Serum Chemistry (MR) Flashcards
Clin Med Serum Chem Lectures
1
Q
Albumin is produced where? If it is low?
A
Liver. If low: Possibly impaired liver function
2
Q
What are the 4 things on a Serum Chemistry that test Liver Function?
A
C-BAG: Cholesterol
BUN (not biliruben)
Albumin
Glucose
3
Q
What do liver enzymes tell you about function?
A
Nothing
4
Q
When I say Biliruben, you say?
A
Prehepatic, Hepatic, or Posthepatic
5
Q
What causes hyperalbuminemia?
A
Dehydration
6
Q
How do you calculate your globulins?
A
TP - Albumin
7
Q
Big Ruleouts of Hypoalbuminemia? (9)
A
Poor diet Diarrhea/PLE Fever Infection Liver Dz Burns Vasculitis Glomerulopathy/PLN
8
Q
What type of enzyme is AST? AST is a marker for?
A
Mitochondrial Enzyme. Cellular Damage
9
Q
Is AST specific for liver cellular damage?
A
NO
10
Q
An elevation in AST is suggestive of? (4)
A
Liver damage Kidney Infection
Myocardial Infarction
Muscle Damage
11
Q
Regarding ALT & AST what is the magnitude of increase required in dogs? Who is this NOT true for? Why?
A
2-3XC. Not true for ATS!
The t1/2 is very short in cats so if it does get high they pee it out
12
Q
How small of a change in pH can start to kill things?
A
0.1
13
Q
ALT is what type of enzyme?
A
Cytoplasmic Enzyme
14
Q
What is ALT and indicator of?
A
Hepatocyte injury
15
Q
How long post acute injury is AST at max level?
A
48 Hours
16
Q
ALT t1/2 dogs?
A
3 days
17
Q
ALT t1/2 cats?
A
6 hours
18
Q
If you were to kick a dog in the liver which enzyme, ALT or AST would need a harder kick?
A
AST
19
Q
Which of ALT & AST is more specific for liver damage? Why?
A
ALT, A lot of other tissues produce AST
20
Q
Alkaline Phosphate is what type of enzyme? Where does it exist?
A
Membrane Bound, Bile Canicular Surface
21
Q
What is alkaline phosphate (ALP) an indicator of?
A
Intra or Extrahepatic Cholestasis - backup of bile starts stretching out the bile canicular cells and membrane sticking off edge peels off and goes into blood
22
Q
What elevations in ALP are concerning?
A
> 4X
23
Q
ALP isoenzymes? (6)
A
Liver Bone
Pregnancy
Steroids (DOG) - endog or exog - can last weeks or months
Phenobarb
24
Q
ALP t1/2?
A
Again, shorter in cats, any elevation is of concern
25
Who ALWAYS has elevated ALP? Why?
Puppies! Growing - Bone Isoenzymes
26
GGT is almost the same as what other enzyme? Difference in dogs?
ALP, dogs- Not as affected by steroids
27
GGT is what kind of enzyme? Where does it exist?
Membrane Bound, In Bile Duct Epithelium
28
If both GGT and ALP are elevated what is this suggestive of? What else is suggestive of this?
Hepatic Lipidosis. Also indicated by GGT normal with elevated ALP
29
Bilirubin: Prehepatic is?
Hemolytic Anemia
30
Bilirubin: Hepatic is?
Liver Dz or Injury
31
Bilirubin: Post Hepatic is?
Cholestasis
32
BUN/SUN is made where? Meaning?
Liver! Meaning it is a Liver Function Test!
33
What is a GI bleed considered?
A high protein meal!
34
BUN/SUN elevations are due to? (4)
High protein intake/GI bleed, Renal Dz,
Dehydration ,
Exercise
35
BUN/SUN decreases are due to? (4)
Poor diet/Restricted Diet, Malabsorption,
Liver Dz,
Diuresis
36
How much damage in kidney function is lost before Creatinine elevation?
75%
37
What is the earliest kidney function test?
