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DM GI Labs
Gastroenterology Lab Studies
| Question | Answer |
|---|---|
| specific subset of peptic ulcer dz in the setting of appropriate tx. Gastrinoma present increases gastrin production manyfold | Zollinger-Ellison Syndrome. Verify elevated acid secretion via gastric pH or gastric secretory studies. Also imaging study to locate tumor |
| Tumors of argentaffin cells | Carcinoid Syndrome. Secrete a variety of vasoactive materials, such as serotonin, histamine, catecholamines & prostaglandins. Patient complains of flushing and diarrhea. |
| Test to check for Carcinoid | 24 hour urine 5-HIAA. 5HIAA acid is a breakdown product of serotonin (pt must avoid serotonin rich foods). Carincoid syndrome will be elevated |
| Serotonin rich foods | bananas, pineapples, avocados, mushrooms, and walnuts |
| Digestive enzyme made mostly by the pancreas and salivary glands that breaks down starch | amylase. Pronounced elevation in acute pancreatitis, pancreatic pseudocyst. Moderate elevation in pancreatic CA, mumps, Salvary gland inflammation, perforated peptic ulcer. |
| Specimens which can be sampled for amylase levels | serum, urine, pleural fluid, peritoneal fluid. Kidney can clear transient high amylase within a day or two |
| Digestive enzyme made primarily by the pancrease; released into the bloodstream with disease or injury. Breaks down triglycerides | Lipase |
| If lipase and amylase are elevated but patient is feeling fine... | it is not pancreatitis. Pancreatitis hurts. |
| Elevation of this is highly specific for pancreatic disease | Lipase. Specimen is serum |
| _______ is used to evaluate serum proteins, nutritional status, liver function | Total Serum Protein. Components: Prealbumin, albumin, globulins |
| Decreased protein in pregnancy | usually considered dilutional |
| High total serum protein seen in | in dehydration, Waldenström's macroglobulinemia, multiple myeloma, hyperglobulinemia, granulomatous diseases, & some tropical diseases |
| Low total serum protein seen in | in pregnancy, excessive intravenous fluid administration, cirrhosis or other liver diseases, chronic alcoholism, heart failure, nephrotic syndrome, burns |
| Main function of albumin | maintain colloidol osmotic pressure and transport drugs, hormones |
| High ALT content is seen in | liver cells. Increases in ALT are associated with liver inflammation/damage. High specificity for liver damage |
| When should ALT specimens be measured? | Fairly immediately. Breakdown at room temperature. |
| Which elevates ALT greater, Cirrhosis or injury? | Injury. Also observed with severe muscle injury, hemolysis, etc. |
| Where is high AST content found? | liver, heart, brain and skeletal muscle. Moderate AST in RBCs. |
| Elevated AST is associated with | cell necrosis |
| Increased AST is seen in | Increased serum AST activity commonly follows myocardial infarction, pulmonary emboli, skeletal muscle trauma, alcoholic cirrhosis, viral hepatitis, & drug induced hepatitis, plus hemolysis |
| What can you expect to see in hemolysis? | elevated AST |
| Marked elevations of AST and ALT are | 20x normal and greater |
| AST and ALT in alcoholism | Usually less than 300-500. If elevation of AST is about 2x greater than ALT, then alcoholic heptatitis is likely the cause |
| Prothrombin time in liver damage | is prolonged b/c it affects the coagulation pathways |
| Hepatic Function Panel measures | sodium, potassium, chloride, CO2, glucose, urea, creatinine, calcium, albumin, phosphorus. (NOT SPECIFIC FOR LIVER) |
| Gallstones in gallbladder with transient cystic duct obstruction | Biliary colic. Lab studies usually normal. Clinical diagnosis confirmed by US |
| Gallstone(s) consistently obstructing cystic duct | acute cholecystitis. |
| What do labs show in acute cholecystitis? | Increased WBC with left shift, increase amylase and lipase. Mild elevation in AST, ALT, bilirubin, alakaline phosphatase |
| stones in the common bile duct is called | choledocholithiasis. Causes a mild bilirubin elevation. Moderate alkaline phosphatase elevation |
| Infection with pus located in biliary tree | Cholangitis. People get sick quick with this. LFTs and WBCs up. Other labs abnormal (may be a pattern of multisystem organ failure) |
