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Clin Chem Exam
| Question | Answer |
|---|---|
| 5 things the liver synthesizes | 1. bile 2. proteins 3. carbohydrates 4. lipids 5. clotting factors |
| 5 functions of the liver | 1. synthesis 2. secretory 3. detoxification 4. metabolic 5. storage |
| steps in how the liver secretes.. | 1. liver to bile canaliculi to gall bladder to duodenum |
| how does the liver detoxify | harmful or insoluble substances are made less toxic or more soluble by the liver and then excreted by the kidney |
| what are the 3 metabolic fiunctions in the liver | carbohydrate and fat metabolism |
| What does glucose do during periods of hyperglycemia | excess stored as glycogen |
| what does glycogen do during periods of hypoglycemia | turned into glucose |
| what does the liver store | lipids, protein, carbohydrate products |
| what are the two types of liver disorders plus an example | 1. Excretory (bile secretion) 2. Synthetic (production of protein) |
| Define Cholestasis | stoppage of bile within the hepatocytes or bile duct |
| 4 types of hepatic dysfunction | 1. cell necrosis 2. cholestasis 3. atrophy 4. tumours |
| what are the 3 categories of testing for the liver | 1. functional capacity tests 2. serum activity of liver enzyme tests 3. supplemental diagnostics |
| what are the 4 more common functional capacity tests for the liver | 1. Dye testing (BSP or ICG) 2. Ammonia Tolerance Test 3. Globulin 4. Fibrinogen |
| how is the liver related to ammonia | Liver converts ammonia to urea |
| WHy are ammonia levels important | it is very hepato-toxic so the liver needs to be able to convert it to urea |
| with liver dysfunction what would the ammonia levels be and the urea levels | decreased liver function = Increased ammonia + Decreased urea |
| when should you not perform the ammonia test | when the patient is already toxic and their challenged levels are high |
| why might albumin be decreased in relation to the liver | -renal or intestinal disease -nutritional problems |
| what is the main cause of hypoproteinemia | albumin loss (75% function loss before its noticeable) |
| what are the 3 globulin groups and which one is mot produced in the liver | Alpha, Beta, Gamma (gamma is not produced in the liver) |
| Why is fibrinogen important | needing for clotting |
| what are the 2 easy tests for Fibrinogen to check clotting | 1. refractometer (plasma protein & serum protein) 2. Heat precipitation test |
| severe bleeding disorders are common with ___________ _________ injury | acute hepatic |
| non-liver related coagulation problems | -nutrition -sample collection procedures -tissue damage |
| True or False: never take jugular blood from an animal with suspected liver damage | True! |
| why should you not use the jugular for venipuncture in a patient with liver disease | -severe bleeding disorders are common with acute hepatic injury and changes in coagulation predisposes animal to DIC |
| why should serum and urine sample be protected from light when doing a urine profile | because bilurubin are easily oxidized |
| 4 tests to assess coagulation | -prothrombin -ACT (activated clotting time) -APTT -Bleeding time |
| how often should you check your ACT test for clotting | every 20 seconds for 60 seconds and then every 5 seconds |
| what is the normal for ACT clotting test | <2 mins |
| what is the normals for Bleeding times tests | under 4 minutes |
| why is bilirubin a test for liver function | since the liver assesses serum and urine bilirubin and feces appearance |
| how is bilirubin related to the liver | bilirubin is produced AND excreted by the liver |
| explain the bilirubin circuit | Check WorkSheet |
| what is jaundice | discolouration of body tissues due to increased about of circulating bilirubin in the plasma |
| where would you see uncongugated bilirubin | in circulation (blood) bound to albumin, abnormal to see in urine b/c albumin a large protein normally isn't filtered by the kidney |
| where would you see conjugated bilirubin | in circulation from reabsorption from the intestines, in. urine after reabsorption can pass through glomerulus and can be filtered out by kidney |
| what is the cause of pre-hepatic jaundice | -increased RBC destruction which results in an increase in both unconjugated and conjugated bilirubin |
