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PH 166 > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

1
Q

Enumerate the 4 main complex functions of the liver

A

Complex functions: (MEDS)
o Metabolism of carbohydrates, lipids, proteins, and bilirubin
o Excretion of substances to prevent harm
o Detoxification of harmful substances
o Storage of essential compounds

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2
Q

Which is false?
A. The left lobe of the liver is 6x smaller than the right lobe.
B. 1/4 of the blood supply of the liver comes from the hepatic artery.
C. When damaged repeatedly over a long period of time, the liver may undergo irreversible changes that permanently interfere with its essential function.
D. The arrangement of blood flow from hepatocyte to heart is: hepatic sinusoid, then hepatic vein, then central vein, then inferior vena cava.

A

D. baliktad ang central & hepatic

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3
Q 
Bile excretion pathway: arrange fr inside liver to outside. Specify also where it ends up.
A. bile canaliculi
B. common bile duct
C. intrahepatic ducts
D. common hepatic duct
A

A,C,D,B. end point: duodenum

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4
Q

Identify the ff:
A. macrophages lining sinusoids of the liver
B. principal pigment in bile
C. protein that makes bilirubin unconjugated

A

A. Kupffer cells
B. bilirubin
C. albumin

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5
Q

A.What does UDP-glucoronyl transferase do, and where does its action take place?

B.In the intestines, how is urobilinogen formed?

A

A.In the liver, it makes unconjugated bilirubin conjugated!

B. conjugated bilirubin is transformed c/o GI bacteria

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6
Q

Which is false?
A. Conjugated bilirubin – water soluble
B. Unconjugated bilirubin – water insoluble
C. Bilirubin – causes the color of the feces

A

C. Urobilinogen dapat

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7
Q

A. What brings the conjugated bilirubin to endoplasmic reticulum?
B. Which set of enzymes are in-charge of detoxification and drug metabolism?

A

A. ligandin

B. CYP 450 isoenzymes

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8
Q

false about jaundice
A. caused by retention of bilirubin
B. jaundice only occurs when primary problem is in the liver
C. in the intestines, 20% of urobilinogen is absorbed & recirculated in the liver
D. urobilinogen may be excreted in urine

A

B

may pre-hepatic and post-hepatic din

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9
Q
  1. How can hemolytic anemia cause prehepatic jaundice?
  2. False about unconjugated hyperbilirubinemia?
    A.water soluble
    B.bound to albumin
    C.not filtered by the kidneys
    D.not seen in the urine
A
  1. Causes an increased amount of RBC destruction leading to increased amounts of bilirubin presented to the liver for processing
  2. A
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10
Q 
Which is not a problem due to elevated unconjugated bilirubin?
A. Gilbert's disease
B. Rotor syndrome
C. Crigler-Najjar syndrome
D. Physiologic jaundice of the newborn
A

B

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11
Q 
Which is/are not a problem due to elevated conjugated bilirubin?
A. Gilbert's disease
B. Rotor syndrome
C. Dubin-Johnson syndrome
D. Physiologic jaundice of the newborn
A

A and D

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12
Q 
identify the disease: Results from a genetic mutation in the gene (UGT1A1) that produces UDPGT, which leads to defective conjugation system
A. Gilbert's disease
B. Rotor syndrome
C. Dubin-Johnson syndrome
D. Physiologic jaundice of the newborn
A

A

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13
Q 
identify the disease: Syndrome of chronic non-hemolytic unconjugated hyperbilirubinemia
A. Gilbert's disease
B. Rotor syndrome
C. Crigler-Najjar syndrome
D. Physiologic jaundice of the newborn
A

C

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14
Q

A. Differentiate Criggler-Najjar Type 1 fr Type 2.

B. Premature infants may be born without ___ - leading to physio jaundice of newborn

A

A. Type 1 - complete absence of enzymatic bilirubin conjugation
Type 2 - severe deficiency
B. glucuronyl transferase

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15
Q
  1. identify: cell damage and death in the newborn where bilirubin is deposited in the nuclei of brain and degenerate nerve cells
  2. identify the disease: The liver’s ability to uptake and conjugate bilirubin is functional but the removal of conjugated bilirubin from the liver cell and the excretion into the bile are defective
A
  1. Kernicterus

2. Dubin-Johnson syndrome

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16
Q

Which is false?
A. In Dubin-Johnson syndrome, there is increase in conjugated bilirubin.
B. Physiologic jaundice of newborn - usually treated with UV radiation
C. In Rotor syndrome, there is appearance of dark-stained granules on a liver biopsy sample

A

C

wala… sa Dubin-Johnson ito.

