LIVER FUNCTION TEST Flashcards by Sharmaine Madjid

Liver is located in the _____ portion of the _____ beneath the diaphragm and on top of the _____, _______ and _______

upper right; abdominal cavity; stomach, right kidney and intestines.

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liver is shape like a ____, the liver is a dark reddish-brown organ that weighs about ___ pounds (1200 and 1600 grams ) and accounts for _____ of an adult’s body weight.

cone; 3; 2.5%

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liver is unequally divided into ___ lobes

two

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the chief metabolic organ in the body.

liver

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liver is a _____ organ and receives ____ mL of blood per minute

vascular; 1500

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Blood rich in nutrients from the GI tract is carried to the liver by the _______

portal vein.

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the primary supplier of oxygenated blood.

hepatic artery

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To complete hepatic circulation blood is ______ from the liver by _______
into the ________

drained; hepatic veins; inferior vena cava

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anatomic unit of the liver

lobule

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2 types of liver cells

hepatocytes
kupfer cells

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large cells that perform the metabolic, detoxification, excretory and synthesis function

hepatocytes

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active phagocytes that engulf bacteria, aging rbc, toxins and cellular debris

kupfer cells

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If the liver becomes completely nonfunctional, death will occur from _______ within _______.

hypoglycemia; 24 hours

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Substances absorbed from the GI tract must first pass through the ______ before it is distributed by the ________

liver; general circulation

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The liver has a unique capacity to regenerate by _______ and ________ of the remaining tissue in case of tissue injury due to ________ or ______

cell division; hypertrophy; biliary obstruction or toxic exposure.

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liver dysfunction examples

Hepatocellular disease
Cholestasis (obstruction of bile flow)
Cirrhosis
Hepatitis
Jaundice
Liver cancer
Steatosis (fatty liver)

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liver dysfuncition, genetic disorders

Hemochromatosis (iron storage)

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Noninvasive methods for screening of liver dysfunction
Help in identifying general types of disorder
Assess severity and allow prediction of outcome
Disease and treatment follow u

Liver Function Tests

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LFT is broadly classified as:

1.Tests to detect hepatic injury:
* Mild or severe; acute or chronic
* Nature of liver injury (hepatocellular or cholestasis)

2.Tests to assess hepatic function

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Group 1: Markers of Liver Dysfunction

▫ Serum bilirubin: total and conjugated
▫ Urine: bile salts and urobilinogen
▫ Total protein, serum albumin and albumin/globulin ratio
▫ Prothrombin Time

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Group 2: Markers of hepatocellular injury

▫ Alanine aminotransferase (ALT)
▫ Aspartate aminotransferase (AST)

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functions of liver

synthesis, metabolism, detoxification, excretion or secretion, and storage

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A steady supply of glucose is necessary to provide energy for metabolic needs through gluconeogenesis, glycolysis

Carbohydrate synthesis

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Liver is the site of synthesis of plasma proteins (albumin) except immunoglobulins and von Willebrand factor (factor VIII)
- most of the coagulation factors, anticoagulant proteins (factor XIV) and components of the fibrinolytic system are synthesized by hepatic parenchymal cells.

Protein Synthesis

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Liver is the site of synthesis of plasma proteins (albumin) except ______ and _____

immunoglobulins and von Willebrand factor (factor VIII)

most of the coagulation factors, anticoagulant proteins (factor XIV) and components of the fibrinolytic system are synthesized by ________

hepatic parenchymal cells.

The only organ that has the capacity to remove heme waste product from the body

liver

Liver serves to protect the body from potentially ________ absorbed from the intestinal tract and ______ by-products of metabolism.

injurious substances ; toxic

Excess proteins cannot be stored in the body. _____ takes place and this involves the removal of the amino group (NH2) from an amino acid resulting in the formation of __________.

Deamination ; ammonia

Ammonia a (toxic by-product) is consequently converted into _____ which is less toxic.

urea

The latter (urea) is then removed by the _______

kidneys (Ornithine cycle)

The liver breaks down other toxic substances such as ________, _____ released by pathogens, ______ and ________.

hydrogen peroxides, toxins, alcohol and food additives

bile composition

bile acids, phospholipids, cholesterol, bilirubin, inorganic salts, small amount of copper and other metals.

bile acids is also called as _____

bile salts

phospholipids in the bile is mainly ________

phosphatidylcholine

bilirubin in the biles is mostly in its ________ form

conjugated

the inorganic salts in the bile includes _______, _______, and _________

potassium, sodium, and bicarbonates

These bile acids are conjugated with the amino acids _______ and ______ forming bile salts

glycine and taurine

The bile is then stored in the _________ till needed. Once it is needed, it moves the _______ and helps with the _______ and ________.

gallbladder ; duodenum ; digestion and excretory process

liver is the storage site for all _______ vitamins and _______ vitamins.

fat-soluble ; water soluble

Liver also is the storage depot for ________, which are released when glucose is depleted.

glycogen

end product of hemoglobin metabolism

Bilirubin

principal pigment in bile

Bilirubin

Major metabolite of heme

Bilirubin

bilirubin is formed from the destruction of _____

heme

heme is the iron-binding tetrapyrrole ring found in __________, __________ and _________.

hemoglobin, myoglobin and cytochrome

______ mg of bilirubin is produced daily in the health adult.

250-350 mg

___% of bilirubin is derived from turnover of senescent rbc.

85%

- also known as B1 - water insoluble - indirect - pre-hepatic - hemobiliribun - NV: 0.2 to 0.8 mg/dL or 3 to 14 umol/L

Unconjugated Bilirubin

- also known as B2 - water soluble - direct - post-hepatic/obstructive and regurgitative bilirubin - cholebilirubin - NV: 0 to 0.2 mg/dL or 0 to 3 umol/L

Conjugated Brilirubin

Conjugated bilirubin tightly bound to albumin. It is formed due to the prolonged elevation of conjugated bilirubin in biliary obstruction.

