Clin Path S2 Flashcards
1
Q
what are the 4 COMPONENTS of HEMATOPOIESIS?
what LINEAGE is this?
A
4 things?
1. ERYTHROPOIESIS
2. THROMBOPOIESIS
3. GRANULOPOIESIS (neutrophils)
4. MONOPOIESIS (monocytes/macrophages)
MYELOID
2
Q
PANCYTOPENIA…
= definition?
A
= DECREASED production of ALL 3 LINEAGES
1. RBCs
2. WBCs
3. PLATELETS
3
Q
MYELOPHTHISIS..
= definition?
2 specific examples of DISEASES that can do this?
ANY ___ NEOPLASM can cause this!
A
= when the MARROW is CROWDED OUT & HEMATOPOIESIS CANNOT OCCUR
2 examples?
1. LYMPHOMA
2. MULTIPLE MYELOMA
ANY METASTATIC NEOPLASM CAN CAUSE THIS
4
Q
1 common INFECTIOUS causes of PANCYTOPENIA in DOGS?
how would PANCYTOPENIA look on CBC? (3)
A
CHRONIC EHRLICHIA CANIS INFECTION
on CBC…
1. LOW PCV (RBCs)
2. LOW WBCs
3. LOW PLATELETS
5
Q
2 common INFECTIOUS causes of PANCYTOPENIA in CATS?
A
- HISTOPLASMOSIS
- CYTAUXZOON FELIS
6
Q
3 common NON-INFECTIOUS causes of PANCYTOPENIA?
A
- MYELOFIBROSIS = marrow REPLACED BY FIBROUS TISSUE
- NECROSIS
- TOXIC INSULTS (drugs)
7
Q
what are the TWO KINDS OF FORMS of MYELOID NEOPLASM?
A
- ACUTE = BLAST FORM
- CHRONIC = MATURE FORM
8
Q
HEMATOPOIETIC NEOPLASMS can occur in ____ OR ____ LINEAGES because HEMATOPOIETIC STEM CELLS in the ____ ____ can become ____ or….
A
MYELOID, LYMPHOID, BONE MARROW, LYMPHOCYTES or ANYTHING IN THE MYELOID LINEAGE
9
Q
MYELOID NEOPLASMS usually start in the….
A
BONE MARROW
10
Q
LYMPHOID progenitors…
what 2 locations can they be found in?
eventually, where do they go? (4)
A
2 locations?
1. REMAIN IN THE BONE MARROW
2. THYMUS (primary lymphoid orga)
eventually –> go to SECONDARY LYMPHOID ORGANS
1. LNs
2. SPLEEN
3. GALT, MALT
4. TONSILS
11
Q
LYMPHOID LEUKEMIAS arise MOST COMMONLY IN…
whereas LYMPHOMA can originate in the ____ or….
A
THE BONE MARROW
THYMUS or ANY SECONDARY LYMPHOID ORGAN
12
Q
the DIFFERENCE between origin of LEUKEMIA and LYMPHOMA?
which one has a worse prognosis?
A
LEUKEMIA = born in the BONE MARROW & generally WORSE PROGNOSIS
LYMPHOMA = born in the PERIPHERY
13
Q
most often, LYMPHOMA is a disease of the _____ ____ ____
lymphoma can REMAIN in the _____ or spread to the ____ once it reaches ____ ____
on CYTOLOGY of the ___ ____ ___, what do we usually see with ____ ____ LYMPHOMA?
A
PERIPHERAL LYMPH NODES
PERIPHERY, MARROW, STAGE V
on CYTOLOGY of the PERIPHERAL LYMPH NODES with STAGE V, majority are IMMATURE LARGE BLASTS/LYMPHOID CELLS
14
Q
what are 2 reasons LYMPHOMA can cause LYMPHOPENIA?
A
- STRESS
- LYMPH NODES AREN’T ALLOW NORMAL TRAFFICKING –> LYMPHOCYTES CANNOT LEAVE LNs
15
Q
4 organs that can be affected by PRIMARY or SECONDARY LYMPHOMA?
A
- GI
- SPLEEN
- LIVER
- BONE MARROW (stage V if it’s here)
16
Q
CHRONIC LYMPHOID LEUKEMIA…
often a ___ finding
causes WHAT disease?
can appear similarly to ____ ____
diagnosed via…
prognosis?
A
INCIDENTAL
causes ANEMIA OF CHRONIC DISEASE
can appear similarly to REACTIVE LYMPHOCYTOSIS
diagnosed via FLOW CYTOMETRY
prognosis is GOOD, PATIENTS LIVE A LONG TIME
17
Q
3 LYMPHOPROLIFERATIVE diseases?
A
- CHRONIC LYMPHOID LEUKEMIA
- ACUTE LYMPHOID LEUKEMIA
- PLASMA CELL MYELOMA
18
Q
ACUTE LYMPHOID LEUKEMIA…
starts in WHAT location?
likely to see WHAT pathologic sign?
what 2 cells commonly found in CIRCULATION?
what KIND of exam can be helpful for diagnosis?
A
starts in BONE MARROW
likely to see MYELOPHTHISIS
2 cells…
1. BLASTS
2. ATYPICAL CELLS
BONE MARROW EXAM can help diagnose
19
Q
PLASMA CELL MYELOMA…
“alternative name?”
