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Clinical Chemistry Review > Liver Function Tests > Flashcards

Liver Function Tests Flashcards

1
Q

Receives 15 mL of blood per minute

A

Liver

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2
Q

: anatomic unit

A

Lobule

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3
Q

Synthetic function

Proteins, CHO, lipids, LPP, clotting factors, ketone bodies, enzymes
Albumin:

A

12g/day

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4
Q

Conjugation function

Bilirubin metabolism
Bilirubin:

A

200mg/day

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5
Q

Detoxification and Drug metabolism

A

Drugs
Ammonia  Urea  Excreted

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6
Q

Excretory and Secretory functions
Bile acids:
Bile salts:

A

cholic acid and chenodeoxycholic acid

bile acids + amino acids (glycine and taurine)

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7
Q

Storage function

A

Vitamins
Glycogen

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8
Q

Test measuring the Hepatic Synthetic Ability

A

Total Protein Determination
Prothrombin Time (Vitamin K Response Test)

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9
Q

Total Protein Determination:

A

-Kjeldahl method
-Biuret method
-Folin-Ciocalteu (Lowry) method
-UV absorption method
-Electrophoresis
-Refractometry
-Turbidimetric and Nephelometric methods
-Salt fractionation

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10
Q

Test measuring Conjugation/Excretion Function

A

Bilirubin Assay
Bromsulfonphthalein (BSP) Dye Excretion test

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11
Q

Bilirubin Assay:

A

-Evelyn and Malloy method
-Jendrassik and Grof Bromsulfonphthalein (BSP) Dye Excretion test

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12
Q

Test for Detoxification Function
Enzyme tests:
Ammonia:

A

ALP, AST, ALT, 5’NT, GGT, OCT, LAP, LDH

-Kjeldahl (Digestion) method -Nesslerization reaction -Berthelot reaction

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13
Q

0.2-0.4 g/dL higher than serum due to fibrinogen

A

Plasma protein

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14
Q

AMMONIA: Standard reference method

A

Kjeldahl (Digestion) mtd

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15
Q

Measurement of nitrogen content

A

Kjeldahl (Digestion) mtd

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16
Q

Serum + Tungstic acid  PFF

A

Kjeldahl (Digestion) mtd

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17
Q

1g N2 = 6.54g protein

A

Kjeldahl (Digestion) mtd

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18
Q

15.1-16.8% = N2 content of proteins

A

Kjeldahl (Digestion) mtd

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19
Q

Kjeldahl (Digestion) mtd Rgt:

A

H2SO4

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20
Q

Kjeldahl (Digestion) mtd
End product:

A

NH3

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21
Q

Most widely used method (IFCC recommended)

A

Biuret method

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22
Q

Req. at least 2 peptide bonds and an alkaline medium

A

Biuret method

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23
Q

Biuret method Rgts:

A

Alkaline CuSO4
Rochelle salt (NaK Tartrate)
NaOH
KI

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24
Q

Biuret method End product:

A

Violet color (545nm)

