Hepatobiliary Function

Question 1

Main functions of the liver?

Answer 1

Bile production and secretion
Metabolism
Bilirubin production and secretion
Detoxification of substances

Question 2

What does the liver convert to urea?

Answer 2

Ammonia

Question 3

Liver failure can result in _______ that results in edema

Answer 3

Hypoalbuminemia

Question 4

The portal vein brings nutrient rich blood to the liver from what sources?

Answer 4

Colon
Small intestine
Pancreas
Stomach
Spleen

Question 5

Cirrhosis

Answer 5

Chronic liver disease where liver cells are damaged and replaced with scar tissue

Question 6

What is the most common cause of cirrhosis?

Answer 6

Excessive alcohol consumption

Question 7

Excessive alcohol consumption causes what to accumulate in the hepatocytes?

Answer 7

Fat

Question 8

If fat is deposited in hepatocytes, what can it lead to?

Answer 8

Steatohepatitis - fatty liver that leads to inflammation, scarring and cirrhosis

Question 9

Excessive alcohol consumption causes fat to deposit in the liver cells. What can this ultimately result in?

Answer 9

Cirrhosis - damage of liver cells and formation of scar tissue

Question 10

What can cause portal hypertension?

Answer 10

Cirrhosis

Question 11

Portal hypertension

Answer 11

Resistance to portal blood flow

Question 12

2 signs that portal hypertension is present

Answer 12

1. Esophageal varices

2. Caput medusae

Question 13

Esophageal varices

Answer 13

Swollen connections between systemic and portal systems at inferior end of esophagus - seen with portal hypertension, resistance to blood flow

Question 14

Caput medusae

Answer 14

Swollen connections between systemic and portal systems around umbilicus - seen with portal hypertension, resistance to blood flow

Question 15

What can lead to hepatic encephalopathy?

Answer 15

Liver dysfunction

Question 16

Cirrhosis or portal hypertension can result in a ______ hepatic urea cycle

Answer 16

DECREASED

Question 17

If the urea cycle is not occurring, what is building up in the systemic blood?

Answer 17

Ammonia

Question 18

Accumulation of ammonia can do what?

Answer 18

It crosses the blood brain barrier and ALTERS BRAIN FUNCTION

Question 19

Main things that bile is composed of?

Answer 19

Cholesterol
Bile acids and bile salts
Phospholipids
Ions and water

Question 20

Bile makes lipids?

Answer 20

Soluble

Question 21

Once concentrated bile is released from the liver, what stimuli can cause absorption of ions and water to it to dilute it and increase the volume?

Answer 21

Secretin

Question 22

What stimuli causes gallbladder contraction and sphincter of oddi relaxation to successfully secrete bile into the duodenum in response to food?

Answer 22

CCK

Question 23

Where are bile acids absorbed for reuse?

Answer 23

Ileum

Question 24

The recycled bile acids are actively secreted into?

Answer 24

Bile canaliculi along with the newly synthesized bile acids

Question 25

What 2 stimuli stimulate bile secretion?

Answer 25

1. Bile acids drive bile formation | 2. Secretin (small portion)

Question 26

As the liver secretes bile acids, it is accompanied by?

Answer 26

Passive movement of cations (+)

Question 27

Secretin stimulates bile excretion from?

Answer 27

Ductile cells

Question 28

Secretin activates the release of what from ductile cells into the bile?

Answer 28

HCO3- Water Na+

Question 29

Describe what happens with bile secretion during the interdigestive period while you are not eating

Answer 29

The gallbladder is filling and is relaxed | The sphincter of Oddi into the duodenum is contracted and closed

Question 30

Describe what happens with bile secretion during eating

Answer 30

CCK mediates: - gallbladder contraction to empty contents - Relaxation and opening of the sphincter of Oddi to allow bile into the duodenum

Question 31

Bile salts are sent from the ileum into _____ to go back to the liver for reuse

Answer 31

Portal blood (enterohepatic circulation)

Question 32

Hepatocytes uptake bile salts across the basolateral membrane using what 2 transporters?

