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PAM Semester 2 > Diagnostics Lab Exam 3 > Flashcards

Diagnostics Lab Exam 3 Flashcards

1
Q

Two enzymes indicative of hepatocyte disease

A

AST
ALT

(also LD)

AST and ALT usually rise in tandem with liver disease
(Normally AST higher or equal)

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2
Q

Enzyme indicative of biliary tract disease

A

ALP (Can also come from bone)

also GGT and 5-NT

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3
Q

Major sources of ALT

A

Liver and kidneys

lesser amounts are from the skeletal and cardiac muscles

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4
Q

Chronic alcohol abuse Enzymes

A

AST (chronic liver disease)

Elevated to a greater extent than ALT (2 to 1)

(In the liver there is more AST but ALT is metabolized more slowly)

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5
Q

Lactate Dehydrogenase (LD or LDH)

A

LD 5 is the important one

Comes from Hepatocytes, Skeletal muscle & prostate
(when elevated, liver or skeletal, not really prostate)

LD is not favored for routine evaluation of liver

LD is released with injury of many different tissues

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6
Q

Enzyme marker of choice for skeletal muscle

A

CK

If CK is normal with elevated LD5,

skeletal muscle is not the source

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7
Q

What Viruses can LD be related to

A

SARS

MERS

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8
Q

Biliary tract disease

A

ALP for biliary tract disease

Greater increase than AST, ALT or LD

Other markers are
GGT and 5-NT

Used when there is technical difficulties with ALP

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9
Q

If bone is thought to be the source of the ALP

A

Use Bone ALP

BAP

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10
Q

GGT
(Gamma-Glutamyltransferase)
Sources

A

Sources are:

PCT of kidney
Liver
Pancreas
Intestines

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11
Q

GGT
(Gamma-Glutamyltransferase)
Elevated in

A

Alcohol use

Anticonvulsant use

(Not normally elevated in bone disease)

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12
Q

GGT

Gamma-Glutamyltransferase

A

ALP and GGT are compatible with
Biliary Tract disease

If ALP is elevated far higher than GGT
Sources such as bone should be looked at

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13
Q

ALT and AST
VS
ASP

A

Relative increases in ALT and AST

exceed the relative elevation of ASP

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14
Q

Acute reasons for liver disease
(Hepatocellular disease)
(Elevated AST & ALT)

A

Common Causes:
Viral hepatitis A. B & C
Alcoholic hepatitis
Toxic injury

Less common causes:
CMV
Epstein Barr virus
Autoimmune hepatitis (acute or chronic)

Other less common causes:
Viral hepatitis D, & E
Wilsons disease
Liver disease of pregnancy

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15
Q

Chronic reasons for liver disease (+ 6 months)
(Hepatocellular disease)
(Elevated AST & ALT)

A 
Alcoholic Liver Disease
Non alcoholic Fatty Liver Disease (NAFL)
Inborn Errors
Wilsons Disease
Gaucher Disease
Other chronic causes:
Viral Hepatitis B, C
Drug toxicity
Autoimmune Hepatitis
Hemochromatosis
Alpha 1 antitrypsin disease
Glycogen storage disease
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16
Q

Gaucher Disease

chronic liver disease

A

Genetic disorder

Hepatomegaly
Splenomegaly

Bruising, Bleeding

Fatigue, anemia, low platelet count

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17
Q

Wilsons Disease

Chronic Liver Disease

A

Genetic disorder

Copper build up in body

Symptoms are related to brain and liver

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18
Q

Biliary Tract Disease

A

Elevated ALP (exceeds the elevation of AST/ALT)

Failure of formation of bile ducts

Obstruction or destruction of bile ducts

Compression of bile ducts

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19
Q

Biliary Tract disease

Major manifestation of obstruction

A

Jaundice from elevated bilirubin

Total bilirubin exceeds 2 to 3 mg/dl

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20
Q

Unconjugated bilirubin formation

A

Derived from Hemoglobin in normal break down of RBC’s

RBC’s are broken down by macrophages in the spleen

Phagocytes metabolize hemoglobin into biliverdin and then finally bilirubin

Unconjugated bilirubin (not soluble) enters the blood stream

the unconjugated bilirubin is transported to the hepatocytes bound to albumin

Unconjugated bilirubin is not excreted in urine

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21
Q

Bilirubin formation

A

Unconjugated bilirubin is in the hepatocytes:

Inside the hepatocyte, glucuronide molecules are conjugated to bilirubin, making the bilirubin water soluble.

This is now conjugated bilirubin

It is then transported across the plasma membrane into the bile canaliculi.

