Chapter 25 - Liver Function (RVSP) Flashcards
0
Q
Amount of blood that passes into the liver per minute
A
1500 mL/min
1
Q
Average weight of the liver
A
1200-1500 g
2
Q
Spaces between hepatocytes
A
Sinusoids
3
Q
2 blood vessels that supply blood to the liver
A
- hepatic artery
- portal vein
4
Q
3 systems of the liver
A
- hepatocyte system
- biliary system
- reticuloendothelial system (RES)
5
Q
System of the liver; for metabolic reactions and macromolecular synthesis
A
Hepatocyte system
6
Q
System of the liver; for metabolism of bilirubin and bile salts
A
Biliary system
7
Q
System of the liver; for excretory function
A
Biliary system
8
Q
Structure of the liver involved in excretion
A
Bile canaliculi
9
Q
System of the liver for drug metabolism
A
Hepatocyte system
10
Q
Drug metabolism function of the liver
A
Xenobiotic
11
Q
System of the liver; for immune system and degradation of hemoglobin
A
Reticuloendothelial system
12
Q
Cells involved in the reticuloendothelial system
A
Kuppfer cells
13
Q
4 functions of the liver
A
- Synthesis
- Excretory/secretory
- Detoxification
- Storage
14
Q
Removal of waste products
A
Excretion
15
Q
Release of useful substances
A
Secretion
16
Q
2 proteins not produced by the liver
A
- Immunoglobulins
- adult hemoglobin
17
Q
4 substances synthesized by the liver
A
- proteins
- carbohydrates
- lipids
- vitamins
18
Q
2 ways the liver detoxifies toxic substances
A
- bind and inactivate toxin
- chemically modify and excrete toxin
19
Q
4 substances stored by the liver
A
- proteins
- lipids
- amino acids
- glycogen
20
Q
Principal pigment in bile
A
Bilirubin
21
Q
Amount of bile produced per day
A
3 L/day
22
Q
Amount of bile excreted per day
A
1 L/day
23
Q
2 components of bilirubin
A
- RBCs (80%)
- proteins (20%)
24
Divides the liver into two unequal lobes
Falciform ligament
25
Larger lobe of the liver
Right lobe (6x larger)
26
Supplies oxygen-rich blood to the liver; 25% of total blood supply to the liver
Hepatic artery
27
Supplies nutrient-rich blood to the liver; 75% of total blood supply to the liver
Portal vein
28
Functional units of the liver
Lobules
29
Responsible for all metabolic and excretory functions of the liver
Lobules
30
Centrally located vein of the lobule
Central vein
31
Found at each side of the lobule
Portal triads
32
3 components of the portal triads
- hepatic artery
- portal vein
- bile duct
33
2 major cell types of the liver
- hepatocytes
| - Kupffer cells
34
Liver cells responsible for its regenerative properties
Hepatocytes
35
Active phagocytes in the liver
Kupffer cells
36
Major heme waste product
Bilirubin
37
Type of bilirubin bound by albumin
Unconjugated/indirect bilirubin
38
Solubility of indirect bilirubin to alcohol and water
- soluble to alcohol
| - insoluble to water
39
Protein for transport of unconjugated bilirubin to the endoplasmic reticulum
Ligandin
40
Enzyme for the conjugation of bilorubin
Uridyldiphosphate glucoronyl transferase (UDPGT)
41
Solubility of direct bilirubin to alcohol and water
- insoluble to alcohol
| - soluble to water
42
Amount of bilirubin produced per day
200-300 mg
43
Enzymes responsible for the drug-metabolizing system of the liver
Cytochrome P-450 isoenzymes
44
Yellow discoloration of the skin, eyes amd mucous membranes
Jaundice/icterus
45
Most common cause of jaundice
Retention of bilirubin
46
Jaundice not visible to the naked eye
Overt jaundice
47
Bilirubin levels when jaundice is visible
3.0 - 5.0 mg/dL
48
3 classifications of jaundice
- prehepatic/hemolytic hyperbilirubinemia
- hepatic/hepatocellular hyperbilirubinemia
- posthepatic/obstructive hyperbilirubinemia
49
Jaundice that occurs when the problem happens prior to liver metabolism
Prehepatic jaundice
50
Another name for prehepatic jaundice
