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وهذا ملخص الأخ شادي للكيمياء فيه بعض المعلومات العامة ..General Informtion for chemistry :-

pH is defined as a negative logarithm of the hydrogen ion activity in a solution .
PH = - log { H }
pH indicator:- change of the solution color depend on PH.
indicators Acidic Basic
Litmu Red Blue
Phenolphthalein Colorless Pink to red

-Plasma osmolality is a measure of the concentration of substances such as sodium, chloride, potassium, urea, glucose, and other ions in blood.

-The bicarbonate buffering system (HCO3) is an important buffer system in the blood

*Cholsetrol :-
Some types of cholesterol :-
1- Low-density lipoprotein (LDL) :- It is harmful . it cause atherosclerosis .
2- High-density lipoprotein (HDL) :- it is useful .
3- Very-low-density lipoprotein (VLDL) :- It is transports endogenous products
4- Chylomicrons :- transport exogenous


- GGT is elevated by large quantities of alcohol (( alcoholism ))

-The dose of glucose in GTT in adult is 75 Gram . and 30 Gram in children
-For GTT collect 5 sample of blood + 5 sample of urine .

*Copper reducation test :- detect glucose
* Copper reducation test :- not detect sucrose .

*atomic mass = the number of Protons + the Number of Neutrons
*Atomic number = the number of Protons
Proton is positive charge .
Neutron is neutral charge ( متعادلة )
Electron is negative charge .

*Spectrophotometer :- used to measure the light transmitted by solution in order to determine the concentration .
Spectrophotometer components :-
1- light source . 2- monochrmators . 3- cuvettes 4- phtodetector 5- read out device.

*Flamofhotometer :- determine concentration of alkali metals like sodium , potassium , lithium , in body fluid .
Flamofhotometer components :-
1-flame . 2- atomizers. 3- monochromators . 4- detector . 5- read out device

Visible wave length = 400 – 700 nm
Ultraviolet wave length = 10 – 400 nm

* carbohydrate : -
Classification OF Carbohydrate :-
1- monosaccharide . 2- oligosaccharide .
3-polysaccharide .

1- monosaccharide : it contain two group :-
- aldose : which contain aldehyde group . eg : glucose (aldohexosis)
- ketose : which contain ketone group . eg : fructose ( ketohexosis)

2- oligosaccharide : which contain 2-10 unit of monosaccharide .
- example of oligosaccharide :
1- sucrose . 2- maltose .
3- lactose . 4- cellobiose .

* Sucrose (table sugar ) : consist of glucose +fructose .
*Maltose : it is alpha glucose .
* Lactose ( milk sugar ) : consist of glucose + galactose .
* Cellobiose : consist of beta glucose .

3- polysaccharide : there are polymer of monosaccharide (more than 10)
* example : 1- starch . 2- glycogen . 3- cellulose .

* starch : consist polymers of glucose (formed in plant )
|* glycogen : it is called animal starch .

*Digestive of carbohydrate :
1- digestion of carbohydrate start in mouth by alpha amylase secreted by salivary gland .
2- the digestion of carbohydrate contentious in small intestine by pancreatic alpha amylase , which convert starch to maltose & maltase convert maltose to glucose .
3- glucose convert in liver .

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* LIPID : -
* insoluble in water .
* classification of lipid :-
1- simple lipid . 2- complex lipid . 3- derived lipid .

* Simple lipid : it is formed from alcohol +fatty acid only .
*complex lipid : formed from alcohol + fatty acid +another material like phosphate group or protein or carbohydrate .
- example of complex lipid : phospholipid - glycolipid .
* derived lipid : derived from simple and complex lipid , they consist of :
a- fatty acid . b- alcohol. C- hydrocarbon .
-example of derived lipid : steroid – cholesterol .

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* protein : unit of amino acid .
*digestion of protein :
1- start in stomach .
2- the digestive enzyme in the stomach is pepsin and rennin
*pepsin : is initiate protein digestion .
* rennin : cause coagulation milk , found in infant only .
3- digestion of protein continuous in intestine .
* pancreatic secretion consist :trypsin – chemotropsin &elastase .


