Term
| GFR - glomerular filtration rate |
|
Definition
| # of functioning nephrons |
|
|
Term
| creatinine is relative to muscle mass and body weight. It is measured for _________ and associated with_________ |
|
Definition
| measured for GFR and associated with BUN |
|
|
Term
| Elevated BUN is an indicator of |
|
Definition
|
|
Term
|
Definition
prerenal
renal
post renal
uremia |
|
|
Term
|
Definition
decreased renal blood flow
CHF, shock, dehydration
increased protein diet |
|
|
Term
|
Definition
|
|
Term
| postrenal azotemia is due to an |
|
Definition
|
|
Term
|
Definition
| toxic condition, high serum accompianted with renal failure |
|
|
Term
| (BUN) blood urea nitrogen tests for urea which is______________ and dependent on_________________ |
|
Definition
a nitrogen containing metabolit of protein metabolism;
exogenous nitrogen intake and endogensous protein catabolism |
|
|
Term
| urea is synthesized in__________ and excreted_____________ |
|
Definition
the liver (CO2 & NH3)
the kidneys |
|
|
Term
|
Definition
(GGT) glucose tolerance test
(Hgb A1c) glycosalated Hgb
UA
fasting glucose test in a.m. |
|
|
Term
| In ___________insulin levels are too low to maintain normal glucose levels - also called insulin resistant. Obesity is a risk factor/cause. |
|
Definition
|
|
Term
| Symptoms of Type I diabetes |
|
Definition
|
|
Term
| caused by autoimmune destructionof pancreatic beta cells |
|
Definition
|
|
Term
| hormones that elevate glucose levels |
|
Definition
cortisol
thyroid
(GH)growth hormone
ACTH |
|
|
Term
epinephrine_____________
glucose levels |
|
Definition
|
|
Term
| stimulates glycogenolysis and gluconeogenesis (increases sugar) |
|
Definition
|
|
Term
| increases cellular uptake and promotes glycogenesis |
|
Definition
|
|
Term
| causes of hypoglycemia (<70mg/dl) |
|
Definition
hormone deficiency
drug reaction
insulin excess (pumping out too much)
genetic disorder
excess alcohol intake |
|
|
Term
Hyperglycemia is a blood sugar >120mg/dl
and is caused by |
|
Definition
diabetes mellitus
liver failure |
|
|
Term
|
Definition
| glucose in urine- if level in serum exceeds 170-180mg/dl, then it will spill over into urine |
|
|
Term
|
Definition
due to inflammation - APP
hepatic
urinary loss
GI loss
Poor diet |
|
|
Term
| Total Protein measures numerous classes of proteins: |
|
Definition
albumin
alpha-1(AAT,A1-Fetoprotein)
alpa-2 (Haptoglobin,ceruloplasmin)
beta(CRP,transferrin,complement)
Gamma (immunoglobulin) |
|
|
Term
|
Definition
dehydration
excess immunoglubulins-multiple myeloma, waldenstrom's macroglobulinemia |
|
|
Term
|
Definition
kidney disease
blood loss
malnutrition
liver disease |
|
|
Term
|
Definition
synthesized in the liver
constituent of cell membranes
precurser of hormones
transported by LDL and HDL |
|
|
Term
|
Definition
Partially snthesized in the liver
transported by chylomicrons and VLDL
provides inergy to cells
Insulates organs |
|
|
Term
|
Definition
increased triglycerides due to:
diet, pancreatitis, diabetes, ETOH, hypothyroidism |
|
|
Term
| increased cholesterol due to- |
|
Definition
genetic defects in liver
diet
lack of specific receptor on cells |
|
|
Term
| lipoproteins are a transport vehicle for |
|
Definition
|
|
Term
| cholesterol is packaged with triglycerids, phosolipids, and specific apolipoproteins into a large lipoprotein called a_____________ |
|
Definition
|
|
Term
|
Definition
very low density lipoprotein
degrades to LDL in circulation
(triglycerides) |
|
|
Term
|
Definition
low density lipoprotein
"bad" cholesterol into cells |
|
|
Term
|
Definition
