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263 Cards in this Set

  • Front
  • Back
Functions of the cerebellum
Coordinate voluntary movements
Maintain posture and equilibrium
Modulates msucle tone and movement via influences on UMN systems
DOES NOT initiate any movement
Region of the brain in which the cerebellum is located.
Dorsal metencephalon
3 peduncles of the cerebellum that attach it to the brainstem
Rostral
Middle
Caudal
3 neuronal layers of the cerebellar cortex
Molecular
Purkinje
Granular neuronal layer
Four major clinical signs of cerebellar dysfunction
Postural abnormalities
Gait disturbances
Tremors
Vestibular signs
Goal directed or intention tremor is a clinical sign of injury to this region of the brain...
Cerebellum
DAIM can arise from disorders of any of these:
Skeletal muscle
Peripheral nerves
CNS
Tremors may be connected to either of these neurologic conditions
Cerebellar disease
Disorders of autonomic involuntary movement
Persistent, sustained muscle contraction with delayed relaxation
Myotonia
Myotonia is caused by a disorder of...
Skeletal muscle membrane conductance disorder
Is myotonia congenital or acquired?
Either
Acquired myotonia (pseudomyotonia) is a complication of...
Hyperadrenocorticism
Describe the EMG for a pseudomyotonic case
Does not wax and wane
Persistent, wavelike undulating muscle contraction caused by hyperexcitable motor axons
Myokymia
Persistent muscular contraction resulting in stiffness or collapse
Neuromyotonia
These two similar conditions are idiopathic in terrier breeds and are caused by hyperexcitable motor axons
Myokymia
Neuromyotonia
Intermittent state of sustained muscle contraction; usually extensor rigidity
Tetany
Persistent sustained muscle contraction without interspersed period of relaxation.
Tetanus
Two metabolic causes of tetany
Hypocalcemia
Hypomagnesemia
Two toxic causes of tetany
Clostridium tetani toxin
Strychnine poisoning
Trauma to any of these three regions may cause tetany.
Rostral cerebellum
Midbrain
Thoracolumbar spine
This DAIM is typically presented with a sawhorse stance, intermittent contraction of antigravity muscles, and may affect limbs, face, and multiple muscles. Common causes are hypocalcemia and hypomagnesemia
Tetany
Limb and facial grimace and opisthotonous are seen in a young lab puppy. What genetic disease should you test for?
Familial reflex myoclonus of the lab
What causes familial reflex myoclonus of the lab?
Reduced spinal cord glycine (inhibitory) receptors
Treatment for familial reflex myoclonus of the lab
None
Prognosis for familial reflex myoclonus of the lab
Poor
Familial reflex myoclonus is not actually muoclonus, but...
Tetany
Toxin responsible for tetanus
Tetanospasmin toxin
How does tetanospasmin toxin work?
Blocks release of glycine and GABA inhbitory neurotransmitters
Treatment for tetanus
Debride wound
Antitoxin
Metronidazole/penicillin
Supportive care
Prognosis for tetanus
Good: Recovery in weeks to months
What is they mechanism of action for strychnine?
Glycine antagonist in the CNS causing tetany and seizures
Treatment for strychnine
Gastric decompression
Diuresis
Anticonvulsants
Supportive care
Which toxin crosses the blood brain barrier: Tetanospasmin or strychnine?
Strychnine
Sudden contraction of a muscle group followed by immediate relaxation.
Myoclonus (tremor)
Sporadic tremors are often a manifestation of...
Seizure
Three classifications of repetitive tremor.
Resting (postural)
Action related
Persistent
Diffuse action related myoclonus is also called:
White Shaker's DIsease
Onset of diffuse action-related myoclonus
Acute
Signalment of the typical case of diffuse action-related myoclonus
Middle aged small and toy breeds
Treatment for diffuse, action-related myoclonus
Prednisone, immunosuppressive dose for several weeks then tapered off.
Prognosis for diffuse action related myoclonus
Excellent but relapse possible
Breeds predisposed to head bobbing
Doberman, Bulldog, Boxer, Boston terriers
Treatment for episodic postural repetitive tremor of the head and neck
Anticonvulsants (variable response)
Usually just let it be
Course of episodic postural repetitive tremor of the head and neck
Unpredictable intermittent episodes that are non-progressive
Postural repetitive tremor of the pelvic limbs is a benign essential tremor seen in...
