Acute Medicine and Surgery Flashcards
gastric foreign body definition
anything ingested that can’t be digested
examples linear foreign bodies
string, yarn, cloth, dental floss
foreign bodies in cats
usually linear
must be removed asap
can cause intestinal perforation and peritonitis
signs gastric foreign body
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
gastric foreign body - ddx
parvo
gastric neoplasia
diagnostics gastric foreign body
radiography - radio-opaque visible, radiolucent needs positive contrast or double contrast
cytological examination of any effusion
endoscopy - gastroduodenoscopy
treatment - gastric foreign body
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
GDV definition
gastric dilatation-volvulus
enlargement of stomach and roatation on mesenteric axis
simple dilatation definition
stomach engorged but not malpositioned
dilitation definition
organ or structure stretched beyond normal dimensions
GDV pathophysiology
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
risk factors GDV
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
GDV signallment
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
GDV signs
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,
GDV ddx
simple dilatation - common in puppies that overeat
small intestine volvulus
diaphragmatic hernia
ascites
GDV diagnostics
radiograph - differentiate GDV and simple dilatation
free abdominal air - suggests gastric rupture
air within wall of stomach - indicates necrosis
immedaite surgery once stabilised
GDV treatment
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
GDV surgery aims
inspect somtach and spleen
remove damaged or necrotic tissue
decompress stomach
correct malpositioning
adhere stomach to body wall - prevent future malpositioning
enterotomy
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
enterotomy - indications
masses
foreign body removal
luminal examination
biopsy
end to end anastomoses
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
coagulopathy - horses - acute haemorrhage
not a common cause of haemorrhage but consumptive coagulopathy can be an issue after the haemorrhage
signs of haemorrhagic shock
tachycardia
tachypnoea
cold extremities
anxiety or depression
pale mm
prolonged CRT
weak arterial pulse
flow murmur
sweating
colic
abdominal distension
decreased MAP
acute haemorrhage - biochem markers
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
estimating blood loss - acute haemorrhage (horse)
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
controlling blood loss - acute haemorrhage
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
fluid therapy - acute haemorrhage - horse
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
blood transfusion indications - acute haemorrhae - horse
30% loss
signs of hypovolemic shock
PCV < 20% in acute bleed, <12% in chronic anemia
lactate >4mmol/L
blood transfusion - donors - horse
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
calculation blood deficit - acute haemorrhage - horse
(normal PCV - animal PCV/normal PCV) * blood volume
reactions to blood transfusion - horse
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
safety and restraint measures - farm
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
sedation - farm
xylazine
detomidine
romifidine
butorphanol
aims - standing, standing with muscle relaxation, recumbent, deep recumbent sedation
sedation side effects - farm
increased salivation
recumbancy
abortion risk
bloat
regurgitation and inhalation
heat stress
pulmonary oedema risk in sheep
TMPS antibiotics contraindicated
considerations sedation - farm
IM - slower onset, longer duration, larger dose
IV - faster, shorter duration, smaller dose
consider epidural
sacrococcygeal epidural - farm
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
sacrococcygeal epidural - procedure - farm
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
bloat types - farm
frothy bloat - can’t be eructated - consumption of fermentable legumes
free gass - obstructive, can’t eructate
calves - rumen drinking
treatment bloat - farm
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
indications caesarian - farm
legs cross
no room around head/legs
precervical torsion
uterine torsion that won’t move
foetal monster
uncorrectable dystocia
suspected uterine tear
caesarian procedure - farm
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
caesarian complications - farm
infections
dehiscence
seroma
recumbancy/down cow
comorbidities - hypocalcemia
retained placenta
death
peritonitis
abdominal adhesions
reduced future repro performance
metritis
castration - farm
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
castration - rubber ring - farm
efficient and safe
no anaesthetic needed
complications if incorrectly applied
open castration - farm
various methods
1-3 months old
suckler calves to 6 months
castration considerations - farm
health
housing hygiene
size
handling facilities
analgesia
antibiotics
j shaped incision open castration - farm
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
open castration complication - farm
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
urethral obstruction - farm
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
urethral obstruction diagnostics - farm
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
ddx urethral obstruction - farm
