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Clinical Chemistry II - 4378 > LAB Exam 1 > Flashcards

LAB Exam 1 Flashcards

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1
Q

What are the different methods for testing glucose?

A
  • Oxidation Reduction
  • Condensation reaction
  • Enzymatic reactions (3 types)
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2
Q

What are the three glucose enzymatic reactions?

A
  • Hexokinase (reference method)
    – Glucose oxidase-colorimetric (Influenced by heparin)
    – Glucose oxidase- polargraph (Influenced by heparin)
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3
Q

-Type of glucose Redox reaction that is not often used.
-Copper sulfate + Glucose –> Copper II oxide + Glucose-Na
-(In alkaline conditions & heat)

A

Benedicts- semi quantitative

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4
Q

-Glucose redox reaction
-Copper sulfate + Glucose —–> Copper II oxide + Glucose-Na
-Copper II oxide + phosphomolybdate —-> molybdenum blue

A

Folin Wu

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5
Q

Folin Wu reaction:

protein precipitation is….

A

Tungstic acid

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6
Q

Glucose redox reaction that uses Zinc sulfate and barium hydroxide

A

Somogyi Nelson

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7
Q

-Glucose redox reaction
-Ferric cyanide + Glucose —-> Ferrous cyanide (red color)

A

Automated Hagedorn Jensen

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8
Q

Condensation Reaction:

___________ condenses w/ Glucose in presence of Glacial acetic (hot)
producing blue green color (630 nm)

A

Ortho Toluidine

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9
Q

The condensation reaction for glucose can react with other aldoses like….

A

galactose and mannose

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10
Q

What kind of reactions are the most commonly used for testing glucose?

A

Enzymatic Reactions

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11
Q

Enzymatic Reaction:

Glucose + ATP ! G-6-P + ADP
G-6-P + NADP+ —> NADPH + 6-phosphogluconase

A

Hexokinase (reference method)

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12
Q

Enzymatic Reaction:

-Glucose + O2 —-> gluconic acid + H2O2
-H2O2 + Chromogenic peroxidase —-> Color + H20

A

Glucose Oxidase-colorimetric method (influenced by heparin)

-what we use in lab

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13
Q

Enzymatic Reaction:

Glucose + O2 —-> gluconic acid + H2O2

A

Glucose Oxidase- Polarography (influenced by heparin)

-needs electric current

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14
Q

What are the four lipid tests?

A
  • TRIGLYCERIDES
  • CHOLESTEROL
  • HDL ASSAYS
  • PHOSPHOLIPIDS
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15
Q

Why is TG testing done?

A

To calculate LDL using [LDL= total cholesterol-HDL-VLDL]
“ Friedewald equation”
-Assessment for CHD risk

-Determine whether increased TG are depressing HDL

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16
Q

High TG increases the risk of…

A

pancreatitis & numerous other clinical manifestations

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17
Q

How is TG and HDL related?

A

inversely related

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18
Q

What are the assays done for TG?

A

✓Hantzsch condensation
✓Sulfuric acid reaction
✓Pyruvate kinase/lactate dehydrogenase
✓Glycerol phosphate dehydrogenase/Diaphorase

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19
Q

What is the most frequently used “chemical” reaction for TG?

A

HANTZSCH CONDENSATION

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20
Q

Hantzsch condensation involves quantification of ________ using multiple steps

❖Organic extraction of TG
❖Chemical hydrolysis of TG to glycerol & FFA
❖Oxidation of glycerol to formaldehyde

A

glycerol

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21
Q

formaldehyde condenses with NH4+-Ac & acetylacetone to
form product which is measured between _____ and _____nm.

A

400 and 485nm

product measured is 3,5-DIACETYL-1,4-DIHYDROTOLUDINE

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22
Q

What are the first three steps of the Sulfuric acid reaction?

