Liver Function Flashcards
(183 cards)
1
Q
How are most water soluble drugs and substances excreted?
A
Usually unchanged
Excreted in urine or bile
2
Q
How are lipid soluble compounds dealt with in the body?
A
Usually accumulate and affect cells unless they are converted to less active compounds or more soluble metabolites for excretion
3
Q
What is a first stage reaction?
A
Reactions that involve chemical modification of reactive groups
Usually involving enzymatic systems
4
Q
What are some processes a first stage reaction might achieve?
A
Inactivate or detoxify drugs
Activation of drugs
Conversion of nontoxic compounds to toxic ones
(ex acetaminophen, carcinogens)
5
Q
What might induce a first stage reaction?
A
Drugs like ethanol and barbiturates
6
Q
What might inhibit a first stage reaction?
A
Drugs
7
Q
What is a second stage reaction?
A
Conjugation and conversion of substances to permit excretion in bile or urine
8
Q
What is the most common second stage reaction?
A
Conjugation catalyzed by UDP-glucuronyltransferase to form glucuronide derivatives
9
Q
What are the major constituents of bile?
A
Cholesterol
Bile salts
Bilirubin
10
Q
How are hepatic cells involved with metabolism?
A
Exclusive metabolism of galactose and fructose, channels them to glucose pathways
Glycolysis
Glycogenesis
Glycogenolysis
Gluconeogenesis
11
Q
How are hepatic cells involved with amino acids and proteins?
A
Synthesis of majority of serum proteins
Synthesis of many enzymes
Metabolism of amino acids
12
Q
How do hepatic cells metabolize amino acids?
A
Gluconeogenesis (conversion to glucose)
Formation of urea from ammonia during deamination
Deamination
Transamination
13
Q
How are hepatic cells involved with lipid metabolism?
A
Synthesis of: fatty acids from acetyl-CoA cholesterol bile acids from cholesterol formations of ketons
14
Q
What are diseases associated with the liver?
A
Hepatitis
Cirrhosis
Cholestasis
15
Q
What is hepatitis?
How is it caused?
A
Inflammation of the liver
Caused by infection, drugs, toxins, autoimmune
16
Q
What is cirrhosis?
How is it caused?
A
Hepatocellular damage leading to scar tissue
Alcohol
17
Q
What is cholestasis?
A
Blockage of normal bile flow
18
Q
How is bilirubin formed?
A
Catabolism of heme from hemoglobin
Some from cytochromes, myoglobin, peroxidase
19
Q
How does hemoglobin breakdown create bilirubin?
A
Hemoglobin -> globin + heme
Heme -> iron + protoporphyrin
Protoporphyrin -> biliverdin
Biliverdin -> unconjugated / indirect bilirubin
20
Q
Where does hemoglobin catabolism take place?
A
In macrophages
21
Q
What are features of indirect bilirubin?
A
Non-polar, non water soluble
Bound to albumin in plasma
22
Q
How does bilirubin enter the liver?
A
In the sinusoids it attaches to receptors on the cell membranes and release from the albumin
Attaches to ligandin in the cell
23
Q
What happens to bilirubin once it enters liver cells?
A
Indirect bilirubin is converted to conjugated / direct bilirubin
Attaches to glucuronic acid
24
Q
Where does bilirubin go after being conjugated?
A
Secreted into the bile
Enters duodenum
25
What happens to bilirubin in the intestines?
Unconjugated
Bilirubin converted to urobilinogen
Small amount absorbed but most is excreted
26
What happens to reabsorbed urobilinogen?
Goes through liver and GI again
| Small amount secreted by kidneys
27
What lab tests are done to assess liver function?
```
Serum and urine bilirubin
ALP
AST
ALT
GGT
```
sometimes protein, urine urobilinogen, serum ammonia
28
How should a sample for bilirubin analysis be handled?
Serum or plasma
Avoid hemolysis and lipemia
Should be tested quickly or protected from light
29
What can interfere with bilirubin analysis?
