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قضية الأسبوع (3) وتحليل وظائف الكبد(تم حلها)

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  • قضية الأسبوع (3) وتحليل وظائف الكبد(تم حلها)

    Case Study No.3




    A 30-year-old man with a long history of intravenous drug abuse and chronic hepatitis B presents with jaundice. Physical examination reveals a malnourished man with ascites (edema in the abdomen). The patient has poor concentration.

    The doctor has ordered the following tests to him


    Total protein, albumin, globulins, calcium, BUN, creatinine, total bilirubin, AST , ALT, CBC Coagulation profile (PT)


    Q One If you were the phlebotomist who is obtaining the samples, what kind of tubes you may use

    Q Two what is the function of our liver

    Q Three what is liver function profile


    Q Four what are the patient precaution points you may tell the nurse in order to prepare patient

    Q Five If you were the lab technician or specialist who runs the samples for this patient, what are the causes make you reject the patient's specimens



    After running these tests, these are the results of the patient


    Total protein 8.3 g,d/L (normal, 6.O-7.8 g/dL)

    albumin 2.5 g/dL (normal, 3.5.-5.5 g/dL)

    globulins 5.8 g/dL(normal, 2.3-3.5 g/dL)

    calcium 6.5 mg/dL (normal, 8.4-10.2 mg/dL)

    BUN 5 mg/dL (normal, 7-18 mg/dL)

    Creatinine 0.9 mg/dL (normal, 0.6-1.2 mg/dL)

    Total bilirubin 6.0 mg/dL (normal, 0.1-1.0 mg/dL)

    AST 7 U/L, (normal, 8-20 U/L)

    ALT 5 U/L (normal, 8-20 U/L)

    CBC: macrocytic anemia with hypersegmented neutrophils, mild neutropenia, and mild thrombocytopenla

    Coagulation: prothrombin time (PT) is prolonged and does not correct with intramuscul vitamin K


    Q Six If you were responsible for reviewing the patients results before releasing, to ensure the results are accurate an no errors happened


    AA What are the pathological causes that lead to abnormal liver function profile

    BB How do you explain the result of low transaminase enzymes although the patient has hepatitis and drug abuse


    CC How do you explain abnormal tests, hypoalbuminemia, and prolonged prothrombin time that does not correct with intramuscular vitamin K


    DD Why TP is high while Albumin is decreased

    EE Does the patient kidney affected? Why BUN is low


    FF Why Ca is abnormally low in this patient


    Q Seven What is the relation between the patient diagnosis and the poor concentration symptoms

    Q Eight What is the most likely cause of the macrocytic anemia in this patient


    Q Nine the physican is already graduated,


    Aa He forgot to write the diagnosis, what do you think the diagnosis is

    Bb what do you suggest an additional test to investigate liver function


    Cc what do you suggest an additional test to investigate CNS problem




    الأسئلة سهلة ..بس تحتاج تركيز وبحث

    بالتوفيق
    sigpic

    قال صلى الله عليه وسلم:
    (ثلاث كفارات وثلاث درجات وثلاث منجيات وثلاث مهلكات فأما الكفارات فإسباغ الوضوء في السبرات وانتظار الصلوات بعد الصلوات ونقل الأقدام إلى الجماعات وأما الدرجات فإطعام الطعام وإفشاء السلام والصلاة بالليل والناس نيام وأما المنجيات فالعدل في الغضب والرضا والقصد في الفقر والغنى وخشية الله في السر والعلانية وأما المهلكات فشح مطاع وهوى متبع وإعجاب المرء بنفسه)

