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ClinLab 2: Lect 4 & 5 Flashcards

1
Q

What are the classes of plasma proteins?

A

Albumin
Globulin: A-1, A-2, B-globulin, G-globulin
Miscellaneous

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2
Q

The total protein concentration of serum from healthy ambulatory adult is between ?
How does plasma protein level differ?

A

6.3 and 8.3

Plasma- 0.3g higher

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3
Q

What is the albumin/globulin ratio?

What can cause the ratio to change?

A

0.8-2.0

Dec in response to low albumin/high globulin

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4
Q

Primary function of albumin class proteins?

A

Highest concentration (60% of total) contributes nearly 80% of colloid osmotic pressure of intravascular fluid to maintain appropriate fluid balance in tissue

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5
Q

What is the secondary function of albumin class proteins?

A

Carrier protein for bilirubin, hormones and FAs

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6
Q

In what conditions would a decreased albumin level be seen?

A

Low intake, synthesis= malnutrition or liver dz
Inc loss= nephrotic syndromee, burns
GI- protein losing enteropathy

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7
Q

Albumin levels are increased in what type of condition?

A

Dehydration

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8
Q

What is the function of pre-albumin?

A

Low concentrations that are carriers for T3/4.

When complexed with retinol binding protein, transports Vit A

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9
Q

What is the clinical significance of pre-albumin levels?

A

Sensitive marker for inadequate dietary protein intake
Dec- hepatic dz, inflammation, poor nutrition
Inc- steroid therapy, Chronic RF, alcoholism

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10
Q

What are the Alpha-1 globulins?

A

1 Antitrypsin- AAT (majority)
1 Lipoprotein- HDL
1 Fetoprotein- AFP

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11
Q

What are the Alpha-2 globulins?

A

Haptoglobin
Ceruloplasmin
Alpha 2 macroglobulin

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12
Q

Which Alpha-1 globulin is an acute phase reactant?

A

AAT

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13
Q

What is the function of AAT?

A

Protease inhibitor that neutralizes trypsin like enzymes (elastase) that can damage structural proteins

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14
Q

When/where are elastase and trypsin-like enzymes released from/during?

A

WBCs

Phagocytosis

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15
Q

What is the clinical significance of AAT?

A

Deficiency associated with severe destruction of alveolar walls/pulmonary deficiency
Increased during inflammatory disorders

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16
Q

What is the function of AFP?

When is maternal screening performed for this globulin?

A

Fetus protection

15-20wks

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17
Q

What is the clinical significance of AFP?

A

Inc during pregnancy= open neural tube defect
Dec during pregnancy= Downs
Liver/gonad cancer

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18
Q

What is the function of haptoglobin?

A

Acute phase reactant that binds free Hgb to prevent loss of Hgb and iron from kidneys

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19
Q

What is the clinical significance of haptoglobin?

A

Inc during trauma/burns to help prevent loss of Hgb from damaged RBCs
Dec in liver dz and nephrotic syndrome

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20
Q

Function of Ceruloplasmin

A

Cu containing protein w/ enzymatic activity and is an acute phase reactant

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21
Q

What is the clinical significance of Ceruloplasmin?

A

Low level in Wilson’s, liver dz, malnutrition/absorbtion

Inc in pregnancy, inflammatory disorder and oral estrogen

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22
Q

Where is Alpha-2 Macroglobulin found and what is it’s function?

A

Intravascular spaces to inhibit portease enzymes (trypsin, pepsin, plasmin)

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23
Q

What is the clinical significance of Alpha-2 Macroglobulin?

A

Elevated in renal dz, contraceptive use, pregnancy and estrogen therapy
Dec in acute inflammatory disorders and acute pancreatitis

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24
Q

What are the Beta-Globulins?

A 
Transferrin
Hemopexin
Complement proteins
Fibrinogen
CRP
LDL
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25
Q

Which Alpha globulins are not acute phase reactants?

A

AFP

A2 Macroglobulin

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26
Q

Characteristics and function of Transferrin?

A

Synth in liver and major component of B-globulin fraction

Transports Fe and prevents loss through kidneys (2Fe to each transferrin with 1/3 occupied at a time)

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27
Q

Clinical significance of Beta Globulins?

A

Dec in liver dz
Inc in Fe deficiency anemia
Pregnancy

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28
Q

Fucntion of Hemopexin?

