Lab diagnosis 2 final

• Uric acid
• Calcium
• Phosphorous
• Alkaline Phosphatase (ALP)
• Total Protein
• Albumin

• CK (total)
• CK-MB
• Troponin
• Myoglobin

• Cholesterol
• Triglycerides
• HDL
• Glucose
• ApoA/ApoB ratio

• AST (SGOT)
• ALT (SGPT)
• ALP
• SGGT (gamma-glutamyl transpeptidase)
• Total bilirubin
• Albumin
• PT (prothrombin time)

• BUN
• Creatinine
• Total protein
• Albumin
• Electrolytes (Na, K, Cl, CO2)
• Glucose
• Urine tests (urinalysis, 24 hour creatinine, 24 hr. protein, Creatinine clearance)

• Calcium
• Phosphorous
• Magnesium
• ALP
• Total protein
• Albumin
• Creatinine
• Urinary calcium

• T4 (thyroxine)
• T3 (triiodothyroinie)
• TSH

• Amylase
• Lipase
• Glucose
• Calcium

• Glucose
• BUN/Creatinine
• Cholesterol
• Triglyceride
• AST
• ALP
• Total bilirubin
• LDH (lactate dehydrogenase)
• Calcium
• Sodium
• Potassium

• BUN/Creatinine
• Sodium
• Potassium
• Chloride
• CO2
• T4
• Urinary free cortisol
• Urinary VMA/Catecholamines
• Urinalysis/Culture and sensitivity

• HBsAg - positive
• HBeAg - positive
• AntiHBs - negative
• AntiHBc (IgM) - positive
• AntiHBe - negative
• AntiHAV (IgM)

Only Anti-HBs will be positive

• Anti-HBs and Anti-HBc - positive
• All Ag - negative

• HBsAg - Positive
• Anti-HBs - Negative
• HBeAg - Positive indicates high infectivity
• Anti-HBe - Positive indicates low infectivity
• Anti-HBc - IgG

• Glucose (FBS)
• 2 hour post prandiol (eating)
• Elecrolytes
• Cholesterol
• Triglycerides
• Glycosylated hemoglobin (hemoglobin A1c)

• ESR
• C-reactive protein
• RF latex (RA)
• Uric acid
• ANA

• ANA
• Anti-DNA antibody
• C3
• C4

• PT
• PTT
• Platelet count
• Bleeding time
• Fibrinogen
• D-dimer

• AFP (alpha-fetoprotein) - liver cancer
• CEA (carcinoembryonic antigen) - colorectal cancer
• pAcP (prostatic acid phosphate)
• b-HCG (beta-human chorionic gonadotropin) - testicular cancer
• LDH
• Alkaline phosphorous (AP)

• LDH
• AST
• AP
• Total protein
• Albumin
• CEA

• Iron deficiency
• Thalessemia
• Lead Poisoning
• Sideroblastic (too much iron)

• Iron
• Transferrin (Total iron binding capacity)
• Ferritin

• B12
• Folic acid
• Schilling test - for pernicious anemia
• Anti-IF antibodies - for pernicious
• Anti-Parietal antibodies - for pernicious

• PMN (neutrophils) - acute bacterial infections
• Lymphocytes - viral infections
• Monocytes - chronic conditions
• Eosinophils - parasites, skin diseases, chronic allergies, asthma
• Basophils - Acute allergies (hypersensitivity type I)

Strep, rheumatic fever, acute post strep glomerulonephritis, erythema nodosum

Infectious mononucleosis

Acute-phase reactant, inflammation, bacterial infection, necrosis, early coronary artery disease

Generalized inflammtion/necrosis

Screening test for antibodies

Confirmatory test for antibodies

Screening test for syphilis

Confirmatory tests for syphilis

systemic lupus

Rheumatoid arthritis

Systemic lupus, more specific than ANA

prostate screening for enlargement and cancer

Strep

Potassium, LDH, Phosphorous

• Glucose
• Potassium
• Calcium
• Sodium
• Potassium
• CK (only if too high, possible MI or stroke depending on type of CK)
• Bilirubin (infants, only if high)

