 function. I just needed us guys to go back into the beginning, okay, so that you would be reminded that each of the function of your liver may corresponding siya na test. So, Konoari, paano mo malalaman na, di ba Konoari, paano mo malalaman na ma-init na sa isang lugar? You would use thermometer. Paano mo malalaman na yung speed ng hangin ay malakas? You would use barometer, di ba? Paano mo naman malalaman na yung synthetic function ng liver ay tama pa? How would you know that the detoxification function is still functioning well? How would you know that the conjugation, the excretion, secretion, the storage function of your liver is still functioning well? Well, for today, we're going to discuss the assessment of your liver function and to start with, we will be going directly into measuring the conjugation function of your liver. Lagi kang bab, eto yung gusto kung batandaan ninyo, na if you're going to go back and if people would ask you, what is the most important test for your liver? What is the most important test for your liver? You would always revolve into their function. Ay kung ano yung function ng liver, yun yung ita test mo. Parang sa kidney, ang function ng kidney is to filter, to excret the waste, how would you able to know kung mo sa si liver, I.e. kidney to check its kidney function test, creatinine, uric acid, to name a few. Ganon din pagdating kay liver. So right now, okay, ganon din pagdating kay liver. Naalala ko tulay si liver. Hindi ko nakikitang kanyang perfect nakilay ng ilang araw na. So liver baka naman, okay. So moving forward, let's go to the conjugation function of your liver. Okay, when we talk about the conjugation function, we are identifying the ability of your liver to conjugate your bilirubin. Okay? To conjugate your bilirubin. So first and foremost, serum specimen should be free from hemolysis and lipemia. That's why it's actually best if you would have your fasting. Why? Because hemolysis, of course, can liberate your hemoglobin, can liberate your hem that can also pose an increase in your bilirubin levels. Right? Lipemia, bakit lipemia ay problema? Dahil magkukosya ng turbidity. Okay? Magkukosya ng turbidity. So serum should be stored in dark. Okay? Ito napaka importante nito. It should be stored in dark and should be measured ASAP or within two to three hours after collection. Question. Why is it that number two bulit is a requirement? Anyone from the class? Anyone from the class? Why do we need to measure it immediately and to protect it from direct sunlight? Vampire ka girl, ayaw mo ng sunlight. Okay? I am saying answers here. Okay? Ang sagot nila ay bilirubin is the natured by light, photosensitive. Okay? I just want to correct this. Tama yung thought pero mali yung term. The natured is not the term. It would be oxidized by light. Okay? It will be oxidized by light. That's why we need your, ayaw nga. Tama yung sabi ni Kit, photo oxidation. So we call it photo oxidation. So that's why we store it in amber colored bottles. Okay? You know, the amber colored bottles, we store your photosensitive reagents there. That's why you also have an amber colored test tube where you can put your bilirubin in it. Okay? So visible ecteria, okay? Or visible ecterisha is observed if there is greater than 20 milligrams per liter of bilirubin. Okay? 25 milligrams per liter of your bilirubin. Remember this, guys. Okay? Remember in that, in the measurement of your bilirubin, okay? We're talking about the measurement of bilirubin here, huh? In the measurement of your bilirubin, we have this thing called your accelerator. And your accelerator can be in the form of your caffeine, benzoate, or your caffeine, and your methanol, which will be discussed later on when I classify the different, the two types of methods used in bilirubin measurement. Okay? So, accelerations are used for us to be able to measure your B1. Okay? For us to measure your B1. Eto yung kwento niyan, guys. Okay? Please remember, then when measuring your bilirubin, there are only two types of bilirubin directly measured. And I want you to write this on your notes right now. Number one are your total bilirubin. And the second one is your direct bilirubin. Again, let me repeat