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1 Liver
• The largest internal organ of the human body
• Relatively resilient
• 1.2–1.5 kg in the healthy adult
•
2 Blood Supply
• __________
• 25% of the total blood supply to the liver
• supplies oxygen-rich blood
• __________
• supplies nutrient-rich blood
• 75% of the total blood supply to the liver

3 Excretory system of liver

• Begins in __________
• Small spaces between the hepatocytes that form intrahepatic ducts
• Expelled into the __________

4 Lobules
• The __________ of the liver
• Responsible for all metabolic and excretory functions performed by the liver
• Two major cell types
• __________
• major functions
• Regenerative properties
• __________
• macrophages

5 Biochemical Functions
• 4 major functions
• __________
• __________
• __________
• __________
6 __________
• Breakdown of __________
• Principal pigment in bile
• Liver is the only organ that has the capacity to rid the body of heme waste products
• Bile is made up of bile acids or salts, __________, __________, and other substances

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• Liver is the only organ that has the capacity to rid the body of heme waste products
• Bile is made up of bile acids or salts, __________, __________, and other substances
extracted from the blood.

7 Synthetic
• Liver synthesizes __________, __________, and __________
8 Carbohydrates
• __________
• Circulate glucose
• Storage
• __________
• __________
• __________
9 __________
• synthesized in the liver under normal circumstances when nutrition is adequate and
the demand for glucose is being met
•

10 Proteins
• Almost all proteins except immunoglobulins and adult hemoglobin
• Development of hemoglobin in infants
• __________
• Acute-phase reactants
• Coagulation proteins
11 Detoxification and Drug Metabolism
• Gatekeeper
12 LIVER FUNCTION ALTERATIONS
DURING DISEASE

13 Jaundice
• Jaune = __________
• Used to describe the yellow discoloration of the skin, eyes, and mucous membranes
• Overt jaundice
• __________
• Prehepatic, hepatic, and posthepatic
14 Prehepatic
• Hemolytic anemia (usually Bilirubin <5mg/dL)
• ____________________
• Sickle cell anemia, spherocytosis, thalassemia, pyruvate kinase deficiency, and
glucose 6-phosphate dehydrogenase deficiency
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glucose 6-phosphate dehydrogenase deficiency

15 Hepatic Jaundice
• Intrinsic liver defect or disease
• Due to disorders of bilirubin metabolism and transport defects
• ____________________, DubinJohnson syndrome, Gilbert disease, and neonatal
physiologic jaundice of the newborn
• Due to ____________________ or __________

16 Cirrhosis
• __________ replaces normal, healthy liver tissue
• Fatigue, nausea, unintended weight loss, jaundice, bleeding from the gastrointestinal
tract, intense itching, and swelling in the legs and abdomen
• Chronic alcoholism and chronic hepatitis C virus infection
• hepatitis B and D virus infection, autoimmune hepatitis, inherited disorders (e.g.,
alpha1-antitrypsin deficiency, Wilson disease, hemachromatosis, and galac-tosemia),
nonalcoholic steatohepatitis, blocked bile ducts, drugs, toxins, and infections
17 Tumors
• Primary or metastatic
• __________
• Liver cells cancer
• Benign or malignant
• __________ (90%–95%)
• From other parts of the body to the liver
• Colon, lung, and breast cancer

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• __________
• Hepatocellular adenoma (occurring almost exclusively in females of child-bearing
age)
• Hemangiomas (masses of atypical blood vessels usually mesenchymal in origin
with no known etiology)
• __________
• hepatocellular carcinoma (HCC)
• Hepatocarcinoma
• Hepatoma

19 __________
• A group of disorders caused by infectious, metabolic, toxic, or druginduced disease.
• Exclusively in children
• Cause unknown
• But of after viral syndrome
• Fatty degeneration of liver

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• But of after viral syndrome

