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Clin Path > P39 - Liver Function > Flashcards

P39 - Liver Function Flashcards

1
Q

what percentage of functional hepatocytes must be lost before clinical evidence of hepatic insufficiency

A
  • 80%
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2
Q

hepatic enzymes is not ____ ____ tests

A
  • liver function
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3
Q

bilirubin is produced in

A
  • macrophages
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4
Q

what are the 4 types of bilirubin

A
  • Ba - unconjugated
  • Bb - bilirubin monglucuronide
  • By - bilirubin diglucuronide
  • Bs - delta bilirubin (degraded conjugated bound to albumin)
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5
Q

a measurement of direct bilirubin is all forms except

A
  • unconjugated
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6
Q

hemolysis leads to an ____ formation of bilirubin

A
  • increase
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7
Q

pathogenesis of extravascular hemolysis of erythrocytes and concentration of bilirubin
- is Bu or Bc greater

A
  • increase rate of formation of bilirubin (unconjugated) -> incomplete removal of bilirubin by hepatocytes
  • increase conjugation of bilirubin in hepatocytes -> rate of Bc formation exceeds Bc excretion to bile -> conjugated regurgitated to plasma
  • [Bu] > [Bc]
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8
Q

decreased uptake of bilirubin pathogenesis effect on concentration of bilirubin
- is Bu or Bc greater

A
  • conversion of stored triglycerides to fatty acids (FA) -> increase fatty acids delivery to hepatocytes -> fatty acids bind to Z-protein -> decrease ligands available for binding unconjugated bilirubin -> decrease uptake of unconjugated bilirubin by hepatocytes
  • [Bu] > [Bc]
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9
Q

in horses expect increase [Bt] within ____ hr of fasting and peak concentration within ____ days

A
  • 12-15

- 2-3

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10
Q

pathogenesis of decrease transport of bile and decrease bile flow (cholestasis) [which is rate limiting?]
- is Bu or Bc greater

A
  • decrease transport of bile is rate limiting step
  • impaired bile flow -> decrease Bc transport to canaliculi and increase Bc transport to sinusoids -> Bc returns to plasma -> increase Bc interferes with uptake of Bu
  • [Bc] > [Bu]
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11
Q

in dogs, effusion of [bilirubin] is greater than ___ serum [bilirubin]

A
  • twice
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12
Q

bile acids are _____ derived anionic acids and associated anions

A
  • cholesterol
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13
Q

bile salts are ____ forms

A
  • anion
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14
Q

in heath there is ____ BA (bile acid) in systemic blood

A
  • very little
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15
Q
  • decrease functional mass
  • portosystemic shunt
  • obstructive cholestasis
  • functional cholestasis
    can all lead to _____ bile acid (BA) concentration
A
  • increase

- hypercholemia

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16
Q

pathogenesis of decrease functional mass leading to increase bile acids (hypercholemia)

A
  • progressive liver disease or hepatic atrophy -> too few hepatocytes to remove BA from portal blood -> decrease BA clearance from portal blood -> BA pass through liver to central vein (systemic blood)
17
Q

pathogenesis of portosystemic shunt leading to increase bile acids (hypercholemia)

A
  • decrease bile acid deliver to hepatocyte via portal blood -> decrease clearance from portal blood
18
Q

pathogenesis of obstructive cholestasis leading to increase bile acids (hypercholemia)

A
  • lesion impairs bile flow -> decrease bile acid excretion into bile -> bile acids accumulate in hepatocytes -> is regurgitated to blood
19
Q

pathogenesis of functional cholestasis leading to increase bile acids (hypercholemia)

A
  • inflammatory disease that cause release of TNFa -> increase in TNFa cause decrease transport of BA into canaliculi -> decrease bile acid excretion into bile -> bile accumulate in hepatocytes -> regurgitated to blood
20
Q

bile acid (BA) challenge test

A
  • after 12 hour fast collect blood sample
  • feed small meal
  • collect sample after 2 hours
  • challenges systems ability to remove BA from portal blood
21
Q

bile acid (BA) challenge test is not done in what type of animals

A
  • icteric animals
22
Q

most ammonium (NH4) enters blood from ____ and ____

A
  • intestines

- deamination of proteins in tissues

23
Q

does portosystemic shunt cause hyperammonemia or hypoammonemia

A
  • hyperammonemia

- decrease removal from portal blood

Clin Path (43 decks)

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