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VTNE Review > Clinical Chemistry > Flashcards

Clinical Chemistry Flashcards

1
Q

Anticoagulant
Heparin

A
  • Best for plasma - little interference
  • Lithium Heparin - best for electrolyte assays using arterial blood
  • Sodium and Potassium Heparin - artificially increase sample results
  • Best for avian samples
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2
Q

Anticoagulant
EDTA

A
  • Best for hematology tests - little effect on morphology
  • Not used for plasma chemical assays
  • Affects calcium in clotting process
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3
Q

Anticoagulant
Sodium Fluoride

A
  • Preserves glucose
  • Some anticoagulant properties
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4
Q

Anticoagulant
Citrate

A

Best for coagulation assays

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5
Q

Kidney Function

A

75% of glomeruli of both kidneys needs to be nonfunctional for chemistry values to increase
* creatinine
* BUN
* SDMA

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6
Q

Azotemia

A

Elevations in both BUN and creatinine
* increased nitrogen-based waste in body

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7
Q

Creatinine

A

By-product of muscle metabolism
* produced and filtered almost entirely by golmeruli - evaluates function
* less affected by outside changes

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8
Q

Creatinine
Changes

A
  • Increased = lack of glomeruli function or increased muscle activity
  • Fluid and hydration levels
  • Pre-renal factors (shock)
  • Post-renal factors (bladder / urethral obstruction)
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9
Q

Creatinine
Sample Required

A

Hemolysis does not affect results

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10
Q

BUN

A

Blood Urea Nitrogen
* end product of protein metaboism
* reabsorbed by tubules - rate inversely proportional to urine output (opposites)
* evaluates glomerular filtration and renal function

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11
Q

BUN
Non-Renal Changes

A

Increased BUN caused by
* amount of protein in diet
* fever
* bleeding in intestinal tract

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12
Q

BUN
Increased Values

A

Increased with renal insufficiency
* pre-renal: shock / dehydration
* post-renal: obstruction in urinary tract
* enteric digestion of blood (increased proteins)

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13
Q

BUN
Decreased Values

A
  • Anorexia
  • Liver Disease
  • Tubular Injury
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14
Q

BUN
Sample Required

A
  • No ammonium oxalate plasma - false increase
  • No fluoride plasma - decrease
  • Non-lipemic samples
  • Fast 8-12 hours ideal
  • Test asap - bacteria can reduce urea in sample
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15
Q

SDMA

A

More reliable indicator of kidney function than creatinine
* allows earlier detection of acute kidney injury and chronic disease
* reflects glomerular filtration rate
* can be detected with 25% loss of kidney function

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16
Q

Pancreas
Endocrine Function

A

Production of hormones
* glucagon and insulin
* diabetes mellitus most common disorder

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17
Q

Pancreas
Exocrine

A

Production and release of enzymes into duodenum for digestion
* lipase
* amylase
* trypsin

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18
Q

Pancreas
Exocrine vs Endocrine

A

Most disturbances occur in the exocrine function
* dogs have more incidents than cats

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19
Q

Blood Glucose

A

Reflects net balance of glucose produced and utilized
* measures endocrine function
* indicator of carbohydrate metabolism

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20
Q

Blood Glucose
Glucagon and Insulin

A

Glucose utilization depends on amounts of these produced by pancreas

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21
Q

Blood Glucose
Glucagon

A

Release of this directly stimulates insulin release
* acts as a stabilizer to prevent glucose levels from becoming too low

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22
Q

Blood Glucose
Insulin

A

Hypoglycemic Hormone
* lowers blood glucose levels
* increase = decreased glucose (vice versa)

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23
Q

Blood Glucose
Increased

A
  • Diabetes mellitus
  • Non-pancreatic: stress or Cushing’s
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24
Q

Blood Glucose
Decreased

A
  • Malabsorption in duodenum
  • Severe liver disease
  • Blood handling error - sits look long; RBCs metabolize glucose
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25
Q

Blood Glucose
Sample Required

A
  • Centrifuge sample immediately after collection - separate serum / plasma into plain tube
  • Dogs & Cats: fast 8-12 hours
  • Ruminants: do not fast
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26
Q

Blood Glucose
Tube Additives

A

Sodium Fluoride
* only anticoagulant able to be added to sample with another anticoagulant already present
* use with plasma if unable to separate from cells immediately

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27
Q

Amylase

A
  • Enzyme
  • Breaks down complex starches and glycogen in sugars
  • Produced in pancreas; some in salivary glands and small intestines
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28
Q

