Flashcards in Serum Chemistry (MR) Deck (108):
Albumin is produced where? If it is low?
Liver. If low: Possibly impaired liver function
What are the 4 things on a Serum Chemistry that test Liver Function?
BUN (not biliruben)
What do liver enzymes tell you about function?
When I say Biliruben, you say?
Prehepatic, Hepatic, or Posthepatic
What causes hyperalbuminemia?
How do you calculate your globulins?
TP - Albumin
Big Ruleouts of Hypoalbuminemia? (9)
What type of enzyme is AST? AST is a marker for?
Mitochondrial Enzyme. Cellular Damage
Is AST specific for liver cellular damage?
An elevation in AST is suggestive of? (4)
Liver damage Kidney Infection
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
How small of a change in pH can start to kill things?
ALT is what type of enzyme?
What is ALT and indicator of?
How long post acute injury is AST at max level?
ALT t1/2 dogs?
ALT t1/2 cats?
If you were to kick a dog in the liver which enzyme, ALT or AST would need a harder kick?
Which of ALT & AST is more specific for liver damage? Why?
ALT, A lot of other tissues produce AST
Alkaline Phosphate is what type of enzyme? Where does it exist?
Membrane Bound, Bile Canicular Surface
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
What elevations in ALP are concerning?
ALP isoenzymes? (6)
Steroids (DOG) - endog or exog - can last weeks or months
Again, shorter in cats, any elevation is of concern
Who ALWAYS has elevated ALP? Why?
Puppies! Growing - Bone Isoenzymes
GGT is almost the same as what other enzyme? Difference in dogs?
ALP, dogs- Not as affected by steroids
GGT is what kind of enzyme? Where does it exist?
Membrane Bound, In Bile Duct Epithelium
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
Bilirubin: Prehepatic is?
Bilirubin: Hepatic is?
Liver Dz or Injury
Bilirubin: Post Hepatic is?
BUN/SUN is made where? Meaning?
Liver! Meaning it is a Liver Function Test!
What is a GI bleed considered?
A high protein meal!
BUN/SUN elevations are due to? (4)
High protein intake/GI bleed, Renal Dz,
BUN/SUN decreases are due to? (4)
Poor diet/Restricted Diet, Malabsorption,
How much damage in kidney function is lost before Creatinine elevation?
What is the earliest kidney function test?
USG @ 66%
Elevations in Creatinine can be due to? (5)
Renal Dz (75% loss), Muscle degeneration or damage,
Greyhounds - slightly
Who has lower normal range for Creatinine levels?
What must be elevated to qualify as Azotemia?
Elevated BUN and/OR Creatinine
What kind of blood work would you like to run?
UA - if not then at least USG
I say Azotemia, you say?
What MUST you evaluate along with your BUN and/OR Creatinine or you are wasting your time!
What is more important for renal function USG or Creatinine? Why?
USG, It happens first! (66% loss)
What does the liver do with Glucose? Making it a?
Makes, Metabolizes, and
. Making Glucose it a Liver Function Test
Elevations in Glucose are caused by? (6)
Diabetes Mellitus Pancreatitis
Decreases in Glucose are caused by? (6)
Liver Dz Chronic Infections
Hepatomas & other certain tumors
Calcium is regulated by?
Which regulator of Calcium levels is the "BIGGEST GUN"?
TQ! How do you determin whether Ca2+ leverls are actually abnormal?
What are the 3 forms of Ca2+?
What percentage of Ca2+ is Ionized? Bound? Complexed?
50% - Ionized 40% - Bound 10% - Complexed
What is the best representation of free calcium?
What is Bound Ca2+ bound to?
What is complexed with Ca2+?
Is it appropriate to correct Ca2+ for Albumin?
Cx of HYPOcalcemia? (8)
Increases in excitability - lowers threshold, Nervousness
Cx of HYPERcalcemia?(5)
Inhibits neurons & Mm cells - Decreases excitability (lowers threshold). Mineralization of tissues
Parathyroid glands respond to?
Low Serum Ca2+
Where does PTH go? Where does it then send messengers to?
Kidney. Messengers to Bone
What does the gut absorb to enable Ca2+ absorption?
How does the endrocrine system control itself?
What turns off the production PTH?
Increasing serum Ca2+ levels
Rule Out List for Hypercalcemia?
G.O.S.H.D.A.R.N.I.T: Granulomatous Dz
Spurious - lab abnormality
Idiopathic - Cats
Temperature - Cats when they get cold (weird)
What are the neoplasms associated with Hypercalcemia?
Lymphosarcoma - THE MOST. Anal Sac Adenocarcinoma
Rule Out List for HYPOcalcemia?
Pancreatitis/Phosphorous (Never give a cat a phosphate enema)
Low PTH and Low Calcium probably has?
High PTH and Low Calcium probably has? Why?
2º Hyperparathyroidism. Due to Diet
What kind of enema will you NEVER give to a Cat?
If Calcium is High what should PTH levels be?
ZERO OFF NADA
High Calcium and Low PTH?
Hypercalcemia of Malignancy, Lymphosarcoma,
Anal Saac Carcinoma,
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)
What is the active form of Vit D?
Calcitriol (1,25 Dihydroxy Vit D3)
If your calcium goes up what is it?
Cancer: Either Hyperparathyroidism or Hypercalcemia of Malignancy
Why do you get increased Phosphorous?
Decreased GFR Renal Failure - 85%
How much kidney function must be lost to show increased serum phosphorus due to renal failure?
What is phosphorous important for with bone growth?
Which differential for hypophoshatemia gives CRAZY hight levels?
Differentials for Decreases in Phosphorus?
Hyperparathyroidism, Humoral Hypercalcemia of Malignancy (HHM),
What is the Principal INTRAcellular Cation?
Differentials for Elevated Potassium?
Renal Dz Hemolysis
DM (acidosis or lack of insulin)
Which cation is more tightly regulated H+ or K+?
What is the principal EXTRAcellular Cation?
Differentials for increased Na+?
Differentials for Decreas in Na+?
What is the principal EXTRAcellular Anion?
If Cl- levels don't follow Na2+ levels what should you evaluate?
Acid-base status. Getting chucked out by kidney to save Bicarb
What does Cl- cary inversely with?
Why would you see HYPERchloremia?
Low Bicarb = Acidosis
Why would you see HYPOchloremia?
High Bicarb = Alkalosis
Why is Mg2+ important (broad)?
When Mg2+ gets really low what exchanges with it? Cofactor for a ton of functions
What is the biggest result of hypomagnesemia?
What is the result of hypermagnesemia?
??? - slide missing
How do you calculate Anion Gap?
Cations - Anions
What are the differentails for Increased Anion Gap?
Metabolic Acidosis (Organic), Toxins
List causes of Metabolic Acidosis (organic)?
Massice Tissue Injury
List toxins that would cause increased Anion Gap?
Ethylene Glycol, Methanol,
Metaldehyde (snail Bait)
What are the differentials for a decreased Anion Gap?
What is going on with your anions in a decreased Anion Gap?
Increase in unmeasured anions (many carried by albumin)
Creatine Kinase is what type of enzyme?
Why would you show elevated Creatine Kinase?
Hypothyroidism (later Stages)
Checking CK for elevation due to elevated levels of AST helps differentiate what?
Damage in Liver vs Muscle
Cholesterol is what type of test?
Decreases in Cholesterol can be due to?
Differentials for Elevations in Cholesterol?
Dietary ***Hypothyroidism - 85%
Renal Dz - Nephrotic Syndrome
Hepatic Dz - not specific
What % of Dogs with Hypothyroid have elevated Cholesterol levels?
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