year 4 CMS > Liver > Flashcards

Liver Flashcards

(175 cards)

Study These Flashcards
1
Q

From where does blood drain in the venous drainage of the gut?

A

Portal venous system

Blood drains from the gut into the portal venous system toward the liver, unlike other body parts that drain directly into the left side of the heart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What can impede blood flow through the liver if it becomes diseased?

A

Fibrosis or inflammation

If the liver is diseased, it can impede blood flow from the portal vein, potentially leading to portal hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What condition can develop alongside liver disease and lead to oesophageal varices?

A

Portal hypertension

Portal hypertension can lead to dilated vessels at the bottom of the oesophagus, which may erode and bleed profusely.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the role of the liver hepatocytes?

A
  • Filter drugs
  • Metabolise nutrients (i.e.: vitamins)
  • Release into systemic circulation

Nutrient-rich blood flows from the gut to the liver where hepatocytes perform these functions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is the liver located in the body?

A

Right side, crosses midline, underneath the diaphragm

The liver is a large organ with significant regenerative potential.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the regenerative potential of the liver?

A

Can regenerate after losing 90%

The liver has an amazing ability to regenerate itself even after significant loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the two main types of blood vessels associated with the liver’s circulation?

A
  • Portal veins
  • Hepatic arteries

The liver is a very active metabolic organ with both portal veins draining blood from the gut and hepatic arteries supplying blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What drains bile out of the liver into the gall bladder?

A

Hepatic duct

The hepatic duct is responsible for draining bile from the liver to the gall bladder, which then reaches the small intestine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the arrangement of liver cells called that facilitates blood diffusion?

A

Hexagonal liver nodules

Blood is divided into smaller vessels called hepatocytes, allowing for metabolism, synthesis, and detoxification.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the role of the liver in filtering blood from the gut?

A

Contains Kupffer cells that phagocytose dead/infected cells and bacteria

Kupffer cells are specialized phagocytic cells in the liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do bile salts produced by the liver allow?

A
  • Emulsification of fats in diet
  • Increase absorption of fat-soluble vitamins (KADE)

Lack of bile production can lead to malnutrition issues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where are bile salts stored?

A

In the gall bladder

Bile salts are released in response to food in the GI tract.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is bile released into the small intestine?

A
  • Stored in gall bladder
  • Extracted fluid
  • Released in response to fatty meal
  • Squirted into duodenum

This process aids in digestion and absorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the functions of Kupffer cells in the liver?

A
  • Filtering microbes and toxins
  • Metabolizing nutrients and drugs
  • Exocrine function

Kupffer cells play a crucial role in liver health and function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is bilirubin and how is it produced?

A
  • Produced from breakdown of hemoglobin
  • Converted in spleen to bilirubin
  • Needs to bind to albumin to become water soluble

Bilirubin is conjugated in the liver to become water soluble.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens if the body cannot secrete bilirubin?

A

Leads to jaundice

Jaundice is characterized by yellow discoloration of the skin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the components synthesized by the liver?

A
  • Clotting factors
  • Antibodies
  • Albumin

These components are essential for various bodily functions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the importance of cholesterol produced by the liver?

A
  • Important for metabolism and circulation of hormones
  • Important for Vitamin D metabolism

Cholesterol plays a vital role in hormonal balance and vitamin absorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the role of albumin in the blood?

A

Keeps blood in vessels and prevents fluid leakage into tissues

Low albumin levels can lead to oedema and reduced blood pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What happens if albumin levels are low?

A
  • Inability to maintain osmotic potential
  • Peripheral oedema
  • Reduced blood pressure

This can occur in patients with liver failure or low albumin levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why do most drugs need to be de-activated and/or excreted?

A

To prevent them from remaining permanently in the body

This is crucial for maintaining drug safety and efficacy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Most drugs are insoluble in water but soluble in fat. Why is this significant?

A

They must pass through the lipid bilayer of cell membranes

This property allows drugs to interact with cells effectively.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What must drugs be bound to for transport in the blood?

A

Plasma proteins (such as albumin)

Plasma proteins are too large to be filtered by the glomerulus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the function of the glomerulus in drug metabolism?

