Exam 2 Clin Path Flashcards
(384 cards)
1
Q
What are causes of hypotonic dehydration?
A
- Secretory diarrhea
- Vomiting
- 3rd space loss
- Heat stress & sweating in horses: Often Cl-losses are greater than Na+losses
1
Q
Mineralization of soft tissues occurs when calcium x phosphorus > ____
A
70
Also depends on PH
2
Q
T/F: SDMA is clinically used to monitor and manage renal disease in cats
A
True!
3
Q
T/F: Chronic renal failure is irreverible
A
True =(
(acute may or may not be irreversible)
3
Q
Why is Cystatin C a good biomarker for renal function?
A
- Constantly produced and released by nucleated cells
- Freely filtered by glomerulus
- Reabsorbed and catabolized in the renal tubules
- Does not re-enter the bloodstream
- Is not excreted in urine
3
Q
What are two causes of a metabolic alkalosis?
A
Excessive Renal Loss of H+
- Diuretics
- Increased mineralocorticoid activity (aldosterone)
3
Q
What are exudates and when do they occur?
A
High cell (>6000/uL) and high protein (>3 g/dl) that form due to increased capillary permeability due to inflmammation
3
Q
What type of cells would you expect to find in an acute chylous effusion vs a lonstanding chylous effusion?
A
Acute- small lymphoblasts
Chronic- inflammatory = neutrophils and macrophages and lymphocytes
cells may be contracted and fragile due to the lipid in the effusion
4
Q
T/F: Type AB cats are universal blood donors
A
FALSE- They are universal recipients and CANNOT donate blood
4
Q
What makes a fluid suppurative??
A
More the 85-90% neutrophils
4
Q
In large animals (LA), which reflects liver function better: ALT or AST?
A
AST
——————————————–
There is more ALT in muscle than in the liver so it is NOT used in LA.
AST is not liver specific, but it is more in the liver than ALT is in LA. Should run CK concurrently with ALT.
SDH* and GLDH can be used in LA.
5
Q
What test Estimates the quantity of urinary protein excreted/ day?
A
Urinary Protein: Creatinine Ratio (UPCR)
5
Q
What are the top 3 causes of NORMOglycemic glucosuria?
A
- Transient stress
- Reversible tubular damage: drugs, hypoxia, infection, toxins
- Cats with urethral obstruction (unknown mechanism)
Others:
Fanconi’s syndrome: inherited tubular transport protein defects
Primary renal glucosuria: inherited glucosuria w/o hyperglycemia
6
Q
T/F: Cats can maintain some concentrating capacity with renal failure. Thus they may have renal azotemia, but still have concentrating ability
A
True… they are dessert animals
6
Q
Why does hypercalcemia cause PU/PD?
A
Ca interferes with ADH receptor
Secondary to renal failure due to calcification
7
Q
DEA and Dal are the 2 major blood groups of what species?
A
Canine
8
Q
Is it normal to find some fluid in the abdomen of a horse?
A
Yup. There are reference intervals for it.
9
Q
What is the significance of these crystals?
A
Ammonium biurate (urate)
Normal findings in Dalmatians, English bulldogs
Suggest liver disease (seen in association with ↓BUN, ↑NH3)
- LIVER FAILURE
- ‒CONGENITAL OR ACQUIRED SHUNTS
9
Q
What are 4 common causes of respiratory acidosis?
A
- Anesthesia
- Diffuse pulmonary disease
- Intrathoracic lesions
- CNS disease
9
Q
T/F: Plasma ionic Ca and inorganic phosphate are related reciprocally, and solubility is pH-dependant.
A
True
Increase in plasma P decreases plasma Ca
Alkaline pH or large increases in one or both of these ions promotes precipitation of Ca phosphate salts into soft tissues
9
Q
What happens to calcium and glucose levels with ethelyne glycol toxicosis?
A
HYPOcalcemia (metabolite binds calcium)
HYPERglycemia (metabolite inhibits glucose uptake)
(may see Ca oxylate crystals in urine)
10
Q
When do you lose the ability to concentrate urine?
A
after 66% loss
11
Q
Why do we preform crossmatching?
A
Ensures optimal survival of transfused RBCs and RBC of the patient.
12
Q
What are causes of Hypoalbuminemia?
A
-
Decrease production
- Inflammation (negative acute phase protein)
- Liver Failure/Reduced Liver Mass (portosystemic shunt)
- Sever malnutrition/digestion/absorption
- intestinal parasites
-
Abnormal Loss
- Blood loss (with globulin decrease)
- PLE (with globulin decrease)
- PLN
- 3rd spacing (vaculitis, effusions)
- Skin disease, burns
12
Do you like summary tables?
13
T/F: ~25% of addisions/hypoadrenocorticism patients develope hypercalcemia
True
-------------------------------
Will also have low Na and high K
14
What are the three main causes of azotemia?
1. Pre Renal- ↑ BUN, +/-↑ CREA, **↑ SpGr**
2. Renal - ↑ BUN, ↑ CREA, **↓ SpGr**
3. Post-Renal- ↑ BUN, ↑ CREA, **variable SpGr**
15
What else will you see if the hypoalbuminemia is caused by PLE?
**Diarrhea**
**decreased cholesterol, Mg (+/-) and globumin**
--------
should do gastrointestinal endoscopy with biopsy or exploratory laparotomy
15
What type of tumor is this from? The patient had a monoclonal gammopathy.
Multiple Myeloma
Pink stuff= immunoglobulins
15
Which two causes of hypophosphatemia can also cause hypercalcemia?
primary hyperparathyroidism and hypercalcemia of malignancy
-----------------------------------------------
Hypercalcemia may result in mineralization of the kidneys, with resulting decreased GFR, and subsequent normal or increased serum P concentrations.
16
Why do you want to keep fine-needle aspirate slides away from formalin and formalin fumes?
Formalin interferes with the wright stain
16
Extremely high CK due to muscle injury can lead to increases in \_\_\_\_\_\_\_\_\_
ALT
17
Why does metabolic acidosis occur in severe renal disease?
–↑ urinary loss of HCO3
–↓ tubular secretion of H+ions
–Accumulation of unmeasured anions (high anion gap)
18
What directly influences the release ADH?
* Na+ concentration (hyperosmolality)
* Blood volume (SEVERE hypovolemia)
...release lead to water reabsorption via aquaporins in the CT
19
What are two causes of hypofibrinogenemia?
Liver failure (decreased production)
DIC (consumption)
19
What cells are common in joint fluid?
Large mononuclear cells = macrophages and synovial lining cells
21
T/F: Major Crosschecks combine the patients RBC with the donors RBC
FALSE!!!
Major Crosscheck = patient **SERUM** + donor **RBC**
**-------------**
**MINOR** crosscheck = patients **RBC** + donor **serum**
21
When will hypercalcemia of malignancy cause hypophosphatemia?
Early stages, prior to kidney mineralization (which leads to a increase in Phos)
22
What are the advantages and disadvantage to catherization for urine collection?
* Advantages - none listed...
* Disadvantages
* blood or epithelial cell contamination
* trauma
* Difficult, especially in females
* Tracking material into bladder --\> bladder infection
23
Hyperkalemia is associated with what? when is it life threatening?
Oliguria/anuria
## Footnote
**Life-threatening in ARF and/or post-renal conditions**
24
T/F: Type A cats are common in north america and they have strong isoantibodies against type B
False! they have WEAK isoantibodies
24
What are the advantages and disadvantages of voided urine collection?
* Advantages - easy (?)
* Disadvantages
* Contamination - cannot use for culture
24
What is the most common liver disease in dogs?
Chronic Hepatitis
25
What should you do if your bile acids are increased?
Follow up
| ( Radiograph, U/S, FNA, wedge biopsy)
26
T/F: Single un-crossmatched **whole blood** transfusions tend to be well-tolerated in horses and other large animals
true
26
What are 4 systemic fungal diseases that you can find on cytology?
Histoplasmosis
Cryptococcosis
Blastomycosis
Coccidiodomycosis
27
What type of tumor are these cells from? Taken from a mass on a young dog.
Histiocytoma
---------------------------
Cytoplasms may be a little lighter than background protein material
Exfoliate very well - FNA will be very dense in cells
BENIGN- typically in _young_ dogs, but can be in any age
28
What urine collection technique is recommended if you want to do a urine culture?
Cystocentesis
29
T/F: To detect hepatocellular damage in LA you should depend on AST with a concurrent CK.
True
30
TCO2 is \_\_\_\_\_\_\_\_; pCO2 is \_\_\_\_\_\_\_\_.
bicarb, acid
31
What is the most common cause of hyponatremia?
Hypovolemia
Losses via GIT, Renal (addisons, ketonuria, diuresis), Cutaneous, and 3rd space
32
What are 5 causes of Acidic urine?
* **High protein diets:** Carnivores/omnivores
* **Respiratory/Metabolic Acidoses**
* **Hypochloremic metabolic alkalosis + severe dehydration**
* **Hypokalemia**
* K+ is exchanged for H+ to maintain electroneutrality
* **Furosemide** –Blocks Na+K+2Cl-pump in Loop of Henle to Cause increases Na+& H+excretion
32
At what level of fasting bile acids will there usually be an identifiable liver lesion by histopathology?