cystitis
peritonitis
coccidiosis
peritoneal tumour
ruminal tympany
hydrops
GI obstruction
urethral obstruction treatment - farm
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
urethral obstruction - other considerations - farm
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
urethral obstruction prevention - farm
increase urinary chloride excretion - sodium chloride supplementation
decrease urine pH - ammonium chloride dietary supplement
calcium supplement - unless calcium based uroliths present
fracture repair - farm
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
fractures considerations - farm
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
ddx - pyrexia of unkown origin - cats
FIP
Pancreatitis
cat flu - calicivirus and herpes
parasites
FIV
FeLV
feline panleukopenia
neoplasia
toxins
foreign body
pyrexia of unkown origin - testing - cat
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
pathogenesis FIP
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
FIP treatment
remdesivir
steroids
supportive therapy - fluids, nutritional support
euthanasia should be considered if no response in 3 days
ddx pyrexia of unknown origin - dog
infection
immune mediated
neoplasia
young, large breed - steroid responsive meningitis
young, small breed - granulomatous encephalomeningtis
sight hounds, collies, shar peis - immune mediated polyarthritis
common ddx pyrexia of unknown origin - equine
pleuropneumonia
strangles
collitis
peritonitis
pericarditis
bacterial pneumonia - equine
risk factors -
long distance transport
recent oesophageal obstruction
dysphagia
recent anaesthetic
recent viral infection
bacterial pneumonia - signs
congested mm
cough
nasal discharge
often picked up before obvious signs so history important
colitis risk factors - equine
parasite management
recent antimicrobials
recent NSAIDs
consuming oak or sand
recent diet change
stressors
testing - pyrexia of unknown origin - equine
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)
tick borne infection - pyrexia of unkwon origin - equine
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
antimicrobials in pyrexia of unkown origin - equine
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
difference - hyperthermia and pyrexia
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
pyrexia of unknown origin - non specific signs - small animal
lethargy
depression
anorexia
panting
shivering
collapse
reluctance to move/stiffness
trial treatment - pyrexia of unkwon origin - small animal
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
diagnostics - pyrexia of unknown origin - small animal
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
pyrexia of unkown origin - cat bite abscess
lethargy
anorexia
pyrexia
focal swelling
draining abscess
treat -
drain pus
analgesia - NSAIDs, opioids if dehydrated
antibiotics - if pyrexic or systemically unwell
pyrexia of unknown origin - FIP
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
pyrexia of unknown origin - toxoplasma gondii (cats
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
pyrexia of unknown origin - heat stroke
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
pyrexia of unknown origin - steroid responsive meningitis
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
pyrexia of unknown origin - immune mediated polyarthritis
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
challenges for mother - c-section anaesthesia
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
challenges for puppies - c-section anaesthesia
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
situational challenges - c-section anaesthesia
often emergency - late night, limited help, limited time
financial and emotional pressure
limited experience - both owner and vet
lack of clinical evidence
drug challenges - c-section anaesthesia
basically no licensed drugs
initial stabilisation - c-section anaesthesia - emergency
fluids
check electrolytes, TP and PCV
premed - reduce dose of induction agents needed
pre-oxygenate
pre-clip if appropriate
initial stabilisation - c-section anaesthesia - elective
treat as normal
IV canula
pre med
pre oxygenate
prepare equipment and drugs and personnel
pre-clip
drug choice - c-section anaesthesia
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
pre med - c-section anaesthesia
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
induction - c-section anaesthesia
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
maintenance - c-section anaesthesia
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
analgesia - c-section anaesthesia
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)
neonatal resuscitation - c-section anaesthesia
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
small intestine identifying features - dog
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
ddx vomiting dog
foreign body
dietary indiscretion
bacterial - e coli, salmonella, campylobacter, mycotoxins
gastric ulcers
NSAIDs
parasites
parasites
kidney disease
liver disease
gastritis
pancreatitis
neoplasia
vomiting vs regurgitation
if food is partially digested - vomiting
vomiting diagnostics - dog
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
exam - vomiting
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
vomiting - diagnostics - dog
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