A

Filters blood, allowing small molecules to pass into kidney tubules

Large molecules like plasma proteins remain in the blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the first phase of drug metabolism?
Make the molecule more polar (water soluble) ## Footnote This phase includes hydrolysis, reduction, and cytochrome P450 reactions.
26
Name two processes involved in **Phase 1** of drug metabolism.
* Hydrolysis * Reduction ## Footnote Cytochrome P450 enzymes are involved in hydroxylation and oxidation.
27
What is the purpose of **Phase 2** in drug metabolism?
Make the molecule less active and more soluble ## Footnote This phase involves conjugation, making drugs easier to filter and excrete.
28
What are some examples of conjugation in **Phase 2** metabolism?
* Sulphate * Gluconate * Glucuronide ## Footnote These modifications help in making drugs less fat soluble.
29
What is the **phenomenon of first pass metabolism**?
The drug gets one pass through an organ, changed into a form ready to be excreted or deactivated ## Footnote Drugs subject to this won't remain in the body for long and are eliminated through excretory pathways.
30
Name the **organs** where first pass metabolism can occur.
* Liver * Lungs * Gut * Other organs ## Footnote Enzymes facilitate the first pass metabolism process.
31
True or false: **Lignocaine** can be effectively administered orally.
FALSE ## Footnote Lignocaine is subject to first pass metabolism in the gut, leading to deactivation.
32
What is the purpose of **GTN spray** in medical emergencies?
To relieve angina by facilitating absorption through the mucosa ## Footnote GTN spray avoids first pass metabolism in the gut when administered correctly.
33
How does **first pass metabolism** affect **codeine**?
Codeine is converted into morphine during first pass metabolism ## Footnote Pain relief occurs due to the action of morphine rather than codeine.
34
What role do **cytochrome p450 enzymes** play in drug metabolism?
They metabolize drugs and can be induced or inhibited ## Footnote Induction can increase the metabolism of drugs, while inhibition can decrease it.
35
Fill in the blank: **Cytochrome p450** enzymes are a group of enzymes coded by similar _______.
genes ## Footnote These enzymes can be induced by certain drugs.
36
What happens when drug A is metabolized by **cytochrome p450**?
It can lead to the production of a metabolite A’ ## Footnote This same group of enzymes may also metabolize other drugs, affecting their levels.
37
What is the effect of **inhibition** of cytochrome p450?
The enzyme is less able to metabolize drugs, potentially leading to increased levels of those drugs ## Footnote This can cause indirect inhibition of other drugs metabolized by the same enzyme.
38
What is the effect of **Erythromycin** on Cytochrome P450?
Inhibits p450, enhances the activity of warfarin ## Footnote This results in increased warfarin circulation, leading to a higher INR value.
39
What is the effect of **Miconazole** on Cytochrome P450?
Inhibits p450, enhances the activity of warfarin ## Footnote Used for fungal skin conditions.
40
What is the effect of **Grapefruit juice** on Cytochrome P450?
Enhances p450, reduces the activity of warfarin ## Footnote This can lead to decreased warfarin effectiveness.
41
List the **responsibilities of the liver**.
* Filtering blood * Metabolism of drugs * Metabolism of bilirubin * Synthesis of clotting factors * Synthesis of albumin * Synthesis of hormones * Synthesis of antibodies ## Footnote A protein produced by the liver is a marker of liver synthetic function; depletion indicates liver failure.
42
What is **ascites**?
A condition in which fluid collects in spaces within the abdomen ## Footnote It can result from portal hypertension and low albumin levels, leading to fluid retention in the peritoneal cavity.
43
True or false: The liver is responsible for synthesizing **hormones**.
TRUE ## Footnote Hormone metabolism and activity are key functions of the liver.
44
What are the **mechanical uses** of the liver?
* Portal hypertension * Oesophageal varices * Ascites ## Footnote These conditions can lead to complications such as fluid retention and abdominal distension.
45
Fill in the blank: The liver is responsible for the **metabolism of** _______.
[drugs] ## Footnote This includes the metabolism of various substances, including bilirubin.
46
What is **Jaundice** typically caused by?
