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136 Cards in this Set
- Front
- Back
Confidence Intervals
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68.2% CI= ±1sd
95.5% CI =± 2sd 99.7% CI = ± 3sd |
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Precision
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Reproducibility, Evaluated by random error, Estimated by running a sample of known concentration repeatedly. Calculate within run precision and day to day precision— acceptable CV <2-5%
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Accuracy
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True value
Estimated by systematic error (constant or proportional) Method comparison study usually verifies accuracy. So does linearity |
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Random Error
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Present in all measurements (no pattern)
Can be positive or negative Due to instrument, operator or environment |
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Systematic Error or Bias
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Consistent error in one direction
Should not be present in a method Can be constant or proportional |
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Glucose Ref Range
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Fasting: 70 – 99 mg/dL, 126 mg/dL Diabetic
Non Fasting: 70-140 mg/dL, 200 mg/dL Diabetes Diabetes: Confirmed by casual, fasting, 2hr glucose tolerance, Hgb A1C ( 4.1 – 6.5) |
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Type 1 DM
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Juvenile or Insulin dependent
Entirely insulin dependent Keto Acidosis |
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Type 2 DM
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Hyperosmolar coma
Functional insulin deficency |
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Which lipoprotein has the most triglyceride? Second most? Least?
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Chylomicrons, VLDL, HDL (protein rich)
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Which lipoprotein has the most Cholesterol?
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LDL
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Risk factors for Atherosclerosis
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> 45 years old for men, > 55 years old for women
Family history of early coronary heart disease (CHD) Cigarette smoking Hypertension (BP >140/90 mm Hg) Diabetes mellitus Low HDL-cholesterol level -- <40 mg/dL High LDL-cholesterol level -- >100 mg/dL High Total cholesterol level -- >200 mg/dL Severe obesity (>30% over weight) Physical inactivity Stress |
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How do you calculate total cholesterol?
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Friedewald Formula = Calculation Method
total chol = HDL-cholesterol + LDL-cholesterol + VLDL-chol (measure) (measure) (calculate) (calculate from trig/5) |
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Where will free hemoglobin peak on a SPE?
Hemoglobin-haptoglobin complexes? |
Between alpha2 and beta region, Alpha2 region
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What is international unit/liter for enzyme concentration?
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IU/L= moles of substrate used up/minute of incubation/ liter
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BNP
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B-type naturetic peptide; Congestive heart failure
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IMA
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Ischemia modified Albumin; increased before MI
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CRP
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marker for imflamation
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Homocysteine
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amino acid pathway, marker for further heart problems, Low homocysteine = eat more B12
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Freely Filtered glomerular filtrate
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H2O
Na+, K+, Cl-, HCO3-, Ca++, Mg+, PO4, etc. Glucose Urea Creatinine Inulin – not physiologic |
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Not filtered glomerular filtrate
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Immunoglobulins
Cells Protein bound lipids and bilirubin Large molecules Negatively charged plasma proteins |
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Creatinine Clearance
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GFR = U V x 1.73m2 = mL/min per 1.73m2
P BSA |
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Uremia
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very high plasma urea concentration accompanied by renal failure
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prerenal azotemia
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decreased renal blood flow (CHF, dehydration)
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Renal azotemia
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intrinsic renal failure (acute or chronic)
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Post renal azotemia
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obstruction in the urinary system
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Decreased urea concentration
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Decreased protein intake
Liver disease severe diarrhea and vomitting Pregnancy |
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Hyperuricemia
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Caused by overproduction or under excretion
incresed catabolism of nucleic acid, purine rich diet = overproduction of uric acid, renal disease = under excretion |
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Hyperammonemia
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severe liver disease
reye's syndrome |
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Kidney function tests
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Creatinine – not 100% accurate; 10% overestimated
BUN Creatinine clearance Total Protein Uric acid Cystatin C – more accurate Osmolality - # of solutes Electrolytes |
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Acute renal failure
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Sudden, sharp decline in renal function as a result of acute toxic or hypoxic insult to the kidneys.
GFR is reduced to <10 mL/min. |
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Chronic renal failure or kidney disease
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Gradual decline in renal function over time.
Occurs in 5 stages (table 26-3, pg. 574). |
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Acute glomerulonephritis (acute nephritic syn.)
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Injury to glomerular tissue by immune complexes formed with beta-hemolytic strep.
Lab findings: hematuria, proteinuria, reduced GFR, increased sodium and hypertension. |
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Chronic Glomerulonephritis
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Loss of nephron mass over a prolonged period of time
Lab findings: same as acute except - slight hematuria and proteinuria |
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Nephrotic Syndrome
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Increased permeability of the glomerular basement membrane induced by disorders like diabetes mellitus, lupus, etc.
