Liver S2M2

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  1. What is considered the triad in the liver
    • Bile duct
    • Hepatic artery
    • Portal vein
  2. What is the Hilum of the liver
    The site where the Hepatic artery, Portal vein, and Bile duct enter the liver
  3. What is the blood supply to the liver and what makes it unique
    Portal vein carries 75% of the blood to the liver which is deoxygenated, carrying nutrients, and toxins

    Hepatic artery carries the other 25% of the blood to the artery which is oxygenated
  4. What is the blood flow route through the liver
    • Portal vein or Hepatic artery
    • Sinusoids
    • Central vein
    • Sublobular vein
    • Hepatic vein
    • Inferior vena cava
  5. What is the connective tissue capsule called covering the liver
    Glisson's capsule
  6. What does a hepatic lobule consist of
    A six sided polyhedral prism with portal triads at each corner and a central vein in the middle of each lobule
  7. What is the role of the bile canaliculi
    Bile flows from triad into the bile duct between the hepatic cords which make up the bile canaliculi
  8. What are the Peritubular and Centrilobular lobes
    Liver lobule triangular sections consisting of two triads and the central vein, the portion closest to the triad is Perilobular, and the section closest to the central vein is Centrilobular
  9. What is the significance of the Centrilobular section of the liver lobule
    • It is nearest to the central vein and therefore receives the least amount of nutrients (toxins)
    • It is also vulnerable to anoxia being the lasts portion to receive oxygen
  10. What is the significance of the Peritubular region of the liver lobules
    This is the region next to the triad and therefore is less prone to anoxia but supplied more by toxins and nutrients coming from the venous blood
  11. What is the difference between the Portal lobule and the Liver acinus
    Portal lobule is a section of the liver lobule characterized by the area between three central veins

