ch. 23 marieb Flashcards


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1

Digestive System

-takes in food, breaks it down into nutrient molecules, absorbs these molecules into the bloodstream, and then rids the body of the indigestible remains

2

What is another name for the GI tract?

-alimentary canal

3

What are the organs of the alimentary canal?

-mouth
-pharynx
-esophagus
-stomach
-small intestine
-large intestine

4

What are the accessory digestive organs?

-teeth
-tongue
-gall bladder
-salivary glands
-liver
-pancreas

5

What do the accessory glands produce?

-a variety of secretions that help break down foodstuffs

6

What are the 6 essential activities of the digestive processes?

1. ingestion
2. propulsion
3. mechanical digestion
4. digestion (chemical)
5. absorption
6. defecation

7

Ingestion

-taking food into the digestive tract via mouth
-mechanical digestion

8

Propulsion

-moves food thru the alimentary canal (swallowing & peristalsis)

9

Peristalsis

-waves of contraction and relaxation of muscles in the organ walls
-contract behind bolus to move it down

10

Bolus

-the shape the food takes as it goes to and down the pharynx

11

Mechanical Digestion

-increases the surface area of ingested food
-chewing, mixing food with saliva by the tongue
-churning food in the stomach
-segmentation

12

Segmentation

-organs alternately contract and relax, moving food forward then backward
-makes absorption more efficient by moving it over the intestinal wall

13

Digestion (Chemical)

-enzymes secreted into the cavity of the alimentary canal break down complex food molecules to their chemical building blocks

14

Absorption

-passage of digested end products from the lumen into the blood or lymph

15

Defecation

-eliminates indigestible substances from the body via the anus in the form of feces

16

How do you control the GI tract

-stretch receptors that begin the digestive processes
-pacemaker cells in the GI tract
-intrinsic (nerve plexuses and hormone producing cells)
-extrinsic (CNS)
-reflexes

17

Mechanoreceptors and Chemoreceptors

-respond to stretch, osmolarity, and pH
-presence of substrate and end products of digestion

18

Osmolarity

-solute concentration of ions in the GI tract

19

Osmolarity Diarrhea

-lactose intolerant people can get this
-lack enzyme to digest that
-proteins where you don’t normally have them so it draws water in which is the opposite of what you want

20

Gut Brain

-consisting of nerve plexuses that spread the entire length of the GI tract
-regulates digestive activity all along the tract

21

Short Reflexes

-mediated by the "gut" plexuses in response to stimuli arising in the GI tract

22

Long Reflexes

-initiated by stimuli arising inside or outside the GI tract and involve CNS centers and extrinsic autonomic nerves

23

Visceral Peritoneum

-covers the external surfaces of most digestive organs

24

Parietal Peritoneum

-lines the body wall

25

Peritoneal Cavity

-a slitlike potential space containing a slippery fluid secreted by the serous membranes

26

Serous Fluid

-lubricates the mobile organs
-allows them to glide easily across one another and along the body wall as they carry out activities

27

Mesentery

-double layer of peritoneum
-2 serous membranes fused back to back
-provide routes for blood vessels, lymphatics, and nerves
-hold organs in place
-store fat

28

Peritonitis

-inflammation of the peritoneum
-can be caused by a piercing abdominal wound
-burst appendix
-peritoneal coverings tend to stick together around the infection site localizing the infection which provides time for macrophages to prevent the inflammation from spreading

29

Splanchnic Circulation

-arteries that branch off the abdominal aorta to serve the digestive organs and the hepatic portal circulation
-arterial=spleen, liver, and stomach
-mesenteric arteries=small and large intestines

30

Hepatic Portal Circulation

-collects nutrient-rich venous blood draining from the digestive viscera and delivers it to the liver

31

Retroperitoneal Organs

-pancreas and duodenum and parts of the large intestine

32

Intraperitoneal (Peritoneal) Organs

-different from retro because they keep their mesentery and remain in the peritoneal cavity
-stomach

33

What are the 4 basic layer or tunic of the walls?

1. mucosa
2. submucosa
3. muscularis externa
4. serosa

34

Mucosa

-innermost layer
-lines the alimentary canal from mouth to anus
-simple columnar epithelium

35

What are the 3 main functions of the mucosa?

