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AP0411 > Clinical Chemistry > Flashcards

Clinical Chemistry Flashcards

1
Q

List the various forms of carbohydrates

A

Simple- mono and disaccharides
Short chains- oligosaccharides
Complex CHO’s- polysaccharides

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2
Q

List the isomers of glucose

A

Galactose- mirror image of glucose
Fructose

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3
Q

What are the 3 disaccharides that can be made using glucose

A

Maltose= 2x glucose molecules
Lactose= glucose and galactose
Sucrose= fructose and glucose

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4
Q

What is glucose and what is it used for?

A

C6h12O6
Used to make ATP
Only converted to ATP when needed as ATP cannot be stored

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5
Q

List the 5 metabolic pathways

A

1.Glycolysis
2. Gluconeogenesis
3. Glycogenolysis
4. Lipogeneis
5. Glycogenesis

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6
Q

Describe glycolysis

A

Occurs in cell cytoplasm
Conversion of glucose- pyruvate
Converts free energy- ATP
10 enzyme- catalysed reaction= 2 x ATP produced

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7
Q

Describe gluconeogenesis

A

Release of glucose into the blood
The glucose is made from non-CHO sources such as triglycerides, amino acids and lactate

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8
Q

Describe glycogenolysis

A

Breaking down of glycogen to glucose
Glycogen comes from liver and muscles

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9
Q

Describe lipogenesis

A

Making of lipids
Lipids made from excess glucose in the blood
Glucose is made into triglycerides and then adipose tissue

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10
Q

Describe glycogenesis

A

Making of glycogen from excess glucose in the blood
Glycogen then stored in liver and muscles

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11
Q

What is the main hormone that controls blood glucose?

A

Insulin

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12
Q

What is insulin?

A

Peptide hormone
Made of 2 polypeptide chains:
Alpha- 21 amino acids
Beta- 30 amino acids

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13
Q

Describe hormonal control of blood glucose after a meal

A

Blood sugar is high
So insulin is released from the Beta cells in the pancreas
This stimulates the uptake of glucose by the liver and muscles

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14
Q

What happens when blood glucose concentration is low?

A

Glucagon is release from alpha cells in the pancreas
Glycogen is converted to glucose
Glucose is released into the blood

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15
Q

Define hyperglycaemia

A

High blood glucose concentration

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16
Q

Define hypoglycaemia

A

Low blood glucose concentration

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17
Q

What does glucagon do?

A

Stimulates glycogenolyis and promotes gluconeogenesis
Reduces glucose consumption by the liver
Promotes lipolysis

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18
Q

Outline the process of hepatic glycogenesis and glycogenolysis

A
  1. Glucose enters the liver
  2. The enzyme glycogen synthase to convert the glucose to glycogen
  3. The enzyme glycogen phosphorylase converts glycogen back to glucose
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19
Q

What effect does insulin have on hepatic and adipose tissue lipogenesis

A

Hepatic- Increases the action of acetyl co enzyme A in converting glucose to fatty acids
Adipose- Increases the amount of glucose entering the adipose tissue, which increases the glycerol and fatty acids produced
Prevents the conversion of triacyglycerol back to glycerol and fatty acids

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20
Q

When is insulin released and when its release stopped?

A

Released when plasma glucose concentration gets above 4.4 mmol/L
When blood glucose concentration decreases insulin is rapidly removed

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21
Q

Describe Type I diabetes and how is it treated?

A

Tends to be early onset
Autoimmune disease, which causes the destruction of the pancreas
Beta- cels are unable to produce insulin, meaning there’s no/ little insulin present
Therefore insulin needs to e injected

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22
Q

What are some of the chronic complication of Type I diabetes?

A

Heart attack and stroke
Kidney problems
Nerve damage
Sexual problems

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23
Q

What is diabetic ketoacidosis?

A

Life threatening emergency where lack of insulin and high blood sugars lads to a build up ketones
Blood becomes highly osmotic so water leaves cells into blood and cells then become dehydrated

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24
Q

What is Type 2 diabetes and how is it treated?

A

Often late onset and secondary to obesity
Beta-cells become insensitive to insulin combined with the inability of the Beta- cells to produce appropriate quantities of insulin
Treated via lifestyle changes, exercise, hypoglycaemic drugs and blood pressure control

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25
Q

How is the Oral Glucose Tolerance Test carried out?

A

Performed in the morning, following a 12hr fast
Oral admission of 75g of glucose
In normal patients the blood glucose concentration will return back to normal after 2 hours
In diabetic patients the blood glucose conc remains high after 2 hrs

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26
Q

How do diabetes test strips monitor blood glucose levels?

A

0.5-1 ul of blood is used
Blood placed on test strip and reacts with glucose oxidase enzyme to make gluconic acid
Blood glucose meter transfers a current to the test strip
Current changes depending on he amount of gluconic acid that as been produced

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27
Q

How does HbA1c work?

