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240 Cards in this Set
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T/F you should encourage deep breaths during thoracic auscultation
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true.
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what posture facilitates breathing best in dogs and cats?
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dogs - sitting
cats - sternal elbows abducted in both |
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what are 5 NON-respiratory causes of respiratory signs?
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excitement/pain
acid/base abnormalities cushings hyperthyroid anemia heart disease |
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cardiac vs. respiratory signs:
dyspnea cyanosis HR heart |
short term ...chronic
short term....chronic fast HR........slow HR murmur......big sinus arrhythmia |
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what are some options for localization of resp disease when diagnosing?
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nasal
upper airway lower airway parenchymal pleural |
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discharge
epistaxis stertor sneezing facial deformity sounds like ____ disease |
nasal
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exercise intolerance
heat intolerance voice change noisy breathing stridor sounds like _______ disease |
laryngeal
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cough
dyspnea hypoxemia exercise intolerance resp noise sounds like _____ disease |
tracheal
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paradoxical breathing movement implies _________ disease.
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laryngeal
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what are some tracheal disease dx techniques?
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PE
rads fluoroscopy art blood gas |
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cough
dyspnea hypoxemia exercise intolerance resp noise sounds like ______ disease |
bronchopulmonary
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what are 2 big dx measurements for bronchopulmonary disease?
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pulsox
art blood gas |
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what exactly does pulsox measure?
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oxyhemoglobin content of perfused tissues
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pulsox is cheap and easy. that's good. what are a few disadvantages?
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incomplete info about pulm fxn
affected by perfusion and blood color changes only linear at a PaO2 over 70 |
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art blood gas:
what value measures ventilation? "" ability of lung to oxygenate blood |
ventilation = CO2
lung ability = O2 |
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T/F Hb saturation is indirectly related to pO2
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FALSE.
directly related |
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what do you need to correct ABG for?
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body temperature
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what can you do to assess pulmonary lesions, pleural space disease, resectability?
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thoracoscopy
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what is the MAJOR GOAL of treating respiratory disease?
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maintain O2 delivery to tissues
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cyanosis
tachypnea open-mouth breathing tachycardia are indications for what? |
oxygen therapy
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what are 5 causes of hypoxemia?
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decreased O2 intake
hypoventilation diffusion barrier problem V/Q mismatch shunt |
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what can you do to evaluate hypoxemia?
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alveolar-arterial gradient
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over what time frame should you discontinue oxygen therapy?
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taper off over 24-48 hours
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what is coupage?
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cupping the hands and percussing the thorax
loosens secretions stimulates productive cough |
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what 2 classes of drugs are bronchodilators?
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b2 agonists like terbutaline and albuterol
methylxanthines like theophylline |
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what are 3 antitussive drugs?
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morphine
codeine hydrocodone |
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what is the main mucolytic drug?
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acetylcysteine
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what are 3 respiratory decongestants?
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ephedrine
phenylephrine pseudoephedrine |
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nasal disease is usually acute or chronic?
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chronic
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what are 2 ruleouts with nasal disease?
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oral disease
bronchopulmonary disease |
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what do you want to do BEFORE any invasive procedures when diagnosing nasal disease?
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rads/CT
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what needs to be remembered when doing a nasal flush?
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block off the caudal nasopharynx
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brachycephalic dog with stertor and inspiratory dyspnea.
what are you thinking? |
stenotic nares
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5 ddx for nasal discharge in a DOG
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tumor
FB fungal rhinitis LC-PC rhinitis dental disease |
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6 ddx for nasal discharge in a CAT
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viral rhinitis
chlamydia fungal rhinitis tumor FB cuterebra |
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4 ddx for epistaxis
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neoplasia
fungal rhinitis hypertension coagulopathy trauma FB tooth root abcess |
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what are 3 cat causes of feline infectious rhinitis?
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herpes
calicivirus chlamydia |
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what's the big dog cause of infectious rhinitis?
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distemper
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tx for cat infectious rhinitis?
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supportive care, isolation
L-lysine abx |
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what is the agent of fungal rhinitis in cats and 2 in dogs?
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crypto in cats
asper and blasto in dogs |
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copious nasal discharge +/- blood in the caudal nasal cavity or frontal sinus in a dolicho/mesocephalic breed with nasal depigmentation and marked bone destruction.
eh? |
asper
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asper tx
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debulk!
intranasal (topical) antifungals like enilconazole and clotrimazole |
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what is stertor?
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nasal obstruction
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stertor
mucopurulent discharge bridge of nose swelling neuro signs sounds like what? |
nasal crypto
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dx and tx of nasal crypto
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dx cytology w/ india ink
tx azoles for 2-6 months |
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LP rhinitis
possible cause side 2ndary issues |
inhaled allergens
bilateral 2ndary bacT infection |
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LP rhinitis dx and tx
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dx biopsy
tx antiinflammatory and abx |
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T/F nasopharyngeal polyps aren't neoplasms
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true
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URD
dysphagie otic - head tilt, shaking sounds like what? |
nasopharyngeal polyps
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where do nasopharyngeal polyps arise from?
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auditory tube, middle ear
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WHO gets nasopharyngeal polyps primarily?
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young cats
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what are high and low recurrence tx for nasopharyngeal polyps?
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high recur - removal alone
low recur - remove + bulla osteotomy |
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nasal tumors:
age malignancy metastatic activity |
over 5 yrs
usually malignant rarely metastasize |
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nasal discharge
stertor inspiratory dyspnea pain sounds like what? |
nasal tumor
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T/F nasal tumors in dogs and cats are usually sarcomas
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FALSE carcinomas
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what are 3 tx for nasal tumors?
|
sx
radiation of whole nasal cavity chemo |
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what are the 4 "patterns" of thoracic radiographs?
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alveolar
bronchial interstitial vascular |
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which lung pattern causes lungs to look too white on rads?
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alveolar
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what are the 2 types of interstitial patterns of lung rads?
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structured (nodules)
unstructured (regional/diffuse) |
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what are the 2 Roentgen signs of an alveolar pattern?
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1) silhouette (loss of margins)
2) lobar sign (can see true margins of lung lobes, uncommon) |
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what does "air bronchogram" mean?
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can see air in lumen, but can't measure wall thickness
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what are the DDX for alveolar lung patterns?
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APACHE
atelectasis (empty) pneumonia (asp, bacT, fung) atelectasis cancer (lymphoma) hemorrhage edema |
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where will you see pulmonary edema on chest rads? (ie caudal, ventral etc)
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caudal and dorsal (perihilar)
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what do you see on a bronchial pattern of chest rads?
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thickened or more opaque bronchi
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what lung pattern can be attributed to "geriatric thorax" ie mineralization of walls?
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bronchial
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what are causes of vascular patterns on lung rads due to increased diameter and decreased diameter?
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increased (veins = congestion, arteries = heartworm, both = L->R shunt)
decreased (hypovolemia, shock, dehydration, R->L shunt) |
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what are the ddx for a structured interstitial pattern on lung rads?
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CHANG
cyst hematoma abscess neoplasia granuloma (blasto) |
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what are the 5 places blasto can be?
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BELLS
bone eye LNs lungs skin |
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you can see on chest rads that the lungs have retracted back from the ribs. what's going on?
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pneumothorax
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you can see a space between lung lobes. not a line...a little space. what's going on?
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pleural effusion
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what's the difference between the lobar sign and the pleural effusion sign?
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lobar - diseased next to healthy
effusion - both sides are healthy |
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you see a rounding of lung lobes on chest rads. what's going on?
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fibrosing pleuritis
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pneumomediastinum is no big deal, so why do we care about it?
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because that air is coming from somewhere and this can lead to pneumothorax (but not vice versa)
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what are you thinking with an old fat dog with a honking cough?
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collapsed trachea
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what breed is prone to congenital laryngeal paralysis?
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siberian husky
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you get a dog with voice change, stridor, dyspnea, and a cough/gag. what are you thinking?
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laryngeal paralysis
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what are 2 surgeries for laryngeal paralysis?
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unilateral arytenoid lateralization
tracheostomy |
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what are the 4 components of brachycephalic airway syndrome?
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stenotic nares
overlong soft palate big pharyngeal mucosal folds everted laryngeal ventricles |
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you have a little flat faced dog with stertor and inspiratory stridor? what are you thinking?
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brachycephalic airway syndrome?
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what are 4 causes of canine infectious tracheobronchitis aka kennel cough?
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bordetella
parainfluenza adenovirus herpes |
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how contagious is kennel cough and what do you do about it?
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very contagious
self limiting 1-21d so supportive care like antitussives |
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feline infectious tracheobronchitis is usually viral/bacterial and affects the URT/LRT
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viral
URT |
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how can you dx tracheal collapse?
