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Sub by:
Shravankumar Gaddi
MVHK - 1040
Liver Histology
12/6/2011
3.
4.
1.
Metabolic Functions
Liver actively participates in carbohydrate metabolism, lipid,
protein, mineral and vitamin metabolisms.
2. Excretory Functions
Bile pigments, bile salts and cholesterol are excreted in bile
into intestine.
5.
Storage functions
Glycogen, vitamins A, D and B12.
6.
Serum enzymes
Acting as markers of liver damage.
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ALT
Hepatocellular damage
AST
Hepatocellular damage
Bilirubin
ALP
PT
Synthetic function
Albumin
Synthetic function
GGT
Bile acids
5`-nucleotidase
LDH
Icterus index
Principle The yellow color of serum or plasma is due
chiefly to the presence of bilirubin.
The intensity of the yellow color is compared with
a standard potassium dichromate solution.
The standards are expressed as units and
numbered according to the quantity of potassium
dichromate in 10,000 parts of water.
12/6/2011
Interpretation
Increased
Increased blood destruction due to hemolysis
Hepatocellular damage
Biliary obstruction
Fasting or reduced fluid intake in large animals
Decreased
Bone marrow depression
Solution A:
Sulfanilic acid
Qualitative method -
Indirect reaction
After the determination of the direct reaction, shake
the tube containing the serum and diazo reagent, add 3
ml of 95% alcohol, and mix.
If a definite pinkish color fails to appear in 15 min, and
only a white turbidity occurs, the reaction is recorded
as negative.
If a definite pink color develops, or if the color already
present from a positive direct test deepens upon the
addition of alcohol, the reaction is recorded as positive
for the indirect test.
Direct reaction
1g
15 ml
1000 ml
Sodium nitrite
0.5 g
Distilled water
100 ml
Quantitative method
Add 2 ml of nonhemolyzed serum to 18 ml of distilled
water to make a 1:10 dilution, and mix well.
Prepare the diazoreagent by adding 10 ml of solution A to
0.3 ml of solution B just before using.
To prepare the standard, place 10 mg of bilirubin in a 100ml volumetric flask and dilute to 100 ml with chloroform.
Transfer 10 ml of the stock standard to a 100-ml volumetric
flask and dilute to 100 ml with methyl alcohol.
(The dilute standard contains 0.01 mg bilirubin/ml and is
prepared just prior to use.)
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Distilled water, ml
Absolute methyl alcohol, ml
HC1 (1.5%), ml
Tube 1
Tube 2
Direct
blank
5
Direct
test
5
...
1
Tube 3
Tube 4
Total
blank
...
...
...
Total
test
...
...
Diazo reagent, ml
...
...
30
30
Factor
Reaction with diazo reagent
Structure
Conjugated
Unconjugated
Direct
Indirect
Bilirubin
diglucuronide
Bilirubin
In water
In alcohol
normal
In bile
In urine
Unconjugated
insoluble
soluble
0.2-0.9 mg/dl
Absent
Always absent
Conjugated
soluble
soluble
0.1-0.4 mg/dl
Present
Normally absent
Not absorbed
Solubility (water)
Type of compound
Polar
Nonpolar
Absorption gut
Absorbed
Hemolytic jaundice
to +
++
+++
Diffusion into
tissues
Indirect +
Presence in urine
Direct +
Calculation
(a) Direct reaction:
OD of direct test/OD of standard x 0.04 x 10/4 x 100 = mg
direct-reacting bilirubin/dl serum
(b) Total bilirubin:
OD of total test/OD of standard
total bilirubin/dl serum
Normal values
Species
Dog
Cat
Cattle
Horse
Sheep
Goat
Pig
Range
0.06-0.12
0.04-0.44
0-0.4
0-0.27
0-0.3
Mean
0.14
0.18
0.1
0.12
0.10. 1
Urine bilirubin
Interpretation
Increased bilirubin values
Prehepatic
Excessive hemolysis - initially will have more
unconjugated bilirubin, but will be followed in 3
to 4 days by an increase in conjugated bilirubin,
which is probably due to the insult of the hepatic
excretory system by anemic hypoxia; decreased
PCV
Cholestasis - if 50% or more of the bilirubin is
conjugated, cholestasis is the most likely cause of
the hyperbilirubinemia.
