Clinical%20Chemistry - PowerPoint PPT Presentation

About This Presentation
Title:

Clinical%20Chemistry

Description:

Clinical Chemistry Clinical Pathology, K. Canga, RVT – PowerPoint PPT presentation

Number of Views:228
Avg rating:3.0/5.0
Slides: 95
Provided by: LoriC150
Category:

less

Transcript and Presenter's Notes

Title: Clinical%20Chemistry


1
Clinical Chemistry
  • Clinical Pathology, K. Canga, RVT

2
Reading and Assignment
  • Laboratory Procedures for Veterinary
    Technicians,pp 75 113
  • Study Guide as desired

3
Sample Collection Handling
  • Most chemical analyses require collection and
    preparation of _____________ samples
  • Whole blood or blood plasma may be used for some
    test methods or with specific types of equipment
  • Do not use __________ ___________ is usually the
    best choice for clinical chemistry samples
  • Most adverse affects on sample quality can be
    avoided by careful sample ___________________ and
    ________________.

4
Sample Collection Handling
  • Specific blood collection protocols vary
    depending on patient ______________, volume of
    blood needed, method of restraint, and type of
    sample needed
  • Collect blood samples for chemical testing
    ______________ beginning treatment.
  • __________________________ samples are preferred
    postprandial samples may produce inaccurate
    results.
  • Label sample tube with _________ and time of
    collection, ______________ (owners and
    patients), and patients ______number.

5
Serum Sample Collection
  • Blood should be collected from __________, fasted
    animal when possible
  • Avoid ________________ by selecting needles of
    the correct size.
  • Place blood in a tube that contains no
    _____________________. (Serum Separator tubes can
    also be used.)
  • Allow blood to clot at room temperature for 20 to
    30 minutes. (If SST used, gently invert before
    clotting)
  • Gently separate clot by _____________ with a
    wooden stick around the inside of the tube.
  • Replace top and centrifuge at 2000 to 3000 rpm
    for 10 minutes.
  • Remove ___________ with a pipette and transfer to
    appropriate container.

6
Factors Influencing Results
  • _______________ may result when a blood sample
    is
  • drawn into a moist syringe
  • drawn in through too __________ of a needle
  • drawn too _____________ in to needle
  • mixed too __________________ after collection
  • forced through a ___________ when being
    transferred to a tube
  • _________________ as a whole blood sample
  • Hemolysis can also occur when excess ____________
    is used to clean the skin and not allowed to dry
    prior to drawing blood.

7
Hemolysis
  • Fluid from ________________ blood cells can
    dilute the sample, resulting in falsely
    ___________ concentrations of constituents
    present in the animal.
  • Certain constituents, normally not found in high
    concentrations in serum or plasma, escape from
    ruptured blood cells, causing falsely elevated
    concentrations in the sample.
  • Hemolysis may elevate levels of _____________,
    organic phosphorus, and certain ______________ in
    the blood
  • Hemolysis also interferes with __________
    activity and ________________ determinations.

8
Factors Influencing Results
  • _________________ contamination collection tubes
    must be chemically pure
  • Improper ______________ label all tubes
    properly.
  • _________________ influences obtain samples from
    a _____________animal
  • Postprandial samples may have increased blood
    ______________ levels and decreased inorganic
    phosphorus.
  • _______________ results in turbid or cloudy serum
  • _________________ assays affected due to increase
    in GFR after eating.

9
Factors Influencing Results
  • Improper Sample Handling complete chemical
    analysis within __________ of sample collection.
  • Do not allow samples to become too _________.
  • Thoroughly mix serum or plasma that has been
    frozen after thawing to avoid ____________________
    gradients.

10
Reference Ranges
  • Reference ranges are a range of values derived
    when a __________________ has repeatedly assayed
    samples from a significant number of clinically
    _____________ animals of a given species using
    specific test methods.

