Chemical pathology of GERR Flashcards
What is CSF used to test for?
Meningitis
What is a lavage test?
doctor puts fluid into body and then sucks it out and fluid will contain some of what’s in the organ (usually lungs)
What are some of the common sample types?
- blood
- urine
- CSF
- Faces
- Sputum
- Saliva
- Pus
- pleural, ascites or synovial fluid
- semen
What colours are used for blood samples?
yellow - U&E contains gel to make blood clot
purple - used to stop clotting as contains potassium EDTA (anti-coagulant) used for anaemia and high WBC count
What are the three types of blood samples?
- whole blood with anticoagulant (purple)
- blood with anticoagulant that is centrifuged to get plasma layer, Buffy coat and then RBC layer
- blood without anticoagulant which forms serum layer and then clotted blood layer (Yellow)
What is the difference between serum and plasma?
clotting has happened in serum so plasma contains clotting factors still whereas in serum clotting factors used up
What order do the blood sample containers need to be filled in?
Yellow first
orange/red
purple
What does chloride show?
- tracks sodium so should be high when sodium high
- can be low in vomiting as getting rid of lots of HCl
What does CO2 show?
- almost all CO2 in form of bicarbonate but is measure of all CO2
- bicarbonate main blood buffer so if CO2 off then acid-base abnormality may be present
- low = metabolic acidosis can happen in diabetes
What does urea and creatinine show?
- urea = end point of metabolism, high if GI bleeding, dehydration or kidney failure
- creatinine = waste product of muscle metabolism, higher if more muscle and large risk indicative of acute kidney injury (as excreted by kidney)
What does eGFR show?
- calculated using CKD-EPI equation which uses age, gender and creatinine
- measure of kidney function (low eGFR if failing)
How is chronic kidney disease graded?
eGFR and concentration of albumin in the urine (higher the albumin the worse kidney disease is)
Why does high albumin/creatinine ratio indicate kidney disease?
albumin isn’t meant to be excreted in the urine so the more is being excreted the worse kidney functioning is
What does hypernatraemia show?
- severe dehydration usually in elderly and rehabilitated who struggle to ask for water
- diabetes insipidus as get problem with ADH
Why can hyponatremia be fatal?
- osmolality of brain and blood should be equal
- low sodium in blood means low osmolality
- fluid starts moving into brain to lower brain osmolality causing brain to swell
- swelling can impinge on foramen magnum which contains vital structure in brainstem which stop breathing
What can low potassium show?
- either caused by too little potassium going into body, too much shift from blood into cells or too much being excreted
- e.g. malnutrition, alkalosis and hyperaldosteronism (aldosterone increases K excretion)
What can hyperkalaemia show?
- can also be fatal
- can cause abnormal heart rhythm
- again can be caused by too much in, not enough being moved into cells for storage or too little out
- e.g. acidosis, tissue damage (rhabdomyolysis), (too little K leaving:) kidney failure, hypoadosteronims and ACE-inhibitors, ARBs and diuretics
How is hyperkalaemia treated?
- protect heart by giving calcium
- give insulin and salbutamol to force K into cells
- give glucose to prevent hypoglycaemia
How is hypernatraemia treated?
- first check serum osmolality to ensure don’t have pseudohypernatremia
- if low must treat based on causes
- check hydration level to find cause
- can administer hypotonic saline in emergencies if developing cerebral oedema
What do dipsticks test for?
- Leukocytes (UTI)
- Nitrites (UTI)
- Urobilinogens (jaundice)
- Proteins (kidney damage)
- PH
- Blood (kidney stone/tumour)
- S.G-specific gravity (conc urine)
- ketones (diabetes or starving)
- Bilirubin (jaundice)
- glucose (diabetes)
What is checked for in LFTs?
- bilirubin
- ALP
- AST
- GGT
- ALT
- Albumin
How does liver profile differ between hepatitis and cholestatic liver damage?
high ALT + AST = hepatitis
high ALP + GGT = cholestatic
What can prothrombin time show?
- if prothrombin time high liver isn’t making its clotting factor
- so sign of failure
- best indicator of liver failure
What might low albumin show?
- liver has stopped manufacturing albumin
- so sign of failure
What are the causes of liver disease?
- alcohol
- Alpha-1 antitryspin deficiency
- autoimmune hepatitis
- coeliac disease
- haemochromatosis
- paracetamol poisoning
- primary biliary cirrhosis
- viral hepatitis
- Wilsons disease
What is tested for in patients with an ulcer or gastritis?
- check for H Pylori as increases ulcer and gastritis risk
What should be tested for if have acute pancreatitis?
- Amylase and lipase
What is the test for pancreatic insufficiency?
Faecal elastase
What are the markers for tumours in GI tract?
CEA (bowel) and CA19-9 (pancreatic)
Test for coeliac disease?
anti-transglutaminase antibody
What is usually tested for in the endocrine system?
Hormone levels e.g. ACTH, thyroid hormones, testosterone or GH
beware lots have diurnal changes
What are the types of endocrine tests?
baseline - measure how much hormone in blood without stimulation or suppression
dynamic - stimulate or suppress hormone production and then measure hormone
What are the common reproductive tests?
- reproductive hormones
- pregnancy testing
- semen analysis
