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75 Cards in this Set
- Front
- Back
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What test is the gold standard for evaluating peripheral vascular disease |
angiography |
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What contrast agents can be used for angiography |
low osmolar nonionic compounds and best tollerated |
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Briefly describe how arterial angiography is performed |
carotid or femoral arterial access percutaneous cutdown catheter directed under fluoroscopy to location and injection of contract rapid acquition of films |
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How is venous angiography perfomed? |
small IV line is placed in superficial vein distal to site of vascular lesion and contrast material is injected |
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What test accesses the lymphatic system |
lymphangiography |
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What are white thrombi |
clots consisted primarily of platelets |
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What are red thrombi |
clots of fibrin and RBC |
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What conditions are predisposed to pulmonary thomboemboli (9) |
nephrotic syndrome Cushings IMHA thrombocytosis heart disease sepsis DIC HWD neoplasia |
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What is DIC?
What does it result in? |
development of thrombi in the vasculature and consumption of platelets and coagulation factors.
hemorrhage, thrombosis, ischemia, and multiorgan failure |
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What diseases is DIC common with? (7) |
heatstroke sepsis pancreatitis neoplasia immune mediated disease trauma toxins |
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Why is PLN a cause of thromboembolic disease? |
AT III is similar size to albumin and is loss through the glomerulus |
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Pulmonary TE is a major complicating factor and a high cause of mortality with this disease. |
IMHA |
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TX for TE disease - list general (4) |
- TX underlying disorder supportive care (analgesics, fluds, O2) - heparin/warfarin - antiplatelet therapy (aspirin, diphyridamole, ticlopidine) - thrombolysis (tissue plasminogen activator, streptokinase) |
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What is the mainstay for acute anticoagulation TX
MOA? |
heparin - LMW
it is a cofactor with AT III and together neutralizes factor X and thrombin. |
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How is heparin TX monitored? |
Want to prolong PTT to 1.5 x baseline monitoring with PTT/ACT does not correlated well with heparin levels. Recommend to monitor plasma heparin levels |
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How does warfarin (Coumadin) work? |
vitamin K antagonist |
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How is warfarin/Coumadin monitored
TX? |
PT
D/C warfarin and start vit K |
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Which of the anticoagulation medications is recommended for acute TX vs. Chronic |
actute- heparin chronic - warfarin/coumadin |
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What is the side effect of warfarin/Coumadin? |
fatal hemorrhage which occurs acutely and unexpectanly |
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List antiplatelet therapies (3) |
aspirin dipyridamole ticlopidine |
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How does aspirin have antiplatelet therapy?
Problem with aspirin administration |
inhibits Cox leading to decrease thromboxane A2 synthesis. Leads platelets non-function by preventing their aggregation
rethrombosis generally occurs |
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How does dipyridamole inhibit platelet aggregation? |
platelet phosphodiesterase leading to increased cAMP withing platelets |
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How dose ticlopidine inhibit platelet aggregation? |
impairs fibrinogen binding and inhibits platelet aggregation induced by ADP and collagen |
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What are 3 thrombolytic agents? |
sterptokinase urokinase tissue plasminogen activator |
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How does streptokinase work? |
binds plasminogen into plasmin which then binds to fibrin and causes thrombolysis.
Also degrades factors V, VIII and prothrombin re |
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What is tissue plasminogen activator and how does it cause thrombolysis? |
recombinant DNA technology t-PA and fibrin forms a complex and activates plasminogen resulting in rapid fibrnolysis |
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What are the side effects of t-PA |
- life threatening hemorrhage rapid half life - 2-3 min and will be out of the system in 5-10 min. - reperfusion syndrome with lethal hyperkalemia |
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What diseases have been reported to cause systemic thromboemboli |
nephrotic syndrome vegatitive endocartidits neoplastic emboli difrofilariasis trauma emboli of L heart |
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What are the 7 Ps of acute arterial occlusion? |
pain paleness paresthesia pulselessness polar (cold) paresis/paralysis prostation |
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This is a generic term for any acute, nonconvulsive focal neurologic deficit stemming from cerebrovascular disease.
