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Lab Medicine Flashcards

1
Q

Liver Function tests

A
  • Excretory
  • Synthetic
  • Integrity of hepatocytes
  • Tests for cholestasis
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2
Q

Refer to Liver Case Scenario in Notes

A

..

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3
Q

Excterory Liver Function tests

A
  • Serum bilirubin.
  • Urinary Bile Pigment.
  • Bile acids.
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4
Q

Synthetic Liver Function tests

A
  • Plasma proteins.
  • Prothrombin time.
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5
Q

Test for integrity of hepatocytes

A
  • Transaminases (ALT & AST).
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6
Q

Tests for cholestasis

A
  • Alkaline Phosphatase (ALP).
  • Gamma Glutamyl Transferase (GGT).
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7
Q

Metabolism of Hb

A
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8
Q

How does Bilirubin exist in the serum?

A
  • Unconjugated (indirect) bilirubin
  • Conjugated (Direct) bilirubin
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9
Q

Compare between unConjugated & Conjugated bilirubin in terms of:

  • Normal Site
  • Solubility
  • Fate
A
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10
Q

What is the Fate of urobilinogen?

A
  • Most of it converted into stercobilin & excreted in feces (brown color).
  • Part of it oxidized to urobilin & excreted in urine (yellow color).
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11
Q

Def of Delta-Bilirubin

A
  • Conjugated bilirubin covalently bound to albumin.
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12
Q

Level of Delta-Bilirubin

A
  • Normally: Absent or present in very small amount.
  • Increases in: cholestasis (in parallel with other fractions).
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13
Q

Clearence of Delta-Bilirubin

A
  • Cleared slowly from circulation to urine so:
  • When jaundice resolves the delta fraction (which is not filtered) still present & bilirubin testing may become -ve in spite of high serum level.
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14
Q

Causes of increased unconjuguated bilirubin

A
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15
Q

Causes of increased Conjugated bilirubin

A
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16
Q

What is Gilberts Syndrome?

A

Most common cause of Unconjugated hyperblirubinemia

  • Deficiency of uridinediphosphoglucuronyl transferase enzyme (UDP-GT).
  • There is defect in the uptake by hepatocytes.
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17
Q

What is Dubin-Johnson Syndrome?

A
  • A defect in excretion of bilirubin by hepatocyte.
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18
Q

Site of formation of plasma proteins

A

Most of them: in liver.

Except gamma globulins: in plasma cells.

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19
Q

Level of albumin

A
  • Represent: 60% of total serum protein.
  • Level: 3.5 - 5.0 g/di.
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20
Q

What happens to synthetic liver function tests in advanced hepatic affection?

A
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21
Q

What forms blood coagulation factors?

A
  • Most of coagulation factors (except factor VIII) & fibrinolytic enzymes → by the liver.
  • Factor VIII → by spleen.
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22
Q

What happens in patients with hepatocellular damage?

Concerning Blood coagulation factors

A

Decrease in Coagulation factors → Increase Prothrombin time [PT] (an early abnormality in this disease).

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23
Q

Normal site of ALT & AST

A

Inside Hepatocytes

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24
Q

What hapens to serum Levels of ALT & AST in hepatitis?

A
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25
Q

What is Preicteric phase?

A
  • the period prior to appearance of jaundice
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26
Q

What happens to serum level of ALP in Obstructive Jaundice?

A

In obstructive jaundice “serum level is markedly elevated (>3 URL)”

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27
Q

What happens to serum level of GGT in cholestasis & Liver cirrhosis?

A

Serum Level: Inc. in cholestasis & liver cirrhosis (but the rise is marked in cholestasis).

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28
Q

What are other causes of elevated GGT?

A

Alcohol & barbiturates

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29
Q
A
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30
Q

Types of Plasma amaylase

A
  • Salivary (S-isoenzyme)
  • Pancreatic (P-isoenzyme): More specific & sensitive for diagnosis of acute pancreatitis.
  • Total amylase activity > 10 times URL is virtually diagnostic of acute pancreatitis.
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31
Q

Definition of Tumor Markers

A
  • A substance found in an increased amount in (blood - other body fluids - body tissues) that may suggest the presence of a type of cancer.
32
Q

Method of measurment of Tumor Markers

A
  • Qualitatively or quantitatively by chemical, immunological or molecular biological methods (PCR) to identify the presence of cancer.
33
Q

Uses of Tumor Markers

A

Screening in general population:
- It is of limited value as it doesn’t confirm diagnosis.
- May aid diagnosis in high-risk people.

Differential diagnosis in symptomatic individuals:
- But must be in conjunction with clinical & radiological evidence.

