Term
| what are the accessory organs? |
|
Definition
| the liver, gallbladder, and the exocrine pancreas |
|
|
Term
|
Definition
| makes glucose, plasma proteins, and blood clotting factors. |
|
|
Term
| what else does the liver do? |
|
Definition
| elimination of drugs and hormones, ammonia to urea etc... |
|
|
Term
|
Definition
| a tough capsule that surrounds the liver |
|
|
Term
| what are the lobes of the liver? |
|
Definition
| right, left, cuadate, quadrate lobes |
|
|
Term
| the liver is unique in that it has a... |
|
Definition
| dual blood supply- a heptatic portal vein and hepatic artery |
|
|
Term
| venous blood delivered via the hepatic portal vein comes from...? |
|
Definition
| the digestie and major organ tracts. it carries nutrients and toxic materials |
|
|
Term
| what else does the hepatic portal blood transport? |
|
Definition
| insulin, glucagon, and breakdown products |
|
|
Term
| in right sided heart faiure in which the pressure of the vena cava increases... |
|
Definition
| blood backs up and accumilates in the liver |
|
|
Term
| how much blood does the liver store and why? |
|
Definition
| it holds up to 450 mL and it is a storage for blood in case of hypovolemia and shock |
|
|
Term
| what is the functional unit of the liver |
|
Definition
|
|
Term
| why are sinusoids important? |
|
Definition
| they touch the hepatocytes and provide for the exchange between blood and liver cells |
|
|
Term
|
Definition
| capable of removing and phagocytizing old blood cells, bacteria, and foreign material |
|
|
Term
| a major function of the liver is bile formation, what produces it? |
|
Definition
| the bile caniculi that drain the bile into the hepatic ducts |
|
|
Term
| what does the liver convert? |
|
Definition
| it converts fatty acids into ketones |
|
|
Term
| bilirubin gives biles it's color. how is it formed? |
|
Definition
| from broken down hemoblobin from RBC's. |
|
|
Term
| what are the two types of bilirubin? |
|
Definition
| free bilirubin and conjugated bilirubin |
|
|
Term
|
Definition
| insoluble in plasma, attaches to albumin. absorbed into heptatocytes |
|
|
Term
| once the free bilirubin attaches to the hepatocytes what will happen? |
|
Definition
| the free bilirubin is converted into conjugated bilirubin |
|
|
Term
|
Definition
| the bilirubin that is secreted to the bile ducts of the small intestine |
|
|
Term
| usually how much serum bilirubin is found in the blood? |
|
Definition
|
|
Term
|
Definition
| yellow discoleration of the skin due to high levels of bilirubin |
|
|
Term
| when does jaundice become apparent? |
|
Definition
| when the serum bilirubin levels are 2-2.5 mg/dL |
|
|
Term
| what does bilirubin have a soecial affinity for? |
|
Definition
| elastic tissue, such as the sclera of the eyes |
|
|
Term
| what are 2 causes of jaundice? |
|
Definition
| excess destruction of RBC's, impaired uptake of bilirubin by the liver cells |
|
|
Term
| what are 2 additional causes of jaundice? |
|
Definition
| decreased conjugation of bilirubin, and obstruction of bile flow |
|
|
Term
| jaundice can be categorized in what categories? |
|
Definition
| prehepatic, intrahepatic, and post hepatic |
|
|
Term
|
Definition
| hemolysis of RBC's that are destroyed faster than the liver can remove bilirubin |
|
|
Term
|
Definition
| directly affect the ability of the liver to remove bilirubin from the blood |
|
|
Term
| conjugation of bilirubin is impaired when? |
|
Definition
| liver cells are damaged,transport of bilirubin dont work, enzymes to break down bilirubin are absent |
|
|
Term
| what are common forms of ntrahepatic jaundice? |
|
Definition
|
|
Term
| intrahepatic jaundice has what results? |
|
Definition
| dark urine, elevated free and conjugated bilirubin and serum alk. phosphatase are raised |
|
|
Term
|
Definition
| when bile flow is obtructed between liver and intestine |
|
|
Term
| whata re some causes of posthepatic jaundice? |
|
Definition
| strictures of bile duct, gallstones, or tumors |
|
|
Term
| what are common symptoms of posthepatic jaundice? |
|
Definition
| stools is clay colored, urine is dark, pruritis, elevated bilirubin/serum alk. phosphatase |
|
|
Term
| how many types of reactions are involved with hepatic detoxification? |
|
Definition
|
|
Term
|
Definition
| involve chemical modifications or inactivation of a substance |
|
|
Term
|
Definition
| involve the conversion of lipid-soluble substances to water soluble |
|
|
Term
| what are the 3 most common types of alcoholic liver disease? |
|
Definition
| fatty liver disease, alcoholic hepatitis, and cirrhosis |