A

extraction, acidic/alkaline hydrolysis, & oxidation of glycerol

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23
Q

Sulfuric acid reaction:

utilizes chromotropic acid & sulfuric acid to produce a colored product upon reaction with formaldehyde

A

Eegriwe’s reaction

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24
Q

TRIGLYCERIDES —> GLYCEROL + 3 FATTY ACIDS (LIPASE)

GLYCEROL + ATP —> GLYCEROL-3-PHOSPHATE + ADP (GLYCEROL KINASE)

ADP + PEP —-> ATP + PYRUVATE (PYRUVATE KINASE)

PYRUVATE + NADH + H+ —-> LACTATE + NAD+ (LACTATE DEHYDROGENASE)

A

PYRUVATE KINASE/LACTATE DEHYDROGENASE

-frequently used assay

-enzymatic method for quantifying glycerol is multistep and measures NADH consumption

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25
Q

PYRUVATE KINASE/LACTATE DEHYDROGENASE:

NADH is measured at _____ nm.

A

340

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26
Q

PYRUVATE KINASE/LACTATE DEHYDROGENASE:

What are the advantages?

A

1) Rapid and specific
2) Eliminates the need for extraction and caustic solvents

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27
Q

PYRUVATE KINASE/LACTATE DEHYDROGENASE:

What are the disadvantages?

A

1) Instability of enzymes and reagents in working solution.
2) Serum blank must be included to subtract nonspecific absorption of various serum
components.

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28
Q

PYRUVATE KINASE/LACTATE DEHYDROGENASE:

When is a serum blank needed?
How are results calculated?

A

Needed when sample: Hemolysis, Icteric, lipemic conditions

water blank results - sample blank results = true O.D.

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29
Q

enzymatic method which employs the use of the same first two steps as the NADH consumption method.

A

FORMAZAN (COLORIMETRIC)

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30
Q

GLYCEROL-3-PHOSPHATE + NAD+ —> DHAP + NADH (GLYCEROL PHOSPHATE DEHYDROGENASE)

NADH + OXIDIZED TETRAZOLIUM —-> REDUCED TETRAZOLIUM (DIAPHORASE)

A

FORMAZAN (COLORIMETRIC)

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31
Q

employs only lipase/protease step to produce glyceride glycerol

A

FLUORIMETRIC METHOD

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32
Q

GLYCEROL-3-PHOSPHATE + NAD+ —> DHAP + NADH (GLYCEROL PHOSPHATE DEHYDROGENASE)

NADH + RESAZURIN —-> RESORUFIN (DIAPHORASE)

A

FLUORIMETRIC METHOD

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33
Q

TG:

Plasma or serum samples must be from fasting individuals that have not ingested ALCOHOL for greater than ____ hours

A

36

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34
Q

_______ TG values are 2 to 4% lower than serum because of dilution effect of
drawing water from red blood cells by the anticoagulant.

A

Plasma

-remove the RBC from the plasma immediately

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35
Q

What is the anticoagulant of choice for TG testing?

What should not be used?

A

EDTA

Do not use glycerin coated vacutainers & care should be taken to avoid hand and
body creams containing glycerol

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36
Q

What may interfere with TG assays?

A

Hemolysis, icterus and lipemia

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37
Q

What is the sample storage for TG testing?

A

-samples should be analyzed ASAP
-or freeze at -60 degrees Celsius

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38
Q

What are the cholesterol methods?

A
  • LIEBERMAN BURCHARD
  • SALKOWSKI
  • CHOLESTEROL OXIDASE/PEROXIDASE
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39
Q
  • Described in 1885 (modified in 1889)
  • Common method and still in use today
A

LIBERMAN BURCHARD

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40
Q

Cholesterol Extraction,
* React with sulfuric acid & acetic anhydride [sequential oxidation of cholesterol]
* yields a blue-green cholesta-hexene-sulfonic acid

A

LIBERMAN BURCHARD

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41
Q

LIBERMAN BURCHARD:

FREE CHOLESTEROL=

A

TOTAL CHOLESTEROL - ESTERIFIED CHOLESTEROL

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42
Q

LIBERMAN BURCHARD:

What are the disadvantages?

A

1) DIFFERENT ESTERIFIED CHOLESTEROLS YIELD INCREASED COLOR INTENSITIES OF THE
CHROMAGENS.
2) INTERFERENCES INCLUDE BILIRUBIN & UNREACTED DIGOXIN

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43
Q

-Chemical reaction first described in 1872
* Sample is extracted with chloroform

-Addition of sulfuric acid changes the solution from BLUISH RED to VIOLET RED

A

CHOLESTEROL: SALKOWSKI

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44
Q

Salkowski:

addition of sulfuric acid changes the solution from __________ to _________.

A

bluish red, violet red

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45
Q

Ferric chloride in Sulfuric acid was added to the Cholesterol in Acetic acid

A

Zlatkis and Boyle (1953) automated procedure

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46
Q

Zlatkis and Boyle (1953) automated procedure:

Ferric chloride in Sulfuric acid was added to the Cholesterol in Acetic acid to give…

A

a more intense and stable magenta color

‣ Modification is 7x more sensitive than the Burchard method

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47
Q

What is the most popular and accurate method for measuring cholesterol?

A

CHOLESTEROL OXIDASE / PEROXIDASE

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48
Q

CHOLESTEROL OXIDASE / PEROXIDASE:

ESTERIFIED CHOLESTEROL –> CHOLESTEROL + FA (__________)

CHOLESTEROL + O2 —> CHOLEST-4-EN-3-ONE + PEROXIDE (__________)

PEROXIDE + PHENOL + 4-AMINOPHENAZONE —> QUINOEIMINE + H2O

A

CHOLESTEROL ESTERASE

CHOLESTEROL OXIDASE

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49
Q

CHOLESTEROL OXIDASE / PEROXIDASE:

advantages?

A

INCREASED SPECIFICITY & NO HARSH REAGENTS

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50
Q

CHOLESTEROL OXIDASE / PEROXIDASE:

disadvantages?

A

PEROXIDASE REACTION IS INHIBITED BY BILIRUBIN & SURFACTANTS

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51
Q

What specimen type is used for cholesterol testing?

anticoagulant?

A

Serum or plasma

EDTA

-Others tend to cause large water shifts from the RBC to
the plasma

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52
Q

Cholesterol testing:

Should it be a fasting sample?

A

-12 hour fasting sample suggested
-Cholesterol NOT directly affected by diet, except
in patients with very high TG

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53
Q

What is important during the cholesterol sample draw?

A

-Posture is important during the draw because there can be as much as a 10 to 15% decrease after patient switches from standing to reclined position
- Prolonged tourniquet use increases lipids.

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54
Q

What is the sample storage for cholesterol?

A
  • PERFORM ASSAYS AS SOON AS POSSIBLE
  • IF THERE IS A DELAY, SAMPLE MUST BE FROZEN AND STORED AT -60°C (VORTEX SAMPLE WELL UPON THAWING)
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55
Q

HDL cholesterol is quantified by what two methods?

A
  • APOLIPOPROTEIN B PRECIPITATION
  • ELECTROPHORESIS
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56
Q
  • Lipoproteins are precipitated using low-density apoB lipoproteins (except HDL) with ________ solutions
A

polyanion

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57
Q

HDL- APO B PRECIPITATION:

agents include…

A

▪ HEPARIN-MANGANESE CHLORIDE
▪ DEXTRAN SULFATE- MAGNESIUM CHLORIDE
▪ SODIUM PHOSPHOTUGSTATE
▪ POLYETHYLENE GLYCOL
▪ VARIATION-DEXTRAN-SULFATE WITH IRON ATTACHED (PPT W/MAGNET)

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58
Q

HDL- APO B PRECIPITATION:

What is the reference method?