12/6/2011
Urine urobilinogen
Increased
Small amounts
Any febrile reaction in the dog and cat
When the liver disturbance is not sufficiently severe to
cause clinical jaundice
Moderate to marked reaction
Obstructive and hepatocellular jaundice - often the first
test to become positive and frequently precedes
measurable values for serum bilirubin
Acute enteritis
Intestinal obstruction
Increased amounts
Hepatocellular damage - urobilinogen cannot
be effectively removed from the circulation
because of the damaged liver cells
Hemolytic jaundice - excessive hemolysis of
erythrocytes results in an increased amount of
bilirubin, an increase in the production of
urobilinogen in the intestine, and an increased
amount of urobilinogen excreted in the urine
Enzyme (IU/L)
Dog
SGOT
SGPT
ALP
6.2 13
4.8-24
3-16
Cat
6.7 -11
1.7-14
2-7
Horse
58-94
1-6.7
11-31
Sheep
Goat
Pig
20-34
7911
43-132
8.2-21.6
4-11
Cattle
111
7-24
9-17
0-38
5-30
7-30
9-31
ARGINASE
0-4.7
0-70
1-30
0-4.5
GLUTAMIC
DEHYDROGENASE
0-11.8
ISOCITRATE
DEHYDROGENASE
0.4-7.3
2-11.7
4.8-18
9.4-21.9
0.4-8
LACTIC
DEHYDROGENASE
10-35
16-69
41-104
176-365
60-111
31-99
96-160
ORNITHINE
CARBAMYL
TRANSFERASE
2.70.7
3.81
3.34.2
4.70.3
SORBITOL
DEHYDROGENASE
2.9-8.2
3.9-7.7
1.9-5.8
4.3-15.3
5.8-27.9
14-23.6 1-5.8
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Interpretation
Increased value
Hepatic cell damage (Hepatic necrosis is not necessary for the
elevation of SGPT, since an alteration in cell membrane
permeability is all that is required to leak this cytoplasmic
enzyme into the blood.) (There is poor correlation between
hepatic cell necrosis and SGPT elevation.)
Normal to moderate SGPT elevations will be seen in:
Passive congestion of the liver
Fatty metamorphosis
Hepatocellular necrosis will produce moderate to marked
elevations.
Hepatotoxins - marked elevation because of the extensive liver
cell damage
Individual circumscribed nodules or tumors may not involve a
large number of cells at any given time, and the SGPT will be
proportionately lower.
Drugs
Corticosteroids, estrogens, androgens
Antibiotics chloramphenicol, Ampicillin, Gentamycin, Lincomycin,
Erythromycin
Dilantin, Primidone
Salicylates
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Methods
Useful for the dog and cat, but not for the horse and cattle because of
its limited range
Principle
A buffered phenolphthalein phosphate substrate remains colorless until
decomposed by the phosphatase enzyme in the serum.
The amount of phenolphthalein liberated is determined by a color
change and is a measure of alkaline phosphatase activity.
Procedure
Place one Phosphatab tablet in a small tube provided in the kit.
Add 4 drops of serum or plasma. (If plasma is used, any anticoagulant
may be used except EDTA.) (Hemolysis will give false readings.)
Crush the tablet with the applicator stick.
Allow mixture to stand 12 to 30 min, the time being determined by
consulting the room temperature incubation table.
Add one drop of color developer.
Compare the color in the tube with the color chart.
Hepatobiliary conditions
The increased amount of enzyme in hepatobiliary disease is
in response to increased pressure within the biliary system.
This is the overproduction or regurgitation theory and
evidence seems to favor this hypothesis.
It is not known whether it is the hepatocytes or the biliary
tree epithelium that produce the most alkaline
phosphatase, but it appears that the hepatocytes are the
major contributors.
Biliary obstruction - intrahepatic and extrahepatic
cholestasis results in marked SAP elevation
Secondary biliary obstruction, as with high intestinal
obstruction, causes marked elevation.
Liver necrosis - moderate elevation
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Small intestine
Horse - less enzyme than in the liver, but more than in the
kidney
Skeletal muscle and erythrocytes contain minimal amounts
of SDH.
Hemolysis will not produce falsely elevated results.
There is no elevation after intramuscular injections as may
be the case for GOT and CPK.
Interpretation of increased values of SDH
Marked increase
Liver necrosis
Enzyme of choice for detection of liver lesions in the horse
Disappears in 24 hr, which is twice as fast as GOT and 10
times as fast as ornithine carbamyl transferase (OCT)
Moderate increase
Pancreatitis
Cirrhosis
Obstructive jaundice
Diabetes mellitus
Acute intestinal obstruction - in the horse
Acute enteritis - in the horse
Grass sickness - in the horse
Mild increase
Severe azoturia - after a few days
Influenza
Arteritis
Prolonged corticosteroid administration.
