Acute Medicine and Surgery

Question 1

gastric foreign body definition

Answer 1

anything ingested that can’t be digested

Question 2

examples linear foreign bodies

Answer 2

string, yarn, cloth, dental floss

Question 3

foreign bodies in cats

Answer 3

usually linear
must be removed asap
can cause intestinal perforation and peritonitis

Question 4

signs gastric foreign body

Answer 4

may be asymptomatic
vomiting - acute or persistent
anorexia
depression
abdominal pain
dehydration - sometimes
palpable plicated intestines - somtimes
linear foreign body attached to ventral tongue - cats

Question 5

gastric foreign body - ddx

Answer 5

parvo
gastric neoplasia

Question 6

diagnostics gastric foreign body

Answer 6

radiography - radio-opaque visible, radiolucent needs positive contrast or double contrast
cytological examination of any effusion
endoscopy - gastroduodenoscopy

Question 7

treatment - gastric foreign body

Answer 7

induce vomiting - apomorphine for dogs, xylazine for cats - only if quite certain can be expelled without harm
correction of acid base
withold food - 12 hours
radiographs immediately before surgery or endoscopy - localise foreign body
perioperative antibiotics
gastrotomy - to inspect whole GIT
don’t pull on linear foreign body unless comes loose easily
endoscopy - to remove foreign body, care of sharp edges
antiemetics if vomiting continues

prognosis good so long as stomach not perforated and foreign body removed

Question 8

GDV definition

Answer 8

gastric dilatation-volvulus
enlargement of stomach and roatation on mesenteric axis

Question 9

simple dilatation definition

Answer 9

stomach engorged but not malpositioned

Question 10

dilitation definition

Answer 10

organ or structure stretched beyond normal dimensions

Question 11

GDV pathophysiology

Answer 11

enlargment from gastric outflow obstruction - can’t vomit, eructate or empty pylorus to intestine
enlarged with gas/fluid
stomach rotates, usually clockwise ( from surgeons perspective)
spleen displaced to right ventral abdomen
caudal vena cava and portal veins obstructed - reduced venous return and cardiac output, myocardial ischemia, obstructive shock and inadequate tissue perfusion
affects multiple organs

arryhtmias common

Question 12

risk factors GDV

Answer 12

exercise after large meals or a lot of water
soy or cereal based dry foods
irish setters fed single feed type
large meals (regardless of number of meals daily)
feeds that are high oil or fat content
anatomic predisposition
gastric ileus
trauma
primary gastric motility disorders
vomiting
stress
male sex
increasing age
low BCS
rapid eating
raised feeding bowl - may promote aerophagia
dry kibble anxious dogs
spending 5 or more hours with owner
egg supplements
equal time in and outdoors
splenectomy (maybe)

military dogs more commonly develop GDV in November, December, Janurary - don’t know why

adding table food to large or giant breed dogs may decrease GDV incidence

Question 13

GDV signallment

Answer 13

usually large deep chested breeds - but not exclusively (also see in small dogs and cats)
more common in shar peis than other medium breeds
more common in middle aged and older
intact females higher risk

Question 14

GDV signs

Answer 14

distending and tympanic abdomen - varying degrees
recumbency
depression
may have pain - arched back
clinical signs of shock - weak peripheral pulses, tachycardia, prolonged CRT, pale mm, dypnoea,

Question 15

GDV ddx

Answer 15

simple dilatation - common in puppies that overeat
small intestine volvulus
diaphragmatic hernia
ascites

Question 16

GDV diagnostics

Answer 16

radiograph - differentiate GDV and simple dilatation
free abdominal air - suggests gastric rupture
air within wall of stomach - indicates necrosis

immedaite surgery once stabilised

Question 17

GDV treatment

Answer 17

stabilise - fluids - isotonic, 7% saline or hetastarch
blood gas analysis
CBC
broad spectrum antibiotics
oxygen therapy if dyspnoea
gastric decompression - tube, care not to perforate oesophagus
once decompressed wash with warm water to prevent recompression
surgery once stabilised even if stomach decompressed - rotation impedes blood flow so can lead to necrosis
surgery in dorsal

Question 18

GDV surgery aims

Answer 18

inspect somtach and spleen
remove damaged or necrotic tissue
decompress stomach
correct malpositioning
adhere stomach to body wall - prevent future malpositioning

Question 19

enterotomy

Answer 19

allows access to entire GIT
provides full thickness biopsies - important for submucosal masses
can examine and sample rest of abdomen at same time
samples taken from lymph nodes, liver and other tissues before gastric or intestinal - cross contamination

simple interrupted to close

Question 20

enterotomy - indications

Answer 20

masses
foreign body removal
luminal examination
biopsy

Question 21

end to end anastomoses

Answer 21

recommended for removal of ischemic, necrotic or neoplastic tissue or fungal infected segments of intestine or irreducible intussuceptions

care not to pull sutures too tight but make water tight

simple interrupted recommended

Question 22

coagulopathy - horses - acute haemorrhage

Answer 22

not a common cause of haemorrhage but consumptive coagulopathy can be an issue after the haemorrhage

Question 23

signs of haemorrhagic shock

Answer 23

tachycardia
tachypnoea
cold extremities
anxiety or depression
pale mm
prolonged CRT
weak arterial pulse
flow murmur
sweating
colic
abdominal distension
decreased MAP

Question 24

acute haemorrhage - biochem markers

Answer 24

hyperlactatemia - impaired oxygenation to tissues
hypoprteinemia
anemia
may have normal PCV and TP - especially in early stages - can stay normal until fluid redistributes (up to 12 hours) TP changes first

Question 25

estimating blood loss - acute haemorrhage (horse)

Answer 25

total blood volume - 8% body weight <15% loss - HR normal, CRT normal, BP normal, possible mild anxiety 15-30% - increased HR and RR, mildly prolonged CRT, normal BP, mild anxiety 30-40% - moderate to severely increased HR, increase RR, prolonged CRT, decreased BP, anxiety or depression, cool extremities >40% - severely increased HR, increased RR, pale mm, severe hypotension, obtunded, cool extremities

Question 26

controlling blood loss - acute haemorrhage

Answer 26

ligation - surgical pressure - pressure bandage, tourniquet, manual pressure pack sinuses pro-coagulants - topical, absorbable (for smaller areas), IV formalin (no evidence in support) herbal stablise clots - anti-thrombolytics - aminocaprioc acid, transexamic acid (morepotent, better evidence) - inhibit fibronolysis and stabilise clot

Question 27

fluid therapy - acute haemorrhage - horse

Answer 27

assess if controlled or not need coagulation factor replacement uncontrolled - persistant hypotension - dangerous aim to support circulating blood to minimum volume needed for tissue perfusion until controlled crystalloids indicated if donor blood not immediately available and the case is an emergency blood products preferred controlled - if definitive hemotasis - expand volume with crystalloids, hypotonic saline, or blood if unstable controlled - replace minimum of estimated blood lost, can give initial bolus blood products preferred as not diluting RBCs crystalloids and synthetic colloids can dilute RBSs and clotting factors - increase BP so destabilising clot and increasing bleeding, may also cause hypocoagulation

Question 28

blood transfusion indications - acute haemorrhae - horse

Answer 28

30% loss signs of hypovolemic shock PCV < 20% in acute bleed, <12% in chronic anemia lactate >4mmol/L

Question 29

blood transfusion - donors - horse

Answer 29

ideally large healthy geldings good temperament PCV <35% TP <6g/dL ideally negative for Aa and Qa alloantigens 8 equine blood groups, >30 different factors avoid donor mares that have had foals or horses who have previously had a transfusion can't use donkeys - donkey factos cross match by evaluating haemogluttination - may not need to do this is recipient has not had blood products before

Question 30

calculation blood deficit - acute haemorrhage - horse

Answer 30

(normal PCV - animal PCV/normal PCV) * blood volume

Question 31

reactions to blood transfusion - horse

Answer 31

usually in first 15 mins more common after multiple transfusions agitation tremors urticaria pruritis piloerection colic nasal oedema pulmonary oedema weakness collapse tachycardia tachypnoea dyspnoea pyrexia death stop if any reaction, use corticosteroids or antihistamine adrenaline in severe cases if re-starting do so slowly

Question 32

safety and restraint measures - farm

Answer 32

competent human help crush calving gate locking yolk halter kick bar tail jack hobbles tie back leg ppe cotton wool in ears down halter sedation

Question 33

sedation - farm

Answer 33

xylazine detomidine romifidine butorphanol aims - standing, standing with muscle relaxation, recumbent, deep recumbent sedation

Question 34

sedation side effects - farm

Answer 34

increased salivation recumbancy abortion risk bloat regurgitation and inhalation heat stress pulmonary oedema risk in sheep TMPS antibiotics contraindicated

Question 35

considerations sedation - farm

Answer 35

IM - slower onset, longer duration, larger dose IV - faster, shorter duration, smaller dose consider epidural

Question 36

sacrococcygeal epidural - farm

Answer 36

uses - obstetrics prolapse c-section embryo fertility work rectal prolapse epiostomy - cut during parturition to make more space castration when - before starting painful procedure around hindquarters procaine

