Williams- Physiology of Liver and Biliary Tract Flashcards
(98 cards)
1
Q
divides segment 2 and 3 from the 4th segment in the L liver
A
falciform ligament
2
Q
____liver composed of segments 5-8
A
R
3
Q
_____ liver is composed of segments 2,3, and 4
A
L
4
Q
where is segment I (caudate lobe)
A
in b/t the two lobes
5
Q
fibrous capsule that surrounds liver
A
Glisson’s capsule
6
Q
oxygenated blood flows in from the______
A
hepatic artery
7
Q
nutrient rich blood flows in from the ______
A
portal vein
8
Q
cell of the liver
A
hepatocyte
9
Q
more than one hepatocyte
A
lobule
10
Q
confluence of the portal venule and hepatic venule
A
sinusoid
11
Q
b/t hepatocyte and sinusoid (basolateral surface)
A
Space of Disse
12
Q
_______ is secreted into apical/canalicular space
A
bile
13
Q
sinusoids are on what surface
A
basolateral
14
Q
bile flows in what direction to blood
A
opposite
15
Q
bile flowing away from central vein toward portal triad
A
choleresis
16
Q
slowing of bile flow (can be due to injury to hepatocyte)
A
cholestasis
17
Q
____ flows from portal vein and hepatic artery toward central vein (becoming a sinusoid)
A
blood
18
Q
what view of liver
A
hepatic lobule
19
Q
what view of the liver
A
Acinar view
20
Q
zone 1 of liver
A
periportal (most oxygenated)
21
Q
zone that is nearest to portal triad
A
periportal (zone 1)
22
Q
zone 2 of liver
A
intermediate
23
Q
zone 3 of liver
A
centrilobular (least oxygenated)
24
Q
which zone is 1st affected by ischemia
A
centrilobular zone (zone 3)
25
what view of liver
acinar view
26
what makes up the portal triad
hepatic artery
portal vein
bile duct
27
structures that lie within hepatoduodenal ligament
hepatic a.
portal vein
bile duct
28
triangle of Calot borders
Superior: The inferior surface of the liver
Inferior: The cystic duct
Medial: The common hepatic duct
29
cystic duct and common hepatic duct join to form what
common bile duct
30
main area cell death occurs in the liver due to ischemic injury
centrilobular (zone 3)
31
drug toxicity injures what zone
zone 3
32
Hepatitis C injures what zone
Zone 1 (periportal)
33
filtration
digestion
metabolism/detoxification
protein synthesis
storage of vitamin, minerals, energy
main functions of the liver
34
enzymes located in cytosol of hepatocyte; if elevated in the serum, means injury to hepatocyte
AST/ALT
35
enzyme located on canalicular surface of hepatocyte; if elevated in serum, means bile duct in distress
GGT and Alk Phos
36
2 labs that can tell us about liver function
Albumin
INR
37
what enzymes that pertain to the liver don't just belong to the liver
AST/ALT
38
what does it mean if transaminases are elevated (AST/ALT)
hepatocellular injury
39
phase 1 of hepatic detoxification
CYP450 alters parent molecule
40
phase 2 of hepatic detoxification
synthesis drug conjugates (make water soluble)
41
phase 3 of hepatic detoxification
excrete molecule or conjugate into bile
42
major enzymes involved in drug metabolism and mainly act on the liver (speed up metabolism of drugs)
P450 Cytochromes
43
another key enzyme in body (liver) that metabolizes drugs, etc
CYP3A4/3A5
44
drugs come to liver through ____
central vein
45
____ and _____are CYP450 and CYP3A4 enzyme inducers (helps speed up metabolism)
Rifampin and St. John's Wort
46
Phenytoin/carbamazepine
CYP450 inducers
47
Na+/valproate
CYP450 inhibitors
48
3 main CYP3A4/3A5 enzyme inducers (speed up metabolism of drugs)
Rifampin
carbamazepine
St. John's Wort
49
inhibitors of CYP3A4/3A5
antibiotics, anti-virals, and anti-fungals
50
grapefruit juice
wild cherry
chamomile
licorice
CYP3A4 inhibitors (allow for drug to be available longer in body)
51
conjugation of drug or parent molecule requires what 2 enzymes
Glucuronyl transferase
Glutathione transferase
52
