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131 Cards in this Set
- Front
- Back
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Trace elements often function as...
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enzyme co-factors
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non protein helper molecules (ions)
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co-factors
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particularly important in recovery phase
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Trace elements
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zinc
copper arsenic cadmium mercury lead iron |
Trace elements
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selinium
chromium manganese |
Ultra- trace
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stored as ferritin and hemosiderin in BM, liver, spleen
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Iron
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found in rbc bound to hgb
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iron
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best choice for iron deficiency test
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ferritin
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soluble, ready available form of iron, _________ stores releases iron as soon as iron stores are insufficient
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ferritin
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insoluble more difficult source of iron
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hemosiderin
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we consume iron in what form?
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Fe3+
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ferrous iron allows hgb to ____________ to oxygen and CO2
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bind irreversibly
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In IDA, free transferrin is...
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increased, bc there is nothing taking it up
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which DECREASES first in IDA?
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serum ferritin, it responds first to lack of iron leaving iron levels normal
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Decreased RBC, MCH, MCHC, MCV
decreased serum iron and ferritin Increased transferrin and TIBC |
IDA
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excessive absorption of iron from normal diet
leads to iron accumulation in tissues, altered liver function and hyperpigmentation |
Iron overload (hemochromatosis or hemosiderosis)
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overload of iron in BM rather than in other parts of the body
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hemosiderosis
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amount of iron that can be bound by transferrin and other proteins
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TIBC
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formula for calc. TIBC
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Serum transferrin x 1.25
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formula for % saturation
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(total iron/TIBC) x 100%
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travels through the blood bound to albumin or histidine for transport to liver, brain, heart and kidneys.
incorporated as ceruloplasmin, and APR deficiency results in decreased hub, and collagen production |
Copper
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N- Dec serum copper
increased urine copper autosomal recessive disorder, copper accumulates in liver, brain, cornea of eye, etc. characterized by Kayser flecher rings |
Wilson's disease
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X-linked genetic disorder
defects in infants absorption, see brain damage, failure to thrive |
Menkes
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transported in blood with albumin or alpha 2 macrgloubulin carriers and excreted in the feces or pancreatic secretions
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zinc
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concentrations is 10x higher in erythrocytes than in serum/plamsa
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Zinc
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low contents seen in parts of china resulting in Keshin disease or Kashin- Bek disease
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Selenium
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very stron oxidase properties
Selinium related disease causes cardiomyopathy in children and young females |
Keshin disease
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involves cartlidge degeneration and acute arthritis in adolescents and pre-adolescents. Selinium related disease
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Kashin- Bek disease
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Gold standard choice of testing for all and any metals
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Atomic absorption spectroscopy
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Light source in atomic absorption spectroscopy
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hallow cathode lamp specific to metal being tested
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In digestion, enzymes or exocrine secretions ______ large molecules into small one
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hydrolyze
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digestive enzyme derived from chief cells
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pepsin
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digestive enzyme derived from parietal cells
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gastrin
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In absorption, _____________ bind and helps transport Vit. B12
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Intrinsic factor
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Where does the majority of absorption take place?
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small intestine
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stimulates the release of bile from the gall bladder
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Cholecystokinin
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In the pancreas, what produces the endocrine hormones glucagon, insulin, and somatostatin
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Islets of langerhans
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What fluid contains this proteolytic enzymes:
trypsin chymotrypsin elastase carboxypeptidase Nucleas Secretin |
Gastric fluid
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Reabsorbs water from undigested material
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Large intestine
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inherited autoimmune intolerance to gluten
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Non-Tropical sprue
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Tropical sprue is also known as...
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Celiac disease
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Ag-Ab complex deposits in intestinal mucosa causes a specific lesion--> poor absorption and irritation in the stomach
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Non-Tropical sprue/ Celiac disease
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-far east
-Ag unknown - acquired disorder - abnormalities of small bowel structure and function |
Tropical sprue
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-chronic inflammatory disorder of the intestine
-mucosa of rectum and left colon most commonly affected -toxic megacolon |
Ulcerative Colitis
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Chronic inflammation of intestine of unknown etiology that can lead to intestinal obstruction
Ileum and colon most affected |
Regional enteritis (Crohn's disease)
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probably autoimmune
onset sudden with nausea, vomitting, abdominal cramps, and diarrhea metabolic alkalosis with hypochloremia may result in severe dehydration and renal failure |
Inflammatory disease
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gastrin- producing tumor, or gastrinoma.