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17
Q

False about posthepatic jaundice:
A. Results from biliary obstructive disease
B. Prevent the flow of conjugated bilirubin into the bile canaliculi
C. Unable to be properly excreted from the liver
D. Hyperpigmentation of stool

A

D. dapat Stool loses its source of normal pigmentation and becomes clay colored

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18
Q

A. identify: Clinical condition in which scar tissue replaces normal, healthy liver tissue
B. identify: drug used to treat cirrhosis c/o viral hepatitis -
C. identify: drug used to treat cirrhosis c/o autoimmune hepatitis -
D. identify: most common malignant tumor of liver -

A

A. cirrhosis
B. interferon
C. corticosteroids
D. hepatocellular carcinoma

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19
Q

False about Reye syndrome:
A. may cause encelopathy
B. there is strong epid assoc between paracetamol intake during viral syndrome & devt of Reye syndrome
C. Clinical presentation of profuse vomiting accompanied with fluctuating personality changes and deterioration in consciousness
D. Often preceded by a viral syndrome

A

B

aspirin, not paracetamol

20
Q

degeeneration of liver Characterized by all except:
A. severe hyperbilirubinemia
B. threefold increases in ammonia
C. threefold increases in the aminotransferases (AST and ALT)

A

A

21
Q

A. identify: Most common mechanism of toxicity for drug-induced liver disease

B. Approx. 90% of alcohol absorbed from the stomach and small intestines is transported to the liver for metabolism. T/F?

C. main purpose of liver enzyme tests

A

A. immune-mediated injury to the hepatocytes
B. T; products: alcohol dehydrogenase && acetaldehyde dehydrogenase|
C.Important in differentiating hepatocellular (functional) from obstructive (mechanical) liver disease

22
Q

Arrange accdg to decreasing severity.
A. alcoholic fatty liver
B. alcoholic hepatitis
C. alcoholic cirrhosis

A

C,B,A

23
Q

Which does not have significant increase in AST and ALT?
A. alcoholic fatty liver
B. alcoholic hepatitis
C. alcoholic cirrhosis

A

A

24
Q

Which has prolonged prothrombin time?
A. alcoholic fatty liver
B. alcoholic hepatitis
C. alcoholic cirrhosis

A

C

25
Q 
Who proposed this method:  classic diazo reaction with a 50% methanol solution as an accelerator?
A. Erlich
B. van den Bergh 
C. Malloy and Evelyn
D. Jendrassik and Grof
A

C

26
Q

False about bilirubin test
A.Preferred: Fasting sample
B.Lipemia: ↑ measured bilirubin
C.In hemolyzed samples, the reaction of bilirubin with the
diazo reagent is increased.
D.Specimens should be protected from light.

A

C

decreased dapat

27
Q 
Modified \_\_\_ procedure using caffeine- benzoate as a solubilizer as candidate reference method for total bilirubin
A. Erlich
B. van den Bergh 
C. Malloy and Evelyn
D. Jendrassik and Grof
A

D

28
Q

False about Jendrassik & Grof method for bilirubin mess
A. Not affected by hemoglobin up to 750 mg/dL, but affected by pH changes
B. Insensitive to a 50-fold variation in protein
concentration of the sample
C. At low bilirubin concentrations, it maintains optical
sensitivity

A

A

hindi rin soya affected by pH Changes

29
Q

explain the principle for The Jendrassik-Grof Method for Total and Conjugated Bilirubin Determination

A

Bilirubin pigments (serum or plasma) + a diazo reagent (sulfanilic acid in hydrochloric acid and sodium nitrite) → azobilirubin (purple) measured spectrophotometrically

30
Q

false about The Jendrassik-Grof Method for Total and Conjugated Bilirubin Determination
A. Reaction without the accelerator –> conjugated bilirubin only
B. To destroy excess diazo reagent –> add ascorbic acid
C. To shift the absorbance spectrum of the azobilirubin to a
more intense blue colour –> alkalinize solution with alkaline
tartrate
D. Final red product: measured at 600nm

A

D

blue, not red.

