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Final Exam
Liver Function Studies
55
Chemistry
Graduate
04/17/2013

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Term
Duel Blood Supply of Liver
Definition
hepatic portal vein and hepatic arteries.
Term
hepatic portal vein
Definition
carries venous blood drained from the gastrointestinal tract
Term
hepatic arteries
Definition
supply arterial blood to the liver
Term
Liver functions
Definition
produces many substances (synthesis) and which maintains the balance many nutrients (homeostasis).
Term
excretory function
Definition
Our body makes many waste products (such as bilirubin) which can be excreted only by the liver
Term
defense mechanisms
Definition
The liver strategic placement between the gut and the rest of our body permits it to acts as a filter and prevents the passage of bacteria from the gut
Term
Liver disease is categorized both by
Definition
cause and the effect it has on the liver
Term
Causes
Definition
include infection, injury, exposure to drugs or toxic compounds, autoimmune processes, or a genetic defect.
Term
Causes of Liver disease can lead to
Definition
hepatitis, cirrhosis, stones that develop forming blockages, fatty liver, and in rare instances liver cancer
Term
Genetic defects
Definition
can prevent vital liver functions and lead to the deposition and build-up of damaging substances, such as iron or copper
Term
how does bilirubin get to the liver
Definition
Bilirubin is transported to the liver is association with albumin, rapidly taken up by the hepatocytes by a carrier mediated active transport process and bound intracellularly to mostly ligandin and Z protein.
Term
What is bilirubin conjugated to
Definition
glucuronic acid to produce bilirubin diglucuronide which isthen excreted into the bile.
Term
lower intestinal tract the three urobilinogens are spontaneously oxidized to
Definition
stercobilin, mesobilin, and urobilin, which are the orange-brown pigment of the stool.
Term
Unconjugated
Definition
Bilirubin which has not be conjugated with glucuronic acid. This form represents pre-liver processed complex. It is lipid but not water soluble
Term
Conjugated
Definition
Bilirubin which has been conjugated with glucuronic acid. This form represents post-liver processed complex. It is water soluble.
Term
Crigler-Najjar Syndrome-
Definition
rare genetic disorder which has a lower than normal hepatic bilirubin uridine diphosphate glucuronyltransferase (UDP-glucuronyltransferase) activity
Term
Gilberts Syndrome
Definition
as heterogeneous condition usually ascribed to a decreased UDP-glucuronyltransferase activity
Term
Crigler-Najjar Syndrome and Gilberts Syndrome
Definition
bilirubin cannot be conjugated at the normal rate, the rate of excretion of bilirubin is significantly reduced, and the serum concentration of unconjugated bilirubin increases.
Term
Unconjugated Hyperbilirubinemia
Definition
newborn jaundice total serum bilirubin level above 5 mg per dL (86 µmol/L
Term
Association with disease Hyperbilirubinemia
Definition
newborn period can be associated with severe illnesses such as hemolytic disease, metabolic and endocrine disorders, anatomic abnormalities of the liver, and infections
Term
Kernicterus
Definition
refers to the neurologic consequences of the deposition of unconjugated bilirubin in brain tissue.
Term
bilirubin level is above 25mg/dL (428 µmol/L).
Definition
bilirubin toxicity
Term
Unconjugated Hyperbilirubinemia Treatment
Definition
Phototherapy, Exchange Transfusion
Term
Phototherapy
Definition
employs blue wavelengths of light to alter unconjugated bilirubin in the skin
Term
Exchange Transfusion
Definition
removes partially hemolyzed and antibody-coated erythrocytes and replaces them with uncoated donor red blood cells that lack the sensitizing antigen.
Term
Conjugated Hyperbilirubinemia
Definition
conjugated and unconjugated bilirubin are retained in these disorders, and a wide range of abnormal serum concentrations of each form may be observed.
Term
Obstruction of the biliary tree
Definition
an increased synthesis of enzymes such as gamma-glutamyl transferase and alkaline phosphatase.
