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GI Lab Studies

Gastroenterology

QuestionAnswer
Zollinger Ellison syndrome Recurrent PUD; Gastrinoma increases gastrin prodn; Gastric acid hypersecretion
Zollinger Ellison labs elevated acid (gastric pH); serum gastrin; imaging study to locate primary tumor
Carcinoid syndrome Tumors of argentaffin (secretory) cells; assoc w/carcinoid tumor of sm bowel mets to liver; sx flushing & diarrhea
Amylase (panc disorders): specimens: serum, urine, pleural fluid, peritoneal fluid; Lipase: serum
Amylase: pronounced elevation in: acute pancreatitis, pancreatic pseudocyst
Amylase: Moderate elevation in: panc ca, mumps, salivary gland inflam, perforated peptic ulcer
Lipase breaks down TGs; very specific for panc dz (> amylase); pronounced elevation in acute pancreatitis, pancreatic pseudocyst; mod elev in panc ca
Pancreas enzymes Amylase, Lipase
Liver enzymes AST, ALT, GGT, Alk phos
Biliary enzymes Alk phos; GGT, (bilirubin)
Hepatic function panel Na, K, Cl, CO2, glucose, BUN, Cr, Ca, albumin, phosphorus
Albumin part of total protein formed in liver; 14-20 d half life; in liver damage, levels drop slowly; prealbumin more sensitive to rapid damage
ALT & AST: where found ALT: high in liver (mod in kidney, heart, sk mx); ALT more specific for liver damage than AST or alk phos; AST: high in liver, heart, brain, sk mx
ALT/AST: abnml labs ALT: liver injury > cirrhosis/obstruction; AST: cell necrosis
Biliary colic GS: transient cystic duct obstruction; confirm dx with US or CT
Cholecystitis stone in cystic duct; inc WBC w/left shift; inc amylase/lipase; mild inc AST, ALT, bili, Alk phos
Choledocholithiasis stone in CBD; mild inc bili; mod inc alk phos
Cholangitis infxn biliary tree; inc LFT & WBC
GGT highest in liver/biliary tract; asses cholestasis & biliary obstruction (d/t mets?); elevated d/t EtOH
Alk phos rapidly div/metab active cells; high in PG, bone formation, intestinal dz
Hyperbili: conj vs unconj unconj 15-20% of TBil (accelerated RBC hemolysis, hepatitis, drugs); conj >50% TBil (intrahepatic cholestasis: biliary cirrhosis, drugs; hepatocellular damage: drugs, sepsis, inflam, scarring; obstruction: GS)
LFTs: hepatitis pattern A/G ratio >1; ALT >1000; ALT > AST; GGT high if EtOH hep; Bili D>I
LFTs: cirrhosis pattern A/G ratio <1; AST > ALT; GGT high if EtOH/biliary cirrhosis; Bili I > D
ALT/AST elevation: defns mild elev <5x ULN; mod elev 5-10 x nml; marked elev >10 x nml
If alk phos high out of proportion to ALT/AST: evaluate cholestasis with US/CT
UC labs Anemia; Low serum alb; Elevated ESR; Neg stool cx
Normal peritoneal fluid: 50 ml vol; straw-colored & clear; < 100,000 RBCs/microL; <300 WBCs/microL
Paracentesis: testing Cell counts, cytology, Gram stain, chem testing (glucose, amylase, ammonia, alk phos)
Diagnostic Peritoneal Lavage: indications Eval of abd trauma, intraperitoneal hemorrhage, ruptured intestine or other organs
Normal D-xylose tests suggests: pancreatic insufficiency, reduced bile salts, lymphatic obstruction (all may be related to malabsorption)
Hydrogen breath test is used to diagnose: lactase deficiency
Amylase: false negative may be related to: Acute on chronic pancreatitis (eg, EtOH). Elevated TG (associated decreased amylase activity)
Amylase: false positive may be related to: Other abdominal/salivary gland process. Acidemia. Renal failure. Macroamylasemia.
Lipase: false positive may be related to: Renal failure. Other abdominal process. DKA. HIV. Macrolipasemia.
Created by: Abarnard