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Clinical Chemistry 2 (Lecture) > Liver Function (P) > Flashcards

Liver Function (P) Flashcards

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1
Q

What are the characteristics of the liver?

A

1) It is the largest organ
2) It is functionally complex
3) It is unique because it is resilient whereas it has the ability to regenerate cells destroyed by short-term injury or disease

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2
Q

The liver plays a critical role in what?

A

1) Metabolism
2) Synthesis
3) Detoxification
4) Elimination of substances from body

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3
Q

What are lobules?

A

These are the microscopic units that divide the liver

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4
Q

What is the function of lobules?

A

These are responsible for all metabolic and excretory functions

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5
Q

What is the characteristic of lobules?

A

These are 6- sided structures w/ centrally located vein and portal triads

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6
Q

What are the components of portal triad?

A

1) Hepatic artery
2) Portal vein
3) Bile duct

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7
Q

What are the 2 major cell types in the liver?

A

1) Hepatocytes

2) Kupffer cells

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8
Q

What are hepatocytes?

A

These are large cells radiating outward from central vein

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9
Q

What are kupffer cells?

A

These are macrophages lining the sinusoids

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10
Q

What are the functions of kupffer cells?

A

1) These act as phagocytes

2) These engulf bacteria, debris, and toxins

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11
Q

What are the biochemical functions done by the liver?

A

1) Excretory and Secretory
2) Metabolism
3) Detoxification and Drug Metabolism

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12
Q

In terms of excretory and secretory functions, what is the liver capable of?

A

1) Liver is the only organ w/ the capacity to rid body of heme waste
2) It secretes bile
3) It excretes bili

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13
Q

The bile is made up of what?

A

1) Bile acids or salts
2) Bile pigments
3) Chole

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14
Q

What is the volume of bile being produced by the body per day?

A

3 L

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15
Q

What is the volume of bile being excreted by the body?

A

1 L

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16
Q

What is bili?

A

It is the principal pigment in bile

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17
Q

Bili is derived from what?

A

From the breakdown of RBCs

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18
Q

What is the volume of bili produced by the liver per day?

A

200 - 300 mg/day

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19
Q

Most of the bili is eliminated where?

A

In feces

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20
Q

Some of the bili is eliminated where?

A

In urine

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21
Q

In terms of metabolism function, what can be synthesized by the liver?

A

1) Carbs synthesis
2) Lipid synthesis
3) Protein synthesis

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22
Q

What is the principle of carbs synthesis done by the liver?

A

The liver maintains stable glucose concentrated by storing it as glycogen and degrading glycogen when needed by the body

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23
Q

What is the principle of lipid synthesis done by the liver?

A

The liver breaks down fatty acids to form TAGs, phospholipids, or chole

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24
Q

In terms of detoxification and drug metabolism functions, what is the principle being done by the liver?

A

The liver prevents toxic or harmful substances from reaching systemic circulation by binding or chemical modification

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25
Q

What is jaundice?

A

It is the yellow discoloration of skin, eyes, and mucous membranes

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26
Q

Jaundice results from what?

A

It results from the retention of bili or other substances

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27
Q

How is jaundice classified?

A

It is classified based on the site of disorder

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28
Q

What are the classifications of jaundice?

A

1) Prehepatic
2) Hepatic
3) Posthepatic

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29
Q

What is prehepatic jaundice?

A

This is where problem occurs before the liver

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30
Q

What is hepatic jaundice?

A

This is where problem occurs in the liver

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31
Q

What is posthepatic jaundice?

A

This is where problems occurs after the liver

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32
Q

What is cirrhosis?

A

It is a condition in w/c scar tissue replaces healthy liver tissue

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33
Q

What is the principle of action of cirrhosis?

A

The scar tissue blocks blood flow and prevents proper functioning

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34
Q

Cirrhosis is commonly caused by what?

A

1) Chronic alcoholism
2) Hepatitis C infection
3) Chronic hepatitis B
4) Chronic hepatitis D
5) Autoimmune disorders
6) This can also be inherited

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35
Q

90 - 95% of hepatic malignancies are what?

