Liver Function Tests Flashcards
Enumerate the 4 main complex functions of the liver
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
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.
D. baliktad ang central & hepatic
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,C,D,B. end point: duodenum
Identify the ff:
A. macrophages lining sinusoids of the liver
B. principal pigment in bile
C. protein that makes bilirubin unconjugated
A. Kupffer cells
B. bilirubin
C. albumin
A.What does UDP-glucoronyl transferase do, and where does its action take place?
B.In the intestines, how is urobilinogen formed?
A.In the liver, it makes unconjugated bilirubin conjugated!
B. conjugated bilirubin is transformed c/o GI bacteria
Which is false?
A. Conjugated bilirubin – water soluble
B. Unconjugated bilirubin – water insoluble
C. Bilirubin – causes the color of the feces
C. Urobilinogen dapat
A. What brings the conjugated bilirubin to endoplasmic reticulum?
B. Which set of enzymes are in-charge of detoxification and drug metabolism?
A. ligandin
B. CYP 450 isoenzymes
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
B
may pre-hepatic and post-hepatic din
- How can hemolytic anemia cause prehepatic jaundice?
- False about unconjugated hyperbilirubinemia?
A.water soluble
B.bound to albumin
C.not filtered by the kidneys
D.not seen in the urine
- Causes an increased amount of RBC destruction leading to increased amounts of bilirubin presented to the liver for processing
- A
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
B
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 and D
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
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
C
A. Differentiate Criggler-Najjar Type 1 fr Type 2.
B. Premature infants may be born without ___ - leading to physio jaundice of newborn
A. Type 1 - complete absence of enzymatic bilirubin conjugation
Type 2 - severe deficiency
B. glucuronyl transferase
- identify: cell damage and death in the newborn where bilirubin is deposited in the nuclei of brain and degenerate nerve cells
- 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
- Kernicterus
2. Dubin-Johnson syndrome
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
C
wala… sa Dubin-Johnson ito.
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
D. dapat Stool loses its source of normal pigmentation and becomes clay colored
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. cirrhosis
B. interferon
C. corticosteroids
D. hepatocellular carcinoma
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
B
aspirin, not paracetamol
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. 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. immune-mediated injury to the hepatocytes
B. T; products: alcohol dehydrogenase && acetaldehyde dehydrogenase|
C.Important in differentiating hepatocellular (functional) from obstructive (mechanical) liver disease
Arrange accdg to decreasing severity.
A. alcoholic fatty liver
B. alcoholic hepatitis
C. alcoholic cirrhosis
C,B,A
Which does not have significant increase in AST and ALT?
A. alcoholic fatty liver
B. alcoholic hepatitis
C. alcoholic cirrhosis
A
Which has prolonged prothrombin time?
A. alcoholic fatty liver
B. alcoholic hepatitis
C. alcoholic cirrhosis
C
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
C
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.
C
decreased dapat
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
D
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
hindi rin soya affected by pH Changes
explain the principle for The Jendrassik-Grof Method for Total and Conjugated Bilirubin Determination
Bilirubin pigments (serum or plasma) + a diazo reagent (sulfanilic acid in hydrochloric acid and sodium nitrite) → azobilirubin (purple) measured spectrophotometrically
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
D
blue, not red.
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. tail. pag head, madalas jaundice, kaya easily detectable.
B. urobilinogen
C. red
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
B - low dapat
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
B
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
B - high dapat
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
C
Baliktad.
Explain: Diagnosis of liver disease requires serial determination of AST & ALT. why?
they may decrease in some patients with severe acute hepatitis – causes depletion of these enzymes
Useful in differentiating hepatobiliary disease from osteogenic bone disease A. ALT B. AST C. ALP D. ACP
C - Alkaline phosphatase
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
C
increase dap at
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. catalyzing the hydrolysis of nucleotide-5’-phosphate esters
B. T
C. F
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.Gamma-glutamyl transferase
B. serum proteins
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
B and C. baliktad. :)
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
B. IgM dapat
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
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
C
enumerate grounds for rejection @ plasma ammonia test.
Hemolyzed samples (RBCs have NH3 that is 2-3
times more than plasma)
Lipemic samples
With high bilirubin concentrations and with raised
GGT activity
