Practical Exam
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What are the causes of hypoproteinaemia? (5)
Salt retention syndromes - increased water retention and apparent decrease in concentration Liver disease - decreased production of proteins Renal disease - increased loss in urine Burns - increased loss of proteins in exudate Malabsorption - decreased production through lack of essential amino acids
What are the causes of hyperproteinaemia (3)
Dehydration - reduced water volume results in an apparent increase in protein concentration Immune response -> increased production of all Ig due to an infection/inflammation Multiple myeloma -> increased production of a single clone of Ig due to a neoplastic increase in plasma cells
List some diseases that may cause an increase in total protein (8)
Chronic infection e.g. TB Liver dysfunction Dehydration (chronic diarrhea, diabetic acidosis) Respiratory distress Haemolysis Cryoglobulinaemia Alcoholism Leukaemia
List some diseases that cause a decrease in total protein (8)
Malnutrition and malabsorption Liver disease Diarrhea Severe burns Loss through urine in severe kidney disease Low albumin Low globulins Pregnancy
What are the causes of decreased albumin (9)
Decreased synthesis - analbuminaemia -hypoalbuminaemia Increased catabolism Increased loss - Nephrotic syndrome - Exudate loss in burns - Haemorrhage - Gut loss Redistribution - Haemodilution - increased capillary permeability - Decreased lymph clearance
List three abnormalities of albumin synthesis
Bisalbuminaemia -> genetic variant of albumin - no clinical consequences Analbuminaemia -> low synthesis -> slight consequences e.g mild oedmea Hyperalbuminaemia -> high albumin found only artefactually i.e. prolonged venous stasis, loss of protein free fluid - dehydration
Why measure albumin?
To find out if hyperproteinaemia is due to dehydration, hypergammaglobulinaemia, or high albumin
What are the diagnostic differences between dehydration and hypergammaglobulinaemia
Dehydration = high total protein and high albumin Hypergammaglobulinaemia = high total protein and normal/low albumin
What does high total proteins, albumin and globulins indicate?
Dehydration
What does high total proteins, normal/low albumin and high globulins indicate
Immune response
What does very high total proteins, normal/low albumin and very high globulins indicate?
Multiple myeloma
What does low total proteins, albumin and globulins indicate (5)
Liver disease (globulins might be normal) Renal disease Salt retention syndrome Intestinal malabsorption Burns
What does low total protein, normal albumin and low globulin indicate
Immune deficiency
Write a note on some of the important pieces of information on diabetes (3)
GLUT4 = insulin responsive glucose transporter -> found in skeletal muscle, cardiac muscle, adipose tissue Preproinsulin, proinsulin, insulin + C peptide Insulin signalling promotes externalisation of preformed GLUT) -> receptor formed inside the cell but in diabetes no insulin produced so the receptor never gets the signal to be expressed on cell surface -> therefore glucose can not be transported into the cell
Write a note on some of the important pieces of information on diabetes (3)
GLUT4 = insulin responsive glucose transporter -> found in skeletal muscle, cardiac muscle, adipose tissue Preproinsulin, proinsulin, insulin + C peptide Insulin signalling promotes externalisation of preformed GLUT) -> receptor formed inside the cell but in diabetes no insulin produced so the receptor never gets the signal to be expressed on cell surface -> therefore glucose can not be transported into the cell
Write a note on some of the important pieces of information on diabetes (3)
GLUT4 = insulin responsive glucose transporter -> found in skeletal muscle, cardiac muscle, adipose tissue Preproinsulin, proinsulin, insulin + C peptide Insulin signalling promotes externalisation of preformed GLUT) -> receptor formed inside the cell but in diabetes no insulin produced so the receptor never gets the signal to be expressed on cell surface -> therefore glucose can not be transported into the cell
What is produced by the endocrine and exocrine parts of the pancrease
Endocrine = alpha cells = glucagon, beta cells = insulin of islets of Langerhans Exocrine = digestive enzymes to duodenum through ducts
What hormones can raise blood glucose
Glucagon Cortisol Epinephrine Growth hormone
What can be seen in increased blood glucose
Increased insulin Decreased glucagon Increased glycogenesis Increased fatty acid synthesis Decreased glycogenolysis Decreased gluconeogenesis
What can be seen in starvation (5)
Insulin down Glucagon up Glycogen depletion Triglyceride catabolism and ketone formation Protein breakdown and gluconeogenesis
List some causes of atypica/non immune diabetes (6)
Genetic defects of beta-cell function Genetic defects in insulin action Diseases of the exocrine pancreas -> endocrinopathies Drug/chemical induced Infections
List some causes of atypica/non immune diabetes (6)
Genetic defects of beta-cell function Genetic defects in insulin action Diseases of the exocrine pancreas -> endocrinopathies Drug/chemical induced Infections
List some causes of atypica/non immune diabetes (6)
Genetic defects of beta-cell function Genetic defects in insulin action Diseases of the exocrine pancreas -> endocrinopathies Drug/chemical induced Infections
What are the main causes of renal failure
Pre- renal e.g. decreased ECFV or MI Renal e.g. acute tubular necrosis Postrenal e.g. ureteral obstruction (stones)