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Year 1/2 > Clin Path S2 > Flashcards

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

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2
Q

PANCYTOPENIA…

= definition?

A

= DECREASED production of ALL 3 LINEAGES
1. RBCs
2. WBCs
3. PLATELETS

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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

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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

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5
Q

2 common INFECTIOUS causes of PANCYTOPENIA in CATS?

A
  1. HISTOPLASMOSIS
  2. CYTAUXZOON FELIS
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6
Q

3 common NON-INFECTIOUS causes of PANCYTOPENIA?

A
  1. MYELOFIBROSIS = marrow REPLACED BY FIBROUS TISSUE
  2. NECROSIS
  3. TOXIC INSULTS (drugs)
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7
Q

what are the TWO KINDS OF FORMS of MYELOID NEOPLASM?

A
  1. ACUTE = BLAST FORM
  2. CHRONIC = MATURE FORM
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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

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9
Q

MYELOID NEOPLASMS usually start in the….

A

BONE MARROW

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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

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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

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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

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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

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14
Q

what are 2 reasons LYMPHOMA can cause LYMPHOPENIA?

A
  1. STRESS
  2. LYMPH NODES AREN’T ALLOW NORMAL TRAFFICKING –> LYMPHOCYTES CANNOT LEAVE LNs
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15
Q

4 organs that can be affected by PRIMARY or SECONDARY LYMPHOMA?

A
  1. GI
  2. SPLEEN
  3. LIVER
  4. BONE MARROW (stage V if it’s here)
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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

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17
Q

3 LYMPHOPROLIFERATIVE diseases?

A
  1. CHRONIC LYMPHOID LEUKEMIA
  2. ACUTE LYMPHOID LEUKEMIA
  3. PLASMA CELL MYELOMA
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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

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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

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20
Q

CUTANEOUS PLASMA CELL MYELOMA vs. MULTIPLE MYELOMA PROGNOSIS

A

CUTANEOUS&raquo_space;> MM

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21
Q

4 common causes of PANCYTOPENIA if caused by the BONE MARROW?

A
  1. MYELOPHTHISIS from FIBROSIS
  2. DRUGS
  3. METASTATIC CANCER
  4. HEMATOPOIETIC NEOPLASM
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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

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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

  1. 201-399 ug/L = GRAY ZONE, needs a RETEST
  2. > 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

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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

  1. ABNORMAL = dot is DARKER THAN CONTROL; >400 ug/L
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25
Q

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?

A

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

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26
Q

LIPASE…

enzyme made by WHAT 2 organs?

its excretion is DEPENDENT on… (2)

if INCREASED… (5)

if DECREASED… (1)

POORLY SPECIFIC for what dz?

A

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

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27
Q

if BOTH AMYLASE & LIPASE are INCREASED, what 4 DDxs should we have?

A
  1. STEROID USAGE
  2. PANCREATIC CARCINOMA
  3. EDTA COLLECTION
  4. STEATITIS
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28
Q

if BOTH amylase & lipase are increased and AMYLASE > LIPASE, then WHAT Ddx is most likely?

A

PANCREATIC CARCINOMA

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29
Q

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?

A

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

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30
Q

TLI is often a ____-specific test

A

SPECIES

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31
Q

COBALAMIN (vitamin B12)…

what can PREVENT its ABSORPTION?

if INCREASED… (1)

if DECREASED… (3)

A

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)

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32
Q

FOLATE…

= what is it?

what is it produced by? where is it absorbed?

if INCREASED… (2)

if DECREASED… (1)

A

= B VITAMIN

PRODUCED by BACTERIA, ABSORBED in JEJUNUM

if INCREASED…
1. TOO MANY BACTERIA PRESENT MAKING THIS
2. EPI

if DECREASED…
1. JEJUNAL DZ

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33
Q

LIPID TURBIDITY

= what does this aim to detect?

if INCREASED… (1)

if DECREASED… (2)

LOW SENSITIVITY for what dz?

