LIVER FUNCTION (BOOK) Flashcards
1
Q
a very large and complex organ responsible
for performing vital tasks that impact all body systems
A
liver
2
Q
The liver has a myriad of functions, including the metabolism of? (4)
A
carbohydrates, lipids, proteins, bilirubin
3
Q
Functions of the Liver (4)
A
Detoxification
Synthetic/Metabolism
Storage
Excretion/Secretion
4
Q
T or F: The liver is unique in the sense that it is a relatively resilient organ that can regenerate cells that have been destroyed by some short-term injury or disease or have been removed such as in the case of organ donors.
A
T
5
Q
T or F: if the liver is damaged repeatedly over a long period of time, it may undergo irreversible changes that permanently interfere with its essential functions.
A
T
6
Q
T or F: If the liver becomes completely nonfunctional for any reason,
death will occur within approximately 24 hours due to hyperglycemia.
A
F (hypoglycemia)
7
Q
Approximate weight of the liver in kg
A
1.2-1.5 kg
8
Q
T or F: The liver is located beneath and attached to the diaphragm, protected by the upper rib cage, and held in place by ligamentous attachments.
A
F (lower ribcage)
9
Q
The liver is divided into how many lobes?
A
2
10
Q
T or F: The liver is divided equally into two lobes by the falciform ligament.
A
F (unequal, mas malaki right)
11
Q
T or F: The right lobe is approximately six times larger than the left lobe.
A
T
12
Q
Two main sources of the liver’s blood supply
A
Hepatic artery & portal vein
13
Q
a branch of the aorta, supplies oxygen-rich blood from the heart to the liver and is responsible for providing approximately 25% of the total blood supply
A
Hepatic Artery
14
Q
% blood supply provided by the hepatic artery
A
25%
15
Q
supplies nutrient- rich blood, collected from the digestive tract as food is digested; this vein is responsible for providing approximately 75%
of the total blood supply to the liver
A
Portal Vein
16
Q
% of blood supply provided by the portal vein
A
75%
17
Q
The hepatic artery & portal vein eventually merge into the _______ _____ which is lined with hepatocytes capable of removing potentially toxic substances from the blood
A
hepatic sinusoid
18
Q
From
the sinusoid, blood flows to the _____ _____ (_____ _____) of each lobule
A
central canal / central vein
19
Q
It is through this vessel that blood leaves the liver
A
central canal
20
Q
Approximately how much blood passes through the liver / min?
A
1500 mL
21
Q
The liver is drained by a collecting system of veins that empties into the ______ _____ and ultimately into the (superior inferior?) vena cava
A
hepatic veins; inferior
22
Q
are small spaces between
the hepatocytes that form intrahepatic ducts, where excretory products of the cells can drain.
A
bile canaliculi
23
Q
Arrange the following by the order of excretion
- right & left hepatic ducts
- common bile duct
- bile canaliculi
- cystic duct (in the gallbladder)
- common hepatic duct
- intrahepatic ducts
A
- bile canaliculi
- intrahepatic ducts
- right & left hepatic ducts
- common hepatic duct
- cystic duct (in the gallbladder)
- common bile duct
3-6-1-5-4-2
24
Q
Where can the cystic duct be located?
A
gallbladder
25
The _____ are the functional units responsible for all metabolic and excretory functions performed by the liver.
lobules
26
roughly a six-sided structure with a centrally located vein (called the central vein) with portal triads at each of the corners
lobules
27
3 components of the portal triad
hepatic artery
portal vein
bile duct
28
2 major cell types in the liver
Kuppfer cells
hepatocytes
29
makes up approx. 80% of the volume of the liver; large cells that radiate in plates from central vein to the periphery of the lobules
hepatocytes
30
perform the major functions associated with the liver and are responsible for the liver’s regenerative properties.
hepatocytes
31
macrophages that line the sinusoids of the liver and act as active phagocytes capable of engulfing bacteria, debris, toxins, and other substances flowing through the sinusoids
Kuppfer cells
32
Kupffer cells are macrophages that line
the _____ of the liver and act as active phago-
cytes capable of engulfing bacteria, debris, toxins, and other substances flowing through the sinusoids
sinusoids
33
T or F: One of the most important functions of the liver’s is the processing and excretion of endogenous and exogenous substances into the bile or urine such as the major globin waste product, bilirubin
F. (major heme waste product)
34
T or F: The liver is the only organ that has the capacity to rid the body of heme waste products
T
35
____ is made up of bile acids or salts, bile pigments, cholesterol, and other sub-
stances extracted from the blood
Bile
36
T or F: The body produces approximately 3 L of bile per day and excretes 1 L of what is produced.