Prognostic indicator of disease progression:
- As the plasma concentration correlates with the tumor mass.

Monitoring of response to therapy & detecting recurrence.

34
Q

Categories of Tumor Markers

A
  • Enzymes
  • Hormones
  • Oncofetal Antigens
  • Blood Group Antigens
  • In addition to : Proteins, Hormone Receptors, Genetic markers
35
Q

Enzyme Tumor Markers

36
Q

Hormonal Tumor Markers

37
Q

Oncofetal antigins as Tumor Markers

38
Q

Blood group antigens as Tumor Markers

39
Q

What is a Sample?

A

A biological material taken from a patient for diagnostic, prognostic or therapeutic monitoring.

40
Q

Types of samples

A
  • Blood.
  • Sweat.
  • Urine & other fluids.
  • Semen.
    Feces.
    Tissue.
41
Q

Collection site of blood samples

42
Q

Types of blood samples

A
  • Venous sample.
  • Capillary sample.
  • Arterial sample.
43
Q

In Blood sample collection, Avoid the hand with ……

A
  • Extensive scarring.
  • Burn.
  • Hematoma.
  • Containing I.V. access for I.V. infusion.
  • Infection.
  • On the side of mastectomy.
  • Edema.
44
Q

Cleansing of venipuncture site

45
Q

Types of urine samples

46
Q

Outcomes of Improper sample collection

47
Q

Specimen Quality & Markers for rejection

48
Q

Refer to Thyroid Case Scenario in Notes

49
Q

Tests to assess thyroid function

A

TSH (Thyroid Stimulating Hormone).
Free T3.
Free T4.

50
Q

What are other tests to assess the function of thyroid gland?

51
Q

Aim of TSI Testing

A

to determine the cause of the disease.

52
Q

Lab results of TSI

53
Q

Thyroid Disorders and T4,T3 & TSH levels

54
Q

What are Variables affecting (T3- T4 - TSH) testing?

A
  • Hospitalized patient & recovery from Iliness.
  • Pediatric & neonate.
  • Pregnancy.
  • Drug treatment.
  • Assay interference.
  • Reference range.
  • Follow up test selection.
55
Q

Def of Euthyrold sick syndrome (ESS)

A
  • Abnormal levels of thyroid hormones despite normal thyroid gland function.
56
Q

Synonyms of Euthyrold sick syndrome (ESS)

A
  • Sick Euthyroid Syndrome (SES).
  • Non-Thyroidal tilness syndrome (NTI).
57
Q

Etiology of Euthyrold sick syndrome (ESS)

A

Occurs in severe illness or severe physical stress Most common in intensive care patients”

58
Q

Pathophysiology of Euthyrold sick syndrome (ESS)

59
Q

Patterns of Euthyrold sick syndrome (ESS)

60
Q

Clinical features of Euthyrold sick syndrome (ESS)

A

No symptoms of hypothyroidism (as It Is a temporary state).

61
Q

TTT of Euthyrold sick syndrome (ESS)

A

Once the person recovers from the Iliness → thyrold hormone returns to normal.

62
Q

Neonatal Thyroxine Levels at birth

63
Q

Neonatal Thyroxine Levels then

64
Q

Examples of Conditions causing Increase of plasma TBG

A

Cases associated with Increased estrogen:
* Pregnancy.
* Oral contraceptives.

65
Q

Effect of Conditions causing Increase of plasma TBG

A

Lead to false inc. of Total T4 & T3.

66
Q

Reliable test in Conditions causing Increase of plasma TBG

A

Free T3 & Free T4 reliable In these cases.

67
Q

Examples of Conditions causing Decrease of plasma TBG

A

Protein losing states

68
Q

Effect of Conditions causing Decrease of plasma TBG

A

Cause a false dec of Total T4 & T3.

69
Q

Reliable test in cases of Conditions causing Decrease of plasma TBG

A

Free T3 & Free T4 reliable In these cases.

70
Q

What are Drugs that interfere with thyroid function leading to thyroid disfunction (Hypo or hyperthyroidism)?

71
Q

Def of Assay Interference

A
  • A nonspecific binding with assay reagents leading to false increase in concentration of the measured substance.
72
Q

What is Thyroid Assay?

A

An animal anti-body against thyroid hormones used to determine their serum level.

73
Q

Thyroid assay interference

74
Q

Def of reference Range

A

A set of values that Includes upper & lower limits of a lab test based on a group of otherwise healthy people.

75
Q

Is reference Range Age related?

76
Q

reference Range Must be trimester related in pregnancy

77
Q

What test is used in follow up in cases of thyroid dysfunction?

Drafts (11 decks)

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