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Flashcards in Serum Chemistry (MR) Deck (108):
1

Albumin is produced where? If it is low?

Liver. If low: Possibly impaired liver function

2

What are the 4 things on a Serum Chemistry that test Liver Function?

C-BAG: Cholesterol
BUN (not biliruben)
Albumin
Glucose

3

What do liver enzymes tell you about function?

Nothing

4

When I say Biliruben, you say?

Prehepatic, Hepatic, or Posthepatic

5

What causes hyperalbuminemia?

Dehydration

6

How do you calculate your globulins?

TP - Albumin

7

Big Ruleouts of Hypoalbuminemia? (9)

Poor diet
Diarrhea/PLE
Fever
Infection
Liver Dz
Burns
Vasculitis
Glomerulopathy/PLN

8

What type of enzyme is AST? AST is a marker for?

Mitochondrial Enzyme. Cellular Damage

9

Is AST specific for liver cellular damage?

NO

10

An elevation in AST is suggestive of? (4)

Liver damage Kidney Infection
Myocardial Infarction
Muscle Damage

11

Regarding ALT & AST what is the magnitude of increase required in dogs? Who is this NOT true for? Why?

2-3XC. Not true for ATS!
The t1/2 is very short in cats so if it does get high they pee it out

12

How small of a change in pH can start to kill things?

0.1

13

ALT is what type of enzyme?

Cytoplasmic Enzyme

14

What is ALT and indicator of?

Hepatocyte injury

15

How long post acute injury is AST at max level?

48 Hours

16

ALT t1/2 dogs?

3 days

17

ALT t1/2 cats?

6 hours

18

If you were to kick a dog in the liver which enzyme, ALT or AST would need a harder kick?

AST

19

Which of ALT & AST is more specific for liver damage? Why?

ALT, A lot of other tissues produce AST

20

Alkaline Phosphate is what type of enzyme? Where does it exist?

Membrane Bound, Bile Canicular Surface

21

What is alkaline phosphate (ALP) an indicator of?

Intra or Extrahepatic Cholestasis - backup of bile starts stretching out the bile canicular cells and membrane sticking off edge peels off and goes into blood

22

What elevations in ALP are concerning?

>4X

23

ALP isoenzymes? (6)

Liver Bone
Pregnancy
Steroids (DOG) - endog or exog - can last weeks or months
Phenobarb

24

ALP t1/2?

Again, shorter in cats, any elevation is of concern

25

Who ALWAYS has elevated ALP? Why?

Puppies! Growing - Bone Isoenzymes

26

GGT is almost the same as what other enzyme? Difference in dogs?

ALP, dogs- Not as affected by steroids

27

GGT is what kind of enzyme? Where does it exist?

Membrane Bound, In Bile Duct Epithelium

28

If both GGT and ALP are elevated what is this suggestive of? What else is suggestive of this?

Hepatic Lipidosis. Also indicated by GGT normal with elevated ALP

29

Bilirubin: Prehepatic is?

Hemolytic Anemia

30

Bilirubin: Hepatic is?

Liver Dz or Injury

31

Bilirubin: Post Hepatic is?

Cholestasis

32

BUN/SUN is made where? Meaning?

Liver! Meaning it is a Liver Function Test!

33

What is a GI bleed considered?

A high protein meal!

34

BUN/SUN elevations are due to? (4)

High protein intake/GI bleed, Renal Dz,
Dehydration ,
Exercise

35

BUN/SUN decreases are due to? (4)

Poor diet/Restricted Diet, Malabsorption,
Liver Dz,
Diuresis

36

How much damage in kidney function is lost before Creatinine elevation?

75%

37

What is the earliest kidney function test?

USG @ 66%

38

Elevations in Creatinine can be due to? (5)

Renal Dz (75% loss), Muscle degeneration or damage,
Drugs,
Dehydration,
Greyhounds - slightly

39

Who has lower normal range for Creatinine levels?

Puppies

40

What must be elevated to qualify as Azotemia?

Elevated BUN and/OR Creatinine

41

What kind of blood work would you like to run?

CBC,Chem,
UA - if not then at least USG

42

I say Azotemia, you say?

Pre-renal Renal
Post-renal

43

What MUST you evaluate along with your BUN and/OR Creatinine or you are wasting your time!

USG

44

What is more important for renal function USG or Creatinine? Why?

USG, It happens first! (66% loss)

45

What does the liver do with Glucose? Making it a?

Makes, Metabolizes, and
Stores it
. Making Glucose it a Liver Function Test

46

Elevations in Glucose are caused by? (6)

Diabetes Mellitus Pancreatitis
HYPERadrenocorticism
Steroids
Hypothyroid
Postprandial

47

Decreases in Glucose are caused by? (6)

Liver Dz Chronic Infections
Sepsis
Pyometra
Insulinoma
Hepatomas & other certain tumors

48

Calcium is regulated by?

PTH Calcitonin
Vit D
GI absorption
Renal Function

49

Which regulator of Calcium levels is the "BIGGEST GUN"?

PTH

50

TQ! How do you determin whether Ca2+ leverls are actually abnormal?

Evaluate Ionized

51

What are the 3 forms of Ca2+?

Ionized Bound
Complexed

52

What percentage of Ca2+ is Ionized? Bound? Complexed?

50% - Ionized 40% - Bound 10% - Complexed

53

What is the best representation of free calcium?

Ionized

54

What is Bound Ca2+ bound to?

Albumin

55

What is complexed with Ca2+?

Phosphate Citrate
Sulfate
Lactate
Bicarb

56

Is it appropriate to correct Ca2+ for Albumin?

NO!

