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LIVER ANATOMY AND FUNCTION Flashcards

1
Q

What separates the two lobes of the liver?

A

The falciform ligament

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2
Q

What happens in the gall bladder?

A

Bile brains into bile ducts and then gathers in the gall bladder where it is stored and released when eating

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3
Q

What triggers the gall bladder to release bile?

A

Signals of early digestion e.g peptides released from carbohydrates trigger a release of a sphincter muscle and the contraction of the gall bladder to release bile into the common bile duct into the intestines to help emulsify fat

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4
Q

Describe the 3 stages in the transportation of bile?

A

1) Liver cells secrete bile which is collected by ducts that flow from the liver through the right and left hepatic ducts which ultimately drain into the hepatic duct
2) The common hepatic duct then joins with the cystic duct from the gallbladder to form the common bile duct
3) The common bile duct runs from the liver to the duodenum

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5
Q

Which two structures form the common bile duct?

A

The cystic duct from the gall bladder and the common hepatic duct come together to form the common bile duct

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6
Q

How many segments is the liver divided into and what do they each have?

A
  • The liver has 8 segments
  • Each has its own blood supply and bile drainage
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7
Q

What is a sinusoid and what happens here?

A
  • Sinusoids are the capillary beds found in the liver
  • Blood enters the liver via veins and arteries and mixes at the sinusoids
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8
Q

After blood has mixed at the sinusoids, how is it drained from the liver?

A

Blood is drained from the hepatic veins into the Inferior vena cava near the right atrium

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9
Q

Where does structural support in the liver come from?

A

Lots of connective tissue made from extracellular matrix gives the liver structural support

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10
Q

What increases when the liver cells become damaged?

A

There is an increase in connective tissue in places where there would normally be hepatocytes. A normal healthy liver would have minimal structural connective tissue

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11
Q

What is the scale of fibrosis?

A
  • This is a scale that demonstrates the level of fibrosis of the liver
  • F1 is the lowest level of fibrosis
  • F4 is the highest level of fibrosis
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12
Q

Give 4 facts about hepatocytes

A
  • Are the main functional and most common cells in the liver
  • Very versatile
  • Low mitotic index
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13
Q

What is the function of tight junctions in the hepatocytes?

A

Tight junctions to prevent bile from leaking out and damaging neighbouring hepatocytes

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14
Q

What is the function of the sinusoidal plane in the hepatocytes?

A

Sinusoidal plane of the cell faces the blood supply . Proteins and carbohydrates made by the liver can be secreted into the circulation

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15
Q

Describe the biliary epithelium (3)

A
  • It forms collecting vessels to collect canalicular bile
  • They have transport and secretion properties
  • They gradually increase in size to form mature bile ducts
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16
Q

What type of cells is the liver epithelium made from and what is its function?

A
  • Squamous epithelium cells
  • Regulation of coagulation and leukocyte traffic
  • They allow the selective transport of materials and things like white blood cells into the tissue
  • Line the liver
  • Protect The liver from blood cells, bacteria, viruses
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17
Q

What are Kupffer cells?

A
  • Hepatic macrophages within the sinusoids
  • Have functions related to phagocytosis and regulation of the microcirculation
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18
Q

Describe the shape of stellate cells

A

Star shaped with multiple membrane processes and branching structures

19
Q

Where are stellate cells located?

A

Located in the sinusoidal space

20
Q

What is stored in stellate cells?

A

Vitamin A stored in these cells

21
Q

How are stellate cells important in liver fibrosis?

A

Important in liver fibrosis - they can transform to become more like a myofibroblast. They can produce lots of extra cellular matrix. They help with wound healing response. When function becomes unregulated they contribute most towards fibrosis

22
Q

Which cells store hepatocytes?

A

Iron

23
Q

What are the digestive functions of the liver (2)

A
  • Carbohydrate and fat metabolism
  • Protein metabolism
24
Q

What do statins act on?

A

Enzymes in the liver

25
Q

Describe the immune function of the liver?

A
  • Protection of pathogens arriving in the blood
  • Phagocytosis of old or dying cells
26
Q

How much bile is produced, recycled and what are its 3 uses?

A
  • 0.5L per day produced by hepatocytes
  • Recycled about 6-8 times per day
  • Involved in emulsification of fat
  • Involved in fat soluble vitamin uptake
  • Involved in excretion of some substances
27
Q

What would happen to serum albumin levels in liver disease?

A

They would get lower

28
Q

What is cancer of the pancreas?

A

Growth obstructs the bottom of the common bile duct

29
Q

What is viral hepatitis?

A
  • Hepatitis means inflammation of the liver
  • Viruses selectively infect hepatocytes (A-E)
  • Very strong immune response causes severe hepatitis
  • The immune system then kills infected hepatocytes
30
Q

What is end stage liver disease called and what is the consequence of it?

A
  • Cirrhosis
  • Liver failure will occur and this can cause death
  • Portal hypertension also occurs which leads to renal failure
  • It can also cause splenomegaly – enlargement of the spleen
31
Q

What is non alcoholic fatty liver disease?

A
  • Being overweight or obese can put you at risk of liver disease as well as alcohol
  • This disease is when more than 5% of the liver’s weight is fat
  • It can lead to cirrhosis
32
Q

What effect can alcohol have on the liver?

A
  • Can damage and cause the death of hepatocytes
  • Chronic injury caused by response to inflammation
33
Q

Describe the progression of liver fibrosis?

A
  • Acute hepatis
  • Chronic hepatitis (activates wound healing which causes scaring and fibrosis)
  • Liver fibrosis
  • Liver cirrhosis
  • Liver Cirrhosis may eventually lead to liver cancer
34
Q

Name 3 useful proteins made by the liver

A
  • Albumin -
  • Fibronectin
  • Transferrin
35
Q

What is jaundice and what causes it?

A

Jaundice is a yellow discolouration of the skin, eyes and other tissues. It is caused by a build up of bilirubin in tissue fluids and bloodstream. To see visible jaundice it would be around 2mg/ml

36
Q

What is the raw material for bile and what is it made from?

A

Bilirubin - it is a breakdown product of haemoglobin, myoglobin and some enzymes like cytochromes

37
Q

What are the 3 categories of causes of jaundice

A
  • Pre hepatic -Upstream of the liver that has nothing to do with the liver
  • Intra hepatic - Jaundice relates to something in the liver
  • Extra hepatic - Downstream outside of the liver
38
Q

What are the levels of bilirubin and liver enzymes in pre hepatic jaundice?

A
  • Increased unconjugated bilirubin
  • Normal levels of liver enzymes e.g transaminase enzymes
39
Q

What other disease needs to be excluded when looking for pre hepatic jaundice?

A

Haemolysis

40
Q

What are the levels of bilirubin and liver enzymes in hepatic jaundice?

A
  • Increased total bilirubin
  • Increased liver enzymes
  • Liver is still able to conjugate bilirubin however in liver disease. The problem is that it is hard to clear it
41
Q

Jaundice can be caused through liver injury in hepatic jaundice, give 4 examples.

A
  • Interruption of bile flow
  • Cancer
  • Destruction of bile ducts
  • Viral related hepatic jaundice
42
Q

What is the consequence of post hepatic jaundice

A

Bile flow is disrupted e.g gall stones, compression or diseases of the duct

43
Q

What are the levels of bilirubin and liver enzymes in post hepatic jaundice?

A
  • Increased bilirubin
  • Slight/ moderate increase in liver enzymes

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