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Mercy CLS 5: Chemistry > 12) Liver function > Flashcards

12) Liver function Flashcards

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1
Q

what makes the liver unique?

A

only organ in mammals that can regenerate

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2
Q

divides liver’s lobes

A

falciform ligament

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3
Q

liver receives —% of blood per minute

A

30

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4
Q

explain dual blood supply of liver

A

Portal vein: Carries blood from GI tract (nutrient rich) and spleen

Hepatic artery: a branch of celiac axis (well-oxygenated)

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5
Q

liver lobule

A

Basic microscopic unit
contains four to six portal triads

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6
Q

portal triad has branches of…

A

Portal vein
Hepatic artery
Bile duct

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7
Q

acinus

A

Functional anatomical unit of the liver

Diamond-shaped mass of liver parenchyma

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8
Q

kupffer cells

A

phagocytes that engulf bacteria, old red blood cells (RBCs), toxins, and cellular debris from the blood flowing through the sinusoids

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9
Q

The ———— and ———– flow in opposite directions.

A

bile in the bile canaliculi
blood in the sinusoids

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10
Q

space of disse

A

Space between the endothelial cells and hepatocytes where nutrient uptake occurs

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11
Q

5 major categories of liver function

A
  • Metabolism
  • Excretion
  • Detoxification
  • Storage
  • Immunologic
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12
Q

liver’s metabolism functions

A
  • Most of plasma proteins, except gamma globulins, vWF, and hemoglobin
  • Produces, stores, and breaks down glycogen
  • Lipid and lipoprotein synthesis
  • Synthesis of Urea
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13
Q

liver’s excretion functions

A

Bile acids
Cholesterol
Bilirubin

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14
Q

bile functions

A
  • Fatty acid metabolism by provide surface-active detergent molecules that facilitate excretion of cholesterol and solubilization of the lipids for intestinal absorption.
  • Excretion of waste products.
  • Kill off bad microbes.
  • Blood sugar metabolism
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15
Q

liver’s detox functions

A

Bilirubin conjugated to direct bilirubin
Drugs
Alcohol dehydrogenase

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16
Q

liver’s storage functions

A

Glycogen
Iron
Copper
Vit A, D, E, K

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17
Q

liver’s immunologic functions

A

Phagocytosis of bacteria and other substances by Kupffer cells
Secretion of I g A

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18
Q

Approximately 200 to 400 mg of bilirubin produced daily, 80% of which is produced from…

A

hemoglobin released from old RBCs.

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19
Q

Degradation of RBCs occurs in the…

A

macrophages of the reticuloendothelial system (spleen, liver, and bone marrow).

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20
Q

what happens to hemoglobin’s porphyrin ring?

A
  • Converted to biliverdin (green bilirubin) by the action of heme oxidase
  • Biliverdin is reduced to unconjugated bilirubin by biliverdin reductase in the macrophages
  • Unconjugated bilirubin is transported to the liver by plasma albumin
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21
Q

unconjugated bilirubin has an affinity for…

A

nervous tissue

kernicterus

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22
Q

Unconjugated bilirubin reaches liver
albumin is removed in the sinusoidal space
enters the hepatocyte by binding to ——- or passive diffusion.

A

ligandin

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23
Q

Unconjugated bilirubin is conjugated to glucuronic acid by …

A

UDP-glucuronyl transferase

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24
Q

3 types of conjugated bilirubin found in plasma

A

Bilirubin monoglucuronide
Bilirubin diglucuronide
Delta bilirubin

unconjugated is found in serum

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25
Q

conjugated bilirubin is bound to —— acid

A

glucaronic

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26
Q

Seen only in cases of significant hepatic obstruction

A

delta bilirubin

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27
Q

pathway of conjugated bilirubin

A

Bile canaliculi → larger bile ducts → hepatic ducts → gallbladder → duodenum

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28
Q

Conjugated bilirubin is metabolized into ———-, ———-, and ———- by bacteria enzyme.

