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AP0411 > Clinical Chemistry > Flashcards

Clinical Chemistry Flashcards

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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
How is the Oral Glucose Tolerance Test carried out?
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
26
How do diabetes test strips monitor blood glucose levels?
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
27
How does HbA1c work?
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
28
Outline the gross anatomy of the kidneys
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
29
Outline renal function
Produce urine: Filter glomerulus Reabsorbtion Secretion
30
What are the 3 major types kidney functions?
1. Homeostasis 2. Excretion 3. Synthetic
31
What is GFR?
Glomerular Filtration rate Amount of filtrate the kidneys produce each minute
32
What is the average GFR in healthy kidneys?
100-125 ml/min
33
What 3 things does the kidney synthesise?
1. Synthesis of vitamins D 2. Synthesis of renin 3. Synthesis of erythropoietin
34
What does the production of Renin by the kidneys do?
Maintains blood pressure
35
What id the importance and function of erythropoietin?
Erythropoietin is essential to the production of red blood cells The hormone acts upon bone marrow to signal the production of RBC’s
36
What is the importance of water in the body?
Acts as a coolant and solvent Needed for transport and physically pushing osmotic gradients
37
What is the importance of sodium?
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
How is water homeostasis maintained?
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
What effect does ADH have on distal collecting tubules and collecting ducts?
Causes them to be more permeable, so more water can be reabsorbed so a smaller amount of urine is collected for excretion
40
What is the function of aldosterone?
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
Which waste products does the kidney excrete?
Urea- from toxic ammonia Uric cid- from Nucleic acid catabolism Creatine- from muscle metabolism
42
What is chronic renal failure?
Slow progressive loss of renal function Causes inflammation of the glomerulus and inflammation of the renal pelvis
43
What is acute renal failure?
Sudden loss of renal function- within a few hours/ days Cause by kidney tones, UTI’s, Calculi or Prostitis
44
What is the oliguric phase of ARF?
When nothing is filtered= low urine volume Tubules are ok, so there’s a rapid increase of urea and creatine in the blood
45
What is the polyuric phase of ARF?
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
Why is urine analysed?
No interference form proteins or RBC’s
47
What are the 3 types of urinalysis?
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
What can you analyse in urine?
1. Colour 2. Turbidity 3. Volume 4. Odour
49
Define proteinuria
Excessive protein excretion in the urine Sig not glomerular/ tubular disease
50
What is haematuria and what is it caused by?
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
Why hare biochemical markers used for assessing kidney function?
They allow for: 1. Accurate diagnosis 2. Asessing risk 3. Adopting therapy
52
What are biomarkers?
"a characteristic that is objectively measured and evaluated as an indicator of normal biological, pathologic processes, or pharmacologic responses to a therapeutic intervention”
53
What is creatine?
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
What is the scrum Creatine reference range in the UK?
Male- 59-104umol/l Female- 45-84 umol/l
55
What is the normal creatine clearance value in the UK?
Male- 110-150 ml/min Femal- 100-130 ml/min
56
Why way creatine levels be elevated?
Muscular dystrophy Paralysis Anaemia Leukaemia
57
Why way creatine levels be decreased?
Glomerulonephritis Congestive heart failure Acute tubular necrosis Shock Polcystic kidney disease
58
What is urea?
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
Why is blood urea nitrogen (BUN) tested?
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
What is renal clearance?
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
How is clearance calculated?
Clearance= Urine conc x Urine volume excreted per min/ Plasma concentration
62
Give the Cockcroft- guilt equation that calculates GFR without urine
(140-age) x weight x 1.23(male) or 0.85 (female)/ serum creatine concentration (micromol/L)
63
List the biological functions of lipids
Rich energy source Structural components of cell memebrane Essential for fat soluble vitamains Maintain body temp Absorb shock
64
List the fat soluble vitamins
A D K
65
What are the different types of lipid?
Fatty acids- saturated/ unsaturated Glycerides Complex lipids Nonglycerde lipids- sphingolipids/ steroids
66
Give the 3 roles of fatty acids in the body
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
What is the difference between saturated and unsaturated fatty acids?
Saturated have no double bonds, whereas unsaturated fatty acids do The double bonds lower meting temp
68
What are Eicosanoids?
3 groups of structurally related compounds They produce 3 bioactive lipids: Prostaglandins Leukotrienes Thromboxanes
69
What is the function of Eicosanoids?
Blood clotting Inflammatory response Reproductive system- stimulate smooth muscle
70
How are triglycerides formed?
Formation of ester bonds between a glycerol and 3 fatty acids
71
What are the steroid class of lipids?
Cholesterol Linked to CVD Important in lipid digestion
72
What are the complex lipids?
Lipoproteins- molecular complexes found in blood plasma that contain a neutral lipid core of cholesterol and/ triocide glycerols
73
What are the major classes of lipoproteins and what do they transport?
Chylomicrons- transport intestine to adipose VLDL- transport lipids to tissues LDL- carry cholesterol to tissues HDL- scavenge cholesterol esters
74
List the common lipid disorder stat lead to atherosclerosis (narrowed arteries)
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
Give the “good” levels of total, LDL and HDL cholesterol
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
Give some wider impact of elevated lipid levels
Renal impairment Cognition Cardiovascular disease Sensory neuropathy Erectile dysfunction
77
What is Xanthelasmas?
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
What is Lipemia retinalis?
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
What is Tendon xanthomas?
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
What is Tuberous?
Common lipid disorder Range from pea-sized to lemon-sized and can be seen in dysbetalipoproteinemia and FH
81
List the 4 function of apolipoproteins
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
Describe the structure of apolipoprotein
Group of plasma proteins associated with variety of diseases
83
What 3 things can be down to manage the risk of CVD?
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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