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exam 2 things to remember Flashcards

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1
Q

chronic lymphocytic leukemia

A
  • over 30,000
  • CML- rare, CLL common- small and well differentiated
  • clinical signs: asymptomatic lymphocytosis +/- anemia and thrombocytopenia
  • increase in small lymphocytes on bone marrow
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2
Q

acute leukemia

A
  • see blasts in blood
  • short survival time
  • differentiate from stage V lymphoma
  • clinical signs: anemia, thrombocytopenia
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3
Q

myeloproliferative leukemia

A

-granulocytic, erythroid, megakaryocytic

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4
Q

lymphoproliferative leukemia

A

-lymphoblastic, lymphocytic, plasma cell (multiple myeloma)

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5
Q

multiple myeloma

A
  • Bence-Jones proteins in urine
  • > 20% plasma cells in bone marrow
  • monoclonal/biclonal gammopathy
  • lytic lesions in bone marrow
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6
Q

BUN

A
  • used to assess GFR

- in ruminants correlate changes in BUN with changes in CREA and USG to predict renal disease

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7
Q

increased BUN

A
  • increased protein in upper GI (upper GI bleed), increased production
  • decreased GFR
  • renal reabsorption varies with rate of flow through tubules
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8
Q

decreased BUN

A
  • decreased urea production by liver: portosystemic shunt, decreased protein in diet, intestinal loss of protein (PLE), hepatic insufficiency
  • renal causes of decreased BUN: decreased water resorption in PCT, increased GFR, increased tubular flow (osmotic diuresis, less concentrated urine)
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9
Q

Creatinine

A
  • muscle mass matters
  • filtered by glomeruli and excreted, not reabsorbed or changed by kidney
  • excellent indicator of GFR
  • increased creatinine= decreased GFR, possibly altered nephron function
  • decreased creatinine- not clinically significant
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10
Q

SDMA

A
  • only IDEXX, excreted almost exclusively by kidneys, not impacted by extrarenal factors, early indicator of kidney disease
  • used for monitoring and management
  • if SDMA increased and creatinine is normal, rule out all other causes of decreased GFR besides renal failure
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11
Q

causes of pre-renal proteinuria

A
  • physiologic: hypertension, fevers, seizures, exercise

- increase small proteins in blood: hemoglobin, myoglobin, para-proteins (Bence Jones)

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12
Q

causes of renal proteinuria

A
  • Glomerulonephritis

- tubular proteinuria- acute renal disease/ Fanconi syndrome

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13
Q

Post-renal proteinuria

A
  • hemorrhage

- inflammation

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14
Q

UPCR

A
  • normal: <5
  • tubular or glomerular: >.5
  • glomerular: >1.0= most severe, only time you will see hypoalbuminemia
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15
Q

isosthenuria

A

-1.008-1.012

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16
Q

pre-renal azotemia

A
  • before kidneys (blood, liver, GI)
  • increase in BUN +/- increase in CREA, increase in SPG, P & Mg
  • Ddx: decreased renal bloodflow–> decreased GFR, dehydration
  • Ddx: increased urea production: upper GI bleed
  • dehydrated animal with normal renal function: decreased urine function, increased urine spg (concentrated)
  • dehydration or bleeding
  • increased urea production- due to increased amino acids, decreased rumen motility or upper GI bleed
  • increased creatinine due to muscle or in neonatal foals
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17
Q

Renal azotemia

A
  • increased BUN, CREA, decreased specific gravity
  • isosthenuria
  • increased water loss
  • check analytes: increase P, Ca varies based on- species, cause, or age, increased PTH, decreased phosphorus in chronic, and increased potassium in acute, metabolic acidosis, Na-CL usually normal, decreased in chronic
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18
Q

post-renal azotemia

A
  • after kidneys (ureter, bladder, urethra)- increase in BUN, CREA, variable specific gravity
  • obstruction of urinary outflow distal to nephron
  • uroabdomen
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19
Q

