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Sm Animal Medicine I
Final Exam Review - From Preprinted Notes Endocrine Disease Done
| Question | Answer |
|---|---|
| What is the Problem-Oriented Medical Record (POMR)? | System of organizing patient records to enhance patient diagnosis, treatment and monitoring. |
| List seven things you might find in the POMR: | Master Problem List (Right), SOAP Sheets (Recent on top), Treatment Sheets, Laboratory Data, Radiology Reports, Surgery Reports, Anesthetic Log |
| What two things might you find in the Client Communication Sheets (Left)? | Administration/Invoice Sheets, Consent Forms |
| List seven steps, in order, for the Medical Diagnostic Method in POMR (in order): | Form a Problem list. Form a Ruleout list. Form a Diagnostic Plan. Form a Diagnosis. Form a Therapeutic Plan. Form a Monitoring Plan. Form a Client Education Plan. |
| Medical Record - SOAP What does SOAP stand for? | Subjective/Objective/Assessment/Plan |
| Medical Record - SOAP Subjective: | All information that is not a test result. History, attitude, etc. |
| Medical Record - SOAP Objective: | All information that is a test result. Physical exam, blood work, radiography results, etc. |
| Medical Record - SOAP Assessment: | Problem List and problem status: A1, A2, A3, etc. |
| Medical Record - SOAP Plan: | Dx, Tx, CE |
| Subjective: Database- Gathering Information General History Includes: | Lifestyle, Vaccination status, Travel history, Diet and Medications, General Health: Coughing/Sneezing, Vomiting/Diarrhea, Weight change, Appetite, Water consumption. |
| Subjective: Database Specific History Information | Duration of problem, Recent changes in problem, Therapies tried, Other animals effected |
| Objective: Database Includes what two things? | Physical exam, and Initial tests: Radiographs/ Ultrasound, Urinalysis, In-house tests: CBC, Chemistries, Viral Testing. |
| Assessment: The Problem List | Each problem identified is listed separately. If there is a strong probability that two problems are due to same cause list together: Vomiting/diarrhea, Anorexia/ weight loss, Polyuria/polydipsia (PU/PD). Date when problem is identified and resolved. |
| The Problem List When a problem is further identified, it is relabeled with what? | " ----->" Example: 4/15/09 Vomiting/diarrhea ------> Parvovirus |
| What is a "Rule Out List"? | A list of possible causes of a problem. The most likely 3-5 causes are listed initially. Each problem listed has a separate rule out list of its own. Remember it is common for animals to come in with multiple unrelated problems (especially seniors). |
| The Rule Outs What does the acronym DAMN IT mean? | Processes that cause disease in animals. After a problem list has been developed, the ruleouts are listed based on possible disease process. Tests, observations, and therapy response remove a ruleout or move it up the list to probable cause of disease. |
| The Ruleout - DAMNIT D can mean: | Degenerative or Developmental |
| The Ruleout - DAMNIT A can mean: | Anomalous or Allergic |
| The Ruleout - DAMNIT M can mean: | Metabolic, Mechanical, Mental |
| The Ruleout - DAMNIT N can mean: | Neoplastic, Nutrition |
| The Ruleout - DAMNIT I can mean: | Infectious (Viral, Bacterial, Fungal, Parasitic), Inflammatory, Immune-mediated, Ischemic, Iatrogenic, Idiopathic. |
| The Ruleout - DAMNIT T can mean: | Toxin or Trauma |
| Plan: Therapy Name five possible therapies: | Medications, Surgery, Environment changes, Physical Therapy, Nutrition Management. |
| Plan: Client Education Plan What three things can you educate a client about? | Prevention: of future problems is extremely important. Verbal information + Demonstrations. Written information. (15% rate of retention from verbal). Follow-up phone calls. Monitoring Plan: be specific. Zoonotic or other Human Health Issues! |
| P: Monitoring Plan Should be specific. What should be assessed? | Should be specific: Recheck: blood tests, imaging, physical exam. Weigh animal every time it comes into clinic. Clinical status! Should be scheduled before pet leaves clinic. |
| Nurse Note What is the goal of the Nurse Note? | To plan the nursing care from the tech point of view. This helps vet techs be proactive critical thinkers and not simply reactors to DVM instructions! |
| Nursing Note Technician Nursing Notes include what four types of information? | Technician Evaluation (TE) of clinical concerns. Intervention Plans (IP). “At risk” list (AR). Monitoring Plan (MP). |
| Nursing Note What is the Technician Evaluation (TE)? | Assessment of clinical concerns. Ideally, listed in order of import. NOT a diagnosis! |
| Nursing Note What types of observations are noted under the Technician Evaluation (TE)? | Acute pain, Altered Mentation, Altered Oral health Altered Ventilation, Altered Urinary production, Chronic pain, Hypovolemia, Client knowledge deficiency, Decreased perfusion, Diarrhea, Homeostasis imbalance, Hyperthermia, Hypothermia |
| What does perfusion mean? | The passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. |
| How do we prioritize TE? List in order of most important to least: | Oxygenation, Homeostasis, Acute Pain, Hydration, Elimination, Nutrition, Quality of Life, Activity, Utility, Client Education. |
| Intervention Plan What is included? | May overlap DVM orders. Enhance DVM orders due to nursing care perspective. Almost always includes a client education plan. Often includes scheduling follow-up tests and appointments. |
| Nursing Note Example Technician Evaluation (TE): | Altered Tissue Health (Open wound tail base) or Malnutrition (Poor appetite) |
| Nursing Note Example Intervention Plan (IP): | NPO prior to surgical wound care. Req. pain control/ antibiotic instruction from DVM. Encourage eating post-op. CE: prev. of cat fights/risks of infectious disease (FIV/FeLV) Verify vacc. CE: Wound care/med. instructions. Schedule recheck-drain removal. |
| Nursing Notes Step 1: | Technician Evaluations in priority order. |
| Nursing Notes Step 2: | Intervention Plan for the TE list generated. |
| Nursing Notes Step 3: | “At Risk” List: Assessment of potential concerns or complications. Guides monitoring of patient. Guides client education. Examples: Hypothermia, Volume overload, Heart arrhythmia, Aspiration, Acute pain, Recurrence dental disease. |
| Nursing Notes Step 4: | Monitoring Plan: Based on procedure. Based on At Risk List for patient. Based on DVM orders. |
| AR List List a Monitoring plan action for Hypothermia. | Temp q 30 min during procedure and 2 hr post. |
| AR List List a Monitoring plan action for Volume overload. | IV pump for fluid delivery, ck vol q 1 hr. |
| AR List List a Monitoring plan action for Heart arrhythmia. | EKG during procedure. |
| AR List List a Monitoring plan action for Aspiration. | Inflate cuff or suction throat during procedure. |
| AR List List a Monitoring plan action for Acute pain. | Ask DVM for pain Rx. |
| AR List List a Monitoring plan action for Recurrence dental disease. | Client education pertaining to dental disease. |
| Cardiac Anatomy List the four layers of the heart | Pericardial sac, Epicardium, Myocardium, Endocardium |
| Cardiac Anatomy List the four chambers of the heart and related anatomical structures. | 2 Atria, 2 Ventricles, 1 Septum, 2 AV Valves, Apex |
| Cardiac Cycle What is the purpose? | Move oxygenated blood from lungs to tissues. Move de-oxygenated blood from tissues to lungs. Perform above functions in an efficient synchronous manner. |
| Cardiac Cycle - How does it work? Diastole | Heart muscle is relaxed and all chambers fill with blood. Relaxed Heart |
| Cardiac Cycle - How does it work? Systole | Heart muscle contraction wave beginning at the Atria and then through the Ventricles moving blood from the heart chambers into great vessels. Contracting heart. |
| Cardiology Electrocardiography | Muscle contractions of the heart are carefully orchestrated by an electrical system. What do you call the method of recording this electrical activity? |
| Cardiology The heart's electrical activity can be recorded by a: | electrocardiograph (ECG) |
| Electrical activity moves across the heart from the ______ ____ to the _____ ____. | Sinoatrial node (SA node) - the pacemaker, Atrioventricular node (AV node) - the signal booster |
| Cardiology - ECG Each electrical wave results in | heart muscle contraction |
| Cardiology - ECG P wave | Atrial Contraction (Atrial Systole) |
| Cardiology - ECG QRS wave | Ventricles Contract (Ventricular Systole) |
| Cardiology - ECG T wave | Muscle relaxation (Left Ventricle Diastole) |
| Heart Rhythms Sinus Rhythm | Normal/Steady Rhythm |
| Heart Rhythms Bradycardia | Arrhythmia - Abnormal Rhythm "slow heart" |
| Heart Rhythms Tachycardia | Arrhythmia - Abnormal Rhythm "fast heart" |
| Heart Rhythms Asystole | Arrhythmia - Abnormal Rhythm "no contraction" |
| Blood Tests for Cardiac Disease How do they work? What three chemical levels can they evaluate? | Test for specific markers of cardiac muscle injury - commonly used in human medicine. Such tests are now available for veterinary use. Cardiac Troponin, Atrial Natriuretic Peptide, B-type Natriuretic Peptide |
| Cardiovascular Disease Name two categories of cardiovascular disease. | Myocardial dysfunction. Circulatory Failure |
| Cardiovascular Disease Myocardial dysfunction | Any heart disease that leads to “pump failure” |
| Cardiovascular Disease Circulatory Failure | Inadequate / ineffective circulating fluid volume |
| Cardiovascular Disease Clinical Signs (1 or more of the following) | Exercise Intolerance or weakness, Tachypnea or Dyspnea, Coughing, Syncope (fainting), Abnormal Heart Rate or Heart Rhythm, Abnormal Pulse Quality or Pulse Deficit, Prolonged Capillary Refill Time (CRT), Ascites |
| What is Pulse Deficit? | Occurs when there are fewer pulses than there are heartbeats. |
| Circulatory Failure Pathology | Insufficient blood volume to deliver oxygen to tissues. Insufficient vascular pressure to deliver oxygen to tissues. |
| Circulatory Failure Causes | Anemia (HCT<15), Dehydration (>12%), Vasculitis, Hypotension (MAP<60), Shock |
| Cardiology What is MAP? | Mean Arterial Pressure. The average pressure in a patient's arteries during one cardiac cycle. It is considered a better indicator of perfusion to vital organs than systolic blood pressure (SBP). |
| Heart Failure What is it? | A non-specific term referring to ANY heart disease that leads to very significant "heart pump" insufficiency and compensatory mechanisms of the body cause fluid to accumulate in tissues. |
