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DU PA GE Labs
Duke PA Gastroenterology Labs
| Question | Answer |
|---|---|
| recurrent PUD, gastrinoma increases gastrin production many fold, gastric acid hypersecretion | Zollinger-Ellison syndrome |
| digestive enzyme made mostly by pancreas and salivary glands, breaks down starch | amylase |
| digestive enzyme made mostly by pancreas, released into the bloodstream with diseas or injury, breaks down triglycerides | lipase |
| if you have elevated amylase and lipase but the patient feels well, then | it is not pancreatitis, pancreatitis hurts |
| elevation in serum is highly specific for pancreatic disease | lipase |
| amylase, lipase | pancreatic enzymes |
| AST, ALT, GGT, alkaline phosphatase | liver enzymes |
| alkaline phosphatase, GGT, bilirubin | biliary enzymes |
| total protein, albumin, ALT, AST, alkaline phosphatase, total bilirubin, conjugated bilirubin | liver function tests (LFT) |
| used to evaluate serum proteins, nutritional status, liver function | total serum protein |
| components of total serum protein | prealbumin, albumin, globulins |
| reasons for increased serum proteins | dehydration, multiple myeloma, hyperglobulinemia, |
| reasons for decreased serum proteins | pregnancy, escessive intravenous fluid administration, cirrhosis of the liver, chronic alcoholism, heart failure, nephrotic syndrome, burns |
| the portion of the total serum protein formed in the liver | albumin |
| half-life of albumin | 14-20 days |
| serum albumin drops slowly with | acut hepatocellular dysfunction |
| can be used as a more sensitive test to assess rapid liver damage (viral or toxic) b/c it has a half life of 2 days | serum prealbumin |
| alanine aminotransferase | ALT |
| high specificity for liver damage, increases with liver inflammation. hepatocellular enzyme | ALT |
| moderate __ content in kidney, heart, and skeletal muscle, found mostly in liver | ALT |
| low ALT content in | pancreas, spleen, lung and RBC's |
| is more elevated in injury than obstruction or cirrhosis of liver | ALT |
| aspartate aminotransferase | AST |
| high __ in liver, heart, brain, and skeletal muscle | AST |
| moderate __ in RBC's | AST |
| elevated AST associated with __ | cell necrosis |
| increased serum AST activity commonly follows | MI, PE, skeletal muscle trauma, alcoholic cirrhosis, viral hepatitis, drug induced hepatitis |
| __ causes elevate of AST due to RBC contents | hemolysis |
| screening test of extrinsic or initiator pathway of coagulation | prothrombin time |
| monitor anticoagulation therapy with warfarin | prothrombin time |
| may be abnormal in patients with liver disease or vitamin K deficiency | prothrombin time |
| hepatic function panel contains | sodium, potassium, chloride, CO2, glucose, urea, creatinine, calcium, albumin, phosphorus |
| gallstones in gallbladder with transient cystic duct obstruction. Clinical diagnosis confirmed by US | biliary colic |
| gallstones obstructing cystic duct, WBC increase with left shift. elevated amylase and lipase, mild elevation in AST, ALT, bilirubin, alkaline phosphatase | acute cholecystitis |
| common bile duct stones, mild bilirubin elevation, moderate alkaline phosphatase elevation, transient transaminase elevation | choledocholithiasis |
| infection with pus located in biliary tree (usually from impacted CBD stone), increased LFT's, increased WBC's, other labs normal | cholangitis |
| gamma-glutamyltransferase | GGT |
| very useful in assessing cholestasis and biliary obstruction,biliary stasis | GGT |
| enzyme most often measured to indicate bile duct obstruction | ALP |
| expect __ to rise in active bone formation, pregnancy, and some intestinal disorders | ALP |
| alkaline phosphatase | ALP |
| may be associated with intrahepatic cholestasis, hepatocellular damage, and extrahepatic biliary obstruction | conjugated bilirubin |
| used to evaluate hepatocellular function, degree of hemolytic disease, or some hereditary diseases | total bilirubin |
| total bilirubin is increased from | hemolysis, defective removal of heme, defective hepatic bilirubin metabolism |
| exposure to light may alter __ chemical and spectral properties | bilirubin |
| total protein is __ in hepatitis | normal |
| total protein is __ in cirrhosis | decreased |
| albumin is __ in hepatitis | normal |
| albumin is __ in cirrhosis | elevated |
