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

2. 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

3. 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

4. Liver Functions and Pathology
Anatomy and Physiology Menu
Pathology Menu
You will find information about the function of the liver in this section.
You will find information about abnormals and information on liver cancer in this section.
Case Study
Directions Page
Image from Microsoft clip art
References

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

6. Anatomy In this section you will find information
on the basic anatomy of the liver.
Click below to start.
Anatomy and
Physiology Menu
Next Anatomy
Page

7. The liver is covered in the Gilsson’s capsule made of a fibroelastic material.
Anatomy of the Liver
Diaphragm
Gallbladder
Hepatic Duct
Cystic Duct
Common Bile Duct
Duodenum
Next Anatomy Page
Lopez, E.B., Used with Permission. 7

8. 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

9. Anatomy
The liver is 3 lbs. and the largest visceral organ in the body.
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.
The large right lobe and small left lobe.
Click here for the answer.
The caudate and quadrate lobes.
Click here for the answer.
Next Anatomy Page
The hepatic artery and portal vein.
Click here for the answer.

10. Anatomy
Lobules - there are 50, ,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

11. They also remove enteric bacilli from blood in from the intestine.
Anatomy
Kupffer’s cells line the venous sinusoids.
What do these cells do?
Image from Microsoft Clip art
They remove defective blood cells, bacteria, and foreign material from portal blood.
They also remove enteric bacilli from blood in from the intestine.
They filter blood.
Next Anatomy Page

12. Click on each step to organize the flow of bile.
Anatomy
Bile empties into the bile canaliculi.
The hepatocytes produce bile.
The Sphincter of Oddi opens.
Bile enters the hepatobiliary tree.
STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
STEP 6
STEP 7
Bile flows through the common bile duct.
Bile empties into the duodenum.
If the sphincter is closed the bile moves back into the common bile duct and the gallbladder.
Click on each step to organize the flow of bile.
Next Page 12

13. The Flow of Bile 1. Hepatocytes produce bile.
2. Bile empties into the bile canaliculi.
3. Bile enters the hepatobiliary tree.
6. If the sphincter is closed the bile moves back into the common bile duct and the gallbladder.
4. The Sphincter of Oddi opens.
5. Bile flows through the common bile duct.
7. Bile empties into the duodenum.
Anatomy and
Physiology
Menu

14. Physiology
In the following section you will find information on the different functions of the liver.
Physiology Menu 14

15. Physiology Bilirubin Elimination Bile Production Carbohydrate
Fat/Lipids
Hormones/Drugs
Protein
Synthesis of Clotting Factors
Anatomy and Physiology Menu
End Show 15

16. 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
Fluid Wave
Test Your Knowledge
Scratch Test
Palpating the Liver
Anatomy and Physiology
Menu

17. Click to find out the possible cause
Abnormal Assessent
Portal Obstruction, Cirrhosis, High Obstruction of Inferior Vena Cava and Lymphocytic Leukemia
Enlarged liver noted with palpation.
Possible Abnormal Assessment signs that need further investigation.
Click to find out the possible cause
Bulging flanks when supine. Taut skin.
Ascites
Hepatitis
Pain in the RUQ.
Enlarged nodular liver noted with palpation.
Cirrhosis, Metastatic Cancer, Syphilis
Peritoneal friction rub over lower right rib cage.
Localized distention.
Tumor
Abscess or Metastatic Tumor
Pathology of the Liver Menu

18. Liver Span STEP 1 PERCUSSION:
Start at the area of lung resonance until a dull sound is heard
(mark this spot).
STEP 2
Start at abdominal tympany up until dull sounds are heard
(mark this spot).
NEXT
Nursing Assessment Menu
Back to Pictures

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

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

21. Liver Span Use a tape measure to compare. 9-12CM (Normal Liver Span)
Images from Sarah Arvelo
Use a tape measure to compare.
9-12CM (Normal Liver Span)
Next Page
Liver Span
The bottom border can extend slightly past the costal margin.

22. Palpating the Liver Step 2
Place right hand in the RUQ. Fingers should be pointed toward patient's head.
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.
Back to Pictures
Nursing Assessment Menu

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

24. The Scratch Test
When the abdomen is distended or the muscles are tense the examiner can perform the scratch test to determine borders.
STEP 2
Start RLQ scratch. Make short strokes over abdomen toward liver.
Back to Pictures
STEP 1
Place stethoscope over the liver.
Next
Nursing Assessment Menu
THE BORDER IS FOUND WHEN THE SCRATCHING IS MAGNIFIED.

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

26. Fluid Wave
This test is done when the examiner suspects fluid in the peritoneal cavity (ascites).
STEP 3
Place left hand on the person’s right flank while the right hand strikes the left flank.
Nursing Assessment Menu
STEP 2
Have patient place hand, fingers down and ulnar side down, on the middle of the abdomen.
STEP 1
Stand on the right side of the patient .
Back to Pictures
A fluid wave indicates ascites.