  • #2
    Q1

    PLAIN TUB
    EDTA TUB
    sodium citrait tube

    Q2
    Major function of liver

    (
    carbohydrate metabolism(gluconeogenesis, glycogen synthesis and breakdown
    fat metabolism(fatty acid synthesis, cholesterol synthesis and excreation, lipoprotein synthesis, ketogenesis, bile acid synthesis and 25-hydroxylation of VD)I
    PROTEIN METABOLISM (synthesis of plasma protein (including some coagulation facyors ),urea synthesis
    Hormone metabolism (metabolism and excretion of steroid hormones, metabolism of polypeptide hormones)i
    Metabolisme and Excretion of Drugs and foreign compounds
    Metabolisme and Excretion of bilirubin
    glycogen, VA, VB12 AND IRON STORGE


    liver function profile

    Alanine aminotransferase (ALT) – an enzyme mainly found in the liver; the best -test for detecting hepatitis
    • Alkaline phosphatase (ALP) – an enzyme related to the bile ducts; often increased when they are blocked
    • Aspartate aminotransferase (AST) – an enzyme found in the liver and a few other places, particularly the heart and other muscles in the body
    • Bilirubin – two different tests of bilirubin often used together (especially if a person has jaundice): total bilirubin measures all the bilirubin in the blood; direct bilirubin measures a form that is conjugated (combined with another compound) in the liver
    •Albumin – measures the main protein made by the liver and tells whether or not - the liver is making an adequate amount of this protein
    • Total Protein - measures albumin and all other proteins in blood, including antibodies made to help fight off infections
    Other tests that could be requested along with the liver panel are gamma-glutamyl transferase (GGT), lactic acid dehydrogenase (LDH), and prothrombin time (PT).

    Q6

    A) the pathological causes that lead to abnormal liver function profile

    hepatitis, cirrhosis, cholestasis and malignancy and infiltration


    B) low transaminase enzymes although the patient has hepatitis and drug abuse

    due to hepatocellular destruction
    CC) How do you explain abnormal tests, hypoalbuminemia, and prolonged prothrombin time that does not correct with intramuscular vitamin K
    synthesis of plasma protein (including some coagulation facyors and albumin are one of liver function,so hypoalbuminemia, and prolonged prothrombin time that does not correct withintramuscular vitamin K is due to hepatocellular dysfunction in chronic hepatitis

    E)Does the patient kidney affected? Why BUN is low

    NO,BUN is low due to urea cycle defect(urea is the end product of protein metabolism that occure in liver and due to liver damage the urea cycle will be defect then their concentration increases in blood.
    FF) Ca is abnormally low in this patient blc he is malnourished man

    Q7

    the relation between the patient diagnosis and the poor concentration symptoms(Due to ammonia that produce due to urea cycle defect while ammonia is blood brain bariar
    )
    Q8

    cause of the macrocytic anemia in this patient(since the patient is malnourished man,so the
    macrocytic anemia is aresult of folat deficincy
    Q9

    an additional test to investigate liver function
    Alkaline phosphatase
    Gamma-glutamyl transferase
    Ammonia
    an additional test to investigate CNS problem
    Ammonia, CA

    تعليق


    • #3
      Q1-If you were the phlebotomist who is obtaining the samples, what kind of tubes you may use? -
      plain tube or heparin tube for chemistry test
      -EDTA tube for CBC
      -sodium citrait tube for coagulation profile


      Q2-what is the function of our liver?
      The liver is intimately involved in many of the important functions of our body. The liver secretes vital digestive juices that help us properly digest our food and cleanses our blood of the pesticides, steroids, pharmaceuticals and additives that we absorb. With the help of our liver we naturally expel the metabolic by-products and toxins produced from the regular functioning of our bodies. The liver also has a profound effect on the hormonal system, helping to regulate and balance hormonal activity to ensure the proper functioning of our neurological system.

      Q3-what is liver function profile?
      Total bilirubin – measures all the yellow bilirubin pigment in the blood. Another test, direct bilirubin, measures a form made in the liver and is often requested with total bilirubin in infants with jaundice.
      Albumin – measures the main protein made by the liver and tells how well the liver is making this protein


      Total protein - measures albumin and all other proteins in blood, including antibodies made to help fight off infections


      Alanine aminotransferase (ALT) – an enzyme mainly found in the liver; the best test for detecting hepatitis


      Alkaline phosphatase (ALP) – an enzyme related to the bile ducts; often increased when they are blocked


      Aspartate aminotransferase (AST) – an enzyme found in the liver and a few other places, particularly the heart and other muscles in the body



      Q4-what are the patient precaution points you may tell the nurse in order to prepare patient?
      I think no specail precaution to prepare patient except: Explain test purpose and blood drawing procedure for the patient.


