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MLT 203 > Liver Function > Flashcards

Liver Function Flashcards

1
Q

location of the liver

A

upper right quadrant, beneath diaphragm

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2
Q

largest internal organ, able to regenerate

A

the liver

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3
Q

blood supply to the liver

A

portal vein

hepatic artery

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4
Q

brings blood from the intenstines

A

portal vein

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5
Q

brings blood to liver from the heart

A

hepatic artery

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6
Q

where is bile stored?

A

gallbladder

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7
Q

_____mL of blood to liver per minute

A

1500 mL

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8
Q

what are lobules?

A

small, six sided structures. Central vein with portal triads at each corner. Functional unit of the liver

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9
Q

Portal triad contains:

A

hepatic artery
portal vein
bile ducts

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10
Q

cells of the liver

A

Kuplfer cells

hepatic cells

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11
Q

macrophages of the liver, clean up waste

A

Kuplfer cells

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12
Q

Cuboidal cells, most abundant cell in liver

A

Hepatic cells

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13
Q

70% of volume of liver
regenerative
perform major functions (nutrient uptake, liver output)
waste dumping

A

Hepatocytes

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14
Q

what the liver excretes

A

bile acids, cholesterol, bilirubin

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15
Q

metabolic functions of liver

A

carbohydrates, lipids, amino acids, proteins, hormones, bilirubin

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16
Q

internal toxins

A

NH3, bilirubin

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17
Q

external toxins

A

drugs, poisons, alcohol

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18
Q

hematology function of the liver

A

blood production in fetus, coagulation proteins

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19
Q

only organ with capacity to rid body of heme waste

A

liver

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20
Q

bile is composed of

A

bile salts/acids, bile pigments, cholesterol, heme waste products

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21
Q

bild production/excretion rates

A

3L produced/day

1L excreted/day

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22
Q

bile functions

A

bile acids needed for fat absorption

mechanism to remove cholesterol

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23
Q

principal pigment in bile

A

Bilirubin

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24
Q

hemoglobin in broken down into

A

heme
globin
iron

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25
Q

converted to bilirubin in 2-3 hours

A

Heme

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26
Q

broken into amino acids and recycled

A

globin

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27
Q

bound by transferrin and returned to ___ stores in the liver or bone marrow

A

Iron

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28
Q

unconjugated/indirect bilirubin

A

bilirubin bound by albumin and taken to liver

water-insoluble

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29
Q

metabolism of bilirubin

A
  • unconjugaed bili flows into sinusoidal tissue, albumin releases it
  • ligandin picks up unconjugated bili and presents it to hepatocytes
  • in liver, bili is conjugated with help of UDP.
  • conjugated bilirubin is converted to urobilinogen by bacteria
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30
Q

conjugated bilirubin

A

water-soluble

combines with gallbladder secretions and expelled into intestines

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31
Q

80% of urobolinogen

A

oxidized to urobilin and excreted in feces (why stool is brown)

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32
Q

20% of urobolinogen

A

absorbed by extrahepatic circulation and recycled

filtered by kidneys and excreted in urine

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33
Q

______mg of bilirubin produced/day

A

200-300 mg

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34
Q

3 fractions of Bilirubin

A
  • unconjugated/indirect
  • conjugated/direct
  • Delta/Conjugated bilirubin bound to protein
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35
Q

syntheis of carbohydrates in liver

A
  • uses glucose for energy
  • stores glucose as glycogen
  • maintains stable glucose concentration due to glycogenesis, gluconeogenesis, glycogenolysis
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36
Q

synthesis of lipids in liver

A
  • free fatty acids broken down to Acetly-CoA
  • converts insoluble lipids to soluble
  • 70% cholesterol
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37
Q

synthesis of proteins in liver

A
  • most proteins are made in liver
  • large functional reserve
  • loss of plasma proteins causes edema
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38
Q

mechanisms of detoxification

A
  • binds material to inactivate compound

- chemically modify compound for excretion

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39
Q

yellow discoloration of the skin, eyes, mucous membranes

A

jaundice/icterus

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40
Q

bilirubin level in jaundice

A

> 3.0 mg/dL

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41
Q
  • increased unconjugated bilirubin
  • yellow staining of meninges of brain
  • found in newborns
A

Kernicterus

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42
Q

Classes of Jaundice

A
  • prehepatic
  • hepatic
  • posthepatic
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43
Q

abnormality outside liver, caused by increased bilirubin presented to liver due to increased RBC destruction or hemolysis .

