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Clinical Pathology Final Part 2

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pbhati17's version from 2016-12-03 17:36

Section 1

Question Answer
What are some causes of nonselective dysproteinemia?Dehydration
-all values increase
Hemodilution
-all values decrease
What are some causes of selective dysproteinemia?Inflammation PLN PLE B cell neoplasia Hepatic insuffx
What are the values like in inflammation[Alb] decreased but overall inflammatory dz leads to hyperproteinemia
What are the values like for PLE?proteins entering intx are not being absorbed [Alb] decreased [glob] decreased
What are the values like for PLN?Smaller proteins leak out [Alb] decreased, and smaller proteins leak too
What are the values like in Hepatic insuff?The liver doesn't make all the globulins so only those made in the liver and albumin deccrease
What are the values like in B cell neoplasms?selective increase in just globulins
What are some causes of increases in fibrinogen?Increased fibrinogen prodx due to...
-inflammation
-hemoconcentration ( more of a minor increase)
memorize

Section 2

Question Answer
What are some causes of hypernatremia?1)Decreased H2O intake
2)Pure H2O loss -
Diabetes Insipidus (lack of ADH means poor reabsorption) -
water vapor loss
What are some reasons for hyponatremia?1)Edematous states
2)Hyponatremic dehydration( more Na lost than water)
3)Shifting of water from ICF==>ECF
4)3rd space loss/uroperitoneum
What is the mechanism behind edematous states leading to hyponatremia?Water retention is greater than Na retention
What are some reasons for hyponatremic dehydration?Loss of Na containing water followed by increased water intake
renal retx of water(ADH) -vomx/diarrhea -renal loss(hypoadrenocorticism,prolonged diuresis)
-Sweating in horse
Why would shifting of water from ICF to ECF lead to hyponatremia?It dilutes the Na This happens when hyperglycemia is present
Why would 3rd space loss lead to hyponatremia?shift of Na from ICF to ECF down the concentration gradient
What are some reasons for hyperkalemia?1) Shift of K+ from ICF to ECF(no change in tbK+)
2)Increased tbK+
What would be some reasons for a shift of K+ from ICF to ECF? (hyperkalemia)Metabolic acidosis due to accumulation of inorganic acids(H+ from HPO4, H2SO4, citric acids from renal failure)
Muscle damage
What are some reasons for increased tbK+?Renal failure
Urinary obx
Hypoaldosteronism(Addison's)
uroperitoneum
Increased intake via admin
What are some reasons for hypokalemia?1)Shifting of K+ from ECF to ICF
2)Decreased tbK+
What would be the reason for a shift in K+ from ECF to ICF?Metabolic alkalosis
What would be some reasons for a decrease in tbK+?Anorexia
Increased excretion by kidneys
Vomiting/seq of H+,Cl-
Increased alimentary loss:
vomx,diarrhea,excess salivation
Increased cutx loss: sweating in horses
What are some reasons for hyerchloremia?Same reasons as hypernatremia(water deficit) and Hyperchloremic metabolic acidosi
What is the reason for Hyperchloremic metabolic acidosis?Alimentary loss of HCO3- due to diarrhea
Renal loss of HCO3- due to proximal/distal tubular acidosis
What are some reasons for hypochloremia?Metabolic alkalosis
Metabolic acidosis with an increased anion gap(ketoacids,lactic acids)
What are some reasons for increased bicarb?Loss of H+ from the body
What are some reasons you would lose H+ from the body and thus, end up with increased bicarb?1) Gastric loss due to vomx/pyloric obx
2)Renal loss secondary to resp acidosis
3)Loop diuretics
4)Hypokalemia
What are some reasons for decreased bicarb?1) Buffering of H+ in organic acidosis
2)Decreased renal excretion of H+
3)Increase loss
What are some reasons for decreased renal excretion of H+ leading to decreased bicarb?renal failure
uroperitoneum
urinary tract obstruction
What are some reasons for increased loss of bicarb?Diarrhea
Proximal Tubular Acidosis-type 2
What causes an increased anion gap?Increased levels of...
L-lactate
Ketone bodies
renal failure(PO4,sulfate,citrate)
Ethylene glycol
What causes a decreased anion gap?Hypoalbuminemia
memorize

