Liver and Gallbladder Phys and Path again

Question 1

what receives portal blood that drains the stomach, small intestine, large intestine, pancreas, and spleen?

Answer 1

the liver

Question 2

what is in the liver that represent up to 80% of the mononuclear phagocyte system?

Answer 2

Kupffer cells

Question 3

what are the four lobes of the liver?

Answer 3

right, left, quadrate, and caudate

Question 4

what are the important ligaments of the liver?

Answer 4

• coronary ligaments
• falciform ligament
• round ligament
• ligamentum venosum

Question 5

what anchors the liver to the diaphragm

Answer 5

coronary ligaments

Question 6

what ligament separates right and left lobe

Answer 6

falciform ligament

Question 7

what is the ligament found on free border of falciform ligament separates quadrate and left lobe

Answer 7

round ligament (ligamentum teres)

Question 8

what connects the liver to the umbilicus

Answer 8

round ligament (ligamentum teres)

Question 9

what ligament separates the caudate and left lobe

Answer 9

ligamentum venosum

Question 10

what separates the caudate and right lobe

Answer 10

gallbladder

Question 11

the liver receives oxygenated blood from the ?

Answer 11

hepatic artery

Question 12

the liver receives deoxygenated, nutrient-rich blood from the ?

Answer 12

hepatic portal vein

Question 13

what is the opening for the 3 main things entering the liver called? (hepatic artery, portal vein, common hepatic duct)

Answer 13

Porta hepatis

Question 14

what are the 3 main components of the liver

Answer 14

• hepatocytes
• bile canaliculi/cholangiocytes
• hepatic sinusoids

Question 15

what are the major functional cells in the liver

Answer 15

hepatocytes

Question 16

what are hepatocytes arranged into ?

Answer 16

hepatic laminae

Question 17

what are hepatic laminae

Answer 17

“Plates” of hepatocytes, bordered by endothelial-lined vascular spaces (hepatic sinusoids)

Question 18

what are bile canaliculi

Answer 18

Small ducts found between hepatic laminae that collect bile

Question 19

what is the central vein

Answer 19

• drains hepatic sinusoids
• empties into hepatic vein

Question 20

what does the portal triad contain?

Answer 20

• bile duct
• arteriole branch of hepatic artery
• venule branch of portal vein

Question 21

what is the capillary system specific to the liver?

Answer 21

hepatic sinusoids

Question 22

what separates the hepatocytes and sinusoids?

Answer 22

space of disse

Question 23

what is the area where blood from the portal vein and hepatic artery mix and then converge and drain into central vein

Answer 23

hepatic sinusoids

Question 24

where are hepatic stellate cells found?

Answer 24

space of disse

Question 25

hepatic stellate cells are normally...

Answer 25

in a quiescent state

Question 26

the hepatic stellate cells become active when...

Answer 26

there is damage

Question 27

what does hepatic stellate cells do?

Answer 27

secrete collagen and extracellular matrix in response to damage -> scar tissue formation

Question 28

what is the resident macrophage of the liver

Answer 28

Kupffers cells

Question 29

what is the function of kupffers cells

Answer 29

phagocytose old RBC's, hemoglobin, particulate matter, cellular debris, microorganisms

Question 30

Hepatocytes, bile duct system and hepatic sinusoids can be organized into functional units called

Answer 30

hepatic acinus

Question 31

hepatocytes are arranged in ? zones around short axis

Answer 31

3 zones ○ Zone 1 – most O2 ○ Zone 2 ○ Zone 3 – least O2

Question 32

Hepatocyte function differs based on ? within hepatic acinus

Answer 32

zones

Question 33

what is the liver functions

Answer 33

- Biotransformation & degradation - Bilirubin conjugation - Storage & synthesis of nutrients - Bile production

Question 34

why does the liver process lipophilic chemicals into polar, water-soluble metabolites?