Hemolysis (decreases)
| Extended light exposure (decreases)
30
What are 4 methods that cane be used to measure bilirubin?
Jendrassik-Grof Method
Vitros Method
Direct Spectrophotometry
Evelyn-Malloy Method
31
How does the Jendrassik-Grof Method work?
Diazo reaction with conjugated bili produces colored product
| Measured spectrophotometrically
32
What are the steps of the Jendrassik-Grof Method?
Diazotized sulphanilic acid converts direct bili to azobilirubin
Ascorbic acid stops the reaction
Tartrate shifts absorbance from 585 to 600nm for reading
33
How can the Jendrassik-Grod Method measure total bilirubin?
Accelerator like caffeine-sodium benzoate quickly separates indirect bili from albumin
Then sulphanilic acid can convert all bili to azobilirubin
34
How can indirect bilirubin be calculated?
Total - direct
35
What is the reference range for direct bilirubin?
0-4 umol/L
36
What is the reference range for indirect bilirubin?
0-16 umol/L
37
What is the reference range for total bilirubin?
0-20 umol/L
38
What are the steps of the vitros bilirubin method?
Spreading layer contains caffeine-sodium benzoate to separate indirect bili from albumin
Screening layer traps other substances and lets bilirubin pass
Reaction layer is where bili binds to mordant
Reflectance measured at 400 for direct bili and 460 for indirect bili
39
How is bilirubin measured spectrophotometrically?
Bilirubinometer with capillary sample
Measures bili+hemoglobin at 454 nm
Hemoglobin only at 540
Hemoglobin - hemoglobin + bili = bili
40
Why is a bilirubinometer only used on babies?
After 3 months lipochromes can interfere
Absorb at 454 nm and cause positive interference
41
What are the reference ranges for bilirubin in babies?
```
birth < 34
24 hrs 34-103
48 hrs 103-120
3-5 days 68-103
1 week < 34
```
42
Why might premature babies have higher bilirubin levels?
Lack glucuronyltransferase
Cannot conjugate bili
Unconjugated bili builds up
43
What happens if bilirubin exceeds 225 umol/L?
Can cause kernicterus
44
What is kernicterus?
Bili entering the brain and nervous tissue and depositing causing neurological disorders
45
What is a critical level of bilirubin in babies?
> 300 umol/L
46
How is kernicterus treated?
Phototherapy or exchange transfusions
47
At what bilirubin level could kernicterus start to occur?
225 umol/L
48
What is jaundice?
Yellowing of skin and eyes due to bilirubin
49
When can jaundice occur?
Total bilirubin exceeds 35 umol/L
50
How does the Evelyn-Malloy method work?
Diazo reaction at acid pH
Direct bili measured at 1 minute
Methanol added to make indirect bili more soluble to read total bilirubin level
51
What causes pre-hepatic jaundice?
Increased RBC destruction
- hemolytic anemias
- ineffective erythropoiesis
- HDN/TR
- drugs
52
What blood results are expected with pre-hepatic jaundice?
Increased indirect bili
Decreased hemoglobin
Decreased LD
53
What effect does pre-hepatic jaundice have on excretions?
Presence of increased urobilinogen
Increased indirect bili = increased direct bili = increased urobilinogen
54
What might cause hepatic jaundice?
Necrosis from viruses, drugs, poison (alcohol)
Diseases impairing direct bili from entering bile
Cholestasis caused by cirrhosis or inflammation of bile ducts
Diseases causing failure of or decreased conjugation of bili
Impaired uptake of bilirubin into the liver
55
What is Gilbert's disease?
Most common inherited cause of hepatic jaundice
Causes impaired uptake of bilirubin into hepatic cells
56
What blood results are expected with hepatic jaundice?
Increased indirect bili
| Possible increased direct bili if conjugation can occur
57
What effect does hepatic jaundice have on excretions?
Decreased direct bili in bile
Decreased urobilinogen in excretion
If direct bili increased in blood, may be found in urine
58
What might cause post-hepatic jaundice?