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history
PE rads endoscopy |
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list several treatments for tracheal collapse
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anxiolytics
bronchodilators cough suppressants weight loss harness surgery |
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you have a YOUNG brachycephalic dog with a cough, dyspnea, stridor and bronchopneumonia. what are you thinking?
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tracheal hypoplasia
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what's the criteria for diagnosing chronic bronchitis?
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2 months of a cough with no known etiology
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what type of lung pattern on rads with chronic bronchitis?
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bronchial
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chronic bronchitis tx
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palliative b/c bronchial changes are permanent
steroids for inflammation bronchodilators |
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what is bronchiectasis?
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irreversible dilation of mid-sized bronchi with destruction of elastic and muscular portion of walls. secretions accumulate and 2ndary bacT infection.
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what is the cause of bronchiectasis in young and old dogs?
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young - primary ciliary dyskinesia
old - chronic pulm disease |
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how do you diagnose bronchiectasis?
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bronchoscopy
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how you treat bronchiectasis?
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aggressive support, abx but NO antitussives
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what are the 4 components of feline asthma and the overall result
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smooth muscle constriction
muscle hypertrophy bronchial wall edema submucosal gland hyperplasia inflammation induces reversible airflow obstruction |
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you have a cat with cough, expiratory wheeze, dyspnea and tracheal sensitivity but is normal at rest. what are you thinking?
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asthma
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what are 3 acute tx for asthma
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oxygen
terbutaline short-acting corticosteroid |
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why should you NOT use beta blockers with feline asthma?
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sympathetic tone is important to maintain bronchodilation
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list 3 breeds that get primary cilia dyskinesia
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pointer
english springer spaniel shar pei |
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you have an english springer spaniel with cough, nasal discharge, and trouble getting pregnant. what are you thinking?
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primary ciliary dyskinesia maybe
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what exactly causes primary ciliary dyskinesia?
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inherited microtubule defect. causes recurrent pneumonia due to defective mucociliary clearance.
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list the 2 bugs that can cause PRIMARY bacterial pneumonia
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bordetella bronchiseptica
strep zooepidemicus |
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list 2 bugs that cause protozoal pneumonia
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toxo
neospora |
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what are 3 zoonotic respiratory pathogens
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mycobacteria
yersinia francisella |
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what are 3 lung parasites?
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p. kellicoti
aelurostrongylus filaroides hirthi |
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what 2 pathologies can p. kellicoti cause?
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pulmonary cysts
pneumothorax |
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where does aelurostrongylus colonize and what pattern is shown on rads?
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bronchioles
interstitial nodular |
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where does filaroides hirthi live in the dog?
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bronchioles and alveoli
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what is the standard tx for infectious pneumonia?
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ID agent->> select abx
-proper duration -nebulize/coupage -lung lobectomy maybe? |
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what do you call a pulmonary infiltrate with eosinophils. what breed and age of dog gets this?
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eosinophilic bronchopneumonopathy
young/mid age huskies |
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you have a huskie with cough, gagging, a thick green-yellow nasal discharge and dyspnea. what could it be?
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maybe eosinophilic bronchopneumonopathy
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how do you treat eosinophilic bronchopneumonopathy?
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steroids
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what do you call a parenchymal infiltrate with eosinophils?
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eosinophilic granulomatosis
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what does eosinophilic granulomatosis look like on rads and what are 3 causes?
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distinct nodules (unlike EB)
fungal, mycobacT, neoplastic |
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blasto:
full name which form in environment how it transforms |
blastomyces dermatitidis
mycelial form (which makes spores) turns into yeast @ body temp |
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what kind of soil does blasto live in?
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sandy, acidy near water
also disruption |
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what 2 vet schools see a lot of blasto?
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UIUC
LSU |
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what are the 3 clinical forms of blasto?
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primary pulmonary dz
disseminated local cutaneous |
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what happens with a blasto infection with and w/o effective immunity?
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effective = pulmonary
ineffective = disseminated |
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blasto:
breed/sex incubation period |
young, large breed males
5-12 week incubation |
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what are the clinical signs of disseminated blasto?
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pulmonary signs + lymphadenopathy and cutaneous lesions
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what OTHER organ systems (besides pulmonary) can blasto affect?
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eyes (uveitis)
bone (lameness) urogenital (pee/poo probs) CNS (behavior/seizures) |
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do cats get blasto?
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yes, less common though. usually have huge abcesses and CNS involvement
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blasto:
3 CBC and 3 chem results |
CBC: mild anemia, leukocytosis and lymphopenia
chem: high calcium + globulins, low albumin |
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you have a dog with respiratory signs and you see a diffuse, interstitial, nodular miliary pattern. what are you thinking?
|
BLASTO
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how could you differentiate osteosarcoma from blasto if you see bony lysis?
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biopsy it.
also blasto is usually distal to stifle and elbow |
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what's the BEST way to dx blasto?
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cytology!!!!! snowmen
impression smears from skin lesions, FNA of ln's, bone, eye, TTW |
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read L33 slides 19-29
|
ok.
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animals with pleural effusions often present with _______ and the first thing you should do is _________
|
severe respiratory distress
GIVE OXYGEN |
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what causes these lung sounds:
crackles wheezes moist rales friction rubs |
crackles: alveoli snapping open (not fluid)
wheezes: narrowed airways moist rales: fluid in bronchi friction rubs: pleural adhesions |
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what is a "fluid line"?
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normal heart/lung sounds dorsally, muffled ventrally
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dyspnea, tachypnea, pallor, muffled chest sounds, fluid line, pleural friction rub and subQ emphysema are signs of what?
|
pleural space disorders
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what's a possible immediate tx for suspected pleural effusion? how exactly do you do it?
|
thoracocentesis.
fluid = 7th intercostal ventral air = 8th-9th intercostal dorsal |
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what are 3 causes of a pleural space transudate?
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CHF
fluid overload hypoalbuminemia |
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what are the 4 ddx for pneumothorax?
|
trauma
iatrogenic neoplasia spontaneous |
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what are the 3 ddx for hemothorax?
|
coagulopathy
trauma neoplasia |
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what's the most likely cause of pyothorax in cats?
|
bite wounds
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how do you treat chylothorax?
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sx but usually not very successful
need pleural drainage |
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what abx should you use to treat pyothorax in cats (after drainage and lavage of course)?
|
for ANAEROBES like pasteurella, bacteroides, fusobacT, clostridia
CLAVAMOX! |
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what are the 3 ricketssioses?
|
ehrlichia
neorickettsia anaplasma |
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ehrlichia:
gram where in the cells _____borne transmission |
gram neg coccobacilli
obligate intracellular arthropod ticks, fleas, chiggers |
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WHERE in the U.S. is e. canis most commonly reported?
|
SE and SW
|
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how long can adult ticks transmit erhlichiosis?
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155 days = 5 months
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how long is the incubation of acute canine erhlichiosis? how long does it last?
|
8-20d
2-4 weeks |
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what does ehrlichia do in the vascular system acutely?
|
adheres to the endothelium and causes vasculitis
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what are 2 hematologic abnormalities with acute phase canine ehrlichiosis?
|
thrombocytopenia
anemia |
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ADR signs + petechia + peripheral ecchymoses + dyspnea + CNS and ocular signs = ?
|
acute phase ehrlichiosis
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acute ehrlichosis:
resolution mimic |
resolve in 1-2 weeks w/o tx
CAN look like RMSF |
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what's the incubation period of the subclinical phase of ehrlichiosis and how long does it last?
|
6-9 weeks
3-4m up to years |
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what are 3 things that can increase the severity of chronic ehrlichiosis?
|
young dogs
german shepherds concomitant disease |
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what is the blood abnormality of chronic ehrlichiosis?
|
PANCYTOPENIA, mainly low platelets
epistaxis, retinal hemorrhage, severe anemia. just bleed and bruise like crazy., |
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what is a common differential between uveitis and pancytopenia?
|
ehrlichiosis
|
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what are 2 chem changes with ehrlichiosis?
|
high globulins (monoclonal)
low albumin (nephropathy) |
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does a negative serology of ehrlichia mean you don't have it? does a positive mean you have it?
|
no and no
|
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what should you do if you have a patient that you think has tick-borne disease that might not have long?
|
TREAT THEM. even if you don't have a positive test. treatment isn't harmful really.
