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Clinical Chemistry > LIVER FUNCTION TESTS > Flashcards

LIVER FUNCTION TESTS Flashcards

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1
Q

Liver is composed of 2 types of cells:

A
  1. Hepatocytes
  2. Kupffer Cells (Phagocytic)
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2
Q

To abolish liver tissue function, more than ___ of the liver must be destroyed

A

80%

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3
Q

Liver secretes plasma proteins, carbohydrates, lipids, lipoproteins, clotting factors, ketone bodies and enzymes

12g of albumin produced daily

A

Synthetic Function

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4
Q

Involved in metabolism of bilirubin

200g - 300g of bilirubin produced daily

A

Conjugation Function

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5
Q

Liver serves to protecy the body from potentially injurous substances absorbed from intestinal tract and toxic by-products of metabolism
Ammonia is converted to urea in liver

A

Detoxification and Drug metabolism

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6
Q

Excretion of bile involves the elimination of bile acids or salts, pigments, cholesterol

A

Excretory and Secretory Function

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7
Q

Storage site for all fat-soluble and water-soluble vitamins
Storage depot for glycogen

A

Storage Function

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8
Q

Important for assessing nutritional status and presence of severe disease involving liver, kidney and bone marrow

A

Total Protein

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9
Q

Transudates have a TP of

A

(<)3.0 g/dL

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10
Q

Exudates have a TP of:

A

(> 3.0 g/dL)

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11
Q

Total Protein is usually performed in serum, which has no __ and no ____

A

Fibrinogen
and Anticoagulant

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12
Q

Reference Method of TP

A

6.5-8.3 g/dL

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13
Q

Reference method but not routinely use
Based on measurement of the nitrogen content of protein
Serum treated with tungstic acid, forming protein-free filtrate

A

Kjedahl Method

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14
Q

Nitrogen content of proteins

A

15.1% to 16.8%

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15
Q

Reagent of Kjedahl Method

A

H2SO4
Sulfuric Acid

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16
Q

End product of Kjedahl Method

A

Ammonia

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17
Q

Most widely used method
Extensively used in clinical laboratories
Requires at least 2 peptide bonds and an alkaline medium to measure total protein

A

Biuret Method

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18
Q

Cupric ions complex the groups involved in the peptide bond forming a violet-colored chelate is ___ to the number of peptide bonds present and reflects the TP level at 545 nm

A

Proportional

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19
Q

Reagents of Biuret Method:

A
  1. Alkaline Copper Sulfate
  2. Rochelle Salt (NaK Tartrate)
  3. NaOH & Potassium Iodide
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20
Q

Highest Analytical Sensitivity
Oxidation of phenolic compounds such as tyrosine, tryptophan and histidine to give a deep blue color

A

Folin-Ciocalteu (Lowry) Method

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21
Q

Main reagent of Folin-Ciocalteu

A

Phosphotungstic-Molybdic Acid
Phenol Reagent

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22
Q

Color enhancer of Folin-Ciocalteu Method

A

Biuret reagent

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23
Q

Absorbance of proteins at 210 nm is due to absorbance of peptide bonds at specific wavelength
Proteins absorb light at 280 nm and at 210 nm

A

Ultraviolet Absorption Method

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24
Q

Migration of charged particles in an electric field

A

Serum Protein Electrophoresis

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25
Q

Fastest band
Most Anodal Protein

A

Albumin

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26
Q

2nd Fastest band
Includes:
> Glycoproteins
> AAT
> AAG (A1- Acid glycoprotein)
> TBG
Increases as a non specific response to inflammation

A

Alpha-1 Globulin

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27
Q

3rd Fastest band
Includes:
1. Haptoglobin
2. AMG (a2-Macroglobulin)
3. Ceruloplasmin

A

Alpha-2 Globulin

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28
Q

4th band
Includes:
1. Transferrin
2. Beta-lipoprotein
3. Hemopexin
4. Complement C3 and C4

A

Beta Globulin

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29
Q

5th band
Slowest band
Includes:
Immunoglobulin
CRP

A

Gamma-globulin

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30
Q

Gamma Spike

A

Multiple Myeloma

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31
Q

Beta-Gamma bridging

A

Hepatic Cirrhosis

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32
Q

A2-Globulin band spike

A

Nephrotic Syndrome

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33
Q

A1-Globulin Flat curve

A

Juvenile Cirrhosis or
AAT deficiency

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34
Q

Spikes of a1, a2, and B globulin bands

A

Inflammation

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35
Q

Presence of this protein causes “Blip” in late alpha-2 or early beta zone

A

Free Hemoglobin

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36
Q

Presence of small spikes in beta region is due to:

A

Iron Deficiency Anema
Transferrin

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37
Q

Alternative test to chemical analysis of serum total proteins
Based on measurement of refractive index of solutes in serum

A

Refractometry

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38
Q

Utilize Sulfosalicylic Acid or Trichloroacetic acid
Measurement depends on formation of a uniform fine ppt which scatters incident light in suspension (nephelometry) or block light (turbidimetry)

