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Pathophysiology > Liver > Flashcards

Liver Flashcards

1
Q

What are the 5 functions of the liver?

A
  • Detoxification and drug metabolism
  • Lipid and carb metabolism
  • Protein synthesis
  • Synthesis and excretion of bile acids
  • Conjugation and excretion of bilirubin
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2
Q

Describe detoxification and drug metabolism

A

-Clears blood of toxins and metabolic wastes (bilirubin and ammonia) and hormones (estrogen/sex hormones)

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3
Q

What are the 2 places that waste goes?

A
  • In bile (bilirubin)

- Converts toxic chemical to nontoxic chemical (ammonia to urea)

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4
Q

Describe lipid and carbohydrate metabolism

A

-Converts glucose into glycogen for energy storage and reconverts it to glucose if needed

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5
Q

The liver synthesizes ______ and ______

A

-Triglycerides and cholesterol

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6
Q

The liver also burns fat. This is the byproduct

A

Ketones/ketoacids

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7
Q

What are examples of proteins that are made by the liver

A
  • Albumin
  • Clotting factors
  • Transport proteins
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8
Q

T/F- The liver excretes bilirubin into bile

A

True

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9
Q

What is added to secrete bilirubin into bile?

A

Glucuronide

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10
Q

What do intestinal bacteria convert bilirubin into?

A

Bilirubin –> Urobilinogen (this makes poop look brown)

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11
Q

What is the main constituent of bile

A

Bile acids

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12
Q

What is used to make bile acids

A

Cholesterol

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13
Q

What do bile acids do?

A

-Allow ingested fats to become water soluble and allow pancreatic lipase to act

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14
Q

How are bile acids reabsorbed?

A

Enterohepatic circulation

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15
Q

_______ refers to excretion of bile acids (made from cholesterol) from the liver into the intestine and the reabsorption of most of the bile acids (and their cholesterol) by the intestine for recirculation through the portal system and reuse by the liver.

A

Enterohepatic circulation

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16
Q

Where does most absorbed cholesterol come from?

A

Cholesterol absorbed by the intestine from reabsorbed bile acids- not dietary cholesterol

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17
Q

Liver complications include toxic accumulations such as…

A
  • Toxic accumulations (ammonia, bilirubin, drugs, hormones)
  • Bleeding (lack of coagulation factors)
  • Edema (deficiency in plasma albumin)
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18
Q

Generalized edema=

A

anasarca

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19
Q

abdominal edema=

A

ascites

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20
Q

A deficiency in bile acids causes…

A
  • Failure to absorb intestinal fat

- Failure to absorb fat-soluble vitamins

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21
Q

What causes jaundice?

A
  • Increase levels of bilirubin in the blood

- May be conjugated or unconjugated

22
Q

What are the main causes of hepatitis?

A
  • Viral infection

- Autoimmune

23
Q

What are 2 types of degeneration?

A

Hydropic or fatty

24
Q

Is degeneration reversible?

A

-YES!

25
Q

What causes hydropic deneration?

A

-Too much water

26
Q

What causes fatty degeneration?

A

Fat (seen in alcohol excess)

27
Q

Hepatitis and chronic alcohol abuse can kill cells _____ at a time

A

One at a time- infarcts are rare

28
Q

This is when the flow of bile stops or slows

A

Cholestasis

29
Q

What does cholestasis lead to?

A

-Accumulation of bile acids and cholesterol in the blood

30
Q

This is loss of hepatic metabolic function

A

Hepatic failure

31
Q

Describe unconjugated bilirubin

A
  • Not water soluble

- tightly bound to albumin for transport to the liver

32
Q

In the liver, bilirubin is joined (conjugated) with _______

A

glucuronine

33
Q

What does the joining of glucuronine do?

A

-Makes water soluble conjugated bilirubin

34
Q

This is a superimposed acute renal failure

A

Hepatorenal syndrome

35
Q

Describe hepatorenal syndrome

A

-Related to decreased renal blood flow
-Decreased filtering and kidney excretion
(the kidney cells are structurally normal and can return to normal function with a liver transplant)

36
Q

_______ occurs with increasing levels of ammonia in the blood

A

Hepatic encephalopathy

37
Q

What are the 4 stages of hepatic encephalopathy

A
  1. Irritability and personality changes
  2. Lethargy and disorientation
  3. Deep sleep
  4. Coma
38
Q

What is a DISTINCT clinical sign of hepatic encephalopathy

A
  • Asterixis

- Flapping tremor in the upper extremities (hepatic flap)

39
Q

What are the 3 types of jaundice?

A
  1. Prehepatic
  2. Hepatic
  3. Post hepatic
40
Q

Describe prehepatic jaundice

A

-Increased levels of UNCONJUGATED bilirubin in the blood

41
Q

What causes preheptic jaundice

A

-Hemolytic anemia
-Sickle cell disease
(bc it increases production of unconjugated bilirubin)

42
Q

This is caused by interference with the livers ABILITY TO CONJUGATE bilirubin or to SECRETE it after conjugation

A

Hepatic Jaundice

43
Q

Are increased levels of blood bilirubin due to conjugated or unconjugated bilirubin in hepatic jaundice?

A

Either one

44
Q

This is caused by the obstruction of bile flow inside or outside the liver

A

Posthepatic jaundice

45
Q

IN posthepatic jaundice, are increased levels of blood bilirubin conjugated or unconjugated?

A

Conjugated

46
Q

What is the most common cause of unconjugated bilirubinemia?

A

Gilbert syndrome

47
Q

This is a modest elevation in serum bilirubin because of a genetic deficiency of uridine diphsophate glucuronyl transferase

A

Gilbert Syndrome

48
Q

What is uridine diphosphate glucuronyl transferase

A

An enxyme in the metabolic pathway

  • about 7% of the population is affected
  • Men more than women
49
Q

These 3 enzymes spill from damaged hepatocytes

A
  • LDH
  • AST
  • ALT
50
Q

DIRECT Bilirubin levels measure the _________ bilirubin

A

Conjugated bilirubin

51
Q

INDIRECT Bilirubin levels measure the _________ bilirubin

A

Indirect= total- direct and it represents UNCONJUGATED plus all bound bilirubin

52
Q

What are the TRUE liver function tests

A

-Albumin
-PT
-PTT
(because clotting factors are liver proteins)

Pathophysiology (18 decks)

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