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Clinical Chemistry 1 > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

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1
Q

The chief metabolic organ

A

liver

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2
Q

Large organ divided unequally into 2 lobes by a ____

A

falciform ligament

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3
Q

functional unit of the liver

A

Lobules

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4
Q

2 major type of cells in liver

A

Hepatocytes
Kupffer cells

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5
Q

AKA hepatic macrophage

A

Kupffer cells

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6
Q

Produces majority of lobules

A

Hepatocytes

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7
Q

2 blood supply of liver

A

Hepatic artery
Portal vein

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8
Q

Supplies 25% of blood

A

hepatic artery

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9
Q

Supplies majority of blood (75%)

A

portal vein

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10
Q

blood produced by liver (____ mL/min)

A

1500

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11
Q

synthetic function secretes ____ (6)

A

plasma proteins, CHO, lipids, lipoproteins, ketone bodies, & enzymes

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12
Q

Its tests quantitates the severity of hepatic dysfunction

A

synthetic function

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13
Q

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

A

TP

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14
Q

sample of TP

A

serum

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15
Q

serum is preferred as sample for TP because plasma contains _____

A

fibrinogen and anticoagulant

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16
Q

Effect of fibrinogen to TP

A

increases total protein to 0.2-0.4 g/dL

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17
Q

Effect of anticoagulant to TP

A

decreases total protein due to dilutional effect

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18
Q

interference of TP

A

hemolysis, ictericia

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19
Q

serous fluid transudates

A

<3.0 g/dL

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20
Q

serous fluid exudates

A

> 3.0 g/dL

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21
Q

methods for TP

A

Kjeldahl Method
Biuret Method
Folin-Ciocalteu (Lowry) Method
UV Absorption Method
Refractometry
Turbidimetry and Nephelometry
Salt Fractionation
Coomasie Brilliant Blue Dye
Ninhydrin
Serum Protein Electrophoresis

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22
Q

In SPE, Width of the protein band in a particular fraction depends on the ______ in the fraction

A

concentration of protein

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23
Q

The acidic and basic amino acids content of proteins determines its net charge.

A

Isoelectric Property of Proteins

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24
Q

pH of SPE

A

8.6

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25
Q

Buffer for SPE

A

Barbital (Veronal)

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26
Q

When particles are large, they ____ in the point of origin

A

stay

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27
Q

The smaller the particle, the ____ its migration towards the anode

A

faster

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28
Q

Order of Normal SPE Pattern

A

albumin, a1 globulin, a2 globulin, b-globulin, y-globulin

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29
Q

Fastest band to migrate to the anode

A

albumin

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30
Q

albumin is ___ of TP

A

53-65%

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31
Q

a1 globulin is ___ of TP

A

2.5-5%

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32
Q

a2 globulin is ___ of TP

A

7-13%

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33
Q

b-globulin is ___ of TP

A

8-14%

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34
Q

y-globulin is ___ of TP

A

12-22%

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35
Q

Slowest band to migrate to the anode

A

y-globulin

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36
Q

multiple myeloma is AKA

A

Cancer of plasma cells or Monoclonal gammopathy

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37
Q

There is Increase of γ globulin (gamma spike)

A

multiple myeloma, hepatic cirrhosis

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38
Q

Plasma cells produces too many immunoglobulins

A

multiple myeloma

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39
Q

increased TP is seen in:

A

malignancy, multple myeloma, Waldenströms macroglobulinemia

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40
Q

decreased TP is seen in:

A

Hepatic cirrhosis
Glomerulonephritis
Nephrotic syndrome
Starvation

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41
Q

Formation of β-γ bridging and is connected by IgA

A

hepatic cirrhosis

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42
Q

in hepatic cirrhosis, SPE shows abnormality in __

A

albumin, b-globulin, y-globulin bands

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43
Q

Decrease albumin and a significant increase of α2-globin (______) and β-globulin fractions (________)

A

Nephrotic syndrome, α2 Macroglobulin & Haptoglobin, β lipoprotein & Complement

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44
Q

Seen in juvenile cirrhosis

A

a1 antitrypsin deficiency

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45
Q

Flat curve is observed in SPE

A

a1 antitrypsin deficiency

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46
Q

α1-Antitrypsin comprises ____ of the proteins found in the α1-globulin band

A

90%

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47
Q

Inflammatory pattern in SPE indicating an inflammatory condition is seen when:

A

Albumin is decreased
Increased α1 globulin band (AAG & AAT)
Increased α2 globulin band (Ceruloplasmin & Haptoglobin)
Increased β globulin band (CRP)

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48
Q

AKA acute phase reactant pattern

A

inflammation

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49
Q

Seen in conditions related to burns, infarction, trauma, malignancy, liver diseases

A

inflammation

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50
Q

Concentration is inversely proportional to the severity of hepatic disease.

