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Duke PA Gastroenterology Labs

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