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Clinical Chemistry (LECT) > Liver Function (Liver-Syndrome) > Flashcards

Liver Function (Liver-Syndrome) Flashcards

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1
Q

The chief metabolic organ of the body

A

Liver

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2
Q

A large organ divided unequally into two lobes by a falciform ligament

A

Liver

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3
Q

functional unit of the liver

A

Lobules

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4
Q

2 major cells

A

Hepatocytes (80%)

Hepatic macrophage (20%)

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5
Q

Most abundant cell

A

Hepatocytes (80%)

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6
Q

aka Kupffers cells

A

Hepatic macrophage (20%)

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7
Q

Liver blood supply: ________

A

1500 mL/min

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8
Q

2 blood supply of liver

A

Hepatic artery (25%)

Portal vein (75%)

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9
Q

Majority of the blood that is supplied to the liver.

A

Portal vein (75%)

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10
Q

Functions of the Liver

A
  1. Synthetic Function
  2. Conjugation Function
  3. Detoxification and Drug Metabolism
  4. Excretory and Secretory Function
  5. Storage Function
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11
Q

The capacity of liver to synthesize substances

A

Synthetic Function

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12
Q

Example of substances being synthesize by the liver

A

Proteins, cholesterol, carbohydrates, lipids, lipoproteins, enzymes, albumin (plasma protein)

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13
Q

Albumin rate of production

A

9-12 g/day

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14
Q

Involves the metabolism of bilirubin

A

Conjugation Function

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15
Q

Product of hemoglobin metabolism

A

Bilirubin

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16
Q

Liver conjugates bilirubin to ___________

A

200-300 mg/day

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17
Q

The liver protects the body from potential toxic substances absorbed from the intestine and toxic metabolic byproducts (eg. pharmaceutical drugs)

A

Detoxification and Drug Metabolism

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18
Q

Function of the liver that involves the bile

A

Excretory and Secretory Function

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19
Q

Emulsify fats (cholesterol) which is then excreted in the body

A

Bile

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20
Q

Liver is a storage site of glycogen, fat-soluble vitamins (A, D, E, K), and water-soluble vitamins

A

Storage Function

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21
Q

In storage function, Liver is a storage site of __________, ____-_______ (_, _, _, _), and ____-_____ _______

A

Glycogen

Fat-soluble vitamins (A, D, E, K)

Water-soluble vitamins

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22
Q

T/F: Storage Function is still assessed in the laboratory

A

FALSE: Not assessed in the laboratory; no diagnostic significance

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23
Q

T/F: All functions of the liver are assessed in the laboratory

A

FALSE: Out of the 5 functions of liver, only 4 functions are assessed in the laboratory (1-4)

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24
Q

enumerate which functions of the liver are assessed in the laboratory

A
  1. Synthetic Function
  2. Conjugation Function
  3. Detoxification and Drug Metabolism
  4. Excretory and Secretory Function
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25
Q

All functions of the liver are assessed in the laboratory EXCEPT:

A

Storage Function

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26
Q

Used to quantitate the severity of hepatic dysfunction

A

TESTS FOR LIVER SYNTHETIC FUNCTION

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27
Q

The more severe the hepatic dysfunction = the (less, more) the synthetic activity of liver

A

Less

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28
Q

TESTS FOR LIVER SYNTHETIC FUNCTION Measures:

A

Albumin (plasma protein)
Vitamin K-dependent clotting factors
Cholesterol (endogenous)

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29
Q

What are the Vitamin K-dependent clotting factors:

A
  1. Clotting Factors 2,7,9,10
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30
Q

What is Clotting Factor 2?

A

Prothrombin

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31
Q

What is Clotting Factor 7?

A

Stable Factor (Proconvertin)

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32
Q

What is Clotting Factor 9?

A

Plasma thromboplastic component (Christmas factor)

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33
Q

What is Clotting Factor 10?

A

Stuart-prower factor

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34
Q

What are the tests for liver synthetic function?

A
  1. Total Protein
  2. Albumin
  3. Albumin/Globulin Ratio
  4. Prothrombin Test
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35
Q

Assessment of nutritional status and presence of severe disease involving the liver, kidney and bone marrow

A

Total protein

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36
Q

Sample in Total Protein

A

Serum; NEVER plasma

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37
Q

Why is plasma never used in Total Protein?

A

Because all clotting factors are present and the majority is fibrinogen

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38
Q

Fibrinogen can increase total protein by _____________

A

0.2-0.4 g/dL

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39
Q

TOTAL PROTEIN

Interferences

A

hemolysis, ictericia

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40
Q

TOTAL PROTEIN

Reference value (serum)

A

6.5-8.3 g/dL
(CF to g/L: 10)

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41
Q

Methods for Total Protein

A
  1. Kjeldahl Method
  2. Biuret Method
  3. Folin-Ciocalteu (Lowry) Method
  4. UV Absorption Method
  5. Refractometry
  6. Turbidmetry and Nephelometry
  7. Salt Fractionation
  8. Coomasie Brilliant Blue Dye
  9. Ninhydrin
  10. Serum Protein Electrophoresis
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42
Q

Which method for Total is the MOST sensitive

A

Folin-Ciocalteu (Lowry) Method

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43
Q

Concentration is inversely proportional to the severity of hepatic disease.

A

ALBUMIN

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44
Q

ALBUMIN

T/F: Concentration is directly proportional to the severity of hepatic disease.

A

FALSE: Inversely proportional

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45
Q

↓albumin = (more, less) severe hepatic disease

A

more

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46
Q

Albumin is produced in the _______

A

Liver

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47
Q

Low albumin due to decrease synthesis

A

Hepatic cirrhosis

Nephrotic syndrome:

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48
Q

In hepatic cirrhosis and nephrotic syndrome, albumin and total protein are (increased, decreased)

A

Decreased

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49
Q

Why is total protein decreased in hepatic cirrhosis and nephrotic syndrome?

A

total protein is decreased because majority of total protein is albumin

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50
Q

ELECTROPHORETIC PATTERN

What is seen in hepatic cirrhosis?

A

β-γ bridging

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51
Q

ELECTROPHORETIC PATTERN

What is seen in Nephrotic syndrome?

A

α2 globulin spike

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52
Q

Methods in Albumin

A

Salt precipitation

Dye-binding

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53
Q

ALBUMIN

Reference value:

A

3.5 - 5.0 g/dL

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54
Q

ALBUMIN

Decreased reference value = (increased, decreased) total protein concentration

A

decreased

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55
Q

Used to validate if globulin is higher than the albumin

A

Albumin/Globulin Ratio

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56
Q

Globulin > Albumin

A

Inverted A/G ratio

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57
Q

Inverted A/G ratio occurs due to:

A

Hepatic cirrhosis
Multiple myeloma
Waldenström’s macroglobulinemia

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58
Q

ELECTROPHORETIC PATTERN

What is seen in Multiple myeloma?

A

gamma spike

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59
Q

ALBUMIN/GLOBULIN RATIO

Reference value:

A

1.3-3.1 g/dL
(CF to g/L: 10)

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60
Q

AG ratio =

A

Albumin/Globulin

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61
Q

Globulin =

A

Total protein - Albumin

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62
Q

Prothrombin test aka

A

Vitamin K Response Test

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63
Q

T/F: Prothrombin test is called as Vitamin K Response Test in case of laboratory liver synthetic function assessment

A

TRUE

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64
Q

What Vitamin K is being administered in Prothrombin Test?

A

phyloquinones

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65
Q

What is the method of administration in Prothrombin Test?

A

Intramuscularly

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66
Q

Dosage of Vitamin K administered in Prothrombin Test

A

10 mg for 1-3 days

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67
Q

T/F: Administration of Vitamin K in Prothrombin Test is done after the testing

A

FALSE: Prior the testing

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68
Q

Prolonged Prothrombin Time – liver cannot synthesize _______________

A

Clotting factors

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69
Q

It differentiates intrahepatic disorder from extrahepatic disorder

A

Prothrombin Test

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70
Q

PROTHROMBIN TEST

T/F: Intrahepatic disorder occurs in the liver

A

TRUE

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71
Q

PROTHROMBIN TEST

Intrahepatic disorder is due to (decreased, increased), (short, prolonged) prothrombin time

A

Increased

Prolonged

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72
Q

PROTHROMBIN TEST

T/F: Extrahepatic disorder occurs in the liver

A

FALSE: Outside the liver

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73
Q

PROTHROMBIN TEST

T/F: Extrahepatic disorder (normal, abnormal) prothrombin time

A

Normal

74
Q

Prolonged prothrombin time signifies massive cellular damage.

A

Acute/Chronic Hepatitis

75
Q

TESTS FOR CONJUGATION AND EXCRETION FUNCTION

A
  1. Bilirubin
  2. Delta Bilirubin
76
Q

End product of hemoglobin metabolism (waste product)

A

Bilirubin

77
Q

No function in the body; excreted

A

Bilirubin

78
Q

Principal pigment in bile

A

Bilirubin

79
Q

____ of bilirubin are from hemoglobin

A

85%

80
Q

15% of bilirubin are from ____, _______,_______

A

myoglobin, cytochrome, peroxidase/catalase

81
Q

Produced if RBCs are senescent

A

Bilirubin

82
Q

How is Bilirubin Synthesized by the body?

