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454 Cards in this Set
- Front
- Back
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What is the packed cell volume?
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Percentage of whole blood that is red cells
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Decreased PCV can indicate regenerative anemia, caused by what 2 conditions?
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-IMHA
-Blood loss |
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What are some examples of non-regenerative anemia?
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-Inflammation
-Renal dz -Bone marrow dz |
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What is polycythemia?
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Increase on PCV (relative and absolute)
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How are blood total proteins assessed?
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Refractometer or chemical method
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Out of the 200+ blood proteins, which ones are commonly evaluated?
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-Albumin
-Globulins -Acute phase proteins (fibrinogen, haptoglobin) |
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An increase in total proteins can indicate what?
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-Dehydration
-Chronic infection (FIP) -Leukemia |
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What are some of the causes of decreased total proteins?
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-Poor nutrition
-Liver dz -Malabsorption -Diarrhea -PLN/PLE -Burns |
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What protein is lost with a PLE?
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Globulin
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What protein is lost with PLN?
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Albumin
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An elevation of both PCV and TP would indicate what?
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-Dehydration and relative polycythemia
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What would an elevated TP along with low-low-normal PCV indicate?
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-Dehydration may be masking a more sever anemia
(when you correct dehydration, may decrease PCV to alarming levels) |
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Which blood value is a bit more sensitive than PCV?
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Hematocrit
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What is the oxygen carrying molecule?
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Hemoglobin
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By what manual method is a leukogram performed?
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With a hemocytometer
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What values indicate a physiologic leukocytosis?
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-Neutrophilia & lymphocytosis
(catecholamines) |
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In which species is physiologic luekocytosis seen?
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cats- fear
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What woul you see with a stress leukogram?
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-Mature neutrophilia, monocytosis and lymphopenia
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An inflammatory leukogram has bands in the amount greater than what>
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1000 bands
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What are some causes of extreme neutrophilic leukocytosis?
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-Pyometra
-Erlichia -Hepatozoanosis -Fungus |
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What might you expect with a leukocytosis greater than 50,000?
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Leukemia
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Elevated mature neutrophils can indicate what conditions?
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-Inflammation
-Infection -Immune mediated disease -Stress -Fear -Neoplasia |
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A decrease in mature neutrophils can indicate what condition in bone marrow?
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-Disease
-Dysfunction -Suppression |
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What other general conditions can a decrease in mature neutrophils indicate?
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-Overwhelming inflammation.infection
-Destruction -Neoplasia -Cyclic hematopoiesis |
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What is meant by a regenerative left shift?
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Neutrophil response to inflammation are adequately responding to demand
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What tern is used when neutrophils are not adequately responding to demand?
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Degenerative left shift
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Which WBC's are circulating immune system cells?
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Lymphocytes
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Lymphocytes are indicators of what?
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Antigenic stimulation
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What would elevated lymphocytes make you suspicious of?
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-Chronic inflammation esp. rickettsial infection, neoplasia, catecholamines, hypoadrenocorticism
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A decrease in lymphocytes might indicate what?
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-Steroids, acute inflammation, effusions, lymphois hypoplasia/aplasia
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Monocytes that migrate into tissues are called what?
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Macrophages
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Monocytes are indicators of what condition?
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Chronic inflammation
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What does a decrease in lymphocytes indicate?
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Not really a problem
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Eosionophils and Basophils are what type of cells?
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Granulocytes
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Elevations of eosinophils and basophils are indicative of what conditions?
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-Allergic dz
-Parasitic dz -Eosinophilic dz -Mast cell neoplasia -Hypoadrenocorticism -Neoplasia |
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What might cause eosinopenia?
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Steroids, acute inflammation, bone marrow dz
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What stain is used to demonstrate reticulocytes?
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New methylene blue
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In felines, aggregate reticulocytes are newly released from where?
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Bone marrow
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Aggregate reticulocytes mature into what type of cells>
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Punctate reticulocytes
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How long do punctate reticulocytes circulate?
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About 7 days
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What is the absolute reticulocyte number for dogs? Cats?
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Dogs >80,000
Cats > 40,000 |
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What does the corrected reticulocyte value tell you?
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If there is regeneration, is it enough
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In a dog, the CRP should be what, that indicates regeneration?
In a cat? |
Dog >1.5%
Cat > 1% |
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In terms of mean cell volume (MCV), Macrocytosis indicates what conditions?
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Regeneration (and seen in Poodles)
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Microcytosis is an indicator of what conditions?
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Fe deficiency
PSS |
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In terms of hemoglobin concentration, blood loss, hemolysis and Fe deficiency would show what type of chromia?
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Hypochromia
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What cause hyperchromia?
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Doesn't happen, if the machine reads elevated, think heinz bodies
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Fibrinogen is what type of protein?
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Acute phase protein
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Fibrinogen is an indicator of what condition?
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Inflammation, cleaved into fibrin in clotting cascade
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Giant platelets are a sign of what?
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Regeneration
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What causes thrombocytopenia?
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-Increased destruction
-Increase use (DIC) -Decreased production -Sequestration |
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What can change blood cell morphology in a smear?
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-regeneration
-Hgb content -membrane composition -structural proteins -oxidative damage -fragmentation -platelet clumping |
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What causes heinz body formation?
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-Oxidative damage
-Denatured Hgb -Onion toxicity -Tylenol toxicity |
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Agglutination of blood cells is caused by what condition?
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IMHA
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Where is albumin produced?
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In the liver
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Is albumin a liver function test?
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Yes
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What is the only condition that causes hyperalbuminemia?
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Dehydration
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When measuring albumin what else should be measured?
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Total protein
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What are some causes of hypoalbuminemia?
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-poor diet
-diarrhea/PLE -fever -infection -liver disease -burns -vasculitis -glomerulopathy/PLN |
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Alanine transaminase (AST) is what type of enzyme?
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Mitochondrial
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AST is a marker for what?
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Marker for cellular damage
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True or False. AST is specific to just the liver.
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False
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AST is suggestive of what conditions?
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-liver damage
-kidney infection -myocardial infarction -muscle damage |
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In a dog, what level of increase would you expect to see?
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2-3 X
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Alanine Aminotransferase (ALT) is what type of enzyme?
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Cytoplasmic enzyme
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ALT is an accurate indicator of what type of damage?
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Hepatocyte injury
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ALT is at its maximum level at what time post acute injury?
