BOOK
Clinical Biochemistry E-Book
Allan Gaw | Michael Murphy | Rajeev Srivastava | Robert A. Cowan | Denis St. J. O'Reilly
(2013)
Additional Information
Book Details
Abstract
This edition covers all aspects of the subject needed by medical students. It is a volume in the Illustrated Colour Text series, with the subject matter divided into double-page spreads; this makes the information very accessible to the reader. Full use is made of flow charts and other graphics; clinical "boxes;" summary points; case histories; and clinical photographs. The whole orientation of the book is to concentrate on how clinical biochemistry relates to the care of the patient and to ensure that the medical student understands how to interpret laboratory.
- Covers clinical biochemistry from the point of view of the clinician using the diagnostic service
- Presents topics in easily accessible two-page spreads
- Includes mini case histories, key point boxes, flowcharts, and summary points
- Well illustrated with four-color drawings and clinical photographs
- New appendix added of annotated web resources for students to take further many of the topics covered in the book.
- To reflect the difficulties people have sometimes in analyzing hyper- and hypo-kalaemia, the existing spread is split into two - one spread on hyperkalaemia and another on hypokalaemia.
- The spread on hypertension will be revised and updated to reflect the fact that biochemistry is used as much or more in guiding treatment as it is in screening for secondary hypertension.
- Spreads on Myocardial Infarction, Cancer and Tumour Markers will all substantially revised and updated.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Clinical Biochemistry | i | ||
| Copyright page | iv | ||
| Preface to the fifth edition | v | ||
| Preface to the first edition | v | ||
| Acknowledgements | vi | ||
| Contents | vii | ||
| 1 Introducing Clinical Biochemistry | 1 | ||
| 1 The clinical biochemistry laboratory | 2 | ||
| The use of biochemical tests | 2 | ||
| Core biochemistry | 2 | ||
| Specialized tests | 2 | ||
| Urgent samples | 2 | ||
| Automation and computerization | 3 | ||
| Test repertoire | 3 | ||
| Laboratory personnel | 3 | ||
| 2 The use of the laboratory | 4 | ||
| Specimen collection | 4 | ||
| Blood specimens | 4 | ||
| Urine specimens | 4 | ||
| Other specimen types | 4 | ||
| Dangerous specimens | 4 | ||
| Sampling errors | 4 | ||
| Timing | 5 | ||
| Analysing the specimen | 5 | ||
| Unnecessary testing | 5 | ||
| 3 The interpretation of results | 6 | ||
| How biochemical results are expressed | 6 | ||
| Variation in results | 6 | ||
| Laboratory analytical performance | 6 | ||
| Precision and accuracy | 6 | ||
| Analytical sensitivity and specificity | 6 | ||
| Quality assurance | 6 | ||
| Reference intervals | 7 | ||
| Specificity and sensitivity of tests | 7 | ||
| Biological factors affecting the interpretation of results | 7 | ||
| Other factors | 7 | ||
| 4 Point of care testing | 8 | ||
| Outside the laboratory | 8 | ||
| Methodology | 8 | ||
| General problems | 9 | ||
| Analytical problems | 9 | ||
| Interpretive problems | 9 | ||
| The future | 9 | ||
| 5 Reference intervals | 10 | ||
| 2 Core Biochemistry | 11 | ||
| 6 Fluid and electrolyte balance: | 12 | ||
