Liver Function Test 2

Yves Laure Pimentel · 70問 · 2年前

通報

問題一覧

brain degeneration >20mg/dl

KERNICTERUS

WHAT BILIRUBIN increased affinity in brain

BILIRUBIN 1

KERNICTERUS mg/dl

>20 mg/dl

treatment for kernicterus

PHOTOTHERAPY/UV

THIS TREATMENT DESTROYS BILIRUBIN

PHOTO THERAPY/UV

- Bilirubin excretion deficit

Dubin-Johnson

Dubin-Johnson - WHAT deficit

Bilirubin excretion

obstructive in nature i. Delta bilirubin is seen

Dubin-Johnson

WHAT IS SEEN IN Dubin-Johnson

Delta bilirubin

SAMPLE FOR THE OBSERVATION OF LIPOFUCHSIN

LIVER BIOPSY

PIGMENT USED IN LIVER BIOPSY

LIPOFUCHSIN

Dubin-Johnson LIKE AND NEGATIVE PIGMENT

Rotor

- circulating INHIBITOR of bilirubin conjugation

Lucey Driscoll

Delta bilirubin is COMBINATION OF?

B2+ALBUMIN

B2+ALBUMIN SEEN IN POST HEPATIC

Delta bilirubin

B2 ACCUMULATION WHICH CREATES PIGMENT

Dubin-Johnson

B2 ACCUMULATION WHICH DOESNT CREATE PIGMENT

Rotor

INCREASED/DECREASED/NORMAL 1. B1 2. B2 3. URINARY UROBILINOGEN HEMOLYTIC DISEASE

(INCREASED HIGHEST) INCREASED NORMAL INCREASED

INCREASED/DECREASED/NORMAL 1. B1 2. B2 3. URINARY UROBILINOGEN EARLY LIVER DISEASE

INCREASED INCREASED DECREASED

INCREASED/DECREASED/NORMAL 1. B1 2. B2 3. URINARY UROBILINOGEN LATE LIVER DISEASE

INCREASED INCREASED INCREASED

INCREASED/LOW/NORMAL 1. B1 2. B2 CN

INCREASE LOW

INCREASED/DECREASED/NORMAL 1. B1 2. B2 GILBERT

INCREASED NORMAL

INCREASED/DECREASED/NORMAL 1. B1 2. B2 DJ AND ROTOR

NORMAL INCREASED

INCREASED/DECREASED/NORMAL 1. B1 2. B2 NEWBORN JAUNDICE

INCREASED NORMAL

INCREASED/DECREASED/NORMAL 1. B1 2. B2 3. URINARY UROBILINOGEN BILE DUCT OBSTRUCTION

INCREASED INCREASED DECREASED

PARTIAL OBSTRUCTION STOOL COLOR

PALE YELLOW STOOL

COMPLETE OBSTRUCTION STOOL COLOR

GRAY

not noticeable to the eye

Overt jaundice

YELLOW EYE, SKIN, MUCUS MEMBRANE

Jaundice

Jaundice AKA

JAUNE OR YELLOW

Called icterus or hyperbilirubinemia.

Jaundice

Jaundice Called

icterus or hyperbilirubinemia.

BILIBURIN Evident: bilirubin level exceeds

3-5 MG/DL

The clinical manifestation of jaundice develops when total bilirubin levels exceed:

3mg/dL or 51.3 umol/L

BILIBURIN Methods c. Hemolysis – ? reaction

decrease reaction

BILIBURIN Methods c. ? – decrease reaction

Hemolysis

BILIBURIN Methods – false increase

Lipemia

BILIBURIN Methods Lipemia –

false increase

BILIBURIN Methods SHOULD BE TESTED WITHIN? IN WHAT PLACE?

2-3 HOURS, DARK PLACE

BILIBURIN Room temp FOR HOW MANY DAYS?

2 days

SAMPLE IN BILIBURIN WHEN KEEP IN 4 DEGREES C IS UP TO?

1 week

SAMPLE IN BILIBURIN WHEN KEEP IN .-20oC IS UP TO?

Indefinite

SAMPLE IN BILIBURIN 1 week STORAGE IS KEEP IN

4oC

SAMPLE IN BILIBURIN Indefinite STORAGE IS KEEP IN

-20oC

BILIBURIN Visible icterisia:

>25mg/dl

BILIBURIN reagent

Diazo reagent

no need for accelerant

= reacts slowly = need accelerants

- pink to purple azobilirubi

Evelyn and Malloy Method

Evelyn and Malloy Method -

pink to purple azobilirubin

Evelyn and Malloy Method Accelerant:

Methanol

.reaction at pH 1.2 with maximal absorbance at 560nm

Evelyn and Malloy Method

Evelyn and Malloy Method reaction at pH ? with maximal absorbance at NM?

1.2 560nm

- pink to blue azobilirubin

Jendrassik and Grof

Jendrassik and Grof -

pink to blue azobilirubin

Jendrassik and Grof Accelerant:

Caffeine sodium benzoate

More sensitive than Evelyn and Malloy Not affected by Hb and pH changes Vit C. Terminates the reaction and destroy diazo

Jendrassik and Grof

Terminates the reaction and destroy diazo

Vit C.

Not affected by Hb and pH changes

Jendrassik and Grof

FORMULA OF B1

B1=TB-DB

bilirubin Method only for neonates

Bilirubinometer

Principle: reflectance photomotery on skin

Bilirubinometer

NON PROTEIN NITROGEN: LIVER DETOXIFICATION

AMMONIA

AMMONIA DETOXIFICATION OF?

LIVER

From deamination of amino acids

AMMONIA

AMMONIA Severe liver disease

Hepatic Coma (NH3 is neurotoxic) and Encephalopathy

AMMONIA USES ASPIRIN INGESTION

REYE'S SYNDROME

REYE'S SYNDROME INGESTION

ASPIRIN

Monitor hyper alimentation therapy

AMMONIA

eating in a tube

hyper alimentation therapy

Neonate UREA cycle defect

AMMONIA

ANTI PAIN/ POSION

Acetaminophen/ TYLENOL

INCREASED BUN; DECREASED NH3

SEVERE LIVER DISEASE

WHAT DECREASES WHEN THERE IS HEPATIC COMA?

GABA-GAMMA AMINO BUTYRIC ACID

FALSE ELEVATION/FALSE LOW prolonged specimen

FALSE ELEVATION

FALSE ELEVATION/FALSE LOW hemolyzed sample

FALSE ELEVATION

FALSE ELEVATION/FALSE LOW Diphenhydramine

FALSE LOW

FALSE ELEVATION/FALSE LOW Lactobacillus acidophilus

FALSE LOW

ARE ACID PRODUCERS + NH3 (BASE)

Diphenhydramine Lactobacillus acidophilus

Glucose at concentrations > ______________mg/dL (33 mmol/L) interferes in dry slide methods

600

Glucose at concentrations > 600mg/dL (?) interferes in dry slide methods

33 mmol/L

AMMONIA BLOOD Specimen

arterial blood

AMMONIA PREFERRED TUBE

Heparin/EDTA

AMMONIA Specimen TO SLOW down deamination

.ice water

Plasma stable up to ? in ice bath; stable several days frozen

3 1/2 hr

NH3 in Microdiffusion chamber-> NH3 gas + Sol’n w/pH indicator-> Measured using Titration

CONWAY

Methods AMMONIA –The most common technique

Glutamate dehydrogenase (GLDH)

Methods AMMONIA Direct measurement NH3 thru the ISM -> NH3 + Ammonium chloride -> Change in pH

Potentiometry (Ion selective electrode)

REVERSE REACTION AKA?

WROBLEUSKI METHOD

WROBLEUSKI METHOD AKA

REVERSE REACTION

WROBLEUSKI METHOD AKA REVERSE REACTION

NADH->NAD DECREASED ABS. 340NM INVERSELY PROPORTIONAL TO INCREASED CONCENTRATION

WACKER METHOD AKA

FOWARD METHOD

FOWARD METHOD AKA

WACKER METHOD

WACKER METHOD AKA FOWARD METHOD

NAD->NADH INCREASED ABS. 340NM DIRETCLY PROPORTIONAL TO INCREASED CONCENTRATION

AMMONIA

Berthelot reaction and Nesslerization reaction

AMMONIA

other names parasitology

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