Clinical Chemistry 3

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Clinical Chemistry 3
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2011-11-27 15:00:49
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Clinical Chemistry Bel Rea Unit Clin Chem Vet Tech
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Clinical Chemistry Bel Rea Unit 3 COMPLETE
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  1. Enzymes
    formed and function intracellulary thus we should see decreased levels in the blood. Exist in specific cells/tissues/organs thus increased levels in the blood indicates a problem with that specific cell/tissue/organ
  2. 3 reasons for increased enzyme levels in the blood
    • 1. Leap out of damaged or dying cells
    • 2. Increased production (i.e. growth)
    • 3. Blockage of excretory route
  3. Measure of enzmye activity is in ___________
    IU - international units
  4. __________ and ___________ can interfere with results of enzyme tests
    • Hemolysis
    • Lipemia
  5. Liver functions
    • Protein synthesis (albumin, clotting proteins)
    • Metabolism of carbs, proteins, lipids, and drugs
    • Cholesterol synthesis
    • Bile synthesis
    • Detoxification of blood (converts ammonia to urea)
  6. Liver enzymes
    • ALT
    • AST
    • Alk Phos
    • GGT
    • Bilirubin
  7. ALT
    • Alanine aminotransferase. Routine test
    • Dogs, cats, primates --> major source is hepatocytes. Liver specific enzyme
    • Horses, ruminants, pigs --> NOT liver specific
  8. Increased ALT
    • Liver disease
    • Hepatic trauma
    • Neoplasia
    • Long term use of certain drugs (steroids, NSAIDs)
  9. Decreased ALT
    Cirrhosis (Liver failure)
  10. AST
    • Asparate aminotransferase
    • NOT liver specific (in hepatocytes, RBCs, cardiac muscle, skeletal muscle, kidneys, and pancreas)
  11. Increased AST
    • Liver disease
    • Hepatic trauma
    • Neoplasia
    • Long term use of drugs
    • Strenuous exercise
    • IM injection
    • Cardiac disease
  12. ALP
    • Alkaline Phosphatase (ALKP, Alk Phos, ALK)
    • Made by hepatobiliary cells and osteoblasts/chondroblasts
    • Not reliable in sheep and cattle because it fluctuates
  13. Increase Alk Phos
    • HBO
    • Drugs
    • Bone injury
    • Bone tumors
    • Young patient - bone growth
  14. GGT
    • Gamma glutamyltranspeptidase
    • Not used much in dogs or cats
    • Good large animal indicator of liver function. Primary source in large animals is hepatocytes
  15. Increased GGT
    Liver disease - usually obstructive
  16. Bilirubin
    • T. Bili
    • Light sensitive
    • On most routine panels
  17. Increased I. bili
    Hemolysis
  18. Increased D. bili
    liver disease
  19. CHOL
    • Cholesterol
    • On most routine panels.
    • Synthesized by liver. Also comes with food. Synthesized by many cells
  20. Hypercholesterolemia
    • HBO (Chol component of bile)
    • Hypothyroidism (thyroid hormones play role in breakdown of Chol)
    • Steroids
    • DM, pancreatitis, obstructive liver disease
  21. Hypocholesterolemia
    • Liver failure (can't synthesize)
    • Prolonged anorexia/starvation
  22. TP
    • Total Protein
    • Includes TP, albumin, and globulin
    • On most routine panels
    • SERUM protein is lower then PLASMA because it's missing clotting proteins
  23. Alb
    • Albumen
    • Synthesized by liver
  24. Glob
    • Globulins
    • Alpha and Beta are synthesized by liver. Gamma is synthesized by lymph and are the most abundant in the body
  25. Hypoalbuminemia
    • Liver disease
    • Protein losing enteropathy (like parvo)
    • Protein losing nephropothy (abnormal filtration in glomerulus)
    • Prolonged anorexia/starvation (decreased intake)
  26. Hyperglobulinemia
    Immune response
  27. Hypoglobulinemia
    • Liver disease/failure (no production)
    • Immunosuppression (decreased gamma)
  28. Kidney functions
    • Regulate H2O balance
    • regulate electrolytes
    • regulate blood pH
    • excrete non-protein nitrogenous wastes (BUN, creatinine)
    • Synthesize renin
    • Synthesize EPO
    • Conserve nutrients like glucose and protein
  29. BUN
    Blood, Uria, Nitrogen
  30. Decreased BUN
    • liver disease/failure (unable to convert ammonia to urea)
    • young animals (anabolic and high H2O intake)
  31. CREA
    • Creatinine
    • Non-protein nitrogenous waste product from muscle cells
  32. Increased CREA
    • Pre-renal azotemia
    • Primary renal azotemia
    • Post renal azotemia
  33. Decreased CREA
    Diuresis
  34. Bun, CREA, USG used to diagnose and classify _________________
    Azotemia
  35. Pancreas functions
    Exocrine and Endocrine functions
  36. Exocrine functions
    • Digestive enzmes:
    • Amylase
    • Trypsine
    • Lipase
  37. Endocrine functions
    • Hormones
    • Insulin ( decreases bood glucose, drives it into cells)
    • Glucagon (increases blood glucose. Glycogen = stored glucose in liver --> glucose)
  38. GLU
    • Glucose. On most routine panels
    • Measures endocrine function of the pancreas. Separate serum or plasma ASAP becauseglucose decreases by 10% every hour
  39. Hyperglyecmia
    • DM (lacks insulin)
    • Post-prandial
    • Stress, fear, excitement, restraint
    • Pancreatitis
    • Hyperadrenocorticism
  40. Hypoglycemia
    • Liver failure (decreased glycogen storage)
    • Prolonged anorexia/starvation
    • Jeuvenile hypoglycemia
    • Insulinoma (overproduction of insulin)
    • Insulin overdose
  41. Amylase/lipase test
    • run together. Amylase is difficult to interpret results because of large range of valuse and short half life.
