INTRODUCTION
Liver
Functions
Metabolism of carbohydrates, lipids,
proteins, and bilirubin
Detoxification of harmful substances
Storage of essential compounds
Excretion of substances to prevent
harm
Can regenerate cells that have been
destroyed by some short-term injury or
disease or have been removed
If the liver becomes nonfunctional, death will
occur within approximately 24 hours due to
hypoglycemia
Portal Vein
the
*Note
ANATOMY
Gross Anatomy
Hepatic Artery
Excretory system
Microscopic Anatomy
Lobules
Macromolecular synthesis
Biliary System
Excretory
Metabolism of bilirubin and bile salts
Reticuloendothelial System
BIOCHEMICAL FUNCTIONS
Excretory and Secretory
Kupffer cells
Bile
Hepatocyte System
*NOTES:
Bilirubin
NOTES:
Metabolism
Carbohydrates
Lipids
Proteins
Vitamins
Fat soluble
A, D, E, K
Water soluble
B12
Storage
Glycogen
Lipids
Amino acids and proteins
LIVER FUNCTION
DISEASE
ALTERATIONS
DURING
Alcohol
Ethanol
In very small amounts, causes very
mild, transient, and unnoticed injury
to the liver
Can lead to alcoholic cirrhosis
Alcohol-induced liver injury may be
categorized into three stages
Alcoholic fatty liver
Alcoholic hepatitis
Alcoholic cirrhosis
*Alcoholic hepatitis
*Alcoholic cirrhosis
Reye Syndrome
increases
in
aminotransferases
ammonia
and
Tumors
Benign
Hepatocellular adenoma
A
condition
occurring
almost
exclusively in females of childbearing age
Hemangiomas
Masses of blood vessels with no
known etiology
Malignant
Hepatocellular carcinoma
Also known as hepatocarcinoma and
hepatoma
Most common
Bile duct carcinoma
Hepatoblastoma
Uncommon hepatic malignancy of
children
Types
Flavivirus
Delta agent
Needs coinfection
surface antigen
Hepevirus
Fecal-oral route
Toga virus
B
C
D
with
heap
F
G
G-B virus
Transfusion-transmitted virus
SEN virus
Alcoholic Hepatitis
Drug
Ketoconazole
Methyl dopa
Nitrofurantoine
Isoniazid
Hepatitis
Cirrhosis
macronodules
micronodules
or
Classifications of Jaundice
Pre-hepatic
Hemolytic hyperbilirubinemia
Hepatic
Hepatocellular hyperbilirubinemia
Post-hepatic
Obstructive hyperbilirubinemia
Pre-hepatic
Hepatic
Jaundice or Icterus
French
Jaune which means yellow
Yellowish discoloration of the skin and
sclera
Hyperbilirubinemia
>1 mg/dL up to 2-3 mg/dL
Associated with kernicterus
*Gilbert Syndrome
Gilbert-Muelengracht syndrome
Benign autosomal recessive hereditary
disorder
Results from a genetic mutation in the gene
UGT1A1
Impaired cellular uptake of bilirubin
Asymptomatic; only mild icterus
Increased B1
*Crigler-Najjar Syndrome
Syndrome
of
chronic
non-hemolytic
unconjugated hyperbilirubinemia
Deficiency of the enzyme UDPGT
Type I
Complete absence of enzymatic
bilirubin conjugation
No B2 is formed
Bile is colorless
Type II
Mutation
causing
a
severe
deficiency
of
the
enzyme
responsible for bilirubin conjugation
*Lucey Driscoll
*Dubin-Johnson Syndrome
LABORATORY TESTS
Icterus Index
*Rotor Syndrome
Muelengracht Method
Dilute serum with NSS and compare
with 0/01% potassium dichromate
Newberger Method
Sodium citrate is used
to
Diazo-Colorimetric Procedure
*Reagents
*Reagents
*Advantages of JG over EM
Fecal
Urobilinogen
aldehyde/Watsons Reaction)
*Note
Specimen
considerations
Measurement
for
Bilirubin
(Ehrlichs
Increased
Hemolytic disease
Defective
liver
(hepatitis)
Absence
Biliary obstruction
cell
function
Hepatocellular disease
Urine Bilirubin
Hay Test
inadequate
clotting factors
Albumin-Globulin ratio is also measured
Bromsulphalein Test
Foam Test
Diazotization Test
Tablet test/Ictotest
Strip test
(serum
%retention-%excretion
BSP is toxic
[Flying Cockroach]