Dogs & cats Flashcards
Weight loss with reduced appetite
* DDx
DDx
- Anorexia
- Dysphagia
- Regurg / Vomiting
- Malassimilation
- Cancer cachexia
- Neuro - LMN Dz
Hypoadrenocorticisim / Addison Dz
Aetx * Primary - immune-mediated * Secondary - pituitary dmg * Iatrogenic - CS drugs => cortisol & aldosterone deficiency
CSx - wax & wane
DGx
- CBC
- nonregen normocytic normochromic anaemia / erythrocytosis dt dehydration
- LACK OF STRESS LEUKOGRAM
- v Na, Cl
- Na:K <27:1
- ^ K, Ca, P
- Metabolic acidosis
- v albumin, cholesterol, glucose
- ^ liver enzymes
- pre-renal azotaemia
- USG <1.030 / poorly concentrated
- RGx
- microcardia, microhepatica +/- megaoe
- small adrenal g
- ECG - hyperkaelaemia
- Basal cortisol (rule out)
- ACTH stim test
Tx
- IVFT - Tx hypovolaemia, electrolyte imbalance
- Ca gluconate, insulin / glucose - Tx hyperkalaemia
- GC - hydrocortisone, pred
- MC - DOCP, fludrocortisone
Sepsis
* PGx
Sepsis - host resp to pathogens -> pro-inflam > compensatory anti-inflam -> lost homeostasis:
* loss of vasomotor tone
* dysreg of inflam & coag - hyper -> hypocoag -> thrombocytopaenia -> prolonged PT/PTT -> bleeding
* dysreg of endothelial, microcirc, mito - tissue / cryptic / cytopathic hypoxia
=> septic shock
CATS = SLOW, COLD & PALE
Tx
* Acute resus fluid therapy
* ABs
* C&S
=> MODS
Osmolality r/s w PUPD
- what & how does it work?
- what formula can be used as diagnostic tool?
PUPD DDx?
Calculated osmolality ECF = 2(Na + K) + urea + glucose
DI = MARKED HYPOSTHENURIC
- CDI vs NDI - DDx?
- DGx
- Tx
# Primary PD - alternation in thirst centre & osmoreg - assoc w behavioural
# SIADH - neuro signs dt marked hyponatraemia
# Hypercalcaemia CSx? - think about Ca homeostasis & what does biochem tells about Ca DDx? - what's the mnemonic? - HyperPTH - DGx? Tx? - Malignancy - DDx? DGx? Tx?
PUPD DDx in
- well animals
- unwell animals
Well
- DM
- HyperAdr
- Primary PD
Unwell
- a lot !
Complicated diabetic
CSx? - dogs & cats
DGx? - what are the steps? & how to interpret
DDx of insulin resistance conditions
- R/O management factors
- R/O diabetogenic drugs
- R/O insulin factors
- Increase till 1.5IU/kg lean BW twice daily
- Do BGC, fructosamine
- spot glucose, underdose, overdose, short acting, long acting, persistent hyperglycaemia
Acromegaly
- Aetx - P4 on mammary g (D) ; pituitary adenoma (C)
- CSx
- DGx - IGF-1, CT/MRI (C)
- Tx
- Dogs: stop P4 / spey / aglepristone
- Cats: hypophysectomy, radation, ss analogues, GH rct antagonists, high insulin dose
Phaeochromocytoma
- CSx
- DGx MDB + Ux, BP, imaging, fundoscopic, plasma & urine catecholamines
- Tx
- phenoxybenzamine
- surg
Glucagonoma
- Aetx - tumour in liver (C) / pancreas (D)
- DGx - imaging
- Tx - surg
Feline Inapp Urination
DGx
DDx
Tx
MDB & other DGx to rule out disease
Behavioural Hx & household Mx
House soiling vs urine spraying / marking
Preference/aversion vs stress / territorial
Tx
- House soiling
- litter tray (numb, type, location, mx), smell of soiled area
- training
- Urine spraying / marking
- spaying / castration
- env - reduce stress (household, enrichment, litter tray, away from outside cats, core areas & address inter-cat aggression)
- drugs - TCA (clomipramine), SSRI (fluoxetine)
BRAIN DISEASES
Degen
- Ceberellar abiotrophy
- L2 hydroxyglutaric aciduria
- Cerebellar hypoplasia
# Anomalous * Hydrocephalus
# Metabolic * HE
# Neoplastic * Brain tumour
Idiopathic
- Idiopathic epilepsy
- Idiopathic cerebrellitis
Inflammatory
- GME / NME / MUE
- Toxo / neospora
- Viral
- Bacterial
- Fungal
Toxin
- Metronidazole
- Ivermectin
- Lead
- OP
# Vascular * Feline ischaemic encephalopathy
Degen
- Ceberellar abiotrophy
- L2 hydroxyglutaric aciduria
- staffy
