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78 Cards in this Set

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T or F:
It is appropriate to use hospital patients to calculate "normal" reference intervals.
False!
You want NORMAL HEALTHY individuals
How can age affect reference intervals of liver enzymes?
High alk phos in young animals;
High GGT in neonates from colostrum
How can gender affect a reference interval (PCV and Ca)?
Males have higher PCV;
Females have lower PCV than normal during pregnancy;
Pregnancy depresses Ca
How many healthy animals should NORMALLY be outside the boundaries of a reference interval?
a) none - all normal animals are within the interval
b) 1%
c) 5%
d: 10%
c) 5%; calculation is a 2-tailed t-test w/a 95% CI
Can you ever make a diagnosis solely from a lab result?
NOOOOOOOOOOOOO
Choose sensitivity or specificity...
...measures the frequency of the test being positive in animals having the disease.
Sensitivity
Choose sensitivity or specificity...
...involves the proportion of animals with disease remaining undetected.
Sensitivity
How many false negatives would be expected on a test with 99% sensitivity?
only 1%
Choose sensitivity or specificity...
...measures the frequency of a test being negative in undiseased animals.
Specificity
Choose sensitivity or specificity...
...involves the certainty that a positive test means actual disease.
Specificity
How many false positives would be expected on a test with 88% specificity?
12% false positives
What test metric is better to use than sensitivity/specificity?
Predictive values
Which test metric takes into account the prevalence of disease?
PRedictive value
What are 3 reasons to separate serum from cells?
Prevent glycolysis
Cells may leak AST, K, and P
Cells produce lactate
What are two main differentials for chronic diarrhea and/or weight loss?
Maldigestion
Malabsorption
What is the most common cause of maldigestion?
Exocrine pancreatic insufficiency
What is the significance of decreased enzymatic activity?
none usually
What tests are available in evaluation of the pancreas?
Seurm amylase
Serum lipase
Pancreatic lipase immunoreactivity
Trypsin-like immunoreactivity
Which enzyme is responsible for hydrolysis of starch? Glycogen? Triglycerides?
Amylase (starch & glycogen)
Lipase (TGs)
What are some possible causes for increased serum amylase?
Pancreatic injury
Obstruction of pancreatic ducts
Chronic renal insufficiency
Intestinal dz.
Hepatobiliary dz.
What are some causes of increased serum lipase?
Pancreatic injury
Obstruction of pancreatic ducts
Chronic renal insufficiency
Intestinal dz.
Glucocorticoids
Hepatobiliary dz.
What levels of serum amylase/lipase are generally indicative of pancreatitis?
increases of 3 to 4x above normal and NO azotemia
Choose horses, cats, or dawgz...
...generally have normal or slightly increased serum amylase in cases of pancreatitis.
Horses and cats
When will a major increase in serum lipase first be seen after a pancratic injury? When is the peak noted?
Increases after 24h; peaks at 2-5d.
What is the likely diagnosis of an azotemic dog with serum lipase and amylase increased by a factor of 3 above normal?
Renal dz (reduced GFR)
Which test measures lipase of pancreatic origin only?
Pancreatic lipase immunoreactivity
T or F:
Both PLI and TLI tests are species specific.
True!
What will the relative levels of PLI tests return in cases of pancreatitis? With EPI?
PLI (pancreatic lipase immunoreactivity) is high in pancreatitis and low in EPI (exocrine pancreatic insufficiency)
What test is the most sensitive/specific for pancreatitis? For exocrine pancreatic insufficiency?
Pancreatitis = PLI
EPI = TLI
What conditions in cats will give false positives in the TLI test?
Cats with hepatic or GI disease
Which of the following are NOT common lab findings with pancreatitis?
a) neutrophilia & left shift
b) hypolipidemia
c) renal azotemia
d) increased liver enzymes
e) hyperglycemia
b) hypolipidemia (should be HYPER)
c) renal azotemia (should be prerenal)
What is a fluid besides serum that can be evaluated for pancreatitis?
Peritoneal fluid (kinda flaky...works in camelids)
In which dog breed is EPI common? What is a good test to confirm this?
Exocrine pancreatic insufficiency is common in German Shepherds. Use TLI (Trypsin-like Immunoreactivity) to test
What are some less commonly used tests of malabsorption?
Serum folate
Cobalamin (vit B12)
Oral D-xylos absorption test
Feal exam/cytology
Fecal alpha-1 protease inhibitor
T or F:
A dog with EPI will have a very high TLI value.
False!
VERY LOW TLI with EPI
What conditions may give abnormally low cobalmin tests? Abnormally high values?
EPI
Bacterial overgrowth
Small intestinal dz.
(supplementation will give high values)
What conditions may give low serum folate values? High values?
low - decreased absorption
high - SIBO (small int bacterial overgrowth); EPI, excessive acid; supplementation
What would relative values of folate and cobalamin be with EPI?
