Chapter 25 - Liver Function (RVSP) Flashcards Preview

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Flashcards in Chapter 25 - Liver Function (RVSP) Deck (180):
0

Average weight of the liver

1200-1500 g

1

Amount of blood that passes into the liver per minute

1500 mL/min

2

Spaces between hepatocytes

Sinusoids

3

2 blood vessels that supply blood to the liver

- hepatic artery
- portal vein

4

3 systems of the liver

- hepatocyte system
- biliary system
- reticuloendothelial system (RES)

5

System of the liver; for metabolic reactions and macromolecular synthesis

Hepatocyte system

6

System of the liver; for metabolism of bilirubin and bile salts

Biliary system

7

System of the liver; for excretory function

Biliary system

8

Structure of the liver involved in excretion

Bile canaliculi

9

System of the liver for drug metabolism

Hepatocyte system

10

Drug metabolism function of the liver

Xenobiotic

11

System of the liver; for immune system and degradation of hemoglobin

Reticuloendothelial system

12

Cells involved in the reticuloendothelial system

Kuppfer cells

13

4 functions of the liver

- Synthesis
- Excretory/secretory
- Detoxification
- Storage

14

Removal of waste products

Excretion

15

Release of useful substances

Secretion

16

2 proteins not produced by the liver

- Immunoglobulins
- adult hemoglobin

17

4 substances synthesized by the liver

- proteins
- carbohydrates
- lipids
- vitamins

18

2 ways the liver detoxifies toxic substances

- bind and inactivate toxin
- chemically modify and excrete toxin

19

4 substances stored by the liver

- proteins
- lipids
- amino acids
- glycogen

20

Principal pigment in bile

Bilirubin

21

Amount of bile produced per day

3 L/day

22

Amount of bile excreted per day

1 L/day

23

2 components of bilirubin

- RBCs (80%)
- proteins (20%)

24

Divides the liver into two unequal lobes

Falciform ligament

25

Larger lobe of the liver

Right lobe (6x larger)

26

Supplies oxygen-rich blood to the liver; 25% of total blood supply to the liver

Hepatic artery

27

Supplies nutrient-rich blood to the liver; 75% of total blood supply to the liver

Portal vein

28

Functional units of the liver

Lobules

29

Responsible for all metabolic and excretory functions of the liver

Lobules

30

Centrally located vein of the lobule

Central vein

31

Found at each side of the lobule

Portal triads

32

3 components of the portal triads

- hepatic artery
- portal vein
- bile duct

33

2 major cell types of the liver

- hepatocytes
- Kupffer cells

34

Liver cells responsible for its regenerative properties

Hepatocytes

35

Active phagocytes in the liver

Kupffer cells

36

Major heme waste product

Bilirubin

37

Type of bilirubin bound by albumin

Unconjugated/indirect bilirubin

38

Solubility of indirect bilirubin to alcohol and water

- soluble to alcohol
- insoluble to water

39

Protein for transport of unconjugated bilirubin to the endoplasmic reticulum

Ligandin

40

Enzyme for the conjugation of bilorubin

Uridyldiphosphate glucoronyl transferase (UDPGT)

41

Solubility of direct bilirubin to alcohol and water

- insoluble to alcohol
- soluble to water

42

Amount of bilirubin produced per day

200-300 mg

43

Enzymes responsible for the drug-metabolizing system of the liver

Cytochrome P-450 isoenzymes

44

Yellow discoloration of the skin, eyes amd mucous membranes

Jaundice/icterus

45

Most common cause of jaundice

Retention of bilirubin

46

Jaundice not visible to the naked eye

Overt jaundice

47

Bilirubin levels when jaundice is visible

3.0 - 5.0 mg/dL

48

3 classifications of jaundice

- prehepatic/hemolytic hyperbilirubinemia
- hepatic/hepatocellular hyperbilirubinemia
- posthepatic/obstructive hyperbilirubinemia

