NON PROTEIN NITROGENS Flashcards by Unknown Unknown

I. NON-PROTEIN NITROGENS (4)

Urea
● Uric Acid
● Creatinine
● Ammonia
UUCA

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○ Accounts for more than _____ of the non-protein
nitrogen which will eventually be excreted

75% - UREA

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_______ is commonly termed as blood urea
nitrogen (BUN)

UREA

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________ was based on the measurement of your
nitrogen.

UREA

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BUN x _______ = Urea

2.14

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90%
■ Present and can be detected in urine

KIDNEYS

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■ 10%
■ Through the action of your bacteria,
urea will be converted back to
ammonia. Ammonia will be
reabsorbed and recycled in the liver

GI Tract

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passage of your fluid
through your blood vessels to an
organ or tissue

Perfusion

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■ Before the kidney

Prerenal

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Kidney

○ Renal

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■ After kidney

○ Postrenal

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● Causes of azotemia in the blood; 3 “locations”

Prerenal
○ Renal
Postrenal

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elevation of urea in the blood

Azotemia

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lack of fluid, no waste
product is excreted

Dehydration

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hemorrhage- bleeding
shock- not enough blood flow; life
threatening condition

Shock, hemorrhage

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Heart no longer
pumps blood efficiently kaya nagiging
congested with blood. If there is
congestion, there is improper functioning sa
pag pump ng heart. No proper renal blood
flow. Accumulation of urea concentration in
the body

Congestive heart failure

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inflammation in your glomerulus.
no proper filtration of urea

Nephritis

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death in body tissue. Tubules
cannot reabsorb properly

Necrosis

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Hormonal changes. Plasma urea concentration will
be decreased during ________

Pregnancy

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Formed from creatine and creatine phosphate in the
muscle

CREATININE

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Creatine is synthesized by __________, ________, _________

arginine, glycine and methionine

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Progressive weakness and loss of
muscle mass

○ Muscular dystrophy

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■ Polio
■ Affects our spinal cord that can cause
paralysis

○ Poliomyelitis

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It is an insensitive marker and is not measurably
increased until the renal function is decreased by ______

PATHOPHYSIOLOGY: 50%

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Product of the catabolism of purine nucleic acids

. URIC ACID

_________ of filtered uric acid is reabsorbed in the PCT

98-100%

__________excreted in the kidneys, others excreted in the GI tract

70%

Purine- _________ and ___________

guanine and adenosine

Most uric acid in the plasma is in the form __________

monosodium urate

Uric acid can form crystals in joints __________

Gout

At the pH of plasma (about ____), urate is relatively insoluble ● At concentrations ______ mg/dL, the plasma is saturated forming ___________

about 7 and greater than 6.8 mg/dl forming urate crystals

In acidic urine (pH _______), uric acid predominates and is seen as uric acid crystals

lesser than 5.7

CLINICAL APPLICATION OF URIC ACID MEASUREMENT (5)

Diagnosis and monitoring of treatment of gout ● Prevent uric acid nephropathy during chemotherapeutic treatment ○ In chemotherapy, there is increased destruction of cells, RNA and DNA of the cells will be released causing an increased uric acid ● Assess inherited disorders of purine metabolism ○ Included are Lesch-Nyhan and SCID ● Detect kidney function ● Assist in the diagnosis of renal calculi

Due to increased concentration of uric acid or a certain enzyme deficiency

GOUT

● Found primarily in men (_________ years old)

30-50 years old

● Plasma uric acid is usually greater than _________

6.0 mg/dl

Normal range: ■ Women _______ mg/dL ■ Men ________ mg/dL

2.4 - 6.0 mg/dl 3.4 - 7.0 mg/dl

Crystals(Sodium urates or uric acids) would build up around your joints ○ Swollen and bulbous

● TOPHI formation

Free ammonia is ______

toxic

Produced from the deamination of amino acids during protein metabolism ● Exists as ammonium ion at normal physiological pH ● Free ammonia is toxic ● Consumed by the parenchymal cells of the liver in the production of urea

AMMONIA

○ Common in children ○ Acute metabolic disorder of the liver ○ A child’s blood sugar level would typically drop, while the level of ammonia and acidity in the body would increase ○ Liver may swell and may develop fatty deposits

● Reye’s syndrome

If there is enzyme deficiencies, ammonia would accumulate

● Inherited defects in the urea cycle

Certain liver diseases in which our liver will struggle to filter toxins out of our body including converting ammonia to urea. These toxins will accumulate in the blood. There is a tendency that our ammonia will reach the brain and temporarily or permanently affect brain function.

Hepatic Encephalopathy

The liver weighs approximately ____________ kg in a healthy adult. ● It is located beneath and attached to the diaphragm, protected by the lower rib cage, and held in place by ligamentous attachments. ● Has 2 lobes, right and left, separated by the ____________ → Right lobe is approximately _____ larger

1.2-1,5 kg falciform ligament 6x

BLOOD SUPPLY 2 Main blood vessels supplying blood: → Hepatic Artery (____ - oxygen rich) → Portal Vein (______ -nutrient rich)

25% 75%

Chief metabolic organ ● Composed of _________ and _________

hepatocytes kupffer cells

Liver Functional unit: ___________

Lobules

Portal triad:

Hepatic artery portal vein, bile duct HPB

During _________, the patient can survive as long as only _______ is taken.

Lobectomy - 65%

● Capable to create substances

A. SYNTHETIC FUNCTION

Normal:

12g albumin/day

_________ mg bilirubin(conjugated) produced daily

200-300

The form of iron that the transferrin can carry

Ferric iron ((Fe3+)

storage form of iron

Ferritin

carrier protein of unconjugated bilirubin

ALBUMIN

substances found inside the hepatocyte:

Y&Z Proteins and Ligandin

ONE of the substances that causes the yellow coloration of the urine. (urochrome is the primary substance that causes the yellow coloration of urine)

Urobilin

the urobilinogen will be reabsorbed into the blood and goes either into the liver for reexcretion in the bile, or the urine.

Extrahepatic circulation

urobilinogen may go to the kidney, then to the urinary bladder.

Systemic circulation:

Now,______of the urobilinogen will become _______ _________: reason why feces is brown.

80% - stercobilin

The remaining ______ of the urobilinogen will go to either the extrahepatic circulation or the systemic circulation

20%

bilirubin monoglucuronide ● unconjugated bilirubin ● water- insoluble bilirubin ● indirect bilirubin ● non-polar bilirubin

bilirubin diglucuronide ● conjugated bilirubin ● water- soluble bilirubin ● direct bilirubin ● polar bilirubin

Delta bilirubin

● B2 + Albumin

Total bilirubin

● TOTAL BILIRUBIN= B1+ B2 + DELTA BILIRUBIN

● B1= TOTAL BILIRUBIN - B2

Protects body from potentially harmful substances absorbed from GIT and toxic by-products of metabolism

C. DETOXIFICATION AND DRUG METABOLISM

Excretion of bile

- bile acids or salts, pigments, cholesterol

● All fat-soluble vitamins

ADEK

● Water-soluble vitamins

→ B12