CHEM 207 Test 1 | Verified with 100% Correct Answers

CHEM 207 Test 1 | Verified with 100% Correct Answers T/F Extrahepatic biliary atresia is fatal and must be treated with a transplant True Why is a newborn more at risk for kernicterus if they are experiencing jaundice? Their blood brain barrier is not as developed, meaning that bilirubin can cross into the brain and cause damage T/F The liver is only an endocrine gland False - exocrine AND endocrine Which of the below are the phagocytic macrophages of the liver that help with regenerative capabilities? a) Kupffer's cells b) Red pulp macrophages c) Microglia d) Hepatocytes The hepatic artery is responsible for a) Bringing absorbed material from the GI tract to the liver b)supplying the kidney with oxygen c) supplying the liver with oxygen d) Bringing processes material from the liver to the kidneys for excretion The Hepatic portal vein is responsible for a) Bringing absorbed material from the GI tract to the liver b) supplying the kidney with oxygen c) supplying the liver with oxygen d) Bringing processes material from the liver to the kidneys for excretion Which of the below does the liver not metabolize? a) Lipids b) Carbs c) Proteins d) it metabolizes all of the above What are the 5 functions of the liver? Excretion (bile acids and bilirubin) synthesis of proteins and NPNs Metabolism Detoxification Storage T/F The liver is good at dealing with acute problems compared to chronic problems False - acute problems are harder for it to deal with, regenerative capabilities make it easier for What would you expect to see for each of the below when a patient is experiencing liver failure? glucose regulation coagulation Enzymes vascularity Metabolic/nutritional glucose regulation decreased due to glycogen storage issues coagulation - prolonged due to reductions in coagulation factors synthesized Enzymes - increased or decreased release of enzymes vascularity - damage due to tension in portal vein Metabolic/nutritional - bilirubin buildup or issues with digestion of fat (bile salts) Which portion of hemoglobin is broken down and reduced to biliverdin? a) globin portion b) heme portion c) iron portion d) porphyrin portion T/F Bilirubin production is a pathological process always false - breakdown of bilirubin is a normal process, however it can become pathological T/F The majority of bilirubin seen in the blood is conjugated false - unconjugated is mostly seen as it is attached to albumin for transport What enzyme is responsible for converting unconjugated bilirubin to conjugated bilirubin? UDPG-T Bilirubin diglucuronide is also known as a) Direct bilirubin b) Indirect bilirubin c) Unconjugated bilirubin d) Conjugated bilirubin e) Two of the above (a and d) Compare and contrast direct and indirect bilirubin. Direct = conjugated = not bound to albumin = not as much in bloodstream = soluble indirect = unconjugated = bound to albumin = more in bloodstream = insoluble What is delta bilirubin? a) Conjugated bilirubin attached to albumin b) Unconjugated bilirubin attached to albumin c) Another form of conjugated bilirubin d) A unique form of bilirubin Explain the process of bilirubin generation starting in the spleen and ending in excretion 1) RBCs broken down in the spleen by macrophages 2) Globin and iron get recycled, while porphryin gets converted to biliverdin, then to unconjugated bilirubin 3) unconjugated bilirubin travels to the liver where it gets converted into conjugated bilirubin by UDPG-T enzyme. 4) Conj bilirubin travels via the hepatic duct into the intestine 5) Intestinal microbiota enzymes convert the bilirubin into urobilinogen which will be excreted in the urine, or urobilin which is excreted in stool Which of the below is normally excreted in urine? a) Biliverdin b) Direct bilirubin c) Urobilinogen d) Urobilin e) Indirect bilirubin T/F Unconjugated bilirubin is insoluble while conjugated bilirubin is soluble True Which of the below describes Crigler Nijjar syndrome type 1 a) Lacks the UDPG-T enzyme leading to high levels of conjugated bilirubin and is fatal due to kernicterus b) Lacks the UDPG-T enzyme leading to high levels of unconjugated bilirubin and is fatal due to kernicterus c) Partial deficiency of the UDPG-T enzyme leading to high levels of unconjugated bilirubun but responds to phenobarbital d) Partial deficiency of