      Q5-If you were the lab technician or specialist who runs the samples for this patient, what are the causes make you reject the patient's specimens?1-Unlabeled sample
      2-Mislabeled sample
      3-Improperly/Incompletely Labeled
      4-Corrective Action for Labeling Errors
      5-Specimen collected in wrong tube, container or preservative for the test requested.
      Incorrect Information—unsigned, not dated misspelled name, etc.
      6-Specimen inappropriately handled with respect to temperature, timing or storage requirements.
      8-Quantity not sufficient (QNS).
      9-Lipemic and grossly hemolyzed specimens may be rejected for certain tests.



      Q6-What are the pathological causes that lead to abnormal liver function profile?
      A- hepatitis A, hepatitis B and hepatitis C cirrhosis. Jaundice , cancer ,hemochromatosis.

      B-How do you explain the result of low transaminase enzymes although the patient has hepatitis and drug abuse?B- because in severe liver disease can cause false decreases in transaminase enzymes .

      C-How do you explain abnormal tests, hypoalbuminemia, and prolonged prothrombin time that does not correct with intramuscular vitamin K?C- because the patient has hepatocellular dysfunction in chronic hepatitis
      D-Why TP is high while Albumin is decreased?
      D- it is due to incrase in globulins which lead to incrase TP

      E-Does the patient kidney affected? Why BUN is low?
      E-The kidney of the patient not effected. and the BUN high due to the defect in urea cycle
      F-Why Ca is abnormally low in this patient?
      F-The hepatits and drug abuse can cause hypocalcemia

      Q8-What is the most likely cause of the macrocytic anemia in this patient ?
      The main causes of macrocytic anemia for this patient are 1-liver diseases 2- B12 deficincy

      Q9-what do you suggest an additional test to investigate liver function?
      we must do the following test :-
      1- ALP 2-Serum protein electrophoresis 3-amalyse enzyme 4- GGT 5- ammonia-

      what do you suggest an additional test to investigate CNS problem
      ?
      Ion selective electrode test
      التعديل الأخير تم بواسطة antivirus; الساعة 15-02-2008, 12:18 PM.

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      • #4
        This is my answer in the attached file
        الملفات المرفقة
        :extra77:

        تعليق


        • #5
          My answer

          :Q1: EDTA(CBC)
          Plaine for chemistry
          sodium citrate(pT-PTT)

          Q2: metabolism of CHO, protien, lipid and drug
          synthesis of bile, caogulation profile, albumine and complement
          secreation of bile salt and bilirubin

          Q3: secreation the following
          ALT, AST and ALp enzymes
          bilirubin: yellow color substance result from break down of RBCs these substanceremove from the circulation via the liver which utilize the bilirubin to synthesis the bile which then storag in the gall blader elevation of bilirubin indecate massive break dawon of RBCs or liver disease.
          Albumin:

          Q4: No specific precaution

          Q5: unlabelled sample
          mislabelled sample
          underfilled samples(espicially for PT, PTT)
          sample wilthout requist
          heamolyzed samples(not For all testes)
          clotted samples(for cBc_ coagulation profile)
          Q6: run QC before
          compare the diagnosis with lab results

          Q7: inflamation(hepatitis A,B,C)
          cancer(hepatocellularcarcinoma)
          biliary cirrhosis or obstruction

          Q8: low transaminase b/c when the liver infected by the viral hepatitis there is active generation of hepatocyte due to high viral replication therefore the liver enzyme is very high in the early stage(acut) but in the late stage(chronic) almost hepatocyte become scar therefor liver enzyme back to the normal or low level

          Q9: hypoalbuminemia: albumin is the protien synthesis by the liver these patient has chronic liver disease so, no proper synthesis for albumin
          prolong PT b/c the coagulation profile(pT,PTT) synthese in the liver when there is liver disese no proper synthesis for PT naturaly it not corrected with intravenous K b/c these patiant not suffer from hypokalemia the defect is in the factory(liver)

          Q10: total protien=albumin+globuline
          in state of liver faliure no synthesis for albumin so, the body start to synthesis high level of globuline to compensate the decrease in albumin to miantian the balance therefor TP is high while albumin is low.

