LFT - PART 2 Flashcards by Sharmaine Madjid

markers for hepatocellular necrosis

ALT or Alanine Aminotransferase
AST or Aspartate Aminotransferase

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ALT is also known as

Serum Glutamate Pyruvate Transaminase

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ALT is most specific due to ________ in the liver

high concentration

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best test to assess hepatocellular integrity.

ALT

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ALT is present in the ______ of liver cells

cytosol

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____ concentration is higher than ________ in acute liver disease

ALT ; AST

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significance of ALT

hepatocellular disorder exhibit higher level than intra or extrahepatic obstruction

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normal range of ALT in male

13 to 35 U/L

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normal range of ALT in female

10 to 30 U/L

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AST or Aspartate Amino Transferase is also kown as

Serum Glutamic-Oxaloacetic Transaminase

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less specific (found in the mitochondria and cytosol liver cell, heart and skeletal muscle)

AST

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significance of AST

4x increased in cirrhosis; 100x increased in viral hepatitis.

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ALT and AST > 1000

ischaemic hepatitis, viral hepatitis, paracetamol overdose

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AST > ALT

alcoholism, drug intoxication, cirrhosis

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AST requires __________ (PSP or vitamin B6) as a cofactor.

pyridoxal 5 phosphate

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If a patient is ________ deficient it can lead to false negative AST results in some commercially available assays.

vitamin B6

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normal range of AST

8 to 20 U/L

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_____________ least specific – increased in cardiac and hepatic injury.

Lactate Dehydrogenase (LD)

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Markers that reflect cholestasis

Alkaline Phosphatase (ALP)
Gamma-Glutamyl Transferase (GGT)

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increased in obstructive diseases.

Alkaline Phosphatase (ALP)

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found on cell surfaces, sinusoidal and bile canalicular.

Alkaline Phosphatase (ALP)

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ALP is significantly increased in ______ diseases and _____ disease

obstructive ; Paget

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ALP is decreased in _______ because of lack of ______

hypophosphatasia ; ALP isoenzyme

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normally higher in children than adults because of bone growth.

ALP

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Best test for cholestatic disease (More specific than GGT)

ALP

significantly increased in alcoholism.

Gamma-Glutamyl Transferase (GGT)

Helps confirm excess alcohol intake, highly sensitive to detecting alcohol abuse.

GGT

GGT is increased in _______ despite normal liver function tests.

alcoholics

Accompanies ALP increase in biliary obstruction/lesion.

GGT

ALP > GGT = ?

bone disease, pregnancy

GGT > ALP = ?

alcohol, medications

Tests for Biliary Excretion

Total Bilirubin, B1, B2

commonly elevated with ALP during cholestasis.

Total Bilirubin, B1, B2

elevated with severe liver disease.

Total Bilirubin, B1, B2

elevated in non-liver disease (hemolysis)

Total Bilirubin, B1, B2

Tests for Liver Synthetic Function

Albumin

decrease _______ indicated severe liver injury.

Albumin

increase may indicate severe liver injury.

PT/INR or Prothrombin Time

Analysis of _______ is important for assessing nutritional status and presence of severe diseases involving the liver, kidney and bone marrow.

proteins

_______ and _______ are about 10% higher in ambulatory individuals.

Total protein and albumin

Plasma levels of total protein is ______ higher than serum due to fibrinogen.

0.2 to 0.4 g/dL

Transudates have a total protein of ______ (<50% of the serum total protein)

< 3.0 g/dL

Exudate gas total protein

> 3 g/dL

T or F.. In measuring total proteins in serum, fasting may not be required.

True

Total Protein Det is usually performed on ______, which has no fibrinogen and no anticoagulant that may slightly dilute proteins in plasma.

serum,

_______ may false elevate the total protein

Hemolysis

Total protein det. reference value

6.5 to 8.3 g/dL

Differentiates intrahepatic disorder (prolonged protime) from extrahepatic obstructive liver disease (normal protime)

PROTHROMBIN TIME (VITAMIN K RESPONSE TEST)

Persistent prolongation of protime despite vitamin K administration indicates loss of _________ to synthesize proteins

hepatic capacity

In acute viral or toxic hepatitis, prolongation of protime signifies ______________.

massive cellular damage

In _____, concentration of the protein is inversely proportional to the severity of the liver disease.

