The liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
The liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
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It is a well known fact that metal ions have a profound effect on cellular processes
The importance or the role that ions play in cellular activity can be gauged by the fact that most cells maintain a very critical Na+ & k+ balance between the extracellular and the intracellular spaces.
Any distribution in this critical balance is to the cellular metabolism through a drastic change in the osmotic pressure resulting in cellular swelling.
Perioperative management of a patient with diabetes mellitusrajkumarsrihari
Anesthetic implications in a patient with Diabetes Mellitis with latest updates taken from british journal of anesthesia on perioperative glycemic control (2013)
This content is suitable for medical technologists/technicians/lab assistants/scientists writing the SMLTSA board exam. The content is also suitable for biomedical technology students and people also interested in learning about the liver. This chapter describes the liver and interpretation of the liver function tests. Please note that these notes are a collection I used to study for my board exam and train others who got distinctions using these.
Disclaimer: Credit goes to those who wrote the notes and the examiners of each exam question. Please use only as a reference guide and use your prescribed textbook for the latest and most accurate notes and ranges. The material here is not referenced as it is a collection of pieces of study notes from multiple people, and thus will not be held viable for any misinterpretations. Please use at your own discretion.
Liver function tests and interpretation is a very important topic for students of medical and allied fields. It is essential for efficient practice of clinical and laboratory medicine.
It is characterized by a yellow appearance of the (1) Skin (2) Mucous membranes and (3) Sclera caused by bilirubin deposition. It is the most specific clinical manifestation of Hepatic dysfunction.
Jaundice is usually present clinically when the plasma bilirubin concentration reaches 2 to 3 mg/dl.
When bilirubin clearance from the Liver to the Intestinal tract is impaired (as in acute hepatitis and bile duct obstruction) it may be accompanied by alcoholic (Gray coloured) stools.Solubility increases in water , soluble conjugated bilirubin leads to Tea coloured urine.
INTERPRETATION OF COMMON BIOCHEMICAL TESTS INCLUDING LFT & RFT.pptxDr Debasish Mohapatra
Biochemical tests are commonly used in day-to-day practices for diagnosis of diseases. Liver function test and renal function tests are common tests done.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Liver is the principle organ for maintaining
the body’s internal environment & of vital
importance in intermediary metabolism,
detoxification and the elimination of toxic
substances.
3. Largest internal body organ
Largest gland
Largest organ apart from skin
Weighs about 1.5kg
Found in the upper abdominal cavity:
extends from right upper quadrant to left
upper quadrant of the abdomen
Attached to diaphragm by
1. Falciform and coronary ligaments
2. Left and right triangular ligaments
8. Estimation of Serum Albumin:
Principle: Bromocresol-Green method
Albumin+ BCG → Green coloured compound
(citrate buffer)
Reference Range: 35-50 g/l
Interpretation: Used to asses chronicity and
severity of liver disease.
↓ in Chronic liver disease.
9. PROTHROMBIN TIME:
Synthetic dysfunction
↑ in liver disease due to ↓ of clotting factors
Reference Range: 10-14 sec
10. Liver is the only organ that has the capacity to
rid the body of heme waste products.
Major heme waste product is Bilirubin,
principle pigment of bile derived from
breakdown of RBCs.
Hepatocytes in liver are separated by sinusoidal
spaces along walls known as Kupffer cells
present for detoxifying function.
13. Catabolism of Heme
Estimated by Van den bergh reaction
Principle:
When diazotised sulfanilic acid reacts with
bilirubin, it forms ‘azobilirubin’, a purple
coloured product.
↑ Conjugated Bilirubin: gives colour immediately
→ Direct positive
↑ Unconjugated Bilirubin: Gives colour after
addition of methanol → Indirect positive
↑ Both conjugated and Unconjugated → Biphasic
15. Bile salts: Hay test
Principle: Bile salts have property of lowering
surface tension.Hence when sulphur powder
is sprinkled to urine containing bile salts, it
sinks to bottom.
Bile pigments: Fouchet’s test
Principle: Bile pigments adhere to the
precipitate of barium sulphate. On addition of
fouchet’s reagent, FeClз in presence of
trichloroacetic acid oxidizes yellow colour
bilirubin to green colour biliverdin.
16. Allows important substances to reach systemic
circulation and serve as a barrier to prevent toxic
or harmful substances
Either bind with material to inactivate the
compound or chemically modify it
Drug Metabolism: Detoxification of drugs by
1. Oxidation
2. Reduction
3. Hydrolysis
4. Hydroxylation
5. Carboxylation
6. Demethyaltion
17. HIPPURIC ACID TEST:
Principle: Hippuric is produced in the liver when
benzoic acid combines with glycine.
Procedure:
6gm of sodium benzoate is given to the patient.
Urine is collected up to 4hrs.
Hippuric excreted in urine is estimated.
