Chemical Pathology Flashcards
1
Q
What is the normal resting tone of the lower oesophageal sphincter?
A
15- 24mmHg
2
Q
The relaxation of the lower oesophageal sphincter immediately after swallowing is mediated by what ?
A
VIP and NO with myenteric plexus
3
Q
Fill in the blanks. “During swallowing relaxation occurs _____ of bolus while contraction is _______ bolus.”
A
Relaxation occurs INFRONT bolus while contraction occurs BEHIND bolus.
4
Q
What is Dysphagia?
A
It is difficulty swallowing
5
Q
What is Odynophagia?
A
This is painful swallowing
6
Q
What are the classifications of dysphagia based on their etiolgoy?
A
Mechanical : obstruction in lumen, wall or compression from outside.
Functional
7
Q
What are some mechanical causes of dysphasia ?
A
- Strictures
- Malignancy: primary, secondary
- Webs
- Diverticulum
- Atresia
8
Q
What are some functional causes of dysphagia?
A
- Esophageal motility disorders:Achalasia, esophageal spasm
- Poor function post CVAs
9
Q
What is Achalasia?
A
Achalasia is characterized by the triad of incomplete lower esophageal sphincter (LES) relaxation, increased LES tone, and esophageal aperistalsis.
10
Q
What is the pathophysiology associated with achalasia ?
A
- Loss of NO, VIP secreting interneurons in myenteric plexus.
- This creates an imbalance between excitatory and inhibitory stimulation.
- Result is a contracted LES that fails to relax on swallowing
11
Q
What type of cells present first during Achalasia?
A
Cytotoxic T-cells, eosinophils, mast cells
12
Q
What are the two types of Achalsia?
A
Primary and Secondary
13
Q
Which type pf Achalasia is associated with Chagas disease (trypanosoma cruzi protozoa) and Psudoachalasia from malignant infiltration into LES?
A
Secondary type
14
Q
Fill in he blanks. “Primary Achalasia is normally ________.”
A
Idiopathic - but can be related to Hereditary, Autoimmune & Viral infections.
15
Q
What are the symptoms of Achalasia?
A
- Dysphagia (most common)
- Regurgitation of undigested foods (80%) * Chest pain (25-50%)
- Aspiration (wheezing, cough, pneumonia)
- Weight loss ..not usually severe
16
Q
What are the findings of Achlasia during Barium Swallow study?
A
A” bird beak “appearance
17
Q
What is the gold standard used for the diagnosis of Achlasia?
A
Manometry
18
Q
What are drugs given to treat achalasia?
A
- Nitrates
- Ca channel blockers
- Sildenafil
19
Q
True or False? Achalsia is as a result of
Loss of NO, VIP secreting interneurons in Meissener’s plexus.
A
FALSE!! It is a loss of NO, VIP in the MYENTERIC PLEXUS!
20
Q
What is the most effective treatment for Achlasia?
A
Surgery - Modified single anterior myotomy , Ernest Heller 1913
21
Q
What do TRUE liver function tests indicate?
A
It provides assessment of functional hepatic cell activity – non routine.
22
Q
What do ROUTINE liver function tests indicate?
A
Routine LFTs indicate nature of disease but less often a specific diagnosis.
23
Q
What are the functions of Liver Function tests?
A
- Detect the presence of liver disease,
- Distinguish among different types of liver disorders, eg - differentiating between acute viral hepatitis, various cholestatic disorders and chronic liver disease,
- Assess the severity and predict the outcome.
4.Follow up/monitoring – evaluate response to therapy.
24
Q
Which enzymes are biomarkers for liver injury?
A
Transaminases: Alanine and aspartate aminotransferase (ALT & AST respectively).
25
True or False? Albumin is used to test for the excretory function of the liver while Direct and total bilirubin is used to indicate synthetic function.
FALSE!! Excretion: Direct and total bilirubin.
Synthetic function: Albumin.
25
Which enzymes indicates diseases linked to biliary tract?
