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629 Cards in this Set
- Front
- Back
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The pituitary secretes TSH in response to what?
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Release of TRH from the hypothalamus
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What does the thyroid release in response to TSH?
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T3 T4
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What can an increase in T3 T4 cause?
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Increased metabolism, O2 consumption and + inotropic/chronotropic effects
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Need a physio question here
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Need aphysio answer
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What is the prevelance of hypothyroidism in small animals?
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0.2%
over diagnosed |
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Which species is primarily affected by hypothyroidism?
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Canine
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How much of the thyroid must be destroyed before clinical signs are seen?
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75%
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What are the 2 primary causes of hypothyroidism?
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-Lymphocytic thyroiditis
-Idiopathic thyroid atrophy |
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What are the causes of lymphocytic thyroiditis?
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-leakage of thyroglobin
-fibrosis and inflammation -immune mediated |
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idiopathic question
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idiopathic answer
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What are the other causes of hypothyroidism?
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-neoplasia
-adenomatous hyperplasia -iatrogenic |
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What are some of the causes of iatrogenic hypothyroidism?
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-surgery
-I131 -antithyroid drugs |
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What is the (rare) cause of secondary hypothyroidism?
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pituitary malformation/neoplasia
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What are the causes cretinism?
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- congenital hypothyroidism
- rare I deficiency -thyroid dysgenesis, dyshormonogensis |
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What is the typical signalment of a hypothyroid dog?
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-middle aged (4-10 years, 7.2 mean)
-spayed female, neutered male |
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In which breeds is hypothyroidism inherited?
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-beagle
-borzoi -danes -OESD |
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What are the general clinical signs of hypothyroidism in a dog?
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-weight gain
-lethargy/mental dullness -dermatological signs -heat seeking/ cold intolerance -bradycardia -constipation -muscle weakness/atrophy -edema |
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What are the dermatological signs of hypothyroidism in a dog?
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-rat tail
-seborrhea (back of rear legs and lumbar area) -poor wound healing -non-pruritic -acanthosis nigricans |
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A hypothyroid dog may present with what expression?
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Tragic expression
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Why does hypothyroidism cause infertility?
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erratic cycles and poor libido
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Opthalmologic abnormalities caused by hypothyroidism can include what?
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-KCS
-corneal lipidosis -ulceration -uveitis -lipid effusion into the aqueous humor -2ndary glaucoma -lipemia retinalis -retinal detachment |
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Neuro abnormalities of hypothyroidism might include what?
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-peripheral neuropathies
-vestibular disease -lar, par and megaesophagus |
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Which clinical sign of hypothyroidism might be seen, but is rare?
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Myxedema
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What are the clinical signs of cretinism?
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-mental retardation
-stunted/disproportionate growth -large broad head -macroglossia -hypothermia -delayed dental eruption -ataxia and abdominal distension -similar dermatologic signs in adults |
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What are the expected CBC/Chem results of a dog with hypothroidism?
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-mild, non-regenerative anemia
-fasting hypercholesterolemia -hypertriglyceridemia |
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What is the screening test for hypothyroidism?
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Total T4
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What diagnostic test can be run for hypothyroidism?
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Free T4 by equilibrium dialysis
TSH |
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How would u interpret the results if a total T4 comes back elevated in a dog?
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-Anti T4 anitbodies
-R/A -+/- hypothyroid |
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What 2 provocative tests could be done? (but rarely done)
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TSH stim
TRH response |
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A systemic disease from any source that decreases T4 is termed what?
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Euthyroid Sick Syndrom
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The administration of which drugs can lower T4?
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-steroids
-phenobarbital -antibiotics -furosemide |
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What drug is used to treat hypothyroidism?
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L-thyroxine
(also spay or neuter) |
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Feline hypothyroidism is rare, but can be caused by what?
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Iatrogrenic cause (non-thyroidal illness)
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In which cat breeds is hypothyroidism congenital?
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DSH and Abyssinian
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Hyperthyrodism is the most common endocrine disorder of which species?
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Cats
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Hyperthyroidism is caused by a functional thyroid that has been effected by what?
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adenomatous hyperplasia/adenoma
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Is hyperthyroidism typically unilateral or bilateral?
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70% bilateral
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What is the occurrence of hyperthyroidism caused by thyroid carcinoma?
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1-2% (not as malignant as in dogs)
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How does hyperthyroidism contribute to CKD?
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-hypertension
-increased GFR/ sclerosis |
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Treating hyperthyroidism in a cat my unmask what other condition?
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CKD
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hyperthyroidism affects cats of what age?
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Middle aged to old
median is 13 years (no breed or sex predilection) |
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What signs might you see during a physical exam of a cat with hyperthyroidism?
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-weight loss
-PU/PD +/- polyphagia -V/D +/- hyperactivity -weakness -dyspnea/panting -palpable thyroid -systolic murmur -tachycardia -gallop rhythm -aggressive -unkempt appearance |
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While palpating the thyroid gland, what could sign indicated asymmetry?
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Thyroid slip
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CBC results on a cat with hyperthyroidism will show what results?
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-erythrocytosis
-increased MCV -leukocytosis -lymphopenia -eosinopenia |
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What elevated chem results will be seen in a cat with hyperthyroidism?
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Elevated:
-ALT -ALP -LDH -AST -glucose -azotemia -phosphorus -bilirubin |
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Hyperthyroidism can mimic or occur with what other diseases?
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-Dm
-CKD -cardiomyopathy -hepatic insufficiency -maldigestion/malabsorption -neoplasia |
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What would you expect to see on an ECG of a hyperthyroid cat?
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-tachycardia
-increased R wave -ventricular arrhythmias -conduction abnormalities |
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Radiographic findings of a hyperthyroid cat may show what?
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-mild to sever cardiomegaly
-pleural effusion/pulmonary edema |
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What is the potential cause of thyrotoxic cardiomyopathy?
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Increased cardiac output due to ibcreased tissue metabolism and O2 reqs, volume overlaod
(reversible w/therapy if early enough) |
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What would you expect to Total T4 level to be in a cat with hyperthyroidism?
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High, upper 1/2 of normal
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What other diagnostic test can be performed?
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-Free T4 and TSH
-Provocative testing: T3 suppression TRH stimulation TSH response |
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What is the value of performing a Tc99m pertechnetate scan?
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-useful for cats with no slip
-distinguish from salivary gland -indentify distant mets |
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When is surgery indicated?
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If the hyperthyroidism is unilateral
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What anti-thyroid drug can be used to treat hyperthyroidism?
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Methimazole
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What other medical treatments can be considered for hyperthyroidism?
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I-131 therapy
Beta blockers for cardiomyopathy Treatment for renal failure if present |
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What is the mechanism of action of Methimazole?
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blocks hormone synthesis and release
-prevents I incorporation and inhibits coupling of DIT and MIT |
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Is methimazole reversible?
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Yes, signs return 24 -73 hours after removal
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When would Methimazole be used as a trial?
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Prior to I-131 therapy or surgery
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After starting a patient on Methimazole, when should tT4 be checked?
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After 2 weeks
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What are the reversible side effects of Methimazole?
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-anorexia
-vomiting -lethargy (stop rx for a few days, re-start at lower dose) |
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What are the irreversible side effects of Methimazole?
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-facial excortiations
-bleeding diathesis -hepatopathy -MG -cold agglutinin like disease Will cause + ANA |
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What is the method of action of I-131?
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Selectively destroys active thyroid tissue
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A patient injected with I-131 must be isolated for how long?
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3-14 days depending on local law
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Prior to I-131 treatment, a cat should be treated with Methimazole to see if the tT4 reaches what level?
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lower 1/2 of the range
(in conjunction with USG) |
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In dogs, thyroid tumors tend to be of what type?
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large, non-functional, invasive, follicular carcinoma
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What is an important concern with thyroid tumors in dogs?
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usually have distant mets, local invasion and bleed (a lot)!
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Which dog breeds are predisposed to thyroid carcinoma?
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-boxers
-beagles -goldens |
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What are the clinical signs of a dog with a thyroid tumor?
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-mass that bleeds with FNA
-dyspnea -dysphoria -dysphagia |
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What are the treatments options for thyroid carcinoma?
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-sx removal
-chemo -radiation -I-131 palliative relief usually achieved |
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DM is caused by what 2 physiologic changes?
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-lack or insulin
-inability of receptors to respond to insulin |
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Why is there a loss of body mass in patients with DM?
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Proteins used to make glucose
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What is the cause of ketosis in DM patients?
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Ketoacids build up in the liver from fat mobilization
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What are produced by the pancreatic B cells, a cells and delta cells?
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B- insulin
A- glucagon Delta- somatostatin |
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What else do the islets produce?
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PP cells produce pancreatic polypeptide
-gastrin -D cells vasoactive intestinal peptide -ghrelin |
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Which type of Dm affects dogs primarily?
Cats? |
lack of insulin (type I) and some cats
cats: insulin resistance (type II) |
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What is the cause of secondary DM?
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Insulin antagonists
growth hormone progesterone glucagon epinephrine |
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Which dog breeds are predisposed to DM?
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dachshunds and poodles
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What is the typical signalment of a DM dog?
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Middle age to older
female (4 x more likely) |
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In cats, is DM more common in male or females?
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males slightly more represented
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What might be an initial sign of DM in cats?
