Term
| Creatinine production is directly related to what? |
|
Definition
|
|
Term
| Creatine and ________ are inversely |
|
Definition
|
|
Term
| Where is creatin phosphate primarily stored? |
|
Definition
|
|
Term
| Creatine clearance is a measure of what? |
|
Definition
|
|
Term
| What is the formula for GFR & Crcl? |
|
Definition
| (urineCr x Urinevolume/ plasmaCr)/1440 |
|
|
Term
| A crystallizable substance found in all body fluids that is formed by the metabolism of protein and nucleic acids. |
|
Definition
|
|
Term
| Rate at which plasma is filtered through the glomeruli |
|
Definition
|
|
Term
|
Definition
| blood urine nitrogen, measures how much urea is in the blood |
|
|
Term
| What do high levels of urea in the blood mean? |
|
Definition
|
|
Term
| What is seen in prerenal azotemia? |
|
Definition
| Inc BUN and/or creatinine secondary to a dec in renal perfusion. |
|
|
Term
| What is seen in postrenal azotemia? |
|
Definition
| Acute renal failure from impediment of urine flow, from tubules to urethra. |
|
|
Term
| What is seen in renal azotemia? |
|
Definition
| Acute renal failure from disease of the renal vasculature, glomeruli, tubules, or interstitium. |
|
|
Term
| What is the tx for postrenal azotemia? |
|
Definition
| easily treatable, foley catheter and renal ultrasound. |
|
|
Term
| What is the major cause of renal azotemia? |
|
Definition
| acute tubular necrosis (ATN) |
|
|
Term
| What is the BUN:creatinine ratio for prerenal azotemia? |
|
Definition
|
|
Term
| What is the BUN:Cr ratio for ATN (and often renal azotemia) |
|
Definition
|
|
Term
| What ratio is used to differentiate between prerenal and renal azotemia? |
|
Definition
|
|
Term
| What is the most common form of acute renal failure? |
|
Definition
|
|
Term
| What is the uncommon type of renal azotemia? |
|
Definition
| disease of the large renal vessels |
|
|
Term
| What types of disease affects large renal vessels? |
|
Definition
| Thromboembolic Disease of the Renal Artery; Renal Vein Thrombosis |
|
|
Term
| What are some diseases of the glomeruli/small renal vessels that can cause renal azotemia? |
|
Definition
| glomeruloephritis/vasculitis, malignant HTN, thrombotic macroangiopathy (TTP, HUS), artheroembolic disease, scleroderma renal crisis |
|
|
Term
| What is acute interstitial nephritis (AIN) |
|
Definition
| get acute renal failure several days after starting a new medicine |
|
|
Term
| what is the major cause of AIN? |
|
Definition
| allergic drug induced nephritis |
|
|
Term
| What are some other things you must consider after ruling out AIN? |
|
Definition
| ATN, rhabdomyolysis, hemolysis, radiocontrast-induced renal failure, tumor lysis syndrome, taking any nephrotoxic antibiotics, chemo or immunosuppressive meds, ethylene glycol intox, myeloma kidney, ischemic ATN? |
|
|
Term
| What are the stages of chronic kidney disease? |
|
Definition
| mild, moderate, severe, end stage (not compatible with life unless dialysis is maintained) |
|
|
Term
| What is most useful in distinguishing between acute or chronic renal failure? |
|
Definition
|
|
Term
| What is commonly found in blood with CRF? |
|
Definition
| normocytic, normochromic anemia |
|
|
Term
| What are some causes of CRF? |
|
Definition
| diabetic nphropathy, hypertensive nephropathy, chronic glomerulonephritis (account for 60-90% of cases) |
|
|
Term
| What should be considered is hematocrit falls below 25%? |
|
Definition
| other causes of anemia such as bleeding, hemolysis, etc. |
|
|
Term
| What happens to Creatinine clearance in CRF? |
|
Definition
|
|
Term
| Why does Cr clearance fall in CRF? |
|
Definition
| due to the decreased filtration of the kidneys |
|
|
Term
| What is included in the pentad of nephrotic syndrome? (5 things) |
|
Definition
| 1) nephrotic range proteinuria; 2) hypoalbuminemia; 3) hyperlipidemia; 4) edema; 5) lipiduria |
|
|
Term
| What is present when urinary protein excretion is greater than 3.5g/24hr? |
|
Definition
|
|
Term
| In nephrotic syndrome, the more severe the proteinuria, the greater risk for __________. |
|
Definition
|
|
Term
| What are the causes of nephrotic syndrome? |
|
Definition
| DM, SLE, amyloidosis, drug-induced, infection, malignancy |
|
|
Term
| What are some features/things seen in acute glomerulonephritis? |
|
Definition
| hematuria, oliguria, HTN, edema, RBC casts, acute renal failure proteinuria |
|
|
Term
