Izadi Diagnostics Final Review

erythrocyte sedimentation rate (ESR)

timed test that measures the rate at which red blood cells settle through a volume of plasma
-determined by the aggravation of erythrocytes in which plasmatic and erythrocytic factors are involved

moderately elevated ESR

occurs with inflammation but also with anemia, infection, pregnancy, rheumatologist disease, and aging

extremely elevated ESR

(>100 mm/hr.) are infections like TB, collagen vascular disease, malignancy, or metastatic cancer.

C-reactive protein (CRP)

Normal <10 mg/L.

blood test used to measure the level of inflammation in the body; may indicate conditions that lead to cardiovascular disease

high CRP:

• Check for inflammation due to an infection

• Help diagnose a chronic inflammatory disease, such as rheumatoid arthritis or lupus

• Determine your risk of heart disease

• Evaluate your risk of a second heart attack

high CRP indicates

inflammation which could be a result of infection, chronic disease, or trauma.

extremely high levels w/ nonclinical findings: non-rheumatic diagnoses, such as infection and malignancy, even in the presence of a previously diagnosed RD.

ESR & CRP

-establishes active inflammation somewhere in body
-opioid reduce ESR & CRP b/c its anti-inflammatory

liver failure

one condition observe to impair CRP production

CRP time taken to increase

increase: 4-6 hours

peak: 36-50 hours

normal: 3-7 days following resolution

ESR time taken to increase

peak: a week

normal: several weeks

Acute phase proteins (APP)

• are a class of proteins whose plasma concentrations increase (positive acute-phase proteins) or decrease (negative acute-phase proteins) in response to inflammation.

-response is called acute phase reaction/response

-fever, acceleration of peripheral leukocytes, circulating neutrophils, and their precursors.

hepcidin

• Hepcidin inhibits iron absorption in the intestinal mucosal cells by binding to the ferroprotein and inhibits iron transport by binding to ferroprotein in macrophages. Increased hepcidin during inflammation causes anemia of chronic disease.

anemia of chronic disease

Increased hepcidin during inflammation causes

ferritin

iron storage protein
-to sequester iron to inhibit microbial iron scavenging.

high ferritin

-during malignancy and infection its elevated to reduce free iron available to tumor cells or pathogens
-upregulated by pro inflammatory cytokines

fibrinogen

as a coagulation factor is to promote endothelial repair.

-C3 complement function.

-correlates with ESR.

ANA test

plasma is tested for antibodies that are present in patients with systemic lupus erythematosus

-looks for antinuclear antibodies in your blood. If the test finds antinuclear antibodies in your blood, it may mean you have an autoimmune disorder.

nuclear antigens & antinuclear antibodies

antigens are:

-DNA

-RNA

-Histones

-nucleoli

antibodies against:

-anti-DNA

-anti-RNA

-Anti-Histones

-Anti-nucleoli

anti-double-stranded DNA antibodies

• a group of anti-nuclear antibodies the target antigen of which is double stranded DNA.

• Blood tests such as enzyme-linked immunosorbent assay and immunofluorescence are routinely performed to detect anti-dsDNA antibodies

• They are highly diagnostic of systemic lupus erythematosus and are implicated in the pathogenesis of lupus.

Rheumatoid Factor (RF)

blood test used to help diagnose rheumatoid arthritis
-indicates rheumatoid arthritis or another autoimmune disease

rheumatoid arthritis symptoms

• Joint pain
• Joint stiffness, especially in the morning
• Joint swelling
• Fatigue
• Low-grade fever

Anti-cyclic citrullinated peptide (anti-CCP)

antibody present in most rheumatoid arthritis patients.

-Levels of anti-CCP can be detected in a patient through a simple blood test.

-A positive anti-CCP test result can be used in conjunction with other blood tests, imaging tests, and/or physical examination findings to diagnose rheumatoid arthritis

TORCHeS infections

Prenatal infex that lead to severe abnormalities = most common HEARING IMPAIRMENT & MR

Toxoplasmosis
Other (varicella, listeriosis)
Rubella
Cytomegalovirus
Herpes Simplex/HIV
Syphilis

STD

An infection transmitted through sexual contact, caused by bacteria, viruses, or parasites.

Human Papillomavirus (HPV)

An infection that causes warts in various parts of the body, depending on the strain.

genital herpes

• A common sexually transmitted infection marked by genital pain and sores.

Chlamydia

A bacterial infection that affects the reproductive organs of both males and females
-common sexually transmitted infection that may not cause symptoms.

gonorrhea

• A sexually transmitted bacterial infection that, if untreated, may cause infertility.

HIV/AIDS

• HIV causes AIDS and interferes with the body's ability to fight infections.

