Endocrine Flashcards
describe the anatomy of the thyroid gland
paired
bilobed
may or may not be joined by an isthmus
where is the thyroid gland typically located?
caudal to the larynx
ventrolateral to the trachea
which of the thyroid glands is more cranial?
right
at the level of what tracheal rings is the thyroid gland located?
5th - 8th
what structures are found surrounding the thyroid glands that are of surgical significance?
neurological structures
highly vascular
is thyroid tissue found only within the thyroid glands themselves?
no - ectopic tissue seen
where is ectopic thyroid tissue located?
midline from the tongue to the abdomen
what structure does the oesophagus sit in contact with?
left thyroid gland
what are functional thyroid conditions?
those where thyroid hormones are produced
what size are benign thyroid masses often in dogs?
small and rarely diagnosed
are benign thyroid masses in dogs functional or non-functional?
non-functional
are benign thyroid masses often seen in cats functional or non-functional?
functional and cause hyperthyroidism
what are the causes of 95% of all feline thyroid masses?
benign adenoma or adenomatous hyperplasia
in what species are malignant thyroid masses more common?
dogs
what are the common benign masses seen in the thyroid?
adenoma
adenomatous hyperplasia
what types of malignant neoplasia are seen in the thyroid?
carcinoma
adenocarcinoma
how many hyperthyroid cats have functional malignant tumors?
<5%
before thyroidectomy what are the key considerations for patients with a functional mass?
ASA grade
medical stabilisation as best as possible
likely complications discussed as a team and with owner
what are the main systemic effects of hyperthyroidism?
BCS/MCS
presence of metastasis
CVS
renal
ocular
what are the CVS effects of hyperthyroidism?
tachycardia
hypertension
what are the renal effects of hyperthyroidism?
pre-renal azotemia due to hypertension
what are the ocular signs of hyperthyroidism?
retinal detachment seen secondary to hypertension
what comorbidities are often seen in hyperthyroid patients?
CVS
renal
increased ASA grade
cachexia
arthritis
what has a major impact on thyroidectomy anaesthetic and outcome if a patient has a functional mass?
success of pre-op medical management
how can HR be decreased before thyroidectomy in patients with a functional mass?
antithyroid meds
how can hypertension be managed before thyroidectomy if patient is hyperthyroid?
atenolol
what is involved in stabilisation of a patient with a functional mass before thyroidectomy?
decrease HR
treat hypertension
support renal function
increase body weight
what may affect ASA grade of thyroidectomy patients with a non-functional mass?
BCS
metastasis
co-morbidities
what effect may non-functional thyroid masses have on BCS?
PNS/cancer may be having an impact
is medical stabilisation of patients with non-functional masses required pre-op?
no as non-functional
how can a thyroid mass be made more or less difficult to remove?
easier - discrete/mobile
harder - fixed, inflitrative
what will post op management of the non-functional thyroid mass patient involve?
depends on surgery (uni or bilateral)
discuss with vet
what clip is required for thyroidectomy?
level of the jaw to the thoracic inlet
out to jugular groove
what position should patients be in for thyroidectomy?
dorsal recumbency
neck kept straight
sandbag under neck to elevate
what must be considered when choosing to remove the thyroid gland?
is the parathyroid gland (s) going to be removed too
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
what are the risks associated with re-implanting parathyroid tissue?
tumour may be seeded
what is the advantage of modified extracapsular technique for thyroidectomy?
reduced risk of recurrence
what is the disadvantage of modified extracapsular technique for thyroidectomy?
increased risk of post op hypocalcaemia
what are the complications of thyroidectomy which are unrelated to surgical technique?
GA
unmasking of CRF
hypothyroidism
why may CRF be umasked following thryoidectomy?
hypertension caused by hyperthyroid resolves and as a result GFR is no longer adequate
what are the complications of thyroidectomy that are related to surgical technique and skill?
haemorrhage
seroma
laryngeal paralysis
horners
hypocalcaemia
recurrence
what type of thyroid mass often leads to haemorrhage during surgery?
canine invasive masses
how can laryngeal paralysis be caused during thyroidectomy?
damage to recurrent laryngeal nerve
how does horners syndroms occur following thyroidectomy?
damage to the sympathetic trunk
what are the signs of horners syndrome?
anisocoria
nictating membrane visible
how is hypocalcaemia caused following thyroidectomy?
deliberate or inadvertent damage to normal parathyroid tissue resulting in iatrogenic hypoparathyroidism
what can cause iatrogenic hypoparathyroidism?
arterial spasm
damage to tissue (deliberate or inadvertent)
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
what does recurrence of thyroid tissue following thyroidectomy depend on?
presence of ectopic tissue
technique used
malignancy
where is ectopic thyroid tissue mostly seen?
chest
what are the most common thyroidectomy complications?
hypocalcaemia
recurrence
what is the parathyroid made up of?