- Cerebellar hypoplasia
- kitten at births
Anomalous
- Hydrocephalus
- Tx pred + CAI or ventriculoperitoneal shunt
Metabolic
- HE
- bilateral symmetrical + liver Dz
Neoplastic
- Brain tumour
- Tx surg + radiation
Idiopathic
- Idiopathic epilepsy
- Tx phenobarb
- Idiopathic cerebrellitis / shaker dog syndrome
- peracute tremor / hypermetria
- Tx pred, diazepam
Inflammatory
- GME / NME / MUE
- Tx pred
- Toxo / neospora
- Tx clindamycin
- Viral - FIP, distemper, rabies
- Bacterial
- Fungal - crypto
- Tx ampB, fluconazole,
Toxin
- Metronidazole
- Ivermectin
- Lead
- OP
# Vascular * Feline ischaemic encephalopathy
BRAIN DISEASES
Degen
- Ceberellar abiotrophy
- L2 hydroxyglutaric aciduria
- Cerebellar hypoplasia
# Anomalous * Hydrocephalus
# Metabolic * HE
# Neoplastic * Brain tumour
Idiopathic
- Idiopathic epilepsy
- Idiopathic cerebrellitis
Inflammatory
- GME / NME / MUE
- Toxo / neospora
- Viral
- Bacterial
- Fungal
Toxin
- Metronidazole
- Ivermectin
- Lead
- OP
# Vascular * Feline ischaemic encephalopathy
Degen
- Ceberellar abiotrophy
- L2 hydroxyglutaric aciduria
- staffy
- Cerebellar hypoplasia
- kitten at births
Anomalous
- Hydrocephalus
- Tx pred + CAI or ventriculoperitoneal shunt
Metabolic
- HE
- bilateral symmetrical + liver Dz
Neoplastic
- Brain tumour
- Tx surg + radiation
Idiopathic
- Idiopathic epilepsy
- Tx phenobarb
- Idiopathic cerebrellitis / shaker dog syndrome
- peracute tremor / hypermetria
- Tx pred, diazepam
Inflammatory
- GME / NME / MUE
- Tx pred
Infectious
- Toxo / neospora
- Tx clindamycin
- Viral - FIP, distemper, rabies
- Bacterial
- Fungal - crypto
- Tx ampB, fluconazole,
Toxin - Hx of ingestion
- Metronidazole
- Tx diazepam
- Ivermectin
- Tx supp care
- Lead
- cyto: non regen, basophilic stippling, nRBC
- Tx chelation
- OP
Vascular - acute signs
* Feline ischaemic encephalopathy
* Infarction
Tx supp care
Seizure
- Classification?
- Aetx?
- Pharmacokinetics
- Drugs
- Cluster seizures, status epilecticus - implication & Tx?
Classification
- Generalised - tonic-clonic, tonic, clonic, atonic, myclonic
- Focal
Aetx
RMP maintained by NaK ATPase - Na out, K in => cell more negative
AP occurs when depolarisation reaches threshold - controlled by NT which alter permeability of cell memb by acting on GABA (influx of -ve -> hyperpolarisation) or glutamate (influx of +ve -> hypopolarisation)
-> Seizure occurs when
- altered neuronal memb function eg pump, permeability
- decreased GABA
- increased glutamate
- altered K/Ca conc
Pharmacokinetics
- absorption
- protein -bound
- lipid solubility
- half life (short vs long - loading dose)
- elimination
Drugs
- Phenobarb, Diazepam - GABA agonist
- Bromide - hyperpolarization
- Imepition - BDZ agonist
- Levetiracetam, Gabapentin, Zonisamide
Cluster seizure, status epilepticus
- Implications
- hyperthermia -> DIC SIRS MODS
- lactic acidosis, increase CK (renal)
- hypoxia
- seizure
- Tx
- stop seizure
- IVFT, collect blood
- cooling
- thamine, corts, phenobarb loading dose
SPINAL CORD DISEASE
DGx
DGx observation palpation postural spinal reflexes - crossed extension, cutaneous trunci - UMN vs LMN - urinary incontinence - schiff scherington - spinal shock pain assessment
IVDD
C2-S1
# Hansen I = DISC EXTRUSION - chondrodystrophic breed (daschunds), large breed (90%) - beagle C2-T1 - T11-S1 but T12-L2 most common - acute - G1-5 DGx * RG - calcified disc, reduced IV disc & foramen - x specific * Myelograph - specific, location in 2 views - logistics, oedema / myelomalacia, toxicity * CT/MRI - bone / ST - expensive, x available Tx * G1-3 - Medical - strict rest >4weeks, analgesia (opiates, ketamine + lignocaine, gabapentin + tramdol + nsaids) * G4-5 - decompressive surg + medical mx
# Hansen II - large breed (10%) - chronic DGx - NO MYELOGRAPHY * RG * CT/MRI * Genetic test for degen myelopathy Tx - med / surg - Poor Px
Surg