Syphilis

A bacterial infection usually spread by sexual contact that starts as a painless sore..

approach to syphilis

-TPHA (treponema pallidum hemagglutination assay
- if positive -> nontreponoma or VDRL (ventral disease research laboratory)
=current or past syphilis

if VDRL negative then FTA-Abs=fluerescent treponema antibody absorption
-if positive then early syphilis

Fluorescent treponemal antibody absorption test (FTA-ABS)

-measures a specific antibody made against treponema pallidum
-should always be followed to confirm a positive RPR and/or VDRL test for syphilis
-test positive for life

approach to viral hepatitis

• If an individual presents with yellow discoloration, the first tests performed should be the AST and ALT.
• Increased AST and ALT indicated viral hepatitis.
• Hepatitis B can measure HBs Ag = acute

HBsAg (Hepatitis B surface antigen)

-indicates th person is infectious
-found in high levels during acute and chronic infection
-used to make the HBV vaccine

HBcAg (Hepatitis B core antigen)

-indicates acute or chronic infection
-not found with vaccine

HBeAg (Hepatitis B envelope antigen)

-associated with the nucleocapsid gene found during acute an chronic HBV
-presence indicates replication virus and high levels of HBV

high serum bilirubin levels mean what?

blockage
-jaundice
-pale stool

AST/ALT ratio

If HEPATOCYTES are damaged AST and ALT will LEAK into the BLOOD.
"AST": LIVER, BRAIN, PANCREAS, HEART, MUSCLE, KIDNEY, LUNGS
"ALT": ONLY in LIVER. L for LIVER

ALT > AST (<1)

-non alcoholic fatty liver disease (diabetes/obesity)
-liver injury

ALT=AST (=1)

-acute viral hepatitis
-liver toxicity

AST>ALT (>1)

cirrhosis

AST>ALT (>2)

-alcoholic liver disease
-chemical hepatitis
-primary biliary cirrhosis
-myocardial infarction

high GGT

-problem is in liver

low GGT

-problem is in RBC or muscle

low albumin means

cirrhosis

high ALP

may be obstruction in bile duct

• Serum bilirubin (T) is high

• Serum bilirubin (D) is high

• AST (SGOT) and ALT (SGPT) is high

• AST/ALT = possibility of alcoholic disease

• GGT is high (suggest chronic alcohol use)

• Albumin is low = ?

• Prothrombin time is high

The patient has liver disease due to alcoholism.

-high serum bilirubin (t)
-high serum bilirubin (d)
-AST/ALT =>2 meaning chemical hepatitis
-high ALP = obstruction bile duct
-High GGT = liver problem
-patient has chemical hepatitis or primary biliary cirrhosis

• Serum bilirubin (T) is high

• Serum bilirubin (D) is high

• AST is high

• GGT is high = confirms the problem is in the liver

• Albumin is low = liver cirrhosis for long term

• Prothrombin time is high

• The patient has long-term cirrhosis.

• The patient is not confirmed for having HIV.
• The patient is reactive, but needs a confirmatory test (Western blot test).
• The Western blot test confirms the patient has HIV.

Western blot test

a blood test to confirm the diagnosis of HIV

urine analysis normal values

• Appearance: clear

• Color: amber yellow

• Odor: aromatic

• pH: 4.6 – 8

• Protein: 0 – 8 mg/dL

• Specific gravity: 1.005 – 1.030

• Leukocyte esterase: negative

• Nitrites: none

-Ketones: none

• Bilirubin: none

• Urobilinogen: 0.01 – 1 Ehrlich unit/mL

• Crystals: none

• Casts: none

• Glucose: negative

• White Blood Cells: 0 – 4/low-power field

• WBC casts: none

• Red Blood Cells (RBCs): ≤ 2

• RBC casts: none

pH

ability of Kidney to maintain normal H+ concentration in plasma & extracellular fluids

Specific gravity of urine

• concentration, Kidney ability to maintain homeostasis of fluid & electrolytes

glucose in urine

diabetes; low renal threshold

bilrubin (UA)

liver dysfunction; blood in urine

ketones in urine

fasting, diabetes, dehydration

blood in urine

menstrual, UTI, stones, malignancy

protein (albumin) in urine

dehydration, fasting, kidney disease, UTI, positional

nitrates in urine

produced by bacteria

Leukocyte esterase in urine

WBC, LEUKOCYTE INFECTION

WBC in urine

white blood cells, ↑ in infection, inflammation

RBC in urine

red blood cells; ↑ stones, renal disease, infection

epithelial In urine

squamous, transitional, renal

casts

hyaline, fine/course granular, RBC, WBC, waxy, fatty

crystals in urine

• type formed based on urine pH, presence of inorganic elements, ability to precipitate; normal component w/few exceptions; can indicate type of calculi w/stones

