CLINICAL LAB!!!! Exam 1

natural or synthetic fluids are

colloids

salt/sugar fluids are

crystalloids

which fluid therapy have no large molecules in them, can readily cross the endothelium, and redistributes throughout the body

crystalloids

which fluid therapy has large molecules in them, cant readily cross the endothelium, and pulls fluids into the vessel

colloids

which type of fluid therapy contributes to oncontic pressure

colloids

what is shock

decreased delivery of fuel/o2 at the cellular level which can cause irreversible injury to cells if occurs for long enough

what are the types of shock

obstructive

distributive

cardiogenic

hypovolemic

which type of shock is NOT corrected by volume replacement (fluids)

CARDIOGENIC

what happens if you treat cardiogenic shock with fluid therapy

MORE DAMAGE TO THE HEART OR DEATH

very no good

what is hypovolemic shick

reduced circulating blood volume in relation to total vascular capacity

what is cardiogenic shock

heart pump failure due to loss of contractility and/or functional myocardium

what is obstructive shock

impaired venous return

tension pneumothorax, pericardial tamponade, or GDV can lead to what type of shock

obstructive

what types of shock is not treated (or not best treated) with fluid therapy

cardiogenic and obstructive

what is distributive shock

loss of vasomotor control

pulse quality is weak and thready for what type of shock

everything but distributive

what clinical signs are expected with obstructive shock

pale MM
thready/weak pulses

SLOW CRT more than 2 seconds

QAR dull possibly unresponsive

tachycardia

cold extremities

what clinical signs are expected with cardiogenic shock

pale MM
thready/weak pulses

SLOW CRT more than 2 seconds

QAR dull possibly unresponsive

tachycardia

cold extremities

what clinical signs are expected with hypovolemic shock

pale MM
thready/weak pulses

SLOW CRT more than 2 seconds

QAR dull possibly unresponsive

tachycardia

cold extremities

what clinical signs are expected with distributive shock

tachycardia

right red/injected MM

SUPER FAST CRT (less than 1 second)

strong/bounding pulses

warm extremities

QAR, dull and possibly unresponsive

what is phase 1 for shock treatment

resuscitation

what is phase 2 for shock treatment

rehydration

what is phase 3 for shock treatment

maintainence

colloid shock dose canine

20ml/kg/hr

colloid shock dose feline

10-20 ml/kg/hr

crystalloid shock dose canine

80-90ml/kg/hr

crystalloid shock dose feline

40-60 ml/kg/hr

1 gram is equal to

1ml of fluid

1 kg is equal to

1 L of fluid

what is the solution of choice for treating dehydration

crystalloids

volume replacement is the treatment of choice for what type of shock

distributive and hypovolemic

USE WITH CAUTION WITH OBSTRUCTIVE SHOCK

what is the most accurate way to estimate dehydration level of a pt

using weight /weight loss

less accurate would be MM texture or skin tent turgor

what is the fluid of choice for dehydration

crystalloids

how long does it take a pt to be rehydrated

24-36 hours

crystalloids are designed to meet what objectives

acid-base imbalances

electrolyte abnormalities

tonicity

when is urine considered an ongoing loss

when urine production is above 2ml/kg/hr

when should ongoing losses be added

during the rehydration phase of fluid therapy

what is the common fluid maintenance formula

66ml/kg/day

(60ml/kg/day for the VTNE)

what is the most accurate way to measure fluid losses

based on surface area

what is the formula to determine fluid deficit

% dehydrated TIMES body weight in kg = L/24hr of deficit

DONT FORGET TO INCLUDE MAINTENANCE FLUIDS!!!!! (60-66 ML/KG/DAY)

what are the clinical signs of lower urinary tract disease

pollakiuria

inappropriate urination

stranguria

hematuria

FISH!!

what are the common indication for urine analysis

• clinical signs

• changes in character of urine

• known or suspected renal dz or urolithaisis

• previous hx of UTI

• pre-op testing

when is the best time to get a urine sample

the most concentrated sample I.E first morning sample

ways to collect a urine sample

voided/free catch

manual expression

catheterization

cystocentesis

what urine sample collection techniques is preferred the least

manual expression

what are the disadvantages of voided sample collection

can have bacteria in it since bacteria naturally lives in the distal urethra or the ground if not collecting mid-stream

most accurate if collected mid stream but still skew due to bacteria in distal urethra

increased cellular count

what are the disadvantages of manual expression sample collection

possibility of bleeding or rupturing the bladder

increased cell count

increased bacterial count

increased blood in the sample

traumatic to the patient

what are the disadvantages of catheterization sample collection

harder to do in females

increased bacterial count from passing the distal urethra

iatrogenic infection risk from pushing bacteria into the bladder

increased cellular count

increased blood from stiff catherter or forceful application

how is urinary catheter placed

urinary catheter placed through urethra and into the bladder to collect a sample

what are the disadvantages of cystocentesis sample collection

bleeding

what urine collection technique is the best for urine analysis but DEFINITELY a urine culture?

