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HT/Anamnesis
Physical Examination
Looked unwell
Blood pressure:
Normal
Pulse rate: Normal
Respiratory rate:
Normal
Temperature: Normal
Abdominal tenderness:
+
Treatment
Pharmachology:
Give enzyme
substitution
Fat soluble vitamin
Non- Pharmachology:
Surgery
Prognosis
Ad vitam
: Ad bonam
Laboratory Examination
CONCEPT MAP
RF :
GALL STONE
(etiology)
ENZYME
DEFINITION
CLASSIFICATION
BASIC STRUCTURE
CHARACTERISTIC
MECHANISM
FUNCTION
FACTOR S INFLUENCE
ENZYME ACTIVITY
INHIBITOR AND
ACTIVATOR
KINETIC
ENZYME PATHWAY
BLOCKAGE
PANCREAS DISSORDER
(diagnosis)
AUTO DIGESTION
AMYLASE
BURNING PAIN
LIPASE
TREATMENT
BHP PHOP
Pancreas Disorder
1.
2.
3.
4.
5.
6.
ENZYME
Definition
A protein that catalyzes chemical reactions of other substances without itself being destroyed
or altered upon completion of the reactions (Dorlands Dic)
Basic Structure
PROTEIN
Non Protein
Tight. Stable
Binds transciently
Prostetik
Coenzyme
Cofactor
Example : Pyidoxal phosphate, Navin mononucleotide, FAD, metal ions Co, Cu, Mg,
Mn, Zn
most common prosthetic group.
Enzyme-metal ion bond : metalloenzyme
Function :
o Facilitate substrate binding and orientation
o To render substrate electrophilic (e -) or neucleophilic (e +) = more
reactive
Cofactor
- Same function as prosthetic group
- Transcient, dissociable bond
- Must be present in enzymes medium
- Commonly metal ion (metal-activated enzymes)
Coenzyme
- Definition: an organic nonprotein molecule, frequently phosphorylated
derivative of water-soluble vitamin
- Function:
o Transport substrates from point of generation to point of utilization
o stabilizes substrate such as hydrogen atoms or hydride ions thath are
unstable in aqueous env. of cell
Characteristic
Enzyme is protein molecule that is a biological catalyst
Increase the rate of a reaction
Enzymes act specifically with only one reactant (called a substrate) to produce products.
Metabolic enzyme reaction are reversible can catalyzed both forward and reverse
reaction.
Enzyme are unaffected by the reactions that they speed up, so they can be reused again
and again.
b. Induced Fit: The active site is flexible, possessing a structure complementary to that of
substrate only when the substrate is bound to the enzyme
Divided by reaction
a. Ping-Pong:
Jadi, akan ada substrat (A) yang masuk membentuk product(P) lalu enzyme berubah menjadi
enzyme intermediate(E*), selanjutnya ada substrat baru(B) yang masuk dan membentuk
product baru lainnya(Q) dan enzyme berubah menjadi enzyme semula(E)
b. Bi-bi: Semua substrat direaksikan terlebih dahulu lalu baru dihasilkan products.
Classification
More than 2000 different enzymes are currently known. A system of classification has been
developed that takes into account both their reaction specificity and their substrate specificity. Each
enzyme is entered in the Enzyme Catalogue with a four-digit Enzyme Commission number (EC
number). The first digit indicates membership of one of the six major classes. Enzymes with similar
reaction specificities are grouped in to each of the six major classes:
The oxidoreductases (class 1)
catalyze the transfer of reducing equivalents from one redox system to another.
Ared + Boks
A oks + Bred
Subclass:
- Oxidases: Use oxygen as an electron acceptor but do not incorporate it into
substrate
- Dehydreogenases: use molecules other then oxygen (e.g: NAD+) as an electron
acceptor
- Oxygonases: Directly incorporate oxygen into substrate
- Poroxidases: Use H2O2 as an electrin acceptor
The transferases (class 2) catalyze the transfer of other groups from one molecule to
another.
