Pancreatic & GI tests & Renal Function Labs

Question 1

Is amylase specifically targeted to the pancreas?

Answer 1

No

It’s in the salivary glands and the pancreas

Question 2

Amylase levels are seen in what conditions?

Answer 2

acute pancreatitis
obstruction of a pancreatic duct
perforated stomach ulcers
acute appendicitis 
acute cholecystitis

Question 3

How many hours after symptoms start will the amylase increase?

Answer 3

2-12 hours

Question 4

Amylase serum levels will return to normal after how many days after the onset of symptoms?

Answer 4

3-4 days

Question 5

When would you order an amylase lab?

Answer 5

When you are suspicious of pancreatitis, obstruction of a pancreatic duct, perforated stomach ulcers, acute appendicitis, or an acute cholecystitis

Question 6

This is an enzyme that is found primarily in the pancreas.

Answer 6

Lipase

Question 7

The role of lipase is?

Answer 7

to change fats to fatty acids

Question 8

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?

Answer 8

24-36 hours

14 days

Question 9

What conditions is an elevated lipase level associated with?

Answer 9

pancreatitis, pancreatic carcinoma, cholycystitis, renal disease, strangulated or impacted bowel, peritonitis

Question 10

If lipase is elevated, we know that what organ is involved?

Answer 10

pancreas

Question 11

Which bacteria is adapted to survive in the highly acidic gastric environment?

Answer 11

H. pylori

Question 12

Is H. pylor gram-neg, gram-pos, or an anaerobe? What is the shape of it?

Answer 12

Gram-negative rod bacteria

Question 13

H. pylori is associated to what infections of the gut?

Answer 13

chronic active gastritis, peptic ulcer disease, gastric CA, gastric lymphoma

Question 14

When would you order H. pylori?

Answer 14

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

Question 15

How can H. pylori be detected? What examination techniques are used? There are 4.

Answer 15

endoscopy
serum test
stool antigen test
Urea Breath test

Question 16

Which test is the most common? What does it measure?

Answer 16

Serum test

Detects IgG antibody to H. pylori

Question 17

This test uses chemical indicators on stool samples to detect the presence of blood not otherwise visible

Answer 17

Rapid Fecal Occult Blood Test (FOBT)

Question 18

What are some indications for ordering this test (5)?

Answer 18

Routine PE
Routine screening of asymptomatic individuals over 50 yo (Colon CA)
Anemia
Abdominal pain
suspected GI blood loss

Question 19

How do you get a specimen to be used for a FOBT?

Answer 19

Digital Rectal Exam! (DRE)

Question 20

When would you order a stool culture (4)?

Answer 20

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

Question 21

What kind of bacteria would we worry about when ordering a stool culture?

Answer 21

Campylobacter species
Salmonella species
Shigella species
e-coli

Question 22

Why is a stool culture helpful?

Answer 22

Helps determine what bacteria are causing the infection. It helps guide treatment: determines whether abx or medication is necessary to resolve the symptoms.

Question 23

Are fecal leukocytes normally seen in stools in the absence of infection or other inflammatory processes?

Answer 23

No

Question 24

Fecal leukocytes are commonly found in patients with?

Answer 24

Shigellosis
Salmonellosis
sometimes amebiasis
ulcerative colitis

Question 25

Fecal leukocytes are commonly ordered in patients experiencing what symptoms?

Answer 25

Abdominal pain with fever Diarrhea lasting longer than 3 days Abdominal cramping Bloody or mucousy stools

Question 26

Stool ova and Parasides is order to determine what?

Answer 26

Whether there are parasites present in the lower digestive tract, and so, to identify them

Question 27

What are the most common parasites detected?

Answer 27

Giardia Entamoeba histolytica (causes amebiasis) Cryptosporidium It can also detect worms: roundworms, hookworms, tapeworms, flatworms, and flukes

Question 28

When would I order any of the 3 stool studies (5)?

