Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Small Animal Medicine > Approach to the Bleeding Patient > Flashcards

Approach to the Bleeding Patient Flashcards

1
Q

Why do patients bleed?

A

-Primarily hemostatic disorders
-hemorrhage from mass
-gastrointestinal ulceration
-parasitism
-trauma
-iatrogenic/pharmacologic
-toxins: xylitol causing liver failure, anticoagulant rodenticide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What differentials are possible for dyspnea in a dog?

A

-pharyngeal/laryngeal disease
-pulmonary disease
-pleural space disease
-cardiac disease
-mediastinal mass
-hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What differentials are possible with multifocal bleeding?

A

-trauma
-coagulopathy/primary hemostatic disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What differentials are possible with lameness/MSK pain?

A

-trauma
-foreign body
-coagulopathy/primary metastatic disorder
-neoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the main things that can greatly prolong PT/PTT?

A

-anticoagulant rodenticide (will result in the most severe increases)
-liver failure
-DIC
-primary clotting disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is fresh frozen plasma the first thing grabbed in anticoagulant rodenticide cases if the patient is not yet anemic?

A

It contains clotting factors
-blood also contains clotting factors, but is not needed if the patient is normovolemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the first factor affected by anticoagulant rodenticide?

A

Factor 7 -PT is therefore prolonged before PTT
- PT assesses the extrinsic pathway

Also affects factor 2, 9 and 10
- when both pathways are affected, this is where you see spontaneous bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How many days should a dog receive vitamin K therapy in a case of anticoagulant rodenticide?

A

28-30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the differentials for petechiation?

A

Thrombocytopenia, Thrombocytopathia, Endothelial dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

At what platelet value can you see spontaneous hemorrhage?

A

30-50,000
-hemorrhage most commonly occurs at skin and GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the differentials of destructive, decreased production, consumptive and sequestration based thrombocytopenia?

A

Destructive: infectious disease, immune mediated, neoplasia, inflammatory disorders, drug induced

Decreased production: myelodysplastic disorders, drug induced, immune mediated, infectious agents, hereditary

Consumptive: DIC, Vasculitis, envenomation, thrombosis

Sequestration: splenomegaly, vasculitis
- usually secondary to other problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What differential causes the most severe decreases in platelet numbers?

A

IMTP
-diagnosed through ruling everything else out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What blood products should you give in IMTP patients that are losing blood?

A

Whole blood- BEST to replenish all of the lost components of blood
- dont just give platelets- not a lot of good evidence in veterinary medicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the different treatment options for IMTP?

A

Whole blood, Corticosteroids (2 mg/kg), secondary and tertiary immunosuppressants (azathioprine, cyclosporine, mycophenolate), vincristine, human immunoglobulins (when other options arent helping-very expensive)
-can also give sucralfate and omeprazole as they are prone to ulceration (need to give 2X per day- evidence this is superior to famotidine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the side effects of steroids?

A

PUPD, excessive hunger, panting, agitation/abnormal behavior
-essentially cushings signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which is superior of the secondary and tertiary immunosuppressants?

A

No literature really supports any being better
-all have risk of causing GI effects
- azathioprine and cyclosporine can cause liver changes

17
Q

What is the mechanism of action of vincristine in IMTP cases?

A

It is a chemotherapy agent that stimulates bone marrow to release megakaryocytes sooner, thus replacing lost platelets
- provides some relief to decrease bleeding

Also interferes with immune mechanisms that cause platelets to be targeted for destruction

18
Q

T/F: Primary IMTP in cats is very rare

A

True
- if it happens it is usually a secondary problem, usually still rare

19
Q

What is the normal platelet count for a dog with primary IMTP?

A

<10,000

If between 10,000-50,000 it is usually secondary (infectious causes, drug effects, neoplasia, sequestration in spleen, vasculitis)

20
Q

T/F: the higher the platelet count and the lower the Hct the worse the outcome in IMTP cases

A

False- lower platelet counts associated with worse outcomes

21
Q

Why can you not trust analyzers to report an accurate platelet count in cats?

A

The platelets in cat blood clump significantly
- need to do a manual count

22
Q

What are some differentials for pleural effusion?

A

Cardiac, neoplasia, chronic pericardial effusion, hepatic/renal disease, diaphragmatic hernia, lung lobe torsion, thrombus, heartworm

23
Q

What are some differentials for pericardial effusion?

A

-neoplastic rupture
-pericarditis
-coagulopathy/thrombocytopathia
-infectious
-left atrial rupture

24
Q

What are the only differentials for a regenerative anemia?

A

Hemorrhage or hemolysis

25
Q

T/F: liver elevations always need to worry you in a cat

A

True- even mild changes are often significant
- liver enzymes never get that high in cats

26
Q

In a case of chronic bleeding into the lungs/pericardium, why may total solids not drop?

A

If globulins are high (due to cancer or infection/inflammation), if the patient is very dehydrated

27
Q

What blood product is preferred in cases of internal blood loss?

A

Whole blood
- very rare to find for a cat

28
Q

What are some differentials for hematochezia/hematemesis?

A

AHDS/HGE, intestinal parasitism, GI ulceration, endocrinopathy (addisons), coagulopathy

29
Q

How can you diagnose HGE? How long does it take to resolve with supportive care?

A

Only by ruling everything else out

Takes up to a week to resolve
- do not add on metronidazole- does not work

30
Q

Why is it not recommended anymore to change the diet in GI cases?

A

Could make the GI upset worse
- hard to determine if the GI upset is newly related to food change or it is due to the dog not getting over diagnosis in hospital
- if you do anything, add pumpkin

Small Animal Medicine (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions