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Diagnostic Patterns
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Veterinary Medicine
Professional
05/01/2011

Additional Veterinary Medicine Flashcards

 


 

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Term
Hepatic lipidosis
Definition
Clinical Signs:
- most frequently seen in cats secondary to stress or starvation
- recent onset of anorexia (especially in an obese, diabetic cat), vomiting/diarrhea, depressed/lethargy, hypersalivation (cat), weight loss
- icteric mucous membranes +/- hepatomegaly
- +/- neuro signs/hepatic coma if has progressed to hepatic encephalopathy (uncommon)

Hemogram:
- normocytic, normochromic , nonregenerative anemia (chronic disease)
- +/- Heinz bodies
- +/- poikilocytosis= acanthocytes (altered lipid/cholesterol RBC membrane)
- icteric plasma
- +/- steroid leukogram (mature neutrophilia)

Chemistry Profile: cholestasis due to lipid accumul.!
- hyperbilirubinemia (liver can’t remove from blood stream, physical cholestasis)
- >2X increase in AST/ALT/ALP
- +/- increase in GGT (ALP >>> GGT)
- mild hyperglycemia (stress); UNLESS concurrent diabetes
- decreased BUN w/ normal creatinine (b/c urea from liver); UNLESS concurrent renal disease

Urinalysis:
- USG usually <1.020
- +/- bilirubinuria

Coagulation Panel:
- prolonged PT/PTT (liver produces coagulation factors ALSO anorexia and decreased Vitamin K uptake; rare to have bleeding disorders)
- hypofibrinogenemia
Other:
SBA elevated (liver can’t take up) HOWEVER with hyperbilirubinemia- unlikely to run this test because of no additional value!
May see abnormalities in other chemistry values due to underlying GI disease, renal disease, etc.
Term
Hypoadrenocorticism
Addison's disease
Definition
Clinical Signs:
- more frequent in middle aged female dogs
- vomiting, diarrhea, depression, lethargy, anorexia, severe weight loss, dehydration, bradycardia (because of hyperkalemia)
- +/- PU/PD

Hemogram:
- Absence of a steroid leukogram in a really sick animal (lymphocytosis, eosinophilia)
- Relative erythrocytosis /polycythemia (dehydration)

Chemistry Panel:
- azotemia (usually pre-renal)
- increased Phos & Mg (b/c of decreased GFR)
- increased Ca2+ (b/c of decreased glucocorticoids)
- decreased cholesterol & glucose (b/c of decreased glucocorticoids)
* - severely decreased Na+, decreased Cl- (may be proportional or disproportional to change in sodium), significant increase in K+ (ALL due to mineralocorticoid deficiency)
- +/- mild acidosis

Urinalysis:
- decreased Na/K ratio (<25:1)
- +/- low USG (<1.018)

Differential Diagnoses:
- Oliguric/anuric renal failure
- GI disease (whipworms, etc)
Term
Hyperadrenocorticism
Cushing's Disease
Definition
Clinical Signs: 5 P’s!!!
* - PU/PD/PP
* - potbelly (b/c of abdominal muscle weakness/redistribution of fat to the abdomen)
* - panting
- bilateral, symmetrical, non-pruritic , noninflammatory alopecia
- heat intolerance
- lethargy

Hemogram:
* - steroid leukogram
- evidence of RBC regeneration (erythrocytosis)

Chemistry Panel:
- increased glucose and cholesterol
- increased ALT
- increased ALP (steroid effects)
- decreased BUN

Urinalysis:
- USG <1.015

Differential Diagnoses:
- other endocrine diseases
Term
Hypoperfusion/Shock
Definition
Clinical Signs:
- pale, tacky mucous membranes
- tachycardia (cats may have bradycardia), tachypnea
- thready/rapid OR weak pulses
- prolonged CRT, cold distal extremities= decreased perfusion and peripheral vasoconstriction
- decreased mentation

Hemogram:
- +/- erythrocytosis/relative polycythemia

Chemistry Panel:
- pre-renal azotemia
- +/- increased proteins
- +/- increased ALT/AST
- +/- increased amylase (b/c of decreased GFR)

Urinalysis:
- +/- urine concentration (dehydration)
All of the above depends on type of shock and whether in compensatory/decompensatory!
Term
IMHA
Definition
Clinical Signs:
- depression
- panting/tachypnea
- anorexia, weight loss
- pale/icteric mucous membranes
- +/- vomiting