A

urobilinogen
stercobilinogen
mesobilinogen

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29
Q

————- is accountable for more symptoms of jaundice than ———— because it is more easily absorbed into the tissues

A

conjugated
unconjugated

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30
Q

types of prehepatic jaundice

A
  • increased production of bilirubin (hemolysis, dyserythropoiesis)
  • decreased delivery to hepatocytes
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31
Q

most common cause of unconjugated hyperbilirubinemia

A

neonatal jaundice

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32
Q

examples of posthepatic jaundice

A
  • Common bile duct stones, gallbladder stones (most common)
  • Cancer of the bile ducts, pancreas, or ampulla of Vater
  • Bile duct stricture or stenosis
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33
Q

↑ total bilirubin
N conj. bilirubin
↑ unconj. bilirubin
↑ urine urobilinogen
N or ↑ fecal urobilinogen
N urine bilirubin

A

prehepatic jaundice

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34
Q

↑ total bilirubin
↑ conj. bilirubin
↑ unconj. bilirubin
↑ or N urine urobilinogen
N or ↑ fecal urobilinogen
↑ urine bilirubin

A

hepatic jaundice

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35
Q

↑ total bilirubin
↑ conj. bilirubin
↑ unconj. bilirubin
↓ urine urobilinogen
↓↓ fecal urobilinogen
↑ urine bilirubin

A

posthepatic jaundice

36
Q

Benign condition manifested by mild unconjugated hyperbilirubinemia

A

gilbert’s syndrome

37
Q

Rare disorder caused by complete absence of UDP-glucuronyl transferase

A

Crigler-Najjar Syndrome (CNS)

38
Q

Most patients die of severe brain damage caused by kernicterus within the first year of life.

A

type 1 CNS

39
Q

Milder form, partial deficiency of enzyme, 10% of enzyme activity.

A

type 2 CNS

40
Q

Defect in canalicular excretion of the conjugated bilirubin into the bile.

A

Dubin-Johnson Syndrome (DJ)

41
Q

Dark brown pigment, lipofuscin, in hepatocytes and Kupffer cells

A

Dubin-Johnson Syndrome (DJ)

42
Q

Defect in hepatic uptake and storage of bilirubin

A

rotor syndrome

43
Q

Rapidly progressive encephalopathy with hepatic dysfunction

Often begins several days after apparent recovery from a viral illness, especially varicella or influenza A or B

Salicylate use identified as a risk factor in kids with varicella or influenza A or B

A

Reye’s syndrome

44
Q

Vomiting and confusion, rapidly evolving to seizures and coma.

A

Reye’s syndrome

45
Q

causes of hepatitis

A

Infections (viral hepatitis)
Toxic (alcohol-related disease)
Genetic (hemochromatosis)
Immune (autoimmune hepatitis and primary biliary cirrhosis)
Neoplastic (hepatocellular carcinoma)

46
Q

picornavirus

A

HAV

47
Q

hepadnavirus

A

HBV

also Dane particle

48
Q

Persistent HbsAg without clinical hepatitis

A

chronic carrier

49
Q

Always present once infected with HBV

A

HBcAb

50
Q

Indicates recovery from HBV infection or immunity status

A

HBsAb

51
Q

core window

A

Brief interval between disappearance of HBsAg and appearance of HBsAb during HBV infection

52
Q

flaviviridae

A

HCV

53
Q

75% acutely infected individuals fail to clear the virus and develop a chronic infection

A

HCV

54
Q

coinfection vs superinfection

A

Coinfection: Infections with two virus at the same time;
Superinfection: HDV infection occurs in the presence of persistent HBV infection

55
Q

Infection when HBsAb is present but observe clinical deterioration of the patient

A

suspect HDV

56
Q

80%-90% develop chronic hepatitis, leading to cirrhosis or hepatic cancer

A

HDV coinfection

57
Q

herpesvirus

A

HEV

58
Q

Devastating to pregnant women (20% mortality rate for both mom & baby)

A

HEV

59
Q

hepatitis with no vaccine

A

HCV
HEV

60
Q

most common causes of chronic hepatitis

A

hepatitis B
hepatitis C
autoimmune disease
Wilson disease
α1-antitrypsin deficiency

61
Q

suspect ALD in these pts

A

> 15 drinks per week for men and >10 drinks per week for women over at least a two-year period

62
Q

Fat accumulation in the hepatocytes.

