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31 Cards in this Set
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ddx for increased bile acids
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loss of functional hepatic mass
PSS cholestasis *no need to measure if bilirubin is increased *measure fasting & 2 hr. postprandial |
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ddx for increased GGT
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cholestasis
steroids: DOGS *induced hepatic enzyme *preferred enzyme to detect cholestasis in large animals |
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What is the test of choice to detect hepatocellular injury in large animals?
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SDH
hepatocellular leakage enzyme: liver specific in all species assay must be run immediately |
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ddx for increased anion gap
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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) |
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ddx for hyperbilirubinemia
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prehepatic: hemolysis, internal hemorrhage
hepatic: loss of hepatic functional mass, anorexia (horses) posthepatic: cholestasis |
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ddx for hypercholesterolemia
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Cushing's
exogenous steroids hypothyroidism hyperlipidemia: diet, hepatic lipidosis, familial pancreatitis nephrotic syndrome DM intestinal dz |
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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 |
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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 |
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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 |
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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 |
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What is the difference b'twn conjugated & unconjugated bilirubin?
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conjugated: sent in bile to intestines via biliary system
unconjugated: transported in blood bound to albumin |
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ddx for decreased anion gap
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uncommon to have dec. AG
hemodilution (d/t fluid therapy) hypoalbuminemia hypercalcemia hyperimmunoglobulinemia: myeloma |
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ddx for increased ALT
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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 |
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What are some causes of metabolic alkalosis?
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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 |
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What values are expected to be affected by hepatic insufficiency?
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increased: globulin, bile acids, ammonia, bilirubin, clotting times
decreased: glucose, albumin, cholesterol, BUN, MCV |
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ddx for increased amylase:
a. inc. < 3x RR b. inc. > 3x RR |
a. dec. GFR, intestinal dz, hepatic dz, pancreatic dz
b. pancreatic dz |
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ddx for increased CK
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muscle injury
hemolysis *normal CK lower in old dogs |
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ddx for increased lipase:
a. inc. < 3x RR b. inc. > 3x RR |
a. dec. GFR, pancreatic dz
b. pancreatic dz, steroids (dog) |
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TLI
a. ddx for inc. b. ddx for dec. |
a. pancreatic cell damage, dec. GFR
b. EPI * test of choice to dx EPI |
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ddx for inc. PLI
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pancreatic cell damage
*test of choice to dx pancreatitis in dogs, NOT cats * not affected by renal function |
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What lab abnormalities are associated w/ pancreatitis?
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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 |
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ddx for increased AST
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hepatocellular injury
muscle injury hemolysis enzyme induction by drugs *hepatocellular leakage enzyme *ALT preferred in SA, AST in LA *NOT liver specific |
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What are the types of metabolic acidosis & their assoc. lab values?
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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 |
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ddx for increased ammonia
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hepatic insufficiency
PSS urea toxicosis: ruminants congenital def. of urea cycle enzymes (dogs: rare) *converted to urea in liver |
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cholangitis, cholangiohepatitis, extrahepatic biliary obstruction, biliary rupture
a. HC injury? b. cholestasis? c. functional defects? |
a. mild to moderate
b. marked c. usually not |
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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 |
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massive hepatic necrosis
a. HC injury? b. cholestasis? c. functional defects? |
a. marked
b. +/- c. usually not |
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MF/Centrilobular/Large Focal Liver Lesions
a. HC injury? b. cholestasis? c. functional defects? |
a. marked
b. no c. no |
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Congenital PSS
a. HC injury? b. cholestasis? c. functional defects? |
a. no
b. no c. yes (no hyperbilirubinemia) |
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End Stage Liver
a. HC injury? b. cholestasis? c. functional defects? |
a. yes (variable inc.)
b. yes b. many |
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steroid hepatopathy
a. HC injury? b. cholestasis? c. functional defects? |
a. yes
b. yes c. inc. cholesterol, bile acids |