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Peripheral neuropathy- plaintigarde stance
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In dogs, what is the pathophys cause of DM?
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-chronic pancreatic inflammation
-pancreatic atrophy -immune mediated destruction of beta cells |
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What are the causes of transient DM in dogs?
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-pregnancy
-diestrus |
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In cats, what is the pathophys cause of DM?
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-chronic insuline resistance with B cell exhaustion
-pancreatic amyloidosis -increased basal hepatic glucose production -obesity -glucose toxicity |
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What are the clinical signs of DM in a non-ketotic stable animal?
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-hyperglycemic
-weight loss in the face of increased intake -polyphagia -PU/PD -cataracts (dogs) |
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What is the cause of cataracts in dogs with DM?
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glucose in lens attracts water
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What are the clinical signs in a DM patient that is ketoacidotic or non-ketotic hyperosmolar?
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-weight loss
-PU/PD -dehydration -labored breathing -leathargy/collapse/stupor -NKH (decreased GFR, blood glucose high chronically, idiogenic osmoles) |
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In general, how is Dm diagnosed?
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Persistant fasting hyperglycemia
In dogs, BG > 200 mg/dl |
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Hyperglycemia in cats can be due to what?
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Stress
BG > 300 must do repeated measures |
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What CBC results would you expect in a DM animal?
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usually normal
could be anemic due to chronic disease |
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What additional diagnostic test should you run on a potential Dm cat?
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All cats greater than 6, do a Total T4
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What additional diagnostic test should you run on a potential Dm dog?
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Free T4 and TSH
may have low T4 due to euthyroid sick syndrome |
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What would you expect to see on a chem panel of a DM animal?
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-dehydration
-azotemia -elevated TP (dehydration) -elevated cholesterol & triglycerides -low sodium |
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Urinalysis of a DM patient will show what?
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-glucosuria
-ketonuria -sediment |
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Why is it important to do a urine culture on a DM patient?
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-PU obscures bacterial identification on sediment exam
-glucosuria facilitates bacterial growth -neutrophils have decreased function |
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What 3 ketoacids are produced by DM?
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-acetone
-acetoacetate -B hydroxybutyrate |
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What ketoacid is most prevalent?
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B hydrobutyrate
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How is B hydroxybutyrate detected?
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Hydrogen peroxide
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How are acetone and acetoacetate detected?
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Urine dipstick
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What diagnostic tests are useful for monitoring and for evaluation in a complicated case of DM?
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-fructosamine
-glycosylated hmeoglobin -glucotest |
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What are the main goals of insulin therapy for DM animals?
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-decrease clinical signs
-decrease BG (dog 80-200, cat 80-300) -rehydrate, decrease osmolality -monitor and correct electrolytes |
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Which insulin type is used for cats?
for dogs? |
Bovine (cats/cows)
Porcine (puppies/pigs) |
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Which insulin type is the only one that can be given IV?
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Regular (also IM and SQ)
(is potent) |
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Regular insulin is a good choice to treat what condition?
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emergency treatment of ketroacidosis
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What is another term for Vetsulin? And from where is it derived?
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Lente
from pigs |
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Where is NPH insulin derived from?
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Human recombinant
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Which insulin type is FDA approved for cats, dogs don't respond well?
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PZI
90% bovine, 10% porcine |
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What is Glargine?
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A human recombinant insulin that works well for cats. Ultra long duration of action
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Adjustments to the dosing of Glargine that a cat is on is based off of what?
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Pre-insulin BG levels
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When treating a cat with Glargine, could remission occur?
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Yes, after a minimum of 2 weeks of therapy
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Glucose toxicity is a result of what condition?
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Persistant hyperglycemia (inhibits release of insulin form B cells)
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What is the most important point for nutritional management of DM animals?
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That they eat!
dog: high fiber may help cat: low carbs, high protein |
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In which species can oral hypoglycemics be tried?
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cats
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When might oral hypoglycemics be tried?
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When owners can't give injections
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What type of oral hypoglycemic is Glipizide?
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Sulfonylureas
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what are the other types of oral hypercylcemics available?
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-A glycosidase inhibitor
-Biguanides -Thiazolidinediones -Transition metals |
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What are the steps to initiating insulin therapy for an uncomplicated case?
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In the hospital
-AM, feed -initiate insulin ay low dose SQ -monitor BG for first 12-24 hours -PM, feed -give insulin |
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What important points about DM education do you need to make with your clients?
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-insulin
-syringes -practice |
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After initiating insulin therapy, when should a glucose curve be done?
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1 week
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How often should a glucose curve been done?
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5-7 days after any change in dosage
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If dosage needs to be adjusted, how much do you adjust?
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10-15%
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What condition should you monitor for with a cat on glargine?
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Hypoglycemia (BG <70 at anytime)
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How do you treat an emergency ketoacidotic animal?
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Regular insulin CRI or IV Q1hr until BG < 250
monitor K frequently and supplement fluids |
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What is the appearance of an ECG with increased K?
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bradycardia....no P's wide QRS
tented T |
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Why is it important to give fluids as a slow rate to a DM patient who is non-ketotic but hyperosmolar?
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Slow re-hydration to prevent cerebral edema
also give insulin Q1 hr, monitor K and supplement, NO bicarb |
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What should owners monitor about their Dm animal?
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-attitude
-appetite -water uptake and PU -body weight -urine glucose or ketones |
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What test is used to check the overall health and monitor a long term DM patient?
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Fructosamine level
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What is the most important condition to avoid in DM patients?
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Hypoglycemia
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What type of behavioral changes are seen with a DM patient with hypoglycemia?
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-ataxia
-depression -ptyalism |
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What are some causes of hypoglycemia in DM animals?
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-insulin overdose
-incorrect syringe -insulin given to anorexic animal/vomiting -long acting insulin -cat who requires only Q24h dosing -aging -adrenalectomy -beta blockers -remission |
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What is common complications of long term DM?
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Chronic infections- UTI, dermatologic
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If a DM patient is going to have surgery, what is the procedure for keeping BG under control?
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-no food in AM
-1/2 insulin dose -schedule procedure to be done first -monitor frequently -5% dextrose in fluids |
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What problems arise in controlling the BG of a DM patient, what should you do?
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A BG curve
(also evaluate for concurrent dz) |
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What are the steps to perform a BG curve?
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-BG
-feed -admin insulin -BG Q2hr for 12-24 hours |
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What is the glucose nadir?
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Low limit of BG
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What do you do in the case of a BG curve that shows insulin resistance?
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Increase dose, perform additional diagnostics.
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What dz is a potential cause of insulin resistance in dogs?
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Cushing's
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If the insulin dose is >2U/kg and BG is still not regulated, what should you suspect?
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-incorrect insulin handling/administration
-concurrent dz |
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Concurrent dz in a DM dog that can cause unregulated BG includes which diseases?
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-hyperadrenocorticism
-hypothyroidism -chronic pancreatitis |
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Concurrent dz in a DM cat that can cause unregulated BG includes which diseases?
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-hyperadrenocorticism
-hyperthyroidism -acromegaly |
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What is the Somogyi effect?
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If the body has periods of hypoglycemia, you will see rebound hyperglycemia.
Need 24 hr curve to see |
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What is another name for hypoadrenocorticism?
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Addison's disease
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In typical Addison's the body is deficient in what?
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-mineralocorticoid
-glucocorticoid |
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In atypical Addison's, what is deficient?
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Glucocorticoid only
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What a would be a typical signalment for a dog with Addison's?
|
-Young (4 yrs avg)
-female (3 x more likely) -Danes, WHST, bearded collies, Poodles, bassets |
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True or false...Addison's is a rare condition in cats.
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True
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What condition causes immune mediated destruction of the adrenal cortex?
|
Lymphocytic adrenalitis
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What other condition can cause hypoadrenocroticism?
|
Infectious disease
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What condition can cause secondary, atypical, hypoadrenocorticism?
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Decreased ACTH
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What drugs can cause iatrogenic, typical, Addison's?
|
-mitotane
-trilostane |
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What drugs can cause iatrogenic, atypical, Addison's?
|
-steroids
-mitotane -trilostane -ketoconazole |
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What are the clinical signs of chronic Addison's?
|
The Great Pretender
-waxing/waning -v/d -anorexia -lethargy -weakness -wt loss can have any to no signs |
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What are the clinical signs of acute Addison's?
|
-sudden severe collapse
-shock -severe bloody diarrhea -any hx of chronic signs -bradycardia -dehydration -abdominal pain |
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What first steps would you take in an acute Addison's case?
|
-IV fluids
-dexamethasone |
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What results would you see in a CBC of an Addison's patient?
|
-absence of a stress leukogram (stress=cortisol (glucocort)
-anemia after fluid replacement |
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What chem results would you expect in an Addison' patient?
|
-prerenal azotemia
-hyponatremia -hyperkalemia -hypercalcemic |
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USG for an Addison's patient is usually <1.030 due to what?
|
Medullary washout
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True or False....sodium-potassium ratio is diagnostic for Addison's.
|
False! Not diagnostic or pathognomonic
|
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A change in the sodium potassium ratio only occurs with a deficiency of what?
|
Mineral corticoids
|
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What sodium potassium ration value is SUGGESTIVE of Addison's?
