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Clin Med II > Labs of Gastroenterology (Schoenwald) > Flashcards

Labs of Gastroenterology (Schoenwald) Flashcards

1
Q

What labs are liver tests on a CMP?

A 
Protein, total, serum 
Albumin, serum 
Globulin, total 
A/G ratio
Bilirubin, total 
Alkaline phosphatase, serum 
AST (SGOT) 
ALT (SGPT)
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2
Q

What are the functional cells in the liver called?

A

Hepatocytes

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3
Q

What are the functions of the liver?

A

Produces bilirubin
Amino acid and carbohydrate metabolism
Produces coagulation factors (Vit K dependent) and albumin
Lipid metabolism- cholesterol production
Metabolizes must drugs and hormones

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4
Q

Liver enzymes show…

A

Inflammation in the liver

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5
Q

What are the liver function tests?

A

Albumin
Prealbumin
Prothrombin

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6
Q

What is the normal range for albumin?

A

3.5-5 g/dl

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7
Q

What is the main function of albumin?

A

Maintain plasma oncotic pressure (holds fluid where it is supposed to be)

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8
Q

Why is albumin called a “carrier protein”?

A

Because albumin is the main carrier of hormones, drugs, anions, and fatty acids

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9
Q

How does albumin indicate liver function?

A

With severe damage, such as in cirrhosis, albumin will decrease

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10
Q

Low albumin causes…

A

Third spacing, fluid leaking into the interstitium (edema)

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11
Q

Low concentration of albumin in the setting of liver disease indicates

A

Poor prognosis

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12
Q

What are some non hepatic causes of hypoalbuminemia?

A 
Malnutrition 
Malabsorption 
Protein loss from kidney or gut 
Increased volume of distribution (ascites or over hydration) 
Pregnancy 
Burns 
Trauma 
Alcohol use
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13
Q

Albumin has to be ______ to be associated with symptoms

A

Extremely low

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14
Q

What are the symptoms of low albumin?

A

Peripheral edema, ascites, or pulmonary edema (third spacing)

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15
Q

How does low albumin cause edema?

A

Albumin maintains oncotic pressure, if low, fluid leaks from intravascular space into interstitial spaces of tissue or into body cavities

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16
Q

What other value do low levels of albumin affect?

A

Interpretation of calcium levels- calcium could come up as low but once corrected for low albumin levels, really is not low

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17
Q

What is the normal range for prealbumin?

A

16-40 mg/dl

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18
Q

Prealbumin has a smaller/larger body pool compared to albumin

A

Smaller

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19
Q

Is prealbumin more sensitive to dietary protein intake than albumin?

A

Yes, prealbumin is more sensitive to dietary protein intake than albumin is

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20
Q

Is prealbumin affected by hydration state as albumin is?

A

No, prealbumin is not affected by hydration state as albumin is

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21
Q

Prealbumin is a good tool to assess _______ status

A

Nutritional

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22
Q

Total protein measures. _____ + _______

A

Albumin + globulin

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23
Q

What is globulin?

A

Total immunoglobulins in serum
NOT synthesized by the liver
Usually calculated, not measured

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24
Q

What is the normal range of total protein?

A

5.5-8.3 g/dl

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25
Q

Since total protein is of little value in assessing liver disease if albumin is known , what is total protein useful for?

A

Total protein is useful in assessing immune or hematologic dysfunction

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26
Q

What is prothrombin produced by?

A

The liver

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27
Q

What is the normal range of prothrombin time? (PT)

A

Normal range is 10-13 seconds, INR 1-2

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28
Q

What does prothrombin time measure?

A

Extrinsic coagulation pathway

Factors II, V, VII, X

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29
Q

What are the vitamin K dependent factors?

A

II, VII, IX, X

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30
Q

Coumadin therapy can be monitored by which lab value?

A

Prothrombin Time (PT)

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31
Q

There will be a ______ PT in liver disease

A

Prolonged PT

If it is substantial, this indicates >80% loss of liver function

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32
Q

Other than liver disease, what causes a prolonged PT?

A

Vitamin K deficiency.
Clotting factor deficiency
Autoimmune disease such as lupus

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33
Q

What is the normal value for aPTT (activated partial thromboplastin time)?

A

Normal varies between 30-40 seconds

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34
Q

What does aPTT measure?

A

Measures the intrinsic pathway-

Factors II, V, VIII, IX, X, XI

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35
Q

What lab value is used for monitoring heparin therapy?

A

APTT

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36
Q

Is aPTT dependent on liver function?

A

No, but PT is :)

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37
Q

What are the five liver enzymes?

A 
Alkaline phosphatase (ALP) 
Gamma glutamyl transpeptidase (GGT) 
Aspartame aminotransferase (AST) 
Alanine aminotransferase (ALT) 
Lactate dehydrogenase (LDH)
38
Q

What is the normal range of ALP?

A

The normal range varies, is depends on what methodology that the lab uses

39
Q

What is the exact function of ALP?

A

Exact function is unknown

40
Q

Where is ALP found?

A

In the liver, bone, placenta, small intestine, kidneys, and leukocytes

41
Q

What are some conditions that ALP is elevated in?

A 
Pregnancy 
Bone Mets (cancer)
42
Q

Where does most of the ALP come from?

A

The liver and the bone

43
Q

What do elevations of >4 times the normal of ALP suggest?

A

Cholestasis- obstruction of the large bile duct

44
Q

What is the normal range of GGT?

A

The normal range of GGT varies

45
Q

What can GGT be helpful in assessing?

A

If an increased ALP is from a hepatic source

Increased ALP, normal GGT= most like non hepatic

46
Q

What level can you check to see if a patient is being compliant with not drinking?

A

GGT- elevated in alcohol abuse

47
Q

With abstinence from alcohol, GGT can decrease by ___% in 2 weeks

A

50%

48
Q

AST/ALT is used to assess….

A

Cellular damage

49
Q

What causes ALT/AST to be released into the serum?

A

Released due to a leaky cell or necrosis of a cell

50
Q

Do higher concentrations of ALT/AST correlate with poorer prognosis?

A

No

51
Q

AST elevations without ALT elevations suggest a ____ source

A

Cardiac

This measure has been replaced by troponin

52
Q

AST is usually higher/lower than ALT in alcohol abuse

A

Higher

53
Q

AST/ALT ratio in alcoholic liver disease

A

Ratio >1

54
Q

AST/ALT ratio in hepatitis

A

Ratio <1

55
Q

LDH is specific/nonspecific

A

Nonspecific- found in the heart, liver, blood, brain, skeletal muscle, lung

56
Q

LDH increases/decreases in liver disease

A

Increases, but not only in liver disease

57
Q

What is the normal range of total bilirubin?

A

0.3-1 mg/dl

58
Q

Total bilirubin is the sum of ____ and _____

A

Conjugated and unconjugated bilirubin

59
Q

Elevations of bilirubin can be due to…

A

Obstructions vs liver damage

60
Q

What is the hallmark sign of elevated bilirubin?

A

Jaundice

61
Q

What syndrome is classified as a benign trait with intermittent elevations in unconjugated (non hepatic sources) of bilirubin?

A

Gilbert’s syndrome, causes mild elevations in total bilirubin

62
Q

What is the normal range of ammonia?

A

30-70 ug/dl

63
Q

What does the majority of ammonia originate from?

A

Intestinal bacterial catabolism

64
Q

Ammonia is absorbed and processed by the….

A

Liver

65
Q

If the liver is damaged, ammonia is decreased/increased?

A

Increased

66
Q

Elevations of what level result in hepatic encephalopathy and therefore altered mental status?

A

Elevations in ammonia

67
Q

What are the serologies for hepatitis?

A

Hep A, B, C, D, E

68
Q

What strains of hepatitis are fecal to oral spread?

A

A, E fecal to oral spread

69
Q

What strains of hepatitis are blood borne?

A

B C D

70
Q

What is the normal range for Alpha fetoprotein?

A

10-20 ng/ml

71
Q

What does alpha fetoprotein indicate?

A

Tumor marker for hepatocellular carcinoma (HCC)

72
Q

Alpha fetoprotein is elevated in ____% of HCC cases

A

70-80%

73
Q

What organ is both an exocrine and endocrine gland?

A

The pancreas

74
Q

What does exocrine secrete into?

A

Ducts

75
Q

What does endocrine secrete into?

A

Circulation

76
Q

What are the exocrine enzymes of the pancreas?

A

Trypsin
Chymotrypsin
Amylase
Lipase

77
Q

Amylase and lipase are _____ enzymes

A

Digestive enzymes

78
Q

What are the endocrine hormones of the pancreas

A

Insulin and glucagon (glucose metabolism)

79
Q

What is pancreatitis?

A

Inflammation of the pancreas

80
Q

How is pancreatitis measured?

A

By measuring amylase and Lipase

81
Q

What are the clinical sxs of pancreatitis?

A

Nausea, vomiting, severe abdominal pain with radiation to the back

82
Q

What are the main causes of pancreatitis?

A

Alcohol abuse and gallstones

83
Q

What are the normal levels of amylase?

A

44-128 IU/L

84
Q

What is the function of amylase?

A

Breaks starch into individual glucose molecules

85
Q

What is amylase secreted by?

A

Pancreas and salivary glands

86
Q

Concentrations of amylase rise within ___ hours of onset of acute pancreatitis and peak at ____ hours

A

2-6

20-30

87
Q

What is the normal range for lipase?

A

<1.5 U/ml

88
Q

What enzyme aids in the digestion of fats?

A

Lipase

89
Q

Lipase declines slower/faster than amylase

A

Slower

90
Q

What is carcinoembryonic Antigen (CEA) a tumor marker for?

A

Colorectal carcinomas

91
Q

What is CEA used for?

A

Monitoring progress of treatment of colorectal carcinoma not diagnosis

Clin Med II (7 decks)

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