USG @ 66%
38
Elevations in Creatinine can be due to? (5)
Renal Dz (75% loss), Muscle degeneration or damage,
Drugs,
Dehydration,
Greyhounds - slightly
39
Who has lower normal range for Creatinine levels?
Puppies
40
What must be elevated to qualify as Azotemia?
Elevated BUN and/OR Creatinine
41
What kind of blood work would you like to run?
CBC,Chem,
| UA - if not then at least USG
42
I say Azotemia, you say?
Pre-renal Renal
| Post-renal
43
What MUST you evaluate along with your BUN and/OR Creatinine or you are wasting your time!
USG
44
What is more important for renal function USG or Creatinine? Why?
USG, It happens first! (66% loss)
45
What does the liver do with Glucose? Making it a?
Makes, Metabolizes, and
Stores it
. Making Glucose it a Liver Function Test
46
Elevations in Glucose are caused by? (6)
```
Diabetes Mellitus Pancreatitis
HYPERadrenocorticism
Steroids
Hypothyroid
Postprandial
```
47
Decreases in Glucose are caused by? (6)
```
Liver Dz Chronic Infections
Sepsis
Pyometra
Insulinoma
Hepatomas & other certain tumors
```
48
Calcium is regulated by?
PTH Calcitonin
Vit D
GI absorption
Renal Function
49
Which regulator of Calcium levels is the "BIGGEST GUN"?
PTH
50
TQ! How do you determin whether Ca2+ leverls are actually abnormal?
Evaluate Ionized
51
What are the 3 forms of Ca2+?
Ionized Bound
| Complexed
52
What percentage of Ca2+ is Ionized? Bound? Complexed?
50% - Ionized 40% - Bound 10% - Complexed
53
What is the best representation of free calcium?
Ionized
54
What is Bound Ca2+ bound to?
Albumin
55
What is complexed with Ca2+?
Phosphate Citrate
Sulfate
Lactate
Bicarb
56
Is it appropriate to correct Ca2+ for Albumin?
NO!
57
Cx of HYPOcalcemia? (8)
```
Increases in excitability - lowers threshold, Nervousness
Behavior Changes
Facial Itchiness
Muscle Cramping
Stiff Gait
Tetany
Seizures
```
58
Cx of HYPERcalcemia?(5)
Inhibits neurons & Mm cells - Decreases excitability (lowers threshold). Mineralization of tissues
Weakness
Vomiting
Constipation
59
Parathyroid glands respond to?
Low Serum Ca2+
60
Where does PTH go? Where does it then send messengers to?
Kidney. Messengers to Bone
61
What does the gut absorb to enable Ca2+ absorption?
Vit D
62
How does the endrocrine system control itself?
Negative Feedback
63
What turns off the production PTH?
Increasing serum Ca2+ levels
64
Rule Out List for Hypercalcemia?
```
G.O.S.H.D.A.R.N.I.T: Granulomatous Dz
Osteopathy/Osteolytic Dz
Spurious - lab abnormality
Hyperparathyroidism
D Hypervitaminosis
Addisons
Renal Dz
Neoplasia
Idiopathic - Cats
Temperature - Cats when they get cold (weird)
```
65
What are the neoplasms associated with Hypercalcemia?
Lymphosarcoma - THE MOST. Anal Sac Adenocarcinoma
| Multiple Myeloma
66
Rule Out List for HYPOcalcemia?
```
H.E.R.P.E.S.: Hypoparathyroidism
Eclampsia
Renal Dz
Pancreatitis/Phosphorous (Never give a cat a phosphate enema)
Ethylene glycol
Spurious
```
67
Low PTH and Low Calcium probably has?
1º Hypoparathyroidism
68
High PTH and Low Calcium probably has? Why?
2º Hyperparathyroidism. Due to Diet
| Renal
69
What kind of enema will you NEVER give to a Cat?
Phosphate Enema.
70
If Calcium is High what should PTH levels be?
ZERO OFF NADA
71
High Calcium and Low PTH?
