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56 Cards in this Set
- Front
- Back
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CK
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Creatine kinase
skeletal muscle, heart, brain (liver, kidney, pancreas, intestine, prostate) |
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creatine kinase
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-enzyme used to asses cardiac damage (also found in skeletal muscle and brain)
- rises around 4-6 hours -peaks at 24 hours -returns to normal within 2-3 days -can be elevated 10 times the normal levels in mycardial infarction -has the isoenzyme CKMB and CKBB -Mg is an activator |
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CKMB
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-isoenzyme of CK
-can be elevated 15 times normal levels -more specific to the heart than total CK |
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AST
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aspartate aminotransferase
liver, skeletal musle, heart, kidney, RBC, pancreas |
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aspartate aminotransferase
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-enzyme used to measure cardiac damage (muscle, liver, kidney, especially when liver and heart together)
-rises around 6-8 hours -peaks at 24 hours -cardiac tissue contains more AST than any body tissue (liver is a close second) -returns to normal within 4-6 days -levels are highest in hepatobiliary disorders -pyridoxial phosphate is a coenzyme |
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LD
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lactate
heart, liver, skeletal muscle, kidney, RBC |
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lactate dehydrogenase
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-enzyme used to measure cardiac damage (found in liver diseases and hemolytic anemias aswell)
-rises within 12-24 hours -peaks at 48-72 hours -can rise 3-4 times normal levels following a MI -remains elevated for 10 days -increased serum LD is expected in almost any condition involving cell damage (including hemolysis) -has five isoenzymes Flipped LD ratio-> measured after a MI, there will be an increase in LD1 so that the ratio of LD1/LD2 is greater than one - normal LD1/LD2 ratio is less than one |
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enzymes used to assess cardiac damage
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Creatine Kinase (CK)
Aspartate aminotransferase (AST) Lactate dehydrogenase (LD or LDH) |
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AST will be elevated in
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cardiac damage
liver damage (necrosis) |
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LD will be elevated in
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cardiac damage
Red blood cell (hemolysis) kidney damage liver damage skeletal muscle damage |
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CK will be elevated in
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cardiac damage
brain damage skeletal muslce damage |
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lactate dehydrogenase principle
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LD catalyzes the oxidation of lactate to pyruvate with simultaneous reduction of NAD to NADH. this results in an increase in absorbance.
the rate of increase in absorbance at 340nm is directly proportional to LD activity in sample. U/L of lactate dehydrogenase are calculated by using the change in absorbance per minute during the linear part of the reaction and molar absorptivity of NADH |
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aspartate aminotransferase principle
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primary substrates of AST usually produce the product oxaloacetate
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ACP
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acid phosphatase
RBC, prostate, kidney, liver |
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acid phosphatase
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differs from ALP by functioning optimally at pH of 5.0
metastatic prostate cancer found in prostate but also in bone, liver, spleen, kidney, RBCs, platelets |
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ALP
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alkaline phosphatase
liver, heart, bone, intestine |
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alkaline phosphatase
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-main diagnostic purposes- paget's disease, bone and liver disease, hepatobiliary disorders
-found- liver, bone, intestine, placenta, kidney -increased level in bone growth or destruction during pregnancy -pH 9.0-10.0 -bone source is heat labile at 56* for 10min -Mg is the activator - 5 isoenzymes measured by different techniques |
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ALT
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alanine aminotransferase
liver(most specific), heart, skeletal muscle |
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alanine aminotransferase
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diagnosis liver disease
pyridoxal phosphate is the coenzyme |
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GGT
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gamma-glutamyl transpeptidase
liver(most sensitive), kidney, pancreas, prostate |
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gamma-glutamyl transpeptidase
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-main diagnostic-liver disease, hepatobiliary disorders, alcoholism
-most sensitive for liver disorders -highest levels in obstructive disorders along with ALP |
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Amylase
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pancreas, intestine
diagnostic for- acute pancreitis, peptic ulcers, cholecystitis, ruptured ectopic pregnancy, acute appendicitis -requires cholride and calcium as activators -can be filtered into the urine by the kidney -found in pancreas and salivary glands |
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lipase
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diagnostic for- acute pancreatitis
-elevated for 5days -found in pancreas, stomach and small intestine -will not be elevated in salivary gland problems |
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pseudocholinesterase
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plasma
diagnostic for- exposure to organophosphate insecticides (inhibit enzyme activity) or genetic deficiency - found in plasma and RBCs |
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CKMB
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heart
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CKMM
