Chemistry Tests: Albumin & Ammonia

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Questions and Answers

What is the primary purpose of conducting lab tests?

To screen for disease, evaluate drug therapy, confirm a diagnosis, or rule out a clinical problem.

How do normal ranges differ from reference ranges in lab tests?

Normal ranges are based on healthy individuals, while reference ranges vary by age and gender.

What condition might a lower albumin level indicate?

Malnutrition or liver disease.

Why is it important to interpret lab results in context?

Lab results can vary significantly based on individual factors like age, gender, and health status. Signup and view all the answers

What are critical values in laboratory diagnostics?

Values that indicate immediate action must be taken as they may be life-threatening. Signup and view all the answers

What is the role of albumin in the body?

Albumin maintains colloidal osmotic pressure and is important for fluid balance. Signup and view all the answers

Identify one interfering factor that may affect albumin test results.

Drugs such as corticosteroids or aspirin. Signup and view all the answers

What lab tests are primarily used to measure chemical components in the body?

Chemistry tests, commonly using blood and urine samples. Signup and view all the answers

What enzyme is primarily responsible for converting ammonia to urea in the body?

The liver enzymes convert ammonia to urea. Signup and view all the answers

What effect can smoking have on ammonia blood levels?

Smoking can increase blood ammonia levels. Signup and view all the answers

What is a common critical threshold for total bilirubin in adults?

A total bilirubin level greater than 12 mg/dL is considered critical in adults. Signup and view all the answers

What is the range for normal total bilirubin levels in adults?

0.3-1.0 mg/dL or 5.1-17 μmol/L. Signup and view all the answers

Which syndrome is associated with defective bilirubin conjugation and may lead to jaundice?

Crigler-Najjar syndrome. Signup and view all the answers

How can strenuous exercise affect ammonia test results?

Strenuous exercise may lead to elevated ammonia levels. Signup and view all the answers

What is the role of the kidneys concerning urea and ammonia?

The kidneys excrete urea, the product formed from ammonia detoxification. Signup and view all the answers

What pathological condition can cause elevated levels of conjugated bilirubin?

Hepatocellular injuries can result in elevated conjugated bilirubin levels. Signup and view all the answers

What dietary factors can interfere with ammonia test results?

High-protein and low-protein diets can alter ammonia levels. Signup and view all the answers

How does newborn hemolysis relate to bilirubin production?

Increased hemolysis in newborns raises unconjugated bilirubin production. Signup and view all the answers

What condition can lead to decreased hepatic clearance of bilirubin?

Congestive heart failure can decrease hepatic clearance of bilirubin. Signup and view all the answers

What is one effect of broad-spectrum antibiotics on ammonia levels?

Broad-spectrum antibiotics may decrease blood ammonia levels. Signup and view all the answers

In cases of jaundice, what are the potential anatomical sites of pathology for elevated bilirubin?

The sites include prehepatic, hepatic, and posthepatic. Signup and view all the answers

What is an inference drawn from elevated indirect bilirubin levels?

Elevated indirect bilirubin suggests potential hemolysis or ineffective erythropoiesis. Signup and view all the answers

What are some drugs associated with isolated elevated bilirubin levels?

Isoniazid, Chlorpromazine, Erythromycin, and Anabolic steroids. Signup and view all the answers

Which medical conditions can lead to conjugated hyperbilirubinemia?

Sepsis, shock, and hemochromatosis. Signup and view all the answers

Describe the solubility characteristics of unconjugated bilirubin.

Unconjugated bilirubin is water-insoluble and binds to tissues. Signup and view all the answers

What is the primary form of conjugated bilirubin found in the body?

Bilirubin diglucuronide is the predominant conjugated form. Signup and view all the answers

How does bilirubin enter the small intestine?

Conjugated bilirubin is excreted into bile and delivered to the small intestine. Signup and view all the answers

What causes the characteristic colors of urine and stool related to bilirubin?

Urobilinogens, converted from bilirubin, give urine a yellow color and stool a brown color. Signup and view all the answers

At what bilirubin level is jaundice typically observed?

Jaundice is generally seen when total bilirubin reaches 2-3 mg/dL. Signup and view all the answers

What is the significance of dark urine in hyperbilirubinemia?

