Liver Function Flashcards
Weight of liver
1.2 to 1.5 kg
Liver is a reddish brown organ that is located beneath the ______ and protected by _______
Beneath the diaphragm and protected by lower rib cage
Liver is held by what
Ligament
Largest organ of the body
Skin gaga, di ko naman sinabing internal organ
The right and left lobe of the liver is divided by what
Falciform ligament
Which is larger? Right or left lobe
Right = 6 times larger
Structural unit of the liver
Lobule
Functional unit of the liver
Hepatocyte
2 major cells of the liver
Hepatocyte
Kupffer cells
Cells that regenerates the liver
Hepatocyte
Macrophages of the liver
Kupffer cells
Kupffer cells are found lining the ____
Sinusoid
2 major source of blood
Hepatic artery
Portal vein
This supplies the liver with oxygen rich blood
Hepatic artery
Hepatic artery supplies ____rich blood
Oxygen
This supplies the liver with nutrient rich blood
Portal vein
Portal vein supplies the liver with ___ rich blood
Nutrient
Hepatic artery = ____% blood supply
Portal vein = ____% blood supply
25% ; 75%
Blood from the liver exits where
Central canal / central vein
Portal vein and hepatic artery merge in _____
Hepatic sinusoid
This is a branch of the aorta that carries oxygen-rich blood from the heart providing approximately 25% of the total blood supply of the liver.
Hepatic artery
Each lobule is roughly a ____ structure
six-sided structure
Portal of triad
Hepatic artery
Portal vein
Bile duct
System of the liver (3)
Hepatocyte system
Biliary system
Reticuloendothelial system
Which system or component of the liver is involved in immune response?
Reticuloendothelial system (kupffer cells)
Which system or component of the liver is involved metabolism of bilirubin and bile salts
Biliary system
Which system or component of the liver is involved in metabolic reactions
Hepatocyte system
Biliary system is involved in metabolism of what
Bilirubin and bile salts
Primary roles of the liver
- excretion or secretion
- metabolism
- storage
- detoxification
liver synthesizes various proteins essential for blood clotting and immune system function except
von willebrand factor (endothelial cells)
Immunoglobulin (plasma cells)
liver has extensive capacity for metabolizing many biological compounds such as
Carbohydrate
Lipids
Protein
test that measures the total amount of protein in your blood.
total protein and A/G ratio test
Explain first pass
Every substance absorbed in the gastrointestinal tract must pass through the liver before reaching the rest of the body.
2 mechanism of liver detoxification
Inactivation
Modification
What specific function
liver is a gatekeeper between substances absorbed by the gastrointestinal tract and those released into the systemic circulation.
Detoxification
Where does drug detoxification takes place
Liver microsome
Liver stores substances such as
Glycogen
Lipids
Amino acids and proteins
Vitamin K
After a meal, how many % of carbohydrates are going to the liver
20%
Storage form of lipids
Triglycerides
process by which glycogen is broken down into glucose
Glycogenolysis
process of storing excess glucose for use by the body at a later time.
Glycogenesis
process transforming non-carbohydrate substrates into glucose
Gluconeogenesis
process in which glucose is broken down to produce energy.
Glycolysis
Explain the excretory system of the liver
Bile canaliculi will form intrahepatic duct.
These ducts then join to form the right and left hepatic ducts
Right and left hepatic duct will merge to form common hepatic duct
Common hepatic duct + cystic duct = common bile duct
T/F
The liver is the only organ that has the capacity to rid the body of globin waste products
F: heme waste
Comprises of bile acids or salts; bile pigments, cholesterol, and other substances extracted from blood
Bile
Bile comprises of (4)
- Bile acids or salt
- Bile pigments
- Cholesterol
- Other substances from blood
Production rate of bile
3L per day
Excretion rate of bile
1 L per day
Principal pigment in bile
Bilirubin
Pathway of bile
Cholesterol
Liver
Primary bile acids
Conjugation
Bile salts
Excretion
Terminal ileum and colon with bacteria
Dehydration to secondary bile acids
Absorbed into portal circulation
Primary bile acids
Cholic acid
Chenodeoxycholic acid
Secondary bile acid
Deoxycholic acid
Lithocholic acid
Stored form of iron
Ferritin
B1 enters the hepatocyte with the help of ____
Ligandin
What are the sources of bilirubin?
