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
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
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
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
5
Q
What is the secondary function of albumin class proteins?
A
Carrier protein for bilirubin, hormones and FAs
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
7
Q
Albumin levels are increased in what type of condition?
A
Dehydration
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
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
10
Q
What are the Alpha-1 globulins?
A
1 Antitrypsin- AAT (majority)
1 Lipoprotein- HDL
1 Fetoprotein- AFP
11
Q
What are the Alpha-2 globulins?
A
Haptoglobin
Ceruloplasmin
Alpha 2 macroglobulin
12
Q
Which Alpha-1 globulin is an acute phase reactant?
A
AAT
13
Q
What is the function of AAT?
A
Protease inhibitor that neutralizes trypsin like enzymes (elastase) that can damage structural proteins
14
Q
When/where are elastase and trypsin-like enzymes released from/during?
A
WBCs
Phagocytosis
15
Q
What is the clinical significance of AAT?
A
Deficiency associated with severe destruction of alveolar walls/pulmonary deficiency
Increased during inflammatory disorders
16
Q
What is the function of AFP?
When is maternal screening performed for this globulin?
A
Fetus protection
15-20wks
17
Q
What is the clinical significance of AFP?
A
Inc during pregnancy= open neural tube defect
Dec during pregnancy= Downs
Liver/gonad cancer
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
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
20
Q
Function of Ceruloplasmin
A
Cu containing protein w/ enzymatic activity and is an acute phase reactant
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
22
Q
Where is Alpha-2 Macroglobulin found and what is it’s function?
A
Intravascular spaces to inhibit portease enzymes (trypsin, pepsin, plasmin)
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
24
Q
What are the Beta-Globulins?
A
Transferrin Hemopexin Complement proteins Fibrinogen CRP LDL
25
Which Alpha globulins are not acute phase reactants?
AFP
| A2 Macroglobulin
26
Characteristics and function of Transferrin?
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)
27
Clinical significance of Beta Globulins?
Dec in liver dz
Inc in Fe deficiency anemia
Pregnancy
28
Fucntion of Hemopexin?
Removes circulating heme and porphyrins (part of heme)
29
What is the clinical significance of hemopexin?
Inc in malignant melanoma
30
Complement protein family is involved in?
Immune and inflammatory response
31
Functions of complement proteins?
Lysis of celll to which Ag-Ab complexes attach to
| Opsonization
32
What is the clinical significance of Complement proteins?
Inc level in inflammation
| Dec in Systemic Lupus
33
What is the function of fibrinogen?
Formation of fibrin clot when activated by thrombin
34
What is the clincial significance of fribrinogen?
Dec in DIC and afibrinogenemia
35
How does CRP move and what is it's function?
Moves with gamma globulins to facilitate opsonization
36
What is the clinical significance of CRP?
Inc in inflammatory dz
Assayed for risk assessment of CVD
Inc levels indicate chronic inflammatory process in vascular system
37
What is the most abundant gamma-globulin?
| Where are they synthesized?
IgE
By plasma cells (B cells)
Synth stim'd by immune response
38
Clinical significance of gamma globulins?
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
39
Decreased immunoglobulins are caused by?
Faulty plasma cell function/inherited immunodeficiency
40
Clinical significance of immunoglobulins?
Inc in monoclonal gammopathies- group of disorders that proliferate singel clone of plasma cells that produce homogenous monoclonal protein
41
Multiple myeloma will have increased immunoglobulins except which one?
IgM
| Inc in Waldenstroms Macroglobulinemia
42
What are the acute phase reactants?
```
CRP
Alpha-1 Antitrypsin
Fibrinogen
Haptoglobin
Complement proteins
Ceruloplasmin
```
43
What organ synthesizes most of the plasma proteins?
Liver
44
What Dz is characterized by decrease in serum albumin, alpha 1, beta and gamma but increased levels of Alpha 2 proteins detected by electrophoresis?
Nephrotic syndrome
45
An insufficiency in what plasma protein leads to pulmonary insufficiency?
Alpha-1 Antitrypsin
46
Define Lipid
Hydrophobic compounds soluble in organic solvents and insoluble in water
47
What are the five subdivisions of lipids?
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
48
How are lipids transported?