Alkaline phosphatase (ALP)
Gamma glutamyl transferase (GGT)
5’-nucleotidase.
26
True or False? Serum bilirubin is a True test of liver function.
TRUE!!
27
What is the normal serum bilirubin levels?
< 18 mol/L ( conjugated )
< 6 mol/L ( unconjugated)
28
How is Indirect Bilirubin Calculated?
Indirect bilirubin = Total Bilirubin - Direct Bilirubin
29
True or False? Conjugated bilirubin is Water soluble, so it is excreted by kidneys while Unconjugated - insoluble in water, bound to albumin in blood.
TRUE!!
30
Fill in the blanks. " __________ is the yellow breakdown product of normal haem catabolism."
Bilirubin
31
What is the name of the enzyme that converts haem to biliverdin?
Haemolytic Oxygenase
32
What is the enzyme that reduces biliverdin to unconjugated bilirubin?
Biliverdin reductase.
Duhh must be a reductase if its gonna reduce
33
Fill in the blanks. "Unconjugated bilirubin circulates in plasma bound tightly but reversibly to ________."
Albumin
34
What is the name of the structure that carries bilirubin from cytosol into the smooth endoplasmic reticulum of the hepatocytes?
Ligandin
35
In the liver, where does the unconjugated bilirubin disassociate from albumin?
At the sinusoidal surface of the hepatocyte.
36
By what process is the unconjugated bilirubin after being disassociated by albumin taken up by the hepatocytes?
Facilitated diffusion that requires inorganic anions, such as Cl-.
37
What are examples of Haem proteins?
Catalase
Perioxidase
Cytochromes
Myoglobin
Tryptophan pyrrolase
38
In what part of the hepatocyte, is bilirubin conjugated with glucoronic acid?
Smooth Endomplasmic Reticulum
39
What is the rate-limiting step in bilirubin metabolism?
Secretion of conjugated bilirubin into the bile canaliculi.
40
What happens to conjugated bilirubin in the GI tract?
Conjugated bilirubin is degraded by bacterial action (bacterial proteases) mainly in the colon, to urobiligen( colourless )
Urobiligen is then further metabolised to stercobiligen and further OXIDIZED to stercobilin in large intestines.This gives faeces its brown colour.
41
What is the name of the process in which A small amount of urobilinogen (10%) is reabsorbed by the intestines (terminal ileum) and reaches the liver by portal blood supply and is then resecreted by the liver into the small intestine?
Enterohepatic circulation
42
What is the name of the substance that gives urine its yellow/straw colour?
Urobilin
43
What is the name of the substance that gives faeces its brown colour?
Stercobilin
44
What percentage of reabsorbed urobilinogen is transported by the blood to the kidneys where it is oxidized to urobilin and excreted.
ABout 5%
45
In which diseases are urobilin/urobilinogen and stercobilin are absent in urine and stool respectively. The stool will have a pale colour ( clay colour)?
Severe intrahepatic cholestasis or complete obstruction of the bile duct.
46
In what diseases , will there be urinary urobilinogen excretion increase?
In liver disease and states of increased bilirubin production.
47
What is the normal amount of serum bilirubin in the body?
Less than 18 micro -mol/L).
48
If the body's serum bilirubin exceeds about 50 micro-mol/L , what disease can be indicated?
Jaundice (Icterus)
49
What are the three types of Hyperbilirubinaemia?
Pre-hepatic/ hemolytic - pathology is occurring prior to the liver.
Hepatic/ hepatocellular - The pathology is located within the liver.
Post-Hepatic/ cholestatic- pathology is located after the conjugation of bilirubin in the liver.
50
When does Prehepatic Hyperbilirubinaemia occur?
Results from excess production of bilirubin (beyond the livers ability to conjugate it) following hemolysis
51
What can cause pre-hepatic hyperbilirubinaemia ?
1.Excess RBC lysis the result of - autoimmune disease; hemolytic disease of the newborn.
