This evening involved Zoe Belshaw going through some small animal blood work, and understanding some parameters. Before going through some cases on Thursday
So urea is synthesized in the liver, from the breakdown of protein. But its important to know what might increase urea apart from renal disease. There was a mixture of answers here
It turns out that a few of us were confused here, and in fact liver disease would lead to decreased urea levels.
So GI bleeds are important, and will often see melena
and finally a pre-renal azotaemia will also increase the urea
Factors listed in the Ettinger textbook for increased BUN are…
Pre-renal azotaemia High protein diet, dehydration, heart failure, shock, GI haemorrhage, fever, tetracyclines
Renal azotaemia Renal failure
Postrenal azotaemia urethral/bladder obstruction, bladder neoplasia/polyp.
So moving on
The breed thing stumped a lot of us…
Lots of us happy with this one!
So good liver function tests are bile acid stim test, urea, cholesterol, proteins (albumin, globulin, CRP, acute phase proteins) & coagulation factors
So what do you know about AlkP
So looks like ALKP is a marker for quite a lot of stuff, so as we can see not very liver specific!
And the exogenous steroids only increase ALKP in dogs not cats- as there is no steroid induced isomer present in cats!
I didn’t have a clue on this one but turns out the answer was the scottie dog!
More liver enzymes…
And one more…
A few of us a bit confused about the pathways for bilirubin, so a good tutorial on youtube to watch if you want to learn a bit more. Explains the difference in conjugated & unconjugated bilirubin, and where it travels to be processed.
So what causes the hyperbilirubinaemia? Loads of different answers here…
So my notes on hyperbilirubinaemia and jaundice say… animals will present with weight loss, jaundice, inappetance & PU/PD.
Pre-hepatic (haemolysis)- IMHA, babesia, mycoplasma, DIC
Intra-hepatic- Chronic hepatitis, acute hepatic necrosis, cholangitis, lymphoma, leptospirosis, infectious hepatitis (adenovirus), FIP & amyloidosis
Post-hepatic- obstruction, pancreatitis, pancreatic carcinoma, cholelithiasis, fluke, gall bladder rupture, gall bladder mucocoele, duodenitis & duodenal neoplasia
Hope this helps put all of the information together for you!
And a final thought on what to consider with elevated blood parameters…
Hope these notes are helpful, and hope to see lots of you for the cases on Thursday!