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

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

29. Test Your Knowledge Correct, for and adult A. 6-12 CM
Liver span can be determine through percussion.
What is the normal size of the liver
A CM
Correct, for and adult
Abnormal
B CM
C. The span of the rib cage
Incorrect
Next Question
Nursing Assessment Menu

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

31. 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

32. Metabolism of Hormones and Drugs
Image from Microsoft Clip art
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

33. 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

34. Bile Production
Bile contains water, bile salts, bilirubin, and cholesterol. The liver produces 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

35. 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

36. 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

37. 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

38. Plasma proteins, albumin, globulins, and fibrinogen.
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.
Examples
Next Page

39. 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

40. Acetoacetic Acid (Highly Soluble Ketoacid)
Lipid Metabolism
Next Lipid Page
FAT
Fat is spit and converted.
Glycerol
Fatty Acids
BETA OXIDATION
Acetoacetic Acid (Highly Soluble Ketoacid)
Acetyl- CoA
Acetyl- CoA
Liver cannot not use all Acetyl-CoA formed.
Citric Acid Cycle
ATP

41. 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

42. Lipid Metabolism Triglyceride removed Fat cells triglyceride VLDL IDL
Transport
Muscle cells
VLDL or LDL
HDL Good cholesterol
Cholesterol and Triglycerides must attach to lipoproteins to transport in the blood
LDL is the main transporter of Cholesterol Known as the (bad cholesterol)
Physiology Menu

43. 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

44. Fibrin (Stabilizes the Clot)
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
Fibrinogen
Thrombin
Antithrombin III converts…
Acts as an enzyme to convert …
Physiology Menu
Fibrin (Stabilizes the Clot)

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

46. Liver Function Test Menu
PT (Prothrombin Time)
Used to evaluate clotting ability.
PT measures Factor I (fibrinogen), II
(prothrombin), V, VII, and X.
Normal PT seconds %
PT is prolonged when clotting factors are lacking.
Image from Microsoft Clip art
Liver Function Test Menu

47. Liver Function Tests Menu
Serum Bilirubin
Image from Microsoft Clip art
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 mg/dl, indirect 0.2 mg/dl, direct mg/dl.
Liver Function Tests Menu

48. GGT y-glutamyltransferase
Image from Microsoft Clip art
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

49. Alkaline Phosphatase (ALP)
Image from Microsoft Clip art
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 IU/ml. Elderly levels are slightly higher.
Liver Function Tests Menu

50. AST Aspartate Aminotransferase
AST (Adult 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

51. ALT Alanine Aminotransferase
ALT (Adult IU/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

52. Prealbumin/Albumin
Image from Microsoft Clip art
Prealbumin normal lab values for adults/elderly is 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

53. Liver Function Test Menu
Prealbumin/Albumin
Image from Microsoft Clip art
Albumin is most important in maintaining oncotic pressure (this pressure keeps water in the vascular space).
Albumin g/dl
Liver Function Test Menu

54. Liver Function Tests Menu
A-fetoprotien
Image from Microsoft Clip art
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

55. Back to Liver Function and Pathology Menu
Pathology of the Liver
Abnormal Assessment
Cancer Review
Abnormal Lab
Values/
Symptoms
Liver Cancer
TP53 Gene
Treatment/
Cancer
Back to Liver Function and Pathology Menu
Image from Microsoft clipart

56. 1)Nontender and smooth or
Enlarged Liver
Images from Sarah Arvelo
Causes:
1)Fatty infiltration, portal obstruction, cirrhosis, high obstruction of inferior vena cava, lymphocytic leukemia.
2)Early heart failure, acute hepatitis, hepatic abscess
Possible Findings:
1)Nontender and smooth or
2)Tender and smooth
Abnormal Assessment

57. 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.
Pathology Menu
Cancer Continued

58. 1) Cell characteristics.
Cancer
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.
Benign and malignant are differentiated by:
Pathology Menu
Cancer Continued

59. Cancer
Right! Cancer cells do not go through normal cell proliferation and differentiation. Lack of differentiation is called anaplasia.
FALSE
Cancer cells are like normal cells.
Pathology Menu
Click on the right answer.
TRUE
Incorrect. Cancer cells can resemble normal cells but are not exactly like normal cells.
Cancer Continued

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

61. 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

62. Symptoms and Abnormal Lab Values
A. Serum Bilirubin
CORRECT
> 2.5 mg/dl produces jaundice.
A person with liver cancer can become jaundiced. What liver function test results can be elevated when this occurs?
Pathology Menu
B. ALT
INCORRECT
Next Slide Symptoms and Abnormal Lab Values
Sorry! This measures bleeding.
C. Protime