Obstruction of bile duct preventing bile excretion
Bile duct cancer
Tumor compression of bile duct
Gallstones
Common bile duct inflammation
59
What are other names for post-hepatic jaundice?
Obstructive jaundice
| Extrahepatic cholestasis
60
What blood results are expected in post-hepatic jaundice?
Increased direct bili (unable to enter bile)
Indirect usually normal but may build up if severe
61
How does post-hepatic jaundice affect excretions?
Direct bili present in urine
Decreased urobilinogen in stool and urine
Pale colored stool
62
Where does ALP come from?
Bone (osteoblasts)
| Liver sinusoid cells, bile canaliculi
63
When would ALP be elevated?
Bone disease, pregnancy growth
Markedly elevated in cholestasis
Moderately in liver damage
64
Why is ALP so increased in cholestasis?
ALP is usually excreted into bile
| When there is a blockage it spills over massively into the blood just like direct bilirubin
65
Serum ALP is increased but bilirubin is normal. Why might this be?
Bone disease
or
Possible lesion/carcinoma or obstruction of one of the radicles of the common bile duct
66
Where does GGT come from?
Widespread
| Highest levels in cells lining bile canaliculi and ducts
67
What might cause elevated GGT?
Markedly elevated in cholestasis
Moderately in liver damage
Acute hepatitis, cirrhosis, tca abuse
Often first enzyme to rise
Increases with alcohol
68
How can GGT and ALP levels be used together for diagnosis?
GGT + ALP elevated = liver
| ALP only elevated = bone
69
Where are ALT and AST found?
Highest in hepatocytes and heat and skeletal muscle
70
When might ALT and AST be elevated?
Markedly in hepatocellular damage
| Moderately in cholestatis
71
How can the ratio of AST to ALT be used?
AST:ALT < 1.0 = acute (viral or toxic hepatitis)
AST:ALT = 1.0 obstructive jaundice
AST:ALT > 2.0 = chronic (hepatitis, alcoholism, cirrhosis)
72
Where is 5'-Nucleotidase found?
Bile canaliculi lining cells
73
When might 5'-Nucleotidase be increased?
Markedly in cholestasis
| Moderately in liver damage
74
When might lactate dehydrogenase be elevated?
Mostly in liver conditions but not like other enzymes
Not as sensitive
LD-4 and LD-5 elevated in liver disease
75
Where is albumin synthesized?
Liver
76
When might albumin level be decreased?
Decrease gradually in acute liver disease
| Markedly decreased in chronic liver disease
77
When might a-fetoprotein (AFP) be elevated?
Hepatocellular carcinoma
78
Is a-fetoprotein (AFP) usually found in adults?
No
| Maximum concentration at 12-15 weeks gestation
79
When might gamma globulins be increased?
Chronic active hepatitis
| Increase in both IgG and IgM
80
What is beta-gamma bridging in electrophoresis?
Elevated levels of IgA and beta-globulins showing a bridge between beta and gamma on an electrophoresis gel
Caused by cirrhosis
81
When might ammonia be increased?
```
Liver damage (cirrhosis, failure, necrosis)
Cannot be quickly converted to urea
```
82
What hematology tests might be affected by liver problems?
INR
| RBC morphology
83
How is INR affected by liver disease?
Increased
| Not corrected with vitamin K
84
How is RBC morphology affected by liver disease?
Target cells
Acanthocytes
Macrocytes
85
Define hepatitis
Inflammation of liver caused by infection, toxins, drugs, autoimmune disorders
86
Define cirrhosis
Heptocellular damage leading to scar tissue effecting flow of blood and bile
87
Define cholestasis
Blockage of bile flow
88
What is intrahepatic cholestasis?
Blockage of bile inside the liver
| In bile canaliculi and ducts
89
What is extrahepatic cholestasis?
Blockage after the liver
In common bile duct, gallbladder
May be caused by gallstones
90
What blood tests might be elevated with cholestasis?
ALP, GGT, 5'NT
91
What is the reference range for ALP?
30 - 130 U/L
92
What is the reference range for GGT?