11
Protein Assays
  • Plasma proteins are produced primarily by the
    ___________ , as well as _________________________
    _ tissues, _______________ tissues, and
    ___________ cells
  • Plasma proteins have many functions
  • Form the structural matrix of all ________,
    ___________, and ______________
  • Maintain _________________ pressure
  • Serve as enzymes for biochemical reactions
  • Act as ________________ in acid-base balance
  • Serve as _______________
  • Function in blood ___________________
  • Defend the body against pathogenic microorganisms
  • Serve as _____________/______________molecules
    for most constituents of plasma

12
Protein Assays
  • Total Plasma Protein
  • Total Serum Protein
  • Albumin
  • Globulins
  • Albumin/Globulin Ratio
  • Fibrinogen

13
Protein Assays
  • Total _____________ protein measurements include
    fibrinogen values
  • Total _____________ protein determinations
    measure all the protein fractions except
    fibrinogen.
  • Total protein concentration may be affected by
    altered _____________ synthesis, altered protein
    _________________, and altered protein
    ______________ or excretion, as well as
    _________________ or ____________________.

14
Determination of Total Protein Levels
Refractometric Biuret Photometric Methods
  • Refractometric method measures the refractive
    index of serum or plasma with a
    _____________________________.
  • Refractive index of the sample is a function of
    the concentration of solid particles in the
    sample. In plasma, the primary solids are the
    _______________.
  • Biuret method measures the number of molecules
    containing more than three peptide bonds in serum
    or plasma. (Done via ______________)
  • Note Both techniques are _______________

15
Albumin
  • Albumin comprises 35 to 50 of the total plasma
    _______________ in most animals.
  • Significant _____________________________ is most
    likely caused by albumin loss.
  • ___________ disease, ___________ disease, dietary
    intake, and intestinal protein _______________
    may influence the plasma albumin level.

16
Globulins Complex Group of ______________
  • ____________ globulins are synthesized in the
    ___________ and primarily transport and bind
    proteins.
  • __________ globulins include complement (C3
    C4), transferrin, and ferritin
  • _______________ globulins (immunobulins) are
    synthesized by ___________ cells
  • Concentration is calculated by determining
    difference between total protein and albumin
    concentrations.

17
Albumin/globulin (A/G) ratio
  • Alteration in the normal ratio is frequently the
    first indication of a protein abnormality
  • Determined by dividing the albumin concentration
    by the globulin concentration.

18
Fibrinogen
  • 3 to 6 of the total plasma protein content
  • Most common method of fibrinogen evaluation is
    the heat precipitation test (If you would like to
    know more about this, please reference chapter 2,
    pg 71).

19
Hepatobiliary Assays
  • Liver functions include
  • _________________ of amino acids, carbohydrates,
    and lipids
  • _______________ of albumin, cholesterol, plasma
    protein, and clotting factors
  • ___________________ and ________________ of
    nutrients related to bile formation
  • secretion of ______________, or bile
  • _________________, such as detoxification of
    toxins and ________________of certain drugs

20
Hepatobiliary Assays
  • The __________________ is closely associated with
    the liver, both anatomically and functionally
    its primary function is as a storage site for
    _________.
  • More than 100 different types of tests can be
    used to evaluate liver function
  • Liver disease is usually greatly ________________
    before clinical signs appear.
  • Damage to one _________ of the liver may not
    affect all liver functions.

21
Hepatobiliary Assays
  • Liver function tests are designed to measure
    substances ________________ by the liver,
    modified by the liver, _________________ when
    _________________ are damaged, or those enzymes
    with altered serum concentrations as a result of
    _________________.
  • Liver function tests are usually done with serial
    determinations and several different types of
    liver tests completed to assist in verifying
    functional status.

22
Enzymes Released from Damaged Hepatocytes
  • Alanine aminotransferase (ALT)
  • Aspartate aminotransferase (AST)
  • Sorbitol dehydrogenase
  • Glutamate dehydrogenase

23
Alanine Aminotransferase (ALT)
  • Enzyme found free in the cytoplasm of hepatocytes
  • Considered a ________-specific enzyme in dogs,
    cats, and primates
  • ___________, ruminants, ________, and ___________
    do not have enough ALT in the hepatocytes for
    this enzyme to be considered liver specific
  • Other sources of ALT are _________ cells,
    _____________ muscle, ____________ muscle, and
    the _______________.

24
ALT (contd)
  • Used as a __________________ test for liver
    disease because it is not precise enough to
    identify specific liver diseases
  • Increases are usually seen within _____ hours of
    hepatocyte damage and peak levels in 24 to 48
    hours
  • Serum levels will return to reference ranges
    within a few weeks unless _____________ liver
    damage is present.

