Midterm 2 PQs Flashcards
What is ALKP
How to measure score
What species
Causes of variation of ALKP
Alkaline phosphatase, Bile obstruction enzyme
- blood levels due to ALKP from bone and liver
Ca and Ru: 200 IU/L (Not cats!). Measure in blood.
Dogs: produce SIAP (steroid induced alkaline phosphatase), which is ALKP produced by liver.
Causes of increased ALKP:
- bile obstruction
- bone disorder/damage
- liver injury
- high levels of glucocorticoids
Urinary specific gravity: methods and causes of variation
Urine osmolality, physiological: Hypersthenuric (1015 - 1040 g/l)
Measure weight of urine vs. weight of equal volume distilled water.
METHODS:
Urinometer
- best method
Refractometer
- only if urine is transparent
Test strip
- not so good
RESULTS Hyposthenuria = "watery" urine - Central or Peripheral/Nephrogenic Diabetes Insipidus - Renal tubular damage Medullary washout
Isosthenuria
- CDI/NPI/PP
Hypersthenuria
- acute kidney failure
- diabetes mellitus
What causes alkalytic urine in Carnivores?
Urinary tract infection
- urease positive bacteria: urea —> NH3 increases pH
Feeding
- increased HCO3 excretion
Metabolic/respiratory alkalosis
Proximal tubular acidosis
- increased HCO3 excretion
Urinary tract obstruction or Long storage time
- cause urea decomposition
What parameters change with PSS -explain!
Increased ammonia (NH3) and bile acids (BA) i the blood.
NORMALLY: Both NH3 (produced by bacteria, increased postprandial) and BA (postprandial and preprandial value different) in intestines are taken up by portal veins and filtered through liver and detoxified.
PSS (Portosystemic shunt): portal vein BYPASSES liver and goes straight to vena cava, so NH3 and BA does not get filtered and reach circulation unchanged/not detoxified.
How to measure the total protein/Total creatinine ratio and what are the causes
Urine total protein : Creatinine ratio (UPC)
Creatinine (mmol/l)
- JAFFE method: creatinine+picric acid=yellow/orange
- Enzymatic method: creatinase
Creatinine in urine given as mmol/l —> x 0.00013 to get g/l
Total protein (g/l) - spectrophotometric method
Ratio
>1 proteinuria
>2 significant proteinuria
proteinuria = indication of GLOMERULAR DISEASE.
- Glomerulonephorpathy
- Tubulonephropathy
What causes acidotic urine in herbivores?
Metabolic/respiratory acidosis
- increased H+ excretion by kidneys
Vomiting
- decreased HCO3 excretion
Paradoxial aciduria
Hypokalaemia
- increased H+ excretion
Distal tubular acidosis
- decreased HCO3 excretion
Abomasal displacement
Toxicosis
List the causes of hematuria
Lower UTI
Trauma/tumour/inflammation of
- urinary bladder, urethra, ureter, kidney (injury by e.g. urolithiasis)
- genital tract
Renal infarction
Thrombocytopenia and coagulopathies
What is the value of ALT and AST and how is it measured and in what species
ALT – alanine transferase
= in cytoplasm of liver and RBCs
- Measured in dogs and cats: carnivore liver-specific
normal ca >60 IU/ - Reagent contains lactic dehydrogenase and converts pyruvic acid to lactic acid —> decreased absorbency measured with spectrophotometer
AST – Aspartate transferase
= in mitochondria of liver, muscle and RBCs
- Measured in ruminants and horses: herbivore liver spiecific
normal dog >30 IU/l - Reagent contains malate dehydrogenase and converts oxalic acid to malate —> reduced absorbancy = measured with spectrophotometer
What are the semi-quantitative methods for urinary protein measurement and what changes can be seen
TEST STRIPS
- Bromo-phenol blue indicator
- a.a. indice pH change:
colour from BLUE —> GREENish
HELLER/GMELIN TEST
- Nitric acid (HNO3) poured under urine in glass tube
- Protein will coagulate —> opaque zone above biliverdin layer and below clear urine.
SULPHOSALICYLIC ACID TEST
- 4-5 drops 20% sulphosalicylic acid in 1-2ml urine
- proteins coagulate —> opaque
Causes of bilirubinuria in cat, horse and human
Increased bilirubin in urine:
- PRE-HEPATIC (hemolytic) jaundice
- HEPATIC jaundice
- POST-HEPATIC (cholestatic) jaundice
(bilirubinuria is seen in healthy dogs!)
The value of bile salt measurements, causes of changes and indicate it’s values
Bile acids (e.g. cholic acid) released from gall bladder in response to increased cholcystokinin and secretin after eating (post-prandial)
PRE-PRANDIAL BA’s = 6 mmol/L
POST-PRANDIAL BA’s = 30 mmol/L
95% of BA’s are reabsorbed.
