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CLS 701 > Day 6 - Liver, Pancreas, Heart > Flashcards

Day 6 - Liver, Pancreas, Heart Flashcards

1
Q

4 major functions of the liver

A

Synthetic and metabolic

Excretory

Detoxification and protective

Hematology and coagulation

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2
Q

Difference between essential and non-essential amino acids

A

Essential = have to get in diet

Non-essential = can be made by liver
-needs right precursors

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3
Q

4 important liver enzymes. Do they increase or decrease with liver damage?

A 
Aspartate Aminotransferase (AST) 
Alanine Aminotransferase (ALT) 
Gamma-Glutamyl Transferase (GGT) 
Alkaline Phosphatase (ALP)

Increase
-intracellular enzymes

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4
Q

Amino acids break down into ___, which is converted by the liver into ___

A

Ammonia

Urea
-kidneys filter out urea and remove from body

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5
Q

Heme is broken down into ___. The protein, ___, transports the compound to the liver

A

Bilirubin

Albumin

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6
Q

Two differences between bilirubin transported by albumin vs bilirubin after it’s processed by the liver

A

Bilirubin bound to albumin is unconjugated and water insoluble

Liver makes conjugated bilirubin, which is water soluble
-can be excreted out of body

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7
Q

This is used to make conjugated bilirubin in the liver…

A

Glucaronic acid

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8
Q

Macrophages in the liver are called…

A

Kupffer cells

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9
Q

Why do the intestines send blood to the liver first?

A

Liver removes toxins

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10
Q

Two main types of liver diseases based on injury are categorized as… What types of injuries/damages are associated with each?

A

Heptocellular - injury to hepatocytes

Cholestatic - injury to bile ducts

-also infiltrative category, non-liver tissues invading the liver (amyloid, neoplasm)

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11
Q

What are the 3 stages of liver damage?

A

Fatty liver - fat deposits causes liver enlargement

Liver fibrosis - scar tissue forms

Cirrhosis - growth of connective tissue destroys liver cells

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12
Q

Reye’s syndrome - when does it occur? What does it cause?

A

Mostly in children following viral infection, and aspirin related
-don’t give kids aspirin

Swelling of liver and brain

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13
Q

Jaudice is caused by… How is it treated?

A

Unconjugated bilirubin buildup (hyperbilirubinemia)

Sunlight
-degrades bilirubin

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14
Q

Extremely high levels of bilirubin can build up in this organ… Also known as this condition…

A

Brain

Kernicterus

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15
Q

When testing a sample for bilirubin, it’s important to take this extra precautionary step to prevent degradation…

A

Keep samples in dark, away from light

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16
Q

3 different categories of bilirubin buildup in the body… What is happening in each?

A

Prehepatic - unconjugated bilirubin, no bilirubin in urine
-hemolytic

Hepatic - defective conjugation, transport failure, hepatocellular damage or necrosis

Posthepatic - inability to transport conjugated bilirubin out of liver, obstruction of common bile duct by gall stones, neoplasms, spasms or stricture

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17
Q

The most serious condition due to bilirubin buildup is called… What is happening?

A

Crigler-Najjar syndrome

No conjugation in liver
-unconjugated bilirubin buildup in body

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18
Q

The 3 important liver proteins that we test for are… This compound is also tested… The one liver test also involved in coagulation testing is…

A

Bilirubin
Albumin
Prealbumin (transthyretin)

Ammonia

PTT

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19
Q

Why are bilirubin and ammonia normally elevated in newborns?

A

Immature liver

-can’t conjugate bilirubin

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20
Q

Conjugated bilirubin bound to albumin is called…

A

Delta bilirubin

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21
Q

What are the direct and indirect bilirubin tests looking for?

A

Direct = all water soluble bilirubin. Includes conjugated bilirubin AND delta bilirubin (albumin bound)

Indirect = not water soluble (unconjugated bilirubin)

  • alcohol soluble
  • requires accelerator to solubilize so we can measure
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22
Q

What is the equation to measure total bilirubin?

A

Total bilirubin = direct (+ delta) + indirect

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23
Q

Where is albumin made in the body?

A

Liver

-drops in value if liver is damaged

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24
Q

Is albumin a good assessment for acute or chronic liver damage? Why?

