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FA2 Clinical Pathology > Lecture 20 11/21/24 > Flashcards

Lecture 20 11/21/24 Flashcards

1
Q

Which glucose monitoring instruments use whole blood as a sample?

A

-glucometer
-blood gas instrument

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2
Q

Which glucose monitoring instrument uses plasma or serum as a sample?

A

chem analyzer

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3
Q

Which glucose monitoring instrument uses interstitial fluid as a sample?

A

freestyle libre style monitors

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4
Q

What are the characteristics of glucose in the blood?

A

-glucose is dissolved in the aqueous fraction of blood
-cell cytosol contains less water than plasma
-more glucose is found in the plasma than the RBC cytosol
-a given volume of whole blood contains less glucose than the same volume of plasma

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5
Q

What are the characteristics of modern glucometers?

A

-measure glucose in whole blood
-assume normal PCV and normal distribution of glucose in RBCs and plasma
-covert whole blood glucose to plasma-equivalent glucose via calculation

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6
Q

Why is it important to use veterinary glucometers?

A

human glucometers have been known to provide falsely low results for animals

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7
Q

When should glucometers NOT be used?

A

-patients with abnormal PCV; inaccurate results
-effusions; falsely high glucose

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8
Q

What should be done to minimize pre-analytical error?

A

separate plasma or serum from cells ASAP; separates glucose from the cells that will continue to use glucose until they die

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9
Q

What are the characteristics of glucose on urine dipstick?

A

-glucose is freely filtered and reabsorbed
-glucosuria can occur if resorption mechanism is overwhelmed or tubular damage/defect is present

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10
Q

What are the mechanisms of hyperglycemia?

A

-increased intestinal absorption
-catecholamine release
-increased gluconeogenesis/glycogenolysis
-absolute insulin deficiency
-increased insulin resistance
-impaired insulin release
-excess growth hormone
-excess glucagon
-pharmacologic

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11
Q

What are the characteristics of glucose in llamas and alpacas?

A

-hyperglycemia common when sick
-presumed that hyperglycemia is due to stress hormone release and insulin resistance
-may require insulin treatment, especially with marked abnormalities

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12
Q

What are the mechanisms of hypoglycemia?

A

-pre-analytical error
-insulin excess
-decrease in insulin antagonists
-decreased gluconeogenesis
-decreased glycogenolysis
-increased tissue utilization of glucose
-pharmacologic
-paraneoplastic

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13
Q

Which patients are predisposed to hypoglycemia during fasting?

A

-patients undergoing starvation/cachexia
-neonates/juveniles with immature liver
-patients with liver disease

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14
Q

Which ketones are of medical importance?

A

-acetoacetate
-acetone
-beta-hydroxybutyrate

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15
Q

When are ketones measured?

A

-as part of routine urine dipstick test
-when diabetes mellitus is suspected
-when negative energy balance is suspected

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16
Q

Which samples are typically used to measure ketones?

A

-urine
-milk

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17
Q

What is the pathogenesis of ketosis?

A

-high metabolic energy demand + carb poor diet OR insulin lack/resistance
-fats catabolized for energy
-ketones accumulate

18
Q

What are the components of ketosis?

A

-ketonemia
-ketonuria
-ketonlactia

19
Q

What is the consequence of ketosis?

A

can lead to titrational metabolic acidosis with a high AG

20
Q

What are the characteristics of beta-hydroxybutyrate?

A

-not detected on urine dipstick
-must be measured using a BHB meter or via referral lab

21
Q

What are the causes of ketosis?

A

-untreated or poorly regulated diabetes mellitus
-diabetic ketoacidosis
-hypoglycemia of lactation or pregnancy with inadequate carb intake
-endurance athletes with inadequate carb intake

22
Q

What are the characteristics of ketosis with hyperglycemia?

A

-think diabetes mellitus
-form of chronic negative energy balance due to insulin lack
-body starves because cells cannot utilize glucose without insulin
-classic findings are PU/PD, polyphagia, and weight loss
-PU/PD due to osmotic diuresis

23
Q

What are the characteristics of ketosis with hypoglycemia?

