LIVER FUNCTION TEST Flashcards
Liver is located in the _____ portion of the _____ beneath the diaphragm and on top of the _____, _______ and _______
upper right; abdominal cavity; stomach, right kidney and intestines.
liver is shape like a ____, the liver is a dark reddish-brown organ that weighs about ___ pounds (1200 and 1600 grams ) and accounts for _____ of an adult’s body weight.
cone; 3; 2.5%
liver is unequally divided into ___ lobes
two
the chief metabolic organ in the body.
liver
liver is a _____ organ and receives ____ mL of blood per minute
vascular; 1500
Blood rich in nutrients from the GI tract is carried to the liver by the _______
portal vein.
the primary supplier of oxygenated blood.
hepatic artery
To complete hepatic circulation blood is ______ from the liver by _______
into the ________
drained; hepatic veins; inferior vena cava
anatomic unit of the liver
lobule
2 types of liver cells
hepatocytes
kupfer cells
large cells that perform the metabolic, detoxification, excretory and synthesis function
hepatocytes
active phagocytes that engulf bacteria, aging rbc, toxins and cellular debris
kupfer cells
If the liver becomes completely nonfunctional, death will occur from _______ within _______.
hypoglycemia; 24 hours
Substances absorbed from the GI tract must first pass through the ______ before it is distributed by the ________
liver; general circulation
The liver has a unique capacity to regenerate by _______ and ________ of the remaining tissue in case of tissue injury due to ________ or ______
cell division; hypertrophy; biliary obstruction or toxic exposure.
liver dysfunction examples
- Hepatocellular disease
- Cholestasis (obstruction of bile flow)
- Cirrhosis
- Hepatitis
- Jaundice
- Liver cancer
- Steatosis (fatty liver)
liver dysfuncition, genetic disorders
Hemochromatosis (iron storage)
- Noninvasive methods for screening of liver dysfunction
- Help in identifying general types of disorder
- Assess severity and allow prediction of outcome
- Disease and treatment follow u
Liver Function Tests
LFT is broadly classified as:
1.Tests to detect hepatic injury:
* Mild or severe; acute or chronic
* Nature of liver injury (hepatocellular or cholestasis)
2.Tests to assess hepatic function
Group 1: Markers of Liver Dysfunction
▫ Serum bilirubin: total and conjugated
▫ Urine: bile salts and urobilinogen
▫ Total protein, serum albumin and albumin/globulin ratio
▫ Prothrombin Time
Group 2: Markers of hepatocellular injury
▫ Alanine aminotransferase (ALT)
▫ Aspartate aminotransferase (AST)
functions of liver
synthesis, metabolism, detoxification, excretion or secretion, and storage
- A steady supply of glucose is necessary to provide energy for metabolic needs through gluconeogenesis, glycolysis
Carbohydrate synthesis
Liver is the site of synthesis of plasma proteins (albumin) except immunoglobulins and von Willebrand factor (factor VIII)
- most of the coagulation factors, anticoagulant proteins (factor XIV) and components of the fibrinolytic system are synthesized by hepatic parenchymal cells.
Protein Synthesis
Liver is the site of synthesis of plasma proteins (albumin) except ______ and _____
immunoglobulins and von Willebrand factor (factor VIII)
most of the coagulation factors,
anticoagulant proteins (factor XIV) and components of the fibrinolytic system are synthesized by ________
hepatic parenchymal cells.
The only organ that has the capacity to remove heme waste product from the body
liver
Liver serves to protect the body from potentially ________ absorbed from the intestinal tract and ______ by-products of metabolism.
injurious substances ; toxic
Excess proteins cannot be stored in the body. _____ takes place and this involves the removal of the amino group (NH2) from an amino acid resulting in the formation of __________.
Deamination ; ammonia
Ammonia a (toxic by-product) is consequently converted into _____ which is less toxic.
urea
The latter (urea) is then removed by the _______
kidneys (Ornithine cycle)
The liver breaks down other toxic substances such as ________, _____ released by pathogens, ______ and ________.
hydrogen peroxides, toxins, alcohol and food additives
bile composition
bile acids, phospholipids, cholesterol, bilirubin, inorganic salts, small amount of copper and other metals.
bile acids is also called as _____
bile salts
phospholipids in the bile is mainly ________
phosphatidylcholine
bilirubin in the biles is mostly in its ________ form
conjugated
the inorganic salts in the bile includes _______, _______, and _________
potassium, sodium, and bicarbonates
These bile acids are conjugated with the amino acids _______ and ______ forming bile salts
glycine and taurine
The bile is then stored in the _________ till needed. Once it is needed, it moves the
_______ and helps with the _______ and ________.
gallbladder ; duodenum ; digestion and excretory process
liver is the storage site for all _______ vitamins and _______ vitamins.
fat-soluble ; water soluble
Liver also is the storage depot for ________, which are released when glucose is depleted.
glycogen
end product of hemoglobin metabolism
Bilirubin
principal pigment in bile
Bilirubin
Major metabolite of heme
Bilirubin
bilirubin is formed from the destruction of _____
heme
heme is the iron-binding tetrapyrrole ring found in __________, __________ and _________.
hemoglobin, myoglobin and cytochrome
______ mg of bilirubin is produced daily in the health adult.
250-350 mg
___% of bilirubin is derived from turnover of senescent rbc.
85%
- also known as B1
- water insoluble
- indirect
- pre-hepatic
- hemobiliribun
- NV: 0.2 to 0.8 mg/dL or 3 to 14 umol/L
Unconjugated Bilirubin
- also known as B2
- water soluble
- direct
- post-hepatic/obstructive and regurgitative bilirubin
- cholebilirubin
- NV: 0 to 0.2 mg/dL or 0 to 3 umol/L
Conjugated Brilirubin
Conjugated bilirubin tightly bound to albumin. It is formed due to the prolonged elevation of conjugated bilirubin in biliary obstruction.
