deck_2764924 Flashcards
What is a Rule Out List?
List of Differentials
What is the 1º Rule Out?
What you think it is the most
How much kidney must be lost to show clinical signs?
66%
How much kidney must be lost to be azotemia?
75%
Azotemic and can concentrate urine, do they have kidney failure?
No, they are concentrating urine. Azotemia can be: Pre, Renal, Post
Are Clinical Signs diseases?
NO!
Most CX are what?
Protective mechanisms
When does loss of function give you the dz?
Beyond reserve capacity of the system
Does inflammation require loss of function?
NO
What is a problem list?
Every single problem an animal has
What are Rule Out lists designed for?
Every single problem has its own Rule Out List
DAMNITV: What does D stand for?
Degenerative Developmental
DAMNITV: What does A stand for?
Anomalous Allergic
DAMNITV: What does M stand for?
Metabolic
DAMNITV: What does N stand for?
Neoplastic Nutritional
DAMNITV: What does I stand for?
Infectious InflammatoryImmune MediatedIdiopathicIschemicIatrogenic
DAMNITV: What does T stand for?
Trauma Toxic
DAMNITV: What does V stand for?
Vascular
What does PARSIMONY mean?
Everything comes down to one thing
When should you collect baseline samples?
When pet is healthy
What is more important (regarding severity) for kidney function, azotemia or ability to concentrate?
Ability to concentrate, take a USG (UA)
TQ! What tests will you always want?
CBC, Chem, UA (at least USG)
What is polachyuria?
Small spots all over the place
CKD?
Chronic Kidney Disease
CDI?
Central Diabetes Insipidus
PSS?
Portal Systemic Shunt
1º NDI?
Nephrogenic Diabetes Inspipidus - exceedingly rare don’t have receptors for ADH, puppies
2º NDI?
Nephrogenic DI - inability of receptors to respond to ADH - most cases
When does epilepsy happen?
6 mo - 5 yrs
What do buff colored cocker spaniels get?How many more times likely?
IMHA: This is your top differential. 8X more likely
When do we treat clinical signs?
When we know what is causing the clinical signs! Diagnosis!
What does S.O.A.P. stand for?
Subjective ObjectiveAssessmentPlan
Is CBC qualitative or quantitative?
BOTH
What is ALWAYS done with a CBC?
Blood Smear!!!
TQ! 2 Primary Rule Outs for Regenerative anemia?
Hemolysis Hemorrhage
Why should you make sure tube is filled appropriately?
Anticoagulation Artifacts will change ratios of numbers
Immature cells are bigger or smaller?
Bigger
Decreased PCV is?
Anemia
Increased PCV is?
Polycythemia
What is PCV?
% of Whole blood that is RBC
Primary Rule Outs for Non-regenerative anemia?
InflammatoryRenal Dz - Could be anywhereBone Marrow Dz
What comes with inflammation?
Cytokines
What do Cytokines do?
Turn on and turn off all kinds of cells including inflammatory cells and some of which live in the bone marrow
What is an increased PCV?
Polycythemia
Types of Polycythemia?
RelativeAbsolute
What is Relative Polycythemia?
Dehydration
Total Solids is best measured how?
Refractometer
Acute phase proteins? What are they turned on by?
Fibrinogen (LA!)HaptoglobinLiver
Total Solid Elevations occur due to?
DehydrationChronic InfectionsLeukemia
Total Solids Decreases are due to?
Poor nutrition Liver DiseaseMalabsorptionDiahhreaPLN/PLEBurns
If something is low, what are the most possible reasons?
Using LosingNot makingSequestering it
What are 2 smallest proteins?
AlbuminAntithrombin III
Why would you go into DIC with a nephropathy?
Antithrombin III leaks out and then you cant clot.
PLE you tend to lose which proteins?Why?
Albumin & Globulins Leakier than nephrons
Which proteins are lost in PLN?
Albumin Antithrombin III
Elevations in both PCV and TS suggest?
Dehydration Polycythemia
Elevated TS with low/low-normal PCV suggest?
Dehydration masking more severe anemia. PVC will tank once rehydrated!
What is the difference between a Hct and PCV?
Hct is calculated PCV is measured
Hemoglobin does what?
Carries O2 in g/dL
How do you get PCV from Hgb?
Hgb X 3
Leukogram relative values are?
%
I promise I will never do what with a leukogram?
Read relative (%) values.
What is the very best leukogram machine?
Flow cytometry
Which machine is most inaccurate?
QBC
How is Leukogram taken manually?
Hemocytometer
TQ!!! What is a Stress leukogram?
Mature NeutrophiliaMonocytosis, Lymphopenia(sometimes Eosinopenia)
What is Physiological Leukocytosis? Why?Who?
Neutrophilia & LymphocytosisCatecholamines/fearCATS!
Corticosteroid Leukogram think what animal?
DOG
What causes Extreme neutrophilic leukocytosis?
PyometraEhrlichiaHepatozoanosis (can be really high 154,000 neuts)FungusLeukemia >50,000
What are the levels of leukocytosis in a leukemia?
> 50,000
TQ! What will be on every DDX list ever!
EhrlichiaFungusNeoplasia
Why mature neutrophilia in stress leukogram?
