The Functions of the Liver and Liver Cancer Tutorial PowerPoint Presentation

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WelcomeTo The Functions of the Liver and Liver Cancer Tutorial Alverno College 2008 Sarah Arvelo Directions and Objectives

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The Functions of the Liver and Liver Cancer Directions 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

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The Functions of the Liver and Liver Cancer Objectives 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

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Liver Functions and Pathology 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

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Anatomy and Physiology Anatomy Labs Nursing Assessment of the Liver Physiology Image from Microsoft clip art Liver Functions and Pathology Menu End Show

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Anatomy 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

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Anatomy of the Liver 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

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Anatomy 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

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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. Anatomy Next Anatomy Page

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Anatomy 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

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Anatomy 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

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Anatomy Click on each step to organize the flow of bile. STEP 5 STEP 4 STEP 3 STEP 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.

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The Flow of Bile 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 and Physiology Menu

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Physiology In the following section you will find information on the different functions of the liver. Physiology Menu

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Physiology Fat/Lipids Protein Bile Production Synthesis of Clotting Factors Hormones/Drugs Carbohydrate Bilirubin Elimination Anatomy and Physiology Menu End Show

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Nursing Assessment of the Liver 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

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Cirrhosis, Metastatic Cancer, Syphilis Abscess or Metastatic Tumor Tumor Portal Obstruction, Cirrhosis, High Obstruction 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. Abnormal Assessent Possible Abnormal Assessment signs that need further investigation. Click to find out the possible cause Pathology of the Liver Menu

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Liver Span 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 Menu Back to Pictures

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Liver Span Finding the upper border of the liver. Next Page Liver Span 1 2 3 Images from Sarah Arvelo

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Liver Span 4 5 6 Measure between your marks, to find the border of the liver. Next Page Liver Span Images from Sarah Arvelo

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Liver Span 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

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Palpating the Liver 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 Menu Back to Pictures

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Palpating The Liver 1 2 3 4 Next Page Palpating the Liver Images from Sarah Arvelo

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The Scratch Test 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

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Scratch Test 1 2 3 Next Page Scratch Test Images from Sarah Arvelo

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Fluid Wave 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

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Fluid Wave 1 2 3 4 Next Page Fluid Wave Images from Sarah Arvelo

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Test Your Knowledge When palpating the liver what is normal? Yes C. All of the above Close A. Nothing is felt Almost B. The edge of the liver is felt Nursing Assessment Menu Next Question

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Test Your Knowledge 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

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Test Your Knowledge Obesity produces a fluid wave. Obesity and gas would produce no change. Correct TRUE FALSE Nursing Assessment Menu

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Metabolism of Hormones and Drugs 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 Drugs Images from Microsoft Clip art

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Metabolism of Hormones and Drugs 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

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Hormones Metabolized by the Liver 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

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Bile Production Bile contains water, bile salts, bilirubin, and cholesterol. The liver produces 600 - 1200 ml of bile, that is yellow-green in color, a day. Bile salts assist with digestion and absorption of fats. 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

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Bilirubin Elimination 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

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Carbohydrate Metabolism 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

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Protein Metbolism 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

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Protein Metabolism 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

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Lipid Metabolism 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

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Lipid Metabolism FAT Glycerol Fatty 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

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Lipid Metabolism 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

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Lipid Metabolism VLDL triglyceride Transport 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

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Clotting Factors 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

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Clotting Factors 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

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The purpose of these tests is to evaluate the extent of damage as well as identify different dysfunctions of the liver. Liver Function Tests Serum Bilirubin ALT/AST GGT ALP PT Prealbumin/ Albumin Anatomy and Physiology Menu AFP Image from Microsoft Clip art

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PT (Prothrombin Time) 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

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Serum Bilirubin 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

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GGT y-glutamyltransferase 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

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Alkaline Phosphatase (ALP) 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

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AST Aspartate Aminotransferase 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

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ALT Alanine Aminotransferase 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

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Prealbumin/Albumin 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

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Prealbumin/Albumin 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

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A-fetoprotien 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

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Pathology of the Liver 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

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Enlarged Liver Abnormal Assessment Possible Findings: 1)Nontender and smooth or 2)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

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Cancer 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

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Cancer 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

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Cancer 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

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Cancer Metastasis - the development of a second site of the primary tumor. Metastasis occurs through: Blood Vessels Lymph Channels Pathology Menu

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Symptoms and Abnormal Lab Values 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

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CORRECT > 2.5 mg/dl produces jaundice. INCORRECT Sorry! This measures bleeding. C. Protime B. ALT A. Serum Bilirubin Symptoms and Abnormal Lab Values 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

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INCORRECT 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

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INCORRECT 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

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Right 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

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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. Symptoms and Abnormal Lab Values Damage to the liver can cause a persons abdomen to increase in size. What causes this? Next Question Pathology Menu

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. 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. Symptoms and Abnormal Lab Values A person with liver damage is on your unit. He has multiple bruises over his body. What is causing this? Next Question Pathology Menu

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Incorrect. Can not measure bleeding time. C. CBC Incorrect. Can indicate alcohol abuse. Correct B. GGT A. Protime Symptoms and Abnormal Lab Values Bleed time is measured by: Next Question Pathology Menu

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B. PT What test would be significant in evaluating the proteins synthesized by the liver involved in blood coagulation? Symptoms and Abnormal Lab Values C. A and B Next Question A. Prealbumin and Albumin

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Incorrect. Back to Question

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

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

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Symptoms and Abnormal Lab Values 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

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

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

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Incorrect Back to Question

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Symptoms and Abnormal Lab Values What is the purpose of liver function tests? B. Evaluate if there is damage to the liver Pathology Menu Next Question

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Quiz No Back to Question

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

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

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Treatment of Cancer Chemotherapy Biotherapy Bone Marrow Transplant Hormonal Therapy Radiation Therapy Surgery Pathology Menu Targeted Therapy

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Treatment of Cancer The following are treatments for all cancers and are not specific to the liver. Treatment of Cancer Menu Image from Microsoft Clip art

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Symptoms and Abnormal Lab Vaules 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

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Surgery 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. Treatment of Cancer Menu

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Radiation Therapy 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

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Chemotherapy Systemic treatment (administered intravenously). Prevents cell growth and replication. Can be used in combination with other therapy. Treatment of Cancer Menu

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Hormonal Therapy 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

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Hormonal Therapy 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

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Biotherapy 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 Page Image from Microsoft clip art

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Biotherapy 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 Menu Image from Microsoft clip art

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Bone Marrow and Stem Cell 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

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Targeted Therapy 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

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Primary Liver Cancer 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

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Pathology of the Liver/Primary 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

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Case Study 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

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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. Case Study Questions

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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. Case Study Questions Liver Function and Pathology Menu

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Tumor Suppressor Genes 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

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Tumor Suppressor Genes 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

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Tumor Suppressor Genes Mutations of the TP53 Gene Linked to: Development of lung, breast, liver, and colon cancer. Pathology Menu Next Page Image from Microsoft clip art

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Tumor Suppressor Genes TP53 Gene Initiates 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

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References 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

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Abnormal Lab Values and Symptoms 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

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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

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Proteins 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

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Proteins The Complement System plays a role in inflammation 1) Vasodilatation and increases vascular permeability 2)Leukocyte activation, adhesion, and chemotaxis 3) Phagocytosis Physiology

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Hormones 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