*Differentials* Flashcards
Relative Polycythemia
Dehydration
Fluid Shifts
Redistribution: Excitement or Exercise
Absolute Polycythemia
Chronic Hypoxia
Renal Cysts
Tumors
Primary Polycythemia
Myeloproliferative disorder
Pure Transudate
Hypoalbuminemia
Modified Transudate
Impaired Blood or Lymph Flow
Exudates
Inflammation
Triglyceride in the fluid
Chylus Effusion
Round Discrete Cell tumors
Lymphoma Plasma cell tumors Mast cell tumors Histiocytomas Transmissible Venereal tumors Malignant histiocytosis
Mesenchymal tumors
Lipomas Hemangiopericytomas Hemangiosarcomas Osteosarcomas Chondrosarcomas Fibrosarcoma Neurofibrosarcoma Peripheral nerve sheaath tumor Poorly differentiated sarcoma
Epithelial tumors
Basal cell tumors
Squamous Cell carcinomas
Thyroid carcinoma
Hypoalbuminemia
Inflammation Liver Failure Chronic Liver Disease Reduction in liver mass : Portosystemic shunt Blood loss: Hemorrhage or GI Parasites Protein Losing Enteropathy Protein losing nephropathy Effusions or vasculitis
Proteinuria Hypoalbuminemia Hypercoagulable Hypercholesterolemia Ascites
Nephrotic Sydrome
Hypoglycemia
Hypocholesterolemia
Decreased Urea
Hyperglobulinemia
Hepatic Insufficiency
Hypercholesterolemia
Protein losing nephropathy
Hypoglobulinemia
Hypocholesterolemia
+/- Hypomagnesium
Protein losing enteropathy
Hyperalbuminemia
Dehydration
Hypoglobulinemia
Severe combined immunodeficiency syndrome (SCIDS) Hemorrhage Protein Losing Enteropathy Failure of passive transfer in neonates Chronic Liver Disease
Hyperglobulinemia
Dehydration
Inflammation
Neoplasia: Multiple Myeloma or B cell Lymphoma
Hypoalbuminemia
Hyperglobulinemia
Polyclonal gammopathy: Inflammation
Increased Gamma Globulins
Monoclonal gammopathy: Neoplasia
Panhypoproteinemia
Blood loss
Protein losing enteropathy
Panhyperproteinemia
Dehydration
Hypofibrinogenemia
Liver Failure
DIC
Hyperfibrinogenemia
Inflammation Renal Disease (Cats and Cattle)
Increased BUN
High Protein Diet
Upper GI Bleed
Increased Catabolism
Decreased BUN (Pre-Renal)
Low Protein Diet
Portosystemic Shunt
Liver insufficiency
Protein losing enteropathy
Decreased BUN (Renal)
Diuresis
Increased Creatinine
High Muscle Mass
Decreased GFR
Renal insufficiency
Decreased Creatinine
Not significant
Increased SDMA
Renal Tubular Disease
Isosthenuria
Renal Failure
Medullary Washout
Diabetes Mellitus
Diuresis
Polyuria
Renal Failure Pyelonephritis Diuresis Medullary Washout Diabetes Hyperadrenocorticism Pyometra
Increased BUN Increased CREA Increased SpGr Hyperphosphatemia Hypermagnesemia
Dehydration
Shock
Cardiac Insufficiency
Increased CREA
Increased Muscle Mass
Dams with dysfunctional placentas prevent normal clearance of fetal CREA
Increased BUN
Increased CREA
Decreased SpGr
Hyperphosphatemia
Renal DAMAGE!! Infectious Toxic Hypoxia Neoplasia Congenital
Increased BUN
Increased CREA
Decreased SpGr
NOT ALWAYS RENAL DAMAGE!! Diabetes Insipidus Endocrine: Cortisol, glucose Fanconi syndrome Diuresis Medullary washout
Increased BUN
Increased CREA
Variable SpGr
Obstruction of urinary outflow:
Urolithiasis
Uroabdomen
Trauma
Pre-Renal Proteinuria
Paraproteinuria
Hemoglobinuria
Myoglobinuria
Post-colostral proteinuria
Glomerular Proteinuria
Hypoalbuminemia
Tubular Proteinuria
Normal Albumin
Loss of low molecular weight proteins
Post Renal Proteinuria
Hemorrhage/Inflammatory
Trauma
Neoplasia
Hypercalcemia with signs of Renal Disease
Mineralization of the renal tubules caused by hypercalcemia
Hypercalcemia
Polyuria
Low concentrating ability
Impairs urine concentrating ability by affecting ADH receptors
Hypocalcemia
Decreased in Vitamin D
Hyperphosphatemia and renal disease
Renal failure due to mineralization of soft tissues