In plasma in macromolecular lipoproteins
49
What are the categories of lipoproteins?
```
Chylomicron
VLDL
iDL
VLDL
HDL
Lipoprotein
```
50
____ are the protein components of a lipoprotein
Apolipoprotein
51
What is the function of apolipoprotein?
Activate enzymes in lipoprotein metabolic paths
Maintain integrity of lipoprotein complex
Facilitate uptake of lipoprotein into cells through receptors
52
Clinical significance of lipids is associated with ?
Coronary heart disease and other vascular disorders
53
When are adults tested for lipids?
Every 5yrs
| If total cholesterol is above 200 or HDL is <40, fasting lipoprotein is required
54
Lipoprotein A result greater than 30mg is indicator of increased risk of?
CHD
55
Apolipoprotein E is found where?
Chylomicron
| iDL
56
Apolipoprotein A-I is the major lipoprotein of ____
HDL
Less than 120- risk of CHD
+160= protective
57
Apolipoprotein B-100 is the major lipoprotein of ____
LDL
| 100-120mg correspond to borderline high LDL point
58
Define dyslipoporteinemia
Based on relationship between lipoprotein concentrations and risk for CHD
59
Define 1* and 2* Hyperlipoproteinemia Dx
Dx of primary after 2* causes are ruled out
60
What are causes of 2* hyperlipidemia and dyslipoproteinemia?
```
Drugs/ETOH
DM/hypothyroid
Glycogen storage dz
Tay-Sachs Dz
Nephrotic Synd.
Chronic RF
Hepatitis
Burns
```
61
Which lipoprotein is more important for therapeutic decision making?
LDL
62
Which apoprotein is inversely related to risk of CHD and a surrogate marker for HDL?
Apo A-1
63
What is the secretory unit of the thyroid gland?
Thyroid follicle
64
Where is thyroglobin made by follicular cells stored?
Outer layer of epithelial cells enclosed in colloid
65
What do parafollicular cells secrete?
Hormone called calcitonin
66
Abbreviations for
Free Thyroxine
Free Triodothyroinin
DIT + DIT= FT4
| DIT + MIT= FT3
67
Abbreviation for
Total Thyroxine
Total Triodothyronine
DIT + DIT= T4
| DIT + MIT= T3
68
Abbreviation for
Reverse Triodothyronine
Monoiodotyrosine
Diodotyrosine
rT3
MIT
DIT
69
What protein is the most important carrier of T4?
Thyroxine binding protein TGB
70
T4 and T3 circulate bound to one of what three proteins?
TBG
Transthretin TBPA
Albumin
71
Alterations in concentration or affinity for thyroid binding protein will cause what change?
Amount of bioavailable T3/4
72
Majority of T3 is produced by?
Extrathyrodial deiodination of T4 in liver and kidneys
73
___ has more biological activity than the other thyroid hormone
T3 10x more
74
Thyroid hormone synthesis and secretion are controlled by negative feed back loops to what organs?
Hypothalamus
Pituitary
Thyroid follicle cells
75
Funtion of TRH
Thyrotoponin releasing hormone- from hypothalamus, enter portal system to release TSH thyrotropin from anterior thyroid thyrotrophs
76
TSH stimulates the release of ? from ?
T4 and 3 from thyroid gland
77
T4/3 negatively feed back onto what?
Hypothalamus and pituitary
78
What are the functions of thyroid hormones?
```
Basal metabolic rate
Mitochndrial metabolism
Neural development/growth
Sexual maturation
Inc HR
Protein synthesis
Inc Ca and PO4 metabolism
```
79
What is tested in a Thyroid Function Test?
TSH
T4
T3
Free T4
80
What is the best way to measure thyroid function?
TSH level
High= failing thyroid from primary hypothyroidism
Low- overactive thyroid producing too much thyroid hormone (hyperthyroidism)
81
T4 and T3 circulates in the blood in what two forms?
Protein bound
| Free fraction- most important for determining thyroid function
82
What are the names of the Free Fraction tests?
FT4I or FTI
83
PTs with hyperthyroidism will have an elevated __ or ___
| PTs with hypothyroidism will have low __ or __
FT4 or FTI
| FT4 or FTI
84
T3 tests are usually used to diagnose ? or to determine?