-amorphous urates/phosphates, uric acid, calcium oxalate, triple phosphate, ammonium biurate, calcium phosphate/carbonate

Abnormal Crystals in Urine

cystine, tyrosine, leucine

bacteria in urine

increase with infection

-miscellaneuous: yeast, parasites

normal

hematuria

increased #s RBCs in urine

• Nephron: glomerulonephritis

• In association w/casts: glomerular

• Extraglomerular: kidney stones, bladder stones, trauma, malignancy, infection, medications

• Interstitial nephritis, pyelonephritis, acute cystitis, sickle cell anemia

pyuria

increased #s WBCs (pus) in urine

• Cystitis: UTI

• Pyelonephritis

• Urethritis

- Glomerulonephritis

uric acid

Increased in gout, renal failure, acute fever, chronic nephritis

proteinuria

protein in urine

• Chronic diseases: diabetes, hypertension; sign of kidney damage.

• Transient elevations: infection, medication, exercise, emotional or physical stress; orthostatic; pre-eclampsia

• Diseases: amyloidosis, bladder cancer, CHF, diabetes, drugs, glomerulonephritis, heavy metal poisoning, kidney infection, multiple myeloma, SLE, UTI, polycystic kidneys

E. coli

normal GI bacteria, most common cause of UTI (90%), acute/chronic pyelonephritis, cystitis

symptoms of UTI

-painful urine
-constant urge to urinate
-cloudy urine
-fould odor
-pelvic pain

UTI risk factors

-multiple sex partner
-pregnancy
-menopause
-diabetes
-catheter
-lack of water

Upper UTI

-axcute pyleonephritis
-chronic pyleonephritis
-interstitial pyleonephritis
-renal abscess
-perirenal abscess

lower UTI

-cystitis
-prostatitis
-urethritis

Uncomplicated UTI

UTI without underlying renal or neurological disease

Complicated UTI

UTI with underlying structural medical or neurological disease

recurrent UTI

> 3 symptomatic UTI within 12 months following clinical therapy

reinfection UTI

recurrent UTI caused by a different pathogen at any time

Relapse UTI

recurrent UTI cause by same species causing original utilization w/in 2 weeks after therapy

Pyleonephritis

inflammation of the renal pelvis and the kidney
-white blood cell casts
-(fever, chills, back pain, nausea, vomiting)

UTI babys and infants

-failure to thrive
-fever
-apathy
-diarhea

UTI in children

-dysuria, urgency, frequency
-hematuriqa
-acute abdominal pain
-vomiting

steps for UTI

-urinalysis
-urine culture

nitrite positive

-uti
-bacteria present

• Blood is present = indicates hematuria

• Nitrite is 1+ = bacteria is present, indicates a UTI

• Leukocyte esterase is 3+ = indicates there are WBCs, leukocytes and it could be from an infection

• Bacteria is 3+ = indicates an infection

• WBCs are high = infection or inflammation

• Epithelial cells are high = ?

• A urine culture antibiogram should be performed. The patient has a urinary tract infection.

-could just be menstrual period
-trace blood

protein in urine

could indicate dehydration, fasting, kidney disease, diabetes, or UTI

• Leukocyte esterase is positive = indicates there are WBCs, leukocytes and it could be from an infection

• Nitrite is positive = bacteria is present, indicates a UTI

• WBCs are high = infection or inflammation

• RBCs are high = malignancy, kidney stones, menstrual cycle

• Bacteria is many = contamination during sampling or an infection

glomerulonephritis urine analysis

-red blood cells and protein in urine or white blood cells

• Blood is 3+ = could indicate menstrual, UTI, stones, or malignancy

• Protein is 2+ = could indicate dehydration, fasting, kidney disease, diabetes, or UTI

• RBCs are high = could indicate stones, renal disease, infection

• Casts are present

• The patient has glomerular nephritis

normal (urine)

• Few RBCs, severe increase in glucose, protein is 100, bacteria is occasion

• Dd: diabetes or nephrotic syndrome

• Diabetes because of the excreted protein

• Diabetes with the end stage renal failure

• Bilirubin is 1+
• DD: Increase bilirubin needs a test for liver function. Then you should search for liver diseases.

UTI diagnosis

-microscope
-urinalysis
-urine cultue
-images

stool

• Made of ¾ water and ¼ solid.

• included:

• undigested and unabsorbed foods.

• intestinal secretions, mucosa.

• Bile secretion and salts.

• Bacteria and inorganic material.

• Epithelial cells and leukocytes

brown stool color

normal

black stool indicates

-bleeding in the upper GI tract
-drugs