| What is the one thing that is hugely diagnostic of acute glomerulonephritis? |
|
Definition
|
|
Term
| What is the most common cause of nephrotic syndrome in children? |
|
Definition
|
|
Term
| What is the normal cause for minimal change disease? |
|
Definition
|
|
Term
| What are some other names for minimal change disease? |
|
Definition
| nil disease, lipoid nephrosis |
|
|
Term
| What are some other names for membranous nephropathy? |
|
Definition
| membranous glomerulopathy, membranous glomerulonephritis |
|
|
Term
| What can cause a false-negative for hematuria with a urine dipstick? |
|
Definition
| vit C >200mg/day (make the urine very acidic, messes up the dipstick results); high nitrite concentration |
|
|
Term
| What should be considered if urine dipstick is positive for hematuria but microscopy is negative for blood cells? |
|
Definition
| hemoglobinuria, myoglobinuria, RBC lysis |
|
|
Term
| What are the criteria for positive result of urine microscopy for hematuria? |
|
Definition
| presence of >3 RBCs/HPF is positive for hematuria/abnormal |
|
|
Term
| What are some symptoms for a urinary tract infection? |
|
Definition
| dysuria, frequency, fever, or possibly asymptomatic |
|
|
Term
| When a UTI is suspected, but urine culture is negative with pyuria, what should be considered? |
|
Definition
|
|
Term
| What might you see if the hematuria is glomerular in origin? |
|
Definition
| RBC casts, dysmorphic/"distorted" RBCs, or protein excretion >500mg/day |
|
|
Term
| What is the test of choice to evaluate nonglumerular hematuria? |
|
Definition
| intravenous pyelography study (IVP) |
|
|
Term
| What patients with hematuria get a cystoscopy? |
|
Definition
| older pts w/ nonglomerular hematuria, pts with risk factors for bladder CA |
|
|
Term
| What can predate urinary tract CA for years? |
|
Definition
|
|
Term
| What is the earliest recognizable indicator of nephropathy? |
|
Definition
|
|
Term
| In pts with DM, what condition signals a higher risk for cardiovascular disease? |
|
Definition
|
|
Term
| True or False.... microalbuminuria is nonreversible. |
|
Definition
|
|
Term
| What are some causes of microalbuminuria? |
|
Definition
| CHF, UTI, exercise, pregnancy, febrile state, inflammatory disorders, urinary tract bleeding |
|
|
Term
| What are the criteria to diagnose microalbuminuria? |
|
Definition
| urine albumine excretion between 30-300mg/day on at least 2 to 3 urine tests over 3-6 months |
|
|
Term
| What is the major urinary tract protein? |
|
Definition
|
|
Term
| Where is the Tamm-Hosfall protein excreted in the kidney? |
|
Definition
| ascending limb of loop of Henle and the distal tubule cells |
|
|
Term
| What are the 3 classifications of proteinuria? |
|
Definition
| 1) glomerular; 2) tubular; 3) overflow |
|
|
Term
| What is the mechanism of glomerular proteinuria? |
|
Definition
| increased glomerular permeability |
|
|
Term
| What is the mechanism for tubular proteinuria? |
|
Definition
| Proximal tubular epithelium almost completely reabsorbs freely filtered low molecular weight proteins. |
|
|
Term
| What is the mechanism for overflow proteinuria? |
|
Definition
| The overproduced protein (due to multiple myeloma) overwhelms the proximal tubular epithelium to reabsorb and catabolize the protein |
|
|
Term
| What is the urine protein excretion for proteinuria? |
|
Definition
|
|
Term
| What can affect urine dipstick results (false positive/negative) when checking for preoteinuria? |
|
Definition
| specific gravity, pH, bloody urine, recent radiocontrast |
|
|
Term
| What is orthostatic proteinuria? |
|
Definition
| increased protein excretion in the upright position but normal protein excretion in the supine position |
|
|
Term
| What does <3g/24hr urine protein indicate? |
|
Definition
| glomerular, tubular, or overflow proteinuria (hard to differentiate) |
|
|
Term
| What does >3g/24hrs urine protein indicate? |
|
Definition
| usually glomerular disease |
|
|
Term
| What ratio calculated from a urine spot test could be helpful in determining the 24hr urine protein? |
|
Definition
| urine protein: creatinine |
|
|
Term
| What test is used to differentiate between the 3 types of protienuria? |
|
Definition
| urine protein electrophoresis |
|
|
Term
| What could be used to determine the etiology of glomerular disease? |
|
Definition
|
|
Term
| What is characteristic of tubular proteinuria? |
|
Definition
|
|
Term
| What is the second leading cause of CA deaths among males? |
|
Definition
|
|
Term
| What percentage of those with prostate CA have a normal PSA? |
|
Definition
|
|
Term
|
Definition
| prostate-specific antigen |
|
|
Term
| What are the PSA derivatives? (3) |
|
Definition
| age-adjusted PSA, PSA velocity, PSA density |
|
|
Term
| What ratio determines the percent free PSA? |
|
Definition
|
|
Term
| When is the Percent Free PSA useful? |
|
Definition
| when PSA levels are between 4-10ng/mL |
|
|
Term
|
Definition
| to stage prostate cancer, following radical prostatectomy, following radiotherapy |
|
|
Term
| What is the preferred value used: urine osmolality or specific gravity, in renal disease? |
|
Definition
|
|
Term
| What is the specific gravity value for dilute urine? |
|
Definition
|
|
Term
| What is the specific gravity value for concentrate urine? |
|
Definition
|
|
Term
| With impaired tubular function, a fixed specific gravity of 1.010 is know as what? |
|
Definition
|
|
Term
| What happens to urine pH after a meal? |
|
Definition
| becomes more alkaline due to HCL being secreted from parietal cells, leaving bicarb in the serum, which is therefore filtered by the kidneys |
|
|
Term
| What is diagnostic of renal tubular acidosis? |
|
Definition
| urine pH that does not fall to <5.5 after an acid load |
|
|
Term
| What types of proteins could show a false negative urine protein? |
|
Definition
| low molecular weight proteins |
|
|
Term
| What should be considered when low molecular weight proteins are in the urine (causing a false negative urine protein)? |
|
Definition
| renal tubular disease, immunoglobulin light chains (Bence Jones proteins in multiple myeloma) |
|
|
Term
| What is the renal threshold for blood glucose? |
|
Definition
|
|
Term
| What happens to glucose in the kidneys? |
|
Definition
| filtered with almost complete resorption in proximal tubule |
|
|
Term
| What are 2 conditions that will have positive urine dipstick test for glucose in absence of hyperglycemia? |
|
Definition
| pregnancy & renal glucosuria |
|
|
Term
| What are some causes of false-positive urine dipstick for glucose? |
|
Definition
|
|
Term
| A positive LE (leukocyte esterase) with no WBCs present on light microscopy suggest what? |
|
Definition
|
|
Term
| When is cell lysis in the urine common? |
|
Definition
| alkaline or hypotonic urine |
|
|
Term
| What is the most common cause of pyuria? |
|
Definition
|
|
Term
| How sensitive is the LE test for pyuria? |
|
Definition
|
|
Term
| What can increase the sensitivity of a LE test? |
|
Definition
|
|
Term
| What can cause a false-positive urine nitrite test? |
|
Definition
| pyridium or sitting at room temp for a while |
|
|
Term
| What can cause a false-negative urine nitrite test? |
|
Definition
|
|
Term
| What is the sensitivity of the urine nitrite test? |
|
Definition
|
|
Term
| Unconjugated bilirubin can give urine a ______ color. |
|
Definition
|
|
Term
| What are WBCs in the urine indicative of? |
|
Definition
|
|
Term
| What type of cells in urine microscopy indicate contamination in women and uncircumcised men? |
|
Definition
| squamous epithelial cells |
|
|
Term
| What is the one infectious process when pyuria is sterile? |
|
Definition
|
|
Term
| What should be suspected with absent pyuria and bacturia present? |
|
Definition
|
|
Term
| What 2 diseases cause an increase in renal tubular epithelial cells in urine microscopic analysis? |
|
Definition
| tubular or interstitial disease |
|
|
Term
| Urinary catheterization can cause clusters or sheets of what to be found in the urine? |
|
Definition
|
|
Term
| ____________ cells are increased in UTI, but a few present are normal. |
|
Definition
|
|
Term
| If transitional cells are present in urine, but pt has not been recently catheterized, what should be suspected? |
|
Definition
| transitional cell carcinoma |
|
|
Term
| What types of crystals in the urine are ALWAYS abnormal findings? |
|
Definition
| Cystine, tyrosine, and leucine crystals |
|
|
Term
| Crystals in the urine are a common finding, but what condition could they give insite to? |
|
Definition
|
|
Term
| What type of tests are AST & ALT tests? |
|
Definition
|
|
Term
| Normal transaminase levels do not exclude presence of liver disease. Why? |
|
Definition
| because there may be an absence of continuing inury to the liver (giving the normal value), but the liver may still be damaged |
|
|
Term
