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Clinical Chemistry II > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

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1
Q

It is the largest internal organ of the body

A

Liver

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2
Q

A factor safety of x < 80% indicates?

A

normal liver function

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3
Q

A factor safety of x > 80% indicates?

A

abnormal liver function

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4
Q

Enumerate the 5 functions of liver.

A
  1. Metabolic
  2. Detoxification/conjugation
  3. Storage
  4. Excretory function
  5. Sythetic function
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5
Q

Give which liver function indicates the statement:
stores glycogen

A

storage

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6
Q

Give which liver function indicates the statement:

excretes bilirubin

A

excretory function

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7
Q

Give which liver function indicates the statement:

  • molecular structure is altered
  • toxic to non-toxic
  • protection
A

detoxification/conjugation

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8
Q

Give which liver function indicates the statement:

protein synthesis

A

synthetic function

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9
Q

Give the 4 substances that the liver does not produce.

A
  1. antibodies
  2. y-globulins
  3. immunoglobulins
  4. Von Willebrand factor
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10
Q

Detoxification/Conjugation Assessment

sodium benzoate is ingested and converted into benzoic acid

A

Quick’s/Hippuric Acid Test

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11
Q

bilirubin in urine

A

urobilin

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12
Q

bilirubin in stool

A

stercobilin

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13
Q

Detoxification/Conjugation Assessment

In Quick’s/Hippuric Acid Test, benzoic acid conjugates with ____ to produce ____.

A
  1. glycine
  2. hippuric acid
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14
Q

Detoxification/Conjugation Assessment

In Quick’s test, urine is titrated with ___.

A

standard NaOH

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15
Q

Excretory Assessment

Bilirubin profile is part of ___.

A

Screening test

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16
Q

Excretory Assessment

Bilirubin profile determines what type of bilirubin?

A
  1. conjugated bilirubin
  2. unconjugated bilirubin
  3. total bilirubin
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17
Q

Excretory Assessment

It is the confirmatory test.

A

Bromsulphthalein Test

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18
Q

Excretory Assessment

The solution intravenously injected to the patient in Bromsulphthalein test.

A

5 mL of 5% BSP dye

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19
Q

Excretory Assessment

Intrepret the results of BSP Test:

colorless serum blood: _____
red serum blood: _______

A

colorless serum blood: absent BSP (normal)
​red serum blood: present BSP (hepatic insufficiency)

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20
Q

Sources of Bilirubin

  1. 90% (due to RBC destruction):
  2. 5%:
  3. 5%:
A
  1. hemoglobin degradation
  2. myoglobin degradation
  3. cytochrome
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21
Q

Types of Bilirubin

first bilirubin produced

A

unconjugated

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22
Q

Types of Bilirubin

Unconjugated Bilirubin
main product of RBC destruction

A

hemobilirubin

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23
Q

Types of Bilirubin

Unconjugated Bilirubin
insoluble in water

A

nonpolar bilirubin

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24
Q

Types of Bilirubin

Unconjugated Bilirubin
coated with albumin

A

indirect bilirubin

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25
Q

Types of Bilirubin

Unconjugated Bilirubin
deposited in the brain

A

kernicterus bilirubin

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26
Q

Types of Bilirubin

Unconjugated Bilirubin
deposited in the CSF

A

icterus bilirubin

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27
Q

Types of Bilirubin

Unconjugated Bilirubin
xanthochromia

A

icterus bilirubin

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28
Q

Types of Bilirubin

Unconjugated Bilirubin
not yet excreted by the liver

A

pre-hepatic bilirubin

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29
Q

Types of Bilirubin

Conjugated Bilirubin
soluble in water

A

polar bilirubin

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30
Q

Types of Bilirubin

Conjugated Bilirubin
​no albumin coating

A

direct bilirubin

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31
Q

Types of Bilirubin

Conjugated Bilirubin
​excreted by the liver

A

post hepatic bilirubin

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32
Q

Types of Bilirubin

Conjugated Bilirubin
​reason why stool is brown

A

stercobilinogen

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33
Q

Types of Bilirubin

Conjugated Bilirubin

  • ​reason why urine is yellowish
  • pigment
  • excess conjugated bilirubin
A

urobilin

34
Q

Unconjugated Bilirubin Production

RBC explodes in the sinusoidal spaces of the spleen, hemoglobin is release into the plasma

A

Hemoglobin fragmentation

35
Q

Unconjugated Bilirubin Production

  • abundant in Hb
  • stored as ferritin
  • transported by transferrin
A

iron

36
Q

Unconjugated Bilirubin Production

Transferrin is also known as?

A

siderophilin

37
Q

Unconjugated Bilirubin Production

  • protein component of Hb
  • hydrolyzed into amino acids
  • used to build new proteins
A

globin

38
Q

Unconjugated Bilirubin Production

  • broken into biliverdin
  • reduced by biliverdin reductase to form unconjugated bilirubin
A

porphyrin ring

39
Q

Unconjugated Bilirubin Production

conjugation occurs at ____

A

Smooth ER

40
Q

Unconjugated Bilirubin Production

Bilirubin will mix with ___(1)___. It is broken by ___(2)___ to create __(3)__ & __(4)__.

