Term
| What does a PLE clinically look like? |
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Definition
- Panhypoproteinemia with hypocholesterolemia
- Intermittent diarrhea
- Pitting edema with peripheral edema
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Term
| Why do dogs with PLE also present with hypocalcemia? |
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Definition
| PLE has panhypoproteinemia which includes the loss of albumin. Albumin is the main oncotic molecule and is also largely complexed to calcium. Loss of albumin leads to peripheral edema and also lowering of calcium. Check for actual calcium level through ionized calcium levels since this is the biologically active form. |
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Term
| In a dog, what are the main differentials for PLE? |
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Definition
- IBD: inflammatory leukogram and thrombocytosis supportive
- Gastric or alimentary neoplasia
- Intussusseption
- Lymphangectasia: ascites and lymphopenia supportive
- Intestinal parasites: eosinophilia
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Term
| Describe what makes you think PLE is a possibility |
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Definition
- Panhyproproteinemia + hypocholesterolemia
- Intermittent GI signs such as diarrhea, weight loss, decreased appetite, etc.
- +/- inflammatory leukogram. NOT REQUIRED for DX
- Typical small breeds! Yorkies over represented, maltese, shih tzu, etc.
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Term
| In a dog with dec albumin, dec cholesterol, dec globulin (though you suspect PLE) can you also think liver disease? |
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Definition
Yes!
Liver responsible for production of albumin and cholesterol. However, if bili normal, glucose normal, no serious changes in liver enzymes, and a decrease in the globulins, liver disease less likely. |
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Term
| When do you consider a protein losing neuropathy? |
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Definition
Most often a PLN is seen as low albumin with a NORMAL globulin.
Urinalysis is important as well since you would expect to see proteinuria (fairly significant) |
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Term
| Besides edema in the distal extremities, where else might you expect clinically detectable amounts of fluid to accumulate in a panhypoproteinemic dog? |
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Definition
Edema associated with low oncotic pressure (low albumin) can manifest in the peripheral limbs, as ascites, and as pleural effusion. Basically, in any of the potential spaces within the body cavity.
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Term
| If you were to obtain a sample of the fluid from a hypoproteinemic animal, how would it most likely be characterized based on specific gravity and cellularity? |
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Definition
Fluid accumulation outside of the vasculature secondary to low oncotic pressure would be classified as a pure transudate. The protein should be <2.5g/dL, have a WBC count less than 1000 with mononuclear cells being the predominant cell type, and a specific gravity less than 1.020.
The loss of oncotic pressure means hydrostatic prevails. Leaky vessels simply leak a pure transudate. |
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Term
| How does a modified transudate fluid look in terms of SG and cellularity? |
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Definition
TP >2.5, WBC >1,000 cells with mononuclear cells still predominating,and a specific gravity greater or equal to 1.020.
You may see a modified transudate with vasculitis, gastric or alimentary neoplasias, and some IBD types. |
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Term
| What rule outs should you always have for thrombocytosis? |
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Definition
- Inflammation—very common in horse and cattle. Less often with cats and dogs but possible. IL-6 can stimulate megakaryocytes though and inc thrombocytosis
- Hypercoagulability--due to loss of ATIII or an inflammatory GI disease. Mechanisms are still unclear but it has been seen. ATIII can be lost at the level of the kidney OR the gut
- Iron Deficiency Anemia--not commonly seen but can contribute to the thrombocytosis--not sure mechanism
- Neoplasia and/or paraneoplastic syndrome--600K is often the “cut off” but closer you get to 1 million, the more you start to worry about neoplasia!
- Hyperadrenocorticism--steroid effects
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Term
| How do you make a fluid plan? |
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Definition
Deficits: % dehydration x BWkg x 1000mL
Maintenance: 40-60mL x BWkg per day
Ongoing losses: based on presentation
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Term
| How do you calculate nutritional needs? |
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Definition
RER: 30(BWkg) + 70 if 2kg<kg<40kgs
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Term
| How does Mycoplasma haemofelis typically present? |
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Definition
- Typically evidence of hemolysis
- Most often regenerative anemia
- Thrombocytopenia typical
Acute vs Chronic in nature
- Acute: weakness, mental depression, collapse, pale mucous membranes, tachypnea, anorexia, and vomiting
- Chronic: lethargy, anorexia with weight loss, and splenomegaly
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Term
| How long does a bone marrow response typically take for the RBC line? |
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Definition
| 3-5 days you should see polychromasia and inc in size |
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Term
| How do you diagnose Mycoplasma haemofelis? |
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Definition
Organism identification on a blood smear--low sensitivity and specificity
molecular diagnosis using PCR |
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Term
| Describe PRCA (Pure red cell aplasia) |
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Definition
- Not an uncommon disorder of cats
- Decrease in the erythroid cell line due to antibody attachment to the precursor cells
- Anemia will be non-regenerative OFTEN SEVERE!