Question 37

sacrococcygeal epidural - procedure - farm

Answer 37

18gauge 1.5inch needle 5ml procaine lift tail and bend slightly palpate 1st or 2nd coccygeal space clip and sterile prep needle at 15degrees to vertical effective within 5-10 mins no motion of tail, no sensation around perineum and no straining

Question 38

bloat types - farm

Answer 38

frothy bloat - can't be eructated - consumption of fermentable legumes free gass - obstructive, can't eructate calves - rumen drinking

Question 39

treatment bloat - farm

Answer 39

stomach tube NSAID antacids electrolytes recurrent bloat - local anaesthesia red devil trochar or rumenotomy incision paralumbar fossa screq red devil into the abdominal muscle and rumen release gas remove once animal recovered oozing and slow hole closure common

Question 40

indications caesarian - farm

Answer 40

legs cross no room around head/legs precervical torsion uterine torsion that won't move foetal monster uncorrectable dystocia suspected uterine tear

Question 41

caesarian procedure - farm

Answer 41

edipural - 5ml procaine for 600kg cow clenbuterol IV nsaid 3-5 days antibiotic - penicillin, amoxycillin, tetracycline clip left paralumbar fossa abdominal local same as LDA incision same as LDA bring uterus to incision edge incision on uterus greater curvature aim to incise over calf distal limb pull out calf - assistant for resuscitation check for twins/tears trim placenta absorbable suture - utrecht for uterus close abdomen - as in LDA 2-4ml oxytocin - counteracts clenbuterol treat calf umbilicus with iodine 10% bw colostrum in first 6 hour

Question 42

caesarian complications - farm

Answer 42

infections dehiscence seroma recumbancy/down cow comorbidities - hypocalcemia retained placenta death peritonitis abdominal adhesions reduced future repro performance metritis

Question 43

castration - farm

Answer 43

calves/lambs/kids - <7 days - rubber ring - no anaesthetic calves/goats - >2months - any method, local anaesthetic lambs - >3 months - any method, local pigs - <7days - any methods, local

Question 44

castration - rubber ring - farm

Answer 44

efficient and safe no anaesthetic needed complications if incorrectly applied

Question 45

open castration - farm

Answer 45

various methods 1-3 months old suckler calves to 6 months

Question 46

castration considerations - farm

Answer 46

health housing hygiene size handling facilities analgesia antibiotics

Question 47

j shaped incision open castration - farm

Answer 47

3-5ml procaine under scrotal skin and into cord +/- sedation or GA NSAID clean skin - hibiscrub push testes into sac j shaped incision lateral scrotum through vaginal tunic separate vascular and non vascular spermatic cord strip vaginal tunic twist testicle and pull to break cord snip off dangling ductus deferens spray incision with antibiotic spray

Question 48

open castration complication - farm

Answer 48

haemorrhage - watch for continuous bleeding, monitor, twist or ligate vessles, pack scrotum with wool may then develop scrotal haematoma or abscess remnant of spermatic cord recoils into abdomen - intestinal obstructions

Question 49

urethral obstruction - farm

Answer 49

ruminants, esp goats adolescent fattening and mature breeding animals wether goats texel and scottish blackface sheep dietary mineral imbalance concentrate feeding - imbalance calcium:phosphate or magnesium signs - off colour straining to urinate anuria down blood tinged urine distended abdomen abdominal fluid thrill

Question 50

urethral obstruction diagnostics - farm

Answer 50

palpation - uroliths, enlarged or diappeared bladder palpable per rectum, urethral pulsations complete blood count - increased urea, BUN, creatinine, potassium and muscle enzymes, deacreased sodium, chloride acidic urine pH imaging - US shows distended bladder and urethra hypoechoic radiography - may see stones depending on crystal type contrast to confirm rupture abdominocentesis - creatinine in peritoneal fluid 2x more than plasma

Question 51

ddx urethral obstruction - farm

Answer 51

cystitis peritonitis coccidiosis peritoneal tumour ruminal tympany hydrops GI obstruction

Question 52

urethral obstruction treatment - farm

Answer 52

correct fluid and electrolye imbalances medical - sedation analgesia local anaesthetic foley catheter to flush out stones ammonium chloride - decrease urine pH and dissolve stones - calcium carbonate stone bronze and dont dissolve IV fluids for depressed uremic animals surgery - usually perineal urethrostomy - 82% non recurrentce in 12 months penile amputation tube cystotomy drain urine from abdomen bladder marsupialisation - 67-84% long term success euthanasia prognosis good for small number years

Question 53

urethral obstruction - other considerations - farm

Answer 53

often relapse after medical treatment prognosis good after surgery but not for so long males can't breed after perineal urethrostomy - salvage procedure evaluate diet iceberg disease long time to correct complications - UTI strictures bladder mucosal prolapse scalding

Question 54

urethral obstruction prevention - farm

Answer 54

increase urinary chloride excretion - sodium chloride supplementation decrease urine pH - ammonium chloride dietary supplement calcium supplement - unless calcium based uroliths present

Question 55

fracture repair - farm

Answer 55

NB - small ruminants do well with amputations NSAIDS to minimise swelling and give analgesia +/- sedation bandage stirrups padding for cast fibreglass hooves inside cast confine animal cast for 4-6 weeks tape for further 2 weeks closed fractures only

Question 56

fractures considerations - farm

Answer 56

manage expectations - esp if growth plate involvement or infection cases over 400kg need specialist case - referral - poorer prognosis schroader thomas splint for tibia/radial fracture neonates need regular recasting euthanasia often most economical option

Question 57

ddx - pyrexia of unkown origin - cats

Answer 57

FIP Pancreatitis cat flu - calicivirus and herpes parasites FIV FeLV feline panleukopenia neoplasia toxins foreign body

Question 58

pyrexia of unkown origin - testing - cat

Answer 58

FIV, FeLV, Feline panleukopenia SNAPs abdominal ultrasound hemo and biochem - WBCs, serum proteins, pancreatic parameters, renal and liver parameters biopsy - liver and kidney (FIP virus in non effusive) FNA enlarged lymph nodes - FIP virus in macrophages

Question 59

pathogenesis FIP

Answer 59

feco-oral spread (usually multi-cat houses, catteries, shelters) enteric coronavirus replicates in enterocytes mutates to live in macrophages spreads immunodeficiency, vasculitis, damage to blood vessels organ damage (various) signs variable based on organ system adamaged

Question 60

FIP treatment

Answer 60

remdesivir steroids supportive therapy - fluids, nutritional support euthanasia should be considered if no response in 3 days

Question 61

ddx pyrexia of unknown origin - dog

Answer 61

infection immune mediated neoplasia young, large breed - steroid responsive meningitis young, small breed - granulomatous encephalomeningtis sight hounds, collies, shar peis - immune mediated polyarthritis

Question 62

common ddx pyrexia of unknown origin - equine

Answer 62

pleuropneumonia strangles collitis peritonitis pericarditis

Question 63

bacterial pneumonia - equine

Answer 63

risk factors - long distance transport recent oesophageal obstruction dysphagia recent anaesthetic recent viral infection

Question 64

bacterial pneumonia - signs

Answer 64

congested mm cough nasal discharge often picked up before obvious signs so history important

Question 65

colitis risk factors - equine

Answer 65

parasite management recent antimicrobials recent NSAIDs consuming oak or sand recent diet change stressors

Question 66

testing - pyrexia of unknown origin - equine

Answer 66

clinical exam hemo and biochem - inflammation may not show in bloods if erly stages, SAA and fibrinogen useful to guide whether acute or chronic, low WBC and left shift in severe infection peritoneal fluid - peritonitis, increased WBC and TP indicate intra-abdominal infalmmation, cytology for insight into cause, culture if WBC increased rectal palpation US thorax and abdomen nasopharyngeal swab - combined PCR influenza, strangle and EHV 1 and 4 - negative result doesn't rule out bacterial pneumonia - US lungs - pleural effusion and lung parenchyma consolidation, trachel wash and BAL also useful (but more invasive)

Question 67

tick borne infection - pyrexia of unkwon origin - equine

Answer 67

anaplasma and borellia (lyme disease) neuro sign, abortion, pain, arthritis NSAIDS - analgesia and reduciton of inflammation and pyrexia contraindication if suspected colitis, renal disease or severe hypovolemia - run hemo and biochem first

Question 68

antimicrobials in pyrexia of unkown origin - equine

Answer 68

yes if bacterial pneumonia, even if secondary if cause unknown - risk factors for bacterial pneumonia - severe pyrexia, cough, lethargy - then yes no risk factors - then no

Question 69

difference - hyperthermia and pyrexia

Answer 69

hyperthermia - increased muscle activity, increased ambient temperature, or increased metabolic rate - heat stroke, stress, medication pyrexia - hypothalamus resets body thermoregulation point higher - infectious, immune mediated, or neoplastic

Question 70

pyrexia of unknown origin - non specific signs - small animal

Answer 70

lethargy depression anorexia panting shivering collapse reluctance to move/stiffness

