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Clinical Chemistry 2 > Chapter 25 - Liver Function (RVSP) > Flashcards

Chapter 25 - Liver Function (RVSP) Flashcards

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0
Q

Amount of blood that passes into the liver per minute

A

1500 mL/min

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1
Q

Average weight of the liver

A

1200-1500 g

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2
Q

Spaces between hepatocytes

A

Sinusoids

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3
Q

2 blood vessels that supply blood to the liver

A
  • hepatic artery

- portal vein

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4
Q

3 systems of the liver

A
  • hepatocyte system
  • biliary system
  • reticuloendothelial system (RES)
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5
Q

System of the liver; for metabolic reactions and macromolecular synthesis

A

Hepatocyte system

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6
Q

System of the liver; for metabolism of bilirubin and bile salts

A

Biliary system

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7
Q

System of the liver; for excretory function

A

Biliary system

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8
Q

Structure of the liver involved in excretion

A

Bile canaliculi

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9
Q

System of the liver for drug metabolism

A

Hepatocyte system

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10
Q

Drug metabolism function of the liver

A

Xenobiotic

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11
Q

System of the liver; for immune system and degradation of hemoglobin

A

Reticuloendothelial system

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12
Q

Cells involved in the reticuloendothelial system

A

Kuppfer cells

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13
Q

4 functions of the liver

A
  • Synthesis
  • Excretory/secretory
  • Detoxification
  • Storage
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14
Q

Removal of waste products

A

Excretion

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15
Q

Release of useful substances

A

Secretion

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16
Q

2 proteins not produced by the liver

A
  • Immunoglobulins

- adult hemoglobin

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17
Q

4 substances synthesized by the liver

A
  • proteins
  • carbohydrates
  • lipids
  • vitamins
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18
Q

2 ways the liver detoxifies toxic substances

A
  • bind and inactivate toxin

- chemically modify and excrete toxin

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19
Q

4 substances stored by the liver

A
  • proteins
  • lipids
  • amino acids
  • glycogen
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20
Q

Principal pigment in bile

A

Bilirubin

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21
Q

Amount of bile produced per day

A

3 L/day

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22
Q

Amount of bile excreted per day

A

1 L/day

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23
Q

2 components of bilirubin

A
  • RBCs (80%)

- proteins (20%)

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24
Q

Divides the liver into two unequal lobes

A

Falciform ligament

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25
Q

Larger lobe of the liver

A

Right lobe (6x larger)

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26
Q

Supplies oxygen-rich blood to the liver; 25% of total blood supply to the liver

A

Hepatic artery

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27
Q

Supplies nutrient-rich blood to the liver; 75% of total blood supply to the liver

A

Portal vein

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28
Q

Functional units of the liver

A

Lobules

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29
Q

Responsible for all metabolic and excretory functions of the liver

A

Lobules

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30
Q

Centrally located vein of the lobule

A

Central vein

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31
Q

Found at each side of the lobule

A

Portal triads

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32
Q

3 components of the portal triads

A
  • hepatic artery
  • portal vein
  • bile duct
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33
Q

2 major cell types of the liver

A
  • hepatocytes

- Kupffer cells

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34
Q

Liver cells responsible for its regenerative properties

A

Hepatocytes

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35
Q

Active phagocytes in the liver

A

Kupffer cells

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36
Q

Major heme waste product

A

Bilirubin

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37
Q

Type of bilirubin bound by albumin

A

Unconjugated/indirect bilirubin

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38
Q

Solubility of indirect bilirubin to alcohol and water

A
  • soluble to alcohol

- insoluble to water

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39
Q

Protein for transport of unconjugated bilirubin to the endoplasmic reticulum

A

Ligandin

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40
Q

Enzyme for the conjugation of bilorubin

A

Uridyldiphosphate glucoronyl transferase (UDPGT)