A

= 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

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34
Q

FECAL ELASTASE…

= what is this?

if INCREASED… (1)

if DECREASED… (1)

why is this NOT a CHOICE test for ___?

A

= 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

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35
Q

in PANCREATITIS, what’s the BIOCHEMICAL process that occurs to CAUSE it?

why does this happen?

A

AUTODIGESTION OF THE PANCREAS

occurs because LYSOSOMES FUSE WITH ZYMOGEN GRANULES TO PREMATURELY ACTIVATE DIGESTIVE ENZYMES

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36
Q

common cause for ACUTE PANCREATITIS?

A

HIGH-FAT MEAL

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37
Q

3 SpecPL ALTERNATIVE PARAMETERS… (potentially cats)

A
  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
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38
Q

TRUE/FALSE

a SNAP test CAN be used to DIAGNOSE PANCREATITIS

A

FALSE, can only RULE IT OUT

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39
Q

2 BENIGN neoplasms of EXOCRINE PANCREAS?

MALIGNANT neoplasm of EXOCRINE PANCREAS?

sometimes can see ____ > ____

A

BENIGN?
1. ADENOMA
2. NODULAR HYPERPLASIA

MALIGNANT?
1. ADENOCARCINOMA

sometimes see LIPASE > AMYLASE

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40
Q

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?

A

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

  1. 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!

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41
Q

3 common UNDERLYING causes of PANCREATITIS?

what is a SPECIFIC EXAMPLE of one?

A
  1. HIGH-FAT DIETS
  2. ISCHEMIA
  3. DRUGS –> AZATHIOPRINE
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42
Q

4 common causes of PLE?

PLE causes MAL-____

4 possible CBC findings for PLE? (2 are +/-)

A

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

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43
Q

HYPERLIPIDEMIA definition?

which component makes blood LIPEMIC?

A

= INCREASES in CHOLESTEROL, TRIGLYCERIDES or BOTH

TRIGLYCERIDES make blood LIPEMIC

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44
Q

3 causes of HYPOCHOLESTEROLEMIA?

A
  1. PROTEIN-LOSING ENTEROPATHY (PLE)
  2. LIVER FAILURE
  3. ADDISON’S DZ
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45
Q

2 MAIN categories of causes for INCREASED TRIGLYCERIDES & CHOLESTEROL?

second one has 4 subs

A
  1. POST-PRANDIAL = NORMAL absorption of CHYLOMICRONS by LYMPHATICS to then be DUMPED INTO CIRCULATION
  2. SYSTEMIC DZ, such as…
  3. ENDOCRINE DISEASES
  4. PROTEIN-LOSING NEPHROPATHY
  5. FAMILIAL DISEASE causing INHERITED DEFECT of LIPOPROTEIN METABOLISM
  6. PANCREATITIS
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46
Q

INHERITED DEFECT of LIPOPROTEIN METABOLISM causing INCREASED ____ & ____ is common in WHAT 2 BREEDS?

A

INCREASED TRIGLYCERIDES & CHOLESTEROL

  1. SCHNAUZERS
  2. BEAGLES
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47
Q

SERUM CHOLESTEROL..

measures ____

can be INCREASED due to what 2 diseases?

A

measures LIPOPROTEINS

can be INCREASED due to…
1. ENDOCRINE DZ
2. PRIMARY DISORDERS

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48
Q

SERUM TRIGLYCERIDES…

always use a ____ SAMPLE because…

A

FASTED SAMPLE because want to avoid POST-PRANDIAL LIPEMIA

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49
Q

what 3 things does the PANCREAS make?

A
  1. DIGESTIVE ENZYMES
  2. INTRINSIC FACTOR
  3. BICARBONATE
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50
Q

INTRINSIC FACTOR…

= what is it/who produces it?

enters the ____ & binds to ____, and then gets DETECTED by ____ in the ____

WITHOUT INTRINSIC FACTOR…

A

= 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
Q

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?

