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clinical chemistry > Liver Function > Flashcards

Liver Function Flashcards

1
Q

What is the role of the liver?

A

Key roles included excretion and secretion, synthesis, and detoxification and drug metabolism.
-Other functions include metabolic function, and storage.

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2
Q

What enzymes are used to assess liver function?

A
  • ALT
  • AST
  • ALKP
  • GGT
  • 5’ Nucleotidase
  • LDH
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3
Q

Which two enzymes rise together in liver disorders?

A
  • AST/ALT – Rise rapidly in liver disorders. Remain elevated in chronic conditions.
  • Both will be low when liver cells are destroyed ( liver failure ).
  • Both normal or slightly elevated in obstruction
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4
Q

Where is ALT found and what is it sensitive to?

A

Found in hepatocytes – specific to liver

More sensitive in viral induced hepatocellular damage

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5
Q

Which stays elevated longer, AST or ALT?

A

ALT

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6
Q

What is ALT>AST indicative of?

A

ALT>AST – hepatitis, most liver disease

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7
Q

Where is AST found and what causes it to increase?

A

Found in many sources. Many things can cause it to increase

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8
Q

What is AST>ALT indicative of?

A

AST>ALT – cirrhosis

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9
Q

What do AST values higher than 400 suggest?

A

Acute viral hepatitis

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10
Q

Where is ALKP found?

A

many sources of the body

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11
Q

What is ALKP useful to distinguish?

A

Useful to differentiate obstruction from Hepatocellular injury

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12
Q

What do high ALKP values suggest?

A

Highest amounts found in obstruction

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13
Q

What do mild ALKP values suggest?

A

Mild elevation in cirrhosis or hepatitis

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14
Q

What is GGT and where is it found?

A

Membrane enzyme that helps amino acid cross cell membrane

-Found in liver cells and bile duct walls

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15
Q

What is GGT a sensitive marker for?

A

Makes it sensitive marker for obstructive cholestasis and ETOH ingestion – highest values seen in these cases

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16
Q

How is GGT used to help determine where high ALKP values come from?

A

Can help differentiate cause of increased ALKP. If ALKP is high and GGT is normal – probably not liver
When liver cells are destroyed, values will be decreased

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17
Q

Where is LDH found?

A

Widely distributed in the body.
high amounts in RBCs
LDH is increased as RBCs turnover

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18
Q

What can LDH be used to differentiate the cause of?

A

the cause of increased ALKP

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19
Q

What does moderate LDH increase suggest?

A

hepatobiliary disease

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20
Q

What does a slight LDH elevation suggest?

A

biliary tract disease

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21
Q

What does a high LDH elevation suggest?

A

hepatic carcinoma

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22
Q

Where is 5’ nucleotidase found?

A

widely distributed in the cells

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23
Q

What can 5’ nucleotidase help differentiate?

A

elevated ALKP

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24
Q

What 2 enzymes will be elevated in liver disease?