\>25 umol/L
---------------------------
If b/w 10 and 25 ("grey zone") you should preform a 2 hours post-prandaial bile acid test
Normal fasting bile acids is
33
What two blood types are highly immunogenic and can cause neonatal isoerythrolysis in horses?
Aa & Qa
33
What are 4 common causes of alkaline urine?
* **Urinary Tract Infections (UTI)**
* Urea splitting bacteria: Proteus, Pseudomonas, Staphylococcus
* **Low protein diets;** Herbivores –OR- Diet treatment for pathologic crystalluria
* **Respiratory/Metabolic alkalosis**
* **Alkalinizing drugs**
33
What is the significance of Epithelial and Fatty casts in urine?
Activetubular degeneration or necrosis
Renal ischemia, or toxic nephrosis
NOT evidence of extent or reversibility of injury
33
Think of pCO2 as an \_\_\_
acid
34
Acidoisis ____ ionized calcium
Alkalosis ______ ionized calcium
(Decrease or increase)
Acidosis INCREASES ionized calcium
Alkalosis DECREASES ionized calcium
35
What are type B cats susceptible to?
**severe/lethal transfusion reaction**s and **neonatal isoerythrolysis**
35
What is a normal anion gap? What normal ions are not considered?
15-25 is normal
Ca2+, Mg2+, gammaglobulins, Albumin, phosphate, sulfate, organic acids are not considered
36
Immune complex & Amyloid deposition on the renal glomerulus occur in what disease?
GLOMERULONEPHRITIS (GN)
36
Which types of enzymes Usually attached to membranes, rarely
increase due to cell injury
**Induced enzymes**
**-----------------------------**
Increases are usually due to increased production
37
What group of tumors has these characteristics:
* cells in sheets or clusters
* usually many cells present
* distinct cytoplasmic borders + /-
* cells often large with abundant cytoplasm
* sometimes show signs of differentiation
38
How do the periperal blood cells and prognosis vary between acute and chronic leukemias?
* Acute- immature blast cells and short survival time
* Chronic- "mature" well-differentiated cells and long survival time
39
What are dalmatians at risk of when given a blood transfusion?
acute and delayed onset hemolytic transfusion reactions
40
What urine SpGr is considered hypersthenuria?
\>1.040
41
The compensation for acid-base imbalances is of the ______ system and \_\_\_\_\_\_\_type
opposite, opposite
42
In Spectrophotometry: analyte + chemical --\> \_\_\_\_\_\_
color
43
When is isosthenuria normal?
If the animal is **perfectly hydrated**
44
Which is more common in dogs and cats: T-cell CLL or B-cell CLL
**T-cell CLL** (often LGLs)
T cells tend to proliferate in the spleen
45
Are you more concerned if a patient has a 2+ bilirubin with a USG of 1.020 or USG 1.040?
USG 1.020
45
Bile acids are made by the liver from \_\_\_\_\_\_\_\_
cholesterol
46
Symmetric dimethylarginine (SDMA) is a great test to rule ___ chronic renal failure in cats
OUT
\_\_\_\_\_
100% sensitivity test
47
How does necrotizing pancreatitis cause liver disease?
Cytokins insut liver
Inflammation can cause obstruction of the bile duct
48
**T/F:** DEA 7 occurs in 50% of the canine population and is highly immunogenic
FALSE! it is **midly** immunogenic
48
Abdominal fluid from a foals abdomen. What is the arrow pointing to? What is your diagnosis?
arrow: **Calcium carbonate crystal** (normal finding in horse urine)
diagnosis: **uroabdomen**
**----------------------------------------------------------**
It is common for a foals bladder to rupture, especially males, during parturition
48
How much liver function lost do you need in order to see a decrease in albumin?
60-80% function lost = Chronic liver disease
49
What is the cause of prerenal proteinuria?
Increased small proteins in blood
* Paraproteinuria (Bence-Jones= multiple myeloma)
* Hemoglobinuria
* Myoglobinuria
* Post-colostral proteinuria
50
How does addisons disease cause hyperkalemia due to failure of renal excretion?
Decrease aldosterone --\> K retention & Na loss
50
Cholestasis ____ serum cholesterol
| (increases/decreases)
increase
Chol is a precursor of bile acids
51
Normal cells are about \_\_\_\_% small lymphocytes
**~95%**
---------------------------
will also find very few lymphoblasts (2-3%), plasma cells, macrophages and other cells
52
If you have decreased total calcium, what should you check _first:_
1. albumin
2. urine calcium
3. Lung X-rays for calcification
4. go on a cancer hunt
**1. albumin**
50% of Ca is bound to albumin, thus a decrease in total calcium can be due to a decrease in albumin (= apparent hypocalcemia)
Can calculate a corrected calcium (=Total Ca - Albumin + 3.5) or measure ionized/active calcium to determine if it is a true hypocalcemia
54
What are your DDx's for polyuria?
1. Renal
* Renal failute (loss of ~ 66% of functional renal mass)
* pyelonephritis
2. Extra-Renal
* Diuresis
* medullary washout
* endocrine issue (diabetes, cushings)
* pyometra (endotoxins)
54
What will you see in the blood work and urinalysis of an animal with chronic renal disease with a GFR fo ~20% of normal
* Blood work
* Nonregenerative anemia
* Dehydration
* Azotemia
* Hyperphosphatemia (85%)
* Metabolic Acidosis
* **Normal to Hypokalemic (MOST IMPORTANT)**
* Urinalysis
* polyuria
* isothenuria
56
What do you look for on your Macroscopic crossmatch?
Hemolysis (red serum)
Agglutination (specks)
57
What do you see in the BW and Urinalysis of a animal in end-stage renal disease (GFR ~5%)
* Bloodwork
* Nonregenerative anemia
* *Marked* dehydration & azotemia (patients are uremic)
* Hyperphosphatemia
* Metabolic acidosis
* **Hyperkalemia\*\*\***
* Urinalysis
* Isosthenuria
* **Oliguria to anuria**
57
What is your diagnosis for a 2 year old dog with:
* Non-regenerative anemia with other cell lines normal
* Azotemic
* High Ca & High Phos -- product is enough for mineralization
* High K
* Urine SpGr of 1.010
**Primary Renal Disease - Congenital Polycystic Kidney Disease**
He thinks he is a horse and developed a **secondary hyperparathyroidism**
Must correct calcium ASAP to reduce further mineralization
57
Why does a small focal hepatic necrosis not change your leakage enzyme levels?
Only a small number of hepatocytes are leaking. It is not enough to appear abnormal on refernce intervals
58
Blood typing identifies specific RBC ____ in an animal
antigens (Ag)
58
What process should you expect if you have a suppurative joint fluid?
**Immune mediated or bacteial**
----------------------
immune mediated joint disease usually involves multiple joints and they are usually peripheral joint
If septic, it is difficult to find bacteria because they tend to stick to the surface of the joints
59
With protein measurements with a chemistry analyzer, which is calculated: albumin or globulin?
Globulin!
-------------------
Chemistry analyzers use spectrophotometry and a dye binds to albumin to obtain an accurate measurement of albumin.
Globulin is calculated by substracting the measured albumin from the measured TP
**Globulin = TP-Albumin**
This calcualtion is drawn from the fact that almost all total protein in blood is from either albumin or globulin
60
Should we be worried if there is a decreased CREA?
\*\*\*Nope, it is not clinicall significant \*\*\*
61
In a hemoabdomen/thorax, will you find platelets?
Nope, if you find someit means you may have hit a vessel
61
What is the purple stuff in the background of this cat abdominal effusion with a 5.5 TP (high) and Low NCC
protein - the pealed off area is another indicator of high protein fluids
the cat had FIP
62
What is your diagnosis if you have a 8 y.o. dog with:
* Neutropenia
* Lymphocytosis (13.8 on 1-4.8 reference interval)
* Azotemic
* High Ca (15.4 on 9-11.2 RI) & High Phos (7.1 on 2.8-6.1 RI)
* Increased TP (7.9 on 5.4-7.4 RI) - normal ALB and High Glob
* Increase Total bili and increased Alk Phos and ALT
* Normal Na
* High K (5.8 on 4.1-5.5 RI)
* Low TCO2 and a increased anion gap
* Urine SpGr 1.011 & 2+ urine protein
And the following on a liver FNA
**Hypercalcemia of malignancy secondary to lymphoma**
Lymphocytosis and hypercalcemia are the key indicators
Lymphoma infiltrated the liver and bone marrow - explains liver signs and neutropenia
Increase K due to metabolic acidosis or oliguric
Increase anion gap could be due to increase Phos
Kidney signs, electrolyte imbalance and azotemia are due to calcification of kidney --\> decrease GFR
62
What will happen to your ammonia and BUN levels during liver disease?
Ammonia increases = BAD
BUN decreases
63
What is your diagnosis if you have a older male dog patient presenting with seizures, tremors and these findings:
* Stress leukogram
* mildly increased glucose
* Low calcium
* High Phosphorus
* Normal albumin
* _No_ Azotemia
* Low normal PTH
**Primary Hypoparathyroidism**
--------------------------------------------------------------------------
PTH should be very high in the presence of such low Ca, thus a low normal PTH is considered abnormal
Any variation in Ca and P should be concerning
The lack of Azotemia rules out renal disease
64
Perirectal/Anal sac apocrine tumors are typically _______ (benign or malignant)
Malignant!
--------------------------------------------
DO NOT CONFUSE with perianal adenomas
64
What are causes of Hyperphosphatemia?