M 0 - 60 U/L
| F 0 - 35 UL
93
What is the reference range for AST?
0 - 40 U/L
94
What is the reference range for ALT?
0 - 60 U/L
95
What is the reference range for albumin?
35 - 55 g/L
96
What is the reference range for ammonia?
10 - 45 umol/L
97
Describe the purpose of first stage reactions
Chemically modify substances to
- detoxify
- activate
- convert from non-toxic to toxic
98
Describe the purpose of second stage reactions
Convert substances to more water soluble forms by conjugation
99
Name the enzyme most commonly used to second stage reactions
UDP-glucuronyltransferase
100
List the 3 classes of substances the liver displays metabolic functions for
Carbohydrates
Amino acids and proteins
Lipids
101
Identify the source of bilirubin in the body
Hemoglobin breakdown
Heme -> protoporphyrin -> biliverdin -> bilirubin
102
```
Describe unconjugated bilirubin including
alternate name
solubility
transport in plasma
if it can be excreted in urine
```
indirect bilirubin/alpha bilirubin
not water soluble
transported attached to albumin
cannot be excreted in urine
103
```
Describe conjugated bilirubin
alternate name
types
solubility
if it can be excreted in urine
```
direct bilirubin
water soluble
one glucuronide group (beta bilirubin) two glucuronide groups (gamme bilirubin)
can be excreted in urine
104
Describe delta bilirubin
Levels rise when conjugated bilirubin levels are very high
| Irreversiblely bound to albumin
105
```
Describe urobilinogen
where it is formed
color
how is it primarily excreted
the yellowed color product it is oxidized to in feces and urine
```
formed in the duodenum
colorless
excreted mostly in feces
urobilin
106
Name the specimen type for analysis including cautions for the specimen integrity and result of failing to follow precautions
Serum or plasma
Run quickly or protect from light
Too much light = decreased bili
107
Describe the Jendrassik-Grof method
| - purpose of each reagent
- diazoitized sulphanilic acid converts bilirubin to azobilirubin
- ascorbic acid stops reaction
- tartrate shifts A from 585 to 600 nm
108
Describe the Jendrassik-Grod method
| - final product measured
Azobilirubin
109
Describe the Jendrassik-Grof method
| - difference in the method for total vs direct
Original reaction measures direct bilirubin
Accelerator like caffeine-sodium-benzoate is added to measure indirect bili
Total - direct = indirect
110
Name the 3 layers of the Vitros dry slide method and what occurs on each
Spreading layer - contains caffeine-sodium-benzoate to separate indirect bili from albumin
Screening layer - traps proteins but allows bili to pass
Reaction layer - bilirubin binds to mordant, reflectance measured
111
Describe spectrophotometric measurement of bili
- what it is used for
- the substances measured
- reason for using 2 wavelengths
- reason it cannot be used on adults
- measuring bili in babies < 3 months
- oxyhemoglobin and bilirubin
- oxyhemoglobin measured at 1, bilirubin and hemoglobin measured at the other
- carotenoid interferes
112
List the reference range for bilirubin in adults
Direct 0 - 4 umol/L
Indirect 0 - 16 umol/L
Total 0 - 20 umol/L
113
Describe neonatal bilirubin
- type of bilirubin
- reason for increased levels
- treatments
- critical bilirubin level
- indirect bili
- lack glucuronyltransferase to convert it to direct for excertion
- phototherapy or exchange transfusion
- > 300 umol/L
114
Describe jaundice including at what plasma bilirubin level it occurs
Yellowing of skin and eyes
Occurs around 35 umol/L
May be pre-hepatic, hepatic, or post-hepatic
115
For pre-hepatic jaundice list
- primary cause
- two common examples of a condition that will produce the cause
- primary form of increased bilirubin
- relative bilirubin and urobilinogen levels in plasma, feces, and urine
- increased hemolysis
- hemolytic anemia
- ineffective erythropoiesis,
HDN, transfusion reactions
- increased total bili due to increased indirect bili
- increased direct bili = increased urobilinogen
116
For hepatic jaundice list
- primary cause