Normalkalemia
Chronic Renal Failure
Hypokalemia
Decreased intake
Hypokalemia nephropathy in cats
Hyperkalemia
Acute Renal Failure
Hyperkalemia
Hyponatremia
Increased urea in the blood
Peritoneal creatinine 2x serum creatinine
Uroabdomen
Good BCS Anorexia Vomiting Diarrhea Halitosis Oliguric or anuric Neuro: Depressed or seizures Azotemia Hyperkalemia Acidemia Proteinuria Cellular Casts in the urine Variable SpGr
Acute Renal Failure
Geriatric - frequently in cats Poor BCS Anorexia vomiting Diarrhea Halitosis Polyuric Neuro: Depressed Hypertension Azotemia Isosthenuria
Chronic Renal Failure
GFR less than 20-25% Nonregenerative anemia Dehydration Azotemia Hyperphosphatemia Metabolic Acidosis Normal to Hypokalemia Polyuria Isosthenuria
Chronic Renal Failure
GFR less than 5% of normal Nonregenerative anemia Marked dehydration Marked Azotemia Hyperphosphatemia Metabolic Acidosis Hyperkalemia Isosthenuria Oliguria to anuria
Chronic Renal Failure
Proteinuria
Hypoproteinemia: Hypoalbuminemia and Normalglobulinemia
Azotemia
Isosthenuria
Glomerulonephrits
Hyperglycemic glucosuria
Diabetes Mellitus Hyperadrenocorticism Drugs Postprandial Acute pancreatitis
Normalglycemic glucosuria
Transient stress
Reversible tubular damage: Drugs, Hypoxia, infection, toxins
Urethral obstruction
Bilirubinuria
Liver disease
Bile duct obstruction
Hemolysis
Ketonuria
Negative energy balance
DKA
Insulinoma
Hemoglobinuria
Intravascular hemolysis
Hematuria
Trauma Infection Inflammation Infarction calculi neoplasia coagulopathy
Myoglobinuria
Increased CK and AST
Myocyte damage
Alkaline urine
low protein diet
UTI
Respiratory or Metabolic Alkalosis
Alkalinizing drugs
Acidic urine
High protein diets Respiratory and Metabolic Acidoses Hypochloremic metabolic alkalosis + severe dehydration Hypokalemia Furosemide
Pre-Renal Proteinuria
Fever
Hypertension
Seizures
Renal Proteinuria
Glomerulonephritis
Renal damage
Post-Renal Proteinuria
Hemorrhage
Infection
Transitional epithelial cells in urine
Hyperplasia with inflammation
Transitional cell tumors
Caudate cells in urine
Pyelonephritis
Renal Cells in urine
Renal tubular injury: Infectious, toxic, and ischemic injury
RBCs in the urine
Hemorrhage
Inflammation
WBCs in the urine
Inflammation: infection and noninfectious
Lipids in urine
Degeneration of sloughed cells
Renal tubular injury
Struvites in urine
Normal
Urease positive bacteria promote formation
Bilirubinuria
Normal in dogs
In other species: Hemolysis, heptaobiliary disease
Calcium carbonate in urine
Normal in horses, rabbits, guinea pigs, and goats
Calcium oxalate dihydrate in urine
Normal in domestic animals
Storage artifact
Increased calcium excretion due to hypercalcemia
Calcium oxalate monohydrate in urine
Seen in normal animals and horses also associated with: Urolithiasis Hypercalciuric disorders Hyperoxaluric disorders Ehtylene glycol toxicosis
Ammonium biurate in the urine
Normal in dalmations and english bulldogs
Liver failure
Congenital or acquired shunts
Cystinuria
Inherited disease - renal function is normal
Hyponatremia
GI loss: Vomiting, diarrhea, saliva Renal: Hypoadrenocorticism, Ketonuria, Diuresis Effusions: Peritonitis, Ascites, Chylothorax, Uroabdomen, GI sequestration Sweating CHF Cirrhosis Nephrotic syndrome Body fluid shifts: Hyperglycemia Decreased intake Psychogenic Polydipsia Nephrotic Syndrome Hepatic or Renal Failure Edema
Hypernatremia
Dehydration
Increased intake
Increased aldosterone
Hypochloremia
All the causes of Hyponatremia! Hypochloremic metabolic alkalosis --> Paradoxical aciduria Severe vomiting Abomasal disorders High GI obstruction Sweating
Hyperchloremia
All the causes of Hypernatremia!
