Canine Top 20 Diseases - Part 1 Flashcards
what is the classic case presentation of diabetes mellitus?
PU/PD/PP + weight loss
what is the classic case presentation of a very ill or DKA patient?
vomiting, inappetence, & lethargy
what is the classic case presentation of hyperadrenocorticism?
PU/PD/PP/PANTING
pot bellied appearance, truncal alopecia, cutaneous thinning, & calcinosis cutis
what is the classic case presentation of collapsing trachea?
toy/small breed middle aged dog with a honking cough that is elicited with increased activity or exercise that ends with the animal retching
what is the classic case presentation of IMHA?
patient is icteric, lethargy, weak, increased pallor, variable degrees of organomegaly, & discolored urine from hemoglobinuria or bilirubinuria
what is the classic case presentation of IVDD?
PAIN!!! in the neck or back, arched back or head down, ataxia, paraparesis, tetraparesis, or paraplegia
what is the classic case presentation of a severe case of collapsing trachea?
cyanosis & exercise intolerance
how is diabetes mellitus diagnosed?
chemistry panel - hyperglycemia
fructosamine - elevated levels indicate BG levels over 2 weeks
urinalysis - glucosuria, elevated USG, +/- ketonuria
how is hyperadrenocorticism diagnosed? include expected findings on CBC, chemistry, UA, urine cortisol:creatinine, ACTH stim test, LDDST, endogenous ACTH, HDDST, & abdominal ultrasonography.
CBC - stress leukogram (neutrophilia, lymphopenia, eosinopenia) + thrombocytosis
chemistry - elevated ALP & hypercholesterolemia
UA - hyposthenuria +/- proteinuria
urine cortisol:creatinine: if normal, rules out cushings, if abnormal, further testing indicated
ACTH stim: test of choice for iatrogenic cushings (excessive cortisol response)
LDDST: more sensitive for PDH/ADH (no suppression, or loss of suppression at 8 hours)
endogenous ACTH: used to differentiate between PDH & ADH (if low, PDH, if normal to high, ADH)
HDDST: in PDH 75% will suppress & 25% will not but in ADH, there will be no suppression
abdominal ultrasound: in PDH, same size of adrenals or bilateral enlargement, in ADH: one adrenal gland is enlarged & the other is small or not seen
how is collapsing trachea diagnosed?
rads - may be hard to see dynamic collapse
fluoroscopy - I would think this is best
endoscopy - requires general anesthesia
how is IMHA diagnosed? include expected findings on CBC, saline agglutination test, coomb’s test, etc.
CBC - anemia, +/- reticulocytosis, spherocytes, polychromasia, & anisocytosis, icteric serum on PCV
positive saline agglutination test
positive coomb’s test for antibodies against RBC
infectious disease testing - 4DX test!!!
how is IVDD diagnosed?
MRI - safe, fast, & best quality
CT - safe & faster than MRI but lower quality
myelogram - invasive & seizures may occur during recovery
how is a stable diabetes mellitus patient treated?
long acting insulin (NPH or vetsulin)
increased fiber in the diet & RX diabetic diet
how is an ill/DKA patient treated?
hospitalization with supportive care, regular insulin CRI until controlled, & potassium/phosphorus derangements are corrected
what test can be done to rule out stress hyperglycemia when trying to diagnose diabetes mellitus?
fructosamine
T/F: glucosuria can cause an elevated USG in patients with diabetes mellitus
true
what is the prognosis of diabetes mellitus?
good
what medical & surgical treatment is used for PDH? what about ADH? what about iatrogenic hyperadrenocorticism?
PDH medical - trilostane, inhibits the enzyme key for cortisol synthesis or lysodren
PDH surgical - hypophysectomy or bilateral adrenalectomy (requires lifelong post-op hormonal therapy though)
ADH medical - trilostane or lysodren (may get neoplastic necrosis of the adrenals)
ADH surgical - adrenalectomy
iatrogenic - change to a short acting oral steroid that is gradually decreased over several weeks & do an ACTH stim test to see if steroids can be stopped
what are the 3 types of hyperadrenocorticism?
- PDH, most common
- ADH, 25% of cases
- iatrogenic hyperadrenocorticism
what medical treatment is used for patients with a collapsing trachea? what surgical therapy?
medical - short course of steroids, cough suppressant, & weight loss plan if indicated
surgical - tracheal stent placement if patient is refractory to medical treatment (requires referral)
what is the prognosis of hyperadrenocorticism?
guarded to good
what diagnostic test should always been done for a patient with a suspected collapsing trachea? why?
thoracic radiographs - rule out pulmonary edema as a cause of the cough
what treatment is used for patients with IMHA?
immunosuppression!!! prednisone, cyclosporine, azathioprine, or mycophenolate
blood transfusion
prevention of thromboembolism - aspirin or low molecular weight or unfractionated heparin
what is the prognosis of IMHA? is it usually regenerative or non-regenerative?
guarded
regenerative anemia is expected but bone marrow needs 3-5 days to respond
why are steroids falling out of favor for treatment of IVDD? what drug is used instead?
numerous adverse effects & poor efficacy
NSAIDS
what is the prognosis of IVDD if the patient is ambulatory? what if they are non-ambulatory but deep pain positive? what if they are non-ambulatory & deep pain negative?
ambulatory - excellent
non-ambulatory & deep pain positive - guarded without surgery, but excellent with surgery
non-ambulatory & deep pain negative - 50% chance of regaining function if surgery occurs within 24 hours
what animals are affected by hansen type I IVDD? what about hansen type II?
hansen type I - chondrodystrophic breeds (weenies) where the nucleus pulposus extrudes through the annulus
hansen type II - non-chondrodystrophic breeds (any type of dog) with hypertrophy or bulging of the annulus
what surgery is done for IVDD for cervical discs? what about thoracolumbar discs?
cervical - ventral slot
thoracolumbar - hemilaminectomy
when is medical treatment used for IVDD patients? what is included in treatment?
if they are painful only with no neurological signs
strict cage rest & analgesia with opioids or NSAIDS
what therapies are looking promising for pituitary tumors causing PDH?
stereotactic radiosurgery & radiotherapy