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skeletal muscle
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CKBB
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brain
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LD principle
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catalyzes the oxidation of lactate to pyruvate with simultaneous reduction of NAD
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AST principle
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produces the product oxaloacetate
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Total CK principle
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catalyzes the trasfer of a phosphate group from a creatine phosphate substrate to adenosine diphosphate(ADP)
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alanine aminotransferase
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most specific for liver
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gamma-glutamyl transpeptidase
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most sensitive for liver disease
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ALP
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Bone and hepatobiliary
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amylase
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secreted by pancreas and salivary glands
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immunoinhibition
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CK is measured by teh presence of an Ab to CK-M monomer which inhibits CKMM but does not affect the B monomer
CKMB is 50/50. M subunit is inactivated |
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CKMB (%) calculation
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CKMB/TCK x 100
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CKMB (%)
1. less than 6% 2. between 6% and 20% 3. greater than 20% |
1. No MI or happened less than 6 hours ago/more than 48 hours ago or skeletal muscle damage
2. MI 3. Atypical CK (macro CK) - falsely elevated |
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macro CK
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CK complexed with an immunoglobulin in the body
also called atypical CK |
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mass measurement of CKMB
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double antibody technique
isolates the entire CKMB protein by binding to the antigenic sites on the protein with a specific Ab AMI likely present if CKMB >9.0ug/L and RI is >4.0% |
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troponin
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-not an enzyme
-protein in striated muscle -regulates muscle contraction -cardiac troponins have amino acid sequences unique to the cardiac muscle -hemolysis does NOT falsely elevate it |
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Troponin (I&T)
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-rises within 4-6 hours of chest pain
-peaks 18-24 hours and returns to normal 7-10 days -TI and TT are specific to mycardial damage -rarely detectable in blood unless cardiac damage has occured -immunoassay |
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myoglobin
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-oxygen binding protein found in skeletal muscle and myocardial muscle
-detected 1-3 hours after MI symptoms -NOT specific for myocardial muscle -rules out an AMI if not increased in 8 hours -immunoassay |
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triglycerides
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-95% of fat stored in this form
-insulin promotes synthesis of triglycerides by adipose cells -insulin deficiency accelerates break down for energy -must be a fasting sample and <5mmol/L |
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cholesterol
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-dietary animal products
-liver is the site of cholesterol disposal or degradation as well as the major site of synthesis -synthesized by acetyl- coA -structural component of cell membranes -digestion of fat -precursor to steroid hormones |
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lipoproteins
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transports cholesterol and triglycerides in the blood
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chylomicrons
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-lipoprotein
-transport triglycerides -carry dietary fat for energy production -milkshake blood |
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very low density lipoproteins
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-VLDL
- transport triglycerides to the peripheral tissue |
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Low density lipoproteins
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-LDL
-major cholesterol carrier in the blood -Bad, deposits in the lumen of blood vessels |
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high density lipoproteins
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-HDL
-transports excess cholesterol from teh tissues back to the liver so it can be metabolized and excreted in the bile -Good |
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friedwald formula
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LDL= total cholesterol-HDL-VLDL
VLDL=triglyceride/2.2 if total triglyceride is >4.52 mmol/L then this calculation is not considered accurate |
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measuring cholesterol
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-cholesterol oxidase reacts with cholesterol and H2O to produce H2O2
-colour intensity proportional to [cholesterol] |
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measuring triglyceride
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-need fasting sample
-enzymatically using lipase to free glycerol >5mmol/L=impossible |
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measuring HDL
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-chemical precipitation
-precipitating reagent is added to aggregate all non-HDL lipoproteins -supernatant is run for cholesterol (quantitative) |
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homocysteine
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-increased levers are increased risk of heart or clotting problems
-amino acid -animal products -formed from methionine -requires folic acid, vitamin B6 and B12 to convert |
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C reactive protein rises
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inflammatory, injury or infection
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BNP
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-brain time natriuetic peptide
-indicator of congestive heart failure |