• Glucose
• Lipids (cholesterol and triglycerides)
• PO4

• Hypercalcemia occurs in primary hyperparathyroidism, malignancy, vitamin D intoxication, metastatic bone tumors
• Hypocalcemia occurs in malnutrition, renal disease, secondary hyperparathyroidism, vitamin D deficiency, low albumin (most common)

• Hyperphosphatemia occurs in hypoparathyroidism, renal failure, secondary hyperparathyroid, excess vitamin D
• Hypophosphatemia occurs in primary hyperparathyroidism, vitamin D deficiency, malabsorption

Hyperuricemia is from excess cell break down or excess purine metabolism (ex. gout), renal disease

• Bone (highest concentration) - osteoblasts
• Liver (2nd highest)- obstruction

Liver or heart

Liver only

most senstive to alcohol usage, also elevated in liver diseases

Will be elevated in blood and urine in Gallstones (cholelithiasis, liver cancer, duct obstruction)

Will be elevated in blood only, urobilinogen will will elevated in urine in pre-hepatic and many liver conditions

decreases in malnutrition/malabsorption, liver disease, inflammatory diseases, 3rd degree burns, nephrotic syndrome

need for clotting

Increases in advanced liver failure, reyes syndrome (asprin overdose in young children with virus --> brain and liver damage)

pre-natal testing (birth defects) or liver cancer (adults)

decreased levels in emphysema, neonatal respiratory distress syndrome, low serum proteins

tumor marker, particularly colorectal and breast cancer

• CK-MM (CK-3) is increased in muscle injury or disease, as well as after strenouous exercise
• CK-MB (CK-2) is increased after damaged to heart
• CK-BB (CK-1) is increased after brain injury

Used to estimate the amount of damage from an MI

Increased after MI or muscle trauma or disease

• Increased if genectic, hyperlipidemia, hypothyroid, uncontrolled diabetes, nephrotic syndrome, MI, stress, atherosclerosis, biliary cirrhosis
• Decreased if malnutrition, malabsorption, hyperthyroid, liver diesease

• Increased in hyperlipidemias, genetic, high carb diet, hypothyroid, nephrotic syndrome, diabetes, chronic renal disease, glycogen storage disease
• Decreased in malabsorption, malnutrition, abetalipoproteinemia, hyperthyroid

• Increases due to genetics, excessive exercise, moderate alcohol consumption, estrogen
• Decreases due to genetics, hepatitis, nephrotic syndrome, malnutrition
• Want higher numbers

• Increases due to genetics, nephrotic syndrome, hypothyroid, glycogen storage disease, chronic liver disease, excess alcohol consumption, multiple myeloma, cushing's
• Decreases due to genetics, malabsorption, malnutrition, hyperthyroid
• Want lower numbers

Want a higher ratio (more Apo A) (high Apo B is Bad - indicates high risk of heart disease)

High fibrinogen, Insulin, Lp-PLA2 (PLAC - also used to evaluate stroke risk), Chlamydia pneumoniae, homocysteine, C-reactive protein

Type IV - very high triglycerides because of eating habits, lack of exercise, diabetes (very little genetic influence for this type)

Congestive heart failure - differentiate from respiratory conditions

tumor in chromaffin cells of adrenal medulla secretes catecholamines (epinephrine and norepinephrine) leading to excess VMA (breakdown product) - can detect with 24 hour urine collection

DIC (disseminated intravascular coagulation - tiny clots all over body) or DVT (deep vein thrombosis)

• Best blood test for kidney
• Increases indicate kidney problem
• Decreases indicate muscular dystrophy or decreased muscle mass

Increases in muscular dystrophy and muscle damage

• Urea is the main nonprotein nitrogen end product of protein metabolism
• Increases in kidney problems (kidneys cannot filter out)
• Note: high levels cause disorientation and convulsions

