*WIP* Final study guide Lab procedures

on


 FINAL exam study stuff

Module 1

  • Lab safety

    • OSHA stuff

  • Secondary label container stuff

    • Moving chem from primary container to another one, label it properly with hazard label and pictogram

  • PPE stuff

    • OSHA says you get it for free from ur job

  • Chemical hygiene policy

    • Nuances & how to use PPE and chemicals

Module 2

  • Veterinary lab and equipment

    • Centrifuges-> purpose is to separate things of different densities

      • Microhematocrit

        • Holds capillary tubes

      • Swing arm

        • Tube holders that swing out Heat builds up at high speeds, and when they return to normal position there can be mixing

      • Angled

        • Fixed at 52 degrees can be run faster than swing arms, fixed tube sizes, can have adapters

    • If you run centrifuge too fast or too long you can rupture cells

    • Too short or to slow improper separation

  • Sediment= heavier component that settles to the bottom

  • Supernatant= liquid component that remains above

  • Refractometer

    • Measures degree of refraction or bending of light rays as they pass through a medium of one density into a medium of  a different optical density

      • Used for USG and total protein in plasma (total solids eh)

  • Microscopes

    • Compound light most commonly used

      • Ocular lens system located in eye piece

      • Objective lenses, usually 3-4 of em

        • Start on the lowest objective lens you have

      • If you want total magnification---> magnification times ocular lens magnification (next to eye)

      • Substage condenser

        • Focuses light from the light source onto an object can adjust it by raising or lowering it

      • Apiture (????) diaphragm

        • Opens and closes to control the amount of light illuminating an object on the microscope

  • Dilution formulas (weak from strong)

    • V1*C1=V2*C2

      • V1 and C1 is volume and concentration you START with

  • Dilution factors are used to correct for having to use a diluted sample in a blood test

    • So the number you get from the machine after diluting you multiply by the factor that you diluted it

    • So blood test times dilution I guess

  • Lab errors

    • Preanalytic errors

      • Specific to the patient biologic or non biologic like handling

    • Analytic errors

      • Issue by the equipment itself

    • Post analytic error

      • Data entry and record keeping

  • Know which WBC are granulocytes or agranulocytes

Granulocytes (neutrophils, eosinophils, basophils)

Agranulocytes

Granulocytes, granulocyte colony stimulating factor & granulocyte ...

 

 



 

  • Hematology and hematopoiesis

  • Erythropoiesis, granulopoeisis and normal WBC and RBC

    • Formation of WBC and RBC and what they look like

  • Erythropoiesis is…

    • The formation of erythrocytes

  • Megakaryopoiesis

    • The formation of platelets

  • Granulopoiesis

    • Formation of neutrophils, eosinophils and basophils (the granulocytes)

  • Lymphocytopoiesis

    • Formation of lymphocytes

  • Hematopoiesis

    • Happens in the bone marrow, formation of blood cells

      • If happens in bone marrow it's called medullary hematopoiesis

      • If happens elsewhere it's called extramedullary hematopoeisis

  • Places that active cellular marrow persists in adult animals…

    • The ENDS of long bones and flat bones

    • Humerus and radius (long

    • Sternum, ribs pelvis, vertebrae (flat)

  • Changes in cells as they grow

    • As blood cells are born and mature they become smaller, they nucleus becomes smaller, cytoplasm gets larger, chromatin becomes more dense and less delicate, nucleoli disappear, perinuclear clear zone disappears as well

  • Features of WBC and how they function

  • How WBC responds to disease

  • CBCs

  • Include the following

      • Erythrogram

        • RBC count, hematocrit, hemoglobin concentration, RBC indices, MCV, MCH, MCHC, platelet count

          • RBC count= amount of RBC in a volume of blood

          • Hematocrit (the way the machine calculates the percentage)= percentage of a specific volume of blood that consists of RBC so PCV

          • Hemoglobin concentration= concentration of the blood in the blood of a RBC protein that carries oxygen from the lungs to the tissues

          • RBC indices= set of values that describe the size of the RBC & concentration of hemoglobin within them