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41
Q

Solubility of direct bilirubin to alcohol and water

A
  • insoluble to alcohol

- soluble to water

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42
Q

Amount of bilirubin produced per day

A

200-300 mg

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43
Q

Enzymes responsible for the drug-metabolizing system of the liver

A

Cytochrome P-450 isoenzymes

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44
Q

Yellow discoloration of the skin, eyes amd mucous membranes

A

Jaundice/icterus

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45
Q

Most common cause of jaundice

A

Retention of bilirubin

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46
Q

Jaundice not visible to the naked eye

A

Overt jaundice

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47
Q

Bilirubin levels when jaundice is visible

A

3.0 - 5.0 mg/dL

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48
Q

3 classifications of jaundice

A
  • prehepatic/hemolytic hyperbilirubinemia
  • hepatic/hepatocellular hyperbilirubinemia
  • posthepatic/obstructive hyperbilirubinemia
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49
Q

Jaundice that occurs when the problem happens prior to liver metabolism

A

Prehepatic jaundice

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50
Q

Another name for prehepatic jaundice

A

Unconjugated hyperbilirubinemia

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51
Q

Type of anemia that causes prehepatic jaundice

A

Acute and chronic hemolytic anemia

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52
Q

Jaundice that occurs when the problem resides inside the liver

A

Hepatic jaundice

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53
Q

3 diesease that cause hepatic jaundice that increases unconjugated bilirubin

A
  • physiologic jaundice of the newborn
  • Gilbert’s disease
  • Crigler-Najjar syndrome
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54
Q

2 conditions that cause hepatic jaundice that elevates conjugated bilirubin

A
  • Dubin-Johnson

- Rotor syndrome

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55
Q

Most common cause of hepatic jaundice

A

Gilbert’s syndrome

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56
Q

Type of hepatic jaundice where there is impaired cellular uptake of bilirubin

A

Gilbert’s syndrome

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57
Q

Type of hepatic jaundice; chronic nonhemolytic unconjugated hyperbilirubinemia; deficiency of UDPGT

A

Crigler-Najjar syndrome

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58
Q

Type of Crigler-Najjar syndrome; complete absence of UDPGT, no B2 formed, colorless bile

A

Type I

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59
Q

Type of Crigler-Najjar syndrome; relative deficiency of UDPGT, some B2 formed

A

Type II

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60
Q

Condition of relative deficiency of UDPGT

A

Arias syndrome

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61
Q

Conjugated bilirubin bound to albumin

A

Delta bilirubin

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62
Q

Type of hepatic jaundice caused by a deficiency of the canalicular multidrug resistance/multispecific organic anionic transporter protein (MDR2/cMOAT)

A

Dubin-Johnson syndrome

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63
Q

Type of hepatic jaundice where the removal of conjugated bilirubin from the liver cell and the excretion into the bile are defective

A

Dubin-Johnson syndrome

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64
Q

Type of hepatic jaundice that is idiopathic

A

Rotor syndrome

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65
Q

Appearance of liver in Dubin-Johnson syndrome

A

With black pigmentation

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66
Q

Appearance of liver in Rotor syndrome

A

Normal histology

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67
Q

Gallbladder visualization of Dubin-Johnson syndrome

A

No visualization

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68
Q

Gallbladder visualization of Rotor syndrome

A

Visualized by oral cholecystogram

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69
Q

Total urine coproporphyrin of Dubin-Johnson syndrome

A

Normal w/ >80% of isomer 1

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70
Q

Total urine coproporphyrin of Rotor syndrome

A

High w/ <70% of isomer 1

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71
Q

Enzyme that is deficient in physiologic jaundice of the newborn

A

Glucoronyl transferase

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72
Q

Movement of bilirubin from the bloodstream to brain tissue

A

Kernicterus

73
Q

Enzyme responsible for bilirubin conjugation in infants

A

Glucoronyl transferase

74
Q

Jaundice caused by biliary obstructive disease

A

Posthepatic jaundice

75
Q

Type of bilirubin increased in posthepatic jaundice

A
  • unconjugated

- conjugated

76
Q

Type of jaundice where the stool loses its normal pigmentation and becomes clay-colored