|
< 27:1
|
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If the patient has a sodium potassium ratio of < 27:1, what is your next diagnostic step?
|
ACTH stim
|
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What are some of the differentials for Addison's?
|
-renal dz (ARF, obstruction uroabdomen)
-severe hepatic failure -severe GI dz -severe acidosis (also DKA) -CHF -massive tissue destruction -primary polydipsia -3rd spacing (pleural effusion -whipworms |
|
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What condition can cause pseudo Addison's? and how do you test for this condition?
|
-whipworms
-do a fecal |
|
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What radiographic findings might you see in a case of Addison's?
|
-microcardia
-hypocirculation -esophageal dilation |
|
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What changes would you see on an EKG due to bradycardia?
|
-tall tented T's
-absent P's -prolonged QRS all due to hyperkalemia |
|
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Before starting an ACTH stim test, what value is needed?
|
baseline cortisol
|
|
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When checking the endogenous ACTH concentration, what chemical needs to be in the sample tube?
|
a-proteinin
|
|
|
is it necessary to check the aldosterone levels?
|
Not necessary most of the time
|
|
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At what dose is ACTH stim given?
|
5ug/kg IV
|
|
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When do you check the ACTH levels??
|
-baseline
- 1 hour post |
|
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What level is considered hypoadrenocorticism?
|
< 14 mmol/L both
|
|
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What factors determine the treatment of an Addison's patient?
|
-which hormone is deficient
-is the patient in an acute crisis? |
|
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In the tx of chronic Addison's which oral steroids are given?
|
Predisone daily
|
|
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What mineralcortcoid supplementation can be given?
|
Fludrocortisone
|
|
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Which drug is given IV for supplementation of mineralcorticoids only?
|
DOCP
|
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|
Doses of DOCP are based on the levels of what?
|
-Na+ and K+ concentration
|
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What is the protocol for the tx of apt in acute Addison's
|
critical emergfency
-IV fluids, NaCl -IV dexamethasone -oral fludrocortisone -GI protectant (sucralfate) when stable reassess and change to maintenance protocol |
|
|
Secondary Hyporadrenocorticism can result from an acute withdrawal from what?
|
Acute glucorticoid withdrawal
(iatrogenic Cushing's with rapid steroid withdrawal) |
|
|
is pituitary dz a cause of secondary hypoadreno?
|
yes but not common
|
|
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In secondary hypoadreno, what are the electrolyte levels and ACTH stim response?
|
-normal electrolytes
-low ACTH stim response |
|
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What is the tx protocol for secondary hypoadrenocorticism?
|
-replace glucocorticoids
-slow reduction from steroids -supportive care (wound management) |
|
|
Pheochromocytoma are found in which age of dogs?
|
Older
|
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What effects can a Pheochromocytoma have?
|
Excessive catecholamines
|
|
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What effect does excess epinephrine have?
|
-elevated glucose
-secondary DM |
|
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What effects does norepinephrine have?
|
-hypertentsion
-retinal hemorrhage -splenic contraction |
|
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How is a Pheochromocytoma diagnosed?
|
-repeated BP measurements
-abdominal rads and U/S -venography CT |
|
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What is a tx for Pheochromocytoma?
|
-adrenalectomy
-if bilateral must treat for hypoadrenocorticism |
|
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What is the primary mineralcorticoid?
|
-aldosterone
|
|
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What does aldosterone control?
|
-salt and water
-electrolytes -ECF volume |
|
|
Which glucocorticoid controls energy generation, protein/fat/glucose metabolism and stress?
|
Cortisol
|
|
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Name a primary androgen and what it is responsible for.
|
DHEA, secondary sex charateristics
|
|
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What is the most common endocrinopathy of dogs?
|
Hyperadrenocorticism (Cushing's)
|
|
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Cushing's is an overproduction of what?
|
Glucocorticoids
|
|
|
Which breeds are over represented with Cushing's?
|
-poodles
-dachshaunds -bostons average age 8 y/o |
|
|
Dose Cushing's shw sex predilection?
|
No...females more prone to adrenal tumors than males
|
|
|
What is the primary cause of hyperadrenocorticism in dogs?
|
Pituitary dependent- 80% anterior lobe tumors (micro & macro adenoma)
|
|
|
What percentage of cases of hyperadrenocorticism are adrenal tumor related?
|
15% (50/50 malignant vs benign)
|
|
|
What percentage of hyperadrenocorticism cases are iatrogenic?
|
50% overall
|
|
|
What are the clinical signs of hyperadrenocorticism?
|
-PU/PD
-polyphagia -panting -pendulous abdomen -proteinuria -bilateral alopecia -thin skin -hyperpigmentation -hepatomegaly -calcinosis cutis |
|
|
What results would you expect in a CBC of a dog with Cushing's?
|
-stress leukogram
|
|
|
What blood results would you expect in a case of hyperadrenocorticism?
|
Elevated
-glucose -ALT -cholesterol -ALP |
|
|
What UA results would you see in hyperadrenocorticism?
|
-dilute urine
-proteinuria |
|
|
Why must the proteinuria be treated?
|
Will cause glomerular necrosis and renal failure
|
|
|
What lab screening test are performed for diagnosing Cushing's?
|
-chemistry (increased ALP)
-urine cortisol/creatinine ratio |
|
|
What 2 dx tests are performed for diagnosing Cushing's?
|
-ACTH stim
-Low dose dexamethsone suppression test |
|
|
Which tests are performed to differntiate pituitary vs adrenal induced Cushing's?
|
-high does dexamethasone
-endogenous ACTh concentration |
|
|
What other diagnostic tests are considered?
|
-abdominal rads, U/S
-brain MRI/CT |
|
|
What will a urine cortisol/creatinine ratio do for dx hyperadrenocorticism?
|
-can rule OUT hyperadrenocorticism
-morning urine -if negative, dog does NOT have Cushing's -if positive, could have ANY dz |
|
|
An ACTH stim test is normal if the post injection result is what?
|
< 500 mmol/L
(pre is ~50mmol/L) |
|
|
What is the sensitivity and specificity of the ACTH stim test?
|
85% sensitive
86% specific |
|
|
What is measured with a low dose dexamethasone suppression test?
|
-cortisol
|
|
|
During the LDDST, cortisol is measured when?
|
0, 4hr, 8 hrs
|
|
|
LDDST can help dx Cushing's and what else can it help define?
|
Differentiate for PDH
|
|
|
What would a normal response be to a LDDST?
|
Feedback to the hypothalamus that there is cortisol in the body
|
|
|
How does this test help dx Cushings?
|
At 8hrs, if the level is still high, suspect Cushing;s
|
|
|
What can you conclude from a LDDST when the results show a depression of cortisol and then a return of high cortisol levels after 8 hours?
|
Positive for hyperadrenocroticism and Pituitary dependent hypoadreno
|
|
|
What is a high does DST used for?
|
Only for differentiation...85% of PDH will suppress
|
|
|
What must you do if you are concerned about an adrenal tumor?
|
Image it
|
|
|
In what type of sample is endogenous ACTH measured?
|
Single serum sample
|
|
|
Waht does a normal to high level of eACTH indicate?
|
PDH
|
|
|
What does a low eACTH indicate?
|
AT, high cortisol feedng back makes ACTH low
|
|
|
Why would you see an hepatomegaly on an abdominal radiograph of a dog with Cushing's?
|
Steroid hepatopathy
|
|
|
What other findings might be seen radiographically?
|
-soft tissue mineralization
-if adrenal tumor: mass, adreanl mineralization |
|
|
What is the appearance of the adrenals on U/S with PDH?
|
-bilateral enlargement
-plump |
|
|
What is the appearance of an adrenal tumor on U/S?
|
Unilateral mass near the kidney, other adrenal not identified
alos livr mets, caval invasion |
|
|
What drugs are used to treat Cushing's?
|
-Mitotane
-Trilostane -Ketoconazole -Selegeline |
|
|
What is the tx of choice for adrenal tumors?
|
Surgery
possible for PDH |
|
|
What other tx can be used for PDh and macroadenoma?
|
Radiation TX
|
|
|
What effect does Mitotane (Lysodren) have?
|
Selectively detsroys the zonae fasiculata and reticularis
|
|
|
What are the side effects of Mitotane?
|
-vomiting
-anorexia -can affect aldoesterone |
|
|
What is the protocol for starting a pt of Mitotane?
|
-loading dose of 20-15 mk/kg Q12hrs for maximum of 8 days, until repsonse is noted
-do ACTH stim test |
|
|
After the loading doses, how do you proceed?
|
Maintenance of 20-25 mg/kg 1-3 times a week
|
|
|
When should ACTH stim be re-checked?
|
1 month, 3 months, 6 months
|
|
|
When tx with Mitotane, what drug should the owner always have available?
|
Emergency prednisone
|
|
|
What is the of mitotane tx in the case of adrenal tumors?
|
to destroy the adrenal
|
|
|
What is the loading does of Mitotane for an adrenal tumor?
|
50 mg/kg twice the loading does of the PDH protocol
|
|
|
What protocol is used for mitotane in the case of diabetes mellitus?
|
load at 25 mg/kg Q 24 hrs
-give prednison concurrently -monitor |
|
|
Dogs respond to Trilostane given how often?
|
twice daily
|
|
|
When using Trilostane, when is the ACTH stim re-checked?
