Saunders- Clinical Pathology and Chemistry Flashcards
BUN increased means decreased GFR, but can be falsely elevated with high ____ and/or this issue
high protein diet and/or GI bleeding
Creatinine
elevated- less than 25% of renal functioning
may be normal even if p has renal disease
younger p have lower creatinine and same with cachexic animals (but whatever bc we only care about elevated creatinine really anyway)
Serum phosphorus concentration
an increase in serum phosph. is not seen until more than 85% of nephrons are nonfunctional (chronic renal failure aka CRF)
what regulates phosphorus resorption in the renal tubules?
Parathyroid hormone (PTH)
what causes high phosphorus?
renal diseases, elevated from growing (bone growth) in young animals, cell damage, acute acidosis, ruptured urinary bladder, hypertonic sodium enema, hyperparathyroidism
what is the gold standard for GFR evaluation?
INULIN (which is a type of prebiotic) clearance (but inulin is hard to get so good luck)
What e’lyte is useful to evaluate to find out if its prerenal or renal azotemia?
Sodium
with prerenal azotemia- sodium conservation (not heavily excreted)
with renal azotemia- high sodium excreted
why might urine be green in color?
Bilirubin oxidation to biliverdin or pseudomonas bacterial infection
why is rabbit urine white?
bc high concentration of calcium carbonate
1+ protein in n in dogs with _____
high USG
what does persistent heavy proteinuria in the absence of high USG suggest?
GLOMERULAR DISEASE
active sediment with proteinuria usually means….
inflammatory renal disease or low urinary tract disease
only ___ bilirubin appears in the urine and can be normal in male dogs
conjugated
what are some causes of bilirubinuria?
hemolysis, liver disease, extrahepatic biliary obstruction, fever and starvation
occ. ___ and ____ are normal in urine sample
RBCs and WBCs
in diabetic p there is a higher chance of the p having UTI that is chronic without any CS but hard to detect any bacteria in a urine sample bc low USG because pu/pd likely, so send it out for a _____ every ____ months
culture every 12 months
clumps aka rafts of transitional epithelial cells in urine means
neoplasia or infection
if there is just a few without clumps then that suggests inflammation, irritation, or neoplasia
renal epithelial cells in a urine sample means..
NOT NORMAL, means ischemic, nephrotoxic, or degenerative renal disease
if they are arranged in a cast (looks like toad poop under microscope means necrotic renal tubular structures)
What are casts in a urine sample
Casts are cylindrical molds of the renal tubules composed of aggregated proteins or cells.
white cell casts means… in urine sample
means pyelonephritis or interstitial nephronic disease
types of urine crystals found in alkaline urine:
Struvite, phosphate, ammonia biurate
Types of urine crystals found in acidic urine-
uric acid crystals (associated with Dalamatians) ++
Calcium oxalate
Cystine crystals++
Cant see on rads ++
what type of crystals are seen In dalmatian p???
Uric acid
What crystals in urine are found in cases of acute renal failure from ethylene glycol toxicity?
Calcium Oxalate monohydrate crystals
______ dehydration is assoc. with diabetes insipidus and cattle in heat stress bc they produce ____ sweat and dogs and cats bc they dont sweat
hypertonic dehydration; hypotonic
____ dehydration occurs in horses in heat stress bc they produce ____ sweat
Hypotonic dehydration; hypertonic sweat is produced by horses
_____ dehydration is the most common type of dehydration where the conc of NaCl goes down
Hypotonic dehydration (loss of electrolytes)
Know hypertonic dehydration is primarily just loss of water
metabolic acidosis
primary loss is decreased HCO3 and PCO2 increased for compensation
Metabolic alkalosis
primary change is increased HCO3- and the compensation is PCO2 will increase
respiratory acidosis
Primary change is increased PCO2 and the compensation will be increased HCO3-
respiratory alkalosis
primary change will be decreased PCO2 and HCO3- is increased in compensation
increased base deficit means…. what about decreased????
increased means metabolic alkalosis and decreased means metabolic acidosis
what is anion gap?
