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Clinical Laboratory Techniques > The Liver > Flashcards

The Liver Flashcards

1
Q

The Liver

A

Largest internal organ
Has multiple lobes
Can regenerate if damaged
The powerhouse of the body

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2
Q

What are the functions of the liver run by

A

Enzymatic reactions

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3
Q

What are the functions of the liver?

A
  1. Metabolism
  2. Production
  3. Secretion
  4. Detoxification
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4
Q

What does the liver metabolize?

A

Amino acids, carbohydrates, and lipids

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5
Q

What does the liver produce?

A

Cholesterol, plasma proteins, and clotting factors

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6
Q

What does the liver secrete?

A

Bile to aid in digestion

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7
Q

What does the liver detoxify?

A

drugs, chemicals, and toxins

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8
Q

Hepatobiliary Assays

A

Liver cells compartmentalize so that damage in one zone will not affect all liver functions
No single test is superior to any other
Tests are being developed to detect problems sooner

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9
Q

What percentage of cells are damaged before tests show abnormalities?

A

70%

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10
Q

What happens to test results in end-stage liver disease and why?

A

Can have a normal test

Because the remaining living cells are not producing enzymes

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11
Q

Gallbladder

A

the “biliary” part of hepatobiliary

Closely associated with the liver both anatomically and functionally

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12
Q

What is the primary function of the gallbladder?

A

Bile storage

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13
Q

What are the three types of tests?

A

Liver enzymes
Cholestasis Enzymes
Liver function

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14
Q

What are the hepatocyte function tests?

A

The test primarily run in veterinary settings
Bilirubin
Bile Acids
Cholesterol

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15
Q

What do bilirubin function tests determine?

A

Helps determine the cause during icterus

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16
Q

What is the best test for liver function?

A

Bile acids

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17
Q

What other liver function tests are there?

A

Cholesterol and albumin
Not as sensitive
Do not indicate a problem until 2/3 or 3/4 of tissue is damaged

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18
Q

What is bilirubin?

A

Orange bile pigment produced by the breakdown of the heme protein of hemoglobin

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19
Q

What happens if bilirubin is abnormally high?

A

Causes icterus

Yellow mucous membranes, sclera, and skin

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20
Q

What does Bilirubin Metabolism start with?

A

The breakdown of hemoglobin by macrophages in the spleen.

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21
Q

Where does iron go?

A

Back to the bone marrow to make new red blood cells

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22
Q

Where does Globulin go?

A

Back to the liver for reuse

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23
Q

Where does the heme go?

A

It is waste and becomes bilirubin

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24
Q

What happens to the unconjugated bilirubin during metabolism

A

It binds with albumin and is transported to the liver

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25
Q

What happens to the unconjugated bilirubin when it reaches the liver during metabolism?

A

The hepatic cells metabolize it and conjugate it (water-soluble)
It is a major component of bile

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26
Q

What happens to the conjugated bilirubin after a meal?

A

It exits the biliary tract with the bile and enters the GI system

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27
Q

What happens to the conjugated bilirubin when it enters the GI tract

A

The bacteria convert it into urobilinogen

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28
Q

What happens to the urobilinogens during metabolism?

A

It is reabsorbed and excreted in the kidney

Excreted through the feces as stercobilin

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29
Q

What are the causes of icterus?

A

The liver can not conjugate bilirubin because the hepatocytes are not functioning properly
Excessive RBC destruction that overwhelms the liver
Blockage of the biliary tract

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30
Q

What does bilirubin testing tell us?

A

The difference in the solubility between unconjugated and conjugated bilirubin

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31
Q

What does the presence of unconjugated bilirubin indicate?

A

A prehepatic or hepatic issue

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32
Q

Unconjugated bilirubin comprises approximately what of the total bilirubin in the serum?

A

Two thirds

33
Q

What do increased levels of unconjugated bilirubin indicate?

A

The cells of the liver have not processed it

34
Q

What causes an increase in unconjugated bilirubin

A 
Excess hemolysis (prehepatic)
Liver cells are not functioning properly (Hepatic)
35
Q

What is conjugated bilirubin also known as?

A

Direct bilirubin

36
Q

What does conjugated bilirubin indicate?

A

Posthepatic issue such as a bile duct obstruction

37
Q

What does elevated conjugated bilirubin indicate

A

The cells of the liver did their job but there is a blockage somewhere preventing the bile from exiting

38
Q

What are bile acids?

A

They are made from cholesterol in the liver

39
Q

What is the job of the bile acids?