- two common examples of a condition that will produce the cause
- primary form of increased bilirubin
- relative bilirubin and urobilinogen levels in plasma, feces, and urine
- liver disease
- necrosis -> cirrhosis
- Gilbert's disease (impaird bilirubin uptake)
- impairment of conjugation
- indirect bilirubin
- increased indirect bili in plasma
decreased urobilinogen in feces and urine
117
For post-hepatic jaundice list
- primary cause
- two common examples of a condition that will produce the cause
- primary form of increased bilirubin
- relative bilirubin and urobilinogen levels in plasma, feces, and urine
- cholestasis
- gallstones
- tumors
- direct bili
- increased direct bili in blood
decreased urobilinogen in feces and urine
direct bilirubin present in urine
118
Name the most common inherited cause of jaundce and the defect involved
Gilbert's disease
Impaired uptake of bilirubin into liver cells
119
For ALP list
- where it is primarily found
- conditions that levels are most increased
- liver canaliculi and bile ducts, bone
- post-hepatic jaundice
cholestasis
moderate in liver damage and bone conditions
120
For GGT list
- where it is primarily found
- conditions that levels are most increased
- liver canaliculi and bile ducts
- post-hepatic janudice
cholestasis
moderate in liver damage, alcohol use
121
For AST list
- where it is primarily found
- conditions that levels are most increased
- hepatocytes, heart, skeletal muscle
- hepatocellular damage
moderate in cholestasis
122
For ALT list
- where it is primarily found
- conditions that levels are most increased
- hepatocytes, heart, skeletal muscle
- hepatocellular damage
moderate in cholestasis
123
For 5'NTD list
- where it is primarily found
- conditions that levels are most increased
- liver canaliculi and bile ducts
- cholestasis
moderate in liver damage
124
Describe how ALP and GGT can be used together to identify liver issues
ALP and GGT elevated = liver issue, likely cholestasis
ALP only elevated = bone related
125
Describe how AST and ALT can be used together to identify liver issues
AST : ALT < 1.0 = acute (viral / toxic hepatis)
AST : ALT = 1.0 = post-hepatic jaundice
AST : ALT > 2.0 = chronic (hepatitis, alcoholism, cirrhosis)
126
Indicate the levels of albumin observed in acute and chronic liver disease, as well as pre and post heptic conditions
Acute - gradual decrease
Chronic - markedly decreased
Norma in pre and post hepatic jandice
127
Indicate the condition that AFP can be elevated in
Hepatocellular carcinoma
128
Indicate the changes observed in gamma globulin levels in liver disease, including characteristic finding in electrophoresis
Increased IgG and IgM in chronic acute hepatitis
Elevated IgA and beta-globulins in cirrhosis
Beta-gamma bridging
129
Describe when ammonia levels can be elevated, and the significance related to this
Elevated in cirrhosis, failure, and necrosis
May lead to coma
130
Name the hematology and coagulation findings associated with liver disease
Increased INR not corrected with vitamin K
Target cells, acantocytes, macrocytes
131
Name some appropriate followup testing for cholestasis
Liver biopsy
132
Name some appropriate followup testing for hepatitis
Hepatitis serology
| Toxicology
133
Name some appropriate followup testing for cholestasis
Ultrasound
134
Where does catabolism of hemoglobin into globin, iron, and biliverdin take place?
Macrophages of liver and spleen
135
What is the source of bilirubin
Heme -> protoporphyrin -> biliverdin -> bilirubin
136
In normal persons how is most bilirubin transported in plasma?
Bound to albumin
137
Where does the conjugation of bilirubin with glucuronic acid take place? What is the enzyme involved?
Liver
Glucuronyltrasferase
138
What portion of the bilirubin excreted by normal persons is derived from hemolysis and catabolism of circulating erythrocytes?
80-90%
| rest derived from other heme proteins
139
What happens to urobilinogen in the intestine?
Converted to urobilin and excreted
| Small amount reabsorbed
140
What happens to urobilinogen in the intestine?
Mostly converted to stercobilin and excreted
| Small amount reabsorbed
141
What's the principle of the Evelyn-Malloy method for bilirubin?
direct bili soluble in acid, reacts with diazo reagent
methanol makes indirect soluble and reactive
direct and total measured at the same time
indirect = total - direct
142
What are the reference ranges for bilirubin in adults?
Direct 0 - 3 umol/L
Indirect 0 - 14 umol/L
Total 0 - 17 umol/L
143
Compare total bilirubin in full term and premature infants
```
FT PM
24h 34-103 17-103
48h 103-120 103-137
3-5d 68-103 171-205
1w =34 higher
```
144
In cases of sever hemolytic anemia, how high can the urinary excretion of indirect bilirubin reach
a. very high
b. moderately high
c. only slightly elevated
d. not elevated
e.
d. not elevated
145
In cases where there is large scale liver necrosis and normal renal function, the serum urea level would be
a. greatly elevated
b. moderately elevated
c. normal decreased
d. decreased
a. greatly elevated
146
Hepatic cellular plates are composed of
a. parenchyma cells
b. hepatocytes
c. Kuppfer cells
d. endothelial cells
e. all of the above
f. a and b only
g. c and d only
f. a and b
147
Sinusoids are composed of
a. parenchyma cells
b. hepatocytes
c. Kuppfer cells
d. endothelial cells
e. all of the above
f. a and b only
g. c and d only
g. c and d
148
The phagocytic function of the liver is carried out by
a. parenchyma cells
b. hepatocytes
c. Kuppfer cells
d. endothelial cells
e. all of the above
f. a and b only
g. c and d only
c. Kuppfer cells
149
Which of the following is/are part of the bile
a. cholesteol
b. bilirubin
c. bile salts
d. enzymes
e. all of the above
e. all of the above
150
Crigler-Najjar Syndrome is caused by
a. congenital lack of glucuronic acid
b. failure of bilirubin transport
c. hemolysis
d. congenital lack of glucuronyl transferase
e. a and d
d. a and d
151
Rotor Syndrome
a. results in hepatic jaundice
b. results in lack of transport of direct bilirubin to bile canaliculi
c. is a type of hepato-cellular jaundice
d. all of the above
e. a and c only
d. all of the above
152
The purpose of caffeine/sodium benzoate in the Jendrassik-Grof procedure is/are
a. to destroy excess bilirubin
b. to convert bilirubin to azobiliruin
c. an accelerating agent
d. all of the above
e. b and c only
c. and accelerating agent
153
The beta gamma briding noted on serum electrophoresis
a. occurs in post hepatic jaundice
b. is characteristic of cirrhosis
c. is the result of elevated IgD and IgM
d. results from and elevation of IgA
e. a, b, and c
f. b and d
g. c and d
f. b and d
154
An increased prothrombin time that fails to respond to vitamin-K is typical of
a. hepatocellular jaundice
b. obstructive jaundice
c. pre-hepatic jaundice
d. post-hepatic jaundice
a. hepatocellular jaundice
155
In cases where there is large scale liver necrosis and normal renal function, the serum urea level would be
a. greatly elevated
b. moderately elevated
c. normal decreased
d. decreased
d. decreased
156
The synthesis of bilirubin diglucuronide occurs
a. in hepatocyte cytosol
b. while bilirubin is attached to ligandin
c. in Kuppfer cells
d. all of the above
e. a and b
e. a and b
157
In the Jendrassik-Grof procedure for bilirubin, ascorbic acid is used to
a. react with bilirubin
b. stop the reaction
c. destroy excess sulphanilic acid
d. all of the aove
e. a and b
f. b and c
f. b and c
158
The purpose of sodium nitrite in the Jendrassik-Grof procedure is
a. to form nitrous acid
b. to provide acidity
c. to convert bilirubin to azobilirubin
d. a and c
e. b and c
a. to form nitrous acid
159
The enterohepatic circulation involves
a. intestine-colon-blood-liver
b. liver-bile duct-intestine-portal vein
c. liver-bile duct-colon-feces
d. portal vein-liver-kidney-bile duct
e.
b. liver-bile duct-intestine-portal vein
160
Hyperbilirubinemia of premature infants is caused by
a. lack of glucuronic acid
b. immaturity of hepatic cells
c. destruction of hemoglobin
d. none of the above
b. immaturity of hepatic cells
161
Diazotization of sulphanilic acid introduces the following function groups on the molecule
a. NH2
b. SO3H
c. COOH
d. NO2
e. N:N
e. N:N
162
In the dry chemistry method of total bilirubin the following is used to dissociate bilirubin from albumin
a. a cationic hydrophobic polymer
b. caffeine-sodium benzoate
c. bilirubin filter
d. a carotenoid compound
e. b and c
b. caffeine-sodium benzoate
163
In the dry chemistry method for total bilirubin, the compound that ensures the reaction of unconjugated bilirubin is
a. oxyhemoglobin
b. delta bilirubin
c. lipid
d. dyphylline
d. dyphylline
164
Which of the following are true
In most types of hepatic jaundice
a. urobilinogen synthesis is increased
b. urobilin excretion is increased
c. urine shows reduced levels of urobilinogen
d. there is urinary excretion of conjugated bilirubin
d
165
In a space occupying lesion of the liver the following may be observed
a. fecal urobilinogen is elevated
b. serum direct bili is elevated
c. urinary urobilinogen is elevated
d. serum ALP is elevated
e.
b and d
166
The following are observed in post-hepatic jaundice
a. decreased excretion of urobilinogen in urine
b. elevated urobilinogen in feces
c. presense of bilirubin diglucuronide in urine
d. increased excretion of direct bilirubin in bile
a and c
167
In normal adults plasma bilirubin should consists of the following factors
a. delta bilirubin
b. gamma bilirubin
c. beta biliruin
d. alpha bilirubin
d.
168
Which of the following are true. In a bilirubinomter
a. measurement of A at 454 nm
b. measurement of A at 540nm
c. subtraction of A at 540 from A at 454
d. difference in solubility of bilirubin at 454 nm and 540 nm
a, b, and c
169
The following is/are characteristics of jaundice caused by hemolytic anemia
a. elevated urine urobilinogen
b. presence of indirect bili in urine
c. elevated serum indirect bili
d. elevated serum direct bili
e.
a and c
170
The following enzymes are greatly increased in obstructive jaundice
a. ALP
b. 5'NTD
c. GGT
d. LDH
a, b, and c
171
An elevation in AST greater than twice the amount of ALT is suggestive of
a. cirrhosis
b. chronic hepatic disease
c. alcoholism
d. viral hepatitis
a, b, and c
172
TRUE OR FALSE
Dublin-Johnson syndrome is a type of hepatic jaundice
True
173
TRUE OR FALSE
Kernicterus is pigmentation of basal ganglia by indirect bili
True
174
TRUE OR FALSE
AST and ALT levels are normal in hemolytic jaundice
True
175
TRUE OR FALSE
5'NTD occurs in the membrane of the cells lining bile canaliculi
True
176
TRUE OR FALSE
Serum albumin is lowered in obstructive jaundice
False
Normal
Lowered in hepatic jaundice
177
TRUE OR FALSE
Chronic alcoholism results in an increase in gamma glutamyl transferase
True
178
TRUE OR FALSE
Inflammation of the walls of the bile ducts is termed cholangitis
True
179
TRUE OR FALSE
ALP is found in the membrane of cells lining the bile canaliculi
True
180
TRUE OR FALSE
The enzyme that results in the release of glucuronic acid from direct bili is beta-glucuronidase
True
181
TRUE OR FALSE
Urobilin is a colorless oxidation product of urobilinogen
False
| Orange brown
182
TRUE OR FALSE
Bilirubin has a hydrophobic non-polar structure
True
183
TRUE OR FALSE
Cholesteol is not a normal constituent of bile
False
