Term
| In Ischemic Heart Disease Evaluation, Based on the patients history, physical exam, and ekg, patients are categorized into what 3 groups? |
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Definition
- Non-cardiac chest pain
- Unstable angina
- Myocardial Infarction
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Term
| in the WHO classification of Myocardial Infarction, 2/3 of what criteria need to be met? |
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Definition
- Ischemic symptoms
- EKG changes
- Increased serum markers
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Term
| Name 3 thrombolytic agents |
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Definition
- t-PA
- Streptokinase
- Urokinase
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Term
| What are the risks of thrombolysis? |
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Definition
- Intracranial hemorrhage
- GI bleeding
- Anaphalaxis
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Term
| What are the early markers for Myocardial infarction? When do they peak? When do they return to normal? |
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Definition
- Myoglobin (nonspecific)
- CK isoforms, CK-MB (very specific)
Peak: 6-12 hours
Return to normal: 24-36 hours |
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Term
What is the normal ratio of MB2 to MB1?
After AMI? |
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Definition
Normal: 1:1
AMI: ratio increases due to MB2 (tissue isoform) spilling into the serum |
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Term
What method is used for myoglobin and CK-isoform detection? |
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Definition
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Term
| What are the intermediate markers of myocardial infarction? When to they peak? When do they return to normal? |
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Definition
- CK-MB
- Cardiac Troponin I or T
- AST
Peak: 12-24 hrs
Return to normal: within 2 days (except troponin) |
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Term
| What are the late markers for Myocardial Infarction? When do they peak? When do they return to normal? |
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Definition
- Total CK
- Peak: 24-36 hrs Normal: 3-4 days
- Troponins
- Peak: 12-24 hrs Normal: 10-14 days
- LDH Flip: Peaks: 72 hrs Normal: 8-10 days
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Term
| In what diseases would you find a normal bilirubin level with increased ALP AST and ALT |
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Definition
Ischemic disease
Malignancy |
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Term
| When would you find normal bilirubin values with increased ALP & LD |
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Definition
Malabsorption
Chronic Renal Failure
CHF
Pulmonary Embolism/Infarct
Primary Malignancy
Metatastic Diseases |
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Term
| When you see Indirect bilirubin>>Direct bilirubin, it usually indicates... |
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Definition
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Term
| When you see Direct Bilrubin > Indirect bilirubin, it usually indicates... |
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Definition
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Term
| In acute liver disease, you will see an increase in which enzymes? |
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Definition
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Term
| What is the principle LD isoenzyme seen in liver disease? |
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Definition
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Term
Very large increase in ALT
May also see Increased AST, Bilibrubin, ALP, and LDH
Would indicate what disease? |
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Definition
Hepatocellular (ex. hepatitis) |
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Term
| In chronic liver disease, what happens to enzyme levels? Albumin? PT? |
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Definition
- Enzyme levels arent always markedly elevated
- Decrease in Albumin
- Prolonged PT
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Term
What is a normal ALT/AST Ratio?
In acute hepatitis? |
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Definition
Normal: < 1
Acute hep: > 1 (more ALT than AST) |
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Term
| Elevated serum ALT activity is seen in... |
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Definition
Hepatitis!!
Cirrhosis
Obstructive Jaundice |
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Term
Elevated Serum AST activity is seen in... |
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Definition
- Acute and Toxic hepatitis
- Infectious Mononucleosis
- Intrahepatic Cholestasis
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Term
Increased ALP
May also see increased GGT, Bilirubin, AST, ALT, & Cholesterol
Usually indicates...
