LIVER FUNCTION LEC

LIVER

• largest organ in the body

• most expert organ in terms of multitasking

• only organ that can be partially removed from the body and still functions the same

TRUE

The liver have the capacity to regenerate

1.4 liter

Liver filters about ____ of blood per minute

Direct measurement of natural color

• used in the Development of Icterus index

MEULENGRACHT METHOD AND NEWBERGER METHOD

What are the 2 types on icterus index?

Icterus index

the nuhher of times the serum is diluted

• carotene

• xanthophyll 2

• hemoglobin 67

Interferences of icterus index

1. Muelengracht method

2. Neweberger method

1. ______: dilute with serum with NSS and compare wirh 0.001 K2Cr207

2. ______: used of sodium citrate

Classic Diazo reaction

method serves as the basis for all the commonly used methods today. dicovered by paul ehrlich

Urine

Specimen utilized for diazo reaction?

Total Azobilirubin

Determnie whether Direct or total azobilirubuin:

Bilirubin + DSA + Accelerator

Direct Azobilirubin

Bilirubin+ DSA

Evelyn and Malloy

• this people uses the accelerator of 50% methanol solution

• Sulfanilic acid

• Sodium nitrite

Composition of Diazotized Sulphanilic acid

Sodium acetate

used as buffer ph for evelyn and malloy method

• remove indoles

Ascorbic Acid

used as to terminate/stop the reaction in the remaining diazo reagent

Van den bergh test

• diazo reaction applied to the serum only in the presence of the accelerator

Jendrassik and Grof

• candidate method used for total bilirubin

• more complex

• Color result: purple azobilirubin

Total Bilirubin

Bilirubin + Diazotize sulfanilic acid + accelerator= 2 azobilirubin

Conjugated Bilirubin

Bilirubin + Diazotize sulfanilic acid = 2 azobilirubin

Unconjugated bilirubin

Total bilirubin- conjugated bilirubin

• insensitive to sample pH

• Insensitive to a 50 fold variation in protein concentration

• Adequate optical sensitivity even for low bilirubin concentration

• Minimal turbidity and with constant serum blank

• Not affected by hemoglobin up to 70mg/dl

Give the advantages of jendrassik and grof over evelyn and malloy

• fasting

• non hemolyzed

• non lipemic serum or plasm

What are specimen consideration

• Lipochrome

• hemolysis,

• lipemia

• exposure to light

sources of errors in the bilirubin measurement

Ehrlich’s method

what method used to determine the urine urobilinogen

• p-dimethly aminobenzaldehyde

• ascorbic acid

• Nach3coo/ sodiuma acetate

reagent used for urine urobilinogen

Ascorbic acid

• reducing agent to maintain urobilinogen in reduced state

red

What is the color product of ehrlich method

• porphobilinogen

• sulfonamides

• procaine

• 5 hydroxyindileacetic acid

Error in in ruine urobilinogen

2 hours fresh urine

Specimen used for urine urobilinogen

Alkaline ferric hydrozide

reduce urobilin to urobilinogen

full biliary blockage

absence of urobilinogen in the urine and stool is mostly commonly found with

Fecal urobilinogen

• aqueous extract of fresh feces+ feoh2 + ehrlich regaent red colored

increased

Determine if fecal urobilinogen increased or decreased:

Hemolytic disease and defective live cell funciton

Decreased

Determine if fecal urobilinogen increased or decreased:

Biliary obstruction and heptocellular disease

Hay test

What is the test for bile salt?

test for bile salt/ hay test

The sprinkle of powder to 5ml of Urine

floats at the top

Bile salt is absent when sulfur powder____

1. sink to the bottom

2. obstructive jaundice

Bile salt is present when sulfur powder____ leading to ____

• total protein

• albumin

• a-globin

• prothrombin time

This measure the products of liver

Test for synthetic function

• measure products of liver

• vitamin K response

• special protein determination

Test for execretory function

• ecectreatuib if foreign dyes

• brompsulphalein test

• rose bengal test

Rose bengal test

• used tagged I2

• radioactivity of the dye

brown to amber

Color of the urine for inspection

• yelow foam

Foam test for urine bilirubin

harrison spot test and diazotization test

what are the test utilized for urine bilirubin?

Harrison spot test

• used barium chloride filter + ferric chloricde in TCA resulting to green color precipitate

Diazotization test

Strip test and tbale test

hippuric acid test

used for detoxification test that giving sodium benzoate meal

AST/SGPT

• Aspartate aminotransferase

• Liver, skeletal muscle and hear

ALT/SGOT

● Alanine aminotranferase

● lIVER

ALP

● Alkaline phosphatase

● Liver and bone

● Zinc metalloenzymes

● Widely spread across all tissues.