Body releases neutrophils (mature bc not infection)
If all neutrophils are young and numbers are decreased what is this?
Degenerative Left Shift
Why Lymphopenia in stress leukogram?
They’re marginated
What causes Monocytosis?
Chronic InflammationNecrosisSteroids (stress leukogram),Neoplasia
Why would there be an elevation in Mature Neutrophils?
Inflammation InfectionImmune Mediated DzStress - corticosteroidsFearNeoplasia
Why would there be a decrease in Mature Neutrophils?
Overwhelming infection Overwhelming inflammationDestructionNeoplasiaBone Marrow Dz, (Dysfunction or Suppression)Cyclic Hematopoisis
What is a Regenerative Left Shift? Is it a normal reaction? What cells will you see?
Neutrophil response to inflammation and are adequately responding to demand.YesThere are mature and immature cells.
What is degenerative left shift? Is it a normal reaction?What cells are present?
Neutrophil production where release is not meeting the demand. Abnormal response. You will see bands but not mature/segmented neuts.
What are lymphocytes? What are they markers for? Which cells are lymphocytes?
Circulating immune system cellsAntigenic stimulationB & T cells
What do B cells produce?
Ab Cytokines
What do T cells produce/do?
CytokinesAssist B cellsCan be cytotoxic/killerSpecialized duties
What causes elevations in Lymphocytes?
Chronic inflammationESPECIALLY Rickettsial infections!!!!!,NeoplasiaCatecholaminesHYPOadrenocorticism - it’s a balance thing - absence of steroids
What causes decreases in lymphocytes?
Steroids - suppress immune system cause marginationAcute inflammationEffusionsLymphoid Hyperplasia/aplasia
What are Monocytes in the blood? What are they markers of?
Traveling to their designated site in tissue to become macrophages. Chronic inflammation
Who shows up first neuts or monos?
Neuts ya twit!
What type of cells are eosinophils and basophils?
Granulocytes
What are eosinophils and basophils markers for?
Allergic and Parasitic DzsEosinophil dzs,Mast cell neoplasiaHYPOadrenocorticismNeoplasia
Eosinopenia is caused by?
Steroids, Acute InflammationBone Marrow Dz
Eosinophils and Mast cells share what?
Same Cytokines (IL5) turns them on!
Who gets eosinophilic dzs?
Cats & Horses
What is the stain for reticulocytes? What are you staining?
New Methylene BlueRNA Precipitates
% retic based on what cell count?
1000
Two types of Feline Retics?
Aggregate & Punctate
Which Feline Retics are newly released from marrow?
Aggregate (Lots of dots)
What are aggregate retics specific from?
Bone Marrow Response
What are Punctate Retics? How long do they circulate?
Mature aggregates7 days
Corrected Reticulocyte % tells you what?
If it is regenerative enoughIf bone marrow is responding appropriately to the severity of the PCV.
What is the absolute retic count for dogs?
> 80,000
What is the absolute retic count for cats?
> 40,000 aggregates
What % of corrected reticulocyte % (CRP) indicates regeneration in a dog?
> 1.5%
What % of corrected reticulocyte % (CRP) indicates regeneration in a cat?
> 1%
What is Retic Production Index?
CRP/lifespan of retics
What is MCHC for all species with discoid RBCs?
33 g/dL
What is RDW?
Population spread
Bimodal RDW signifies?
Regeneration
MCV: Macrocytic RBCs signify?
Regeneration or you’re a poodle!
MCV: Microcytic RBCs signify?
Fe deficiency PSS (Portal Systemic Shunt) Cu DeficiencyYou’re an Akita or Shibu Inu
MCHC measures what?
[Average Hgb]
MCHC: What does HYPOchromia signify?
Hemorrhage HemolysisFe Deficiency
MCHC: What does HYPERchromia signify?
DOESN’T HAPPEN, if machine reads this think HEINZ BODIES look at your blood smear
What do congenital PSS animals tend to have for RBC indicies?
Microcytic hypochromic
What is fibrinogen? How long does it take to show up in blood after inflammation?
Acute Phase Protein24 - 72 hours
TQ!!! Which species activate platelets easily?
CATS! Like Rough Stick!
Which breed has larger platelets than others?
Cavalier King CharlesSometimes they even have less of them
When can platelets be artificially decreased?
Clumping
Thrombocytopenia occurs due to?
Use itLose it,Don’t make itSequestration
What size are young platelets?
Bigger
Thrombocytosis happens when?
RareCanine HYPERadrenocorticism
Blood Smear: What changes morphology?
Regeneration Hgb contentMembrane compostitionStructural ProteinsOxidative Damage = Heinz bodiesFragmentationPlatelet Clumping
Why do a smear?
Helps decide if regenerative
On Blood Smear what would RBC with low Hb look like?
clear
Blood Smear: Heinz bodies happen due to?
Oxidative DamageDenatured HgbOnion ToxicityTylenol Toxicity
Blood Smear: Agglutination occurs due to?
IMHARouleaux formation is NOT agglutination!
How should you do Saline Dilution to decipher Rouleaux from Agglutination?
1/2 drop of blood with 4-5 drops of saline
If bands are under 10,000 what scenario could their number be significant?
if > 10% total neuts
QBC: Dark black line is?
DNA
QBC: Thinner line is?
RNA/LP