Lab findings: hyperprotinuria, hypoproteinemia (hypoalbuminemia), azotemia, hyperlipidemia, lipiduria Symptoms: edema |
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Tubular disease
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Acute and noninfectious pyelonephritis
(pyelo = pertaining to the pelvis) Decreased excretion/reabsorption of certain substances or reduced urinary concentrating ability Caused by drug toxicity, gram negative bacteria, etc. Lab findings: decreased GFR, acidosis (decreased H+ secretion) |
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Anion Gap
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[Na + K] - [Cl + HCO3-] = anion gap (AG)
Reference range: 10 – 20 mmol/L |
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Osmolality
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Measure of the number of dissolved particles (molecules or ions) in a solution
Normal = 275 - 300 mOsm/Kg |
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Calculated Osmolality
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2[Na+] + [glucose ]/20 + [BUN ]/3
Each 1000 mOsm./Kg of solute depresses the freezing point of H2O by 1.86oC |
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Osmolal Gap
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measured osmo - calculated osmo = osmolal gap
normal value (included in the calculated osmo) = 9 mOsm/Kg |
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Trace Elements
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Elements found in very small amounts in body; 1ug/gram tissue.
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% Saturation
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(Total Iron/TIBC) * 100
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Copper
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ESSENTIAL?
travels through blood bound to albumin or histidine for transport to the liver, brain, heart and kidneys. Incorporated as ceruloplasmin, an acute phase reactant. Deficiency results in decreased hemoglobin and collagen production |
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Menkes syndrome
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Decreased serum copper, uncreased urine copperinherited; impaired copper absorption, serum copper extremely low
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Wilson's disease
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Norm-decreased serum copper, Increased urine copper. Inherited disorder of copper metabolism. Copper accumulates in liver, brain cornia, kidneys. Gold/green cashun-flavor rings around eyes
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Zinc
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ESSENTIAL
Absorbed through the intestine from the dietary nutrients. Transported in blood with albumin or alpha 2 macroglobulin carriers and finally excreted in feces or pancreatic secretions. |
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Lead
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Exposure primarily respiratory or gastrointestinal. Tranported in blood, 94% transferred to erythrocytes, 6% in plasma.
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Half life of lead
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2-3 weeks
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Lead is stored in ______________
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Soft tissue 5% and Bones 95%
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Whole blood lead levels
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Whole Blood Lead
Children = > 10 ug/dL is toxic Adults = >30 ug/dL is toxic |
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Arsenic
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Used in wood preservative.
Ingestion. |
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Selenium
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Enters food chain via plants.
In organ meats, etc. |
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Trace metal analysis
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Royal blue tube free of all contaminants. Atomic absorption spectroscopy most sensitive and precise method
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Macronutrient
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jh
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Registered Dietitian preforms nurtitional assessment by looking at which data?
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anthropometric measures (height, weight, BMI)
biochemical analyses (Nutritional markers) clinical history and physical exam dietary profile environmental information |
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Macronutrient assessment
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ID and analysis of concentration of proteins, lipids, and carbs
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Micronutrient assessment
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testing of plasma levels of vitamins and minerals
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Functional lab testing
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Kidney = Creatinine, BUN, electrolites
Heart = Lipids, risk factors, AST, ALT Bone = Calcium, Phosphorus, Parathyroid |
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Albumin
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Protein in highest concentration
Half life of 18-20 days Indicator of protein deficiency |
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Retinol binding protein
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Correlates protein energy status of the patient
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Transferrin
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acts as a carrier protein for iron
8 day half life marker of recent protein-energy nutritional status |
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Transthyretin (thyroxin-binding pre-albumin)
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Carrier to thyroid hormones
1-2 day half life marker for protein-energy nutritional status |
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Nitrogen balance
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Difference between nitrogen intake and excretion.
positive wanted for therapy patients |
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Vitamins
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Obtained by diet or intestinal bacteria.
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Fat soluble vitamins
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Absorbed, transported, stored for long periods
A, D, E, K Must have carrier molecule to transport through blood. Stored in fat for long periods of time |
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Water soluble vitamins
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retained less and excreted more in urine
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Vitamin A
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retinal, retinol, and retinoic acid.