2 pairs of parathyroid glands
what are the 4 parathyroid glands?
left extracapsular
right extracapsular
left intracapsular
right intracapsular
what parathyroid glands make up the cranial portion of the gland?
left and right extracapsular
what parathyroid glands make up the caudal portion of the gland?
left intracapsular
right intracapsular
what is secreted by the parathyroid gland?
parathyroid hormone
what is the role of parathyroid hormone?
increases blood calcium levels
in what animals is primary hyperparathyroidism seen?
dogs but uncommon
how can primary hyperparathyroidism be managed medically?
ethanol injection
heat ablation
how can primary hyperparathyroidism be managed surgically?
parathyroidectomy
what must be monitored for in the post op period following parathyroidectomy?
hypocalcaemia
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
what is the prognosis for primary hyperparathyroidism?
95% if benign, functional adenoma
what may affect ASA grade of patients undergoing parathyroidectomy?
systemic effects of hyperparthyroidism
comorbidities unrelated to hyperparathyroidism
what organ system is affected by hypercalcaemia?
kidneys
how may hyperparathyroid patients be medically stabilised?
diuresis with furosomide
IVFT to dilute calcium
renal support
how should patients be clipped for parathyroidectomy?
jaw to thoracic inlet
out to jugular groove on either side - as for thyroidectomy
what position should patients be in for parathyroidectomy?
dorsal recumbancy
sandbag under neck to keep anatomy level
what is likely removed alongside caudal (intracapsular) parathyroid?
associated thyroid gland
what are the complications of parathyroidectomy which are unrelated to surgical technique?
GA
hypothyroidism
what are the complications of parathyroidectomy that are related to surgical technique?
haemorrhage
seroma
laryngeal paralysis
horners
hypoparathyroidism
what does risk of seroma following surgery relate to?
size of mass
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
what is involved in post op care for parathyroidectomy patients?
IVFT
analgesia
monitor for complications
what analgesia should be avoided following parathyroidectomy?
NSAIDs until kidney function known
what procedures pose highest risk of iatrogenic hypoparathyroidism?
bilateral thyroidectomy
unilateral parathyroidectomy
what is the risk of iatrogenic thyroid/parathyroid damage in patients undergoing unilateral thyroidectomy?
low risk hypocalcaemia
low risk hypothyroid
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
what is the risk of iatrogenic thyroid/parathyroid damage in patients undergoing unilateral parathyroidectomy?
highest risk of hypocalcaemia
low risk hypothyroid
what will influence risk of hypocalcaemia post thyroid/parathyroid surgery?
is function surpressed, normal or raised pre op
when should iatrogenic hypoparathyroidism be treated?
only if clinical signs seen
what are the initial signs of hypoparathyroidism?
inappetance
weakness/lethargy
ptyalism
pawing at face
what are the more advanced signs of iatrogenic hypoparathyroidism?
tremors
muscle fasiculation
tetany
seizures
coma
death
when are clinical signs of iatrogenic hypoparathyroidism seen following surgery?
within 2-3 days
how can post parathyroidectomy hypocalcaemia be avoided?
vitamin D administered 24-48 hours prior to surgery
when should vitamin D be administered to parathyroidectomy patients?
24-48 hours pre op
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
what calcium value must be measured following parathyroidectomy?
ionised calcium as is unbound and so usable by the body
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
when should calcium levels be checked post op?
definitely 2-3 days following surgery
what are the treatment options for hypocalcaemia?
vitamin D
oral calcium
IV calcium
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
how long does oral calcium therapy take to work?
1-3 days
how is calcium usually given?
oral - sent home with patient
what is found within oral calcium?
elemental calcium
in what form is calcium given IV?
10% calcium gluconate
how should IV calcium be given?
over 10-20 mins
when is IV calcium gluconate given?
if clinical signs
if levels of calcium VERY low
what monitoring is needed when patients are receiving calcium IV?
ECG
what may be seen on ECG when giving calcium gluconate?
arrhythmia
bradycardia
what types of IV fluids should be avoided if calcium gluconate has been given?
bicarbonate
lactate
phosphate
why should bicarbonate, lactate or phosphate containing fluids be avoided in patients receiving calcium gluconate?
precipitate calcium
should calcium gluconate be given IV?
no recommended - skin may slough
is pancreatic anatomy the same in cats and dogs?
cats sometimes have a second accessory duct
where is the right limb of the pancreas located?
next to duodenum
where is the left limb of the pancreas located?
next to spleen
where does the body of the pancreas sit?
close to pancreatic ducts and common bile duct
what are the main pancreatic surgical conditions?
insulinoma
exocrine pancreatic neoplasia
pancreatic abscessation
pancreatic cysts
what is the main endocrine surgical condition of the pancreas?
insulinoma
what type of tumour is an insulinoma?
malignant carcinoma
what are the main indications of insulinoma?
hypoglycaemia (<2 mmol/L) in a standing dog
lethargy
tremors
seizures
collapse
peripheral neuropathy
what level of hypoglycaemia is associated with insulinoma?