Answer 34

easier to excrete into bile when hydrophilic

Question 35

what are the 4 major steps of biotransformation and degradation of the liver

Answer 35

1. Hepatocyte imports the compounds from blood across it’s basolateral membrane 2. Hepatocyte transport material within the cell 3. Hepatocyte may chemically modify/ degrade products intracellularly 4. Hepatocyte excretes the molecule into bile across its apical membrane

Question 36

what are the 2 phases of hepatocyte chemically modifying and degrading products intracellularly

Answer 36

- Phase I – oxidation or reduction reactions typically catalyzed by P-450 cytochromes enzymes (aka CYP450) - Phase II – conjugation

Question 37

what is an inducer of many CYP450 enzymes

Answer 37

Hypericum perforatum (St. John's Wort)

Question 38

what can transport a wide variety of conjugated drugs and bilirubin either into bile or blood

Answer 38

ATP-binding Casette

Question 39

Senescent erythrocytes are phagocytosed by macrophages & heme will be degraded into ? & released into the blood ○ Unconjugated ? will be carried to the liver bound to ?

Answer 39

Bilirubin bilirubin albumin

Question 40

Bacteria in the terminal ileum and colon converts some of the conjugated bilirubin back into bilirubin. Then, this bilirubin will be converted to ? and some will then be converted to ?

Answer 40

urobilinogen stercobilin

Question 41

what is the main pigment of feces

Answer 41

stercobilin

Question 42

bile production by the liver serves 2 functions:

Answer 42

1. elimination of exogenous and endogenous waste products 2. promotes digestion and absorption of lipids from the intestines

Question 43

Bile is synthesized initial from ? in the liver

Answer 43

cholesterol

Question 44

what is the process called when ileum and colon bile can be dehydroxylated by bacteria and reabsorbed

Answer 44

Enterohepatic circulation

Question 45

what is the bile flow pathway

Answer 45

hepatocyte -> bile canaliculi -> bile ductules -> bile ducts -> common hepatic duct -> cystic duct -> common bile duct -> duodenum

Question 46

what is the small, pear shaped organ on inferior aspect of liver

Answer 46

gallbladder

Question 47

what is continuous with the cystic duct?

Answer 47

gallbladder

Question 48

what are the layers of the gallbladder

Answer 48

- mucosa - muscularis - serosa

Question 49

what is the function of the gallbladder

Answer 49

Storage of bile that is secreted continuously by hepatocytes until it’s needed in the duodenum

Question 50

When food digestion begins in upper GI tract, the gallbladder begins to ?

Answer 50

empty

Question 51

Emptying occurs with ?

Answer 51

rhythmical contractions of gallbladder wall also requires simultaneous relaxation of the sphincter of Oddi

Question 52

what is cirrhosis

Answer 52

Diffuse remodeling of the liver into parenchymal nodules surrounded by fibrous bands and variable degree of vascular shunting

Question 53

what are the leading causes of cirrhosis

Answer 53

- Chronic hepatitis B, - chronic hepatitis C, - Nonalcoholic fatty liver disease - Alcoholic liver disease

Question 54

what are the symptoms of cirrhosis

Answer 54

- Many are asymptomatic until most advanced stages of disease - Symptoms are often non-specific: ○ Anorexia, weight loss, weakness

Question 55

cirrhosis is reversible but will often progress to ?

Answer 55

liver failure

Question 56

what is the most common biliary tract disease

Answer 56

cholelithiasis (gallstones)

Question 57

what are the 2 main types of gallstones

Answer 57

- cholesterol stones - pigment stones

Question 58

what is the pathogenesis of cholesterol stones

Answer 58

Cholesterol concentrations exceed the solubilizing capacity of bile (supersaturation) -> cholesterol can no longer remain dispersed and nucleates into solid cholesterol monohydrate crystals

Question 59

cholelithiasis can progression into?

Answer 59

acute cholecystitis

Question 60

what results in jaundice and icterus?

Answer 60

elevated bilirubin

Question 61

what is jaundice

Answer 61

yellow discolouration of the skin

Question 62

what is icterus

Answer 62

yellow discolouration of the sclera

Question 63

the etiology of jaundice can be divided into :

Answer 63

- Pre-hepatic causes - Intra-hepatic causes - Post-hepatic causes

Question 64

pre-hepatic causes mean

Answer 64

excessive extrahepatic production of bilirubin

Question 65

intra-hepatic causes mean

Answer 65

reduced hepatocute uptake, impaired conjugation, decreased heptocellular excretion

Question 66

post-hepatic causes mean

Answer 66

impaired bile flow