49

Jaundice that occurs when the problem happens prior to liver metabolism

Prehepatic jaundice

50

Another name for prehepatic jaundice

Unconjugated hyperbilirubinemia

51

Type of anemia that causes prehepatic jaundice

Acute and chronic hemolytic anemia

52

Jaundice that occurs when the problem resides inside the liver

Hepatic jaundice

53

3 diesease that cause hepatic jaundice that increases unconjugated bilirubin

- physiologic jaundice of the newborn
- Gilbert's disease
- Crigler-Najjar syndrome

54

2 conditions that cause hepatic jaundice that elevates conjugated bilirubin

- Dubin-Johnson
- Rotor syndrome

55

Most common cause of hepatic jaundice

Gilbert's syndrome

56

Type of hepatic jaundice where there is impaired cellular uptake of bilirubin

Gilbert's syndrome

57

Type of hepatic jaundice; chronic nonhemolytic unconjugated hyperbilirubinemia; deficiency of UDPGT

Crigler-Najjar syndrome

58

Type of Crigler-Najjar syndrome; complete absence of UDPGT, no B2 formed, colorless bile

Type I

59

Type of Crigler-Najjar syndrome; relative deficiency of UDPGT, some B2 formed

Type II

60

Condition of relative deficiency of UDPGT

Arias syndrome

61

Conjugated bilirubin bound to albumin

Delta bilirubin

62

Type of hepatic jaundice caused by a deficiency of the canalicular multidrug resistance/multispecific organic anionic transporter protein (MDR2/cMOAT)

Dubin-Johnson syndrome

63

Type of hepatic jaundice where the removal of conjugated bilirubin from the liver cell and the excretion into the bile are defective

Dubin-Johnson syndrome

64

Type of hepatic jaundice that is idiopathic

Rotor syndrome

65

Appearance of liver in Dubin-Johnson syndrome

With black pigmentation

66

Appearance of liver in Rotor syndrome

Normal histology

67

Gallbladder visualization of Dubin-Johnson syndrome

No visualization

68

Gallbladder visualization of Rotor syndrome

Visualized by oral cholecystogram

69

Total urine coproporphyrin of Dubin-Johnson syndrome

Normal w/ >80% of isomer 1

70

Total urine coproporphyrin of Rotor syndrome

High w/ <70% of isomer 1

71

Enzyme that is deficient in physiologic jaundice of the newborn

Glucoronyl transferase

72

Movement of bilirubin from the bloodstream to brain tissue

Kernicterus

73

Enzyme responsible for bilirubin conjugation in infants

Glucoronyl transferase

74

Jaundice caused by biliary obstructive disease

Posthepatic jaundice

75

Type of bilirubin increased in posthepatic jaundice

- unconjugated
- conjugated

76

Type of jaundice where the stool loses its normal pigmentation and becomes clay-colored

Posthepatic jaundice

77

Condition in which scar tissue replaces normal, healthy liver tissue

Cirrhosis

78

Most common cause of cirrhosis

Chronic alcoholism

79

Type of liver cancer that begins in the liver cells

Primary liver cancer

80

Type of liver cancer that occurs when tumors from other parts of the body spread to the liver

Metastatic cancer

81

3 cancers that commonly spread to the liver

- breast cancer
- lung cancer
- colon cancer

82

2 types of liver cancer

- primary liver cancer
- metastatic liver cancer

83

2 types of liver tumors

- benign tumors
- malignant tumors

84

2 common benign liver tumors

- Hepatocellular adenoma
- hemangiomas

85

2 malignant liver tumors

- hepatocellular carcinoma (HCC)
- bile duct carcinoma

86

Benign liver tumor occuring in females of child-bearing age

Hepatocellular adenoma

87

Benign liver tumor; masses of blood vessels with no known etiology

Hemangiomas

88

Most common malignant liver tumor

Hepatocellular carcinoma (HCC)/hepatocarcinoma/hepatoma

89

Uncommon hepatic malignancy in children

Hepatoblastoma

90

Disease found primarily in children; idiopathic; related to aspirin therapy; usually occurs following recovery from viral infection

Reye syndrome

91

Most important drug related to hepatic toxicity

Ethanol

92

Caused by heavy and prolonged consumption of ethanol

Alcoholic cirrhosis

93

3 stages of alcohol-induced liver injury

- alcoholic fatty liver
- alcoholic hepatitis/liver fibrosis
- alcoholic cirrhosis