stabilisation - vomiting dog
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
signs - oesophageal obstruction - dog
choking/gagging or coughing a bit
regurg a while after food (chronic)
increased salivation
lethargy
dyspnoea
sequelae - oesophageal obstruction - dog
aspiration pneumonia
perforation
mediastinitis
pleuritis
pneumothorax
diagnosis - oesophageal obstruction - dog
radiograph - preferred - may need contrast, check lungs for aspiration pneumonia
oesophagoscopy - can also sometimes use to remove objects
treatment - oesophageal obstruction - dog
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
GDV signs
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
GDV - sequelae
arrythmia
endotoxemia - compromised mucosal barrier
gastric necrosis - peritonitis and septic shock
electrolyte and acid base disruptions
DIC - end stage - euthanise
GDV - diagnosis
radiograph - looks like 2 compartments
GDV - treatment
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
GDV - prevention
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
signs - gastric and intestinal foreign bodies
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
sequelae - gastric and intestinal foerign bodies
perforation –> septic shock
DIC - compromised intestinal barrier
diagnosis - gastric and intestinal foreign bodies
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
treatment - gastric and intestinal foreign body
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
post op care - gastric and intestinal foreign bodies
monitor
electrolyte imbalances
low fat diet 12-24 hours post op
antiemetic if needed
omeprazole if suspect ulceration
presentation - intussuception
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
diagnosis - intussusception
radiograph - better with contrast
us - best
bloods
fecal analysis - parasitic cause
treatment - intussuception
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
presentation - mesenteric volvulus/torsion
collapse
swollen abdomen
blood from anus
sudden onset
rare - rapidly fatal - once sick usually necrotic intestines
ddx acute hemorrhagic diarrhoea syndrome
parvo
clostridial endotoxicosis
coagulopathy
intussusception
foreign body leading to intestinal trauma - rare
presentation - acute hemorrhagic diarrhoea syndrome
haemorrhagic diarrhoea - raspberry jam consistency
anorexia
lethargy
usually self limiting with supportive care - fluids, bland diet, adsorbants
test for parvo
testing - acute hemorrhagic diarrhoea syndrome
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
treatment - acute hemorrhagic diarrhoea syndrome
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
horse GI - indications for referral
presistent pain after analgesia
progressive abdominal distension
tachycardia <60bpm
hypovolemia signs
absence of borborygmi
abnormal rectal findings
gastric reflux >4L
horse GI - prior to referral
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
CHF pathophysiology
increased cardiac filling pressure –> venous congestion –> extravasation of fluids
pleural effusion
pulmonary oedema - left sided
ascites, peripheral oedema - usually right sided
CHF signs
tachypnoea/dyspnoea
reduced exercise tolerance
reduced appetite
lethargy
weight loss
abdominal distension
CHF tests
Essential -
TFAST/POCUS - fluid, left atrium size
bonus -
BP
biochem
xray - if stable
CHF sedation
methadone or butorphanol - if thromboembolism butorphanol not enough
Furosemide CHF
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
CHF thoracocentesis
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
CHF pimobendan
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
CHF radiographs
gold standard confirmation
only use once stable to sedate and restrain
after thoracic US, thoracocentesis and diuretics
assessment for concurrent disease
pericardial effusion signs
muffled heart sounds - main thing
ascites - right sided heart failure
weak pulses
paradoxical pulses
collapse
lethargy
weakness
exercise intolerance
pericardial effusion diagnosis
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
pericardial effusion - treatment
pericardiocentesis - only treatment if tamponade
IV fluid boluses - support cardiac filling to stabilise
DO NOT GIVE FUROSEMIDE - makes mild effusion severe, can be fatal
Aortic thromboembolism presentation
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
aortic thromboembolism management
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
diagnostic ECG - lead positions
red - right fore
yellow - left fore
green - (left) fore
diagnostic ECG - considerations
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
ventricular tachycardia ECG
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
causes ventricular tachycardia
cardiac disease - basically always primary cardiac in cats, mostly in dogs, but sometimes none cardiac
neoplasia - splenic, hepatic
GDV
SIRS/sepsis
toxins
anemia
trauma
ventricular tachycardia treatment
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
emergency bradycardia
3rd degree atrial ventricular block
or high grade 2nd degree
3rd degree AV block ECG
no communication between atria and ventricles
P waves but QRS not associated
QRS wide and bizarre, not premature
sick sinus syndrome presentation
old dogs
westies and schnauzers
not an emergency
pauses in rhythm on ECG
persistent atrial standstill presentation