          • Platelet count= number of platelets in a volume of blood

      • leukogram

        • Total WBC count WBC differential

      • Blood film eval

      • Total protein from blood chem

     

    • Ways WBC can change in a CBC

    • Module 3

      • How as blood cells mature they name changes

      • Stem cell--->blast cell--->procyte-->-cyte-->metacyte--->mature cell

        • Youngest to oldest list

      • Words used to describe things happening inside of cells

        • Howell Jolly bodies

          • Small piece of nucleus left behind  in RBC while the nucleus was being extruded

          • Usually found in basophilic erythrocyte

        • Reticulocyte

          • Important stage in maturation of RBC

          • Stage in formation of erythrocyte, this stage can also be called basophilic erythrocyte or polychromatophil

            • If stained with new methylene blue will make the reticulocyte show up and is called reticulocyte

            • Used to diagnose the regenerativeness of anemia 

            • If body is hypoxic (decrease in oxygen), stimlates kidneys to produce more erythropoeitin which acts on bone marrow to stimulate erythropoeitin

        • Mature erythrocytes have no DNA or RNA If your dog, cat or person

      • Rouleau normal in horses

        • Coin stacks

      • Birds and reptiles have nRBCs

      • Megakaryocyte is LARGEST cell in the bone marrow

        • Stays in bone marrow

        • Pieces of it will become platelets

      • Largest cell in peripheral blood is monocyte

      • Platelets/Thrombocytes

        • Fragments of cytoplasm of the megakaryocytes has no nucleus but has some granules

      • Appearance of the types of WBCs

        • Seg neutrophils

          • Single nucleus divided into distinct segments/lobes

          • Cytoplasm is light blue to pink

        • Band neutrophil

          • Horse shoe shaped  nucleus

          • Slightly young neutrophils

        • Eosinophil

          • Present in low numbers in peripheral blood

          • Has many reddish-orange granules

        • Basophils

          • Rarely seen in peripheral blood but if you do see it, it has dark blue granules

        • Lymphocytes

          • Very round

          • Coarse clumped nucleus with a very small amount of cytoplasm

          • Slightly smaller than neutrophils

          • Nucleus is usually off to the side of the cell

          • Chromatin coarse and clumped

        • Monocyte

          • Blue/grey cytoplasm with MANY vacuoles

          • Largest!

          • Nuclear chromatin not clumped

      • Neutrophils are the most common WBC in all common domestic species besides ruminants, rats and mice

        • Lymphocytes are the largest in numbers for ruminants, rats, and mice

          • Some lymphocytes are formed in the bone most are formed in lymphoid tissue

          • 2nd most common in peripheral blood of most species

      Module 4

      • How granulocytes move in vascular system

      • Different pools of em

        • Circulating pool

          • Pool seen on the blood smear

        • Marginal pool

          • Sticks along vessel walls

        • Reserve pool

          • Stays in the bone marrow getting ready to be pushed out when needed

      • Granulocytes can move between circulating and marginal pool, perform their actions in tissues

        • CAN'T RETURN TO BLOOD ONCE THEY ENTER TISSUES THEY ARE LOST FROM THE TISSUES

      • Different functions of each of the granulocytes

        • Neutrophils

          • First responders that phagocytize bacteria

        • Eosinophils

          • Work and become important with parasite, allergies and immune complex diseases

        • Basophils

          • Inflammatory responses, acute and chronic allergic diseases

      • Functions of agranulocytes (WBC)

        • Lymphocytes

          • T lymphocytes

            • From thymus, formed in thymus involved in cell mediated immunity, destruction of antigen via cytotoxic effects

            • Toxic to the target cells

            • Kill other cells

          • B lymphocytes

            • Found in bone marrow and gut associated lymph tissue (lymph tissue in intestinal tract)

            • Involved in humoral immunity they produce antibodies that float around the humors of ur body and destroy antigens

        • Monocytes

          • Migrate to tissues to become macrophages which phagocytize dead or damaged cells or debris, esp large particles like fungi and protozoa

      • Leukocyte (WBC) responses

        • Increase in numbers

          • Granulocytes have the -philia and the agranulocytes have the -cytosis

            • Neutrophilia, eosinophilia, basophilia, lymphocytosis, monocytosis, thrombocytosis

