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Chem II exam 2 > Liver > Flashcards

Liver Flashcards

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1
Q

Liver functions

A

Metabolize carbs, lipids, proteins, bilirubin
Detox
storage of essential compounds
clearing waste products into bile

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2
Q

Liver anatomy

A

extremely cascular
bi-lobal (connected by falciform ligament)
Right lobe 6x larger

Blood supplied by: hepatic artery (25%) Portal vein (75%)

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3
Q

Liver micro anatomy

A

Lobules:
Functional units
extretory/metabolic funtions
6 sided
portal triad each corner

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4
Q

Liver cell types

A

Hepatocytes: 80% of the volume
Kupffer cells: fancy location specific macrocytes

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5
Q

Death in liver failure

A

24 hours due to hypoglycemia

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6
Q

Liver
Excretion and secretion

A

Endogenous and exogenous substances in bile or urine
Only organ that gets rid of heme waste

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7
Q

Bile

A

Bilirubin principle pigment
made of bile salts, pigments, cholesterol, other substances from the blood

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8
Q

Unconjugated bilirubin

A

Also called indirect
Bound by albumin
insoluble

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9
Q

Conjugated bilirubin

A

Soluable
Hepatocyte into bile

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10
Q

Urobilinogen

A

colorless byproduct of bilirubin made by bacteria

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11
Q

Bilirubin processing

A

RBC -> heme -> unconj bilirubin -> +albumin makes indirect bilirubin -> conjugated bilirubin -> urobilinogen -> excreted in feces, urine, or recirculated

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12
Q

Glycogenesis

A

storing glucose as glycogen

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13
Q

Glucogenolysis

A

break down glycogen

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14
Q

Gluconeogenesis

A

Generate glucose from non carb sources

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15
Q

Lipid metabilism in the liver

A

Both lipids and lipoproteins
70% daily lipids come from liver and not diet
fatty acids -> Acytal CoA -> triglycerides, phospholipids, Cholesterol

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16
Q

Liver proteins

A

Almost all synth in liver
Dev Hgb in infants
most important: Albumin
Syth pos/neg acute phase reactants

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17
Q

Liver detox

A

Gate keeper to the GI tract
First pass effect
Drug detox major function

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18
Q

Pre hepatic Jaundice

A

Increased bili sent to liver
hemolytic anemias
unconjugated hyperbilirubinemia

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19
Q

Post hepatic Jaundice

A

Biliary obstruction disease
Gallstones or tumors
conjugated bili can’t be eliminated
bile not brought to intestines - grey poop

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20
Q

Hepatic jaundice

A

primary problem in liver
bili metabolism and transport defects

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21
Q

Gilbert’s syndrome

A

autosomal recessive disorder
hepatic jaundice
no clinical consequences
intermittent unconjugated hyperbilirubinemia

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22
Q

Crigler-Najjar

A

Hepatic jaundice
chronic unconj. hyperbilirubinemia
inherited
type 1: complete abcense of enzymatic conjug
type 2: severe deficiency

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23
Q

Dublin Johnson

A

Obstructive in nature
can’t remove conj. bili
Dark stain granules on liver
mild, no treatment needed

24
Q

physiologic Jaundice

A

Kernicterus - unconj. bili in the neonate, deposited in brain
Treated with phototherapy, IVIG, metalloporphryrins

25
Q

Cirrhosis

A

Scar tissue replaces normal tissues
poor prognosis
alcoholism

26
Q

Liver tumors
Benign

A

Hepatocellular adenoma

27
Q

Liver tumors
Malignant

A

Hepatocellular carcinoma
Continues to rise

28
Q

Reye’s Syndrom

A

Don’t give kids asprin
Encephalopathy
follows a viral syndrome
3x increase in ammonia, AST,ALT

29
Q

Drug and alcohol related liver disorders

A

Ethanol - most important drug
Long term consumption can result in a number of disorders

30
Q

Fatty liver

A

sl. elevation in ALT, AST, GGT
Very mild

31
Q

Alcoholic Hepatitis

A

Fever, Ascites, proximal muscle loss
Elevated AST, ALT, GGT, ALP
Serum protein decrease (albumin)
Creatinine increase = kidney dmg

32
Q

alcoholic cirrhosis

A

more common in males.
60% survival rate if alcohol is stopped
increased AST, ALT, GGT, ALP

33
Q

3 fractions of bilirubin

A

Delta
conj
unconj

34
Q

Remembering bilirubin

A

Vowels: Indirect, unconj, insoluble
Consonants: direct, conj, water soluble

35
Q

Bili collection for testing

A

Serum or plasma
Mallory Evelyn prefers serum (alcohol can precip. proteins)
fasting
avoid hemolysis
sensitive to light

36
Q

Bilirubin methods

A

Jendrassik-Grof procedure
more complicated than Malloy-Evelyn

37
Q

Mallory Evelyn procedure

A

Diazo reagent
1.2 pH
red-purple pigment
Methanol accelerator

38
Q

Jendrassik-Grof procedure

A

diazo reagent
Diazo only gives conj. bili
caffeine-benzoate gives tot. bili

39
Q

Liver enzymes

A

most useful LFTs
ALT, AST, ALP, 5’ nucleotidase, GGT, LD

40
Q

ALT/AST

A

Aminotransferases
AST: Heart, Skeletal muscle, liver
ALT: mainly in liver

41
Q

ALP/5NT

A

ALP: Bone, Liver. Hepatobiliary vs. bone disease
5NT: rarely ordered. no bone source, use for differentiation w/ ALP

42
Q

GGT/LD

A

GGT: Used for detection of alcoholism. Hepatic Neoplasms.
LD: widely distributed. released from cellular destruction

43
Q

Hepatitis

A

Inflam of the liver
Most common cause - Viral
Chronic hepatitis seen in HBV and HCV

44
Q

Hep A

A

HAV. Infectious or short incubation
Most common
Non-envoloped RNA
From contaminated food - fecal -> oral route
Self limiting

45
Q

Hep A clinical markers

A

IgM anti-HAV
IgG Anti-HAV
if IgM = and IgG +, then past infection indicated
Vaccine availible.

46
Q

Hep B

A

HBV. “serum Hepatitis”
Ubiquitous
Can live in environ. for 7 days
detected in all body fluids

47
Q

Hep B routes

A

Parenteral
Perinatal
Sexual

48
Q

Hep B Sero markers

A

DNA virus
Replicates in liver
HBcAg - Core antigen
HBsAg - Surface antigen
HBeAg - envelope antigen

49
Q

HBsAg - Surface antigen

A

Testing all donated blood
not infectious
indicated possible infection
can be positive 10-20 days post-vaccination
Anti-HBs + mean acquired immunity

50
Q

Chronic infection with HBV

A

90% recover in 6 months
4 phases :
Tolerance
Clearance
Non-replication
Reactivation

51
Q

Hep C

A

Non-A. Non-B hepatitis
RNA genome
Parentally xmitted
High rate of progress to chronic hep, cirrhosis, carcinoma
Leading cause of liver xplants

52
Q

HCV tests

A

Anti-HCV
PCR for serum HCV RNA

53
Q

Hep D

A

Super infects with Hep B
Requires HBsAg to replicate

54
Q

Hep E

A

nonenveloped RNA
21-42 day incubation
simlar to HAV
Anti-HEV IgM testing

55
Q

Hepatitis routes of infection

A

Hep A/E: Fecal Oral
B/C/D: parenteral, sexual

Chem II exam 2 (6 decks)

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