A

albumin

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51
Q

Albumin declines when severe liver disease lasts for more than

A

3 wks

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52
Q

Can be measured directly based on its dye-binding property

A

albumin

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53
Q

In salt preparation, Globulins are precipitated because it is ____ in water but not in dilute salt solution

A

insoluble

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54
Q

In salt preparation, Albumin is ____ in water and not in saturated salt solution

A

soluble

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55
Q

Albumin in supernatant is quantitated by

A

biuret reaction

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56
Q

reagent of salt preparation

A

Sodium sulfate salts

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57
Q

Nonspecific for Albumin

A

methyl orange

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58
Q

Many Interferences (_____)

A

2,4’- hydroxyazobenzene- benzoic acid (НАВА) // Salicylates, Bilirubin, Aspirin, Penicillin, Sulfonamides

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59
Q

More specific to Albumin than Methyl Orange

A

2,4’- hydroxyazobenzene- benzoic acid (НАВА)

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60
Q

Sensitive & Overestimates low albumin levels

A

Bromcresol green

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61
Q

Specific, Sensitive and Precise

A

Bromcresol purple

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62
Q

Most commonly used dye

A

Bromcresol green

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63
Q

seen in hyperalbuminemia

A

Severe dehydration
Prolonged tourniquet application

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64
Q

Causes pseudohyperalbuminemia due to poor specimen collection.

A

Prolonged tourniquet application

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65
Q

Albumin becomes concentrated due to low fluid level

A

Severe dehydration

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66
Q

seen in hypoalbuminemia

A

Reduced synthesis
Increased catabolism
Increased loss

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67
Q

Hereditary absence of albumin

A

Analbuminuria

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68
Q

Seen in chronic liver disease, malabsorption syndrome, malnutrition, muscle wasting disease

A

Reduced synthesis

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69
Q

Seen in massive burns, widespread malignancy, thyrotoxicosis

A

increased catabolism

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70
Q

Due to inability of glomerulus to restrict the passage of proteins from the blood

A

increased loss

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71
Q

Nephrotic syndrome (___ g/day)

A

20-30

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72
Q

Presence of two albumin bands instead of a single band in electrophoresis

A

bisalbuminemia

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73
Q

Associated with excess amount of therapeutic drugs in serum

A

bisalbuminemia

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74
Q

Used to validate if globulin is higher than albumin

A

a/g ratio

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75
Q

Inverted A/G ratio:

A

If globulin > albumin

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76
Q

Globulin is elevated in ___ which will balance the loss of albumin and will result to normal levels of protein

A

early cirrhosis

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77
Q

Vitamin K is administered _____ ( ___days; ___mg)

A

intramuscularly, 1-3, 10

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78
Q

It differentiates intrahepatic disorder (PT is ____) from extrahepatic disorder (PT is ____)

A

Vit. K Response test, prolonged, normal

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79
Q

_____ after Vit. K administration indicates loss of hepatic capacity to synthesize proteins

A

Prolonged PT

80
Q

Involves the metabolism of Bilirubin

A

CONJUGATION AND EXCRETION FUNCTION

80
Q

prolonged prothrombin time signifies massive cellular damage.

