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Clinical Pathology II > Proteins > Flashcards

Proteins Flashcards

1
Q

Increased protein synthesis is caused by: (3)

A

T4, cortisol, anabolic steroids

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2
Q

Decreased protein synthesis

A

Malnutrition, malignancies, hot environments

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3
Q

Protein (Functions)

A

• Transport
• Maintain osmotic balance
• Immune defense reactions
• Coagulation
• Contribute to nitrogen needs
• Structural components
• Enzymes
• Hormones

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4
Q

What makes up the majority of total protein

A

Albumin

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5
Q

Albumin is synthesized in the:

A

Liver
-Water-Soluble

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6
Q

Albumin: Functions

A

Oncotic Pressure, Transport

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7
Q

Albumin: Clinical Significance

A

• Serum albumin depends on: synthesis, degradation, and loss of albumin, volume distribution between vascular compartments
• If synthesis and loss are not the problem, can be useful as nutritional assessment

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8
Q

Albumin: Increased Levels

A

Dehydration*

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9
Q

Albumin: Decreased Levels

A

• Chronic liver disease: Cirrhosis
• Protein-losing enteropathies (malabsorption)*
• Protein-losing nephropathies*
• Third space losses
• Malnutrition
-Tea & Toasters

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10
Q

Globulin: General

A

• Larger molecules
• Alpha, beta, gamma (antibodies)
• Synthesis: Gamma globulins-lymphoid
• Functions: Transport & Blood Clotting (Alpha + Beta), Immune functions (antibodies)

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11
Q

Globulin: Increased Levels

A

-Multiple Myeloma: B-Cells->Plasma Cells->antibodies
-Chronic inflammatory/autoimmune (RA/SLE)
-Acute/Chronic Infections

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12
Q

Globulin: Decreased Levels

A

•Genetic immune disorders
• Secondary immune disorders

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13
Q

Total Protein

A

Albumin + globulin

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14
Q

A:G Ratio

A

2:1

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15
Q

Reverse A:G Ratio is caused by:

A

Multiple Myeloma and Liver Disease

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16
Q

Total protein is determined by:

A

Nutritional state, hepatic function, renal function, hydration, various disease states

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17
Q

Total Protein: Increased

A

Dehydration, chronic infections

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18
Q

Total Protein: Decreased

A

Chronic liver, enteropathy, neuropathy, malnutrition

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19
Q

Chronic Liver Disease: Reversed A:G Ratio is caused by

A

Albumin (Low), Globulin (Normal/slight increase), Total Protein (Low)

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20
Q

Multiple Myeloma: Reversed A:G ratio is caused by

A

Albumin (Normal), Globulin (Elevated-Notable), Total Protein (Elevated or NL)

21
Q

*Preferred screen after abnormalities on TP, alb, glob, A:G ratio

A

Protein Electrophoresis (ELP)

22
Q

ELP separates protein into 5 fractions

A

• Albumin, Alpha 1, Alpha 2, Beta, Gamma

23
Q

• Constitutes majority of circulating blood antibodies (75%)

A

IgG

24
Q

IgG: Functions

A

-Material Transfer
• Responsible for major antibacterial and antiviral (forever) activity in serum
•Opsonization, agglutination
• Tumor recognition
• Neutralization of toxins, virus
• Activates complement

25
Q

IgA: Functions

A

Mucosal immunity-Respiratory, GI, GU

26
Q

IgA deficiency is associated with:

A

Upper respiratory and GI infections, autoimmune disease

27
Q

IgM is responsible for:

A

• Responsible for ABO blood grouping and rheumatoid factor
-First made after antigen exposure

28
Q

IgE

A

-Eosinophils
-Hay fever, asthma, parasitic

29
Q

Smallest portion of immunoglobulins, rarely evaluated/detected

A

IgD

30
Q

Malabsorption: Common Lab Findings

A

• CBC: Anemia (IDA, B12, Folate)~ACD
• Inflammatory tests: CRP/ESR
• CMP/Additional: Hypoalbumemia, Fat Soluble Vitamins (D, A, E, K), Fecal Fat Test

