The Functions of the Liver and Liver Cancer Tutorial

Alverno College 2008Sarah Arvelo

Directions and

Objectives

Please click the buttons that contain black text and are outlined in black to move through the tutorial.

Information will be provided on the functions of the liver, normal lab values, as well as signs and symptoms caused by a dysfunctional liver. The learner will be able to test their new knowledge through questions given throughout this exercise.

When a question appears click on the correct answer.

To get started click the button on the right. Next Page

Learn and apply knowledge about the functions of the liver, i.e., labs, signs, symptoms and nursing assessment.

Learn and apply knowledge about the symptoms produced by liver cancer and what labs may be affected.

Learner will be able to verbalize a few treatments for liver cancer and how the TP53 gene plays a role in its effectiveness.

Main Menu

Anatomy and Physiology Menu

Pathology Menu

Case Study Image from Microsoft clip art

You will find information

about abnormals and information on liver cancer in this section.

You will find information about the

function of the liver in this

section.

Directions Page

References

Anatomy

LabsNursing

Assessment of the Liver

Physiology

Image from Microsoft clip art Liver Functions

and Pathology Menu

End Show

In this section you will find information on the basic anatomy of the liver.

Click below to start.

Next Anatomy Page

Anatomy and Physiology Menu

Diaphragm

Gallbladder

Cystic Duct

Common Bile Duct

Duodenum

Hepatic Duct

Lopez, E.B., 2008. Used with Permission.

The liver is covered in the Gilsson’s capsule made of a

fibroelastic material.

Next Anatomy

Page

Hepatobiliary Tree - intrahepatic and extrahepatic duct.

Common Bile Duct - formed by the cystic and hepatic ducts. Both ducts lead to the duodenum.

Bile Canalculi - lie between hepatocytes.

Sphincter of Oddi - tissue that regulates the flow of bile. Bile is produced by the

hepatocytes and is where 75% of LDL is found. Bile moves through the liver

into the duodenum of the intestine.

Next Anatomy Page

How big is the liver?

The liver has two lobes.

The visceral surface also has two lobes.

The liver has a dual blood supply. Click here for the answer.

Click here for the answer.

Click here for the answer.

Click here for the answer.

The hepatic artery and portal vein.

The caudate and quadrate lobes.

The large right lobe and small left lobe.

The liver is 3 lbs. and the largest visceral organ in the body.

Next Anatomy Page

Lobules - there are 50,000 - 100,000 lobules in the liver. Lobules empty into a central vein that connects to the hepatic vein.

Sinusoids - are hepatic cells that form a plate like structure that branch off the central vein and extend to the lobule.

Due to this structure, hepatic cells are exposed to blood that travels

through the sinusoid.

Next Anatomy Page

Kupffer’s cells line the venous sinusoids.

What do these cells

do?

They remove defective blood cells, bacteria,

and foreign material from portal blood.

They filter blood.

They also remove

enteric bacilli from blood in

from the intestine.

Next Anatomy Page

Image from Microsoft Clip art

Click on each step to organize the flow of bile.

STEP 5STEP 4STEP 3STEP 1 STEP 2 STEP 7

The hepatocytes produce bile.

Bile enters the hepatobiliary

tree.

Bile flows through the common bile

duct.

The Sphincter of Oddi opens.

Next Page

STEP 6

If the sphincter is closed the bile moves back into the

common bile duct and the gallbladder.

Bile empties into the bile canaliculi.

Bile empties into the

duodenum.

1. Hepatocytes produce bile.

2. Bile empties into the bile canaliculi.

3. Bile enters the

hepatobiliary tree.

5. Bile flows through the common bile

duct.

4. The Sphincter of Oddi opens.

7. Bile empties into the

duodenum.

6. If the sphincter is closed the bile moves back into

the common bile duct and the gallbladder.

Anatomy andPhysiology

Menu

In the following section you will find information on the different

functions of the liver.

