Pathology Exam 2

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Pathology Exam 2
2012-06-11 11:48:53
Pathology Exam

Pathology Exam 2
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  1. Liver
    • 8 lobes
    • sits in RUQ
    • Blood flow: blood from all abdominal organs --> mesenteric vein --> hepatic portal vein --> into individual lobes of liver (with hepatic artery) --> blood is "processed" --> hepatic veins (R, L, and middle) --> IVC
  2. Liver Functions
    • Storage: blood (can be released with increased metabolic activity or hemorrhage) — can store up to a liter of blood; fat soluble vitamins — A, D, E, K, B12, iron
    • Filter: detoxifies blood of toxins, drugs, bacteria, visues etc; filters and metabolises certain drugs and hormones
    • -physical filter: Kupffer cells (macrophages); Pit cells (tumor factor defense); Stellate cells (remove foreign debris/bacteria)
    • -biochemical filter: Phase 1: Cytochrome P450 — enzyme in hepatic cells that helps break down toxins and metabolites --> makes them water soluble --> can be filtered out by the kidneys; Phse 2: Esterification — hydrolises toxin/metabolite; go into blood and are excreted by kidney, or into bile and excreted by GI system
    • Metabolism:
    • -Carbs: broken down in liver into simple sugars like glucose and glycogen --> allows liver to buffer blood glucose levels, can store glycogen, can convert non-carbs into glucose via gluconeogenesis
    • -Ammonia: only place in body that filters ammonia out, ammonia is formed in gut and can affect CNS, liver converts it to urea --> filtered out by kidneys
    • -ETOH: broken down in liver, higher amounts of ETOH --> increased cytochrome P450 --> ETOH tolerance
    • -Bilirubin: bilirubin comes from heme section of hemoglobin (conjugated is bound to albumin [lipid soluble], unconjugated is not [water soluble]) --> liver makes bilirubin become unconjugated --> excreted in bile or urine
    • -Vitamin D: forms calcitrol (active vitamin D) --> regulated calcium and phosphorus levels
    • -Fats: break down into glycerol and FFAs --> used to make ATP. Excessive amount of fat --> triglycerides released into blood --> picked up by adipose tissue
    • Synthesis:
    • -proteins: in particular albumin — regulates osmolarity of vasculature, high affinity for water, low albumin levels --> fluid into third space
    • -fats: from protein and carbs
    • -cholesterol
    • -bile salts: help digestion
    • Clotting factors: synthesizes all clotting factors related to K, breaks down activated clotting factors
  3. Bile
    • Made in liver in hepatic cells
    • Drains through bile ducts
    • Bile acids, salts, and pigments
    • Aids digestion of fats and buffers GI acids
    • Stored in the gallbladder
    • about 1 liter made/day
  4. Gallbladder
    • Function: stores and concentrates bile
    • not essential to digestion
  5. Liver Function Tests — LFTs
    • Enzymes released by damaged hepatic cells
    • ALT: Alanine Aminotransferase (SGPT); normal level: 5–35; specific to hepatic cell injury
    • AST: Asparate Aminotransferase (SGOT); normal level: 8–20; detects inflammation, injury, or necrosis of hepatic cells, but is non specific (also found in skeletal muscle, kidney, brain, pancreas, lungs, and spleen)
    • ALP: Alkaline Phosphatase "alk phos"; normal level 30–85; non specific marker of liver disease, bone disease, or hyperparathyroidism
    • GGPT: Franctionated alk phos: liver specific alk phos; elevated with any dysfunction in biliary tree