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SEM 1 > SEM 1 - (CC) LIVER FUNCTION TEST 1 > Flashcards

SEM 1 - (CC) LIVER FUNCTION TEST 1 Flashcards

1
Q

It is the chief metabolic organ in the body with lobules as its microscopic and function units.

A

Liver

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2
Q

Liver framework is composed of 3 systems, what are those 3?

A

Hepatocytic
Hepatobiliary
Reticuloendothelial

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3
Q

The liver receives _____ of blood per minute from the portal vein for filtration while it also delivers toxins to the liver for processing and detoxification.

A

15 mL

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4
Q

In the liver, to eliminate toxins such as alcohol, two enzymes are essential in the pathway, which are?

A
  1. alcohol dehydrogenase
    and
    2, acetaldehyde dehydrogenase.
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5
Q

a unique organ with the capacity to regenerate cells that have been damaged, injured, or removed.

A

liver

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6
Q

_______ of the remaining tissue in case of tissue injury due to biliary obstruction or toxic exposure is a distinguishing feature of the liver.

A

Hypertrophy

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7
Q

______ are the primary liver parenchymal cells and play complicated roles in fibrosis and cirrhosis;

A

Hepatocytes

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8
Q

In hepatocytes ; the targets for most hepatotoxic agents, including what?

A

hepatitis viruses, alcohol metabolites, and bile acids

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9
Q

Major Cell Types of Liver:

A
  1. Hepatocyte
  2. Kupfer Cell
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10
Q

major liver cell type that represents 80% of the volume of the liver; performs the major hepatic functions; responsible for
the regenerative property.

A

Hepatocyte

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11
Q

Major live cell type that has the phagocytic role; it is the hepatic macrophage, engulfing organisms and toxins.

A

Kupfer cell

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12
Q

5 Functions of the Liver:

A
  1. Synthetic Function
  2. Conjugation Function
  3. Detoxification and Drug Metabolism
  4. Excretory and Secretory Function
  5. Storage Function
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13
Q

Synthetic Function of the Liver:

  • The liver secretes the ff….
  • The normal liver produces about ______ of albumin daily,
  • It is also involved in the metabolism of cholesterol into ______
A
  • plasma proteins, carbohydrates, lipids, lipoproteins, clotting factors, ketone bodies, enzymes, and xenobiotics.
  • 12 grams
  • bile acids.
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14
Q

Conjugation Function of the Liver:

  • ____ is the site of liver metabolism.
  • ______ of bilirubin is produced daily in the healthy adult.
A
  • Liver
  • 200 to 300 mg
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15
Q

Detoxification and Drug Metabolism of Liver:

  • Liver serves to protect the body from potentially injurious substances absorbed from the intestinal tract and toxic by-product of metabolism.
  • ______ (toxic by-product) is converted to urea in the liver.
A

Ammonia

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16
Q

Excretory and Secretory Function of Liver

  • Excretion of bile involves the elimination of _______, _______ and _____
  • Bile acids (_______ and _____) are conjugated with the amino acids _____ and _____ to form bile salts.
A
  • bile acids or salts, pigments, and cholesterol.
  • cholic acid and chenodeoxycholic acid ; glycine and taurine
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17
Q

Storage function of liver:

  • Storage site for all _____ and _____ vitamins.
  • Liver is also the storage depot for ______, which is released when glucose is depleted.
A
  • fat-soluble and water-soluble
  • glycogen
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18
Q

MAJOR LIVER FUNCTION TESTS

A
  1. TESTS MEASURING THE HEPATIC SYNTHETIC FUNCTION
  2. TEST MEASURING CONJUGATION AND EXCRETION FUNCTION
  3. TEST FOR DETOXIFICATION FUNCTION
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19
Q

Liver function test that is useful in quantitating the severity of hepatic dysfunction.