Geriatric dogs
Cause of postural repetitive tremor of the hind limbs
Unknown
Ruleouts with postural repetitive tremor of pelvic limbs
Painful orthopedic diseases of pelvic limbs and lumbar spine
True or false: Postural repetitive tremor of the pelvic limbs is non-progressive.
False. May progress to thoracic limbs but will not typically intervene with the animal's quality of life.
Treatment for postural repetitive tremor of the pelvic limbs
None needed
Does postural repetitive tremor if the pelvic limbs occur while at rest or in motion?
Only at rest
Difficulty in swallowing
Dysphagia
Phases of swallowing
Oral
Pharyngeal
Cricopharyngeal
Esophageal
Gastroesophageal
Esophageal and gastroesophageal dysphagia presents as...
Regurgitation
Deficit in bolus accumulation, difficulty lapping water or prehending food, excessive salivation and chomping, and loss of food from mouth are all signs of what form of dysphagia?
Oral phase
Weight loss, failure to thrive, loss of food from mouth, food reflux through nose, and adpiration pneumonia may all result from what form of dyshagia?
Pharyngeal phase
Weight loss, failure to thrive, loss of food from the mouth after attempting to swallow, repeated swallowing attempts, food reflux from the nose, aspiration pneumonia are all CS of this form of dysphagia.
Cricopharyngeal phase dysphagia
Basic cause of functional dysphagia
Neuromuscular issue
Basic cause of structural dysphagia
Obstructive mass
List some specific causes of structural dysphagia
Trauma
FB
Gingivitis/stomatitis
Neoplasia
Granuloma
Ranula/ pharyngeal mucocele
Nasopharyngeal polyp
Deficits in these areas may cause functional dysphagia
Mucosal receptors fro swallowing
Cranial nerves 5, 7, 9, 10, 11
Medullary swallowing center
NMJ
Striated muscle
Type of musclulature in the pharynx
Striated muscle
Another word for cricopharyngeal dysphagia
Achalasia
In what age group is cricopharyngeal achalasia evident?
Young dogs soon after weaning
How is cricopharyngeal achalasia diagnosed?
Radiography
How is cricopharyngeal achalasia treated?
Cricopharyngeal myotomy
Describe cricopharyngeal myotomy.
Cutting of the cricopharyngeal sphincter to relax it
Prognosis for cricopharyngeal achalasia
Good unless there are pharyngeal and esophageal motility defects
Decreased esophageal motility may result from any of the following:
Striated muscle
NMJ
Medulla
Peripheral nerves
Idiopathic disease of the esophagus often results from...
Abnormalities in esophageal compliance and response of esophageal mechanoreceptors
Myasthenia gravis causes esophageal problems at this level...
NMJ
A normal meal should be removed from a healthy canine stomach within...
6-8 hours
Clinical signs of delayed gastric motility...
Chronic vomiting, delayed up to 6-8 hours after eating. May be projectile.
Weight loss
Post-prandial abdominal distension and discomfort
Possible causes of pyloric outflow obstruction
Pyloric hypertrophy
FB
Gastric/duodenal neoplasia
Extraluminal neoplasia (pancreas, liver)
Diagnosis of pyloric outflow obstruction based on...
Endoscopy (food retention after fast)
Radiography (delayed gastric emptying, enlarged ingesta-filled stomach, intramural mass)
Abdominal ultrasound
3 view thoracic radiographs
First diagnostic test for chronic vomiting
Abdominal ultrasound
Usual signalment of dog with chronic hypertrophic pyloric gastropathy
Middle aged small breeds of dogs
What special pre-anesthetic considerations should be made when an animal with chronic hypertrophic pyloric gastropathy is undergoing anesthesia?
Increased risk of aspiration pneumonia so prolong the fast to 24+ hours
On abdominal rads you see a "beak sign" in the stomach. THis is a sign of...
Pyloric hypertrophy
With chronic hypertrophic pyloric gastropathy will the duodenum be normal or abnormal?
Normal
Diagnosis of pyloric hypertrophy is best made with...