rare
usually springer spaniels
looks similar on ECG to 3rd degree block but no P waves
3rd degree block management
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
Small animal neuro diagnostics
CSF analysis
imaging - radiographs, myelopgraphy, CT, MRI, US, scintigraphy
electrodiagnosticss
neuro clinical exam important - localisation, ddx, decision re further tests
CSF analysis indications - small animal
suspected inflammatory disease - meningitis, meningo-myelitis, meningo-encephalitis,
before myelography
if multifocal signs
CSF analysis
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
CSF analysis - contraindications
raised intercranial pressure
conformation - chiari like malformation/syringomyelia, occipital dysplasia
coagulopathy
neuro diagnostics - radiography
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
neuro diagnostics - myelography
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
neuro diagnostics - CT
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
neuro diagnostics - MRI
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
equine - acute MSK emergency - initial assessment and first aid
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
equine - acute MSK emergency - further assessment
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)
equine - acute MSK emergency - common causes
subsolar abscess - very common, pus in foot
laminitis
ceullulitis
synovial sepsis
fracture
tendonitis
tendon laceration or rupture
myopathy
equine - acute MSK emergency - diagnostics
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
equine - subsolar abscess - signs
severe lameness
heat
focal pain around coronary band
increased pulse amplitude
pain on hoof testers
equine - subsolar abscess - causes
bruising
conformatino
penetrating wound
white line
laminitis
keratoma
in recurrent - address underlying issue
equine - subsolar abscess - treatment
nerve blocks - may be contraindicated if non weight bearing
remove shoe
tetanus prophylaxis
antiseptic
bandaging
analgesia
draining - poultice
equine - periarticullar cellulitis - treatment
broad spectrum antibiotics
NSAIDs
Steroids
Cryotherapy
Physio
Bandaging
equine - wound and synovial sepsis exam
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
equine - wound and synovial sepsis - complicating factors
fracture - changes approach, esp if anaesthetising, impact on cost
sepsis
tendon or ligament damage
vascular damage
thoracic perforation
abdominal penetration
equine - wound and synovial sepsis - synovial sepsis signs
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
Horse GI - indications for referral
persistant pain after analgesia
progressive abdominal distension
tachycardia <60bpm
signs of hypovolemia
absence or borborygmi
abnormal rectal findings
gastric reflux >4litres
Horse GI - FLASH ultrasound
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
Horse GI exam - rectal exam quadrant system
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
Horse GI - indications for surgery
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
Horse GI - large intestine displacement
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
Horse GI - causes post-op colic
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
Horse GI - common surgical complications
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
pyo - predisposing factors
age
conctraceptice/abortion medications
previous pyos
pyo - diagnostics
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
pyo - treatment
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
orchitis - tests
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
orchitis - treatment
antibiotics - TMPS, baytil but not first line
NSAIDs - meloxicam
cold compress
probiotics for GI signs
castration - risk of abscessation in acute inflammation
Foot and mouth signs - cattle
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
foot and mouth signs - sheep/goats
often asymptomatic
may have lesions only at one site
stopped milk
vesicles
abortions
death of lambs - myocarditis
foot and mouth signs - pigs
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
incubation by species - foot and mouth
sheep - 1-12 days
cattle - 2-14 days
pigs - 2+ days
important to know for tracking
transmission - foot and mouth
inhalation - direct contact or aerosol over distance (esp pigs)
fomites
ingestion of contaminated feed - mostly pigs
ingestion of infected milk
AI with infected semen
ddx foot and mouth
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
feline lower urinary tract disease
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
urethral obstruction - presentation
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
causes of urethral obstruction
cats - crystalline mucus plugs
dogs - uroliths
prostatic disease - hypertrophy, neoplasia inflammation, abscess
neoplasia
upper motor neurone bladder
stricture
reflex dysynergia
blocked cat - presentation
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
blocked cat - diagnostics
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
blocked cat - treatment
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
ddx - foal neonatal colic
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
meconium impaction - foal colic
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
ruptured bladder/uroperitoneum - foal colic
