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Clinical Pathology > Liver Function > Flashcards

Liver Function Flashcards

1
Q

What are the functions of the liver?

A

Protein metabolism
Carbohydrate metabolism
Lipid metabolism
Storage function (glycogen, triglycerides, iron, and copper)
Detoxification
Mononuclear phagocyte system through Kupffer cells
Excretory function

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2
Q

What is bile acids dependent?

A

BA excretion increased water excretion due to osmotic gradient

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3
Q

What is BA independent?

A

Active transport Na, glutathione, and HCO3; promote bile formation

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4
Q

How does secretin promote bile formation?

A

By stimulating HCO3 and Cl secretion into bile

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5
Q

What are the components of bile?

A 
H2O
BA
Conjugate bilirubin
Lecitin
Cholesterol
Fatty acids
Electrolytes
Water soluble wastes
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6
Q

What are abnormal CBC results due to hepatic insufficiency or disease?

A

Acanthocytosis
Anemia
Codocytosis
Microcytosis

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7
Q

What are abnormal chemistry assays due to hepatic insufficiency or disease?

A 
Decreased BUN
Hyperammonemia
Hyperbilirubinemia
Hyper/Hypocholesterolemia
Hyper/Hypoglycemia
Hyperuricemia
Hypoalbuminemia
Hypoproteinemia
Hypofibrinogenemia
Increased ALT, AST, LD, ID, GMD, AST, GGT
Lipemia
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8
Q

What are abnormal UA results due to hepatic insufficiency or disease?

A

Ammonium biurate crystalluria
Bilirubinuria
Hyposthenuria
Isosthenuria

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9
Q

What are other abnormal lab results due to hepatic insufficiency or disease?

A

Prolonged PTT, PT
Ascites
Steatorrhea

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10
Q

What is hepatic insufficiency?

A

Pathophysiological state where there is a marked reduction on functioning hepatocytes numbers

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11
Q

What is cholestasis?

A

Stoppage or suppression of bile flow

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12
Q

What causes stoppage of bile flow?

A

Distended bile ducts and bile plugs

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13
Q

What causes suppression of bile flow?

A

Decreased BA secretion

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14
Q

What is icterus caused by?

A

Hyperbilirubinemia

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15
Q

What causes obstructive biliary disease?

A

Decreased Bc and BA excretion

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16
Q

What does bilirubin come from?

A

Heme

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17
Q

What does BA come from?

A

Cholesterol

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18
Q

What are the 3 type of bilirubin in the plasma?

A 
Unconjugated bilirubin (Bu) bound to albumin
Conjugated bilirubin (Bc)
Conjugated bilirubin bound covalently to albumin (δ)
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19
Q

What is bilirubin cleared by?

A

The liver or kidneys

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20
Q

In what species is small amounts of bilirubin commonly present in urine?

A

Dogs

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21
Q

What can bilirubin be measured by?

A

Wet colorimetric assay or dry chemistry

22
Q

How is [Bt] calculated with wet colorimetric?

A

[Bc] + [Bδ] + [Bu]

23
Q

How is [Bc] calculated with wet colorimetric?

A

[Bc] + [Bδ]

24
Q

How is [Bu] calculated with wet colorimetric?

A

[Bt] - [Bc]

25
Q

How is [Bδ] calculated?

A

Only from dry chemistry

[Bt] - [Bu] - [Bc]

26
Q

How do you calculate Bt with dry chemistry?

A

[Bu] + [Bc] + [Bδ]

27
Q

What are causes of hyperbilirubinemia?

A

Increased Bu production (prehepatic)
Decreased uptake by hepatocytes (hepatic)
Obstructive cholestasis (posthepatic)
Functional cholestasis (posthepatic)

28
Q

What are the findings associated with increased Bu production?

A 
Bt may be markedly increased
Early: [Bu] > [Bc]
Later: [Bu] = [Bc]
Regenerative anemia
Hemoglobinuria or hemoglobinemia
Bilirubinuria
29
Q

What are the non-hemolytic increased Bu production?

A

Ineffective erythropoiesis
Destruction of myoglobin
Cytochromes
Peroxidases

30
Q

What are causes of decreased uptake by hepatocytes associated with hyperbilirubinuria?

A

Fasting hyperbilirubinemia:
Horses that are off feed
Anorexic cattle with rumen stasis

Decreased functional hepatic mass

31
Q

What causes impairment of bile flow?

A

Hepatocellular swelling
Periportal lesions that compress bile ducts
Other process that damage or compress bile ducts (infection, neoplasia, etc.)

32
Q

What is the cause of functional cholestasis?

A

Impaired excretion of Bc without biliary obstruction

33
Q

What is an additional finding with functional cholestasis?

A

Inflamamtory leukogram

34
Q

What happens to most of the bile acids secreted in the intestines in healthy animals?

A

Resorbed by the intestines and reuptaken by hepatocytes

35
Q

What may happen after intestinal resorption of BA?

A

It may overwhelm the liver’s ability to uptake causing postprandial increased in [Ba]

36
Q

What assay is used to measure bile acids?

A

Colorimetric assay

37
Q

What are the 2 major pathologic processes of increased bule acids?

A

Decreased BA clearance from portal circulation

Decreased biliary excretion of BA

38
Q

What causes decreased BA clearance from portal circulation?

A

Decreased hepatic function caused by any mechanism

39
Q

What causes decreased biliary excretion of BA?

A 
Hepatic or posthepatic cholestasis by any mechanism
Hepatocytes may pump BA in sinusoidal circulation (regurgitation)
Functional cholestasis (inflammatory cytokines)
40
Q

What are factors other than hepatobiliary that can change results of BA?

A 
Fasting BA (spontaneous contraction of gallbladder, intestinal diseases)
2h postprandial
41
Q

What is the most common form of ammonium in plasma?

A

NH4, not NH3 (ammonia)

42
Q

Where can you get a sample of ammonium?

A

Plasma, not whole blood

43
Q

What can cause a false increase in NH4?

A

Hemolysis

44
Q

What are causes of increased ammonium?

A

Decreased clearance from portal blood
Decreased clearance due to congenital diseases that involve the urea cycle
Increased production
Increased intake or absorption

45
Q

What are causes of decreased clearance from portal blood that causes an increase in ammonium?

A

Diffuse hepatocellular disease that reduces functional mass

Portosystemic shunts

46
Q

What are causes of an increased production of ammonium?

A

Urea toxicosis in cattle
Strenuous exercise
Urinary infection with urease-containing bacteria
Intestinal diseases in horses

47
Q

What are causes of increased intake or absorption?

A

NH4Cl for ammonia tolerance test
NH3 treated forage
Malicious release of NH3 from storage tanks

48
Q

What is the ammonium toelerance test?

A

NH3Cl is administered to challenge removal from portal circulation and/or challenge to hepatocytes urea cycle

49
Q

When is the tolerance test not recommended?

A

If there is fasting hyperammonemia

50
Q

What does increased ammonium mean with the tolerance test?

A

Decreased functional hepatocyte mass or PSS

Clinical Pathology (16 decks)

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