High density lipoprotein
"good" (H for Heart Healthy)
removes excess cholesterol from cells (protein and some cholesterol) |
|
|
Term
genetic defect
low LDL/HDL |
|
Definition
|
|
Term
| absent LDL w/low cholesterol causes: |
|
Definition
failure to thrive
steatorrhea(increased fat in stool)
CNS degeneration
Malabsorption of fats and vitamins |
|
|
Term
|
Definition
increased life expectancy
decreased CAD,AMI |
|
|
Term
|
Definition
| increased risk of atherosclerosis/CAD |
|
|
Term
|
Definition
Absent HDL
causes and increased accumulation of cholesterol in tonsils, adenoids, and spleen (lymph tissue) |
|
|
Term
|
Definition
catabolism of heme (RBCs)
conjugated (direct) bilirubin
- bound to glucuronide
unconjugated (indirect) bilirubin
- free bilirubin that has not been attached to a glucuronide molecule |
|
|
Term
| disorders assoc with bilirubin |
|
Definition
jaundice
HDN - hemolytic disease of newborn
Inherited:gilbert's syndrome, Crigler-Najjar syndromes
cirrhosis of liver |
|
|
Term
|
Definition
affects 30% of breast fed babies
due to B-glucuronidase in brease milk
(deconjugates bilirubin)
**stop breast feeding and try supplement |
|
|
Term
|
Definition
| inadequate milk supply so dehydration occurs |
|
|
Term
|
Definition
| a yellow color in skin, mucous membranes, or the eyes |
|
|
Term
|
Definition
| though to be caused by a deficience in the enzyme glucuronosyltransferase |
|
|
Term
|
Definition
| absence or deficiency of uridine diphosphate (UDP) glucuronyl transferase |
|
|
Term
|
Definition
cholesterol <200
Triglycerides =50
HDL >60 (men and women differ)
LDL <120 |
|
|
Term
liver disorders classified as:
A _________can assist in Dx |
|
Definition
prehepatic
posthepatic
hepatic -usua due to obstruction
(UA) urinalysis |
|
|
Term
________is the major cation of extracellular fluid. It _________
nerves and muscles. Has a major role in water distribution/osmalality/osmotic pressure/ |
|
Definition
|
|
Term
| How is sodium regulated by the kidneys? |
|
Definition
ADH (anti diuretic hormone)
Aldosterone (Na/K+) |
|
|
Term
|
Definition
Na loss in excess of water loss due to:
-loss of fluid(GI,Burns) w/ hypotonic fluid replacement
-Thiazide diuretics
-K+ depletion in cells causing Na to rush in
aldosterone deficiency;not absorbing Na |
|
|
Term
| Loss of Na poor fluids caused by |
|
Definition
Profuse sweating,vomiting,diarrhea
decreased ADH
Cushing's syndrome |
|
|
Term
|
Definition
| Excess cortisol, which inhibits ADH release |
|
|
Term
|
Definition
sodium
potassium
chloride
bicarbonate/CO2
Magnesium
calcium
phosphate
anion gap |
|
|
Term
|
Definition
metabolic processes
osmotic pressure
H20 distribution
pH
oxidation-reduction
heart and muscles |
|
|
Term
|
Definition
water overload;
CHF-increased back pressure promotes movement of fluid from blood to interstitium
Hepatic cirrhosis
Overhydration
SIADH
Nephrotic syndrome |
|
|
Term
|
Definition
defective/excess water balance;
SIADH (syndrome of inappropriate ADH hormone secretion)
Severe hyperglycemia(water movement into plasma to normalize plasma osmolality)
Polydipsia
Diminished cortisol (ADH antagonist) |
|
|
Term
| Potassium is a major intracellular cation. Its functions are: |
|
Definition
neurovascular excitability
CONTRACTION OF THE HEART
intracellular fluid volume
H+ ion exchange |
|
|
Term
|
Definition
Kidneys-proximal tubules
Aldosterone-Na+/K+ exchange |
|
|
Term
| symptoms of hyper/hypokalemia |
|
Definition
muscle weakness
cardiac arrhythmias/arrest |
|
|
Term
chloride is a major intracellular anion,
though not well understood, it functions in __________.
