1
Q
Chemistry
Interference Factors
A
- Hemolysis
- Icterus
- Lipemia
2
Q
Albumin
Function
A
- Produced in liver
- Maintains osmotic pressure (keeps fluid within vascular system)
- Transports certain molecules (Calcium)
3
Q
Albumin
Increased
A
Hyperalbuminemia
* fluid has decreased
* dehydration
4
Q
Albumin
Decreased
A
Hypoalbuminemia
* decreased synthesis by liver
* loss from kidney disease (check for proteinuria)
* hemorrage or GI loss (if globulin also decreased)
5
Q
Globulins
A
Alpha and Beta
* made in liver
* acute phase proteins
Gamma
* made by plasma proteins (B lymphocytes)
* immunoglobulins (think antibodies)
* most common
6
Q
Globulin
Increased
A
Hyperglobulinemia
* inflammation / infections
* neoplasia
* tick-borne diseases
* HW disease
* dehydration (if albumin also increased)
7
Q
Globulin
Decreased
A
Hypoglobulinemia
* immunodeficiencies
* inherited
* failure of passive transfer
* FeLV / FIV
* hemorrage or GI loss (if albumin also decreased)
8
Q
Liver Enzyme
Functions
A
Leakage Enzymes
* inside the cell
* increase when damage to cell
Cholestatic Enzymes
* outside the cell
* found within biliary tract
9
Q
ALP and ALT
in Cats
A
Both have a shorter half life in cats
* if it goes up, it will come down very quickly
* if elevated liver values, there is a major issue (it went up super high and is now at the level being seen)
10
Q
ALT
A
- Liver-specific
- Leakage enzyme
- Enzyme free within hepatocyte cytoplasm - leakage from damage
11
Q
AST
A
- Liver
- Leakage enzyme - hepatocyte damage
- Skeletal muscles - IM injections and exercise
- Erythrocyte hemolysis
12
Q
AST
Increases
A
Only elevates with severe liver disease
* if elevated, check for hemolysis and creatine
13
Q
APL
Enzyme Type
A
Cholestatic
* with many isoenzymes
14
Q
ALP
Locations
A
- Hepatobiliary (liver)
- Bone / Cartilage
- Steriods
15
Q
ALP
Elevations
A
Young Animals
* bone developement
Older Animals
* cholestasis
* osteosarcoma
Steriods (dogs only)
Drugs (phenobarbital)
16
Q
GGT
A
- Cholestatic enzyme
- Liver (biliary)
- If elevated, biliary in nature
- Elevates with obstructive liver disease
17
Q
Bilirubin
A
- Produced from breakdown of hemoglobin
- Elevated due to hepatic damage - bilirubin unable to be secreted into bile after being conjugated
- In IMHA, see this increased because there is so much RBC breakdown, liver can’t keep up
18
Q
Bile Acid
A
- Synthesized in liver, stored in gallbladder
- Stimulated by meal to help breakdown fat
- Elevates with liver disease, PSS, and cholestasis
19
Q
Bile Acid Testing
A
- 12 hour fast
- Collect sample
- Feed high fat meal (wait 2 hours)
- Collect sample
20
Q
Bile Acid Testing
Normal Results
A
- Before Meal: low levels
- After meal: slightly elevated but WNL
21
Q
Indicators of Normal Liver Function
A
- Protein (albumin)
- Cholesterol
- Glucose
- BUN
if all are low alongside liver elevations
22
Q
BUN
A
Protein waste product removed by kidneys
23
Q
BUN
Elevated
A
Pre-renal
* Dehydration
* High protein diet
Renal
* Actual kidney disease causing elevation
Post-renal
* Any type of obstruction
75% of kidney function gone
24
Q
BUN
Decreased
A
Contamination of blood with bacteria
* refrigerate sample
* assess quickly
25
Creatinine
Produced from skeletal muscle metabolism
* function of total body muscle mass
26
Creatinine
Increased
* Dehydration
* Renal disease
* Obstruction
| 75% of kidney function gone
27
Creatinine
Decreased
Total muscle mass loss
* levels may look normal or start to normalize because of loss, and kidneys not needing to work as hard
28
USG Change
Not observed until at least 66% of kidney function is gone
29
SDMA
Elevations
Seen when >25% of kidney function is gone
* early indicator of kidney dysfunction
* not affected by other outside factors
30
