Exam 1 Clin Path 2

Front 1

Blue, red, yellow, and white.

Back 1

Color codes that must be stored in the prep rooms.

Front 2

Green and gray

Back 2

Color codes for general storage chemicals that can be stored in the lab.

Front 3

Micro-prep room.

Back 3

Where master MSDS files are stored.

Front 4

Level 1: handled by lab workers.

Level 2: Handled by facilites.

Level 3: Handled by facilities and HAZMAT

Level 4: Under authority of state police

Unstable containers: BR City police bomb team

Back 4

Spill severity levels (1-4 and unstable containers)

Front 5

Lipemic sample if post-prandial, contaminated urine sent for culture and sensitivity, and blood collected in the wrong type of tube.

Back 5

Improper sampling that produces erroneous results.

Front 6

Results of improper handling

Back 6

Hemolysis, cell lysis, stain precipitate, cytology in the same bag as formalin histopath samples, mislabeled, etc.

Front 7

Proteins

Back 7

Any group of complex, organic macromolecules that contain carbon, hydrogen, oxygen, nitrogen, and usually sulfur, and are composed of one or more chains of amino acids.

Front 8

Proteins

Back 8

Fundamental components of all living cells and include many substances such as enzymes, hormones, and antibodies that are necessary for the proper functioning of an organism.

Front 9

Enzymes

Back 9

A protein that catalyzes chemical reactions of other substances without itself being destroyed or altered upon completion of the reaction.

Front 10

Lecture 1

Back 10

See slide 32

Front 11

Clinical chemistry proteins

Back 11

Albumin, globulin, and fibrinogen.

Front 12

Measures albumin, globulin, and fibrinogen.

Back 12

Total Plasma Protein.

Front 13

Albumin and Globulin only. Total solids.

Back 13

Total Serum Protein

Front 14

Albumin

Back 14

The most important protein. It is synthesized by hepatocytes. 35-50% of TP in most animals. Altered levels reflect hydraton staton or pathology (disease)

Front 15

Albumin

Back 15

High levels of this protein can indicate dehydration, and low levels of this protein can indicate decreased production (liver failure), decreased absorption (inflammatory bowel disease), edema thoracic or abdominal effusion,or protein losing nephropathy.

Front 16

Albumin

Back 16

This protein is responsible for maintaining oncolic pressure (colloid osmotic pressure), and serves as a carrier for various molecules such as hormones, calcium and certain medications.

Front 17

Globulin

Back 17

Protein that includes (alpha-, beta-, and gamma). Most are proteins of the immune system called antibodies or immuno______. Increased levels indicate infections, inflammation, or immune stimulation.

Front 18

Lymphocytes

Back 18

Where antibodies are created.

Front 19

Fibrinogen

Back 19

Protein synthesized in hepatocytes. Necessary for blood clot formation and is only present in plasma. Elevations seen with inflammatory disease and is used as a marker for inflammation in large animals. Made by the liver. Factor 1 in coag cascade .

Front 20

Serum

Back 20

Plasma from which fibrinogen has been removed.

Front 21

Acute phase reaction protein

Back 21

Indicates inflammation in large animal species.

Front 22

Lecture 1

Back 22

See slides 38 & 39

Front 23

Enzymes in the liver used for chemistry analysis

Back 23

ALT, AST, SDH, ALKP, GGT, Bilirubin, Bile acids, and cholesterol.

Front 24

Enzymes in the kidney used for chemistry analysis

Back 24

BUN, creatninine

Front 25

Enzymes in the pancreas used for chemistry analysis

Back 25

Lipase, amylase, trypsin, glucose

Front 26

Other enzymes used for chemistry analysis

Back 26

CK, Lactate

Front 27

ALT (Alanine Aminotransferase)

Back 27

Enzyme released from hepatocyte damage that is produced by the liver cells. Liver specific whose elevations occur during liver damage. Useful in small animals, large animals and birds don't produce enough to be useful (5GPT).

Front 28

ALT (Alanine Aminotransferase)

Back 28

Enzyme that is liver specific that is seen in hepatitis, protosystemic shunt in young animals, toxin ingestion, inflammation, ischemia and metabolic disorders.

Front 29

Protosystemic shunt

Back 29

Abnormality of liver vasculature. Elevation in the liver enzyme ALT can indicate this. Usually a congenital defect that bypasses the hepatocytes and is not processed normally. Results in high levels of substances such as ammonia that are toxic to the individual.

