Contents

Physiology
I.SalivatorySecretions................................2
II.GastricSecretions....................................2
III.GastricMucosalDisorders.......................2
IV.PancreaticSecretions...............................2
V.BileSecretion...........................................3
VI.IntestinalSecretion..................................3

Nutrition
VII.NutritonalEquations................................3
VIII.DietaryMacromoleculesandVitamins....3
IX.DietaryMinerals.......................................4

LipidBiochemistry
X.LipidSynthesis..........................................4
XI.LipidMetabolism......................................4
XII.Lipoproteins.............................................4
XIII.FattyAcidsandObesity............................5

Pharmacology/Laboratory
XIV.Pharmacology...........................................5
XV.LaboratoryTests.......................................5

Ineedabreak.

Page2

GastrointestinalExamIITables

TableI
Gland
Parotid
Submandibular
Sublingual
Oral/buccalmucosa
Duct
Intercalatedducts
Striatedducts
Excretoryducts
Functions
Digestion
Protection
Excretion
Regulation
Parasymathetic
Sympathetic

SalivatorySecretions
Secretion
Innervation (salivatorynucleus)
Serous,highamylase
Oticganglion(CNIX)
4:1seroustomucus,weakamylase,highlysozyme
Submandibularganglion(CNVII)
4:1mucustoserous
Submandibularganglion(CNVII)
Mucus
Action
Effect
Secreteprotein
Influencedbyaldosterone;absorbNa/Cl,secreteK/HCO
Salivabecomeshypotonictoplasma,alkalineathighsecretions
KH,HCOClexchange
Secretedepidermalgrowthfactor,enzymes;lowwaterpermeability
Partialdigestionoffood,maintainshypotonicityofsecretion
Factorsinvolved
amylase,lipase,DNA/RNAse
Thiocyanate,sialoperoxidase,IgA/G/M,lysozyme,kallikrein
Glucose,urea,Hg,Pb
Effect
Pathway
Sustainedincreaseinrateupto20x;Na/Cl,K/HCO,protein
ACh/SubstanceP/VIP:secretionviaIP
Slighttransientincreaseinrate,K/HCO,protein
adrenergic:secretionviaIP
Overalldecreaseinsecretionduetovasoconstriction
adrenergic:amylaseviacAMP
Basalrate:11.5L/day,30mL/hr;maximalsecretions:400600mL/hr

TableII

GastricSecretions

Cell

Location

Secretions

Mucusneck

Neckofgastricglands

Mucus

Gcell

Pyloricantrum

Gastrin

EnterochromaffinDcells

Pyloricantrum

Somatostatin

Parietalcell

Fundus

HCl

Chiefcell
Mastcells
Entericneurons

Fundus
Throughout
PostganglionicCNX

Intrinsicfactor
Gastroferrin
Pepsinogen
Histamine
GRP(Bombesin)

TableIII
Disorder
Acutesuperficialgastritis
Chronicatrophicgastritis

Pepticulcerdisease

Helicobacterpylori
infection

Description
Protectsautodigestionbypepsinwithtightjunctions,mucusgelbarrierpreventsabsorption
StimuatedbyPGE,ACh,HCl,glucagon,VIP;InhibitiedbyNSAIDs,alcohol,bilesalts,agonists
StimulatesHClsecretion,increasesmotility,mildlyincreasespancreaticenzymerelease
StimulatedbyACh,GRP/bombesin,pH,protein,alcohol,Ca,coffee(AAs);releasedingastricphase
Inhibits ofgastrin,releasedatpH23,inhibitssecretioninsmallint.,pancreas,gallbladder
Releasedinintestinalphase
FormedviaactiveH transport(protonpump);pH0.8,1500cal/Ltosynthesize
Alkalinetide:HCOintobloodaftercarbonicanyhdraserxn(CO+HOH+HCO)
SecretedwithNa,K,HO;hencevomitingcausesmetabolicalkalosis,increasedratelowers[Na]
Highlevelsofacidityarerelatedtoduodenalulcers,gastriculcersaremoreduetomucosaldamage
NecessaryforabsorptionofVitB interminalileum
Necessaryforabsorptionofiron induodenum;convertsferric(Fe)toferrous(Fe)
StimulatedbyNE/epi,ACh,VIP,CCK,gastrin,H; cleavedtopepsin,onlyproteaseformeatcollagen
ActivatesstimulatoryH2receptorsonparietalcells,stimulatedbyfood,ACh,gastin,HCl,pepsin
Stimulatedbyprotein,neuralreflexesincephalicphase;gastrinandpancreaticsecretions