USG Concentration
Hypersthenuria
* Term not used often
* Dogs: >1.030
* Cats: >1.035
* Decreased water intake
* Dehydration
* Increased urination
31
USG Concentration
Moderately Concentrated
* Dogs: 1.013 - 1.029
* Cats: 1.013 - 1.034
* Normal function as long as hydrated normally
* Inapproriate kidney response if otherwise dehydrated
32
USG Concentration
Isosthenuria
* 1.008-1.012
* Same as GRF and Plasma
* Going out same as it came in
* If azotemia / dehydration: renal dysfunction (retest to get repeated values)
* If normal hydration: inappropriate response, but should be retested
33
USG Concentration
Hyposthenuria
* <1.008
* Kidneys are working, but are just not able to concentrate for whatever reason
* Can be appropriate with primary polydipsia
* Diabetes
* Pyometra
* Pyelonephritis
* Steroids or Diuretics
* Hypercalcemia
* Liver failure
34
UPC Use
Quantitative assessment of renal proteinuria
* can indicate glomerular disease
* normal <1
35
Amylase
* From Pancreas primarily (salivary glands, small intestine)
* Breakdowns starches and glycogen
36
Amylase
Increases
Degree of elevation does not equal severity of disease
* Pancreatic disease (especially if >3x upper reference range)
* Kidney disease (excreted by them)
37
Lipase
* Primary sourse: pancreas
* Breakdowns long-chain fatty acids of lipids
38
Lipase
Elevation
Degree of elevation not equal to severity of disease
* Pancreatic disease
* Kidney and Liver disfunction
* Steriods
39
Trypsin
* Produced exclusively in pancreas
* Enzyme important for protein breakdown
* Normally detected in feces (should be there)
* Run TLI to get serum levels
40
TLI
Increases
Check Cobalamin and Folate levels
* Pancreatitis (normal range does not rule this out)
* Renal dysfunction (excreted by kidneys)
* Small intestine disease in cats
41
TLI
Decreased
Pancreas not making enough trypsin
* EPI
* Weight loss
* Polyphagia
* Diarrhea
* Secondary to chronic pancreatitis
* See a lot with GSD
42
PLI
Specific tests that are organ specific (no interference from extrapancreatic sources)
* do when TLI increased to get better diagnosis
* normal PLI does not rule out pancreatitis
43
PLI
Increased
* Pancreatitis
* Renal dysfunction (excreted by kidneys) - not sure if significant or not
* Potentialy from steroids, but unclear
44
PLI
Decreased
Does not rule out pancreatitis
45
Sodium
Most important cation of extracellular space
* around the cells
* helps with water distribution and osmotic pressure
* relationship with chloride (follows)
46
Sodium
Increased
Hypernatremia
* Water loss: dehydration, diabetes
* Sodium gain: NaCl ingestion (sea water), IV of hypertonic saline solutions
* If chronic changes - must decrease slowly
47
Sodium
Decreased
Hyponatremia
* Water gain: too much IV administration of dextrose in water
* Sodium loss: GI disease, renal loss, hypoadrenocorticism (Addison's)
* Treat with saline infusion
48
Potassium
Most important cation of intracellular space
* inside the cell
* important for muscle / cardiac/ nerve function
49
Potassium
Increased
Hyperkalemia
* Acute renal failure
* Urinary bladder rupture
* Metabolic acidosis
* Hypoadenocorticism (Addison's)
50
Potassium
Decreased
Hypokalemia
* Diuretics
* CKD in cats
* GI loss
* Metabolic acidosis
* IVF >24 hr without supplementation
51
Potassium
Toxic Effects
Potential myocardial toxic effects
* life-threatening disorder when increased
52
Chloride
Close relationship with Sodium
53
Calcium
* All cells require this to function
* Maintains neuromuscular function and many enzymes
* Facilitates blood coagulation
* Inverse relationship with Phosphorus
54
Calcium
Increased
Hypercalcemia
* hyperparathyroidism
* neoplastic osteolytic metastasis
* Hypervitaminosis D
* Paraneoplastic Syndrome (LSA, ASA)
55
