GI IV

Question 1

Glisson’s capsule

Answer 1

fibrous CT
made of type III collagen (reticular) fibers
richly innervated
deep to visceral peritoneum

Question 2

______ fibers from Glisson’s capsule penetrate into the liver ________

Answer 2

reticular

parenchyma

Question 3

Classic hepatic lobule

Answer 3

hexagonal plate of hepatocytes and sinusoids

Question 4

Portal canal

Answer 4

3-6 found at the angles

Question 5

What does the portal canal contain?

Answer 5

CT
portal triad
lymphatic vessels
autonomic nerve fibers

Question 6

What are the branches of the portal triad?

Answer 6

hepatic artery
portal vein
bile duct

Question 7

Periportal space (space of Mall)

Answer 7

area between the hepatic lobule and the portal triad

believed to originate from lymphatics

Question 8

Can’t see well defined borders of the liver lobule because it lacks _____

Answer 8

developed CT

Question 9

What is the blood supply of the liver?

Answer 9

portal vein (75%)
hepatic artery proper (25%)

Question 10

Portal vein

Answer 10

• blood enters lobule via inlet venule
• inlet venule dumps into hepatic sinusoidal capillaries between hepatocytes
• rich in nutrients from GI tube

Question 11

hepatic artery proper

Answer 11

• blood enters lobule via arteriosinusoidal branch
• arteriosinusoidal branch dumps into hepatic sinusoidal capillaries between hepatocytes
• rich in oxygen

Question 12

Kupffer cells

Answer 12

phagocytes cells that remove pathogens from blood
also remove worn out RBCs
cause internal volume of RBCs to decline

Question 13

Space of Disse (perisinusoidal space)

Answer 13

space between epithelial cells and hepatocyte cytoplasm
occupied by numerous hepatocyte microvilli
also contains hepatic stellate cell

Question 14

Hepatic Stellate cell

Answer 14

signature feature is large lipid droplet

vitamin A stored here

Question 15

Hepatic acinus

Answer 15

diamound shaped area
extends from a central vein to a hepatic canal to another, adjacent central vein to a second hepatic canal then back to the original central vein

Question 16

What are the zones of the hepatic acinus and which is most susceptible to damage?

Answer 16

1, 2, 3

3 is most susceptible

Question 17

Zone 1

Answer 17

closest to blood supply
has more oxygen and extrahepatic hormones
has more enzymes for glucose liberating and fatty-acid-oxidation

Question 18

Zone 3

Answer 18

closest to central vein

has more enzymes for glycolysis, fatty acid synthesis, and detoxidifcation

Question 19

Organelles in hepatocytes

Answer 19

rER for protein synthesis
sER for detox
mitochondria to provide fuel

Question 20

Protein synthesis and carbohydrate storage require what?

Answer 20

a well developed rER

Question 21

What happens to colloid osmotic pressure and blood clotting with severe liver injury

Answer 21

edema (because of less albumin)

longer clotting time (because of less clotting factors)

Question 22

Unconjugated (indirect) bilirubin

Answer 22

water insoluble

released from lysed RBCs

Question 23

conjugated (direct) bilirubin

Answer 23

what you get after liver modifies the unconjugated bilirubin to make it soluble

Question 24

Dubin Johnson Syndrome

Answer 24

defect in MDR-2
pt presents with elevated levels of direct bilirubin
relatively benign

Question 25

Gilbert Syndrome

Answer 25

``` decreased conjugation (by UGT1A1) benign condition ```

Question 26

Type I crigler-najjar syndrome and neonatal hyper-bilirubinemia

Answer 26

absent conjugation | fatal

Question 27

Type II crigler-najjar syndrome and neonatal hyper-bilirubinemia

Answer 27

decreased conjugation | can be benign

Question 28

Alcoholic liver disease

Answer 28

fatty liver | damage is reversible

Question 29

Alcoholic cirrhosis

Answer 29

irreversible liver has a bunch of nodules liver is highly dysfunctional

Question 30

Stellate cells

Answer 30

normally dormant injury/insult activates it and makes it start to proliferate become contractile/constrict blood flow

Question 31

Bile canaliculus

Answer 31

formed by membranes of hepatocytes | beginning portion of the bile collecting system

Question 32

Canal of Hering

Answer 32

stem cell niche | lined by cholangiocytes and hepatocytes

Question 33

Periductular null cells

Answer 33

sit in the periportal space | can regenerate liver cells

Question 34

Layers of a normal gallbladder

Answer 34

mucosa (epithelium, BL, and lamina propria) muscularis CT layer of serosa/adventitia

Question 35

Hallmark feature of inflamed gallbladder

Answer 35

purple specks that are inflammatory cells

Question 36

Cholesterolosis

Answer 36

elevated cholesterol levels leading to formation of foam cells in gallbladder benign, reversible

Question 37

What do acinar cells in the exocrine pancreas secrete?

Answer 37

enzymes

Question 38

What do ductal cells in the exocrine pancreas secrete?

Answer 38

water and ions (HCO3-)

Question 39

Acute pancreatitis

Answer 39

enlarged pancreas with shaggy margins peripancreatic fat infiltration elevated serum amylase and lipase