Liver Function Flashcards
Functions of the liver
metabolism of…
d
s
c
Metb of carbs, lipids, proteins,bilirubin
Detox
storage of compounds
Cleaving waste
Describe the livers resilience
can regenerate w short term damage
limited
gross anatomy
weight
beneath…
protected by/held by
extremely?
1.2-1.5kg
beneath and attached to diapragm
protected by ribs/held by ligaments
extremely vascular
Gross anatomy of lobes
connected by?
right lobe size?
Blood supply
h
p
two lobes connected by falcif ligament
right lobe 6x larger than left
hepatic artery - 25%
Portal vein - 75%
Microanatomy
divided into…
responsible for?
how many sides?
what at corners?
divided into lobules
resposible for excetion/met functions
6 sided with central vein
portal triads at corners
major cell types in liver
hepatocytes
kupper cells (macrophages speciifc to liver)
T/F liver has bad regeneration in transplants
false its good
Bichemical functions of liver
excretion/secretion
storage
metabolism
detox
What happens if the liver stops working
death in 24hr due to hypoglycemia
Excretion/secretion definition
processing/excretion of endogenous/exog materials in bile or urine
ex bilirubin
The liver is the only organ that can get rid of?
heme waste products
Describe Bile
made of ….b/p/c
body produces?
excretes?
what is principle pigment?
made of bile acid salts pigments and cholesterols
body produced 3L/day
excretes 1L/day
bilirubin is the principle pigment
Unconjugated bilirubin
indirect, bound by ALB and transported to liver,
INSOLUBLE in h20 cannot be removed from the body
Conjugated bilirubin
also called bilirubin dig…
solubility
secreted from? into?
bilirubin diglucoulronide
h20 SOLUBLE can be secreted from hepatocyte into bile canalculi
urobilinogen
colorless product of bilirubin formed by action of bacteria
excreted in feces, circulation or urine
Metabolism in liver
carbs
ways of processing
g
c
s
carbs - one of the most important
3 ways of processing
glucose for energy
circulation glucose for use by periph tissues
storage of glucose as glycogen
T/F the liver has Major importance in maintaining glucose levels
t
glycogenesis
glucose stored as glycogen
Glycogenolysis
breakdown glycogen
gluconeogensis
creation of glucose from non sugar /carb substance
Lipids
metabolized where?
l/lp
forms?
how much daily prod of lipids from liver
metab in liver under normal circumstances
lipids and lipoproteins
forms ACETLY-COA from free fatty acids
70% daily prod of lipids from liver
What does ACETYL-COA do
forms
forms triglycerides, phosph, cholesterols
Proteins
almost all synth in…..
essential role in development of….
one of most important
trans/deanim of…
almost all synth in liver except Igs and Hgb
essential role in develope of Hgb in infants
ALB one of most important
trans/deanimation of AA
First pass
every substance absorbed into gi must pass through the liver before reaching the rest of the body
Mech for detoxing drugs
f
m
foregin materials (drugs/posions) and metabolic functions (bilirubin/ammonia)
Jaundice
discoloration
retention of
noticable at what amount
icterus
classified based on?
yellow discoloration
retention of bilirubin
noticable jaundice 3-5mg
Icterus - discolor of plasma/serum
CLASSIFED BASED ON SITE
Prehepatic jaundice
increased…
acute/chronic
what rarely exceeds 5mg
also called?
increased bilirubin to liver
acute/chronic hem anemia
bilirubin rare exceeds 5mg
also called
UNCONJUGATED HYPERBILIRUIB (bound to alb)
Post hepatic jaundice
what kind of disease?
physical obstruction =
what form is bilirubin in? not?
stool?
biliary obstructive disease
physical obstruction: gallstones/tumors
bilirubin is CONJUGATED but not excreted
stool - grey colored
Hepatic jaundice
primary….
disorders of …
primary liver problems
disorders of bilirubin metabolism, transport defects, hepatocell injury
Gilberts syndrome
auto recessive
consequences
intermediate….uh
underlying…due to
auto recessive disorder
no clinical conseqeunces
intermediate unconjugated hyperbiliruin underlying liver disease due to defective conjug system
Crigler-Najjar syndrome
chronic non…..
type 1: abs
type 2: severe
rare?
chronic non-hem unconjugated hyperbilirubin
Type 1: absence of enzyme conjug
2: severve deficiny of enzyme for conjugation
rare but can result in death
Dubin-Johnson sydrome
c/h
rare?
o
ability to remove?
granules?
life?
conjugated hyperbili
rare auto recessive
obstructive in nature
ability to remove conjug bilirubin affected
dark stained granules
normal life
delta bilirubin
conjugated bilirubin bound to ALB
Rotor syndrome
auto?
rare?
what is less effectivly taken up…
normal?
auto recessive
rare bengn
bilirubin less effetive taken up by liver and removed
norm ALP/GGT from biliary obstruction
Physiologic jaundice
neonatal
common
deficient in
last function to be activated in…
neonatal hyperbilirubin
common w/in first week of life
def in UDPGT enzyme required for bili conjugation
last liver fucntions to be activated in prenatal life
Kernicterus
uncong……
therapy?
danger level
unconjugated bilirubin buildup in neonatal brain
light therapy, IVIG danger level >20mg
Cirrhosis
what replaces norm
blocks?
signs?
prognosis
most common cause?
other causes?
scar tissue replaces normal
blocks blood flow
signs rare in early stages
poor prognosis
ALCOHOLISM
(HBV/HCV/HDV)
Tumors
p/m
benign: ha/ha
malignant: h…%…pb
primary or metastatic (colon/lung/breast)
Benign: hepato adenoma/hemaangiomas
Malign: HCC 90% primary bile duct carcinoma
Reyes syndrome
disorders caused by
age?
cause?
ACUTE?
3x….
drug
group of disorders caused by infection/metb. toxin/drug induced disease
children exclusively
unknown cause VIRAL INFECTION
ACUTE = non inflam encephalatis
3x ammonia/AST/ALT
ASPIRIN
Drug/alc related disorders
1/3 acute liver failure caused by
prim target
most common immune…
drug induced liver disease 1/3 of acute liver failure
liver primary target for adverse drug rxn
MOST COMMON IMMUNE- DAMAGE TO HEPATOCYTE
Ethanol
most important…
ac
what % goes to liver
stgs
most important drug related to toxicity
alcoholic cirrhosis
90% of alc absorbed goes to liver
3 stgs:
alc fatty liver
alc hepatitis
alc cirrhosis
Fatty liver disease
changes?
slight elevation in?
nodes?
ages?
few changes in liver function
slight elev in AST/ALT/GTT
fatty node
middle aged/obesity
reduce factors
Alc hepatitis
symptoms
mod elev in
total bili
dec
inc
fever acitis, muscle loss
moderate AST/ALT/GTT
total bilirubin >5mg
dec alb
increase PT/creatinine
Alc cirrhosis
symptoms
survival
what % abst from drinking recover
common in?
increased
biop
dec
gi bleed/acites
5 yr survival
60% abst from drinking
common in males
inc AST/ALP
liver biopsy
dec ALB
T/F acetomenophin/tranquilizers affect the liver
true
