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Clinical Chemistry Review > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

1
Q

Receives 15 mL of blood per minute

A

Liver

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2
Q

: anatomic unit

A

Lobule

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3
Q

Synthetic function

Proteins, CHO, lipids, LPP, clotting factors, ketone bodies, enzymes
Albumin:

A

12g/day

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4
Q

Conjugation function

Bilirubin metabolism
Bilirubin:

A

200mg/day

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5
Q

Detoxification and Drug metabolism

A

Drugs
Ammonia  Urea  Excreted

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6
Q

Excretory and Secretory functions
Bile acids:
Bile salts:

A

cholic acid and chenodeoxycholic acid

bile acids + amino acids (glycine and taurine)

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7
Q

Storage function

A

Vitamins
Glycogen

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8
Q

Test measuring the Hepatic Synthetic Ability

A

Total Protein Determination
Prothrombin Time (Vitamin K Response Test)

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9
Q

Total Protein Determination:

A

-Kjeldahl method
-Biuret method
-Folin-Ciocalteu (Lowry) method
-UV absorption method
-Electrophoresis
-Refractometry
-Turbidimetric and Nephelometric methods
-Salt fractionation

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10
Q

Test measuring Conjugation/Excretion Function

A

Bilirubin Assay
Bromsulfonphthalein (BSP) Dye Excretion test

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11
Q

Bilirubin Assay:

A

-Evelyn and Malloy method
-Jendrassik and Grof Bromsulfonphthalein (BSP) Dye Excretion test

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12
Q

Test for Detoxification Function
Enzyme tests:
Ammonia:

A

ALP, AST, ALT, 5’NT, GGT, OCT, LAP, LDH

-Kjeldahl (Digestion) method -Nesslerization reaction -Berthelot reaction

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13
Q

0.2-0.4 g/dL higher than serum due to fibrinogen

A

Plasma protein

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14
Q

AMMONIA: Standard reference method

A

Kjeldahl (Digestion) mtd

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15
Q

Measurement of nitrogen content

A

Kjeldahl (Digestion) mtd

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16
Q

Serum + Tungstic acid  PFF

A

Kjeldahl (Digestion) mtd

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17
Q

1g N2 = 6.54g protein

A

Kjeldahl (Digestion) mtd

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18
Q

15.1-16.8% = N2 content of proteins

A

Kjeldahl (Digestion) mtd

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19
Q

Kjeldahl (Digestion) mtd Rgt:

A

H2SO4

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20
Q

Kjeldahl (Digestion) mtd
End product:

A

NH3

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21
Q

Most widely used method (IFCC recommended)

A

Biuret method

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22
Q

Req. at least 2 peptide bonds and an alkaline medium

A

Biuret method

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23
Q

Biuret method Rgts:

A

Alkaline CuSO4
Rochelle salt (NaK Tartrate)
NaOH
KI

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24
Q

Biuret method End product:

A

Violet color (545nm)

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25
Q

Highest analytical sensitivity

A

Folin-Ciocalteu (Lowry) method

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26
Q

Oxidation of phenolic compounds (tyrosine, tryptophan, histidine)

A

Folin-Ciocalteu (Lowry) method

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27
Q

Folin-Ciocalteu (Lowry) method Rgts:

A

Phenol (or phosphotungstic-molybdic acid)
Biuret (color enhancer)

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28
Q

Folin-Ciocalteu (Lowry) method End product:

A

Blue color

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29
Q

MI: elevated APRs (AAT, HPG, a1-x)

A

Electrophoresis

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30
Q

Gamma-spike

A

Monoclonal gammopathy (multiple myeloma)

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31
Q

Beta-gamma bridging
In serum:
In plasma:

A

Hepatic cirrhosis (IgA)

normal (fibrinogen)

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32
Q

Alpha2-globulin band spike

A

Nephrotic syndrome

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33
Q

Alpha1-globulin flat curve

A

Juvenile cirrhosis (AAT deficiency)

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34
Q

Alpha1, alpha2, betaglobulin band spikes

A

Inflammation

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35
Q

Polyclonal gammopathy

A

Chronic inflammation (RA, malignancy)

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36
Q

Small spikes in beta region

A

IDA (transferrin)