A

To help the body digest and absorb fats

40
Q

What are normal serum bile acid levels?

A

Low but will be high right after eating

41
Q

Bile Acid test

A

Paired serum samples

  1. Collect the first sample after 12 hours fast
  2. feed a small meal
  3. Collect the second sample 2 hours after eating
42
Q

What does the bile acid test measure?

A

The difference in the bile acid concentration between the two samples

43
Q

In what species do you only need one sample and why?

A

Horses because they do not have a gallbladder

44
Q

What factors can create a false bile acid test

A

Inadequate fasting
Food aromas
Prolonged fasting or diarrhea

45
Q

Why is food aromas a factor for false bile acid testing?

A

Because in dogs the bile acid system will kick in creating inappropriate results

46
Q

What does an elevated bile acid indicate?

A

Liver disease.

47
Q

What kind of liver disease does the elevated bile acid indicate?

A 
Congenital portosystemic shunts
Chronic hepatitis
Hepatic cirrhosis
Cholestasis
Neoplasms
48
Q

What is one problem with the bile acid test?

A

It is unspecific for the type of liver problem

It is only a screening test

49
Q

What is Cholesterol

A

A lipoprotein produced mainly in the liver

50
Q

Is high cholesterol due to diet common in animals?

A

No. More common in humans

51
Q

In what conditions do veterinarians see high cholesterol?

A 
Hypothyroidism (dogs)
Cushing's Disease (dogs)
Diabetes (dogs and cats)
Hepatic Lipidosis (cats)
Steroid use
52
Q

Liver Enzyme Leakage tests

A

ALT
AST
ID
GLDH

53
Q

What does liver leakage enzyme testing tell you?

A

The cells of the liver are damaged, dying, and the contents are “leaking” into the bloodstream

54
Q

Dehydrogenase enzymes

A 
Iditol dehydrogenase (ID)
Glutamate dehydrogenase (GLDH)
more commonly used in large animals
55
Q

Alanine Transaminase or Aminotransferase

A

ALT

liver-specific in dogs and cats

56
Q

What other organs does Alanine Transaminase come from?

A

Kidney
Heart
Pancreas
Muscle

57
Q

In what species is ALT not liver-specific?

A

Horses
Ruminants
Pigs
Birds

58
Q

How long, after liver damage does it take for ALT to increase?

A

12 hours

Considered an acute problem

59
Q

After damage how long does ALT stay high?

A

A few weeks unless ongoing liver damage

60
Q

What else can cause an increase in ALT?

A

Certain drugs

61
Q

Is there a direct correlation between the severity of liver damage and ALT level?

A

NO

62
Q

Aspartate transaminase or Aminotransferase

A

AST

NOT a liver-specific enzyme

63
Q

What if there is an elevation in ALT and AST

A

Considered more severe liver damage

64
Q

Where can AST be found?

A 
Liver
Heart
KIdney
Pancreas
Muscle
RBCs
65
Q

What does a high AST indicate?

A

A more severe liver damage when compared to ALT

66
Q

What could cause an elevated AST?

A

Liver disease
Muscle inflammation
Hemolysis of RBCs

67
Q

How does muscle inflammation cause an elevated AST?

A

Strenuous exercise

IM injection

68
Q

How does hemolysis of the RBCs cause an elevated AST?

A

By improper handling of the blood

69
Q

What did ALT use to be called?

A

SGPT

serum glutamic pyruvate transferase

70
Q

What did AST use to be called?

A

SGOT

Serum glutamic oxaloacetic transferase

71
Q

Iditol Dehydrogenase or Sorbitol Dehydrogenase

A

Useful in evaluating liver disease in large animals because large animals do not have diagnostic levels of ALT

72
Q

What is the primary source of iditol dehydrogenase?

A

Hepatocytes

73
Q

Cholestasis Enzymes

A

AP or ALKP

Alkaline Phosphatase

74
Q

Alkaline Phosphatase

A

leakage enzyme during cholestasis

75
Q

Where is ALKP present?

A

Liver, bone, and other tissues

76
Q

In what conditions can you also see an increase in levels of ALKP?

A

Young animals due to bone growth
Bone disease (neoplasia)
Corticosteroid use
Cushings disease

77
Q

Other enzymes Associated with Cholestasis

A

Gamma-glutamyltransferase (GGT)

78
Q

Gamma-glutamyltransferase (GGT)

A

Found in many tissues

79
Q

What species have higher GGT levels?

A 
Cattle
Horses
Sheep
Goats
Birds

Clinical Laboratory Techniques (45 decks)

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