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FA2 Clinical Pathology > Lecture 16 11/7/24 > Flashcards

Lecture 16 11/7/24 Flashcards

1
Q

What are the characteristics of hepatic circulation?

A

-oxygenated blood arrives at the liver via the hepatic artery
-deoxygenated blood arrives at the liver via the portal vein for filtration
-deoxygenated, filtered blood leaves the liver via the hepatic vein

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2
Q

What are the components of a portal triad?

A

-bile duct
-vein
-artery

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3
Q

Which functions of the liver contribute to carbohydrate metabolism?

A

-storage of glycogen
-gluconeogenesis

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4
Q

Which functions of the liver contribute to fat metabolism?

A

-oxidation of fatty acids
-synthesis of cholesterol, lipoproteins, and phospholipids

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5
Q

Which functions of the liver contribute to protein metabolism?

A

-synthesis of plasma proteins
-synthesis of urea
-removal of ammonia

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6
Q

Which function of the liver contributes to bilirubin metabolism?

A

conjugation of bilirubin

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7
Q

Which function of the liver contributes to iron storage?

A

storage of ferritin

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8
Q

Which function of the liver contributes to detoxification?

A

removal of drugs and hormones from the bloodstream

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9
Q

How can enzyme activity be determined in biochemical tests?

A

-substrate consumption
-product formation

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10
Q

What are the characteristics of clinical enzymology?

A

-enzyme unit of measure is activity (U/L)
-activities less than 3x the upper reference limit are considered mild
-activities less than the lower reference limit are clinically insignificant
-trends are more informative than a single measurement

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11
Q

Why is it important to look at enzyme trends rather than single values?

A

single values could be indicative of a worsening condition, an improving condition, or a persistent increase

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12
Q

Which biochemical tests detect hepatocellular injury?

A

-ALT
-AST
-SDH
-GLDH

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13
Q

Which biochemical tests detect cholestasis?

A

-ALP
-GGT
-bilirubin
-cholesterol

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14
Q

Which biochemical tests detect hepatic insufficiency?

A

-albumin
-urea
-glucose
-cholesterol

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15
Q

What are the characteristics of hepatocellular injury?

A

-detect “leakage” enzymes
-magnitude of increase varies with micro-anatomic injury site, specificity of enzyme, and half-life of enzyme
-non-specific tests; does not indicate cause

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16
Q

What are the characteristics of alanine aminotransferase/ALT?

A

-cytosolic enzyme
-sensitive marker of hepatocellular injury in dogs and cats
-specific for hepatocellular injury unless there is severe musculoskeletal injury
-not as useful in large animal

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17
Q

What are the characteristics of aspartate aminotransferase/AST?

A

-cytosolic and mitochondrial enzyme
-very sensitive indicator of hepatocellular injury
-less specific than ALT for hepatocellular injury
-found in muscles and erythrocytes in addition to liver
-preferred in large animal

18
Q

In addition to hepatocellular injury, what else can lead to increased AST?

A

-muscle damage
-intravascular hemolysis
-in vitro hemolysis/poor sample handling

19
Q

What are the characteristics of sorbitol dehydrogenase/SDH?

A

-cytosolic enzyme
-high specific marker of hepatocellular injury
-preferred in horses, cattle, and camelids when available
-labile with a very short half life; difficult to get to lab in time

20
Q

What are the characteristics of glutamate dehydrogenase/GLDH?

A

-mitochondrial enzyme
-most specific biomarker of hepatocellular injury in birds

21
Q

What is cholestasis?

A

impaired bile flow

22
Q

What are the obstructive causes of cholestasis?

A

-hepatocellular swelling
-neoplasia
-choleliths

23
Q

What is the functional cause of cholestasis?

A

altered biochemical pathway/receptors

24
Q

What are the characteristics of cholestatic enzymes?

A

-expressed on membranes of hepatocytes and biliary epithelium
-“inducible” enzymes

25
Q

What are the characteristics of alkaline phosphatase/ALP?

A

-sensitivity for cholestatic disease is variable
-high sensitivity in dogs
-low sensitivity in cats and horses
-specificity for cholestatic disease is low
-should be evaluated in conjunction with other cholestasis indicators

26
Q

What are the characteristics of L-ALP?

A

-produced by liver
-indicates cholestatic disease

27
Q

What are the characteristics of C-ALP?

A

-dogs only
-produced by liver
-indicates corticosteroid excess or phenobarbital use

28
Q

What are the characteristics of B-ALP?

A

-produced by bone
-indicates young/growing animal, osteosarcoma, or hyperthyroidism

29
Q

What are the characteristics of gamma-glutamyl transferase/GGT?

A

-most common cause of increase is biliary hyperplasia
-can see transient increases in neonates

30
Q

What is bilirubin?

A

end product of hemoglobin degradation

31
Q

What are the three main fractions of bilirubin?

A

-unconjugated/bound to albumin
-conjugated/water soluble
-delta-bilirubin/conjugated to proteins

32
Q

What are the potential lab measurements of bilirubin?

A

-total bilirubin
-indirect/unconjugated bilirubin
-direct/conjugated bilirubin

33
Q

What are the characteristics of pre-hepatic hyperbilirubinemia?

A

-hemolysis cause
-clinical examples include IMHA and oxidant injury

34
Q

What are the characteristics of hepatic hyperbilirubinemia?

A

-obstructive cause
-clinical examples include hepatocellular swelling and neoplasia

35
Q

What are the characteristics of post-hepatic hyperbilirubinemia?

A

-obstructive cause
-clinical examples include gall bladder mucocele, choleliths, and neoplasia

36
Q

How does hemolysis lead to pre-hepatic hyperbilirubinemia?

A

abundant unconjugated bilirubin overwhelms the liver’s ability to conjugate and excrete bilirubin

37
Q

How does obstruction lead to hepatic hyperbilirubinemia?

A

hepatocyte swelling or infiltrative neoplasia squeeze the bile canaliculi, leading to backup of conjugated and unconjugated bilirubin

38
Q

How does obstruction lead to post-hepatic hyperbilirubinemia?

A

obstruction in gall bladder or bile duct results in backup of conjugated or unconjugated bilirubin

39
Q

What are the characteristics of functional cholestasis?

A

-impaired excretion of conjugated bilirubin
-associated with sepsis and inflammation
-see a mild hyperbilirubinemia without other indications of cholestasis

40
Q

What are the characteristics of fasting/anorexic cholestasis?

A

-seen in horses and cattle
-impaired conjugation of bilirubin
-increased unconjugated/indirect bilirubin

41
Q

What are the characteristics of cholesterol?

A

-precursor to bile acids
-hypercholesterolemia can occur with obstructive cholestasis

42
Q

What are other causes of hypercholesterolemia besides obstructive cholestasis?

A

-endocrinopathies
-nephrotic syndrome
-acute pancreatitis
-postprandial/after meals
-breed-associated

FA2 Clinical Pathology (21 decks)

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