GastricMucosalDisorders
Description
Benign,selflimiting;vaguediscomfort,diarrhea
Smallerosionsandhemorrhages,normalgastricglands
Progressiveatrophyofglandularepithelium
Lossofparietalandchiefcells;littleornoglandactivity
Resultsinperniciousanemia,HClsecretion

Cause
Commonresponsetoirritants:caffeine,
ETOH,antibiotics,NSAIDs,spices,infection

Treatment

Unknown;H.pylori,ZollingerEllisontumor,
cancer,smoking,ETOH,stress,autoimmune

Hblockers,antacids,sucralfate,
prostaglandins,VitB

Penetrationofmusc.mucosa,mostlyduodenum,
antrum

Presentswithepigastricpain13haftermeals,relieved
byfood/antacids;N/V,weightloss,bleeding

Excessivepepsin/HCl,ETOH,tobacco,
caffeine,H.pylori,NSAIDs

Hdiffusioncausestissueinjuryreleasing
histamine,whichfurtherstimulatesHCl

7595%ofallulcersnotcausedbydrugsorchemicals

TableIV

Urease:ureaammonia+CO
Protease:digestsglycoproteinsinmucosa
Phospholipases:digestepithelialcells
Proteins:immuneresponse,pepsinsecretion

Function
SpontaneoussecretionsofNa,K,Cl,HCO;stimulatedbycAMP(secretin)orIP/Ca(ACh,VIP,CCK)
SecretinstimulatedsecretionofNa,K,Cl,HCO,especiallyHCO(carbonicanhydrase)
Cl(in)/HCO(out)exchange,limitedbyhighflowrate(HCO,pHinduct)

Enzyme

Secretedby

Cholecystokinin(CCK)

Icells(duod,jej)

Pancreatitis

Surgical:gastroenterostomy,subtotal
gastrectomy,truncalvaogotomy,
selectivegastricvagotomy
Pharm:Hagonists,PPIs,antacids,
antimuscarinics,sucralfate,
prostaglandinagonists,colloidalBi
Abxamoxicillin,clarithromycin
Protonpumpinhibitor
Treatmentforconditionscausedby
infection

PancreaticSecretions

Component
Acinarcells
Extralobularducts
Maincollectingduct

Secretin

Removeoffendingagent

Stimulus

Function

pancreatic secretion,gallbladdercontraction
gastricemptying
Scells(duod,jej)
Acid,high/lowosmolaritychyme pancreaticHCO,HOsecretion,cAMP
Causes:alcoholism(90%),gallstones,tumors,hyperlipidemia,postoperative,trauma
Presentation:epigastric/LUQpain,leastbothersomewhenbentforward,N/V/D,BP,WBC,Hct,amylase,lipase
Treatment:painrelief,nutritionalsupport,alcoholabstention,oralpancreaticenzymeextract
Fats,AAs,secretin

Image

GastrointestinalExamIITables

TableV

Liver

Gallbladder

SmallIntestine
Functions
Cycle

Page3

BileSecretion
Action
Biledependent
Bileindependent
Storage
Concentration
Release

Description
Secretedbyhepatocytes,nodirecthumoral/neuronalcontrol;formsprimary(1)acid
Secretedbybileductepithelium,stimulatedbysecretin;HCO,water
Holds60mLofbile
ActiveabsorptionofNa(withCl,HO)concentratesbile1220x
StimulatedbyCCK(relaxessphincterofOddiatMDP),secretin,vagalstimulation
80%arecholesterol,20%arepigment;obstructioncausesfatmalabsorption,hepatic
Gallstones
damage,drugtoxicity,inflammation
Bacterialconversion Formssecondary(2)bileacidsfrom1bileacids
Conjugation
2bileacidsareionized,reabsorbedbyepitheliumboundtoproteins
Emulsification,micelletransport,bufferingofgastricacid,excretionofbilirubin,cholesterol,toxins
Synthesis:0.20.6g/day,bilepool:3g,secretorycycles:412/d,sototalsecretion=poolcycles=1236g/day
Henceexcretionroughlyequalssynthesis:urinary<0.5mg/day(negligible),fecal0.20.6g/day

Image

TableVI
Area
Small
Intestine
Large
Intestine

IntestinalSecretions
Celltype
Brunnersglands(duodenum)

