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92 Cards in this Set
- Front
- Back
Approximately how much cardiac output is directed toward the liver?
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25%
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Which of the following animals lacks a gallbladder?
a) horse b) pig c) camelid d) cow e) javelina f) Sara!! |
a) horse
b) camelid e) javelina f) Sara!! |
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What are the major hepatic functions?
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Carb metabolism
Fat metabolism Protein metabolism Detox Bile acid synthesis Urea synthesis |
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What is the metabolic fate of cholesterol?
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BILE ACIDS
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Put the following in the correct order
Albumin/bilirubin Biliverdin Conjugated bilirubin Heme Hemoglobin Urobilinogen Uncongugated bilirubin |
Hemoglobin
Heme Biliverdin Uncongutated bilirubin Albumin/bilirubin Conjugated bilirubin Urobilinogen |
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What can cause increases in unconjugated bilirubin?
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Excess production (hemolysis)
Decreased uptake into liver Disturbed protein binding Disturbed conjugation |
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What can cause increases in conjugated bilirubin?
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Disturbed secretion of CB
Intra/extrahepatic cholestasis |
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What are common, fairly specific signs in hepatic failure?
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Jaundice/icterus
Photosensitization Hepatic encephalopathy (wt loss, colic, depression, anorexia are less specific) |
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What is the pathogenesis of ventral edema in hepatic failure? Which species is this less common in?
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Low protein = edema
Hepatic fibrosis > portal hypertension > edema Less common in horseses |
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What compound causes photosensitization?
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Phylloerythrin
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What enzymes indicate hepatocellular damage in large animals? Which is mainly for ruminants and which for horses?
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AST, GLDH (ruminants), SDH (horses), LDH5
(note: ALT doesn't work well in large animals) |
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What enzymes indicate cholestasis in large animals? How long do the induced enzymes take to peak?
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ALP, GGT
Take ~7d to peak |
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Hypoalbuminemia is uncommon in what large animal species?
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Horses
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Bilirubinemia can be indicative of what conditions?
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Anorexia/fasting
Hemolysis Early hepatic disease Obstructive biliary disease |
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What urine parameters can be indicative of hepatobiliary disease?
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High conjugated bilirubin = cholestasis
Increased urobilinogen = hemolysis or hepatocellular dz |
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T or F:
Increased BUN can be indicative of hepatic dysfunction. |
False!
Altered NH3 metabolism = DECREASED BUN |
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Serum bile acids greater than what values are indicative of liver disease in large animals? What conditions would cause the highest values?
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>15-20 umol/L
Greatest increases w/cholestasis and portal shunts |
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Where can you pretty much always find the liver with ultrasound in a horse? In a cow?
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Horse - left 7 to 9th ICS
Cow - right 8 to 12th ICS |
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How should a normal liver look on ultrasound as compared with the spleen? With the kidney?
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Liver is hypoechoic (darker) to the spleen and hyperechoic (lighter) to the kidney.
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What are liver biopsy landmarks for the horse? The cow?
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Horse - R side 12th ICS along line from tuber coxae to olecranon
Cow - 20-30cm to R of midline in 11 or 12th ICS |
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What are poor prognostic indicators for hepatobiliary disease in horses?
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Hypoalbuminemia (<2.5g/dL)
Chronic hyperglobulinemia PT>30% above normal High GGT and ALP with low or normal SDH Marked fibrosis Hepatic encephalopathy Hemolytic crisis Bile Acids >50umol/L |
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What occurs in the three acinar zones? Which has the highest/lowest O2 levels?
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Zone 1 - high O2; gluconeogenesis, oxidative metabolism
Zone 2 - mix of 1 and 2 Zone 3 - low O2; glycolysis, lipogenesis |
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The most common cause of acute hepatitis/hepatic failure in horses is...
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...Theiler's Disease (idiopathic acute hepatitis)
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Idiopathic acute hepatitis is often associated with...
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...tetanus antitoxin
...plasma transfusion |
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What is a common signalment for Theiler's disease?
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Adult (>2yo) lactating mare 1-3 months post foaling.
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What clinical sign is pathognomic for Theiler's disease?
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Nothing really! You will see a dishrag liver on necropsy though but that's not too clinical...
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What is the causative agent of Tyzzer's disease? What is the signalment of this disease?
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Clostridium piliformis
Foals <6wks |
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How is Tyzzer's disease diagnosed?
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Usually post-mortem;
Demonstration of bacterium in liver (chinese characters); Maybe PCR or FAb |
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What is the common signalment of infectious necrotic hepatitis? What is the causative agent?