25
Aspartate Aminotransferase (AST)
  • Found free in the cytoplasm of hepatocytes and
    bound to the __________________ membrane.
  • Levels tend to rise more ___________ than ALT and
    return to normal levels within a day if chronic
    liver insult is not present
  • Found in __________________ amounts in many other
    tissues, including _______, cardiac muscle,
    ____________ muscle, ______________, and pancreas

26
AST (contd)
  • Increased blood level may indicate
    _______________ liver damage or be caused by
    strenuous exercise or intramuscular injection
  • Assess _________ ____________ activity to rule
    out muscle damage before attributing an AST
    increase to liver damage.

27
Sorbitol Dehydrogenase
  • Found in liver, kidney, small intestine, skeletal
    muscle, and RBCs
  • Especially useful for evaluating liver damage in
    ___________ animals such as ________, ________,
    _________, ___________, and ____________.
  • Plasma level rises __________ with
    ___________________ damage or ____________.
  • Assays can be used in all species to detect
    hepatocellular damage or necrosis
  • Tests not readily available to average vet. lab.

28
Glutamate dehydrogenase
  • Mitochondrial-bound enzyme found in high
    concentrations in the hepatocytes of cattle,
    sheep, and goats
  • No standardized test method has been developed
    for use in a veterinary practice laboratory

29
Enzymes Associated with Cholestasis
  • Alkaline phosphatase (AP)
  • Gamma glutamyltransferase (GGT)

30
Alkaline Phosphatase (AP)
  • Present as isoenzymes in _________________ in
    bone, and as ___________________ in cartilage,
    intestine, placenta, and cells of the
    hepatobilary system in the liver.
  • Isoenzymes of AP remain in circulation for
    approximately 2 to 3 days, with the exception of
    intestinal isoenzyme, which circulates for just a
    few hours.
  • A corticosteroid isoenzyme of AP has been
    identified in dogs with exposure to increased
    endogenous or exogenous __________________________
    ____.

31
AP (contd)
  • Source of an isoenzyme or location of the damaged
    tissue is determined by electrophoresis and other
    tests performed in commercial or research
    laboratories.
  • In older animals, nearly all circulating AP comes
    from the ___________ as _________ development
    stabilizes.

32
AP (contd)
  • Assay in a practice laboratory determines the
    total blood concentration.
  • Concentrations used to detect _________________
    in adult dogs and cats
  • Not a useful test for detecting cholestasis in
    cattle and sheep because of wide fluctuations in
    ____________blood levels in these species.

33
Gamma glutamyltransferase (GGT)
  • Also called gamma glutamyltranspeptidase
  • Primary source is ____________
  • Also found in _________ , _____________, and
    _____________,epithelia, as well as in the
    kidneys, pancreas, intestine, and muscle cells
  • Cattle, horses, sheep, goats, and birds have
    ___________blood activity than dogs and cats
  • Blood level is evaluated with liver disease,
    especially _________________disease.

34
Hepatocyte Function Tests
  • Bilirubin
  • Bile acids
  • Cholesterol
  • Others (dye excretion, ammonia tolerance,
    caffeine clearance)

35
Hepatocyte Function Tests
  • Evaluated substances are taken up, modified,
    produced, and/or secreted by the liver, primarily
    _____________ and __________ acids other tests
    include albumin, ammonia, and cholesterol.

36
Bilirubin
  • Derived from the breakdown of ___________________
    by macrophages in the _____________
  • Measurements of the circulating levels of these
    various populations of bilirubin can help
    pinpoint the cause of _______________.
  • Assays can directly measure _________ bilirubin
    (____________ bilirubin plus ________________
    bilirubin), and _______________ bilirubin

37
Bilirubin (contd)
  • Blood levels of _______________ bilirubin are
    elevated with _________________ damage or bile
    duct injury/obstruction
  • Blood levels of ___________________ bilirubin are
    elevated with excessive erythrocyte
    __________________ or defects in the transport
    mechanism that allow bilirubin to enter
    hepatocytes for conjugation.