Decreases (causes edema) is caused by hepatic disease, malnutrition, malabsorption, nephrotic syndrome, CHF, eclampsia, burns

tests for concentrating and diluting ability of kidney, specific gravity is screening, osmolarity is confirmatory

tests for prostate cancer

screen for bacterial infection in urine

• Low (more common) occurs with nephrotic syndrome, liver disease, malabsorption
• High occurs in multiple myeloma (increased globulin), dehydration

increases in multiple myeloma, chronic infections

Glomerulonephritis, SLE, servere recurrent bacterial infections, nephritis, RA, immune complex disorders all decreased levels

• Increases in graves disease, plummer disease, acute thyroiditis (hashimotos)
• Decreases in chronic thyroiditis , myxedema, cretinism

• Increases in hashimoto's (primary hypothyroidism), severe and chronic illness
• Decreases in secondary hypothyroidism, hyperthyroidism

Hyperthyroid antibodies

hypothyroid

Hypothalamus releases CRH which stimulates the Anterior pituitary to release ACTH which stimulates the adrenal cortex to release all of its hormones

Mineralcorticoids, Glucocorticoids and Androgens

Aldosterone, found in blood and urine, reabsorbs sodium, excretes potassium, regulated by the renin-angiotensin system (decreased renal blood flow --> glomeruli releases renin --> liver secretes angiotensin I --> lungs and kidney convert it to angiotensin II --> simulates aldosterone production in adrenals), stimulated by ACTH, low sodium, high potassium, diurinal higher in AM

17OHCS (in urine) and cortisol (in blood, only found in urine if there is too much in blood) stimulate the metabolism (breakdown) of carbs, lipids, and proteins - strongests effect on glucose (inhibits insulin- stressful job will cause secondary diabetes), vary diurnally, highest in morning, lowest at night, increased by stress

17 KS stimulates male sex characteristics

• distinguishes cause of hyperfunctioning adrenal gland (cushing's), ACTH is suppressed, possible reactions:
• If cushing's is due to bilateral hyperplasia then cortisol and 17-OHCS will decrease by about 1/2
• If cushing's is due to a tumor (malignant or benign) of adrenal gland than there will be no change

ACTH (adrenocorticotropic hormone) - if increased then indicates secondary, if decreased indicates primary, also can be increased by stress

used in conjuction with aldosterone to diagnose primary hyperaldosteronism (decreases) from secondary (normal or increases)

• Rounded, moon face
• Truncal obesity
• Slender extremeties
• Buffalo hump
• Muscle wasting/weakness
• Thin, atrophic skin
• Hirsuitism
• Purple striae on abdomen
• Intolerance to heat

Increase cortisol, does not decrease at night, also present in urine, increased blood glucose (secondary hyperglycemia), dexamethasone test determines if primary or secondary

• Increased pigmentation (increased melanin)
• Hypotension
• Fainting spells
• Decreased cold tolerance
• Nausea/vomiting/diarrrhea
• Weakness/fatigue
• Salt cravings
• Muscle cramping (from increased potassium)

Hyponatremia, hyperkalemia, decreased cortisol, decreased aldosterone, increased PRA

• Tetany
• Paresthesias
• Hypertension
• Periodic muscle weakness
• Renal dysfunction - polyuria, nocturia, albuminuria

Hypokalemia, increased aldosterone, decreased PRA, hypernatremia

formed by the hypothalamus, stored in and released from the posterior pituitary, release of ADH is stimulated by increase in serum osmolaltiy or a decrease in intravascular blood volume, ADH then stimulates the collecting ducts to absorb water only

• SIADH (syndrome of inappropriate ADH secretion)
• CNS tumors/infections, ectopic ADH secretion, hypovolemia, drugs (barbs, nicotine, acetaminophen, some diuretics, narcotics)

