Clinical Enzymology Overview
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Questions and Answers

What is the primary significance of changes in plasma enzyme levels?

  • They reflect dietary influences only.
  • They are used to predict future health outcomes.
  • They indicate normal physiological states.
  • They suggest potential underlying diseases. (correct)

Which enzyme is primarily associated with biliary tract disease?

  • CK
  • AST
  • ALP (correct)
  • ALT

Which of the following factors does NOT influence plasma enzyme assays?

  • Dietary habits (correct)
  • Temperature
  • pH levels
  • Gender

What characterizes isoenzymes?

<p>They migrate differently in electrophoresis. (C)</p> Signup and view all the answers

Which of the following enzymes is mainly related to muscle diseases?

<p>CK (C)</p> Signup and view all the answers

Which enzyme is predominantly found in high concentrations in the liver and is significantly elevated during acute hepatitis?

<p>Alanine Transaminase (ALT) (C)</p> Signup and view all the answers

What condition is most likely indicated by elevated levels of Alkaline Phosphatase (ALP) in the serum?

<p>Obstructive jaundice (D)</p> Signup and view all the answers

Which enzyme is primarily used as a marker for alcohol-induced liver disease?

<p>Y-glutamyl-transferase (GGT) (B)</p> Signup and view all the answers

What role does Lactate Dehydrogenase (LDH) primarily serve in the body?

<p>Catalyzing the conversion of pyruvate to lactate (D)</p> Signup and view all the answers

Which isoenzyme of Creatine Kinase (CK) would be most indicative of myocardial damage?

<p>CK-MB (D)</p> Signup and view all the answers

In the diagnosis of cancer, which enzyme is commonly elevated indicating prostate carcinoma?

<p>Acid Phosphatase (ACP) (A)</p> Signup and view all the answers

What is the primary consequence of tissue damage as indicated by enzyme activity levels?

<p>Correlation of enzyme elevation with tissue damage degree (B)</p> Signup and view all the answers

Which of the following conditions would most likely lead to elevated levels of Lactate Dehydrogenase (LDH) in the plasma?

<p>Hemolysis (D)</p> Signup and view all the answers

Which enzyme's level is indicated to peak at 24-36 hours post myocardial infarction?

<p>Creatine Kinase (CK) (C)</p> Signup and view all the answers

Which of the following statements about Aspartate Transaminase (AST) is correct?

<p>AST can be elevated in hemolysis. (B)</p> Signup and view all the answers

Flashcards

Functional enzymes

Enzymes that are produced in the liver or other tissues, work directly in the plasma, and have a substrate that is present in the plasma.

Non-functional enzymes

Enzymes that are normally present inside cells but leak into the plasma when the cell is damaged. Their activity is low in healthy individuals and increases with tissue damage.

Isoenzymes

A group of enzymes that catalyze the same reaction but differ in their physical and chemical properties, allowing them to be separated by techniques such as electrophoresis.

Clinical Enzymology

The study of enzymes in clinical settings, particularly their levels and activities in blood and other bodily fluids, to help diagnose and monitor various diseases.

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Zymogen

An inactive precursor of an enzyme that must be converted to its active form before it can catalyze a reaction. Many digestive enzymes are initially produced as zymogens.

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Aspartate Transaminase (AST)

An enzyme present in high concentrations in cardiac cells, skeletal muscle, liver, kidney, and erythrocytes. Elevated levels in the plasma indicate damage to these tissues, often due to conditions like myocardial infarction (MI), hepatitis, trauma, or surgery.

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Alanine Transaminase (ALT)

An enzyme primarily concentrated in the liver. Elevated levels in the serum are indicative of liver damage, often associated with hepatitis, cirrhosis, or liver congestion.

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Lactate Dehydrogenase (LDH)

An enzyme present in high concentrations in cardiac cells, skeletal muscle, liver, brain, and erythrocytes. While its wide presence limits its diagnostic value, it serves as a marker for conditions like myocardial infarction, hemolysis, and anemia.

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Creatine Kinase (CK)

An enzyme abundant in skeletal muscle, cardiac muscle, brain, and smooth muscle. Elevated levels are associated with muscle injuries like myocardial infarction (MI), muscular dystrophy, and even hemolysis.

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CK Isoenzymes

A group of enzymes present in various tissues, often with unique composition, including skeletal muscle, cardiac muscle, and brain. CK-MB, a specific isoenzyme, is primarily found in cardiac muscle and rises significantly during myocardial infarction.

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Amylase

A digestive enzyme produced by the pancreas. Elevated levels in the plasma indicate pancreatitis due to damage to the organ and its ducts. Pancreatitis often leads to an increase in amylase levels, which are also excreted in urine.