Normally bilirubin is not excreted in the urine

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22
Q

Bilirubin concentration elevation

A

If the concentration of either conjugated or unconjugated gets too high

Skin & eyes can turn a yellow color
Jaundice or icterus

Pathologic elevation of conjugated (Water soluble) bilirubin can lead to bilirubin in the urine turning it yellow-brown or green-brown

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23
Q

Classifying hyperbilirubinemia

A

Conjugated

or

Unconjugated

When conjugated is 0.4 greater
it is conjugated hyperbilirubinemia

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24
Q

Unconjugated Hyperbilirubinemia

with hemolysis

A

Schistocytes present
Microangiopathic hemolytic anemia
Artificial heart valve
Autoimmune hemolytic anemia

Schistocytes are not present
Intra-marrow hemolysis
RBC Membrane defects
RBC Enzyme defects
Hemoglobinopathies

Schistocytes = Hemolyisis or heart valve

Non schistocytes = RBC Defects

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25
Q

unconjugated hyperbilirubinemia

without hemolysis

A 
Newborns
Transient
Physiological jaundice
Breast milk jaundice
Crigler-najjar syndrome Types 1 & 2
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26
Q

Exam 3 topics
Topics for exam 3

Know the microorganisms and tests that we discussed. Be able to pick out the organisms based on the tests we discussed as well as the types of infections they cause.

Know the tests we discussed for liver disease including hepatocellular and biliary causes

Be able to diagnose conditions based on urinalysis results

Know the chronic liver diseases we discussed including patient symptoms.

Know the fate of bilirubin as discussed in class

Know tables 16-5 and 16-8

Know the different types of casts and crystals as discussed in class

Know the different substances that can be found in urine and what the causes are for their presence. Also, what tests are used to measure these substances

Understand BUN and GFR

A

????

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27
Q

Hepatitis B Virus HBV

A

HBV surface antigen HBsAG
followed by HBV e Antigen HBeAG
Then HBV IgM antibody

During recovery HBsAG & HBeAG disappear
— HBcIGM converts to negative

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28
Q

HBV Antibodies

A

All negative = never infected, no immz

HBsAG & T-anti-HBc = Chronic

HBsAG & T-HBC & IgM anti-HBC = Acute

T-anti-HBC & anti-HBs = recovered

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29
Q

In acute hepatic failure how much does AST/ALT increase

A

100 fold increase for acute liver failure

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30
Q

Clotting factors and Liver failure

A

Liver produces clotting factors

Liver failure can result in prolonged PT
Vitamin K deficiency

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31
Q

Liver failure does what to BUN/Creatinine

A

Elevates them

decreased urine output

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32
Q

Cirrhosis

A

Ethanol abuse is the most common cause of cirrhosis in the western world
60-70%

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33
Q

Cirrhosis

A

Ethanol abuse is the most common cause of cirrhosis in the western world
60-70%

Some can have end stage liver disease

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34
Q

Kidney (renal disease indications)

A

malaise, headache, visual disturbances, N/V

Flank pain that radiates to the groin

Reduction in urine (<500 QD), Anuria (<100 QD)

Hematuria, RBC casts, WBC casts, proteinuria, Protein casts, Pyuria

discolored or odorous urine

> BUN/Cr

Electrolyte abnormalities

Bleeding, acidosis, anemia fractures, Malar rash, HTN

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35
Q

Hyaline casts

A

Not indicative of Renal disease

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36
Q

Cellular casts are most commonly the result of

A

ischemia
infarction
nephrotoxicity

Acute tubular injury

Casts are named after the cells they come from

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37
Q

Granular casts

A

Breakdown of other cells

Can’t distinguish between RBC or WBC

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38
Q

Red blood cell casts

A

from when there is intrarenal hemorrhage and the RBC’s get caught up in the Tamm-Horsfall matrix

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39
Q

Fatty casts

A

Identified by the presence of refractile lipid droplets

Thought to represent tubular degeneration

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40
Q

Waxy casts

A

Final stage of cast degeneration

Indicate tubular injury of a more chronic nature

likely associated with low urine flow

These are always of pathological significance

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41
Q

Bilirubin in urine

A

Must be conjugated

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42
Q

Pseudo gout

A

Calcium crystals

affects knees

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43
Q

Cholesterol Crystals

A

Nephrotic syndrome

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44
Q

Cystine crystals

A

Proximal tubular defects

AA reabsorption

45
Q

Leucine crystals

A

Liver disorders

impaired AA metabolism

46
Q

Tyrosinemia

A

Liver disorders

impaired AA metabolism

47
Q

Sulfonamide crystals

A

Due to Sulfa drugs
not pathological
can be linked to kidney stones

48
Q

Indinavir crytals

A

HIV Meds

49
Q

Normal crystals

A 
Uric acid
Ca oxalate
Ca phosphate
Ca carbonate
Triple Phosphate
Hippuric
Ammonium Blurate
50
Q