GI loss of HCO3 - Diarrhea
Alkalemia
Hyperkalemia
Failure of Renal Excretion Hypoadrenocorticism: Aldosterone Inorganic acidosis Insulin deficiency Muscle trauma: Rhabdomyolysis Massive hemolysis Increased intake or administration Potassium Sparing Diuretics
Hypokalemia
Decreased intake Vomiting Diarrhea abomasal disorders Horse sweat Alkalemia Insulin injection
No difference between calculated osmolality and measured osmolality but increase in measured osmolality?
Increased Sodium or Glucose or Urea
No difference between calculated osmolarity and measured osmolarity but there is a decreased in measured osmolality?
Decreased sodium
There is a difference between calculated and measured osmolality with an increase in measured osmolality?
Presence of unmeasured osmole (ethylene glycol)
Lymphadenopathy
Hyperplasia/Reactive (Antigenic Stimulation)
Lymphadenitis
Metastatic neoplasia
Primary neoplasia
Greater than 50% lymphoblast
Lymphoma
Increase in plasma cells
Reactive lymph node (hyperplasia)
Hematoidin crystal
RBC break down pigment indicating prior hemorrhage
Apparent Hypocalcemia
Hypoalbuminemia causes a decrease in calcium bound to albumin
Common causes of Hypocalcemia
Renal Disease Ethylene Glycol toxicosis Pancreatitis Eclampsia Sepsis
Uncommon causes of Hypocalcemia
Hypoparathyroidism Nutritional secondary hyperparathyroidism inadequate calcium intake inadequate vitamin D intake excess phosphorus Intestinal malabsorption Phosphate containing enemas Citrate toxicity Hypomagnesemia Massive tissue degeneration Hypercalcitonism (C-cell thyroid tumors)
Causes of Hypercalcemia
Hypercalcemia of Malignancy Granulomatous inflammatory disease Renal disease Idiopathic hypercalcemia of cats Vitamin D toxicosis Grape and Raisin Toxicosis Hypoadrenocorticism Primary Hyperparathyroidism
Causes of Hypophosphatemia
Metabolic acidosis Diabetic Ketoacidosis Primary hyperparathyroidism Hypercalcemia of malignancy Vitamin D Deficiency Respiratory Alkalosis Decreased intestinal absorption Renal tubular defects Chronic renal failure in horses
Causes of Hyperphosphatemia
Decreased GFR (Pre renal azotemia or renal disease) Ruptured Bladder or ureter or urethral obstruction Vitamin D intoxication Acute acidosis Excessive P intake Primary Hypoparathyroidism
Causes of Hypomagnesemia
Lost through GI track, kidney, and skin of horses Malabsorption from the GI tract Diarrhea Fluid diuresis Diuretics Renal Disease Grass tetany Milk Tetany Diabetes Mellitus Hypercalcemia Hyperaldosteronism Third space syndrome
Causes of Hypermagnesemia
Compromised Renal function
Magnesium containing laxatives or antacids with decreased GFR
Increased ALP
Cholestasis
Corticosteroid Induced
High in young animals from bone
Increased GGT
Cholestasis (Especially in cats!!)
Steroid Induction
Hepatic injury
Increased AST
Hepatocellular Damage
Rhabdomyolysis (Muscle Damage )
Increased ALT
Hepatocellular Damage in dogs and cats!!