A
  1. Happens in the Circulation
  2. Happens in the Liver
83
Q

HAPPENS IN THE CIRCULATION

After ____ days, RBC will be transported to ______, which will then be destroyed, resulting to the release of __________.

A

120

Spleen

Hemoglobin

84
Q

Three components of hemoglobin:

A

Ferrous Iron (Fe²⁺)
Heme
Globin

85
Q

Ferrous iron (Fe²⁺) in hemoglobin are transported by _________ to the liver and bone marrow

A

Transferrin

86
Q

HAPPENS IN THE CIRCULATION

When globins are degraded, amino acids will be
(excreted, reused)

A

reused

87
Q

HAPPENS IN THE CIRCULATION

Heme will be converted to __________

A

Biliverdin

88
Q

HAPPENS IN THE CIRCULATION

The conversion of heme to biliverdin is through the action of ____________

A

Heme oxygenase

89
Q

HAPPENS IN THE CIRCULATION

Biliverdin, in the action of ____________ will be converted to bilirubin 1

A

Biliverdin reductase

90
Q

HAPPENS IN THE LIVER

Albumin will release ___________

A

Bilirubin 1

91
Q

HAPPENS IN THE LIVER

Bilirubin 1 will be bound to a transport protein called as ________

A

Ligandins

92
Q

HAPPENS IN THE LIVER

Bilirubin 1 esterification/conjugation in the ligandins produces _________________________

A

Bilirubin monoglucuronide

93
Q

HAPPENS IN THE LIVER

Conjugation of the other propionic acid by addition of another glucuronic acid to produce _____________________ _________________

A

bilirubin diglucuronide/bilirubin 2

94
Q

The conjugation process is catalyzed by the enzyme

A

uridine diphosphate glucuronyl transferase (UDPGT)

95
Q

In the intestine, the B2 will be reduced to __________, _________, and to ___________ in the intestines

A

mesobilirubin —> mesobilirubinogen –> urobilinogen

96
Q

Urobilinogen fates:

A

80% - feces
20% - urine

97
Q

Principal pigment of feces

A

Stercobilin

98
Q

Principal pigment of urine

A

Urochrome

99
Q

BILIRUBIN 1 other names

A
  • Unconjugated Bilirubin
  • Water insoluble
  • Non-polar Bilirubin
  • Indirect Bilirubin
  • Hemobilirubin
  • Slow reacting
  • Pre-hepatic Bilirubin
100
Q

BILIRUBIN 2 other names

A
  • Conjugated Bilirubin
  • Water soluble
  • Polar Bilirubin
  • Direct Bilirubin
  • Cholebilirubin
  • One-minute/Prompt Bilirubin (quickly reacts with)
  • Post-hepatic / Hepatic / Obstuctuve / Regurtitative Bilirubn
101
Q

Plasma concentration of bilirubin increases upon birth and reaches its peak on the ___ day.

A

5th

102
Q

If bilirubin synthesis > liver clearance rate = (increased, decreased) bilirubin level

A

Increased

103
Q

BILIRUBIN

Reference value for Conjugated Bilirubin (B2)

A

0 - 0.2 mg/dL (0-3 µmol/L)

104
Q

Requires the most sensitive reagent because the normal value is zero

A

Conjugated Bilirubin (B2)

105
Q

BILIRUBIN

Reference value for Unconjugated Bilirubin (B2)

A

0.2-0.8 mg/dL (3-14 µmol/L)

106
Q

BILIRUBIN

Reference value for Total Bilirubin (B2 + B1)

A

0.2-1.0 mg/dL (3-17 µmol/L)

107
Q

Must be conjugated to be excreted

A

Bilirubin 1

108
Q

Common bilirubin found in the circulation

A

Bilirubin 1

109
Q

Normally present in blood (formed in the circulation)

A

Bilirubin 1

110
Q

Normally not present in serum

A

Bilirubin 2

111
Q

Small amount of ____________ in the blood is because of minor leakage from ______________

A

Bilirubin 2

Hepatocytes

112
Q

Formed in the liver

A

Bilirubin 2

113
Q

Conjugated bilirubin bounded to albumin

A

Delta Bilirubin

114
Q

DELTA BILIRUBIN

Helps in monitoring the decline of serum bilirubin following _____________

A

Cholecystectomy (Surgical removal of the gall bladder)

115
Q

Prolonged elevation of conjugated bilirubin is due to the binding of albumin in serum/plasma

A

Delta Bilirubin

116
Q

T/F: Delta Bilirubin has shorter life compared to other bilirubin

A

FALSE: Longer

117
Q

Delta bilirubin reacts with what reagent?

