Liver Function Flashcards by Secret Shh

Weight of liver

1.2 to 1.5 kg

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Liver is a reddish brown organ that is located beneath the ______ and protected by _______

Beneath the diaphragm and protected by lower rib cage

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Liver is held by what

Ligament

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Largest organ of the body

Skin gaga, di ko naman sinabing internal organ

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The right and left lobe of the liver is divided by what

Falciform ligament

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Which is larger? Right or left lobe

Right = 6 times larger

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Structural unit of the liver

Lobule

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Functional unit of the liver

Hepatocyte

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2 major cells of the liver

Hepatocyte
Kupffer cells

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Cells that regenerates the liver

Hepatocyte

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Macrophages of the liver

Kupffer cells

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Kupffer cells are found lining the ____

Sinusoid

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2 major source of blood

Hepatic artery
Portal vein

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This supplies the liver with oxygen rich blood

Hepatic artery

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Hepatic artery supplies ____rich blood

Oxygen

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This supplies the liver with nutrient rich blood

Portal vein

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Portal vein supplies the liver with ___ rich blood

Nutrient

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Hepatic artery = ____% blood supply

Portal vein = ____% blood supply

25% ; 75%

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Blood from the liver exits where

Central canal / central vein

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Portal vein and hepatic artery merge in _____

Hepatic sinusoid

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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

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Each lobule is roughly a ____ structure

six-sided structure

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Portal of triad

Hepatic artery
Portal vein
Bile duct

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System of the liver (3)

Hepatocyte system
Biliary system
Reticuloendothelial system

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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)

1. Bile acids or salt 2. Bile pigments 3. Cholesterol 4. 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

1. Pre hepatic jaundice or hemolytic hyperbilirubinemia 2. Hepatic jaundice or hepatocellular hyperbilirubinemia 3. 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

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