Liver Flashcards
0
Q
Location of the liver
A
Beneath and attached to the diaphragm
1
Q
Size of the liver in a healthy adult
A
1.2-1.5 kg
2
Q
Liver is divided into 2 lobes, which is divided by?
A
Falciform ligaments
3
Q
A chronic disease of the liver marked by degeneration of cells inflammation and fibrous thickening of tissue. Typically a result of alcoholism
A
Cirrhosis
4
Q
Branch of aorta
Supplies an oxygen rich blood from the heart to the liver.
25%
A
Hepatic artery
5
Q
Supplies nutrient rich blood from the digestive tract
75%
A
Portal vein
6
Q
How many mL of blood passes through the liver/min
A
1,500 mL
7
Q
Microscopic units that divides the liver
A
Lobules
8
Q
Functional unit of the liver
A
Lobules
9
Q
2 functions of the lobules performed by the liver
A
Secretory and metabolism
10
Q
2 major cell type of the liver
A
Hepatocyte and Kupffer cells
11
Q
Makes up of 80% of tot cells of the liver. Performa the major functions associated with the liver. Responsible for the regenerative properties.
A
Hepaticyte
12
Q
Macrophages (active phagocytosis)
A
Kupffer cells
13
Q
Biochemical functions:
A
Excretory and Secretory
Synthetic function
Detoxification and drug metabolism
14
Q
Excretion of the endogenous and exogenous subs into the bile or urine such as the major product, Bilirubin.
A
Excretory and Secretory
15
Q
Bitter tasting, dark green to yellowish brown fluid, produced by the liver
A
Bile
16
Q
Principal elements in the bile
Derived from the breakdown of rbc
A
Bilirubin
17
Q
After 126 days, rbcs are phagocytized and will release hemoglobin. Then hemoglobin will breakdown into?
A
Iron
Heme
Globin
18
Q
Proteins involved
A
Transferrin
Ligandin
Albumin
19
Q
Conversion of B1-B2
A
Conjugated
20
Q
Orange colored product
A
Urobilin or stercobilin
21
Q
Remaining 20%
A
Enters systematic circulation
Absorbed by the extrahepatic circulation
22
Q
CHO Metabolism when ingested and absorbed?
A
- use the glucose for its own cellular energy requirement
- store glucose as glycogen
- circulate glucose for the use at the peripheral tissue
23
Q
Glucose to glycogen
A
Glycogenesis
24
Breakdown of glycogen to glucose
Degradation
Condition of stress or in fasting when there is increased requirement of glucose
Glycogenolysis
25
Glucose from non sugar carbon
Glucogenesis
26
In Lipid synthesis, liver is responsible for gathering fatty acids from the diet and those produce by the liver itself and breakdown to produce what?
Acetyl-CoA
27
Greatest source of cholesterol comes from what is produced by the liver. How many grams is produced by the liver?
1.5 to 2.0 g
28
Liver is also involve in the metabolism of fluid and other removal from the body through the use of what?
Lipoprotein and apoliprotein
29
In protein synthesis, all protein are synthesized by the liver except for?
Immunoglobulin and adult hemoglobin
30
One of the most important protein synthesized is the?
Albumin
31
Every subs absorb in the GIT must first pass in the liver and it is referred to as?
First pass
32
2 mechanisms if detoxification and drug metabolism
Detoxification of foreign material ( drug and poisons) and metabolic products( bilirubin and ammonia)
33
Responsible for the detoxification of drugs through, OXIDATION, REDUCTION, HYDROLYSIS, HYDROXYLATION, CARBOXYLATION, DEMETHYLATION
Drug metabolizing system
34
Yellow discoloration of skin, mucous membrane due to Bilirubin retention
Jaundice
35
Upper limit if normal total bilirubin
| Jaundice not noticeable to the naked eye
1.0 -1.5 mg/dL
36
Jaundice can be seen
3.0 mg/dL
37
Seen in acute and chronic hemolytic anemia
Rarely have more than 5 mg/dL because liver is capable of heading the overload
Unconjugated hyperbilirubinemia
⬆️ B1, NB2
Pre-hepatic hyperbilirubinemia
38
Not water soluble, bound to albumin, not filtered by the kidney therefore not seen in the urine. Only B1 produce
Unconjugated hyperbilirubinemia
39
Liver problem
Intrinsic liver defect or disease
⬆️B1 and B2
Hepatic Jaundice
40
Elevation of unconjugated bilirubin
| hepatic jaundice
Gilbert disease
Crigler-Nojjar syndrome
Physiological jaundice of newborn
41
Elevation of conjugated bilirubin
| Hepatic disease
Dubor-johnson
| Rotor-syndrome
42
Benign hereditary syndrome/autosomal recessive.
