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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
unconjugated hyperbilirubinemia | without hemolysis
``` Newborns Transient Physiological jaundice Breast milk jaundice Crigler-najjar syndrome Types 1 & 2 ```
26
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
????
27
Hepatitis B Virus HBV
HBV surface antigen HBsAG followed by HBV e Antigen HBeAG Then HBV IgM antibody During recovery HBsAG & HBeAG disappear --- HBcIGM converts to negative
28
HBV Antibodies
All negative = never infected, no immz HBsAG & T-anti-HBc = Chronic HBsAG & T-HBC & IgM anti-HBC = Acute T-anti-HBC & anti-HBs = recovered
29
In acute hepatic failure how much does AST/ALT increase
100 fold increase for acute liver failure
30
Clotting factors and Liver failure
Liver produces clotting factors Liver failure can result in prolonged PT Vitamin K deficiency
31
Liver failure does what to BUN/Creatinine
Elevates them | decreased urine output
32
Cirrhosis
Ethanol abuse is the most common cause of cirrhosis in the western world 60-70%
33
Cirrhosis
Ethanol abuse is the most common cause of cirrhosis in the western world 60-70% Some can have end stage liver disease
34
Kidney (renal disease indications)
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
35
Hyaline casts
Not indicative of Renal disease
36
Cellular casts are most commonly the result of
ischemia infarction nephrotoxicity Acute tubular injury Casts are named after the cells they come from
37
Granular casts
Breakdown of other cells Can't distinguish between RBC or WBC
38
Red blood cell casts
from when there is intrarenal hemorrhage and the RBC's get caught up in the Tamm-Horsfall matrix
39
Fatty casts
Identified by the presence of refractile lipid droplets Thought to represent tubular degeneration
40
Waxy casts
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
41
Bilirubin in urine
Must be conjugated
42
Pseudo gout
Calcium crystals | affects knees
43
Cholesterol Crystals
Nephrotic syndrome
44
Cystine crystals
Proximal tubular defects | AA reabsorption
45
Leucine crystals
Liver disorders | impaired AA metabolism
46
Tyrosinemia
Liver disorders | impaired AA metabolism
47
Sulfonamide crystals
Due to Sulfa drugs not pathological can be linked to kidney stones
48
Indinavir crytals
HIV Meds
49
Normal crystals
``` Uric acid Ca oxalate Ca phosphate Ca carbonate Triple Phosphate Hippuric Ammonium Blurate ```
50
Abnormal Crystals
``` Bilirubin Cholesterol Cystine Leucine Tyrosine Sulfa Acyclovir Indinavir ```
51
Renal function is assessed by
Acid base and electrolyte balance K, cl, Ca, Na, CO2, HCO3 BUN, Cr, GLU Chem 20
52
Creatinine origin
Comes from creatine produced in the skeletal muscle, kidney and pancreas Then transported to the skeletal muscle and brain
53
Creatinine concentration in the blood
Inversely related to GFR
54
Creatinine clearance
Occurs in the kidney and is a suitable estimate of GFR | Universally accepted
55
Steady decline in GFR
Serve as precursor to end stage renal disease
56
GFR
The number of milliliters cleared by the kidneys per unit of time People 18 and over
57
GFR calculation
``` Urine Cr / Serum Cr X Urine Volume / Collection time X 1.73 / Body surface area = Corrected GFR ```
58
GFR adjustments for gender and race
``` 186(Serum Cr) -1.154 Exponent X Age -0.203 X F = eGFr ``` Females F = 0.742 African Americans F = 1.210
59
Stages of kidney damage
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
Urea
Produced by liver | Looks at ammonia and nitrogen content
61
BUN
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
What does BUN do if GFR decreases
BUN elevates
63
BUN / Cr ratio 20:1
``` If BUN alone or BUN and Cr are elevated and if BUN/Cr ratio is 20:1 = Prerenal azotemia ```
64
Prerenal Azotemia
Results from a reduction in GFR while the kidney tubules are functioning ``` Causes of prerenal azotemia include Dehydration Hemorrhage Heart failure hypoalbuminemia ```
65
BUN / Cr ratio 10:1
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
Proteinuria
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
Nephritis
Clinical syndrome of ``` Hypertension Mild edema mild proteinuria hematuria RBC casts ```
68
Protein in urine scale
``` 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
Albumin in urine
Minimal but persistent amounts of albumin in urine are associated with Diabetic nephropathy and hypertensive renal damage
70
Urinalysis
Examination of urine Physical Chemical microscopic contents UA should complement BUN and Cr testing
71
Urine color
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
Red urine =
Blood, Beets, medications
73
Brown or green urine
Elevated bilirubin and urobilirubin
74
Smokey or cloudy red brown urine =
intact RBC 's in urine
75
Orange Urine =
Rifampin, bilirubin, pyridinium
76
Black Urine
Alkaptonuria (when exposed to air)
77
Purple urine =
UTI | P. aeruginosa, E. Coli, klebsiella, Providencia stuartii, enterococcus
78
Cloudy urine
Crystals, phosphate, urates, RBC's, WBC's, Chyluria
79
Chyluria
Milky white fluid appearance in urine results from leakage from lymphatic leakage into the kidneys
80
Urine Ph
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
Exogenous causes of elevated urine pH
Uncapped urine can lose CO2 raising pH Urease producing organisms can cleave urea freeing ammonia that can raise urine pH
82
Specific gravity
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
Specific gravity | failure to concentrate urine can indicate
tubular disease central DI (ADH deficiency) Nephrogenic DI (ADH resistance) Drugs (i.e. Lithium) Chronic Hypokalemia Chronic Hypercalcemia
84
Urine Dipstick Test
``` 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
Unconjugated Hyperbilirubinemia with hemolysis Schistocytes present
Microangiopathic hemolytic anemia (Rule out DIC, TTP, HUS) Artificial heart valve (history of valve replacement) Autoimmune hemolytic anemia (Prefer Coombs Test)
86
Unconjugated Hyperbilirubinemia with hemolysis Schistocytes are not present
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
Tests for viral hepatitis HAV
HAV total antibody = past, present infection or immz HAV IGM = acute infection
88
Ammonia
Can be elevated in end stage renal disease
89
Tests for immune hepatitis
Positive for immune hepatitis Anti-nuclear antibody Anti-smooth muscle antibody Anti-LMK1 auto antibody
90
Alpha fetoprotein
Positive for hepatocellular carcinoma
91
IGM antibodies
Acute infection
92
HDV antibody
Past or present infection
93
HCV Anitbody
Past or present infection
94
HBV Antibodies & Antigens
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
BAP Plate
Different types of strep
96
Beta hemolysis
Ring around colony
97
Alpha hemolysis
Green colonies
98
Gamma hemolysis
Red colonies
99
MacConkey plate
Selective | only lets gram negative to grow
100
CNA plate
selective | Only lets gram positive grow
101
Chocolate plate
Good for haemophilus and Neisseria
102
Mannitol salt agar plate
Staph
103
MTM plate
Meningitis | Neisseria
104
Gram positive color
Purple
105
Gram negative color
Pink
106
Catalase on gram positive
Means staph (coagulase) Catalase negative is strep
107
Gram positive cocci and negative catalase, with Beta hemolysis
Strep pyrogenes Rheumatic fever Strep throat Strep agalactia Endocarditis
108
Gram negative | oxidase positive
N. meningitis Moraxella C. Eye, ear, Resp, CNS, joint infections
109
Gram negative rods
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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