Excreted in___________. |
|
Definition
osmolality,
blood volume(water distribution)
electric neutrality
Excreted in sweat and urine. Excess sweating stimulates aldosterone, conserves Na+ and Cl- |
|
|
Term
|
Definition
prolonged vomiting (HCL acid out)
Diabetic ketoacidosis
Aldosterone excess-decrease Cl- due to increased Bicarb
Pyelonephritis |
|
|
Term
|
Definition
kidney infection
salt losing renal disease |
|
|
Term
|
Definition
| excess loss of bicarbonate-aldosterone deficiency |
|
|
Term
| hyperchloremia result of: |
|
Definition
GI loss-diarrhea
renal tubular acidosis-fail to reclaim bicarb or kidneys fail to acidify urine |
|
|
Term
| hypokalemia can be caused by |
|
Definition
-decreased dietary intake
-diuretics(MOST COMMON)-
-insulin-
-Alkalemia-
hypomagnesemia
hyperaldosteronism
K+spiraling |
|
|
Term
| Alkalemia affects potassium levels by |
|
Definition
| promoting cellular H+loss/K+ gain in cell |
|
|
Term
| Hypomagnesemia affects K+ level by |
|
Definition
promoting cellular and renal loss of K+
(it diminishes Na-K ATPase and enhances aldosterone secretion) |
|
|
Term
| Hyperaldosteronism affects K+ level by |
|
Definition
| causing K+ secretion in urine |
|
|
Term
Bicarbonate is a ___________system.
Consisting of__________,__________,and ___________________. |
|
Definition
buffering
CO2, H2O, and H+ |
|
|
Term
| bicarbonate is reabsorbed in kidneys, mainly as_________. |
|
Definition
|
|
Term
| increase loss of HCO-3 and Na+ |
|
Definition
|
|
Term
|
Definition
| loss of H+ and reabsorption of HCO-3 |
|
|
Term
| magnesium is an essential cofactor of over ___________. Funtions are: |
|
Definition
300 enzymes; Functions:
glucolusis
transcellular ion transport
muscle contraction
oxidative phosphorylation |
|
|
Term
| the upper GI is _________ in magnesium, the lower GI is __________ in magnesium. |
|
Definition
|
|
Term
| hypomagnesemia: factors concerning- |
|
Definition
cardiac disorders; coronary vasospasm, acute infarction and sudden death
drugs-diuretics, gentamicin,cisplastin,cyclosporine (enhanced renal output)
Diabetes-insulin, PTH and Vit D
Alcoholism:urinating out Mg++ |
|
|
Term
| hypermagnesemia occurs because of: |
|
Definition
renal failure-can't excrete it
hyperparathyroidism
diabetic ketoacidosis |
|
|
Term
| Hypercalcemia can be caused by hyperparathyroidism because___________________. |
|
Definition
| it increases absorption of Ca through PTH |
|
|
Term
| hypercalcemia also caused by malignancies, renal diseases, vit D disorders, and __________________. |
|
Definition
| growth spurts in adolescence |
|
|
Term
|
Definition
primary hyperphosphatemia
hypoparathyroidism
altered vit D metabolism
sepsis
burns
cardiac insufficiency |
|
|
Term
|
Definition
healthy teeth and bones
muscle and cardiac contractions |
|
|
Term
|
Definition
PTH;bone and kidney
Vit. D;absorption and resorption
Calcitonin;inhibits PTH and Vit D |
|
|
Term
|
Definition
RNA/DNA
coenzymes
ATP
creatine phosphate
phosphoenol pyruvate
2,3-DPG |
|
|
Term
|
Definition
PTH-increases renal excretion
VIT.D - increases absorption (GI & Kidney)
Growth hormone-decreased renal excretion |
|
|
Term
| hyperphosphatemia caused by |
|
Definition
renal failure
intense exercise
Lyphoblastic leukemia
severe infections
in neonates: PTH and Vit D metabolism
(synthesis hasn't developed yet) |
|
|
Term
| hypophosphatemia occurs in hospitalized patients, why? |
|
Definition
infusion of dexrose soln.