Most common cause of jaundice
No morbidity or mortality
Intermittent unconjugated hyperbilirubinemia
Most frequently diagnosed during adolescent or early adulthood
Gilbert's syndrome
43
Insertion of two bases into the promote region of the UGTA 1 gene resulting to lower enzymatic act.
Impared cellular uptake of the bilirubin
Gilbert's syndrome
44
Race, more serious disorder.
Chronic nonhemolytic unconjugated hyperbilirubinemia.
Inherited disorder of bilirubin metabolism resulting from moleculsr defect with the gene involved with bilirubin conjugation.
Crigler-Nojjar syndrome
45
Total absence of B2
Complete absence of enzymatic bilirubin conjugation.
(Crigler-Nojjar syndrome)
Type 1
46
Partial deficiency of UDPGT
Small amount of B2 is produced
( Crigler- Nojjar syndrome)
Type 2
47
Deficiency in the enzyme glucornyl transferase
Physiological jaundice of the newborn
48
Results in cell damage and death.
Kernicterus
49
Treatment for kernicetrus
UV radiation to destroy bilirubin as it passes the capillaries of skin.
50
A familial form of unconjugated hyperbilirubinemia caused by circulating inhibitor of conjugation.
Lucey-Driscoll syndrome
51
Rare in inherited disorder
Dubin-Johnson syndrome
52
Obstructive in nature
Dubin-Johnson Syndrome
53
Removal of conjugated bilirubin from the liver cell and the excretion into the bile are adoptive
Dubin-Johnson syndrome
54
Inc. bilirubin in blood and urine
Dubin-Johnson syndrome
55
Distinguishing feature of Dubin-Johnson syndrome
Dark stained granules (pigmented lysozyme) on a liver biopsy sample
56
Bilirubin tightly bound to albumin
Delta bilirubin
57
Normal values of delta bilirubin
<3 umol/L
58
Detect causing is unknown
Rotor syndrome
59
Less common than dubin-johnson
Rotor syndrome
60
Liver biopsy does not show dark pigmented granules
Rotor syndrome
61
Possibly virus-induced
Rotor syndrome
62
Biliary obstructive disease
Post-Hepatic jaundice
63
Since bile is not being brought to the intestines, stool loses its sources of normal pigmention
Post-Hepatic jaundice
64
Prevent the flow of conjugated bilirubin into the bile canaliculi
Post-Hepatic jaundice
65
Gallstones and tumor
Post-Hepatic jaundice
66
Aspartate Amino Transferase is also known as
Serum glutamic-oxoloacetic transaminase
67
Aspartate Amino Transferase is distributed mainly.
Heart, liver and skeletal muscle
68
Alanine amino transferase is also known as
Serum glutamic-pyruvic transaminase
69
Alanine Amino Transferase is found mainly in where?
Liver
70
Remained elevated for up to 2-6 weeks in almost all disease of the liver
Alanine Amino Transferase
71
Highest levels of alanine amino transferase are found in the acute conditions such as?
Viral hepa, drug and toxin-induced liver necrosis and hepatic ischemia.
