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12 Cards in this Set

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• List the important functions of the liver
– Role of Kupffer Cells (3)
– Storage (4)
– Excretion (3)
– Synthesis (3)
– Detoxification (2)
Role of Kupffer Cells
1) Bind old serum proteins & remove from circulation
2) Phagocytosize circulating damaged cels
3) Phagoscytosize bacterial/antibody complexes.
Storage
1) Glycogen 2) Protein blood-clotting factor (prothrombin)
3) Vitamins (A) 4) Iron bound to ferritin
Excretion
1) Formation of water-soluble metabolites (urea)
2) Bile pigment synthesis (glucuronides excretion)
Synthesis of Plasma Proteins
1) Albumin (exclusive) 2) Coagulation factors II, VII, IX, X
3) Apoprotein A-1 & B-100
Detoxification and Protein Catabolism
1) Ammonia 2) Metabolites 3) Xenobiotics
Discuss the 2 substances whose excretion in bile shows liver disease:
1) Serum & Urine Bilirubin (serum bile acids)
2) Membrane-bound Enzymes
Discuss the three proteins whose secretion in blood shows liver disease:
1) Serum Albumin
2) Prothrombin
3) Fibrinogen
Discuss the 3 enzymes whose elevated activity shows liver disease:
1) Serum Aspartate Aminotransferase (AST)
2) Serum Alanine Aminotransferase (ALT)
3) Serum LDH
Compare and contrast the changes in liver function tests in hepatocellular diseases and disorders associated with cholestasis
Signs of Cholestasis - elevated total bilirubin concentration and ALP activity
Differentiate between acute and chronic liver disease based on liver function tests
Acute - normal serum albumin, serum total bilirubin concentrations and ALP activity (cholestasis)

Chronic - GGT (long term alcohol abuse), decreased serum albumin, elevated serum globulins and prothrombin time
Explain the biochemical mechanisms for the following symptoms and signs in patients with liver disease –edema, icterus, ascites, encephalopathy, bleeding tendency
Edema - low albumin levels affect osmotic pressure of the blood causing liquid to enter the extra-cellular space
Icterus - Increased bilirubin levels secondary to liver necrosis
Ascites - Portal hypertension
Encephalopathy - build up of toxins such as ammonia or scleroses
Bleeding Tendency - Deficiency in clotting factors
Name 4 signs that reflect Cholestatic Disease and Bile Duct Injury
1) GGT
2) ALP (also in bone disease)
3) 5’ Nucleotase (NT)
4) Conjugated bilirubin in serum,
Name 5 signs that reflect liver necrosis
1) AST
2) ALT
3) decreased serum albumin
4) decreased serum gamma-globulins
5) decreased serum prothrombin time
Name 2 signs that reflect Alcoholic Liver Disease
1) GGT
2) AST:ALT = 2:1,
Specify the relevance and findings of each special Liver Function Test (LFT):
Serum ammonia, AFP, α1-antitrypsin, ceruloplasmin, serum iron, transferrin and ferritin.
Serum ammonia – Protein catabolism secondary to muscle wastage. Poor correlation for liver function.
AFP – Neural tube defects in children
α1-antitrypsin – deficiency indicates abnormal liver function
ceruloplasmin (ferroxidase enzyme) – decrease indicates Wilson’s disease (Cu++ or Fe++ increase)
serum iron (haemochromatosis) – increased iron in the serum, liver or urine indicates a defective human hemochromatosis protein (HFE) as excessive amounts are absorbed in the intestines
transferrin - High or low levels indicate iron metabolism disorders
ferritin – Abnormal levels indicate disruptions in iron stores