NON PROTEIN NITROGENS Flashcards
I. NON-PROTEIN NITROGENS (4)
Urea
● Uric Acid
● Creatinine
● Ammonia
UUCA
○ Accounts for more than _____ of the non-protein
nitrogen which will eventually be excreted
75% - UREA
_______ is commonly termed as blood urea
nitrogen (BUN)
UREA
________ was based on the measurement of your
nitrogen.
UREA
BUN x _______ = Urea
2.14
90%
■ Present and can be detected in urine
KIDNEYS
■ 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
passage of your fluid
through your blood vessels to an
organ or tissue
Perfusion
■ Before the kidney
Prerenal
Kidney
○ Renal
■ After kidney
○ Postrenal
● Causes of azotemia in the blood; 3 “locations”
Prerenal
○ Renal
Postrenal
elevation of urea in the blood
Azotemia
lack of fluid, no waste
product is excreted
Dehydration
hemorrhage- bleeding
shock- not enough blood flow; life
threatening condition
Shock, hemorrhage
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
inflammation in your glomerulus.
no proper filtration of urea
Nephritis
- death in body tissue. Tubules
cannot reabsorb properly
Necrosis
Hormonal changes. Plasma urea concentration will
be decreased during ________
Pregnancy
Formed from creatine and creatine phosphate in the
muscle
CREATININE
Creatine is synthesized by __________, ________, _________
arginine, glycine and methionine
Progressive weakness and loss of
muscle mass
○ Muscular dystrophy
■ Polio
■ Affects our spinal cord that can cause
paralysis
○ Poliomyelitis
It is an insensitive marker and is not measurably
increased until the renal function is decreased by ______
PATHOPHYSIOLOGY: 50%
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%
B1
bilirubin monoglucuronide
● unconjugated bilirubin
● water- insoluble bilirubin
● indirect bilirubin
● non-polar bilirubin
B2
bilirubin diglucuronide
● conjugated bilirubin
● water- soluble bilirubin
● direct bilirubin
● polar bilirubin
Delta bilirubin
● B2 + Albumin
Total bilirubin
● TOTAL BILIRUBIN= B1+ B2 + DELTA BILIRUBIN
B1
● 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
