Dr Gihan Gawish

1. Dr Gihan Gawish

2. Liver - Anatomy and Physiology Largest organ in the body Three basic functions � Metabolic � Secretory � Vascular Major function � Excretion of waste products from bloodstream by excretion into bile Dr Gihan Gawish

3. Liver - Anatomy and Physiology Location � Upper right quadrant � Four lobes made up of hepatocytes � phagocytic cells Blood supply � One major vein - portal vein � One major artery - hepatic

4. Liver - Anatomy and Physiology Functions of liver � Blood glucose concentration � Protein metabolism � Fat metabolism � Storage functions � Drug metabolism � Ammonia conversion Dr Gihan Gawish

5. Metabolic Profile of the Liver The primary function of the liver is to regulate the metabolism. It metabolizes the intake of carbohydrates, fats, and proteins. It accomplishes this function by working closely with other systems such as lymphatic system, circulatory system, as and endocrine system. In order for the liver to metabolize the fats, carbohydrates, and proteins, it must be healthy and free of any diseases.

6. Bile Production Liver produces and secretes a product called bile. This is what makes it possible for metabolize the intake of fats, proteins, and carbohydrates. This fluid is a very important presence in the body due to the fact that it aids in the elimination of contaminants in the body, such as drugs. The bile system is also responsible for re-circulating red blood cells. Dr Gihan Gawish

7. BILIRUBIN PRODUCTION Heme is degraded by reticuloendothelial cells (mononuclear phagocytes of the spleen, liver, and bone marrow). Bilirubin is insoluble in water and is responsible for the toxic effects. This unconjugated (indirect) bilirubin is transported in the serum bound to albumin.Heme is degraded by reticuloendothelial cells (mononuclear phagocytes of the spleen, liver, and bone marrow). Bilirubin is insoluble in water and is responsible for the toxic effects. This unconjugated (indirect) bilirubin is transported in the serum bound to albumin.

8. Dr Gihan Gawish BILIRUBIN PROCESSING UDP: uridine diphosphate ER: endoplasmic reticulum Unconjugated (indirect, pre-hepatic) bilirubin is transported from the surface of the hepatocyte to the endoplasmic reticulum through the binding of ligandin. Glucuronic acid is added to bilirubin (catalyzed by glucuronyl transferase) to produce the conjugated (direct) mono- and diglucuronides. UDP-glucuronyl transferase deficiencies - mild deficiency (Glibert�s syndrome), severe deficiency (Crigler-Najjar) Conjugated bilirubins, which are water soluble, may be excreted in the urine and feces. The diglucuronide is primarily excreted in normal bile. Almost all of the bilirubin produced is excreted as one of the components of bile salts. Bilirubin is the pigment that gives bile its characteristic bright greenish yellow color.UDP: uridine diphosphate ER: endoplasmic reticulum Unconjugated (indirect, pre-hepatic) bilirubin is transported from the surface of the hepatocyte to the endoplasmic reticulum through the binding of ligandin. Glucuronic acid is added to bilirubin (catalyzed by glucuronyl transferase) to produce the conjugated (direct) mono- and diglucuronides. UDP-glucuronyl transferase deficiencies - mild deficiency (Glibert�s syndrome), severe deficiency (Crigler-Najjar) Conjugated bilirubins, which are water soluble, may be excreted in the urine and feces. The diglucuronide is primarily excreted in normal bile. Almost all of the bilirubin produced is excreted as one of the components of bile salts. Bilirubin is the pigment that gives bile its characteristic bright greenish yellow color.

9. Dr Gihan Gawish BILIRUBIN EXCRETION When the bile salts reach the intestine via the common bile duct, the bilirubin is acted on by bacteria to form chemical compounds called urobilinogens. Most of the urobilinogen is excreted in the feces; some is reabsorbed and goes through the liver again and a small amount is excreted in the urine. Urobilinogen gives feces their dark color. An absence of bilirubin in the intestine, such as may occur with bile duct obstruction, blocks the conversion of bilirubin to urobilinogen, resulting in clay-colored stools. Some of the urobilinogen that is produced in the intestine is reabsorbed and recycled through the liver.When the bile salts reach the intestine via the common bile duct, the bilirubin is acted on by bacteria to form chemical compounds called urobilinogens. Most of the urobilinogen is excreted in the feces; some is reabsorbed and goes through the liver again and a small amount is excreted in the urine. Urobilinogen gives feces their dark color. An absence of bilirubin in the intestine, such as may occur with bile duct obstruction, blocks the conversion of bilirubin to urobilinogen, resulting in clay-colored stools. Some of the urobilinogen that is produced in the intestine is reabsorbed and recycled through the liver.

11. NORMAL BILIRUBIN METABOLISM

12. Failure to Produce Bile It is possible for a type of liver disease to cause the liver to stop the secretion of bile. When this happens, the liver loses the capability to metabolize the fats, carbohydrate, and proteins. The only way fats can be absorbed into your blood system is if bile is present. This is why it would be impossible for the body to absorb the fat-soluble vitamins without bile.

13. HYPERBILIRUBINEMIA

15. Diagnoses of Jaundice

16. Red Blood Cell System Another important function the liver performs is that it cleanses the body from the damaged, or old, red blood cells. The liver will also store iron in your body, as well as breakdown hemoglobin. This is the reason why many people who suffer from liver disease may suffer from anemia. Dr Gihan Gawish

17. Hepatitis Inflammation of the liver Viral hepatitis is the most common type A, B, C, D and E Noninfectious hepatitis may be caused by drugs and chemicals Dr Gihan Gawish

18. Hepatitis � Clinical Manifestations Preicteric or Prodromal phase � Precedes jaundice � Lasts 1 � 21 days � Maximal infectivity for hepatitis A � Symptoms Anorexia, right upper quadrant pain, constipation or diarrhea, malaise, fever, headache, arthralgias, weight loss Dr Gihan Gawish

19. Lab Tests Elevated Alkaline phosphatase Elevated with bone and liver disorders Elevated SGOT/AST Elevated SGPT/ALT Elevated serum globulin Elevated LDH Decreased albumin Increased prothrombin time Blood ammonia level � Increased due to decreased metabolism of ammonia to urea by the liver Dr Gihan Gawish