    • Pancreatitis --> increased in both
    • Normal lipase = NOT pancreatitis
  42. Increased lipase
    • DM
    • duct obstruction
    • steroid treatment
  43. Increased amylase
    • acute pancreatitis
    • obstructed duct
    • renal failure
    • dcreased excrection by the kidney
  44. CK
    Creatine Kinase. Produced by striated muscle (skeletal and cardiac)
  45. Increased CK
    • CK leaks into blood when muscle is damaged:
    • IM inject.
    • Sx
    • Lacerations
    • Bruising of muscle
    • Paralysis
    • Electric shock
    • Vigorous exervise
    • Saddle thrombus (cats)
    • Mylopathies
  46. Na+
    Sodium
  47. Sodium
    • regulated by aldosterone
    • released by renal tubules
    • sodium in, potassium out
    • Regulates H2O balance, H2O follows Na
  48. Hyponatremia
    • Decreased Sodium
    • Decreased intake (salt deficiency in herbivores)
    • Dilution (overhydration, edema)
    • Increased loss (V/D, Addison's disease, diuresis, chronic renal failure)
  49. Hypernatremia
    • Increased sodium
    • Water loss (dehyrdration)
    • Increased intake (salt poisoning)
  50. K+
    Potassium
  51. Potassium
    • Regulated by aldosterone
    • Released by renal tubules
    • Na in K out
    • Muscle function
    • Increased K --> bradycardia --> death
  52. Hypokalemia
    • Decreased Potassium
    • Decreased intake
    • Increased loss (V/D, diuresis, chronic renal failure)
  53. Hyperkalemia
    • Increased potassium
    • Decreased loss (Acute renal failure, urinary tract obstruction/rupture, Cushing's disease)
    • Cellular redistribution (Acidosis, decreased insulin levels - DM)
    • Artifacts (Hemolysis - K is component of RBC membrane)
  54. Cl-
    Chloride
  55. Chloride
    • Closely associated with Na+
    • Tends to follow Na+
    • Component of many secretions (tears, sweat, saliva, HCl in stomach)
  56. Hypochloridemia
    • Decreased chloride
    • Decreases with hyponatremia
    • Vomiting (HCl loss)
    • Diuresis
  57. Hyperchloridemia
    • Increased chloride
    • Increases with hypernatremia
    • Relative increase varies inversely with HCO3
    • Diarrhea (HCO3 loss, Cl left behind)
  58. Mg++
    Magnesium
  59. Magnesium
    • 50% bone, 50% blood
    • function of enzymes
    • plays role in break down of acetylcholine
  60. Hypomagnesemia
    • Dietary deficiency
    • Grass Tetany
  61. Ca++
    Calcium
  62. Calcium
    • parathyroids --> parathormone (PTH) --> acts on renal tubules
    • Keep Ca, ditch Phos
    • 99% in bone, 1 % in blood
    • Blood coagulation, maintains neuromuscular exibility and tone
  63. Hypocalcemia
    • Decrease calcium
    • Hormonal imbalance (hypoparathyroidism,parathyroidectomy)
    • Increased utilization (exlampsia, ethylene glycol intoxication)
  64. Hypercalcemia
    • Increased calcium
    • Hormonal imbalance (hyperparathyroidism, lymphosarcoma)
    • Bony lessions (multiple myeloma, osteosarcoma)
  65. Phos
    Phosphorous
  66. Phosphorus
    • 80% in bone, 20% in blood
    • plays a role in energy storage, release, and transfer
    • ATP
    • CHO metabolism
    • Part of nucleic acids (DNA, RNA)
    • Component of phospho-lipids
  67. Hyperphosphatemia
    • Increased Phos
    • Decreased excretion (renal failure - decreased filatration, urinary obstruction)
    • Decreased loss (Hormonal balances that affect calcium)
    • Artifact (Hemolysis - phospholipid bilayer)
  68. Hypophosphatemia
    • Decreased Phos
    • Decreased intake