* Decrease GFR due to renal or pre-renal- MOST COMMON CAUSE
* Ruptures bladder and ureter
* urethral obstruction
* Vit D intoxication
* ACUTE acidosis - due to decrease use of P (chronic will cause decrease P)
* Excessove P intake - only if unfunctional kidney
* Primay Hypoparathyroidism
65
T/F: Fibrinogen (Beta globulin) is a positive acute phase protein
True!
It is used as a marker of inflammation in Horses, ruminants and camelids
66
In what species and age group are **histiocytomas** most common in?
**YOUNG dogs (~6m-2yrs)**
benign and spontaneously regress
67
Any analyte filtered by the glomerulus is an indicator of \_\_\_\_\_
GFR
68
If your urine is red-brown, what cause will not have a change in serum color?
Myoglobin
69
What is the source of renal cells? What is their significance?
Source- renal tubules
Significance- renal tubular injury: infectious, toxic, and ischemic injury
69
What type of crystals have a "picket fence" appearance in Ethylene glycol toxicosis?
**Calcium oxalate monohydrate**
Also seenin healthy animals, animals with Oxalate urolithiasis and Hypercalciuric or hyperoxaluric disorders
69
What type of tumor? From a uncastrated male/female.
**TVT- Transmissible Veneareal tumor**
*Small Vacuoles* and abundant large nucleoli
71
What measures the intensity of light passig though or emitting from a test chamber?
Photometry
72
T/F: increases in fibrinogen alone usually do not significantly affect the total protein concentration
**True!**
**------------**
Fibrinogen is part of the beta-globulin fraction that is measured in mg/dL, while TP/ALB/GLOB is measured in g/dL
72
Which test in more stable: SDH or GLDH
GLDH
--------------------------------
SDH is liver specific for hepatocellular damage in large animals, BUT it has a short half life in vitro and needs to be ran ASAP (
GLDH is liver specific, more stable, but difficult assay to preform and generally in NOT USED, but occasionally used in large animals.
To detect hepatocellular damage in LA you should depend on AST with a concurrent CK.
73
What are 4 causes in increase in nonvolatile acids/ High Anion Gap Acidosis?
* *K**etones
* *L**actate
* *U**remic acids (phosphates, sulfates)
* *E**thylene glycol metabolites (toxins)
74
What are two possibilities of having a fluid bacteria but no neutrophils?
(1) accidently tapped the GI tract (common in large animals) = enterocentesis
(2) Massive rupture and the cells are diluted
-------------------
go back to clinical signs and blood work
75
T/F: Lymph node aspirate cells are very fragile and clot quickly. Thus it is very common to see **Smudgocytes**
True
76
What are causes of Hypokalemia?
* Decreased intake or low K+ IV fluids
* Loss
* Alimentary: vomiting, diarrhea, abomasal disorders\*\*
* Renal: Diuresis, Hyperaldosteronism (Cushing’s), Renal failure in cats (mechanism is unclear)
* Horse sweat
* Redistribution: –Alkalemia –INSULIN injection (or glucose bolus)
77
What happens to Na when total body K decreases?
Na moves into cells to maintain electroneutrality
78
What is on this slide? When will you see this (3 things)?
**_Keratin_**
(1) SCC
(2) epidermal inclusion cysts
(3) From the skin of the slide handler\*\*\* or animal
79
Why do you get a paradoxical aciduria in patients that are hypovolemic, hypochloremic and alkalotic?
80
Although freely filtered by the kidney, why is BUN a poor indicator of GFR?
1. **Liver Production Varies**
* increases with high protein diet & upper GI bleed
* decreases with liver failure
2. **About 60% is reabsorbed**, and this reabsorption varies with rate of flow thru tubules
* 50% is passively reabsorbed in PCT, 10% is actively reabsorbed in CT
* slow flow --\> more BUN resorbed
3. **It is excreted in other ways**
* horses and ruminants excrete BUN through the GI
* Ruminants put urea into the salivary glands and then back into the rumen so that microflora can create a.a.
81
How would you interpret this protein electrophoresis? Monoclonal, polyclonal or normal?
Normal
83
What type of tumor are these cells from? FNA was taken from a lump at a *previous vaccination site* on a cat
**Giant Cell Sarcoma**
**----------------------------------------------------**
Vaccine induced sarcoma in cats
Should vaccinate cats on lower limbs and tails, in case amputation is necessary
84
Which species becomes hypochloremic with renal failure?
Cattle
85
Which of the following are function of the kidney:
1. Water balance
2. Produce hormones: Erythropoietin & Renin
3. Activate vitamin D–Calcium & Phosphorous homeostasis
4. Regulate blood pressure –RAAS
5. Excrete Waste (urea, creatinine, NH4+, K+, H +, PO4, drugs, hormones, enzymes)
6. Conserve important substances
7. Regulate acid-base balance
all of them!!
86
If changes in Na+ and Cl-are proportional,then consider differentials that pertain to abnormalities in \_\_\_\_\_\_\_
Na
87
How does hypercalcemia lead to hypomagnesium?
Hypercalcemia inhbits renal Mg reabsorption
88
T/F: Bilirubinuria of +1 is notmal in some dogs
true
89
How does hypercalcemia cause PU/PD (with no azotemia)?
Ca interferes with the ADH receptor
Will see PU/PD BEFORE calcification of renal tubules
90
Why does liver failure cause PU/PD?
lack of BUN --\> inability to create proper concentration gradient
91
What problems are seen with hypotonic dehydration? Why is the dehydration poorly fixed?
* Fluid shifts from vasculature into cells
* Vascular volume decreases further, and cells swell
* **Cerebral edema occurs when Na+, Especially with rapid change
* depression, ataxia etc**
* Osmoreceptors not stimulated, **ADH not released**
* May or may not have *renal medullary washout*
92
50% of dogs with Acute lymphoblastic leukemia have \_\_\_\_\_\_\_\_\_
lymphadenopathy
93
"Leakage liver enzymes" may take ____ weeks to decrease after injury?
2 weeks
--------------------------
As a side note, remember, Leakage enzymes are neither specific for the cause of the liver disease nor predictive of outcome.
These include ALT, AST, SDH, and GLDH
94
Portal Vein Hypoplasia is commonly in which dog breeds?
small breeds – Maltese, Yorkshire terriers, Cairn terriers
-------------------------
Diagnosis requires wedge biopsy. Dz does not change animals life span
95
What would your urine specific gravity be if you have renal azotemia?
Isothenuria (1.007-1.013)
------
Renal azotemia occurs at 75% loss, while concentrating ability is lost at 66% loss of functional renal mass
95
What are DDx for the cause of renal damage that lead to a renal azotemia?
95
What are the disadvantages of using serum BUN and CREA levels as proxies for GFR?
‐Variance in biomarker production rate
‐Variance in extrarenal factors that ↓ GFR
‐Renal handling is not consistent (esp. BUN)
‐Provide general estimates of renal tubular function
96
What are the two major roles of Albumin?
Transport Protein
Colloidal osmotic pressure
(+ Buffer capcaity)
98
What are 6 examples of effective osmoles in serum?
Na+, Cl-, HCO3-, proteins, glucose, ethylene glycol
They are all osmotically active and cause water to move toward it
99
What species are these most common in? What is their significance?
**Struvite Crystals**
Most common crystal in **dogs and cats**
Formation is favored by **alkaline pH** - promoted by **urease** positive bacteria
Can be found in **normal patients**
100
What is the Base Excess (BE) calculation used for?
Calculate bicarbonate dosage in IVF
It Characterizes the overall metabolic acid-base status independent of the respiratory acid-base status
Metabolic alkalosis=(+) BE
Metabolic acidosis=(-) BE
101
What is the most common cause of Cl loss \> Na loss (selective Cl loss)?
hypochloremic metabolic alkalosis
Gastric secretions are NOTresorbed by the small intestine
* Monogastric: severe vomiting
* Ruminants: abomasal disorders, high GI obstructions
102
Where does urea come from?
Synthesized in the liver
Dietary protein amino acids are deaminated in the liver and then the amine group of the a.a. is used to make urea which is then put into the blood
103
Is it better to diagnose round cell tumors via histology or cytology?
cytology - you will be able to see granules better and you will not have any fixation artifacts
104
All cats carry an antigen from the ____ blood group
AB
105
What are your DDx if you hvae prerenal azotemia (↑ BUN, +/-↑ CREA, ↑ SpGr )
1. **_Decreased GFR_** (also affects P & Mg)
* **Dehydration**
* Shock
* Cardiac insufficiency (↓ C.O.)
2. **_Increased Urea Production_**
* **Upper GI Bleed\***
* High protein diet
* Endogenous protein catabolism
* Ruminants, ↓ ruminal motility
3. **_Increased Creatinine Production_**
* Increased Muscle Mass - grey hounds
* Dysfunctinal placentas --\> prevents normal clearance of fetal CREA (resolves within a few daws)
106
What is the term for increaded frequency of urination?
pollakiuria
108
What could be in the urine sample if the color is:
**Yellow-orange**
**Yellow- green/brown**
**Red**
**Red-brown**
**Brown to black**
* Yellow-orange- bilirubin
* intravascular hemolysis (IMHA)
* delayed transfusion reactions
* Yellow- green/brown - bilirubin & biliverdin
* Red- rbc, Hfb & Mgb
* Red-brown- RBCs, Hb, Mgb, MetHgb
* Brown to black - MetHgb
109
What type of tumor are these cells from? they were taken from a very hard mass closely associated with a bone
Osteosarcoma
--------------------------------------
pink stuff= GAGs- glycosaminoglycans
May be spindle shaped or look like normal osteoclast
May be easier to diagnose via cytology \> histology
110
What are two causes of **osmotic shifts** from ICF to ECF that causes hyponatremia?
