Exam 3 Flashcards by AE G

what things interfere with refractometer readings

lipids
hemoglobin
bilirubin

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what does electrophoresis measure?

albumin
𝛼-glob (app)
𝜷-glob (app & ig)
𝛾-glob (ig)

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if you want to measure specific proteins (ig, fibrinogen, CRP, etc.) what would you do

protein assay

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Explain the difference between Serum & Plasma.

serum - anticoagulant, albumin & all globulins

plasma - clotted, albumin, globulin minus fibrinogen

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mechanisms of hypoalbuminemia

decreased albumin production
selective loss of albumin

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causes of decreased production of albumin

hepatic failure (most common)
starvation/malabsorption
Exocrine Pancreatic Insufficiency
acute phase protein response

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causes of selective loss of albumin

glomerular disease such as amyloidosis

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how do you characterize:
decreased albumin
decreased globulin

what are your DDx?

panhypoproteinemia

blood loss (most common)
GI disease, severe exudative skin dz/severe burns

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how do you characterize:
decreased albumin
increased globulin

what are your DDx?

hypoalbuminemia
hyperglobulinemia

decreased production of albumin due to hepatic failure (most common), starvation, malabsorption, EPI or APP response
selective loss of albumin due to glomerular disease (amyloidosis)

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how do you characterize:
increase albumin

what are your DDx?

hyperalbuminemia

always dehydration

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how do you characterize:
decreased globulins

what are your DDx?

hypoglobulinemia

failure of passive transfer or immunodeficiency diseases

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Samples to submit when testing for monoclonal gammopathy/monoclonal immunoglobulin or free light chains/Bence-Jones proteinuria.

monoclonal gammopathy/monoclonal immunoglobulin = SERUM

free light chains/Bence-Jones proteinuria = URINE

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Explain the Concepts of Positive & Negative Acute Phase Proteins.

(+) APP = increase with inflammation

(-) APP = decrease with inflammation

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positive acute phase proteins

haptoglobin
SAA
alpha1 acid glycoprotein
fibrinogen
C-reactive protein (CRP)

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negative acute phase proteins

albumin
transferrin

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what does fibrinogen increase with?

inflammation & dehydration

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what are the suggestive levels of dehydration of the plasma protein:fibrinogen in equine and ruminants?

equine pp:fb < 15 inflam
ruminants pp:fb < 10 inflam

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causes of prerenal azotemia with increased BUN & creatinine

decreased perfusion of the kidney due to dehydration, shock, hypovolemia or cardiac disease

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causes of prerenal azotemia with increased BUN and unaffected creatinine

increased protein catabolism due to high-protein diet, starvation, fever, GI bleed, massive necrosis or prolonged exercise

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causes of renal azotemia

kidney inability to excrete BUN/Cr

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cause of postrenal azotemia

obstruction (blocked, tumor, urethral stones)
uroabdomen (trauma, prolonged obstruction, severe inflam)

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how does urine specific gravity determine adequate or inadequate renal function?

what information does USG give?

used clinically to decide if kidneys are concentrating urine; measures solute concentration

info on hydration status and the concentrating ability of kidneys

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what characterizes “isosthenuria”? what does this suggest? when is this an appropriate response?

USG 1.008-1.012

suggestive that neither sig concentration nor dilution of glomerular ultrafiltrate occurred

can be normal under certain hydration conditions

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what does a fixed isosthenuric commonly mean?

end stage renal disease

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if USG is high what is this indicative of?

prerenal

if USG is low or isosthenuria what is this indicative of?

renal

dog USG

> 1.030

cat USG

> 1.035

horse and cow USG

> 1.025

horse common pattern of renal disease

increased BUN increased Cr decreased P increased Ca2+

cat & dog common pattern of renal disease

increased BUN increased Cr increased P decreased Ca2+

what abdominal fluid creatinine value is indicative of a uroabdomen

abdominal fluid:serum creatinine ratio > 2-fold

UPC > 5 with clean/quiet sediment (no WBC or RBC) is indicative of what?