Diabetes insipidus, hypervolemia, alcohol

• Increased ADH will decrease serum osmolality, increase urine osmolality, and decrease sodium in blood
• Low ADH will do the opposite and will also cause polyuria and polydipsia

secreted by acinar cells of pancreas, catabolizes carbs in duodenum, increases will occur in acute pancreatitis, mumps and salivary gland inflammation

secreted by the acinar cells into the duodenum where it breaks down triglycerides into fatty acids, increases in pancreatic diseases

autosomal recessive, most common inherited disease in white children, affects mucous glands (increases production) of bronchioles, sweat glands and pancreas leading to obstruction --> hyponatremia, hypochloremia, dry nonproductive cough, dyspnea, tachypnea, severe atelectasis, emphysema, failure to thrive, malabsorption

Sweat test (pilocarpine nitrate stimulates sweat production, high chloride), family history, chest x-rays, stool sample (absence of trypsin, elevated fat)

stimulated by low glucose levels, stimulates glycogenolysis in liver, made in alpha cells of the pancreas

secreted in respone to high glucose levels, stimulates uptake of glucose into cells, made in beta cells of pancreas

ACTH, Epinephrine and thyroxine all increase blood glucose levels

Diabetes mellitus, Acute stress, Cushing's, pheochromocytoma, hyperthyroid

Insulinoma, Addison's, insulin overdose, extensive liver diease

safe way to screen for DM or hypoglycemia, glucose levels should normalize within 2 hours after eating, a value of >200 indicates diabetes

hyperglycemia (due to diabetes), hypoglycemia (insulin shock)

most common medical complication of pregnancy, carbohydrate intolerance, to test give 50 grams of glucose then test after 1 hour >140 indicates gestational diabetes, should confirm with a glucose tolerance test

used to detect DM and hypoglycemia, first obtain fasting blood glucose then give 100 grams of glucose then test after 30 minutes, 1 hour, 2 hours and 3 hours (both blood and urine samples are taken at each interval)

under normal conditions glucose is not present in urine (renal threshold is 160 to 170 mg/dL - up to this value all glucsoe will be reabsorbed), note: glucose clearance declines with age

within 1 to 2 hours levels should be normal, modest elevation at 2 hours and normal at 3 hours suggests impaired glucose metabolism, hyperthyroidism and liver disease give a sharp rise and decline to subnormal

A1c can combine with glucose depending on the amount of glucose in the blood, remains bound for the lifespan of the RBC (120 days), long term indicator of diabetes (used to moniter patient)

• Primary Type 1 = primary insulin dependent DM (Juvenile) (IDDM)
• Primary Type 2 = Non-insulin dependent DM (adult onset) (NIDDM)
• Secondary -stress, pancreatic disease and endocrine diseases (cushing's, adrenal medulla/pheochromocytoma, thyrotoxicosis, hyperaldosteronism/Conn's), bronze diabetes (hemochromotosis), genetics, chronic renal disease, liver failure, infections, steroids, oral contraceptives, phenytoin (dilantin - antisiezure meds)

absorb too much iron, interferes with production of insulin

stress, steroids, diuretics, drugs, obesity, adrenal infections, pregnancy, anesthesia

polyuria, polydypsia, polyphagia, Kussmaul's breathing, sores that don't heal, especially on lower extremity, many other symptoms (see notes pg. 96) but these are the many ones

CSF has lower levels, brain is deprived more than the rest of the body

• method for diagnosing hypoglycemia:
• 1. symptoms appear
• 2. Take blood sample
• 3. Give food --> symptoms diappear

• insulin OD - "brittle diabetic" - takes wrong does of insulin (doesn't bother taking blood sugar first)
• Reactive - most common in non-diabetics - blood sugar drops 2 to 4 hours after a meal (body overresponds to glucose in meal)
• Insulinoma - most common in 40 to 60 in islet cell of pancreas
• Fasting or organic (pathological - chronic alcoholic, liver disease)
• Glycogen storage disease (ex. von Gierke's)
• Persistent neonatal hypoglycemia
• Hypoadrenalism/Addison's

