Liver Function Flashcards by Gilbert Villegas

Anatomy of the Liver

Lobes:
Weight:
Two major vessels:

Largest and Most versatile organ
2 main lobes separated by falciform ligament
1.2 - 1.5 kg
Major Vessels: Hepatic Artery & Portal Vein

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Right lobe is ____ larger than the left lobe

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Two major Vessels:
_______: Heart ——25% of blood——> Liver

Contributes 25% of blood from the aorta to the liver

Hepatic Artery

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Two major Vessels
_______: GI tract ——nutrient rich——> Liver

Transports nutrient rich material from digestive tract to the liver

Portal Vein

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Volume of blood that travels to the liver

15000 ml/min

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smallest functional unit of the liver

Lobules

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Cells

___: Hepatocytes
___: Kuppfer cells

80%: Hepatocytes

20%: Kuppfer cells

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Phagocytic macrophages of the liver

Kuppfer cells

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Liver cells:
Vascular spaces in the cord:
Phagocytic Macrophage:

Liver cells: Heatocytes
Vascular spaces in the cord: Sinusoids
Phagocytic Macrophage: Kuppfer cells

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Liver Function

Metabolic
Synthetic 
Secretory and Excretory
Detoxification & Drug  Metabolism
Storage

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Liver functions

Excretion: \_\_\_\_\_\_\_\_\_\_\_\_
Synthesis: \_\_\_\_\_\_\_\_\_\_\_\_
Detoxification: \_\_\_\_\_\_\_\_\_
Conjugation:\_\_\_\_\_\_\_\_\_\_\_
Storage: \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Excretion: Bilirubin, Bile salts, Bile pigments
Synthesis: CHO, Proteins, Lipids, LPP, Clotting factors, Enzymes
Detoxification: Toxic substance - Drugs, Biproducts
Conjugation: Bilirubin
Storage: Glycogen, Fat soluble vitamins

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Main secretory/excretory product of the liver

Bile

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Principal pigment of the Bile

Bilirubin

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Bilirubin is derived from the degradation of ___________

Hemoglobin

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Most important excretory product of the Liver

Bilirubin

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Bilirubin 1 vs. Bilirubin 2

Unconjugated
Non-Polar
Indirect
Water Insoluble
Hemobilirubin

Conjugated
Polar
Direct
Water Soluble
Cholebilirubin

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__________ is broken down and is excreted as a waste product

Protoporphyrin IX

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Transports bilirubin to the liver

Albumin

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Conversion of Protoporphyrin IX to Biliverdin is catalyzed by _____________

Heme Oxygenase

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Conjugation site

Liver

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What specific site in the liver does conjugation occurs

Smooth ER of Hepatocytes

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Enzyme that converts B1 to B2

UDPGT - Uridyldiphosphate glucoronyl transferase

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Bilirubin diglucuronide

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After B2 goes out to the Liver, bilirubin passes to the ___________ & ____________

Bile duct and further to the INTESTINES

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An ORANGE-BROWN pigment after oxidation of Urobilinogen

Urobilin (80%)

Delta Bilirubin

Conjugated Bilirubin bound to albumin

Delta Bilirubin is present in severe _____________________

Biliary Obstruction

Increase bilirubin level that results to yellow discoloration

Jaundice

Laboratory Description with Yellow plasma

Icterus

Clinically Significant level of Bilirubin in Jaundice

> 3.0 mg/dL or 2.0 mg/dL

Prehepatic Jaundice: ____________ Hepatic jaundice: ____________ Post Hepatic jaundice: ____________

Prehepatic Jaundice: Happens in circulation due to Increase RBC degradation Hepatic jaundice: defect in the Liver due to decreased conjugation Post Hepatic jaundice:

Prehepatic jaundice is characterized by __________________

Unconjugated Hyperbilirubinemia

Most common type of Jaundice

Gilbert's Syndrome

Due to impaired cellular uptake or entrance of Bilirubin in the liver, causing elevated B1

Gilbert's syndrome

Defect in Gilbert's Syndrome

Bilirubin transport deficit

A rare, more serious disease with the onset at birth due to complete or partial absence of UDPGT

Crigler-Najjar Syndrome

No UDPGT - Conjugation deficit

Type of Crigler-Najjar Syndrome with complete absence of UDPGT

Type 1

Type II Crigler-Najjar Syndrome

Partial deficiency of UDPGT

Dubin-Johnson Sydrome

Accumulated B2 (+) Dark Stained granules (+) Delta Bilirubin

Bilirubin derangement that is positive for Delta bilirubin

Dubin-Johnson Sydrome

Bilirubin excretion deficit

Dubin-Johnson Sydrome

Bilirubin derrangement with unknown cause and no pigmentation in liver biopsy

Rotor Syndrome

Conjugation Inhibition

(+) Kernicterus

Crigler-Najjar Syndrome

Hyperbilirubinemia in infants affecting CNS/Brain

Kernicterus

Disorder caused by excessive ingestion of Vitamin A

Hypercarotenemia

__________ refers to the IRREVERSIBLE SCARRING process by which liver structure is transformed into a ABNORMAL NODULAR architecture.

Cirrhosis

Classification of Cirrhosis

1. Size of Nodules - (1) Micronodular (2) Macronodular | 2. Etiology- Alcohol abuse, Hemochromatosis, Postnecrotic cirrhosis, Primary Bile cirrhosis

Sources of Error Hemolysis: ____________ Lipemia: ______________

Hemolysis - Increase Bilirubin | Lipemia - Decrease Bilirubin

Most preferred sample for Bilirubin Analysis

Fasting Specimen

Classic Method of Analysis of Bilirubin

Diazo reaction "Ehrlich reaction"

Directly measured

Diazo Reaction Principle

Bilirubin is coupled with Diazotized Sulfanilic acid to produce Azobilirubin

Total Bilirubin is measured ____ minutes after adding methanol or caffeine solution,

15 minutes

___________ bilirubin produces color after the addition of alcohol

Unconjugated bilirubin

Current Principle of Bilirubin Reaction

Van Den Bergh Reaction

Difference of Van Den Bergh Reaction from Diazo reaction

Uses ACCELARATOR (solubilizer)

Most commonly used Method in Bilirubin assay

Jendrassik and Grof

Evelyn Malloy Accelerator: __________ pH: __________ End color: _________

Evelyn Malloy Accelerator: 50% Methanol pH: Acidic End color: Red-Purple

Jendrassik-Grof Accelarator: __________ pH: __________ End color: _________

Jendrassik-Grof Accelarator: Caffeine-Na Benzoate pH: Alkaline End color: Blue

Jandressik-Grof is performed with ____ aliquots of sample

2 aliquots of sample

Purpose of accelerator

Removes unconjugated bilirubin bound to albumin and make it soluble

Jendrassik-Grof 1st aliquot - w/ Diazo : __________ 2nd aliquot - w/ Diazo + Accelerator: ___________

Jendrassik-Grof 1st aliquot: B2 2nd aliquot: Total Bilirubin

Diazo reagent

Diazotized Sulfanilic Acid

Synthetic Function Tests

Total Protein Albumin Prothrombin time

Conjugation and Excretion Function Tests

Bilirubin

Major Synthetic Product of Liver

Albumin

______ of Cholesterol in the circulation is from the Liver

70%

Decreased Albumin is caused by: 1. 2.

Decreased Albumin is caused by: 1. Decreased Production in the Liver 2. Excreted in the Kidney

Liver enzymes

``` AST (SGOT) ALT (SGPT) ALP LDH GGT 5' Nucleotidase ```