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48 hours
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Is ALT a liver function test?
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No
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What is the T1/2 of ALT in dogs?
Cats? |
Dogs: 3 days
Cats: 6 hours |
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Where is Alkaline Phosphate located?
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Bile canalicular surface (membrane bound)
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Alkaline Phosphate is an indicator of what condition?
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Cholestasis
Is not a liver function test |
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Alk Phos is an indicator of cholestasis...where?
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Intra or extrahepatic
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Alk Phos is also found where in the body?
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-liver
-bone -pregnancy -skeletal growth -steroids- dog |
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Where is Gamma Glutamyl Transferase (GGT) found?
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Bile duct epithelium (membrane bound)
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In a cat, elevated GGT and ALP are indicative of what?
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Hepatic lipidosis
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Pre-hepatic bilirubinemia is caused by what condition?
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Hemolytic anemia
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Hepatic bilirubinemia is a result of disease of injury where?
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Liver disease
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Cholestasis is an example of what type of bilirubin-related condition?
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Post-hepatic
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Total bilirubin consists of what?
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Conjugated and unconjugated
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BUN is made by which organ?
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Liver
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Is BUN a liver function test?
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Yes
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Elevated levels of BUN can indicate what conditions?
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-high protein intake/GI bleed
-renal dz -dehydration -exercise |
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What conditions can cause a decrease in BUN?
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-poor/restricted diet
-malabsorption -liver disease -diuresis |
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What percentage of renal damage must occur before increases in creatinine will be seen?
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75% damage
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Elevated creatinine can indicate what conditions?
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-renal disease
-muscle degen/damage -drugs -dehydration -greyhounds |
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Azotemia is defined as what?
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An elevation in BUN or creatinine
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Azotemia can be of what 3 types?
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pre-renal, renal, post-renal
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Azotemia must be evaluated in conjunction with what other parameter?
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Urine Specific Gravity
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Is glucose an assessment of liver function
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Yes
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Elevated levels of glucose can indicate what conditions?
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-DM
-pancreatitis -hyperadrenocorticism -steroids -hypothyroidism -post prandial |
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Decreases in glucose levels can be indicative of what conditions?
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-liver dz
-chronic infection -sepsis -pyometra -insulinoma -hepatomas |
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Calcium is tightly regulated by what other processes and substances?
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-PTH
-calicitonin -Vit D -GI absorption -renal function |
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Which form of calcium is measured on a chemistry report?
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Total
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Free calcium is best represented by which value?
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Ionized 50%
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Complexed calcium (10%) includes what?
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Phosphate, citrate, sulfate, lactate, bicarbonate
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What mnemonic is used to remind yourself of the causes of hypercalcemia?
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GOSHDARNIT
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Causes of hypocalcemia includes what conditions?
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-hypothyroidism
-eclampsia -renal disease -pancreatitis/phosphorus -ethylene glycol -spurious |
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Elevated levels of phosphorus can indicate what conditions?
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-decreased GFR
-renal failure 85% -growth -diet -ethylene glycol -hypoparathyroidism |
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Decreases in Phosphorus may be due to what?
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-hyperparathyroidism
-humoral hypercalcemia of malignancy (HHM) -eclampsia |
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What is the principal extracellular cation?
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Sodium
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Elevations of Sodium can be seen in what consditions?
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-dehydration
-V/D -hyperaldosteronism |
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The principal extracellular anion is...
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Chloride
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Chloride usually follows sodium, if it doesn't, what should be evaluated?
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Acid-base status
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Chloride varies inversely with what?
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Bicarbonate
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Is hyperchloremia associated with acidosis or alkalosis?
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Acidosis= low bicarb
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Alkalosis would be associated with what level of chloride?
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Hypochloremia = high bicarb
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Anion gap is a measure of what?
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Measured cations - measure anions
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Increased anion gap indicates metabolic acidosis or alkalosis?
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Metabolic acidosis
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What types of toxins will increase the anion gap?
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-ethylene glycol
-methanol -methaldehyde |
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An increase in UNmeasured anions can indicate what?
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Hypoalubinemia
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Creatine Kinase is an enzyme from where?
|
Muscle
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Elevations in creatine kinase are indications of what conditions?
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-myopathy
-trauma -hypothyroidism (later stages) |
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Elevated cholesterol can be caused by what?
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-dietary
-hypothyroidism -renal dz (nephrotic syndrome) -hepatic dz -pancreatitis -DM |
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Decreased levels of cholesterol can indicate what?
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-hepatic insufficiency
(can be a liver function assessment) |
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Elevated Amylase & Lipase can indicate what conditions?
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-exocrine pancreatic dz
-renal dz |
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What are the problems with relying an amylase and lipase?
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-Not sensitive nor specific
-short T 1/2 -wide ref ranges |
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What are the 3 components of a urinalysis?
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-Physical appearance
-Chemical exam -Sediment exam |
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Normal urine should be what color?
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Yellow to amber
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Turbidity of urine increases with what?
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Increased particulate matter
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Red to red/brown colored urine can indicate what?
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-hematuria
-hemoglobinuria -myoglobinuria |
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What color is urine that is classified as bilirubinuria?
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Orange to brown
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What is the use of a USG?
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Renal function test
Renal tubule assessment |
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What is the range of USG?
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1.001 -1.080
depends on health and hydration status |
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A USG 1.008 is termed what?
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Hypersthenuria
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What ranges of USG is termed isothenuria?
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1.008 - 1.012
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What USG reading is hypersthenuria in a dog? Cat?
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Dog: 1.030
Cat: 1.035 |
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Urine protein should always be evaluated in relation to what?
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USG
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Elevated urine protein can indicate what conditions?
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-hemorrhage
-shock -fever -recent exercise -inflammation -glomerular dz |
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Chemical analysis of urine includes levels of which keytones?
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-B hydroxybutyric acid
-acetone -acetoacetic acid |
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Under what conditions are keytones elevated?
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-When fat metabolism replaces carbs
-starvation -diet -diabetic ketoacidosis |
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What is the renal threshold of glucose in dogs? In cats?
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Dogs: 180 mg/dl
Cats: 280 mg/dl |
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Elevation of urine glucose indicates what conditions?
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-rare kidney abnormalities
-stress -DM |
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True or False. Even a small amount of bilirubin in a dog's urine is abnormal.
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False
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Urobilinogen is an indication of what?
