2. Clinical Chem Flashcards
(29 cards)
CMP
BMP
Ca
LFTs
CHEM -7
electrolytes
Na
K
Cl-
renal function
BUN (blood nurea Nitogen)
creatinine
glucose
LFTs
albumin total protein ALP ALT ASR total bilirubin, direct bilirubin, indirect bilirubin (liver eliminated bili)
when to order LFT
sx jaundice, dark urine, n/v, fatigue if it it safe to admin drug herbal remedies damaging liver response to tx AUD
bilirubin
from breakdown of hemoglobin, then conjugated in liver
measured in 2 assasys (total and direct) - subtract direct from total to give indirect
elvaluate wide range of disease states, production of bile, uptake storing and excreting
indirect bili - unconjugated - hemolysis, inc production
direct bili - conjugated liver and billiary conditions, hepatocellular damage from Rx, toxins
albumin
cruicial protein formed in liver, large part of plasma proteins
TAXI- binda ca, water, Na, K, FAs, hormones, billi, T4, vits
assess nutritional status, liver diseases
hypoalbuminemia vs hyper
hypo: liver disease, nephrotic synd, late pregnanyc, easting disorders, chronic disease states
hyper: dehydraion (common), Vit A deficency
Transaminases
ALT- orimarily in liver, indications of lover injury
AST - liver, brain, pancrease, heart, kidny, lung, muscles - elevations is damage to any of these tissue
AST/ALT ratio
AST/ALT ratio
<1 non alc fatty liver disease
=1 acute viral hepatitis, Rx related tox
>1 = cirrohsis
2:1 oe > alcoholic liver disease
alkaline phosphaphatase
used to dephosphorylate compounds, integral role in liver metabolism and development of skeleton
dx diseases such as hepaitits, PTH disease and osetomalacia
pancreatic enzymes
amalyase - digest carbs, made in pancreas gland which make saliva,
when pancreas is inflamed or infected amalyse released into body
Lipase: produced by pancrease digest FATS, break down TGs, also produced in tongue stomach and liver
INC when pancreas is inflamed, or gallstone blocks pancreatic duct
BOTH raised in acute pancreatitic, mar not be raised in chronic pancreatitis
Dx pancreatitis
USE lipase >5x upper limit of normal
More likely miss amalyse elevation then lipase elevation
lipase has greater pancreas specificity then amalyse (95%)
LA
degree of tissue hypoxia
elevated in anaerobic met
shock, vasc occlusion, ischemic bowel
correlated w severity of illness
cardiac enzymes
troponin test creatinine kinase (CK-MB) lactate dehydrogenase (LDH) myoglobin (Mb) glycerin phosphorlyase isoenzyme BB (GPBB)
troponin
cardiac enzymes
most sensitive and specific test for myocardial damage
T and I are specific to myocardium
T can be elevated in CKD pts
released 2-4 hrs after injury and can persist up to 14 + days
peaks 12 hrs after injury
CK-MB
cardiac enzymes
released by any muscle - isoform of CK and is espressed in heart muscles
if other muscle damage can be falsely elevated
3-5 hrs after injury persists 36-48 hrs
CL-BB (CK1) - brain and lung
CK-MB (CK2) myocardial cells, small amount of sk muscle
CK-MM (CK3) - Sk muscle
LDH
cardiac enzymes
nor used regularly
was used in combo w AST and CK-MB prior to triponin
myoglobin
cardiac enzymes
rapidly released from damaged tissue
low specificity for MI
can be beneficial in detecting MIs early
released in minutes of injury but persistes <12 hrs
peask 2 hrs after injury
GPBB
prsent in heart and brain
BBB prevents GPBB that is release in brain from enetering blood so GPBB detected in blood is cradiac specific
“new cardiac marker” to help detect early ACS
1-3 hrs after injury and persists 24 hr
peak 7 hr after injur
triponin assay
sensitive are used in US
High sensitive in other countries
PRO HS: detects MI earlier
CON: detects triponin elevation in chronic diseases no clear threshold and risk of unnecessary procedures
arterial blood gas
tell respiratory and metabolic state
evaluate gas exchange in lungs
acid-base balance
O2 status
COMES FROM ARTERY
perform allens test prior
allens test
to test collateral circulation in wrist
radial and ulnar arteries
radial is easier
CI of ABG
no pulse cellulutus compromised skin no ulnar artery AV fistula coagulopathy
