Endocrine Flashcards
1
Q
describe the anatomy of the thyroid gland
A
paired
bilobed
may or may not be joined by an isthmus
2
Q
where is the thyroid gland typically located?
A
caudal to the larynx
ventrolateral to the trachea
3
Q
which of the thyroid glands is more cranial?
A
right
4
Q
at the level of what tracheal rings is the thyroid gland located?
A
5th - 8th
5
Q
what structures are found surrounding the thyroid glands that are of surgical significance?
A
neurological structures
highly vascular
6
Q
is thyroid tissue found only within the thyroid glands themselves?
A
no - ectopic tissue seen
7
Q
where is ectopic thyroid tissue located?
A
midline from the tongue to the abdomen
8
Q
what structure does the oesophagus sit in contact with?
A
left thyroid gland
9
Q
what are functional thyroid conditions?
A
those where thyroid hormones are produced
10
Q
what size are benign thyroid masses often in dogs?
A
small and rarely diagnosed
11
Q
are benign thyroid masses in dogs functional or non-functional?
A
non-functional
12
Q
are benign thyroid masses often seen in cats functional or non-functional?
A
functional and cause hyperthyroidism
13
Q
what are the causes of 95% of all feline thyroid masses?
A
benign adenoma or adenomatous hyperplasia
14
Q
in what species are malignant thyroid masses more common?
A
dogs
15
Q
A
16
Q
what are the common benign masses seen in the thyroid?
A
adenoma
adenomatous hyperplasia
17
Q
what types of malignant neoplasia are seen in the thyroid?
A
carcinoma
adenocarcinoma
18
Q
how many hyperthyroid cats have functional malignant tumors?
A
<5%
19
Q
before thyroidectomy what are the key considerations for patients with a functional mass?
A
ASA grade
medical stabilisation as best as possible
likely complications discussed as a team and with owner
20
Q
what are the main systemic effects of hyperthyroidism?
A
BCS/MCS
presence of metastasis
CVS
renal
ocular
21
Q
what are the CVS effects of hyperthyroidism?
A
tachycardia
hypertension
22
Q
what are the renal effects of hyperthyroidism?
A
pre-renal azotemia due to hypertension
23
Q
what are the ocular signs of hyperthyroidism?
A
retinal detachment seen secondary to hypertension
24
Q
what comorbidities are often seen in hyperthyroid patients?
A
CVS
renal
increased ASA grade
cachexia
arthritis
25
what has a major impact on thyroidectomy anaesthetic and outcome if a patient has a functional mass?
success of pre-op medical management
26
how can HR be decreased before thyroidectomy in patients with a functional mass?
antithyroid meds
27
how can hypertension be managed before thyroidectomy if patient is hyperthyroid?
atenolol
28
what is involved in stabilisation of a patient with a functional mass before thyroidectomy?
decrease HR
treat hypertension
support renal function
increase body weight
29
what may affect ASA grade of thyroidectomy patients with a non-functional mass?
BCS
metastasis
co-morbidities
30
what effect may non-functional thyroid masses have on BCS?
PNS/cancer may be having an impact
31
is medical stabilisation of patients with non-functional masses required pre-op?
no as non-functional
32
how can a thyroid mass be made more or less difficult to remove?
easier - discrete/mobile
harder - fixed, inflitrative
33
what will post op management of the non-functional thyroid mass patient involve?
depends on surgery (uni or bilateral)
discuss with vet
34
what clip is required for thyroidectomy?
level of the jaw to the thoracic inlet
out to jugular groove
35
what position should patients be in for thyroidectomy?
dorsal recumbency
neck kept straight
sandbag under neck to elevate
36
what must be considered when choosing to remove the thyroid gland?
is the parathyroid gland (s) going to be removed too
37
what can be done with the parathyroid gland if it is removed during thyroidectomy?
can be re-implanted into the surgical site to allow for neovascularisation
38
what are the risks associated with re-implanting parathyroid tissue?
tumour may be seeded
39
what is the advantage of modified extracapsular technique for thyroidectomy?
reduced risk of recurrence
40
what is the disadvantage of modified extracapsular technique for thyroidectomy?
increased risk of post op hypocalcaemia
41
what are the complications of thyroidectomy which are unrelated to surgical technique?
