LFT - PART 2 Flashcards
markers for hepatocellular necrosis
ALT or Alanine Aminotransferase
AST or Aspartate Aminotransferase
ALT is also known as
Serum Glutamate Pyruvate Transaminase
ALT is most specific due to ________ in the liver
high concentration
best test to assess hepatocellular integrity.
ALT
ALT is present in the ______ of liver cells
cytosol
____ concentration is higher than ________ in acute liver disease
ALT ; AST
significance of ALT
hepatocellular disorder exhibit higher level than intra or extrahepatic obstruction
normal range of ALT in male
13 to 35 U/L
normal range of ALT in female
10 to 30 U/L
AST or Aspartate Amino Transferase is also kown as
Serum Glutamic-Oxaloacetic Transaminase
less specific (found in the mitochondria and cytosol liver cell, heart and skeletal muscle)
AST
significance of AST
4x increased in cirrhosis; 100x increased in viral hepatitis.
ALT and AST > 1000
ischaemic hepatitis, viral hepatitis, paracetamol overdose
AST > ALT
alcoholism, drug intoxication, cirrhosis
AST requires __________ (PSP or vitamin B6) as a cofactor.
pyridoxal 5 phosphate
If a patient is ________ deficient it can lead to false negative AST results in some commercially available assays.
vitamin B6
normal range of AST
8 to 20 U/L
_____________ least specific – increased in cardiac and hepatic injury.
Lactate Dehydrogenase (LD)
Markers that reflect cholestasis
Alkaline Phosphatase (ALP)
Gamma-Glutamyl Transferase (GGT)
increased in obstructive diseases.
Alkaline Phosphatase (ALP)
found on cell surfaces, sinusoidal and bile canalicular.
Alkaline Phosphatase (ALP)
ALP is significantly increased in ______ diseases and _____ disease
obstructive ; Paget
ALP is decreased in _______ because of lack of ______
hypophosphatasia ; ALP isoenzyme
normally higher in children than adults because of bone growth.
ALP
Best test for cholestatic disease (More specific than GGT)
ALP
significantly increased in alcoholism.
Gamma-Glutamyl Transferase (GGT)
Helps confirm excess alcohol intake, highly sensitive to detecting alcohol abuse.
GGT
GGT is increased in _______ despite normal liver function tests.
alcoholics
Accompanies ALP increase in biliary obstruction/lesion.
GGT
ALP > GGT = ?
bone disease, pregnancy
GGT > ALP = ?
alcohol, medications
Tests for Biliary Excretion
Total Bilirubin, B1, B2
commonly elevated with ALP during cholestasis.
Total Bilirubin, B1, B2
elevated with severe liver disease.
Total Bilirubin, B1, B2
elevated in non-liver disease (hemolysis)
Total Bilirubin, B1, B2
Tests for Liver Synthetic Function
Albumin
decrease _______ indicated severe liver injury.
Albumin
increase may indicate severe liver injury.
PT/INR or Prothrombin Time
Analysis of _______ is important for assessing nutritional status and presence of severe diseases involving the liver, kidney and bone marrow.
proteins
_______ and _______ are about 10% higher in ambulatory individuals.
Total protein and albumin
Plasma levels of total protein is ______ higher than serum due to fibrinogen.
0.2 to 0.4 g/dL
Transudates have a total protein of ______ (<50% of the serum total protein)
< 3.0 g/dL
Exudate gas total protein
> 3 g/dL
T or F..
In measuring total proteins in serum, fasting may not be required.
True
Total Protein Det is usually performed on ______, which has no fibrinogen and no anticoagulant that may slightly dilute proteins in plasma.
serum,
_______ may false elevate the total protein
Hemolysis
Total protein det. reference value
6.5 to 8.3 g/dL
Differentiates intrahepatic disorder (prolonged protime) from extrahepatic obstructive liver disease (normal protime)
PROTHROMBIN TIME (VITAMIN K RESPONSE TEST)
Persistent prolongation of protime despite vitamin K administration indicates loss of _________ to synthesize proteins
hepatic capacity
In acute viral or toxic hepatitis, prolongation of protime signifies ______________.
massive cellular damage
In _____, concentration of the protein is inversely proportional to the severity of the liver disease.
