Proteins, Carbs, Lipids Clinical Pathology

Front 1

What's the difference b/w serum and plasma?

Back 1

Plasma: before blood clots, has plasma proteins-fibrinogen, clotting factors
Serum: after blood has clotted, lacks fibrinogen and clotting factors

Front 2

How are plasma proteins measured? Serum proteins?

Back 2

Plasma: refractometer
Serum: spectrophotometry

Front 3

How do you determine serum globulin concentration?

Back 3

Subtract albumin from total protein

Front 4

What proteins do we measure? (4)

Back 4

1) Total
2) Albumin
3) Fibrinogen-large animals
4) Globulins

Front 5

What does it mean if total protein increases and the PCV increases?

Back 5

Dehydration
-Albumin and globulins both increase

Front 6

What does it mean if the total protein decreases and the PCV decreases?

Back 6

Blood loss
-Albumin and globulins both decrease

Front 7

Serum protein is _____% albumin.

Back 7

35-50%

Front 8

What protein makes up the majority of oncotic pressure?

Back 8

Albumin

Front 9

Are globulins larger or smaller than albumin (69000)?

Back 9

smaller

Front 10

Where is albumin synthesized?

Back 10

Liver

Front 11

What 5 things do globulins include?

Back 11

1) antibodies
2) Complement
3) Clotting factors
4) Many enzymes
5) Protein carriers-lipids, vitamins, hormones, etc.

Front 12

How are globulins classified?

Back 12

Based on how far they migrate in a gel-vary by size

Front 13

What 2 globulins are produced in the liver?

Back 13

alpha globulins
betaglobulins

Front 14

What makes up most of the gamma globulins?

Back 14

Primarily IgG

Front 15

What type of globulin are IgM and IgA?

Back 15

Beta-globulins

Front 16

What are 3 general causes of hyperproteinemia?

Back 16

1) Hemocontration
2) Increased globulin synthesis
3) Hyperfibrinogenemia
-Usually inflammation

Front 17

What is hemoconcentration?

Back 17

Dehydration causes a proportional increase in both albumin and globulin

Front 18

What are 2 causes of increased globulin synthesis?

Back 18

1) Inflammation--> increase both acute phase proteins and Igs and complement
2) B lymphocyte neoplasia

Front 19

What is the only cause of hyperalbuminemia?

Back 19

Dehydration

Front 20

What are acute phase proteins?

Back 20

Mixed group of factors that are produced by the liver within 24 hours of inflammation, infection, tumors, necrosis, immune-mediated disease or surgery.

Front 21

What is used to evaluate increased globulins?

Back 21

Protein electrophoresis:
Polyclonal gammopathy
Monoclonal gammopathy

Front 22

What kind of gammopathy is this? What could cause it?

Back 22

Polyclonal gammopathy
Increased IgG produced by a mixed population of B lymphocytes or plasma cells w/ chronic antigenic stimulation

Front 23

What could cause this pattern?

Back 23

Monoclonal: IgG production by a clone of B lymphocytes or plasma cells
-Usually neoplastic-lymphoma, plasma cell tumor, or lymphocytic leukemia
Sometimes associated w/ infections such as ehrlichiosis, leishmaniasis, chronic pyoderma

Front 24

What is the most common cause of an increase in alpha globulins?

Back 24

Acute inflammation bc most of the acute phase reactants migrate as alpha

Front 25

What does a polyclonal gammopathy represent?

Back 25

Increased quantities of immunoglobulins produced by a heterogeneous population of B lymphocytes or plasma cells w/ chronic antigenic stimulation

Front 26

What does a monoclonal gammopathy represent?

Back 26

Increased immunoglobulin proudction by a single clone of B lymphocytes or plasma cells
-Most commonly neoplasia: lymphoma, plasma cell tumor, lymphocytic leukemia

Front 27

What are the 2 general causes of hypoproteinemia?

Back 27

1) Loss
2) Failure of synthesis

Front 28

What is the cause of just hypoalbuminemia?

Back 28

Loss through glomeruli

Front 29

What are 4 causes of panhypoproteinemia from protein loss?