GA
unmasking of CRF
hypothyroidism
42
why may CRF be umasked following thryoidectomy?
hypertension caused by hyperthyroid resolves and as a result GFR is no longer adequate
43
what are the complications of thyroidectomy that are related to surgical technique and skill?
haemorrhage
seroma
laryngeal paralysis
horners
hypocalcaemia
recurrence
44
what type of thyroid mass often leads to haemorrhage during surgery?
canine invasive masses
45
how can laryngeal paralysis be caused during thyroidectomy?
damage to recurrent laryngeal nerve
46
how does horners syndroms occur following thyroidectomy?
damage to the sympathetic trunk
47
what are the signs of horners syndrome?
anisocoria
nictating membrane visible
48
how is hypocalcaemia caused following thyroidectomy?
deliberate or inadvertent damage to normal parathyroid tissue resulting in iatrogenic hypoparathyroidism
49
what can cause iatrogenic hypoparathyroidism?
arterial spasm
damage to tissue (deliberate or inadvertent)
50
what may be given pre and post operatively to support patients undergoing thyroidectomy who are at risk of hypoparathyroidism?
pre-op oral vitamin D
post op oral calcium
51
what does recurrence of thyroid tissue following thyroidectomy depend on?
presence of ectopic tissue
technique used
malignancy
52
where is ectopic thyroid tissue mostly seen?
chest
53
what are the most common thyroidectomy complications?
hypocalcaemia
recurrence
54
what is the parathyroid made up of?
2 pairs of parathyroid glands
55
what are the 4 parathyroid glands?
left extracapsular
right extracapsular
left intracapsular
right intracapsular
56
what parathyroid glands make up the cranial portion of the gland?
left and right extracapsular
57
what parathyroid glands make up the caudal portion of the gland?
left intracapsular
right intracapsular
58
what is secreted by the parathyroid gland?
parathyroid hormone
59
what is the role of parathyroid hormone?
increases blood calcium levels
60
in what animals is primary hyperparathyroidism seen?
dogs but uncommon
61
how can primary hyperparathyroidism be managed medically?
ethanol injection
heat ablation
62
how can primary hyperparathyroidism be managed surgically?
parathyroidectomy
63
what must be monitored for in the post op period following parathyroidectomy?
hypocalcaemia
64
why is hypocalcamia a risk following parathyroidectomy even if only one gland is removed?
hypercalcaemia seen prior
other glands atrophy due to over production by one - need time to recover and function normally
65
what is the prognosis for primary hyperparathyroidism?
95% if benign, functional adenoma
66
what may affect ASA grade of patients undergoing parathyroidectomy?
systemic effects of hyperparthyroidism
comorbidities unrelated to hyperparathyroidism
67
what organ system is affected by hypercalcaemia?
kidneys
68
how may hyperparathyroid patients be medically stabilised?
diuresis with furosomide
IVFT to dilute calcium
renal support
69
how should patients be clipped for parathyroidectomy?
jaw to thoracic inlet
out to jugular groove on either side - as for thyroidectomy
70
what position should patients be in for parathyroidectomy?
dorsal recumbancy
sandbag under neck to keep anatomy level
71
what is likely removed alongside caudal (intracapsular) parathyroid?
associated thyroid gland
72
what are the complications of parathyroidectomy which are unrelated to surgical technique?
GA
hypothyroidism
73
what are the complications of parathyroidectomy that are related to surgical technique?
haemorrhage
seroma
laryngeal paralysis
horners
hypoparathyroidism
74
what does risk of seroma following surgery relate to?
size of mass
75
why is hypoparathyroidism likely to be more severe in patients following parathyroidectomy?