Folate - high;
Cobalamin - low
Which test of GI integrity can have false positives due to a meat diet?
Fecal occult blood; very sensitive for Hgb and myoglobin can give false positives
What are the BIG TWO regarding muscle enzymes?
CK (creatine kinase)
AST (aspartate aminotransferase)
T or F:
CK is found in skeletal, cardiac and smooth muscle.
True!
When will CK peak? What is its half life?
Peak 6-12h post injury;
2-4h half-life
When will AST peak?
24-36h post injury
T or F:
ALT is found in cardiac, skeletal, and smooth muscle.
FALSE!
NOT IN SMOOTH MUSCLE. This is mostly a liver enzyme.
T or F:
AST is found in muscle and liver.
True!
Predict the relative CK and AST values for...
...very acute muscle injury.
High CK
normal AST
Predict the relative CK and AST values for...
...recent or active muscle injury.
High CK and high AST
How is myoglobinuria diagnosed? How is this distinguished from hemoglobinuria?
dipstick test (tests for myo and Hgb); can't reliably differentiate the two! if serum or plasma are hemolyzed, it denotes Hgb usually
What would you expect the relative Ca values to be with severe acute muscle injury?
hypocalcemic
How can primary vs. secondary liver hepatopathy be differentiated through blood chemistries?
THEY CAN'T
T or F:
Liver failure occurs with irreversible destruction of 70-80% of the liva.
Tru dat!
T or F:
In cases of liver failure, serum enzyme activity will always be elevated.
False!
If there is no active damage, enzymes may be normal.
What is the test of choice for hepatocellular injury in small animals.
ALT (alanine aminotransferase)
What are some extrahepatic factors that can affect ALT values?
Massive hemolysis (some ALT in RBCs);
Feline hyperthyroidism;
Steroid/phenobarb administration
T or F:
ALT is a good test of hepatocellular injury in small and large animals.
False! ALT activity is usually too low in large animals (use AST or SDH instead)
T or F:
SDH is a good test of hepatocellular injury in small and large animals.
True!
ALT and SDH both work for small animals; SDH works best for large animals.
Which liver specific enzyme test might some loser from Barcelona order?
GLDH (glutamate dehydrogenase)
Which of the following enzymes are associated with leakage?
AST, ALP, ALT, SDH, GGT
AST, ALT, SDH
Which enzyme is most often elevated in instances of cholestasis?
GGT (gamma glutamyltransferase)
Which enzyme is used to assess passive transfer in cattle?
GGT (high in colostrum; high in neonatal nursing calves)
What are the three major isoenzymes of ALP?
Liver
Bone
Drug-induced
T or F:
Both dogs and cats show an increase in ALP liver isoenzyme in times of cholestasis.
True!
Remember that only dogs will be ALP elevated with corticosteroids and anticonvulsants too!
T or F:
ALT increase indicates hepatocellular damage and, thus, reduced hepatic function.
False!
ALT = hepatocellular damage but is not indicative of function
What is a major (general) pre-hepatic cause of bilirubinemia?
erythrolysis
What is a major (general) hepatic cause of bilirubinemia?
hepatopathy (hepatocytes not taking-up bilirubin)
What is a major (general) post-hepatic cause of bilirubinemia?
Bile obstruction
How is unconjugated bilirubin measured?
Total bilirubin - conjugated bilirubin = unconjugated bilirubin
T or F:
Increased conjugated bilirubin would likely indicate a patient with hepatopathy.
True
T or F:
Increased unconjugated bilirubin would likely indicate a patient with hepatopathy.
False! It would indicate increased hemolysis
At what level can bilirubeinemia cause icterus?
>2-3mg/dl
T or F:
Due to the low renal threshold for bilirubin, bilirubinuria is commonly seen before bilirubinemia.
True!
What is a common cause of bilirubinemia in horses?
Anorexia
Which is more clinically significant; bilirubinemia in a cat or in a dog?
Cat!
What tests are commonly used to assess liver function?
Bilirubin (total, conjugated, unconjugated)
Bile Acids
Blood ammonia
What factors are important to maintain enterohepatic circulation and serum bile acid concentrations?
good portal circulation
functional hepatocytes w/normal blood flow
unimpaired bile flow
T or F:
Most bile acids are reabsorbed in the cecum and then returned to the liver.
False! Most are reabsorbed in the ileum!
T or F:
Regarding liver function, testing bile acids is more sensitive than testing bilirubin.
True!
Bile acids increase before bilirubin
Which of the following values can commonly be affected by non-congenital hepatopathy?
a) BUN
b) Albumin
c) PCV
d) Urea
e) Cholesterol
f) PTT
everything except for PCV