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Patent bile ducts
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What level of urobilinogen mightr suggest a bile duct obstruction?
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Absence of urobilinogen
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Occult blood may be seen in what urinalysis results?
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-myglobinuria
-hemoglobinuria -hematuria |
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Urine sediment is examined for what types of cells?
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-WBC's
-RBC's -epithelial cells |
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How many cells could you expect to see in a cystocentesis sample?
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0-5 RBC
0-5 WBC occasional epithelial |
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The presence of RBC's and WBC's in urine can indicate what?
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Inflammation
Blood contamination |
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Elevated levels of epithelial cells can indicate what?
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-inflammation
-degeneration -neoplasia |
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What types of crystals can normally be present in urine?
|
-triple phosphate
-calcium oxylate -calcium carbonate -urate -amorphous |
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Pathology can exist especially with which crystal types?
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-ammonium biurate
-tyrosine -bilirubin -calcium oxalate monohydrate -cystine |
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Hyaline casts are made of what?
|
-mucoprotein from glomerular leakage
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Epithelial casts that age and become modified have what appearance?
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Granular and waxy
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Bacterial examination of urine should only be carried out on what type of sample?
|
Only if collected by cystocentesis
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In the dog, the primary site of digestion and absorption is where?
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Small intestines
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The small intestines include what?
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Pylorus of stomach- duodenum-jejunum-ileum
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What is the difference between the esophagus of the dog versus the cat?
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In the dog, the esophagus is all striated muscle
In the cat the distal portion is smooth muscle |
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Primary peristalsis of the esophagus is a reaction to what?
|
Swallowing
|
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Secondary peristalsis of the esophagus is a reaction to what?
|
Stretch
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The ANS control of the stomach is thru which nerves?
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Vagus and celiac plexus
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Enteric control of the stomach is via what?
|
Myenteric and submucosal plexua
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Peristalsis works in conjunction with what other process?
|
Migrating motor complexes
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What do the parietal cells of the stomach secrete?
|
-Hcl
-gatrin -ach -histamine |
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Pepsinogen is secreted by which cells?
|
Chief
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Mucous cells produce what in the stomach?
|
Bicarbonate
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The pancreas is attached where to the stomach?
|
Greater curve and duodenum
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Digestive enzymes are released in packages called what?
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Zymogens
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Where are zymogens then activated?
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In the intestines
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Digestive enzymes are cleaved to their active form by what substance?
|
Enterokinase
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What defense mechanisms are in place to ensure that the release of digestive enzymes occurs in the proper place?
|
-physical separation of zymogens within acinar cells
-distance between the site of eneterokinase release and zymogens -enzyme inhibitors in pancreas and within circulation |
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What is the function of bicarbonate in the GIT?
|
Neutralize gastric acid
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Along with enzyme activation, what other function does the exocrine pancreas have?
|
-nutrient absorption
-mucosal cell turnover |
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What 2 processes does the exocrine pancreas inhibit?
|
-autodigestion by enzyme inhibitors
-bacterial proliferation |
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In the dog, the duodenum is what % of the length of the intestines?
|
10%
|
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The majority of the SI is made up of which section?
|
Jejunum
|
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The last 12 inches of the is is the what?
|
Ileum
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Enterocytes are located where on the intestinal villi?
|
on the top
|
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Enterocytes have a short life span, and have what type of function?
|
Absorptive
|
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Which cells of the SI secrete mucins?
|
Goblet cells
|
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What is the function of the Paneth cells?
|
-defense
-antimicrobial |
|
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Parvo virus attacks which portion of the intestines?
|
stem cells and crypt cells
|
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Which viral agent attacks the enterocytes?
|
Corona
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What are the 5 primary functions of the GIT?
|
-digestion
-absorption -excretion -water balance -electrolyte and acid/base balance |
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The jejunum absorbs how much of the presented fluid? The ileum? Colon?
|
J = 50%
I = 75% C = 90% |
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Survey radiographs of the esophagus may help to visualize what?
|
-dilation
-air -displacement -FB -masses |
|
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Radiographs of the thorax can help to visualize what other conditions?
|
-pneumomediastinum
-metastatic disease -aspiration pneumonia |
|
|
Contrast radiography may help in detecting what?
|
-defects
-FB |
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What GI contrast agent is used?
|
Barium
|
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What GI radiographic contrast is used if a perforation is suspected?
|
Iodinated agent
|
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What is the benefit of fluoroscopy?
|
Functional analysis
|
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Regurgitation must be differentiated from what other symptom?
|
Vomiting
|
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What do you need to know from the Hx to determine regurgitation from vomiting?
|
-chronicity
-recent anesthesia? -FB ingestion/removal? |
|
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What additional clinical signs of regurgiation do you look for?
|
-dyshagia
-halitosis -hypersalivation -wt loss (can be severe) -+ coughing, dyspnea -+ depression, anorexia |
|
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Is regurgitation a passive or active function?
|
Passive
|
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What is the appetite level of a dog with regurgitation?
|
increased
|
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What other conditions do you need to rule out when dealing with regurgitation?
|
-megaesophagus/esophageal wekaness
-vasc ring anomaly -FB -stricture, diverticula, fistulas -esophagitis -LES achalasia |
|
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What is the most common vascular ring anomaly that can cause regurgitation?
|
PRAA
|
|
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Reguritation rule outs also include what?
|
-esophgeal masses (neoplasia, granulomas)
-hiatal hernia -GE intussusceptions -lead poisoning -canine distemper |
|
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What could be the cause of an esophageal granuloma?
|
Spirocerca lupi
|
|
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What other tool can be used to visualize the esophagus?
|
Endoscopy
|
|
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When evaluating regurgitation, why is a CBC/Chem/UA helpful?
|
Allows for systemic evaluation
|
|
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What might a fecal exam reveal?
|
Spirocerca lupi
|
|
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When evaluating regurgitation, an acetylcholine anitbody titer would help to determine the presence of what disease?
|
Myasthenia gravis
|
|
|
Why would you consider doing an ACTH stim test?
|
To check for Addison's
|
|
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When evaluating regurgitation, what other specific lab test might you request?
|
Toxicology
|
|
|
When evaluating regurgitation what neuromucular testing might you consider?
|
-EMG
-Tensilon test- MG -peripheral muscle/nerve bx -dysautonomia evaluation |
|
|
Vomiting usually includes what contents?
|
Gastric and duodenal contents
|
|
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Vomiting can lead to a metabolic acidosis or alkalosis?
|
Metabolic alkalosis
|
|
|
A high GI obstruction can lead to metabolic alkalosis from what?
|
Hypochloremia
|
|
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When evaluating an animal for vomiting, what Hx questions would you ask?
|
-vaccs
-deworming -travel hx -freq and severity -wt loss -behavior change -hydration status -concurrent GI signs -hematemesis assoc w/ eating? -appearance of vomitus |
|
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When might vomitng become a life-threatening situation?
|
Continual, non-stable patient
|
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What would you suspect if a patient presents with non-productive vomiting, distended abdomen and shock/collapse?
|
GDV
|
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What steps would you take in the case of life threatening vomiting?
|
-rads
-bloodwork -emergency stabilization and surgery |
|
|
Know the primary GI causes of vomiting
|
and the non-GI causes of vomiting
|
|
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When working up a case for vomiting, additional diagnostics may include what?
|
-rads
-US -additional biochem (bile acids, ACTH stim, HW test, tox, GI panel) |
|
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In the case of chronic vomiting what steps would you take first?
|
-Blood work and imaging
|
|
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If the patient is stable, with chronic vomiting, what therapeutic trail might you try?
|
Dietary change
|
|
|
When does diarrhea occur?
|
When the GI systems enormous absorptive, secretory and motility compensatory mechanisms are overwhelmed.
|
|
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What are the general causes of diarrhea?
|
-osmotic
-secretory -decreased absorptive ability -motility disorders -abnormal GI permeability |
|
|
Hyper secretion of ions, toxins, or intestinal inflammation can lead to what type of diarrhea?
|
Secretory
|
|
|
What causes osmotic diarrhea?
|
Decreased solute absortion, water follows
-Diet change -Lactulose |
|
|
What can cause primary dysmotility of the gut?
|
-primary hypermotility
-hypomotility -ileus |
|
|
What are causes of secondary dysmotility?
|
-drugs
-hyperthyroidism -enterotoxin |
|
|
What are exudative mechanisms od diarrhea?
|
-increased permeability
-damage to mucosal barrier -leakage of blood, proteins |
|
|
Diarrhea classification include what categories?
|
-Chronic versus acute
-self-limiting -potential fatal or systemic -small or large imtestine -diffuse |
|
|
Acute diarrhea has a duration of what timeframe?
|
Less than 3 weeks
|
|
|
What age of dog are most frequently affected by acute diarrhea?
|
Puppys and kittens
|
|
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What type of onset does acute diarrhea have?
|
Abrupt or recent?
|
|
|
What pathophysiological changes are related to acute diarrhea?
|
-luminal disturbances
-villous atrophy -enterocyte dysfunction |
|
|
What are some of the metabolic causes of diarrhea?
|
-hypoadrenocorticism (Addison's)
-renal, hepatic, pancreatic dz |
|
|
What are some of the dietary causes of diarrhea?
|
-indiscretion
-intolerance -abrupt change |
|
|
What GI obstructions can induce diarrhea?
|
-FB
-intussusception -intestinal volvulus |
|
|
Diarrhea can be caused by what infectious organisms?
|
-viral
-bacterial -parasite |
|
|
What kind of history would you expect in the case of abrupt diarrhea?
|
-short duration
-fecal accidents -vomiting -hematochezia -dietary changes -exposure to toxins |
|
|
A complete PE for diarrhea should include examination of what?
|
Rectal and oral cavities esp under tongue
|
|
|
What might you find on abdominal palpation?
|
Thickened bowel loops, masses, effusion, pain
|
|
|
Defection attempts may exhibit what?
|
-dyschezia
-tenesmua -evaluation of feces |
|
|
When would radiographs be indicated in a case of acute diarrhea?
|
To identify the presence or absence of a FB, intussusception, ileus
|
|
|
Chronic diarrhea is defined as lasting for how long?
|
Over 3 weeks
|
|
|
True or false. Chronic diarrhea of the large intestine has less frequent occurance then diarrhea of the small intestine?
|
False, very frequent
|
|
|
Is mucous usually present in the diarrhea of small or large intestine?
|
Large intestine
|
|
|
Know causes of chronic small bowel diarrhea
|
Know causes of chronic large bowel diarrhea
|
|
|
Dehydration is a common physical finding with what type of chronic diarrhea?
|
Small intestine
|
|
|
What stain is used to show fat (on a rectal scraping)?
|
Sudan
|
|
|
Fat in feces could indicate what condition?
|
EPI
|
|
|
What functional tests might you conduct in the case of chronic diarrhea?
|
-exocrine pancreatic function
-tests for malabsorption -test for metabolic disease |
|
|
A GI panel could show high folate levels due to what?
|
Bacterial overgrowth
|
|
|
Pancreatitis can be caused by what conditions?
|
-activation of digestive enzymes within the pancreas
-inflammatory cytokines -free radical production -vasculitis and edema -multisystem involvment |
|
|
What physical presentation is commonly seen in dogs with pancreatitis?
|
Prayer position
|
|
|
Pancreatitis can be caused by....
|
-unknown etiology
-diet/malnutrition -stress -low protein, high fat -hyperlipdemia -drugs -duct obstruction -trauma -hyperadrenocorticism -Dm -previous GI dz -hypothyroidism |
|
|
Acute pancreatitis can be characterized by what processes?
|
-necrotizing
-hemorrhagic -leakage of digestive enzymes -systemic inflammation -critical care pts |
|
|
What is the typical signalment for a dog with pancreatitis?
|
-middle age
-obese -female -hx of high fat meals or garbage invasion -holiday time |
|
|
What are the clinical signs of
pancreatitis? |
-depression
-anorexia -vomiting -diarrhea -shock -abdominal pain +- icterus |
|
|
What triad of signs might a cat exhibit?
|
-pancreatitis
-cholangiohepatitis -IBD |
|
|
Why would you check amylase and lipase for pancreatitis?
|
Digestive enzymes
|
|
|
What results would you expect to see in a CBC in a case of pancreatitis?
|
-hemoconcentration
-anemia -thrombocytopenia -neutrophilia w/ left shift |
|
|
UA results in pancreatitis might show what?
|
-bilirubinuria
-hemoglobinuria -concentrated USG |
|
|
Blood chemistry in pancreatitis would show what?
|
-hyper or hypoglycemia
-hypocalcemia -elevated liver enz (ALP, bile duct obst) -hypercholesterolemia/hypertriglyceridemia/hyperlipidemia -bilirubinemia -renal or pre-renal azotemia -amylase and lipase |
|
|
Rule outs for pancreatitis should include?
|
Causes of abdominal pain
|
|
|
What advanced diagnostics could be used in diagnosing pancreatitis?
|
-trypsin -like immunoreactivity
-pancreatic lipase immunoreactivity (test of choice) |
|
|
What would you expect to see radiographically in pancreatitis?
|
Loss of cranial abdomen detail
|
|
|
US may show what in pancreatitis?
|
-decreased peristalsis
-mixed pancreatic echogenicity -peripancreatic hyperechogenicity -cranial abdominal mass -free abdominal fluid |
|
|
Acute pancreatitis has what clinical signs associated with it?
|
-vomiting
-abdominal pain -lethargy |
|
|
Pancreatic masses can include....
|
-neoplasia
-adenocarcinomas -adenomas -insulinoma -glucagonoma -abscesses and pseudocysts -cysts |
|
|
What signs might indicate a pancreatic adenocarcinoma?
|
-very agressive
-repeated pancreatitis -EPI |
|
|
In which species are pancreatic cysts congenital?
|
Persian cats
|
|
|
pH is a measure of what?
|
Measure of acidity or alkalinity based on the hydrogen ions present
|
|
|
How is partial pressure of oxygen that is dissolved in blood denoted?
|
PaO2
|
|
|
What is the normal range of PaO2?
|
80 -100 mm Hg
|
|
|
SaO2 denotes what?
|
Arterial oxygen saturation
normal = 95-100% |
|
|
The amount of carbon dioxide dissolved in arterial blood is denoted by what?
|
PaCO2
35-45 mmHg |
|
|
HCO3 denotes what in the blood stream?
|
Calculated value of the amount of bicarbonate
22-26 mEq/liter |
|
|
What is Base excess? (BE)
|
The amount of excess or insufficient level of bicarbonate in the system
-2 to +2 mEq/liter (negative = base deficit in blood) |
|
|
Why would you order an ABG?
|
-aids in establishing a dx
-helps guide tx plan -aids in ventilator management -acid/base management allows optimal function of medications -acid/base status may alter electrolyte level |
|
|
The PaCO2 equation is an indication of what process?
|
Alveolar ventilation
|
|
|
The alveolar gas equation is an indication of what process?
|
Oxygenation
|
|
|
Oxygenation is also calculated by what other equation?
|
Oxygen content equation
|
|
|
The Henderson-Hasselbach equation calculates what?
|
Acid/base balance
|
|
|
CO2 diffusion out of blood into alveolar air is only limited by what?
|
Amount of ventilation (air) that arrives in the alveolus
|
|
|
CO2 is directly related to what 2 processes?
|
Metabolism (CO2 produced)
Ventilation (CO2 cleared) |
|
|
In regards to the alveolus, HYPER capnia is a result of what?
|
HYPOventilation
|
|
|
n regards to the alveolus, HYPOcapnia is a result of what?
|
HYPERventilation
|
|
|
True or false. An elevated respiratory rate always equals hyperventilation
|
False
|
|
|
What is the only physiologic reason for elevated PaCO2?
|
Inadequate alveolar ventilation for the amount of the body's CO2 production
|
|
|
Hypercapnia (hypoventilation) can arise from what 3 conditions?
|
-insufficient ventilation
-increased dead space -both of the above |
|
|
What are some examples of conditions that lead to inadequate VE (ventilation)?
|
-sedative drug overdose
-respiratory muscle paralysis -central hypoventilation |
|
|
What are some examples of increased dead space leading to decreased alveolar volume ( and hypercapnia)?
|
-COPD
-severe restrictive lung disease (with shallow, rapid breathing) |
|
|
How can an increased respiratory rate lead to an increased V total but not an increased in V alveolus?
|
Pulmonary disease may result in increased physiologic dead space, ventilation of air going to nonperfused alveoli
|
|
|
Hypoventilation (hypercapnia, incr CO2) isn't always caused by the lungs. What conditions can cause hypoventilation?
|
-inadequate V total from
CNS depression Respiratory muscle paralysis/weakness Excess V dead space |
|
|
To determine if the lungs are functioning well ( the PaO2 expected) what do we need to know to determine PAO2?
|
Inspired oxygen fraction
Barometric pressure |
|
|
Normal air consist of how much O2?
|
21%
|
|
|
What makes up the remainder of normal air?
|
78% nitrogen
1% inert gas |
|
|
An animal of oxygen supplementation (by nasal insufflation) can breath how much oxygen?
|
40-60%
|
|
|
What is barometric pressure?
|
Weight of the atmosphere at the point of measurement
|
|
|
Higher altitude means what in terms of barometric pressure?
|
Lower
|
|
|
Inhaled air becomes fully saturated with water vapor which exerts how much pressure?
|
47mm Hg water pressure
|
|
|
Typically, which is higher, alveolar PAO2 or arterial PaO2?
|
Alveolar
|
|
|
As a result of alveolar PAO2 being higher than arterial PaO2, what happens when alveolar PAO2 decreases?
|
PaO2 decreases
|
|
|
The amount of difference between PAO2 and PaO2 will depend on what?
|
V/Q mismatching and diffusion impairment
|
|
|
For a healthy person breathing normal room air, the A-a difference should be what?
|
5-15 mm Hg
|
|
|
An increased A-a difference suggests what?
|
Lung disease
|
|
|
What are some of the non-respiratory, physiologic causes of low PaO2?
|
-cardiac right to left shunt (increased)
-decreased PIO2 (normal) -loe mixed venous O2 content (increased) |
|
|
What are the respiratory causes of low PaO2?
|
-pulmonary right to left shunt (incr)
-V/Q imbalance (incr) -diffusion barrier (incr) -hypoventilation (normal) |
|
|
By far, what is the most common cause of a low PaO2?
|
V/Q imbalance
|
|
|
Does venous O2 tell us anything?
|
Venous saturation is an indicator of oxygen delivery to the tissues
-as delivery falls, extraction increase and venous O2 falls |
|
|
What is normal venous saturation?
|
> 65%
|
|
|
PaO2 and SaO2 do NOT tell how much oxygen is in the blood. Which calculation tells how much O2 is in the blood?