* Obstruction of the bile duct * Liver disease * Excessive breakdown of red blood cells ## Footnote Jaundice arises from excess of the pigment bilirubin, leading to yellowing of the skin or whites of the eyes.
47
What are the signs of **Jaundice**?
* Yellowing of the skin * Yellowing of the whites of the eyes (sclera) * Discoloration of palmer creases ## Footnote Jaundice can be difficult to identify in darker skin tones, but the sclera is a consistent reference point.
48
What is **Finger clubbing**?
A loss of the angle between the nail bed and the nail ## Footnote The cause is unknown but thought to be linked to protein deposits in the fingers.
49
What is **Dupuytren's contracture** associated with?
* Contraction of the fascia in the hand * Affects the ring and pinky finger ## Footnote It can be quite debilitating, causing two fingers to be more or less glued to the palm.
50
What is **Gynaecomastia**?
Development of breasts in males ## Footnote It can lead to feminisation of the male body.
51
What is **Sialosis**?
* Painless, bilateral swelling of the salivary glands * Usually noticed in the parotids ## Footnote The parotid glands are big, bulky, smooth, and have discrete lumps to rule out tumors.
52
What are the characteristics of **Sialosis**?
* Bilateral swelling * Present in diabetics or patients with liver disease * Associated with chronic alcohol use ## Footnote The swelling is usually noticed in the parotid glands.
53
What do **deranged liver function tests (LFTs)** indicate?
They can indicate if liver function is deranged ## Footnote LFTs test bilirubin levels and other liver functions.
54
What does an **impaired clotting (INR)** or clotting screen look for?
Different clotting functions ## Footnote These will be deranged if there is significant liver disease.
55
What is **acute liver disease**?
A type of liver disease characterized by rapid onset and inflammation ## Footnote It can be caused by factors such as alcohol and drugs.
56
What is the process of ethanol metabolism in the liver?
* Ethanol → Acetaldehyde → Acetate ## Footnote Acetaldehyde is highly reactive and toxic, causing inflammation and hepatocyte death.
57
What is the effect of **acetaldehyde** on hepatocytes?
Causes inflammation and death of hepatocytes ## Footnote It is the toxic nature of acetaldehyde that leads to liver damage.
58
What is the **maximum recommended dose** of paracetamol for an average-sized adult?
1000mg, 4 times a day ## Footnote Exceeding this dose can lead to liver damage.
59
What percentage of paracetamol is converted to **non-toxic conjugates**?
95% ## Footnote These non-toxic conjugates include sulphates and glucuronides, which can be safely excreted.
60
What happens to the remaining **5% of paracetamol**?
Converted into toxic metabolites by cytochrome P450 ## Footnote This process can lead to liver inflammation and hepatocyte death if the recommended dose is exceeded.
61
What is formed in **phase one** of paracetamol metabolism?
A highly reactive and toxic metabolite ## Footnote The specific name is not necessary to know, just that it is toxic.
62
What are the **signs and symptoms** of hepatitis?
* Abdominal pain * Fever * Jaundice * Itchy skin * Dark urine * Pale bowel motions ## Footnote Symptoms can overlap with gallbladder disease and liver failure.
63
What indicates an **active infection** in hepatitis?
Fever ## Footnote Fever is a common sign of infection and can be present in hepatitis.
64
What causes **pale bowel motions** in liver disease?
Unabsorbed fat due to lack of bile salts ## Footnote The liver's inability to produce bile salts leads to this symptom.
65
What is the **route of infection** for **Hepatitis A**?
Fecal-oral ## Footnote Hepatitis A is primarily transmitted through poor hygiene and consumption of contaminated food or water.
66
What are the **risk factors** associated with **Hepatitis B**?
* Unprotected sex * Transfusion of unscreened blood * IV drug abuse * Sex workers * Healthcare workers ## Footnote These factors increase the likelihood of exposure to the virus.
67
What type of **diagnosis** is used for **Hepatitis C**?
* Blood antibodies * RNA ## Footnote Diagnosis involves detecting the presence of antibodies and viral RNA in the blood.
68
True or false: There is a **vaccine available** for **Hepatitis E**.
FALSE ## Footnote Currently, there is no vaccine available for Hepatitis E.
69
What is the **long term impact** of **Hepatitis B**?