• Fatty degeneration of liver
• mild hyperbilirubinemia
• 3x Ammonia, AST and ALT
20 Drug- and Alcohol-Related Disorders
• __________ is a primary target organ for adverse drug reactions
• Many drugs are known to cause liver damage
• Immune-mediated injury to hepatocytes
• __________
• 90% of alcohol absorbed in the stomach

21 Alcohol Consumption
• __________
• Alcoholic fatty liver with inflammation
• Result to scar tissue formation
• Hepatic fibrosis
• Hepatic cirrhosis
•
22 ASSESSMENT OF LIVER FUNCTION / LIVER FUNCTION TESTS

23 Bilirubin
• __________
• Bilirubin + diazotized sulfanilic acid solution = __________
• __________
• Van den Bergh
• __________
• Jendrassik and Grof
• Bilirubinometry
24
• Unconjugated (__________) bilirubin
• __________
• Water-insoluble
• Bound to __________
• Conjugated (__________) bilirubin
• __________
• Water-soluble
• __________

25 Delta bilirubin
• Conjugated bilirubin that is __________ bound to albumin

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25 Delta bilirubin
• Conjugated bilirubin that is __________ bound to albumin
• Seen only when there is significant hepatic obstruction

26 Specimen Collection and Storage

• Serum is preferred
• Lipemia – __________ Tb
• Hemolysis – __________ Tb
• Light – __________ Tb
• 30%–50% per hour
• Pure Serum in the dark
• 2 days at room temperature, 1 week at 4°C, and indefinitely at -20°C
27 Malloy-Evelyn Procedure
• Serum or Plasma(bilirubin pigments) + diazo reagent (diazotized sulfanilic acid)
• diazotized sulfanilic acid ----> __________
• pH __________
• Red-purple with a maximal absorption of __________
• __________

28 Jendrassik-Grof Method for Total and Conjugated Bilirubin Determination

• Serum or Plasma(bilirubin pigments) + diazo reagent (sulfanilic acid in hydrochloric
acid and sodium nitrite) = __________
• Caffeine-benzoate

29 Error
• Bilirubin standards are subject to deterioration from exposure to light
• Lipemia – __________ Tb
• Hemolysis – __________ Tb
• Light – __________ Tb
• 30%–50% per hour
• Pure Serum in the dark
• 2 days at room temperature, 1 week at 4°C, and indefinitely at -20°C
•
30 Urobilinogen in Urine and Feces
• Colorless end product of _______________
• Oxidized by intestinal bacteria to the brown pigment urobilin
•
31 Alterations in Urinary Urobilinogen
• Increase
• _________________
• Defective liver-cell function (__________)

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• _________________
• Defective liver-cell function (__________)
• Absence
• ____________________

32 Quantitative methods
• __________ + p-dimethyl aminobenzaldehyde (Ehrlich’s reagent) = _____ color
33 Enzymes
• Liver damage
• To differentiate hepatocellular (functional) from obstructive (mechanical) liver disease
• ____________________[ALT]
• ___________________[AST]
• ____________________[ALP]
• 5-neucleotidase
• ____________________ (GGT
• ____________________

34 Aminotransferases
• AST (formerly referred to as ______________________________[SGOT])
• Aspartate to __________
• ALT (formerly referred to ______________________________ [SGPT])
• Alanine to __________
• Detection of hepatocellular (functional) damage to the liver
• Rises rapidly in almost all diseases of the liver and may remain elevated for up to
__________
35 ALT
• Found mainly in the liver (lesser amounts in skeletal muscle and kidney)
• More “__________” marker than AST

36 AST
• Widely distributed in equal amounts in the __________, __________, and __________
37 Alterations
• Increased
• Highest in Viral hepatitis, drug- and toxin-induced liver necrosis, and hepatic
ischemia
• Normal or mildly Elevated in obstructive liver damage
• Organ dysfunction or failure such as acute myocardial infarction, renal infarction,
progressive muscular dystrophy
• Secondary liver disease such as infectious mononucleosis, diabetic ketoacidosis,
and hyperthyroidism
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and hyperthyroidism

