Notes in 07LiverFunctionTests

To Subscribe, use this Key

Status	Last Update	Fields
Published	07/30/2024	Portal vein provides ~{{c1::75}}% of total blood supply to liver
Published	07/30/2024	{{c1::Cords}} are columns of hepatocytes
Published	07/30/2024	What is the functional unit of the liver?{{c1::Hepatic lobule}}
Published	07/30/2024	4 functions of the liver {{c1::1. Excretory2. Synthetic (metabolism)3. Detoxification*4. Storage::4}}
Published	07/30/2024	Most proteins are synthesized by the liver EXCEPT {{c1::Immunoglobulins}} and {{c1::HbA}}
Published	07/30/2024	During inflammation, plasma albumin levels are {{c1::decreased}}*bonus: why?
Published	07/30/2024	70–80% of daily bilirubin comes from RBC breakdown* and {{c1::turnover of hemoproteins (e.g., myoglobin)}}
Published	07/30/2024	Heme oxygenase cleaves the {{c1::α}} portion of the heme porphyrin
Published	07/30/2024	Heme degradation (via heme oxygenase) produces bilverdin, {{c1::Fe2+}}, and {{c1::CO}}
Published	07/30/2024	Rate of bilirubin production:{{c1::200–300}} mg/day
Published	07/30/2024	Heme is converted to bilirubin in {{c1::2–3 hours::time}}
Published	07/30/2024	Unconjugated bilirubin (B1) is transported from the perisinusoidal space into liver {{c2::endoplasmic reticulum}} via {{c1::ligandin (OATP-1…
Published	07/30/2024	Ampulla of Vater empties to the {{c1::2nd}} part of the duodenum
Published	07/30/2024	Conjugated bilirubin → {{c1::mesobilirubin}} → {{c1::mesobilirubinogen}} → urobilinogen (via bacterial metabolism)
Published	07/30/2024	QCFate of urobilinogen 1. Absorption (via enterohepatic circulation)2. Intestinal excretion (stercobilin)3. Renal excretion (urobilin) {{c1::2 …
Published	07/30/2024	Conjugated bilirubin (B2) is transported from the liver ER into bile canaliculi via {{c1::MRP-2 (multidrug resistance protein 2)}}
Published	07/30/2024	What makes up the majority of total bilirubin?{{c1::Unconjugated bilirubin (B1)}}
Published	07/30/2024	{{c1::Unconjugated}} bilirubin will react with the diazo reagent only in the presence of an accelerator*
Published	07/30/2024	{{c1::Delta bilirubin}} is conjugated bilirubin covalently bound to albumin and is only seen in significant {{c2::hepatic obstruction}}
Published	07/30/2024	EquationIndirect bilirubin = {{c1::Total bilirubin - Direct bilirubin}}
Published	07/30/2024	Bilirubin is measured by reacting it with the diazo reagent to form {{c1::azobilirubin}}
Published	07/30/2024	In the {{c1::Jendrassik-Grof}} method, bilirubin is tested at a pH of {{c2::13}} to produce a {{c2::blue}}-colored product
Published	07/30/2024	In the {{c1::Malloy-Evelyn}} method, bilirubin is tested at a pH of {{c2::1.3}} to produce a {{c2::red}}-colored* product
Published	07/30/2024	Bilirubin testing Diazo reagent = {{c1::diazotized sulfanilic acid}}Accelerator = {{c1::sodium benzoate-caffeine mixture}} or {{c1::methanol}}
Published	07/30/2024	{{c2::Hemolysis::interference}} may show a falsely {{c1::decreased}} bilirubin level
Published	07/30/2024	{{c2::Lipemia::interference}} may show a falsely {{c1::elevated}} bilirubin level
Published	07/30/2024	In neonates, total bilirubin is tested in {{c1::phosphate}} buffer solution of pH {{c1::7.4}}
Published	07/30/2024	Bilirubin test spectrum of absorption{{c2::Azobilirubin::molecule measured}} (Jendrassik-Grof): {{c1::600}} nm{{c2::Azobilirubin}} (Malloy-Evelyn): {{…
Published	07/30/2024	In neonates, levels of unconjugated bilirubin are {{c1::increased}}
Published	07/30/2024	Reference range of bilirubin (mg/dL) in adults Total bilirubin: {{c1::0.2–1.0}}Unconjugated bilirubin: {{c1::0.2–0.8}}Conjugated bilirubin: {{c1::0.…
Published	07/30/2024	Reference range of total bilirubin (in mg/dL) in infants PrematureFull-term at 24 hours{{c1::1–6}}{{c1::2–6}}at…
Published	07/30/2024	Overt jaundice occurs when bilirubin levels reach {{c1::3.0–5.0}} mg/dL*bonus: upper limit of bilirubin?
