Lab Exam 2 Flashcards
1
Q
Why is glucose important to the CNS?
A
Because the central nervous system as well as RBC’s require glucose for their energy needs and without it they die
2
Q
What is a monosaccharide?
A
A single unit sugar
3
Q
What is hexose?
A
Simple sugars whose molecules contain six carbon atoms
4
Q
Why is the liver important in reference to glucose?
A
It synthesizes, stores, converts and releases glucose
5
Q
What is the excess glucose stored as in the liver?
A
Glycogen
6
Q
What organ releases insulin?
A
The pancreas
7
Q
What hormones control the concentration of glucose?
A
Insulin and glucagon; insulin lowers BG levels while glucagon elevates it
8
Q
How is glucose metabolized?
A
Via glycolysis followed by the TCA cycle (aka krebs cycle)
9
Q
How many glucose atoms are produced as a result of glycolysis?
A
It produces 4 total, but 2 are eliminated, leaving a net gain of 2 glucose atoms
10
Q
How many ATP atoms are produced at the conclusion of the TCA cycle?
A
36 ATP for every glucose molecule
11
Q
What is required for the complete oxidation of glucose?
A
Because it is an aerobic response, it requires oxygen
12
Q
What by-products are released by the oxidation of glucose?
A
- CO2, H2O, ATP, and heat
- The heat produced helps maintain body temperature
13
Q
What is fermentation of glucose?
A
Anaerobic metabolism that can produce ATP if the body is experiencing hypoxia
14
Q
Is fermentation an effective way to produce ATP?
A
It is less effective than glycolysis because it only produces 4 ATP for every glucose molecule
15
Q
Where is the highest concentration of glycogen stored?
A
In the liver, but because muscle tissue has a greater mass, there is more glycogen contained within it
16
Q
What cells produce, monitor and control glucose?
A
Beta cells, which are created in the endocrine portion of the pancreas
17
Q
What cells within the islets of langerhaans produce glucagon?
A
Alpha cells
18
Q
What do the delta cells within the pancreatic islets produce?
A
Somatostatin, which regulates insulin and glucagon
19
Q
What cell is the only cell in the body that does NOT require insulin to function?
A
Beta cells
20
Q
At what concentration would a beta cell be triggered to release insulin?
A
When the blood glucose concentration exceeds 110 mg/dl
21
Q
At what concentration is insulin synthesis and concentration inhibited?
A
When the blood glucose concentration falls between 60 mg/dl
22
Q
What is euglycemia?
A
Normal concentration of glucose in the blood
23
Q
How can euglycemia be maintained?
A
Exogenously, which is from outside the body, mainly through diet; or endogenously which is inside the body derived from the liver
24
Q
What is gluconeogenesis?
A
The creation of more glucose
25
What hormone is the most dominant when lowering glucose?
Insulin
26
What hormones may elevate glucose?
Glucagon, epinephrine, growth hormone, and cortisol
27
What is Diabetes Mellitus?
Results from a decrease in insulin secretion from the beta cells and/or a decrease in insulin action
28
What is Type I Diabetes?
- Insulin dependent diabetes mellitus
| - There is a low amount of insulin in the body and it can't produce enough to meet the need
29
What is the most common form of diabetes in dogs and cats?
Type I IDDM
30
What is the second most common form of diabetes in cats?
Type II NIDDM
31
What is Type II Diabetes?
- Non-insulin dependent diabetes mellitus
| - Spikes in BG levels usually after eating that require insulin which the body can produce
32
How is type I diabetes managed?
With insulin injections
33
How is type II diabetes managed?
With dietary therapy and oral hypoglycemic medications
34
What is Type III Diabetes?
- Impaired glucose tolerance
| - Can be caused by hormones or medications
35
Which type of diabetes can affect pregnant animals?
Type III
36
What long term medication use can result in type III diabetes?
Corticosteriods
37
What is thought to be the cause of canine diabetes?
It is considered to be immune mediated in which the body thinks beta cells are foreign and attacks them
38
What are some other causes of canine diabetes?
Genetic predisposition, chronic pancreatitis, and medication induced
39
At what percentage of destruction of pancreatic islets do diabetic clinical signs occur?
Progression is slow and 90% of islets are lost before diabetes mellitus occurs
40
What are the common causes of feline diabetes?
Obesity, pancreatitis, amyloidosis of pancreatic beta cells
41
What is amyloidosis?
Deposition of material around beta cells which prevents their measurement of glucose
42
What canine gender is typically afflicted with diabetes?
3x more likely to occur in females
43
At what age do canines typically become diagnosed with diabetes?