A

= 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
Q

SIBO…

stands for?

= definition & what disease it’s ASSOCIATED with

what 2 things do bacteria do here?

A

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
Q

what are the 2 reasons that COBALAMIN LEVELS DROP with SIBO?

hint: SIBO is usually associated with another disease

A
  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
Q

3 components of the PORTAL TRIAD?

hepatocytes around the CENTRAL VEIN will get BLOOD ___, so…

A

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
Q

what 2 things make up bile?

A
  1. BILE ACIDS
  2. BILIRUBIN
56
Q

if BILE CANALICULI are BLOCKED…

can STAIN ___

give 4 reasons why this can occur

A

can STAIN BLACK

5 reasons?
1. HEPATOCELLULAR SWELLING
2. INFILTRATIVE NEOPLASIA in PERIPORTAL AREA can BLOCK BILE DUCT
3. PERIPORTAL FIBROSIS
4. INFLAMMATION

57
Q

what 4 things are PRODUCED by the LIVER?

3 BIOCHEMICAL processes does the liver do?

what 4 things can the liver STORE?

A

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
Q

CHOLESTEROL is used to make WHAT?

A

BILE & BILE ACIDS

59
Q

INDIRECT LIVER FUNCTION TESTS…

DECREASES in… (4)

INCREASES in… (1)

A

DECREASES in…
1. ALBUMIN
2. BUN
3. CHOLESTEROL
4. GLUCOSE

INCREASES in…
1. PTT/PT

60
Q

DIRECT LIVER FUNCTION TESTS…

INCREASES in… (2)

A

INCREASES in..
1. AMMONIA
2. BILE ACIDS

61
Q

what 3 things should we assess for the LIVER in CLIN PATH?

A
  1. ENZYMES (leakage or induced)
  2. BILIRUBIN (for CHOLESTASIS)
  3. LIVER FUNCTION (for FAILURE)
62
Q

AMMONIA = ____ LIVER FUNCTION TEST

UREA = _____ LIVER FUNCTION TEST

A

AMMONIA = DIRECT

UREA = INDIRECT

63
Q

3 reasons we’d see INCREASED AMMONIA?

A
  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
Q

why would we expect to see SEVERE GI DZ in HORSES if AMMONIA IS INCREASED?

what other 3 things should we expect to see?

A

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
Q

TRUE/FALSE

AMMONIA has NOTHING to do with BILE CIRCULATION, just BLOOD CIRCULATION

therefore, CHOLESTASIS would cause an INCREASE IN AMMONIA

A

FALSE, CHOLESTASIS WOULD NOT CAUSE AN INCREASE IN AMMONIA

66
Q

BILE ACIDS are made IN ____ from ____ or….

A

made in HEPATOCYTES from CHOLESTEROL or RECYCLED FROM PORTAL VEIN

67
Q

OBSTRUCTIVE CHOLESTASIS…

= definition

what 4 things do you expect to be INCREASED?

A

= BILE CANALICULI (or something in bile transport system) is BLOCKED

4 INCREASES…
1. BILIRUBIN
2. ALP
3. GGT
4. BILE ACIDS

68
Q

2 overarching reasons for INCREASED BILE ACIDS?

second one has 2 subs

A
  1. OBSTRUCTIVE CHOLESTASIS
  2. DECREASED CLEARANCE OF BILE ACIDS by the LIVER
    –> PORTOSYSTEMIC SHUNT
    –> HEPATIC FAILURE
69
Q

PORTOSYSTEMIC SHUNT…

causes INCREASE in what 2 values?

can cause DECREASES in what 2 values? (one is +/-)

common in… (2)

A

INCREASE in…
1. BILE ACIDS
2. AMMONIA

DECREASE in…
1. MCV
2. +/- UREA

common in..
1. YOUNG animals
2. OLD animals

70
Q

why can ALT/AST be an indicator for HEPATIC FAILURE causing INCREASED BILE ACIDS? (2)

A

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
Q

for liver enzymes, we should DISREGARD…

A

ANY DECREASES!

