Notes in Exam 2

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Published	03/25/2024	KIDNEY FUNCTIONHelps maintain {{c1::homeostasis}}1) By {{c2::excreting waste products of metabolism}}a. Urea, creatinine, and uric acid, etc.2) By {{c…
Published	03/25/2024	WHY ASSESS KIDNEY FUNCTION?• Monitor disease progression• Monitor drug therapy {{c1::(efficacy)}}• Monitor for {{c1::toxicity}} of drug…
Published	03/25/2024	GLOMERULAR FILTRATION RATE (GFR)Normal GFR• The glomerular filtration rate (GFR) = {{c1::the sum of the filtration rates in all ofthe functioning…
Published	03/25/2024	CREATININE- Creatinine is derived from:• The metabolism of {{c1::creatine in skeletal muscle.}}• Dietary {{c1::meat intake.}}- It is re…
Published	03/25/2024	MULTIPLE FACTORS CAN AFFECT THE AMOUNT CREATININE OF IN THEBODY/BLOOD.• Muscle mass  {{c1::more muscle, more creatinine}}• Gender  {{c2::f…
Published	03/25/2024	ASSUMPTIONS ABOUT CREATININE AND USING IT IN CALCULATIONSLevels must be at steady state.• {{c1::Not always the case}}Creatinine is completely fil…
Published	03/25/2024	How is the general trend of GFR and SCr?
Published	03/25/2024	EGFR VS. GFR• Measuring GFR directly is complicated and rarely done clinically.• Estimated GFR (eGFR) usually provides a {{c2::close approximatio…
Published	03/25/2024	COCKCROFT-GAULT (CG)-DOSING ONLY!(140 - age) x body weight [kg]  CrCl (mL/min) =———————————————SCr [mg/dL] x 72• Multiply by {{c1::0.85}} if female• …
Published	03/25/2024	BODY WEIGHT CALCULATIONS:• If actual weight {{c1::< 130% of IBW = use actual weight}}• If actual weight {{c1::> 130% of IBW = use adjusted BW (A…
Published	03/25/2024	What is the general trend on how GFR categorizes CKD?
Published	03/25/2024	How does albuminuria effect CKD?
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Published	03/25/2024	B.U.N.• NORMAL RANGE {{c1::8-20 mg/dL}}• BLOOD UREA NITROGEN• End product of {{c2::protein metabolism• Filtered at the glomerulus}}• Reabsor…
Published	03/25/2024	What is the general trend for the prognosis of CKD?{{c1::GFR- As GFR decreases (G increases) it indicates higher risk of CKDAlbuminuria- A1, A2, A3 (a…
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Published	03/25/2024	B.U.N. AND GFR• BUN varies {{c1::inversely}} with the GFR but it is generally {{c1::less}} useful than the serum creatinine becaus…
Published	03/25/2024	B.U.N. AND GFRApproximately {{c1::40 to 50 percent}} of the filtered urea is {{c1::passively reabsorbed, mostly in the proximal tubule.}}• W…
Published	03/25/2024	What are the elements of the Electrolyte "Fishbone"?{{c1::Na+ Cl- BUNBlood glucoseScrHCO3- K+}}
Published	03/25/2024	URINALYSISUsed in the assessment of:• {{c1::Kidney function• Kidney disease• Liver function• Volume status• Electrolyte status• Ketoacidosis• Inf…
Published	03/25/2024	URINALYSISColor and Odor• Normal – {{c1::clear and yellow}}• Dark- {{c1::urine is concentrated- dehydration.}}• Cloudy- {{c1::infections, precipitants…
Published	03/25/2024	URINALYSISBlood cells• RBCs- normal is {{c1::1-2 per low power field}}    - Hematuria• WBCs- normal is {{c1::3-4 per low power fie…
Published	03/25/2024	URINALYSIS- DIPSTICK TESTMeasures a multitude of tests• {{c1::Bilirubin, blood, glucose, ketones}}• {{c1::Leukocyte esterase, nitrites, prot…
Published	03/25/2024	URINALYSIS• Specific Gravity- compares to {{c1::pure water at 60 degrees F}}     - pure water at 60 degrees F has a SpGr of {…
Published	03/25/2024	URINALYSISpH– normal range {{c1::4.6- 8}}• Usually {{c1::slightly acidic}}• {{c1::Diet}} can change this• pH is helpful in the wor…
Published	03/25/2024	URINALYSISGlucose- normal level is {{c1::0}}• Presence indicates {{c2::diabetes}}• Usually appears when blood glucose is {{c3::over 180 mg/dL}}• BE CA…
