Liver Function Flashcards
(100 cards)
1
Q
Functions of the liver.
Ma, Dala Sa’g Carrots
A
- Metabolism of carbohydrates, lipids, proteins, and bilirubin
- Detoxification of harmful substances
- Storage of essential compounds; and
- Clearing waste products
2
Q
It is a relatively resilient organ that can regenerate cells that have been removed.
A
Liver
3
Q
If liver becomes completely nonfunctional, death will occur within approximately 24 hours due to …
A
Hypoglycemia
4
Q
Weight of the liver in kg
A
approximately 1.2 - 1.5 kg
5
Q
How many times larger is right lobe when compared to the left?
A
6 times larger
6
Q
2 major sources where the liver receives blood supply
A
- Hepatic artery
- Portal Vein
7
Q
It supplies the oxygen-rich blood from the heart to the liver which is responsible for 25% of the total blood supply to the liver
A
Hepatic artery
8
Q
This supplies nutrient-rich blood, collected from the digestive tract, which is responsible for providing 75% of the total volume of blood supply to the liver.
A
Portal vein
9
Q
This is where the two blood supplies eventually merge which is lined by hepatocytes that remove toxic substances from the blood.
A
Hepatic sinusoid
10
Q
It is through this that the blood leaves the liver.
A
central canal
11
Q
How many mL of blood passes through the liver per minute?
A
1,500 mL
12
Q
This is where the excretory system of the liver begins.
A
Bile Canaliculi
13
Q
This is where excretory products can drain
A
Bile Canaliculi
14
Q
2 major cell types of the liver.
A
- Hepatocytes
- Kupffer Cells
15
Q
A cell that makes up approximately 80% of the volume of the organ which is responsible for the liver’s regenerative properties.
A
Hepatocytes
16
Q
Cells that are macrophages that line the sinusoids which act as active phagocytes capable of engulfing bacteria, debrix, toxins, etc.
A
Kupffer Cells
17
Q
First major functions of the liver
A
Excretory and Secretory processes
18
Q
Major heme waste product
A
Bilirubin
19
Q
True or False. The liver is one of the organs that get rid of heme waste products.
A
False. It is the only organ.
20
Q
Components of bile.
A
- Bile acids/salt
- Bile pigments
- Cholesterol
21
Q
The produces ____L of bile per day and excretes ____L.
A
Produces 3L;
Excretes 1L
22
Q
Principal pigment in bile and is derived from the breakdown of RBCs.
A
Bilirubin
23
Q
Hemoglobin is degraded to three
A
- Heme
- Iron
- Globin
24
Q
Bound by transferrin and returned in the liver/bone marrow for reuse.
A
Iron
25
Degraded into amino acids to be reused by the body.
Globin
26
The heme portion of hemoglobin is converted to bilirubin within how many hours?
2-3 hours
27
Bilirubin that is ***bound by albumin*** which is insoluble in water and cannot be removed until it is conjugated by the liver.
Unconjugated Bilirubin
28
A carrier protein that picks up unconjugated bilirubin released from albumin, responsible for transporting it to the endoplasmic reticulum where it is conjugated.
Ligandin
29
Enzyme for the conjugation (esterification) of bilirubin
Uridine Diphosphate Glucuronosyltransferase (UDPGT); or
UDP-glucoronyl transferase enzyme
30
Water soluble and can be excreted from the hepatocytes into the bile canaliculi.
Conjugated bilirubin
31
A colorless product oxidized to an orange-colored product which is excreted in the feces.
Urobilinogen
32
Oxidized urobilinogen that gives the feces its brown color.
urobilin or stercobilin
33
How many mg of bilirubin is produced per day?
200 to 300 mg
34
Levels of bilirubin in the serum of a healthy adult.
