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