= definition & 2 locations
2 common CBC findings?
2 other diagnostic findings?
A
“MULTIPLE MYELOMA”
= when there’s WAY TOO MANY PLASMA CELLS in the BONE MARROW, SPLEEN OR BOTH
2 CBC findings?
1. HYPERGLOBULINEMIA
2. HYPERCALCEMIA
2 diagnostics?
1. LYTIC BONE LESIONS
2. ABNORMAL PROTEIN IN URINE
20
Q
CUTANEOUS PLASMA CELL MYELOMA vs. MULTIPLE MYELOMA PROGNOSIS
A
CUTANEOUS»_space;> MM
21
Q
4 common causes of PANCYTOPENIA if caused by the BONE MARROW?
A
- MYELOPHTHISIS from FIBROSIS
- DRUGS
- METASTATIC CANCER
- HEMATOPOIETIC NEOPLASM
22
Q
PANCREATIC LIPASE IMMUNOREACTIVITY (PLI)…
used for WHAT disease?
if we see this disease, what does the value do?
NOT dependent on what?
what is often used IN PLACE of this test?
A
used for PANCREATITIS
if we see PANCREATITIS = PLI IS INCREASED
NOT dependent on RENAL EXCRETION
SpecPLI is USUALLY USED IN PLACE OF THIS
23
Q
SpecPLI…
3 parameters & what they mean?
this test has HIGH ___ for ruling ____ ____
this test is NOT dependent on what?
more reliable in WHAT species?
A
3 parameters…
1. <200 ug/L = RULES OUT PANCREATITIS
- 201-399 ug/L = GRAY ZONE, needs a RETEST
- > 400 ug/L = PANCREATITIS LIKELY if there’s OTHER SUGGESTIVE FINDINGS
this test has HIGH SENSITIVITY for ruling OUT PANCREATITIS
NOT dependent on RENAL EXCRETION
MORE RELIABLE IN DOGS > CATS
24
Q
SnapPL…
used to RULE ___ ____ if there’s a ___ result
2 parameters?
A
used to RULE OUT PANCREATITIS if there’s a NORMAL result
2 parameters?
1. NORMAL = dot is LIGHTER THAN CONTROL; <200 ug/L & RULES OUT PANCREATITIS
- ABNORMAL = dot is DARKER THAN CONTROL; >400 ug/L
25
AMYLASE...
this enzyme is made by WHAT 3 ORGANS?
its excretion is DEPENDENT on... (2)
if INCREASED? (5)
if DECREASED? (1)
POORLY specific for WHAT DISEASE?
3 organs?
1. PANCREAS
2. SI
3. LIVER
excretion dependent on...
1. RENAL EXCRETION
2. GFR
if INCREASED...
1. RENAL DZ
2. GI/ABDOMINAL DZ
3. NEOPLASIA
4. PANCREATITIS
5. DECREASED GFR
if DECREASED...
--> WE DO NOT INTERPRET DECREASED AMYLASE
POORLY SPECIFIC for PANCREATIC DZ
26
LIPASE...
enzyme made by WHAT 2 organs?
its excretion is DEPENDENT on... (2)
if INCREASED... (5)
if DECREASED... (1)
POORLY SPECIFIC for what dz?
2 organs?
1. PANCREAS
2. STOMACH
excretion dependent on...
1. RENAL EXCRETION
2. GFR
if INCREASED...
1. RENAL DZ
2. GI/ABDOMINAL DZ
3. NEOPLASIA
4. PANCREATITIS
5. DECREASED GFR
if DECREASED...
--> WE DO NOT INTERPRET DECREASED LIPASE
POORLY SPECIFIC for PANCREATIC DZ
27
if BOTH AMYLASE & LIPASE are INCREASED, what 4 DDxs should we have?
1. STEROID USAGE
2. PANCREATIC CARCINOMA
3. EDTA COLLECTION
4. STEATITIS
28
if BOTH amylase & lipase are increased and AMYLASE > LIPASE, then WHAT Ddx is most likely?
PANCREATIC CARCINOMA
29
TRYPSIN-LIKE IMMUNOREACTIVITY (TLI)
what organ MAKES this enzyme? what organ EXCRETES it?
this value can be affected by ___ status; for example, if TLI is INCREASED, then...
if INCREASED... (1)
if DECREASED... (1)
test of choice/poor SPECIFICITY for WHAT dz?
what do we need to do with the SAMPLE prior to taking it?
made by the PANCREAS, excreted by the KIDNEY
can be affected by HYDRATION status; for example, if TLI is INCREASED, then DECREASED GFR so that TRYPSIN BUILDS UP
if INCREASED = PANCREATITIS (poor SPECIFICITY)
if DECREASED = EPI (TEST OF CHOICE)
need to have a FASTED SAMPLE
30
TLI is often a ____-specific test
SPECIES
31
COBALAMIN (vitamin B12)...
what can PREVENT its ABSORPTION?
if INCREASED... (1)
if DECREASED... (3)
BACTERIA can BIND TO IT to PREVENT its ABSORPTION
if INCREASED...
