Liver Function (Liver-Syndrome) Flashcards by Marlo Roque

The chief metabolic organ of the body

Liver

How well did you know this?

Not at all

Perfectly

A large organ divided unequally into two lobes by a falciform ligament

Liver

How well did you know this?

Not at all

Perfectly

functional unit of the liver

Lobules

How well did you know this?

Not at all

Perfectly

2 major cells

Hepatocytes (80%)

Hepatic macrophage (20%)

How well did you know this?

Not at all

Perfectly

Most abundant cell

Hepatocytes (80%)

How well did you know this?

Not at all

Perfectly

aka Kupffers cells

Hepatic macrophage (20%)

How well did you know this?

Not at all

Perfectly

Liver blood supply: ________

1500 mL/min

How well did you know this?

Not at all

Perfectly

2 blood supply of liver

Hepatic artery (25%)

Portal vein (75%)

How well did you know this?

Not at all

Perfectly

Majority of the blood that is supplied to the liver.

Portal vein (75%)

How well did you know this?

Not at all

Perfectly

Functions of the Liver

Synthetic Function
Conjugation Function
Detoxification and Drug Metabolism
Excretory and Secretory Function
Storage Function

How well did you know this?

Not at all

Perfectly

The capacity of liver to synthesize substances

Synthetic Function

How well did you know this?

Not at all

Perfectly

Example of substances being synthesize by the liver

Proteins, cholesterol, carbohydrates, lipids, lipoproteins, enzymes, albumin (plasma protein)

How well did you know this?

Not at all

Perfectly

Albumin rate of production

9-12 g/day

How well did you know this?

Not at all

Perfectly

Involves the metabolism of bilirubin

Conjugation Function

How well did you know this?

Not at all

Perfectly

Product of hemoglobin metabolism

Bilirubin

How well did you know this?

Not at all

Perfectly

Liver conjugates bilirubin to ___________

200-300 mg/day

How well did you know this?

Not at all

Perfectly

The liver protects the body from potential toxic substances absorbed from the intestine and toxic metabolic byproducts (eg. pharmaceutical drugs)

Detoxification and Drug Metabolism

How well did you know this?

Not at all

Perfectly

Function of the liver that involves the bile

Excretory and Secretory Function

How well did you know this?

Not at all

Perfectly

Emulsify fats (cholesterol) which is then excreted in the body

Bile

How well did you know this?

Not at all

Perfectly

Liver is a storage site of glycogen, fat-soluble vitamins (A, D, E, K), and water-soluble vitamins

Storage Function

How well did you know this?

Not at all

Perfectly

In storage function, Liver is a storage site of __________, ____-_______ (_, _, _, _), and ____-_____ _______

Glycogen

Fat-soluble vitamins (A, D, E, K)

Water-soluble vitamins

How well did you know this?

Not at all

Perfectly

T/F: Storage Function is still assessed in the laboratory

FALSE: Not assessed in the laboratory; no diagnostic significance

How well did you know this?

Not at all

Perfectly

T/F: All functions of the liver are assessed in the laboratory

FALSE: Out of the 5 functions of liver, only 4 functions are assessed in the laboratory (1-4)

How well did you know this?

Not at all

Perfectly

enumerate which functions of the liver are assessed in the laboratory

Synthetic Function
Conjugation Function
Detoxification and Drug Metabolism
Excretory and Secretory Function

How well did you know this?

Not at all

Perfectly

All functions of the liver are assessed in the laboratory EXCEPT:

Storage Function

Used to quantitate the severity of hepatic dysfunction

TESTS FOR LIVER SYNTHETIC FUNCTION

The more severe the hepatic dysfunction = the (less, more) the synthetic activity of liver

Less

TESTS FOR LIVER SYNTHETIC FUNCTION Measures:

Albumin (plasma protein) Vitamin K-dependent clotting factors Cholesterol (endogenous)

What are the Vitamin K-dependent clotting factors:

1. Clotting Factors 2,7,9,10

What is Clotting Factor 2?

Prothrombin

What is Clotting Factor 7?

