Liver Flashcards
(28 cards)
Hepatic Portal Circulation:
Vein located btw 2 capillary beds. The ___ collects blood from capillaries in visceral structures located in the abdomen & empties into the liver. Hepatic veins return blood to the ___.
- Hepatic Portal Vein
- IVC
Some bacteria will sneak out of the large intestine & go to the liver, liver will destroy = ___ will eat the bacteria (macrophages).
Kupffer cells
Make ___ when we do gluconeogenesis, atom an amino acid that is not on a glucose is ___. Need to get rid of the ___ no matter what amino acid we are using, this becomes an ___. Liver will take ammonia (+ammonia + CO2) & make ___. Kidney is going to secrete this ___ into the lumen as a buffer for acid. We should essentially have no ___ in our blood. If liver not converting ammonia into urea it means the liver is not functioning ok and ammonia will build up. Other toxins will also build up as well. ___ will cross BBB & will have effects on the brain.
- ammonia
- nitrogen
- nitrogen
- ammonia
- urea
- ammonia
- ammonia
- Ammonia
Equation to determine Unconjugated Bilirubin?
Unconjugated = Total -Direct
Bile cannaliculi btw hepatocytes which ultimately leads to bile ducts > hepatic ducts etc. If the hepatocyte can’t dump stuff in, canaliculus will get really large & eventually the bile ducts will die, new bile ducts will be made but they won’t work any better because clog is still present. All of the wastes the hepatocytes you are trying to get rid of will build up and eventually cause the cell to die because it can’t get rid of them?
Cholestasis
*Sudden & massive hepatic dysfunction?
-Often end point of progressive ___
- ___-___ of liver function must be lost
-Life threatening (multiple organ failure)
~Special Problems include = ??
*Hepatic Failure
-liver damage
-80-90%
~Hepatic encephalopathy, Hepatorenal syndrome
Hepatic Failure:
~ ___ = causes severe hepatocyte damage > enough damage will cause you to go into hepatic failure (this takes about a week to occur, a week to see of patient will die or survive).
~The more liver you damage the more liver you lose, and the more at risk the remaining portion of the liver is. Ex: accidental acetaminophen overdose
~Acetaminophen overdose
___ impairs blood flow through the liver & causes ___.
*Don’t need to increase portal vein pressure very much before you start to see problems. Low resistance circuit, not a lot of driving pressure.
Cirrhosis
Hepatic Portal HTN
- Cirrhosis impairs blood flow through the liver & causes hepatic portal hypertension which causes:
1) ?
2) Portosystemic Shunts = ???
3) ?
1) Ascites (edema of the abdomen)
2) esophageal varices, hemorrhoids, caput medusae
3) Splenomegaly
These are typically self limiting, 2-8 week incubation ??
- Do not cause carrier state.
- Do not cause chronic hepatitis.
- Do not cause cancer.
- Transmission?
- Present in the US?
Hepatitis A & E
- oral transmission
- not usually present in US
Common childhood disease in developing countries.
Adult infection more dangerous.
Sporadic infections (associated with oysters).
Hepatitis A virus
Sporadic infections are rare.
Typically endemic and seen in travelers.
High (20%) mortality rate in pregnant women.
***Only have vaccines for ?
Hepatitis E virus
***Vaccines only available for Hepatitis A & B
Cause a carrier state. Cause chronic hepatitis. (carrier state slowly chewing away at your liver) Cause cancer. -Transmission? -Present in US?
Hepatitis B, C, D Virus
- Parenteral transmission (sex & needles)
- Yes they are present in the US
- Both __ & ___ increase the rate of liver cancer.
- ___ can only survive in a cell that also has ___. Can either get both infections at once, or can have ___ & then get ___. If vaccinated against ___, will never get ___.
- Hepatitis B & C
- Hepatitis D
- Hepatitis B
- B & then D
- Hepatitis B
- Hepatitis D
Fat droplets inside the hepatocytes, the liver cells have taken up the alcohol, and patched these into lipoproteins (typically VLDL). Because of high alcohol content, the cells have been impaired and now can’t make lipoproteins. If you stop drinking cells will slowly get rid of this stuff and will slowly recover. This is known as?
Hepatic Steatosis (Fatty Liver)
Hepatic Steatosis is on the road to ?
Alcoholic Liver Disease
Alcoholic Liver Disease:
1) ___ (90-100% of alcoholics end up with this)
2) ___ (10-35% of alcoholics end up with this)
3) ___ (8-20% of alcoholics end up with this)
1) Hepatic steatosis (reversible)
2) Alcoholic hepatitis (reversible)
3) Cirrhosis (irreversible)
*Alcoholic Liver Disease
~Lots of cases of ___. Every time you do this your injuring the liver and if you do this often enough eventually will end up with ___. This is now irreversible.
~Or can get ___, which is reversible (can get an acute form of this from drinking too much alcohol, if you do enough of this will end up with __).
- Hepatic steatosis
- Cirrhosis
- Alcoholic hepatitis
- Cirrhosis
With this will see diffuse nodularity of the liver surface induced by underlying fibrous scarring?
*Blood flow through this will be greatly impaired, liver is extremely vascular and under normal conditions has very low resistance hence blood flow greatly impaired. Yellow from jaundice from bilirubin, lumps from collagen, green from the bile.
Alcoholic Cirrhosis
Uncontrolled uptake of iron?
*Stored iron largely in liver (not a lot of iron in storage). One of the problems with iron is we have no way of getting rid of iron (can’t pee it out because it is bound to protein, don’t sweat it out, don’t exhale it). We regulate our iron content by uptake. The only way we can get rid of iron is from bleeding.
Hemochromatosis
Impaired outflow = with this, liver will sense increased right atrial pressure before any one else (except for the feet)?
Right-sided HF
Arise from hepatocytes (will see a large neoplasm, unifocal)?
- Most of the liver cancer you will ever see will be secondary, liver is primary spot for metastasis. This can be from high BF going to the liver. Any cancer of the GI tract going straight to the liver and just happens to be a happy place for the cancer cells to land.
- How do you tell the difference btw Primary & Secondary?
- Hepatocellular Carcinoma (Primary carcinoma of the liver)
- Primary = one big tumor
- Secondary = lots of little tumors (metastasis)
*Hepatocellular Carcinoma (Primary carcinoma of the liver)
Caused by:
1) ___ (the longer you carry it, the more likely you will get cancer-China)
2) Chronic liver disease (___ & ___)
3) ___ (mold on peanuts, strong carcinogen)
4) Tyrosinemia (rare, but 40% get HCC)
5) ___ (85-90%, not necessarily the cause)
1) Hepatitis B Virus
2) Hepatitis C Virus & alcohol
3) Aflatoxin
5) Cirrhosis
- Hepatocellular Carcinoma (Primary carcinoma of the liver)
- Early ___ gives greater HCC rate.
- Mean survival is 7 months - BAD!
-Hepatitis B virus
