Liver

Question 1

Which structure is responsible for eliminating bacteria from the liver?
a. Kupffer cell
b. canaliculus
c. sinusoid
d. acinus

Answer 1

a. Kuppfer cell

Question 2

The largest internal organ is the

Answer 2

liver

Question 3

the functional unit of the liver is

Answer 3

the lobule

Question 4

__________- is another way to functionally classify liver tissue.

Answer 4

Acinus

Question 5

The acinus encompasses the liver tissue that is served by

Answer 5

a single terminal branch of the hepatic artery

Question 6

______________ in the acinus are organized into zones according to their proximity to the portal triad and central vein.

Answer 6

Hepatocytes

Question 7

__________________ are the most susceptible to ischemic injury

Answer 7

Hepatocytes in zone 3

Question 8

______________ remove bacteria from the portal blood before the blood enters the systemic circulation

Answer 8

Kuppfer cells

Question 9

Bile is produced by the ________ and stored in the ________

Answer 9

hepatocytes; gallbladder

Question 10

What is the specific path that bile follows?

Answer 10

canaliculi–> bile duct–> common hepatic duct–> common bile duct–> ampulla of Vater–> duodenum

Question 11

Lymph and proteins drain into __________ before they empty into the lymphatic duct

Answer 11

space of Disse

Question 12

___________ is a connective tissue covering that encapsulates the liver along with parts of the hepatic artery, portal vein, and bile ducts.

Answer 12

Glisson’s capsule

Question 13

What ligaments attach to the anterior abdominal wall attachments?

Answer 13

falciform and round ligaments

Question 14

What ligaments attach to the diaphragmatic attachments?

Answer 14

coronary ligament and triangular ligaments

Question 15

The liver receives SNS innervation from

Answer 15

T3-T11

Question 16

A lobule is hexagonal in cross section with (how many veins)?

Answer 16

a central vein at its center and portal veins at its six corners

Question 17

Sinusoids can be compared to

Answer 17

capillaries (serve this function)

Question 18

The arterioles of the liver are the

Answer 18

hepatic artery and portal vein

Question 19

The acinus is divided into 3 zones that correspond to the

Answer 19

distance from the arterial oxygen supply (portal triad)

Question 20

The highest concentration of CYP450 enzymes is in

Answer 20

zone 3

Question 21

The _______ controls the flow of bile released from the common hepatic duct.

Answer 21

sphincter of Oddi

Question 22

What are the 3 functions of bile?

Answer 22

1. absorption of fat and fat-soluble vitamins
2. excretory pathway for bilirubin and products of metabolism
3. alkalization of the duodenum

Question 23

Eating fat and protein increases release of ______________________; which stimulates _______ contraction & increases the flow of bile into the duodenum

Answer 23

Cholecystokinin; gallbladder

Question 24

Which statement MOST accurately describes hepatic perfusion?
a. the hepatic artery provides 75% of liver blood flow
b. the portal vein provides 50% of liver blood flow
c. the hepatic artery provides 75% of the liver’s oxygen content
d. the portal vein provides 50% of the liver’s oxygen content

Answer 24

d. the portal vein provides 50% of the liver’s oxygen content

Question 25

The liver receives about _______ of the cardiac output via a dual blood supply

Answer 25

30%

Question 26

The portal vein provides _______ of the total liver blood flow and provides ____ of the liver's oxygen supply

Answer 26

75%; 50%

Question 27

The hepatic artery provides __ of the total liver blood flow and provides _____ of the liver's oxygen supply.

Answer 27

25%; 50%

Question 28

Is portal blood flow autoregulated?

Answer 28

Nope

Question 29

Increased splanchnic vascular resistance ____________ portal vein flow

Answer 29

reduces

Question 30

When there's a reduction in portal vein blood flow, the hepatic arterial buffer response compensates by

Answer 30

increasing flow through the hepatic artery

Question 31

_________________ impairs the response of the hepatic arterial compensation

Answer 31

severe liver disease; makes the diseased liver even more susceptible to hypoperfusion

Question 32

_________ and ____________- reduce MAP and cardiac output which can reduce liver blood flow in a dose-dependent fashion.

Answer 32

Both general and neuraxial

Question 33

The liver receives a dual blood supply from the

Answer 33

portal vein and hepatic artery

Question 34

The following can increase splanchnic vascular resistance and decrease portal vein blood flow

Answer 34

SNS stimulation pain hypoxia hypercarbia

Question 35

Portal perfusion pressure is calculated by

Answer 35

Portal perfusion pressure= portal vein pressure- hepatic vein pressure

Question 36

Normal portal vein pressure is

Answer 36

7-10 mmHg

Question 37

Portal vein pressure of ____-- is diagnostic for portal HTN

Answer 37

>20-30 mmHg

Question 38

Normal sinusoid pressure is

Answer 38

0 mmHg

Question 39

Sinusoid pressure of __________ is diagnostic for portal HTN

Answer 39

>5 mmHg

Question 40

Portal hypertension reduces blood flow through the liver which produces back pressure to the following splanchnic organs:

Answer 40

vascular engorgement--> splenomegaly, & varices of the esophagus, stomach, & intestine

Question 41

Additional physiologic consequences of portal hypertension include

Answer 41

ascites, spider angiomas, hemorrhoids, and encephalopathy

Question 42

Perioperative factors that reduce liver blood flow include:

Answer 42

increased splanchnic vascular resistance (SNS stimulation, pain, hypoxia) things that increase CVP (PPV, excessive hydration, & CHF) some beta-blockers (propranolol) intraabdominal surgical procedures (surgical retraction and release of vasoactive substances) laparoscopic surgery (pneumoperitoneum)

Question 43

The celiac artery provides blood flow to which 3 organs?

Answer 43

liver spleen stomach

Question 44

The superior mesenteric artery provides blood flow to which 3 organs?

Answer 44

pancreas small intestine colon

Question 45

Name 1 organ that receives blood flow from the inferior mesenteric artery.

Answer 45

colon