that. Your total bilirubin and your direct bilirubin, a.k.a. B2, a.k.a. water soluble, a.k.a. fast-acting bilirubin. Nakukuhat. So, direct bilirubin lang at si total bilirubin, ang kaya mong imesure sa laboratory. Sir, papayano po ngayon si indirect bilirubin? Anyone who can explain to me how to compute the indirect bilirubin? How to compute the indirect bilirubin? Okay, anong minus? Minus? Anong minus? How? By subtracting the value of your direct bilirubin from your total bilirubin. Okay, guys, ato yung kwento noon na. I'll translate it in Tagalog para makuhan natin. When it comes to direct bilirubin, ang ginagawa natin. Sinisindingan natin kaya imesure si indirect or si B1. What we do first is to measure the direct. Si B2 muna ang minimesure ko. Bakit? Kasi siya yung directly nagre-react saan? Directly nagre-react kay diazo reagent. Okay? Diazo reagent. So, sa diazo reagent, pagdagdag ko ng diazo reagent, nagkakaronol agad ng azo or azo bilirubin. Okay? And that azo bilirubin is convert is now measured and that is now the value of your direct, your B2 bilirubin. Sir, paano po si B1 na left behind, hindi po kama yan, ganyan. Kanwari naging inartetayan ang ganoon, paano po si B1? Si B1, we will be adding your accelerators first. Accelerators such as what? Your methanol or your caffeine benzoate. Okay? Your methanol or your caffeine. So, dahil dinagdag mo ngayong si caffeine, dinagdag mo, or kung di si caffeine, si methanol, si indirect bilirubin will be converted now in the tube into your direct bilirubin. Nakukuha. It will be converted to direct bilirubin. And now we can measure your total bilirubin. Okay? We can now measure your total bilirubin. And am I clear? And everybody, am I clear? Can I just see a raise of hand if I'm clear pa so far? Ang tagal ng ora sa unfairness. Okay? So, clear tayo dun ha? Okay, thank you so much. So, bilirubin ase in general, mga kapanalik sa paniniwala is governed by a principle, a reaction which we call your Vandenberg reaction. Okay? Your Vandenberg reaction is the diazotization of your bilirubin to produce your azo bilirubin. Eto yung rason kung bakit may tinatawag tayong ngayong direct and indirect bilirubin. Why? Kasi tinawag siyang direct bilirubin. Okay? Dinawag siyang direct bilirubin. Kasi pagkadagdag ko ng diazot reagent ay amazing. Kagadagdag ko ng azo bilirub ng diazot reagent ay amazing. Nakompet ko na react agad siya. Kaya siya tinawag na direct bilirubin. E yung isa, pagkadagdag ng diazot reagent ay no reaction. Wala ng ganap. Then they realize that probably these are actually your unconjugated bilirubin. So nagdagdag sila ng caffeine, ng bilirubin, ay ng bilirubin, ng methanol, ng accelerator. That's the reason why, dagdagdag pagdagdag mo ng azo bilirubin, it will now already react. Okay? So kung makikita nyo dito, bilirubin plus your diazot sulfonylic acid, your diazot reagent plus your accelerator, perfect. That is your total bilirubin. Alright? Bilirubin plus your diazot bilirubin is equal to azo bilirubin. This is your conjugated bilirubin. This is your B2. This is your direct bilirubin. Okay? So to compute for the indirect or the unconjugated bilirubin, how do we do that? We compute it by first getting the, oh my gosh, I forgot the difference. Okay? So you get the difference between your total bilirubin and your conjugated bilirubin. Okay? So that any turn will give you your unconjugated bilirubin. Okay? Your unconjugated bilirubin. So clear tayo, mga kapanalik sa paniniwala. Are we clear? Hello? Are we clear? Kasi ito na yung, ano, ito na yung foundation ng dalawang principle. Are we clear? Can I see a race of hands, guys? If we're clear, carry? Okay. So having said that now, there are two types of bilirubin acid. These two types of bilirubin acid differ from one another sa iisang bagay lang. The accelerator that they are using. The one, the first one is the evilin and maloy, or your evilin-maloy method. Yung procedure, guys, itong nakikita niya dito sa screen, makikitingin sa screen kung sumusubukang hyon, chinachek mo yung IG mo, or chinachek mo yung message ng jawa mo. Ito to muna. Okay? Dito sa screen na to, this is the general reaction for both of the methods. Okay? Both of the methods. So in evilin-maloy, anong