          Q11: No, urea is low b/c in the liver disease no proper metabolism for protien so no urea secreation (end product of protien metabolism is urea)

          Q12: Ca is low b/c 50% of ca in the blood is bound in albumin (in active form of ca) the other 50% called ionized calcium of free which metabolically active. total ca measure both bound and free ca when there is no albumin in liver faliure the total calcium is low also b/c these patient is malnurished.

          Q13: folate deificncy (malnourished)

          Q14: GGT
          ALP

          Q15: ammonia measurment and PH of the blood
          b/c ammonia is co-factor in protien metabolism in tiver faliure no protien metabolism so, there is accumulation of ammonia which can penetrate blood brian bariar lead to CNS problem.
          :sm199: miss laboratory

          تعليق


          • #6
            مو رد على الأسئلة فقط تعبير عن وجودي

            What is the Liver?

            The liver is the largest glandular organ of the body. It weighs about 3 lb (1.36 kg). It is reddish brown in color and is divided into four lobes of unequal size and shape. The liver lies on the right side of the abdominal cavity beneath the diaphragm. Blood is carried to the liver via two large vessels called the hepatic artery and the portal vein. The heptic artery carries oxygen-rich blood from the aorta (a major vessel in the heart). The portal vein carries blood containing digested food from the small intestine. These blood vessels subdivide in the liver repeatedly, terminating in very small capillaries. Each capillary leads to a lobule. Liver tissue is composed of thousands of lobules, and each lobule is made up of hepatic cells, the basic metabolic cells of the liver.



            What is its major function?

            The liver has many functions. Some of the functions are: to produce substances that break down fats, convert glucose to glycogen, produce urea (the main substance of urine), make certain amino acids (the building blocks of proteins), filter harmful substances from the blood (such as alcohol), storage of vitamins and minerals (vitamins A, D, K and B12) and maintain a proper level or glucose in the blood. The liver is also responsible fore producing cholesterol. It produces about 80% of the cholesterol in your body.

            Diseases of the Liver?

            Several diseases states can affect the liver. Some of the diseases are Wilson's Disease, hepatitis (an inflammation of the liver), liver cancer, and cirrhosis (a chronic inflammation that progresses ultimately to organ failure). Alcohol alters the metabolism of the liver, which can have overall detrimental effects if alcohol is taken over long periods of time.

            Hemochromatosis can cause liver problems.

            Medications that negatively effect the liver?

            Medications have side effects that may harm your liver. Some of the medications that can damage your liver are: serzone, anti-cancer drugs (tagfur, MTX, and cytoxan), and medications used to treat diabetes.

            Serzone is a prescription drug manufactured by Bristol-Myers Squibb for the treatment of depression.

            The possible side effects of Serzone® are: agitation, dizziness, clumsiness or unsteadiness, difficulty concentrating, memory problems, confusion, severe nausea, gastroenteritis, abdominal pain, unusually dark urine, difficult or frequent urination, fainting, skin rash or hives yellowing of the skin or whites of the eyes (jaundice) or a prolonged loss of weight or loss of appetite.

            If you or a family member have suffered serious side effects or a fatal injury after taking Serzone®, you or the family member may be eligible to file a claim against the manufacturer. You should contact an attorney that specializes in class action lawsuits immediately.

            To help prevent liver damage, let your doctor know about your liver condition when being treated for other conditions. Medications come in many forms and it is best to find out what is in them and what it can do to your liver.
            Liver Function Tests:

            Liver function tests represent a broad range of normal functions performed by the liver. The diagnosis of liver disease depends upon a complete history, complete physical examination, and evaluation of liver function tests and further invasive and noninvasive tests. Many patients become confused regarding the meaning of a liver function test. This section is designed to describe the basic liver function tests and the meaning for patients.

