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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
What happens to the unconjugated bilirubin when it reaches the liver during metabolism?
The hepatic cells metabolize it and conjugate it (water-soluble) It is a major component of bile
26
What happens to the conjugated bilirubin after a meal?
It exits the biliary tract with the bile and enters the GI system
27
What happens to the conjugated bilirubin when it enters the GI tract
The bacteria convert it into urobilinogen
28
What happens to the urobilinogens during metabolism?
It is reabsorbed and excreted in the kidney | Excreted through the feces as stercobilin
29
What are the causes of icterus?
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
30
What does bilirubin testing tell us?
The difference in the solubility between unconjugated and conjugated bilirubin
31
What does the presence of unconjugated bilirubin indicate?
A prehepatic or hepatic issue
32
Unconjugated bilirubin comprises approximately what of the total bilirubin in the serum?
Two thirds
33
What do increased levels of unconjugated bilirubin indicate?
The cells of the liver have not processed it
34
What causes an increase in unconjugated bilirubin
``` Excess hemolysis (prehepatic) Liver cells are not functioning properly (Hepatic) ```
35
What is conjugated bilirubin also known as?
Direct bilirubin
36
What does conjugated bilirubin indicate?
Posthepatic issue such as a bile duct obstruction
37
What does elevated conjugated bilirubin indicate
The cells of the liver did their job but there is a blockage somewhere preventing the bile from exiting
38
What are bile acids?
They are made from cholesterol in the liver
39
What is the job of the bile acids?
To help the body digest and absorb fats
40
What are normal serum bile acid levels?
Low but will be high right after eating
41
Bile Acid test
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
What does the bile acid test measure?
The difference in the bile acid concentration between the two samples
43
In what species do you only need one sample and why?
Horses because they do not have a gallbladder
44
What factors can create a false bile acid test
Inadequate fasting Food aromas Prolonged fasting or diarrhea
45
Why is food aromas a factor for false bile acid testing?
Because in dogs the bile acid system will kick in creating inappropriate results
46
What does an elevated bile acid indicate?
Liver disease.
47
What kind of liver disease does the elevated bile acid indicate?
``` Congenital portosystemic shunts Chronic hepatitis Hepatic cirrhosis Cholestasis Neoplasms ```
48
What is one problem with the bile acid test?
It is unspecific for the type of liver problem | It is only a screening test
49
What is Cholesterol
A lipoprotein produced mainly in the liver
50
Is high cholesterol due to diet common in animals?
No. More common in humans
51
In what conditions do veterinarians see high cholesterol?
``` Hypothyroidism (dogs) Cushing's Disease (dogs) Diabetes (dogs and cats) Hepatic Lipidosis (cats) Steroid use ```
52
Liver Enzyme Leakage tests
ALT AST ID GLDH
53
What does liver leakage enzyme testing tell you?
The cells of the liver are damaged, dying, and the contents are "leaking" into the bloodstream
54
Dehydrogenase enzymes
``` Iditol dehydrogenase (ID) Glutamate dehydrogenase (GLDH) more commonly used in large animals ```
55
Alanine Transaminase or Aminotransferase
ALT | liver-specific in dogs and cats
56
What other organs does Alanine Transaminase come from?
Kidney Heart Pancreas Muscle
57
In what species is ALT not liver-specific?
Horses Ruminants Pigs Birds
58
How long, after liver damage does it take for ALT to increase?
12 hours | Considered an acute problem
59
After damage how long does ALT stay high?
A few weeks unless ongoing liver damage
60
What else can cause an increase in ALT?
Certain drugs
61
Is there a direct correlation between the severity of liver damage and ALT level?
NO
62
Aspartate transaminase or Aminotransferase
AST | NOT a liver-specific enzyme
63
What if there is an elevation in ALT and AST
Considered more severe liver damage
64
Where can AST be found?
``` Liver Heart KIdney Pancreas Muscle RBCs ```
65
What does a high AST indicate?
A more severe liver damage when compared to ALT
66
What could cause an elevated AST?
Liver disease Muscle inflammation Hemolysis of RBCs
67
How does muscle inflammation cause an elevated AST?
Strenuous exercise | IM injection
68
How does hemolysis of the RBCs cause an elevated AST?
By improper handling of the blood
69
What did ALT use to be called?
SGPT | serum glutamic pyruvate transferase
70
What did AST use to be called?
SGOT | Serum glutamic oxaloacetic transferase
71
Iditol Dehydrogenase or Sorbitol Dehydrogenase
Useful in evaluating liver disease in large animals because large animals do not have diagnostic levels of ALT
72
What is the primary source of iditol dehydrogenase?
Hepatocytes
73
Cholestasis Enzymes
AP or ALKP | Alkaline Phosphatase
74
Alkaline Phosphatase
leakage enzyme during cholestasis
75
Where is ALKP present?
Liver, bone, and other tissues
76
In what conditions can you also see an increase in levels of ALKP?
Young animals due to bone growth Bone disease (neoplasia) Corticosteroid use Cushings disease
77
Other enzymes Associated with Cholestasis
Gamma-glutamyltransferase (GGT)
78
Gamma-glutamyltransferase (GGT)
Found in many tissues
79
What species have higher GGT levels?
``` Cattle Horses Sheep Goats Birds ```

Clinical Laboratory Techniques (45 decks)

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