38
Bile Acids
  • Aid in ______ absorption and modulate cholesterol
    levels
  • Synthesized by hepatocytes from cholesterol and
    conjugated with glycine or taurine
  • Conjugated bile acids are secreted across the
    _______________ membrane and reach the duodenum
    by the biliary system
  • Gallbladder stores ________ acids (except in the
    ___________) until contraction associated with
    feeding.

39
Bile Acids (contd)
  • Any process that impairs the hepatocellular,
    biliary, or portal enterohepatic circulation of
    bile acids results in elevated serum levels.
  • Serum level is normally ______________ after a
    meal because the gallbladder has contracted and
    released increased amounts of _______ into the
    __________________.
  • Paired serum samples performed after 12 hours of
    fasting and 2 hours postprandial are needed to
    perform the test.
  • Difference in concentration of the samples is
    reported
  • Only a single sample is tested in horses.

40
Bile Acids (contd)
  • Inadequate ______________ or spontaneous
    ___________________ contraction can increase
    fasting bile acids prolonged fasting and
    _______________ decreases bile acids
  • Most commonly used method for determination of
    bile acids is an enzymatic method measured by
    machine
  • Bile acid test that uses immunologic methods
    (ELISA) is available for use in the veterinary
    clinic.

41
Cholesterol
  • Produced primarily in the __________ and ingested
    in food.
  • _________________ causes an increase in serum
    cholesterol in some species
  • Some automated analyzers provide cholesterol and
    other lipoprotein values
  • Fluoride and oxalate anticoagulants may
    ______________ enzymatic method results

42
Cholesterol (contd)
  • Assay is sometimes used as a screening test for
    ________________________
  • _______________ hormone controls
    _________________ and _____________________ of
    cholesterol in the body
  • Other diseases associated with hypercholesterolemi
    a include _____________________________,
    _______________ ____________, and nephrotic
    syndrome.
  • Administration of ____________________ may also
    cause an elevated blood cholesterol concentration.

43
Other Tests of Liver Function
  • Dye excretion bromsulfophthalein excretion and
    indocyanine green excretion tests require
    administration of a dye that binds to a protein
    in serum.
  • Ammonia tolerance any condition that reduces the
    uptake of ammonia or conversion of ammonia to
    urea can lead to increased plasma ammonia
    concentration.
  • Caffeine clearance test used in human medicine
    few experimental studies have been performed in
    canine species.

44
Kidney Assays
  • Kidney functions
  • _______________ or ____________water and
    electrolytes in times of imbalance.
  • Excrete or conserve _________ ions to maintain
    blood _______ within normal limits.
  • Conserve ________________
  • Remove end products of ______________ metabolism
  • Produce renin, _______, and prostaglandins
  • Lower blood pressure
  • Regulate acid secretion in the stomach
  • Aid in regulation of body temperature and
    platelet aggregation
  • Aid in vitamin D activation

45
Kidney Assays
  • Kidneys receive blood from the _________
    arteries blood enters the ________________ of
    the ______________where nearly all water and
    small dissolved solutes pass into the collecting
    tubules.
  • Each nephron contains sections that function to
    ______________ or ____________specific solutes.
  • Resorption of glucose occurs in the _______
  • Secretion and reabsorption of mineral salts
    occurs in the ascending limb of the loop of
    __________ and in the __________.

46
Kidney Assays (contd)
  • Nephron has a specific reabsorptive capability
    for each substance called the ____________________
    _____.
  • Blood returns from the _____________ to the rest
    of the body through the renal __________, which
    connect to the caudal ___________ ___________.
  • _____________ and ___________ may be analyzed to
    evaluate kidney function.

47
Kidney Assays (contd)
  • Primary serum chemistry tests for kidney
    function ____________________ and
    ______________.
  • Other tests are designed to evaluate the rate and
    efficiency of __________________ filtration.

48
Blood Urea Nitrogen (BUN)
  • Also called serum urea nitrogen
  • Urea is the principal end product of
    __________________ breakdown in mammals.
  • Urea passes through the glomerulus and enters the
    renal tubules
  • Approximately __________ the urea is reabsorbed
    in the tubules and the remainder excreted in the
    urine
  • If the kidneys do not remove sufficient urea from
    the plasma, BUN levels _________________.
  • Contamination of the blood sample with
    urease-producing bacteria may result in
    decomposition of urea and decreased BUN levels.
  • Staphylococcus aureus, Proteus spp. and
    Klebsiella spp.

