Professional Documents
Culture Documents
Cell destruction Cell Proliferation Increases synthesis oxidoreductases, transferases, hydrolases, lyases, isomerases, ligases Substrate concentration Enzyme concentration pH Temperature Cofactors inhibitors
1.Enzyme 2.Substrate 3.E-S complex 4.End Product the at nearby concentrations of substrate is almost negligible At these concentrations almost all of the enzyme molecules are bound to substrate and the rate is independent of substrate, zero order. At substrate concentrations near point A the rate appears to be directly proportional to substrate concentration At the substrate concentration exactly half the enzyme molecules are in an ES complex at any instant and the rate is exactly one half of Vmax concentration of substrate that gives "halfmaximal activity". if enzyme is elevated that all substrate is consumed early in reaction. Then the rate change is minimal = Errors sudden decrease in reaction rate, may indicate that the patient sample containing a enzyme level requires a dilution or decreased amount. Lipase: Triglyceride substrate Omylase: Starch substrate Elevated in liver and bone disorders Normal elevations in children and during pregnancy. 1
Vmax = Point B
Constant Km =
Alkaline Phosphatase
delta bilirubin
1.Which is helpful in diagnosing bone disease? 2.Which enzymes are helpful in diagnosis of muscle disorders? 3.Which enzymes tests for hepatic function? 4.Which one enzyme is most sensitive for all types of liver disease? 5.Is AST or ALT more specific for liver disease? 6.Which is sensitive indicator of alcoholism? first organ to encounter nutrients, vitamins, drugs, toxic agents etc. Most common liver injury is due to
3.ALT,AST, alkaline PO4 4.GGT 5.ALT is primarily found in liver & RBCs
6.GGT Liver viruses (hepatitis). 1. Synthetic and Metabolic 2. Excretory 3. Detoxification and protective 4. Hematology/Coagulation
FUNCTIONS OF LIVER
Steatosis
Necrosis means neoplasia BILIRUBIN Conjugated (water soluble) bilirubin is excreted from liver into the removes the glucuronide from bilirubin and reduces bilirubin to
premature death of cells in living tissue The formation or presence of a new, abnormal growth of tissue. bile.
urobilinogen.
excreted in
2 ways how?
turns color which gives feces and urine its color. BILIRUBIN METABOLISM Excreted as: 2 chemicals? Where? stays attached until the albumin molecule is turned over, but measures as conjugated 3
Delta bilirubin
JAUNDICE 2 kinds
Posthepatic Jaundice
Direct Bilirubin =
Indirect Bilirubin =
INCREASED ALBUMIN In 4?
> ALT
6-37 U/L
Less than 1:1 viral hepatitis nonalcoholic steatohepatitis Greater than 1:1 (2:1, 3:1) chronic alcohol-induced liver damage (AST rarely more than 8x normal; ALT seldom more than 5x; maybe normal)
AST:ALT ratio
ALT
44 to 147 IU/L Bile Duct Obstruction gall stones, surgery, cancer Bile Duct Disease primary biliary cirrhosis Drug-Induced cholestasis Liver Infiltration cancer, fungus, sarcoidosis may give highest values 7
disease Reference Ranges ALT AST ALP GTT - 37 U/L female - 30 U/L - 90 U/L age important - 45 U/L male 5 30 U/L Female
AMMONIA (NH3)
Elevated in blood when liver failure levels low in Serum Encephalopathy, or damage to nerves in the brain, may be consequence of high ammonia (up to 5x)
GASTRIN hormones, and enzymes Zollinger-Ellison syndrome : Gastric-producing tumor leading to peptic ulcers, gastric hypersecretion; elevated gastrin Acute Pancreatitis Blockage of pancreatic duct with gallstones Alcohol excess Physical Trauma Chronic Pancreatitis Gall Bladder disease Alcoholism Pancreatic Cancer 4th most frequent form of fatal cancer 5 year survival <5% Pancreatic Insufficiency Cystic Fibrosis Chronic Pancreatitis
Pancreatic diseases
formed Amyloclastic: measure decrease in starch substrate from dye-labeled substrate Hydrolyzes triglycerides
LIPASE earlier and persist longer Titrimetric: olive oil substrate; titrate fatty acids using pH indicator Turbidimetric: measure decrease in turbidity due to hydrolysis of substrate coupled with enzymatic reaction
mutations in a gene located on chromosome 7. Causes production of thick mucus due to faulty transport of Na and Cl within cells lining lungs and pancreas. Mucus obstructs pancreatic secretions from reaching duodenum Manifestations: intestinal obstruction, pulmonary infections, malabsorption
CYSTIC FIBROSIS
CYSTIC FIBROSIS DIAGNOSIS SWEAT CHLORIDE ANALYSIS CONSIDERED MOST RELIABLE SINGLE TEST FOR DIAGNOSIS OF CYSTIC FIBROSIS Elevated sweat sodium and chloride (>60 mmol/L) in cystic fibrosis Iontophoresis, using drug pilocarpine to induce sweat Sweat is collected on preweighed gauze Elevated sweat sodium and chloride (>60 mmol/L) in cystic fibrosis Iontophoresis, using drug pilocarpine to induce sweat Sweat is collected on preweighed gauze Chloride/ Na is measured d-Xylose: pentose sugar not normally in blood Ability to absorb D-xylose helps in diagnosing malabsorption problems in intestine vs pancreatic insufficiency Test Fast, void in AM, drink d-Xylose and water Collect blood at 2 hours, and Urine collected after 5 hours
10