BILIRUBIN Flashcards
(112 cards)
1
Q
4 Functions of the liver
A
- Detoxification
- Storage
- Synthetic
- Excretion/Secretion
2
Q
Organ capable of conjugating bilirubin
A
Liver
3
Q
is a product of intravascular hemolysis (due to
parasites, virus), or in the normal course (senescence (after 120 days))
A
Bilirubin
4
Q
Components of Hemoglobin
A
- Heme (+ Iron)
- Globin
5
Q
An electrolyte found in hemoglobin that can be reused / recycled by the body
A
Iron
6
Q
Waste product of hemoglobin catabolism
A
Bilirubin
7
Q
Enzyme that converts heme to biliverdin
A
Heme oxygenase
8
Q
B1 or B2: Water insoluble but alcohol soluble
A
B1
9
Q
B1 or B2: Water soluble but alcohol insoluble
A
B2
10
Q
What must happen for B1 to be water soluble?
A
Conjugation
11
Q
Three Major Systems in the Liver
A
- Hepatocyte System
- Biliary System
- Reticuloendothelial System
12
Q
From the _______ system, unconjugated bilirubin
will travel in the bloodstream and bind to albumin
A
reticuloendothelial
13
Q
From the reticuloendothelial system, (unconjugated / conjugated)_______ bilirubin
will travel in the bloodstream and bind to _____
A
unconjugated; albumin
14
Q
In the bloodstream, albumin will covalently attach to unconjugated bilirubin forming the ____ complex
A
unconjugated bilirubin-albumin complex
15
Q
IN the bilirubin-albumin complex, which bilirubin is bound? B1 or B2?
A
B1
16
Q
Albumin is _______, making it able to enter the liver alongside the bound bilirubin
A
amphoteric
17
Q
Enzyme that transfers glucuronic acid
to unconjugated bilirubin to become conjugated bilirubin
A
Uridine diphosphate glucuronosyltransferase family 1 A1 (UDPGT)
18
Q
UDPGT stands for
A
Uridine diphosphate glucuronosyltransferase
19
Q
At times that albumin remains covalently bonded to B1, it will form ____ bilirubin
A
delta
20
Q
Conjugated bilirubin will now enter the ____ _____ and be transported to the intestine
A
bile duct
21
Q
B2 enters the intestine and will be reduced by the normal flora to
A
urobilinogen
22
Q
Color of urobilinogen
A
Colorless
23
Q
% of urobilinogen remaining in the intestine
A
80%
24
Q
Majority 80% of the urobilinogen will remain in the intestine. Other name:
A
Stercobilinogen
25
Once stercobilinogen is degraded by the bacteria and incorporated to feces, it will now be oxidized to form _____
stercobilin
26
20% will enter the ______ (via the portal duct system) and reabsorbed, going back to the blood circulation
enterohepatic circulation
27
T or F: Since all blood will be filtered by kidneys, and urobilinogen is a waste product, it is normally incorporated into the urine
T
28
Once urobilinogen becomes oxidized in the urine, it will now be termed as:
urobilin
29
T or F: Urobilinogen contributes to the yellow color of the urine
F - urobilin
30
Match:
urobilin
stercobilin
feces
urine
urobilin - urine ; stercobilin - feces
31
If bilirubin accumulates into the bloodstream, it will be deposited to the tissues resulting to:
jaundice
32
Principle employed for the Ehrlich test
Classic Diazo Reaction
33
Ehrlich or Van Den Bergh:
Specimen = urine
Ehrlich
34
Ehrlich or Van Den Bergh:
Specimen = serum
Van den Bergh
35
Ehrlich or Van Den Bergh:
More used due to its high reliability
Van Den Bergh
36
Classify whether B1, B2, or Delta:
Unconjugated
B1
37
Classify whether B1, B2, or Delta:
Indirect
B1
38
Classify whether B1, B2, or Delta:
Conjugated
B2
39
Classify whether B1, B2, or Delta:
Direct
B2
40
Classify whether B1, B2, or Delta:
Water insoluble, alcohol soluble
B1
41
Classify whether B1, B2, or Delta:
Water soluble, alcohol insoluble
B2
42
Classify whether B1, B2, or Delta:
Polar
B2
43
Classify whether B1, B2, or Delta:
Hemobilirubin
B1
44
Classify whether B1, B2, or Delta:
covalently bound to albumin
Delta
45
Classify whether B1, B2, or Delta:
found if there is significant hepatic obstruction
Delta (di ko to sure ang alam ko b2)
46
Formula for Total Bilirubin (TB)
Total Bilirubin = Unconjugated + Conjugated + Delta Bilirubin
47
Formula for Indirect Bilirubin
Indirect Bilirubin = TB - Direct
48
Bilirubin Reaction: Classify whether Total, Conjugated, Unconjugated
Bilirubin + Diazotized sulfanilic acid +
accelerator --> 2 azobilirubin
Total
49
Bilirubin Reaction: Classify whether Total, Conjugated, Unconjugated
Does not use accelerator
Conjugated
50
Bilirubin Reaction: Classify whether Total, Conjugated, Unconjugated
Computed Value
Unconjugated
51
Composition of Diazo Reagent
Sulfanilic acid + HCl and Sodium Nitrite
52
Two Methods of Testing for Bilirubin
Malloy-Evelyn & Jendrassik-Grof
53
Classify: Malloy-Evelyn or Jendrassik-Grof
Accelerator: 50% Methanol
pH: Acidic
Malloy-Evelyn
54
Classify: Malloy-Evelyn or Jendrassik-Grof
Accelerator: Caffeine Sodium Benzoate
pH: Alkalin
Jendrassik-Grof
55
Accelerator in Malloy-Evelyn
50% methanol
56
Accelerator in Jendrassik-Grof
Caffeine Sodium Benzoate
57
End color in Malloy-Evelyn
Pink to Purple
58
End color in Jendrassik-Grof
Blue
59
Commonly used method in bilirubin testing since it is not affected by pH, protein, and is optically more sensitive
Jendrassik-Grof
60
T or F: Samples for bilirubin testing should be a fasting specimen
T
61
T or F: Lipemia = falsely ↑. Photooxidation = falsely ↓
T
62
T or F: Specimens for bilirubin testing should be protected from light
T
63
For neonates, this is employed based on the optical densities of bilirubin.