57

Cx of HYPOcalcemia? (8)

Increases in excitability - lowers threshold, Nervousness
Behavior Changes
Facial Itchiness
Muscle Cramping
Stiff Gait
Tetany
Seizures

58

Cx of HYPERcalcemia?(5)

Inhibits neurons & Mm cells - Decreases excitability (lowers threshold). Mineralization of tissues
Weakness
Vomiting
Constipation

59

Parathyroid glands respond to?

Low Serum Ca2+

60

Where does PTH go? Where does it then send messengers to?

Kidney. Messengers to Bone

61

What does the gut absorb to enable Ca2+ absorption?

Vit D

62

How does the endrocrine system control itself?

Negative Feedback

63

What turns off the production PTH?

Increasing serum Ca2+ levels

64

Rule Out List for Hypercalcemia?

G.O.S.H.D.A.R.N.I.T: Granulomatous Dz
Osteopathy/Osteolytic Dz
Spurious - lab abnormality
Hyperparathyroidism
D Hypervitaminosis
Addisons
Renal Dz
Neoplasia
Idiopathic - Cats
Temperature - Cats when they get cold (weird)

65

What are the neoplasms associated with Hypercalcemia?

Lymphosarcoma - THE MOST. Anal Sac Adenocarcinoma
Multiple Myeloma

66

Rule Out List for HYPOcalcemia?

H.E.R.P.E.S.: Hypoparathyroidism
Eclampsia
Renal Dz
Pancreatitis/Phosphorous (Never give a cat a phosphate enema)
Ethylene glycol
Spurious

67

Low PTH and Low Calcium probably has?

1º Hypoparathyroidism

68

High PTH and Low Calcium probably has? Why?

2º Hyperparathyroidism. Due to Diet
Renal

69

What kind of enema will you NEVER give to a Cat?

Phosphate Enema.

70

If Calcium is High what should PTH levels be?

ZERO OFF NADA

71

High Calcium and Low PTH?

Hypercalcemia of Malignancy, Lymphosarcoma,
Anal Saac Carcinoma,
Multiple Myeloma

72

Why are the kidneys important for calcium? (2)

PTH goes to the Kidney and tells it to save calcium: Kidney activates Calcidiol (25 Hydroxy - Vit D3) -> Calcitriol (1,25 Dihydroxy Vit D3)

73

What is the active form of Vit D?

Calcitriol (1,25 Dihydroxy Vit D3)

74

If your calcium goes up what is it?

Cancer: Either Hyperparathyroidism or Hypercalcemia of Malignancy

75

Why do you get increased Phosphorous?

Decreased GFR Renal Failure - 85%
Growth
Diet
Ethylene Glycol
Hypoparathyroidism
Hemolysis

76

How much kidney function must be lost to show increased serum phosphorus due to renal failure?

85%

77

What is phosphorous important for with bone growth?

ATP

78

Which differential for hypophoshatemia gives CRAZY hight levels?

Ethylene Glycol

79

Differentials for Decreases in Phosphorus?

Hyperparathyroidism, Humoral Hypercalcemia of Malignancy (HHM),
Eclampsia

80

What is the Principal INTRAcellular Cation?

K+

81

Differentials for Elevated Potassium?

Renal Dz Hemolysis
Acidosis
Hypoadrenocorticism
Iatrogenic
DM (acidosis or lack of insulin)

82

Which cation is more tightly regulated H+ or K+?

H+

83

What is the principal EXTRAcellular Cation?

Na+

84

Differentials for increased Na+?

Dehydration Vomitting
Dxa
Hyperaldosteronism

85

Differentials for Decreas in Na+?

Vomitting Dxa
Hypoadrenocorticism

86

What is the principal EXTRAcellular Anion?

Cl-

87

If Cl- levels don't follow Na2+ levels what should you evaluate?

Acid-base status. Getting chucked out by kidney to save Bicarb

88

What does Cl- cary inversely with?

HCO3- (bicarb)

89

Why would you see HYPERchloremia?

Low Bicarb = Acidosis

90

Why would you see HYPOchloremia?

High Bicarb = Alkalosis

91

Why is Mg2+ important (broad)?

When Mg2+ gets really low what exchanges with it? Cofactor for a ton of functions

92

What is the biggest result of hypomagnesemia?

Arrhythmias

93

What is the result of hypermagnesemia?

??? - slide missing

94

How do you calculate Anion Gap?

Cations - Anions

95

What are the differentails for Increased Anion Gap?

Metabolic Acidosis (Organic), Toxins

96

List causes of Metabolic Acidosis (organic)?

Lactic Ketotic
Uremic
Massice Tissue Injury

97

List toxins that would cause increased Anion Gap?

Ethylene Glycol, Methanol,
Metaldehyde (snail Bait)

98

What are the differentials for a decreased Anion Gap?

Hypoalbuminemia

99

What is going on with your anions in a decreased Anion Gap?

Increase in unmeasured anions (many carried by albumin)

100

Creatine Kinase is what type of enzyme?

Muscle

101

Why would you show elevated Creatine Kinase?

Myopathy Trauma
Hypothyroidism (later Stages)

102

Checking CK for elevation due to elevated levels of AST helps differentiate what?

Damage in Liver vs Muscle

103

Cholesterol is what type of test?

LIVER FUNCTION!!!

104

Decreases in Cholesterol can be due to?

Hepatic Insufficiency

105

Differentials for Elevations in Cholesterol?

Dietary ***Hypothyroidism - 85%
Renal Dz - Nephrotic Syndrome
Hepatic Dz - not specific
Pancreatitis
DM

106

What % of Dogs with Hypothyroid have elevated Cholesterol levels?

85%

107

Amylase & Lipase elevation/decreases are significant for? (2)

Can have elevation or low and still have pancreatitis or renal dz. Neither sensitive nor specific - SHORT t1/2

108

High Calcium and High PTH? 1º

Hyperparathyroidism