Delta bilirubin

- It has the longer half life than other forms of bilirubin. - It is computed by using this formula TB – DB = IB - Not calculated on neonatal patients.

Delta bilirubin

Delta bilirubin normal value

<0.2 mg/dL

Jaundice is also called as _______ or ______

Icterus or Hyperbiluribinemia

Characterized by yellow discoloration of the skin, sclerae, and mucus membrane.

Jaundice

In jaundice, bilirubin greater than _ or __ mg/dL is already a clinical significant.

2 or 3 mg/dL

occurs when there is excessive erythrocyte destruction as seen in: * Hemolytic Anemia * Spherocytosis * Toxic Condition * Hemolytic Disease of the Newborn * Gilbert’s, Crigler-Najjar syndrome

Prehepatic Jaundice

occurs when liver cells malfunction and cannot take up, conjugate, or secrete bilirubin.

Hepatic Jaundice

such conditions is seen in hepatic jaundice

Viral hepatitis, Toxic Hepatitis, Intrahepatic Cholestasis.

- Bilirubin Transport Deficit from the sinusoidal membrane to the microsomal region - Impaired cellular uptake of Bilirubin - Mild increased of B1

GILBERT SYNDROME

- There is partial or complete conjugation deficit of UDP- Glucoronyl Transferase which causes deposition of bilirubin in the brain (kenicterus) resulting to motor dysfunction and retardation. - moderate to extremely increased level of B1

CRIGLER NAJJAR SYNDROME

deposition of bilirubin in the brain

kernicterus

partial or complete conjugation deficit of UDP- Glucoronyl Transferase in Crigler Najjar Syndrome, causes deposition of bilirubin in the brain (kenicterus) resulting to ______________

resulting to motor dysfunction and retardation.

- Bilirubin Excretion Deficit - Blockage of the excretion of bilirubin 2 into the canaliculi caused by hepatocyte membrane defect. - Elevated B2 and mild increase of B1

DUBIN JOHNSON SYNDROME

- Level of UDP-Glucoronyl Transferase is low at birth. - Takes several days for the liver to synthesize an adequate amount of enzyme to catalyze bilirubin conjugation. - Increased level of B1

NEONATAL PHYSIOLOGICAL JAUNDICE

- may be caused by hepatocyte injury such as cirrhosis which results from scarring of liver tissue caused by excessive alcohol ingestion, hepatitis, hematochromatosis.

INTRAHEPATIC CHOLESTASIS

INTRAHEPATIC CHOLESTASIS is associated also to the different conditions such as:

- Neoplasm - Bile Duct Injury (Rotor Syndrome) - Reye Syndrome (Neurologic abnormalities including Seizures or Coma) - Drug Related Disorders (Acetaminophen, Antibiotics, Antineoplastics) - Acute and Chronic Hepatitis

Reye Syndrome is a neurologic abnormalities including _____ or _____

Seizures or Coma

in intrahepatic cholestasis, drug related disorders includes the triple A drugs

Acetaminophen, Antibiotics, Antineoplastics

bile duct injury is also known as

rotor syndrome

occurs when an obstruction blocks the flow of bile into the intestines this is referred as extrahepatic cholestasis.

Post-hepatic Jaundice

obstruction blocks the flow of bile into the intestines

extrahepatic cholestasis

- Gallstone obstructing the common bile duct. - Neoplasm such as carcinoma of the pancreas. - Inflammatory conditions such as cholangitis or acute pancreatitis. - Significant increased level of B2 in serum. - Increased level of B1 in serum. - Increased level of B2 in urine. - Decreased urine and fecal urobilinogen. - Stool appear pale in color.

Post-hepatic Jaundice

In Post-hepatic Jaundice, __________ obstructing the common bile duct

Gallstone

In Post-hepatic Jaundice, there is a ______ such as carcinoma of the pancreas

Neoplasm

In Post-hepatic Jaundice, there is inflammatory conditions such as ________ or __________

Cholangitis or Acute Pancreatitis

In Post-hepatic Jaundice, there is a significant _____ level of B2 in serum

Increased

In Post-hepatic Jaundice, there is an ______ level of B1 in serum

Increased

In Post-hepatic Jaundice, there is an ________ level of B2 in urine

Increased

In Post-hepatic Jaundice, there is a decreased _______ and ________

urine and fecal urobilinogen

In Post-hepatic Jaundice, the stool appear _____ in color

pale

such syndromes are increased in B1

Gilberts Syndrome Criggler Najjar Syndrome Hemolytic Anemia Hepatocellular dse. Lucey Driscoll Syndrome G-6-PD Deficiency

such syndromes are decreased in B2

Billary Obstruction Pancreatic Cancer Dubin Johnson Alcoholic and Viral Hepatitis Billary Atresis Hepatocellular Disease