Liver, organ meats, fish oils Careteniods found in yellow-orange fruits; green veggies are precursors of vitamin A Deficiency leads to night blindness and abnormal growth |
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Vitamin D
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cholecalciferol
Produced by sunlight exposure deficiency: rickets (children) or osteomalacia (adults) |
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Vitamin E
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Alpha-tocopherol
Accumulates in liver, fat, muscle antioxidant, protects RBCs deficiency produces hemolytic anemia |
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Vitamin K
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phylloquinone
diet and bacteria forms coag factors 7,9,10, protein c and s Deficiency: hemorrhage (easy bruising) |
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Vitamin C
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Ascorbic acid
Reducing agent helps synthesize collagen and neurotransmitters Reduces risk of Cancer and Cold Def: Scurvy |
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B complex
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Enzyme cofactors
Deficiency: Pernicious anemia B12 and folate Def: megaloblastic anemia |
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Folate reference range
(Serum and RBC) |
Serum Folate: 2.6 - 12.2 ug/L
RBC Folate: 103 - 411 ug/L |
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Schilling Test
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test for B12 absorption
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What cells secrete pepsinogen in the stomach?
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Chief Cells
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What converts pepsinogen to pepsin?
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HCL
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What cells secrete HCl into the stomach? What causes the cell to release HCl?
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Parietal cells
Sight and smell of food hits vagus nerve Parietal cells produce HCL and intrinsic factor. H+ transported by H+ATPase across parietal cell barrier stimulated by gastrin. |
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What compound acts on the pancreas and cause the release of pancreatic enzymes?
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Secretin
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What does pepsin do?
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Breaks down protein
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Intrinsic factor
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protein that binds and helps transport vitamin B12 throughout the lining of the intestine to blood.
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what hormone stimulates the release of bile from the gall bladder?
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Cholecystokinin
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The pancreas has the islets of langerhans which produces what endocrine hormones?
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glucagon, insulin, somatostatin
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Pancreatic fluid contains ______________ which neutralizes gastric fluid.
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sodium bicarbonate
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Gastric fluid contains which pancreatic proteolytic enzymes?
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Trysin, Chymotrypsin, Elastase, Carboxypeptidase, nuclease, secretin
These enzymes are in pancreatic fluid. Nucleic acids largest molecule in body. |
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Which pancreatic hormones produced in the Islets of Langerhans contribute to nutrient degradation?
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Amylase, lipase, pepttidases, disaccharidases
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What is the role of the large intestine?
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reabsorb water from undigested material
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What is Steatorrhea?
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Greasy, pale stools that have an abnormal appearance.
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Non-Tropical sprue, Celiac disease, gluten sensitive enteropathy
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An inherited autoimmune intolerance to gluten (in flour) ---> Ag-Ab complex deposits in intestinal mucosa causes a specific lesion ----> poor absorption and irritation in the stomach
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Tropical sprue
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Acquired, Abnormalities of small bowel structure and function ----> nutritional deficiency
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Ulcerative Colitis
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Chronic inflammatory disorder of the intestine
Mucosa of rectum and left colon are most commonly affected Toxic megacolon can occur |
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Regional enteritis (Crohn’s disease)
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Chronic inflammation of intestine of unknown etiology that can lead to intestinal obstruction
Ileum and colon are most often affected |
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Vomiting that causes excessive fluid loss may produce __________________.
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Metabolic alkalosis with hypochloremia
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Zollinger-Ellison syndrome
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caused by a gastrin-producing tumor, or gastrinoma. High levels of gastrin cause overproduction of stomach acid and the high acid levels lead to multiple ulcers in the stomach and small bowel. The gastrinoma may occur in the stomach, pancreas, lymph node or mesentery.
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What is the most common carbohydrate malabsorption disorder?
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Lactose intolerance
Intestinal enzyme Lactase breaks down lactose into glucose and galactose. 70% of people show diminished lactase activity after the first few years of life |
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Qualitative analysis for fecal fat employs which fat-soluble stains?
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Sudan III and IV
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What is the reference range for a fecal fat specimen?
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Qualitative reference range: 40-50 droplets per high powered fieldQuantitative reference range: less than or equal to 6 grams/day (fecal fat may also be reported as percentage of total fecal weight)
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What is the D-xylose absorption test?
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an indirect but specific method for assessing mucosal absorption of the small intestine.
Normal: 60% passed in urine |
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How is Xylose measured?
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Spectrophotometrically;Xylose is measured by heating the protein-free specimen to convert xylose to a furfural, then combining the product to a chromagen for measurement by spectrophotometry.
An o-toluidene procedure is also available for xylose with differential absorbance at 630 nm. |
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D-Xylose Reference range
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Patient fasts overnight.
Reference 1.4 g Borderline 1.2-1.4 g Abnormal: <1.2 g |
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Lactose breath test
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Increased H2 caused by increased bacteria breaking down increased amounts of lactose in large intestine
Measured at 1, 2 and 3 hr post-ingestion an increase greater than or equal to 20 ppm |
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What are four disorders of pancreatic function?
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Acute Pancreatitis
Cystic Fibrosis Diabetes mellitus Tumors of Pancreas |
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What lab results signify acute pancreatitis?
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Increased serum amylase, urine amylase, and serum lipase
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What is the most common single-gene inherited disease in americans of Northern European heritage?