A

-think excess energy demand
-happens when there are inadequate carbs in diet
-occurs with lactational hypoglycemia, pregnancy hypoglycemia, and endurance athletes

24
Q

What is the pathogenesis of milk fever/parturient paresis in cattle?

A

-lactation leads to calcium loss
-calcium loss results in hypocalcemia
-hypocalcemia impairs insulin activation
-hyperglycemia occurs
-hyperglycemia can be exacerbated by stress

25
Q

What is the pathogenesis of lactational hypoglycemia in cattle?

A

-poor feed quality or decreased food intake during lactation leads to increased tissue demand for glucose
-liver cannot keep up with tissue glucose demand
-hypoglycemia and ketosis occur

26
Q

What is the pathogenesis of pregnancy hypoglycemia in sheep?

A

-poor feed quality or decreased food intake when carrying twins leads to increased tissue demand for glucose
-liver cannot keep up with tissue glucose demand
-hypoglycemia and ketosis occur

27
Q

What are the characteristics of fructosamine?

A

-protein, typically albumin, irreversibly binds to glucose
-reflects blood glucose over the lifespan of the albumin molecule
-measured in serum
-increased with sustained hyperglycemia

28
Q

How is fructosamine used in vet med?

A

-helps determine if hyperglycemia is transient and due to stress or caused by true diabetes mellitus
-used to monitor response to insulin treatment in diabetics
-increased fructosamine suggests prolonged hyperglycemia

29
Q

What causes increased fructosamine?

A

persistent hyperglycemia/diabetes mellitus

30
Q

What causes decreased fructosamine?

A

-persistent hypoglycemia
-hypoproteinemia/hypoalbuminemia

31
Q

What are the characteristics of medically important lipids?

A

-cholesterol, triglycerides, and NEFAs are commonly measured
-no routine tests to measure various lipoprotein classes, such as LDL vs HDL
-increased conc. of lipid in plasma referred to as hyperlipidemia, hyperlipemia, or hyperlipoproteinemia

32
Q

What are the characteristics of cholesterol?

A

-cholesterol readout on biochem panel is total cholesterol; HDL + LDL + VLDL
-measured in plasma or serum
-measured in mg/dL
-ideally measured in a fasted sample

33
Q

What are the characteristics of triglycerides?

A

triglyceride readout on biochem panel is chylomicron + VLDL
-in fasting sample, TG = mostly VLDL
-in post-prandial sample, TG = mostly chylomicron
-measured in plasma or serum
-measured in mg/dL
-ideally measured in a fasted sample

34
Q

What are the potential causes of lipemia?

A

-not fasting patient (error)
-endocrine disease
–idiopathic hyperlipidemia
-pancreatitis

35
Q

What is the visible appearance of lipemia?

A

opaque, white, milky plasma or serum

36
Q

What are the characteristics of lipemia as an interferent?

A

falsely increases:
-total protein
-hemoglobin
-MCH/MCHC

37
Q

What are the characteristics of lipemia handling in lab?

A

-labs prevent lipemia from interfering with sample readouts by running samples through ultrafugation
-need to tell labs not to do ultrafugation when trying to do a medical assessment of tryglycerides

38
Q

What are the characteristics of the lipemia refrigeration test?

A

-crude assessment of chylomicron presence
-positive test will have formation of a cream layer

39
Q

Which disorders always cause hypercholesterolemia?

A

-cholestasis
-hyperadrenocorticism
-hypothyroidism
-protein-losing nephropathy

40
Q

Which disorders always cause hypertriglyceridemia?

A

-acute pancreatitis
-anorexia in obese animals
-diabetes mellitus
-equine metabolic syndrome
-post-prandial

41
Q

Which disorders cause low cholesterol?

A

-hepatic insufficiency
-protein-losing enteropathy
-hypoadrenocorticism
-certain cancers

42
Q

What are the characteristics of NEFAs/FFAs?

A

-biomarker of negative energy balance
-measured in plasma or serum
-measured in mEq/mL
-typically measured in dairy cattle; increased NEFAs suggests need for better management

FA2 Clinical Pathology (21 decks)

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