INTERNSHIP: CC > Liver Function > Flashcards

Liver Function Flashcards

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1
Q

Two major vessels of the Liver

A

Hepatic aorta
Portal vein

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2
Q

Branch of aorta that provides most of the oxygen requirement

A

Hepatic aorta

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3
Q

Contributes to the 20-25% of blood supply

A

Hepatic aorta

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4
Q

Drains the gastrointestinal tract and spleen, this transports most of the recently absorbed materials from the intestines to the liver

A

Portal vein

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5
Q

Drains from the general circulation

A

Portal vein

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6
Q

Reticuloendothelial cells

A

Kupffer cells

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7
Q

The major cell type responsible for fibrosis

A

Stellate cells

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8
Q

Total loss ld liver function leads to death due to ____ within 24 hours

A

Hypoglycemia

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9
Q

Divides the liver into two unequally lobes

A

Falciform ligament

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10
Q

Six sided functional unit, which is responsible for the metabolic and excretory functions performed by the liver

A

Liver lobules

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11
Q

Components of the liver lobule

A
  1. Branches of hepatic portal vein and hepatic artery
  2. Central vein
  3. Sinusoids
  4. Hepatocytes and Kupffer cells
  5. Bile canaliculi
  6. Bile duct
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12
Q

Liver functions

A
  1. Detoxification
  2. Secretion/Excretion
  3. Synthesis/Metabolism
  4. Storage
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13
Q

Everything absorbed by the body passes through the liver is called

A

First pass effect

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14
Q

Phagocytosis is action of

A

Kupffer cells

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15
Q

Detoxification is production of:

A

Urea from ammonia
Conjugated bilirubin

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16
Q

Secretion/Excretion is the synthesis of

A

Bile salts and bile acids

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17
Q

Synthesis/Metabolism of:

A
  1. Carbohydrates
  2. Fats
  3. Lipoproteins
  4. Ketone bodies
  5. Proteins
  6. Hormones
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18
Q

Formation of glucose from amino acids and fats

A

Gluconeogenesis

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19
Q

Hormones produced by synthesis/metabolism

A

Somatomedin and Angiotensin

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20
Q

By product of gluconeogenesis

A

Ketone bodies

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21
Q

Liver function storage of

A

Fat soluble and water soluble vitamins
Glycogen
Iron

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22
Q

Bilirubin Forms a complex with _____ for transport to the liver

A

Albumin

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23
Q

Bilirubin is conjugated in the endoplasmic reticulum with 2 molecules of glucuronic acid to form

A

Bilirubin diglucuronide (Conjugated bilirubin or B2)

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24
Q

The reaction of bilirubin is catalyzed by

A

Uridine Diphosphate Glucuronyl Transferase (UDPGT)

