Liver Flashcards


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1

The liver has how many functionally independent segments?

8

2

T/F: each segment of the liver has vascular inflow, outflow, and biliary drainage

True

3

List the structures located at the center of the liver

  • Portal vein
  • hepatic artery
  • bile duct
4

List the structures located in the periphery of the liver:

Hepatic veins

5

T/F: The right portal vein divides the right lobe into anterior and posterior, and the middle portal vein divides the liver into right and left hemiliver

False

6

T/F: The portal vein divides the liver into upper and lower segments

True

7

Functional unit of the liver:

Lobules

8

Where are portal triads distributed?

Equidistant points along the rim of lobules

9

The portal triad consists of:

  • Bile duct
  • Hepatic artery
  • Portal vein
10

Which structure is responsible for transporting oxygen-rich blood to liver?

Hepatic artery

11

Which structure is responsible for transporting nutrient-rich blood from the GIT to the liver?

Portal vein

12

Function of Kupffer cells:

Liver resident macrophages = remove old RBCs and desctroy invading organisms

13

Where do we see the Kupffer cells?

Sinusoids

14

Where do we see hepatocytes?

In rows between sinusoids

15

Where is formed bile collected?

Bile canalliculi

16

Liver receives ____% of total cardiac output (Splanchnic circulation)

25%

17

Liver accounts for ____% of resting total body oxygen consumption

20%

18

T/F: Blood leaves the liver through the hepatic vein

True

19

List common functions of the liver:

  1. Bile production
  2. Certain ptn production for blood plasma
  3. Cholesterol production
  4. glycogenesis
  5. AA regulation
  6. Processing hgb for use of iron content
  7. Conversion of ammonia to urea
  8. Clearing blood of toxins/drugs
  9. Regulating blood clotting
  10. Making immune factors/removing bacteria from blood
  11. Clearance of bilirubin
20

Endocrine function of liver:

Secretes hormones/hormone precursors

21

Hormones produced by the liver (insulin-like growth factor, angiotensinogen, thrombopoietin, hepcidin) leave the liver through _________

Hepatic vein

22

Exocrine function of liver:

Secretes bile into intestine

23

Bile leaves the liver through _________

Common biliary duct

24

Why does jaundice occur?

Bilirubin is not taken up by the liver and conjugated with glucuronic acid, instead it remains in the body

25

A parasitic infection of the liver

Fascioliasis

26

Inflammation of the liver caused by viruses, toxins, or autoimmune response

Hepatitis

27

Excessive triglyceride accumulation in liver

Fatty liver dz

28

Disorder of bilirubin metabolism

Gilbert's syndrome

29

Caused by viral hepatits, alcohol overconsumption, and other forms of liver toxicity

Cirrhosis

30

Caused by occlusion of hepatic vein

Budd-Chiari syndrome

31

How might pollutants cause DNA damage in the liver?

  • Direct toxicity
  • Altered metabolism and liver fxn
  • Inflammation
32

How might fatty liver cause DNA damage in the liver?

  • Scarring
  • Inflammation
33

How might HBV/HCV infection cause DNA damage in the liver?

  • Reactive oxygen species
  • Free radicals
34

How might alcohol consumption cause DNA damage in the liver?

  • Acetaldehyde, free radicals
  • Epigenetic alterations of gene expression
35

Consequence of chronic liver dz, characterized by

  • replacement of normal liver tissue w fibrous scar tissue and regenerative nodules
  • Progressive loss of liver fxn

Cirrhosis

36

List some manifestations/complications of cirrhosis:

  • Portal HTN
  • Ascites
  • Spontaneous bacterial peritonitis
  • Esophageal varices
  • Hepatic encephalopathy
  • Hepatorenal syndrome
37

T/F: Nonalcoholic fatty liver dz and cirrhosis are not reversible

False

38

Presence of a gradient of > ____ mmHg between the portal vein and central venous pressure is considered portal HTN

5

39

Back up of blood in the portal vein may lead to the formation of ______________

Collateral vessels

40

What is the most common complication of cirrhosis?

Ascites

41

Accumulation of an excessive amount of fluid w/in the peritoneal cavity

Ascites

42

Infectious complication of ascites:

Spontaneous bacterial peritonitis (SBP)

43

Drugs used to treat alcohol related cirrhosis:

  • Disulfiram
  • Naltrexone
  • Acamprosate
44

Disulfiram MOA

Treats alcohol abuse, negative rxn

45

Natrexone MOA

Reduces craving for alcohol

46

Acamprosate MOA

Reduces physical and emotional distress - sleep disorder, anxiety

47

List chelating agents used to treat the causes of cirrhosis

  • Penicillamine
  • Trientine
  • Deferoxamine
48

Which two drugs remove excess copper (in Wilson's dz)

  • Penicillamine
  • Trientine
49

Which drug removes excess iron (in hemochromatosis)

Defroxamine

50

List corticosteroids used to treat liver cirrhosis

  • Prednisone
  • Prednisone+azathioprine
51

List antiviral drugs that might be used to treat the cause of cirrhosis

  • Lamivudine
  • Entecavir
  • Tenofovir
52

Which drug types are used to treat the complications of cirrhosis?

  • Diuretics
  • BB
  • Antibiotics
  • Vitamin K
53

List drugs used to reduce excess fluid accumulation from cirrhosis

  • Bumetanide
  • Furosemide
  • HCTZ
  • Chlorothiazide
  • Amiloride
  • Triamterene
  • Spironolactone
54

List drugs used to reduce venous BP in the abdomen (portal HTN)

  • Atenolol
  • Metoprolol
  • Nadolol
  • Propranolol
  • Timolol
  • Carvedilol
55

List drugs used to treat and prevent bacterial infections in pts with cirrhosis and GI bleeding

  • Ciprofloxacin
  • Norofloxacin
  • Ceftriaxone
  • Amoxicillin-clavulanate
56

Which drug will reduce bleeding via splanchnic vasoconstriction?

Octreotide

57

List drugs that will restore critical coagulation factors to help reduce persistent bleeding

  • Fresh frozen plasma
  • Platelet transfusion
  • Blood clotting factors
58

Diuretics used for ascites (include doses)

Spironolactone (100-400 mg/d) + Furosemide (40-160 mg/d)

59

Diuretics should be titrated every _________ to goal natriuresis and WL?

3-5d

60

T/F: Patients with ascites who are receiving diuretics may receive NSAIDs to help control ascites associated pain

False

61

Monitoring for ascites pts on diuretics:

  • Urine output
  • WL
  • BP
  • Electrolytes
62

Counseling for diuretics:

  • Take in AM to avoid nocturesis
  • Monitor BP
  • Monitor for cramps, AMS, irregular heartbeat
63

Child-Pugh Grade A:

<7

64

Child-Pugh Grade B

7-9

65

Child-pugh Grade C:

>10

66

T/F: A child-pugh grade of A indicates better liver function than a grade of C

True