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Gastro-intestinal System > Liver and Pancreas Physiology and Disease > Flashcards

Liver and Pancreas Physiology and Disease Flashcards

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1
Q

Which areas of the abdominal does the liver reside in?

A

Right hypochondrium

Epigastric

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2
Q

What do we call the 2 liver surfaces?

A

Diaphragmatic

Visceral

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3
Q

What is contained within the falciform ligament?

A

Remnant of umbilical vein

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4
Q

What is the role of the coronary and triangular ligaments of the liver?

A

Attach superior liver to the diaphragm

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5
Q

Which ligaments are contained in the lesser omentum?

A

Hepatoduodenal

Hepatogastric

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6
Q

Name the hepatic recesses and state where they are

A

Subphrenic spaces (left and right) - between diaphragm and liver
Subhepatic space - between liver inferior surface and transverse colon
Morison’s pouch - between liver and the right kidney

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7
Q

What is the deepest part of the peritoneal cavity when supine?

A

Morison’s pouch

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8
Q

What do we call the fibrous layer covering the liver?

A

Glisson’s capsule

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9
Q

What divides the liver into right and left lobes?

A

Falciform ligament

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10
Q

Where are the accessory lobes of the liver?

A

Visceral surface
Caudate - between the IVC and a fossa produced by ligamentum venosum
Quadrate - between gall bladder and fossa produced by ligamentum teres

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11
Q

What lies between the caudate and quadrate lobes?

A

Deep fissure - porta hepatis

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12
Q

What provides the dual blood supply to the liver?

A

Hepatic artery proper (from coeliac trunk)

Hepatic portal vein (from small intestine)

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13
Q

What is the dominant blood supply to the liver parenchyma?

A

Hepatic portal vein

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14
Q

How is the parenchyma of the liver innervated?

A

Hepatic plexus:
SNS - coeliac plexus
PNS - vagus nerve

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15
Q

What innervates the Glisson’s capsule?

A

Branches of the liver intercostal nerves

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16
Q

What kind of pain occurs with distension of the liver capsule?

A

Sharp

Well localised

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17
Q

Does the duodenum add or remove water to the gut lumen?

A

Adds (from ECF)

For dilution because chyme so hypertonic

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18
Q

What is the osmotic status of chyme when it leaves the duodenum?

A

Isotonic

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19
Q

What percentage of the pancreas is exocrine?

A

90%

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20
Q

Which basic parts of the pancreas produce the different exocrine parts?

A

Acinus - produces enzymes
Centroacinar - aqueous component
Duct - modifies secretion

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21
Q

What happens to pancreatic secretions if the flow is faster?

A

More HCO3- ions

More alkaline

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22
Q

Describe the neuronal control of the pancreas

A

SNS - inhibits secretions

PNS - vagus stimulates secretions

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23
Q

What stimulates the acinus to produce enzymes?

A

Vagus nerve

CCK

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24
Q

What stimulates the release of CCK in the duodenum?

