CLINICAL ENZYMOLOGY.pptx ALP, GGT AND AMYLASE

For chemical pathology/ clinical biochemistry.

1. CLINICAL ENZYMOLOGY. By ADEYEMI OYINDAMADE ANGEL. waec , jamb, path/pharm{in view}.

2. ALKALINE PHOPHATASE GAMMA-GLUTAMYL TRANSPEPTIDASE [GGT] AMYLASE

3. OUTLINE. Brief overview of enzymes in biochemical reactions. Importance of clinical enzymology in diagnosis & monitoring of diseases. ALP { Structure & function, isoenzymes & their clinical significance, regulation of ALP activity, clinical application}. GGT {Structure & function, cellular localization, clinical applications} AMYLASE {Structure & function, sources of amylase, clinical applications}

4. ENZYMES & THEIR ROLE Enzymes are biochemical catalysts that accelerate chemical reactions in living organisms. They are essential for all metabolic processes. Functions: Aid in regulation, conversion, detoxification, protein synthesis & degradation, cell signaling, defense. Enzymes are essential for: proper growth & development, energy production & storage, antioxidant defenses, anti-inflammatory responses, overall health & well-being.

5. CLINICAL ENZYMOLOGY. Clinical enzymology is the study of enzymes in clinical diagnosis & monitoring. Importance: diagnosis, differential diagnosis, monitoring disease progression, early detection, prognosis.

6. ALKALINE PHOSPHATASE{ALP} Alkaline phosphatase(ALP) is a group of enzymes that hydrolyse organic phosphate at high pH. It is found in many body tissues such as liver, bile ducts, bones, kidneys, placenta & intestinal mucosa. ALP functions best under alkaline pH environments (9-10.5). Half life is 3-7 days. Physiologic increase occurs at growing age. It is found in or near the bile canalicular memebrane of hepatocytes. Normal serum level is 21-92 IU/L

7. ALP Physiological increase Age: neonates, children, young adults. Pregnancy: Last trimester Pathological increase Liver disease: hepatocellular disease, cholestasis, space occupying lesions. Bone disease: paget’s disease, malignancy, hyperparathyroidism osteomalacia .

8. ALP ISOENZYMES.

9. GAMMA-GLUTAMYL TRANSFERASE. GGT is one of a large group of enzymes “peptidases”. It is a hepatobiliary tract enzyme. GGT catalyzes the transfer of glutamyl group from peptides or peptide like compounds to an acceptor peptide molecule. It only acts on peptides or peptide like compounds. It is found in the cell membrane & mitochondria of liver and other tissues. GGT plays a major role in glutathione metabolism, leukotriene synthesis, drug & xenobiotic detoxification.

10. GGT activity is elevated in all forms of liver disease like: obstructive jaundice, cholangitis, cholecystitis , biliary atresia, infectious hepatitis. GGT in alcoholics, receiving drugs such as phenytoin, phenobarbital are usually elevated. DECREASED LEVELS OF GGT: can be found in: chronic renal failure, hypothyroidism, hypothalamic malfunctions.

11. Elevation of GGT generally parallels that of ALP however, GGT is more sensitive. Normal GGT with elevated ALP indicates bone disease. Elevated GGT & ALP indicates hepatobiliary disease. Unlike ALP, GGT is not elevated in childhood or pregnancy. GGT can be used to detect chronic alcohol ingestion & is elevated in about 75% of pts who chronically drink alcohol.

12. AMYLASE They are hydrolases that split complex carbohydrates constituted of alpha-1,4 glycosidic bonds & alpha-1,6 glycosidic bonds e.g starch & glycogens. The main isoenzymes are those of salivary glands & pancreas. Serum level is <300 IU/L. Serum amylase is elevated in perforated peptic ulcer, salivary gland conditions and appendicitis, among other conditions. It is removed by renals & appears in the urine because of its small weight [50-55KD].

13. Causes of increased activity of Amylase. Pancreatic disorders: Acute pacreatitis , trauma, carcinoma, pancreatic pseudocyst . Non pancreatic abdominal disease: Perforated ulcer, intestinal obstruction, ruptured ectopic pregnancy. Salivary gland disorders: Mumps, salivary calculi, sjogren syndrome. Decreased renal excretion. DKA Macroamylasemia

14. CLINICAL APPLICATIONS. ALP: -Liver disease: elevated in hepatitis, cirrhosis, or bile duct obstruction. Bone disorders: Pagets disease, osteomalacia , & bone metastases. Differentiation when used with GGT. GGT: liver & bile duct diseases, alcohol abuse, diagnostic aid. Amylase: pancreatic disorders, salivary gland disorders, macroamylasemia .

15. CONCLUSION. In summary, it is impossible to overestimate the clinical importance of ALP, GGT & amylase. These enzymes serve us in diagnosing & monitoring a range of conditions. By understanding their roles & regulatory mechanisms, we can better appreciate their importance in clinical practice. THANK YOU FOR YOUR KIND ATTENTION, AND I HOPE THIS PRESENTATION HAS ENHANCED YOUR UNDERSTANDING OF CLINICAL ENZYMOLOGY.

16. Reference Dr Mohammed Al- huraiby Martin Crook Google Gemini