Term
Mechanical obstruction of the biliary tress Causes
Definition
carcinoma of the head of the pancreas, common bile, or ampulla of Vater.
Term
Dubin-Johnson Syndrome
Definition
a rare and benign genetic disorder of bilirubin excretion where the uptake and storage of bilirubin are normal but the excretion of bilirubin into the bile is markedly impaired.
Term
Rotor Syndrome
Definition
A rare idiopathic form of hyperbilirubinaemia affecting both sexes, with onset shortly after birth or in childhood. It is due to a defect in the excretion of unconjugated bilirubin into the biliary craniculi with the bilirubin being absorbed into the blood and excreted in the urine. Primarily reported in patients from the Philippines.
Term
Prehepatic Jaundice
Definition
causes of jaundice include hemolysis and hematoma resorption, which lead to elevated levels of unconjugated bilirubin.
Term
Intrahepatic Jaundice
Definition
disorders can lead to unconjugated or conjugated hyperbilirubinemia. The conjugated bilirubin level is often elevated by alcohol, infectious hepatitis, drug reactions, and autoimmune disorders.
Term
Posthepatic Jaundice
Definition
disorders also can cause conjugated hyperbilirubinemia. Gallstone formation is the most common posthepatic process that causes jaundice
Term
classic definition of jaundice is a serum bilirubin level
Definition
greater than 2.5 to 3 mg per dL (42.8 to 51.3 µmol per L) in conjunction with a clinical picture of yellow skin and sclera
Term
First-line serum testing in a patient presenting with jaundice should include
Definition
CBC, total and direct bilirubin, liver enzymes
Term
AST and ALT
Definition
markers of hepatocellular injury
Term
Alkaline phosphatase and gamma-glutamyltransferase
Definition
markers for cholestasis.
Term
The second-line serum investigations may include
Definition
tests for Hepatitis A IgM antibody, Hepatitis B surface antigen and core antibody, Hepatitis C antibody, and autoimmune markers such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies.
Term
Acute viral hepatitis
Definition
levels of ALT to rise several thousand units per liter. Patients with acute alcoholic hepatitis have AST and ALT levels that rise to several hundred units per liter
Term
alcohol-induced damage
Definition
ratio of AST to ALT is usually greater than 1
Term
ALT Levels greater than 10,000 U per L
Definition
acute injury to the liver from another source (e.g., drugs [acetaminophen] or ischemia).
Term
primary biliary cirrhosis
Definition
positive for antimitochondrial antibody
Term
Protein Synthesis
Definition
primary site of plasma protein synthesis.
Term
Albumin
Definition
Synthesized only by the liver
Term
Hypoalbuminemia
Definition
various liver disorders and may be a consequence of decreased synthesis or distribution.
Term
Prealbumin
Definition
synthesized by the liver and is a sensitive indicator of alteration in hepatic synthetic or catabolic function.
Term
Serum immunoglobulins
Definition
indirectly reflect impairment of hepatocyte uptake and impairment of the reticuloendothelial system to filter incoming intestinal tract antigens from venous blood.
Term
Ceruloplasmin
Definition
levels increase in liver disease such as chronic active liver diseases, biliary cirrhosis and hemochromotosis.
Term
haptoglobin
Definition
low levels are seen in liver disease.
Term
Parenchymal liver disease
Definition
bleeding disorders.
Term
Ammonia Metabolism
Definition
Under normal circumstances most of the portal vein ammonia load is metabolized to urea in hepatocytes through the urea cycle during the first pass through the liver.
Term
Liver Cancer
Definition
Hepatitis and cirrhosis
Term
The most common type Liver Cancer
Definition
hepatocellular carcinoma, cancer that develops in the liver’s hepatocyte cells. According to the American Cancer Society, this type encompasses about 3 out of 4 cases of primary liver cancer.
Term
Hemochromatosis
Definition
most common genetic liver disorder. It involves excess iron storage and is usually diagnosed in adults.
Term
Reye's Syndrome
Definition
potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver.
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