A

Chronic

Albumin lasts ~2 months in the blood, takes awhile to drop

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25
Does prealbumin or albumin drop first in response to liver damage?
Prealbumin | -shorter half life
26
Hemolytic interferences affect AST or ALT more?
AST > ALT - only AST rise - ALT, ALP, GGT normal
27
An AST:ALT ratio less than 1:1 indicates... Greater than 1:1 (2:1 or 3:1) indicates...
Viral hepatitis - also seen in nonalcoholic steatohepatitis (fatty liver disease) - also a normal ratio in healthy adults - ratio may not always be accurate Chronic alcohol-induced liver damage
28
This liver enzyme requires zinc and magnesium cofactors... A cofactor deficiency would cause enzyme levels to...
ALP Decrease
29
ALP vs GGT - which one increases and which one decreases with food intake? Which one has a direct relation with alcohol intake?
ALP increase GGT decrease GGT -GGT more specific liver enzyme than ALP
30
When more elevated, which two liver enzymes are associated with hepatocellular disease? Cholestatic disease?
AST and ALT ALP and GGT
31
When determining whether liver damage is acute or chronic, we look at... What are the test results for acute vs chronic liver damage?
Albumin ``` Acute = no change Chronic = albumin decrease ```
32
How can we tell the difference between bone disease and obstructive liver disease based on the levels of liver enzymes?
Bone disease = ALP elevated, GGT normal Obstructive liver disease = both ALP and GGT elevated -ALP and GGT much more elevated than AST and ALT
33
What type of bilirubin in elevated in hepatocellular liver damage? Cholestatic?
Hepatocellular = unconjugated bilirubin Cholestatic = conjugated (urine)
34
Ammonia is volatile and needs this extra storage condition
Kept cold | -evaporates
35
The most sensitive marker for alcoholic liver disease is...
GGT | -high AST:ALT ratio also indicator, but GGT is the most sensitive
36
What are some endocrine products of the pancreas? Exocrine?
Hormones: insulin, glucagon, gastrin, somatostatin Digestive enzymes
37
Two important digestive enzymes secreted by the pancreas and their function. Which one is specific to the pancreas?
Amylase - digest carbs Lipase - digest lipids/fats Lipase
38
What are the two types of amylase? How do we isolate one type from the other?
``` S-type = salivary glands P-type = pancreas (acinar cells) ``` Inhibit S-type with antibodies -P-type elevated when pancreas is damaged
39
Are amylase and lipase stable for a short period of time or long period of time?
Long - lipase 1 week at room temp - amylase several days at room temp
40
A lifestyle contributing risk factor for chronic pancreatitis is...
Alcohol
41
What is an angina?
Chest pain caused by reduced blood flow to heart
42
True/false - a heart attack always shows an ST segment elevation on an EKG/ECG
False - every STEMI is a heart attack, but not all heart attacks produce a STEMI (called non-STEMI; NSTEMI) - STEMI and NSTEMI each occur about 50% of the time
43
STEMI can be detected via... NSTEMI can be detected via...
EKG Lab tests
44
Stable vs unstable angina
Stable - chest pain upon exertion Unstable - chest pain without exertion, rupture can block off blood and oxygen to heart, heart attack
45
What are the 3 cardiac "enzymes"... This molecule leaks out of damaged cells... What is the default cardiac marker for heart attacks...
AST (also marker for liver) LDH (LD) CK/CK-MB Myoglobin Troponin I - more sensitive/specific for heart attack - spikes within the same day, gradually lowers over a few days
46
Levels of CK are often not helpful in initial heart attack diagnosis since it takes at least ___ hours for there to be an "enzyme leak"
6 - needs to be reassessed every 8 hrs for first 24 hrs - CK2 = CK-MB - look for rise in both total CK and CK-MB - drops within 2-3 days
47
What are the 2 LD flips/inversions? What does each flip correlate with?
LD1 > LD2 - heart attack, hemolytic anemia, pernicious anemia LD5 > LD4 - liver disease
48
4 other cardiac biomarkers less routinely tested are...
CRP Fibrinogen Lipoprotein (a) Homocysteine
49
Which cardiac marker is the first to rise and fall in a heart attack... Which cardiac marker takes the longest to rise?
Myoglobin - elevates 1-4 hrs after symptoms - returns to normal after 12 hrs LDH -days
50
Myoglobin is abundant in (2)...
Cardiac muscle Skeletal muscle - nonspecific, sensitive marker - muscle damage (not heart attack) = creatinine, AST, myoglobin increase - myoglobin and CK-MB redundant today
51
What diseases are troponin I and T associated with?
I = heart attack T = kidney disease - T is also released during heart attack, but not as specific as I - little difference in cTnT and cTnI
52
A common interference when measuring troponin values is insufficient... The primary source of interference for a troponin assay is...
Centrifugation Fibrin
53
Define congestive heart failure. Is CHF associated with low or high blood pressure?
Condition where heart cannot pump enough blood to other organs -body fluids build up in lungs and limbs High blood pressure -heart pumping harder to get blood throughout body
54
Name a marker for congestive heart failure... What does the peptide do?
BNP (brain-derived natriuretic peptide) and NT-proBNP -made in response to elevated blood pressure Vasodilation and renal excretion of sodium and water - antagonist to renin-angiotensin-aldosterone system - decreases blood pressure
55
Difference between diuretic and natriuretic...
Diuretic - increase urine output Natriuretic - increase sodium output in urine; urine very salty
56
Do hemolysis cause an elevation in amylase levels?
No
57
The buildup of plaque in arteries and restricting bloodflow is called... As a result, lack of bloodflow reduces oxygen to organs and tissues, causing what is called...
Atherosclerosis Ischemia
58
Why does unconjugated bilirubin require an accelerator?
Unconjugated bilirubin is not water soluble - indirect test - accelerator helps solubilize unconjugated bilirubin
59
Acute heptatitis patients see a rise in this liver enzyme the most...
AST
60
Patients with renal failure see an increase in this marker...
Troponin T
61
Patients have an increased blood clotting time if this organ is impaired...
Liver | -clotting factors made in liver

CLS 701 (10 decks)

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