Biochemical Profile 3 Flashcards
where is most alkaline phosphatase found?
liver bone biliary tract epithelium placenta interstital mucosa
ALP is importnat for what?
detecting liver and bone disorders
alkaline phosphatase is increased in?
intrahepatic and extrahepatic obstructions biliary disease cirrhosis tumors hepatitis liver mets
elevated ALP in the bone is associated with?
new bone growth (increased osteoblastic activity)
alkaline phosphatase is high in?
adolescents
pathological new bone growth (metastasis, paget’s, bone disease, healing fracutres)
HPT
alkaline phosphatase is decreased in
hypothyroidism
pernicious anemia
if you have anxray with accentuated trabeculation, what tests might you need to run?
baseline alkaline phosphatase test
bone scan
xray hot spots
what do people with paget’s need?
an MRI to see if the basilar invagination is affecting them
if you saw one large blob on an xray, what are the ddx?
bone island
blastic mets
fibrous dysplasia
chondrocalcinosis etiologies
3 Cs
cartilage degeneration
crystal deposition (primary CPPD, gout)
cation disease (hemochromatosis, hyperparathyroidism, Wilson’s disease)
if you had an 11 year old girl with a circular density near the epiphyseal part of the bone, what are the ddx? what labs would you want to perform?
osteosarcoma, bone island
alkaline phosphatase
acid phosphatase is normally found in?
liver
RBCs
platelets
bone marrow
highest levels of acid phosphatase are in?
prostate gland
elevated levels of acid phosphatase from the prostate indicate?
prostate cancer that has metastasized beyond the prostate capsule to toehr part of the body (bone)
can also be seen in multiple myeloma, benign prostatic hypertrophy, recent prostate examination
describe prostate specific antigen
glycoprotein
detected in all males
elevated levels are seen in prostate cancer
PSA levels are elevated in?
benign prostatic hypertorphy
prostatitis
between 4 and 10 ng/mL is suspicious
a high jump in PSA is a good indicator of PSA
PSA velocity
change in PSA level over time
PAP and PSA
markedly elevated with elevated alkaline phosphatase indicates prostate cancer with metastasis to bone
LDH
total not specific indicator for any one disease
disease affects cells that contain LDH, the cell lyse and release LDH
GGTP
highest concentrations in liver and biliary tract
lesser concentration in kidneys, spleen, heart
detects liver cell dysfunction
GGTP is not elevated in?
bone disease
elevated GGTP and ALP indicates
hepatobiliary disease
GGTP is sensitivie for?
chronic alcohol ingestion and is the most sensitivie for alcohol induced liver disease
AST/SGOT
used for suspected coconary occlusive heart disease or
suspected hepatocellular disease
which is more sensitivie for heart? liver?
heart: AST/SGOT
liver: ALT/SGPT
liver panel
ADT/SGOT (heart) ALT/SGPT (liver) Alkaline phosphatase (liver and bone) GGTP (liver) protein (liver) bilirubin BUN elevated (kidney) BUN decreased (liver) UA would also be helpful
calcium
99% in bone and involved with neurotransmission an dmuscular contraction
phosphorous
80-85% in bone
magnesium
50-60% in bone
cofactor for enzymes
activator for some enzymes
neurotransmission and muscular contraction
hypercalcemia
muscle weakness disorientation seen with skeletal metastasis HPT multiple myeloma hyperthyroidism renal transplant
hypocalcemia
tetany hypoalbuminemia (alcoholics) renal failure vitamin D deficiency hypoparathyroidism
most common cause of hypercalcemia, second?
MC: primary hyperparathyroidism
2nd MC malignancy
S/S of hypercalcemia
constipation nausea loss of appetite extreme thirst dehydration tired weak sleepy confused coma
xray finding for HPT?
aco-osteolysis
primary HPT
most common type parathyroid adenoma in 90% carcinoma, hyperplasia, ectopic PTH producing tumors elevated parathormone levels hypercalcemia hypophosphatemia
secondary HPT
complication of chronic renal disease
persistent loss of calcium and phosphorous
stimulates PTH release (calcium low to normal)
hyperphosphatemia (kidneys can’t extrete it as well)
tertiary HPT
dialysis patients
parathyroid gland acts independent of serum calcium levels
high PTH and calcium
s/s of HPT
30-50 women bone pain fractures weakenss lethargy polydipsia polyuria muscle weakness hypotonia renal stones pancreatitis elevated alkaline phosphatatse elevated PTH hypercalcemia in primary normal to low calcium in secondary
parathormone
stimulates osteoclasts, which reabsorb bone and release calcium and phosphorous ion into the blood stream
increases calcium absorption through small intestine
radiologic findings associated with HPT
osteopenia subperiosteal resorption distal tuft resorption accentuated trabeculation brown tumors loss of cortical definition soft tissue calcification dystrophic, physiological calcification
what is the most definitive radiographic sign of HPT?
subperiosteal resorption
where might you see subperiosteal resorption
radial margins of middle and proximal phalanges of the 2nd and 3rd digits
widened joint spaces and osteolysis
AC and SI joints
symphysis pubis
what spinal radiographic changes do you see in people with HPT?
rugger jersey spine
salt and pepper skull
you see wide, irregular pubic symphysis. DDX? labs?
HPT, infection
CBC, biochemical profile
if you see soft tissue calcification, what is the DDX?
diabetes
HPT (secondary>primary)
hyperphosphatemia
renal failure hypoparathyroidism excess vit. D bone mets myeloma cell destruction
hypophosphatemia
decreased intestinal absorption
increased renal extretion
HPT
bone panel
calcium phosphorus alkaline phosphatase uric acid total proteins A/G ratio serology CBC/ESR/CRP (men only) acid phosphatase, PSA
hypermagnesemia
dehydration
renal insufficiency
uncontrolled diabetes
hypomagnesemia
malabsorption malnutrition alcoholism cirrhosis tetany muscle weakness cardiac arrhythemias
