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Biochemistry > Liver Function > Flashcards

Liver Function Flashcards

1
Q

3 functions of the liver

A
  1. Protein metabolism
    - proteins such as albumin and Igs synthesised
  2. Carbohydrate metabolism
    - glucose stored as glycogen
  3. Fat metabolism
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2
Q

Liver biosynthetic functions: albumin

A

Major plasma protein
T1/2 of 21 days
Key role in maintaining intravascular colloid osmotic pressure (pressure resulting from difference between ECF & plasma/interstitial fluid protein content) ie be able to hold water in blood vessels.
Decrease in albumin = decrease in on oncotic pressure (water leaves blood vessels & collects in tissues leading to oedema & swelling)
Fall in albumin => chronic liver disease

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3
Q

Liver biosynthetic functions: clotting factors

A

Prothrombin (factor II) (so increased bleeding risk in those with liver disease)

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4
Q

Name a sensitive marker for liver disease

A

International normalised ratio - measure of blood clotting time

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5
Q

Liver biosynthetic functions: give an example of a hormone binding protein that the liver produces

A

Ceruloplasmin

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6
Q

What causes ascites?

A

Scar tissue -> prevents free blood flow through liver -> blood backup in portal vein -> blocks lymph channels -> lymph spills into abdomen (peritoneal cavity)(also cased by low albumin)

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7
Q

Ascites can also be caused by low ________ levels.

A

Albumin

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8
Q

Constituents of bile

A

Bile salts
Water
Electrolytes
Cholesterol
Phospholipids
Bilirubin
Small amount of protein

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9
Q

Where are bile acid metabolites synthesised?

A

Synthesised in liver cells from cholesterol

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10
Q

Function of bile salts

A

Acts as a detergent - lipid solubilisation

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11
Q

Where is bile stored?

A

gallbladder

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12
Q

Most bile salts reaching ___ are re absorbed in terminal _____ & returns to ______ via ___________.

A

Gut
Ileum
Liver
Portal vein

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13
Q

Where does the majority of bilirubin come from?

A

Breakdown of Hb

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14
Q

Haem converted to _________ by oxygenation.

A

Biliverdin

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15
Q

Biliverdin is ______ to bilirubin.

A

Reduced

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16
Q

__________ bilirubin bound to albumin - transported to liver.

A

Unconjugated

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17
Q

Glucuronicated _________ secreted via AT, some secreted via gut. Most oxidised to ____________ and secreted in urine.

A

Bilirubin
Urobillinogen

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18
Q

What are the three types of jaundice?

A

Pre-hepatic (haemolytic)
Hepatic or Hepatocellular (intrahepatic cholestasis)
Post-hepatic or obstructive (extraheptic cholestasis)

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19
Q

Features of pre-hepatic jaundice

A

Fault upstream of conjugation
- excess haemolysis => increased bilirubin load
- fragile cells or immune attack

Unconjugated bilirubin increased
- liver unable to handle the increased bilirubin load

No bilirubin in urine

20
Q

Features of hepatic jaundice (hepatocellular jaundice)

A

Failure of conjugating system
Results from disease/damage to the liver such as cirrhosis or hepatitis
Both conjugated and/or Unconjugated bilirubin can be increased

21
Q

Features of post-hepatic jaundice (cholestatic jaundice)

A

Obstruction to flow of bilirubin from liver
Mainly increased conjugated bilirubin
Faeces are pale
Urine is dark
Gallstones
Cancer of pancreas

22
Q

Causes of liver injury

A

Infection
Drugs
Toxins
Tumours
AIDs

23
Q

Classification liver damage by site:

A

Hepatocellular disease
Cholestatic disease

24
Q

Features of hepatocellular disease

A

Direct damage to liver cells
Causes include:
- alcohol
- hepatitis
- toxins e.g. NSAIDs

25
Q

Features of cholestatic liver disease

A

Caused by obstruction:
- within the liver (intrahepatic) => impairment of bile formation in liver or obstruction of small bile ducts within the liver e.g. drugs
- outisde the liver (extrahepatic) => obstruction in bile duct e.g. gallstones

Bile salts, bilirubin and lipids accumulate in the blood stream

26
Q

What is NAFLD?

A

Non-alcoholic Fatty Liver Disease => increased fat in liver

27
Q

What is cirrhosis?

A

Chronic disease
Fibrosis
Liver failure

28
Q

Explain the Indocyanine green-clearance test

A

After IV injection -> binds to plasma proteins -> rapidly uptaken by liver; excreted in the bile ~ 8 min after injection

29
Q

What does AST stand for?

A

Aspartate aminotrasnferase

30
Q

What does ALT stand for?

A

Alanine aminostransferase

31
Q

What does ALP stand for?

A

Alkaline phosphatase

32
Q

What does GGT stand for?

A

Gamma Glutamyl transpeptidase

33
Q

What are high levels of ALT and AST indicative of?

A

Hepatocellular disease

34
Q

ALT is more specific to the ________ than AST.

A

Liver

35
Q

___ also present in muscle and red blood cells.

A

AST

36
Q

Sources of ALP

A

Liver
Bones
Intestine
Placenta

37
Q

ALP when associated with ___ suggests liver origin.

A

GGT

38
Q

Increased ALP is indicative of

A

Cholestasis

But also rises in hepatocellular injury

39
Q

Enzyme produced in the bile ducts

A

GGT

40
Q

Sensitive indicator of liver disease

A

GGT

41
Q

Raised in any liver disease

A

GGT

42
Q

Features of ammonia

A

Elevated in severe acute or chronic liver disease
Due to impaired breakdown of nitrogenous waste
Elevated levels cause lethargy and confusion

43
Q

LFT in hepatocellular injury

A

⬆️⬆️ AST
⬆️⬆️⬆️ALT
ALP normal or ⬆️
Bilirubin normal or ⬆️⬆️
Serum albumin normal

44
Q

LFTin cholestatic liver disease

A

ALP ⬆️⬆️⬆️
GGT ⬆️⬆️⬆️
AST normal or ⬆️
ALT normal or ⬆️
Bilirubin ⬆️⬆️*

*may be normal if cholestasis is very localised

45
Q

LFT in chronic liver disease (cirrhosis)

A

⬇️ Albumin
⬆️ INR
⬆️Bilirubin
⬆️⬆️ AST

Biochemistry (19 decks)

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