Question 71

trial treatment - pyrexia of unkwon origin - small animal

Answer 71

only for animals confortable to send home - alert, eating and drinking, not clinically dehydrated focus on most common causes (cats - FIP, cat flu, infection, dogs - kennel cough, steroid responsive meningitis) NSAIDs - correct dehydration first fluids antibiotics - esp in cats with suspected cat bite that can't be found - amoxyclav, in dogs most causes are viral steroids - if signs suggest steroid responsive meningitis, confirm not bacterial first because steroids will make that worse

Question 72

diagnostics - pyrexia of unknown origin - small animal

Answer 72

H & B SNAPs - FeLV, FIV, Parvo urinalysis radiograph abdominal US fecal analysis immune - saline auto agglutination - IMHA cytology - FNA of masses of biopsy, CSF tap for meningitis, bone marrow aspiration for panleukopenia outdoor cats - toxo IgG, tick borne disease PCRs, bartonella pCR cats with anemia - anemia panel

Question 73

pyrexia of unkown origin - cat bite abscess

Answer 73

lethargy anorexia pyrexia focal swelling draining abscess treat - drain pus analgesia - NSAIDs, opioids if dehydrated antibiotics - if pyrexic or systemically unwell

Question 74

pyrexia of unknown origin - FIP

Answer 74

immune mediated young or old multi cat environment recent stress common trigger anorexia lethargy pyrexia weight loss pale or jaundiced mm wet form - effusion dry form - harder to recognise, various organ problems but most common ocular and CNS non regn anemia, lymphopenia, IMHA proteinaceous effusion hyperglobulinemia adnd high bilirubin without other liver changes staining of coronavirus infected macrophages (lymph node FNA) steroids to moderate immune response remdesivir euthanasia

Question 75

pyrexia of unknown origin - toxoplasma gondii (cats

Answer 75

usually no signs self limiting intermittent diarrhoea (20% of cases) more likely in hunters acute - pyrexia, danorexia, CNS signs, multifocal inflammation detect in tissue biopsy or cytology samples - immunohistochemistry (tricky as not knwoing what tissue involved) elimination difficult predisposed to future episodes

Question 76

pyrexia of unknown origin - heat stroke

Answer 76

actually hyperthermia high environmental temp or physical activity in hot weather panting hypersalivation cyanotic mm stifness collapse - severe - dic increased risk - brachys and dogs that run around like mental cases (greyhounds, spaniels) treat - active cooling (cool water not cold), fluid, oxygen (esp brachys), if seizures then diazepam (seizures --> muscle contraction --> worsened hyperthermia), check for renal and hepatic damage

Question 77

pyrexia of unknown origin - steroid responsive meningitis

Answer 77

most common canine meningitis young dogs pyrexia neck pain with no other neuro deficits beagles, boxers, bernese mountain dogs diagnosis - signallment and exam left shift leukocytosis c reactive protein CSF cytology - pliocytosis and nondegenerated neutrophils in early stages, lymphcytes and macropahfes in later stages treat - prednisolone - moderate to severe NSAIDs - very mild cases azathiopine - in combination with preds, lowers dose of pred needed

Question 78

pyrexia of unknown origin - immune mediated polyarthritis

Answer 78

primary - idiopathic secondary - to another inflammatory condition depositing immune complexes in joints reluctance to walk lameness swollen painful joints altered gait pyrexia inappetance vomiting diarrhoea baseline tests to establish primary condition arthroscopy to diagnose treat - preds with or without azathiopine culture - main ddx is septic arthritis - steroids will make that worse so get this back first opioid analgesia while waiting for results

Question 79

challenges for mother - c-section anaesthesia

Answer 79

physiological anemia - increase in blood volume but no increase in RBCs increased oxygen demand decreased functional residual capacity of lungs (pressure on diaphragm) and increased alveolar ventilation (panting) - rapid reuptake and offloading of anaesthetic gases enlarged and full abdomen - can't breathe well on their backs poor venous return - compressed vena cava increased prgesterone and increased blood brain barrier permeability - quicker sedation delayed gastric emptying, decreased oesophageal sphincter tone, lower gastric pH - greater regurgitation risk electrolyte disturbances exhaustion and pain

Question 80

challenges for puppies - c-section anaesthesia

Answer 80

viability - hypoxia, hypercapnia, acidosis, effect of drugs respiratory depression - usually caused by hypoxia hypoxia - biggest issue - placental separation, impaired maternal ventilation, impaired maternal blood pressure hypercapnia

Question 81

situational challenges - c-section anaesthesia

Answer 81

often emergency - late night, limited help, limited time financial and emotional pressure limited experience - both owner and vet lack of clinical evidence

Question 82

drug challenges - c-section anaesthesia

Answer 82

basically no licensed drugs

Question 83

initial stabilisation - c-section anaesthesia - emergency

Answer 83

fluids check electrolytes, TP and PCV premed - reduce dose of induction agents needed pre-oxygenate pre-clip if appropriate

Question 84

initial stabilisation - c-section anaesthesia - elective

Answer 84

treat as normal IV canula pre med pre oxygenate prepare equipment and drugs and personnel pre-clip

Question 85

drug choice - c-section anaesthesia

Answer 85

short acting antagonisable local anaesthetics and blocks if familiar with them - if not may take too long minimum effective doses but don't underdose - distress will cause restriction of arteries to placenta fluids and oxygen support

Question 86

pre med - c-section anaesthesia

Answer 86

reduces stress - improves uterine blood flow reduces induction and maintenance agents needed - reduced negative cv effects and foetal drug exposure care with locals - can cross placenta and ionise so can't cross back full mu agonists - sedation and anaesthesia, minimum cv effects, maternal bradycardia potential but treatable, foetal hr not affected because not under autonomic control short acting fentanyl an option if want to be quick ACP - avoided generally - prolonged sedation and hypothermia in mother - no increased mortality so can use if needed alpha-2s - xylazine associated with increased mortality benzos - not advised - floppy infant syndrome

Question 87

induction - c-section anaesthesia

Answer 87

avoided inhaled - IV better - common to see struggling to breathe propofol - maternal 3x higher than foetal after 1 bolus - not associated with poorer outcomes alfax - some evidence may be better ketamine - more profound foetal depression, intensive resuscitation often needed, also usually with benzos so not advised regurg a problem - head raised, secure airway quickly - sellicks manouver (pressure on crichoid while tubing) pre-oxygenate to avoid apnoea

Question 88

maintenance - c-section anaesthesia

Answer 88

iso or sevo in oxygen IPPV avoid nitrous oxide only use neuromuscular blocking agents if familiar with use - need IPPV because won't be able to breathe epidural - good if familiar, if not increased time, decreased epidural space because of engorged sinuses, lidocaine extradural opioids - good, minimal systemic effects tilt mother to left - pressure off vena cava, reduce supine hypotension syndrome - effective in patients up to 20kg

Question 89

analgesia - c-section anaesthesia

Answer 89

pain --> sympathetic stimulation --> sudden reduction in uterina blood flow --> hypoxia --> puppy mortality welfare inadequate analgesia associated with decreased milk production NSAIDS - useful in dam, often given after puppies removed, negligible transfer in milk opioids - excellent analgesia, can accumulate but can be antagonised through IV injection to umbilical vein (naloxone or butorphanol to antagonise)

Question 90

neonatal resuscitation - c-section anaesthesia

Answer 90

agpar scoring - HR, RR, reflexes, mobility, suckling and vocalisation - guide to puppy distress considerations - warmth vigorous body rubbing suction and removal of membranes oxygen - if suspect hypoxia give oxygen GV26 acupuncture point on head - used as respiratory stimulant avoid doxopram - increased myocardial oxygen demand

Question 91

small intestine identifying features - dog

Answer 91

duodenum - cranial RHS abdomen jejunum - longest all over abdomen in mesentery ileum - shortest looks like ileum except from artery running along border at 180 degrees from mesentery attachment most common site for foreign body

Question 92

ddx vomiting dog

Answer 92

foreign body dietary indiscretion bacterial - e coli, salmonella, campylobacter, mycotoxins gastric ulcers NSAIDs parasites parasites kidney disease liver disease gastritis pancreatitis neoplasia

Question 93

vomiting vs regurgitation

Answer 93

if food is partially digested - vomiting

Question 94

vomiting diagnostics - dog

Answer 94

pancreatitis SNAP endoscopy fecal analysis radiograph - VD and both laterals, contrast to show radiolucent bodies and timing of passage through abdominal ultrasound bloods - renal, hepatic, pancreatic, neutrophilia

Question 95

exam - vomiting

Answer 95

assess for shock - hypovolemic and distributive most common - HR, pulse, pale mm in hypovolemic, congested in distributive or septic, RR and resp effort, sometimes bradycardia in cats hypothermia or pyrexia may be seen if infection cardiac - vomiting, abdominal distension, ascites hepatic and pancreatic - vomiting, diarrhoea, pain, and distension urogenital - vomiting and pain splenic - pain and distension endocrine - vomiting and diarrhoea MSK - eg IVDD - may present as abdominal pain

Question 96

vomiting - diagnostics - dog

Answer 96

radiographs - plain and contrast - opacities, gas build up, foreign bodies, GDV abdominal US - AFAST for trauma, survery for general look, good for effusion, stricture due to neoplasia, detect free fluid for sample peritoneal fluid tap - us guided, type of fluid, cytology bloods - rule out other causes of GI signs (renal, hepatic, cardiac), corrections before surgeries, metabolic alkalosis in upper GI, WBC changes in infectious disease