3 remaining parathyroids function is suppressed by functional mass so there is a delay in the recovery of their function and hypocalcaemia can occur
76
what is involved in post op care for parathyroidectomy patients?
IVFT
analgesia
monitor for complications
77
what analgesia should be avoided following parathyroidectomy?
NSAIDs until kidney function known
78
what procedures pose highest risk of iatrogenic hypoparathyroidism?
bilateral thyroidectomy
unilateral parathyroidectomy
79
what is the risk of iatrogenic thyroid/parathyroid damage in patients undergoing unilateral thyroidectomy?
low risk hypocalcaemia
low risk hypothyroid
80
what is the risk of iatrogenic thyroid/parathyroid damage in patients undergoing bilateral thyroidectomy?
higher than unilateral risk of hypocalcaemia
hypothryoid due to complete thyroid resection
81
what is the risk of iatrogenic thyroid/parathyroid damage in patients undergoing unilateral parathyroidectomy?
highest risk of hypocalcaemia
low risk hypothyroid
82
what will influence risk of hypocalcaemia post thyroid/parathyroid surgery?
is function surpressed, normal or raised pre op
83
when should iatrogenic hypoparathyroidism be treated?
only if clinical signs seen
84
what are the initial signs of hypoparathyroidism?
inappetance
weakness/lethargy
ptyalism
pawing at face
85
what are the more advanced signs of iatrogenic hypoparathyroidism?
tremors
muscle fasiculation
tetany
seizures
coma
death
86
when are clinical signs of iatrogenic hypoparathyroidism seen following surgery?
within 2-3 days
87
how can post parathyroidectomy hypocalcaemia be avoided?
vitamin D administered 24-48 hours prior to surgery
88
when should vitamin D be administered to parathyroidectomy patients?
24-48 hours pre op
89
what is the role of vitamin D pre-op for parathyroidectomy patients?
increases calcium absorption from the GI tract
reduces calcium losses through the kidneys
90
what calcium value must be measured following parathyroidectomy?
ionised calcium as is unbound and so usable by the body
91
why should you wait for clinical signs rather than just blood results to treat hypocalcaemia?
calcium needs to drop below normal to encourage the other parathyroid glands to work
exogenous may suppress action even further
92
when should calcium levels be checked post op?
definitely 2-3 days following surgery
93
what are the treatment options for hypocalcaemia?
vitamin D
oral calcium
IV calcium
94
what is the purpose of giving oral vitamin D before parathyroid surgery?
prepares the body for a drop in calcium so can stimulate PT glands to work
95
how long does oral calcium therapy take to work?
1-3 days
96
how is calcium usually given?
oral - sent home with patient
97
what is found within oral calcium?
elemental calcium
98
in what form is calcium given IV?
10% calcium gluconate
99
how should IV calcium be given?
over 10-20 mins
100
when is IV calcium gluconate given?
if clinical signs
if levels of calcium VERY low
101
what monitoring is needed when patients are receiving calcium IV?
ECG
102
what may be seen on ECG when giving calcium gluconate?
arrhythmia
bradycardia
103
what types of IV fluids should be avoided if calcium gluconate has been given?
bicarbonate
lactate
phosphate
104
why should bicarbonate, lactate or phosphate containing fluids be avoided in patients receiving calcium gluconate?
precipitate calcium
105
should calcium gluconate be given IV?
no recommended - skin may slough
106
is pancreatic anatomy the same in cats and dogs?
cats sometimes have a second accessory duct
107
where is the right limb of the pancreas located?
next to duodenum
108
where is the left limb of the pancreas located?
next to spleen
109
where does the body of the pancreas sit?
close to pancreatic ducts and common bile duct
110
what are the main pancreatic surgical conditions?
insulinoma
exocrine pancreatic neoplasia
pancreatic abscessation
pancreatic cysts
111
what is the main endocrine surgical condition of the pancreas?
insulinoma
112
what type of tumour is an insulinoma?
malignant carcinoma
113
what are the main indications of insulinoma?
hypoglycaemia (<2 mmol/L) in a standing dog
lethargy
tremors
seizures
collapse
peripheral neuropathy
114
what level of hypoglycaemia is associated with insulinoma?
