Liver Function Test

Question 1

Portal triad

Answer 1

portal vein
hepatic artery
bile duct

Question 2

cholesterol to cholesteryl esters via

Answer 2

lecithin-cholesterol acyl transferase or LCAT reaction

Question 3

Oxidation of drugs and other toxic compounds or xenobiotics via

Answer 3

the cytochrome P450 system

Question 4

Oxidation of alcohol

Answer 4

1.alcohol and acetaldehyde dehydrogenases
2. microsomal ethanol oxidizing system (MEOS)

alternate pathway of ethanol metabolism that occurs in the smooth endoplasmic reticulum in the oxidation of ethanol to acetaldehyde.

Question 5

enzyme used in synthesis of creatine

Answer 5

guanidoacetate…. which is used to produce creatine phosphate, mainly in muscle and brain

Question 6

the liver stores?

Answer 6

glycogen,
vitamin A,
vitamin B12
iron

Question 7

enzyme needed to convert heme to biliverdin

Answer 7

heme oxygenase

Question 8

enzyme needed to convert biliverdin to bilirubin

Answer 8

biliverdin reductase

Question 9

What is the immediate precursor of bilirubin?

Answer 9

urobilinogen

Question 10

other name for conjugated bilirubin

Answer 10

bilirubin diglucuronide

Question 11

What enzyme system is responsible in the conjugation of bilirubin?

Answer 11

uridine diphosphate glucuronyltransferase
(UDG)

Question 12

Oxidation of urobilinogen by microorganisms will produce

Answer 12

urobilin

Question 13

other name for free bilirubin

Answer 13

non-polar bilirubin
Unconjugated bilirubin
Indirect bilirubin
hemobilirubin
hemolytic bilirubin

Question 14

other name for Conjugated bilirubin

Answer 14

Polar bilirubin
Direct bilirubin
Cholebilirubin
Cholestatic bilirubin

Question 14

FACTORS AFFECTING INTERPRETATION OF PLASMA LEVELS OF “LIVER” ENZYMES

Answer 14

age
gender
race
food ingestion
body mass index
exercise
diurnal variation

Question 15

CLASSIFICATON OF LIVER FUNCTION TESTS
-Excretory Function Tests

Answer 15

✅Test for urobilinogen and other bilirubin pigments in the urine and feces
✅Icterus Index
✅Dye excretion tests (BSP, ICG) Serum bilirubin

Question 16

CLASSIFICATON OF LIVER FUNCTION TESTS
–Metabolic Function Tests

Answer 16

✅Carbohydrate metabolism Galactose tolerance test
✅OGTT
✅Protein metabolism
✅TP, A/G ratio
✅Cephalin cholesterol flocculation test
✅Thymol turbidity test (Shank & Hoagland; MacLagan) Hippuric acid test
✅Lipid metabolism

Question 17

Enzyme Tests

Answer 17

● ALT
● AST
● AST/ALT (De Ritis ratio)
● ALP
● GGT
● 5’-NT
● LAP
● LDH
● ICD
● OCT

(10)

Question 18

Tests for Bilirubin

Answer 18

✅Evelyn- Malloy
✅Jendrassik and Grof Anino,
✅Ducci & Watson
✅Stoner & Wiseberg
✅Modified Michaelson
✅Thamhauser & Anderson
✅Alkaline methanolysis
✅Icterus index

Question 19

Side note:

TB, DB and IB

Answer 19

✅Unlike DB, IB is insoluble in deionized water and dilute HCl.

✅IB must first be mixed with methanol or caffeine-sodium benzoate to solubilize it before one can proceed with the diazo reaction.

✅Because of these properties, TB and DB are always chemically analyzed, and the IB fraction is calculated from the difference between the TB and DB values.

Question 19

used as dissociating agent (coupling promoter) to measure the total bilirubin in Evelyn-Malloy Method

Answer 19

Methanol

Question 20

what buffer is used Jendrassik-Grof Method

Answer 20

Sodium acetate

Question 20

what method

●The diazotized product (bilirubin-diazotized sulfanilic acid) has a red to reddish-purple color in an acid pH (HCl).

Answer 20

Evelyn-Malloy Method

Question 21

Evelyn-Malloy Method product has an absorption maximum at ___ nm?

Answer 21

560 nm

Question 22

what coupling accelerator is used Jendrassik-Grof Method ???

Answer 22

caffeine sodium benzoate

Question 23

In Jendrassik-Grof Method,, The diazotization is terminated by the addition of __??