A

Removes circulating heme and porphyrins (part of heme)

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29
Q

What is the clinical significance of hemopexin?

A

Inc in malignant melanoma

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30
Q

Complement protein family is involved in?

A

Immune and inflammatory response

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31
Q

Functions of complement proteins?

A

Lysis of celll to which Ag-Ab complexes attach to

Opsonization

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32
Q

What is the clinical significance of Complement proteins?

A

Inc level in inflammation

Dec in Systemic Lupus

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33
Q

What is the function of fibrinogen?

A

Formation of fibrin clot when activated by thrombin

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34
Q

What is the clincial significance of fribrinogen?

A

Dec in DIC and afibrinogenemia

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35
Q

How does CRP move and what is it’s function?

A

Moves with gamma globulins to facilitate opsonization

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36
Q

What is the clinical significance of CRP?

A

Inc in inflammatory dz
Assayed for risk assessment of CVD
Inc levels indicate chronic inflammatory process in vascular system

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37
Q

What is the most abundant gamma-globulin?

Where are they synthesized?

A

IgE
By plasma cells (B cells)
Synth stim’d by immune response

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38
Q

Clinical significance of gamma globulins?

A

Inc A- liver dz, autoimmune, infection
Inc D- liver dz, infection, CT disorders, multiple myeloma
Inc IgE- asthma, allergic, parasitic infections
Inc IgG- liver dz, infection, collagen dz
IgM- first to appear in immune response

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39
Q

Decreased immunoglobulins are caused by?

A

Faulty plasma cell function/inherited immunodeficiency

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40
Q

Clinical significance of immunoglobulins?

A

Inc in monoclonal gammopathies- group of disorders that proliferate singel clone of plasma cells that produce homogenous monoclonal protein

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41
Q

Multiple myeloma will have increased immunoglobulins except which one?

A

IgM

Inc in Waldenstroms Macroglobulinemia

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42
Q

What are the acute phase reactants?

A 
CRP
Alpha-1 Antitrypsin
Fibrinogen
Haptoglobin
Complement proteins
Ceruloplasmin
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43
Q

What organ synthesizes most of the plasma proteins?

A

Liver

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44
Q

What Dz is characterized by decrease in serum albumin, alpha 1, beta and gamma but increased levels of Alpha 2 proteins detected by electrophoresis?

A

Nephrotic syndrome

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45
Q

An insufficiency in what plasma protein leads to pulmonary insufficiency?

A

Alpha-1 Antitrypsin

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46
Q

Define Lipid

A

Hydrophobic compounds soluble in organic solvents and insoluble in water

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47
Q

What are the five subdivisions of lipids?

A

Sterol- choleserol, steroids, Vit D
FA- short/long chain, prostaglandins
Glycerol esters- tri/phsphoglycerides
Sphingosine derivatives- sphingomyelin, glychosphingolipids
Terpenes- isoprene polymers, Vit A E and K

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48
Q

How are lipids transported?

A

In plasma in macromolecular lipoproteins

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49
Q

What are the categories of lipoproteins?

A 
Chylomicron
VLDL
iDL
VLDL
HDL
Lipoprotein
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50
Q

____ are the protein components of a lipoprotein

A

Apolipoprotein

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51
Q

What is the function of apolipoprotein?

A

Activate enzymes in lipoprotein metabolic paths
Maintain integrity of lipoprotein complex
Facilitate uptake of lipoprotein into cells through receptors

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52
Q

Clinical significance of lipids is associated with ?

A

Coronary heart disease and other vascular disorders

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53
Q

When are adults tested for lipids?

A

Every 5yrs

If total cholesterol is above 200 or HDL is <40, fasting lipoprotein is required

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54
Q

Lipoprotein A result greater than 30mg is indicator of increased risk of?

A

CHD

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55
Q

Apolipoprotein E is found where?

A

Chylomicron

iDL

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56
Q

Apolipoprotein A-I is the major lipoprotein of ____

A

HDL
Less than 120- risk of CHD
+160= protective

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57
Q

Apolipoprotein B-100 is the major lipoprotein of ____

A

LDL

100-120mg correspond to borderline high LDL point

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58
Q

Define dyslipoporteinemia

A

Based on relationship between lipoprotein concentrations and risk for CHD

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59
Q

Define 1* and 2* Hyperlipoproteinemia Dx

A

Dx of primary after 2* causes are ruled out

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60
Q

What are causes of 2* hyperlipidemia and dyslipoproteinemia?

