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Updated: 10/25/07 11:31 AM |
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| HOME | HEAL | EDUCATE | RESEARCH | DIRECTORY | OUTREACH |
Authors: W. Volwiler, R.A. Willson, A.M. Larson, and J.D. Ostrow
Download Chapter ♦ Download Lecture Slides & Notes
Download Chapter ♦ Download Lecture Slides & Notes
"With mirth and laughter let old wrinkles come,
and let my liver rather heat with wine than my heart cool with mortifying groans."
The Merchant of Venice
“Puir auld Jimmie Purdie. His step’s getting gey feeble.
I’m thinkin’ whusky’s nae sae guid a cure for the rheumatics after a’.”
Robert Service
and let my liver rather heat with wine than my heart cool with mortifying groans."
The Merchant of Venice
“Puir auld Jimmie Purdie. His step’s getting gey feeble.
I’m thinkin’ whusky’s nae sae guid a cure for the rheumatics after a’.”
Robert Service
A. Objectives
- What percentage of the liver’s supply of O2 comes from the hepatic artery? Learn the differences between the liver lobule and the functional acinus, and the components of the portal triad. Learn that the flow of blood into a liver lobule is in a direction opposite to that of bile flow. What liver cells are most vulnerable to anoxic injury? Why can pain of hepatic origin be felt at the right shoulder?
- Be able to describe the multiple functions of hepatocytes, and how loss of these functions determines the clinical syndrome of acute hepatic failure. What is hepatic encephalopathy? Why might the serum iron be elevated in acute hepatocellular injury? What is the importance of Kupffer cells?
- Give an overview of the role of the liver in drug metabolism, including the microsomal mixed function monoxygenase and conjugating of enzymes. Why might alcohol abuse contribute to the toxicity of another drug? Is ethanol regarded as a direct hepatotoxin? Describe the spectrum of alcoholic liver disease. What are the histological features of alcoholic hepatitis? What are the general characteristics of drug sensitivity reactions? Why might someone ingesting oral androgens become jaundiced?
- What are the characteristics of cirrhosis of the liver? Does the histology correlate with etiology? What is Child’s classification of chronic liver disease?
- Learn about the three anatomic types of portal hypertension. What are the major complications? What factors promote the formation of ascites? How does obstruction to hepatic venous outflow contribute to the formation of ascites?
- What are the major components of bile, which is an important vehicle for excreting endogenous substances, such as cholesterol, and xenobiotics, such as drugs? How does gallbladder bile concentrated yet remain isotonic with plasma? Describe differences between the enterohepatic circulation of bilirubin and of bile salts. What are likely steps in the formation of cholesterol gallstones. How might cholesterol gallstones be prevented? What are pigment stones? How would you investigate a patient with suspected disease of the biliary tract? What theories are offered to explain acute cholecystitis? How does the histology of chronic cholecystitis differ from the normal gallbladder? Why must stones in the common duct be treated expeditiously?
- Realize that the clinician can pinpoint, about 85% of the time, the cause of jaundice on the basis of careful history and physical exam. What four hepatic functions do the liver tests assess? Describe the pathway of bilirubin excretion. What is conjugated bilirubin, and how does it enter the plasma? What is the half-life of factor VII? Of albumin? What is the usual elevation of serum transaminases in acute viral hepatitis? In alcoholic hepatitis? What are the pitfalls in interpreting the serum levels of alkaline phosphatase? Be able to outline results of liver tests in transfusion reaction, acute viral hepatitis, common duct stone, and chronic hepatitis.
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