Liver Function (P) Flashcards
What are the characteristics of the liver?
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
The liver plays a critical role in what?
1) Metabolism
2) Synthesis
3) Detoxification
4) Elimination of substances from body
What are lobules?
These are the microscopic units that divide the liver
What is the function of lobules?
These are responsible for all metabolic and excretory functions
What is the characteristic of lobules?
These are 6- sided structures w/ centrally located vein and portal triads
What are the components of portal triad?
1) Hepatic artery
2) Portal vein
3) Bile duct
What are the 2 major cell types in the liver?
1) Hepatocytes
2) Kupffer cells
What are hepatocytes?
These are large cells radiating outward from central vein
What are kupffer cells?
These are macrophages lining the sinusoids
What are the functions of kupffer cells?
1) These act as phagocytes
2) These engulf bacteria, debris, and toxins
What are the biochemical functions done by the liver?
1) Excretory and Secretory
2) Metabolism
3) Detoxification and Drug Metabolism
In terms of excretory and secretory functions, what is the liver capable of?
1) Liver is the only organ w/ the capacity to rid body of heme waste
2) It secretes bile
3) It excretes bili
The bile is made up of what?
1) Bile acids or salts
2) Bile pigments
3) Chole
What is the volume of bile being produced by the body per day?
3 L
What is the volume of bile being excreted by the body?
1 L
What is bili?
It is the principal pigment in bile
Bili is derived from what?
From the breakdown of RBCs
What is the volume of bili produced by the liver per day?
200 - 300 mg/day
Most of the bili is eliminated where?
In feces
Some of the bili is eliminated where?
In urine
In terms of metabolism function, what can be synthesized by the liver?
1) Carbs synthesis
2) Lipid synthesis
3) Protein synthesis
What is the principle of carbs synthesis done by the liver?
The liver maintains stable glucose concentrated by storing it as glycogen and degrading glycogen when needed by the body
What is the principle of lipid synthesis done by the liver?
The liver breaks down fatty acids to form TAGs, phospholipids, or chole
In terms of detoxification and drug metabolism functions, what is the principle being done by the liver?
The liver prevents toxic or harmful substances from reaching systemic circulation by binding or chemical modification
What is jaundice?
It is the yellow discoloration of skin, eyes, and mucous membranes
Jaundice results from what?
It results from the retention of bili or other substances
How is jaundice classified?
It is classified based on the site of disorder
What are the classifications of jaundice?
1) Prehepatic
2) Hepatic
3) Posthepatic
What is prehepatic jaundice?
This is where problem occurs before the liver
What is hepatic jaundice?
This is where problem occurs in the liver
What is posthepatic jaundice?
This is where problems occurs after the liver
What is cirrhosis?
It is a condition in w/c scar tissue replaces healthy liver tissue
What is the principle of action of cirrhosis?
The scar tissue blocks blood flow and prevents proper functioning
Cirrhosis is commonly caused by what?
1) Chronic alcoholism
2) Hepatitis C infection
3) Chronic hepatitis B
4) Chronic hepatitis D
5) Autoimmune disorders
6) This can also be inherited
90 - 95% of hepatic malignancies are what?
Metastatic
True or False
The 90 - 95% of hepatic malignancies primarily originates in the liver cells
False, because the 90 - 95% of hepatic malignancies primarily does not originate in the liver cells
What are the 2 types of tumors?
1) Benign
2) Malignant
What are the exs of benign tumors?
1) Hepatocellular adenoma
2) Hemangiomas
What are the exs of malignant tumors?
1) Hepatocellular carcinoma
2) Hepatocarcinoma
3) Hepatoma
What is Reye syndrome?
It is a grp of disorders caused by infectious, metabolic, toxic, or drug-induced disease found predominantly in children
What are the characteristics of Reye syndrome?
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
What is the characteristic of drug-induced liver disease (in terms of reported cases)?
It accounts for 1/3 to 1/2 of all reported cases of acute liver failure in U.S.
What is the most common mechanism of injury (in connection w/ drug-induced liver disease)?
Adverse immune response to drug directed against liver
What is the most significant cause of hepatic toxicity?
Ethanol (alcohol)
What are the 3 stages of liver injury due to excessive alcohol consumption?
1) Alcoholic fatty liver
2) Alcoholic hepatitis
3) Alcoholic cirrhosis
What are the characteristics of alcoholic fatty liver?
1) Mild
2) Recovery w/ removal of drug
What is the characteristic of alcoholic hepatitis?
It is the evidence of liver damage
What are the characteristics of alcoholic cirrhosis?
1) Most severe
2) Poor prognosis
What is the method / technique for measuring bili where all commonly used methods stem from?
