Labs of GI - Schoenwald Exam 3 Flashcards
What are the Vitamin K dependent coagulation factors? Where are they produced?
Factors II, VII, IX, and X. Produced in the liver
What is measured on a standard liver function test (LFT)? (3 things produced by the liver)
- Albumin
- Prealbumin
- Prothrombin
What is the normal range for albumin?
3.5 - 5 g/dl
What is the main function of albumin?
Maintains plasma oncotic pressure. Main carrier of hormones, drugs, anions and fatty acids. “Carrier protein”
A patient with severe damage to the liver (such as in cirrhosis) would have an (increased/decreased) albumin level
Decreased albumin
What are some non-hepatic causes of hypoalbuminemia?
- malnutrition
- malabsorption
- protein loss from kidney or gut
- increased volume of distribution (ascites or overhydration)
- pregnancy
- burns
- trauma
- alcohol use
A patient’s labs come back with mildly decreased albumin levels. Would you expect them to be symptomatic? What kind of symptoms can you expect from hypoalbuminemia?
No symptoms until albumin levels are very low.
Symptoms you may see with significantly low albumin levels: peripheral edema, ascites, pulmonary edema
*remember albumin maintains oncotic pressure. If low, fluid leaks into interstitial spaces
What other lab value on a CMP may be affected with low albumin levels?
Calcium levels
*you need to correct for low albumin to get an accurate calcium level (unless it is an ionized calcium lab)
What is the normal range for prealbumin?
Prealbumin: 16-40 mg/dl
(really hoping we don’t actually have to memorize these, but just in case!)
Which hepatic protein is more sensitive to dietary protein intake, albumin or prealbumin? Is it affected by hydration state, too?
Prealbumin is more sensitive to dietary protein intake. It is not affected by hydration status.
*not used by nutritionists much anymore, but can be useful in a patient who was found down and unable to give a good history. (low prealbumin = they haven’t eaten in a while)
Which of these is not synthesized by the liver?
A) prealbumin
B) prothrombin
C) globulin
D) albumin
C) globulin
How do you calculate globulin levels?
Total protein - albumin = globulin
(Globulin levels are not given on a CMP. TP and albumin are)
What is globulin a measure of?
Total immunoglobulins in serum (antibodies)
What is the total protein level useful in assessing for? What is a normal range for TP?
Immune or hematological dysfunction. TP is of little value in assessing liver disease (if the albumin is known)
nl range: 5.5-8.3 g/dl (again hopefully we don’t need to memorize these, but just in case)
What are the normal ranges for prothrombin time and INR?
Prothrombin time: 10-13 seconds
INR 1-2
Prothrombin time measures the (extrinsic/intrinsic) coagulation pathway. Which clotting factors?
Extrinsic
Factors II, V, VII, and X