?

A

Between heaptocytes

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6
Q

From whom do sinusoids (capillaries) receive blood from?

A

Hepatic Artery

Hepatic Portal Vein

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7
Q

Where do sinusoids (capillaries) drain?

A

Central vein –> hepatic veins and IVC

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8
Q

Where are bile canaliculi located?

A

Plates of hepatocytes

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9
Q

Where do the bile canaliculi drain?

A

Small bile ducts –> eventually make their way into common bile duct

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10
Q

What are the immune/defense cells that line the sinusoids?

A

Kupffer Cells

Stellate Cells

Pit Cells

Disse Space

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11
Q

What are kupffer cells?

A

Macrophage (phagocytic) cells that line the sinusoids

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12
Q

What is the function of the kupffer cells?

A

Phagocytic cells –> RBC breakdown (bilirubin production)

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13
Q

What is clinically important about kupffer cells?

A

Early response to liver injury/pathology

Responsible for early steps in alcoholic (ethanol) induced injury

1st step in cascade of events leading to fibrosis/cirrhosis

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14
Q

What are stellate cells and where are they located?

A

Contractile cells

Located in perisinusoidal space

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15
Q

When do stellate cells become activated?

A

During pathology –> usually store vitamin A when dormant

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16
Q

What is the function of stellate cells when they become activated?

A

Contraction/relaxation to regulate sinusoidal blood flow

Production of scar tissue (collagen –> fibrosis) in development of cirrhosis

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17
Q

What do pit cells do?

A

Produce interferon and other immune defense substances

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18
Q

Clinically what is the function of pit cells?

A

“First line of defense” against tumor formation

Cytotoxic effect on tumor cells

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19
Q

What is the Disse space?

A

Interstitial space between hepatocytes and sinusoids that drains into lymphatic vesels

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20
Q

Describe the general pathway of bile (start w/ production)

A

Produced in Liver

Secreted into duodenum

Excreted/reabsorbed

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21
Q

What is the pH of bile?

A

7.6 - 8.6

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22
Q

What is bile alkaline?

A

Helps to neutralize stomach acids in duodenum

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23
Q

Describe bile

A

Alkaline, yellow fluid that is made mostly of water

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24
Q

What are the organic compounds found in bile?

