Blood Chemistry Flashcards
Blood Chemistey analysis involves?
The comparison of measurable blood components of a patients to the normal values of the general population
Very low levels of enzymes are?
Normal
Increased levels of enzymes are seen when?
cells are damaged
Enzymes are
Are proteins found inside cells that increase the rate of biochemical reactions but the enzymes itself does not get altered/changed.
Factors influencing enzyme activity:
‣ Temperature, dehydration, UV light, PH extremes (excessive alcohol), Organic solvents, heavy metal solvents.
Enzyme names usually end w/ the suffix
“-ASE”
Liver function:
is the largest internal organ w/ many vital functions
• Metabolism of carbohydrates - Fats
• Synthesis of albumin - Clotting Factors
• Secretion of Bilirubin
• Metabolism & elimination of toxins/drugs
Enzymes values are often associated with what type of disease?
Liver Disease
explain hepatocellulary Injury
“inflammation/damage to the liver cells that cause blockages in the liver ducts not allowing fluid to go through causing a back up”
Alanine Aminotransferase (ALT) is what organ specific in what species?
• Liver specific in dogs & cats not other animal
• Not liver specific in horses, cattle & Swine
Increased Alanine Aminotransferase (ALT) levels may be due to?
drug administration:
◦ Glucocorticoids
◦ Anticonvulsants
ALT stands for?
Alanine Aminotransferase (ALT)
Aspartate Aminotransferase (AST) is not what?
• Not liver specific but its enough of it in large animals to have value to us
Aspartate Aminotransferase (AST) increased levels
• AST increased levels often seen w/ muscle inflammation, & hemolysis of blood sample
◦ You must decipher if the elevated levels are due to AST from a hepatocellullary injury to the liver or if the patient has muscle inflammation
AST stands for?
Aspartate Aminotransferase (AST)
what test is often added on when you have high levels of Aspartate Aminotransferase (AST)
◦ You can add on Creatine Kinase which is a lab test that test for muscle damage to help decipher between AST and muscle inflammation
Sorbitol Dehydrogenase is
• Liver specific in all species
• Not routinely measured in veterinary medicine due to cost
Alkaline Phosphatase (Alk Phos, AP) is ran why?
to check Liver enzymes associated w/ obstruction of bile flow
Alkaline Phosphatase (Alk Phos, AP) is
• Not liver specific
High concentration of Alkaline Phosphatase (Alk Phos, AP) is found in the?
liver & bones
Alkaline Phosphatase (Alk Phos, AP) is useful in what species and not useful what species?
• Useful in dogs and cats
• Not useful in horses and cattle
increased levels of Alkaline Phosphatase (Alk Phos, AP) are often seen?
◦ Bone Injury/Broken Bone
◦ Rapidly Growing Animals (Rapid Puppy Growth)
◦ Use of Glucocorticods and/or Anticonvulsants
• Determining between a bone issue and a liver issue is the true tricky part to this test
What disease is associated with increased levels of Alkaline Phosphatase (Alk Phos, AP)?
Cushings Disease will have elevated Alk Phos Levels
◦ Can even have other normal liver values
◦ Most of the times this is the only warning sign that an animal as early signs of cushings disease and/or if they have it already
Alk Phos and/or AP stands for?
Alkaline Phosphatase
Gamma Glutamyltranspeptidase/Glutamyltransferase (GGT) primary source is?
Liver is primary source
increased Gamma Glutamyltranspeptidase/Glutamyltransferase (GGT) levels may be seen when?
when prescribed glucocorticoids &/or anticonvulsants
GGT stands for?
Gamma Glutamyltranspeptidase/Glutamyltransferase
Gamma Glutamyltranspeptidase/Glutamyltransferase is ran why?
to check Liver enzymes associated w/ obstruction of bile flow
Bilirubin
Not an enzyme - this is just a breakdown of hemoglobin which are released by lysed RBCs
Increased bilirubin is associated with?
◦ Increased RBC destruction
◦ Liver disease because the bilirubin does not have anywhere to go w/ the clogged liver duct therefore it’s backing out.
◦ UV light will breakdown Bilirubin
• False elevated readings: Lipemia and hemolysis of the blood sample
Bile Acid is?
• Substance produced by the liver & secreted in bile to promote the digestion and absorption of fat from the small intestine
• Bile acids are reabsorbed from the Small Intestine & removed from circulation by the liver
Bile Acid levels may be increased when?
• in portosymstemic shunts & chronic liver disease
• 3-4 months of age will begin to show signs
Kidney Functions:
◦ Eliminates metabolic wastes
◦ Maintains normal homeostasis:
‣ Regulates electrolyte, essential organic molecule levels
◦ Produce important hormones (Erythropoietin)
◦ The renal artery brings blood from the heart to the kidney to be filtered
◦ The renal vein takes the “clean” blood from the kidney back to the heart
‣ The nephron takes the waste product and send it the glomerulus to the bowman’s capsule into the loop of henle & out through the collecting ducts to the urethra & into the bladder.
‣ Blood and urine do not mix.
Urine consists of?
95% of urine is water
5% Electrolytes & waste
Blood Urea Nitrogen Blood Chemistry Test (BUN)
• This test checks for Urea in the blood
• Urea is a metabolic waste that results from amino acid breakdown
◦ Amino acids are eliminated from the body through urine
• Freely filtered at the glomerulus
• BUN essentially tests to see if their is a problem with the kidneys but does not tell us exactly what is the wrong or where exactly within the kidney is the problem.
Azotemia refers to
increased BUN level
Increased Blood Urea Nitrogen (BUN) may be due to?
Increased BUN (Azotemia) may be due to:
Renal Abnormalities &
Common to see an elevated BUN when an animal is Dehydrated
- False positives may occur if animal ingests a high protein meal prior to test
Creatinine Blood Chemistry Tests
Renal Disease
• Creatinine is a waste product
◦ A nitrogen containing molecule released from muscle at a constant rate (waste product)
• Freely filtered by the kidney at a constant rate
• All waste products need to be released by the body
Increased Creatinine levels are due to?
Increased levels of Creatine are due to the same problems that lead to elevated BUN:
◦ Prerenal Abnormalities
◦ Renal Abnormalities
◦ Postrenal Abnormalities
Two parts of the pancreas
◦ Exocrine: Has Ducts & is in charge of releasing digestive enzymes
◦ Endocrine: No ducts, dumps directly into circulation, in charge of releasing insulin
The pancreas is involved in:
Digestion of food
Regulation of blood glucose (Insulin)
Digestive Enzymes produced by the pancreas include:
Amylase - Starch, Carbs & Sugar
Lipase - Fat
Trypsin: Protein
Pancreatitis
Inflammation of the pancrease
‣ Generally acute/sudden onset due to eating food that is not normally in their diet
• Inflammation of the pancreas shrinks the ducts of the exocrine portion of the pancreas causing a reduction in digestive enzymes being released into the GI. Therefore the digestive enzymes stay inside the pancreas and/or are backed up into the pancreas and those digestive enzymes begin digesting the pancreas itself which causes inflammation of the pancreas/Pancreatitis
Amylase & Lipase Blood Chemistry Test -
Pancreatic Disease/Pancreatitis
• Common add on to a normal blood chemistry panel
• Found primarily in the pancreas but also found in other parts of the GI tract
• increased levels associated w/ injury to the pancreatic cells
◦ Elevations 3Xs the normal level is considered significant and is considered Pancreatitis
Pancreatic Lipase Immunoreactivity (PLI)
• Highly specialized test for pancreatitis & often sent to an outside lab
◦ For both dogs & cats
• Used to diagnose Exocrine Pancreatic Insufficiency (EPI)
◦ Not producing the digestive enzymes
• Help to determine:
◦ Acute pancreatitis
◦ Checking digestive enzymes function
• Treatment: Supplement w/ digestive enzymes
• Generally ran in house (20ish minutes)
• The Lipase levels will remain elevated for much longer
• This is a quick snap test that will help determine if the pancreatitis is acute or if there is something else going on
Trypsin-Like Immunoreactivity: Blood Chemistry Test -
Pancreatic Disease
• Trypsin-Like Immunoreactivity (TLI) is a blood chemistry test to rule out pancreatitis and exocrine pancreatic insufficiency (EPI)
• Cannot be ran in clinic but will need to be sent to an outside lab
• Trypsin: Digestive enzyme that helps break down proteins
Endocrine portion of the pancreas creates insulin that goes into circulation as?
Glucose
Blood Glucose Test
• Blood Glucose levels reflect an equilibrium between:
◦ The amount of glucose entering the bloodstream (Eating)
◦ The amount of glucose leaving the bloodstream
• Glucagon & Insulin help maintain normal blood glucose levels
Hyperglycemia
To Much Glucose in the Blood
‣ Diabetes mellitus: its a disease where the islets of langerhagn of the pancreas no longer produces insulin
• Clinical Signs: Increased Thirst (Polydipsia), Increased Urination (Polyuria), & Weightloss
Hypoglycemia
To Little Glucose in the Blood
Insulinoma
To much insulin in circulation (Tumor in the pancreas causing the pancreatic cells to over make Insulin)
A cell is unable to accept the Glucose no matter how much it’s needed if there is no?
Insulin
◦ Insulin is needed to unlock the cell to allow Glucose to enter
‣ If no insulin the Glucose just sits outside of the cell in the blood stream causing Hyperglycemia
• Eventually the Glucose will spill over into the urine which is why this can also be seen on urinalysis
Blood chemistry tests that are ran to test the plasma proteins:
◦ Total Plasma Protein
◦ Albumin
◦ Globulins
◦ Fibrinogen
The 3 most important & largest plasma protein fractions are:
◦ Albumin
◦ Globulins
◦ Fibrinogen
‣ Beta Protein
Total Plasma Protein:
• All plasma proteins are added together
• Good indicator of overall health
Increased Total Plasma Protein values are associated with?
• chronic inflammation and/or infection
Low Total Plasma Protein values are associated with?
• Can be low or decreased w/ liver disease because the liver cannot make the proteins
◦ The majority of our plasma proteins are produced by the liver This is a blood chemistry test that test the plasma protein
Albumin:
• an important protein produced by the hepatocytes
• Make up 35-50% of total plasma protein level
• Helps maintain water levels in the circulatory system
Globulins:
• Second largest plasma protein fraction
• Produced in the liver and by the B-Lymphocytes
• Globulins have various functions
Increased Globulins levels are associated with?
infection, chronic inflammation and Neoplasia
◦ Cancer creates inflammation
Increased albumin is a result of
dehydration
Fibrinogen:
• Protein produced in the liver
• Involved in blood clot formation
◦ Fibrinogen - Fibrin
• Measure in clinic by heating a microhematocrit tube to precipitate fibrinogen
• Makes up 3-6% of total plasma protein
Increased levels of fibrinogen are associated with?
w/ inflammation and/or tissue injury
Electrolytes:
• Mineral Ions (Cations, & Anions) found in the circulating blood
• Play an important role in:
◦ Maintenance of water balance
◦ Nerve function
◦ Muscular function
Blood Chemstry Tests that test electrolyte levels:
◦ Potassium
◦ Calcium
◦ Phosphorus
◦ Sodium
◦ Chloride
◦ Magnesium
Potassium:
Important in maintaining normal neuromuscular function
Hypokalemia:
decreased potassium levels
Hypokalemia occurs with
‣ Renal Failure, vomiting, diarrhea - common to see anytime there is large amount of fluid loss.
Hyperkalemia:
Increased levels of potassium
Acidosis
‣ Hyperkalemia: Increased levels of potassium
Hyperkalemia is associated with?
‣ Common to see in renal deficiency, urinary blockage, or urinary tract obstructions. Any disorder that decreases the urine output which backloads the potassium into circulation
‣ Can cause cellular damage or neurosis
‣ Ruptured RBC release potassium
‣ Prevent hemolysis in the blood draw.
• Chemical abbreviation is: K+
Calcium allows the?
muscles to relax. You can constrict your muscle w/out calcium but you cannot relax the muscle without calcium
Calcium
Cannot be measured in anticoagulated plasma
◦ Can only be measured w/ SERUM
◦ Calcium is used in the anticoagulated blood tubes
Hypocalcemia seen in?
Hypocalcemia seen in eclampsia/puerperal tetany
◦ Tetany: Unable to relax muscle
◦ Eclampsia: Muscle Tetany during pregnancy
◦ Puerperal Tetany: Muscle tetany during birth
Phosphorus:
• Important in energy storage - part of normal cell membranes
Hyperphosphatemia seen in?
chronic renal failure
Hyperphosphatemia:
High levels of phosphorus in the blood stream
Sodium:
• Chemical abbreviation: Na+
• Imprant in maintaining water balance in the body
• Sodium really likes Chloride
◦ Sodium Chloride is salt
◦ They work together to maintain the water balance in the body
Hyponatremia occurs with vomiting & diarrhea
◦ Hyponatremia: Loosing fluids outside of the body
‣ Includes vomiting, diarrhea, & even sweating
• Should release excessive salt in the urine & reabsorbs what the body needs
Hypertremia
Increased levels of sodium in circulation which causes dehydration
◦ Also can happen if you a lot of super salty food
Chloride:
• Important in water balance
• Works with Sodium
• Hypochloremia occurs with vomiting
• Anytime the body is losing fluids they are loosing chloride and sodium
• Chloride and Sodium always go together, there will not be one elevated and one decreased they will always be the same: decreased together or increased together
Magnesium:
• Important in neuromuscular function
◦ Super important when preventing muscle cramps - even more so that potassium
Hypomagnesemia
◦ Decreased amount of magnesium found in circulation
◦ Seen in Grass Tetany which happens in cows when there strictly fed grass which is low in magnesium and causes uncontrollable muscle cramps.
Creatine Kinase (CK) & Creatine Phosphokinase (CPK)
◦ Found in muscles tissues
◦ High level occur w/ muscle injury
‣ Whenever a muscle injury happens the muscle tissues poor Creatine kinase into the bloodstream
‣ Inflammation in the muscle fibers
‣ Trauma
‣ Exercise (Often happens with horses)
‣ Surgery
‣ Injection into the muscles causes muscle damage
Creatine Kinase (CK) & Creatine Phosphokinase (CPK) is found in?
◦ Found in all animals large & small
◦ Fractious Cats often have an elevated CK level when the cat is fighting the blood draw it can cause muscle damage therefore releasing the CK into circulation
Elevated AST & Normal CK means that
the AST high value is coming from the liver muscle versus the muscles. Therefore this would tell us that something is going on with the liver not the muscles
Elevated AST & Elevated CK means that
there is muscle damage/injury which often occurs with Horses and other large animals.
Creatine is in?
the muscle that gets broken down into Creatinine that is released/eliminated from the kidneys
Cholesterol is a
type of fat that is formed inside the body from fatty acids
◦ cholesterol is an important component of cellular membranes, adrenal & gonadal hormones
◦ Human cholesterol and animal cholesterol are viewed & valued different
◦ Found in many tissues including the liver, adrenal gland, gonads, & Nerves
Abnormally high levels of cholesterol are associated with?
cholesterol metabolism
‣ Hypothyroidism: Not to producing enough thyroid hormones that helps digest fat
‣ Hyperadrenocorticism (Cushings Disease):
‣ Diabetes Mellitus
◦ In Vet Med we generally do not monitor or try to change a lifestyle due to cholesterol we more use it to determine if a more serious underlying medical conditions is happen.
