Hepatobiliary and Pancreatic Disorders: Liver Structure and Functions

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Questions and Answers

What percentage of liver function is required to sustain life?

50%

10% to 20% (correct)

30%

80%

How many tasks does the liver perform?

More than 500 (correct)

100

200

1000

What is the function of the hepatic duct?

To transport bile produced by the liver cells to the gallbladder and duodenum (correct)

To store bile

To supply oxygenated blood to the liver

To filter nutrient-rich blood from the intestine

What is the relative size of the right lobe to the left lobe of the liver?

The right lobe is 6 times the size of the left lobe Signup and view all the answers

How much blood circulates through the liver every minute?

1500 mL/min Signup and view all the answers

What are the two sources of blood supply to the liver?

Hepatic artery and hepatic portal vein Signup and view all the answers

What happens to bilirubin in the liver?

It is conjugated with glucoronic acid and then excreted in bile Signup and view all the answers

What does an increase in unconjugated bilirubin indicate?

Disease of liver cells (hepatocytes) Signup and view all the answers

What is the name of the test that measures conjugated bilirubin?

Van den Bergh's test Signup and view all the answers

What is the characteristic of fulminant hepatitis?

Severe liver dysfunction accompanied by hepatic encephalopathy Signup and view all the answers

What is the duration of chronic hepatitis?

At least 6 months Signup and view all the answers

What is the main mode of transmission of hepatitis A and E?

Oral-fecal route Signup and view all the answers

What are the four phases of acute viral hepatitis?

Prodromal, preicteric, icteric, and convalescent Signup and view all the answers

What is the complication of fulminant hepatitis?

All of the above Signup and view all the answers

What is a characteristic of severe advanced liver disease?

Jaundice Signup and view all the answers

What is the accumulation of fat droplets in hepatocytes likely to lead to?

Fibrosis and cirrhosis Signup and view all the answers

What is Non-Alcoholic Fatty Liver Disease (NAFLD) characterized by?

Accumulation of fat droplets in hepatocytes Signup and view all the answers

What is the major route of oxidation of alcohol?

Alcohol Dehydrogenase System (ADH) Signup and view all the answers

What is the result of the formation of lactic acid in the liver?

Increased lactate production Signup and view all the answers

What is the characteristic of Alcoholic Hepatitis?

Modest elevation of transaminase levels Signup and view all the answers

What is the main treatment for Alcoholic Hepatitis?

Nutrition support and counseling Signup and view all the answers

What is the result of the increase in NADH in the liver?

Increased triglyceride production Signup and view all the answers

What is the primary reason for using MCTs in the treatment of pancreatic disorders?

Because MCTs do not require bile salts and micelle formation for absorption Signup and view all the answers

What is the primary goal of medical nutrition therapy (MNT) in chronic pancreatitis?

To provide optimal nutrition support and decrease pain Signup and view all the answers

What is the characteristic of severe acute pancreatitis (AP)?

Hypercatabolic Signup and view all the answers

What is the recommended treatment for steatorrhea in patients with pancreatic disorders?

Supplemental pancreatic enzymes Signup and view all the answers

What is the characteristic of hepatorenal syndrome?

Renal failure due to severe liver disease without intrinsic kidney abnormality Signup and view all the answers

What is the recommended nutrition approach for patients with mild to moderate acute pancreatitis?

Clear liquid, low fat diet Signup and view all the answers

What is the primary purpose of lactulose in the treatment of hepatic encephalopathy?

To act as a laxative and retain ammonia Signup and view all the answers

What is the main contribution of branched-chain amino acids to the body?

They furnish up to 30% of energy requirements for skeletal muscle, heart, and brain Signup and view all the answers

What is the result of muscle proteolysis in ESLD?

Release of aromatic amino acids and methionine into circulation Signup and view all the answers

What is the effect of high levels of aromatic amino acids on the brain?

They compete with branched-chain amino acids for carrier-mediated transport at the blood-brain barrier Signup and view all the answers

What percentage of patients with cirrhosis can tolerate mixed-protein diets up to 1.5 g/kg of body weight?