T
37
principal pigment in bile, and it is derived from the breakdown of red blood cells
Bilirubin
38
_____ is degraded to heme, globin, and iron.
hemoglobin
39
After hemoglobin catabolism, which are the two components that can be reused by the body? Which is further degraded to become bilirubin?
Reused: Iron (via transferrin) & globin (to AA pool)
Further converted: heme
40
The heme portion of
hemoglobin is converted to bilirubin in ______ hours
2-3
41
Bilirubin bound (not covalent) by albumin & transported to the liver
B1, indirect, or unconjugated bilirubin
42
Insoluble in water, alcohol soluble.
B1, indirect, or unconjugated bilirubin
43
Once at the liver cell, unconjugated bilirubin flows into the sinusoidal spaces and is released from albumin and then picked up by a carrier protein called _____
ligandin
44
Ligandin, which is located inside the hepatocyte, is responsible for transporting unconjugated bilirubin to the ______ _______, where it is conjugated.
endoplasmic reticulum
45
The conjugation (esterification) of bilirubin occurs in the presence of the enzyme?
uridine diphosphate glucuronosyltransferase (UDPGT)
46
UDPGT transfers a glucuronic acid molecule to each of the two propionic acid side chains of bilirubin to form _______ _______, also known as _______ _______
bilirubin diglucuronide; conjugated bilirubin
47
water soluble, alcohol insoluble, can be secreted directly from hepatocyte to bile canaliculi
Conjugated bilirubin, B2, direct bilirubin
48
Intestinal bacteria (especially the bacteria in the lower portion of the intestinal tract)
work on conjugated bilirubin to produce ______, which is reduced to form ________ and then _________
mesobilirubin, mesobilirubinogen, urobilinogem
49
Color of urobilinogen
colorless
50
Most of the urobilinogen formed (roughly 80%) is oxidized to an _____-colored product called _________ and is excreted in the feces.
orange-; stercobilin
51
What happens to the remaining 20% of urobilinogen?
1. absorbed by extrahepatic circulation, recycled in the liver, re-excreted
2. enter systemic circulation, filtered by kidney, excreted in urine
52
T or F: Approximately 200 to 300 mg of bilirubin is produced per day,
T (as per the book)
53
T or F: Almost all the bilirubin formed
is eliminated in the feces, and a small amount of the colorless product, urobilinogen, is excreted in the urine.
T
54
The healthy adult has very low levels of total
bilirubin (______ to ______ mg/dL) in the serum, and of this amount, the majority is in the ______ form
0.2-1.0 mg/dL; unconjugated
55
When carbohydrates are ingested and absorbed, the liver can process them in one of three ways:
1. use glucose for own cellular energy requirements
2. circulate glucose for use at peripheral tissues
3. store glucose as glycogen
56
Under conditions of stress or in a fasting state when there is an increased requirement for glucose, the liver will break down stored glycogen (________), and when the supply of glycogen becomes depleted, the liver will create glucose from non-sugar carbon substrates like pyruvate, lactate, and amino acids ( _________).
glycogenolysis; gluconeogenesis
57
The liver is responsible for metabolizing both lipids and the lipoproteins and is responsible for gathering free fatty acids from the diet, and those produced by the liver itself, and breaking them down to produce ___________
acetyl-coA
58
T or F: The greatest source of cholesterol in the body comes from the dietary sources.
F (Despite popular belief, the greatest source
of cholesterol in the body comes from the cholesterol produced by the liver, not from dietary sources - bishop)
59
T or F: approximately 70% of the daily production of cholesterol (roughly 1.5 to 2.0 g) is produced by the liver
T
60
Almost all proteins are synthesized by the liver
except for the ______ and adult _______
immunoglobulins; hemoglobin + von willebrand factor
61
T or F: Since the liver processes include metabolism of proteins, The most critical aspect of protein metabolism includes transamination and deamination of amino acids.
T
62
It results in the exchange of an amino group on one acid with a ketone group on another acid.
Transamination
63
After transamination, _________
degrades them to produce ammonium ions that are consumed in the synthesis of urea, which is excreted by the kidneys
deamination
64
T or F: The liver serves as a gatekeeper between substances absorbed by the gastrointestinal tract and those released into systemic circulation
T
65
Every substance that is absorbed in the gastrointestinal tract must pass through the liver before reaching the rest of the body
First pass
66
The liver has two mechanisms for detoxification of foreign & metabolic products, which are:
1. binding the material to inactivate compound
2. chemical modification to excrete the compound
67
Detoxification of the liver can be via. (give atleast 2)
oxidation, reduction, hydrolysis, hydrox-
ylation, carboxylation, and demethylation.