Secretion
Alkaline(HCO)mucusforprotectionfromacid,hormones

CryptsofLieberkuhn

Waterysubstanceforabsorption
Peptidase,saccharidases,intestinallipase,enterokinase

CryptsofLieberkuhn

MucuswithK,HCO;noenzymesforprotectionagainst
scratching,bacterialactivity,acids

Regulation
Static
Neural:ACh,VIP,subP(PS);local:distention,tactilereflex
Choleratoxin:cAMPincreasesClactivetransportinto
crypts,causesrapidfluidsecretion,espjejunum(512L/d)
Distention,pelvicnerves(PS),acuteemotionalstress
Irritation:secretionoflargevolumesofHO(diarrhea)

TableVII

NutritionalEquations

.85lbfat
454g 9Kcal
3,473Kcal
Caloriestoburn
Idealbodyweight

fat
1lbadiposetissue 1lb
1gfat 1lbadiposetissue
Glycogen:1000Kcal;0.53%(400gminliver&muscle)
Storageof
BodyMassIndex
Fat:130,000150,000Kcal;68.8%
energy
(BMI)
Protein:40,00060,000Kcal;21.2%
restingmetabolicexpexpenditure+thermiceffectoffood +activeenergyexpenditure
Kcal
Kcal
RMR=24
=.0167
;normal0.81Kcal/min(women),1.11.3Kcal/min(men)
TotalEnergy
daykg
min kg
Expenditure
TEFisdifficulttoestimate,sogeneralactivity(35%ofRME)isused

Men:106lbforfirst5ft+6lb/in
Women:100lbforfirst5ft+5lb/in
weightinKg

(heightinm)

