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22 Cards in this Set
- Front
- Back
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what are the m/c enzymes used for dx?
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- CK/CPK
- AST - ALT - Alkaline Phosphatase(ALP) - GGT also discussed in PSA/Acid phosphatase |
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what is ALP?
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is actually a group/collection of isoenzymes that mainly originate in the:
bone Liver Placenta some activity in the small intestines and kidney |
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when does ALP work best?
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alkaline because it functions best at a pH of 9.0
and its age & gender specific |
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what are causes of ↑ALP?
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rem: "SAM HUE BBL HM"
Sarcoidosis Amyloidosis Myocardial or pulmonary infarct Hyperparathyroidism Ulcerative colitis Excessive Vitamin D ingestion Biliary Obstruction Bone "growth spurts" Liver Damage Healing Fractures Metastatic CA |
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what are some bone dz, bone loss, bone growth issues that would lead to ↑ALP?
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Rheumatoid Arthritis
Hodgkin’s disease Growth spurt in children – will be elevated but other enzymes will be normal Fracture healing Osteomalacia Rickets Paget’s Disease Osteogenic sarcoma |
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what are causes of ↓ALP?
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rem: "H.A.Z.E.E."
Hypothyroid Adrenal Hypofxn (addisons dz) Zinc Def. Estrogen Extremely low fat & low protein diet Estrogen |
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what affects ALP?
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Magnesium deficiency
B12 deficiency Vitamin C deficiency – Scurvy |
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what are falsely elevated levels of ALP?
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preg
growth spurts phenytoin |
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falsely decrsd levels of ALP?
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anticoag blood sample
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how many fractions are in ALP?
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6
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where is AST found?
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in highly metabolic tissues such as skeletal muscle, liver, pancreas, heart, kidney, and lung
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when is AST released in circulation?
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following injury or death of cells
Amt of AST in circulation is directly related to the number of damaged cells/injury. AST is more specific for detection of problems of CV origin than for biliary tree or liver problems |
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causes of ↑AST?
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• CHF
• Coronary Artery Insufficiency • Acute Mi • Liver Dz/damage/dysfxn (but wont be as elevated as ALT) Excessive breakdown of muscle tissue: • Dermatomyositis • Polymyositis • Marathon training/running • Weight training injuries/crush injuries • Progressive muscular dystrophy (i.e. Duchenne’s) Infxous mononucleosis • Asthma attack • Metastatic cancer • Acute and chronic pancreatitis • Hypothyroidism • Mushroom poisoning • Shock(will see electrolyte issues) • Heat stroke |
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what is seen in AST levels when pt has MI?
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AST levels peak w/in the first 24 hrs
Levels normalize w/in 3 to 5 days |
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causes of ↓AST?
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alcoholism
B6 deficiency |
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where is ALT found?
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present in high concentrations in the liver and to a lesser extent skeletal muscle, the heart, and kidneys
Primarily used to determine the presence of liver disease |
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what is the difference btw AST & ALT?
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ALT takes longer to normalize than AST
therefore its easier to differentiate btw Acute & Chronic Liver dz |
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causes of ↑ALT?
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- Fatty liver Dz (steatosis)
- Liver Dyfxn - MI - CHF - Biliary Tract Obstruction - Cirrhosis of Liver Levels up to 50X the normal are seen with Hepatocellular damage due to: Acute/chronic hepatitis Active acute infectious mononucleosis Hepatic necrosis Metastatic CA |
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causes of ↓ALT
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b6 def
alcoholism Protein deficiency states Malabsorption syndromes Kidney failure |
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what is Prostatic Acid Phosphatase(PAP)?
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used as an indicator of prostatic carcinoma as a raised value suggests spread beyond the capsule; especially the bone
is normal in 20% of pts w/prostate CA |
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compare PSA and PAP
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PSA detects(more specific) incidental(mild) as well as aggressive tumors (PAP only aggressive and/or advanced)
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T/F PSA lacks sensitivity & specificity to be used alone as a marker for screening for prostate CA.
However, combined with a DRE the specificity for detecting prostate CA is greatly increased |
true
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