Front 30

Ischemia

Back 30

Look up

Front 31

AST (Aspartate Aminotransferase)

Back 31

Enzyme released from hepatocyte damage called the hepatocyte leakage enzyme or SGOT. Due to being liver specific, elevations reflect liver damage, muscle necrosis or hemolysis. found in muscle cells, RBCs, kidney and pancreas.

Front 32

Hemolysis

Back 32

Common error in veterinary practices that can be avoided by gently pulling the sample, using adequately sized needles and not forcing the blood into a collection tube.

Front 33

Tiger top tube

Back 33

Tube that contains substances to seperate serum from blood after it has clotted.

Front 34

SDH (Sorbitol dehydrogenase)

Back 34

Liver specific enzyme released from hepatocyte damage. Hepatocyte leakage enzyme found to a lesser extent in other tissues. Used in large animal to detect liver damage. It is unstable and activity declines in a few hours.

Front 35

Glutamate dehydrogenase (GLDH)

Back 35

Mitochondrial-bound enzyme in hepatocytes in cattle, sheep, goats, avian, amphibian, and reptile species. Indicates hepatocyte damage or necrosis. No standardized test method for in house lab, and only available in reference lab.

Front 36

Four enzymes released from hepatocyte damage

Back 36

AST, ALT, SDH, GLDH

Front 37

Cholestasis

Back 37

Term for bile duct obstruction which is when the excretion of bile is slowed or blocked.

Front 38

ALKP Alkaline phosphatase (ALKP, ALP, ALK, Alk Phos)

Back 38

Enzyme associated with cholestasis that is useful in dogs and cats. Liver specific. Elevations seen in liver, bone, and intestinal disease as isoenzymes.

Front 39

In dogs

Back 39

In this animal, ALKP elevation can also be seen in growing animals due to new bone formation and increases in blood cortisol level.

Front 40

Isoenzymes

Back 40

An enzyme associated with cholestasis that is a different amino acid sequence of the same enzyme as ALKP. Makes ALKP less specific for liver damage than other enzymes. Pay attention to age when checking normal values.

Front 41

Gamma Glutamyltransferase

Back 41

enzyme associated with cholestasis whose primary source is the liver, but is found in epithelium such as mammary, renal, and bilary. Indicates obstructive liver disease. Specific to the gallbladder.

Front 42

Within the biliary system the gallbladder, at the small intestine

Back 42

Where could obstruction occur in the liver?

Front 43

Bilirubin

Back 43

Enzyme used in a hepatocyte function test that is liver specific. It is a byproduct of hemoglobin breakdown. (lysed RBC). Liver clears blood of this and secretes it into bile, which is stored in the gallbladder and released into the small intestine.

Front 44

Urobilinogen

Back 44

Bacteria on the gut act on the bilirubin to produce ____________, which is excreted into feces or urine.

Front 45

Bilirubin

Back 45

The liver can process up to 30x the normal limit of this enzyme. Even slight elevations of this can indicate jaundice, and hepatic function or severe hemolysis.

Front 46

Hemolytic anemia

Back 46

A product of an over-production of bilirubin indicated by elevations of bilirubin.

Front 47

Cirrhosis

Back 47

Indicated by elevated levels of bilirubin that are caused by deficiencies in bilirubin metabolism.

Front 48

Bile duct obstruction

Back 48

Indicated by elevated levels of bilirubin from decifiencies in bilirubin excretion

Front 49

Bile Acids (BA)

Back 49

Enzymes that aid in hepatic function tests. Produced by the liver to help with the breakdown of fats. Evaluate liver function as it pertains to blood flow in the liver and diagnosis of portosystemic disease.

Front 50

Serum Bile Acids (SBA)

Back 50

Enzyme that aids in hepatic function test. Produced in the liver as a result of cholesterol metabolism. Secreted into the bile, stored in gallbladder, then released into duodenum to aid in lipid digestion.

Front 51

BA

Back 51

The majority of ___ are reabsorbed in the small intestine (ileum) and brought back to the liver via the portal circulation to be re-secreted into the biliary system.

Front 52

Lecture 1

Back 52

See slide 55 - 56

Front 53

Cholesterol

Back 53

Enzyme that helps test for hepatocyte function. A plasma lipoprotein.

Indicates hyperlipidemia.

Front 54

Primary hyperlipidemia

Back 54

An uncommon disorder (unless you're a miniature schnauzer) that is indicated by the enzyme cholesterol.