94

Alcoholic fatty liver with inflammation

Steatohepatitis

95

Amount of ethanol that causes one to be under the influence of alcohol

>1000 mg/L

96

Amount of ethanol that causes CNS impairment/coma

3000 mg/L

97

Amount of ethanol that causes death

4000 mg/L

98

Reagent used in Muelengracht mtd for icterus index

NSS

99

Solution used for comparison in Newberger mtd for icterus index

Sodium citrate

100

3 substances that interfere with icterus index

- carotene
- xantophyll II
- hemoglobin

101

Property used to differentiate conjugated and unconjugated bilirubin

Solubility

102

3 fractions comprising total bilirubin

- conjugated bilirubin
- unconjugated bilirubin
- delta bilirubin

103

Preferred sample for Malloy-Evelyn procedure

Serum

104

Number of days serum/plasmais stable for bilirubin at room temperature

2 days

105

Number of days serum/plasma for bilirubin is stable at 4 degrees Celsius

7 days

106

Number of days that serum/plasma is stable for bilirubin at -20 degrees Celsius

Indefinite

107

4 reagents in Malloy-Evelyn procedure

- diazo reagent (sulphanilic acid & sodium nitrite)
- 50% methanol
- sodium acetate
- ascorbic acid

108

pH level of Malloy-Evelyn procedure

pH 1.2

109

Color of product in Malloy-Evelyn procedure

Red-purple

110

Wavelength of Malloy-Evelyn procedure

560 nm

111

Most common accelerator used in Malloy-Evelyn procedure

50% Methanol

112

4 reagents of the Jendrassik-Grof method

- diazotized sulphanilic acid (lphanilic acid & sodium nitrite)
- caffeine sodium benzoate
- sodium acetate
- ascorbic acid

113

Color of initial product in Jendrassik-Grof method

Purple

114

Accelerator in Jendrassik-Grof method

Caffeine sodium benzoate

115

Terminates the reaction of the aliqouts with the diazo reagent in Jendrassik-Grof method

Ascorbic acid

116

Solution used to alkalinize the solution in Jendrassik-Grof method

Alkaline tartrate solution

117

Color of final product in Jendrassik-Gtof method

Blue

118

Wavelength used in Jendrassik-Grof method

600 nm

119

Colorless end product of bilirubin metabolism

Urobilinogen

120

Urobilinogen that is oxidized by intestinal bacteria; brown pigmented

Urobilin

121

3 reagents for Ehrlich's method for urine urobilinogen

- Ehrlich's reagent (p-dimethylaminobenzaldehyde)
- ascorbic acid
- saturated sodium citrate (NaCH3COO)

122

Reagent in Ehrlich's method that serves as reducing agent to maintain urobilinogen in a reduced state

Ascorbic acid

123

Reagent in Ehrlich's method that stops the reaction and minimizes the combination of other chromogens

Saturated sodium citrate (NaCH3COO)

124

Color of product of Ehrlich's method for urine urobilinogen

Red

125

Specimen for Ehrlich's method for urine urobilinogen

Fresh 2-hour urine specimen

126

4 substances that interfere with urine urobilinogen measurement (Ehrlich's method)

- 5-hydroxyindoleacetic acid
- porphobilinogen
- sulfonamides
- procaine

127

Sample in fecal urobilinogen

Aqueous extract of fresh feces

128

Reagent used for fecal urobilinogen that reduces urobilin to urobilinogen

Alkaline ferrous hydroxide (Fe(OH)2)

129

Color of product for fecal urobilinogen

Red

130

2 clinical significance of increased urobilinogen

- hemolytic disease
- defective liver cell function (hepatitis)

131

2 clinical significance of absence of urobilinogen

- biliary obstruction
- hepatocellular disease

132

Test used for bile salts

Hay Test

133

Used in Hay Test to detect the presence of bile salts

Sulphur powder

134

Interpretation of Hay test when sulphur powder floats

Bile salts absent

135

Interpretation of Hay test when sulphur powder sinks to the bottom

Bile salts present (obstructive jaundice)

