Clin Path Final - Kubuusu TS Flashcards
How much of the kidney must be damaged for creatinine to show up in blood?
80%
How much of the kidney must be damaged for Urea to show up in blood?
75%
Term for raised urea OR creatinine OR both and is likely caused by dehydration
Azotemia
Term for raised urea and creatnine plus clinical signs
Uremia
What is the molecule used for measuring renal failure in birds?
uric acid
Which molecules most significantly influence specific gravity of urine?
salts/electrolytes
What term is used to describe specific gravity of urine that is lover than glomerular filtrate?
hyposthenuria
What are some causes of hyposthenuria?
overhydration, pyometra, renal failure
What term is used for urine having a fixed low SG?
isosthenuria
What are the ranges for isosthenuria?
1.008 - 1.012
What percent of the kidney is damaged before they lose their ability to concentrate urine effectively?
loss of 60-65%, early indicator
What are some causes of hypersthenuria?
dehydration, hypovolemia, heart disease
What is pre-renal uremia a result of?
decreased renal perfusion
How is pre-renal uremia presented in tests?
mild to moderate raised urea and creatinine, SG is high
How does renal uremia present in tests?
Urea is moderate to marked, so is creatinine, and isosthenuria
What can cause post renal uremia?
urinary tract obstruction from urolithiasis or rupture
How does post renal uremia present clinically?
creatinine is markedly raised, specific gravity is variable
What chemicals on reagent strips are NOT accurate for animals?
nitrates, urobilinogen, specific gravity, leukocytes
What conditions cause aciduria?
carnivores, protein catabolism (pregnant, exercise)
What conditions lead to alkalinuria?
herbivores, stale urine, UTI/cystitis
What test can be used to confirm a positive protein on a urine strip?
sulphosalicylic acid test
What are some causes of trace positive readings for protein on a urine strip?
strenuous exercise, fever, convulsions, colostrum
What are some causes of true proteinuria?
hemoglobinuria, hemorrhage, inflammation, protein losing neuropathies
Why must you interpret the protein finding in urine with the SG?
the lower the SG, the more significant is the finding of a positive protein result
What rare congenital disease can cause glycosuria?
congential fanconi’s syndrome, a tubular disease
What tests can be used to confirm glucose in the urine?
Fehlings or Benedicts test
What can cause glycosuria besides DM?
marked stress in cats, admin of ketamine or xylazine
What are the RELIABLE tests on a urine strip for animals?
pH, protein, glucose, ketones, blood, bilirubin
What number and type of cells indicate active urine sediment?
trace rbcs (5-8) or higher
trace WBCs or higher
high numbers of epithelial cells
What conditions usually lead to high RBCs in urine?
estrus, UT inflammation/trauma, urogenital neoplasm, some coagulopathies
What are the most consistent and reliable hallmarks of urinary tract inflammation?
WBC and protein
What are the urinanalysis hallmarks of cystitis/pyelonephritis?
4+ WBC, 4+ RBC, strong protein, bacteria
What size are tubular epithelial cells of the urinary tract?
same as WBC size
What does dysplastic epithelial cellls in the urine point to?
chronic inflammation
What do really high numbers of epithelial cells in urine without any WBC or RBCs indicate?
neoplasm
What 3 minerals make up struvite?
mg, ammonium, phosphate
What kind of crystal looks like a wagon wheel or dumbell shaped?
calcium carbonates
What kind of crystal looks like a coffin lid or brick shaped?
struvite
What conditions do struvite crystals tend to accumulate?
alkaline urine of dogs and cats, UTI, especially in urease bacteria,
What species most commonly have calcium carbonate crystals?
horses and rabbits
What urine crystal looks like an envelope or maltese cross?
calcium oxalate dihydrate
Where do calcium oxalate dihydrate crystals occur?
acid urine in dogs
What crystals look like a picket fence or spindle shape?
calcium oxalate monohydrate
What conditions cause calcium oxalate monohydrate crystals to occur?
ethylene glycol poisoning (along with hypocalcemia)
What crystals look like a thorn apple?
ammonium (bi)urate
What breeds may have naturally occuring ammonium biurate crystals?
dalmatians and english bulldogs
What are the pathological causes of ammonium biurate crystals?
portocaval shunts, chronic severe liver dz
What is seen in bird and reptile urine?
urates
What do cysteine crystals look like?
large clear hexagons
What crystal looks like brown needles or tufts?What do large numbers indicate?
billirubin crystals
hemoytic or hepatic dz
What crystals are consistent with adulterated pet food?
melamine-cyanuric
What crystals look like sheaf of wheat and indicate congenital hepatic problem?
leucine and tyrosine
What doe hyaline casts indicate in a urinanalysis?
proteinuria –> mild renal disease
What do granular casts indicate?
moderate renal dz
What do cellular casts of RBC or WBC indicate?
severe renal disease
Is the following casts acute or chronic? Hyaline, cell, granular.
Hyaline -chronic
cell/granular - acute
What is the sensitivity/specificity for ALP enzyme in dog and cat seperately?
Dog - good sensitivity, fair specificity
Cat - poor sensitivity, mild increases are significant
What conditions can lead to an increase in ALP enzyme?
growing animals, osteosarcoma, corticosteroids (dogs only), may or may not be elevated in chronic liver dz
What is ALP enzyme always interpreted with?
ALT enzyme
What is the specificity and sensitivity of ALT enzyme?
excellent sensitivity and specificity
What is the half life of ALT for dogs and cats?
dogs - 2 days
cats - 4 hours
What can cause an increase in ALT enzyme?
primary hepatocyte injury - hepatitis, hepatocellular carcinoma
What liver enzyme is fairly sensitive in large animas but increases in myocyte injury in all species?
AST
What enzyme is paired with AST to interpret results?
GGT
What could be some causes of increased AST enzyme?
liver dz, muscle dz, hemolysis (found in RBCs)
What enzyme increases are induced mostly by cholestasis?
GGT (gamma glutamyl transferase)
What is the sensitivity and specificity for GGT?
good sensitivity, fair specificity
What enzyme is just as good as GGT in measuring liver disease in small animals?
ALP
What liver enzyme is the best indicator of chronic liver problems?
GGT
What should be suspected if a cat has an increased ALP but GGT is within RI?
hepatic lipidosis
What should be suspected if there is a significant increase in cALP but mild increase in other liver enzymes in a dog?
cushings
What liver enzymes would indicate bone disease?
raised bALP, hx of trauma, lameness
What liver enzymes would be elevated in muscle disease?
AST, CPK
What is the sensitivity and specificity for CPK for muscle injury?
very sensitive, very specific
What other enzyme is muscle specific and offers no advantages over CPK?
aldolase
What would be seen in the clinical pathology of a horse with rhabdomyolysis?
inflammatory hemogram, acidosis, dehydration, low Na, high K, myoglobinnuria
What is the gold standard to test for myoglobinuria?
immunoelectrophoresis
What are the drugs that can have an effect on liver enzymes?
corticosteroids, NSAIds, antineoplastics, anticonvulsants, antimicrobials
What may a mild bilirubin level indicate?(3)
starvation (horses), septicemia, toxemia
What are the 2 causes of prehepativ hyperbillirubinemia?
hemolysis or decreased uptake of Bu
What is the major cause of hyperbilirubin in cattle? What about horses?
cattle - decreased uptake of Bu
horses - starvation
What bilirubin pattern indicates hepatocellular hyperbilirubinemia?
Bu and Bc but Bc predominates
What bilirubin pattern is comprised of neither Bu or Bc predominating?
posthepatic/extrahepatic
in long notes says Bc is the only one present but ppt says neither predominate
Which species has a low renal threshold for Bc, therefore making it easier to detect in urine?
dog
Where is Bc easiest to detect in cats?
blood
How great is the damage to the liver if ammonia is present in the blood?
> 85%
What diseases cause hyperammonemia?
portal vascular shunts, advanced liver failure
What indicates a disease when post prandial blood ammonia is compared to pre prandial blood ammonia?
post prandial is 3x the base value
What is probably the most sensitive liver test?
Serum bile acids
What diseases do increased serum bile acids indicate?
cholestasis, hepatitis, fatty infiltration, necrosis, steroids, vascular shunt, cirrhosis
Why are serum bile acids the test of choice for portal vein shunts?
because serum bile acids will be taken up even in chronic liver failure but wont be if there is a shunt
What can increase the sensitivity and specificity for serum bile acids in detecting hepatic insufficiency?
pre and post analysis (before and after eating)
What cells make gamma globulins?
lymphoid cells
What is the most accurate and quantitative method for protein measurement?
electrophoresis
What term is used for “an abnormal condition of proteins”?
protein dyscrasia
What term is used for “abnormal concentrations of protein in blood”?
dysproteinemia
What 2 conditions cause an absolute hyperproteinemia?
inflammation
B-cell neoplasia
What i it called when refractometer measures greater than 0.3g/dl difference between plasma and serum?
pseudohypoproteinemia (due to high glucose, urea, etc)
Which 2 conditions are true hypoproteinemia is also a selective dysproteinemia?
failure of passive transfer of maternal immunoglobulins
hypoalbuminemia from renal problem
all others are non-selective
What are the only 2 causes of hyperalbuminemia?
hemoconcentration
dehydration
What is the specificity and sensitivity for albumin to indicate dehydration?
high specificity, lower sensitivity (some dehydrated animals have it WRI)
What are the 3 acute phase proteins?
serum amyloid A
Hatoglobin
ceruloplasmin
What are the 3 beta globulins?
fibrinogen
C reactive protein
transferrin
When can acute phase proteins first be detected?
within several hours to days after the onset of inflammation
When does the concentration of negative phase proteins such as albumin and transferrin decrease?
within weeks
What can cause polyclonal gammopathies?
chronic inflammation, liver dz, FIP, parasites, ehrlichia, IM dz, lymphoma
What can cause monoclonal gammopathies?
multiple myeloma
What 3 conditions can cause the body to lose more albumin than globulins and therefore lower the AG ratio?
protein losing nephropathy, enteropathy, dermatopathy
What may a high A/G ratio indicate?
rare - immunodeficiency or in neonates before suckling
What is important to determine in large animals when they have a high concentration of fibrinogen?
can be inflammation or dehydration
must do plasma protein: fibrinogen ratio (TPP:F)
What is the equation for the TPP:F ratio in large animals?
TPP-Fibrinogen
divided by fibrinogen
What TPP:F ratio indicates active inflammation in cattle? horses?
cattle: <15
What does a ratio of 10-15 for TPP:F indicate in cattle?
non-diagnostic
What TPP:F ratio indicates dehydration in cattle? horses?
cattle: >15
Horses: >20
How can you check the globulin content in mares colostrum?
SG should be > 1.060, also can use electrophoresis or radial immunodiffusion
What test can be used to measure globulin content in neonate serum?
turbidity test - serum is turbid if globulin present
What are some causes of acute exocrine disease?
acute pancreatitis, pancreatic necrosis, pancreatic neoplasia
What is an example of chronic exocrine disease?
exocrine pancreatic insufficiency - EPI
What is the sensitivity and specificity for amylase and lipase to detect acute pancreatic disease?
sensitivity is good, but specificity is poor to moderate
What could also increase amylase or lipase besides pancreatic disease?
renal failure, gastroenteritis, hyperadrenocorticocism, stress
What is used to diagnose pancreatic disease in cats?
feline pancreatic lipase immunoreactivity or ultrasound
What clinical abnormalities are seen in a dog with pancreatic disease?
inflammatory CBC, increased globulin
increase in amylase and lipase in blood and peritoneal fluid
moderate liver increases
increased TLI, cPLI, and TAP
What is the only definitive test for exocrine pancreatic insufficiency?
a low serum TLI
What should be checked in older cats that have diarrhea?
blood T4 levels
Where is vitamin B12 absorbed in the gut? what about folate?
Vit B12 - distal small intestine
Folate - proximal small intestine
What would low folate with normal B12 suggest?
upper small intestine problem
What would high folate and normal or low B12 suggest?
small intestinal bacterial overgrowth (SIBO)
What may low folate and low B12 suggest?
diffuse small intestinal problem
What medium should blood be taken in to analyze for absorption test for GI tract?
fluoride oxalate ( establish blood glucose)
What will rumenal fluid look like in grain overload or rumenal atony?
gray and maladorous
When does normal sedimentation take place in normal rumen fluid?
< 8 minutes
What is the normal pH of rumen fluid?
5.5 - 7
How long does a methylene blue reaction take in a normal rumen fluid sample?
6 minutes
What is the major cation intracellularly?
K+
What is the major cation extracellulary? anion?
cation - Na
anion - Cl
What are the 5 conditions that could cause abnormal electrolyte results?
- inc/dec in water or electrolyte uptake
- shift from ICF
- renal retention
- loss thru gut, kidney,skin, resp
- acid base disturbance
When may an animal get hypotonic dehydration?
just replenishes water, not salt lost
horse - sweating
What are some causes of hyperkalemia?
IV destruction of RBC +platelets
renal failure, iatrogenic, hypoadrenocorticocism,metabolic acidosis
What happens to K in inorganic acidosis?
only H+ enters cells, with K+ going into ECF
What are some causes of hypokalemia?
anorexia (cats), increased renal excretion, increased loss thru the gut, metabolic alkalosis, iatrogenic insulin
What organ regulates the HCO3- concentration?
kidneys
What ions does TCO2 consist of?
bicarbonate (HCO3-), carbonic acid (H2CO3), and CO2
What is the bicarbonate-carbonic acid buffer equation?
HCO3- + H+ H2CO3 H2O + CO2
What is tCO2 a indirect measure of?
HCO3- (TQ!)
What is HCO3- inversely related with?
Cl
Metabolic acidosis will be an increase or decrease in sodium?
hypernatremia
alkalosis - hyponatremia
How can you determine a selective loss of Cl-?
Na - Cl > 42-45
What can cause a selective loss of chloride ions?
vomiting, obstruction at pylorus, abomasal displacement
What does loss of NaHCO3 rich fluid in intestinal secretions lead to in regards to chlorine and sodium?
hyperchloremia, but NOT hyperanetremia
What does a Na:K ratio of less than 15:1 indicate?
semi diagnostic for hypoadrenocorticocism
What does a increased anion gap indicate?
metabolic acidosis or increase in unmeasured ions (ketones, uremic acids, ethylene glycol, lactic, and salicyclic acid
What does a positive BE (base excess) indicate? negative BE?
\+ = metabolic alkalosis - = metabolic acidosis