2. Structurally abnormal RBCs (sickle cell disease); or breakdown of extravasated blood.
3. Ineffective erythropoiesis
4. Bleeding into tissues
52
What are the laboratory findings of Prehepatic hyperbilirubinaemia?
1.Urine: Urobilinogen may be increased.
2. Serum: increased unconjugated (indirect) bilirubin in the blood.
" Pre hepatic - increased UNCONJUGATED"
53
True or False? Hepatic Hyperbilirubinaemia occurs as a result Impaired uptake, conjugation, or secretion of bilirubin and normally reflects a generalized liver (hepatocyte) dysfunction.
TRUE!!
54
What are the causes of Hepatic Hyperbilirubinaemia?
Acute Hepatitis
Hepatotoxicity
Alcohol Liver disease
Primary biliary cirrhosis
Gilberts’s syndrome (Low UDP-glucuronosyltransferase activity
55
What is the name of the enzyme which catalyses the production of conjugated bilirubin?
Uridine diphosphate (UDP)-glucuronosyltransferase
56
What are the laboratory findings of Hepatic Hyperbilirubinaemia?
Urine: Conjugated bilirubin; urobilinogen (x 2 ULN) variable.
Serum: increased conjugated (direct) bilirubin in the blood (due to inability to excrete).
57
Which type of Hyperbilirubinaemia is caused by an obstruction of the biliary tree?
Posthepatic Hyperbilirubinaemia
58
Fill in the blanks. "Posthepatic Hyperbilirubinaemia is characterized by ________"
Pale coloured stools (absence of fecal bilirubin or urobilin),
Dark urine (increased conjugated bilirubin )
59
Fill in the blanks. " In a complete obstruction of the biliary tree , ________ is absent from urine.
Urobilin
60
What are the most common causes of the Post- hepatic Hyperbilirubinaema ?
Gallstones in the common bile duct
Pancreatic cancer at the head of pancreas
61
Which type of Posthepatic Hyperbilirubinaemia occurs in acute hepatocellular cholestasis, cirrhosis, intrahepatic carcinoma, primary biliary cirrhosis etc?
Intrahepatic hyperbilirubinaemia
62
Which type of Posthepatic Hyperbilirubinaemia occurs occurs in gallstones, carcinoma of the head of the pancreas, carcinoma of the biliary tree, bile duct compression etc.
Extrahepatic hyperbilirubinaemia
(Extra occurs outside liver )
63
What are the laboratory findings of Posthepatic Hyperbilirubinaemia?
Urine: Dark (increased conjugated bilirubin),
Serum: increased conjugated bilirubin,
Decreased urobilinogen, in urine.
Stool colour: pale.
64
What is the test used to test serum bilirubin?
Van den Bergh test
65
In what type of hyperbilirubinaemia will give a Biphasic result when using the Van den Bergh test?
Hepatic Hyperbilirubinaemia
66
Fill in the blanks."When testing with the Van den Bergh test , Pre- hepatic hyperbilirubinaemia will give a __________ result while Post hepatic hyperbilirubinaemia will give a_________ result."
Pre- hepatic -----> Indirect Positive
Post- hepatic ------> Direct Positive
67
In which type of hyperbilirubinaemia is the AST and ALT levels very high?
Hepatic hyperbilirubinaemia
68
What are the types of bilirubin elevated in pre- hepatic , hepatic & post-hepatic bilirubinaemia?
Pre- hepatic ---- Unconjugated bilirubinaemia
Hepatic Bilirubinaemia------ Unconjugated & Conjugated bilirubunaemia
Post - Hepatic ----- Conjugated Bilirubinaemia
69
Which liver function test, tests for hepatocellular damage?
ALT & AST
70
Which liver function test, tests for cholestasis, impair conjugation or biliary construction?
Bilirubin
71
Which liver function test, tests for the synthetic function of the liver?
PT & Albumin
72
Which liver function test , tests for Cholestasis , Infiltrive disease or biliary obstruction ?
ALP
73
Which liver function test , tests for cholestasis or biliary construction ONLY?
GGT , Bile acids & 5' nucleotidase
74
Which organ has the highest AST levels?
Heart
75
Which organ has the highest ALT levels?
Liver
76
True or False? Alanine aminotransferase ALT is more specific for liver diseases than AST.
TRUE!!
77
What is the normal reference interval in serum for ALT in males?
6-21 IU/ml
78
What is the normal reference interval in serum for ALT in females?
4-17 IU/ml
79
Greater than (>1,000 IU/mL ) in ALT will indicate what?
Extensive hepatocellular damage (viral acute hepatitis, ischemic liver injury , toxin /drug induced liver injury
80
What is the normal reference interval in serum for Aspartate aminotransferase (AST )?
7 - 32 U/L
81
Where is AST found in liver cells?
In the mitochondria and cytosol of liver cells
82
Where is ALT found in the liver cells?
ONLY in the cytosol
83
True or False? In Hepatobiliary diseases, Mild hepatobiliary injury the causes the plasma membrane to be damaged while in severe hepatocellular injury the mitochondrial membrane
damaged.
TRUE!!
84
Fill in the blanks. "In relation to liver function tests, In inflammatory or infective conditions, the ____________sustains the main damage. Leakage of cytoplasmic contents causes a relatively greater increase in ______than __________.
Cytoplasmic membrane sustains main damage
Increase in plasma ALT activities than AST activities
" InfLammatory - ALT >>>> AST
85
Fill in the blanks. "In relation to liver function tests , In infiltrative disorders in which there is damage to both __________, there is a proportionately greater increase in _______ activity than ______. "
Both mitochondrial and cytoplasmic membranes
Greater increase in plasma AST than ALT
Infiltrative - AST >>> ALT
86
Where is Alkaline phosphatase (ALP) found in the liver ?
* Sinusoidal surface of hepatocytes
* The microvilli of the bile canaliculi.
87
Where is Alkaline phosphatase (ALP) produced from?
Produced by biliary epithelial cells
87
True or False? Placental isoenzyme ( isozyme of ALP) rises during the first 6 weeks of pregnancy .
FALSE!! It rises during the LAST 6 weeks of pregnancy.
87
Which isoenzyme of alkaline phosphatase rises after a fatty meal and may increase during various GI disorders?
Intestinal isozyme
88
What are the different isozymes of alkaline phosphatase?
Hepatic isozyme
Bone isozyme
Placental isozyme
Intestinal isozyme
88
Which liver function test is a marker for biliary dysfunction?
ALP
88
If the plasma ALP is usually increased to levels greater than three times ULN (Normal range, 15-105 U/L, this can be an indication of?
Obstructive cholestasis
89
Which enzyme is a microsomal enzyme in which its synthesis is induced by ethanol and anticonvulsant drugs?
Gamma - glutamyl transferase (GGT) .
90
Where is Gamma Glutamyl transferase located?
Bile canaliculi
Epithelial cells lining the bile ducts
Peripheral hepatocytes
91
True or False? In biliary obstruction, plasma GGT activity may increase before that of alkaline phosphatase.
TRUE!!
92
What are the causes of an elevated serum gammaglutamyl transferase (SGGT)?
Hepatobiliary disease
Pancreatic disease
Alcoholism
COPD
Renal failure
Diabetes
Myocardial Infarction
Drugs
93
Which specific drugs will cause an increase in Serum gammaglutamyl transferase (SGGT)?
C- Carbamazepine
P- Phenytoin
B - Barbiturates
94
What is the normal reference interval in serum for GGT ?
10-70 U/L
95
Which enzyme liver function test can be used to confirm hepatic origin of elevated ALP levels?
5’-Nucleotidase
96
What is the half life of Albumin?
20 days.
97
True or False? Albumin significantly increases in chronic liver disease ex cirrhosis.
FALSE!! Significantly decreases in chronic liver disease (e.g. cirrhosis).
98
An abnormally low content of albumin may indicate ?
Kidney disease
Malnutrition
Extensive burns
Malabsorption syndromes
99
Which liver function test is a poor indicator of acute hepatitis disease?
Serum albumin
100
Which tests are useful in determining the etiology of liver diseases ( the special tests of liver functions)?
1. Alpha-1-antitrypsin,
2. Alpha-fetoprotein,
3. Immunoglobulins,
4. Caeruloplasmin,
4. Iron and Ferritin.
101
What does elevated levels of plasma apple-fetopritein found in 75% of cases normally indicate?
Primary hepatocellular carcinoma.
102
Which immunoglobulin is increases in alcoholic liver disease?
IgA - A for alcohol
103
Which immunoglobulin is increases in Autoimmune hepatitis ( Chronic Hepatitis)?
IgG
( G comes before H - H for hepatitis)
104
Which immunoglobulin is increased in a primary biliary cirrhosis (but these changes are non-specific)?
IgM
105
Which liver function tests are useful in the diagnosis of Myocardial infarction also?
AST & GGT
106
Conditions such as Osteomalacia, rickets , Paget's disease , Pregnancy, Hyperparathyroidism will cause an increase in what enzyme?
Alkaline phosphatase ( ALP )
107
What is Hepatitis?
Hepatitis is defined by the inflammation of the liver and characterized by the presence of inflammatory cells.
108
Acute hepatitis can be characterised by ?
*No evidence of fibrosis or cirrhosis
* Normal architecture is preserved.
* May be some lobular disarray
109
What enzymes are increases as a result of cell necrosis in Acute Hepatitis?
AST & ALT
ALT>>> AST
110
What enzymes are increased as a result of swollen hepatocytes?
ALP levels (enzyme induction) and GGT.
111
What are the different forms of alcoholic liver disease?
Hepatic steatosis ( Fatty liver disease)
Alcohol hepatitis
Cirrhosis
112
How does alcohol induce alcohol hepatitis?
Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates.
113
Which enzyme is elevated in severe alcohol hepatitis?
Serum aspartate aminotransferase (AST) is typically elevated to a level of 2-6 times the upper limits of normal in severe alcoholic hepatitis.
114
What are the laboratory findings for Alcohol hepatitis?
1. Increased Transaminases AST>> ALT
2. Markedly increase GGT - enzyme induction by alcohol.
3.Elevated total bilirubin
115
What are the symptoms of Alcohol hepatitis?
Patients present with :
* Fever, Jaundice
* Painful hepatomegaly
*Absolute neutrophilic leukocytosis
* Macrocytic anaemia ( due to folate deficiency )
* Abnormal coagulation test ( Prolonged PT)
116
According to the histopathology of chronic hepatitis, Inflammatory activity confined to PORTAL areas is classified as?
Chronic persistent hepatitis
117
According to the histopathology of chronic hepatitis, inflammation that has spilled into the adjacent lobule of associated with necrosis or fibrosis, which progresses to cirrhosis and liver failure is calcified as?
Chronic Active hepatitis.
118
According to the histopathology of chronic hepatitis, Chronic lobular hepatitis is classified as?
Inflammatory activity and necrosis scattered throughout the lobule.
119
True or False? Neither hepatitis A nor hepatitis E causes chronic hepatitis.
TRUE!!
120
What specific drugs are associated with the causes of Chronic hepatitis ?
Methyldopa
Nitrofurantoin
Isoniazid
Ketoconazole
121
Which hereditary diseases are associated with causing Chronic hepatitis?
Wilson's disease & alpha 1-antitrypsin deficiency .
122
Fill in the blanks. The albumin level is _______ in Chronic Alcoholic hepatitis.
DECREASED
123
What are causes of Chronic Persistent Hepatitis include?
Causes include hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), autoimmune diseases such as lupus, alcohol, and drugs.
124
What is Cirrhosis?
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules .
125
What is the most type of Liver cancer?
Hepatocellular carcinoma
126
What are the main risk factors for hepatocellular carcinoma?