| What disease of the liver does not neccessarily have an elevated transaminase level? |
|
Definition
|
|
Term
| What is a condition that can lead to falsely low transaminase levels? |
|
Definition
|
|
Term
| Which liver function test is more specific: AST or ALT? |
|
Definition
|
|
Term
| Does the degree of transaminase elevation correlate with liver damage or prognosis? |
|
Definition
|
|
Term
| What is the level for marked transaminase elevation? |
|
Definition
|
|
Term
| What should be suspected with a AST:ALT ratio of >1? |
|
Definition
| Alcoholic liver disease, cirrhosis and Reye’s syndrome |
|
|
Term
| What should be suspected with an AST:ALT ratior <1? |
|
Definition
| all other types of liver disease |
|
|
Term
| True or False. Transaminase levels always climb well above 400 units/L with alcoholic liver disease. |
|
Definition
| FALSE. Transaminase levels rarely get above 400units/L in alcoholic liver disease. |
|
|
Term
| Where is albumin synthesized? |
|
Definition
|
|
Term
| What effect does albumin have? |
|
Definition
| significant osmotic effect |
|
|
Term
| What is albumin's half-life? |
|
Definition
|
|
Term
| What is a good gauge of synthetic function in pts with chronic liver disease? |
|
Definition
|
|
Term
| In cases of acute hepatic necrosis, what is a better marker than the serum albumin levels? |
|
Definition
| PT, due to the shorter half-life compared to albumin (hours with PT compared to weeks with albumin) |
|
|
Term
| True or False. Hypoalbuminemia is specific for liver disease. |
|
Definition
| FALSE. Hyperalbuminemia is NOT specific for liver disease. |
|
|
Term
| Prothrombin time is a function of what clotting pathway? |
|
Definition
|
|
Term
| Is PT a sensitive test for liver disease? |
|
Definition
| NO... normal test results until at least 80% of liver's synthetic ability is compromised. |
|
|
Term
| What is best used to estimate prognosis in liver disease? albumin or PT? |
|
Definition
| PT (good correlation between PT and outcome) |
|
|
Term
| What can elevated ALP, otherwise normal liver function tests, and a high 5 nucleotide indicate? |
|
Definition
| hepatobiliary disease (excludes bone disease) |
|
|
Term
| What are 2 conditions possible with elevated alkaline phosphatase(ALP) levels? |
|
Definition
| hepatobiliary disease or bone disease |
|
|
Term
| What should be considered when ALP is >1000units/L and bilirubin level is <1? |
|
Definition
| granulomatous or infiltrative liver disease |
|
|
Term
| What are the 2 types of bilirubin? |
|
Definition
| Direct (conjugated) and indirect (unconjugated) |
|
|
Term
| What is bilirubin a product of? |
|
Definition
| catabolism of senescent RBCs and other hemoproteins (ie cytochrome P450) |
|
|
Term
| What should pts with unconjugated type bilirubin be evaluated for? |
|
Definition
| hepatobiliary disease, and other liver abnormalities |
|
|
Term
| Bilirubin levels of >15mg/dL are rare with what condition? |
|
Definition
| common bile duct obstruction due to gallstones |
|
|
Term
| What does a bilirubin level of >25-30 mg/dL indicate? |
|
Definition
| hemolysis or renal insufficiency superimposed on hepatobiliary disease |
|
|
Term
| What is the only indication for measurement of a 5' nucleotidase? |
|
Definition
| isolated increase in alkaline phosphatase |
|
|
Term
| What is indicated with an elevated 5' nucleotidase? |
|
Definition
| a hepatobiliary orgin to the ALP instead of a bone origin |
|
|
Term
| What does a gamma glutamyl transferase (GGT) test confirm? |
|
Definition
| hepatobiliary disease origin |
|
|
Term
| What does ammonia levels test for? |
|
Definition
|
|
Term
| Are ammonia levels definitive or hepatic encephalopathy? |
|
Definition
| NO. Some pts with hepatic encephalopathy have normal levels. Diagnosis is based on neurological signs and symptoms. |
|
|
Term
| There is a strong correlation between alpha fetoprotein (AFP) levels above 500ng/mL and ________________. |
|
Definition
|
|
Term
| What could an elevated AFP be indicative of? |
|
Definition
| hepatocellular CA, acute liver disease, chronic liver disease, cirrhosis, and hepatic metastasis |
|
|
Term
| What can be used to measure response to treatment in liver CA? |
|
Definition
| serial measurement AFP levels |
|
|
Term
| Which type of hepatitis (ischemic hepatitis or acute viral hepatitis) can cause an impressive elevated LDH (lactate dehydrogenase)? |
|
Definition
|
|
Term