* 10% develop chronic hepatitis * Cirrhosis * Liver failure ## Footnote Chronic conditions can arise from Hepatitis B infection, leading to severe health complications.
70
What is the **carrier state** for **Hepatitis A**?
No ## Footnote Individuals infected with Hepatitis A do not become carriers of the virus.
71
What is the **route of infection** for **Hepatitis C**?
* Infected blood * Mother to newborn ## Footnote Hepatitis C is primarily transmitted through blood-to-blood contact.
72
What are the **risk factors** for **Hepatitis A**?
* Poor hygiene * Travel abroad to endemic areas ## Footnote These factors increase the risk of contracting Hepatitis A.
73
What is the **diagnosis** method for **Hepatitis A**?
Blood antibodies ## Footnote Diagnosis is confirmed by detecting antibodies in the blood.
74
What is the **long term impact** of **Hepatitis E**?
Most recover <2 months ## Footnote Hepatitis E typically resolves within a short period without chronic effects.
75
What is **Hepatitis B** important for understanding?
* Transmission * Protection * Testing ## Footnote Understanding Hepatitis B includes knowing how it is transmitted, how we are protected against it, and how we test for it.
76
What can the type of **antigen/antibody** in the blood indicate regarding Hepatitis B?
* Fresh infection * Old infection (recovered) * Vaccination status ## Footnote This information is crucial for diagnosing and understanding the patient's history with Hepatitis B.
77
Hepatitis B vaccinations are now routinely offered to _______.
babies ## Footnote This vaccination helps protect infants from Hepatitis B from an early age.
78
Why are **Hepatitis C** and **E** important?
* Link with infected blood transmission * Ongoing transmissibility * Risk of developing cirrhosis ## Footnote Hepatitis C is less common but more concerning due to its higher risk of cirrhosis.
79
What is the chance of developing **cirrhosis** for Hepatitis B?
10% ## Footnote This statistic highlights the potential long-term effects of Hepatitis B infection.
80
What is the chance of developing **cirrhosis** for Hepatitis C?
60% ## Footnote Hepatitis C poses a higher risk for cirrhosis compared to Hepatitis B.
81
What is the primary method for diagnosing **Hepatitis B**?
Blood tests detecting antigens and antibodies ## Footnote These tests determine if an infection is acute, chronic, or if immunity exists.
82
Name the **key diagnostic blood tests** for Hepatitis B.
* HBsAg (surface antigen) * Anti-HBs (surface antibody) * Total anti-HBc (core antibody) * HBeAg (e antigen) * HBV DNA Test (Viral Load) ## Footnote These tests help assess the infection status and severity.
83
What does a **positive HBsAg** test indicate?
Current infection (acute or chronic) ## Footnote If positive for over 6 months, it suggests chronic infection.
84
What does a **positive Anti-HBs** test indicate?
Immunity from vaccination or recovery from a past infection ## Footnote This test shows that the body has developed antibodies against the virus.
85
What does a **positive Total Anti-HBc** test indicate?
Past or present infection ## Footnote This test detects antibodies against the core of the virus.
86
What does a **positive HBeAg** test suggest?
High, active viral replication and high transmissibility ## Footnote This indicates a more severe form of the infection.
87
What does the **HBV DNA Test** measure?
The amount of virus in the blood ## Footnote This helps monitor infection severity.
88
When should individuals be tested for **Hepatitis B**?
* Symptoms: Jaundice, fatigue, dark urine, abdominal pain * Screening: All adults 18 and older at least once in their lifetime * Risk Factors: High-risk behaviors, abnormal liver enzymes, high-prevalence areas ## Footnote The CDC recommends screening based on these criteria.
89
What does a **positive HBsAg** and a **negative Anti-HBs** indicate?
Active infection ## Footnote This combination shows that the virus is currently present in the body.
90
What does a **negative HBsAg** and a **positive Anti-HBs** indicate?
Immune (via infection or vaccination) ## Footnote This means the body has developed immunity against the virus.
91
What does a **negative HBsAg**, **positive Anti-HBs**, and **positive Anti-HBc** indicate?
Immune due to natural infection ## Footnote This shows that the person has recovered from a past infection.
92
What further evaluations may be used to measure **liver damage**?
* Ultrasound (transient elastography) * Liver biopsy ## Footnote These methods provide insights into the extent of liver damage.