A

Acute/Chronic Hepatitis

81
Q

Approximately ___ of BIlirubin is conjugated per day

A

200-300mg

82
Q

End product of hemoglobin metabolism

A

BILIRUBIN

83
Q

Principal pigment in bile

A

BILIRUBIN

84
Q

Formed from the destruction of heme-containing proteins (myoglobin) and catalase & cytochrome oxidase

A

BILIRUBIN

85
Q

Unconjugated Bilirubin / Indirect Bilirubin

A

BILIRUBIN 1

86
Q

Water insoluble type of bilirubin

A

BILIRUBIN 1

87
Q

Non-polar Bilirubin

A

BILIRUBIN 1

87
Q

Hemobilirubin

A

BILIRUBIN 1

88
Q

Slow reacting type of bilirubin

A

BILIRUBIN 1

89
Q

Prehepatic Bilirubin

A

BILIRUBIN 1

90
Q

Conjugated Bilirubin / Direct Bilirubin

A

BILIRUBIN 2

91
Q

Water soluble type of bilirubin

A

BILIRUBIN 2

92
Q

Polar Bilirubin

A

BILIRUBIN 2

93
Q

Cholebilirubin

A

BILIRUBIN 2

94
Q

One-minutes / Prompt Bilirubin

A

BILIRUBIN 2

95
Q

Post-hepatic / Hepatic / Obstructive / Regurgitative Bilirubin

A

BILIRUBIN 2

96
Q

R.R of Bilirubin 1

A

0.2-0.8 mg/dL

97
Q

R.R of Bilirubin 2

A

0-0.2 mg/dL

98
Q

In Bilirubin pathway, The heme portion in the presence of _____ will be converted to ________.

A

heme oxygenase, biliverdin

99
Q

In Bilirubin pathway, Biliverdin will be converted to _____ in the presence of _______.

A

Bilirubin 1, biliverdin reductase

100
Q

In Bilirubin pathway, The process of converting heme to indirect bilirubin takes

A

2-3 hrs

101
Q

In Bilirubin pathway, Bilirubin is bound by _____ and transported to the liver.

A

albumin

102
Q

In Bilirubin pathway, Once at the liver cell, unconjugated bilirubin is released from albumin so it can be picked up by a carrier protein called __

A

ligandin

103
Q

In Bilirubin pathway, ____ is responsible for transporting unconjugated bilirubin to the endoplasmic reticulum, where the conjugation (esterification) of bilirubin occurs in the presence of the enzyme ________

A

ligandin, uridyldiphosphate glucuronyl transferase

104
Q

In Bilirubin pathway, ___ work on conjugated bilirubin to produce mesobilirubin, which is reduced to form mesobilirubinogen and then urobilinogen

A

Intestinal bacteria

105
Q

In Bilirubin pathway, Most of the urobilinogen formed (roughly ____) is oxidized to an ______-colored product called ____ and is secreted in the ____

A

80%, orange, urobilin, feces

106
Q

In Bilirubin pathway, For the remaining 20% urobilinogen, majority will be absorbed by _____ to be recycled through the liver and reexcreted.

A

extrahepatic circulation

107
Q

In Bilirubin pathway, Almost all the bilirubin formed is eliminated in the _____, and a small amount of urobilinogen is excreted in the ____.

A

feces, urine

108
Q

In Bilirubin pathway, The healthy adult has very low levels of total bilirubin (_________) in the serum, and of this amount, the majority is in the ________ form.

A

0.2 to 1.0 mg/dL, unconjugated

109
Q

Conjugated bilirubin bounded to albumin

A

Delta bilirubin

110
Q

Has longer half-life than other forms of bilirubin

A

Delta bilirubin

111
Q

Formed due to prolonged elevation of conjugated bilirubin in biliary obstruction

A

Delta bilirubin

112
Q

Helps in monitoring the decline of serum bilirubin following cholecystectomy

A

Delta bilirubin

113
Q

It reacts with diazo reagent

A

Delta bilirubin

114
Q

AKA Hyperbilirubinemia or Icterus

A

jaundice

115
Q

Computed: Delta bilirubin =

A

TB – DB + IB

116
Q

Not calculated on neonatal patients (_____)

A

Delta bilirubin, ≤14 days

117
Q

Yellow discoloration of the skin, sclera of the eyes, and mucous membrane

A

Jaundice

118
Q

Bilirubin ______ / Normal: _____

A

> 2.0 mg/dL, 3.0-5.0 mg/dL

119
Q

AKA Hemolytic jaundice or Unconjugated hyperbilirubinemia

A

PRE HEPATIC JAUNDICE

120
Q

Caused by too much red blood cell destruction

A

PRE HEPATIC JAUNDICE

121
Q

Seen in HDN, Hemolytic anemia, Hemolytic transfusion reaction, Malaria

A

PRE HEPATIC JAUNDICE

122
Q

When indirect bilirubin cross the BBB it causes ______

A

Kernicterus

123
Q

Bilirubin deposition in the brain which causes severe motor dysfunction and retardation

