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Questions and Answers

What cellular change occurs in hepatic fibrosis that negatively affects liver function?

  • Enhanced Kupffer cell activation
  • Reduced blood volume storage
  • Increased vascular endothelial function
  • Decreased hepatocyte microvilli (correct)

Which cell type is primarily responsible for the remodelling of the extracellular matrix in chronic liver disease?

  • Ito cell (correct)
  • Kupffer cell
  • Sinusoidal endothelial cell
  • Hepatocyte

What is the primary metabolic function of the liver concerning ammonia?

  • Direct excretion
  • Conversion to uric acid
  • Storage in hepatocytes
  • Conversion to urea (correct)

Which of the following is NOT a function of the liver?

<p>Filtration of lymph (C)</p> Signup and view all the answers

How does the activation of Kupffer cells affect hepatic stellate cells during liver injury?

<p>It leads to their paracrine activation (B)</p> Signup and view all the answers

What is a consequence of liver dysfunction related to lipid metabolism?

<p>Accumulation of triglycerides in the liver (B)</p> Signup and view all the answers

Which type of lipoprotein is synthesized and secreted by hepatocytes?

<p>Very-low-density lipoproteins (VLDL) (B)</p> Signup and view all the answers

What function does the liver perform related to vitamins and minerals?

<p>Storage of certain vitamins and iron (B)</p> Signup and view all the answers

What is the primary function of Kupffer cells in the liver?

<p>Phagocytosis and clearance of foreign material (A)</p> Signup and view all the answers

Which cell type in the liver is specifically noted for its ability to perform phagocytosis?

<p>Kupffer cells (C)</p> Signup and view all the answers

What prevents proteins from leaking out of the blood into the extracellular fluid in the liver?

<p>Colloidal osmotic pressure from proteins (C)</p> Signup and view all the answers

What role do lymphatic vessels play concerning the liver?

<p>They return fluid to the subclavian vein (A)</p> Signup and view all the answers

How does the structure of sinusoids in the liver differ from typical capillaries?

<p>They have large fenestrations between endothelial cells. (A)</p> Signup and view all the answers

What triggers an increase in the number of Kupffer cells present in the sinusoids?

<p>Increase in particulate matter in the blood (B)</p> Signup and view all the answers

What is the primary role of hepatic receptors in lipoprotein metabolism?

<p>To recognize apolipoprotein E (apo E) from chylomicron remnants (B)</p> Signup and view all the answers

What is transported in the core of very-low-density lipoprotein (VLDL) particles?

<p>Triglycerides (B)</p> Signup and view all the answers

What is NOT a function of Kupffer cells in the liver?

<p>Storage of glycogen (B)</p> Signup and view all the answers

Which lipoprotein metabolic pathway is associated with lipoprotein lipase (LPL)?

<p>Hydrolyzing triglycerides in circulation (B)</p> Signup and view all the answers

Which component of the liver lobule drains into bile ducts?

<p>Biliary canaliculi (B)</p> Signup and view all the answers

What role does ATP binding cassette transporter 1 (ABCA1) play in lipoprotein metabolism?

<p>Transporting cholesterol from peripheral tissues to the liver (A)</p> Signup and view all the answers

What is a key characteristic of intermediate-density lipoprotein (IDL)?

<p>It is denser than low-density lipoprotein (LDL) (A)</p> Signup and view all the answers

What component is primarily utilized by hepatic triglyceride lipase (HTGL) in lipid metabolism?

<p>Hydrolyzed triglycerides from VLDL (C)</p> Signup and view all the answers

Which protein is recognized by LDL receptors in lipoprotein uptake?

<p>Apolipoprotein B-100 (A)</p> Signup and view all the answers

What is the function of lecithin:cholesterol acyltransferase (LCAT) in lipoprotein metabolism?

<p>Catalyzing the esterification of free cholesterol (A)</p> Signup and view all the answers

What is the primary function of bile acids in the digestion process?