Answer 28

``` prolonged diarrhea abdominal pain abdominal cramping N/V blood and mucus in the stool ```

Question 29

What organ is the sole site of urea formation?

Answer 29

Liver

Question 30

Urea is removed from the blood by which organ?

Answer 30

Kidneys

Question 31

The amount of urea is directly related to the amount of ______ in the patient's diet, as well as the _____ ability to excrete urea.

Answer 31

protein | kidneys

Question 32

The BUN test measures what?

Answer 32

the glomeruli's ability to filter and excrete urea, providing an estimate of renal function

Question 33

BUN is considered a ____ estimate? Why?

Answer 33

rough estimate because it's neither specific or sensitive

Question 34

What could cause a falsely low BUN?

Answer 34

a low protein diet

Question 35

What could cause an elevated BUN level?

Answer 35

impaired glomerular/renail function

Question 36

Excessive amounts of urea in the blood is called?

Answer 36

Uremia

Question 37

Excessive amounts of nitrogen in the blood is called?

Answer 37

Azotemia

Question 38

An elevated Bun is uremia or azotemia?

Answer 38

Azotemia

Question 39

Creatinine is proportional to ____ ____ of the patient?

Answer 39

muscle mass

Question 40

Creatinine is filtered from the ____, and excreted by the ____?

Answer 40

blood | kidneys

Question 41

Creatinine levels reflect what?

Answer 41

glomerular filtration rate (GFR)

Question 42

Creatinine is utilized in several equations to calculate what?

Answer 42

estimated GFR

Question 43

Impaired renal function or urinary tract obstruction can lead to increased or decreased serum creatinine?

Answer 43

Increased serum creatinine

Question 44

What is more valuable: eGFR, GFR, creatinine?

Answer 44

eGFR

Question 45

Is eGFR on a CMP? Is it considered one of the 14 tests?

Answer 45

Yes | No

Question 46

eGFR helps detect what disease?

Answer 46

chronic kidney disease

Question 47

What 3 things can eGFR be used for?

Answer 47

screening purposes diagnostic purposes disease staging

Question 48

People with what 2 chronic conditions should their eGFR be screened?

Answer 48

DM Type II HTN *elderly should also be screened

Question 49

Screening for chronic kidney disease (CKD) usually utilizes what 2 things?

Answer 49

eGFR (in the blood/from serum creatinine) and urine protein

Question 50

eGFR does not usually detect CKD until it has reached what stage?

Answer 50

3

Question 51

eGFR alues above ____ are not reliable?

Answer 51

60

Question 52

At what stage or eGFR number do we refer a patient to a nephrologist?

Answer 52

stage 3 | eGFR of 30

Question 53

Does eGFR increase as kidney function decreases?

Answer 53

No, it decreases

Question 54

What type of progression would an eGFR change of 10-20 in one year be?

Answer 54

Rapid progression

Question 55

What kind of change would constitute a slow progression of eGFR?

Answer 55

2-3 in one year

Question 56

This test compares the level of creatinine in the urine with the creatinine level in serum

Answer 56

Creatinine clearance

Question 57

How is the creatinine clearance test performed?

Answer 57

Urine is collected for 24 hours and blood is drawn at the time the urine is brought to the lab

Question 58

What tests have replaced the creatinine clearance test?

Answer 58

eGFR; urine dipsticks, urine ablumin creatinine ratio (UACR)

Question 59

What test is considered the gold standard for picking up kidney disease before the eGFR picks up on it?

Answer 59

Urine Albumin-to-Creatinine Ratio (UACR)

Question 60

When is urine collected for a UACR?

Answer 60

first morning void

Question 61

What test is recommended when the standard urine dipstick (tests for macroalbuminuria) returns positive (when screening a patient with DM or HTN)?

Answer 61

UACR

Question 62

When can a UACR also be ordered?

Answer 62

When the microalbumin-sensitive dipstick returns positive