A

Measures average blood glucose for the last 2-3 months because the half life is aprox 180 days
The more glucose in the blood, the more will stick to red blood cells
Non-diabetics will have a 4-5.9% glycated haemoglobin
Diabetics will have a 6.5% glycated haemoglobin

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28
Q

Outline the gross anatomy of the kidneys

A

2 kidneys
Both surrounded by perinehric fat
Lie outside the abdominal all
Each supplied by a renal artery
Use up 1/5 of cardiac output

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29
Q

Outline renal function

A

Produce urine:
Filter glomerulus
Reabsorbtion
Secretion

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30
Q

What are the 3 major types kidney functions?

A
  1. Homeostasis
  2. Excretion
  3. Synthetic
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31
Q

What is GFR?

A

Glomerular Filtration rate
Amount of filtrate the kidneys produce each minute

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32
Q

What is the average GFR in healthy kidneys?

A

100-125 ml/min

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33
Q

What 3 things does the kidney synthesise?

A
  1. Synthesis of vitamins D
  2. Synthesis of renin
  3. Synthesis of erythropoietin
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34
Q

What does the production of Renin by the kidneys do?

A

Maintains blood pressure

35
Q

What id the importance and function of erythropoietin?

A

Erythropoietin is essential to the production of red blood cells
The hormone acts upon bone marrow to signal the production of RBC’s

36
Q

What is the importance of water in the body?

A

Acts as a coolant and solvent
Needed for transport and physically pushing osmotic gradients

37
Q

What is the importance of sodium?

A

Concentration of sodium is a prime determinant of the extracellular fluid volume
Intake and excretion needs to be balanced to maintain volume and function

38
Q

How is water homeostasis maintained?

A

Antidiuretic hormone (ADH) secretion is increased following dehydration
ADH causes water reabsorption in the kidney and triggers aldosterone
Aldosterone works primarily in the colon causing the absorption of salt and water

39
Q

What effect does ADH have on distal collecting tubules and collecting ducts?

A

Causes them to be more permeable, so more water can be reabsorbed so a smaller amount of urine is collected for excretion

40
Q

What is the function of aldosterone?

A

Primary function is to act on the ate distal tubule and collecting duct, impacting Na absorption and K excretion
Also indirectly affects excretion of H+, by changing the amount of K in the lumen of the nephron
Affects blood pressure by regulating the amount of Na in the, inc/ dec the ECF volume

41
Q

Which waste products does the kidney excrete?

A

Urea- from toxic ammonia
Uric cid- from Nucleic acid catabolism
Creatine- from muscle metabolism

42
Q

What is chronic renal failure?

A

Slow progressive loss of renal function
Causes inflammation of the glomerulus and inflammation of the renal pelvis

43
Q

What is acute renal failure?

A

Sudden loss of renal function- within a few hours/ days
Cause by kidney tones, UTI’s, Calculi or Prostitis

44
Q

What is the oliguric phase of ARF?

A

When nothing is filtered= low urine volume
Tubules are ok, so there’s a rapid increase of urea and creatine in the blood

45
Q

What is the polyuric phase of ARF?

A

Glomerulus is starting to be filtered again
Tubules fail to absorb= lots of urine
Results in a rapid inc in Na and K in blood

46
Q

Why is urine analysed?

A

No interference form proteins or RBC’s

47
Q

What are the 3 types of urinalysis?

A
  1. Complete- in a lab, looks at urine composition
  2. Rapid- at the doctors, checks for common renal abnormalities
  3. 24-hr- at home, gives a clearer picture of renal function
48
Q

What can you analyse in urine?

A
  1. Colour
  2. Turbidity
  3. Volume
  4. Odour
49
Q

Define proteinuria

A

Excessive protein excretion in the urine
Sig not glomerular/ tubular disease

50
Q

What is haematuria and what is it caused by?

A

When red blood cells have been shed and end up in the urine
Usually caused by:
Infection, kidney stones, tumours in the bladder or kidney, leakage from the urinary bladder

51
Q

Why hare biochemical markers used for assessing kidney function?

A

They allow for:
1. Accurate diagnosis
2. Asessing risk
3. Adopting therapy

52
Q

What are biomarkers?

A

“a characteristic that is objectively measured and evaluated as an indicator of normal biological, pathologic processes, or pharmacologic responses to a therapeutic intervention”

53
Q

What is creatine?

A

Breakdown product of creatine phosphate in muscles
Usually produced at family constant rate by the body
Renal failure diagnosis supported when serum creatine is in the upper limit of “normal”

54
Q

What is the scrum Creatine reference range in the UK?

A

Male- 59-104umol/l
Female- 45-84 umol/l

55
Q

What is the normal creatine clearance value in the UK?

A

Male- 110-150 ml/min
Femal- 100-130 ml/min

56
Q

Why way creatine levels be elevated?

A

Muscular dystrophy
Paralysis
Anaemia
Leukaemia

57
Q

Why way creatine levels be decreased?

A

Glomerulonephritis
Congestive heart failure
Acute tubular necrosis
Shock
Polcystic kidney disease

58
Q

What is urea?