A

Bile Salts

Cholesterol

Bilirubin

Phospholipids

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25
What is the major organic compound found in bile?
Bile Salts
26
What are bile salts?
Conjugated bile acids
27
What does bile do?
Emulsifying agent to assist in breakdown of fats for absorption in small intestine and formation of micelles
28
What is bilirubin?
Yellow pigment from RBC (heme portion) degradation
29
Where is bile secreted into initially?
Canaliculi
30
Where do canaliculi eventually drain into?
R/L hepatic duct --> common hepatic duct
31
How much bile will flow into the gall bladder during fasting?
75%
32
What happens to the 25% of bile that doesn't flow into the gall bladder during fasting?
Continue on and flow into the duodenum via common bile duct
33
What happens to the gall bladder during feeding?
Contracts and releases stored bile
34
What stimulates the gall bladder to contract during feeding?
CCK Vagal stimuli
35
What is the name of the sphincter that allows bile to flow during feeding?
Sphincter of Oddi
36
What synthesizes primary bile acid?
Hepatocytes
37
What stimulates bile acid production?
CCK Secretin
38
What is bile acid synthesized from?
Cholesterol **major site of cholestserol metabolism
39
What are bile acids converted into?
Bile salts (they're water soluble)
40
What do bile salts do in the duodenum?
Emulsify fat droplets --> physically arrange them into "micelles"
41
What are micelles?
Clumps (aggregates) of bile salts, fat droplets, fat soluble vitamins, cholesterol and phospholipids Form circle w/ hydrophilic-ends on outside
42
What happens to bile in the ileum/colon?
90% = absorbed and transported back to liver 10% = continue to rectum and are excreted
43
Where are RBCs broken down?
Spleen Liver = Kupffer Cells Throughout Vascular System
44
How is hemoglobin divided during RBC break down?
Globin Heme
45
What is globin further broken down into?
Amino Acids
46
What is heme further broken down into?
Iron --> stored in liver and recycled into new RBCs Bilverdin --> further broken down into bilirubin --> released in plasma
47
What happens to bilirubin in blood plasma?
Attaches to albumin
48
In the blood plasma is bilirubin conjugated or unconjugated?
Unconjugated
49
What happens to the unconjugated bilirubin?
Circulates through hepatocytes in liver and is conjugated --> can be secreted into duodenum or stored in gallbladder
50
What happens to conjugated bilirubin in the duodenum?
Bacteria in intestines "deconjugate" it into urobilinogen
51
What are the 3 pathways that urobilinogen can follow?
Reabsorbed into blood stream --> excreted in urine or recycled in liver Remain in coon and excreted in stool
52
What are normal values of urobilinogen in the urine?
0 - 4 mg/24 hrs
53
What kind of jaundice is increased values of urobilinogen in the urine considered?
Pre-hepatic jaundice
54
What is pre-hepatic jaundice caused by?
Hemolysis --> increased bilirubin production --> increased urobilinogen formation
55
What kind of jaundice is decreased values of urobilinogen in the urine considered?
Post-hepatic jaundice
56
What is post-hepatic jaundice caused by?
Obstruction --> blocks secretion of bile into intestine --> decreased urobilinogen formation Less urobilinogen is reabsorbed into bloodstream for kidney to filter
57
What would your stools look like with post-hepatic jaundice?
Pale
58
What is jaundice (aka icterus)?
Bilirubin pigment causing yellow of skin (tissues) and conjunctival membranes
59
Is jaundice a specific disease/pathology?
NO its a symptom/sign of disease/pathology affecting metabolism/excretion of bilirubin
60
What are the 3 classifications of jaundice?
Pre-hepatic Intra-hepatic Post-hepatic
61
What does it mean for jaundice to be "pre-hepatic"?
Pathology PRIOR to liver --> increased RBC breakdown)
62
What are some diseases that would cause pre-hepatic jaundice?
Genetic diseases: Gilbert's syndrome, sickle cell anemia, thalassemia Kidney Disease
63
What does it mean for jaundice to be "intra-hepatic"?
Pathology located w/in the liver --> liver's ability to conjugate bilirubin is impaired
64
What are some diseases that would cause intra-hepatic jaundice?
Cirrhosis Hepatitis Liver Toxicity
65
What does it mean for jaundice to be "post-hepatic"?
Pathology located AFTER liver --> impaired transport of conjugated bilirubin to GI tract
66
What are some diseases that would cause post-hepatic jaundice?
Gallstones Pancreatic pathology that blocks to bile ducts
67
Can you use lab tests to DDx between classifications of jaundice?
Yes BUT need "whole picture" assessment of all LFTs, urine and stool analysis **each jaundice classification has different lab patterns
68
What does serum bilirubin measure?
Both AMOUNT and TYPE of hyperbilirubinemia --> provide clues to jaundice classification
69
How is total bilirubin measured?
Directly in blood **all 3 types of jaundice can have elevated total bilirubin
70
How is direct (conjugated) bilirubin measured?
Directly in blood **elevated can indicate post or intra-hepatic pathology
71
How is indirect (unconjugated) bilirubin measured?
Calculated from total/direct measurements **if elevated can indicate pre or intra-hepatic pathology
72
What serum enzymes can be measured when analyzing for jaundice?
Alkaline Phosphatase AST ALT LDH GGT
73
What serum proteins can be measured when analyzing for jaundice?
Albumin Globulins A/G ratio transferrin AFP = alpha fetoprotein
74
When looking @ urinalysis for jaundice what are you looking for?
Urobilinogen Conjugated bilirubin Color
75
What would you expect urine and stool to look like with pre-hepatic pathology of jaundice?
Urine = elevated urobilinogen Urine color = normal Stool color = normal
76
What would you expect blood tests to look like with pre-hepatic pathology of jaundice?
Blood: hyperbilirubinemia Total bilirubin = elevated Direct (conjugated) bilirubin = normal/potentially elevated (d/t increased production) Indirect (unconjugated) bilirubin = elevated
77
What would you expect urine and stools to look like with post-hepatic pathology of jaundice?
Urine = dark --> elevated conjugated bilirubin and decreased urobilinogen Stool color = pale --> d/t decrease of urobilinogen
78
What would you expect blood tests to look like with post-hepatic pathology of jaundice?
Blood = hyperbilirubinemia Total bilirubin = elevated Direct (conjugated) bilirubin = elevated --> d/t "congestive back up" Indirect (unconjugated) = normal
79
What would you expect to see in intra-hepatic jaundice pathology?
Decreased uptake --> d/t CHF, drug/meds OR Decreased conjugation in the liver --> neonatal (pysiological), liver dz (hepatitis, cirrhosis), hyperthyroidism
80
What do you expect the labs to look like with intra-hepatic jaundice?
Elevated total bilirubin (d/t elevated conjugated bilirubin) Elevated indirect (unconjugated) bilirubin (d/t congestive back up of indirect (unconjugated bilirubin in the blood stream) Elevated direct (conjugated) bilirubin (d/t congestive hepatic "back-up")
81
What will urine and stool samples look like in intra-hepatic jaundice?
Urine: increased conjugated bilirubin; normal or low urobilinogen Urine Color = dark Stool color = normal (no decrease of urobilinogen in stools

Patho Summer Test #1 (8 decks)

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