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What is the largest gland and most versatile organ in the body?
Liver
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What is the weight of the adult liver?
1400-1600 grams
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The liver is devided into how many major lobes?
two
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This is a branch of the aorta that supplies 20% overall blood and the majority of O2 needed.
hepatic artery
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This drains the GI tract and transports the most recently absorbed material from intestines.
portal vein
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what is the main digestive chemical synthesized by the liver?
bile
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excretion of _____ is one of the most important liver functions.
bile
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What is the total daily bile production?
- about 3 liter a day
- one liter is excreted
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during a meal what is bile secreted by?
liver cells
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where is bile stored between meals?
gall bladder
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plasma protein and all blood clotting factors are produced in the liver except which one?
factor V111
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what is metabolized to form bile acids?
cholesterol
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What is stored in the liver?
- Fat soluble vitamins (A,D,E,K)
- water soluble vitamins such as B12
- Carotene into vitamin A
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What is the group of peptides formed in the liver that mediates growth hormone.
somatomedin
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What is the most important mechanism in detoxification and drug metabolism in the liver?
Microsomal Drug Metabolism System
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This is a waste product of RBC breakdown
bilirubin
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When the heme ring from RBC destruction splits what is formed?
verdohemoglobin
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When biliverdin is reduced in the RE system what is formed?
bilirubin
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Which type of blirubin is insoluble?
unconjugated bilirubin
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When mesobilirubin is oxidized what is formed?
urobilinogen
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What are the three ways that urobilinogen is removed from the body?
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This is a yellowish pigmentation in the sclera of the eyes, skin, and mucus membrane.
jaundice
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This type of Jaundice is caused by increased RBC destruction or a larger load than the liver can handle.
prehepatic/hemolytic jaundice
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What are the three conditions associated with hemolytic (prehepatic) jaundice?
- autohemolytic anemia
- HDN
- incompatible transfusion
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What are the laboratory findings of hemolytic (prehepatic) jaundice.
- increased unconjugated bilirubin
- increased urobilinogen
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This type of jaundice is caused by a conjugation failure, bilirubin transport disruption, or general hepatic damage.
hepatic jaundice
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What are the laboratory findings associated with hepatic jaundice?
- increased conjugated/unconjugated bilirubin
- increased or normal urobilinogen
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This type of jaundice is caused by obstruction of common bile duct.
post hepatic (obstructive) jaundice
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what are the laboratory findings of Post hepatic (obstructive) jaundice.
- increased conjugated bilirubin
- urobilinogen in urine will be decreased or 0.
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These are typically very large proteins that react with one or only a few types of molecules.
enzymes
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This enzyme structure shows the specific amino acid sequence.
primary structure
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This enzyme structure shows the stearic arrangement of chains.
secondary structure
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This enzyme structure shows the 3-D configuration.
tertiary structure
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This enzyme structure contains >1 polypeptide chain
quaternary
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What is the naming of enzymes based on?
- what it reacts with
- how it reacts
- add -ase ending
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This organization created a standardized classification of naming enzymes in 1961.
international union of biochemistry (IUB)
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This model, created by Emil Fisher, assumes that an enzyme active site will only accept a specific substrate.
Lock and key model
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This model recognizes that there is much flexibility in an enzyme's structure. according to the model, an enzyme is able to conform to a substrate.
induced fit model
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This is the site where the reaction actually occurs.
catalytic site
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This is the area that holds substrate in proper place.
binding site
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these are molecules that react with specific enzymes
substrates
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When substrate concentration is lower than the enzyme, substrate readily binds to the enzyme, binding increases as more substrate is added. This is called what?
first-order kinetics
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Once substrate concentration reaches a point of maximum enzyme activity (saturation), the rate of reaction becomes dependent upon enzyme concentration.
zero-order kinetics
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How does changes in pH and temp affect enzyme reactions?
it causes denaturation
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most enzymatic reactions occur at a pH of what?
7-8
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what is the optimum temp for most enzymatic reactions?