Unconjugated hyperbilirubinemia
51
Type of anemia that causes prehepatic jaundice
Acute and chronic hemolytic anemia
52
Jaundice that occurs when the problem resides inside the liver
Hepatic jaundice
53
3 diesease that cause hepatic jaundice that increases unconjugated bilirubin
- physiologic jaundice of the newborn
- Gilbert's disease
- Crigler-Najjar syndrome
54
2 conditions that cause hepatic jaundice that elevates conjugated bilirubin
- Dubin-Johnson
| - Rotor syndrome
55
Most common cause of hepatic jaundice
Gilbert's syndrome
56
Type of hepatic jaundice where there is impaired cellular uptake of bilirubin
Gilbert's syndrome
57
Type of hepatic jaundice; chronic nonhemolytic unconjugated hyperbilirubinemia; deficiency of UDPGT
Crigler-Najjar syndrome
58
Type of Crigler-Najjar syndrome; complete absence of UDPGT, no B2 formed, colorless bile
Type I
59
Type of Crigler-Najjar syndrome; relative deficiency of UDPGT, some B2 formed
Type II
60
Condition of relative deficiency of UDPGT
Arias syndrome
61
Conjugated bilirubin bound to albumin
Delta bilirubin
62
Type of hepatic jaundice caused by a deficiency of the canalicular multidrug resistance/multispecific organic anionic transporter protein (MDR2/cMOAT)
Dubin-Johnson syndrome
63
Type of hepatic jaundice where the removal of conjugated bilirubin from the liver cell and the excretion into the bile are defective
Dubin-Johnson syndrome
64
Type of hepatic jaundice that is idiopathic
Rotor syndrome
65
Appearance of liver in Dubin-Johnson syndrome
With black pigmentation
66
Appearance of liver in Rotor syndrome
Normal histology
67
Gallbladder visualization of Dubin-Johnson syndrome
No visualization
68
Gallbladder visualization of Rotor syndrome
Visualized by oral cholecystogram
69
Total urine coproporphyrin of Dubin-Johnson syndrome
Normal w/ >80% of isomer 1
70
Total urine coproporphyrin of Rotor syndrome
High w/ <70% of isomer 1
71
Enzyme that is deficient in physiologic jaundice of the newborn
Glucoronyl transferase
72
Movement of bilirubin from the bloodstream to brain tissue
Kernicterus
73
Enzyme responsible for bilirubin conjugation in infants
Glucoronyl transferase
74
Jaundice caused by biliary obstructive disease
Posthepatic jaundice
75
Type of bilirubin increased in posthepatic jaundice
- unconjugated
| - conjugated
76
Type of jaundice where the stool loses its normal pigmentation and becomes clay-colored
Posthepatic jaundice
77
Condition in which scar tissue replaces normal, healthy liver tissue
Cirrhosis
78
Most common cause of cirrhosis
Chronic alcoholism
79
Type of liver cancer that begins in the liver cells
Primary liver cancer
80
Type of liver cancer that occurs when tumors from other parts of the body spread to the liver
Metastatic cancer
81
3 cancers that commonly spread to the liver
- breast cancer
- lung cancer
- colon cancer
82
2 types of liver cancer
- primary liver cancer
| - metastatic liver cancer
83
2 types of liver tumors
- benign tumors
| - malignant tumors
84
2 common benign liver tumors
- Hepatocellular adenoma
| - hemangiomas
85
2 malignant liver tumors
- hepatocellular carcinoma (HCC)
| - bile duct carcinoma
86
Benign liver tumor occuring in females of child-bearing age
Hepatocellular adenoma
87
Benign liver tumor; masses of blood vessels with no known etiology
Hemangiomas
88
Most common malignant liver tumor
Hepatocellular carcinoma (HCC)/hepatocarcinoma/hepatoma
89
Uncommon hepatic malignancy in children
Hepatoblastoma
90
Disease found primarily in children; idiopathic; related to aspirin therapy; usually occurs following recovery from viral infection
Reye syndrome
91
Most important drug related to hepatic toxicity
Ethanol
92
Caused by heavy and prolonged consumption of ethanol
Alcoholic cirrhosis