glomerular disease

3 types of proteinurea and where the increased protein arises

1. preglomerular - outside urogenital tract - hyperproteinemia, fever, exercise 2. glomerular - glomerular membrane 3. post-glomerular - renal tubule, inflammation or hemorrhage

utility of UPC

measure urinary protein excretion because creatinine is excreted in uniform quantities

when to use UPC

interpreted in light of a urine specific gravity test and sediment

pros and cons of voided sample

pros: easy, cheap, owner can do it cons: contamination

pros and cons of cystocentesis

pros: best for culture, bypass repro tract in females, mainly used in SA cons: enterocentesis or RBC

pros and cons of catheter sample

pros: best for culturing LA cons: requires sterile technique and risk of iatrogenic UTI

best container for urine samples

completely sealed, hard plastic container, label as urine with patient ID, name, date and species

storage technique for urine samples

keep at room temp if testing within 30-60min if refrigerated warm to room temp for 20min

4 steps of performing a complete UA

1. appearance (color & clarity) 2. concentration (refractometer & USG) 3. biochemistry 4. microscopy

for urine sediment prep, how much do you want to decant

10-fold

first step of a urine sediment wet-mount exam

1. lower the condensor

what obj do you use to scan for epithelial cells, larger crystals and casts

10x

what obj do you use to scan for RBC, WBC, bacteria, yeast, and smaller crystals

40x

do you ever add oil to a urine sediment wet mount exam

List which dipstick tests are used?

pH protein bilirubin blood/hemoglobin glucose ketones

sources of error for dipstick tests

handling - sunlight, aging, uncapped urine strip interference - peroxide/bleach, formaldehyde, moisture, expired strips, cold urine, strip contamination with hand

normal pH for carnivores, herbivores and dairy cattle what does prolonged room temp cause pH to do? what crystals form?

carnivores 5.5-7.5 herbivores 7+ dairy cattle 6-7 false alkaline pH due to prolonged room temp, struvites

when would ketones be found in the urine is (+) or (-) for ketones accurate?

(-) energy balance - diabetic ketoacidosis, cattle ketosis, low carb diet, low glucose, prong fast (+) likely (-) doesn't rule out

what ketone is detected with the dipstick? what ketone needs to be measured in the serum?

acetoacetic acid with strip BHB in serum??

presence of bilirubin in the urine

male dogs liver disease, hemolytic disease, prolong fast, starvation, fever

what amount of blood in the urine is normal

hematuria < 5 cells/hpf

squamous epithelial cells contaminants

common from genital tract, distal urethra, prepuce

transitional cell contaminants

inflammation or neoplasia

renal tubular cell contaminants

renal tubular injury

normal WBC in urine

0-5/hpf

lipid droplets present in urine?

normal in cat urine renal tubular cell degeneration nephrotic syndrome

cellular casts are indicative of...

some level of acute renal tubular pathology gives concurrent info not amount of damage

granular casts are indicative of...

some level of renal pathology - cellular, Hgb, Myoglobin, bilirubin

waxy casts are indicative of...

chronic renal pathology most concerning

hyaline casts are indicative of...

rehydration post dehydration glomerular or myeloma-related proteinuria fever

how can you confirm bacteria in urine?

wright's or quick stain

struvites (magnesium ammonium phosphate) can be due to...

urine retention infection with urease-producing bacteria uroliths prolonged room temp

most common crystal in healthy animals

1. struvites 2. calcium oxalate dihydrate

calcium oxalate dihydrate crystals due to...

urolith hypercalcemia

calcium oxalate monohydrate crystals due to...

ethylene glycol (antifreeze) toxicity

bilirubin in urine can be due to...

normal in concentrated male dog urine hemolytic disease liver disease starvation bilirubinemia

calcium carbonate crystals due to...

normal in horses/herbivores uroliths in small ruminants/steers

amorphous crystals due to...

uroliths mimic cocci bacteria - stain and verify

ammonium biurates due to....

normal in healthy Dalmatians & english bulldogs liver disease (portosystemic shunt) uroliths

cystine crystals due to...