        • Decreases in numbers

          • All end in -penia

            • Neutropenia, eosinopenia, basophilia, lymphocytopenia, monocytopenia, thrombocytopenia

        • Components of the leukogram

          • Total WBC count

          • Leukocyte differential

          • Absolute leukocyte counts

            • Absolute vs relative values

              • Absolute is absolute number of each WBC type in a volume of blood

              • Relative is percentage of each type of WBC in the total WBC count

                • Percents

            • For calc absolute value

              • Divide amount you found of each cell type by the NUMBER of cells you looked at and multiply that by your total WBC count

                • Ex. You looked at 100 WBC, 90 were neutrophils, 7 were lymphocytes and 3 were eosinophils

                • To find absolute and relative neutrophil count u would divide ur neutrophil count (90) by  100 you counted and multiply by the total WBC count the MACHINE GIVES YOUUU

          • Blood smear (to look for abnormalities)

        Module 5

        • Left shift=when there are immature neutrophils present in circulation

          • Compensated left shift

            • Neutrophilia with mature neutrophils still outweighing the immature neutrophils

          • Non compensated left shift (more immature, or normal neutrophil with immature present, neutropenia with any neutrophils present)

            • Neutrophilia you have more immature cells than mature. When you have a normal neutrophil count or decreased neutrophil count with any immature cells present.

        • Changes in leukocyte populations

        • Left shift is hallmark of leukogram due to INFLAMMATION

          • Inflammatory leukogram

            • If you have a left shift, that’s usually due to inflammation and is called above

          • Toxic neutrophils seen when there's inflammation due to..

            • Infectious process that’s having a systemic effects

            • Characterized by cytoplasm that has Dohle bodies, vacuoles, is more blue than usual/has blue granules

        • Leukograms can be changed when steroids are in play in the body

          • Due to increase in them or because they were given to pet as medication

          • Stress leukogram

            • When it occurs and some things happen due to the effect of steroids or stress

        • Sequestration of neutrophils

          • Only occur during anaphylaxis or endotoxic shock

            • Happens when neutrophils in circulating pool suddenly become part of marginal pool and stick to the sides of the blood vessels

        • Different causes in changes of WBC populations

          • Causes of neutrophilia (increase in neutrophils)

            • Excitement, stress, inflammation

          • Causes of neutropenia (decrease in neutrophils)

            • Excessively utilized, when they production is decreased or they sequestered

          • Eosinophilia

            • Due to parasites and allergies

          • Eosinopenia

            • Due to stress and steroids

          • Lymphopenia

            • Due to stress and steroids

          • Lymphocytosis

            • Due to cancer or adrenal gland disease (not enough steroids) or illness causing prolonged immune system stimulation

              • Physiologic causes of lymphocytosis

                • In really young animal or if pet experiences fear or excitement at time of blood draw

  • Module 6

    • Abnormalities of WBC

    • Abnormalities of RBCs

    • Buffy coat

      • Pale section that has the most WBC between PRBC and plasma

        • PRBC are at bottom

      • Can make smear of buffy coat to look for abnormalities of WBCs

    • Variation of forms of lymphocytes we can see

      • Reactive lymphocytes

        • Have dark blue cytoplasm

        • More likely to have perinuclear clear zone than normal small lymphocytes

      • Atypical lymphocytes

        • Larger than neutrophil

        • Nucleus may be clefted or indented

        • Dark blue cytoplasm

      • Lymphoblasts

        • We try to identify in blood films or mass aspirates because they mean cancer usually if there are a lot

        • Largest

        • Chromatin are less clumped

      • Normal small lymphocyte

        • Small amount of light blue cytoplasm

        • Smaller than neutrophil

        • "moon" of cytoplasm

        • Nucleus moved to the side

    • Spleen important for removing older damaged RBCs

      • Spleen has these reticuloendothelial cells in the sinusoids that do the above

    • In most species exercise, fear, excitation increase the total RBC count, PCV, and hemoglobin concentration most likely due to splenic contractions

