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Liver Function Flashcards

1
Q

Liver Function

A

Organ of the RES (Reticuloendothelial System)
Active in Immune Response
Metabolism
Detoxification
Excretion and Secretion
Storage

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2
Q

Liver Metabolism Proteins

A

Made in Liver
Albumin & Amino Acids converted into Alpha & Beta globulins
Coagulation Factors
Carrier proteins
Acute phase reactants

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3
Q

Liver Metabolism Carbohydrates & Lipids

A

Processed in Liver

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4
Q

Liver Metabolism Bilirubin

A

Made in liver
Waste product of hemoglobin

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5
Q

Detoxification “First Pass” Conversion

A

Substances absorbed from the GI tract pass through liver and are changed in process

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6
Q

Detoxification Drug Metabolism

A

Substances are converted to more soluble or less toxic forms

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7
Q

Forms of conversion

A

Hydrolysis
Hydroxylation
Oxidation
Reduction
Carboxylation
Demethylation

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8
Q

Alcohol conversion

A

To Acetaldehyde and then to acetate by alcohol dehydrogenase

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9
Q

Ammonia conversion

A

To Urea which is the soluble form and excreted in kidneys

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10
Q

Liver Excretion and Secretion

A

Bile Acids into GI tract and help with digestion
Bilirubin through common bile ducts
Metabolites: Drugs and Hormones

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11
Q

Liver Storage Metabolites

A

Glycogen
Iron as ferritin
Fat soluble vitamins (A, E, D, K, B12)
Albumin

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12
Q

Bilirubin Metabolism

A

Senscent or damaged RBCs phagocytized by RES

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13
Q

Hemoglobin Breakdown

A

Globulin
Iron
Porphyrin ring holding iron molecule

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14
Q

Bilirubin Transport

A

Unconjugated bilirubin is loosely bound to albumin once it is formed
- Unconjugated bilirubin is highly insoluble
- Bilirubin-albumin complex is soluble
Complex transported to liver via bloodstream
Bilirubin is converted to a conjugated form in liver

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15
Q

Anatomy of Liver

A

Weighs 3.5 lbs
Situated in top right portion of abdominal cavity
Felt as hard mass just below the bottom right rib
Liver receives blood from two sources
- Venous
- Hepatic
Blood leaves liver via a central vein which drains to hepatic vein

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16
Q

Venous Blood

A

Gastrointestinal tract
Containing nutrients from the intestines

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17
Q

Hepatic Artery

A

Supplies oxygenated blood
Branch of the celiac trunk from abdominal aorta

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18
Q

Microscopic Anatomy of Liver

A

Lobule is the functional unit of liver
- Hexagonal shaped
- Made up of hepatocytes
- Arranged in layers
- Sinusoids (small blood vessels) located between hepatocyte sheets
- Kupffer cells

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19
Q

Sinusoids

A

Receive blood from hepatic artery and nutrients from intestines via portal vein

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20
Q

Kupffer cells

A

Specialized macrophages that remove bilirubin-albumin complex

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21
Q

Corners of Lobules

A

Branch of hepatic portal vein, hepatic artery, and bile duct
- Bile drains from hepatocytes
- Joins the cystic duct, which leads from gallbladder
- Central canal in middle of each lobule receives blood

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22
Q

Small bile ducts

A

AKA Bile Canaliculi
Unite to form the hepatic duct in liver

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23
Q

Cystic duct in liver

A

Leads from gallbladder
Forms the common bile duct
Drains into duodenum

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24
Q

Transport of Unconjugated bilirubin

A

Into the microsomal region of the hepatocyte
Bilirubin-albumin complex is broken down & albumin returned to circulation
Bilirubin is conjugated within the hepatocyte