Answer 32

1. NTCP - Na+ dependent | 2. OATP - Na+ independent

Question 33

What transporter on the enterocyte in the ileum absorbs bile acids?

Answer 33

ASBT - with Na+

Question 34

What transporter on the enterocyte in the ileum sends bile acids into enterohepatic circulation?

Answer 34

OSTalpha-OSTbeta

Question 35

The hepatocytes use what 2 transporters to absorb bile acids from the portal circulation?

Answer 35

NTCP and OATP

Question 36

What 2 transporters use ATP to help pump bile acids back into the bile canaliculi?

Answer 36

BSEP | MRP2

Question 37

7alpha - hydroxylase is inhibited by?

Answer 37

Bile salts | - As they return via portal circulation to the liver, they inhibit their own formation!

Question 38

Red blood cell (RBC) breakdown in the bloodstream creates?

Answer 38

Bilirubin-Albumin complex

Question 39

Bilirubin is then sent to the liver for uptake. What enzyme is required to convert bilirubin to its conjugated form?

Answer 39

UDP-glucuronyltransferase

Question 40

If a neonate has some jaundice right after birth, why could that be?

Answer 40

UDP-glucuronyltransferase takes some time to develop OR Bilirubin production is high due to fetal RBCs breaking down

Question 41

If the liver cannot take bilirubin to its conjugated form, what will result?

Answer 41

UNconjugated hyperbilirubinemia

Question 42

If the liver can take bilirubin to its conjugated form, where does it send it?

Answer 42

Into the bile to go to the small intestine

Question 43

As conjugated bilirubin is sent into the small intestine, what is it changed to in the colon?

Answer 43

Urobilin and stercobilin

Question 44

What gives stool its dark color?

Answer 44

Urobilin and stercobilin (conjugated bilirubin break down in the colon)

Question 45

Direct bilirubin

Answer 45

Conjugated

Question 46

Indirect bilirubin

Answer 46

UNconjugated

Question 47

Jaundice is due to?

Answer 47

Hyperbilirubinemia

Question 48

Hemolytic anemia

Answer 48

Increased RBC breakdown = increased UNCONJUGATED bilirubin

Question 49

Neonatal jaundice has increased?

Answer 49

UNCONJUGATED bilirubin

Question 50

Gilbert's syndrome has increased?

Answer 50

UNCONJUGATED bilirubin

Question 51

Crigler - Najjar syndrome has increased?

Answer 51

UNCONJUGATED bilirubin

Question 52

Dubin - Johnson has increased?

Answer 52

Conjugated bilirubin

Question 53

Rotor's syndrome has increased?

Answer 53

Conjugated bilirubin

Question 54

If there is a buildup of conjugated bilirubin, what is the problem?

Answer 54

The liver can convert bilirubin to it's conjugated form but cannot excrete it into the bile

Question 55

Primary therapy for neonates with UNconjugated hyperbilirubinemia?

Answer 55

Phototherapy

Question 56

Phototherapy should be used if total serum bilirubin is above?

Answer 56

21

Question 57

2 things that can cause gallstones?

Answer 57

1. Excess pigment of bilirubin breakdown | 2. Excess cholesterol

Question 58

Excess pigment of bilirubin breakdown can be seen with what disease?

Answer 58

Hemolytic anemia

Question 59

Obstruction of cystic duct, intermittent pain

Answer 59

Cholecystitis

Question 60

Gallstone occluding common bile duct

Answer 60

Choledocholithiasis

Question 61

Choledocholithiasis can result in what symptoms?

Answer 61

Jaundice and Hyperbilirubinemia

Question 62

Cholangitis

Answer 62

Infection of bile duct

Question 63

Hepatocyte injury levels of ALT or AST

Answer 63

Increased

Question 64

Bile duct injury lab value

Answer 64

Increased alkaline phosphatase

Question 65

Albumin levels fall as?

Answer 65

Liver function declines, such as cirrhosis

Question 66

PT levels increase as the liver decreases?

Answer 66

Production of clotting factors