CC liver functions

its complex functions include metabolism of _________________, ______________, _______________, and ____________; detoxification of harmful substances; storages of essential compounds; and excretio of substances of prevent harm

liver (carbohydrates, lipids, proteins and bilirubin)

responsible for performing vital tasks that impacts all the body system

liver

resilient organ that can regenerate that have been destroyed or some short term injury or disease or it have been removed

liver

if become completely non functional for any reason, death may occur with approximately _______________ due to ____________

liver (24 hours due to hypoglycemia)

largest and most versatile organ in the body

liver

color of liver

reddish brown

liver located under the _______________ in the ____________________

diapghragm in the upper right quadrant of the abdomen

it is the only organ in the body of mammals that has the ability to ______________, it can grow back after ___________ of large portion (as much as approximately __________) of the organ

regenerate (surgical removal and 80%)

has an abundant blood supply, receiving approximately _____________ from 2 major vessels

1500 ml/min

2 major vessels of liver

1. hepatic artery
2. portal vein

contributes approximately ____________ of the blood supply and provies most of the most o2 requirement

hepatic artery (25%)

transports the most recently absorbed material _________ from the _____________ to the ___________

protal vein (75%) intestines to liver

hepatic artery what supply?

oxygen rich blood

portal vein what supply?

nutrient rich blood

major cells of of the liver, lined with hepatocytes that are capable of removing protentially toxic substance

hepatic sinusoids

cells found on the liver

1. hepatocytes
2 .kupffer cells
3. stellate cells
4. oval cells

major functioning cells; performs most of the metabolic and synthetic functions of the liver

hepatocytes (80%)

contains lysosomes with hydrolytic enzymes, immunoglobulin and complement receptors

kupffer cells

kupffer cells secretes

interleukins, TNF, collagenase and prostaglandins

anatomical units of liver

lobules

storage of soluble fat vitamins

stellate cells

synthesize collage-fibrosis-cirrhosis
synthesize nitric oxide-regulate intrahepatic blood flow

stellate cells

liver progenitor cells involved in the regeneration of hepatocytes and bile ducts after liver injury

ova cells

liver systems

1. biochemical hepatocytic system
2. hepatobiliary system
3. reticuloendothelial sytem

involves in immunity or immune system

reticuloendothelial system

vast majority for all metabolic activities

biochemical hepatocytic system

concerns on metabolization of bilirubin

hepatobiliary system

converts glycogen to glucose during times of high energy demand or lowered plasma glucose concentration

glycogenolysis

converts glucose to glycogen during excess CHO intake

glycogenesis

synthesis glucose from the catabolism of some amino acids

gluconeogenesis

example of non carbohydrates

1. pyruvate
2. lactate
3. amino acids
4. lipids

converts lactate back to glucose

cori cycle

synthesized most all the plasma protein with exception of ____________ and ___________

protein synthesis (immunoglobin and adult hemoglobin)

in protein synthesis of positive and negative _________________ and _______________

acute phase reactants and coagulation proteins

store a pool of _______________ through protein degradation

amino acids

transmination and deamination of __________

amino acids

___________ of cholesterol is synthesized in the liver
__________ from diet

(80% and 20%)

in lipid metabolism is synthesize

endogenous lipid

catabolize fatty acids to acetyl CoA and cholesterol to ______________

primary bile acids

act like detergents and essential emulsifiers of ingested lipids

bile acids and their conjugates

transamination

1. keto acid to amino acids
2. acetyl CoA to ketone bodies

liver is storage site for

1. glycogen
2. vitamin A, D, B12, E, and K
3. iron (RE cells)

phagocytosis by

kupffer cells

(protective function) metabolism and excretion of

steriod hormones, drugs and foreign compounds

production of ______________ , ___________ and other molecules that are less than their parent compound

urea and uric acid

plays in immunologic defense through its R-E system (Kupffer cells)

circulatory system

(circulatory system) helps to regulate blood volume by serving as a

blood storage area

(circulatory system) means of mixing blood from the portal with that of the

systemic circulation

processing and excretion of endogenous and exogenous substances into the bile or urine such as the major heme waste product

bilirubin

bile is made up of

1. bile acids or salts
2. bile pigments
3. cholesterol
4. other substances excreted from the blood

the body produces approximately __________ of bile per day and excretes __________ of what is produced

(3L and 1L)

serve as a gatekeeper between substances absorbed by the gastrointestinal tract and those released into systemic circulation

liver

every substance that is absorbed in the gastrointestinal tract must 1st pass through the ___________, this is referred as a

liver (1st pass)

this is an important function of the liver because it can allow important substances to reach the systemic circulation and can serve as a barrier to prevent toxic or harmful substances from reaching systemic circulation

