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Fundamental Of Disease > Plasma enzymes > Flashcards

Plasma enzymes Flashcards

1
Q

what is an Enzyme?

A

enzymes are proteins that act act as biological catalysr, altering reaction rates and providing a means of regulating metabolic rxn?

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2
Q

how are plasma enzymes measured?

A

by their biological activity or their masses

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3
Q

which enzymes fulfil their physiological function in the plasma?

A

renin and coagulation factors

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4
Q

enzymes are naturally present in the plasmadue to turn over.What happens when damage to cell occurs?

A

there is increased amounts of enzymes willbe released and their concentrations in the blood will rise.

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5
Q

Not all increases of enzymes levels are due to cell damage. what are other factors?

A
  • increase cell turnover
  • cellular proliferation ( e.g. neoplasmia)
  • increased enzyme synthesis ( enzyme induction)
  • decreased clearance
  • obstruction to secretion
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6
Q

Reduced plasma enzyme activity maybe caused by ?

A
  • genetic abnormality
  • reduced activity
  • reduced cell production
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7
Q

most enzymes are removed by which cells?

A

reticuloendothelial cells and amylase is removed by glomeruli cells becasue the component is small enough to be filtered

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8
Q

plasma amylase activity rises in which diease forms?

A

acute renal failure, change in clearance is not as important as changes in plasma enzymes

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9
Q

what is an isoenzyme?

A

different molecular forms of proteins with the same catalyic activity. an isoenzyme may be unique to a tissue or several may be present in proportion charactistic of a tissue.

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10
Q

how are isoenzymes measured?

A

individually measured or detected by exploiting differences in their biological or physio-chemical properties.

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11
Q

enzyme assays usually depend on the measurement of?

A

measurement of catalytic activity of the enzyme, rather than the concentration of the enzyme protein itself.

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12
Q

why does assays for enzymes require optimised and standardised testing ot be reliable?

A

because each enzyme molecule can catalyse the reaction of many reactions of many molecules of substate , measurement of activity provides great sensitivity.

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13
Q

Disadvantages of enzyme assay

A
  1. lack of specificity to a particular tissue or cell types especiallly in diagnosis of tissue damage.
  2. many enzymes are common to more than one tissue, and hence if may be hard to determine where the tissue is damage.
  3. after a singly damage to the tissue there is a rise in the level as the ezyme is release and as the enzyme is cleared it is released. it is important to check the time the test was taken and not the result.
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14
Q

Many enzymes are common to more than one tissue, hence when there is an increase in enzyme it is likely that the tissue origin is not known. this problem may be obviated in two ways

A
  1. different tissues may contain two or more enzymes in different portions. e.g ASt and ALT are both release in the heart and liver cells. but ALT is more common in liver cells .
  2. some enzymes exist in different form such as isoenzymes. individual isoforms are often characteristic of a particular tissue, although they may have similiar catalytic activities they often differ in some other measureable property such as heat stability.
    3.
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15
Q

There are two types of Aminotranferase. what are they?

A
  1. alanine aminotransferase
  2. aspartate aminotransferase
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16
Q

AST Is lower or higher in most cells except the liver

A

LOWER

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17
Q

Where is AST found in liver cells?

A

Mitochondria and cytosol

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18
Q

ALT is found where in liver cells?

A

Cytosol only

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19
Q

AST is released in which tissue other than the liver?

A
  • caradiac muscle
  • skelItalianpancreas
  • RBC
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20
Q

high levels of AST and ALT are indicative of ?

A

severe liver damage, acute hepatitis, crush injuries and tissue hypoxia

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21
Q

what does ULN mean?

A

Upper limit of normal

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22
Q

In inflammatory or infective conditions, such as viral hepatitis which enzyme is higher

A

ALT

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23
Q

In inflitative disorder which liver enzyme is higher

A

AST because there is damage to both mitochondrial and cytoplasmi membranes .

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24
Q

in hepatocellular disease plasma levels of transaminases are

A

10- 100 times higher ULN

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25
Q

in uncomplicated Cholestasis (obstruction) what is the rate of of transminase

A

less than 10 times ULN

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26
Q

levels of AST to up 2x ULN without cell damage

A

Alcoholism

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27
Q

ALP means?

A

Alkaline Phosphatase

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28
Q

What is alkaline phosphatase?

A

a group of glycoprotein enzymes that act as a phosphotransferases by hydrolysing various types of monophosphate bond at alkaline pH.