More than 95% Signup and view all the answers

What is the role of rifaximin in the treatment of hepatic encephalopathy?

To decrease colonic ammonia production Signup and view all the answers

What is the effect of the altered plasma amino acid ratio on the development of hepatic encephalopathy?

It may contribute to the development of hepatic encephalopathy Signup and view all the answers

What is another suggested mechanism that contributes to neuronal inhibition in hepatic encephalopathy?

The y-aminobutyric acid receptor complex Signup and view all the answers

Study Notes

Structure of the Liver

The liver is the largest gland in the body, divided into right and left lobes.
1500 mL of blood/min circulates through the liver and exits via the hepatic veins into the inferior vena cava.
Bile is formed in the liver and exits through a system of ducts.

Physiology and Functions of the Liver

The liver is integral to most body functions, performing over 500 tasks.
The liver has the ability to regenerate, but only 10% to 20% of its function is needed to sustain life.

The Liver

The right lobe is 6 times the size of the left lobe.
Both lobes are made up of thousands of lobules connected to small ducts that form the hepatic duct.
The hepatic duct transports bile produced by liver cells to the gallbladder and duodenum.
The liver has two blood supplies: the hepatic artery, which provides oxygenated blood, and the hepatic portal vein, which provides nutrient-rich blood from the intestine.

Bile Production

The liver produces bile, which is then stored in the gallbladder and transported to the duodenum through the biliary tract.
Bilirubin is conjugated with glucoronic acid in the liver and then excreted in bile.
Increased levels of bilirubin indicate liver disease.

Diseases of the Liver

Acute viral hepatitis: widespread inflammation caused by viruses A, B, C, D, E, and G.
Fulminant hepatitis: severe liver dysfunction accompanied by hepatic encephalopathy.
Chronic hepatitis: lasting at least 6 months, caused by auto-immune, viral, metabolic, or medicine-induced factors.
Non-alcoholic steatohepatitis (NASH): accumulation of fat droplets in hepatocytes leading to fibrosis and cirrhosis.
Alcoholic liver disease: caused by alcohol metabolism, leading to fatty liver, alcoholic hepatitis, and cirrhosis.

Acute Viral Hepatitis

Symptoms are divided into 4 phases: prodromal, preicteric, icteric, and convalescent.
Viruses A and E are spread orally, while B, C, and D are spread through blood and body fluids.

Fulminant Hepatitis

Defined by the absence of existing liver disease, with viral hepatitis accounting for 75% of cases.
Complications include cerebral edema, coagulopathy, renal failure, and electrolyte imbalances.

Chronic Hepatitis

Characterized by fatigue, sleep disturbances, difficulty concentrating, and right upper quadrant pain.
Advanced disease is marked by jaundice, muscle wasting, edema, ascites, and encephalopathy.

Non-Alcoholic Fatty Liver Disease

Accumulation of fat droplets in hepatocytes leads to fibrosis and cirrhosis.
May be caused by inborn errors of metabolism, diabetes, obesity, or lipodystrophy.

Alcoholic Liver Disease

Metabolism of alcohol leads to fatty acid accumulation, causing fatty liver and hyperlipidemia.
Acetaldehyde causes cell membrane damage and necrosis.
NADH replaces fatty acid as a fuel, promoting triglyceride accumulation.

Hepatic Encephalopathy

Lactulose and rifaximin are used to treat encephalopathy by reducing ammonia production in the gut.
Other hypotheses suggest the role of GABA receptors, altered neurotransmitters, and branched-chain amino acid imbalance in the development of encephalopathy.

Renal Insufficiency and Hepatorenal Syndrome

Renal failure due to severe liver disease, characterized by low urine sodium levels.
Treatment involves dextrose-based solutions, somatostatin, and H2 receptor antagonists.

Chronic Pancreatitis

Recurrent attacks of epigastric pain, precipitated by meals, accompanied by nausea, vomiting, and diarrhea.
Treatment involves avoiding large meals and alcohol, pancreatic enzyme replacement, and medium-chain triglycerides.

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Description

This quiz covers the structure and functions of the liver, including its physiology, blood circulation, and bile formation. Learn about the liver's vital roles in the body and its importance for survival.