A

Metastatic

36
Q

True or False

The 90 - 95% of hepatic malignancies primarily originates in the liver cells

A

False, because the 90 - 95% of hepatic malignancies primarily does not originate in the liver cells

37
Q

What are the 2 types of tumors?

A

1) Benign

2) Malignant

38
Q

What are the exs of benign tumors?

A

1) Hepatocellular adenoma

2) Hemangiomas

39
Q

What are the exs of malignant tumors?

A

1) Hepatocellular carcinoma
2) Hepatocarcinoma
3) Hepatoma

40
Q

What is Reye syndrome?

A

It is a grp of disorders caused by infectious, metabolic, toxic, or drug-induced disease found predominantly in children

41
Q

What are the characteristics of Reye syndrome?

A

1) It is often produced by viral syndrome such as varicella, gastroenteritis, or upper respiratory tract (influenza)
2) It is associated w/ ingestion of aspirin during viral syndrome
3) It is an acute illness characterized by:
A. Noninflammatory encephalopathy
B. Fatty degeneration of liver
C. Clinical presentation of profuse vomiting
D. Neurologic impairment

42
Q

What is the characteristic of drug-induced liver disease (in terms of reported cases)?

A

It accounts for 1/3 to 1/2 of all reported cases of acute liver failure in U.S.

43
Q

What is the most common mechanism of injury (in connection w/ drug-induced liver disease)?

A

Adverse immune response to drug directed against liver

44
Q

What is the most significant cause of hepatic toxicity?

A

Ethanol (alcohol)

45
Q

What are the 3 stages of liver injury due to excessive alcohol consumption?

A

1) Alcoholic fatty liver
2) Alcoholic hepatitis
3) Alcoholic cirrhosis

46
Q

What are the characteristics of alcoholic fatty liver?

A

1) Mild

2) Recovery w/ removal of drug

47
Q

What is the characteristic of alcoholic hepatitis?

A

It is the evidence of liver damage

48
Q

What are the characteristics of alcoholic cirrhosis?

A

1) Most severe

2) Poor prognosis

49
Q

What is the method / technique for measuring bili where all commonly used methods stem from?

A

From technique described by Malloy & Evelyn in 1937

50
Q

What is the principle of action of the technique described by Malloy & Evelyn?

A

Based on the rxn of bili w/ a diazotized sulfanilic acid solution w/ a 50% methanol solution as an accelerator

51
Q

In the neonatal population, bili can also be quantified by what?

A

Bilirubinometry

52
Q

What are the 3 fractions of bili (for analysis)?

A

1) Conjugated (direct)
2) Unconjugated (indirect)
3) Delta

53
Q

In terms of sx collection, what are the sxs that can be used for bili measurement?

A

1) Serum or 2) plasma

54
Q

What is the preferred sx for performing bili measurement?

A

Serum

55
Q

What is the type of sx that is preferred for bili measurement?

A

Fasting sx

56
Q

What type of sx should be avoided when measuring bili?

A

Hemolyzed sxs

57
Q

In terms of sx storage, what is the consideration that should be considered and what is the resolution for this storage consideration?

A

Bili is sensitive to light, hence, it should be protected

58
Q

What are the methods that are most commonly used for bili measurement?

A

1) Jendrassik-Grof or

2) Malloy Evelyn

59
Q

What is urobilinogen?

A

It is a colorless end product of bili metabolism

60
Q

Urobilinogen is oxidized by what?

A

Intestinal bacteria

61
Q

What is the purpose for oxidizing urobilinogen by intestinal bacteria?

A

Urobilinogen is oxidized by intestinal bacteria to brown pigment urobilin

62
Q

What are the conditions / diseases where increased lvls of urobilinogen in the urine are present?

A

1) Hemolytic disease

2) Defective liver cell function

63
Q

What is the condition / disease where the absence of urobilinogen from urine / stool is present?

A

Complete biliary obstruction

64
Q

Most quantitative methods for urobilinogen involve what?

