Liver Function Flashcards
1
Q
location of the liver
A
upper right quadrant, beneath diaphragm
2
Q
largest internal organ, able to regenerate
A
the liver
3
Q
blood supply to the liver
A
portal vein
hepatic artery
4
Q
brings blood from the intenstines
A
portal vein
5
Q
brings blood to liver from the heart
A
hepatic artery
6
Q
where is bile stored?
A
gallbladder
7
Q
_____mL of blood to liver per minute
A
1500 mL
8
Q
what are lobules?
A
small, six sided structures. Central vein with portal triads at each corner. Functional unit of the liver
9
Q
Portal triad contains:
A
hepatic artery
portal vein
bile ducts
10
Q
cells of the liver
A
Kuplfer cells
hepatic cells
11
Q
macrophages of the liver, clean up waste
A
Kuplfer cells
12
Q
Cuboidal cells, most abundant cell in liver
A
Hepatic cells
13
Q
70% of volume of liver
regenerative
perform major functions (nutrient uptake, liver output)
waste dumping
A
Hepatocytes
14
Q
what the liver excretes
A
bile acids, cholesterol, bilirubin
15
Q
metabolic functions of liver
A
carbohydrates, lipids, amino acids, proteins, hormones, bilirubin
16
Q
internal toxins
A
NH3, bilirubin
17
Q
external toxins
A
drugs, poisons, alcohol
18
Q
hematology function of the liver
A
blood production in fetus, coagulation proteins
19
Q
only organ with capacity to rid body of heme waste
A
liver
20
Q
bile is composed of
A
bile salts/acids, bile pigments, cholesterol, heme waste products
21
Q
bild production/excretion rates
A
3L produced/day
1L excreted/day
22
Q
bile functions
A
bile acids needed for fat absorption
mechanism to remove cholesterol
23
Q
principal pigment in bile
A
Bilirubin
24
Q
hemoglobin in broken down into
A
heme
globin
iron
25
converted to bilirubin in 2-3 hours
Heme
26
broken into amino acids and recycled
globin
27
bound by transferrin and returned to ___ stores in the liver or bone marrow
Iron
28
unconjugated/indirect bilirubin
bilirubin bound by albumin and taken to liver
| water-insoluble
29
metabolism of bilirubin
- unconjugaed bili flows into sinusoidal tissue, albumin releases it
- ligandin picks up unconjugated bili and presents it to hepatocytes
- in liver, bili is conjugated with help of UDP.
- conjugated bilirubin is converted to urobilinogen by bacteria
30
conjugated bilirubin
water-soluble
| combines with gallbladder secretions and expelled into intestines
31
80% of urobolinogen
oxidized to urobilin and excreted in feces (why stool is brown)
32
20% of urobolinogen
absorbed by extrahepatic circulation and recycled
| filtered by kidneys and excreted in urine
33
______mg of bilirubin produced/day
200-300 mg
34
3 fractions of Bilirubin
- unconjugated/indirect
- conjugated/direct
- Delta/Conjugated bilirubin bound to protein
35
syntheis of carbohydrates in liver
- uses glucose for energy
- stores glucose as glycogen
- maintains stable glucose concentration due to glycogenesis, gluconeogenesis, glycogenolysis
36
synthesis of lipids in liver
- free fatty acids broken down to Acetly-CoA
- converts insoluble lipids to soluble
- 70% cholesterol
37
synthesis of proteins in liver
- most proteins are made in liver
- large functional reserve
- loss of plasma proteins causes edema
38
mechanisms of detoxification
- binds material to inactivate compound
| - chemically modify compound for excretion
39
yellow discoloration of the skin, eyes, mucous membranes
jaundice/icterus
40
bilirubin level in jaundice
>3.0 mg/dL
41
- increased unconjugated bilirubin
- yellow staining of meninges of brain
- found in newborns
Kernicterus
42
Classes of Jaundice
- prehepatic
- hepatic
- posthepatic
43
abnormality outside liver, caused by increased bilirubin presented to liver due to increased RBC destruction or hemolysis .
prehepatic jaundice
44
result of prehepatic jaundice
increased total and unconjugated bilirubin
45
disease states of prehepatic jaundice
- hemolytic anemia
- chemical exposure
- congestive heart failure
- transfusion reaction
- hemolytic disease of Newborn
46
intrinsic liver disease or defect caused by; disordered bilirubin conjugation, bilirubin transport, hepatocellular injury
hepatic jaundice
47
result of hepatic jaundice
increased total/con. Bilirubin
| -AST/ALT may also be increased
48
disease states of hepatic jaundice
- genetics
- hepatitis
- alcoholism
- infection
- neonatal physiologic jaundice
- cirrhosis
- carcinomas
- toxins
49
genetic mutation of enzyme for bilirubin metabolism.