Question 97

stabilisation - vomiting dog

Answer 97

fluids - dehydration, account for ongoing losses correct shock correct electrolytes antiemetics - if suspected dietary indiscretion or infection not if suspect obstruction - hide signs maropitant ondansetron metoclopramide gastroprotectants - H2 receptor agonists - ranitidine, famotidine omeprazole - proton pump inhibitor sucralfate - binds to ulcer sites and creates barrier antimicrobials - not indicated in mild cases amoxyclav - perioperative if surgery on GIT metronidazole - giardia or clostridium

Question 98

signs - oesophageal obstruction - dog

Answer 98

choking/gagging or coughing a bit regurg a while after food (chronic) increased salivation lethargy dyspnoea

Question 99

sequelae - oesophageal obstruction - dog

Answer 99

aspiration pneumonia perforation mediastinitis pleuritis pneumothorax

Question 100

diagnosis - oesophageal obstruction - dog

Answer 100

radiograph - preferred - may need contrast, check lungs for aspiration pneumonia oesophagoscopy - can also sometimes use to remove objects

Question 101

treatment - oesophageal obstruction - dog

Answer 101

endoscopic removal surgical removal - move to stomach first if possible - gastrtomy - or thoracostomy and end to end anastomoses medical treatment after removal - sucralfate, anti inflammatories, gastroprotectants, antimicrobials if indicated, soft diet feeding tube if severe damage - should enter GIT after point of damage

Question 102

GDV signs

Answer 102

non-productive retching abdominal distension lethargy and collapse - later stages dyspnoea and/or tachypnoea tympanic anterior abdomen tachycardia dysrhythmia weak pulses pale mm prolonged CRT

Question 103

GDV - sequelae

Answer 103

arrythmia endotoxemia - compromised mucosal barrier gastric necrosis - peritonitis and septic shock electrolyte and acid base disruptions DIC - end stage - euthanise

Question 104

GDV - diagnosis

Answer 104

radiograph - looks like 2 compartments

Question 105

GDV - treatment

Answer 105

gastric decompression - orogastric tube or through outside manage shock manage dysrhythmias surgery - partial resection of necrotic stomach and spleen correct position adhere stomach to abdominal wall post op - monitor electrolytes, acid base and ECG - 24-48 hours - hypokalemia common fluids analgesia - opioids small soft low fat meals - asap after surgery anti emetic omeprazole antibiotics if evidence of infection of lots of leakage into abdomen

Question 106

GDV - prevention

Answer 106

frequent smaller meals avoid stress during feeding don't use elevated feed bowl avoid breeding from dogs who have had one prophylactic gastropexy - tack stomach to abdominal wall

Question 107

signs - gastric and intestinal foreign bodies

Answer 107

total obstruction - vomit everything up including water almost always present as emergency young animals known to scavenge - esp golden retrievers acute gastric - no signs maybe vomiting, dehydration, hypovolemic shock, quick progression chronic gastric - intermittent vomiting, weight loss, may be asymptomatic or incidental finding proximal SI - vomiting, dehydration, shock distal SI - more intermittent and chronic

Question 108

sequelae - gastric and intestinal foerign bodies

Answer 108

perforation --> septic shock DIC - compromised intestinal barrier

Question 109

diagnosis - gastric and intestinal foreign bodies

Answer 109

palpation abdomen check under tongue - linear foreign bodies, esp cats radiograph - with or without contrast gastroduodenoscopy - if gastric or proximal GI, can sometimes remove object bloods

Question 110

treatment - gastric and intestinal foreign body

Answer 110

induce vomiting - only if object small enough move to stomach - easier surgery fluid correction of acid base analgesia - opioids, risk of ulceration with NSAIDs antibiotics - if sepsis - amoxyclav or cephalosporins endoscopic removal gastrotomy enterotomy ex lap - check whole GIT in case multiples milk object to area of healthy tissue end-to-end anastomoses

Question 111

post op care - gastric and intestinal foreign bodies

Answer 111

monitor electrolyte imbalances low fat diet 12-24 hours post op antiemetic if needed omeprazole if suspect ulceration

Question 112

presentation - intussuception

Answer 112

rarely acute young quiet inappetence often in recovery from parvo or parasitic enteritis older animals - associated with neoplasia varying signs based on site and severity acute - bloody diarrhoea, vomiting, abdominal pain, mass on abdominal palpation chronic - intermittent diarrhoea, depression, lethargy, emaciation

Question 113

diagnosis - intussusception

Answer 113

radiograph - better with contrast us - best bloods fecal analysis - parasitic cause

Question 114

treatment - intussuception

Answer 114

treat underlying condition stabilise - fluids etc surgery - manual reduction or end-to-end anastomoses enteroenteropexy - pexy one bit of SI to another if mass, resection and anastomoses, also if manual reduction not working or dead tissue

Question 115

presentation - mesenteric volvulus/torsion

Answer 115

collapse swollen abdomen blood from anus sudden onset rare - rapidly fatal - once sick usually necrotic intestines

Question 116

ddx acute hemorrhagic diarrhoea syndrome

Answer 116

parvo clostridial endotoxicosis coagulopathy intussusception foreign body leading to intestinal trauma - rare

Question 117

presentation - acute hemorrhagic diarrhoea syndrome

Answer 117

haemorrhagic diarrhoea - raspberry jam consistency anorexia lethargy usually self limiting with supportive care - fluids, bland diet, adsorbants test for parvo

Question 118

testing - acute hemorrhagic diarrhoea syndrome

Answer 118

bloods - decreased PCV, inflammatory leukogram (increased PCV in parvo), low protein, low potassium, renal azotemia fecal analysis SNAP for parvo CPLI for pancreatitis imaging - for pancreatitis or neoplasia diagnosis of exclusion

Question 119

treatment - acute hemorrhagic diarrhoea syndrome

Answer 119

supportive - fluid, antibiotics if sepsis low fat easy digestible diet in early stages protectants and adsorbants parvo treatment - barrier nursing antiemetics gastroprotectants tube feeding blood transfusion if very sick virbagen omega - licensed antiviral monoclonal antibodies

Question 120

horse GI - indications for referral

Answer 120

presistent pain after analgesia progressive abdominal distension tachycardia <60bpm hypovolemia signs absence of borborygmi abnormal rectal findings gastric reflux >4L

Question 121

horse GI - prior to referral

Answer 121

plan transport if inconclusive whether surgical or moedical avoid flunixin decompress stomach with NG tube analgesia rug and bandage limbs - might go down in box

Question 122

CHF pathophysiology

Answer 122

increased cardiac filling pressure --> venous congestion --> extravasation of fluids pleural effusion pulmonary oedema - left sided ascites, peripheral oedema - usually right sided

Question 123

CHF signs

Answer 123

tachypnoea/dyspnoea reduced exercise tolerance reduced appetite lethargy weight loss abdominal distension

Question 124

CHF tests

Answer 124

Essential - TFAST/POCUS - fluid, left atrium size bonus - BP biochem xray - if stable

Question 125

CHF sedation

Answer 125

methadone or butorphanol - if thromboembolism butorphanol not enough

Question 126

Furosemide CHF

Answer 126

Either every 4 hours, based on CRI or based on resp rate monitor mentation - if stressed may artificially rase resp rate care not to dose too much - kidney injury diuretic

Question 127

CHF thoracocentesis

Answer 127

required to fix significant pleural effusion day 1 skill can US guide quickly reduces resp effort if inspiratory dyspnoea - can usually assume pleural effusion without needing US

Question 128

CHF pimobendan

Answer 128

management of chronic heart disease utility in emergencies less clear improves cardiac output and systolic function - not usually the main issue in an emergency care if suspected obstruction - cats, or dogs with aortic stenosis expensive

Question 129

CHF radiographs

Answer 129

gold standard confirmation only use once stable to sedate and restrain after thoracic US, thoracocentesis and diuretics assessment for concurrent disease

Question 130

pericardial effusion signs

Answer 130

muffled heart sounds - main thing ascites - right sided heart failure weak pulses paradoxical pulses collapse lethargy weakness exercise intolerance

Question 131

pericardial effusion diagnosis

Answer 131

echo/TFAST - check for effusion and right atrium collapse (tamponade) tamponade - main sign need pericardiocentesis check for masses on US - usually hemangiosarcoma or heart base masses radiographs - US quicker, do first

Question 132

pericardial effusion - treatment

Answer 132

pericardiocentesis - only treatment if tamponade IV fluid boluses - support cardiac filling to stabilise DO NOT GIVE FUROSEMIDE - makes mild effusion severe, can be fatal

Question 133

Aortic thromboembolism presentation

Answer 133

complication associated with severe heart disease - blood clots thrown off from left atrium cats usually caudal aorta - hindlimb paresis less commonly forelimb, sometimes just one forelimb pain - vocalising - distressing absent femoral pulses cold paws cyanosis