|
14 days
once stable do ACTH stim q 3-6 months |
|
|
What is the mechanism of action of Ketoconazole in the tx of Cushing's?
|
Inhibits numerous steps in steroid biosynthesis
|
|
|
What (reversible) side effects does ketoconazle have?
|
-anorexia
-V/D -enzyme elevations -icterus |
|
|
When is Ketoconazole used?
|
In dogs that can't handle Mitotane/Trilostane
Presurg for AT to stabilize the pt |
|
|
What is the mechanism of aciton of Selegilene (Anipryl)?
|
-increases dopamine from the hypothalamus to the intermediate lobe
|
|
|
What effect does increased dopamine have?
|
-will decrease ACTH
-will only work on animals with intermeidate lobe tumors |
|
|
What are the drawbacks to Selegiline?
|
-may not stop clinical signs
-not very successful -$$ |
|
|
When is radiation tx an indicated treatment?
|
If neuro signs are present (CT to evaluate)
|
|
|
What is the prognosis of radiation tx treament?
|
33% worsen
33% improve short term 33% improve long term |
|
|
Adrenocortical tumors will causes excesses of what chemicals?
|
-glucocorticoids
-mineralcorticoids -sex hormone excess |
|
|
What is Conn's syndrome?
|
Mineralcorticoid excess
|
|
|
What is a common side effect of excess sex hormones?
|
Feminization- seen in ferrets
|
|
|
What caution needs to be taken when performing sx removal of an adrenal tumor?
|
Often invade the vena cava
|
|
|
Can Mitotane be used to Tx adrenal tumors?
|
Yes, higher doses, more side effects
|
|
|
Feline hyperadrenocorticism occurs concurrently with what dz?
|
DM
|
|
|
What are the clinical signs of hyperadreno in cats?
|
-PU/PD
-markedly thin skin -alopecia of the ears |
|
|
What type of diabetes do cats with hyperadrenocorticism exhibit?
|
Insulin resistant
|
|
|
How is Cushing's dx in a cat?
|
-ACTH stim
-serum chemistry -abd rads, U/S |
|
|
In a Cushing's cat, why isn't the ALP elevated?
|
No steroid induced isoenzymes
|
|
|
What is the Tx for feline hyperadrenocorticism?
|
-adrenalectomy
-caution with insulin dose, can get severly hypoglycemic |
|
|
In which species do insulinomas occur?
|
-dog
-cat -ferret older animals (standard poodles, boxers, terriers) |
|
|
What are the clinical signs of an insulinoma?
|
-weakness
-good appetite -seizures (low glucose, elevated epinephrine |
|
|
Along with a CBC, what blood chem results will be seen in a case of insulinoma?
|
-fasting hypoglycemia
-severly low glucose (repeatable, insulin levels must be measured concurrently with a BG of < 40mg/dl (measure glu & insulin at the same time) -no ketones (inhibited by insulin) |
|
|
What imaging procedures should be included in diagnosing an insulinoma?
|
-thoracic rads to evaluate for mets
-abdominal U/S : insulinoma usually very small and not visible, evaluate liver for mets |
|
|
Differential diagnoses to insulinoma include what other dz that cause hypoglycemia?
|
-cancer cachexia
-sepsis -liver dz -insulinoma -hepatomas -drugs -puppies (small breeds) -preg w/ malnutrition |
|
|
What are the sx tx for insulinoma?
|
-excision
-debalking -liver bx |
|
|
What are the post sx risks for insulinoma?
|
-pancreatitis
-DM -cerebral laminar necrosis |
|
|
What are the medical treatments for insulinoma?
|
-predisone
-diazoxide -streptozotocin (chem) -dietary management (many small meals) |
|
|
What is Zollinger-Ellison syndrome?
|
Gastrinoma
|
|
|
In what age dogs does gastrinoma occur?
|
Older dogs
|
|
|
What are the clinical signs of gastrinoma?
|
-vomiting (+/- hematemsis)
-diarrhea -melena -anorexia -weight loss |
|
|
How is a gastrinoma dx.?
|
-elevated serum gastrin levels
-abd U/S (mass in stomach) |
|
|
What are the tx options for grastrinoma?
|
-proton pump inhibitor
-sucralfate (gi protectant) -Sugery, tumor removal and may need partial gastrectomy |
|
|
What is the function of the parathyroid gland?
|
Calcium homeostasis
|
|
|
When is parthormone released and from where?
|
From the chief cells in the PTh gland
in response to low Ca++ |
|
|
What role does calcitonin play?
|
Secreted by the C cells in the thyroid , lowers Ca++
|
|
|
What is cholecalciferol?
|
Dietary Vit D3
|
|
|
Which type of Vit D is found in the liver?
|
25-hydroxycholcalciferol
|
|
|
What is 1,25 dihydroxycholecalciferol?
|
Active Vit D3, in kidney
|
|
|
What is a primary cause of hyperparathyroidism?
|
Benign adenoma
hyperplasia is rare |
|
|
What are the secondary causes of hyperparathyroidism?
|
-nutritional
-renal -intestinal |
|
|
What is a tertiary cause of hyperparathyrodism?
|
Receptor abnormalities
|
|
|
How can you summarize the causes of hypercalcemia?
|
GOSH DARN IT
|
|
|
What are the clinical signs of hypercalcemia?
|
-PU/PD
-lethargy -incontinence -weakness/exercise intolerance -anorexia -muscle wasting -vomiting -constipation -NONE -urinary tract dz (Ca++ urolithiasis) |
|
|
How is hyperparathyroidism dx?
|
-elevated PTH in the face of elevated Ca++
-evaluate ionized calcium -radiographs (osteopenia, uroliths) -U/s of neck- often can id affected gland, normal gland will be atrophied |
|
|
What is the goal of sx for hyperparathyroidism?
|
-remove tumor
-remove uroliths |
|
|
After removing the affected parathyroid gland, what condition will the pt be in?
|
Hypocalcemic--until the remaining parathyroid is no longer suppressed
(monitor Q 2-4 hrs) |
|
|
What are the clinical signs of hypocalcemia?
|
-behavior changes
-muscle fasciculations -itchy face |
|
|
How do you tx a pt with hypocalcemia?
|
IV calcium gluconate, monitor ECG
|
|
|
When would you begin giving calcitiol for these sx patients?
|
On the day of sx (takes 3 days to have effect)
|
|
|
When giving calcitriol, what levels of Ca++ do you want the pat to be at?
|
Low end of normal, then slowly decrease until they can maintain a normal level
|
|
|
What oral Ca++ supplementation can be given?
|
-Calcium carbonate (tums) taper over 2-4 months
|
|
|
What is renal secondary hyperparathyroidism?
|
In chronic renal dz, low Ca++ levels trigger PTH (leads to demineralized bone)
|
|
|
What is the tx for renal secondary hyperparathyroidism?
|
-treat the chronic renal disease
-ensure normal Ca++/Phos product -Calcitrol tx |
|
|
What is the cause of nutritional secondary hyperparathyroidism?
|
-Intestinal malabsorption, fat malabsorption
Dietary: -improper Ca++/Phos ratio in diet -low Ca++ -low Vit D |
|
|
The dietary cause of secondary hyperparathyroidism can show what clinical signs?
|
-lameness
-loose teeth -swollen maxilla -pathologic fxs |
|
|
What can cause hypothyroidism?
|
-immune meidated destruction of parathyroids
(at any age, no breed or sec predileciton) |
|
|
What are the clinical signs related to hypocalcemia?
|
-muscle fasiculations/cramps
-seizures -itchiness, pawing at face -cataracts -diaphragm contractions concurrent with heartbeat Ms DIC |
|
|
How is hypoparathyroid dx?
|
-decreased total and ionized calcium
-incressed phosphorus -decreasd iPTH |
|
|
What is the tx for hypocalcemia?
|
-IV calcium for emergency stabilization
-oral calcitriol -oral calcium supplements |
|
|
What are the types of diabetes insipidus?
|
Primary (central)
Nephrogenic |
|
|
DI results from what?
|
Decrease in ADH/VP
Decrease in receptors (rare) |
|
|
What are the clinical signs of DI?
|
-PU/PD
-Incontinence (large amount of urine) +/- neuro signs |
|
|
What results would you expect from a min database on a DI patient?
|
+/- polycythemia
+/- azotemia +/- hypernatremia USG 1.002-1.012 -consider CT/MRI if acquired DI |
|
|
What other steps do you take to Dx DI?
|
-quantify water intake (>100 mk/kg/day)
-rule out ever other cause of PU/PD which is everything |
|
|
What response test is used to DX DI?
|
DDAVP response test
|
|
|
After performing the DDAVP, what results indicate central DI or pyschogenic polydipsia?
|
-dramatic decrease in water intake
-USG increase by 50% |
|
|
What is the huge caution with doing a water deprivation test?
|
You can kill a dog!