Front 55

Secondary hyperlipidemia

Back 55

Indicated by the enzyme cholesterol. Usually indicates a disease such as cholestasis, diabetes mellitus, hepatic lipidosis, hypothyroidism, hyperadrenocorticism, etc.

Front 56

Enzymes used in hepatic function tests

Back 56

.Bilirubin, bile acids, cholesterol, albumin, and glucos
e

Front 57

BUN (Blood Urea Nitrogen)

Back 57

test that assesses renal function. Nitrogenous waste from amino acid breakdown. High protein diet, GI bleed and strenuous exercise can influence these levels. 50% of ___ in the blood goes into urine.

Front 58

Azotemia

Back 58

Increased urea in the blood.

Front 59

Creatinine

Back 59

Test that assesses renal function. Comes from creatine (A muscle metabolite). Excreted by kidneys into urine. See an increase when kidneys are 75% nonfunctional.

Front 60

Creatnine

Back 60

Anything that alters the glomerular filtration rate (GFR) will alter the ________ level.

Front 61

SDMA Test

Back 61

test that is an early indication of renal dysfunction. called urine protein to creatnine ratio.

Front 62

Urine Protein to Creatnine Ratio (UP;C)

Back 62

Chemical test used to assess renal function. Indicates glomerular disease in an inactive sample. should be 1:1 ratio. Elevated levels indicate a 'leakage' of protein in the urine/

Front 63

Inactive sediment

Back 63

A urine sediment that does not contain RBCs, WBCs, RBC casts or WBC casts. The opposite would falsely elevate the urine protein to creatnine ratio.

Front 64

Lecture 1

Back 64

See slides 62-63

Front 65

Uric acid

Back 65

Used to evaluate renal function in avian species. Dalmations can have this too.

Front 66

Renal function tests

Back 66

BUN, creatnine, UPC, SDMA, Uric Acid,

Front 67

Exocrine pancreas

Back 67

Most of the pancreas. Responsible for production and secretion of enzymes into the small intestine to aid in digestion. Trypsin, amylase, and lipase.

Front 68

Endocrine pancreas

Back 68

Located in the "islands" of pancreatic tissue. Alpha, beta, gamma, and PP cells. Produce hormones like insulin, glucagon, and somatostatin.

Front 69

Lecture 1

Back 69

See slide 67

Front 70

Amylase

Back 70

A pancreatic assay. Extreme elevation often indicates disease, especially if lipase is elevated. Must be evaluated with lipase. Can be elevated also with decreased GFR, or intestinal disease. Pancreatitis if more than 2-3 times the normal range.

Front 71

Lipase

Back 71

A pancreatic assay that is more sensitive to pancreatic disease than amylase. cPL and fPL snap tests. Specific to pancreas in dogs and cats.

Front 72

trypsin

Back 72

Diffuses into the bloodstream and can be measured as abnormally increased in the case of pancreatic injury.

Front 73

EPI Exocrine Pancreatic Insufficiency

Back 73

Insufficiency that occurs in german shepards. Is indicated by low levels of lipase. Dog ravenous with weight loss and chronic diarrhea. Disease of malabsorption.

Front 74

Glycogen

Back 74

Excess glucose is converted into _______ in the liver, which can be converted back to glucose as needed. Cannot be stored in a diseased liver which can lead to hypoglycemia.

Front 75

Glucose

Back 75

Indirect pancreatic assay that is also blood sugar. Increase indicated stress or insulin resistance. Decrease could indicate sepsis, transient juvenile hypoglycemia, insulin overdose, end stage liver failure, xylitol ingestion.

Front 76

Finish slide 73

Back 76

Lecture 1

Front 77

Diabetes mellitus

Back 77

Condition when glucose rises postprandial, and insulin is released to "pull" the extra glucose into the cell to be used for fuel. Not enough insulin = hyperglycemia.

Front 78

glycogen

Back 78

In cases of persistent hypoglycemia ____, a stored glucose, is released from the liver.

Front 79

Glucose

Back 79

Measuring ____________ is an indirect indication of pancreatic and liver function

Front 80

Fructoseamine

Back 80

Indirect pancreatic assay that is glucose irreversibly binding to protein. If elevated, this can be an indication of persistent elevation in glucose. Can help differentiate between stress hyperglycemia and persistent hyperglycemia. Indirect way to measure pancreatic function. Can be useful in cats.

Front 81

Creatnine kinase or creatnine phosphokinase (CK or CPK)

Back 81

Miscellaneous chemistry test enzyme that comes from striated muscle and is increased in cases of muscle damage.