A

prehepatic jaundice

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44
Q

result of prehepatic jaundice

A

increased total and unconjugated bilirubin

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45
Q

disease states of prehepatic jaundice

A
  • hemolytic anemia
  • chemical exposure
  • congestive heart failure
  • transfusion reaction
  • hemolytic disease of Newborn
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46
Q

intrinsic liver disease or defect caused by; disordered bilirubin conjugation, bilirubin transport, hepatocellular injury

A

hepatic jaundice

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47
Q

result of hepatic jaundice

A

increased total/con. Bilirubin

-AST/ALT may also be increased

48
Q

disease states of hepatic jaundice

A
  • genetics
  • hepatitis
  • alcoholism
  • infection
  • neonatal physiologic jaundice
  • cirrhosis
  • carcinomas
  • toxins
49
Q

genetic mutation of enzyme for bilirubin metabolism.

decreased bilirubin transport

A

Gilbert syndrome

50
Q

-defective UDPG-transferase
type 1: complete absence
type 2: mutation
(unconjugated hyperbilirubinemia)

A

Crigler-Najjar syndrome

51
Q

bilirubin removal from hepatocyte defective, liver function is normal

A

Dublin-Johnson disease

52
Q

Benign condition, decreased bilirubin carrier proteins

conjugated hyperbilirubinemia

A

Rotor’s Syndrome

53
Q

Jaundice of Newborn cause

A

UDPG deficiency

54
Q

Jaundice of newborn ungonjugated bilirubin levels

A

> 20mg/dl (very dangerous)

liver is normal until 3rd day of life

55
Q

Jaundice of Newborn treatment

A

UV light/Bilirubin lamp

56
Q

Jaundice caused by biliary obstruction, stool turns clay-colored, liver function is normal

A

Posthepatic Jaundice

57
Q

Lab results of posthepatic jaundice

A
  • increased total/conj. Bili
  • increased urinary bilirubin
  • increased ALP, GGT
  • Decreased urine/fecal urobolinogen
58
Q

scar tissue replaces normal healthy liver tissue, and blocks flow of blood to liver

A

Cirrhosis

59
Q

causes of cirrhosis

A

alcoholism

hepatitis

60
Q

lab results of cirrhosis

A

increased un/conj. bilirubin, ALP, GGT, AST, ALT, Prothrombonin time.
decreased cholesterol, albumin

61
Q

any baby born before ____ will become Jaundiced

A

36 weeks

62
Q

often preceeded by viral syndrome, associated with ingestion of Asprin

A

Reye Syndrome

63
Q

reye syndrome symptoms

A
  • profuse vomiting/diarrhea
  • neurological impairment
  • encephalopathy and fatty degredation
64
Q

lab results of Reye Syndrome

A

increased ammonia, AST, ALT, slight increase in Bilirubin

65
Q

common drugs that damage hepatocytes

A
  • ethanol

- acetaminophen

66
Q

mildest form of alcoholic injury. Slight elevation in AST, ALT, GGT. Complete recovery possible

A

Alcoholic fatty liver

67
Q

Moderate elevations of AST, ALT, GGT, ALP.
Bili >5.0mg/dl
Decreased albumin
PT prolonged

A

Alcoholic hepatitis

68
Q

Marked elevation AST, ALT, GGT, ALP, Bilirubin
decreased albumin
PT prolonged

A

Alcoholic cirrhosis

69
Q

DeRitis Ratio

determining cause of liver disease

A

AST/ALT

70
Q

normal DeRitis ratio

A

0.7-1.4

71
Q

DeRitis >2.0

A

Indicative of alcoholism or alcoholic hepatitis

72
Q

DeRitis <1.0

A

Viral hepatitis, acute inflammatory disease, obstructive liver (ALT>AST)