1. secrete mucus, digestive enzymes, and hormones
2. absorb the end products of digestion into the blood
3. protect against infectious disease

36

What are the 3 layers of the mucosa?

1. a lining epithelium
2. lamina propria
3. muscularis mucosa

37

Mucosa Epithelium

-mucus secreting cell
-mucus protects certain digestive organs from being digested by enzymes working within their cavities and eases food passage along the tract

38

Lamina Propria

-capillaries nourish the epithelium and absorb digested nutrients

39

MALT

-help defend us against bacteria and other pathogens
-mucosa associated lymphoid tissue

40

Muscularis Mucosa

-produces local movements of the mucosa
-increase surface area
-prevents it from collapsing

41

Submucosa

-rich supply of blood and lymphatic vessels, lymphoid follicles, and nerve fibers which supply the surrounding tissues of the GI tract
-dense connective tissue containing elastic fibers

42

Muscularis Externa

-responsible for segmentation and peristalsis
-has the circular layer and longitudinal layer

43

Circular Layer

-inner layer
-goes around the tube
-advances food thru GI tract

44

Longitudinal Layer

-outer layer
-lays on top of tube
-shortens intestine during peristalsis
-allows for stuff to be absorbed
-shortens GI tract

45

Serosa

-outermost layer of intraperitoneal organs

46

Esophagus

-takes you down from mouth to stomach
-stretches to expand
-has an adventitia layer that binds it to surrounding structures

47

Enteric Neurons

-communicate with one another to regulate digestive system activity
-has two intrinsic nerve plexuses

48

What are the 2 intrinsic nerve plexuses?

1. submucosal nerve plexuses
2. myenteric nerve plexuses

49

Submucosal Nerve Plexus

-occupies the submucosa
-underneath the circular layer

50

Myenteric Nerve Plexus

-lies between circular and longitudinal muscle layers
-provide the major nerve supply to the GI tract
-controls GI tract motility (motion)

51

What does parasympathetic input do?

-enhance digestive activities

52

What does sympathetic input do?

-inhibits digestive activities

53

Mouth

-only part of the alimentary canal involved in ingestion
-chew food and mix it with salvia containing enzymes that begin the process of digestion
-beings the propulsive process of swallowing which carries food thru pharynx and esophagus to the stomach
-oral cavity (buccal cavity)

54

What does the mouth have?

-bounded by the lips, cheeks, palate and tongue
-oral orifice
-continuous with the oropharynx

55

Why is the tongue keratinized?

-for extra protection against abrasion during eating

56

Defensins in the Mouth

-oral mucosa responds to injury by producing these antimicrobial peptide which causes the mouth to retain healthiness

57

Hard Palate

-bone on top of the mouth

58

Soft Palate

-where air moves in and out

59

Tongue

-when we swallow, the tongue pushes upward towards the hard palate which prevents food from coming up and out
-aids in swallowing, speech, and moves food around

60

Snorting

-air is trapped in the soft palate

61

How does fluid come out of your noise?

-can get fluid in the fauces, by the pharynx if fluid goes up to the nose so you can get milk out of your nose

62

Fauces

-to openings in your mouth that empty into the cavity in your mouth

63

Saliva

-cleanses the mouth
-dissolves food chemicals so they can be tasted
-moistens food and helps compact it into a bolus
-contains enzymes that begin the chemical breakdown of starchy foods

64

What happens to a saltine cracker when you let it dissolve in your mouth?

-saliva breaks down the saltine cracker into glucose making it sweet

65

What would happen if we didn't have saliva?

-our oral health would decline

66

Major (Extrinsic Salivary Glands)

-where most saliva is produced

67

Minor (Intrinsic Salivary Glands)

-buccal glands that line the cheeks

68

Parotid Gland

-near ear
-duct opens around maxillary molars

69

Submandibular Gland

-duct opens under the tongue

70

Sublingual Gland

-duct opens under the tongue
-10 to 20 ducts in the floor of the mouth

71

What are the 2 types of secretory cells?

1. serous
2. mucous

72

Serous Cells

-produce watery secretion containing enzymes, ions, and mucin

73

Mucous Cells

-produce mucus
-a stringy, viscous solution

74

What is saliva composed of?