nutritional recovery syndrome
use of antacids (binding PO4) |
|
|
Term
| ETOH withdrawl also can cause hyposphosphatemia- |
|
Definition
poor diet
use of antacids
vomiting
Mg deficiency
ketoacidosis |
|
|
Term
| how does nutritional recovery syndrome cause hypophosphatemia? |
|
Definition
| refeeding a starved person results in a shift of potassium and phosphorus into the body's cells for ATP production, which can result in electrolyte imbalance. |
|
|
Term
| Elevated anion gap: MUDPILES |
|
Definition
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron, Isoiazides
Lactic acidosis
Ethanol, Ethylene glycol
Salicylates, Starvation |
|
|
Term
|
Definition
organ specific-
CK,BB fraction-prostate & stomach cancer (elevated)
ALP (elevated with bone diseases)
Non-organ-specific:
Total LD-hepatic metasasis-
LD5-breast, stomach, lung and colon cancers
LD3-leukemias
Lysozyme-granulomatous disease |
|
|
Term
|
Definition
screening tool
Dx-how high or how low is it
staging of disease
response to therapy; how it changes
prognosis
recurrance |
|
|
Term
| Function of cretine kinase (CK) |
|
Definition
| production of ATP needed for muscle contraction |
|
|
Term
| _________needed as a cofactor to CK |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
occurs as a dimer with 2 subunits(isozymes)
CK-1(BB)brain type, fastest migration
CK-2(MB)hybrid type, cardiac tissue, 2nd fastest
CK-3(MM)muscle type(card & skel)slowest |
|
|
Term
| 98-100% of serum CK fraction is__________ |
|
Definition
|
|
Term
|
Definition
skeletal m.-CK-3 & CK-2
brain - CK-1
heart m. - CK-3 & CK-2
smooth m. CK-1
other sources - kidney & diaphragm
Liver & RBC's - devoid of CK |
|
|
Term
| CK as an indication of myocardial Infraction: |
|
Definition
elevated CK-2
4-6 hrs to exceed upper limit
peaks @ 24 hrs, RTN @ 48-72 hrs
Dx sensitivity <60%
can detect reinfarct soon after initial |
|
|
Term
| High voltage electropheresis can seperate compounds according to charge. It can separate CK-MB in isoforms 1 & 2. This increses the clinical sensitivity @6 hrs. to_________ and the Dx specificity to ___________. |
|
Definition
|
|
Term
| CK indication and muscle disease |
|
Definition
muscular dystrophy(Duchenne type) - elevated CK-3
-viral myositis, polymyositis |
|
|
Term
| Reye's syndrome affecting the CNS, will have an elevated CK-_________. |
|
Definition
| CK-1 will be elevated x70 |
|
|
Term
| hypothyroidism will have an elevated CK-________________. |
|
Definition
|
|
Term
| CK is unstable at temps above___________ |
|
Definition
37 degrees C
Best stored frozen or refrigerated
not affected by slight hemolysis |
|
|
Term
| Troponin is a protein that regulates__________. It consists of 3 subunits ____,_____,and________. |
|
Definition
muscle contraction
T,I, and C |
|
|
Term
| Troponin is located in___________. It is absent in the serum of healthy and noncardiac patients. |
|
Definition
|
|
Term
| _____and_______subunits of troponin are useful in the Dx of MI. It is more specific than CK-MB. |
|
Definition
|
|
Term
Troponin T levels become elevated 4-8 hours after reported________pain. It will remian elevated for _________days.