CYSTO! <3

how should a urine sample be handled

• sample should be placed in an clean, airtight container

• perform the urinanalysis within 30 minutes of sample collection

  • if not REFRIGERATOR

• mix well before transferring from collection container to centrifugation tube

list possible problems from delayed urine analysis

• bacterial contamination

• altered pH

• disrupted or dissolved casts

• cellular detail loss

• Chemical precipitation can be confused with crystals

• crystal formation in vetro

what are casts important in urine

They indicate problems in the kidneys

VERY IMPORTANT TO FIND

methods of urine collection

voided

catheterization

manual expression

cystocentesis

what are the disadvantages of catheterization for urine collection

increased bacterial count

increased risk of iatrogenic infection

increased cellular count

increased blood

risk of rupturing the bladder or urethra

when is it best to perfom a UA

within 30 minutes of sample collection

what should you do with urine sample if UA is delayed over 30minutes of collection

refrigerate

what are the possible problems from delayed analysis

• bacterial contamination

• altered pH

• disrupted or dissolved casts

• cellular detail loss

• chemical precipitation

  • crystal formation in vitro

on BG, when is an animal considered diabetic

200mmHG or more

what are the three major ketones

acetone

acetoacetane

beta-hydroxybutyrate

how much urine sample is required for a UA

minimum of 5ml

what speed and time should you centrifuge a UA sample

1500-2000 rpm for 3-5 minutes

how many RBC is normal for UA

4-5 per high powered field

how many WBC is normal for UA

4-5 per high powered field

what types of epithelial cells are seen in UA

renal cells

caudate cells

transitional cells

squamous cells

what are casts

structures that are formed in the renal tubule

what forms casts

uromodulin

what shape are casts

cylindrical

what are the types of cellular casts

RBC casts

WBC casts

Epithelial casts

what are hyaline casts

pure uromodulin that solidified

what does FISH stand for

increased Frequency of urination

Inappropriate urination

Stranguria

Hematuria

common indications for urine analysis

• showing clinical signs of lower urinary tract infection

• changes in urine (color, texture, smell)

• known or suspected renal disease or urolithiasis

• pre-ops

what are the 3 components to urine analysis

1. physical properties/ Gross exam

2. Chemical properties/ Dipstick exam

3. Microscopic properties

what is part of a gross exam during a UA

color

pH

transparency

odor

foam

specific gravity

what does a urine specific gravity tell us

gives information about the kidney function/ concentrating abilities of the kidney

what does an ammonia smell to urine indicate

possible bacteria

what does an sweet or fruity smell to urine indicate

possible glucose

what does an acetone smell to urine indicate

possible ketones in the urine

isosthenuria

the urine concentration is within the same range as plasma. This means that urine is not being adequately filtered and suggests kidney dysfunction.

urine concentration of 1.008 - 1.012 is

isosthenuric

hyposthenuric

urine concentration is too dilute

could indicate that the kidneys are not concentrating urine properly

urine concentration of <1.008 is

hyposthenuric

hypersthenuric

urine concentration is more than plasma concentration

this is healthy

urine concentration of >1.012 is

hypersthenuric

what is the normal urine concentration range for dogs

1.015-1.045

what is the normal urine concentration range for cats

1.035-1.060

what is the normal urine concentration range for large animals

1.015 - 1.030

what is part of a dipstick test

pH

protein

occult blood

glucose

bilirubin

ketones

leukocytes esterase reaction

nitrites

what does it mean if your dipstick shows positive for leukocytes esterase reaction and nitrites

indicates the presence of bacteria

when is it normal for bilirubin to be present in feline urine

NEVER

what is the renal threshold for glucose in dogs

180mm/dL

what is the renal threshold for glucose in cats

280mm/dL

when is it normal to have proteins in feline urine

NEVER!

when is it normal to have proteins in dog urine

trace proteins is normal

what is used to stain urine sample

new methylene blue or sedi-stain

what epithelial cells are rarely seen on a sediment exam of urine

caudate and renal cells

what do struvite crystals looks like

coffin lids

what do calcium oxalate crystals looks like

monohydrate form: looks like text bubbles with points

dihydrate from: looks like pyramids from a birds eye view

what do cystine crystals look like

a stop sign

carbon rings