Published	07/30/2024	5% BSP-retention test measures the hepatic excretion of bromsulphthalein dye as a {{c1::mecarptide}} after its {{c1::glutathione}} conj…
Published	07/30/2024	Rate of hepatic excretion of 5% BSP{{c1::10–15}}% of total per minute
Published	07/30/2024	Excretion tests: amount administered (IV){{c1::5}}% BSP: {{c1::5}} mg/kg of body weight{{c1::1}}% Rose Bengal*: {{c1::10}} mL
Published	07/30/2024	To measure BSP excretion, {{c2::serum}} is taken from {{c1::5–10}} mL of blood extracted {{c1::25–45}} minutes* after administrationREAD EXTRA
Published	07/30/2024	Liver function test for excretion: normal results 5% BSP: {{c1::<5}}% remaining after {{c1::45}} minutes1% Rose Bengal: {{c1::≥50}}% excreted aft…
Published	07/30/2024	5% BSP retention test is contraindicated in patients with {{c1::bile obstruction}}
Published	07/30/2024	As the liver excretes the Rose Bengal dye, the {{c1::neck}} count decreases as {{c1::abdomen}} count increases
Published	07/30/2024	In hepatocellular liver diseases, blood galactose* {{c1::inc::dec/inc}}reases (galactose tolerance test)
Published	07/30/2024	{{c2::Galactose tolerance}} test {{c1::can}} be performed in a patient with jaundice and can also distinguish obstructive from non-obstructi…
Published	07/30/2024	Galactose tolerance test: amount administered Oral: {{c1::40}} g of galactose in solutionIV: {{c1::0.5}} g/kg body weight of {{c1::50}}% solution
Published	07/30/2024	Galactose tolerance test: blood sample collection schedule Oral*: {{c1::0.5 hrs. → 1 hr. → 1.5 hrs. → 2 hrs.}}IV: {{c1::5 min. → 0.5 hrs. → 1 hr. → …
Published	07/30/2024	{{c1::Galactose index}} is the sum of all glucose levels obtained (galactose tolerance test)
Published	07/30/2024	Oral galactose tolerance test (Maclagan): urine galactose Normal/obstructive jaundice: {{c1::≤3}} g w/in {{c1::3–5}} hoursIntrahepatic jaundice*: …
Published	07/30/2024	Normal IV galactose tolerance test (King) C = blood galactose concentration C0 = {{c1::200}} mg/100 dL (average)C{{c2::2}}hrs. = {{c1::0–10%…
Published	07/30/2024	What is the most useful liver function test?{{c1::Total plasma proteins (albumin, globulin, A:G ratio)}}
Published	07/30/2024	Liver function test for protein synthesis in cases of {{c2::infectious}} hepatitis Early stage: increased {{c1::β}}-globulinLater stage: increa…
Published	07/30/2024	In hepatocellular liver diseases, albumin/globulin ratio is {{c1::decreased}}
Published	07/30/2024	Plasma {{c1::albumin::protein}} is preferred in measuring the synthetic function of the liver
Published	07/30/2024	Which liver function test is more sensitive for acute cases?{{c1::Test for clotting factor synthesis}}
Published	07/30/2024	Reference range of plasma fibrinogen{{c1::200–400}} mg/dL
Published	07/30/2024	Plasma fibrinogen may drop to <{{c2::100}} mg/dL in cases of 1. Acute hepatic necrosis2. Advanced liver cirrhosis3. {{c1::Carbon tetrachloride}} …
Published	07/30/2024	Reference rage of total blood cholesterol{{c1::150–250}} mg/dL {{c1::60–70}}% of which are esterified
Published	07/30/2024	In cholestatic liver diseases, total serum cholesterol {{c1::increases}} with a(n) {{c1::increase}} in ester fraction
Published	07/30/2024	In hepatocellular liver diseases, total serum cholesterol is {{c1::normal or decreased}} with a(n) {{c1::greatly decreased}} ester fraction*bonus: tot…
Published	07/30/2024	Liver function test for detoxification is done using the {{c1::Hippuric acid}} test of Quick by administering {{c2::sodium benzoate}}