<p>They emulsify lipids to increase surface area for enzymes. (B)</p> Signup and view all the answers

What triggers the contraction and emptying of the gallbladder?

<p>The hormone CCK released in response to fats. (C)</p> Signup and view all the answers

How much bile typically enters the duodenum each day?

<p>250-1500 ml (C)</p> Signup and view all the answers

What percentage of the bile acid pool is normally excreted in the feces each day?

<p>10-20% (B)</p> Signup and view all the answers

Which of these compounds is NOT a significant component of bile?

<p>Lipase (A)</p> Signup and view all the answers

Which part of the intestine is primarily responsible for the active absorption of bile acids?

<p>Ileum (D)</p> Signup and view all the answers

What happens to cholesterol levels in bile when drugs that inhibit bile acid reabsorption are used?

<p>Cholesterol levels in bile increase. (C)</p> Signup and view all the answers

What role does the enterohepatic circulation play in bile acids?

<p>It facilitates the recirculation of bile acids during digestion. (A)</p> Signup and view all the answers

What are the two primary bile acids synthesized by the liver?

<p>Cholic acid and chenodeoxycholic acid (A)</p> Signup and view all the answers

How do bile acids increase their solubility in bile?

<p>By aggregating into micelles (A)</p> Signup and view all the answers

Which statement about conjugated bile acids is true?

<p>They are more complexly ionized at near-neutral pH. (C)</p> Signup and view all the answers

What happens when bile acids reach the critical micelle concentration?

<p>They exclusively incorporate into micelles. (A)</p> Signup and view all the answers

What role does lecithin play in bile?

<p>It helps to solubilize cholesterol in micelles. (B)</p> Signup and view all the answers

What are the consequences of excess cholesterol in bile?

<p>Formation of cholesterol gallstones (B)</p> Signup and view all the answers

Which of the following statements regarding secondary bile acids is correct?

<p>They are formed through dehydroxylation of primary bile acids. (C)</p> Signup and view all the answers

What feature of bile acids contributes to their ability to form micelles?

<p>Their amphipathic nature (C)</p> Signup and view all the answers

Which of the following proteins is NOT synthesized by the liver?

<p>Fibrinogen (D)</p> Signup and view all the answers

What role does the sphincter of Oddi play in bile secretion?

<p>It regulates the diameter of the bile duct orifice. (B)</p> Signup and view all the answers

Which component is primarily synthesized by hepatocytes and contributes to bile composition?

<p>Cholesterol (D)</p> Signup and view all the answers

How does bile duct secretion differ from plasma in terms of bicarbonate concentration?

<p>Bile duct secretion has a higher concentration of bicarbonate than plasma. (C)</p> Signup and view all the answers

Which statement about gallbladder contraction is accurate?

<p>Secretin stimulates gallbladder contraction and emptying. (B)</p> Signup and view all the answers

What is the primary function of protease inhibitors produced by the liver?

<p>To prevent excessive blood coagulation. (B)</p> Signup and view all the answers

Which protein serves as a carrier for copper in the plasma?

<p>Ceruloplasmin (D)</p> Signup and view all the answers

Which bile constituents are specifically secreted by hepatocytes into bile canaliculi?

<p>Bile acids, cholesterol, and lecithin (D)</p> Signup and view all the answers

Flashcards

Liver Lobule Structure

Liver lobules are organized around a central vein, with blood entering from the portal vein and hepatic artery sinusoids. Hepatocytes are in direct contact with the blood due to fenestrations in sinusoidal endothelial cells.

Liver Sinusoids

Blood vessels in the liver that allow direct contact between blood and hepatocytes due to fenestrations (gaps) in their endothelial cells.

Hepatocytes

Liver cells directly involved in various metabolic functions, such as processing nutrients and detoxifying substances.

Kupffer Cells

Specialized macrophages within liver sinusoids that act as immune cells, phagocytosing foreign materials and debris.