72
Q

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?

A

= 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
Q

AST…

what TYPE of liver enzyme is this?

specific to WHAT 2 things? what supports each? (2)

A

LEAKAGE LIVER ENZYME

specific to MUSCLE & LIVER
1. CK INCREASED = supports MUSCLE if AST increased
2. ALT INCREASED = supports LIVER if AST increased

74
Q

INDUCED LIVER ENZYMES…

what are the 2? which one is most important for DOGS/CATS & which one is ALL SPECIES?

A
  1. ALKALINE PHOSPHATASE (ALP, has 3 isoenzymes)
  2. GGT (all species)
75
Q

ALP…

what KIND of liver enzyme is this?

what are the 3 ISOENZYMES?

which one is INCREASED in YOUNG, GROWING DOGS?

A

INDUCED LIVER ENZYME

3 ISOENZYMES?
1. ALP-L = LIVER

  1. ALP-B = BONE MARROW
    –> INCREASED in YOUNG, GROWING DOGS
  2. ALP-CS = CORTICOSTEROIDS (dogs only)
76
Q

GGT..

what KIND of liver enzyme is this?

can come from WHAT 3 locations?

often INCREASED in HORSES because…

A

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
Q

3 causes of INDUCED ENZYME INCREASE? (GGT & ALP)

A
  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
Q

PRE-HEPATIC HYPERBILIRUBINEMIA…

due to WHAT 2 OVERARCHING THINGS?

A

due to…
1. HEMOLYSIS (can be INTRA or EXTRAVASCULAR) causing INCREASED CONJUGATED BILIRUBIN IN BLOOD

  1. ANOREXIA (HORSES ONLY) from INCREASED FREE FATTY ACIDS COMPETING WITH BILIRUBIN TO GET TO LIVER
79
Q

HEPATIC HYPERBILIRUBINEMIA…

3 OVERARCHING causes?

A

3 causes?
1. OBSTRUCTIVE CHOLESTASIS
2. FUNCTIONAL CHOLESTASIS
3. HEPATIC FAILURE

80
Q

HEPATIC HYPERBILIRUBINEMIA caused by OBSTRUCTIVE CHOLESTASIS…

= definition

what other 2 things can be INCREASED?

A

= blockage of BILE CANALICULI or BILE DUCTULES going into the LIVER

can see INCREASED INDUCED LIVER ENZYMES…
1. INCREASED ALP
2. INCREASED GGT

81
Q

FUNCTIONAL CHOLESTASIS…

most common in WHAT species?

why does it occur?

usually see WHAT on CBC?

A

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
Q

3 causes of POST-HEPATIC HYPERBILIRUBINEMIA?

A
  1. CHOLELITH
  2. GALLBLADDER INFLAMMATION/INFECTION
  3. PANCREATITIS
83
Q

4 CBC findings for PANCREATITIS?

A
  1. INFLAMMATORY LEUKOGRAM
  2. HYPOCALCEMIA
  3. INCREASED ALP
  4. INCREASED GGT
84
Q

what are the 4 ways in which water gets OUT of the body?

how is water DISTRIBUTED? (2)

A

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
Q

what are the 3 locations of TRANSCELLULAR FLUID (third space)?

in these regions there’s a ____ amount of ____ present that helps…

A
  1. ABDOMINAL CAVITY
  2. PERICARDIAL SPACE
  3. PLEURAL CAVITY

SMALL, FLUID, BATHE ORGANS

86
Q

what are the 2 ways in which kidneys DETERMINE BLOOD VOLUME? & how for each

A
  1. JUXTOGLOMERULAR CELLS to ACTIVATE RAA
  2. ADH to RESORB WATER from COLLECTING DUCT
87
Q

PLASMA OSMOLALITY is determined by WHAT organ? what do they respond to?