It has a clinical sensitivity at 6 hrs of___________, and a high clinical sensitivity(>90%) up to 5-7 days post MI |
|
Definition
|
|
Term
Troponin I levels become elevated 4-8 hrs post MI. It will peak at ____hours.
and will remain elevated for ______days. At 48-72 hrs, it has a clinical specificity of >85%, and a Dx sensitivity of <60%. |
|
Definition
12 hours;
3-5 days;
IT STAYS IN THE BLOOD LONGER, SO ITS A BETTER INDICATOR OF MI |
|
|
Term
| ISOENZYMES -FORCE CONVERSION OF PYRUVATE TO LACTATE, REGENERATION OF NAD |
|
Definition
LD-1 (HHHH)
LD-2 (HHHM)
LD-3 (HHMM)
LD-4 (HMMM)
LD-5 (MMMM)
2,1,3,4,5 HIGH TO LOW CONC. |
|
|
Term
Lactate Dehydrogenase (LD or LDH)
Function: |
|
Definition
H+ ion transfer enzyme w/NAD as acceptor
Catalyzes the reversible reaction of pyruvate to lactate (based on pH)
L to P : pH of 8.8 -9.8
P to L : pH pf 7.4 -7.8 |
|
|
Term
|
Definition
*5 major fractions
-present in all cell's cytoplasm
-tissue levels 500x higher than serum levels
*6th form(LD-X) & *7th form(LD-6) have been discovered |
|
|
Term
|
Definition
major fraction:2,1,3,4,5(high to low concentration)
-cardiac tissue & RBCs have highest conc of LD-1;also have LD-2 (1>2)
kidneys 1&2
PLTs and lymph nodes - 3
skeletal m. and liver - 4&5,5>4 |
|
|
Term
| clinical significance of Isoenzymes |
|
Definition
acute MI-LD rise within 12-24 hrs, peak within 72hrs, elev.for 10 days.
"flipped pattern" - 80% seen
Hemolysin;see flipped pattern (in post MI also) |
|
|
Term
| Other diseases with elevated LD |
|
Definition
pernicious anemia-elev 1&2
toxic hepatitis - 10x total LD
cirrhosis/obstructive - 2x total LD
Germ cell tumors - elev LD-1
malignancies - elev total LD |
|
|
Term
|
Definition
PLT destruction (ITP)
lymphatics-mono, lymphomas, and leukemias |
|
|
Term
|
Definition
liver dis.
CHF(passive)
skeletal injuries/disorders |
|
|
Term
| increased LD in all levels but with a normal pattern |
|
Definition
hypoxia
hyperthermia
CHF
renal disease |
|
|
Term
| in cerebral spinal fluid(CSF), high LD activities in ___% of bacterial infections |
|
Definition
90
in specimen, free from hemolysis,separate from cells immediately |
|
|
Term
| functions of Alkaline Phosphate (ALP) |
|
Definition
non-specific enzyme
-catalyzes the hydrolysis of many phosphomonoesters at and alkaline pH
-movement of substances across cell
-membranes
-lipid transport in GI
-calcifying process in bone |
|
|
Term
ALP located at or in cell__________.
Major enzymes derived from: |
|
Definition
membranes;
liver, bone, intestine, placenta, spleen, and kidney
most common elevation causes-bone and liver
placental (2nd and 3rd trimester) |
|
|
Term
|
Definition
| bone is fragile to heat and will degrade, liver will not. Electropheresis used to separate-will not degrade liver. |
|
|
Term
| clinical significance of ALP in bone disease |
|
Definition
osteoblast involvment is highest (paget's dis.)