      • Most marked in horses b/c they have big ass splenic reserve of rbcs

    • Reticulocytes (younger RBCs stained with new methylene blue) are NOT found in the blood of healthy horses, sheep, & goats

      • Can be found in small numbers in dogs, cats, pigs and rodents

        • If reticulocytes are increased and the animal is anemic we are worried about regenerative anemia

    • Roulax

      • Normal in horses

      • Due to electric charges on the RBC surface

      • If there is marked formation in dogs, cats and pigs they prolly have issues with the formation of RBCs

    • Agglutination

      • 3D clustering of RBCs due to linkage of antibodies on the surface of RBCs

      • Can be seen grossly or w/microscope

      • Can be seen with IMHA or w/immune disorders

    • Heinz bodies

      • Can be seen with hemolytic anemias and toxicities

        • Tylenol toxicity

    • nRBCs

      • Seen with anemia due to lead poisoning

      • If we see a lot CONCERN

    • Spherocytes

      • RBCs that lack the central area of paleness

      • Happens a lot with IMHA

      • Results from the binding of antibodies to the RBC surface and the removal of the portion of the cell membrane  and the macrophages in the spleen

    • Howell Jolly bodies 

      • Basophilic remnants of nuclear material

    • Basophilic stippling

      • Blue staining basophilic granules in the cytoplasm of RBC

      • Due to abnormal accumulation of RNA due to defective erythropoiesis

      • Can also be seen with lead poisoning

    • Anisocytosis

      • Variation of RBC size

    • Poikilocytosis

      • Variation of RBC morphology

    • Polychromasia

      • Variation of RBC color

      • Ex: blood with increased polychromatophils (younger RBCs/erythrocytes) will lead to blood population that has lots of colors

    •  Hypochromasia (decrease in color of RBCs)

      • When there's iron deficiencies anemia

      • Hemoglobin give RBCs their color & hemoglobin can't be formed without iron

    • Schistocytes

      • Irregularly shaped fragments of RBCs

    • RBC indices

      • MCV is avg size of RBC

        • v=volume

          • If low (microcytic) RBC are smaller than normal

          • If high Macrocytic RBC are larger than normal

          • Normocytic RBC are normal size

      • MCHC and MCH

        • H=hemoglobin

        • Deals with color

        • Hemoglobin concentration

      • MCHC

        • Avg concentration of hemoglobin in a RBC

          • Normochromic= normal hemoglobin content

          • Hypochromic= less than norm hemoglobin content

          • Hyperchromic=

      • MCH

        • Avg amount of hemoglobin by weight in a blood sample

        • Not done as often tbh

        • Measures the change of color in the RBC

    Module 7

    • Anemia

      • Deficiency in blood O2 carrying capacity due to a decrease below normal in either number in RBC, hemoglobin concentration or both

        • Happens when the rate of RBC loss or destruction exceeds the rate of RBC production

      • Aplastic anemia

        • Due to decreased production of RBCs

          • Bone marrow cant regenerate

      • Anemias of chronic disease fit into this category

        • Non regenerative

          • Most common form is anemia of chronic disease

          • Usually due to suppression or decreased production of erythropoietin (which stimulates RBC production)

      • Hemolytic Anemia

        • Anemia due to RBC destruction

        • Things that cause this: parasites, toxins, metabolic disorders, immune mediated disorders and some infections that attack RBCs

      • Increased loss of RBC anemia due to acute or chronic blood loss (or increased destruction)

        • Due to hemolysis which happens secondary to parasites, toxins & immune disorders

      • If there's not enough of something it can either be increased destruction/use or loss, decreased production or

      • Chronic vs acute blood loss

        • Chronic

          • Can be secondary to parasites, GI bleeding, bleeding tumors

            • Usually microcytic, hypochromic & regenerative

              • Small, pale RBC and bone can respond

            • Iron reserves are depleated & hemoglobin decreased

            • You'll see nRBCs and reticulocytes

        • Acute

          • Trauma and Sx

            • Normocytic, normochromic, nonregenerative

              • Not bone marrows fault but blood loss is causing anemia, it takes bone a few days to respond tbh