A 
Drugs/ETOH
DM/hypothyroid
Glycogen storage dz
Tay-Sachs Dz
Nephrotic Synd. 
Chronic RF
Hepatitis
Burns
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61
Q

Which lipoprotein is more important for therapeutic decision making?

A

LDL

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62
Q

Which apoprotein is inversely related to risk of CHD and a surrogate marker for HDL?

A

Apo A-1

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63
Q

What is the secretory unit of the thyroid gland?

A

Thyroid follicle

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64
Q

Where is thyroglobin made by follicular cells stored?

A

Outer layer of epithelial cells enclosed in colloid

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65
Q

What do parafollicular cells secrete?

A

Hormone called calcitonin

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66
Q

Abbreviations for
Free Thyroxine
Free Triodothyroinin

A

DIT + DIT= FT4

DIT + MIT= FT3

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67
Q

Abbreviation for
Total Thyroxine
Total Triodothyronine

A

DIT + DIT= T4

DIT + MIT= T3

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68
Q

Abbreviation for
Reverse Triodothyronine
Monoiodotyrosine
Diodotyrosine

A

rT3
MIT
DIT

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69
Q

What protein is the most important carrier of T4?

A

Thyroxine binding protein TGB

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70
Q

T4 and T3 circulate bound to one of what three proteins?

A

TBG
Transthretin TBPA
Albumin

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71
Q

Alterations in concentration or affinity for thyroid binding protein will cause what change?

A

Amount of bioavailable T3/4

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72
Q

Majority of T3 is produced by?

A

Extrathyrodial deiodination of T4 in liver and kidneys

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73
Q

___ has more biological activity than the other thyroid hormone

A

T3 10x more

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74
Q

Thyroid hormone synthesis and secretion are controlled by negative feed back loops to what organs?

A

Hypothalamus
Pituitary
Thyroid follicle cells

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75
Q

Funtion of TRH

A

Thyrotoponin releasing hormone- from hypothalamus, enter portal system to release TSH thyrotropin from anterior thyroid thyrotrophs

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76
Q

TSH stimulates the release of ? from ?

A

T4 and 3 from thyroid gland

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77
Q

T4/3 negatively feed back onto what?

A

Hypothalamus and pituitary

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78
Q

What are the functions of thyroid hormones?

A 
Basal metabolic rate
Mitochndrial metabolism
Neural development/growth
Sexual maturation
Inc HR
Protein synthesis
Inc Ca and PO4 metabolism
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79
Q

What is tested in a Thyroid Function Test?

A

TSH
T4
T3
Free T4

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80
Q

What is the best way to measure thyroid function?

A

TSH level
High= failing thyroid from primary hypothyroidism

Low- overactive thyroid producing too much thyroid hormone (hyperthyroidism)

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81
Q

T4 and T3 circulates in the blood in what two forms?

A

Protein bound

Free fraction- most important for determining thyroid function

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82
Q

What are the names of the Free Fraction tests?

A

FT4I or FTI

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83
Q

PTs with hyperthyroidism will have an elevated __ or ___

PTs with hypothyroidism will have low __ or __

A

FT4 or FTI

FT4 or FTI

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84
Q

T3 tests are usually used to diagnose ? or to determine?

A

Hyerthyroidsism

Severity of hyperthyroidism

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85
Q

What part of the thyroid function test is the least helpful for hypothyroid PTs?

A

T3- last to become abnormal

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86
Q

In hypo/hyperthyroid PTs what process happens that is counter effective for their health?

A

Lymphocytes make Abs (Anti TPO or Anti-Tg) against the thyroid to stim/destroy it

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87
Q

What do Anti-TPO and Anti-Tg stand for?

A

Thyroid peroxidase

Thryoglobulin

88
Q

What happens if thyroid receptor antibodies TR-Ab are produced?

A

Stimulate or inhib thyroid gland

89
Q

What are the two groups of thyroid function disorders?

A 
Hyper- over production;
Hypo- under production
Further categorized:
1*- dz originating in thyroid
2*- pituitary or hypothalmic dysfunction- NOT common
90
Q

What is the most common cause of thyroid dysfunction worldwide?

A

Iodine deficiency

91
Q

S/Sx of hypothyroidism?