(Na + K ) - (Cl + HCO3-)
estimates changes in unmeasured cations and anions
what is fanconi syndrome? (usually seen in benji’s)
a defect of proximal tubule leading to malabsorption of various electrolytes that would otherwise be absorbed if n
What metabolic derangement (low ____ ) is assoc. with alkalosis
hypokalemia
Glucose or insulin or release of catecholamines (cushing’s disease) can cause ____
hypokalemia which is metabolic alkalosis
Hyperkalemia is assoc. with acidosis and is seen with what common issues?
thrombocytosis, leukemia, hemolysis, akita dogs, HYPP in QH, ischemia, reperfusion injuries, Cushing’s disease, renal failure, ruptured urinary bladder, NSAIDs and ACE inhibitors
______ increases phosphorus resorption from the bone to put into GI tract and in urine
Calcitriol
what levels of e’lyte move along with phosphorus?
Calcium
Low magnesium is seen with what two diseases in cattle?
Milk tetany- calves fed magnesium deficient milk diet
Grass tetany- adult cattle on lush green pasture that is high in potassium and blocks uptake of magnesium in the rumen
Addisons disease e’lyte abn:
Hyperkalemia, hyponatremia, hypercalcemia
and hypochloremia with hypermagnesia
👌👌
High K+, Ca2+, Mg+
Low NaCl
What measurement of Calcium is most accurate?
ionized (and beware low albumin causes Ca to be low on labwork bc they travel together so always check ionized calcium for accurate calcium status)
acidosis increases ____ concentration
ionized calcium concentration
enzymes of the liver- leakage enzymes (2 of them)
ALT and AST
enzymes of the liver- induced enzymes-
ALP and GGT
what enzymes tell you there is liver damage?
GGT and ALP (liver induction enzyme)
what enzymes tell you there is liver failure? what about liver damage?
liver failure is leakage enzymes (so ALT and AST) and liver damage is GGT and ALP which are liver induction enzymes
high ALT and AST in cat or dog=
High ALT and AST in horse or cattle=
dog or cat= liver failure +/- muscle damage
cows and horses= muscle damage
In horses and in cattle, what leakage enzyme that IS liver specific if used to be more accurate in detecting injury to the hepatocytes?
SDH (liver specific leakage enzyme with very short 1/2 life)
ALP
Increases can be from the following:
Increased osteoblastic activity or hyperparathyroidism (bc PTH works on the bone)
Liver- cholestasis
Corticosteroids- steroids, anti-seizure meds
Dehydration, general inflammation
what is a good indicator of cholestasis from labwork?
ALP increased (and bilirubin will be increased later on)
Half life of ALP is about ____ hours in dogs and ___ hours in cats
60 hours; 6 hours
GGT enzyme
induced enzyme, but acute injuries will cause it to increase
usually increased from cholestasis or steroids or anti-seizure meds,
____ is the enzyme to look at if suspecting cholestasis in cows or horses
When might it be elevated NOT due to cholestasis???
GGT (but beware bc will be increased in p that just ingested colostrum!!)
bile acids
if more than 200= PSS
Fasting and postprandial (post-feeding high fat diet like a/d) samples are usually collected in dogs and cats
ammonia concentrations is usually increased in those with PSS or if ___% of the ____ mass is lost
60%; liver mass
Albumin decreases if more than ___-___% of liver functional is lost
60-80%
Explain the fluctuations of glucose with liver disease:
The liver converts glucose to glycogen; glucose may be increased if there is decreased glucose uptake by the liver
Glucose may be decreased if there is decreased gluconeogenesis
urea is synthesized in the ____ from _____
liver from ammonia
BUN increases or decreases with liver failure? What about blood ammonia levels?
BUN DECREASES but blood ammonia INCREASES
cholesterol may be increased with ____ and is increased with _____
cholestasis; hypothyroidism
Coag. factors will be ___ with liver damage
low
PSS signs on labwork-
high bile acids and microcytic anemia with low iron +/- urate crystals in the urine
Hepatic lipidosis clin path
Leakage enzymes will be increased along with bilirubin and bile acids
Steroid hepatopathy is most common in what species? What clin path signs will you appreciate??
Dogs; Induced enzymes will be the most increased followed by mild increased leakage enzymes and bilirubin
End stage liver disease (when more than 60-80% of the liver fxn is lost clin path signs:
What values are increased? What about decreased???
INCREASED: ammonia, induced liver enzymes, bilirubin, and bile acids
DECREASED: BUN, albumin+/- glucose
if amylase is through the roof in dogs (the only species this is true for…) think this:
Pancreatic injury
Vit B12 aka cobalamin and folate both decreased in cat means what? What about in dogs???