Peak incidence at 7-9 years
44
What breeds are genetically predisposed to diabetes?
Australian terriers, samoyed, mini and standard schnauzers, mini and toy poodles, pugs, fox terriers, keeshonds, bichon fries, finnish spitz, lhasa apso, cairn terriers
45
What feline gender is typically affected by diabetes?
Males generally greater than 6 years old
46
What feline breed is diabetes common in?
None, all can be affected equally
47
What are the clinical signs of diabetes?
Polyuria, polydipsia polyphagia, weight loss, cataracts in dogs, peripheral neuropathy in cats, plantigrade posture
48
How can diabetes be diagnosed?
- CBC: red blood cells may be decreased
- Chem panal: hyperglycemia; BG > 200 mg/dl
- UA: glucosuria or ketonuria
49
What are some goals of diabetes treatment?
- Elimination of clinical signs
- Prevention or slowing or cataract formation and resulting blindness
- Prevention of hypoglycemia or overtreatment
- Prevention and/or treatment of concurrent diseases such as cushing's, skin infections, or UTI's
50
How is diabetes treated?
Dietary management, exercise, insulin injections, or oral hypoglycemic agents
51
What are some goals of dietary management?
Eliminate obesity and maintain consistency in the timing and caloric content of meals to minimize fluctuations by having slow release of carbohydrates in BG concentrations
52
What should a diabetic diet contain?
High fiber and low fat, cats should also be fed a high protein, low carb diet and semi moist foods should be avoided
53
What are some goals of exercise?
To promote fat loss and increase mobilization of insulin from its injection site, but avoid strenuous and sporadic exercise as it can cause severe hypoglycemia
54
What are the three types of insulin?
- Short acting: emergency use of R insulin
- Intermediate acting: canine use of NPH and Vetsulin
- Long acting: feline use of Lantise and glargine
55
What are some problems with insulin therapy?
- Rapid insulin metabolism
- Insulin resistance if there is another disease present
- Hypoglycemia aka insulin overdose
- Somogyi phenomenon aka insulin induced hyperglycemia
56
How can hypoglycemia be treated at home?
If a diabetic animal is exhbiting signs of weakness, shaking, ataxia and seizures, they can be given karo syrup rubbed on the their gums
57
What is renal disease?
When something is physically wrong with the kidneys, but the function may not be affected
58
What is renal failure?
When something is functionally wrong with the kidney, at least 75% of total nephron population is non-functional
59
What happens to the kidneys in renal failure?
The kidneys are no longer able to maintain the regulatory, excretory and endocrine functions required
60
What happens to hormone production to kidneys in renal failure?
The kidney produces less erythropoietin hormone, which results in anemia especially in cats
61
What is the result of renal failure?
It results in retention of nitrogenous solutes and derangement of fluid, electrolyte, and acid balance
62
What is azotemia?
A build up of waste in the blood due to failure of kidneys and an increased concentration of non-protein nitrogenous waste products in the blood
63
What us pre-renal azotemia?
A problem occurring before the kidney involving impaired blood flow to the kidney
64
What is pre-renal azotemia due to?
A decrease in glomerular filtration rate from circulatory disturbances causing decreased renal perfusion
65
What is renal azotemia?
A primary failure of the kidney which results from decreased GFR, check functionality with a specific gravity
66
What is post-renal azotemia?
When the urine does not leave the body and results from obstruction or rupture of urinary outflow tracts and hyperkalemia
67
What is uremia?
A condition involving abnormally high levels of waste products in the blood from a critical loss of functioning nephrons
68
What are the clinical signs of uremia?
- PU/PD
- Mild non-regenerative anemia
- Vomiting
- Weight loss
- Depression
69
What is ammonia?
Produced from dietary proteins and by catabolism of proteins and nitrogenous wastes in peripheral tissues
70
What converts amino acids and urea into ammonia?
Gastrointestinal micro-organisms in the colon and cecum which are then absorbed into the portal circulation
71
How much ammonia is shunted to the liver?
80-90% and then it is converted into urea via the urea cycle
72
What peripheral tissues metabolize 10-20% of ammonia?
The kidneys, heart and brain
73
How is ammonia measured?
With arterial blood collection and heparinized plasma samples
74
What can result of increased ammonia?
Ammonia is toxic to the CNS and is one cause of hepatic encephalopathy (damage to the CNS due to the build up of ammonia)
75
What could be a physiologic normal body function that would result in elevated ammonia?
A high protein diet, can also result in increase GFR and urea excretion
76
What kind of artifact may result in a increased ammonia?