A 
Mental dullness
Inc sleep
Lethargy
Hair/weight gain
Cold intolerance
92
Q

S/Sx of hyperthyroidism?

A 
Nervous
Sleeplessness
Weight loss
Sweating
Heat intolerance
Difficulty concentrating
93
Q

Primary Thyroid disorders?

A

Anutoimmune- Hashimoto
Inborn- Na/Iodine pump dysfuntion, defective thryoglobin
Development abnormality- congenital hypothyroidism, hypo/asplasia

94
Q

Primary hypothyroidism exogenous causes?

A

Iodine deficiency
Excess dietary goitrogens
Drugs
Thyroidectomy

95
Q

Secondary Hypothyroidism sub categories?

A

TSH deficiency

TRH deficiency

96
Q

Hyperthyroidism is AKA and primary causes are?

A

Thyrotoxicosis
Graves
Infection/post-viral
Toxic adenoma

97
Q

Secondary hyperthyroidism causes include?

A

TSH producing pituitary adenoma

hCG mediated trophoblastic disease

98
Q

Serum TSH levels are almost absent in what form of thyroidism?

A

Primary hyper

99
Q

What is the anion gap equation?

A

Na - (Cl + BiCarb)

Na + K) - (Cl + BiCarb

100
Q

What are the nonprotein nitrogen?

A

NH3 (from pyrimidines)
Uric Acid (from purines)
Urea- majority (from NH3)
Cratinine (from creatine)

101
Q

Ammonia is not useful for testing renal functions but typically manifests as ?

A

Neurological abnormalities from defect in urea cycle

102
Q

Majority of ammonia produced in the body has what fate ?

A

Excreted by kidneys

103
Q

Increased plasma levels of Urea are referred to as ?

104
Q

BUN is a rough estimate of renal function but requires ? level to show clinically significant levels?

A

<50%

Normal ratio 10-20:1

105
Q

What is creatinine and where does it come from?

A

Cyclic anhydride of creatine from decomposition of phosphocreatine

106
Q

What part of the urine can be used as diagnostic indicators of kidney function?

A

Plasma creatine and its renal clearnace

107
Q

Where is creatine synthesized?

It is proportional to ?

A

Kidney Liver Pancreas

Muscle mass

108
Q

What is the end product of purine catabolism?

109
Q

What happens if hyperuricemia occurs?

A

Monosodium urate- gout

110
Q

What are three important physiological components of renal function?

A

GFR
Renal blood flow
Glomerular permeability

111
Q

The most practical tests in evaluating renal function on a routine basis are determining clearances of various compound to estimate what 4 things?

A

eGFR
Permeability from types of proteins in urine
Non-protein N compounds
Tubules concentration ability

112
Q

GFR measurements can be based off of one of what two things?

A

Urinary or plasma clearance of a marker

113
Q

Renal clearance of a substance is defined as ?

A

Volume of plasma from which a substance is completely cleared by the kidneys per unit of time

114
Q

Amount of a substance filtered at glomerulus is equal to amount of urine excretion if what 4 rules are met?

A

Stable plasma concentration
Physiologically inert
Freely filtered at glomerulus
Not altered/absorbed by kidney

115
Q

What is the GFR equation?

A

GFR = urine concentration x flow / plasma concentration

116
Q

GFR is considered to be a reliable measure of kidney _____ and thought as an indicator of _____

A

Functional capacity
Number of functioning nephrons
Physiological measurement of changes in renal function

117
Q

Rate of glomerular filtrate depends on what?

A

Balance between hydrostatic and oncotic forces along afferent arteriole and across the glomerular filter

118
Q

GFR can be used for what purpose?

A

Detect renal insufficiency
Adjust drug doses
Evaluate therapies
Points for pending transplant PTs

119
Q

What are the three labs tests used to determine eGFR?

A

Inulin clearance- reference method
Creatinine clearance- most practical
Cystatin C- more reliable than creatinine

120
Q

Creatinine clearance is a rough measure of ? and is indicative of ?

A

glomerular filtration

Indicative of working nephrons

121
Q

Define creatinine clearance

A

Milliliters of plasma cleared of creatinine by kidneys in one minute

122
Q

Creatinine clearance uses what samples for computation?

A

Urine and blood timed specimens

Calculated with body mass

123
Q

What are the procedural steps for a 24hr creatinine clearance test?

