Liver

Question 1

What are the 5 functions of the liver?

Answer 1

• Detoxification and drug metabolism
• Lipid and carb metabolism
• Protein synthesis
• Synthesis and excretion of bile acids
• Conjugation and excretion of bilirubin

Question 2

Describe detoxification and drug metabolism

Answer 2

-Clears blood of toxins and metabolic wastes (bilirubin and ammonia) and hormones (estrogen/sex hormones)

Question 3

What are the 2 places that waste goes?

Answer 3

• In bile (bilirubin)

- Converts toxic chemical to nontoxic chemical (ammonia to urea)

Question 4

Describe lipid and carbohydrate metabolism

Answer 4

-Converts glucose into glycogen for energy storage and reconverts it to glucose if needed

Question 5

The liver synthesizes ______ and ______

Answer 5

-Triglycerides and cholesterol

Question 6

The liver also burns fat. This is the byproduct

Answer 6

Ketones/ketoacids

Question 7

What are examples of proteins that are made by the liver

Answer 7

• Albumin
• Clotting factors
• Transport proteins

Question 8

T/F- The liver excretes bilirubin into bile

Answer 8

True

Question 9

What is added to secrete bilirubin into bile?

Answer 9

Glucuronide

Question 10

What do intestinal bacteria convert bilirubin into?

Answer 10

Bilirubin –> Urobilinogen (this makes poop look brown)

Question 11

What is the main constituent of bile

Answer 11

Bile acids

Question 12

What is used to make bile acids

Answer 12

Cholesterol

Question 13

What do bile acids do?

Answer 13

-Allow ingested fats to become water soluble and allow pancreatic lipase to act

Question 14

How are bile acids reabsorbed?

Answer 14

Enterohepatic circulation

Question 15

_______ refers to excretion of bile acids (made from cholesterol) from the liver into the intestine and the reabsorption of most of the bile acids (and their cholesterol) by the intestine for recirculation through the portal system and reuse by the liver.

Answer 15

Enterohepatic circulation

Question 16

Where does most absorbed cholesterol come from?

Answer 16

Cholesterol absorbed by the intestine from reabsorbed bile acids- not dietary cholesterol

Question 17

Liver complications include toxic accumulations such as…

Answer 17

• Toxic accumulations (ammonia, bilirubin, drugs, hormones)
• Bleeding (lack of coagulation factors)
• Edema (deficiency in plasma albumin)

Question 18

Generalized edema=

Answer 18

anasarca

Question 19

abdominal edema=

Answer 19

ascites

Question 20

A deficiency in bile acids causes…

Answer 20

• Failure to absorb intestinal fat

- Failure to absorb fat-soluble vitamins

Question 21

What causes jaundice?

Answer 21

• Increase levels of bilirubin in the blood

- May be conjugated or unconjugated

Question 22

What are the main causes of hepatitis?

Answer 22

• Viral infection

- Autoimmune

Question 23

What are 2 types of degeneration?

Answer 23

Hydropic or fatty

Question 24

Is degeneration reversible?

Answer 24

-YES!

Question 25

What causes hydropic deneration?

Answer 25

-Too much water

Question 26

What causes fatty degeneration?

Answer 26

Fat (seen in alcohol excess)

Question 27

Hepatitis and chronic alcohol abuse can kill cells _____ at a time

Answer 27

One at a time- infarcts are rare

Question 28

This is when the flow of bile stops or slows

Answer 28

Cholestasis

Question 29

What does cholestasis lead to?

Answer 29

-Accumulation of bile acids and cholesterol in the blood

Question 30

This is loss of hepatic metabolic function

Answer 30

Hepatic failure

Question 31

Describe unconjugated bilirubin

Answer 31

- Not water soluble | - tightly bound to albumin for transport to the liver

Question 32

In the liver, bilirubin is joined (conjugated) with _______

Answer 32

glucuronine

Question 33

What does the joining of glucuronine do?

Answer 33

-Makes water soluble conjugated bilirubin

Question 34

This is a superimposed acute renal failure

Answer 34

Hepatorenal syndrome

Question 35

Describe hepatorenal syndrome

Answer 35

-Related to decreased renal blood flow -Decreased filtering and kidney excretion (the kidney cells are structurally normal and can return to normal function with a liver transplant)

Question 36

_______ occurs with increasing levels of ammonia in the blood

Answer 36

Hepatic encephalopathy

Question 37

What are the 4 stages of hepatic encephalopathy

Answer 37

1. Irritability and personality changes 2. Lethargy and disorientation 3. Deep sleep 4. Coma

Question 38

What is a DISTINCT clinical sign of hepatic encephalopathy

Answer 38

- Asterixis | - Flapping tremor in the upper extremities (hepatic flap)

Question 39

What are the 3 types of jaundice?

Answer 39

1. Prehepatic 2. Hepatic 3. Post hepatic

Question 40

Describe prehepatic jaundice

Answer 40

-Increased levels of UNCONJUGATED bilirubin in the blood

Question 41

What causes preheptic jaundice

Answer 41

-Hemolytic anemia -Sickle cell disease (bc it increases production of unconjugated bilirubin)

Question 42

This is caused by interference with the livers ABILITY TO CONJUGATE bilirubin or to SECRETE it after conjugation

Answer 42

Hepatic Jaundice

Question 43

Are increased levels of blood bilirubin due to conjugated or unconjugated bilirubin in hepatic jaundice?

Answer 43

Either one

Question 44

This is caused by the obstruction of bile flow inside or outside the liver

Answer 44

Posthepatic jaundice

Question 45

IN posthepatic jaundice, are increased levels of blood bilirubin conjugated or unconjugated?

Answer 45

Conjugated

Question 46

What is the most common cause of unconjugated bilirubinemia?

Answer 46

Gilbert syndrome

Question 47

This is a modest elevation in serum bilirubin because of a genetic deficiency of uridine diphsophate glucuronyl transferase

Answer 47

Gilbert Syndrome

Question 48

What is uridine diphosphate glucuronyl transferase

Answer 48

An enxyme in the metabolic pathway - about 7% of the population is affected - Men more than women

Question 49

These 3 enzymes spill from damaged hepatocytes

Answer 49

- LDH - AST - ALT

Question 50

DIRECT Bilirubin levels measure the _________ bilirubin

Answer 50

Conjugated bilirubin

Question 51

INDIRECT Bilirubin levels measure the _________ bilirubin

Answer 51

Indirect= total- direct and it represents UNCONJUGATED plus all bound bilirubin

Question 52

What are the TRUE liver function tests

Answer 52

-Albumin -PT -PTT (because clotting factors are liver proteins)