DL: Endocrine 4 Cases

Question 1

is 2+ protein in reasonably concentrated urine worrying?

Answer 1

No can be normal

Question 2

Causes of malutilisation

Answer 2

• DM
• Neoplasia
• LIver dz
• CHF
• Hyperthyroidism

Question 3

3 broad causes of hepatomegaly

Answer 3

• infiltration
• accumulation
• congestion

Question 4

Why may DM cause an azotaemia?

Answer 4

Produces a catabolic state -> ^ urea and creatininte

Question 5

Neutrophilia in the abscnce of a stress leucogram indicates what?

Answer 5

• focus of inflame/infection somewhere

Question 6

What can cause ^ urine pH ?

Answer 6

• UTI (urease producing bacteria -> ammonia NH3 collects H= -> alkalination)
• ^ veg content diet

Question 7

Empirical tx or diagnostics for a suspected UTI?

Answer 7

urine culture

tx amoxyclav

Question 8

What endocrine causes of wt loss despite ^ appetite and CV changes are possible?

Answer 8

• hypersomatotropism (expect concurrent DM, r/o with UA)

- hyperthyroidism

Question 9

What does azotaemia with appropriately concentrated USG tell you?

Answer 9

Pre-renal azotaemia

Question 10

How does phosphate change in diabetic cats?

Answer 10

decreases

-> haemolysis (cuase or effect? not sure look up)

Question 11

If unsure whether apparent hyperglycaemia is d/t stress or DM, how can this be differentiated?

Answer 11

> fructosamine poss to r/o immediate stress at time of sample (pooled average of 10-14d)
- BUT if stress hyperglycaemia more chronic d/t stress of chronic disease then this will not differentiate and stress still poss cause

Question 12

When can IGF-1 levels not be used to test for acromegaly?

Answer 12

• on admittance of an uncontrolled diabetic
• liver has no insulin to make IGF1
• need to give insulin 1st for a few days then retest when insulin in system

Question 13

What IGF1 levels indicate hyperosmatotrophism?

Answer 13

> 90 (32-90 normal)

Question 14

How can hyperthyroidism be dx?

Answer 14

Serum T4 conc (20-45)

Question 15

What can falsely increase the TSP/ TPP count?

Answer 15

Lipaemic serum

Question 16

What can cause a relative insulin deficiency in the dog?

Answer 16

• pancreatitis
  > not typical type 1 DM seen commonly in the dog
• if not improved in few days try insulin but give time for pancreas to recover first

Question 17

What may cause bilirubin to be present in the urine?

Answer 17

• pancreatitis

> bile duct runs through pancreas to get to SI

Question 18

What does a significantly increased amylase suggest? (>2-3x upper limit) What finding would support this finding?

Answer 18

Exocrine pancreatic disease

- PANCREATITIS -> fasting lipaemia

Question 19

Why may liver enzymes be raised with pancreatitis?

Answer 19

2* dmagae to liver

Question 20

Will you expect to see an inflammatory profile with pancreatitis?

Answer 20

YES and left shift likely

Question 21

What tests could you perform to further clarify suspicions of pancreatitis?

Answer 21

> cPLI (canine pancreatic lipase immunoreactivity)
- SNAP test (^ risk false +, yes/no)
rads/ultrasound for structural change
- spec tet (lab IDEX numerical, 25% false -ves)

Question 22

Tx for pancreatitis?

Answer 22

• fluids, pain relief
• Nil per os until stops vomming
• v dietary fat
• antiemetic (ensure tx nausea as well as emesis: maropitant potensh not very good, ondansetron better)

Question 23

Describe the typical presentation of DM with acute ketoacodiosis

Answer 23

• 3d V+ and inappetance
• rapidly progressive lethargy, V+, anorexia
• months hx PD, ravenous apetitie with wt loss
• hepatomegaly

Question 24

Will all DM animals become ketotic?

Answer 24

NO severe insulin deficiency needed for this

Question 25

What are the functions/actions of insulin?

Answer 25

Best at v peripheral lipolysis -> v ketone body production -> ^ lipogenesis
- v mm catabolism -> v hepatic gluconeogenesis
- ^ intracellular K+ flux
Worst at ^ peripheral glucose uptake
~ hence why very low insulin levels needed for ketosis to occour

Question 26

How can acidosis affect other biochemical parameters?

Answer 26

• will see v HCO3 as trying to compensate
• casues Hyperkalaemia (^H+ taken into cells to be converted by carbonic anhydrase to CO2 + H20, K+ pumped out to balance charges as most permeable ion)
• UNLESS vomiting
  > K+ lost in vomit and with PU (^tubular flow -> ^ K+ loss)
  > No insulin to encourage reuptake into cells
  -> ALL K+ LOST FROM BODY, VERY BAD
• if IVFT started K+ concentration drops even more -> cardiac arrest

Question 27

What should be thought about as a priority with diabetic ketoacidosis?

Answer 27

POTASSIUM

• don’t correct acidosis too quickly
• always spike fluids

Question 28

What are the features of diabetic ketoacidosis?

Answer 28

• metabolic acidosis
• v total body K+ (even if normal on bloods, reserves likely to be low, assume total body K+ is low)
• ketonuria

Question 29

Tx diabetic ketoacidosis

Answer 29

• Fluids spiked with K+ (phosphate or chloride)
• 2x maintainance rate
• soluble insulin CRI/IM q1hr
• Avoid fluids with Ca (K phosphate spike will mineralise with Ca P - bad)
  > then tx as standard DM

Question 30

How will glucose and ketone levels respond to insulin tx?

Answer 30

• hepatic ketogenesis continues despite lipolysis being inhibited so glucose will v faster than ketones -> HYPOGLYCEAMIA
• at this point v insulin and start glucose/dextrose infusion for 1-3d