Hyperglycemia
Mannitol administration
111
What is a common signalment/clinical history of a animal with post-renal azotemia?
Castrated male cat
straining to urinate
large bladde/Dsitended abdomen
111
Horses with renal failure tend to have ______ calcium levels
high = hypercalcemic
112
What should you do if you suspect Transitional cell carcinoma?
Send it to an expert
114
What are the causes of bilirubinuria?
1. **Liver disease**
2. **Bile duct obstruction**
3. **Hemolysis**
**Others:** –Starvation –Pyrexia –Horses off feed
116
What would be a renal cause of decreased BUN?
Decreased reabsorption in the PCT with water
decreased GFR (IVF diuresis) or increase tubular flow (osmotic diuresis)
117
T/F: It is common to find the cause of the **reactive node** within the cytologic specimen
FALSE!
In most cases you do NOT find the cause for the reactive node in the cytologic specimen.
The “antigen” stimulating the node is outside the node but in its field of drainage.
118
What is the only tumor the elicits an inflammatory response?
**Squamous Cell Carcinoma**
Keratin can induce inflammation
119
Aldosterone is secreted in response to what three things?
**Angiotensin, Hyperkalemia & ACTH**
It acts to conserve Na and secrete K
121
What is the source of transitional cells in a urine sample? What is their significance?
Source= renal pelvis, ureter, bladder, proximal urethra
Significance= Seen with hyperplasia associated with inflammation -or- transitional cell tumors (benign and malignant)
122
What is the one differential for panhyperproteinemia?
dehydration
123
What is the typical signalment of a chronic renal failure patient?
geriatric cat, with a poor BCS
124
What is the differency b/w Grass Tetany and Milk Tetany?
* _Grass Tetany_- **High K** content of pasture blocks Mg absorption
* _Milk Tetany-_ Milk is low in Mg
125
What happens to your globulin levels during chronic liver disease?
1. May decrease, some are synthesized by the liver ( alpha and beta)
2. Probably increase, due to the lack of kuffer cells filtering GIT antigens in the liver. These antigens then enter circulationand stimulate an increase in production of gamma globulins by lymphoid tissue
126
PTH _________ Ca and is inhibited by calcitonin
increases Ca
127
What do bacteria reduce bilirubin into?
**urobilinogen**
It is reabsorbed and excreted in the urine (makes urine yellow)
128
Calcitonin is produced by the C cells of the thyroid gland and \_\_\_\_\_\_\_\_\_serum Ca concentration by inhibiting PTH
decreases
129
What is the osmole gap? What does it mean if it is increased?
**Osmole Gap = measured osmolality -calculated osmolality**
* An increased Osmole gap indicates An increase in an osmotically active molecule in blood; that is not measured on the serum biochemical profile
* An osmole gap less than 30 is OK
* Ex: TOXINS! and some therapeutics = Ethylene glycol, methanol, paraldehyde, Mannitol or radiographic contrast medium
130
Pottasium levels are often \_\_\_\_\_\_\_in chronic renal failure
normal
---------
Increased tubular secretion prevents hyperkalemia
131
GFR is considered a sensitive index of functional ____ \_\_\_
renal mass
132
What are the late signs of a portosystemic shunt?
Liver failure decreased albumin, BUN, glucose, cholesterol, coag factors
Marked increase in bile acids
Maybe cholestasis ( inc bilirubin, ALP)
Microcytic anemia
133
What are causes of hypochloremic metabolic alkalosis in monogastrics and ruminants?
_Monogastrics_: severe vomiting, pyloric outflow obstruction
_Ruminants_: sequestration of fluid in abomasum and forestomachs. GI atony
---------------
Can result in paradoxical aciduria
134
What are the causes of a pre-reanl decreased BUN?
1. **Decreased Urea Production**
* low a.a. delivery to liver - Portosystemic shunts, decreased protein diet
* hepatic insufficiency (\>80% loss)
2. **Intestinal Loss**
* PLE & Diarrhea in monogastrics
* Metobolism in gut in horses and Cattle\*
136
What are key difference b/w ARF and CRF? (ie history, CS, PCV, **potassium levels**)
137
If you see a cast in urine, what should you do?
Send it out to be evaluated
...alot could indicate renal disease
138
When does mineralization of soft tissue occur?
**Ca x PO4\> 70**
139
What blood type is the universal donor in horses?
**premise is false! there are NO UNIVERSAL DONORS**- there are over 7 blood systems and over 400000 combination
140
What method is most commonly used to measure fibrinogen?
**Heat precipitation** with use of refractometry (estimate)
141
When would you use packed RbC? Whole Blood? FFP? Platelet-rich plasma?
142
Protein on dipsticks only detect \_\_\_\_\_\_
albumin
144
What other signs would you see if a hypoalbuminemia is due to liver insufficiency?
**Decrease glucose, cholesterol and urea**
**Increased globulins** (usually)- the liver is not lfiltering antigens
Check bile acids and NH3
145
What can lead to neonatal isoerythrolysis in bovine?
vaccination of blood origin
146
Blood typing identifies specific RBC \_\_\_\_\_, while crossmating identifies RBC \_\_\_\_
**anti**_gens_** , anti**_bodies_****
-----
"positives" for both tests = agglutination
147
Why would you see an increase in bilirubin?
1. Increased production due to RBC destruction
2. Decrease uptake/conjugation by liver
* Decrease blood flow (tumor, shunt, etc)
* Decrease in functional hepatocytes
* Long term Food depervation in horses\*, cattle and cats
3. Blockage of bile flow
148
GGT is a better than ALP to detect markers of cholestasis in CATs, except in cases of _____ \_\_\_\_\_
Hepatic lipidosis
149
What are the early signs of portosystemic shunts?
Enzyme activity may be normal or increased
Bile acids increased
Microcytic anemia maybe
150
Type B cats have strong isoantibodies against type \_\_\_\_
A
----
Type B cats are at risk for neonatal isoerythrolysis if queen is mated with a type A or type AB tom = Fading Kitten Syndome
150
Which will return to normal more quickly: AST or ALT
AST
151
Define azotemia
**Retention of nitrogenous waste products in blood**
↑ [BUN] and/or ↑ [CREA]
Implies 75% loss of renal function
152
What should you do if your SDMA is increased, but your CREA is normal?
1. **Go back to the patient:** Does your history, C/S, and/or PE findings support renal disease
2. **Rule out all other causes of ↓ GFR besides CRF**: Pre-renal, Renal, Post-renal
* May need to run additional diagnostics:
* UPCR
* Urine culture and sensitivity
* Blood pressure measurement
* r/o other infectious diseases (lyme, leptospirosis, ehrlichiosis)
* Imaging (uroliths, structural changes, etc.)
153
Why do you find stain sediment on cytology slides?
If the stain is not rinsed properly
or if the stain is not changed regularly
154
What blood albumin levels do you see with glomular proteinuria?
Hypoalbuminemia
155
T/F: Sarcoma cells are commonly found in effusions?
False- they do not exfoliate well
156
What are clinical signs of abnormal serum K concentrations?
Cardiac dysfunction\* --can be life-threatening
Skeletal muscle dysfunction
157
What are non-immue mediated transfusion reactions (aka complications)?
Sepsis
Volume overload
Tranmission of infectious agents
158
What are 2 common causes of ketonuria?
1. Negative Energy balance
2. DKA
159
What osmolites are used to estimate osmolality in plasma?
Na, Glucose and BUN
160
What are these cells from?
**Salivary Mucocele**
---------------------------
Orange crystal= Hematoidin crystal (RBC breakdown product)
Mucin in the backbround
161
Why would you find nothing on a FNA (3 reasons)?
1. Missed lesion
2. Lipoma (fat dissolved in alcohol dip)
3. Lesion is connective tissue
162
Portocaval shunt can cause what kind of anemia?
Microcytic
163
What are the three causes of a lymphoproliferative disorder?
1. Lymphocyte neoplasm
2. Plasma cell neoplasm
3. Dog with Ehrlichia
164
Where does ADH act?
**Collecting ducts - on aquaporins**
Responds to increase osmolality and decrease plasma volume
165
What should you susepct as the cause of an increased ALP without hyperbilirubinemia?
ALP increase is induced by **steroids (exogenous or endogenous**) or **anticonvulsant medication**
**-------------------------**
Effects may last 1-2 months, so get a good history
Dont forget about topical eye and otic steroids.
166
What tumor cells have abundant vacuolated cytoplasm, many multinucleated cells, and look like macrophages with criteria of malignancy?
Malignant histiocytosis, histiocytic sarcoma
167
Small cell lymphomas can be possibly identified by atipical cytoplasmic projections called \_\_\_\_\_\_\_\_\_\_\_\_
"Cone heads"
--------------
If a dog, PCR can also identify lymphoma
168
What are common causes of a loss of HCO3 --\> metabolic acidosis?
