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Pathology > Clinical biochemistry (year 2) > Flashcards

Clinical biochemistry (year 2) Flashcards

1
Q

what is the role of diagnostic tests?

A

to conform/refute a clinical hypothesis so shouldn’t be carried out blind

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2
Q

what must be done before taking blood?

A

history
physical exam
identify clinical problems
differential diagnosis

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3
Q

what are the two types of tests?

A

screening

confirmation

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4
Q

what samples can be taken?

A

urine, blood, faeces, cavitary fluid, synovial fluid, CSF

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5
Q

define clinical biochemistry

A

analysis of samples of bodily fluid

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6
Q

what is plasma?

A

extracellular fluids plus additional proteins

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7
Q

what are the functions of plasma?

A

transport - nutrients, hormones, metabolites
clotting
osmolarity maintenance
oncotic pressure maintenance

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8
Q

what is the difference between whole blood and plasma?

A

plasma doesn’t have any cells

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9
Q

what is the main difference between the collection of plasma and serum?

A

serum is allowed to clot so doesn’t contain clotting factors

plasma still contains coagulation factors by using an anticoagulant

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10
Q

what is chemicals is blood placed in to prevent clotting to obtain plasma?

A

lithium heparin

sodium citrate

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11
Q

when measuring glucose in plasma/serum what tube is blood collected into?

A

NaFluoride/oxalate or NaFluoride/EDTA tube

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12
Q

what colour are NaFluoride/oxalate or NaFluoride/EDTA tubes?

A

grey top

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13
Q

what does fluoride inhibit?

A

glycolysis - so glucose isn’t used up and can be measured

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14
Q

why may a decrease in concentration of analytes in serum occur?

A

decreased input

increased output

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15
Q

why might input be decreased causing a decrease in concentration of serum analytes?

A

decrease synthesis, nutritional deficiency, poor absorption, lack of precursors

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16
Q

why might input be increased causing a decrease in concentration of serum analytes?

A

excessive demand, increased excretion, pathological loss

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17
Q

why may an increase in concentration of analytes in serum occur?

A

increased input

decreased output

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18
Q

some changes to plasma analytes can be relative, what does this mean?

A

changes caused by increased/decreased water - haemoconcentration

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19
Q

what is the reference interval?

A

range of values encompassing 95% of a tested population of apparently healthy animals

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20
Q

why is 95% used as a reference interval instead of 100%?

A

maximise detection of diseased animals

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21
Q

what is the term used for decreased albumin in serum?

A

hypoalbuminaemia

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22
Q

what are pre-analytical errors?

A

errors that happen before test is carried out

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23
Q

what are some common pre-analytical errors?

A

labelling, anticoagulation, contamination, improper handling, inappropriate storage

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24
Q

what may an abnormal increase in potassium during blood sampling be due to?

A

EDTA contamination

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25
Q

what is accuracy?

A

how close the result is to the true value

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26
Q

what is precision?

A

reproducibility of the laboratory methods

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27
Q

what is sensitivity?

A

likelihood of a positive result when disease is present

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28
Q

what is specificity?

A

likelihood of a negative result when disease is absent

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29
Q

what is a positive predictive value?

A

likelihood that a patient with a positive result has the disease

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30
Q

what is a negative predictive value?

A

likelihood that a patient with a negative result does not have the disease

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31
Q

what are the proteins measured in total protein?

A

albumin

globulins (include clotting factors)

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32
Q

how can total protein be measured?

A

refractometry

biuret method

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33
Q

where is albumin produced?

A

hepatocytes

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34
Q

where is albumin catabolised?

A

most tissues

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35
Q

what is the function of albumin?

A

carrier protein

role in oncotic pressure

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36
Q

what is albumin a carrier protein for?

A 
unconjugated bilirubin
bile acid
free-fatty acid
drugs
hormones
calcium
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37
Q

where are globulins produced?

A

B lymphocytes
plasma cells
liver

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38
Q

what does serum protein electrophoresis separate proteins based on?

A

size of molecule

electrical charge

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39
Q

what is increased levels of albumin called?