1st pass

components of bile acids

1. bile acids
2. lecithin
3. cholesterol
4. bilirubin
5. electrocytes

bile is important in

lipid digestion

results from the catabolism of the heme moiety of the hemoglobin molecule due to ___________ or __________

bile pigments (old age or trauma)

after __________ there would be degradation occurs in the _________, ___________ and __________

120 days (spleen, bone marrow and liver)

conjugated bilirubin or b2

delta bilirubin

that has longer half life than other forms of bilirubin

delta bilirubin (conjugated bilirubin)

bilirubin tightly bounded to

albumin

delta bilirubin is formed due to prolonged evelation of

conjugated bilirubin

delta bilirubin helps in monitoring the decline of serum bilirubin following

gallstones

manifestation that there is high bilirubin in the body

jaundice

a condition characterized by a _______ discoloration or pigmentation of the skin, sclera and mucuos membrane

jaundice (yellow)

normal value to bilirubin

0.2 to 1.0 mg/dl

signifies hyperbilirubinemia and becomes clinically evident when serum bilirubin exceeds __________

2 mg/dl

over jaundice

no manifestation (2-3 mg/dl

clinical jaundice

there's manifestation (5 mg/dl)

excessive production of bilirubin due to excessive RBC destruction

pre-hepatic hyperbilirubinemia

prehepatic hyperbilirubinemia is characterized by

(BIH NB2) benign intrahepatic cholestasis, neonatal jaundice type 2

causes of prehapatic hyperbilirubinemia

1. malaria
2. hemolytic anemia
3. hemolytic disease of the newborn
4. hemolytic transfusion reaction

urobilinogen in urine is decreased

hepatic hyperbilirubinemia

positive to hepatic hyperbilirubinemia

bilirubin

hepatic hyperbilirunemia implies damage to _____________ where both types of _______ are increased

hepatocytes (bilirubin)

in hepatic hyperbilirunemia what increases?

b1 and b2

hepatic hyperbilirunemia causes: retention jaundice or inability to conjugate as seen in:

1. physiologic jaundice of the newborn
2. gilbert's syndrome
3. crigler-najjar syndrome (type 1 kernicterus) and (type 2 absence of UDPGT)

hepatic hyperbilirunemia causes:
hepatocyte injury (hepatocellular) as seen in

1. viral hepatitis
2. cirrhosis and alcoholic hepatitis
3. toxic liver injury
4. parasitism
(increase bilirubin to kidney to inestines)

hepatic hyperbilirunemia causes:
impaired excretion of products from the hepatocytes as seen in:

1. dubin-johnson syndrome ( pigmentation
2. rotor syndrome (no pigmentation)
3. viral hepatitis
4. cirrhosis

failure of bile to flow due to obstruction of the biliary tree

post hepatic hyperbilirubenimia

no. 1 marker of biliary tree damage

alkaline phosphatase (ALP)

no. 2 marker of biliary tree damage

gamma glutamyl transpeptidase (GGT)

in post hepatic hyperbilirubinemia what increases??

B2 (5 nucleotidase, LAP, ALP, GGT)

causes of post hepatic hyperbilirubinemia

1. choledocholelithiasis (stone in bile duct)
2. strictures and spasm caused by bacteria
3. parasitism
4. pancreatic sarcoma
5. cholangiocarcinoma- tumor cancer

characterized by a mild unconjugated hyperbilirubinemia. also, characterized by decreased conjugation and decreased uptake of bilirubin and pre conjugation failure

gilbert's syndrome

increase in b1 disorders

1. gilbert's syndrome
2. crigler-najjar syndrome

absence of UDPGT, increased b1- death

type 1: autosomal recessive (crigler-najjar syndrome)

partial defect to conjugated enzyme, increased b1- adulthood

type 1: autosomal dominant (cirgler-najjar syndrome)

characterized by a decreased hapetic secretion of bilirubin. increased b2 (with hepatic pigmentation)

dubin-johnson syndrome

without hepatic pigmentation (increased b2)

rotor syndrome

A familial form of unconjugated hyperbilirubinemia caused by a circulating inhibitor of bilirubin conjugation

lucey-driscoll syndrome

clinical condition in which scar tissue replaces normal healthy liver tissue

cirrhosis

blocks the flow of blood through the organ and prevents the liver from functioning properly

cirrhosis

cirrhosis abnormal?

nodular

cirrhosis ____________-> ______________->_______________

fatty liver, liver fibrosis, cirrhosis

types of cirrhosis:
according to size of the nodules

1. macronodular cirrhosis
2. micronodular cirrhosis
3. possible mixed forms

types of cirrhosis:
according to etiology

1. alcohol abuse
2. hemochromatosis
3. viral hepatitis

hemochromatosis

1. iron overload
2. disposition of hemosiderin in the tissue (color black discoloration)
3. biliary cirrhosis

Cirrhosis causes

1. portal hypertension
2. affected synthetic activity

portal hypertension

1. blocked passageway
2. splenomegaly
3. esophageal varices