| Heart Failure What clinical sign do we see specifically in Right Sided Failure? | Free fluid accumulates in pleural and abdominal cavity: Example: Ascites - abnormal buildup of fluid in the abdomen. |
| Heart Failure What clinical sign do we see specifically in Left Sided Failure? | Fluid accumulates in the lungs: example: Pulmonary Edema - abnormal accumulation of fluid in the tissue, airways, or air sacs (alveoli) of the lungs |
| Myocardial Dysfunction | Cardiomyopathies: Dilated or Hypertrophic. Myocarditis. Heart Valve Dysfunction. Anatomic Defects: Septal Defects, Patent Ductus Arteriosus (PDA), Arrhythmias |
| DAMNIT D stands for: | D = Degenerative or Developmental |
| DAMNIT A stands for: | A = Anomalous or Autoimmune |
| DAMNIT M stands for: | M = Metabolic, Mechanical, or Mental |
| DAMNIT N stands for: | N = Nutritional or Neoplastic |
| DAMNIT I stands for: | I = Inflammatory, Infectious, Ischemic, Immune-mediated, Inherited, Iatrogenic, or Idiopathic |
| DAMNIT T stands for: | T = Traumatic or Toxic |
| Cardiomyopathy Dilated Cardiomyopathy (DCM) in dogs | Hereditary disease in dogs (i.e. Dobermans, Boxers, Cocker Spaniels, St. Bernards, etc.) |
| Cardiomyopathy Dilated Cardiomyopathy (DCM) - Pathology | Heart muscle becomes thin and flabby. Heart chambers enlarge to compensate. Heart arrhythmias are common. |
| Cardiomyopathy Dilated Cardiomyopathy (DCM) - Diagnosis | Radiographs, ultrasound, ECG consistent with heart enlargement and/or heart failure. |
| Cardiomyopathy Dilated Cardiomyopathy in cats | Rare disease, in US, since taurine deficiency, in feline commercial foods, was addressed-late 1980s. Reversible if high taurine diet provided & cat survives first 2 weeks of HF. Extreme care needed handling HF in cats to prevent sudden death! |
| Cardiomyopathy Hypertrophic Cardiomyopathy (HCM) | Hereditary disease in cats: Persian, Maine Coon, Norwegian Forrest Cat. Common due to Hyperthyroidism. Reversible if Hyperthyroidism is successfully treated. |
| Cardiomyopathy Hypertrophic Cardiomyopathy (HCM) - Pathology | Thickened heart muscle with very small chamber size. Thromboembolism to caudal aorta is possible fatal complication. Saddle-Thrombus leading to acute bilateral hind leg paralysis. |
| Cardiomyopathy Hypertrophic Cardiomyopathy (HCM) - Diagnosis | Radiographs and/or Ultrasound consistent with heart changes or heart failure. |
| Cardiomyopathy Myocarditis | An inflammation of the heart muscle due to any infection or inflammatory process: Heartworm disease, Tetanus or other toxin, Lyme disease or other bacterial infection, Trauma. Arrhythmias are common. Cure is possible if cause can be completely reversed. |
| Heart Murmur | "Swishing" sound heard on auscultation of heart due to turbulent blood flow. Location of sound in cardiac cycle and "type" of murmur may be consistent with certain anatomic defects. |
| Valve Dysfunction Mitral Valve Insufficiency - Pathology | Nodular thickening of the heart valve causes leaking of the valve during systole and increased work load on the left atrium and the potential for heart failure. Most common cause of bacterial infection of the mitral valve due to chronic dental disease. |
| Valve Dysfunction Mitral Valve Insufficiency - Diagnosis | Systolic heart murmur, cough (especially at night or with exercise), radiographs and/or ultrasound showing left atrial enlargement with or without heart failure (pulmonary edema). |
| Anatomic (Congenital) Defects Septal Defects - Atrial & Ventricular - Pathology | Failure of heart septum to completely form in the fetus creates "hole" in septal wall. This causes blood to be pushed from L heart to R heart during systole. This overloads R heart and usually causes early heart failure. Sx correction is rare in animals. |
| Anatomic (Congenital) Defects Septal Defects - Atrial & Ventricular - Diagnosis | Harsh heart murmur. Heart murmur in puppy or kitten. Radiographs and/or ultrasound showing juvenile heart failure. Right heart enlargement. |
| Anatomic (Congenital) Defects Patent Ductus Arteriosus - Pathology | Failure of the ductus to close after birth. Causes re-circulation of blood from aorta into lung and then left heart develops volume overload. |
| Anatomic (Congenital) Defects Patent Ductus Arteriosus - Diagnosis | Loud heart murmur in puppy. Radiograph: enlarged pulmonary vasculature, enlarged left heart. |
| Anatomic (Congenital) Defects Patent Ductus Arteriosus - Treatment | Excellent prognosis with surgical correction |
| Anatomic (Congenital) Defects Subaortic Stenosis | Disease affecting large breed dogs (Newfie, German Shepard) |
| Anatomic (Congenital) Defects Subaortic Stenosis - Pathology | Thickening of tissue below aortic valve in puppy. Narrows aorta and causes increased workload for left heart. |
| Anatomic (Congenital) Defects Subaortic Stenosis - Diagnosis | Heart murmur, syncope, sudden death common, lesion seen on echocardiography |
| Arrhythmias General | any abnormality in the rate, rhythm, or electrical generation of the heart beat. They cause abnormal hemodynamics in body blood flow, blood flow to brain may be decreased by 8 - 80%. |
| Arrhythmias Pathology - Abnormal impulse formation | Low oxygen, Hypocalcemia or Hypercalcemia, Cardiomyopathy Heart tissue trauma/ injury |
| Arrhythmias Pathology - Abnormal impulse conduction | Anatomic defect of electrical conduction system |
| Arrhythmias Pulse Deficit | Demonstrates altered hemodynamics. A heart beat does not generate matching pulse wave. Important for Vet Techs to monitor for pulse deficits. |
| Arrhythmias Atrial Fibrillation | No organized atrial contraction, but "quivering" muscle tissue. Decreased cardiac output due to poor ventricular filling of blood (ventricular contraction is relatively normal) |
| Arrhythmias Atrial Fibrillation - Diagnosis | "Tennis shoes in the dryer" auscultation. ECG does not have a "P wave" |
| Arrhythmias Premature Ventricular Contractions (PVCs) | Heart beat is spontaneously generated from the Bundle of His independent of the SA node. Individual PVCs may not cause problem in animal, but groups of 7 or 80% PVCs will cause hemodynamic problems. |
| What does hemodynamic mean? | Relating to the flow of blood within the organs and tissues of the body. |
| Arrhythmias Premature Ventricular Contractions (PVCs) - Causes | Hypoxia or heart trauma. Anesthesia or toxins. Heart Disease. Electrolyte abnormalities (i.e. hyperkalemia) |
| Arrhythmias Premature Ventricular Contractions (PVCs) - Diagnosis | Pulse deficit or ECG |
| Ventricular Tachycardia Pathology | Cardiomyopathy, Heart Failure, Mycarditis, Heart Tumor may cause PVCs has predominate beat, if heart rate >130 due to PVCs sudden death may occur and must be treated |
| Ventricular Tachycardia ECG - What does it look like? | "Ghosts Holding Hands" |
| What does Auscultation mean? | The action of listening to sounds from the heart, lungs, or other organs, typically with a stethoscope, as a part of medical diagnosis. |
| Define CRT | Capillary Refill Time: usually less than 2 seconds. |
| What does Dysfunction mean? | Abnormality or impairment in the function of a specified bodily organ or system. |
| Define Cyanosis | A bluish cast to the skin and mucous membranes. |
| What does Dyspnea mean? | The medical term for shortness of breath. |
| Define Pleural effusion | “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs. |
| What does Heart failure mean? | When the heart muscle doesn't pump blood as well as it should. |
| Respiratory system works in combination with cardiovascular and hematopoietic systems to provide: | Necessary gas exchange for the body: deliver oxygen to tissues & remove carbon dioxide from tissues |
| Respiratory System Function What four basic parts make up the upper airway? | Nose, Larynx, Sinuses, Trachea |
| Respiratory System Function What are the functions of the upper airway? | Warm and humidify air, protect lower airway from debris by: sneeze, cough, gag, vocalization |
| Respiratory System Function What structures make up the lower airway? | Lungs: gas exchange Bronchi -> Bronchioles -> Alveolar ducts -> Alveoli |
| What is the mechanism of breathing called? | ventilation |
| Describe inspiration: | Pleural cavity creates negative pressure in the chest when the diaphragm contracts and the pleural space expands: air rushes into the lungs. |
| Describe expiration: | Relaxation of the diaphragm, elastic recoil of the lungs, air pressure differential, air rushes out of the lungs. |
| Define Tachypnea | Abnormally rapid breathing. |
| Define Dyspnea | The medical term for shortness of breath. Difficulty breathing. |
| Define Apnea | Temporary cessation of breathing, especially during sleep. |
| Define Aspiration | Breathing in a foreign object like sucking food into the airway. Also: to draw in or out using a sucking motion. |
| Define Cyanosis | A bluish cast to the skin and mucous membranes. |
| Define Oxymetry | A procedure for measuring the concentration of oxygen in the blood. |
| Diseases of the Upper Respiratory Tract What are the clinical signs of Rhinitis? | Serous, mucoid or mucopurulent nasal discharge. Sneezing, “reverse sneezing” or pawing at nose. Dried exudate on nares. Possible ocular signs, cough, or gag. |
| Diseases of the Upper Respiratory Tract What is the etiology of Rhinitis? | Allergic, Infectious, Foreign body/irritant |
| Diseases of the Upper Respiratory Tract Supportive care techniques for Rhinitis? | Keep nostrils clean QID. Vasaline to prevent chapping Warm food to encourage eating. Treat primary cause Do not use NeoSynephrine more than 3 days, if using. |
| What does the word etiology mean? | The cause, set of causes, or manner of causation of a disease or condition. |
| What does Serous mean? | Of, resembling, or producing serum. |
| Define mucoid. | Involving, resembling, or of the nature of mucus. |
| What does mucopurulent mean? | Discharge is the emission or secretion of fluid containing mucus and pus (muco- pertaining to mucus and purulent pertaining to pus). |
| Reverse Sneeze: | Honking nasal noise common in dogs. Often caused by post-nasal drip. Dog is normal between episodes. Episodes last 10-15 seconds & occur in small groups. Mucous membranes remain normal. Owners often think they are choking. Not dangerous to animal. |