A

hyperalbuminaemia

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40
Q

hyperalbuminaemia is usually only relative, what does this mean?

A

body doesn’t overproduce albumin

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41
Q

what may be a causes of hyperalbuminaemia?

A

dehydration

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42
Q

what may hyperalbuminaemia be accompanied by?

A

increased PCV
azotaemia
increase of all proteins

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43
Q

what is increased levels of globulins called?

A

hyperglobulinaemia

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44
Q

what could cause hyperglobulinaemia?

A

dehydration

inflammation

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45
Q

how is hyperglobulinaemia characterised by electrophoresis?

A

monoclonal or polyclonal

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46
Q

what is monoclonal hyperglobulinaemia?

A

production of a single type of immunoglobulin usually due to neoplasia

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47
Q

what is the most common neoplasia that causes monoclonal hyperglobulinaemia?

A

multiple myeloma

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48
Q

what are the types of protein associated with inflammation? (3)

A

positive acute-phase
negative acute phase
delayer response

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49
Q

what are some examples of positive acute phase proteins?

A

haptoglobin

fibrinogen

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50
Q

what are some examples of negative acute phase proteins?

A

albumin

transferrin

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51
Q

what are some examples of delayed response proteins?

A

complement

immunoglobulin

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52
Q

what do positive acute phase proteins do during inflammation?

A

increase in number

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53
Q

what do negative acute phase proteins do during inflammation?

A

decrease in number

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54
Q

are acute phase proteins specific?

A

no (non-specific)

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55
Q

what are acute phase proteins under the influence of?

A

cytokines

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56
Q

what do rapid reacting acute phase proteins do?

A

increase within 24 hours then decrease rapidly after the insult is removed

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57
Q

what are some examples of rapid reacting acute phase proteins?

A

serum amyloid A

C reactive protein

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58
Q

what are some examples of late reacting acute phase proteins?

A

haptoglobin

fibrinogen

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59
Q

what are the causes of hyperfibrinogenaemia?

A

inflammation

dehydration

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60
Q

how can hyperfibrinogenaemia be measured?

A

heat precipitation

coagulation assay

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61
Q

what may cause hypofibrinogenaemia?

A 
decreased synthesis from liver
increased consumption (fibrinogeneolysis)
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62
Q

what tests can be effected by decreased fibrinogen production?

A

fibrinogen concentration
PT
PTT
TP

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63
Q

what is the term used if all proteins are low?

A

panhypoproteinaemia

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64
Q

what could cause panhypoproteinaemia?

A

acute haemorrhage

GI loss

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65
Q

what are some causes of hypoaluminaemia due to decreased production?

A

chronic liver disease
prolonged malnutrition
maldigestion/malabsorption

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66
Q

what are some causes of hypoaluminaemia due to increased loss?

A

kidney-glomerular leakage
GI loss
burns

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67
Q

when is hypoglobulinaemia seen?

A

failure of passive transfer in neonates

combine immunodeficiency in foals

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68
Q

what are cholesterol and triglyceride required to be incorporated with to be transported in blood?

A

into a soluble lipid-protein complex (lipoprotein)

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69
Q

what are the types of lipoproteins?

A

chylomicrons
very low density lipoprotein
low density lipoprotein
high density lipoprotein

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70
Q

what do chylomicrons deliver to cells?

A

dietary triglycerides

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71
Q

what do very low density lipoproteins deliver to cells?

A

triglycerides made by the liver

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72
Q

what do low density lipoproteins deliver to cells?

A

cholesterol

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73
Q

what do high density lipoproteins do?

A

pick up tissue cholesterol for elimination in bile

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74
Q

what lipids are tested for in blood?

A

total cholesterol and triglycerides

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75
Q

what is lipaemia primarily caused by?

A

increased chylomicrons

increased VLDLs

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76
Q

what does plasma look like during lipaemia?

A

opaque plasma

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77
Q

what artefacts can be caused by lipaemia?

A 
enhanced tendency to haemolysis
falsely high haemoglobin
falsely high TP
unreliable fructosamine
low sodium
78
Q

what is requires when measuring triglycerides?

