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Basic medicine: physiology
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Developmentally the liver, biliary tree and pancreas are part of the gut, and their functions complement those of the alimentary canal (Figure 1.4). As the largest gland in the body, the liver plays a major role in metabolism. It receives nearly all the nutrients from the gut via the portal vein. It is responsible for synthesis of albumin, several clotting factors, bile salts and cholesterol. The liver secretes bile, which contains bile pigments (degraded haemoglobin), bile salts, lecithin and cholesterol; imbalance in these constituents leads to the formation of gallstones, which usually contain a mixture of cholesterol and bile pigment. The liver is also responsible for the detoxification of many drugs, including alcohol. Bile is secreted into the biliary, which conveys it to the upper small intestine (duodenum) where it assists in the digestion of fat. Liver disease and bile duct obstruction are the usual causes of jaundice, when retention of bile pigment in the blood provides the characteristic yellow pigmentation of the skin and eyes. The gallbladder is attached to the side of the bile duct and acts to concentrate and store bile until it is required at mealtimes, The pancreas has a double function: it elaborates many of the enzymes needed for proper digestion of food and it synthesizes insulin (among other hormones), which is needed for the uptake of glucose into cells. Insufficiency of insulin leads to an increased blood sugar level or diabetes.
The lymphoreticular system and bone marrow
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
The most important of these is hereditary spherocytosis, caused by a defect in the molecule spectrin, which anchors the cytoskeleton to the cell membrane. This causes membrane loss, and the erythrocytes cannot maintain their usual biconcave shape, so that the cell becomes spheroidal. This reduces the plasticity of the cells, which are consequently trapped in the red pulp of the spleen and destroyed. Splenomegaly is therefore usual in spherocytosis. The anaemia is often mild, but can be aggravated by intercurrent infections, pregnancy, or folic acid deficiency. The constant haemolysis may lead to bile pigment gallstones. The diagnosis is made by finding spherocytes in the peripheral blood (Figure 9.31), and showing that the red cells are excessively fragile when placed in a hypotonic salt solution. Splenectomy restores erythrocyte survival to normal, but of course does not correct the abnormal shape or osmotic fragility of the cells.
Introduction
Published in Shayne C. Gad, Toxicology of the Gastrointestinal Tract, 2018
The principal bile pigment is conjugated bilirubin. The phagocytosis of aged red blood cells liberates iron, globin, and bilirubin (derived from heme). The iron and globin are recycled, and some of the bilirubin is converted to conjugated bilirubin, in which the bilirubin is attached to glucuronic acid molecules. Conjugated bilirubin is then secreted into the bile and is eventually broken down in the intestine. One of its breakdown products—stercobilin—gives feces their normal brown color.
Microstructural and heavy metal analysis of gallstones prevalent in Jharkhand and its implications in the treatment
Published in Postgraduate Medicine, 2023
Bhavna Sharma, Shubha Rani Sharma
Table 3 illustrates the CHNS analysis of gallstones. Five samples were used for the analysis [two of cholesterol gallstones (Ma3, Fe16), two of mixed gallstones (Fe6, Fe7) and one of pigmented gallstones (Ma5)]. Pigmented stones have been associated with large amounts of sulfur in their core as well as with phosphorus and calcium. We also found sulfur content is highest in pigmented stones. Nitrogen content was also highest in pigmented stone this can be associated with the degradation of tetrapyrrolic bile pigments present in bilirubinates and also bilirubin. Raman et al. also reported more nitrogen content in pigment gallstones (almost eight times) as compared to other stones [8]. Weerakon et al., have associated nitrogen with pigmented gallstones in the form of protein streaks [9]. As pigmented stones have less amount of cholesterol so C content was lowest in them and was highest in cholesterol and mixed stones. Also, the absence of nitrogen from Ma3 as well as Fe16 confirmed that they were pure cholesterol stones.
Predictors of adverse maternal outcome in jaundiced pregnant women identified as having pregnancy-specific liver disease (P-sLD)
Published in Journal of Obstetrics and Gynaecology, 2022
Thendral Natarajan, Sasirekha Rengaraj, Latha Chaturvedula, Mukta Wyawahare
The study was approved by the JIPMER Scientific Committee and Ethical Review Board. Demographic variables like age, weight, height, and clinical features like the onset of jaundice hypoglycaemia and ascites were collected. All the women were managed as per the department policy and underwent detailed haematological, biochemical tests and ultrasound imaging of abdomen and liver. The laboratory values at admission, peak and before discharge were collected including liver function tests, fibrin degradation products, PT/INR, platelet count, peripheral smear, S. Electrolytes, urine bile salts and bile pigments. The studied maternal morbidity included PPH, patients requiring massive transfusion, encephalopathy, adult respiratory distress syndrome (ARDS), multi-organ dysfunction, acute kidney injury (AKI) requiring dialysis, and admission to ICU for ventilator support. MELD score was calculated based on the following formula 3.78 × log (Bilirubin) + 11.2 × log (INR) + 9.57 × log (Creatinine) + 6.43
Hepatoprotective effect and metabonomics studies of radix gentianae in rats with acute liver injury
Published in Pharmaceutical Biology, 2021
Shizhao Xu, Fanli Kong, Zhengwu Sun, Yalin Xi, Fei Qi, Jianzhi Sun
Bilirubin is an important molecule in the pathway of porphyrin and chlorophyll metabolism. Bilirubin is a kind of bile pigment, a yellow catabolic product of haem and a major metabolite of iron porphyrin in vivo. The role of bilirubin in the mechanism of liver injury is still controversial. Some studies revealed that bilirubin exhibited a high level when encountering liver injury (Li et al. 2021). However, bilirubin has the antioxidant and anti-inflammatory function at a physiological concentration (Ziberna et al. 2016), which is also an important indicator of assessing liver function in the clinic (Kusakabe et al. 2020). The abnormal expression of bilirubin in this study indicated that porphyrin and chlorophyll metabolism were in disorder in the state of liver injury. Rats treated with RG showed an increased level of bilirubin, indicating that RG can improve porphyrin and chlorophyll metabolism of rats with liver injury.