ganap ng mga ring evilin at ni maloy, ang accelerator nila is 50% methanol. Okay? 50% methanol and the reagents are as follows. And the final reaction is the pink to purple, pink to purple azo bilirubin. Okay? Pink to purple azo bilirubin. Methanol, pink to purple azo bilirubin, evilin and maloy. Girls at evilin kaya pink to purple ang paborito niyang kulay. Okay? Next, is your gen-drastic growth method. This is the most common method currently. Why? Because of a lot of things later that I will be mentioning. Okay? So it is the most popular technique in most of your discrete analyzer. Bakit siya mas preferred? Because it's more sensitive than your evilin-maloy, meaning to say it can measure low levels of your bilirubin. Aside from that, it is not affected by pH changes and it's not affected by hemoglobin, meaning to say if the hemolysis is within that 750 mg per dl below, siya kumparing gen-drastic growth can still measure your bilirubin accurately. Nakakukuhapo tayo, nakakukuhapo dun ha, na si... Okay, question. Tanong ko lang ha, tingan ko lang kung gano ka tindi yung mga brain powers natin right now. What carbohydrate method is not affected by your ascorbic acid and bleach? And this is considered to be the reference method for your glucose measurement. Okay, mabilis. Anong sagot? Okay, very good guys. That is your hexokinase method. Okay? That is your hexokinase method. So, gen-drastic and growth. Okay? Anong pinagkaiba mga kapanalik, ang pinagkaiba niya ay, ay pinagkaiba niya is the accelerator. Ang accelerator natin dito is your caffeine sojum benzoate. Caffeine sojum benzoate. Ano pang pinagka, ano pang importante at mahalaga sa gen-drastic growth is the presence of your, is the presence of your sojum acetate. Your sojum acetate on the other hand is what? Your sojum acetate is a type of buffer that prevents pH changes. Tama. And aside from that, you also have ascorbic acid. Your ascorbic acid terminates, terminates the initial reaction and destroy the excess diallur agent. Okay? So para walang interference sa bilirobin measurement, gen-drastic growth, meron tayo niya. Guys, I want you to remember what is the function of your caffeine benzoate, the function of your sojum acetate, pakebilogan na yan, and the function of your ascorbic acid. At dahil si Kuyang gen-drastic growth ay lalaki, so pink to blue naman siya. Pink to blue, pink to purple yung isa. Okay? So I'll just finish things up. I think I can naman. The rest that I will not be able to discuss, I will be sending it to you via video. Okay? And lahat ng liver function siguradong kasama sa finance. Okay? Next we have your bilirobinometry. Your bilirobinometry is a newer, a newer, a new generation of bilirobinometer na you just have to put it on the skin of the baby. So it involves the reflected light from the skin using two wavelengths to provide the numerical index based on the spectral reflectance. So the new generation bilirobinometers use micro spectrophotometers. So pag tinanong ko, sining gumagamit ng micro spectrophotometers, alam mo na. Okay? So moving on, so what we discussed sa bilirobin, that in itself palang is already the classificate, the test that you can use to actually identify if there's John Biss. And di ba napakahalaga nga kanina, di ba? We were able to classify which one is hepatic, prehepatic, and post-hepatic with the level of bilirobin. And ako sinasabi ko na sa inyo ganun ako magpa-exam. I would give a particular level. You would say if it is hepatic, prehepatic, post-hepatic alongside with the diseases and the hepatic like your Gilbert, Triggler, DJ, Rotor, kaya ninyo yan. Okay? So before I go and before we end, let me just continue the last part. It's the Bromsoftalene Dye Excretion Test. Okay? So what is this test for? This test is for the hepatocellular function and the potency of your bile duct. Specifically, it's excretion function. Okay? It's excretion function. There are two ways on how to do this. We can have your Rosenthal White, which is a double collection. And we also have your McDonald's Single Collection. Okay? Siguro nagotam ka. So treat yourself with McDonald's, okay? At isang Happy Meal. So your Rosenthal White are two doses. So you collect after five and 