Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MLT 203, Fall 2023 > Liver Function > Flashcards

Liver Function Flashcards

1
Q

Where is the liver located?

A

beneath and attached to the diaphragm and is protected by the lower rib cage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The liver is composed of how many lobes?

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Left and Right lobes are the largest and are separated by the ________ __________

A

falciform ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The right lobe is about 5 to 6 times ______ than the left lobe

A

larger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

small lobe that extends from the posterior side of the right lobe and wraps around the inferior vena cava

A

Caudate lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

small lobe that is inferior to the caudate lobe and extends from the posterior side of the right lobe and warps around the gallbladder

A

quadrate lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A branch of the aorta and supplies nutrient rich arterial blood, 25% of blood supply

A

hepatic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

it brings nutrient rich blood (collected as food is digested) to the liver from the gastrointestinal tracts, 75% of blood supply

A

portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The hepatic artery and the portal vein merge into the ______ ______

A

hepatic sinusoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The sinusoid is lined with ______ that remove toxic substances from the blood

A

hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

After leaving the sinusoid the blood flows into the _______ _______ of each lobule, then through a collecting system of veins and empties into the _______ veins and finally the ______ _______ _______

A

central canal

hepatic

inferior vena cava

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hepatic veins and the vena cava return what to the heart

A

processed/cleaned blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where does the excretory system begin?

A

bile canaliculi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are small spaces between the hepatocytes that form intrahepatic ducts called?

A

bile canaliculi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The intrahepatic ducts join to form the what?

A

The left and right hepatic ducts which allow the filtered waste and toxic products from the cells to drain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is the common bile duct formed?

A

The left and right hepatic ducts merge into the common hepatic duct and join the cystic duct of the gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The combined waste and digestive secretions are then passed into the _________

A

duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the functional unit of the liver?

A

lobules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are responsible for all of the metabolic and excretory functions

A

Lobules

small hexagonal shaped functional units

approx 100,000 total

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Each lobule consists of what?

A

a central vein surrounded by 6 hepatic portal veins, 6 hepatic arteries, and 6 bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In each corner of the lobule is a ______ _______ composed of a portal vein, hepatic artery and bile duct surrounded by connective tissue

A

portal triad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

The blood vessels are connected by capillary-like tubes called ______ which extend from the portal veins and arteries to meet the _____ ______

A

sinusoids

central vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the two cell types in the liver lobules

A

Kupffer cells

hepatocyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

tissue macrophages that line the sinusoids and capture and break down old or damaged red blood cells, bacteria, toxins, and debris passing through the sinusoids

A

Kupffer cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

cuboidal shaped epithelial cells that radiate out from the central vein to the periphery of the lobule, they perform most of the livers functions (metabolism, storage, digestion, and bile production)

A

hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which cell type has a high regenerative ability?

A

hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which cell type makes up 80% of the liver’s mass?

A

hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is made up of bile salts, bilirubin, cholesterol, and other waste products removed from the blood?

A

Bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Excretion and secretion of the liver

A

removal of exogenous and endogenous waste products into the bile or urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

After approx. ______ days RBCS are phagocytized and hemoglobin is released

A

126

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Hemoglobin is degraded into (3)

A

heme
globin
iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is bound to transferrin and returned to the liver and bone marrow stores?

A

Iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is degraded to amino acids to be reused?

A

Globin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is converted into bilirubin and transported to the liver by albumin?

A

Heme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Form of bilirubin that is bound to albumin and transported to the liver, insoluble in water, and must be removed from the body.

