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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%)

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
IgA: Functions
Mucosal immunity-Respiratory, GI, GU
26
IgA deficiency is associated with:
Upper respiratory and GI infections, autoimmune disease
27
IgM is responsible for:
• Responsible for ABO blood grouping and rheumatoid factor -First made after antigen exposure
28
IgE
-Eosinophils -Hay fever, asthma, parasitic
29
Smallest portion of immunoglobulins, rarely evaluated/detected
IgD
30
Malabsorption: Common Lab Findings
• CBC: Anemia (IDA, B12, Folate)~ACD • Inflammatory tests: CRP/ESR • CMP/Additional: Hypoalbumemia, Fat Soluble Vitamins (D, A, E, K), Fecal Fat Test
31
Gluten-Induced Enteropathy/Celiac Disease:
Immune disorder triggered by environmental agent (gliadin)
32
Gluten-Induced Enteropathy/Celiac Disease: Typical Presentation
• Diarrhea illness* • Villous atrophy->malabsorption* • Steatorrhea, weight loss, vitamin deficiencies, anemia* • Resolution of symptoms with gluten free diet*
33
Celiac Disease: Digestive Signs & Symptoms
• Diarrhea, cramping, flatulence • Steatorrhea • Large appetite* • Abdominal bloating, distention • Abdominal pain, nausea
34
Celiac Disease: Systemic Signs & Symptoms (6)
• Weight loss • Migraines • Muscle cramping • Bone/joint pain • Edema • Skin problems
35
Celiac Disease: Signs & Symptoms of Deficiency States
• Weakness • Fatigue • Pallor*
36
Celiac Disease: Special Testing
• 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
Celiac Disease: Management
• 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
Lactose Intolerance
• Inability to digest lactose into glucose and galactose d/t low levels of lactase enzyme in brush border of duodenum
39
Lactose Intolerance: Primary
• Seen in adults with decreasing levels of lactase* • Intolerance noted after lactose consumption* • Intolerance level varies with amount of lactose consumed
40
Lactose Intolerance: Secondary
• Inability to digest lactose caused by any condition injuring intestinal mucosa (eg: diarrhea) or decreasing mucosal surface (eg: resection)
41
Lactose Intolerance: Signs & Symptoms
• 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
Lactose Intolerance: Screening tests
Stool pH
43
Lactose Intolerance: Diagnostic Tests
• Lactose absorption test • Lactose breath hydrogen test
44
Lactose Intolerance: Management
• 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
Crohn’s Disease: Digestive Signs & Symptoms
• Abdominal pain • Diarrhea • Bleeding • Nausea/vomiting • Loss of appetite
46
Crohn’s Disease: Systemic Signs & Symptoms (3)
• Weight loss • Joint pain • Skin problems
47
Crohn’s Disease: Tests
• CRP/ESR: Increases • Fecal calprotectin: Intestinal Information • Stool tests for pathogens • Colonoscopy with biopsy
48
Chronic Pancreatitis: Signs & Symptoms
• Persistent/recurrent pain – LUQ* • Pain worse after meals* • Nausea/vomiting* • Diarrhea/steatorrhea* • Weight loss • Jaundice possible: Block common bile duct
49
Chronic Pancreatitis: Lab Testing
• Amylase/lipase • Abdominal ultrasound • CT/MRI

Clinical Pathology II (10 decks)

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