A

Posthepatic jaundice

77
Q

Condition in which scar tissue replaces normal, healthy liver tissue

A

Cirrhosis

78
Q

Most common cause of cirrhosis

A

Chronic alcoholism

79
Q

Type of liver cancer that begins in the liver cells

A

Primary liver cancer

80
Q

Type of liver cancer that occurs when tumors from other parts of the body spread to the liver

A

Metastatic cancer

81
Q

3 cancers that commonly spread to the liver

A
  • breast cancer
  • lung cancer
  • colon cancer
82
Q

2 types of liver cancer

A
  • primary liver cancer

- metastatic liver cancer

83
Q

2 types of liver tumors

A
  • benign tumors

- malignant tumors

84
Q

2 common benign liver tumors

A
  • Hepatocellular adenoma

- hemangiomas

85
Q

2 malignant liver tumors

A
  • hepatocellular carcinoma (HCC)

- bile duct carcinoma

86
Q

Benign liver tumor occuring in females of child-bearing age

A

Hepatocellular adenoma

87
Q

Benign liver tumor; masses of blood vessels with no known etiology

A

Hemangiomas

88
Q

Most common malignant liver tumor

A

Hepatocellular carcinoma (HCC)/hepatocarcinoma/hepatoma

89
Q

Uncommon hepatic malignancy in children

A

Hepatoblastoma

90
Q

Disease found primarily in children; idiopathic; related to aspirin therapy; usually occurs following recovery from viral infection

A

Reye syndrome

91
Q

Most important drug related to hepatic toxicity

A

Ethanol

92
Q

Caused by heavy and prolonged consumption of ethanol

A

Alcoholic cirrhosis

93
Q

3 stages of alcohol-induced liver injury

A
  • alcoholic fatty liver
  • alcoholic hepatitis/liver fibrosis
  • alcoholic cirrhosis
94
Q

Alcoholic fatty liver with inflammation

A

Steatohepatitis

95
Q

Amount of ethanol that causes one to be under the influence of alcohol

A

> 1000 mg/L

96
Q

Amount of ethanol that causes CNS impairment/coma

A

3000 mg/L

97
Q

Amount of ethanol that causes death

A

4000 mg/L

98
Q

Reagent used in Muelengracht mtd for icterus index

A

NSS

99
Q

Solution used for comparison in Newberger mtd for icterus index

A

Sodium citrate

100
Q

3 substances that interfere with icterus index

A
  • carotene
  • xantophyll II
  • hemoglobin
101
Q

Property used to differentiate conjugated and unconjugated bilirubin

A

Solubility

102
Q

3 fractions comprising total bilirubin

A
  • conjugated bilirubin
  • unconjugated bilirubin
  • delta bilirubin
103
Q

Preferred sample for Malloy-Evelyn procedure

A

Serum

104
Q

Number of days serum/plasmais stable for bilirubin at room temperature

A

2 days

105
Q

Number of days serum/plasma for bilirubin is stable at 4 degrees Celsius

A

7 days

106
Q

Number of days that serum/plasma is stable for bilirubin at -20 degrees Celsius

A

Indefinite

107
Q

4 reagents in Malloy-Evelyn procedure

A
  • diazo reagent (sulphanilic acid & sodium nitrite)
  • 50% methanol
  • sodium acetate
  • ascorbic acid
108
Q

pH level of Malloy-Evelyn procedure

A

pH 1.2

109
Q

Color of product in Malloy-Evelyn procedure

A

Red-purple

110
Q

Wavelength of Malloy-Evelyn procedure

A

560 nm

111
Q

Most common accelerator used in Malloy-Evelyn procedure

A

50% Methanol

112
Q

4 reagents of the Jendrassik-Grof method

A
  • diazotized sulphanilic acid (lphanilic acid & sodium nitrite)
  • caffeine sodium benzoate
  • sodium acetate
  • ascorbic acid
113
Q

