[CC LECT] Liver Function Test: Part II Flashcards by mti era

Sample used in bilirubin methodology

Serum

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BILIRUBIN METHODOLOGY

After extraction, the blood should be placed
in a ______, using _____ or _______

Dark place;

amber bottles of foil or carbon paper

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Bilirubin Methodology

If exposed to light: ↓ _____ per hour in bilirubin

30-50%

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Bilirubin Methodology

If sample is prepared and stored properly:
→ Room temperature: ________

2 days

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Bilirubin Methodology

If sample is prepared and stored properly:
→ Refrigerator (4˚C): ______

1 week

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Bilirubin Methodology

If sample is prepared and stored properly:
Freezer (-20˚C): ______

Indefinite

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T/F: In bilirubin methodology, fasting sample is required

False; Fasting sample is preferred but not required

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What are the 2 interferences in bilirubin methodology

Lipemia and Hemolysis

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BILIRUBIN METHODOLOGY

Lipemia: ________ bilirubin concentration

Hemolysis: _______ reaction of bilirubin
with diazo reagent (________ bilirubin)

increased

decrease; decrease

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Principle in bilirubin assay

Van den Berg Reaction

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diazotization of bilirubin to form azobilirubin

Van den Berg Reaction

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Van den Berg Reaction is the – _______ of bilirubin to form ______

diazotization; azobilirubin

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T/F: the bilirubin assay Only measure conjugated/direct bilirubin and
total bilirubin.

True

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what is added to measure indirect bilirubin (B1) ?

accelerators or accelerants

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What are the two methods in bilirubin assay

Evelyn and Malloy Method
Jendrassik and Grof Method

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T/F: In Evelyn and Malloy Method only conjugated are directly measured

True

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Principle used in Evelyn and Malloy Method

Van den berg reaction

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Coupling accelerator used in Evelyn and Malloy Method

Methanol

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What is the disadvantage of methanol

precipitate protein which causes
turbidity = increased absorbance = false
increase in concentration

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What are the 3 Diazo reagents used in evelyn and malloy method

Diazo A
Diazo B
Diazo blank

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Composition of Diazo A

0.01% sulfanilic acid + HCl

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Composition of Diazo B

0.5% sodium nitrite

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Composition of Diazo blank

1.5% HCl

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T/F: Diazo reagents in Evelyn and Malloy Method are performed at pH near 2.0

False; 1.0

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Diazo reagents in Evelyn and Malloy Method are performed at pH near 1.0 to form the _____

final reaction

Final reaction in Evelyn and Malloy Method

pink to purple azobilirubin (with maximal absorption at 560 nm)

Most commonly used method because it is more sensitive than Evelyn and Malloy method

Jendrassik and Grof Method

Jendrassik and Grof Method is a popular technique for _______

discreet analyzers

Main reagent in Jendrassik and Grof Method

Diazo reagent

T/F: the Diazo reagent in Jendrasssik and grof method has the same composition with Evelyn and Malloy method

True

Accelerator in Jendrassik and Grof Method

Caffeine Sodium Benzoate

Buffer in Jendrassik and Grof Method

Sodium Acetate

terminates the accelerator and destroys excess diazo reagent

Ascorbic acid:

provides alkaline pH after addition of ascorbic acid

Alkaline Tartrate Solution

Final reaction in Jendrassik and Grof Method

blue azobilirubin (measured at 600nm)

Incubation time for Jendrassik and Grof Method

5 mins

State the conditions associated with increased INDIRECT Bilirubin

● Gilbert’s Syndrome ● Criggler-Najjar Syndrome ● Hemolytic anemia ● Dubin-Johnson Syndrome ● Hepatocellular disease ● Lucey-Driscoll Syndrome ● G-6-PD deficiency

What is G-6-PD

Glucose-6-phosphate dehydrogenase

What is G-6-PD

Glucose-6-phosphate dehydrogenase

State the conditions associated with increased DIRECT Bilirubin

● Biliary obstruction or cholelithiasis (gall stones) ● Pancreatic (head) cancer ● Dubin-Johnson Syndrome ● Alcoholic and viral hepatitis ● Biliary atresia ● Hepatocellular disease

Urobilinogen is a colorless end product of _________ that is oxidized by intestinal flora to _______

Bilirubin metabolism; urobilin

The absence of urobilin in the urine or stool means there is ________

complete biliary obstruction

Collection of sample in urobilinogen

avoid light exposure

What is the specimen used in urobilinogen

2-hr freshly collected urine or freshly collected stool.