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Phagocytosis (Kupffer)

The process by which Kupffer cells engulf and destroy foreign particles like pathogens and cellular debris.

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Biliary Canaliculi

Small channels between hepatocytes that collect bile, eventually draining into bile ducts.

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Starling Equilibrium

(Not relevant to liver), a theoretical balance in the kidneys that does not apply to the liver

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Liver Lymph Production

The liver produces a significant portion of the body's lymph, which is drained by lymphatic vessels.

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Hepatic Blood Volume Expansion

In liver failure, the amount of blood in the liver can increase to as much as 60 ml per gram of liver tissue.

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Space of Disse

A space in the liver where Ito cells (stellate cells) are located.

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Hepatic Stellate Cell Function

These cells play a role in extracellular matrix remodeling during liver injury and fibrosis, and in fibrous capsule formation around tumors.

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Liver Fibrosis Impact

Liver fibrosis leads to deteriorating liver function due to matrix and cellular changes.

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Stellate Cell Activation

In liver disease, stellate cells become active, leading to scar tissue formation, impacting liver function.

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Kupffer Cell Activation

Activated Kupffer cells (liver macrophages) contribute to stellate cell activation in the liver.

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Liver Glycogen Storage

The liver and skeletal muscles are the main sites of glycogen storage in the body.

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Chylomicron Removal

Lipoprotein lipase in muscle, heart, and fat removes triglycerides from chylomicrons.

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Bile Production

The liver produces bile, a fluid that aids in digestion and absorption of fats.

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Bile Composition

Bile contains bile acids, cholesterol, bile pigments, and other substances.

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Bile Storage

Between meals, bile is stored and concentrated in the gallbladder.

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Gallbladder Release

When we eat fatty foods, the gallbladder releases concentrated bile into the duodenum.

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Bile Acid Function

Bile acids emulsify fats, breaking them down into smaller droplets for easier digestion and absorption.

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Bile Acid Recycling

Bile acids are absorbed in the ileum and circulated back to the liver for reuse.

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Cholesterol Excretion

Bile acids are a key mechanism for excreting excess cholesterol from the body.

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Enterohepatic Circulation

The recycling process of bile acids between the liver, intestine, and gallbladder.

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Chylomicron Remnants

The leftover parts of chylomicrons after most triglycerides are removed by lipoprotein lipase. They mainly contain cholesterol and cholesterol esters.

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Apolipoprotein E (apo E)

A protein on the surface of chylomicron remnants that is recognized by receptors in the liver, allowing the remnants to be taken up and processed.

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Very-Low-Density Lipoprotein (VLDL)

A type of lipoprotein mainly made by the liver that carries triglycerides and cholesterol from the liver to other tissues.

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Hepatic Receptors

Receptors on the surface of liver cells that bind to specific molecules, like apolipoprotein E, allowing uptake of substances like chylomicron remnants.

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Triglycerides

A type of fat (lipid) that is a major energy source for the body. It is composed of glycerol and three fatty acids.

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Lipoprotein Lipase (LPL)

An enzyme that breaks down triglycerides in chylomicrons and VLDL, releasing fatty acids to be used by tissues.

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What is the role of the liver in lipid metabolism?

The liver plays a central role in lipid metabolism. It produces VLDL to export triglycerides, takes up chylomicron remnants and other lipoproteins, and synthesizes cholesterol and other lipids.

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Why are chylomicron remnants cleared from the circulation?

Chylomicron remnants need to be cleared because they contain high levels of cholesterol, which if left in the circulation could lead to plaque buildup and heart disease.

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What are the major plasma proteins produced by the liver?

These proteins are essential for various functions, including clotting, transport, and immune defense. They are synthesized by hepatocytes and released into the bloodstream.

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What is the sphincter of Oddi?

A muscular ring located at the junction of the common bile duct and the duodenum, controlling the flow of bile into the small intestine.

