Name
Name |Importance
|Increased |Decreased | |
|Fasting Blood Glucose |-regulated by glucagon and insulin |(hyperglycemia) |(hypoglycemia) |
|(FBG) |-glucose metabolism: |diabetes mellitus |pancreatic islet cell carcino |
| |ACTH, adrenocorticosteriods |Cushing’s Ds |Addison’s Ds |
| |epinephrine, thyroxine |acute stress |liver damage |
| |-pre-diabetes = 110 - 125 mg/dL |acromegaly |hypopituitarism |
| |-fasting blood plasma glucose is a vital |pituitary adenoma |hypothyroid |
| |component of diabetes management |pancreatitis | |
| | |chronic renal ds | |
| |-GTT confirm the diabetes diagnosis | | |
| |-polyuria, polydiapsia, weight loss | | |
| |-oral glucose tolerance | | |
|Glucose Tolerance Test |-if fasting and postload glucose test results |pancreatic islet cell tumor |diabetes mellitus |
|(GTT) |are borderline, the GTT can support or rule out |poor intestinal absorption |postgastrectomy |
| |a diagnosis of diabetes mellitus |hypoparathyroidism |hyperthyroidism |
| | |Addison’s ds |excess glucose ingestion |
| |-2 hour plasma glucose test is done after |liver ds |Cushing’s ds |
| |glucose load to detect diabetes in individuals | | |
|Glycosylated Hemoglobin (Hb A1c) |-glycohemoglobin is a normal, minor type of |iron-deficiency anemia |hemolytic anemia |
| |hemoglobin / it is blood glucose bound to |splenectomy |chronic blood loss |
| |hemoglobin |alcohol toxicity |pregnancy |
| | |lead toxicity |chronic renal failure |
| |-this test is useful in determining treatment | | |
| |for juvenile-onset diabetes with acute | | |
| |ketoacidosis and tracks control of blood | | |
| |glucose in milder cases of diabetes | | |
|Bilirubin |-bilirubin results from the breakdown of |(hepatocellular jaundice): | |
| |hemoglobin in the RBCs and is a byproduct of |viral hepatitis | |
| |hemolysis |cirrhosis | |
| |-indirect / unconjugated = protein bind |infectious mononucleosis | |
| |-direct / conjugated = circulate freely | | |
| | |(obstructive jaundice): | |
| |-the measurement of bilirubin allow evaluation |produces high conjugated bilirubin | |
| |of liver function and hemolytic anemias |level | |
| | |-bile stone obstruction | |
| | | | |
| | |(hemolytic jaundice): | |
| | |produce high unconjugated bilirubin | |
| | |level | |
| | |-sickle cell anemia | |
| | |-pernicious anemia | |
| | | | |
| | | | |
|Blood Urea Nitrogen |-urea is the final product of protein metabolism|(azotemia) |liver failure |
|(BUN) | |impaired renal function |acromegaly |
| |-the amount of excreted urea varies directly |chronic renal ds |malnutrition |
| |with dietary protein intake, increased excretion|-glomerulonephritis |celiac ds |
| |in fever, diabetes, and increased adrenal gland |-pyelonephritis | |
| |activity |urinary tract obstruction | |
| | |hemorrhage into GI tract | |
| |-increased BUN = severe impaired glomerular |diabetes mellitus | |
| |function | | |
| |(chronic renal ds) | | |
|Albumin |-function of albumin: |dehydration |acute and chronic inflammation and |
| |maintenance of colloidal osmotic pressure in the| |infection |
| |vascular and EVS | |cirrhosis / liver ds |
| |-it decreases in response to acute inflammatory | |nephrotic ds |
| |infectious processes | |Crohn’s ds |
| | | |heart failure |
| |-albumin is used to evaluate nutritional status,| |burn / severe skin ds |
| |albumin loss in acute illness, liver ds, renal | |thyroid ds = Cushing’s ds |
| |ds with proteinuria, hemorrhage, burns, exudates| | |
| |of leaks in the GI tract, and other chronic ds | | |
|Creatinine |-creatinine is byproduct in the breakdown of |impaired renal function |small stature |
| |muscle creatine phosphate resulting from energy |chronic nephritis |decreased muscle mass |
| |metabolism |obstruction of UT |advanced and severe liver ds |
| | |muscle ds | |
| |-a disorder of kidney function reduces excretion|congestive heart failure | |
| |of creatine, resulting in increased blood |shock | |
| |creatine level |dehydration | |
| |-creatine levels give an apporoximation of the | | |
| |GFR | | |
|Uric Acid |-uric acid formed from the breakdown of |(hyperuricemia) |Wilson’s ds |
| |nucleonic acids and is an end product of purine |gout |Fanconi’s syndrome |
| |metabolism |renal ds and renal failure |SIADH |
| | |alcoholism |Hodgkin’s ds |
| |-measurement of uric acid is used most commonly |Down syndrome |Xanthinuria |
| |in the evaluation of renal failure, gout, and |lead poisoning | |
| |leukemia |leukemia, lymphoma | |
|Alanine Aminotransferase |-ALT is an enzyme and high concentrations occur |hepatocellular ds |-AST level is always increased in |
|(ALT) or SGPT |in the liver |alcoholic cirrhosis |acute MI, ALT level does not always |
| | |metastatic liver tumor |increase unless there is also liver |
| |-ALT is more sensitive in the detection of liver|obstructive jaundice |damage |
| |ds than in biliary obstruction |biliary obstruction |-AST/ALT ratio is high in alcoholic |
