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Flashcards in 2 - Hepatic Physiology Deck (57)
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1

If the liver is too big

It will shrink

2

If the liver is too small

It will grow

3

Bilirubin Produced By

Oxidation of Heme and Reduction of resultant bilverdin

Heme oxygenase converts Heme to Biliverdin
Biliverdin Reductase converts Bilverdin into Bilirubin

4

After C-Glycine Administration Early Peak

Ineffective Erythropoiesis

5

Conjugation of Bilirubin

To make it more soluble

6

Bilirubin

Delivered in sinusoid
Uptaken into hepatocyte
Biotransformed and secreted into biliary flow

7

Glucuronyl Transferase

Does something I don't know he did not use enough words

8

Bilirubins

Unconjugated (UCB)
Mono-Glucuronide (BMG)
Diglucuronide (BDG)

These are progressive steps

9

Bacterial Breakdown of Bilirubin

In color

Gives stool brown color

Deconjugation
Reduction
Oxidation

10

No bilirubin in stool

Clay colored stool

11

Biliary Atresia

Agenesis of common bile duct

Treat with "Cuh-sai" procedure
Sew intestine into intrahepatic bile ducts
Stool color doesn't matter much actually. Stool swatches were more for parents. What more counts is bilirubin in serum.

12

Enterohepatic Circulation of Bilirubin - In Hepatocyte dysfunction (hepatocellular)

Increased urobilinogen in urine because it is less efficiently reabsorbed by hepatocytes

13

Enterohepatic Circulation of Bilirubin - In Biliary Obstruction

Stools appear white
No urobilinogen detected in urine

14

Measurement of bilirubin in blood

=

15

Hyperbilirubinemia and Jaundice

Occur when liver fails or when other steps of the metabolism are abnormal.
Bilirubin >35μM can begin to detect jaundice clinically.
Coca Cola urine

16

Beefy Red Liver

Bile getting stuck in liver
Leads to micronodules too

17

Cause of Unconjugated Hyperbilirubinemia

Overproduction: Hemolysis or Ineffective Erythropoiesis
Impaired Uptake: Fast, Sepsis, Drugs (eg probenecid)

Impaired Conjugation:
Inherited Mutations in UGT1 - Grigler-Najjar Syndrome (Type I and Type II)
Inherited polymorphisms in UGT1 - Gilbert Syndrome

18

Cause of Conjugated Hyperbilirubinemia

Hepatocellular Diseases Cause Decreased Secretion:
Cirrhosis
Acute Hepatitis (drugs, viral, alcohol)

Pregnancy

Drugs

Inherited Diseases:
Dubin-Johnson Syndrome (ABCC2 mutation)
Rotor Syndrome (SLCO1B1 and SCLO1B3 mutations)

Biliary Obstruction:
Gallstones
Tumors
Primary Biliary Cirrhosis
Sclerosing Cholangitis

19

"Physiological Neonatal Jaundice"

Results from immaturity of ALL steps in bilirubin metabolism

Increased Production
Decreased Delivery
Decreased Uptake

High bilirubin level
BBB not great yet
Bilirubin in brain leads to kernicterus

20

Kernicterus

Brain damage due to bilirubin deposition

21

Treatment of Neonatal Jaundice

Phototherapy
Biliblankets or Bililight
Convert Natural Bilirubin to Photobilirubin (can pee out)

22

Jaundice

At "50", you can glow in the dark

23

Plasma proteins secreted by liver

Albumin
Clotting Factors
Antithrombin III
α-1-antitrypsin
Ceruoloplasmin
Complement C3
C-reactive protein
α-1-fetoprotein
fibrinogen
Haptoglobin
Hemopexin
α-lipoprotein
β-lipoprotein
α-2-macroglobulin
Orosomucoid
Other clotting factors
Prothrombin
Transferrin
IL-6

24

Factor VIII Level tells us

High = Liver Failure
Low = DIC

25

Clotting Factor tests

PTT or INR
Responsive to Vitamin K
II, VII, IX, X, Protein C & Protein S

Gotta start heparinizing and coumadinizing them because the tests will hypercoagulabilize them? I don't understand.

26

IL-6

Regulates body temperature

27

Pathway of protein Secretion

Synthesized in ER
Golgi Network
Secretion into bloodstream

28

Prolonged Prothrombin Time

Bleeding Tendency

29

Low Serum Albumin

Edema or maybe ascites but that can be portal hypertension as well

30

Blood Supply of the Liver

Hepatic Artery - Directly from the Heart
Portal Vein - Drains the gut (FIRST PASS METABOLISM)