ASSESSMENT OF LIVER FUNCTION Flashcards
Storage functions of the liver
Glycogen, fat-soluble vitamins A, D, E, K
Synthetic functions of the liver
Lipids, carbohydrates, proteins (TP, Albumin, Gamma globulin), Coagulation factors (PT)
Detoxification function of the liver
Drugs, poisons, metabolic products (NH2, B1)
Secretory and excretory function of the liver
Conjugated bilirubin
Hepatocellular markers
ALT, AST, LD
Hepatobiliary marker
ALP
Markers for synthetic liver function
TP, Albumin, Bilirubin
Marker for liver detoxification
Ammonia
Conditions causing hepatocellular damage
Hepatitis, cirrhosis, fulminant hepatic failure
Conditions causing hepatobiliary damage
Biliary obstruction, space-occupying lesions, passive congestion
Laboratory findings in hepatitis
AST, ALT, LD, ALP, Bilirubin (B1 and B2) elevated
Laboratory findings in cirrhosis
ALP (normal to slightly high), TP and Albumin (low), Bilirubin (B1 and B2) high, Ammonia high
Laboratory findings in fulminant hepatic failure
AST very high, ALT, LD, ALP, Bilirubin (B1 and B2), Ammonia high; TP and Albumin low
Laboratory findings in biliary obstruction
ALP, Bilirubin (B2) elevated
Laboratory findings in space-occupying lesions (tumors)
AST, ALT, Bilirubin (B2) normal to high
Laboratory findings in passive congestion
AST, ALT, LD slightly high, ALP and Bilirubin (B2) normal to slightly high
Definition of panhepatic cirrhosis
Destruction of >80% of liver tissue, with no regeneration
Cause of fulminant hepatic failure
Reye syndrome, hepatitis, cirrhosis
Bilirubin 1 (Unconjugated) characteristics
Water insoluble, non-polar, indirect reading, hemobilirubin, free bilirubin/slow, pre-hepatic
Bilirubin 2 (Conjugated) characteristics
Water soluble, polar, direct reading, cholebilirubin, one-minute/prompt, post-hepatic/obstructive/regurgitative
Where is conjugated bilirubin excreted?
Excreted in urine
Which form of bilirubin has a high affinity to CNS?
Unconjugated bilirubin (B1)
Delta bilirubin characteristics
Bilirubin tightly bound to albumin, longer half-life of 17 days, formed due to prolonged elevation of conjugated bilirubin in biliary obstruction
Use of delta bilirubin in monitoring
Helps monitor the decline of serum bilirubin following gallstone removal
Reaction of delta bilirubin with diazo reagent
Reacts in the direct bilirubin assay
Formula for computing delta bilirubin
DB = TB – B2 + B1
Who is delta bilirubin not calculated for?
Neonates (≤ 14 days old)
Reference value for delta bilirubin
< 0.2 mg/dL (<3 µmol/L)
Method used to separate delta bilirubin
HPLC