<2 mmol/L
115
how is insulinoma diagnosed?
bloods for insulin / glucose ratio
imaging
116
how can patients with insulinomas cope with such low blood glucose levels?
adjustment over time as decreases slowly
117
how should insulinoma patients be managed pre-op?
feed diabetic food
feed every 4-6 hours
gentle and regular exercise
118
how often should insulinoma patients be fed pre-op?
every 4-6 hours
119
how should hypoglycaemic crisis due to insulinoma be managed?
oral glucose where possible
120
what is the issue with using IV glucose for insulinoma patients in hypoglycaemic crisis?
can cause mass to produce even more insulin as placed directly into the blood vessel
121
how is an insulinoma hypoglycaemic crisis managed?
oral glucose
one off IV 50% dextrose
glucose infusion
122
how is insulinoma treated?
partial pancreatectomy
123
what glucose supplementation is required during partial pancreatectomy for insulinoma?
5% dextrose infusion
124
what is essential when handling the pancreas?
gentle to reduce pancreatitis risk
125
where can insulinomas metastasise?
liver
126
what is the impact of micrometastasis from insulinoma?
patient will continue to be hypoglycaemic
127
how should post-op insulinoma patients be fed?
as pre-op
Q4-6h
diabetic food
128
how should post-op insulinoma patients be exercised?
as pre op initially
129
what drugs may insulinoma patients be on post op?
IVFT
analgesia
steroids
chemo
130
what is the role of steroids following insulinoma removal?
increase glucose levels
131
why may insulinoma patients need chemo?
for residual tumor and any mets
132
what are the complications seen with insulinoma?
persistent hypoglycaemia
transient hyperglycaemia
pancreatitis
DM
133
what intervention gives better outcome for insulinoma patients?
surgery better prognosis than medical management
134
where are adrenal glands located?
close to kidneys, vena cava and renal vessels
135
what are the 2 segments of the adrenal gland?
outer cortex
inner medulla
136
where is the cortex of the adrenal gland located?
outer portion of the gland
137
where is the medulla of the adrenal gland located?
inside of the cortex
138
what are the typical masses found in the adrenal cortex?
adenoma
adenocarcinoma
139
what hormones are affected by cortical masses?
androgens
mineralocorticoids
glucocorticoids
140
what medullary adrenal masses are seen?
phaeochromocytoma
141
what hormones are affected by medullary masses?
catecholamines (e.g. adrenaline)
142
what are the main adrenal gland surgical conditions?
primary adrenal mass
secondary adrenal enlargement due to pituitary mass
143
how is secondary adrenal enlargement treated?
need hypophyscetomy as enlargement is due to pituitary dependent hyperadrenocorticism
144
what are the main signs of adrenal gland disease?
often none
functional signs
haemoabdomen
145
what is essential before surgery if the patient has a functional adrenal mass?
patient must be stabilised pre-operatively
146
what is seen if overproduction is coming from the adrenal cortex?
cushings
Conns
masculinising syndrome
147
what is over produced by the adrenal cortex that leads to cushings?
glucocorticoids (e.g. cortisol)
148
what is over produced by the adrenal cortex that leads to conns syndrome?
mineralocorticoids (e.g. aldosterone)
149
what is over produced by the adrenal medulla if there is a functional mass?
catecholamines (e.g. adrenaline)
150
what can overproduction of catecholamines lead to?
intermittent hypertension
151
why do some adrenal masses present with haemoabdomen?
some will spontaneously bleed due to location near renal vessels and cranial vena cava
152
how are adrenal masses diagnosed?