<2 mmol/L
how is insulinoma diagnosed?
bloods for insulin / glucose ratio
imaging
how can patients with insulinomas cope with such low blood glucose levels?
adjustment over time as decreases slowly
how should insulinoma patients be managed pre-op?
feed diabetic food
feed every 4-6 hours
gentle and regular exercise
how often should insulinoma patients be fed pre-op?
every 4-6 hours
how should hypoglycaemic crisis due to insulinoma be managed?
oral glucose where possible
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
how is an insulinoma hypoglycaemic crisis managed?
oral glucose
one off IV 50% dextrose
glucose infusion
how is insulinoma treated?
partial pancreatectomy
what glucose supplementation is required during partial pancreatectomy for insulinoma?
5% dextrose infusion
what is essential when handling the pancreas?
gentle to reduce pancreatitis risk
where can insulinomas metastasise?
liver
what is the impact of micrometastasis from insulinoma?
patient will continue to be hypoglycaemic
how should post-op insulinoma patients be fed?
as pre-op
Q4-6h
diabetic food
how should post-op insulinoma patients be exercised?
as pre op initially
what drugs may insulinoma patients be on post op?
IVFT
analgesia
steroids
chemo
what is the role of steroids following insulinoma removal?
increase glucose levels
why may insulinoma patients need chemo?
for residual tumor and any mets
what are the complications seen with insulinoma?
persistent hypoglycaemia
transient hyperglycaemia
pancreatitis
DM
what intervention gives better outcome for insulinoma patients?
surgery better prognosis than medical management
where are adrenal glands located?
close to kidneys, vena cava and renal vessels
what are the 2 segments of the adrenal gland?
outer cortex
inner medulla
where is the cortex of the adrenal gland located?
outer portion of the gland
where is the medulla of the adrenal gland located?
inside of the cortex
what are the typical masses found in the adrenal cortex?
adenoma
adenocarcinoma
what hormones are affected by cortical masses?
androgens
mineralocorticoids
glucocorticoids
what medullary adrenal masses are seen?
phaeochromocytoma
what hormones are affected by medullary masses?
catecholamines (e.g. adrenaline)
what are the main adrenal gland surgical conditions?
primary adrenal mass
secondary adrenal enlargement due to pituitary mass
how is secondary adrenal enlargement treated?
need hypophyscetomy as enlargement is due to pituitary dependent hyperadrenocorticism
what are the main signs of adrenal gland disease?
often none
functional signs
haemoabdomen
what is essential before surgery if the patient has a functional adrenal mass?
patient must be stabilised pre-operatively
what is seen if overproduction is coming from the adrenal cortex?
cushings
Conns
masculinising syndrome
what is over produced by the adrenal cortex that leads to cushings?
glucocorticoids (e.g. cortisol)
what is over produced by the adrenal cortex that leads to conns syndrome?
mineralocorticoids (e.g. aldosterone)
what is over produced by the adrenal medulla if there is a functional mass?
catecholamines (e.g. adrenaline)
what can overproduction of catecholamines lead to?
intermittent hypertension
why do some adrenal masses present with haemoabdomen?
some will spontaneously bleed due to location near renal vessels and cranial vena cava
how are adrenal masses diagnosed?
CT
what are benign adrenal enlargements known as?
adenomas
what type of tumor are most malignant adrenal masses?
adenocarcinoma
are phaeochromocytomas benign or malignant?
can be either
what is commonly seen alongside malignant adrenal tumors?
tumor thrombus within the vena cava
what should happen to all adrenal mass patients before surgery?
stabilisation
what affects ASA status of adrenal mass patients?
systemic effects of mass
co-morbidities unrelated to mass
what systemic effects can Conns syndrome cause?
hypokalaemia
what is the impact of cushings on surgery likelihood?
endogenous steroids make patient poor surgical candidate
how can adrenal mass patients be medically stabilised if they are hypokalaemic?
K+ supplementation
how can adrenal mass patients be medically stabilised if they have cushings?
Trilostane to stabilise
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
how does presence of unilateral or bilateral adrenal masses affect prognosis?
bilateral likely palliation and euthanasia
what is a significant risk with adrenalectomy?
haemorrhage
thromboembolism
very challenging
what monitoring is needed for patients undergoing adrenalectomy?