High levels of gastrin cause overproduction of stomach acid leading to multiple ulcers in the stomach and small bowel can have tumors in pituitary or parathyroid gland suspected in patients with relevant clinical history, x-ray evidence of ulceration and excessive gastric acid |
Zollinger- Ellison syndrome
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Most common Carbohydrate malabsorption disorder
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Lactose intolernce
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results in microcytic anemia
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Iron deficiency
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results in megaloblastic anemia
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Folic acid deficiency
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Tests for gastrointestinal funtion
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d-xylose
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Useful in assessing gastrin- secreting tumors such as Zollinger-Ellison syndrome
evaluate gastric hyperacidity and diagnosis of achlorhydria |
Gastric fluid analysis
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Gastrin stimulation test following secretin injection can help distinguish
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Zollinger Ellison syndrome from patients with secondary causes of elevated gastin levels
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Stimulus: Low Ca concentration in plasma
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PTH
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enhances osteoclast activity in bones
Increases renal tubular reabsorption on Ca Inhibits transmembrane protein in PCT that reabsorbs Pi Works with Vit. D to absorb Ca from food |
PTH
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Net:
Increased Serum Ca Decreased serum Pi Increased urine Pi |
PTH
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What inhibits/ supresses PTH
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rising blood Ca
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peptide hormone
from parafollicular or c-cells of thyroid gland stimulus: Increased Ca |
calcitonin
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inhibits osteoclast activity in bone--> synthesis of bone-->removal of Ca from plasma
Inhibited tubular reabsorption of Ca Increased renal excretion of Ca |
calcitonin
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Net:
Decreased Serum Ca Increased urine Ca |
calcitonin
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Symptoms:
GI symptoms nuerologic changes coma kidney stones osteopenia |
hypercalcemia
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most frequent cause of hypercalcemia...
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primary hyperparathyroidism
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symptoms:
tetany spams convulsions |
hypocalcemia
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caused by adenoma or hyperplasia
symptoms include: thinning of bones and fractures, altered mental status and kidney stones |
Primary hyperparathyroidism
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Net:
increased serum Ca decreased serum Pi Increased serum ALP Increased urine Ca Increased Pi |
Primary hyperparathyroidism
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in primary hyperparathyroidism, the physiologic defect is with the...
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parathyroid gland
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PTH protein produced by cancer cells that causes hypercalcemia Similar to to the N terminal of PTH and acts like PTH, but its supressed by PTH
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PTHrP
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Net:
increased calcium decreased Pi increased urine Ca and Pi |
ectopic PTHrP hyperparathyroidism
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PTH is elevated due to a threat of hypocalcemia from drugs, chronic renal disease, Vit D def. etc
PTH gland is normal and healthy |
secondary hyperPTH
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Increaed Pi (bc of insufficient excretion)
dec. Ca (bc of decreased reabsorption) inc. PTH (bc of Ca) inc. ALP dec Vit. D dec. protein and Albumin |
Secondary hyperparathyroidism
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hyposecretion of PTH
symptoms include tetany, drying skin, brittle hair, hypotension and GI upset labs: Decreased Ca Increased Pi Decreased PTH |
primary hypoparathyroidism
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hyperactivity of osteoclasts
constant remodeling of bone thickened and mishappen bones surfaces |
Paget's disease
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Net:
increased Ca increased Pi increased ALP decreased PTH bone has decalcified holes |
primary bone disorders or paget's disease
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high pyridinoline in urine is indicative of
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osteoporosis
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decreased levels of T4 causes what to be stimulated
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TRH
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TRH does what...
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stimulates pituitary to secrete thyrotropin or TSH
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primary thyroid disease is an abnormality where...
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in the thyroid gland
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abnormality in the pituitary gland causes error in the amount of TSH produced
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Secondary thyroid disease
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abnormality in the hypothalamus causes error in amount of TRH produced
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tertiary thyroid disease
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thyroid gland secretes excess T3 and T4
symptoms: weight loss, anxiety and tremor Lab inc. total T4/T3 inc. free T4/T3 dec. TSH dec. TRH |
primary hyperthyroidism
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most common cause of thyrotoxicosis
autoimmune production of an antibody that resembles TSH uncontrolled increase of T4/T3 secretion TSH normal to decreased |
primary hyperthyroidism
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thyroid gland secretes insuffficient T3/T4
destruction of thyroid gland labs dec. total and free T3/T4 inc. TSH |
primary hypothyroidism
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symptoms: slowdown of metabolic processes, weight gain, cold intolerance, legarthy
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primary hypothyroidism
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if primary hypothyroidism is congenital, causing mental and somatic retardation results in...
