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142 Cards in this Set
- Front
- Back
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If a dog has isosthenuria due to renal disease, but is not azotemic, what much renal tubular function must remain?
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must have 25-33% function
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An animal that is not azotemic and can concentrate urine may have what proportion of functional nephrons?
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35-100%
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What is the hallmark of glomerular injury?
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proteinuria in the absence of hematuria or pyuria
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What is normal 24 hour protein excretion?
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dog: < 10-25 mg/kg
cat < 200 mg |
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What is a normal protein:creatinine ratio?
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<0.5
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Why might a urine S.G. be normal in an animal in renal failure?
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cats- early chronic renal failure (creatinine/BUN)
protein losing nephropathies |
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Treatment for AKD cause by leptospirosis
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penicillin or doxycycline
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Fluids for an animal with a negative fluid balance with renal failure.
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calculated deficit + maintenance + ongoing loss (over 4-6 hours)
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How to establish urine flow with oliguric/anuric renal failure?
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water diuresis w/ fluids- may be detrimental
diuretics (after rehydration): mannitol, furosemide dopamine or fenoldopam dialysis |
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What should be given/done if attempting diuresis with dopamine?
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give 5% dextrose IV
EKG monitoring |
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At what point during therapy for renal diseasemight bicarbonate therapy be instituted?
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blood pH < 7.1 or HCO3 < 12 mEq
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What are complications of giving bicarbonate too rapidly (replace over 48 hours)?
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alkalosis
paradoxical CSF acidosis hypokalemia sodium loading |
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When should more aggressive therapy for hyperkalemia be instituted?
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K+ > 8 mEq or clinical signs (weakness, depression, cardiac arrhythmias) present
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How much K+ can be added to a liter of LRS prophylactically during diuresis phase?
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20 mEq
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Serum K+ is less than 2 mEq. How much K+ to add to 250 ml LRS?
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20
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Serum K+ is 2.6-3 mEq. How much K+ to add to 250 ml LRS?
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10 mEq
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How often should Na+ be monitored during diuresis?
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q 1-2 days
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For animals with chronic renal disease, where should blood pressure be maintained?
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120-160 mmHg systolic
Use ACEi or amlopidine |
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When might aspirin be added to treatment for protein-losing glomerulopathy?
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AT III < 70%
albumin < 2 |
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Fast calculation of drug interval change for patient with renal failure?
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normal interval x serum creatinine
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Fast calculation of drug dose change for patient with renal failure?
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normal dose/serum creatinine
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What are some considerations for use large volumes for peritoneal dialysis?
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greater surface area for diffusion
longer equilibration times increase intra-abdominal pressure and peripheral vascular resistance can cause frank dyspnea |
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Acute dialysis procedure for oliguric renal failure
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40-45 minutes
exchange every 1-2 hours continue until BUN = 60-100, creatinine 4-6 |
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Procedure for chronic dialysis.
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abdomen for 4-6 hours
3-4 exchanges a day |
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What to monitor doing peritoneal dialysis
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Na, K, Cl, blood gas, osmolality, BUN, creatinine q8-12 hours
chronic- continue 3-4 days, then every 2 days |
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Treatments for protein-losing glomerulopathies?
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restrict protein
treat edema aspirin or clopridogrel for hypercoagulability ACEi can reduce proteinuria |
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Drugs that are excreted by the kidney?
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tetracyclines
sulfonamides fluoroquinolones aminoglycosides cephalosporins ampicillin, amoxicillin penicillin |
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What is the procedure to correct extramural ectopic ureter?
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ureteroneocystotomy
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What is the procedure to correct inramural ectopic ureter?
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neoureterostomy
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50-60% of ectopic ureters corrected surgically require what postop treatment?
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Phenylpropanolamine or DES due to continued incontinence.
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What is the most common neoplasm of the bladder?
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transitional cell carcinoma
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True/False. Diagnosis of ruptured bladder usually includes a fluid BUN > serum BUN.