A

the animal has fasted

79
Q

what may cause hypercholesterolaemia?

A 
endocrine disease
hepatic disease
steroid administration
diet
nephrotic syndrome
80
Q

why may enzyme activity be increased? (5)

A 
cell damage 
impaired enzyme clearance
physiological
induction
artifactual
81
Q

what are typical diagnostic uses of enzyme activity in serum? (3)

A

hepatocyte damage
exocrine pancreas damage
myocyte damage

82
Q

why may enzymes leak from myocytes? (3)

A

degradation
necrosis
inflammation

83
Q

what are enzymes of muscles that can be measured?

A 
creatine kinase (CK)
aspartate aminotransferase (AST)
lactate dehydrogenase (LDH)
84
Q

what is the most tissue specific enzyme of muscle that can be measured?

A

creatine kinase (CK)

85
Q

what is the function of creatine kinase?

A

make ATP available for muscle contraction

86
Q

what is creatinine?

A

waste product from the spontaneous breakdown of creatine

87
Q

what is creatinine used to assess?

A

kidney function

88
Q

where in the cell in creatine kinase found?

A

cytoplasm

89
Q

where else (other than skeletal muscle) is creatine kinase found?

A

brain (CSF)

90
Q

is creatine kinase sensitive and specific?

A

yes (rapid increase/decrease)

91
Q

what is the degree of increase of creatine kinase proportional to?

A

degree of muscle damage

92
Q

what could a small increase in creatine kinase be due to?

A

IM injections

traumatic venupuncture

93
Q

what does persistent increase of creatine kinase mean?

A

ongoing muscle damage

94
Q

what are some causes of muscle injury?

A 
degenerative (hypoxia)
metabolic
neoplasia
nutritional
inflammatory
toxic
trauma
95
Q

what can interfere with creatine kinase levels, causing an artifictual increase?

A

haemolyiss (releases other enzymes)

hyperbilirubinaemia

96
Q

what enzymes are used to identify injury to pancreatic cells? (2)

A

amylase

lipase

97
Q

what is the most common reason for increase in amylase and lipase?

A

inflammation (pancreatitis)

98
Q

what enzymes can be used to assess liver function?

A 
alanine aminotransferase (ALT)
aspartate aminotransferase (AST)
lactic dehydrogenase (LDH)
sorbitol dehydrogenase (SDH)
glutamate dehydrogenase (GLDH)
99
Q

where is ALT found?

A

mainly liver

some in muscle

100
Q

what animals is ALT mainly used in?

A

small

101
Q

where is AST and LDH found?

A

liver

muscle

102
Q

where is SDH and GLDH found?

A

liver specific

103
Q

what animals is GLDH mainly used in?

A

large

104
Q

what are the liver leakage enzyme that are measured not correlative of? (3)

A

reversibility of injury
hepatic function
prognosis

105
Q

what is cholestasis?

A

stopping of the flow of bile

106
Q

what enzymes can be used to assess cholestasis? (cholestatic liver enzyme)

A

ALP (alkaline phosphatase)

GGT (gammaglutamil transferase)

107
Q

what is the major measurable isoform of ALP?

A

liver-ALP

108
Q

during cholestasis what happens to the concentration of ALP?

A

increases

109
Q

where is liver-ALP found?

A

bound to plasma membrane of hepatocytes and biliary epithelium

110
Q

what does an increase in GGT indicate?

A

cholestasis

111
Q

what species is GGT a more sensitive measure of cholestasis?

A

cats
horses
cattle

112
Q

what may lead to decreased bile flow/excretion?

A

intrahepatic - hepatocellular swelling
extrahepatic - bile duct obstruction
functional

113
Q

what are the markers of cholestasis?

A

bilerubin
bile acids
cholesterol
cholestatic enzymes

114
Q

in horses why may be see hyperbilirubinaemia?

A

due to fasting/starving

115
Q

what are the clinical signs of hyperbilirubinaemia?