              • Will initially be nonregenerative but bone will respond later

      • Reticulocyte counts in anemic patients

        • Reticulocyte counts are a good indication of the effectiveness of bone marrow activity and regeneration

        • Look at 5 oil fields at 100 power

      • Can get uncorrected count but you have to correct for the anemia

        • Multiply OG number from uncorrected count by PCV of your patient DIVIDED by normal PCV

          • 35 normal for cats

          • 45 normal for dogs

        • Regenerative is OVER ONE

        • Ex: if you get a quick estimate reticulocyte count for a dog and get 30

          • Uncorrected count is 3%

          • If patient is anemic ur corrected count is 2%

          • Then u determine the type of anemia

      Module 8

      • Hemostasis

        • Primary

          • Vasoconstriction-->platelet adhesion-->platelet activation-->platelet aggregation

            • Results in temporary hemostatic plug

          • Disorders of primary include…

            • Von Willebrand's disease

              • Von willibrands factor is important for platelet adhesion (it facilitates that)

            • Immune mediated thrombocytopenia

            • Thrombopathia

          • Tests of primary

            • Buccal mucosal bleeding time

              • Time it takes for the blood to clot

            • Plasma von willebrand's factor levels

            • Platelet count

        • Secondary

          • Process of stabilizing the platelet plug by the formation of fibrin

          • Involves coagulation cascades which ends with the formation of fibrin

          • Formation of fibrin is the result of entire cascade of reactions that occurs

            • Coagulation cascade

          • Disorders of secondary…

            • Rodenticide toxicities 

            • Hemophilias

          • Tests of secondary

            • PT

              • Needs citrated plasma (BTT)

              • Evaluated extrinsic & common pathways of coagulation cascade

            • PTT

              • Needs citrated plasma (BTT)

              • Evaluates intrinsic and common pathways

            • ACT

              • Requires blood tube that has diatomaceous earth (Grey top tube)

              • Evaluates extrinsic and common pathways of coagulation cascade

      • Things that go into making blood clot

      • Deficiencies or disruptions in coagulation factors

        • Called hemophilia (coagulant deficiencies)

      • Anticoagulant rodenticides toxicities

        • Affects specific coagulation factors (Vit K dependent coagulation factors)

          • 2,7,9,10

        • Cause disorders of secondary hemostasis

      • Disorders of anticoagulation

        • Usually from DIC or Thrombosis

          • So blood clots are forming too much or arent broken down appropriately

      • Anticoagulant rodenticide

        • Affect intrinsic, extrinsic & common pathways of the coagulation cascade & prolong PT/PTT

       

      • Petechiation

        • Small red to purple spots caused by bleeding into the skin

      • Thromboembolism

        • Obstruction of a blood vessel by a clot

      • Thrombosis

        • Combination of platelets, fibrin & cellular debris that form within the vasculature

      • Hemarthrosis

        • Bleeding into a joint

      • Ecchymosis

        • Discoloration of the skin due to bleeding underneath or bruising

      • Epistaxis

        • Nasal bleeding

      • Fibrinolysis

        • Dissolution of a clots fibrin by plasma as healing occurs

      • D-dimer tests (if done)

        • Levels of clot degradation

          • You can tell if clots are breaking up appropriately if ur D-dimer levels are increased

      • Spontaneous bleeding occurs at platelet counts LESS 20-30,000

      • How to perform quick estimate of platelet count

        • You look at avg number of platelets in 5-10 oil immersion fields

          • Should be 8-15 per field (if no clumping)

            • If there's clumping you can get incorrect count

      • Module 9

        • Immune system

          • Innate

            • First line of defense, physical and chemical barrier to prevent tissue infection

            • Inflammatory responses

            • Main line of response for jellyfish and other invertebrates

          • Adaptive

            • Delayed and develops over time & involves T and B lymphocytes

        • Innate immune responses

          • Involves physical and chemical barriers like skin, bacterial populations in the gut

          • Inflammatory responses include

            • Phagocytosis by neutrophils and macrophages

              • Engulfing and destroying of abnormal things

            • Extracellular killing caused by the release of the content of the granules of granulocytes