-largely water, causing it to be hypo-osmotic
-slightly acidic
-includes electrolytes: Na, K, Cl, PO, HCO
-salivary amylase
-proteins: mucin, lysozyme, IgA
-urea and uric acid

75

Salivary Amylase

-breaks down carbs to release glucose

76

Sjorgen's Syndrome

-auto immune destruction of the salivary glands
-everything has to go down with liquid
-rampant decay

77

Human Bites

-so much bacteria in the mouth, so its very dangerous

78

Control of Salivation

-controlled by the parasympathetic system

79

What are chemoreceptors activated most strongly?

-by acidic substances such as vinegar and citrus juices

80

What can mechanoreceptors be stimulated by?

-any mechanical stimulus

81

What can cause salivation?

-sight or smell of food
-mere thought of food
-irritation of spicy food, increase salivation

82

Xerostomia

-strong activation of the sympathetic division constricts blood vessels serving the salivary glands and almost completely inhibits saliva release
-dry mouth

83

Mumps

-inflammation of the parotid glands caused by the mips virus which spreads from person to person in saliva
-viral infection of salivary glands
-adult men who orchitis where they get inflamed testicles

84

Halitosis

-bad breath
-anaerobic respiration that yields hydrogen sulfide and methyl mercaptan, cadaverine and other smelly chemicals

85

Impacted

-when a tooth remains embedded in the jawbone
-can cause pressure and pain and have to be removed surgically
-wisdom teeth

86

Enamel

-hardest substance in the body
-brushing too hard or too much and eating acidic food, takes away the enamel

87

Root

-portion of tooth in the jawbone

88

Periodontal Ligament

-anchors the tooth in the bony socket

89

Root Canal

-pulp gets infected
-anesthesize the pulp chamber to take it out and seal the tooth

90

Where does the food go after the mouth?

-into the oropharynx and then the laryngopharynx

91

Esophagus

-pierces diaphragm at esophageal hiatus
-joins to mach at cardinal orifice which surrounds the gastroesophageal or cardiac sphincter
-a layer of skeletal and smooth muscle (upper is skeletal)

92

GERD

-gastroesophageal reflux disease
-heartburn
-burning pain that occurs when stomach acid regurgitates into the esophagus
-can cause the inflammation process which can lead to cancer

93

Deglutition

-swallowing

94

Barette's Esophagitis

-screen for inflammation of esophagitis
-shows cellular changes that lead to mutations that cause cancer

95

What does it mean when your stomach growls?

-air and fluid movement in the stomach

96

Stomach

-a temporary storage where chemical breakdown of proteins begins and food is converted to chyme

97

Chyme

-creamy paste

98

Rugae

-large, longitudinal folds in the stomach
-increase surface area and absorption

99

Cardial Part (Cardia)

-surrounds the cardinal orifice thru which food enters the stomach from the esophagus

100

Funuds

-stomach's dome shaped part, beneath diaphragm

101

Body

-mid portion of stomach is continuous with the pyloric part

102

Pyloric Antrum

-food stretches, and pools here which can cause gastric ulcers

103

Greater Curvature

-convex lateral surface

104

Lesser Curvature

-concave medial surface

105

Omenta

-tether the stomach to other digestive organs and the body wall

106

Lesser Omentum

-runs forms the liver to the lesser curvature of the stomach, where it becomes continuous with the visceral peritoneum covering the stomach

107

Greater Omentum

-from the greater curvature of the stomach to cover the coils of the small intestine
-fat deposits
-contains lymph nodes

108

What are the 3 layers of stomach?

1. longitudinal
2. circular
3. oblique (which moves food a different way/runs on an angle)

109

How long does food stay in the stomach?

-4 to 6 hours
-moves around continuously
-can hear it sometimes

110

What is the amount of food and liquid that passes thru the pyloric sphincter?

-about a teaspoon, 5mL
-the more you eat, the faster it goes thru

111

Pyloric Sphincter

-food exits the stomach here and goes to duodenum
-duodenum determines how fast it digest

112

Carbs vs. Protein Digestion

-proteins take a long time to break down
-carbs break down quickly and we can store it in our liver and muscles and glucose for the athletes

113

Why should you eat before you drink?