A

HEPARIN-MANGANESE CHLORIDE

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59
Q

HDL- APO B PRECIPITATION:

Good Specificity for HDL

A

DEXTRAN SULFATE- MAGNESIUM CHLORIDE

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60
Q

HDL- APO B PRECIPITATION:

Problem w/ Reagent Stability

A

SODIUM PHOSPHOTUGSTATE

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61
Q

HDL- APO B PRECIPITATION:

Problems w/ Accuracy

A

POLYETHYLENE GLYCOL

62
Q

HDL- APO B PRECIPITATION:

advantages?

A

SIMPLE, FAST, AND INEXPENSIVE

63
Q

HDL- APO B PRECIPITATION:

disadvantages?

A

TENDENCY TO UNDERESTIMATE HDL

64
Q

What are the HDL-CHOLESTEROL: ELECTROPHORESIS methods?

A

❖ STARCH BLOCK & GEON-PEVIKON BLOCK ELECTROPHORESIS
❖ AGAROSE GEL ELECTROPHORESIS
❖ POLYACRYLAMIDE GEL ELECTROPHORESIS

65
Q
  • SEPARATION OF LIPOPROTEINS BASED ON SIZE & NET CHARGE
    ✓HDL MIGRATES THE FASTEST
    ✓USED FOR ISOLATING LARGE QUANTITIES OF HDL BUT RARELY USED CLINICALLY
A

STARCH BLOCK & GEON-PEVIKON BLOCK ELECTROPHORESIS

66
Q

✓SAME PRINCIPLE AS BLOCK ELECTROPHORESIS, but WITH A DIFFERENT RESOLUTION MATRIX
* AFTER SEPARATION, AGAROSE GEL OVERLAYED WITH ENZYME REAGENTS FOR DETECTING
CHOLESTER. AGAROSE STRIPS ARE SCANNED USING DENSITOMETER
* NOT USED FOR ROUTINE ANALYSIS BECAUSE OF LOW RESOLUTIONS

A

AGAROSE GEL ELECTROPHORESIS

67
Q

❖DATA WITH THIS TECHNIQUE CORRELATES WELL WITH ULTRACENTRIFUGATION

A

POLYACRYLAMIDE GEL ELECTROPHORESIS

68
Q

Specimen collection and handling for HDL cholesterol?

A
  • Patient should fast for 12 hours, although in most cases fasting does not affect HDL cholesterol
  • All other conditions are the same as for total cholesterol
69
Q

What are the two types of liver function tests?

A
  1. Intravascular injection of dye (indocyanine green) that is processed solely through
    liver (bile).
    i. Serum clearance of dye monitored
  2. Injection of drugs to monitor liver’s ability to metabolize drugs
    - Appearance of modified drugs in serum or urinary excretion
70
Q

Intravascular injection of dye liver test:

Normal is ____ % dye remaining after 45 minutes.

A

<5

71
Q

Intravascular injection of dye liver test:

Higher retention times are indicative of…

A

hepatocellular disease or obstructive liver disease.

72
Q

Why is Bromsulphalein (BSP) no longer used for intravascular injections?

A

due to “ANAPHYLAXIS”

73
Q

Analytes for liver function tests?

A

▪ Enzymes
▪ Bilirubin
▪ Cholesterol
▪ Bile acids
▪ Serum proteins
▪ Urea and ammonia

74
Q

Analyte that is helpful in differentiating the cause of jaundice*

A

BILIRUBIN

75
Q
  • 1) increased unconjugated bilirubin due to hemolysis; 2) serum bilirubin may be slightly increased, but liver will excrete large amounts of bile. 3) Increased urobilinogen in urine and feces. Urinary bilirubin will be absent.
A

Pre hepatic cause of jaundice

76
Q

intermediate pattern, 1) unconjugated & conjugated bilirubin increased.
2) Fecal concentration of urobilinogen decreased but 3) conjugated bilirubin
increased in urine.

A

Hepatic cause of jaundice

-Hepatocellular damage / Bile excretion defect

77
Q

1) increased conjugated bilirubin; serum conjugated bilirubin increased because of decreased biliary excretion. 2) Urobilinogen is decreased but bilirubin can now be detected in urine.