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Disease of sheep
Caused by Clostridium novyi type B |
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Infectious necrotic hepatitis is nearly always associated with what other variables?
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Hepatic parasitism (F. hepatica)
Liver biopsy |
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Compare infections by Clostridium novyi types B and D.
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Type B - Black Disease (Infectious Hepatic Necrosis); mostly sheep and sometimes horses; subcut hemorrhage; ubiquitous in distribution
Type D - Redwater (Bacillary hemoglobinuria); ruminants and occasionally horses; bleeding from orifices; more regional in distribution |
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Clostridium novyi type D is also known as...
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...Clostridium haemolyticum (causes redwater or bacillary hemoglobinuria)
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What are most hepatic abscesses in cattle caused by? In goats?
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Fusobacterium necrophorum (cows)
Corynebacterium pseudotuberculosis (goats) |
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T or F:
Due to their lack of a gallbladder, horses have a lower incidence of hepatic abscesses than do cattle. |
False! This just makes no sense! Its really due to rumenal bacteria crossing into the portal vein and lodging in the liver
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What laboratory values may be diagnostic for hepatic abscess in cattle?
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Reversed N:L ratio (normal is 40:60)
Increased fibrinogen and globulins Elevated GGT and AST |
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What are some important differentials when considering a hepatic abscess?
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Johne's disease
Traumatic reticuloperitonitis Parasitism Lymphosarcoma Malnutrition |
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What variable can increase chances in cattle to hepatic abscesses?
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Abrupt high grain diet
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What is the most common equine hepatic issue at the OSU large animal hospital? What is the signalment?
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Equine Herpesvirus 1;
affects foals |
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When is the earliest that clinical signs will present after ingestion of Fasciola hepatica metacercariae? How long before they shed eggs?
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6-7 wks
2-4 wks after (8 - 11 wks total) |
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What are the 3 syndromes of liver fluke disease? How many flukes are associated with each?
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Subclinical disease (<40 flukes)
Clinical disease (>200 flukes) Acute illness/death (clostridial disease) |
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T or F:
Cattle can clear Fasciola while sheep and goats often cannot. |
True!
After 5-6 months cattle mount an immune response and clear the infection. |
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Fasciola hepatica eggs can be confused with...
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...Paramphistomum spp.; the rumen fluke
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How can liver flukes be treated in OR with one treatment?
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treat in late fall/early winter;
removes adults prior to onset of winter stress and prevents egg shedding |
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Fascioloides magna infection has a high mortality in:
a) goats b) sheep c) deer d) cattle |
goats and sheep
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Which liver fluke doesn't hurt sheep all that much...
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Dicrocoelium dendriticum (Lancet fluke)
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What is the fat composition threshold for hepatic pathology in cattle?
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>34% fat = pathology
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Which types of equids most commonly develop hyperlipemia or hyperlipidemia? What are these conditions associated with?
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Donkeys, ponies, and mini horses;
Associated with a sudden drop in dietary carbohydrates |
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Choose hyperlipemia or hyperlipidemia...
...much worse clinically. |
hyperlipemia
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Choose hyperlipemia or hyperlipidemia...
...often presents with concurrent rhabdomyopathy. |
hyperlipemia
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Choose hyperlipemia or hyperlipidemia...
...associated with azotemia. |
hyperlipidemia
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Choose hyperlipemia or hyperlipidemia...
...white to yellow plasma. |
hyperlipemia
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Choose hyperlipemia or hyperlipidemia...
...sky high triglycerides |
hyperlipemia
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Administration of what hormone reduces fat mobilization?
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Insulin
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Chronic active hepatitis is characterized by what kind of infiltrate?
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Lymphocytic/Plasmacytic
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What are some fairly nasty-sounding clinical signs associated with chronic active hepatitis in horses?
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Moist exfoliative dermatits at the coronary band
Focal areas of necrotic leathery skin |
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Which enzymes will be markedly high during chronic active hepatitis in a horse?
a) AST b) ALT c) GGT d) SDH e) GLDH |
ALP and GGT
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What histologic change denotes chronic active hepatitis?
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bridging necrosis and bridging fibrosis
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What feature characterizes suppurative cholangiohepatitis?
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Neutrophilic invasion of the hepatic portal tracts and bile ducts
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T or F:
Steroid-responsive lymphacytic/plasmacytic infiltrates in chronic active hepatitis provide a moderate prognosis. |
True!