| decreased bilirubin transport
Gilbert syndrome
50
-defective UDPG-transferase
type 1: complete absence
type 2: mutation
(unconjugated hyperbilirubinemia)
Crigler-Najjar syndrome
51
bilirubin removal from hepatocyte defective, liver function is normal
Dublin-Johnson disease
52
Benign condition, decreased bilirubin carrier proteins
| conjugated hyperbilirubinemia
Rotor's Syndrome
53
Jaundice of Newborn cause
UDPG deficiency
54
Jaundice of newborn ungonjugated bilirubin levels
>20mg/dl (very dangerous)
| liver is normal until 3rd day of life
55
Jaundice of Newborn treatment
UV light/Bilirubin lamp
56
Jaundice caused by biliary obstruction, stool turns clay-colored, liver function is normal
Posthepatic Jaundice
57
Lab results of posthepatic jaundice
- increased total/conj. Bili
- increased urinary bilirubin
- increased ALP, GGT
- Decreased urine/fecal urobolinogen
58
scar tissue replaces normal healthy liver tissue, and blocks flow of blood to liver
Cirrhosis
59
causes of cirrhosis
alcoholism
| hepatitis
60
lab results of cirrhosis
increased un/conj. bilirubin, ALP, GGT, AST, ALT, Prothrombonin time.
decreased cholesterol, albumin
61
any baby born before ____ will become Jaundiced
36 weeks
62
often preceeded by viral syndrome, associated with ingestion of Asprin
Reye Syndrome
63
reye syndrome symptoms
- profuse vomiting/diarrhea
- neurological impairment
- encephalopathy and fatty degredation
64
lab results of Reye Syndrome
increased ammonia, AST, ALT, slight increase in Bilirubin
65
common drugs that damage hepatocytes
- ethanol
| - acetaminophen
66
mildest form of alcoholic injury. Slight elevation in AST, ALT, GGT. Complete recovery possible
Alcoholic fatty liver
67
Moderate elevations of AST, ALT, GGT, ALP.
Bili >5.0mg/dl
Decreased albumin
PT prolonged
Alcoholic hepatitis
68
Marked elevation AST, ALT, GGT, ALP, Bilirubin
decreased albumin
PT prolonged
Alcoholic cirrhosis
69
DeRitis Ratio
| determining cause of liver disease
AST/ALT
70
normal DeRitis ratio
0.7-1.4
71
DeRitis >2.0
Indicative of alcoholism or alcoholic hepatitis
72
DeRitis <1.0
Viral hepatitis, acute inflammatory disease, obstructive liver (ALT>AST)
73
Inflammation of the liver, caused by viruses, bacteria, drugs, radiation, and other chemical exposure
Hepatitis
74
clinical symptoms of hepatitis
Jaundice, dark urine, fatigue, nausea, abdominal pain
75
lab results for hepatitis
increased AST< ALT< GGT, Bilirubin
| -positive serological markers
76
hep A transmission
fecal-oral
77
hep A incubation
3-4 weeks
78
non chronic hepatitis
Hep A hep E
79
hep B incubation
8-26 week s
80
hep B transmission
parenteral, sexual
81
hep C incubation
2-15 weeks
82
hep C transmission
parenteral, sexual
83
hep D incubation
21-90 days
84
hep D transmission
parenteral, sexual
85
hep E incubation
3-6 weeks
86
hep E transmission
fecal-oral
87
bilirubin total ref range (Adults)
0.2-1.0 mg/dl
88
Infant total bilirubin
2-6 mg/dl
89
Peak infant bilirubin
48 hours, 6-7 mg/dl
90
bilirubin specimen
serum/plasma
-fasting
no hemolysis, no lipemia
91
Bilirubin storage
light sensitive. light will falsely decrease results
92
elrich test specimen for bilirubin
urine
93
Van de Bergh bilirubin testing
serum could be tested with accelerator. DIAZO REACTION
94
Malloy and Evelyn bilirubin testing
Serum , Diazo reaction with 50% methanol
95
Jendrassik and Grof bilirubin testing
Diazo reaction with caffeine-benzoate-acetate as accelerator. increased sensitivity
96
measures total and conjugated bilirubin with 2 aliquotes of serum
Jendrassik-Grof
97
Jendrassik-Grof principle
bilirubin pigments react with diazo reagent and produced azobilirubin (purple). Caffeine accelerates, ascorbic acid stops reaction, tartrate converts purple to blue. Measured at 600 nm
98
formula for indirect bilirubin
indirect= total - direct
99
end product of bilirubin metabolism
urobilinogen
100
increased urobilinogen
hemolytic disease, defective liver-cell function
101
decreased urbilinogen
biliary obstruction, carcinoma
102
prehepatic jaundice (hemolytic) conjugated/unconjugated bili
normal conjugated, increased unconjugated
103
prehepatic jaundice urine results
negative bilirubin, increased urobilinogen
104
hepatic jaundice con/uncon bilirubin
increased conjugated, increased unconjugated
105
hepatic jaundice urine results
positive bilirubin, normal/increased urobilinogen
106
posthepatic jaundice conjugated/unconjugated
increased conjugated, normal unconjugated
107
posthepatic jaundice urine results
positive bilirubin, decreased urobilinogen
108
liver function tests
albumin, total protein, bilirubin (direct/total), AST, ALT, ALP
109
prethrombin time
increased in liver disease
110
ammonia
elevated in liver disease, hepatic coma
111
glucose/galactose tolerance
asses liver's ability to metabolize carbohydrates
112
liver enzymes in alcoholic hepatitis (elevated)
AST
113
decreased liver enzymes in alcoholic hepatitis
albumin
114
viral hepatitis increased liver results
AST, ALT, ALP, GGT
115
increased enzymes in biliary obstruction
ALP, GGT