Physiology Menu

Fat/Lipids

Protein

Bile Production

Synthesis of Clotting Factors

Hormones/Drugs

CarbohydrateBilirubin

Elimination

Anatomy and Physiology

MenuEnd Show

The nursing assessment of the liver includes the entire abdominal assessment. This tutorial will only focus on the specific assessment of the liver. CLICK ON THE ASSESSMENT TO FIND OUT MORE.

Liver Span

Test Your Knowledge

Palpating the Liver

Scratch Test

Fluid Wave

Anatomy and

Physiology Menu

Cirrhosis, Metastatic

Cancer, Syphilis

Abscess or Metastatic

TumorTumor

Portal Obstructio

n, Cirrhosis,

High Obstructio

n of Inferior

Vena Cava and

Lymphocytic

Leukemia

Ascites

Hepatitis Enlarged nodular

liver noted with

palpation.

Enlarged liver noted

with palpation.

Peritoneal friction rub over lower

right rib cage.

Bulging flanks when

supine. Taut skin.

Localized distention.

Pain in the RUQ.

Possible Abnormal Assessment signs that

need further investigation.

Click to find out the possible cause

Pathology of the Liver Menu

STEP 1

PERCUSSION:Start at the area

of lung resonance until a dull sound is

heard (mark this spot).

NEXT

STEP 2

Start at abdominal

tympany up until dull

sounds are heard

(mark this spot).

Nursing Assessment

MenuBack to Pictures

Finding the upper border of the liver.

Next Page Liver Span

1 2

3

Images from Sarah Arvelo

45

6

Measure between your marks, to find the

border of the liver.

Next Page Liver Span

Images from Sarah Arvelo

9-12CM (Normal Liver Span)

Next Page Liver Span

The bottom border can extend slightly past the costal margin.

Use a tape measure to compare.

Images from Sarah Arvelo

Step 1

Place left hand under

patient’s back.

Step 3

Push deeply down and under the

right costal margin.

Step 4

Have the patient take

a deep breath.

Step 2

Place right hand in the

RUQ. Fingers should be pointed toward

patient's head.

Nursing Assessment

MenuBack to Pictures

1 2

3 4

Next Page Palpating the Liver

Images from Sarah Arvelo

When the abdomen is distended or the muscles are tense the examiner can perform the scratch test to determine borders.

STEP 1

Place stethoscope

over the liver.

Next

STEP 2

Start RLQ scratch.

Make short strokes over

abdomen toward liver.

THE BORDER IS FOUND WHEN THE SCRATCHING IS MAGNIFIED.

Nursing Assessment

Menu

Back to Pictures

1 2

3

Next PageScratch Test

Images from Sarah Arvelo

This test is done when the examiner suspects fluid in the peritoneal cavity (ascites).

STEP 1

Stand on the right side of the patient .

STEP 3

Place left hand on the

person’s right flank while

the right hand strikes the left flank.

STEP 2

Have patient place hand, fingers down

and ulnar side down, on the middle of the

abdomen.A fluid wave

indicates ascites.

Nursing Assessment

Menu

Back to Pictures

1 2

3 4

Next Page Fluid Wave

Images from Sarah Arvelo

When palpating the liver what is

normal?

YesC. All of the

above

CloseA. Nothing is

felt

Almost B. The edge of the liver is

felt

Nursing Assessmen

t MenuNext

Question

Liver span can be determine

through percussion.

What is the normal size of

the liver

Correct, for and adult

Abnormal

A. 6-12 CM

B. 14-20CM

Incorrect

C. The span of the rib cage

Nursing Assessment

Menu

Next Question

Obesity produces a fluid

wave.

Obesity and gas would produce

no change.

Correct

TRUE

FALSE

Nursing Assessment Menu

PHASE I REACTIONS PHASE II REACTIONS

Chemical modification or inactivation of a substance.

Conversion of lipid-soluble substances to water-soluble.