Normal:male:22,female:21
>30=overweight,>40=obese

AEE:givenforspecificexerciseintermsofKcal/hr;So,estimatedTEE=1.35(RME)+AEE

TableVIII

DietaryMacromolecules&Vitamins

Amountneeded
Molecule
Requiredfunctions
Metabolism
(%ofcaloricintake)
Carbohydrate
4565%oftotal
Almostexclusivesourceforneurons,RBCs
Sucrose=GlcFru,Maltose=GlcGlc,Lactose=GlcGal;occursatbrushborder
<2530%(total)
Flavor,membranestructure,steroids,
Polyunsaturated:essentialFAs(e.g.linoleic,linolenic);LDL,BP,clotting
Lipids
<10%(saturated)
prostaglandins,leukotrienes,absorption,
Transfat:hydrogenatedunsaturatedfat,moresolid,detrimentaltohealth
<200mg(cholesterol) insulation,energystorage
Cholesterol:bilesalts,steroidhormones,vit.D
0.8g/kgbodyweight Structuralmaterials,enzymes,nitrogen
Animalprotein:complete,all22aminoacids;plants:canbeincomplete
Protein
1035%oftotal
balance
Nostoragefunctionasinfat,CHO
Vitamin
Sources
Functions
Metabolism
Deficiency
VitaminA
Yellow,orange,greenveggies
Moisturization,vision,tooth/bone
Formedfromcaroteneinintestine, Poordarkadaptation,stunted
(retinoids)
Fishoils,eggyolk,fortifiedmilk
development,antioxidant
liver,kidney;fatsoluble
growth,keratinization,infections
VitaminD
Fish,liver,eggyolk,fortifiedmilk EnhancesCa,PO absorption
Concentratedinliver,someinskin,
Disorderedbonegrowth,
(calciferols)
andorangejuice,sunlight
MobilizesCafrombonesw/PTH
spleen,kidneys;fatsoluble
osteomalacia
VitaminE
Vegetableoils,nuts,wholegrains,
Rare;hemolyticanemia
Anticoagulant,antioxidant
Storedinadiposetissue;fatsoluble
(tocopherals)
greenleafies
Toxicity:slowwoundhealing
VitaminK
Darkgreenleafies,cheese,pork, Bloodclotting(II,VII,IX,X)
Smallamountsstoredinliver,but
Uncommon;fatmalabsorption,
(quinones)
liver,cereal,fruits,bacteria
Electrontransportchain(III)
mostlyexcreted;fatsoluble
defectiveclotting,hemorrhage
Antioxidant,connectivetissue
VitaminC
Citrus,melons,strawberries,
Requiresacidforabsorptioninsmall
Scurvy:gingivallesions,painful
formation,Trp5HT,cholesterol
(ascorbicacid)
potatoes,tomatoes,greenleafies
intestine,watersoluble
movement
bile,Fereduction,folateactivation
VitaminB
Leanmeats,liver,fish,eggs,whole Carbohydrate metabolism,alcohol
Requiresacidforabsorptioninupper Beriberi (myelindegeneration),
(thiamine)
grains,greenleafies,beans
oxidation,AChandacetylCoAsynth.
smallintestine,watersoluble
heartfailure,fatigue,CNSdep.
VitaminB
Milk,liver,yeast,eggwhite,whole CoenzymesFADandFMN, aminoacid Joinedwithadenineandribosetoform Oneofmostcommon;dermatitis,
(riboflavin)
grains,meat,poultry,fish,legume oxidases
FADandFMN
lipcracking,photosensitivity
Pellagra:listlessness,headache,loss
VitaminB
Poultry,meat,fish;liver,yeast,
NAD/NADP;oxphos,nuclear
Joinedwithadenineandribosetoform
ofappetite,laterdermatitis,
(niacin)
peanuts,potatoes,greenleafies
reactions,DNArepair,vasodilation
NADandNADP
diarrhea,dementia
VitaminB5
Animalfoods(esp.liveryeast,egg Combineswithphosphoroustoform
Possiblerelationtoalcoholic
Absorbedinsmallintestine
(pantothenate)
yolk),wholegrains,legumes
CoA;acetyltransfers,hemesynthesis
neuropathy
VitaminB6
Meat,poultry,fish,wholegrains, Trp5HT,GABAsynthesis,immunity, Existsmostlyaspyridoxalphosphate
Irritability,convulsions,anemia,
(pyridoxine)
bananas,sweetpotatoes,spinach glycogenolysis,AAmetabolism
Storedinmuscle
vomiting,weakness,abdominalpain
VitaminB
Liver,meat,poultry,fish,dairy,
Coenzyme,DNA,methionine,and
Requiresintrinsicfactorforabsorption Perniciousanemia
(cyanocobalamin) eggs;notinplants
cholinesynthesis
interminalileum,storedinliver(3mo) Moreduetomalabsorption
Biotin
Gutbacteria,liver,yolk,legumes De/carboxylationanddeaminationrxns Storedinsmallamountsinliver,kidney Noneknown
Folate
Liver,orangejuice,greenleafies
Methyltransfers,RBCformation
Storedinliver
Macrocytic anemia,birthdefects

Page4

GastrointestinalExamIITables

TableIX
Mineral
Calcium
Sodium
Iron
Iodine

DietaryMinerals

Sources
Dairy,greenleafies,legumes,
nuts,grains

Functions
Musclecontraction,nervetransmission,clotting,
bones,teeth,heartrhythm,cellpermeability
Osmoticbalance,acid/basebalance(w/PO),cell
Salt,meats,cheese
permeability,neuronal/musclefxn,GIabsorption
Meat,liver,shellfish,yolk,fruit, Heme(70%),myoglobin(5%),storedasferritin
nuts,legumes,molasses
(20%),cellularenzymecofactor(5%)

Metabolism
Increasedabsorptionwithvit.D,CHO,
protein,acidicenvironment,bodilyneed
Excretedviakidneys,sensitiveto
aldosterone
Hemeisslower,mustbereducedfrom
ferric(Fe)toferrous(Fe)byvit.CinSI

Seafood,iodizedtablesalt

7080%storedinthyroid;TSHfromant.
pituitarystimulatesIuptake

Thyroidhormonesynthesis(thyroxine)

Deficiency
Tetany,rickets,osteomalacia,
osteoporosis,boneresorption
Dehydration
Toxicity:HTN
Womenneedtwiceasmuch
Hypochromic,microcyticanemia
Cretinism,braindamage
Goiter:creationofthyroglobulin
insteadofthyroxine,hypertrophy

TableX

LipidSynthesis

Agent

Actions

AcetylCoAcarboxylase FormsmalonylCoAusingATPandbiotinascofactor

Regulators
bycitrate,insulin,dephosphorylation
bylongchainacylCoA,glucagon,cAMP

MalonylCoA

BindstoPsiteofFAsynthaseatstartofeachcycle

Malicenzyme

Oxidizesmalatetopyruvate,reducesNADPtoNADPH bypyruvate,NADPH;byNADP

carnitinepalmitoyltrxansferase1(CPT1)

