| LIVER AND PROTEIN METABOLISM
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| Hepatic protein synthesis is important, as the majority of plasma proteins are synthesized in the liver, and hepatocellular disease may alter protein synthesis both quantitatively and qualitatively.
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| Albumin is the most abundant protein in blood, and is synthesized exclusively by the liver (see Chapter 3). Low plasma albumin concentrations occur commonly in liver disease, but a better index of hepatocyte synthetic function is the production of the coagulation factors, II, VII, IX, and X (Chapter 6), which all undergo post-translational γ-carboxylation of specific glutamyl residues, allowing them to bind calcium. As a group, their functional concentration can be readily assessed in the laboratory by measurement of the prothrombin time (PT) (see Chapter 6).
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| The liver also synthesizes most of the plasma α and β-globulins. Plasma concentrations of these globulins change in hepatic disease and in systemic illness; in the latter case, the changes form part of the important acute phase response to the illness (Chapter 3).
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