| Body fluid compartments | 12 | ||
| Electrolytes | 12 | ||
| Concentration | 13 | ||
| Osmolality | 13 | ||
| Oncotic pressure | 13 | ||
| 7 Water and sodium balance | 14 | ||
| Water | 14 | ||
| AVP and the regulation of osmolality | 14 | ||
| Sodium | 14 | ||
| Aldosterone | 15 | ||
| Atrial natriuretic peptide | 15 | ||
| Regulation of volume | 15 | ||
| 8 Hyponatraemia: | 16 | ||
| Development of hyponatraemia | 16 | ||
| Water retention | 16 | ||
| Sodium loss | 16 | ||
| Sodium depletion – a word of caution | 16 | ||
| Pseudohyponatraemia | 17 | ||
| 9 Hyponatraemia: | 18 | ||
| Clinical assessment | 18 | ||
| Severity | 18 | ||
| Mechanism | 18 | ||
| History | 18 | ||
| Clinical examination | 18 | ||
| Biochemistry | 18 | ||
| Oedema | 19 | ||
| Treatment | 19 | ||
| 10 Hypernatraemia | 20 | ||
| Water loss | 20 | ||
| Sodium gain | 20 | ||
| Clinical features | 20 | ||
| Treatment | 21 | ||
| Other osmolality disorders | 21 | ||
| 11 Hyperkalaemia | 22 | ||
| Serum potassium and potassium balance | 22 | ||
| Hyperkalaemia | 22 | ||
| Decreased excretion | 22 | ||
| Redistribution out of cells | 22 | ||
| Increased intake | 23 | ||
| Treatment | 23 | ||
| Pseudohyperkalaemia | 23 | ||
| 12 Hypokalaemia | 24 | ||
| Diagnosis | 24 | ||
| Reduced intake | 24 | ||
| Redistribution into cells | 24 | ||
| Increased losses | 24 | ||
| Gastrointestinal | 24 | ||
| Urinary | 25 | ||
| Investigation | 25 | ||
| Treatment | 25 | ||
| 13 Intravenous fluid therapy | 26 | ||
| Does this patient need IV fluids? | 26 | ||
| Which IV fluids should be given? | 26 | ||
| How much fluid should be given? | 26 | ||
| Existing losses | 26 | ||
| Anticipated losses | 26 | ||
| How quickly should the fluids be given? | 26 | ||
| Perioperative patient | 27 | ||
| Hyponatraemia | 27 | ||
| How should the fluid therapy be monitored? | 27 | ||
| 14 Investigation of renal function (1) | 28 | ||
| Functions of the kidney | 28 | ||
| Glomerular function | 28 | ||
| Serum creatinine | 28 | ||
| Creatinine clearance | 28 | ||
| Estimated GFR (eGFR) | 28 | ||
| Limitations of eGFR | 29 | ||
| eGFR – additional observations | 29 | ||
| Other measures | 29 | ||
| Proteinuria | 29 | ||
| 15 Investigation of renal function (2) | 30 | ||
| Renal tubular function | 30 | ||
| Tubular dysfunction | 30 | ||
| Investigation of tubular function | 30 | ||
| Osmolality measurements in plasma and urine | 30 | ||
| The water deprivation test | 30 | ||
| Urine pH and the acid load test | 30 | ||
| Specific proteinuria | 31 | ||
| Glycosuria | 31 | ||
| Aminoaciduria | 31 | ||
| Specific tubular defects | 31 | ||
| The Fanconi syndrome | 31 | ||
| Renal stones | 31 | ||
| Urinalysis | 31 | ||
| 16 Urinalysis | 32 | ||
| Procedure | 32 | ||
| Glucose | 32 | ||
| Bilirubin | 33 | ||
| Urobilinogen | 33 | ||
| Ketones | 33 | ||
| Specific gravity | 33 | ||
| pH (hydrogen ion concentration) | 33 | ||
| Protein | 33 | ||
| Blood | 33 | ||
| Nitrite | 33 | ||
| Leucocytes | 33 | ||
| 17 Proteinuria | 34 | ||
| Mechanisms of proteinuria | 34 | ||
| Glomerular proteinuria | 34 | ||
| Tubular proteinuria | 34 | ||
| Overflow proteinuria | 34 | ||
| Tamm–Horsfall proteinuria | 34 | ||
| Ways of measuring proteinuria | 35 | ||
| Dipstick urinalysis | 35 | ||
| Protein/creatinine ratio | 35 | ||