A

Post hepatic cause of jaundice

78
Q

BILIRUBIN METHODOLOGY, what are the different types?

A

▪ Evelyn-Mallory
▪ Jendrassik-Groff
▪ Bilirubin oxidase
▪ HPLC
▪ Jackson Bilirubinometer
▪ Urine Bilirubin
▪ Bilirubin in amniotic fluid

79
Q

Van den Bergh first discovered that bilirubin in serum reacted with ________ reagents

A

diazo

80
Q

Reactions conducted directly on serum were hence called “direct” bilirubin measurements
(actually measures ____________ bilirubin and δ-bilirubin)

A

hydrophilic conjugated

81
Q

1883: Ehrich: Bilirubin (Urine) + ____________ —-> color

A

Diazotized Sulfanilic acid

82
Q
  • Unconjugated bilirubin (associated with albumin) required an “accelerator” (ex. Methanol) to dissociate from protein and solubilize bilirubin. Bilirubin that requires solvent is known as…
A

“indirect” bilirubin

83
Q

Bilirubin + diazotized sulfanilic acid —-> 2 molecules azobilirubin

A

BILIRUBIN METHODOLOGY: EVELYN-MALLORY

84
Q

“Direct” reaction performed at pH 1.2-azobilirubin (red purple) absorbs at 560nm in absence of solvent

A

BILIRUBIN METHODOLOGY: EVELYN-MALLORY

85
Q

EVELYN-MALLORY:

Total measurement conducted in presence of…

A

Methanol, urea, or DMSO

Total – “direct” = “indirect”

86
Q

What are the interferences with EVELYN-MALLORY method?

A

hemoglobin

87
Q

What is the modified test of Evelyn-Mallory?
What is different?

A

JENDRASSIK-GROFF

“Direct” reaction carried out at pH 6.5 (NaOH used to alkalinize reaction) yields more intense blue color at 600nm

88
Q

JENDRASSIK-GROFF:

Total measurement conducted in presence of…

A

sodium benzoate, caffeine, methanol, urea or DMSO.

89
Q

JENDRASSIK-GROFF:

Total, indirect….

A

Serum (plasma) + Sodium acetate with caffeine-sodium benzoate

90
Q

Enzymatic method that uses bilirubin oxidase to catalyze oxidation of bilirubin to biliverdin

A

BILIRUBIN OXIDASE

91
Q

What absorbance is Bilirubin oxidase testing measured at?

A

decreased absorbance monitored at 405-460 nm

92
Q

BILIRUBIN OXIDASE:

Total bilirubin measured upon addition of detergent (____ or _______) added to
dissociate bilirubin

A

SDS or Na-cholate

93
Q

-pH of reaction manipulated to monitor conjugated bilirubin.
▪ Relatively new method, with promise of improved specificity and high precision

A

BILIRUBIN OXIDASE

94
Q

What does HPLC stand for?
What is it used for?

A

High Pressure Liquid Chromatography developed to separate methyl esters of
conjugated & unconjugated bilirubin.

95
Q

HPLC:

Column elute is measured at ____ nm

A

430

96
Q

Only means for accurate quantitation of bilirubin fractions.
Interfering compounds are removed.

A

HPLC

97
Q

HPLC:

α:
β:

A

α: unconjugated
β: monoglucuronide

98
Q

HPLC:

γ:
δ:

A

γ: diglucuronide
δ: irreversibly bound to albumin

99
Q

Direct spectrophotometric measurement of bilirubin at 454 nm

A

JACKSON BILIRUBINOMETER

100
Q

JACKSON BILIRUBINOMETER:

What is the drawback?

A

HbO2 absorbs at 454 nm, but HbO2 also absorbs at 540 nm
Bilirubin level obtained by subtracting HbO2 contribution.*

101
Q

Good screening method for neonates to 3 mo.; do not have significant carotenoids

A

JACKSON BILIRUBINOMETER

102
Q

JACKSON BILIRUBINOMETER:

Interference?

A

carotenoids absorb in same region and falsely elevate bilirubin levels.

