The liver has how many functionally independent segments?
T/F: each segment of the liver has vascular inflow, outflow, and biliary drainage
List the structures located at the center of the liver
- Portal vein
- hepatic artery
- bile duct
List the structures located in the periphery of the liver:
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
T/F: The portal vein divides the liver into upper and lower segments
Functional unit of the liver:
Where are portal triads distributed?
Equidistant points along the rim of lobules
The portal triad consists of:
- Bile duct
- Hepatic artery
- Portal vein
Which structure is responsible for transporting oxygen-rich blood to liver?
Which structure is responsible for transporting nutrient-rich blood from the GIT to the liver?
Function of Kupffer cells:
Liver resident macrophages = remove old RBCs and desctroy invading organisms
Where do we see the Kupffer cells?
Where do we see hepatocytes?
In rows between sinusoids
Where is formed bile collected?
Liver receives ____% of total cardiac output (Splanchnic circulation)
Liver accounts for ____% of resting total body oxygen consumption
T/F: Blood leaves the liver through the hepatic vein
List common functions of the liver:
- Bile production
- Certain ptn production for blood plasma
- Cholesterol production
- AA regulation
- Processing hgb for use of iron content
- Conversion of ammonia to urea
- Clearing blood of toxins/drugs
- Regulating blood clotting
- Making immune factors/removing bacteria from blood
- Clearance of bilirubin
Endocrine function of liver:
Secretes hormones/hormone precursors
Hormones produced by the liver (insulin-like growth factor, angiotensinogen, thrombopoietin, hepcidin) leave the liver through _________
Exocrine function of liver:
Secretes bile into intestine
Bile leaves the liver through _________
Common biliary duct
Why does jaundice occur?
Bilirubin is not taken up by the liver and conjugated with glucuronic acid, instead it remains in the body
A parasitic infection of the liver
Inflammation of the liver caused by viruses, toxins, or autoimmune response
Excessive triglyceride accumulation in liver
Fatty liver dz
Disorder of bilirubin metabolism
Caused by viral hepatits, alcohol overconsumption, and other forms of liver toxicity
Caused by occlusion of hepatic vein
How might pollutants cause DNA damage in the liver?
- Direct toxicity
- Altered metabolism and liver fxn
How might fatty liver cause DNA damage in the liver?
How might HBV/HCV infection cause DNA damage in the liver?
- Reactive oxygen species
- Free radicals
How might alcohol consumption cause DNA damage in the liver?
- Acetaldehyde, free radicals
- Epigenetic alterations of gene expression
Consequence of chronic liver dz, characterized by
- replacement of normal liver tissue w fibrous scar tissue and regenerative nodules
- Progressive loss of liver fxn
List some manifestations/complications of cirrhosis:
- Portal HTN
- Spontaneous bacterial peritonitis
- Esophageal varices
- Hepatic encephalopathy
- Hepatorenal syndrome
T/F: Nonalcoholic fatty liver dz and cirrhosis are not reversible
Presence of a gradient of > ____ mmHg between the portal vein and central venous pressure is considered portal HTN
Back up of blood in the portal vein may lead to the formation of ______________
What is the most common complication of cirrhosis?
Accumulation of an excessive amount of fluid w/in the peritoneal cavity
Infectious complication of ascites:
Spontaneous bacterial peritonitis (SBP)
Drugs used to treat alcohol related cirrhosis:
Treats alcohol abuse, negative rxn
Reduces craving for alcohol
Reduces physical and emotional distress - sleep disorder, anxiety
List chelating agents used to treat the causes of cirrhosis
Which two drugs remove excess copper (in Wilson's dz)
Which drug removes excess iron (in hemochromatosis)
List corticosteroids used to treat liver cirrhosis
List antiviral drugs that might be used to treat the cause of cirrhosis
Which drug types are used to treat the complications of cirrhosis?
- Vitamin K
List drugs used to reduce excess fluid accumulation from cirrhosis
List drugs used to reduce venous BP in the abdomen (portal HTN)
List drugs used to treat and prevent bacterial infections in pts with cirrhosis and GI bleeding
Which drug will reduce bleeding via splanchnic vasoconstriction?
List drugs that will restore critical coagulation factors to help reduce persistent bleeding
- Fresh frozen plasma
- Platelet transfusion
- Blood clotting factors
Diuretics used for ascites (include doses)
Spironolactone (100-400 mg/d) + Furosemide (40-160 mg/d)
Diuretics should be titrated every _________ to goal natriuresis and WL?
T/F: Patients with ascites who are receiving diuretics may receive NSAIDs to help control ascites associated pain
Monitoring for ascites pts on diuretics:
- Urine output
Counseling for diuretics:
- Take in AM to avoid nocturesis
- Monitor BP
- Monitor for cramps, AMS, irregular heartbeat
Child-Pugh Grade A:
Child-Pugh Grade B
Child-pugh Grade C:
T/F: A child-pugh grade of A indicates better liver function than a grade of C