Pancreatic and GI tests Flashcards
What is Amylase?
An enzyme found in the pancreas and salivary glands. It converts starch into sugar.
Where is Amylase found?
55-60% in salivary glands (makes it tricky to pinpoint to the pancreas)
40-45% in pancreas
What conditions may increased levels of Amylase be found in?
Acute pancreatitis, obstruction of a pancreatic duct, perforated stomach ulcers, acute appendicitis, and acute cholecystitis.
How long after the onset of symptoms will you see an increase in Amylase levels?
2-12 hours.
Will return to normal levels after 3-4 days
When do you order Amylase levels?
When suspicious of pancreatitis (or other associated conditions)
Which levels rise faster, Amylase or Lipase?
Amylase.
BUT, Lipase is more specific to the pancreas
What is Lipase?
An enzyme found primarily in the pancreas.
It changes fats into fatty acids.
When might you see an increase in Lipase levels?
Following pancreatic damage.
Pancreatic carcinoma, cholecystitis, renal disease, strangulated or impacted bowel, peritonitis.
What can you be sure of with elevated Lipase levels?
Pancreatic involvement
How quickly will Lipase levels increase after symptoms arise?
24-36 hours.
Will remain elevated up to 14 days
What situations might you order a Lipase or Amylase over the other?
They are generally ordered together, but it can be time sensitive.
Since Lipase levels take longer to rise, an Amylase might be ordered earlier.
Since Lipase levels remain raised longer, you might order a Lipase if it has been longer than 4 days since symptoms started.
What other tests might you order with an Amylase or Lipase to aid in the diagnosis of pancreatitis?
ALP, AST/ALT, CMP in general
What is Helicobacter pylori (H-pylori)?
Gram-negative rod bacteria.
Uniquely adapted to survive in highly acidic gastric environment.
What types of infections might H-pylori cause?
Infections of the stomach and duodenum.
Chronic active gastritis, peptic ulcer disease, gastric cancer, possibly some forms of gastric lymphoma.
What tests can you do to confirm an H-pylori infection?
Endoscope.
Serum level for IgG specific to H-pylori.
Stool antigen test.
Urea Breath test
Why might you order an H-pylori test?
New onset of upset stomach or indigestion (impaired digestion).
Chronic or recurrent pain in the upper abdomen, upper abdomen fullness, feeling full earlier than expected.
Persistent dyspepsia despite 2 weeks of appropriate antibiotic therapy.
Reevaluation of eradication of H-pylori.
How does the Rapid Fecal Occult Blood Test (FOBT) work?
Uses chemical indicators on stool samples to detect the presence of blood not otherwise visible.
What conditions may blood in the stool indicate?
Colon cancer, rectal cancer, gastric cancers
ulcers, hemorrhoids, polyps, inflammatory bowel disease, irritations or lesions of GI tract caused by medications… LOTS of possibilities!
Blood coming from what region of the GI tract would cause the stool to be DARK/BLACK looking?
Upper - Esophagus, Stomach, Duodenum
Blood coming from what region of the GI tract would cause the stool to be BRIGHT RED?
Lower - Descending colon, sigmoid, rectum
Blood coming from what region of the GI tract would cause the stool to be MEDIUM RED/MAROON colored?
Jejunum to the transverse colon.
What indications might cause you to order an FOBT?
Routine physical exam. Routine screening for asymptomatic patients >50 years old Anemia Abdominal Pain Suspected GI blood loss
How do you obtain an FOBT specimen?
Digital Rectal Exam.
Released stool.
How fast do you get the results of an FOBT?
QUICK!!! A positive result is where there is a quick color change on the film.
What is the purpose of a stool culture?
To detect the presence of disease-causing bacteria and help diagnose infection of GI tract.
Why is a stool culture normally ordered?
To determine the cause of prolonged diarrhea.
Can help guide treatment.
What bacteria might a stool culture reveal?
Campylobacter species, salmonella, shigella, e. coli
When should you order a stool culture?
Get a good history!!!
Diarrhea lasting more than a few days, and might contain blood or mucous.
Diarrhea in a person who has been traveling outside of the country.
Abdominal cramping/pain with fever.
Nausea, vomiting, fever.
Why do you see fecal leukocytes?
Response to infection with microorganisms that invade tissue or produce toxins, causing tissue damage.
What conditions would you see fecal leukocytes?
Shigellosis, Salmonellosis, Amebiasis
Ulcerative colitis.
When would you order a fecal leukocyte test?
Patients with ab pain and fever, diarrhea lasting longer than 3 days, ab cramping, bloody or mucousy stools.
What is the purpose of a Stool Ova and parasite exam (O&P)?
To help diagnose the cause of prolonged diarrhea. To determine whether there are parasites present in the lower digestive tract, and identify them.
What are the most common parasites found in the US?
Typically only one at a time, but can be multiple.
Giardia, Entamoeba histolytica, Cryptosporidium.
Dientamoeab fragilis, Balantidium coli, Cyclospora cayetanensisc.
Roundworms, Hookworms, Tapeworms, Flatworms, Flukes
When would you order an O&P?
Order when pt. has prolonged diarrhea, ab pain, ab cramping, nausea, vomiting, blood, mucous in stool.