*homeostasis : keep internal environment constant .
*water content in the body : 40-75% of total body weight .
*water balance :-
2500ml/day where loss from the body
* regulation of body water :
- normal water balance maintained by 2 important factor :
1- rennin –angiotensin –aldosteron system
2- anti – diuretic hormone (ADH)

* MINERAL METABOLISM :

*SODIUM (NA+)
- is the most abundant cation (positive ion ) in the extra – cellular fluid (ECF)
- it is found associated with minerals mainly with NACL (common salt )
-RDA (recommended daily allowance ) 10-15 g nacl /day .
- normal range of NACL : 135- 145 mmol/l

* Hyponatremia :
-decrease level of NA+ .
* causes :
- decrease intake of NACL
- addism"s disease ( deficiency of mineralocorticoid )

* hypernatremia :
- increase plasma level of NA
*causes :
-cushings syndrome ( excess glucocorticoid ) .

*estimation OF SODIUM :
-iron selective electrode (ISF )

*POTTASIUM (K) :
- the most abundant cation (positive ion ) in the intra-cellular fluid (ICF ) of the body .

*RDA :at least 1,3 g/day .
-normal range : 3.5-5 mmole/l .





*hypokalemia :
- decrease plasma level of K
-causes :
1- cushings syndrome (excess glucocorticoids ) .
2- insuline overdose .
3- alkalosis .

*hyperkalemia :
- increase plasma level of K
-causes :
1- adisson disease (deficiency of mineralcorticoid )
2- acidosis .
-estimation of K :
1- iron selective electrode (ICF)

*CALCIUM (CA2+)
-it is most abundant mineral in the body 70kg contain one kg calcium .
- RDA : 4-6 g/day .
-normal range : 9-11 mg /dl .
-the free calcium (ionized ) is active calcium .
* function of ionized calcium :
1- participates in blood coagulation .
2- important for contraction of all heart .
*regulation of calcium metabolism :
- calcium and phosphorus is controlled by :
1- parathyroid hormone (PTH) secret from parathyroid gland
2- active vit D3
3- calcitonin ( secreted from the thyroid gland )

* function of parathyroid hormone :
a- on bone :
it promote mobilization of calcium and phosphorous from bone to blood .
b- on kidney :
it promote re-absorption of calcium and excretion of phosphorous by kidneys .
*there for , PTH is ahypercalcemic hormone ,
*function of active vit D3 :
a- on intestine :
it promote absorption of calcium and phosphorus in the intestine .
b- on bone :
promote formation of bone ,
vitamin D deficiency has been associated with Rickets
*function of calcitonin :
Antagonized the action of PTH :
a-on bone :
promote mobilization of calcium and phosphorous from blood to bone , it promote bone formation .
b- on kidney :
promote excretion of calcium and re-absorption of phosphorous by kidneys .
therefore , calcitonin is hypocalcemic hormone .

* HYPOCALCEMIA :
-low plasma calcium level .
-causes :
1- acute pancreatitis
2- renal disease .

*HYPER CALCEMIA :
- high plasma calcium level .
- causes :
1- malignancy .
2- hyperparathyroidism .
*hypercalcemia cause renal stone .
-Estimation of calcium ;
Anticoagulant such as oxalate or EDTA , bind calcium interfere with calcium estimation , they should be avoided .
Iron selective electrode (ISE)

* ANTICOAGULANT example : heparin – citrate – oxalate – EDTA .

CHLORIDE (Cl-) : *
-major anion of ECF.
-normal plasma level : 300-365 mg/dl .
-normal CSF Cl level : 350 – 440 mg/dl .
*HYPOCHLOREMIA :
-low plasma chloride level .

*MAGNESIUM (Mg2+)
- it is the fourth most abundant cation in the body (after calcium – phosphorous – sodium )
-RDA : 350 mg/ day .

*TRACE ELEMENTS :
-they are needed in the body in minute (trace) amount .
a- essential trace elements:
-they have known physiological function in the body e.g. :iron –copper – zinc – manganese – iodine – fluorine .
b- non – essential trace elements:
they have no known physiological function in the body , their administration may harm the body e.g. : aluminum – cadmium – arsenic –lead – mercury – gold .