| what is the cause of hepatic jaundice | -hepato-cellular damage -primary defect -virus, toxins, hepatic lipidosis |
| what is the cause of post hepatic jaundice | -inability to excrete bilirubin into the duodenum often due to a biliary obstruction |
| why is important to evaluate feces | it can help assess liver function |
| what does an increased fecal bilirubin mean | pre or primary hepatic problem |
| what does a lack of colour in feces mean | post hepatic problems/ cholestasis, lack of bilirubin to intestine |
| how are bile acids related to the liver | -produced in liver by hepatocytes -stored in the gall bladder -aids in digestion of fat and transport of bilirubin and cholesterol to intestines for excretion -95% of bile acids are reabsorbed in ileum |
| what serum enzymes indicates liver cell damage | ALT and AST |
| what does it mean when ALT and AST are increased | cell membrane defect either blunt damage or leakage |
| what enzymes indicated impaired bile flow | ALP and GGT |
| why would ALP and GGT not be elevated during impaired blood flow | Both membrane bound so not obviously elevated with 1 degree cell damage |
| what happens with intra-hepatic cholestasis | -blockage within the liver -stones, tumours, hepatitis |
| what happens with extra-hepatic cholestasis | -blockage outside the liver -stones, tumours, pancreatitis |
| what is Phenobarbital | medication used to treat epilepsy and seizures |
| why is it important to monitor a patients liver function and enzymes when on phenobarbital | -Hepato-toxic when dosed incorrectly -can lead to hypoalbuminemia |
| what specifically should you monitor every 6-12 months while on phenobarbital | -enzymes and albumin |
| what is the safe level of phenobarbital for dogs | 100-120 μmol/L |
| what is the toxic level of phenobarbital for dogs | >140 μmol/L |
| what are the signs of liver toxicity build up | -weakness -lethargy -vomiting -diarrhea -weight loss -ascites -icterus |
| For a liver profile should plasma or serum be higher and why | Plasma should be higher because it contains fibrinogen |
| why are older patients more at risk during anesthesia | as we age out bodies slow down and the liver doesn't detoxify as well, the kidneys don't excrete as well as they used too |
| why do we do geriatric profiles | to help assess various organs and systems in the body that are usually first to slow down (liver, heart, kidney) |
| what is the percentage of geriatric patients | 25-33% of entire canine/feline population |
| What functions determine when an animal is geriatric | -breed, species, lifestyle, functional capacity |
| list 3 specific organ related changes with geriatrics | 1. Atrophy 2. fatty Infiltration 3. Fibrosis |
| periodontal changes in geriatrics | -circulating bacteria = systemic disease -calculus, hyperplasia, tooth loss, enamel weak, periodontitis |
| GI tract changes in geriatrics | -impaired absorption -reduced salivation -impaired esophageal function -reduced HCI secretions -reduces villous size |
| Liver changes in geriatrics | reduced function hepatocytes -increased fat infiltration -increased fibrotic tissue Decreased overall function -decreased bile, albumin production -decreased ammonia conversion -decreased bilirubin conjugation |
| kidney changes in geriatrics | -reduced renal size -decreased glomerular and tubular function -inappropriate urination |
| what is the #1 reason for euthanasia | Inappropriate Urination |
| eye changes in geriatrics | iris atrophy -light sensitive Nuclear sclerosis -cloudy vision, pupils grey/blue colour Cataracts -opacity in lens can progress to blindness Increased tear viscosity -thick tears, less flow, results in dry eye |
| Skin changes in geriatrics | -thick, loose elasticity, coat changes |
| Endocrine changes in geriatrics | -reduced production and response (thyroid, adrenals, sex hormones) - +/- tumours |
| skeletal changes in geriatrics | -loss of muscle mass -decreased bone density -joint problems |
| CNS and PNS changes in geriatrics | -loss of reflexes, impaired GIT motility -reduced serotonin -memory loss |
| Respiratory changes in geriatrics | -COPD -pulmonary fibrosis -chronic bronchitis -depressed cough reflex |
| Cardiovascular changes in geriatrics | -Decreased Cardiac Output -BP changes -Contractility of heart muscle |