CT
153
what are benign adrenal enlargements known as?
adenomas
154
what type of tumor are most malignant adrenal masses?
adenocarcinoma
155
are phaeochromocytomas benign or malignant?
can be either
156
what is commonly seen alongside malignant adrenal tumors?
tumor thrombus within the vena cava
157
what should happen to all adrenal mass patients before surgery?
stabilisation
158
what affects ASA status of adrenal mass patients?
systemic effects of mass
co-morbidities unrelated to mass
159
what systemic effects can Conns syndrome cause?
hypokalaemia
160
what is the impact of cushings on surgery likelihood?
endogenous steroids make patient poor surgical candidate
161
how can adrenal mass patients be medically stabilised if they are hypokalaemic?
K+ supplementation
162
how can adrenal mass patients be medically stabilised if they have cushings?
Trilostane to stabilise
163
how can adrenal mass patients be medically stabilised if they have phaeochromocytoma?
alpha adrenergic blocker 2-3 weeks pre op to stabilise BP and HR
164
how does presence of unilateral or bilateral adrenal masses affect prognosis?
bilateral likely palliation and euthanasia
165
what is a significant risk with adrenalectomy?
haemorrhage
thromboembolism
very challenging
166
what monitoring is needed for patients undergoing adrenalectomy?
ECG for arrythmia
BP
electrolytes
167
what are the main intraoperative complications seen with adrenalectomy?
tumor rupture
haemorrhage
tachycardia
arrhythmias
hyper/hypotension
168
what may need to be supplemented during adrenalectomy surgery?
gluco and mineralocorticoids
dexmethasone
electrolytes
169
what are the main post op complications seen with adrenalectomy?
electrolyte abnormalities
hypertension
hypotension
adrenal insufficiency
delayed healing
pulmonary thromboembolism
SIRS/sepsis
170
what is the most common endocrine condition in cats?
hyperthyroidism
171
what causes hyperthyroidism?
benign tumor which secretes excess thyroid hormone - either unilateral or bilateral
172
what diseases are often seen along side hyperthyroidism?
HCM
CKD
hypertension
173
what are the signs of hyperthyroidism?
polyphagia
weight loss
palpable goitre
tachycardia
174
how is hyperthyroidism diagnosed?
measure blood T4
175
what are the main treatment methods for hyperthyroidism?
antithyroid drugs
iodine restricted diet
thyroidectomy
radioactive iodine
176
what hyperthyroid management should be tried first?
medical management
also serves to stabilise before surgery
177
what organ function must be tested once patients are euthyroid on medical management?
kidneys
178
what is the role of antithyroid drugs?
block synthesis of thyroid hormone
179
why may dose increases of antithyroid drugs be required?
if adenoma continues to grow then more T4 is produced and more drug required
180
what drugs are used for hyperthyroid management?
methimazole
carbimazole
181
how long after starting antithyroid medication should patients be euthyroid?
2-3 weeks
182
when should T4 be checked?
3 weeks after treatment starts or any dose change
183
what are the common side effects of antithyroid drugs?
vomiting
anorexia
lethargy
usually minor and transient
184
what are the rare side effects of antithyroid drugs?
persistent GI signs
bone marrow suppression
facial pruritis
hepatopathy
185
what should be done if rare antithyroid drug side effects are seen?
stop treatment
186
what are the main nursing considerations for hyperthyroid patients?
careful handling
often fractious
consider concurrent disease (e.g. OA/cardiac)
look for signs in senior cat clinics
monitor treatment efficacy
187
how often should hyperthyroid patients be rechecked?
3-12 months
188
what is involved in hyperthyroid treatment monitoring?
look for recurrence
concurrent disease
bloods
urine
BP
189
what is found in hyperthyroid diets?
iodine restricted - must be sole diet
190
why is an iodine restricted diet of benefit with hyperthyroid patients?
iodine required for thyroid hormone synthesis
191
if on dietary management for hyperthyroidism how quickly can patients become euthyroid?
within 3 weeks
192
when is dietary management of hypothyroid cats not suitable?
if severe hyperthyroidism
if patient has other dietary requirements
if there are euthyroid cats in the house
193
what causes canine hypothyroidism?
destruction of thyroid tissue
194
in what animals is hypothyroidism commonly seen?