|
|
Term
| most deaths from alcoholic cirrhosis are attributed to...? |
|
Definition
| liver failure, bleeding from esophageal varices, and kidney failure |
|
|
Term
| what are the 2 systems that alcohol metabolism proceeds? |
|
Definition
| the alcohol dehydrogenase system and the microsomal ethanol-oxidizing system |
|
|
Term
| the alcohol dehydroginase system (ADH) is located in? |
|
Definition
| located in the cytoplasm of the hepatocytes |
|
|
Term
| the microsomal ethanol-oxidizing system is located in? |
|
Definition
| the endoplasmic retitticulum |
|
|
Term
|
Definition
| an enzyme that catalyzes the conversion of alcohol to acetylaldehyde |
|
|
Term
| during ADH-mediated break down of alcohol what is produced? |
|
Definition
| acetelaldehyde and hydrogen |
|
|
Term
| once acelaldehyde and hydrogen are produced what happens tothe hydrogen? |
|
Definition
| it binds to NAD, forming NADH which is toxic to the liver. |
|
|
Term
|
Definition
| it is nessecary for metabolic processes for pyruvates, fatty acids, and urates. |
|
|
Term
| if hydrogen binds to NAD, what happens? |
|
Definition
| the NAD can no longer metabolize properly because it is NADH instead of NAD |
|
|
Term
| what is acetadehyde broken down into? |
|
Definition
| it is metabolize to acetate |
|
|
Term
| alcohol induced hypoglycemia |
|
Definition
| developes when excessive alcohol ingestion occurs with depleted liver glycogen stores |
|
|
Term
| the MEOS pathway produces |
|
Definition
| acetaldehyde and free radicals |
|
|
Term
| the use of NAD fr alcohol breakdown can result in? |
|
Definition
| the accumilation of lactic acid in the blood |
|
|
Term
|
Definition
| depressed by testosterone |
|
|
Term
| t or f: acetealdehyde is toxic on the liver cells? |
|
Definition
|
|
Term
| acetealdehyde is known to..? |
|
Definition
| impee the mitochondrial electron transport chain(oxidative metabolism and ATP maker) |
|
|
Term
| what are the 3 stages in which alcoholc exerts its toxic effects? |
|
Definition
| fatty changes, alcoholic hepatitis, and cirrhosis |
|
|
Term
|
Definition
| accumulation of fat in the liver |
|
|
Term
|
Definition
| the middle stage between a fatty liver and cirrhosis. common in binge drinkers |
|
|
Term
| what are symptoms of alcoholic hepatitis? |
|
Definition
| hepatic tenderness,pain, aneorexia, nausea, fever, jaundice, acites, liver failure |
|
|
Term
|
Definition
| nodules alrge and irregular. they may compress the veins |
|
|
Term
| in alcoholic cirrhosis, compression of the veins will produce? |
|
Definition
| portal hypertension, shunts, cholestasis and reduced blood flow OUT of the liver. |
|
|
Term
| if we have a reduced amount of blood LEAVING the liver, what will happen? |
|
Definition
| the toxins will stay in the liver |
|
|
Term
|
Definition
| Last stage of chronic liver disease in which good tissue is replaced with fibrous tissue |
|
|
Term
| what can cause cirrhosis? |
|
Definition
| alcoholism, viral hepatitis, toxic reaction to drugs, biliary obstruction, and chemicals |
|
|
Term
| what does a liver with cirrhosis have? |
|
Definition
| nodule that are encircled by fibrotic tissue. |
|
|
Term
| what are some signs of cirrhosis? |
|
Definition
| weight loss, ascites, diarrhea, jaundice, pain in URP, hepatomegaly, weakness, anorexia |
|
|
Term
| what are the late manifestations of cirrhosis? |
|
Definition
| portal hypertension, shunts, hemorrhoids, testicular atrophy, spider angiomas, neuro signs |
|
|
Term
|
Definition
| increased resistance to flow in the portal venous system |
|
|
Term
| what can cause portal hypertension? |
|
Definition
| prehepatic, post hepatic, and intrahepatic. |
|
|
Term
| prehpatic causes of portal hypertension include ...? |
|
Definition
| portal vein thrombosis and compression due to cancer or enlarged lymph nodes |
|
|
Term
|
Definition
| blood obstruction via right sided heart failure, thrombosis of hepatic veins |
|
|
Term
| intrahepatic causes of portal hypertension are...? |
|
Definition
| bands of fibrous tissue which circle the lobules causing an increased resistance of the blood |
|
|
Term
|
Definition
| in late stage cirrhosis and portal hypertension |
|
|
Term
|
Definition
| abdominal discomfort, dyspnea, insomnia, difficulty walking or doing ADL's |
|
|
Term
| why do we get decreased colloid osmotic pressure? |
|
Definition
| due to impaired synthesis of albumin |
|
|
Term
| overfill theory proposed that the intial event that causes ascites is? |
|
Definition
| renal salt retention of salt and water caused by the liver's disturbances |
|
|
Term