A

Discard first morning specimen

Save all urine for rest of day and 1st morning sample on second day

124
Q

What are the drawbacks of a creatinine clearance test?

A

Individual variations
Interfering substances that alter results
Abnormally high/low body mass

125
Q

When/why are prediction equations recommended for use?

A

Estimate GFR from serum creatinine for PTs with CKD and PTs are risk for developing CKD

126
Q

What are the 4 testing methods for assessment of glomerular permeability?

A

Dipstick method (qualitative)
Spot urine albumin:creatinine
24hr urine (quantitiative)
Test for other protein

127
Q

What causes glomerular proteinuria?

A

Inc glomerular permability

128
Q

What causes overflow proteinuria?

A

Inc plasma concentration of freely filtered protein

129
Q

What are the causes of tubular proteinuria?

A

Proximal/distal tube damage

Dec nephrons

130
Q

What are the two methods for measuring tubule/renal concentration ability?

A

SpecGrav

Osmolality

131
Q

Phosphorus is essential for what ?

A

Structural integrity of cell membrane

Nucelic acid/high energy nucleotides (ATP)

132
Q

Increased phosphorus excretion is seen in what issue?

A 
Renal tubular damage
Nonrenal acidosis (excreted with H)
133
Q

How is Acute Renal Failure diagnosed?

A

Excretory function of kidney declines over hours or days

134
Q

What is the definition of CKD?

A

Kidney damage/GFR less than 60mL x 3mon

135
Q

How is kidney damage defined?

A

Abnormalities/markers of damage including abnormalities in blood, urine or imaging studies

136
Q

What are the stages of CKD?

A

1- mild

5- failure, GFR less than 15mL

137
Q

What causes acute renal failure pre/at/post renal?

A

Hypovolemia
Glomerulonephritis
Lower GU obstruction

138
Q

What are the main causes of chronic renal failure?

A 
Primary glomerular dz
Renal vascular dz
Metabolic dz
HTN nephropathy
Nephrotoxins
139
Q

What are the two key markers for CKD?

A

eGFR

Urine albumin

140
Q

AMA renal function panel includes ? tests

A 
Ca CO2 Cl PO4 K Na 
Albumin
Glucose
Urea nitrogen
eGFR
Creatinine ratio
141
Q

What are two early markers that may prove beneficial for identifying early predictors of acute kidney injury?

A

Kidney injury molecule 1 111

Neutrophil gelatinase associated lipocalin 64

142
Q

UN/Creatinine ratio of <10 may indicate what issue?

A

Malnutrition

143
Q

What are the cardiac markers that are combined for Dx of MI?

A

Myoglobin
Total CPK
CK-MB

144
Q

Troponin and evidence of ischemia can indicated what series of issues?

A 
Ischemic Sx
New ST-T changes
Left bundle branch block
Pathologic Q waves
Imaging evidence of loss of myocardium or wall abnormality
145
Q

What are the 7 steps of acute MI pathogenesis?

A 
Endothelial cell injury
Plaque
Plaque rupture/thrombogenesis
Reduced blood, inc O2 demand
Ischemia
Myocardial necrosis
Acute MI
146
Q

What are the 3 parts of troponin?

A

C- Ca binding
I- inhibitory
T- tropomyosin binding
I and T are derived from myocardium

147
Q

What are the time frames for troponing to be drawn and tested for MI Dx?

A

3-6hrs after Sx onset

After 6hrs if initially negative

148
Q

What are the non-MI causes of elevated troponin?

A 
Trauma
CHF
Valve HD
HTN
HOTN and Tachy
Sepsis
Vital exhaustion
149
Q

What is the draw back of using POCT for cardiac marker testing?

A

Lower sensitivity and accuracy

150
Q

When/why is CRP released?

A

Acute phase reactant made in liver and released at start of infection/inflammation

151
Q

CRP concentrations below infection but above healthy values can be a marker of ?

A

Atherosclerotic preocess

152
Q

Characteristics of Pentraxin 3

A

Marker of vascular inflammation
Adverse outcome biomarker for PTs with unstable angina MI or HF
More specific than CRP for vessel inflammation

153
Q

Characteristics of Homecysteine

A

High level makes PT prone to endothelial injury increasing risk of CHD, stroke of Vascular dz

154
Q

What vitamin deficiencies can cause homecysteine to increase?