| Urine protein excretion | 35 | ||
| Albumin/creatinine ratio and ‘microalbuminuria’ | 35 | ||
| 18 Acute renal failure | 36 | ||
| Aetiology | 36 | ||
| Diagnosis | 36 | ||
| Acute tubular necrosis | 36 | ||
| Management | 36 | ||
| Recovery | 37 | ||
| 19 Chronic renal failure | 38 | ||
| Consequences of CRF | 38 | ||
| Sodium and water metabolism | 38 | ||
| Potassium metabolism | 38 | ||
| Acid–base balance | 38 | ||
| Calcium and phosphate metabolism | 38 | ||
| Erythropoietin synthesis | 38 | ||
| Clinical features | 38 | ||
| Management | 38 | ||
| Dialysis | 39 | ||
| Renal transplant | 39 | ||
| 20 Acid–base: | 40 | ||
| H+ concentration | 40 | ||
| H+ production | 40 | ||
| Buffering | 40 | ||
| H+ excretion in the kidney | 40 | ||
| Assessing status | 41 | ||
| Acid–base disorders | 41 | ||
| Compensation | 41 | ||
| Terminology | 41 | ||
| 21 Metabolic acid–base disorders | 42 | ||
| Metabolic acidosis | 42 | ||
| The anion gap | 42 | ||
| Causes of metabolic acidosis | 42 | ||
| Clinical effects of acidosis | 43 | ||
| Metabolic alkalosis | 43 | ||
| Clinical effects of alkalosis | 43 | ||
| 22 Respiratory and mixed acid–base disorders | 44 | ||
| Respiratory acidosis | 44 | ||
| Respiratory alkalosis | 44 | ||
| Mixed acid–base disorders | 44 | ||
| 23 Oxygen transport | 46 | ||
| Normal oxygen transport | 46 | ||
| Respiratory failure | 46 | ||
| Impaired diffusion | 46 | ||
| Ventilation/perfusion imbalance | 47 | ||
| Oxygen therapy | 47 | ||
| 24 Acid–base disorders: | 48 | ||
| Specimens for blood gas analysis | 48 | ||
| Interpreting results | 48 | ||
| Clinical cases | 48 | ||
| Management of acid–base disorders | 49 | ||
| 25 Proteins and enzymes | 50 | ||
| Plasma proteins | 50 | ||
| Total protein | 50 | ||
| Albumin | 50 | ||
| Specific proteins | 50 | ||
| Enzymes | 50 | ||
| Serum enzymes in disease | 50 | ||
| Isoenzyme determination | 51 | ||
| 26 Immunoglobulins | 52 | ||
| Structure | 52 | ||
| Electrophoresis of serum proteins | 52 | ||
| Measurement | 52 | ||
| Increased immunoglobulins | 52 | ||
| Paraproteins | 52 | ||
| Deficiencies or absence of immunoglobulins | 53 | ||
| 27 Myocardial infarction | 54 | ||
| Pathology | 54 | ||
| Definitions | 54 | ||
| Acute coronary syndrome | 54 | ||
| Myocardial infarction | 54 | ||
| Diagnosis | 55 | ||
| Cardiac biomarkers | 55 | ||
| 28 Liver function tests | 56 | ||
| Introduction | 56 | ||
| Liver function tests | 56 | ||
| Bilirubin | 56 | ||
| The aminotransferases (AST and ALT) | 57 | ||
| Alkaline phosphatase (ALP) | 57 | ||
| Gamma-glutamyl transpeptidase (γGT) | 57 | ||
| Plasma proteins | 57 | ||
| Prothrombin time | 57 | ||
| 29 Jaundice | 58 | ||
| Biochemical tests | 58 | ||
| Differential diagnosis | 58 | ||
| Haemolysis | 58 | ||
| Extrahepatic biliary obstruction | 58 | ||
| Hepatocellular damage | 59 | ||
| 30 Liver disease | 60 | ||
| Acute liver disease | 60 | ||
| Investigation | 60 | ||
| Poisoning | 60 | ||
| Liver infection | 60 | ||
| Outcome | 60 | ||
| Hepatic failure | 60 | ||
| Chronic liver disease | 60 | ||
| Aetiology | 61 | ||
| Clinical features | 61 | ||
| Unusual causes of cirrhosis | 61 | ||
| Other liver problems | 61 | ||
| 31 Glucose metabolism and diabetes mellitus | 62 | ||
| Insulin | 62 | ||
