Hepatobiliary System Lecture Powerpoint

Question 1

Liver borders

Answer 1

Superior - diaphragm
Lateral and anterior - rib cage
Medial - crosses into left upper quadrant
Inferior - gall bladder

Question 2

How does the liver allow for living donor transplants?

Answer 2

Because it is divided into 8 functionally independent segments each with own vascular in and outflow

Question 3

Falciform ligament

Answer 3

Infolding of mesentary that separtes right and left lobes of livers suspending it from the diaphragm and anterior abdominal wall

Question 4

Round ligament of the liver

Answer 4

Fibrous remains of fetal umbilical vein, travels inferiorally from in between the right and left lobes to the umbilicus

Question 5

Lesser omentum

Answer 5

Small piece of double layer peritoneum that anchors liver to lesser curvature of stomach

Question 6

Visceral peritoneum

Answer 6

Covers entire liver except for superior bare area of liver

Question 7

Bare area of the liver

Answer 7

Superior diaphragmatic triangular portion of the liver containing portacaval anastamoses where infection can spread to the thoracic cavity

Question 8

Hepatic portal vein

Answer 8

Derived from: merging of splenic and superior mesenteric veins
Travels to the liver receiving branches from gastric and cystic veins before bifurcating and entering
Empties into: hepatic veins

Question 9

Hepatic veins

Answer 9

Derived from: hepatic portal vein
Travels throughout the liver to filter and remove toxins
Empties into the inferior vena cava

Question 10

Splenic vein

Answer 10

Derived from: the spleen
Travels toward the liver, receiving blood supply from inferior mesenteric vein
Drains into: hepatic portal vein

Question 11

Gastric vein

Answer 11

Derived from: stomach
Travels toward the liver
Empties into the hepatic portal vein shortly before it bifurcates

Question 12

Cystic vein

Answer 12

Derived from: the gall bladder
Travels toward the liver
Empties into the heppatic portal vein shortly after it bifurcates

Question 13

Superior mesenteric vein

Answer 13

Derived from: The small intestine
Travels toward the liver
Empties into the hepatic portal vein after merging with the splenic vein

Question 14

Inferior mesenteric vein

Answer 14

Derived from: Large intestine
Travels toward the liver
Empties into the splenic vein superiorally

Question 15

Hepatic portal vein carries ___ of hepatic blood supply, the hepatic artery carries ___

Answer 15

75%, 25%

Question 16

Hepatic artery

Answer 16

Derived from: celiac trunk artery

Travels giving off the gastroduodenal artery before supplying the liver

Question 17

Hepatic hypertension can manifest as distally as….

Answer 17

….rectal hemorroids

Question 18

Biliary canuliculi

Answer 18

Projections off hepatocytes that collect bile excreted by hepatocytes to eventually enter the common hepatic duct

Question 19

Bilirubin

Answer 19

Breakdown product of red blood cell degradation, gives a yellow coloration

Question 20

Common hepatic duct

Answer 20

Product of bile canaliculi from hepatocytes within the liver converging, exits the inferior base of the liver before merging with the common cystic duct to form the common bile duct

Question 21

Common cystic duct

Answer 21

Derived from the gall bladder, connects to the common hepatic duct to form the common bile duct

Question 22

Gall bladder

Answer 22

Accessory organ used to store and concentrate bile, contracts via smooth muscle layer in response to lipid presence in intestine to promote emulsification, if removed can see difficutly digesting fatty meals

Question 23

Common bile duct

Answer 23

Formed from the combination of the common cystic duct and common hepatic duct, receives branch from pancreatic duct before exiting at the spincter of Oddi in the duodenum

Question 24

Pancreatic duct

Answer 24

Releases exocrine secretions from the pancreas into the common bile duct to exit via sphincter of Oddi

Question 25

CCK mechanism of action

Answer 25

- Stimulated for release by chyme entering duodenum - enters blood stream - Induces secretion of pancreatic enzymes - Induces gallbladder contracttion

Question 26

Secretin mechanism of action

Answer 26

- Release by chyme entering duodenum - enters blood stream - Induces secretion of pancreatic bicarbonate

Question 27

An obstruction in sphincter of Oddi often causes....