middle aged dogs
doberman
boxer
malamute
195
what are the signs of hypothyroidism?
weight gain
lethargy
bradycardia
endocrine alopecia
myxoedema
coma
196
how is hypothyroidism diagnosed?
measure T4 and TSH
197
how is hypothyroidism treated?
oral synthetic T4 - sodium levothyroxine
198
when can hypothyroidism be picked up?
weight management clinics
199
why can it take time to find ideal sodium levothyroxine dose?
bioavailability and absorption vary between patients
200
what affects bioavailability of sodium levothyroxine?
food - consistent dosing crucial
200
what should be measured when monitoring hypothyroid patients?
T4 only
TSH not needed
201
when should T4 be measured in relation to tablet time?
3h post pill for peak conc
when due for lowest
202
when should T4 bloods be done after starting sodium levothyroxine treatment?
6-8 weeks
203
when should T4 bloods be done after altering sodium levothyroxine dose?
2-4 weeks
204
long term how often should T4 be measured in hypothyroid patients?
every 6-12 months
205
what is calcium required for?
muscle contraction
nerve conduction
206
where is calcium stored?
in bones with phosphate
207
what are the 3 forms of calcium found in the blood?
ionised
complexed
protein bound
208
what is the biologically active form of calcium?
ionised
209
what is usually measured on biochemistry when checking calcium?
total calcium - combination of all 3 forms within the blood
210
what is the role of parathyroid hormone?
increases calcium resorption in kidneys and bone
increases calcitriol formation
211
what is calcitriol?
vitamin D
212
where is calcitriol / vitamin D released from?
kidney
213
what is the role of calcitriol / vitamin D?
increases calcium reabsorption in kidneys
increases calcium absorption in the gut
214
where is calcitonin released from?
thyroid gland
215
what is the role of calcitonin?
inhibits osteoclasts and so reduces calcium release from bone
216
what hormone is released in response to hypocalcaemia?
PTH release
217
what is caused by PTH release?
increased calcium reabsorption in kidneys
calcium and phosphate mobilised from bone
activation of calcitriol
218
what is triggered by hypercalcaemia under normal circumstances?
PTH blocked from release
calcitonin released
219
what is the role of calcitonin?
increased calcium storage in bone
increased calcium excretion in kidneys
220
what are the main parathyroid diseases?
primary hyperparathyroidism
secondary hyperparathyroidism
hypoparathyroidism
221
what occurs during primary hyperparathyroidism?
one or more parathyroid glands become hyperfunctional and secrete excess PTH
222
what breed has a genetic predisposition to primary hyperparathyroidism?
Keeshonds
223
is primary hyperparathyroidism seen in cats?
very rare
224
what are the main clinical signs of primary hyperparathyroidism?
neurological
GI
urinary
CVS
225
what are the neurological signs of primary hyperparathyroidism?
weakness
lethargy
exercise intolerance
trembling
226
what are the GI signs of primary hyperparathyroidism?
reduced appetite
nausea
vomiting
constipation
227
what are the urinary signs of primary hyperparathyroidism?
PUPD
urolithiosis
UTI
228
what are the CVS signs of primary hyperparathyroidism?
hypertension
arrhythmias
229
how is primary hyperparathyroidism diagnosed?
often incidental elevated calcium
ionised calcium then checked
if elevated check PTH
230
what must be done when collecting calcium samples?
check with the lab as special sampling and storage requirements
231
what is the treatment used for primary hyperparathyroidism?
surgery
US glandular ablation
232
what is used to perform US guided parathyroid gland ablation?
heat
ethanol injection
233
what are the issues associated with US guided glandular ablation of the parathyroid gland?
damage to recurrent laryngeal nerve possible
234
what are the signs of recurrent laryngeal nerve damage?
bark change
coughing
laryngeal dysfunction
235
what is the only indicator of true hypercalcaemia?
elevated ionised calcium
236
what is the cause of secondary hyperparathyroidism?
chronically low calcium leading to elevated PTH
237
what can cause secondary hyperparathyroidism?