‒GI loss from diarrhea
‒Intestinal ileus
‒Salivation (ruminants) --choke
‒Urinary loss
‒Titration
169
How do you tell the difference from nocardia or actinomyces in cytology?
acid fast
nocardia is partially acid fast while actinomyces is not
they are both difficult to culture
they are both gram positive filamentous bacterium
170
Cats with Acute Lymhoblastic leukemia are usually young and ______ positive
FeLV
171
What are the 3 function of alpha1, alpha2, and beat globulins?
Inflammation
Coagulation
Transport proteins
171
What are causes of hyperalbuminemia?
Dehydration!...and thats it!
171
When does hypokalemia occur in renal failure patients?
1. When **decreased appetite/ K intake** in **uremic animals**
2. **Hypokalemic nephropathy in cats**
171
What are causes of Hyperosmolality with NO Fluid Shifts?
Increased plasma concentration of **ineffective** solutes: intracellular osmolality = extracellular osmolality
Example: uremia - Urea/BUN is freely diffusable
172
What is happening when there is a Normal osmole gap with increased measured osmolality?
There is **increased Na+**, or _markedly_ increased **urea or glucose** (ie if uremic or a diabetic patient)
173
What are causes of Pseudohyperkalemia?
* **EDTA contamination**
* Marked thrombocytosis: leakage of intracellular K+
* Hemolysis: K+ released from RBCs
* Separate serum quickly! –Horses, Pigs–Most cattle, some sheep –Akitas, some Japanese dog breeds –Mice and rats, monkeys
174
What are the effects of PTH, Calcitonin and Vit D in Phos levels?
* _PTH_ **decreases Phos**
* by decreasing renal tubular reabsorption
* _Calcitonin_ **decreases Phos**
* by inhibiting PTH stimulated bone resorption
* by increasing movement into tissues
* by decreasing renal tubular resorption of phosphorus.
* _Vitamin D_ **increases Phos**
* by stimulating absorption from intestine and kidney
* by inihibiting PTH synthesis.
175
Do you typically have to treat animals with delayed hemolytic immune-mediated reaction to transfusions?
NOPE
They are usually mild reactions
176
What are causes of lymphocytosis that are NOT leukemia?
Ehrlichia
Vaccinated PUPPIES
Addisions (rare)
Spirocurpi lupi (maybe)
Excitement (Cats)
Bartonella henselae
177
T/F: Over worked horses can develop hypomagnesemia
True- Horses lose Mg through sweat
179
What are causes of isotonic dehydration?
Renal Disease
Diarrhea
180
What are the 5 top causes of Hyperglycemic glucosuria?
1. **•Diabetes mellitus** –glucose
2. •**Hyperadrenocorticism** –cortisol
3. •**Drugs** –dextrose, glucocorticoids, progesterone
4. •**Postprandial**
5. •**Acute pancreatitis**
****
Less common: stress, pheochromocytoma, glucagonoma, head trauma
181
‘”Any substance, structure or process that can be measured in the body or its products and influence or predict the incidence of outcome or disease.” is considered a what?
Biomarker
182
Which will occur first, polyuria or azotemia?
Polyuria
183
What are the advantages and disadvantages of cystocentesis?
* Advantages
* minimizes contamination and iatrogenic contamination
* aid localization of hematuria, pyuris and bacteriuria
* therapeutic cystocentesis in blocked cat
* Diadvantages
* Cannot use if pyometra, coagulopathy, neoplasm
* If insufficient volume in bladder
* Patient resist restraint and abdominal palapation
184
Reflectand photometry is used in ___ chemistry systems, which is common w/ "in house" analyzers
dry
\_\_\_\_\_\_\_\_
(1) fluid is placed on fiber pad --\> (2) chemical reaction --\> (3) product form is proportional to the concentration of analyte
185
Why is creatinine a good indicator of GFR?
1. Consistently and constantly produce by endogenous muscle catabolism
2. Freely filtered
3. NOT reabsorbed
4. Excreted Unchanged
186
What influences the release of aldosterone?
Plasma volume \*, hyperkalemia, angiotensin II, ACTH
...Acts on the CT to reabsorb Na and exchange K for K
187
What else will you see if a hypoalbuminemia is due to PLN?
**Hypercholesterolemia (usually)**
You should preform a urinalysis and urine protein:creatinine ratio
188
Which type of enzymes escape from the cell as a result of injury to cell membranes or organelles
**Leakage enzymes**
---------------------------------------------
Injury may be as severe as cell death, or may be as mild as increased cell membrane permeability.
Include: ALT, AST, SDH, GLDH, CK
190
Why does albumin travel the farthest on a gel electrophoresis?
Small size (69 kDa)
High negative charge
192
What are two causes of panhypoproteinemia?
Blood loss and PLE
193
Hypercalcemia due to renal disease is common in _________ (species)
horses
Horses secrete large amounts of Ca through their urine
194
Thyroid tumors are ______ in dogs and ______ in cats
(Benign or malignant)
DOG= malignant
CAT=benign/hyperplasia
195
What tumors are considered Mesenchymal tumors?
Lipomas
hemangiopericytomas
hemangiosarcomas
osteosarcomas
chrondrosarcomas
197
SulphosalicylicAcid Test(SSA) is used to confirm dipstick results and reacts with \_\_\_\_, _____ and \_\_\_\_\_\_\_
Albumin, globulins & bence-jones proteins
198
What kind of tumor are these cells from? Take form a soft mass on a dog.
Lipoma
----------------------------
Typically benign, very common in dogs
Look like normal cutaneous fat, so ensure you actually hit the mass
May be hormonally active
199
Why are greyhounds such good blood donors? what should you watch out for?
Grey hounds are large, have high PCV, and most are DEA 1.1 negative & \>50% are DEA 4/6 positive (universal donors)
WATCH OUT FOR: Babesia, Anaplasma, Ehrlichia
201
What else will you see in the blood work if a hypoalbuminemia is due to malnutrition?
**decreased glucose, chlesterol and urea**
**------------------**
also a thing BCS and ravenous appetite
202
What happens to serum ALB during tubular proteinuria?
Normal or increased serum ALB (e.g. _no_ hypoalbuminemia)
203
T/F: Cold fluids are more dense, Falsely increasing SpGr
True - glucose and urea can also falsly increase SpGr
204
In what species is it normal to find some protein (mostly albumin) in the urine of a healthy animal?
Dog
205
What is the significance of \> 2/LPF hyaline casts?
Indicate proteinuria of renal or extra-renal disease
e.g. glomerular disease / Bence-Jones proteinuria
206
What 4 things determine the pH of blood?
1. pCO2- Changes in ventilation
2. Addition or removal of acids (H+) - Lactate, Toxic metabolites of ethylene glycol, Loss of H+
3. Strong ion movements -- Na+, K+, Cl-
4. Serum proteins, phosphates, and other weak acids
207
What are the sources of squamous cells? When are they pathologic in urine samples?
Sital urethra, vaginal tract, skin -- very common
Only pahtologic in sertoli cell tumor causing squamous cell metaplasia in male dogs
-----
Squamous cells are large, thin, transparent and angular/folded
208
Which liver specific leakage enzyme can also increase in very severe muscle injury?
ALT
209
T/F: Specific agents are more likely to *maybe* be identified in inflammed lymph node (lymphadenitis) apsirates, compared to reactive lymph nodes
TRUE!
Ex. Equine strangles, plague
210
What benign epithelial tumor is this?
**Perianal gland adenomas**
-----------------------------------------------
"Hepatoid tumor" - abundant cytoplasm, single round nucleolus
BENIGN- common in male dogs
Can be found on the tail head or prepuce
Responsive to Testosterone- should castrate males
DO _NOT_ confuse with perirectal apocrine gland carcinoma
211
What class of tumors typically have these characteristics:
* Individual cells
* exfoliate well
* circular cells with distinct cytoplasmic borders
Round/Discrete Cell Tumors
213
How would you be able to confirm this is a chylous effusion?
cholesterol:triglyceride ratio or compare triglyceride in fluid to that of serum (Chyle is high in triglycerides, if an animal eating).
look at history and cells within- can be due to trauma or tumor
214
There is low numbers to 100% neutrophils in _________ lymphadenitis
suppurative
216
What are causes of increased serum Na?
217
When do you have a monunuclear inflammatory fluid in a cavity?
Foreign body or mycobacterium infection
conists of primarily macrophages
218
T/F: Similar to ALP, Gamma glutamyl transferase (GGT) will be increased in young animals due to bone formation
FALSE- there is NO GGT produced by bones
----------------
It also may NOT be affected by anticonvulsant therapy (maybe)
219
Peritoneal [CREA] 2x serum [CREA] = diagnostic for \_\_\_\_\_\_\_\_\_\_\_
uroperitoneum
221
What is the significance of Waxy casts?
ALWAYS of pathologic significance
Associated with **chronic renal disease**
222
What are 4 causes of false negative bilibrubinuria?
1. Old sample
2. Light exposure
3. Nitrites
4. Ascorbic acid
224
What does it mean if after calculating corrected chloride, it is still below the reference interval?
a selective loss of Cl-should be suspected
(dont need to memorize equation, just how to use it)
225
Why is there constipation with renal failure?
muscle weakness
226
65% of dogs presenting withmulticentric lymphoma are \_\_\_\_\_\_\_
leukemic
227
What benign epithelial tumor is this msot likely?
Basal Cell Tumor
228
Hypermagnesemia is seen only when what organ function is compromised?