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what's the DOC for treating ehrlichia?
|
doxycycline
|
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how long should it take for patients treated for ehrlichiosis to feel better?
|
1-2 days
|
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`what is the agent for grANulocytic ehrlichiosis (NOT monocytic)?
|
anaplasma equi
|
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what's the big sign of granulocytic ehrlichiosis?
|
orthopedic signs
also thrombocytopenia |
|
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what is the agent of thrombocytic ehrlichiosis?
|
anaplasma platys
|
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what causes rocky mountain spotted fever?and where does it replicate?
|
rickettsia rickettsii. replicates in the endothelial cells = severe vasculitis
|
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what's important to realize about RMSF control?
|
the tick has to be on the animal for a LONG time so if you can find and remove the tick you might prevent it.
|
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what kind of tick contact can transmit RMSF?
|
touching any MM or poop or a bite from the tick
|
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RMSF:
age prone dogs incubation period |
over 2 yrs old
g shepherds 2-14d incubation |
|
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what's the earliest and most consistent findings of RMSF?
|
fever! 2-3d after tick attachment
also cutaneous lesions |
|
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what about the chronic RMSF?
|
no such thing. total duration of illness is very short = 2 weeks. so they either die or get better.
|
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what's the most consistent CBC finding with RMSF?
|
thrombocytopenia
|
|
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how do you diagnose RMSF via serology?
|
acute titer ASAP then convalescent titer 2-3 weeks later. 4 fold increase confirms RMSF.
|
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how do you tx RMSF?
|
tetracycline, doxycycline
prednisone DOES NOT potentiate severity |
|
|
T/F rickettsemia grants life-long immunity
|
TRUE
|
|
|
what 2 rickettsiae cause salmon poisoning disease (SPD)?
|
neorick. helminthoeca
elokomin fluke fever |
|
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what does an animal have to eat to get SPD? where does it develop?
|
FISH with the n. salmincola metacercariae
develops in villous epithelial and intestinal lymphoid cells |
|
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T/F SPD is usually self-limiting.
|
false. untreated = death in about a week.
|
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you live in oregon and your dog goes outside by the lake. then gets a sudden high fever, ADR signs, nasal and ocular d/c, vomiting and diarrhea blood and rapid weight loss?
whah happen? |
SPD
|
|
|
how do you diagnose SPD?
|
eggs in feces 5-8d after eating fish
|
|
|
what bug causes lyme disease
|
the spirochete (bacteria) borrelia burgdorferi
|
|
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how long does the tick have to be attached to transmit lyme disease?
|
48 hours
|
|
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what 3 tissues does lyme really like?
|
CT
joints CNS |
|
|
lyme disease:
clinical dz time frame severity vs age/immune status clinical disease prevalence |
2-5m PI is clinical dz
severity is inversely proportional to age and immune status clinical dz 5% of the time only |
|
|
what's the major syndrome associated with lyme disease?
|
polyarthritis
|
|
|
besides polyarthritis, what other organ is affected by lyme disease?
|
acute progressive renal failure
|
|
|
T/F lyme disease is way overdiagnosed
|
TRUE. vax can cause high titers for a loooong time.
|
|
|
what can indicate natural exposure to lyme disease?
|
the C6 peptide
|
|
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what test can prove illness from Bb?
|
NONE!
|
|
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what's the DOC for blasto?
|
itraconazole
|
|
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what's important to remember when treating blasto with amphotericin B?
|
it doesn't cross the BBB so ocular signs and such won't be cured.
also it is nephrotoxic! |
|
|
what's important about treating blasto with ketoconazole?
|
it's less effective and it can cause hypocortisolemia
|
|
|
what's the px with blasto?
|
50% w/ severe lung disease die
also high relapse rate. |
|
|
a blasto dog is coughing like crazy.. should you be worried about getting it?
|
NO.....but watch out for needles
|
|
|
where is coccidiodomycosis prevalent?
|
arizona and the southwest
EL PASO, LUBBOCK, BROWNSVILLE, FLAGSTAFF |
|
|
T/F coccidia is usually asymptomatic
|
true.
general ADR signs might show up. |
|
|
what kind of lesions can you see in cats with coccidiodes?
|
draining skin lesions
|
|
|
so what 3 body systems are affected by coccidiodes?
|
respiratory
CNS cardiac |
|
|
what are the cardiac signs of coccidiodes?
|
pericardial effusion
pericarditis |
|
|
T/F serology is not useful for coccidiodes but is for blasto
|
FALSE
that's backwards tube precipitin test for cocc. |
|
|
how long should animals be on drugs for blasto and cocc?
|
2 months past clinical signs which is usually 6-12 months.
chronic low dose tx might be needed to prevent relapse |
|
|
what 2 serology tests can be used for cocc?
|
CF antigen (IgG)
and tube precipitin test (IgM) |
|
|
what drug should be used to tx fungal disease with CNS signs?
|
fluconazole
cross that BBB |
|
|
zoonotic concerns with cocc?