Section 3

Question Answer
What causes a prerenal azotemia and what USGref do you expect in this situation?Dehydration/shock leading to a decrease in renal blood flow and a decrease GFR ==> decrease clearance leads to azotemia Expect the USGref to be very concentrated or >1.030
What causes renal azotemia and what USGref would you expect in this situation?Renal azotemia is caused by decrease in functional nephrons==>decreased GFR resulting in azotemia A decrease in functional nephrons means we can't concentrate urine==> lower USGref hypo to isosthenuric(<1.007 -1.0013)
What causes post renal azotemia and what USG ref do you expect in this situation?A partial or complete obx causes release of vasoactive substances resulting in constriction of glomerular arterioles==>decreased renal blood blow and decreased GFR Expect a very concentrated/ high USGref since we' have more time to reabsorb water from the urine
What are some reasons for decreased [UN]?1)Disorders that cause decreased urea synthesis
-hepatic insuff
2)Disorders that cause increased renal excretion of urea
-diabetes insipidus
-proximal tubular resorption of urea
3)Protein def
Which USG would NOT be expected in chronic renal failure?CRF mean there's less functional capacity of the kidney meaning it can't concentrate urine resulting in hypostenuria(<1.007)
What are some other potential causes for hyposthenuria?CRF
Diabetes Mellitus
Hypoadrenocorticism
Hyperadrenocorticism
Diabetes Insipidis
Hypercalcemia
Liver Failure
What is the mechanism for polyuria in CRF?Decreased tubular response to ADH due to damaged renal tubular cells==> can't reabsorb fluid
What is the mechanism for polyuria in Diabetes Mellitus?Glucosuria reduces the osmotic gradient so can't reabsorb fluid from tubules
What is the mechanism for polyuria in Hypoadrenocorticism?Persistent hyponatremia/chloremia leads to decreased transport of these solutes leading to decreased medullary tonicity of the LOH
What is the mechanism for polyuria in hyperadrenocorticism?Increased cortisol inhibits ADH secretion
What is the mechanism for polyuria in Diabetes Insipidus?In D.I the tubules don't respond to ADH so less fluid reabsorption
What is the mechanism for polyuria in hypercalcemia?Free Ca2+ interferes with ADH activity
What is the mechanism for polyuria in liver failure?Decreased urea synthesis means decreased urea delivery to the renal medulla and as a result a decrease in response to ADH
What is the indication if you find fine granular, coarse granular epithelial casts in urine?Active tubular degeneration
Diff between uroliths and crystals?Crystals have a definite composition while uroliths/stones do not
What crystals do we find predominantly in acidic urine?Ammonium biurate
bilirubin
Ca oxalate
Cystine Urate/uric acid
Are we worried if we find ammonium biurate crystals in dalmations, english bulldogs, black russian terriers?No they're genx predisposed
What's the indication if we see urate/uric acid crystals?small amounts are healthy If more then hepatic dysfunction dalmations, english bulldogs, black russian terriers are predisposed
What's the concern if we see bilirubin crystalluria?Hemolytic icterus disorders
Cholestatic icterus disorders
What's the indication if we see calcium carbonate crystalluria?common in herbivores
Calcium phosphate crystaluria could be indicative of...hypercalcemia,
UTI
Calcium oxalate crystalluria is indicative of....if it's monohydrate==> rumx diets dihydrate is more indx of ethylene glycol toxicosis
Indication of Magenesium ammonium phosphate crystalluria?Struvites are common in dogs/cats and are due to degredation of urea
memorize

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