Question 134

aortic thromboembolism management

Answer 134

euthanasia should be considered if after 72 hours unlikely to further deteriorate prognosis poor - esp if hypothermia, low HR, multiple limbs affected, absent motor function long recovery, usually permanent deficits, risk of recurrence pain relief - methadone, butorphanol not enough, NSAIDs risk kidney injury furosemide if concurretn heart disease clopridogrel - anticoagulent - possibly better than aspiring for reducing recurrence aspirin - anticoagulent - can be used with clopridogrel rivaroxaban - anticoagulent - newer, expensive clot breaking drugs tissue plasminogen activator - risk of reperfusion issue from toxins released from clot low molecular weight heparin - slower effect - owners can inject at home

Question 135

diagnostic ECG - lead positions

Answer 135

red - right fore yellow - left fore green - (left) fore

Question 136

diagnostic ECG - considerations

Answer 136

electrical interference from other devices is it tachy or brady is the HR appropriate for the situation - emergency, stress, pain regular ror irregular pulses - weak in shock, same time as heart beats, pulse per beat P for every QRS? QRS for every P? normal QRS? - tall and narrow normal, wide and bizarre not

Question 137

ventricular tachycardia ECG

Answer 137

short R-R - premature ventricular complex no P wide QRS 4 or more VPCs at fast rate - >160-180bpm if slow rate - not emergency emergency - will be showing signs - eg collapsed

Question 138

causes ventricular tachycardia

Answer 138

cardiac disease - basically always primary cardiac in cats, mostly in dogs, but sometimes none cardiac neoplasia - splenic, hepatic GDV SIRS/sepsis toxins anemia trauma

Question 139

ventricular tachycardia treatment

Answer 139

lidocaine - bolus then CRI - care with cats, can get neurotoxicity easily, always be a bit careful anyway as any animal can get neuro signs majority will respond to some degree to lidocaine continuous ECG monitoring check electrolytes - hypokalemia reduces lidocaine efficacy - could be addisons or blocked cat sotalol - coming off lidocaine, longer term oral meds refractory cases - referral - amiodarone or electrical cardioversion

Question 140

emergency bradycardia

Answer 140

3rd degree atrial ventricular block or high grade 2nd degree

Question 141

3rd degree AV block ECG

Answer 141

no communication between atria and ventricles P waves but QRS not associated QRS wide and bizarre, not premature

Question 142

sick sinus syndrome presentation

Answer 142

old dogs westies and schnauzers not an emergency pauses in rhythm on ECG

Question 143

persistent atrial standstill presentation

Answer 143

rare usually springer spaniels looks similar on ECG to 3rd degree block but no P waves

Question 144

3rd degree block management

Answer 144

check potassium - could be addisons or blocked cat treat underlying disease and electrolytes chronotropics - terbutaline - sick sinus might respond, otherwise usually doesn't referral - pacemaker if escape beat rate 50-60bpm - bad - but probably not middle of the night surgery emergency if rate 30-40 - more urgent, usually present collapsed - still probably not the best idea to do OOH pacemaker

Question 145

Small animal neuro diagnostics

Answer 145

CSF analysis imaging - radiographs, myelopgraphy, CT, MRI, US, scintigraphy electrodiagnosticss neuro clinical exam important - localisation, ddx, decision re further tests

Question 146

CSF analysis indications - small animal

Answer 146

suspected inflammatory disease - meningitis, meningo-myelitis, meningo-encephalitis, before myelography if multifocal signs

Question 147

CSF analysis

Answer 147

establish if infectious (viral, bacterial, protozoal), or non-infectious (steroid response meningitis-arteritis, meningitis of unknown origin) cell count and basic protein analysis in house cytology and full protein analysis, PCR and other tests at lab sites - cisternia magna, lumbar

Question 148

CSF analysis - contraindications

Answer 148

raised intercranial pressure conformation - chiari like malformation/syringomyelia, occipital dysplasia coagulopathy

Question 149

neuro diagnostics - radiography

Answer 149

needs sedation or anaesthesia careful positioning - don't want to make it worse eg if spinal indications - fracture or sublux infectious cause neoplasia congenital abnormalities look at apine

Question 150

neuro diagnostics - myelography

Answer 150

radiograph with non-ionic contrast agent - injected at cisterna magna or lumbar L5/6/7 lateral, VD and oblique localise lesions complications - potential for neuro deterioration, seizures, cardio-resp depression

Question 151

neuro diagnostics - CT

Answer 151

see soft tissue and bone windows nonionic iodinated contrast indications - trauma - spinal (more accurate than radiographs), acute head trauma (broken bone and haemorrhage), chest and abdomen evaluation middle/inner ear assessment - tympanic bullae IVDD spinal malformations surgical planning if metal in body so can't MRI

Question 152

neuro diagnostics - MRI

Answer 152

best soft tissue detail need anaesthesia, but have to leave machine outside because metal longer than CT and more expensive planes - sagittal, dorsal, transverse IV paramagnetic agent - gadolinium indications - gold standard - shows brain, spinal cord and peripheral nerves CT+MRI - best for most detail for surgical planning

Question 153

equine - acute MSK emergency - initial assessment and first aid

Answer 153

ideally don't move but may need to - owner might have anyway, lighting, floor give owner instructions on haemorrhage control - pressure, multi layer bandage, esp if arterial bleed remove foreign object if sticking out a lot and putting foot down will cause more damage, if below level of shoe can leave in CV and neuro exam sedate - alpha 2, safety consideration if distressed horse history - known trauma, onset, exercise, when last normal, other horse, management factors (stabled?) sigalment coaptation - wrapping for support - sometimes not always pre plan transport and call referral to see what they want done immediate euthananasia if large bone fracture in an adult horse

Question 154

equine - acute MSK emergency - further assessment

Answer 154

fuller history - shoeing, lameness history, medication - ongoing or just given for this exam - posture, swelling, asymmetry, wounds, deformity determine affected limbs assess degree of lameness clean limbs - better visualisation and better for wounds palpation - welling, effusion, wounds, digital pulses, foreign bodies (esp easy to miss in frog sulci - pick out and clean), hoof testers, pain on flexion/extension, press all muscle groups (proximal to distal), range of motions (limited, abnormal or painful), crepitus (may be palpable or audible)

Question 155

equine - acute MSK emergency - common causes

Answer 155

subsolar abscess - very common, pus in foot laminitis ceullulitis synovial sepsis fracture tendonitis tendon laceration or rupture myopathy

Question 156

equine - acute MSK emergency - diagnostics

Answer 156

radiograph - fracture, sublux, wound assessment (see if bony injury involvement, especially before anaesthetising) US - see course of wound track, tendons and ligaments, pelvic fractures, foreign bodies or gas indicated their presence synoviocentesis - synovial sepsis MRI - penetrating foot injuries, further assessment dital limb injuries scintigraphy - pelvic or stress fracture serum biochem/urinalysis - myopathy or rhabdo

Question 157

equine - subsolar abscess - signs

Answer 157

severe lameness heat focal pain around coronary band increased pulse amplitude pain on hoof testers

Question 158

equine - subsolar abscess - causes

Answer 158

bruising conformatino penetrating wound white line laminitis keratoma in recurrent - address underlying issue

Question 159

equine - subsolar abscess - treatment

Answer 159

nerve blocks - may be contraindicated if non weight bearing remove shoe tetanus prophylaxis antiseptic bandaging analgesia draining - poultice

Question 160

equine - periarticullar cellulitis - treatment

Answer 160

broad spectrum antibiotics NSAIDs Steroids Cryotherapy Physio Bandaging

Question 161

equine - wound and synovial sepsis exam

Answer 161

general exam haemorrhage - quantify, measure venous blood lactate to gauge hypovolemia check if multiple injuries careful attention to anatomical location feel (digital exploration) - gloves, decomtaminate wound first, look if foreign bodies, bone fragments, feel for tendon tissue (tendon sheath sepsis) xray - bone damage, esp kick injuries, or if planning anaesthesia Ultrasound

Question 162

equine - wound and synovial sepsis - complicating factors

Answer 162

fracture - changes approach, esp if anaesthetising, impact on cost sepsis tendon or ligament damage vascular damage thoracic perforation abdominal penetration

Question 163

equine - wound and synovial sepsis - synovial sepsis signs

Answer 163

draining tracts with pus acute onset or progressive severe lameness if draining - variable lameness - not as much pressure build up in foals may spread from distinct wound site in blood heat and pain

Question 164

Horse GI - indications for referral

Answer 164

persistant pain after analgesia progressive abdominal distension tachycardia <60bpm signs of hypovolemia absence or borborygmi abnormal rectal findings gastric reflux >4litres

Question 165

Horse GI - FLASH ultrasound

Answer 165

fast localised abdominal sonography of the horse gastric window - ventral to lung tip (10-15th intercostal space) left hand side - see splenic vein and ocassional small intestine loops, usually can't see gastric contents splenorenal region - LHS slightly more caudal than gastric - left kidney, liver and spleen - nephrosplenic entrapment, masses, displacements duodenal window - RHS, 14-17th intercostal space - descending duodenum, duodenal distension ventrum - small intestine, bladder - strangulation, entrapment, lipomas, masses, distension, thickened SI walls, free peritoneal fluid, hemoabdomen colon and caecum - wall thickness (colitis, enteritis, sometimes volvulus) - normal thickness 3-4mm