Water-soluble substances can be excreted unchanged in the urine or bile. Lipid-soluble substances can accumulate in the

body until they are converted by this process.

Next Page Hormones and

DrugsImages from Microsoft Clip art

PHASE I PHASE II

Drug metabolism occurs in the lipophilic membrane of the smooth endoplasmic reticulum of the liver cells.

Microsomal enzymes, located in the lipophilic membrane, are responsible for oxidation of the drug.

Conjugation occurs and is the process that breaks down the drug to make in more water soluble.

Next Page Hormones and

Drugs

Image from Microsoft Clip art

Glucocorticoids Aldosterone Sex Hormones

Cortisol is released by the adrenal gland during the stress response. The liver helps maintain blood glucose during the time when mechanisms of the body are hypoactive.

Next Page

o Bile contains water, bile salts, bilirubin, and cholesterol. The liver produces 600 - 1200 ml of bile, that is yellow-green in color, a day.

o Bile salts assist with digestion and absorption of fats.

o 94% of bile salts are reabsorbed into portal circulation and go through the system at least 18 times before being excreted in the feces.Physiology

Menu

DIRECT BILIRUBIN (CONJUGATED)

INDIRECT BILIRUBIN (FREE BILIRUBIN)

Is a part of the contents of bile and passes through bile ducts into the small intestine.

½ of bilirubin is converted into urobilinogen by the flora of the intestine.

Urobilinogen is absorbed into portal circulation or excreted in the feces.

1) Travels through blood attached to albumin.

2) Travels through the liver, releases from albumin, and moves into the hepatocytes.

3) Inside hepatocytes it is converted into conjugated bilirubin.

Physiology Menu

The liver stores excess glucose (glycogen) and releases it into circulation when glucose levels fall.

Converts excess carbohydrates into triglycerides and stores them in adipose tissue.

Physiology Menu

Image from Microsoft Clip art

Fibrinogen and C-reactive protein increase in production in the acute-phase response of inflammation.

The increased presence of these proteins increases the ESR (an important indicator of inflammation).

Deamination is the conversion of proteins, amino acids, and nucleic acids into urea.

Transamination is the conversion of an amino group to an acceptor substance, allowing amino acids to be involved in the metabolism of carbohydrates.

Next Slide Protein

Plasma proteins allow for fluid to stay in the capillary and not move into the tissue spaces.

Plasma proteins, albumin, globulins, and fibrinogen.

Next Page

Examples

Oxidation of fatty acids supply energy for other body functions.

Synthesis of cholesterol, phospholipids, and lipoproteins.

Glycerol and fatty acids split by beta oxidation

into two-carbon acetyl-coenzyme A.

Acetyl-coenzyme is converted by the citric acid cycle to produce adenosine triphosphate (ATP).

Next Lipid Page

FAT

GlycerolFatty Acids

Acetyl- CoA

BETA OXIDATION

Fat is spit and converted.

Citric Acid Cycle

Acetyl- CoA

ATP

Acetoacetic Acid (Highly

Soluble Ketoacid) Liver cannot

not use all Acetyl-CoA formed.

Next Lipid Page

Ketoacids are used to deliver energy into other tissues in the body.

Extra Acetl-CoA is used for synthesis of cholesterol and bile acids.

Physiology Menu

VLDL

triglycerideTranspor

t

Fat cells

Muscle cells

IDL

Triglyceride removed

VLDL or LDL

LDL is the main transporter of Cholesterol

Known as the (bad cholesterol)

HDL Good cholesterol Cholesterol and Triglycerides must attach

to lipoproteins to transport in the blood

Physiology Menu

The liver produces procoagulants vitamin K, factor VII, IX, X, prothrombin and protein C as well as plasma proteins that are involved in the process.

Blood clotting decreases blood loss when injury occurs.

