Where is billiuben derived from?
Heme in hemoglobin
What are the two types of billiruben?
Conjugated and unconjugated! unconjugated is not water soluble and is indirect approach!
-Conjugated billiruben is water soluble and made directlyusing UDP glucuronyl transferase!
What is the function of bile?
Aids in lipid digestion,
-Emulsifies lipids because of its amphiphilic nature and can allow lipase to break down large fat molecules
What are the causes of jaundice?
- Obstruction of billary tree
- Temporary or permenant abnormal hepatocyte function
- Make too much billiruben (Due to hemolysis)
- Born with bad billiruben genes
What are the things LFTs measure?
Liver function test hepatocyte activity and billiary obstruction
- Alt (cytoplasm -hepatitis) and Ast (Mitochondira-alcohol) these test hepatocyte function
- GGT and Alkaline phosphotase is billary obsruction
When is the conjucgated billiruben increase and when is unconjugated increase?
- Conjugated increase when there is an obstiruction of billary tree
- UCB happens when there s too much hemolysis
- Ammonia is hugh in serum crrrohsis aka liver damage
How does the liver look like in billary cirrhosis?
-Its nodular, pigmented and firm
What is primary billary cirrhosis?
Chronic progressive Autoimmune,
- More likely in women
- fatigue, jaundice and xanthoma (Yellow patches on skin due to collection of fats in macrophages
- The autoimmunity is due to high mitochondiral antibodies
-LEADS TO BILE DUCT DESTRCTION
What is cholestasis?
- A disease that shows bile pigments in hepatocytes, Bile plugs in canaliculi
- Bile duct proliferation
-REDUCTION OR SLOWING DOWN OF bile flow
What can caused by cholestasis?
Bile stones! primarly will show bile duct poliferation
- secondary inflammation -PMNs
- Distended ductes and calaiculi
- bile lakes in parecnhyma
- -periportal cirrhosis! aka fibrosis
Sclerosing cholangitis (Inflammation of bile ducts)
possibly autoimmune,
more common in makes
-increase in serum alkaline phosphatase because that measures obstruction of billary tree
-Involves small and large extrahepatic bile ducts
-constriction of bile ducts
– You will see onion skin like fibrosis and you do trichromatic stain for portal fibrosis to see the collagen
What is acute cholecystitis
gall bladder inflammation
-can be due to obstruction and ischemia or due to spesis shock and trauma
What are the different types of gall stones?
- Yellow is cholestrol and its the most common
- Billiruben is going to be black stones
- Calcium carbonate stones are white and opaq
Hepatocellualr carcinoma vs cholangiolar carcinoma?
one is cancer of livercells and cholangiolar carcinoma is damage to bile ducts
What are the different types of possible liver cancers?
- Bengin hemaangioma and hepatic adenoma
- Malignant: Hepatocellular carcinoma and choligiocarcinoma
Most of the cancers are due to secondary metabolim to the liver.
Whats a hepatocelluar carcinoma shape vs choligiocarcinoma?
Its usually a large tumor in te liver! due to lier cells not ducts.
=This one youll see more little tumors thorigh out
liver metastisis is usually what type?
CANON ball metastisis