MDR1, MRP2, and BSEP, MDR3 proteins are located where help secrete drugs/conjugates into bile
canalicular surface
53
______is located where and helps facilitate passage of drug conjugate into sinusoidal circulation
MRP3
54
3 phases of liver detoxification
1. alter parent molecule (CYP450)
2. conjugation (make water soluble)
3. secrete into bile
55
bilirubin that is not water soluble and cant be measured
indirect bilirubin
56
water soluble bilirubin and can be measured
direct bilirubin
57
step 1 of bilirubin metabolism
hemeprotein from old RBC's enters macrophages
58
step 2 and 3 in bilirubin metabolism
breakdown of heme into biliverdin (green), then biliverdin into unconjugated bilirubin in macrophage
59
step 4 in bilirubin metabolism
unconjugated bilirubin attaches to buddy albumin and is carried into liver
60
until step ____ is complete, bilirubin remains unconjugated
step 4
61
what happens at the end of step 4 of bilirubin metabolism
bilirubin is conjugated (made water-soluble)
62
how is heme broken down to biliverden
heme oxygenase
63
how is biliverden broken down to bilirubin
biliverdin reductase
64
step 1-4 of bilirubin metabolism
unconjugated bilirubin
65
2 enzymes used in phase 2 of liver detoxification and presents bilirubin for conjugation
glucuronic acid
glutathione-S-transferase
66
reduces efflux of bilirubin back into serum and presents bilirubin for conjugation
glutathione-S-transferase
67
rate limiting step in bilirubin metabolism
UGT1A1 (UDPGT) conjugates bilirubin
68
bilirubin + glucuronic acid=
conjugated bilirubin
69
step 5 of bilirubin metabolism
conjugated bilirubin now secreted into bile duct and intestines
70
how is conjugated bilirubin transported into bile
by active transport of MRP2
71
step 6 of bilirubin metabolism
bile drains into duodenum and bacteria can reduce bilirubin to urobilinogen
72
what happens to most of the bilirubin
gets excreted out through poop
73
upper limit of normal conjugated bilirubin (direct bilirubin)
0.3 mg/dL
74
gene that produces an enzyme that attaches glucuronic acid to bilirubin for conjugation
UGT1A1
75
what to do if serum bilirubin is 4.2 mg/dL
FRACTIONATE (indirect and direct)
76
indirect hyperbilirubinemia (unconjugated): TB<5 mg/dL
Gilbert syndrome
77
insufficient UGT1A1 seen with this syndrome
Gilbert Syndrome
78
pt w/ an elevated total and indirect bilirubin in serum from CMP labs performed fasting for an unrelated issue
Gilbert Syndrome
79
what to do with total bilirubin
fractionate it
80
complete loss of UGT1A1 (no conjugation); infants will die
Type I Crigler Najjar syndrome
81
significantly reduced UGT1A1
type II Crigler Najjar syndrome
82
to Rx type II Crigler Najjar syndrome
phenobarbital (increases enzyme)
83
defect in MRP2
liver is black
80% of urine coproporphyrin is isomer 1
Dubin-Johnson syndrome
84
defect in OATP1B1 and OATP1B3
mixed conjugated and unconjugated hyperbilirubinemia
urine coproporhyrin
Rotor Syndrome
85
Dubin-Johnson syndrome and Rotor's syndrome both have impaired canalicular export of what
conjugated bilirubin
86
2 main bile acids
CA and CDCA
87
what synthesizes bile acids
cholesterol
88
rate limiting enzyme of bile acid metabolism
CYP7A1
89
how are bile acids made stronger
conjugated with glycine or taurine
90
functions in lipid digestion and absorption
bile acids
91
need ______ to absorb fat soluble vitamins
bile acids
92
also used for anti-microbial defense
bile acids
93
contains bile acids and other molecules
bile
94
flow of bile
choleresis
95
during fasting state, bile acids concentrate where
gallbladder
96
after a meal, _____ will relax sphincter of Oddi and stimulate gallbladder contraction and bile will move into small intestine
CCK
97
facilitates fat absorption and delivers lipids to mucosa surface
micelles
98
slowing of bile movement
cholestasis