38 Phosphatases
• Alkaline Phosphatase
• Highest activity is seen in the liver, bone, intestine, kidney, and placenta
• Differentiate hepatobiliary disease from ____________________
• Great marker of extrahepatic biliary obstruction (stone in the common bile duct,
or in intrahepatic cholestasis (drug cholestasis or primary biliary cirrhosis ))
• 5-Nucleotidase
• Significantly elevated in _________________
• Useful in differentiating ALP elevations due to the liver from other conditions

39 y-Glutamyltransferase
• Membrane-localized enzyme found in high concentrations in the kidney, liver,
pancreas, intestine, and prostate
• Highest in ____________________
• Ingestion of alcohol or certain drugs (barbiturates, tricyclic antidepressants, and
anticonvulsants) elevates GGT

40 Lactate Dehydrogenase
• Very wide distribution throughout the body
• Moderate elevations of total serum LDH levels in acute viral hepatitis and in cirrhosis
• Slight elevations in biliary tract disease
• High serum levels may be found in ______________________________

41 Hepatitis
• Injury to the liver characterized by presence of __________ in the liver tissue
• Viral, bacterial, and parasitic infections
• Radiation, drugs, chemicals, and autoimmune diseases and toxins
• Symptoms: jaundice, dark urine, fatigue, nausea, vomiting, and abdominal pain
42

43 Hepatitis A (HAV)
• Also known as infectious hepatitis or short-incubation hepatitis
• The __________ form of viral hepatitis worldwide
• Nonenveloped RNA virus of the Picornavirus family
• Excreted in __________
• Measured through presence of __________(__________)
• Detectable at or prior to the onset of clinical illness and decline in 3–6 months
• IgG antibodies to __________ (__________) appear soon after IgM
• Persist for years after infection, and confer __________

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• Persist for years after infection, and confer __________

•
44 Hepatitis B virus (HBV)
• Known as serum hepatitis or long-incubation hepatitis
• __________ virus classified in the Hepadnaviridae family
• Two billion individuals are infected globally and between 350 and 400 million
persons are carriers of the virus
• Detected in virtually all body fluids, including blood, feces, urine, saliva, semen, tears,
and breast milk
45 Routes of transmission
• __________, __________, and __________

46 At risk
• Persons who engage in the sharing of body fluids
• ____________________(e.g., prostitution, male homosexuality)
• Sharing of drug-injection needles
• Children born to mothers who are hepatitis B __________ antigen–positive at the time
of delivery

47 Serologic Markers of HBV Infection

• __________ is the primary site of HBV replication
• Following an HBV infection, the core of the antigen is synthesized in the nuclei of
hepatocytes and then passed into the cytoplasm of the liver cell, where it is
surrounded by the protein coat
• (__________) - An antigen present in the core of the virus
• (__________) – Present on the surface protein
• (__________) – Envelope antigen
48 Hepatitis B Surface Antigen
• HBsAg is the antigen for which routine testing is performed on all donated units of
blood
• Not infectious
• Presence in the serum may indicate the presence of the hepatitis virus
• Only serologic marker detected during the first __________ after infection
• The average time from exposure to detection of HBsAg is __________(range, 6–60
days)
49 Hepatitis B Core Antigen
• Present only in the __________ of hepatocytes during an acute infection with HBV

50 Hepatitis B e Antigen
• Closely associated with the __________ of the viral particle

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50 Hepatitis B e Antigen
• Closely associated with the __________ of the viral particle
• Detected in the serum of persons with acute or chronic HBV infection
51 HBV Treatment and Prevention
• Medical evaluation and regular monitoring
• Hepatitis B vaccination
• __________
52 Hepatitis C
• Originally “non-A non-B hepatitis”
• __________ family
• __________
• Anti-HCV detection by enzyme immunoassay (EIA)
53 Hepatitis D
• Requires the __________ of HBV for replication

54 Hepatitis E
• ____________________
• Sole member of the genus __________ in the family __________
• Incubation period: __________ prior to the onset of symptoms
• __________ route
• __________ epidemics