the UDPG-T enzyme lading to high levels of conjugated bilirubin but responds to phenobarbital Which of the below describes Crigler Nijjar syndrome type 2 a) Lacks the UDPG-T enzyme leading to high levels of conjugated bilirubin and is fatal due to kernicterus b) Lacks the UDPG-T enzyme leading to high levels of unconjugated bilirubin and is fatal due to kernicterus c) Partial deficiency of the UDPG-T enzyme leading to high levels of unconjugated bilirubun but responds to phenobarbital d) Partial deficiency of the UDPG-T enzyme lading to high levels of conjugated bilirubin but responds to phenobarbital Gilbert syndrome has high levels of a) Conjugated bilirubin b) Unconjugated bilirubin c) Delta bilirubin Which of the below is not characterized by hyperconjugated bilirubinemia? a) Lucey-Driscoll syndrome b) Dubin-Johnson syndrome c) Rotor syndrome d) Gilbert syndrome If a patient has jaundice does that always mean something is wrong with the liver? NO - can also mean there is an excess in bilirubin production, which could occur due to excess RBC breakdown like hemolytic anemias Which of the below is false regarding physiological jaundice in newborns? a) Is conjugated bilirubin b) Doesn't occur in all babies, but it is normal for it to occur c) Occurs 24hours after birth, and no longer than 2 weeks d) All of the above are true When is jaundice in newborns considered pathological? a) 10 umol/L b) 100 umol/L c) 300 umol/L d) 50 umol/L Why does it take jaundice 24 hours to appear typically after a baby is born? The mother is dealing with the bilirubin while the baby is inside them, it takes 24 hours ish for the RBC turnover to become too much for baby to handle T/F All babies will show jaundice 24 hours after they are born due to liver immaturity False Which of the below would you NOT be worried about kernicterus possibility in the newborn? a) Mother has jaundice b) HDFN c) Hypoglycemic infant d) Premature baby/ low birth weight e) All of the above are factors What is the first course of action when a baby has jaundice? Get them under the light! Which of the below would you expect an infant to have high levels of conjugated bilirubin? a) HDFN b) Hypoglycemic infant c) biliary atresia d) acidosis What is biliary atresia? Does it affect males or females more? When there is a defect in the bile ducts, leading to conjugated bilirubin buildup in infants; females are more likely to get it What is the normal range for bilirubin in the serum for adults? 3-17umol/L T/F You should see more unconjuted bilirubin in the blood than conjugated normally True Explain what is happening in this chart This chart describes the relative risk for different classes of infants. Top line - low risk babies; these babies were born at the correct time and thus higher levels of bilirubin are tolerable before Bottom line - high risk babies; some risk factors such as premature birth, low birth weight, HDFN, etc. mean that lower levels of bilirubin are tolerable before we start treatment Which of the below could have the highest levels of bilirubin before starting phototherapy? a) Premature by 3 weeks b) Born 38 weeks c) Born 38 weeks but is low birth weight d) The tolerance of bilirubin is the same for each baby Which of the below can be transmitted by blood? a) Hep A b) Hep B c) Hep C d) Two of the above e) All of the above Which of the below is considered acute ONLY hepatitis? a) Hep A b) Hep B c) Hep C d) Two of the above e) All of the above Which of the below could be chronic or acute a) Hep A b) Hep B c) Hep C d) Two of the above e) All of the above Which of the below is only chronic a) Hep A b) Hep B c) Hep C d) Two of the above e) All of the above T/F Hep C is the most common form of blood transmitted associated hepatitis True Which of the below would not be a cause of chronic hepatitis? a) Hep A b) Alcohol abuse c) Fatty liver disease d) Hep B e) Two of the above Which of the below enzymes is MOST specific for the liver? a) GGT b) ALT c) AST d) ALP e) NTP Which of the below would you start to consider a hepatobilliary disease obstruction if it was high? a) GGT b) ALT c) AST d) ALP e) NTP f) Two of the above Which of the below is false regarding cirrhosis of the liver? a) Regenerative capacity is zero b) Caused by only chronic liver disease c) Ascited and portal hypertension common with jaundice in these patients