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
AKI CSx DDx DGx Tx
CSx - azotaemia, oliguria/anuria/polyuria
DDx
- Pre/post
- hypovolaemia/hypotension
- sepsis / MODS
- ureteral obstruction
- Drugs
- aminoglycosides
- NSAIDs
- Toxins
- onions, grapes, raisins, currants
- lilies
- Inflam
- Lepto
- Pyelonephritis
Tx
- Perfusion
- correct hypovolaemia, dehydration + maintenance
- measure UOP - Metabolic distrub
- Hyperk -> bradycardia - Tx
- metabolic acidosis - Azotaemia
- pre / post - Establish UOP
- Tx furesemide, mannitol, diltiazem, fenoldapam - Remove nephrotoxic drugs
- Treat underlying cause
- Dialysis
- Supp care
- analgesia, anti-emetic, gastroprotectants
- nutritional support
- Mx BW, UOP, BP
URETHRAL OBSTRUCTION
CSx
Approach
Stabilisation - ABC, MBS Correct hyperkalaemia -> bradycardia - Ca gluconate, insulin + dextrose Correct perfusion - IVFT Sedation - sick - opioids + diazepam - stable- ketamine + BDZ Unblock
LOWER URINARY TRACT DISEASE
FLUTD
UTI
Prostatitis
Pyelonephritis
USMI
BPH
FLUTD
CSx - obstructed vs non-obstructed
DDx
DGx - CBC, Ux, RG/US, cystourethrogram, cystoscopy, biopsy
Tx
* Non obstructed
- RESOLVE WITHIN 1 WEEKS
- analgesia
- smooth m (phenoxybenzamine) or skeletal m (prazosine) relaxant
- anxiolytic (amitriptyline, clomipramine, fluoxetine)
- fluids, ABs if +ve culture
- diet (low protein, Mg, P -> acidic urine + omega3) + salt supp
Px - good w recurrence
PVx - reduce stress
UTI
Tx ABs based on cystocentesis C&S
Prostatitis
Tx ABs, castration
Pyelonephritis
Tx ABs based on pyelocentesis C&S
USMI
Tx a-agonist (PPA), oestrogen (estriol)
BPH
Tx castration, DMA, finasteride , GnRH analogue
HAEMATURIA - LUT vs UUT Bladder neoplasia Prostatic neoplasia Paraprostatic cyst Renal neoplasia => DDx DGx Tx???
URINARY INCONTINENCE
DGx? DDx?
Ectopic ureters
CSx? DGx?
HAEMATURIA
+ LUT = LUT origin
- LUT +/- systemic signs = UUT origin
Bladder neoplasia
- TCC
- DGx cystoscopy / traumatic catherisation + biopsy
- Tx urinary stent, piroxicam, chemo
Prostatic neoplasia - + irregular urethral mucosa
- adenocarcinoma
- DGx FNA, wash, biopsy
- Tx piroxicam, chemo, radiation
Paraprostatic cyst
- DGx RG w constrast
- Tx excision, drainage, castration
Renal neoplasia
- Cat - lymphoma
- Dog - adenoma/ adenocarcinoma
- Young - nephroblastoma
- Tx uteronephrectomy, chemo for lymphoma & carcinoma, surg excision for nephroblastoma
URINARY INCONTINENCE - URINARY CATH !! DDx * Large bladder - neuro vs non-neuro * Small bladder - USMI, Destrusor hyperreflexia, Ectopic ureters
Ectopic ureters - <5yo !!
CSx
DGx cystoscopy, CT, constrast RG
Tx laser ablation, ureterostomy, uterocystostomy, Tx 2ndary infection
TX
Increase bladder contration - PSNS
Reduce bladder contraction - X-PSNS, SmM relaxants
Increase urethral tone - aagonist
Decrease urethral tone - Xaagonist, SkM relaxants
URINARY OBSTRUCTION
Significance of crystalluria
PG of stone formation
UROLITHIASIS CSx DGx DDx - KNOW MICROSCOPIC & GROSS APPEARANCE !! * Struvite * Calcium oxalate * Ammonium urate * Cystine
Treatment - To reduce recurrence risk
- Increase water intake, urination -> low USG
- Tx UTI > 3weeks
Struvite - F, urease producing bact, alkaline urine
Tx ABs, diet (acidic, low USG)
CaO - M, genetic / hyperCa, acidic urine
Tx surg, diet (low CaO, alkaline, low USG)
Urate - M, dalmations / liver Dz, acidic urine
Tx allopurinol, diet (alkaline, low USG), Tx liver dz
Cystine - M, acidic urine
Tx Penicillamine, diet (alkaline, low USG)
MONITOR UX, RGX
Cats DDx * Uroliths struvite>CaO * Plugs struvite Tx control urine pH min building block of stone (low P,Mg for struvite ; CaO for CaO) increase water intake -> decrease USG
CHRONIC KIDNEY DISEASE CSx cf AKI !!!! DDx DGX TX
DGx
- SDMA !!! = GFR
Tx
- NUTRITION
- ad lib water
- Hypertension -measure BP - Tx ACEi, CCB
- Proteinuria - measure UPC - Tx ACEi, angiotensin rct blocker (telmisartan)
- Anaemia - EPO + iron dextran
- Renal 2ndary hyperPTH - calcitriol
DIABETES MELLITUS IN CATS CSx AETx DGx Tx
CSx
- FAT OLD CATS
- PUPD + PP + WEIGHT LOSS
Aetx - persistent hyperglycaemia dt defective insulin type II (b-cell dysfunction or insulin resistance) >> type i (inadq production)
DGx CBC- stress Biochem- hyperglycaemia, hypercholesterolaemia, ALT & ALP (HL, Cholestatic hepatopathy), metabolic acidosis Ux - glucosuria, UTI, ketonuria FRUCTOSAMINE RG/US - enlarged liver
Tx
Insulin / glargin
Diet - low carbs, high protein
Mx BG, fructosamine, UA
PROTEINURIA
Significance?
UPC - Values & consideration?
DDx
Glomerulopathies
- when to suspect?
- Aetx?
- DGx
- Tx
What is nephrotic syndrome
Significant
- early indx of renal dz
- likely to develop azotaemia & uraemic crisis if x treated
Suspect when persistent proteinuria, hypoproteinaemia, FAT AND HYPERTENSIVE
Tx
- IVFT
- Tx underlying Dz
- Correct BP & proteinuria -> ACEi (benezapril), CCB (amlodipine), ARB (telmisartan)
- Correct azotaemia
- Anticoag (aspirin / clopidogrel)
- Diet - low protein + o3 FA
- Drain / furesemide for ascites
NS = hypoalb, fluid accum (ascites), hypercholesterolmaeia, proteinuria = SEVERE DISEASE
DM
CSx
DGx
Tx
HyperAdr
CSx
DGx
DM
CSx
OLD FAT
PUPD PP, WT LOSS, CATARACT
DGx - persistent hyperglycaemia & glucosuria
= same as DM in cats
Tx * Insulin * Diet * Exercise * Tx concurrent infection Mx BG
HyperAdr
CSx
PUPD POT BELLY SKIN CHANGES
DGx CBC - stress Biochem - increase ALP/ALT, hypercholesterol & glycaemia UA - USG <1.008 RG/UA - hepatomegaly, adrenal/pituitary UCCR ACTH stim test LDDST - rebound = PDH - persistent = PDH/AT Endogenous ACTH - high = PDH ; low = AT
Tx
PDH = trilostane, mitotane, hypophysectomy
AT = trilostane, mitotane, adrenalectomy
