Gastroenterology
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| Zollinger Ellison labs | show 🗑
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| show | Tumors of argentaffin (secretory) cells; assoc w/carcinoid tumor of sm bowel mets to liver; sx flushing & diarrhea
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| show | serum, urine, pleural fluid, peritoneal fluid; Lipase: serum
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| Amylase: pronounced elevation in: | show 🗑
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| show | panc ca, mumps, salivary gland inflam, perforated peptic ulcer
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| show | breaks down TGs; very specific for panc dz (> amylase); pronounced elevation in acute pancreatitis, pancreatic pseudocyst; mod elev in panc ca
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| show | Amylase, Lipase
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| Liver enzymes | show 🗑
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| show | Alk phos; GGT, (bilirubin)
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| Hepatic function panel | show 🗑
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| show | part of total protein formed in liver; 14-20 d half life; in liver damage, levels drop slowly; prealbumin more sensitive to rapid damage
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| show | 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
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| show | ALT: liver injury > cirrhosis/obstruction; AST: cell necrosis
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| show | GS: transient cystic duct obstruction; confirm dx with US or CT
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| show | stone in cystic duct; inc WBC w/left shift; inc amylase/lipase; mild inc AST, ALT, bili, Alk phos
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| show | stone in CBD; mild inc bili; mod inc alk phos
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| show | infxn biliary tree; inc LFT & WBC
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| GGT | show 🗑
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| show | rapidly div/metab active cells; high in PG, bone formation, intestinal dz
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| show | 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)
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| LFTs: hepatitis pattern | show 🗑
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| show | A/G ratio <1; AST > ALT; GGT high if EtOH/biliary cirrhosis; Bili I > D
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| show | mild elev <5x ULN; mod elev 5-10 x nml; marked elev >10 x nml
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| show | evaluate cholestasis with US/CT
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| show | Anemia; Low serum alb; Elevated ESR; Neg stool cx
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| show | 50 ml vol; straw-colored & clear; < 100,000 RBCs/microL; <300 WBCs/microL
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| Paracentesis: testing | show 🗑
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| Diagnostic Peritoneal Lavage: indications | show 🗑
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| Normal D-xylose tests suggests: | show 🗑
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| show | lactase deficiency
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| show | Acute on chronic pancreatitis (eg, EtOH). Elevated TG (associated decreased amylase activity)
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| show | Other abdominal/salivary gland process. Acidemia. Renal failure. Macroamylasemia.
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| show | Renal failure. Other abdominal process. DKA. HIV. Macrolipasemia.
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| show | choledocholithiasis (most common); liver disease; hemolysis (indirect bili); recent transfusion; gram-negative sepsis; TPN; obstruction (tumor, mass, stone); Gilbert
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| Causes of elevated LDH | show 🗑
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| show | Inflammation; Infection; Malignancy; Surgery; Trauma; Corticosteroids
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| show | Hemolysis; Liver disease; Malnutrition; Estrogens; Pregnancy
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| Biliary dz: dx test | show 🗑
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| show | Colon Carcinoma
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| show | Hepatocellular carcinoma (also high alk phos), testicular seminoma (germ cell tumor)
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| show | Pancreatic Ca
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| show | Ovarian Carcinoma
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| show | 95% adenocarcinoma; other: lymphoma, SSC
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| show | direct; bound to glucuronic acid; water soluble; caused by obstruction of outflow tract or in the liver
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| show | indirect; water insoluble; caused by hemolysis
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| Chronic pancreatitis: dx tests | show 🗑
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| Pancreatic cancer: labs | show 🗑
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| Dx giardiasis with: | show 🗑
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| show | Hep A, B, C; ANA; ASMA; IgG; Anti-mito Ab (primary biliary cirrhosis)
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| ALT & AST >1000 may be due to: | show 🗑
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| show | ALT: liver injury > cirrhosis/obstruction; AST: cell necrosis; ALT:AST >1.0 = infxs hep; AST:ALT >2:1 = alcoholic hep; <500: EtOH; poss normal in cirrhosis
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| show | part of total protein formed in liver; 14-20 d half life; in liver damage, levels drop slowly; prealbumin more sensitive to rapid damage
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| show | ALT: high in liver (mod in kidney, heart, sk mx)
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| show | Liver damage
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| Alk phos | show 🗑
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| show | ELISA (pos in 8-10 wks; good screen for chronic); HCV RNA; HCV genotype
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| Serum ascites albumin gradient | show 🗑
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| IBD labs | show 🗑
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| show | acute pancreatitis, pancreatic pseudocyst
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| Amylase: Moderate elevation in: | show 🗑
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| show | breaks down TGs; very specific for panc dz (> amylase); pronounced elevation in acute pancreatitis, pancreatic pseudocyst; moderately elevated in panc cancer
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| show | AST, ALT, GGT, Alk phos
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| show | Alk phos; GGT, (bilirubin)
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| show | highest in liver/biliary tract; assess cholestasis & biliary obstruction (d/t mets?); elevated d/t EtOH
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| show | rapidly div/metab active cells; high in PG, bone formation, intestinal dz
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| LFTs: hepatitis pattern | show 🗑
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| show | A/G ratio <1; AST > ALT; GGT high if EtOH/biliary cirrhosis; Bili I > D
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| ALT/AST elevation: defns | show 🗑
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| show | evaluate cholestasis with US/CT
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| show | Anemia; Low serum alb; Elevated ESR; Neg stool cx
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| show | 50 ml vol; straw-colored & clear; < 100,000 RBCs/microL; <300 WBCs/microL
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| FOBT guidelines | show 🗑
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| show | EtOH, anticoag, steroids, CTx, iodine prep
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| show | specimen >5 ml (fridge if >1 hr); pt 5 soft/liquid stools /24 hr; submit 3 specimens on 3 different days
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| show | tissue cx (rarely done; usu do toxin assays); if done, need bx and anaerobic cx
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| Hyperbilirubinemia: conjugated vs unconjugated | show 🗑
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| Serologic tests for celiac: | show 🗑
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| AST: where found: | show 🗑
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| show | bilirubin, alk phos, ALT, AST
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| show | cholestasis: bili/alk phos high; hep: ALT/AST high
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| jaundice labs | show 🗑
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| show | Bilirubin >3mg/dl; indirect bili high = hemolysis; Direct bili high = liver dz.
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| Elevated unconjugated (indirect) bilirubin indicates: | show 🗑
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| show | liver disease
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| Elevated AST & ALT indicates: | show 🗑
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| show | cholestatis or obstruction
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| IBD labs | show 🗑
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| Celiac dz labs | show 🗑
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| Zollinger Ellison testing | show 🗑
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| show | Elevated alk phos; LFT, anti-mito Ab; ERCP/MRCP
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Created by:
Abarnard
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