| globulin is __ in cirrhosis | normal |
| globulin is __ in cirrhosis | increased |
| CBC, serum albumin, ESR, thyroid function tests, FOBT should all be normal in | IBS |
| if a patient has IBS and is <45 consider | flexible sigmoidoscopy |
| if a patient has IBS and is >45 they get | DCBE or colonoscopy (unless previously negative) |
| laboratory findings of __ are anemia, low serum albumin, elevated ESR, negative stool cultures | ulcerative colitis |
| sigmoidoscopy finding of a patient with __ will be edema, friability, mucopus and erosions | ulcerative colitis |
| normal amount of peritoneal fluid __ ml | 50 |
| RBC count in normal peritoneal fluid <__ | 100,000 |
| WBC count in normal peritoneal fluid <__ | 300 |
| procedure to obtain peritoneal fluid for diagnosis or therapeutics | paracentsis |
| indication for paracentesis | evaluation of ascites |
| testing done on peritoneal fluid | cell counts, cytology, gram stain, chemical testing (glucose, amylase, ammonia, alkaline phosphatase) |
| indication for a peritoneal lavage | evaluation of abdominal trauma, intraperitoneal hemorrhage, ruptured intestine or other organs |
| elevated in new bone growth | alkaline phosphatase |
| the most comon cause of elevated serum lipase level is | acute pancreatitis |
| lipaw elevations in non-pancreatic diseases are less than three times the upper limit of normal as compared with pancreatitis in which they are often elevated __ times normal values | 5-10 |
| because the peak later (24-48 hours) and remain elevated longer (5-7 days)__ levels are more useful in the late diagnosis of acute pancreatitis | serum lipase |
| normal serum amylase | 60-120 |
| an abnormal rise in serum amylase occurs within __ hours of the onset of disease | 12 |
| serum amylase levels return to normal within __ hours | 48-72 |
| patients with chronic pancreatits often have too few acinar cells to produce __ | amylase and lipase |
| total serum protein is a combination of __ | prealbumin, albumin, and globulins |
| __ is a protein that is normaly found in the liver | albumin |
| the key building blocks of antibodies, glycoproteins, lipid proteins, clotting factors, complement, and acute phase reactants | globulins |
| __ are immune globulins (antibodies) | gamma globulins |
| malnourished patients, especially after surgery, have a greatly decreased level of __ | serum proteins |
| pregnancy, especially in the third trimester is associated with reduced __ | total protein |
| some __ is made in the liver but most is made in the reticuloendothelial system | globulin |
| the __ fraction of the total protein can be factitiously elevated in dehydrated patients | albumin |
| this enzyme is found in very high concentrations within highly metabolic tissue, such as the heart muscle, liver cells, skeletal muscle cells, and to a lesser degree in the kidney | aspartate aminotransferase (AST) |
| serum AST levels become elevated __ hours after cell injury | 8 |
| serum AST levels peak at __ hours after cell injury | 24-36 |
| serum AST levels return to normal __ days after cell injury | 3-7 |
| in __ AST levels can rise 20 times the normal value | acute hepatitis |
| in __ AST levels quickly rise to 10 times the norm and swiftly fall | extrahepatic obstruction (gallstones) |
| serum AST levels are often compared to __ levels | alanine aminotransferase (ALT) |
| the AST/ALT ratio is usually greater than 1 in patients with __ | alcoholic cirrhosis, liver congestion, and metastatic tumor of the liver |
| AST/ALT ratios of less than 1 may be seen in patients with __ | acute hepatitis, viral hepatitis, or infectious mononucleosis |
| normal serum levels of alanine aminotransferase | 4-36 |
| in jaundiced patients an abnormal __ will incriminate the liver rather than RBC hemolysis as the source | ALT |
| ALT is found predominantly in __ | the liver |
| most __ elevations generally are caused by liver dysfunction | ALT |
| in hepatocellular disease other than viral hepatitis the ALT/AST ratio is | less than 1 |
| used as an indicator of heavy and chronic alcohol use | gamma-glutamyl transpeptidase (GGTP), or gamma-glutamyl transferase (GGT) |
| the highest level of GGTP enzyme are found in | liver and biliary tract |
| lesser concentrations of GGTP are found in | kidney, spleen, heart, intestine, brain, and prostate gland |
| highly accurate in detecting even the slightest degree of cholestasis | GGTP |
