CLINICAL CHEMISTRY 2 MTPC12
LESSON 1: LIVER FUNCTION
Prof. Geromil J. Lara, RMT, MSMT
Prelim: 2nd semester
• Functional unit of liver is hepatocyte
Pathways
• Canaliculi
o Small canals that will terminate into the
bile duct
o Directly connected to hepatocytes
• Sinusoids
o For the blood cells and other cells
Physiology of LIVER
• Mainly synthesize major substances of the body like
carbohydrates, protein, fats
• Detoxification of the compounds that are not part
of the body
• Transports substances such as fats and other
substances to other tissues
• Stores substances
• Secrete substances
PEREZ, A.J.L BSMT 3-1 LPU-D MEDICAL TECHNOLOGY
CLINICAL CHEMISTRY 2 MTPC12
LESSON 1: LIVER FUNCTION
Prof. Geromil J. Lara, RMT, MSMT
Prelim: 2nd semester
globin vitamin b12 and the hormone erythropoietin
to from heme
Secretory Functions
7. The other portion of the heme which is
• Bile – Emulsifying agent
protoporphyrin becomes biliverdin to Bilirubin 1
o Bile Acids
(not soluble in water) bilirubin 1is carried by
▪ Cholic Acids
albumin to the liver and conjugated by the liver to
▪ Chenodeoxycholic acid
form bilirubin 2 (waste) released in small intestine
o Bile salts
then converted to urobilinogen because of bacteria
o Bile Pigments
then to stercobilin then it will become feces
▪ Bilirubin
8. In the kidney the urobilinogen will be converted to
o Cholesterol
urobilin then to urine
Conjugation of Bilirubin
Bilirubin Monoglucuronide (B1) + Uridine-Diphospho-
Glucuronic acid = Bilirubin Diglucuronide (B2)
Uridine Diphosphate-Glucuronyl transferase (enzyme)
Bilirubin metabolism
1. Red blood cell death and phagocytosis
2. Hemoglobin will undergo degradation into Heme
and globin
3. Globin will undergo catabolism releasing amino
acids to be used for protein synthesis
4. The heme (ferrous state of iron) will undergo more
catabolism
5. The iron in heme will be converted to a ferric state
and will be transported by transferrin into the liver
cells and will be stored as a protein called ferritin
6. Ferritin is transferred to red bone marrow by
transferrin to form heme and is accompanied by
PEREZ, A.J.L BSMT 3-1 LPU-D MEDICAL TECHNOLOGY
CLINICAL CHEMISTRY 2 MTPC12
LESSON 1: LIVER FUNCTION
Prof. Geromil J. Lara, RMT, MSMT
Prelim: 2nd semester
Jaundice
• Icterus/Jaundice
• Characterized by the yellow discoloration of
the skin and sclera because of
hyperbilirubinemia
o Prehepatic jaundice
o Hepatic jaundice
o Postherpetic jaundice
• If concentration of bilirubin is higher than
normal the plasma is darker and excess
bilirubin will go to skin and sclera (jaundice)
• Icteric serum or plasma (dark yellow due to
increase bilirubin)
Prehepatic Jaundice
• Due to excessive amount of bilirubin that is
presented to the liver for metabolism
• B1 is in excessive amount
o Hemolysis
o Hemolytic anemia (increased
hemolysis of RBC means more B1
formed)
o Malaria (there is a stage where P.
malariae develop in RBC which
Hemolyze RBC which means more B1
formed) RBC hemolyzed because of
rapturing of schizont because of
maturation and ring formed by the P.
malariae
▪ Increased B1
PEREZ, A.J.L BSMT 3-1 LPU-D MEDICAL TECHNOLOGY
CLINICAL CHEMISTRY 2 MTPC12
LESSON 1: LIVER FUNCTION
Prof. Geromil J. Lara, RMT, MSMT
Prelim: 2nd semester
Hepatic jaundice Analysis of Bilirubin
• Result from impaired cellular uptake, defective • Ehrlich’s Reaction (1883)
conjugation, or abnormal secretion of bilirubin o Urine bilirubin reacted to diazotized
by the liver cell sulfanilic acid
• Abnormality of Hepatocyte o B1
o Gilbert Syndrome (impaired cellular • Van den Bergh (1913)
uptake of bilirubin) (elevated B1) o Using serum
o Crigler-Najjar Syndrome (Characterized o Used alcohol accelerator for the
by deficiency of the enzyme of UDPGT) coupling of bilirubin to diazotized
▪ Type 1- Complete absence of sulfanilic acid.
UDPGT o B1 and b2
▪ Type 2- Less severe deficiency
of UDPGT • Malloy-Evelyn Method (1937)
o Roto’s Syndrome o Serum Bilirubin
▪ Liver cells are not pigmented o Not widely utilized
▪ Same symptoms with Dubin- o 50% methanol
Johnson syndrome • Jendrassik and Grof (1938)
▪ Increased b1 o Serum bilirubin
o Dubin-Johnson Syndrome o Most utilized
▪ Is an autosomal recessive o Caffeine-benzoate-acetate
disease which presents shortly ▪ Ascorbic acid – terminates
after birth with an increase of reaction
conjugated bilirubin without • Both Malloy-Evelyn Method and jendrassik
elevation of liver enzymes and Grof use same principle with Van den
Bergh but uses different coupling accelerator
• Coupling accelerator for whole bilirubin count
Post hepatic Jaundice • Total B2-B1 to get B1
• B1 indirect bilirubin (water insoluble)
• Impaired bilirubin Excretion
• B2 Direct bilirubin (water soluble)
o Gallstones (blocks bile flow from the
liver to the gallbladder or from the
gallbladder to duodenum)
• Icterus Index (oldest)
o Tumor of liver
o Yellowishness of the serum or plasma
o Bacterial infection of liver
o 01% potassium dichromate (light
o Elevated B2
yellow)
o NOT AN ACCURATE MEASURE OF
JAUNDICE
PEREZ, A.J.L BSMT 3-1 LPU-D MEDICAL TECHNOLOGY
CLINICAL CHEMISTRY 2 MTPC12
LESSON 1: LIVER FUNCTION
Prof. Geromil J. Lara, RMT, MSMT
Prelim: 2nd semester
Liver enzymes
• ALP
• ALT or AST
• 5’N
• GGT
• LAP
• LDH
PEREZ, A.J.L BSMT 3-1 LPU-D MEDICAL TECHNOLOGY
