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IPA > GI labs > Flashcards

GI labs Flashcards

1
Q

CMP

what does it include

A

complete metabolic panel- Chem 14

includes:

  • protein/albumin, globulin
  • BILIRUBIN (TOTAL)
  • ALKALINE PHOSTPHATES
  • AST AND ALT
  • electrolytes, chloride, CO2, glucose, urea nitrogen, creatinine
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2
Q

chem 7

A

basic metabolic panel= more expensive might as well do CMP

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3
Q

what are the electrolytes

A

na
k
ca

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4
Q

what is the process of hemoglobin breakdonwn

A

hemoglobin->heme -> biliveriden in spleen

biliverdin-> indirect bilirubin via enz reaction
indirect= unconjugated bilirubin

indirect-> direct bilirubin via liver
direct= conjugated bilirubin

direct-> excretion

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5
Q

bilirubin

A

product of hemoglobin breakdown

total bilirubin on CMP

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6
Q

what is not on CMP related to bilirubin

A

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

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7
Q

what test would you run for a jaundice patient

A

check total bilirubin

if abnormal order indirect/direct bilirubin test

fractioned bilirubin tells us indirect vs direct

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8
Q

what is one way to check CB

A

conjugated bilirubin

can check in urine

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9
Q

icterus

A

jaundice eyes

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10
Q

if total bilirubin elevated

A

too much hemoglobin would increase both UCB and cB

cause

  • hemolytic anemia
  • DIC
  • abnormal shape of RBCs
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11
Q

what does too much UCB indicate

A

problem in liver where conjugation occurs
would have low CB

hepatic or pre hepatic

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12
Q

what does increased total bilirubin with more than half conjugated indicate

A

problem with biliary obstruction

conjugation has occurred but CB not cleared from body

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13
Q

what two tests are deemed the liver funciton tests (LFT)

A
  1. aspartate aminotransferase (AST)

2. alanine aminotransferase (ALT)

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14
Q

what does AST tell us

A

found in metabolically active tissues
(heart muscle, liver cells, skeletal muscle, kidneys, pancreas, RBCs)

levels change frequently

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15
Q

what does ALT tell us

A

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

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16
Q

ULN

A

upper limit of normal

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17
Q

2-8x’s ULN of less of AST or ALT indicates what?

small elvation

A

small= fatty liver / NASH, meds

18
Q

what does a 5-20 Xs ULN for AST and ALT indicate

A

likely acute viral hepatitis

19
Q

what is ALP

what does it do

common causes

is it on CMP?

A

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

20
Q

what do you order to differentiate increased ALP between bone and liver

A

5-nucleotidase

indicative of liver

21
Q

what is GGT and what does it test

is it on cmp?

A

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

22
Q

what two pancreatic enzymes are commonly tested

are they included on the CMP

A

lipase and amylase - tests are usually ran together

NOT on CMP

increased levels indicate pancreatitis

23
Q

what does lipase do

what is common to see with this enzyme

and what increases it

A

breaks down TG to fatty acids

Lipase levels increase LATER and remain LONGER (L’s again)

acute pancreatitis, renal failure, biliary intestinal conditions= increases

24
Q

what does amylase do

A

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

25
Q

what is LDH

is it on CMP

A

lactate dehydrogenase

enzyme found in many tissues

not a very sensitive or specific test

not on cmp

26
Q

what are the different protein tests

A

total protein

on cmp

27
Q

what is included in total protein

when does it decrease

when does it increase

A 
includes: albumin (60% of total protein)
and globulins (rest of non albumin proteins)

decreases with liver disease, malnutrition, burns, protein loss, pregnancy

increases- dehydration

28
Q

what is major role of albumin

A

oncotic pressure

if low= edema

29
Q

what is major role of globulins

A

immunity

30
Q

albumin

  • how much of total protein is it
  • where is it made
  • when does it decrease
  • increase?
A

60% of total protein

made in liver

decrease in disease, malnutrition, alcholism, nephrotic syndrome

increases: dehydration / diarrhea - not common

31
Q

globulins

  • types
  • decreases with
  • increases with
A

alpha and beta and gamma
immunoglobulins

decreases with= kidney or liver dz

increases with= inflammation, immune responses, malignancy

32
Q

what labs do you run for general hepatitis as first line

A

liver status tests
-AST
-ALT
Alkaline phosphate

33
Q

what labs do you run for viral hepatitis

A

check the antibodies associated

IgM forms early shows recent infection

IgG chronic past infections

also run surface antigens

34
Q

for hep A what do you run

aka spread via fecal oral route

A

HAV-Ab IgM and HAV-Ab IgG

35
Q

for Hep C which is transmitted via body fluids what labs

A

HCV-Ab (total)

or HCV-RNA (tests directly for virus RNA)

36
Q

Hep B which is transmitted via body fluids what labs

A

HBV tests: surface

37
Q

what tests are used for alcholism

A

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

38
Q

what is a malabsorption study

A

for celiac which is autoimmune rxn to gluten

test with serum antibody (igA)

39
Q

what does serum antibody testing of IgA include

used in malabsorption study

A

anti tissue transglutaminase (anti-tTG IgA) most specific start here

anti endomysial Ab (EmA)

Gladin (deamidated gladin peptide DPG antibodies, anti glaidin ab)

40
Q

what test would order for pt with jaundice

A

CMP

this has liver function tests on it (ALT, AST, alk phos)

41
Q

what benefits do labs provide

A

diagnostic

42
Q

what does AST, ALT and alk phos being elevated tell you

A

elevated liver enyzymes= being used more so metabolizing toxins

if alk phos is elevated check GGT = if normal look at the bones

IPA (14 decks)

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