Endoscopy and FNA
How is pyloric hypertrophy treated?
Surgical correction of obstruction
List some possible causes of abnormal gastric motility
Idiopathic
Sympathetic stimulation
Hypokalemia
Anticholinergics
Gastritis
How does the endoscopic exam for abnormal gastric motility differ from that of delayed gastric emptying?
Still see retention of food but no obstruction seen
How do the survey radiographs for abnormal gastric motility differ from that of delayed gastric emptying?
Look the same: Distended full stomach
How is abnormal gastric motility treated?
Correct underlying defect
Metoclopramide
Cisapride (more effective prokinetic than metaclopramide)
How does cisapride work as a prokinetic?
Causes release of ACH from enteric nervous system.
Noncholinergic effect on feline colonic smooth muscle
Causes smooth muscle contraction
What feeding modifications should be made with an animal having delayed gastric emptying?
Small frequent meals, restrict fat to speed emptying
Two most common Salmonella serovars seen in small animals
S. typhimurium
S. anatum
Is Salmonella in the dog and cat a zoonotic disease?
Possibly. We treat it as if it is.
Increased incidences of canine Salmonella carriage occur with...
Raw diets, possibly
Clinical signs of Salmonellosis in dogs and cats
Vomiting and diarrhea (D > V)
Acute onset
Pyrexia
Septicemia
Neutropenia
Debilitated, stressed, immunosuppressed animals
How is Salmonellosis diagnosed?
Fecal culture
Blood culture
BAL
How is GI Salmonellosis treated?
Supportive care (hydration, probiotics, etc.)
(Abx may prolong carrier state!)
How is Salmonella septicemia treated?
Antibiotics based on C/S for 10 days
Amoxicillin
Choramphenicol
Gentamicin
TMS
Enrofloxacin
How common is it to have an asymptomatic canine carrier of Campylobacter jejuni?
Common
Incidence of clinical C. jejuni is highest in...
Immature dogs
Sheltered/kenneled dogs
Which diarrheal disease is seen more commonly in dogs: Campylobacter or Salmonella?
Campylobacter
Percentage of dogs with C. jejuni who show no CS
50%!
CS of Campylobacter
Acute diarrhea
Acute vomiting
Fever
Anorexia
Depression
How is Campylobacter diagnosed?
Direct saline fecal exam: See highly motile spiral bacteria
Fecal cytology: Seagull shaped bacteria
Bacteria culture
Significance of seeing Campylobacter jejuni on a fecal smear.
Not diagnostic but suspicious. Confirm with culture but begin treatment right away.
Special considerations for submitting a Campylobacter culture.
Needs special transport and culture media.
Oxygen requirement for Campylobacter.
Microaerophillic
Treatment for Campylobacter
Based on C/S
Usually erythromycin for 7-10 days
Number 1 side effect of erythromycin in dogs and cats. What special consideration minimizes this CS?
Vomiting (GI irritant). Give with food.
List some differential diagnoses for chronic SI diarrhea.
Parasites
Dietary indiscretion/ Fiber-responsive/ Dietary sensitivity
Pancreatic exocrine insufficiency
Feline hyperthyroidism
FeLV/FIV
Stagnant loop syndrome
Initial diagnostic plan for chronic SI diarrhea
3 fecals for intestinal parasites
Saline fecal smear
Fecal cytology
Correct DI/fiber responsive trial
STLI
Therapeutic deworming
FeLV/FIV
T4
Possible causes of abnormal abdominal palpation in an animal with chronic SI diarrhea
Stagnant loop syndrome
Nodular neoplasia
FB
Intussuception
IBD
Diffuse SI lymphosarcoma
What % of chronic small bowel diarrhea cases will have abnormal abdominal palpation?
1%
Diagnostic plan for chronic SI diarrhea with abnormal palpation
Survey abdominal rads
Abdominal US
3 view thoracic radiographs
FNA/ percutaneous biopsy
+/- barium UGI
Exploratory laparotomy
A cat has chronic SI diarrhea and its bowel loops feel thick, distended, and similar to a garden hose. What would be the best diagnostic tool to pinpoint the cause and why?