Hypercalcemia of Malignancy, Lymphosarcoma,
Anal Saac Carcinoma,
Multiple Myeloma
72
Why are the kidneys important for calcium? (2)
PTH goes to the Kidney and tells it to save calcium: Kidney activates Calcidiol (25 Hydroxy - Vit D3) -> Calcitriol (1,25 Dihydroxy Vit D3)
73
What is the active form of Vit D?
Calcitriol (1,25 Dihydroxy Vit D3)
74
If your calcium goes up what is it?
Cancer: Either Hyperparathyroidism or Hypercalcemia of Malignancy
75
Why do you get increased Phosphorous?
```
Decreased GFR Renal Failure - 85%
Growth
Diet
Ethylene Glycol
Hypoparathyroidism
Hemolysis
```
76
How much kidney function must be lost to show increased serum phosphorus due to renal failure?
85%
77
What is phosphorous important for with bone growth?
ATP
78
Which differential for hypophoshatemia gives CRAZY hight levels?
Ethylene Glycol
79
Differentials for Decreases in Phosphorus?
Hyperparathyroidism, Humoral Hypercalcemia of Malignancy (HHM),
Eclampsia
80
What is the Principal INTRAcellular Cation?
K+
81
Differentials for Elevated Potassium?
```
Renal Dz Hemolysis
Acidosis
Hypoadrenocorticism
Iatrogenic
DM (acidosis or lack of insulin)
```
82
Which cation is more tightly regulated H+ or K+?
H+
83
What is the principal EXTRAcellular Cation?
Na+
84
Differentials for increased Na+?
Dehydration Vomitting
Dxa
Hyperaldosteronism
85
Differentials for Decreas in Na+?
Vomitting Dxa
| Hypoadrenocorticism
86
What is the principal EXTRAcellular Anion?
Cl-
87
If Cl- levels don't follow Na2+ levels what should you evaluate?
Acid-base status. Getting chucked out by kidney to save Bicarb
88
What does Cl- cary inversely with?
HCO3- (bicarb)
89
Why would you see HYPERchloremia?
Low Bicarb = Acidosis
90
Why would you see HYPOchloremia?
High Bicarb = Alkalosis
91
Why is Mg2+ important (broad)?
When Mg2+ gets really low what exchanges with it? Cofactor for a ton of functions
92
What is the biggest result of hypomagnesemia?
Arrhythmias
93
What is the result of hypermagnesemia?
??? - slide missing
94
How do you calculate Anion Gap?
Cations - Anions
95
What are the differentails for Increased Anion Gap?
Metabolic Acidosis (Organic), Toxins
96
List causes of Metabolic Acidosis (organic)?
Lactic Ketotic
Uremic
Massice Tissue Injury
97
List toxins that would cause increased Anion Gap?
Ethylene Glycol, Methanol,
| Metaldehyde (snail Bait)
98
What are the differentials for a decreased Anion Gap?
Hypoalbuminemia
99
What is going on with your anions in a decreased Anion Gap?
Increase in unmeasured anions (many carried by albumin)
100
Creatine Kinase is what type of enzyme?
Muscle
101
Why would you show elevated Creatine Kinase?
Myopathy Trauma
| Hypothyroidism (later Stages)
102
Checking CK for elevation due to elevated levels of AST helps differentiate what?
Damage in Liver vs Muscle
103
Cholesterol is what type of test?
LIVER FUNCTION!!!
104
Decreases in Cholesterol can be due to?
Hepatic Insufficiency
105
Differentials for Elevations in Cholesterol?
```
Dietary ***Hypothyroidism - 85%
Renal Dz - Nephrotic Syndrome
Hepatic Dz - not specific
Pancreatitis
DM
```
106
What % of Dogs with Hypothyroid have elevated Cholesterol levels?
85%
107
Amylase & Lipase elevation/decreases are significant for? (2)
Can have elevation or low and still have pancreatitis or renal dz. Neither sensitive nor specific - SHORT t1/2
108
High Calcium and High PTH? 1º
Hyperparathyroidism