A

5’ nucleotidase and ALKP

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25
What one enzyme will be elevated in bone disease?
ALKP
26
What does a significant elevation of 5' nucleotidase suggest?
hepatobiliary disease
27
What usually happens to ammonia and what can changes in ammonia reflect?
- Normally converted to urea by liver and excreted | - Reflects the liver’s ability to convert ammonia to urea
28
In what conditions will ammonia be increased?
Will be increased in liver failure and can lead to hepatic coma, also in Reye Syndrome
29
What methods are used to assess ammonia?
Caraway, Nessler’s and Enzymatic reaction
30
What are normal and critical values of ammonia?
Normal 20-50 umol/l. greater than 100 is critical
31
Where is albumin synthesized and what can it help measure?
Synthesized in liver – liver problem will result in decreased synthesis
32
What type of disease is decreased albumin usually found in?
Decrease found more in chronic disease
33
When are IgG and IgM both increased?
chronic active hepatitis
34
When is just IgM elevated (Liver)
in primary biliary cirrhosis
35
What liver problem will just IgA be increased?
alcoholic cirrohosis
36
Why would PT be increased in liver disease?
The clotting factors are synthesized in the liver
37
What is a common tumor marker and may be used to see cancer in the liver?
AFP-hepatic carcinoma
38
What are the general characteristics of unconjugated bilirubin?
Bound to albumin – insoluble in water, is not filtered and excreted by kidney
39
What are the general characteristics of conjugated bilirubin?
Is now soluble in water and can be filtered and excreted
40
What is delta bilirubin and how does it occur?
conjugated bili that is bound to albumin. Can occur when liver is conjugating effectively but it cannot be excreted from the liver. Is a problem because it is measured as conjugated in lab testing
41
when is delta bilirubin generally seen?
Results will not add up. Only seen in significant obstruction
42
Where is urobilinogen created ?
Derived from Bilirubin in GI tract. Oxidized by intestinal bacteria to form urobilin. Adds color to stool.
43
When is urobilinogen seen in disease and when is it absent?
- Absent in obstruction | - Increased in hemolytic disease, defective liver cell function, hepatitis
44
When is hepatomegally generally seen?
Seen primary or secondary to liver disease.
45
What is ascites fluid?
Presence of free fluid in the peritoneal cavity
46
When is ascites fluid generally seen?
Commonly seen in cirrhosis due to alcoholism Hepatitis Hepatic vein obstruction
47
What is kernicterus?
Bilirubin deposited in nuclei of brain and nerve cells. Is life threatening. May require exchange transfusion
48
What are signs of prehepatic jaundice?
Total Bili rarely exceed 5 mg/dL Bilirubin will not be seen in a UA Urobilinogen in seen in urine as result of increased bili being conjugated Stool will be dark brown due to increase in conjugated bili being broken down
49
What are the common diseases of biliary metabolism?
Gilberts syndrome Criggler-Najjar syndrome Neonatal jaundice
50
What will you see an increase in if you have a biliary disorder?
Results in increase in unconjugated bili
51
What are some common disorders of biliary transport?
Dubin-Johnson syndrome Rotors syndrome other intra or extrahepatic obstruction
52
What will you see an increase in if you have a biliary transport disorder?
See increase in conjugated bilirubin
53
What is Gilbert disease and what does it effect?
- inherited disease affecting 5% of population – No morbidity or mortality - Increase in Bu absent of hemolysis or other disease affecting bili conjugation - Occurs in adolesence or early adulthood - Problem is with encoding of enzyme that catalyzes bilirubin conjugation
54
Which diseases are Unconjugated Hyperbilirubinemia | diseases?
Gilbert disease Criggler Najjar neonatal jaundice
55
Which diseases are Conjugated Hyperbilirubinemia | diseases?
dubin-johnson syndrome | rotor syndome
56
What is dubin-johnson syndrome and what does it cause?
rare inherited disorder causing a deficiency in a transport protein Liver can uptake and conjugate bilirubin properly, problem is in transporting it out of cells to be excreted in Bile The conjugated Bili can back-up into blood and bind with albumin ( delta bilirubin ) Mild in nature – normal life expectancy Characterisitic dark staining granules seen on liver biopsy
57
What are the signs of posthepatic jaundice?
Bile is not presented to intestines No urobilonogen Stool - no color Urine – No urobilinogen
58
What things should you avoid when taking a bilirubin sample?
Protect from light Avoid hemolysis Icteric sample
59
What is Ehrlich's method and how is it done?
original method for bili determination Done on urine Bili reacts with Diazotized Sulfanilic Acid to form a color Diazo reaction
60
What is the van den bergh method?
Modified this in early 1900 to use on serum Addition of an accelerator or solubilizer – Bu not soluble in water Method had errors
61
What is cholestasis?
Stoppage of bile flow. Commonly due to bile duct obstruction
62
What is cirrhosis and what are common causes?
Normal, healthy tissue is replaced by scar tissue Liver unable to function. Scar tissue disrupts blood flow through the organ Most common causes – Alcohol abuse, Hep C infection
63
What is hepatitis?
Inflammation of liver tissue Caused by bacteria, virus or parasite in addition to autoimmune disorders, radiation or drugs Most hepatitis is viral in nature
64
What is the most useful hepatitis marker and why?
HbsAG can detect before symptoms occur allows for early treatment
65
What can be used to differentiate active, chronic or resolving infection when used with other tests in hepatitis cases?
Hbcore AB

clinical chemistry (5 decks)

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