Cleavesesterbondat2carbonofglycerol
Prostaglandinsynthesis,presentinsnakevenom
Inhibitsplateletaggregation
Causesvasodilation
Stimulatesplateletaggregation
Causesvasoconstriction
CleavesNAcGalfromsialylceramide
DeficientinTaySachsdisease;GM2ganglioside

byphosphorylation
bysteroidantiinflammatories
byeicosapentenoicacid(20:53),PGIsynthase
bycyclooxygenase(COX)inhibitors(NSAIDs)
byarachidonicacid(20:46),TXAsynthase
bycyclooxygenase(COX)inhibitors(NSAIDs)

Glucosidase

Cleavesglucoseceramide,deficientinGauchers

Cholicacid

Basicprecursorofallbileacidsincludingcholesterol

HMGCoAsynthase

FormsHMGCoAfromacetylandacetoacetylCoA

bycholesterol

HMGCoAreductase

Formsmevalonatefrom3hydroxy3methylglutarate

bystatins,cholesterol(keylimitingstep)
InhibitingHMGCoAreductaseupregulatesLDLrec.

PhospholipaseA2
Prostacyclins(PGIs)
ThromboxaneA
HexosaminidaseA

AcylCoAAcyltransferase Formscholesteryloleateesterinsidecell

Image
FattyAcidSynthesisFromGlucose/Pyruvate

CholesterolSynthesisfromAcetylCoA

bycholesterolviaLDLbinding

TableXI

LipidMetabolism

Agent

Location

Pancreaticlipase

Secretedbypancreas

FattyacylCoAsynthase
Shortchainfattyacids
MediumchainFAs

Intestinalmucosalcell
Various
Various

Actions
Triacylglycerol2monoacylglycerol(2MAG)+2fattyacids
Requiredforpassagethroughintestinalepithelium
UsesCoAandATPAMP+PPitoformfattyacylCoAtoregenerateTAG
28carbons;unesterified,absorbedbyportalcirculationtoliver
1012carbons;someesterified,absorbedbyportalandlymphatics

LongchainFAs

Various

12+carbons;esterified,absorbedbylymphaticsaschylomicrons

Bilesalts

Intestinallumen

Lipoproteinlipase
Propionicacid

Image

Emulsification;amphipathicsaltsurroundsTAGforabsorption
CeasesformingbileacidmonomerandstartsformingmicellesatCMC
Outersurfaceofmostly HydrolyzeslipidsinchylomicronsinordertoabsorbTAGsforstorage
adipose,somemuscle
(adipose)orenergymetabolism(muscle)
Liver

Onlyrecoverableenergyproductofcholesterolmetabolism

TableXII

Lipoproteins
Composition

Lipoprotein

Transport

Destination

Chylomicron

Dietarytriglyceridesfrom
intestine

Components
ApoB48:neededforformation
ApoCII:activateslipoproteinlipase
Remnantsreturnedtoliverandareatherogenic

Tissues,liver

VLDL

Endogenous(hepatic)TGs
fromliver

Tissues

ApoB100:receptormediatedcatabolism

LDL(atherogenic)

Cholesterol

Tissues,liver

ApoB100:receptormediatedcatabolism
OxidizedLDLstimulatesmacrophages,coagulability

HDL(antiathero)

Cholesterol

Liver

Lowersperipheraltissuecholesterolandreturnsitto
liversinceitcannotbemetabolizedintissue

GastrointestinalExamIITables

TableXIII

Page5

FattyAcidsandObesity

Substance
Insulin

Action
Promotesfattyacidsynthesisandstorage

Hormonesensitivelipase

BreaksdownTAGinto3FAs,glycerolinadipocytes

Regulation
by cAMP,glucose;releasebyfreeFAs
Deactivatedbylipasephosphatase
Activeinphosphorylatedform

Leptin

Promotessatiety,glucoseuptakebymuscles
Oxidizedinmuscle/livercausingglucoseutilizationand
byinsulin;FFAscauseshyperinsulinemia,
Freefattyacids
gluconeogenesis,causinghyperglycemia
Chronicelevationcausesmuscleinsulinresistance,resultinginglucose

Impairsinsulinreleasebyinterferingwithcells
outputandglucosetolerance,insulinsecretioncausingdiabetes
Metabolicsyndrome:obesity,TGs,HDLc(atherogenicdyslipidemia),HTN,insulinresistance,prothromboticandproinflammatorymarkers(CRP,fibrinogen,coagfactors)

