Liver Structure and Function Flashcards

1
Q

What are the four lobes of the liver?

A

Right
Left
Caudate
Quadrate

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2
Q

Where do blood vessels, lymphatic vessels, ducts and nerves enter and exit the liver?

A

Via the porta hepatis

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3
Q

What are the functions of the falciform ligament?

A

Attaches liver to anterior surface of the abdomen

Separates the lobes

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4
Q

What is the name of the only area of the liver not covered by connective tissue?

A

Bare area

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5
Q

Hepatocytes make bile which runs out through the _ to the _

A

canaliculus

to the outer of the liver lobule and into the bile duct

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6
Q

What is the difference between the two blood supplies received by the liver?

A

One is oxygen rich but nutrient depleted via hepatic artery, the other is oxygen depleted but nutrient rich via hepatic vein

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7
Q

The hepatic sinusoids are

A

open blood vessels, so blood is in very close contact with the hepatocytes as it passes between them

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8
Q

What are the main components of bile?

A
Bile acids 
Lecithin 
Cholesterol 
Bile pigments 
Toxic metals 
Bicarbonate
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9
Q

Bile acids, lecithin and cholesterol are synthesised in the

A

liver and solubilise fat

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10
Q

What feature of bile acids, lecithin and cholesterol allows them to solubilise fat and prevent the re-aggregation of fat droplets?

A

They are amphipathic

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11
Q

Bile pigments are breakdown products of

A

haemoglobin from old/damaged erythrocytes

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12
Q

Where are toxic metals detoxified?

A

In the liver

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13
Q

Bicarbonate neutralises

A

acid chyme

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14
Q

When bilirubin is extracted from the blood by hepatocytes and secreted into the bile, what colour will the bile be?

A

Yellow

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15
Q

Bile acids are synthesised by hepatocytes in the liver from

A

cholesterol

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16
Q

What happens to bile acids before secretion?

A

They are conjugates with glycine or taurine to produce bile salts to make them soluble and able to put into solution

17
Q

Secreted bile salts are recycled via the

A

enterohepatic circulation

18
Q

When the sphincter in the duodenum is closed, excess bile in the common bile ducts moves

A

to the gall bladder for storage

19
Q

What are the main functions of the gallbladder?

A

Stores bile

Secretes bile into the cystic duct which secretes into common bile duct

20
Q

What is the function of the sphincter of Oddi?

A

Controls the release of bile and pancreatic juice into the duodenum

21
Q

When the sphincter of Oddi is contracted, the bile is forced

A

back into the gallbladder

22
Q

By how many times does the gallbladder concentrate the bile?

A

5-20 times

23
Q

The presence of fat in the duodenum stimulates cholecystokinin causing the sphincter of Oddi to

A

relax and the gallbladder to contract

24
Q

Cholecystokinin causes

A

pancreatic enzyme secretion and bile secretion

25
Surgical treatment of gallstones is only indicated when
the patient is symptomatic
26
What are the symptoms of gallstones?
Post-cholecystectomy pain Painful obstructive jaundice Acute pancreatitis Ascending cholangitis
27
What tests are most effective to identify gallstones and the structures being obstructed by them?
MRCP EUS Amylase and lipase CT
28
Why would a WCC be done if suspecting gallstones?
To determine any signs of sepsis
29
What two invasive procedures might be done to gather more information once there is evidence of gallstones?
PTC | ERCP
30
What are the possible surgical options for gallstones?
Open/mini/NOTES/single port/subtotal cholecystectomy Laparoscopic cholecystectomy - treatment of choice
31
What is the typical presentation of cholangiocarcinoma?
Obstructive jaundice Itching Non-specific symptoms e.g. fatigue, malaise
32
Give 6 investigations which would be done if suspecting cholangiocarcinoma
``` Bloods USS EUS CT MRA MRCP PTC Angiography FDG PET ERCP Cholangioscopy and cytology ```
33
What are the possible treatment options for cholangiocarcinoma?
Surgery is the only potentially curative option | Palliative care