Stable Factor (Proconvertin)

What is Clotting Factor 9?

Plasma thromboplastic component (Christmas factor)

What is Clotting Factor 10?

Stuart-prower factor

What are the tests for liver synthetic function?

1. Total Protein 2. Albumin 3. Albumin/Globulin Ratio 4. Prothrombin Test

Assessment of nutritional status and presence of severe disease involving the liver, kidney and bone marrow

Total protein

Sample in Total Protein

Serum; NEVER plasma

Why is plasma never used in Total Protein?

Because all clotting factors are present and the majority is fibrinogen

Fibrinogen can increase total protein by _____________

0.2-0.4 g/dL

TOTAL PROTEIN Interferences

hemolysis, ictericia

TOTAL PROTEIN Reference value (serum)

6.5-8.3 g/dL (CF to g/L: 10)

Methods for Total Protein

1. Kjeldahl Method 2. Biuret Method 3. Folin-Ciocalteu (Lowry) Method 4. UV Absorption Method 5. Refractometry 6. Turbidmetry and Nephelometry 7. Salt Fractionation 8. Coomasie Brilliant Blue Dye 9. Ninhydrin 10. Serum Protein Electrophoresis

Which method for Total is the MOST sensitive

Folin-Ciocalteu (Lowry) Method

Concentration is inversely proportional to the severity of hepatic disease.

ALBUMIN

ALBUMIN T/F: Concentration is directly proportional to the severity of hepatic disease.

FALSE: Inversely proportional

↓albumin = (more, less) severe hepatic disease

Albumin is produced in the _______

Liver

Low albumin due to decrease synthesis

Hepatic cirrhosis Nephrotic syndrome:

In hepatic cirrhosis and nephrotic syndrome, albumin and total protein are (increased, decreased)

Decreased

Why is total protein decreased in hepatic cirrhosis and nephrotic syndrome?

total protein is decreased because majority of total protein is albumin

ELECTROPHORETIC PATTERN What is seen in hepatic cirrhosis?

β-γ bridging

ELECTROPHORETIC PATTERN What is seen in Nephrotic syndrome?

α2 globulin spike

Methods in Albumin

Salt precipitation Dye-binding

ALBUMIN Reference value:

3.5 - 5.0 g/dL

ALBUMIN Decreased reference value = (increased, decreased) total protein concentration

decreased

Used to validate if globulin is higher than the albumin

Albumin/Globulin Ratio

Globulin > Albumin

Inverted A/G ratio

Inverted A/G ratio occurs due to:

Hepatic cirrhosis Multiple myeloma Waldenström's macroglobulinemia

ELECTROPHORETIC PATTERN What is seen in Multiple myeloma?

gamma spike

ALBUMIN/GLOBULIN RATIO Reference value:

1.3-3.1 g/dL (CF to g/L: 10)

AG ratio =

Albumin/Globulin

Globulin =

Total protein - Albumin

Prothrombin test aka

Vitamin K Response Test

T/F: Prothrombin test is called as Vitamin K Response Test in case of laboratory liver synthetic function assessment

TRUE

What Vitamin K is being administered in Prothrombin Test?

phyloquinones

What is the method of administration in Prothrombin Test?

Intramuscularly

Dosage of Vitamin K administered in Prothrombin Test

10 mg for 1-3 days

T/F: Administration of Vitamin K in Prothrombin Test is done after the testing

FALSE: Prior the testing

Prolonged Prothrombin Time – liver cannot synthesize _______________

Clotting factors

It differentiates intrahepatic disorder from extrahepatic disorder

Prothrombin Test

PROTHROMBIN TEST T/F: Intrahepatic disorder occurs in the liver

TRUE

PROTHROMBIN TEST Intrahepatic disorder is due to (decreased, increased), (short, prolonged) prothrombin time

Increased Prolonged

PROTHROMBIN TEST T/F: Extrahepatic disorder occurs in the liver

FALSE: Outside the liver

PROTHROMBIN TEST T/F: Extrahepatic disorder (normal, abnormal) prothrombin time

Normal

Prolonged prothrombin time signifies massive cellular damage.