Glomerulonephropathy

A
  • hypoalbuminemia
  • proteinuria
  • evidence of renal insufficiency (?)
  • nephrotic syndrome= protein losing nephropathy, leads to abdominal effusion
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20
Q

acute renal failure

A
  • usually good BCS
  • anorexia, V+, D+, halitosis
  • renal: oliguric–> anuric
  • neuro: depressed to non-responsive, seizures
  • etx: toxic, ischemia, infeciton
  • decreased GFR, azotemia- FAST
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21
Q

chronic renal failure

A
  • usually old cats
  • poor BCS, dehydration, anorexia, V+, D+, halitosis, polyuria, depressed, hypertension
  • non-regenerative anemia, azotemia, hyperphosphotemia, hypokalemia, metabolic acidosis–> more severe at end stage, isosthenuria
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22
Q

uroabdomen

A
  • males
  • trauma, chronic urethral obstruction
  • abdominal effusion: increased K, decreased sodium and Cl in serum
  • increased Na and CL in urine
  • urea and K in plasma
  • bloodwork: decreased sodium, increased potassium, decreased chlorine, increased BUN
  • increased CREA in plasma
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23
Q

Birubinuria

A
  • orange urine
  • some normal in hypersthenuric dog
  • hyperbilirubinemia- cholestasis, hemolysis, fever, prolonged fasting (esp in horses)
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24
Q