80% rbc
20% proteins
protein produced by the liver which acts as a marker for tumors
Alpha fetoprotein
Irreversible scarring of the liver
Cirrhosis
Most common drug that can cause liver disorder
Acetaminophen
Effect of lipemic blood
False positive
Effect of hemolyzed blood
False negative
Enzyme responsible in converting heme to biliverdin
Heme oxygenase
Enzyme responsible in converting biliverdin to b1
Biliverdin reductase
Enzyme that converts b1 to b2
Uridine diphosphate glucoronosyl transferase
3rd form of bilirubin
Delta bilirubin
Most significant alcohol in alcohol related disorder
Ethanol
Ethanol destroys ____ of Hepatocyte
Mitochondria
Heavy consumption of alcohol can lead to
Alcoholic cirrhosis
____ mg/L of ethanol = under the influence of alcohol
More than 1000
____mg/L of ethanol = CNS impairment/coma
3000
____mg/L of ethanol = death
4000
3 stages of Alcohol- induced liver injury
Alcoholic fatty liver
Alcoholic hepatitis
Alcoholic cirrhosis
mildest stage of alcohol induced liver injury
Alcoholic fatty liver
In alcoholic hepatitis, these enzymes are moderately increased
GGT and ALT
Most severe form of alcohol induced liver injury
Alcoholic cirrhosis
term used to describe a group of disorders caused by infectious, metabolic, toxic, or drug-induced diseases
Reye’s syndrome
Reye’s syndrome is almost exclusively seen in _____
Children
Possible cause of Reye’s syndrome (2)
Viral infection
Aspirin ingestion
This disease is characterized by Non inflammatory encephalopathy
Reye’s syndrome
In reye’s syndrome, ammonia is ____ increase
3 fold
Two classification of cancer of the liver
Primary
Metastatic
Difference between primary and metastatic liver cancer
Primary = originates from liver cells
Metastatic = tumors from other organ spread to the liver
occurs when tumors from the other parts of the body spread to the liver.
Metastatic cancer
More common classification of cancer of the liver
Metastatic cancer
Two types of tumor
Benign and malignant
Example of benign liver tumor
Hepatocellular adenoma
Hemangiomas
This is the term used to describe masses of atypical blood vessels
Hemangiomas
refers to an inflammatory condition of the liver
Hepatitis
Hepatitis (fecal oral)
Hepa A and E
Hepatitis A is also known as
infectious hepatitis or short incubation hepatitis
also known as infectious hepatitis or short incubation hepatitis
Hepatitis A
most common form of viral hepatitis
Hepatitis A
caused by a non-enveloped RNA virus of the picornavirus family.
Hepatitis A
Hepatitis A is cause by what family
Picornaviridae
Hepatitis that can cause acute and chronic infections
Hepatitis B
Hepatitis B is caused by what family
Hepadnaviridae
Hepatitis that is primarily transmitted through contact with infected blood.
Hepatitis C
Hepatitis C is caused by what family
Flaviviridae
Hepatitis D is dependent on the presence of what
Hepatitis B
Hepatitis D is caused by what family
Deltaviridae
Hepatitis that can cause both acute and, in some cases, chronic infections.
Hepatitis E
Hepatitis E is caused by what family
Hepeviridae
Two cardinal features of cirrhosis
Fibrosis and nodules
Enumerate the different types of hepatitis that can be transmitted through blood contact.
B C D
Cirrhosis may lead to ____
Portal hypertension
In cirrhosis, this fluid accumulates the abdomen
Ascitic
This is the term used to describe diseases of unknown cause.
Idiopathic
Term to describe a yellow serum or plasma sample
Icteric
French word for yellow
Jaune
Yellowish discoloration of the skin and sclerae
Jaundice
Yellowish discoloration is seen if the bilirubin level is
Above 3 mg/dl
Hyperbilirubinemia = ___ mg/dL
> 1 mg/dL to 2-3 mg/dL
Jaundice is associated with
Kernicterus
Deposition of unconjugated bilirubin in the nuclei of the brain and nerve cells of infants
Kernicterus
Kernicterus is the deposition of _____ bilirubin in the brain
Unconjugated
Kernicterus is a deposition of unconjugated bilirubin in the _____
nuclei of the brain and nerve cells of infants.