1. IATROGENIC (over supplementation)
if DECREASED...
1. BACTERIAL OVERGROWTH
2. SEVERE INTESTINAL DZ of the ILEUM
3. EPI (can cause bacterial overgrowth)
32
FOLATE...
= what is it?
what is it produced by? where is it absorbed?
if INCREASED... (2)
if DECREASED... (1)
= B VITAMIN
PRODUCED by BACTERIA, ABSORBED in JEJUNUM
if INCREASED...
1. TOO MANY BACTERIA PRESENT MAKING THIS
2. EPI
if DECREASED...
1. JEJUNAL DZ
33
LIPID TURBIDITY
= what does this aim to detect?
if INCREASED... (1)
if DECREASED... (2)
LOW SENSITIVITY for what dz?
= aims to detect LIPEMIA where CHYLOMICRONS enter blood POST-PRANDIAL
if INCREASED..
1. NORMAL DIGESTION & ABSORPTION OF FOOD
if DECREASED...
1. EPI
2. INTESTINAL DZ (malabsorption)
LOW SENSITIVITY for PANCREATIC DZ
34
FECAL ELASTASE...
= what is this?
if INCREASED... (1)
if DECREASED... (1)
why is this NOT a CHOICE test for ___?
= DIGESTIVE ENZYME made by the PANCREAS that's found in FECES
if INCREASED = NOT RECOGNIZED
if DECREASED = can suggest EPI
NOT a CHOICE test for EPI because can have FALSELY LOW MEASUREMENTS that INACCURATELY DIAGNOSE EPI
35
in PANCREATITIS, what's the BIOCHEMICAL process that occurs to CAUSE it?
why does this happen?
AUTODIGESTION OF THE PANCREAS
occurs because LYSOSOMES FUSE WITH ZYMOGEN GRANULES TO PREMATURELY ACTIVATE DIGESTIVE ENZYMES
36
common cause for ACUTE PANCREATITIS?
HIGH-FAT MEAL
37
3 SpecPL ALTERNATIVE PARAMETERS... (potentially cats)
1. <3.5 ug/L = RULES OUT PANCREATITIS
2. >5.4 ug/L = RAISES SUSPICION FOR PANCREATITIS
3. 3.6 --> 5.3 ug/L = GRAY ZONE
38
TRUE/FALSE
a SNAP test CAN be used to DIAGNOSE PANCREATITIS
FALSE, can only RULE IT OUT
39
2 BENIGN neoplasms of EXOCRINE PANCREAS?
MALIGNANT neoplasm of EXOCRINE PANCREAS?
sometimes can see ____ > ____
BENIGN?
1. ADENOMA
2. NODULAR HYPERPLASIA
MALIGNANT?
1. ADENOCARCINOMA
sometimes see LIPASE > AMYLASE
40
ACUTE PANCREATITIS...
more common in WHAT species?
4 common clinical signs?
why can we see LIVER ENZYMES change? which enzymes can change/why? (2)
3 other CBC findings?
what DIAGNOSTIC test would be best? would it be INCREASED/DECREASED?
DOGS > CATS & HORSES
4 common clinical signs?
1. V+
2. D+
3. ANOREXIA
4. ICTERUS
LIVER IS NEAR PANCREAS, so it can be DAMAGED
1. can see HEPATOCELLULAR ENZYMES from INJURY
2. can see INDUCIBLE ENZYMES from STRESS from INJURY TO BILIARY TRACT or PANCREATIC SWELLING CAUSE CHOLESTASIS
3 other CBCs?
1. HYPOCALCEMIA
2. LOW Na, Cl, K
3. ACIDOSIS
SpecPL would be best! INCREASED!
41
3 common UNDERLYING causes of PANCREATITIS?
what is a SPECIFIC EXAMPLE of one?
1. HIGH-FAT DIETS
2. ISCHEMIA
3. DRUGS --> AZATHIOPRINE
42
4 common causes of PLE?
PLE causes MAL-____
4 possible CBC findings for PLE? (2 are +/-)
4 causes?
1. INFLAMMATORY BOWEL DZ
2. INTESTINAL NEOPLASIA
3. INFECTIOUS AGENTS
4. ADDISON'S DZ
PLE causes MAL-ABSORPTION
4 possible CBC findings for PLE?
1. LOW ALBUMIN
2. LOW GLOBULIN
3. +/- LOW CHOLESTEROL
4. +/- HYPOCALCEMIA
43
HYPERLIPIDEMIA definition?
which component makes blood LIPEMIC?
= INCREASES in CHOLESTEROL, TRIGLYCERIDES or BOTH
TRIGLYCERIDES make blood LIPEMIC
44
3 causes of HYPOCHOLESTEROLEMIA?
1. PROTEIN-LOSING ENTEROPATHY (PLE)
2. LIVER FAILURE
3. ADDISON'S DZ
45
2 MAIN categories of causes for INCREASED TRIGLYCERIDES & CHOLESTEROL?
second one has 4 subs
1. POST-PRANDIAL = NORMAL absorption of CHYLOMICRONS by LYMPHATICS to then be DUMPED INTO CIRCULATION
2. SYSTEMIC DZ, such as...
1. ENDOCRINE DISEASES
2. PROTEIN-LOSING NEPHROPATHY
3. FAMILIAL DISEASE causing INHERITED DEFECT of LIPOPROTEIN METABOLISM
4. PANCREATITIS
46
INHERITED DEFECT of LIPOPROTEIN METABOLISM causing INCREASED ____ & ____ is common in WHAT 2 BREEDS?