Amylase
Sample Required

A

Not useful test for cats

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29
Q

Lipase

A
  • Enzyme
  • Breaks down lipids into fatty acids and glycerol
  • May be more sensitive to detect pancreatitis than amylase
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30
Q

TLI

A

Test that uses antibodies to trypsin
* highly specific and sensitive for EPI in dogs
* trypsin only produced in pancreas

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31
Q

TLI
Sample Required

A

Samples should be fasted for 12 hours
* serum TLI increases after eating

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32
Q

TLI
Increased Levels

A

Results from EPI
* lack of functional tissue means less enzymes produced leading to maldigestion of food

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33
Q

EPI

A

Exocrine Pancreatic Insufficiency

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34
Q

PLI

A

Pancreatic Lipase Immunoreactivity
* highly sensitive and specific to diagnose pancreatitis
* species specific tests

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35
Q

Liver Function

A
  • No single test is used - liver profile
  • Hepatic cells able to regenerate if damaged
  • Damage in one zone of liver may not affect all liver function
  • 70% of liver may be non-functional before changes noted
36
Q

Bilirubin

A

Come from breakdown of hemoglobin by macrophages in spleen
* becomes bile component in liver
* conjugated vs unconjugated forms

37
Q

Bilirubin
Unconjugated Form

A

Also called indirect bilirubin
* prehepatic form
* lipid soluble

38
Q

Bilirubin
Conjugated Form

A
  • Hepatic form
  • Water soluble - readily excreted from body via urine
39
Q

Bilirubin
Large Animals

A

Most increases caused by hemolytic disorders
* serum not good indicator of liver disease
* only slight increase with severe liver disease

40
Q

Bilirubin
Sample Required

A
  • Remove from cells within 3 hours
  • Store samples in dark
  • Refrigerate or freeze samples
  • Urine should be run immediately
41
Q

TP / TS
Serum vs Plasma
Results

A

Total Proteins / Solids
* serum will have slightly lower value
* caused by loss of fribrinogen in clot

42
Q

Albumin

A
  • Formed in liver
  • Binds and transports protein in blood
  • Makes up 35-50% of TP
42
Q

Globulins

A
  • Complex group of proteins
  • Estimated by: TP - Albumin = Globulins
43
Q

a-globulins

A
  • Synthesized in liver
  • Transport and bind proteins
44
Q

B-globulins

A
  • Iron transport
  • Heme binding
  • Fibrin formation / lysis
45
Q

y-globulins

A
  • Immunoglobulins - produce antibodies
  • Synthesized by plasma cells
46
Q

Globulin
Sample Required

A

Serum is preferred
* fibrinogen present in plasma - goes through B and y-globulins
* complicates results

47
Q

Albumin-to-Globulin
Ratio

A
  • Divide albumin concentration by globulin concentration
  • Gives early indication of abnormal protein profile
  • Dogs, Horses, Sheep: >1
  • Cats, Cattle, Pigs: <1
48
Q

Enzymes

A

Leak into the bloodstream when hepatocytes are damaged

49
Q

ALT

A

Alanine Aminotransferase
* large amounts found in dogs and cats - specific test of liver function
* not in large amounts in large animals (not significant)
* no relationship between the blood level and severity of damage
* significant only if remains elevated

50
Q

AST

A

Aspartate Animotransferase
* found in all tissues - especially heart, skeletal, and liver
* not an organ-specific enzyme
* best to evaluate with ALT to assess liver
* horses have higher normal value than others

51
Q

AST
Sample Required

A

Centrifuge and separate immediately
* AST can leak out of RBCs into serum or plasma

52
Q

AST and ALT

A

Both should be elevated in dogs and cats
* increased ALT with normal AST = liver damage (reversible)
* both increased = hepatic cell death
* increased AST with normal ALT = AST source is not liver

53
Q

ALP

A

Alkaline Phosphatase
* found in all tissues - especially bone and liver
* normal in small amounts in blood
* indicates cholestasis (impaired bile flow in liver)

54
Q

ALP
Increases

A

Caused by increased production of enzymes
* common in young - bone growth
* adults with bone injury or obstructive liver disease

55
Q

LDH

A

Lactate Dehydrogenase
* found in most tissues - liver, muscles, RBCs
* elevations nonspecific - can be damage to any of the areas where it is found
* collect sample with heparin

56
Q

GGT

A

Y-Glutamyltransferase
* found in liver, pancreas and kidneys
* liver is primary source
* elevations generally indicate cholestatic disease
* increases in cats = fatty liver