-slows down movement of alcohol into the duodenum
-have to let both food and liquid get thru
-slows down absorption rate

114

Lining of the Stomach

-simple columnar epithelium composed of mucous cell
-produce alkaline mucus that traps bicarbonate rich fluid beneath it

115

Gastric Pits

-dot the smooth lining of the stomach
-lead into the gastric glands

116

Gastric glands

-produce the stomach secretion called gastric juice

117

Parietal Cells

-secrete HCL and intrinsic factor (vitamin B12)
-contain microvilli
-provides a surface area for secreting H and Cl into stomach lumen

118

HCL

-makes the stomach contents acidic which is necessary for activation of pepsin

119

Chief Cells

-cuboidal cells that produce pepsinogen which is the inactive form of pepsin

120

Pepsinogen and Pepsin

-becomes pepsin in the presence of HCL
-more pepsin the more HCL you secrete and the more pepsinogen you make into pepsin
-positive feedback mechanism

121

Enteroendocrine Cells

-release chemical messengers directly into the interstitial fluid
-histamine and serotonin
-somatostatin
-gastrin

122

Sliding Hiatal Hernia

-loose but food keeps it down, but when you go to sleep it creeps up and they say the feel full because food didn’t find its way to the intestine
-more common then people realize

123

Stomach Lining

-to keep from digesting itself, the stomach has a mucosal barrier
-a thick coat of bicarbonate rich mucus on the stomach wall
-epithelium cells that are joined by tight junctions
-gastric glands that have cells impermeable to HCL
-damaged to epithelial cells are quickly replaced

124

What happens if the stomach doesn't increase intrinsic factor?

-vitamin B12 won't be made, so DNA won't be made and defective DNA will eventually kill you
-pernicious anemia

125

What are the 3 phases of gastric secretion?

1. cephalic phase
2. gastric phase
3. intestinal phase

126

Cephalic Phase

-occurs before food enter the stomach
-stimulated by smell, taste, sight, though of food

127

Gastric Phase

-stomach dissension activates stretch receptors
-food chemicals and rising pH activate chemoreceptors

128

Intestinal Phase

-presence of partially digested foods in duodenum or distension of the duodenum when stomach begins to empty

129

What stimulates secretion of gastric juices?

-Stretching of the stomach
-what is in the food can also stimulate secretion
-rising pH
-stuff in duodenum can influence whats going on in your stomach
-low pH and partially digested food, it sends a chemical message and gastrin gets released in the blood increasing motility

130

Inhibitory Events

-loss of appetite, depression
-excessive acidity
-emotional stress
-distension of duodenum, presence of fatty acidic or hypertonic chyme, irritants in the duodenum
-distension; presence of fatty, acidic partially digested food in the duodenum

131

HCL Formation

-H and HCO3 are generated by dissociation of carbonic acid H2CO3 within the parietal cell
-HK ATPase pumps H into the lumen, K enters the cell
-HCO into the interstitial space in exchange for Cl causing the alkaline tide.
-one H leaves, K enters

132

Potassium

-regulates pH by swapping hydrogen in and out
-vomiting causes you to eject H ions

133

Alkaline Tide

-blood leave stomach is alkaline

134

Response of the Stomach to Filling

-stretches to accomodate incoming food, but internal pressure remains constant until food has been ingested and then it rises

135

What 2 factors keeps the pressure relatively unchanging?

1. Receptive Relaxtion
2. Gastric Accommodation

136

Receptive Relaxtion

-as food travels in the esophagus, stomach muscles relax

137

Gastric Accommodation

-plasticity: intrinsic ability of smooth muscle to exhibit the stress relaxation response
-adaptive relaxation: the stomach dilates in response to gastric filling

138

Gastric Contractile Activity

-after a meal, peristalsis occur by producing gentle rippling movements of the thin stomach wall, but as they reach the pylorus, they become stronger
-peristaltic wave reaching the pyloric muscle squirts 3mL or less of chyme into the small intestine
-most vigorous mixing occurs near the pyloric sphincter

139

What is the basic electrical rhythm (BER) contractile rhythm set by?

-enteric pacemaker cells which are interstitial cells of Cajal

140

What happens to chyme during gastric contractile activity?

-delivered in small amounts to duodenum
-forced backward into the stomach for further mixing

141

Regulation of Gastric Emptying

-stomach empties within 4 hours later
-rate depends on the contents of duodenum
-when chyme enters the duodenum, receptors stretch starting the enterogastric reflex and entergastrone mechanism that inhibit acid and pepsin secretion
-reduce pyloric contractions

142

Small Intestine

-usuale food is prepared for it joinery into the cells of the body, but it cannot occur with out liver secretions of bile and pancreas of enzyme

143

What are the 3 layers of the small intestine?