Endoscopy, b/c full thickness biopsy will not heal well in these cases
Typical diagnostic route when investigating abnormal palpation in a chronic SI diarrhea case.
Rads, ultrasound, exploratory surgery and biopsy.
Syndrome that involves partial SI obstruction leading to intestinal stasis and SIBO.
Stagnant loop syndrome
Most common causes of stagnant loop syndrome
Intestinal tumor or FB
Normal SI flora count
<100,000 cfu/mL
CS of stagnant loop syndrome
Chronic SI diarrhea
Wt loss
Chronic vomiting if high obstruction
Dehydration
Dilated bowel loop
Abdominal mass
How does SIBO cause diarrhea?
Bacteria ferment CHO (osmotically active particles)
Endoscopic findings in an animal with SIBO.
Normal
Significance of abnormal palpation in a case of chronic SI diarrhea
Need further investigation
Prognosis of SIBO
Varies with underlying disease, length of affected SI, and degree of dilation
Syndrome resulting in loss of protein in the SI lumen
Protein losing entropathy
Two causes of PLE
Damaged mucosal barrier
Dilated and obstructed lymphatics
List some causes of PLE
Lymphagiectasia
IBD
Diffuse lymphoma
Histoplasmosis
Parvovirus
HGE
Hookworms
Acute idiopathic enteritis
Two main signs of PLE
Chronic SI diarrhea
Weight loss
Hypoalbuminemia from PLE may cause these CS...
Chronic vomiting
Abdominal distension/ascites
Peripheral edema
Dyspnea and pulmonary edema, pleural effusion
Lab findings associated with PLE
Low albumin, globulin, Ca
Possible lymphopenia, cholesterol
Pathophysiology of PLE
GIT is site of plasma protein breakdown
Mucosal capillaries have large fenestrae
Plasma proteins enter SI--> Usually digested, absorbed, recycled
Increased loss with increased permeability, inflammation, erosion, ulceration, venous congestion, lymphatic obstruction
Excessive loss exceeds absorptive ability of GIT
Liver can increase protein synthesis by how much in the event of PLE?
2X normal
Hypoproteinemia may be seen with any of the following diseases:
PLE
Glomerulonephritis
Hepatic failure
Chronic hemorrhage
Starvation/Malabsorption
Burns
With glomerulonephritis, what protein levels will you find on bloodwork?
Normal albumin, low globulin
Liver disease will result in low levels of these blood proteins
Albumin
Globulin
Diagnostic plan for hypoprotenemia
Evaluate chronic SI diarrhea
If GI signs mild, R/O other causes protein loss (creatinine, UA, liver function)
Fecal alpha1-protease
Purpose of testing fecal alpha1-protease
Document enteric protein loss when kidney and liver problems are rules out and there is little to no diarrhea.
Purpose of alpha1-protease in the body.
Protects animal against premature activation of trypsin in pancreas
Alpha1 protease is normally found in...
The blood
Number of samples needed to test for fecal alpha1 protease
3 in one day
Therapy for PLE
Treat underlying disease
Causes of SIBO include
Stagnant loop syndrome
PEI
Malabsorptive disorders
Idiopathic syndrome
Which animal is more tolerant of higher GI flora? Dog or cat?
Cat
SIBO occurs in what % of PEI patients?
80%
How is SIBO diagnosed?
Quantitative SI bacterial culture of duodenal juice. (Aerobic and anaerobic)
How relaible are the cutoff values for SIBO?
Controversial
Diagnosis of SIBO may be made indirectly based on...
SUCA (Serum unconjugated cholic acid)
SUCA is normally reabsorbed in what part of the SI?
Jejunum
Serum bile acids are deconjugated by what process?
Bacterial breakdown in the SI
Purpose of conjugated bile acids
Carry fats to the SI mucosa for absorption
Diagnostic plan for SIBO
Evaluate primary SI disorder causing chronic SI diarrhea
Serum B12 and folate (nonspecific)
Quantitative duodenal culture
SUCA
How effective are the present diagnostic tests for SIBO?
Not very. Usually just do abx trial.
Therapeutic plan for SIBO
Treat underlying condition
Abx therapy for 3 weeks (tetracyclines, ampicillin, MTDZ, tylosin, clindamycin)
Are benign SI polyps more common in the dog or cat?
