The Liver

• increased production of bilirubin • decreased uptake of bilirubin by hepatocytes • decreased ability of the liver to conjugate bilirubin

• not related to the liver • excessive breakdown of red blood cells • increased unconjugated bilirubin in bloodstream • dark faeces • normal urine

• Gilberts syndrome - gene deficiency neonatal - delays in clearance of bilirubin from red blood cell breakdown

• liver related • liver loses ability to conjugate bilirubin • mixture of both conjugated and unconjugated bilirubin

• alcoholic liver disease - viral hepatitis

• obstruction of biliary drainage • increased conjugated bilirubin • pale faeces • dark urine

obstruction of bile ducts caused by gall stones, disease of ducts (eg cancer) or compression of ducts

liver –> glycogen muscle –> glycogen adipose tissue –> triglycerides other tissues –> krebs

liver –> keto acids muscle –> protein

adipose tissue as fatty acids and glycerol –> triglycerides

• when you eat glucose increases • glucose moves into beta cells in islets of Langerhans in pancreas by GLUT2 • triggers ATP generation from glucose metabolism and calcium influx • calcium influx causes insulin exocytosis

• blood glucose increases • insulin secretion stimulated • glucose uptake into cells (GLUT4) • blood glucose concentration falls • stimulus for insulin secretion removed • blood insulin concentration falls - post absorptive state`

glucose supplying reactions - glycogenolysis, gluconeogenesis glucose sparing reactions - beta oxidation of fats

• fall in insulin - increase in adrenaline, glucagon, cortisol and growth hormone