Type of jaundice associated with deficiency of glucoronyl transferase
Physiologic jaundice
Physiologic jaundice has a deficiency of
Glucoronyl transferase
Treatment for Kernicterus
Exposure to UV light
exchange transfusion
Classification of Jaundice
- Pre hepatic jaundice or hemolytic hyperbilirubinemia
- Hepatic jaundice or hepatocellular hyperbilirubinemia
- Post hepatic jaundice or obstructive hyperbilirubinemia
Pre hepatic jaundice is also known as
Hemolytic hyperbilirubinemia
Pre hepatic jaundice is due to
Excessice rbc destruction
Causes of hemolytic hyperbilirubinemia
Malaria
Hemolytic anemia
Classification of jaundice that is characterized by unconjugated hyperbilirubinemia
Pre hepatic jaundice
In pre hepatic jaundice, is b1 present in urine?
No no no
In pre hepatic jaundice, what is increased
Unconjugated bilirubin
Hepatic jaundice is also known as
Hepatocellular hyperbilirubinemia
This classification of jaundice is due to impaired cellular uptake, defective conjugation, or abnormal secretion of bilirubin by the liver cell
Hepatic jaundice
In hepatic jaundice, what bilirubin is increased
Both b1 and b2
What bilirubin is increased:
Gilbert’s disease
Unconjugated
What bilirubin is increased:
Crigler-najjar syndrome
Unconjugated
What bilirubin is increased:
Neonatal hyperbilirubinemia
Unconjugated
What bilirubin is increased:
Dubin Johnson
Conjugated
What bilirubin is increased:
Rotor syndrome
Conjugated
Mutation in UGT1A1 gene that produces the enzyme UDPGT
Gilbert syndrome
Gilbert syndrome is caused by a mutation in what gene
UGT1A1
Disease where there is an impaired cellular uptake of bilirubin
Gilbert syndrome
An asymptomatic disease that reduces UDPGT levels around 20-30%
Gilbert syndrome
Which is more severe? Gilbert or Crigler
Crigler
Deficiency of the enzyme uridyl diphosphate glucuronyl transferase (UDPGT) resulting into a defect in bilirubin conjugation
Crigler-Najjar syndrome
Crigler-Najjar syndrome:
complete absence of UDPGT
Type 1
Crigler-Najjar Syndrome:
Bile is colorless
Type 1
Crigler-Najjar syndrome:
relative deficiency of UDPGT
Type 2/ Arias syndrome
Types of Hepatocellular hyperbilirubinemia that causes increase in B2
Dubin-Johnson Syndrome
Rotor’s Syndrome
Deficiency of the canalicular multidrug resistance/multispecific organic anionic transporter protein (MDR2/cMOAT)
Dubin-Johnson Syndrome
Dubin-Johnson syndrome is caused by a deficiency of what
Canalicular multidrug resistance transporter protein (MDR2) or Multispecific organic anionic transporter protein (cMOAT)
Idiopathic type of hepatic jaundice
Rotor’s syndrome
Liver has black pigmentation
Dubin Johnson syndrome
No visualization of the gallbladder
Dubin Johnson syndrome
High total urine coproporphyrin
Rotor’s syndrome
Total urine coproporphyrin of Dubin Johnson syndrome
Normal w/ >80% of isomer 1
Total urine coproporphyrin of rotor’s syndrome
High w/ <70% of isomer 1
Impaired excretion of bilirubin caused by mechanical obstruction of the flow of bile into the intestines
Post hepatic jaundice
Post hepatic jaundice is also known as
Obstructive hyperbilirubinemia
What is increased during post hepatic jaundice
B2
Color of stool of px with increased b2
Clay
cholecystolithiasis
Gallstone