| What can also be seen along with prolonged elevated LDH levels in malignancy inflitrating the liver? |
|
Definition
|
|
Term
| What ratio can be useful in differentiating between acute viral hepatitis from from shock liver and acetamimophen toxicity. |
|
Definition
|
|
Term
| What is the ALT: LDH ratio in acute viral hepatitis? |
|
Definition
|
|
Term
| What is the ALT:LDH ratio in shock live and acetaminophen toxicity? |
|
Definition
|
|
Term
| What does the Child-Turcotte tell us? |
|
Definition
| info about liver function and prognosis |
|
|
Term
| If you have an asymptomatic pt with elevated AST, what should you do next? |
|
Definition
| do ALT since it is more specific for liver disease |
|
|
Term
| If you have an asymptomatic pt with elevated AST that is <5x the ULN, what do you do next? |
|
Definition
| Repeat the tests. If normal, no further evaluation unless you suspect hep C or other disease |
|
|
Term
| What does cholestasis mean? |
|
Definition
| impairment in or lack of bile flow |
|
|
Term
| What should be considered if the ALP level is elevated (>4xnormal) than the transaminase (<300 units/L)? |
|
Definition
|
|
Term
| What should be ordered to differentiate between extrahepatic and intrahepatic cholestasis? |
|
Definition
|
|
Term
| Where is the blockage in extrahepatic cholestasis? |
|
Definition
|
|
Term
| What occurs in intrahepatic choestasis? |
|
Definition
| it is the functional impairment of bile formation/flow at the level of the hepatocyte |
|
|
Term
| Absence of biliary dilation does not exclude the diagnosis of extrahepatic cholestasis. What else should be done for evaluation of extrahepatic cholestasis? |
|
Definition
|
|
Term
| What assesses for primary biliary cirrhosis? |
|
Definition
| antimitochondrial antibodies |
|
|
Term
| What confirms primary biliary cirrhosis? |
|
Definition
|
|
Term
| When is it normal to see isolated elevated ALP? |
|
Definition
| children, adolescents, and pregnant women |
|
|
Term
| What is the next step if isolated evelation of ALP is found? |
|
Definition
| repeat test in fasting state |
|
|
Term
| With isolated elevation of ALP, how do you determine whether it is hepatobiliary or bone origin? |
|
Definition
| high resolution electrophoresis, isoelectric focusing (most useful), 5' nucleotidase, or GGT |
|
|
Term
| What is the cause of jaundice? (value) |
|
Definition
| when bilirubin is >2.5mg/dL |
|
|
Term
| Which type of bilirubin makes the urine foam yellow? |
|
Definition
|
|
Term
| What percentage of serum bilirubin is conjugated in predominately conjugated hyperbilirubinemia? |
|
Definition
|
|
Term
| What else might be present when you suspect unconjugated hyperbilirubinemia due to hemolysis? |
|
Definition
| other lab tests may show anemia, increased reticulocyte count, increased LDH, urine hemosiderin, or decreased haptoglobin |
|
|
Term
| Unconjugated hyperbilirubinemia can be due to ineffective erythropoiesis. What is the mechanism of this? |
|
Definition
| increased RBC destruction in bone marrow |
|
|
Term
| What medicines can cause unconjugated hyperbilirubinemia due to decreased hepatic uptake of bilirubin? |
|
Definition
|
|
Term
| What is the most common cause of unconjugated hyperbilirubinemia in outpatients? |
|
Definition
|
|
Term
| What are some causes of extrahepatic cholestasis? |
|
Definition
| choledocholithiasis, cholangiocarcinoma, pancreatic CA, ampularry tumor, metastases to portal lymph nodes (porta hepatis), primary sclerosing cholangitis (PSC), pancreatitis, pancreatic pseuocyst, AIDS cholangiopathy, biliary stricture, choledochal cysts |
|
|
Term
| How do you differentiate between extrahepatic and intrahepatic cholestasis? |
|
Definition
|
|
Term
| What would you use to detect a ductal obstruction and the location of the obstruction? |
|
Definition
|
|
Term
| What are some causes of intrahepatic cholestasis? |
|
Definition
| primary biliary cirrhosis, viral hepatitis, alcoholic hepatitis, drug-induced cholestasis, total parenteral nutrition (TPN), systemic infection, postoperative jaundice, benign recurrent intrahepatic cholestasis, intrahepatic cholestasis of pregnancy |
|
|
Term
| What are some etiologies of hepatocellular disease? |
|
Definition
| Acute Viral Hepatitis, Chronic Viral Hepatitis, Alcoholic Hepatitis, Cirrhosis (p 653), Drug-Induced Liver Disease |
|
|
Term
| What does haptoglobin do in regards to hemoglobin? |
|
Definition
| specifically binds hemoglobin released from lysed RBCs |
|