Albumin
Decrease serum albumin concentration may be due to decrease ______.
synthesis
Low protein + low albumin =
hepatic cirrhosis or nephrotic syndrome
Dye used for measurement of Albumin
- Bromcresol Green
- Methyl Orange
- Hydroxyazobenzene Benzoic Acid (HABA)
- Bromcresol Purple
Increased serum albumin is also called/known as
Hyperalbuminemia
- Severe Hydration
- Prolonged tourniquet application – artifactual hyperalbuminemia.
Increased Serum Albumin (Hyperalbuminemia)
Decreased Serum Albumin is also known/called as
Hypoalbuminemia
3 that is included in Decreased Serum Albumin (Hypoalbuminemia)
Reduced Synthesis
Increased Loss
Increased Catabolism
Chronic Liver Disease, Malabsorption Syndrome, Malnutrition, and Muscle Wasting Disease
Reduced Synthesis
Nephrotic Syndrome, Massive Burns, Orthostatic Albuminuria
Increased Loss
Massive Burns, Malignancy, Thyrotoxicosis
Increased Catabolism
In measuring conjugation and excretion function, the specimen should be free of _____ and ______
hemolysis and lipemia
In measuring conjugation and excretion function, the specimen should be stored in the ______ and measured _____
dark ; ASAP
In measuring conjugation and excretion function, the specimen should have ___ visible icteria
> 25mg/dL
belongs to bilirubin assay
Van Den Berg Reaction
Evelyn and Malloy
Jendrassik and Grof
Principle of Bilirubin Assay
Van Den Berg Reaction – diazotization of bilirubin
Coupling Accelerator of Evelyn and Malloy
Methanol
Final Reaction in Evelyn and Malloy
(+) Pink to Purple
o Popular technique for Discreet Analyzer
o Not affected by Hemolysis
Jendrassik and Grof
Jendrassik and Grof coupling accelerator
Caffeine Sodium Benzoate
In Jendrassik and Grof, _________terminates initial reaction and destroy excess diazo
Ascorbic Acid
diazo is made up of …
sulfanilic acid in hydrochloric acid and sodium nitrite
Jendrassik and Grof final reaction
(+) = Pink to Blue
It is a test for hepatocellular function and potency of bile duct; rarely used
Bronsulfothalein (BSP) Dye Extraction Test
Double collection method in Bronsulfothalein (BSP) Dye Extraction Test
Rosenthal White
Single collection method in Bronsulfothalein (BSP) Dye Extraction Test
Mac Donald Method
Colorless end product of bilirubin
UROBILINOGEN
Excreted in urine and feces or reabsorbed into the portal blood and return to the liver.
UROBILINOGEN
Absence of substance + complete biliary obstruction
UROBILINOGEN
method of testing in urobilinogen
Ehrlich Method
NV of UROBILINOGEN in Feces
75-225
NV of UROBILINOGEN in 24 hours urine
75-400
In test for detoxification function, it involves ______ and ______ test
enzyme and ammonia
Any injury to the liver that results to _____ and _________ causes liberation of enzymes.
cytosis ; necrosis
Used to assess the extent of liver damage and to differentiate hepatocellular from jaundice.
Enzymes
examples or the enzymes included are
ALT, AST, ALP, GGT 5’nucleoside, LDH
Arise from the deamination of amino acid
Ammonia
Released from the skeletal muscle during exercise
Ammonia
Elevated level of ammonia are ___________ and often associated with ________
neurotoxic ; encephalopathy
ammonia clinical significance
diagnosis of hepatic failure and Reyes syndrome.
ammonia Normal value
11 to 35 mmol/dL
in test for detoxification function, ______ is a source of contamination
smoking
in test for detoxification function, preferred specimen is
arterial blood
in test for detoxification function, specimen requirement is
Heparin, EDTA kept in ice water immediately.
in test for detoxification function, method of testing is
Berthelot reaction, Glutamate dehydrogenase.
in test for detoxification function, digestion includes
Kjehdal Method
in test for detoxification function, measurement for ammonia is
o Nesslerization Reaction
o Berthelot Reaction
characterized by necrosis and inflammation of the hepatocytes that results in a decrease in functional ability and abnormal liver function test results.
HEPATITIS
In hepatitis, changes can be caused by ______ and/or ______ agents
infectious ; toxic
6 hepatitis viruses
Hepa A, Hepa B, Hepa C, Hepa D, Hepa E and Hepa G.