Type 1 - hemilaminectomy / pediculectomy /
Type 2 - Lateral corpectomy
Cervical disk - ventral slot + fenestration
Tumour - Dorsal laminectomy
Hansen III = Hansen I w/o compression
CSSM / wobbler syndrome
- chronic, choppy gait, scapular m atrophy
- young - dorsolateral ; old - ventral
- DGx - RG, CT/MRI w traction
- Tx
- med - poor px
- surg - traction responsive (distraction-fusion) or not (ventral slot)
DLLS
- lameness, backpain, m atrophy
- dt malform
- DGx - RG CT/MRI
- Tx
- med or surg
Other spinal cord Dz Degen myelopathy Familial ataxia Vertebral malform (hemivertebra, spina bifida, block vertebral, transitional vertebrae, AA instability COMS w secondary syringomyelia Spinal cord tumours Discospondylitis Steroid responsive meningitis-arteritis FCE
AA instability
- intermittent neck pain
- Tx neck brace or surg
COMS
- scratching ear, neck pain
- dt overcrowding
- Tx gabapentin, tramadol, corts
Tumour
- Tx surg, radiation
Discospondylitis - pain, pyrexia, neuro deficit - infection of vertebral end plate dt bacteria / fungal thru direct / haematogenous DGx CBC, RG/CT/MRI, fluid culture Tx ABs / antifungals, analgesia
SRMA / beagle pain syndrome
- wax & wane neck pain & pyrexia
- auto-immune disease
- DGx CSF tap
- Tx steroids
FCE
- exercise induced acute ataxia/paresis w pain -> non painful
- DGx myelography CT/MRI
- Self resolution
NMJ WEAKNESS
NMJ refers to?
Neurolocalisation approach?
CSx?
Neuropathies vs Junctionapathies vs Myopathies
DGx
# Neuropathies Lar-par-polyneuropathy complex Idiopathic facial n paralysis Diabetic polyneuropathy Hypothyroid-polyneuropathy PNST Idiopathic polyradiculoneuritis Peripheral nerve trauma
Junctionopathies
Myasthenia gravis
Botulism
Tick paralysis
Myopathies
Masticatory m myositis
Idiopathic polymyositis
- pathies
- Neuro - sensory/proprioception
- Junction - reflex intact
- Myo - pain, atrophy, decreased reflex
DGx
- CK
- CBC - hyperCa, hypoK
- RG - megaoes, asp pneu
- EMG / ENG
Neuropathies
Lar-par-polyneuropathy complex
- axonal loss from long nerves
- Tx arytenoid lateralisation
Idiopathic facial n paralysis
- CSx x blink, dropped cheek (SLOTH FACE !)
- Tx artificial tear
Diabetic polyneuropathy
- Tx control DM
Hypothyroid-polyneuropathy
- DGx low T4, high TSH
- Tx thryoxine supp
PNST
- DGx electrophysiology, CT/MRI
- Tx amputation, radiation
Idiopathic polyradiculoneuritis
- CSx dysphonia, progressive tetraparesis, facial n paralysis, hyperaesthesia
- Tx supp care - good Px
Peripheral nerve trauma
Junctionopathies
Myasthenia gravis
- congenital / acquired / generalized form (EXERCISE INDUCED WEAKNESS, NECK VENTROFLEXION IN CATS)
- DGx RG, tensilon test, electrophysiology
- Tx supp (nutrition, asp pneu), AChE, corts + underlying cause
Botulism
- prevent ACh release
- DGx toxin in blood, electrophysiology
- Tx supp, antitoxin, cook food
Tick paralysis
- prevent ACh release
- Tx remove tick, supp, antiserum, tick control
Myopathies
Masticatory m myositis
- CSx pain, swelling, atrophy, x open mouth
- DGx Antibodies against tyep II myofibres, CK, EMG, biopsy, MRI/CT
- Tx pred
Idiopathic polymyositis
- DGx CK, EMG, biopsy, CT/MRI
- Tx pred
APPROACH TO PUPD
PUPD - quantify?
- aetpathogenesis?
Approach
* USG - DDx of glucosuria - different USG
DDx of PUPD in dogs & cats
AetPGx
- water diuresis - DI (hyperAdr, hyperCa)
- solute diuresis - DM, renal Dz
- Abnormal RMCG - PSS
- RM wash out - chronic PD
- Drugs - GC, barbs, mannitol
DDx
- Dogs
- Renal
- DM
- HyperAdr
- HyperCa
- Pyelonephritis
- Pyometra
- Cats
- Renal
- DM
- Hyperthyroidism