A

TESTS MEASURING THE HEPATIC SYNTHETIC FUNCTION

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20
Q

In TESTS MEASURING THE HEPATIC SYNTHETIC FUNCTION ;

_____ and ________ provide the most useful indices for assessing severity of liver disease.

A

Serum albumin and the vitamin-K-dependent coagulation factors

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21
Q

Proteins are abundantly produced in liver except the _______

A

immunoglobulins

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22
Q

Routine Markers in TESTS MEASURING THE HEPATIC SYNTHETIC FUNCTION

A

Total protein, albumin, globulin, and albumin/globulin ratio

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23
Q

Secondary Markers in TESTS MEASURING THE HEPATIC SYNTHETIC FUNCTION

A

Prothrombin TIme

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24
Q

Analysis of proteins is important for assessing nutritional status and presence of severe diseases involving the liver, kidney, and bone marrow.

A

Total Protein

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25
Q

Plasma levels of total protein is _______ higher than serum due to _______

A

0.2 to 0.4g/dL ; fibrinogen.

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26
Q

Total protein and albumin are about ____ higher in ambulatory individuals.

A

10%

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27
Q

Transudates have a total protein of ______ (<50% of the serum total protein);

exudates has _____

A

<3.0g/dL ; >3g/dL.

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28
Q

Total protein measurement is usually performed in serum which has no _______ and no ________ that may slightly dilute proteins in plasma.

A

fibrinogen ; anticoagulant

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29
Q

In measuring total proteins in serum, ____ may not be required.

A

fasting

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30
Q

Total Protein Reference range: _________

A

6.5-8.3 g/dl

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31
Q

METHODS FOR TOTAL PROTEIN MEASUREMENT

A
  1. Kjeldahl Method
  2. Biuret Method
  3. Folin-Ciocalteu Method
  4. Lowry Method
    5, Turbidimetric and Nephelometric Method
    6, Ultraviolet Absorption Method
  5. Refractometry
  6. Immunofixation Electrophoresis
  7. Salt Fractionation
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32
Q

a method for total protein measurement that is a reference method but not routinely used.

A

Kjeldahl Method

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33
Q

Kjeldahl Method is based on the measurement of __________

A

nitrogen content of protein.

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34
Q

Kjeldahl Method uses serum samples treated with _________, _______

A

tungstic acid, forming protein-free filtrate(PFF).

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35
Q

According to Kjeldahl, 1 gram of nitrogen is equivalent to ______ of proteins

A

6.54 grams

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36
Q

In kjeldahl method, the nitrogen content of proteins is about _____ to ______

A

15.1% to 16.8%.

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37
Q

Reagent in Kjeldahl Method and its end product

A

Reagent: Sulfuric acid (digesting agent)

End product: Ammonia

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38
Q

a method for total protein measurement that is most widely used method

A

Biuret Method

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39
Q

Biuret method of total protein measurement is recommended by the __________ expert panel.

A

International Federation of Clinical Chemistry (IFCC)

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40
Q

Principle: Cupric ions form a complex with the peptide bonds, forming a violet-colored chelate which is proportional to the number of peptide bonds present and reflects the total protein level at 545 nm.

A

Biuret Method

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41
Q

Biuret method requires at least two _______ and an _____ medium to measure total protein.

A

peptide bonds ; alkaline

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42
Q

It is preferred by automated analyzers since protein concentration as low as 10 or 15 mg/dL can be measured.

A

Biuret Method

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43
Q

_____ and _____ influence the Biuret method, causing falsely elevated total protein

A

Hemolysis and ictericia

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44
Q

Reagents in Biuret Method

A

Alkaline copper sulfate, Rochelle salt (Nak Tartrate), NaOH, and Potassium iodide

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45
Q

ref range in biuret method

A

6.5-8.3 g/dL

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46
Q

a method for total protein measurement that has the highest analytical sensitivity.

A

Folin-Ciocalteu Method

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47
Q

Principle: Oxidation of phenolic compounds, such a s tyrosine, tryptophan, and histidine, to give a deep blue color

A

Folin-Ciocalteu Method

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48
Q

Folin-Ciocalteu Method give a _____ color

A

deep blue

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49
Q

Folin-Ciocalteu Method main reagent and color enhancer

A

Main reagent: Phosphotungstic-molybdic acid o r phenol reagent

Color enhancer: Biuret reagent

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50
Q

a method for total protein measurement that utilizes the reagents of Folin-Ciocalteu method (phenol) and biuret method where the addition of phenol reagent to the biuret reagents improves the color formation.

