Common Labs Flashcards
digests starch and glucose
Amylase (AML)
salivary glands, lung tumors, ovarian cyst/tumors, pancreas produces
Amylase (AML)
Causes of elevated amylase levels
Pancreatitis (only 10% of the time! - usually WNL)
Chronic Renal Failure
Possible Perforated Peptic Ulcer
Macroamylasemia (rare, benign; serum vs urine)
Causes of low amylase levels
usually insignificant, but Chronic pancreatitis Pancreatic cancer Liver disease Toxemia pregnancy
Diagnostic findings of acute pancreatitis
serum amylase (rises within 2 hours, peaks at 12 - 48 hours, normal 3 - 4 days) serum lipase (*high levels up to 14 days!!*)
Why would a provider order an amylase lab? (uses)
Acute pancreatitis dx
Differential dx of Abdominal pain
Abdominal trauma/surgery = pancreatic injury
Perforation of peptic ulcer (r/o pancreatic damage which could cause chemical pancreatitis)
Produced by the liver and responsible for oncotic (pull) pressure
Albumin - the blood’s main protein
Cause of elevated albumin
dehydration!
most common
Hypoalbuminemia: causes of low albumin
*Malnutrition
*Liver disorder
Chronic diseases - hyperthyroidism, lupus, diabetes
Burns
Nephrotic Syndrome/Chronic Renal Failure
Hodgkin’s disease
Post Operative
Sepsis
Why would a provider order a albumin level?
Evaluate edema
Liver disease - jaundice
Suspcted malnutrition
______ is composed of 50% albumin
Total Protein
An elevation of total protein suggests:
Multiple Myeloma (will need to do immunologic typing)
Low total protein is caused from
Pregnancy
Cytotoxic Drugs
Dietary Deficiency
A provider orders a total protein for:
suspected hepatic disease (jaundice)
suspected protein deficiency
NP may also consider protein electrophoresis
Two enzymes located in hepatocytes and injury to the liver causes a release. Measurement of these enzymes reflects severity of hepatic injury
Aminotransferases:
Alanine (ALT)
Aspartate (AST)
Aminotransferase: ALT vs AST
ALT - L specific for the Liver
AST - increases after Cardiac or Skeletal muscle injury
An elevation of ALT and AST - hepatic problem, Alcholic, liver injury
An elevation of AST is caused by
Skeletal or Cardiac injury
A decrease in ALT and AST indicates
advanced cirrhosis or hepatitis
When should the NP request ALT and AST?
diagnosing/monitoring liver disease
screening tool for medications that cause liver damage
found in nearly all body tissues, produced by the liver and bones, and children’s levels is 2x - 4x that of adult due to growth
Alkaline Phosphatase (ALP)
An elevation of ALP (alkaline phosphatase) occurs when
Bile ducts are obstructed (conjugated or direct bilirubin increases too)
New bone formation
Paget’s disease (thickening & hypertrophy of long bones/deformity of flat bones - elderly)
Why would a NP select a ALP (alkaline phosphatase) lab?
To detect biliary obstructing hepatic lesions
Assessing Vitamin D tx to Rickets
Detect osteoblastic skeletal disease (Paget’s)
Acid phosphatase is a test to detect _______ and an elevation likely means _____
Prostate Cancer
Prostate-Specific Antigen (PSA) is produced by
normal, hyperplastic, and cancerous prostate tissue
An elevated prostate-specific antigen (PSA) may indicate
benign prostatic hyperplasia prostate cancer doubles after prostate massage - need to wait 2 weeks prostate biopsy (50 fold increase)
A prostate specific antigen lab value is used to:
detect prostate diseases (benign or cancer)
stage patient with cancer
confirm response to cancer
This lab value is responsible for increasing triiodothyronine and thyoxine secretion
Thyroid-stimulating hormone - T3 and T4 scretion
An increase of thyroid stimulating hormone may indicate
Hypothyroidism - primary (TSH is working hard, why? failure of thyroid)
Thyroiditis
Inadequate hormone therapy (levothyroxine or Synthroid)
A decrease of thyroid stimulating hormone
Hyperthryoidism
Excess Levothyroxine intake
Pituitary failure - secondary (low or normal TSH)
Hypothalamic failure - tertiary (low or normal TSH)
A patient that is considered euthyroid is a result of?
Thyroid stimulating hormone becomes normal
A patient’s lab values present with elevated radioactive-iodine, T3 uptake, and total T4. The thyroid stimulating hormone level is low. What clinical syndrome may this patient have?
Thyrotoxicosis - this refers to an excess of circulating thyroid hormones. The thyroid gland senses you have enough = low TSH.
A patient’s lab values presents with low radioactive iodine, T3 uptake, total and free T4. The thyroid stimulating hormone is elevated. What clinical syndrome is this?
Myxedema - a cause of untreated/poorly managed hypothyroidsim
the product of protein metabolism
Blood Urea Nitrogen
An elevation of blood urea nitrogen (BUN) is called? (medical term)
Azotemia
Causes of elevated blood urea nitrogen (BUN) or azotemia (DR HUBCAP)
Decreased water intake (Dehydration)
Renal Insufficiency
Hyperthyroidism decreased Urine flow (CHF) Blood in GI tract burns - increased protein Catabolism inhibition of Anabolism by corticosteroid drugs increased dietary intake of Protein
Causes of decreased blood urea nitrogen (BUN)
NOLL
Nephrosis (possible)
Over-hydration
Liver failure or hepatitis
Late Pregnancy
Why would a NP order a blood urea nitrogen level?