A

determined by OSMORECEPTORS in the HYPOTHALAMUS, which respond to HYPEROSMOLALITY

88
Q

HYPEROSMOLALITY…

3 CBC findings?

3 SUBSTANCES that could cause this?

what do we see as a BIG CLINICAL SIGN?

A

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
Q

5 OVERALL causes of HYPERNATREMIA? which is the most common? (*)

how must this disease be treated & why?

A
  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
Q

DIABETES INSIPIDUS…

CENTRAL = ???
–> give 3 reasons

NEPHROGENIC = ???
–> give 6 reasons

overall, this can be a reason for WHAT CBC finding?

A

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
Q

what type of diabetes insipidus is MOST COMMON?

A

NEPHROGENIC

92
Q

GLOMERULAR FILTRATION is dependent on what 3 things?

3 subs for first, 1 for second, 4 for third

A
  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
Q

TUBULAR FLOW RATE IS DICTATED BY…

A

GLOMERULAR FLOW RATE

94
Q

what is considered the FUNCTIONAL unit of the nephron?

what part of the kidney is MOST METABOLICALLY ACTIVE? what does this mean clinically?

A

FUNCTIONAL unit of nephron = GLOMERULUS

the PROXIMAL CONVOLUTED TUBULE is MOST METABOLICALLY ACTIVE, so likely to be affected by DAMAGE/AKI

95
Q

in the ASCENDING LOOP OF HENLE…

in the DESCENDING LOOP OF HENLE….

A

ASCENDING = ACTIVELY RESORBS NaCl

DESCENDING = PASSIVELY RESORBS WATER (due to active resorption)

96
Q

what part of the kidney is dependent on ALDOSTERONE?

what 2 functions does ALDOSTERONE participate in?

A

DISTAL CONVOLUTED TUBULE DEPENDENT ON ALDOSTERONE

ALDOSTERONE functions…
1. RESORPTION of NaCl & WATER
2. EXCRETION OF K

97
Q

the USG is determined by…

A

the TUBULAR CELLS of the KIDNEY

98
Q

4 places that urine is CONCENTRATED & HOW

A
  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
Q

3 NON-RENAL causes of DECREASED USG?

A
  1. MEDULLARY WASHOUT
    –> from LONG-TERM LOW NaCl & DECREASED UREA
  2. LACK OF ALDOSTERONE
    –> ex = ADDISON’S
  3. DIABETES INSIPIDUS
    –> central or nephrogenic
100
Q

what 2 things do we need to observe to EVALUATE RENAL FUNCTION/AZOTEMIA?

A
  1. BLOODWORK = BUN & CREATININE INCREASES
  2. USG = helps determine if it’s PRE-RENAL or RENAL
101
Q

AZOTEMIA (1) vs. UREMIA? (3)

A

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
Q

what are the 2 common sources of BUN in SMALL ANIMALS?

if TUBULAR FLOW RATE is SLOW, this causes…

A
  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
Q

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?

A

HORSES = CECUM, COWS = RUMEN

OVERALL, UREA is BROKEN DOWN to SYNTHESIZE PROTEIN in GI TRACT, so NOT AS MUCH BUN IS CIRCULATING

104
Q

what 4 things must be FUNCTIONAL for USG TO BE NORMAL?

A
  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
Q

USG basic definition

A

how much WATER is in URINE when water should be NORMALLY RESORBED by the TUBULES

106
Q

we DO NOT see an INCREASE IN BUN & AZOTEMIA until…

A

> 2/3 of FUNCTIONAL NEPHRONS ARE LOST

107
Q

ISOSTHENURIA…

range?

= definition & what it means CLINICALLY

A

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
Q

HYPOSTHENURIA…

range?

what does it mean?