Image from Microsoft Clip art Next Slide

Intrinsic and extrinsic pathways are activated by the coagulation process. This is the 3rd step in the hemostatic process.

Factor X Activated

Prothrombin

Thrombin Fibrinogen

Fibrin (Stabilizes the

Clot)

Acts as an enzyme to convert …

Antithrombin III converts…

Physiology Menu

The purpose of these tests is to evaluate the extent

of damage as well as identify different

dysfunctions of the liver. Serum

Bilirubin

ALT/AST

GGT

ALP

PT

Prealbumin/ Albumin

Anatomy and Physiology

Menu

AFP

Image from Microsoft Clip art

Used to evaluate clotting ability.

PT measures Factor I (fibrinogen), II (prothrombin), V, VII, and X.

Normal PT 11-12.5 seconds 85 - 100%

PT is prolonged when clotting factors are lacking. Liver

Function Test Menu

Image from Microsoft Clip art

Levels greater than 2.5 mg/dl produce jaundice.

Levels can increase due to the liver’s inability to excrete bilirubin or with a defect in metabolism.

Adults normal total bilirubin is 0.1 - 1.0 mg/dl, indirect 0.2 mg/dl, direct .1 - 0.3 mg/dl.

Liver Function Tests Menu

Image from Microsoft Clip art

Measures hepatic excretory function.

GGT assists in the transport of amino acids and peptides into liver cells.

May indicate alcohol abuse.

Liver Function Test Menu

Image from Microsoft Clip art

Used to monitor diseases of the liver.

ALP is excreted in bile and found in the bile duct epithelium and canalicular membrane of the hepatocytes.

Normal levels are 30 - 85 IU/ml. Elderly levels are slightly higher. Liver

Function Tests Menu

Image from Microsoft Clip art

AST (Adult 5 - 40 IU/L)

AST is an enzyme found in tissue of the heart muscle, liver cells and skeletal muscle cells and is released when cells become injured.

This test is used to evaluate patients with possible coronary occlusive heart disease or suspected hepatocellular diseases.

Liver Function Test Main Menu

ALT (Adult 5 - 35IU/L)

Test is used to identify heptatocellular diseases because this enzyme is released when tissue of the liver is damaged.

Can indicate jaundice caused by hemolysis rather than liver damage.

Can indicate worsening of disease.Next Page AST

Prealbumin normal lab values for adults/elderly is 15 - 36 mg/dl or 150mg/L.

This test is used to assess a person’s nutritional status as well as liver function.

Prealbumin has a 1.9 day half life and is a sensitive indicator of protein synthesis and catabolism. Next Page

Albumin

Image from Microsoft Clip art

Albumin is most important in maintaining oncotic pressure (this pressure keeps water in the vascular space).

Albumin 3.5 - 5.0 g/dl

Liver Function

Test Menu

Image from Microsoft Clip art

Differentiate metastatic from primary liver cancer.

Normally this protein is found in low levels in the adult.

AFP is found in 90% of hepatomas.

Normal levels in an adult less than 40 mg/ml or greater than 40 mg/L (SI units). Liver

Function Tests Menu

Image from Microsoft Clip art

Back to Liver Function and

Pathology Menu

Cancer Review

Treatment/ Cancer

Abnormal

Assessment

Abnormal Lab Values/ Symptoms

Liver Cancer

TP53 Gene

Image from Microsoft clipart

Abnormal Assessmen

t

Possible Findings:

1)Nontender and smooth or2)Tender and smooth

Causes:

1)Fatty infiltration, portal obstruction, cirrhosis, high obstruction of inferior vena cava, lymphocytic leukemia.

2)Early heart failure, acute hepatitis, hepatic abscess

Images from Sarah Arvelo

Neoplasm - uncontrolled growth of tissue/abnormal mass of tissue.

Tumor - area of swelling.

Malignant - a neoplasm, less differentiated, that can break loose and enter circulation.

Benign - a neoplasm; a well-differentiated cluster of cells.