Renal
229
What is most likely happening when there is a Normal osmole gap with a decreased measured osmolality?
decreased in [Na]
230
Which dog breeds commonly have copper storage disease?
Bedlington terriers, West Highland White terriers, Skye terriers, Doberman, Dalmations, Labs
If you see an ALT increase in these breed when youn, you can use copper chelation theraoy and a low copper diet to slow progresion
231
Since Urine SpGr is an estimate of urinary concentrating capacity it must always be accesed in conjunction with what?
**Serum BUN & CREA** and **hydration status**
232
What is the significance of WBC and RBC casts?
WBC cast- tubular inflammation (pyelonephritis)
RBC cast- tubular hemorrhage (pyelonephritis)
233
How does the half life of ALT differ between cats and dogs?
Cats- 6 hours
Dogs- 72 hours
-----------------------
Cat increases are generally considered more severe due to the short half life and a smaller degree of accumulation, when compared to dogs
234
How do you interpret a positive/negative cross match?
235
T/F: Cattle Salivary Phos excretion \> renal Phos excretion
True!!
236
If removing fluid from thoracic cavity, what should you use to avoid pneumothorax
use catheter, rather than needle
237
Which two canine DEA blood types are highly immunogenic?
DEA 1.1 and DEA 1.2
238
What causes hyperosmolality WITH fluid shifts? What does it lead to?
_Cause_: Increased plasma concentration of **effective solutes**: intracellular osmolality \> extracellular osmolality
* Examples: **Hypernatremia & Severe hyperglycemia**
_Leads to_ **cellular dehydration**
239
What are two indications for transfusion therapy
Anemia & Clinical Signs of Hypoxia
241
Hyposthenuria and hypersthenuria are both _____ processes
active
243
Kidneys have large functional reserve capacity if \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**basement membrane is intact**
244
What is the pattern in whcih a substance absorbs light at various wavelenghts called?
Absorption Spectrum
-------
Different analytes absorb and reflect different wavelengths of UV or IR light in a pattern that is typical of the substance
245
T/F: Generally you should not bother blood typing large animals, except horses
true
----
Single un-crossmatched whole blood transfusions tend to be well-tolerated.
crossmatching/blood typing should only occur is repeated transfusions and plasma transfusions
246
If liver enzymes are abnormal in a 'healthy' appearing, what should you do?
Many options: just cont ignore them
* Repeat immediatly
* Take a good history- determine in corticosteroid or anticonvalsant
* If an old dogs, U/S liver and take FNA to determine if due to **benign nodular hyperplasia**
* If a middle age dog, suspect **chronic hepatitis** and evaluate further (ie bile salts)
* Consider other non-hepatic disease. Hypothyroid?
Pancreatitis? Hypoxia? Peridontal disease?
* Repeat in 4-6 weeks, no longer than 8 weeks
* IF still increased, do bile acids
* If young dog, consider **portocaval shunt.**
* Do bile acids. IF increased, evaluate further for shunt.
* If no shunt, consider **portal vein hypoplasia.** (small breeds – Maltese, Yorkshire terriers, Cairn terriers). Diagnose with wedge biopsy, life span usually normal.
* IF bile acids normal in young dog, repeat enzymes and bile acids in one year
247
What are these cells from? They contained macrophages that have phagocytosed RBC and contain hemosiderin
Hematoma
248
What DEA blood types are universal blood DONERs? Why?
**DEA 4 and DEA 6** - they are very common (98%) and are **non-immunogenic**
249
What kind of cells?
Mesenchymal cells - fibrosarcoma
Tell by the spindle shaped, distinct nucleoli, chromatin pattern
Aspirate will be creamy and white
250
What two things are required for a selective Cl loss / Paradoxical aciduria?
* *1)Volume depletion
2) Chloride depletion**
-----------------------
Kidney:
* –Resorbs Na+ to correct dehydration
* –Resorbs HCO3-instead of Cl-(electoneutrality)
Result: exacerbated alkalosis (more HCO3-)
251
What are common causes of increase liver enzymes in young dogs?
* **Portocaval shunts-** do bile acids test (will be VERY high)
* **Bone growth** --\> increased ALP
* **Portal vein hypoplasia** - common in small breeds (Maltese,
Yorkshire terriers, Cairn terriers).
* Diagnose with wedge biopsy, life span usually normal.
253
Why would you only find blood on a FNA?
Needle too large
Lesion is vascular
Lesion is mesenchymal tissue (connective tissue)
254
overhydration may lead to what 3 things?
‒Cardiovascular overload
‒Pulmonary edema
‒Generalized edema
256
What tumors are considered round/discrete cell tumors?
Lymphoma (lymphosarcoma)
Plasma cell tumors
Histiocytomas
Transmissable venereal tumors
Malignant histiocytosis
257
Due to the ability to filter more large and negatively charged proteins, animals with GN typically have what blood and urine abnormalities?
* **Proteinuria** -proteins enter the filtrate faster than they are resorbed
* **Hypoproteinemia-**protein loss exceeds production
* albumin loss \>\> globulins loss
259
Diagnosis?
***Crytococcus neoformans***
No inflammatory reaction due to thick capsule not being antigenic
Staining/ink will give contrast to the capsules, they do not stain
261
These are all characteristics of what group of tumors:
* Elongated nuclei and cytoplasmic tails (spindle cells)
* May be few cells present - do not exfoliate well
* Cells usually individual but sometimes in clusters with intercellular matrix
* Active fibroblasts resemble malignant mesenchymal cells
* May see ground substance being secreted (pink in color)
Mesenchymal tumors- CT origin
-----------------------------------------
_Examples:_
Fibrosarcoma
Hemangiosarcoma
Hemangiopericytoma- on limbs of dogs
Giant Cell Sarcoma - vaccine inducedin cats
Neurofibrosarcoma
Peripheral nerve sheath tumor
262
More than \_\_\_% lymphoblasts within an lymph node cytology indicates **lymphoma**
\>50%
--------------------------------------
In small cell lymphomas, the decrease in plasma cells can distinguish it from a reactive lymph node
In dogs, PCR can be used to confirm lymphoma
264
What kind of crystal? significance?
**Bilirubin**
Dogs: ↓ number in highly concentrated urine is NORMAL
Abnormal in all other species: **ICTERUS**
265
T/F: Most of the time hypercalcemia CAUSES kidney disease
TRUE
-----
Hypercalcemia can cause kidney disease.
* –Impairs urine concentrating ability causing primary PU
* affects ADH receptors
* –Commonly leads to mineralization of renal tubules --\> nephronal(kidney) dysfunction
267
Why are minor crossmatches rarely done?
Transfused serum is low volume compared to the patient’s serum; therefore, not enough antibodies present to cause significant issues.
Youmay want to preform one if you are transfusing a large volume of plasma
268
What kind of crystal? What species are these found in?
**Calcium Carbonate**
NORMAL in **horses, rabbits, guinea pigs and goats**
269
When will you typically have degenerative neutrophils in a fluid?
(1) old sample- aging (2) bacterial infection
271
At what osmole gap value are you concerned about unaccounted osmoles?
Greater than 30!
272
What renal biomarker increases with 40% loss of renal tubular function? \*\*\*\*
Symmetric dimethylarginine (SDMA)
273
In what cases it it ok to imprint a ulcerative lesion?
TVT
274
Chronic lymphocytic leukemia is more common in \_\_
**dogs**
Must be differentiated from other causes of lymphocytosis.
But, If \>35,000 lymphs, it is leukemia.
lymphocytes are small and appear well differentiated
usually asymptomatic until later stages/"blast crisis"
276
At what level of renal insufficiency do you become azotemic?
75%
278
What is the difference b/w plasma and serum? What tubes should you use to obtain each?
* _Plasma_- liquid portion of blood that has not clotted.
* Contains all proteins (ie fibrinogen and clotting factors), thus has a higher total protein than serum.
* Collected in a tube containing a anti-coagulant= EDTA, Heparin, Citrate
* _Serum_- liquid portion of blood that remains AFTER clotting.
* Contains NO fibrinogen or coagulation factors.
* Collect in a red top or tiger top tube.
280
If you have a hemabdomen due to hemangiosarcoma, would you expect to find exfoliated neoplastic cells within the effusion?
NOPE, sarcomas usually do not exfoliate
Only lymphomas and carcinomas tend to exfoliate.
282
What are 4 criteria of malignancy?
Variable nuclear size (anisokaryosis)
Large multiple nucleoli
Abnormal mitoses
Nuclear molding
283
What can increase serum CK?
Sketetal uscle injury - necrosis, IM injections, trauma, exercise
Cardiac muscle injury
Severely anorexic cat- muscle catabolism
285
What are the BEST blood donors for dogs? cats? horses?
286
What type of tumor are these cells from?
**Mast Cell tumor**
-----------------------------------------------
Have wide surgical margins
~5% do not stain well with wright stain =( but in these cases you can use the abundance of eosinophils as a clue.
Mast cell secrete chemotactic substance for eosinophils
287
What do diabetes mellitus, hypercalcemia , hyperaldosteronism and third space syndromes due to Mg levels?
**Decrease Mg**
Due to diuresis - DM and hyperaldosteronism
Due to Inhibiting Mg reabsorption - hypercalcemia
Due to reduced cation reabsorption due to Cl deficiency- third space syndromes
288
What are the clinical signs of hypermagnesemia?
paresis, paralysis, heart dysfunction , GI upset
290
What type of crystals? significance?
