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Comprehensive guide NAVLE > Saunders- Clinical Pathology and Chemistry > Flashcards

Saunders- Clinical Pathology and Chemistry Flashcards

1
Q

BUN increased means decreased GFR, but can be falsely elevated with high ____ and/or this issue

A

high protein diet and/or GI bleeding

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2
Q

Creatinine

A

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)

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3
Q

What does increased serum phosphorus concentration raise concern for?

A

an increase in serum phosph. is not seen until more than 85% of nephrons are nonfunctional (chronic renal failure aka CRF)

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4
Q

what regulates phosphorus resorption in the renal tubules?

A

Parathyroid hormone (PTH)

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5
Q

what causes high phosphorus?

A

renal diseases, elevated from growing (bone growth) in young animals, cell damage, acute acidosis, ruptured urinary bladder, hypertonic sodium enema, hyperparathyroidism

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6
Q

what is the gold standard for GFR evaluation?

A

INULIN (which is a type of prebiotic) clearance (but inulin is hard to get so good luck)

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7
Q

What e’lyte is useful to evaluate to find out if its prerenal or renal azotemia?

A

Sodium
with prerenal azotemia- sodium conservation (not heavily excreted)
with renal azotemia- high sodium excreted

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8
Q

why might urine be green in color?

A

Bilirubin oxidation to biliverdin or pseudomonas bacterial infection

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9
Q

why is rabbit urine white?

A

bc high concentration of calcium carbonate

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10
Q

1+ protein in n in dogs with _____

A

high USG

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11
Q

what does persistent heavy proteinuria in the absence of high USG suggest?

A

GLOMERULAR DISEASE

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12
Q

active sediment with proteinuria usually means….

A

inflammatory renal disease or low urinary tract disease

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13
Q

only ___ bilirubin appears in the urine and can be normal in male dogs

A

conjugated

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14
Q

what are some causes of bilirubinuria?

A

hemolysis, liver disease, extrahepatic biliary obstruction, fever and starvation

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15
Q

occ. ___ and ____ are normal in urine sample

A

RBCs and WBCs

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16
Q

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

A

culture every 12 months

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17
Q

clumps aka rafts of transitional epithelial cells in urine means

A

neoplasia or infection
if there is just a few without clumps then that suggests inflammation, irritation, or neoplasia

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18
Q

renal epithelial cells in a urine sample means..

A

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)

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19
Q

What are casts in a urine sample

A

Casts are cylindrical molds of the renal tubules composed of aggregated proteins or cells.

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20
Q

white cell casts means… in urine sample

A

means pyelonephritis or interstitial nephronic disease

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21
Q

types of urine crystals found in alkaline urine:

A

Struvite, phosphate, ammonia biurate

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22
Q

Types of urine crystals found in acidic urine-

A

uric acid crystals (associated with Dalamatians) ++
Calcium oxalate
Cystine crystals++

Cant see on rads ++

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23
Q

what type of crystals are seen In dalmatian p???

A

Uric acid

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24
Q

What crystals in urine are found in cases of acute renal failure from ethylene glycol toxicity?

A

Calcium Oxalate monohydrate crystals

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25
Q

______ dehydration is assoc. with diabetes insipidus and cattle in heat stress bc they produce ____ sweat and dogs and cats bc they dont sweat

A

hypertonic dehydration; hypotonic

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26
Q

____ dehydration occurs in horses in heat stress bc they produce ____ sweat

A

Hypotonic dehydration; hypertonic sweat is produced by horses

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27
Q

_____ dehydration is the most common type of dehydration where the conc of NaCl goes down

A

Hypotonic dehydration (loss of electrolytes)

Know hypertonic dehydration is primarily just loss of water

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28
Q

What are the blood gas derangements expected with metabolic acidosis?

A

primary loss is decreased HCO3 and PCO2 increased for compensation

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29
Q

What blood gas derangements do you expect with metabolic alkalosis?