Delta bilirubin
- It has the longer half life than other forms of bilirubin.
- It is computed by using this formula TB – DB = IB
- Not calculated on neonatal patients.
Delta bilirubin
Delta bilirubin normal value
<0.2 mg/dL
Jaundice is also called as _______ or ______
Icterus or Hyperbiluribinemia
Characterized by yellow discoloration of the skin, sclerae, and mucus membrane.
Jaundice
In jaundice, bilirubin greater than _ or __ mg/dL is already a clinical significant.
2 or 3 mg/dL
occurs when there is excessive erythrocyte destruction as seen in:
* Hemolytic Anemia
* Spherocytosis
* Toxic Condition
* Hemolytic Disease of the Newborn
* Gilbert’s, Crigler-Najjar syndrome
Prehepatic Jaundice
occurs when liver cells malfunction and cannot take up, conjugate, or secrete bilirubin.
Hepatic Jaundice
such conditions is seen in hepatic jaundice
Viral hepatitis, Toxic Hepatitis, Intrahepatic Cholestasis.
- Bilirubin Transport Deficit from the sinusoidal membrane to the microsomal region
- Impaired cellular uptake of Bilirubin
- Mild increased of B1
GILBERT SYNDROME
- There is partial or complete conjugation deficit of UDP- Glucoronyl Transferase which causes deposition of bilirubin in the brain (kenicterus) resulting to motor dysfunction and retardation.
- moderate to extremely increased level of B1
CRIGLER NAJJAR SYNDROME
deposition of bilirubin in the brain
kernicterus
partial or complete conjugation deficit of UDP- Glucoronyl Transferase in Crigler Najjar Syndrome, causes deposition of bilirubin in the brain (kenicterus) resulting to ______________
resulting to motor dysfunction and retardation.
- Bilirubin Excretion Deficit
- Blockage of the excretion of bilirubin 2 into the canaliculi caused by hepatocyte membrane defect.
- Elevated B2 and mild increase of B1
DUBIN JOHNSON SYNDROME
- Level of UDP-Glucoronyl Transferase is low at birth.
- Takes several days for the liver to synthesize an adequate amount of enzyme to catalyze bilirubin conjugation.
- Increased level of B1
NEONATAL PHYSIOLOGICAL JAUNDICE
- may be caused by hepatocyte injury such as cirrhosis which results from scarring of liver tissue caused by excessive alcohol ingestion, hepatitis, hematochromatosis.
INTRAHEPATIC CHOLESTASIS
INTRAHEPATIC CHOLESTASIS is associated also to the different conditions such as:
- Neoplasm
- Bile Duct Injury (Rotor Syndrome)
- Reye Syndrome (Neurologic abnormalities including Seizures or Coma)
- Drug Related Disorders (Acetaminophen, Antibiotics, Antineoplastics)
- Acute and Chronic Hepatitis
Reye Syndrome is a neurologic abnormalities including _____ or _____
Seizures or Coma
in intrahepatic cholestasis, drug related disorders includes the triple A drugs
Acetaminophen, Antibiotics, Antineoplastics
bile duct injury is also known as
rotor syndrome
occurs when an obstruction blocks the flow of bile into the intestines this is referred as extrahepatic cholestasis.
Post-hepatic Jaundice
obstruction blocks the flow of bile into the intestines
extrahepatic cholestasis
- Gallstone obstructing the common bile duct.
- Neoplasm such as carcinoma of the pancreas.
- Inflammatory conditions such as cholangitis or acute pancreatitis.
- Significant increased level of B2 in serum.
- Increased level of B1 in serum.
- Increased level of B2 in urine.
- Decreased urine and fecal urobilinogen.
- Stool appear pale in color.
Post-hepatic Jaundice
In Post-hepatic Jaundice, __________ obstructing the common bile duct
Gallstone
In Post-hepatic Jaundice, there is a ______ such as carcinoma of the pancreas
Neoplasm
In Post-hepatic Jaundice, there is inflammatory conditions such as ________ or __________
Cholangitis or Acute Pancreatitis
In Post-hepatic Jaundice, there is a significant _____ level of B2 in serum
Increased
In Post-hepatic Jaundice, there is an ______ level of B1 in serum
Increased
In Post-hepatic Jaundice, there is an ________ level of B2 in urine
Increased
In Post-hepatic Jaundice, there is a decreased _______ and ________
urine and fecal urobilinogen
In Post-hepatic Jaundice, the stool appear _____ in color
pale
such syndromes are increased in B1
Gilberts Syndrome
Criggler Najjar Syndrome
Hemolytic Anemia
Hepatocellular dse.
Lucey Driscoll Syndrome
G-6-PD Deficiency
such syndromes are decreased in B2
Billary Obstruction
Pancreatic Cancer
Dubin Johnson
Alcoholic and Viral Hepatitis
Billary Atresis
Hepatocellular Disease