Never do on a dehydrated dog! |
|
|
What is DDAVP?
|
-structurally similar to ADH/VP
-more antidiurectic than pressor effect -$$$ -can give only at night and leave out during the day |
|
|
What is the cause of primary nephrogenic DI?
|
Thiazie diuretics- inhibits Na reabsorption in the ascending LOH
-low salt diet |
|
|
What is the cause of secondary nephrogenic DI?
|
Most of the dz on the PU/PD list
|
|
|
What is SIADH?
|
Syndrome of Inappropriate ADH release
|
|
|
What condition causes SIADH?
|
Severe hyponatremia
-with natriuresis -normal renal/adrenal function -water intoxication |
|
|
Growth hormone has what catabolic actions?
|
-insulin antagonist
(stimulates gluconeogensis, promotes lipolysis, hyperglycemia and ketogensis) |
|
|
What are the anabolic actions of Growth Hormone?
|
-Via IGF-1
-liver, body size proportion levels, stimulates protein synthesis and growth promotion |
|
|
What is a congenital cause of growth hormone deficiency?
|
Retained Rathke's pouch
|
|
|
Dwarfism is seen primarily in which breed?
|
GSD
some cats |
|
|
What is the tx for dwarfism?
|
hGH
|
|
|
GH excess can result in what condition?
|
Acromegaly
|
|
|
Acromegaly is seen in older cats (males) and all have what other dz?
|
DM (insulin resistance)
|
|
|
The acromegaly is typically a result of what?
|
GH secreting tumor (adenoma)
|
|
|
Which type of dog is affected by acromegaly?
|
Older, in tact females, GH synthesis in mammary tissue
|
|
|
What conformational alterations can acromegaly cause?
|
-big heads
-big intedental spaces -prognathism |
|
|
Acromegaly can have what other physical effects?
|
-weight gain in the face of DM
-inspiratory stridor (increased soft tissue in the throat) seen in intact female dogs |
|
|
What is the first step in treating a dof with acromegaly?
|
Spay
|
|
|
How can the pituitary dz be treated?
|
Radiation Tx
|
|
|
GI DISEASE
|
GI DISEASE
|
|
|
What are the functions of the GI system?
|
-digestion
-absorption -excretion -water balance -electrolyte and acid/base balance |
|
|
What are the clinical signs of dysphagia?
|
-halitosis
-ptyalism -gagging and multiple swallowing attempts -abnormal prehension -weight loss -painful mouth -coughing hematemesis |
|
|
What conditions are possible causes of dysphagia and should be on your rule out list??
|
-FB
-ulceration, inflammation, infection -dental dz -fxs -sialoadenitis |
|
|
In cats, what additional infectious causes of dysphagia need to be considered?
|
-eosinophilic granulomas
-L/P gingivitis/pharyngitis -calicivirus |
|
|
What neuromuscular diseases are possible causes of dysphagia?
|
-masticatory myositis
-oropharangeal dysphagia -cricopharangeal achalasia and asynchrony -tetanus/botulism/rabies |
|
|
What neurological condition can cause dysphagia?
|
CN V, VII, IX, X, XII paresis or paralysis
|
|
|
An abscess can also cause dysphagia. What types of neoplasia need to be ruled out?
|
-SCC
-MM -FSA -OSA -epulus (AA) -plasmacytomas |
|
|
The physical exam for dysphagia should include which specific components?
|
-PE
-oral exam (esp teeth) -palpate face and neck -complete neuro exam -auscultation (thorax and neck) -observe animal eating if necessary |
|
|
What specific bloodwork might you request for dyspahgia?
|
-FeLV
-FIV -2M antibody titer |
|
|
What contrast radiographic studies can assist in diagnosing the cause of dysphagia?
|
-esophagram
-barium swallow under fluoro |
|
|
Describe the muscle pattern of the dog esophagus?
The cat? |
Dog: all striated
Cat: distal portion is smooth muscle lower esophageal sphintcer is smooth muscle |
|
|
What is the clinical manifestation of esophageal disease?
|
regurgitation
|
|
|
A differentiation must be made between regurgitation and what?
|
Vomiting
|
|
|
When taking the hx on a dog with regurgitation, what questions are important to ask?
|
-how long has this been going on
-any recent anesthesia -any f/b ingested/removed? |
|
|
What additional clinic signs may accompany regurgitation?
|
-dysphagia
-halitosis -hypersalivation -weight loss -+ coughing, dyspnea (aspiration) -+ depression, anorexia |
|
|
Is regurgitation an active or passive function?
|
-passive
|
|
|
How do you distinguish regurgitation from vomiting?
|
-no abdominal component/retching
-no bile -no neusea |
|
|
Which is more common....congenital or acquired megaesophagus/esophageal weakness?
|
Acquired
|
|
|
What are the causes of acquired megaesophagua/esophageal weakness?
|
a lot of things
|
|
|
Which vascular ring anomaly can be a cause of regurgitation? and in which breed is it more common?
|
PRAA
GSD's |
|
|
Regurgitation can also be caused by what other conditions of the esophagus?
|
-FB
-strictiure/diverticula -esophagitis (post anesthesia, GERD, excessive acidity) -LES achalsia |
|
|
Granuloma from which parasite can cause regurgitation?
|
Spirocerca lupi
|
|
|
What physical changes to the esophagus can cause regurg?
|
-hiatal hernia
-intussusception |
|
|
Name a toxic substance and a virus that can cause regurg.
|
-lead poisoning
-canine distemper |
|
|
In a case of regurgitation, which radiographs should be taken first?
|
Survey of thoracic and cervical
|
|
|
What features of the esophagus should you evaluate on the rads?
|
-dilation
-air -dipslacement -fb -masses |
|
|
What should you evaluate the chest rads for?
|
-pneumomediastinum
-mets -aspiration pneumonia |
|
|
which lung lobe is most prone to aspiration?
|
Right middle
|
|
|
What is the benefit of using contrast rads?
|
-defects
-fb |
|
|
What contrast material do you use for rads if you suspect a perforation?
|
-iodinated
|
|
|
What additional information does fluoroscopy give you?
|
Function analysis (use barium and food)
|
|
|
What are the benefits of endoscopy in a case of regurgitation?
|
-direct visualization
-assess severity of dz -therapeutic interventions (fb removal, balloon dilation) |
|
|
Why would you perform a CBC, Chem and UA for regurg?
|
Systemic evaluation
|
|
|
A fecal evaluation would identify which cause of regurg?
|
Spirocerca lupi
|
|
|
An acetylcholine antibody titer would help for evaluation of which dz?
|
MG
|
|
|
If you suspect a myositis or myopathy, what test would you order?
|
Creatinine kinase
|
|
|
Neuromuscular conditions can be evaluated via which tests?
|
-EMG
-tensilon (MG) -peripheral muscle/nerve bx -dysautonomia evaluation |
|
|
When is congenital megaesophagus usually discovered?
|
With regurgitation and poor growth after weaning
|
|
|
Acquired megaesophagus is a condition of older dogs due to what?
|
neuronal dysfunction in esophageal motility
|
|
|
What are some of the tx steps that can be taken for megaesophagus?
|
-elevated feeding and water (bailey chair)
-experiment w/ foods -/+ motility drugs (metoclopramide/cisapride) -feeding tubes (PEG) -tx pneumonis if present |
|
|
What is the tx of choice for a PRAA?
What is the prognosis? |
Surgical removal of the vascular band
-PEG tube prognosis: good if caught early |
|
|
What are the common location for esophageal FB?
|
-thoracic inlet
-heart base -LES (rawhides, bones, fish hooks , hairballs) |
|
|
Why are esophageal FB considered an emergency?
|
-secondary peristalsis will continue, pressure necrosis
-esophagus does not respond well to damage |
|
|
What protocol should you follow if using an endoscpe for a fb?
|
-retrieve if possible (do not manipulate if appears to penetrate full thickness)
-advance to stomach -evaluate muscosal damage or perforation |
|
|
What are the potential complications with esophageal fb removal?
|
-hemorrhage
-perforation -esophagitis -stricture -diverticulum |
|
|
What can cause esophageal stricture?
|
Fibrous ring secondary to injury
|
|
|
What injuries can cause stricture?
|
-esophagitis
-FB -doxycylcline in cats |
|
|
What is the tx for esophageal stricture?
|
Endoscopy with balloon dilation (will need repeated treatments, q 4-7 days)
|
|
|
What are the causes of esophagitis?
|
-recent anesthesia
-GERD, chronic vomiting, gastrinoma -hiatal hernia -caustic material -can stimulate stricture formation |
|
|
Esophageal perforations are usually a result of what?
|
-post FB or esophagitis
can cause pneumomedisatinum, systemic involvement |
|
|
How are small perforation treated?
|
-PEG tube
-Gi protectants -supportive care, abx |
|
|
How are large peforations treated?
|
-sx correction
-abx, support |
|
|
What is a common sequellae to perforation?
|
Stricture
|
|
|
In what regions is spriocerca lupi found?
|
-gulf coast states, Isreal, Caribbean
|
|
|
What are the potential complication of spirocerca lupi?
|
-sarcoma
-aneurysms |
|
|
What are the clinical signs of spirocerca lupi?
|
-regurg
-vomiting -dyspnea |
|
|
How is spirocerca treated?
|
-Doramectin
-+ Selamectin -+ fenbendazole |
|
|
What is the course of treatment for esophageal masses?
|
-FNA, bx or removal
-sx or chemo |
|
|
What are the clinical signs of hiatal hernia or intusussception?
|
-regurg
-aspiration pneumonia |
|
|
The parietal cells of the stomach produce what?
|
HCl
|
|
|
What 3 factors are needed for the production of HCl?
|
-gastrin
-ACh -histamine |
|
|
Which cells produce pepsinogen?
|
Chief cells
|
|
|
Mucous cells produce what?
|
Bicarbonate
|
|
|
Vomiting is a tightly coordinated reflex action involving the vomiting center and....
|
the chemorecptor trigger zone (CRTZ)
|
|
|
The CRTZ responds to stimulus from where?
|
-toxins
-drugs |
|
|
What key questions need to be asked when taking a hx for vomiting?
|
-vaccs?