Maldigestion

A
  • exocrine pancreatic insufficiency
  • voluminous, poorly formed stool, flatulence, malodorous
  • decrease in weight
  • chronic biliary obstruction
  • increase in serum bile acids
  • TLI test
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25
Malabsorption
- intestinal disease - voluminous, poorly formed grey feces, weight loss - hypoproteinemia - protein losing enteropathy - intestinal lymphoma
26
TLI
- test for exocrine pancreatic insufficiency - dogs: > 5ug/L=normal - <2.5 ug/L= EPI - grey zone= 2.5-5 ug/L - cats= <8 ug/L= EPI
27
vitamin B and folate
- both decreased= generalized malabsorption - folate decreased, B12 normal= proximal SI defect - folate normal, B12 decreased- distal SI defect - cats: EPI may result in decreased IF release which leads to decreased B12- do TLI to determine if generalized malabsorption or EPI, intestinal disease may accompany EPI - dogs: stomach also secretes some IF, B12 levels slightly decreased - increased folate, decreased B12= bacterial overgrowth - decreased folate or B12= PLE, increased fecal alpha-1 protease inhibitor, decreased albumin and globulin
28
albumin binds Ca
-decreased albumin= apparent hypocalcemia
29
fructosamine increases with:
-hyperglycemia, diabetes mellitus
30
regulation of calcium
- increased by: PTH, vitamin D (calcitriol) | - decreased: calcitonin
31
What changes would you see in calcium and phosphorus in renal disease?
-decreased calcium, increased phosphorus
32
Calcium
- hypoalbuminemia= hypocalcemia - acidosis: increased ionized calcium - alkalosis= decreased ionized calcium
33
common causes of hypocalcemia
- renal disease: no vit D activation by kidney - ethylene glycol - pancreatitis: Ca 2+ binds necrotic fat - eclampsia - sepsis
34
uncommon causes hypocalcemia
- hypoparathyroidism: No PTH - nutritional secondary hyperparathyroidism - intestinal malabsorption - fleet enemas - citrate tox - hypomagnesia needed for PTH production and release - massive tissue degeneration - hypercalcitonism
35
hypercalcemia
- hypercalcemia of malignancy - granulomatous inflammatory disease - renal disease - idiopathic - vitamin D toxicosis - Addison's - primary hyperparathyroidism - renal disease in horses
36
regulation of phosphorus
- decrease- PTH and calcitonin | - increase- vitamin D
37
hypophosphatemia
- metabolic acidosis - osmotic diuresis - primary hypoparthyoidism - hypercalcemia of malignancy - vitamin D deficiency - chronic renal failure in horses - increased phosphorus and decreased calcium- leads to mineralization
38
hyperphosphatemia
- decreased GFR - ruptured bladder - vitamin D toxicosis - acidosis - excessive intake - primary hypoparathyroidism
39
hypokalemia
- chronic renal failure | - cats and cows in chronic renal failure
40
hyperkalemia
- oliguria/anuria | - renal failure/ end stage chronic renal failure
41
sodium and chloride
- normal in most cases of renal failure - hyponaturemia and hypochloremia- sometimes in chronic renal failure expecially in horses and cows - uroabdomen
42
When would you find metabolic acidosis?
in severe renal disease
43
glucose regulation
- insulin: decrease blood glucose - glucocorticoids: increase blood glucose - catecholamines- increase blood glucose - glucagon- increase blood glucose - growth hormones- increased blood glucose
44
-hypoglycemia
- apparent--> failure to remove serum from clot within 30 mins - increased insulin levels: insulinoma (hypoglycemic with high insulin), overdose - liver disease - sepsis - ketosis/pregnancy toxemia - neonatal/juvenile - starvation/ malabsorption/exertion - neoplasia - xylitol/ackee fruit
45
hyperglycemia
- glucocorticoids - catecholamines - diabetes mellitus - eating - pancreatitis - hormone imbalance - ethylene glycol toxicosis - cattle: proximal duodenal obstruction, milk fever
46
hypomagnesemia
- loss through- GI (malabsorption and diarrhea), kidney - dietary deficiency in ruminants - diabetes mellitus - hypercalcemia - hyperaldosteronism - third space syndromes - hypokalemia - impaired PTH production
47
hypermagnesemia
-compromised renal function
48
diabetes mellitus
- dehydration - glucosuria, ketonuria, osmotic diuresis - low urine spg, electrolyte loss
49
leakage enzymes
- released with cell injury | - AST,ALT, CK, SDH, GLDH
50
induced enzymes
- produced with cell injury | - ALP, GGT
51
CK
- muscle specific | - increase with muscle damage: IM injection, necrosis, trauma, exercise, downers, anorexic cats
52
AST
-liver and muscle, look at CK and ALT
53
CK and AST
- CK increases rapidly during injury, once resolves goes back to normal in 48 hs - AST lasts longer
54
ALT
- liver specific | - with super severe muscle damage can somewhat increase ALT
55
myoglobin
-released by dying muscle
56
hepatocellular injury
- look at leakage enzymes: ALT, AST, SDH, GLDH - old dogs: chronic hepatitis - young dogs: portocaval shunt - measure bile acids
57
hepatic necrosis
- diffuse: increase in leakage and induced enzymes and bile acids - focal: usually no lab changes
58
cholestasis
- ALT and GGT - cholangitis, bile duct obstruction, hepatic lipidosis (biopsy to diagnose) - increase in total bilirubin - cats= GGT for cholestasis, ALT for hepatic lipidosis
59
liver function test
- removed by liver: bilirubin, cholesterol, ammonia, exogenous stuff- failing liver can't remove this - liver makes: albumin, urea (BUN), cholesterol, coag factors: if failing--> decreases - bilirubin: increases with RBC destruction and blockage of bile flow - bile acids:increase in deviation of portal circulation and liver damage, decrease: in hepatocyte uptake and cholestasis
60
liver failure
- leakage--> normal/increased - induced: moderately increased - bilirubin: increased - ammonia: increased - what liver makes: decreased
61
chronic hepatitis
- leakage enzymes increased - induced enzymes increased - bilirubin is normal to increased - bile acids increased - loss of function
62
portosystemic shunt
-will see microcytic anemia, increased bile acids
63
cardiac
- myocardial cell injury: ALT, CK, troponin - functional proteins: naturetic peptides - BNP increase in production with ventricular hypertrophy, tachycardia, hypoxia, expanded fluid volume, decreased renal clearance of peptide
64
pancreas
- amylase levels> 3-4x upper end of normal suggest pancreatic injury - lipase >2x upper end of normal suggests pancreatic injury, exception: dogs on steroids - TLI to detect EPI- dogs- dexamethosone will increase increase TLI - PLI to detect pancreatitis- can be increased due to anticonvulsants - with pancreatitis: hyperglycemia, hypocalcemia, increase in liver enzyme
65
secondary hyperlipidemia
- hypothyroidism - diabetes mellitus - hypoadrenocorticism - pancreatitis - hepatic disease - nephrotic syndrome- hypocholesterolemia, PLE
66
hypolipidemia
- liver failure - maldigestion/absorption - PLE - starvation
67
PLE
-decrased protein and cholesterol
68
PLN
-decreased protein, cholesterol normal

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