|
Term
| When is haptoglobin elevated? |
|
Definition
| medically stressful situations such as infection, malignancy, and burns |
|
|
Term
| How is iron conserved when RBCs are lysed? |
|
Definition
| haptoglobin binds to hemoglobin, creating a haptoglobin-hemogolbin complex that is rapidly taken up by the reticulo-endothelial system cells |
|
|
Term
| What conditions can occur when haptoglobin is low? |
|
Definition
| hemoglobinemia and hemoglobinuria |
|
|
Term
| When is decreased haptoglobin seen? |
|
Definition
|
|
Term
| What is the peak transaminase level with acute viral hepatitis? |
|
Definition
| up to 100x normal value due to hepatocellular necrosis |
|
|
Term
| What is the most common cause of chronic hepatic injury? |
|
Definition
|
|
Term
| True or False. Chronic hepatitis will always present with abnormal ALT levels. |
|
Definition
| FALSE. Abnormal ALT levels do not exclude the diagnosis of chronic hepatitis. |
|
|
Term
| What 2 antibodies are present with an acute Hep A infection? |
|
Definition
| IgM anti-HAV and IgG anti-HAV |
|
|
Term
| When do the antibodies for hep A appear and disappear in an infected patient? |
|
Definition
IgM appears after 1-2 wks after exposure, disappears after 4-6 months
IgG appears 5-6 wks after exsposure and never disappears |
|
|
Term
| How is Hep E transmitted? |
|
Definition
| fecal-oral route, usually contaminated water |
|
|
Term
|
Definition
| Patients with recent travel and new immigrants |
|
|
Term
| How would you diagnose Hep E? |
|
Definition
| presence of IgG and IgM anti-HEV |
|
|
Term
| What is the first identified serologic marker for Hep B? |
|
Definition
| Hep B Surface Antigen (HBsAg) |
|
|
Term
| When does HBsAg show up in patients? |
|
Definition
| 1-10 wks after exposure, not neccessarily acute hep B; can be present >6mo with chronic Hep B |
|
|
Term
| What is a marker of viral replication in Hep B and is also used to select antiviral therapy and assess response to treatment? |
|
Definition
|
|
Term
| What antigen appears shortly after HBsAg and is a measure of acute viral replication? |
|
Definition
|
|
Term
| When suspecting Hep B, what marker is useful in diagnosing during the "window period" - time between disappearance of HBsAg and appearance of anti-HBs? |
|
Definition
| Antibody to Hepatitis B Core Antigen (Anti-HBc) |
|
|
Term
| What markers would you check to when suspecting an acute Hep B infection? |
|
Definition
| Do HBsAg (10% are negative) and IgM anti-HBc. |
|
|
Term
| What is seen when liver disease progesses to cirrhosis? |
|
Definition
| leukopenia, thrombocytopenia (suggesting splenomegaly), hypoalbuminemia or prolonged PT |
|
|
Term
| What is a sign of chronic hep B infection? |
|
Definition
| persistence of HBsAg >6mo |
|
|
Term
| What 2 markers can distinguish between the replicative and nonreplicative infections of chronic Hep B? |
|
Definition
|
|
Term
| What markers will increase or become detectable when a nonreplicating chronic Hep B infections transitions to a replicating infection? |
|
Definition
| transaminase increased 2-5x previous levels, and IgM anti-HBc becomes detectable |
|
|
Term
| What needs to be ruled out when a flare of chronic Hep B occurs? |
|
Definition
| that the flare is not a superimposed infection with other hepatotropic viruses |
|
|
Term
| What is seen in spontaneous resolution of chronic Hep B? |
|
Definition
| disappearance of HBsAg and appearance of anti-HBs, occurs in 1-2%/yr |
|
|
Term
| What antibody is used in the Hep B vaccine? |
|
Definition
|
|
Term
| If someone has had the Hep B vaccine, what will the antibody profile show? |
|
Definition
|
|
Term
| What marker determines viral load (helps predict response to tx) in Hep C? |
|
Definition
|
|
Term
| When is viremia established in Hep C? |
|
Definition
| just a few days after exposure |
|
|
Term
| When is a recombinant immunoblot assay required in helping diagnose Hep C? |
|
Definition
| in pts with positive EIA but low-risk for Hep C, it helps determine if the anti-HCV test is false-positive |
|
|
Term
| What type of hepatitis makes up 20% of acute cases in US? |
|
Definition
|
|
Term
| What is the percentage of pts who recover form acute Hep C and how can we tell? |
|
Definition
| 15-20% of pts with Hep C; test shows negative HCV RNA by PCR |
|
|
Term
| How do we distinguish patients recovered from chronic Hep C patients? |
|
Definition
|
|
Term
| Who can get Hep D and why? |