Abnormal Crystals

A 
Bilirubin
Cholesterol
Cystine
Leucine
Tyrosine
Sulfa
Acyclovir
Indinavir
51
Q

Renal function is assessed by

A

Acid base and electrolyte balance
K, cl, Ca, Na, CO2, HCO3

BUN, Cr, GLU

Chem 20

52
Q

Creatinine origin

A

Comes from creatine
produced in the skeletal muscle, kidney and pancreas

Then transported to the skeletal muscle and brain

53
Q

Creatinine concentration in the blood

A

Inversely related to GFR

54
Q

Creatinine clearance

A

Occurs in the kidney and is a suitable estimate of GFR

Universally accepted

55
Q

Steady decline in GFR

A

Serve as precursor to end stage renal disease

56
Q

GFR

A

The number of milliliters cleared by the kidneys per unit of time

People 18 and over

57
Q

GFR calculation

A 
Urine Cr / Serum Cr
X
Urine Volume / Collection time
X
1.73 / Body surface area
=
Corrected GFR
58
Q

GFR adjustments for gender and race

A 
186(Serum Cr) -1.154 Exponent
X 
Age -0.203
X
F 
= eGFr

Females F = 0.742

African Americans F = 1.210

59
Q

Stages of kidney damage

A

0 = >90 = Normal kidney function

1 = >90 = Kidney damage despite normal GFR

2 = 60-89 = Mild GFR decrease with kidney damage

3 = 30-59 = Mod decrease in GFR

4 = 15-29 = Sever decrease in GFR

5 = <15 = Renal failure = Dialysis/Transplant

60
Q

Urea

A

Produced by liver

Looks at ammonia and nitrogen content

61
Q

BUN

A

Urea measured in serum or plasma (not whole blood)

Affected by state of hydration, protein intake and presence of blood in GI tract

BUN can decrease with liver failure or malnutrition
leading to decreased urea production

62
Q

What does BUN do if GFR decreases

A

BUN elevates

63
Q

BUN / Cr ratio 20:1

A 
If BUN alone
or
BUN and Cr are elevated
and if
BUN/Cr ratio is 20:1
=
Prerenal azotemia
64
Q

Prerenal Azotemia

A

Results from a reduction in GFR
while the kidney tubules are functioning

Causes of prerenal azotemia include
Dehydration
Hemorrhage
Heart failure
hypoalbuminemia
65
Q

BUN / Cr ratio 10:1

A

BUN and Cr are elevated at 10:1

Renal azotemia (insufficient filtering)

(assuming a chronic urinary tract obstruction had been excluded)

If chronic, not likely dehydration

66
Q

Proteinuria

A

Greater than 1 g per day is considered clinically significant

Greater than 3.5 g per day is consistent with nephrotic syndrome

Many causes which include
Primary and secondary cause

Primary causes include:
Glomerulonephritis, Neuropathy, Glomulerosclerosis

Secondary causes include:
Drug use, lupus, HIV, HBV, Syphilis, malaria DM, etc

67
Q

Nephritis

A

Clinical syndrome of

Hypertension
Mild edema
mild proteinuria
hematuria
RBC casts
68
Q

Protein in urine scale

A 
Protein= (mg/dl)
Negative
trace = 10-20
\+1 = 30
\+2 = 100
\+3 = 300
\+4 = 1000-2000

Done with urine dipstick
or 24 hour urine

69
Q

Albumin in urine

A

Minimal but persistent amounts of albumin in urine

are associated with

Diabetic nephropathy and hypertensive renal damage

70
Q

Urinalysis

A

Examination of urine

Physical
Chemical
microscopic contents

UA should complement BUN and Cr testing

71
Q

Urine color

A

Normal straw colored
Color produced by urobilin

Elevated bilirubin and urobilirubin
can be brown or green

Red urine = Blood, Beets, medications

Smokey or cloudy red brown = intact RBC ‘s in urine

Orange Urine = Rifampin, bilirubin, pyridinium

Black Urine = Alkaptonuria (when exposed to air)

Purple urine = UTI (P. aeruginosa, E. Coli, klebsiella, Providencia stuartii, enterococcus)

Cloudy urine = Crystals, phosphate, urates, RBC’s, WBC’s, Chyluria

72
Q

Red urine =

A

Blood, Beets, medications

73
Q

Brown or green urine

A

Elevated bilirubin and urobilirubin

74
Q

Smokey or cloudy red brown urine =

A

intact RBC ‘s in urine

75
Q

Orange Urine =

A

Rifampin, bilirubin, pyridinium

76
Q

Black Urine

A

Alkaptonuria (when exposed to air)

