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FINALS CC 1 > TESTS FOR CONJUGATION AND EXCRETION FUNCTION > Flashcards

TESTS FOR CONJUGATION AND EXCRETION FUNCTION Flashcards

1
Q

End product of hemoglobin metabolism

A

BILIRUBIN

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2
Q

85% of bilirubin are derived from

A

hemoglobin metabolism

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3
Q

RBCs are phagocytized, releasing Hgb

A

PREHEPATIC

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4
Q

In prehepatic, Hgb is degraded into________ , ____________ & ______

A
  1. iron (binds with transferrin & transported to liver)
  2. globin (recycled in liver as AA)
  3. heme
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5
Q

biliverdin through Heme Oxygenase

A

HEME

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6
Q

unconjugated bilirubin
through Biliverdin Reductase

A

BILIVERDIN

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7
Q

In prehepatic, B1 is released in ________ and binds with ______ to be transported to the liver

A

plasma, albumin

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8
Q

Albumin is detached on the surface of hepatocytes

A

HEPATIC

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9
Q

In hepatic, after albumin is detached B1 will then bind to _______ to enter the ________

A

ligandin, SER

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10
Q

B1 undergo conjugation catalyzed by) ___________

A

Uridine Diphosphate Glucuronyl Transferase

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11
Q

Uridine Diphosphate Glucuronyl Transferase converts B1 to __________ then to _________ (B2)

A

Bilirubin monoglucuronide, Bilirubin diglucuronide

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12
Q

B2 in liver is transported to the ________ → combined with secretion from the __________ → transported to __________ → transported to

A

hepatic duct, gallbladder, common bile duct, intestine

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13
Q

In the intestine:
B2 is reduced into __________ → _________ → urobilinogen by ________

A

mesobilirubin, mesobilirubinogen, intestinal flora

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14
Q

80% of urobilinogen formed is oxidized to become _________

A

stercobilin

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15
Q

Stercobilin is responsible for

A

responsible for stool pigment: yellow-brown

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16
Q

20% of urobilinogen is

A

reabsorbed by the extrahepatic circulation and recycled through the liver and then re-excreted in urine in the form of urobilin

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17
Q

Bilirubin is also formed from destruction of heme-containing proteins such as

A

myoglobin, catalase, and cytochrome oxidase (15%)

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18
Q

Bilirubin has _______ in the body, thus, it needs to be __________

A

No physiologic function, excreted through liver

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19
Q

Principal pigment in bile

A

BILIRUBIN

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20
Q

Unconjugated bilirubin (form measured in the lab)

A

BILIRUBIN 1

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21
Q

Water Insoluble bilirubin

A

BILIRUBIN 1

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22
Q

Non-polar bilirubin

A

BILIRUBIN 1

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23
Q

Indirect bilirubin

A

BILIRUBIN 1

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24
Q

Hemobilirubin

A

BILIRUBIN 1

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25
Q

Slow reacting bilirubin

A

BILIRUBIN 1

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26
Q

Prehepatic bilirubin

A

BILIRUBIN 1

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27
Q

Conjugated bilirubin (form that can be excreted)

A

BILIRUBIN 2

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28
Q

Water soluble bilirubin

A

BILIRUBIN 2

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29
Q

Polar bilirubin

A

BILIRUBIN 2

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30
Q

Direct bilirubin

A

BILIRUBIN 2

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31
Q

Cholebilirubin

A

BILIRUBIN 2

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32
Q

One-minute/Prompt bilirubin

A

BILIRUBIN 2

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33
Q

Plasma concentration of bilirubin increases upon _______ and reaches its peak on the ________

A

birth, 5th day

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33
Q

Post-hepatic/Hepatic /Obstructive/ Regurgitative

A

BILIRUBIN 2

34
Q

If bilirubin synthesis > liver clearance rate =

A

increased bilirubin level

35
Q

Conjugated bilirubin reference value

A

0-0.2 mg/dL (0-3 µmol/L)

36
Q

Unconjugated bilirubin reference value

A

0.2-0.8 mg/dL (3-14 µmol/L)

37
Q

Total bilirubin reference value

A

0.2-1.0 mg/dL (3-17 µmol/L)

38
Q

Conjugated bilirubin bounded to albumin (having longer half-life)

A

DELTA BILIRUBIN

39
Q

Formed due to chronic/prolonged elevation of conjugated bilirubin

A

DELTA BILIRUBIN

40
Q

Helps in monitoring the decline of serum bilirubin following cholecystectomy

A

DELTA BILIRUBIN

41
Q

Delta bilirubin reacts with ______

A

diazo reagent
o Can be measured using total bilirubin (TB= B2 + B1)
o DB = TB – (B2+B1)

42
Q

Bilirubin specimen

A

Serum

43
Q

Must be covered with carbon paper/aluminum foil as it is __________

A

photosensitive
If exposed to light: bilirubin is decreased 30-50%/hour

44
Q

In bilirubin methodology if sample is prepared and stored properly:
o Room temperature: ________
o Refrigerator (4˚C): __________
o Freezer (-20˚C): ________

A

o Room temperature: 2 days
o Refrigerator (4˚C): 1 week
o Freezer (-20˚C): indefinite

45
Q

Fasting sample is required. TRUE OR FALSE

A

FALSE. Fasting sample is preferred (NOT REQUIRED)

