liver function Flashcards
3 systems of hepatic system
hepatocytic, hepatobiliary, reticuloendothelial
the liver receives how many mL of blood per minute
15 ml of blood
two enzymes responsible for elimination of toxins such as alcohol
alcohol dehydrogenase
acetaldehyde dehydrogrenase
the only organ that can regenerate cells that have been damaged, injured, or removed
liver
to suppress liver fucntion, how many percent of liver must be destroyed
80%
weight of liver
1.2 to 1/5 kg
size of right lobe of the liver to left lobe
6x times bigger than the left
Contributes approx. of 25% of the blood
supply and provides most of the O2
requirement
hepatic artery
Transports the most recently absorbed
material 75% from the intestines to the
liver
Portal vein
major functioning cells;
performs most of the metabolic and
synthetic functions of the liver
Hepatocytes
represents 80% of the volume of the liver
hepatocyte
Contains lysosomes with hydrolytic
enzymes, immunoglobulin and
complement receptors
has the phagocytic role; it is the hepatic macrophage, engulfing organisms and toxins
Kupffer Cells
site of fat soluble vitamins
Stellate cells (Ito cells)
Synthesize collagen
which in excess production might cause
> fibrosis > cirrhosis
Stellate cells (Ito cells
Synthesize nitric oxide which is for regulation of intrahepatic blood flow
Stellate cells (Ito cells)-
liver progenitor cells involved
in the regeneration of hepatocytes and bile
ducts after liver injury
Oval cells
a system of liver that is about the metabolic activities
.Biochemical Hepatocytic System
a system of liver that is about the metabolism of bilirubin
Hepatobiliary System
a system of liver that is about the immune system
Reticuloendothelial System
METABOLIC FUNCTIONs of the liver
carbohydrate metabolism
lipid metabolism
protein II
hormone II
in the liver, there will be a pool of amino acids through __
protein degradation
liver Catabolize fatty acids to acetyl CoA and cholesterol to form ____
primary bile acids
Phagocytosis by ___
Kupffer cells
the first organ to metabolized foods is
liver - first pass metabolism
Helps to regulate blood volume by serving as a ___
blood storage area
liver can be a storage for all fat and water soluble vitamins, but can be a storage of ___ which is released when glucose is depleted
glycogen
Bile is made up of ______, and other
substances extracted from the blood.
bile acids or salts,
lecithin
bilirubin
urobilinogen
electrolytes
The body produces approximately ____ of bile
per day and excretes ____ of what is
produced
3 L; 1 L
The liver serves as a ___ between substances absorbed by the gastrointestinal tract and those released into systemic circulation
gatekeeper
Every substance that is absorbed in the gastrointestinal tract must
first pass through the liver; this is referred to as ___.
first pass
This is an important function of the liver because it can allow
important substances to reach the systemic circulation and can
serve as a barrier to prevent toxic or harmful substances from
reaching systemic circulation
first pass of the liver
Bile components ___
bile acids, lecithin, cholesterol, bilirubin, and
electrolytes
Bile is important in __ digestion
lipid
through formation of micelles that helps to digest fats or lipids
Bile pigment that results from the catabolism of the heme moiety of the hemoglobin molecule due to old age or trauma
Bilirubin
characterized by a mild unconjugated hyperbilirubinemia
Gilbert’s Syndrome
Characterized by decreased conjugation and decreased
uptake of bilirubin
Gilbert’s Syndrome
Pre-conjugation failure
Gilbert’s Syndrome
o Characterized by a decreased hepatic excretion of bilirubin
Dubin-Johnson Syndrome
Increased B2 with hepatic pigmentation (melanin)
Dubin-Johnson Syndrome
Cause is still unknown
oSimilar to Dubin-Johnson but without hepatic pigmentation
Rotor Syndrome
A familial form of unconjugated hyperbilirubinemia caused by a
circulating inhibitor of bilirubin conjugation
Lucey-Driscoll Syndrome
GGT is number 1 marker of
alcoholic hepatitis
most sensitive marker of hepatocytic injury
ALT alanine transaminase - SGPT
function of accelerator
to measure the total bilirubin fraction
routine markers for measuring hepatic synthetic fucntion
total protein
albumin
globulin
albumin/globulin ratio
secondary marker for measuring the hepatic synthetic function
prothrombin time
provides the most useful indices for assessing the severity of the liver disease
serum albumin
vitamin K dependent coagulation factors
the reference method but not routinely used for total protein measurement
kjeldahl method
kjeldahl method is base don the measurement of
nitrogen content of protein
according to kjeldahl, 1 gram of nitrogen is equivalent to grams of proteins
6.54 grams
reagent used for kjeldahl method
sulfuric acid (digesting agent )
end product for kjeldahl method
ammonia
most widely used, recommended by the international deferations of clinical chemistry