Hemogram:
* - macrocytic, hypochromic regenerative anemia (reticulocytosis, polychromasia)
* - spherocytosis
* - autoagglutination
- inflammatory leukogram

Chemistry Panel:
- increased total bilirubin (b/c of hemolysis)
- increased ALT/AST (result of hypoxia)
- +/- increased ALP/GGT (result of hypoxia)

Urinalysis:
- bilirubinuria
- hemoglobinuria

Differential Diagnoses:
- blood parasites (Ehrlichia, etc.) causing a hemolytic anemia
- drug reactions (sulfas, penicillin), vaccination induced IMHA
Term
IBD/PLE
Definition
Clinical Signs:
- chronic diarrhea
* - weight loss
- +/- polyphagia
- dehydration

Hemogram:
- +/- anemia (chronic disease) normocytic/normocytic nonregenerative
- lymphopenia (loss from GIT)

Chemistry Panel:
* - decreased total protein (both albumin and globulin low = panhypoproteinemia)
- +/- increased ALT/AST
- +/- hypocholesterolemia (loss from GIT)

Differential Diagnoses:
- liver failure
- hypoadrenocorticism
- renal disease
Term
Zinc toxicity
Definition
Heinz bodies and spherocytes ; anemia= regenerative
Other changes to RBC that can occur in oxidative damage: eccentrocyte/ghost cells, intravascular hemolysis
Term
Rodenticide toxicity
Definition
Clinical Signs:
- hemorrhage somewhere (or everywhere)
- weakness/lethargy
- ataxia
- dyspnea, pale MM (blood loss)

Hemogram:
- non-regenerative anemia (acutely; after 2-3 days will regenerate RBC; blood loss anemia)
- steroid leukogram
- +/- thrombocytopenia (usually normal)

Chemistry Panel:
- hypoproteinemia (24-48 hrs post-ingestion; blood loss)

Coagulation Panel:
- prolonged PT/PTT (PT= FIRST because the Vit. K dependent factors are 2, 7, 9, 10)
- normal fibrinogen
- normal FDP’s

Differential Diagnoses:
- DIC
- Coagulopathies (VonWillebrand’s Disease, Factor Deficiencies, Platelet Deficiency)
- Blood parasites (Ehrlichia)
Term
Leptospirosis
Definition
Clinical Signs:
- fever
- depression, lethargy
- anorexia
- arthralgia, myalgia (joint/muscle pain)
- vomiting, dehydration

Hemogram:
- non-regenerative anemia
* - steroid leukogram

Chemistry Panel:
* - azotemia
- increased phos & Mg (b/c of decreased GFR)
- disproportionate decreases in sodium and chloride (chloride down more = alkalosis)
- no opposing change in bicarb w/ decreased chloride = mixed acid-base disorder
- increased anion gap (acidosis)
* - SIGNIFICANT increase in total bilirubin
* - mild to moderate increase in ALP
- +/- increased ALT/AST

Urinalysis:
- bilirubinuria
- proteinuria
- granular casts – tubular disease/sloughing of tubular epithelial cells= cast
- +/- hematuria
- USG <1.019

Differential Diagnoses:
- renal disease
- cholestatic liver disease
Term
Pancreatitis
Definition
Clinical Signs:
- anorexia
- vomiting, diarrhea
- abdominal pain (cranial)
- weakness
- dehydration
- cats = lethargy, hypothermia

Hemogram:
- inflammatory leukogram (+/- steroid= stress)
- relative erythrocytosis (dehydration)

Chemistry Panel:
- pre-renal azotemia (dehydration)
- increased amylase/lipase (insensitive)
- +/- increased ALT/AST (spillover to liver)
- +/- increased total bilirubin
- +/- increased ALP/GGT
- +/- increased glucose= stress
- +/- increased cholesterol (decreased liver function with spillover)

Differential Diagnoses:
- renal disease
- cholestatic liver failure
Term
PSS/Liver failure
Definition
Clinical Signs:
- smaller than littermates (failure to thrive)
* - hepatic encephalopathy
- vomiting, diarrhea
- anorexia, nausea
- PU/PD (dogs, not cats; DUE to decreased BUN)
- hypersalivation (cats)

Hemogram:
* - microcytosis (+/- anemia)
- +/- acanthocytes, codocytes, poikilocytes

