Clinical biochemistry
Friday, October 20th, 2006important to evaluate the health status of individual
once blood clotted, remaining liquid phase is serum
activity of serum enzyme depend on
enzyme conct, rather of enzyme synthesis, rate of enzyme clearance,biological factors ie age.
ALT = alanine aminotransferase
ALP = alkaline phosphatatse
AST = aspartate aminotransferase
CK = creatine kinase
GGT = gamma glutamyltransferase
LDH = lactate dehydrogenase
LIP = lipase
OCT = ornithine carbomoyltransferase
GLDH = glutamate dehydrogenase
liver receive 1.5L/min of blood , damage to liver result
a range of enzyme released intoblood
disturbance of blood chemistry chnage in total bilirubin
reduced blood level of albumin and globulins
Liver function test- abnormalities may caused by
direct damage to hepatocytes
damage of biliary system
specific disease such as tumours
serum AST and ALT tend to change in parallel with ALT more specific and sensitive marker of hepatic function.
ALP alkaline phosphatase rise when active bone formation, pregnancy and damage of bile duct epithelium, intestinal dysfunction.
both obstruction and hepatocellular liver disease result increased free and conjugated bilirubin
bilirubin is degradation product of haem due to haemoglobin breakdown
free biliburin take up by liver hepatocyte and conjugated to glucuronic acid, leave liver via bile duct to bowel. reduced to urobilinogen colourless and urobilin color in both intestinal bacteria. colorless urobilinogen are excreted in faeces.in liver disease ,urobilinogen may be excreted in urine.
increase in serum bilirubin may caused by
increased RBC turnover
liver disease
when excess 1mg/dL result jaundice yellow skin and passage to brain cause kernicterus in which bilirubin deposit in lipid rich basal ganglia of the brain.
Diagnosis of MI based on
physical exam, ECG changes, elevation of serum enzymes
CK creatine kinase, AST: aspartate aminotrasnferase, LDH: lactate dehydrogenase
Ck dimer of 2 part M muscle and B brain. brain CK is almost enitrely BB.
heart 60% MM and 40 % MB
serum CK is virtually MM except after MI ,MB isenzyme increases.
lactate dehydrogenase LDH
tetramer of 4 subunit H, M
LDH 1/LDH2 increase with CK-MB = SIGNIFICANT OF MI
AST - aspartae aminotransferase
elevated 1-4 days after MI
Prolonged elevation due to hepatic damage
Kidney function test
GFR glomerular filtration
assessment of GFR could be achieved by infusing a suitable tracer into blood and recording its rate of appearance in the urine.
hyperamylasemia : high level of plasma amylase activity in blood
pancreatic oedema to severe necrosis and haemorrhage of the organ allows the release of pancreatic enzyme (amylase,lipase,and protease)
occur when pancreatic disease such as acute/chronic pancreatitis, non-pancreatic abdominal such as local surgery and intestinal obstruction. renal insufficiency and burns
electrophoresis : migration of charged particle under the influence of an electric field .
cellulose acetate is the most common electrophoresis used for analyzing plasma protein such as fibrinogen, albumin and globulins.
albumin is major protein abt 60 % of plasma protein. albumin is the major determinant of plasma osmotic pressure. albumin bind with various ligands such as calcium, free fatty acids, steroid hormones, and some drug like aspirin.
liver disease px, low albumin coz body produce insufficient albumin
during nephrotic syndrome , level of albumin decrease .
malnutrition, decrease in albumin level during kwashiorkor. not enuff protein for liver to make new albumin. human lack of albumin will exhibit moderate odema which is called analbuminemia.