Bilirubinometry
64
Bilirubinometry measures bilirubin at ____ nm
450
65
Complete the table: Bilirubin Ref Ranges
For adults
Total =
Conjugated =
Unconjugated =
0.2-1.0 mg/dL, 0.0-0.2 mg/dL, 0.2-0.8 mg/dL
66
Complete the table: Bilirubin Ref Ranges
For infants (pre-mature):
24 hrs =
48 hrs =
3-5 days =
1-6 mg/dL, 6-8 mg/dL. 10-12 mg/dL
67
Complete the table: Bilirubin Ref Ranges
For infants (full-term):
24 hrs =
48 hrs =
3-5 days =
2-6 mg/dL, 6-7 mg/dL, 4-6 mg/dL
68
Infants have higher bilirubin than adults since?
Their liver still hasn't fully developed
69
How do we lessen bilirubin values among babies?
Pinapaarawan, or in NICU, may incubators with the warm light
70
Positive result is foam formation after shaking the specimen
Urine Foam Test
71
In the Urine foam test, this color of the sample is indicative of increased bilirubin
amber or brown color
72
Foam Test: white, small amount of foam
Normal
73
Foam test: White, large amount
Possible Protein
74
Foam Test: Yellow large amount
May be due to bile / bilirubin
75
What we can detect in the urine?
Bilirubin & urobilinogen
76
Urine has about ____% water, so B2 should be in small amounts
90-95%
77
Urobilinogen Reference Range
Urine:
0.1-1.0 Ehrlich's unit (2 hrs)
78
Urobilinogen Reference Range
Feces:
75-275 Ehrlich's units/100g
79
Enzymes synthesized by the liver (give atleast three)
● Aminotransferases AST and ALT
● Phosphatases ALP and 5Nucleotidase
● γ-Glutamyltransferase
● LDH Lactate dehydrogenase
80
T or F: at times of liver transplantation, the risk of bleeding is high since since we rely mostly on the ability of the person to heal and recuperate through coagulation factors and
platelets.
T (since part ng synthetic function ni liver ang pagproduce ng coag factors)
81
Hepatitis: Transmitted via the fecal oral route
A & E (You cannot spell tae without A & E - sir gam)
82
Hepatitis: Transmitted via parenteral or sexual routes
BCD
83
Jendrassik & Grof Method: Principle
direct bilirubin reacts with diazotized sulphanilic acid DSA to form a red azo
dye
84
Jendrassik & Grof Method: The absorbance of this dye @ ____ nm is directly proportional to the bilirubin concentration in the sample.
546
85
T or F: Water-insoluble bilirubin glucuronides react directly with DSA whereas the albumin conjugated direct bilirubin will
only react with DSA in the presence of an accelerator caffeine sodium benzoate or cetrimide.
F (water soluble, albumin conjugated indirect bilirubin)
86
How many measurements were done in testing for bilirubin?
2
87
What absorbance was used for measuring bilirubin levels?
550nm and 700nm
88
Hemolyzed samples will falsely _____ bilirubin levels
decrease
89
T or F: Bilirubin is photosensitive
T
90
What method did we use in measuring bilirubin levels?
Malloy-Evelyn / Endpoint method
91
What is the sample/reagent ratio?
1:20
92
Temperature of sx before reading must be
37C
93
Specimen must be read against (reagent blank)
Water/distilled blank
94
How much reagent 1 did we add for testing total bilirubin?
800uL
95
How much of the cal, CN, CP, sx did we use for TB measurement?
50 uL
96
How much Reagent 2 did we add for TB?
200 uL
97
For direct bilirubin, how much Cal, CN, CP, UK did we add to Reagent 1?
100 uL
98
Did we incubate before measuring R2?
Yes
99
Conversion factor from mg/dL -> umol/L
17.1
100
Increase in Conjugated bilirubin can be seen in?
Obstructive Jaundice
101
Increase in Unconjugated bilirubin can be seen in?
Hemolytic Jaundice
102
Increase in both un and conjugated bilirubin can be seen in?
Hepatocellular Jaundice
103
Factor for TB
0.81
104
Factor for DB
0.82
105
Morse Type: As a waste product, bilirubin should be excreted in the body. The excretion is processed only in the liver.
Both true (Labman, page 147)
106
T or F: Measurement of bilirubin in the laboratory is a good measure of the synthetic function of the liver
F - excretory & secretory function (labman haha traumatized s gantong tanong ni gammy)
107
First form of bilirubin produced immediately after heme has been converted to biliverdin
Indirect bilirubin
108
Why is unconjugated bilirubin called indirect bilirubin?
Since it needs to be converted first to direct (conjugated) bilirubin before being secreted / excreted.
108
Upon entry to the liver, indirect bilirubin detaches itself from albumin and binds to another carrier protein called?
ligandin
109
UDPGT works by transferring ________ to each of the two ________ side chains of indirect bilirubin
glucuronic acid; propionic acid
110
Bilirubin diglucuronide is also known as?
Direct bilirubin or Conjugated Bilirubin
111
Stercobilin is an ____-colored pigment that gives stool its brown color.
orange-colored