Arginase
Sources
GLDH is quite liver-specific and is mainly localized in the
mitochondria.
Other organs such as muscle may contain a certain amount
of this enzyme but do not appear to influence the serum
level in a way that has clinical significance.
Interpretation of increased values
Liver disease - an elevation of its serum activity may
indicate a more severe cellular lesion than an elevation of
sorbitol dehydrogenase or transamine, especially in cattle
It is probably the liver enzyme of choice for cattle, as it is
much more sensitive than transaminase.
Limitation: Commercial kits are no longer available, which
limits the use for testing in many laboratories.
Principle
After the injection of BSP intravenously, the dye is bound to
plasma albumin.
It is mainly confined in the vascular compartment except in
the liver, where it readily moves across the sinusoidal
endothelium and results in an accumulation within the
hepatocytes.
Unlike capillaries in other tissues of the body, the sinusoids are
freely permeable to proteins.
At the cell boundary of the hepatocyte, the dye dissociates
from the plasma albumin, moves across the cell membranes,
then associates again on the other side with proteins of the
cytoplasm.
Within the hepatocytes much of the BSP is conjugated with
glutathione.
Both conjugated BSP and unconjugated BSP are excreted into
the canaliculi and the bile.
12/6/2011
Methods
Variations may be due to
The amount of dye injected and the time interval
of the testing period
Most of the dye is removed from the plasma
relatively early, with the remaining amount
becoming progressively less as time passes.
Hepatic blood flow
Ability of the hepatic parenchymal cell mass to
remove the dye
Bile duct patency through which the excreted
products pass to the intestine
Interpretation
Normal
Dog - less than 5% retention at 30 min is considered to be within
normal limits
Horse - the normal average T1/2 value is 2.80.5 min, with a range of
2 to 3.7 min.
Cattle
Mature dairy cow - 3.1 0.6 min with a range of 2.5 to 4 min
Yearling feeder steers - average T1/2 value of 4.5 0.32 min
Sheep - the normal T1/2 value is 2 0.3 min
Increased
Parenchymal hepatic disease
Fatty metamorphosis - mild increase
Cirrhosis (Averaged 28% retention in the dog)
Toxic hepatic injury
Hepatic necrosis, especially if acute and diffuse
Biliary tract disease
Bile duct obstruction
Extrahepatic disease
Circulation
o Congestive heart failure
o Shock
o Fever - increases hepatic blood flow, but decreases BSP
extraction
o Hepatic vein occlusion
o Spinal cord injury
Infiltrative lesions of the liver from systemic disease
Metastatic neoplasms
Granulomatous disease (Histoplasmosis)
Amyloidosis
SGOT
AP
BSP
SGPT
+
+ +
+++
+ +
+++
++
+++
+++
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12/6/2011
Cholesterol
Cholesterol is a steroid alcohol with lipid like solubility.
It is produced by almost every cell in the body, with the
following tissues being especially active in its synthesis:
Liver
Adrenal cortex
Ovaries and testes
Intestinal epithelium
Besides the manufacture of cholesterol, the liver also:
Esterifies it, chiefly with linoleic acid
Converts a portion of it to cholic acid
Excretes it in the bile
Contraindications
Increased bilirubin levels in the blood - especially if
over 4 mg/dl (The BSP will almost always be elevated
due to competition for conjugation with free bilirubin.)
Drugs that compete for conjugation with BSP or
interfere by sharing transport steps
Cholate
Telepaque
Phenolsulfonphthalein
Iodine
125 to 250
Cat
Goat
95 to 130
80 to 130
Sheep
52 to 76
Cattle
80 to 120
Horse
75 to 150
Pig
Rat
36 to 54
49.9 11.7
Serum protein
Dog
Cattle
Sheep
Goat
Total protein
Serum (g/dl)
6.7 - 7.4
6 7.9
Albumin (g/dl)
2.3 3.8
3 3.5
Globulin (g/dl)
2.6 - 4
3 3.4
Alpha 1
0.2-0.5
0.2-1.1
0.06-0.7
0.75-0.8
0.3-0.6
Alpha 2
0.3-1.10
0.4-0.90
0.31-1.31
Beta 1
0.6-1.20
0.3-0.90
0.4-1.58
0.70-1.2
0.70-1.2
0.60-1.0
0.29-0.89
0.4-1.40
0.3-0.60
1.2-1.6
0.3-2.50
0.55-1.90
0.7-2.20
0.9-3.00
2.2-2.4
0.6-1.26
0.3-0.5
Beta 2
Gamma 1
0.5-1.30
Cat
Gamma 2
0.4-0.90
1.4-1.90
0.5-1.11
0.4-1.19
Horse
0.6-1.46
0.5-0.7
Pig
0.3-0.4
1.2-1.5
0.8-1.12
1.6-2.25
0.2-1.10
0.8-0.94
0.4-0.76
0.1-0.3
Albumin
The normal range for most animals will vary between 5 and
8 g/dl
The total serum protein concentration is usually of little
value in the assessment of liver function or disease.
