Bryan - Clin Path - Test 2 Lectures 1-3 - Winter 2Nd Year

Front 1

T or F:
It is appropriate to use hospital patients to calculate "normal" reference intervals.

Back 1

False!
You want NORMAL HEALTHY individuals

Front 2

How can age affect reference intervals of liver enzymes?

Back 2

High alk phos in young animals;
High GGT in neonates from colostrum

Front 3

How can gender affect a reference interval (PCV and Ca)?

Back 3

Males have higher PCV;
Females have lower PCV than normal during pregnancy;
Pregnancy depresses Ca

Front 4

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%

Back 4

c) 5%; calculation is a 2-tailed t-test w/a 95% CI

Front 5

Can you ever make a diagnosis solely from a lab result?

Back 5

NOOOOOOOOOOOOO

Front 6

Choose sensitivity or specificity...
...measures the frequency of the test being positive in animals having the disease.

Back 6

Sensitivity

Front 7

Choose sensitivity or specificity...
...involves the proportion of animals with disease remaining undetected.

Back 7

Sensitivity

Front 8

How many false negatives would be expected on a test with 99% sensitivity?

Back 8

only 1%

Front 9

Choose sensitivity or specificity...
...measures the frequency of a test being negative in undiseased animals.

Back 9

Specificity

Front 10

Choose sensitivity or specificity...
...involves the certainty that a positive test means actual disease.

Back 10

Specificity

Front 11

How many false positives would be expected on a test with 88% specificity?

Back 11

12% false positives

Front 12

What test metric is better to use than sensitivity/specificity?

Back 12

Predictive values

Front 13

Which test metric takes into account the prevalence of disease?

Back 13

PRedictive value

Front 14

What are 3 reasons to separate serum from cells?

Back 14

Prevent glycolysis
Cells may leak AST, K, and P
Cells produce lactate

Front 15

What are two main differentials for chronic diarrhea and/or weight loss?

Back 15

Maldigestion
Malabsorption

Front 16

What is the most common cause of maldigestion?

Back 16

Exocrine pancreatic insufficiency

Front 17

What is the significance of decreased enzymatic activity?

Back 17

none usually

Front 18

What tests are available in evaluation of the pancreas?

Back 18

Seurm amylase
Serum lipase
Pancreatic lipase immunoreactivity
Trypsin-like immunoreactivity

Front 19

Which enzyme is responsible for hydrolysis of starch? Glycogen? Triglycerides?

Back 19

Amylase (starch & glycogen)
Lipase (TGs)

Front 20

What are some possible causes for increased serum amylase?

Back 20

Pancreatic injury
Obstruction of pancreatic ducts
Chronic renal insufficiency
Intestinal dz.
Hepatobiliary dz.

Front 21

What are some causes of increased serum lipase?

Back 21

Pancreatic injury
Obstruction of pancreatic ducts
Chronic renal insufficiency
Intestinal dz.
Glucocorticoids
Hepatobiliary dz.

Front 22

What levels of serum amylase/lipase are generally indicative of pancreatitis?

Back 22

increases of 3 to 4x above normal and NO azotemia

Front 23

Choose horses, cats, or dawgz...
...generally have normal or slightly increased serum amylase in cases of pancreatitis.

Back 23

Horses and cats

Front 24

When will a major increase in serum lipase first be seen after a pancratic injury? When is the peak noted?

Back 24

Increases after 24h; peaks at 2-5d.

Front 25

What is the likely diagnosis of an azotemic dog with serum lipase and amylase increased by a factor of 3 above normal?

Back 25

Renal dz (reduced GFR)

Front 26

Which test measures lipase of pancreatic origin only?

Back 26

Pancreatic lipase immunoreactivity

Front 27

T or F:
Both PLI and TLI tests are species specific.

Back 27

True!

Front 28

What will the relative levels of PLI tests return in cases of pancreatitis? With EPI?

Back 28

PLI (pancreatic lipase immunoreactivity) is high in pancreatitis and low in EPI (exocrine pancreatic insufficiency)

Front 29

What test is the most sensitive/specific for pancreatitis? For exocrine pancreatic insufficiency?

Back 29

Pancreatitis = PLI
EPI = TLI

Front 30

What conditions in cats will give false positives in the TLI test?

Back 30

Cats with hepatic or GI disease

Front 31

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

Back 31

b) hypolipidemia (should be HYPER)
c) renal azotemia (should be prerenal)

Front 32

What is a fluid besides serum that can be evaluated for pancreatitis?

Back 32

Peritoneal fluid (kinda flaky...works in camelids)

Front 33

In which dog breed is EPI common? What is a good test to confirm this?

Back 33

Exocrine pancreatic insufficiency is common in German Shepherds. Use TLI (Trypsin-like Immunoreactivity) to test

Front 34

What are some less commonly used tests of malabsorption?

Back 34

Serum folate
Cobalamin (vit B12)
Oral D-xylos absorption test
Feal exam/cytology
Fecal alpha-1 protease inhibitor

Front 35

T or F:
A dog with EPI will have a very high TLI value.

Back 35

False!
VERY LOW TLI with EPI

Front 36

What conditions may give abnormally low cobalmin tests? Abnormally high values?

Back 36

EPI
Bacterial overgrowth
Small intestinal dz.
(supplementation will give high values)

Front 37

What conditions may give low serum folate values? High values?

Back 37

low - decreased absorption
high - SIBO (small int bacterial overgrowth); EPI, excessive acid; supplementation

Front 38

What would relative values of folate and cobalamin be with EPI?

