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Tests.
Dr. Samer El-Daher
University of Greenwich.
Lecture Outline
Overview of structure and function of the liver
Separation of Blood.
The formed elements
Blood enters via the hepatic artery and the portal vein
bringing blood rich in nutrients from the gut.
Blood then passes across a large surface area of
hepatocytes which excrete bile into the bile canaliculi.
Blood leaves via hepatic vein.
blood.
Excretes bile, which helps carry away waste products
from the liver.
All the blood leaving the stomach and intestines
passes through the liver.
In the liver this blood is processed.
It breaks down the nutrients and drugs into forms that
are easier to use for the rest of the body.
More than 500 vital functions have been identified
with the liver.
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Glucose/carbohydrate metabolism.
Protein metabolism.
Lipid metabolism.
Fat metabolism.
Ammonia conversion.
Vitamin and iron storage.
Drug metabolism.
Bile formation metabolism.
Storage of metabolites.
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Bilirubin.
Liver enzymes
Transaminases.
Alkaline phosphatase.
Albumin.
Bile Acids.
Ammonia.
Specific proteins; 1-antitrypsin, -foetoprotein &
coagulation factors.
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Liver Diseases.
Liver is vulnerable to many diseases caused by metabolic,
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Regeneration
Response to tissue resection and cell death
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Bilirubin
Bilirubin is a yellow compound formed from the
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Jaundice
Jaundice is a yellowish discoloration of the
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hepatocytes.
If cells are damaged they will be released into
the blood stream, can be measured and
levels are used to assess liver disease.
The two activities that are routinely assessed
for liver function are:
Aspartate aminotransferase, AST
Alanine aminotrasferase, ALT, more specific.
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ALT
Used for identification of inflammation and
AST.
Usually high in cases of alcohol induced liver
ALP.
Present in liver canalicular and sinusoidal membranes.
Level increases in liver damage usually due to
cholestasis
In cholestatic jaundice level is 4-6 X reference range
(80-280 IU/L).
Test complicated by presence of isoforms in other
tissues, bone, kidney and placenta.
Then need to combine this test with -GT, if both raised
then its due to liver damage.
This can be then confirmed by electrophoresis of liver
isoforms.
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in the liver.
The most abundant protein in circulation.
It is used mainly as a marker for the synthetic
function of the liver.
It has a long half-life, therefore reduced levels in the
serum indicate a long term problem.
If level is reduced, hypoalbuminaemea, is a strong
indication of advanced chronic liver disease.
Reference value, 40-52 g/L.
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The Kidney.
A secretory organ.
Contains millions of filtration units, the functional
units, nephrons.
They filter blood and produce urine that contains
waste products.
Precisely regulate body concentration of:
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Pathology.
Kidney diseases are very complex but can be divided
Glomeruli,
Tubules,
Interstitium,
And blood vessels.
affecting them;
Clinical Manifestations.
Acute nephritic syndrome;
Nephrotic syndrome;
Urine colour/appearance
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Creatinine.
Creatinine is formed by dehydration of muscle
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Sodium.
Re-absorption regulated by aldosterone.
Most re-absorption 60-70% takes place in the
Potassium.
Potassium is reabsorbed in proximal tubules
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Urinanalysis - Appearance
Blood (haematuria)
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Urinanalysis - Volume
Temperate climates: output of 800-2500 ml urine per day
is usual.
Dependent upon subjects activity, hydration status, diet
and body size.
Always need to urinate to get rid of metabolic wastes,
even if not drinking. Remember that you can urinate to
death if you are shipwrecked either through lack of
water, or by ingestion of salt water!
Sudden changes in volume of urine can indicate
problems with ability to concentrate urine, or in feedback
mechanisms that help you control ECF
volume/osmolality.
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Urinanalysis
Oligouria excrete < 300 ml/day.
Might be physiological as in hypotension or hypovolaemia where we
compensate, but more often due to renal disease or obstructive
nephropathy.
Polyuria persistent, large increase in urine output associated with
nocturia.
subject.
May indicate renal failure (e.g. excess urea) or problems with ADH.
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Dipstix
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www.mdsdx.com
Urine Microscopy
Clean, mid-stream sample needed.
White cells
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Antegrade pyelography
Retrograde pyelography
Micturating cystourethrography (MCU)