-deworm? -travel hx -freq and severity -weight loss -behavior changes -hydration status -concurrent Gi signs -hematemesis -associated w/ eating? -appearance of vomitus (bile?) |
|
|
When performing the PE for hx of vomiting, where in the oral exam must you specifically look?
|
Under the tongue
|
|
|
What are conditions are you evaluating when palpating the abdomen?
|
-masses
-fluid -pain -tympany |
|
|
With the data from the hx, clinical signs and PE, it is important to distinguish the type of diarrhea such as....
|
-acute vs chronic
-self limiting vs life threatenin systemic illness -GI vs non GI causes |
|
|
Compared to regurgitation, what does the contents of vomiting usually include?
|
gastric and duodenal contents
|
|
|
From vomiting there is a loss of bicarb, leading to what metabolic condition?
|
metabolic acidosis
|
|
|
How would you differentiate a high GI obstruction?
|
-no duodenal contents
-hypochloremic metabolic alkalosis |
|
|
If a stable, healthy animal presents for vomiting, what should the minimum database include?
|
-PCV/TS/FeLV/FIV
-fecal float, tx deworming -parvo elisa if indicated |
|
|
It may be helpful to keep a dog NPO for day, would you also do this for a cat?
|
No
|
|
|
Is it wise to give anti emetics to a vomiting animal?
|
No, can mask clinical signs...don't give anti emetics until you know th cause of vomiting
|
|
|
Vomiting can be a sign of systemic illness , what other signs of systemic illness should you be aware of?
|
-pyrexia
-painful abdomen -oral ulceration -icterus -ascites -wounds -melena -lethargy -PU/PD -non-productive retching (GDV) |
|
|
When would vomiting be considered life threatening?
|
If it continues and the patient is unstable
|
|
|
What minimum database do you start with in a case of an unstable pt?
|
-CBC/CHEM/UA
-fecal float and smear |
|
|
What is suspected with unproductive vomiting and distended abdomen (shock and collapse)?
|
GDV
|
|
|
A lactate level of what is an indication of GDV?
|
>6
|
|
|
What are some examples of primary GI causes of vomiting?
|
-dietary indiscretion/diet change
-motility disorders -ulcers -allergy -neoplasia etc |
|
|
What are some non GI causes of vomiting?
|
-neoplasia
-renal dz/failure -hepatobiliary dz -peritonitis |
|
|
What information are you looking for from the GI panel levels of
PLI Cobalamine Folate? |
PLI: pancreatitis
Cobalamine: lower w/ GI dz Folate: produce by GU bacteria |
|
|
What is the purpose of an exploratory laparotomy?
|
Diagnostic and therpeutic
TAKE BX! |
|
|
What is the diagnostic protocol for chronic vomiting?
|
-bloodwork
-imaging then therapeutic deworming |
|
|
Of the patient is stable, what trials can be made to address the vomiting?
|
-dietary change
|
|
|
Why are fluids essential in tx vomiting?
|
-maintenance of on-going losses
+/- electrolytes -acid/base status |
|
|
What considerations do you make to the diet while tx vomiting?
|
-NPO 1 day
-bland diet, limited anitgen -TPN, PPN, feeding tubes |
|
|
What types of gastric protectants might you administer?
|
-H2 blockers, proton pump inhibitors
-sucralfate -misoprostal |
|
|
What effect do metaclopramide, cisapride and erythromycin have?
|
Pro kinetics, increase motility
countra indicated in GI obstruction |
|
|
TPN contains what?
PPN contains what? |
TPN: amino acids, glucose, fat
PPN: amino acid, glucose |
|
|
When are anti-emetics contra- indicted?
|
(can mask signs)
-GI infection, toxicity, obstruction |
|
|
Why should anti cholinergics be used?
(atropine, scopolamine etc) |
-cause ileus
-cramping |
|
|
Antibiotics may be indicated in the case of what?
|
Helicobacter
|
|
|
What are the dietary causes of acute gastritis?
|
-indiscretion
-caustic substances -FB's |
|
|
What class of drug can cause gastritis?
|
NSAIDs
|
|
|
What is the approach to diagnosing acute gastritis?
|
A diagnosis of exclusion
|
|
|
Hemorrhagic gastroenteritis is profuse, sever and acute. What clinical signs are seen?
|
-hematemesis
-hematochezia |
|
|
Why do you see an elevated PCV & normal YO with Hemorrhagic gastroenteritis?
|
Severe dehydration
|
|
|
What is a typical signalment for a Hemorrhagic gastroenteritis dog?
|
small breed, critically ill
|
|
|
What are the steps in the tx of Hemorrhagic gastroenteritis?
|
-cystalloids +- colloids
-GI protectants +- abx |
|
|
What are the potential complications of Hemorrhagic gastroenteritis?
|
-DIC
-TBE -renal failure -shock |
|
|
What are the types of chronic gastritis?
|
-lymphocytic/plasmacytic
-eosinophilic -granulomatous -atrophic |
|
|
What diagnostic technique is need for a definitive dx of chronic gastritis?
|
Bx- often endoscopic, many muscosal biopsies
|
|
|
What is a cause of lymphocytic/plasmacytic gastritis?
|
Immune mediated
|
|
|
What are the potential causes for an eosinophilic gastritis?
|
-parasite/allergy
|
|
|
The presence of neutrophils/ macrophages in a gastritis indicate what?
|
Chronic condition
|
|
|
After identifying the primary cause of chronic gastritis, how is it treated?
|
-hypo/low allergy diet
+/- corticosteroids -GI protectants +/- prokinetics |
|
|
Define pyloric stenosis
|
benign, muscular pyloric hypertrophy
|
|
|
What is a common sign of GI outflow obstruction/stenosis?
|
-persistant vomiting
-right after eating |
|
|
What animals are predisposed to GI outflow obstruction/stenosis?
|
-brachycephalic dogs
-siamese cats |
|
|
GI outflow obstruction/stenosis can lead to what complications?
|
-esophagitis
-ME -regurgitation can lead to hypochloremia, metabolic alkalosis |
|
|
What techniques are used to dx GI outflow obstruction/stenosis?
|
-U/S
-contrast rads -endoscopic bx -bx (r/o infiltrative dz) |
|
|
What is the tx for GI outflow obstruction/stenosis?
|
Pyloroplasty
|
|
|
What is the cause of antral hypertrophy?
|
-idiopathic
-excess mucosa |
|
|
How is antral hypertrophy corrected?
|
-pyloroplasty and mucosal resection
|
|
|
What are the underlying causes of GD/GDV?
|
-abnormal motility
-lax ligaments |
|
|
GD/GDV tend to occur in what type of dog?
|
Deep chested
|
|
|
What are some of the predisposing factors of GD/.GDV?
|
-large meals
-rapid eating -underweight -elevated platform (?) -male -older |
|
|
What are the clinical signs of GD?
|
-unproductive retching
-large cranial abdomen -tympany |
|
|
What radiographic view is taken for GD/GDV?
|
Right lateral abdomen
|
|
|
Prognosis of GD/GVD is based on what 2 factors?
|
-time
-amount of lactate |
|
|
How do you stabilize a GDV patient for surgery?
|
-shock dose fluids (multi large bore catheters)
-gastric decompression and lavage |
|
|
Electrolyte abnormalities for GDV can lead to what complications?
|
-ECG abnomalities (hyperkalemia--> VPC's)
-reperfusion injury |
|
|
A GDV is repaired by what procedure?
|
-gastropexy
+/- splenectomy |
|
|
Define gastric atony
|
idiopathic gastric hypomotility
|
|
|
What are the DDx's for gastric atony?
|
-obstruction
-IBD -hypercalcemia -hypocalcemia |
|
|
What radiographic technique is used to dx atony?
|
Fluoroscopy
|
|
|
How is gastric atony tx?
|
Prokinetics (metaclopramide, cisapride, erythromycin)
|
|
|
GI ulceration can be caused by stress from what?
|
-hypovolemia
-sepsis -extreme exertion |
|
|
What class of drugs can cause ulcers?
|
NSAIDs
|
|
|
What tumors can induce ulcers?
|
Mast cell(histamine release --> HCl)
-gastrinoma |
|
|
What are 2 systemic causes of GI ulcers?
|
-hepatic dz
-uremia |
|
|
How are ulcers treated?
|
-eliminate predisposing cause
-GI protectants |
|
|
Gastric adenocarcinoma tend to be found where?
|
Pylorus
|
|
|
Which neoplasia tends to affect the cardia of the stomach?
|
leiomyosarcoma
|
|
|
Why does GI lymphoma occur?
|
anywhere
|
|
|
What fungus is found in the gulf coast, Israel and the caribbean and causes V/D?
|
Pythium insidium
|
|
|
How is pythium dx?
|
-cytology
-histology -serology |
|
|
If pythium is caught early, how is it tx?
