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Clinical Chemistry 2 > Liver Function > Flashcards

Liver Function Flashcards

1
Q

Chief metabolic organ in the body. And is composed of three systems

A

Liver
Hepatocytic, hepatobiliary, and reticuloendothelial

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2
Q

To eliminate toxins such as alcohol, what are the two enzymes are essential in the pathway?

A

Alcohol dehydrogenase
Acetaldehyde dehydrogenase

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3
Q

Primary liver parenchymal cells and play complicated roles in fibrosis and cirrhosis. It represents 80% of the volume of the liver and is responsible for regenerative property.

A

Hepatocyte

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4
Q

Has the phagocytic role, engulfing organisms and toxins

A

Kupfer cell

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5
Q

What does liver secretes?

A

plasma proteins, carbohydrates, ketone bodies, lipids, lipoproteins, clotting factors, enzymes and xenobiotics

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6
Q

The normal liver produces how many g or albumin daily?

A

12grams

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7
Q

How many mg of bilirubin is produced daily in the healthy adult?

A

200 to 300mg

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8
Q

Ammonia is converted to what in the liver?

A

Urea

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9
Q

Bile acids (cholic acid and chenodeoxycholic acid are conjugated with amino acids _______ to form bile salts

A

glycine and taurine

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10
Q

routine markers for the measurement of hepatic synthetic function

A

total protein, albumin, globulin and albumin/globulin ratio

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11
Q

secondary for the measurement of hepatic synthetic function

A

prothrombin time

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12
Q

plasma levels of tp is _____ higher than serum due to fibrinogen

A

0.2 - 0.4 g/dL

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13
Q

In measuring total protein, is fasting required?

A

naur

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14
Q

Reference range for total protein?

A

6.5 - 8.3 g/dL

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15
Q

It is the reference method for total protein measurement but not routinely used

A

Kjeldahl method

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16
Q

Kjeldahl method is based on the measurement of_______ of protein. It uses serum samples treated with ___ forming protein free filtrate.

A

nitrogen content; 15.1 to 16.8%
tungstic acid

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17
Q

1 grams of nitrogen is equivalent to?

A

6.54 g of proteins

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18
Q

What is the reagent and end product in Kjeldahl method?

A

sulfuric acid (digesting agent)
ammonia

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19
Q

Widely used method for tp measurement and recommended by the IFCC. Explain the principle

A

Biuret Method
Cupric ions form a complex with peptide bond, forming a violet-colored chelate which is proportional to the number of peptide bonds present and reflect the total protein level (545 nm)

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20
Q

It influences the Biuret method, causing falsely elevated total protein

A

hemolysis
ictericia

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21
Q

What is/are the reagents and reference range for biuret method?

A

Alkaline copper sulfate, Rochelle salt (NaK Tartrate), NaOH, Potassium Iodide
6.5 - 8.3 g/dL

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22
Q

It has the highest analytical sensitivity. Reagents used are phosphotungstic-molybdic acid or phenol reagent

A

Folin-Ciocalteu Method

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23
Q

Turbidimetric and nephelometric utilizes what acids?

A

sulfosalicylic acid and trichloroacetic acid

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24
Q

proteins absorbs light at?

A

210nm - due to absorbance of peptide bonds
280nm - due to tyrosine, tryptophan and phenylalanine

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25
Q

It is preferred in detecting such as the M-spike in multiple myeloma. Has higher analytical sensitivity compared to conventional electrophoresis since it can measure small abnormalities such as ___ in hepatic cirrhosis

A

Immunofixation electrophoresis
beta-gamma bridging

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26
Q

T or F. Globulin is insoluble in water but not in dilute salt solution

A

True

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27
Q

T or F. Albumin is insoluble in water and concentrated salt solution

A

False

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28
Q

What is the principles of SPE?

A

migration of charged particles in an electrical field

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29
Q

What are the major proteins that contribute to electrophoreis?

A

albumin, a-1 antitrypsin, a-2 macroglobulin, haptoglobin, b-lipoprotein, transferrin, immunoglobulin, fibrinogen, complement C3

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30
Q

what is the protein that increases as non specific response to inflammation?

A

a-1 globulin

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31
Q

Normal SPE pattern

A
  1. Albumin (1st) - fastest band
  2. Alpha 1- globulin (2nd) - glycoproteins, AAT, AAG, thyroxine binding-globulin
  3. Alpha 2-globulin - (3rd) - haptoglobin, AMG, ceruloplasmin
  4. Beta-globulin (4th) - transferrin, b-lipo, hemopexin, C3 and C4
  5. Gamma-globulin (5th); slowest - immunoglobulin and CRP
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32
Q
  1. g- spike - ?
  2. b-g-bridging - ?
  3. a2 globulin band spike - ?
  4. a1 globulin flat curve- ?
  5. a1, a2, and B-globulin bands - ?
A
  1. multiple myeloma
  2. hepatic cirrhosis
  3. nephrotic syndrome
  4. juvenile cirrhosis (AAT deficiency)
  5. inflammation
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33
Q

the presence of small spikes in the beta region is due to?