Acute/Chronic Hepatitis

TESTS FOR CONJUGATION AND EXCRETION FUNCTION

1. Bilirubin 2. Delta Bilirubin

End product of hemoglobin metabolism (waste product)

Bilirubin

No function in the body; excreted

Bilirubin

Principal pigment in bile

Bilirubin

____ of bilirubin are from hemoglobin

85%

15% of bilirubin are from ____, _______,_______

myoglobin, cytochrome, peroxidase/catalase

Produced if RBCs are senescent

Bilirubin

How is Bilirubin Synthesized by the body?

1. Happens in the Circulation 2. Happens in the Liver

HAPPENS IN THE CIRCULATION After ____ days, RBC will be transported to ______, which will then be destroyed, resulting to the release of __________.

120 Spleen Hemoglobin

Three components of hemoglobin:

Ferrous Iron (Fe²⁺) Heme Globin

Ferrous iron (Fe²⁺) in hemoglobin are transported by _________ to the liver and bone marrow

Transferrin

HAPPENS IN THE CIRCULATION When globins are degraded, amino acids will be (excreted, reused)

reused

HAPPENS IN THE CIRCULATION Heme will be converted to __________

Biliverdin

HAPPENS IN THE CIRCULATION The conversion of heme to biliverdin is through the action of ____________

Heme oxygenase

HAPPENS IN THE CIRCULATION Biliverdin, in the action of ____________ will be converted to bilirubin 1

Biliverdin reductase

HAPPENS IN THE LIVER Albumin will release ___________

Bilirubin 1

HAPPENS IN THE LIVER Bilirubin 1 will be bound to a transport protein called as ________

Ligandins

HAPPENS IN THE LIVER Bilirubin 1 esterification/conjugation in the ligandins produces _________________________

Bilirubin monoglucuronide

HAPPENS IN THE LIVER Conjugation of the other propionic acid by addition of another glucuronic acid to produce _____________________ _________________

bilirubin diglucuronide/bilirubin 2

The conjugation process is catalyzed by the enzyme

uridine diphosphate glucuronyl transferase (UDPGT)

In the intestine, the B2 will be reduced to __________, _________, and to ___________ in the intestines

mesobilirubin ---> mesobilirubinogen --> urobilinogen

Urobilinogen fates:

80% - feces 20% - urine

Principal pigment of feces

Stercobilin

Principal pigment of urine

Urochrome

BILIRUBIN 1 other names

- Unconjugated Bilirubin - Water insoluble - Non-polar Bilirubin - Indirect Bilirubin - Hemobilirubin - Slow reacting - Pre-hepatic Bilirubin

BILIRUBIN 2 other names

- Conjugated Bilirubin - Water soluble - Polar Bilirubin - Direct Bilirubin - Cholebilirubin - One-minute/Prompt Bilirubin (quickly reacts with) - Post-hepatic / Hepatic / Obstuctuve / Regurtitative Bilirubn

Plasma concentration of bilirubin increases upon birth and reaches its peak on the ___ day.

5th

If bilirubin synthesis > liver clearance rate = (increased, decreased) bilirubin level

Increased

BILIRUBIN Reference value for Conjugated Bilirubin (B2)

0 - 0.2 mg/dL (0-3 µmol/L)

Requires the most sensitive reagent because the normal value is zero

Conjugated Bilirubin (B2)

BILIRUBIN Reference value for Unconjugated Bilirubin (B2)

0.2-0.8 mg/dL (3-14 µmol/L)

BILIRUBIN Reference value for Total Bilirubin (B2 + B1)

0.2-1.0 mg/dL (3-17 µmol/L)

Must be conjugated to be excreted

Bilirubin 1

Common bilirubin found in the circulation

Bilirubin 1

Normally present in blood (formed in the circulation)

Bilirubin 1

Normally not present in serum

Bilirubin 2

Small amount of ____________ in the blood is because of minor leakage from ______________

Bilirubin 2 Hepatocytes

Formed in the liver

Bilirubin 2

Conjugated bilirubin bounded to albumin

Delta Bilirubin

DELTA BILIRUBIN Helps in monitoring the decline of serum bilirubin following _____________

Cholecystectomy (Surgical removal of the gall bladder)

Prolonged elevation of conjugated bilirubin is due to the binding of albumin in serum/plasma

Delta Bilirubin

T/F: Delta Bilirubin has shorter life compared to other bilirubin

FALSE: Longer

Delta bilirubin reacts with what reagent?