Measured:
- spectrophotometry or radioimmunoassay
Increased BA value indicate liver function failure, e.g. PSS
Semi quantitative way of measuring UBG and glucose in urine and the cause of changes in them
UBG:
- Gmelin test: HNO3 poured under urine, measure width of UBG layer
- Test-strip: can measure, but not so good for UBG
Increased UBG: pre-hepatic jaundice
decreased UBG: post-hepatic jaundice
GLUCOSE:
- TEST STRIP good measure: Glucose oxidase / peroxidase precipitated in glucosuria
Glucosuria: DM (Diabetes Mellitus), and stress in cats
Parameters in blood and urine for HEPATIC ICTERUS
BLOOD PLASMA
- Increase of BrI and BrII : ++
URINE
- BrII: ++
- UBG: +
FECES
hypochromatic*?
(BrII produced in normal amounts but decreased uptake by liver!)
Parameters in blood and urine for PRE-HEPATIC ICTERUS
BLOOD PLASMA
- BrI +++
URINE
- UBG ++
- Haemoglobinaemia
FECES
- Hyperchromic –> dark yellow brown
(Haemolytic jaundice)
Parameters in blood and urine for POST-HEPATIC ICTERUS
BLOOD PLASMA
- Br II ++
URINE
- BrI +
- UBG -decreased !!
FECES
- achromatic*?
Parameters in blood and urine for POST-HEPATIC ICTERUS
BLOOD PLASMA
- Br II ++
URINE
- BrI +
- UBG -decreased !!
FECES
- achromatic*?
Causes
- human: gall bladder stones
- animals: inflamed pancreas or intestinal tumour
Causes for increased blood UREA
Normal urea in blood = 8-10 mmol/l
PRE-RENAL FACTORS
- increased N intake
- Ru: decreased energy in rumen
- increased intestinal breakdown of protein
- intstinal/gastric bleeding
- haemolysis
- pre-renal azotaemia –> decreased perfusion of kidneys
RENAL FACTORS
- glomerular function –> RETENTION AZOTAEMIA
- tubular funciton –> TUBULAR REABSORPTION AZOTAEMIA
increased urea = decreased GFR
POST-RENAL FACTORS
- obstruction of ureter/urethra –> RETENTION AZOTAEMIA
- rupture of kidney/bladder/urethra –> RESORPTION AZOTAEMIA, UROPERITONITIS (lethal!!)
Causes of decreased UREA in plasma
Decreased liver function
increased water intake
decreased protein intake
RIVALTA TEST - goal, how to perform and evaluate
To evaluate if fluid is transudate or exudate
3% acetic acid + fluid
COAGULATE –> exudate (proteins coagulate in weak acids)
Not coagulate, but DISSOLVE –> TRANSUDATE (less proteins and stable proteins do not coagulate in weak acid)
Drop of fluid coagulated, but not dissolved –> high in GLOBULINS (FIP)
Steps for body cavity fluid analysis
- Rivalta test
- Biochemical tests
- albumin : globulin ratio –> Cats Glob>50% = FIP
- creatinine or urea conc.–> bladder, kidney, urether rupture
- amylase or lipase activity –> duoden., gall bl., urine bladder, pancreas rupture in peritoneum,
or esophageal rupture in pleural cavity - LDH activity –> fluid of neoplastic origin
- TG more than Cholesterol –> fluid of LYMPH origin
3. Cytological tests
Increased creatinine level in blood
Normal Creatinine = 50-200 mmol/l
increased Creat = decreased GF
Increased protein diet
Muscle trauma/inflammation
decreased GFR!
Local and systemic symptoms of DISTAL ILEUS
Foreign body in jejunum and more distal parts
Stomach is empty
Vomiting BICARBONATE - high pH
- intestinal fluid
- MISERE –> reflux of int. content into stomach, vomiting brown-green feces-like
SYMPTOMS
dehydration -Kidney damage
anaerobic glycolysis - bacterial overgrowth - Liver and pancreas damage
LA formation -tissue necrosis
METABOLIC ACIDOSIS
Gall bladder not releasing BA’s –> endotoxaemia
Hypokalaemia
Endotoxaemia
Bacteriaemia
= SHOCK AND DEATH
Local and systemic symptoms of PROXIMAL ILEUS
Foreign body in or near stomach
Increased gas and fluid
Vomiting HCL -low pH
- animal lose acids –> first sign is metabolic alkalosis
MORE SEVERE: result in metabolic acidosis
SYMPTOMS = more pronounced than distal ileus
- dehydration
- anaerobic glycolysis
- LA formation
*similar symptoms to prox just more severe