73
Q

Inflammation of the liver, caused by viruses, bacteria, drugs, radiation, and other chemical exposure

A

Hepatitis

74
Q

clinical symptoms of hepatitis

A

Jaundice, dark urine, fatigue, nausea, abdominal pain

75
Q

lab results for hepatitis

A

increased AST< ALT< GGT, Bilirubin

-positive serological markers

76
Q

hep A transmission

A

fecal-oral

77
Q

hep A incubation

A

3-4 weeks

78
Q

non chronic hepatitis

A

Hep A hep E

79
Q

hep B incubation

A

8-26 week s

80
Q

hep B transmission

A

parenteral, sexual

81
Q

hep C incubation

A

2-15 weeks

82
Q

hep C transmission

A

parenteral, sexual

83
Q

hep D incubation

A

21-90 days

84
Q

hep D transmission

A

parenteral, sexual

85
Q

hep E incubation

A

3-6 weeks

86
Q

hep E transmission

A

fecal-oral

87
Q

bilirubin total ref range (Adults)

A

0.2-1.0 mg/dl

88
Q

Infant total bilirubin

A

2-6 mg/dl

89
Q

Peak infant bilirubin

A

48 hours, 6-7 mg/dl

90
Q

bilirubin specimen

A

serum/plasma
-fasting
no hemolysis, no lipemia

91
Q

Bilirubin storage

A

light sensitive. light will falsely decrease results

92
Q

elrich test specimen for bilirubin

A

urine

93
Q

Van de Bergh bilirubin testing

A

serum could be tested with accelerator. DIAZO REACTION

94
Q

Malloy and Evelyn bilirubin testing

A

Serum , Diazo reaction with 50% methanol

95
Q

Jendrassik and Grof bilirubin testing

A

Diazo reaction with caffeine-benzoate-acetate as accelerator. increased sensitivity

96
Q

measures total and conjugated bilirubin with 2 aliquotes of serum

A

Jendrassik-Grof

97
Q

Jendrassik-Grof principle

A

bilirubin pigments react with diazo reagent and produced azobilirubin (purple). Caffeine accelerates, ascorbic acid stops reaction, tartrate converts purple to blue. Measured at 600 nm

98
Q

formula for indirect bilirubin

A

indirect= total - direct

99
Q

end product of bilirubin metabolism

A

urobilinogen

100
Q

increased urobilinogen

A

hemolytic disease, defective liver-cell function

101
Q

decreased urbilinogen

A

biliary obstruction, carcinoma

102
Q

prehepatic jaundice (hemolytic) conjugated/unconjugated bili

A

normal conjugated, increased unconjugated

103
Q

prehepatic jaundice urine results

A

negative bilirubin, increased urobilinogen

104
Q

hepatic jaundice con/uncon bilirubin

A

increased conjugated, increased unconjugated

105
Q

hepatic jaundice urine results

A

positive bilirubin, normal/increased urobilinogen

106
Q

posthepatic jaundice conjugated/unconjugated

A

increased conjugated, normal unconjugated

107
Q

posthepatic jaundice urine results

A

positive bilirubin, decreased urobilinogen

108
Q

liver function tests

A

albumin, total protein, bilirubin (direct/total), AST, ALT, ALP

109
Q

prethrombin time

A

increased in liver disease

110
Q

ammonia

A

elevated in liver disease, hepatic coma

111
Q

glucose/galactose tolerance

A

asses liver’s ability to metabolize carbohydrates

112
Q

liver enzymes in alcoholic hepatitis (elevated)

A

AST

113
Q

decreased liver enzymes in alcoholic hepatitis

A

albumin

114
Q

viral hepatitis increased liver results

A

AST, ALT, ALP, GGT

115
Q

increased enzymes in biliary obstruction

A

ALP, GGT

MLT 203 (10 decks)

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