A

B6 B9 B12 deficiency

155
Q

When/why is homecysteine a more useful as a potential biomarker?

A

Family Hx or lifestyle risk factors

156
Q

Characteristics of Interleukin 6

A

Marker of early atherosclerosis that stims liver to produce CRP

157
Q

Elevated serum levels of IL-6 and CRp are indicative of what?

A

Atherosclerosis development or Type 2 DM in insulin resistant individuals

158
Q

Characteristics of Myeloperoxidase

A

Produced by polymorph. leukocytes and macrophages
Inc MPO= marker of plaque instability
Predicive marker for future CV events

159
Q

Characteristics of Soluble cluster of differentiation 40 ligand

A

Belongs to TNF-a family, upregulated on platelets in intraluminal thrombus
Releases is indicative of plaque rupture and subsequent MI

160
Q

Characteristics of TNF-a

A

Role in athersclerosis as production of tissue inhibitors of metalloproteinases by fibroblasts
Elevated levels= recurrent non-fatal MI or fatal CV event

161
Q

Characteristics of Heart Fatty Acid Binding Prtoein

A

Responsible for FA transport
Appears 30m after MI
Predictive marker for mortality after ACS

162
Q

Characteristics of B Type Natriuretic Peptide

A

Secreted by ventricles due to stretching

Inc in CHF and seves as predictive marker for identifying PT with CHF

163
Q

Characeristics of Ischemia Modified Albumin

A

Inc with ischemic conditions
Inc immediatley after onset of ischemia and returns to baseline in 6-12hrs
Enables early ID of ischemia

164
Q

Function of Stellate Cells

A

Store Vitamin A

Synthesize NO

165
Q

What are the biochemical functions of the liver

A

Produce bile
Produce plasma proteins
Metabolize carbs, aa, lipids and drugs

166
Q

What type of tests are used for liver function in transplant/advanced liver dz?

A

Drug metabolic tests

167
Q

What plasma proteins are made in the liver?

A 
Albumin
Transthyretin
Ceruloplasmin
A1 Antitrypsin
A Fetoprotein
168
Q

What type of PT will have low concentrations of urea in their plasma?

A

End stage liver Dz

169
Q

What are the inherited causes for hyperammonemia?

A

Adv liver dz
RF
Liver failure
Reye syndrome

170
Q

Abnormal hemostais is common in ___ dz

171
Q

Cirrhosis PTs commonly have what issue?

Acute hepatic necrosis PTs usually have ?

A

Thrombocytopenia

DIC

172
Q

Most labs use tests to detect ___ bilirubin which is called ____

A

Conjugated

Direct

173
Q

Elevation in unconjugated bilirubin poases a great risk for developing ___ especially in ___

A

Kernicterus

Infants

174
Q

Define Prehepatic Jaundice

A

Inc unconjugated bilirubin are brought to liver most commonly from increased RBC destruction

175
Q

What are the lab findings for prehepatic jaundice?

A 
Everything inc except urine bilirubin
Total bilirubin- inc
Conjugated- norm to inc
Unconjugated- inc
Urine urobilinogen- inc
Urine bilirubin- neg
176
Q

What are the Dz/Syndromes that can cause hepatic jaundice?

A

***Gilberts Dz- poor bilirubin transport through liver
Crigler Najjar Syndrome- dec UDP transferase
**Dubin-Johnson Syndrome- ineffective removal of conjugated bilirubin
Rotor’s

177
Q

What are the lab findings for hepatic jaundice?

A 
Total bilirubin- inc
Conjugated- inc
Unconjugated- norm or inc
Urine urobilinogen- dec, norm or inc
Urine bilirubin- pos/neg (Dz dependent)
178
Q

What are the lab findings for post-hepatic jaundice?

A 
Total bilirubin- inc
Conjugated- inc
Unconjugated- norm or inc
Urine urobilinogen- dec/none
Urine bilirubin- pos
179
Q

Functions of Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT)

A

Metabolizing aspartate and alanine
ALT- liver and kidney
AST- liver, heart, kidney, pancreas and muscle

180
Q

AST increases are seen in what types of conditions?

A

Necrosis of liver, heart, blood cells or muscle cells

181
Q

____ is the most important cause of increased transaminase activity in serum

A

Liver dz

In most, ALT is higher than AST

182
Q

Levels of AST usually exceed ALT in what four conditions?