|
-sx resection
-itraconazole |
|
|
What is the mechanism of osmotic diarrhea?
|
-decreased solute absorption
-water follows solute -diet changes (unabsorbed solutes in lumen) |
|
|
What is the mechanism of action of secretory diarrhea?
|
-hypersecretion of ions from:
-toxins (bacterial or chemical) -intestinal inflammation -DSS (diethyl sodium succinate) rare in small animals seen in horses |
|
|
Which types of GI dysmotility are rare?
|
-primary
-hypermotility hypomotility more common |
|
|
What are the causes of secondary dysmotility?
|
-drugs
-hyperthyroidism -exterotoxigenic |
|
|
What can cause an exudative dysmotility?
|
-increased permeability
-damage to mucosal barrier -leakage of blood proteins |
|
|
What are the clinical manisfestations of GI dysmotility?
|
-diarrhea/constipation
-vomiting -weight loss -anorexia -polyphagia, coprophagia, pica -abd pain -melena, hematochezia -tenesmus -ascites/edema -borborygumus/flatulence -halitosis -dehydration -polydipsia |
|
|
The history and PE must be evaluated to determine the classification of diarrhea which be be what?
|
-chronic vs acute
-self limiting, potentially fatal, systemic dz -small intestine vs large intestine or diffuse |
|
|
When evaluating an acute diarrhea, what dietary issues do you need to consider?
|
-changes/indescretion
|
|
|
When evaluating an acute diarrhea, what parasites do you need to consider?
|
-helminths
-protozoa (giardia, tritrich, coccidia) |
|
|
When evaluating an acute diarrhea, what infectious dzs do you need to consider?
|
-parvo, corona, FeLV/FIV
-bacterial overgrowth -rickettsia |
|
|
When evaluating an acute diarrhea, what mechanical obstruction do you need to consider?
|
Intussusception
|
|
|
When evaluating an acute diarrhea, what endocrine issue do you need to consider?
|
Hypoadrenocorticism
|
|
|
Chronic diarrhea can have many of the same causes as acute, what additional causes should you keep in mind?
|
-neoplasia
-fungal infection -lymphangectasia -breed specific enteropathies (basenji, wheaton, shar pei) |
|
|
What systemic dzs can cause chronic diarrhea?
|
-pancreatitis
-hyperthyroidism -hepatic dz -hypoadrenocorticism -renal dz -toxins -parasties |
|
|
What conditions cause malabsortive dz?
|
-ARE/SIBO
-dietary -IBD |
|
|
What condition causes maldigestive dz?
|
EPI
|
|
|
Which produces a larger volume....small bowel diarrhea or large bowel?
|
Small bowel
|
|
|
Which frequently has mucus present...small bowel diarrhea or large bowel??
|
large bowel
|
|
|
Which produces uregency to poop...small bowel diarrhea or large bowel?
|
large bowel
|
|
|
Which is usually accompanied by weight loss..small bowel diarrhea or large bowel?
|
small bowel
|
|
|
The PE for a workup for diarrhea must include what 2 components?
|
-oral exam
-rectal |
|
|
What are you feeling for when palpating the abd of a pt with diarrhea?
|
-thickened bowel loops
-masses -effusions -pain |
|
|
Why should you observe defecation attempts?
|
-dyschezia
-tenesmus -evaluate feces |
|
|
Fecal evaluation should include what components?
|
-observation
-floatation -cytology |
|
|
What would a foul odor or steatorrhea indicate in a fecal sample?
|
Malabsorption
|
|
|
What should be included in the minimum database for a diarrhea workup?
|
-CBC
-Chem -UA -VBG -FeLV/FIV/Parvo |
|
|
An anemia in a pt with diarrhea would indicate what?
|
chronic blood loss
|
|
|
An decrease in albumin indicates what condition? A decrease in albumin and globulins indicates what?
|
Albumin: nephropathy
Albumin and globulin: PLE |
|
|
A loss of bicarb and sodium could show as what in the Chem panel?
|
Metabolic acidosis
(resultant hyperkalemia) |
|
|
Abdominal rads are used to r/o what?
|
-fb, mass effects, obstruction
look for serosal detail, free fluid/gas, ileus |
|
|
What additional imaging procedures can be performed in the assessment of diarrhea?
|
-contrast rads
-U/S |
|
|
A specific GI blood panel would show what indices?
|
-PLI
-TLI -cobalamine -folate |
|
|
Are cobalamine levels increased or decreased with malabsorptive dz?
What increases folate? |
cobalamine increases
intestinal bacterial overgrowth causes high folate |
|
|
What is a drawback to using endoscopy in Gi work?
|
limited for most of the SI
|
|
|
What is the benefit to doing a bx via sx?
|
-bx more sites
-full thickness samples -evaluate all abd organs |
|
|
When treating diarrhea is it better to feed the animal of have it be NPO?
|
feed
|
|
|
What fiber supplements can be given?
|
-metamucil
-canned pumpkin |
|
|
When would abx be indicated?
|
If systemically ill
|
|
|
Are anti-diarrheal drugs necessary?
|
rarely
if so use opiates, bismuth subsalicylate |
|
|
In young animals what are the complications of acute enteritis?
|
-dehydration
-fever -anorexia -pain -hypolycemia -hypothermia |
|
|
Are fecal cultures helpful in identifying the cause of an enterotoxemia?
|
rarely
|
|
|
Enterotoxemia patients can present critically ill, what CBC results do you expect?
|
Inflammatory leukogram, left shift, toxic neutrophls
|
|
|
How is enterotoxemia diagnosed?
|
By exclusion
|
|
|
What is the Tx for enterotoxemia?
|
-aggressive fluids
-Abx IV -monitor serum proteins (may need colloids) |
|
|
What are the complications that can arise from enterotoxemia?
|
Sepsis
DIC |
|
|
Canine parvovirus has an affinity for what type of cells?
|
Rapidly dividing cells (crypt epithelium, bone marrow)
|
|
|
The severity of parvo depends on what?
|
Size and virulence of innoculum
Ag, host defenses |
|
|
How do you dx parvo?
|
-PE and Hx
-neutropenia -elisa |
|
|
What is the first step to tx parvo?
|
-fluids (crystalloid +/- colloids)
-with glucose (esp young pups) -K+ supplementation |
|
|
What abx are sued for parvo?
|
-newer potentiated B lactams IV
-ampicillin/enrofloxacin combo (caution w/ cartilage damage) |
|
|
Tx for parvo also includes what steps?
|
-nutrional support
-deworming -anti-emetic -gastric protectants |
|
|
What is a potential complication of canine parvo?
|
Intussusception
|
|
|
What is the cause of feline parvo enteritis?
|
Panleukopenia virus
|
|
|
Early in the infection of feline parvo, how can it be dx?
|
-CBC- drastic changes
-Canine elisa tx similar to pups |
|
|
Often, how is the causative agent of a bacterial enteropathy identified?
|
By finding consistent clinical signs and response to tx
|
|
|
How can campylobacter ans salmonellosis be identified?
|
PCR
(also blood culture for salmonella) |
|
|
How can clostridium be identified?
|
Spore forming bacteria on a fecal smear
|
|
|
What kind of diarrhes does histoplasmosis cause?
|
Chronic large bowel diarrhea
weight loss +/- SI involvement |
|
|
Which other body systems can be affected with histo?
|
-eyes
-respiratory -lnn |
|
|
What type of GI dz does hist induce?
|
-diffuse, severe, granulomatous ulcerative mucosal dz
|
|
|
What tests are used to confirm histo?
|
-cytology/histology on rectal scrapes
-abd tap if acites -Urine Ag test |
|
|
What is the tx for Histo?
|
Itraconzaloe for 4-6 months
|
|
|
What type of organism is Prototheca?
|
Algae
|
|
|
Prototheca infects which organs?
|
-skin
-colon (colitis, hematochezia) -eyes |
|
|
Which dog breed is over represented with Prototheca?
|
Collies
|
|
|
Is there a Tx for prototheca?
|
-not a good one
-amphotercin B (renal failure common) |
|
|
Which parasites are responsible for diarrhea/GI infection?
|
-whipworms
-roundworms -hookworms -tapeworms |
|
|
Which parasite can give pseudoaddison's signs?
|
Whipworms (hyperkalemia, hyponatremia)
|
|
|
Roundworms are found where?
|
Inflammatory SI infiltrates
|
|
|
What is a sign of hookworm infection?
|
Severe anemia
|
|
|
Tapeworms are tx with what?
|
praziquantal
|
|
|
Why are strongyloides a concern?
|
Pose a human health risk
tx w/ fendendazole |
|
|
What is the tx for cryptosporidia?
|
None known
|
|
|
Histiocytic Ulcerative Colitis is seen in which breeds?
|
Boxers and Frenchies
|
|
|
What symptoms does Histiocytic Ulcerative Colitis induce?
|
Recurrent large bowel diarrhea
|
|
|
What is IBD?
|
An idiopathic intestinal inflammation
can affect any portion of the GI tract |
|
|
How does IBD manifest?
|
Exaggerated response to normal fauna or dietary antigens
can look like lymphoma |
|
|
How is IBD diagnosed?
|
Diagnosis of exclusion
-histopath (lots of variety between pathologists) cobalamine deficiency |
|
|
How is IBD treated?