osteomalacia-moderate involement
osteoporosis-normal
bone CA-high |
|
|
Term
| clinical significance of ALP in liver disease |
|
Definition
extrahepatic obstruction- >3x (UL)upper limit
intrahepatic obstruction-<3x UL
Liver diseases <3x UL to normal |
|
|
Term
| clinical significance of ALP in other disorders |
|
Definition
hyperparathyroidism-slight to mod.increase
Physiological(transient)-pregnancy, healing fx, infections |
|
|
Term
| amylase is a pancreatic enzyme, a hydrolase, which functions to break down_____________. It is readily filtered by________. It requires _ and _. |
|
Definition
polysaccharides, different rates;
kidneys;
Ca++ and Cl- |
|
|
Term
|
Definition
pancreatic-p type
synthesized by acinar cells
major digestion of starches
salivary - s type
mouth
neutralized by stomach pH |
|
|
Term
|
Definition
salivary glands
pancreas, in alkaline conditions
ovaries, testes
small conc. in other tissues |
|
|
Term
| accute pancreatitis can cause: |
|
Definition
hyperamylasemia
serum levels rise to 4-6x UL in 2-12 hrs.;peak in 12-72 hrs. normal within 3-4 days (bowel or liver) |
|
|
Term
| other than pancreatitis, what causes hyperamylasemia? |
|
Definition
obstruction
mumps - 2x UL
carcinomas-lung & ovary - 50x UL |
|
|
Term
| Hypoamylasemia can detect other complications such as- |
|
Definition
pseudocyst
ascites
pleural effusion
trauma
alcoholism |
|
|
Term
| __________hydrolyzes ester linkage of triglycerides to glycerol and fatty acids (carbons 1&3) |
|
Definition
|
|
Term
| Sources of Lipase are the _______and_________.______and ________ assist Lipase in emulsification of triglycerides. |
|
Definition
pancreas and tongue;
bile salt and colipase |
|
|
Term
|
Definition
Pancreatitis- serum levels rise in 4-8 hrs,(2-50xUL), peak @24 hrs, decrease in 8-14 days.
Other causes of elevation-obstruction |
|
|
Term
|
Definition
catalyze the reversible transfer of an amine from an a-amino to an a-keto acid.
participates in amino acid catabolism and biosynthesis |
|
|
Term
| ________catalyzes the reversible transfer of an amine group. |
|
Definition
ALT-(Alaine Aminotransferase)
Alaine + Oxoglutarate <--> Pyruvate + glutamate
it's widely distributed in tissues
Liver is the predominate source |
|
|
Term
| Clinical sugnificance of ALT |
|
Definition
Liver specific- indicates liver damage
-hepatocellular disorders, i.e.hepatitis |
|
|
Term
AST(aspartate) reverses what reaction?
what are the tissue sources for its distribution? |
|
Definition
aspartate+ oxoglutarate<-->oxaloacetate + glutamate
heart and liver
skeletal muscle
seen in bile and CSF
located in cytoplasm and mitochondria |
|
|
Term
| Clinical significance of AST |
|
Definition
In acute MI - rise in 6-8 hrs, peak at 18 to 48 hrs, normal w/in 4-5 days (ALT is usua normal) Avg increase of 4-5x, increase of 10-15x = fatal infarct.
in muscular dystrophy, an ~8x UL increase |
|
|
Term
| ALT/AST ratio in various diseases |
|
Definition
Hepatic necrosis - ALT/AST 20-50xUL
Alcoholic liver dis. - AST<300 IU/L
(AST>ALT 2x or more)
Infectious hepatitis - ALT>AST
Toxic hepatitis - ALT/AST ~20x UL
Cirrhosis - vary w/AST>ALT
liver cancer - 5-10x UL w/AST>ALT |
|
|
Term
| Liver Funtion Tests (LFT) |
|
Definition
ALT
AST
GGT
PT
ALP
Albumin/Total Protein
Bilirubin(jaundice) |
|
|
Term
|
Definition
Troponin T and/or I
CK-MB
Total CK
Myoglobin:assoc. w/MI
LD(1/2):flip pattern?
AST? |
|
|
Term
|
Definition
Amylase
Lipase
Calcium(amylase needs Ca++ and Cl-)
Triglycerides
Glucose |
|
|