Dark urine is a primary indication of conjugated hyperbilirubinemia. Signup and view all the answers

Name a symptom that can be seen in chronic liver disease.

Symptoms include ascites, splenomegaly, and spider angiomata. Signup and view all the answers

What test type is bilirubin testing usually performed alongside?

Bilirubin testing is typically performed along with liver function tests such as ALT and AST. Signup and view all the answers

What is the primary cause of Crigler-Najjar syndrome, and how does it differ between type I and type II?

Crigler-Najjar syndrome is caused by an alteration in the bilirubin-UGT gene, leading to a complete loss of function in type I and a very low level of function in type II. Signup and view all the answers

How does Gilbert syndrome differ from Crigler-Najjar syndrome despite both involving decreased UGT activity?

Gilbert syndrome involves a mutation in the promoter region leading to reduced amounts of normal protein, while Crigler-Najjar syndrome leads to a loss-of-function mutation with complete or near loss of UGT activity. Signup and view all the answers

What distinguishes primary sclerosing cholangitis (PSC) from other forms of biliary obstruction?

PSC is characterized by progressive inflammation and scarring of bile ducts, often associated with inflammatory bowel disease, and treated supportively. Signup and view all the answers

What is the underlying genetic defect in Dubin-Johnson syndrome (DJS) and how does it present biochemically?

DJS is caused by a mutation in the cMOAT/MRP2 gene, leading to impaired transport of organic anions across the hepatocyte membrane, resulting in conjugated hyperbilirubinemia. Signup and view all the answers

What are the key clinical features of primary biliary cirrhosis?

Primary biliary cirrhosis presents with pruritus, fatigue, and jaundice, leading to progressive destruction of intrahepatic bile ducts. Signup and view all the answers

In patients with Wilson disease, what is the typical biochemical finding, and what is the treatment?

Wilson disease typically presents with reduced ceruloplasmin levels due to copper accumulation, and its treatment involves copper chelation therapy. Signup and view all the answers

How does Rotor syndrome compare to Dubin-Johnson syndrome in terms of genetic defect and clinical presentation?

Rotor syndrome is similar to DJS but the exact genetic defect is unknown; it is characterized by high urinary coproporphyrin and lacks black pigmentation of the liver. Signup and view all the answers

What factors contribute to the pathogenesis of TPN-induced cholestasis?

TPN-induced cholestasis is thought to result from multifactorial issues including excessive caloric intake and deficiencies in micronutrients. Signup and view all the answers

What is AIDS cholangiopathy, and what is its primary cause?

AIDS cholangiopathy is a syndrome of biliary obstruction primarily caused by infection-induced strictures in the biliary tract. Signup and view all the answers

What defines benign recurrent intrahepatic cholestasis (BRIC) and how does it impact liver health?

BRIC is characterized by recurrent episodes of intense pruritus and jaundice that resolve spontaneously without causing significant liver damage. Signup and view all the answers

What distinguishes conjugated hyperbilirubinemia from unconjugated hyperbilirubinemia in clinical terms?

Conjugated hyperbilirubinemia is typically associated with conditions affecting the liver and bile ducts, while unconjugated hyperbilirubinemia usually arises from increased production or decreased uptake. Signup and view all the answers

Identify the major categories contributing to unconjugated hyperbilirubinemia.

Major contributors include hemolytic disorders, Gilbert syndrome, and Crigler-Najjar syndrome. Signup and view all the answers

What are the common forms of biliary obstruction and their implications?

Common forms include malignant conditions (cholangiocarcinoma), pancreatitis, and congenital anomalies like biliary atresia. Signup and view all the answers

What is the main purpose of measuring albumin levels in laboratory tests?

To assess liver and kidney function Signup and view all the answers

Which of the following factors may interfere with albumin test results?

Corticosteroids Signup and view all the answers

What condition can lead to an abnormally high level of albumin in serum?

Severe dehydration Signup and view all the answers

What is indicated by a lower than normal albumin level?

Liver dysfunction or malnutrition Signup and view all the answers

How are normal ranges for laboratory tests typically established?