*IRON (FE)
-RDA : 10-20mg /day .
-pregnant or pre-menopausal women and children have greater iron requirements .
-distribution of iron in the body : 5 g ( 60% in hemoglobin )





*form of iron in the body :
1-iron is present the divalent (ferrous fe2+) state in hemoglobin – mycoglobin – catalase and peroxidase .
2 – iron is present in the trivalent (ferric state fe3+ )in the transferrin – ferritin – hemosiderin .

*function of iron :
- hemoglobin transports O2 from lungs to tissues and CO2 in the reverse direction .

*metabolism of iron :
-dietary iron is mainly in the ferric (Fe3+) form .
- in the stomach :
Ferric (Fe3+) is converted to ferrous (Fe2+) by vit C and gastric HCL .
- in the small intestine :
Absorption of Fe2+ mainly occur in small intestine
-in the plasma :
Fe2+ is oxidized to Fe3+ by ferroxidase and bound to transferrin which transport Fe3+ and release it in the bone marrow .
- in bone marrow :
Iron incorporated in the hemoglobin of RBC .

*clinical disorders of iron :
1- iron deficiency anemia .
2- iron overload .

* iron deficiency anemia :
-parameters of iron deficiency anemia :
1- decrease serum iron ,
2- increase plasma transferrin,
3- increase total iron binding capacity (TIBC)
4- decreased serum ferritin

*Iron overload :
- parameters of iron overload :
1- increased serum iron .
2- decreased plasma transferrin.
3- decrease total iron binding capacity (TIBC)
4- increase serum ferritin .

*COPPER (CU):
-copper essential for normal pigmentation .
-copper excess cause Wilson disease .

* ZINC (ZN2+)
- RDA : 15mg/day .





* IODINE (I)
-plasma level : 5-10 mg/dl .
- iodine enter in the formation of thyroid hormone (T3 –T4)
-deficiency of iodine ;
Causes enlargement of thyroid gland (goiter)
-function of iodine is prevent dental caries .




Organ Function :-
*Heart :-
Plasma enzymes used in diagnosis of myocardial infraction :-
1- Creatin kinase ( CK )
2- Aspartate transaminase ( AST )
3- Lactate dehydrogenase ( LDH )

These are used in diagnosis in heart attack ( Myocardial infraction )

- Creatin kinase ( CK ) or creatine phosphokinase ( CPK ) :-
CK in brain and heart and skeletal muscles .
1- CK 1 ( BB ) mainly in the brain .
2- CK 2 ( MB ) mainly in heart
3- CK 3 ( MM ) mainly in skeletal muscle .
* CKMB :increased 4- 8 hours following acute myocardial infraction .
* LDH :- increased 24 hours following the acute myocardial infraction .

* Liver :-
- liver function tests :-
1- Alanine transaminase (ALT)(SGPT):- diagnosis for abnormality liver function .
2- Aspartate transaminase (AST)(SGOT) :- diagnosis for abnormality liver and heart function .
3- Alkaline phosphatase (ALP) :- diagnosis for abnormality liver and Bone function . it is better to diagnosis of chronic bile duct .
Bile is :- secreted from the liver .
- Carbohydrate metabolism in liver :-
1- Glycolysis :- oxidation of glucose ( in cytoplasm or cystol ) .
2- Gluconeogenesis :- synthesis of glucose from non carbohydrate compounds .
3- Glycogenesis :- synthesis of glycogen from glucose .
4- Glycogenolysis :- Breakdown of glycogen to glucose .
-Proteins metabolism in liver :-
1- Protein convert to -----} amino acid .
2-Ammonia convert to ----} urea .
3- synthesis of Albumin .

-Liver store Vitamin B12 which is necessary for synthesis of RBCs .
- Kupffer cells are found in liver .