- Signs of hemolysis may not be seen since attack is in the bone marrow not the circualation
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Term
| Describe IMHA and how it complicated Gopher's case |
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Definition
- Marked rouleaux with slight agglutination typical
- Severe anemia
- Can be a secondary situation to diseases such as Mycoplasma haemofelis or a primary and most likely genetic disease
- REGENERATIVE ANEMIA
- Thrombocytopenia
- Fairly uncommon disease in cats
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Term
| Thrombocytosis of what level should neoplasia be on your differential list? |
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Definition
600K is borderline
1 million is when neoplasia becomes a very real possibility
take the age, breed, etc into account though as well |
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Term
| With a case such as Gopher, PRCA suspect, what would you expect an arterial blood gas to look like? |
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Definition
**THIS CARD MAY BE WRONG**
pH dec--severe anemia = hypoxia = anaerobic metabolism = lactic acid production = possible metabolic acidosis
pO2--normal--this is a measure of DISSOLVED OX so its independent of hB
pCO2--decreased--compensatory biproduct of hyperventilation in an effort to blow off "extra acid" being produced by lactic acid
HCO3--metabolic attempt to buffer an acidosis situation |
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Term
| What are the indications for a blood transfusion? |
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Definition
- anemia (hemorrhage, hemolysis, ineffective erythropoiesis) with severity dependent on patient
- coagulopathies
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Term
| Whats the main blood type of a cat? |
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Definition
A
B has serious antibodies against A so if you transfuse B into A, you have killed your patient. Don't do this! |
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Term
| How high do you aim to get the PCV when you administer a transfusion? |
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Definition
| You want to achieve no longer a clinical state for anemia which is typically between 20-25% |
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Term
| How do you determine the transfusion amount? |
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Definition
| 1mL of blood per pound of body weight roughly raises the PCV by 1% |
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Term
| What can echinocytes be suggestive of? |
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Definition
| renal disease, neoplasia, electrolyte depletion, or drying artifact |
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Term
| What can hyponatremia, hypochoremia, and hyperkalemia be suggestive of? |
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Definition
- Uroabdomen
- Oliguric renal failure
- Hypoaddrenocorticism
Guess what...you treat this really differently....check whats the actual cause! |
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Term
| Which liver enzymes support hepatocellular necrosis or damage? |
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Definition
ALT = liver specific
AST = not liver specific |
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Term
| What laboratory changes are suggestive of an overal drop in GFR? |
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Definition
Hypercalcemia
Hyperphosphatemia
Hypermagnesemia
Hyperamylasemia |
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Term
| When you are looking for a uroabdomen confirmation which electrolyte should you focus on? |
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Definition
| Creatinine should be 1.5-2x greater than the serum level. Creatinine is not reabsorbed as quickly and therefore doesn't equillibrate fast. BUN DOES so this is pretty much useless to confirm or deny you are dealing with uroabdomen |
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Term
| In general what effects do LRS and NaCl have on the system i.e. acidifying vs alkalinizing |
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Definition
LRS: alkalinizing
NaCl: acidifying |
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Term
| What would the leukogram look like for an acute phase endotoxemia or an overwhelming tissue demand in a cat or dog |
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Definition
Neutropenia--remember how big a pool cats and dogs have
Degenerative left shift--means more bands than mature neuts so the being used up even before maturation finalizes
+/- metamyelocytosis--precursor to the bands so even further back in the precursor pool suggesting severity |
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Term
| Explain the presence of metamyelocytosis |
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Definition
Metamyelocytes are step before bands
Should mature in the bone marrow to bands and then to segmented neut before release into circulation
If you see this indicates course of disease under 2 days since thats the WBC mature at a faster pace than RBC |
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Term
| Inflammation WITHOUT hyperglobulinemia suggests what? |
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Definition
| No antigenic stimulation in processes such as tissue damage or necrosis |
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Term
| How quickly can a fructosamine value change in a cat? |
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Definition
| Within 3-5 days of a persistent hyperglycemia |
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Term
| To interpret fructosamine what two things must be present in the circulation? |
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Definition
Glucose and serum proteins to bind to.
