PhyS: LIVER Flashcards
Name all the functions of the liver (6)
Carbohydrate metabolism Protein synthesis Lipid metabolism Drugs metabolism Hormone metabolism Bile production
glads are derived from the
alimentary epithelium
including the gallbladder which comes from the common hepatic duct
and they contribute to the process
mout: saliva
gut: liver and pancreas are accessory organs that facilitate the process
movement of bile from production to absorption
made in the liver
stored in gallbladder
travels through sphincter of Oddi to get to the duadenum and emulsify fat
90% bile salts reabsorbed in ileum as URObilinogen
circulates back through blood stream protal vein and back to the liver
10% bile salts lost in faeces as STEROcobilinogen
proteins made by the liver
clotting factors
albumine
lipoproteins
we get bilirubin from
Bilirubin comes mostly from hemoglobin 85%
also comes from myoglobin breakdown in muscle 15%
(break down of blood) gives stool it’s color
before becoming bilirubin haemoglobin and myoglobin and broken down into
biliverdin before becoming unconjugated bilirubin and albumin
this occurs from RBC breakdown after 120 days
this is absorbed by hepatocytes in the liver
bilirubin is conjugated in the and then become
liver and then become part of bile
If liver is impaired, then you would have elevated unconjugated bilirubin bc the liver is not able to do its job
if you have an abnormality in bilirubin what questions should you be asking
production problem?
too much made ?
that would mean
Bleeding
Hemolysis at abnormal rate
is it conjugated or unconjugated?
three physiological processes that would lead to hyper unconjugated bilirubin
can’t absorb because impaired uptake
making so much of it liver can’t keep up
reduced enzymatic activity
what would lead to impairment in bilirubin uptake
drugs
newborn
heptocellular injury: hepatitis
what would lead to an over production of bilirubin
bleeding
Erythroblastosis
Congenital RBC dz: sickle sell
Immune hemolysis
when would we see high bilirubin leading to
Newborns: hepatocytes not ready to go
Gilbert syndrome
why would you see hyper conjugatebilirubin
i. Build up from blockage
1. Stone
why are LFTs inappropriately named
AST and ALT are transaminase enzymes within the hepatocytes
they test liver health (of hepatocytes) not function
more appropriate name for LFTS
what exactly are they testing
necrosis index (amt. of damage done to hepatocytes)
these enzymes are usually not in the blood (AST mitochondria)
(ALT are found in cytosol)
they end up in blood after damage
ii. When ALT, AST, and LDH goes up, you are talking about liver cell death
amines and how they relate to transaminase enzymes in the liver
amines are nitrogen containing molecules that come from proteins
gluconeogenesis
3 carbon protein taken out of protein and made into glucose
nitrogen group is taken my a transaminase
which one is usually higher ALT or AST
ALT
what is a cholestasis index
ALP and GGT
what is a common drug that would cause an increase in liver enzymes
tylenol
Severity index
looks at how severe liver damage is
albumin mostly
this is actually a liver FUNCTION test
PT is also a function test because this is a function of the liver
what is cholestasis
refers to a decrease in the bile flow through the intraheptic cancaliculi (stones)
liver is trying to secrete bile through the SI
can be intraheptic (hepatic cell problem) or extrahepatic (biliary tree)
what lab values would we see with cholestasis
increase in cholesterol bilirubin and bile acids in the blood
bile lakes
intraductil build up of bile
bile pigment
seen as the result of intracellular accumulation