93
What is **chronic liver disease** commonly referred to as?
cirrhosis ## Footnote Chronic liver disease involves long-term damage to the liver, leading to scarring and impaired function.
94
What is the primary function of the liver related to blood?
* Filtering blood * Detoxifying substances * Metabolizing nutrients ## Footnote The liver has a large blood supply coming in from the gut, which is essential for these functions.
95
What leads to **scarring and fibrosis** in chronic liver disease?
Chronic inflammation ## Footnote This inflammation affects the liver's ability to function properly.
96
What are the main problems associated with **chronic liver disease**?
* Functions of the liver * Metabolism and synthesis * Blood flow ## Footnote These issues arise due to the liver's compromised ability to process blood and nutrients.
97
What is crucial for the **management of liver disease**?
Preventing damage ## Footnote Early prevention is key to avoiding the development of liver disease.
98
Name two methods of **preventing liver disease**.
* Alcohol education * Vaccination against Hepatitis B ## Footnote Limiting over-the-counter paracetamol is also important.
99
What is a significant challenge once the liver has stopped functioning?
Limited treatment options ## Footnote Management becomes largely supportive after liver failure.
100
What nutritional issue may arise in patients with liver disease?
Inability to absorb fat-soluble vitamins ## Footnote Alternative forms of vitamins may be needed for proper metabolism.
101
What should be avoided in patients with **active liver failure**?
Normal levels of paracetamol ## Footnote Drug choice must be carefully managed in these patients.
102
What may a patient with severe liver disease require?
A liver transplant ## Footnote Transplantation can be successful but is complex and requires suitable donors.
103
What is necessary for **liver transplantation**?
* Tissue typing * Finding a suitable donor ## Footnote Donors must have died, as part of the liver cannot be donated.
104
Where does the **pancreas** sit in the body?
In the upper abdomen above the lower small intestine ## Footnote The pancreas lies next to the liver.
105
What drains into the **duodenum** through the common bile duct?
* Liver * Gall bladder * Pancreatic secretions ## Footnote Obstruction of the distal part of the common bile duct can cause obstruction of bile and pancreatic secretions.
106
What can happen if there is an obstruction in the common bile duct?
Autodigestion of the pancreas ## Footnote Pancreatic digestive pro-enzymes will still be secreted and can become activated.
107
What are the **two main functions** of the pancreas?
* Exocrine * Endocrine ## Footnote Each function has distinct roles in digestion and hormone regulation.
108
What does the **exocrine** function of the pancreas secrete?
Digestive enzymes ## Footnote These are secreted by the acini, which are similar to salivary gland acini.
109
What enzymes are produced by the pancreas?
* Amylase * Protease * Lipases ## Footnote Amylase and protease are involved in digesting sugars and amino acids, while lipases digest fats.
110
What stimulates the secretion of **lipases**?
* Low pH in duodenum * Presence of fat * Vagal stimulation ## Footnote The vagus nerve is a parasympathetic stimulatory nerve to the pancreas.
111
How are digestive enzymes secreted by the pancreas initially?
As pro-enzymes ## Footnote They are converted to active enzymes in the duodenum to prevent the pancreas from digesting itself.
112
What hormones are secreted by the **endocrine** function of the pancreas?
* Insulin * Glucagon * Somatostatin ## Footnote These hormones are produced by the Islets of Langerhans.
113
What controls the production of **insulin** and **glucagon**?
Blood glucose levels ## Footnote Insulin and glucagon have opposing actions in regulating blood sugar.
114
What is **pancreatitis**?
Inflammation of the pancreas ## Footnote It occurs due to obstruction of secretions causing autodigestion of the pancreas.
115
What are the **risk factors** for developing pancreatitis?
* Direct trauma * Gall stones * Diabetes * Gall bladder surgery * Excessive alcohol consumption * Pancreatic cancer * Drugs like azathioprine ## Footnote Azathioprine is used for conditions like Crohn's disease, rheumatoid arthritis, and lupus.
116
What are common **signs and symptoms** of pancreatitis?