A

Unconjugated/indirect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Bilirubin that has glucuronic acid attached, is soluble in water and can be excreted into the bile and travels to the small intestine where it is converted to urobilinogen

A

Conjugated/direct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Liver metabolizes (3)

A

carbohydrates

lipids

proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Forms glycogen from excess glucose through ______ for storage

A

glycogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

During stress or fasting conditions the liver can break down ______ to use for energy

A

glycogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Brief fast (<1day)

A

glycogenolysis

breakdown of stored glycogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Long fast (>1day)

A

gluconeogenesis

use of non-sugar carbon substrates to create glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

The liver gathers and stores lipids as ______ ________

A

fatty acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Fatty acids can be converted into ______ to make ________, _________, __________, and __________

A

acetyl-coA

phospholipids
cholesterol
vitamins
triglycerides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

70% of the body’s daily lipid (_________) requirements is made by the liver (___________), 30% is ingested (_________)

A

cholesterol

endogenous

exogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

The liver produces almost all proteins in circulation except

A

hemoglobin and immunoglobulins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

The liver serves as a ______ _______ for free amino acids from protein degradtion.

A

storage pool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

uses transaminases to exchange an amino group on one acid with a ketone on another

A

transamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

after transamination, degrades the acids to produce ammonium ions that are consumed in the synthesis of urea and then urea is excreted in the urine

A

deamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Will not see a decrease in protein synthesis until approx. _____ of the liver is damaged

A

2/3

50
Q

What is the degradation/alteration of a substance taken by mouth, after absorption, by removing some of the active substrate from the blood before it enters the body’s circulation?

A

First pass metabolism

51
Q

What are 2 methods for the detox of metabolic waste (ammonia, bilirubin) or foreign substances (drugs or poisons)

A

binding

modifications

52
Q

The material can be reversibly bound to inactivate the compound

A

binding

53
Q

The material may be chemically modified so it can be excreted

A

Modifications

54
Q

A yellow discoloration of the eyes, skin, mucus membranes due to the retention of bilirubin

A

Jaundice (Icterus)

55
Q

Why is jaundice commonly seen in infants?

A

because of the increased destruction of RBCs with fetal hemoglobin

56
Q

The three classifications of jaundice

A

Prehepatic

Hepatic

Posthepatic

57
Q

Prehepatic

A

Problem prior to the liver

Usually due to an increased amount of bilirubin being presented to the liver for processing (ex. hemolytic anemia)

Will see elevated levels of unconjugated bilirubin

58
Q

Hepatic

A

Problem in the liver

Due to a genetic defect or disease that effects bilirubin metabolism or transport

Can also be caused by cirrhosis, carcinoma, or hepatitis

will see elevated total bilirubin (conjugated and unconjugated will depend on the disease involved)

59
Q

Posthepatic

A

Problem after the liver

Usually due to a physical obstruction in the biliary ducts (ex. gallstones, tumors)

Will see elevated conjugated and unconjugated bilirubin

60
Q

An autosomal recessive disorder that affects approx. 5% of the population.

It is a result of the genetic mutation in the gene for the enzyme UGT1A1 (one of the enzymes important for bilirubin metabolism)

A

Gilbert’s disease

Generally, has no adverse clinical consequences. Most commonly diagnosed after puberty, when alterations in sex hormone levels cause the blood bilirubin levels to rise.

Liver enzymes will be normal (the livers conjugation system is working at about 30% of normal)

61
Q

More severe form of Gilbert’s disease.

A

Crigler-Najjar Syndrome

Can be divided into two types, type 1 and type 2.

62
Q

What type of Crigler-Najjar syndrome is more severe?

A

Type 1

There is a complete absence of bilirubin conjugation and affected individuals can die in childhood due to kernicterus

63
Q

Type 2 Crigler-Najjar

A

Causes a major deficiency in the enzyme that conjugates bilirubin

Most affected individuals survive into adulthood.

64
Q

A rare autosomal recessive condition caused by a deficiency in the protein required to remove conjugated bilirubin from the liver cells and excrete it into the bile

A

Dubin-Johnson Syndrome

65
Q

How is Dubin-Johnson Syndrome characterizied?

A

Conjugated hyperbilirubinemia with normal liver enzymes and the deposition of a pigment that gives the liver a characteristic black color.

Patients have a normal life expectancy and no treatment is necessary.

66
Q

Similar to Dubin-Johnson syndrome but the defect causing the syndrome is unknown.

A

Rotor syndrome

It is suspected to be caused by a deficiency in the intracellular binding proteins

Will see elevated levels of conjugated bilirubin, but no dark pigment in the liver.

