Assessment of liver function tests Flashcards
Who founded bilirubin testing?
Ehrlich, diazo rxn
How do you do indirect bilirubin?
calculate it
What does the neonatal population use?
uses bilirubinometry
two wave lengths
vowels
indirect, unconjugated, insoluble
3rd tract of bilirubin
another name?
total bilirubin made up of?
delta bilirubin, total bilirubin made up of 3 tract conjugate
Collection/handling
usually serum/plasma
malloy- eveyn prefers serum
fasting preferred - reduces lipids
avoid hemolysis (decrease rxn of bilirubin w diazo)
light sensitive
unprotected from light, how much does bilirubin decrease by?
decreases 30-50% per hour
Methods
not affected by?
insensitive to?
optical?
minimal?
not affected by?
no preferred method
J.G procedure (more complicated)
not affected by pH
insensitive to protein
optical sensitivity
minimal turbitity
not aff by hgb
Malloy-evelyn procedure
what is reacting?
pH?
color change?
nm?
accelerator?
bilirubin rxn w/ diazo rgnt
1-2 pH
azobilirubin red - purple
560nm
accelerator: methanol
J.G Method
rxn with?
two ….
diazo…ONLY
bilirubin rxn w/ diazo
two aliquots and one w diazo
Diazo - conjug bilirubin only
Urobilinogen
addition of?
oxidation of? tb
excreted/reabsorbed?
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
When is urobilinogen increased
in hemolytic diseases and hepatitis
absence of urobilinogen?
biliary obstruction
what color is erhlichs rgnt?
red color
Serum Bile acids
rarely preformed
increased in liver disease
no diagn volume
Liver enzymes
assessment?
injury to liver w……releases
helps differ?
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
ALT/AST
rise rapidly for?
high levels in? avh/ln
may decline due to? hs
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
Phosphatases
Alk phos
high in?
differentiates between? h/o
in ALP? = ehbo
high in liver/bone/kidney/placenta
differentiates between hepatocellular/osteogenic bone disease
inc ALP = extrahep biliary obstruction
5NT
sign to ?hbd
no…source used with?
more sensitive to?v mld
rare order
significant in hepato biliary disease
no bone source used w/ ALP
more sensitive to met. liver disease
GGT
differentiates s/h
inc in? bo
more sensitive for? ld
sensitive for ? c/ac
useful if?
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
LD
wide….released?
what kind of marker?
mod elevations?
high elevations?
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
Test measure hepatic synth ability
measure of?
assess?
dec alb?
dec Alpha glob? cld
measure of serum protein, asses synth ability of liver
dec alb = dec protein synth
alpha-glob dec w/ chronic liver disease
IgG/IgM elevated in?
chronic/acute hepatitis
IgM elevated in
pbc
primary bilirary cirrhosis
IgA elevated in
alcoholic cirrhosis
T/F PT increased is able to maintain clotting facotrs
false
Nitrogen Met
what from blood?
converts to?
reflects?
increase toxins/ammonia=
no correlation betwwen
stability?
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