Hyerthyroidsism
| Severity of hyperthyroidism
85
What part of the thyroid function test is the least helpful for hypothyroid PTs?
T3- last to become abnormal
86
In hypo/hyperthyroid PTs what process happens that is counter effective for their health?
Lymphocytes make Abs (Anti TPO or Anti-Tg) against the thyroid to stim/destroy it
87
What do Anti-TPO and Anti-Tg stand for?
Thyroid peroxidase
| Thryoglobulin
88
What happens if thyroid receptor antibodies TR-Ab are produced?
Stimulate or inhib thyroid gland
89
What are the two groups of thyroid function disorders?
```
Hyper- over production;
Hypo- under production
Further categorized:
1*- dz originating in thyroid
2*- pituitary or hypothalmic dysfunction- NOT common
```
90
What is the most common cause of thyroid dysfunction worldwide?
Iodine deficiency
91
S/Sx of hypothyroidism?
```
Mental dullness
Inc sleep
Lethargy
Hair/weight gain
Cold intolerance
```
92
S/Sx of hyperthyroidism?
```
Nervous
Sleeplessness
Weight loss
Sweating
Heat intolerance
Difficulty concentrating
```
93
Primary Thyroid disorders?
Anutoimmune- Hashimoto
Inborn- Na/Iodine pump dysfuntion, defective thryoglobin
Development abnormality- congenital hypothyroidism, hypo/asplasia
94
Primary hypothyroidism exogenous causes?
Iodine deficiency
Excess dietary goitrogens
Drugs
Thyroidectomy
95
Secondary Hypothyroidism sub categories?
TSH deficiency
| TRH deficiency
96
Hyperthyroidism is AKA and primary causes are?
Thyrotoxicosis
Graves
Infection/post-viral
Toxic adenoma
97
Secondary hyperthyroidism causes include?
TSH producing pituitary adenoma
| hCG mediated trophoblastic disease
98
Serum TSH levels are almost absent in what form of thyroidism?
Primary hyper
99
What is the anion gap equation?
Na - (Cl + BiCarb)
| Na + K) - (Cl + BiCarb
100
What are the nonprotein nitrogen?
NH3 (from pyrimidines)
Uric Acid (from purines)
Urea- majority (from NH3)
Cratinine (from creatine)
101
Ammonia is not useful for testing renal functions but typically manifests as ?
Neurological abnormalities from defect in urea cycle
102
Majority of ammonia produced in the body has what fate ?
Excreted by kidneys
103
Increased plasma levels of Urea are referred to as ?
Uremia
104
BUN is a rough estimate of renal function but requires ? level to show clinically significant levels?
<50%
| Normal ratio 10-20:1
105
What is creatinine and where does it come from?
Cyclic anhydride of creatine from decomposition of phosphocreatine
106
What part of the urine can be used as diagnostic indicators of kidney function?
Plasma creatine and its renal clearnace
107
Where is creatine synthesized?
| It is proportional to ?
Kidney Liver Pancreas
| Muscle mass
108
What is the end product of purine catabolism?
Uric acid
109
What happens if hyperuricemia occurs?
Monosodium urate- gout
110
What are three important physiological components of renal function?
GFR
Renal blood flow
Glomerular permeability
111
The most practical tests in evaluating renal function on a routine basis are determining clearances of various compound to estimate what 4 things?
eGFR
Permeability from types of proteins in urine
Non-protein N compounds
Tubules concentration ability
112
GFR measurements can be based off of one of what two things?
Urinary or plasma clearance of a marker
113
Renal clearance of a substance is defined as ?
Volume of plasma from which a substance is completely cleared by the kidneys per unit of time
114
Amount of a substance filtered at glomerulus is equal to amount of urine excretion if what 4 rules are met?
Stable plasma concentration
Physiologically inert
Freely filtered at glomerulus
Not altered/absorbed by kidney
115
What is the GFR equation?
GFR = urine concentration x flow / plasma concentration
116
GFR is considered to be a reliable measure of kidney _____ and thought as an indicator of _____
Functional capacity
Number of functioning nephrons
Physiological measurement of changes in renal function
117
Rate of glomerular filtrate depends on what?
Balance between hydrostatic and oncotic forces along afferent arteriole and across the glomerular filter
118
GFR can be used for what purpose?