Front 82

Rhabdomyolosis

Back 82

HBC in small animals. Also known as tying up, azotura, or Monday morning disease in equine. IT damages the muscle tissue that is usually due to an increased intake of carbs and always involves physical exertion. CK

Front 83

Lactate

Back 83

Lactic acid produced by anaerobic cellular metabolism. Indicated hypoxia and hypoperfusion. Can be used as a prognosis indicator of critically ill patients.

Front 84

Sepsis

Back 84

Overwhelming systemic inflammation (SIRS) in response to infection. High or low hr, increased rr, fever, high or low wbc count, immature wbcs, low bp, high or low bs.

Front 85

Transient juvenile hypoglycemia

Back 85

Common disease in toy dog breeds brought on by fasting. Stress, low body temperature, poor nutrition, sudden change in feed, water and schedule patterns, infections, and premature birth may precipitate the onset of hypoglycemia. Drowsiness, shivering, collapsing, disorientation, listlessness, depression, muscle weakness, and tremors.

Front 86

Insulin overdose

Back 86

Disease more common in cats than dogs. Leads to hypoglycemia. Symptoms include lethargy, disorientation, nausea, weakness, abnormal behavior, increased appetite, unsteadiness, and rapid heartbeat. Weight loss, polyuria and polydipsia could also indicate this.

Front 87

End stage liver disease

Back 87

Occurs when there are no symptoms until the liver has degressed about 3/4ths, where the liver is almost completely consumed with dead tissue. death can be instant or in a few months. Jaundice, bleeding, loss of appetite, fluid in abdomen, vomiting, diarrhea, seizures, loss of consciousness, coma, lethargy.

Front 88

Xylitol ingestion in dogs.

Back 88

Occurence in dogs that causes hypoglycemia, and high doses can result in liver failure.

Front 89

Spectrophotometry

Back 89

Most common chemistry and electrolyte analyzer method for enzymes. Measuring the amount of light transmitted or absorbed through a solution. Measure the amount of light absorbed by a blood sample and given a numerical value.

Front 90

Chemistry and electrolyte analyzers

Back 90

Spectrophotometry for enzymes and electrochemical methods to measure electrolytes and and other ionic components.

Front 91

Spectrophotometry

Back 91

Front 92

Control serum

Back 92

Commercially available serum that has known "normal" results. Assures that the procedure was performed correctly and all components such as reagants are functioning correctly. Handled exactly like patient sample and run according to the schedule you devise.

Front 93

When to run control samples

Back 93

When a new assay is up, when a new lot number of reagents is used, or if the instrument performs erratically.

Front 94

Electrolytes

Back 94

Minerals that exist as charged ions in solutions, or any substance that dissociates into ions in a solution. Can be positively or negatively charged.

Front 95

Ions

Back 95

An atom or molecule in which the total number of electrons is not equal to the total number of protons, giving the atom a net positive or negative electrical charge.

Front 96

Serum

Back 96

Substances often preferred since many anticoagulants interefere with results.

Front 97

Hemolysis

Back 97

_______________ can dilute some electrons (Ca,Cl) and falsely elevate others (Phos, Mg, K)

Front 98

Lecture 2

Back 98

See slide 8

Front 99

Maintenance of water balance

Back 99

A function of electrolytes. Water follows the movement of electrolytes into and out of the cell. If too much water enters a cell it will swell and burst. If there is not enough water in the cell, it will shrink and collapse (crenate). Vomiting, diarrhea, sweating, etc. all cause a loss of body water which could imbalance electrolytes.

Front 100

Fluid osmotic pressure

Back 100

Function of electrolytes. The potential pressure of a solution directly related to its solute osmolar concentration. It is the max. Pressure developed by osmosis in a solution separated from another by a semi-permeable membrane, which is the pressure that will prevent osmosis between two such solutions.

Front 101

Muscular function

Back 101

Function of electrolytes along with nerve function, maintenance and activation of enzymes, acid-base regulation, fluid osmotic pressure, and maintenance of water balance.

Front 102

Nerve functions

Back 102

Function of electrolytes. Necessary for regulation of nerve impulses.