57
Q

Bile Acids

A
  • Formed in liver from cholesterol
  • Secreted into bile in GI tract to help with digestion and absorption
  • Stored in the gallbladder (not in horses)
  • Reabsorbed in the ileum
58
Q

Bile Acids
Sample Required

A
  • Fasted blood sample collected
  • High-fat meal fed after
  • Second sample collected 2 hours later
  • Too much food can lead to hyperlipidemia and impair results
  • Collect with heparin
59
Q

Bile Acids
Increased

A

Seen with all forms of liver disease or if a portosystemic shunt is present
* increase before bilirubin levels increase

60
Q

Electrolytes

A

Substances in blood that carry an electrical charge
* positive vs negative charged ions
* intracellular vs extracellular
* arterial samples preferred
* spin and separate from cells asap

61
Q

Intracellular Electrolytes

A
  • Phosphate / Phosphorus
  • Magnesium
  • Potassium
62
Q

Extracellular Electrolytes

A
  • Sodium
  • Chloride
  • Calcium
  • Bicarbonate
63
Q

Electrolytes
Positive Charged Ions

A

Cations
* Magnesium
* Potassium
* Sodium
* Calcium

64
Q

Electrolytes
Negative Charged Ions

A

Anions
* phosphorus
* chloride
* bicarbonate

65
Q

Electrolytes
Function

A
  • Water balance
  • Osmotic pressure
  • Muscular / nervous functions
66
Q

Electrolyte
Sodium

A
  • Na+
  • Most abundant extracellular cation
  • Collect sample with lithium heparin
67
Q

Electrolyte
Sodium
Function

A

If sodium is retained, water is retained
* water distribution
* osmotic pressure
* pH regulation of urine and acid-base balance

68
Q

Hyponatremia

A

Decreased blood sodium
* renal failure
* CHF
* overhydration
* vomiting / diarrhea

69
Q

Hypernatremia

A

Increased blood sodium
* rare
* dehydration

70
Q

Electrolyte
Potassium
Function

A
  • K+
  • Normal muscle function
  • Respiration
  • Cardiac function
  • Nerve impulse transmission
  • Carbohydrate metabolism
71
Q

Electrolyte
Chloride

A
  • Cl-
  • Most abundant extracellular anion
  • Regulated by kidneys
  • Close relationship with sodium
72
Q

Electrolyte
Chloride
Function

A
  • Water / electrolyte balance
  • Osmotic pressure
73
Q

Electrolyte
Calcium

A
  • Ca+
  • Inverse relationship with phosphorous
74
Q

Electrolyte
Calcium
Function

A
  • 99% found in the bone
  • Facilitates coagulation
  • Ion transfer across cell membrane
75
Q

Electrolyte
Calcium
Sample Requirement

A

Do not collect sample with EDTA
* binds calcium
* false decrease

76
Q

Electrolyte
Phosphorus

A
  • P-
  • Inversely related to calcium
  • Most found in bone
77
Q

Electrolyte
Magnesium

A
  • Mg+
  • Intracellular cation
  • Found in all body tissues; half in bone
  • Closely related to calcium and phosphorus
  • Minor electrolyte - sheep and cattle only show C/S associated
  • Activator of enzymes
78
Q

Electrolyte
Magnesium
Sample Required

A
  • Use heparin
  • Other anticoagulants may cause false decrease
  • Hemolysis may cause false increase
79
Q

Electrolyte
Bicarbonate

A
  • HCO3-
  • Second most abundant extracellular anion
  • Estimate levels from blood CO2 levels
80
Q

Electrolyte
Bicarbonate
Sample Required

A
  • Tissue levels - use venous blood
  • Oxygenated blood - use arterial blood
  • Lithium heparin preferred
  • Chill in ice bath if there will be a delay in processing
81
Q

Thyroxine

A
  • Thyroid hormone (T4)
  • 4 indicates number of iodine molecules
  • Total T4 = baseline resting thyroid hormone concentration
  • Cat T4 levels fluctuate daily
82
Q

Sick Euthyroid Syndrome

A

Single low T4 result
* not indicative of a diagnostic

83
Q

Thyroxine
Sample Required

A

Serum separator tubes are not recommended
* gel believed to trap molecules

84
Q

Free Thyroid

A
  • Measures portion of T4 not bound to proteins
  • Not as influenced by meds and disease as T4
  • Helps diagnose hyperthyroid in cats
85
Q

cTSH

A

Canine Thyroid-Stimulating Hormone
* measured along with fT4
* helps provide accurate diagnostic of hypothyroidism
* increased cTSH = decreased fT4

VTNE Review (31 decks)

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