Liver Enzymes and Function Tests

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Questions and Answers

Which isoenzyme of alkaline phosphatase is the most heat stable?

  • Intestinal
  • Bone
  • Placental (correct)
  • Hepatic

In electrophoresis, which alkaline phosphatase isoenzyme exhibits the fastest mobility towards the anode?

  • Bone
  • Placental
  • Intestinal
  • Liver (correct)

Which of the following best describes the heat stability characteristic of the bone isoenzyme of alkaline phosphatase?

  • Intermediate labile: disappears at 56°C
  • Stable at 56°C for 30 minutes
  • Labile: disappears at 56°C (correct)
  • Stable at 65°C for 30 minutes

What is a characteristic of Regan isoenzyme?

<p>It is a carcinoplacental isoenzyme (D)</p> Signup and view all the answers

To improve the separation of liver and bone isoenzymes during electrophoresis, which substance can be added?

<p>Lectin in wheat germ (D)</p> Signup and view all the answers

What is the characteristic of the intestinal alkaline phosphatase isoenzyme in terms of heat stability?

<p>Intermediate labile (D)</p> Signup and view all the answers

In electrophoresis, which of these alkaline phosphatase isoenzymes demonstrates the slowest mobility?

<p>Intestinal (B)</p> Signup and view all the answers

What is a common source of carciono-isoenzymes?

<p>Neoplasms (C)</p> Signup and view all the answers

Which isoenzyme of alkaline phosphatase demonstrates the greatest heat stability, being able to withstand denaturation at 65°C for up to 30 minutes?

<p>Placenta (A)</p> Signup and view all the answers

During electrophoresis, which alkaline phosphatase isoenzyme migrates most anodically?

<p>Liver (B)</p> Signup and view all the answers

Which of the following isoenzymes demonstrates the most heat labile property?

<p>Bone (C)</p> Signup and view all the answers

What is the effect of phenylalanine on the activity of alkaline phosphatase isoenzymes?

<p>It inhibits the activity of the placental, Regan, Nagao and intestinal isoenzymes (B)</p> Signup and view all the answers

Which of the following is true regarding the activity of alkaline phosphatase isoenzymes in the presence of urea?

<p>Strong inhibition of bone isoenzyme (A)</p> Signup and view all the answers

In an alkaline phosphatase heat fractionation test, after 10 minutes at 56°C, which isoenzyme would show the highest relative activity?

<p>Placenta (D)</p> Signup and view all the answers

Which specific isoenzymes are directly inhibited by L-phenylalanine?

<p>Placental, Regan, and Nagao isoenzymes (A)</p> Signup and view all the answers

If an electrophoretic test is performed on a sample containing different alkaline phosphatase isoenzymes, which isoenzyme would migrate closest to the cathode?

<p>Bone (C)</p> Signup and view all the answers

In the reaction involving pyruvate and DNPH, which condition is required?

<p>Alkaline (A)</p> Signup and view all the answers

What is the relationship between the activity of the colored complex and ALT activity?

<p>Directly proportional (C)</p> Signup and view all the answers

At which wavelength is the change in absorbance of the colored complex measured?

<p>500 nm (D)</p> Signup and view all the answers

Which chemical compound is used for color development in the reactions described?

<p>2,4-DNPH (A)</p> Signup and view all the answers

What is the primary category of enzymes to which ALP belongs?

<p>Hydrolases (B)</p> Signup and view all the answers

Which of the following is a major organ primarily associated with AST/SGOT?

<p>Heart (B)</p> Signup and view all the answers

Which organ is ALT considered to be highly specific for?

<p>Liver (B)</p> Signup and view all the answers

Which of the following is NOT a specific disorder associated with ALP?

<p>Cardiac disorders (A)</p> Signup and view all the answers

What is the main role of NaOH in the described methods?

<p>Color intensifier (B)</p> Signup and view all the answers

What is the main purpose of using Reitman and Frankel method?

<p>Measure ALT or AST (B)</p> Signup and view all the answers

In which condition will G-6-PD levels decrease?

<p>Cirrhosis (A)</p> Signup and view all the answers

Which tissue does NOT contain G-6-PD?