A

Detection of hypertonicity, small peptides and fats in the duodenum

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25
What enzymes are released from the pancreas?
Amylases and lipase Proteases - trypsin, chymotrypsin, elastase, carboxypeptidases (Proteases as zymogens)
26
What are zymogen granules?
Membrane bound | Contain inactive precursor of an enzyme
27
Pancreatic enzymes in the blood indicate ...
Pancreatic damage | Pancreatitis
28
How high can the rate of mortality in pancreatitis be?
50%
29
What is the role of pancreatic duct cells?
Produce aqueous component - isotonic solution Secrete HCO3- stimulated by secretin HCO3- pumped into lumen therefore H+ moves into blood (Transient lowering of pH of blood leaving the pancreas)
30
What are the roles of the liver?
Energy metabolism - glycogen storage Detoxification Plasma protein production Bile production
31
How many hepatic veins attach the liver to the IVC?
3
32
How much bile is secreted per day?
250ml - 1 litre
33
Describe hepatocytes
Chief functional cell of liver Very active at producing proteins/lipids for export Contain lots of glycogen
34
What is the structural unit of the liver and describe?
``` Lobule Contains many hepatocytes in radiating branches Central vein Hexagonal Portal triads at each corner ```
35
What is the functional unit of the liver and describe?
Acinus Diamond shaped - from one central vein to another in an adjacent lobule (long axis) One portal triad to another - short axis 3 zones
36
Which zones of the acinus of the liver are most at risk?
Zone 1 - receives highest blood supply so most at risk of toxic damage Zone 3 - receives lowest blood supply so most at risk of hypoxic damage
37
Which veins all drain together to make the hepatic portal vein?
``` Splenic vein Superior mesenteric vein Inferior mesenteric vein Gastric veins Cystic vein ```
38
What are the 2 component types of bile?
Bile acid dependent - bile acids and pigments | Bile acid independent - alkaline solution
39
What are the 2 primary bile acids?
Cholic acid | Chenodeoxycholic acid
40
What are bile salts?
Bile acids that are conjugated with amino acids | Glycine and taurine
41
Describe the structure and function of bile salts
Generally soluble at duodenal pH Amphipathic molecules Crucial for emulsification of dietary lipids Form micelles with products of lipid breakdown Moves fat into enterocytes and bile salts remain in gut Reabsorbed at terminal ileum then go back to liver to be recycled
42
What are the products of lipid digestion in the gut?
Cholesterol Monoglycerides Free fatty acids
43
Inside cells, fat is re-esterified back to ...
Triglycerides Phospholipids Cholesterol
44
What are chylomicrons?
Reformed lipids packaged with apoproteins
45
How do chylomicrons travel?
Exocytosis through basolateral membrane Enter lymph capillaries - lacteals Travel through lymphatic system Re-enter vascular system at the thoracic duct
46
What is the function of the gall bladder?
To store and concentrate bile
47
Name the different types of gallstones we can get
Pigment stones - black Cholesterol stones - yellow Mixed stones - black and yellow
48
What is the effect of CCK towards bile?
Stimulates gall bladder contraction | Relaxes sphincter of Oddi
49
What is steatorrhoea?
Fat in the faeces Pale, floating, foul smelling stool If bile acids or pancreatic lipase are not secreted in adequate amounts
50
Give some common symptoms/signs of liver disease
``` Abnormal blood tests (LFTs) Abdominal pain Nausea/vomiting Jaundice Skin irritation Hepatomegaly ```
51
Give some signs of very severe liver disease
Small, irregular liver Bleeding/poor clotting Oedema Encephalopathy
52
How do you get abdominal pain in liver diseases?
Inflamed liver/swelling Surrounded by visceral peritoneum Poorly localised visceral pain
53
Why do you become nauseous in liver failure?
High number of toxins in the blood | Liver cannot detoxify as well
54
Why can the skin become irritated in liver disease?
Bile salts deposited in the skin - itchy
55
Why do you get hepatomegaly in liver disease?
Inflammation and swelling | Increased fat deposition
56
How does ascites occur in liver failure?
Decreased albumin production Decreased oncotic pressure of plasma Fluid moves out of plasma Also if portal hypertension - increased hydrostatic pressure in the portal system - fluid moves out
57
How does encephalopathy occur in liver disease?
``` Break down of the urea cycle Increase in ammonia Crosses in BBB Toxic to the brain Can lead to coma ```
58
Describe the life cycle of bilirubin
``` 120 days in a RBC Bilirubin is the breakdown product of Hb Joined with albumin to carry to liver Conjugation Joined with bile salts and excess cholesterol Drains into biliary tree Secreted into duodenum Bilirubin converted to urobilinogen which gives colour to faeces Some bilirubin recycled to liver ```
59
Describe pre-hepatic jaundice
Excess bilirubin load to the liver Excessive RBC breakdown eg. Haemolytic anaemia Liver cannot conjugate fast enough Unconjugated bilirubin remains in blood
60
Describe hepatic jaundice
Decreased rate of bilirubin conjugation Injury/damage to liver or defects in conjugation Some bilirubin remains insoluble
61
Describe post-hepatic jaundice
Obstruction to bile drainage into duodenum Conjugated but cannot leav ebiliary tree Refluxes into circulation No bilirubin in stool - pale, fatty, smelly steatorrhoea
62
What are the tests for the true liver function?
Albumin | Clotting factors
63
Briefly describe hepatitis
``` Hepatocytes inflammation and breakdown Many causes: Viral Hep Autoimmune Drugs eg. Alcohol, paracetamol Hereditary disorders ```
64
How does chronic liver disease lead to cirrhosis?
``` Inflammation of the liver Ongoing liver cell damage/necrosis Nodular regeneration and fibrosis Architectural change to liver structure Increased resistance to blood flow ```
65
Describe the symptoms of stones in the biliary tree
Nausea/vomiting Abdominal pain Jaundice (Fever and right upper quadrant pain = cholecystitis)
66
How do we tend to identify gall stones?
Ultrasound scan
67
What are the most common causes of pancreatitis?
Gallstones | Alcohol
68
What are the symptoms of pancreatitis?
Abdominal pain Vomiting Hypotension
69
What is the treatment for pancreatitis?
Supportive Analgesics Lots of IV fluids
70
What type of cancer is the majority of pancreatic cancers?
Ductal adenocarcinoma
71
What are the symptoms of pancreatic cancer as it progresses?
``` Obstructive jaundice Pain (referred to back) Weight loss Vomiting Malabsorption Diabetes ```

Gastro-intestinal System (10 decks)

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