stones in the common bile duct
Choledocholithiasis
Gallstone
Cholecystolithiasis
Jaundice few days after birth up to 2 weeks
Physiologic Jaundice of the Newborn
Physiologic Jaundice of the Newborn happens after birth up to _____
2 weeks
Type of jaundice in neonates where appearance of shunt bilirubin is present
physiologic jaundice of the newborn
Type of jaundice in neonates where increased absorption of bilirubin in the intestine by B- glucuronidase in meconium is present
Physiologic Jaundice of the Newborn
newborn’s first poop
Meconium
results from maternal-fetal incompatibility of Rhesus blood factors
Hemolytic disease
Disease due to α-glucuronidase in breast milk, which hydrolyzes conjugated bilirubin in the intestine
Breast Milk Hyperbilirubinemia
Breast Milk Hyperbilirubinemia is due to _____ in breast milk
α-glucuronidase
α-glucuronidase hydrolyzes _____ bilirubin in the intestine
Conjugated
Jaundice in neonates that causes conjugated hyperbilirubinemia
Idiopathic neonatal hepatitis
Biliary atresia
Reference value for conjugated hyperbilirubinemia
> 1.5 mg/dL
Upper limit of normal bilirubin level
1.0 to 1.5 mg/dL
Jaundice of neonates where there is a presence of giant cells hepatocyte acinar formation
Idiopathic neonatal hepatitis
This type of jaundice in neonates is caused by down syndrome, trisomy 17 or 18, cytomegalovirus etc
Biliary atresia
Liver filters about ___ L of blood per minute.
1.4 L
Used in the development of Icterus Index
Direct Measurement of Natural Color
Direct Measurement of Natural Color is used to develop
Icterus index
Two methods for icterus index
Muelengracht method
Newberger method
dilute serum with NSS and compare with 0.01% K2Cr2O7
Muelengracht method
In Muelengracht method, serum is diluted with ___ and compared with ____
NSS: 0.01% K2Cr2O7 (Potassium Dichromate)
dilute serum with NSS and compare with sodium citrate
Newberger method
In newberger method, diluted serum is compared with ___
Sodium citrate
Interfering substances in Icterus index
carotene, xantophyll II, hemoglobin
Specimen used for classic diazo rxn
Urine
Who is the person behind the classic diazo rxn
Ehrlich
Color of the colored complex in classic diazo rxn
Red
Component of diazotized sulfanilic acid
Sodium nitrite + HCL + sulfanilic acid
Bilirubin + DSA =
2 azobilirubin
Bilirubin + DSA + Accelerator =
Total azobilirubin
Accelerator used in evelyn and malloy
50% methanol
Sodium acetate in diazo rxn is used as
pH buffer
Ascorbic acid in diazo rxn is used to
Terminate the rxn
What reagent in diazo rxn is used to buffer the pH
Sodium acetate
What reagent in diazo rxn is used to terminate the rxn
Ascorbic acid
This is the first diazo colorimetric procedure that uses serum as a sample
Van den bergh test
What sample does van den bergh used
Serum
Accelerator used by Jendrassik and Grof
Caffeine sodium benzoate
Computation for Unconjugated bilirubin
Total bilirubin - conjugated bilirubin
pH of Malloy – Evelyn
Acidic
End color of Malloy – Evelyn
Pink to purple
pH of Jendrassik-Grof
Alkaline
End color of Jendrassik-Grof
Blue
Jendrassik and Grof is not affected by hemoglobin up to ____
750 mg/dL
Increase / decrease?
Lipemic blood
Increase
Increase / decrease?
Hemolyzed blood
Decrease
Increase / decrease?
