FEDERAL UNIVERSITY OTUOKE
A SIWES INDUSTRIAL TRAINING PRESENTATION ON
LIVER FUNCTION
BY
NAME: OMADI TEMPLE OBIOGO
MAT NO: FUO/20/BCH/14070
DEPARTMENT OF BIOCHEMISTRY
FACULTY OF SCIENCE
SUPERVISED BY
SEPTEMBER, 2024
OUTLINE
• INTRODUCTION
• FUNCTIONS OF THE LIVER
• SERUM BILIRUBIN
• BILIRUBIN METABOLISM
• DIAGNOSTIC IMPORTANCE
OF BILIRUBIN
• A-CONJUGATED
HYPERBILIRUBINEMIA
• NORMAL RANGE
• CONCLUSION
• REFERENCES
INTRODUCTION
The liver is a reddish brown wedge shaped organ with four
lobes of unequal size and shape.
A human liver normally weighs, 1.44–1.66 kg (3.2–3.7lb).
Liver function tests are blood tests used to help diagnose and monitor
liver disease or damage.
The tests measure the levels of certain enzymes and proteins in our blood
(Johnston et al., 2019).
Some of these tests measure how well the liver is performing its normal
functions of producing protein and clearing bilirubin, a blood waste
product (McClatchey, and Kenneth, 2022).
FUNCTIONS OF THE LIVER
Synthetic functions : synthesis of plasma proteins, cholesterol,
triacylglycerol and lipoprotein
Metabolic function: protein metabolism, ketogenesis, TCA cycle,
production of ATP
Detoxification & excretion: ammonia to urea, bilirubin,
cholesterol, drug metabolites.
Homeostasis : blood glucose regulation
Storage function: Vitamin A, D, K, B12 (Shivaraj, and Desai,
2018).
Production of bile salts
SERUM BILIRUBIN
The major pigment present in bile is the orange
compound bilirubin (Kwo and Stanley, 2017).
Bilirubin: is the end product of heme degradation
derived from breakdown senescent (aging)
erythrocytes by mononuclear phagocytes system
specially in the spleen, liver and bone marrow.
BILIRUBIN METABOLISM
Bilirubin is the excretory product formed by the catabolism of heme
part of hemoglobin.
Porphyrin part of heme are converted to bilirubin in
reticuloendothelial cells of liver, spleen, bone marrow (Johnston et
al., 2019).
Unconjugated bilirubin is bound to serum albumin &transferred to
liver where it is conjugated to glucuronate by UDP Glucuronyl
transferase.
Conjugated bilirubin is excreted into bile. A fraction of bilirubin
from stool is reabsorbed into blood via portal circulation
(enterohepatic circulation) (Shivaraj, and Desai, 2018).
The liver removes bilirubin from the circulation rapidly, mediated by a carrier
protein (receptor), and conjugates it with glucuronic acid. This reaction is
catalyzed by the enzyme glucuronyl transferase in the smooth endoplasmic
reticulum to have conjugated bilirubin, which is more water soluble than
bilirubin.
The bilirubin-glucuronide (conjugated bilirubin) is secreted into the bile
canaliculi (Johnston et al., 2019).
Note: the unconjugated bilirubin is normally not secreted.
In the small intestine, bilirubin glucuronide is poorly absorbed. In the gut,
however, bacteria deconjugate it back to bilirubin, and convert it to the highly
soluble colorless compound called Urobilinogen
Only 20% of Urobilinogen can be absorbed by the small intestine (this
represents the enterohepatic circulation of bile pigments). 70% of the
Urobilinogen can be oxidized in the large intestine to Stercobilin and
stercobilinogen (by bacteria).
10 % of Urobilinogen is excreted in
either urine (where it is converted to
yellow urobilin in the kidney) or feces
(after it is converted to Stercobilin which
is responsible for the brown color of
feces). (entero-hepatic circulation) (Shivaraj,
and Desai, 2018).
DIAGNOSTIC IMPORTANCE OF BILIRUBIN
• Disruption of bilirubin metabolism and excretion can
cause hyper bilirubinaemia and subsequent jaundice
• Hyper bilirubinaemia may be unconjugated (indirect) or
conjugated (direct) depending on the type of bilirubin
present in plasma (Kwo and Stanley, 2017).
A-UNCONJUGATED HYPERBILIRUBINEMIA
• It is due to overproduction of bilirubin by reticuloendothelial system over
the capacity of the liver to remove and clear from blood. It is characterized
by high level of indirect or unconjugated bilirubin. This type of bilirubin
can cross the blood-brain barrier into the central nervous system and cause
kernicterus (Johnston et al., 2019).
• Jaundice becomes clinically evident when the serum bilirubin level
exceeds 2.5mg/dL.
• Several types of Jaundice:
– Hemolytic
– Hepatocellular
– Obstructive
• Symptoms:
– Yellow discoloration of the skin, sclera and mucous membranes
– Itching (pruritus) due to deposits of bile salts on the skin
– Stool becomes light in color
– Urine becomes deep orange and foamy
NORMAL RANGE
Bilirubin type Bilirubin level
Total bilirubin 0.0-1.4 mg/dL or 1.7-20.5 mcmol/L
Direct bilirubin 0.0-0.3 mg/dL or 1.7-5.1 mcmol/L
Indirect bilirubin 0.2-1.2 mg/dL or 3.4-20.5 mcmol/L
CONCLUSION
Evaluation of liver function is an evolving science. Many aspects of liver
function assessment have been described in this slide, and each must be
integrated with subjective and objective clinical and diagnostic information
for best utility. Currently available methods have proven useful and
reliable in recognizing disease patterns and in identifying the need for liver
biopsy. No test surpasses liver biopsy for definitive diagnosis of
hepatobiliary disease. Improved disease surveillance by combined
application of routine assessments and the useful liver function tests
described here has shortened the interval between disease onset and its
definitive histological characterization and treatment.
REFERENCES
• Johnston, D. E (2019). "Special considerations in interpreting liver function tests". Am
Fam Physician. 59 (8): 2223–30.
• McClatchey, and Kenneth, D. (2022). Clinical laboratory medicine. Lippincott Williams
& Wilkins. p. 288. ISBN. 978-0-683-30751-1.
• Mengel, M., Schwiebert, B and Peter, L. (2015). Family medicine: ambulatory care &
prevention. McGraw-Hill Professional. p. 268. ISBN 978-0-07-142322-9.
• Kwo, P., Stanley, P., Lim, M and Joseph, K. (2017). "ACG Clinical Guideline:
Evaluation of Abnormal Liver Chemistries". American Journal of
Gastroenterology. 112 (1): 18–35.
• Shivaraj, G., Desai, B., Vinayak, P and Hull, V. (2018). "A review on laboratory liver
function tests". The Pan African Medical Journal. 3 (17): 17.
• Lisa, B, and VanWagner, T. (2015). "Evaluating Elevated Bilirubin Levels in
Asymptomatic Adults". Journal of the American Medical Association. 313 (5):
516–517.