* Severe upper abdominal pain * Vomiting * Weight loss * Very unwell * Steatorrhea * Jaundice * Diabetes mellitus * Increased serum amylase ## Footnote Steatorrhea is characterized by pale, brown, floating stool due to fat malabsorption.
117
True or false: **Severe upper abdominal pain** in pancreatitis typically radiates to the back.
TRUE ## Footnote This pain reflects the position of the pancreas at the back of the peritoneum.
118
What is the management approach for pancreatitis?
* Supportive care * Encourage fluids if in shock * Correct glucose/electrolyte imbalance * Antibiotics if necessary * Surgery to remove obstruction ## Footnote Surgery is generally avoided unless there are complications.
119
In pancreatitis, increased **serum amylase** indicates what?
Amylase is released into the blood instead of the duodenum ## Footnote Testing for serum amylase is a key diagnostic step in suspected pancreatitis.
120
Fill in the blank: **Pancreatitis** can lead to _______ if related to gall stones affecting liver function.
jaundice ## Footnote Jaundice occurs when the liver cannot process bilirubin.
121
What structures drain into the **duodenum** through the **common bile duct**?
* Liver * Gall bladder * Pancreas ## Footnote These structures are essential for digestion and secretion of bile and pancreatic juices.
122
What can cause obstruction of bile and/or pancreatic secretions?
Obstruction of the **distal part of the common bile duct** ## Footnote This obstruction can lead to significant digestive issues.
123
Approximately what percentage of **60 year olds** experience gallstones?
10% ## Footnote Gallstones are quite common in this age group.
124
What are **chylomicrons**?
Fats secreted by the liver within bile ## Footnote They include cholesterol and are involved in fat digestion.
125
What leads to the formation of **gallstones**?
* Cholesterol is excreted in the bile * Supersaturated solution of cholesterol in the gall bladder * Absorption of more water out of the bile * Crystallisation of cholesterol salts ## Footnote These processes contribute to gallstone formation.
126
List the **risk factors** for gallstones.
* Age * Gender (F>M) * BMI (high BMI increases risk) * Affluence (more common in rich people) * Diet (high fat diet) ## Footnote These factors can increase the likelihood of developing gallstones.
127
True or false: Most **gallstones** are symptomatic.
FALSE ## Footnote Most gallstones are asymptomatic and only cause problems if they obstruct drainage.
128
What are some **signs** of gall bladder disease?
* Abdominal pain (right upper quadrant) * Biliary colic (worse at meal times) * Nausea/vomiting * Fever (if infected - cholecystitis) * Jaundice (raised serum bilirubin) ## Footnote These signs indicate potential issues with the gall bladder.
129
What are the **symptoms of gallbladder disease**?
* Abdominal pain (right upper quadrant, 1-5 hours) * Biliary colic (worse at meal times) * Nausea/vomiting (if infected) * Fever (if infected-cholecystitis) * Jaundice (raised serum bilirubin) ## Footnote Biliary colic occurs when gallbladder contraction is obstructed, leading to increased pressure and pain.
130
Define **biliary colic**.
Pain when the gallbladder is contracting but cannot empty due to obstruction ## Footnote It is worse at meal times due to stimulation of gallbladder contraction.
131
What triggers **biliary colic**?
* Stomach contents injected into the duodenum * Gallbladder contraction obstructed * Increased pressure experienced as pain ## Footnote This pain comes in the form of peristaltic waves as the gallbladder attempts to contract.
132
What is the significance of **jaundice** in gallbladder disease?
Indicates raised serum bilirubin due to obstruction ## Footnote Jaundice can lead to bilirubin deposits in the liver and blood, causing dark smoky brown urine.
133
True or false: Most **gallstones** are symptomatic and cause problems.
FALSE ## Footnote Most gallstones are asymptomatic and only cause issues if they obstruct bile or pancreatic secretions.
134
What are the management options for gallbladder disease?
* Diet changes (lower fat) * Treatment of acute infections * Cholecystectomy (gallbladder removal) if problems persist ## Footnote Management depends on the severity and frequency of symptoms.
135
What are the two sources of **blood supply** to the liver?
* Portal vein (~75%) * Hepatic artery (~25%) ## Footnote The portal vein carries nutrient-rich, low oxygen blood, while the hepatic artery supplies oxygen-rich blood.
