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BLD 416 > Liver > Flashcards

Liver Flashcards

1
Q

What does TSP stand for?

A

Total Serum Protein

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2
Q

What percentage of TSP come from the liver?

A

75-80%

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3
Q

75-80% of TSP comes from the liver. Where does the majority of the remainder come from?

A

The majority of the remainder of serum protein is from immunoglobulin.

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4
Q

What percentage of normal liver is needed to maintain normal serum proteins?

A

~25%

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5
Q

Total Serum Protein is not very specific for liver dysfunction, why?

A

Can have a Decrease in TSP for reasons other than liver function. Such as; Nephrotic syndrome and malnutrition.

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6
Q

Why is Total Serum Protein not very sensitive for liver dysfunction?

A

Hydration can affect Total Serum Protein

It has a wide normal reference range

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7
Q

Why is Total Serum Protein a late stage indicator of liver function?

A

Because it only takes 25% of functioning liver tissue to maintain normal serum protein levels

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8
Q

What is the major protein in serum?

A

Albumin

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9
Q

Where is all of the albumin synthesized?

A

Liver

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10
Q

Why is albumin a late stage indicator of liver function?

A

It only takes 25% of functioning liver tissue to maintain normal serum albumin levels

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11
Q

What affects the specificity of an albumin assay?

A

Malnutrition, Renal Disease, and hydration

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12
Q

How can we compensate for hydration while measuring albumin?

A

Do an A:G ratio. If problem is due to hydration, the ratio will stay the same. If due to albumin, the ratio will increase or decrease.

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13
Q

If a patient had some type of liver disease, what would be the PT and APTT? Why?

A

Prolonged PT and APTT because there is a decrease in fibrinogen which is made in the liver.

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14
Q

If a patient had some type of liver disease, what would be the effect on ammonia and urea levels? Why?

A

Increase ammonia, decrease urea. The liver is the only place which contains the urea cycle.

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15
Q

Ammonia/Urea levels are an end stage hepatic insufficiency indicator, Why?

A

Only need 10% of liver tissue to produce urea

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16
Q

Is bilirubin an early or late stage indicator of hepatic insufficiency?

A

Bilirubin is an early indicator. Only ~70% of functional tissue needs to be lost to see changes in analyte concentrations.

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17
Q

What will bilirubin levels be in someone experiencing some type of liver disease?

A

Increased Serum Indirect Bilirubin

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18
Q

Explain the Bile acid cycle

A

Cholesterol is taken up by the liver and converted to primary bile acids which are secreted into the bile. Bile containing primary acids is secreted into the GI where it is subject to bacterial conversion to secondary bile acids. There are some residual primary bile acids that were not converted. 20% of these converted and non converted bile acids are excreted in the feces while 80% is reabsorbed into the enterohepatic circulation. While in the portal circulation, 80% is reabsorbed by the liver while 20% remains in general circulation where it is eliminated in the urine.

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19
Q

What is the relative concentration of primary to secondary bile acids in the bile?

A

Primary > Secondary

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20
Q

What is the relative concentration of primary to secondary bile acids in the GI?

A

Primary < Secondary

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21
Q

What is the relative concentration of serum and urine concentrations of primary and secondary bile acids?

A

Low Total

Primary < Secondary

22
Q

What would be the relative concentrations of primary and secondary bile acids in a patient with a Bile Duct Obstruction?

A

Serum Primary&raquo_space; Secondary

Urine Primary&raquo_space; Secondary

23
Q

What would be the relative concentrations of primary and secondary bile acids in a patient with Hepatitis?

A 
Serum Primary (approx. =) Secondary
Urine Primary (approx =) Secondary
24
Q

What does AST stand for?

A

Aspartate Amino Transferase

25
Q

Is AST diagnostic for liver disease?

A

NO! It is NOT specific because there is a high activity in the heart, skeletal muscle, RBC’s, and GI tract as well!

26
Q

Is AST an early or late indicator of liver disease?

A

Early indicator because it is Low MW, when there is a small amount of cell swelling, this protein comes out early.

27
Q

Is AST cytosolic or membrane bound?

A

CYTOSOLIC

28
Q

What does ALT stand for?

A

Alanine Amino Transferase

29
Q

If you saw a patient with a high AST but normal ALT, is this diagnostic of liver disease?

A

Absolutely not! This says that AST is not coming from the liver, because if it was, ALT would be high too!

30
Q

Does ALT have hepatic specificity?

A

Absolutely! Other tissues have it too, but not nearly in the amount that the liver does.

31
Q

Is ALT cytosolic or membrane bound?

A

Cytosolic

32
Q

Is ALT an early or late indicator of liver disease?

A

Early indicator because it is Low MW, when there is a small amount of cell swelling, this protein comes out early.

33
Q

What does ALP stand for?

A

Alkaline Phosphatase

34
Q

Is ALP cytosolic or membrane bound?

A

Membrane Bound

35
Q

Where is ALP highest in activity?

A

Hepatic biliary tract

36
Q

Where is ALP also located?

A

Bone, GI, Placenta

37
Q

What does GGT stand for?

A

Gamma Glutamyl Transferase

38
Q

Is GGT cytosolic or membrane bound?

A

Membrane bound

39
Q

Are GGT levels specific for liver disease?

A

No, high levels can also be induced in Gonads, kidneys, and ovaries

40
Q

Is GGT an early or late indicator of liver disease?

A

Very early indicator of liver disease because this gets synthesized due to a change of transcription/translation which is a result of necrosis.

41
Q

What are the major inducers of GGT synthesis?

A

Exogenous substances such as Ethanol, antibiotics, heroin

42
Q

What does LDH stand for?

A

Lactate Dehydrogenase

43
Q

Is LDH cytosolic or membrane bound?

A

cytosolic but High MW

44
Q

Is LDH specific for liver disease?

A

No, LDH is a glycolytic enzyme, all cells metabolize glucose, so all cells contain LDH.

45
Q

Is LDH an early or late stage indicator of necrosis?

A

Late indicator of necrosis because it is high MW, only when cells are lysing can this enzyme actually get out.

46
Q

In ascending order, list the half-life of the liver enzymes.

A

GGT<LDH

47
Q

During acute phase hepatitis which liver enzymes would be expected to be elevated?

A

AST, ALT, possibly LDH if severe enough
Not GGT since it is exogenously induced
Not ALP since it is in the biliary tract

48
Q

Due to the half life of liver enzymes, which liver enzyme would constantly be elevated during chronic hepatitis?

A

ALT will be elevated for a long time, so when the patient’s liver is cycling with viral loads ALT will constantly be elevated.

49
Q

What does cholangiopathy mean?

A

Disease of the Bile Duct

50
Q

What does cholestasis mean?

A

blockage of the bile duct

51
Q

What are symptoms of cholestasis?

A

Dark urine, light stools
Dark Urine caused by increased bilirubin and bile acids.
Light stools caused by decrease urobilinogen conversion to urobilin

BLD 416 (5 decks)

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