A

Involve the rxn of urobilinogen w/ p-dimethylaminobenzaldehyde (Ehrlich’s rgnt) to form a red color

65
Q

What is the outcome / product of urobilinogen reacting w/ Ehrlich’s rgnt?

A

The formation of a red product

66
Q

What is the other term for p-dimethylaminobenzaldehyde?

A

Ehrlich’s rgnt

67
Q

What is the characteristic of assessment of serum bile acids and what is the reason behind the characteristic?

A

It is rarely performed because methods are very complex

68
Q

What are being examined in terms of assessment of serum bile acids?

A

Patterns of individual bile acids and their state of conjugation

69
Q

What is the action done to enzymes?

A

These are released into the circulation after an injury

70
Q

What are the results when enzymes are released into the circulation after an injury?

A

It results in cytolysis or necrosis

71
Q

Enzymes are used for what?

A

These are used to differentiate hepatocellular from obstructive liver disease

72
Q

What are the types of enzymes?

A

1) Aminotransferases

2) Phosphatases

73
Q

What are the exs of aminotransferases?

A

1) Aspartate aminotransferase (AST)

2) Alanine aminotransferase (ALT)

74
Q

What are the exs of phosphatases?

A

1) Alkaline phosphatase
2) 5’-Nucleotidase
3) Gamma-glutamyltransferase
4) Lactate dehydrogenase

75
Q

What can be tested or what are the tests for measuring hepatic synthetic ability?

A

1) Serum albumin

2) PT

76
Q

Decreased lvl of serum albumin may be caused by what?

A

Decreased liver protein synthesis

77
Q

In what condition / disease is PT commonly increased?

A

Liver disease

78
Q

What can be tested for measuring nitrogen metabolism?

A

Plasma ammonia lvl

79
Q

In what condition / disease is plasma ammonia lvl increased?

A

Liver failure

80
Q

What is hepatitis and what is its characteristic?

A

It is the injury to the liver w/c is characterized by inflammation in liver tissue

81
Q

What are the causes of hepatitis?

A

1) Viral
2) Bacterial
3) Parasitic infections
4) Radiation
5) Drugs
6) Chemicals
7) Autoimmune diseases
8) Toxins

82
Q

What are the symptoms if a pt has hepatitis?

A

1) Jaundice
2) Dark urine
3) Fatigue
4) Nausea
5) Vomiting
6) Abdominal pain

83
Q

What is the state of serum conjugated bili in the ff cases:

1) Reference range
2) Hemolytic Jaundice
3) Intrahepatic Early Hepatitis
4) Extrahepatic Obstructive

A

1) 0.0 - 0.2 mg/dL
2) Normal or sl. (slightly) increase
3) Increase
4) Double increase

84
Q

What is the state of serum unconjugated bili in the ff cases:

1) Reference range
2) Hemolytic Jaundice
3) Intrahepatic Early Hepatitis
4) Extrahepatic Obstructive

A

1) 0.2 - 0.8 mg/dL
2) Increase
3) Double increase
4) Increase

85
Q

What is the state of feces urobilinogen in the ff cases:

1) Reference range
2) Hemolytic Jaundice
3) Intrahepatic Early Hepatitis
4) Extrahepatic Obstructive

A

1) 75 - 400 EU/d or (+2)
2) Increase (+4)
3) Decrease (+1)
4) Decrease or neg (-)

86
Q

What is the state of urine urobilinogen in the ff cases:

1) Reference range
2) Hemolytic Jaundice
3) Intrahepatic Early Hepatitis
4) Extrahepatic Obstructive

A

1) 0.5 - 4.0 EU/d or (+1)
2) Increase (+4)
3) Increase
4) Decrease or neg (-)

87
Q

What is the state of urine bili in the ff cases:

1) Reference range
2) Hemolytic Jaundice
3) Intrahepatic Early Hepatitis
4) Extrahepatic Obstructive

A

1) Negative (neg)
2) Neg
3) Increase
4) Increase

Clinical Chemistry 2 (Lecture) (17 decks)

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