31
Q

Gluten-Induced Enteropathy/Celiac Disease:

A

Immune disorder triggered by environmental agent (gliadin)

32
Q

Gluten-Induced Enteropathy/Celiac Disease: Typical Presentation

A

• Diarrhea illness*
• Villous atrophy->malabsorption*
• Steatorrhea, weight loss, vitamin deficiencies, anemia*
• Resolution of symptoms with gluten free diet*

33
Q

Celiac Disease: Digestive Signs & Symptoms

A

• Diarrhea, cramping, flatulence
• Steatorrhea
• Large appetite*
• Abdominal bloating, distention
• Abdominal pain, nausea

34
Q

Celiac Disease: Systemic Signs & Symptoms (6)

A

• Weight loss
• Migraines
• Muscle cramping
• Bone/joint pain
• Edema
• Skin problems

35
Q

Celiac Disease: Signs & Symptoms of Deficiency States

A

• Weakness
• Fatigue
• Pallor*

36
Q

Celiac Disease: Special Testing

A

• IgA Anti-Tissue Transglutaminase Antibodies (IgA anti-tTG)*
• Total serum IgA (+): Total IgA is too low->cannot interpret*
• Anti-gliadin antibodies
• Anti-endomysial antibodies (EMA)
• Genetic testing: HLA DQ2 and DQ8*
• Zonulin: Increased intestinal permeability
• Endoscopy with biopsy*

37
Q

Celiac Disease: Management

A

• Removal of all gluten from diets
• Watch for cross-reactive foods
• See some improvement 1-2 weeks after removal
• Most symptom resolve in 4-6 weeks
• Supplemental vitamins as needed

38
Q

Lactose Intolerance

A

• Inability to digest lactose into glucose and galactose d/t low levels of lactase enzyme in brush border of duodenum

39
Q

Lactose Intolerance: Primary

A

• Seen in adults with decreasing levels of lactase*
• Intolerance noted after lactose consumption*
• Intolerance level varies with amount of lactose consumed

40
Q

Lactose Intolerance: Secondary

A

• Inability to digest lactose caused by any condition injuring intestinal mucosa (eg: diarrhea) or decreasing mucosal surface (eg: resection)

41
Q

Lactose Intolerance: Signs & Symptoms

A

• 30 minutes to 2 hours after consumption of produces containing lactose*
• Distinguish from IBS w/ trial of lactose free diet*
• Bloating
• Rumbling
• Cramping
• Diarrhea/loose stool
• Steatorrhea
• Flatulence

42
Q

Lactose Intolerance: Screening tests

A

Stool pH

43
Q

Lactose Intolerance: Diagnostic Tests

A

• Lactose absorption test
• Lactose breath hydrogen test

44
Q

Lactose Intolerance: Management

A

• Reduce or restrict dietary lactose*
• Yogurt, fermented products such as hard cheeses – better tolerated*
• May tolerate full fat milk better than skim*
• Lactase preparations: Lactic Acid
• Read labels
• Maintenance of calcium and vitamin D-Kids
• May tolerate 12-15g of lactose
• Certain probiotics can help when taken with lactose containing food

45
Q

Crohn’s Disease: Digestive Signs & Symptoms

A

• Abdominal pain
• Diarrhea
• Bleeding
• Nausea/vomiting
• Loss of appetite

46
Q

Crohn’s Disease: Systemic Signs & Symptoms (3)

A

• Weight loss
• Joint pain
• Skin problems

47
Q

Crohn’s Disease: Tests

A

• CRP/ESR: Increases
• Fecal calprotectin: Intestinal Information
• Stool tests for pathogens
• Colonoscopy with biopsy

48
Q

Chronic Pancreatitis: Signs & Symptoms

A

• Persistent/recurrent pain – LUQ*
• Pain worse after meals*
• Nausea/vomiting*
• Diarrhea/steatorrhea*
• Weight loss
• Jaundice possible: Block common bile duct

49
Q

Chronic Pancreatitis: Lab Testing

A

• Amylase/lipase
• Abdominal ultrasound
• CT/MRI

Clinical Pathology II (10 decks)

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