• Mild: Lethargic, irritable/anxious, GI complaints, Headache, shaky/trembling, slurred speech
• Advanced: Tachycardia, hypothermia, neurological abnormalities, convulsions, unconscious/coma, muscle spasms, shock/death

sodium, potassium, chloride, carbon dioxide, anion gap (calculated)

lungs and kidney

hypothalamus, posterior pituitary kidneys

sodium - main extracellular cation

potassium - main intracellular cation

chloride - main extracellular anion

• Body must have equal positive and negative charges, difference is calculated from sodium, potassium, choloride and CO2 to account for unmeasured anions (serum protein, phosphates, sulfates, ketones, lactic acid) and cations (calcium and magnesium), normal is 8 to 16 anions are unaccounted for
• Increased anions occurs in uremia, ketosis, lactic acidosis, toxic ingestion (all causes of metabolic acidosis)
• Increased cations occur in lithium intoxication, hypermagnesemia and multiple myeloma

aldosterone, natriuretic hormone, carbonic anhydrase, ADH, kidney reabsorption

Due to cushing's, hyperaldosteronism/conn's, diabetes inspidous

Addison's, diarrhea, vomiting, suction, hyperglycemia, CHF, Peripheral edema, SIADH

GI

important in cardiac function, affected by hemolysis as well, concentration depends on aldosterone, sodium reabsorption, acid-base balance, if deficient will see a U wave on ECG

Addison's, Renal failure (most common), hemolysis, acidosis

GI (vomiting/diarrhea), Conn's/Cushing's, licorice (mimics conn's/cushing's), alkalosis

increases and decreases with sodium except during chloride shift (CO2 increases --> bicarbonate moves out of cells --> Chloride moves into cells)

• estimate of pH (arterial blood gases is more definitive), exists in 3 forms - dissolved in water, undissociated H2CO3 and HCO3 ion (most are in ion form), regulated by kidney, proportional to pH
• Increases with metabolic alkalosis, COPD, aldosteronism
• Decreases with metabolic acidosis, renal failure, diabetes, shock

respiration, renal titration and buffers (hemoglobin has histadine which binds H, plasma proteins bind H, RBC and plasma phosphates

pH = 6.1 + log (base/acid)

caused by MI, Diabetic ketoacidosis, renal failure, salicylate OD, methanol OD, intestinal vomiting, body will compensate by hyperventilating to remove CO2 (called Kussmaul's breathing in diabetics)

Primary hyperaldosteronism, Conn's, ingestion of sodium bicarbonate, licorice OD, body compensates by decreasing breathing rate (hypoventilation)

Acute asthma, hypoventilation, COPD, Flail chest, Pickwickian syndrome (sleep apnea due to obestiy), body will try but fail to compensate with air hunger (desperately sucking in air) then will adjust renal titration to reabsorb more HCO3

excess CO2 is lost, high altitudes, anxiety, CNS disease, body will respond by adjusting renal titration to get rid of more HCO3, if body cannot correct quickly may result in tetany

too much CO2, usually due to respiratory failure

decreases caused by DM (most common), chronic alcoholism, increased intestinal losss or decreased intake causes calcium to drift out of the bones and may lead to abnormal calcification of aorta and kidneys as well as weakness/tremors, chovstek/trousseaus

black tarry stool indicating an upper GI bleed, excess iron intake, antacids, charcoal

red stool indicates lower GI bleeding, hemorrhoids, red food coloring, beets, pyridium/rifampin

bile duct obstruction, gall bladder or liver issue, increased dairy or barium studies

steatorrhea, cystic fibrosis, fat malabsorption, chocolate overdose

hemolytic jaundice, biliverdin, green veggies

cholera

growth, tumor, polyp, intestinal constriction

malabsorption

constipation

lactose intolerance, food poisoning, antibiotics, diet changes, inflammatory bowel disease, irritable bowel

irritable bowel syndrome

imbalance of intestinal bacteria or eating too much protein

detected by guaiac test/hemoccult test, based on perocidase activity so many false positives, vitamin C intake will give false negative

salmonella and shigella (most common food poisoning), campylobacter, yersinia

antibiotins may lead to over growth of anti-biotic resistance bacteria such as C.difficile causing watery and voluminous diarrhea

many malabsorption pathologies cause steatorrhea

lack enzyme (lactase) which converts lactose to glucose and galactose, give patient 50 grams of lactose to test then run blood glucose levels, in normal person would increase, remain normal is lactose intolerant person