Calcium
Decreased
Hypocalcemia
* associated with hypoalbuminemia
* CKD
* hypoparathyroidism
* vitamin D deficiency
* malabsorption
* small breeds nursing large litters
56
Phosphate
Increased
Hyperphosphatemia
* see in young, growing animals
* renal disease
* dehydration
* hypoparathyroidism
* look for hemolysis (organic phosphorus found in RBCs)
57
In-House Microbiology
* Separate room with limited traffic
* Ventilation hood
* Adequate light
* Easy and washable floor and surfaces
* At least 2 work areas
* Incubator
* Separate fridge
* OSHA is VERY strict
58
Sample Collections
Collect early in disease process, before antimicrobial initiation
* if already on antimicrobials, collect sample just before next dose (lowest antimicrobial concentration will be present)
59
Gram Stain +
Cell walls composed of peptidoglycan
* retains crystal violet stain (primary)
* bacteria will appear purple
60
Gram Stain +
Bacteria
* Streptococcus
* Staphlyococcus
* Listeria
* Corynebacterium
61
Gram Stain -
Cell wall composed of double-lipid layer
* decolorized in order to accept the safranin/counter stain (secondary)
* bacteria stains pink
62
Gram Stain -
Bacteria
* Salmonella
* Proteus
* E. Coli
* Klebsiella
* Pasteurella (cat abscess)
* Pseudomonas
* Borrelia burgdorferi (weakly)
* Bartonella (cat scratch fever)
* Brucellosis
63
Acid - Fast Stain
* Ziehl-Neelson Stain
* Detects mycobacterium and nocardia species
* If stains remains, it's positive (bright pink/red)
* If stains remove, it's negative (blue/ green)
64
Microbiology
Culture Timing
Plates should incubate for 18-24 hours
* examine for growths
* negative after 3 days
65
Culture Media Types
* Transport
* Enriched
* Selective
* Differential
* Enrichment
66
Culture Media Types
Transport
Preserves organism
67
Culture Media Types
Enriched
Basic nutrient media with extra nutrients added
* formulated
68
Culture Media Types
Selective
Inhibit / kill all but a few bacteria
69
Culture Media Types
Differential
Indicators present
* allow to differentiate between the various organisms
* based on their biochemical reactions
70
Culture Media Types
Enrichment
Favor growth of a particular group of organisms
71
Blood Agar
Media
Enriched
* nearly anything will grow on it
Differential
* induces hemolysis
72
Blood Agar
Hemolysis
* Alpha: partial (only where organism is growing)
* Beta: complete (where organism is growing and surrounding area)
* Gamma: no change
73
MacConkey Agar
Use
Selective and Differential media
* gram (-) grows
* gram (+) doesn't grow
* determines if organism is able to ferment lactose (turns media red)
74
Thioglycollate Broth
Use
Enrichment and Differential liquid media
* encourages fastidious / specific bacteria to grow
* can differentiate between anerobic and aerobic by reaction to broth in test tube and where it grows
75
Antimicrobial Sensitivity Testing
* Do after bacterial isolation
* Determines susceptibility / resistance to antimicrobial drugs
* Culture and Sensitivity / Identification
76
Bacteria Oxygen Requirements
Main
Obligate Aerobes
* require oxygen to survive
Obligate Anaerobes
* killed / inhibited by presence of oxygen
Facultative Anaerobes
* can survive with or without oxygen
* generally do better without oxygen
77
Bacteria Temp Requirements
Mesophiles
* grow best at 20-40 C / 68-104 F
* all bacteria pathogenic to animals
Psychrophile
* grows best below 20 C
Thermophile
* grows best above 40 C
78
Bacterial Spores
Resistant parts created by bacteria
* don't stain well
* where spore is located on bacteria determines the species
79
Coliforms vs Non-Coliform Bacteria
Coliforms
* natural inhabitants of GI tract
* E. Coli, Salmonella
* cause secondary opportunistic infections
Non-Coliforms
* "3 P's and 2 B's"
80
Pasteurella spp.