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25
Conjugated Bilirubin
Bilirubin diglucuronide Water soluble Actively removed from hepatocytes into the bile canaliculi and excreted into the bile ducts
26
Enzyme UDPG-transferase
Bilirubin diglucuronyl transferase converts bilirubin to conjugated form
27
Conjugated & Unconjugated Bilirubin
Fractionated Bilirubin Assays Total Bilirubin = Conjugated + Unconjugated Bilirubin
28
Liver Function at Intestines
Conjugated bilirubin is excreted into the small intestine with bile salts via the common bile duct Anaerobic bacteria
29
Anaerobic bacteria on Bilirubin
Acts on bilirubin and produces: Urobilinogen - colorless Urobilin - brown
30
Urobilinogen
50% is reabsorbed by the portal circulation Filtered by kidney and returned to liver
31
Obstruction stools
Turn chalky color Conjugated bilirubin cannot be removed through the common bile duct No conversion to urobilin
32
Jaundice Definition
Yellow discoloration of skin and sclera Caused by build-up of bilirubin in circulation and tissues Sign that liver or bile duct system is not working
33
Types of Jaundice
Elevated Bilirubin in circulation Pre-hepatic Hepatic Post-hepatic
34
Pre-hepatic Note
Increase breakdown of RBCs = elevation in unconjugated bilirubin
35
Hepatic Note
Increase build-up of conjugated bilirubin due to damaged hepatocytes - Not enough hepatocytes are working
36
Post-hepatic Note
Increase in products of bilirubin metabolism due to decrease outflow from common bile duct
37
Pre-hepatic Jaundice
Caused by Acute Hemolysis (most common) - Liver presented with more unconjugated bilirubin than it can handle - Unconjugated bilirubin builds up in serum - Conjugated bilirubin may increase due to liver reserve - No bilirubin detected in urine - Increase in urine urobilinogen
38
Pre-hepatic Jaundice Tests info
Total Serum Bilirubin = Increased Conjugated Bilirubin = Normal to Increased Unconjugated Bilirubin = Increased Urine Urobilinogen = Increased Urine Bilirubin = Normal LD = Increased
39
Pre-hepatic Neonatal Physiological
Caused by immature liver - UPDG transferase not fully functioning - Babies naturally have elevated Hct - Hemolytic Disease of Newborn can complicate this situation and cause more destruction of RBCs - Kernicterus results from hemolusis
40
Kernicterus
Deposition of bilirubin in lipid portion of brain tissue Results in mental retardation
41
Treatment for Neonatal Jaundice
Phototherapy
42
Other Causes of Pre-hepatic Jaundice
Crigler-Naijar Gilbert's Disease Dubin-Johnson
43
Crigler-Naijar
Failure to conjugate bilirubin - Congenital lack of UPDG transferase - Type 1: Child usually dies in first months of life (>50% mortality) - Severe mental retardation - Chronic persistent jaundice - Type 2: milder form
44
Gilbert's Disease
- Defect in ability to transport unconjugated bilirubin into the microsomal region - May have mild jaundice - Most individuals are asymptomatic
45
Dubin-Johnson
- Defect in transport system of conjugated bilirubin from microsomal region to bile acnaliculi - May have upper right quadrant pain - Non-specific jaundice - Not life-threatening
46
Hepatic Jaundice
- Diffuse hepatocellular damage or necrosis - Viral or Toxic hepatitis - Cirrhosis - Intra-hepatic destruction from pressure or edema
47
Viral or Toxic Hepatitis
Selective areas of hepatocytes are inflamed blocking the out flow of conjugated bilirubin into the bile canaliculi
48
Cirrhosis
Nodular damage throughout the liver Also blocks outflow of bilirubin into the bile canaliculi
49
Hepatic Jaundice Tests Info
Total Serum Bilirubin = Increased Conjugated Bilirubin = Increased Unconjugated Bilirubin = Normal to Increased Urine Urobilinogen = Increased Urine Bilirubin = Increased AST/ALT = Increased (10-100x) Alk Phos = Increased but <5x N GGT = Increased >10x N in alcoholic cirrhosis
50
Viral Hepatitis AST/ALT
ALT > AST
51
Post-Hepatic Jaundice
Obstruction of common bile duct Caused by stones, spasms, strictures or neoplasms (tumor)
52
Post-Hepatic Jaundice Tests Info
Total Serum Bilirubin = Increased Conjugated Bilirubin = Increased Unconjugated Bilirubin = Normal to Increased Urine Urobilinogen - Decreased Urine Bilirubin = Increased AST/ALT = Normal to Increased, up to 5x Normal Alk Phos = Increased, >5x Normal
53
Jendrassik Grof Method
Most used method, Detects: Total Bilirubin Direct Bilirubin
54
Total Bilirubin Tests
Total Bilirubin + diazonium salt +caffeine = Diazo Bilirubin (pink color) Note: Hemolysis interferes with color spectrum Diazo Bilirubin + alkaline tartrate = Green Note: causes shift in color spectrum due to pH change
55
Direct Bilirubin (Conjugated) Tests
Direct bilirubin + diazonium salt + HCL = Diazo Bilirubin (pink color) Note: Hemolysis interferes with color spectrum Diazo Bilirubin + alkaline tartrate = green Note: causes shift in color spectrum due to pH change
56
Indirect Bilirubin Test
Calculated Total - Direct = Indirect
57
Other Bilirubin Tests
Evelyn Malloy Method (reference or research now) - Original Method - Tartrate step not added so hemolysis was problem Automated Methods - Modification of Jendrassik Grof
58
Liver Isoenzymes
LD - Rarely Performed Test 5 LDs tests
59
Normal LD
LD1 < LD2
60
Acute Myocardial Infarction LD
LD1 and LD2 eleveated LD1 > LD2 - referred to as 1:2 flip
61
Liver Disease LD
LD5 is elevated LD3 and LD4 slight elevation
62
Acute Mycardial Infarction with 2nd Liver Involvement LD
LD1 and LD2 elevated LD1 > LD2 LD5 elevated
63
Alkaline Phosphatase Isoenzymes
Heterogeneous group of enzymes from various tissues Migrate with alpha-2 globulins Hard to differentiate - Heat stability is best method (10 min at 56 C) - Removes Bone Alk Phos, Liver Alk Phos remains - Other heat stable AP isoenzymes (Placental Alk Phos and Tumor Markers - Regan and Nagao AP)
64
Alk Phosphate Increases in
Intestine = Active disease Bone = Active disease Liver = Active disease Fast Liver = Liver and Liver metastases = Bone and Malignant Bone Disease Post Bone = Placental
65
Intestine Alk Phos
<20% of total More frequently noted in patients with blood group O and B who secrete H-blood group substance Increased postprandially and after a fatty meal Increased cirrhosis, malignancy, diabetes, chronic renal failure
66
Placental Alk Phos
Increased during the later stages of pregnancy Heat stable like liver Alk Phos - Low levels of heat stable isoenzyme + poor prognosis for fetus
67
Bone Alk Phos
Elevated in Osteoblastic activity Normal to increased in growing children Greatly Increased in Paget's Disease or Renal Rickets Increased in Bone cancer or osteomalacia Decreased in children with cretinism or hypophosphatemia
68
Liver Alk Phos
Increased in Acute hepatitis, cirrhosis, fatty liver, drug induced liver disease, obstruction, metastatic humar Increased fast fraction in metastatic carcinoma - Sometimes seen in viral hepatitis and alcoholic cirrhosis

Chemistry (11 decks)

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