liver function

Question 1

what holds the liver in place

Answer 1

ligaments
segments separated by falciform ligament

Question 2

portal vein blood supply

Answer 2

75%

Question 3

hepatic artery blood supply

Answer 3

25%

Question 4

hepatoctes

Answer 4

liver function cells

Question 5

Kupfer cells

Answer 5

liver-specific macrophages

Question 6

list the biochemical functions of the liver

Answer 6

• excretion/secretion
• storage
• metabolism
• detoxification

Question 7

what happens to water sol bilirubin

Answer 7

conjugated bilirubin
secretated from hepatocyte into bile canaliculi

Question 8

glycogenesis

Answer 8

store glucose as glycogen

Question 9

glycogenolysis

Answer 9

breakdwown of glycogen

Question 10

gluconeogensis

Answer 10

creatoin of glucose from non sugar carbon substrates

Question 11

lipid metabolism

Answer 11

free fatty acids-> acetyl CoA -> trigs, phospholipids, cholesterol

Question 12

describe the two mechanisms for detoxification of waste products

Answer 12

• binds material irreversibly = inactivated
• chemically modifies compound to be excreted

Question 13

describe jaundice generally

Answer 13

retention of bilirubin (3-5mg/dL) causing yellowing of skin
- classified based on site of disorder

Question 14

prehepatic jaundice

Answer 14

• increased amount of bilirbin sent to liver
• hemolytic anemia (acute/chronic)
• unconjugated hyperbilirubinemia
• increased urobilinogen in urine

Question 15

posthepatic jaundice

Answer 15

• biliary obstructive disease
• bilirubin conjugated but can’t be excreted
• bile not through intestines = pale poop

Question 16

hepatic jaundice

Answer 16

• disorder of bilirubin metabolism
• transport defects
• hepatocellular injury or destruction

Question 17

gilberts syndrome

Answer 17

• hepatic jaundice
• benign recessive
• defect conjugation system = intermittent unconjugated hyperbilirubinemia

Question 18

crigler-Najjar syndrome

Answer 18

• hepatic jaundice
• nonhemolytic hyperbilirubinemia
• either absence or defiency of enzyme for conjugation
  –> can’t conjugate bilirubin

Question 19

Dubin-Johnson syndrome

Answer 19

• hepatic jaundice
• conjugated hyperbilirubinemia
• ability to remove conjugated bilirubin impacted (can’t remove)
• delta bilirubin = conjugated and albumin bound

Question 20

rotor syndrome

Answer 20

• hepatic jaundice
• bilirubin less effectively taken up and removed
• the movement rotor non functional
• use of ALP and GGT to differentiate from obstruction

Question 21

physiologic jaundice

Answer 21

• hepatic jaundice
• common in first week of life
• deficiency in UDPGT

Question 22

kernicterus

Answer 22

physiologic jaundice
unconjugated bilirubin in neonate that can deposite in brain

Question 23

describe Cirrohis

Answer 23

• scar tissue replaces normal tissue
• blocks flow of blood
• prevents normal liver function

Question 24

which type of tumor is more common in liver

Answer 24

metastatic (vs primary)

Question 25

most common primary cancer in liver

Answer 25

hepatocellular carcinoma (HCC)

Question 26

reye's syndrome

Answer 26

found in children following viral syndrome w/ aspirin -> increase in AST and ALT

Question 27

most common mechanism of alcohol related injury to liver

Answer 27

immune mediated injury to hepatocytes

Question 28

fatty liver disease

Answer 28

- from alcohol - mild with slight liver marker elevations: AST, ALT and GGT

Question 29

alcoholic hepatitis

Answer 29

- serum proteins decrease (albumin) - increase AST, ALT, GGT, ALP and bilirubin

Question 30

AST/ALT ratio in alcoholic hepatitis

Answer 30

>2

Question 31

alcoholic cirrhosis

Answer 31

- increase in liver markers - decreased albumin - need liver biopsy

Question 32

describe the malloy-evelyn procedure for bilirubin assesment

Answer 32

- diazo reagent - methanol accelerator

Question 33

describe the jandrassik- Grof method of bilirubin assesment

Answer 33

- more commonly used - diazo binds conjugated bilirubin only - caffeine-benzoate accelerator gives total bilirubin

Question 34

what does increased levels of urinary urobilinogen indicate

Answer 34

hemolytic disease

Question 35

describe the role of liver enzyme measurment for functionality

Answer 35

- differentiates hepatocellular (functional) from obstructive (mechanical)

Question 36

describe alkaline phosphatase

Answer 36

- differentiates heptobiliary disease and osteogenic bone disease - high ALP seen in extrahepatic biliary obstruction

Question 37

describe 5'-nucleotidase

Answer 37

- significantly elevated in hepatobiliary disease - not ordered often

Question 38

describe GGT

Answer 38

- biliary obstruction measurment - most sensitive hepatic enzyme indicator for liver disease

Question 39

test for assessing synthetic ability of liver

Answer 39

serum protein

Question 40

test to measure decreased protein synthesis

Answer 40

decreasing albumin

Question 41

what Ig is seen in primary biliary cirrhosis

Answer 41

IgM

Question 42

what Ig is seen in alcoholic cirrhosis

Answer 42

IgA - A for alcohol

Question 43

describe nitrogen metabolism testing

Answer 43

converts to urea -> ammonia level reflects liver function