* Non-coliform bacteria
* Gram -, rods
* Cat-bite abscess
81
Pseudomonas spp.
* Non-coliform bacteria
* Gram -, rods
* Environmental contaminant
* Gets into ears - causes resistant ear infections
* Creates grean culture on blood agar
* Very smelly
82
Proteus spp.
* Non-coliform bacteria
* Gram -, rods
* Common with UTI
* Also gets into wounds
* Swarms cultures
83
Fungus
Mold Form
* plant-like shapes
* very small
* dermatophytes most common
Yeast Form
* single-cellular organisms
* bud to reproduce
84
Dermatophytes
Saprophytic (grow on dead things / cells)
85
# Dermatophyte
Microsporum canis
* Zoophilic (find on other animals)
* Very zoonotic and contagious to other animals
* "Cigar-shapes"; thicker membranes with 6+ compartments inside
86
Microsporum canis
87
# Dermatophyte
Microsporum gypseum
* Geophilic (find in environment; in soil)
* Not as zoonotic
* Thin-walled cells; <6 compartments inside
88
Microsporum gypseum
89
# Dermatophyte
Trichophyton mentagrophytes
* Zoophilic (find on other animals)
* Anthropophilic (find with humans)
* Form "cigar-shapes" but globoid shapes are main colonies
90
Trichophyton mentagrophyte
91
Dermatophyte Testing
* Collect hair around lesion or use new toothbrush to brush hair
* Put sample on DTM culture
* Look for color change and growth happening at same time
* Once this is seen, do tape prep of colony and look under microscope
* Determine if indeed ringworm and what type
92
Aspergillus
* Environmental contaminant
* Affects respiratory / sinuses of dogs
* Invasive: destroys sinus bone
* Non-invasive: forms blockage
93
Aspergillus
94
Malassezia
* Yeasts
* Skin and ear issues
* Do not need a culture to diagnose, just cytology
95
Dimorphic Fungi
2 Forms: Yeast vs Mold
* "mold in cold": cold environments; infectious and allows to get into body and forms into yeast form
* "yeast in beast": find in warm areas on animal; forms actual disease process
96
Dimorphic Fungi
Sending Samples to Lab
Lab needs to be alerted of potential sample
* biohazard sample
* need to be cautious and grow sample in correct way to avoid contamination to staff and environment
97
Blastomyces
* Dimorphic fungi
* Found in river valleys
* "Broad Based Buddings"
* Cutaneous and Pulmonary Form
98
Blastomyces
99
Histoplasma capsulatum
* Dimorphic fungi
* Found worldwide in soil
* Pulmonary disease in dogs and cats
* GI disease in dogs
* Small organisms in large macrophages
100
Histoplasma capsulatum
101
Cryptococcus neoformans
* Dimorphic fungi
* Associated with pigeon droppings
* Upper respiratory and CN disease
* Narrow-base budding
* Pendulous attachment
* Thick capsule
102
Cryptococcus neoformans
103
Coccidioides immitis
* Dimorphic fungi
* Found in desert
* Cause respiratory disease
* May disseminate and cause other diseases
* Large, thick-walled with a lot of different yeast inside
104
Coccidioides immitis
Blood II
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