examination of liver function 1

Question 1

causes of increased biliruben - 1 in the blood

Answer 1

• excess production of Br - 1
  
  • due to increased RBC destruction
  • Acute haemolysis
  • Absorption of Hgb following massive internal heamorrhage “resorption icterus”
  • transfusion of blood containg dead or dying RBCs
• Reduced uptake of Br - 1 by hepatocytes
  
  • impaired hepatic function
  • acute haemolysis
• reduced rate of coagulation of Br -1 by hepatocytes
  
  • impaired hepatic function

Question 2

Causes of Br - 2 increase in the serum

Answer 2

• a few days after severe acute haemolysis (increased production)
• decreased excretion of Br - 2 by hepatocytes
  
  • impaired hepatic function
• obstruction of the bile caniculi within the liver
  
  • often due to inflammation - cell swelling fibrosis
  • blockage of bile duct - rupture of biliary vessels/ duct/ gall bladder

Question 3

lab finding of pre hepatic jaundice

Answer 3

• increased levels of unconjugated Br
• stercobilin in the stool
• urinary urobilinogen

Question 4

lab findings of hepatic jaundice

Answer 4

• increased amounts of Br conjugates
• decreased amounts of unconjugated Br
• increased urobilinogen in the urine

Question 5

findings in post hepatic jaundice

Answer 5

urinary urobilinogen + faecal stercobilin are absent

Question 6

describe the G-melin test

Answer 6

HNO₃ - carefully layered under urine in a test tube, width between layers is evaluated

1. condensed material
2. urine
3. Proteins - Normal Eq, pathological in Ca and Fe
4. lndicane - physiological in Eq
5. Biliverdin - physiological in Ca
6. UBG
7. HNO₃

Question 7

describe the erlich test

Answer 7

• determination of UBG
• drops of erlich reagent
• normal = mild reddish from above, no change from side
• abnormal = intense red from above, mild/intense red from side, any colour change from the original urine

Question 8

colour of faeces when stercobilin is increased?

Answer 8

orange faeces

Question 9

tests for examination of Br derivatives in urine and faeces

Answer 9

• G- melin test
• Erlich test
• examination of faeces

Question 10

tests for the examination of hepatic excretory function

Answer 10

• Brom - sulphalein retention test (BSP)
• Indocyane green (ICG) retention test

Question 11

describe the BSP retention test

Answer 11

• BSP dye is administered IV - examination of hepatic clearance
• Purple in alkaline PH
• Good liver function BSP dye is removed from plama
• BSP should be excreted in the bile
  
  • giving information about the UDP - glucuronyl transferase activity
• normal time of elimination of 95% of the dye is 35-45 minutes
• in cats this test is not liver specific, BSP is also secreted by te kidneys
• BSP can cause anaphalaxis and is not used very often

Question 12

causes of increased BSP retention

Answer 12

• Primary liver failure
  
  • cirrhosis
  • tumour
  • hepatic lipidosis
  • lipid metabolism syndrome
• decreased hepatic perfusion
  
  • right sided heart failure
  • PSS
  • Portal vein blockage
  • Arteriole - venous fistulas in the liver
• other causes
  
  • decreased UDP glucouronyl transferase activity

Question 13

causes of increased bile acids in the blood

Answer 13

• liver injury
  
  • increased outflow of bile acids from damaged hepatocytes to the blood
• blocked bile duct/ damaged bile epithelium
  
  • decreased secretion of bile acids
  • increased outflow into the plasma
• biliary stasis
  
  • pancreatitis
  • pancreatic/ hepatic neoplasm
• PSS

Question 14

causes of decreased bile acids in the blood

Answer 14

• decreased absorption from the intestines
  
  • intestinal wall damage/ surgical removal of the ileum
  • bile acids fail to increase (not reduction from the blood)
• severe liver cirrhosis - decreased synthesis of bile acids