1. duodenum
2. jejunum
3. ileum

144

Jejunum

-extends from duodenum to ileum

145

Ileum

-joins the large intestine at the ileocecal valve

146

Heaptopancreatic Ampulla

-the bile duct and pancreatic duct unite in the duodenum here

147

Hepatopancreatic Sphincter

-controls entry of bile and pancreatic juice
-sphinter of Oddi

148

Pyloric Obstruction

-pylorus doesn’t open enough
-retaining food and chyme

149

Plicae Circulares

-deep, folds of the mucosa and submucosa
-force chyme to spiral thru lumen, slowing movement, and increasing absorption

150

Villi

-fingerlike projections of the mucosa
-contain a lacteal in the center which absorb fats
-increase surface area

151

Microvilli

-on top of villi that enhance absorption

152

Histology of the Small Intestine Wall

-absorptive cells bound by tight junctions and they absorb nutrients and electrolytes
-goblet cells which secrete mucus

153

Intestinal Crypts or Crypts of Lieberkuhn

-mucosa is studded with pits that lead into the glands
-secrete intestinal juice and has Paneth cells that secrete defensins and lysozymes
-decreases further along intestine
-enteroendorcine cells are scattered and secrete secretin and CCK and T cells

154

IELs

-intraepithelial lymphocytes
-immunological defensive component
-release cytokines upon contacting Ag

155

Intestinal Juice

-watery mixture that contains mucus and serves as a carrier fluid for absorbing nutrients from chyme

156

Peyer's Patches

-prevent bacteria from entering the bloodstream

157

Duodenal Glands

-produce an alkaline mucus that helps neutralize acidic chyme moving in from the stomach

158

Bile

-fat emulsifier that breaks down fats into tiny particles to make them more readily digestible

159

Liver

-largest gland of the body
-accessory gland

160

What are 4 lobes of the liver?

1. right lobe
2. left lobe
3. caudate lobe
4. quadrate lobe

161

Falciform Ligament

-separate the right and left lobes and suspends the liver from the diaphragm and abdominal wall

162

Round Ligament

-a fibrous remnant of the fetal umbilical vein

163

Caput Medusa

-dilated veins that look the snakes on the medusa
-stomach becomes distended in the stomach
-tap the abdominal cavity
-liver is failing

164

Cirrhosis

-hardening of the liver due to scar tissue

165

Gall Bladder

-is a sac on the underside of the liver
-store bile
-it releases it through the cystic duct
-emulsifies fats

166

What is the pathway of the ducts?

-right and left hepatic duct form common hepatic duct and they merge together with the cystic duct to form bile duct and it empties into the duodenum and empties into the hepatopancreatic duct and into the sphincter of ode

167

Pancreatic Duct

-he pancreas releases enzymes that joins up in the bile duct where they release bile, and pancreatic juices into the duodenum
-proteases

168

Bile

-made up of cholesterol and bile salts
-all salts are crystallid and possess charges
-bile gets released when you have fatty diet

169

Cholecystitis

inflamed gall bladder leads to gall stones

170

Cholelithiasis

-gall stones which can lead to removal

171

Cholecystectomy

-removal of gall baldder

172

Why do you need fat?

-to make plasma membrane and sex hormones, and to make certain compounds

173

Gall Stones

-only release bile when its in duodenum, when you don’t eat fat, it stays in the gall bladder and becomes concentrated and loses the water and the crystals don’t stay dissolved anymore so they fall out of solution and they are charged and are attracted to each other and with time, combined with chlosterol you form stones
-can cause obstruction and increase pressure abdomen

174

Gall Stones and Pacncreas

-can cause the pancreas to back up and cause pancreatitis
-auto digestion where the pancreas eats itself

175

Liver Sinusoids

-fenestrate capillaries
-allows blood to pool in the liver, so it can process it; receives blood from hepatic artery and hepatic portal vein

176

Kupffer Cells

-macrophages in the liver that remove RBC's

177

Regenerative Capacity of the Liver

-can regenerate to 6 to 12 months after loss of 80%
-hepatocytes secrete growth factors that prompt endothelial cells that release other growth factors that replace dead and dying hepatocytes

178

Jaundice

-bilirubin back up
-backs up and deposits in the skin
-yellow skin, liver malfunctioning

179

What does the hepatocytes do?