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False. BUN equilibrates rapidly, so creatinine is most often used.
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True/False. Animals with a ruptured bladder will not be able to urinate normally.
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False.
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when should testicles be descended?
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2 months
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Which breed is prone to urethral prolapse, and how can it be treated?
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young English bulldog
castration |
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When is pyometra most likely to occur?
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8 weeks post-estrus
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A mass of tissue in the shape of a donut is hanging out the rear of a female dog. What most likely is happening?
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Vaginal prolapse
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True/False. Spay is an option for a bitch who has recurrent vaginal prolapse.
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True.
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A pedunculated mass appears suddenly in the perineal area of a female dog. What is the prognosis?
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Good. It is a tumor, but is easy to remove and doesn't metastasize.
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Episioplasty.
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reconstructive surgery to correct deep fold dorsal to vagina.
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True/False. The larger a mammary tumor is, the more likely it is to be malignant.
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True.
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Regional mastectomy.
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removal of glands based on lymph drainage.
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Lab results for pituitary dwarfism
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decreased Pi, albumin, PCV
elevated BUN |
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What is the specific test for pituitary dwarfism?
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GH stimulation test with clinidine or xylazine to stimulate GH release. Dwarfs have little or no response.
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What are two options for treating a pituitary dwarf?
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GH replacement
Progestin- induces GH expression in mammary gland |
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What are the most common cause of PDH?
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Microadenomas
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What is the most common cause of acromegaly in the
dog? cat? |
dog- progestational agents
cat- tumor |
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Which three endocrine disorders can cause DM?
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Acromegaly
Hyperadrenocorticism Hyperthyroidism |
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What are lab results consistent with acromegaly?
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elevated ALP
hyperglycemia |
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True/False. DM resulting from acromegaly may be irreversible.
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True.
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name some causes of nephrogenic DI.
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hypercalcemia
hypercortisolemia outdated tetracycline endotoxemia |
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What SG following vasopressin administration is consistent with central DI?
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SG > 1.030 dogs (1.035 cats)
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What endpoint is the goal of DDAVP therapy for central DI?
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increase in urine specific gravity by 50% or to greater than 1.030
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What are some therapies for nephrogenic DI?
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Thiazide diuretics
Low salt/low protein diet Chlorpropamide- stimulates secretion of ADH, sensitizes renal tubules to ADH |
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What is the limiting effect of chlorpropamide?
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hypoglycemia
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Which breeds have familial inheritance of hyperadrenocorticism?
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poodles
bearded collies Nova Scotia DTR Leonbergers |
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What is the characteristic electrolyte profile for hypoadrenocorticism
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hypercalcemia
Na: K < 22:1 |
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What type of urine concentrating ability is seen with Addison's disease?
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Full gamut
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What resting cortisol concentration rules out Addison's disease?
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> 1.7-2 ug/dl
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A dog with primary hypoadrenocorticism will/will not respond to ACTH
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Will not
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Plasma ACTH will be high/low in dogs with primary hypoadrenocorticism
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high (> 500 pg/ml)
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What is the test of choice for Addison's disease?
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ACTH response
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True/False. Sodium and potassium are normal with secondary hypoadrenocorticism are normal.
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True. ACTH- independent.
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True/False. Secondary hypoadrenocorticism will respond to ACTH with an increase in cortisol.
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False. The adrenal gland will be atrophied, and so will not respond.
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Lab abnormalities in Cushing's.
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fasting hyperglycemia
elevated ALP, mildly elevated ALT hypercholestrolemia, lipemia T3 and T4 often depressed |
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What results would you expect for an animal with hyperadrenocorticism to exogenous ACTH?
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greater than normal increase in cortisol.
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Once hyperadrenocorticism has been diagnosed. what is the best way to differentiate adrenal tumor vs PDH?
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Endogenous ACTH
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What is the goal of the induction phase of mitotane/lysodren treatment for hyperadrenocorticism?
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Stop when water consumption is normal or 50% reduced. ACTH response test 1 week later.
