liver stuff

Question 1

what is liver inflammation most often due to?

Answer 1

• obesity
• the metabolic syndrome
• alcohol excess
• nonalcoholic steatohepatitis

Question 2

where is the liver situated?

Answer 2

-right hypochondrium

Question 3

how many segments is the liver split into?

Answer 3

8

Question 4

what allows individual segment surgery in the liver?

Answer 4

that each segment has its own portal pedicle (branch of hepatic artery, portal vein and bile duct)

Question 5

what is special about the caudate lobe (lobe 1)?

Answer 5

• physiologically independant part of the liver, receives an independant blood supply from the portal vein and hepatic artery
• only part of the liver that is directly in contact with the inferior vena cava

Question 6

where are lymphatics present?

Answer 6

-portal tracts

Question 7

function of liver?

Answer 7

• protein metabolism (ablumin, blood clotting factors)
• carbohydrate metabolism
• lipid metabolism

Question 8

what are hepatocytes?

Answer 8

-liver cells

Question 9

what are the anterosuperior and the posteroinferior surfaces called?

Answer 9

anterosuperior- diaohragmatic surface

posteroinferior- visceral surface

Question 10

what are the 4 main lobes of the liver?

Answer 10

• left
• right
• caudate
• quadrate

Question 11

how does the liver receive nutrients?

Answer 11

-the portal vein delivers nutrient rich, deoxygenated blood from the stomach and intestines (75% of blood)

Question 12

how does the liver receive oxygenated blood?

Answer 12

the left and right hepatic arteries branch off the aorta and supply the liver with oxygenated blood (only supplies 25% of blood)

Question 13

how does blood leave the liver?

Answer 13

through the left, right and middle hepatic veins that join up the inferior vena cava

Question 14

what are sinusoids?

Answer 14

-gaps between the hepatocytes that blood flows through from the hepatic artery + portal vein to the central vein

Question 15

what makes up the portal triad?

Answer 15

• bile duct
• hepatic artery
• portal vein

Question 16

where are portal triads located?

Answer 16

-on the corners of the hexagonal lobules of the liver

Question 17

what are liver macrophages called?

Answer 17

Kupffer cells

Question 18

where are Kupffer cells found?

Answer 18

-sinusoids

Question 19

where is the perisinusoidal space?

Answer 19

-between hepatocytes and sinusoids

Question 20

what produces bile?

Answer 20

-hepatocytes

Question 21

what is the fibrous protective lining of the liver called?

Answer 21

External Glisson’s capsule

Question 22

what are the stages of drug metabolism?

Answer 22

Phase 1

• oxidation
• reduction
• hydrolysis

Phase 2
-conjugation

Excretion

• renal
• faeces (bile)
• lungs
• sweat/tears
• milk, saliva

Question 23

what is the role of phase 1 in drug metabolism?

Answer 23

• increase drug polarity

- new chemically reactive group permits conjugation

Question 24

what is the role of phase 2 in drug metabolism?

Answer 24

• further increases polarity
• adds endogenous compound
• usually results in inactive products

Question 25

what mediates the oxidation of lipid soludble drugs?

Answer 25

CYP450

Question 26

what are the 'True LFTs'?

Answer 26

- albumin - bilirubin - prothrombin time The chemical markers that measure the livers ability to synthesise proteins

Question 27

what does increased ALT indicate?

Answer 27

hepatucellular injury

Question 28

what does increased AST indicate?

Answer 28

may be elevated in: - liver injury - MI - pancreatits - haemolytic anaemia - renal or MSK disease

Question 29

where is AST found?

Answer 29

- heart - liver - skeletal muscle - kidneys - brain - RBC

Question 30

what does increased ALP suggest?

Answer 30

cholestasis

Question 31

what does increased GGT indicate?

Answer 31

- biliary obstruction - liver and pancreas disease - CV disease - alcohol

Question 32

what LFT changes are seen in hepatocellular injury?

Answer 32

increase ALT | increast AST

Question 33

what LFT changes are seen in cholestasis?

Answer 33

increase ALP | increase GGT

Question 34

what does AST< ALT indicate

Answer 34

-chronic liver disease

Question 35

what does AST>ALT suggest?

Answer 35

- cirrhosis | - acute alcoholic hepatitis

Question 36

what is diagnosis if transferases (AST or ALT) very high? (>1000)

Answer 36

-alomst certanly hepatitis

Question 37

what does a AST:ALT ratio of >2 suggest?

Answer 37

alcohol

Question 38

what will never occur to AST in chronic liver disease?

Answer 38

>1000

Question 39

when may albumin fall?

Answer 39

- cirrhosis - nephrotic syndrome - inflammation in acute phase temporarily decreases albumin

Question 40

what can increase prothrombin time indicate?

Answer 40

-liver disease causing reduced production of clotting factors

Question 41

what are the types of jaundice?

Answer 41

- pre hepatic - hepatocellular - post hepatic (obstructive)

Question 42

what does AST increased 20x suggest?

Answer 42

acute cause

Question 43

what does AST increased 5-10x suggest?

Answer 43

chronic cause