Published	07/30/2024	The liver conjugates benzoic acid with {{c1::glycine}} to produce {{c2::hippuric acid}} which is subsequently excreted in the {{c3::urine}}
Published	07/30/2024	Hippuric acid test of quick: bladder empty when Oral: {{c1::4 hours}} afterIV: {{c1::1 hour and 2 hours}} after
Published	07/30/2024	Normal hippuric acid test: amount of hippuric acid excreted in urine (in grams) Eq in benzoic acidEq in sodium benzoate …
Published	07/30/2024	In hepatocellular liver diseases, excretion of hippuric acid (detoxification test) is {{c1::dec::dec/inc}}reased
Published	07/30/2024	AST and ALT may be normal in cases of {{c1::cirrhosis}} despite hepatocellular damage
Published	07/30/2024	If ALT elevation > ALP elevation, then the liver pathology is {{c1::hepatocellular}}*bonus: R value?
Published	07/30/2024	If ALT elevation < ALP elevation, then the liver pathology is {{c1::cholestatic}}*bonus: R value?
Published	07/30/2024	In {{c2::alcoholic}} hepatitis, AST/ALT ratio is {{c1::2:1}}
Published	07/30/2024	Liver pathology: elevations in serum lactodehydrogenase Slight: {{c1::biliary tract disease}}Moderate: {{c1::acute viral hepatitis}}High: {{c1::meta…
Published	07/30/2024	Alkaline phosphatases (ALP) are {{c1::zinc}} metalloenzymes
Published	07/30/2024	Alkaline phosphatase is associated with the cell membrane of hepatocytes adjacent to the {{c1::biliary canaliculi}}
Published	07/30/2024	The placental isoenzyme of {{c2::ALP}} may be elevated in the {{c1::3rd}} trimester of pregnancy
Published	07/30/2024	ALP is reflective of {{c1::osteoblast}} activity in bone, hence it is higher in children (2–3x)
Published	07/30/2024	γ-glutamyl transferase (GGT) is a hepatic {{c1::microsomal}} enzyme
Published	07/30/2024	GGT may also be used to confirm {{c1::hepatic neoplasms}} in the absence of jaundice
Published	07/30/2024	Bilirubin is measured in adults via diazonium salt methods (unlike in neonates) due to the presence of {{c1::dietary pigments}}
Published	07/30/2024	Coagulopathy may not correlate with increased PT when {{c1::anticoagulants}} are also decreased
Published	07/30/2024	Which inherited hyperbilirubinemia may be either autosomal recessive or autosomal domimant? 1. {{c1::Gilbert syndrome}}2. {{c1::Crigler-Najjar syndr…
Published	07/30/2024	Memory aid Inherited Hyperbilirubinemia Etiology 1. Gilbert syndrome {{c1::mild reduction in UDP-GT,or impaired B1 uptake}} 2. Crigler-N…
Published	07/30/2024	Intrahepatic cholestatis may be due to {{c1::Rotor}} syndrome, cirrhosis, or neoplasms
Published	07/30/2024	In Rotor syndrome, the fraction of coproporphyrin I is {{c1::<70}}% of total coproporphyrins
Published	07/30/2024	In Dubin-Johnson syndrome, the fraction of coproporphyrin I is {{c1::~90}}% of total coproporphyrins
Published	07/30/2024	Dubin-Johnson syndrome and Rotor syndrome are differentiated by measuring the ratio of {{c1::coproporphyrin I to III}}
Published	07/30/2024	Differentials for elevated AST (SGOT) {{c1::1. Hepatocellular disease+2. Hemolysis3. Rhabdomyolysis4. Myocardial infraction*::4}}
Published	07/30/2024	Memory AidIn course of HBV infection, there is no HBc {{c1::antigen}}
Published	07/30/2024	What tests may be performed to determine if HCV infection is active or not? {{c1::1. AST/ALT levels2. Liver biopsy3. PCR of HCV RNA::3}}
Published	07/30/2024	Unconjugated bilirubin (B1) is transported from the perisinusoidal space into liver {{c2::endoplasmic reticulum}} via {{c1::ligandin&nb…
Published	07/30/2024	Bilirubin conjugation occurs in the presence of {{c1::uridyldiphosphate glucoronyl transferase (UDPGT)}}.
