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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
Q

Prothrombin Time (PT) measures..

A

extrinsic coagulation pathway

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26
Q

PT measures the Vitamin K clotting factors which are..

A

2, 7, 9 , and 10

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27
Q

Coagulation Factors in the extrinsic pathway

A

II,V,VII, and X

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28
Q

PT is used to monitor _____ therapy ?

A

Coumadin therapy

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29
Q

In liver disease, what can happen to the PT?

A

Prolonged PT in liver disease (substantial, >80% loss of function) but is not specific

30
Q

Other causes of prolonged PT:

A
  • Vit K deficiency
  • Clotting factor deficiency
  • Autoimmune diseases-lupus
31
Q

Activated partial thromboplastin time (aPTT):

  • how long?
  • Measures the ______ pathway
  • factors?
A

-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
Q

Activated partial thromboplastin time (aPTT): is used for monitoring ______ therapy

A

heparin!

-aPTT is NOT dependent on liver function *

33
Q

You can use PT and /or ____ to monitor liver disease

A

INR

34
Q

Liver enzymes: (list 5)

A
  • Alkaline Phosphatase (ALP)
  • Gamma glutamyl transpeptidase (GGT)
  • Aspartate aminotransferase (AST)
  • Alanine aminotransferase (ALT)
  • Lactate dehydrogenase (LDH)
35
Q

Alkaline Phosphatase=

  • normal?
  • Exact function?
  • where is it found?
A
  • Normal varies
  • Exact function unknown
  • Found in liver, bone, placenta, small intestine, kidneys and leukocytes
36
Q

Alk phosphatase MC comes from from?

A

liver and bone

37
Q

Alkaline Phosphatase: elevations ____x normal are suggestive of cholestasis

A

4x normal

38
Q

Cholestasis=

A

obstruction of large bile duct

39
Q

GGT(Gamma glutamyl transpeptidase (GGT):

  • normal range?
  • Can be helpful in assessing?
A
  • Normal range varies
  • Can be helpful in assessing if increased ALP due to hepatic source (increased ALP with normal GGT most likely nonhepatic)
40
Q

GGT is elevated in ____ ____ Pts

A

alcohol abuse

41
Q

Abstinence from alcohol, often decreases GGT by ___% in 2 weeks

A

50%

42
Q

AST/ALT:

-assess?

A

-cellular damage

43
Q

AST/ALT is released into serum due to ____

A

leaky cell or necrosis of cell

44
Q

Higher concentrations of AST/ALT do not necessarily correlate with ..

A

poorer prognosis

45
Q

AST elevations WITHOUT ALT elevations suggests _____ source

A

cardiac

46
Q

AST is generally _____ than ALT in alcohol abuse

A
  • HIGHER

- *AST/ALT ratio >1 in alcoholic liver disease

47
Q

AST/ALT ratio <1 in _____ Pts

A

hepatitis

48
Q

Lactate dehydrogenase (LDH)

  • found in?
  • elevations occur in?
A
  • Nonspecific- found in heart, liver, blood, brain, skeletal mm, lung
  • **Elevations occur in liver disease
49
Q

Bilirubin:

  • total bilirubin normally is _____
  • = the sum of ?
A

-0.3-1 mg/dl

=Sum of conjugated and unconjugated bili

50
Q

Bilirubin elevations can be due to ..

A

obstruction vs liver damage

51
Q

____ is hallmark sign of elevated bilirubin

A

**JAUNDICE

52
Q

Gilbert’s syndrome=

A

=benign trait with intermittent elevations in unconjugated(non hepatic source) bilirubin

53
Q

Ammonia:

  • normal range?
  • majority originates from?
A
  • Normal 30-70ug/dl

- from intestinal bacterial catabolism

54
Q

Ammonia is absorbed and processed by ____

A

liver

55
Q

If the liver is damaged, ammonia levels will be _____

A

increased

56
Q

Elevations in ammonia result in _______ _______

A

**hepatic encephalopathy-altered mental status

57
Q

Hepatitis serologies:

  • which ones are fecal to oral spread?
  • which ones are blood borne?
A
  • 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
Q

Alpha fetoprotein:

  • normal range?
  • marker for?
A
  • 10-20 ng/ml

- Tumor marker for hepatocellular carcinoma (HCC)

59
Q

Alpha fetoprotein is elevated in ____% of HCC cases

A

70-80%

60
Q

Pancreas:

  • exocrine fx?
  • endocrine fx?
A

Exocrine(secrete into ducts) and endocrine(secrete into circulation) functions

61
Q

Pancreas:

exocrine enzymes? (list)

A

trypsin, chymotrypsin, amylase and lipase-digestive enzymes

62
Q

Pancreas:

-endocrine enzymes? (list)

A

hormones insulin and glucagon

63
Q

Pancreatitis=

A

inflammation of the pancreas

64
Q

Pancreatitis:

-assessed by measuring?

A

amylase and lipase

65
Q

Pancreatitis: sx?

-what are the main causes? (2)

A

sx: Nausea, vomiting, severe abdominal pain with radiation to the back
- Alcohol abuse and gallstones =main causes

66
Q

Amylase:

  • normal range?
  • fx?
A
  • 44-128 IU/L

- Breaks starch into individual glucose molecules

67
Q

Amylase is secreted by pancreas and _____

A

salivary glands

68
Q

Amylase concentrations rise within ____hrs of onset of acute pancreatitis and peak at ______hrs

A
  • 2-6 hrs

- peak @ 20-30 hrs

69
Q

Lipase:

  • normal range?
  • aids in _____
A

Normal <1.5 U/ml

–Aids in fat digestion

70
Q

T/F: Lipase declines faster than amylase

A

FALSE! Lipase declines slower than amylase

71
Q

Carcinoembryonic Antigen (CEA)=

  • marker for?
  • used for monitoring progress of _____
A

=Tumor marker for colorectal carcinomas

–Used for monitoring progress of treatment, NOT diagnosis**

Clin Med semester 2 (24 decks)

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