68
T or F: Many of
these take place in the liver microsomes via the cytochrome P-450 (CYP450) isoenzymes
T
69
The word jaundice comes from the French word _____ meaning ______
jaune; yellow
70
one of the oldest known pathologic conditions reported, having been described by Hippocratic physicians.
jaundice
71
used to describe the yellow discoloration of
the skin, eyes, and mucous membranes, most often resulting from the retention of bilirubin
jaundice
72
Although the upper limit of normal for total bilirubin is 1.0 to 1.5 mg/dL, jaundice is usually not noticeable to the human eye (known as _____ jaundice) until bilirubin levels reaches 3.0 to 5.0 mg/dL
overt
73
jaundice is usually not noticeable to the
human eye (known as overt jaundice) until bilirubin levels reaches _____ to ______ mg/dL
3.0 to 5.0 mg/dL
74
used in the clinical laboratory to refer to a serum or plasma sample with a yellow discoloration due to an elevated bilirubin level
icterus
75
Classification of Jaundice based on the site of disorder:
prehepatic, hepatic, posthepatic
76
_____ and ______ jaundice, as the names imply, are caused by abnormalities outside the liver
prehepatic & posthepatic
77
T or F, in pre-hepatic & post-hepatic jaundice, liver function is normal, or it may be functioning at a maximum to compensate for abnormalities occurring elsewhere.
T
78
Classify: Pre-hepatic, hepatic, post hepatic:
jaundice is due to a problem with the liver itself
Hepatic
79
Classify: Pre-hepatic, hepatic, post hepatic:
problem causing the jaundice occurs prior to liver metabolism
Pre-hepatic
80
Classify: Pre-hepatic, hepatic, post hepatic:
Seen in acute & chronic hemolytic anemia
Pre-hepatic
81
Classify: Pre-hepatic, hepatic, post hepatic:
Hemolytic jaundice
Pre-hepatic
82
T or F: Individuals with hepatic jaundice rarely have bilirubin levels that exceed 5.0 mg/dL because the liver is working efficiently to handle the increased workload.
F (pre-hepatic)
83
Classify whether pre-hepatic, hepatic, or post-hepatic:
unconjugated hyperbilirubinemia
Pre-hepatic
84
Classify whether pre-hepatic, hepatic, or post-hepatic:
due to hepatocellular injury or destruction
Hepatic
85
Classify whether pre-hepatic, hepatic, or post-hepatic:
Due to intrinsic liver defect / disease
Hepatic
86
Give examples of diseases that cause hepatic jaundice
1. Crigler-Najjar syndrome
2. Dubin-Johnson syndrome
3. Gilbert’s disease
4. neonatal physiologic jaundice of the newborn
87
Gilbert’s disease, Crigler-Najjar syndrome, and
physiologic jaundice of the newborn are hepatic causes of jaundice that result in elevations in (conjugated/unconjugated) bilirubin.
unconjugated bilirubin
88
Conditions such as Dubin-Johnson
and Rotor syndrome are hepatic causes of jaundice that result in elevations in ______ bilirubin
conjugated
89
Match: B1 or B2
1. Dubin-Johnson Syndrome
2. Gilbert’s disease
3. Rotor syndrome
4. Crigler-Najjar Syndrome
5. Physiologic Jaundice of the Newborn
1. B2
2. B1
3. B2
4. B1
5. B1
90
a benign autosomal recessive
hereditary disorder that affects approximately 5% of the U.S. population
Gilbert’s syndrome
91
results from a genetic mutation in the UGT1A1 gene that produces the enzyme uridine diphosphate glucuronosyltransferase
Gilbert’s Syndrome
92
Gilbert’s syndrome results from
a genetic mutation in the ____ gene
UGT1A1
93
The UGT1A1 gene is located on chro-
mosome ___, and other mutations of this same gene produce _______ syndrome, a more severe and dangerous form of hyperbilirubinemia.
