Term
most metabolically complex organ
hepatocytes perform liver's metabolic functions:
formation and excretion of bile
regulation of carbohydrate homeostasis
lipid synthesis and secretion of plasma lipoproteins
control of cholesterol metabolism
formation of serum albumin, clotting factors, enzymes, urea, and numerous other proteins
metabolism and detoxification of medications and other foreign substances
storing glycogen, iron, vitamins, and minterals |
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Definition
| metabolic functions of the liver |
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Term
endocrine and exocrine functions
3 major functions:
to secrete fluid containing digestive enzymes into the duodenum
to secrete the hormones insulin and glucagon, which help to regulate sugar levels in the blood stream
to secrete into the duodenum the large quantities of sodium bicarbonate needed to neutralize the acid coming from the stomach |
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Definition
| metabolic functions of the pancreas |
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Term
primary function = store and concentrate bile
bile = bile salts, bilirubin, phospholipids, cholesterol, bicarbonate, and water
bile emulsifies fat and fat-dependent vitamins (DEAK) to promote absorption of food
food enters the duodenum -> cholecystokinin is released -> stimulates contraction of the gallbladder and common bile duct -> bile secretion |
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Definition
| metabolic functions of the gallbladder |
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Term
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Definition
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Term
| inflammation of the gallbladder |
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Definition
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Term
| back up of bile in the liver |
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Definition
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Term
cholelithiasis
cholecystitis
cholestasis |
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Definition
| common disorders of the gallbladder |
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Term
fatigue, weakness
nausea, poor appetite, weight loss
abdominal pain and distention
fever
steatorrhea - loose, fatty stool |
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Definition
| general symtpoms associated with hepatobiliary dysfunction |
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Term
spider angioas - spiderlike blood vessels on face and chest (usually NOT on the lower extremities)
palmar erythema - red palms
pruritis - itching
clubbing |
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Definition
| skin manifestations associated with hepatobiliary dysfunction |
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Term
anemia
leukopenia
THROMBOCYTOPENIA
COAGULOPATHY |
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Definition
| blood abnormalities associated with hepatobiliary dysfunction |
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Term
increased amylase
increased lipase |
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Definition
| laboratory tests that indicate pancreatic injury |
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Term
increased aminotransferases (AST and ALT)
increased lactate dehydrogenase (LDH) |
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Definition
| laboratory tests that indicate liver injury |
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Term
increase in unconjugatd bilirubin and conjugated bilirubin
increase in alkaline phosphatase
increase in gamma-glutamyl transpeptidase |
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Definition
| laboratory tests that indicate cholestasis |
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Term
increased PT/INR
decreased serum albumin |
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Definition
| laboratory tests that indicate hepatic synthetic incapacity |
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Term
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Definition
| laboratory test that indicates hepatic encephalopathy |
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Term
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Definition
enzyme used to help digest carbohydrates
INCREASED when the pancreas is diseased, injured, or inflamed
non-specific alone: use in combination with lipase and signs/symptoms |
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Term
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Definition
enzyme used to help trigger the breakdown of fat
INCREASED when the pancreas is diseased, injured, or inflamed
non-specific alone: use in combination with amylase and signs/symptoms |
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Term
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Definition
enzymes located in the cytoplasm of hepatocytes
aspartate transaminase (AST) and alanine transaminase (ALT) are INCREASED with hepatocellular injury |
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Term
highest level (> 20 x) = acute viral, drug-induced, or ischemic
alcohol liver disease: rarely ALT > 500 IU/L
ratio of AST/ALT > 2 suggests alcoholic liver disease
moderate elevation (100-300 IU/L) = chronic liver disease
AST can be elevated in rhabdomyolysis, heart or brain tissue damage |
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Definition
| degree of aminotransferase elevation is helpful for suggesting what possible etiologies? |
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Term
| lactate dehydrogenase (LDH) |
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Definition
enzyme found in almost all body tissues and release is INCREASED when cells are damaged or destroyed
inentitive for hepatocellular injury but sensitive for cancers involving the liver
INCREASE also indicates hemolysis, MI, or pulmonary embolism |
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Term
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Definition
bile pigment
formed when the liver breaks down old red blood cells
then removed from the body through the stool |
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Term
bilirubin circulates int he blood in 2 forms:
1) indirect (unconjugated) bilirubin
insoluble in water
changed into soluble (conjugated) bilirubin in the liver
2) direct (conjugated) bilirubin
water soluble form created from indirect bilirubin by the liver
release into bile and stored in the gallbladder before eventually being excreted in the stool |
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Definition
| indirect (unconjugated) bilirubin vs. direct (conjugated) bilirubin |
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Term
excessive production -> hemolysis
immature enzyme system -> jaundice of newborn/prematurity
inherited defects -> Gilbert syndrome, Crigler-Najjar syndrome |
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Definition
| what can cause an INCREASE in unconjugated (indirect) bilirubin? |
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Term
impaired intrahepatic excretion:
hepato cellular disease -> hepatitis, CIRRHOSIS, medications
intrahepatic cholestasis -> pregnancy, medications
congenital -> Dubin-Johnson syndrome, Rotor syndrome
obstruction:
extrahepatic -> calculus, stricture, neoplasm
intrahepatic -> sclerosing cholangitis, CIRRHOSIS, neoplams |
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Definition
| what can cause an INCREASE in conjugated (direct) bilirubin? |
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Term
| alkaline phosphatase (ALP) |
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Definition
cellular enzyme with high concentrations in the liver and bone
in the liver, found in cells that join to form bile ducts
INCREASED when bile flow through the bile ducts is disrupted (OBSTRUCTION) |
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Term
| gamma-glutamyl transpeptidase (GGT) |
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Definition
liver enzyme that is very sensitive to changes in liver function
levels correlate well with ALP
INCREASE = biliary tract disease
combination with ALP is sensitive and specific for biliary tract disease |
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Term
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Definition
liver's ability to synthesize vitamin K dependent clotting factors: factors II (prothrombin), V, VII, and X
INCREASED (in absence of warfarin administration) indicates severe hepatocellular dysfunction and indicates progression to advanced cirrhosis |
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Term
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Definition
most abundant protein in the blood plasma
maintains oncotic pressure, nourishes tissues, and transports hormones, vitamins, drugs, and ions like Ca throughout the body
synthesized in the liver and is extrememly sensitive to liver damage
DECREASED with liver damage, kidney disease, malnutrition, alcoholism, inflammation, and shock |
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Term
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Definition
prduced by colonic bacteria and metabolism of glutamine
liver metabolizes it from urea
level correlates poorly with severity of hepatic encephalopathy
INCREASED with hepatic encephalopathy, high protein meals, GI bleeding, hypokalemia, or metabolic alkalosis |
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Term
| Child-Pugh Classification |
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Definition
quantifies effects of cirrhotic processes
based on combination of clinical and laboratory data
USE FOR DRUG-DOSING ADJUSTMENTS
limitation = relies on subjective scoring for ascites and encephalopathy |
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Term
| Mayo End-Stage Liver Disease (MELD) |
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Definition
the accepted classification system used by the United Network of Organ Sharing (UNOS)
USED IN THE ALLOCATION OF LIVERS FOR TRANSPLANT
relies solely on objective data
NOT currently used for medication dosing |
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Term
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Definition
| test that measure liver injury |
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Term
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Definition
| tests that measure cholestasis |
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Term
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Definition
| test that measure the synthetic capacity of the liver |
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