By analyzing a large group of healthy individuals Signup and view all the answers

What is the consequence of failing to act on critical lab values?

Potential life-threatening conditions Signup and view all the answers

In what way can reference ranges vary?

Depending on age and gender Signup and view all the answers

What is an important consideration for follow-up assessments post-lab tests?

Assessment based on the types of tests performed Signup and view all the answers

Which of the following drugs is known to cause isolated elevated bilirubin levels?

Isoniazid Signup and view all the answers

What is the primary process through which bilirubin is conjugated in the liver?

Reaction with uridine diphosphoglucuronate Signup and view all the answers

What is the expected appearance of feces in a condition with absent urobilinogens?

Clay-colored Signup and view all the answers

Which of the following symptoms is most commonly associated with jaundice due to hyperbilirubinemia?

Yellowing of the skin and eyes Signup and view all the answers

What is the primary cause of unconjugated hyperbilirubinemia?

Overproduction of bilirubin due to hemolysis Signup and view all the answers

What characteristic feature differentiates dark urine in conjugated hyperbilirubinemia from that in unconjugated hyperbilirubinemia?

Conjugated bilirubin is excreted in urine Signup and view all the answers

Which condition is NOT a known cause of conjugated hyperbilirubinemia?

Gilbert syndrome Signup and view all the answers

What laboratory tests are typically conducted alongside bilirubin testing?

Alanine aminotransferase and aspartate aminotransferase Signup and view all the answers

What process allows the reabsorption of urobilinogen back to the liver after intestinal bacteria convert bilirubin?

Enterohepatic circulation Signup and view all the answers

What is the main indication for measuring ammonia levels in the blood?

To diagnose severe liver diseases Signup and view all the answers

Which of the following factors can contribute to elevated bilirubin levels?

Duct obstruction Signup and view all the answers

What range is considered critical for total bilirubin levels in adults?

<blockquote> 12 mg/dL </blockquote> Signup and view all the answers

How does smoking affect ammonia levels in the blood?

It increases ammonia levels Signup and view all the answers

Which of the following pathologies is most likely to cause elevated unconjugated bilirubin?

Hemolysis Signup and view all the answers

What factor may lead to decreased hepatic clearance of bilirubin?

Congestive heart failure Signup and view all the answers

What is a common cause of conjugated hyperbilirubinemia?

Sepsis and biliary obstruction Signup and view all the answers

Which type of bilirubin is primarily associated with liver dysfunction?

Conjugated bilirubin Signup and view all the answers

What is the primary metabolic process associated with ammonia in the body?

Excretion as urea Signup and view all the answers

What role does the liver play in the metabolism of bilirubin?

It conjugates bilirubin for excretion Signup and view all the answers

What is the potential impact of using broad-spectrum antibiotics on bilirubin levels?

They inhibit bilirubin uptake Signup and view all the answers

What condition may indicate the presence of elevated direct bilirubin levels?

Significant liver dysfunction Signup and view all the answers

What is a prevalent condition associated with unconjugated hyperbilirubinemia in newborns?

Breastfeeding Signup and view all the answers

What laboratory test is often performed alongside bilirubin testing for a comprehensive evaluation?

Liver function tests Signup and view all the answers

What is the main difference between type I and type II Crigler-Najjar syndrome?

Type I is often fatal by age two while type II is typically benign. Signup and view all the answers

Which condition is characterized by a mutation in the promoter region affecting UGT activity?

Gilbert syndrome Signup and view all the answers

What is the primary treatment for type I Crigler-Najjar syndrome?

Plasma exchange followed by phototherapy Signup and view all the answers

Which factor is associated with conjugated hyperbilirubinemia due to liver infiltration?

Lymphoma Signup and view all the answers

What is the characteristic finding in Dubin-Johnson syndrome?

Black pigmentation of the liver Signup and view all the answers

What usually causes total parenteral nutrition (TPN)–induced cholestasis?

Excessive calories combined with nutrient deficiencies Signup and view all the answers

What is a key clinical feature of primary biliary cirrhosis?

Jaundice and pruritus Signup and view all the answers

Which condition is associated with biliary obstruction secondary to infection?