            The hepatobiliary tree represents hepatic cells and biliary tract cells. Inflammation of the hepatic cells results in elevation in the alanine aminotransferase (ALT), aspartate aminotransferase (AST) and possibly the bilirubin. Inflammation of the biliary tract cells results predominantly in an elevation of the alkaline phosphatase. In liver disease there are crossovers between purely biliary disease and hepatocellular disease. To interpret these, the physician will look at the entire picture of the hepatocellular disease and biliary tract disease to determine which is the primary abnormality.

            Alanine Aminotransferase (ALT):

            ALT is the enzyme produced within the cells of the liver. The level of ALT abnormality is increased in conditions where cells of the liver have been inflamed or undergone cell death. As the cells are damaged, the ALT leaks into the bloodstream leading to a rise in the serum levels. Any form of hepatic cell damage can result in an elevation in the ALT. The ALT level may or may not correlate with the degree of cell death or inflammation. ALT is the most sensitive marker for liver cell damage.

            Aspartate Aminotransferase (AST):

            This enzyme also reflects damage to the hepatic cell. It is less specific for liver disease. It may be elevated and other conditions such as a myocardial infarct (heart attack). Although AST is not a specific for liver as the ALT, ratios between ALT and AST are useful to physicians in assessing the etiology of liver enzyme abnormalities.

            Alkaline Phosphatase:

            Alkaline phosphatase is an enzyme, which is associated with the biliary tract. It is not specific to the biliary tract. It is also found in bone and the placenta. Renal or intestinal damage can also cause the alkaline phosphatase to rise. If the alkaline phosphatase is elevated, biliary tract damage and inflammation should be considered. However, considering the above other etiologies must also be entertained. One way to assess the etiology of the alkaline phosphatase is to perform a serologic evaluation called isoenzymes. Another more common method to asses the etiology of the elevated alkaline phosphatase is to determine whether the GGT is elevated or whether other function tests are abnormal (such as bilirubin)

            Alkaline phosphatase may be elevated in primary biliary cirrhosis, alcoholic hepatitis, PSC, gallstones in choledocholithiasis.

            Gamma Glutamic Transpeptidase (GGT):

            This enzyme is also produced by the bile ducts. However, it is not very specific to the liver or bile ducts. It is used often times to confirm that the alkaline phosphatase is of the hepatic etiology. Certain GGT levels, as an isolated finding, reflect rare forms of liver disease. Medications commonly cause GGT to be elevated. Liver toxins such as alcohol can cause increases in the GGT.

            Bilirubin:

            Bilirubin is a major breakdown product of hemoglobin. Hemoglobin is derived from red cells that have outlived their natural life and subsequently have been removed by the spleen. During splenic degradation of red blood cells, hemoglobin (the part of the red blood cell that carries oxygen to the tissues) is separated out from iron and cell membrane components. Hemoglobin is transferred to the liver where it undergoes further metabolism in a process called conjugation. Conjugation allows hemoglobin to become more water-soluble. The water solubility of bilirubin allows the bilirubin to be excreted into bile. Bile then is used to digest food.

            As the liver becomes irritated, the total bilirubin may rise. It is then important to understand the difference between total bilirubin, which has undergone conjugation (that is hepatic cell metabolism), and at portion of bilirubin which has not been metabolized. These two components are called total bilirubin and direct bilirubin. The direct bilirubin fraction is that portion of bilirubin that has undergone metabolism by the liver. When this fraction is elevated, the cause of elevated bilirubin (hyperbilirubinemia) is usually outside the liver. These types of causes are typically gallstones. This type of abnormality is usually treated with surgery (such as a gallbladder removal or choleycystectomy).

            If the direct bilirubin is low, while the total bilirubin is high, this reflects liver cell damage or bile duct damage within the liver itself.

