1. what is the functional unit of the liver?
    1. The lobules


  1. what are the sinusoids?
    1. Branches of the portal vein and hepatic artery
    2. Lined with Kupffer cells


  1. what is the function of the renal canaliculi?
    1. Bile formed in the hepatocytes is excreted into the canaliculi
    2. Canaliculi join to form increasingly larger bile ducts, until the common bile duct is reached


  1. what is the function of the Kupffer cells?
    1. Remove bacteria and other foreign particles from the blood


  1. blood is suppled to the liver by what two sources?
    1. Portal vein
    2. Hepatic artery


  1. name the five major functions of the liver
    1. excretory/ secretory
    2. synthetic
    3. detoxification
    4. steroid metabolism
    5. filtration


  1. what is the main bile pigment?
    1. Bilirubin


  1. bilirubin complexes with what protein from transport to the liver?
    1. Albumin of course


  1. what are the two forms of bilirubin?
    1. Unconjugated ( prehepatic, free, indirect and alcohol soluble)
    2. Conjugated (post hepatic, direct, water soluble)


  1. what is the name of the compound that conjugates with bilirubin for excretion in the bile?
    1. Glucaronic acid


  1. the adult ref range for serum Total bilirubin is…
    1. 0.2 – 1.0 mg/dL


  1. what are the synonyms for unconjugated bilirubin?
    1. Prehepatic, free, indirect, alcohol soluble


  1. what are the synonyms for conjugated bilirubin?
    1. Post hepatic, direct, water soluble


  1. name the 5 synthetic functions of the liver?
    1. Carbohydrate metabolism
    2. Protein synthesis
    3. Urea formation
    4. Lipid metabolism
    5. Vit and mineral storage


  1. what purpose does urea formation serve?
    1. For ammonia excretion in the urine and feces


  1. what is the chemical precursor for steroid hormones?
    1. Cholesterol


  1. what action is performed by the Kupffer cells?
    1. Remove bacteria and other foreign particles from the blood


  1. the 5 major enzymes of the liver are?
    1. AST
    2. ALT
    3. ALP
    4. GGT
    5. LD


  1. elevated serum AST is noted in which disease states?
    1. Chronic active hepatitis
    2. Chronic persistent hepatitis
    3. Alcoholic liver disease


  1. elevated serum ALT is noted in which disease states?
    1. Acute hepatitis
    2. Cholestatic conditions


  1. elevated serum GGT is noted in which disease states?
    1. Hepatocellular and obstructive disorders
    2. Used as screening test for alcohol abuse+++


  1. elevated serum ALP is noted in which disease states?
    1. Canalicular membrane damage
    2. Biliary obstruction


  1. elevated serum LD is noted in which disease states?
    1. Malignancies
    2. Alcoholic, viral, and toxic hepatitis
    3. Any liver disease


  1. in acute liver disease, what is the relationship between serum ALT and AST levels?
    1. ALT elevates as high or higher then AST
    2. AST levels are normally 2.5 times greater then ALT in the liver


  1. AST is commonly used/known as?
    1. SGOT


  1. ALT is commonly used/known as ?
    1. SGPT


  1. ALP levels greater then reference adult levels are normally seen in?
    1. Pregnancy
    2. Bone growth (kids)


  1. what 3 enzymes may be associated with alcohol abuse?
    1. ALT
    2. GGT
    3. LD


  1. what LD isoenzyme is associated with the liver?
    1. LD5


  1. when measureing bilirubin, what function of the liver is being evaluated?
    1. The livers excretory function


  1. when measuring albumin, what function of the liver is evaluated?
    1. The livers synthetic function


  1. name 4 tests tha tcan be used to evaluate liver functions?
    1. Bilirubin
    2. Albumin
    3. Ammonia
    4. Prothrombin time


  1. abnormal NH3 (ammonia) levels may be noted in which diseases?
    1. Reye’s syndrome
    2. End stage cirrhosis
    3. Hepatic encephalopathy


  1. a doc wants to monitor the synthesis of adequate clotting factors in a patient…what test would she order?
    1. Prothrombin time


  1. define jaundice/ what is it?
    1. Yellow discoloration of the plasma, skin and mucous membranes
    2. Caused by an accumulation of bilirubin


  1. name 3 types of jaundice and the bilirubinemia associated with each?
    1. Prehepatic jaundice---unconjugated hyperbilirubinemia
    2. Hepatic jaundice---conjugated and unconjugated hyperbilirubinemia
    3. Post hepatic jaundice---conjugated hyperbilirubinemia


  1. what jaundice is the most commonly occurring form of hyperbilirubinemia.  And the population most commonly affected by it are?
    1. Physiologic
    2. Neonates


  1. hepatic jaundice could be a result from what three syndromes?
    1. Gilber’s syndrome
    2. Crigler-najjar syndrome
    3. Dubin-johnson syndrome


  1. what can cause post-hepatic jaundice?
    1. Impaired excretion of conjugated bili caused by obstruction of flow of bile to the intestines due to gallstones or tumor


  1. define cirrhosis
    1. a result of excessive hepatic damage and subsequent regeneration
    2. irreversible scarring with the formation of connective tissue


  1. what is the primary cause of cirrhosis?
    1. Primarily by alcohol abuse
    2. Can also be caused by heochromatosis, post necrotic cirrhosis and primary biliary cirrhosis


  1. define hepatitits
    1. inflammation of the liver caused by virus, bacteria, parasites, radiation, drugs, chemicals or toxins


  1. name the types of hepatitis and their common names?
    1. Acute viral hepatitis A---infectious hep
    2. Acute viral hepatitis B---serum hep
    3. Hep C, D, non-A, non-B—viral hep


  1. what are the usual routes of transmission for hepatitis A?
    1. fecal-oral route or by contaminated food, water, shellfish


  1. what are the usual routes of transmission of hepatitis B?
    1. parenteral, perinatal and sexual


  1. what causes reye’s syndrome?
    1. Liver damage due to neurologic changes that arise primarily in children following varicella (chix pox) or influenza B infection


  1. name the type of specimen required for testing bilirubin?
    1. Serum---fasting is preferred


  1. what three precautions must be observed when testing bilirubin?
    1. Specimen must be non hemolyzed
    2. Free from lipemia
    3. ‘protected from light


  1. what are the 2 diazo colorimetric methods for testing bilirubin and which is the most common?
    1. Modified evelyn-malloy method
    2. Jendrassik and grof method


  1. what wavelength is used in the jendrassik-grof method?
    1. 600nm


  1. what wavelength is used in the evelyn malloy method?
    1. 540nm


  1. what is the purpose of methanol addition in the evelyn-malloy meth?
    1. Methanol reagent is added to develop the unconjugated bilirubin
    2. The glucaronic acid is cleaved


  1. what reagents are required to perform the jendrassik-grof method?
    1. HCl
    2. Diazo reagent (diazotized sulfanilic acid)
    3. Sodium caffeine benzoate (accelerator)
    4. Ascorbic acid solution
    5. Alkaline tartrate


  1. what wavelength is used in the direct spectrophotometry method?
    1. 454nm


  1. why is direct spectrophotometry only used for neonatal bilirubin?
    1. The serum of neonates does not contain carotene and other pigments that increase the absorbance at 454nm
    2. Use is limited to neonates because of strong interference from carotinoids (colors in the serum of older kids and adults)