Liver

Question 1

What globulins are not metabolized in the liver?

Answer 1

Gamma

Question 2

The three most useful liver function tests?

Answer 2

1. Serum bilirubin
2. Alkaline phosphatase (ALP)
3. Aminotransferases (AST, ALT)

Question 3

Bilirubin metabolism begins with the breakdown of ____ in the reticuloendothelial system (spleen, bone marrow)

Answer 3

RBCs

Question 4

After hemoglobin is released from the RBC and broken into Heme and Globin molecules, ____ is catabolized to form biliverdin, which is then transformed to bilirubin

Answer 4

Heme

Question 5

The initial form of bilirubin is called ____

Answer 5

Unconjugated (indirect)

Question 6

The original unconjugated bilirubin is converted to conjugated in what organ?

Answer 6

Liver

Question 7

Once conjugated, bilirubin is excreted into the bile ducts and eventually the intestine, where it is converted to ____ by bacterial action

Answer 7

Urobilinogen

Question 8

____ is the discoloration of body tissues caused by abnormally high levels of bilirubin

Answer 8

Jaundice

Question 9

The yellow discoloration of jaundice is recognized when the total serum bilirubin exceeds ___ mg/dl

Answer 9

2.5

Question 10

Physiologic jaundice of a newborn is caused by an immature liver that does not have enough conjugating enzymes. This results in a high circulating blood level of ______ bilirubin

Answer 10

Unconjugated

Question 11

In the liver, unconjugated bilirubin is conjugated with a _____

Answer 11

Glucuronide

Question 12

If the defect in bilirubin metabolism occurs after glucuronide addition (after it is conjugated…), ____ hyperbilirubinemia will result.

Answer 12

Direct (conjugated)

Question 13

A classic example of direct hyperbilirubinemia?

Answer 13

Obstruction of bile duct by a gallstone

Question 14

Normally, the unconjugated bilirubin makes up __-__% of the total bilirubin

Answer 14

70-85%

Question 15

When more than __% of the total bilirubin is conjugated, it is considered conjugated hyperbilirubinemia

Answer 15

50%

Question 16

The three major causes of hyperbilirubinemia?

Answer 16

1. Hemolysis
2. Intrahepatic biliary tract obstruction
3. Extrahepatic biliary tract obstruction

Question 17

____ jaundice is ultimately caused by hemolysis (most of the time)

Answer 17

Prehepatic

Question 18

Hemolysis results in increased amounts of ____ bilirubin, as well as higher amounts of urobilinogen (which gets excreted in the urine)

Answer 18

Unconjugated

Question 19

List the 4 causes of hemolysis:

Answer 19

1. Congenital hemolytic anemia
2. Drug-induced causes
3. Autoimmune disease
4. Transfusion reactions

Question 20

__% of full term newborns are born w/physiological jaundice due to conjugation failure (immature liver and enzymes)

Answer 20

50%

Question 21

Pre-conjugation bilirubin transport failure is known as ___ syndrome

Answer 21

Gilbert’s

Question 22

Post-conjugation bilirubin transport failure is known as ____ syndrome

Answer 22

Dubin-Johnson

Question 23

List the 4 pathophysiologies of hepatic jaundice:

Answer 23

1. Conjugation failure
2. Bilirubin transport failure
3. Diffuse hepatocellular damage or necrosis
4. Intrahepatic obstruction

Question 24

Posthepatic jaundice is caused by?

Answer 24

Common bile duct obstruction

Question 25

Which type of bilirubin is water soluble?

Answer 25

Conjugated

Question 26

In a common bile duct (CBD) obstruction the conjugated bilirubin rises significantly early on d/t the fact that it cannot be excreted into the small intestine. Later, the unconjugated bilirubin starts to rise to closer to a 1:1 ratio. Why?

Answer 26

After several days of obstruction, some of the conjugated bilirubin in the blood breaks down to unconjugated

Question 27

What can produce falsely reduced levels of bilirubin?