Cat
Clinical signs associated with SI neoplasia
Chronic SI diarrhea and vomiting (or mixed bowel diarrhea)
Wt loss
Anorexia
Anemia/melena
Abdominal mass/lymphadenopathy
SI obstruction
Diarrhea may be minimal to absent
Diagnosis for intestinal neoplasia is based on:
Ultrasound, 3 view thoracic rads
FNA
Biopsy (Endoscopic, US, laparotomy)
Treatment for intestinal adenocarcinoma
Surgical resection
Treatment for intestinal lymphosarcoma
Chemotherapy
Prognosis for intestinal neoplasia in dogs
Guarded
Which species as a group has a poorer prognosis for intestinal neoplasia: Dogs or cats?
Cats
Most common SI malignancy in dogs
Adenocarcinoma
Most common SI malignancy in cats
Lymphoma
Does adenocarcinoma present as a solitary mass or as an annular mass?
Either
CS of adenocarcinoma in dogs
Chronic small bowel diarrhea
Wt loss
Anemia/melena
Anorexia
Abdominal madd
Diarrhea can be minimal or absent
True or false: SI adenocarcinoma is localized and benign.
False. It is invasive and metastatic
Diagnosis of SI adenocarcinoma is based on...
Ultrasound, 3 way TXR
Biopsy
Treatment for SI adenocarcinoma
Surgical resection
Px for SI adenocarcnoma
Guarded in dogs
Poor in cats
Why is endoscopy not always diagnostic for SI adenocarcinoma?
Endoscopy only reaches to the duodenum. Most tumors in jejunum or ileum
What is the relationship between SI LSA in cats and FeLV?
Believed that FeLV causes LSA, but most cats FeLV negative when LSA diagnosed.
Maybe due to neutralizing response by body?
Lymphosarcoma in cats involves these organs commonly...
Stomach, LI, liver, mesenteric LN, kidneys
Signalment of LSA in dogs and cats
Middle aged dogs, older cats
Is lymphosarcoma more common in dogs or cats?
Cats
How does LSA present in the SI?
Diffuse mucosal infiltration
SIngle or multiple masses
Annular constricting mass
CS of lymphosarcoma
Chronic SI (mixed) diarrhea
Chronic vomiting
Weight loss
Anemia/melena
Anorexia
Abdominal mass/ lymphadenopathy
Diarrhea may be minimal or absent
Lymphosarcoma is best diagnosed by...
Endoscopy and biopsy of duodenum
Treatment for invasive/infiltrative lymphosarcoma of the SI.
Chemotherapy
Cats: Prednisone and chlorambucil
Two chemotherapeutic drugs used to treat SI LSA in the cat
Prednisone
Chlorambucil
Treatment for a single mass of lymphosarcoma.
Surgical removal followed by multiagent chemotherapy
3 reasons to treat SI LSA surgically.
Obstructive mass
Risk of perforation
Severe ulceration and bleeding
Prognosis for lymphocytic LSA in the cat.
Good! 2 year survival with chemotherapy!
Prognosis for LSA in the dog
Poor to grave
Histoplasma is most common in this area of the US
Ohio and Mississippi River basins
Histoplasma spread is associated with...
Bird droppings
3 forms of Histoplasma disease
Acute
Chronic respiratory
Disseminated
How does Histoplasma infection become disseminated
Macrophages from the lungs
How is Histoplasma diagnosed?
Rectal cytology
Endoscopy/ mucosal biopsy
Percutaneous FNA or tru-cut biopsy

GOAL: Identify the organism
Treatment for Histoplasma
Amphotericin B (quick-kill)
Ketoconazole
Itraconazole (if stable)
True or false: SI neoplasia tends to cause chronic SI diarrhea, wt loss, icterus, and anemia.
False--> all of these except icterus are signs of SI neoplasia. Icterus would result if the cancer spread to liver.
Two causes of ascites
Portal hypertension
Hypoalbuminemia
Two possible causes of portal hypertension and ascites.
Distortion/obstruction of sinusoids
Increased portal blood flow volume
Describe the under-filling theory of ascites.