● Most activity occurs in the liver, bone,

and gut, kidney and placenta

GGT

● Gamma glutamyl transferase

● Membrane-localized enzyme

● High levels in kidney, liver, pancreas,

gut, and prostate, but not in bone

● Helps identify the reason of increased

ALP levels, as GGT levels are greatest

in the biliary system obstruction

5’-nucleotidase

● Liver synthetic function

● Only significant if decreased

● Catalyzes the hydrolysis of

nucleoside-5'-phosphate esters

LD

● Lactate dehydrogenase

● Nonspecific marker for cellular injury

● Most important hemolytic enzyme

Enzymes

act as catalysts, facilitating and accelerating chemical reactions within living organisms. These proteins play a crucial role in various physiological processes by lowering the activation energy required for a specific reaction to occur.

ALKALINE PHOSPHATASE

an enzyme found in various tissues throughout the body, with particularly high concentrations in the liver, bones, and bile duct.

● It catalyzes the hydrolysis of phosphate groups from various substrates under alkaline conditions.

GAMMA-GLUTAMYL TRANSFERASE

• an enzyme found in various tissues, with high concentrations in the liver and bile ducts

LIVER

• capable of regeneration

• in a mild injury it can heal itself

• make of the coagulation factors

LIVER, 1.2-1.5kg

known as the largest internal organ composed of_____

Below the diagram proected by ribs in upper quadrant of the abdomen

Location of the liver

Reddish Brown

Color of the healthy liver

False, baliktad

True or False: left lobe of the liver is 6x larger than right lobe?

Falciform Ligament

holds, connects and separates the right and the left lobe of the liver

Gallbladder

store the bile

Bile

exogenous lipids , bile acids digest fats

Bilirubin

the color of the bile is called

Chylomicrons

Lipoproteins that carry exogenous substances

1,500 ml

How many blood per minute does the liver supply?

hepatic artery and porta vein

What are the 2 supplies blood supply of the liver

Aorta/ Hepatic Artery

○ Supplies oxygen-rich blood from the heart to the liver (but nutrient-poor)

○ Responsible for providing approximately 25% of the total blood supply to the liver

Portal Vein

Supplies nutrient-rich blood (but oxygen-poor) from the digestive tract

○ Brings blood from the intestines

○ Responsible for providing approximately 75% of the total blood supply to the liver

hepatic vein

drain blood into the inferior vena cava

hepatic sinusoid

blood supplies merge that lined with hepatocytes in order to remove potentially toxic substance from the blood.

Central canal

the blood leaves to the liver

1. hepatic veins

2. inferior vena cava.

The liver is drained by a collecting system of veins that empties into the 1._____ and ultimately into the 2._______

Lobules

• functional units responsible for all the metabolic and execretory funcitons performed by the liver

• this is the structural unit of the liver

hepatocytes and kupffer cells

Lobules contains ___ & _____

Six sided structure

How many sides of the lobule?

Central vein

What do u call to the centrally located vein in the six sided structure of the lobule composing with portal triad at corners?

Hepatocytes

• structural cell of the liver

• ability to self generate due to this

• drained in the bile canliculi and can make bile

• hepatic artery

• portal vein

• bile duct

Portal triad composed of what?

Bile canaliculi

• transports the bile into the bile duct until store in gallbladder

• execreatory function start

• membrane like conduit connecting bile duct to portal triad

in sinusuoid

Where do u find kupffer cells?

Hepatocytes

large cells that radiate outward in plates from the central vein to the periphery of the lobule. These cells perform the major functions associated with the liver and are responsible for the liver’s regenerative properties.

Kupffer cells

macrophages that line the sinusoids of the liver and act as active phagocytes capable of engulfing bacteria, debris, toxins, and other substances flowing through the sinusoids

Hepatocyte System

Metabolic reactions and macromolecular synthesis

Biliary System

Metabolism of bilirubin and bile salts

Reticuloendothelial System

Immune system and production of heme and globin metabolites

1. Excretion/Secretion

2. Metabolism

3. Storage

4. Detoxification

FOur major functions of the liver

METABOLISM

The second major function of the liver is metabolic processes. The liver has extensive capacity for metabolizing many biological Metabolism compounds including carbohydrates, lipids, and proteins

FALSE

True or false: liver produce von willbrand factors and antiglobulins

TRUE

True/ False:all proteins are produce by the liver

1. carbohydrates

2. lipid and lipoprotein

3. proteins

What are underly of metabolism

glycogenesis

maintaining stable glucose concentrations due to its ability to store glucose as glycogen

glycogenolysis

degrade glycogen called

gluconeogenesis

when the supply of glycogen becomes depleted, the liver will create glucose from non-sugar carbon substrates like pyruvate, lactate, and amino acids

albumin

most important proteins synthesized by the liver carries a wide range of important functions.

Liver

positive and negative acute-phase reactants and

coagulation proteins, and it also serves to store a

pool of amino acids through protein degradation