liver a p Flashcards
(122 cards)
1
Q
factors involved in liver regeneration
A
hepatocyte growth factor
epidermal growth factor
2
Q
4 lobes of liver
A
left
right
caudate
quadrate
3
Q
right and left liver lobes separated by this:
A
falciform ligament
4
Q
A layer of connective tissue (_____) surrounds the liver and forms a sheath around hepatic artery, portal vein, and bile ducts within it
A
Glisson’s capsule
5
Q
based on vascular supply, liver divides into how many lobes
A
8
6
Q
Functional unit of liver
A
lobule
50k - 100k
7
Q
liver blood flow per minute
A
1350 ml/min
8
Q
liver % of cardiac output
A
25%
9
Q
% of O2 extracted from each, hepatic artery and portal vein
A
50% from each
10
Q
Receives blood from stomach, pancreas, spleen, large and small intestines via these major vein
A
Inferior and superior mesenteric veins Splenic vein Left and right gastric veins Cystic vein Paraumbilical vein
11
Q
Blood from heart (hepatic)
A
aorta arteries arterioles capillaries in gut venules veins portal vein venules in liver capillaries in liver venules vena cava To heart
12
Q
Main functions of zone 1 cells
A
detoxification and secretion
13
Q
normal hepatic arteriole pressure
A
35 mmHg
14
Q
normal portal vein pressure
A
8-10 mmHg
15
Q
hepatic vein pressure
A
0 mmHg
16
Q
intrinsic liver regulation of BP
A
hepatic arterial autoregulation
hepatic arterial buffer system (reciprocity)
metabolic control
17
Q
extrinsic liver regulation of BP
A
neuronal
hormonal
18
Q
no autoregulation here
A
hepatic portal blood flow (pressure dependent)
19
Q
hepatic artery neuronal receptors
A
alpha 1
alpha 2
beta 2
20
Q
portal vein neuronal receptors
A
ONLY alpha
21
Q
relax hepatic smooth muscle (extrinsic fx)
blocks effects of vasocontriction in hep artery
A
glucagon
22
Q
increased splanchnic artrerial resistance
decreased portal venous resistance (tx portal HTN)
A
vasopressin
23
Q
fxs of liver
A
Blood reservoir Carbohydrate metabolism -Gluconeogenesis -Glycogenolysis -Glycogenesis Protein synthesis -Albumin -Thrombopoietin Amino acid synthesis Protein metabolism Bile production Lipid metabolism -Lipogenesis -Cholesterol synthesis Coagulation factor synthesis -Factors 1, 2, 5, 7, 9, 10, 11 Insulin clearance Drug metabolism and/or transformation Bilirubin metabolism
24
Q
primary energy source for many of body’s cells and preferred source for the brain
A
glucose
25
Four main functions of liver in CHO metabolism
Glycogen storage
Conversion of galactose and fructose to glucose
Gluconeogenesis
Formation of compounds form products of CHO metabolism
26
order of nutrient preference for energy
1. carbs (90% used for ATP)
2. fats
3. proteins
27
primary monosaccharide going back to tissue cells
glucose
28
renal gluconeogenesis happens here
proximal tubule
29
renal glucose uptake here
distal medullary segment (CO2 converted to lactate here)
30
Required ATP and NAD+ for energy
Required: 2 ATP & NAD+
Yield: 4 ATP + 2 NADH + 2 Pyruvate molecules
Net: 2 ATP
31
% of plasma proteins are liver derived
90%
32
amino acids: how much formed from liver vs obtained in diet
liver - 20
| diet - 10