| Diseases of the Upper Respiratory Tract What are the clinical signs of Nasal Tumors? | Epistaxis is common, also sneezing. Mucopurulent discharge that improves on antibiotics (due to secondary bacterial infections). Tenderness to face on one side. |
| Diseases of the Upper Respiratory Tract What is the etiology of Nasal Tumors? | Direct pressure to nose (pinch) with cold compress when nose bleeds occur. Antibiotics if discharge is present. Feldene (NSAID) for comfort. Treat with radiation as primary tx. |
| Diseases of the Upper Respiratory Tract Supportive care techniques for Nasal Tumors? | Most nasal tumors are malignant, but slowly progressive and don’t metastasize. |
| What is Epistaxis? | Defined as acute hemorrhage from the nostril, nasal cavity, or nasopharynx. |
| Diseases of the Upper Respiratory Tract What are the clinical signs of Sinusitis? | Swelling under the eye (over tooth). Unilateral nasal discharge and discomfort. |
| Diseases of the Upper Respiratory Tract What is the etiology of Sinusitis? | Most commonly associated with tooth abscess. Fungal infections also occur. |
| Diseases of the Upper Respiratory Tract How is Sinusitis diagnosed? | Oral exam & Radiographs. |
| Diseases of the Upper Respiratory Tract What therapy is helpful with Sinusitis? | Antibiotics. Dental extraction. Irrigation of infected tract. |
| Diseases of the Upper Respiratory Tract What are the clinical signs of Laryngitis? | Change or loss of voice. Exaggerated swallowing effort. Gagging. |
| Diseases of the Upper Respiratory Tract What is the etiology of Laryngitis? | Viral infection (including rabies), excessive vocalizing, tumor, trauma or laryngeal paralysis. |
| Diseases of the Upper Respiratory Tract Supportive care techniques for Laryngitis? | Soft foods. Voice rest (decreased stress). Treat primary cause. |
| Upper Airway Obstruction Clinical Signs: | Noisy breathing in throat, coughing, gagging. Extended head posture, slow deep breathing. Hypersalivation. Possible weakness, cyanosis. |
| Upper Airway Obstruction Etiology: | Anything in airway from larynx to bronchus: foreign object or tumor. Swelling due to: trauma, anaphylaxis, laryngeal paralysis, collapsing trachea, or Brachycephalic Syndrome |
| Upper Airway Obstruction Supportive care: | Keep animal calm, minimize exercise until animal primary cause can be resolved. Oxygen. |
| Diseases of the Upper Respiratory Tract Infectious Canine Tracheobronchitis is also called: | "Kennel Cough" |
| Diseases of the Upper Respiratory Tract Clinical Signs of Infectious Canine Tracheobronchitis | Loud, dry, honking cough followed by gag, but otherwise the animal is otherwise well. |
| Diseases of the Upper Respiratory Tract Etiology of Infectious Canine Tracheobronchitis | Virus: adenovirus, parainfluenza, distemper. Bacteria: Bordetella, Mycoplasma). |
| Diseases of the Upper Respiratory Tract Supportive care for Infectious Canine Tracheobronchitis | Vaporizer or steam. Cough suppressants. Isolation (Quarantine) in hospital setting. |
| Diseases of the Upper Respiratory Tract Prevention of Infectious Canine Tracheobronchitis | Vaccinations |
| Tracheal Collapse Clinical Signs: | “Goose honk” cough, often induced by exercise, excitement, or lifting dog by chest. Common in Yorkies, Malteses and other small breeds. |
| Tracheal Collapse Etiology: | Tracheal rings lose stiffness & dorsal membrane hangs into airway, entire trachea will close with heavy breathing. |
| Tracheal Collapse Symptomatic Care: | Keep animal calm & resting. Cough suppressants. Weight reduction! Treat primary & secondary problems. |
| Feline Upper Respiratory Infections Clinical Signs | Ocular & nasal discharge, possible squinting. Sneezing. Poor appetite. Lethargy, possible fever. |
| Feline Upper Respiratory Infections Etiology | Viral: Rhinotracheitis, Calicivirus, Herpesvirus. Mycoplasma: genus of bacteria that lack a cell wall around their cell membranes. This characteristic makes them naturally resistant to antibiotics that target cell wall synthesis. |
| Feline Upper Respiratory Infections Supportive Care | Keep eyes and nose clean of debris QID. Saline nose drops. Warm canned food. Possibly SQ fluids. Eye antibiotics. |
| Feline Upper Respiratory Infections Prevention | URIs are highly contagious! Vet Techs must use Quarantine Protocols for all sneezing cats! Vaccinations. Minimize stress/overcrowding. |
| Feline Upper Respiratory Infections Rhinotracheitis | Common to rhino: severe conjunctivitis, extremely common in kittens, possible death, transmitted via air or cat-to-cat. Viral shed for 3 wks. Chronic eye disease/URI relapse for years (Herpes virus). |
| Feline Upper Respiratory Infections Calicivirus | Common signs: Mouth & throat ulcers, hypersalivation (oral pain), high fever, lameness (rarely, but sometimes occurs after vaccination), diarrhea |
| Evaluation of Respiratory Health - (Primarily lower tract) | Common Tests: RR/MM and effort, Pulse oximetry, Blood gas analysis, Radiographs, Culture, Cytology. Less Common Tests: Bronchoscopy, Ultrasound, Biopsy. |
| Pulse Oximetry "Pulse Ox" How does it work? | % saturation of hemoglobin w/ oxygen. Probe placed over superficial artery & light, specific wavelength, is passed through skin. Hemoglobin saturated w/ oxygen absorbs light differently vs unsaturated Hgb. Normal animal 98-100% & 90% severe hypoxia |
| Pulse Oximetry "Pulse Ox" Common Veterinary Sites | Ear, Tongue, Toe web, Prepuce/ vulva |
| Pulse Oximetry "Pulse Ox" Will not work if… | Dirty or damaged probe, poor skin contact, thick tissue, low blood pressure, shivering, bright overhead light |
| Blood Gas Analysis How it works... | Blood is collected from patient (arterial blood is best) in a manner that does not contaminate sample with room air. Blood is immediately placed into a blood gas analyzer. Machine measures blood pH, pCO2 and pO2 Evaluates gas exchange in lungs. |
| Transtracheal Wash | Cultures from nasal discharge or coughed PO are usually not diagnostic due to contamination w/ normal flora. Transtracheal wash or bronchoscopy samples are ideal for culture & cytology. Possible risk to patient w/ severe lung diseaseand or cat or sm. dog |
| Bronchoscopy | Small sterile endoscope passed thru mouth to visualize/sample trachea & bronchi. Limited use in small animal medicine (small size of patients, need for general anesthesia) Risk in animals w/ severe lung disease. Great for removing foreign bodies airway! |
| Feline Asthma Clinical Signs: | Acute labored breathing, chronic cough possible wheeze, exercise intolerance. May be life threatening! |
| Feline Asthma Etiology | Allergies or irritants cause severe airway inflammation and narrowing. |
| Feline Asthma Supportive Care | Emergency Oxygen and Medications! Minimal handling/stress! Chronic bronchodilators, antibiotics, air purifiers, cortcosteroids. |
| Signs of Respiratory Distress Animal will assume posture to maximize airway size. | Flared nostrils. Open-mouth breathing with lips pulled back. Extended neck. Elbows away from body. Refusal to lay down. |
| Signs of Respiratory Distress Other Signs: | Signs of distress: (dilated pupils, tachycardia, tachypnea, dyspnea). Noisy breathing. Muddy or dusky mucous membranes. |
| Bronchitis (canine) Clinical Signs | Coughing, Tachypnea, Exercise intolerance |
| Bronchitis (canine) Etiology | Inflammation of the small airways, two or more causes may occur together: allergic, irritant, infectious - (bacterial, viral, mycoplasma, parasite). |
| Bronchitis (canine) Diagnosis | Radiographs, Cytology of transtracheal wash or BAL, Culture of wash |
| Bronchitis (canine) Supportive Care | Bronchodilators, Cough suppressant, Treat primary problem, Moist air/steam, Quit smoking |
| Bronchoalveolar lavage (BAL) | A diagnostic method of the lower respiratory system in which a bronchoscope is passed through the mouth or nose into an appropriate airway in the lungs, with a measured amount of fluid introduced and then collected for examination. |
| Pneumonia | Disease of alveoli causing formation of exudate and consolidation (alveolar collapse) |
| Pneumonia Clinical Signs | Productive cough, Nasal discharge, Fever, Dyspnea or tachypnea. |
| Pneumonia Etiology | Infection (bacteria, viral, parasite or fungal). Chemical burn (aspiration of vomit). Primary ______ is rare in adult dogs & cats so underlying cause should be searched for whenever ______ is diagnosed in an adult. |
| Pneumonia Diagnosis | Radiographs Transtracheal wash (cytology & culture) |
| Pneumonia Supportive Care | Treat primary disease. Maintain hydration. Nebulize. Coupage. |
| Pneumonia is best treated by ________ the productive cough. | encouraging (The lungs way of cleaning themselves) |
| Nebulize: | Expose animal to ultra fine water droplets to moisten small airways (humidifier is not as effective, water droplets are too large and land in nose). |
| Coupage: | Technique of slapping thorax with cupped hand over consolidated lung to encourage coughing and loosening debris; usually for 5-10 minutes after 10-15 min of nebulization. |
| Parasites True or False: there are many parasites which may invade the lungs during their life cycle. | True. Parasites that reach adult stage in lungs include lungworms: Aelerostrongylus, Filaroides, Crenosoma, Capillaria. Parasites that migrate thru lungs during their life cycle: Ascarids (roundworms), Trematodes (flukes), Ancyclostoma (hookworms). |
| Pulmonary Edema is defined as: | Accumulation of transudate (serum) in the lung tissue which impairs oxygen transport across alveoli |
| Pulmonary Edema Clinical Signs: | Coughing (soft, moist, especially at night). Tachypnea &/or dyspnea. Exercise intolerance. |
| Pulmonary Edema Etiology: | heart failure, electrocution, drowning, vasculitis, hypoalbuminemia |
| What is hypoalbuminemia? | Medical sign in which the level of albumin in the blood is low. Can be due to decreased production in the liver, increased loss in the gastrointestinal tract or kidneys, increased use in the body, or abnormal distribution between body compartments. |
| Define vasculitis: | Inflammation of the blood vessels. Happens when the body's immune system attacks the blood vessel by mistake. It can happen because of an infection, a medicine, or another disease. |
| Pulmonary Edema Diagnosis | Radiographs, History / Physical, Blood albumin level |
| Pulmonary Edema Supportive Care | Minimize Stress, Oxygen, Diuretics, Treat primary disease |
| Lung Tumors Primary neoplasia | Origination site is in the lungs, usually one discrete tumor. Surgery is curative in many cases. |