always abnormal many pure and mix breed dogs metabolic disorder of cystine metabolism - prone to uroliths

best test for dogs for hypothyroidism

tT4, fT4 & cTSH

best test for horses for hypothyroidism

TSH or TRH response test

best test for cats for hyperthyroidism

tT4 (single test OK), if normal-high do 2nd test fT4

majority of dogs have what type of acquired hypothyroidism (primary, secondary or tertiary)

primary - thyroid gland itself

majority of cats have what type of hyperthyroidism (primary, secondary or tertiary)

primary - one or both thyroid glands

a cat with weight loss, polyphagia, PUPD, hyperactivity, restlessness, diarrhea, vomiting, skin changes, resp signs, “sick cat”, 12 year old cat acting young

hyperthyroidism

a dog with ... dermatologic (endocrine alopecia, pyoderma, otitis, demodicosis, facial myxoedema) metabolic (lethargy, inactivity, weight gain) neuromuscular (weakness, ataxia)

hypothyroidism

most common cause of hypothyroidism in foals? adults?

foals - I def or ingestion of goitrogen adults - neoplasia

foals that are affected at birth, and have goiter, weakness, incoordination, poor suckle reflex, ossification/tendon defects

hypothyroidism

dog lab abnormalities with thyroid disease (hypothyroidism)

hypercholesterolemia mild nonreg anemia

cat lab abnormalities with thyroid disease (hyperthyroidism)

increased liver enzymes (ALT, ALP) *most consistent* erythrocytosis excitement leukogram decrease cholesterol increased BUN false decrease in fructosamide

most common endocrinopathy in cats

hyperthyroidism

most common endocrinopathy in dogs

hypothyroidism

what is euthyroid sick syndrome

decrease total T4 normal fT4 and TSH

majority of dogs have what type of cushing's (hyperadrenocorticism)

pituitary-dependent - resulting in bilateral adrenocortical hyperplasia

cause of equine cushing's (hyperadrenocorticism)

pituitary adenoma

majority of cats have what type of cushing's (hyperadrenocorticism)

pituitary-dependent

dog addison's (hypoadrenocorticism) primarily due to

adrenocortical failure from destruction of adrenal cortex from immune-mediate, granulomatous disease, infarct, neoplasia or idiopathic

what test is often used to rule out Cushing's in dogs and cats

urine cortisol:creatinine ratio

LDDST in dogs - what is indicative of... decreased cortisol response? 4hr & 8hr not suppressed? 4 hr suppressed, 8hr not?

decreased cortisol response = normal 4hr & 8hr not suppressed = PDH or ADH 4 hr suppressed, 8hr not = PDH

only test for iatrogenic cushings?

ACTH stim test

ACTH stim test - what is indicative of.. mild increase in cortisol? marked increase in cortisol? no change in cortisol?

mild increase in cortisol = normal marked increase in cortisol = PDH or ADH no change in cortisol = iatrogenic

endogenous ACTH normal-increased? low-undetectable?

normal-increased? PDH low-undetectable? ADH

dog with PUPD, polyphagia, pendulous abdomen, panting, hepatomegaly, muscle weakness, lethargy, lameness, endocrine alopecia, pyoderma, demodex, calcinosis cutis

hyperadrenocorticism "Cushing's"

dog lab abnormalities with Cushing's

stress leukogram thrombocytosis, erythrocytosis hypercholesteralemia hyperglycemia increased ALP low USG

equine with hirsutism and inability to shed winter coat has?

pituitary pars intermedia dysfunction (PPID)

lab abnormalities in equine with Cushing's

stress leukogram anemia hyperglycerma, hyperlipidemia increased liver enzymes

most common equine endocrinopathy

PPID

why do you not want to use a dexamethasone suppression test in horses?

increased risk of laminitis

recommended testing for Cushing's in horses

endogenous ACTH TRH stim

a cat with uncontrollable diabetes mellitus, PUPD, polyphagia, weight loss, lethargy, weakness, dermatopathies

Cushing's

lab abnormalities in cats with Cushing's

stress leukogram normal liver enzymes and cholesterol concurrent DM usually inconsistent

recommened test in cats with Cushing's

LDDST

a young-middle aged dogs, females > males, vague clinical signs, intermittent illness, GI (vomit/diarrhea), lethargy, anorexia, polyuria, shaking, abdominal pain, addisonian crisis

hypoadrenocorticism "addisons"

lab abnormalities in a dog with hypoadrenocorticism

lack of stress leukogram non-regenerative anemia azotemia & hyperphosphatemia hyponatremia, hypochloremia, hyperkalemia (Na:K < 27:1)

recommended test for suspected dog with Addison's

baseline cortisol < 2 ug/dL then ACTH stim = no/low cortisol <2 ug/dL

what is the gold standard test for Addison's

ACTH stim