Although steroids don't prolong survival so it confuses me why this is true... |
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What type(s) of bacteria usually shows up in culture with suppurative cholangiohepatitis?
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Gram negative gut bacteria (salmonella, citrobacter, E. coli, aeromonas, actinobacter)
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The condition involving stones in the common bile duct is...
How about in the L or R bile ducts? Gallbladder? Intrahepatic duct? |
Choledocholithiasis (common)
Cholelithiasis (L, R or bladder) Hepatolithiasis (intrahepatic) |
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Which type of cholelith can horses not get?
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They get them all! More common in horses anyhow!
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What is the triad of signs indicating cholelithiasis? What is the common signalment?
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colic, pyexia, and icterus in horses >5yo
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What are fairly diagnostic biochemical values indicating cholelithiasis?
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Sky high ALP and GGT (15x normal)
Conjugated bilirubin >25% of total bilirubin |
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What is a common site to view choleliths in horses via ultrasound?
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Cranioventral R lobe (6th to 8th ICS)
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What is the channel sign?
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distended intrahepatic bile duct running alongside the portal vein
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What toxin is most likely the most common cause of chronic liver disease in large animals?
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Pyrrolizodine alkaloids
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With regard to hepatic toxicity, megalocytosis is associated with which toxin?
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mycotoxins
Pyrrolizodine alkaloids too |
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Describe the pathogenesis of pyrrolizodine alkaloids.
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PAs converted to pyrroles in the liver.
Pyrroles crosslink DNA, previnting mitosis, leading to megalocytic hepatopathy. Cells die leading to fibrosis. |
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What are the best methods for controlling behavior in cases of hepatic encephalopathy?
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Use alpha-2 agonists (avoid diazepam)
Treat acute hypoglycemia Reduce blood ammonia |
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When does Dr. McKenzie say that acidosis should be corrected with bicarb?
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At or below 7.1
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What are poor prognostic indicators when treating hepatic disease?
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Hemolysis
Hepatic encephalopathy Severe acidosis Diarrhea Bridging necrosis/fibrosis on biopsy |
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Sepsis is...
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...the systemic inflammatory response to infection.
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What is SIRS?
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Systemic inflammatory response syndrome
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What is endotoxemia?
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Endotoxemia refers to circulating LPS from gram negative bacteria cell walls.
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What are the clinical insults that constitute SIRS?
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Tachycardia
Tachypnea Increased/decreased body temp increased/decreased WBCs (or left shift w/>10% bands) |
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The presence of viable bacteria in the blood stream describes...
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...bacteremia
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What constitutes severe sepsis?
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Sepsis with at least one organ dysfunction or hypoperfusion.
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Septic shock occurs when:
a) bacteremia increases beyond 10000 cfu/dL b) two or more organ systems are impaired c) at least one organ is impaired d) sepsis with hypotension unresponsive to fluids |
d) sepsis with hypotension unresponsive to fluids
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Which two classes of circulating molecules trigger the pro-inflammatory mediators?
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DAMPS and PAMPS
Damage-associated and Pathogen associated molecular pattern molecules |
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What are some examples of gram positve toxins?
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Flagellin
Peptidoglycan Bacterial DNA |
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How is sepsis diagnosed?
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Usually 2 or 3 of the following:
Tachycardia Tachypnea Pyrexia WBC changes (leukopenia) |
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How is sepsis treated?
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Circulatory support
Remove underlying cause (possibly neutralizing endotoxin) |
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T or F:
Fluids are given in septic cases to alleviate dehydration. |
False!
It mostly helps with organ perfusion and nutrient distribution. |
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What is the emergency bolus for a 500kg horse?
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5-10L in 30-60 min
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Do not use hypertonic saline if > _____ % dehydrated!!!
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if >8% dehydrated
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What is probably the most important pharmaceutical when treating sepsis?
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NSAIDS
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When are antibiotics indicated in cases of sepsis?
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Marked immunosuppression
Pneumonia, metritis, etc - DEFINITELY NOT GI ISSUES Specific diseases (like rickettsial diseases) |
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Name the form of hepatic lipidosis that affects...
...dairy cows. |
Fat cow syndrome
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Name the form of hepatic lipidosis that affects...
...beef cows. |
Protein/energy malnutrition
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Name the form of hepatic lipidosis that affects...
...ewes and does. |
Pregnancy toxemia
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Name the form of hepatic lipidosis that affects...
...ponies and miniature horses. |
Hyperlipidemia and Hyperlipemia
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