A
  1. glucuronic acid
  2. uridine diphosphate glucuronyltransferase (UDP GT)
  3. B1 (bilirubin monoglucuronide)
  4. B2 (bilirubin diglucuronide)
41
Q

Unconjugated Bilirubin Production

incomplete conjugation: _____
complete conjugation: ______

A

incomplete conjugation: B1 (bilirubin moglucuronide)
complete conjugation: B2 (bilirubin diglucuronide)

42
Q

Unconjugated Bilirubin Production

  • 1:1 ratio
  • remains in the liver for conjugation to be completed
A

B1 (bilirubin monoglucuronide)

43
Q

Unconjugated Bilirubin Production

  • 1:2 ratio
  • excreted by the liver
A

B2 (bilirubin diglucuronide)

44
Q
  • excess bilirubin in the blood
  • yellowish discoloration
A

jaundice

45
Q

True or False:
Bilirubin is photosensitive

A

True

46
Q

True or False:
Test specimen must be placed in amber glass bottle.

A

False

*Test tube must be protected with aluminum foil or carbon paper

47
Q

Bilirubin Measurement

  • color reaction for bilirubin
  • fast reaction
A

Van den Bergh reaction

48
Q

Bilirubin Measurement

DSA stands for?

A

diazotized sulfanilic acid

49
Q

Bilirubin Measurement

How is nitrous acid formed?

A

sodium nitrite + HCl

50
Q

Bilirubin Measurement
What reaction involves the ff:
serum + DSA → azobilirubin

A

Van den Bergh reaction

51
Q

Bilirubin Measurement

  • one-step method
  • fast reaction
  • measures conjugated bilirubin only
A

Direct VDB Method

52
Q

Bilirubin Measurement

serum with conjugated bilirubin + Ehrlich’s DSA → azobilirubin

A

Direct VDB Method

53
Q

Bilirubin Measurement

measures total bilirubin (conjugated + unconjugated)

A

Indirect VDB Method

54
Q

Bilirubin Measurement

Indirect VDB:
Caffeine Sodium Benzoate

A

Jendrassik-Grof

55
Q

Bilirubin Measurement

Indirect VDB:
modified method

A

diphyllin

56
Q

Bilirubin Measurement

  • rough measurement of bilirubin content in the serum
  • HDN
A

icterus index

57
Q

Icterus Index

standard used

A

diluted potassium dichromate (K2Cr2O7)

58
Q

Icterus Index

Interpret/advise the following if the indicated tubes have the same color:

  • 1st-3rd tubes:
  • 4th-5th tubes:
  • 6th-10th tubes:
A
  • 1st-3rd tubes: exchange blood transfusion
  • 4th-5th tubes: phototherapy
  • 6th-10th tubes: normal
59
Q

Jaundice

  • excessive RBC degradation
  • fast turnover of RBC
A

hemolytic jaundice

60
Q

Jaundice

  • presence of gallstones and biliary stones
A

obstructive jaundice

61
Q

Jaundice

hapatocellular jaundice is also known as ____

A

hepatogenous jaundice

62
Q

Jaundice

  • liver dysfunction
  • due to hepatitis, cirrhosis, cancer
  • conjugation & excretion is very slow
A

hepatocellular jaundice

63
Q

Interpret the following bilirubin measurements

conjugated bilirubin: normal
unconjugated bilirubin: elevated
total bilirubin: elevated

A

hemolytic anemia

64
Q

Interpret the following bilirubin measurements

conjugated bilirubin: elevated
unconjugated bilirubin: normal
total bilirubin: elevated

A

obstructive anemia

65
Q

Interpret the following bilirubin measurements

conjugated bilirubin: elevated
unconjugated bilirubin: elevated
total bilirubin: elevated

A

hepatocellular jaundice

66
Q

Metabolism

Normal transport of bilirubin in the entire liver tissue requires?
*There are two.

A

ligandin & z-protein

67
Q

Metabolism

Adequate enzyme (UDP-GT) to be conjugated in the liver. How do you produce UDP-GT?

A

bilirubin + glucuronic acid

68
Q

Abnormal Metabolism

defective bilirubin transport

A

Gilbert Syndrome

69
Q

Abnormal Metabolism

deficient ligandin & z-protein
*cannot transport 1 hepatocyte to another

A

Gilbert Syndrome

70
Q

Abnormal Metabolism

elevated unconjugated bilirubin = ______

A

elevated unconjugated bilirubin = slow conjugation

71
Q

Abnormal Metabolism

Give 2 syndromes that have high unconjugated bilirubin/slow conjugation.

A
  1. Gilbert Syndrome
  2. Crigler Najjar Syndrome
72
Q

Abnormal Metabolism

  • deffective bilirubin conjugation
  • deficient conjugating UDP-GT
A

Crigler Najjar Syndrome

73
Q

Abnormal Metabolism

  • defective excretion due to canalicular damage
A

Dubin Johnson Syndrome

74
Q

Abnormal Metabolism

elevated conjugated = ______

A

elevated conjugated = slow excretion

75
Q

Abnormal Metabolism

Give 2 syndromes that have slow excretions or high conjugated bilirubin.

A
  1. Dubin Johnson Syndrome
  2. Rotor Syndrome
76
Q

Abnormal Metabolism

defective excretion due to an obstruction in billiary passages caused by a viral infection

A

Rotor Syndrome

77
Q

used to monitor hepatic coma

A

ammonia

78
Q

__(1)__ need to be converted to urea with the help of __(2)__.

A
  1. ammonia
  2. ornithine carbamyl transferase (OCT)
79
Q

detected in the amniotic fluid of pregnant women

A

alpha-1 fetoprotein (AFP)

80
Q

True or False & follow ups:
alpha1 globulin is normally present in the fetus.

Is it normal for adults to have a1 globulin?

A

True

If present in adults, hepatoma is present (liver cancer).

81
Q

If alpha 1 fetorpotein is above reference range what happens?

If it is below reference range?

A

above ref range: Hemolytic Tube/Neural Tube defect (fetus brain is outside the skull)

below ref range: Down Syndrome

Clinical Chemistry II (4 decks)

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