GI labs Flashcards
CMP
what does it include
complete metabolic panel- Chem 14
includes:
- protein/albumin, globulin
- BILIRUBIN (TOTAL)
- ALKALINE PHOSTPHATES
- AST AND ALT
- electrolytes, chloride, CO2, glucose, urea nitrogen, creatinine
chem 7
basic metabolic panel= more expensive might as well do CMP
what are the electrolytes
na
k
ca
what is the process of hemoglobin breakdonwn
hemoglobin->heme -> biliveriden in spleen
biliverdin-> indirect bilirubin via enz reaction
indirect= unconjugated bilirubin
indirect-> direct bilirubin via liver
direct= conjugated bilirubin
direct-> excretion
bilirubin
product of hemoglobin breakdown
total bilirubin on CMP
what is not on CMP related to bilirubin
indirect/unconjugated bilirubin (UCB) AND direct/conjugated bilirubin (CB)
indirect= lipid soluble so cannot be excreted direct= water soluble= stored in gall- released via bile ducts to duodenum
have to order separate from CMP
what test would you run for a jaundice patient
check total bilirubin
if abnormal order indirect/direct bilirubin test
fractioned bilirubin tells us indirect vs direct
what is one way to check CB
conjugated bilirubin
can check in urine
icterus
jaundice eyes
if total bilirubin elevated
too much hemoglobin would increase both UCB and cB
cause
- hemolytic anemia
- DIC
- abnormal shape of RBCs
what does too much UCB indicate
problem in liver where conjugation occurs
would have low CB
hepatic or pre hepatic
what does increased total bilirubin with more than half conjugated indicate
problem with biliary obstruction
conjugation has occurred but CB not cleared from body
what two tests are deemed the liver funciton tests (LFT)
- aspartate aminotransferase (AST)
2. alanine aminotransferase (ALT)
what does AST tell us
found in metabolically active tissues
(heart muscle, liver cells, skeletal muscle, kidneys, pancreas, RBCs)
levels change frequently
what does ALT tell us
found in liver, kidneys, heart, skeletal muscle
ALT more specific for LIVER (ALT has an L)
and has a longer half life than AST
The L’s
-longer / liver
ULN
upper limit of normal
2-8x’s ULN of less of AST or ALT indicates what?
small elvation
small= fatty liver / NASH, meds
what does a 5-20 Xs ULN for AST and ALT indicate
likely acute viral hepatitis
what is ALP
what does it do
common causes
is it on CMP?
alkaline phosphate
found in bone, liver, biliary tract, epithelium !!!!
NONSPECIFIC!! (need additional tests to figure out what is causing elevation)
possible causes
- cirrhoiss, biliray obstruction, CHILD/TEEN GROWTH NORMAL, pagets, hyperthyroid, RA, rickets
ON CMP
what do you order to differentiate increased ALP between bone and liver
5-nucleotidase
indicative of liver
what is GGT and what does it test
is it on cmp?
gamma glutamyl transpeptidase
found in liver and biliary tract!!!
- helpful t order in follow up with increased ALP
sensitive test!
- esp for biliary obstruction or cholestasis and alcohol ingestion
not on cmp
what two pancreatic enzymes are commonly tested
are they included on the CMP
lipase and amylase - tests are usually ran together
NOT on CMP
increased levels indicate pancreatitis
what does lipase do
what is common to see with this enzyme
and what increases it
breaks down TG to fatty acids
Lipase levels increase LATER and remain LONGER (L’s again)
acute pancreatitis, renal failure, biliary intestinal conditions= increases
what does amylase do
breaks down carbohydrates
sensitive, not specific, rises quickly
can be normal in chronic pancreatitis, but increased with acute
also increased with peptic ulcers, bowel perf, etc
what is LDH
is it on CMP
lactate dehydrogenase
enzyme found in many tissues
not a very sensitive or specific test
not on cmp
what are the different protein tests
total protein
on cmp
what is included in total protein
when does it decrease
when does it increase
includes: albumin (60% of total protein) and globulins (rest of non albumin proteins)
decreases with liver disease, malnutrition, burns, protein loss, pregnancy
increases- dehydration
what is major role of albumin
oncotic pressure
if low= edema
what is major role of globulins
immunity
albumin
- how much of total protein is it
- where is it made
- when does it decrease
- increase?
60% of total protein
made in liver
decrease in disease, malnutrition, alcholism, nephrotic syndrome
increases: dehydration / diarrhea - not common
globulins
- types
- decreases with
- increases with
alpha and beta and gamma
immunoglobulins
decreases with= kidney or liver dz
increases with= inflammation, immune responses, malignancy
what labs do you run for general hepatitis as first line
liver status tests
-AST
-ALT
Alkaline phosphate
what labs do you run for viral hepatitis
check the antibodies associated
IgM forms early shows recent infection
IgG chronic past infections
also run surface antigens
for hep A what do you run
aka spread via fecal oral route
HAV-Ab IgM and HAV-Ab IgG
for Hep C which is transmitted via body fluids what labs
HCV-Ab (total)
or HCV-RNA (tests directly for virus RNA)
Hep B which is transmitted via body fluids what labs
HBV tests: surface
what tests are used for alcholism
AMMONIA : waste product that can be toxic to brain, normally processed for elimination of alcohol
- hard test to do bc sample must be iced or frozen
- increases with severe liver dysfunction
ETHANOL: blood or urine test to determine presence of alcohol
what is a malabsorption study
for celiac which is autoimmune rxn to gluten
test with serum antibody (igA)
what does serum antibody testing of IgA include
used in malabsorption study
anti tissue transglutaminase (anti-tTG IgA) most specific start here
anti endomysial Ab (EmA)
Gladin (deamidated gladin peptide DPG antibodies, anti glaidin ab)
what test would order for pt with jaundice
CMP
this has liver function tests on it (ALT, AST, alk phos)
what benefits do labs provide
diagnostic
what does AST, ALT and alk phos being elevated tell you
elevated liver enyzymes= being used more so metabolizing toxins
if alk phos is elevated check GGT = if normal look at the bones