93
3 stages of alcohol-induced liver injury
- alcoholic fatty liver
- alcoholic hepatitis/liver fibrosis
- alcoholic cirrhosis
94
Alcoholic fatty liver with inflammation
Steatohepatitis
95
Amount of ethanol that causes one to be under the influence of alcohol
>1000 mg/L
96
Amount of ethanol that causes CNS impairment/coma
3000 mg/L
97
Amount of ethanol that causes death
4000 mg/L
98
Reagent used in Muelengracht mtd for icterus index
NSS
99
Solution used for comparison in Newberger mtd for icterus index
Sodium citrate
100
3 substances that interfere with icterus index
- carotene
- xantophyll II
- hemoglobin
101
Property used to differentiate conjugated and unconjugated bilirubin
Solubility
102
3 fractions comprising total bilirubin
- conjugated bilirubin
- unconjugated bilirubin
- delta bilirubin
103
Preferred sample for Malloy-Evelyn procedure
Serum
104
Number of days serum/plasmais stable for bilirubin at room temperature
2 days
105
Number of days serum/plasma for bilirubin is stable at 4 degrees Celsius
7 days
106
Number of days that serum/plasma is stable for bilirubin at -20 degrees Celsius
Indefinite
107
4 reagents in Malloy-Evelyn procedure
- diazo reagent (sulphanilic acid & sodium nitrite)
- 50% methanol
- sodium acetate
- ascorbic acid
108
pH level of Malloy-Evelyn procedure
pH 1.2
109
Color of product in Malloy-Evelyn procedure
Red-purple
110
Wavelength of Malloy-Evelyn procedure
560 nm
111
Most common accelerator used in Malloy-Evelyn procedure
50% Methanol
112
4 reagents of the Jendrassik-Grof method
- diazotized sulphanilic acid (lphanilic acid & sodium nitrite)
- caffeine sodium benzoate
- sodium acetate
- ascorbic acid
113
Color of initial product in Jendrassik-Grof method
Purple
114
Accelerator in Jendrassik-Grof method
Caffeine sodium benzoate
115
Terminates the reaction of the aliqouts with the diazo reagent in Jendrassik-Grof method
Ascorbic acid
116
Solution used to alkalinize the solution in Jendrassik-Grof method
Alkaline tartrate solution
117
Color of final product in Jendrassik-Gtof method
Blue
118
Wavelength used in Jendrassik-Grof method
600 nm
119
Colorless end product of bilirubin metabolism
Urobilinogen
120
Urobilinogen that is oxidized by intestinal bacteria; brown pigmented
Urobilin
121
3 reagents for Ehrlich's method for urine urobilinogen
- Ehrlich's reagent (p-dimethylaminobenzaldehyde)
- ascorbic acid
- saturated sodium citrate (NaCH3COO)
122
Reagent in Ehrlich's method that serves as reducing agent to maintain urobilinogen in a reduced state
Ascorbic acid
123
Reagent in Ehrlich's method that stops the reaction and minimizes the combination of other chromogens
Saturated sodium citrate (NaCH3COO)
124
Color of product of Ehrlich's method for urine urobilinogen
Red
125
Specimen for Ehrlich's method for urine urobilinogen
Fresh 2-hour urine specimen
126
4 substances that interfere with urine urobilinogen measurement (Ehrlich's method)
- 5-hydroxyindoleacetic acid
- porphobilinogen
- sulfonamides
- procaine
127
Sample in fecal urobilinogen
Aqueous extract of fresh feces
128
Reagent used for fecal urobilinogen that reduces urobilin to urobilinogen
Alkaline ferrous hydroxide (Fe(OH)2)
129
Color of product for fecal urobilinogen
Red
130
2 clinical significance of increased urobilinogen
- hemolytic disease
| - defective liver cell function (hepatitis)
131
2 clinical significance of absence of urobilinogen
- biliary obstruction
| - hepatocellular disease
132
Test used for bile salts
Hay Test
133
Used in Hay Test to detect the presence of bile salts
Sulphur powder
134
Interpretation of Hay test when sulphur powder floats
Bile salts absent
135
Interpretation of Hay test when sulphur powder sinks to the bottom
Bile salts present (obstructive jaundice)
