Liver Biochemistry and Jaundice Flashcards
What is the liver enclosed in?
Capsule covered by visceral peritoneum
What does the falciform ligament do?
Divides the left lobe and the larger right lobe
What is a hepatic lobule?
A smaller hexagonal division of lobes
What does a hepatic lobule consist of?
Portal triad
Hepatocytes in linear cords
Capillary network and central vein
Lymphatics and vagus nerve
What is the functional unit of the hepatic lobule?
Liver acinus
What are sinusoids?
Capillaries with fenestrated epithelium that carry blood towards to central vein
What is the space of Disse?
The part of the liver between a hepatocyte and a sinusoid
What carbohydrate metabolism does the liver do?
Anabolism and catabolic of sugars
What fat metabolism does the liver do?
Break down and synthesis
Processing chylomicron remnants
Lipoprotein and cholesterol synthesis
What protein metabolism does the liver do?
Synthesis of proteins like albumin
Transamination and deamination of amino acids
Conversion of ammonia to urea
What hormones does the liver deactivate?
Insulin
Glucagon
ADH
Steroid hormones
What molecules does the liver store?
Vit B12 Vit A, D, E, K (fat-soluble) Iron Copper Glycogen
What is drug metabolism?
The breakdown of drugs to facilitate excretion
What happens in phase 1 of drug metabolism?
The polarity of the drug is increased by oxidation, reduction or hydrolysis in order to permit conjugation
What molecule plays a big role in phase 1 of drug metabolism?
Cytochrome P450
What happens in phase 2 of drug metabolism?
Polarity is further increased by adding a reactive group to the drug to result in an inactive product which can be excreted
Which blood tests are included in LFTs?
AST ALT ALP GGT Bilirubin Albumin Prothrombin time
Which are the ‘true’ LFTs and what does that mean?
Bilirubin
Albumin
PT
Ones involved in the synthesis of proteins that give a measure of whether the liver is making stuff
Which structures is ALT present in?
Liver
What increases the levels of ALT?
Hepatocellular injury
Which structures is AST present in?
Liver Heart Skeletal muscle Kidneys Brain RBC
What increases the levels of AST?
Liver injury MI Pancreatitis Haemolytic anaemia Renal or MSK disease
What does a higher level of AST than ALT indicate?
Muscle injury
What is AST a marker of?
How acute hepatocellular damage is
What is ALT a marker of?
Hepatocellular injury
Which structures is ALP present in?
Liver
Bile duct
Bone
Placenta
What alters the level of ALP?
Biliary obstruction Liver disease Bone pathology Thyroid abnormality Pregnancy
What is ALP a marker of?
Cholestasis
Which structures is GGT present in?
Liver Bile ducts Kidney Pancreas Gallbladder Spleen Heart Brain