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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
Q

Does prealbumin or albumin drop first in response to liver damage?

A

Prealbumin

-shorter half life

26
Q

Hemolytic interferences affect AST or ALT more?

A

AST > ALT

  • only AST rise
  • ALT, ALP, GGT normal
27
Q

An AST:ALT ratio less than 1:1 indicates… Greater than 1:1 (2:1 or 3:1) indicates…

A

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
Q

This liver enzyme requires zinc and magnesium cofactors… A cofactor deficiency would cause enzyme levels to…

A

ALP

Decrease

29
Q

ALP vs GGT - which one increases and which one decreases with food intake? Which one has a direct relation with alcohol intake?

A

ALP increase
GGT decrease

GGT

-GGT more specific liver enzyme than ALP

30
Q

When more elevated, which two liver enzymes are associated with hepatocellular disease? Cholestatic disease?

A

AST and ALT

ALP and GGT

31
Q

When determining whether liver damage is acute or chronic, we look at… What are the test results for acute vs chronic liver damage?

A

Albumin

Acute = no change
Chronic = albumin decrease
32
Q

How can we tell the difference between bone disease and obstructive liver disease based on the levels of liver enzymes?

A

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
Q

What type of bilirubin in elevated in hepatocellular liver damage? Cholestatic?

A

Hepatocellular = unconjugated bilirubin

Cholestatic = conjugated (urine)

34
Q

Ammonia is volatile and needs this extra storage condition

A

Kept cold

-evaporates

35
Q

The most sensitive marker for alcoholic liver disease is…

A

GGT

-high AST:ALT ratio also indicator, but GGT is the most sensitive

36
Q

What are some endocrine products of the pancreas? Exocrine?

A

Hormones: insulin, glucagon, gastrin, somatostatin

Digestive enzymes

37
Q

Two important digestive enzymes secreted by the pancreas and their function. Which one is specific to the pancreas?

A

Amylase - digest carbs
Lipase - digest lipids/fats

Lipase

38
Q

What are the two types of amylase? How do we isolate one type from the other?

A 
S-type = salivary glands
P-type = pancreas (acinar cells)

Inhibit S-type with antibodies

-P-type elevated when pancreas is damaged

39
Q

Are amylase and lipase stable for a short period of time or long period of time?

A

Long

  • lipase 1 week at room temp
  • amylase several days at room temp
40
Q

A lifestyle contributing risk factor for chronic pancreatitis is…

A

Alcohol

41
Q

What is an angina?

A

Chest pain caused by reduced blood flow to heart

42
Q

True/false - a heart attack always shows an ST segment elevation on an EKG/ECG

A

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
Q

STEMI can be detected via… NSTEMI can be detected via…

A

EKG

Lab tests

44
Q

Stable vs unstable angina

A

Stable - chest pain upon exertion

Unstable - chest pain without exertion, rupture can block off blood and oxygen to heart, heart attack

45
Q

What are the 3 cardiac “enzymes”… This molecule leaks out of damaged cells… What is the default cardiac marker for heart attacks…

A

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
Q

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”

A

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
Q

What are the 2 LD flips/inversions? What does each flip correlate with?

A

LD1 > LD2 - heart attack, hemolytic anemia, pernicious anemia

LD5 > LD4 - liver disease

48
Q

4 other cardiac biomarkers less routinely tested are…

A

CRP

Fibrinogen

Lipoprotein (a)

Homocysteine

49
Q

Which cardiac marker is the first to rise and fall in a heart attack… Which cardiac marker takes the longest to rise?

A

Myoglobin

  • elevates 1-4 hrs after symptoms
  • returns to normal after 12 hrs

LDH
-days

50
Q

Myoglobin is abundant in (2)…

A

Cardiac muscle

Skeletal muscle

  • nonspecific, sensitive marker
  • muscle damage (not heart attack) = creatinine, AST, myoglobin increase
  • myoglobin and CK-MB redundant today
51
Q

What diseases are troponin I and T associated with?

A

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
Q

A common interference when measuring troponin values is insufficient… The primary source of interference for a troponin assay is…

A

Centrifugation

Fibrin

53
Q

Define congestive heart failure. Is CHF associated with low or high blood pressure?

A

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
Q

Name a marker for congestive heart failure… What does the peptide do?

A

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
Q

Difference between diuretic and natriuretic…

A

Diuretic - increase urine output

Natriuretic - increase sodium output in urine; urine very salty

56
Q

Do hemolysis cause an elevation in amylase levels?

A

No

57
Q

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…

A

Atherosclerosis

Ischemia

58
Q

Why does unconjugated bilirubin require an accelerator?

A

Unconjugated bilirubin is not water soluble

  • indirect test
  • accelerator helps solubilize unconjugated bilirubin
59
Q

Acute heptatitis patients see a rise in this liver enzyme the most…

A

AST

60
Q

Patients with renal failure see an increase in this marker…

A

Troponin T

61
Q

Patients have an increased blood clotting time if this organ is impaired…

A

Liver

-clotting factors made in liver

CLS 701 (10 decks)

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