    • Increased loss (Hormone imbalances that affect calcium - hyperparathyroidism)
  69. TCO2
    Total CO2
  70. Decreased TCO2
    • Metabolic Acidosis
    • Renal Disease
    • Ketosis/Diabetic Ketoacidosis
    • Lactic Acidosis -
    • -Heart failure
    • -shock
    • -colic
    • -pneumonia
    • -extreme exercise
    • Poisoning
    • Diarrhea
  71. Increased TCO2
    • Metabolic Alkalosis
    • Vomiting
  72. Blood Gas Analysis
    Used to diagnose Acid base imbalance and hypoxia
  73. Acid/Base analysis uses __________ blood and tests ________
    • venous
    • pCO2
  74. PCO2
    • Partial pressure of CO2 (Dissolved CO2 in plasma)
    • Helps measure alveolar ventilation (how well O3 and CO2 are being exchanges across alveoli)
  75. Increased PCO2
    • Hypercapnia (hypercarbia)
    • Respiratory Acidosis
    • Decreased alveolar ventilation (CO2 is building up in blood, not leaving blood stream across alveoli)
    • Causes can be anesthesia
  76. Decreased pCO2
    • Hypocapnia (hypocarbia)
    • Respiratory alkalosis
    • Increased alceolar ventilation (too much CO2 is leaving blood stream)
    • Causes are panting and hyperventilation
  77. pO2
    • Partial pressure of O2 (dissolved O2 in plasma)
    • Does NOT measure total O2 in blood (O2 hooked to hemoglobin)
    • Destermines O2 saturation of HgB
  78. Normal pO2
    • 100 mmHg breathing room air. Dissolved O2 in plasma (not hooked to anything)
    • O2 sat: 95-97% of Hgb has O2 hooked onto it
  79. Increased pO2
    • Increased O2 sat: 98-100%
    • Causes are breathing gases with increased O2 concentration
    • Anesthesia
    • 100% O2, O2 cage, mask
  80. Decrease pO2
    • Decrease O2 sat.
    • Hypoxis (decrease O3 in blood, decreased O2 getting to tissue)
  81. Hypoxia testing uses ________ blood
    Arterial
  82. Hypoxia
    • Decreased pO2
    • Decrease O2 sat
    • Increased reduced Hgb
    • Cyanosis
  83. Blood gas analysis diagnose ___________ and ___________
    • Hypoxia
    • acid/base imbalances
  84. What kind of syringe is used to perform a blood gas analysis
    3 cc syring with a 22 or 25 gauge needle, coated with heparin
  85. How much blood is drawn for a blood gas analysis
    0.5-1.5 ml
  86. Arterial sites
    • Femoral artery
    • Dorsal metatarsal artery
    • Lingual artery
  87. Venous blood reflects the _______________
    metabolic state at tissue level
  88. Blood gas analysis sample is good for _________ at room temperature and ________ if immersed in an ice bath
    • 15-30 min
    • 2 hours
  89. Metabolic acidosis
    • Decreased pH
    • Decreased HCO3
    • Diabetic ketoacidosis
    • Lactic acidosis
    • Diarrhea
    • Renal insufficiency
    • hypoadrenocorticism
    • Oral intake of ammonium chloride, ethylene glycol, methanol, salicylate
  90. Respiratory acidosis
    • Decreased pH
    • Increased pCO2
    • Decreased alveolar ventilation
    • primary lung disease
    • airway obstruction
    • chest wall disease
    • pleural space disease
    • medistinal disease
    • diaphragmatic hernia
    • neuromuscular disease
    • cardiopulmonary arrest
  91. Metabolic alkalosis
    • Increased pH
    • Increased HCO3
    • Vomiting
    • hyperadrenocorticism
    • exogenous steroid therapy
    • potassium deplteting diuretic therapy
    • bicarbonate therapy
  92. Respiratory alkalosis
    • Increased pH
    • Decreased pCO2
    • hypoxemia
    • sepsis
    • fever
    • pain

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