49
BUN (contd)
  • Several photometric tests are available to
    measure urea nitrogen
  • _________________ results in increased retention
    of urea in the blood (_______________)
  • High-______________ diets and strenuous exercise
    may cause elevated BUN levels because of
    increased _____________________ breakdown.

50
Serum Creatinine
  • Formed from creatine found in ____________ muscle
    as part of muscle metabolism
  • Creatine diffuses out of muscle cells and into
    most body fluids, including ___________
  • Amount of creatine metabolized to creatinine
    usually remains _______________, as does blood
    level of creatinine
  • Total amount of ______________ is a function of
    the animals total muscle mass.

51
Creatinine (contd)
  • Serum creatinine is filtered through the
    _______________ and eliminated in urine
  • Any condition that ___________ glomerular
    filtration rate alters serum ____________ level
  • Nearly ____ of kidney tissue must be
    _________________ before blood creatinine levels
    rise.
  • __________________ decreases in creatinine occur
    from transient increase in glomerular filtration
    rate after a meal.

52
Creatinine (contd)
  • Increased serum creatinine levels are seen when
    there is a lack of functional _______________
  • Serum creatinine concentrations are influenced
    by
  • Fluid and _______________ levels
  • _____________ factors, such as shock
  • _________________ factors, such as bladder and
    urethral obstructions
  • Used to evaluate __________________ function

53
BUN/Creatinine Ratio
  • Both measurements have a wide range of reference
    intervals
  • Used in human medicine for diagnosis of renal
    disease
  • BUN and creatinine have an ___________
    logarithmic relation.

54
Urine Protein/Creatinine Ratio
  • Mathematical method that compares urine
    ______________ level with urine
    _____________________ levels in a single urine
    sample
  • 5 to 10 mL of urine collected via
    ________________________.
  • Sample is centrifuged and ____________________
    used to determine both concentrations for each
    sample by photometric methods.

55
Pancreas Assays
  • The pancreas has both ______________ and
    _________________ functions.
  • Pancreatic endocrine function involves production
    of ____________ and ___________. Diabetes
    mellitus, or a deficiency of ___________
    resulting in hyperglycemia, is the most common
    endocrine disorder of the pancreas.
  • Pancreatic exocrine function involves the
    production of ____________, _____________, and
    ____________. Most pancreatic disturbances occur
    in the exocrine function of the pancreas.
    ___________ seem to have a greater incidence than
    ____________.

56
Pancreas Assays
  • Exocrine pancreas also referred to as the acinar
    pancreas.
  • Secretes enzymes necessary for ____________ into
    the small intestine
  • Primary pancreatic enzymes are trypsin, amylase,
    and lipase
  • Trauma to pancreatic tissue is often associated
    with pancreatic duct ____________________ that
    results in a back-up of digestive enzymes into
    peripheral circulation.

57
Pancreas Assays
  • Endocrine Pancreas interspersed within the
    exocrine pancreatic tissue are the __________ of
    _________________
  • Four types of islet cells present designated as
    a(_________), ß(__________), d(________), and
    ____ cells.
  • Delta and PP cells comprise less than 1 of the
    islet cells and secrete somatostatin and
    pancreatic polypeptide, respectively.
  • Beta cells comprise approximately _____ of the
    islet cells and secrete _____________.
  • 20 consists of alpha cells that secrete glucagon
    and somatostatin.

58
Pancreas Assays
  • Diseases of the pancreas may result in
    inflammation and cellular damage that causes
    leakage of ______________ enzymes or insufficient
    ___________________ or ___________________of
    enzymes.
  • Primary ______________ pancreas tests are amylase
    and lipase trypsinlike immunoreactivity and
    pancreatic lipase immunoreactivity

59
Amylase
  • Primary source is the pancreas, but also produced
    in the ______________ glands and small intestine.
  • Increases in serum amylase are nearly always
    caused by pancreatic disease (_________________),
    especially when accompanied by increased lipase
    levels
  • ______________, intestinal obstruction, or
    intestinal ___________________may also result in
    increased serum amylase from increased absorption
    of intestinal amylase into bloodstream.