INCREASED TRIGLYCERIDES & CHOLESTEROL
1. SCHNAUZERS
2. BEAGLES
47
SERUM CHOLESTEROL..
measures ____
can be INCREASED due to what 2 diseases?
measures LIPOPROTEINS
can be INCREASED due to...
1. ENDOCRINE DZ
2. PRIMARY DISORDERS
48
SERUM TRIGLYCERIDES...
always use a ____ SAMPLE because...
FASTED SAMPLE because want to avoid POST-PRANDIAL LIPEMIA
49
what 3 things does the PANCREAS make?
1. DIGESTIVE ENZYMES
2. INTRINSIC FACTOR
3. BICARBONATE
50
INTRINSIC FACTOR...
= what is it/who produces it?
enters the ____ & binds to ____, and then gets DETECTED by ____ in the ____
WITHOUT INTRINSIC FACTOR...
= factor produced by the PANCREAS that ALLOWS INTESTINE to ABSORB COBALAMIN
enters the DUODENUM & binds to COBALAMIN, and then gets DETECTED by RECEPTORS in the ILEUM
WITHOUT INTRINSIC FACTOR, COBALAMIN CANNOT BE ABSORBED & LEVELS DROP
51
EXOCRINE PANCREATIC INSUFFICIENCY...
= disease of ____ ____ ____ SECRETION resulting in ____ ____
2 forms? which is more common? & give 2 causes for second one
common in WHAT breed?
3 clinical signs?
best diagnostic test? INCREASED or DECREASED?
= disease of INADEQUATE PANCREATIC ENZYME SECRETION resulting in IMPAIRED DIGESTION
2 forms?
1. CONGENITAL = born LACKING ACINAR TISSUE
2. ACQUIRED = more common
--> ATROPHY OVER TIME
--> DESTRUCTION due to SECONDARY diseases
common in GERMAN SHEPHERDS
clinical signs?
1. MALODOROUS FECES
2. STEATORRHEA
3. RAVENOUS APPETITE w/ WEIGHT LOSS
TLI BEST TEST, DECREASED
52
SIBO...
stands for?
= definition & what disease it's ASSOCIATED with
what 2 things do bacteria do here?
stands for SMALL INTESTINAL BACTERIAL OVERGROWTH
= when UNDIGESTED FOOD REMAINS IN INTESTINAL TRACT so INTESTINAL BACTERIA PROLIFERATE/EXPLODE, usually associated with EPI
2 things?
1. BACTERIA PRODUCE EXCESS FOLATE
2. BACTERIA BIND TO COBALAMIN
53
what are the 2 reasons that COBALAMIN LEVELS DROP with SIBO?
hint: SIBO is usually associated with another disease
1. BACTERIA ARE BINDING TO COBALAMIN & PREVENTING ABSORPTION
2. since EPI is usually also involved, NOT PRODUCING ENOUGH INTRINSIC FACTOR so COBALAMIN CANNOT BE ABSORBED
54
3 components of the PORTAL TRIAD?
hepatocytes around the CENTRAL VEIN will get BLOOD ___, so...
portal triad?
1. HEPATIC ARTERY
2. PORTAL VEIN
3. BILE DUCT
hepatocytes around the CENTRAL VEIN will get BLOOD LAST, so PRONE TO ISCHEMIC INJURY if VOLUME-DEPLETED
55
what 2 things make up bile?
1. BILE ACIDS
2. BILIRUBIN
56
if BILE CANALICULI are BLOCKED...
can STAIN ___
give 4 reasons why this can occur
can STAIN BLACK
5 reasons?
1. HEPATOCELLULAR SWELLING
2. INFILTRATIVE NEOPLASIA in PERIPORTAL AREA can BLOCK BILE DUCT
3. PERIPORTAL FIBROSIS
4. INFLAMMATION
57
what 4 things are PRODUCED by the LIVER?
3 BIOCHEMICAL processes does the liver do?
what 4 things can the liver STORE?
4 things PRODUCED?
1. ALBUMIN
2. CHOLESTEROL
3. GLUCOSE
4. CLOTTING FACTOR
2 BIOCHEMICAL processes?
1. FATTY ACID METABOLISM
2. DETOXIFICATION to convert AMMONIA --> UREA
3. CONJUGATION (water INSOLUBLE to WATER SOLUBLE)
4 things it STORES?
1. COPPER
2. IRON
3. GLYCOGEN
4. TRIGLYCERIDES
58
CHOLESTEROL is used to make WHAT?
BILE & BILE ACIDS
59
INDIRECT LIVER FUNCTION TESTS...
DECREASES in... (4)
INCREASES in... (1)
DECREASES in...
1. ALBUMIN
2. BUN
3. CHOLESTEROL
4. GLUCOSE
INCREASES in...
1. PTT/PT
60
DIRECT LIVER FUNCTION TESTS...
