Podcast
Questions and Answers
Which of the following is NOT a function of the liver?
Which of the following is NOT a function of the liver?
Jaundice is characterized by an abnormally low plasma concentration of bilirubin.
Jaundice is characterized by an abnormally low plasma concentration of bilirubin.
False
What percentage of blood supply to the liver comes from the hepatic artery?
What percentage of blood supply to the liver comes from the hepatic artery?
30
The liver is the main site of ______ which produces glucose from non-carbohydrate sources.
The liver is the main site of ______ which produces glucose from non-carbohydrate sources.
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Match the following liver functions with their descriptions:
Match the following liver functions with their descriptions:
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What condition is associated with markedly increased unconjugated bilirubin in the blood?
What condition is associated with markedly increased unconjugated bilirubin in the blood?
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In prehepatic jaundice, there is bilirubin present in the urine.
In prehepatic jaundice, there is bilirubin present in the urine.
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What substance is formed when hemoglobin is broken down?
What substance is formed when hemoglobin is broken down?
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Prehepatic jaundice results in an increase of ________ bilirubin in the blood.
Prehepatic jaundice results in an increase of ________ bilirubin in the blood.
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Match the following bilirubin types with their characteristics:
Match the following bilirubin types with their characteristics:
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What color urine is typically observed in prehepatic jaundice?
What color urine is typically observed in prehepatic jaundice?
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Urobilinogen is water soluble and can be excreted in urine.
Urobilinogen is water soluble and can be excreted in urine.
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What is the main role of the liver in bilirubin metabolism?
What is the main role of the liver in bilirubin metabolism?
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Which reagent is used to detect substances in the context of liver conditions?
Which reagent is used to detect substances in the context of liver conditions?
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Cirrhosis of the liver can occur as a result of chronic alcohol consumption.
Cirrhosis of the liver can occur as a result of chronic alcohol consumption.
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What is the primary enzyme indicator that comes up first in cases of hepatocellular damage?
What is the primary enzyme indicator that comes up first in cases of hepatocellular damage?
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Gamma glutamyl transferase is primarily derived from the ______ system.
Gamma glutamyl transferase is primarily derived from the ______ system.
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Match the liver conditions with their characteristics:
Match the liver conditions with their characteristics:
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Which of the following factors is NOT commonly associated with hepatocellular damage?
Which of the following factors is NOT commonly associated with hepatocellular damage?
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The sequence of events leading to cirrhosis includes injury, inflammation, cell death, ______, and regeneration.
The sequence of events leading to cirrhosis includes injury, inflammation, cell death, ______, and regeneration.
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Alanine aminotransferase (ALT) is specific to liver disease.
Alanine aminotransferase (ALT) is specific to liver disease.
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What is the normal range for albumin in g/l?
What is the normal range for albumin in g/l?
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Alkaline phosphatase is considered a great standalone biomarker for liver function.
Alkaline phosphatase is considered a great standalone biomarker for liver function.
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What does an increase in alanine aminotransferase levels typically indicate?
What does an increase in alanine aminotransferase levels typically indicate?
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The liver can be subjected to numerous conditions, and a battery of tests is vital to diagnose ______ abnormalities.
The liver can be subjected to numerous conditions, and a battery of tests is vital to diagnose ______ abnormalities.
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Match the liver tests with their normal ranges:
Match the liver tests with their normal ranges:
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Which biochemical test indicates cholestatic liver disease by showing elevation?
Which biochemical test indicates cholestatic liver disease by showing elevation?
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The biological half-life of albumin is approximately 10 days.
The biological half-life of albumin is approximately 10 days.
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What type of bilirubin is primarily elevated in cholestatic liver disease?
What type of bilirubin is primarily elevated in cholestatic liver disease?
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Primary biliary cirrhosis is a __________ condition that commonly affects women in mid-life.
Primary biliary cirrhosis is a __________ condition that commonly affects women in mid-life.
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Match the following liver conditions with their characteristics:
Match the following liver conditions with their characteristics:
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What is the primary immune response marker for hepatitis B infection?
What is the primary immune response marker for hepatitis B infection?
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Bilirubin is not detectable in urine during significant biliary obstruction.
Bilirubin is not detectable in urine during significant biliary obstruction.
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Drug-induced cholestatic liver disease can occur due to __________ agents.