2; Crigler-Najjar syndrome
94
most common cause, carries no morbidity or mortality in the majority of those affected
Gilbert’s Syndrome
95
characterized by intermittent
unconjugated hyperbilirubinemia, underlying liver disease due to a defective conjugation system in the absence of hemolysis
Gilbert’s Syndrome
96
The ______ of an extra TA in the sequence, as seen in Gilbert’s syndrome, reduces the expression of the UGT1A1 gene to 20% to 30% of normal values
insertion
97
Crigler-Najjar syndrome was first described by
Crigler and Najjar in 1952 as a syndrome of chronic nonhemolytic (conjugated/unconjugated?) hyperbilirubinemia.
unconjugated
98
Crigler-Najjar syndrome may be divided into two types. How do you differentiate the two?
type 1 = complete absence of enzymatic bilirubin conjugation
type 2 = mutation causing severe deficiency
(parang insulin type 1 & 2 lol)
99
Classify: Gilbert or Crigler-Najjar
rare, can result in death
Crigler-Najjar
100
is a rare, autosomal recessive–inherited disorder caused by a deficiency of the canalicular multidrug resistance/multispecific organic anionic transporter protein (MDR2/cMOAT).
Dubin-Johnson syndrome
101
T or F: In dubin-johnson syndrome, the liver’s
ability to uptake and conjugate bilirubin is func-
tional; however, the removal of conjugated bili-
rubin from the liver cell and the excretion into the bile are defective
T
102
This results in accumulation of
conjugated and, to some extent, unconjugated bilirubin in the blood, leading to hyperbilirubinemia and bilirubinuria
Dubin-Johnson Syndrome
103
condition that is obstructive in nature, so much of the conjugated bilirubin circulates bound to albumin.
Dubin-Johnson Syndrome
104
conjugated bilirubin bound to albumin
delta bilirubin
105
Distinguishing feature is the appearance of dark stained granules (thought to be pigmented lysosomes) on a liver biopsy sample.
Dubin-Johnson Syndrome
106
first described in 1948 and
is an autosomal recessive disease caused by mutations in both the SLCO1B1 and SLCO1B3 genes on chromosome 12
Rotor Syndrome
107
the proteins are abnormally short; therefore, bilirubin is less efficiently taken up by the liver and removed
Rotor Syndrome
108
Morse: Rotor Syndrome is a rare yet benign condition characterized by chronic jaundice. Therefore, it requires treatment.
TF (it does not require tx)
109
T or F: Abnormal levels of alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) seen in Rotor syndrome distinguish it from biliary obstruction. Abnormal levels of urinary coproporphyrin excretion with normal liver histology distinguish it from Dubin-Johnson syndrome
F - T (normal levels of alp & ggt)
110
neonatal hyperbilirubinemia,
Physiologic Jaundice of the Newborn
111
premature infants may be born with a UDPGT deficiency, resulting in the rapid buildup of unconjugated bilirubin, which can be life threatening.
Physiologic Jaundice of the Newborn
112
When unconjugated bilirubin builds up in the
neonate, it is deposited in the brain, causing a form of brain injury
kernicterus
113
Tx for physiologic jaundice of the newborn
1. phototherapy
2. exchange transfusion
3? phenobarbitone tx
3. IVIG
5. metalloporphyrins
114
the baby’s skin is exposed to the light, while the
baby’s eyes are covered to protect the nerve layer at the retina from the bright light
phototherapy
115
involves removing aliquots of
neonatal blood and replacing it with donor blood to remove the hyperbilirubinemia from circulation while maintaining adequate blood volume
exchange transfusion
116
aims to decrease plasma concentration of unconjugated bilirubin by inhibiting production, stimulating hepatic clearance, or interrupting the enterohepatic circulation of the
pigment
pharmacological tx
117
results from biliary obstructive disease, usually from physical obstructions (gallstones or tumors) that prevent the flow of conjugated
bilirubin into the bile canaliculi
Post-hepatic jaundice
118
In post-hepatic jaundice, since bile is not being brought to the intestines, stool loses its source of normal pigmentation and becomes ____-colored
clay
119
scar tissue replaces normal, healthy liver tissue; blocking the flow of blood through the organ and prevents the liver from functioning properly
Cirrhosis
120
Signs & Symptoms of Cirrhosis include:
fatigue
nausea
unintended weight loss
jaundice
bleeding from GIT
intense itching & swelling of legs & abdomen
121
Prognosis for those w/ cirrhosis (good or poor)?
Poor
122
Causes of cirrhosis
1. chronic alcoholism (haha venmar)
2. hepatitis b, c, d
3. autoimmune hepatitis
4. iberited disorders (aat deficiency, wilsons disease, hemochromatosis, galactosemia)
5. non-alcoholic steatohepatitis
6. blocked bile ducts
7. drugs, toxins, infections
123
Causes of cirrhosis
1. chronic alcoholism (haha venmar)
2. hepatitis b, c, d
3. autoimmune hepatitis
4. iberited disorders (aat deficiency, wilsons disease, hemochromatosis, galactosemia)
5. non-alcoholic steatohepatitis
6. blocked bile ducts
7. drugs, toxins, infections
124
Differentiate primary & metastatic liver cancer
Primary liver cancer is cancer that begins in
the liver cells, while metastatic cancer occurs when
tumors from other parts of the body spread
125
Which is more common, primary or metastatic?