        • Complement system

          • Complement cascade

            • Series of chemical reactions that result in the production of proteins that work to enhance immune responses

              • So results in lysis of microbes & activation of other immune responses

        • NK cells/Natural Killer cells

          • Part of inflammatory response

          • Defend against intracellular pathogens like viruses

        • Adaptive immune responses

          • Involves T and B cells

          • T-cells

            • Responsible for cell mediated immunity

              • Contact other cells and destroy them

          • B-cells

            • Responsible for antibody mediated immunity

              • They produce antibodies that have effects on other cells

          • Involves immunologic memory

            • Anamnestic immune response

              • Faster stronger immune response that results from previous exposure to an antigen

          • Involves the formation of antigen specific T and B cells that remain after initial reaction with an antigen

        • Immunoglobulins produced by b cells/b lymphocytes

          • IgM- 1st one produced

          • IgG- most ABUNDANT

          • IgE- allergic responses

          • IgA- found in lg amounts in SECRETIONS

          • IgD- founds in humans, chickens and some lab animals, function unclear

        • Clonal expansion

          • When a T cell becomes activated by an antigen presenting cell and leads to an expansion into an enormous amount of clones of the originally activated T cells

            • Antigen presenting cell is usually a macrophage

        • Immunologic tolerance

          • Ability of the immune system to differentiate self from non self

        • Active vs Passive immunity

          • Active

            • Animal itself develops an immune response as a result of being exposed to an antigen by natural infection OR immunization

          • Passive

            • Another creature forms antibodies and those antibodies are transferred from one creature to another

              • Can be done across placenta from mom to baby or through colostrum

                • Colostrum can only be absorbed the first 24-48 hours

              • Can be done by direct injection

            • Regardless of how it happens it's short lived

            • Don’t cause receiver to produce they own antibodies

              • Immune system won't have memory

        • Whole intact antibodies can only be absorbed by intestines for about the first 24hrs after birth via colostrum

        Module 10

        • Types of vaccines

          • Live attenuated

            • A version of the vaccine that has been weakened in a lab so it's unlikely to produce a disease

            • There's a live version of the microbe that we mess with so it doesn't produce the disease when we inject it

            • More effective and longer lasting

            • Keep a lot of the characteristics of the OG pathogen but less virulent

          • Inactivated/killed vaccines

            • Exposed to chemical or physical processes (i.e: heat or formalin) used to kill the pathogens

            • Not as effective as live attenuated & boosters are needed

          • Recombinant vaccines

            • Use harmless pathogens to express gene products of the target pathogen

          • Toxoid

            • Has non-harmful chemicals that have a structure similar to that of a toxin produced by a bacteria

          • Adjuvants

            • Added to vaccines to increase immune responses

            • Like things that may keep a vaccine in a specific spot for a certain amount of time

        • Core vs Non-core vaccines

          • Core vaccines in dogs

            • Rabies, distemper, adenovirus 2, parvo 2 (so Da2PP)

          • Core vaccines in cats

            • Rabies, FVRCP (feline viral rhinotracheitis calicivirus and panleukopenia)

          • Non core vaccines in dogs

            • Parainfluenza, lepto, Bordetella,  CIV and coronavirus

          • Non core vaccines in cats

            • Feline leukemia, FIV, Bordetella and clamatophetol (???)

        • Sometimes cores are combined with non cores

          • DA2PP/DHPP vax has

            • Distemper, Adenovirus, dog hepatitis, Parvo, parainfluenza

          • Sometimes Bordetella, parainfluenza, adenovirus can be combined


        • FERCP/FVRCP (can't really understand her well enough tbh) are all core

        • When vaccinating neonates goal is to provide protection ASAP after maternal antibodies wane

          • Hard to tell when that happens so we repeatedly vaccinate till they 16 weeks of age until we know those maternal antibodies have worn off