            Albumin:

            Albumin is the major protein present within the blood. Albumin is synthesized by the liver. As such, it represents a major synthetic protein and is a marker for the ability of the liver to synthesize proteins. It is only one of many proteins that are synthesized by the liver. However, since it is easy to measure, it represents a reliable and inexpensive laboratory test for physicians to assess the degree of liver damage present in the in any particular patient. When the liver has been chronically damaged, the albumin may be low. This would indicate that the synthetic function of the liver has been markedly diminished. Such findings suggest a diagnosis of cirrhosis. Malnutrition can also cause low albumin (hypoalbuminemia) with no associated liver disease.

            Prothrombin time (PT):

            Another measure of hepatic synthetic function is the prothrombin time. Prothrombin time is affected by proteins synthesized by the liver. Particularly, these proteins are associated with the incorporation of vitamin K metabolites into a protein. This allows normal coagulation (clotting of blood). Thus, in patients who have prolonged prothrombin times, liver disease may be present. Since a prolonged PT is not a specific test for liver disease, confirmation of other abnormal liver tests is essential. This may include reviewing other liver function tests or radiology studies of the liver. Diseases such as malnutrition, in which decreased vitamin K ingestion is present, may result in a prolonged PT time. An indirect test of hepatic synthetic function includes administration of vitamin K (10mg) subcutaneously over three days. Several days later, the prothrombin time may be measured. If the prothrombin time becomes normal, then hepatic synthetic function is intact. This test does not indicate that there is no liver disease, but is suggestive that malnutrition may coexist with (or without) liver disease.

            Platelet count:

            Platelets are cells that form the primary mechanism in blood clots. They're also the smallest of blood cells. They derived from the bone marrow from the larger cells known as megakaryocytes. Individuals with liver disease develop a large spleen. As this process occurs platelets are trapped with in the sinusoids (small pathways within the spleen) of the spleen. While the trapping of platelets is a normal function for the spleen, in liver disease it becomes exaggerated because of the enlarged spleen (splenomegaly). Subsequently, the platelet count may become diminished.

            Serum protein electrophoresis:

            This is an evaluation of the types of proteins that are present with in a patient's serum. By using an electrophoretic gel, major proteins can be separated out. This results in four major types of proteins. These are 1) albumin, 2) alpha globulins, 3) beta globulins and 4) gammaglobulins. This test is useful for evaluation of patients who have abnormal liver function tests since it allows a direct quantification of multiple different serum proteins. If the gamma globulin fraction is elevated, autoimmune hepatitis may be present. In addition a deficiency in the alpha globulin fraction can result in the diagnosis, or a clinical clue, to A. alpha-1 antitrypsin deficiency. This is a simple blood test that is commonly performed by hepatologists.

            تعليق


            • #7
              بعدني طالبه طب سنه أولى:sm257:
              أبغي أشاركم، بس ماعرف
              متى أتخرج

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              • #8
                Q One If you were the phlebotomist who is obtaining the samples, what kind of tubes you may use
                1-plain tube for ::Total protein, albumin, globulins, calcium, BUN, creatinine, total bilirubin, AST , ALT

                2-EDTA tube::CBC

                3-sodium citrait tube for coagulation profile

                Q Two what is the function of our liver

                The liver is the largest and one of the most important organs in the body. As the body's "chemical factory," it regulates the levels of most of the biomolecules found in the blood, and acts with the kidneys to clear the blood of drugs and toxic substances. The liver metabolizes these products, alters their chemical structure, makes them water soluble, and excretes them in bile. Laboratory tests for total protein, albumin, ammonia, transthyretin, and cholesterol are markers for the synthetic function of the liver. Tests for cholesterol, bilirubin, ALP, and bile salts are measures of the secretory (excretory) function of the liver. The enzymes ALT, AST, GGT, LDH, and tests for viruses are markers for liver injury.