| a decreased colloidal osmotic pressure causes? |
|
Definition
| limited reabsorbtion of fluid from the peritoneal cavity. |
|
|
Term
|
Definition
| progressive azotemia, increases serum creatinine, oliguria |
|
|
Term
|
Definition
| CNS manifestation in response to liver failure |
|
|
Term
| what are some symptoms of hepatic encephalopathy? |
|
Definition
| lack of mental alertness, confusion, coma, convulsions, asterixis |
|
|
Term
|
Definition
| a flapping tremor of the hand |
|
|
Term
| what are some aditional symptoms of hepatic encepthalopathy? |
|
Definition
| euphoria, irritability, anxiety, lack of concern over their appearance and self |
|
|
Term
| why do we THINk we get hepatic encephalopathy? |
|
Definition
| the build up of toxins such as ammonia which goes to the cerebral circulation |
|
|
Term
|
Definition
|
|
Term
| what is the functional cell of the liver? |
|
Definition
|
|
Term
| the bile duct carries bile to the? |
|
Definition
|
|
Term
|
Definition
| carries oxygenaed blood from the heart |
|
|
Term
|
Definition
| carried blood from the liver to the systemic circulation |
|
|
Term
|
Definition
| it will cause bile to go back into the gall bladder when it's not needed |
|
|
Term
|
Definition
| synthesis, storage, metabolism, and excretion |
|
|
Term
| what is a normal serum albumin? |
|
Definition
|
|
Term
|
Definition
| maintains normal colloid osmotic pressure, transports drugs, proteins,and enzymes |
|
|
Term
|
Definition
|
|
Term
| what is a normal prothrombin time? (PT) |
|
Definition
|
|
Term
| proteins are important in....? |
|
Definition
|
|
Term
| what does albumin bind to? |
|
Definition
|
|
Term
| why is the normal colloid osmotic pressure important? |
|
Definition
| it keeps the blood where it is supposed to be, veins, arteries etc |
|
|
Term
| if the liver is not sythesizing it's proteisn what will happen? |
|
Definition
| the serum albumin levels will be low. |
|
|
Term
| what is the total protein? |
|
Definition
| prealbumin, albumin, and globulins added up. normal is 6.4-8.3g/dL |
|
|
Term
| people wth malnutrition will have a low? |
|
Definition
|
|
Term
|
Definition
| released into the circulation via the kidneys |
|
|
Term
| what are some normal lab values forserum ammonia levels? |
|
Definition
|
|
Term
| the liver converts excess proteins into...? |
|
Definition
|
|
Term
|
Definition
| the way the liver stores glucose |
|
|
Term
| the liver inactivates...? |
|
Definition
| insulin, glucagon, t3, t4, estrogen, adrogens, aldosterone, glucocorticoids |
|
|
Term
| almost all conversion of proteins and glucose into fat is done in...? |
|
Definition
|
|
Term
| when the RBC is broken down, the iron is reused and the remaining is used for? |
|
Definition
|
|
Term
| what are some normal lab value for conjugated bilirubin? |
|
Definition
|
|
Term
| what are the normal values for conjugated bilirubin values? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| t or f: woman are more susceptable to EtOH induced liver damage? |
|
Definition
|
|
Term
| after drinking what medicine should you NEVER take for a hangover? |
|
Definition
|
|
Term
| t or f: cancer usually begins in the liver? |
|
Definition
| FALSE, it commonly metastasizes to the liver |
|
|
Term
| t or f: there is no sign of inflammation in a fatty liver |
|
Definition
|
|
Term
| what are the 3 types of enzymes released when the heptocytes are damaged? |
|
Definition
|
|
Term
| ALT-alanine aminotranferase |
|
Definition
| liver specific. normal range is 4-36 units/L |
|
|
Term
| when there is an increase in ALT |
|
Definition
| there is an increase in liver hepatitis |
|
|
Term
| AST (aspartate aminotransferase) |
|
Definition
| normal range: 0-35 units/L |
|
|
Term
| AP/ ALP (alkaline phosphatase) |
|
Definition
| found when the bile excretion is blocked. normal range is: 30-120 units/L |
|
|
Term
| can there be regeneration of the liver's lobules during liver heptitis? |
|
Definition
|
|
Term
| can there be regeneration of the liver lobules/cells during cirrhosis? |
|
Definition
| no, it it an irreversable progression |
|
|
Term
| how does portal hypertension affect the spleen? |
|
Definition
| it causes an icnreased breakdown of the blood (rbc's, platelets, wbc's) |
|
|
Term
|
Definition
| breakdown of white blood cells |
|
|
Term
|
Definition
|
|
Term
| portal hypertension causes varices...tell me about them. |
|
Definition
| esophageal, gastric, hemmorhoidal. prone to rupture. less clotting factor causes bleeding out |
|
|
Term
|
Definition
| increased pressure in the vasculature that causes dilated veins that protrude into the lumen |
|
|