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What are the key components of bile?

Bile is a complex fluid composed of bile acids, cholesterol, lecithin, and bile pigments. These substances are essential for fat digestion and absorption.

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How does bile duct secretion differ from plasma?

While both have similar Na+, K+, Cl- levels, bile duct secretion has a higher concentration of HCO3- (bicarbonate) and a lower concentration of Cl- than plasma.

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What stimulates bile duct secretion?

The hormone secretin, released from the duodenum in response to acidic chyme, specifically triggers the increased secretion of bicarbonate-rich fluid by bile duct cells.

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What is the role of secretin in bile secretion?

Secretin stimulates the secretion of bicarbonate-rich fluid from bile duct cells, increasing the volume and alkalinity of bile.

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Does secretin cause gallbladder contraction?

No, secretin does not cause gallbladder contraction. Cholecystokinin (CCK) is the hormone responsible for gallbladder contraction and bile release.

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What is the function of bile acids in digestion?

Bile acids act as detergents, emulsifying fats into smaller droplets, increasing their surface area for digestion by lipase enzymes.

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Primary Bile Acids

Bile acids synthesized by the liver, including cholic acid (3-hydroxyl groups) and chenodeoxycholic acid (2-hydroxyl groups).

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Secondary Bile Acids

Bile acids formed from primary bile acids by bacteria in the digestive tract through dehydroxylation.

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Conjugated Bile Acids

Primary bile acids linked to glycine or taurine, increasing water solubility.

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Bile Salts

Conjugated bile acids that are ionized and water soluble, existing as salts of various cations (mainly Na+).

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Micelle Formation

Bile acids, with their hydrophilic and hydrophobic domains, form aggregates called micelles above a critical concentration.

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Lecithin's Role in Micelles

This phospholipid, being amphipathic, buries its fatty acyl chains inside the micelle and presents its polar head to the surface, increasing cholesterol solubility.

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Cholesterol Gallstones

When cholesterol levels in bile exceed micelle capacity, excess cholesterol crystallizes, forming gallstones.

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Critical Micelle Concentration

The specific concentration of bile acids needed for the formation of micelles.

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Study Notes

Liver and Gallbladder Functions

  • The liver and gallbladder are crucial for various bodily functions.
  • The liver has vascular functions, storing and filtering blood.
  • The liver has secretory functions, secreting bile into the gastrointestinal tract.
  • The liver performs metabolic functions.

Liver Structure

  • Liver lobules are organized around central veins.
  • Blood enters sinusoids from the portal vein and hepatic artery.
  • Blood flows towards the center of the lobule between hepatic cells.
  • Hepatic cells are one or two hepatocytes thick.
  • Sinusoids have large gaps between endothelial cells.
  • The normal Starling equilibrium does not operate in the liver.
  • Fluid is readily leaked into the extracellular fluid.
  • Lymph in the liver returns fluids from the liver through the thoracic duct and subclavian vein.
  • The liver produces about 1/3 to 1/2 of the lymphatic fluid in the body.

Kupffer Cells

  • Kupffer cells are specialized macrophages in the sinusoids.
  • They express complement receptor (CRlg).
  • Their function is to catch pathogens.
  • Their number increases when particulate matter or debris is present in the blood.

Kupffer Cell Functions

  • Phagocytosis of micro-organisms (bacteria, viruses).
  • Endotoxins removal.
  • Immune complexes removal.
  • Tumour cell removal.
  • Lipid assemblies removal.
  • Fibrin degradation products removal.
  • Other particulate matter removal.
  • Modulation of acute phase proteins and lipoproteins synthesis.
  • Cytokine secretion.
  • Antigen processing.
  • Glycoproteins and lipids catabolism.