B12 aka cobalamin and folate decreased in cat= EPI
B12 aka cobalamin decreased and folate increased in dogs/cats= SIBO
B12 cobalamin decreased and folate normal in dogs= EPI
Magnitude of CK elevation does not correspond with the level of muscle injury and has a 1-2 day half life so will be high with acute injury and go to normal after like a day or two T/F
True!!
ALT higher than AST in dogs and cats with no CK elevation=
Liver injury
Increased AST but not ALP and CK in dogs and cats=
muscle damage
Increased AST and no CK in horses and rum=
Liver injury
Increased AST and CK in horses or rum=
skeletal muscle injury or skeletal muscle and liver muscle injuries
Cholesterol is present only within ____ ____
animal tissues
what is the test of choice for iatrogenic hyperadrenocorticism?
ACTH stim test
what are the 4 P’s for Hyperadrenocorticism?
Classic case- the four P’s- Polyuria, polydipsia, polyphagia, panting
What are the 3 types of cushings disease?
- Pituitary dependent hyperadrenocorticism (PDH)
- Adrenal dependent hyperadrenocorticism (ADH)
- Iatrogenic
What changes to labwork to we see in p with cushings?
Chem- ALP elevation and hypercholesterolemia
CBC- stress leukogram (neutrophilia, lymphopenia, eosinopenia), thrombocytosis
Urinalysis- hyposthenuria +/- proteinuria
Urine cortisol: creatinine
If normal- rules out hyperadrenocorticism
If abnormal, further testing needed
What is the tx of choice for Cushing’s disease?
Trilostaine- inhibits enzyme that is key to cortisol production
Lysodren- causes necrosis and destruction of cortisol- secreting portions of adrenals
Surgical- hypophysectomy or bilateral adrenalectomy
RX for collapsing trachea dogs
Medical- short course of corticosteroids
Cough suppressants “cough tabs”- which is an anti-tussive
Weight loss if overweight
Tracheal stent if refractory to medical management, requires referral
Symptoms of IMHA–>
lethargy, weakness, pallor, tachypnea, icterus, variable organomegaly, discolored urine from hemoglobinuria or bilirubinuria
Diagnosis of IMHA:
CBC- anemia, +/- elevated reticulocytes, spherocytes, polychromasia, anisocytosis
Do saline slide agglutination test
Coombs test- to see if there are antibodies against RBC’s
Imaging to look for neoplasia
Infectious disease testing
RX for iMHA
Immunosuppressive- prednisone, azathioprine, cyclosporine, mycophenolate
Blood transfusion
Prevent thromboembolism with aspirin, low molecular weight or heparin
Prognosis for IMHA
Prognosis is guarded, regenerative anemia is expected but bone marrow needs 3-5 days to respond
Pyometra facts
usually E. coli is cultured from them, occurs within 3-4 weeks after estrus (so in diestrus), HIGH PROGESTERONE
What stones are common with ethylene glycol toxicity?
Calcium oxalate monohydrate crystals
_____ are stones found in dalmatians and ____ stones are those commonly found in p with PSS
Uric acid; urate
euthyroid sick syndrome causes high or low thyroid?
Low
snake envenom tx
Benadryl, NSAIDs (if not already too thrombocytopenic), antivenom, IV fluid +/- blood transfusion
snake bite p have what on blood smear?
Echinocytes
What causes echinocytes (abn shaped RBC that look like what?
Caused by some drugs, dehydration, e’lyte depletion, renal disease, RBC disorders, snake envenomation, severe burns in horses, clostridial infections, bee stings, and colic
What are the clin path signs of snake envenomation?
Prolonged PT and PTT, decreased antithrombin activity, elevated lactate, CK, triglycerides, bilirubin, globulins, thromboycytopenia, hypoproteinemia, hemolysis and anemia
what is the tx of snake envenomization in dogs/cats??
Fluids, ampicillin to prevent secondary clostridial infections, antihistamines, glucocorticoid steroids (contoversials bc decreased anti-venom activity and may make bacterial inf worse so only use if p has laryngeal edema from shock!!!), antivenom, monitor p every 24 hours with CBC, PT, PTT, PCV/TS, and blood pressure and monitor HR, RR, Temp Q 10 mins when giving the antivenom since it is a biologic and adverse rxns like anaphylaxis may occur
