week 2 Flashcards by Eilidh Green

What is the blood supply to the liver?

Hepatic artery (oxygenated blood))
Portal vein (nutrient rich)

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What are some functions of the liver?

removing waste
breakdown of drugs
synthesis of clotting factors
bile production
vitamin and mineral storage
glycogen

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What is cirrhosis?

End result of chronic inflammation and scarring

Altered circulation and function

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What are some causes of cirrhosis?

alcohol
viruses
toxins / drugs
inherited conditions

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What are the signs and symptoms of cirrhosis?

encephalopathy
sparse body hair
muscle wasting
dilated vessels
red palms
jaundice 
hobnail fibrotic liver

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What is the function of the gallbladder?

To store and concentrate bile

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What are the three types of jaundice?

pre hepatic
hepatic
post hepatic

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What is pre-hepatic jaundice?

haemolytic - more bilirubin than can be excreted

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What is hepatic jaundice?

liver is damaged, can’t excrete normal levels of bilirubin

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What is post hepatic jaundice?

bile can’t flow properly

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Describe ulcerative colitis

idiopathic
relapsing
caecum -rectum
pain, bloody diarrhoea
increased risk of malignancy

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Describe Crohn’s disease

idiopathic
chronic 
anywhere from mouth to anus
transmural inflammation
skip lesions
abdominal pain, diarrhoea, weight loss, obstructive symptoms

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IN what ways are sinusoids different from capillaries?

have fenestrations to exchange material

no complete basement membrane to facilitate transfer of substances

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what types of parenchymal cells are there?

hepatocytes
endothelial
Kupffer (macrophages)
Perisinusoidal (fat storing)
liver - associated lymphocytes

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What types of collagen are found in the liver capsule?

I and III

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Describe expected stool and urine in prehepatic jaundice

urine normal

stool normal

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Describe expected stool and urine in hepatic jaundice

urine dark

stool normal

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Describe the expected stool and urine in post hepatic jaundice

urine dark

stool pale

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What are the complications of cirrhosis?

portal hypertension
portal systemic shunts - varices
ascites
splenomegaly
liver failure
hepatocellular cancer

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What are the effects of liver failure?

jaundice
coagulation disorders
impaired synthesis of urea and glycogen
altered xenobiotic metabolism
immune, circulatory and endocrine disturbances

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what are the three zones of metabolic processes in the liver?

periportal
ill-defined intermediate
perivenular

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What reactions occur in the peri portal area of the liver?

respiratory chain
citric acid cycle
fatty acid oxidation
gluconeogenesis
urea synthesis
production and secretion of bile

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What occurs at the perivenular part area of the liver?

glycolysis
glutamine synthesis
xenobioic metabolism

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What is contained in bile?

Study These Flashcards

water
electrolytes
phospholipids
bile salts
cholesterol
waste

why do we need iron?

for the production of red blood cells - forms part of haemoglobin many enzymes require iron

How is the majority of iron stored?

In ferrritin

How is a small amount of iron stored?

in haemosderin

Discuss changes in serum ferritin levels

Decreased in IDA increased in iron overload increased in tissue inflammation - acute phase protein

How is iron transported?

by transferrin

What is normal Tf saturation?

30%

What happens the the amount of Tf if iron levels decrease?

It increases

What is the daily requirement of iron?

1-2mg

How much iron is taken in a western diet?

15-20mg

What regulates the absorption and release of iron?

hepcidin

Where does most iron absorption occur?

the duodenum

How is non-haem iron released?

by acid digestion and proteolytic enzymes. | Must be reduced from ferric to ferrous iron by duodenal cytochrome C (influenced by vitamin C)

How is iron taken up by an enterocyte?

through the divalent metal transporter 1.

How is iron transported from the enterocyte to the plasma?

through ferroportin and hepcidin

Describe hepcidin

reduces iron in plasma binds to ferroportin and degrades it reduces GI absorption reduces macrophage iron release

HFE and haemochromatosis

autosomal recessive but mainly in men abnormalities in HFE gene reduces hepcidin production

Describe transferrin quantities and saturations in normal, IDA and HHC

normal - normal, 30% IDA - more transferin - 15% HHC - less transferrin - 100%

What does HHC cause?

``` cirrhosis diabetes restrictive cardiomyopathy bronzing of skin arthritis ```

What are the treatments of HHC?

venesection monitoring prevent or limit organ damage

What is sideroblastic anaemia?

iron taken up by eryhtroblasts but get trapped in the mitochondria

Describe emulsifcation

the breakdown of large lipid droplets into small droplets hydrophobic portion binds to and disperses large triglycerides hydrophilic portion prevents large droplets from reforming increases surface area for lipase to act on

What are miscelles made from?

bile salts, fatty acids, monoglycerides, phospholipids, cholesterol and fat soluble lipids

Describe the regulation of bile secretion

during inter digestive period sphincter of Oddi is contracted fatty acids and amino acids stimulate the production of CCK which relaxes the sphincter Acidic chyme in the duodenum stimulates secretin release which stimulates bicarbonate secretion

What is achalasia?

lower oesophageal sphincter does not relax after swallow | absence of peristaltic activity

What is scleroderma?

week lower oesophageal sphincter absent peristalsis severe oesophagitis

What is nutcracker oesophagus?

assoiciated with pain on swallowing muscles contract too strongly functional swallow benign prognosis

What are standard LFTs?

``` bilirubin albumin alkaline aminotransferase (ALT) aspartate aminotransferase (AST) Alakline phosphate ```

What does elevated AST / ALT indicate?

hepatocellular injury

What does increased ALP indicate?

cholestasis / bone disease

What would increased ALP with normal GGT normally indicate?

bone disease

What is Gilbert's disease?

lack of enzyme to conjugate bilirubin

What are the 3 types of alcoholic liver disease?

fatty liver (steatosis) alcoholic hepatitis cirrhosis

Describe hepatic alcohol metabolism

two main metabolic pathways both oxidise alcohol to produce acetaldehyde Acetaldehyde converted to acetate the acetyl Co-A

What immediate effect does alcohol metabolism have on the liver function

reduces capacity of hepatocyte to oxidise other molecules

week 2 Flashcards

(58 cards)