Answer 23

ascorbic acid

Question 24

in Jendrassik-Grof Method,, the pink azobilirubin is then converted to a____?
🔵💙

Answer 24

Blue Azobilirubin

Question 24

What method uses a strong alkaline tartrate solution, the pink azobilirubin is then converted to a blue azobilirubin.

Answer 24

Jendrassik-Grof Method

Question 25

Side note:

As unconjugated bilirubin circulates through the liver, hepatocytes perform the following functions:

Answer 25

✅ Uptake of bilirubin from the circulation
✅ Enzymatic conjugation as bilirubin
glucuronides
✅ Transport and excretion of conjugated bilirubin into the bile for elimination from the body

Question 26

Side note:

Congenital defects in each of these metabolic steps are recognized clinically:

1️⃣ Defect in uptake?
2️⃣ Defect in hepatic glucuronyl transferase
3️⃣ Defect in transport extracellularly

Answer 26

1️⃣ Defect in uptake
—- (GILBERT SYNDROME)

2️⃣ Defect in hepatic glucuronyl transferase
—- (CRIGLER NAJJAR SYNDROME)

3️⃣ Defect in transport extracellularly
—- (DUBIN-JOHNSON SYNDROME)

Question 27

SERUM BILIRUBIN reference range:

Total:
Direct

Answer 27

✅Total 0.3-1.1 mg/dl
✅Direct 0.1-0.4 mg/dl

Question 28

SERUM BILIRUBIN Conversion factor:

Answer 28

✅17.1 (mg/dl to μmol/L)

Question 29

CAUSES OF HYPERBILIRUBINEMIA

Answer 29

● Increased unconjugated bilirubin (HEMOLYSIS)

● Red cell degradation

● Defective hepatocellular uptake or conjugation

Increased unconjugated bilirubin
– ● Hemolysis
● Hemoglobinopathies
● Spherocytosis
● G-6-PD deficiency
● Autoimmunity
● Hemolytic transfusion reaction

– ● Red cell degradation
● Hemorrhage into soft tissue or body cavities
● Inefficient erythropoiesis
● Pernicious anemia

– ● Defective hepatocellular uptake or conjugation
● Viral hepatitis
● Hereditary enzyme deficiencies
● Hepatic immaturity in newborns

Question 29

Increased total bilirubin due to increased direct bilirubin suggests
a. hemolytic jaundice
b. neonatal jaundice
c. Crigler-Najjar syndrome
d. obstructive jaundice

Answer 29

d. obstructive jaundice

Question 30

Mesobilirubinogen, urobilinogen and stercobilinogen are collectively known as

a. urobilinogen b. urobilins
c. bilirubin products d. mesobilirubins

Answer 30

b. urobilins

Question 31

Complete obstruction of the common bile duct would yield all of the following results except

a. negative urine urobilinogen
b. negative fecal urobilinogen and urobilin
c. negative urine bilirubin
d. passage of acholic stools

Answer 31

b. negative fecal urobilinogen and urobilin

Question 32

Which of the following chracterizes Crigler-Najjar syndrome?
a. inability to transport bilirubin
b. deficiency of enzyme required for bilirubin conjugation
c. inability to transport bile to the intestine
d. necrotic liver damage

Answer 32

b. deficiency of enzyme required for bilirubin conjugation

Question 33

The inability to transport bilirubin from the sinusoidal membrane to the hepatocyte is characteristic of

a. carcinoma of common bile duct
b. Crigler-Najjar syndrome
c. Dubin-Johnson syndrome
d. Gilbert’s syndrome

Answer 33

c. Dubin-Johnson syndrome

Question 34

Dubin-Johnson is characterized by all of the following except

a. Impaired excretion of bilirubin into bile
b. Normal hepatic uptake of bilirubin
c. Inability to conjugate bilirubin
d. Increased urine bilirubin

Answer 34

b. Normal hepatic uptake of bilirubin

Question 35

(GENETIC DISEASES OF THE LIVER)

– Alpha1-antitrypsin deficiency (AAT)
✅ what gene
✅ what protein product

Answer 35

✅Gene: SERPIN1 (Pi)
✅Protein product: Alpha1-antitrypsin

Question 36

are microscopically centered around portal triads, which are interconnecting loose bands that contain branches of the portal vein, hepatic artery, and bile duct.

Answer 36

lobules/acini

Question 37

Side note:
✍️Hepatic Anatomical Features

Answer 37

Has a dual blood supply of oxygen and nutrients amounting to 1500 mL per minute approximately 80% enters from the portal vein and 20% from hepatic artery

Question 39

The line that separates the left and right hepatic lobe?

Answer 39

Falciform ligament