103
Q

In urine the only concern is __________ bilirubin

A

“direct”

104
Q

What are the two methods to measure urine bilirubin?

A
  1. Dipstick- Ehrlich diazo reagent
  2. Ictotest- uses p-nitrobenzene diazonium p-toluenesulfonate
105
Q

What is the most sensitive test to measure urine bilirubin?

A

Ictotest (2-4 times more sensitive than dipstick)

106
Q

Conjugated Bilirubin + diazonium salt —-> azobilirubin (brown)

A

Dipstick- Ehrlich diazo reagent (2,4-dichloroaniline diazonium salt)

107
Q

Bilirubin in amniotic fluid is measured by ________ spectrophotometric technique

A

DIRECT

108
Q

High levels of bilirubin in Amniotic Fluid can indicate…

A

hemolytic disease

-Most often associated with Rh incompatibility

109
Q

Specimen storage for bilirubin testing?

A

Samples are stable in dark for 2 days at RT, 4 days at 4 degree C and indefinitely at -20 °C.

110
Q

Bilirubin testing:

Specimen should be protected from direct light.
▪ ___________ and ________ may effect determinations.

A

Hemolysis, lipidemia

111
Q

Why is serum preferred for bilirubin testing?

A

proteins in plasma are likely to interfere with Evelyn-Malloy procedure

112
Q

Infections precipitate ____% of hyperosmolar hyperglycemic states (HHS)

A

40-60

113
Q

Major differences between HHS and other metabolic crises associated with diabetes?

A

-HHS is typically in older pts
-HHS is often precipitated by an infection
-acidosis does not occur in HHS, but still present with severe hyperglycemia

114
Q

symptoms of HHS and DKA?

A

HHS- extreme thirst, dry mouth, dehydration
DKA- nausea vomiting

115
Q

What is the diagnostic criteria for hyperosmolar hyperglycemic state?

A

-Hyperglycemia- plasma glucose of grater than 600 mg/dl
-plasma osmolality greater than 320 mOsm/kg
-absence of ketoacidosis
-dehydration
-altered mental status
-takes days to weeks to develop

116
Q

What is the mechanism behind the pseudohyponatremia seen in hyperglycemic hyperosmolar state?

A

In HHS, blood glucose can be elevated to such a degree that osmolality increases as well. When this occurs, water moves from the intracellular space into the extracellular space, diluting the sodium concentration. In actuality, the concentration of sodium has not changed.

117
Q

How do you calculate corrected sodium concentrations in the context of significant hyperglycemia?

A

-Methods such as the ion-selective electrode or using a corrected sodium formula that takes into account the serum glucose level.

Corr. Na+ = [(Glucose – 100 mg/dl) * 0.016] + Na+

118
Q

HHS is associated with what type of diabetes?

A

type 2

119
Q

What enzymes are generally tested to determine liver function?

A

-Alanine transaminase (ALT)
-Aspartate aminotransferase (AST)
-Alkaline phosphatase (ALP)
-Bilirubin

120
Q

Released into bloodstream from damaged hepatocytes.

A

Alanine transaminase (ALT) and Aspartate aminotransferase (AST

121
Q

Possible indicator of liver disease although can be present from damage to other tissues, like bone or the intestines.

A

Alkaline phosphatase (ALP)

122
Q

Waste product produced when RBCs are broken down. Normally removed by the liver from the body through bile excretion into the GI tract. Declining liver function cannot remove bilirubin effectively so hyperbilirubinemia can occur.

A

Bilirubin

123
Q

What are the expected values for direct bilirubin in adults?

A

Adults and infants (over one month): 0 – 0.5 mg/dl

124
Q

What are the tests done to diagnose diabetes?

A

A1C, Fasting plasma glucose, Oral glucose tolerance test, and random plasma glucose test

125
Q

What is the A1C threshold for diabetes mellitus?

A

6.5% or higher

126
Q

measures the average blood glucose of the past several months.

