[OS 214 Exam 1] Lec 11: Lab Diagnosis in GI and Hepatobiliary Diseases

Question 1

What is the usual size of tissue obtained during CNB?

Answer 1

diameter: 0.1-0.3 cm
length: 0.5-2 cm

Question 2

Why is FNAB preferable over CNB for a 10 cm mass suspected to be hepatocellular CA?

Answer 2

Liver parenchyma is very friable and large lesions can spontaneously rupture.

Question 3

How many specimens are submitted when FNAB is performed?

Answer 3

2

Question 4

When is excision biopsy usually performed?

Answer 4

skin lesions and cases of basal cell carcinoma

Question 5

What cytokeratin (CK) tandem is useful in determining sources of primary tumor?

Answer 5

CK7 and CK20

Question 6

What is the most up-to-date method used in the immunopathology section?

Answer 6

Chemiluminescence method

Question 7

Which liver enzymes are most useful in gauging liver damage?

Answer 7

Aminotransferases (ALT, AST), Alkaline Phosphatase (ALP), Gamma Glutamyl Transferase (GGT)

Question 8

(T/F) Liver enzyme measurements can measure how well the luver is functioning.

Answer 8

F - Liver enzyme measurements gauge the level of damage sustained by liver cels

Question 9

Which aminotransferase has a more widespread distribution?

Answer 9

AST - heart, liver, skeletal muscle, kidney, brain, pancreas, lungs, leukocytes, and erythrocytes
ALT - liver, kidney

Question 10

Which aminotransferase is the test of choice?

Answer 10

ALT (more specific)

Question 11

AST and ALT values are greater than 10x normal in which cases?

Answer 11

massive hepatic necrosis, acute hepatitis, severe alcoholic hepatitis, severe ischemia(usually affecting centrilobular area)

Question 12

AST/ ALT values are 2-10x normal in which cases?

Answer 12

infectious mononucleosis (EBV, CMV), chronic hepatitis, autoimmune diseases, alpha-1-protease inhibitor deficiency, drug-related hepatitis, liver hypoxemia, recoverinig hepatitis, mild alcoholism, hemochromatosis, impacted gallstone

Question 13

What conditions cause a non-specific elevation in AST/ALT values?

Answer 13

obesity, metastatic liver disease, amyloidosis, cirrhosis without any current necrosis, influenza, paracetamol intake

Question 14

What is the normal distribution of ALP?

Answer 14

liver, bone, kidney, placenta

Question 15

What are the common indications of elevated ALP values?

Answer 15

obstruction along the biliary tree, hepatobiliary disease, bone disease

Question 16

What are the usual causes of obstruction of the biliary tree?

Answer 16

extrinsic bile duct obstruction or damage, hepatocellular damage or inflammation, space-occupying lesions

Question 17

What is the usual distribution of GGT?

Answer 17

proximal renal tubule, liver, pancreas, intestine

Question 18

Where is amylase produced?

Answer 18

pancreas - acinar cells

salivary glands

Question 19

Which enzyme is usually used to diagnose acute pancreatitis?

Answer 19

lipase

Question 20

What determines the synthetic rate of albumin?

Answer 20

colloidal osmotic pressure and protein intake

Question 21

When is the maximum level in AFP normally reached?

Answer 21

end of first trimester

Question 22

Which liver enzyme is best measured to diagnose HCC?

Answer 22

AFP

Question 23

AFP is elevated in which kinds of germ cell tumors?

Answer 23

Yolk sac tumor, embryonal carcinoma

Question 24

Elevated CEA levels correlate the most with what kind of cancer?

Answer 24

colorectal CA

Question 25

Which is the only blood-group antigen-related marker measured in the Philippines?

Answer 25

CA 19-9

Question 26

What is the cut-off for a positive FOBT?

Answer 26

blood loss greater than 5-10 mL per day