| Diabetes mellitus | 62 | ||
| Type 1 diabetes mellitus | 62 | ||
| Type 2 diabetes mellitus | 62 | ||
| Late complications of diabetes mellitus | 63 | ||
| 32 Diagnosis and monitoring of diabetes mellitus | 64 | ||
| Blood glucose | 64 | ||
| Diagnosis of diabetes mellitus | 64 | ||
| Criteria for diagnosis | 64 | ||
| Fasting blood glucose | 64 | ||
| Other glucose measurements | 64 | ||
| Impaired glucose tolerance and impaired fasting glycaemia | 64 | ||
| Monitoring of diabetes | 65 | ||
| Glycated haemoglobin | 65 | ||
| Current issues in diabetes diagnosis | 65 | ||
| Other | 65 | ||
| Self-monitoring | 65 | ||
| Glycosuria | 65 | ||
| Ketones in urine or blood | 65 | ||
| 33 Diabetic ketoacidosis | 66 | ||
| How diabetic ketoacidosis develops | 66 | ||
| Treatment | 66 | ||
| Laboratory investigations | 66 | ||
| Hyperosmolar non-ketotic (HONK) coma | 66 | ||
| Diagnosis | 66 | ||
| 3 Endocrinology | 79 | ||
| 40 Endocrine control | 80 | ||
| Biochemical regulators | 80 | ||
| Hormone structure | 80 | ||
| Assessment of endocrine control | 80 | ||
| Types of endocrine control | 80 | ||
| Negative feedback | 80 | ||
| Positive feedback | 80 | ||
| Pitfalls in interpretation | 81 | ||
| Dynamic function tests | 81 | ||
| 41 Dynamic function tests | 82 | ||
| Insulin stress test | 82 | ||
| TRH test | 82 | ||
| GnRH test | 82 | ||
| Oral glucose tolerance test with GH measurement | 82 | ||
| Synacthen tests | 83 | ||
| Short Synacthen test | 83 | ||
| Long Synacthen test | 83 | ||
| Dexamethasone suppression tests | 83 | ||
| Low dose dexamethasone suppression test | 83 | ||
| High dose dexamethasone suppression test | 83 | ||
| Dynamic function tests – protocol variation | 83 | ||
| 42 Pituitary function | 84 | ||
| The pituitary gland | 84 | ||
| Anterior pituitary hormones | 84 | ||
| Hyperprolactinaemia | 84 | ||
| Posterior pituitary hormones | 84 | ||
| Pituitary tumours | 84 | ||
| Diagnosis | 84 | ||
| Treatment | 85 | ||
| Hypopituitarism | 85 | ||
| 43 Growth disorders and acromegaly | 86 | ||
| Normal growth | 86 | ||
| Growth hormone insufficiency | 86 | ||
| Tests of growth hormone insufficiency | 86 | ||
| Treatment | 86 | ||
| Excessive growth | 87 | ||
| Acromegaly | 87 | ||
| Diagnosis | 87 | ||
| Treatment | 87 | ||
| 44 Thyroid pathophysiology | 88 | ||
| Introduction | 88 | ||
| Goitre | 88 | ||
| Thyroid hormone action | 88 | ||
| Binding in plasma | 88 | ||
| Regulation of thyroid hormone secretion | 88 | ||
| Thyroid function tests | 88 | ||
| Drugs and the thyroid | 89 | ||
| 45 Hypothyroidism | 90 | ||
| Clinical features | 90 | ||
| Causes | 90 | ||
| Diagnosis | 90 | ||
| Treatment | 90 | ||
| Screening for neonatal hypothyroidism | 90 | ||
| Non-thyroidal illness | 91 | ||
| 46 Hyperthyroidism | 92 | ||
| Clinical features | 92 | ||
| Causes | 92 | ||
| Diagnosis | 92 | ||
| Treatment | 92 | ||
| Thyroid eye disease | 93 | ||
| 47 Adrenocortical pathophysiology | 94 | ||
| Cortisol | 94 | ||
| Adrenal androgens | 94 | ||
| Assessing the function of the hypothalamic–pituitary–adrenocortical axis | 94 | ||
| Aldosterone | 94 | ||
| Congenital adrenal hyperplasia (CAH) | 95 | ||
| Relationship of adrenal cortex and medulla | 95 | ||
| 48 Hypofunction of the adrenal cortex | 96 | ||
| Adrenal insufficiency | 96 | ||