A

A1C

127
Q

Diabetes diagnosis:

Fasting Plasma Glucose (FPG) that is ____ mg/dl or higher. The patient must fast for a minimum of 8 hours.

A

126

128
Q

Diabetes diagnosis:

Oral Glucose Tolerance Test (OGTT) that is ____ mg/dl or higher. This tests how well the patient can process sugar. It is done by testing blood glucose 2 hours before and after drinking a specific sweet drink.

A

200

129
Q

Diabetes diagnosis:

Random (Casual) Glucose Test that is ___ mg/dl or higher. This is a blood glucose test at any time of the day.

A

200

130
Q

What chronic diseases are related to diabetes?

A

Cardiovascular disease, stroke, chronic kidney disease, diabetic neuropathy, vision loss.

131
Q

What are the normal levels for fasting blood triglycerides in adults.

A

44-148 mg/dl (0.50-1.67 mmol/L)^9 (Pointe Scientific manual)

132
Q

Hepatitis B

A

Most common chronic viral infection
42nm DnA virus hepadna virus family

Made from RNA template (reverse transcription)—-> prone to mutation

133
Q

Mutant prevents

A

HbeAg

Mutant resistance to Reverse transcription inhibitor

134
Q

HbsAg is

A

Common tests for Hep B

135
Q

AntiHbcAg is also common

A

For testing Hep B

136
Q

Liver function tests identify

A

Liver disease without jaundice

137
Q

Monitor serum clearance of what

A

Indocyanine which is solely processed through liver(bile) and normal is 5% dye remaining after 45 minutes

High retention time indicates liver disease

138
Q

In the past Bromsulphalein was used but

A

Not today because of anaphylaxis toxicity

139
Q

Bilirubin in four types

A

Alpha bilirubin= unconjagated bilirubin
Beta bilirubin= 1 gluconic acid monocojagated bilirubin
Gamma bilirubin= 2 glucocnic acid binding
Delta bilirubin= reversely bound irreversibly to bilirubin

140
Q

Alkaline phosphatase hydrolyzes

Highest activity in

A

Hydrolyzes monophosphate esters

Liver bone intestine and kidneys

Placental obstruction increase activity about 10 fold

141
Q

Hepatocytes damage but no release of

A

Alkaline phosphatase

142
Q

Y- glutamyltransferase

A

Microsomal enzyme induced by drugs or alcohol
Catalysts transfer of glutamate from glutathione to peptide

143
Q

5’ nucleotidase-

A

Microsomal enzyme ( not elevated by drugs or alcohol
Activity is solely in obstructive disease similar with AP

144
Q

5’ nucleotidase can be used to exclude

A

Bond disease and damage

145
Q

Lactate dehydrogenase

A

Cytosolic enzymes lactate-pyruvate
Released after cell damage
Viral/ toxic hepatitis, extra hepatic biliary obstructio, acute hepatic necrosis, and cirrhosis

146
Q

5 types of lactate dehydrogenase

A

LD1- heart
LD2- renal disease
LD3- lung
LD4- Skelton muscle
LD5-liver

147
Q

AST

A

Aspartate aminotransfersse and ALT alanine transaminase

Converts aspartate and alanine to oxaloacetate and pyruvate respectively

Most useful for detecting liver damage

AST and ALT are also in the heart

148
Q

Three types of jaundice

A

Pre hepatic
Hepatic
Post hepatic

149
Q

Pre hepatic jaundice

A

Increase unconjugated bilirubin due to hemolysis
Liver will secrete large amount of bile

Increased urobilinogen in urine and feces

Urinary bilirubin is absent

150
Q

Hepatic jaundice

A

Uncojugated and conjugated bilirubin increased.

Fecal concentration of urobilinogen decreased

Conjugated bilirubin increase in urine

151
Q

Post hepatic jaundice

A

Increased conjugated bilirubin, serum congated bilirubin increased because of decrease in bilirary excretion aka blockage

Urobilinogen is decreased but bilirubin is in urine

Clinical Chemistry II - 4378 (28 decks)

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