|
-hypo/low allergen diet
-Abx for ARE -cobalomine supplements -anti-tinflammatory to immunosuppressive doses of corticosteroids -addiotnal immuno drugs |
|
|
Which breeds are predisposed to lymphangectasia?
|
-yorkies
-wheatons -lundehund |
|
|
What are the clinical signs of lymphangectasia?
|
-diarrhea (PLE)
-ascites (transudates) |
|
|
With lymphangectasia, what do the lacteals leak?
|
-protein
-lymph -chylomicrons |
|
|
How is lymphangectasia diagnosed?
|
-endoscopy or sx bx
|
|
|
What is the tx for lymphangectasia?
|
-ultra low fat diet
-prednisone |
|
|
How is lymphoma tx?
|
chemo
|
|
|
How is adenocarcinoma tx?
|
sx resection (chem)
|
|
|
How is leimyosarcoma tx?
|
sx +/- chemo
|
|
|
How are polyps tx?
|
Sx
|
|
|
What inflammatory conditions can cause tenesmus/dyschezia?
|
-anal sacculitis
-perianal fistula -tumors |
|
|
What are the infectious causes of tenesmus/dyschezia?
|
-pythiosis
-histoplasma |
|
|
Obstructive causes of tenesmus/dyschezia include what?
|
-neoplasia
-granuloma/abscess -prostatic dz -pelvic fx |
|
|
In cats esp., tenesmus/dyschezia can be caused by what condition?
|
Urethral obstruction
|
|
|
What are some causes of constipation?
|
-drugs
-behavioral -dietary -colonic weakness -dehydration -obstruction.deviation -spinal cord dz |
|
|
What therapeutics are used to treat constipation?
|
-fiber
-stool softener -enema (not phsophate) |
|
|
What is a perianal fistula?
|
painful draining tract around the anus
|
|
|
What is the cause of a perianal fistula?
|
idiopathic/immune mediated
|
|
|
Anal sac adenocarcinoma can cause which electrolyte imbalance?
|
Hypercalcemia
|
|
|
What is the tx for dogs for perianal gland adenoma?
|
Neuter (testosterone responsive)
|
|
|
Idopathic megacolon affect which species primarily?
|
Cats
|
|
|
What causes idiopathic megacolon?
|
Altered colonic neurotransmitters
|
|
|
How is megacolon tx medically?
|
-feces removal: enema, digital
-cisapride -stool softener -fiber -litterbox issue? |
|
|
How is megacolon tx surgically? What is a potential drawback to the sx?
|
-subtotal colectomy
-soft stools prermanently |
|
|
HEPATOBILIARY DISEASE
|
HEPATOBILIARY DISEASE
|
|
|
Ia a liver acinus a functional or an anatomic unit?
|
Functional
|
|
|
Which liver unit is anatomic?
|
Lobule
|
|
|
Liver fibrosis occurs from stellate cells (Ito) located where?
|
In the space of Disse
|
|
|
What are the functions of the hepatocytes?
|
-bile production
-glycogen storage -urea synthesis -metabolize fat -synthesize plasma proteins (incl clotting & anti-clotting) -detoxify drugs & toxins -activates hormones |
|
|
Which liver cells are macrophages?
|
Kuppfer
|
|
|
What clinical signs make you consider liver dz?
|
-hepatomegaly/microhepatica
-ascites -icterus -coagulopathies -neurologic abnormalities -acholic feces/steatorhhea -bilirubinuria |
|
|
What CBC resluts indicate liver dz?
|
-microcytes
-target cells |
|
|
What UA results would you expect with liver dz?
|
-dilute USG (low urea)
-ammonium biurate crystals -bilirubinuria -urobilinogen |
|
|
What does the presence of urobilinogen indicate?
|
No bile duct obstruction
|
|
|
Which serum chem values can assess liver function?
|
-alubumin
-glucose -cholesterol -BUN -bilirubin |
|
|
What happens to the cholesterol value in the of intrahepatic cholestasis?
|
-increases
in PSS and fibrosis ir decreases |
|
|
What is AST found?
|
Mitochonrial enzyme
|
|
|
AST is a marker for cellular damage, is it specific to the liver?
|
No
|
|
|
What does an increased AST indicate?
|
-liver damage
-kidney infection -myocardial infarction -muscle damage |
|
|
Which serum chem values can assess liver function?
|
-alubumin
-glucose -cholesterol -BUN -bilirubin |
|
|
What happens to the cholesterol value in the of intrahepatic cholestasis?
|
-increases
in PSS and fibrosis ir decreases |
|
|
What is AST found?
|
Mitochonrial enzyme
|
|
|
AST is a marker for cellular damage, is it specific to the liver?
|
No
|
|
|
What does an increased AST indicate?
|
-liver damage
-kidney infection -myocardial infarction -muscle damage |
|
|
Where is ALT found?
|
Cytoplasm
|
|
|
What does ALT indicate?
|
An accurate indicator of hepatocyte injury (max at 48 post acute injury)
|
|
|
Is ALT a function test?
|
NO!
|
|
|
What is half life of ALT in a dog?
Cat? |
Dog: 3 days
Cat: 6 hours |
|
|
Where is Alk Phos found?
|
Membrane bound on the bile canallicular surface
|
|
|
Is alk phos a liver function test?
|
No!
|
|
|
What does alk phos indicate?
|
Indicator of cholestasis (intra or extra hepatic)
|
|
|
Isoenzymes can be released by what?
|
-liver
-bone -pregnancy -skeletal growth -steroids -phenobarbital -any elevation in a cat is a concern |
|
|
GGT is membrane bound and found where?
|
Bile duct epithelium
|
|
|
In which species is evaluation of ALP and GGT helpful?
|
Cats..if both elevated and ALP> GGT suggestive of hepatic lipidosis
|
|
|
What is the cause of pre-hepatic increased serum biliruibin?
|
Hemolytic anemia
|
|
|
What does heptic serum bilirubin indicate?
|
Liver disease or injury
|
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What is the post hepatic cause of serum bilirubin?
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Cholestasis
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Total bilirubin consist of which 2 components?
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-conjugated
-unconjugated |
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What diseases can affect the synthesis of clotting proteins?
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-EBDO decreases vit K absorption (fat malabsorption)
-Portal hypertension -GI Hemorrhage |
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Which clotting cascade does PT test?
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Extrinsic
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What 2 general conditions can lead to a hepatic encephalopathy?
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-reduction in hepatic mass
-reduction i portal blood flow |
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What are some of the clinical signs of hepatic encephalopathy?
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-anorexia/lethargy/depression
-ataxia -dementia -hysteria -circling -head pressing |
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What causes the encephalopathy?
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Inability to detoxify GI toxins
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What are the sources of ammonia that can cause encephalopathy?
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-bacterial
-intestinal -high protein meals/GI blood -lean body mass breakdown |
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Bile acids are released in response to what?
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CCK from intestinal cells
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How is a serum bile acid test performed?
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-12 hour fast
-fasted serum sample -feed small amount of dog food -2 hours post prandial serum sample |
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What should the bile acid levels be for pre and post eating?
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Pre: < 5 or 5-10 mmol/L
Post: <15 05 25 mmol/L |
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What post feeding bile acid levels are seen in the case of a PSS?
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> 100
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Does a serum bile acid test differentiate between causes for reduced function?
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No
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A bile acids test cannot be used on a dog in with what condition?
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Icterus
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What serum level could you check to help dx hepatic encephalopathy?
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Resting ammonia concentration
( 6 hrs post meal) indicates reduced hepatic mass or shunting |
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True or False. An abdominal centesis can be used to remove large amounts of fluid?
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False, rarely therapeutic
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If you perform an abdominal centesis and remove clear fluid (pure transudate), what condition does this indicate?
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Chronic hepatic falure, decreased albumin
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If you perform an abdominal centesis and remove serosanquinous, amber colored fluid, what condition does this indicate?
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-chronic hepatic failure
-RSHF -intrahepatic portal hypoplasia -FIP -neoplasia |
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What is the color of a septic exudate that indicates a perforation or bile peritonitis?
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-cloudy
-red -green -dark yellow |
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When testing for urine bile acids, what are the compared with?
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UBA:creatinine ratio
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What is plasma protein C and what information can it give?
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-anti-coagulant protein
-synthesized in the liver -assesses hepato-portal circulation |
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Dose urine bile acids help identifying PSS?
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yes
improves after sx repair |
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A lateral abdominal radiograph is excellent for assesing the liver in what way?
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Size
-checks gastric axis -look for mass effect |
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In which cases of hepatobiliary dz is U/S helpful?
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-w/ ascites
-hepatic parenchyma eval -gall bladder & bile duct -portal vein |
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Which U/S mode is used to determine the presence of a PSS?
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Doppler
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How does U/S identify what a mass is?
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It can't can only locate it...histpath is needed
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U/s can be useful in guiding a FNA or a needle bx. Prior to performing a needle bx, what test is needed?
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Coagulation, check later for bleeders
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What contrast radiographic procedure is used to visualize the liver and its blood supplies?
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Mesenteric portovenography
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What are the benefits of an exploratort laparotomy/laparoscopy in hepatic dz?
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-examine all abd organs
-examine gall bladder -assess CBD patency -culture bx -wedge bx |
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What is a good overall abx for hepatic infection?
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Clavamox
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What is ursodiol?
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Bile acid supplement
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