| Lung Tumors Metastasis | Origination site is in a different site and dozens of small tumors seed themselves into lung tissue because of its extensive capillary bed and ideal growing conditions. Extremely difficult to treat. |
| Lung Tumors Clinical Signs | Cough, Exercise intolerance, Weight loss |
| Lung Tumors Diagnosis | Radiographs are mainstay, but not all lung masses are tumors. R/o abscesses, fungal infections, cysts, FIP. Cytology or biopsies of nodules prior to sx. Histopathology of surgically removed tissue is essential for additional treatment and prognosis. |
| R/o | Rule out |
| What is Feline infectious peritonitis (FIP)? | A viral disease that occurs worldwide in wild and domestic cats. Caused by a coronavirus which tends to attack the cells of the intestinal wall. |
| Histopathology | the study of changes in tissues caused by disease. |
| Pleural Effusion | A generally term to describe and abnormal accumulation of fluid in the pleural space. It is important as a sign for the primary disease and because large amounts will impair ability to ventilate. |
| Pleural Effusion Purulent | (opaque, tan to yellow) Also called “pyothorax” caused by infection. Often both aerobic and anaerobic due to bite wounds or foreign bodies. |
| Pleural Effusion Chylous | (opaque, white to pink) Lymph, caused by trauma to thoracic duct or heart failure. |
| Pleural Effusion Transudate | (clear) Serum, due to tumor, vasculitis or heart failure |
| Pleural Effusion Hemorrhagic | (red to red-brown) Due to trauma, bleeding disorder or tumor. |
| chyle | A milky fluid consisting of fat droplets and lymph. It drains from the lacteals of the small intestine into the lymphatic system during digestion. |
| lymph | A colorless fluid containing white blood cells, which bathes the tissues and drains through the lymphatic system into the bloodstream. |
| Pleural Effusion Should always be evaluated by ________ to develop an ideal treatment strategy. | both culture and cytology |
| Pleural Effusion Clinical Signs | Shallow, rapid breathing with exaggerated abdominal movements. Possible cough, fever or chest pain. |
| Pleural Effusion Diagnosis | Imaging (radiographs or ultrasound). Thoracocentesis. |
| Pleural Effusion Supportive Care | Minimize Stess! Provide Oxygen. Remove pleural fluid ASAP. Treat primary disease. |
| Thoracocentesis | Place needle into pleural space to remove air/fluid. Can be diagnostic & therapeutic. Always sterile procedure! First draw samples evaluated by culture & cytology. Volume of air or fluid collected on each side needs to be measured and carefully recorded. |
| What does obstipation mean? | Severe or complete constipation. |
| Name four normal GI functions: | Digestion of ingredients. Absorption of nutrients. Move food through GI tract. Eliminate waste (undigested) or bi-products (bile acids, nitrogen). |
| Inappetence vs Anorexia | Decreased appetite vs Not eating at all |
| What are four normal GI functions? | Digestion of ingredients. Absorption of nutrients. Move food through GI tract. Eliminate waste (undigested) or bi-products (bile acids, nitrogen) |
| Gastrointestinal tract The Oropharynx is the: | connection of the mouth to the esophagus |
| Gastrointestinal tract Digestion begins in the: | mouth. Grinding of food by teeth. Saliva contains amylase to digest starch in some species. |
| Gastrointestinal tract Once in the stomach, food is further digested by: | Hydrochloric Acid (HCl) |
| Gastrointestinal tract True or false: little absorption of nutrients occurs in the stomach. | True |
| Gastrointestinal tract What is the region of the stomach that attaches to the esophagus? | Cardia |
| Gastrointestinal tract What is the region of the stomach that attaches to the small intestines? | Pylorus |
| Gastrointestinal tract Where does most digestion and absorption of nutrients occur? | small intestines |
| What are the three regions of the small intestines called? List them in order. | Duodenum, Jejunum, Ileum |
| They line the small intestine to maximize digestion and absorption by increasing surface area? | Villi |
| Gastrointestinal tract What is the main purpose of the large intestine (colon)? | Absorption of water. Empties into the rectum. Material exits the anus. |
| Liver & biliary tree What are three functions associated with the alimentary system? | Fat digestion and processing. Nutrient storage (Fat soluble vitamins: A, D, E, K), Copper, Iron. Detoxify blood from the GI tract. |
| Pancreas What are its exocrine (digestive) functions? | Make digestive enzymes and transport them and bicarbonate to the duodenum. |
| Pancreas What are two examples of enzymes it produces? | Amylase, Lipase |
| Esophageal Disease What are five clinical signs? | Dysphagia, excess salivation, regurgitation, anorexia, teeth grinding in the cat |
| Define Dysphagia. | Difficulty swallowing |
| Describe vomiting: | Retching (abdominal contractions). Bile-tinged fluid. Presence of digested food. Event occurs independent of eating or drinking. Signs of nausea: lip licking, and anorexia |
| Describe regurgitation: | No retching. Food or fluid “falls” out of mouth. Clear or foamy fluid. Food not digested. Event occurs shortly after eating or drinking (<20 minutes). Event triggered by exercise or excitement. |
| Esophagitis Etiology | Gastric reflux or severe vomiting. Caustic agent ingestion. Foreign body ingestion. |
| What does etiology mean? | The cause, set of causes, or manner of causation of a disease or condition. |
| Esophagitis Supportive Care | Don't induce vomiting if caustic agent ingested. Sucralfate: drug of choice to treat mucosa 3-4xday Treat underlying problem ASAP. Essential: Avoid scar tissue in esophagus to prevent stricture. Soft food diet. Liquid diet is low calorie/exacerbate reflux |
| Esophageal Foreign Body Clinical Signs | Hypersalivation. Exaggerated swallowing efforts. Anxious/painful. Anorexia. |
| Esophageal Foreign Body Etiology | Foreign object swallowed but unable to advance to the stomach (toys, bones, Greenies, rawhide). |
| Esophageal Foreign Body Diagnosis | History of foreign body ingestion. Physical Examination. Radiographs +/- barium swallow. Endoscope. |
| Esophageal Foreign Body Therapy | Endoscopic or Gastrotomy Retrieval. Aggressive therapy with Sucralfate and other drugs to treat/prevent esophageal ulcers. Surgical or endoscopic placement of gastric feeding tube may be indicated. |
| Esophageal Foreign Body Therapy: Important note | The DVM makes every effort to avoid surgery on the esophagus due to the high risk of stricture formation. Strictures cause severe problems with regurgitation and animal may starve! |
| What does esophageal stricture mean? | Abnormal narrowing of the esophageal lumen; it often presents as dysphagia commonly described by patients as difficulty swallowing. |
| Megaesophagus What is it? | The development of a flaccid esophageal wall with poor contractility. When visible on radiographs they may be greatly dilated with air or food. |
| Megaesophagus Clinical Signs | Regurgitation. Aspiration pneumonia (common). Weight loss. |
| Megaesophagus Etiology | Congenital, Hypoadrenocorticism, Severe Esophagitis, Neoplasia, and Idiopathic. |
| Megaesophagus Diagnosis | Radiographs +/- barium swallow |
| Megaesophagus Supportive Care | Treat primary problem when possible. Prevent aspiration pneumonia by hand feeding meatballs of food and maintaining dog in upright position for at least 20 minutes after meals. |
| Gastritis Clinical signs | Vomiting, Lip licking, Anorexia |
| Gastritis Etiology | Many specific causes are possible. General Categories include: Dietary, Infection, Toxin, Medication (NSAIDS, doxycycline, etc) |
| Gastritis Supportive Care | Support hydration status. NPO for 12 hours, no food for 24 hours. Then small meals frequently, “bland diet.” Commercial prescription diet is ideal i/d, or EN or Sensitive for 5 days. White meat chicken/white rice or poached egg/rice is alternative. Meds. |
| Gastritis Supportive Care: Important note | Further evaluation if does not rapidly resolve!!! |
| Gastric Ulceration Clinical Signs | Vomiting fresh blood or digested blood ("coffee grounds"), Anorexia, Lip licking |
| Gastric Ulceration Etiology | NSAID medications, caustic agents, neoplasia, foreign body, Helicobacter |
| Gastric Ulceration Supportive Care | Histamine blockers. Comfort medication (nausea/pain). Treat primary disease. |
| Gastric Dilation Volvulus (GDV) What is it? | A disorder in which the stomach distends with food or air and then twists on its axis at the esophagus. If complete, is fatal within hours if not aggressively treated. |
| Gastric Dilation Volvulus (GDV) Clinical Signs | Weakness/collapse, Restless/anxious, Enlarged "bloated" abdomen, Large Breed Dog (Deep chest), "Dry Vomiting" |
| Gastric Dilation Volvulus (GDV) Etiology | Exercise after a large meal is the most common trigger in the deep-chested dogs. Volvulus of stomach results in obstruction of blood supply to stomach/spleen. Tissue necrosis releases vast amounts of toxins. Death: shock, enterotoxins, heart arrhythmias |
| What does volvulus mean? | An abnormal rotation of the stomach of more than 180°, which creates a closed-loop obstruction that can result in incarceration and strangulation. |
| Gastric Dilation Volvulus (GDV) Supportive Care | Shock dose fluids. Immediate decompression of stomach. Pain medication. Anti-arrhythmia drugs(lidocaine). Surgical correction when patient is stabilized (must be maintained decompressed until surgery). Other care based on individual complications. |
| Gastric Dilation Volvulus (GDV) Diagnosis | Right Lateral radiograph! |
| Diseases of the Intestines Clinical Signs: Small Intestine | Large volume diarrhea 1-3x per day. “Tarry” appearance or other extreme color. Weight loss. Change in appetite. Borborygmi. |
| Diseases of the Intestines Clinical Signs: Large Intestine | Small volume diarrhea frequently >3x/day. Mucous on feces. Frank blood on feces. Straining to defecate. |
| Diseases of the Intestines Basic cause of diarrhea? | The balance between fluid secretion and fluid reabsorption by the intestines is disturbed. |
| Acute Diarrhea – Enteritis or Colitis Clinical Signs | Small or large bowel diarrhea. Otherwise normal. Animals that are lethargic, vomiting, very young or old, or have a fever should be evaluated fully. |
| Define enteritis: | Inflammation of the intestine, especially the small intestine, usually accompanied by diarrhea. |