<p>Skin (C)</p> Signup and view all the answers

What is the primary function of angiotensin-converting enzyme (ACE)?

<p>Converts angiotensin 1 into angiotensin 2 (B)</p> Signup and view all the answers

A deficiency in G-6-PD will most likely lead to which condition?

<p>Hemolysis (C)</p> Signup and view all the answers

What is a diagnostic significance of ACE?

<p>Diagnosis and monitoring of sarcoidosis (B)</p> Signup and view all the answers

Which marker is significant for detecting prostate cancer?

<p>Acid phosphatase (ACP) (A)</p> Signup and view all the answers

What role does alkaline phosphatase (ALP) play in differentiating liver and bone problems?

<p>ALP can be used to differentiate between liver problems and bone issues (B)</p> Signup and view all the answers

Which band of alkaline phosphatase isoenzymes is associated with prostatic tissue?

<p>Band 1 (B1) (A)</p> Signup and view all the answers

In cholestatic disorders, which substance is expected to increase?

<p>Gamma-glutamyl transferase (GGT) (B)</p> Signup and view all the answers

What is the typical reference value range for alkaline phosphatase?

<p>0-1.6 units (D)</p> Signup and view all the answers

Which isoenzyme band is primarily found in white blood cells (granulocytes)?

<p>Band 3 (B3) (C)</p> Signup and view all the answers

What happens to ACP levels in cases of thrombocytopenia?

<p>ACP levels increase (C)</p> Signup and view all the answers

Which method was NOT mentioned for the diagnostic evaluation of alkaline phosphatase isoenzymes?

<p>Smith &amp; Johnson (C)</p> Signup and view all the answers

What is the significance of GGT elevation in patients with acute pancreatitis?

<p>GGT is also present in the pancreas, leading to elevation. (A)</p> Signup and view all the answers

Which of the following drugs is known to induce enzyme activity, leading to an increase in GGT levels?

<p>Phenytoin (B)</p> Signup and view all the answers

Why is placental ALP considered a good tumor marker for germ cell tumors?

<p>It increases in pregnancy regardless of tumor presence. (A)</p> Signup and view all the answers

What role does phosphorus play in the testing process of ALP levels?

<p>It inhibits the reaction/testing process. (B)</p> Signup and view all the answers

In which cellular structure is GGT primarily located?

<p>Smooth endoplasmic reticulum (C)</p> Signup and view all the answers

What happens to GGT levels in a patient diagnosed with diabetes mellitus?

<p>GGT levels may increase due to pancreatic injury. (B)</p> Signup and view all the answers

Which of the following methods can be used to determine GGT activity?

<p>Szass method (C)</p> Signup and view all the answers

What is the substrate used in the determination of GGT levels?

<p>Gamma-glutamyl-p-nitroanilide (C)</p> Signup and view all the answers

Flashcards

Alanine Aminotransferase (ALT)

An enzyme involved in the breakdown of amino acids, specifically converting alanine to pyruvate.

ALT Isoenzyme for Bone

A liver-specific enzyme that can also be found in bone.

Aspartate Aminotransferase (AST)

An enzyme primarily found in the heart and liver, but also present in other tissues.

AST Isoenzyme for Heart

A specific form of AST found in the heart, often used as part of cardiac marker panels.

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Alkaline Phosphatase (ALP)

A group of enzymes that catalyze the hydrolysis of various phosphate esters, including those found in bone.

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ALP Isoenzyme for Liver

A specific form of ALP found in the liver. Elevated levels can indicate liver damage or dysfunction.

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Colorimetric Reaction

A process that generates a colored complex, allowing the measurement of enzyme activity.

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Color Intensifier

A reagent used in a colorimetric reaction to intensify the color of the complex.

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Color Developer

A reagent used in a colorimetric reaction to initiate the formation of a colored complex.

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Reitman and Frankel Method

A method used to measure enzyme activity based on the colorimetric reaction.

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Alkaline Phosphatase

A type of enzyme that plays a crucial role in transporting lipids (fats) around the body.