Answer 27

pancreatitis

Question 28

Portal triad

Answer 28

Groups of hepatic artery, hepatic portal vein, and hepatic duct that sit at corners of lobules in the liver

Question 29

Central vein

Answer 29

Drainage structure that eventually combines into the vena cava after receiving blood flow from hepatic sinusoids in a lobule as they are modified by hepatocytes

Question 30

Hepatic sinusoids

Answer 30

Paths that blood flows from hepatic veins and hepatic arteries before draining into a central vein where it is filtered by hepatocytes

Question 31

Pathway of blood flow generally to the liver

Answer 31

- hepatic portal vein and hepatic artery - hepatic sinusoids - central veins - hepatic veins - inferior vena cava

Question 32

Space of disse

Answer 32

Space between hepatocyte and a sinusoid that allows for proteins to be absorbed by microvilli from the hepatocytes

Question 33

Kupffer cells and their 4 key functions

Answer 33

Liver macrophages 1) RBC destruction 2) Antibody production aid 3) phagocytosis 4) cause early ETOH induced liver injury

Question 34

11 Liver functions

Answer 34

- produce bile salts - eliminate bilirubin - metabolize steroid hormones - metabolize drugs - meetabolize fat - metabolize protein - metabolize carb - recycling vitamins - remove bacteria - coagulation factors - produce urea

Question 35

RBC breeakdown pathway

Answer 35

- RBC to hemoglobin in spleen or kupfer cells - Globin recylced in liver - Heme digested to iron and bilirubin - Iron turned to storage form (ferritin) - Bilirubin enters liver

Question 36

Bile components

Answer 36

-Bile acids -cholesterol bilirubin -electrolytes 0water

Question 37

Unconjugated bilirubin (indirect bilirubin)

Answer 37

Bound to albumin, water insoluble but fat soluble, typically calculated and not measured

Question 38

Conjugated bilirubin (direct bilirubin)

Answer 38

In the hepatocyte, Water soluble, can be measured via liver function test

Question 39

Total bilirubin =

Answer 39

Direct + indirect

Question 40

Excess not reasorbed conjugated bilirubin is converted by bacteria into...

Answer 40

...urobilinogen (if reabsorbed gives urine yellow color, most exits into colon giving feces brown color)

Question 41

Kernicterus

Answer 41

High levels of bilirubin buildup in babies causing neurological problems

Question 42

3 types of jaundice

Answer 42

Prehepatic - excessive hemolysis of RBC Intrahepatic - affect ability of liver to remove or conjugate bilirubin Posthepatic - obstruction between liver and intestine

Question 43

Absorptive state characteristics

Answer 43

- Glucose to glycogen - Excess becomes triglycerides - amino acids to protein syntehsis

Question 44

Postabsorptive state characteristics

Answer 44

- Glycogenolysis - Gluconeogenesis - Ketogenesis

Question 45

Urea formation in liver

Answer 45

Ammonia conversion via combination with CO2

Question 46

Common liver function test in response to alcohol abuse

Answer 46

GGT

Question 47

Portal hypertension

Answer 47

Occurs when portal blood cannot flow thru liver increasing pressure in portal vasculature

Question 48

Hepatorenal syndrome

Answer 48

Tendency for cirrhosis of the liver to cause compromising of circulation to abdominal vessels, sometimes disrupting renal blood supply leading to renal failure

Question 49

3 alcohol metabolizing systems in the liver

Answer 49

1) alcohol dehydrogenase (ADH) system in cytoplasm 2) Microsomal ethanol oxidizing system (MEOS) in ER 3) Catalase in peroxisomes