| Biochemical features | 96 | ||
| Diagnosis | 96 | ||
| Random cortisol | 96 | ||
| Synacthen tests | 97 | ||
| Relative adrenal insufficiency | 97 | ||
| Isolated aldosterone deficiency | 97 | ||
| 49 Hyperfunction of the adrenal cortex | 98 | ||
| Cortisol excess | 98 | ||
| Confirming the diagnosis | 98 | ||
| Determining the cause | 98 | ||
| Androgen excess | 99 | ||
| Aldosterone excess | 99 | ||
| 50 Gonadal function | 100 | ||
| Sex steroid hormones | 100 | ||
| Hypothalamic–pituitary–gonadal axis | 100 | ||
| Male gonadal function | 100 | ||
| Disorders of male sex hormones | 100 | ||
| Disorders of male sexual differentiation | 100 | ||
| Female gonadal function | 100 | ||
| Disorders of female sex hormones | 100 | ||
| The androgen screen in women | 101 | ||
| 51 Subfertility | 102 | ||
| Endocrine investigations in the subfertile woman | 102 | ||
| Endocrine investigations in the subfertile man | 102 | ||
| 4 Specialized Investigations | 103 | ||
| 52 Nutritional assessment | 104 | ||
| History | 104 | ||
| Examination | 104 | ||
| Biochemistry | 104 | ||
| Preoperative nutritional assessment | 105 | ||
| 53 Nutritional support | 106 | ||
| What do patients need? | 106 | ||
| Energy | 106 | ||
| Nitrogen | 106 | ||
| Vitamins and trace elements | 106 | ||
| How should they receive it? | 106 | ||
| Monitoring patients | 107 | ||
| 54 Parenteral nutrition | 108 | ||
| Indications for parenteral nutrition | 108 | ||
| Route of administration | 108 | ||
| Components of TPN | 108 | ||
| Complications | 108 | ||
| Monitoring patients on TPN | 109 | ||
| 55 The metabolic response to injury | 110 | ||
| The phases of the metabolic response to injury | 110 | ||
| The acute phase protein response | 110 | ||
| Clinical uses | 111 | ||
| Starvation and the metabolic response to injury | 111 | ||
| 56 Gastrointestinal disorders | 112 | ||
| Physiology of digestion and absorption | 112 | ||
| Malabsorption | 112 | ||
| Gastrointestinal disorders | 112 | ||
| Gastro-oesophageal | 112 | ||
| Pancreas | 113 | ||
| Small intestine | 113 | ||
| Inflammatory bowel disease | 113 | ||
| Malignant disease | 113 | ||
| 57 Iron | 114 | ||
| Iron physiology | 114 | ||
| Laboratory investigation of iron disorders | 114 | ||
| Iron deficiency | 114 | ||
| Treatment | 115 | ||
| Iron overload | 115 | ||
| Haemochromatosis | 115 | ||
| Iron poisoning | 115 | ||
| 58 Zinc and copper | 116 | ||
| Zinc | 116 | ||
| Zinc physiology | 116 | ||
| Zinc deficiency | 116 | ||
| Zinc toxicity | 116 | ||
| Laboratory assessment | 116 | ||
| Copper | 116 | ||
| Copper physiology | 116 | ||
| Copper deficiency | 116 | ||
| Copper toxicity | 116 | ||
| Laboratory assessment | 117 | ||
| Inborn errors of copper metabolism | 117 | ||
| Wilson’s disease | 117 | ||
| 59 Therapeutic drug monitoring | 118 | ||
| Sampling for TDM | 118 | ||
| Interpretation of drug levels | 118 | ||
| Drug interactions | 119 | ||
| Pharmacokinetics | 119 | ||
| 60 Toxicology | 120 | ||
| Confirming poisoning | 120 | ||
| Measurement of drug levels | 120 | ||
| Treatment | 120 | ||
| Common causes of poisoning | 120 | ||
| Chronic poisoning | 121 | ||
| 61 Metal poisoning | 122 | ||
| Metals associated with poisoning | 122 | ||
| Diagnosis | 122 | ||
| Treatment | 122 | ||