A

jaundice

bilirubinaemia

116
Q

what could cause hyperbilirubinaemia? (4)

A

cholestasis
haemolytic anaemia
reduced hepatocellular function
fast/starving in horses

117
Q

what functions of the liver can be testing in clinical biochemistry?

A

uptake/excretion of bilirubin/bile acids
ammonia to urea conversion
synthesis of metabolites
immunological function

118
Q

what functions would be decreased if there was alterations of hepatic blood flow?

A

uptake/excretion of bile acids
ammonia to urea conversion
immunological function

119
Q

what are the major sources of glucose? (2)

A

dietary absorption

liver production

120
Q

what are the processes that produce glucose in the liver?

A

glycogenolysis

gluconeogenesis

121
Q

what promotes the process of glycogenolysis?

A

catecholamines

glucagon

122
Q

what promotes the process of gluconeogenesis?

A

corticosteroids
glycogen
growth hormone

123
Q

what regulates glucose metabolism?

A

absorption
insulin production
insulin antagonists

124
Q

what is the best tube for collecting a glucose sample into if it is being sent off for analysis?

A

fluoride oxalate

125
Q

what is a common cause of transient hyperglycaemia?

A

adrenalin (fear/excitement)

126
Q

what are the causes of hypoglycaemia? (5)

A 
excessive use
reduced hepatic storage
insufficient diet
excessive insulin/analogues
lack of corticosteroid
127
Q

what could cause excessive use of glucose?

A

sepsis
neoplasia
excessive physical exertion

128
Q

what are common causes of hyperglycaemia? (5)

A 
after a meal
cathecolamines
iatrogenic (exogenous glucose administration)
insulin antagonism
diabetes mellitus
129
Q

is glucose normally present in urine?

A

no (reabsorbed in proximal tubules)

130
Q

what is glucose in urine called?

A

glucosuria

131
Q

what does glucosuria usually mean in dogs?

A

diabetes mellitus

132
Q

other than glucose concentration, what else can be measure to confirm diabetes?

A

glycated proteins

133
Q

how are glycated proteins formed?

A

glucose slowly reacts with amino acid groups on all proteins

134
Q

what is the rate of reaction of glycated protein formation dependant on?

A

blood glucose concentration

135
Q

what is the glycated protein measured in animals?

A

fructosamine

136
Q

what is fructosamine?

A

irreversibly glycated albumin

137
Q

what will be the difference in fructosamine of a diabetic and stressed cat?

A

diabetic - high

stress - low

138
Q

what electrolytes are mainly present extracellularly?

A

sodium
chloride
bicarbonate

139
Q

what mechanisms control sodium concentration? (3)

A

thirst
RAAS
ADH

140
Q

what ways can alter sodium concentration?

A

loss of sodium/water

loss of just water

141
Q

what are the overall causes of hyponatraemia? (2)

A

loss of sodium

water retention

142
Q

what are some causes of loss of sodium rich fluids?

A

vomiting/diarrhoea
kidney
skin (burns/sweat)

143
Q

what is the most common cause of hypernatraemia?

A

water loss in excess of sodium

144
Q

what could cause water loss in excess of sodium?

A

fever/panting
lack of ADH
inadequate water intake
osmotic diuresis

145
Q

what is high blood sodium called?

A

hypernatraemia

146
Q

what does chloride follow?

A

sodium (increase/decrease together)

147
Q

what is a causes of chloride increasing/decreasing without sodium?

A

vomiting pure stomach continents (HCl)

148
Q

what effect does aldosterone have on potassium?

A

increases excretion

149
Q

what could cause hyperkalaemia?

A

increased intake
reduced renal excretion
movement out of cell

150
Q

what could cause hypokalaemia?

A

reduced intake
renal losses
GI losses
movement into cells

151
Q

what can cause potassium to move out of a cell?

A

acidosis

lack of insulin

152
Q

what can cause potassium to move into a cell?

A

alkalosis

insulin

153
Q

what regulates calcium and phosphorus? (3)

A

parathyroid hormone
vitamin D3
calcitonin

154
Q

what effect does increased parathyroid hormone have on calcium and phosphorus?