**Calcium oxalate dihydrate**
NORMAL in domestic animals
Storage artifact
Pathologic:
* **Miniature Schnauzers** are predisposed to calcium oxalate urolithiasis
* Increased calcium excretion due to **hypercalcemia** (e.g. hyperparathyroidism)
* **Acute renal fialure**
291
What are non-bicarbonate components of maintaining blood pH?
Hemoglobin, Plasma proteins and others...
293
T/F: TP measurement via a refractometer is simple and inexpensive and tells you the exact amount of protein
**FALSE- it is only an estimate**
**----------------------**
Uses refractive index and assumes all solutes are proteins.
Lipids, cholesterol, glucose and urea can interfere with reading.
295
What are causes of low serum Na?
296
What is the most common cause of extreme Hypophosphatemia?
Most striking decreases are seen in patients with **metabolic acidosis** due to **increased urinary loss** (phosphates eliminated with excess acid)
Patients with **diabetic ketoacidosis** may have life-threatening hypophosphatemia due to increased urinary loss, both from acidosis, and osmotic diuresis.
------------------------------
Other causes:
* Primary hyperparathyroidism (renal loss)
* Hypercalcemia of malignancy (PTH-rp inhibits renal P reabsorption in EARLY stages of disease, P goes up once kidney mineralization occurs)
* Vitamin D deficiency
* Respiratory alkalosis
* Decreased intestinal absorption of P
* Renal tubular defects (ie, Fanconi syndrome)
* Chronic renal failure in horses (opposite in SA)
297
What is your disgnosis if you have a 6 yr old terier with:
* Diarrhea for 2 months
* Seizure today
* On steroids
* Regnerative anemia
* VERY low protein (2.5 on 6.0 -8 RI)
* VERY low Ca
* Low Creat
* Low Phos
* LOW Mg
* Low Alb and Glob
* Low Chol
* High liver enzymes with NO increase in Total bili
* High CK
* Low electrolytes= Na, K, Cl
* Long Protime and APTT with Low Antithrombin III
**Low Mg --\> lack of PTH production and release**
**DUE TO MALABSORPTION** (has had D for a long period)
Low Vit D, Vit K, protein and electrolytes due to malabsorption
Low Ca due to malabsorption and PTH deficiency --\> Seizure
**Steroid Hepatopathy** due to steroid administration
**Muscle damage** due to IM injections and seizure
298
What is you diagnosis for a 6 mo old female cat with:
* Tachypnea, vomiting, weakness
* stress leukogram with increased glucose
* Azotemic
* VERY high Ca (18 on 8.5-11 RI )
* High K and Phos
* Acidemic with high PCO3, low HCO3 and low PO2
**Cholecalciferol (Vit D) Toxicosis** --\> causes hypercalcemia and hyperphosphatemia
Ca and Phos product is 171 --\> mineralization of the kidneys and lungs
Metabolic acidosis and respiratory acidosis due to mineralization of lungs --\> hypoxia
299
Diagnosis?
Mononuclear inflammation with **mycobacterium** within M0
Mycobacterium is acid fast
300
How do you tell the difference between polycythemia due to: Hemoconcentration, Appropriate increase in EPO, Inappropriate EPO or Polycythemia vera?
* Relative Hemoconcentration - look at TP , it will also be increased
* Approriate EPO- low arterial oxygen w/ EPO increase
* check for collapsed trachea, lung issues and heart issues
* Inappropriate EPO - normal arterial oxygen w/ EPO increase
* check for kidney mass, cyst etc
* Polycythemia vera- normal TP, arterial oxygen, and EPO
* it is a non-neoplastic myeloproliferative disorder
302
What is this dogs blood type?
**DEA 1.2 -** due to the weak line (compared to the control)
304
what are causes of redistribution hyperkalemia?
305
What are the 3 main causes of Bile acid increase?
1. Deviation of Portal Circulation
* Portosystemic shunt or cirrhosis
2. Decrease in hepatocyte uptake
* Inflammation, necrosis, Steroid hepatopathy, Decreased functional hepatic mass
3. Decreased bile excretion with subsequent regurgitation into blood (~90% of bile acids are recycles from GIT)
* Cholestasis, bile duct leakage
306
accidental liver stick. diagnosis?
cholestasis
The bile within the canaliculi is indicative of cholestasis
308
What should you do if you are unable to evaluate a urine sample within 30 minutes of collection?
refrigerate for up to 12 hours
Must warm to room temperature for 20 minutes before you perform the analysis
Have to Gently swish to remix and resuspend sediment
309
What is the source of caudate cells? What is their significance?
Source- renal pelvis (cone shaped)
Significance: pyelonephritis
310
What are 4 common causes of respiratory alkalosis?
1. Hypoxemia
2. Pain, anxiety, etc.
3. Hyperthermia
4. Drugs that stimulate the medullary respiratory center
311
What type of tumor cells have an eccentric nuclei, golgi clearing and abundant cytoplasm?
Plasma cell tumors
312
If you have a mononuclear inflammatory joint fluid, what two processes should you suspect?
Degenerative disease or trauma
313
What are causes of hypoglobulinemia?
1. **Decrease production** (SCIDS in dogs and horses)
2. **Abnormal loss** (hemorrhage, PLE)
3. **Failure of passive transfer** (FPT)
314
What are the characteristics of fluid from a FIP cat?
**High Protein (4-9)**
**Low Cells (**
**Yellow and thick**
More Triglycerides than cholesterol
Higher globulin than albumin
315
In renal failure, dogs and cats most commonly have ____ calcium
**normal**
-----
Occasionally have hypocalcemia, But Rarely have hypercalcemia
316
A lack of bile acids will lead to the decrease in absorption of what important fat soluable vitamines?
Vit K and D
317
What are key differences b/w infectious, immmune-mediated and trauma joint fluid?
* _Infectious_- high cell count, non-degenerative neutrophils, single joint, rare to finf agent
* _Immune-mediate_- low to high cellularity, increase non degenerate neutrophils and usually MULTIPLE joints
* _Trauma_- mononuclear inflammation and single joint
318
If you suspect liver disease, what should you preform before you do your liver biopsy?
Coagulation profile
319
What are the two ways to determine the plasma osmolality?
1. **Measurement**- freezing point depression
2. **Estimated by Calculation** using major osmotically active solutes
321
What is the most common cause of hyperkalemia?
**Failure of Renal Excretion (addisons disease\*, oliguria, anuria, urethral obstruction, ruptured urinary bladder, loop diuretics)**
_Other causes:_
Redistribution- acidosis, insulin deficiency, rhabdomyolysis, massive hemolysis
Increase Intake - Parenteral administration of K
In-vitro artifact
322
What causes the release of atrial natriuretic factor?
↑central venous pressure (CVP)
...causes Na loss, diuresis and vasodilation
...inhibits aldosterone release
323
What is present?
Talc crystals (from gloves) and *Coccidioides immitis*
324
What are two manifestations of hypomagnesemia?
1. Secondary hypokalemia due to renal wasting of K
2. Impaired PTH production and release leading to secondary hypocalcemia
Clinical Signs: Associated with electrolyte abnormalities and NM and cardiac abnormalities
325
In dogs, Hypercalcemia is most commonly due to \_\_\_\_\_\_\_\_\_\_\_\_
Malignancy
Lymphoma \> Perirectal apocrine gland carcinoma
Due to production of PTH-RP
326
What are the clinical signs and treatment of acute hemolyitc immune-mediated reactions to transfusions?
327
From cytology of cavity. What is it?
"bearded" mesothelial cells
328
Acute myeloid leukemia must have
\_\_\_\_% or greater blast cells in the bone marrow.
**\>20%**
% of blasts in blood is variable
329
What are causes of hypertonic dehydration?
**‒Diabetes insipidus**
‒Diabetes mellitus
‒Osmotic diuretics
‒Osmotic diarrhea
‒Water deprivation
330
Mg plays an important role in the synthesis and release of what hormone?
PTH
Low Mg can lead to hypocalcemia
332
If on the dip stick your protein is 2+, but on the SSA your protein in 3+, what does this mean?
there is albumin AND globulins/bence-jones proteins present
333
What is your diagnosis of a 2 year old icteric & vomiting dog with:
* Mild anemia
* Inflammatory leukogram
* No azotemia and normal glucose
* Mild hypocalcemia (8.1)
* Normal albumin
* High cholesterol
* ALK Phos increase
* ALT increase
Pancreatitis
------------------------------
Mild hypocalcemia is due to Ca binding necrotic fat
High cholesterol, ALK Phos, and ALT indicate cholistasis and liver damage
Bile duct is obstructed due to swelling of the area due to pancreatitis
335
What is your top DDx for a thoracic effusion of cat with high proteins and low cells and a polyclonal gammopathy?
**FIP**
**--------------------------------**
should do albumin"globulin ration, if high globulin it is more likely to be FIP
chylous effusion can cause a false high total protein and low cellularity, but the fluid would appear turbid and there would not typically be a polyclonal gamopathy
336
What is this indicative of?
Inflammation!
337
What is this dogs blood type?
DEA 1.1
338
The origin of the azotemia is detemined by the \_\_\_\_\_\_\_\_
Specific Gravity
339
What is TCO2?