Cancer Continued

Pathology Menu

Benign and malignant are differentiated by:

1) Cell characteristics. 2) Rate of growth. 3) Manner of

growth. 4) Capacity to metastasize and spread to other parts of the body. 5) Potential for

causing death.

Cancer Continued

Pathology Menu

Cancer cells are like normal cells.

Right! Cancer cells do not go through

normal cell proliferation and

differentiation. Lack of differentiation is called anaplasia.

Incorrect. Cancer cells can resemble normal

cells but are not exactly like normal

cells.

FALSE

Cancer Continued

Click on the right answer.

TRUE

Pathology Menu

Metastasis - the development of a second site of the primary tumor.

Metastasis occurs through:

Blood Vessels

Lymph Channels

Pathology Menu

In the following section you will find information on the above as well as questions you can answer to obtain more information on the topic.

Please click on the answer you feel best explains the question. Next Page

Symptoms and Abnormal Lab

Values

CORRECT> 2.5 mg/dl

produces jaundice.

INCORRECT

Sorry! This measures bleeding.C. Protime

B. ALT

A. Serum Bilirubin

A person with liver cancer can

become jaundiced. What liver function test results can be elevated when this

occurs?

Next Slide Symptoms

and Abnormal Lab Values

Pathology Menu

Prehepatic

is caused by excessive destruction of red blood cells. This may be caused by a hemolytic blood transfusion reaction. Red blood cells are destroyed quickly and the liver cannot compensate.

Back to question

Intrahepatic

This is directly related to the ability of the liver to remove bilirubin from the blood or its’ ability to eliminate it in the bile. Cancer of the liver can cause this type of jaundice.

Back to Question

Posthepatic

A tumor that obstructs the bile duct can produce this type of jaundice. The bile cannot move to the

intestine and removal of bilirubin is prevented. .

Back to question

C. Incorrect.

B. Correct. Albumin is a very important protein. It helps regulate oncotic pressure

which is what keeps fluid in the vascular space.

A. Incorrect. A person with a damaged liver is

malnourished, due to a decrease in appetite from

poor bile production, which is important for digestion.

C. Malnutrion

B. A decrease in circulating albumin.

A. A person can gain a lot of weight due to the swelling of

the liver. Damage to the liver can

cause a persons abdomen to increase in size. What causes this?

Next Question

Pathology Menu

.

Correct! The liver produces very

important clotting factors. See lab

function menu for more info.

C. The blood is unable to clot

properly due to the liver damage.

Incorrect. A person may be jaundiced with liver damage, but it does not cause bruising.

Incorrect. Normally,

someone with liver damage is malnourished, but it does not affect bruise formation.

B. The skin is bruised because he is jaundiced.

A. The person is

malnourished so the skin is more fragile.

A person with liver damage

is on your unit. He has

multiple bruises over

his body. What is

causing this?

Next Question

Pathology Menu

Incorrect. Can not measure bleeding

time.

C. CBC

Incorrect. Can

indicate alcohol abuse.

Correct

B. GGT

A. Protime

Bleed time is

measured by:

Next Question

Pathology Menu

B. PT

What test would be significant in evaluating the proteins synthesized by the liver involved in blood coagulation?

C. A and B

Next Question

A. Prealbumin

and Albumin

Incorrect.

Back to Question

Incorrect. Albumin is a protein, but it is an indicator of oncontic pressure and keeps water in the vascular space.

Back to Question

Correct. The liver produces prothrombin and fibrinogen which are coagulation factors.

Next question

Which test can identify the liver as a cause for jaundice rather than RBC hemolysis?

A. GGT

B. None of the tests

C. ALT

Next Question

Pathology Menu

Incorrect. Can measure alcohol abuse and excretory function of the liver

Back to question

Correct! ALT is released when the liver cells are damaged and then released into the blood causing serum levels to rise.

