Final - Hepatic/Urinary Flashcards
ALT
alanine aminotransferase
high [ ] in liver cells
doesn’t show failure, signal dysfunction
ALP
alkaline phosphate
high [ ] in biliary tree epithelium
inducible isoform from glucocorticoids
also in kidneys, bone, placenta
not liver dz specific
AST
aspartate aminotransferase
mitochondrial
high [ ] in muscles
not liver dz specific
Pseudo liver function tests
BUN
albumin
glucose
cholesterol
pre/post prandial bile acids
easiest, best test
do if bilirubin is NOT elevated
pre hepatic - hemolytic anemia
hepatic
post-hepatic - obstruction outside liver parechyma
basic dietary management strategies for liver disease
energy
protein
fiber
vitamin/minerals
anti-oxidants
energy - high palatability & energy density; small meals freq, fat and carbs
protein - high quality, digestible, low in Cu
fiber - soluble, moderate amount
vitamins/minerals - increased vit B and E, moderate Na restriction, adequate K, restricted Cu
anti-ox - increase Zn, E, C, taurine
management of ascites
sodium restriction
diuretics (furosemide, spironolactone)
management of hepatic encephalopathy
- correct precipitating factors like hypokalemia, GI hemorrhage, infection
- restrict dietary protein
- modify protein quality
- adjunctive like lactulose, Abx, probiotics
Azotemic
increased BUN, creatinine or SDMA
anuria
no urine
oliguria
decreased urine
polyuria
increased urine
pre-renal azotemic
dehydration
urine specific gravity > 1.035 cats, 1.030 dogs
renal azotemic
urine specific gravity < 1.035 cats, 1.030 dogs
management of polyuric renal azotemia
high digestible, low protein to control BUN
alkalizing diet for acidosis control
2 renal hyperparathyroidism for P control
extra K supplements to correct K wasting
eating, slow progression