A

Kernicterus

124
Q

Lab findings of PRE HEPATIC JAUNDICE

A

Indirect Bilirubin: increased
Direct Bilirubin: normal
Urobilinogen: normal
Urine bilirubin: Negative

125
Q

AKA Obstructive jaundice

A

POST HEPATIC JAUNDICE

126
Q

Failure of bile to flow to the intestine (impaired bile excretion)

A

POST HEPATIC JAUNDICE

127
Q

Laboratory diagnosis of POST HEPATIC JAUNDICE

A

Indirect bilirubin: normal
Direct bilirubin: increased
Urobilinogen: decreased
Urine bilirubin: positive
Alkaline phosphatase: increased

128
Q

1 marker of post-hepatic jaundice

A

Alkaline phosphatase

129
Q

AKA Hepatocellular combined jaundice

A

HEPATIC JAUNDICE

130
Q

Bilirubin Transport Deficit

A

GILBERT’S SYNDROME

130
Q

Caused by disorders of bilirubin metabolism, transport defects, hepatocyte injury caused by viruses, parasites, or excessive alcohol intake

A

HEPATIC JAUNDICE

131
Q

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

A

UGT1A1, GILBERT’S SYNDROME

131
Q

Laboratory findings of HEPATIC JAUNDICE

A

Indirect bilirubin: increased
Direct bilirubin: increased
Urobilinogen: decreased
Urine bilirubin: positive

132
Q

Affected individuals may have no symptoms but may have mild icterus and predisposed acetaminophen toxicity.

A

GILBERT’S SYNDROME

133
Q

Conjugation deficit

A

Crigler-Najjar Syndrome

134
Q

Referred to as Chronic non-hemolytic unconjugated hyperbilirubinemia

A

Crigler-Najjar Syndrome

134
Q

Treatment of CRIGLER-NAJJAR SYNDROME

A

phototherapy

135
Q

Laboratory result of CRIGLER-NAJJAR SYNDROME

A

elevated indirect bilirubin

136
Q

Complete deficiency of UDPGT

A

Crigler-Najjar Syndrome Type 1

137
Q

Symptoms of Crigler-Najjar Syndrome Type 1

A

kernicterus, colorless bile

137
Q

Laboratory result of Crigler-Najjar Syndrome Type 1

A

Indirect bilirubin: >25 mg/dL
Direct bilirubin: none

137
Q

Partial deficiency of UDPGT

A

Crigler-Najjar Syndrome Type 2

138
Q

Laboratory results of Crigler-Najjar Syndrome Type 2

A

Indirect bilirubin: 5-20 mg/dL

139
Q

Only small amount of direct bilirubin is produced.

A

Crigler-Najjar Syndrome Type 2

140
Q

Bilirubin Excretion Deficit

A

DUBIN-JOHNSON SYNDROME

141
Q

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

A

DUBIN-JOHNSON SYNDROME

142
Q

Characterized by intense dark pigmentation of the liver (Black liver) due to accumulation of _____

A

DUBIN-JOHNSON SYNDROME, lipofuscin

143
Q

similar with Dubin-Johnson Syndrome without the “black liver” and cause is unknown

A

Rotor Syndrome

144
Q

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

A

LUCEY-DRISCOLL SYNDROME

145
Q

UDPGT is inhibited

A

LUCEY-DRISCOLL SYNDROME

145
Q

lab findings of LUCEY-DRISCOLL SYNDROME

A

Indirect bilirubin: increased (2-3 weeks of life)

146
Q

Principle of BILIRUBIN ASSAY

A

Van den Berg Reaction

147
Q

In Bilirubin assay, Only ____ are measured

A

TB and DB

147
Q

diazotization of bilirubin to form azobilirubin

A

Van den Berg Reaction

148
Q

Result is mathematically derived based on the result of TB and DB (IB = TB - DB)