46
Q

Bilirubin Interferences:

A

Lipemia: causes increased bilirubin concentration (why fasting is PREFERRED)
o Hemolysis: decrease bilirubin reaction w/diazo reagent (↓bilirubin)

47
Q

BILIRUBIN ASSAY Principe

A

Van den Berg Reaction → diazotization of bilirubin to form azobilirubin

48
Q

Bilirubin assay only measure __________________ and ___________________

A

conjugated bilirubin (can directly react to the diazo reagent), total bilirubin (measured by adding accelerants for unconjugated bilirubin)

49
Q

Two methods of bilirubin assay

A
  1. EVELYN AND MALLOY METHOD
  2. JENDRASSIK-GROF METHOD
50
Q

EVELYN AND MALLOY METHOD principle

A

Van den berg reaction

51
Q

Reagents of EVELYN AND MALLOY METHOD

A
  1. Coupling accelerator: Methanol (will measure indirect bilirubin)
  2. Diazo Reagents: (measures direct bilirubin)
     Diazo A – 0.1% sulfanilic acid + HCl
     Diazo B – 0.5% sodium nitrite
     Diazo blank – 1.5% HCl
52
Q

EVELYN AND MALLOY METHOD is performed at pH

A

near 1.0

53
Q

Final reaction of EVELYN AND MALLOY METHOD

A

pink to purple azobilirubin (with maximal absorption at 560 nm)

54
Q

Disadvantage of EVELYN AND MALLOY METHOD

A

methanol can cause protein precipitation (causing turbidity)

55
Q

Popular technique for discreet analyzers

A

JENDRASSIK-GROF METHOD

56
Q

Most used as it is more sensitive, safer (uses a more neutral pH), no turbidity

A

JENDRASSIK-GROF METHOD

57
Q

JENDRASSIK-GROF METHOD Main reagent

A

Diazo Reagent

58
Q

JENDRASSIK-GROF METHOD accelerator

A

Caffeine Sodium Benzoate

59
Q

JENDRASSIK-GROF METHOD buffer

A

Sodium acetate

60
Q

terminates the accelerator and destroys excess diazo reagent

A

Ascorbic acid:

61
Q

provides alkaline pH after addition of ascorbic acid

A

Alkaline tartrate solution

62
Q

JENDRASSIK-GROF METHOD Final reaction

A

blue azobilirubin (measured at 600nm)

63
Q

INCREASED INDIRECT BILIRUBIN

A
  • Hemolytic anemia
  • G-6-PD deficiency
  • Gilbert’s Syndrome
  • Criggler-Najjar Syndrome
  • Hepatocellular disease
  • Lucey-Driscoll Syndrome
64
Q

INCREASED DIRECT BILIRUBIN

A
  • Biliary obstruction (gall stones)
  • Pancreatic (head) cancer
  • Dubin-Johnson Syndrome
  • Alcoholic and viral hepatitis
  • Biliary atresia
  • Hepatocellular disease
65
Q

PRE/POST/HEPATIC JAUNDICE

A

INCREASED TOTAL BILIRUBIN

66
Q

Colorless end product of bilirubin metabolism that is oxidized by intestinal flora to urobilin/stercobilin

A

UROBILINOGEN

67
Q

In cases of COMPLETE biliary obstruction → _______ urobilinogen (due to failure in B2 transport to interstine

A

ABSENT

68
Q

Urobilinogen Collection of sample

A

avoid light exposure

69
Q

Urobilinogen Specimen

A

2-hr freshly collected urine or freshly collected stool.

70
Q

Urobilinogen method

A

Ehrlich’s method (p-dimethylaminobenzaldehyde) PDABA

71
Q

Urobilinogen urine reference value

A

0.1-1.0 Ehrlich Unit/2 hour or 0.54 Ehrlich Unit/day urine

72
Q

Urobilinogen stool reference value

A

75-275 Ehrlich Unit/100g of feces

73
Q

Test for hepatocellular function and potency of bile duct

A

BROMSULFONTHALEIN (BSP) DYE EXCRETION TEST

74
Q

Rarely used as it involves administration of bromsulfonthalein dye

A

BROMSULFONTHALEIN (BSP) DYE EXCRETION TEST

75
Q

BROMSULFONTHALEIN (BSP) DYE EXCRETION TEST principle

A

injection of bromsulfonthalein dye (waste) to the body

76
Q

BROMSULFONTHALEIN (BSP) DYE EXCRETION TEST 2 methods of administration

A
  1. ROSENTHAL WHITE METHOD (Double collection)
  2. MAC DONALD METHOD (Single collection)
77
Q

ROSENTHAL WHITE METHOD Specimen collection

A

o 5 mins after BSP administration
o 30 mins after BSP administration

78
Q

ROSENTHAL WHITE METHOD BSP DOSE

A

2 mg/kg body weight

79
Q

ROSENTHAL WHITE METHOD reference value

A
  • After 5 mins: 50% dye retention
  • After 30 mins: 0% dye retention
80
Q

MAC DONALD METHOD BSP dose

A

5 mg/kg body weight

81
Q

MAC DONALD METHOD Specimen collection

A

after 45 mins

82
Q

MAC DONALD METHOD reference value

A

After 45 minutes: (slightly) +/- 5%
dye retention

FINALS CC 1 (6 decks)

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