TableXIV

GIPharmacology

Drug
NSAIDs
(Aspirin,ibuprofen)
Protonpumpinhibitors
(prazole)
Hreceptorantagonists
(tidine)
Aluminumhydroxide
Magnesiumhydroxide
Bismuthsalicylate
(PeptoBismol)
Sucralfate
Misoprostol
Bulkforminglaxatives
(methylcellulose,psyllium)
Osmoticlaxatives
(polyethyleneglycol/lytes)
Opioids(loperamide
[Imodium],diphenoxin)
5HTreceptorantagonists
(setron)
D2receptorantagonists
(metaclopramide)

TableXV
Test
ALT(SGPT)
AST(SGOT)
Alkalinephosphatase
GGT
Bilirubin
Albumin
Prothrombintime(PT)
Amylase
Lipase
Trypsin
BUN
Dxyloseabsorption
ANCAs(vsneutrophil)
CK(CPK)
CKMB
TroponinI

Action

Effect
PGIsynthesis,decreasingmucussecretioncausing
GIupset

Inhibitscyclooxygenasebyacetylation
BlocksH/Kpumpinparietalcellbycovalently
modifyingsulfhydrylgroup
Competetivelyinhibitshistaminemediated
stimulationofH/Kpumpinparietalcell
OHionsreactwithHinsolution
OHionsreactwithHinsolution
Enhancesmucus/HCOsecretion
Inhibitspepsinactivity,chelatesulcerbase
Formsstickygelwhichadherestoepithelium
AnalogofPGE;stimulatesmucus/HCOsecretion
Insolubletohumandigestiveenzymes

IrreversiblyinactivatesHClsecretion,pH
volume/concentrationofHClsecretion,pH
CimetidineinhibitsP450,slowingdrugmetabolism
Decreasedacidity(pH)
Decreasedacidity(pH)
Enhancedprotectionofepithelium,especiallyat
ulcers
Enhancedprotectionofepithelium
Enhancedprotectionofepithelium
Accumulatesbulkinchimeofintestineoverseveral
days

ConditionsIndicated
NoneGIrelated
Duodenalandgastriculcers,
GERD,H.pylori
Duodenalandgastriculcers,
GERD,hypersecretorystates
Constipation
Diarrhea
Ulcers,H.pylori

Constipation

Altersosmolarityofchime

Rapidliquiddiarrhea

Endoscopy,colorectalsurgery

ActatreceptorsinGItract,poorCNSpenetration

DecreaseGImotility

Diarrhea

Blocksserotoninatsitesinvomitingreflex,including
Veryeffectiveinhibitionofemesis
chemoreceptortriggerzone(CTZ)
Blocksdopamineatsitesinvomitingreflex
Increasesmotility,depressesvomitingreflex
Alsoforpromotility:5HTantagonist,5HTagonist

Vomiting
Vomiting,gastroparesis,GERD

GILaboratoryTests
Associatedconditions
inhepatitis,drugtoxicity;specificforliverdisease
inalcoholism(withlowerALT),lessspecificforliver
inbileduct,intestine,kidney,placenta,andboneDx
inbileductdisease
direct:impairedliverdisease,indirect:hemolysis
inpoorliverfunction,cirrhosis,malnutrition,kidney
inbleedingdisorders,liverdysfunction(clottingfax)
inpancreatitis,salivaryhyperamylasemia
inpancreatitis;lip/amyratioinalcoholism
inpancreatitis,renalfailure;radioimmunoassay
inkidneydisease,dehydration,pancreatitis
inceliacdisease,malabsorption
Inflammatoryboweldisease:perinuclearstaining
inmuscledamage,includingcardiac
inMI,specificforMI
inMI,specificforMI

Condition
Hepatocellularliverdisease
Obstructiveliverdisease
Pancreatitis
Celiacdisease
Inflammatorybowel(Crohns)
Cholecystitis
Myocardialinfarction

Elevated
ALT,AST;bili,GGT,AP
Bili,AP,GGT;ALT,AST
Amy,lip,AST,Na,K,WBC
AntigliadinIg
ANCAsw/perinuclear
WBC,AP,ALT,AST,bili,amy
CK,CKMB,TropI

Decreased
albumin
Ca,
Dxyloseabs
H&H,K,Mg,Ca,alb,B,fol