-production of bile
-processing bloodborne nutrients
-storage of fat soluble vitamins
-detoxification: requires a lot of SER
-clotting factors
-produces albumin

180

Regulation of Bile Release

-acidic, fatty chyme causes the duodenum to release:
-cholecystokinin (CCK) and secretin into the bloodstream; CCK stimulates pancreas to release bicarbonate enriched juice
-bile salts made from cholesterol
-bile salts and secretin transported in blood stimulate the liver to produce bile
-vagal stimulate causes weak contractions of the gallbladder

181

What does CCK cause?

-gallbladder to contract
-stimulate pancreas to release bicarb
-the hepatopancreatic sphincter to relax

182

Pancreas

-produces enzymes that break down all categories of foodstuffs

183

Pancreatic Juice

-drains from the pancreas into the duodenum

184

Acini

-clusters of secretory acinar cells surrounding ducts
-zymogen granules that contain the inactive digestive enzymes

185

Pancreatic Juice

-mainly of water, and contains enzymes and electrolytes
-neutralizes acid chyme
-provides optimal environment for pancreatic enzymes

186

Enzymes that are released in the inactive form?

-trypsinogen is activated to trypsin
-this must occur for the second and third conversion to take place
-procarboxypeptidase is activated to carboxypeptidase
-chymotrypsinogen→chymotrypsin

187

Enzymes that are released in the active form?

-amylase, lipases, and nucleases
-require ions or bile be present in the intestinal for optimal activity

188

When are CCK and secretin released?

-when fatty or acidic chyme enters the duodenum

189

Large Intestine

-three bands of longitudinal smooth muscle in its muscularis

190

Haustra

-pocketlike sacs caused by the tone of the teniae coli

191

Epiploic Appendages

-fat filled pouches of visceral peritoneum

192

What is the large intestine divide into?

-cecum, appendix, colon, rectum, and anal canal

193

Ileoecal Valve

-first part of the large intestine

194

What are the four parts of the colon?

-ascending
-descending
-sigmoid
-transverse

195

Right Colic (Hepatic Flexure)

-travels across the abdominal cavity to transverse colon

196

Left Colic (Splenic) Flexure

-descends down the left side of the posterior abdominal wall to the descending colon

197

Appendix

-vermiform appendix
-can live without your appendix
-houses natural flora that will reboot the system if it is wiped out
-can rupture causing e.coli to go into the large intestine

198

Anus

-internal sphincter: smooth muscle, out of our control
-external sphincter: in our control

199

Levinator Ani Muscle

-helps us defecate
-raises the anus and completes the process of defecation

200

Bacterial Flora

-bacteria surviving the small intestine that enter the cecum
-those entering via the anus
-colonize the colon
-ferment indigestible carbohydrates
-release irritating acids and gases (flatus)
-synthesize B complex vitamins and vitamin K
-flatulence

201

Hemorrhoids

-when you are constipated and you want to move the stool as fast you can, you increase the pressure and blood pressure in the hepatic portal system and you squeeze blood down
-if you do it consistently, the blood vessels become engorged or enlarged and you see bright red blood in your stool
-if you ignore the stimulus, you can cause hemorrhoids

202

Diverticulosis

- out pouches in the walls of the colon
-relieves pressure in the colon
-if something goes into them, it festers and decomposes, inflaming
-diverticulisis
-swelling
-compressed capillaries causing hypoxia and cell death
-perforation
-things that get trapped
-tomato seeds
-popcorn seeds

203

Fats from the GI Tract

-fats are harder to digest because lipids are nonpolar
-in the duodenum, fat molecules break down and flip themselves inside out and form a micelle
-puts the polar side outside
-charged side
-reassembles its self once it gets thru the cell membrane of the duodenum
-takes long time for it to happen
-uses bile to break down the fats
-when there are fats in the duodenum, it sends a signal to the stomach to slow down digestion
-slows down gastric release
-unique property of fats

204

Fatty Liver

-fat can find its way into the liver
-could indicate alcoholism
-non alcoholic fatty liver: people who never drink, can end up with a fatty liver
-not normal, but doesn’t mean its doing any damage
-has to be monitored
-can lead to an inflammatory process which could damage liver in the long term process