A

Turbidimetric and
Nephelometric Method

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39
Q

Globulins can be separated from albumin by salting-out procedures using sodium salts
Globulin is insoluble in water but not in dilute salt solution

A

Salt Fractionation

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40
Q
  1. Malignancy
  2. Multiple Myeloma
  3. Waldenstrom’s Macroglobulinemia
A

Increased TP

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41
Q
  1. Hepatic Cirrhosis
  2. Glomerulonephritis
  3. Nephrotic Syndrome
  4. Starvation
A

Decreased Total Protein

42
Q

Differentiates intrahepatic disorder (prolonged protime) from extrahepatic obstructive liver disease (normal protime)

A

Prothrombin Time
Vitamin K Response Test

43
Q

Concentration of this protein is inversely proportional to the severity of the liver disease

A

Albumin

44
Q

Low total protein + Low albumin =

A

Hepatic Cirrhosis (Gradual loss)
Nephrotic Syndrome (Abrupt loss)

45
Q

Most commonly used dye for measurement

A

Bromcresol Green (BCG)

46
Q

Most Specific Dye used for measurement

A

Bromcresol Purple

47
Q
  1. Severe Dehydration
  2. Prolonged tourniquet application (Artifactual Hyperalbuminemia)
A

Hyperalbuminemia

48
Q
  1. Reduced Synthesis
    * Chronic Liver Disease
    * Malabsorption Syndrome
    * Malnutrition and Muscle Wasting Disease
  2. Increased Loss
    * Nephrotic Syndrome (Inc Albumin excretion)
    * Massive burns
    * Protein-losing enteropathy
    * Orthostatic Albuminuria
  3. Increased Catabolism
    * Massive burns
    * Widespread malignancy
    * Thyrotoxicosis
A

Hypoalbuminemia

49
Q

Hereditary absence of albumin or inability to synthesize albumin

A

Analbuminemia

50
Q

Presence of 2 albumin bands instead of a single band in electrophoresis
Presence of albumin with unusual molecular characteristics in blood

A

Bisalbuminemia

51
Q

Determine to validate if globulin is higher than albumin

A

Albumin/Globulin Ratio

52
Q

If globulin is greater than albumin is known as inverted A/G ratio and seen in:

A
  1. Cirrhosis
  2. Multiple Myeloma
  3. Waldenstrom’s Macroglobulinemia
53
Q

Reference Value of A/G ratio

A

1.3 - 3.1

54
Q

End product of hemoglobin metabolism and the principla pigment in bile
Formed from destruction of heme-containing proteins such as myoglobin, catalase and cytochrome oxidase

A

Bilirubin

55
Q

Enzyme that is needed to conjugate Uncojugated bilirubin in the Liver

A

Uridine Diphosphate Glucoronyl Transferase
UDPGT

56
Q

Unconjugated bilirubin binds to ___ to be transported Liver

A

Albumin

57
Q

Uncojugated Bilirubin is increased in:

A

Pre-hepatic bilirubin

58
Q

Uncojugated Bilirubin is increased in:

A

Pre-hepatic bilirubin

59
Q

Conjugated bilirubin is increased:

A
  1. Post-hepatic bilirubin
  2. Hepatic bilirubin
  3. Obstructive and Regurgitative bilirubin
60
Q

Reference Value of Conjugated Bilirubin

A

0-0.2 mg/dL

61
Q

Reference Value of Uncojugated bilirubin

A

0.2 - 0.8 mg/dL

62
Q

Reference Value for Total bilirubin

A

0.2 - 1.0 mg/dL

63
Q

Conjugated bilirubin tightly bound to albumin
Formed due to prolonged elevation of conjugated bilirubin in biliary obstruction
Reacts with Diazo reagent

A

Delta Bilirubin

64
Q

Computed Delta bilirubin formula:

A

TB - DB + IB = Delta Bilirubin

65
Q

Reference Value of Delta Bilirubin

A

(<) 0.2 mg/dL

66
Q

Also called Icterus or Hyperbilirubinemia
Yellow discoloration of the skin, sclera and mucus membranes
Bilirubin levels > 2mg/dL

A

Jaundice

67
Q

Cause: Too much destruction of RBC
Bilirubin Assay: Elevated B1, & Urobilinogen

A

Pre-hepatic Jaundice

68
Q

Cause: Failure of bile to flow to the intestine or impaired bilirubin excretion
Assay: Elevated B2

A

Post-Hepatic Jaundice

69
Q

Cause: Hepatocyte injury caused by viruses, alcohol and parasites
ASsay: Elevated B1, and B2, Urobilinogen & (+) Urine bilirubin

A

Hepatocellular Combined Jaundice

70
Q

Characterized by impaired cellular uptake of bilirubin
Lab: Elevated B1

A

Gilbert’s Syndrome

Bilirubin Transport Deficity

71
Q

Characterized by impaired cellular uptake of bilirubin
Lab: Elevated B1
Bilirubin Transport Deficit

