Outline the anatomy and physiology of liver blood flow (60% of marks).

Explain the changes to drug metabolism when liver blood flow decreases (40% of marks).

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College Answer

A statement regarding the quantum of hepatic blood flow with recognition of the contributions 
made by the Hepatic Artery and Portal Vein, drainage into the sinusoids before entering the 
hepatic vein which drains into the IVC would have been a good start. Discussion was then 
expected to revolve around how the liver blood flow is controlled. Answering this with respect 
to intrinsic and extrinsic factors along with an understanding of the semi-reciprocal relationship 

between hepatic arterial and portal venous blood flow would have rounded out a good answer 
to the first part of the question.
The second part of the question required recognition that hepatic clearance is the product of 
hepatic blood flow and the hepatic extraction ratio and considering the impact on drugs with a 
high or a low extraction ratio.
Many answers failed to adequately mention how hepatic blood flow was controlled/regulated 
thus limiting the marks available. Similarly, in the second part of the question, many candidates 
spent considerable time mentioning the principals of drug metabolism rather than focusing on 
the question asked. 
The concept of hepatic drug clearance as the product of blood flow and its extraction ratio was 
poorly appreciated.