A

Diazo reagent

118
Q

DELTA BILIRUBIN

Reference Value:

A

<0.2 mg/dL

119
Q

T/F: Delta bilirubin is computed, not measured

A

TRUE

120
Q

Delta bilirubin is measured if patient is ________ (_________) due to high bilirubin

A

neonate (≤14 days)

121
Q

Delta bilirubin =

A

TB - (IB+DB)

122
Q

Condition where there is increase in bilirubin

A

Jaundice

123
Q

_____________________ characterized by yellow discoloration of the skin, sclera, and mucus membranes.

A

Hyperbilirubinemia

124
Q

Most common hyperbilirubinemia among adults?

A

Cholelithiasis (gallstones)

125
Q

More commonly termed for serum or plasma with abnormal yellow discoloration due to hyperbilirubinemia.

A

Icterus

126
Q

T/F: Icterus is always visible

A

FALSE: NOT always visible

127
Q

ICTERUS

It will be visible if the bilirubin ________

A

> 25mg/dL (visible ictericia)

128
Q

T/F: Icterus is still used interchangeably with jaundice

A

FALSE: BEFORE, but is now only referring to serum or plasma

129
Q

Type of jaundice is not visible to the naked eyes (although with high bilirubin)

A

Overt Jaundice

130
Q

Over jaundice has a bilirubin level of

A

1.0 - 1.5 mg/dL

131
Q

Overt jaundice will only become visible if the bilirubin is ________

A

3.0 - 5.0 mg/dL

132
Q

THREE TYPES OF JAUNDICE

A
  • Pre-hepatic jaundice
  • Post-hepatic jaundice
  • Hepatic jaundice
133
Q

aka Hemolytic jaundice, Unconjugated hyperbilirubinemia

A

PRE-HEPATIC JAUNDICE

134
Q

Caused by too much red blood cell destruction

A

PRE-HEPATIC JAUNDICE

135
Q

PRE-HEPATIC JAUNDICE

Conditions where there is too much RBC destruction

A
  • Hemolytic disease of the newborn
  • Hemolytic anemia
  • Malaria
136
Q

PRE-HEPATIC JAUNDICE

Very rare because bilirubin are removed by the placenta

A

Hemolytic disease of the newborn (HDN)

137
Q

PRE-HEPATIC JAUNDICE

Cause of malaria

A

Plasmodium spp.

138
Q

From most to least common, enumerate the Plasmodium spp.

A

P. falciparum
P. vivax
P. malariae
P. ovale

139
Q

PRE-HEPATIC JAUNDICE

Increased destroyed RBCs = (increased, decreased) hemoglobin released

A

increased

140
Q

PRE-HEPATIC JAUNDICE

Laboratory findings:
- Indirect Bilirubin: __________
- Direct Bilirubin: ________
- Urobilinogen: _________
- Urine bilirubin: ________

A

Increased
Normal
Normal
Negative

141
Q

T/F: Increase indirect bilirubin is toxic (neurotoxic)

A

TRUE

142
Q

Indirect bilirubin is neurotoxic because it can cross the blood brain barrier (BBB) causing __________

A

Kernicterus

143
Q

bilirubin deposition in the brain causing severe motor dysfunction and retardation

A

Kernicterus

144
Q

aka Obstructive jaundice

A

POST-HEPATIC JAUNDICE

145
Q

Caused by failure of bile to flow to the intestine or impaired bilirubin excretion

A

POST-HEPATIC JAUNDICE

146
Q

POST-HEPATIC JAUNDICE

Laboratory findings:
- Indirect Bilirubin: __________
- Direct Bilirubin: ________
- Urobilinogen: _________
- Urine bilirubin: ________
- Alkaline phosphatase: __________

A

Normal
Increased
Decreased
Positive
Increased

147
Q

No.1 marker of the post-hepatic jaundice

A

Alkaline phosphatase:

148
Q

It is increased due to increased excretion rate

A

Alkaline phosphatase:

149
Q

aka Hepatocellular combined jaundice

A

HEPATIC JAUNDICE

150
Q

Caused by disorders of bilirubin metabolism, transport defects, hepatocellular injury or destruction.