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cretinism
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in newborns due to deficiency of the thyroid tissue, defect in thyroid hormone synthesis or pituiatry/ hypothalamic hormone synthesis
Dec. T4 can result in mental retardation |
primary congenital hypothyroidism
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autoimmune disease
thyroglobulin autoantibodies present early most common cause of primary hypothyroidism |
hashimoto's thyroiditis
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massive infiltration of thyroid gland by lymphs
anti- microsomal abs present |
Hashimoto's thyroiditis
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Uncommon
Labs Low TSH Low total T4/ T3 Low FT4/FT3 |
secondary hypothyroidism
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in diagnosis of Thyroid disorder, what is the FIRST lab test that should be ordered
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TSH
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acute serious disease uses up thyroid hormones faster, so faster turnover of FT4 and FT3, but thyroid and pituitary are normal
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euthyroid sick syndrome
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how do we differentiate b/w thyroid disease and euthyroid sick syndrome
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THBR
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increased THBR
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euthryoid sick syndrome
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THBR levels are inversely related to...
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TBG levels
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stimulates Na reabsorption in DCT in exchanges potassium and hydrogen
regulates extracellular fluid volume increases blood volume and BP |
aldosterone
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decreased plasma K
increased Na (but plasma levels are normal) increased serum/urine aldosterone metabolic alkalosis |
hyperaldosteronism
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adrenal adenoma or hyperplasia
decreased renin |
primary hyper aldosteronism/ Conn's syndrome
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excessive production of renin
increased aldosterone production |
secondary hyperaldosteronism
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decreased renin
Glayer enzyme deficiency |
Hypoaldosteronism
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decreased plasma Na
increase K decreased Ald metabolic acidosis decreased BP |
hypoaldosteronism
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decreased production of cortisol and or aldosterone
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Addison's disease
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decreased plasma Na
increased K decreased aldosterone metablolic acidosis Increased ACTH |
primary adrenal insufficiency
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normal plasma Na
normal K normal aldosterone decreased ACTH |
secondary adrenal insufficiency
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symptoms: dehydration, decreased kidney function, shock, all over tan
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Addisons
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hypercortisolism due to increased cortisol production
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primary cushings
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hypercortisolism due to increased ACTH release from pituitary
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secondary cushings
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hyperglycemia
poor wound healing trunkal obesity weakening of bones fat accumulation on the upper shoulders and collar bone aka buffalo hump moon face |
primary cushings syndrome
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increased FBS
increased plasma cortisol at 8am/11pm decreased ACTH at 8am increased urinary free cortisol |
primary cushings syndrome
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hyper ACTH due to tumor
no regard for feedback increased FBS increased Plasma cortisol at 8am/11pm increased ACTH at 8am increased urinary cortisol |
secondary cushings
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increased ACTH
decreased cortisol decreased urinary free cortisol levels caused by autoimmune destruction |
primary hypocortisolism
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characterized by insulin sensitivity, hypoglycemia increased urinary excretion of sodium, electrolyte imbalance, circulatory shock, cardiac weakness
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primary hypocoritsolism
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decreased ACTH and cortisol levels
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secondary hypocortisolism
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tertiary hypocortisolism arises in the...
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hypothalamus
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moderate cortisol rise following ACTH stimulation and lack of 11-deoxycortisol
ACTH elevations following metryapone administration |
tertiary hypocortisolism
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most common method of analysis for cortisol
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EIA or FPIA
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genetic disorder due to congenital lack of enzyme needed to synthesize cortisol
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adrenogenital syndrome (congenital adrenal hyperplasia
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males show no symptoms
females= virilization fetus=ambiguous genitals |
congenital adrenal hyperplasia
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predominant estrogen in non preggo female
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Estradiol
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predominant estrogen in pregnancy
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estriol
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synthesized by placenta using precursor steroid that is synthesized by fetus
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estriol
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female sex hormone produced by the corpus luteum
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progesterone
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stimulates growth and mitosis/meisos of gametes(ovum and spermatogonia)
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FSH
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interstitial cell stimulating hormone
hormone producing to trigger release of gametes |
LH
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peaks at fourteen days during menstruation
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LH
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increase after the fourteenth day in menstruation
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progesterone
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increases before fourteen days
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estradiol
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small peak around fourteen days
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FSH
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Hcg, hPL, and progesterone are produced by...
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the placenta
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lack of gonadal function
children have delayed onset of of puberty adults amenorrhea and decreased libido or infertility |
hypogonadism
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decreased gonadal hormones (E2/ testosterone)
increased gonadotropins (FSH/LH) |
primary hypogonadism
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decreased gonadal hormones (Estrogen/testosterone)
decreased gonadotropins |
secondary hypogonadism
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excessive androgen sensitive hair growth in women
ethnic background is important |
hirsutism
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