136
Describe the **flow pathway** of blood through the liver.
* Gut capillaries * Portal vein * Liver sinusoids * Central vein * Hepatic vein * IVC ## Footnote This pathway illustrates how blood is processed in the liver.
137
What are **sinusoids** in the liver?
* Highly permeable capillaries * Allow exchange between blood & hepatocytes ## Footnote Sinusoids are crucial for liver function and metabolism.
138
What types of cells are present in the liver sinusoids?
* Hepatocytes * Kupffer cells * Stellate (Ito) cells ## Footnote Each cell type has specific functions, such as metabolism and immune response.
139
What is the role of **Stellate (Ito) cells** in the liver?
* Store vitamin A * Produce collagen when activated ## Footnote Activation of Stellate cells is key in the development of fibrosis and cirrhosis.
140
What is the most common cause of **portal hypertension**?
Cirrhosis ## Footnote Other causes include portal vein thrombosis and schistosomiasis.
141
List the **consequences** of portal hypertension.
* Portosystemic anastomoses open * Blood bypasses liver ## Footnote This can lead to complications such as varices and hemorrhoids.
142
What are the **zones** of the liver lobule?
* Zone 1: Near portal triad, oxygen-rich * Zone 2: Middle, intermediate * Zone 3: Near central vein, low oxygen ## Footnote Zone 3 is the most hypoxia-sensitive and first to die in shock.
143
What does the liver produce for **clotting**?
* Fibrinogen * Prothrombin * Factors II, VII, IX, X ## Footnote The production of these factors requires Vitamin K.
144
What is the **bilirubin pathway** in the liver?
* RBC breakdown → haem → biliverdin → unconjugated bilirubin * Conjugation via UDP-glucuronyl transferase → conjugated bilirubin → bile ## Footnote This pathway is essential for the metabolism of bilirubin.
145
What are the **types of jaundice**?
* Pre-hepatic: haemolysis, ↑ unconjugated * Hepatic: liver damage, mixed * Post-hepatic: obstruction, ↑ conjugated ## Footnote Each type is associated with different underlying conditions.
146
What is the consequence of **ammonia detoxification** failure in the liver?
Hepatic encephalopathy ## Footnote Symptoms include confusion, asterixis, and coma.
147
What is the **Cytochrome P450 System**?
Family of enzymes located in smooth ER of hepatocytes ## Footnote It plays a crucial role in drug metabolism.
148
What happens during **induction** of the Cytochrome P450 system?
↑ enzyme activity, ↓ drug effect ## Footnote Examples include rifampicin and carbamazepine.
149
What happens during **inhibition** of the Cytochrome P450 system?
↓ enzyme activity, ↑ drug levels → toxicity ## Footnote Examples include erythromycin and azoles.
150
What is the **pathophysiology of cirrhosis**?
* Chronic injury * Stellate cell activation * Collagen deposition * Fibrosis + nodules * Distorted blood flow ## Footnote These changes lead to complications like portal hypertension and liver failure.
151
What causes **ascites** in liver disease?
* Portal hypertension * ↓ albumin * Sodium/water retention (RAAS activation) ## Footnote Ascites is the accumulation of fluid in the abdominal cavity.
152
What is the toxic metabolite produced in **paracetamol toxicity**?
NAPQI ## Footnote NAPQI accumulates when glutathione is depleted, leading to hepatocyte necrosis.
153
What are the **types of gallstones**?
* Cholesterol stones (most common) * Pigment stones (bilirubin-related) ## Footnote These stones can lead to various complications.
154
What is **Charcot’s triad** in ascending cholangitis?
* Fever * Jaundice * RUQ pain ## Footnote This triad indicates a medical emergency.
155
What is the **gold standard** surgical treatment for gallbladder disease?
Laparoscopic cholecystectomy ## Footnote This procedure is minimally invasive.
156
What stimulates **exocrine control** of the pancreas?
* CCK (cholecystokinin) * Secretin * Vagus nerve ## Footnote These factors trigger enzyme secretion in response to food.
157
What is the mnemonic for the causes of **pancreatitis**?
GET SMASHED ## Footnote This includes Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hyperlipidaemia/Hypercalcaemia, ERCP, Drugs.
158
What are the **complications** of pancreatitis?
* Shock * Sepsis * Necrosis * Pseudocyst * Multi-organ failure ## Footnote These complications can arise from severe cases of pancreatitis.
159
What is the connection between the **liver, gallbladder, and pancreas**?