Diazo reagent

DELTA BILIRUBIN Reference Value:

<0.2 mg/dL

T/F: Delta bilirubin is computed, not measured

TRUE

Delta bilirubin is measured if patient is ________ (_________) due to high bilirubin

neonate (≤14 days)

Delta bilirubin =

TB - (IB+DB)

Condition where there is increase in bilirubin

Jaundice

_____________________ characterized by yellow discoloration of the skin, sclera, and mucus membranes.

Hyperbilirubinemia

Most common hyperbilirubinemia among adults?

Cholelithiasis (gallstones)

More commonly termed for serum or plasma with abnormal yellow discoloration due to hyperbilirubinemia.

Icterus

T/F: Icterus is always visible

FALSE: NOT always visible

ICTERUS It will be visible if the bilirubin ________

>25mg/dL (visible ictericia)

T/F: Icterus is still used interchangeably with jaundice

FALSE: BEFORE, but is now only referring to serum or plasma

Type of jaundice is not visible to the naked eyes (although with high bilirubin)

Overt Jaundice

Over jaundice has a bilirubin level of

1.0 - 1.5 mg/dL

Overt jaundice will only become visible if the bilirubin is ________

3.0 - 5.0 mg/dL

THREE TYPES OF JAUNDICE

- Pre-hepatic jaundice - Post-hepatic jaundice - Hepatic jaundice

aka Hemolytic jaundice, Unconjugated hyperbilirubinemia

PRE-HEPATIC JAUNDICE

Caused by too much red blood cell destruction

PRE-HEPATIC JAUNDICE

PRE-HEPATIC JAUNDICE Conditions where there is too much RBC destruction

* Hemolytic disease of the newborn * Hemolytic anemia * Malaria

PRE-HEPATIC JAUNDICE Very rare because bilirubin are removed by the placenta

Hemolytic disease of the newborn (HDN)

PRE-HEPATIC JAUNDICE Cause of malaria

Plasmodium spp.

From most to least common, enumerate the Plasmodium spp.

P. falciparum P. vivax P. malariae P. ovale

PRE-HEPATIC JAUNDICE Increased destroyed RBCs = (increased, decreased) hemoglobin released

increased

PRE-HEPATIC JAUNDICE Laboratory findings: - Indirect Bilirubin: __________ - Direct Bilirubin: ________ - Urobilinogen: _________ - Urine bilirubin: ________

Increased Normal Normal Negative

T/F: Increase indirect bilirubin is toxic (neurotoxic)

TRUE

Indirect bilirubin is neurotoxic because it can cross the blood brain barrier (BBB) causing __________

Kernicterus

bilirubin deposition in the brain causing severe motor dysfunction and retardation

Kernicterus

aka Obstructive jaundice

POST-HEPATIC JAUNDICE

Caused by failure of bile to flow to the intestine or impaired bilirubin excretion

POST-HEPATIC JAUNDICE

POST-HEPATIC JAUNDICE Laboratory findings: - Indirect Bilirubin: __________ - Direct Bilirubin: ________ - Urobilinogen: _________ - Urine bilirubin: ________ - Alkaline phosphatase: __________

Normal Increased Decreased Positive Increased

No.1 marker of the post-hepatic jaundice

Alkaline phosphatase:

It is increased due to increased excretion rate

Alkaline phosphatase:

aka Hepatocellular combined jaundice

HEPATIC JAUNDICE

Caused by disorders of bilirubin metabolism, transport defects, hepatocellular injury or destruction.