Published	07/30/2024	Sources of γ-glutamyl transferase (in decreasing concentration){{c1::Kidney (PCT) > Liver > Pancreas > Intestines}}
Published	07/30/2024	In bone disease, GGT is typically {{c1::not elevated::elevated/not elevated}}.
Published	07/30/2024	Elevations in alkaline phosphataseslight to moderate: {{c1::hepatocellular disorders (hepatitis, cirrhosis)}}elevated: {{c1::children, bone …
Published	07/30/2024	Aminotransferase found mainly in the liver and is more liver specific: {{c1::alanine transaminase (ALT)}}
Published	07/30/2024	ALT catalyzes the conversion of {{c1::alanine}} to {{c1::pyruvate}}.
Published	07/30/2024	Elevation in ALT/AST are indicative of {{c1::liver diseases}} but not specific.
Published	07/30/2024	AST & ALT Levelsnormal/mildly elevated: {{c1::obstructive liver damage}}highest: {{c1::acute conditions (viral hepa, drug-/toxin-induced…
Published	07/30/2024	General, nonspecific marker of cellular injury due to its very wide distribution: {{c1::lactodehydrogenase::enzyme}}
Published	07/30/2024	Highest ALP activity is seen in the {{c1::liver, bone, intestine, kidney, placenta}}
Published	07/30/2024	[QC]specificity for liver disease/injury(1) ALT, AST (2) LD{{c1::1>2}}
Published	07/30/2024	Biliary tract disease produces relatively larger increases in {{c1::ALP}}
Published	07/30/2024	Highest levels of {{c1::GGT}} are seen in biliary obstruction.
Published	07/30/2024	GGT is found in high concentrations in the {{c1::kidney, liver, pancreas, intestine, prostate, but not in bone}}.
Published	07/30/2024	Ingestion of {{c1::alcohol/drugs (barbiturates, tricyclic antidepressants, anticonvulsants)}} elevates {{c2::GGT}}
Published	07/30/2024	{{c1::GGT}} is a sensitive test for {{c2::cholestasis}} caused by {{c2::chronic alcohol/drug ingestion}}
Published	07/30/2024	Combined elevations of {{c1::ALP, GGT}} are compatible with {{c2::biliary tract disease}}
Published	07/30/2024	Lipids are metabolized in the liver when nutrition is {{c1::ad::inad/ad}}equate
Published	07/30/2024	Biliverdin is converted to unconjugated bilirubin by {{c1::cytosolic biliverdin reductase}}
Published	07/30/2024	The conjugation (esterification) of bilirubin occurs in the presence of the enzyme {{c1::uridyldiphosphate glucuronyl transferase (UDPGT)}} to form {{…
Published	07/30/2024	Urobilinogen is color{{c1::less::less/ful}}
Published	07/30/2024	Direct bilirubin measures {{c1::conjugated and delta bilirubin}}
Published	07/30/2024	In the Jendrassik-Grof reaction and Malloy-Evelyn method for measuring bilirubin, {{c1::serum, plasma, spinal fluid, and urine}} specimens may be…
Published	07/30/2024	In testing for neonatal bilirubin, {{c1::serum, plasma}} specimens may be used
Published	07/30/2024	Hemolysis and Lipemia have no effect on the results of {{c1::neonatal bilrubin measurement::bilirubin testing method}}
Published	07/30/2024	Older pediatric to adult specimens under neonatal bilirubin measurement will register {{c1::inc::dec/inc}}reased bilirubin levels because of {{c1::die…
Published	07/30/2024	The BSP-retention test (Bromsulphthalein Test) is most useful in cases of liver damage {{c1::w/o::with/without}} jaundice
Published	07/30/2024	Prehepatic jaundice is caused by {{c1::excessive erythrocyte destruction}}.