A

HEPATIC JAUNDICE

151
Q

HEPATIC JAUNDICE

Laboratory findings:
- Indirect Bilirubin: __________
- Direct Bilirubin: ________
- Urobilinogen: _________
- Urine bilirubin: ________

A

Increased
Increased
Decreased
Positive

152
Q

INHERITED DISORDERS OF BILIRUBIN METABOLISM (HEPATIC JAUNDICE)

A
  1. Gilbert’s Syndrome
  2. Crigler-Najjar Syndrome (Type 1 & 2)
  3. Dubin Johnson Syndrome
  4. Rotor Syndrome
  5. Lucey-Driscoll Syndrome
153
Q

Bilirubin Transport Deficit

A

Gilbert’s Syndrome

154
Q

Characterized by impaired cellular uptake of bilirubin due to genetic mutation in UGT1A1 gene (chromosome #2)

A

Gilbert’s Syndrome

155
Q

GILBERT’S SYNDROME

Characterized by impaired cellular uptake of bilirubin due to genetic mutation in _______ gene (chromosome #2)

A

UGT1A1

156
Q

GILBERT’S SYNDROME

Affected individuals may have no symptoms but may have mild _________ and predisposed ______________ (aka paracetamol) toxicity.

A

Icterus

Acetaminophen

157
Q

GILBERT’S SYNDROME

Laboratory Findings:
- Indirect Bilirubin: ________

A

1.5-3.0 mg/dL

158
Q

GILBERT’S SYNDROME

Indirect Bilirubin rarely increased to _______ as it maximizes its conjugation activity

A

4.5 mg/dL

159
Q

Conjugation Deficit

A

Crigler-Najjar Syndrome

160
Q

CRIGLER-NAJJAR SYNDROME

Problem: _______

A

conjugation process

161
Q

CRIGLER-NAJJAR SYNDROME

Laboratory result:

A

Elevated indirect bilirubin

162
Q

Complete deficiency of UDGPT

A

Crigler-Najjar Syndrome Type I

163
Q

CRIGLER-NAJJAR SYNDROME TYPE 1

Complete deficiency of _______

A

UDGPT

164
Q

CRIGLER-NAJJAR SYNDROME TYPE 1

Laboratory results:
- Indirect bilirubin: _______
- Direct bilirubin: _________

A

> 25 mg/dL

None

165
Q

CRIGLER-NAJJAR SYNDROME TYPE 1

Symptoms:

A

kernicterus, colorless bile

166
Q

Partial deficiency of UDGPT

A

CRIGLER-NAJJAR SYNDROME TYPE 2

167
Q

CRIGLER-NAJJAR SYNDROME TYPE 2

(partial, complete) deficiency of UDGPT

A

Partial

168
Q

CRIGLER-NAJJAR SYNDROME TYPE 2

Laboratory results:
- Indirect bilirubin: _______
- Direct bilirubin: _________

A

5-20 mg/dL
small amount

169
Q

Diagnostic treatment for Crigler-Najjar Syndrome: ___________

A

Phototherapy

170
Q

Bilirubin Excretion Deficit
Conjugated Hyperbilirubinemia

A

Dubin-Johnson Syndrome

171
Q

Defective excretion of direct bilirubin into the canaliculi caused by hepatocyte membrane defect.

A

Dubin-Johnson Syndrome

172
Q

DUBIN-JOHNSON SYNDROME

Characterized of an intense dark pigmentation of the liver due to accumulation of ________________

A

lipofuscin pigment

173
Q

Accumulation of lipofuscin pigment is called as

A

Black liver (black discoloration of the liver)

174
Q

DUBIN-JOHNSON SYNDROME

Laboratory findings:
- Elevation in direct bilirubin and total bilirubin (___________)
- Delta Bilirubin: __________

A

2-5 mg/dL
Increased

175
Q

Similar with Dubin-Johnson Syndrome WITHOUT the “black liver”

A

Rotor Syndrome

176
Q

Inherited disorders of bilirubin metabolism which cause is unknown

A

Rotor Syndrome

177
Q

ROTOR SYNDROME

Laboratory findings:
- Elevation in direct bilirubin and total bilirubin (___________)
- Delta Bilirubin: __________

A

2-5 mg/dL
Increased

178
Q

Familial form of unconjugated hyperbilirubinemia caused by a circulating inhibitor of bilirubin conjugation

A

Lucey-Driscoll Syndrome

179
Q

LUCEY-DRISCOLL SYNDROME

________ (conjugation enzyme) are inhibited - no conjugation, no B2

A

UDPGT

180
Q

LUCEY-DRISCOLL SYNDROME

Laboratory findings:
- Indirect bilirubin: _________

A

increased (2-3 weeks of life)

Clinical Chemistry (LECT) (2 decks)

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