Metastatic
126
Classify whether benign or malignant: hepatocellular adenoma
benign
127
Classify whether benign or malignant:
hemangioma
benign
128
Classify whether benign or malignant:
hemangioma
benign
129
Benign condition occuring almost exclusively in females of childbearing age
Hepatocellular adenoma
130
masses of blood vessels with no known
etiology
hemangioma
131
also known as
hepatocarcinoma, and hepatoma
hepatocellular carcinoma
132
most common primary liver malignancy, is the leading cause of death worldwide
Hepatocellular carcinoma
133
used to describe a group of disorders caused by infectious, metabolic, toxic, or drug-induced disease found almost exclusively in children,
Reye’s Syndrome
134
often preceded by a viral syndrome such as varicella, gastroenteritis, or an upper respiratory tract infection such as
influenza
Reye’s Syndrome
135
Syndrome associated with viral infection & aspirin intake
Reye’s Syndrome
136
acute illness characterized by noninflammatory encephalopathy and fatty degeneration of the liver, with a clinical presentation of profuse vomiting accompanied with varying degrees of neurologic impairment such as fluctuating personality changes and deterioration in consciousness.
Reye’s Syndrome
137
Of all the drugs associated with hepatic toxicity,
the most important is _____
ethanol
138
Alcohol-induced liver injury
may be categorized into three stages:
1. alcoholic fatty liver
2. alcoholic hepatitis
3. alcoholic cirrhosis
139
_________ is very common and rep-
resents the mildest category where very few changes in liver function are measurable
Fatty liver disease
140
characterized by slight elevations in AST, ALT, and y-glutamyltransferase (GGT), and on biopsy, fatty infiltrates are noted in the vacuoles of the liver.
fatty liver disease
141
presents with common signs
and symptoms including fever, ascites, proximal muscle loss, and laboratory evidence of liver damage such as moderately elevated AST, ALT, GGT, ALP, and elevations in total bilirubin greater than 5 mg/dL.
alcoholic hepatitis
142
The elevations in ALT are comparatively lower than AST, resulting in an AST/ALT ratio (De Ritis ratio) greater than 2.
Alcoholic hepatitis
143
The elevations in ALT are comparatively lower than AST, resulting in an AST/ALT ratio (De Ritis ratio) greater than 2.
Alcoholic hepatitis
144
Increase/Decrease
In alcoholic hepatitis,
serum proteins such as albumin are _____
ptt is ______
decreased; increased ____
145
The last and most severe stage is
alcoholic cirrhosis
146
This condition appears to be more common
in males than in females, and the symptoms tend to be nonspecific and include weight loss, weakness, hepatomegaly, splenomegaly, jaundice, ascites, fever, malnutrition, and edema.
alcoholic cirrhosis
147
Lab test for alcoholic cirrhosis (increased/decreased)
liver function test (ADT, ALT, GGT, ALP, TB)=
albumin=
ptt =
liver function tests = increased
albumin = decreased
ptt = prolonged
148
T or F: A liver biopsy,is the only method by which a definitive diagnosis may be made.
T
149
T or F: When acetaminophen is taken in massive doses, it is virtually certain to produce fatal hepatic necrosis unless rapid treatment is initiated.
T
150
Inc/Dec
Prehepatic jaundice
TB=
CB=
UB=
TB = INCREASED
CB = VARIED
UB = INCREASED
151
Inc/Dec
Hepatic jaundice - Gilbert’s Disease
TB=
CB=
UB=
TB = INC
CB = VARIED
UB = INC
152
Inc/Dec
Hepatic jaundice = Crigler-Najjar Syndrome
TB=
CB=
UB=
TB = INC
CB = DEC
UB = INC
153
Inc/Dec
Hepatic jaundice = Dubin-Johnson Syndrome
TB=
CB=
UB=
TB = INC
CB= INC
UB= VARIED
154
Inc/Dec
Hepatic jaundice = Rotor’s Syndrome
TB=
CB=
UB=
TB= INC
CB= INC
UB= VARIED
155
Inc/Dec
Hepatic jaundice = Physiologic Jaundice of Newborn
TB=
CB=
UB=
TB= INC
CB= VARIED
UB= INC
156
Inc/Dec
Posthepatic Jaundice
TB=
CB=
UB=
TB= INC
CB= INC
UB= INC
