Liver Function Tests

This lecture by Dr. Bruce Clayton occurred on Thursday September 2nd and Tuesday September 7th.

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Study Materials
Required reading:


 * Lecture handout,


 * Helms, RA and Quan, DJ, eds. Textbook of Therapeutics, Drug and Disease Management, 8th ed., Lippincott, Williams and Wilkins, Philadelphia, 2006: 98-101

Handouts

 * Tests to Evaluate and Monitor Liver Function PPT
 * Liver Function Tests Handout

Panopto

 * Thursday September 2nd
 * Tuesday September 7th

Objectives
Edited by Coastermonger 15:49, September 23, 2010 (UTC)

Describe the gross anatomy of the liver with respect to size, consistency and anatomic location.


The liver is a reddish brown organ with four lobes of unequal size and shape. A human liver normally weighs between 1.4–1.6 kg (3.1–3.5 lb), and is a soft, pinkish-brown, triangular organ. It is both the largest internal organ (the skin being the largest organ overall) and the largest gland in the human body.

It is located in the right upper quadrant of the abdominal cavity, resting just below the diaphragm. The liver lies to the right of the stomach and overlies the gallbladder. It is connected to two large blood vessels, one called the hepatic artery and one called the portal vein. The hepatic artery carries blood from the aorta whereas the portal vein carries blood containing digested nutrients from the small intestine and the descending colon. These blood vessels subdivide into capillaries which then lead to a lobule. Each lobule is made up of millions of hepatic cells which are the basic metabolic cells.

===Describe the anatomy of the liver with respect to the following: lobule, portal vein, hepatic artery, central vein, intrahepatic sinusoids & Kupffer cells, biliary canaliculi, common bile duct, cystic duct, ampulla/papilla of Vater.===

Distinguish between vessels that flow into vs out of the liver, including in your discussion, the “portal triad”.
Vessels that flow into the liver and mix in the Sinusoids include: Vessels that flow out of the liver The "Portal Triad" is a collection of 3 vessels that can be found clustered together in 3's around the central vein of a liver lobule. It consists of:
 * The hepatic Artery - containing oxygen rich, nutrient poor blood fresh from the heart following the aorta and celiac trunk
 * The portal vein system - containing nutrient rich, oxygen poor blood fresh from the GI tract.
 * The central vein, which leads to the Hepatic vein that empties into the inferior vena cava (IVC)
 * The portal vein
 * The hepatic artery
 * The intrahepatic biliary duct

List functions that the liver performs under each of the following categories: excretory, synthetic, metabolic and storage.
Excretory Synthetic
 * The liver conjugates bilirubin, makes and excretes bile and bile salts into the duodenum for the purpose of emulsifying fats
 * The liver synthesizes all major plasma proteins, including albumin & the coagulation proteins.


 * It also synthesizes transport proteins essential for the transport of hormones, vitamins, cholesterol (lipoproteins), and other substrates


 * it does NOT synthesize the immunoglobins.

Given a set of enzyme lab data, make a preliminary differentiation between liver disease, biliary disease, heart disease, and bone disease.
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