Normal: >4.5g of hippuric acid
Abnormal: <3g of hippuric acid
19. METABOLISM OF CARBOHYDRATES:
Store glucose as glycogen
Degrade glycogen to glucose
(Glycogenolysis)
Create glucose from non-sugar carbon
substrates e.g. pyruvate (Gluconeogenesis)
20. METABOLISM OF LIPIDS & LIPOPROTEINS:
Gathering free fatty acids from diet to
produce Acetyl-CoA
Greatest source of cholesterol in body
METABOLISM OF PROTEINS:
Synthesize all proteins except
immunoglobulin's complement & adult
hemoglobin
Transamination of amino acids to produce
ammonium ions.
21. CARBOHYDRATE METABOLISM
• Glucose tolerance test
Interpretation:
Normal: 2h PG level less than 7.8 mmol/l
IGT: between 7.8-11.1 mmol/l
DM: greater than 11.1 mmol/l
LIPID METABOLISM
• Serum cholesterol
22. Protein metabolism
• Serum Ammonia:
Liver detoxicates ammonia to form urea
Normal: 40-70µg /100ml
Congenital defect in urea cycle
Ornithine transcarbamylase deficiency
Liver cirrhosis
Hepatic failure
Acute & sub acute liver necrosis
Sample: Arterial Blood
23. LFTs help in diagnosis of liver disease to
evaluate severity, monitor therapy and asses
the prognosis.
24.
25. ALANINE AMINO TRANSFERASE:
Highest in liver
Principle: Coupled enzyme technique with
continuous UV monitoring of NADH
disappearance
ɖ -oxoglutarate + L- Alanine→L-glutamate+
pyruvate
Pyruvate+ NADH + H⁺→Lactate+ NAD⁺
Calculations:
ALT U/l = 1746 ӿ ∆A (340nm/min)
Reference range: Up to 42U/l
26. ASPARTATE AMINOTRANSFERASE
Principle:
Coupled enzyme technique with UV
monitoring of NADH disappearance.
Reaction:
2-oxoglutarate+ L-aspartate → L-glutamate+oxaloacetate
Oxaloacetate+NADH+H⁺ → L-Malate+ NAD⁺
Calculations:
AST U/l = 1746 ӿ ∆A (340nm/min)
Reference range: Up to 0-37 U/l
27. Sample: Serum heparinized, EDTA plasma
stable for 1 week at 2-8ºC
Serum shouldn't be hemolysed
Interpretation:
Markers of Hepatocellular damage.
Raised in Acute Hepatitis
Cytoplasmic Damage:↑ALT
Mitochondrial damage:↑AST
28. Derived from Liver, osteoblasts and placenta
Principle:
Alkaline phosphatase catalyses the hydolysis of p-
nitropheylphosphatse in the presence of Mg ions at
alkaline pH
4-PNPP + H₂O → ƿ-Nitrophenol + PO₄
ALP U/l = 2760 ӿ ∆A/min @ 405nm
Reference Range= Adults 65-306 U/l
Children 0-645 U/l
↑ in cholestatic liver disease
29. Marker of severe Alcoholic Liver disease.
Extremely sensitive test
Reference Range: 11-60 U/l
5 Nucleotidase
Hydrolysis of nucleoside 5’ phosphate esters.
Increased in hepatobiliary diseases
Measurement of GGT & 5- Nucleotidase tends to
parallel Alp levels in hepato-biliary diseases.
30.
31. Yellow colour of conjunctiva, mucous membrane,
and skin due to increased bilirubin level
Pre hepatic Jaundice: ↑metabolism
In Acute & chronic hemolytic anemia's
Hepatic Jaundice: Intrinsic liver defect or disease
Due to disorders of bilirubin metabolism & transport
defects.
Crigler najjar syndrome
Dubin-johnson syndrome
Gilbert’s disease
Physiologic jaundice(Newborn)
Post hepatic jaundice: biliary obstructive disease
Physical obstructions gall stones and tumors
32. Gilbert syndrome:
Benign autosomal recessive hereditary
disorder
Due to mutation in gene UGT1A1
Crigler najjar syndrome:
Due to defect in gene involved in bilirubin
conjugation.
Dubin Johnson syndrome:
Rare autosomal recessive inherited disorder
↑ in delta bilirubin
33. Rotor syndrome:
Similar to dubin johnson
↓ ligandin
Physiological jaundice of Newborn:
↓ glucoronyl transferase
34. Cholestasis is an hepatic disorder
characterized by retention of conjugated
bilirubin & ALP
Cholestasis may be either:
INTRAHEPATIC: Bile secretion from
hepatocytes into canaliculi is impaired
EXTRAHEPATIC: Due to obstruction to the
flow of bile through biliary tract
36. Clinical condition in which scar tissue replaces
normal
SIGNS & SYMPTOMS: fatigue, nausea, weight loss,
jaundice, bleeding from GIT
COMMON CAUSES: Chronic Alcoholism,
HBV,HCV,HDV
Inherited disorders: ɖ1-antitrypsin deficiency, Wilson
disease, hemochromatosis
Albumin , Total
protein, Total
Cholesterol
Prothrombin time
37. Hepatitis B
HBsAg
HBeAg
Anti-HBs
Anti-HBc
HBV DNA
Hepatitis C
Anti HCV
HCV RNA
Auto-immune hepatitis:
ANA
ASTHMA
38. It is indicated in patients in whom ALT & AST
are persistently greater than two-fold
elevation.