0.2 to 1.0 mg/dL
35
Maximum excreted urobilinogen per day
1-4 mg
36
***Second major function*** of the liver that has the capacity to ***metabolize biological compounds***, including carbohydrates, lipids, and proteins (from the digestive system)
Metabolism
37
When carbohydrates are ingested and absorbed, the liver can process them for 3 ways.
1. Cellular energy requirements
2. Use at peripheral tissues
3. Store glucose as glycogen
38
Principal storage form of glucose
glycogen
39
Approximately ____% of the daily production of cholesterol is produced by the liver.
70%, roughly 1.5 to 2.0 grams
40
One of the most important proteins synthesized by the liver.
Albumin
41
The most critical aspect of protein metabolism
transmination and deamination of amino acids
42
Result in the ***exchange of an amino acid*** on one acid with a ketone group on another acid.
Transmination
43
This ***degrades the products to produce ammonium ions*** that are consumed in the synthesis of urea, excreted by the kidneys.
Deamination
44
Take note: The liver ***must be extensively impaired*** before it loses its ability to perform essential functions
45
The thrid major function of the liver wherein it serves as a ***gatekeeper between substances*** from the gastrointestinal tract and those released in the circulatory system.
Detoxification of waste products
46
Refers to every substance absorbed in the gastrointestinal tract that must pass through the liver before reaching through the rest of the body.
first pass
47
2 mechanisms of detoxification of foreign materials (drugs and poisons) and metabolic products (bilirubin and ammonia).
1. ***Binds the material*** to reversibly inactivate the compound
2. ***Chemically modifies*** the compound
48
Fourth major function of the liver
Drug Detoxification
49
This is where drug detoxification takes place.
Liver microsomes via cytochrome-P450 (CYP450) isoenzymes
50
***Yellow discoloration*** of the skin, eyes, and mucous membranes, most often resulting from the retention of bilirubin.
Jaundice
51
Upper limit of normal for total bilirubin
1.0 to 1.5 mg/dL
52
Jaundice not noticeable to the human eye
Overt Jaundice
53
Jaundice is noticeable at what bilirubin level/s?
3.0 to 5.0 mg/dL
54
Pertains to a ***serum or plasma sample with a yellow discoloration*** due to the elevation of bilirubin levels.
Icterus
55
Commonly caused by increased amounnt of bilirubin being ***presented to the liver***, as seen in acute and chronic hemolytic anemia.
Prehepatic jaundice
56
Prehepatic jaundice may also be referred to as
unconjugated hyperbiliribunemia
57
Occurs when the primary problem causing the jaundice ***resides in the liver*** (intrinsic liver defect or disease)
Hepatic jaundice
58
Disorders of bilirubin metabolism causing intrinsic liver defect that results in the elevation of inconjugated bilirubin. ***(C DG Naay Newborn)***
Crigler-Najjar Syndrome
Dubin Johnson Syndrome
Gilbert's Disease
Neonatal Physiologic Jaundice of Newborn
59
Elevated conjugated bilirubin in hepatic jaundice
***(C Derek Ramsay)***
Dubin-Johnson & Rotor Syndrome
60
A ***benign autosomal recessive hereditary disorder*** that results from a ***genetic mutation in the UGT1A1 gene*** that produces the enzyme uridine diphosphate glucuronosyltransferase.
Gilbert's syndrome
61
Location of UGT1A1
Chromosome 2
62
***Other mutation of the UGT1A1 gene*** that is a more severe and dangerous form of hyperbilirubinemia
Crigler-Najjar Syndrome
63
Of the many causes of jaundice, this is the ***most common cause*** which carries no morbidity or mortality in the majority of those affected and carries no clinical consequences
Gilbert's syndrome
64
A syndrome of nonhemolytic unconjugated hyperbilirubinemia resulting from a ***molecular defect within a gene involved with bilirubin conjugation***.
Crigler-Najjar Syndrome
65
A type of Crigler-Najjar Syndrome where there is ***complete absence*** of enzymatic bilirubin conjugation.
