PT: Lab values to evaluate organ function
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40 terms
Terms | Definitions |
|---|---|
 What are the 3 things that could be going on in someone who has acute coronary syndrome (ACS)? | 1. Unstable angina 2. Non ST segment elevation MI 3. ST segment elevation MI |
| What is MI | Myocardial infarction |
| What are the 3 criteria for diagnosing acute myocardial infarction (AMI)? | 1. Clinical Presentation 2. Electrocardiogram (EKG or ECG) 3. Elevated biochemical markers of myocardial necrosis (also look at blood gases (arterial oxygen) |
| What does clinical presentation tell you? | This does not rule out anything - you could have a silent MI or just really bad angina |
| What does the EKG tell you? | What percent of heart muscle is gone and distinguishes between NSTEMI or STEMI |
| What do the biochemical markers of myocardial necrosis tell you? | Measure necrosis (cell death) |
| Do the biochemical markers of myocardial necrosis tell you about function? | NO |
| What enzymes/biochemical markers are indicative of myocardial necrosis? | 1. Creatine Kinase (CK) 2. Troponin |
| What is creatine kinase? | cellular enzyme used for phosphate group transfer (ATP) |
| What are the different isoenzymes (and the tissues they reside in)? | 1. BB - In the brain 2. MM - Skeletal muscle 3. MB - Heart muscle |
| After an MI how long does it takes for heart muscle creatine kinase to peak? | 24 hours |
| What is normal creatine kinase levels? | LESS THAN 5% |
| What is troponin? | A polypeptide that mediates interation of actin and myosin (requires Calcium) |
| What are the different troponin polypeptides? | Tnl TnT TnC - NOT cardiac specific |
| Which forms of troponin do you use to identify an MI? | Tnl and TnT |
| When does Tnl peak? | 24 hours |
| When does TnT peak? | 12 hours - 2 days |
| How do you diagnose AMI (acute myocardial infarction) - STEP 1? | 1. Myocardial tissue damage/necrosis will come with a release of intracellular enzymes and polypeptides. |
| How do you diagnose AMI (acute myocardial infarction) - STEP 2? | 2. CK more than 5% (the # will be like in the 1000's) Rises: 6-12 hours Peaks: 24-36 hours Dec: 1-2 days |
| How do you diagnose AMI (acute myocardial infarction) - STEP 3? | 3. Troponin Rises: 3-6 hours Peaks: 24 hours Dec: 7-10 days |
| How often are blood samples drawn in hospital if patient is suspect to have AMI? | 1 time (IN ER) + 2 more times over the next 12 - 24 hours (IN ICU) |
| Are CK and troponin blood samples draw together? | Yes |
| What is diagnostic for MI ? | 1 elevated Troponin or 2 elevated CK |
| What does the liver manufacture? | 1. Albumin 2. Bilirubin (processed in the liver) 3. Clotting factors |
| What else does the liver do besides manufacture? | -Excretes -Stores (glycogen) -Metabolizes |
| What are the liver enzymes that are evaluated in liver function tests? | 1. Bilirubin 2. LDH5 (Lactate dehydrogenase - isoenzyme 5) 3. AST/ALT 4. Alkaline phosphatase 5. Albumin (and pre-albumin) 6. PT (prothrombin time) |
| What are the two types of bilirubin tests? | 1. Direct 2. Indirect |
| What is direct bilirubin? | Conjugated with glucuronic acid (WATER SOLUBLE) = Post hepatic events |
| What is indirect bilirubin? | Unconjugated (WATER INSOLUBLE) =Pre-hepatic (hemolysis) or decreased hepatic function |
| Why do you look at AST and ALT in liver function tests? | They are very sensitive to hepatic inflammation and necrosis |
| What 2 diseases or physical states are associated with elevated AST/ALT levels? | 1. Acute viral hepatitis 2. Severe drug toxicity |
| When is ALP usually elevated? | In cholestasis (most often) also elevated in many other hepatic disorders |
| What are the two enzymes related to ALP? | LAP AND GGTP (elevated with alcohol use) |
| Why do we look at albumin levels in liver function tests? | Because the liver makes albumin |
| What are the 3 functions of albumin? | 1. Oncotic pressure 2. AA transport 3. Ligands |
| What is a better test than albumin ? | Pre-albumin |
| What is pre-albumin a better test than albumin? | Albumin 1/2 life: 15-20 days pre-albumin 1/2 life: 2 days --See what the liver made within the last 2 days, not the last 20 days... more recent knowledge with pre-albumin |
| What happens to the prothrombin time/INR test in a patient that has liver disease? | It increases above normal range (PT: above 13 seconds; INR: above 2) |
| Why would the PT/INR increase? | That means that the patients clotting ability has decreased and may be due to liver disease because the liver makes certain clotting factors |
| What is the normal ranges for PT/INR? | PT: 10-13 SEC INR: 1-2 |
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