Question

Case Study num33

Mrs. F has a history of mild heart problems, but she has been admitted to the medical-surgical floor for management of her liver failure. She is a white-haired woman in her sixties with a puffy face, overweight, and presents with yellowish skin and sclera, mild generalized edema (swelling), spider nevi (broken capillaries), high blood pressure, increased respiratory rate, and a heart rate of 59 bpm (normal is 60-100 bpm). When you ask whether she has noticed any changes lately, Mrs. F complains about dizziness and lightheadedness. She also mentions weight gain and that her slacks are too tight. She says “They told me this disease would interfere with my digesting lipid, so I thought I'd lose weight!”

1. How is the liver-related to lipid digestion?

2. Can you see any evidence that the liver is failing to perform this role in Mrs. F?

3. Mrs. F’s blood work has come back and shows that she has low plasma osmolarity and decreased levels of plasma proteins. The doctor says “this explains her edema!” How are plasma proteins related to edema?

4. Mrs. F has spider nevi, broken skin capillaries. Normally, broken skin capillaries do not cause visible blemishes, but hers are bleeding more than usual. Could this be due to her liver problems?

Answer 1

Question no 1

Metabolic Functions of the Liver

Hepatocytes are metabolic overachievers in the body. They play critical roles in synthesizing molecules that are utilized elsewhere to support homeostasis, in converting molecules of one type to another, and in regulating energy balances. If you have taken a course in biochemistry, you probably spent most of that class studying metabolic pathways of the liver. At the risk of damning by faint praise, the major metabolic functions of the liver can be summarized into several major categories:

Fat Metabolism

Few aspects of lipid metabolism are unique to the liver, but many are carried out predominantly by the liver. Major examples of the role of the liver in fat metabolism include:

The liver is extremely active in oxidizing triglycerides to produce energy. The liver breaks down many more fatty acids that the hepatocytes need, and exports large quantities of acetoacetate into blood where it can be picked up and readily metabolized by other tissues.

A bulk of the lipoproteins are synthesized in the liver.

The liver is the major site for converting excess carbohydrates and proteins into fatty acids and triglyceride, which are then exported and stored in adipose tissue.

The liver synthesizes large quantities of cholesterol and phospholipids. Some of this is packaged with lipoproteins and made available to the rest of the body. The remainder is excreted in bile as cholesterol or after conversion to bile acids.

Question no 2

puffy face, overweight, and presents with yellowish skin and sclera, mild generalized edema (swelling), spider nevi (broken capillaries), these are main symptoms of liver failure