From technique described by Malloy & Evelyn in 1937
What is the principle of action of the technique described by Malloy & Evelyn?
Based on the rxn of bili w/ a diazotized sulfanilic acid solution w/ a 50% methanol solution as an accelerator
In the neonatal population, bili can also be quantified by what?
Bilirubinometry
What are the 3 fractions of bili (for analysis)?
1) Conjugated (direct)
2) Unconjugated (indirect)
3) Delta
In terms of sx collection, what are the sxs that can be used for bili measurement?
1) Serum or 2) plasma
What is the preferred sx for performing bili measurement?
Serum
What is the type of sx that is preferred for bili measurement?
Fasting sx
What type of sx should be avoided when measuring bili?
Hemolyzed sxs
In terms of sx storage, what is the consideration that should be considered and what is the resolution for this storage consideration?
Bili is sensitive to light, hence, it should be protected
What are the methods that are most commonly used for bili measurement?
1) Jendrassik-Grof or
2) Malloy Evelyn
What is urobilinogen?
It is a colorless end product of bili metabolism
Urobilinogen is oxidized by what?
Intestinal bacteria
What is the purpose for oxidizing urobilinogen by intestinal bacteria?
Urobilinogen is oxidized by intestinal bacteria to brown pigment urobilin
What are the conditions / diseases where increased lvls of urobilinogen in the urine are present?
1) Hemolytic disease
2) Defective liver cell function
What is the condition / disease where the absence of urobilinogen from urine / stool is present?
Complete biliary obstruction
Most quantitative methods for urobilinogen involve what?
Involve the rxn of urobilinogen w/ p-dimethylaminobenzaldehyde (Ehrlich’s rgnt) to form a red color
What is the outcome / product of urobilinogen reacting w/ Ehrlich’s rgnt?
The formation of a red product
What is the other term for p-dimethylaminobenzaldehyde?
Ehrlich’s rgnt
What is the characteristic of assessment of serum bile acids and what is the reason behind the characteristic?
It is rarely performed because methods are very complex
What are being examined in terms of assessment of serum bile acids?
Patterns of individual bile acids and their state of conjugation
What is the action done to enzymes?
These are released into the circulation after an injury
What are the results when enzymes are released into the circulation after an injury?
It results in cytolysis or necrosis
Enzymes are used for what?
These are used to differentiate hepatocellular from obstructive liver disease
What are the types of enzymes?
1) Aminotransferases
2) Phosphatases
What are the exs of aminotransferases?
1) Aspartate aminotransferase (AST)
2) Alanine aminotransferase (ALT)
What are the exs of phosphatases?
1) Alkaline phosphatase
2) 5’-Nucleotidase
3) Gamma-glutamyltransferase
4) Lactate dehydrogenase
What can be tested or what are the tests for measuring hepatic synthetic ability?
1) Serum albumin
2) PT
Decreased lvl of serum albumin may be caused by what?
Decreased liver protein synthesis
In what condition / disease is PT commonly increased?
Liver disease
What can be tested for measuring nitrogen metabolism?
Plasma ammonia lvl
In what condition / disease is plasma ammonia lvl increased?
Liver failure
What is hepatitis and what is its characteristic?
It is the injury to the liver w/c is characterized by inflammation in liver tissue
What are the causes of hepatitis?
1) Viral
2) Bacterial
3) Parasitic infections
4) Radiation
5) Drugs
6) Chemicals
7) Autoimmune diseases
8) Toxins
What are the symptoms if a pt has hepatitis?
1) Jaundice
2) Dark urine
3) Fatigue
4) Nausea
5) Vomiting
6) Abdominal pain
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
1) 0.0 - 0.2 mg/dL
2) Normal or sl. (slightly) increase
3) Increase
4) Double increase
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
1) 0.2 - 0.8 mg/dL
2) Increase
3) Double increase
4) Increase
What is the state of feces urobilinogen in the ff cases:
1) Reference range
2) Hemolytic Jaundice
3) Intrahepatic Early Hepatitis
4) Extrahepatic Obstructive
1) 75 - 400 EU/d or (+2)
2) Increase (+4)
3) Decrease (+1)
4) Decrease or neg (-)
What is the state of urine urobilinogen in the ff cases:
1) Reference range
2) Hemolytic Jaundice
3) Intrahepatic Early Hepatitis
4) Extrahepatic Obstructive
1) 0.5 - 4.0 EU/d or (+1)
2) Increase (+4)
3) Increase
4) Decrease or neg (-)
What is the state of urine bili in the ff cases:
1) Reference range
2) Hemolytic Jaundice
3) Intrahepatic Early Hepatitis
4) Extrahepatic Obstructive
1) Negative (neg)
2) Neg
3) Increase
4) Increase