A

Lowry Method

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51
Q

a method for total protein measurement that utilize sulfosalicylic acid and or trichloroacetic acid.

A

Turbidimetric and Nephelometric Method

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52
Q

Turbidimetric and Nephelometric Method Measurement depends on the formation of a uniform fine precipitate which scatters incident light in suspension (______) or block light (______).

A

nephelometry ; turbidimetry

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53
Q

Turbidimetric methods is also used in _____ and ______ specimens.

A

CSF and urine

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54
Q

Principle: The absorbance of proteins at 210 nm is due to the absorbance of the peptide bonds a t specific wavelength.

A

Ultraviolet Absorption Method

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55
Q

In Ultraviolet Absorption Method, absorption of proteins at 280 nm is due to _______, ______ and _______

A

tryptophan, tyrosine, and phenylalanine

56
Q

Proteins absorb light at ________ and ______

A

210 nm and 280 nm.

57
Q

a method for total protein measurement that is an alternative test to chemical analysis of serum total proteins.

A

Refractometry

58
Q

Refractometry is based on measurement of _______ of solutes in serum.

A

refractive index

59
Q

Refractive index is not applicable for _____ measurements because of increased concentration of solutes.

A

urine protein

60
Q

a method for total protein measurement that characterizes the abnormal bands by adding specific antisera to each sample cell of the electrophoretic gel and
the immune complex is viewed by staining

A

Immunofixation Electrophoresis

61
Q

Immunofixation Electrophoresis is used to diagnose and monitor different plasma cell dyscrasias such as _______ and _______

A

multiple myeloma and Waldenstrom’s
macroglobulinemia

62
Q

Immunofixation Electrophoresis is preferred in detecting (not quantification) abnormal proteins such as the _________

A

M-spike in multiple myeloma

63
Q

a method for total protein measurement that has higher analytical sensitivity compared to the conventional electrophoresis since it can measure small abnormalities such as the beta-gamma bridging in hepatic cirrhosis.

A

Immunofixation Electrophoresis

64
Q

a method for total protein measurement where Globulins can be separated from albumin by salting-out procedures using sodium salts.

A

Salt Fractionation

65
Q

Salt Fractionation reagent

A

sodium sulfate salt

66
Q

The albumin that remains in solution in the supernatant can be measured by any of the routine _______ methods ; globulin is insoluble in ____ but not in _______

A

total protein ; water ; dilute salt solution

67
Q

SOLUBILITY PROPERTY OF PROTEINS:

WHAT PROTEIN?
Soluble: Water, Conc. Salt Solution

Insoluble: Saturated Salt Sol, Highly Conc. Salt Sol, Hydrocarbon solvents

68
Q

SOLUBILITY PROPERTY OF PROTEINS:

WHAT PROTEIN?
Soluble: Weak Salt Sol, Hydrocarbon Solvents

Insoluble: Water Saturated Salt Sol, Conc. Salt Sol

69
Q

Principle: Migration of charged particles in an electric field

A

Serum Protein Electrophoresis (SPE)

70
Q

The single most significant clinical application of SPE is the identification of __________ and differentiating them from _____________

A

monoclonal spike of immunoglobulins ; polyclonal hypergammaglobulinemia.

71
Q

In SPE; _______ exhibits a pattern of acute inflammation associated with tissue injury producing elevated acute phase reactants (A.AT, haptoglobin, alpha-1 antichymotrypsin).

A

Myocardial infarction

72
Q

Major proteins that contribute to electrophoresis:

A

albumin
a1-antitrypsin
a2-macroglobulin
haptoglobin
B-lipoprotein
transferrin
complement C3
fibrinogen
immunoglobulins

73
Q

_______ proteins increase as a non-specific response to inflammation.

A

Alpha 1-globulin

74
Q

Normal SPE Pattern (FASTEST TO SLOWEST)

A
  1. Albumin
  2. A1 Globulin
  3. A2 Globulin
  4. Beta-globulin
  5. Gamma-globulin
75
Q

Fastest band in SPE

76
Q

2nd Fastest band in SPE

what does it include?