Detect renal insufficiency
Adjust drug doses
Evaluate therapies
Points for pending transplant PTs
119
What are the three labs tests used to determine eGFR?
Inulin clearance- reference method
Creatinine clearance- most practical
Cystatin C- more reliable than creatinine
120
Creatinine clearance is a rough measure of ? and is indicative of ?
glomerular filtration
| Indicative of working nephrons
121
Define creatinine clearance
Milliliters of plasma cleared of creatinine by kidneys in one minute
122
Creatinine clearance uses what samples for computation?
Urine and blood timed specimens
| Calculated with body mass
123
What are the procedural steps for a 24hr creatinine clearance test?
Discard first morning specimen
| Save all urine for rest of day and 1st morning sample on second day
124
What are the drawbacks of a creatinine clearance test?
Individual variations
Interfering substances that alter results
Abnormally high/low body mass
125
When/why are prediction equations recommended for use?
Estimate GFR from serum creatinine for PTs with CKD and PTs are risk for developing CKD
126
What are the 4 testing methods for assessment of glomerular permeability?
Dipstick method (qualitative)
Spot urine albumin:creatinine
24hr urine (quantitiative)
Test for other protein
127
What causes glomerular proteinuria?
Inc glomerular permability
128
What causes overflow proteinuria?
Inc plasma concentration of freely filtered protein
129
What are the causes of tubular proteinuria?
Proximal/distal tube damage
| Dec nephrons
130
What are the two methods for measuring tubule/renal concentration ability?
SpecGrav
| Osmolality
131
Phosphorus is essential for what ?
Structural integrity of cell membrane
| Nucelic acid/high energy nucleotides (ATP)
132
Increased phosphorus excretion is seen in what issue?
```
Renal tubular damage
Nonrenal acidosis (excreted with H)
```
133
How is Acute Renal Failure diagnosed?
Excretory function of kidney declines over hours or days
134
What is the definition of CKD?
Kidney damage/GFR less than 60mL x 3mon
135
How is kidney damage defined?
Abnormalities/markers of damage including abnormalities in blood, urine or imaging studies
136
What are the stages of CKD?
1- mild
| 5- failure, GFR less than 15mL
137
What causes acute renal failure pre/at/post renal?
Hypovolemia
Glomerulonephritis
Lower GU obstruction
138
What are the main causes of chronic renal failure?
```
Primary glomerular dz
Renal vascular dz
Metabolic dz
HTN nephropathy
Nephrotoxins
```
139
What are the two key markers for CKD?
eGFR
| Urine albumin
140
AMA renal function panel includes ? tests
```
Ca CO2 Cl PO4 K Na
Albumin
Glucose
Urea nitrogen
eGFR
Creatinine ratio
```
141
What are two early markers that may prove beneficial for identifying early predictors of acute kidney injury?
Kidney injury molecule 1 111
| Neutrophil gelatinase associated lipocalin 64
142
UN/Creatinine ratio of <10 may indicate what issue?
Malnutrition
143
What are the cardiac markers that are combined for Dx of MI?
Myoglobin
Total CPK
CK-MB
144
Troponin and evidence of ischemia can indicated what series of issues?
```
Ischemic Sx
New ST-T changes
Left bundle branch block
Pathologic Q waves
Imaging evidence of loss of myocardium or wall abnormality
```
145
What are the 7 steps of acute MI pathogenesis?
```
Endothelial cell injury
Plaque
Plaque rupture/thrombogenesis
Reduced blood, inc O2 demand
Ischemia
Myocardial necrosis
Acute MI
```
146
What are the 3 parts of troponin?
C- Ca binding
I- inhibitory
T- tropomyosin binding
I and T are derived from myocardium
147
What are the time frames for troponing to be drawn and tested for MI Dx?
3-6hrs after Sx onset
| After 6hrs if initially negative
148
What are the non-MI causes of elevated troponin?
```
Trauma
CHF
Valve HD
HTN
HOTN and Tachy
Sepsis
Vital exhaustion
```
149
What is the draw back of using POCT for cardiac marker testing?
Lower sensitivity and accuracy
150
When/why is CRP released?
Acute phase reactant made in liver and released at start of infection/inflammation
151
CRP concentrations below infection but above healthy values can be a marker of ?