63. 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

64. 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

65. 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

66. Symptoms and Abnormal Lab Values
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.
A. A person can gain a lot of weight due to the swelling of the liver.
Damage to the liver can cause a persons abdomen to increase in size. What causes this?
B. A decrease in circulating albumin.
B. Correct. Albumin is a very important protein. It helps regulate oncotic pressure which is what keeps fluid in the vascular space.
Next Question
C. Incorrect.
C. Malnutrion
Pathology Menu

67. Symptoms and Abnormal Lab Values
A. The person is malnourished so the skin is more fragile.
Incorrect. Normally, someone with liver damage is malnourished, but it does not affect bruise formation.
C. The blood is unable to clot properly due to the liver damage.
Correct! The liver produces very important clotting factors. See lab function menu for more info. .
A person with liver damage is on your unit. He has multiple bruises over his body. What is causing this?
B. The skin is bruised because he is jaundiced.
Incorrect. A person may be jaundiced with liver damage, but it does not cause bruising.
Pathology Menu
Next Question

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

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

70. Incorrect.
Back to Question

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

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

73. Symptoms and Abnormal Lab Values
Which test can identify the liver as a cause for jaundice rather than RBC hemolysis?
A. GGT
Next Question
B. None of the tests
Pathology Menu
C. ALT

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

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

76. Incorrect
Back to Question

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

78. Quiz No
Back to Question

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

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

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

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

83. Symptoms and Abnormal Lab Vaules
Image from Microsoft Clip art
Metastatic cancer is more common than primary cancer. What lab test can be used to differentiate the two?
C. All of the above
Incorrect
B. albumin
Incorrect! This test is helpful in identifing possible liver damage. Albumin is produced by the liver.
Pathology Menu
Correct! Levels are normally low in an adult but occur in 90% hepatomas
A. AFP
Next Question

84. Treatment of Cancer Menu
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

85. Treatment of Cancer Menu
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

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

87. Next Hormonal Therapy Page
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

88. Treatment of Cancer Menu
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

89. 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

90. Treatment of Cancer Menu
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

91. Bone Marrow and Stem Cell
Image from Microsoft clip art
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

92. Treatment of Cancer Menu
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

93. Next Slide Liver Cancer
Primary Liver Cancer
Hepatocellular cARcinoma
cholangiocarcinoma
Bile duct cells
Possible causes can be unknown, cirrhosis, or chronic hepatitis.
Liver cells
Possible causes: chronic viral hepatitis, cirrhosis, exposure to environmental agents(aflatoxins), drinking contaminated water (arsenic).
Pathology Menu
Next Slide Liver Cancer

94. 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

95. Liver Function and Pathology Menu
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.
Liver Function and Pathology Menu
Click here to move to the next page and test your knowledge of the liver.

96. Case Study Questions
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)
Click here for the answer.
Due to the structure and placement of the pancreas, a tumor can cause narrowing of the common bile duct.
Click here for the answer.

97. Case Study Questions
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.
The liver produces cholesterol and if the liver is dysfunctional it can longer perform this function.
Liver Function and Pathology Menu

98. Tumor Suppressor Genes
Image from Microsoft clip art
Tumor Suppressor Genes
Oncogenesis:
a process that transforms normal cells into cancer cells.
PROTO-ONCOGENES
3 types of genes control cell growth
TUMOR SUPPRESSOR GENES
APOPTOSIS
Pathology Menu
Next Page Tumor Suppressor Genes

99. Tumor Suppressor Genes
Image from Microsoft clip art
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

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

101. Tumor Suppressor Genes
Image from Microsoft clip art
Tumor Suppressor Genes
TP53 Gene
Initiates
Apoptosis with chemotherapy and radiation.
What could happen to apoptosis if there was a mutation?
Apoptosis is the process of cell death.
Pathology Menu

102. References End of Tutorial
Jarvis, C., (2000).Physical examination and health assessment, 4th edition. Saunders. Lewis, S.M., Heitkemper, and Dirksen, Medical Surgical Nursing, 5th edition. Mosby. Lopez, E.B., Used with Permission. Microsoft Office clip art available from Pagana, K.D. and Pagana, T.J., 1998.Diagnostic and laboratory tests.Mosby. Personal Pictures Sarah Arvelo Collection, Porth, C.M., 2005.Patholophisiology, 7th edition. Lippinicott.
End of Tutorial

103. 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.
A. Prehepatic
B. Intrahepatic
C.Posthepatic
Jaundice (icterus) can be categorized by cause; Preheptic, Intrahepatic, or posthepatic.
Pathology Menu

104. 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

105. Proteins Complement System
The complement system consists of a group of proteins. Almost all proteins are produced by the liver.
Inflammatory responses
Activation Enhances
The lysis of foreign cells, and increases phagocytosis.
Afects the humoral and innate immune responses.
Next Protein Page

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

107. Stimulates the liver to glycogen
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