A

A1 Globulin

glycoproteins, AAT, AAG, thyroxine binding-globulin (TBG)

77
Q

3rd fastest band?

what does it include/

A

A2 Globulin

haptoglobin, AMG, ceruloplasmin

78
Q

4th band

what does it include?

A

Beta globulin

transferrin, beta-lipoprotein, hemopexin, complement (C3 and C4)

79
Q

5th & slowest band

what does it include?

A

Gamma-globulin

immunoglobulin and CRP

80
Q

REF VALUE FOR ALBUMIN

A

53-65% (3.5-5.0 g/dL)

81
Q

REF VALUE FOR A1-GLOBULIN

A

2.5-5% (0.1-0.3g/dL)

82
Q

REF VALUE FOR A2-GLOBULIN

A

7-13% (0.6-1.0 g/dL)

83
Q

REF VALUE FOR B-GLOBULIN

A

8-14% (0.7-1.1 g/dL)

84
Q

REF VALUE FOR GAMMA-GLOBULIN

A

12-22% (0.8-1.6 g/dL)

85
Q

ABNORMAL SERUM ELECTROPHORETIC PATTERN AND ITS RELATED DISORDER:

GAMMA SPIKE

A

MULTIPLE MYELOMA

86
Q

ABNORMAL SERUM ELECTROPHORETIC PATTERN AND ITS RELATED DISORDER:

B-GAMMA BRIDGING

A

HEPATIC CIRRHOSIS

87
Q

ABNORMAL SERUM ELECTROPHORETIC PATTERN AND ITS RELATED DISORDER:

A2-GLOBULIN BAND SPIKE

A

NEPHROTIC SYNDROME

88
Q

ABNORMAL SERUM ELECTROPHORETIC PATTERN AND ITS RELATED DISORDER:

A1-GLOBULIN FLAT CURVE

A

JUVENILE CIRRHOSIS (AAT DEFICIENCY)

89
Q

ABNORMAL SERUM ELECTROPHORETIC PATTERN AND ITS RELATED DISORDER:

SPIKES OF A1, A2, AND B-GLOBULIN BANDS

A

INFLAMMATION

90
Q

The presence of free hemoglobin will cause _____ in the late alpha-2o r early beta zone region.

A

“blip”

91
Q

The presence of small spikes or striking elevation in the beta region is due to ______________

A

Iron deficiency anemia (transferrin).

92
Q

Rheumatoid arthritis and malignancy would result in _____________ classified as __________

A

polyclonal gammopathy ; chronic inflammation.

93
Q

Other Measurements for Total Proteins:

____________ Is for detection of proteins to as little as 1 ug.

A

Coomassie brilliant blue dye

94
Q

Other Measurements for Total Proteins:

________, which develops a violet color by reacting with primary amines, is widely used for detection of peptides and amino acids after paper chromatography.

95
Q

Other Measurements for Total Proteins:

________ utilized ion-exchange columns, while ________ detects drugs as part of the toxicology screens.

A

Amino acid analyses ; thin-layer chromatography

96
Q

DISEASE WITH INCREASED TOTAL PROTEIN

A
  1. Malignancy
  2. Multiple myeloma
  3. Waldenstrom’s macroglobulinemia
97
Q

DISEASE WITH DECREASED TOTAL PROTEIN

A
  1. Hepatic cirrhosis
  2. Glomerulonephritis
  3. Nephrotic syndrome
  4. Starvation
98
Q

The concentration of this protein is inversely proportional to the severity of the liver disease.

99
Q

Plasma levels of albumin decline when severe hepatocellular disease lasts more than ______

100
Q

In hepatic circulatory disorder, _____ is used because its concentration reflects the shift of protein and fluid
into ascites, and its important contribution to the plasma oncotic pressure.

101
Q

Decreased serum albumin concentration may be due to ________

A

decreased synthesis

102
Q

Low total protein and low albumin: ________ and _______

Reference range of albumin: ______

A

Hepatic cirrhosis and nephrotic syndrome ; 3.5-5.0 g/dl

103
Q

albumin methods: dye assays

A

1 . Bromcresol green (BCG) . most commonly used method 2. Bromcresol purple (BCP)- most specific method
3. Hydroxyazobenzene benzoic acid (HABA)
4. Methyl orange (MO)

104
Q

Albumin can be measured by direct methods based on its _______

A

dye-binding property.