INCREASES in... (2)
INCREASES in..
1. AMMONIA
2. BILE ACIDS
61
what 3 things should we assess for the LIVER in CLIN PATH?
1. ENZYMES (leakage or induced)
2. BILIRUBIN (for CHOLESTASIS)
3. LIVER FUNCTION (for FAILURE)
62
AMMONIA = ____ LIVER FUNCTION TEST
UREA = _____ LIVER FUNCTION TEST
AMMONIA = DIRECT
UREA = INDIRECT
63
3 reasons we'd see INCREASED AMMONIA?
1. HEPATIC FAILURE or DZ AFFECTS >75% HEPATOCYTES
2. PORTOSYSTEMIC SHUNT where AMMONIA GETS TAKEN UP BY SYSTEMIC VASCULATURE rather than LIVER from INTESTINE
3. SEVERE GI DZ (horses)
64
why would we expect to see SEVERE GI DZ in HORSES if AMMONIA IS INCREASED?
what other 3 things should we expect to see?
because horses have SUCH A LARGE GI TRACT, when DISEASED, causes BACTERIAL OVERGROWTH that ALL CONVERT PROTEIN --> AMMONIA
other 3?
1. HYPOCALCEMIA
2. NEUROLOGIC
3. INFLAMMATION
65
TRUE/FALSE
AMMONIA has NOTHING to do with BILE CIRCULATION, just BLOOD CIRCULATION
therefore, CHOLESTASIS would cause an INCREASE IN AMMONIA
FALSE, CHOLESTASIS WOULD NOT CAUSE AN INCREASE IN AMMONIA
66
BILE ACIDS are made IN ____ from ____ or....
made in HEPATOCYTES from CHOLESTEROL or RECYCLED FROM PORTAL VEIN
67
OBSTRUCTIVE CHOLESTASIS...
= definition
what 4 things do you expect to be INCREASED?
= BILE CANALICULI (or something in bile transport system) is BLOCKED
4 INCREASES...
1. BILIRUBIN
2. ALP
3. GGT
4. BILE ACIDS
68
2 overarching reasons for INCREASED BILE ACIDS?
second one has 2 subs
1. OBSTRUCTIVE CHOLESTASIS
2. DECREASED CLEARANCE OF BILE ACIDS by the LIVER
--> PORTOSYSTEMIC SHUNT
--> HEPATIC FAILURE
69
PORTOSYSTEMIC SHUNT...
causes INCREASE in what 2 values?
can cause DECREASES in what 2 values? (one is +/-)
common in... (2)
INCREASE in...
1. BILE ACIDS
2. AMMONIA
DECREASE in...
1. MCV
2. +/- UREA
common in..
1. YOUNG animals
2. OLD animals
70
why can ALT/AST be an indicator for HEPATIC FAILURE causing INCREASED BILE ACIDS? (2)
if BILE ACIDS are STUCK IN HEPATOCYTES due to HEPATIC FAILURE, then there will be a BACKUP OF BILE ACIDS IN BLOOD (increased bile acids) & can DAMAGE LOCAL HEPATOCYTE CELL MEMBRANES via EMULSIFYING FAT (ALT/AST increase)
71
for liver enzymes, we should DISREGARD...
ANY DECREASES!
72
LEAKAGE LIVER ENZYMES...
= if INCREASED, what does this mean?
what are the 3 enzymes?
--> which one is DOG/CAT specific?
--> which one is ALL SPECIES?
--> which one is good for LARGE ANIMAL?
5 reasons for INCREASES?
= if INCREASED, then INJURY or DEATH of HEPATOCYTES
3 enzymes?
1. ALT --> DOG/CAT
2. AST --> ALL SPECIES
3. SDH --> LARGE ANIMALS
5 reasons?
1. TRAUMA
2. TOXINS/DRUGS
3. INFECTIOUS/INFLAMMATORY
4. NEOPLASIA
4. METABOLIC
73
AST...
what TYPE of liver enzyme is this?
specific to WHAT 2 things? what supports each? (2)
LEAKAGE LIVER ENZYME
specific to MUSCLE & LIVER
1. CK INCREASED = supports MUSCLE if AST increased
2. ALT INCREASED = supports LIVER if AST increased
74
INDUCED LIVER ENZYMES...
what are the 2? which one is most important for DOGS/CATS & which one is ALL SPECIES?
1. ALKALINE PHOSPHATASE (ALP, has 3 isoenzymes)
2. GGT (all species)
75
ALP...
what KIND of liver enzyme is this?
what are the 3 ISOENZYMES?
which one is INCREASED in YOUNG, GROWING DOGS?
INDUCED LIVER ENZYME
3 ISOENZYMES?
1. ALP-L = LIVER
2. ALP-B = BONE MARROW
--> INCREASED in YOUNG, GROWING DOGS
3. ALP-CS = CORTICOSTEROIDS (dogs only)
76
GGT..
what KIND of liver enzyme is this?
can come from WHAT 3 locations?
often INCREASED in HORSES because...
INDUCED LIVER ENZYME
3 locations?