A

Hepatic hypoxia
Liver neoplasia
Alcoholic hepatitis
Cirrhosis

183
Q

Presence of ALT is much more specific for ___ damage than AST

A

Hepatocyte

184
Q

Typically AST and ___ inc= ?

Increased ___ and GGT indicate ?

185
Q

Characteristics of GGT

A

Gamma Glutamyltransferase

Enzyme that transfers glutamyl groups from peptides

186
Q

Where is GGT found in decreasing sequence?

A

Prox renal tube
Liver
Pancreas
Intestine

187
Q

Even though renal tissue has the highest concentration of GGT, it’s presence in serum originates primarily from ___

A

Hepatobiliary system

188
Q

GGT will be markedly increased before ALT/AST in what conditions?
It’s elevation is common in?

A

Bile duct obstruction

Chronic alcohol abuse

189
Q

Characteristics of ALP

A

Alkaliine Phosphatase

On cell surfaces that catalyzes alkaline hyrolyses of substances in sm intestine, bone, liver and placenta

190
Q

ALP level increases are usually associated with what issues?

A

Bone disorders- Paget’s Dz (osteoblast involvement)

Liver Dz- cholestasis

191
Q

What is Glutamate Dehydrogenase

A

Mitochondria enzyme in heart, liver and kidney

192
Q

What is the clinical significance of Glutamate Dehydrogenase

A

GLD serum inc in PTs with hepatocellular damage
4-5x inc in chronic hepatitis
2x in cirrhosis

193
Q

GLD is released from mitochondris in response to ?

A

Necrosis

Release is less in inflammatory processes and ALT will predominate

194
Q

What is 5’ Nucleotidase

A

Phosphatase that acts on AMP and adenylic acid to release inorganic phosphate

195
Q

What is the Clinical Significance of 5’ Nucleotidase

A

Inc 3-6x in hepatobiliary dz with interfered bile secretion

196
Q

What is Glutathione S-Transferase

A

Cytosolic dimeric enzyme that catalyze addition of glutathione for detox reactions

197
Q

What is the clinical significance of a-GST

A

Emerging marker for assessing hepatocellular damage.

Evenly distributed throughout liver so its released in all types of liver injury

198
Q

Hepatitis PTs will have what elevated lab results?

A

AST and ALT

Mild inc of ALP and GGT

199
Q

Alcoholic liver PTs will have what lab elevation?

200
Q

What are the lab indicators of chlestasis?

A

Inc plasma activities of canalicular enzymes ALP and GGT

201
Q

AMA hepatic function panel includes ? tests

A 
Albumin 
Total protein
Prothrombin time
Bilirubin
GGT
ALT
AST
ALP
202
Q

What is the function of amylase and where is it found?

A

Catalyzes break down of glycogen and starch

Found in pancreas and salivary glands

203
Q

Elevated levels of amylase are indicative of ?

A

Acute pancreatitis
Mumps
Parotitis

204
Q

In acute pancreatitis, amylase levels increase and return how quickly?

A

Inc 5-8hrs of Sx onset

Norm by 3-4days

205
Q

What is the function of lipase and where is it found

A

Hydrolyze ester linkages of fats to make alcohols and FAs

Found in pancreas

206
Q

How quickly do lipase levels inc during acute pancreatitis?

A

Inc 4-8hrs

Dec in 7-14 days

207
Q

Function of trypsin

A

Pancreas specific serine protease

208
Q

During acute pancreatitis, serum trypsin levels will increase in parallel with what other enzyme?

209
Q

Trypsin levels are elevated in the serum during ?

What other increases will be seen?

A

Chronic RF

Inc amylase and lipase will be noted

210
Q

The greatest activities of serum AST and ALT are seen during?

A

Acute viral hepatitis

211
Q

Elevated ALP with normal AST, ALT and GGT levels is associated with ? condition

A

Osteogenic sarcoma

212
Q

What is the most specific enzyme test for acute pancreatitis?

213
Q

Not made in liver

A

BNP
Focus on BNP
Homecysteine
Unaccounted anion- larger gap

214
Q

What are the 3 LDL goal ranges?

A

CHD- <100
+2 risks= <130
1 or less risks= <160

215
Q

Difference between Broad cast and Waxy casts

A

Broad- RF/End stage RF casts

Waxy- Chronic RF

IPAP (212 decks)

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