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29
Q

where is ALP found?

A

liver, bone (osteoblast), placenta and intestinal epithelium.

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30
Q

Pathological increases in ALP activity are seen in?

A

Cholestatic liver disease and in bone diseases in which there is an increase in osteoblastic activity e.g. Paget disease and osteomalacia.

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31
Q

what is the level of ALP in obstructive cholestasis?

A

Greater than 3 times the ULN. approximately 350 ULN

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32
Q

hepatocelular disease the level of ALP is?

A

a slight increase but less than three times ULN (150 - 300)

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33
Q

in the liver ALP is found on two sites. which are?

A
  1. the sinusoidal surfaces of hepatocytes
  2. the microvilli of the bile canaliculi
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34
Q

The isoenzyme of ALP is found in which conditions?

A
  1. pregnancy
  2. growing children
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35
Q

Is ALP activity higher or lower in normal healthy eldery people?

A

Higher , thi smay reflect the high incidence of mild sub-clinical Paget’s disease in the elderly.

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36
Q

Is ALP increased in osteoporosis?

A

No, unless it there is a fracture .

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37
Q

ALP levels are increased in which type of tumours.

A

Bony and hepatic origin and seen in primary and secondary tumours.

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38
Q

Regan Isoenzyme

A
  • found in patients with bronchial carcinoma
  • similiar heat stablity to placental ALP
39
Q

The origin of isoenzyme ALP is done by measuring ?

A

tissue specific isoenzyme of ALP

40
Q

an alternative tp meeasuring ALP is?

A
  • gamma- glutamyl transferase
41
Q

What does GGT Stands for?

A

Gamma- Glutamyl transferase

42
Q

Where is GGT found?

A

in widely distrubuted thoughout the body and is present in the kidneys, liver and pancreas

43
Q

elevated plasma levels of GGT indicates ?

A

Hepatic disease

44
Q

Where in the liver is GGT found?

A

bile canaliculi, the epithelial cells lining the bile ducts and to a certain extend the periportal hepatocytes.

45
Q

Measurement of its plasma activity provides a sensitive indicator of?

A

Hepatobiliary Disease, but it cant distinguish btw cholestatic or hepatocellular disease

46
Q

In which disease does GGT increase before ALP

A

Biliary obstruction

47
Q

Plasma GGT can be raised in the absence of liver disease in which situations?

A

in taking drugs for TB. anticonvulsant drugs phenytoin and phenobaritone, rifampicin.

48
Q

the increased plasma GGT is not due to cell damage but

A

to an increase in enzyme production within cells with the result that an increased during normal cell turnonver.

49
Q

Plasma GGT can remain elevated for up to how many weeks?

A

3-4 weeks. following absintence from alcohol, even in the absence of liver damage.

50
Q

Describe creatine phosphokinase (CPK) or CK

A
  1. enzyme found mainly in the skeletal muscle and heart and brain
  2. it catalyses the transfer of phosphate groups from creatine phosphate to adensoine diphosphate, yielding ATP and creatine.
51
Q

what are the 3 isoenzymes of Ck.

A
  1. MM
  2. MB
  3. BB
52
Q

MM

A

is found in the cardiac muscle and skeletal muscle

53
Q

MB

A

found in the cardiac muscle and trace in skeletal muscle

54
Q

BB

A

Brain, only CK form present in the CSF

55
Q

whic isoenzyme is mainly in the skeletal muscles?

A

MM

56
Q

which isoenzyme is found in different porportions thoughout the myocardian, approximately ranging from 10%- 40%

A

MM

57
Q

Normal leakage of CK plasma activity is ?

A

>97MM and < 3 MB. the level of BB is usually low in severe brain danage.

58
Q

how do you know when the CK is of cardiac origin?

A

more than 5% of the total CK is due to the isoenzyme MB

59
Q

in children the levels of CK is higher or lower

A

2-3 higher in children and then falls in adults.

60
Q

female or males have a higher CK activity

A

Males <240 females <170

61
Q

Why is CK- MB the major marker for cardiac disease?

A

it located in the heart on an activity per tissue weight basis . (myocardium: skeletal > 20)

62
Q

the level of which isoenzyme is increased in muscle regenerating and muscle that has prolonged activity, e.g heavy athletic training.