Exposure to light
30-50% decrease per hour
Normal range of conjugated bilirubin
0 – 0.2 mg/dL
Normal range of Unconjugated bilirubin
0.2 – 0.8 mg/dL
Normal range of total bilirubin of children
0.2 – 1.0 mg/dL
Normal range of total bilirubin in adult
0.2 – 1.2 mg/dL
Reference range of total bilirubin
Premature infants 24 hrs
1-6 mg/dL
Reference range of total bilirubin
Premature infants 48 hours
6-8 mg/dL
Reference range of total bilirubin
Premature infants 3-5 days
10-12 mg/dL
Reference range of total bilirubin
Full term infants 24 hours
2-6 mg/dL
Reference range of total bilirubin
Full term infants 48 hours
6-7 mg/dL
Reference range of total bilirubin
Full term infants 3-5 days
4-6 mg/dL
Ehrlich reagent
p-dimethyl aminobenzaldehyde
reducing agent to maintain urobilinogen in reduced state
Ascorbic acid
Role of Ascorbic acid in urine urobilinogen
reducing agent to maintain urobilinogen in reduced state
stops the reaction and minimizes the combination of other chromogens
Sodium acetate
Sources of errors for urine urobilinogen
porphobilinogen, sulfonamides, procaine, 5-hydroxyindoleacetic acid
Specimen for urine urobilinogen
2 hour-fresh urine
Reference range for urine urobilinogen
0.1-1.0 Ehrlich units/2 hour or
0.5-4.0 Ehrlich units/day (0.868 mmol/day)
This type of rxn measures fecal urobilinogen
Ehrlich’s aldehyde/ Watsons’ Reaction
Reference values for fecal urobilinogen
75-275 Ehrlich’s unit/100 g or 75-400 Ehrlich units/24 hours
Test where sprinkle sulfur powder to 5 mL of urine
Hay test
In hay test, we sprinkle ___ to 5 ml urine
Sulfur
Interpret
Sulfur powder floats at the top =
Bile salt absent
Interpret
Sulfur powder sinks to the bottom =
bile salts present (obstructive jaundice)
Test for Excretory Function
Bromsulphalein Test
Rose Bengal Test
Best test to determine excretory fxn of the liver
Bromsulphalein test
Rosenthal method
Dose
Time of collection
NV
Dose: 2 mg/kg BW
Time: 5’ and 30’
NV: 50% and 0-100%
Dose for mc donald
5 mg/kg BW
Method under bromsulphalein test
Rosenthal and mc donald
Rose bengal test uses ___
I131
Urine color for urine bilirubin
Brown to amber
Process for Fouchet’s Test or Harrison Spot Test
Urine + BaCl2 = filter
Precipitate + FeCl2 in TCA = green colored precipitate
Test where urine and barium chloride is being filtered
Fouchet’s Test or Harrison Spot Test
Positive result for Fouchet’s Test or Harrison Spot Test
Green colored precipitate
Tests under Diazotization Test
Tablet test/ ictotest
Strip test
Example of detoxification function test
Quick’s test or hippuric acid test
In Quick’s Test or Hippuric Acid Test, px is given ____
Sodium benzoate meal
In Quick’s Test or Hippuric Acid Test, ___% of sodium benzoate should be secreted within ___
40%; 60 mins
AST
aspartate aminotransferase
ALT
Alanin aminotransferase
GGT
Gamma glutamyl transferase
biological molecules that act as catalysts, facilitating and accelerating chemical reactions within living organisms.
Enzymes
enzyme found in various tissues throughout the body, which catalyzes the hydrolysis of phosphate groups from various substrates under alkaline conditions.
Alkaline phosphatase
Alkaline phosphates has a particularly high concentrations in
Liver, bones, bile duct
catalyzes the transfer of gamma- glutamyl groups from molecules such as glutathione to amino acids and peptides.
Gamma-glutamyl transferase (GGT)
This enzyme is high during hepatobiliary disorder and alcoholic hepatitis
GGT
Prompt
Conjugated bilirubin
Slow-reacting
Unconjugated bilirubin
Cholebilirubin
Conjugated bilirubin
Hemobilirubin
Unconjugated bilirubin
RV: AST
5-35 U/L
RV: ALT
7-45 U/L
RV: total protein
6.5 to 8.3 g/dL
RV: total albumin
3.5 to 5.5 g/dL
RV: total bilirubin
0.2 to 1.0 mg/dL
RV: ammonia
11-35 umol/L
What condition
AST, ALT, Bilirubin = High
TP, Albumin, Ammonia = Normal
Hepatitis
What condition
Bilirubin, ammonia = High
AST, ALT = normal
TP, albumin = low
Cirrhosis
What condition
Bilirubin = High
All = normal
Biliary obstruction
What condition
All = High
TP, Albumin = low
Fulminant failure