It may not be an accurate number
77
What kind of disease may result in an increased ammonia level?
It can be a liver shunt, dehydration or a tumor
78
How is urea formed?
2 NH3 molecules are combined with 1 molecule of CO2
79
What is the chemical formula of urea?
CO(NH2)2
80
What is urea?
The end product of protein and amino acid catabolism
81
How is urea metabolized?
Synthesized in the liver using ammonia derived from amino acids
82
How is urea excreted?
By the kidneys which is the most important route of urea excretion
83
Where is urea filtered?
At the glomeruli and requires no metabolic work by the kidneys because glomerular filtration is driven by cardiac output
84
How is urea concentration measured?
As blood urea nitrogen, and is a screen for decreased GFR
85
What are the non-renal factors contributed to increased BUN?
- High protein meal
- Hemorrhage into gastrointestinal tract
- Increased catabolism (breakdown of protein)
- Drugs
86
What are the renal factors contributing to increased BUN?
- Pre-renal: shock, dehydration, congestive heart failure
- Primary: kidney is not functioning properly
- Post-renal: Urethral obstruction, ruptured bladder
87
What are some reasons that could contribute to a decreased BUN?
- Low protein diet
- Severe liver disease of portosystemic shunting
- Anabolic steroids due to building protein instead of breaking it down
88
What is creatinine?
Spontaneous, non-enzymatic breakdown product of phosphocreatine in muscle and is released into the blood from muscle at a constant rate
89
Which gender tends to have more creatinine?
Males due to higher muscle mass
90
Where is creatinine excreted?
By glomerular filtration and the rate of excretion is relatively constant and a good estimate of GFR
91
What is creatinine a measurement of?
It is a screen for decreased GFR?
92
What might be some reasons for increased creatinine?
- Non renal: massive muscle necrosis and prolonged strenuous exercise
- Pre-renal: shock, dehydration, congestive heart failure
- Post-renal: urethral obstruction, ruptured bladder
93
What does an increased BUN:creatinine ratio suggest?
Non-renal azotemia, may be due to an increased protein diet
94
What does a decreased BUN:creatinine ratio suggest?
Chronic liver failure
95
What are plasma proteins?
Total proteins consist of albumins and globulins, also includes fibrinogen
96
What could decreased plasma protein level indicate?
- Glomerular disease
- Liver disease
- Starvation
- Malabsorption
- Hemorrhage
97
What organ produces albumin?
The liver
98
What could a increased plasma protein level indicate?
- Severe dehydration
| - Neoplasia (lymphoma and plasm- Infection
99
What is albumin?
It contributes to plasma colloid oncotic pressure and synthesized in the liver and catabolized by all metabolically active tissues, serves as a carrier protein for many insoluble organize substances
100
What can contribute for hypoalbuminemia?
- Physiologic: low protein diet
- Increased loss: kidney, liver, gut and bleeding
- Catabolism
101
Where are globulins produced?
- Alpha and beta are synthesized by the liver, and gamma globulins are produced by b-lymphocytes and plasma cells
102
What does a high total protein with a normal A:G ratio indicate?
Dehydration
103
What does a high total protein with a low A:G ratio suggest?
Hyperglobulinemia
104
What us hyperglobulinemia?
Decreased gamma globulins are seen when there is a deficiency of immunoglobulins
105
What are the biochemical functions of the liver?
- Detoxification of toxins
- Synthesis of all coagulation factors
- Synthesis of plasma proteins (mainly albumin)
- Catabolism, degradation and storage of lipids
- Formation and elimination of bile
106
What tests can be used to diagnose liver disease?
Chem panel, CBC, bile acids, U/A, fecal, RADS, US, biopsy
107
What are the clinical signs associated with liver disease?
- Depression/lethargy
- Anorexia, diarrhea, vomiting, weight loss
- Fever, hemorrhage
- Abdominal pain
- CNS signs
- Icterus/jaundice
- PU/PD, dark brown urine, dark or light brown stool
108
What is hematemesis?
Vomiting blood, which may occur in a patient with liver disease
109
What is hemoptysis?
Coughing up blood, which may occur in a patient with liver disease
110
What bleeding disorders may a liver patient suffer from?
- Hematemesis
- Hemoptysis
- Hematochezia
- Melena
- Hematuria
- Petecchia
- Eccymoses
- Pale MM
111
Why would a patient with liver disease suffer from hepatic encephalopathy?
Due to the build up of ammonia not being converted to urea
112
What kind of heart failure may a patient with liver disease suffer from?
Right sided heart failure, often associated with hepatomegaly
113
What may hepatomegaly be due to?