Splanchnic pooling = decreased venous return to heart
Decreased cardiac output, activation of RAAS
Increased circulatory volume
Dilution of serum albumin from fluid retention
Describe the over-filling theory of ascites
Primary renal retention of Na and water
Increased circulatory volume
Dilution of serum and albumin
Which is the current dominant theory of ascites etiology: Over-filling or under-filling?
Mixture of two
Toxins responsible for hepatic encephalopathy.
Amino acids
Ammonia
SCFA's
Mercaptans
GABA
Endogenous benzodiazepines
How does hepatic encephalopathy occur?
Liver cannot remove toxic material produced in the bowel or unable to undergo normal metabolism. Abnormal concentrations of toxins in the blood.
Most potent inhibitory neurotransmitter
GABA
GABA is released when these two compounds bind appropriate receptors in the brain.
Benzodiazepines
Barbiturates
Drugs contraindicated for treatment of seizures induced by hepatic encephalopathy.
Benzodiazepines
Barbiturates
Why would flumazenil be a possible treatment for hepatic encephalopathy?
GABA antagonist, since liver may not be removing GABA effectively
Processes that lead to an increase in GABA in the CNS.
GI bacterial metabolism
GI hemorrhage
Increased permeability of BBB in liver disease
Glutamic acid--> GABA in CNS as result of ammonia metabolism
Normal ratio of branched to aromatic amino acids in a healthy animal.
3:1
Liver disease causes a relative increase in the level of this type of amino acid.
Aromatic (3 fold increase)
Type of amino acid that crosses blood brain barrier
Aromatic
What effect do aromatic amino acids have in the brain?
Increase production of inhibitory and false neurotransmitters.
Mercaptans are a byproduct of...
Bacterial metabolism of sulfur-containing AA
How can "liver sparing" drugs contribute to hepatic encephalopathy?
If they contain mathionine, may be metabolized to mercaptans that can induce coma.
Why does SAMe not cause HE even though it is a form of methionione?
Methionine not available for bacterial metabolism, sent to liver whole
Mercaptans decrease the hepatic metabolism of...
Ammonia
The effect of SCFA's on the brain is similar to that of...
Barbiturates
Where do endogenous benzodiazepines come from?
Food
Liver diets should have low levels of...
Highly digestible proteins
Goal of protein restriction in liver diets
Reduce levels of ammonia
Purpose of suluble fiber in a liver diet
Decrease colonic pH and trap ammonia in LI
Three common hepatobiliary disorders
Vacuolar hepatopathy
Microvascular dysplasia
Gallbladder mucocele
Benign reversible vaculolar hepatopathy of dogs caused by exogenous or endogenous glucocorticoids
Steroid hepatopathy
How frequently does steroid hepatopathy lead to liver disease?
Rare
CS of steroid hepatopathy
Related to corticosteroid excess
This enzyme is greatly elevated with steroid hepatopathy
Alkaline phosphatase
True or false: Vacuolar hepatopathy is always linked to corticosteroid excess.
False.
Current hypothesis behind vacuolar hepatopathy
Stress of severe disease--> Hypercortisolemia--> Increased ALP--> vacuolar hepatopathy
Absence or dysplasia of terminal portal veins
Hepatic microvascular dysplasia
Hepatic microvascular dysplasia is inherited in...
Cairn terriers
CS for hepatic microvascular dysplasia resemble those for...
Portosystemic shunt
Often the only clinical sign of hepatic microvascular dysplasia
Elevated serum bile acids
Sign seen with portosystemic shunts that is not seen with hepatic microvascular dysplasia.
Microcytosis
Does HMD or PSS have a higher shunt fraction?
PSS
Prognosis for hepatic microvascular dysplasia
Good if asymptomatic
Dogs with CS can often be managed for years
In a dog with elevated bile acids, how do you determine whether due to PSS or hepatic microvascular dysplasia?
Abdominal U/S (50-80% accuracy in shunt detection)
How can a symptomatic animal be treated for hepatic microvascular dysplasia?