A
149
Q

Evelyn and Malloy Method
Coupling accelerator: ____
Final result: ______

A

Methanol, Pink to purple azobilirubin

150
Q

Jendrassik and Grof Method
Coupling accelerator: ______
Final reaction: ______

A

Caffeine sodium benzoate, Pink to blue azobilirubin

151
Q

More sensitive than Evelyn and Malloy Method

A

Jendrassik and Grof Method

152
Q

Popular technique for discrete analyzers

A

Jendrassik and Grof Method

153
Q

Test for hepatocellular function and potency of bile duct

A

BROMSULFONTHALEIN (BSP) DYE EXCRETION TEST

153
Q

Rarely used, requires administration of bromsulfonthalein dye

A

BROMSULFONTHALEIN (BSP) DYE EXCRETION TEST

154
Q

In BSP Dye Excretion test, it is also called Double collection method

A

Rosenthal White Method

155
Q

In BSP Dye Excretion test, it is also called Single collection method

A

Mac Donald Method

156
Q

BSP Dose of Rosenthal White Method

A

2mg/Kg body weight

156
Q

BSP Dose of Mac Donald Method

A

5 mg/Kg body weight

157
Q

Specimen collection of Rosenthal White Method

A

5 minutes after BSP administration
30 minutes after BSP administration

157
Q

Specimen collection of Mac Donald Method

A

after 45 minutes

158
Q

Reference value of Rosenthal White Method

A

After 5 minutes: 50% dye retention
After 30 minutes: 0% dye retention

159
Q

Reference value of Mac Donald Method

A

After 45 minutes: +/- 5% dye retention

160
Q

Liver protects the body from potentially toxic substances which are absorbed from the intestine and toxic metabolic byproducts (ammonia)

A

DETOXIFICATION AND DRUG METABOLISM

161
Q

Used to assess the extent of liver damage

A

ENZYME TESTS

161
Q

Normally found intracellularly

A

ENZYME TESTS

162
Q

Any injury to the liver that results in cytolysis and necrosis causes the liberation of various hepatic enzymes

A

ENZYME TESTS

163
Q

Often the only indication of cell injury in early or localized liver disease

A

ENZYME TESTS

164
Q

Used to differentiate hepatocellular (functional) from the obstructive (mechanical) disease

A

ENZYME TESTS

164
Q

Diagnostic marker of hepatic failure

A

ammonia

165
Q

Hepatic enzymes:

A

Alanine aminotransferase (ALT)
Aspartate aminotransferase (AST)
5’ Nucleotidase
Gamma glutamyl transferase
Lactate dehydrogenase
Ornithine Carbamoyl Transferase

165
Q

Produced by the catabolism of amino acids and by bacterial metabolism in the intestine.

A

ammonia

166
Q

Also released from metabolic reactions in the skeletal muscle

A

ammonia

167
Q

In severe liver disorder, ammonia will circulate in the blood which is converted to______in the brain
Neurotoxic

A

glutamine

168
Q

Not useful for renal studies

A

ammonia

169
Q

preferred specimen for ammonia

A

arterial blood

170
Q

smoking is increased by ___

A

100-200 ug/L/cigar

171
Q

common methods of ammonia

A

Berthelot & Glutamate Dehydrogenase

172
Q

uses Kjeldahl Method

A

digestion method

173
Q

Nitrogen ion in a protein-free filtrate of the specimen is converted to ammonia using hot concentrated sulfuric acid in the presence of catalyst

A

digestion method

174
Q

Catalyst of digestion method

A

copper sulfate, mercury, and selenium

175
Q

In DIRECT COLORIMETRIC METHOD, Reaction is facilitated by ______

A

gum ghatti

176
Q

Amount of nitrogen will determine the color of the end product

A

DIRECT COLORIMETRIC METHOD

177
Q

Yellow end-color: N2 (___)

A

low to moderate

178
Q

Orange-brown end-color: N2_____

A

high

179
Q

Decrease in absorbance at 340nm as NADPH is consumed (oxidized)

A

GLUTAMATE DEHYDROGENASE METHOD

180
Q

Excretion of bile involves elimination of bile acids (salt pigments, cholesterol)

A

EXCRETORY AND SECRETORY FUNCTION

180
Q

Facilitated by glutamate dehydrogenase

A

GLUTAMATE DEHYDROGENASE METHOD

181
Q

Liver is the storage site for all fat & water soluble vitamins and glycogen

A

STORAGE FUNCTION

Clinical Chemistry 1 (3 decks)

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