Liver

Question 1

Describe the path of the portal vein

Answer 1

Drains nutrient rich blood from the gut into the liver to be filtered

Question 2

Which vein does the filtered blood leave the liver through

Answer 2

Hepatic vein

Question 3

Location of the liver in the body

Answer 3

Upper Right sextant of the abdominal cavity, directly underneath diaphragm

Question 4

what blood vessel supplies the liver itself

Answer 4

Hepatic artery

Question 5

Name the structure that filtration happens in

Answer 5

Acini (which are arranged in groups of 6 to create a liver lobule)

Question 6

How is blood filtered in the kidneys

Answer 6

Blood enters acini through portal tract, travels down low-pressure sinusoid pathways, exits through hepatic vein

Question 7

what is the product created in the liver from the breakdown of red blood cells

Answer 7

Bilirubin

Question 8

name 3 exocrine functions of the liver

Answer 8

excretion of bilirubin
creation of bile salts
synthesise cholesterol

Question 9

why do drugs need to be metabolised in the liver before going to the kidney?

Answer 9

• drugs are bound with plasma proteins to be transported in blood, these are too large for kidney filtration
• a fat-soluble drug will be able to diffuse right back through the membrane back into the blood

Question 10

what is first pass metabolism

Answer 10

the drug passes through an organ, and gets altered on use/exit so it leaves the organ deactivated (lidocaine first pass in gut so it won’t work orally)

Question 11

explain interaction with warfarin and Cytochrome P450

Answer 11

group of enzymes, warfarin is metabolised by Cyt P450

Question 12

Name 3 things that can impact Cyt P450 and what drug this can interact with

Answer 12

Interacts with WARFARIN
- Erythromycin inhibits CytP450, which would cause less warfarin breakdown than expected (INR spikes)
- Miconazole inhibits CytP450
- Grapefruit juice enhances CytP450

Question 13

Name mechanical causes of liver disease

Answer 13

Portal hypertension, abnormal enlarged veins in oesophagus, ascites (fluid collects in abdomen)

Question 14

What is Dupuytren’s contracture?

Answer 14

contraction and thickening of fascia in palm of hand, causing contraction and paralysis of ring and little finger - sign of alcohol related liver disease

Question 15

Signs and Symptoms of liver disease

Answer 15

• Jaundice (body stops being able to break down bilirubin, you go yellow)
• finger clubbing
• Dupuytren’s contracture
• Gynecomastia (interferences with sex hormones)
• Sialosis (bilateral smooth salivary gland swelling)

Question 16

Causes of Acute Liver Disease

Answer 16

Extreme alcohol consumption, drugs, infections (esp hepatitis)

Question 17

what happens to the liver in chronic liver disease

Answer 17

cirrhosis

Question 18

how does alcohol destroy the liver

Answer 18

ethanol metabolised acetaldehyde (highly reactive, toxic, kills hepatocytes) before being broken down again into acetate

Question 19

How does metabolism of paracetamol work

Answer 19

in a small proportions, around 5% will be metabolised into toxic metabolites, which you can cope with
in an overdose, you oversaturate the non-toxic reaction pathways, forcing it to be metabolised into the highly reactive toxic metabolite killing hepatocytes

Question 20

Signs and symptoms of hepatitis

Answer 20

abdominal pain UR abdomen, fever, jaundice, pale bowel motions, dark urine, itchy skin

Question 21

How do you manage liver disease preventatively

Answer 21

Prevention: hepatitis vaccination, reduce alcohol, limit paracetamol usage

Question 22

How do you manage liver disease

Answer 22

large supportive - manage nutrition, drug choice, try to optimise remaining function
liver transplant
nutrition - need ways to get the right amount of fat-soluble vitamins into pt

Question 23

What is the function of the pancreas

Answer 23

Exocrine: secretes digestive enzymes produced by acini, secreted as pro-enzymes then converted in duodenum

Question 24

why does the pancreas secrete ___-enzymes?

Answer 24

Pre-enzymes, otherwise the digestive enzymes would eat through the pancreas itself

Question 25

What is the endocrine function of the pancreas?

Answer 25

Insulin, glucagon, somatostatins to regulate blood glucose levels

Question 26

How can gall stones cause pancreatitis?

Answer 26

Liver, gall bladder, pancreas all drain into duodenum through common bile duct stones from gall bladder obstructing the common bile duct will obstruct pancreas, no path for pro-enzymes, some can get activated and cause auto-digestion

Question 27

Risk factors for pancreatitis

Answer 27

Trauma, gall stones, diabetes, gall bladder surgery, alcohol, pancreatic cancer

Question 28

Signs and symptoms for pancreatitis

Answer 28

severe upper abdominal pain > radiating to back vomiting, weight loss, jaundice, increased serum amylase

Question 29

Management of pancreatitis

Answer 29

Fluids, antibiotics if necessary, correct glucose/electrolyte imbalance, surgery if necessary to remove physical obstruction

Question 30

how can gallstone appear

Answer 30

cholesterol deposits in the gall bladder calcification of salts

Question 31

Risk factors for gallstones

Answer 31

old age, F>M, high BMI, rich people, high fat diet

Question 32

Signs of gallbladder disease

Answer 32

(only really become systematic if obstruct drainage) abdominal URQ pain, pain worse at mealtimes, nausea/vomiting, fever, jaundice

Question 33

Management of gall stones

Answer 33

stopping high-fat diet, treat acute infection, cholecystectomy (removal of gall bladder)