Color of initial product in Jendrassik-Grof method

A

Purple

114
Q

Accelerator in Jendrassik-Grof method

A

Caffeine sodium benzoate

115
Q

Terminates the reaction of the aliqouts with the diazo reagent in Jendrassik-Grof method

A

Ascorbic acid

116
Q

Solution used to alkalinize the solution in Jendrassik-Grof method

A

Alkaline tartrate solution

117
Q

Color of final product in Jendrassik-Gtof method

A

Blue

118
Q

Wavelength used in Jendrassik-Grof method

A

600 nm

119
Q

Colorless end product of bilirubin metabolism

A

Urobilinogen

120
Q

Urobilinogen that is oxidized by intestinal bacteria; brown pigmented

A

Urobilin

121
Q

3 reagents for Ehrlich’s method for urine urobilinogen

A
  • Ehrlich’s reagent (p-dimethylaminobenzaldehyde)
  • ascorbic acid
  • saturated sodium citrate (NaCH3COO)
122
Q

Reagent in Ehrlich’s method that serves as reducing agent to maintain urobilinogen in a reduced state

A

Ascorbic acid

123
Q

Reagent in Ehrlich’s method that stops the reaction and minimizes the combination of other chromogens

A

Saturated sodium citrate (NaCH3COO)

124
Q

Color of product of Ehrlich’s method for urine urobilinogen

A

Red

125
Q

Specimen for Ehrlich’s method for urine urobilinogen

A

Fresh 2-hour urine specimen

126
Q

4 substances that interfere with urine urobilinogen measurement (Ehrlich’s method)

A
  • 5-hydroxyindoleacetic acid
  • porphobilinogen
  • sulfonamides
  • procaine
127
Q

Sample in fecal urobilinogen

A

Aqueous extract of fresh feces

128
Q

Reagent used for fecal urobilinogen that reduces urobilin to urobilinogen

A

Alkaline ferrous hydroxide (Fe(OH)2)

129
Q

Color of product for fecal urobilinogen

A

Red

130
Q

2 clinical significance of increased urobilinogen

A
  • hemolytic disease

- defective liver cell function (hepatitis)

131
Q

2 clinical significance of absence of urobilinogen

A
  • biliary obstruction

- hepatocellular disease

132
Q

Test used for bile salts

A

Hay Test

133
Q

Used in Hay Test to detect the presence of bile salts

A

Sulphur powder

134
Q

Interpretation of Hay test when sulphur powder floats

A

Bile salts absent

135
Q

Interpretation of Hay test when sulphur powder sinks to the bottom

A

Bile salts present (obstructive jaundice)

136
Q

Buffer in Evelyn-Malloy procedure

A

Sodium acetate

137
Q

Stop solution in Evelyn-Malloy method

A

Ascorbic acid

138
Q

Tested for the synthetic function of the liver

A
  • total protein
  • albumin
  • alpha-globulin
  • prothrombin time
139
Q

2 tests for testing the excretory function of the liver

A
  • Bromsulphalein test

- Rose Bengal Test

140
Q

2 methods under Bromsulphalein test

A
  • Rosenthal

- Mc Donald

141
Q

Element used in Rose Bengal Test

A

Tagged Iodine 131

142
Q

Color of urine foam positive for bilirubin

A

Yellow

143
Q

Urine color positive for bilirubin

A

Brown to amber

144
Q

4 tests for urine bilirubin

A
  • Foam test
  • Urine color inspection
  • Fouchet’s test or Harrison Spot Test
  • Diazotization Test
145
Q

Used to precipitate bilirubin in Fouchet’s test

A

BaCl2

146
Q

Reagent in Fouchet’s test/Harrison Spot test

A

FeCl3 and TCA

147
Q

Color of final precipitate in Fouchet’s test/Harrison Spot test; positive for bilirubin

A

Green precipitate

148
Q

Test used to determine detoxification function

A

Quick’s Test/Hippuric Acid Test

149
Q

Consumed by patient in Quick’s test/Hippuric acid test

A

Sodium benzoate meal

150
Q

In normal patients, what percentage of the benzoate meal in Quick’s test is excreted within 1 hour?