|
The oxygen content
CaO2 |
|
|
Which values are helpful in determining how much oxygen is in the blood and is it adequate for the patient?
|
SaO2 (saturation)
CaO2 (content) |
|
|
Why doesn't the PaO2 values let us know how much oxygen is in the blood?
|
PaO2 reflects on the free oxygen molecules dissolved in plasma and not those bound to hemoglobin...for "how much" need to also know the amount bound to Hbg Given by SaO2 and Hbg content
|
|
|
Which is the only value that can tell how much O2 is in the blood since it takes into account the amount in Hbg?
|
CaO2
|
|
|
Metabolic acidosis and alkalosis are primary acid/base disorders caused by what?
|
Too little or too much bicarbonate
|
|
|
Respiratory acidosis and alkalosis are primary acid/base disorders caused by what?
|
Too much too little CO2
|
|
|
When evaluating the acid/base status, what values do you look at first?
|
pH
|
|
|
A high anion gap is suggestive of what condition?
|
High Ag acidosis as part of the A/B status
|
|
|
If the A/G is low, what should you look for?
|
-hypoproteinemia
-increased unmeasured cations (UC) |
|
|
Metabolic acidosis is divided into elevated and normal anion gap (AG) acidosis. How is this calculated?
|
Ag = Na+ - (Cl- + CO2)
|
|
|
Give an example of a mixed A/B disturbance.
|
Respiratory acidosis with inadequate metabolic compensation
|
|
|
Glucose is metabolized to what?
|
Pyruvate
|
|
|
If there is a lack of oxygen, pyruvate is metabolized to what?
|
Lactate
|
|
|
Which organs are lactate producers?
|
-muscle
-brain -gut -rbc's |
|
|
Which organs utilize lactate?
|
-liver
-kidney -heart |
|
|
When does lactate accumulate?
|
When production exceeds its use by mitochondria
|
|
|
What are some of the primary causes of hyperlactatemia?
|
-decreased oxygen delivery
-increased muscle activity -increased glycolysis -thiamine deificiency -liver failure -neoplasia -congenital defects in gluconeogenesis, pyruvate dehyrdrog, TCA cycle, resp chain |
|
|
Metabolic acidosis (decr HCO3 & pH) with an increased AG can be caused by what?
|
-lactic acidosis
-ketoacidosis -drug poisoning |
|
|
Metabolic acidosis (decr HCO3 & pH) with a normal AG can be caused by what?
|
-diarrhea
-some kidney problems |
|
|
Metabolic alkalosis (incr HCO3 & pH) that is chloride responsive can be caused by what?
|
-contraction alkalosis
-diuretics -corticosteroids -gastric suctioning -vomiting |
|
|
Metabolic alkalosis (incr HCO3 & pH) that is chloride resistant can be caused by what?
|
-any hyperaldosterone state (Cushing's, Bartter's syndrome, sever K+ depletion)
|
|
|
Respiratory acidosis (incr PaCO2 & decr pH) can be caused be what conditions?
|
-central nervous system depression (drug overdose)
-chest bellows dysfunction (MG) -dz of lungs and upper airway |
|
|
Respiratory alkalosis (decr PaaCO & incr pH) can be caused by what?
|
-hypoxemia
-axiety -sepsis -any acute pulmonary insult |
|
|
In which type of patient are mixed A/B disorders commoly seen?
|
Chronically ill respiratory pts
Renal failure pts |
|
|
What is the first step in analyzing an A/B status?
|
Assess the pH of the blood
of above 7.45 it's alkalotic if below 7.35 it's acidotic |
|
|
What is step 2 of assessing A/B status?
|
Determine if the primary cause of alkalosis.acidosis is respiratory or metabolic
|
|
|
Which value is looked at next? And how to you interpret it?
|
PaCO2
If it's a respiratory problem as pH drops below 7.35, PaCO2 should rise If pH rises above 7.45 PaCO2 should drop If pH and PaCO2 are moving in opposite directions = respiratory in nature |
|
|
With a metabolic problem, normally the pH increases, what usually happend with HCO3?
|
Increases
(as pH decreases so does HCO3) If values moving in same direction = metabolic in nature |
|
|
Are cows browsers or grazers?
|
Grazers
|
|
|
Fibrous carbs can only be digested by what?
|
Microbial enzymes
|
|
|
What structures divide the rumen?
|
Pillars (muscular folds)
|
|
|
What is the capacity of the rumen?
|
40-50 gallons
|
|
|
What type of microbes does the rumen contain?
|
-anaerobic microbes
-protozoa -fungi |
|
|
Which is the most cranial compartment of a cow's stomach?
|
Reticulum
|
|
|
What is another name for the reticulum?
|
The honeycomb
|
|
|
What is the function of the reticulum?
|
-formation of food bolus
-regurgitation initiated here -collects hardware |
|
|
What is the purpose of the esophageal groove?
|
Formed by muscular folds of the reticulum, liquids bypass the rumen, pass into the omasum and onto the abomasum
|
|
|
What controls the formation of the esophageal groove?
|
-neural stimulation from suckling and milk proteins
|
|
|
Does the esophageal groove from when a calf drinks from a nippled bottle or a bucket?
|
Either
|
|
|
What effect does feeding milk for an extended time usually have?
|
Results in growth of the calf, but limited rumen development
|
|
|
What is important in the development of a pre-ruminant animal into a ruminant?
|
Diet
|
|
|
What is another term for omasum?
|
-butcher's bible
-many ply |
|
|
What structures line the omasum?
|
Laminae
|
|
|
What is the function of the omasum?
|
-reduces particle size
-absorption of water -absorption of VFAs |
|
|
What is the name of the glandular portion of the stomach?
|
Abomasum
|
|
|
Name the 3 regions of the abomasum
|
-cardiac
-fundic -pyloric |
|
|
What is the purpose of the acidic (2.5) pH in the abomasum?
|
-denatures protein
-kills bacteria and pathogens -dissolves minerals -gastric digestion |
|
|
What is the primary function of the rumen/reticulum compartment?
|
Fuction as chamber for fermentative digestion of cellulose, hemicellulose and pectin
|
|
|
Which chamber transports material from the rumen and reticulum to the abomasum?
|
Omasum
|
|
|
Normal ruminal contraction occur how often?
|
2-3 per minutes
|
|
|
By what methods can you detect ruminal contractions?
|
-felt by forced fist into left paralumbar fossa
-listen with a stethoscope |
|
|
What are the 4 phases of rumination?
|
-regurgitation
-remastication -reinsalivation -reswallowing |
|
|
What is the purpose of rumination?
|
Allows animal to rapidly ingest food, then complete chewing at another time
|
|
|
Under normal circumstances, a cow should spend how much time chewing cud?
|
8 hours/day
|
|
|
Anaerobic fermentation results in what 4 main products?
|
-VFA
-methane -CO2 -ammonia |
|
|
What condition can result if the cow doesn't belch?
|
Bloat
|
|
|
Almost all carbohydrates are fermented where?
|
Reticulorumen
|
|
|
What is responsible for fiber digestion?
|
Cellulolytic bacteria
|
|
|
The cellulolytic bacteria produce cellulase by breaking what?
|
B1-->4 linkages
|
|
|
What products do the cellulolytic bacteria produce?
|
-acetate
-proprionate -little butyrate (animals on roughage) |
|
|
What is the blood glucose levels in adult cows?
|
40-60 mg/dl
|
|
|
Why is there less glucose fluctuation in a cow?
|
-eat more constantly
-continuous VFA production -continuous digesta flow -continuous gluconeogenesis |
|
|
Acute rumen acidosis can be caused by what?
|
Grain engorgment
|
|
|
What are the clinical findings for a case of rumen acidosis?
|
-abdominal pain
-dehydration -diarrhea (fluid, fetid) -splashy rumen, bloat -depression -scleral injection |
|
|
Rumen fluid analysis may show what, in the case of rumen acidosis?
|
-pH <5
-sour odor -protozoa dead, prominence of gram + bacteria |
|
|
Clin path findings in ruminal acidosis would include what for
PCV Protein BUN, creatinine -AG -Calcium |
PCV elevated
Protein elevated BUN, creatinine elevated AG increased Calcium decreased |
|
|
The pathogenesis of rumen acidosis inlcudes excess CHO ingesiton followed by...
|
-increased VFA production
-decreased rumen pH -decreased rumen motility -Srep bovis proliferates producing lactate acid, further dropping pH |
|
|
What causes the "splashy" rumen?
|
Lactic acid accumulation changes osmolarity of rumen fluid drawing in more body water
|
|
|
How do liver abscesses result from ruminal acidosis?
|
-acidic rumen pH samages muscosal surfaces
-blood vessles thrombose & sections of rumen mucosa and submucosa slough allowing bacteria to enter -bacteria travel thru portal circ & cause abscess -mycotic ruminitis may develop |
|
|
What is the Liptak test?
|
-rumenocentesis
|
|
|
How is the Liptak test performed?
|
-clip & prep small area on left abdomen of cow
-spinal needle used to aspirate 5 ml of ruminal fluid -check pH and microbes |
|
|
What is the cause of bloat?
|
If eructation is prevented
|
|
|
What are some of the clinical signs of bloat?
|
-distended left paralumbar fossa
-discomfort (grunting, colic) -open-mouth breathing -anorexia -salivation -anxious -depressed -sudden death |
|
|
What is primary bloat?
|
Erucatation is normal but gas can't be expelled. Frothy bloat (from legumes)
|
|
|
What is secondary bloat?
|
Failure of eructation
-esophageal fb -vagal indigestion -positional -hypocalcemia -pharyngitis -pneumonia |
|
|
What clinical steps would you take with bloat?
|
-free gas bloat can be relieved via stomach tube
-frothy bloat needs a detergent to break up |
|
|
What is vagal indigestion syndrome?
|
-motor disturbances which impair passage of ingesta from the reticulorumen and/or abomasum int the lower GI tract
-a collection of diseases |
|
|
What vague signs are seen with vagal indigestion syndrome?
|
-slow loss of production
-slow weight loss -poor appetite -scant pasty feces, poorly digested fiber particles -abdominal enlargement- papple shape -rumen hypo/hypermotility -bradycardia |
|
|
Off feed cows ave what kind of appearance?
|
-slab sided abdomen contour
|
|
|
What is the funtional unit of the kidney?
|
Nephron
|
|
|
Most nephrons are located where?
|
Cortex
|
|
|
Which part of the nephron filters filters fluid from blood?
|
Glomerulus
|
|
|
Filtered fluid is turned into urine in what structure?
|
Tubule
|
|
|
What does Bowman's capsule encase?
|
Epithelial cells which cover anastomosing capillaries
|
|
|
In Bowman's capsule. pressure forces fluid into where?
|
Proximal cortical tubules and LOH
|
|
|
What % of water is absorbed back into the vascular system?
|
99%
|
|
|
The remainder of tubular water and dissolved substances forms what?
|
Urine
|
|
|
What structure regulated to blood flow to and from the capillary beds?
|
Afferent and efferent arterioles
|
|
|
What are the very deep, long branching capillary loops that extend into the medulla and lie adjacent to the JG LOH all the way to the renal papillae?
|
Vasa Recta
|
|
|
How much renal blood flow actually enters the vasa-recta?
|
1-2 %
|
|
|
Blood flow in the kidney affects what?
|
-filtration
-renal function |
|
|
When/where does filtration occur?
|
Occurs in flowing glomerular blood thru the glomerular membrane (tubule), water and electrolytes are resorbed, unwanted substances are not
|
|
|
In the process of filtration, the remaining substances are secreted (2nd mechanism) into where?
|
Through the lining of the epithelial cells directly into urine
|
|
|
What does the glomerular filtrate consist of?
|
Fluid the passes through the glomerulus and into Bowman's capsule
|
|
|
What are the 3 layers of the glomerular membrane?
|
-endothelial: has fenestrations for fluid to move through
-basement membrane: fliters fluid and has proteoglycans with negative charge (repels plasma proteins) -outer epithelial layer |
|
|
Glomerular filtrate has a composition very similar to what?
|
ISF- no RBC and essentially no protein
|
|
|
What is GFR?
|
Glomerular Filtration Rate- quantity of GF formed each minute in all nephrons of both kidneys
|
|
|
What is the Filter Fraction?
|
Fraction of the renal plasma flow that becomes GF (avg is 19%)
|
|
|
What is the average glomerular pressure?
|
In Glomerular capillaries = 55-70 mm HG (dog)
|
|
|
What is the Filtration Pressure?