Hepatic Circulation Zones

  • Liver acinus is divided into three circulatory zones surrounding the portal axis.
  • Zone 1 hepatocytes are close to the portal axis and are bathed in blood rich in nutrients and oxygen.
  • Zone 1 cells are most active for oxidative metabolism and bile acid uptake.
  • Zone 3 cells are near the central vein and receive blood already exchanged nutrients and oxygen in Zones 1 and 2.
  • Zone 3 cells are mainly geared towards anaerobic metabolism.
  • Zone 3 cells are sensitive to ischemia, nutritional deficiency, and toxic substances.

Hepatic Blood Flow

  • Total hepatic blood flow accounts for approximately 25% of cardiac output.
  • Portal vein supplies 70-75% of liver blood supply.
  • Hepatic artery supplies 25-30%.

Liver as a Blood Reservoir

  • The liver is a significant blood reservoir in humans.
  • It contains 25-30 ml of blood per 100 grams of tissue.
  • Liver blood volume can expand to 60 ml/grams of liver with cardiac failure.
  • It plays a crucial role during hemorrhage.

Bile Secretion and Composition

  • Bile is elaborated by hepatocytes.
  • It contains bile acids, cholesterol, lecithin, and bile pigments.
  • Hepatocytes secrete bile constituents into the bile canaliculi.
  • Bile is an isotonic fluid similar in concentrations of Na+, K+, Cl−, and HCO3− to plasma.
  • Bile duct epithelium secretes a watery bicarbonate-rich fluid.
  • The fluid contributes to bile volume.
  • Secretion of bile duct epithelium is stimulated by secretin.
  • Bile, without secretin, does not increase the concentration.

Bile Concentration in Gallbladder

  • Bile is diverted to the gallbladder between meals.
  • The Gallbladder is a small organ with 15-60 ml capacity (average 35ml).
  • The volume may be more than what liver secretes between meals.
  • Gallbladder concentrates bile by absorbing Na+, Cl−, HCO3− and water.
  • Bile acid concentration increases 5 to 20 times in gallbladder.

Bile Acid Absorption and Transport

  • Bile acids are absorbed primarily in the terminal ileum.
  • Active transport system in ileum has higher affinity for conjugated bile acids.
  • Bile acid absorbed by either active transport or simple diffusion.
  • Bile acids move from intestine into portal blood and are bound to plasma proteins.
  • Hepatocytes absorb bile acids from portal blood.
  • The hepatocytes then reconstitute the original structure.
  • Bile acids are secreted into bile with newly synthesized bile acids.

Choleretic Effect and Excretion

  • The rate of bile acid return to the liver influences synthesis and secretion.
  • Bile acids stimulate secretion but inhibit synthesis, called choleretic effect.
  • Choleretics enhance secretion.

Liver and Biliary Pain

  • Pain may be from stretching liver capsule over right hypochondrium.
  • or stretching of bile duct or gallbladder, mid epigastrium or right subcostal region.
  • Rarely, pain is experienced below the scapula.

Bile Pigments and Gallstones

  • Bilirubin is a yellow pigment in bile.
  • Bilirubin may form in the intestines as urobilinogen.
  • Most urobilinogen is returned to liver and re-secreted in bile.
  • A small amount is absorbed into general circulation and then excreted by the kidneys.
  • Bile pigments that form gallstones called calcium salts of unconjugated bilirubin.
  • Individuals with liver disease have a higher chance of gallstones formation.

Phospholipids in Bile

  • Liver secretes phospholipids, mainly lecithin.
  • Cholesterol dissolves into the middle of micelles.
  • Lecithin is amphipathic; it buries its fatty acyl chains inside the micelle and its hydrophilic surface faces water, thus solubilizing cholesterol.

Other Liver Details

  • Jaundice: yellowing of skin and mucous membranes.
  • Jaundice occurs when bilirubin levels elevate to more than 2 mg/dl.
  • Hepatic diseases, reduced intracellular bilirubin uptake, failure in intracellular protein binding, impaired secretion or biliary obstruction can cause jaundice.

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