Back 29

1) GI loss
2) Intestinal parasitism
3) Hemorrhage
4) Severe effusion

Front 30

What are 2 causes of failure to synthesize just albumin (just hypoalbuminemia)?

Back 30

1) Liver failure
2) Prolonged malabsorption/ maldigestion causing malnutrition

Front 31

What are 2 causes of hypoglobulinemia from a failure of synthesis?

Back 31

1) Failure of passive transfer
2) Immune-deficiency

Front 32

What levels mean there is failure of passive transfer in foals? calves?

Back 32

Foals: < 800 mg/dl
Calves < 1000 mg/dl

Front 33

What are 2 methods used to test for failure of passive transfer in calves, but NOT foals?

Back 33

1) Refractometer
2) Sodium sulfite (also ok in crias)

Front 34

What method is used to detect failure of passive transfer in calves and foals?

Back 34

Zinc sulfate

Front 35

What are two methods used to detect failure of passive transfer in foals only?

Back 35

1) Glutaraldehyde conjugation
2) ELISA

Front 36

True or false. The ELISA SNAP test is not a quantitative test for failure of passive transfer in foals.

Back 36

False, semiquantitative test by color change

Front 37

What is the major force holding fluid in vessels?

Back 37

Colloid osmotic pressure

Front 38

What can you do in a patient with a really low colloid osmotic pressure?

Back 38

Can give synthetic colloids

Front 39

How is colloid osmotic pressure measured?

Back 39

Using a colloid osmometer

Front 40

What do you call increased concentrations of lipids in the blood that may or may not be grossly visible?

Back 40

Hyperlipidemia

Front 41

What do you call increased concentrations of lipids in the blood that are grossly visible in serum or plasma?

Back 41

lipemia

Front 42

What does post-prandial (physiologic) hyperlipidemia occur in dogs or cats? How long does it take to clear?

Back 42

About 2-6 after eating
Clears by 8-16 hours

Front 43

What are 5 causes of fasting/persistent (at least a 12 h fast) hyperlipidemia?

Back 43

1) Usually hormonal or metabolic
2) Primary hyperlipidemia-genetic
e.g. Schnauzers
3) Drug- induced e.g. glucocorticoids
4) Enterocolitis in horses
5) Acute pancreatitis, hepatopathy

Front 44

True or false. Hypercholesterolemia is usually associated with atherosclerosis in domestic animals.

Back 44

False, that's humans

Front 45

What are the 4 forms of cholesterol?

Back 45

Very low density lipoproteins (VLDL)
Intermediate-density lipoproteins (IDL)
Low density lipoproteins (LDLs)
High density lipoproteins (HDL)

Front 46

What are 4 causes of hypercholesteremia?

Back 46

1) Endocrinopathies
2) Protein-losing glomerulopathy
3) Cholestasis
4) Acute pancreatitis

Front 47

What are 3 endocrinopathies that cause hypercholesteremia?

Back 47

1) Diabetes mellitus
2) Hypothyroidism
3) Hyperadrenocorticism

Front 48

What are 4 causes of hypocholesteremia?

Back 48

1) Decreased production-hepatopathy
2) Protein-losing enteropathy (e.g. lymphangectasia)
3) Hypoadrenocorticism
4) Severe malnutrition/ maldigestion/ malaborption

Front 49

What are the causes of hypertriglyceridemia?

Back 49

Similar to causes of hypercholesteremia:
1) Endocrinopathies
2) Protein-losing glomerulopathy
3) Cholestasis
4) Acute pancreatitis

Front 50

What causes hypotriglyceridemia?

Back 50

Nothing clinically significant

Front 51

When do non-esterified fatty acids (NEFAs) increase in plasma?

Back 51

When there's a negative energy balance

Front 52

What are 5 common causes of increased NEFA?

Back 52

1) Hepatic lipidosis
2) Ketosis
3) Diabetes mellitus
4) Equine "Cushing's"
5) Hyperlipidemia

Front 53

True or false. Adipokines can not be measured.

Back 53

True

Front 54

What are the 3 adipokines?

Back 54

1) Leptin
2) Adiponectin
3) Resistin

Front 55

What are adipokines?

Back 55

Factors produced by adipocytes or macrophages

Front 56

What are 3 ways that glucose is increased in plasma?

Back 56

1) Diet
2) Glycogenolysis
3) From amino acids and fats

Front 57

What 5 things regulate glucose? How does each one impact glucose levels?

Back 57

1) Insulin--> lower blood levels
2) Glucagon--> increases
3) Glucocorticoids--> increases
4) Catecholamines--> increases
5) Growth hormone--> increases

Front 58

What are 2 ways to test serum glucose?`

Back 58

1) Several assay techniques
2) Portable glucometers-usually less accurate at higher glucose concentrations

Front 59

When is there glucose in the urine?

Back 59

When blood glucose exceeds the renal threshold
-About 180 mg/dl in dogs,cats, borses
About 100 mg/dl in cattle

Front 60

What are 2 common causes of hypoglycemia?

Back 60

1) Increased utilization by tissues
2) Decreased production
OR combination of both

Front 61

What is the most common cause of hypoglycemia at the lab?

Back 61

Not separating the cells from the serum promptly

Front 62

What are 7 other causes of hypoglycemia?

Back 62

1) Hyperinsulinism (tumor, iatrogenic)
2) Hepatic insufficiency
3) Sepsis
4) Starvation, malabsorption, maldigestion-rare!
5) Hypoadrenocorticism (decreased insulin antagonist)
6) Extreme exertion-"hunting dog hypoglycemia"
7) Glycogen storage diseases

Front 63

What are 3 physiologic causes of hyperglycemia?

Back 63

1) Stress
2) Excitement
3) Postprandial

Front 64

What are 3 pathologic causes of hyperglycemia?

Back 64

1) Diabetes mellitus
2) Hyperadrenocorticism
3) Pharmacologic (glucocorticoids)

Front 65

What is the definitive test for hyperinsulinism due to neoplasia?

Back 65

Serum insulin assay

Front 66

What is the serum insulin assay based on?

Back 66

Plasma glucose concentrations should be proportional to plasma glucose concentration
i.e. insulin should be elevated in conjugation with glucose

Front 67

What is a normal serum insulin assay ratio for dogs?

Back 67

< 30 is normal for dogs

Front 68

What do fructosamine and glycated hemoglobin measure?

Back 68

Assays that estimate average blood glucose over the long-term

Front 69

What is fructosamine?

Back 69

Glucose bound to albumin

Front 70

What is serum fructosamine concentration proportional to?

Back 70

Blood glucose over last 2-3 weeks

Front 71

True or false. Fructosamine is affected by physiologic hyperglycemia.

Back 71

False, not affected by physiologic hyperglycemia

Front 72

Where is glycated hemoglobin formed?

Back 72

In erythrocytes as a reaction b/w glucose and hemoglobin

Front 73

What does glycated hemoglobin reflect?

Back 73

Average blood glucose over life span of erythrocyte (longer than albumin) e.g. 2-3 months

Front 74

What are 3 ketones?

Back 74

Acetoacetate
B-hydroxybutyrate
Acetone

Front 75

When are ketones formed?

Back 75

When there is carbohydrate deficiency and increased fat metabolism

Front 76

What happens when there's excess ketones?

Back 76

Causes metabolic acidosis

Front 77

How are ketones detected?

Back 77

In the urine by a dipstick

Front 78

What are 7 causes of hyperketonemia?

Back 78

1) Diabetes mellitus (also hyperglycemia)
2) Bovine ketosis
3) Pregancy toxemia
4) Hepatic lipidosis
5) Starvation
6) Anorexia
7) Low-carb diet

Front 79

What is different about diabetic hyperketonemic animals compared to other causes of hyperketonemia?

Back 79

Only one where animal is also hyperglycemic

Front 80

When is lactate formed?

Back 80

During anaerobic metabolism- when there is decreased tissue perfusion

Front 81

What tube do you want to use to measure lactose?

Back 81

Sodium fluoride-grey top

Front 82

What are 4 causes of increased lactic acid?

Back 82

1) Shock
2) Ischemia
3) Grain overload
4) Sustained heavy exercise