Published	03/25/2024	URINALYSISProteinuria• {{c1::Very, very, small}} amounts of protein are normal• Dipstick tests are most specific for {{c1::albumin but not other prote…
Published	03/25/2024	URINALYSISACR (UACR)– {{c1::Urinary albumin to creatinine}} ratio• Helps correct for {{c1::false positives and false negatives}} due to {{c2::urine di…
Published	03/25/2024	URINALYSISUrinary sodium• Normal range is {{c1::approximately 20 mEq/L}}• Can fluctuate wildly due to {{c2::diet, kidney dysfunction, and vo…
Published	03/25/2024	FENAThe {{c1::fractional excretion of sodium}} (FENa) measures {{c1::the percent of filtered sodium that is excreted in the urine.}}• T…
Published	03/26/2024	LIVER AND G.I.• “LIVER” Tests or LFT’s are an {{c1::imprecise}} term.• Most tests are not SPECIFIC for the liver• No “liver function” test means …
Published	03/26/2024	Type I error ({{c1::false positive}})Type II error ({{c1::false negative}})
Published	03/26/2024	SENSITIVITY VS. SPECIFICITYSensitivity—probability that {{c1::a person with the disease or condition you are testing for will test positive.}}• H…
Published	03/26/2024	SENSITIVITY AND SPECIFICITYSensitivity = TP/(TP+FN)• If the # of FN increases, what happens to sensitivity?{{c1::Decreases}}Specificity = TN/(TN+FP)• …
Published	03/26/2024	SENSITIVITY VS. SPECIFICITY FACTORS IN INTERPRETATION• Clinical decisions involve ruling-in or ruling-out a condition or cause.• What type of test wou…
Published	03/26/2024	SENSITIVITY VS. SPECIFICITY FACTORS IN INTERPRETATION• Clinical decisions involve ruling-in or ruling-out a condition or cause.• What type of test wou…
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Published	03/26/2024	LIVER FUNCTION TESTS CATEGORIES1. {{c1::Synthesis of proteins}}•{{c2::Manufacturing function}}2. {{c1::Cholestatic}}• {{c2::Excreto…
Published	03/26/2024	1. TESTS OF SYNTHESIS OF PROTEINS•{{c2::Albumin and clotting factors}}• NOT sensitive to {{c2::low levels of liver damage}}• Can take time to sho…
Published	03/26/2024	SYNTHESIS-ALBUMINHalf life of {{c1::20 days}}Major {{c1::plasma protein}}Maintains {{c1::plasma oncotic}} pressureTransports {{c1:…
Published	03/26/2024	SYNTHESIS- PT/INR• Prolonged PT/INR (measure of {{c1::coagulation)}}• PT- {{c1::Prothrombin Time}}• INR- {{c1::International normalized…
Published	03/26/2024	CHOLESTASIS• Cholestasis– The excretory function of the liver is {{c1::inhibited in some way}}• This failure causes an accumulation of {{c1::bili…
Published	03/26/2024	CHOLESTASISBILIRUBIN• Breakdown product of hemoglobin from {{c1::dead red blood cells}}Liver converts: {{c1::indirect (unconjugated)}} -->  {{…
Published	03/26/2024	CHOLESTASIS PATIENT PRESENTATION• Patients with cholestasis may present clinically in many different ways depending on the disease process.• In most c…
Published	03/26/2024	CHOLESTASISALKALINE PHOSPHATASE (ALP or AP or Alk Phos)Found in :{{c1::LiverBoneSmall intestineKidneyLeukocytesPlacenta}}Alkaline phosphataseWill incr…
Published	03/26/2024	CHOLESTASIS5’Nucleotidase• Found in {{c1::liver, heart, brain, blood vessels.}}• Very {{c2::rarely elevated}} in {{c2::NON HEPATIC}} diseases.• Can mi…
Published	03/26/2024	CHOLESTATIC PATTERNS1. {{c1::ALP >>> AST/ALT}} (can be normal or mildly elevated)2. Is the ALP of hepatic origin?• {{c1::Bilir…
Published	03/26/2024	HEPATOCELLULAR INJURY• {{c2::AST/ALT}} assess {{c1::hepatocellular injury}}• Found {{c1::INSIDE}} the hepatocytes• AST is found in {{c2::liver, heart,…
Published	03/26/2024	MAGNITUDE OF AST AND ALT ELEVATIONS• The magnitude of AST and ALT elevations varies depending on the cause of the hepatocellular injury.• {{c1::Alcoho…