77
Q

Purple urine =

A

UTI

P. aeruginosa, E. Coli, klebsiella, Providencia stuartii, enterococcus

78
Q

Cloudy urine

A

Crystals, phosphate, urates, RBC’s, WBC’s, Chyluria

79
Q

Chyluria

A

Milky white fluid appearance in urine

results from leakage from lymphatic leakage into the kidneys

80
Q

Urine Ph

A

Altered pH can be associated with
Metabolic acidosis or alkalosis

Fresh normal urine should be 5.0-6.5

pH over 8.0 suggests delayed analysis

Uncapped urine can lose CO2 raising pH

Urease producing organisms can cleave urea freeing ammonia that can raise urine pH

81
Q

Exogenous causes of elevated urine pH

A

Uncapped urine can lose CO2 raising pH

Urease producing organisms can cleave urea freeing ammonia that can raise urine pH

82
Q

Specific gravity

A

Urine specific gravity =
the weight of urine to the weight of an equal amount of water

Provides an assessment of capacity of the renal tubules

Normal should be 1.003 -1.035

Presence of glucose, protein, blood can elevate it

83
Q

Specific gravity

failure to concentrate urine can indicate

A

tubular disease

central DI (ADH deficiency)

Nephrogenic DI (ADH resistance)

Drugs (i.e. Lithium)

Chronic Hypokalemia

Chronic Hypercalcemia

84
Q

Urine Dipstick Test

A 
Blood (Hemoglobin, RBC, myoglobin)
Nitrites (bacteria)
Glucose
Bilirubin (hemolysis, biliary obstruct, liver dysfunction)
Urobilirubin (Liver disease)
Leukocyte esterase (WBC's)
Ketones (DM)

BNG BULK

85
Q

Unconjugated Hyperbilirubinemia
with hemolysis
Schistocytes present

A

Microangiopathic hemolytic anemia
(Rule out DIC, TTP, HUS)

Artificial heart valve
(history of valve replacement)

Autoimmune hemolytic anemia
(Prefer Coombs Test)

86
Q

Unconjugated Hyperbilirubinemia
with hemolysis
Schistocytes are not present

A

Intra-marrow hemolysis
(Rule out B12 deficiency)

RBC Membrane defects
(Look for spherocytes/ elliptocytes)

RBC Enzyme defects
(Look for bite cells, Check G6PD)

Hemoglobinopathies
(Perform Hemoglobin analysis)

87
Q

Tests for viral hepatitis

HAV

A

HAV total antibody = past, present infection or immz

HAV IGM = acute infection

88
Q

Ammonia

A

Can be elevated in end stage renal disease

89
Q

Tests for immune hepatitis

A

Positive for immune hepatitis

Anti-nuclear antibody
Anti-smooth muscle antibody
Anti-LMK1 auto antibody

90
Q

Alpha fetoprotein

A

Positive for hepatocellular carcinoma

91
Q

IGM antibodies

A

Acute infection

92
Q

HDV antibody

A

Past or present infection

93
Q

HCV Anitbody

A

Past or present infection

94
Q

HBV Antibodies & Antigens

A

HBV surface antibody = chronic, past or immz

HBV e antibody = Chronic or past infection

HBV core total antibody= Present or past infection

HBV e antigen = Acute/chronic infection
(with increased infectivity)

HBV surface antigen = Acute/chronic infection

95
Q

BAP Plate

A

Different types of strep

96
Q

Beta hemolysis

A

Ring around colony

97
Q

Alpha hemolysis

A

Green colonies

98
Q

Gamma hemolysis

A

Red colonies

99
Q

MacConkey plate

A

Selective

only lets gram negative to grow

100
Q

CNA plate

A

selective

Only lets gram positive grow

101
Q

Chocolate plate

A

Good for haemophilus and Neisseria

102
Q

Mannitol salt agar plate

A

Staph

103
Q

MTM plate

A

Meningitis

Neisseria

104
Q

Gram positive color

A

Purple

105
Q

Gram negative color

A

Pink

106
Q

Catalase on gram positive

A

Means staph
(coagulase)

Catalase negative is strep

107
Q

Gram positive cocci and negative catalase, with Beta hemolysis

A

Strep pyrogenes
Rheumatic fever
Strep throat

Strep agalactia
Endocarditis

108
Q

Gram negative

oxidase positive

A

N. meningitis

Moraxella C.
Eye, ear, Resp, CNS, joint infections

109
Q

Gram negative rods

A

Klebsiella
Lungs, brain, eyes, bladder, blood, wounds, liver

Proteus
UTI’s, catheters, Elderly

Serratia
Teeth, Resp, eyes, UTI, wound

Pseudomonas A.
Hospital acquired
Ventilator associated pneumonia
Sepsis
Resistant forms

PAM Semester 2 (22 decks)

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