Drug-induced cholestatic liver disease can occur due to __________ agents.
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What is the role of albumin in bilirubin transport?
What is the role of albumin in bilirubin transport?
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Urobilinogen is formed in the small intestine after bilirubin enters the gut.
Urobilinogen is formed in the small intestine after bilirubin enters the gut.
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What virus was the 21-year-old student infected with after returning from Asia?
What virus was the 21-year-old student infected with after returning from Asia?
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The _____ vein carries bilirubin from the spleen to the liver.
The _____ vein carries bilirubin from the spleen to the liver.
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Match the following substances with their descriptions:
Match the following substances with their descriptions:
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Which combination of tests is considered more effective?
Which combination of tests is considered more effective?
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Bilrubin must be excreted through urine before forming urobilinogen.
Bilrubin must be excreted through urine before forming urobilinogen.
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In the case of jaundice, what is the primary substance that is elevated in urine?
In the case of jaundice, what is the primary substance that is elevated in urine?
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Study Notes
Liver Function Tests
- Liver disease is the fifth biggest killer in the UK and the only major cause of death that is increasing.
- Approximately 1 in 25 people in the UK have abnormal liver function.
- Liver receives 70% of blood supply from the portal vein and 30% from the hepatic artery.
Liver Structure and Function
- Excretion of nitrogen: Produces urea.
- Protein biosynthesis: Creates albumin and clotting factors.
- Metabolism: Main site of gluconeogenesis and produces low-density lipoprotein.
- Bile formation: Contains phospholipids, bile salts, and cholesterol. Bilirubin is a breakdown product of haem.
Jaundice
- Jaundice is characterized by an abnormally high plasma concentration of bilirubin, typically greater than 21 µmol/L.
- Jaundice can be categorized as prehepatic, hepatocellular, or cholestatic.
Bilirubin Metabolism and Transport
- Bilirubin is processed in the spleen, where haemoglobin is broken down.
- Bilirubin is then transported to the liver, where it is conjugated.
- The conjugated bilirubin is actively transported across canaliculi into the bile.
- Urobilinogen is produced, either excreted in urine or recycled in the enterohepatic circulation then converted into stercobilinogen in the large intestine.
Prehepatic Jaundice
- Markedly increased unconjugated bilirubin in the blood, often due to haemolytic anaemia.
- No bilirubin is present in the urine.
- Bilirubin is bound to albumin so not filtered in the kidneys
- Detected using dipsticks impregnated with a diazo reagent
- Urobilinogen is present in the urine
- Urobilinogen is water-soluble and can be excreted in the urine, but recycling via the liver is impaired because of the saturated uptake system.
- Urine will be orange due to the conversion of urobilinogen to urobilin
- Large amounts of stercobilinogen are present in the stools.
Hepatocellular Damage
- Hepatitis A, B, and C are the most common causes.
- Poisons and drugs (e.g., carbon tetrachloride, paracetamol) can also cause liver damage.
- Alcohol can cause cirrhosis.
- Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are also important hepatocellular damage causes
- NAFLD is fat build-up in the liver without inflammation and fibrosis; it can transition to NASH
- NASH is characterized by inflammation and fibrosis and can lead to cirrhosis.
Cirrhosis
- Normal liver has a smooth surface and dark purple color.
- Cirrhotic liver has a nodular surface and yellow/green color.
- Cirrhosis develops from injury (like alcohol) causing inflammation, cell death, fibrosis, and regeneration of cells which form nodules that are encased by fibrous tissue
Biochemical Serum Tests for Hepatocellular Damage
- Alanine aminotransferase (ALT) is usually the first indicator of damage. ALT is found in cardiac and skeletal muscle, but is highly concentrated in the liver.
- Aspartate aminotransferase (AST) is measured with ALT; it is present in cardiac, skeletal muscle, liver, and kidney. AST increases in liver disease but usually to a lesser extent than ALT.
- Gamma glutamyl transferase (GGT) - serum activity is derived from the liver. It's less useful in distinguishing between hepatocellular and cholestatic liver disease, but may indicate increased alcohol intake.
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Description
Test your knowledge on liver function, structure, and the causes and categories of jaundice. This quiz covers crucial aspects of liver metabolism, bilirubin transport, and the significance of liver function tests in diagnosing liver diseases. Ideal for students and professionals in health and medical fields.