Back 38

Folate - high;
Cobalamin - low

Front 39

Which test of GI integrity can have false positives due to a meat diet?

Back 39

Fecal occult blood; very sensitive for Hgb and myoglobin can give false positives

Front 40

What are the BIG TWO regarding muscle enzymes?

Back 40

CK (creatine kinase)
AST (aspartate aminotransferase)

Front 41

T or F:
CK is found in skeletal, cardiac and smooth muscle.

Back 41

True!

Front 42

When will CK peak? What is its half life?

Back 42

Peak 6-12h post injury;
2-4h half-life

Front 43

When will AST peak?

Back 43

24-36h post injury

Front 44

T or F:
ALT is found in cardiac, skeletal, and smooth muscle.

Back 44

FALSE!
NOT IN SMOOTH MUSCLE. This is mostly a liver enzyme.

Front 45

T or F:
AST is found in muscle and liver.

Back 45

True!

Front 46

Predict the relative CK and AST values for...
...very acute muscle injury.

Back 46

High CK
normal AST

Front 47

Predict the relative CK and AST values for...
...recent or active muscle injury.

Back 47

High CK and high AST

Front 48

How is myoglobinuria diagnosed? How is this distinguished from hemoglobinuria?

Back 48

dipstick test (tests for myo and Hgb); can't reliably differentiate the two! if serum or plasma are hemolyzed, it denotes Hgb usually

Front 49

What would you expect the relative Ca values to be with severe acute muscle injury?

Back 49

hypocalcemic

Front 50

How can primary vs. secondary liver hepatopathy be differentiated through blood chemistries?

Back 50

THEY CAN'T

Front 51

T or F:
Liver failure occurs with irreversible destruction of 70-80% of the liva.

Back 51

Tru dat!

Front 52

T or F:
In cases of liver failure, serum enzyme activity will always be elevated.

Back 52

False!
If there is no active damage, enzymes may be normal.

Front 53

What is the test of choice for hepatocellular injury in small animals.

Back 53

ALT (alanine aminotransferase)

Front 54

What are some extrahepatic factors that can affect ALT values?

Back 54

Massive hemolysis (some ALT in RBCs);
Feline hyperthyroidism;
Steroid/phenobarb administration

Front 55

T or F:
ALT is a good test of hepatocellular injury in small and large animals.

Back 55

False! ALT activity is usually too low in large animals (use AST or SDH instead)

Front 56

T or F:
SDH is a good test of hepatocellular injury in small and large animals.

Back 56

True!
ALT and SDH both work for small animals; SDH works best for large animals.

Front 57

Which liver specific enzyme test might some loser from Barcelona order?

Back 57

GLDH (glutamate dehydrogenase)

Front 58

Which of the following enzymes are associated with leakage?
AST, ALP, ALT, SDH, GGT

Back 58

AST, ALT, SDH

Front 59

Which enzyme is most often elevated in instances of cholestasis?

Back 59

GGT (gamma glutamyltransferase)

Front 60

Which enzyme is used to assess passive transfer in cattle?

Back 60

GGT (high in colostrum; high in neonatal nursing calves)

Front 61

What are the three major isoenzymes of ALP?

Back 61

Liver
Bone
Drug-induced

Front 62

T or F:
Both dogs and cats show an increase in ALP liver isoenzyme in times of cholestasis.

Back 62

True!
Remember that only dogs will be ALP elevated with corticosteroids and anticonvulsants too!

Front 63

T or F:
ALT increase indicates hepatocellular damage and, thus, reduced hepatic function.

Back 63

False!
ALT = hepatocellular damage but is not indicative of function

Front 64

What is a major (general) pre-hepatic cause of bilirubinemia?

Back 64

erythrolysis

Front 65

What is a major (general) hepatic cause of bilirubinemia?

Back 65

hepatopathy (hepatocytes not taking-up bilirubin)

Front 66

What is a major (general) post-hepatic cause of bilirubinemia?

Back 66

Bile obstruction

Front 67

How is unconjugated bilirubin measured?

Back 67

Total bilirubin - conjugated bilirubin = unconjugated bilirubin

Front 68

T or F:
Increased conjugated bilirubin would likely indicate a patient with hepatopathy.

Back 68

True

Front 69

T or F:
Increased unconjugated bilirubin would likely indicate a patient with hepatopathy.

Back 69

False! It would indicate increased hemolysis

Front 70

At what level can bilirubeinemia cause icterus?

Back 70

>2-3mg/dl

Front 71

T or F:
Due to the low renal threshold for bilirubin, bilirubinuria is commonly seen before bilirubinemia.

Back 71

True!

Front 72

What is a common cause of bilirubinemia in horses?

Back 72

Anorexia

Front 73

Which is more clinically significant; bilirubinemia in a cat or in a dog?

Back 73

Cat!

Front 74

What tests are commonly used to assess liver function?

Back 74

Bilirubin (total, conjugated, unconjugated)
Bile Acids
Blood ammonia

Front 75

What factors are important to maintain enterohepatic circulation and serum bile acid concentrations?

Back 75

good portal circulation
functional hepatocytes w/normal blood flow
unimpaired bile flow

Front 76

T or F:
Most bile acids are reabsorbed in the cecum and then returned to the liver.

Back 76

False! Most are reabsorbed in the ileum!

Front 77

T or F:
Regarding liver function, testing bile acids is more sensitive than testing bilirubin.

Back 77

True!
Bile acids increase before bilirubin

Front 78

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

Back 78

everything except for PCV