routine method for total protein determination
biuret method
principle of biuret method
cupric ions form a complex with peptide bonds
forming a violet colored chelate which is proportional to the number of peptide bonds and reflects the total protein level at 545 nm
cupric ions+ peptide bonds = violet complex
biuret requires at least how many peptide bond and what pH of the medium to measure the total protein
atleast 2 peptide bond and alkaline medium
preferred automated analyzers since protein concentration as low as 10 or 15 mg/dl can be measured
biuret
routine yan eh most widely used pa
reagents for biuret method
alkaline copper sulfate
rochelle salt
NaOH
Potassium Iodide
a method for total protein that has the highest analytical sensitivity
folin-ciocalteu method
folin-ciocalteu method’s principle
oxidation of phenolic compounds such as tyrosine, tryptophan, and histidine to give a deep blue color
color enhancer for folin-ciocalteu method
biuret reagent
main reagent for folin-ciocalteu method’s
phosphotungstic-molybdic acid or phenol reagent
this method utilizes the reagent of folin-ciocalteu method and biuret method
lowry method
these methods utilize sulfosalicylic acid and trichloroacetic acid for total protein determination
turbidimetry and nephelometry method
principle of ultraviolet absorption method
absorbance of proteins at 210 nm is due to absorbance of the peptide bonds at specific wavelength
proteins with an absorption at wavelength 280 nm
tryptophan, tyrosine, and phenylalanine
proteins can absorb light at
210 nm and 280 nm
is an alternative test to chemical analysis of serum total proteins
refractometry
based on the measurement of refractive index of solutes in serum
refractometry
characterizes the abnormal bands by adding specific antisera to each sample cell of the electrophoretic gel and the immune complex is viewed by staining
immunofixation electrophoresis
preferred in detecting abnormal proteins such as M-spike in multiple myeloma
immunofixation electrophoresis
it has higher analytical sensitivity compared to the conventional electrophoresis since it can measure small abnormalities such as beta-gamma bridging in hepatic cirrhosis
immunofixation electrophoresis
reagent used for salt fractionation
sodium sulfate salt
the albumin that remains in solution in the supernatant can be measured by any of the routine total proteins methods; globulin is insoluble in water but not in dilute salt solutions.
salt fractionation
albumin is soluble in what solution
water
concentrated salt solution
globulin is soluble in
weak salt solution
hydrocarbon solvents
the principle of this total protein determination method is the migration of charged particles in an electric field
serum protein electrophoresis
the single most significant clinical application of SPE is the
identification of monoclonal spike of immunoglobulins and differentiating from polyclonal hypergammaglobulinemia
MI exhibits pattern in SPE like in acute inflammation with elevated Acute phase reactants such as
AAT, AAC, haptoglobulin
proteins under alpha 1 globulin
glycoproteins
AAT
AAG
thyroxine binding globulin
proteins under alpha 2 globulin
haptoglobulin
AMG
ceruloplasmin
proteins under beta globulin
transferrin
beta lipoprotein
hemopexin
complement c3 and c4
proteins under gammaglobulin
immunoglobulin and CRP
presence of free hemoglobin will cause a “__” in late alpha 2 and early beta region
blip
the presence of small spikes or striking elevation in the beta region is due to ___
iron deficiency anemia - increased transferrin
rheumatoid arthritis and malignancy would result in polyclonal gammopathy classified as
chronic inflammation
a dye used for the detection of proteins to as little as 1 ug
coomassie brilliant blue dye
conditions where we can observed increased total protein
malignancy
multiple myeloma
waldenstrom’s macroglobulinemia
conditions where we can observed decreased total protein
hepatic cirrhosis
glomerulonephritis
nephrotic syndrome
starvation
the concentration of this protein is inversely proportional to the severity of the liver disease
albumin
low total protein and low albumin might be caused by
hepatic cirrhosis and nephrotic syndrome
dye assay for albumin
most commonly used
bromcresol green
dye assay for albumin
most specific method
bromcresol purple
if globulin is greater than albumin, it is known as the inverted A/G ratio, what might be the causes
cirrhosis
multiple myeloma
waldenstroms macroglubulinemia
describe the total protein, albumin, and ammonia if the hepatic injury is less than 80% and if more than 80%
kapag less than, kaya pa niyan, normal pa ung total protein, albumin, and ammonia. Kasi kaya pa ni liver magcompensate and working pa siya, from the previous discussion diba sabi kailangan 80% of the liver must be destroyed for it to stop functioning well
and if 80% na or more than, TP and albumin will be decreased na since wala nang organ ang makakproduce ng proteins.
