Liver Flashcards
hepatocytes
- mjr functional cells of the liver that perform metabolic, secretory, and endocrine functions
Kupffer cells
- make up 80-90% of bodys macrophages
- line the sinusoids
- produce cytokines
- remove toxins and drugs
- destroy worn RBC and WBCs
what does the liver do : 8
- carb metabolism
- protein metabolism
- synthesis of clotting factors
- lipid metabolism
- bile production
- filtration of old RBCs
- storage of vitamins and minerals
- detox, bacteria removal, and cell cleanup
glycogenisis
genisis- making glucose
converts glucose to glycogen for storage
glycogenolysis
lysis- breaking (convert)
convert stored glycogen back into glucose for use in the body
gluconeogenisis
neogenisis- convert one thing into another
if no glucose is avail and glycogen stores are used up, the liver can convert non-carb things like amino acids into energy
protein metabolism and synthesis for clotting factors
AA uses old RBCs to form ammonia, then converts it to urea for excretion
- converts some AA’s to glucose or lipids
- plasma protein formation
albumin, globulins (immune) - synthesis for clotting factors
how do we treat a PT with decreased clotting factors
FFP and platelets
**Total Bili
unconjugated bilirubin
conjugated bilirubin
- total = conj and unconj circulating in blood
- uncoj is a waste product of Hgb breakdown (kuppfer cells) that is lipid soluble, then carried by albumin to the liver where hepatcytes conjugated it and make it water soluble and send it to the gall bladder to dispose in the digestive tract
- unconj high = impaired liver function or increased RBC breakdown
- Conj high = functioning liver but blocked hepatic ducts
liver storage
vit A, D, E, K, B12
iron copper
sinusoids can hold blood to be shunted in to circulation when needed
detox
kupffer cells remove drugs, toxin, lactate clearance
convert ammonia to water-sol urea excreted in kidneys (ammonia created in gut)
- lactulose binds to ammonia
effects of the liver
- decreased LOC
- bleeding
- edema, ascites, leaking wounds
- jaundice
- infection (not able to detox/bacteria)
AST
aspartate aminotransferase- liver, heart, skeletal muscles
- low specificity for the liver
ALT
Alanine Aminotransferase
- Most ALT elevations are caused by liver damage
- produced primarily in the liver
- high specificity for the liver
AST and ALT
both will go up in recent injury but must be correlated with PT hx/condition
- decreasing AST/ALT might not mean that the liver is getting better. It could be that it is worse and progressed to the point where there is few working hepatocytes
albumin
1/2 life 20 days
- good indication of chronic injury
PTT/INR
both sensitive indicators of liver dysfunction
* liver synthesis clotting factors*
- bleeding / delayed clotting is a good indicator of acute and chronic liver disease
- if these are going up but not on drugs, then liver dysfunction
GGT***
gammaglutamyl transferase
- transfer of AA across cell membrane
- most concentrated in biliary ducts (cholestsis)
- sensitive but NOT specific indicator to hepatobiliary disease
- does not elevate in bone disease
ALK PHOS***
Alkaline Phosphatase
- enz found in many tissues, mostly bones and liver
- more specific to bone disease
- If GGT and ALK PHOS both elevated = liver
- If ALK PHOS up and GGT normal = most likely bone related
refeeding syndrome
can occure 12-72 hrs after start feed to 2-7 days
- body uses glucogen stores, glyconeogenisis used all the fat, AA, protein and now body down regulates mechanisms that normally maintain cell integrity. Lose cell integrity into plasma K, Mg, Ca, PO4
- the increased concentration in plasma makes kidneys get rid of them to maintain acid/base balance, causing whole body depletion
what happens with refeed
insulin secretion from new glucose pulls the K and PO4 into cells. Then Ca and Mg move into cells to restore cell integrity, depleting serum concentration
- fast drop can cause dysrhythmias, muscle weakness and fluid retention
what is the hallmark signs to watch for in refeeding?
- hypoPHO4
- hypoMg
- HypoK
- fluid overload
- vit deficiency (B1, thiamine)
- these can lead to cardiac, resp and neuromuscular consequences
