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Samenvatting Klinische chemie 2 - MLT2 - HoGent
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Samenvatting gebaseerd op de cursus en twee samenvattingen van .
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Samenvatting Klinische chemie 2Inhoud
Hoofdstuk 1: Afbraakproducten......................................................................................................................................4
1. Ureum......................................................................................................................................................................4
1.1. Fysiologische gegevens.....................................................................................................................................4
1.2. Bepaling ureum................................................................................................................................................5
1.3. Stalen + Normaalwaarden................................................................................................................................5
1.4. Oorzaken verhoogde concentratie ureum in bloed..........................................................................................6
1.5. Oorzaken verlaagde concentratie ureum in bloed............................................................................................6
1.6. Nut van ammonium -en ureumbepaling...........................................................................................................6
Nut van ureumbepaling...........................................................................................................................................6
2. Creatinine................................................................................................................................................................7
2.1. Fysiologische gegevens.....................................................................................................................................7
2.2. Creatinineklaring..............................................................................................................................................7
2.3. Normaalwaarden..............................................................................................................................................8
2.4. Bepaling van creatinine....................................................................................................................................8
2.5. Oorzaken verhoogde creatinine plasmaconcentratie.......................................................................................8
2.6. Oorzaken verlaagde creatinine plasmaconcentratie........................................................................................8
2.7. Klaringen...........................................................................................................................................................9
3. Urinezuur...............................................................................................................................................................10
3.1. Fysiologische gegevens...................................................................................................................................10
3.2. Normaalwaarden + stalen...............................................................................................................................11
3.3. Bepaling van urinezuur...................................................................................................................................11
3.4. Oorzaken van verhoogde concentratie van urinezuur....................................................................................11
3.5. Oorzaken verlaagde concentratie van urinezuur............................................................................................11
4. Bilirubine............................................................................................................................................................... 12
4.1. Fysiologische gegevens...................................................................................................................................12
4.2. Stalen + Normaalwaarden..............................................................................................................................13
4.3. Bepaling van bilirubine...................................................................................................................................13
4.4. Oorzaken verhoogde concentratie van indirect bilirubine.............................................................................14
4.5. Oorzaken verhoogde concentratie van direct bilirubine................................................................................14
4.6. Nut van bepaling bilirubine in het bloed.........................................................................................................14
4.8. Nut van bepaling bilirubine in de urine...........................................................................................................15
4.4. Nut bepaling bilirubine...................................................................................................................................15
Hoofdstuk 2: Enzymen...................................................................................................................................................17
Pagina 1 van 37
,1. Inleiding................................................................................................................................................................. 17
2. Amylase................................................................................................................................................................. 19
2.1. Fysiologische gegevens...................................................................................................................................19
2.2. Staal + Normaalwaarden................................................................................................................................20
2.3. Bepaling van amylase.....................................................................................................................................20
2.4. Oorzaken verhoogde concentratie amylase...................................................................................................20
2.5. Nut bepaling amylase in bloed.......................................................................................................................20
2.6. Nut van bepaling amylasurie..........................................................................................................................20
3. Lipase..................................................................................................................................................................... 21
3.1. Fysiologische gegevens...................................................................................................................................21
3.2. Bepaling van lipase.........................................................................................................................................21
3.3. Oorzaken verhoogde concentratie lipase in bloed.........................................................................................21
3.4. Oorzaken verlaagde concentratie lipase in bloed...........................................................................................21
3.5. Stalen + Normaalwaarden..............................................................................................................................22
3.6. Pancreatitis.....................................................................................................................................................22
3.5. Oorzaak verlaagde lipase EN amylase in bloed...............................................................................................22
4. Alkalische fosfatase...............................................................................................................................................23
4.1. Fysiologische gegevens...................................................................................................................................23