136

Buffer in Evelyn-Malloy procedure

Sodium acetate

137

Stop solution in Evelyn-Malloy method

Ascorbic acid

138

Tested for the synthetic function of the liver

- total protein
- albumin
- alpha-globulin
- prothrombin time

139

2 tests for testing the excretory function of the liver

- Bromsulphalein test
- Rose Bengal Test

140

2 methods under Bromsulphalein test

- Rosenthal
- Mc Donald

141

Element used in Rose Bengal Test

Tagged Iodine 131

142

Color of urine foam positive for bilirubin

Yellow

143

Urine color positive for bilirubin

Brown to amber

144

4 tests for urine bilirubin

- Foam test
- Urine color inspection
- Fouchet's test or Harrison Spot Test
- Diazotization Test

145

Used to precipitate bilirubin in Fouchet's test

BaCl2

146

Reagent in Fouchet's test/Harrison Spot test

FeCl3 and TCA

147

Color of final precipitate in Fouchet's test/Harrison Spot test; positive for bilirubin

Green precipitate

148

Test used to determine detoxification function

Quick's Test/Hippuric Acid Test

149

Consumed by patient in Quick's test/Hippuric acid test

Sodium benzoate meal

150

In normal patients, what percentage of the benzoate meal in Quick's test is excreted within 1 hour?

40%

151

Inflammation of the liver

Hepatitis

152

2 hepatitis types acquired through the fecal-oral route

A and E

153

Causes Hepatitis A

Picorna virus

154

Causes Hepatitis B

Hepadna virus

155

Causes Hepatitis C

Flavivirus

156

Causes Hepatitis D

Delta agent (needs HBsAg)

157

Causes Hepatitis E

Hepevirus

158

2 cardinal features of cirrhosis

- fibrosis
- nodules

159

Prevents regeneration of the liver

Fibrosis

160

Elevated in Reye's Syndrome

Elevated liver function tests except bilirubin

161

Causes Hepatitis F

Toga virus

162

Causes Hepatitis G

G-B virus

163

MOT of Hepatitis A&E

Fecal-oral route

164

MOT of Hepatitis B, C, and D

Parenteral, sexual

165

Classification of hepatitis based on etiology

- viral hepatitis (B, C, D)
- alcoholic
- toxic
- metabolic (hemochromatosis, Wilson's disease, galactosemia)
- autoimmune
- cardiac
- biliary

166

Classification of cirrhosis based on morphology

- micronodular
- macronodular
- micromacronodular (mixed cirrhosis)
- septal

167

Classification of cirrhosis based on activity and spread of progression

- active (rapidly, slowly, latent)
- nonactive

168

Classification of cirrhosis based on the course of the disease

- compensation (hepatic encephalopathy)
- subcompensation (hepatic encephalopathy stages I-II, ascites controlled by drugs)
- decompensation (hepatic encephalopathy stage III, ascites not controlled by drugs)

169

Classification of cirrhosis based on complications

- hepatic coma (precoma)
- bleeding esophageal stomach/hemorroidalvarices
- bacterial peritonitis
- portal vein thrombosis
- primary cancer of the liver

170

A congenital condition due to maternal steroids causing increased B1 becuase of a defect in UDPGT

Lucey Driscoll

171

Solution used for comparison in Muelengracht mtd for icterus index

0.01% K2Cr2O7

172

Advantages of Jendrassik-Groff mtd over Evelyn-Malloy mtd for bilirubin

- insensitive to pH changes
- insensitive to a 50-fold variation in protein conc
- adequate optical sensitivity even with low bilirubin conc
- minimal turbidity and with constant serum blank
- not affected by Hb up to 750 mg/dL

173

Normal range for conjugated bilirubin

0 - 0.2 mg/dL

174

Conjugated bilirubin is increased during

Obstructive jaundice

175

Normal range for unconjugated bilirubin

0.2 - 0.8 mg/dL

176

Unconjugated bilirubin is increased during

Hemolytic jaundice

177

Normal range for total bilirubin

0.2 - 1.0 mg/dL

178

Total bilirubin is increased during

Hepatocellular jaundice

179

Sources of error for bilirubin measurement

- hemolysis
- exposure to light
- lipemia
- lipochrome