Good prognosis and no treatment is needed.

67
Q

Jaundice in newborns results in the deficiency of what enzyme?

A

Uridine Diphosphate glucuronosyltransferase (UDPGT)

*Responsible for bilirubin conjugation

68
Q

What is the term for bilirubin build up in the brain

A

Kernicterus

69
Q

How is jaundice in newborns treated?

A

UV light to destroy bilirubin as it passes through the capillaries in the skin

Severe cases may require an exchange transfusion
(levels greater than 20 mg/dL)

70
Q

Scarring of the liver tissue that eventually blocks the blood flow to certain portions of the liver and prevents it from functioning properly

A

Cirrhosis

71
Q

Causes of Cirrhosis (6)

A

Chronic drug and alcohol abuse
Hepatitis (B, C, and D)
inherited disorders (alpha1-antitrypsin deficiency, Wilson’s Disease)
blocked bile ducts
nonalcoholic steatohepatitis
toxins or infections

72
Q

Symptoms of Cirrhosis

A
  • Will not see symptoms in early disease stages
    *Fatigue
    *Nausea
    *weight loss
    *Jaundice
    *edema
    *increased PT
    GI bleeding
    Intense itching
73
Q

Treatment for cirrhosis

A

*Damage is not reversible, but progression and symptoms can be managed
*Treatment focuses on underlying causes
-for example hepatitis use medications (interferon) to treat

74
Q

Primary Tumors

A

*begins in the liver
*usually associated with chronic hepatitis
*approx. 80% caused by hepatitis B or C

75
Q

metastatic Tumors

A

*begins elsewhere in the body and moves to the liver
*More common form (90-95%)
*commonly caused by colon, lung, or breast cancers

76
Q

Common types of benign tumors

A

hepatocellular adenomas and hemangiomas

77
Q

Most common type of malignant liver tumor

A

hepatocellular carcinoma (HCC)

*poor prognosis (survival times of months)
*high percentage is in places where HBV is endemic
*In US patient with chronic HBV or HCV infection account for 30-40% of HCC cases

78
Q

Causes abnormal deposits of fat to develop in the liver and other organs of the body, along with severe increase of pressure in the brain

A

Reye’s Syndrome

79
Q

When is Reye’s syndrome normally seen?

A

In children recovering from a viral infection (flu or chickenpox)
*has been linked to aspirin administration to children with a viral syndrome

80
Q

True or false

Reyes syndrome can be seen in adults

A

True (rare)

81
Q

Symptoms of Reye’s syndrom

A

increased ammonia, AST, ALT levels in the blood
encephalopathy
neurodegenerative disorders (confusion, personality changes)
vomiting

82
Q

Treatment for Reyes Syndrome

A

Must be treated quickly with IV fluid, diuretic to relieve pressure on the brain, and medications to prevent bleeding

83
Q

Drug and alcohol abuse accounts for _____ to ______ of all acute liver failures

A

1/3 to 1/2

84
Q

Most common mechanism drugs cause damage to liver

A

Immune-mediated injury to the hepatocytes

*the drug indices and adverse immune response against the liver itself resulting in inflammation and eventually cirrhosis

85
Q

What is one of the most commonly abused substances?

A

Alcohols (ethanol)

86
Q

Early alcohol damage begins where?

A

Begins as fatty deposits in the liver with elevations in AST, ALT and GGT

*This stage can be cured if patient abstains from alcohol

87
Q

Long term excessive alcohol use leads to what?

A

Moderate elevations in AST, ALT, and GGT with lower elevations of ALP

Will also see decreased protein levels and elevated bilirubin

88
Q

Swelling and inflammation of the liver

A

Hepatitis

89
Q

Causes of hepatitis

A

Viral (most common, major concern)
Bacterial/parasitic
drug/alcohol induced
autoimmune
radiation induced

90
Q

Common forms of viral Hepatitis

A

A
B
C

91
Q

Less common forms of viral Hepatitis

A

D
E
F
G

92
Q

Why is fasting best for bilirubin?

