Clinical Laboratory Chemistry: Chapter 19 Liver Flashcards


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1

Bilirubin is a metabolic product of

Hemoglobin catabolism

2

The phagocytic cells that line the sinusoidal space in the liver are called:

Kupffer cells

3

The liver's blood supply is provided by the:

Hepatic artery and Portal vein

4

In the liver bilirubin is converted to:

Bilirubin diglucoronide

5

What are some functions of the liver?

Detoxification of drugs, excretion of bile acids, metabolism of glucose and synthesis of proteins.

6

As a result of excessive accumulation of bilirubin in the blood, certain body areas such as the skin and sclera take on a yellow-pigmented appearance. The condition that is charac terized by this yellow pigmentation is know as:

Jaundice

7

Which of the following groups would be at greater than normal risk of getting hepatitis A?

Day care workers

8

The type of hepatitis spread by the fecal-oral route is:

Type A

9

How is the Hepatitis B virus commonly transmitted?

Transfusion/Contact with Blood

10

Which of the following causes 90% of posttransfusion hepititis?

HCV

11

Hepatitis C differs from hepatitis A and hepatitis B because it:

Has a high incidence of a chronic carrier state

12

If a total bilirubin is 3.1 mg/dL and the conjugated bilirubin is 2.0 mg/dL, then the unconjugated bilirubin is:

1.1 mg/dL

13

Which of the following statements regaurding rilirubin metabolism is true?

A. Bilirubin is inhibited by salicylates.
B. Bilirubin is excreted only as conjugated bilirubin.
C. Bilirubin undergoes photooxation when exposed to daylight.
D. Bilirubin excretion is decreased by barbituartes.

Bilirubin undergoes photooxidation when exposed to daylight.

14

When measuring bilirubin, the purpose of adding caffeine-sodium benzoate or methanol to the reation mixture is to:

Accelerate the reaction with unconjugated bilirubin.

15

In the Jendrassick-Grof bilirubin methodology, what converts purple azobilirubin to blue-green azobilirubin measured at 600nm?

Alkaline tartrate

16

Specimens for ammonia should be:

Kept on ice as soon as drawn

17

Ammonia measurement is helpful in the diagnosis of all of the following except:

Kidney failure

18

An 8-year-old boy was recovering from chicken pox when he suddenly suffered a relapse. He eventually went into a coma. An ammonia level was performed that was extremely elevated. What is a possible diagnosis?

Reye's syndrome

19

Delivers 70% of the total blood volume to the liver

Portal Vein

20

Deliver the remaining 30% of blood supply to the liver

Hepatic Artery

21

The hepatic vein drains the blood from the ________ ______ ______.

Inferior Vena Cava

22

The portal vein, the hepatic artery, and the bile duct compose the _______ ________.

Portal Triad

23

Blood flows from the portal vein and hepatic artery though the sinusoids, toward the _________ vein, which merges with the _________ vein and drains blood from the liver.

Central; Hepatic

24

Cells that make up 70% of the liver's mass.

Hepatocytes

25

Endothelial cells and Kupffer cells line the _________.

Sinusoids

26

Hepatocytes that take up nutrients and secrete/excrete into the bile

Canaliculi

27

Liver can play a role in their metabolism via glycolysis, gluconeogenesis, and glycogenolysis

Carbohydrates

28

Liver can synthesize all proteins except _______ _______ and _________.

Gamma globulins; Hemoglobin

29

Lipid and fat metabolism in the liver produces ______________ cholesterol and lipoproteins

Endogenous

30

Liver excretes ______ acids, cholesterol, bilirubin, and _______-containing metabolic products of protein catabolism

Bile; Nitrogen

31

Vitamins A, D, E, and K are all fat-_________

Soluble

32

Immunologic roles of the liver include phagocytosis by Kupffer cells and secretion of _____ antibodies

IgA

33

Which item does the liver NOT store:

Iron
Copper
Lead
Vitamins ADEK
Glycogen

Lead

34

Uncogugated Bilirubin (a.k.a. ____________ bilirubin)

Indirect

35

Congugated Bilirubin (a.k.a. _____________ bilirubin)

Direct

36

Fecal and Urine urobilinogen is (increased/decreased) in posthepatic jaundice

Decreased

37

Gilbert and Rotor Syndromes are examples of ________ jaundice

Hepatic

38

Congestive Heart Failure and Hemolytic Disease of the Newborn are examples of __________ jaundice

Prehepatic

39

Syndrome characterized by:

Unconjugated bilrubinemia
Higher prevalence in males
Reduced activity of Gluconyl-transferase
Slight elev. of Unconjugated bilirubin

Gilbert Syndrome

40

Autosomal Recessive Syndrome characterized by:

Absolute lack of UDP-glucoronyl transferase
Elevated unconjugated bilirubin
Children w/ Type 1 usu. die within 1st yr. of life
Kernicterus
Type 1 - Severe jaundice
Type 2 - Less Severe jaundice

RARE!