                Q Three what is liver function profile
                Liver function tests, or LFTs, include tests for bilirubin, a breakdown product of hemoglobin, and ammonia, a protein byproduct that is normally converted into urea by the liver before being excreted by the kidneys. LFTs also commonly include tests to measure levels of several enzymes, which are special proteins that help the body break down and use (metabolize) other substances. Enzymes that are often measured in LFTs include gamma-glutamyl transferase (GGT); alanine aminotransferase (ALT or SGPT); aspartate aminotransferase (AST or SGOT); and alkaline phosphatase (ALP). LFTs also may include prothrombin time (PT), a measure of how long it takes for the blood to clot.


                Q Four what are the patient precaution points you may tell the nurse in order to prepare patient
                Patients are asked to fast and to inform clinicians of all drugs, even over-the-counter drugs, that they are taking. Many times liver function tests are done on an emergency basis and fasting and obtaining a medical history are not possible.


                Q Five
                1-unlebeled tube
                2-unsufficient sample
                3-hemolyzed sample
                4-wrong tube collected
                5-clotted sample for EDTA tube


                Q Six
                AA What are the pathological causes that lead to abnormal liver function profile

                ALT: Values are significantly increased in cases of hepatitis, and moderately increased in cirrhosis, liver tumor, obstructive jaundice, and severe burns. Values are mildly increased in pancreatitis, heart attack, infectious mononucleosis, and shock. Most useful when compared with ALP levels.

                AST: High levels may indicate liver cell damage, hepatitis, heart attack, heart failure, or gall stones.

                ALP: Elevated levels occur in diseases that impair bile formation (cholestasis). ALP may also be elevated in many other liver disorders, as well as some lung cancers (bronchogenic carcinoma) and Hodgkin's lymphoma. However, elevated ALP levels may also occur in otherwise healthy people, especially among older people.

                GGT: Increased levels are diagnostic of hepatitis, cirrhosis, liver tumor or metastasis, as well as injury from drugs toxic to the liver. GGT levels may increase with alcohol ingestion, heart attack, pancreatitis, infectious mononucleosis, and Reye's syndrome.

                LDH: Elevated LDH is seen with heart attack, kidney disease, hemolysis, viral hepatitis, infectious mononucleosis, Hodgkin's disease, abdominal and lung cancers, germ cell tumors, progressive muscular dystrophy, and pulmonary embolism. LD is not normally elevated in cirrhosis.

                Bilirubin: Increased indirect or total bilirubin levels can indicate various serious anemias, including hemolytic disease of the newborn and transfusion reaction. Increased direct bilirubin levels can be diagnostic of bile duct obstruction, gallstones, cirrhosis, or hepatitis. It is important to note that if total bilirubin levels in the newborn reach or exceed critical levels, exchange transfusion is necessary to avoid kernicterus, a condition that causes brain damage from bilirubin in the brain.

                Ammonia: Increased levels are seen in primary liver cell disease, Reye's syndrome, severe heart failure, hemolytic disease of the newborn, and hepatic encephalopathy.

                Albumin: Albumin levels are increased due to dehydration. They are decreased due to a decrease in synthesis of the protein which is seen in severe liver failure and in conditions such as burns or renal disease that cause loss of albumin from the blood.


                BB How do you explain the result of low transaminase enzymes although the patient has hepatitis and drug abuse

                CC How do you explain abnormal tests, hypoalbuminemia, and prolonged prothrombin time that does not correct with intramuscular vitamin K

                Albumin is the protein found in the highest concentration in blood, making up over half of the protein mass. Albumin has a half-life in blood of about three weeks and decreased levels are not seen in the early stages of liver disease. A persistently low albumin in liver disease signals reduced synthetic capacity of the liver and is a sign of progressive liver failure. In the acute stages of liver disease, proteins such as transthyretin (prealbumin) with a shorter half-life may be measured to give an indication of the severity of the disease.
                The liver is responsible for production of the vitamin K clotting factor.. In obstructive liver

                diseases a deficiency of vitamin K-derived clotting factors results from failure to absorb vitaminK. In obstructive jaundice, intramuscular injection of vitamin K will correct the prolonged prothrombin time. In severe necrotic disease, the liver cannot synthesize factor I (fibrinogen) or factors II, VII, IX, and X from vitamin K. When attributable to hepatic necrosis, an increase in the prothrombin time by more than two seconds indicates severe liver disease.



