BCSE Pathology · ⏱ 30 min read · 📅 Mar 28, 2026 · by BCSE Exam Prep Team · 👁 1

Clinical Chemistry – BCSE Study Guide

Enzyme Type Location Key Points
ALT Leakage (cytoplasmic) Hepatocytes (dogs/cats) Most liver-specific in small animals
AST Leakage (cyto + mito) Liver, muscle, RBCs Check CK to rule out muscle source
ALP Induction (membrane) Liver, bone, intestine C-ALP in dogs only; cats lack this
GGT Induction (membrane) Biliary epithelium More sensitive for cholestasis in cats
Type Mechanism Common Causes
Prehepatic Excess bilirubin production from hemolysis IMHA, transfusion reactions, Heinz body anemia, babesiosis
Hepatic Impaired uptake, conjugation, or excretion by hepatocytes Hepatitis, hepatic lipidosis, cirrhosis, sepsis
Posthepatic Obstruction of bile flow Cholelithiasis, pancreatitis, neoplasia, mucocele
Mechanism Causes
Decreased production Hepatic failure, chronic liver disease, malnutrition
GI loss (PLE) IBD, lymphangiectasia, GI lymphoma, parasitism
Renal loss (PLN) Glomerulonephritis, amyloidosis, familial nephropathies
Third spacing Effusions, vasculitis, burns
Type BUN:Creatinine USG Causes
Prerenal Increased (greater than 20:1) Concentrated (greater than 1.030 dogs, greater than 1.035 cats) Dehydration, decreased cardiac output, shock
Renal Normal to mildly increased Isosthenuric (1.008-1.012) or inadequately concentrated AKI, CKD, nephrotoxins
Postrenal Variable Variable Urethral obstruction, uroabdomen, bilateral ureteral obstruction
Stage Creatinine (dogs) Creatinine (cats) SDMA Guidance
1 Less than 1.4 mg/dL Less than 1.6 mg/dL Less than 18 mcg/dL
2 1.4-2.8 mg/dL 1.6-2.8 mg/dL 18-35 mcg/dL
3 2.9-5.0 mg/dL 2.9-5.0 mg/dL 36-54 mcg/dL
4 Greater than 5.0 mg/dL Greater than 5.0 mg/dL Greater than 54 mcg/dL
Albumin Globulin Pattern Causes
Decreased Decreased Panhypoproteinemia Hemorrhage, severe PLE, severe burns
Decreased Normal Selective albumin loss PLN, liver failure, PLE (early)
Decreased Increased Inflammation + loss Chronic infection, FIP, ehrlichiosis
Normal Increased Hyperglobulinemia Chronic inflammation, neoplasia (myeloma)
Increased Increased Dehydration All proteins concentrated
Result Spec cPL (Dogs) Spec fPL (Cats)
Normal Less than 200 mcg/L Less than 3.5 mcg/L
Equivocal 200-400 mcg/L 3.5-5.3 mcg/L
Consistent with pancreatitis Greater than 400 mcg/L Greater than 5.3 mcg/L

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Practice Questions

Test yourself before moving on. Click an answer to reveal the explanation.

Question 1 On the BCSE, which approach is most appropriate when evaluating a clinical scenario involving Clinical Chemistry?

Question 2 On the BCSE, which approach is most appropriate when evaluating a clinical scenario involving Clinical Chemistry?

Question 3 On the BCSE, which approach is most appropriate when evaluating a clinical scenario involving Clinical Chemistry?

Question 4 On the BCSE, which approach is most appropriate when evaluating a clinical scenario involving Clinical Chemistry?

Question 5 Which of the following best describes the BCSE exam approach for Clinical Chemistry?

Question 6 Which of the following best describes the BCSE exam approach for Clinical Chemistry?

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