| what are some signs of cardiovascular disease | -coughing -exercise intolerance -lethargy |
| what enzyme can be evaluated to determine cardiovascular damage | CK (Creatine Kinase) |
| why can CK be used to devaluate cardio function | -needed for proper muscle contraction -will increase in serum if there is muscle damage -can rule out false causes -can indicate heart attack |
| why can CK be falsely elevated | -levels may falsely increased after exercise or heavy manual labour |
| what is the #1 disease that kills geriatrics | Renal disease |
| What should you assess in a geriatrics urinalysis | -filtering, excretion, reabsorption abilities -urine P:C ratio -glucose |
| what should you assess in a geriatric blood chemistry | BUN/Creatinine |
| what can pancreatic endocrine dysfunction lead to in geriatrics | -chances of diabetes mellitus |
| what can pancreatic exocrine dysfunction lead to in geriatrics | -digestive difficulties and decreased ability to utilize food |
| what is the anion gap | helps assess acid-base status |
| how is the anion gap calculated | (Na+ + K+) – (Cl- + HCO3-) |
| what does the anion gap primary measure | Metabolic acidosis |
| what is the normal anion gap | >0 meaning there is always a gap due to natural circulating cations than anions in serum |
| what can an increased anion gap indicate | -fluid loss -azotemia -toxicities |
| what are the reasons bicarbonate levels may decrease during metabolic acidosis | Fluid losses -diarrhea -dehydration The need to buffer in conditions -Lactic acidosis -Azotemia -Toxicities |
| clinical signs of metabolic acidosis | -headache -altered mentation -bone and muscle weakness -nausea -weight loss |
| what does a decreased anion gap indicate | metabolic alkalosis -Increased bicarbonate |
| Clincial signs of metabolic alkalosis | -hypoventilation -myalgia (muscle pain) -weakness -polyuria |
| how are albumin and decreased anion gap related | Loss of albumin found in the gap is compensates by retained by carbonate and chloride |
| what do hormones control in the body | -metabolic activity -regulation of mineral uptake and excretion |
| neurological signs of aging | -change in gait or posture -sensitivity to light and sound -hearing loss -decreased motor function -decreased response time |
| what does the pituitary gland produce | -ACTH -TSH |
| what does the thyroid gland produce | -Thyroxine |
| what does the Parathyroid gland produce | -PTS |
| what does the adrenal gland produce | -Cortisol -Aldosterone |
| hypothyroidism signs | -alopecia -pyoderma -otitis externa -lethargy -obesity -cardiac symptoms -neuromuscular symptoms -fertility problems (abortions) |
| what serum value would be elevated to help diagnose hypothyroidism | TSH (thyroid stimulating hormone) |
| what tests can be done to look for thyroid function | -T4 -TSH stimulation test -TSH concentration -Cholesterol |
| signs of hyperthyroidism | -weight loss -no loss of appetite -elevated T4 levels |
| True or false: hypothyroidism is common in dogs while hyperthyroidism is common in older cats? | True! |
| what is the parathyroid gland and what does it do | -It has one single job and it is to regulate serum calcium |
| what condition primarily effects the parathyroid gland | hyperparathyroidism |
| what can hyperparathyroidism cause you bones to become | -Weak and brittle |
| what is cushings disease | hyperadrenocorticism -ACTH-secreting tumor of the pituitary gland. |
| Pituitary dependant cushings disease | -both adrenal glands are normal but there is an abnormality of the pituitary -increased ACTH = increased Cortisol |
| Primary Adrenal gland cushings disease | -increased cortisol release from tumourous adrenal gland |
| clinical signs of cushings disease | -alopecia -think skin -PU/PD/PP -muscle weakness -Panting |
| What is addisons disease | Hypoadrenocorticism |
| which test confirms addisons disease and what would the results be | -ACTH stimulation test -results would be Low baseline + no response |
| clinical signs of addisons disease | -depression -collapse -weakness -vomiting |
| which test differentiates between pituitary and adrenal cushing disease and what would the results be? | Hight Dose Dexamethasone Suppression -Low cortisol: pituitary -High cortisol: adrenal |
Created by:
jscott41
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