• arthrocentesis (sample fluid):
• Inflammatory diseases will often have auto-antibodies and increased WBCs slightly
• Non-inflammatory will be clear, normal
• Purulent will give increased WBCs (very high) and decreased glucose
• Hemorrhagic will have RBCs
• Gouty arthritis will have monosodium urate crystals
• CPPD (pseudogout) will have calcium pyrophosphate crystals

safer alternative to amniocentessi, gives karyotypes and genetics, can be done earlier in pregnancy

• early pregnancy: genetic and chromosomal abnormalitites, mother-fetal Rh compatibility, sex of fetus, neural tube defects (alpha-fetoprotein)
• Late pregnancy: fetal maturity, risk of respiratory distress, fetal distress/meconium presence

lecithin/sphingomyelin ration, phosphatidylglycerol (PG), lamellar body count - all determine if lungs are mature

should be a true bronchial secretion, no saliva, no nasal, first in morning is best in a sterile container

• Mucoid (pearly gray) - bronchitis
• Frankly purulent - infective process, acute bacterial pneumonia
• Green - virido peroxidase from WBCs
• Uniform rust with no pus - pneumococcal pneumonia
• Uniform rust without pus - CHF/mitral valve desease
• Bright streaks in a viscid sputum "red current jelly" - Klebsiella pneumonia (alcoholics)
• Episodic small hemorrhages - TB
• Episodic large hemorrhages - pulmonary infarction, cavitary TB, fungal pneumonia
• Few persistent streaks in mucoid - bronchogenic carcinoma
• Pink and frothy sputum - pulmonary edema

Strep pneumonia (salmon color), hemophilus influenza, staph, gram negative rods (E. coli, Klebsiela), Entamoeba histolytica

• increased eosinophils and charcot leyden crystals - asthma
• Curschmann's spirals coiled mucous filaments - asthma, acute bronchitis, bronchopenumonia, any problem with small bronchi

#1 is stroke, #2 is CSF

• Tube 1 - chemistries and immunologies (contaminated on way in, can't use for cultures)
• Tube 2 - cultures
• Tube 3 - cell counts and microscopic exams (no blood should be left from any nicks that occured on the way in

• Xanthochromia (yellowish/pink tinge) from old hemorrhage, protein, meningeal melanoma, hypercarotenemia (vitamin A overdose)
• Bloody - traumatic tap, fresh hemorrhage

indicates presence of WBC's and/or protein

normal for viral meningitis, decreased in bacterial meningitis

increased protein

bacterial meningitis - LD 1 and 2 indicate CNS involvement

increased in bacterial and fungal meningitis but not viral

increased in heptic encephalopathy and hepatic coma/reyes syndrome

• hemophilus influenza in children
• neisseria or strep in adults

Alcoholic questionnaire: do you ever feel you need to Cut down on your drinking? are you Annoyed by people critizing your drinking? do you ever feel Gulity about your drinking? do you ever need an Eye opener to start the day? - if answered yes to any question indicates problem with drinking

allergy blood test for IgE in response to certain antigens (used in place of skin test)

test panel of infections that may be detrimental to a fetus: Toxoplasmosis, Other (syphilis), Rubella, CMV, Herpes/HIV - all can cause abortion or premature labor

RPR (done today), VDRL, Wasserman

TPI (treponemal pallidum immobilization), dark field, FTA, TP-MHA, HATTS (hemagglutination)