Assess renal function
Assess hydration
The more muscle mass correlates with what serum laboratory product and is a better measurement of renal impairment (“specific” test for renal impairment)
serum Creatinine - specific for renal impairment
elevation = FALLING glomerular fitration rate
Specificity versus Sensitivity of serum creatinine
Specificity - good, detects poor renal function by increasing
Sensitivity - not good, elderly (poor muscle mass) may have kidney damage without elevation. Overall, slow rise per day with moderately severe kidney damage
An increase in serum creatinine can indicate:
Renal impairment
Athlete - nonpathological elevation due to increased muscle mass
(decreases are NOT significant)
What laboratory value regulates and promotes neuromuscular activity, skeletal development, and blood coagulation?
Serum Calcium
child 10.6
adult 8.9 - 10.1
What laboratory value is controlled by the parathyroid hormone (PTH), calcitonin, adrenal steroids, and is absorbed best with vitamin D
Serum Calcium
child 10.6
adult 8.9 - 10.1
What are causes of elevated serum calcium?
D-MORPHIA
Diuretics (Hydrochlorothiazide slows/prevents Ca loss in urine)
Metastatic cancer Overuse/excess ingestion of antacids Renal disease (poor excretion) Parathyroid tumor & Paget's disease Hyperparathyroidism Immobility, prolonged Adrenal insufficiency
A decrease in serum calcium is caused by
Cushing’s syndrome
Hypothyroidism
Malabsorption
Why would a NP order a serum calcium
BAD AT
Blood clotting problems
Acid-base imbalance
Disorders - neuromuscular, skeletal, and endocrine
Arrhythmias
Tetany - muscle cramping
Negative ion present in blood and stomach controlled by renal excretion; regulated by aldosterone secondarily to regulation of sodium
Chloride 95-105
What is the primary cause of abnormal chloride levels?
the body responding to a shift in CO2 (carbon dioxide, increase = chloride decrease, CO2 decrease = chloride increase)
Causes of increased chloride levels
MD CANE
Metabolic Acidosis - body blowing off CO2
Dehydration from diarrhea
Cardiac disease
Anemia
Nephritis
Eclampsia
Hypochloremia is caused by
Diabetes GI loss - vomiting or gastric suction Thiazide Diuretic Fever Pneumonia CHF - dilutional hypochloremia
An intracellular cation that maintains electrical conduction within the cardiac and skeletal muscles.
Potassium 3.5 - 5.3
Hyperkalemia causes include
DKA Burns or crushing injuries Renal disorders Abnormal intake Medications Myocardial infarction (MI) or your specimen hemolyzed
What will the EKG show in a patient with hyperkalemia?
prolonged PR interval
wide QRS complex
ST-segment depression
tall, tented T-waves
What are causes of hypokalemia?
REM
Renal disorders
Excess licorice ingestion (aldosterone-like effect)
Medications
What will the EKG show in a patient with hypokalemia?
ST-segment depression
flattened T wave
U wave elevation
severe - ventricular fibrillation, respiratory paralysis, and cardiac arrest
Why would a NP want to know serum potassium levels?
CARD
Complaints of weakness, muscle cramps, or parathesias
Arrhythmias - can detect orgin
Renal function
Diuretics (thiazide or loop)
Maintains osmotic (pull) pressure of extracellular fluid, promotes neuromuscular function, and maintains acid-base balance
Sodium
Hypernatremia causes are
Aldosteronism
Inadequate water intake or Insensible loss (fever, sweat)
Excess intake
(dehydration, kidney dysfunction, diuretics, diarrhea)
Hyponatremia causes
Heart failure
Cirrhosis
Nephrotic Syndrome
(all three have elevated body water, but low circulating volume = ADH stimulation and water retention = sodium dilution
Diarrhea, Vomiting
Diuretics
Why would a NP monitor sodium levels
Disease monitoring: heart failure, liver disease, chronic renal failure
Edematous patient
Fluid and Electrolyte evaluation
Acid-base balance evaluation
Neuromuscular function evaluation
Lithium medication - can cause diabetes insipidus
What lab value is affected by red blood cells degradation and attaches to blood albumin
Bilirubin
How is bilirubin excreted? When bilirubin is above ___ jaundice is visible
bile - stool will have a PALE color when bile duct is obstructed
> 3
An increase in unconjugated or indirect bilirubin indicates
hepatic damage
hemolytic disease of newborn
sickle cell crisis
An increase in direct or conjugated bilirubin results from
obstruction
possible hepatic damage
Why would the NP order bilirubin levels?
Liver function evaluation
Biliary obstruction assessment
Hemolytic anemia assessment and diagnosis
Jaundice monitoring
Aids in differential diagnosis of jaundice
Phototherapy or transfusion needs - > 18 = exchange, possible brain damage
First line defense against bacteria & inflammation
50% - 70% total WBC
Neutrophils
Increase in chronic or viral infection or in leukemia
25-35% of total WBC
Lymphocytes
Secondline of defense
Stronger & longer lived than neutrophils
Respond to viral infections & chronic bacterial infections and inflammation
2 - 6% total WBC
Monocytes
Elevated in Allergies, parasite infections, and drug reactions
0-3% of WBC
Eosinophils
Similar to neutrophils. Play a role in preventing blood clotting, are elevated in allergic reactions and in hypothyroidism
1-3% of total WBC
Basophil
Immature or early stage neutrophils. These are elevated when the body is first launching a response to a bacterial or viral infection and are a sign of acute infection
0-5% of total WBC
Immature granulocytes (Bands)
Acute infection with an increase in bands.
Up in some leukemia & pernicious anemia
shift to left
An increase in mature neutrophils. Seen in diseases of liver
shift to right