Type 1
66
A type of Crigler-Najjar Syndrome where there is a ***mutation causing the deficiency*** of the enzyme responsible for bilirubin. conjugation
Type 2
67
Characterized by elevated unconjugated bilirubin
***(U Got Cancelled)***
Gilbert's Syndrome
Crigler-Najjar
68
Deficiency of the ***canalicular multidrug resistance/multispecific organic anionic transporter*** protein (MDR2/cMOAT)
Dubin-Johnson Syndrome
69
Liver's ability to uptake and conjugate bilirubin is functional but removal and excretion are defective.
Dubin-Johnson Syndrome
70
Its distinguishing feature is the appearance of ***dark stained granules***
Dubin-Johnson Syndrome
71
Caused by mutations in the SLCO1B1 and SLCO1B3 genes on chromosome 12
Rotor Syndrome
72
Genes that provide instructions for making proteins found on liver cells.
SLCO1B1 and SLCO1B3
73
Common complication encountered during the neonatal period (first week) characterized by the deficiency of UDPGT
Physiologic jaundice/neonatal hyperbilirubinemia
74
Causes posthepatic jaundice
Liver cirrhosis
Bile duct obstruction
GI obstruction
75
A condition where ***scar tissue*** replaces normal, healthy liver tissue which ***blocks the flow of blood*** to the organ, preventing the liver from functioning properly
Cirrhosis
76
Most common cause of Cirrhosis
Chronic alcoholism
77
Cancer that begins in in the liver cells
Primary liver cancer
78
Occurs when tumors from other parts of the body metastasize to the liver.
Metastatic liver cancer
79
Most common primary liver malignancy
Hepatocellular carcinoma
80
A ***group of disorders*** caused by infectious, metabolic, toxic or drug-induced disease found ***almost exclusively in children***.
Reye's syndrome
81
Of all the drugs associated with hepatic toxicity, this is the most important.
Ethanol
82
Bilirubin with a diazotized sulfanilic acid solution
Diazo reaction
83
Method to measure Total Bilirubin
**Bilirubin + diazotized sulfanilic acid + accelerator**
would yield
**2 azobilirubin**
84
Method to measure Conjugated Bilirubin
**Bilirubin + diazotized sulfanilic acid**
would yield
**2 azobilirubin**
85
Method to measure Indirect Bilirubin
**Total bilirubin - Conjugated bilirubin** = unconjugated bilirubin
86
A polar and water-soluble compound found in plasma in the free state.
Conjugated bilirubin
87
Tips:
**Vowels** - indirect, unconjugated, insoluble
**Consonants** - direct, conjugated, water-soluble
88
Specimen for Total Bilirubin
serum/plasma
89
Preferred spx for Malloy-Evelyn procedure because of the addition of alcohol
serum
90
Why is a fasting sample preferred?
Lipemia will increase bilirubin conc.
91
These samples should be avoided because it decreases the reaction of bilirubin with the diazo reagent
Hemolyzed samples
92
Bilirubin is sensitive to and is destroyed by
light
93
Separated serum/plasma from cells and stored in the dark is stable for
2 days at RT
1 week at 4oC
Indefinitely at -20oC
94
Most common accelerator to solubulize unconjugated bilirubin
Methanol
95
Reagent for Malloy-Evelyn Procedure
Diazotized sulfanilic acid
96
Malloy-Evelyn procedure is performed at what pH? Resulting to what color of the azobilirubin? With a maximal absorption of how many nm?
1.2
red-purple
560 nm
97
Bilirubin pigments react with diazo reagent (***sulfanilic acid with hydrochloric acid and sodium nitrate***)
Jendrassik-Grof Method
98
Jendrassik-Grof results in the production of
purple product: azobilirubin
99
Its addition in the Jendrassik-Grof method will ***solubilize the water-insoluble fraction of bilirubin***
caffeine-benzoate
100
Final product of Jendrassik-Grof
Blue (measured at 600 nm)