A

Because high lipid levels will increase bilirubin concentration

93
Q

Why avoid hemolysis with Bilirubin?

A

It can decrease the reaction with the diazo reagent (falsely low results)

94
Q

Bilirubin must be kept away from light, why?

A

Light breaks down bilirubin, sample exposed to light will have a decrease in bilirubin of 30-50% per hour.

95
Q

Commonly used bilirubin methods that are based on the diazo reaction

A

Malloy-Evelyn
Jendrasski-Grof

*colormetric methods
*use different accelerators

96
Q

Bilirubin +sulfamic acid + accelerator =

Bilirubin + sulfamic acid =

A

Total bilirubin

Conjugated/direct bilirubin

97
Q

Total bilirubin determinations include what 3 fractions?

A

Conjugated
unconjugated
delta

98
Q

Conjugated bilirubin that is bound to albumin

A

Delta

Only seen when there is a significant hepatic obstruction or with dubin-johnson syndonrome

99
Q

What is the end product of bilirubin metabolism?

A

Urobilinogen

100
Q

What is urobilinogen converted to

A

It is converted to urobilin by the intestinal bacteria

101
Q

Urobilinogen uses what reagent

A

Colorimetric reaction using Ehrlich’s reagent

102
Q

Specimen (2)

A
  1. fresh 2 hour urine, kept cool and away from light
  2. Aqueous extract of fresh feces
103
Q

Common methodology used for serum bile acids

A

(not commonly done - only reference labs)

Uses GCMS, requires extraction with organic solvents prior to analysis

104
Q

Will see an increase in bile acids with what?

A

with certain liver disorders

Can use the ratio of certain bile acids to differentiate between disorders

105
Q

Liver Enzymes (6)

A

ALT
AST
ALP
5’-Nucleotidase
GGT
LDH

106
Q

ALT/AST increased with…

A

hepatocellular disorders

highest with hepatitis

107
Q

ALP increased with…

A

biliary obstruction
bone disorders
pregnancy
growth

108
Q

5’ Nucleotidase increased with…

A

biliary obstructions

*but not with bone disease, pregnancy, or childhood growth
*can be used to differentiate the cause for elevated ALP levels

109
Q

GGT increased with…

A

biliary obstruction
chronic drug/alcohol abuse

110
Q

LDH increased with…

A

not specific for the liver

hepatocellular disorders

111
Q

When liver is functioning properly should have ______ protein levels, if liver is damaged will see ______ protein levels and _______ test results

A

normal

decreased

abnormal

112
Q

Albumin

_______ levels can indicate systemic inflammation and liver disease/failure

A

decreased

113
Q

Clotting Factors

Decreased with _______ ________

Will see ________ PT times

A

Liver damage

increased

114
Q

Immunoglobulins

will see _________ levels with liver disease because there are _______ concentrations of the liver proteins

A

increased

lower

115
Q

The liver is responsible for converting _______ to urea

A

ammonia

116
Q

Elevated ammonia levels indicates what?

A

That the liver is damaged and can not perform the conversion

117
Q

Elevated ammonia levels can lead to what?

A

Hepatic coma

*patient becomes increasingly disoriented and gradually lapses into unconsciousness

*more likely due to the build-up of toxic substances in the blood

118
Q

Bilirubin (Adults)

Total =
Conjugated =
Unconjugated

A

Total = 0.2-1.0 mg/dL
Conjugated = 0.0-0.2 mg/dL
Unconjugated = 0.2-0.8 mg/dL

118
Q

Bilirubin (Full Term Infants)

Total 24hr =
Total 48hr =
Total 3-5days =

A

Total 24hr = 2.6 mg/dL
Total 48hr = 6-7 mg/dL
Total 3-5days = 4-6 mg/dL

118
Q

Urobilinogen

Urine =
Feces =

A

Urine = 0.1-1.0 Ehrlich units per 2h
Feces = 75-400 Ehrlich units per 24h

119
Q

When does full term infants bilirubin normally peak?

A

between day 2 and 4

MLT 203, Fall 2023 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions