Clin Path- Liver Evaluation.txt

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  1. Liver disease can occur from... (5)
    trauma, hypoxia, toxicity, neoplasia, or obstruction of the bile duct
  2. 4 broad categories of diseases of the liver.
    hepatocellular damage, decreased hepatic functional mass, cholestasis/ enzyme induction, alterations in portal blood flow
  3. Generally, __________ of hepatic function is necessary before clinical signs of liver failure are observed.
    a loss of 70%
  4. We detect the activity of leakage enzymes by providing a specific _________ for _________ and then measuring the known _______.
    substrate; enzyme interaction; by-product
  5. Enzymes located in the ________ require more cellular damage for release than those located in the ________.
    mitochondria; cytosol
  6. ALT is located in the _____ of...
    cytosol; hepatocytes and muscle cells
  7. ALT is NOT useful in... (3)
    horses, ruminants, and pigs (low conc in hepatocytes)
  8. Because serum ALT activity is proportional to the number of injured hepatocytes, increased ALT activity may not be detected with...
    liver failure where the number of hepatocytes is markedly reduced
  9. Muscle leakage should be considered a potential source of increased serum ALT if...
    there is significant muscle damage
  10. AST is located in the _________ and _________ of...
    cytosol; mitochondria; hepatocytes, muscle, and erythrocytes
  11. Increased serum AST activity may be due to... (3)
    hepatocellular damage, muscle damage, or hemolysis
  12. Elevated AST suggests more severe hepatocelluar damage than ALT because...
    it is mostly present in the mitochondria
  13. SDH is located in the _______ of ________; therefore it is...
    cytosol; hepatocytes; liver-specific in all species
  14. GLDH is located in the ________ of _________, but is it not widely used because the assay is difficult.
    mitochondria; hepatocytes
  15. Obstruction of bile flow or excretion.
  16. Cholestasis can present as _______.
  17. Hepatocyte injury may result in cell swelling, causing...
    obstruction of bile canaliculi, leading to cholestasis
  18. Post-hepatic cholestasis often occurs in patients with ___________ due to...
    pancreatitis; inflammation of the pancreatic duct that spreads to affect the biliary duct
  19. Cholestasis:
    Total bilirubin-
    Bile acids-
    • ALP- liver and steroid isoforms increase
    • GGT- increased
    • T. bilirubin- pre-hepatic, hepatic, or post-hepatic increases
    • Cholesterol- increased
  20. ALP is a ___________ protein that increases by _________.
    membrane-associated; induction
  21. What are the isoforms of ALP?
    Liver, bone, corticosteroids (dogs only)
  22. The hepatic isoform of ALP is increased with...
    cholestatic disorders or significant hepatocyte swelling (lipidosis)
  23. ALP is typically increased in cats with _________.
    hepatic lipidosis
  24. In cats ALP>>GGT is consistent with __________; GGT>ALP is more consistent with ________.
    hepatic lipidosis; cholangiohepatitis
  25. In dogs, corticosteroids can simultaneously induce...
    liver and corticosteroid ALP isoforms
  26. The ALP bone isoform is associated with....
    increased osteoblastic activity (growing animals, osteosarcoma, bone healing)
  27. GGT is a ____________ protein that is elevated by ________.
    membrane-associated; induction
  28. Most serum GGT is of _________ origin.
  29. Elevated serum GGT occurs with ________ and _________.
    cholestatic disease; steroid induction
  30. How is GGT used in neonates?
    used as a marker of colostral absorption
  31. Bilirubin and bile acids are markers of... (2)
    cholestasis and hepatic function
  32. Bilirubin is increased with... (3)
    hemolysis, biliary obstruction (decreased clearance), or defect in processing
  33. Bile acids are produced by the _______, and they are increased with...
    liver; reduced clearance by the liver
  34. Unconjugated bilirubin in the blood is tightly bound to ________.
  35. Pre-hepatic hyperbilirubinemia is caused by... (2)
    hemolysis, internal hemorrhage
  36. Hepatic hyperbilirubinemia i caused by... (4)
    lipidosis, cirrhosis, hepatitis (biliary obstruction due to hepatocellular swelling), neoplasia
  37. Post-hepatic hyperbilirubinemia is caused by... (2)
    pancreatitis, cholangitis
  38. Hyperbilirubinemia can be a sign of ________ in horses and ruminants because...
    anorexia; fatty acids compete with unconjugated bililrubin for binding on hepatocyte surface receptors
  39. Miid bilirubinuria is ________ in dogs.
  40. In horses and ruminants, ___________ bilirubin predominates.
  41. Measurement of bile acids in _________ animals is redundant.
  42. Increased bile acids concentrations are seen when there is ________________________, which can be due to...
    decreased clearance by the liver; reduced functional hepatic mass or cholestasis
  43. Increased serum bile acids due to reduced functional hepatic mass may be caused by... (4)
    cirrhosis, nodular fibrosis, massive necrosis, portosystemic shunts
  44. Decreased bile acid concentrations occur with ________.
    ileal malabsorption
  45. What is measured to analyze hepatic synthesis? (5) Do they increase or decrease?
    glucose, cholesterol, BUN, albumin, clotting factors; decreased
  46. Insufficient Vitamin K can be associated with ________ due to decreased fat digestion and absorption (Vit K is fat soluble).
  47. Hepatic macrophage in reticuloendothelial cells in the body that do not stimulate an antibody response against the majority of antigens they remove; affect globulin concentration.
    kupffer cells
  48. If portal blood flow i shunted to bypass Kupffer cells, antigens normally removed in the liver would...
    stimulate an antibody response in other tissues of the body; thus, increase globulins
  49. Hyperammonianemia is seen with... (5...3 are species specific)
    hepatic insufficiency (reduced functional mass), portosystemic shunts, congenital enzyme deficiency in dogs, urea toxicosis in ruminants, intestinal bacterial overgrowth in horses
  50. 5 functions of the kidneys.
    excretion of waste products, retention/reabsorption, water and electrolyte balance, urine concentration, hormone production
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Clin Path- Liver Evaluation.txt
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