Module 1 Flashcards
To understand the basics of functional medicine and an overview of how it works including the diagnostic assessment, testing, and treatment
What are Leukocytes
White blood cells
How are Leukocytes divided
Into 2 groups: Granulocytes and Non-Granulocytes
What are the 3 types of Granulocytes
Polymorthphonuclear neutrophils, Eosinophils, Basophils
What are 2 types of Non-Granulocytes
Lymphocytes, Monocytes
What is the function of a WBC
To fight infection, react against foreign bodies, defend body by phagocytosis
Clinical significance of Increased WBC
Childhood disease, acute viral or bacterial infection, Intestinal parasites, some cancers, infectious mononucleosis, adrenal dsyfuncntion
Clinical Significant of Decreased WBC
chronic viral or bacterial infection, autoimmune disorder, systemic lupus erythematosus, hepatitis, vitamin B12, B6, folic acid anemia, intestinal parasites, RA
Red Blood Count means?
RBC is carrier of O2 by reason of hemoglobin it contains from lungs to body tissue and transfer of CO2 from tissue to lung
Clinical Significance of Increased red blood count
Polycythemia, respiratory distress( asthma/emphysema)
Clinical Significance of decreased red blood count
Iron anemia, vitamin B12, B6 or folic acid anemia, liver and renal dysfunction, some cancers
What is hemoglobin
HGB is major component of RBC: functions in transport of CO2
Clinical significance of Increased levels of hemoglobin
Dehydration, Emphysema, Asthma, Polycythemia
Clinical significance of decreased levels of hemoglobin
Iron deficiency
Microscopic internal bleeding
Digestive inflammation
What is Hematocrit
packed cell volume % of total volume occupied by RBC
Clinical significance of increased Hematocrit
Dehydration
EMphysema
Asthma
Polycythemia
Clinical Significance of decreased Hematocrit
Iron deficiency anemia
Microscopic Internal Bleeding
Digestive inflammation
What is MCV
MCV indicates volume in cubic microns of average single RBC
Increases along with decrease in MCH. Should always be viewed together. If problem suspected confirm with serum or urinary methylmalonic acid and homocysteine
Clinical significance of increased MCV
Vitamin B12/folic acid anemia
Dehydration
Clinical significance of decreased MCV
iron anemia
microscopic internal bleeding
What is MCH
indicates weight of hemoglobin in single RBC. Increases or decreases in response to increase/decrease of MCV
Clinical significance of increased MCH
vitamin B12/ folic acid anemia
Clinical significance of decreased MCH
iron anemia
internal bleeding
toxic effects of lead, aluminum, cadmium- other metals
Vitamin B6 anemia
What is MCHC
indicates average hemologic concentration per unit of RBC
Clinical significance of increased MCHC
Vitamin B12/ folic acid anemia
Dehydration
Clinical significance of decreased MCHC
Internal bleeding
Toxic effects of lead, aluminum and other metals
Vitamin B6 anemia
What is RDW
electronic mesasurement of anisocytosis( red cell availability)
Increased RDW means
iron deficiency anemia or B12 folate anemia
What are platelets
involved with clotting of blood coagulation and with retraction of clots
Increased platelets mean
RA Arteriosclerosis Some cancer Inflammatory Arthritis Several Anemia Polycythemia slight increase in pregnancy
Decreased platelets mean
Idiopathic Thrombocytopenia
Blood loss
Thrombocytopenia
What are neutrophils
job is phagocytosis
Increased neutrophils mean
chronic viral and bacterial infection
Decreased neutrophils mean
active viral and chronic infection
Leukemia
What are Monocytes and function.
Cells that Phagocytize bacteria and matter and protozoa. They remain after neutrophils phagocytize and are responsible for clean up
Increased Monocytes mean
viral infections
4 important considerations with monocytes
- always rule out liver dysfunction with increased monocytes
- Increased monocytes indicate excessive tissue breakdown
- increased in monocytes, basophil and eosinophils mean respect intestinal parasites
- percentage will increase with decrease of lymphocytes percentage in hodgekins disease and other forms of cancer
Eosinophils- what are they and function
WBC that have role in detox and breakdown and removal of protein
Increase eosinophils mean
intestinal parasites
Food and environmental allergy/sensitivities
Asthma
Emphysema
Decreased eosinophils mean
count at or below 1% is uncommon and present adrenal cortical hyper function and should be ruled out
Basophils- what are they and function
WBC that during inflammation deliver heparin to inflamed tissue to prevent clotting; therefore basophils will almost be increased with tissue inflammation. Basophils contain histamine and serotonin.
Basophil increase mean
Tissue inflammation
Intestinal parasites
Polycythemia
Decreased Basophil mean
acute allergic reactions
What is included in Comprehensive Metabolic Panel
AST, ALT, ALP, Total Bilirubin, Total Protein, Albumin, Total Globulin, AG/Ratio, Glucose, BUN, Creatine, Bun/Creatine ratio, Calcium, Sodium, Potassium, Chloride, CO/2,
What is AST
Aspartate Amino Transferase: enzyme found in high concentration in kidney, pancreas, heart, liver, skeleton, and muscles. Does not increase as much as ALT in liver dysfunction.
AST increase mean
heart disease
liver disease
CHF
Acute pancreatitis
AST decrease mean
Vitamin B6 anemia
Renal Disease
ALT what is it
Alanine Amino transferase: used to detect hepatocellular disease
ALT increase mean
Cirrhosis of liver
Acute and chronic liver necrosis
Hepatitis/Monoucleosis
Epstein Barr Virus and city megalovirus
Decreased ALT mean
Vitamin B6 anemia
What is ALP
Alkaline Phosphatase- member of zinc metalloprotein enzyme that functions to split off a terminal phosphate- located in liver, bone, kidney and placenta
ALP increase mean
Healing Fracture
Liver Cancer
Cirrhosis
Pagets disease of the bone
ALP decrease mean
Biliary Dysfunction
Zinc Deficiency
Vitamin C insufficiency
What is total Bilirubin
breakdown of hemoglobin by spleen, liver, kupffer cells, and bone marrow
How is bilirubin classified
3 ways:
- ) total- combination of indirect and direct
- ) Direct- post hepatic, water soluble, conjugated
- ) Indirect- pre-hepatic, non-water soluble and unconjugated
Bilirubin increase mean conjugated
gallstones- biliary obstruction
Extrahepatic duct obstruction
Bilirubin increased unconjugated mean
Gilver syndrome- congenital enzyme deficiency interrupting conjegation of bilirubin
Hepatitis
Cirrhosis
Bilirubin decree mean
non-signficant
What is the Total Protein
Combination of albumin and total globulin
Increased total protein mean
Digestive Dysfunction
Dehydration
Decreased total protein mean
Protein malabsorption/Amino acid need
Gastritis, Leaky Gut, Colitis, ileitis, Chron’s, IBS
What is albumin
produced almost entirely in the liver- responsible for 80% colloid-osmotic pressure between blood and tissue fluids and serves as transport protein for many substances
Albumin increased means?
Dehydration
Albumin decreased means
Liver biliary dysfunction
Neoplasm
Protein malnutrition/ amino acid need
What is Total Globulin
Combination of alpha, 1, 2 and gamma beta fractions. Most labs calculate a combination of the serum total globulin by subtracting serum albumin from total serum protein.
Increased Total Globulin means
Hypochlorhydria
Liver dysfunction
neoplasm
Decreased Total Globulin means
Digestive dysfunction( primary inflammation or secondary inflammation to HCL deficiency
What is the AG/Ratio?
Value of A/G ratio is limited because of countless amount of variables in the components of alpha, 1, 2, beta and gamma. An abnormal A/G is called a suppressed, low or reversed ration- reflection of hepatic dysfunction
Clinical significance of increased A/G ratio
not signficiant
Clinical significance of decreased A/G ratio
Liver Biliary dysfunction Chronic Renal Disease Some types of Cancer Sarcoidosis Collagen Disease Severe Inflammation Burns Digestive Inflammation
What is Glucose test
a sugar that is measure via blood test- levels influenced by carb intake, stress, granular and liver function
clinical sig of increased glucose( fasting)
Acute stress response
Diabetes
Thiamine deficiency
Dysinsulinsim
Decreased glucose fasting
Fasting hypoglycemia
Severe Liver Disease
Hypothyroidism
What is BUN
reflects the difference and clearance of Urea
Increased BUN means
Chronic Renal Dysfunction Renal Hypertension Prescribed diuretics Dehydration Cirrhosis of the liver Benign prostrate hypertrophy Urinary Obstruction
Decreased BUN means
Liver failure
Protein malnutrition
Celiac
What is Creatine Testing
used to diagnose renal function. It is a waster product formed from spontaneous decomposition of creatine- which is required in muscle- those with higher muscle mass may have higher creatine
Increased levels of creatine mean
Chronic Renal dysfunction
Benign prostate hypertrophy
Decreased levels of creatine mean
Serum creatine is normal decreased in children, patients with less muscle mass and geriatric patients with muscle wasting
muscle wasting
What is the BUN/Creatine Ratio
Useful when assessing patients with chronic renal dysfunction- has the potential to be skewed
Clinical Significance of Increased BUN/Creatinine Ratio
CHF Intestinal Bleeding Shock Hypotension Dehydration Renal Disease
Clinical Significance of Decreased BUN/Creatine Ratio
Low protein diets
Malnutrition
what is Calcium
absorbed from upper part of small intestine- dependent on acidity of intestine and amount of phosphate- relates to bone metabolism
Increased Calcium
Parathyroid Hyperfunction
Cancer
Hypervitaminosis D
Decreased Calcium means
Parathyroid Hypofunction Digestive Dysfunction( Hypochlordria) Low normal total protein Vitamin D Deficiency Protein Malnutrition Osteoporosis Pancreatitis
Sodium- what is it
most abundant cation in the extra-cellular fluid- most important in osmotic regulation of fluid balance, acid-base balance, renal, cardiac, and adrenal function
Increased Sodium means
Chronic Renal Dysfunction
Dehydration
Adrenal Cortical Hypofunction
Decreased Sodium means
Adrenal Cortical hypofunction
Diarrhea
What is Potassium
major cation found in the intracellular fluid- essential for maintenance of pH and osmotic pressure
Increased Potassium means
Adrenal Cortical hypofunction
Renal Dysfunction
Decreased Potassium means
Diarrhea
Adrenal Cortical hyperfunction
Drug Diuretics
Chloride what is it?
Principle anion found in the serum. Chloride almond with Sodium, potassium and CO2 are important in acid-base relationships and show state of hydration, renal and adrenal function. usually varies inversely to CO2 function.
Increased Chloride mean
renal dysfunction
Dehydration
Decreased Chloride mean
Hypochlorhydria
CO2- what is it
amount of base bound as bicarbonate in blood that is available for neurtralization of fixed acids such as lactic acid HCL. CO2 refers to base bound and not total base of blood.
Clinical significance of increased CO2
Metabolic Alkalosis
Vomiting
Decreased CO2 means
Thiamine Deficiency- anion gap is generally increased
Diabetes
Metabolic Acidosis
Lipids: Cholesterol what is it?
a steroid normally found in all body cells and plasm. Information relative to increased/decreased cholesterol can be extrapolated to triglycerides.
Generally increased in endocrine or organ hypo function and decreased in endocrine and organ hyperfunction
Cholesterol increased means
Coronary artery disease
diabetes
Primary thyroid hypofunction or hyperfunction secondary to anterior pituitary hypofunction
Cholesterol decreased means
Thyroid hyperfunction/or anterior pituitary hyperfunction Cancer Chrons Cirrhosis of liver Celiac Malnutrition
Triglycerides what are they
serum TG family of complex lipids-saturated and unsaturated. Soluble in blood and composed of 95% fat in adipose tissue. Travel in blood with cholesterol and need to be drawn together and viewed together.
Increased Triglycerides mean
Dysinulinism( metabolic syndrom)
Hypothryoidism
Decreased Tryiglycerides mean
Hyperthoridism Vegetairan diets Autoimmune phenomenon Genetic Predisposition Cirrhosis of liver Celiac Disease
What is HDL
High Density lipoprotein Cholesterol- class of heterogeneous particles of varying density and size containing lipid and protein. Includes triglycerides, phospholipids, cholesterol and apoprotein- predominatly phospholipids. Functions to transfer cholesterol to the liver for metabolism of bile acids. Must be viewed in relation to cholesterol and LDL/HDL
Increased HDL mean
possibly consider autoimmune pathology
Decreased HDL means
thyroid hyperfunction
Diabetes
Dysinsulinsim( metabolic syndrom)
LDL what is it?
Low Density Lipoprotein Cholesterol- association between LDL and HDL. Generally, as LDL increases HDL decreases. Most cases LDL is major part of decision relative to beginning dietary therapy and supplemental support.
Hs-CRP what is it?
C-reactive protein- acute phase reactant protein found in liver. Rises rapidly and nonspecifically in response to tissue inflammation and injury CRP is more sensitive than ESR in detecting inflammation. CRP is excellent test in monitoring efficacy of prescriptions/supplemental therapies.
Increased CRP means
Viral and bacterial infections
Non-specific tissue inflammation
coronary artery inflammation
RA
Iron panel- Iron what is it
measures iron in blood- need to order serum iron and serum ferritin- without both serum amount converted to hemoglobin is unknown
Increased iron mean
Hemochromatosis
Hepatic dysfunction
Decreased iron means
Chronic blood loss Iron deficiency anemia Menses Cancer Hepatic dysfunction Chron's disease
TIBC what is it
Total Iron Binding Capacity- Transferrin is responsible for 50-70% of the iron binding capacity of the serum
Increased TIBC means
iron anemia
Decreased TIBC means
Inflammatory disease
Ferritin- what is it?
second most abundant iron-bearing protein in the body. Functions as iron storage in the liver, spleen and bone marrow.
What 3 factors determine levels of ferritin
iron content of body tissue
rate of ferritin dispersal from the tissues
rate of ferritin extraction from blood
Increased ferritin means
Iron overload- hemochromatosis Inflammatory disease Hepatitis HIV infection Cancer
Decreased ferritin means
Iron deficiency anemia
TSH- what is it
Thyroid Stimulating Hormone- originally used to confirm or rule primarily hypofunction and now recognizes hyperfunction
Increased TSH means
Primary thyroid hypofunction
liver dysfunction
HIV
Decreased TSH means
Thyroid Hyperfunction secondary to anterior pituitary hypofunction
What is T4
T4 is major hormone secreted by thyroid. transported bound to Thyroxine Binding Globulin( TBG), prealbumin and albumin. Free T4 is small part of TSH but metabolically active
What is T3
thyroid hormone produced mainly from conversion of T4 to T3. Approx 1/3 of T4 is converted to T3. Higher biological activity than T4 and will bind to TBG less effectively than T4. Both T4 and T3 exist in free and bound form
Increased T3 means
Primary Hyperthyroidism( graves)
Decreased T3 means
Hypothyroidism
Uric acid what is it
principle end product of purine, nucleic acid and nucleoprotein metabolism
Increased Uric acid means
Gout
RA
Decreased Uric Acid means
Molybdenum insufficiency
GGT what is it
Gamma-Glutamyl Transpeptidase- more sensitive and specific indicator of liver dysfunction than serum ALP and in some cases ALT. It is generally increased in all forms of liver/biliary dysfunction and is generally increased above ALT and AST with biliary problems( gall bladder, common bile duct and pancreas) obstructive disease and alcoholism
Increased GGT means
Biliary obstruction
Alcoholism
Bile duct and gall bladder inflammation/ Biliary Stasis
Acute and chronic pancreatitis and Pancreatic Insufficiency
Increased GGTP with increase of serum ALP indicates liver/biliary problem. Normal GGTP with increased ALP indicates a probably bone issue.
Decreased GGT means
GGT<10 is commonly associated with vitamin B6 anemia
Hemoglobin A1c- what is it
Glycated hemoglobin are an irreversible glucose protein bond that extends through life or red blood cell. Glycated hemoglobin used to assess long term glucose control in diabetes- especially insulin dependent
Increased Hemoglobin A1c means
Diabetes
What is Vitamin D 25-Hydroxy
Level of Vitamin D in blood
Increased Vitamin D mean
Vitamin D toxicity- hypercalcemia
Decreased Vitamin D mean
Rickets( children) osteomalacia( adult Osteopororisis Osteoarthritis Hypertension Cardiovascular disease
What is phosphorus
Parathryoid hormone and functional state of kidneys important in evaluating phosphorus serum levels. Parathryoid hormones responsible for increased serum calcium and phosphorus. Important in physiology of bone and formation of active compounds such as phospholipids, nucleic acids, ATP, creatine phosphate and complexes required for utilitzation of glucose. General indicator of digestive dysfunction.
Clinical increase of Phosphorus
Parathyroid hypofunction
Acute and chronic renal dysfunction
Sarcoidosis
Decreased clinical increase of phosphorus mean
Parathryoid hyperfunction Digestive dysfunction( Hypochlorhydria) Vitamin D Deficiency
Anion Gap is?
calculation from sodium, potassium, chloride and CO2 to determine the unmeasured anions and cations.
Increased anion gap means
thiamine deficiency Diabetes Lactic acidosis Dehydration Toxin ingestion Metabolic Acidosis Renal Dysfunction
Decreased Anion gap means
Renal dysfunction
Lithium toxicity