A

CK- MB

63
Q

Following an acute myocardium infaction

A
  1. level of CK-MB rises within 3-8 hours
  2. reaches a peak in about 10-24hrs if there is no infarct extension
  3. with a half life of 12 hours
  4. MB activity would return to normal after 2-3 days of an uncomplicated MI
64
Q

what is the suggested way of diagnosing a MI

A

taking samples at admission. 12 and 24 hours .

65
Q

CK- MB is found in whAT CONDITIONS?

A

Crushing Syndrome, major surgery, defibrillation, cardiac procedures, severe exercise, rhabomyolysis, and malignant hypothermia.

66
Q

CK-MB can be measured by?

A
  • enzyme mass using immunoassay
  • enzyme activity in the presence of antibodies.
67
Q

describe Lactate dehydrogenase

A

cytoplamsic enzyme found in all tissue and reversibly catalyses the reduction of pyruvate to lactate, using NADH as co enzyme.

68
Q

LD1

A
  • HHHH
  • heart, RBC, kidney
69
Q

LD2

A
  • HHHM
  • heart, RBC, kidney
70
Q

LD3

A

HHMM

Lung, Spleen, Platelets

71
Q

LD4

A

HMMM

Liver, skeletal muscle

72
Q

LD5

A

MMMM

Liver, skeletal muscle

73
Q

Plasma LD activity indicates?

A

Normal Leakage from tissue and erthyroctyes

74
Q

when does the levels of LD in children lower

A

age 12-15

75
Q

Total LD level is elevated in non-haemolysed plasma in?

A
  • myocardial infarction
  • liver disease
  • skeletal muscle
  • leukemia
  • pernicious anemia
  • renal infarction
  • congestive cardiac failure
  • hypothyriodism
  • myeloproliferative disorders
76
Q

In uncomplicated MI, LD activity?

A
  1. starts to rise 8-12 hrs post infaction
  2. peaks 3-5 days after
  3. half life of 100 hours
  4. remain in the plasma for 10 days or more
77
Q

which LD is seen in a wide variety of malignancies?

A

LD3

78
Q

which LD is seen in viral hepatits?

A

LD5

79
Q

Very high LD actvity (>15-20 folds) is seen in?

A

acute leukemia

lymphomas mainly due to LD2, LD3

80
Q

Describe Amylase?

A
  1. breaks down starch and glycogen.
  2. present in high concentration in pancreatic juice and saliva
  3. seen in gonads, fallopian tubes, skeletal muscle and adipose tissues
81
Q

Increased plasma amylase in seen and used to diagnosis whihc conditions?

A

pancreatitis

82
Q

Pancreatitis is caused mainly by?

A

gall stones

alcohol ingestion

83
Q

the structural damage to the pancreas allows the release of

A

pancreatic enzymes (lipase and amylase) whihc then attack and damge healthy pancreatic tissue

84
Q

why are high enzymes level found in the peritoneal area?

A

the released of the enzymes are absorbed from the peritoneal area by the lymphatic system and enter the bloodstream via the thoracic duct.

85
Q

Hyperamylasaemia is not a pathogmic for pancreatits, but very elevated activity over the ULn is a?

A

a diagnosis of pancreatitis

86
Q

follwing an acute attack, Amylase

A
  1. rises 2-12 hrs
  2. reaches a maximum in 12 hrs
  3. returns to normal within 3 days
87
Q

what is the half life of amylase

A

12 hours.

88
Q

Marked increase in plasma amylase is found in?

A
  • acute pancreatitis
  • severe glomerular impairment
  • diabetic ketoacidosis
  • perforated peptic ulcer
89
Q

moderate increase in amylase is seen in?

A
  1. acute cholecystitis
  2. intestinal obstruction
  3. abdominal trauma
  4. ruptured ectopic pregnancy
  5. salivary gland disorder
  6. severe glomerulay dysfunction
  7. acute alcohol intoxication
  8. macroamylasamemia
90
Q

Acid phosphatase function?

A

hydrolyses phosphate esters at ph < 7.0

91
Q

where is acid phosphatase found?

A

prostate

liver

RBC

platelets

spleen

bone marrow

92
Q

Half of the serum acid phosphatase in males is found in?

A

prostate and the remainder are found in bone marrow, platelets, rbc, and liver contributes.

93
Q

prostate specific phosphatase is markedly raised in the majority of patients with

A

metastatic prostate cancer.

94
Q

prostate specific antigen should only be used for?

A

monitoring treatment purposes only and not diagnosis

Fundamental Of Disease (19 decks)

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