| Define colitis: | A chronic digestive disease characterized by inflammation of the inner lining of the colon. |
| Acute Diarrhea – Enteritis or Colitis Etiology | Dietary indiscretion. Stress. Mild virus. |
| Acute Diarrhea Supportive Care | Support hydration status. NPO for 12 hours, no food for 24 hours, then small meals frequently, “bland diet.” Medication for symptoms. |
| Acute Diarrhea Supportive Care: Special Note | Further evaluation if does not rapidly resolve!!! |
| Acute Diarrhea Supportive Care: What is the "bland diet" | Commercial prescription diet is ideal: i/d, or EN or Sensitive for 5 days. w/d or Hifactor or OM for large intestine diarrhea. White meat chicken/white rice or poached egg/rice is alternative if cooking at home can add mini Wheats if indicated |
| Inflammatory Bowel Disease (IBD) What is it? | A disease complex (a collection of clinical signs) that may have many possible causes that varies from patient to patient. |
| Inflammatory Bowel Disease (IBD) Chronic Clinical Signs | +/- vomiting (may contain hair in cats), +/- diarrhea, +/- weight loss, +/- decreased appetite, +/- borborygmi |
| Gastrointestinal Health Gut Associated Lymphoid Tissue (GALT): What is it? | 70% of the body's immune system is in the digestive tract. Tonsils, Peyer’s Patches, Lymphoid aggregates in colon & esophagus, Diffuse lymphocytes & plasma, cells in lamina propria. |
| Gastrointestinal Health Gut Associated Lymphoid Tissue (GALT): Definition | Gut-associated lymphoid tissue (GALT) is a component of the mucosa-associated lymphoid tissue (MALT) which works in the immune system to protect the body from invasion in the gut. |
| Inflammatory Bowel Disease (IBD) Etiology | Many possible “triggers” for hyperstimulation of GI immune system: Food allergies, Infections (viral, bacterial, parasitic), Food intolerances (chemical intolerance), Genetic (Wheaten terrier, Irish setter, Shar pei), Other |
| Inflammatory Bowel Disease (IBD) Common secondary problems | Ulcers, Bacterial overgrowth, Gastric reflux |
| Inflammatory Bowel Disease (IBD) Diagnosis | Ultrasound, Endoscopy |
| Inflammatory Bowel Disease (IBD) Therapy: Step 1 - Diet Trial | Novel antigen. Hydrolyzed protein. Minimum 6 weeks duration. Calculate and confirm meeting calorie needs. May need to feed 4x/day. May need to feed 2x normal amount if malabsorption is present. |
| Inflammatory Bowel Disease (IBD) Therapy: Step 2 - Patient Comfort | Treat nausea. Treat acid reflux or ulcers. Treat inappetence. Treat all concomittent conditions: UTI, EPI (Exocrine Pancreatic Insufficiency), Dermatitis, Parasites. |
| Inflammatory Bowel Disease (IBD) Therapy: Step 3 - Treat GI Inflammation with immune system modifiers. | Important to taper drugs to lowest effective dose. May be needed for rest of animal’s life. |
| Inflammatory Bowel Disease (IBD) Therapy: Step 4 - Monitoring | Diary!! Weekly patient update. Recheck exam q. 2 weeks initially. |
| Intestinal Disease - Infectious Parasites | Common of animals <1 year old, exposure to young animals or immunosuppressed. Zoonotic potential. |
| Intestinal Disease - Infectious Bacterial | Occasional of young animals, certain breeds or immunosuppressed. Secondary to other conditions. Zoonotic potential. |
| Intestinal Disease - Infectious Viral | Common of young or unvaccinated animals. |
| Parasitic Diarrhea Clinical Signs | Large or small bowel. Unthrifty, pot-belly appearance. Hx: Poor care or raw diet. |
| Parasitic Diarrhea Diagnosis | Fecal centrifugation evaluation (3x). Giardia ELISA. Remember can have multiple species. |
| Parasitic Diarrhea Supportive Care | Maintain hydration. Very digestible diet (i/d or EN). Specific therapy for diagnosed parasite. Client education re: zoonotic issues. Reevaluation within 3 weeks. |
| Define unthrifty | not strong and healthy. |
| Viral Diarrhea Clinical Signs | Diarrhea with or without blood. +/- vomiting. +/- fever. Anorexia/ depression. Juvenile or unvaccinated. |
| Viral Diarrhea Etiology | Parvovirus, Distemper virus, Corona or others |
| Viral Diarrhea Diagnosis | Fecal parvo ELISA, Distemper titer (in unvaccinated), Leukopenia (CBC) |
| Viral Diarrhea Supportive Care | Isolation facilities! (Highly contagious diseases). Aggressive IV fluids and antibiotics (risk for sepsis). Comfort care (cleanliness, nausea, etc). Client education. |
| Viral Diarrhea Supportive Care: Specific Client Education | Potentially fatal diseases: Animals will be contagious for 6 weeks. Yards will be contagious for 6 months. |
| Isolation Procedures The Room | Utilized for suspect cases of URI, Parvo, Distemper, Ringworm, Salmonella, Leptospirosis, etc. Separate room with separate air exchange. One-way flow of traffic through hospital. Bleach in – Bleach out foot bath. |
| Isolation Procedures Equipment and Supplies | All items into Iso unit stay in unit or are discarded. Staff caring for isolated animals must wear gowns & gloves at all times in unit. Those items stay in unit. Minimal staff in unit. Separate supplies for each animal in isolation unit. |
| Isolation Procedures The animals | Dogs don't step on any surface people or animals will walk through. They should be carried out an alternative exit upon discharge. |
| What is Intussusception? | The telescoping of one bowel loop into another where it remains. This results in GI obstruction and damaged blood supply of the intestine. Most common in puppies with Parvo or similar GI disorder. |
| Intussusception Clinical Signs | Vomiting/diarrhea, Abdominal pain/ abdominal mass, Depression/shock |
| Intussusception Supportive Care | Aggressive IV fluids for shock. Aggressive IV antibiotics for sepsis. Surgical emergency. |
| Megacolon What is it? | A dysfunction of the motility of the colon allowing the accumulation of large quantities of feces to accumulate in the body. |
| Megacolon Etiology | Most commonly an inherited muscle abnormality in cats. Also can occur secondary to nerve damage, tumor or colon stricture in dog or cat. |
| Megacolon Clinical Signs | Straining to defecate/no bowel movements. Anorexia/dehydration. Vomiting is common secondary to straining. |
| Megacolon Diagnosis | Radiographs: large colon with no tone WHEN EMPTY. |
| Megacolon Supportive Care | Aggressive fluid therapy! Multiple warm water enemas (never phosphorous salts). Stool softeners. Soluble fiber diets. Motility drugs (i.e. cisapride). Often anesthesia for digital evacuation is required. Surgery to remove colon is sometimes indicated. |
| Anal Gland Abscess Clinical Signs | "Scooting," pain with defecation or sitting. Grooming perineum, open wound of perineum with foul odor. |
| Anal Gland Abscess Etiology | Glands do not drain into rectum in normal manner: inspissated material, chronic soft stool, tumor |
| What does inspissated mean? | thickened or congealed. |
| Anal Gland Abscess Supportive Care | Peri clip/clean. Empty anal glands digitally from INSIDE rectum. Systemic antibiotics. Infuse open wound w/ antibiotics. Client ed. After healed add insoluble fiber to diet: encourages glands to empty w/ defecation. Sx removal is occassionally indicated. |
| Perianal Fistulas What is it? | An immune disorder that causes painful chronic open wounds around the anus and in the rectum of dogs. |
| Perianal Fistulas Clinical Signs | Straining to defecate often with vocalization. Constipation. May need to sedate and clip perineum to see open wounds. German Shepard is the most commonly affected breed. |
| Perianal Fistulas Etiology | Immune system disorder, especially German Shepard & Border Collie. Food allergies. |
| Perianal Fistulas Supportive Care | Antibiotics for secondary infections. Immune modifiers (especially: Tacrolimus & Cyclosporine). Diet trial! Stool softeners and pain medication. Sx or tail amputation no longer recommended. |
| Liver & Biliary Tree What are the three functions associated with the alimentary system? | Fat digestion and processing. Nutrient storage: Fat-soluble Vitamins A, D, E, K, Copper & Iron, Glycogen (glucose storage). Detoxify blood from GI tract. |
| The Liver About how many biochemical functions does this organ carry out? | ~1500 |
| The Liver It has phenomenal functional reserve and ___ capabilities. | regenerative |
| The Liver True or False: Liver injury must be severe or strategic before hepatobiliary injury is recognized. | True |
| The Liver Clinical Signs of disease | Polydipsia, Jaundice, Inappetance, Lethargy, Neurologic signs, Vomiting, Uroliths |
| The Liver Evaluation: Radiogragh | Evaluate: liver size and shape and for pulmonary metastasis, Uroliths (Ammonium urate), Ascites. |
| The Liver Evaluation: Laboratory | Complete Blood Count (CBC), Chemistry Panel (ALT, AST, Bilirubin, Glucose, Albumin. Urinalysis: WBC, specific gravity, bilirubinuria, ammonium urate crystals, bacteria. |
| The Liver Further Evaluation | Bile Acid Study: Useful for long term monitoring of liver function. Useful screening test for Hepatic Shunts. Blood Ammonia: Screening test for hepatic encephalopathy (HE). Normal results do not exclude HE. |
| Hepatic Encephalopathy (HE) What is it? | A decline in brain function that occurs as a result of severe liver disease. In this condition, the liver can't adequately remove toxins from the blood. This causes a buildup of toxins in the bloodstream, which can lead to brain damage. |
| The Liver Evaluation: Abdominal Ultrasound | Useful for evaluation of tumors, ascites, and portal hypertension. Useful to guide hepatic aspirates and biopsies. |
| The Liver Evaluation: Hepatic Biopsies | Very useful diagnostic info. Wedge biopsies more accurate than ultrasound-guided-16 g 4 dogs. Samples should be cultured. Collect fresh frozen samples if special stains to be done. Evaluate clotting status prior to procedure. Evaluate PCV 4-6 hours post. |
| Specific Liver Disease Toxins and Drug Reactions | acetaminophen, griseofulvin, ketaconazole, tetracycline, trimethoprim sulfa, phenobarbital/primidone, carprofen (Rimadyl), halothane, aflatoxins, mushrooms |
| Specific Liver Disease: Toxins and Drug Reactions Decontaminate: Oral ingestion | Activated Charcoal: 1-3 g/kg by syringe feeding. Not indicated if caustic substance. Cathartics: Cause rapid bowel movements. Usually added to activated charcoal. Clears toxin from body. |
| Specific Liver Disease: Toxins and Drug Reactions Supportive Care: Aggressive IV Fluid Therapy | Treats dehydration. Treats shock. Speed toxin processing by body. Support vital organs. Especially kidneys and liver. |