Question 166

Horse GI exam - rectal exam quadrant system

Answer 166

left dorsal - caudal edge of spleen, nephrosplenic ligament, nephrosplenic space, caudal pole left kidney, aorta, root of mesentery right dorsal and ventral - duodenum not often palpable unless distended or displaced, caecum, inguinal ring left ventral - pelvic flexure, left dorsal colon, small colon (fecal balls inside), inguinal ring, bladder, reproductive tract

Question 167

Horse GI - indications for surgery

Answer 167

uncontrollable or severe pain poor response to flunixin or detomidine more than 4L gastric reflux distended SI distended and displaced large colon distension that can't be medically relieved palpable mass or foreign body found during a rectal exam absent intestinal noice on auscultation peritoneal fluid analysis showing increased TP, RBCs or degenerate neutrophils not indicated if depressed or lack of pain, if pyrexic (more often associated with medical colics), if neutrophilia or neutropenia, progressive intestinal sounds on auscultation

Question 168

Horse GI - large intestine displacement

Answer 168

medical treatment - withhold food, pain management may need surgery if very distended with gas then risk of rupture during surgery when handled - can decompress with needle centesis

Question 169

Horse GI - causes post-op colic

Answer 169

within 48 hours - incisional/surgical pain ischemic bowel reperfusion injury leakage at anastomosis post-op ileus recurrent displacement 2-7 days - obstruction at an anastomosis impaction ulceration infection 7+ days - adhesions recurrence

Question 170

Horse GI - common surgical complications

Answer 170

incision infection - encourage drainage by removing some suture, topical lavage, antibiotics, abdominal banage to reduce risk of hernia herniation - importance depends on size of hernia and intended use of horse - hernia belt or bandage, box rest. can do surgery 3-6 months after the colic surgery if needed thrombo phlebitis - common if have endotoxemia and can progress to septic thrombophlebitis - remove catheter if still on, antibiotics if septic, topical treatment, monitor with ultrasound (will show cording of jugular vein

Question 171

pyo - predisposing factors

Answer 171

age conctraceptice/abortion medications previous pyos

Question 172

pyo - diagnostics

Answer 172

ultrasound - fluid filled uterus bloods - increased PCV and TP (dehydration), raised albumin, raised globulin, pre renal azotemia, leukocytosis or leukopenia, anemia cytology - degenerative neutrophils, bacteria culture and sensitivity - needed it doing medical treatment route

Question 173

pyo - treatment

Answer 173

stabilise - fluids, antibiotics surgery - spay medical management - only if open and not too severe - antibiotics, fluids, alizin (relaxes cervix), prostaglandin (luteolysis and contractions) galistop - caberglione - dopamine agonist, opens cervix

Question 174

orchitis - tests

Answer 174

ultrasound - testes - infected more heterogenous, can see discrete mass if neoplasia, torsion can be shown with doppler blood flow bloods - increased WBCs, inneoplasia may see paraneoplastic hypercalcemia FNA - cytology - neutrophils, bacteria, culture and sensitivity serology/PCR - available for pasteurella multocida - commensal to resp tract so needs sterile sample from inside testicle in case licking

Question 175

orchitis - treatment

Answer 175

antibiotics - TMPS, baytil but not first line NSAIDs - meloxicam cold compress probiotics for GI signs castration - risk of abscessation in acute inflammation

Question 176

Foot and mouth signs - cattle

Answer 176

pyrexia anorexia shivering reduced milk smacking lips grinding teeth drooling lameness vesicles - oral mm, tears, between toes, coronary bands death in calves - myocarditis -tiger stripe pattern on heart at pm

Question 177

foot and mouth signs - sheep/goats

Answer 177

often asymptomatic may have lesions only at one site stopped milk vesicles abortions death of lambs - myocarditis

Question 178

foot and mouth signs - pigs

Answer 178

pyrexia foot lesions lameness vesicles - snout, dry lesions on tongue, pressure points on limbs detached claw horn - esp if housed on concrete death of piglets up to 14 weeks old - myocarditis

Question 179

incubation by species - foot and mouth

Answer 179

sheep - 1-12 days cattle - 2-14 days pigs - 2+ days important to know for tracking

Question 180

transmission - foot and mouth

Answer 180

inhalation - direct contact or aerosol over distance (esp pigs) fomites ingestion of contaminated feed - mostly pigs ingestion of infected milk AI with infected semen

Question 181

ddx foot and mouth

Answer 181

clinically indistinguishable - swine vesicular disease vesicular stomatitis vesicular exanthema of swine seneca valley virus others - rinderpest BVD and mucosal disease IBR MCF Bluetongue epizootic haemorhagic disease bovine mammilitis bovine papular stomatitis trauma or chemical burn

Question 182

feline lower urinary tract disease

Answer 182

usually in bladder or urethra usually feline idiopathic cystitis - stress or lack of stimulation sometimes UTI or neoplasia obstruction is usually from accumulation of mucus creating a plug but occassionally blocked by uroliths or urethral stricture

Question 183

urethral obstruction - presentation

Answer 183

usually males straining to urinate large taut bladder - small on palpation if ruptured may pass small drops of urine around block or from bladder overflow often hyperkalemia - post renal AKI

Question 184

causes of urethral obstruction

Answer 184

cats - crystalline mucus plugs dogs - uroliths prostatic disease - hypertrophy, neoplasia inflammation, abscess neoplasia upper motor neurone bladder stricture reflex dysynergia

Question 185

blocked cat - presentation

Answer 185

common, emergency males indoor and overweight most at risk often associated with a stressor post renal AKI --> intrinsic AKI signs at <72 hours repeat attempts to urinate pollakuria dysuria sometimes able to pass small amount pain - yowling, licking at perneal area progression - vomiting, lethargy, collapse large taut bladder - unless rupture severe - bradycardia, hyperkalemia

Question 186

blocked cat - diagnostics

Answer 186

bloods - azotemia - post renal AKI hyperkalemia - educed potassium secretion ultrasound - point of care small amount of fluid around bladder normal lots of fluid - rupture sediment and uroliths thickened bladder wall taut bladder detached inner membrane of bladder - pseudomembranous cystitis, severe inflammation causes detachment radiograph - lateral abdominal if will tolerate without sedation include perineum do not sedate until hyperkalemia corrected

Question 187

blocked cat - treatment

Answer 187

fluid - lactated ringers - correct dehydration and hypotension analgesia - methadone, sometimes pass urine when pain gone treat hyperkalemia - fluids and glucose then insulin, then calcium gluconate cystocentesis - to decompress (Care, risk of rupture) sedation - once hyperkalemia sorted unblocking and placing of urinary catheter hospitalisation to monitor

Question 188

ddx - foal neonatal colic

Answer 188

enterocolitis - most common meconium impaction transient medical colic - unknown cause, responds to analgesia ruptured bladder/uroperitoneum intestinal impaction - volvulus, impaction, intussuception overfeeding lactose intolerence - can develop after enterocolitis gastric or duodenal ulcers hernia - inguinal, scotal or umbilical congenital - atresia ani or atresia coli - colon ends in blind sac or no natural perforation at anal sphincter

Question 189

meconium impaction - foal colic

Answer 189

first few hours after birth failure to pass meconium abdominal pain flapping tail lying on back restless straining to defecate gas distension around blockage US or radiography to see fecal balls treat - enema, analgesia, fluids, laxatives surgery if no response to medical treatment ddx - ruptured bladder

Question 190

ruptured bladder/uroperitoneum - foal colic

Answer 190

more often colts 1-3 days after birth, later if tear happens after birth (ususlly in recumbent foals) usually still urinate but smaller amounts depression abdominal distension - increasing dysuria/stranguria pain severe - acute colic, tachycardia, tachyppnoea, collapse, arrythmia neuro - seizures, spasticity diagnosis - Ultrasound - free fluid fluid analysis - 2x serum creatinine bloods - hyperkalemia, hyponatremia, hypochloremia, may have increased serum BUN and creatinine but sometimes normal treatment - abdominal drainage correct electrolytes - esp hyperkalemia - saline and glucose surgery once potassium corrected refer

Question 191

hernitation - foal colic

Answer 191

inguinal or umbilical inguinal common in males and can often be manually reduced if no distress gradually reduce daily until stays in if associated colic or very large then surgery

Question 192

gastric ulceration - foal colic

Answer 192

abdominal pain bruxism ptyalism dorsal recumbent diarrhoea - in foals but not adults can start from 2 days deep ulcers can perforate --> death diagnosis - gastroscopy treatment - omeprazole +/- sucralfate

Question 193

patent urachus - foal colic

Answer 193

should close at birth when umbilicus ruptures cause unknown seems to happen as secondary issue in ill neonates may resolve with supportive care - routine disinfection, antimicrobials, umbilical dips multiple times a day refer for surgical resection if septic

Question 194

omphalitis/omphalphlebitis - foal colic

Answer 194

infection or inflammation of umbilical structures contamination of cord with bacteria external may appear normal if limited to intenal structures Ultrasound - examine size of inner parts - should be 18mm reducing to 15mm 7 days later for stump, umbilical vein 10mm-7mm at 7 days, umbilical arteries 13mm-10mm at 7 days treatment - antibiotics (not very effective if inside parts affected), surgical removal may present with other complaints - swollen joints, other infection - disseminates bacteria around the body