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Definition
| Hepatobiliary Tract Obstruction |
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Term
Increased ALP is seen in? |
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Definition
Huge increase in Biliary Tract Obstruction
Also seen in Liver Disease & Bone Disease |
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Term
What are you looking at in a Pancreatic Panel? |
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Definition
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Term
| What are some of the causes of Acute Pancreatitis? |
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Definition
- Gall Stones
- Alcohol
- Idiopathic
- Meds, Hypercalcemia, Renal Failure, Cystic fibrosis, high triglycerides
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Term
| Symptoms of Acute Pancreatitis? |
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Definition
Abdominal pain
Nausea
Vomitting
Sweating
Anxiety
Fever
Mild Jaundice
Fatty Stools
Weakness
Weight loss |
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Term
| What are the 2 types of Gall Stones? |
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Definition
- Cholesterol: Made of hardened cholesterol (80% of gall stones)
- Pigment: Made of bilirubin
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Term
| What are the clinical signs of Acute Pancreatitis? |
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Definition
--Increased serum amylase (Urine may be increased when serum is normal)
--Increased WBC
--Increased Glucose (decreased insulin release with increase glycogen release)
--Increased Lipase (increase may be delayed) |
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Term
| What are the Clinical Signs of Chronic Pancreatitis? |
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Definition
--Pancreatic Calcification
--Steattorhea
--Diabetes Mellitus
--Vit B12 Malabsorption
Typically decreased Amylase levels due to tissue destruction |
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Term
What are the enzymes used in Malignancy Panels? |
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Definition
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Term
| In Heat Inactivation of ALP.. heating for 65C for 30 minutes; what bands are stable? |
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Definition
Placental
Regan Isoenzyme |
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Term
| In heat inactivation of ALP heating for 56C for 10 minutes, Which isoenzyme shows a <20% in activity? >20% in activity? |
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Definition
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Term
| In Chemical Treament of ALP, Phenyalanine inhibits which isoenzymes? |
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Definition
| Intestinal, placental, Regan Isoenzymes |
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Term
| In Chemical Treament of ALP with urea, which isoenzymes are most resistant? Least? |
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Definition
Most resistant: Placental/Regan
Intermediate: Liver
Least: Bone |
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Term
| What test is used for Prostatic ACP measurement? |
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Definition
Tartrate Inhibition
Prostatic ACP is inhibited |
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Term
| What other enzyme can be used to differentiate Bone Disease and Liver Disease when you see increased ALP? |
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Definition
GGT
Increased in liver dis.
Normal in bone dis. |
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Term
| What bone diseases have elevated ALP? |
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Definition
Pagets
Bone Cancer
Rickets
Osteomalacia |
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Term
| What elevated enzymes would you see in Degenerative Muscle Diseases? |
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Definition
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Term
| What other reasons, besides MI, would troponin be increased? |
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Definition
| CHF, Sepsis, Myocarditis, Pulmonary Embolism, Kidney Disease, Aortic Dissection |
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Term
| What is the reason for increased CK activity in serum dilutes with saline or water? |
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Definition
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Term
| Besides dilution, how would you perform a CK that yields extremely high results on initial assay? |
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Definition
Increased substrate concentration
or you can shorten the lag phase |
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Term
AST = 843 (8-22 u/L @ 30¡)
ALT = 1,422 (8-30 u/L @ 30¡)
CK = 101 (<150 u/L)
LD = 345 (100-225 u/L)
T. Bilirubin = 4.8 (0.2-1.0 mg/dL)
D. Bilirubin = 2.4 (0.0-0.2 mg/dL)
Most likely Diagnosis?? Why? |
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Definition
Viral Hepatitis
ALT>AST
Direct Bili = Indirect Bili |
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Term
AST = 151 (8-22 u/L @ 30¡)
ALT = 88 (8-30 u/L @ 30¡)
CK = 42 (<150 u/L)
LD = 242 (100-225 u/L)
TP = 5.0 (6-8 g/dL)
Albumin = 2.3 (3.4-5 g/dL)
ALP = 121 (35-100 u/L)
Bilirubin = 1.4 (0.4-1.0)
What is the likely Diagosis? Why?? |
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Definition
Liver Cirrhosis
Inc ALT AST ALP Bili
A/G Ratio 0.85 (Dec Alb, Inc Glob) |
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Term
AST = 221 (8-22 u/L @ 30¡)
ALT = 227 (8-30 u/L @ 30¡)
LD = 181 (100-225 u/L)
TP =6.3 (6-8 g/dL)
Albumin = 3.9 (3.4-5 g/dL)
ALP = 561 (35-100 u/L)
Bilirubin = 3.7 (0.4-1.0)
What is the most likely diagnosis? why?? |
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Definition
Obstructive Jaundice
Huge ALP increase
ALT>AST |
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Term
AST = 21 (8-22)
ALT = 18 (8-30)
LD = 2144 (100-225)
Total Bilirubin = 5.8 (0.2-1.0)
Direct Bilirubin = 1.4 (0.0-0.2)
What is the most likely diagnosis? Why? |
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Definition
Intravascular hemolysis
Indirect>Direct
Inc LD (found in RBC)
In sample hemolysis you would see increase AST |
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