d) Coagulation is disrupted as the liver cannot synthesize coagulation factors e) All of the above are true *acute as well What is cohlestatic liver disease? What liver enzyme do you anticipate being high in this? Is it a chronic or acute liver concern? This is when there is a blockage in the hepatobiliary system, such as gallstones, tumours, etc. ALP is the one that is linked to this. Acute concern Which of the below is false regarding causes of cholestatic liver disease? a) Primary biliary cholangitis is an autoimmune disease where the bile ducts are damage b) Gallstones are an extrahepatic cause of disease where a buildup of cholesterol blocks the ducts c) Sclerosing cholagitis is an inflammatory condition d) Tumours in the liver would be considered an extrahepatic origin of this disease What is Reyes syndrome? what is it caused by? is it acute or chronic? This is an ACUTE inflammatory encephalopathy and fatty degenerative liver failure after a viral infection and use of salicylate T/F Reyes syndrome is a chronic liver disease caused by prolonged use of salicylates due to viral infections False - it is ACUTE, even tho it is caused by prolonged use of these drugs Which of the below is typically used to test for hepatic tumours? a) ALP b) AFP c) ALT d) NTP e) AST Which of the below is the leading cause for liver transplants? a) HCV b) HBV c) HAV d) Hepatic cancer What tests are used to generate the Model for End-Stage Liver Disease Score? INR (coag factors) Bilirubin Creatinine Ammonia levels can be tested to assess the function of a) Liver b) Kidneys c) Stomach d) Spleen What would you expect for each column? 1. Acute hep 2. Chronic hep 3. Cholestasis 4. Cancer 5. Alcohol/drugs How are amino acids broken down into their end product? Amino acids get metabolized and ammonia is a product of this. Ammonia gets broken down in the liver via the ornithine cycle. Urea travels to the kidney so it may be excreted The toxic byproduct of amino acid breakdown, _________, gets broken down in the liver in the ___________ cycle. This generates the non toxic product ________, which can be excreted by the kidneys Ammonia, ornithine, urea T/F Ammonia can be a standalone test for liver function False What are the specimen practices for ammonia? Plasma, on ICE, run ASAP, NO HEMOLYSIS, NO tourniquet Which of the below would you not expect for hemolytic disease in an adult? a) Buildup of unconjugated bilirubin in the blood b) Normal levels of conjugated bilirubin in the blood c) Elevated unconjugated bilirubin in the urine d) Normal levels of conjugated bilirubin in the urine e) You would expect all of these ** Not soluble so will not turn up in the urine Which of the below would you not expect for deficient conjugation of bilirubin/ hepatic cellular damage? a) Buildup of unconjugated bilirubin in the blood b) Buildup of conjugated bilirubin in the blood c) Low levels of conjugated bilirubin in the urine d) No unconjugated bilirubin in the urine *** conversion is not happening so you would not get increased levels Which of the below would you not expect for a post-hepatic blockage? a) Normal levels of unconjugated bilirubin in the blood b) High levels of conjugated bilirubin in the blood c) No urobilinogen in the blood or urine d) Low levels of conjugated bilirubin in the blood **conversion is happening just getting stuck and built up If your patient had white chalky feces, what would you anticipate is happening? (explain why) a) Adult hemolytic disease b) Hepatic cellular damage c) Deficient conjugation d) Post hepatic blockage If there is a blockage, no conjugated bilirubin is making it to the intestine, therefore it is not converted into urobilin which colours the stool brown What does the caffiene reagent do in the Diazo method for total bilirubin? This converts your unconjugated bilirubin to conjugated bilirubin so that all of it can react with the Diazo reagent Which of the below stops the Jendrassik and Grof method? a) Diazo reagent b) Caffiene c) Ascorbic acid d) Alkaline tartrate Which of the below converts unconjugated bilirubin to conjugated in the Jendrassik and Grof method? a) Diazo reagent b) Caffeine c) Ascorbic acid d) Alkaline tartrate Which of the below converts all bilirubin to azobilirubin in the Jendrassik and Grof method? a) Diazo reagent b) Caffeine c) Ascorbic acid d) Alkaline tartrate