1. LIVER
2. BILIARY EPITHELIAL CELLS
3. MAMMARY EPITHELIAL CELLS
often INCREASED in HORSES because of RIGHT DORSAL DISPLACEMENT OF LARGE COLON
77
3 causes of INDUCED ENZYME INCREASE? (GGT & ALP)
1. INTRAHEPATIC CHOLESTASIS = bile CANALICULI are BLOCKED
2. EXTRAHEPATIC CHOLESTASIS = COMMON BILE DUCT is BLOCKED
3. BILIARY HYPERPLASIA = usually just causes INCREASED GGT, +/- ALP
78
PRE-HEPATIC HYPERBILIRUBINEMIA...
due to WHAT 2 OVERARCHING THINGS?
due to...
1. HEMOLYSIS (can be INTRA or EXTRAVASCULAR) causing INCREASED CONJUGATED BILIRUBIN IN BLOOD
2. ANOREXIA (HORSES ONLY) from INCREASED FREE FATTY ACIDS COMPETING WITH BILIRUBIN TO GET TO LIVER
79
HEPATIC HYPERBILIRUBINEMIA...
3 OVERARCHING causes?
3 causes?
1. OBSTRUCTIVE CHOLESTASIS
2. FUNCTIONAL CHOLESTASIS
3. HEPATIC FAILURE
80
HEPATIC HYPERBILIRUBINEMIA caused by OBSTRUCTIVE CHOLESTASIS...
= definition
what other 2 things can be INCREASED?
= blockage of BILE CANALICULI or BILE DUCTULES going into the LIVER
can see INCREASED INDUCED LIVER ENZYMES...
1. INCREASED ALP
2. INCREASED GGT
81
FUNCTIONAL CHOLESTASIS...
most common in WHAT species?
why does it occur?
usually see WHAT on CBC?
most common in CATS?
occurs because of an INFLAMMATORY MEDIATOR (like TNF-ALPHA) that DOESN'T ALLOW BILIRUBIN TO EXIT HEPATOCYTE
on CBC = SLIGHT increase in BILIRUBIN WITHOUT increases in ALP/GGT
82
3 causes of POST-HEPATIC HYPERBILIRUBINEMIA?
1. CHOLELITH
2. GALLBLADDER INFLAMMATION/INFECTION
3. PANCREATITIS
83
4 CBC findings for PANCREATITIS?
1. INFLAMMATORY LEUKOGRAM
2. HYPOCALCEMIA
3. INCREASED ALP
4. INCREASED GGT
84
what are the 4 ways in which water gets OUT of the body?
how is water DISTRIBUTED? (2)
4 ways water gets OUT?
1. PANTING
2. SWEATING
3. URINE
4. GI
water DISTRIBUTED?
1. 2/3 = INTRACELLULAR
2. 1/3 = EXTRACELLULAR (blood, plasma, GI)
85
what are the 3 locations of TRANSCELLULAR FLUID (third space)?
in these regions there's a ____ amount of ____ present that helps...
1. ABDOMINAL CAVITY
2. PERICARDIAL SPACE
3. PLEURAL CAVITY
SMALL, FLUID, BATHE ORGANS
86
what are the 2 ways in which kidneys DETERMINE BLOOD VOLUME? & how for each
1. JUXTOGLOMERULAR CELLS to ACTIVATE RAA
2. ADH to RESORB WATER from COLLECTING DUCT
87
PLASMA OSMOLALITY is determined by WHAT organ? what do they respond to?
determined by OSMORECEPTORS in the HYPOTHALAMUS, which respond to HYPEROSMOLALITY
88
HYPEROSMOLALITY...
3 CBC findings?
3 SUBSTANCES that could cause this?
what do we see as a BIG CLINICAL SIGN?
3 CBC?
1. INCREASED Na
2. INCREASED UREA
3. INCREASED GLUCOSE
3 SUBSTANCES?
1. ETHYLENE GLYCOL
2. MANNITOL
3. ETHANOL/METHANOL
BIG CLINICAL SIGN = POLYDIPSIA
89
5 OVERALL causes of HYPERNATREMIA? which is the most common? (*)
how must this disease be treated & why?
1. DEHYDRATION (*)
2. NO WATER from either NO ACCESS or NEUROLOGIC & NOT DRINKING IT
3. LOSS OF FREE WATER usually due to ADH problem
4. LOSS OF FREE WATER > LOSS OF SODIUM
5. SODIUM TOXICITY from ingesting something
HYPERNATREMIA must be treated SLOWLY because cells GET USED TO AMOUNT OF SODIUM, so giving too much fluid = CELL SWELLING
90
DIABETES INSIPIDUS...
CENTRAL = ???
--> give 3 reasons
NEPHROGENIC = ???
--> give 6 reasons
overall, this can be a reason for WHAT CBC finding?
CENTRAL = NOT MAKING ENOUGH ADH from HYPOTHALAMUS so WATER LOST
1. CONGENITAL
2. TRAUMA
3. TUMOR
NEPHROGENIC = DISTAL RENAL TUBULAR CELLS & COLLECTING DUCT DO NOT RESPOND TO ADH & WATER LOST
1. E. COLI
2. HYPERCALCEMIA
3. STEROIDS
4. DRUGS
5. HYPOKALEMIA
6. RENAL DISEASE (no RECEPTORS for ADH)
overall, can be a reason for HYPERNATREMIA (loss of FREE WATER)
91
what type of diabetes insipidus is MOST COMMON?