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What is the goal of the maintenance phase of treatment for hyperadrenocorticism?
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Abolish response to ACTH stimulation (<5 ug/dl)
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What medical therapies can be used to treat hyperadrenocorticism?
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Mitotane/Lysodren- necrsosi of zona fasciculata and reticularis
trilostane- blocks conversion of pregnenalone to progesterone. radiation for PDH (not curative) |
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True/False. Bilateral adrenalectomy is a treatment for feline PDH.
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True. But treatment of choice is Trilostane.
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Medical management of pheochromocytoma.
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alpha blockade followed by beta blockade to control hypertension and arrhythmia
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True/False. Surgical excision is treatment of choice for pheochromocytoma.
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False- high morbidity and mortality.
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What can cause acquired secondary hypothyroidism?
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compression by a pituitary tumor.
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What is found on PE for hypothyroid dogs?
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alopecia
hyperpigmentation, hyperkeratosis bradycardia, weak pulses constipation |
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True/False. Total T3 and T4 is more reliable and less prone to artifactual decrease than free T4.
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False.
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Can serum TSH be used to diagnose hypothyroidism?
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No, overlaps with normal dogs. Use in conjunction with fT4 for accuracy.
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What thyroid and related hormone profile is consistent with Euthyroid Sick Syndrome?
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low total T4
high free T4 initially, then normal low TSH or TRH |
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What is the drug of choice for canine hypothyroidism?
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L-thyroxine
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What is the most common cause of feline hyperthyroidism?
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functional thyroid adenoma
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What tests can be used to diagnose hyperthyroidism?
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consistently elevated fT4, T3
T3 suppression (should decrease T4 in normal animals) TRH stimulation- no change scintigraphy |
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What is the drug of choice for hyperthyroidism?
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methimazole
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What is one reason to discontinue methimazole?
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neutrophenia/thrombocytopenia
will also increase ALT, ALP, bilirubin |
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What does sodium iodate do?
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inhibits peripheral conversion of T4 to T3. Monitor T3.
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What can occur to thyroid levels in with (functional?)canine thyroid neoplasia?
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serum T3 or T4 can be normal, high, or low (destruction of tissue)
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What is the risk of aspiration pneumonia following laryngeal "tie back" surgery?
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25%
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What upper airway disorder is characterized by a honking cough?
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Collapsing trachea
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What medical management can be used for collapsing trachea?
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cough suppression
abx bronchodilators steroids |
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True/False. Intraluminal stents are the recommended surgical treatment for younger, moderately affected dogs with collapsing trachea.
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False. Extraluminal ring prostheses.
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True/False. primary hyperparathyroidism typically affects one gland.
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True.
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Diagnosis of hyperparathyroidism on ultrasound.
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gland > 5mm
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What pre-op treatment should be undertaken before surgical removal of parathyroid gland?
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treat hypercalcemia
< 14 : fluids >14: diuresis, calcitonin |
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What to monitor post parathyroid removal?
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Calcium every 12 hours
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How many thyroid tumors are carcinomas?
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2/3, have will have metastasized
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What is the blood supply to the pancreas?
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right- cranial pancreaticoduodenal artery
left- splenic and hepatic arteries |
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What are 3 criteria that hypoglycemia is the result of an insulinoma?
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symptoms of hypoglycemia
low blood glucose (<40) symptoms alleviated with glucse |
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What post op care is needed after debulking an insulinoma?
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blood glucose monitoring every 3 hours
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What is the prognosis for an insulinoma?
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90% are malignant, 11 month remission
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Which vein crosses the surface of the (left?) adrenal gland?
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Phrenicoabdominal
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What vessel must be avoided when dissecting out the right adrenal gland?
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caudal vena cava
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What is different about ferret hyperadrenocorticism?
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elevation in androgens, not cortisol
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What are the signs of ferret hyperadrenocorticism?
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alopecia
enlarged vulva stranguria (males) +/- pruritis |
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A female dog presents with a perianal adenoma. What are you thinking is the cause?
