1S [LEC]: Liver Function Flashcards
The functional units responsible for all metabolic and excretory functions performed by the liver
Lobules
Components of the portal triad
Hepatic artery
Portal vein
Bile duct
The four primary roles of liver
Detoxification
Metabolism
Excretory and secretory
Storage
The metabolic function of the liver include the synthesis of all proteins except ___ and ___
Immunoglobulin
Von Willebrand factor
The excretory system of the liver starts in the ___
bile canaliculi
The bile canaliculi forms the ___
intrahepatic duct
Production rate of bile per day
3L/ day
Excretion rate of bile per day
1L/ day
Principal pigment in bile
bilirubin
Enumerate the pathway of bile
Cholesterol»_space; Liver»_space; Primary bile acids»_space; Conjugation»_space; Bile salts»_space; Excretion»_space; Terminal ileum and colon with bacteria»_space; Dehydration to secondary bile acids»_space; Absorbed into portal circulation
Derived from iron-containing heme
Bilirubin
80% of bilirubin is from __, while 20% is from ___
RBCs
Proteins (myoglobin, cytochromes, catalase)
Ethanol concentration under the influence of alcohol
> 1000 mg/L
Ethanol concentration that causes CNS impairment or coma
3000 mg/L
Ethanol concentration that causes death
4000 mg/L
The three stages of alcohol-induced liver injury
- Alcoholic fatty liver
- Alcoholic hepatitis
- Alcoholic cirrhosis
Mildest of the alcohol-induces liver injury
Alcoholic fatty liver
An alcohol-induced liver injury that causes moderate increase in enzymes such as ALT and GGT
Alcoholic hepatitis
An alcohol-induced liver injury that is the most severe, often presented as weight loss, weakness, hepatomegaly, splenomegaly, jaundice, ascites, and edema
Alcoholic cirrhosis
A term used to describe a group of disorders caused by infectious, metabolic, toxic, or drug-induced diseases found almost exclusively in children
Reye’s syndrome
How much ammonia increase is expected in Reye’s syndrome?
3-fold
Refers to an inflammatory condition of the liver
Hepatitis
The most common form of viral hepatitis worldwide
Hepatitis A
Family of hepatitis A
Picornaviridae
Family of hepatitis B
Hepadnaviridae
Hepatitis that can cause acute and chronic infections and primarily targets hepatocytes in the liver
Hepatitis B
Family of hepatitis C
Flaviviridae
Hepatitis primarily transmitted through contact with infected blood and can occur through sharing of needles among intravenous drugs users, unsafe medical procedures, and sexual transmission
Hepatitis C
Family of hepatitis D
Deltaviridae
Hepatitis that is dependent on the presence of HBV and enters the hepatocytes using the same receptor as HBV
Hepatitis D
Family of hepatitis E
Hepeviridae
Hepatitis that can cause both acute and chronic infections, that is usually occurring in immunocompromised individuals
Hepatitis E
The only hepatitis classified as DNA virus
Hepatitis B
T/F: Hepatitis A can cause chronic infection
F
Irreversible scarring of the liver
Cirrhosis
The two cardinal features of cirrhosis
Fibrosis and nodules
A clinical condition in which scar tissue replaces normal, healthy liver tissue
Cirrhosis
T/F: Fatty liver is reversible, but cirrhosis does not enable hepatocytes to regenerate anymore
T
Synthetic functions affected by cirrhosis
Hypoalbuminemia, low clotting factors
Yellowish discoloration of the skin and sclerae
Jaundice
Jaundice is associated with ___, especially in infants
Kernicterus
Level of albumin classified as hyperbilirubinemia
> 1 to 2-3 mg/dL
Deposition of unconjugated bilirubin in the nuclei of the brain and nerve cells of infants
Kernicterus
Physiologic jaundice is caused by a deficiency in the enzyme ___
UDGPT
Treatment for physiologic jaundice
Exposure to UV light
Exchange transfusion
Classify the jaundice:
Too much RBC destruction
Pre-hepatic
Classify the jaundice:
Excessive amount of bilirubin is presented to the liver for metabolism
Pre-hepatic
Classify the jaundice:
Characterized by unconjugated hyperbilirubinemia
Pre-hepatic
Classify the jaundice:
Caused by malaria
Pre-hepatic
Classify the jaundice:
Due to impaired cellular uptake, defective conjugation, or abnormal secretion of bilirubin by the liver cell
