Assessment of liver function tests

Question 1

Who founded bilirubin testing?

Answer 1

Ehrlich, diazo rxn

Question 2

How do you do indirect bilirubin?

Answer 2

calculate it

Question 3

What does the neonatal population use?

Answer 3

uses bilirubinometry
two wave lengths

Question 4

vowels

Answer 4

indirect, unconjugated, insoluble

Question 5

3rd tract of bilirubin
another name?
total bilirubin made up of?

Answer 5

delta bilirubin, total bilirubin made up of 3 tract conjugate

Question 6

Collection/handling

Answer 6

usually serum/plasma
malloy- eveyn prefers serum

fasting preferred - reduces lipids
avoid hemolysis (decrease rxn of bilirubin w diazo)
light sensitive

Question 7

unprotected from light, how much does bilirubin decrease by?

Answer 7

decreases 30-50% per hour

Question 8

Methods
not affected by?
insensitive to?
optical?
minimal?
not affected by?

Answer 8

no preferred method
J.G procedure (more complicated)
not affected by pH
insensitive to protein
optical sensitivity
minimal turbitity
not aff by hgb

Question 9

Malloy-evelyn procedure
what is reacting?
pH?
color change?
nm?
accelerator?

Answer 9

bilirubin rxn w/ diazo rgnt
1-2 pH
azobilirubin red - purple
560nm
accelerator: methanol

Question 10

J.G Method
rxn with?
two ….
diazo…ONLY

Answer 10

bilirubin rxn w/ diazo
two aliquots and one w diazo
Diazo - conjug bilirubin only

Question 11

Urobilinogen
addition of?

oxidation of? tb
excreted/reabsorbed?

Answer 11

colorless end product of bilirubin metabolism
addition of cafffine-benzo = total bilirubin

oxidation of bacteria in intestines - brown pigm urobilinogen
excreted in feces/reabs in blood

Question 12

When is urobilinogen increased

Answer 12

in hemolytic diseases and hepatitis

Question 13

absence of urobilinogen?

Answer 13

biliary obstruction

Question 14

what color is erhlichs rgnt?

Answer 14

red color

Question 15

Serum Bile acids

Answer 15

rarely preformed
increased in liver disease
no diagn volume

Question 16

Liver enzymes
assessment?
injury to liver w……releases

helps differ?

Answer 16

impaired liver function assessment
injury to liver w cytolysis or necorsis release enzymes

helps differ hepatocellular (functional) from obstructive (mechanical)

AST/ALT/ALP/GTT/LD

Question 17

ALT/AST

rise rapidly for?
high levels in? avh/ln

may decline due to? hs

Answer 17

two most common in labs
AST: heart/skeletal muscle
ALT: specific to liver/higher than AST

rise rapidly for 2-6wk

high levels in acute viral hep/liver necrosis

may decline to due hepatocellular stores

Question 18

Phosphatases
Alk phos
high in?

differentiates between? h/o

in ALP? = ehbo

Answer 18

high in liver/bone/kidney/placenta
differentiates between hepatocellular/osteogenic bone disease

inc ALP = extrahep biliary obstruction

Question 19

5NT
sign to ?hbd
no…source used with?
more sensitive to?v mld

Answer 19

rare order
significant in hepato biliary disease
no bone source used w/ ALP
more sensitive to met. liver disease

Question 20

GGT

differentiates s/h
inc in? bo
more sensitive for? ld

sensitive for ? c/ac
useful if?

Answer 20

dif ALP due to skeletal or hepato bil disease

increased in bile obstruction
more sensitive marker for liver disease
sensitive for cholestasis by chronic alc
useful if jaundice is absent/hep neoplasms

Question 21

LD
wide….released?
what kind of marker?
mod elevations?
high elevations?

Answer 21

wide distribut in body, released when cells destroyed/released in body
non specific marker of injury
mod elevation - acute viral hep
high levels: met carcinoma

Question 22

Test measure hepatic synth ability

measure of?
assess?

dec alb?
dec Alpha glob? cld

Answer 22

measure of serum protein, asses synth ability of liver

dec alb = dec protein synth
alpha-glob dec w/ chronic liver disease

Question 23

IgG/IgM elevated in?

Answer 23

chronic/acute hepatitis

Question 24

IgM elevated in
pbc

Answer 24

primary bilirary cirrhosis

Question 25

IgA elevated in

Answer 25

alcoholic cirrhosis

Question 26

T/F PT increased is able to maintain clotting facotrs

Answer 26

false

Question 27

Nitrogen Met
what from blood?
converts to?
reflects?

increase toxins/ammonia=
no correlation betwwen

stability?

Answer 27

liver plays major role in ammon from bld stream
converts in to urea
ammonia levels reflect function

increase toxins and ammonia = hepatic coma no correlation between level/severity

ammonia samples not stable use ice