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
hernitation - foal colic
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
gastric ulceration - foal colic
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
patent urachus - foal colic
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
omphalitis/omphalphlebitis - foal colic
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
pregnancy toxemia - small animals
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
ovarian cysts - small animal
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
uterine tumour - small animal
common in rabbits and hedgehogs
uterine adenocarcinoma
surgery treatment if no mets
hyperoestrogenism - small animal
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
mammary tumours - small animal
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
testicular trauma - small animal
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
bird repro emergencies
dystocia
chronic egg laying
salpingitis
yolk coelomitis
penile prolapse - ducks
cat - dyspnoea - feline asthma - diagnostics and treatment
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
dyspnoea - small animal ddx
aspiration pneumonia
heart disease
asthma
BOAS
drug reaction
lungworm
toxin
pneumonia
pulmonary oedema
nasal polyps
neoplasia
trauma
dyspnoea - respiratory noises - small animal
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
pleural effusion types - small animal
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
small animal lower respiratory disease - signallment - age and breed
puppies - infectious
<2 yo - angiostrongyles
older - laryngeal paralysis, chronic bronchitis, neoplasia
toys and minis - tracheal collapse
westies and border terriers - IPF
orthopneoa meaning
dyspnoea in any position other than standing or sitting up - usually bilateral pulmonary oedema
trepopnoea meaning
dyspnoea only in one lateral recumbancy - unilateral lung or pleural disease, or unilateral airway obstruction
thoracic exam - auscultation and percussion - small animal
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
small animal lower airway respiratory disease - diagnostics
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
small animal lower respiratory disease - treatments
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
small animal - causes of difficulty breathing
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
small animal - causes pulmonary parenchymal disease
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
small animal - aspiration pneumonia
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
pulmonary radiograph patterns
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
pulmonary oedema - small animal
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
physical lung injury - small animal
thoracic trauma - eg from RTA
pain
lag between injury and lung patterns on xray
treat - oxygen and analgesia
drowning - small animal
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
eosinophilic lung disease - small animal
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
interstitial pulmonary fibrosis (westie lung) - small animal
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
lungworm (angiostrongylus vasorum) - small animal - signs
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)
lungworm (angiostrongylus vasorum) - small animal - diagnosis
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
lungworm (angiostrongylus vasorum) - small animal - management
advocate, milbemax etc
fenbendizole - weekly - good for acute management phase but unlicensed
supportive - bronchodilators, cage rest, oxygen therapy
feline asthma - signs and presentation
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
feline asthma - diagnosis
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
feline asthma - management
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
pulmonary thromboembolism - cats
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
pregnancy toxemia - small animal
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
ovarian cysts - small animal
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
uterine tumours - small animal
common in rabbits and hedgehogs
uterine adenocarcinoma in rabbits
just lots of tumours in hedgehogs
if no mets - surgery to cure
hyperoestrogenism - small animal
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
mammary tumours - small animal
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
testicular trauma - small animals
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
common repro emergencies - birds
dystocia
chronic egg laying
salpingitis
yolk coelomitis
penile prolapse - ducks
dystocia - birds
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
chronic egg laying - birds
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)
ssalpingitis - birds
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
yolk coelomitis - birds
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
reptiles - common repro emergencies
preovulatory ovarian stasis
dystocia
cloacal prolapse
pre-ovulatory ovarian stasis - reptiles
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
dystocia - reptiles
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
cloacal prolapse - reptiles
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