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Isoenzymes

Variations of the same enzyme found in different tissues. They have similar functions but differ in their structure and properties.

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CarcinoPlacental Isoenzyme

An isoenzyme of Alkaline Phosphatase found in high levels during cancer. It is also present in the placenta.

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Electrophoresis

A technique used to separate molecules based on their charge and size. Different isoenzymes of Alkaline Phosphatase can be distinguished using this method.

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Mobility (Electrophoresis)

The degree to which a molecule moves towards the positive electrode (anode) during electrophoresis.

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Electrophoretic Mobility of Alkaline Phosphatase Isoenzymes

The liver isoenzyme of Alkaline Phosphatase is the fastest in electrophoresis, followed by bone, placenta, and finally intestine, which is the slowest.

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Lectin (Electrophoresis)

Lectin, a protein found in wheat germ, can be added to improve separation of the liver and bone isoenzymes during electrophoresis.

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Neuraminidase (Electrophoresis)

Neuraminidase is an enzyme that can also be used to enhance the separation of liver and bone isoenzymes during electrophoresis.

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Heat Fractionation/Stability Test

A test that uses heat to determine the stability of different alkaline phosphatase isoenzymes.

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Placental Alkaline Phosphatase

The most heat-stable alkaline phosphatase isoenzyme, resisting denaturation up to 65°C for 30 minutes.

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Intestinal Alkaline Phosphatase

An isoenzyme of alkaline phosphatase found in high concentrations in the intestines, liver, and bone. It has moderate heat stability.

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Bone Alkaline Phosphatase

The most heat-labile alkaline phosphatase isoenzyme, easily denatured by heat.

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Chemical Inhibition Test

A test that utilizes specific chemicals to inhibit the activity of alkaline phosphatase isoenzymes.

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Phenylalanine

A common inhibitor of several alkaline phosphatase isoenzymes, including placental, Regan, Nagao, and intestinal.

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Synthetic Urea

A synthetic form of urea, which specifically inhibits bone alkaline phosphatase activity.

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What is G-6-PD?

An enzyme found in red blood cells (RBCs) that helps prevent oxidative damage. It's crucial for maintaining RBC integrity.

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What happens when G-6-PD is deficient?

A deficiency in G-6-PD can lead to hemolysis, or the breakdown of red blood cells.

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Where's G-6-PD found?

This enzyme is found in various tissues throughout the body, including the liver, pancreas, and myocardium.

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What is ACE (Angiotensin-Converting Enzyme)?

An enzyme that converts angiotensin I to angiotensin II, a powerful vasoconstrictor.

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What is the diagnostic significance of ACE?

Elevated ACE levels can indicate the presence of sarcoidosis, a chronic inflammatory disease.

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GGT (Gamma-Glutamyl Transferase)

An enzyme found in liver cells, particularly in the smooth endoplasmic reticulum, involved in the transport of amino acids and peptides.

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Elevated GGT Not Indicating Liver Damage

An increase in GGT activity due to factors other than liver damage, such as enzyme-inducing drugs.

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GGT in Pancreatitis

An increase in GGT levels due to damage in the pancreas, often seen in conditions like acute pancreatitis.

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Substrate

A substance that is acted upon by an enzyme in a chemical reaction.

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ALP Inhibition by Phosphorus

The reaction of ALP can be interfered with by phosphorus, requiring careful considerations in measurement.

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Placental ALP

A specific form of alkaline phosphatase (ALP) produced by the placenta during pregnancy.

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Placental ALP as a Tumor Marker

Placental ALP is a useful indicator for detecting germ cell tumors, particularly those in the reproductive organs.

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What is 5' Nucleotidase (5'N) and why is it important?

5' Nucleotidase (5'N) is an enzyme that can be used to detect liver problems. When levels are elevated, it may indicate cholestatic disorders. It is especially helpful to identify liver issues as other enzymes can be found in other parts of the body, such as the bone.

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When does 5'N increase?

5' Nucleotidase (5'N) levels can increase in cholestatic disorders, a condition where bile flow is blocked.

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Where is Acid Phosphatase (ACP) found?

Acid Phosphatase (ACP) is an enzyme found in several different parts of the body, including prostate, bone, and platelets.

