Flashcards
MDPL 1 - Liver Structure, Function, and Dysfunction
Cards in this deck (88)
- 1Location of liver (3 abdominal areas)Right hypochondrium
Epigastric
Left hypochondrium - 22 surfaces of liver (which sides of the liver are they, shape of surface, what other organs are they in contact with)Diaphragmatic
(anterosuperior surfaces, smooth + convex, contact with diaphragm)
Visceral
(posteroinferior surfaces, irregular + flat, contact with right kidney, right adrenal gland, right colic flexure, transverse colon, duodenum (1st part), gallbladder, oesophagus, and stomach) - 34 lobes of liverRight
Left
Caudate
Quadrate - 45 ligaments of liverfalciform
coronary
left triangular
right triangular
lesser omentum - 5What does the falciform ligament do (2)anatomical division of R&L lobes
attaches anterior liver surface to the anterior abdominal wall - 6What does the coronary ligament doattaches superior surface of the liver to the inferior surface of the diaphragm
- 7What does the lesser omentum doattaches liver to the lesser curvature of the stomach and the first part of the duodenum
- 8Which 2 ligaments is the lesser omentum made up ofhepatoduodenal ligament
hepatogastric ligament - 93 recesses of liverSubphrenic spaces
Subhepatic space
Morison’s pouch - 10Clinical relevance of recesses of liverInfection may collect + form an abscess
- 11What kind of cell makes up the liver and its regeneration patternhepatocytes
stable cells - 12What is a liver lobulestructural unit of the liver
- 13what shape is a lobulehexagonal
- 14What drains a lobulecentral vein
- 15Size + weight of liver (men + women)1.5kg
men - 10.5cm
women - 7cm - 16Where are the portal tracts and what are they made up ofperiphery of the lobule
- arteriole
- venule
- bile duct
- lymphatic vessels
- vagus nerve - 17What is the portal triadarteriole, venule + bile duct
- 18What are the portal tracts a branch ofarteriole - hepatic artery
venule - hepatic portal vein
bile duct - bile duct - 19How do you identify portal tract on a histological slideportal tract connective tissue stains blue with trichromic stain
- 20What is a sinusoidlocation for mixing of the oxygen-rich blood from the hepatic artery and the nutrient-rich blood from the portal vein
- 21Where do sinusoids drain intocentral hepatic vein branch
- 22Blood supply of the liverdual blood supply:
- hepatic artery
- hepatic portal vein - 23What does the hepatic artery supply (what does it bring + where does it go)oxygenated blood to non-parenchymal structures of liver
- 24What does the hepatic portal vein supply (what does it bring + where does it go)partially deoxygenated blood + nutrients absorbed from the small intestine to liver parenchyma
- 25What is the hepatic artery a branch ofcoeliac trunk
- 26Venous drainage pathway of livercentral vein -> hepatic vein -> IVC
- 27What are sinusoids lined with (2)fenestrated endothelium
macrophages (Kupffer cells) - 28Where is the space of disse + what does it containbetween sinusoids and hepatocytes
hepatic stellate cells - 29What innervates the liver parenchymasympathetic (coeliac plexus) + parasympathetic (vagus nerve fibres)
- 30How do nerves innervating the liver entervia porta hepatis
- 31What is Glisson's capsule (+ what is it's clinical function)fibrous covering of the liver innervated by branches of the lower intercostal nerves
(distension of the capsule results in sharp, well-localised pain) - 32Flow path of bile from hepatocyte -> CBDhepatocyte -> canaliculi (merge) -> ductules -> ducts -> R + L hepatic ducts -> common hepatic duct (merge w/ cystic duct) -> CBD
- 33What is the ampulla of Vater + where does it drainCBD + pancreatic duct
drains into duodenum - 34What is the gallbladder + its rolestorage pouch for bile
concentrates bile - 35What is the acinusfunctional unit of the liver
- 36Describe an acinus (shape + position)irregular shaped, roughly ellipsoidal mass of hepatocytes aligned around the hepatic arterioles and portal venules just as they join into sinusoids
- 37What are acini divided intozones (1 - 3)
- 38What is the difference between zones 1 -3 in acinuszone 1 = closest = best oxygenated
zone 3 = furthest = poorly oxygenated - 39What do the cells in zone 1 of acinus do (+ what is the impact of this)first to sense + potentially absorb blood-borne toxins absorbed into portal blood from the small intestine
(ischaemic/toxic injury most severe in zone 3 - reflects pattern of dmg/fibrosis) - 404 main functions of liverprocesses blood + breaks down/balances/creates nutrients
metabolises drugs to make easier for rest of the body to use or make it nontoxic
regulates most serum chemical levels
secretes bile - 41What does the liver synthesise (2)plasma proteins
bile - 42Which plasma proteins are produced by liverAlbumin
Acute-phase proteins (e.g. CRP)
Clotting factors (not FVIII)
Complement proteins
Protease inhibitors (e.g. A1AT)
Transport proteins - 43Hallmark appearance of liver with chronic venous congestionnutmeg liver
- 44What is chronic venous congestion caused byright heart failure - congestive heart failure or right heart failure in cor pulmonale or mitral stenosis
- 45LFTs in chronic venous congestionmild elevation of ALT, AST
- 46What is Budd Chiari syndromeObstruction to venous outflow from liver (hepatic vein/IVC)
- 47What is Budd Chiari syndrome associated with (4)Myeloproliferative disorder
Inherited hypercoagulable/thrombophilic states
OCP (rarely)
Hepatoma - 48DDx of Budd Chiari syndrome (3)acute liver failure
acute hepatitis
chronic liver disease - 49Potential progression of Budd Chiari syndromerapid onset portal HTN/ascites
- 50Why are liver infarctions rare (but if it happens, why is usually the case)liver is protected via a dual blood supply
(trauma to hepatic artery likely) - 51What is ischaemic injury to the liver usually associated withacute circulatory failure
(i.e. shock/hypotension) - 52Where in the liver is most affected by ischaemic injuryzone 3 of acini
- 53What kind of liver is more susceptible to ishaemic injuryliver with chronic passive venous congestion or cirrhosis/portal hypertension
- 54What affects possible outcomes of acute liver damage (2)degree of damage?
