skeletal Flashcards
alkaline phosphatase is what
enzyme measured in blood
where is AP present in greatest concentrations
bone, live, and bile duct lining cells
what is AP ordered for
to help differentiate a liver problem from bone sources
what is ALP1 or ALP A
enzyme largely from liver
If elevated look at liver etiology
if other liver fx tests elevated, problem is likely with liver
what is ALP2 or ALP B
enzyme mostly from bone
if elevated look for bone etiology
if liver tests are normal, elevation likely with bone, further testing needed
ap is used for what
to point out growth abnormalities such as metastatic bone disease to bone, Paget’s disease, and arthritis (particularly RA)
elevation is not dx
what lab is AP included in
CMP
in addition to giving info for sources of problems, ap can be used for what
follow course of disease
bone scan is what
nuclear scan done after injection of radioactive material into circulation
uses technicium 99
TC 99 is incorporated into bone depending on metabolic activity of bone- uptake is uniform, but will increase around areas of tumor metastases, fx, and other pathological conditions
what do bone scans look like with tumors
bone formation is stimulated around tumors
what will show metastases first, bone scan or xray
bone scan
when to order bone scan
- detect metastases
- detect small fx that don’t show up on regular xray
- part of w/u for pt with CA to stage disease and to determine best tx
- for pt with c/o pain in extremity, hx of trauma when regular xray negative for fx
white color on xray
structures with more calcium block passage eof xrays and show as white or nearly white
darker color on xray
soft tissues are darker
air and blood are black or darker gray depending on intensity of xray
bone and joint xray
ordered after trauma including falls to determine presence of fx
used to aid in dx of various kinds of arthritis
OA findings on bone and joint xray
spurring, loss of intra-articular joint space, swelling, remodeling of peri-articular joint areas, and evidence of synovial fluid
bone and joint xray after trauma
after trauma initial xray may show no overt fx
pt may return with pain and inability to bear wt fully and repeat xray may show fx that did not appear on initial xray
reason why bone and joint xray did not show fx initally
it can take several days for edema to develop along fx line that will make fx observable on xray
indications for bone xray
- hx of trauma
- pain
- arthritis (acute and chronic)
- masses which seem attached to bone
- when osteomyelitis is suspected
what is spinal xray
regular or plain films of spine taken from different views- AP, lateral, oblique
order what part of spine you want to xray
spinal xray dx what
- dx fx
- spurring (perhaps indicating protruding disc)
- vertebral collapse
- osteoporosis
- kyphosis
- scoliosis
- bone metastases
what is most common indication for spinal x-ray and then what
pain
followed by trauma involving spine
what kind of imaging from w/u for pt newly dx with CA
sometimes plain films of spine
but tc99 bone scan are superior for this purpose
how accurate are spinal x-ray
accuracy of films depends on the finding
if plain film shows vertebral fx after trauma, further testing is probably not indicated
if plain film of spine shows spurring of vertebral bodies, this is non-specific finding and MRI may be needed to determine protruding disc
great when they confirm NP impression
what are the 3 general areas usually examined when ordering spinal x-ray
- cervical
- lumbar
- lumbo-sacral
most common reason to order spine x-ray
pain- acute or chronic
following trauma
what is uric acid
by product of breakdown of purines- 1 of building blocks of DNA, RNA, and some proteins
elevated uric acid indicates what
risk for gout
risk for kidney stones
pts with genetic predisposition or bc of dietary factors r/t excessive ingestion of meat and/or etoh
do you need clinical eval with gout
yes, uric acid level does not replace clinical eval
normal uric acid levels are common during attack
other factors that can lead to acute gout
- meds- like HCTZ
- diet
- sudden wt loss
- trauma, including surgery
expected findings on x-ray for osteoarthritis
hands, spine, and large joints are involved with spurring, narrowing of intra-articular space, subchondral cysts
on hand dx-rays- PIP (Bouchard’s nodes) and DIP (Heberden’s nodes)
foods that can contribute to high uric acid
foods high in purines like meat (esp liver), fish, poultry, red wine, beer, and to lesser extent some vegetables and grains (asparagus, cauliflower, spinach, mushrooms green peas, lentils), oatmeal, and wheat germ