|
Definition
| only patients with Hep B because Hep D (defective RNA virus) requires the Hep B to replicate |
|
|
Term
| What is the clinical presentation for Hep D? |
|
Definition
| biphasic illness separated with 2-5 wk interval |
|
|
Term
| What is considered when pt with chronic Hep B develops acute hepatitis? |
|
Definition
|
|
Term
| When is chronic Hep D developed? (superinfection or coinfection) |
|
Definition
|
|
Term
| What is commonly seen with coinfection rather than in Hep B alone? |
|
Definition
|
|
Term
| What are 2 indications for Hep D serology in acute hepatic injury? |
|
Definition
| fulminant hepatitis, and acute hepatic injury in chronic hepatitis B viral infection |
|
|
Term
| In addition to HDV markers (HDAg and HDV RNA), what must be present to establish the diagnosis of coinfection of Hep B & D? |
|
Definition
|
|
Term
| What would be done if you suspect chronic Hep D? |
|
Definition
|
|
Term
| What should be considered in every liver disease of unknown etiology? |
|
Definition
|
|
Term
| What are the 3 types of alcoholic liver disease? |
|
Definition
| fatty liver, alcoholic hepatitis, alcoholic cirrhosis |
|
|
Term
| In alcoholic liver disease, what will be the relation of AST to ALT? |
|
Definition
|
|
Term
| What provides the best index of disease severity in alcoholic hepatitis? |
|
Definition
| serum bilirubin combined with PT |
|
|
Term
| What may be seen with enzyme levels in end-stage alcoholic liver disease? |
|
Definition
|
|
Term
| What other abnormalities may be seen in lab tests when alcoholic liver disease is present? |
|
Definition
| leukocytosis, anemia, macrocytosis, thrombocytopenia, elevated serum ferritin, metabolic acidosis (from alcoholic ketoacidosis), hyponatremia |
|
|
Term
| With alcoholic liver disease, anemia could be attributed to what? |
|
Definition
| GI loss, folate deficiency, hypersplenism, or anemia of liver disease |
|
|
Term
| What are some possible causes of thrombocytopenia in relation to alcoholic liver disease? |
|
Definition
| from direct effects of alcohol on bone marrow, from hypersplenism, or from folic acid deficiency |
|
|
Term
| In a patient with alcoholic liver disease, what lab abnormality is suggestive of alcoholic cirrhosis? |
|
Definition
|
|
Term
| What levels are significantly elevated in ischemic hepatitis? |
|
Definition
| transaminase levels 10-20x ULN within 1-3 days |
|
|
Term
| In ischemic hepatitis, what are some of the possible causes of marked transaminase elevation? |
|
Definition
| hypotension/shock, sepsis, hemorrhage, dehydration or burns |
|
|
Term
| In what cases would enzyme levels stay high with ischemic hepatitis? |
|
Definition
| levels are sustained in viral, alcoholic, and drug-induced hepatitis |
|
|
Term
| In addition to transaminase elevation, what other level is often elevated with ischemic hepatitis? |
|
Definition
|
|
Term
| When the perfusion is corrected in ischemic hepatitis, how long would it take for enzyme levels to return near normal? |
|
Definition
| enzymes would fall >50% in 3 days and are near normal in 10 days |
|
|
Term
| What would be seen with a consumptive coagulopathy? |
|
Definition
| prolonged PT/PTT, low fibrinogen levels, thrombocytopenia, elevated fibrin-fibrinogen degradation prodcuts |
|
|
Term
| What is the most common genetic metabolic disease of the liver? |
|
Definition
| a-1 antitrypsin deficiency |
|
|
Term
| What is the serum level when a-1 antitrypsin deficiency is diagnosed? |
|
Definition
| when the serum level is 25% less than the lower limit of normal |
|
|
Term
| What other tests should be run when suspecting a-1 antitrypsin deficiency? |
|
Definition
| blood tests for diagnosis of chronic hepatitis or cirrhosis of unclear etiology |
|
|
Term
| What does a pt with Wilson's disease present with? |
|
Definition
| liver disease or neuropsychiatric signs and symptoms |
|
|
Term
| What are the 3 screening tests for Wilson's disease? |
|
Definition
| 24-hour urine for copper (high); Kayser-Fleischer ring; serum ceruloplasmin level (low) |
|
|
Term
| What is the gold standard to check for Wilson's disease? |
|
Definition
|
|
Term
| What is the most common genetic disorder for caucasians in the US? |
|
Definition
| hereditary hemochromatosis (10-15% are carriers) |
|
|
Term
| What is the mechanism behind hereditary hemochromatosis? |
|
Definition
| excessive GI absorption leads to iron overload; results in cirrhosis, DM, cardiomyopathy, arthritis, and other chronic disorders |