Cholangitis Signup and view all the answers

Which of the following conditions does NOT typically require medical treatment?

Gilbert syndrome Signup and view all the answers

What is a major risk factor for cholangiocarcinoma in patients with PSC?

Progressive inflammation of bile ducts Signup and view all the answers

What type of bilirubin is elevated in chronic hepatitis infections?

Conjugated bilirubin Signup and view all the answers

Which syndrome is characterized by recurrent jaundice and pruritus but resolves without liver damage?

Benign recurrent intrahepatic cholestasis Signup and view all the answers

What role does phenobarbital play in the management of hyperbilirubinemia?

It induces the expression of UGT in type II Crigler-Najjar syndrome. Signup and view all the answers

Study Notes

Chemistry Tests

Albumin (AL)
- Normal Range: 35-50 g/L
- Used to diagnose and monitor liver diseases, impaired nutrition, chronic edema, and cancer
- Albumin is a protein made in the liver and maintains colloidal osmotic pressure
- Lower levels can indicate: malnutrition, liver disease, ascites, inflammatory disease, autoimmune disorder, GI malabsorption syndromes, or pregnancy
- Higher levels can indicate: severe dehydration
Ammonia (AMM, NH3)
- Normal Range: 6-47 mcmol/L
- Measures the amount of ammonia in the blood
- Ammonia is created by the breakdown of protein; the liver converts ammonia to urea
- Used to diagnose severe liver diseases
- Lower levels can indicate: Essential or malignant hypertension
- Higher levels can indicate: Liver disease (cirrhosis or hepatitis), Reye syndrome, heart failure, kidney failure, severe bleeding from the stomach or intestines
Bilirubin
- Normal Ranges:
  - Adult: Total bilirubin: 0.3-1.0 mg/dL or 5.1-17 μmol/L, Indirect bilirubin: 0.2-0.8 mg/dL or 3.4-12.0 μmol/L, Direct bilirubin: 0.1-0.3 mg/dL or 1.7-5.1 μmol/L
  - Newborn: Total bilirubin: 1.0-12.0 mg/dL or 17.1-205 μmol/L
- Breakdown product of heme catabolism
- Measured as direct (DBil) and total value bilirubin (TBil)
- Elevated levels (>2.5-3 mg/dL) cause jaundice and can be classified into prehepatic, hepatic, or posthepatic
- Unconjugated hyperbilirubinemia is common in newborns and can be related to higher hematocrit and decreased UGT activity
- Conjugated hyperbilirubinemia is common in individuals with hepatocellular injuries and biliary obstruction
Amylase (AMY)
- Normal Range:
  - Serum Amylase: 25-129 IU/L
  - Urine Amylase: 1-17 IU/L
- An enzyme produced in the pancreas and salivary glands
- Primarily used to diagnose pancreatitis, but also used for salivary gland disorders
- Lower Levels:
  - Can indicate: Liver disease, cystic fibrosis, malnutrition, chronic kidney disease
- Higher Levels:
  - Can indicate: Pancreatitis, salivary gland disorders, perforated peptic ulcer, bowel obstruction, or macroamylasemia
Aspartate Aminotransferase (AST)
- Normal Range: 10-34 IU/L
- An enzyme found in the liver and other organs
- Used to detect liver damage, but also used to monitor heart attack severity and muscle damage
- Lower Levels:
  - Can indicate: Vitamin B6 deficiency
- Higher Levels:
  - Can indicate: Liver damage, heart attack, muscle damage, and other conditions
Creatinine (CRE)
- Normal Range:
  - Male: 53-106 mcmol/L
  - Female: 44-80 mcmol/L
- A waste product produced by muscle metabolism
- Eliminated by the kidneys in urine
- Used to evaluate kidney function
- Lower Levels:
  - Can indicate: Muscle wasting, malnutrition, or pregnancy
- Higher Levels:
  - Can indicate: Kidney disease, dehydration, or muscle injury
Creatinine Kinase (CK)
- Normal Range:
  - Male: 24-195 IU/L
  - Female: 14-160 IU/L
