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SAM Exam 1 > Lecture 1 - Hypoproteinemia (Cooke) > Flashcards

Lecture 1 - Hypoproteinemia (Cooke) Flashcards

1
Q

least likely to result in moderate to severe hypoproteinemia in an adult dog:
anorexia
hepatic dysfunction
PLE

A

anorexia!!

an adult dog with a functional liver can be starved for a long time and liver will maintain glucose, albumin, cholesterol, etc

in puppies this is different bc they don’t have the reserves of an adult

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2
Q

albumin is a __ protein that decreases with inflammation

A

negative acute phase

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3
Q

__ by itself is highly unllikely to cause hypoalbuminemia

A

malnutrition (maldigestion/malabsorption or starvation)

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4
Q

3 mechanisms of decreased protein production

A

hepatic failure
inflammatory dz
malnutrition (maldig/malabs, starvation)

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5
Q

4 mechanisms of increased protein loss

A

renal*
intestinal*
third space
burns/wounds

*first 2 are most common

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6
Q

example of how protein lost via the third space

A

protein entering the third space alone will not cause significant drop, however multiple taps of these spaces can result in hypoalbuminemia (ie. abd taps removing all the fluid)

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7
Q

CS of a patient with hypoproteinemia

A 
none, can be incidental finding
peripheral limb swelling 
ventral pitting edema 
abdominal distension (ascities) 
cough/dypsnea
decreased appetite (incr pressure on viscera) 
vomiting/diarrhea (GI dz, gut edema)
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8
Q

is ascities or pleural effusion more common with hypoproteinemia

A

ascities

the lymphatics in the chest are good at taking excess fluid away

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9
Q

young dog with low protein is likely due to

A

congenital (hepatic shunt, failure of passive transfer)

infectious (parvo, hooks)

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10
Q

older dog with low protein is likely due to

A

inflammation (IBD, lymphangiectasia)
neoplasia
metabolic (EPI, hepatic dz, PLN)
infectious (parasite, fungal)

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11
Q

__ diarrhea more commonly causes protein loss

A

small bowel

large bowel (except HGE) will not cause significant protein loss

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12
Q

Retinal hemorrhage or detachemnt and tortuous retinal vessels indicate

A

hypertension

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13
Q

2 main mechanisms that result in hypooproteinemia

A

decreased production
increased loss

  • NOT anorexia
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14
Q

oral ulcers and PLN indicates

A

uremia/kidney dz

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15
Q

a murmur with hypoproteinemia can indicate

A

endocarditis

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16
Q

more severe muscle wasting indicates __ timeline

A

several weeks, chronic

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17
Q

hypoalbuminemia from decreased production

A

hepatic failure

inflam dz

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18
Q

hypoalbuminemia from increased loss

A

PLN

PLE

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19
Q

Hypoglobulinemia ddx

A

PLE,
blood loss
failure of passive transfer

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20
Q

__ tell you nothing about liver function!

A

liver enzymes

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21
Q

5 liver function values on chemistry

A 
glucose
cholesterol
BUN 
t. bilirubin 
albumin
22
Q

always do a __, easy way to r/o PLN

A

urinalysis

23
Q

don’t do a __ on an active urine sediment

A

UP:C

24
Q

If hypoalbuminemia is causing ascities what do you expect the fluid to look like

A

transudate (or modified transudate if more chronic)

25
Q

radiographs are beneficial in hypoproteinemia cases if

A

no ascities
want to measure liver*
assessing bones for infection or neoplasia*
assess kidneys

*can’t do with AUS

26
Q

what does a normal AUS with bloodwork indicating hepatic damage tell you?

A

know the patient is NOT normal, must pursue other dx

27
Q

r/o kidneys/PLN but not sure if it’s liver, gut, other. What next?

A

bile acids

if bile acids are abnormal then evaluate for PSS

+/- biopsies of liver and intestines

28
Q

if albumin is less than 2 and giving IVF what is a risk

A

fluid overload

try using colloid support:
hetastarch/synthetics can help draw fluid from third spaces
plasma to replace albumin/clotting factors

if albumin less than 1 worry about gut edema

29
Q

colloid therapy in hypoproteinemic patient is used to

A

buy time, it is not fixing the problem!

30
Q

how does low albumin affect anesthesia

A

lots of protein bound agents! animal will be more sensitive to effects of protein bound drugs (more free form, need to decrease dose)

31
Q

how does low protein affect wound healing

A

wound dehiscence is a concern if albumin is less than 1.5

32
Q

in all protein losing dz there is loss of antithrombin, making patient prone to __

A

thromboemboli (most common with PLE)

33
Q

Patient you are concerned has heaptic failure, low protein, and see petechiae. What test should be run before poking anything?

A

PT/PTT

34
Q

7yo Yorkie presents with a chronic reoccuring swollen abdomen and balloted fluid wave (rDVM taps periodically). most likely ddx

A

fluid is most likely edema (not blood or pus due to hx duration)

ddx: 
RHF
portal hypertension
PSS 
hypoproteinemia 
neoplasia
35
Q

panhypoproteinemia w/o azotemia would also expect what other lab abnormality

A

hypocholesterolemia

36
Q

abdominal fluid with SG 1010, TP 1mg/dL and 100 cells/mcl, what kind of fluid is this?

A 
pure transudate (low cell count, low protein count) 
ie. hypoalbuminemia
37
Q

fluid with high protein and cell count

A

exudate

38
Q

fluid with intracellular bacteria observed

A

septic

39
Q

low cell count and higher protein count

A

modified transudate (portal hypertension)

40
Q

liver makes globulins, why is it not usually a differential for panhypoproteinemia?

A

liver makes alpha and beta globulins

we measure gamma globulins on serum chm (made by plasma cells, doesn’t rely on liver function)

41
Q

lymphangectasia tx

A

low fat diet

+/- steroids

42
Q

lymphangectasia causes

A

IBD
Neoplasia
congenital

43
Q

causes of hypoalbuminemia

A

PLN
PLE
Inflammation (neg APP)
liver dysfunction

44
Q

causes of hyperglobulinemia

A

chronic inflammation

neoplasia

45
Q

causes of proteinuria

A

PLN
Infection
neoplasia
hypertension

46
Q

provides oncotic support, clotting factors, fibrin

A

plasma

47
Q

provides oncotic support but no clotting factors or fibrin

A

synthetic colloids (hetastarch)

48
Q

approach to hypoproteinemia; is there proteinuria? yes vs no

A

if yes, is the sediment active or inactive?

if no, run a bile acids

49
Q

if urine sediment is active and proteinuria is present what is the next step

A

urine culture and sensitivity; treat and reassess

50
Q

if urine sediment is inactive with proteinuria what is next step

A

UP:C

if this is normal then look for other sources of low protein

if high the check BP, HW, tick-borne dz

51
Q

if bile acids are abnormal with hypoproteinemic patient? normal?

A

liver bx

if normal then do a fecal, deworm, diet trial, intestinal bx

SAM Exam 1 (15 decks)

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