renal failure
poor nutrition due to diet deficient in vitamin D
238
what is the effect of high PTH seen with secondary hyperparathyroidism?
causes calcium to be mobilised from bone
239
how is secondary hyperparathyroidism treated?
balanced diet
240
what is occurring during hypoparathyroidism?
low or absent PTH despite low calcium
241
what are the causes of hypoparathyroidism?
iatrogenic through surgery
trauma
idiopathic
immune mediated
242
what are the clinical signs of hypoparathyroidism?
seizures
muscle fasiculations
twitching
cramping
weakness
ataxia
anorexia
vomiting
facial rubbing
243
how is hypoparathyroidism diagnosed?
measure ionised calcium
phosphorus
PTH
244
how should severe hypoparathyroidism be treated?
IV calcium with bolus or CRI
245
how should mild hypoparathyroidism be treated?
oral calcium
calcitriol (vitamin D)
246
what can be caused by IV calcium administration?
arrhythmia
arrest
bradycardia even if given slowly
247
what should be done if extravasation of calcium gluconate occurs?
infiltrate tissue with saline
wound management
248
what causes hyperadrenocorticism?
excessive production of cortisol from adrenal gland which is either pituitary, adrenal dependent or iatrogenic
249
what is iatrogenic hyperadrenocoticism caused by?
administration of glucocorticoids
250
what are the clinical signs of hyperadrenocorticism?
PUPD
lethargy
endocrine alopecia
pot-belly
thin skin
poor wound healing
panting
polyphagia
calcinosis cutis
251
how is hyperadrenocorticism diagnosed?
no single test accurate
ACTH stim
LDDS (low dose dexmethasone supression test)
252
how is hyperadrenocorticism treated?
trilostane
surgery
253
what is the action of trilostane?
blockage of synthesis of cortisol
254
what types of hyperadrenocorticism is trilostane suitable for?
PDH
ADH
255
how are patients on medical management for hyperadrenocorticism monitored?
clinical signs
ACTH stim
pre-pill cortisol
256
what are the side effects of trilostane?
GI signs
iatrogenic hypoadrenocorticism
sudden death
257
when should blood testing be performed after starting or changing doses of trilostane?
biochem and ACTH stim 10 days after
258
how often is blood testing needed once patients on trilostane have been tested at 10 days?
4 weeks
12 weeks
then every 3 months
259
when is it recommended trilostane be given?
in the morning
260
when should ACTH stim be performed after admin of medication?
4-6 hours
261
when is pre - pil cortisol measured?
when dose is due - if in the am don't give in the morning and have earliest available appointment
262
what can happen if patients are given trilostane overdose?
iatrogenic hypoadrenocorticism - can lead to addisonian crisis
263
what are the signs of Addisonian crisis?
hypotension
weakness
bradycardia
severe dehydration
hypovolaemia
collapse
264
what is hypoadrenocorticism caused by?
lack of adrenal hormones (glucocorticoids and mineralocorticoids)
265
what animals is hypoadrenocorticism commonly seen in?
young to middle aged
female
rare in cats
266
what are the signs of hypoadrenocorticism?
vague waxing and waning illness
V
D
weight loss
267
how is hypoadrenocorticism diagnosed?
electrolyte abnormalities
ACTH stim
268
how is addisonian crisis treated?
IVFT resuscitation
correct electrolytes (glucose and insulin if hyperkalaemic)
start ACTH stim test ASAP
269
how is hypoadrenocorticism treated in the long term?
glucocorticoid replacement
mineralocorticoid replacement
270
what drug is used to replace glucocorticoids?
prednisolone
271
what drug is used to replace mineralocorticoids?
desoxycortone pivalate - Zycortal
272
how is zycortal administered?
every 4 weeks injection
273
is pancreatitis an endocrine disease?
no - exocrine
274
what causes pancreatitis?
idiopathic
dietary indiscretion
trauma
surgery (hypoperfusion under GA)
275
what is actually happening in the pancreas during pancreatitis?
pancreatic enzymes prematurely activated - pancreas is digested
276
what are the signs of mild pancreatitis?
anorexia
vomiting
abdominal pain
dehydration
lethargy
277
what are the signs of severe pancreatitis?
generalised inflammation
DIC
renal failure
multiorgan failure
death
278
how is pancreatitis diagnosed?
blood tests not overly reliable
abdominal US
279
how is pancreatitis treated?