Next Question

Incorrect

Back to Question

What is the purpose of liver function tests?

B.

Evaluate if there is

damage to the liver

Pathology Menu

Next Question

No

Back to Question

Close. This is part of it. If the tests monitor function of the liver what could they also indicate.

Pathology Menu

Yes. The purpose of this test is to evaluate extent of damage as well as identify different dysfunctions of the liver.

Next Question

Chemotherapy

Biotherapy

Bone Marrow

Transplant

Hormonal Therapy

Radiation Therapy

Surgery

Pathology Menu

Targeted Therapy

The following are treatments for all cancers and are not specific to the liver.

Treatment of Cancer

Menu

Image from Microsoft Clip art

Incorrect

Incorrect! This test is helpful in identifing

possible liver damage.

Albumin is produced by

the liver.

Correct! Levels are

normally low in an adult but occur in

90% hepatomas

Metastatic cancer is more common than

primary cancer. What lab test

can be used to differentiate the

two?

C. All of the above

A. AFP

B. albumin

Next Question

Image from Microsoft Clip art

Pathology Menu

First line of treatment for solid tumors.

90% of people with cancer will have some type of surgical intervention.

Surgery used for dx, staging, or palliation.

Prophylaxis if strong family history.

Can be used in combination with chemotherapy and or radiation. Treatmen

t of Cancer Menu

60% of patients will have radiation.

Can target the affected organ.

Can be palliative to reduce symptoms.

Damaging to all proliferating cells.

Treatment of Cancer Menu

Systemic treatment (administered intravenously).

Prevents cell growth and replication.

Can be used in combination with other therapy.

Treatment of Cancer Menu

Therapy is used to alter the environment of the cancer cell.

Prevent hormonal signals that tell cancer cells to divide.

Cancer can become resistant to hormonal treatment.

Some of the drugs will suppress the hormone relating the organ affected or will decrease hormone receptors.

Next Hormonal Therapy

Page

Androgens - desensitizes the pituitary to decrease hormone levels.

Aromatase Inhibitors - inhibit biochemical processes used to convert androstenedione to estradiol in the peripheral tissues.

Exogenous hormones - produce a decrease in hormone receptors.

Antiandrogens - bind to receptor sites and decrease stimulation.

Treatment of Cancer Menu

Combination of immunotherapy and biologic response therapies.

Immunotherapy is the transfer of cultured immune cells into the host.

Biologic response modifiers are cytokines, monoclonal antibodies, and hematopoietic growth factors.

Next Biotherapy

PageImage from Microsoft clip art

Interferons - inhibit viral replication, tumor protein synthesis, and prolonging the cell cycle.

Interleukins - bind to receptor sites on the cell-surface membranes on the target cells to provide communication between cells.

Monoclonal Antibodies - antibodies from cloned cells or hybridomas. The cancer cell must have the right antigen.

Hematopoietic Growth Factors - control the production of neutrophils, monocytes-macrophages, erythrocytes, and thrombopoietin.

Treatment of Cancer MenuImage from Microsoft clip art

Treatment of previously incurable cancers.

High dose chemo and radiation.

Stem cell transplantation takes stem cells from the patient’s blood.

Stem cells are taken from the bone marrow in the bone marrow transplant.

Treatment of Cancer

Menu

Image from Microsoft clip art

Currently being developed to have therapies for that are specific to the particular cancer being treated i.e.

Drugs that would only harm cancer cells

Vaccines used to boost the tumor’s response to treatment

Treatment of Cancer Menu

HEPATOCELLULAR CARCINOMA CHOLANGIOCARCINOMA

Liver cells Possible causes: chronic

viral hepatitis, cirrhosis, exposure to environmental agents(aflatoxins), drinking contaminated water (arsenic).

Bile duct cells Possible causes can be

unknown, cirrhosis, or chronic hepatitis.

Pathology Menu

Next Slide Liver Cancer

5 year survival rate of about 7%

Advanced at the time of diagnosis.