Chemistry Panel:
* - decreased BUN (decreased urea production in liver)
- decreased total protein due to decreased albumin (decreased production in liver)
- increased ALT/AST (+/- ALP/GGT)
- decreased glucose & cholesterol (decreased production in the liver)
- Bilirubin normal/high

Urinalysis:
- USG <1.019 (low urea, part of medullary concentration grad.)
- +/- ammonium urate crystals
Coagulation profile: elevated PT/PTT (failure to produce coag. Factors)

Differential Diagnoses:
- liver failure
- renal disease
Term
Cholestasis
Definition
• Physical: Swollen pancreas, gallbladder obstruction, tumor, stones (intra vs extrahepatic)
• Serum chemistry: Increase bilirubin, increase ALP / GGT, hypercholesterolemia. Increase bile acid but usually won’t run b/c hyperbilirubin
o Bilirubin in urine. Can also see liver enzymes increase as well in urine.
Metabolic cholestasis (Anorexia) – horses no gallbladder, increase bilrubin but cholestatic enzymes normal
o Leptospirosis, sepsis also

Bili – coming from damaged RBCs, eaten by mac’s in spleen and bili is released from spleen(if hemolysis), after this bili comes to liver and liver takes it up, could be due to lack of hepatocytes(liver failure) or could be anorexia(horses>cow>cat), could be sepsis
- For hemolysis to be the cause of this, should see anemia that is generally regenerative, look for things like spherocytes, schistocytes, Heinz bodies(unless cats)
- Liver failure, anorexia ,and sepsis may be some elevation in ALP/GGT, but not consistent or dramatic
- What causes elevation in ALP/GGT is physical blockage of pathway, if bile stops in the bile ducts and back s up it irritates the epithelial cells, that is what induces increased production of GGT and ALP
Term
Pyometra
Definition
Clinical Signs:
- usually occurs after a heat cycle
- lethargy
- anorexia
- PU/PD (bacterial ADH resistance)
- vomiting
- vaginal discharge (if open pyometra)
- abdominal distension (esp if closed pyometra)

Hemogram:
- inflammatory leukogram (+/- steroid w/ sepsis)
- non-regenerative anemia (early inflammation or chronic disease)

Chemistry Panel:
- increased total protein
- increased globulin (+ phase reactant – increases w/ inflammation)/decreased albumin (negative acute phase protein)
- +/- azotemia (w/ sepsis)
- +/- decreased glucose (b/c of sepsis)
- +/- increased Phos/Mg (b/c of decreased GFR w/ renal damage from sepsis)
- +/- increased total bilirubin and ALP/GGT (septic cholestasis) =biochemical/metabolic

Urinalysis:
- +/- isosthenuria (sepsis)
- +/- proteinuria
Term
Sepsis/DIC
Definition
Clinical Signs:
- lethargy
- depressed mentation
- anorexia
- evidence of bleeding (DIC)

Hemogram:
- inflammatory leukogram (sepsis)
- thrombocytopenia (DIC)
- +/- anemia (DIC)

Chemistry Panel:
- increased total proteins (sepsis – probably see decreased proteins with DIC)
- increased globulins (sepsis – response to inflammation)
- significantly increased total bilirubin (sepsis)
- moderately increased ALP/GGT (septic cholestasis)
- +/- azotemia (sepsis or hypoperfusion from DIC)
- +/- increased ALT/AST (sepsis or hypoperfusion from DIC)


Coagulation Panel:
- prolonged PT/PTT (DIC, maybe sepsis if liver damaged enough)
- increased FDPs (DIC)

Differential Diagnoses:
- trauma (DIC)
- coagulopathy (VonWillebrand’s Disease, coagulation factor deficiency)

Sepsis: looking for marked inflammation/toxic change, severe inflammatory leukogram, may see increased bilirubin, biochem. tend to be similar to trauma- due to shock and multisystemic inflammation
Term
Trauma
Definition
Clinical Signs: visible injury +/- bleeding/hemorrhage
CBC: if bleeding may see an anemia (acutely= will not)

Chemistry Panel:
- +/- increased ALT/AST/GGT/ALP (SDH= large anim.); tissue hypoxia/ischemia
- +/- increased CK (muscle damage; also AST)
- +/- increased FDPs

Urinalysis:
- +/- hematuria
Term
Uroabdomen
Definition
Clinical Signs: foals
- depression
- anorexia
- vomiting
- +/- abdominal pain
- +/- dysuria/stranguria/no urine production

