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31 Cards in this Set

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ddx for increased bile acids
loss of functional hepatic mass
PSS
cholestasis


*no need to measure if bilirubin is increased
*measure fasting & 2 hr. postprandial
ddx for increased GGT
cholestasis
steroids: DOGS


*induced hepatic enzyme
*preferred enzyme to detect cholestasis in large animals
What is the test of choice to detect hepatocellular injury in large animals?
SDH

hepatocellular leakage enzyme: liver specific in all species

assay must be run immediately
ddx for increased anion gap
delayed sample analysis w/ loss of bicarb (exposure to air)
DKA
ketosis
renal insufficiency
poor tissue perfusion (lactic acidosis)
ethylene glycol toxicity

*most changes d/t increase in unmeasured anions (cations remain fairly constant in health & dz)
ddx for hyperbilirubinemia
prehepatic: hemolysis, internal hemorrhage
hepatic: loss of hepatic functional mass, anorexia (horses)
posthepatic: cholestasis
ddx for hypercholesterolemia
Cushing's
exogenous steroids
hypothyroidism
hyperlipidemia: diet, hepatic lipidosis, familial
pancreatitis
nephrotic syndrome
DM
intestinal dz
cobalamin

a. ddx for dec.
b. ddx for inc.
a. intestinal dz, EPI, chronic bacterial overgrowth, H2 blockers, artifact (exposure to sunlight)

b. vit. B12 administration


*cobalamin reflects absorption of vitamin B12 from diet
folate

a. ddx for dec.
b. ddx for inc.
a. severe intestinal dz
b. bacterial overgrowth


*folate reflects absorption of folic acid from diet & bacterial sources

*decreased cobalamin w/ increased folate consistent w/ EPI
What are 2 causes of mixed metabolic disorders?

What is the expected acid/base lab data?
loss of HCl (ex. vomiting) --> alkalosis & hypovolemic shock --> titration of lactic acid by bicarb --> acidosis

titration acidosis w/ DKA or renal failure --> vomiting --> inc. bicarb

normal to inc. bicarb, dec. chloride, markedly inc. anion gap
ddx for increased ALP in:

a. cats
b. dogs
a. cholestasis, hyperthyroidism, DM

b. cholestasis, steroids, Cushing's, DM, hepatic neoplasia, young animal, lytic or proliferative bone lesion

*induced hepatic enzyme
*not commonly used in large animals: wide RR
*main isoenzymes: liver, steroid (dog), bone
What is the difference b'twn conjugated & unconjugated bilirubin?
conjugated: sent in bile to intestines via biliary system

unconjugated: transported in blood bound to albumin
ddx for decreased anion gap
uncommon to have dec. AG

hemodilution (d/t fluid therapy)
hypoalbuminemia
hypercalcemia
hyperimmunoglobulinemia: myeloma
ddx for increased ALT
hepatocellular injury
muscle injury (esp. LA)
enzyme induction by drugs
hemolysis, lipemia can interfere w/ assay


*hepatocellular leakage enzyme
*liver specific in dogs & cats
*not useful in large animals
What are some causes of metabolic alkalosis?
most commonly d/t HCl loss from stomach or abomasum:
vomiting
abomasal or prox. duodenal obstruction: HCl sequestered
drainage of stomach contents w/ tube: horses

inc. bicarb, dec. chloride
What values are expected to be affected by hepatic insufficiency?
increased: globulin, bile acids, ammonia, bilirubin, clotting times

decreased: glucose, albumin, cholesterol, BUN, MCV
ddx for increased amylase:

a. inc. < 3x RR
b. inc. > 3x RR
a. dec. GFR, intestinal dz, hepatic dz, pancreatic dz
b. pancreatic dz
ddx for increased CK
muscle injury
hemolysis


*normal CK lower in old dogs
ddx for increased lipase:

a. inc. < 3x RR
b. inc. > 3x RR
a. dec. GFR, pancreatic dz
b. pancreatic dz, steroids (dog)
TLI

a. ddx for inc.
b. ddx for dec.
a. pancreatic cell damage, dec. GFR
b. EPI


* test of choice to dx EPI
ddx for inc. PLI
pancreatic cell damage


*test of choice to dx pancreatitis in dogs, NOT cats
* not affected by renal function
What lab abnormalities are associated w/ pancreatitis?
inc. amylase, lipase
inflammatory &/or stress leukogram
inc. liver enzymes, bilirubin
hyperglycemia, glucosuria
hypocalcemia
electrolyte abnormalities
metabolic acidosis
lipemia, inc. cholesterol & TG
inc. amylase & lipase in peritoneal fluid
ddx for increased AST
hepatocellular injury
muscle injury
hemolysis
enzyme induction by drugs


*hepatocellular leakage enzyme
*ALT preferred in SA, AST in LA
*NOT liver specific
What are the types of metabolic acidosis & their assoc. lab values?
titration acidosis: organic acid accumulation --> bicarb loss by titration (dec. bicarb, normal chloride, inc. AG)

bicarb loss: intestinal and pancreatic secretions (trapped by obstruction or lost as diarrhea), saliva in ruminants, renal tubular acidosis (dec. bicarb, high normal to inc. chloride, normal AG)

mixed: markedly dec. bicarb, high normal to inc. chloride, mild to mod. inc. AG
ddx for increased ammonia
hepatic insufficiency
PSS
urea toxicosis: ruminants
congenital def. of urea cycle enzymes (dogs: rare)


*converted to urea in liver
cholangitis, cholangiohepatitis, extrahepatic biliary obstruction, biliary rupture

a. HC injury?
b. cholestasis?
c. functional defects?
a. mild to moderate
b. marked
c. usually not
hepatic lipidosis

a. HC injury?
b. cholestasis?
c. functional defects?
d. comparison of ALP & GGT
a. yes
b. yes
c. usually not
d. ALP inc. more than GGT
massive hepatic necrosis

a. HC injury?
b. cholestasis?
c. functional defects?
a. marked
b. +/-
c. usually not
MF/Centrilobular/Large Focal Liver Lesions

a. HC injury?
b. cholestasis?
c. functional defects?
a. marked
b. no
c. no
Congenital PSS

a. HC injury?
b. cholestasis?
c. functional defects?
a. no
b. no
c. yes (no hyperbilirubinemia)
End Stage Liver

a. HC injury?
b. cholestasis?
c. functional defects?
a. yes (variable inc.)
b. yes
b. many
steroid hepatopathy

a. HC injury?
b. cholestasis?
c. functional defects?
a. yes
b. yes
c. inc. cholesterol, bile acids