A

iron deficiency (tranferrin)

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34
Q

It is for the detection of proteins to as little as 1ug

A

Coomassie brilliant blue dye

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35
Q

It is for the detection of amino acid and peptide bond after paper chromatography

A

Ninhydrin

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36
Q

amino acid - ion-exchange columns
thin-layer chromatography - drugs

A

eme

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37
Q

Increased total protein

A

malignancy
multiple myeloma
waldenstrom’s macroglobulinemia

38
Q

Decreased total protein

A

hepatic cirrhosis
glomerulonephritis
nephrotic syndrome
starvation

39
Q

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

A

Albumin
3.5-5.0 g/dL

40
Q

In Albumin, what is the
1. most commonly used method?
2. most specific method?

A
  1. Bromcresol green
  2. Bromcresol purple
41
Q

what are the methods in albumin?

A
  1. Bromcresol green
  2. Bromcresol purple
  3. Hydroxyazobenzene Benzoic Acid
  4. Methyl Orange
42
Q

Affected by the presence of penicillin leading to false decrease of albumin

A

BCG

43
Q

Are not significantly affected by hemolyzed samples. Are cationic dyes and free form interference from bilirubin

A

BCG and BCP

44
Q

Influenced by hyperbilirubinemia

A

HABA

45
Q

Formula of globulin

A

Total protein - Albumin

46
Q

Inverted A/G ration

A

cirrhosis
multiple myeloma
waldenstrom’s macroglobulinemia

47
Q

hereditary absence of albumin

A

analbuminemia

48
Q

presence of two albumin bands and is associated with excess amounts of therapeutic drugs in serum

A

bisalbuminemia

49
Q

presence of two band and is due to lack of amino acids in an individual’s diet

A

Kwashiorkor

50
Q

Differentiates intrahepatic disorders and extrahepatic obstructive liver disease. And is administered intramuscularly 10mg daily for 1-3 days

A

Prothrombin Time (Vitamin K response test)

51
Q

End product of hemoglobin metabolism and principle pigment of bile.

A

Bilirubin
- it is formed from the destruction of heme-containing proteins (myoglobin, catalase, and cytochrome oxidase)

52
Q
  1. Actual site of conjugation?
  2. Major sites of deconjugation?
A
  1. Smooth Endoplasmic Reticulum
  2. Ileum and the early segment of colon
53
Q

oxidized form of urobilinogen which imparts stool its color

A

stercobilinogen or urobilin

54
Q

responsible for the color of urine

A

urobilin

55
Q

The colorless end-product of bilirubin metabolism that is oxidized to the brown pigment urobilin

A

UROBILINOGEN

56
Q

It is the conjugated bilirubin tightly bound to albumin. Also reacts with diazo reagent

A

Delta-Bilirubin

57
Q

Half-life of Delta-Bilirubin

A

12-14 days

58
Q

Formula of d-bilirubin

A

TB - DB + IB

59
Q

The plasma concentration of bilirubin increases upon birth and reaches its peak on the?

A

5th day

60
Q

T or F. If the rate of bilirubin formation exceeds the rate of liver clearance, there will be a rise in the bilirubin level in serum.

A

True

61
Q

Also called as icterus or hyperbilirubinemia. Characterized by yellow discoloration and clinically evident when level exceeds 3mg/dL

A

Jaundice

62
Q

Serum Bilirubin: elevated B1
Urine Bilirubin: Negative
Urine Urobilinogen: Normal/Increased

A

Pre-hepatic Jaundice/Hemolytic Jaundice
- too much destruction of red blood cells

63
Q

Serum Bilirubin: elevated B2
Urine Bilirubin: Positive
Urine Urobilinogen: Decreased/Undetectable

A

Post hepatic Jaundice/Obstructive Jaundice
-failure of bile to flow or reach the intestine

64
Q

Serum Bilirubin: elevated B1 and B2
Urine Bilirubin: Positive
Urine Urobilinogen: Decreased/Undetectable

A

Hepatocellular Combined Jaundice/Hepatic Jaundice
- caused by viruses, alcohol and parasites

65
Q

cirrhosis, viral hepatitis, toxic hepatitis and fascioliasis

A

Hepatocellular Combined Jaundice/Hepatic Jaundice

66
Q

cholelithiasis, bilateral pancreatic tumor and colon parasitism

A

Post hepatic Jaundice/Obstructive Jaundice

67
Q

Malaria, hemolytic anemia, and hemolytic disease of the newborn

A

Pre-hepatic Jaundice/Hemolytic Jaundice

68
Q

Impaired cellular uptake of bilirubin. It is characterized by a molecular defect (UGT1A1) insertion of two bases.