|
|
Term
| What lab tests will be elevated in someone with hereditary hemochromatosis? |
|
Definition
| elevated fasting serum iron level and elevated serum ferritin |
|
|
Term
| What is more sensitive and specific in diagnosing hereditary hemochromatosis? |
|
Definition
| total iron binding capacity/ transferrin saturation |
|
|
Term
| What is the formula for transferrin saturation? |
|
Definition
| transferrin saturation = (serum iron/TIBC) x 100 |
|
|
Term
| What 3 tests should be used together (due to limitations in each test) in diagnosing hereditary hemochromatosis? |
|
Definition
| serum iron levels, total iron binding capacity, and serum ferritin level |
|
|
Term
| What is the gold standard in determining hereditary hemochromatosis? |
|
Definition
|
|
Term
| How much iron can be present in patients in hereditary hemochromatosis? |
|
Definition
| 3-4 g body iron (250mg in unit of blood); you can remove 16 units of blood without causing anemia in these patients!) |
|
|
Term
| Is autoimmune hepatitis more common in women or in men? |
|
Definition
|
|
Term
| What other diseases is autoimmune hepatitis commonly associated with? |
|
Definition
| other autoimmune diseases such as thyroiditis, ulcerative colitis, rheumatoid arthritis, DM, alopecia, nail dystrophy, Sjogren's syndrome |
|
|
Term
| What will be elevated in autoimmune hepatitis? |
|
Definition
|
|
Term
| What are the hallmark tests for autoimmune hepatitis? |
|
Definition
| ANA, ASMA, LKM-1, SLA, LP; liver biopsy is "gold standard" |
|
|
Term
| What disease is indicated with LFTs 3-4x ULN and an enlarged liver? |
|
Definition
|
|
Term
| What imagine studies are used to determine presence of a fatty liver? |
|
Definition
|
|
Term
| Is a liver biopsy required for a diagnosis of fatty liver? |
|
Definition
| No. It can be used, but is not usually required |
|
|
Term
| With acute pancreatitis, when should serum amylase be drawn? |
|
Definition
| within 24-36 hrs of symptom onset |
|
|
Term
| What is more sensitive to diagnose acute pancreatitis after the first day of symptoms? |
|
Definition
|
|
Term
| What other labs will be increased in acute pancreatitis (other than serum lipase and amylase)? |
|
Definition
| increased calcium, increased triglycerides |
|
|
Term
| What are 2 major causes for acute pancreatitis? |
|
Definition
|
|
Term
| What is the cause of acute cholecystitis in 90% of pts? |
|
Definition
| gallstone impaction in the cystic duct |
|
|
Term
| What should be considered when there is a disproportionate elevation of ALP relative to transaminases? |
|
Definition
|
|
Term
| What should be ordered to confirm diagnosis of acute cholecystitis? |
|
Definition
|
|
Term
| What is an ascending infection of the biliary tree proximal to an obstruction? |
|
Definition
|
|
Term
| What is the usual cause of acute cholangitis? |
|
Definition
|
|
Term
| What do the hepatic and common bile ducts look like on US in a pt with acute cholangitis? |
|
Definition
|
|
Term
| What is the gold standard for diagnosing common bile duct stones? |
|
Definition
|
|
Term
| What is seen in lab findings in patients with acute cholangitis? |
|
Definition
| leukocytosis +/- left shift, bilirubin >4, ALP higher than usual |
|
|
Term
| What is a chronic disorder of progressive cholestasis usually seen in middle aged women? |
|
Definition
| primary biliary cirrhosis |
|
|
Term
| How does primary biliary cirrhosis present? |
|
Definition
|
|
Term
| What are the antibodies found in 95% of primary biliary cirrhosis patients? |
|
Definition
| AMA - antimitochondrial antibodies |
|
|
Term
| What may be neccessary to confirm diagnosis of primary biliary cirrhosis? |
|
Definition
|
|
Term
| What is a chronic cholestatic disease with diffuse inflammation and fibrosis affecting the intrahepatic and extrahepatic bile ducts? |
|
Definition
| Primary Sclerosing Cholangitis |
|
|
Term
| Who does primary scleroding cholangitis affect most commonly? |
|
Definition
| caucasion middle-aged men |
|
|
Term
| What is used to diagnose primary sclerosing cholangitis? |
|
Definition
|
|
Term
| What other condition is associated with primary sclerosing cholangitis? |
|
Definition
|
|
Term
| What causes anemia of CRF? |
|
Definition
| EPO production from the kidneys drops because Cr clearance falls, therefore causing anemia |
|
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