Answer 27

Prolonged exposure (over 1 hour) to sunlight or artificial light

Question 28

Normal total, direct, and indirect levels of bilirubin?

Answer 28

Total: 0.1-1.0 mg/dl Direct: 0.1-0.3 mg/dl Indirect: 0.2-0.8 mg/dl

Question 29

The _____ reaction measures total and direct reacting bilirubin

Answer 29

Van den Bergh

Question 30

Because the liver is the key organ in the synthesis and excretion of cholesterol, ____ (a type of liver disease) will eventually cause cholesterol levels to drop below normal

Answer 30

Cirrhosis

Question 31

Enzyme highly elevated in cholestasis

Answer 31

Alkaline Phosphatase (ALP)

Question 32

Serum bilirubin >2.5 mg/dl

Answer 32

Jaundice

Question 33

Bilirubin >20 mg/dl in infant can cause?

Answer 33

Kernicterus (form of brain damage)

Question 34

Cholesterol of 600 mg%

Answer 34

Cholestasis

Question 35

Most specific transaminase for liver disease

Answer 35

ALT (alanine transaminase)

Question 36

Jaundice w/4+ urobilinogen

Answer 36

Prehepatic

Question 37

Liver disease w/hypocholesterolemia

Answer 37

Cirrhosis

Question 38

Elevated in hepatic coma

Answer 38

Ammonia

Question 39

Disease w/normal LFT’s in 50% of patients

Answer 39

Fatty liver

Question 40

Elevated w/necrosis of hepatocytes

Answer 40

Transaminases (AST, ALT)

Question 41

Vitamin K is necessary for formation of this

Answer 41

Prothrombin

Question 42

Usually normal in liver malignancies

Answer 42

Bilirubin

Question 43

Enzyme elevated due to alcohol use

Answer 43

GGT

Question 44

This test differentiates cirrhosis and alcoholic hepatitis

Answer 44

WBC test

Question 45

This type of viral hepatitis is spread mainly through the fecal-oral route

Answer 45

Type A (HAV)

Question 46

What are the three phases of viral hepatitis?

Answer 46

1. Prodromal 2. Icteric 3. Recovery

Question 47

Incubation (period between exposure and appearance of first symptoms) is about how long in HAV?

Answer 47

2-6 weeks

Question 48

__-__% of patients w/viral hepatitis never develop jaundice

Answer 48

75-80%

Question 49

First antibody to increase in HAV?

Answer 49

HAV IgM (about 3-4 weeks after exposure)

Question 50

This type of viral hepatitis is mainly transmitted parenterally and through sexual intercourse

Answer 50

HBV

Question 51

Incubation time for HBV?

Answer 51

6-25 weeks

Question 52

First serological test to become abnormal in HBV?

Answer 52

HBsAg (before onset of symptoms)

Question 53

This HBV antibody rises about 2-6 weeks after it’s antigen is present and signifies the end of acute infection and immunity to future infection.

Answer 53

HBsAb

Question 54

Antibody detected in “core window” of HBV infection (after HBsAg has disappeared, but HBsAb is not detectable yet)

Answer 54

HBcAb (IgG)

Question 55

Consistently high transaminase levels with vague symptoms or none are characteristic. Other LFT’s are unremarkable and jaundice is rare.

Answer 55

Chronic hepatitis

Question 56

In alcoholic liver disease (alcoholic hepatitis) will WBC’s be increased, decreased, or normal?

Answer 56

Increased

Question 57

There is inflammation and destruction of small bile ducts within the liver portal areas

Answer 57

Primary biliary cirrhosis (PBC)

Question 58

Serum antimitochondrial antibodies are elevated in 90% or more of patients w/this liver disease

Answer 58

Primary biliary cirrhosis

Question 59

Name for primary liver cancer

Answer 59

Hepatoma

Question 60

Elevated in hepatoma?

Answer 60

AFP (alpha-fetoprotein)

Question 61

The 3 typical findings in 1/3 of patients w/metastatic carcinoma to the liver?

Answer 61

1. Normal bilirubin 2. Normal AST 3. Elevated ALP