anatomy & functions

Question 1

• Almost exclusively seen in children
• Often preceded by a viral infection
• Strong association with intake of Aspirin
• Acute illness characterized by non-inflammatory encephalopathy and fatty degeneration of the liver
• Mild hyperbilirubinemia; threefold changes in ammonia and aminotransferases (AST and ALT)

Answer 1

reye syndrome

Question 2

The drug metabolizing system of the liver takes place mostly in the liver microsomes via the (?)

Answer 2

cytochrome P450 isoenzyme

Question 3

• Neonatal populations
• Measurement of reflected light from the skin using 2 wavelengths, providing a numerical index based on spectral reflectance
• Cannot be done in adult populations due to positive interference by carotinoid compounds

Answer 3

bilirubinometry

Question 4

major waste product of heme catabolism

Answer 4

bilirubin

Question 5

biliary obstructive disease, stool loses color (clay colored)

Answer 5

post hepatic jaundice

Question 6

• (?) to (?) kg
• Extremely vascular - blood supply comes from the (?) and (?)
• (?) ml blood/min

Functional unit : (?)
* Six - sided with one portal triad (comprised of a hepatic artery, a portal vein and a bile duct) on each side

• Kupffer cells
• Hepatocyte (80%)

Answer 6

• 1.2, 1.5
• hepatic aretry, portal vein
• 1500
• lobule

Question 7

• Used to detect hepatocellular damage
• ALT - more liver specific and more greatly increased; highest increase in acute conditions

Answer 7

aminotransferases

Question 8

lower prpduction of UDPGT due to genetic lesion and overall lower enzymatic activity; an additional defect related to a tranport deficit in the sinusoidal membrane of the hepatocyte may be present

Answer 8

gilbert disease

Question 9

hypothesized to be due to a reduction in the concentration or activity of intracellular binding proteins; Liver biopsy does NOT show dark pigmented granules

Answer 9

rotor syndrome

Question 10

• infants whi are affected with crigler-najjar syndrome, especially the more sever form, develop severe (?), which typically leads to (?), the deposition of bilirubin in the brain.
• the danger of kernicterus is a certainty at levels exceeding (?)

Answer 10

• unconjugated hyperbilirubinemia
• kernicterus
• 20 mg/dl

Question 11

tumors

• (?) are more common than primary liver cancers
• (?) is the most common malignant tumor of the liver

Answer 11

• metastatic liver cancer
• hepatocellular carcinoma

Question 12

• Clinical condition in which tissue scar replaces normal, healthy liver tissue
• Most common causes include chronic alcoholism and chronic hepatitis C infection

Answer 12

cirrhosis

Question 13

excellent marker of extrahepatic biliary obstruction

Answer 13

alkalin phosphatase

Question 14

drug and alcohol-related disorders

• (?) most commonly via immune mediated injury to the hepatocytes
• (?) - most common drug which can cause liver damage; can lead to alcoholic cirrhosis
• (?) can cause hepatic necrosis

Answer 14

• drug cause injury
• ethanol
• acetaminophen

Question 15

• Third fraction of bilirubin
• Conjugated bilirubin that is covalently bound to albumin
• Seen only when there is significant hepatic obstruction
• When present, will react in most laboratory method as conjugated bilirubin

Answer 15

delta bilirubin

Question 16

• bilirubin is very sensitive to and is destroyed by (?); therefore specimens should be protected from light
• if left unprotected, bilirubin may reduce by (?)

Answer 16

• light
• 30-50% per hour

Question 17

jaundice

Increased amounts of bilirubin are being presented to the liver

Answer 17

prehepatic jaundice

Question 18

Jaundice becomes noticeable to the naked eye once bilirubin level reach (?) mg/dL.

Answer 18

> 3.0

Question 19

Almost all serum proteins are synthesized by the liver except (?) and (?)

Answer 19

• immunoglobulins
• vWF

Question 20

(?) are synthesized in the liver under normal circumstances when nutrition is adequate and the demand for glucose is being met. 70% of the daily production of cholesterol is produced by the (?).

Answer 20

• lipids
• liver

Question 21

When carbohydrates are ingested and absorbed, the liver can do three thing;
* Use (?) for its own cellular energy requirements

• Circulate (?) for use at the peripheral tissue
• Store (?) at glycogen

Answer 21

glucose

Question 22

(?) not present in bone; used to differentiate ALP results; more sensitive to metastatic disease

Answer 22

5-nucleotidase

Question 23

more serious disorder; multiple mutations in the gene coding for UDPGT results in the production of midly dysfunctional to completely nonfunctional UDPGT

Answer 23

crigler-najjar syndrome

Question 24

jaundice

Primary problem is within the liver

Answer 24

hepatic jaundice

Question 25

• removal of conjugated bilirubin from the liver cell and the excretion into the bile are defective
• Caused by deficiency of the canalicular transporter protein (MDR2/cMOAT)
• Appearance of dark-stained granules on a liver biopsy

Answer 25

dubin-johnson

Question 26

premature neonates, deficiency of UPDGT

Answer 26

physiologic jaundice

Question 27

• Also used to differentiate increased ALP results
• Highest levels seen in biliary obstruction
• Sensitive test for cholestasis caused by alcohol and drug ingestion

Answer 27

gamma-glutamyl transferase

Question 28

every substance absorbed by the GIT must first pass through the liver

Answer 28

first pass phenomenon

Question 29

Bilirubin + diazotized sulfanilic acid —> (?)

Answer 29

azobilirubin

Question 30

conjugated or unconjugated

• noncovalently attached to albumin
• does not react woth the color reagent until the bilirubin is first dissociated from albumin using an accelerator (indirect)
• nonpolar; water insoluble
• aka hemobilirubin / slow-reacting bilirubin

Answer 30

unconjugated bilirubin

Question 31

conjugated or unconjugated

• attached to one or two glucuronic acid molecules
• reacys directly with the color reagent
• polar;water soluble
• aka cholebilirubin / one-minute / prompt bilirubin

Answer 31

conjugated bilirubin

Question 32

Approximately (?) mg of bilirubin produced per day

Answer 32

200-300