A

Gilbert’s Syndrome

Bilirubin Transport Deficit

72
Q

Infants are treated by phototherapy
Lab: Elevated B1
Conjugation Deficit

A

Crigler-Najjar Syndrome

73
Q

Deficiency of UDPGT
Absence of B2 production
(+) Kernicterus; Bile Colorless

A

Type 1 Crigler-Najjar Syndrome

74
Q

Partial deficiency of UDPGT
Decreased B2

A

Type 2 Crigler-Najjar Syndrome

75
Q

Defective excretion of conjugated bilirubin into the canaliculi, caused by hepatocyte membrane defect
Intense dark pigmentation of the liver (accumulation of lipofuschin pigment)
Elevated B2 and Total Bilirubin
Bilirubin Excretion Defect

A

Dubin-Johnson Syndrome &
Rotor Syndrome

76
Q

Familial form of unconjugated hyperbilirubinemia due to circulating inhibirot of bilirubin
Elevated B1

A

Lucey-Driscoll Syndrome

77
Q

What bilirubin can cross the blood-barrier and lead to kernicterus

A

Unbound Bilirubin
Free Bilirubin

78
Q

Most common cause of hyperbilirubinemia in adults

A

Cholelithiasis
(Gall stones)

79
Q

Van den Berg Reaction is diazotization of bilirubin to produce what:

A

Azobilirubin

80
Q

Accelator: Methanol
Diazo Reagents:
Diazo A = 0.1% Sulfanilic Acid + HCl
Diazo B = 0.5% Sodium Nitrite
Diazo Blank = 1.5% HCl
Final: Pink to purple Azobilirubin

A

Evelyn and Malloy Method

81
Q

Most commonly used method
More sensitice than Evelyn & Malloy method
Not affected by Hemoglobin up to 750 mg/dL & pH changes
Main reagent: Diazo Reagent
Coupling Accelerator: Caffeine Sodium Benzoate
Final: Pink to Blue azobilirubin

A

Jendrassik & Grof Method

82
Q

Solution that provides an alkaline pH

A

Alkaline tartrate solution

83
Q
  1. Gilbert’s Syndrome
  2. Criggler-Najjar Syndrome
  3. Hemolytic Anemia
  4. Hepatocellular disease
  5. Lucey Driscoll
  6. G-6-PD deficiency
A

Increased B1
Uncojugated Bilirubin

84
Q
  1. Biliary Obstruction
  2. Pancreatic cancer
  3. Dubin-Johnson Syndrome (Bilirubin Excretion Deficit)
  4. Alcoholic & Viral hepatits
  5. Biliary Atresia
  6. Hepatocellular disease
A

Increased B2
Conjugated Bilirubin

85
Q

Test for hepatocellular function and potency of bile duct
Rarely used

A

Bromsulfonthalein (BSP) Dye Excretion Test

86
Q

Double Collection Method
Dose: 2mg/BW of patient
Collect: after 5 minutes & 30 minutes

A

Rosenthal White

87
Q

Single Collection Method
Dose: 5kg/BW
Collect: after 45 minutes

A

Mac Donald Method

88
Q

Colorless end product of bilirubin metabolism that is oxidized by intestinal bacteria to the brown pigment, urobilin

A

Urobilinogen

89
Q

Excreted in urine and feces, or reabsorbed into the portal blood & returned to liver

A

Urobilinogen

90
Q

Absence of Urobilinogen in urine or stool denotes

A

Complete Biliary Obstruction

91
Q

Method for Urobilinogen:

A

Ehrlich’s Method
p-dimethyl aminobenzaldehyde reagent

92
Q

Reference Value: Urobilinogen

A

Urine: 0.1 - 1.0 Ehrlich units/2 hr
Stool: 75 - 275 Ehrlich units/100g feces

93
Q

Used to assess the extent of liver damage & differentiate hepatocellular from obstructive disease

A

Enzyme tests

94
Q

Enzymes secreted by the liver:

A

Alkaline Phosphatase
Aminotransferases
5’ nucleotidase
Gamma-Glutamyl Transferase
OCT
LAP
Lactate Dehydrogenase

95
Q

Arises from deamination of amino acids, through action of digestive & bacterial enzymes on proteins in intestinal tract
Marker for Detoxification
Liver normally removes most of this NPN and converts it to Urea and eliminated by kidneys

A

Ammonia

96
Q

Reference Value of Ammonia

A

19 - 60 ug/dL

97
Q

Increased levels of Ammonia

A
  1. Cirrhosis
  2. Hepatitis
  3. Reye’s Sydrome
  4. Chronic Renal Disease
  5. Acetaminophen poisoning
98
Q

Nitrogen is converted to Ammonia by Sulfuric Acid in presence of Catalys (CuSO4, Mercury & Selenium)

A

Kjedahl Method
Digestion Method

99
Q

Ammonia + K2Hg2I2 —-Gum Ghatti—> NH2Hg2I2
End color: Yellow if N2 low to moderate
End color: Orange if N2 high

A

Nesslerization Reaction

100
Q

NH3 + Phenol + Hypochlorite —-Na Nitroprusside—> Indophenol Blue

A

Berthelot Reaction

101
Q

NH3 + a-ketoglutarate + NADPH —Glutamate Dehydrogenase—-> Glutamate + NADP

A

Glutamate Dehydrogenase Method

Clinical Chemistry (16 decks)

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