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Alkaline Phosphatase (ALP)

An enzyme crucial for bone formation. Elevated levels are generally associated with increased osteoblast activity, but can also indicate damage to the liver, bile ducts, intestinal wall, or placenta.

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Acid Phosphatase (ACP)

An enzyme predominantly found in prostate cells, liver, erythrocytes, platelets, and bone. High levels are associated with prostate cancer, and plasma levels of prostate-specific antigen (PSA) aid in diagnosis.

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γ-glutamyl-transferase (GGT)

An enzyme concentrated in hepatocytes (liver cells), kidneys, pancreas, and prostate. Elevated levels are indicative of alcohol-induced liver disease, liver cirrhosis, or blockage of bile ducts.

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Pulmonary Embolism and Infarct

Elevated levels of several enzymes, including LDH, CPK, B-hydroxybutyrate dehydrogenase, are linked to pulmonary embolism. Specific isoenzymes, such as LDH-3 and Alkaline Phosphatase, are often associated with pulmonary infarct.

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Study Notes

Clinical Enzymology: Overview

  • Enzymes are proteins that catalyze biochemical reactions. Some enzymes are secreted into the blood plasma, while others remain primarily intracellular.
  • Active enzymes are produced and stored within cells. Their presence in the plasma is usually indicative of cell damage.
  • Non-functional enzymes may be secreted into the plasma due to cell membrane disruption.

Factors Influencing Plasma Enzyme Assays

  • Analytical factors include substrate and product concentrations, pH, temperature, buffers, and inhibitors/activators, all of which influence enzyme activity measurements.
  • Physiological factors such as age, gender, and current physiological condition can affect enzyme levels in the plasma.

Isoenzymes

  • Isoenzymes catalyze the same reaction but have different structures and electrophoretic migration patterns.

Intracellular Enzyme Location

  • Different enzymes reside in various cellular compartments (cytoplasm, mitochondria, Golgi, ER, lysosomes, and membranes).
  • Specific enzymes are associated with particular cellular structures.

Enzymes of Clinical Significance

  • Elevated enzyme levels in the blood often signify tissue damage in specific organs (e.g., liver, heart, muscles, pancreas).
  • Source and elevated levels, indicating potential disease:
    • ALT (increase): liver damage
    • AST (increase): heart attack (MI), liver damage
    • GGT (increase): Liver disease especially with obstructive jaundice
    • ALP (increase): biliary tract issues (blockages), bone disease
    • ACP (increase): prostate cancer
    • CK (increase): heart attack (MI), muscle diseases
    • AMS (increase): pancreatitis
    • LPS (increase): pancreatitis
    • CHS (decrease): Liver disease

Functional vs. Non-Functional Enzymes

  • Functional enzymes perform metabolic functions within cells and typically have low plasma levels.
  • Non-functional enzymes are used as diagnostic markers of cell damage or disease. Enzyme activity increases in response to cellular damage, changes in membrane permeability or or increased production.

Specific Enzyme Examples and Clinical Significance

  • Lactate Dehydrogenase (LDH): Found in many tissues; increased levels indicate cellular damage (e.g., heart attack, kidney transplant rejection, anemia). Not the best tool as it is plentiful throughout the body.
  • Aspartate Transaminase (AST): Abundant in the heart, liver, and other tissues. Its increase signals damage to these organs (e.g., heart attack, hepatitis). This rise is often an early indicator of hepatitis (before bilirubin detection).
  • Alanine Transaminase (ALT): Primarily in the liver; elevated levels suggest liver damage. Often rise early before liver damage markers increase.
  • Creatine Kinase (CK): Found in muscle cells and brain. Increase suggests muscle or heart damage (e.g., heart attack, muscle disorders). Has isoenzymes (CK-MM and CK-MB) important for specific diagnoses.
  • Alkaline Phosphatase (ALP): Found in various tissues including bone; may signal issues with the biliary tract (obstruction).
  • Acid Phosphatase (ACP): Mostly in prostate; elevated levels indicate possible prostate cancer.
  • Y-glutamyl-transferase (GGT): Found in the liver kidney etc; high in men. Associated with alcohol use and liver disease.

Using Enzymology in Diagnosis

  • Specific enzyme patterns or elevations can help diagnose a variety of conditions, including heart attacks, liver disease, various cancers, and other organ-related issues.
  • Enzyme levels, isoenzyme patterns, and enzyme presence in urine or other body fluids are used to diagnose diseases.

Pancreatitis

  • Increased digestive enzymes (amylase, lipase, trypsin) in the plasma and urine indicate pancreatic damage.

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Description

Explore the fascinating world of enzymes with this quiz on clinical enzymology. Learn about the roles of active and non-functional enzymes, factors influencing plasma enzyme assays, and the significance of isoenzymes in biochemical reactions. Perfect for students and healthcare professionals alike!

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