Question 195

pregnancy toxemia - small animals

Answer 195

rare in dogs common in rabbits and guinea pigs risk factors - obesity, large litters - less space for stomach in pregnancy treat - fluids and dextrose oral glucose syringe feeding high carb food emergency c section - only saves babies treatment rarely successfuol, prevention better prevention - don't breed if obese monitor fetal size and number avoid stress increase carbs in risk periods with care for weight gain encourage gentle exercise during pregnancy

Question 196

ovarian cysts - small animal

Answer 196

guinea pigs serous or follicular cysts serous - usually incidental finding unless large enough to impact other organs - treat by pericutaneous drainage or spay follicular - hormone producing, lead to pruritic alopecia - treat with short acting GnRH agonist or spay

Question 197

uterine tumour - small animal

Answer 197

common in rabbits and hedgehogs uterine adenocarcinoma surgery treatment if no mets

Question 198

hyperoestrogenism - small animal

Answer 198

ferrets if not brought out of oestrus persistent high oestrogen --> panleukopenia treat - spay - risk of cushings deslorelin impant mating with vasectomised hob prevention better supportive care - blood transfusion at PCV <15% - no blood types steroids iron dextran for RBC production antibiotics for secondary infections

Question 199

mammary tumours - small animal

Answer 199

rats lots of mammary tissue fibroadenoma ulceration, necrosis, and infection from trauma to surface surgical removal abergoline post surgery to prevent recurrance - ongoing, expensive selorelin implant to reduce recurrence

Question 200

testicular trauma - small animal

Answer 200

rabbits entire males in groups surgical repair analgesia antibiotics try and keep short so not away from group too long prevent - castration and appropriate housing - enough resources, places to hide

Question 201

bird repro emergencies

Answer 201

dystocia chronic egg laying salpingitis yolk coelomitis penile prolapse - ducks

Question 202

cat - dyspnoea - feline asthma - diagnostics and treatment

Answer 202

bloods - eosinophils - allergic disease BAL - eosinophils radiographs - lung pattern oxygen mask or tent - care with tent, can get hot which makes dyspnoea worse nebuliser - humidify bronchodilators IV catheter - butorphanol and steroids sedative - ketamine + midazolam or butorphanol - minimal CV effects

Question 203

dyspnoea - small animal ddx

Answer 203

aspiration pneumonia heart disease asthma BOAS drug reaction lungworm toxin pneumonia pulmonary oedema nasal polyps neoplasia trauma

Question 204

dyspnoea - respiratory noises - small animal

Answer 204

upper airway - increased inspiratory effort - loud breathing, stertor, stridor lower airway - increased expiratory effort - wheezes parenchymal - increased inrpiratory and expiratory effort - crackles pleural space - short and shallow, increased effort - dull sounds, location depending on area of issue

Question 205

pleural effusion types - small animal

Answer 205

transudate - clear low SG low protein low nucleated cells modified transudate - slightly cloudy mid SG mid protein mid cells exudate - cloudy, turbid or serosanguinous high protein high sg high cells chyle - could white/cream high protein high sg mostly lymphocytes high triglycerides and cholesterol - higher than plasma level

Question 206

small animal lower respiratory disease - signallment - age and breed

Answer 206

puppies - infectious <2 yo - angiostrongyles older - laryngeal paralysis, chronic bronchitis, neoplasia toys and minis - tracheal collapse westies and border terriers - IPF

Question 207

orthopneoa meaning

Answer 207

dyspnoea in any position other than standing or sitting up - usually bilateral pulmonary oedema

Question 208

trepopnoea meaning

Answer 208

dyspnoea only in one lateral recumbancy - unilateral lung or pleural disease, or unilateral airway obstruction

Question 209

thoracic exam - auscultation and percussion - small animal

Answer 209

palpation - masses, pain auscultation - crackles - some kind of fluid moist crackles - CHF, most prominant on inspiration dry crackles - eg IPF wheezes - more chronic - narrowing of airway percussion - pleural effusion - dull below level of fluid diaphragmatic hernia - may be increased sound

Question 210

small animal lower airway respiratory disease - diagnostics

Answer 210

bloods - NTproBNP - cardiac vs non cardiac cardiac troponin esoinophils, neutrophils, blood gas evaluation, anemia imaging - radiographs - thoracic, 2 views, only nce stable enough - fluid, free gas, lung patterns CT - more useful than xray for upper resp, but difficult if conscious and more expensive tracheal wash/BAL - tracheal wash - when suspected large airway disease and in patients where there is concern about anaesthetising - can be done conscious BAL - diffuse airway disease, may be able to culture and PCR bronchoscopy - from specific site - mucosal inspection, airway collapse, foreign body removal relatively safe and allows sample collection thoracocentesis - fluid analysis, cytology

Question 211

small animal lower respiratory disease - treatments

Answer 211

inhaled medications - steroids, bronchodilators, nebulisers bet2 agonists - salbutamol - fast onset, duration over 3 hours, cleared renally steroids - fluicasone propionate slow absorption but long lasting inhibition of mast cell degranulation - cromolyn sodium - not much evidence oral - steroids, NSAIDS, antileukotrienes, bronchodilators, antibiotics, anthelmintics, mucolytics (NAC) benefits inhaled - good for managing chronic disease, minimal systemic absorption, faster onset than oral disadvantages inhaled - expensive, owner compliance and capability, time consuming

Question 212

small animal - causes of difficulty breathing

Answer 212

Obstruction – cyanotic, cough, resp noise, foreign body, nasal pathology (neoplasia, polyps, granuloma, BOAS), tracheal or bronchial collapse Loss of thoracic capacity – fluid (blood, pus, chyle, transudates), trauma, CHF, neoplasia, cardiomegaly, abdominal abnormalities (ascites, mass), FIP Parenchymal disease – tissue damage, increased inspiratory and expiratory effort, may or may not be cough, might cough blood , westies with IPF for long time, aspiration pneumonia (chemical aspiration, large volumes of fluid eg in drowning, gastric contents), pulmonary parenchymal oedema – from increased hydrostatic or decreased osmotic pressure, concurrent DIC, impaired lymphatic drainage from tumour or mass – fluid accumulation in interstitial tissue – cardiogenic or non-cardiogenic, main difference is type of fluid, low protein in cardiogenic, non-cardiogenic from severe lung damage increasing permeability Non-CRS disease – endocrine, physiological

Question 213

small animal - causes pulmonary parenchymal disease

Answer 213

Aspiration pneumonia Pulmonary oedema – cardiac or non-cardiac Drowning Eosinophilic lung disease Idiopathic pulmonary fibrosis – westie lung Pulmonary parasites Pulmonary neoplasia – primary or mets Infectious pneumonias Pulmonary hemorrhage Lung lobe torsion Pulmonary thromboemboli Congenital airway diseases Bullous pulmonary diseases Lipid pneumonias Smoke inhalation Paraquat poisoning

Question 214

small animal - aspiration pneumonia

Answer 214

common care in recumbant patients outcome dependant what inhaled and how much potential secondary infection due to damage signs - cough, harsh or reduced lung sounds, tachypnoea, pyrexia need oxygen alveolar infiltrate on xray BAL - confirm diagnosis and culture antibiotics treat underlying cause antacid if frequent occurence - vomit inhalation metacloprimide - improve motility and increase lower oesophageal sphincter tone

Question 215

pulmonary radiograph patterns

Answer 215

interstitial - donut and track alveolar - air bronchographs - lung acini filled with fluid, pus, blood, oedema - fluffy looking density vascular focal nodular - neoplasia or granulomatous disease symmetrical or asymmetrical lobe cranial/caudal

Question 216

pulmonary oedema - small animal

Answer 216

caused by various conditions - cardiogenic vs non cardiogenic - establish which by type of frluid cardiogenic - low protein, result of lung damage increasing vascular permeability changes in pressure balance or impaired drainage --> fluid accumulation in interstitium and ultimately in alveoli ventilation perfusion mismatch --> hypoxia signs - cough froth from mouth crackles interstitial xray pattern - unstructured and often caudodorsal treat - oxygen and butophanol for sedation diuretics less effective in noncardiogenic

Question 217

physical lung injury - small animal

Answer 217

thoracic trauma - eg from RTA pain lag between injury and lung patterns on xray treat - oxygen and analgesia

Question 218

drowning - small animal

Answer 218

signs - cough, might be unconscious immediate consequences from hypoxia alveoli filled with fluid can progress and become more acute later- acute resp distress can appear after appeared previously stable lactic acidosis and hypercapnia oxygen and drainage of fluid, no evidence for antibiotics or steroids

Question 219

eosinophilic lung disease - small animal

Answer 219

common in dogs young adult most common predisposed breeds - husky, malamutes, rotties acute or chronic presentation weight loss in hcronic pulmonary infiltrate with eosinophils --> eosinophilic pneumonitis usually interstitial lung pattern but can be alveolar may see peripheral eosinophilia in bloods BAL to diagnose - eosinophils excessive mucus or mucopurulence on bronchoscopy 20% airway eosinophils normal, if above this then abnormal causes - parasites, neoplasia, fungal treat - steroids - immunomodulation, outcome good and quick unless other organs involved