A

steatosis

63
Q

Occur within two weeks of regular alcohol ingestion and resolves rapidly with abstinence

A

alcoholic steatosis

64
Q

Fatty accumulation in the hepatocytes and inflammation

A

alcoholic steatohepatitis

65
Q

Follows 6 months to a year of moderate alcohol consumption

A

alcoholic steatohepatits

66
Q

Symptoms caused by the loss of functioning hepatocytes, increased resistance to hepatic blood flow or portal hypertension, ascites, and hepatic encephalopathy

A

cirrhosis

67
Q

leading cause of both chronic hepatitis and cirrhosis

A

HCV

68
Q

cirrhosis complications

A
  • Portal hypertension
  • Varices formed in the stomach and esophagus
  • Edema and ascites
  • Bruising
  • Itching
  • Hepatic encephalopathy
69
Q

Child-Turcotte-Pugh cirrhosis stages

A

Class A: score <7 points
Class B: 7-9 points
Class C: 10-15 points

70
Q

3 blood tests used to get Model for End-Stage Liver Disease (MELD) stage

A

Bilirubin
Prothrombin time
Creatinine

71
Q

3 inherited liver diseases that present as chronic hepatitis

A

Hereditary hemochromatosis (HH)
Wilson disease
α1-antitrypsin deficiency (AAT)

72
Q

Mutations in the HH gene (HFE), increased intestinal iron absorption can lead to total-body iron overload.

A

hereditary hemochromatosis

73
Q

Associated with lung (emphysema) and liver disease

A

AAT deficiency

74
Q

Impairment in the excretion of bile

A

cholestasis

75
Q

T-lymphocyte-mediated attack on small interlobular bile ducts.

A

Primary biliary cirrhosis (PBC)

76
Q

Chronic inflammatory disease of unknown origin

Inflammation, fibrosis and obliteration of the intrahepatic and extrahepatic bile ducts

A

Primary sclerosing cholangitis (PSC)

77
Q

associated with IBD

A

Primary sclerosing cholangitis (PSC)

78
Q

The presence of hepatic steatosis in the absence of excessive alcohol consumption.

A

Nonalcoholic fatty liver disease (NAFLD)

79
Q

Fat accumulation and inflammation and/or fibrosis
ALT level is ≥ AST (De Ritis ratio <1)

A

Nonalcoholic steatohepatitis (NASH)

80
Q

Jendrassik-Grof Test

A

bilirubin method

81
Q

Jendrassik-Grof Test

Bilirubin pigments react with a —– reagent

———- is added (stops reaction by destroying excess sulfanilic acid)

———– promotes the displacement of bilirubin from albumin and increases the reaction rate.

———– buffers the solution.

Results in formation of ———– Azobilirubin

A

diazo
ascorbic acid
caffeine
sodium benzoate
blue-green

82
Q

Converts purple azobilirubin to blue azobilirubin.

A

Alkaline tartrate

83
Q

2 possible results of PT test with injected vitamin K

A

PT corrects: Malabsorption of vitamin K in cholestasis

PT doesn’t correct: Hepatocellular disease

84
Q

ammonia elevated in…

A

advanced liver disease
renal failure

85
Q

ammonia sample

A

arterial blood preferred
avoid tourniquettes, fist clenching if venous
heparinized
on ice, centrifuged, separated w/i 15 mins

86
Q

Berthelot reaction

A

ammonia method

87
Q

glutamate dehydrogenase

A

ammonia method

Mercy CLS 5: Chemistry (24 decks)

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