Common Labs Flashcards by Michele Burr

digests starch and glucose

Amylase (AML)

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salivary glands, lung tumors, ovarian cyst/tumors, pancreas produces

Amylase (AML)

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Causes of elevated amylase levels

Pancreatitis (only 10% of the time! - usually WNL)
Chronic Renal Failure
Possible Perforated Peptic Ulcer
Macroamylasemia (rare, benign; serum vs urine)

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Causes of low amylase levels

usually insignificant, but 
Chronic pancreatitis
Pancreatic cancer
Liver disease
Toxemia pregnancy

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Diagnostic findings of acute pancreatitis

serum amylase (rises within 2 hours, peaks at 12 - 48 hours, normal 3 - 4 days)
serum lipase (*high levels up to 14 days!!*)

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Why would a provider order an amylase lab? (uses)

Acute pancreatitis dx
Differential dx of Abdominal pain
Abdominal trauma/surgery = pancreatic injury
Perforation of peptic ulcer (r/o pancreatic damage which could cause chemical pancreatitis)

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Produced by the liver and responsible for oncotic (pull) pressure

Albumin - the blood’s main protein

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Cause of elevated albumin

dehydration!

most common

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Hypoalbuminemia: causes of low albumin

*Malnutrition
*Liver disorder
Chronic diseases - hyperthyroidism, lupus, diabetes
Burns
Nephrotic Syndrome/Chronic Renal Failure
Hodgkin’s disease
Post Operative
Sepsis

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Why would a provider order a albumin level?

Evaluate edema
Liver disease - jaundice
Suspcted malnutrition

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______ is composed of 50% albumin

Total Protein

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An elevation of total protein suggests:

Multiple Myeloma (will need to do immunologic typing)

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Low total protein is caused from

Pregnancy
Cytotoxic Drugs
Dietary Deficiency

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A provider orders a total protein for:

suspected hepatic disease (jaundice)
suspected protein deficiency
NP may also consider protein electrophoresis

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Two enzymes located in hepatocytes and injury to the liver causes a release. Measurement of these enzymes reflects severity of hepatic injury

Aminotransferases:
Alanine (ALT)
Aspartate (AST)

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Aminotransferase: ALT vs AST

ALT - L specific for the Liver
AST - increases after Cardiac or Skeletal muscle injury

An elevation of ALT and AST - hepatic problem, Alcholic, liver injury

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An elevation of AST is caused by

Skeletal or Cardiac injury

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A decrease in ALT and AST indicates

advanced cirrhosis or hepatitis

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When should the NP request ALT and AST?

diagnosing/monitoring liver disease

screening tool for medications that cause liver damage

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found in nearly all body tissues, produced by the liver and bones, and children’s levels is 2x - 4x that of adult due to growth

Alkaline Phosphatase (ALP)

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An elevation of ALP (alkaline phosphatase) occurs when

Bile ducts are obstructed (conjugated or direct bilirubin increases too)
New bone formation
Paget’s disease (thickening & hypertrophy of long bones/deformity of flat bones - elderly)

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Why would a NP select a ALP (alkaline phosphatase) lab?

To detect biliary obstructing hepatic lesions
Assessing Vitamin D tx to Rickets
Detect osteoblastic skeletal disease (Paget’s)

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Acid phosphatase is a test to detect _______ and an elevation likely means _____

Prostate Cancer

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Prostate-Specific Antigen (PSA) is produced by

normal, hyperplastic, and cancerous prostate tissue

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An elevated prostate-specific antigen (PSA) may indicate

``` benign prostatic hyperplasia prostate cancer doubles after prostate massage - need to wait 2 weeks prostate biopsy (50 fold increase) ```

A prostate specific antigen lab value is used to:

detect prostate diseases (benign or cancer) stage patient with cancer confirm response to cancer

This lab value is responsible for increasing triiodothyronine and thyoxine secretion

Thyroid-stimulating hormone - T3 and T4 scretion

An increase of thyroid stimulating hormone may indicate

Hypothyroidism - primary (TSH is working hard, why? failure of thyroid) Thyroiditis Inadequate hormone therapy (levothyroxine or Synthroid)

A decrease of thyroid stimulating hormone

Hyperthryoidism Excess Levothyroxine intake Pituitary failure - secondary (low or normal TSH) Hypothalamic failure - tertiary (low or normal TSH)

A patient that is considered euthyroid is a result of?

Thyroid stimulating hormone becomes normal

A patient's lab values present with elevated radioactive-iodine, T3 uptake, and total T4. The thyroid stimulating hormone level is low. What clinical syndrome may this patient have?

Thyrotoxicosis - this refers to an excess of circulating thyroid hormones. The thyroid gland senses you have enough = low TSH.

A patient's lab values presents with low radioactive iodine, T3 uptake, total and free T4. The thyroid stimulating hormone is elevated. What clinical syndrome is this?

Myxedema - a cause of untreated/poorly managed hypothyroidsim

the product of protein metabolism

Blood Urea Nitrogen

An elevation of blood urea nitrogen (BUN) is called? (medical term)

Azotemia

Causes of elevated blood urea nitrogen (BUN) or azotemia (DR HUBCAP)

Decreased water intake (Dehydration) Renal Insufficiency ``` Hyperthyroidism decreased Urine flow (CHF) Blood in GI tract burns - increased protein Catabolism inhibition of Anabolism by corticosteroid drugs increased dietary intake of Protein ```

Causes of decreased blood urea nitrogen (BUN) | NOLL

Nephrosis (possible) Over-hydration Liver failure or hepatitis Late Pregnancy

Why would a NP order a blood urea nitrogen level?

Assess renal function | Assess hydration

The more muscle mass correlates with what serum laboratory product and is a better measurement of renal impairment ("specific" test for renal impairment)

serum Creatinine - specific for renal impairment elevation = FALLING glomerular fitration rate

Specificity versus Sensitivity of serum creatinine

Specificity - good, detects poor renal function by increasing Sensitivity - not good, elderly (poor muscle mass) may have kidney damage without elevation. Overall, slow rise per day with moderately severe kidney damage

An increase in serum creatinine can indicate:

Renal impairment Athlete - nonpathological elevation due to increased muscle mass (decreases are NOT significant)

What laboratory value regulates and promotes neuromuscular activity, skeletal development, and blood coagulation?

Serum Calcium child 10.6 adult 8.9 - 10.1

What laboratory value is controlled by the parathyroid hormone (PTH), calcitonin, adrenal steroids, and is absorbed best with vitamin D

Serum Calcium child 10.6 adult 8.9 - 10.1

What are causes of elevated serum calcium? | D-MORPHIA

Diuretics (Hydrochlorothiazide slows/prevents Ca loss in urine) ``` Metastatic cancer Overuse/excess ingestion of antacids Renal disease (poor excretion) Parathyroid tumor & Paget's disease Hyperparathyroidism Immobility, prolonged Adrenal insufficiency ```

A decrease in serum calcium is caused by

Cushing's syndrome Hypothyroidism Malabsorption

Why would a NP order a serum calcium | BAD AT

Blood clotting problems Acid-base imbalance Disorders - neuromuscular, skeletal, and endocrine Arrhythmias Tetany - muscle cramping

Negative ion present in blood and stomach controlled by renal excretion; regulated by aldosterone secondarily to regulation of sodium

Chloride 95-105

What is the primary cause of abnormal chloride levels?

the body responding to a shift in CO2 (carbon dioxide, increase = chloride decrease, CO2 decrease = chloride increase)

Causes of increased chloride levels | MD CANE

Metabolic Acidosis - body blowing off CO2 Dehydration from diarrhea Cardiac disease Anemia Nephritis Eclampsia

Hypochloremia is caused by