| Common sources | 122 | ||
| Lead | 122 | ||
| Mercury | 122 | ||
| Aluminium | 123 | ||
| Arsenic | 123 | ||
| Cadmium | 123 | ||
| Cobalt and chromium | 123 | ||
| 62 Alcohol | 124 | ||
| Metabolism of ethanol | 124 | ||
| Acute alcohol poisoning | 124 | ||
| Chronic alcohol abuse | 125 | ||
| Diagnosis of chronic alcohol abuse | 125 | ||
| 63 Coma | 126 | ||
| Differential diagnosis of coma | 126 | ||
| Cerebrovascular accident | 126 | ||
| Infectious causes | 126 | ||
| Metabolic causes | 126 | ||
| Drugs and poisons | 126 | ||
| Alcohol | 126 | ||
| Carbon monoxide poisoning | 127 | ||
| Hepatic coma | 127 | ||
| Brain death | 127 | ||
| 64 Ascites and pleural fluid | 128 | ||
| Ascites | 128 | ||
| 5 Case History Comments | 163 | ||
| 82 Case history comments | 164 | ||
| Case history 1 | 164 | ||
| Case history 2 | 164 | ||
| Case history 3 | 164 | ||
| Case history 4 | 164 | ||
| Case history 5 | 164 | ||
| Case history 6 | 164 | ||
| Case history 7 | 164 | ||
| Case history 8 | 164 | ||
| Case history 9 | 165 | ||
| Case history 10 | 165 | ||
| Case history 11 | 165 | ||
| Case history 12 | 165 | ||
| Case history 13 | 165 | ||
| Case history 14 | 165 | ||
| Case history 15 | 165 | ||
| Case history 16 | 165 | ||
| Case history 17 | 165 | ||
| Case history 18 | 165 | ||
| Case history 19 | 166 | ||
| Case history 20 | 166 | ||
| Case history 21 | 166 | ||
| Case history 22 | 166 | ||
| Case history 23 | 166 | ||
| Case history 24 | 166 | ||
| Case history 25 | 166 | ||
| Case history 26 | 166 | ||
| Case history 27 | 166 | ||
| Case history 28 | 167 | ||
| Case history 29 | 167 | ||
| Case history 30 | 167 | ||
| Case history 31 | 167 | ||
| Case history 32 | 167 | ||
| Case history 33 | 167 | ||
| Case history 34 | 167 | ||
| Case history 35 | 167 | ||
| Case history 36 | 167 | ||
| Case history 37 | 168 | ||
| Case history 38 | 168 | ||
| Case history 39 | 168 | ||
| Case history 40 | 168 | ||
| Case history 41 | 168 | ||
| Case history 42 | 168 | ||
| Case history 43 | 168 | ||
| Case history 44 | 168 | ||
| Case history 45 | 168 | ||
| Case history 46 | 169 | ||
| Case history 47 | 169 | ||
| Case history 48 | 169 | ||
| Case history 49 | 169 | ||
| Case history 50 | 169 | ||
| Case history 51 | 169 | ||
| Case history 52 | 169 | ||
| Case history 53 | 169 | ||
| Case history 54 | 169 | ||
| Case history 55 | 170 | ||
| Case history 56 | 170 | ||
| Case history 57 | 170 | ||
| Case history 58 | 170 | ||
| Case history 59 | 170 | ||
| Case history 60 | 170 | ||
| Case history 61 | 170 | ||
| Case history 62 | 170 | ||
| Case history 63 | 170 | ||
| Case history 64 | 170 | ||
| 6 Web Resources | 173 | ||
| 83 Web resources | 174 | ||
| Interact with the authors | 174 | ||
| Key journals | 174 | ||
| Key professional bodies | 174 | ||
| General sites | 174 | ||
| History | 175 | ||
| Careers in clinical biochemistry | 175 | ||
| Index | 176 | ||
| A | 176 | ||
| B | 177 | ||
| C | 177 | ||
| D | 178 | ||
| E | 179 | ||
| F | 179 | ||
| G | 180 | ||
| H | 180 | ||
| I | 181 | ||
| J | 182 | ||
| K | 182 | ||
| L | 182 | ||
| M | 182 | ||
| N | 183 | ||
| O | 183 | ||
| P | 184 | ||
| Q | 185 | ||
| R | 185 | ||
| S | 185 | ||
| T | 186 | ||
| U | 186 | ||
| V | 186 | ||
| W | 186 | ||
| X | 186 | ||
| Z | 186 |