| a normal GGTP level with an elevated alkaline phosphatase level would imply __ | skeletal disease |
| an elevated GGTP and elevated alkaline phosphatase level would imply __ | hepatobiliary disease |
| __ is used to detect and monitor diseases of the liver or bone | alkaline phosphatase (ALP) |
| normal level of ALP | 30-120 |
| although ALP is found in many tissue, the highest concentrations are found in the __ | liver, biliary tract epithelium and bone |
| within the live ALP is located within __ which line the biliary collecting system | kupffer cells |
| ALP is secreted into the __ | bile |
| enzyme levels of ALP are greatly increased in __ | obstructive biliary disease |
| reports have indicated that the most sensitive test to indicate tumor metastasis to the liver is the __ | ALP |
| __ is the most frequent extrahepatic source of ALP | bone |
| new bone growth is associated with elevated __ | ALP |
| in pregnancy the placenta produces | ALP |
| __ is a hormone produced by the G cells located in the distal part of the stomach (antrum) | gastrin |
| __ is a potent stimulator of gastric acid | gastrin |
| in normal gastric physiology an alkaline environment stimulates __ | the release of gastrin |
| gastrin stimulates the __ cells to secrete acid | parietal |
| low-pH suppresses further __ secretion | gastrin |
| ZE syndrome and g-cell hyperplasia are associated with high serum __ | gastrin |
| patients with ZE syndrome have aggressive __ disease | peptic ulcer |
| serum gastrin level will be normal in people with routine peptic ulcers | normal |
| patients who are taking antacid peptic ulcer medications, have had peptic ulcer surgery, or have atrophic gastritis will have high serum __ levels | gastrin |
| normal 5-HIAA | 2-8/24 hr or 10-40 micromole/day |
| quantitative analysis of urine __ is performed to detect and monitor the clinical course of carcinoid tumors | 5-HIAA |
| Carcinoid tumors are serotonin secreting tumors that may grow in the appendix, intesting, lung. The serotonin and other hormones secreted by these tumors are metabolized in the liver to __ and excreted in the urine | 5-HIAA |
| bilirubin metabolism begins with __ | breakdown fo RBC's |
| heme is catabolized to form __ | biliverdin |
| __ is transformed into bilirubin | biliverdin |
| brand new bilirubin is called __ | unconjugated bilirubin |
| in the liver bilirubin is conjugated with __ resulting in conjugated bilirubin | glucuronide |
| jaundice is recognized when total serum bilirubing exceeds __ mg/dL | 2.5 |
| why do newborns get jaundice | their livers are immature and cannot conjugate bilirubin |
| if bilirubin levels gets too high in newborns it can __ | cross the blood brain barrier and cause encephalopapthy (kernicterus) |
| in newborns, if bilirubin levels are greater than __mg/dL immediate treatment is required to avoid mental retardation | 15 |
| __ is the classic example of obstructed bilirubin excretion causing a direct hyperbilirubinemia | obstruction of the bile duct by a gall stone |
| if the defect in bilirubin metabolism occurs after addition of glucoronide, __ will result | conjugated (direct) hyperbilirubinemia |
| jaundice caused by hepatocellular dysfunction will lead to elevated levels of __ | indirect bilirubin |
| __ cannot be resolved surgically | indirect bilirubinemia |
| __ can usually be resolved surgically | direct bilirubinemia |
| normally __ bilirubin makes up 70-85% of the total bilirubin | unconjugated (indirect) |
| in patients with jaundice when more than 50% of the bilirubin is direct (conjugated) it is considered a direct hyperbilirubinemia from __ | gallstones, tumor, inflammation, scarring, or obstruction of the extrahepatic ducts |
| indirect hyperbilirubinemia is diagnosed when less than __% of the total bilirubin is direct bilirubin | 15-20 |
| diseases that typically cause jaundice associated with indirect hyperbilirubinemia include __ | accelerated erythrocyte hemolysis, hepatitis, or drugs |
| __ is a form of bilirubin covalently bound to albumin. It has a longer half-life than the other bilirubins | delta bilirubin |
| unlike the unconjugated form, direct bilirubin is __ | water soluble and can be excreted into the urine |
| bilirubin in __ suggests disease affecting bilirubin metabolism after conjugation or defects in excretion (gallstones) | urine |
Created by:
bwyche
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