33
liver proteins examples
```
procoagulants
hormones
cytokines
chemokines
transport proteins
```
34
most abundant, 15% of total protein production
albumin
35
most cells can use fatty acids for energy except
RBC (no mitochondria)
36
brain can utilize these from fat metabolism during starvation
ketone bodies (but brain not happy)
37
most important function of cholesterol
form:
cell structure (specialized)
organelle membranes
38
80% of nonmembranous cholesterol
converted to BILE SALTS
39
cause high cholesterol
saturated fats (diet)
low insulin
low thyroid
40
bile composition
```
Bile acids (50%)
Cholesterol (4%)
Phospholipids, (40%)
Bile pigments (bilirubin) (2%)
Ions (electrolytes)
Water
```
41
all coag factors produced by liver except
8
42
liver - endocrine synthesis (3)
angiotensinogen
thrombopoietin
insulin-like GF
43
liver-endocrine INACTIVATES these:
aldosterone
estrogen
androgens
ADH
44
iron stored in liver
ferritin (releases iron to circ when needed)
45
how is ferritin formed in liver
liver protein (apoprotein/transferrin) + iron
46
50% of current drugs metabolized by this CYP
3A4
| 3A5
47
meaning of 1st number, 2nd letter, last number (after CYP)
1 #: genetic family
2.L: genetic subfamily
3 #: specific gene or isozyme
48
other sites of metabolism (besides liver)
```
brain
kidney
skin
heart
lungs
plasma
GI
```
49
liver zone with highest CYP amnt
3
50
zone most susceptible to toxin damage
1
51
oxidation: changes made to molecule/electrons
add O2 to molecule
loss electrons (H+)
"OIL RIG"
52
reduction: changes made to molecule/electrons
gain electron
| "OIL RIG"
53
biologic activity of Phase II reactions
very little/none
54
enzyme inducing drugs
```
Phenytoin
Smoke from cigarettes or marijuana
Isoniazid (TB abx)
St. John’s Wart
Alcohol
Charbroiled foods
Phenobarbital
Carbamazepine (tegritol)
Garlic supplements
```
55
tegretol (inducer) + estradiol =
pregnancy
56
flagyl (inhibitor) + warfarin
bleeding
57
high ER drugs
```
Propofol
Amitriptyline
Labetalol
Lidocaine
Meperidine
Metoprolol
Morphine
Propranolol
Ranitidine
```
58
low ER drugs
```
Acetaminophen
Aspirin
Diazepam
Digitoxin
Ethanol
Phenobarbital
Phenytoin
Valproic acid
Warfarin
```
59
zero order drugs
```
P's and WHEATS
Phenytoin & Phenylbutazone
Warfarin
Heparin
Ethanol
Alcohol
Theophylline, tolbutamide
Salicylates
```
60
labs for cholestasis
Bilirubin
ALP
GGT
"chole BAG"
61
labs for synthetic function
```
albumin
protein
PT/INR
cholesterol
plasma cholinesterase
```
62
AST > ALT indicative of
alcohol
drugs
cirrhosis
63
ALT and AST > 1000 indicative of
ischemic or viral hepatitis
| acetaminophen ingestion
64
ALP >> GGT indicative of
bone disease
| pregnancy
65
GGT >> ALP indicative of
alcohol
| medications
66
albumin t1/2
2-3 weeks
67
coagulation factor w/ shortest t 1/2
7 (4 hours)
68
prothrombin t 1/2
72 hours
69
normal total bilirubin
0.3 - 1.9
70
direct (conjugated) bili normal value
0 - 0.3
71
serum bilirubin in jaundice
> 3 - 4 mg/dL
72
most common cause of jaundice postop
hemolysis
73
MELD score for inc risk for M&M perioperatively
> 14
74
```
- What disease?