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37
Q

“Blip” in the late alpha2 or early beta region

A

Free hemoglobin

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38
Q

Refractive index

A

Refractometry

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39
Q

Turbidimetric and nephelometric methods

A

SSA
TCA

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40
Q

Salt fractionation

A

Salt: Sodium sulfate

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41
Q

Albumin
Soluble:
Insoluble:

A

Water
Moderately concentrated salt solution
Concentrated salt solution

Hydrocarbon solvents
Highly concentrated salt solution
Saturated salt solution

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42
Q

Globulin
Soluble:
Insoluble:

A

Hydrocarbon solvents
Weak salt solution

Water Saturated salt solution
Concentrated salt solution

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43
Q

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

A

Prothrombin time

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44
Q

Inversely proportional to the severity of the liver disease

A

Albumin

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45
Q

Low total protein + low albumin

A

Hepatic cirrhosis

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46
Q

Most commonly used dye for albumin

A

Bromcresol green

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47
Q

Most specific dye for albumin

A

Bromcresol purple

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48
Q

Other dyes for albumin

A

Hydroxyazobenzene benzoic acid (HABA)
Methyl orange (MO)

49
Q

Albumin excretion: 20-30 g/day

A

Nephrotic syndrome

50
Q

(-) albumin

A

Analbuminemia

51
Q

EP: 2 albumin bands

A

Bisalbuminemia

52
Q

Therapeutic drugs in serum

A

Bisalbuminemia

53
Q

Inverted A/G ratio

A

Hepatic cirrhosis (IgA)
Multiple Myeloma (IgG)
Waldenström’s macroglobulinemia (IgM)
Chronic inflammation

54
Q

Derived from hemoglobin myoglobin, catalase and cytochrome oxidase

55
Q

Protoporphyrin  Biliverdin

A

Heme oxygenase

56
Q

Biliverdin B1

A

Biliverdin reductase

57
Q

Deconjugated bilirubin

A

Urobilinogen

58
Q

Non-polar bilirubin

A

Bilirubin 1

59
Q

Free/Slow bilirubin

A

Bilirubin 1

60
Q

Polar bilirubin

A

Bilirubin 2

61
Q

One-minute/prompt bilirubin

A

Bilirubin 2

62
Q

Regurgitative bilirubin

A

Bilirubin 2

63
Q

Bilirubin tightly bound to albumin

A

Delta bilirubin

64
Q

Delta bilirubin =

65
Q

Bilirubin >2 or 3 mg/dL

66
Q

Hemolytic

A

Pre-hepatic jaundice

67
Q

Pre-hepatic
B1 =
B2 =
UG =
UB =

A

B1 = increased
B2 = normal
UG = increased
UB = negative

68
Q

Hepatocellular

A

Hepatic jaundice

69
Q

Hepatic jaundice
B1 =
B2 =
UG =
UB =
ALT =
AST =

A

B1 = increased
B2 = increased
UG = increased
UB = positive
ALT = increased
AST = increased

70
Q

Obstructive

A

Post-hepatic jaundice

71
Q

Post-hepatic jaundice
B1 =
B2 =
UG =
UB =
ALP =
GGT =
Cholesterol =

A

B1 = normal
B2 = increased
UG = decreased/negative
UB = positive
ALP = increased
GGT = increased
Cholesterol = increased

72
Q

Bilirubin transport deficit (uptake)

A

Gilbert’s syndrome

73
Q

Gilbert’s syndrome
B1 =
B2 =

A

B1 = increased
B2 = decreased

74
Q

Conjugation deficit

A

Crigler-Najjar syndrome

75
Q

= total UDPGT deficiency

A

Crigler-Najjar syndrome Type I

76
Q

= partial UDPGT deficiency

A

Crigler-Najjar syndrome Type II

77
Q

Crigler-Najjar syndrome
B1 =
B2 =

A

B1 = increased
B2 = decreased

78
Q

Danger: Kernicterus

A

Crigler-Najjar syndrome

79
Q

Bile is colorless

A

Crigler-Najjar syndrome

80
Q

Bilirubin excretion deficit

A

Dubin-Johnson syndrome & Rotor syndrome

81
Q

Blockade of excretion into the canaliculi

A

Dubin-Johnson syndrome & Rotor syndrome

82
Q

Dubin-Johnson syndrome & Rotor syndrome
TB =
B2 =

A

TB = increased
B2 = increased

83
Q

Circulating inhibitor of bilirubin conjugation

A

Lucey-Driscoll syndrome

84
Q

Lucey-Driscoll syndrome
B1 =

A

B1 = increased

85
Q

Free from hemolysis and lipemia

A

Methods (Bilirubin)