Front 103

Lecture 2

Back 103

Slide 14

Front 104

Acid base regulation

Back 104

Function of enzymes. Includes HCO3 and phosphate. Normal pH between 7.35 and 7.45

Front 105

Cations

Back 105

Positive ions, from the Greek word meaning "down". Electrolytes include Sodium (Na+), Potassium (K+), Magnesium (Mg+), and Calcium (Ca+). (CaMPS)

Front 106

anions

Back 106

Negative ions, from the Greek word meaning "up". Electrolytes include Chloride (Cl-), Phosphorus (Phos-), and Bicarbonate (HCO3-)

Front 107

Sodium

Back 107

Major cation of extracellular fluid. It is primarily outside of cells in plasma and interstitial fluid. Responsible for the movement of water between cells, into and out of cells, and maintaining osmotic pressure. Plays a role in pH regulation in urine and acid/base station. High = hypernatremia, low = hyponatremia

Front 108

Hyponatremia

Back 108

Low Na that can indicate overhydration among other things.

Front 109

Natrium

Back 109

The latin word for Sodium

Front 110

Sodium heparin

Back 110

Cation that will falsely elevate results when used as an anticoagulant.

Front 111

Kalium

Back 111

The latin name for Potassium

Front 112

Potassium

Back 112

Major intracellular cation (inside cells). Aids in muscle, respiratory, cardiac, and nerve function, and in carb. metabolism. Important in animals with urethralblockage and a ruptured bladder due to inability to properly eliminate ______ leads to hyperkalemia. Low is hypokalemia.

Front 113

Potassium

Back 113

Hemolysis increases _______ from lysed cells, and lipemia also results in falsely elevated _____.

Front 114

Hyperkalemia

Back 114

High potassium that can decrease cardiac function.

Front 115

Hypokalemia

Back 115

Low potassium, an example being ventral flexion of neck in cats with CRF.

Front 116

Sodium/potassium ratio

Back 116

A normal serum ratio of this kind in dogs and cats lies between 27:1 and 40:1 (from VIN). A low ratio can indicate hypoadrenocorticism.

Front 117

Hypoadrenocorticism

Back 117

Also called Addison's disease. Low sodium/potassium ratio. Happens when the adrenal gland is producting lower than normal amound of glucocorticoids and mineralcorticoids, or infection of Tricuris vulpis.

Front 118

Magnesium

Back 118

Fourth most common body cation, 60% in bones. All tissues contain this. Second most common intracellular cation. Activator (catalyst) for many enzymes. A deficiency in this in cattle and sheep leads to clinical signs of tetany. Hemolysis falsely elevates this. Grass tetany in cattle.

Front 119

Calcium Ca

Back 119

>99% of this cation lies in the bones, with the remaining <1% being in the extracellular fluid, and is critically important for various activities. Regulated by the parathyroid gland to store this in bones or absorb whats needed from this cation from diet. Don't use EDTA or oxalate anticoagulants.

Front 120

Functions of Ca

Back 120

Neuromuscular excitability, muscle tone, enzymatic activity, needed for blood coagulation, inorganic ion transfer across cell membrane. Bound to albumin, so low when it is low.

Front 121

Lecture 2

Back 121

Slide 24-25

Front 122

Inorganic phosphorus

Back 122

Anion of which 80% is found in the bones, the remainder are in RBCs and organic _________, or in serum or plasma as inorganic ________. Functions include energy storage, release, and transfer. Used in CHO metabolism. A component of nucleic acids and phospholipids.

Front 123

Inorganic vs organic in context of phosphorus

Back 123

Organic refers to more complex molecules containing carbon, and inorganic refers to small molecules made of few elements.

Front 124

Chloride (Cl)

Back 124

Predominant extracellular anion. Important in water distribution, osmotic pressure, and normal anion/cation ratio. Maintain electroneutrality for sodiu,m. Hemolysis can dilute or falsely increase this. Can be low in cases of severe vomiting due to loss of HCL (stomach acid) from stomach and pylorus.

Front 125

Bicarbonate

Back 125

Second most common anion of plasma (extracellular). Aids in transport of Co2 from tissue to the lungs. Helps keep body pH in balance.Regulated by the kidneys. Can be measured using arterial blood sample, as it's 95% of TCO2.

Front 126

Lithium heparinate

Back 126

If plasma from bicarbonate is used, ____________ is the anticoagulant of choice.

Front 127

Lecture 2

Back 127

See slide 29

Front 128

The anion gap

Back 128

A method used to evaluate a patient's acid-base status. Based on the observation that the sum of blood cations usually exceeds the sum of the anions. This is the difference between the two. Significant departure from the normal level of difference indicated the disturbance in acid-base.

Front 129

Electrolyes

Back 129

Crucial to maintaining homeostasis