AB+C
A+BC
Subclasses::
- Methyl transferases: Transfer 1 carbon unit between substrates
- Amino Transferases: Transfer NH2 from amino acids to keto acids
- Kinoses
: Transfer PO3- from ATP to substrate
The hydrolases (class3) are also involved in group transfer, but the acceptor is always a
water molecule.
A B + H2O
A-H + B-OH
Subclasses:
- Phospatases
: Remove PO3- from substrate
- Phosphodiostorases: Cleave phosphodiester bonds
those in nucleid acid
- Proteases
: Cleave amino bonds
proteins
Lyases (class 4, often also referred to as synthases) catalyze reactions involving ei- ther
the cleavage or formation of chemical bonds, with double bonds either arising or
disappearing.
A (XH) B
AX+B-H
Subclasses:
- Decarboxylases : Product CO2 via elimination reactions
- Aldolases
: Product aldehydes via elimination reactions
- Synthases
: Link two molecules without involvement of ATP
The isomerases (class 5) move groups within a molecule, without changing the gross
composition of the substrate.
A
N30 A
Subclasses:
- Racemases : Intercovert L and D Storeoisomers
- Mutases : Transfer groups between atoms within a molecule
In the presence of a competitive inhibitor, it takes a higher substrate concentration to achieve the
same velocities that were reached in its absence. So while Vmax can still be reached if sufficient
substrate is available, one-half Vmax requires a higher [S] than before and thus Km is larger.
2. Noncompetitive Inhibition
With noncompetitive inhibition, enzyme molecules that have been bound by the inhibitor are taken
out of the game so
nged because the active site of those enzyme molecules that have
not been inhibited is unchanged.
OILY STOOLS
Digestion of Lipid
Triglycerides at the most abundant lipids in the diet, which consist of a molecule of glycerol bonded
to three fatty acid molecules. Enzymes that split triglycerides and phospholipid are called lipase.
Triglycerides are broken down by pancreatic lipase into fatty acids (short-chain and long-chain fatty
acid) and monoglycerides. The digestions mostly take place in the small intestines. There are three
types of lipase:
1. Lingual lipase/ptyalin
2. Gastric lipase
3. Pancreatic lipase
Before triglycerides can be digested in the intestine, lipid should undergo emulsification first.
Emulsification is a process whereas the large lipid globule is broken down into several small lipid
globules, done by the bile salts which pass through the bile duct from the gall bladder where it is
stored after being produced by the liver.
The amphipathic side of bile salt helps the emulsification process and therefore able to form the
small lipid globules that provide a large surface area allowing pancreatic lipase to function more
effectively.
The long-chain fatty acids and monoglycerides which packed along with fat-soluble vitamins and
cholesterol molecules resulted from the emulsification is called micelles.
When the micelles are about to be absorbed by the villi inside the duodenum, the fatty and the
monoglycerides diffuse out of the micelles into the absorptive cells. Once inside the absorptive cells,
it is covered by a protein and formed chylomicrons. The chylomicrons
PHOP,BHP,CRP
PHOP : Healthy Lifestyle and Family Health Education
Promotive
: Provide education for people about the impact from over-consumption of fat.
Preventive
: Promote the importance of having balanced diet, especially eating foods
containing fat with adequate amount of fat intake (20-35% of total calories) .
Curative
: Promote the importance of eating fibres (in oats) to help lower cholesterol
level.
Rehabilitative : Supervision of a balanced diet, counseling, nutritional rehabilitation.
Semua tindakan kedokteran yang akan dilakukan terhadap pasien harus mendapat persetujuan,
dapat berupa persetujuan tertulis atau lisan. Untuk yang beresiko tinggi harus tertulis. Apabila
darurat, tidak perlu persetujuan, tetapi harus tertulis di rekam medik dan sesegera mungkin
harus memberikan penjelasan.
Penjelasan kepada pasien harus dilakukan baik diminta ataupun tidak. Bisa kepada pasien
langsung atau keluarganya apabila pasien tidak sadar.