- An enzyme found in muscle tissue
- Levels increase when muscles are injured, such as in heart attacks, muscular dystrophy, and rhabdomyolysis
- Lower Levels:
  - Can indicate: Hypothyroidism
- Higher Levels:
  - Can indicate: Heart attack, muscle injury (due to exercise, trauma, or genetic disorders), muscular dystrophy, rhabdomyolysis, hypothyroidism, and other conditions
Gamma-Glutamyl Transferase (GGT)
- Normal Range: 5-50 IU/L
- An enzyme found in the liver and other tissues
- Increased levels can indicate alcoholic liver disease or blockage of the bile ducts
- Lower Levels:
  - Can indicate: Vitamin B12 deficiency
- Higher Levels:
  - Can indicate: Alcohol abuse, liver disease, hepatitis, biliary obstruction, and other conditions
Glucose (GLU)
- Normal Range: 4.0-7.0 mmol/L
- A sugar that is the body's primary source of energy
- Used to screen for diabetes and monitor blood sugar control in people with diabetes
- Lower Levels:
  - Can indicate: Hypoglycemia
- Higher Levels:
  - Can indicate: Hyperglycemia, diabetes, and other conditions
Lactate Dehydrogenase (LD)
- Normal Range: 0.6-2.4 mmol/L
- An enzyme found in many tissues, including the heart, liver, skeletal muscles, and red blood cells
- Elevated levels can indicate tissue damage, such as in heart attacks, liver diseases, and muscular dystrophies
- Lower Levels:
  - Can indicate: Anemia, Vitamin B12 deficiency
- Higher Levels:
  - Can indicate: Heart attack, liver damage, muscular dystrophy, cancer, and other conditions
Lipase (LPS)
- Normal Range: 0-160 IU/L
- An enzyme produced in the pancreas
- Increased levels can indicate pancreatitis
- Lower Levels:
  - Can indicate: Pancreatic insufficiency, malnutrition, or cystic fibrosis
- Higher Levels:
  - Can indicate: Pancreatitis, acute or chronic, pancreatitis, intestinal obstruction, and other conditions
Phosphate (PHO)
- Normal Range: 0.8-1.5 mmol/L
- A mineral found in bone, teeth, and other tissues
- Used to evaluate kidney function, bone health, and electrolyte balance
- Lower Levels:
  - Can indicate: Malnutrition, alcoholism, or vitamin D deficiency
- Higher Levels:
  - Can indicate: Kidney failure, hypoparathyroidism, and other conditions
Potassium (POT)
- Normal Range: 3.5-5.3 mmol/L
- An electrolyte that is essential for normal nerve and muscle function
- Used to evaluate electrolyte balance and kidney function
- Lower Levels:
  - Can indicate: Hypokalemia, diuretic use, and other conditions
- Higher Levels:
  - Can indicate: Hyperkalemia, kidney failure, and other conditions
Sodium (SOD)
- Normal Range: 135-145 mmol/L
- A mineral that is essential for normal nerve and muscle function
- Used to evaluate electrolyte balance and kidney function
- Lower Levels:
  - Can indicate: Hyponatremia, dehydration, low blood volume, heart failure, and other conditions
- Higher Levels:
  - Can indicate: Hypernatremia, dehydration, and other conditions
Total Protein (TP)
- Normal Range: 60–80 g/L
- A measure of the total amount of protein in the blood
- Used to evaluate liver function, hydration status, and nutritional status
- Lower Levels:
  - Can indicate: Malnutrition, liver disease, kidney disease, blood loss, or severe burns
- Higher Levels:
  - Can indicate: Dehydration, multiple myeloma, and other conditions
Urea (URE)
- Normal Range: 2.5-8.0 mmol/L
- A waste product produced by the breakdown of protein
- Eliminated by the kidneys in urine
- Used to evaluate kidney function, hydration status, and protein intake
- Lower Levels:
  - Can indicate: Liver disease, malnutrition, or pregnancy
- Higher Levels:
  - Can indicate: Kidney disease, dehydration, high protein intake, or gastrointestinal bleeding