Question 220

interstitial pulmonary fibrosis (westie lung) - small animal

Answer 220

mostly westies, sometimes staffies middle aged to older version in cats insidious onset - progressive chronic breakdown may cough but not always excercise intolerance cyanosis increased inspiratory effort crepitus thoracic CT - shows a pathognomonic - ground glass look, can also gauge severity interstitial alveolar pattern on xray pulmonary hypertension generalised cardiomegaly with right side emphasis 2 types - fibrotic and inflammatory cats - fibrotic type dogs - mixed no cure symptomatic treatment with steroids poor prognosis once fibrotic changes prevention - avoid smoke, harness instead of collar lead, bronchodilators, antifibrotics, antibiotics for secondary infection

Question 221

lungworm (angiostrongylus vasorum) - small animal - signs

Answer 221

anemia sybcut hematoma internal hemorrhage prolonged bleeding from wounds or sugery prolonged appt coagulation profiles neuro signs in cats - depression, aeizure, pruritis, spinal pain, vision loss (from migration of the nematode or secondary hemorrhage in brain due to coagulopathy)

Question 222

lungworm (angiostrongylus vasorum) - small animal - diagnosis

Answer 222

BAL - larvae, PCR SNAP - in house ELISA, good sensitivity but diagnosis should be made in conjunction with exam etc modified baemann fecal floatation - pooled sample radiograph - interstitial and alveolar pattern, diffuse, more caudodorsal

Question 223

lungworm (angiostrongylus vasorum) - small animal - management

Answer 223

advocate, milbemax etc fenbendizole - weekly - good for acute management phase but unlicensed supportive - bronchodilators, cage rest, oxygen therapy

Question 224

feline asthma - signs and presentation

Answer 224

chronic lower airway disease cough - chronic coughing most common sign to come in for, may be confused for retching or vomiting dyspnoea - can be severe, more expiratory than inspiratory exercise intolerance lethargy barrel chested appearance - trapped air because of mucous plugs could be focal sounds - mucous plugs obstructing airways

Question 225

feline asthma - diagnosis

Answer 225

bloods - increased eosinophils bronchoscopy with BAL - eosinophils, culture for secondary infection xray - flattened diaphragm, bronchial pattern usually but can be mixed, may be focal opacities in severe cases with mucus plugs

Question 226

feline asthma - management

Answer 226

stress reduction humidified oxygen steroids bronchodilators adrenaline in very severe cases ongoing salbutamol, ventalin, or fluicasone inhalers - no systemic effects, long term control of inflammation keep away from dusty places avoid over warm environment access to outdoors remove known allergens

Question 227

pulmonary thromboembolism - cats

Answer 227

few signs on radiograph acute onset dyspnoea open mouth breathing/panting/shallow breathing caused by hypercoagulative state - following trauma, sugrery, sepsis, DIC, cushings, steroids, hypothyroidism, IMHA, glomerularnephritis, or pulmonary hypertension risk factors - hyperthermia/heat stroke obersity excitement/fear/stress parturition/false pregnancy/eclampsia anemia/abnormal hemoglobin CNS disease endocrine disease neuromuscular disease

Question 228

pregnancy toxemia - small animal

Answer 228

rare in dogs common in rabbits and guinea pigs risk factors - obesity large litters last 2 weeks gestation or first 2 weeks post partum treat - fluids and dextrose additional oral glucose supportive feeding - high carb emergency c section - usually only saves babies prevention better - treatment rarely successful prevention - don't breed from obese animals monitor foetal size and number avoid stress in risk periods increase carbs in risk times but care for weight gain encourage gentle exercise in pregnancy

Question 229

ovarian cysts - small animal

Answer 229

mainly guinea pigs serous or follicular serous - usually incidental finding unless big enough to impact other organs - pain and GI stasis not responsive to hormones treat with oericutaneous drainage or spay follicular - hormone producing non pruritic alopecia hormone treatment - short acting GnRH agonist spay to cure

Question 230

uterine tumours - small animal

Answer 230

common in rabbits and hedgehogs uterine adenocarcinoma in rabbits just lots of tumours in hedgehogs if no mets - surgery to cure

Question 231

hyperoestrogenism - small animal

Answer 231

ferrets - when not brought our of oestrus persistant high oestrogen --> panleukopenia prevent - surgical spay - risk of cushings deslorelin implant mating with vasectomised hob treatment - rarely successful - prevention key supportive care for panleukopenia - blood transfusion at PCV <15% (no blood types), steroids, iron dextran to help RBC production, antibiotics for secondary infections

Question 232

mammary tumours - small animal

Answer 232

rats - lots of mammary tissue fibroadenoma both sexes surgical removal as early as poss better - if it grows can get trauma to surface --> ulceration, necrosis, infection cabergoline post surgery - may reduce recurrence - ongoing treatment and expensive

Question 233

testicular trauma - small animals

Answer 233

entire male groups rabbits can see evisceration treat - surgical repair castration analgesia - high risk of self trauma antibiotics keep procedure short as poss so not away from group too long castrate all animals in group in one day - all smell weird at once prevention - castration housing - enough of all resources, places to hide away

Question 234

common repro emergencies - birds

Answer 234

dystocia chronic egg laying salpingitis yolk coelomitis penile prolapse - ducks

Question 235

dystocia - birds

Answer 235

common indicative of underlying issue - usually husbandry related (hypocalcemia) but maybe salpingitis or conditions that narrow the canal wide based stance slight distension diagnosis - conscious radiograph treatment - warm dark quiet environment anaesthetic and manual removal if not responding or if distressed removal - warm water, ky gelly, break down adhesions with finger, make sure get all of shell bits analgesia - butorphanol post op antibiosis - TMPS, amoxyclav, doxycycline identify underlying cause and make recommendations - calcium supplements, UV provision oxytocin not effective in birds

Question 236

chronic egg laying - birds

Answer 236

cockatiels and ex laying hens --> calcium and protein depletion --> bone resorption, fractures, immunosuppression, secondary infections management - conservative - decrease day length to max 12 hours, removing nest boxes, dummy eggs, behaviour modification, diet modification (pellets instead of seed - gradual change) hormonal - deslorelin impant, cabergoline (inhibitis prolactin but variable efficacy and daily oral meds hard in birds)

Question 237

ssalpingitis - birds

Answer 237

ex battery hens inflammation of oviduct septic or non septic can lead to - abnormal or lash eggs dystocia impacted oviduct yolk coelomitis signs - egg drop abnormal eggs weight loss anorexia diagnosis - signallment - ex battery hen mass or fluid on coelomic palpation US - fluid around oviduct xray - mass cloacal endoscopy - hard to get in cytology and culture or coecal discharge treat - meloxican antibiotics if septic - amoxyclav or culture and sebnsitivity supportive care - fluids, nutrition, warm environment deslorelin - prevent further ovulations euthanasia if very sick prevent further ovulations once treated - deslorelin and controlled photoperiod

Question 238

yolk coelomitis - birds

Answer 238

sterile coelomitis - egg into coelom then bursts septic coelomitis - secondary infection or multiple eggs in coelom signs - lethargy anorexia coelomic swelling respiratory compromise diagnosis - signalment - ex battery hen fluid on palpation fluid on US coelomic tap - therapeutic as well as diagnostic cytology and culture of coelomic fluid for secondary infections treatment - abdomincentesis - relieve pressure on air sacs anti inflammatories antibiotics supportive care prophylactic antifungals and broad spectrum antibiotics optional treat once and euthanise if recurs or deslorelin and photo period control to prevent future egg laying

Question 239

reptiles - common repro emergencies

Answer 239

preovulatory ovarian stasis dystocia cloacal prolapse

Question 240

pre-ovulatory ovarian stasis - reptiles

Answer 240

older female tortoises or any female with wrong husbandry or kept without a male usually asymptomatic until get coelomitis diagnosis - bloods US - lots of follicles of same size with mixed echogenicity treat - conservative - if no signs - husbandry (temp, UVB, nutrition, nesting sites), may help to provide a mate but can also lead to dystocia medical - always given before surgical, usually dehydrated - fluids, meloxicam, opioids surgery

Question 241

dystocia - reptiles

Answer 241

mostly tortoises but sometimes lizards and snakes often chronic - may not need urgent intervention treat - medical - usually, commonly non obstructive - temp, husbandry, UVB, diet, nesting sites, mate, hydration (bathing), oral calcium if not getting results - oxytocin and injectible calcium if can palpate egg sedate for removal - digital manipulation or break egg up, may be able to milk it down in snakes if can't palpate - surgical removal

Question 242

cloacal prolapse - reptiles

Answer 242

relatively common differentiate which tissue is prolapsed before treatment - narrows down underlying cause always is an underlying cause treat - conservative - only in uncomplicated cases, fresh prolapse with minimal tissue damage - fluid, reduce inflammation (osmotic dressing and NSAIDs if not dehydrated), push back in gently with lots of gel, stay sutures treat underlying cause if complicated - necrosis - surgery - depending on tissue type determines what procedure done, end-to-end anastomosis, resection, or removal or amputation