105
Q

Albumin reversible binds many ________, including dyes that do not interact with the other serum
proteins.

A

small molecules

106
Q

______ is used extensively in automatic analyzers for determining serum albumin parallel with Biuret
reagent for total protein

107
Q

____ reacts almost only to albumin compared to BCG which has affinity with minor globulins

108
Q

The presence of drugs, such as penicillin, and the use of hemolyzed and icteric samples affect measurement of ________

A

serum albumin

109
Q

_____ is affectedby the presence of penicillin leading to false decrease of albumin.

110
Q

BCG and BCP are not significantly affected by ______ sample

111
Q

HABA method is influenced by ________

A

hyperbilirubinemia

112
Q

_______ are catioinic dyes and free from interference from bilirubin.

A

BCG and BCP

113
Q
  1. Severe dehydration
  2. Prolonged tourniquet application artifactual hyperalbuminemia
A

Hyperalbuminemia

114
Q

factors in hypoalbuminemia

A
  1. Reduced Synthesis
  2. Increased Loss
  3. Increased Catabolism
115
Q

Chronic liver disease
Malabsorption syndrome
Malnutrition and muscle wasting disease

related to?

A
  1. Reduced Synthesis
116
Q

Nephrotic syndrome (20-30g/day) - albumin excretion is increased when the glomerulus no longer functions to restrict the passage of proteins from the blood
Massive burns
Protein-losing enteropathy Orthostatic albuminuria

related to?

A

Increased Loss

117
Q

Massive burns
Widespread malignancy Thyrotoxicosis

related to?

A

increased Catabolism

118
Q

4 major fractions of globulin

A

A1, A2, Beta, Gamma

119
Q

determined indirectly through the concentration of total protein.

120
Q

Indirect method of globulin and Ref. Range

A

IM: Total Protein - Albumin = Globulin

Ref. Range = 2.3-3.5 g/dL

121
Q

It is determined to validate if globulin is higher than albumin.

A

Albumin/Globulin Ratio

122
Q

If globulin is greater than albumin, the phenomenon is called the _________, as seen in _______ , ______, and ________

A

inverted A/G ratio ; cirrhosis, multiple myeloma, and Waldenstrom’s macroglobulinemia.

123
Q

_____ and even _________ may help define the clinical situations related to the inverted A/G ratio.

A

Serum ; urine protein electrophoresis

124
Q

ref range of A/G ratio

A

Reference range: 1.3-3:1

125
Q

If the hepatic injury is less than ___, total regeneration will occur and the total protein, albumin, and even ammonia remain normal.

126
Q

In the case of hepatitis, the serum protein may be normal due to less severe hepatic damage but in __________,
regeneration of the liver tissue does not ensue due to more than 80% liver damage, thus, the total protein and albumin are both decreased.

A

panhepatic cirrhosls.

127
Q

It is the hereditary absence of albumin or the inability to synthesize albumin.

A

Analbuminemia

128
Q
  • It is the presence oftwo albumin bands intead of a single band in electrophoresis.
A

Bisalbuminemia

129
Q
  • It is the presence of albumin with unusualmolecular characteristics in the blood.
A

Bisalbuminemia

130
Q

It is associated with excess amounts of therapeutic drugs in serum.

A

Bisalbuminemia

131
Q

It is the presence of two albumin bands instead of a single band in electrophoresis.

A

Kwashiorkor

132
Q

It is the lack of amino acids in an individual’s diet due to severe malnutrition, resulting in the liver’s inability to synthesize proteins and eventually decreased plasma oncotic pressure.

A

Kwashiorkor

133
Q

It differentiatesintrahepatic disorder (prolonged protime) from extrahepatic obstructive liver disease (normal protime).

A

Prothrombin Time (Vitamin K Response Test)

134
Q

Prolonged protime, despite vitamin K administration, indicates _________ capacity to synthesize the proteins.

A

loss of hepatic

135
Q

Vitamin K is administered ________, __ mg daily for __ to __ days.

A

intramuscularly ; 10 ; 1 to 3

SEM 1 (4 decks)

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