Low protein diet
Lactulose
Intermittent, nonabsorbable antibiotics like with hepatic encephalopathy
Disease characterised by gallbladder distension with immobile bile, cystic mucosal hyperplasia, and a stellate pattern on U/S
Gallbladder mucocele
This breed may be predispoded to gallbladder mucocele
Cocker Spaniel
CS of gallbladder mucocele
Vomiting (M/C)
Anorexia
Lethargy
Abdominal pain
Icterus
Pyrexia
Rupture--> Ascites and shock
True or false: Gallbladder mucocele may be an incidental finding
True
Treatment of gallbladder mucocele
Emergency surgery if rupture
Scheduled surgery iof CS
Medical management if subclinical (Ursodeoxycholic acid, recheck q 4-6 weeks)
Copper associated hepatitis is seen most frequently in this dog breed.
Bedlington Terriers

Also see in Westies, Skye terriers, Dalmatians, Labs, Dobermans
What defect causes copper-associated hepatitis?
Autosomal recessive trait causing accumulation of copper within hepatocyte
Why is copper associated hepatitis seen in Dobermans
Propensity for chronic hepatitis--> Cholestasis--> Copper buildup b/c of reduced biliary clearance
Forms of disease caused by copper-associated hepatitis
Severe hepatic failure and death in young adult following stressful event
Chronic hepatitis
Asymptomatic carrier
How is copper-associated hepatitis diagnosed?
Excessive copper in biopsy specimen (> 1000 ppm)
How is copper associated hepatitis treated?
D-penacillamine or trientine to chelate copper, inhibit fibrosis and CMI.
Zinc acetatie (decrease absorption)
Ascorbic acid (increase urinary excretion of Cu)
May need to be treated for over 1 year!
Prognosis of acute copper associated hepatitis
Grave
Prognosis of chronic copper associated hepatitis
Depends on fibrosis
In an animal with primary copper associated hepatitis, is lifelong copper chelation therapy necessary?
Yes although may be able to taper dose down to lower level
List some hepatotoxic drugs.
Phenobarbital
Diazepam
Oxybendazole
TMS
Carprofen
How is a drug proven to be hepatotoxic in a given animal?
Administer drug, reverse CS. Then challenge animal with drug again and get more CS again
Not often done
Median time to carprofen hepatotoxicity in susceptible animals
19 days
Biopsy findings in an animal with carprofen infuced hepatotoxicity
Hepatic necrosis
How long after discontinuing carprofen do clinicopathologic findings return to normal?
3-4 weeks
Clinical signs associated with carprofen-caused hepatocellular necrosis usually resolve after...
20 days once treatment stopped
High incidence of carprofen linked hepatocellular necrosis seen in this breed
Labradors
Most common CS seen with carprofen-related hepatocellular necrosis in Labradors
Anorexia
Vomiting
Icterus
Elevations of these clinicopathological values seen with carprofen linked hepatocellular necrosis
ALT
AP
Bilirubin
Primary histopathologic signs of carprofen-induced hepatitis
Nonspecific necrosis and inflammation
Treatment for carprofen-linked hepatocellular necrosis
Discontinue carprofen
IV fluids 1-7 days
Antibiotics 3-14 days
May use GI drugs or ursodeoxycholic acid as needed
How should a patient on carprofen be monitored for hepatitis?
Blood chem panel before treatment, check liver enzymes after 3-6 months
Is liver neoplasia more commonly metastatic or primary?
Metastatic
Is liver neoplasia more commonly malignant or benign?
Malignant
CS of hepatic neoplasia
Asymptomatic
Abdominal mass
Hepatomegaly
Ascites (+/- tumor cells)
Mild hepatic signs: Anorexia, wt loss, lethargy, occasional vomiting and diarrhea
Primary tumors that tend to metastasize to the liver
Mammary mass
Spleen
Pancreas
Stomach and/or intestines
Are biliary carcinomas more common in male or female dogs?
Female
Icterus is commonly associated with this hepatic neoplasm
Biliary carcinoma
Made from the union of methionine and ATP, being an essential metabolite for hepatocytes
SAMe
(S-adenosylmethionine)
Do endogenous levels of SAMe increase or decrease in liver disease?
Decrease
SAMe is a precursor of this antioxidant.
Glutathione
Three antioxidant nutraceuticals that may be beneficial in liver disease
SAM-e
Vitamin E
Milk thistle