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MLS 411 Clinical Chemistry I > Bishop Chapter 25 Liver Function > Flashcards

Bishop Chapter 25 Liver Function Flashcards

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1
Q

What ligament connects the two lobes of the liver?

A

Falciform Ligament.

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2
Q

What are the two major sources of blood supply to the liver?

A

The hepatic artery and the portal vein.

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3
Q

Approximately how much blood passes through the liver per minute?

A

1,500 mL

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4
Q

The liver contains who major cell types, what are they?

A

Hepatocytes and Kupffer Cells.

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5
Q

What is the importance of hepatocytes?

A

Responsible for the regenerative properties of the liver.

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6
Q

What is the importance of Kupffer cells?

A

Act as active phagocytes capable of engulfing bacteria, debris, toxins and other substances flowing thorough the sinusoids.

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7
Q

What are the four major functions of the liver?

A

Excretion/secretion, metabolism, detoxification, and storage.

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8
Q

What is the significance of bilirubin?

A

It acts as the major heme waste product from the excretion of endogenous and exogenous substances.

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9
Q

The liver is the only organ that has the capacity to rid the body of what?

A

Heme waste products.

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10
Q

Red blood cells are phagocytized and hemoglobin is released within the liver. Hemoglobin is degraded into what three products?

A

Heme, globin, and iron.

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11
Q

When hemoglobin is broken down, what protein binds to the iron?

A

Transferrin.

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12
Q

When hemoglobin is broken down, what happens to the globin?

A

The globin is degraded to its constituent amino acids, which are reused by the body.

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13
Q

When hemoglobin is broken down, what happens to the heme portion?

A

The heme portion is converted to bilirubin in 2 to 3 hours.

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14
Q

Once bilirubin is formed, which protein transports it to the liver?

A

Albumin.

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15
Q

Define unconjugated bilirubin.

A

A form of bilirubin that is insoluble in water and cannot be removed from the body until it has been conjugated by the liver.

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16
Q

Once unconjugated bilirubin arrives to the liver, what protein, within the hepatocyte, acts as the carrier protein for the bilirubin?

A

Ligandin.

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17
Q

The conjugation (esterification) of bilirubin occurs in the presence of what enzyme?

A

Uridine diphosphate glucuronosyltransferase (UDPGT).

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18
Q

Intestinal bacteria degrade conjugated bilirubin to produce what?

A

Urobilinogen.

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19
Q

Most of the urobilinogen formed is oxidized to an orange-colored product, through the stool, called what?

A

Urobilin.

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20
Q

When carbohydrates are ingested and absorbed, the liver can do what three things?

A

(1) Uses glucose for its own energy requirements; (2) circulates glucose to peripheral tissues; (3) Stores glucose as glycogen.

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21
Q

Almost all proteins are synthesized by the liver except for what?

A

Immunoglobulins and adult hemoglobin.

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22
Q

The liver synthesizes what important protein?

A

Albumin.

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23
Q

Define first pass.

A

Every substance that is absorbed in the GI tract must first pass through the liver.

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24
Q

Define jaundice (or icterus).

A

Used to describe the yellow discoloration of the skin, eyes, and mucous membranes.

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25
Q

What is the cause of jaundice?

A

The retention of bilirubin or other substances.

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26
Q

Jaundice is most commonly classified based on what?

A

The site of the disorder: prehepatic, hepatic, and posthepatic jaundice.

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27
Q

Prehepatic and posthepatic jaundice are caused by what?

A

Abnormalities outside the liver.

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28
Q

Prehepatic jaundice commonly caused by what?

A

An increased amount of bilirubin being presented to the liver such as that seen in acute and chronic hemolytic anemias.

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29
Q

People with prehepatic jaundice rarely have bilirubin levels that exceed what value?

A

5.0mg/dL.

30
Q

Prehepatic jaundice may also be referred to as unconjugated hyperbilirubinemia because why?

A

Because the fraction of bilirubin increased in people with prehepatic jaundice is the unconjugated fraction.

31
Q

Define Gilbert’s Syndrome.

A

Results from a genetic mutation in the gene that produces the enzyme uridine diphosphate glucuronosyltransferase (UDPGT) which is important for bilirubin metabolism.

32
Q

For a patient with Gilbert’s syndrome, total serum bilirubin usually fluctuates between what values?

A

1.5 and 3.0 mg/dL.

33
Q

Define Type 1 Crigler-Najjar Syndrome.

A

There is a complete absence of enzymatic bilirubin conjugation.

34
Q

Define Type 2 Crigler-Najjar Syndrome.

A

There is a mutation causing a severe deficiency of the enzyme responsible for bilirubin conjugation.

35
Q

Define Dubin-Johnson Syndrome.

A

The liver’s ability to uptake and conjugate bilirubin is functional; however, the removal of conjugated bilirubin from the liver cell and the excretion into the bile are defective.