Published	03/26/2024	HEPATOCELLULAR INJURY PATTERNS• MEASURED MOSTLY BY AST AND ALT•AST/ALT {{c1::>>>}}ALP• Bilirubin can be {{c1::normal or elevated}}• Some…
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Published	03/26/2024	AMMONIA• Normally detoxified by the {{c1::liver}}• Produced in the gut by {{c1::bacteria}}• Normally metabolized to {{c1::urea}}• Associ…
Published	03/26/2024	RHEUMATIC DISEASE• ALL HAVE TO DO WITH {{c1::JOINTS, CONNECTIVE TISSUE, AND/OR SOFTTISSUE.}}• Some are {{c1::autoimmune diseases.}}• Rheumatoid Arthri…
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Published	03/26/2024	RHEUMATIC DISEASE• Patient presentation and symptomatology are very important in choice of labs and their interpretation.• Many rheumatic diseases h…
Published	03/26/2024	AUTOIMMUNE DISEASE• Immune system is designed to identify, destroy, and remove foreign material.• Immune system identifies everything as “{{c1::self”}…
Published	03/26/2024	RHEUMATIC DISEASE TESTINGRheumatic tests are performed to :• Differentiate between disorders• Eg. Differential Diagnosis• Monitor for {{c1::effic…
Published	03/26/2024	RHEUMATIC-AUTOIMMUNE1. {{c1::General testing}} for inflammation from autoimmune disease or other processes.Markers of inflammation• {{c2::ESR• C-React…
Published	03/26/2024	RHEUMATIC-AUTOIMMUNEMarkers of inflammation --> {{c1::Acute Phase Reactants (APR)}}• Non Specific!!!• Can be elevated by {{c1::infection,…
Published	03/26/2024	RHEUMATIC-AUTOIMMUNEDirect Tests• RF- {{c1::Rheumatoid factor}}• Present in {{c1::26-90%}} of RA patients.• Usually {{c1::IgM medi…
Published	03/26/2024	RHEUMATIC-AUTOIMMUNE{{c1::Anti-CCP, (ACPA), citrulline antibody, or Cyclic Citrullinated Peptide Antibody}}• {{c2::50-75%}} sensitive f…
Published	03/26/2024	DAS-28• The DAS28 is a measure of {{c1::disease activity in rheumatoid arthritis (RA)}}. DAS stands for '{{c1::disease activity score}}' and the numbe…
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Published	03/26/2024	RHEUMATIC-AUTOIMMUNEANAs-{{c1::Antinuclear antibodies}}• Family of tests measuring antibodies to nucleic acids and nucleoproteins.• DNA, RNA, histon…
Published	03/26/2024	ANTIRHEUMATIC DRUG THERAPY-MONITORING{{c1::Methotrexate}} (antimetabolite, chemotherapeutic agent)• CBC w/diff, Plt, AST/ALP, Bili, Albumin, s/s …
Published	03/26/2024	URIC ACIDUric acid levels are used for:• Diagnosis and treatment of {{c1::renal failure}}• Monitoring patients receiving• Cytotoxic drugs• {…
Published	03/26/2024	Musculoskeletal EvaluationsIn General looking at:- ROM- range of motion- {{c2::Swelling/inflammation}}- {{c2::Joints affected}}- {{c2::Deformities}}- …
Published	03/26/2024	LEUKOCYTE DISORDERS• Changes is WBCs can be {{c1::indicative of many things}}Can be caused by:Disease• Cancer/leukemiaDrugs• ChemotherapyGenetics…
Published	03/26/2024	GRANULOCYTES-TYPES{{c1::Neutrophils}} (Aka PMNs, Segs, Polys)• {{c2::Phagocytic cells}}—attack and digest microbes• Most are {{c2::NOT …
Published	03/26/2024	Neutrophils in bone marrow - "bands" or "stabs" are {{c1::immature cells }}Neutrophils in blood - monocytes are {{c1::immature cells}}
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Published	03/26/2024	NEUTROPENIA AND ANC• ANC= {{c1::Absolute neutrophil count}}Neutropenia can be categorized as mild, moderate, or severe• Mild neutropenia – {{c2…
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Published	03/26/2024	MACROPHAGES•Mature form of {{c1::monocytes}}•Mostly found in tissue• Lymph nodes, lungs, spleen, liver, bone marrow•Phagocytic cell• Eats bacteria…
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