30 minutes similar to what? Ano yung two-dose sa OGTT? Ano yung two-dose sa OGTT, children? What is the two-dose in OGTT? Okay, tama. It's your X-Tone Rose. Anong pala tandaan ko doon? X-Tone Two T-T-T-T-T-WO. So X-Tone Rose for the double dose in OGTT. Okay? So we have your Rosenthal White and we have your McDonald's. So in McDonald's naman. Sir, naka-mute po ata kayo. Where? Okay. One moment. I'll just fix the problem. Pero wala pa po. Kalmalang, kalmalang. OMG. Alam yung O-304, pero good choice na dito ako sa inyo nag-record na yun. Kasi kung hindi, mauulit yung nangyari sakin sa Hima. I-recorded a lecture na naka-mute yung mic. So. There. Can you hear me now? Hello? Can you hear me now? Yes, ma'am. So I'll just try to present my screen na. So yun na, going back to what I was saying kanina. When it comes to your McDonald's, which is a single method, you just have to collect that after 45 minutes. So the purpose of this is for us to be able to identify how much of the dye is actually excreted. Dapat wala na siya sa katawan mo after 45 hours. I-45 minutes. So if it remains there, meaning to say, there is a problem with the excretion function. There is a problem in the excretion function of your liver. So aside from that, aside from excretion, aside from your brums of talan, dye excretion method, you can also do your urobilinogen. Your urobilinogen is the colorless end product after the reduction of your conjugated bilirubi, oxidation of your bacteria in your intestine, forming now your urobilin, the brown pigment on your stool. So either excreted in the urine or remember 20% or reabsorb, that's why it would now also be seen in your urine. So complete bilirubstruction would cause the absence of your urobilinogen in your stool and in your urine. Ergo, if you have a clay-colored stool, ang color ng stool mo ay parang clay, walang hindi siya brown, that is a sign of bilirubstruction. Bilirubstruction. So the specimen here should be a 2-hour freshly collected urine or stool and you would now perform the test using your early age method, using your early age method, using your P-diamethyl aminobenzaldehydro agent or your P-dab. I guess you have heard this in your AUBF, correct? Naraling ko sa AUBF yan. So this is the reference interval for your urobilinogen, okay? For your urobilinogen. So again, urobilinogen for obstruction similarly with your bromsoftalene method. Okay? Bromsoftalene method. Amazing, ha? And I expect ko magtatayin na, pero ang dami ko pang tayong. Meron pa akong 7 minutes. Dahil dyan, wait, what do you say? Okay? Ang arte, di ba? Ito pa ko lang. Wait lang ha, I cannot see your... Which one, the early age? What's the matter with the... Alin ba? Ang early age ba? Di ba EH naman talaga? Alam niyo pinakahit kung isang bagay mag-spell. So early age, EHR dapat. EHR. EHR. Okay, so moving on. Okay, sayang yung 1 minute ko. Okay, so let's go now to the measure of the detoxification. Mabilis lang naman to. When it comes to the measurement of the detoxification function. Guys, tapos na tayo sa conjugation, excretion, tapos na tayo sa detoxification. Maganda yun para mamaya yung ilidiskas ko. It's all about synthetic function nalang. Kasi yun yung mas mahaba. So in the detoxification function, this is now, when we say the detoxification, we're trying to make something toxic into less toxic substance. One toxic substance in the body is actually your ammonia. So when it comes to the detoxification, it involves enzymes and ammonia tests. So what enzymes are we going to perform? We can actually perform your ALT, AST, and even your GGT. Okay, and a lot more. But the ultimate measure of your detoxification function, makikisulap na lang ako ha, the ultimate measure of your detoxification function is the ammonia level. Okay, the ammonia level. So these enzymes are used, yung enzymes natin, balikan ko lang ng mabilis, like this one that are shown here. We have your AST, ALT, ALP, and GGT. AST, your aspartate transaminase, ALT alanine transaminase, your ALP, your alkaline phosphatase, and your GGT, which is your glutamyl transferase, damaglutamyl transferase. So those are the things that I want you to remember. So all of these enzymes, pagdating nyo sa clinic sa CC2 