72
Ability to differentiate hepatobiliary disease from osteogenic bone disease
Alkaline Phosphatase
73
Alkaline Phosphatase is seen in where? Which is elevated in Pager's disease.
seen in bone
74
Alkaline Phosphatase is released from which is elevated in pregnancy
Released from placenta
75
Alkaline Phosphatase is localized at the bile canaliculi and serves as a great marker of;
Hepatic biliary obstruction
Stone in common bile duct
Intrahepatic cholestasis
76
Primary biliary cirrhosis
Alkaline Phosphatase
77
Very high conc. cases of extrahepatic obstruction
Alkaline Phosphatase
78
Elevated in hepatobiliary disease
5'Nucleotidase
79
No bone source- useful in differentiating ALP elevation
5'Nucleotidase
80
More sensitive to metastatic liver disease
5'Nucleotidase
81
Sensitive test for cholestasis caused by chronic alcohol or drug ingestion
Gamma-Glutamyltransferase
82
Useful if jaundice is absent for the confirmation of hepatic neoplasm
Gamma-Glutamlytransferase
83
High levels may be found in metastatic carcinoma of the liver
Lactate-Dehydrogenase
84
Moderate elevation- acute viral hepatitis and cirrhosis
Lactate-Dehydrogenase
85
Reference interval for total protein determination
6.5-8.3 g/dL
86
Recumbent for protein determination
6.0-7.8 g/dL
87
Standard reference method for protein determination
Kjedahl Method
88
Not commonly performed method
Kjeldahl Method
89
Measures the nitrogen content
Kjeldahl Method
90
How many grams of protein if there is 1 gram of nitrogen
6.54 grams of protein
91
Most widely used method in protein determination
Biuret method
92
Cupric Ions complex the groups involved in the peptide bond forming a violet colored chelate which is proportional to the number of peptide bonds present and reflects the total protein level.
Biuret method
93
Migration of charged particles in an electric field.
Electrophoresis
94
The single most significant clinical application of serum protein electrophoresis is for the what?
Identification of monoclonal spikes of immunoglobulin and differentiating them from polyclonal hypergammaglobulinemia
95
Normal SPE pattern for the fastest band; 1st band
Albumin
96
Normal SPE pattern for the 2nd fastest band.
Alpha1-Globulin
97
Normal SPE pattern for increasing as a non-specific response to inflammation
Alpha 1-Globulin
98
Glycoproteins, AAT, AAG, thyroxine binding-globulin
Alpha 1-Globulin
99
Normal SPE pattern for 3 rd band visible.
Alpha 2-Globulin
100
Proteins involved in alpha 2-globulin
Haptoglobulin, AMG, ceruloplasmin
101
4th band in the normal SPE pattern.
Beta-globulin
102
Proteins involved in the beta-globulin
Transferrin, beta-lipoprotein, hemopexin, complement system (C3,c4)
103
Slowest band and 5th band in the normal SPE pattern
Gamma-Globulin
104
Protein involved in gamma-globulin
Immunoglobulin
105
Characteristic Abnormal SEP:
| Multiple myeloma
Gamma spike
106
Characteristic Abnormal SEP:
| Hepatic cirrhosis
Beta-gamma bridging
107
Characteristic Abnormal SEP:
| Nephrotic syndrome
A2-globulin band spike
108
Characteristic Abnormal SEP:
| Juvenile cirrhosis
A1- globulin flat curve
109
Characteristic Abnormal SEP:
| Inflammation
Spikes of a1, A2, and globulin bands
110
Presence of free hemoglobin will cause what and where?
Will cause blip in the late alpha2 and early beta zone region
111
Presence of small spikes in beta region is due to what?
Iron deficiency anemia (transferrin)
112
An alternative test to chemical analysis of serum total proteins
Refractometry
113
Measurement of refractive index due to salutes in serum
Refractometry
114
Turbidimetric and Nephlometric Method utilizes what?
Sulfosalicylic acid and trichloroacetic acid
115
Separation of globulin from albumin by salting out procedures using sodium salts
Salt fractionation
116
Salt used for analysis
Sodium sulfate
117
Dose administration methods
Rosenthal White
| Mac Donald Method
118
Dose for Rosenthal White
2 mg/kg body weight of the patient
119
Collection for Rosenthal white
After 5 minutes and after 30 minutes
120
Normal values for Rosenthal white
After 5 minutes-50% dye retention
| After 30 minutes- 0% dye retention
121
Dose for Mac Donald method
5 mg/kg body weight of the patient
122
Collection for Mac Donald Method
After 45 minutes
123
Normal values for Mac Donald Method
After 45 minutes - +/- 5% dye retention
124
The reaction of diazotized sulfanilamide acid with bilirubin is to form what, which forms the basis of quantitating the amount of bilirubin in biologic fluids
Azobilirubin