NEPHROGENIC
92
GLOMERULAR FILTRATION is dependent on what 3 things?
3 subs for first, 1 for second, 4 for third
1. PRE-RENAL FACTORS (move proportionally to GFR)
--> BLOOD VOLUME
--> CO
--> BP
2. NUMBER OF NEPHRONS
--> if decreased, lower GFR
3. presence of WASTE PRODUCTS that should've been EXCRETED IN URINE
--> UREA
--> CREATININE
--> PHOSPHORUS
--> H+ IONS
93
TUBULAR FLOW RATE IS DICTATED BY...
GLOMERULAR FLOW RATE
94
what is considered the FUNCTIONAL unit of the nephron?
what part of the kidney is MOST METABOLICALLY ACTIVE? what does this mean clinically?
FUNCTIONAL unit of nephron = GLOMERULUS
the PROXIMAL CONVOLUTED TUBULE is MOST METABOLICALLY ACTIVE, so likely to be affected by DAMAGE/AKI
95
in the ASCENDING LOOP OF HENLE...
in the DESCENDING LOOP OF HENLE....
ASCENDING = ACTIVELY RESORBS NaCl
DESCENDING = PASSIVELY RESORBS WATER (due to active resorption)
96
what part of the kidney is dependent on ALDOSTERONE?
what 2 functions does ALDOSTERONE participate in?
DISTAL CONVOLUTED TUBULE DEPENDENT ON ALDOSTERONE
ALDOSTERONE functions...
1. RESORPTION of NaCl & WATER
2. EXCRETION OF K
97
the USG is determined by...
the TUBULAR CELLS of the KIDNEY
98
4 places that urine is CONCENTRATED & HOW
1. PCT = if not, then KIDNEY DZ
2. MEDULLARY CONCENTRATION GRADIENT in LOOP OF HENLE
--> DESCENDING = PASSIVE RESORPTION OF WATER
--> ASCENDING = ACTIVE RESORPTION OF NaCl
3. DCT
--> via ALDOSTERONE
4. COLLECTING DUCT
--> via ADH
99
3 NON-RENAL causes of DECREASED USG?
1. MEDULLARY WASHOUT
--> from LONG-TERM LOW NaCl & DECREASED UREA
2. LACK OF ALDOSTERONE
--> ex = ADDISON'S
3. DIABETES INSIPIDUS
--> central or nephrogenic
100
what 2 things do we need to observe to EVALUATE RENAL FUNCTION/AZOTEMIA?
1. BLOODWORK = BUN & CREATININE INCREASES
2. USG = helps determine if it's PRE-RENAL or RENAL
101
AZOTEMIA (1) vs. UREMIA? (3)
AZOTEMIA = BLOODWORK finding that REFLECTS BIOCHEMICAL CHANGE w/ INCREASE IN CREATININE & BUN
UREMIA = MANY CLINICAL SIGNS that appear as a RESULT OF AZOTEMIA, including...
1. V+
2. WEIGHT LOSS
3. GI ULCERATION
102
what are the 2 common sources of BUN in SMALL ANIMALS?
if TUBULAR FLOW RATE is SLOW, this causes...
1. from GI TRACT after PROTEIN BREAKDOWN
2. from GI BLEED (digesting RBCs)
if TUBULAR FLOW RATE is SLOW, this causes MORE BUN TO BE RESORBED --> HIGHER ON B/W
103
in HORSES, BUN is excreted by the ____, while in COWS BUN is excreted by the ___
OVERALL, why do we not see as HIGH elevations in BUN?
HORSES = CECUM, COWS = RUMEN
OVERALL, UREA is BROKEN DOWN to SYNTHESIZE PROTEIN in GI TRACT, so NOT AS MUCH BUN IS CIRCULATING
104
what 4 things must be FUNCTIONAL for USG TO BE NORMAL?
1. BARORECEPTORS to sense changes in blood volume & stimulate HYPOTHALAMUS to MAKE PITUITARY RELEASE ADH
2. NORMAL PITUITARY GLAND
3. NORMAL KIDNEYS
4. ADEQUATE NUMBER OF FUNCTIONAL NEPHRONS (at least 2/3)
105
USG basic definition
how much WATER is in URINE when water should be NORMALLY RESORBED by the TUBULES
106
we DO NOT see an INCREASE IN BUN & AZOTEMIA until...
>2/3 of FUNCTIONAL NEPHRONS ARE LOST
107
ISOSTHENURIA...
range?
= definition & what it means CLINICALLY
range = 1.008 to 1.012
= USG is about the SAME CONCENTRATION as ULTRAFILTRATE as it ENTERS GLOMERULAR CAPSULE
this indicates that TUBULES HAVE NOT CONCENTRATED OR DILUTED THE FILTRATE
108
HYPOSTHENURIA...
range?
what does it mean?
range = 1.001 --> 1.007
the renal TUBULES have DILUTED THE URINE (close to USG of 1.0 or WATER)
109
2 main causes of PRE-RENAL AZOTEMIA?
for the first one, what are the 3 things we should look for CONCURRENTLY?
