LIVER AND GALLBLADER Flashcards by Veronica Arbona

Produces bile

liver

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stores bile

gallbladder

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nutrients travel to liver via which vein

hepatic portal vein

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composed by hepatocytes, kupffer cells and the sinusoids

acinus

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the portal vein and hepatic artery branches terminate in the

sinusoids

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blood flow in the liver

portal vein and hepatic artery drain into sinusoids
the go trough acinus to central vein

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are lined by fenestrated liver sinusoidal endothelial cells with Kupffer cells interspersed onto the endothelium

sinusoids

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between liver plate and sinusoids contains extracellular matrix components and hepatic stellate cells

space of disse

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fxns. of the liver

detoxification
metabolism
immune fxn.
production of cholesterol
storage of micronutrients
blood sugar balance
protein synthesis

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protein produced in liver that regulates blood oncotic pressure

albumin

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what cells have immune fxns. in the liver

kuppfer cells

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what cells produce bile in the liver?

hepatocytes

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major constituents of bile

bile salts
bile pigment
cholesterol + fatty acids
phospholipids
inorganic ions

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bile acids are a derivative of

cholesterol

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oxidation of cholesterol forms

cholic acid

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cholic acid or deoxycholic acid + glycine or taurine form

bile salts

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fxns. of bile

fat digestion
neutralize gastric acid
anti-microbial

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in aqueous solutions bile salts “huddle” together to form aggregates known as

micelles

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causes of stones in the gall bladder

too much absorption of water from bile
too much absorption of bile acids
too much cholesterol in bile
inflammation of epithelium

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Efficient intestinal reabsorption and hepatic extraction of bile acids enable an effective recycling and conservation mechanism that largely restricts bile acids to the intestinal and hepatobiliary compartments

Enterohepatic recyclin of bile

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2 factors that enable enterohepatic recycling of bile?

intestinal reabsorption and hepatic recycling of bile acids

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Main fx. of the enterohepatic recycling if bile is

Restricting bile acids to intestinal ana hepatobiliary compartments

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Anatomic components of the enterohepatic circulation are

liver
biliary tract
gallbladder
small intestine
portal venous circulation

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from I-cells in the small intestine) causes the gallbladder to contract strongly and release bile.

Cholecystokinin (CCK)

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some oral drugs (antibiotics, NSAIDS, hormones, opioids, digoxin, and warfarin) undergoing EHR can

Prolong the elimination time

2 types of bilirubin

conjugated and unconjugated

Bilirubin in blood is bounded with albumin = indirect bilirubin.

unconjugated

(bilirubin glucuronide): Bilirubin in liver is conjugated with glucuronic acid = direct bilirubin

conjugated

test to monitor liver damage can monitor bilirubin in it's conjugated and unconjugated form

Van den Bergh test

10 steps of bilirubin metabolism

1. senescent red cells are a source of hemoproteins 2. breakdown of heme to bilirubin occurs in macrophages in tissues, spleen and liver 3. unconjugated bilirubin attached to albumin is transported to liver 4. bilirubin is taken up by liver by diffusion and become conjugated to glucuronic acid 5. conjugated bilirubin is actively secreted into bile and and then intestine 6. In intestine, glucuronic acid is removed by bacteria converting into urobilinogen 7. urobilinogen is reabsorbed from the gut and enters portal blood 8. a portion of this urobilinogen participates in the enterohepatic recycling cycle 9. remainder of urobilinogen is transported by blood to kidney , converted to yellow urobilin and excreted 10. urobilinogen is oxidized by intestinal bacteria to the brown stercobilin

What gives urine its yellow color?

urobilin in kidneys

Bilirubin is a significant end product of

hemoglobin degradation

what 4 diseases need to be differentiated when bilirubin is elevated in blood?

hemolytic disorders vs. liver diseases biliary obstructions vs. hepatic damages

Bilirubin concentration is measured by measuring the concentration of

conjugated and unconjugated bilirubin

An elevated concentration of unconjugated bilirubin points to what type of disease

excessive hemolysis

An elevated concentration of conjugated bilirubin points to what type of disease

hepatic damage or biliary obstruction

4 liver enzymes essential to monitor to see if there is liver o biliary damage

ALT (Alanine aminotransferase) AST (Aspartate aminotransferase) ALP (Alkaline phosphatase) GGT (Gamma glutamic transpeptidase)

ALT (Alanine aminotransferase) and AST (Aspartate aminotransferase): elevated in

hepatic damage

ALP (Alkaline phosphatase) and GGT (Gamma glutamic transpeptidase): elevated in

biliary damage

in the exocrine pancreas, what 2 structures secrete pancreatic juice?

acinar cells duct cells

Secrete zymogenic granules containing digestive enzymes: Trypsinogen Amylase Lipase Other pancreatic enzymes

acinar cells

acinar cells are stimulated by

CCK

Secrete large amount of bicarbonate (HCO3-)

duct cells

duct cells are stimulated by

secretin

which part of the intestines secretes hormones to stimulate pancreatic juice and bile secretion ?

small intestine

increased osmolarity, stretch, vagal nerve stimulation + the presence of amino acids and fats stimulate which hormone to be secreted from the small intestine

CCK

gastric acid stimulates which hormone to be secreted by the small intestine?

secretin

specific location of small intestine in which CCK and secretin are secreted

duodenum and jejunum

1) Stimulate Pancreatic Acini to secret digestive enzymes 2) Stimulate Gallbladder to contract to release bile 3) Inhibit Gastric motility and secretion

CCK

stimulates pancreatic duct and bile duct

secretin

components of pancreatic juice

water bicarbonate digestive enzymes

amylase trypsin lipase are

pancreatic enzymes

which pancreatic enzyme digests starch?

amylase

which pancreatic enzyme digests protein?

trypsin

which pancreatic enzyme digests triglycerides?

lipase

the complete digestion of food molecules in the small intestine requires the action of both

pancreatic enzymes and brush border enzymes of intestine

inactive form of trypsin

trypsinogen

where is trysinogen activated and by which enzyme?

activated within the small intestine by the catalytic action of the brush border enzyme enterokinase (EN)= enteropeptidase (a protease).

Most pancreatic enzymes are produced as inactive molecules

zymogens

Enterokinase converts

trysinogen to trypsin

what step is the triggering event for the activation of other pancreatic enzymes?

trypsin activation

may occur when the conditions provoke the activation of digestive enzymes within the pancreas, such as: Alcoholism, Gallstones, Traumatic injury, Infections, Toxicosis from various drugs.

pancreatitis

Serum trypsinogen, pancreatic amylase and lipase tests can be used to monitor the health condition of the

pancreas