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25
Highest analytical sensitivity
Folin-Ciocalteu (Lowry) method
26
Oxidation of phenolic compounds (tyrosine, tryptophan, histidine)
Folin-Ciocalteu (Lowry) method
27
Folin-Ciocalteu (Lowry) method Rgts:
Phenol (or phosphotungstic-molybdic acid) Biuret (color enhancer)
28
Folin-Ciocalteu (Lowry) method End product:
Blue color
29
MI: elevated APRs (AAT, HPG, a1-x)
Electrophoresis
30
Gamma-spike
Monoclonal gammopathy (multiple myeloma)
31
Beta-gamma bridging In serum: In plasma:
Hepatic cirrhosis (IgA) normal (fibrinogen)
32
Alpha2-globulin band spike
Nephrotic syndrome
33
Alpha1-globulin flat curve
Juvenile cirrhosis (AAT deficiency)
34
Alpha1, alpha2, betaglobulin band spikes
Inflammation
35
Polyclonal gammopathy
Chronic inflammation (RA, malignancy)
36
Small spikes in beta region
IDA (transferrin)
37
“Blip” in the late alpha2 or early beta region
Free hemoglobin
38
Refractive index
Refractometry
39
Turbidimetric and nephelometric methods
SSA TCA
40
Salt fractionation
Salt: Sodium sulfate
41
Albumin Soluble: Insoluble:
Water Moderately concentrated salt solution Concentrated salt solution Hydrocarbon solvents Highly concentrated salt solution Saturated salt solution
42
Globulin Soluble: Insoluble:
Hydrocarbon solvents Weak salt solution Water Saturated salt solution Concentrated salt solution
43
Differentiates intrahepatic disorder (prolonged PT) from extrahepatic obstructive liver disease (normal PT)
Prothrombin time
44
Inversely proportional to the severity of the liver disease
Albumin
45
Low total protein + low albumin
Hepatic cirrhosis
46
Most commonly used dye for albumin
Bromcresol green
47
Most specific dye for albumin
Bromcresol purple
48
Other dyes for albumin
Hydroxyazobenzene benzoic acid (HABA) Methyl orange (MO)
49
Albumin excretion: 20-30 g/day
Nephrotic syndrome
50
(-) albumin
Analbuminemia
51
EP: 2 albumin bands
Bisalbuminemia
52
Therapeutic drugs in serum
Bisalbuminemia
53
Inverted A/G ratio
Hepatic cirrhosis (IgA) Multiple Myeloma (IgG) Waldenström’s macroglobulinemia (IgM) Chronic inflammation
54
Derived from hemoglobin myoglobin, catalase and cytochrome oxidase
Bilirubin
55
Protoporphyrin  Biliverdin
Heme oxygenase
56
Biliverdin B1
Biliverdin reductase
57
Deconjugated bilirubin
Urobilinogen
58
Non-polar bilirubin
Bilirubin 1
59
Free/Slow bilirubin
Bilirubin 1
60
Polar bilirubin
Bilirubin 2
61
One-minute/prompt bilirubin
Bilirubin 2
62
Regurgitative bilirubin
Bilirubin 2
63
Bilirubin tightly bound to albumin
Delta bilirubin
64
Delta bilirubin =
TB-DB+IB
65
Bilirubin >2 or 3 mg/dL
Jaundice
66
Hemolytic
Pre-hepatic jaundice
67
Pre-hepatic B1 = B2 = UG = UB =
B1 = increased B2 = normal UG = increased UB = negative
68
Hepatocellular
Hepatic jaundice
69
Hepatic jaundice B1 = B2 = UG = UB = ALT = AST =
B1 = increased B2 = increased UG = increased UB = positive ALT = increased AST = increased
70
Obstructive
Post-hepatic jaundice
71
Post-hepatic jaundice B1 = B2 = UG = UB = ALP = GGT = Cholesterol =
B1 = normal B2 = increased UG = decreased/negative UB = positive ALP = increased GGT = increased Cholesterol = increased
72
Bilirubin transport deficit (uptake)
Gilbert’s syndrome
73
Gilbert’s syndrome B1 = B2 =
B1 = increased B2 = decreased
74
Conjugation deficit
Crigler-Najjar syndrome
75
= total UDPGT deficiency
Crigler-Najjar syndrome Type I
76
= partial UDPGT deficiency