* Jaundice :- it is yellowish discoloration of the skin , mucus , membrane , and sclera of eye due to increases serum bilirubin ( more then 2 mg/dl )
-Normal indirect bilirubin = 0.1 – 0.8 mg/dl
-Normal direct bilirubin = 0.1 – 0.4 mg/dl
Normal total bilirubin = 0.2 – 1.2 mg/dl
Bilirubin should be kept away from light . -

-Types and causes of Jaundice :-
1- Pre-hepatic ( Hemolytic ) jaundice :- the pathology is occurring prior ( before ) the liver .
2- Hepatic jaundice :- the pathology is located within the liver .
3- Post-hepatic ( Obstructive ) jaundice :- the pathology is located after the conjugation of bilirubin in the liver.




*Kidney :-
- Non – Protein Nitrogenous ( NPN ) compounds :-
1- urea 2- creatinine 3- uric acid 4- ammonia 5- amino acid

-Urea :- it is the final product of breackdown ( catabolism ) of protein ( amino acid ) -it is present more then 75% of NPN (Non – Protein Nitrogenous )
Ammonia converted in the liver to urea .
-Normal blood urea is 15-45 mg/dl
- Urea in the blood measure as the blood urea nitrogen ( BUN )
- Noraml BUN is 7-22 mg/dl

-creatinine :- Normal plasma creatinine is 0.7 – 1.4 mg/dl
Normal creatinine clearance is 97 – 137 ml/min


-Uric acid :- it is the waste product of the Purine metabolism
Normal plasma uric acid is 3 – 7 mg / dl
- increased in uric acid cause :- Gout disease

-Renal ( kidney ) function test :-
1- blood urea or blood urea nitrogen .
2- serum creatinine .
3- creatinine clearance .
4- serum Uric acid .


* Body fluid :-
- Semen :- is secreation from these glands :
1- testes
2- seminal vesicles
3- prostate
4- bulbourethal gland
- composition of the semen :-
Color : white , opalescent
Volume : 2-5 ml/ejaculation
PH : 7.35 – 7.50
-Components :-
The important component is Fructose ( which is the sugar in the semen that give energy to the sperms )
*Microscopic examination of semen :-
1- sperm count :-
Normal 60-150 millions/ml
Oligospermia : less than 20millions/ ml
Azospemia : no sperm at all .
2- motility : normally less than 80% motile after 1 hour .
3- morphology : normally less than 80% of sperm are normal .
4- WBCs : there are very little number of WBCs .(less than 1).
* biochemical tests of semen :
-fructose test : fructose is secreted from seminal vesicle for nutrition of sperms .
-fructose absent in cases of :
a- absence of seminal vesicle .
b- obstruction of ejaculatory ducts .
- fructose test used as fertility test

.
* cerebrospinal fluid (CSF) : it is found in the subarachonoid space .
-normal composition of CSF :
1- volume : 135-150ml .
2- color : colorless .
3- appearance : clear with no clot .
4- PH : 7.3 .
5- glucose : 45-100 mg/ dl



* Urine :-
- normal compositions :-
1- sodium , potassium , chloride , urea , uric acid , creatinine .
-abnormal biochemical constituents of urine :
1- protein – glucose – lactose – ketone bodies – bile pigments – bile salt – urobilinogen – hemoglobin .

*volume of urine :
-normal volume of urine : 600-2500 ml/24hrs .
-polyuria : abnormal increase of urine volume (more than 2500 ml/24hrs)
-oliguria : abnormal decrease of urine volume (les than 500 ml/24hrs )
- anuruea :complete suppression of urine formation e.g. acute renal failure .
*color of urine :
-normal color : light amber color .
- Greenish yellow due to bilirubin (jaundice )
- Red due to blood (hematouria )
- Black (alkaptonuria )
*odor of urine :
-normal odor : pungent smell due to presence of aromatic acids .
- Ammonia smell : prolonged standing .
- Fecal smell : urinary infection .
- Fruit smell : ketosis .
* aspect of urine :
-normal urine is clear .
- abnormal urine is turbid due to presence of :
a- bacteria . b- suspended crystals .
c- mucus . d- blood .
* Reaction (PH) and specific gravity of urine :
- normal PH : 4.7- 7.5 (acidic )
* Biochemical examination of urine :
1-protien . 2-sugar e.g. glucose .
3- ketone bodies . 4- bile salts (jaundice )
5- bile pigment (jaundice) 6- blood .