The albumin fraction can be diminished and the globulin
fraction increased; the sum of the two fractions may yield a
wide range of values, from low to high, in the presence of
hepatic disease.
It is more reliable to consider the significance of
abnormalities in albumin and in globulin separately,
although a significant hypoproteinemia is usually going to
be the result of a hypoalbuminemia.
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12/6/2011
Methods
Chemical - salt, alcohol, or isoelectric precipitation
Physical - electrophoresis, chromatography, or
ultracentrifuge
HABA dye
This is the method used in many automated clinical
chemistry instruments such as the SMA 12 of Technicon
and blood analyzer systems such as the Ames/BMI.
It produces consistently lower albumin values for animals
than for man when compared to chemical or
electrophoretic methods, as different species have different
dye-binding activities.
In the dog, the ratio of the electrophoretic albumin values
to the HABA dye method values is not too consistent, the
average ratio being 1.56.
Hypoalbuminemia
Chronic diffuse liver disease, especially cirrhosis
Failure of hepatic parenchymal synthesis of serum albumin
is not an early alteration. (The normal half-life of canine
albumin varies from 7 to 10 days, so that alterations in
serum albumin are not seen in acute hepatic failure.)
In portal cirrhosis the characteristic finding is a decrease in
serum albumin and an increase in gamma globulin.
Nonhepatic causes
Renal disease - glomerulonephritis, amyloidosis, nephrotic
syndrome
Inadequate intake or absorption
Inadequate diet
Malabsorption
Pancreatic hypoplasia or atrophy
Protein-losing gastroenteropathy
Gastrointestinal parasitism
Increased protein need - pregnancy, lactation
Globulins
Substance
Cirrhosis
Hepatocellular
Transaminase
Normal to
increased
Elevated
Bromsulphalein
Increased
Increased
Serum albumin
Low
Normal
Prothrombin
Principle - the liver converts vitamin K into
prothrombin
Method
The capillary coagulation time can be used as a
screening test to detect prothrombin deficiencies.
If the capillary coagulation time is prolonged, then the
longer procedure for prothrombin time can be
conducted.
Prothrombin time determination is best performed by
a commercial laboratory or a technologist
experienced in running the test.
Interpretation
Decreased prothrombin levels (increased prothrombin
time)
Two types of liver disturbance
Inability to synthesize prothrombin from vitamin K due
to a reduction of functional hepatic mass
Fat-soluble vitamin K cannot be absorbed from the
intestine with an inadequate amount of bile.
If obstruction of the bile duct occurs, an injection of 50
mg of vitamin K. may decrease coagulation time.
Diffuse parenchymal insufficiency.
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12/6/2011
Species variation
Dog
Acute hepatic failure, as clotting factors have shorter halflives than albumin
Rather insensitive indicator, except during the acute phase;
not as sensitive as the BSP or alkaline phosphatase
elevation in detecting liver injury
Should be a screening test for coagulation problems before
performing a liver biopsy
Horse
Helpful in prognosis, as the severity of the liver damage is
related to the prolongation of prothrombin time
Levels of prothrombin significantly reduced in acute and
subacute hepatitis, hepatic necrosis with regeneration, and
diffuse fibrosis
Blood ammonia
Uric acid
In most mammals, purines are metabolized to
uric acid and then to allantoin.
Exceptions include man, monkey, and the
Dalmatian breed of dog.
In the Dalmatian, only about one-third of the uric
acid is converted to allantoin, while in other
breeds of dogs it is nearly complete.
The site of conversion of uric acid to allantoin is in
the liver, and this is accomplished by the enzyme
uricase.
Interpretation
Increased - in liver cell damage, as the
conversion of uric acid to allantoin is
incomplete; as a result the amount of uric acid
in the blood and urine is elevated
The practical value of uric acid as a liver
function test is questionable, as the enzymes
and other newer tests are more sensitive
indicators of liver damage.
Thank You
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