sa hepatitis naman, kaya yan kasi inflammation palang, unlike sa panhepatic cirrhosis, malala na yan 80% damaged na yan siya
the heridetary absence of albumin or the inability to synthesize albumin
analbuminemia
the presence of 2 albumin bands instead of a single band in electrophoresis
presence of albumin with unusual molecular characteristics in the blood
associated with excess amounts of therapeutic drugs in serum
bisalbuminemia
the presence of two albumin bands instead of a single band in electrophoresis
the lack of amino acids in an individual’s diet due to severe malnutrition, resulting in the liver’s inability to synthesize proteins and eventually causing decreased plasma oncotic pressure,
kwashiorkor
principal pigment in bile
bilirubin
conjugated bilirubin + albumin is called as
delta bilirubin - mainly caused by prolonged elevation of conjugated bilirubin
plasma concentration of bilirubin increases upon birth and reaches its peak on the ___ day
5th day
other sources of bilirubin aside from the lysis of rbc
heme containing proteins:
myoglobin
cytochrome
catalase
jaundice is also called as
icterus or hyperbilirubinemia
characterized by yellow discoloration of the skin, sclerae, mucus membrane
jaundice
jaundice is clinically evident when bilirubin level exceeds
3 mg/dl
what classification of jaundice
too much destruction of the red blood cells
pre-hepatic jaundice
clinical cases of pre hepatic jaundice
malaria, hemolytic anemia, hemolytic disease of the newborn
describe the serum bilirubin, urine bilirubin, urine urobilinogen of pre hepatic jaundice
elevated serum B1
negative urine bilirubin
normal or increased urine urobilinogen
classification of jaundice
failure of bile to flow or reach the intestin
post hepatic jaundice/obstructive jaundice
describe the serum bilirubin, urine bilirubin, urine urobilinogen in post hepatic jaundice
serum bilirubin: elevated B2
urine bilirubin: positive
urine urobilinogen: decreased or undetectable
classification of jaundice
hepatocyte injury caused by viruses, alcohol, and parasites
hepatocellular combined jaundice/hepatic jaundice
hepatocellular combined jaundice/hepatic jaundice
serum bilirubin
urine B
urobilinogen
serum bilirubin: elevated B1 and B2
urine B: positive
urobilinogen: decreased or undetectable
characterized by impaired cellular uptake of bilirubin
gilbert’s syndrome/bilirubin transport deficit
characterized by a molecular defect within the gene involved in bilirubin metabolism, such as the insertion of two bases into the promoter region of the UGT1A1 gene that encodes for UDPGT resulting in lower transcriptional rates and diminished enzymatic activity
gilbert’s syndrome
serum bilirubin for gilbert’s syndrom
elevated B1
characterized by the absence of UDPGT
crigler-najjar syndrome/conjugation deficit syndrome
crigler-najjar syndrome/conjugation deficit syndrom is common among what population
infants and those having treatment by phototherapy
type of crigler-najjar syndrome where there is an absolute deficiency of the enzyme UDPGT
TYPE 1
type of crigler-najjar syndrome
where there is a absence of B2 production
type 1 kasi walang conjugating enzyme- UDPGT
distinct feature of type 1 criggler-najjar
+ kernicterus, bile is colorless
type of crigler-najjar syndrome
characterized by oartial deficiency of UDPGT
type 2
associated with the blockage of the excretion of the bilirubin into the canaliculi caused by a hepatocyte membrane defect
dubin-johnson syndrome
dubin johnson syndrome is also called as
bilirubin excretion deficit
distinct feature of dubin-johnson syndrome/ B excretion deficit
intense dark pigmentation of the liver due to accumulation of lipofuscin pigment
serum bilirubin of dubin johnson/bilirubin excretion deficit
elevated B2
a familial form of unconjugated hyperbilirubinemia and may be caused by a circulating inhibitor of bilirubin conjugation in the baby’s or mother’s blood
lucey-driscoll syndrome/ conjugation inhibitor syndrome
distinct feature of rotor syndrom
+ porphyrinuria
caused by immature blood brain barrier among infants
kernicterus: bilirubin-induced brain dysfunction
bilirubin-induced brain dysfunction is characterized by elevated ___
B1
a type of brain damage that can result from high levels of bilirubin in a baby’s blood
bilirubin-induced brain dysfunction
a fetus with hemolytic disease does not develop hyperbilirubinemia because the placenta normally removes the bilirubin
true or false
true
bilirubin may appear in amniotic fluid, how to monitor it
using liley’s test - spectro at 450nm and determine the degree and progression of fetal hemolytic disease. Bilirubin’s peak absorbance is 450 nm
principle of bilirubin Assay
it follows Van Den Bergh reaction is the diazotization of bilirubin to produce AZOBILIRUBIN
coupling accelerator of evelyn and malloy method
methanol
most commonly used bilirubin assay
jendrassik and grof
main reagent of jendrassik and grof
diazo reagent
a colorless end product of bilirubin metabolism that is oxidized by intestinal bacteria to the brown pigment called stercolin
urobilinogen
a test for hepatocellular function and potency of bile duct, however, rarely used
bromsulphthalein dye excretion test
determines the ability of protein albumin to transport the exogenous dye to the liver where it is excreted in the bile
bromsulphthalein dye excretion test