IVFT
analgesia
anti-emetics
feeding ASAP - may need tube
appropriate diet
280
what diet is appropriate for pancreatitis?
palatable
low fat
highly digestible
281
what is the long term nutrition aim for pancreatitis patients?
low fat
282
what causes diabetes mellitus?
failure of the pancreas to produce insulin
283
what animals is DM more common in?
middle aged to older animals
burmese cats
284
what increases the risk of DM?
obesity
285
what are the clinical signs of DM?
PUPD
polyphagia
weight loss
cataracts
peripheral neuropathy (cats)
286
what is a severe sign of DM?
DKA
287
what are the signs of DKA?
vomiting
collapse
dehydration
288
what indicates DM on tests?
persistent hyperglycaemia
glucosuria
fructosamine elevated
289
how is DM commonly treated in cats?
insulin injections
diet
oral liquid - Senvelgo
290
what insulin is used for cats?
Pro-zinc
291
what diet is best for diabetic cats?
low carb
high protein
calorie controlled
wet food
grazing ok
292
why is wet food best for diabetic cats?
improved glycaemic control
293
what is the role of Senvelgo (liquid) in DM management?
blocks 90% of glucose reabsorption in the kidney so excess is excreted
still able to reabsorb some to prevent hypoglycaemia
294
why is it important to monitor cats for hypoglycaemia?
cats may go into diabetic remission but will often become diabetic again in later life
295
how are dogs with DM treated?
caninsulin injections
diet
exercise
296
what is important about diet for dogs with DM?
high fibre
high carb
consistent schedule
calorie controlled
297
how is insulin administered?
SC SID/BID depending on patient and insuline
298
how often should patients with DM be fed?
BID
299
when should insulin be given if giving BID?
feed every 12 hours and give insulin at the same time
300
when should insulin be given if giving SID?
feed in am before insulin and then 6 hours later at nadir
301
when should insulin be injected in relation to feeding?
after or during meal
302
what is essential about food type and quantity if patients are on insulin?
type and quantity must stay the same at every meal
303
how can glucose levels be monitored?
BG curve
freestyle libre
304
how is a BG curve run?
BG measured every 2 hours
owner supplies food and insulin
305
how does freestyle libre glucose monitoring work?
continuous
routine as normal
306
how long does it take following insulin dose change for blood glucose levels to stabilise?
~7 days
307
where is it recommended first insulin dose is given?
whilst hospitalised to monitor for hypoglycaemia
308
what must owners of patients with DM be aware of?
signs of hypoglycaemia
and what to do if they suspect their pet is hypoglycaemic
309
what are the signs of hypoglycaemia?
weakness
ataxia
depression
altered behaviour
muscle twitching
seizures
310
how should owners manage hypoglycaemic patients if conscious?
offer food
if reluctant to eat put honey on gums
contact vet
311
how should hypoglycaemic patients managed by owners if unconscious?
rub honey onto gums
phone vet
312
how should hypoglycaemic patients managed by owners if seizuring?
phone vet
313
what should be done if owners are unsure if their pet is hypoglycaemic?
feed as far safer to elevate blood sugar than risk hypoglycaemia
314
what syringes must be used to give insulin?
correct pet specific ones
315
how should insulin be handled?
follow manufacturers instructions
often in the fridge
mix gently before administering
316
where should BG samples be taken from each time?
same location as capillary blood will have different glucose levels to venous
317
what is key when managing DM patients?
consistency
keep diet, exercise and routine the same
318
when is extra care needed for DM patients?
if undergoing GA
319