Chemotherapy and radiation are palliative. Liver transplant could be possible treatment but

the organ is scarce.

Metastatic tumors are more common than primary tumors. Pathology

Menu

A 78 year old man, with newly diagnosed pancreatic cancer, arrives for placement of a biliary stent. In his physical assessment you note that he is jaundiced, he has a protruding belly, and has thin arms and legs. He states that he was recently taken off the medication statin. The patient does not have any prior health issues, other than a history of obesity, but has lost 120 lbs. over the last 6 months and has high cholesterol.

Click here to move to the next page and test your knowledge of the liver.

Liver Function

and Pathology

Menu

If he has pancreatic cancer, why does he need a biliary stent?

You noted that he was jaundiced. What is the cause of his jaundice? (RELATES TO THE ANSWER OF THE FIRST QUESTION)

Due to the structure and placement of the pancreas, a tumor can cause

narrowing of the common bile duct.

Click here for the answer.

Click here for the answer.

The liver produces cholesterol and if the liver is dysfunctional it can longer perform

this function.

This patient was on statin. Why wouldn’t he need this medication now that his liver is not working properly?

Click here for the answer.

Liver Function and Pathology

Menu

Oncogenesis:

a process that transforms

normal cells into cancer

cells.

3 types of genes

control cell growth

PROTO-ONCOGENES

TUMOR SUPPRESSOR

GENES

APOPTOSIS

Pathology Menu

Next Page Tumor

Suppressor Genes

Image from Microsoft clip art

These genes inhibit

proliferation of cells in a

tumor.

What would happen if one of these genes was defective?

Pathology Menu

Next Page Tumor

Suppressor Genes

Image from Microsoft clip art

Mutations of the

TP53 Gene Linked to: Development

of lung, breast, liver,

and colon cancer.

Pathology Menu

Next Page

Image from Microsoft clip art

TP53 GeneInitiates Apoptosis with

chemotherapy and radiation.

Apoptosis is the process

of cell death.

What could

happen to apoptosis if there was a

mutation?Pathology Menu

Image from Microsoft clip art

Jarvis, C., (2000).Physical examination and health assessment, 4th edition. Saunders.

Lewis, S.M., Heitkemper, and Dirksen, 2000. Medical Surgical Nursing, 5th edition. Mosby.

Lopez, E.B., 2008. Used with Permission.

Microsoft Office clip art available from http://office.microsoft.com/en-us/clipart/default.aspx

Pagana, K.D. and Pagana, T.J., 1998.Diagnostic and laboratory tests.Mosby.

Personal Pictures Sarah Arvelo Collection, 2008.

Porth, C.M., 2005.Patholophisiology, 7th edition. Lippinicott. End of Tutorial

If a person had a tumor in the liver

which obstructed the bile duct what type of

jaundice would the person have? Please

click on the right answer.

Jaundice (icterus) can be categorized by cause; Preheptic, Intrahepatic, or

posthepatic.

A. Prehepatic

C.Posthepatic

B. Intrahepatic

Pathology Menu

Posthepatic

A tumor that obstructs the bile duct can produce this type of jaundice. The bile cannot move to the

intestine and removal of bilirubin is prevented.

Back to Question

Complement System

The complement system consists

of a group of proteins. Almost all proteins are

produced by the liver.

Activation Enhances

Inflammatory responses

The lysis of foreign cells, and increases

phagocytosis.

Afects the humoral and innate immune responses. Next Protein

Page

The Complement System plays a role in inflammation

1) Vasodilatation and increases

vascular permeability 2)Leukocyte

activation, adhesion,

and chemotaxis

3) Phagocytosis

Physiology

The Glucocorticoid, Cortisol, regulates

the metabolic functions of the body and control the inflammatory response during

the stress response.

Stimulates the liver to

glycogen

Protein Breakdown

Mobilizes fatty acids

Physiology