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25
Reference values Total bilirubin Conjugated bilirubin Unconjugated bilirubin
Total bilirubin: 0.2-1.0 mg/dL Conjugated bilirubin: 0.0-0.2 mg/dL Unconjugated bilirubin: 0.2-0.8 mg/dL
26
Conversion factor of Bilirubin
17.1
27
The most common disease processes affecting the liver are
Hepatitis Cirrhosis Tumors
28
damage to and destruction of liver cells; may be acute or chronic or a combination of both
Hepatitis
29
a process in which death of liver cells with regeneration leads to fibrosis, scarring and destruction of the normal liver architecture
Cirrhosis
30
progressive autoimmune disease characterized by destruction of intrahepatic bile ducts, presence of antimitochondrial antibodies In the plasma
Primary biliary cirrhosis
31
both primary but, more frequently, secondary; for example, metastases from cancers of the large bowel, stomach and bronchus.
Tumors
32
Yellowish pigmentation of the skin, mucous membrane and sclera of the eyes due to hyperbilirubinemia / retention of bilirubin
JAUNDICE / ICTERUS
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Not apparent until bilirubin exceeds 3.0 - 5.0 mg/dL
OVERT JAUNDICE
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⬆️ bilirubin because the liver is working efficiently to handle the increased work load
Pre-Hepatic (HEMOLYTIC /RETENTION JAUNDICE)
35
Excessive destruction of RBCs
Pre-Hepatic (HEMOLYTIC /RETENTION JAUNDICE)
36
Free bilirubin is elevated due to HDN or Erythroblastosis fetalis and malaria
Pre-Hepatic (HEMOLYTIC /RETENTION JAUNDICE)
37
Hepatic uptake is DECREASED: prolonged fasting and intake of drugs
Pre-Hepatic (HEMOLYTIC /RETENTION JAUNDICE)
38
Occurs prior to liver metabolism
Pre-Hepatic (HEMOLYTIC /RETENTION JAUNDICE)
39
Also called unconjugated hyperbilirubinemia
Pre-Hepatic (HEMOLYTIC /RETENTION JAUNDICE)
40
An enzyme responsible for bilirubin conjugation
UDPGT
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Due to disorders of bilirubin metabolism and transport defects
Hepatic (HEPATO CELLULAR / INFECTIOUS JAUNDICE)
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Severe damage to the hepatocytes due to microorganisms or alcohol
Hepatic (HEPATO CELLULAR / INFECTIOUS JAUNDICE)
43
Starvation a n d certain medications Hepatitis and cirrhosis Parasitism (Fasciola hepatica)
Hepatic (HEPATO CELLULAR / INFECTIOUS JAUNDICE)
44
BILIRUBIN CONJUNCTION DECREASED in Hepatic (HEPATO CELLULAR / INFECTIOUS JAUNDICE)
1. Physiological neonatal jaundice 2. Gilbert’s Disease 3. Crigler-Najjar Syndrome 4. Lucey-Driscoll Syndrome
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Transport deficit
Gilbert’s Disease
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UDPGT is only 30% functional
Gilbert’s Disease
47
defect in the transport protein ligandin
Gilbert’s Disease
48
More severe form of hepatic jaundice
Crigler-Najjar Syndrome
49
UDPGT deficiency
Crigler-Najjar Syndrome
50
Conjugatiln deficit
Crigler-Najjar Syndrome
51
Circulating inhibitor of conjugation
Lucey-Driscoll Syndrome
52
IMPAIRMENT OF HEPATIC EXCRETION (ACQUIRED DISORDERS) of hepatic jaundice
1. Dubin-Johnson Syndrome 2. Rotor Syndrome
53
Excretion deficit
Dubin-Johnson Syndrome
54
Presence of delta bilirubin, dark stained granules (lipofuscin) in liver biopsy
Dubin-Johnson Syndrome
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UPTAKE/TRANSPORT DEFICIT
Rotor Syndrome
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reduced/defective ligandin and possibly viral in origin
Rotor Syndrome
57
Causes Obstruction of the biliary flow
Post-Hepatic (Regurgitative/Obstructive/Cholestic Jaundice)
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Intrahepagic cholestasis
Post-Hepatic (Regurgitative/Obstructive/Cholestic Jaundice)
59
Cholelithiasis or gallstones
Post-Hepatic (Regurgitative/Obstructive/Cholestic Jaundice)
60
Cancer of the head of the pancreas
Post-Hepatic (Regurgitative/Obstructive/Cholestic Jaundice)
61
Ascaris lumbricoides infection
Post-Hepatic (Regurgitative/Obstructive/Cholestic Jaundice)
62
Buildup of unconjugated bilirubin and Noted 2-3 days of neonatal life, rarely rises greater than 5 mg/dVday (peaks at 4-5 days)
Neonatal jaundice
63
Most common cause of Hemolytic Disease of the Newborn
Neonatal Jaundice
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Poorly developed blood brain barier alowing at to cause damage to central nervous system - kernicterus (B1 > 20 mg/dL)
Neonatal jaundice
65
Treatment of neonatal jaundice
Phototherapy
66
Prehepatic TB B1 B2 Urine bilirubin Urine urobilinogen Stool
TB: ⬆️ B1: ⬆️ B2: N Urine bilirubin: NEG Urine urobilinogen: ⬆️ Stool: Brown
67
Hepatic TB B1 B2 Urine bilirubin Urine urobilinogen Stool
TB: ⬆️ B1: ⬆️ B2: ⬆️/N Urine bilirubin: Variable Urine urobilinogen: N Stool: Pale/Brown
68
Post hepatic TB B1 B2 Urine bilirubin Urine urobilinogen Stool
TB: ⬆️ B1: N B2: ⬆️/N Urine bilirubin: Positive Urine urobilinogen: N Stool: Clay
69
hepatic destruction following recovery from viral Infection and aspirin ingestion in children, wherein the patient develops neurologic abnormalities due to accumulation of ammonia in t h e CNS.
Reye’s Syndrome
70
non inflammatory hepatic encephalopathy and fatty liver degeneration
Reye’s Syndrome
71
Specimen for bilirubin determination
Fasting serum
72
Bilirubin determination:
Van den Berg Reaction
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Van den Berg Reaction principle
diazotization of bilirubin to produce azobilirubin
74
Diazo reagent of Van den Berg Reaction
0.1% Sulfanilic acid + HCl 0.5% Sodium nitrite
75
reacts with Diazo reagent with an accelerator = Indirect bilirubin
Unconjugated (B1)
76
reacts directly with Diazo reagent
Conjugated (B2)
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B2 bound to albumin and behaves like B2
Delta bilirubin
78
no coupling accelerator; only direct bilirubin is determined
Direct method
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a coupling accelerator is added to make both B1 and B2 react with the reagent
Indirect method
80
Accelerator EVELYN-MALLOY: JENDRASSIK-GROF:
EVELYN-MALLOY: 50% methanol JENDRASSIK-GROF: Caffeine Benzoate
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Stopper EVELYN-MALLOY: JENDRASSIK-GROF:
EVELYN-MALLOY: none JENDRASSIK-GROF: Ascorbic acid
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pH EVELYN-MALLOY: JENDRASSIK-GROF:
EVELYN-MALLOY: acidic JENDRASSIK-GROF: alkaline tartrate / sodium acetate buffer
83
End color EVELYN-MALLOY: JENDRASSIK-GROF:
EVELYN-MALLOY: red- purple JENDRASSIK-GROF: pink-blue
84
Absorbance peak EVELYN-MALLOY: JENDRASSIK-GROF:
EVELYN-MALLOY: 560 nm JENDRASSIK-GROF: 600 nm
85
Reference method and more sensitive
JENDRASSIK-GROF
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