AST>ALT
elevated Bili
elevated INR
tender hepatomegaly
low grade fever
slow recovery
```
acute alcoholic hepatitis
75
causes of cirrhosis
```
alcohol abuse
biliary obstr
hemochromatosis (Fe2-Fe3)
right HF
Wilsons (no ATP7b -> Cu high)
NASH
Alpha 1 - antitrypsin def
```
76
#1 cause of cirrhosis :/
alcohol abuse
77
alcohol oxidizes (steals electrons) to this in liver
acetaldehyde
78
oxidation of lipids is called this
lipid peroxidation
79
alcoholic cirrhosis begins infiltration of this
fatty infiltration
80
precursor to cirrhosis (bolded note)
inflammation (alcoholic hepatitis)
reversed by cessation
81
dx for NASH
elevated LFT
| liver bx
82
portal HTN collaterals develop into
esophagus
| anterior abdominal wall and rectum
83
the point where portal veins meet systemic veins – porta (liver) caval (vena cava)
portocaval anastomoses
84
Three areas are susceptible to formation of varices as portal HTN increases
gut (esoph varicies)
butt (internal hemorrhoids)
caput (caput medusea)
85
most common clinical manifestation of portal HTN
GI bleeding
86
alcohol effects on NMDA receptors
inhibition (dec CNS excitation)
87
Functions of spleen (3)
Filter and destroy damaged RBCs
Prevents infection (produces lymphocytes)
Stores RBCs and platelets
88
CV manifestations of cirrhosis
```
hyperdynamic (high CO)
low SVR
cardiomyopathy
pulm HTN
dec response to stress
diastolic dysfx
down regulated beta receptors
```
89
EKG changes: eccentric LVH
tall R
Q wave
voluminous upright T wave
90
only cure for hepatopulmonary syndrome
liver transplant
91
features of hepatopulmonary syndrome
cyanosis
dyspnea
--platypnea (breathe better when flat)
--orthodoxia (desats with sitting/standing)
92
diagnostic criteria for hepatopulm syndrome
```
liver dz (portal HTN & cirrhosis)
alveolar-arterial O2 gradient > 15
---intrapulm R - L shunt
```
93
pAO2 =
FiO2 (760 mm Hg – 47 mm Hg) – (paCO2/0.8)
94
formula for normal age-dependent ALV-art shunt
age/4 + 4
95
features of portopulm HTN
Fibrosis
PAP > 25 in presence of normal PCWP
RV overload and right heart failure
hepatic congestion
96
Renal manifestations in cirrhosis: what syndrome do these describe?
- -oliguria in prescence of renal failure
- -renal artery constriction
hepatorenal syndrome
97
definitive tx of hepatorenal syndrome
transplant
98
hepatic encephalopathy caused by accumulation of these neurotoxins:
ammonia
fatty acids
serotonin
tryptophan
99
of 3 most common causes of viral hepatitis (hep A, B, C) which one is most common of the 3 in US
C
100
most common FORM of DRUG induced hepatitis
alcoholic hepatitis
101
most common CAUSE of DRUG induced hepatitis
genetic predisposition
102
most common cause of POST OP jaundice
hematoma resorption
| RBC breakdown post transfusion
103
most common complication of CIRRHOSIS
ascites
104
HRS treatment: these vasoconstrict splanchnic
octreotide + midodrine + albumin 20%
ornipressin + albumin
terlipressin + albumin
105
HRS treatment: these vasodilate renal arteries
misoprostol (cytotec)
adenosine - 1 antagonist (caffeine, theoph)
angiotensin II t1 antagonist (losartan)
106
hepatopulmonary TRIAD
liver disease
arterial vasodilation
pulmonary vasodilation
107
hepatotoxins contributing to encephalopathy
ammonia
fatty acids
mercaptans
manganese
108
2 branches of vagus innervation to stomach
```
right posterior (celiac) branch
left anterior (hepatic) branch
```
109
endocrine secretion of stomach (2)
pepsinogen
| serotonin
110
mucus and gastrin (G-cells) secreted by
surface epithelial cells
| mucous cells
111
most of blood supply to stomach from which artery
celiac
112
population most at risk for PUD
men 45-65
| women > 55
113
gastric mucosal acidosis common in this pt population
critically-ill
prolonged complex surgery
CABG
114
milk-akali syndrome manifestations
skeletal muscle weakness
| polyurea
115
H2 antagonist utilizing P450 the least
famotidine
116
15% of ulcerative colitis get acute fulminating incidence with these symptoms (3)
severe abd pain
profuse rectal bleed
high fever
117
agents reducing LES
```
caffeine
chocolate
alcohol
nicotine
fats
```
118
gallstones composition
cholesterol
calcium biliruminate
mixture of cholesterol/bilirubin
119
charcot's triad
fever/chills
jaundice
upper quadrant pain
120
enzymes responsible for acute pancreatitis
trypsin
enterokinase
bile acids
121
spleen major vs minor roles
major: macrophage/immunoglobin M (white pulp)
minor: plt reservoir
122
2 factors enhancing carcinoid syndrome
1. direct tumor manipulation
| 2. beta-adrenergic stimulation