4.2. Bepaling alkalisch fosfatase............................................................................................................................23
4.3. Nut van bepaling alkalisch fosfatase...............................................................................................................23
4.4. Oorzaken van verlaagde alkalische fosfatasen...............................................................................................23
4.5. Oorzaken van verhoogde alkalische fosfatasen uit bot..................................................................................23
4.6. Oorzaken van verhoogde alkalische fosfatasen van hepatobiliaire oorsprong...............................................23
5. Zure fosfatase........................................................................................................................................................24
5.1. Fysiologische gegevens...................................................................................................................................24
5.2. Bepaling zure fosfatase...................................................................................................................................24
5.3. Oorzaken verhoogde zure fosfatase...............................................................................................................24
6. Transaminasen......................................................................................................................................................24
6.1. Fysiologische gegevens...................................................................................................................................24
6.2. Bepaling GOT/ASAT........................................................................................................................................25
6.3. Bepaling GPT/ALAT.........................................................................................................................................25
6.4. Oorzaken verhoogde GOT/ASAT.....................................................................................................................26
6.5. Oorzaken verhoogde GPT/ALAT.....................................................................................................................26
6.6. Nut van bepaling transaminasen....................................................................................................................26
6.7. Interpretatie van transaminasewaarden........................................................................................................26
7. LDH........................................................................................................................................................................ 28
Pagina 2 van 37
, 7.1. Fysiologische gegevens...................................................................................................................................28
7.2. Bepaling van LDH............................................................................................................................................30
7.3. Oorzaken verhoogde concentratie LDH..........................................................................................................30
7.4. Nut van bepaling LDH in bloed.......................................................................................................................30
8. ϒ-Glutamyltransferase...........................................................................................................................................31
8.1. Fysiologische gegevens...................................................................................................................................31
8.2. Bepaling van GGT............................................................................................................................................31
8.3. Oorzaken verhoogde concentratie GGT..........................................................................................................31
8.4. Nut van bepaling GGT.....................................................................................................................................32
9. Creatinekinase (CK)................................................................................................................................................32
9.1. Fysiologische gegevens...................................................................................................................................32
9.2. Bepaling van CK..............................................................................................................................................33
9.3. Oorzaken verhoogde concentratie CK-MB......................................................................................................33
9.4. Oorzaken verhoogde concentratie CK-MM....................................................................................................33
9.5. Oorzaken verhoogde concentratie CK-BB.......................................................................................................33
9.6. Nut bepaling iso-enzymen CK.........................................................................................................................33
10. Cholinesterase.....................................................................................................................................................34
10.1. Fysiologische gegevens.................................................................................................................................34
10.2. Indicaties om te meten.................................................................................................................................34
10.3. Nut bepaling cholinesterase.........................................................................................................................34
10.4. Oorzaken verlaagde concentratie cholinesterase.........................................................................................34
Hoofdstuk 3: Lever en gal..............................................................................................................................................35
1.1. Functies lever..................................................................................................................................................35
1.2. Leverfunctietesten..........................................................................................................................................35
1.3. SAMENVATTING: interpretative van leverparameters....................................................................................36
Pagina 3 van 37
, Hoofdstuk 1: Afbraakproducten
1. Ureum
Herhaling filtratie nieren
- Start: glomerulaire filtratie in lichaampjes Malpighi => haarvaten glomerulus (hoge druk ultrafiltratie)
- Daarna: selectieve reabsorptie en urinevorming (lis van Henle,…)
1.1. Fysiologische gegevens
UREUM
UREUM = afvalproduct bij EW-stofwisseling en AZ-metabolisme
- vrij diffundeerbaar
- in de lever door de ureumcyclus:
- uit 1 CO2 + 2 NH3 door hepatocyten
- uitgedrukt in mmol/L of mg/dL
- Geen goeie merker voor GFR afhankelijk van zoweel renale als niet-renale factoren
Renaal: Ureum in plasma: ~adequate renale doorstroming en fct
Ureum/creatinine ratio diff oorzaken nierinsufficiëntie
Niet-renaal: Voeding, Proteïne-katabolisme, Hydratatietoestand lichaam,
Leverfunctie
AMMONIAK In bloed afkomstig van afbraak eiwitten
In het lichaam (pH 7,4) volledig geprotoneerd (NH4+) = ammoniumion
Toxisch daarom verwijderd door hepatocyten en omgezet naar ureum
Bruikbaar voor evaluatie leverfunctie
UREUMCYCLUS = ORNITHINECYCLUS
Arginase nodig
Carbamoyl fosfaat = donor ammonium
Ureasen: omzetting ureum NH3 (of omgekeerd), w gewonnen uit bacteriën
ELIMINATIE UREUM
EW afbraak °ammoniak = giftig! afbraak ureumcyclus °ureum (=afval) wordt dan op zijn beurt
geëlimineerd thv de nieren
GI: 25% eliminatie als NH3 o.i.v intestinale urease
Renaal: 100% glomerulaire filtratie + 40-80% passieve terugresorptie in proximale tubuli
o TERUGRESORPTIE = afhankelijk van…
1. Ureumconcentratie (in plasma)
2. Urinedebiet (=volume urine)
3. Hydratatietoestand v/h lichaam
Weinig water drinken dehydratatie terugresorptie↑ (H2O recupereren)
Veel water drinken terugresorptie↓ urinedebiet↑
Pagina 4 van 37
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