Lecture 11 - The Liver and Biliary System/Pancreas
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1
Where does the blood go in portal hypertension?
mesentery viens
2
What is anastomosis?
expansion of pre-existing vascular channels within the portal and systemic circulation.
3
what is jaundice?
build up of unconjugated and conjugated yellow pigment
4
what enzyme conjugated billirubin?
GATA1 gene
5
Where does bilirubin come from originally?
portoprophyrin IX of RBCs
6
why does albumin carry billiruben
Billiruben is hydrophobic molecule
7
Is biliruben conjugated soluble or insoluble?
soluble
8
Is biliruben UNconjugated soluble or insoluble?
Insoluble
9
Where does the conjugated biliruben go after the liver?
The bile
10
Where does the conjugated biliruben go after the bile?
Duodenum
11
What else travels through the bile duct besides biliruben?
Cholesterol and salts
12
what type of gland is the pancreas?
Exocrine (95%) & endocrine (5%) gland
13
What does the pancreas create?
Major digestive enzymes
14
Where do the major digestive enzymes get produces in the pancreas?
Acini glands ~ like salivary glands
15
what is the non activated form called (digestive enzymes)?
Proenzyme form ~ not activated
16
when with the proenzyme forms become activated?
when it comes in contact with bile
17
What is acute pancreatitis?
a condition where the pancreas becomes inflamed (swollen) over a short period of time.
18
Why does acute pancreatitis happen?
gallstones can block pancreatic opening;
when the bile and enzymes go back into the pancreas! (life-threatening)
when the bile and enzymes go back into the pancreas! (life-threatening)
19
Which tests should be run to detect acute pancreatis?
lipase (high)
amylase (high)
amylase (high)
20
Which test is specific for acute pancreatitis?
Amylase
21
which test is sensitive for acute pancreatitis?
lipase
22
What causes prehepatic jaundice? (problem comes and goes)
Hemolysis
Hematoma
Gilbert's disease
Hematoma
Gilbert's disease
23
If you see biliruben in the urine, what does that mean?
conjugated biliruben (soluble)
24
Is you no biliruben in the urine but the person is yellow, what does that mean?
unconjugated biriruben (insoluble)
25
What is gilbert's disease?
Mutation in GATA1 gene!!! (reduces activity by 80%)
Liver doesn't properly process biliruben (can't make conjugated biliruben)
INCREASE of unconjugated biliruben in blood.
Liver doesn't properly process biliruben (can't make conjugated biliruben)
INCREASE of unconjugated biliruben in blood.
26
What is hepatic jaundice?
Problem in liver
27
What are examples of hepatic jaundice?
Viral hepatitis
Alcoholic liver disease
Drug-induced liver disease
Chronic hepatitis as a result of various causes
Cirrhosis
Alcoholic liver disease
Drug-induced liver disease
Chronic hepatitis as a result of various causes
Cirrhosis
28
What are examples of posthepatic jaundice?
Gallstones in common bile duct
Carcinoma of head of pancreas
Carcinoma of common bile duct
Carcinoma of gallbladder (late symptom!)
Carcinoma of head of pancreas
Carcinoma of common bile duct
Carcinoma of gallbladder (late symptom!)
29
What is the common cause of acute viral hepatitis?
COMMON: hepatitis viruses: A, B, C, D, E
30
Describe the different types of hepatitus viruses (A-E)
A: fecal and oral (young children) and gaza (warezones)
B & C: blood borne, sexually transmitted
D: not alone
E: Fecal and oral route
B & C: blood borne, sexually transmitted
D: not alone
E: Fecal and oral route
31
What are rare causes of acute viral hepatitis?
EBV
Cytomegalovirus
Herpesvirus
Viruses causing childhood viral diseases
Yellow fever virus (in tropics)
MUMPS virus targets parietal glands AND pancreas
Cytomegalovirus
Herpesvirus
Viruses causing childhood viral diseases
Yellow fever virus (in tropics)
MUMPS virus targets parietal glands AND pancreas
32
What is the vaccine given for hepatitis B?
anti-HbS!!!
33
How do we know hepatitis (+) is from the virus or vaccination?
Virus: anti - HB E & C (body creates anti-HB E ~ IgG & IgM)
Vaccination: anti-HB S ONLY
Vaccination: anti-HB S ONLY
34
What tests are ordered to differentiate hepatitis B virus vs. vaccination?
1. anti-HB S !!
2. anti- HB C ~ only in virus IgM
3. anti- HB E ~ acute infective
2. anti- HB C ~ only in virus IgM
3. anti- HB E ~ acute infective
35
What are the causes of cirrhosis?
Alcohol
Hepatitis viruses (B, C, D)
Hereditary metabolic diseases: hemochromatosis, wilson's disease, alpha1-antitrypsin deficiency
Autoimmune diseases: primary biliary cirrhosis, primary sclerosing cholanitis, autoimmune hepatitis
Drugs
Biliary obstruction: cystic fibrosis, gallstones
Cryptogenic (unknown causes)
Hepatitis viruses (B, C, D)
Hereditary metabolic diseases: hemochromatosis, wilson's disease, alpha1-antitrypsin deficiency
Autoimmune diseases: primary biliary cirrhosis, primary sclerosing cholanitis, autoimmune hepatitis
Drugs
Biliary obstruction: cystic fibrosis, gallstones
Cryptogenic (unknown causes)
36
What is hemochromatosis? (in liver)
genetic disorder ~ HFE gene
iron storage overload caused by increase of hepsidin
iron storage overload caused by increase of hepsidin
37
What is wilson's disease
rare inherited condition that causes copper levels to build up in several organs
38
What is alpha1-antitrypsin (liver enzyme) deficiency?
a genetic disorder that prevents the body from producing enough AAT, a protein that protects the lungs and liver from damage.
Elastase overactivated (breaks down fibers in the alveolar sac)
Elastase overactivated (breaks down fibers in the alveolar sac)
39
What happens in alcoholic liver disease?
Accumulation of acetaldehyde!!!
Accumulation of NADH too = increase of triglyceraldes (fatty liver)
Fatty liver is the first step to cirrhosis
Accumulation of NADH too = increase of triglyceraldes (fatty liver)
Fatty liver is the first step to cirrhosis
40
How is alcohol broken down by the liver?
Alcohol dehydrogenase in hepatocytes break down ethanol > acetaldehyde > acetate
NAD + > NADH helps as well.
NAD + > NADH helps as well.
41
what is caput medusae?
a condition that causes swollen veins on the abdomen, usually around the belly button, that branch out from a central point
PORTAL HYPERTENSION
PORTAL HYPERTENSION
42
what are common tests done for liver cell injury?
ALT (increased) ~alanine transaminase (food > energy)
AST (increased) ~aspartate aminotransferase (food > energy)
AST (increased) ~aspartate aminotransferase (food > energy)
43
Why is ALT and AST good tests to check for liver cell injury?
Hepatocytes release these enzymes when the liver experiences injury
44
If AST is higher than ALT, what is the cause?
Alcoholism
45
What are 2 signs of loss of liver cell function?
Hypoalbuminemia
Prolonged PT time (bleeding tendency)
Prolonged PT time (bleeding tendency)
46
What is a sign of loss of detoxification function?
blood ammonia is elevated!
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