86
Q

Store in the dark

A

Methods (Bilirubin)

87
Q

Measured ASAP or w/in 2-3 hours

A

Methods (Bilirubin)

88
Q

Diazotization of bilirubin

A

Van den Berg reaction

89
Q

Evelyn and Malloy method Accelerator:

90
Q

Evelyn and Malloy method Diazo rgts:

A

Diazo A (0.1% Sulfanilic acid + HCl)
Diazo B (0.5% Sodium nitrite)
Diazo blank (1.5% HCl)

91
Q

(+) pink to purple azobilirubin

A

Evelyn and Malloy method

92
Q

Affected by hemolysis

A

Evelyn and Malloy method

93
Q

Candidate reference method

A

Jendrassik and Grof

94
Q

Jendrassik and Grof Accelerator:

A

Caffeine sodium benzoate

95
Q

Jendrassik and Grof Buffer:

A

Sodium acetate

96
Q

: terminates the initial reaction and destroys the excess diazo rgt

A

Ascorbic acid

97
Q

Not falsely elevated by hemolysis

A

Jendrassik and Grof

98
Q

Total bilirubin is measured 15 minutes after adding methanol or caffeine soln

A

Jendrassik and Grof

99
Q

Absorbs light maximally at 450nm

100
Q

Double collection method

A

Rosenthal White method

101
Q

Rosenthal White method
Collection:
(50% dye retention)
(0% dye retention)

A

-After 5 mins

-After 30 mins

102
Q

Single collection method

A

Mac Donald method

103
Q

Mac Donald method Collection:
(+/- 5% dye retention)

A

-After 45 mins

104
Q

From deamination of amino acids

105
Q

Elevated levels are neurotoxic and often associated w/ encephalopathy and acetaminophen poisoning

106
Q

Diagnosis of hepatic failure and Reye’s syndrome

107
Q

Ammonia In severe liver disorder:

A

NH3  circulation  brain (conv. to glutamine)  increases pH  compromise the Kreb’s cycle  Coma due to lack of ATP for the brain

108
Q

Methods (Ammonia) Specimen:

A

Heparin or EDTA plasma

109
Q

Fasting is required

110
Q

Avoid smoking

111
Q

Prolonged standing of specimen: increased due to deamination

112
Q

Place on iced water immediately

113
Q

Avoid hemolysis

114
Q

Specimen  PFF

A

Kjeldahl (Digestion) method

115
Q

N2 ———-(hot conc. H2SO4 + CuSO4 + Hg + Selenium)———-> NH3

A

Kjeldahl (Digestion) method

116
Q

NH3 + K2Hg2I2 ———-(Gum Ghatti)———-> NH2Hg2I2

A

Nesslerization of ammonia

117
Q

Nesslerization of ammonia End color:

A

Yellow (low to moderate N2)
Orange brown (high N2)

118
Q

NH3 + Phenol + Hypochlorite —–(Na Nitroprusside)—–> Indophenol blue

A

Berthelot reaction

119
Q

Normal Values (Liver Function Tests) Total protein = 6.5-8.3 g/dL Albumin = 3.5-5.0 g/dL Globulin = 2.3-3.5 g/dL α1-globulin = 0.1-0.3 g/dL α2-globulin = 0.6-1.0 g/dL β-globulin = 0.7-1.1 g/dL γ-globulin = 0.8-1.6 g/dL Total bilirubin = 0.2-1.0 mg/dL Indirect bilirubin = 0.2-0.8 mg/dL Direct bilirubin = 0-0.2 mg/dL Urobilinogen: Urine = 0.1-1.0 Ehrlich units/2hrs (or 0.54 Ehrlich units/day) Stool = 75-275 Ehrlich units/100g feces (or 75-400 Ehrlich units/24hrs) Ammonia = 19-60 μg/dL

Clinical Chemistry Review (15 decks)

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