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What are the applications of Acid Phosphatase (ACP)?

Acid Phosphatase (ACP) is an enzyme found in several different parts of the body, including prostate, bone, and platelets. It is useful in detecting prostatic cancer or recurrence. ACP is also employed to help differentiate liver problems from bone issues.

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How is Acid Phosphatase (ACP) fractioned?

Acid Phosphatase (ACP) is fractioned into 5 bands: B1, B2, B3, B4, and B5. Each band is associated with a specific location.

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Where is ACP Band 1 (B1) found?

Band 1 (B1) of ACP originates in the Prostate.

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Where is ACP Band 2 (B2) found?

Band 2 (B2) of ACP is predominantly found in White Blood Cells.

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Where is ACP Band 3 (B3) found and what implication does it have?

Band 3 (B3) of ACP stems from Platelets. Elevated levels of ACP can suggest Thrombocytopenia, a condition where platelet counts are low.

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Study Notes

Liver Enzymes

  • Liver function tests measure the liver's ability to synthesize proteins and the detoxification of substances.
  • Bilirubin and urobilinogen excretion are measured to assess liver's ability to perform these tasks accurately.
  • Elevated ammonia levels indicate liver damage or dysfunction.
  • Urea conversion from ammonia neutralizes its toxicity.
  • Urea is easily excreted through the kidneys, eliminating its toxicity.
  • Liver enzymes are released during liver damage or injury to the liver.
  • Liver damage is identifiable by increased liver enzymes in the blood, indicating cytolysis and necrosis.
  • Differentiating hepatocellular (liver cell) and obstructive (blockages) liver diseases is essential.
  • ALT and AST are common liver enzymes used to assess damage to the liver.
  • GGT (gamma-glutamyl transferase) and LDH (lactate dehydrogenase) are additional liver enzymes.
  • Hepatocellular problems result in increased liver enzymes.
  • Obstructive disorders may cause minor increases in liver enzymes.

Liver Function Tests (LFTs)

  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are used to assess liver damage.
  • Alkaline phosphatase (ALP) is another enzymatic factor used for liver function assessment.

Enzyme Tests

  • ALP (alkaline phosphatase) tests for damage to liver cells and bile ducts.
  • AST (aspartate aminotransferase) assesses damage related to liver cell damage.
  • ALT (alanine aminotransferase) tests for liver damage, particularly in conditions affecting liver cells.
  • Common liver enzymes provide insights into liver damage and are helpful in obstructive diseases for diagnosis.
  • GGT (gamma-glutamyl transferase) tests for liver and bile duct damage.
  • LD (lactate dehydrogenase). LDH can assist in the detection of liver diseases, but is also found in other tissues.

Liver Function and Disease

  • Liver is a key metabolic organ, performing various functions like storage and synthesis.
  • Liver produces various proteins and enzymes, storing important nutrients.

Hepatocellular Function

  • Hepatocytes (liver cells) are crucial for liver function.
  • Hepatocellular disorders indicate damage to the liver cells, causing a range of problems.
  • The synthesis of clotting factors by the liver is assessed through tests like prothrombin time (PT) and clotting factors.

Liver Disorder Evaluation

  • Obstructive jaundice differs from hepatocellular diseases (e.g., hepatitis).
  • Elevated ALT and AST are found in hepatocellular disorders.
  • Normal or slightly elevated ALT and AST may be observed in obstructive conditions.
  • Liver function tests such as ALT, AST, and ALP may indicate dysfunction and potential problems, depending on the results.

Obstructive and Hepatocellular Disorders

  • Obstructive jaundice relates to blockages in the bile ducts.
  • Hepatocellular disorders indicate damage to the liver cells.

Liver Enzyme Isoenzymes

  • Liver enzymes have different forms (isoenzymes) that are specific to the liver and other tissues.
  • Liver isoenzymes are detected by electrophoresis and other methods.
  • Different isoenzymes are helpful in determining the location of damage or disease within the liver or other tissues.
  • Blood tests for certain isoenzymes are useful in diagnosing the specific organ affected by disease or damage.

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