Alcoholism
Hepatitis B
Hepatitis C
Cirrhosis of liver
Haemochromatosis
Wilson's disease
Typer 2 diabetes
127
What is Wilson's disease?
Wilson's disease is an AUTOSOMAL RECESSIVE genetic disorder in which copper accumulates in tissues; this manifests as neurological or psychiatric symptoms and liver disease.
128
What is Haemochromatosis ( Bronze diabetes) ?
An autosomal recessive disease characterized by excessive iron uptake from the gut and iron deposition in the tissues which can affect many organs including the liver.
129
How can one be diagnosed with Haemochromatosis?
Measuring Plasma Iron
Total binding capacity (TIBC)
130
What is a major finding in Haemochromatosis?
Serum Ferritin is elevated
131
Which inborn errors of metabolism results in an increase in unconjugated bilirubin?
Gilbert’s syndrome & Crigler-Najjar syndrome
132
Which inborn errors of metabolism results in an increase in conjugated bilirubin?
Dubin-Johnson syndrome & Rotor’s syndrome
133
What are the two types of Crigler-Najjar syndrome?
Type I - Absolute deficiency
Type II - Partial deficiency
134
Which type of Crigler-Najjar syndrome results in kernicterus ( too much bilirubin in baby's blood causes brain damage)?
Type I - Absolute deficiency
135
Which type of Crigler-Najjar syndrome results in life-long unconjugated hyperbilirubinaemia>
Type II- Partial deficiency
136
True or False? Gilbert syndrome & Crigler-Naijjar Syndrome has no evidence of haemolysis.
TRUE!!
137
What is Dubin- Johnson syndrome?
This is an autosomal recessive disorder due to defective excretion of conjugated bilirubin, but not of bile acids, and is characterized by slightly raised plasma conjugated bilirubin levels that tend to fluctuate.
138
True or False? Gilbert Syndrome is autosomal recessive.
FALSE!! Gilbert syndrome is Autosomal Dominant
Gilbert is dominant lol
139
True or False? Crigler-Najjar Syndrome & Rotor Syndrome is autosomal recessive.
TRUE!!
140
Which in born error metabolism of the liver results in hepatomegaly and liver histology reveals a darkly pigmented liver that is black (or dark brown) on gross inspection?
Dubin -Johnson syndrome
141
What is the main symptom of Rotor Syndrome?
Non- itching jaundice
142
True or False? Rotor syndrome has many things in common with Dubin-Johnson syndrome, an exception being that the liver cells are not pigmented (normal histology and appearance).
TRUE!!
143
What is Zollinger - Ellison syndrome?
A malignant tumor that secretes gastrin, leading to increased acid production with widespread gastroduodenal ulcers.
144
What is the average circulating serum gastrin in a Fasting individual?
0 – 100 pg/mL
145
Fill in the blanks. " Maximal gastric acid secretion can be measured by ___________."
The pentagatrin test.
146
What are the causes of Acute Pancreatitis?
Excessive Alcohol Ingestion
Gallstones
Elevated trigylcerides in blood
Hypercalcaemia
147
What laboratory test can be used to determine acute pancreatitis?
Serum amylase
Serum lipase
2-hour urinary amylase
Blood glucose
Serum calcium
Trigylcerides
148
Which laboratory diagnosis is most preferred for acute pancreatitis?
Serum lipase - it is more specific and remains elevated longer than amylase after disease presentation.
149
At what time is peak hour for serum amylase in detection of acute pancreatitis?
12-72 hours
150
True or False? If the lipase level is 2 – 3 times that of amylase it is an indication of acute pancreatitis due to alcohol or gallstones.
TRUE!!
151
What are the laboratory findings of Acute Pancreatitis?
1.Serum may be lipaemic ( due to hypertriglyceridaemia).
2. There may be mild increase in bilirubin concentration (direct and total)
3.ALP (and GGT) activity in acute pancreatitis due to alcohol use.
4.Hypocalcemia is a frequent finding in acute pancreatitis. Exact mechanism of hypocalcemia in acute pancreatitis is unknown.