36
Q

For a patient with Dubin-Johnson syndrome, total serum bilirubin usually fluctuates between what values?

A

2 and 5 mg/dL; more than 50% due to the conjugated fraction.

37
Q

Posthepatic jaundice commonly results from what condition(s)?

A

Usually from a physical obstruction (gallstones or tumors) that prevent the flow of conjugated bilirubin into the bile canaliculi.

38
Q

Define Cirrhosis.

A

A clinical condition in which scar tissue replaces normal, healthy liver tissue which blocks blood flow and prevents the liver from functioning properly.

39
Q

What is the most common cause of cirrhosis?

A

Chronic Alcoholism.

40
Q

Which type of cancer is most common within the liver, primary or metastatic?

A

Metastatic.

41
Q

What are the most common benign tumors of the liver?

A

Hepatocellular adenoma and hemangiomas.

42
Q

What are the most common malignant tumors of the liver?

A

Hepatocellular carcinoma and bile duct carcinoma.

43
Q

Define Reye’s syndrome.

A

An acute illness characterized by noninflammatory encephalopathy and fatty degeneration of the liver.

44
Q

What type of bilirubin will only react with the diazotized sulfanilic acid solution (diazo reagent) in the presence of an accelerator (solubilizer)?

A

Unconjugated bilirubin.

45
Q

Conjugated bilirubin, in a diazo reaction, reacts only in the absence of what?

A

An accelerator.

46
Q

Define “delta” bilirubin.

A

Conjugated bilirubin that is covalently bound to albumin.

47
Q

“Delta” bilirubin is only seen with what condition?

A

A significant hepatic obstruction.

48
Q

What are the three fractions of total bilirubin?

A

Conjugated, unconjugated, and delta bilirubin.

49
Q

How does light effect bilirubin?

A

Bilirubin is very sensitive and is destroyed by light.

50
Q

Increased levels of urinary urobilinogen are found in which condition(s)?

A

Hemolytic disease and in defective liver cell function (i.e. hepatitis).

51
Q

Absence of urobilinogen from the urine and stool is indicative of what condition(s)?

A

Complete biliary obstruction.

52
Q

For urobilinogen urine testing, a fresh urine is necessary and the test must be performed without delay to prevent what?

A

To prevent oxidation of urobilinogen to urobilin.

53
Q

In fecal, urobilin present is reduced to urobilinogen by treatment with what?

A

Alkaline ferrous hydroxide before Ehrlich’s reagent is added.

54
Q

Enzymes play an important role in differentiating what type(s) of liver disease?

A

Hepatocellular (functional) from obstructive (mechanical).

55
Q

What are the two most common aminotransferases measured?

A

AST and ALT

56
Q

The aminotransferases are responsible for catalyzing what?

A

The conversion of aspartate and alanine to oxaloacetate and pyruvate, respectively.

57
Q

Where is ALT mainly found?

A

In the liver.

58
Q

Where is AST mainly found?

A

Widely distributed in equal amounts in the heart, skeletal muscle, and liver.

59
Q

The highest levels of AST and ALT are found in what condition(s)?

A

Acute conditions such as viral hepatitis, drug- and toxin-induced liver necrosis, and hepatic ischemia.

60
Q

Where is the highest activity of Alkaline Phosphatase (ALP)?

A

Liver, bone, intestine, kidney, and placenta.

61
Q

What is the clinical utility of ALP?

A

Its ability to differentiate hepatobiliary disease from osteogenic bone disease.

62
Q

What is a disadvantage of ALP testing?

A

Enzyme activity of ALP can increase in the absence of liver damage.

63
Q

5’-Nucleaotidase (5NT) is a phosphatase that is responsible for what?

A

Catalyzing the hydrolysis of nucleoside-5’-phosphate esters.

64
Q

What condition is there an increase in both 5NT and ALP?

A

Liver disease.

65
Q

What condition is there an increase in ALP and normal/slight increase in 5NT?

A

Primary Bone Disease.

66
Q

Gamma-Glutamyltransferse (GGT) plays a role in differentiating the cause of elevated levels of ALP as the highest levels of GGT are seen in what condition?

A

Biliary Obstruction.

67
Q

Lactate Dehydrogenase (LD) is released into circulation when cells are what?

A

When cells of the body are damaged or destroyed, serving as a general, nonspecific marker for cellular injury.

68
Q

Moderate elevations of total serum LD levels are common in which hepatic condition(s)?

A

Acute viral hepatitis and in cirrhosis.

69
Q

High elevations of total serum LD levels are common in which hepatic condition(s)?

A

Metastatic carcinoma of the liver.

70
Q

A plasma ammonia level is a reflection of the liver’s ability to do what?

A

Perform the conversion between ammonia to urea.

71
Q

stopped at hepatitis section; page 518

A

MLS 411 Clinical Chemistry I (31 decks)

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