is damage transient or persistent? - 55If damage is persistent, what does acute liver damage progress to? (+ what can this progress to)fibrosis (mild to advanced)
may lead to cirrhosis - 56Pathogenesis of liver cirrhosisconnective tissue framework damaged by continued/repeated insult = complete recovery no longer possible = fibrosis by activated hepatic stellate cells
- 57Main causes of liver damage (8)Alcohol
NAFLD
Virus
Drugs
Autoimmune
Inherited metabolic disorders
Chronic biliary disease
Trauma - 58Which heps. are acute dmg and which are chronic dmgA + E = acute
B + C = chronic - 59Eg of inherited metabolic diseases that can cause liver damage (3)HFE
Wilson's diease
A1AT deficiency - 60Why does chronic biliary disease damage the liverautoimmune damage to bile ducts = cholestasis with injury to the liver from retained bile salts
- 61Where do you obtain liver cells for autopsy when classifying grade (2)portal
periportal - 62What is piecemeal necrosis (+ when is it usually seen)pattern of chronic injury occurring when portal tract inflammation spills over the interface to damage adjacent hepatocytes
(chronic Hep B or autoimmune hepatitis) - 63When is high lymphocyte from liver biopsy commonhepatitis
- 64What are granulomas of portal tract characteristic ofprimary biliary cirrhosis
- 65When do you see high neutrophils in liver Bxsuggest alcohol-related disease or NAFLD
- 66Stage 1 of liver fibrosisportal fibrosis - affecting all or most portal tracts
- 67Stage 2 of liver fibrosisperiportal fibrosis
- 68Stage 3 of liver fibrosisbridging fibrosis - either portal-to-portal or portal-to-central
- 69Stage 4 of liver fibrosisfibrous septa/bands separating regenerative nodules of liver parenchyma
(may be enough to diagnose as cirrhosis) - 70What is liver cirrhosisend-stage liver damage characterised by disruption of normal hepatic parenchyma by bands of fibrosis + regenerative nodules of hepatocytes
- 714 features of liver cirrhosisdiffuse distortion of liver architecture
surrounding fibrous bands/septa
regenerative nodules
distorted vascular relationships - 72What are vascular changes in the liver due to cirrhosis (4)destruction/thrombosis of liver veins
collateral channels/shunts form in liver
‘capillarised’ sinusoids (loose fenestrations)
raised hepatic venous pressure gradient (HVPG) - 73Symptoms of cirrhosis (10)fatigue
easy bleeding/bruising (ecchymosis)
loss of appetite
nausea
peripheral oedema
weight loss
itchy skin (pruritus)
jaundice
ascites
erythema - 74What do you do to Dx cirrhosis (2)lab tests
imaging - 75What do you look in lab tests for cirrhosisbilirubin
enzyme studies
kidney function tests
lood creatinine - 76What imaging techniques do you use to Dx cirrhosisMRE (magnetic resonance elastography)
(checks for hardening/stiffening of liver)
MRI
CT
Ultrasound (fibroscan?) - 77What is the use for Bx in cirrhosisfind severity, extent + cause of damage
- 78Who is screened for advanced fibrosis (NICE guidelines 2016) (3)HCV
High alcohol intake (>50u/wk M, >35u/wk F)
NAFLD with +ELF blood test - 79How is advanced fibrosis screenedFibroscan (transient elastography)
- 80Active management for patient with cirrhosis (6)specific Tx/risk modification or underlying disease
avoid further/additional insults to liver
screen for varices
screen for HCC
prevent/slow/reverse progression of liver disease/development of decompensation
listing for transplantation - 81Considerations of medical interventions with someone with cirrhosis (2)adjust dose or avoid certain medications
risks with surgery: infection, bleeding, healing, ascites - 82Why are there no altered bleeding tendencies in someone with cirrhosis despite abnormal INRliver synthesis of both coagulation and anti-thrombotic proteins both affected
(so balance remains) - 83What is compensated cirrhosisasymptomatic
may or may not have:
- biochemical/radiological abnormalities
- signs of chronic liver disease/portal HTN
- varices on OGD (gastroduodenoscopy) - 84how does compensated cirrhosis develop into decompensated cirrhosis (+ egs.)Further injury:
- infection
- bleeding
- hypotension
- alcohol
- medications
- dehydration
- trauma
- surgery - 85Key complications of decompensated cirrhosis (7)ascites
hepatic encephalopathy
variceal haemorrhage
hepatorenal syndrome (HRS)
jaundice
infection (esp. spontaneous bacterial peritonitis)
hepatocellular carcinoma (HCC) - 86Pathophysiology of Portal HTNincreased hepatic resistance to portal blood flow = HPVG rise
increased by splanchnic vasodilation (NO)
= lower TPR + BP
= complementary increase in CO
= hyperdynamic circulation in cirrhosis - 87Methods of compensating for widespread vasodilation (4)Activation of the RAAS
ADH secretion
Sodium + water retention
Reflex renal vasoconstriction - 88How does ascites arise from portal HTN due to cirrhosisleakage from peritoneal vessels due to:
- higher mean hydrostatic pressure
- Lower oncotic pressure due to low albumin
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- Flashcards on MDPL 1 - Liver Structure, Function, and Dysfunction, created by Erica Lai on 28/09/2019.
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