Liver Function 2

Question 1

Where does the liver get its blood supply from?

Answer 1

The hepatic portal vein and hepatic arteries

Question 2

Where does the hepatic portal vein carry venous blood drained from?

Answer 2

Spleen, GI tract and its associated organs

Question 3

What type of liver cells are parenchymal?

Answer 3

Hepatocytes - 80% liver volume

Question 4

What live cells are non parenchymal?

Answer 4

Endothelial cells
Kupffer cells
Sinusoidal

Question 5

What do bipotential stem cells form?

Answer 5

Ovalocytes form hepatocytes and cholangiocytes

Question 6

What are the functions of the liver?

Answer 6

Synthesis
Breakdown
Storage
Immune system

Question 7

What does the liver synthesise?

Answer 7

Amino acids

Question 8

What does the liver metabolise?

Answer 8

Carbohydrates, proteins and lipids

Question 9

In the first trimester foetus what is the liver the main site of?

Answer 9

Red blood cell production

Question 10

What happens to bile synthesised by the liver?

Answer 10

Some bile drains directly into the duodenum, and some is stored in the gallbladder

Question 11

What is the role of IGF-1 that is produced by the liver?

Answer 11

Important role in childhood growth and continues to have anabolic effects in adults

Question 12

The liver is a major site of thrombopoetin production. What is the role of thrombopoietin?

Answer 12

Thrombopoietin is a glycoprotein hormone that regulates the production of platelets by the bone marrow

Question 13

What is the liver involved in the breakdown of?

Answer 13

Breakdown of insulin and other hormones
Glucoronidates bilirubin, facilitating its excretion into bile
Toxic substances
Drug metabolism - sometimes results in toxication. Toxins are conjugated to avail excretion n bile or urine
Converts ammonia to urea (urea cycle)

Question 14

How does the liver have immunological effects?

Answer 14

The reticuloendothelial system of the liver contains many immunologically active cells, acting as a sieve for antigens carried to it via the portal system

Question 15

What is the role of albumin in blood serum?

Answer 15

It is the major osmolar component of blood serum

Question 16

What hormone does the liver synthesise that is responsible for raising blood pressure where activated by renin?

Answer 16

Angiotensinogen

Question 17

What are the features of bile?

Answer 17

Bitter tasting green / yellowish brown
Produced by the liver
Stored ad concentrated in the gallbladder
Discharged to duodenum

Question 18

What is bilirubin?

Answer 18

Yellow breakdown product of haem metabolism

Excreted in bile and urine

Question 19

What gives urine colour?

Answer 19

Urobilin

Question 20

What gives faeces brown colour?

Answer 20

Stercobilin

Question 21

What happens to bilirubin in heme?

Answer 21

Form larger ring porphyrins

Question 22

What are bile acids?

Answer 22

Steroid acids found in the bile of mammals

Bile acids when conjugated with taurine or glycine in the liver form bile salts

Question 23

Where are primary bile acids synthesised?

Answer 23

Liver

Question 24

What are secondary bile acids a result of?

Answer 24

Bacterial actions in the colon

Question 25

What account for 80% of organic compounds in bile?

Answer 25

Bile acids | Others include phospholipids and cholesterol

Question 26

What are the functions of bile acids?

Answer 26

Amphipathic molecules with hydrophobic and hydrophilic regions Form micelles: aid lipase to digest lipids Move lipids near brush border - fat absorption Eliminate cholesterol Drives bile flow Emulsify fat soluble vitamins (DEAK) to help absorption Reduce bacterial floral in small intestine and biliary tract

Question 27

What is the role of micelles?

Answer 27

Aid lipases to digest lipids

Question 28

What eliminates cholesterol?

Answer 28

Bile salts

Question 29

What emulsifies fat soluble vitamins (DEAK) to help absorption?

Answer 29

Bile salts

Question 30

What is a major route of cholesterol metabolism?

Answer 30

Synthesis of bile acids

Question 31

What percentage of bile acids are reabsorbed in ileum and recycled for further use? (Enterohepatic circulation)

Answer 31

95%

Question 32

What route does bile travel?

Answer 32

Produced in the liver Travel down left or right hepatic duct Into common hepatic duct Either flows into gallbladder to be stored via the cystic duct Or flows down the common pancreatic duct Flow into duodenum via the sphincter of Oddi

Question 33

What are the intra-hepatic types of biliary disease?

Answer 33

PSC PBC Secondary biliary cirrhosis

Question 34

What are the extra-hepatic types of liver disease?

Answer 34

Within lumen - stones In wall of the lumen - stricture, cholangiocarcinoma Extrinsic compression - pancreatic cancer

Question 35

What is jaundice?

Answer 35

Hyperbilirubinaema manifest as yellow sclera or skin | Can be painful or painless

Question 36

When does jaundice become apparent?

Answer 36

When serum bilirubin >2-3 x ULN

Question 37

What are the causes of post hepatic jaundice?

Answer 37

(Conjugated hyperbillirubinaemia) Blockage of flow of bile through liver to duodenum and / or gallbladder Within bile lumen; stones, tumour Within wall of lumen: stricture, PSC Compression on the lumen; pancreatic cancer, hilar lymphadenopathy

Question 38

What is ERCP?

Answer 38

Endoscopic retrograde cholangio-pancreatography Therapeutic technique Stone extraction Stent insertion Diagnosis Tissue acquisition - bile brushings - spy glass