Classic presentation |
stroke
hemiparesis |
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How can cats present with stroke? |
- severe systemic hypertension - acutely blind, - retinal hemorrhage/detachment |
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What is feline ischemic encephalopathy? (Anatomically) Prevelence? |
cerebral ischemic necrosis more prevelant in summer months possibly due to Cuterebra |
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C/S of feline ischemic encephalopathy |
actue non-progressive suggestive or unilateral or cerebral/brainstem seizures - MC, depression, head tilt, aniscoria, |
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TX for feline ischemic encephalopathy Prognosis? Improvement? |
supportive care and favorable prognosis Clinical improvement over several days to weeks. |
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What is fibrocartilaginous embolization |
- ischemic necrosis of the spinal cord parenchyma - spinal cord arteries and veins b/c occluded with fibrocartilage from the nucleus prolposus of the IV disc
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What age dogs and what breeds seem to be particularly prone to FCE |
adult non chondrodystophid breeds Young iris wolfhounds and miniature schnauzers |
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C/S of FCE |
depend on the location of the FCE and severity of ischemia - asymmetrical - non-progressive -non-painful |
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DX of FCE |
exluding other cuases of acute myelopathy MRI |
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TX of FCE |
supportive care Physical therapy |
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Prognosis for FCE |
variable poorer if LMN are present Difficult to do physical therapy on large breed dogs. |
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What occurs histologically with vasculitis |
inflammatory cells within and around blood vessel walls |
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What is the pathogenesis behind vascular permeability and inflammation of vasculitis |
- exposure of subendothelial collagen secondary to endothelial injury. - Activation of Hageman's factor (XII), complement and pasmin - causes increased permeability and inflammation |
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What are diseases that induce vasculitis (8) |
FIP canine coronavirus parvovirus RMSF Leishmaniasis HWD SLE rheumatoid arthritis |
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What species has juvenile polyarteritis syndrome been described in
C/S |
young beagles
phasic pyrexia, listlessness, anorexia MC- circular petechiae and ecchymosis & painful
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DX of juvenile polyarteritis
TX |
biopsy
stop unnecessary drugs pred +/- AB cyclosporin
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This is a rare polysystemic disease associated with a necrotizing vasulitits of unknown cause |
polyarterititis nodosa |
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This disease cases loss of vessel wall integrity, petechial and ecchymotic hemorrhages, infarction, and thickening of the major arteries |
polyarteritis nodosa |
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C/S of polyarteritis nodosa |
linear skin ulceration, mm ulcers nasal discharge spinal pain cardiac failure renal failure |
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DX, TX, & prognosis for Polyarteritis nodosa |
biopsy
prognosis - guarded to poor
glucocorticoids and cyclosporin |
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What is an aneurysm |
vascular dilation causes by a weakened arterial or venous wall with subsequent widening of the vascular lumen |
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What parasite has caused aneurysms of aortas of dogs |
Spirocerca sanguinolenta (formerly lupi)
secondary to migrating larvae |
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These appear as soft warm pulsating buldges |
peripheral aneurysms |
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What is arteriosclerosis |
chronic arterial wall hardening, loss of elasticity and luminal narrowing |
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What is the theory behind arteriosclerosis lesions |
commonly detected in older dogs/cats and possibly part of the natural aging process |
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What is atherosclerosis |
inner arterial wall thickening secondary to lipid deposits |
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What diseases has atherosclerosis been detected with |
not described in cats secondary to hypercholesterolemia & thyroid atrophy |
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What is the most common cause of acquired AV fistula |
blunt or penetrating trauma |
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These appear as painless, easily compressible, warm bulges on the extremities |
AV fistulas |
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What is Branham's sign and what is it pathopnomic for? |
firm pressure applied proximally to an AV fistula, thrill and bruit (abnormal auscultation over a vessel) disappear, and the HR and pulse may drop due to the reduced cardiac output. |
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DX and TX of AV fistulas |
Doppler US SX |
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Three functions of the lymphatic system |
- maintains fluids balance between tissue & CV system - immunity - absorbs fats from SI
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Lymphangitis and lympadenititis occur secondary to inflammation occurring in these places... |
skin mucous membranes SQ tissue |
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With lymphangitis and lympadenitits the LN may become lobstruced, enlarged, warm, and painful. Affected limbs ... |
locally swollen and lameness can result pyrexia, anorexia, and depression are common |
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TX for lymphangitis and lympadenitis |
moist warm compress or soaks AB for pyrexia |
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What is accumulation of fluid in the intersitital space secondary to abnormal lymphatic drainage |
lympedema |
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This condition occurs in young dogs and results in bilateral (occ unilateral) swelling of the hind limbs |
lymphedema cause by dysplasia of the lymph channels or popliteal LN |
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C/S of animals with lymphedema secondary to dysplasia
prognosis |
pitting edema no lameness or pain
Guarded prognosis |
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Obstruction of this area results in bilateral hindlimb edema & edema of the thighs& genitalia |
sublumbar or intrapelvic obstruction with lymphedema |
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This obstruction of the area results in lymphedema of the front limbs and ventral thorax, neck and head |
mediastinal mass and thrombosis of the cranial vena cava |
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How is lymphedema dianosed |
lymphograph or lymposcintigraphy |
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DDX for edema in one limb: |
inflammation trauma vascular obstruction hemorrhage cellulitis phlebitis AV fistula |
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DDX for swelling of both frelimbs |
thrombosis compression of the cranial venal cava (mass)
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DDX for only hindlimb swelling |
obstruction of sublumbar LN by neoplasia |
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DDX for swelling of 4 limbs |
CHF CRF hypoproteinemia portal hypertension |
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C/S of this malignat disease causes pitting edema of the extremitis, inguinal regin, axilla, and head and neck
prognosis |
lymphangiosarcoma
poor - high met rate and local recurrence |
