Biochemical Profile 2 Flashcards
BUN
measures the amount of urea nitrogen in the blood
when is urea formed?
in the liver as an end product of protein metabolism
transported to the kidneys for excretion
BUN is related to?
metabolic function of the liver and extratory function of the kidneys
azotemia
elevated blood levels of BUN
creatinine
only renal disorders such as glomerulonephritis, tubular necrosis, reduced renal blood flow and obstruction can elevate serum levels
creatinine is a better indicator for?
renal disease
better than BUN
when do creatinine levels rise?
they tend to rise later and indicate chronicity
what are the kidney function tests?
BUN and creatinine
uric acid
a nitrogenous compound that is a product of puine catabolism
extreted by kidney and intestinal tract(to a smaller degree)
hyperuricemia is associated with?
gout
uric acid levels may be elevated in?
gout renal disease metastasis multiple myeloma alcoholism leukemia
gout of the big toe
podagra
xray signs of gout
overhanging edge sign
swelling of soft tissues
proteins
most significant factor for osmotic pressure
keeps fluids within the vascular space
what are the proteins that make up most of the protein in the body?
albumin
globulin
protein in the blood is increased in
multiple myeloma
dehydreation
chronic infection
malignancies
protein in the blood is decreased in
liver disease
kidney disease
malabsorption
albumin
formed in the liver and makes up 60% of the total protein
what does albumin do?
helps regulate colloidal osmotic pressure and transports important blood constituents
albumin is a measure of?
liver function
albumin levels are decreased in?
liver disease
malnutrition
overhydration
inflammatory disease
albumin levels are increased in?
dehydration
how can proteins seem normal, but not?
if the albumin is low and globulins are high, then protein total can appear normal
changes in the protein ratio can be detected by?
albumin/globulin ratio
what is the normal A/G ratio?
1.0
diseases that increase total proteins (particularly globulins), thus reversing the ratio
multiple myeloma
malignancy
inflammatory disease
a reversed A/G ratio reflects?
overproduction of globulins
if someone has multiple lytic destructive changes associated with lytic mets or multple myeloma, what tests do you need to order?
CBC ESR C-RP BCP UA serum protein electrophoresis radiographs specialized imaging bone marrow biopsy
if labs suggest lytic mets, what happens next?
bone scan
MRI
biopsy
if labs suggest multiple myeloma, what happens next?
PEP of urine and blood
skeletal survey
MRI
biopsy
common tetrad of multiple myeloma
CRAB Calcium elevated Renal disease Anemia Bone lesions
lab findings for multiple myeloma
hypercalcemia hypercalciuria elevated ESR elevated protein in blood and urine M spike Rouleaux formation normocytic normochromic anemia reversed A/G ratio phosphorous normal alkaline phosphatase usually normal or low increased BUN and creatinine (kidney dysfunction) uric acid may be increased
what malignancy is purely lytic?
multiple myeloma
lytic lab results include
urine calcium levels increased
serum calcium and phosphate normal or increased
serum ALP normal or increased
normocytic normochromic anemia
blastic lab results include
serum calcium usually norma urine calcium low ALP increased acid phosphatase increased serum phosphorus variable normocytic normochromic anemia
bilirubin
mesures excretory function of the liver
describe bilirubin metabolism
breakdown of RBCs in RES
hemoglobin released from RBCs is broken down into heme and globin
heme–>bilirubin (unconjugated)
liver converts it to conjugated bilirubin
jaundice
yellow discoloration f tissue due to high levels of bilirubin
what dysfunction is it if the unconjugated bilirubin is elevated?
hepatocellular dysfunction
what dysfunction is it if the conjugated bilirubin is elevated?
liver disease
extrahepatic dysfunction
bilirubin concentrations are elevated in the blood by?
increased production, decreased conjugation
decreased secretion by the liver
blockage of bile duct
what do you do when you find elevated total bilirubin
check urine
if it is positive for bilirubin, it is direct bilirubin
need liver function tests
if bilirubin is negative, it is indirect bilirubin
means hemolysis, hematoma or Gilbert’s syndrome
bilirubin and urobilinogen in the urine for a healthy person
bilirubin- normal
urobilinogen- negative
bilirubin and urobilinogen in the urine for liver/biliary disease
biliruin- increased
urobilinogen- positive
bilirubin and urobilinogen in the urine for biliary obstruction
bilirubin- absent
urobilinogen- positive
bilirubin and urobilinogen in the urine for hemolytic anemia
bilirubin- increased
urobilinogen- negative
if there is primarily unconjugated hyperbilirubinemia, increased production could mean
hemolysis (intravascular or extravascular)
ineffective erythropoiesis
hematomas, pulmonary embolus
if there is primarily unconjugated bilirubin, decreased hepetic uptake could mean
hereditary diseases
drugs
if there is primarily unconjugated bilirubin, decreased glucouronidation coudl mean
hereditary disease (gilbert’s syndrome)
physiologic jaundice of a newborn
breast milk jaundice
severe liver disease
if there is primarily conjugated hyperbiliruinemia, and there is decreased liver excretion, it could mean
acquired disorders (hepatitis, cirrhosis, drugs and toxins) or hepatic malignancy, primary or metastatic CHF shock sepsis toxemia of pregnancy hepatic trauma intrahepatic obstruction
if there is primarily conjugated bhyperbilirubinemia, what extrahepatic biliary obstruction could this be?
congenital acquired cholecystitis choledocholithiasis tumors infection or external compression (structures, pancreatitis/tumor, parasites (ascaris)
