LIVER FUNCTIONS LABORATORY

• detoxification

• metabolism

• storage

• excretion or secretion

What are the 4 major functions of the liver?

Liver

an organ used to detoxify harmful substances form the blood, metabolize nutriets and produce bile for digestion and storing glycogen for energy regulation

5-35 U/L

Give the reference value for AST

7-45U/L

Give the reference value for ALT

• Total protein= 6.5-8.3 g/dl

• Total Albumin=3.5-5.5 g/dl

• Total Bilirubin-0.2-1.0 mg/dl

• Ammonia= 11-35 umol/L

Give the reference value for:

• Total protein

• Total Albumin

• Total Bilirubin

• Ammonia

Total Protein and total albumin

This is an analytes used for synthetic functions?

• Total Bilirubin

An analyte used for execretion and cojugation

Ammonia

An analyte used for detoxification

AST AND ALT

These analytes are high whenevr there is liver damage

FALSE; ALT

True or False: AST is more liver specific?

Excretion of Endogenous and exogenous subsances

What is the most important functions of the liver?

TRUE

TRUE OR FALSE: the liver is the ONLY organ tha thas the cpaacity to rid the body heme waste products?

Unconjugated Bilirubin/ B1

What type of bilirubin binds to the Albumin?

Smooth endoplasmic Reticulum

Where does the Conjugation of B1 and B2 happened?

Uridine glucuronyl transferase

What enzyme responsible for the Conjugation of B1 and B2 happened?

Gallbladder

Release of BIle happens in the ____

1. Stercobilin

2. Urobilin

The gut bacteria will oxidize and become ____ & ______

BILIRUBIN

• it is the bile pigment derived from heme breakdown

• four pyrrole rings

• methine bridges

What is the composition of bilirubin

Unconjugated Bilirubin

• indirect

• Water insoluble

• Nonpolar

Conjugated bilirubin

2. Glucuronic acid molecules

Bilirubin is converted to ___ in the addition of two or one ______ making it water soluble and suitable for excretion in bile

UNCONJUGATED BILIRUBIN

Identify whether: Unconjugated/Conjugated bilirubin

• Water insoluble

UNCONJUGATED BILIRUBIN

Identify whether: Unconjugated/Conjugated bilirubin

• Indirect

UNCONJUGATED BILIRUBIN

Identify whether: Unconjugated/Conjugated bilirubin

• Pre-hepatic

UNCONJUGATED BILIRUBIN

Identify whether: Unconjugated/Conjugated bilirubin

• Slow reacting

UNCONJUGATED BILIRUBIN

Identify whether: Unconjugated/Conjugated bilirubin

• hemobilirubin

0.2-0.8 mg/dl

Ref range of UNCONJUGATED BILIRUBIN

Conjugated bilirubin

Identify whether: Unconjugated/Conjugated bilirubin

• cholebilirubin

CONJUGATED BILIRUBIN

Identify whether: Unconjugated/Conjugated bilirubin

• Water soluble

CONJUGATED BILIRUBIN

Identify whether: Unconjugated/Conjugated bilirubin

• DIRECT

CONJUGATED BILIRUBIN

Identify whether: Unconjugated/Conjugated bilirubin

• Hepatic/post hepatic

CONJUGATED BILIRUBIN

Identify whether: Unconjugated/Conjugated bilirubin

• PROMPT

0-0.2 MG/DL

REFERENCE RANGE FOR B2?

Unconjugated bilirubin

Identify whether: Unconjugated/Conjugated bilirubin/Total bilirubin

• Increased in hemolytic Jaundice

Total Bilirubin

Identify whether: Unconjugated/Conjugated bilirubin/Total bilirubin

• Increased in Hepatocellular Jaundice

Conjugated bilirubin

Identify whether: Unconjugated/Conjugated bilirubin/Total bilirubin

• Increased in Obstructive jaundice

DELTA BILIRUBIN

• a bilirubin bound to albumin

• reacts like bilirubin 2

• can be life threatening

TRUE

true or false: delta bilirubin is seen only when there is significant hepatic obstruction

DUBIN JOHNSON

• saturated bilirubin will leak to the blood stream

• needed albumin

elevated

Dubin johnson leads to false__

Paul Ehrlich

Who discovered the classic diazo reaction

pink to cherry red color

What is the end color to produce when reacted with diazotized sulfanilic acid?

Classic Diazo Reaction

An earliest chemical reactions used in clinical chemistry to detect UROBILINOGEN and related aromatic compounds in urine?

• this is the determination of bilirubin

MALLOY AND EVELYN

• first clinically methodolody for the quantification of bilirubin in serum samples using the classic diazo reaction with 50% methnaol solution as an accelatror.

Jendrassik and Grof

Method using the diazo reaction with caffeine benzoate acetate as an accelarator?

serum or plasma

total bilirubin using a methods of diazotized sulfanilic acid solution maybe perfoemd on___ and _____

FASTING SAMPLE

What sample is prefered as presence of lipemia will increase measured bilirubin concentatrion

Hemolyzed sample

What sample should be avoided as it falsely decrease the bilirubin

TRUE

True or false":Bilirubin is very sensitive to light and can be destroyed by it

30-50%

How many percent decrease when bilirubin exposed in the light?

Modified Jendrassik Grof

What is the reference method for total bilirubin?

Caffeine benzoate

Jendrassik- Grof Accelerator/Solubilizer?

50% methanol or cetrimide

Evelyn and Malloy Accelerator/Solubilizer?

Blue

Jendrassik- Grof End color?

Red purple

Evelyn and Malloy end color?

Sodium acetate

Evelyn and Malloy & Jendrassik- Grof buffer?

Ascorbic acid

Evelyn and Malloy & Jendrassik- Grof Stopping solution?

Acidic

Evelyn and Malloy Ph?

alkaline

Jendrassik- Grof ph?

hepatobiliary dysfunction such as hepatocellular or obstructive jaundice

Blirubin present in the urine indicates what clinical significance?

Yellow (+)

• Urinary Bilirubinfoam test is _____

Urinary Bilirubin

• urinary inspection

• harrison spot test

• diazotization test

pink-cherry red

End color for positive diazotizatation test?

barrium chloride adding ferric chloride

What is the reagent uses in harrison spot test

Green color precipitate

what color if there is present of bilirubin in harrison spot test?

Urinary urobilinogen

colorless end product of bilirubin metabolism that is oxidized by intestinal bacteria to the brown pihment urobilin.

Ehrlich reagent Pdab color red

Reagent used for Urinary urobilinogen

INCREASE

Urinary urobilinogen hemolytic disease and hepatitis : increased or decreace

DECREASE

Urinary urobilinogen billiary obstruction

fresh 2 hour urine sample

• A pecimen collected used to anlayzed to prevent oxidation to urobililn.

Sodium acetate

used to remove indole interferences

Ferric hydroxide

use to stabilize urobilinogen

• porphobilinogwn

• sulfonamides

• procaine

• 5HAIAA

what are the possible interfering subsrances when handling and specimen collection that causes FALSE RESULTS

Pink/ red

Increased Urine urobilinogen Color

hemolytic disease and heptocellular dysfunction color

Type of jaundice associated in increase urine urobilinogen?

obstructive jaundice or severe liver disease

Type of jaundice associated in decrease urine urobilinogen?

No color change/ no pink or red color

Decreased Urine urobilinogen Color