A

primary change is increased HCO3- and the compensation is PCO2 will increase

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30
Q

respiratory acidosis

A

Primary change is increased PCO2 and the compensation will be increased HCO3-

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31
Q

respiratory alkalosis

A

primary change will be decreased PCO2 and HCO3- is increased in compensation

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32
Q

increased base deficit means…. what about decreased????

A

increased means metabolic alkalosis and decreased means metabolic acidosis

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33
Q

what is anion gap?

A

(Na + K ) - (Cl + HCO3-)
estimates changes in unmeasured cations and anions

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34
Q

what is fanconi syndrome? (usually seen in benji’s)

A

A defect of proximal tubule leading to malabsorption of various electrolytes that would otherwise be absorbed if normal (resulting in release in excess in the urine)

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35
Q

What metabolic derangement (low ____ ) is assoc. with alkalosis

A

hypokalemia

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36
Q

Glucose or insulin or release of catecholamines (cushing’s disease) can cause ____

A

hypokalemia which is metabolic alkalosis

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37
Q

Hyperkalemia is assoc. with acidosis and is seen with what common issues?

A

thrombocytosis, leukemia, hemolysis, akita dogs, HYPP in QH, ischemia, reperfusion injuries, Cushing’s disease, renal failure, ruptured urinary bladder, NSAIDs and ACE inhibitors

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38
Q

______ increases phosphorus resorption from the bone to put into GI tract and in urine

A

Calcitriol

39
Q

what levels of e’lyte move along with phosphorus?

A

Calcium

40
Q

Low magnesium is seen with what two diseases in cattle?

A

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

41
Q

Addisons disease e’lyte abn:

A

Hyperkalemia, hyponatremia, hypercalcemia
and hypochloremia with hypermagnesia

👌👌
High K+, Ca2+, Mg+
Low NaCl

42
Q

What measurement of Calcium is most accurate?

A

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)

43
Q

acidosis increases ____ concentration

A

ionized calcium concentration

44
Q

enzymes of the liver- leakage enzymes (2 of them)

A

ALT and AST

45
Q

enzymes of the liver- induced enzymes-

A

ALP and GGT

46
Q

what enzymes tell you there is liver damage?

A

GGT and ALP (liver induction enzyme)

47
Q

what enzymes tell you there is liver failure? what about liver damage?

A

liver failure is leakage enzymes (so ALT and AST) and liver damage is GGT and ALP which are liver induction enzymes

48
Q

high ALT and AST in cat or dog=
High ALT and AST in horse or cattle=

A

dog or cat= liver failure +/- muscle damage
cows and horses= muscle damage

49
Q

In horses and in cattle, what leakage enzyme that IS liver specific if used to be more accurate in detecting injury to the hepatocytes?

A

SDH (liver specific leakage enzyme with very short 1/2 life)

50
Q

ALP

A

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

51
Q

what is a good indicator of cholestasis from labwork?

A

ALP increased (and bilirubin will be increased later on)

52
Q

Half life of ALP is about ____ hours in dogs and ___ hours in cats

A

60 hours; 6 hours

53
Q

GGT enzyme

A

induced enzyme, but acute injuries will cause it to increase
usually increased from cholestasis or steroids or anti-seizure meds,

54
Q

____ is the enzyme to look at if suspecting cholestasis in cows or horses

When might it be elevated NOT due to cholestasis???

A

GGT (but beware bc will be increased in p that just ingested colostrum!!)

55
Q

bile acids

A

if more than 200= PSS
Fasting and postprandial (post-feeding high fat diet like a/d) samples are usually collected in dogs and cats

56
Q

ammonia concentrations is usually increased in those with PSS or if ___% of the ____ mass is lost

A

60%; liver mass

57
Q

Albumin decreases if more than ___-___% of liver functional is lost

A

60-80%

58
Q

Explain the fluctuations of glucose with liver disease:

A

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

59
Q

urea is synthesized in the ____ from _____

A

liver from ammonia

60
Q

BUN increases or decreases with liver failure? What about blood ammonia levels?