                DD Why TP is high while Albumin is decreased
                http://www.9m.com/thumbnail/51279763/HPIM0301.jpg

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                • #9
                  للأسف
                  أنا كمان لسه طالبة
                  وماعرفت حل غير 3 أسئلة
                  ان شاء الله أقدر أحل المرات الجاية

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                  • #10
                    بالتوفيق للجميع في القضيه وحلاها

                    من قال لا ادري فقد افتى
                    كــــل عـــام وانــتــم بخيــــــر

                    تقبل الله منا ومنكم جميع الاعمال الصالحه

                    وللجميع في المنتدى وللامه الاسلاميه

                    اسأل الله العافيه والمعافاة من كل شر ومكروه
                    ؟؟

                    اتمنى ان يسامحني كل شخص زليت عليه او غلطت
                    واستودعكم الله الذي لا تضيع ودائعه



                    فــــــــأمان الله الكريم الرحيم ..



                    3/10/1429هـ الخميس

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                    • #11
                      لو سمحتم ممكن اعرف متى بالضبط توضع الاسئلة لانى اريد ان اشار ولا اجلس دائما على الكمبيوتر فاريدمعرفة الوقت حتى يتسنى لى الاجابة عليها وشكرا
                      :sm188:

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                      • #12
                        المشاركة الأصلية بواسطة ميسرة مشاهدة المشاركة
                        لو سمحتم ممكن اعرف متى بالضبط توضع الاسئلة لانى اريد ان اشار ولا اجلس دائما على الكمبيوتر فاريدمعرفة الوقت حتى يتسنى لى الاجابة عليها وشكرا
                        مرحبا ميسرة

                        لا استطيع اعطائك وقت محدد لوضع الاسئلة نحاول جعلها اسبوعيا لكن قد تطرأ تغيرات او ظروف تأخر من وضع الاسئلة والقضيا ...لكن المؤكد ان شاء الله انه حين وضع الاسئلة الجديده بالمنتدى ستصلك رساله تخبرك بالامر

                        بتوفيق الله ورعايته
                        sigpic

                        قال صلى الله عليه وسلم:
                        (ثلاث كفارات وثلاث درجات وثلاث منجيات وثلاث مهلكات فأما الكفارات فإسباغ الوضوء في السبرات وانتظار الصلوات بعد الصلوات ونقل الأقدام إلى الجماعات وأما الدرجات فإطعام الطعام وإفشاء السلام والصلاة بالليل والناس نيام وأما المنجيات فالعدل في الغضب والرضا والقصد في الفقر والغنى وخشية الله في السر والعلانية وأما المهلكات فشح مطاع وهوى متبع وإعجاب المرء بنفسه)

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                        • #13
                          my answer for case 3

                          my answer in the attached file
                          الملفات المرفقة
                          http://i30.tinypic.com/s42qn8.jpg

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                          • #14
                            hearin or plain for chemistery,EDTA for CBC,and trisodium citrate for pt
                            2/metabolism, detoxication of wastes, storage of carbohydrates
                            3/total protien, albumin,bilirubin(total and direct),ALT,AST.
                            4/AVOID HEMOLYSIS. prolonged tourinquate applying.adequate sample volume espically for pt
                            5/unadquate volume for pt, hemolysis in chemistery( albumin,AST,)
                            6/hepatitis,druge abuse,cirhosis.
                            6/b/ dute the sever major cellular destruction.
                            6/c/ low albumine level dute the cells damage , pt abnormalities accordinge due to druge abuse which affect the liver coagulation function.
                            6/d/ due to high levels of globulins
                            6/e/the kidney not affectecd , the bun is low due to the decrease in albumin produced by the liver.
                            7/

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                            • #15
                              الشكر الجزيل لكافة الأخوة المشاركين ,,,

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