``` Diabetes GI loss - vomiting or gastric suction Thiazide Diuretic Fever Pneumonia CHF - dilutional hypochloremia ```

An intracellular cation that maintains electrical conduction within the cardiac and skeletal muscles.

Potassium 3.5 - 5.3

Hyperkalemia causes include

``` DKA Burns or crushing injuries Renal disorders Abnormal intake Medications Myocardial infarction (MI) or your specimen hemolyzed ```

What will the EKG show in a patient with hyperkalemia?

prolonged PR interval wide QRS complex ST-segment depression tall, tented T-waves

What are causes of hypokalemia? | REM

Renal disorders Excess licorice ingestion (aldosterone-like effect) Medications

What will the EKG show in a patient with hypokalemia?

ST-segment depression flattened T wave U wave elevation severe - ventricular fibrillation, respiratory paralysis, and cardiac arrest

Why would a NP want to know serum potassium levels? | CARD

Complaints of weakness, muscle cramps, or parathesias Arrhythmias - can detect orgin Renal function Diuretics (thiazide or loop)

Maintains osmotic (pull) pressure of extracellular fluid, promotes neuromuscular function, and maintains acid-base balance

Sodium

Hypernatremia causes are

Aldosteronism Inadequate water intake or Insensible loss (fever, sweat) Excess intake (dehydration, kidney dysfunction, diuretics, diarrhea)

Hyponatremia causes

Heart failure Cirrhosis Nephrotic Syndrome (all three have elevated body water, but low circulating volume = ADH stimulation and water retention = sodium dilution Diarrhea, Vomiting Diuretics

Why would a NP monitor sodium levels

Disease monitoring: heart failure, liver disease, chronic renal failure Edematous patient Fluid and Electrolyte evaluation Acid-base balance evaluation Neuromuscular function evaluation Lithium medication - can cause diabetes insipidus

What lab value is affected by red blood cells degradation and attaches to blood albumin

Bilirubin

How is bilirubin excreted? When bilirubin is above ___ jaundice is visible

bile - stool will have a PALE color when bile duct is obstructed > 3

An increase in unconjugated or indirect bilirubin indicates

hepatic damage hemolytic disease of newborn sickle cell crisis

An increase in direct or conjugated bilirubin results from

obstruction | possible hepatic damage

Why would the NP order bilirubin levels?

Liver function evaluation Biliary obstruction assessment Hemolytic anemia assessment and diagnosis Jaundice monitoring Aids in differential diagnosis of jaundice Phototherapy or transfusion needs - > 18 = exchange, possible brain damage

First line defense against bacteria & inflammation | 50% - 70% total WBC

Neutrophils

Increase in chronic or viral infection or in leukemia | 25-35% of total WBC

Lymphocytes

Secondline of defense Stronger & longer lived than neutrophils Respond to viral infections & chronic bacterial infections and inflammation 2 - 6% total WBC

Monocytes

Elevated in Allergies, parasite infections, and drug reactions 0-3% of WBC

Eosinophils

Similar to neutrophils. Play a role in preventing blood clotting, are elevated in allergic reactions and in hypothyroidism 1-3% of total WBC

Basophil

Immature or early stage neutrophils. These are elevated when the body is first launching a response to a bacterial or viral infection and are a sign of acute infection 0-5% of total WBC

Immature granulocytes (Bands)

Acute infection with an increase in bands. | Up in some leukemia & pernicious anemia

shift to left

An increase in mature neutrophils. Seen in diseases of liver

shift to right

Common Labs Flashcards

(72 cards)