USG?
1. DECREASED RENAL BLOOD FLOW CAUSING DECREASED GFR
--> LOW BLOOD VOLUME
--> LOW CO
--> DEHYDRATION
2. GI HEMORRHAGE CAUSING INCREASED BUN
USG IS NORMAL
110
2 main causes of RENAL AZOTEMIA?
4 subs for second one
USG?
1. DECREASED NUMBER OF FUNCTIONAL NEPHRONS
2. EXTRARENAL CAUSES...
--> DIABETES INSIPIDUS
--> MEDULLARY WASHOUT
--> OSMOTIC DIURESIS FROM GLUCOSE
--> DRUGS
USG IS SUBOPTIMAL
111
2 causes of POST-RENAL AZOTEMIA?
USG?
1. BLOCKAGE OF URINE
2. LEAKAGE OF URINE
USG IS IRRELEVANT SO IT CAN BE VARIABLE
112
4 CBC findings consistent with GI BLEED?
what kind of AZOTEMIA can it cause?
USG?
4 CBC findings?
1. REGENERATIVE ANEMIA
2. LOW TOTAL PROTEIN
3. THROMBOCYTOPENIA
4. INCREASED BUN > > > MUCH MORE THAN CREATININE
can cause PRE-RENAL AZOTEMIA
USG should be NORMAL
113
RENAL AZOTEMIA...
= definition?
2 causes? (for second, list 4 subs)
= USG PRIMARY/CENTRAL DI = NOT MAKING ENOUGH ADH
--> NEPHROGENIC DI = TUBULES DO NOT RESPOND TO ADH
--> DECREASED MEDULLARY CONCENTRATION GRADIENT
--> LACK OF ALDOSTERONE (ADDISON'S)
114
what 3 things are needed for NORMAL USG?
1. BARORECEPTORS to SENSE LOW BP & CONCENTRATE URINE
2. MEDULLARY CONCENTRATION GRADIENT
3. ADEQUATE AMOUNT OF FUNCTIONAL NEPHRONS (at least 2/3)
115
3 CAUSES of DECREASED MEDULLARY CONCENTRATION GRADIENT?
what can this then cause? (2)
3 causes?
1. DECREASED Na in ADDISON'S
2. DECREASED BUN in LIVER FAILURE
3. OSMOTIC DIURESIS in DIABETES MELLITUS
this then causes...
1. EXTRARENAL DZ
2. RENAL AZOTEMIA
116
what 3 tests are INVALID in URINE DIPSTICK?
ACIDIC URINE is common in ____, while ALKALINE URINE is common in ____
3 tests...
1. LEUKOCYTE ESTERASE
2. NITRATE
3. SPECIFIC GRAVITY
ACIDIC URINE is common in CARNIVORES, while ALKALINE URINE is common in HERBIVORES
117
2 reasons for GLUCOSURIA?
1. HIGH PLASMA GLUCOSE due to DIABETES
2. RENAL TUBULAR INJURY, usually in PCT
118
KETONURIA..
we often see KETONES in the ____ before the ____
2 reasons to see it?
we often see KETONES in the URINE before the CIRCULATION
2 reasons?
1. animal in NEGATIVE ENERGY BALANCE (like postpartum)
2. DIABETIC KETOACIDOSIS
119
3 reasons for BLOOD IN DIPSTICK & WHAT EVIDENCE WE SHOULD LOOK FOR
1. HEMOGLOBINURIA = look for EVIDENCE OF INTRAVASCULAR HEMOLYSIS
2. MYOGLOBINURIA = LOOK FOR HIGH CK +/- HIGH AST
3. HEMATURIA = LOOK FOR NO EVIDENCE OF HEMOLYSIS, INTACT RBCs
120
5 reasons for PROTEIN IN DIPSTICK?
1. HIGHLY CONCENTRATED URINE from NORMAL DCT PROTEINS
2. PRE-RENAL PROTEINURIA from MYOGLOBIN or HEMOGLOBIN spilling into GLOMERULUS
3. RENAL PROTEINURIA from TUBULAR or GLOMERULAR DZ
4. POST-RENAL PROTEINURIA from HEMORRHAGE or INFLAMMATION of BLADDER or URETHRA
5. FALSE POSITIVE due to ALKALINE URINE
121
2 causes for BILIRUBIN on DIPSTICK? give what we should look for in each
2 causes?
1. BILIRUBINEMIA --> look for HEMOLYSIS or CHOLESTASIS
2. CONCENTRATED URINE --> look for HIGH USG & +1/+2 for PROTEIN
122
how MUCH urine is needed for a URINE SEDIMENT?
what 4 things can we see on 10X?
what 3 things can we see on 40X?
need >5 mL of URINE
4 things for 10X?
1. EGGS
2. LARVAE of RENAL PARASITES
3. CASTS
4. CRYSTALS
3 things for 40X?
1. CELLS
2. OTHER CRYSTALS
3. BACTERIA
123
what is a CAST?
what is it called when it's NORMAL? what 3 things should we check to make sure?
= CAST of EPITHELIUM from RENAL TUBULE
NORMAL CAST = HYALINE, but check USG, PROTEIN & ALBUMIN