|
not really
draining wounds are bad though. |
|
|
where does histo live (soil-wise)
|
moist, humid conditions and nitrogen rich soil (BIRD SHIT)
MINNESOTA! |
|
|
T/F cat's are just as likely to get histo as dogs
|
true. young animals more common
|
|
|
3 big histo clinical signs in cats
|
ocular
big LNs lung sounds bony lesions skin lesions |
|
|
what's the common sign of canine histo?
|
GI disease
pale MM from GI blood loss so GI + fungal = histo |
|
|
T/F serology RULES for histo.
|
no. really only good for cocc.
|
|
|
know location of fungal infections vs what drug to use.
|
ok.
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what 2 fungals like young animals?
|
histo and blasto
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what age of cats does crypto like?
|
any age!
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what are the big signs of crypto?
|
nasal cavity problems!
sneezing, sniffling, discharge. firm hard SQ swelling on bridge of nose. |
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is there CNS signs with cat crypto?
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20% of the time. forebrain.
50-80% in dogs |
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is serology useful with crypto?
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YES
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|
crypto tx
|
surgical debulking
fluconazole |
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what's the lyme vax protocol?
|
IM at 3 months. repeat 3 weeks then yearly.
only in endemic areas |
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what is the dog serovar of lepto?
|
canicola
|
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what are 4 ways to acquire lepto?
|
contact w/ infected urine
venereal/placental bite wounds ingest tissue |
|
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T/F lepto is shed for up to a week in the urine
|
FALSE
months to years! |
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lepto renal disease:
acute or chronic? |
either
|
|
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what 2 organs are big with lepto infection? also serovars for each
|
kidney - canicola and grippo***
renal - ictero and pomona |
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what's the dog predilection for lepto?
|
large outdoor youngin's
|
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is lepto usually acute/subacute or chronic?
|
chronic!
|
|
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CBC/chem changes with lepto?
|
leukopenia early then leukocytosis w/ left shift
-thrombocytopenia -azotemia, high liver values |
|
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lepto UA findings?
|
glucose/protein/bilirubinuria
casts, wbc, rbc |
|
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lepto dx:
-test and result needed -false negatives? |
microscopic agglut test. need very high titer or 4-fold increase!
often negative in 1st week of illness |
|
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lepto tx
|
supportive care like fluids or diuretics
also abx (penicillins, tetracycline) |
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how can you eliminate lepto in the environment?
|
you CANT
|
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what's the other name for Hemotropic Mycoplasmosis?
|
Feline Infectious Anemia
|
|
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how is mycoplasma transmitted in cats?
|
arthropods
mother-> kittens blood transfusions |
|
|
acute phase of mycoplasma:
length mortality PCV |
1 month
33% w/o tx PCV fluctuates (splenic sequestration) |
|
|
T/F you almost always have clinical disease with mycoplasma haemocanis
|
FALSE
only if splenectomized, immunosuppressed or concurrent disease |
|
|
how does mycoplasma damage RBCs?
|
immune-mediated!
innocent bystanders and EVH |
|
|
mycoplasma recovery phase:
length organism free? |
maybe over a month
still present in low #'s |
|
|
look at the end of leptolyme lecture.
|
ok
|
|
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which strain of parvo is the important one? what is it's affinity and is it a systemic virus?
|
CPV-2
rapidly dividing cells. yes it's systemic |
|
|
what's the "susceptible" window for parvo and why?
|
6wk-6months because maternal protection is waning and their own hasn't developed yet
|
|
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what are 2 breeds that have a worse prognosis for parvo?
|
rottweiler
german shepherd |
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how resistant is parvo in the environment?
|
can live over 5 months on a surface. most disinfectants don't work!
|
|
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what is the shedding pattern for parvo?
|
3-14 days
|
|
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what's the landmark CBC value for parvo?
|
leukopenia, hypoalbuminemia
when they rebound there will be a monocytosis |
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what are the clinical signs of parvo?
|
acute depression, anorexia, vomiting, diarrhea and dehydration.
|
|
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besides the CBC how else can you try to diagnose parvo?
|
fecal antigen test
|
|
|
3 medical tx for parvo
|
antiemetics
pepto (bismuth sali) antibacterials (pen + aminoglycoside) |
|
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what's the parvo vax protocol?
|
6-9-12-16
|
|
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what are the microscopic targets of rota corona and parvo (on the villus)?
|
rota - very very tips
corona - tips parvo - crypts |