This means a hypoproteinemic animal may have a falsely lowered fructosamine and vice versa |
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Term
| Describe some presenting findings for a diagnosis of pancreatitis in a cat |
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Definition
- +/- inflammatory leukogram
- elevated AST probably as bistander damage to the liver
- bilirubinuria
- hx of anorexia
- vomiting (less consistent than with dogs)
- weakness
- dehydration
- abdominal pain
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Term
| In a pancreatitis case which happens first: hyperbilirubinemia or hyperbilirubinuria? |
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Definition
| Hyperbilirubinuria (though no clue the mechanism) |
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Term
| Fluid and insulin therapy will affect the K and P levels how? |
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Definition
| Insulin pushes K and P INTO the cells making the serum both hypokalemic and hypophosphatemic. You therefore need to carefully supplement these in the fluid therapy and continue to closely monitor the electrolytes! |
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Term
| What is the maximum safe rate of K administration? |
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Definition
| 0.5mEq/kg/hr!!!!!!!!!!!!! |
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Term
| What do marked lipemia and hemolysis do to a chemistry |
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Definition
Falsely elevate calcium values
take into consideration with clinical signs |
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Term
| Describe what PTH does in a situation such as PHPT |
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Definition
- hypercalcemia through inc renal resorb, inc formation of active Vit D which inc gut absorb of calc, and inc skeletal remodeling
- Loss of phosphate through urine
- Nephrogenic DI due to alteration of kidney tubules to respond to ADH
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Term
| What are the values of PTH when you have PHPT vs hypercalcemia of malignancy? |
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Definition
PHPT: Elevated
Malignancy: Low most often |
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Term
| What do nRBC in circulation mean? |
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Definition
| There is damage at the level of the endothelium of the bone marrow. Can be do to hypoxia, chemical event, neoplasia, etc. Doesn't state a cause just that damage occured. |
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Term
| What are the 5 things necessary to call DIC (you need 3 out of the 5) |
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Definition
Thromobocytopenia
High fibrinogen
Prolonged PT
Prolonged PTT
Elevated FDPs |
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Term
| Heinz bodies in a dog make you think of what |
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Definition
| Zinc, acetaminophen, onions, etc |
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Term
| What can lipemia do to a serum sample |
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Definition
Elevate the BUN falsely
Calcium may be falsely elevated |
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Term
| What can Icterus do to a serum sample |
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Definition
Falsely elevate amylase
Falsely decrease total protein |
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Term
| Liver disease encompasses what three things? (Broadly termed not specific values) |
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Definition
Cholestasis
Hepatocellular damage
Decreased synthetic function |
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Term
| What values determine cholestasis |
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Definition
ALP
Bilirubin
GGT
In small animals! Remember the ALP can also be inc with exogenous steroid administration, through colostrum, and with bone production |
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Term
| Can you determine which came first, hepatocellular damage or cholestasis when evaluating enzyme levels? |
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Definition
| You use the fold increases over the high end of normal for each enzyme level. If one set outweighs the other by a good amt then you can consider that one first. If they are about equal, you can't tell. |
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Term
| What values determine hepatocellular damage |
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Definition
ALT
AST
Remember AST can be falsely inc from hemolysis due to the fact that RBC also release AST when damaged |
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Term
| How do animals with liver disease end up with isosthenuric urine? |
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Definition
The urea production!
Remember to concentrate urine a kidney needs a medullary gradient. Though not the only component, urea is a major driver. If the liver is not producing urea then this gradient does not exist and even a healthy kidney can't concentrate urine appropriately |
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Term
| If you find MAP crystals on a dog urine sample, does it immediately implicate uroliths? |
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Definition
| NO. MAP crystals can be observed n normal canine urine. If you leave the sample out too long as well they can start to form in vitro |
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Term
| How do dogs most often acquire cholangiohepatitis and cholecystitis? |
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Definition
Through an ascending infection through the common bile duct
Can lead to dec liver function if CHRONIC |
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Term
| Describe a local coagulopathy |
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Definition
| PT and PTT times give you the broad idea of how tissues will respond to an insult. This is NOT locally specific. Necrosis, inflammation, etc in a specific location can alter that area's ability to clot even in light of "normal" PT and PTT times. |
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Term
| What can blunt a regenerative response by the bone marrow in an anemic patient? |
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Definition
| Severe systemic inflammation |
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Term
| What's the potential reason you may see a mild prolongation in only the PTT |
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Definition
| Seriously ill patients--pathomechanism unknown but thought to be potentially an acute phase response as seen with albumin |
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Term
| What do adhesions in a dog suggest? |
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Definition
Chronic disease (usually week +)
NOT SUGGESTIVE OF DIC OR COAG STATUS |
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Term
| What are the most CONSISTENT indicators of sepsis? |
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Definition
| Hypoglycemia and MILD hyperbilirubinemia |
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Term
| In a septic condition, why does the bilirubin go up? |
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Definition
| The endotoxins interfere with the ability of the liver to take in the bilirubin. Leads to unconjugated bilirubin increase |
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Term
| In seriously ill patients, why can you sometimes see hypocholesterolemia? |
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Definition
| Theorized that its an acute phase response much like albumin. The liver focuses on other problems and leaves the cholestrol alone for a while. In human med = poor prognostic indicator |
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Term
| For atypical addisons, what changes on the chemistry will you see? |
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Definition
Lack of steroid leukogram
Hypoglycemia
Hypoalbuminemia
Hypocholesterolemia
The Na, Cl, and K will be normal usually |
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Term
| What is often the ONLY presenting sign of an insulinoma patient? |
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Definition
| Hypoglycemia with NO OTHER COMPLICATIONS on the bloodwork. |
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Term
| Having either too much or too few ENDOGENOUS steroids can lead to what condition? |
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Definition
| GI Ulceration! You'd expect diarrhea, melena, or hemoptysis based on where the ulceration is |
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Term
How do you rule OUT hypoadrenocorticism?
How do you confirm it? |
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Definition
Rule out: Base line cortisol
Confirm: ACTH Stim |
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Term
| What are the components of brachycephalic airway syndrome? |
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Definition
Stenotic nares
Elongated soft palate
Everted laryngeal saccules
can be associated with hypoplastic trachea and collapse as well. |
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