31
Q

A. If a tumor develops @ __ of pancreas, often: metastasis
(head, tail)
B. identify: Colorless end-product of bilirubin metabolism
C. End colour of the product @ Semi-quantitative determination of Urine Urobilinogen

A

A. tail. pag head, madalas jaundice, kaya easily detectable.
B. urobilinogen
C. red

32
Q

False about urobilinogen:
A. high amount in urine: haemolytic disease and hepatitis
B. high amount in feces: biliary obstruction and HCC
C. absence in urine & stool: complete biliary obstruction
D. Visual inspection: enough to detect decreased amount
of urobilinogen

A

B - low dapat

33
Q 
Which reagent is added @ fecal urobilinogen determination that is not added @ Semi-quantitative determination of Urine Urobilinogen?
A. ascorbic acid
B. alkaline ferrous hydroxide
C. saturated sodium acetate
D. Ehrlich’s reagent
A

B

34
Q

false about serum bile acids
A. Analysis for serum bile acids is rarely performed because it requires very complex methods:
B. Low amount detected in liver disease
C. Total concentration is extremely variable, thus adding
no diagnostic value to other tests of liver function

A

B - high dapat

35
Q

Which is false?
A. ALT:Widely distributed in equal amounts in the heart, skeletal muscle, and liver
B. AST: amount in liver»skeletal muscle and kidney
C. BOTA
D. NOTA

A

C

Baliktad.

36
Q

Explain: Diagnosis of liver disease requires serial determination of AST & ALT. why?

A

they may decrease in some patients with severe acute hepatitis – causes depletion of these enzymes

37
Q 
Useful in differentiating hepatobiliary disease from osteogenic bone disease
A. ALT
B. AST
C. ALP
D. ACP
A

C - Alkaline phosphatase

38
Q

False about alkaline phosphatase:
A. widely dist @ all tissues
B. increase @ liver: extra hepatic obstruction
C. decrease @ bone: bone-related disorders
D. increase also observed @ pregnancy

A

C

increase dap at

39
Q

A. main purpose of 5’ - nucleotidase
B. T/F 5’ - nucleotidase has no bone source
C. T/F Gamma-glutamyl transferase has high concentration in bone.

A

A. catalyzing the hydrolysis of nucleotide-5’-phosphate esters
B. T
C. F

40
Q

A. identify: used in testing for cholestasis due to chronic
alcohol consumption and drug ingestion
B. hepatic synthetic ability is assessed by measuring amount of __

A

A.Gamma-glutamyl transferase

B. serum proteins

41
Q

False about lactate dehydrogenase
A. Non-specific marker of cellular injury
B. Moderate elevations –> biliary tract disease
C. Slight elevations –> acute viral hepatitis & cirrhosis
D. High serum elevations –> metastatic liver CA
E. Fractionations into its 5 tissue-specific isoenzymes is
useful in determining site of origin of LD elevation

A

B and C. baliktad. :)

42
Q

if alpha-globulins are measured in high levels @ patients with chronic liver disease, which is not matched properly?
A. IgG, IgM: chronic active hepatitis
B. IgE: postnecrotic cirrhosis; primary biliary cirrhosis
C. IgA: alcoholic cirrhosis

A

B. IgM dapat

43
Q

False about prothrombin time:
A. used in routine diagnosis of liver disease
B. Serial measurements are useful in following the progression of disease & assessment of risk of
bleeding
C. Increased in liver disease due to: inability of liver to produce adequate amounts of clotting factors
D. if increased: may indicate inadequate absorption of vitamin K @ intestine

A

A

44
Q

False about plasma ammonia
A.Reflection of liver’s ability to perform urea conversion
B.Specimen: Plasma collected in EDTA, Lithium Heparin, or
Potassium Oxalate
C.There is strong correlation between blood NH3 and hepatic coma

A

C

45
Q

enumerate grounds for rejection @ plasma ammonia test.

A

 Hemolyzed samples (RBCs have NH3 that is 2-3
times more than plasma)
 Lipemic samples
 With high bilirubin concentrations and with raised
GGT activity

PH 166 (28 decks)

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