Method used in urobilinogen

Ehrlich’s method

Reagent of ehrlich method (urobilinogen)

p-dimethylaminobenzaldehyde (DMAB)

Reference value for urine in urobilinogen

0.1-1.0 Ehrlich Unit/2 hour or 0.54 Ehrlich Unit/day urine

Reference value for stool in urobilinogen

75-275 Ehrlich Unit/100g of feces

1 Erlich unit is approximate of how many mg of urobilinogen

1mg

Test for hepatocellular function and potency of bile duct

BROMOSULFONTHALEIN (BSP) DYE EXTRACTION TEST

T/F: BROMOSULFONTHALEIN (BSP) BYE EXTRACTION TEST HAS physiologic function

F; No physiologic function

Why is BROMOSULFONTHALEIN (BSP) BYE EXTRACTION TEST rarely performed ?

because it involves the administration of the dye

2 Methods of Administration in BROMOSULFONTHALEIN (BSP) BYE EXTRACTION TEST

1. Rosenthal White Method 2. Mac Donald Method

Rosenthal White Method is aka

Double-Collection Method

BSP Dose in Rosenthal White Method

2 mg/Kg body weight

How many specimen collection is performed in Rosenthal White Method

2 5 minutes after BSP administration 30 minutes after BSP administration

Rosenthal White Method: Reference value: → After 5 minutes: _____ → After 30 minutes: ______

→ After 5 minutes: 50% dye retention → After 30 minutes: 0% dye retention

Mac Donald Method is aka

Single-Collection Method

BSP Dose in Mac Donald Method

5 mg/Kg body weight

Specimen collection in Mac Donald Method

after 45 minutes of administration

Mac Donald Method Reference value: → After 45 minutes: ____

+/- 5% Dye Retention

What are the two test for detoxification function

Enzyme and ammonia

It is used to assess the extent of liver damage.

ENZYME TESTS

T/F: All enzymes are extracellular

F; intracellular

Indicator of cell injury in early or localized liver disease (hepatocellular/functional disease)

Enzyme tests

1st marker for detoxification

Enzyme tests

T/F: More enzyme in circulation = severity of the damage in the live

true

What are the 6 Hepatic enzymes

1. Alanine aminotransferase (ALT) 2. Aspartate aminotransferase (AST) 3. Gamma-glutaryl transferase 4. 5’-nucleotidase 5. Lactate dehydrogenase 6. Ornithine carbamoyl transferase

What are the enzymes increased in case of drug toxicity

ALT & AST

T/F; both ALT and AST are increased in case of drug toxicity but ALT is greater)

True

Diagnostic marker of hepatic failure

Ammonia

Ammonia is produced by what

Produced by catabolism of amino acids and by bacterial metabolism in the intestine

Ammonia is detoxified into _____ (liver), then eliminated by the _____ (urine)

urea; kidneys

2nd marker for detoxification and cirrhosis

AMMONIA

first marker for cirrhosis

Albumin

Reference value of ammonia

19-60 ug/dL

Preferred specimen in ammonia

Arterial blood

T/F heparin, and EDTA are used in ammonia

True

T/F; the specimen used in ammonia should NOT be kept in ice water during transport

False; SHOULD BE Kept in ice water during transport

T/F: fist clenching should be avoided as it can increase ammonia

True

Specimen precautions in ammonia

Smoking Exercise Probing of vein Under filing of tube Hemolysis

T/F: the patient and the medtech should not smoke within ____ hours

Rate of increase in ammonia

100-200 ug/L/cigar

stress in skeletal muscles can (increase, decrease) ammonia

inrease

Common methods in ammonia

Berthelot, Glutamate Dehydrogenase & Kjeldahl Method

Digestion method is aka

Kjeldahl reaction

In digestion method, ______ in a _____ filtrate of the specimen is converted to ______ using hot concentrated _______ in the presence of _______

Nitrogen ion protein-free ammonia sulfuric acid catalyst

Example of catalyst used in digestion method

copper sulfate, mercury, and selenium

End product in Digestion Method (Kjeldahl reaction)

Ammonia

measures ammonium content

Nesslerization Reaction

What are the two direct colorimetric methods

Nesslerization Reaction Berthelot Reaction

End product of Nesslerization Reaction

Ammonium mercuric iodide

What is the end color in nesslerization reaction if the N2 is Low to Moderate

● Yellow end-color

What is the end color in nesslerization reaction if the N2 is High

Orange-brown end-color

End product of Berthelot reaction

: Indophenol blue

Most common method used in automated analyzer

Glutamate Dehydrogenase

Decrease in absorbance at 340 nm as NADPH is consumed (oxidized)

Glutamate Dehydrogenase

↓absorbance = ____ ammonia

↑

End product of glutamate dehydrogenase

Glutamate