A

BUN DECREASES but blood ammonia INCREASES

61
Q

cholesterol may be increased with ____ and is increased with _____

A

cholestasis; hypothyroidism

62
Q

Coag. factors will be ___ with liver damage

A

low

63
Q

PSS signs on labwork-

A

high bile acids and microcytic anemia with low iron +/- urate crystals in the urine

64
Q

Hepatic lipidosis clin path

A

Leakage enzymes will be increased along with bilirubin and bile acids

65
Q

Steroid hepatopathy is most common in what species? What clin path signs will you appreciate??

A

Dogs; Induced enzymes will be the most increased followed by mild increased leakage enzymes and bilirubin

66
Q

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???

A

INCREASED: ammonia, induced liver enzymes, bilirubin, and bile acids

DECREASED: BUN, albumin+/- glucose

67
Q

if amylase is through the roof in dogs (the only species this is true for…) think this:

A

Pancreatic injury

68
Q

Vit B12 aka cobalamin and folate both decreased in cat means what? What about in dogs???

A

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

69
Q

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

A

True!!

70
Q

ALT higher than AST in dogs and cats with no CK elevation=

A

Liver injury

71
Q

Increased AST but not ALP and CK in dogs and cats=

A

muscle damage

72
Q

Increased AST and no CK in horses and rum=

A

Liver injury

73
Q

Increased AST and CK in horses or rum=

A

skeletal muscle injury or skeletal muscle and liver muscle injuries

74
Q

Cholesterol is present only within ____ ____

A

animal tissues

75
Q

what is the test of choice for iatrogenic hyperadrenocorticism?

A

ACTH stim test

76
Q

what are the 4 P’s for Hyperadrenocorticism?

A

Classic case- the four P’s- Polyuria, polydipsia, polyphagia, panting

77
Q

What are the 3 types of cushings disease?

A
  1. Pituitary dependent hyperadrenocorticism (PDH)
  2. Adrenal dependent hyperadrenocorticism (ADH)
  3. Iatrogenic
78
Q

What changes to labwork to we see in p with cushings?

A

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

79
Q

What is the tx of choice for Cushing’s disease?

A

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

80
Q

RX for collapsing trachea dogs

A

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

81
Q

Symptoms of IMHA–>

A

lethargy, weakness, pallor, tachypnea, icterus, variable organomegaly, discolored urine from hemoglobinuria or bilirubinuria

82
Q

Diagnosis of IMHA:

A

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

83
Q

RX for iMHA

A

Immunosuppressive- prednisone, azathioprine, cyclosporine, mycophenolate
Blood transfusion

Prevent thromboembolism with aspirin, low molecular weight or heparin

84
Q

Prognosis for IMHA

A

Prognosis is guarded, regenerative anemia is expected but bone marrow needs 3-5 days to respond

85
Q

Pyometra facts

A

usually E. coli is cultured from them, occurs within 3-4 weeks after estrus (so in diestrus), HIGH PROGESTERONE

86
Q

What stones are common with ethylene glycol toxicity?

A

Calcium oxalate monohydrate crystals

87
Q

_____ are stones found in dalmatians and ____ stones are those commonly found in p with PSS

A

Uric acid; urate

88
Q

euthyroid sick syndrome causes high or low thyroid?

A

Low

89
Q

snake envenom tx

A

Benadryl, NSAIDs (if not already too thrombocytopenic), antivenom, IV fluid +/- blood transfusion

90
Q

snake bite p have what on blood smear?

A

Echinocytes

91
Q

What causes echinocytes (abn shaped RBC that look like what?

A

Caused by some drugs, dehydration, e’lyte depletion, renal disease, RBC disorders, snake envenomation, severe burns in horses, clostridial infections, bee stings, and colic

92
Q

What are the clin path signs of snake envenomation?

A

Prolonged PT and PTT, decreased antithrombin activity, elevated lactate, CK, triglycerides, bilirubin, globulins, thromboycytopenia, hypoproteinemia, hemolysis and anemia

93
Q

what is the tx of snake envenomization in dogs/cats??

A

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

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