          • If ur pet is born with passive antibodies from mom vaccines wont work

        Module 11

        • Disorders of the immune system

        •  Congenital and acquired immune deficiencies

        • Immune mediated disease

        • hypersensitivity reactions-each involves different parts of the immune system

          • Type 1

            • Allergies and anaphylactic shock, involves IgE

          • Type 2

            • Autoimmune diseases

          • Type 3

            • Immune complex diseases,

          • Type 4

            • Involves T cells and are responsible for diseases like type 1 diabetes and IBD

        • Cancers of the immune system

        • Serologic tests

          • Tests that look for the presence of an exposure to an antigen by detecting the presence of antibodies

            • So they use serum to either look for antigens in the blood or to look for antibodies in the blood

        • Sensitivity vs specificity

          • Sensitivity

            • The ability to correctly identify all animals that are TRULY positive and indicates the lvl of false negs

          • Specificity

            • Ability to correctly identify all animals that are TRULY negative and indicates the level of false pos

        Module 12

        • Blood chemistries

          • Clinical chemistry testing usually needs serum

            • Usually using a serum seperator

          • Serum abnormalities that can mess with ur chems

            • Lipemia

              • Serum with milky appearance due to a bunch of fat or lipid in serum can happen after meal or diseases that mess with animals ability to digest and metabolize fat like diabetes, hypothyroidism and Cushings disease

            • Jaundice

              • Serum is yellow. Happens when bilirubin (waste product from RBC production) builds up and it develops due to liver disease, gallbladder obstruction or massive RBC destruction

            • Hemolysis

              • Red serum. You know this one. Can also happen due to blood parasites and IMHA

        • Volume regulation of urine

          • ADH and aldosterone is involved

            • ADH=Antidiuretic hormone

              • Prevents diuresis and excessive production or urine

              • Release results in concentration of urine due to reabsorption of water by the kidneys

              • A deficiency of ADH is called diabetes insipidis which results in dilute urine

            • Aldosterone

              • Responsible for sodium and excretion of potassium In the distal convoluted tubules of the kidneys

                • Where sodium goes water follows

              • Responsible for keeping the sodium back and getting it back into the body

              • Also involved in water and urine volume regulation

          • Oliguria

            • Decreased pee production

          • Anuria

            • Lack of urine production

          • Polyuria

            • Increased urine production

        • Blood tubes. Know them.

        • Renal diagnostics

         

        Module 13

        • More kidney stuff

        • GFR (glomerular filtration rate)=rate at which blood is filtered through the glomerulus in the kidneys

        • Primary indicators of renal dysfunction in blood chem is elevations in BUN and creat

          • Azotemia-term used to describe the above elevations

          • BUN (blood urea nitrogen) is produced as the end product of acid breakdown in the body

          • Creatinine is amino acid made in the body by normal skeletal muscle breakdown

            • When glomerular filtration is DECREASED those enzymes (above) will build up in the blood because they aint being excreted right

            • BUN can be elevated due to dehydration, high protein diets and intestinal bleeding

            • 65-70% of all glomeruli need to be affected by disease before your going to see elevations in renal toxins on ur blood chem b4 azotemia occurs

        • Types of azotemia

          • Pre renal

            • Dehydration causes decreased perfusion to the kidneys and decreases the GFR of kidneys

            • BUN and creat elevated

          • Renal

            • When a disease affects the kidneys and causes azotemia and decreases ability of kidneys to concentrate urine

            • BUN and creat elevated

          • Post renal (obstruction)

            • Retrograde flow of pee back into kidneys happens due to obstruction that prevents flow of urine out of the body

        • Info on how the kidneys can concentrate pee helps differentiate whether BUN and creat are elevated due to prerenal causes like dehydration or renal causes like kidney disease

        • Urine specific gravity: test that measures the ability of the kidneys to concentrate pee

          • Dehydrated animals will have high USG since body is trying to keep water

        • Urine protein creat ratio

          • Increase in the protein in pee compared to creatinine is what we look for

          • Gives us indication of whether if we have protein in our urine if its due to glomerular protein loss

            • Sometimes occur due to inflammation

              • Have to take into consideration context symptoms (infection stuff and making sure there isnt one)

              • No signs of inflammation, if signs urine protein creat ratio is elevated likely due to glomerular disease

                • When protein is getting through the fenestration that would not normally get through gets through when its leaky