60
Amylase (contd)
  • Animals have a greater serum amylase activity
    level than humans (___ times greater in dog and
    cat) so it is recommended to dilute the serum
    with normal saline before testing if using tests
    designed for human samples.
  • ______________, ________________, and calcium
    cheleating anticoagulants will affect results.

61
Lipase
  • Nearly all serum lipase is derived from the
    ____________________.
  • Excess lipase is normally filtered through the
    ________________, so lipase levels tend to remain
    normal in the early stages of pancreatic disease.
  • Increased lipase is also seen in ___________
    failure, hyperadrenocorticism, dexamethasone
    treatment, and bile tract disease.
  • Manual methods for testing are cumbersome, easier
    to use automated or SNAP test.

62
Trypsinlike Immunoreactivity (TLI)
  • Considered the test of choice, TLI is highly
    specific and sensitive in detecting
    __________________ insufficiency in dogs.
  • Radioimmunoassay using antibodies to trypsin that
    can detect both trypsinogen and trypsin
  • Antibodies are species specific
  • Trypsin and trypsinogen are produced only in the
    pancreas
  • Serum TLI decreases in parallel with functional
    pancreatic mass
  • Decreased _____________filtration rate increases
    TLI
  • Important to fast animal for ___ hours prior to
    collecting sample.

63
Serum Pancreatic Lipase Immunoreactivity (PLI)
  • Serum feline PLI is specific for
    ___________________ and is recommended instead of
    the previously validated serum feline TLI to
    diagnose cats with symptoms of pancreatitis.
  • Cats must also be fasted for ___ hours prior to
    drawing blood sample.

64
Pancreas Assays
  • Endocrine Pancreas Tests
  • Primary test is blood __________ others
    include fructosamine, beta-hydroxybutyrate,
    glycosylated hemoglobin, serum cholesterol, and
    triglyceride

65
Glucose
  • Pancreatic islets respond directly to blood
    glucose concentrations and release ____________
    (from the beta cells) or ______________ (from the
    alpha cells) as needed.
  • Blood glucose level is used as an indicator of
    _____________________ metabolism in the body and
    as a measure of _________________ function of the
    ________________.
  • Some tests for blood glucose react with only
    glucose, whereas others may quantify all sugars
    in the blood.

66
Glucose (contd)
  • Ideally, samples should be taken from an animal
    that has been fasted for ___ to ___ hours
    (ruminants should not be fasted)
  • ____________ is preferred
  • It is essential to centrifuge sample and transfer
    serum to another tube immediately because blood
    continues to use glucose at a rate of 7 to 10
    per hour if allowed to remain in contact with the
    serum or plasma.

67
Glucose (contd)
  • _______________________ may result from
    ______________ ____________, or any of several
    nonpancreatic causes such as stress and
    hyperadrenocorticism (_____________ disease)
  • Diagnosis of diabetes mellitus is not made
    unless _________________ accompanies
    hyperglycemia.
  • _______________________ may result from
    malabsorption, severe liver disease, or prolonged
    contact of the _________ or _________ with the
    cellular component of blood.

68
Fructosamine
  • Represents irreversible reaction of glucose bound
    to protein, particularly _____________.
  • Increased fructosamine indicates persistent
    ____________________.

69
Glucose Tolerance Test
  • Sometimes referred to as glucose curve
  • Challenge the pancreas with a glucose load and
    measure ___________ effect by blood or urine
    glucose concentrations used to rule out
    __________ ____________.
  • IV test is preferred over oral because oral test
    is affected by abnormal intestinal function such
    as ______________ or hypermotility, and
    excitement.

70
Glucose Tolerance Test (contd)
  • Glucose is injected after a 12- to 16-hour fast
    (except in ruminants)
  • Blood glucose is subsequently checked and
    progress mapped as a tolerance curve.
  • Results are standardized as disappearance
    half-lives or glucose turnover rates expressed as
    percent/minute

71
Insulin Tolerance Test
  • Probes causes of diabetes mellitus
  • Serum glucose levels are measured in blood
    samples obtained before __________ injection
    (fasting blood glucose) and every ___ minutes
    after injection for __ hours.