37oC
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Enzyme concentrations are usually expressed in what?
units per liter (IU/L)
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The standardized reporting unit in which the amount of enzyme that will catalyze a reaction of one micromole of substrate per minute is known as what?
international unit
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This enzyme is found in skeletal muscles, heart, and brain, increased levels are often used to detect disorders of muscle and cardiac tissues, sucha as AMI.
creatine kinase (CK)
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This is the brain type of CK that migrates fastest in an electric field.
CK-BB
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This hybrid type of CK migrates second furthest and is elevated in AMI and serious muscle disorders.
CK-MB
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This is the muscle type of CK that doesnt migrate but is elevated in AMI and muscle disorders.
CK-MM
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This enzyme is found in the heart, liver, skeletal muscles, kidneys, and erythrocytes, increased levels indicate cardiac disorders, but the highest levels are seen in pernicious anemia.
Lactate Dehydrogenase (LD)
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Elevataions of this enzyme are limited mainly to hepatocellular disorders and muscular dystrophies. It is not useful in the diagnosis of AMI.
Aspartate aminotransferase (AST)
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Highest concentrations of this enzyme are found in the liver and is elevated in hepatic disorders.
ALT
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activity of this enzyme in bones is confined to osteoblasts
ALP
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clinical significance of this enzyme is predominant in obstructive conditons, and durring pregnacy especially in preeclampsia, eclampsia, and threatened abortion.
ALP
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This enzyme has the same function as ALP but at an acidic pH, it's richest source is the prostate.
acid phosphatase (ACP)
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This enzyme is used in the diagnosis of prostatic carcinomas.
ACP
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This enzyme is an excellent indicator for chronic alcoholism, and is useful in monitoring the effects fo abstention from alcohol.
GGT
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This enzyme catalyzes the breakdown of starch and glycogen and is found in the pancreas and salivary gland.
Amylase (AMS)
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This enzyme is used to diagnose acute pancreatitis but is also elevated in mumps.
amylase (AMS)
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This enzyme is used in the breakdown of fats, is found in the pancreas, and elevated in the diagnosis of acute pancreatitis
lipase
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deficiency of this enzyme leads to drug-induced hemolytic anemias
G6PD
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These are the two methods of spectrophotometry bilirubin testing.
- evelyn-malloy
- jendrassik-grof
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This method of bilirubin testing uses caffine.
jendrassik-groff
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Bilirubin tests should be protected from _________.
light
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what is the normal ranges for adult bilirubin.
conjugated (direct):
Unconjugated (indirect):
total bili:
- conjugated: 0.0-0.2 mg/dL
- unconjugated: 0.2-0.8 mg/dL
- Total: 0.2-1.0 mg/dL
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what is the reference ranges for premature total bilirubin
24hr:
48hr:
3-5days:
24hr: 1-6mg/dL 48hr: 6-8mg/dL 3-5 days:10-12 mg/dL
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what is the reference range for full term total bilirubin.
24 hr:
48 hr:
3-5 days:
- 24 hr: 2-6mg/dL
- 48 hr: 6-7 mg/dL
- 3-5 days: 4-6 mg/dL
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what is the reference range for total CK
male:
female:
- male: 15-160 U/L (37oC)
- Female: 15-130 U/L (37oC)
-
what are the normal ranges for CK-MB
<6% of total CK
-
What is the reference range of total serum LD
100-225 u/L (37oC)
-
what is then normal range for serum AST
5-30 U/L
-
what is the reference range for serum ALT
6-37%
-
what is the reference range for prostatic ACP.
0-3.5 ng/ml
-
what is the reference range for GGT.
Males:
Females:
- Males: 6-45 U/L
- Females: 5-30 U/L
-
what is the reference range for AMS
Serum:
Urines:
- Serum: 25-130 U/L
- Urine: 1-15 units/hr
-
what is the reference range for serum LPS.
0-1.0 U/mL
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What is the enzyme testing method that uses first or zero order kinetics.
fixed
-
what is the enzymatic testing method that measures reactions at specific times in intervals.
continuous
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______ affects most enzyme testings
hemolysis
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measurements of ______ LD is usually not diagnostically helpful.
total
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what are the most frequently used enzyme for diagnosing/monitoring AMI.
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