    Liver acinus is characterized by the area between to adjacent central veins
  12. What is unique about Hepatocytes
    Each perform most of the functions of the liver (equipotential) but may have specialization
  13. Hepatic sinusoids
    Specialized capillaries that carry blood through the liver parenchyma
  14. What are the three cell types associated with Hepatic sinusoids
    • Endothelial cells (fenestrated)
    • Kupffer cells
    • Stellate cells (Ito cells) fat storing
  15. Where are the Stellate cells found in the liver
    In the space of Disse (between Endothelial cells and the hepatocytes)
  16. What are Kupffer cells
    Cells found lining the sinusoids in liver that are Antigen presenting cells and macrophages
  17. Bile canaliculi
    Space between adjacent hepatocytes sealed by zonula occludens forming Hering's canal where bile travels to the bile ducts
  18. What is the purpose of the Gall bladder
    Serves as a reservoir for bile and functions to concentrate it by removing water
  19. What layers are found in the Gall bladder
    • Mucosa
    • Muscularis externa
    • Serosa
    • (No muscularis mucosa or submucosa)
  20. An excess in copper stored in the body can cause
    • Wilsons disease
    • Keyser-Fleischer rings around the eyes are a classic clinical finding
    • Parkinsons
  21. All circulating protein accept which are synthesized by the liver
  22. Detoxification in the liver undergoes Phase 1 and Phase 2, what happens in phase 1
    (Slow stage) The substance can undergo (P-450) Oxidation, Reduction, or Hydrolysis and is then sent to the kidneys for excretion or to phase 2 for conjugation
  23. What happens in Phase 2 of detoxification in the liver
    (Fast stage) Conjugation, and then the conjugated metabolite is sent to the kidneys for excretion
  24. In what form is iron stored in the liver
  25. Apoferritin
    A protein in the liver that reversibly binds with iron for later release when needed
  26. What vitamin is stored in the highest quantity in the liver
    • Vitamin A
    • Large amounts of B12, K, and D are also stored in the liver
  27. The liver can store vitamins A, D, and B12 for periods up to
    • A - 10 months
    • D - 3 to 4 months
    • B12 - 1 year
  28. What is the path that bilirubin takes to be excreted
    • RBC's are broken down and bilirubin released
    • Bilirubin binds to Albumin and taken to liver
    • Liver turns it into bilirubin diglucuronide
    • Bacteria in the intestines converts it to Urobilinogen
    • Urobilinogen leaves the body through feces and urine, or is recycled to the liver
  29. What gives urine its characteristic color
    Urobilin a derivative of Bilirubin
  30. Periportal hepatocytes are most active in taking in and secreting
    Uptake of Bile salts, Oxygen, and Nutrients and secretion of bile constituents
  31. What functions are more active in Periportal hepatocytes then in Perivenous
    • Oxidation
    • Gluconeogenesis
    • Glygogen deposition
    • Bile salt conjugation
  32. What functions are most active in Perivenous hepatocytes
    • Taking in Drugs and toxins
    • Biotransformation
    • Glycolysis
    • Ketogenesis
    • Fat deposition
    • Excreting metabolites
  33. After feeding, glycogen is deposited firstly into what cells in the liver
    Periportal hepatocytes
  34. Periportal cell vs Perivenous hepatocytes
    • Periportal hepatocytes are next to the Portal vein
    • Perivenous hepatocytes are closer to the Hepatic vein
  35. Bile formation is made of two fluids made by what two cells
    • Hepatocytes (Dependent on Bile acid)
    • Ductule cells/Cholangiocyte (constantly formed)
  36. Hepatocytes in making bile have what two components contributing to its formation
    Bile acid independent portion, and a Bile acid dependent portion, the rate secreted is equal to Bile acid available
  37. An adequate bile flow is dependent on
    Bile salts being returned to the liver by the enterohepatic circulation.
  38. How much bile is secreted a day and how much of that leaves the body through the feces
    • 600ml a day
    • 5% is lost in the feces, the other 95% is taken back by the portal vein to the liver for reuse
  39. Enterohepatic circulation
    This is the process of Bile acids returning to the liver through the Portal vein after being used in the intestines
  40. Bile acids are synthesized in hepatocytes from what
  41. What are the primary bile acids found in the Duodenum
    • Cholate
    • Chenodeoxycholate
  42. What are the secondary bile acids found in the ileum
    • Deoxycholate
    • Lithocholate
  43. How do primary bile acids become secondary bile acids
    Primary bile acids are broken down by bacterial enzymes on their way to the ileum forming secondary bile acids
  44. Reabsorption of secondary bile acids in the intestines is dependent on
  45. What effect does an Ileal resection have on bile salt synthesis
    Due to the decrease in bile acid reuptake bile salt synthesis goes up dramatically
  46. What effect does eating bile acids have on bile acid synthesis
    Dramatically decrease it
  47. Pumping ions into the bile Canaliculi is passive or active
    Active - Pushing against a gradient
  48. What hormones increase Bicarbonate secretion from Cholangiocytes diluting the bile
    • Secretin
    • Glucagon
    • VIP
  49. As the gallbladder becomes more concentrated what happens to the levels of ions in the bladder
    • Na+ and Bile Acid anions increase concentration
    • Cl- and HCO3 decrease concentration in the duct
  50. What hormone inhibits bicarbonate secretion from the Cholangiocytes
  51. Most of the gallbladder absorption is caused by active transport of
    • Sodium through the gallbladder epithelium, and
    • this is followed by secondary absorption of chloride ions, and water
  52. How are gallbladder salts so concentrated
    Sodium/Hydrogen exchange occurs along with water and Cl- leaking out of the lumen to the basal lateral membrane, the bile is impermeable to the lumen wall thus becomes more concentrated
  53. VIP and Serotonin have what effect on gallbladder concentration
    They inhibit the absorption of electrolytes decreasing the gallbladders bile concentration
  54. What is the difference between Hepatic bile and gallbladder bile
    • Hepatic is more concentrated in electrolytes making it less potent
    • Gallbladder is more concentrated with organic components making it more potent
  55. What are the organic components of bile
    • Bilirubin
    • Cholesterol
    • Lecithin
    • Bile salts
  56. What is the effect of CCK on Bile secretion
    It relaxes the sphincter of Oddi and contracts the gallbladder for release into the Duodenum
  57. What is the effect of gallstones floating in the gallbladder
  58. What is the effect of gall stones being stuck in the Ampulla of vater
    This can cause damage to the Liver and Pancreas due to the shared duct
  59. Obstruction of the common bile duct by a gallstone causes
    Biliary colic (pain) and jaundice
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Liver S2M2
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