| Specific Liver Disease: Toxins and Drug Reactions Supportive Care: Treat specific blood findings | Hypoglycemia. Anemia. Electrolyte abnormalities. Coagulation abnormalities. |
| Specific Liver Disease: Toxins and Drug Reactions Supportive Care: Treat Potential Problems | GI ulcers, Nausea |
| Specific Liver Disease Infectious | Viral (ex: Canine Hepatitis CAV-1). Leptospirosis. Diffuse bacteria or abscess (commonly anaerobe). Other: (fungal, toxoplasmosis, ricketsial). |
| Specific Liver Disease Neoplasia | Benign (hepatoma, adenoma)/hyperplasia Malignant (lymphoma, hemangiosarcoma, hepatocellular carcinoma, mast cell). |
| Specific Liver Disease Rickettsia | Any of a group of very small bacteria that includes the causative agents of typhus and various other febrile diseases in humans. Like viruses, many of them can only grow inside living cells, and they are frequently transmitted by mites, ticks, or lice. |
| Specific Liver Disease Inflammatory | Cholangiohepatitis complex: Suppurative (ascending bacterial?) - E.coli and Staphlococcus spp. Non-suppurative (immune-mediated?). Secondary inflammatory: Pancreatitis, heat stroke, Hemolytic Anemia, sepsis. |
| Specific Liver Disease Congenital | Portal Systemic Shunts (PSS): Havanese, Dandie Dinmont, Yorkie, Pug, Maltese, Microvascular Dysplasia. Storage Diseases: Glycogen, Mucopolysaccharides. |
| Specific Liver Disease Goals of treatment | Prevent progression/resolve disease. Provide optimum environment for hepatic recovery. Control disease complications: Hepatic encephalopathy, Coagulopathies, Anorexia / weight loss, Gastrointestinal ulcers, Ascites |
| Acute Treatment of Liver Disease Name four. | Intravenous fluids: use judiciously if hypoalbuminemic and consider plasma or hetastarch. Antiemetics. Ulcer medication. Nutritional Support: Extremely important. Protein restrict only if encephalopathic. |
| What are Antiemetics? | Drugs that interfer with the neurotransmitter receptors involved in vomiting. Neurotransmitters are the cells that receive the signals to send a nerve impulse. The pathways that control these bodily reactions are complex. |
| Specific Liver Disease Portosystemic Shunt | Congenital defect: the blood supply from the GI to the liver doesn’t develop properly and allows bacteria/toxins from the GI to enter the general circulation. The liver does not grow to proper size due to abnormal blood supply. |
| Specific Liver Disease Portosystemic Shunt: Breed Specific? | Common in Yorkies and Malteses, but can occur in any dog or cat breed. |
| Specific Liver Disease Portosystemic Shunt: Treatment? | Surgical correction if single extra-hepatic shunt. Ameroid or cellophane placement therapy of choice. 70-80% excellent result (Mehl, JAVMA June 2005). |
| Hepatic Lipidosis What is it? | Can occur in any cat but most commonly occurs in obese cats. Disease is triggered by anorexia (3 days or more). Stored fat rushes to the liver for processing and causes acute liver failure. |
| Hepatic Lipidosis Clinical Signs | Jaundiced mucous membranes/sclera. Drooling. Depression/anorexia. Overweight (or prior overweight) cat. |
| What is sclera? | The white outer layer of the eyeball. At the front of the eye it is continuous with the cornea. |
| Hepatic Lipidosis Diagnosis | Elevated AP and bilirubin. Cytology of liver. |
| Hepatic Lipidosis Supportive Care | Aggressive Nutritional Support! Must calculate DER/provide the calories. High protein diets optimal. Gastrotomy (PEG) tubes usually optimal tx. Treat underlying cause of anorexia! Requires committed owner. Feed/Care for PEG about 5x/day for 2-6 weeks. |
| What is a PEG? | Percutaneous endoscopic gastrostomy: a endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate. |
| Gall bladder Disease Name four possible causes: | Infection. Inflammation. Mucoceole: Gelatinous mass of secretions due to inflammation. May cause obstruction or gall bladder rupture. Surgical emergency. Choleliths: “Gall stones” – rare in dogs and cats. |
| Pancreatitis (Canine) Clinical Signs | Vomiting/ anorexia. Abdominal pain/ shock. Fever. History of high fat meal. Colitis. |
| Pancreatitis (Canine) Etiology | Trigger causes inappropriate activation of digestive enzymes inside pancreas: High fat meal, Toxin/Meds, Trauma, Tumor. |
| Pancreatitis (Feline) Clinical Signs | 40 cats w/ severe Acute Pancreatitis: Lethargy(100%), Inappetance(97%), Dehydration(92%), Hypothermia(68%), Vomiting(35%) Abdominal pain(25%), Abdominal mass (23%). |
| Pancreatitis (Feline) Etiology | NOT associated with diet. Secondary to inflammation such as IBD or hepatitis most common. Trauma. Neoplasia. Infection. |
| Pancreatitis Diagnosis | Blood tests – amylase, lipase, PLI (Pancreatic Lipase Immunoreactivity). Ultrasound (not accurate in cats). |
| Pancreatitis Supportive Care | Aggressive IV fluids. Pain control. Nausea control. Dogs: NPO until blood tests normal. Cats: Aggressive feeding high protein to prevent hepatic lipidosis. |
| Exocrine Pancreatic Insufficiency (EPI) Etiology | Chronic pancreatitis most common. Idiopathic acinar atrophy (esp. German Shepherd). |
| Exocrine Pancreatic Insufficiency (EPI) Pathogenesis | Lack of digestive enzymes -> maldigestion. Disturbances of intestinal transport. Hypovitaminosis of fat soluble vitamins. |
| Exocrine Pancreatic Insufficiency (EPI) Diagnosis: Clinical Signs | (90% acinar lost) Chronic polyphagia, diarrhea, weight loss |
| What are acinar? | Cell that is the functional unit of the exocrine pancreas. It synthesizes, stores, and secretes digestive enzymes. Under normal physiological conditions, digestive enzymes are activated only once they have reached the duodenum. |
| What is Polyphagia? | Or Hyperphagia, is the medical term for excessive or extreme hunger. |
| Exocrine Pancreatic Insufficiency (EPI) Diagnosis: Lab Results | TLI < 8ug/l. Cobalamin. Folate. FPA: fecal proteolytic activity. |
| Exocrine Pancreatic Insufficiency (EPI) Treatment | Pancreatic Enzyme Supplementation. Cobalamin. Vitamin K if prolonged PTT. Treat diabetes mellitus if present. Treat IBD if present. Avoid high fiber or low fat diets. |
| Retroperitoneal | situated or occurring behind the peritoneum. |
| Peristalsis | The involuntary constriction and relaxation of the muscles of intestinal or urinary canals, creating wave-like movements that push the contents of the canal forward. |
| Nephron | The microscopic structural and functional unit of the kidney. It is composed of a renal corpuscle and a renal tubule. The renal corpuscle consists of a tuft of capillaries called a glomerulus and an encompassing Bowman's capsule. |
| Acute | Of abrupt onset, in reference to a disease. Often also connotes an illness that is of short duration, rapidly progressive, and in need of urgent care. |
| Chronic | (of an illness) Persisting for a long time or constantly recurring. |
| Incontinence | lack of voluntary control over urination or defecation. |
| FLUTD- Feline Lower Urinary Tract Disease | |
| Idiopathic | Relating to or denoting any disease or condition which arises spontaneously or for which the cause is unknown. |
| Ventroflexion | ventral flexion of the head. |
| Hypotension | Medical term for low blood pressure (less than 90/60). A blood pressure reading appears as two numbers. The first and higher of the two is a measure of systolic pressure, or the pressure in the arteries when the heart beats and fills them with blood. |
| Hypertension | High blood pressure. It can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death. Blood pressure is the force that a person's blood exerts against the walls of their blood vessels. |
| Urohydropulsion | The act of using a liquid to expel something from the urinary tract. More specifically, we are using a physiologic solution in the bladder to remove urinary bladder and urethral stones. |
| Hematuria | The presence of blood in urine. |
| Renomegaly | Enlargement of the kidney. |
| Pyelonephritis | A type of urinary tract infection (UTI) that generally begins in your urethra or bladder and travels to one or both of your kidneys. A kidney infection requires prompt medical attention. |
| Cystocentesis | Puncture of the bladder of an animal, through the abdominal wall, in order to obtain a sample of urine. |
| Cystitis | Inflammation of the urinary bladder. It is often caused by infection and is usually accompanied by frequent painful urination. |
| Urolithasis | The formation of stony concretions in the bladder or urinary tract. |
| Nephrotoxin | A substance that is damaging or destructive to the kidneys. |
| Polyuria | Production of abnormally large volumes of dilute urine. |
| Oliguria | The medical term for a decreased output of urine. |
| Pollakiuria | Frequent, abnormal urination during the day. |
| Anuria | No urine production. |
| Proteinuria | Excess protein in the urine. |
| Dysuria | Painful or difficult urination. |
| Azotemia | An elevation of blood urea nitrogen (BUN) and serum creatinine levels. |
| Upper Urinary Tract Kidneys | Are close to the dorsal midline in the retroperitoneal space. Righty tighty, lefty loosey and sometimes last. |
| Upper Urinary Tract Ureters | Move urine from each kidney to the urinary bladder via peristalsis. |
| Upper Urinary Tract Renal Artery | Comes directly from the aorta- large amount of blood filtered each minute. |
| Upper Urinary Tract Name four parts of a kidney: | Capsule, cortex, medulla, pelvis |
| Upper Urinary Tract What are five functions of the kidneys? | Remove waste from blood. Recover useful metabolites. Regulate body fluids. Regulate electrolytes. Produce hormones. |
| Normal Kidney Function - Removes waste products from blood. Name three. | Urea (BUN): a by-product of dietary protein. Creatinine: a by-product of muscle metabolism. Drugs & Toxins. |
| Normal Kidney Function - Recovers useful metabolites. Name two. | Glucose. Amino acids. |
| Normal Kidney Function - Regulates body fluids. How does it do this? | 40 mL/minute fluid goes through the glomerulus. Reabsorbs 99% of fluid in tubule. |
| Normal Kidney Function - Regulates electrolytes and blood pH. Name five electrolytes. What is one important element in regulating blood pH? | Sodium, phosphorous, calcium, chloride, potassium. Hydrogen. |
| Normal Kidney Function - Produces Hormones Name two and what they do. | Renin: regulates blood pressure. Erythropoeitin: regulates red cell production. |
