Liver Functions (Part 3) Flashcards
Three stages of Alcoholic Liver Disease
- Alcoholic fatty liver
- Alcoholic hepatitis
- Alcoholic cirrhosis
Earliest stage of alcoholic liver disease, few symptoms; advanced cases may have hepatomegaly, vomiting, and jaundice
Progressive clinical characteristics used to make a diagnosis of:
- Alcoholic fatty liver
Alcohol liver disease with acute liver necrosis and inflammation; hepatomegaly, jaundice, and ascites
Progressive clinical characteristics used to make a diagnosis of:
- Alcoholic hepatitis
Alcohol liver disease with jaundice, ascites, hepatosplenomegaly, malnutrition, and edema
Progressive clinical characteristics used to make a diagnosis of:
- Alcoholic cirrhosis
Relative increase above the upper limit of normal for enzyme in hepatocellular disease
- Alkaline phosphatase (ALP)
1-3X ULN
Relative increase above the upper limit of normal for enzyme in hepatocellular disease
- Aspartate aminotransferase (AST)
> 8X ULN
ALT>AST
Relative increase above the upper limit of normal for enzyme in hepatocellular disease
- Alanine aminotransferase (ALT)
> 8X ULN
ALT>AST
Relative increase above the upper limit of normal for enzyme in hepatocellular disease
- Lactate dehydrogenase (LD)
Increased LD-4 and LD-5
Relative increase above the upper limit of normal for enzyme in BILIARY OBSTRUCTION
- Alkaline phosphatase (ALP)
10-12X ULN
Relative increase above the upper limit of normal for enzyme in BILIARY OBSTRUCTION
- Gamma glutamyltransferase (GGT)
5-30X ULN
Why is this analyte altered in liver disease and is it increased or decreased:
- Serum albumin
Decreased
- because made in the liver
Why is this analyte altered in liver disease and is it increased or decreased:
- Prothrombin time (PT)
Increased
- trouble clotting
Why is this analyte altered in liver disease and is it increased or decreased:
- Serum lipids
Decreased
- because synthesized in liver, cannot make cholesterol
Why is this analyte altered in liver disease and is it increased or decreased:
- Ammonia
Increased
- detox method interrupted
Why is this analyte altered in liver disease and is it increased or decreased:
- Bile acids
Increased
- in blood, pruritis (itching)
Why is this analyte altered in liver disease and is it increased or decreased:
- Delta bilirubin
Increased
- in cholestatic disease, in recovery would decrease
What are the three Bilirubin Methods?
- Jendrassik-Grof
- Evelyn Malloy
- Direct Spectrophotometry
WHAT TEST?
Principle: sample is mixed with sodium acetate, caffeine sodium benzoate, and diazotixed sulfanilic acid. After incubation, ascorbic acid and alkaline tartrate are added. The absorbance is read at 600nm
Jendrassik-Grof Bilirubin
finding only Total Bilirubin
WHAT TEST?
Principle: sample is mixed with a dilute acid solution and diazo reagent. After incubation, ascorbic acid and alkaline tartrate are added. The absorbance is read at 600nm
Jendrassik-Grof Bilirubin
(finding only direct bilirubin
In Jendrassic-Grof, diazotized sulfanilic acid is added as a reagent in finding TOTAL bilirubin. What is its purpose?
Reacts with bilirubin to form colored azobilirubin
In Jendrassic-Grof, ascorbic acid is added as a reagent in finding both TOTAL and DIRECT bilirubin. What is its purpose?
Stops reaction and destroys excess diazo reagent
In Jendrassic-Grof, alkaline tartrate is added as a reagent in finding both TOTAL and DIRECT bilirubin. What is its purpose?
Changes pH and converts purple azobilirubin to blue azobilirubin
In Jendrassic-Grof, sodium acetate is added as a reagent in finding TOTAL bilirubin. What is its purpose?
buffers reaction
In Jendrassic-Grof, caffeine sodium benzoate is added as a reagent in finding TOTAL bilirubin. What is its purpose?
Accelerates coupling of bilirubin to diazo reagent. (It allows direct and indirect to react so you get total bilirubin not just direct)
Jendrassic-Grofspecimen specimen requirements
use serum or heparinized plasma***?
Jendrassic-Grof reference ranges
- Total:
- Adult
- Infant
Total Adult: 0.2-1.0 mg/dL
Total Infant: 4.0-8.0 mg/dL
Jendrassic-Grof reference ranges
- Conjugated:
- Adult
- Infant
Conj Adult: 0.0-0.4 mg/dL
Conj Infant: 0.0-0.2 mg/dL
Jendrassic-Grof reference ranges
- Unconjugated:
- Adult
- Infant
Unconj Adult: 0.2-0.6 mg/dL
Unconj Infant: 4.0-7.8 mg/dL
WHAT TEST?
Principle: Direct bilirubin is measured first: sample plus water plus diazotixed sulfanilic acid is incubated, then absorbance is taken at 600 nm. Next total bilirubin is measured by adding methanol to the above reactants, incubate then read at 600nm
Evelyn and Malloy Bilirubin
In Evelyn and Malloy Bilirubin, Diazotized sulfanilic acid is added as a reagent in finding DIRECT bilirubin. What is its purpose?
Reacts with bilirubin to form colored azobilirubin
In Evelyn and Malloy Bilirubin, Methanol is added as a reagent in finding TOTAL bilirubin. What is its purpose?
Accelerates coupling of indirect bilirubin to diazo (allows indirect bilirubin to react)
Evelyn and Malloy Bilirubin specimen requirements
?
WHAT TEST?
Principle: this method is reasricted to blood specimens from a healthy newborns in which unconjgated bilirubin is the predominant species. Measure blood at two wavelengths (455 and 575nm) to correct for oxyhemoglobin that also absorbs at 455nm
Bilirubin by Direct Spectrophotometry
WHAT TEST?
Principle: Take 2-oxoglutarate plus NH4 plus NADPH. Measure absorbance at 340nm
Ammonia
Ammonia specimen requirements
Place specimen on ice after drawing and analyze within 20 minutes. Ammonia in freshly-drawn blood rises 2 to 3 fold if left at room temp. Plasma is specimen of choice.
Ammonia ref range
14-45 ug/dl
WHAT TEST:
principle: Urobilinogen plus Ehrlich’s reagent leads to a red color read spectrophotometrically
Fecal and Urine Urobilinogen
Fecal and Urine Urobilinogen specimen requirements
Fresh urine collected over 2 hour period or 24- hour specimen collected in a dark bottle with 5 grams sodium bicarbonate to minimize oxidation and toulene to minimize bacterial growth and to protect from oxygen in the air
Fecal and Urine Urobilinogen ref ranges
0.1-1.0 EU/hours or 0.0-4.0 EU/day