A

40%

151
Q

Inflammation of the liver

A

Hepatitis

152
Q

2 hepatitis types acquired through the fecal-oral route

A

A and E

153
Q

Causes Hepatitis A

A

Picorna virus

154
Q

Causes Hepatitis B

A

Hepadna virus

155
Q

Causes Hepatitis C

A

Flavivirus

156
Q

Causes Hepatitis D

A

Delta agent (needs HBsAg)

157
Q

Causes Hepatitis E

A

Hepevirus

158
Q

2 cardinal features of cirrhosis

A
  • fibrosis

- nodules

159
Q

Prevents regeneration of the liver

A

Fibrosis

160
Q

Elevated in Reye’s Syndrome

A

Elevated liver function tests except bilirubin

161
Q

Causes Hepatitis F

A

Toga virus

162
Q

Causes Hepatitis G

A

G-B virus

163
Q

MOT of Hepatitis A&E

A

Fecal-oral route

164
Q

MOT of Hepatitis B, C, and D

A

Parenteral, sexual

165
Q

Classification of hepatitis based on etiology

A
  • viral hepatitis (B, C, D)
  • alcoholic
  • toxic
  • metabolic (hemochromatosis, Wilson’s disease, galactosemia)
  • autoimmune
  • cardiac
  • biliary
166
Q

Classification of cirrhosis based on morphology

A
  • micronodular
  • macronodular
  • micromacronodular (mixed cirrhosis)
  • septal
167
Q

Classification of cirrhosis based on activity and spread of progression

A
  • active (rapidly, slowly, latent)

- nonactive

168
Q

Classification of cirrhosis based on the course of the disease

A
  • compensation (hepatic encephalopathy)
  • subcompensation (hepatic encephalopathy stages I-II, ascites controlled by drugs)
  • decompensation (hepatic encephalopathy stage III, ascites not controlled by drugs)
169
Q

Classification of cirrhosis based on complications

A
  • hepatic coma (precoma)
  • bleeding esophageal stomach/hemorroidalvarices
  • bacterial peritonitis
  • portal vein thrombosis
  • primary cancer of the liver
170
Q

A congenital condition due to maternal steroids causing increased B1 becuase of a defect in UDPGT

A

Lucey Driscoll

171
Q

Solution used for comparison in Muelengracht mtd for icterus index

A

0.01% K2Cr2O7

172
Q

Advantages of Jendrassik-Groff mtd over Evelyn-Malloy mtd for bilirubin

A
  • insensitive to pH changes
  • insensitive to a 50-fold variation in protein conc
  • adequate optical sensitivity even with low bilirubin conc
  • minimal turbidity and with constant serum blank
  • not affected by Hb up to 750 mg/dL
173
Q

Normal range for conjugated bilirubin

A

0 - 0.2 mg/dL

174
Q

Conjugated bilirubin is increased during

A

Obstructive jaundice

175
Q

Normal range for unconjugated bilirubin

A

0.2 - 0.8 mg/dL

176
Q

Unconjugated bilirubin is increased during

A

Hemolytic jaundice

177
Q

Normal range for total bilirubin

A

0.2 - 1.0 mg/dL

178
Q

Total bilirubin is increased during

A

Hepatocellular jaundice

179
Q

Sources of error for bilirubin measurement

A
  • hemolysis
  • exposure to light
  • lipemia
  • lipochrome

Clinical Chemistry 2 (11 decks)

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