A

Major nitrogenous end product of protein and amino acid catabolism
Processed by liver and distributed throughout intracellular and extracellular fluid
Filtered out from the blood by glomeruli, partially reabsorbed with water

59
Q

Why is blood urea nitrogen (BUN) tested?

A

Most specific marker of the kidney
Inc in BUN is associated with kidney disease/ failure
High BUN levels can sometimes occur during late pregnancy or eating large amounts of protein rich foods
Higher than 1000 mg/dL= severe kidney damage
Low BUUN levels see in trauma, surgery etc

60
Q

What is renal clearance?

A

Measurement that allows the analysis of the activity of the kidney
Volume of plasma from which a substance is completely removed by the kidney in a given amount of time (usually a minute)

61
Q

How is clearance calculated?

A

Clearance= Urine conc x Urine volume excreted per min/ Plasma concentration

62
Q

Give the Cockcroft- guilt equation that calculates GFR without urine

A

(140-age) x weight x 1.23(male) or 0.85 (female)/ serum creatine concentration (micromol/L)

63
Q

List the biological functions of lipids

A

Rich energy source
Structural components of cell memebrane
Essential for fat soluble vitamains
Maintain body temp
Absorb shock

64
Q

List the fat soluble vitamins

A

A
D
K

65
Q

What are the different types of lipid?

A

Fatty acids- saturated/ unsaturated
Glycerides
Complex lipids
Nonglycerde lipids- sphingolipids/ steroids

66
Q

Give the 3 roles of fatty acids in the body

A
  1. Components of more complex membrane lipids.
  2. Major components of stored fat in the form of triglycerides.
  3. Precursors for the synthesis of bioactive lipids.
67
Q

What is the difference between saturated and unsaturated fatty acids?

A

Saturated have no double bonds, whereas unsaturated fatty acids do
The double bonds lower meting temp

68
Q

What are Eicosanoids?

A

3 groups of structurally related compounds
They produce 3 bioactive lipids:
Prostaglandins
Leukotrienes
Thromboxanes

69
Q

What is the function of Eicosanoids?

A

Blood clotting
Inflammatory response
Reproductive system- stimulate smooth muscle

70
Q

How are triglycerides formed?

A

Formation of ester bonds between a glycerol and 3 fatty acids

71
Q

What are the steroid class of lipids?

A

Cholesterol
Linked to CVD
Important in lipid digestion

72
Q

What are the complex lipids?

A

Lipoproteins- molecular complexes found in blood plasma that contain a neutral lipid core of cholesterol and/ triocide glycerols

73
Q

What are the major classes of lipoproteins and what do they transport?

A

Chylomicrons- transport intestine to adipose
VLDL- transport lipids to tissues
LDL- carry cholesterol to tissues
HDL- scavenge cholesterol esters

74
Q

List the common lipid disorder stat lead to atherosclerosis (narrowed arteries)

A

Dyslipidemia- abnormal lipoprotein levels
Hyperlipidemia- elevates blood lipid levels
Hypercholesterolemia- elevated total cholesterol (>200 mg/dL)
Hypertriglyceridemia- elevated triglyceride levels
Hyperlipoproteinemia- elevates levels of certain lipoprotein

75
Q

Give the “good” levels of total, LDL and HDL cholesterol

A

Total- below 200 mg/dL (5.2 mmol/L)
LDL- below 130 mg/dL (3.4 mmol/L)
HDL- above 40 mg/dL (1 mmol/L) in men and above 50 mg/dL (1.3 mmol/L) in women

76
Q

Give some wider impact of elevated lipid levels

A

Renal impairment
Cognition
Cardiovascular disease
Sensory neuropathy
Erectile dysfunction

77
Q

What is Xanthelasmas?

A

Common dyslipideamia disorder
Raised, yellowish macules that typically appear around the medial canthus
Involvement can extend to the eyelids or skin immediately below the eye.

78
Q

What is Lipemia retinalis?

A

A common lipid disorder
Lipemic blood causes opalescence of retinal arterioles,
This can be observed during funduscopic examination
Common in those with Type II diabetes

79
Q

What is Tendon xanthomas?

A

Common lipid disorder
When nodular deposits of cholesterol that accumulate in tissue macrophages in the Achilles and other tendons, including the extensor tendons in the hands, knees, and elbows

80
Q

What is Tuberous?

A

Common lipid disorder
Range from pea-sized to lemon-sized and can be seen in dysbetalipoproteinemia and FH

81
Q

List the 4 function of apolipoproteins

A
  1. Structural
  2. Control cellular uptake of lipoproteins through binding to memebrane receptors
  3. Guiding formation of lipoproteins
  4. Activating/ inhibiting enzymes involved in metabolism of lipoproteins
82
Q

Describe the structure of apolipoprotein

A

Group of plasma proteins associated with variety of diseases

83
Q

What 3 things can be down to manage the risk of CVD?

A
  1. Diet- inc intake of fruit and veg, replace saturated fats with complex carbs
  2. Inc physical exercise
  3. Blood pressure- risk of CVD inc as blood pressure inc

AP0411 (6 decks)

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