Visceral Disorders- Exam 3- Biochemical Profiles (part 2)

What is a nitrogenous compound that is a product of pruine catabolism

Uric acid

Hyperuricema is assoacited with

Gout

Elevated levels of uric acid is called

Hyperuriciemia

Recurrent attacks of acute, red, tender, hot swollen joints

Gout

Deposits of uric acid crystals in and around the joint

Gout

Gout vs DJD on x ray

Gout of the big toe is called

Podagra

DJD vs gout on foot x ray

What is something that you can see on x ray in the foot with gout that you cant see with DJD

Overhanging margin sign

RA vs Gout VS CPPD in the hand

CPPD

calcium pyrophosphate deposition disease

Arthritis in the DIPS

Herbards nodes

Arthritis in the PIPS

Buschards

Arthritis in the MCP

Haggards

Psoriatic arthritis in the hands with the names of the different arthritis joint locations

Psoriatic arthritis vs DJD in the hand

DJD loves what joints in the hand

DIPS

What is known as the lumpy bumpy disease

Gout

What should you order with a soft tissue promince and maybe an erosive change

CBC, uric acid levels and maybe an ESR

What is the most significant factor for osmotic pressure, keeping fluids within the vascular space

Protein

What make up most of the protein in our bodies and is measures as the total protein

Albumin and globulin

What diseases have increased protein

Multiple myeloma

Dehydration

Chronic infections

Malignancies

When are proteins decreasd

Liver disease

Kidney disease

Malabsorption

What is formed in the liver and makes up 60% of total protein

Albumin

Albumin is a measure of

Liver function

Serum albumin and globulins are measures of

Nutrition

Malnourished pains have _______ level of protein

Decreased

Burn patients have _____ level of proteins

Burn victims

Describe the albumin/globulin ratio

If albumin is low and globulins are high then the total proteins are normal

Changes of the albumin/globulin ratio are detected using the

A/G ratio

Normally the albumin/globulin ratio

Exceeds 1

What are diseases that increase total proteins, particularly the globulins that can reverse the albumin./globulin ratio

Multiple myeloma, malignancy and inflammatory diseas

What can you all order for someone with multiple myeloma

CBS, ESR, C-RP, BCP (calcium, protein, A/G ratio, BUN, creatinine, and uric acid)

Serum protein electrophoresis, UA, bone marrow biopsy, radiographs, specialized imaging in

What do you look for in a bone marrow bioipsy for multiple myeloma

>10% plasma cells

Looks like lytic mes

Bone scan

MRI

Biopsy

Looks like multiple myeloma

protein electrophoresis (looking for M spike in urine and blood)

Skeletal survey

MRI

Biopsy (looking for >10% plasma cells)

What must be included for a differential diagnosis of any lytic bone lesion, whether well defined or ill defined for anyone over the age of 40

Multiple myeloma and lytic Mets

CRAB with multiple myeloma

Calcium

Renal Failure/Dysfunction

Anemia (anemia of chronic disease)

Bone lesions

Hypercalcemia can cause

Nausea

Confusion

Constipation

Polyuria

Fatigue

What does the RBC look like with multiple myeloma

Rouleaux formation (seen on CBC where the RBC stick together like coins)

Multiple myeloma does what to the A/G ratio

Reversed it by increasing globulins

Multiple myeloma has _____ ESR

Elevated

Multiple myeloma has______protein

Elevated in urine and blood

Multiple myeloma is what type of anemia

Normocytic normochromic anemai (ACD)

Multiple myeloma does what to BUN and creatinine levels? Meaning?

Increased meaning decreased kidney function

Level alkaline phosphatase (ALP) for multiple myeloma

Normal or low

Lytic mestastis has urine calcium that is often

Increased

Lytic metastasis has serum calcium and phosphate that is usually

Normal or increased

Lytic metastasis has serum ALP levels that are

Normal or increased

Lytic metasits cause what type of anemia

Normocytic normochromic anemia (ACD)

Blastic Mets has serum calcium that is

Usually normal

Blastic Mets has urine caclium that i s

Low

Blastic Mets hat ALP that is

Increased

Blastic Mets has acid phosphatase that is

Increased

Blastic Mets causes what type of anemia

Normocytic normochromic anemia

What measures excretory function of the liver

Bilirubin

Total serum bilirubin is the sum of

Unconjugated or conjugated bilirubin

What type of bilirubin is in the urine

Conjugated

What resulted in elevated unconjugated bilirubin

Hepatocellular dysfunction and increased RBC hemolysis

What results in elevated conjugated biliruin

Liver disease and extrahepatic obstruction such as gallstones, or tumor blocking bile ducts

Conjugated bilirubin in the urine means

Check liver function tests

-liver or post liver problem

If there isn't bilirubin in the urine but there is total elevated bilirubin then

It's unconjugated bilirubin

What can cause elevated unconjugated bilirubin

Hemolysis

Hematoma

Gilberts syndrome

-all things pre liver

Level of urobilinogen that is healthy or normal

Normal is less than 1

Level of urobilinogen with liver/biliary disease

Increased

Level of urobilinogen with biliary obstruction

Absent with 100% obstruction

Low with less than 100% obstruction

Level of urobilinogen with hemolytic anemia

Increased

Level of healthy/normal bilirubin

Negative

Level of biliruin with liver/bilairy disaes

Positive

Level of bilirubin with biliary obstruction

Positive

Level of bilirubin with hemolytic anemia

Negative I

With unconjugated bilirubin increased you should think

Pre liver stuff

Increases in conjugated bilirubin are highly specific for

Diseases of the liver or bile ducts