Hemogram:
- +/- non-regnerative anemia (early inflammation/late chronic disease)
- +/- inflammatory leukogram (+/- steroid if stressed)

Chemistry Panel:
- azotemia
- increased K+
- decreased Na+
- decreased Cl-
- increased anion gap (metabolic acidosis)= uremic acidosis

Urinalysis:
- +/- hematuria

Abdominal Tap:
* - Creatinine/BUN concentration greater than serum concentration

Differential Diagnosis: obstruction in the urinary tract (post-renal azotemia)
Term
Vomiting
Definition
Clinical Signs:
- vomiting (obviously)
- anorexia
- anxiety
- hypersalivation
- dehydration

Hemogram:
- +/- relative erythrocytosis (dehydration)

Chemistry Panel:
- disproportionate decreases in sodium and chlorine (chlorine down more due to high HCl in stomach= alkalosis- loss of major anion, retain other major anion= bicarbonate!)
- decreased K+ (loss of all electrolytes)
Hypochloremic alkalosis (similar to abmosal stasis)
Term
Renal failure vs. blocked cat
Definition
Clinical Signs:
- painful abdomen +/- distended abdomen (HUGE bladder OR painful kidneys)
- dysuria/stranguria OR completely blocked= anuria vs .polyuric RF
- vomiting
- depression
- dehydration
- +/- fever (w/pyelonephritis)

Hemogram:
- non-regenerative anemia (early inflammation/renal failure)
- inflammatory leukogram

Chemistry Panel:
- moderate to marked azotemia
- hypocalcemia (CATS)
- increased Phos/Mg (b/c of decreased GFR)
- proportional decrease in Na+ and Cl- with PU (can also be normal/high)
- significantly increased K+ (post-renal obstruction); low K+ (PU renal fail.)
- decreased bicarbonate (metabolic uremic acidosis)
- +/- increased amylase (b/c of decreased GFR)
- +/- hypoproteinemia (glomerular dz= lose ALB)

Urinalysis:
- proteinuria (glomerular vs. tubular); glucosuria (tubular)
- hematuria
- +/- crystals (if stone present)
- +/- pyuria/bacteriuria (w/pyelonephritis)
- +/- USG <1.019 (isosthenuria= 1.008-1.012= NOT functioning at all; need functionally kidneys to dilute/concentrate urine)

Differential Diagnoses:
- Hypoadrenocorticism (Addison’s Disease= similar to oliguric/anuric RF)
- differentiate between oliguric/anuric renal failure (obstruction), chronic renal failure, acute renal failure, pyelonephritis, and glomerular disease
Term
Colic - decreased gut sounds
Definition
• Inflammation + steroid leukogram and echinocytes
• Hyperfibrinogenemia= inflammation
• Increase P, Decrease Ca
• Increase Bilirubin – sepsis
• Increase ALP – from intestine and liver spillover; biochemical cholestasis
• GGT and SDH normal
• Increase AST and CK
• Hyperglycemia, stress
• Abdominal fluid (transudate vs. exudates= sepsis)
Term
Diabetes
Definition
• Increase Glucose, Increase cholesterol.
• Urine glucose +, ketone +
• Heinz bodies, increase liver enzymes
• Fructosamine high -> diabetes not well regulated.
• Ketoacidosis
• Increase P and K because lack of insulin
Term
Diarrhea
Definition
• Dehydration
• Na increases / decreases depending on if electrolyte loss is greater or less then fluid loss.
• Cl increases / decreases- usually decreases
• K decreases, Gl loss. Usually Na/K change proportional.
• Increase bicarbonate – alkalosis b/c acid lost
• Decrease bicarbonate – acidosis – bicarb lost
Watery diarrhea = increase serum electrolytes, run of the mill = proportional, if drinks a lot of H20 could have decrease
Term
Drug effects - anticonvulsants
Definition
Phenobarb.
• PU/PD
• Hepatotoxicity/elevated ALP
• Anemia

KBr: increase in K, Increase in Cl (Br- reads as Cl-!)