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Adrenal
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What are some potential complications of adrenalectomy for dogs with hyperadrenocorticism?
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coagulation abnormalities
electrolyte abnormalities pulmonary thromboembolism |
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Where do pheochromocytomas metastasize?
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vena cava
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What is given preoperatively for pheochromocytoma?
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phenoxybenzamine
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What is a potential complication of surgery for pheochromocytoma?
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hypotension
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What is a characteristic finding of chronic bronchitis on transtracheal aspirate?
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Chrschmann's spirals
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What is the gold standard for diagnosing chronic bronchitis?
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bronchoscopy
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What lung pattern can be seen in feline asthma?
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bronchial
broncho-interstitial normal |
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On what view are small volume effusions best seen?
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DV
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Where is thoracocentesis performed?
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7-9th ICS
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Which volumes removed by thoracocentesis result in marked clincial improvement?
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150-300 ml in cats
10-40 ml/lb in dogs |
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True/False. Primary, spontaneous pneumothorax in dogs should be managed medically.
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False.
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Signs of tension pneumothorax
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jugular vein distension
barrel chest cannot breathe |
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Treatment for malignant pleural effusion
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intracavitary infusion of carboplatin/cisplatin, bleomycin
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Who is most susceptible to lung lobe torsion?
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young male pugs
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What does a torsed lung look like on radiographs?
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bubbly
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True/False. Cats with pyothorax should be managed medically, while dogs are managed surgically.
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True.
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What is the medical treatment for nasal fungal plaques?
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topical clotrimazole
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Which abx have high urinary concentration?
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Ampicillin/amoxicillin,clavamox, cephalosporins
TMS, sulfas aminoglycosides tetracycline fluoroquinolones |
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Which breeds predisposed to struvite?
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Mutt
min schnauzer shih tzu bichon |
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True/False. Struvite crystals can result from UTI in dogs and cats.
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False. not cats
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Which stones are more soluble in acid?
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struvite
calcium phosphage |
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Which stones are alkaline soluble?
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urate
cystine |
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Type of Stones seen in both dalmatians and english bulldogs.
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urate
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Which stones are commonly found in bulldogs, dachshunds, corgis
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cystine
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What preventative measures can be taken with cystine stones?
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low protein diet
2-MPG D-penicillamine |
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Citrates inhibit the formation of which uroliths?
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Calcium oxalate
calcium phosphate |
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How long of medical management failure to go to surgery for uroliths?
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6-8 weeks
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Which nutrients should be restricted for dissolution of struvite stones?
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protein
phosphorus Mg++ |
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What can occur if prescription diet for uroliths is continued > 6 months?
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hypoalbuminemia
hypercholesterolemia |
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What size stones might be cleared by voiding hydropropulsion?
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3-15 mm (dogs)
1-5 mm (cats) |
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What are the most common primary renal neoplasm in the dog? cat?
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dog-renal cell carcinoma
cat- lymphoma |
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What renal neoplasm has dominant inheritance in GSD?
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renal cystadenocarcinomas
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True/False. Bladder tumors are uncommon in cats.
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True.
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What are risk factors for bladder tumors?
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obesity
cyclophosphamide therapy some topical flea control products lack of vegetables |
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What medical treatments are available for transitional cell carcinomas of the bladder?
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piroxicam or cisplatin (20% remission rate)
mitoxantrone (35% remission) both |
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Because they are high in fat and sodium, urolith dissolving diets are contraindicated with what conditions?
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hyperlipidemia
pancreatitis hypertension heart disease pregnant growing animals |
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Vegetarian diet may be appropriate for the prevention of what type of urinary stones?
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urate
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Prostatomegaly?
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diameter of prostate:
>70% of pelvic inlet >1.5X lumbar vertebrae |
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Which antibiotics get high concentrations in prostatic fluid?
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TMS
Chloramphenicol Cephalosporins Fluoroquinolones |