A

Gilbert’s Syndrome/ Bilirubin Transport Deficit

69
Q

Characterized by the absence of UDPGT. Multiple mutation with UGT1A1 gene. Is common among infants and treated with phototherapy.

A

Crigler-Najjar Syndrome/ Conjugation Deficit Syndrome

70
Q

Absolute deficiency of the enzyme UDPGT
Total absence of B2 production
(+) kernicterus

A

Type I Crigler-Najjar Syndrome

71
Q

Partial deficiency of UDPGT
Small amount of B2 is produced

A

Type II Crigler-Najjar Syndrome

72
Q

Associated with the blockade of the excretion of bilirubin caused by a hepatocyte membrane defect. Deficiency of Multi-drug resistant (MDR2)/ Multi-specific
Organic Anionic Transporter protein (cMOAT)

A

Dubin-Johnson Syndrome/Bilirubin Excretion Deficit

73
Q

Familial form of unconjugated hyperbilirubinemia and may be caused by circulating inhibitor of bilirubin conjugation

A

Lucey-Driscoll Syndrome/Conjugation Inhibitor syndrome

74
Q

An autosomal recessive disease. Mutations in SLCO1B1 and SLCO1B3 gene

A

Rotor Syndrome/Mixed Hyperbilirubinemia

75
Q

due to immature blood brain barrier among infants

A

Kernicterus

76
Q

T or F. Visible icterisia occurs when bilirubin is <25mg/L

A

true

77
Q

Principle of Bilirubin Assay

A

Van den Bergh reaction is the diazotization of bilirubin to produce azobilirubin

78
Q

Explain Evelyn and Malloy Method

A

Accelerator: Methanol
Diazo Reagents
o Diazo A = 0.1% Sulfanilic Acid + HCl
o Diazo B = 0.5% Sodium Nitrite
o Diazo Blank = 1.5% HCl
 Required pH: 1.2
End Color:
Pink to purple azobilirubin at 560 nm

79
Q

Most commonly used method for Bilirubin Assay and is popular for the discreet analyzers.

A

JENDRASSIK-GROF METHOD
Modification of Malloy and Evelyn
 Two Aliquots of Sample
-Reacting one aliquot with the diazo reagent only
(sulfanilic acid in hydrochloric acid and sodium
nitrite)
-Other aliquot with the diazo reagent and an
Accelerator (caffeine sodium-benzoate)
 Reaction is terminated by the addition of ascorbic acid
 Buffer used: Sodium Acetate
End Color: blue at 600nm

80
Q

T or F. Bilirubin absorbs light maximally at 450nm and imparts a yellow color to amniotic fluid

A

true

81
Q

Increased B1

A
  1. Gilbert’s Syndrome
  2. Crigler-Najjar Syndrome
  3. Hemolytic Anemia
  4. Hepatocellular disease
  5. Lucey Driscoll Syndrome
  6. G-6-PD deficiency
82
Q

Decreased B2

A
  1. gall stones
  2. Pancreatic (head cancer)
  3. Dubin-Johnson syndrome
  4. Alcohol and viral hepatitis
  5. Biliary atresia
  6. Hepatocellular disease
  7. Septicemia
  8. Rotor syndrome
83
Q

Colorless end product of bilirubin metabolism

A

Urobilinogen

84
Q

absence of urobilinogen denotes what?

A

complete bile obstruction

85
Q

what is the method use and reagent in urobilinogen?

A

Ehrlich’s method
p-dimethyl aminobenzaldehyde reagent

86
Q

Test for hepatocellular function and potency of bile duct. It determines the ability of protein albumin to transport the exogenous dye to the liver

A

Bromsulphthalein Dye Excretion Test

87
Q

enzymes that are increased in drug and alcohol hepatoxicity

A

ALT and AST

88
Q

Smallest NPN. Marker for hepatic failure and Reye’s syndrome

A

Ammonia

89
Q

preferred spx for ammonia
sample requirement
common method used
major interference

A
  • arterial blood
  • heparin/EDTA
  • Glutamate Dehydrogenase (340nm)
  • hemoglobin
90
Q

End color if the Nitrogen content sample is low to moderate? If high?

A

If low, yellow. If high, brown.

91
Q
A

Clinical Chemistry 2 (5 decks)

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