Estimate of plasma bicarbonate concentration by adding acid to a sample and mesauring the total CO2
95% of the measuredtotal CO2 (TCO2) in plasma is from HCO3-
TCO2 is NOTa measurement of pCO2
340
If you have \> \_\_\_\_% of the liver affected by hepatic necrosis/damage, your liver functions test will be abnormal
\>60-80%
341
Name the systemic fungal organism
*Histoplasma capsulatum*
342
T/F: Evaluation for agglutination is sufficient while crossmatching all species
FALSE - You should look for hemolysis in HORSES.
Horses have both agglutinating and hemolytic antibodies
343
Calcitriol/Vit D _____ Ca concentration by increasing absorption of Ca from the intestine, and by enhancing PTH action on bone and kidney.
increases
344
Abdominal fluid from dog. What is your diagnosis?
Carcinoma? Lymphoma? Mesothelial Cells? Sarcoma?
Carcinoma
345
What 4 parts of the dipstick should you ignore in a urinalysis?
1. Leukocytes
2. USG
3. Nitrite
4. Urobilinogen
346
Approx 20% of dogs with liver disease have \_\_\_\_\_fasted bile acids
(decreased, normal, increased)
normal
347
What happens to Glucose, Bun, Albumin and Chol during liver failure?
All decrease
348
What is the brown matterial in this effusion?
Bile - both free and within macrophages
Bile pigment may turn black during macrophage digestion (below)
Can be in effusion due to ruptured bile duct or from GI origin (may see bacteria as well)
350
What are neuro clinical manifestations secondary to cellular dehydration?
**Depression -\> stupor -\> coma**
**Abnormal PLR, CN deficits, seizures**
Must rehydrate patient SLOWLY
352
What are 5 common causes of HYPOcalcemia? Can you name and less common ones?
1. **Renal Disease** - due to high P & decrease activated vit D
2. **Ethylene glycol toxicosis (**60%) - due to Ca becoming bound to acidic metabolites
3. **Pancreatitis** - mild, necrotic fat binds Ca
4. **Eclampsia** - Ca is going into milk production
5. **Sepsis** - decrease in BOTH ionized and total
-----------------------------------------------------------------------------------------------------
Less common causes:
* **Hypoparathyroidism**
* **Nutritional** secandary hyperparathyroidism- decrease Ca, inadequate Vit D, excess P
* **Malabsorption** - Vit D is fat soluable
* **Phosphate-containing enemas** (Fleet)
* **Hypomagnesemia**- Mg is important for PTH production and release
* **Massive tissue degeneratio**n - necrotic tissye binds Ca
* **Hypercalcitonism** (C-cell thyroid tumor)
353
What are the 3 main sources of increased ALP (ie the different isoenzymes)?
1. **Bone (osteoBLAST)** - high in young growing animals with increased bone formation (or healing bone injury)
2. **Liver-** cholestasis induced
3. **Corticosteroid induced-** exogenous or cortisol producing tumor
* Due to increase glycogen storage within hepatocytes --\> swelling --\> leakage of ALP
-------------------------------
The subtypes have the same function but are structurally different.
Difficult and expensive (and inaccurate) to determine subtypes/isoenymes
354
In electrophoresis, the movement of charged particles through a solution under the influence of an electrical field depens on what? (5 things)
1. **Net charge**
2. **Size and Shape of protein**
3. Strength og electricl field
4. Type of medium
5. Temperature
355
What are the most common breeds for chronic hepatitis?
Doberman (also hereditary)
Bedlington terrier
WHWT
Cocker (Inherited, not assoc w/ Cu)
Standard Poodle (Inherited, not assoc w/ Cu)
Labrador
Dalmation
356
What are two causes of hyperfibrinogenemia?
1. **Inflammation**
* positive acute phase proteins
* cytokines --\>increase synthesis by the liver
2. **Renal Dz in CATS abd CATTLE** (mechanism unknown)
357
What special biochem test can you use if you suspect uroabdomen, chylous effusion or bile leakage?
* **Creatinine** if suspect uroabdomen
* **Triglyceride** if suspect chylous effusion
* **Bilirubin** if suspect bile leakage
Should compare values to the serum values
358
What is the clinical presentation of Multiple Myeloma?
* **Pathological fractures and bone pain**- neoplastic plasma cell in the marrow release osteoclast activating factor, causing lysis of the bone to make room for expansion
* **Lytic lesions in bones**
* **hypercalcemia --\>** mineralization of kidney - due to bone break down
* **Hyperviscosity of the blood -** due to high Ig
* **Engorged retinal blood vessels** (due to hyperviscosity)
* **CNS signs** - due to hyperviscosity
* **\>20 % plasma cells in bone marrow**- usually in aggregates
* r/o chronic antigen stimulation
* **monoclonal/biclonal gammopathy** - usually IgG or IgA.
* **Bence-Jones proteins in urine\*\***
* **Abnormal platelet functions** - due to coating of PLT with Igs --\> **epistasis**
* **thrombocytopenia**
* **PU/PD**
* **Anemia-** crowding out of bone marrow. seen in cats.
359
What is the significance of finding free lipid droplets in urine?
Likely from degeneration of sloughed cells
‒Usually an isolated finding, normal
‒Pathologic: Renal tubular injury
360
Liver Failure ___ serum cholesterol
| (increases/decreases)
decreases
the liver is a major site of CHOL synthesis
361
What family of drugs commonly causes drug-associated crystals?
Sulfa family drugs!
--------------
Also Ampicillin, Ciprofloxacin, etc Anticonvulsants (especially polytherapy and in alkaline urine), Allupurinol administration and Radiographic contrast media
362
In multiple myeloma, organ involvement is very common in \_\_\_\_
cats
363
When does hyperphosphatemia occur in dogs, cats and horses?
**When GFR is , phosphorus excretion impaired**
(horses can lost P through the gut as well)
364
Cats with chronic lymphocytic leukemia are usually FeLV \_\_\_\_\_\_\_\_\_
negative
365
ALT, AST, SDH, and GLDH are all considered ______ enzymes that MAY indicate hepatocelluar injury
leakage
366
What are causes of hyperglobulinemia?
1. **Dehydration**
2. **Inflammation**
1. K9 ehrlichiosis
2. FIP (super high)
3. **Neoplasia**
1. Multiple Myeloma
2. B-cell Lymphoma
367
An ALT that is more than ___ times than normal or an ALT that is persistently increased should be evaluated (even if the dog appears healthy)
2x
-------------------------
_In middle aged to old dogs,_ may indicate chronic hepatitis, for which prompt diagnosis and therapy can improve survival time.
_In young dogs,_ may indicate portocaval shunt, and you should measure bile acids.
368
T/F:
* **Acute** hemolytic immune-mediated reactions are **severe** reactions and are a result of **extravascular** hemolysis
* **Chronic** hemolytic immune-mediated reactions to transfusions are **mild** and a result of **intravascular** hemolysis
* *FALSE**
* *Acute= intravascular** --\> hemoglobinemia/uria
**Chronic = extracascular** --\>hyperbilirubinemia/uria
369
A urine specific gravity some where b/w 1.007 - 1.012 is considered what?
isothenuria
370
What is this indicative of?
Neoplasia (ie multiple myeloma)
371
What tubes and protocols do you use when collecting blood gas?
\*\*\* Learning objective\*\*\*
**Heparin (green) tube**
Collects whole blood from a free flowing vessels as **anaerobically** as possible and then **anayze it ASAP**
If unable to analyze in **\>5 minutes - put it on ice**
372
If the change in Cl-concentrations are greater than Na+, then consider \_\_\_\_\_\_\_abnormalities
acid-base
373
What would indicate a positive crossmatch?
Agglutination
374
What are the major things you look at in a fluid analysis?
1. Note color, clarity, odor
2. Total protein (via refractometry)
3. Cell count
375
What is the 2 most important thing to consider when tooking at TP?
Hydration status
TP is interpreted with ALB and GLOB
377
What three things are required for the kidney to conserve water?
1. **33% functional nephrons**
2. **Production & responsiveness to ADH**
3. **Concentration Dradient**
1. medullary hypertonicity
2. production of urea and aldosterone
378
If lymphocyte concentration \>\_\_\_\_\_\_μl
you can be sure it is leukemia
**\> 35,000/μl**
Also if If \> 15,000/μl and Ehrlichia negative, it is leukemia
379
Effusion from a dog. High cell count (+90,000) adn predominantly degenerate neutrophils with a mixture of different microorganisms. What is your diagnosis?
GI perforation/Bacterial peritonitis
380
Effusion from a cat. What is your diagnosis?
Lymphoma
Due to abundant individual round cells with a high nucleus to cytoplsm ratio, nucleoli and lymphoglandular bodies due to ruptured cells
381
In **uroabdomen**, why is there **↑ K & PO4** and **↓ Na & Cl** in cats/dogs/foals?
Urea and K+ move into plasma quickly, plasma [] increases
Na+ and Cl-move into urine quickly, plasma [] decreases
-----
CREA moves slowly
(Hyperkalemia doe not occur in cattle because they exrete excess K into saliva)
----
382
Lymphomas are always benign or malignant
malignant
383
What are your DDx for proteinuria?
1. Hemorrhage (RBC should sediment out)
2. UTI/Cystitis - see bacteria and WBC on sediment
3. Intravascular hemolysis- see animal also
4. Renal Disease - look at casts, UPCR