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Cystic Fibrosis
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What chromosome is the CF mutant gene located?
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Chromosome 7; Mutation causes all exocrine secretions to have less H2O which causes salty sweat and malabsorption
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Lab test for CF
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sweat chloride level--screening test
RFLP detection of mutant gene--confirmatory test |
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Sweat chloride test
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stimulate sweat by iontophoresis of pilocarpine
collect sweat and measure Cl- content normal < 35 mmol/L CF > 60 mmol/L |
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Amylase requires _____ and ______ for full activity
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Chloride and Calcuim
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Amyloclastic method for Amylase
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measures rate of hydrolysis of starch by Amylase
Usually turbidimetric method (turbidity as starch is used up) or nephelometry (increase in light scatter) |
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Saccharogenic Method for amylase
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measures rate of production of monosaccharides or
disaccharides such as maltose is produced in the reaction when Amylase reacts with substrate |
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What is a tumor/neoplasm?
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Abnormal/uncontrolled proliferation of cells
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What is a benign tumor?
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Tumor that remains confined to its primary site
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What is a malignant tumor?
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Tumor that is capable of invading surrounding normal tissue and metastasizing (spreading) through the circulatory and lymphatic systems to distant body sites—also called “Cancer”
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What is cancer?
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a malignant neoplasm or tumor that must be dealt with
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Tumor marker
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a substance synthesized by the tumor or by the host in response to a tumor that can be used to detect the presence of the tumor
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Anaplasia
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Loss fo cell differentiation and change in cell and tissue structure from typical or normal
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Carcinoma
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Malignant growth arising from skin or organ tissue epithelium
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Adenoma
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benign growth arising from glandular epithelium
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What are the desirable characteristics of a tumor marker?
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Specific for cancer
Always present with tumor Amount of marker produced should correlate well with the tumor load The half-life of the marker should be short so serum levels must drop producing undetectable concentrations when patient is in remission. Levels of marker should have prognostic value |
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Screening test should have high_______________ ; that is low rate of _________________
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sensitivity, false negative
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Confirmatory tests to the positive screening tests should have high _____________ ; that is low rate of ________________
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specificity, false positive
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What are the 7 uses for tumor markers?
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Screening for disease
Diagnosis for symptomatic patients Aid in clinical staging Measurement of tumor burden Monitoring response to therapy Detecting recurrence of disease Prognostic indicator |
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What are the types of tumor markers?
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Enzymes and isoenzymes
Hormones, neurotransmitters and their metabolites Receptors (estrogen, progesterone, androgens, corticosteroids) Proteins (immunoglobulins, glycoproteins, carcinoembryonic proteins or oncofetal antigens) Genetic markers (Oncogens and supressor genes) Other markers (amino acids) |
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CEA is elevated in which cancers?
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Colon cancer
Lung cancer Gastric cancer Breast cancer Pancreatic cancer Ovarian cancer Uterine cancer Prostate cancer |
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What are some problems with using CEA as a marker?
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Elevated in non malignant conditions; not specific
Most useful in establishing prognosis and monitoring therapy and reoccurrence of disease |
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What is PSA?
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Prostate Specific Antigen; Serine protease produced exclusively by the epithelial cells in the prostate
Only tissue specific marker identified so far; also elevated in Benign Prostatic Hyperplasia Only tumor marker approved for screening for prostate cancer. |
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What are the two forms of PSA?
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Free and Complex (alpha1-antichymotrypsin)
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Increase in % free to total PSA means
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Benign prostatic hyperplasia (BHP)
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Increase in % complex to total PSA means
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Prostate cancer
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Human Chorionic Gondotropin (HCG)
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secreted by the synctiotrophoblastic cells of the placenta
Dimer composed of alpha and beta subunits Alpha subunit is found in FSH, LH, and TSH Beta subunit is specific to HCG |
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Where is Alpha-fetoprotein located?
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Synthesized int he yolk sac, fetal liver, GI tract and kidney
Related to albumin Marker for neural tube defects and screens for down syndrome |
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Cancer antigen 15-3
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Glycoprotein on mammary epithelium
increased in breast cancer but not specific Used in combo with CA 27-29 |
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CA 125
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Glycoprotein defined by monoclonal antibody OC125
Good marker for ovarian cancer but not specific |
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CA 19-9
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Blood group antigen
Specific for pancreatic cancer but present in GI cancer May be increased in diseases associated with biliary tract obstruction and CF |
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Prostatic acid Phospatase (PAP)
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Tumor marker for prostate cancer
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CK-BB
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Tumor marker for prostate and stomach cancer
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ALP
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Tumor marker for bone and liver
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Amylase and lipase
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tumor markers for pancreatic cancer
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