5. Hyperglycemia
152
What is Chronic pancreatitis characterised by?
It is a benign inflammatory process & fibrosing disorder characterized by :
1. Irreversible morphologic changes
2. Progressive & Permanent loss of exocrine & endocrine function .
153
Steatorrhea (increase in fat excretion in the stools) is noted in many conditions such as?
Exocrine pancreatic insufficiency (EPI)
Celiac disease
Tropical sprue
154
Fill in the blanks. " _________ is one of the clinical features of fat malabsorption."
Steatorrhea
155
What is the typical triad for Chronic pancreatitis?
Chronic upper abdominal pain
Malabsorption ( Stteatorrhoea & weight loss)
Calcification of Pancreas ( on AXR - abdominal x-ray or Ct)
156
What are the different investigations to detect Chronic pancreatitis?
F - Faecal elastase
A - Amylase /lipase often normal
S -Secretin stimulation test
C- CT to look for calcification
A- Abdominal X-ray to look for calcification
157
What is the gold standard test to determine Chronic pancreatitis but is rarely used?
Secretin Stimulation test
158
What is good diagnostic diagnostic test for chronic pancreatitis?
Faecal elastase
159
Where is Elastase -1 ( a protease) produced from?
Pancreatic acinar cells
160
What are the functions of Elastases?
They are protease enzymes that hydrolyses elastin among many other chemicals.
161
Fill in the blanks. "In Chronic pancreatitis there is a _________ in elastase production."
There is a REDUCTION !
162
What method should be used when testing for faecal elastase?
Immunoassay or Monoclonal ELISA.
163
In what condition , can a false positive of the fecal elastase test be given?
If the stool is watery .
'Alice lol'
164
Which test can indicate autoimmune pancreatitis?
Immunoglobulin G4 serum antibody, antinuclear antibody ,rheumatoid factor, erythrocyte sedimentation rate.
165
In Chronic pancreatitis, what happens to the parenchyma of the pancreas?
Fibrosis
Loss of acini and islets of Langherans
Formation of pancreatic stones
166
In Chronic pancreatitis, what happens to the pancreatic ducts?
There is Stenosis ( narrowing )
Presence of pancreatic stones
167
What is a widely used serum marker for pancreas cancer ?
Carbohydrate antigen19-9 ( CA 19-9)
168
What are laboratory findings for Pancreatic cancer?
Jaundice
Pain
Loss of appetite
Dark urine
Light coloured stool
Increase AST, ALT, ALP, GGT, Direct & Indirect bilirubin
169
What are the main sources of AST?
Heart
Liver
Skeletal muscle
Kidney
170
A crush injury, trauma or myopathy would cause an increase in what enzyme?
AST
171
When the AST/ALT ratio is > 1.0 but less than 2.0 the pathogenesis is most likely associated with?
Cirrhosis of the liver and chronic hepatitis
172
When the AST/ALT > 2.0 it is most likely associated with what conditions?
Alcoholic hepatitis or Hepatocellular carcinoma or Wilson's
173
What are the three enzymes that reflect Cholestasis?
ALP
GGT
5’Nucleotidase
174
Which enzyme may be raised in the case of COPD& Diabetes ?
GGT
175
Which enzyme liver function test may be used to confirm hepatic origin of elevated serum ALP?
5’-Nucleotidase
176
Fill in the blanks. " Albumin levels ____________ in the early stages of acute hepatitis ."
Remain NORMAL
177
Fill in the blanks. " Albumin levels ____________ Chronic liver diseases ex cirrhosis."
Significantly DECREASES
178
True or False? The Clinical Jaundice phase of Acute viral hepatitis occurs 1-2 weeks after onset of Prodromal phase.
TRUE!!
179
What are the forms of Alcoholic liver diseases?
Hepatic steatosis( fatty liver diseases)
Alcoholic hepatitis
Cirrhosis
180
What are the clinical features of Alcoholic Hepatitis?