Hepatic
Classify the jaundice:
Viral hepatitis, liver cirrhosis
Hepatic
Classify the jaundice:
Caused by Fasciola hepatica
Hepatic
A specific liver cirrhosis caused by alcohol intake
Laennec’s cirrhosis
A benign autosomal recessive condition caused by a mutation in the UGt1A1 gene that causes an impaired cellular uptake of bilirubin
Gilbert’s syndrome
T/F: Gilbert’s syndrome is often asymptomatic and causes only mild icterus
T
Increased bilirubin type in Gilbert’s syndrome
B1
A deficiency of the enzyme UDGPT that is rare, more serious, and may cause death
Crigler-Najjar Syndrome
Complete absence of UDGPT wherein no B2 is formed and the bile is colorless
Type I Crigler-Najjar Syndrome
Relative deficiency of UDGPT wherein some B2 is formed
Type II Crigler-Najjar Syndrome
Type II Crigler-Najjar Syndrome is also known as ___
Arias syndrome
Deficiency of the canalicular multidrug resistance/ multispecific organic anionic transported protein
Dubin-Johnson Syndrome
Idiopathic, abnormally short protein causing less efficient bilirubin uptake
Rotor’s syndrome
Dubin-Johnson/ Rotor’s syndrome:
Liver has black pigmentation
Dubin-Johnson
Dubin-Johnson/ Rotor’s syndrome:
Normal liver histology
Rotor’s syndrome
Dubin-Johnson/ Rotor’s syndrome:
Visualized by oral cholecystogram
Rotor’s syndrome
Dubin-Johnson/ Rotor’s syndrome:
Cannot be visualized
Dubin-Johnson
Dubin-Johnson/ Rotor’s syndrome:
Has a normal total urine coproporphyrin with >80% of isomer 1
Dubin-Johnson
Dubin-Johnson/ Rotor’s syndrome:
Has a high total urine coproporphyrin with <70% of isomer 1
Rotor’s syndrome
Classify the jaundice:
Impaired excretion of bilirubin caused by mechanical obstruction of the flow of bile into the intestines
Post-hepatic/ obstructive
Classify the jaundice:
Stool loses its source of normal pigmentation, causes a clay color
Post-hepatic/ obstructive
Identify the cause of jaundice:
Appearance of shunt bilirubin
Physiologic jaundice of the newborn
Identify the cause of jaundice:
Increased absorption of bilirubin in the intestine by B-glucuronidase in meconium
Physiologic jaundice of the newborn
Causes the hydrolysis of B2 back to B1
a-glucuronidase (breastmilk)
B-glucuronidase (meconium)
Breast milk hyperbilirubinemia affects about ___ of breast-fed newborns
30%
Supplies 25% blood supply in the liver
Hepatic artery
Supplies 75% blood supply in the liver
Portal vein
Hepatocytes comprises ___% of the liver
80%
System in the liver: Metabolic reactions and macromolecular synthesis
Hepatocyte system
System in the liver: Metabolism of bilirubin and bile salts
Biliary system
System in the liver: Immune system and production of heme and globin metabolites
Reticuloendothelial system
In the liver, majority of VitaminA is stored in the ___
Stellate cells
In the liver, 1/3 of the Vitamin E is stored in the ___
Mitochondria of hepatocytes
Coagulation factors considered part of coagulation factors
2, 7, 9, 10
Iron is stored in the liver as ___
Ferritin
Primary bile acids
Cholic acid
Chenodeoxycholic acid
Secondary bile acids
Deoxycholic acid
Lithocholic acid
Color of urobilinogen
Colorless
Mass if blood vessels with unknown etiology
Hemangioma
Pre-hepatic jaundice is also known as ___
Hemolytic hyperbilirubinemia
Hepatic jaundice is also known as ___
Hepatocellular hyperbilirubinemia
Post hepatic jaundice is also known as ___
Obstructive hyperbilirubinemia
Also called the “giant cell hepatitis” with increased B2
Idiopathic neonatal hepatitis
Effect of pre-hepatic jaundice in urobilinogen
Increased
Effect of post hepatic jaundice in urobilinogen
Decreased
If the liver becomes completely nonfunctional for any reason, death will occur within approx. 24 hrs due to ___
Hypoglycemia
The liver is divided into two unequal lobes by the ___
Falciform ligament
The hepatic artery and the portal vein merge into the ___
Hepatic sinusoid
It is through the ____ that blood leaves the liver
Hepatic canal
Identify the function of the liver:
a. Excretory/Secretory
b. Storage
c. Detoxification
d. Metabolism
Production of bilirubin as the major heme waste product
A
Identify the function of the liver:
a. Excretory/Secretory
b. Storage
c. Detoxification
d. Metabolism
Bile synthesis
A
Identify the function of the liver:
a. Excretory/Secretory
b. Storage
c. Detoxification
d. Metabolism
Use the glucose for its own cellular energy requirements
D
Identify the function of the liver:
a. Excretory/Secretory
b. Storage
c. Detoxification
d. Metabolism
Circulate the glucose for use at the peripheral tissues
D
Identify the function of the liver:
a. Excretory/Secretory
b. Storage
c. Detoxification
d. Metabolism
Convert glucose to glycogen as the principal storage form of glucose
B
Identify the function of the liver:
a. Excretory/Secretory
b. Storage
c. Detoxification
d. Metabolism
Maintaining stable glucose concentrations
D
Identify the function of the liver:
a. Excretory/Secretory
b. Storage
c. Detoxification
d. Metabolism
Breaking down of lipids and lipoproteins
D
T/F: Once there is a minimal damage in the liver, the metabolic or synthetic function will be the first one to be affected
False (it is the LAST to be impaired and would take extensive damage before being affected)
Identify the function of the liver:
a. Excretory/Secretory
b. Storage
c. Detoxification
d. Metabolism
First pass effect
C
Identify the function of the liver:
a. Excretory/Secretory
b. Storage
c. Detoxification
d. Metabolism
Binding the material reversibly to inactivate the compound
C
Identify the function of the liver:
a. Excretory/Secretory
b. Storage
c. Detoxification
d. Metabolism
Chemically modifies the compound to be excreted
C
The liver has a storage function. It stores lipids, proteins, and which vitamins?
Fat-soluble vitamins (A, D, E, K) and Vitamin B12
The upper limit of normal for total bilirubin is 1.0-1.5 mg/dL, but jaundice is usually not noticeable to the human eye until what bilirubin level?
3.0-5.0 mg/dL
Jaundice to the human eye is called ___
Overt jaundice
Identify whether pre-hepatic, hepatic, or post-hepatic jaundice:
Acute and chronic hemolytic anemia
Pre-hepatic
Identify whether pre-hepatic, hepatic, or post-hepatic jaundice:
Crigler-Najjar Syndrome
Hepatic
Identify whether pre-hepatic, hepatic, or post-hepatic jaundice:
Dubin-Johnson Syndrome
Hepatic
Identify whether pre-hepatic, hepatic, or post-hepatic jaundice:
Gilbert’s disease
Hepatic
Identify whether pre-hepatic, hepatic, or post-hepatic jaundice:
Physiologic jaundice of the newborn
Hepatic
Identify whether pre-hepatic, hepatic, or post-hepatic jaundice:
Rotor Syndrome
Hepatic
T/F: In Crigler-Najjar and Dubin-Johnson, the elevated bilirubin is the B1
True
A conjugated bilirubin that is still bound to albumin
Delta bilirubin
T/F: People with Dubin-Johnson are expected to have a shortened life expectancy due to poor prognosis
False (Dubin-Johnson px. have normal life expectancy, no treatment is necessary)
Normal levels of ___ and ___ seen in Rotor syndrome distinguish it from biliary obstrution
ALP
GGT
Identify whether pre-hepatic, hepatic, or post-hepatic jaundice:
Cholecystolithiasis
Post-hepatic
Identify whether pre-hepatic, hepatic, or post-hepatic jaundice:
Choledocholithiasis
Post-hepatic
Identify whether pre-hepatic, hepatic, or post-hepatic jaundice:
Parasitism
Post-hepatic
Increased bilirubin type in Crigler-Najjar syndrome
B1
Increased bilirubin type in Dubin-Johnson syndrome
B2
Increased bilirubin type in Rotor’s syndrome
B2
Increased bilirubin type in Jaundice of newborn
B1
A benign tumor that occur almost exclusively in females of childbearing age
Hepatocellular adenoma
An acute illness characterized by noninflammatory encephalopathy and fatty degeneration of the liver
Reye’s syndrome
Most common drug associated with hepatic toxicity
Ethanol
The last and most severe stage of alcohol-induced liver condition
Alcoholic cirrhosis
One of the most common drugs associated with serious hepatic injury
Acetaminophen (Paracetamol)
Identify whether pre-hepatic, hepatic, or post-hepatic jaundice:
Breast milk hyperbilirubinemia
Hepatic
Conjugated hyperbilirubinemia that is caused by bile duct problems due to virus infections such as cytomegalovirus, reovirus III, Epstein-Barr virus, rubella virus
Biliary atresia
