Professional Documents
Culture Documents
Enzymes-Part-4 - Creatine Kinase, Gamma GT, Lactate Dehydrogenase, and Lipase
Enzymes-Part-4 - Creatine Kinase, Gamma GT, Lactate Dehydrogenase, and Lipase
Table of Contents
0.1. Diagnostic Value of enzymes in Various Diseases
0.2. Creatine kinase (CK)
0.2.0.0.1. Definition of Creatine kinase (CK):
0.2.0.0.2. It has subunits:
0.3. Gamma-Glutamyl Transferase (GGT)
0.3.0.1. Definition of Gamma-Glutamyl Trasferase (GGT)
0.3.0.2. Indications for the GGT
0.3.0.3. Pathophysiology of GGT:
0.3.0.4. Causes of raised GGT:
0.4. Lactate dehydrogenase (LDH)
0.4.0.0.1. Precautions for LDH
0.4.0.1. Pathophysiology of LDH
0.4.0.2. LDH is raised in:
0.5. Lipase Enzyme
0.5.0.1. Lipase level raised in the following conditions:
0.5.0.2. Lipase level decreased:
0.5.0.3. Lipase level normal in:
0.5.0.4. Questions and answers:
It Has Subunits:
1. CK-1 is CK-BB.
2. CK-2 is CK- MB.
3. CK-3 is CK – MM.
4. CK enzyme activity increases in skeletal muscles, the cardiovascular system, the brain, and thyroid diseases.
5. CK-MM is increased in:
1. Muscular atrophy, especially Duchenne’s type.
2. In progressive muscular dystrophy.
3. The enzyme level is high in children between 7 to 10 years.
1. It falls in the older patient.
6. CK-MB is raised after the acute myocardial infection.
(https://labpedia.net/wp-content/uploads/2020/01/Ck-MB-curve.jpg)
CK-MB level in acute myocardial infarction
https://labpedia.net/enzyme-part-4-creatine-kinase-gamma-gt-lactate-dehydrogenase-and-lipase/ 1/6
1/21/23, 10:43 PM Enzymes-part-4- Creatine Kinase, Gamma GT, Lactate Dehydrogenase, and Lipase
2. GGT is also seen in proximal renal tubules, the brain, the prostate, and the pancreas (ductules and acinar cells).
Pathophysiology of GGT:
1. GGT is responsible for glutathione’s extracellular metabolism (the cells’ main oxidant).
2. Glutathione is its substrate.
3. GGT is present on the cell membranes and assists amino acid transport into the cells.
(https://labpedia.net/wp-content/uploads/2022/01/GGT-role-for-amino-acids-1.jpg)
GGT’s role in amino acids transport
4. GGT is mainly present in the liver cells. It is also presented in the biliary tract epithelium.
1. GGT is present in the smooth endoplasmic reticulum of liver cells, and it will be increased in case of increased toxins.
1. GGT is increased in patients when exposed to drugs like barbiturates, warfarin, valproate, Dilantin, methotrexate, and alcohol.
2. A small amount is found in the kidneys, intestine, heart, brain, pancreas, and spleen.
3. There is some activity in the capillary endothelial cells.
5. The serum GGT level is increased in the newborn but decreases to the adult level by 4 months.
1. GGT usually does not increase in bone disease, childhood or adolescence, or pregnancy.
6. GGT is raised by acute liver cell damage and biliary tract obstruction.
7. Its half-life is 7 to 10 days.
8. This enzyme originates from the hepatobiliary system.
9. GGT is the best indicator of occult alcoholism.
10. GGT is lower in women than men. It is significantly high in African-Americans.
Lactate Dehydrogenase (LDH)
https://labpedia.net/enzyme-part-4-creatine-kinase-gamma-gt-lactate-dehydrogenase-and-lipase/ 2/6
1/21/23, 10:43 PM Enzymes-part-4- Creatine Kinase, Gamma GT, Lactate Dehydrogenase, and Lipase
Sample for LDH
1. It is a marker of hemolysis.
2. It is a useful marker of the disease activity in cryptogenic fibrosing alveolitis and extrinsic allergic alveolitis.
3. LDH was the marker of AMI but is now replaced by the Troponin T.
Pathophysiology of LDH
1. LDH is widely distributed in the tissue and has a high concentration in the liver, cardiac muscles, kidneys, skeletal muscles, RBCs, and other
tissues.