pagtiranong ng professor ninyo, why are we using enzymes in diagnosing disease? Okay, eto yung sagot. We are using enzymes in the diagnosis of diseases because during disease state, these enzymes are abnormally secreted by yourselves. Okay, so kanoa re, dahil nga may problema yung hepatocytes mo, lahat ng AST, ALT, GGT, ALP, pinakawalan niya sa plasma. Kaya mataas sila sa iyong blood. Okay, so in cases of cell destruction or cell injury, okay, ayan, injury to the liver result to cytosis and necrosis causes the liberation of various enzymes. And these various enzymes are your, ang dito pala, di ba, your alkaline phosphatase, your aminotransferases like your aspartate aminotransferase at near alanine. You also have your five nucleotidase, your gamma glutamyltransferase, your ornithin, your lab and your LDH. Ayan. So I think later mababangit ko pa naman yung iba dyan, especially in relation to your liver function. In relation to your liver function. But for now, ayan, let's go to your ammonia first. So it is the main test to detect if there is in kapa, in the liver is no longer in, with capability in detoxifying your, your ammonia. So your ammonia arises from the de-amination of your amino acid. Pero saan ba nangyari yung de-amination na amino acid? Darabang problema natin, but may de-amination na amino acid. De-amination of the amino acids happen in your liver. Okay. And in return, di ba, yung lalabas na NH3 dun sa amino acid mo, di ba, ang amino acid mo may COOH, alpha carbon, then the reactive group and then meron ng aminogrope. The aminogrope when removed, okay, it will now become your ammonia. Amunya is not good for your body. Because ammonia is a, um, ammonia is toxic to your brain and toxic to your kidneys, okay? So your liver normally will remove most of your non-protein nitrogenous compounds via your poor calvane circulation. Nadaan sila dun, it convert your urea, it will convert your ammonia into becoming your urea which is a less toxic waste but still a waste that needs to be eliminated from your body through your urea, okay? So this is the reference value. So I want you guys to remember that when it comes to ammonia, the specimen of choice is collected, should be collected in your green top tube that contains your heparin. Sir, lithium or sodium? Sir is your lithium heparin, okay? It is your lithium heparin. And makikisulat ng malaking bolpen, lakihan mo na, okay? With regards to ammonia, okay, with regards to ammonia, ammonia is a marker of hepatic failure, okay? It is a marker of your hepatic failure. It's already 12 noon, so let me just finish up this last two slides. So in ammonia, you can perform your keldal test, okay? You can perform keldal test. In keldal's test, what you are measuring are the number of nitrogen, okay? The number of nitrogen, you are measuring that in your keldal test. We will be mentioning that later on when I discuss, when I discuss albumin and total protein. We also have your nestlerization, okay? Hindi ito paggawa ng nestleray products. Hindi this is a reaction that invulner gumgati, okay? And the color is yellow, okay? Yellow or orange-brown kung madami sobrang daas ng ammonia. We also have your birthilox method, okay? Your birthilox method, which is for, which is the addition of your sodium nitroproside. This one naman color blue siya. Birthilot, blue. Birthilot, color blue, okay? See, nestlerization, color red, ay color yellow. Kaya nang bahalang mag-isip ko ano ang nestlerization, okay? So, and last but not the least, is your glutamate transferase, okay? Your glutamate transferase, which is an enzymatic method. The rest are all chemical methods. See, keldal, nestlerization, birthilot. The only enzymatic method in the measurement of ammonia is your glutamate dehydrogenase, okay? Your glutamate dehydrogenase. So, guys, thank you so much for listening. Thank you so much for participating in class. So, I still have my last utang with you, which is a video of the synthetic function of your liver. So, I will be ending the, I will be ending now the, I'll be ending the, what do you call this? I'll end the, ane na, I'll end the recording already. I'll end the recording to entertain some of your questions. So, do you have any questions?