HEPATIC JAUNDICE

HEPATIC JAUNDICE Laboratory findings: - Indirect Bilirubin: __________ - Direct Bilirubin: ________ - Urobilinogen: _________ - Urine bilirubin: ________

Increased Increased Decreased Positive

INHERITED DISORDERS OF BILIRUBIN METABOLISM (HEPATIC JAUNDICE)

1. Gilbert’s Syndrome 2. Crigler-Najjar Syndrome (Type 1 & 2) 3. Dubin Johnson Syndrome 4. Rotor Syndrome 5. Lucey-Driscoll Syndrome

Bilirubin Transport Deficit

Gilbert’s Syndrome

Characterized by impaired cellular uptake of bilirubin due to genetic mutation in UGT1A1 gene (chromosome #2)

Gilbert’s Syndrome

GILBERT'S SYNDROME Characterized by impaired cellular uptake of bilirubin due to genetic mutation in _______ gene (chromosome #2)

UGT1A1

GILBERT'S SYNDROME Affected individuals may have no symptoms but may have mild _________ and predisposed ______________ (aka paracetamol) toxicity.

Icterus Acetaminophen

GILBERT'S SYNDROME Laboratory Findings: - Indirect Bilirubin: ________

1.5-3.0 mg/dL

GILBERT'S SYNDROME Indirect Bilirubin rarely increased to _______ as it maximizes its conjugation activity

4.5 mg/dL

Conjugation Deficit

Crigler-Najjar Syndrome

CRIGLER-NAJJAR SYNDROME Problem: _______

conjugation process

CRIGLER-NAJJAR SYNDROME Laboratory result:

Elevated indirect bilirubin

Complete deficiency of UDGPT

Crigler-Najjar Syndrome Type I

CRIGLER-NAJJAR SYNDROME TYPE 1 Complete deficiency of _______

UDGPT

CRIGLER-NAJJAR SYNDROME TYPE 1 Laboratory results: - Indirect bilirubin: _______ - Direct bilirubin: _________

>25 mg/dL None

CRIGLER-NAJJAR SYNDROME TYPE 1 Symptoms:

kernicterus, colorless bile

Partial deficiency of UDGPT

CRIGLER-NAJJAR SYNDROME TYPE 2

CRIGLER-NAJJAR SYNDROME TYPE 2 (partial, complete) deficiency of UDGPT

Partial

CRIGLER-NAJJAR SYNDROME TYPE 2 Laboratory results: - Indirect bilirubin: _______ - Direct bilirubin: _________

5-20 mg/dL small amount

Diagnostic treatment for Crigler-Najjar Syndrome: ___________

Phototherapy

Bilirubin Excretion Deficit Conjugated Hyperbilirubinemia

Dubin-Johnson Syndrome

Defective excretion of direct bilirubin into the canaliculi caused by hepatocyte membrane defect.

Dubin-Johnson Syndrome

DUBIN-JOHNSON SYNDROME Characterized of an intense dark pigmentation of the liver due to accumulation of ________________

lipofuscin pigment

Accumulation of lipofuscin pigment is called as

Black liver (black discoloration of the liver)

DUBIN-JOHNSON SYNDROME Laboratory findings: - Elevation in direct bilirubin and total bilirubin (___________) - Delta Bilirubin: __________

2-5 mg/dL Increased

Similar with Dubin-Johnson Syndrome WITHOUT the “black liver”

Rotor Syndrome

Inherited disorders of bilirubin metabolism which cause is unknown

Rotor Syndrome

ROTOR SYNDROME Laboratory findings: - Elevation in direct bilirubin and total bilirubin (___________) - Delta Bilirubin: __________

2-5 mg/dL Increased

Familial form of unconjugated hyperbilirubinemia caused by a circulating inhibitor of bilirubin conjugation

Lucey-Driscoll Syndrome

LUCEY-DRISCOLL SYNDROME ________ (conjugation enzyme) are inhibited - no conjugation, no B2

UDPGT

LUCEY-DRISCOLL SYNDROME Laboratory findings: - Indirect bilirubin: _________

increased (2-3 weeks of life)

Liver Function (Liver-Syndrome) Flashcards

(180 cards)