Fever, Jaundice
Painful Hepatomegaly
Absolute Neutrophillic leukocytosis
Macrocytic anaemia
Prolonged PT
181
What is the Plasma gastrin concentration for patients with Zollinger- Ellison syndrome?
150- 1000
182
What are reasons for a false positive serum amylase test when trying to detect Acute pancreatitis?
Salivary gland disease & Macroamylasemia.
183
What is the peak level for Serum Amylase?
24 hours
184
True or False? Acute pancreatitis can cause Triaditis in cats.
FALSE!! Chronic pancreatitis causes this.
185
What are direct tests used to test pancreatic function?
1 ) Measurement of Bicarbonate concentration & Amylase or Trypsin activity following a test meal ( Lundh test) or the administration of Secretin and CCK
186
What are Indirect tests used to test for Pancreatic function?
Fluorescein dilaurate ( Pancreolauryl test) and p—aminobenzoic acid (PABA) test.
187
Which test is a non-invasive test of pancreatic exocrine function?
Fluorescein Dilaurate Test
188
True or False? Patients has to intubated when using Direct tests for pancreatic function.
TRUE!! They are NOT intubated in indirect tests such as Fluorescein Dilaurate Test
189
What is the best test used to investigate the ingestion of carbohydrates and its measurement of their plasma concentrations or urinary excretion?
Xylose absorption test.
190
True or False? D- Xylose is a pentose sugar that is NOT normally present in the blood?
TRUE!!
191
What is the function of the D- Xylose absorption test?
It is used to screen for malfunction of absorption and helps to differentiate intestinal malabsorption syndromes from pancreatitis.
192
Fill in the blanks. " In intestinal malabsorption syndrome there is ________ D- Xylose absorption while in pancreatitis there is _______ D-Xylose absorption."
* Reduced D-Xylose absorption in Intestinal absorption
* Normal D-Xylolse absorption in Pancreatitis
193
In what conditions is one expected to see abnormal amounts of D-xylose?
* Severe coeliac disease
* Disorders of the proximal small intestine causing malabsorption.
194
What is Lactose Intolerance?
Lactose intolerance is a condition in which people have symptoms due to the decreased ability to digest lactose, a sugar found in dairy products.
195
Fill in the blanks. " Lactose intolerance is due to a deficiency in the enzyme ______."
Lactase
196
True or False? Lactose is a monosaccharide.
FALSE!! It is a disaccharide
197
What is the function of the Hydrogen breath test?
A hydrogen breath test (or HBT) is used as a diagnostic tool for small intestine bacterial overgrowth and carbohydrate malabsorption, such as lactose, fructose, and sucrose malabsorption.
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Fill in the blanks. " During hydrogen-breath test , the hydrogen exhaled in the breath is estimated using a _________."
Gas chromatograph.
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What is a positive result of the Lactulose Small Intestine Bacterial Overgrowth (SIBO) Hydrogen test?
If the patient produces approximately 20 ppm of hydrogen and/or methane within the first 60–90 minutes (indicates bacteria in the small intestine),
200
What substance is given to patients when doing the SIBO Hydrogen Test?
Glucose,aka DEXTROSE(75–100 grams), or Lactulose (10 grams).
201
What is the gold standard used for diagnosis of Small Intestine Bacterial Overgrowth ?
Quantitative culture of jejunal aspirate
202
How often is a Hydrogen test for Lactose malabsorption taken?
Every 15, 30 or 60 minutes for two to three hours.
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What substance is given to patients who are undergoing a Hydrogen breath test for Lactose absorption ?
Lactose (duhhh ) - 20 -25 grams
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How I a positive result deterred for Lactose & Fructose malabsorption using the Hydrogen Breath test?
* If the level of hydrogen rises above 20 ppm (parts per million) over the lowest preceding value within the test period, the patient is typically diagnosed as a fructose malabsorber or Lactose malabsorber
* If the patient produces methane then the parts per million for the methane typically rises 12 ppm over the lowest preceding value to be considered positive.
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