CLM test 2

liver

processes and synthesizes AA into protein, makes byproducts like ammonia and urea; stores carbs as glycogen, synthesizes cholesterol

liver

what is the primary location of detoxification?

albumin, pre albumin, prothrombin time/INR

tests related to protein synthesis

ALP

test that is most indicative of cholestasis

bilirubin, ALP, 5’ nucleotidase, GGT

tests relate to excretion into the bile ducts and drainage into the duodenum

cholestasis

impairment of excretion of bilirubin into the bile ducts and drainage into the duodenum

AST, ALT

test related to heptocellular injury

ammonia

test related to detoxification

cholesterol

test related to lipid metabolism

albumin, INR/PT, ALP, AST/ALT, bilirubin, ammonia

6 tests for liver damage

GGT, AST, ALT

3 lab tests for alcohol intake

edema

caused by low concentrations of albumin

prealbumin

test that is more sensitive to protein nutrition than albumin and is less affected byliner disease and hydration status

INR/PT

test that indicates end stage liver disease

INR/PT

may be elevated in vitamin K deficiency

alkaline phosphatase, total and direct bilirubin

3 tests used to detect cholestasis

>4x

how high above normal is the alkaline phosphatase indicator of cholestasis?

unconjugated

total bilirubin

conjugated bilirubin

direct bilirubin

total

bilirubin that is not water soluble and is bound to albumin in the blood

direct

bilirubin that is water soluble and excreted by the kidneys

jaundice

elevated bilirubin causes

indirect bilirubin (unconjugated)

produced by breaking down erythrocytes and removed from circulation by converting to direct bilirubin

hemolysis and reduced hepatic conversion

what 2 things can elevate indirect bilirubin

direct (conjugated) bilirubin

synthesized in hepatocytes by conjugating indirect bilirubin and secreted into bile

ammonia

elevation of this correlates with severity of encephalopathy and likelihood of death

child-pugh score

score for assessing prognosis chronic liver disease, primarily cirrohsis

MELD score

prognostic scoring system used to predict 3-month mortality due to liver disease

MELD

score that is the model for end stage liver disease

lipase, amylase

elevation of what 2 tests indicate pancreatitis

lipase

enzyme secreted by the pancreas that aids in fat digestion

3-43

NR for lipase

amylase

enzyme that breaks starch into its individual sugar molecules

20-96

NR for amylase

serology, urea breath test, fecal antigen test

3 noninvasive tests for H pylori

histology, culture, rapid urea test

3 invasive tests for H pylori

enzyme immunoassays for Toxin A+B

most common and accessible test for C diff

dylipidemia

an abnormal lipid profile

BB, thiazides, contraceptives, corticosteroids, atypical antipsychotics

meds associated with dylipidemia

diabetes, obesity, hypothyroid, pregnancy, cholestasis, liver failure

conditions associated with dyslipidemia

alcohol, amiodarone, conraceptives

drugs that cause increased TG

corticosteroids, thiazides

drugs that cause increased LDL and TG

cholesterol

component of cell wall membranes that is a precursor of steroid hormones and bile acids

TG

fat found in your blood that your body uses for energyp

phospholipids

lipid molecules that contain a phosphate groups

apolipoproteins

proteins embedded on the surface of lipoproteins

HDL, LDL, IDL, VLDL, chylomicrons

order the lipoproteins from most dense to lease

LDL

what site is major carrier of cholesterol

HDL

what removes cholesterol from ASCVD plaques

chylomicrons and VLDL

2 molecules that are primarily TGs

LDL and TG

lipid that is impacted by food

TC=LDL+HDL+TG/5

TC equation

TG>400

must obtain a measured LDL

<70

optimal target of LDL

>160

means that LDL is high

LDL=TC-HDL-TG/5

LDL equation

>60

protective HDL value

atherosclerosis

deposits of fatty plaques on the inner walls of the arteries

age, fam history of CHD, cigarette smoking in the past month, HTN, HDL<40

CVD risk factors

<7.5

low risk for ASCVD events

>20%

high risk for ASCVD events

>190

at what LDL value do we start a high intensity statin?

atorvastatin 40-80, rosuvastatin 20-40

high intensity statins

ankle-brachial index

used to diagnose PAD and evaluate blood flow in legs; identifies individuals at risk for heart attack and stroke

T3 and T4

what are the thyroid produced hormones

TSH and TRH

thyroid relevant hormones

decreased sweating, lethargy, constipation, dry, course skin and hair, puffy, cold intolerance, impaired memory, slow speech

s/s of hypothyroid

primary hypothyroid

failure of the thyroid and low TH

secondary hypothyroid

failure of the pit gland and low TSH

tertiary hypothyroid

failure of the hypothalamus and low TRH

hashimotos disease

autoimmune disease that attacks the thyroid gland

central hypothyroidism

secondary and tertiary hypothyroid referred to

atrophy, nervousness, fatigue, weight loss, heat intolerance, increased sweating, tachy

s/s of hyperthyroidism

grave’s disease

autoimmune disease causing hyperthyroid

AST/SGOT, spinal fluid protein, cholesterol and TG, PRL, CPK, lactate

labs that are increased in hypothyroidism

Hgb/Hct, glucose, sodium

labs that are decreased in hypothyroidism

free T4, serum T4, TSH

3 most common thyroid function tests

total T4

most common thyroid function test

TSH

thyroid function test used to monitor medication therapies

radioactive iodine uptake test

detects thyroid’s ability to trap and concentrate iodine

TSH: high; T4 low

how are labs interpreted in primary hypothyroidism

TSH low/normal; T4 low

how are labs interpreted in secondary hypothyroidism

TSH low; T4 high

how are labs interpreted in primary hyperthyroidism

TSH

primary lab for thyroid diagnosis

T4

lab that confirms thyroid dysfunction

TSH

used to monitor treatment effectiveness of thyroid drugs

ACS

severe reduction or total interruption of blood flow leading to ischemia or MI

atherosclerotic plaque rupture

most common cause of ACS

unstable angina

which type of ACS has negative cardiac biomarkers

UA, NSTEMI, STEMI

3 types of ACS

STEMI

which ACS has ECG changes

biochemical cardiac markers

used to diagnose ACS and aid in differentiating between MI and UA

troponins

proteins involved in muscle contraction with actin and myosin; best cardiac biomarker

cardiac specific troponin

gold standard for the detection of myocardial injury

creatine kinase

enzyme that stimulates the transfer or high energy phosphate groups; associated with poor specificity

myoglobin

a low molecular weight heme protein used as a marker for early diagnosis of MI

CRP

non specific reactant that is released in the presence of inflammatory processes; a strong predictor of mortality in pts with ACS

heart failure

heart is unable to pump blood at a rate sufficient to meet the demands of the body or unable to accept the fluid volume with which it is presented

ECHO

provides anatomical assessment of the heart and functional assessment of the cardiac chambers and valves

BNP

released in response to volume overload and increased ventricular myocyte stretch