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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 |
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Discuss the 2 substances whose excretion in bile shows liver disease:
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1) Serum & Urine Bilirubin (serum bile acids)
2) Membrane-bound Enzymes |
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Discuss the three proteins whose secretion in blood shows liver disease:
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1) Serum Albumin
2) Prothrombin 3) Fibrinogen |
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Discuss the 3 enzymes whose elevated activity shows liver disease:
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1) Serum Aspartate Aminotransferase (AST)
2) Serum Alanine Aminotransferase (ALT) 3) Serum LDH |
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Compare and contrast the changes in liver function tests in hepatocellular diseases and disorders associated with cholestasis
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Signs of Cholestasis - elevated total bilirubin concentration and ALP activity
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Differentiate between acute and chronic liver disease based on liver function tests
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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 |
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Explain the biochemical mechanisms for the following symptoms and signs in patients with liver disease –edema, icterus, ascites, encephalopathy, bleeding tendency
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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 |
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Name 4 signs that reflect Cholestatic Disease and Bile Duct Injury
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1) GGT
2) ALP (also in bone disease) 3) 5’ Nucleotase (NT) 4) Conjugated bilirubin in serum, |
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Name 5 signs that reflect liver necrosis
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1) AST
2) ALT 3) decreased serum albumin 4) decreased serum gamma-globulins 5) decreased serum prothrombin time |
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Name 2 signs that reflect Alcoholic Liver Disease
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1) GGT
2) AST:ALT = 2:1, |
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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 |