Crigler-Najjar syndrome Type II
77
Crigler-Najjar syndrome B1 = B2 =
B1 = increased B2 = decreased
78
Danger: Kernicterus
Crigler-Najjar syndrome
79
Bile is colorless
Crigler-Najjar syndrome
80
Bilirubin excretion deficit
Dubin-Johnson syndrome & Rotor syndrome
81
Blockade of excretion into the canaliculi
Dubin-Johnson syndrome & Rotor syndrome
82
Dubin-Johnson syndrome & Rotor syndrome TB = B2 =
TB = increased B2 = increased
83
Circulating inhibitor of bilirubin conjugation
Lucey-Driscoll syndrome
84
Lucey-Driscoll syndrome B1 =
B1 = increased
85
Free from hemolysis and lipemia
Methods (Bilirubin)
86
Store in the dark
Methods (Bilirubin)
87
Measured ASAP or w/in 2-3 hours
Methods (Bilirubin)
88
Diazotization of bilirubin
Van den Berg reaction
89
Evelyn and Malloy method Accelerator:
Methanol
90
Evelyn and Malloy method Diazo rgts:
Diazo A (0.1% Sulfanilic acid + HCl) Diazo B (0.5% Sodium nitrite) Diazo blank (1.5% HCl)
91
(+) pink to purple azobilirubin
Evelyn and Malloy method
92
Affected by hemolysis
Evelyn and Malloy method
93
Candidate reference method
Jendrassik and Grof
94
Jendrassik and Grof Accelerator:
Caffeine sodium benzoate
95
Jendrassik and Grof Buffer:
Sodium acetate
96
: terminates the initial reaction and destroys the excess diazo rgt
Ascorbic acid
97
Not falsely elevated by hemolysis
Jendrassik and Grof
98
Total bilirubin is measured 15 minutes after adding methanol or caffeine soln
Jendrassik and Grof
99
Absorbs light maximally at 450nm
Bilirubin
100
Double collection method
Rosenthal White method
101
Rosenthal White method Collection: (50% dye retention) (0% dye retention)
-After 5 mins -After 30 mins
102
Single collection method
Mac Donald method
103
Mac Donald method Collection: (+/- 5% dye retention)
-After 45 mins
104
From deamination of amino acids
Ammonia
105
Elevated levels are neurotoxic and often associated w/ encephalopathy and acetaminophen poisoning
Ammonia
106
Diagnosis of hepatic failure and Reye’s syndrome
Ammonia
107
Ammonia In severe liver disorder:
NH3  circulation  brain (conv. to glutamine)  increases pH  compromise the Kreb’s cycle  Coma due to lack of ATP for the brain
108
Methods (Ammonia) Specimen:
Heparin or EDTA plasma
109
Fasting is required
Ammonia
110
Avoid smoking
Ammonia
111
Prolonged standing of specimen: increased due to deamination
Ammonia
112
Place on iced water immediately
Ammonia
113
Avoid hemolysis
Ammonia
114
Specimen  PFF
Kjeldahl (Digestion) method
115
N2 ----------(hot conc. H2SO4 + CuSO4 + Hg + Selenium)----------> NH3
Kjeldahl (Digestion) method
116
NH3 + K2Hg2I2 ----------(Gum Ghatti)----------> NH2Hg2I2
Nesslerization of ammonia
117
Nesslerization of ammonia End color:
Yellow (low to moderate N2) Orange brown (high N2)
118
NH3 + Phenol + Hypochlorite -----(Na Nitroprusside)-----> Indophenol blue
Berthelot reaction
119
Normal Values (Liver Function Tests) Total protein = 6.5-8.3 g/dL Albumin = 3.5-5.0 g/dL Globulin = 2.3-3.5 g/dL α1-globulin = 0.1-0.3 g/dL α2-globulin = 0.6-1.0 g/dL β-globulin = 0.7-1.1 g/dL γ-globulin = 0.8-1.6 g/dL Total bilirubin = 0.2-1.0 mg/dL Indirect bilirubin = 0.2-0.8 mg/dL Direct bilirubin = 0-0.2 mg/dL Urobilinogen: Urine = 0.1-1.0 Ehrlich units/2hrs (or 0.54 Ehrlich units/day) Stool = 75-275 Ehrlich units/100g feces (or 75-400 Ehrlich units/24hrs) Ammonia = 19-60 μg/dL

Clinical Chemistry Review (15 decks)

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