        • AKI (acute kidney injury)

          • Sudden severe decrease in kidney function

            • Leading to retention of uremic wastes (BUN/Creat), abnormalities of hydration and electrolytes and imbalances in acid base status (metabolic acidosis)

        • CKD (Chronic kidney disease)

          • Irreversible progressive loss of kidney function and has been present for at least 3 months

        • IRIS (international renal interest society) staging system based on creat lvls, urine protein creat lvls and blood pressure on at least 2 separate occasions

        Module 14

        • Electrolytes

          • Major extracellular cation is sodium

          • Major extracellular anion is chloride

          • Major intracellular cation is potassium

          • Hypokalemia

            • Causes weakness, anorexia, ventroflexation of the neck and depression

          • Hyperkalemia (too much K+)

            • Muscle vesiculation and tremors, bradycardia

            • Can occur due to inability to remove K+ from the blood into the urine because of decreased aldosterone production (or hypoadrenocorticism)

              • Life threatening increases of K+ occur due to hypoadrenocorticism

            • If you over supplement potassium chloride & fluids or if you don’t remove pee from the body appropriately u can build up potassium

          • Hypocalcemia (too low calcium)

            •  restlessness, muscle tremors, bradycardia, stiff gate, tachypnia, and seizure like activity

            • Can be due to loss of albumin

            • Most common cause is eclampsia due to demand of calcium during lactation

            • Fixed by giving calcium PO

          • Hypercalcemia

            • More serious concern since it causes abnormal calcification in the body

            • can lead to kidney failure (calcified kidneys), bladder stone formation, abnormal muscle contractility and hypertension 

          • Sodium potassium ratio should be at least..

            • 25 sodium to 1 potassium

              • Addison's disease or hypoadrenocorticism and urethral obstruction can cause really bad hyperkalemia

                • Addison's can lead to hyponatremia and hyperkalemia b/c no aldosterone so body can get rid of K+ and reabsorb NaCL

                • U/O self explanatory

          • Calcium can exist in the body in an inactive form bound to albumin or an active ionized form

            • Can measure total blood calcium as well as ionized calcium

            • Since a lg amount is complex albumin, if albumin is lost hypokalcemia will result

        • Cardiac arrhythmias

          • Lack of P waves on an ECG & will lead to death if not treated quickly

        • Main plasma proteins

          • Albumin

            • Major binding & transport protein

            • Helps maintain osmotic pressure of plasma

            • Makes up to 35-50% of total plasma proteins

              • Any state of hypoproteinemia is prolly caused by albumin loss

            • Causes of decreased albumin includes liver disease because albumin is made in the liver, renal disease because u can lose it abnormally through your kidneys

              • Can lose it through your glomerulus if it becomes leaky

                • Called a protein losing nephropathy

            • Decreased dietary intake & intestinal protein malabsorption

              • Called a protein losing enteropathy

          • Globulin

            • Complex group of proteins that transport and bind things & make up the immunoglobulins

              • Come in alpha, beta and gamma

            • They concentration is estimated by the difference between the total protein and the albumin concentrations

              • Alterations in the albumin globulin ratio is usually the 1st indication of a protein abnormality

                • You'll lose both together if u have hemorrhage (they’ll decrease the same amount)

          • Fibrinogen

            • Not found in serum just in plasma

            • Is precursor to fibrin which forms the matrix of blood clots

        Module 15

        • Liver tests

          • Malfunction of liver or gallbladder can cause jaundice due to build up of bilirubin

          • Hypoalbuminemia

            • The liver is responsible 4 the formation of albumin so it can signal liver problems

          • Problems with hemostasis/blood clotting can happen when liver not working right

            • b/c responsible for making clotting factors as well

          • Hepatic encephalopathy can happen when u have neuro signs produced 2ndary to decreased liver function due to the build up of toxins that the malfunctioning liver cant clear

            • May see decreased BUN because liver makes BUN from ammonia molecules

            • May see increased bile acids b/c they made in liver from cholesterol and readied in the liver 4 excretion into the gallbladder where they need to B stored until they're released

          • TIME STAMP 17:15 


Comments

Post a Comment