Hematology Tests

Complete Blood Count (CBC)
- Used to evaluate the number of red blood cells, white blood cells, and platelets in the blood.
- Red blood cells : Transport Oxygen
- White blood cells: Fight infection
- Platelets: Help stop bleeding
- CBC is a routine test for blood clotting disorders, and infections.
Erythrocyte Sedimentation Rate (ESR)
- Measures the rate at which red blood cells settle to the bottom of a test tube.
- A higher ESR can indicate inflammation or infection.
Hemoglobin (HGB)
- Measures the amount of hemoglobin in the blood. Hemoglobin is a protein in red blood cells that carries oxygen.
- Used to evaluate anemia.
Hematocrit (HCT)
- Measures the percentage of red blood cells in the blood.
- Used to evaluate anemia.
Platelet Count (PLT)
- Measures the number of platelets in the blood.
- Used to evaluate bleeding disorders.
White Blood Count (WBC)
- Measures the number of white blood cells in the blood.
- Used to evaluate infections.
- Higher levels can indicate infection.

Common Urine Tests

Urinalysis (UA)
- A routine test that checks the physical, chemical, and microscopic properties of urine.
- UA is performed in conjunction with CBCs to evaluate an individual's health status and assess various parameters including kidney function.
- Abnormal UA results can indicate infection, kidney disease, or other conditions.
Urine Culture
- Used to detect bacteria in the urine
- Performed when a UTI is suspected.
Urine Protein
- Measures the amount of protein in the urine.
- Elevated levels can indicate kidney disease.,
- It is also performed to monitor the progress of kidney disease.
Urine Glucose
- Measures the amount of glucose in the urine.
- Elevated levels can indicate diabetes.
Ketones in Urine
- Measures the amount of ketones in the urine.
- Ketones are produced when the body does not have enough glucose for fuel.
- Elevated levels can indicate diabetes or starvation.

Laboratory tests for diagnostics

Laboratory tests are used to screen for disease, evaluate drug therapy, confirm a diagnosis, or rule out a clinical problem.
Normal ranges are established by testing a large group of healthy individuals to determine what a typical “normal” result is.
Reference ranges can vary depending on age and gender.
Critical Values indicate that immediate action must be taken as the results are dangerously abnormal and may be life-threatening if corrective action is not taken.

Chemistry Tests

Albumin (AL)

Measures the amount of albumin in the blood.
Albumin maintains colloidal osmotic pressure.
Normal Range: 35–50 g/L
Indications: Used to diagnose and monitor diseases of the liver, impaired nutrition, chronic edema, and cancer.
Interfering Factors: Drugs that interrupt normal serum electrophoretic patterns (e.g., Aspirin, bicarbonates, corticosteroids, salicylates).

Ammonia (AMM, NH3)

Measures the amount of ammonia in the blood.
Normal Range: 6–47 mcmol/L
Indications: Used to diagnose severe liver diseases.
Interfering Factors: Smoking, Eating high-protein or low-protein diet, Drugs that increase blood ammonia (e.g., Loop diuretics, narcotics, thiazides, alcohol), Drugs that decrease blood ammonia (e.g., broad spectrum antibiotics, levodopa, potassium salts), Strenuous exercise before test.

Bilirubin

Breakdown product of heme catabolism.
Normal Range: 0.3-1.0 mg/dL or 5.1-17 μmol/L (SI units)
Possible critical values: Total bilirubin >12 mg/dL (Adult), Total bilirubin >15 mg/dL (Newborn)
Elevated bilirubin levels: Elevated bilirubin levels (>2.5-3 mg/dL ) cause jaundice and can be classified into prehepatic (increased bilirubin production), hepatic (liver dysfunction), or posthepatic (duct obstruction).

Amylase (AMY)

Normal Range: Serum Amylase:
Indications: Used to diagnose pancreatitis, perforated peptic ulcer, intestinal obstruction, cholecystitis, salivary gland disorders (mumps, sialadenitis), and macroamylasemia.
Interfering Factors: Recent surgery, trauma, certain drugs, and conditions such as diabetic ketoacidosis.

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Description

This quiz focuses on key chemistry tests, specifically Albumin and Ammonia levels in the blood. It explores their normal ranges, significance in diagnosing liver diseases, nutritional status, and other health conditions. Test your knowledge on the implications of abnormal results.