136
Buffer in Evelyn-Malloy procedure
Sodium acetate
137
Stop solution in Evelyn-Malloy method
Ascorbic acid
138
Tested for the synthetic function of the liver
- total protein
- albumin
- alpha-globulin
- prothrombin time
139
2 tests for testing the excretory function of the liver
- Bromsulphalein test
| - Rose Bengal Test
140
2 methods under Bromsulphalein test
- Rosenthal
| - Mc Donald
141
Element used in Rose Bengal Test
Tagged Iodine 131
142
Color of urine foam positive for bilirubin
Yellow
143
Urine color positive for bilirubin
Brown to amber
144
4 tests for urine bilirubin
- Foam test
- Urine color inspection
- Fouchet's test or Harrison Spot Test
- Diazotization Test
145
Used to precipitate bilirubin in Fouchet's test
BaCl2
146
Reagent in Fouchet's test/Harrison Spot test
FeCl3 and TCA
147
Color of final precipitate in Fouchet's test/Harrison Spot test; positive for bilirubin
Green precipitate
148
Test used to determine detoxification function
Quick's Test/Hippuric Acid Test
149
Consumed by patient in Quick's test/Hippuric acid test
Sodium benzoate meal
150
In normal patients, what percentage of the benzoate meal in Quick's test is excreted within 1 hour?
40%
151
Inflammation of the liver
Hepatitis
152
2 hepatitis types acquired through the fecal-oral route
A and E
153
Causes Hepatitis A
Picorna virus
154
Causes Hepatitis B
Hepadna virus
155
Causes Hepatitis C
Flavivirus
156
Causes Hepatitis D
Delta agent (needs HBsAg)
157
Causes Hepatitis E
Hepevirus
158
2 cardinal features of cirrhosis
- fibrosis
| - nodules
159
Prevents regeneration of the liver
Fibrosis
160
Elevated in Reye's Syndrome
Elevated liver function tests except bilirubin
161
Causes Hepatitis F
Toga virus
162
Causes Hepatitis G
G-B virus
163
MOT of Hepatitis A&E
Fecal-oral route
164
MOT of Hepatitis B, C, and D
Parenteral, sexual
165
Classification of hepatitis based on etiology
- viral hepatitis (B, C, D)
- alcoholic
- toxic
- metabolic (hemochromatosis, Wilson's disease, galactosemia)
- autoimmune
- cardiac
- biliary
166
Classification of cirrhosis based on morphology
- micronodular
- macronodular
- micromacronodular (mixed cirrhosis)
- septal
167
Classification of cirrhosis based on activity and spread of progression
- active (rapidly, slowly, latent)
| - nonactive
168
Classification of cirrhosis based on the course of the disease
- compensation (hepatic encephalopathy)
- subcompensation (hepatic encephalopathy stages I-II, ascites controlled by drugs)
- decompensation (hepatic encephalopathy stage III, ascites not controlled by drugs)
169
Classification of cirrhosis based on complications
- hepatic coma (precoma)
- bleeding esophageal stomach/hemorroidalvarices
- bacterial peritonitis
- portal vein thrombosis
- primary cancer of the liver
170
A congenital condition due to maternal steroids causing increased B1 becuase of a defect in UDPGT
Lucey Driscoll
171
Solution used for comparison in Muelengracht mtd for icterus index
0.01% K2Cr2O7
172
Advantages of Jendrassik-Groff mtd over Evelyn-Malloy mtd for bilirubin
- insensitive to pH changes
- insensitive to a 50-fold variation in protein conc
- adequate optical sensitivity even with low bilirubin conc
- minimal turbidity and with constant serum blank
- not affected by Hb up to 750 mg/dL
173
Normal range for conjugated bilirubin
0 - 0.2 mg/dL
174
Conjugated bilirubin is increased during
Obstructive jaundice
175
Normal range for unconjugated bilirubin
0.2 - 0.8 mg/dL
176
Unconjugated bilirubin is increased during
Hemolytic jaundice
177
Normal range for total bilirubin
0.2 - 1.0 mg/dL
178
Total bilirubin is increased during
Hepatocellular jaundice
179
Sources of error for bilirubin measurement
- hemolysis
- exposure to light
- lipemia
- lipochrome