All drain into common bile duct → duodenum ## Footnote Obstruction can cause jaundice, pancreatitis, and malabsorption.
160
What symptom is likely associated with **RUQ pain after a fatty meal**?
Gallstones ## Footnote This symptom is a classic presentation of gallbladder issues.
161
162
What is the role of **albumin** in the blood?
Maintains osmotic pressure in the blood ## Footnote Prevents fluid leaking into tissues → prevents oedema and ascites.
163
What are the consequences of **low albumin** in liver disease?
* Reduced osmotic pressure * Peripheral oedema * Ascites * Hypotension ## Footnote Occurs in conditions like liver failure.
164
Describe the liver’s function in **blood filtration** and **nutrient/drug metabolism**.
* Filters nutrient-rich blood from the portal vein * Metabolises nutrients (vitamins KADE), drugs, and hormones * Produces bile salts * Phagocytoses bacteria and dead cells * Synthesises clotting factors, albumin, and antibodies ## Footnote Hepatocytes and Kupffer cells play key roles in these processes.
165
Define **portal hypertension**.
Increased pressure in the portal venous system due to liver fibrosis or inflammation ## Footnote Can lead to complications such as oesophageal varices and ascites.
166
List the **complications** of portal hypertension.
* Oesophageal varices → risk of bleeding * Ascites → fluid accumulation in the abdomen * Potential impact on blood flow and liver function ## Footnote These complications arise from increased pressure in the portal venous system.
167
Outline the process of **bilirubin metabolism**.
* Haemoglobin breakdown: haem → unconjugated bilirubin * Unconjugated bilirubin binds to albumin → transported to liver * In liver, bilirubin is conjugated → water-soluble → excreted in bile * Excess bilirubin → jaundice ## Footnote Jaundice is characterized by yellow skin and eyes.
168
What is the role of **bile salts** in digestion?
* Produced by the liver * Stored in the gallbladder * Released into duodenum in response to a fatty meal * Emulsify fats → increase absorption of fat-soluble vitamins (KADE) ## Footnote Insufficient bile can lead to malnutrition and vitamin deficiency.
169
Describe the **phases of drug metabolism** in the liver.
* Phase 1: make drugs more polar → oxidation, reduction, hydrolysis (cytochrome P450) * Phase 2: conjugation → make drug water-soluble and less active ## Footnote First-pass metabolism affects drug administration and efficacy.
170
List **5 common signs** of liver disease.
* Jaundice – yellow skin/eyes * Finger clubbing – loss of nail bed angle * Dupuytren’s contracture – fascia contraction of hand * Gynaecomastia – male breast enlargement * Sialosis – bilateral painless parotid swelling ## Footnote Other signs include deranged LFTs, impaired clotting, and ascites.
171
Outline the **causes and risk factors** for liver disease.
* Acute liver injury: alcohol, paracetamol overdose, infections (hepatitis A/B/C/E) * Chronic liver disease: fibrosis → cirrhosis * Risk factors: excessive alcohol, IV drug use, viral hepatitis, paracetamol overdose ## Footnote These factors contribute to liver damage and disease progression.
172
Describe the **endocrine and exocrine functions** of the pancreas.
* Exocrine: secretes digestive enzymes (amylase, lipase, proteases) → duodenum * Endocrine: Islets of Langerhans secrete insulin, glucagon, somatostatin → regulate blood glucose ## Footnote Both functions are crucial for digestion and metabolic regulation.
173
What is **pancreatitis** and its clinical features?
* Inflammation of the pancreas → autodigestion from blocked pancreatic enzymes * Symptoms: upper abdominal pain radiating to back, vomiting, steatorrhea, jaundice, diabetes ## Footnote Risk factors include gallstones, alcohol, trauma, and certain drugs.
174
Describe **gallstone disease** and its clinical features.
* Gallstones: cholesterol crystallisation in gallbladder → may obstruct bile/pancreatic ducts * Symptoms: right upper quadrant pain (biliary colic), nausea/vomiting, fever, jaundice ## Footnote Management may include diet modification and cholecystectomy if symptomatic.
175
Explain the **dual blood supply** of the liver.
* Portal vein: carries nutrient-rich but deoxygenated blood from gut → liver * Hepatic artery: oxygenated blood from systemic circulation → liver ## Footnote Blood mixes in sinusoids, processed by hepatocytes, and exits via hepatic veins.
year 4 CMS
flashcards
Decks in class (54)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions