Pancreatic & GI tests & Renal Function Labs Flashcards
Is amylase specifically targeted to the pancreas?
No
It’s in the salivary glands and the pancreas
Amylase levels are seen in what conditions?
acute pancreatitis obstruction of a pancreatic duct perforated stomach ulcers acute appendicitis acute cholecystitis
How many hours after symptoms start will the amylase increase?
2-12 hours
Amylase serum levels will return to normal after how many days after the onset of symptoms?
3-4 days
When would you order an amylase lab?
When you are suspicious of pancreatitis, obstruction of a pancreatic duct, perforated stomach ulcers, acute appendicitis, or an acute cholecystitis
This is an enzyme that is found primarily in the pancreas.
Lipase
The role of lipase is?
to change fats to fatty acids
An increase in lipase will occur within how many hours after the onset of pancreatitis and will remain elevated for up to how many days?
24-36 hours
14 days
What conditions is an elevated lipase level associated with?
pancreatitis, pancreatic carcinoma, cholycystitis, renal disease, strangulated or impacted bowel, peritonitis
If lipase is elevated, we know that what organ is involved?
pancreas
Which bacteria is adapted to survive in the highly acidic gastric environment?
H. pylori
Is H. pylor gram-neg, gram-pos, or an anaerobe? What is the shape of it?
Gram-negative rod bacteria
H. pylori is associated to what infections of the gut?
chronic active gastritis, peptic ulcer disease, gastric CA, gastric lymphoma
When would you order H. pylori?
1) persistent dyspepsia (upset stomach or indigestion) for 2 weeks despite appropriate Abx therapy for tx of H.pylori infection 2) to assess the eradication of H. pylori
How can H. pylori be detected? What examination techniques are used? There are 4.
endoscopy
serum test
stool antigen test
Urea Breath test
Which test is the most common? What does it measure?
Serum test
Detects IgG antibody to H. pylori
This test uses chemical indicators on stool samples to detect the presence of blood not otherwise visible
Rapid Fecal Occult Blood Test (FOBT)
What are some indications for ordering this test (5)?
Routine PE Routine screening of asymptomatic individuals over 50 yo (Colon CA) Anemia Abdominal pain suspected GI blood loss
How do you get a specimen to be used for a FOBT?
Digital Rectal Exam! (DRE)
When would you order a stool culture (4)?
1) Used a lot to help determine the cause of prolonged diarrhea. 2) for any person that may have been traveling outside of the country and experiences diarrhea 3) persons with abdominal pain and abdominal cramping with fever 4) patients with N/V and fever
What kind of bacteria would we worry about when ordering a stool culture?
Campylobacter species
Salmonella species
Shigella species
e-coli
Why is a stool culture helpful?
Helps determine what bacteria are causing the infection. It helps guide treatment: determines whether abx or medication is necessary to resolve the symptoms.
Are fecal leukocytes normally seen in stools in the absence of infection or other inflammatory processes?
No
Fecal leukocytes are commonly found in patients with?
Shigellosis
Salmonellosis
sometimes amebiasis
ulcerative colitis
Fecal leukocytes are commonly ordered in patients experiencing what symptoms?
Abdominal pain with fever
Diarrhea lasting longer than 3 days
Abdominal cramping
Bloody or mucousy stools
Stool ova and Parasides is order to determine what?
Whether there are parasites present in the lower digestive tract, and so, to identify them
What are the most common parasites detected?
Giardia
Entamoeba histolytica (causes amebiasis)
Cryptosporidium
It can also detect worms: roundworms, hookworms, tapeworms, flatworms, and flukes
When would I order any of the 3 stool studies (5)?
prolonged diarrhea abdominal pain abdominal cramping N/V blood and mucus in the stool
What organ is the sole site of urea formation?
Liver
Urea is removed from the blood by which organ?
Kidneys
The amount of urea is directly related to the amount of ______ in the patient’s diet, as well as the _____ ability to excrete urea.
protein
kidneys
The BUN test measures what?
the glomeruli’s ability to filter and excrete urea, providing an estimate of renal function
BUN is considered a ____ estimate? Why?
rough estimate because it’s neither specific or sensitive
What could cause a falsely low BUN?
a low protein diet
What could cause an elevated BUN level?
impaired glomerular/renail function
Excessive amounts of urea in the blood is called?
Uremia
Excessive amounts of nitrogen in the blood is called?
Azotemia
An elevated Bun is uremia or azotemia?
Azotemia
Creatinine is proportional to ____ ____ of the patient?
muscle mass
Creatinine is filtered from the ____, and excreted by the ____?
blood
kidneys
Creatinine levels reflect what?
glomerular filtration rate (GFR)
Creatinine is utilized in several equations to calculate what?
estimated GFR
Impaired renal function or urinary tract obstruction can lead to increased or decreased serum creatinine?
Increased serum creatinine
What is more valuable: eGFR, GFR, creatinine?
eGFR
Is eGFR on a CMP? Is it considered one of the 14 tests?
Yes
No
eGFR helps detect what disease?
chronic kidney disease
What 3 things can eGFR be used for?
screening purposes
diagnostic purposes
disease staging
People with what 2 chronic conditions should their eGFR be screened?
DM Type II
HTN
*elderly should also be screened
Screening for chronic kidney disease (CKD) usually utilizes what 2 things?
eGFR (in the blood/from serum creatinine) and urine protein
eGFR does not usually detect CKD until it has reached what stage?
3
eGFR alues above ____ are not reliable?
60
At what stage or eGFR number do we refer a patient to a nephrologist?
stage 3
eGFR of 30
Does eGFR increase as kidney function decreases?
No, it decreases
What type of progression would an eGFR change of 10-20 in one year be?
Rapid progression
What kind of change would constitute a slow progression of eGFR?
2-3 in one year
This test compares the level of creatinine in the urine with the creatinine level in serum
Creatinine clearance
How is the creatinine clearance test performed?
Urine is collected for 24 hours and blood is drawn at the time the urine is brought to the lab
What tests have replaced the creatinine clearance test?
eGFR; urine dipsticks, urine ablumin creatinine ratio (UACR)
What test is considered the gold standard for picking up kidney disease before the eGFR picks up on it?
Urine Albumin-to-Creatinine Ratio (UACR)
When is urine collected for a UACR?
first morning void
What test is recommended when the standard urine dipstick (tests for macroalbuminuria) returns positive (when screening a patient with DM or HTN)?
UACR
When can a UACR also be ordered?
When the microalbumin-sensitive dipstick returns positive