72
Other Endocrine Pancreas Tests
  • Glucagon tolerance indicated when repeated
    borderline results are obtained.
  • Insulin/glucose ratio involves simultaneous
    measurements in a fasting animal.
  • Miscellaneous tests of insulin release glucose,
    epinephrine, leucine, tolbutamide, or calcium
    challenges may be attempted.

73
Other Endocrine System Assays
  • Adrenocortical Function Tests
  • Thyroid Assays
  • Pituitary Function Tests

74
Adrenocortical Function Tests
  • Brain or pituitary ___________ leading to
    secondary bilateral adrenal ____________,
    idiopathic adrenal hyperplasia, or neoplasia may
    cause excessive ____________ release and
    _________________________. (Cushings disease)
  • Misuse of _________________________ is the most
    common cause of cortisol excess.
  • ___________________________, (Addisons disease)
    includes mineralocorticoid deficiency, which does
    not occur in iatrogenic disease from rapid
    withdrawal of _________________________.

75
Adrenocortical Function Tests (contd)
  • Addisons disease also may result from Lysodren
    (Rx for adrenal hyperplasia) or from
    ____________________ causes.
  • Dogs with nonadrenal disease such as diabetes
    mellitus, liver disease, or renal disease may
    have false-positive results
  • _________________________ hormone (ACTH) and
    _____________ concentrations may be a helpful
    diagnostic aid in differentiating primary
    (adrenal-dependent) from secondary
    (pituitary-dependent) hypoadrenocorticism.

76
Adrenocortical Function Tests (contd)
  • Measurements taken as _____________ data and
    compared with data obtained from challenge to the
    adrenal gland with ACTH or dexamethasone.
  • Low to undetectable ACTH concentrations occur in
    secondary Addisons disease, whereas normal (or
    increased) concentrations are expected in primary
    Addisons disease.
  • Refer to pp 100-101 in your textbook for
    step-by-step instructions on performing ACTH
    stim. and Dex. suppression tests!

77
Thyroid Assays
  • Baseline thyroxine (T4) concentrations are used
    diagnostically, but normal values vary
    dramatically
  • Semiquantitative immunologic tests are available
    to measure T4 concentrations
  • ________ response test is used on small animals
    (except _________________ cats) and horses and
    provides a reliable diagnostic separation of
    patients with normal versus abnormal thyroid
    function.

78
Thyroid Assays (contd)
  • Free T4 test measures the fraction of thyroxine
    not bound to protein levels are less influenced
    by nonthyroidal diseases or drugs than are total
    T4 concentrations.
  • Triiodothyronine (T3) suppression test based on
    the expected ____________________ regulation of
    TSH induced by high concentrations of
    circulating thyroid hormone.

79
Pituitary Function Tests
  • Diagnosis of canine ______________ may be based
    on documentation of elevated ____________ hormone
    (GH).

80
Electrolyte Assays
  • Electrolytes negative ions, or ___________, and
    positive ions, or ___________, of elements found
    in all body fluids of all organisms.
  • Functions of electrolytes include
  • maintenance of ________ balance,
  • fluid ____________ pressure, and
  • normal ___________ and ____________ functions.
  • Also function in the maintenance and activation
    of several enzyme systems and in acid-base
    regulation
  • Acid-base status depends on _________________ and
    should be interpreted together.

81
Electrolyte Assays
  • ___________, ______________, ____________, and
    ________________ are the four electrolytes in
    plasma.
  • Minerals of importance are __________,
    _____________, and ______________.
  • These two groups together are often simply called
    ________________

82
Electrolyte Assays
  • Calcium
  • Inorganic Phosphorus
  • Sodium
  • Potassium
  • Magnesium
  • Chloride
  • Bicarbonate

83
Calcium
  • Do not use _______, _________, or _________
    anticoagulants to collect calcium samples for
    testing because they bind with calcium and make
    it unavailable for assay.
  • ___ of the bodys calcium is in _________.
  • Remaining calcium maintains __________________
    excitability and tone, acts as an enzyme
    activator, plays a role in _____________ , and
    helps in transport of ions across cell membranes.
  • Serum calcium levels vary with serum protein and
    albumin levels (these levels should be
    _____________ with increased serum calcium)

84
Calcium (contd)
  • ______________________ seen with
    hyperparathyroidism, excessive vitamin __ intake,
    bony ______________.
  • ______________________ seen in malabsorption,
    ____________, pancreatic necrosis,
    hypoalbuminemia, hypoparathyroidism,
    gastrointestinal __________ or blockage in
    ruminants, postparturient ________________ in
    cow, bitch, ewe, and mare.