A

range = 1.001 –> 1.007

the renal TUBULES have DILUTED THE URINE (close to USG of 1.0 or WATER)

109
Q

2 main causes of PRE-RENAL AZOTEMIA?

for the first one, what are the 3 things we should look for CONCURRENTLY?

USG?

A
  1. DECREASED RENAL BLOOD FLOW CAUSING DECREASED GFR
    –> LOW BLOOD VOLUME
    –> LOW CO
    –> DEHYDRATION
  2. GI HEMORRHAGE CAUSING INCREASED BUN

USG IS NORMAL

110
Q

2 main causes of RENAL AZOTEMIA?

4 subs for second one

USG?

A
  1. DECREASED NUMBER OF FUNCTIONAL NEPHRONS
  2. EXTRARENAL CAUSES…
    –> DIABETES INSIPIDUS
    –> MEDULLARY WASHOUT
    –> OSMOTIC DIURESIS FROM GLUCOSE
    –> DRUGS

USG IS SUBOPTIMAL

111
Q

2 causes of POST-RENAL AZOTEMIA?

USG?

A
  1. BLOCKAGE OF URINE
  2. LEAKAGE OF URINE

USG IS IRRELEVANT SO IT CAN BE VARIABLE

112
Q

4 CBC findings consistent with GI BLEED?

what kind of AZOTEMIA can it cause?

USG?

A

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
Q

RENAL AZOTEMIA…

= definition?

2 causes? (for second, list 4 subs)

A

= USG <CUTOFF + DEHYDRATION/AZOTEMIA

2 causes?
1. TRUE KIDNEY DZ from DECREASED FUNCTIONAL NEPHRONS

  1. EXTRARENAL DZ
    –> 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
Q

what 3 things are needed for NORMAL USG?

A
  1. BARORECEPTORS to SENSE LOW BP & CONCENTRATE URINE
  2. MEDULLARY CONCENTRATION GRADIENT
  3. ADEQUATE AMOUNT OF FUNCTIONAL NEPHRONS (at least 2/3)
115
Q

3 CAUSES of DECREASED MEDULLARY CONCENTRATION GRADIENT?

what can this then cause? (2)

A

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
Q

what 3 tests are INVALID in URINE DIPSTICK?

ACIDIC URINE is common in ____, while ALKALINE URINE is common in ____

A

3 tests…
1. LEUKOCYTE ESTERASE
2. NITRATE
3. SPECIFIC GRAVITY

ACIDIC URINE is common in CARNIVORES, while ALKALINE URINE is common in HERBIVORES

117
Q

2 reasons for GLUCOSURIA?

A
  1. HIGH PLASMA GLUCOSE due to DIABETES
  2. RENAL TUBULAR INJURY, usually in PCT
118
Q

KETONURIA..

we often see KETONES in the ____ before the ____

2 reasons to see it?

A

we often see KETONES in the URINE before the CIRCULATION

2 reasons?
1. animal in NEGATIVE ENERGY BALANCE (like postpartum)

  1. DIABETIC KETOACIDOSIS
119
Q

3 reasons for BLOOD IN DIPSTICK & WHAT EVIDENCE WE SHOULD LOOK FOR

A
  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
Q

5 reasons for PROTEIN IN DIPSTICK?

A
  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
Q

2 causes for BILIRUBIN on DIPSTICK? give what we should look for in each

A

2 causes?
1. BILIRUBINEMIA –> look for HEMOLYSIS or CHOLESTASIS

  1. CONCENTRATED URINE –> look for HIGH USG & +1/+2 for PROTEIN
122
Q

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?

A

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
Q

what is a CAST?

what is it called when it’s NORMAL? what 3 things should we check to make sure?

A

= CAST of EPITHELIUM from RENAL TUBULE

NORMAL CAST = HYALINE, but check USG, PROTEIN & ALBUMIN

Year 1/2 (139 decks)

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