A

hypercalcaemia

hypophosphataemia

155
Q

what else other than the parathyroid can release parathyroid hormone related protein?

A

tumours of some organs

156
Q

what is parathyroid hormone opposed by?

A

calcitonin

157
Q

where is calcitonin secreted?

A

thyroid C-cells

158
Q

what are the byproducts of nitrogen metabolism used as markers of renal function? (2)

A

urea

creatinine

159
Q

what is a nephron?

A

functional unit of the kidney formed from glomerulus, bowman capsule and collecting duct

160
Q

where is urea made?

A

liver

161
Q

what group of animals is urea not used as a measure of GFR?

A

ruminants

162
Q

why is urea not used to measure GFR in ruminants?

A

because the excrete some in saliva and its degrades in rumen

163
Q

where is creatinine produced?

A

muscle

164
Q

how is creatinine produced?

A

degradation of muscle (proportional to muscle mass)

165
Q

is creatinine or urea reabsorbed in the kidney?

A

creatinine - no reabsorption

urea - reabsorption

166
Q

what is uraemia?

A

clinical syndrome resulting from loss of kidney function

167
Q

are all uraemic patients azotaemic?

A

yes

168
Q

are all azotaemic patients uraemic?

A

no

169
Q

what is azotaemia?

A

increased creatinine/urea

170
Q

what could be the cause of increased urea?

A

decreased GFR
GI haemorrhage
high protein diet
recent meal

171
Q

what could be the cause of decreased urea?

A

reduced production

low protein diet

172
Q

what could be the cause of increased creatinine?

A

decreased GFR

high muscle mass

173
Q

what could be the cause of decreased creatinine?

A

low muscle mass

174
Q

what is prerenal azotaemia due to?

A

dehydration
decreased CO
increased production

175
Q

what is postrenal azotaemia due to?

A

urine leakage/blockage

176
Q

how can prerenal azotaemia be differentiated from other azotaemia?

A

high urine concentration
dehydration/hypovolaemia signs
responds to fluid therapy

177
Q

how can azotaemia be differentiated from other azotaemia?

A

low urine concentration

no response to fluid therapy

178
Q

how can postrenal azotaemia be differentiated from other azotaemia?

A

clinical evidence (eg. hyperkalaemia)

179
Q

what are the renal influences on urine specific gravity? (3)

A

number of functional nephrons
tubular function
hydration status

180
Q

what are the extra renal influences of urine specific gravity?

A 
ADH release/action
medullary concentration gradient
osmotic forces
drug therapy
behaviour
181
Q

why must urine be analysed rapidly after sampling? (5)

A 
cells disintegrate
pH rises (carbon dioxide evaporates)
crystals form
bilirubin/urobilinogen breakdown
bacteria grow/die
182
Q

what could a red coloured urine be due to? (3)

A

haematuria
haemoglobinuria
myoglobinuria

183
Q

what could a dark yellow/brown coloured urine be due to?

A

bilirubinuria

184
Q

how is haematuria and pigmenturia differentiated? (2)

A

haematuria contains erythrocytes in the sediment

colour doesn’t clear with centrifugation in pigmenturia

185
Q

how can myoglobinuria and haemoglobinuria be differentiated?

A

myoglobin - urine red but plasma clear

haemoglobinuria - urine red and plasma red

186
Q

what could cloudy urine be due to?

A 
mucus
bacteria
lipids
sperm
salts
increased cellular eliments
crystalluria
187
Q

what is used to measure urine specific gravity?

A

refractometer

188
Q

what is specific gravity?

A

measure total solute concentration of urine (weight compared to distilled water)

189
Q

what is urine specific gravity used for?

A

confirm polyuria
evaluate kidney concentrating ability
differentiating renal and pre-renal azotaemia

190
Q

what is the most common cause of protein in urine?

A

pyuria

191
Q

what could be the cause of ketones in urine?

A

diabetes

negative energy balance

192
Q

what is the most common urinary crystals seen?

A

struvite (alkaline urine)

Pathology (17 decks)

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