-protien in urine (proteinuria ):
*TYPE :
1- albuminuria : detect by heat coagulation test .
2- bence – jones proteins : abnormal globulin appear in urine in the condition
a- multiple myeloma . b- leukemia .
* Glucose in urine (glucosuria ) :
Causes :
1- diabetes mellitus .
- glucosuria detect by fehling test .
* Ketone bodies in urine (ketouria ) :
- detect by urine by rothera test .
* Bile salt and Bile pigment in urine :
a- bile salts : they are present in urine in case of obstructive jaundice .
-bile salt detect in urine by hays .
b- bile pigments : they are present in urine in all type of jaundice .
- bile pigment detect in urine by alcoholic iodine ring .
* blood in urine (hematouria ):
- causes :
1- bilhaziasis . 2-blood disease .
3- renal stones. 4- renal tumors .
*Microscopic examination of urine :-
-Include the presence of :-
1- cells ( RBC – WBC – PUS cell )
2- Crystals :- ( oxalate – urate , phosphate , uric acid crystal )
3- casts
4- Ova :- ( Belharzia ova )
5- Parasites ( Leshmania larva – trichomnous )


* Urinary Cells :-
1- Pus cells . 2- Red Cells . 3- Epithelial cells

* Pus cell :- normal urine contain 2- 4 pus cells/HPF
*Red Cells :- normal urine contain 0-2 Red cell/HPF
The presence of excess of RBC is pathological and called Hematuria .
*Epithelial cells :- normal urine contain Few Epithelial cells .

*Urine Crystals :-
a- crystal in acidic urine :- 1- calcium oxalate . 2- uric acid . 3-amorphous urate .
b- crystal in alkaline urine :- 1- Tripple phosphate . 2- Amorphous phosphate .
All these crystal are not present in normal urine .

*Urinary casts :- Normal urine does not contain casts .
*Urinary microorganisims :-
1- Bacteria . 2- yeasts . 3- Protozoa . 4- Parasites .

* Some Normal Range :-
1- AST : 5-35 U/L
2- ALT : 7-56 U/L
3- ALP : 38-126 U/L
4- Albumin : 3.5-4.8 U/L
5- Amylase : 30-110 U/L
6-direct bilirubin : less than 0.3 mg/dl
7- total bilirubin : 0.2-1.3 mg/dl
8-calcium : 8.9-10.4 mg/dl
9-cholestrol : 120-200 mg/dl
10-creatinine : 0.5-1.4 mg/dl
11- Glucose : 70-120 mg/dl
12- Potassium : 3.6-5 mEq/l
13-sodium : 135-145 mEq/l
14-triglyceride : 50-250 mg/dl
15-uric acid : 3.5-8.5 mg/dl
16-urea nitrogen 7-21 mg/dl
17-total protein : 6.3-8.2 gm/dl


* Diabetes mellitus : - it is metabolic disorders of carbohydrates metabolism producing hyperglycemia and glucosuria .
- Types of Diabetes mellitus :-
1- type 1 diabetes .
2- type 2 diabetes .


* Type 1 Diabetes mellitus ( 10% ) :- appear at young age before 30 years .
And it dependent of external insulin .
- Symptoms :-
1- Polyuria ( passing urine increase )
2- polydipsia ( feeling of thirst increase )
3- polyphagia ( feeling of hunger increase )
4- weight loss .
5- weakness .
6- ketoacidosis .

*type 2 Diabetes mellitus (90%) : appear after 40 years of age .
And not depended on external insulin (insulin may be normal or high )
-symptoms :
1- Polyuria ( passing urine increase )
2- polydipsia ( feeling of thirst increase )
3- polyphagia ( feeling of hunger increase )
4- without ketosis
5- obesity is common.

* Normal Random blood sugar : 80- 120 mg/dl .

* أما عن عوامل التجلط فهذا الرابط قد يفيدك ..



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