Crigler-Najjar Syndrome

41

Syndrome characterized by:

Obstructive Liver Disease
Impaired Excretion of Conjugated bilirubin
Mild, Chronic Disorder

Dubin-Johnson

42

Benign conjugated bilirubinemia that is similar to Dubin-Johnson syndrome

Rotor syndrome

43

Early stage alcoholic liver failure; 6 months-1 year of moderate alcohol consumption

Few lab abnormalities, reversible, benign

Alcoholic Fatty Liver

44

Alcoholic Liver Failure after long-term alcohol consumption.
Symptoms include hepatomegally, vomiting, jaundice, acites, fever, abdominal pain, peripheral neuritis.
AST levels are more than twice ALT levels!!

Alcoholic Hepatitis

45

Alcoholic Liver Failure characterized by:

Severe liver damage
Irreversible scarring
10-15% of heavy drinkers develop (Genetic)

Alcoholic Cirrosis

46

To measure _________ bilirubin: (Jendrassik-Groff methodology)

Serum is pretreated with caffeine-Na Benzoate to increase the reaction rate of indirect bili.
Caffeine is an accelerator and dissociating reagent.

HCl and Diazotized sulfanilic acid are added

Ascorbic acid is added to stop the reaction

Alkaline Tartrate is added to form blue-greem azobilirubin

Total

47

To measure _________ bilirubin: (Jendrassik-Groff methodology)

Diazo reagent is added

Incubation

Ascorbic Acid is added to stop the reaction

Alkaline Tartrate and caffeine are added to form blue-green azobilirubin

Direct

48

________ bilirubin = Total bilirubin - _________ bilirubin

(Because it cannot be measured directly)

Indirect; Direct

49

Jendrassik-Groff is (more/less) sensitive than Evelyn-Malloy methodology

Less

50

___, protein, and ______________ concentration cause false decreases in the Jendrassik-Groff methodology

pH; Hemoglobin

51

Classic method for measuring bilirubin concentration is _________ reaction

Ehrlich's

52

VanderBergh used the Ehrilich's reaction with __________.

Alcohol

53

Evelyn-Malloy modified Ehrlich's reaction to a quantitative method using 50% ___________.

Methanol

54

Match the reference ranges to the appropriate bilirubin: Total, Indirect, Direct

0.2-1.0 mg/dL
<0.8 mg/dL
<0.2 mg/dL

Total; Direct; Indirect

55

90% of __________ bilirubin is bound to albumin

Indirect/Unconjugated

56

_________ is elevated in impending hepatic comas, acute viral hepatitis, Reye's syndrome, and inherited deficiences of enzymes in the Krebs-Henselheit urea cycle in infants

Ammonia

57

Ammonia is ___________ in advanced liver disease and renal failure

Elevated

58

AST, ALT, GGT, and Alk Phos are enzymes commonly included in a liver ____________ test

Function

59

Important in determining the severity of liver disease. Less _________ = More severe

Albumin

60

Prothrombin time is often elevated in liver disease. To determine the cause, reapeated Prothrombin time testing is repeated 4 hours after injection with Vitamin ____.

K

61

If prothrombin time is corrected with the vitamin shot, the problem is _________________

Malabsorption

62

If the prothrombin time is not corrected with the vitamin shot the problem is _________________

Liver disease

63

The Berthelot reaction for ammonia can not be _________.

Automated

64

What is the reference range for Ammonia?

19-60 ug/dL

65

Wilson's disease is an autosomal recessive disorder of __________ metabolism associated with low levels of ceruloplasmin.

Copper

66

The stoppage or obstruction of the flow of bile from intrahepatic causes, obstruction of the bile duct by gallstones, or any process that blocks the bile ducts

Cholestasis

67

The product of amino acid and protein catabolism; elevated levels associated with impending hepatic coma and Reye's syndrome

Ammonia