Corticosteriods – steroid leukogram (lymphopenia, eosinopenia, monocytosis- dog, mature neitrophilia
• Increase in glucose, increase in cholesterol
• Decrease in Ca, Decrease in P, PU/PD from decrease ADH sensitivity
• Decrease K, increase Na, alkalosis
• Decrease USG (PU/PD)
• Increased ALP in dogs(also in GGT) , potentially increased urea/ BUN (likely more with overt hyperadrenocorticism)
Term
Drug effects - NSAIDs
Definition
• Asprin: GI ulcer/inhibit COX
• Acetaminophen: Heinz body anemia, increase liver enzymes
• Rimadyl, Ibuprofen: decrease platelet function due to anti-prostaglandin effects, renal toxicity due to interference with autoregulation of blood flow (esp. with volume depletion)
Term
Failure of passive transfer
Definition
• Very sick/septic young animal
• Low -normal albumin
• Dehydration
• Decrease globulins
• Decrease GGT because not as much colostrums - ALP in some
Term
Glomerular disease
Definition
• Decrease Albumin and decrease TP
• Increase BUN/creatinine
• Urine – protein in urine
o Decrease antithrombin III – hyper coagulable state
o Increase USG sediment – urine protein : creatinein (0.5-15)
o Edema
o Casts
• Hallmark is increase of protein in urine
• Inflamm. leukogram
Term
Heart failure
Definition
• Increase in total body water. Promote increase in CO
• Decrease Na with CHF w/ diuretics, normal leukogram
• Decrease bicarbonate= acidosis
• Fluid loading status
• Decrease CO/poor perfusion – therefore H2O retention +/- dec. Na
• Increase ADH= retain free H2O not electrolytes
Term
Hyperparathyroidism
Definition
• Increase in total Ca and increase iCa
• Decrease P unless Ca causes renal failure.
Term
Hypoparathyroidism
Definition
• Major decrease in Total Ca, decrease iCa
• Increase P because no PTH to promote renal loss.
• No steroid effects or pancreatitis
Term
Hyperthyroidism
Definition
• older, skinny cat, PP/PU/PD
• Cats T4 increases, increase ALP with cats
• Endocrinopathy causes an increase in liver enzymes
• Glucose increases
• GFR increases
o Hyper kinetic circulation- BP increases
o USG decreases/ PU/PD
o Not usually a decrease in Mg/P.
• Decrease in cholesterol not consistent.
• Often kidney disease is also going on
• Once treat hyperthyroidism, kidney problems may pop up. Check renal throughout treatment.
o Tapazole (methimazole)= tx
• Increase cholesterol (fasted)
• Non reg anemia
• Hypoglycemia rare
• Derm. Signs- alopecia= noninflamm./nonpruritic
Term
Paraneoplastic syndrome
Definition
• Hypercalcemia – PTHrP mostly with lymphoma or anal sac apocrine gland adenocarc.. iCa increases =bio active. Ddx: renal failure with increase in Ca or increase Ca causing renal failure.
• Hypoglycemia : large tumors make insulin like growth factor IGF- drives glu into cells.
• Hyperglobulinemia: monoclonal gamopathy/elaboration of single class of AB multiple myeloma, lymphoma. Bence-Jones proteinuria.
Term
Glomerular vs. tubular
Definition
- Glomerular – large protein/ALB stays in, water, electrolytes, glucose, and smaller protein filter through
o Decreased albumin with marked proteinuria if glomerular dz
- Tubular – water,electrolyte and mineral, glucose and protein/amino acids reabsorbed proximally.
o Disease: electrolytes can go up and down depending on the stage, urine: glucose, protein. If BG greater than 200 – 300 than there was too much glucose for tubules to reabsorb (DM); if blood glucose is normal, tubules should have been able to handle/concerned about renal dysfunction.
o If proteinuria and glucosuria think more tubules, if see proteinuria alone with low albumin, think glomerular disease( especially the more protein that is present)
- Urine sediment
o Blood/WBC or inflammation in urine active sediment) could be coming from the bladder (e.g.) urinary tract infection or upper urinary tract- must localize!
- Azotemia
o Significant tubular problem
o May not see in early glomerular disease
Term
Age related changes
Definition
Young
• Low protein: low ALB due to increased total body water/low globulins b/c immunologically naive
• High body water
• Low USG- immature kidney, watery diet, (milk)
• Increased ALP= bone isoenz.(ALL species)
• Ca/P high- growing
• Increased GGT in 1st week – horses and cows(colostrums)
• Increased bilirubin LA (horse, cow) in 1st week, depends placenta type
CBC – reactive lymphocytes: antigenic stimulation/just vax; Neonate cows can have increased segs
Adult
• Higher TP but will decrease in old age
• Globulins increase with age
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