Atherosclerotic preocess
152
Characteristics of Pentraxin 3
Marker of vascular inflammation
Adverse outcome biomarker for PTs with unstable angina MI or HF
More specific than CRP for vessel inflammation
153
Characteristics of Homecysteine
High level makes PT prone to endothelial injury increasing risk of CHD, stroke of Vascular dz
154
What vitamin deficiencies can cause homecysteine to increase?
B6 B9 B12 deficiency
155
When/why is homecysteine a more useful as a potential biomarker?
Family Hx or lifestyle risk factors
156
Characteristics of Interleukin 6
Marker of early atherosclerosis that stims liver to produce CRP
157
Elevated serum levels of IL-6 and CRp are indicative of what?
Atherosclerosis development or Type 2 DM in insulin resistant individuals
158
Characteristics of Myeloperoxidase
Produced by polymorph. leukocytes and macrophages
Inc MPO= marker of plaque instability
Predicive marker for future CV events
159
Characteristics of Soluble cluster of differentiation 40 ligand
Belongs to TNF-a family, upregulated on platelets in intraluminal thrombus
Releases is indicative of plaque rupture and subsequent MI
160
Characteristics of TNF-a
Role in athersclerosis as production of tissue inhibitors of metalloproteinases by fibroblasts
Elevated levels= recurrent non-fatal MI or fatal CV event
161
Characteristics of Heart Fatty Acid Binding Prtoein
Responsible for FA transport
Appears 30m after MI
Predictive marker for mortality after ACS
162
Characteristics of B Type Natriuretic Peptide
Secreted by ventricles due to stretching
| Inc in CHF and seves as predictive marker for identifying PT with CHF
163
Characeristics of Ischemia Modified Albumin
Inc with ischemic conditions
Inc immediatley after onset of ischemia and returns to baseline in 6-12hrs
Enables early ID of ischemia
164
Function of Stellate Cells
Store Vitamin A
| Synthesize NO
165
What are the biochemical functions of the liver
Produce bile
Produce plasma proteins
Metabolize carbs, aa, lipids and drugs
166
What type of tests are used for liver function in transplant/advanced liver dz?
Drug metabolic tests
167
What plasma proteins are made in the liver?
```
Albumin
Transthyretin
Ceruloplasmin
A1 Antitrypsin
A Fetoprotein
```
168
What type of PT will have low concentrations of urea in their plasma?
End stage liver Dz
169
What are the inherited causes for hyperammonemia?
Adv liver dz
RF
Liver failure
Reye syndrome
170
Abnormal hemostais is common in ___ dz
Liver
171
Cirrhosis PTs commonly have what issue?
| Acute hepatic necrosis PTs usually have ?
Thrombocytopenia
DIC
172
Most labs use tests to detect ___ bilirubin which is called ____
Conjugated
| Direct
173
Elevation in unconjugated bilirubin poases a great risk for developing ___ especially in ___
Kernicterus
Infants
174
Define Prehepatic Jaundice
Inc unconjugated bilirubin are brought to liver most commonly from increased RBC destruction
175
What are the lab findings for prehepatic jaundice?
```
Everything inc except urine bilirubin
Total bilirubin- inc
Conjugated- norm to inc
Unconjugated- inc
Urine urobilinogen- inc
Urine bilirubin- neg
```
176
What are the Dz/Syndromes that can cause hepatic jaundice?
***Gilberts Dz- poor bilirubin transport through liver
Crigler Najjar Syndrome- dec UDP transferase
**Dubin-Johnson Syndrome- ineffective removal of conjugated bilirubin
Rotor's
177
What are the lab findings for hepatic jaundice?
```
Total bilirubin- inc
Conjugated- inc
Unconjugated- norm or inc
Urine urobilinogen- dec, norm or inc
Urine bilirubin- pos/neg (Dz dependent)
```
178
What are the lab findings for post-hepatic jaundice?
```
Total bilirubin- inc
Conjugated- inc
Unconjugated- norm or inc
Urine urobilinogen- dec/none
Urine bilirubin- pos
```
179
Functions of Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT)
Metabolizing aspartate and alanine
ALT- liver and kidney
AST- liver, heart, kidney, pancreas and muscle
180
AST increases are seen in what types of conditions?