| |-ALT also differentiates b/w hemolytic jaundice |viral / infectious hepatitis |liver ds |
| |and jaundice due to liver dis |(30 - 50 X normal) |ALT = specific for liver ds |
| | | |AST = sensitive to alcoholic |
|Alkaline Phosphatase |-alkaline phosphate is an enzyme originating |(elevated level in liver ds): |hypophosphatasia |
|(ALP) |mainly in the bone, liver, and placenta, with |obstructive jaundice |malnutrition |
| |some activity in the kidney and intestines |space-occupying lesions |hypothyroidism |
| | |hepatocellular cirrhosis |pernicious anemia |
| |-alkaline phosphate is used as an index of liver|biliary cirrhosis |magnesium deficiency |
| |and bone disease when correlated with other |hepatitis | |
| |clinical findings |(elevated level in bone ds): | |
| | |Paget’s ds (10 to 25 X) | |
| | |matastatic bone tumor | |
| | |osteogenic sarcoma | |
| | |osteomalacia (diff. w OP) | |
|Alkaline Phosphatase |AP-1 (alpha 2) = liver |(liver ISO): | |
|Isoenzymes (ISO) |AP-2 (beta 1) = bone |cirrhosis | |
| |AP-3 (beta 2) = intestine |hepatic carcinoma | |
| |AP-4 = placental |(bone ISO): | |
| | |Paget’s ds | |
| |-ALP ISO is mainly used to distinguish between |hyperparathyroidism | |
| |bone and liver elevations of alkaline |bone cancer / rickets | |
| |phosphatase |(intestinal ISO): | |
| | |intestinal infarction | |
| | |(placental ISO): | |
| | |pregnancy late 3rd trimester | |
|Amylase and Lipase |-amylase is enzyme that changes starch to sugar,|-greatly increased amylase levels |(decreased amylase): |
| |is produced in the salivary glands and pancreas |occur in the acute pancreatitis |pancreatic insufficiency |
| |-lipase is glycoprotein that, in presence of |(increased amylase): |hepatitis |
| |bile salts and colipas, changes fats to fatty |chronic pancreatitis | |
| |acids and glycerol |partial gastrectomy | |
| | |acute appendicitis | |
| |-amylase and lipase tests are used to diagnoses |cerebral trauma | |
| |and monitor treatment of acute pancreatitis and |(increased lipase): | |
| |to differentiate pancreatitis from other acute |pancreatic disorder | |
| |abdominal disorders |hemodialysis | |
|Aspartate Trasaminase |-AST is an enzyme present in tissues of high |(increased AST in MI) |azotemia |
|(AST) or SGOT |metabolic activity |MI = 4 to 10 X |chronic renal dialysis |
| |-any ds that causes change in these highly | |vit B6 deficiency |
| |metabolic tissues with rise in AST levels |(increased AST in liver ds) | |
| |(injury or cell death) |liver ds = 10 to 100 X | |
| | | | |
| |-the amount of AST in the blood is directly |acute hepatitis = | |
| |related to the number of damaged cells and the |ALT > AST | |
| |amount of time that passes between injury to the| | |
| |tissue and the test |active cirrhosis = | |
| | |AST > ALT | |
| |-this test is used to evaluate liver and heart | | |
| |ds | | |
|Creatine Phosphokinase |-creatine kinase (CPK/CK) is an enzyme found in |-elevated CK level = | |
|(CPK) |higher concentrations in the heart and skeleton |muscular dystrophy | |
|CPK and CK ISO |muscles |CNS disorder (Reye’s ds) | |
| | |-elevated MB = | |
| |-this test is used as a specific index of injury|myocardial cell damage | |
| |to myocardium and muscle |-elevated MM = | |
| |(MM / MB / BB) |skeletal damage | |
| | |-elevated BB = | |
| |-CK (CPK) test is used in the diagnosis of MI |brain tissue and GI tract damage | |
| |and as a reliable measure of skeletal and | | |
| |inflammatory muscle ds | | |
|Lactate Dehydrogenase |-LD isoenzymes are released into the bloodstream|-LD flip (LD1>LD2): | |
|(LDH, LD) |when tissue necrosis occurs |extremely helpful in the diagnosis of| |
|isoenzymes (eletrophoresis) |LD1 and LD2 = cardiac tissue |MI | |
| |& erythrocytes |-LD3 = advanced cancer and malignant | |
| |LD3 = lung, spleen, pancreas, placenta |lymphoma / pulmonary infaction | |
| |LD4 and LD5 = skeletal muscle |-LD5 = liver ds and striated muscle | |
| |& liver |trauma, burn | |
| | | | |
| |-this test is useful in the differential |-all LD isoenzymes are increased in | |
| |diagnosis of acute MI, megaloblastic anemia, |systemic ds | |
| |hemolytic anemia, renal infaction | | |
|Glutamyltransferase |-enzyme glutamyltransferase is present mainly in|liver ds: |hypothyroidism |
|(GGT) |the liver, kidney, and pancreas |hepatitis / cirrhosis | |
| | |liver matastasis | |
| |-this test is used to determine liver cell | | |
| |dysfunction and to detect alcohol-induced liver |pancreatitis | |
| |ds |carcinoma of breast and lung | |
| |-very sensitive to the amount of alcohol | | |
| |consumed by chronic drinkers | | |
| | | | |
| |-GT activity is elevated in all forms of liver | | |
| |ds | | |
| |-this test is much more sensitive than alkaline | | |
| |phosphatase test or SGOT | | |
| | | | |
| |-differential diagnosis of liver ds in children | | |
| |and pregnant women | | |
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