Myocardial Cell injury
Increased CK
Rhabdomyolysis (Muscle Damage )
Myocardial cell injury
Cause of Myoglobinuria
Rhabdomyolysis (Muscle Damage)
Cause of Hemoglobinuria
Hemolysis
Increased Serum Natriuretic Peptide
Cardiac dysfunction
Causes of Increased Plasma NT-proBNP
Ventricular Hypertrophy Tachycardia Hypoxia Expanded Fluid Volume Reduce renal clearance of the peptide
Increased SDH in Large Animals
Hepatocellular Damage
Increased GLDH in Large Animals
Hepatocellular Damage
Increased ALP in cats
Cholestasis
NO STEROID INDUCTION!!
Hyperthyroidism
Increased ALP WITHOUT hyperbilirubinemia
steroid or anticonvulsant medication
Hyperbilirubinemia
Hemolysis
Decreased uptake or conjugation by the liver
Blockage of bile (Cholestasis)
Increased Bile Acids
Portosystemic Shunt
Cirrhosis
Decreased hepatic uptake (Inflammation, necrosis, steroid hepatopathy, decreased functional hepatic mass)
Decreased bile excretion (Cholestasis, bile duct leakage)
Hypercholesterolemia
Cholestasis
Hypocholesterolemia
Liver Failure
Increased Enzyme Activity
Increased Bile Acids
Microcytic Anemia (Maybe)
Early Portosystemic Shunt
Hypoalbuminemia Decreased BUN Hypoglycemia Hypocholesterolemia Decreased Coag factors Increased Bile Acids Cholestasis Microcyctic Anemia
Late Portosystemic shunt
Causes of Chronic Hepatitis
Copper storage disease Infectious (Lepto, ICH, etc) Drugs (Primidone, phenobarbitol, some NSAIDs) Genetic Idiopathic (Immune mediated)
Decreased TLI
Exocrine Pancreatic Insufficiency
Decreased Folate
Decreased B12
Generalized Malabsorption
Decreased Folate
Normal B12
Proximal Small Intestine defect
Normal Folate
Decreased B12
Distal Small Intestine Defect
Increased Folate
Decreased B12
Bacterial Overgrowth
Mild to Moderate nonregenerative anemia Fasting Hypercholesterolemia Fasting Hypertriglyceridemia Decreased Total T4 Decreased Free T4 Increased TSH
Canine Hypothyroidism
Decreassed Total T4
Canine Hypothyroidism
Euthyroid Sick Syndrome
Decreased Total T4
Decreased Free T4
Decreased TSH
Secondary Hypothyroidism
Decreased Total T4
Normal to decreased Free T4
Normal to increased TSH
Euthyroid Sick Syndrome
Decreased TSH
Glucocorticoid induced
Increased TSH
Early Hypothyroidism
Normal Total T4
Normal Free T4
Normal TSH
Canine Thyroid Carcinoma (Nonproductive)
Tachycardia Hyperactivity Weight loss Polyphagia Diarrhea Polycythemia Heinz Body Formation Stress Leukogram Mild to Moderate ALT Azotemia --> Dehydration Increased Total T4
Hyperthyroidism
Hypercalcemia
Hypophosphatemia
Normal to Increased PTH
Primary Hyperparathyroidism
Causes of Hypercalcemia
D - Vitamine D Toxicosis R - Renal Failure A - Addison's Disease G - Granulomatous Disease O - Osterolytic Disease N- Neoplasia S - Spurious H - Hyperparathyroidism I - Idiopathic (Cats), Iatrogenic T - Temperature, Toxins
DRAGONSHIT!!
Hypocalcemia
Hyperphosphatemia
Normal to decreased PTH
Hypoparathyroidism
PU/PD
Low USG
DDx??
Diabetes Insipidus (Central and Nephrogenic) Psychogenic polydipsia (PPD)
PU/PD
Concentrated Urine after Water Dep test
Psychogenic Polydipsia
PU/PD
Low USG after Water Dep test
Concentrates with Desmospression administration
Central Diabetes Insipidus
PU/PD
Low USG after Water Dep test
NO Concentrating with Desmospression administration
Nephrogenic Diabetes Insipidus
"Pot Bellied" appearance Panting Muscle Weakness Ligament Weakness Alopecia Calcinosis Cutis Cutaneous Hyperpigmentation Stress Leukogram Increased ALP Increased ALT Hypercholesterolemia Low USG UTI
Canine Hyperadrenocorticism
Increased Urine Cortisol: Creatinine Ratio
Hyperadrenocorticism
Injection of Steroids –>
No Suppression of ACTH
Pituitary Tumor
Adrenal Tumor
If decreased ACTH at 8 hours after LDDST
Normal Dog
If increased ACTH at 8 hours after LDDST
Hyperadrenocorticism
If increased ACTH at 8 hours and 4 hours after LDDST
Hyperadrenocorticism (Primary-dependent Hyperadrenocorticism or Adrenal Tumor)
If increased ACTH at 8 hours and decreased at 4 hours
Primary-dependent Hyperadrenocorticism (PPDH)
Ferret: Alopecia Vulvar enlargement Aggression Muscle Atrophy Lethargy Anemia Pancytopenia
Ferret Hyperadrenocorticism
Lack of Stress Leukogram Hyponatremia Pre Renal Azotemia Dehydration Increased BUN Hypoglycemia Hyperkalemia
Hypoadrenocorticism
Amylase levels greater than 3-4x upper end of normal
Pancreatic injury
Lipase greater than 2x upper end of normal
Pancreatic injury
Corticosteroids
Higher levels of peritoneal amylase/lipase
Pancreatitis
Increased TLI
Pancreatitis
Corticosteroids
Increased Pancreatic lipase immunoreactivity (PLI)
Pancreatic injury
Anticonvulsant drugs
C-reactive protein
Acute Pancreatitis
Causes of Apparent Hypoglycemia
Glycolysis by erythrocytes due to failure to remove serum from clot within 30 min
Causes of Hypoglycemia
Insulinoma Insulin overdose Sepsis Hepatic Failure Neonatal/juvenile hypoglycemia Ketosis/ Pregnancy toxemia Neoplasia Starvation/malabsorption Extreme exertion Hypoadrenocorticism Xylitol in dogs Ingestion of Ackee Fruit
Causes of Hyperglycemia
Glucocorticoids Catecholamines Diabetes Mellitus Post-prandial Pancreatitis Hormone Imbalance Ethylene Glycol Drugs (Glucocorticoids and Megestrol acetate in cats) Milk fever in cattle Moribund animals Proximal duodenal obstruction in cattle
Glucosuria
Diabetes Mellitus
Renal Tubular Disorder (Normal Blood glucose)
Increased Fructosamine
Diabetes Mellitus
Ketonemia and Ketonuria
Altered Lipid metabolism
Starvation
Pregnancy toxemia
Bovine Ketosis
Excitement Leukogram
Lymphocytosis
Stress Leukogram
Lymphopenia
Neutrophilia
Eosinopenia
Inflammatory Leukogram
Neutrophilia (2x the upper limit)
Band Neutrophils present
Sometimes see Metamyelocytes
Lymphocytosis
Excitement
Neoplastic lymphoproliferative disease
Antigenic Stimulation
Ehrlichia
Neutropenia
Inflammation
Immune mediated destruction
Lack of production by bone marrow
Lymphopenia
Steroid Response
Acute viral infections
Immunodeficiency
Monocytosis
Inflammation
Stress Response
Eosinophilia
Parasitism
Hypersensitivity
Lesions producing eosinophil chemoattractants
Basophilia
Accompanies eosinophilia
Microcytic Anemia
Iron Deficiency
Portosystemic Shunt
Keratocytes
Schistocytes
Microcytic Anemia
Iron Deficiency
Heinz Body Anemia in small animals
Acetominophen
Propylene glycol
Cats: Lymphoma, Hyperthyroidism, Diabetes
Ingestion of Onions and garlic powder
Dogs: Cephalosporins and Zinc toxicosis (penny ingestion)
Heinz bodies in large animals
Horses: Phenothiazine and wilted red maple leaves
Cattle: Kale and Onions
Sheep: Copper toxicosis
Basophilic Stippling
Normal in ruminants
Regenerative anemia in cats and dogs
Lead Poisoning
Howell Jolly Bodies
Regenerative Anemia
Non-functioning spleen or splenectomy
Increased Corticosteroids
Lead Poisoning
Agglutination
IMHA
Regenerative anemia Spherocytosis Agglutination neutrophilia with left shift thrombocytopenia
IMHA