85
Inorganic Phosphorus
  • Most phosphorus in whole blood is found within
    the RBCs as _______________ phosphorus
  • Phosphorus in plasma and serum is _____________
    phosphorus and is the phosphorus assayed in the
    laboratory
  • Plasma or serum phosphorus and calcium
    concentrations are _____________ related as
    phosphorus concentrations decrease, calcium
    concentrations ___________.
  • ___________________ samples should not be used
    because organic phosphorus liberated from
    ______________ may be hydrolyzed to inorganic
    phosphorus, which results in a falsely ______
    inorganic phosphorus concentration.

86
Inorganic Phosphorus
  • ______________________________ may be seen in
    renal failure, ________, excessive vitamin __
    intake, ethylene glycol poisoning, and
    hypoparathyroidism.
  • ______________________________ may occur in
    primary hyperparathyroidism, ____________________,
    inadequate intake, hyperinsulinism,
    _____________________, lymphosarcoma,
    hyperadrenocorticism

87
Sodium
  • Most abundant ______________ cation that plays a
    major role in the distribution of ___________ and
    the maintenance of _____________ pressure of
    fluids in the body.
  • If ________ is retained, _____ is retained.
  • Sodium heparin should not be used as an
    anticoagulant because it may falsely _____
    results.

88
Sodium (contd)
  • _______________________ is rare unless the animal
    is deprived of ________.
  • _______________________ is quite common and is
    seen in such conditions as ________ failure,
    __________, or diarrhea use of diuretics
    excessive ____ congestive heart failure water
    toxicity or excessive ________ administration.

89
Potassium
  • Major _______________ cation important for
    normal _______________ function, nerve impulse
    transmission, and ________________ metabolism.
  • __________ levels are so ____ that measurement of
    serum potassium does not give much information
    about the bodys potassium levels.
  • ___________ is the preferred sample because
    platelets may release potassium during the
    clotting process (elevating K levels).
  • ______________ releases potassium into plasma
    (elevating K levels).

90
Potassium (contd)
  • ______________________ will be seen in adrenal
    cortical hypofunction, ____________, or
    late-stage ________ failure.
  • ______________________ will be seen in
    ____________, ____________ therapy, or excess
    fluid _________ due to diuretics, vomiting, and
    diarrhea.

91
Magnesium
  • Functions to activate _____________ systems and
    involved in production and decomposition of
    acetylcholine
  • __________ and ________ are the only domestic
    animals that show clinical signs related to
    magnesium deficiencies.
  • Imbalance in __________ -_____________ ratio can
    lead to muscle _________ in cattle and sheep
  • Anticoagulants other than ___________ may
    artificially decrease results
  • ________________ may elevate the results through
    liberation of magnesium from RBCs

92
Chloride
  • Predominant ________________ ion.
  • Functions in maintenance of _______ distribution,
    ____________ pressure, and the normal
    ________/_________ ratio.
  • Concentration is regulated by the ___________.
  • There is a close relationship between ________
    and ___________ levels
  • ______________ may affect test results by
    diluting the sample with RBC fluid

93
Chloride (contd)
  • _______________________ may be due to metabolic
    ___________ or renal tubular acidosis
  • _______________________ may be due to excessive
    ___________ , anorexia, ________________, or
    diabetes insipidus, or may accompany hypokalemia.

94
Bicarbonate
  • Second most common __________ of plasma.
  • Functions in the bicarbonate/carbonic acid
    __________ system and aids in the transport of
    ____ from the tissues to the lungs.
  • Kidney regulates bicarbonate levels in the body
    by excreting excesses after it has ____________
    all that it needed.
  • Levels are frequently estimated from blood carbon
    dioxide levels (___________ blood best)
  • Bicarbonate level is approximately ___ of the
    total carbon dioxide measured.
Write a Comment
User Comments (0)
About PowerShow.com