1. Less concentration is found in the lungs, smooth muscles, and the brain.
(https://labpedia.net/wp-content/uploads/2022/01/LDH-reaction-3.jpg)
LDH’s role in chemical reactions
https://labpedia.net/enzyme-part-4-creatine-kinase-gamma-gt-lactate-dehydrogenase-and-lipase/ 3/6
1/21/23, 10:43 PM Enzymes-part-4- Creatine Kinase, Gamma GT, Lactate Dehydrogenase, and Lipase
3. Severe shock and anoxia.
4. Megaloblastic anemia.
5. In the case of liver disease.
6. In 1/3 of the cases of renal diseases like tubular necrosis and pyelonephritis.
7. In liver metastatic tumor infiltration.
8. LDH-raised value in the urine is seen in the case of glomerulonephritis, diabetic nephropathy, systemic lupus erythematosus, urinary bladder,
and kidney malignancies.
9. CSF infiltration by the granulocytes increases the LDH value.
1. In bacterial meningitis, there is an increase in LD-4 and LD-5.
10. In cerebrovascular accidents:
1. Subdural and subarachnoid hemorrhage increases all isoenzymes of LD, especially LD-3, 4, 5
2. Where peak level reaches in 1 to 3 days.
3. It is not related to xanthochromia.
4. In CNS tumors, there is an increase in the LD-5 in >9% of the cases and decreased level of LD-1: LD-5 ratio.
5. LD-1: LD-5 ratio <2.5 in the absence of infection or hemorrhage suggests meningeal tumors.
6. LD-5 in >10% of the cases suggests high-grade malignant tumors.
11. This is normal in angina and pericarditis.
Lipase Enzyme
Definition of lipase
1. Lipase is a glycoprotein enzyme filtered by glomeruli and completely absorbed by proximal tubules.
2. Lipase is more specific than amylase in pancreatic damage.
Pathophysiology of lipase
1. The pancreas is the main organ for lipase secretion, which goes into pancreatic juice.
1. Lipase may be found in the stomach and intestinal mucosa but doesn’t have a significant role in the processing of fats.
2. Lipase from the pancreas is secreted into the duodenum, converting triglycerides into fatty acids.
2. Lipase concentration in the pancreas is 100 times greater than in the other tissue.
1. The difference between amylase in the pancreas and serum is 20,000 times.
2. A very small amount is found in the serum.
3. Lipase estimation is very difficult and not reproducible, so not common in the labs.
4. Lipase hydrolyzes glycerol esters of long-chain fatty acids.
3. Acute pancreatitis:
1. Lipase enzymes can diagnose it.
2. The serum lipase level rises slightly later than amylase.
3. The initial rise is seen in 4 to 8 (3 to 6) hours.
4. The peak level is 24 hours (another reference says the peak level is after 72 to 96 hours).
5. The peak remains for a longer time.
6. The normal level is seen after 8 to 14 days (7 to 10 days).
(https://labpedia.net/wp-content/uploads/2022/01/lipase-enzyme-curve-1.jpg)
Lipase enzyme in acute pancreatitis
https://labpedia.net/enzyme-part-4-creatine-kinase-gamma-gt-lactate-dehydrogenase-and-lipase/ 4/6
1/21/23, 10:43 PM Enzymes-part-4- Creatine Kinase, Gamma GT, Lactate Dehydrogenase, and Lipase
Add Comment
Comments
Your name
Your email
Save my name, email, and website in this browser for the next time I comment.
ADD COMMENT
ABOUT US
Labpedia.net is non-profit health information resource. All informations are useful for doctors, lab technicians, nurses, and paramedical staff. All the
tests include details about the sampling, normal values, precautions, pathophysiology, and interpretation.
https://labpedia.net/enzyme-part-4-creatine-kinase-gamma-gt-lactate-dehydrogenase-and-lipase/ 5/6
1/21/23, 10:43 PM Enzymes-part-4- Creatine Kinase, Gamma GT, Lactate Dehydrogenase, and Lipase
QUICK LINKS
Blog (https://labpedia.net/category/blog/)
About Us (https://labpedia.net/about-us/)
Contact (https://labpedia.net/contact/)
Disclaimer (https://labpedia.net/disclaimer/)
OUR TEAM
Professor Dr. Riaz Ahmad Bhutta (https://www.labpedia.net/dr-riaz/)
https://labpedia.net/enzyme-part-4-creatine-kinase-gamma-gt-lactate-dehydrogenase-and-lipase/ 6/6