- Inflammation
- Steatosis aka fatty liver
- Neoplasia
- Congestion or cholestasis (low bile flow)
114
What is hepatodynia?
Liver pain
115
Why would a patient with liver disease suffer from microhepatica aka small liver?
May be due to a congenital portosystemic shunt or cirrhosis
116
What may ascites in the abdomen occur in a liver disease patient?
May be due to hypoalbuminemia or liver hemorrhage
117
What is the only test that can determine the functionality of the liver?
Bile acids test
118
What are the major enzymes found in the liver?
- ALT
- AST
- ALKP
- GGT
119
Aside from the liver, where else may would you find ALT?
Mainly in the hepatocellular cytoplasm in the liver, but smaller amounts may be found in the kidney, heart, muscles and pancreas
120
What would a increased ALT suggest?
Persistent hepatocellular disease
121
When being treated, how often should ALT values decrease?
By 50% every 1-2 days, as the serum half life is <24 hours
122
Where would you find AST?
As it is not liver specific, it may be found in RBC's, heart, muscle tissue, pancreas and kidney in addition to the liver
123
Which liver enzyme is a more sensitive indicator of hepatobillary (liver and gallbladder) disease in cats?
AST, in general it tends to parallel ALT with respect to liver damage
124
What is ALKP?
- A membrane bound enzyme present in many tissues
- Dogs have 4 isoenzymes: bone, liver, corticosteroid, and intestines
- Cats have 2 isoenzymes: bone and liver
125
What would an elevated ALKP possibly indicate?
- Osteoblast activity (2-3 times the normal range)
- Feline hyperthyroidism
- Canine glucocorticoids
- Synthesis induced by other drugs aside from glucocorticoids
- Primary or secondary hepatocellular disorders
- Mammary neoplasia (will result in a milder increase)
126
If a dog is on a prescription of prednisone, which liver enzyme may be elevated?
ALKP
127
Where is most serum GGT activity in the dog and cat?
It is derived from the liver
128
Where is the largest tissue GGT activity in the dog and cat?
In the kidney and pancreas
129
What may an increased GGT level indicate?
- Intrahepatic or extrahepatic cholestasis
- Pancreatitis
- Drug induction by corticosteriods or anticonvulsants
130
What is intrahepatic cholestasis?
Cholestasis due to either a blockage, tumor, or tissue inflammation in the liver
131
What is extrahepatic cholestasis?
Cholestasis due to either a gallstone or a tumor outside the liver
132
Which liver enzyme is the most sensitive to diagnose liver disease than ALKP in cats?
GGT
133
What diseases may have secondary effects on the liver?
- Endotoxemia/septicemia
- Diabetes
- Hyper and hypothyroidism
- Hyperthermia
- Decreased hepatic perfusion with hepatocellular hypoxia due to shock, CHF, Hw disease, or anemia
134
What is stercobilin?
It provides brown color to feces, if it lacks that it is referred to as acoholic or without bile
135
What is bilirubin?
It is produced from the breakdown of RBC's, when hemoglobin is converted to bilirubin
136
Is bilirubin a normal finding in the urine of a cat?
Never
137
When does jaundice in an animal develop?
When the bilirubin levels exceed 2.0 mg/dl to 3.0 mg/dl or 10x the normal amount
138
How is jaundice classified?
- Prehapatic: high RBC, typically seen in DIC
- Hepatic: liver disease
- Posthepatic: liver blockage
139
What is the major plasma protein produced in the liver?
Albumin
140
When would albumin decreased on a chem panel?
When greater than 70% of hepatobilary function has been compromised
141
Where are alpha and beta globulins synthesized?
In the liver
142
What are the primary bile acids synthesized in the liver?
Cholic acid and chenodeoxycholic acid come from cholesterol
143
What is the secondary bile acids for cats?
Taurine
144
Where are bile acids stored and concentrated?
In the gallbladder
145
What stimulates the release of CCK into the small intestine?
The presence of hydrochloric acid, dietary fats and proteins after eating
146
What does CCK do?
It stimulates the contraction of the gallbladder with the release of bile acids
147
What does the small intestine do with bile acids?
It facilitates fat to emulsification, digestion and absorption, then most of the bile acids are reabsorbed in the ileum by active transport
148
What is bile acids functionality based on?
The efficiency of the enterohepatic circulation
149
What kind of food should you feed an animal with encephalopathic tendencies for a bile acids test?
High fat low protein, as it helps produce less ammonia
150
What may happen to an animal with a liver shunt if fed a high protein meal?
They may develop seizures
