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Clin Med semester 2 > Labs of gastroenterology-schoenwald-exam 3 > Flashcards

Labs of gastroenterology-schoenwald-exam 3 Flashcards

1
Q

Anion gap Calculation=

A

Sodium- (Cl- and CO2)=

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2
Q

GI labs included in the CMP:

A
  • protein
  • Albumin
  • A/G ratio= albumin/globulin
  • Bilirubin
  • Alk phos
  • AST
  • ALT
  • GFR
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3
Q

Liver contains ______

A

hepatocytes

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4
Q

List the 5 functions of the liver

A

liver is complex!

  • Produces bilirubin
  • Amino acid and carbohydrate metabolism
  • Produces coagulation factors (Vit K dependent) and albumin
  • Lipid metabolism
  • cholesterol production
  • Metabolizes most drugs and hormones
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5
Q

LFT= (what does this include)

A 
=liver function tests
Includes: 
-albumin
-prealbumin
-prothrombin

(if these are all normal the liver is fine)

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6
Q

ALbumin= normal range?

A

3.5-5 g/dl

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7
Q

albumin- main fx?

A

to maintain plasma oncotic pressure

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8
Q

albumin: other functions?

A

-Main carrier of hormones, drugs, anions and fatty acids-”carrier protein”

  • Indicates liver function
  • with severe damage, albumin decreases (ex cirrhosis)
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9
Q

Low concentrations of albumin in the setting of liver disease=

A

poor prognosis

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10
Q

Nonhepatic causes of hypoablbuminemia (list ex’s)

A

-Malnutrition
-Malabsorption
-Protein loss from kidney or gut
-Increased volume of distribution (ascites or overhydration)
-Pregnancy
-Burns
Trauma
Alcohol use

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11
Q

Hypoalbumin is not associated with Sx until _______

A

extremely low

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12
Q

Sx associated with low albumin levels

A

peripheral edema, ascites or pulmonary edema

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13
Q

Remember*** albumin maintains ______ ______, if low, fluid leaks form intravascular space into interstitial spaces of tissue or into body cavities

A

oncotic pressure**

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14
Q

Low levels of albumin effect interpretation of _____ levels

A

Calcium levels

(most Ca 2+ is bound to albumin) ionized Ca 2+ is NOT bound to albumin

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15
Q

Prealbumin:

  • normal range?
  • similar to?
A

16-40 mg/dl

-Similar to albumin- in that it’s synthesized by liver

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16
Q

Prealbumin: has a _____ body pool than albumin

A

Smaller body pool than albumin AND more sensitive to protein intake (dietary) than albumin

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17
Q

T/F: prealbumin is not affected by hydration state

A

true

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18
Q

T/F: prealbumin is a good tool to assess nutritional status

A

true

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19
Q

Total protein= albumin + _____

A

globulin

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20
Q

Globulin=

A

== total immunoglobulins in serum

  • *Not synthesized by liver
  • *Usually calculated, not measured
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21
Q

Normal Range of total protein=

A

5.5-8.3 g/dl

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22
Q

TP (total protein) is _____ value in assessing liver disease if albumin is known

A

little value

albumin is MUCh more important

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23
Q

TP is useful in assessing..

A

immune or hematologic dysfunction

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24
Q

Prothrombin Time (PT):

  • Prothrombin is produced by the ____
  • normal range=
A
  • liver

- 10-13 seconds, INR 1-2

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25
Prothrombin Time (PT) measures..
extrinsic coagulation pathway
26
PT measures the Vitamin K clotting factors which are..
2, 7, 9 , and 10
27
Coagulation Factors in the extrinsic pathway
II,V,VII, and X
28
PT is used to monitor _____ therapy ?
Coumadin therapy
29
In liver disease, what can happen to the PT?
Prolonged PT in liver disease (substantial, >80% loss of function) but is not specific
30
Other causes of prolonged PT:
- Vit K deficiency - Clotting factor deficiency - Autoimmune diseases-lupus
31
Activated partial thromboplastin time (aPTT): - how long? - Measures the ______ pathway - factors?
-Normal varies (30-40-seconds) -Measures intrinsic pathway -Factors II,V,VIII,IX,X,XI (2,5,8,9,10,11) -Used for monitoring heparin therapy NOT dependent on liver function
32
Activated partial thromboplastin time (aPTT): is used for monitoring ______ therapy
heparin! | -aPTT is NOT dependent on liver function *
33
You can use PT and /or ____ to monitor liver disease
INR
34
Liver enzymes: (list 5)
- Alkaline Phosphatase (ALP) - Gamma glutamyl transpeptidase (GGT) - Aspartate aminotransferase (AST) - Alanine aminotransferase (ALT) - Lactate dehydrogenase (LDH)
35
Alkaline Phosphatase= - normal? - Exact function? - where is it found?
- Normal varies - Exact function unknown - Found in liver, bone, placenta, small intestine, kidneys and leukocytes
36
Alk phosphatase MC comes from from?
liver and bone
37
Alkaline Phosphatase: elevations ____x normal are suggestive of cholestasis
4x normal
38
Cholestasis=
obstruction of large bile duct
39
GGT(Gamma glutamyl transpeptidase (GGT): - normal range? - Can be helpful in assessing?
- Normal range varies - Can be helpful in assessing if increased ALP due to hepatic source (increased ALP with normal GGT most likely nonhepatic)
40
GGT is elevated in ____ ____ Pts
alcohol abuse
41
Abstinence from alcohol, often decreases GGT by ___% in 2 weeks
50%
42
AST/ALT: | -assess?
-cellular damage
43
AST/ALT is released into serum due to ____
leaky cell or necrosis of cell
44
Higher concentrations of AST/ALT do not necessarily correlate with ..
poorer prognosis
45
AST elevations WITHOUT ALT elevations suggests _____ source
cardiac
46
AST is generally _____ than ALT in alcohol abuse
- HIGHER | - *AST/ALT ratio >1 in alcoholic liver disease
47
AST/ALT ratio <1 in _____ Pts
hepatitis
48
Lactate dehydrogenase (LDH) - found in? - elevations occur in?
- Nonspecific- found in heart, liver, blood, brain, skeletal mm, lung - **Elevations occur in liver disease
49
Bilirubin: - total bilirubin normally is _____ - = the sum of ?
-0.3-1 mg/dl | =Sum of conjugated and unconjugated bili
50
Bilirubin elevations can be due to ..
obstruction vs liver damage
51
____ is hallmark sign of elevated bilirubin
**JAUNDICE
52
Gilbert's syndrome=
=benign trait with intermittent elevations in unconjugated(non hepatic source) bilirubin
53
Ammonia: - normal range? - majority originates from?
- Normal 30-70ug/dl | - from intestinal bacterial catabolism
54
Ammonia is absorbed and processed by ____
liver
55
If the liver is damaged, ammonia levels will be _____
increased
56
Elevations in ammonia result in _______ _______
**hepatic encephalopathy-altered mental status
57
Hepatitis serologies: - which ones are fecal to oral spread? - which ones are blood borne?
- Serologies for Hep A,B,C,D and E - -Hepatitis A and E fecal to oral spread - -Hepatitis B, C and D blood borne
58
Alpha fetoprotein: - normal range? - marker for?
- 10-20 ng/ml | - Tumor marker for hepatocellular carcinoma (HCC)
59
Alpha fetoprotein is elevated in ____% of HCC cases
70-80%
60
Pancreas: - exocrine fx? - endocrine fx?
Exocrine(secrete into ducts) and endocrine(secrete into circulation) functions
61
Pancreas: | exocrine enzymes? (list)
trypsin, chymotrypsin, amylase and lipase-digestive enzymes
62
Pancreas: | -endocrine enzymes? (list)
hormones insulin and glucagon
63
Pancreatitis=
inflammation of the pancreas
64
Pancreatitis: | -assessed by measuring?
amylase and lipase
65
Pancreatitis: sx? | -what are the main causes? (2)
sx: Nausea, vomiting, severe abdominal pain with radiation to the back - Alcohol abuse and gallstones =main causes
66
Amylase: - normal range? - fx?
- 44-128 IU/L | - Breaks starch into individual glucose molecules
67
Amylase is secreted by pancreas and _____
salivary glands
68
Amylase concentrations rise within ____hrs of onset of acute pancreatitis and peak at ______hrs
- 2-6 hrs | - peak @ 20-30 hrs
69
Lipase: - normal range? - aids in _____
Normal <1.5 U/ml | --Aids in fat digestion
70
T/F: Lipase declines faster than amylase
FALSE! Lipase declines slower than amylase
71
Carcinoembryonic Antigen (CEA)= - marker for? - used for monitoring progress of _____
=Tumor marker for colorectal carcinomas | --Used for monitoring progress of treatment, NOT diagnosis**

Clin Med semester 2 (24 decks)

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