|
Net pressure forcing fluid through the glomerular membrane
|
|
|
Filtration is promoted by what force?
|
Pressure inside the glomerular capillaries
|
|
|
Filtration is opposed by what force?
|
Pressure in the Bowman's capsule
|
|
|
What else opposes filtration?
|
Colloid osmotic pressure of the plasma proteins
|
|
|
Filtration is promoted by colloid osmotic pressure or proteins where?
|
In Bowman's capsule, but has so little effect that it is usually 0
|
|
|
What happens to GFR is renal blood flow through the nephrons is increased?
|
GFR increases
|
|
|
What happens to GFR is the afferent areteriolar pressure in reduced?
|
Blood flow to the glomerulus drops, glomerular pressure drops, GFR drops
|
|
|
What would need to happen on efferent arteriole to make the GFR increase?
|
Efferent constriction = increased GFR
|
|
|
If efferent blood flow is increased, what happens to GFR?
|
Reduces
|
|
|
What structure provides feedback to auto-regulate blood flow through the kidneys?
|
Tubuloglomerular feedback mechanism at the JG complex
|
|
|
What is the feedback that occurs at the afferent areteriole when the GFR decreases (vasodilation)?
|
decreased GFR --> increased absorption of Na & Cl ions, decreased ion concentration at macula densa-->dilates the AA--> increased GFR
|
|
|
What is the feedback mechanism of vasoconstriction of the efferent arteriole?
|
Too few Na & Cl ions at macular densa causes JG cells to release renin-->angiotensin II -->EA contstriction --> increased GFR
|
|
|
What is primary active transport?
|
Na+ ions through tubular membrane via Na+,K+, ATPAse pump via facilitated diffusion
|
|
|
What is secondary active transport?
|
From the tubular lumen with no energy from ATP. Movement of Na+ energizes other substances = co transport
|
|
|
Secondary active secretion occurs where?
|
Into tubules
|
|
|
Passive H2O absorption occurs where?
|
Through tubular epithelium via osmosis
|
|
|
Where does passive absorption occur?
|
Of Cl- ions and urea and solutes via diffusion
|
|
|
Renal disease patients often present with what clinical signs?
|
-PU/PD
-lethargy -abnormal behaviors -inappetence |
|
|
Inappropriate urination is a broad term that clients use to describe what conditions?
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-stranguria
-pollakuria -hematuria |
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How do clients describe normal urination in their pet?
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-larger quantity
-less frequently -yellow coloration -specific location -no pain |
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How should kidneys feel on palpation?
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Smooth, right more cranial than left
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On palpation how might a neoplasm feel?
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Rough (lobulation)
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On palpation, when might a bladder be painful?
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-cystitis
-UTI -urolithiasis |
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On physical exam, an animal with acute renal disease can look normal. How does an animal with chronic renal disease appear?
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-poor hair coat (tacky)
-weight loss -sunken appearance of face and eyes |
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What are normals for U/A
pH and SG? |
pH: 5.5-7.5 (dogs/cats) (>7.4 rum/horse)
SG: cat 1.025 -1.060 dog 1.020 - 1.050 |
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What does urobilinogen in urine indicate?
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normal enterohepatic bilirubin circulation
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Reddish/brown urine would indicate what?
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-hematuria
-hemoglobinuria -myoglobinuria |
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Dark brown or black urine indicates what?
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Methemoglobinuria
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Yellow-brown to yellow-green urine indicates....
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concentrated bilirubinuria
Pseudomonas infection |
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Orange colored urine can indicate what?
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Bilrubinuria
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Turbidity of urine is caused by what?
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-mucus
-cellular material -crystals |
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Odor in urine is produced by what?
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Ammonia (urease producing bacteria)
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A USG of 1.008- 1.012 is called what? And indicates what?
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Isosthenuria = renal failure, rarely seen with polydipsia
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What is a USG of < 1.008 called?
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Hyposthenuria = pu/pd, diabetes insipudus
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What can cause changes in urine pH?
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-diet
-acid/alkaline agents -respiratory acidosis/alkalosis -bacteria |
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What renal condition would cause increased urinary proteins?
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Glomerular disease
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Which disease condition would cause glucose to appear?
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When renal threshold is exceeded = DM, proximal renal tubular disease
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When are ketones produced?
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-diabetic ketoacidosis
-starvation -glycogen storage disease persistant pyrexia -hypoglcemia |
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When are RBCs, myoglobin or hemoglobin seen?
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RBCs- hematuria
Hemoglobin- hemolysis Myoglobin- rhabdomyolysis |
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When would you see bilirubin in the urine?
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-liver disease
-hemolysis -extrahepatic obstruction -fever -starvation |
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How many WBC and RBC are found in normal urine sediment?
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None
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What does the presence of WBC's indicate?
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Pyuria - UTI but does not localize it
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An increase in the number of transistional cells may indicate what?
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-neoplasia
-infection -UTI inflammation |
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What type of casts are always abnormal in urine?
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Hyaline or granular may be normal
Cellular casts are abnormal |
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Alkaline urine may contain what crystals?
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struvite, calcium phosphate, calicum carbonate, amorphous phosphate, ammonium biurate
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Acidic urine may contain what crystals?
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urate, calicum oxalate, cystine
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Which breed may normally have urate crystals?
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Dalmation
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With what disease condition might you see urate crystals?
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Porto Systemic Shunt
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When would you see increased BUN?
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-pre-renal azotemia (dehydration, heart failure, shock)
-GI hemorrhage -protein diet |
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When would you seen decreased BUN?
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Overhydration/diuersis, some live disease
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Creatinine levels rise with what condition? And drops with what condition?
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Rises with azotemia
Drops with anything that causes decreased muscle mass |
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Define azotemia
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Excess urea and nitrogenous waste compounds in the blood
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Azotemia may or may not have clinical signs but does show an increase in which blood values?
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BUN
Creatinine |
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What is the term for azotemis with clinical signs?
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Uremia
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Azotmia can be of what 3 types?
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-pre renal
-renal -post renal |
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Pre-renal azotemia reduces GFR, and can be caused by what?
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-hypotension
-hypovolemia -dehydration (need to r/o other metabolic dz, CV, endocrine) |
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What causes renal azotemia?
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-generalized renal dysfunction
-may exclusively be PU/PD |
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Post renal azotemia is caused by what?
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Urinary outflow obstruction/damage
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