Clinical Examination and Diagnostic Investigation Flashcards
List the body postures of an anxious/fearful cat.
- Tense musculature
- Closed, crouched body position
- Dilated pupils
- Pads on the floor
- Tail tucked close or under the body
- Head and neck pulled in close to the body
- Ears flattened down against the head
List the common behaviours exhibited by an anxious/fearful cat.
- Creating distance between themselves and the stressor
- Hiding
- Hypervigilance
- Inhibition of sleep
- Inhibition of maintenance behaviours
- Altered eating patterns
- Decreased exploratory and play behaviour
- Decreased movement/freezing and being quiet
- Startling easily
When avoidance and retreat are not an option, list the common behaviours exhibited by an anxious cat.
- Hypersalivation. Tongue licking nose or exaggerated swallowing
- Vocalisations or spitting
- Aggressive behaviour
- Trembling/shaking
- Rapid breathing – particularly open mouthed breathing (don’t pant like dogs)
How should you modify your behaviour for cat friendly handling technique?
- Need to be calm around them
- Gentle tone of voice
- Quietly confident
- Patient
- Avoid confrontation
- Slow, gentle, quiet approach at all times
Name 4 pharmacological interventions for a stressed cat.
- Local anaesthetic ointment - assist jugular blood sampling or IV catheter
- Gabapentin orally
- Butorphanol 0.3mg/kg IM for sampling/catheter
- Sedation - alpha-2 agonist and opiate, alphaxlone, midazolam, butorphanol
What is cytology?
A test that evaluates the cells present in samples of fluid – bronchoalveolar lavage, CSF, synovial fluid, body cavity fluid or tissue.
What are the advantages of cytology?
- Easy – rarely needs GA if peripherally located lesion, or sophisticated equipment
- Minimally invasive with low risk of complications
- Can be performed in house
- Quick with rapid turnaround of results as it does not require additional fixation
- Cheap
- Multiple sites can be sampled simultaneously
What are limitations of cytology?
- For some tissues/disease processes cytology may only be a screening test that indicates the need for follow-up histopathology
- Tissue architecture cannot be evaluated, less complete than histopathology and not suitable for some diseases
- Does not give information on degree of invasiveness
What are the uses of cytology?
- Fluids
- Lesions that are easily accessible
- Lesions that exfoliate cells plentifully
- Lesions with uniform/consistent changes
When is cytology less useful?
- Lesions that are poorly exfoliative
- Complex/mixed structures
- Samples that require tissue architecture evaluation
- The characterise location of inflammation/pathology within a complex organ
Which techniques can be used for histopathology?
- FNA
- Incisional punch biopsy (circular blade digs down into tissue to get a core)
- Excisional biopsy (removing tissue to send off)
Name 3 fixatives that may be used in histopathology.
Formalin
Glutaraldehyde
Liquid nitrogen
Describe FNA with aspiration.
Performed with syringe attached and suction applied. Needle re-directed within the lesion 3-5 times causing suction released and needle withdrawn
What is the aim of FNA with aspiration?
To suck tiny cores of tissue into the needle
Describe FNA without aspiration.
Performed with (if entering or near a body cavity) or without syringe attached to needle. Needle repeatedly moved up and down in the lesion around 4-6 times.
What is the aim of FNA without aspiration?
To push tiny cores of tissue into the needle
What is the benefit of FNA with aspiration?
High numbers of cells collected
What is the benefits of FNA without aspiration?
Lower risk of cell damage/barotrauma and blood contamination
What is the risk of FNA with aspiration?
Risk of blood contamination and cell damage/barotrauma, meaning it is no longer diagnostic
What is the risk of FNA without aspiration?
Lower numbers of cells collected so non-diagnostic
What types of lesions can be assessed using FNA with aspiration?
Hard masses
Lesions where FNA without aspiration has been unsuccessful
What types of lesions can be assessed with FNA without aspiration?
Soft masses and masses in very vascular tissues
What does barotrauma result in?
Cells rupture and they cannot be analysed
What must be done if body cavity fluid preparation has low cellularity?
Concentrate sample – centrifuge and then smear re-suspended pellet, line smear or cytospin
What must be done if a body cavity fluid preparation is haemorrhagic?
Look how does PCV compare to PCV of blood, are the platelets (suggestive of active bleeding)
When are EDTA and plain tubes used for body cavity fluid preparations?
EDTA tube for cell counts and cytology
Plain tube – total proteins on refractometer or analyser, culture
What smear type is used for haemorrhagic fluid?
Direct smear
Buffy coat smear
What smear type is used for high cellularity fluid?
Direct smear
What smear type is used for low cellularity fluid?
Sediment smear
Cytospin preparation
What type of smear is used for viscous fluid?
Squash preparation
What should be avoided on slides?
Ultrasound gel
Dirty slides
Formalin fumes
Describe the Giemsa/modified wright stain.
Used in most commercial labs, give more nuclear and cytoplasmic detail, more time consuming bit often automated
What is the advantage and disadvantage of Diff-Quik/haemacolour stain?
+ Very practical and quick
- Unreliable staining of mast cells
Name 5 stains.
Giemsa/modified wright
Diff-Quik/haemacolour
Methylene blue
Toluidine blue
Periodic acid Schiff
What are the common problems of slide diagnostic quality?
No cells
Ruptured cells
Insufficient staining
Wrong tissue aspirated
Too thick
What are some common artefacts?
Poor staining
Formalin fumes
Ultrasound or KY/gel
Glove powder starch granules
What should be analysed in the presence of inflammatory cells?
- What is the predominant inflammatory cell present or is it mixed?
- Do neutrophils exhibit signs of degeneration?
- Do neutrophils or macrophages contain any intracellular material/organisms?
- Are there any organisms or foreign material in the background?
Describe non-degenerate neutrophils.
Nuclear lobation (3-5 lobes)
Crisp nuclear outlines that stain darkly
Dense dark purple chromatin
Cytoplasm is pale
Clear to slight eosinophilic
Think immune mediated disease, neoplasia, foreign body reaction, sterile conditions caused by irritants, pre-treatment with antimicrobials.
Describe degenerative neutrophils.
Loss of segmentation
More open/swollen fluffy nuclear chromatin
Cytoplasm may be more pinky/purple
Think bacterial or fungal infection toxin action on neutrophils.
Describe macrophagic inflammation.
High numbers of macrophages, granulomatous or histiocytic
Macrophages + neutrophils = pyogranulomatous
Describe mesenchymal tumour cells.
- Often have spindle, oval shaped cells
- Indistinct cell borders that taper
- Round elongated nuclei
- Usually scattered sometimes in aggregates
- Can see matrix sometimes (pinkish backgrounds that could signify presence of bone)
- Less cellular but nasty type
Describe epithelial tumours cells.
- Large round polygonal cells
- Tightly adherent/clustered
- Distinct cell borders
- Nuclei are round to oval
- Can be arranged in columnar cells
How areendocrine/neuroendocrine tumour cells distinct from the epithelial cells they are derived from?
- Frequent individually but can have free nuclei
- Indistinct cell borders that make them very hard to evaluate psychologically
- Well-formed clusters (particularly those from the thyroid gland)
Describe round tumour cells.
- Very round
- Often very numerous
- Often distinct from each other
- Do not tend to sit in clusters
- Some have intracellular granules (mast cells or melanocytes)