| Name six structures that make up a nephron. | Glomerulus, Bowman's Capsule, Proximal Tubule, Loop of Henle, Distal Tubule, Collecting Duct |
| Lower Urinary Tract Disease What are five common clinical signs? | Dysuria. Polakyuria. Hematuria. Inappropriate urination. Excessive grooming of genitals. |
| Feline Urinary Tract Disease - FLUTD Also called? What is it? | Feline Urologic Syndrome (FUS), Feline Cystitis, Feline Idiopathic Cystitis, or Feline Interstitial Cystitis. Clinical signs that might be caused by one of several etiologies. |
| What are the top three causes of FLUTD. What is the least common? | Feline Idiopathic Cystitis, Urolithiasis, Anatomic Defects. Infection (bacterial, viral) |
| Idiopathic Cystitis What are three common clinical signs? | Cats present w/ signs of lower urinary tract disease: urinating small amounts in abnormal places (sink). Commonly seen in patient history. NSF on PE except a small firm urinary bladder: due to extreme wall thickening. Urinalysis = hematuria |
| Idiopathic Cystitis Etiology: | Unknown. Theories include: viral infection, neurologic disorder of urinary bladder, abnormality in GAG layer of bladder mucous. |
| Idiopathic Cystitis Diagnosis: | Exclusion: after performing UA, bladder imaging and urine culture. |
| Idiopathic Cystitis Supportive Care | Pain relief. SQ fluids: dilute urine via diet. Minimize stress (do not change diets frequently). No antibiotics. |
| Urolithasis (feline) What is it? | Is the formation of urinary calculi anywhere in the urinary tract. If formed in the bladder or urethra, presents with signs consistent with lower urinary tract disease. |
| Urolithasis (feline) What causes it? Why is it a problem? | Minerals or proteins precipitate in the urine as crystals which adhere to form stones. The uroliths cause irritation of the bladder lining, can be a nidus for infections and cause obstruction in the urinary tract. |
| Define nidus. | A place in which bacteria have multiplied or may multiply; a focus of infection. |
| Urolithasis (feline) True or False: Urethral obstruction is life-threatening emergency of males cats. | True. The distal urethra becomes obstructed with uroliths or a mucous plug and the cat is physically unable to urinate. |
| Urolithasis - Urethral Obstruction Renal failure occurs within __ hours of obstruction. | 24 hours |
| Urolithasis - Urethral Obstruction Death will occur within ____ days if obstruction and renal failure are not treated. | 3-5 |
| Urolithasis - Urethral Obstruction Owners will often call in describing the cat as "______." Any calls with this complaint should be treated as an immediate emergency. | constipated |
| Feline Uroliths Etiology | Diet, concentrated urine, metabolic disorder |
| Feline Uroliths Diagnosis | Urinalysis (UA), Imaging (ultrasound better than rads), Urolith analysis. |
| Feline Uroliths Supportive Care | Nutritional management, surgery, or Urohydropulsion. |
| Feline Uroliths Struvite Predisposition Characteristics | Younger cat, obese, neutered, alkaline urine pH |
| Feline Uroliths Calcium oxalate Predisposition Characteristics | Older cat, obese, neutered, breed (Persian, Burmese, Himalayan), acidic urine pH, male |
| Urolith Prevention - Increased Water & Urine Volume Describe three means of accomplishing this: | Canned food, cold or running water, clean litter pan |
| Canine Uroliths Etiology | Triggered by urinary tract infections (very common in dogs). Improper diet (Breed associated). Liver failure. Concentrated urine with high mineral content. |
| Canine Uroliths Diagnosis | Urinalysis (UA), imaging (ultrasound better than rads), urolith analysis |
| Canine Uroliths Supportive Care | Nutritional management, surgery, or Urohydropulsion |
| Canine Uroliths Struvite | Usually associated with infection |
| Canine Uroliths Ca Oxalate | Breed predisposition |
| Canine Uroliths Ammonium Urate | Improper ammonia processing by the liver leads to high uric acid secretion in the urine. Dalmantions (espeically males), English bulldog, and other breeds. Liver failure: especially animals with portacaval shunt (or portal caval shunt) |
| Canine Uroliths Types: name five. How to identify. | Silica, Cystine, Xanthine, Calcium Phosphate, Mixed (common). It is NOT possible to accurately visually identify them. If a "guess" of urolith is made and it is incorrect, inappropriate therapy will be administered and progression will worsen. |
| Urolith: Therapy Goals Name and briefly describe three: | Identify urolith type. Dissolve uroliths (Struvite only) or remove them. Prevent recurrence. |
| Urolith: Therapy Goals How do we prevent recurrence? Describe four methods. | Treat infection if present. Target appropriate pH. Target appropriate precursors (diet). Increase water intake and promote dilute urine. |
| Urinary Incontinence Diagnosis & Therapy Specific to Cause | Urinalysis with culture. Dilute urine must be excluded. All infections must be resolved before advanced studies. Medical or Surgical. |
| Urinary Incontinence What are three advanced studies? | Intravenous Pyelogram/Cystourethrovaginogram. Endoscopy. Urethral pressure profile. |
| Urinary Incontinence True or False: severe arthritis in the spine may cause urinary incontinence. | True |
| Upper Urinary Tract Disease What is urine? | Mostly water. Urine concentration: measured by specific gravity. Pure water = 1.000. Isosthenuria = 1.010-1.012. Normal urine = +/- 1.025. Nitrogen waste products: Urea, ammonia, uric acid. Creatinine. Electrolytes & Minerals. Drugs & Toxins. |
| Upper Urinary Tract Disease Renal Disease | Kidneys are unable to excrete adequate urea and other substances which accumulates as an internal poison. Kidneys are unable to perform other metabolic functions. |
| Upper Urinary Tract Disease Acute Renal Failure: Define. | Abrupt decrease in glomerular filtration causing azotemia (elevated BUN). |
| Upper Urinary Tract Disease Acute Renal Failure: Clinical Signs | Polyuria or inadequate urine production. Vomiting/Anorexia. Dehydration. Possible: fever or kidney pain/enlargement. |
| Upper Urinary Tract Disease Acute Renal Failure: Etiology | Hypotension (anesthesia, dehydration, hemorrhage, Addisons), Toxin or Drug, Infection, Urinary obstruction (urolith or lymphoma) |
| Upper Urinary Tract Disease Acute Renal Failure: Diagnosis | Urnialysis (specific gravity, casts, WBC) with culture, Imaging (ultrasound usually preferred), Hx of toxin or hypotension etc, Serology, biopsy. |
| Upper Urinary Tract Disease Nephritis: Define | Inflammation of the kidney. Pyelonephritis is infection of the collecting system. |
| Upper Urinary Tract Disease Glomerulonephritis | Inflammation of the glomerulus: Immune-mediated, infection, toxin |
| Upper Urinary Tract Disease Toxins: Name four. | Ethylene glycol (antifreeze), Easter Lily, Medications (esp if dehydrated): NSAIDS or Antibiotics (Gentamycin), heavy metals: Zinc, Mercury, etc. |
| Acute Renal Disease Therapy Goals: Describe three. | Slow or reverse underlying cause: aggressive IV fluids, treat infections/remove toxins. Reduce work of the kidneys: low protein diet, remove drugs of renal excretion. Reduce clinical signs: anti-nausea; ulcer therapy, pain relief (opiates only). |
| Chronic Renal Failure What is it? | Renal failure than occurs over months or years. A cure is not possible due to scar tissue formation. The body has time to compensate and supportive care may improve quality and extend life for a considerable period of time. |
| Chronic Renal Failure Clinical Signs: | Polyuria/Polydipsia (PU/PD), may be asymptomatic, weakness (anemia and azotemia), weight loss, vomiting/inappetence. |
| Chronic Renal Failure Etiology | Any disease that causes acute failure. May become chronic failure if the animal survives. Chronic infection. Aging (?) |
| Chronic Renal Failure Consequence? | Chronic renal failure can lead to may lead to other problems (secondary problems). |
| Chronic Renal Failure Secondary Problems: Name five. | GI ulcers, non-regenerative anemia, hypertension, osteopenia, neurologic signs. |
| Chronic Renal Failure What is Osteopenia? | Reduced bone mass of lesser severity than osteoporosis. |
| Chronic Renal Failure Supportive Care: Name nine in priority order. | Maintain hydration/correct electrolytes. Treat hypertension, if present. Comfort (nausea, ulcers, appetite). Treat chronic infections. Low protein, high quality diet. Phosphorous binders. Treat anemia if PCV < 21. Cobalamin therapy. Calcitriol therapy. |
| Chronic Renal Failure Name three secondary clinical signs: | Blindness (caused by hypertension), ventroflexion caused by hypokalemia, ulcers on tongue. |
| Endocrine System What are two functions of this system? | Internal communication system utilizing chemicals called hormones. Feedback loop: communication moves from endocrine organ to target tissue and back to endocrine organ. |
| Endocrine Organs Name six: | Pituitary gland, thyroid glands, parathyroid glands, adrenal glands, pancreas, ovaries & testes. |
| Pituitary Gland "The Master Gland" gives directions to ___ ___ ___. What is another name for it? Where is it located in the body? | other endocrine glands. Hypophysis. Ventromidline of the brain. |
| Pituitary Gland Is divided into two regions. Name them. | Anterior pituitary (lobe): Adenohypophysis. Posterior pituitary (lobe): Neurohypophysis. |
| Pituitary Gland Hormones of the Adenohypophysis (6): | ACTH (Adreno-cortico-tropic Hormone), FSH (Follicle-stimulating Hormone), Growth Hormone (GH), Luteinizing Hormone (LH), Prolactin, Thyroid-Stimulating Hormone (TSH). |
| Pituitary Gland Hormones stored in the Neurohypophysis(2): | Antidiuretic Hormone (ADH), Oxytocin (OT) |
| Thyroid Glands Location? How many lobes? What do they secrete(2)? | Ventrolateral to trachea/Caudal to larynx. Two. Thyroxine (T4) & Calcitonin. |
| Thyroid Glands Normal Functions (2)? | Production of T3 and T4 (thyroxine) and production of Calcitonin. |
| Thyroid Glands T3 & T4 (Thyroxine) are: | Iodine-containing hormones that adjust metabolic rate in response to TSH from the pituitary (specifically the adenohypophysis/anterior pituitary lobe). |
| Thyroid Glands Calcitonin: | decreases blood calcium level and facilitates storage of calcium in bone. |
| Diseases of the Thyroid Glands Hypothyroidism: what is it? | Common disease of dogs, uncommon in cats. |
| Diseases of the Thyroid Glands: Hypothyroidism Etiology | Thyroid atrophy or thyroiditis. |
| Diseases of the Thyroid Glands: Hypothyroidism Clinical signs: | Weight gain on a stable diet. Endocrine alopecia. Lethargy. Heat-seeking. |
| Diseases of the Thyroid Glands: Hypothyroidism Endocrine Alopecia | Bilateral Symmetric Flank Alopecia. "Rat tail" Hyperpigmentation of the skin. Dry coat & Excess shedding. Loss of curl (poodles). |
| Diseases of the Thyroid Glands: Hypothyroidism Diagnosis: | Blood evaluation: test of choice is fT4 and TSH. T4 and clinical signs without thyroid panel might misdiagnose Euthyroid Sick. |
| Diseases of the Thyroid Glands: Hypothyroidism Treatment | Thyroid replacement hormones life-long. Dose should be monitored with blood tests. |
| Diseases of the Thyroid Glands: Hypothyroidism Name four aspects of thyroid axis that can be evaluated: | T4, fT4, TSH, Thyroglobulin antibodies. |
| Diseases of the Thyroid Glands: Hypothyroidism What is Euthyroid Sick? | Body's NORMAL response to illness. Lowering T4 in illness protects animal from weight loss, muscle wasting, and hypertension. These animals shouldn't be treated w/ thyroid medication. If primary health problem is resolved, thyroid will return to normal. |
| Diseases of the Thyroid Glands: Hypothyroidism Clinical Signs in the dog: | Flank alopecia. Overweight (minimal calorie intake). "Tragic" facial expression. Heat seeking. Lethargy. Infertility. |
| Diseases of the Thyroid Glands: Hyperthyroidism What is it? | Very common in senior cats, extremely rare in dogs. |
| Diseases of the Thyroid Glands: Hyperthyroidism Etiology | Functional thyroid adenoma tumor. Adenoma are benign tumors formed from glandular structures in epithelial tissue. |
| Diseases of the Thyroid Glands: Hyperthyroidism Clinical Signs: | Weight loss with excellent appetite (polyphagia). Vocalizing/behavior change. Tachycardia. Thyroid nodule. Vomiting/Diarrhea. Hypertension. |
| Diseases of the Thyroid Glands: Hyperthyroidism Clinical Signs: Secondary | Retinal hemorrhage due to hypertension. Hypertension = systolic > 150. Treat > 180 mm Hg |
| Diseases of the Thyroid Glands: Hyperthyroidism Diagnosis | Elevated T4!!! Thyroid nodule. Thyroid Scintigraphy. |
| Diseases of the Thyroid Glands: Hyperthyroidism What is Scintigraphy? | A technique in which a scintillation counter or similar detector is used with a radioactive tracer to obtain an image of a bodily organ or a record of its functioning. |
| Diseases of the Thyroid Glands: Hyperthyroidism Therapy | Surgery: curative, invasive on senior cat. Methimazole: medication given twice daily for the rest of the animal's life. Needs monitoring of liver + bone marrow. Radioactive Iodine (I131): Curative, but cat is radioactive for 7-14 days. Special handling. |
| Diseases of the Thyroid Glands: Hyperthyroidism New Therapy? | Therapeutic diet: iodine restriction. Controversial because low iodine or high soybean based diets may be causative to hyperthyroid tumors. More research needed. |
| Diseases of the Thyroid Glands: Hyperthyroidism Additional Therapy | Ultrasound guided alcohol injection into thyroid tumor. Experienced radiologist needed! |
| Pancreas What are it's two roles within the body? | Exocrine pancreas: digestive enzymes. Endocrine pancreas: glucose homeostasis through insulin and glucagon. |
| Pancreas Insulin's function: | lowers blood sugar by moving sugar into cells. |
| Pancreas Glucagon's function: | raises blood sugar by activating liver gluconeogenesis. |
| Pancreas: Diabetes mellitus What is it? | Inadequate secretion or utilization of insulin resulting in a disorder of carbohydrate metabolism. |
| Pancreas: Diabetes mellitus Diagnosis: | Clinical signs: polydipsia/polyuria, polyphagia, weight loss, lethargy, weakness, unkept appearance, plantigrade stance (walking on the soles of the feet, like a human. Instead of on toes.), sudden cataracts, obtunded. |
| Pancreas: Diabetes mellitus What is obtundation in a patient? | A state similar to lethargy in which the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states. |
| Pancreas: Diabetes mellitus Clinical Pathology (2) | Persistent hyperglycemia: if "stress" artifact concern, elevated serum fructosamine is confirmatory. Blood insulin level not usually helpful. Glucosuria: serum glucose >280 mg/dl. |
| Pancreas: Diabetes mellitus Type I | Diabetes mellitus in dogs. An absolute lack of insulin production. |
| Pancreas: Diabetes mellitus in dogs Type I: Predisposing Factors? | Genetics, Pancreatitis, Endocrine disease, Obesity |
| Pancreas: Diabetes mellitus in dogs Type I: Risk Factors | Breeds at increased risk: Poodles, Schnauzers, Keeshonds, Dachshunds. History: of Severe Pancreatitis. |
| Pancreas: Diabetes mellitus in cats Type II | Relative decrease of insulin (tissues are less sensitive). |
| Pancreas: Diabetes mellitus in cats Type II: Predisposing Factors | Pancreatitis, Certain medications, Obesity, Obesity, Obesity! |
| Pancreas: Diabetes mellitus in cats Let's look at percentages: | 35% of cats are obese: Middle aged, neutered males high risk. 60% of obese cats become diabetic. Five-fold increase in last 30 years! Carbohydrate-based diets? Hypersecretion of Insulin: Defective insulin action. |
| Pancreas: Diabetes mellitus in cats Oral Hypoglycemics | Sulfonylurea drugs (glipizide, glimiperide). Directly stimulate B cells to produce insulin. Not a therapy option in dogs. Adverse reactions (liver damage) in some cats. Generally do not work well in veterinary medicine. |
| Pancreas: Diabetes mellitus in cats Insulin Therapy Goals | Maintain blood glucose between 100 - 300 mg/dl. Sustain ideal body weight. Resolution of neuropathies. General well-being of pet (and owner). |
| Pancreas: Diabetes mellitus in cats Diet Therapy | High fiber vs. high protein. Dogs do best on high fiber (low fat diets). Some cats do best on high protein other cats do better on high fiber (if causes weight loss in obese animals). |
| Pancreas: Diabetes mellitus in cats Exercise | Goal: Correct obesity. Decrease insulin requirements. Improve muscle tone. Should be consistent on daily basis. |
| Pancreas: Diabetes mellitus Diabetic Ketoacidosis is: | A serious complication of diabetes which is fatal if untreated. Clinical signs: ketonuria & metabolic acidosis, profound dehydration, hyperglycemia, electrolyte derangement, lethargy, vomiting, weakness, Kussmaul breathing, stupor, hyperosmolar coma |
| Pancreas: Diabetes mellitus Insulin Overdose: Causes? | Too much insulin administered. Animal is not eating or is vomiting. Animal is getting increased exercise. Animal's needs change (cats can become non-diabetic after a few months of treatment) |
| Pancreas: Diabetes mellitus Insulin Overdose: Consequences? | Hypoglycemia (and possible hypokalemia): weakness, disorientation, seizures, coma. |
| Pancreas: Diabetes mellitus Insulin Overdose: Treatment? | Feed animal if swallowing well. Syrup on gums (corn syrup, honey, maple syrup). IV glucose support until normalization. |
| Pancreas: Insulinoma What is it? | Functional tumor of the pancreatic B cells leading to excess secretion of insulin and chronic, severe hypoglycemia. |
| Pancreas: Insulinoma Clinical signs | Weakness, collapse, disorientation, seizures |
| Pancreas: Insulinoma Treatment | Surgical removal or medical support. (These are malignant tumors). |
| Adrenal Glands Location? Name two regions within these glands. | Cranial to each kidney. Adrenal medulla & Adrenal cortex. |
| Adrenal Glands Adrenal Medulla | Epinephrine & Norepinephrine. Signal from sympathetic nervous system. "Fight or Flight" magnification. |
| Adrenal Glands Adrenal Cortex | Secretes Corticosteroids (cortisol) & ACTH (Adrenocorticotropic hormone): Pro, Antiinflammatory, chronic stress (i.e. starvation). Con, lowers the immune system function, muscle mass, and causes polyuria/polydipsia (PU/PD) |
| Adrenal Glands Adrenal Cortex: Minerolocorticoids | Aldosterone: conserves Na+ and water in the kidney to maintain blood pressure. Signaled by renin release by kidney as part of a hormone cascade. |
| Adrenal Glands Hypoadrenocorticism | Also called Addison's Disease |
| Adrenal Glands: Hypoadrenocorticism: Addison's Etiology | Insufficient production of glucocorticoids and mineralocorticoids. |
| Adrenal Glands: Hypoadrenocorticism: Addison's Clinical signs: May be vague | Intermittent vomiting and diarrhea. Weakness. Polydipsia/Polyuria. Bradycardia. Endocrine coat pattern. |
| Adrenal Glands: Hypoadrenocorticism: Addison's Clinical signs: May be severe | Collapse. Renal Failure. Megaesophagus. |
| Adrenal Glands: Hypoadrenocorticism: Addison's Possible blood changes(4)? | Non-regenerative anemia. Low glucose. Low sodium/high potassium. Low white blood count. |
| Adrenal Glands: Hypoadrenocorticism: Addison's ACTH Stimulation Test | Test of choice. Sometimes evaluates hyperadrenocorticism. Blood drawn, ACTH given IV or IM, blood drawn 30min – 2 hours post (depends on species), and blood evaluated for cortisol and possible aldosterone & sex hormones. |
| Adrenal Glands: Hypoadrenocorticism: Addison's Therapy: If severe acute: | IV fluids, electrolyte correction, glucocorticoids |
| Adrenal Glands: Hypoadrenocorticism: Addison's If chronic: | Mineralocorticoid replacement: Percortin (IM every 3 weeks), Florinef PO twice a day. Glucocorticoid replacement. |
| Adrenal Glands: Hyperadrenocorticism | Also called Cushing's Syndrome |
| Adrenal Glands: Hyperadrenocorticism: Cushing's Etiology | Excess cortisol in the body: pituitary tumor (most common), adrenal tumor, iatrogenic |
| Adrenal Glands: Hyperadrenocorticism: Cushing's Clinical Signs | Polyuria/polydipsia (PU/PD), Urine sp. Gr. <1.015, Panting, Abdominal fat, Hair coat changes, Elevated AP (Alkaline phosphatases-a liver enzyme). |
| Adrenal Glands: Hyperadrenocorticism: Cushing's Common sequelae (a condition that is a consequence of a previous disease or injury) | Hypertension. Chronic infections. Pancreatitis. Diabetes mellitus. Heart Failure. Cruciate ligament rupture. |
| Adrenal Glands: Hyperadrenocorticism: Cushing's Diagnosis | Low Dose Dexamethasone Suppression Test (LDDS): Baseline blood drawn, pet given IV dexamethasone, blood drawn again 4 hr & 8 hr later, all blood submitted for cortisol level, most sensitive test for Cushing's. False (+) if pet ill with other disease. |
| Adrenal Glands: Hyperadrenocorticism: Cushing's Therapy | Surgical removal of adrenal tumor if present. Medical: Chemotherapy to shrink hyperplasia of adrenals: opDDD (Lysodren). Chemical interference with excess steroid production: Trilostane & Melatonin. |
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