Published	07/30/2024	Summary of Urobilinogen/Bilirubin Levels in Prehepatic Jaundice serum unconjugated bilirubin{{c1::elevated}}fecal urobilinogen{{c1…
Published	07/30/2024	{{c1::Hepatic}} jaundice occurs when the liver cells malfunction or cannot take up, conjugate, or secrete bilirubin.
Published	07/30/2024	syndromes causing unconjugated hyperbilirubinemia: {{c1::Gilbert SyndromeCrigler-Najjar Syndrome}}
Published	07/30/2024	syndromes causing conjugated hyperbilirubinemia: {{c1::Dubin-Johnson SyndromeRotor Syndrome}}
Published	07/30/2024	Summary of Urobilinogen/Bilirubin Levels in Hepatic Jaundice unconjugated bilirubin{{c1::elevated}}fecal bilirubin{{c1::normal/dec…
Published	07/30/2024	Gilbert syndrome: mild increase in serum unconjugated bilirubin, about {{c1::1.5-3}} mg/dl
Published	07/30/2024	Treatment for Crigler-Najjar SyndromeType 1{{c1::liver transplantation}}Type 2{{c1::barbiturates}}
Published	07/30/2024	Neonatal physiological jaundice is caused by low levels of {{c1::UDP-GT}}, causing an increase in {{c1::unconjugated}} bilirubin.
Published	07/30/2024	{{c1::F::T/F}} Unconjugated bilirubin is normal in Dubin-Johnson Syndrome.
Published	07/30/2024	{{c1::Posthepatic}} jaundice occurs when an obstruction blocks bile flow.
Published	07/30/2024	Summary of Urobilinogen/Bilirubin Levels in Posthepatic Jaundiceconjugated bilirubin {{c1::significantly elevated}}unconjugated bilirubin{{c1::…
Published	07/30/2024	+ Anti-HAV IgM indicates {{c1::acute/recent infection}}.
Published	07/30/2024	Elevated {{c1::HAV total antibody}} cannot diffferentiate acute viral hepatitis A infection from previous infection or immunization.
Published	07/30/2024	Acute hepatitis B infection is serologically first noted by the appearance of {{c1::HBsAg}}, followed by {{c1::HBeAg}}, and then {{c1::…
Published	07/30/2024	During recovery from hepatitis B:markers that disappear/decrease: {{c1::HBsAg, HBeAg, HBc IgM}}markes that increase/appear (in order): {{c1:…
Published	07/30/2024	In chronic HBV infection:- {{c1::HBsAg}} remains positive- variable {{c1::HBeAg}} positivity; presence indicates infectivity- variable …
Published	07/30/2024	In hepatitis C infection, a positive {{c1::HCV Ab}} cannot differentiate acute from chronic infection; does not distinguish patients with infecti…
Published	07/30/2024	Hepatitis D virus requires coinfection of the host with {{c1::HBV}}.
Published	07/30/2024	+ {{c1::HDV IgM}} indicates acute HDV infection.
Published	07/30/2024	{{c1::HDV total Ab}} cannot differentiate present or past HDV infection.
Published	07/30/2024	BSP-excretion test is most useful in:{{c1::liver cell damage w/o jaundiceliver cirrhosischronic hepatitis}}
Published	07/30/2024	Rose Bengal Dye Test results in parenchymal liver disease: {{c1::high}} count in neck, {{c1::hardly any rise}} in abdomen count
Published	07/30/2024	Total plasma protein is {{c1::normal}} in obstructive jaundice.
Published	07/30/2024	Possible causes of hypoalbuminemia:{{c1::decreased liver functionmalnutritionacute inflammation}}
Published	07/30/2024	In moderate to severe liver disease, PT is {{c1::prolonged}}.
Published	07/30/2024	Factors affecting hippuric acid test:{{c1::ability of liver cells to produce and provide glycinecapacity of liver cells to conjugate glycine with benz…
Published	07/30/2024	Normal results should be seen in cases of obstructive jaundice in the {{c1::intravenous galactoce tolerance test}} and {{c1::total plasma proteins}}
Status	Last Update	Fields