| Gamma-glutamyltransferase | Primary use is to further assess an Alkaline phosphatase level; bone or liver issue? Elevated in liver issues. Nonspecific test. Strong association between GGT and chronic alcoholism |
| Alkaline Phosphatase is found | ALP high in rapidly dividing or metabolically active cells. Epithelium of biliary tract (Kupffer cells), liver, & intestine, osteoblasts, circulating granulocytes, placenta, lactating mammary glands |
| Elevated ALP levels are normal in | active bone formation and pregnancy. Abnormal elevations: mets, some intestinal disorders |
| This enzyme is often measured to check mets to the liver | Alkaline Phosphatase |
| Used to evaluate hepatocellular function, degree of hemolytic disease, or some hereditary diseases (Gilbert's, Criglar-Najjar). | Total Bilirubin |
| Protect a bilirubin specimen from | light |
| Intrahepatic Cholecystasis, extrahepatic biliary system, gallstones, cancers, will affect which type of bilirubin? | Conjugated. Conjugated hyperbilirubinemia is present when total bilirubin is elevated & > 50% is conjugated ("direct" bilirubin) |
| Conjugated vs. Unconjucated bilirubin | Useful to differentiate hyperbilirubinemia due to hemolysis (unconjugated) vs. hepatobiliary disease (conjugated). |
| When is unconjugated hyperbilirubinemia present? | Unconjugated hyperbilirubinemia is present in (higher bilirubin production): hemolytic anemias, hemolytic rxns, hematoma, pulmonary infarction |
| Where is bilirubin conjugated? | in the liver! |
| Cirrhosis | damage and scarring of the hepatocytes |
| Conjugated bilirubin is | Direct |
| Unconjugated bilirubin is | Indirect |
| Tests need to rule out organic disease if you think patient has IBS | CBC, serum albumin, ESR, thyroid function tests, FOBT should all be normal. If diarrhea, serology for celiac and stool Ova & Parasites performed. Consider flex sig or colonoscopy |
| Lab findings in Ulcerative Colitis | Anemia, Low serum albumin, Elevated ESR, Negative stool cultures |
| What test is used to establish diagnosis of acute colitis? | Sigmoidoscopy. Edema, friability, mucopus and erosions seen |
| Gold standard of diagnosis in Celiac Disease | GI biopsy |
| What is the nl volume of peritoneal fluid? | 50ml (1/4 cup!). Nl is straw colored or clear. |
| Amount of RBC's and WBC's in normal peritoneal fluid? | RBCs<100,000/microliter, WBCs<300/microliter |
| Procedure to obtain peritoneal fluid for diagnosis or therapeutics | Paracentesis |
| Lower glucose in peritoneal fluid | likely bacteria |
| Decreased WBC count in peritoneal fluid | TB |
| Amylase in peritoneal fluid | pancreatic damage/pancreatitis |
| Increased ammonia level in peritoneal fluid | bowel perforation or bladder perforation |
| High alkaline phosphatase in peritoneal fluid | bowel perforation or incarceration of small bowel. |
| Indications for peritoneal lavage | Evaluation of abdominal trauma, intraperitoneal hemorrhage, ruptured intestine or other organs |
| In which procedure do you Instill & then aspirate sterile saline into abdominal cavity | Peritoneal lavage. Check for cell counts and chemical analysis. |
| When do you use peritoneal lavage instead of Paracentesis? | If fluid amount is subtle, use peritoneal lavage. |
| Which test is most specific for pancreatic disease? | Lipase |
| Prealbumin, albumin and globulins are | part of total serum protein |
| Which test is most useful in differentiating between RBC hemolysis and liver disease in a jaundiced patient? | ALT |
| Which is the most sensitive liver enzyme for detecting biliary obstruction, cholangitis or cholecystitis? | GGT. |
| A normal GGT with an elevated alkaline phosphatase would most likely indicate disease in the | Skeleton. GGT would be abnormal if liver problem. Alkaline phosphatase is going to be present in new bone growth, also in pregnancy |
| Which test is most likely going to elevated during childhood growth spurts? | Alkaline phosphatase |
| Which test is most associated with heavy chronic alcohol use? | GGT |
| Specimen hemolysis is most likely to cause elevation in which analyte? | ALT (lots of ALT is found in RBCs) |
| Conjugated hyperbilirubinemia causes | hereditary cholestatic syndromes, hepatitis, hepatic cirrhosis, sepsis, postoperative jaundice, cholangitis, choledocholithiasis, carcinoma of biliary ducts, pancreatitis, pancreatic neoplasms, etc. |
| ___ is the enzyme most often measured to indicate bile duct obstruction | Alkaline Phosphatase |
Created by:
ltm12