Albumin

Decrease serum albumin concentration may be due to decrease ______.

synthesis

Low protein + low albumin =

hepatic cirrhosis or nephrotic syndrome

Dye used for measurement of Albumin

- Bromcresol Green - Methyl Orange - Hydroxyazobenzene Benzoic Acid (HABA) - Bromcresol Purple

Increased serum albumin is also called/known as

Hyperalbuminemia

- Severe Hydration - Prolonged tourniquet application – artifactual hyperalbuminemia.

Increased Serum Albumin (Hyperalbuminemia)

Decreased Serum Albumin is also known/called as

Hypoalbuminemia

3 that is included in Decreased Serum Albumin (Hypoalbuminemia)

Reduced Synthesis Increased Loss Increased Catabolism

Chronic Liver Disease, Malabsorption Syndrome, Malnutrition, and Muscle Wasting Disease

Reduced Synthesis

Nephrotic Syndrome, Massive Burns, Orthostatic Albuminuria

Increased Loss

Massive Burns, Malignancy, Thyrotoxicosis

Increased Catabolism

In measuring conjugation and excretion function, the specimen should be free of _____ and ______

hemolysis and lipemia

In measuring conjugation and excretion function, the specimen should be stored in the ______ and measured _____

dark ; ASAP

In measuring conjugation and excretion function, the specimen should have ___ visible icteria

>25mg/dL

belongs to bilirubin assay

Van Den Berg Reaction Evelyn and Malloy Jendrassik and Grof

Principle of Bilirubin Assay

Van Den Berg Reaction – diazotization of bilirubin

Coupling Accelerator of Evelyn and Malloy

Methanol

Final Reaction in Evelyn and Malloy

(+) Pink to Purple

o Popular technique for Discreet Analyzer o Not affected by Hemolysis

Jendrassik and Grof

Jendrassik and Grof coupling accelerator

Caffeine Sodium Benzoate

In Jendrassik and Grof, _________terminates initial reaction and destroy excess diazo

Ascorbic Acid

diazo is made up of ...

sulfanilic acid in hydrochloric acid and sodium nitrite

Jendrassik and Grof final reaction

(+) = Pink to Blue

It is a test for hepatocellular function and potency of bile duct; rarely used

Bronsulfothalein (BSP) Dye Extraction Test

Double collection method in Bronsulfothalein (BSP) Dye Extraction Test

Rosenthal White

Single collection method in Bronsulfothalein (BSP) Dye Extraction Test

Mac Donald Method

Colorless end product of bilirubin

UROBILINOGEN

Excreted in urine and feces or reabsorbed into the portal blood and return to the liver.

UROBILINOGEN

Absence of substance + complete biliary obstruction

UROBILINOGEN

method of testing in urobilinogen

Ehrlich Method

NV of UROBILINOGEN in Feces

75-225

NV of UROBILINOGEN in 24 hours urine

75-400

In test for detoxification function, it involves ______ and ______ test

enzyme and ammonia

Any injury to the liver that results to _____ and _________ causes liberation of enzymes.

cytosis ; necrosis

Used to assess the extent of liver damage and to differentiate hepatocellular from jaundice.

Enzymes

examples or the enzymes included are

ALT, AST, ALP, GGT 5’nucleoside, LDH

Arise from the deamination of amino acid

Ammonia

Released from the skeletal muscle during exercise

Ammonia

Elevated level of ammonia are ___________ and often associated with ________

neurotoxic ; encephalopathy

ammonia clinical significance

diagnosis of hepatic failure and Reyes syndrome.

ammonia Normal value

11 to 35 mmol/dL

in test for detoxification function, ______ is a source of contamination

smoking

in test for detoxification function, preferred specimen is

arterial blood

in test for detoxification function, specimen requirement is

Heparin, EDTA kept in ice water immediately.

in test for detoxification function, method of testing is

Berthelot reaction, Glutamate dehydrogenase.

in test for detoxification function, digestion includes

Kjehdal Method

in test for detoxification function, measurement for ammonia is

o Nesslerization Reaction o Berthelot Reaction

characterized by necrosis and inflammation of the hepatocytes that results in a decrease in functional ability and abnormal liver function test results.

HEPATITIS

In hepatitis, changes can be caused by ______ and/or ______ agents

infectious ; toxic

6 hepatitis viruses

Hepa A, Hepa B, Hepa C, Hepa D, Hepa E and Hepa G.