Necrosis of liver, heart, blood cells or muscle cells
181
____ is the most important cause of increased transaminase activity in serum
Liver dz
| In most, ALT is higher than AST
182
Levels of AST usually exceed ALT in what four conditions?
Hepatic hypoxia
Liver neoplasia
Alcoholic hepatitis
Cirrhosis
183
Presence of ALT is much more specific for ___ damage than AST
Hepatocyte
184
Typically AST and ___ inc= ?
| Increased ___ and GGT indicate ?
ALT
| ALP
185
Characteristics of GGT
Gamma Glutamyltransferase
| Enzyme that transfers glutamyl groups from peptides
186
Where is GGT found in decreasing sequence?
Prox renal tube
Liver
Pancreas
Intestine
187
Even though renal tissue has the highest concentration of GGT, it's presence in serum originates primarily from ___
Hepatobiliary system
188
GGT will be markedly increased before ALT/AST in what conditions?
It's elevation is common in?
Bile duct obstruction
| Chronic alcohol abuse
189
Characteristics of ALP
Alkaliine Phosphatase
| On cell surfaces that catalyzes alkaline hyrolyses of substances in sm intestine, bone, liver and placenta
190
ALP level increases are usually associated with what issues?
Bone disorders- Paget's Dz (osteoblast involvement)
| Liver Dz- cholestasis
191
What is Glutamate Dehydrogenase
Mitochondria enzyme in heart, liver and kidney
192
What is the clinical significance of Glutamate Dehydrogenase
GLD serum inc in PTs with hepatocellular damage
4-5x inc in chronic hepatitis
2x in cirrhosis
193
GLD is released from mitochondris in response to ?
Necrosis
| Release is less in inflammatory processes and ALT will predominate
194
What is 5' Nucleotidase
Phosphatase that acts on AMP and adenylic acid to release inorganic phosphate
195
What is the Clinical Significance of 5' Nucleotidase
Inc 3-6x in hepatobiliary dz with interfered bile secretion
196
What is Glutathione S-Transferase
Cytosolic dimeric enzyme that catalyze addition of glutathione for detox reactions
197
What is the clinical significance of a-GST
Emerging marker for assessing hepatocellular damage.
| Evenly distributed throughout liver so its released in all types of liver injury
198
Hepatitis PTs will have what elevated lab results?
AST and ALT
| Mild inc of ALP and GGT
199
Alcoholic liver PTs will have what lab elevation?
GGT
200
What are the lab indicators of chlestasis?
Inc plasma activities of canalicular enzymes ALP and GGT
201
AMA hepatic function panel includes ? tests
```
Albumin
Total protein
Prothrombin time
Bilirubin
GGT
ALT
AST
ALP
```
202
What is the function of amylase and where is it found?
Catalyzes break down of glycogen and starch
| Found in pancreas and salivary glands
203
Elevated levels of amylase are indicative of ?
Acute pancreatitis
Mumps
Parotitis
204
In acute pancreatitis, amylase levels increase and return how quickly?
Inc 5-8hrs of Sx onset
| Norm by 3-4days
205
What is the function of lipase and where is it found
Hydrolyze ester linkages of fats to make alcohols and FAs
| Found in pancreas
206
How quickly do lipase levels inc during acute pancreatitis?
Inc 4-8hrs
| Dec in 7-14 days
207
Function of trypsin
Pancreas specific serine protease
208
During acute pancreatitis, serum trypsin levels will increase in parallel with what other enzyme?
Amylase
209
Trypsin levels are elevated in the serum during ?
| What other increases will be seen?
Chronic RF
| Inc amylase and lipase will be noted
210
The greatest activities of serum AST and ALT are seen during?
Acute viral hepatitis
211
Elevated ALP with normal AST, ALT and GGT levels is associated with ? condition
Osteogenic sarcoma
212
What is the most specific enzyme test for acute pancreatitis?
Lipase
213
Not made in liver
BNP
Focus on BNP
Homecysteine
Unaccounted anion- larger gap
214
What are the 3 LDL goal ranges?
CHD- <100
+2 risks= <130
1 or less risks= <160
215
Difference between Broad cast and Waxy casts
Broad- RF/End stage RF casts
| Waxy- Chronic RF
