LS 2 PG DIP UCL pharmacy diploma (LIVER TEST ONLY) PHAY0042

In the liver what is the role of the gall bladder ? your gall bladder where bile is produced and transported via the bile duct releasing the bile into the duodenum Answer = Bile production What is the definition of cholestasis Cholestasis = The reduced bile secretion or flow due to problem with hepatocytes production of bile acid or a blockage of the gall bladder or associated ducts that help transport bile. The liver has metabolic, synthetic and excretory functions, what are the metabolic functions of the liver ? Metabolic functions of the liver are :- a) Converts glucose into glycogen for storage b) The liver is also involved in the metabolism and excretion of drugs and toxins c) The liver also causes hormone inactivation The liver has metabolic, synthetic and excretory functions, what are the synthetic functions of the liver ? 1.) production of bile – bile helps to carry away waste and break down fats in the small intestine during disgestion bile helps the absorption of fat and fat soluble vitamins particularly ADEK – you need bile to be able to absorb those fat soluble vitamins 2.) the liver is also involved in the synthesis and metabolism of cholesterol, phospholioids, triglycerides, lipoproteins 3.) the liver also produces plasma proteins 4.) the liver is involved in the synthesis of clotting factors 5.) the liver is also involved in the regulation of blood levels of amino acids The liver has metabolic, synthetic and excretory functions, what are the excretory functions of the liver ? Excretory functions 1.) the liver converts posinous ammonia to urea which can then be excreted out as urine 2.) the liver is also involved in the conjugation and excretion of bilirubin What is bilirubin ? bilirubin is the breakdown product of red blood cells from haem - in haemoglobin Haem needs to be made more soluble - so it needs to undergo conjugation in the liver to make it more soluble so it can be mixed with bile via the bile duct into the duodenum and excreted out. If we have raised bilirubin in a patient it may be due to pre hepatic issues - intra hepatic issues or post hepatic issues what is meant by pre hepatic issues ? Over production of bilirubin or impaired uptake of the bilirubin by the liver to be conjugated What would you expect in total bilirubin vs unconjugated bilirubin of a pre-hepatic jaundice patient ? Answer = high amount of unconjugated bilirubin Total bilirubin vs unconjugated bilirubin ratio will be 100:92 roughly so 100% of your total blood bilirubin count and 92% of that will be unconjugated (liver hasn't been able to conjugate it yet) What are some of the causes of pre hepatic jaundice ? Answer = haemolytic anaemia, blood transfusions and patient taking haemolytic drugs explanation = Prehepatic jaundice:- will have increased levels of unconjugated bilirubin, because we are talking about a problem occurring before bilirubin gets to the liver- these are going to be causes featuring excessive haemolysis- so red blood cells being destroyed quicker than usual and releasing a lot of bilirubin examples are haemolytic anaemia, blood transfusions and patient taking haemolytic drugs If we have raised bilirubin in a patient it may be due to pre hepatic issues - intra hepatic issues or post hepatic issues what is meant by Intra-hepatic Jaundice? Intra Hepatic jaundice - reduced conjugation of bilirubin by the liver hepatocytes – is either due to having damaged hepatocytes – which is the case in hepatitis, cirrhosis, or hepatic carcinoma- Or alternatively you have problems conjugating or secreting bilirubin into the bile such as Crigler-Najjar syndrome, or Gilbert's syndrome