ECG for arrythmia
BP
electrolytes
what are the main intraoperative complications seen with adrenalectomy?
tumor rupture
haemorrhage
tachycardia
arrhythmias
hyper/hypotension
what may need to be supplemented during adrenalectomy surgery?
gluco and mineralocorticoids
dexmethasone
electrolytes
what are the main post op complications seen with adrenalectomy?
electrolyte abnormalities
hypertension
hypotension
adrenal insufficiency
delayed healing
pulmonary thromboembolism
SIRS/sepsis
what is the most common endocrine condition in cats?
hyperthyroidism
what causes hyperthyroidism?
benign tumor which secretes excess thyroid hormone - either unilateral or bilateral
what diseases are often seen along side hyperthyroidism?
HCM
CKD
hypertension
what are the signs of hyperthyroidism?
polyphagia
weight loss
palpable goitre
tachycardia
how is hyperthyroidism diagnosed?
measure blood T4
what are the main treatment methods for hyperthyroidism?
antithyroid drugs
iodine restricted diet
thyroidectomy
radioactive iodine
what hyperthyroid management should be tried first?
medical management
also serves to stabilise before surgery
what organ function must be tested once patients are euthyroid on medical management?
kidneys
what is the role of antithyroid drugs?
block synthesis of thyroid hormone
why may dose increases of antithyroid drugs be required?
if adenoma continues to grow then more T4 is produced and more drug required
what drugs are used for hyperthyroid management?
methimazole
carbimazole
how long after starting antithyroid medication should patients be euthyroid?
2-3 weeks
when should T4 be checked?
3 weeks after treatment starts or any dose change
what are the common side effects of antithyroid drugs?
vomiting
anorexia
lethargy
usually minor and transient
what are the rare side effects of antithyroid drugs?
persistent GI signs
bone marrow suppression
facial pruritis
hepatopathy
what should be done if rare antithyroid drug side effects are seen?
stop treatment
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
how often should hyperthyroid patients be rechecked?
3-12 months
what is involved in hyperthyroid treatment monitoring?
look for recurrence
concurrent disease
bloods
urine
BP
what is found in hyperthyroid diets?
iodine restricted - must be sole diet
why is an iodine restricted diet of benefit with hyperthyroid patients?
iodine required for thyroid hormone synthesis
if on dietary management for hyperthyroidism how quickly can patients become euthyroid?
within 3 weeks
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
what causes canine hypothyroidism?
destruction of thyroid tissue
in what animals is hypothyroidism commonly seen?
middle aged dogs
doberman
boxer
malamute
what are the signs of hypothyroidism?
weight gain
lethargy
bradycardia
endocrine alopecia
myxoedema
coma
how is hypothyroidism diagnosed?
measure T4 and TSH
how is hypothyroidism treated?
oral synthetic T4 - sodium levothyroxine
when can hypothyroidism be picked up?
weight management clinics
why can it take time to find ideal sodium levothyroxine dose?
bioavailability and absorption vary between patients
what affects bioavailability of sodium levothyroxine?
food - consistent dosing crucial
what should be measured when monitoring hypothyroid patients?
T4 only
TSH not needed
when should T4 be measured in relation to tablet time?
3h post pill for peak conc
when due for lowest
when should T4 bloods be done after starting sodium levothyroxine treatment?
6-8 weeks
when should T4 bloods be done after altering sodium levothyroxine dose?
2-4 weeks
long term how often should T4 be measured in hypothyroid patients?
every 6-12 months
what is calcium required for?
muscle contraction
nerve conduction
where is calcium stored?
in bones with phosphate
what are the 3 forms of calcium found in the blood?
ionised
complexed
protein bound
what is the biologically active form of calcium?
ionised
what is usually measured on biochemistry when checking calcium?
total calcium - combination of all 3 forms within the blood
what is the role of parathyroid hormone?
increases calcium resorption in kidneys and bone
increases calcitriol formation
what is calcitriol?
vitamin D
where is calcitriol / vitamin D released from?
kidney
what is the role of calcitriol / vitamin D?
increases calcium reabsorption in kidneys
increases calcium absorption in the gut
where is calcitonin released from?
thyroid gland
what is the role of calcitonin?
inhibits osteoclasts and so reduces calcium release from bone
what hormone is released in response to hypocalcaemia?
PTH release
what is caused by PTH release?
increased calcium reabsorption in kidneys
calcium and phosphate mobilised from bone
activation of calcitriol
what is triggered by hypercalcaemia under normal circumstances?
PTH blocked from release
calcitonin released
what is the role of calcitonin?
increased calcium storage in bone
increased calcium excretion in kidneys
what are the main parathyroid diseases?
primary hyperparathyroidism
secondary hyperparathyroidism
hypoparathyroidism
what occurs during primary hyperparathyroidism?
one or more parathyroid glands become hyperfunctional and secrete excess PTH
what breed has a genetic predisposition to primary hyperparathyroidism?
Keeshonds
is primary hyperparathyroidism seen in cats?
very rare
what are the main clinical signs of primary hyperparathyroidism?
neurological
GI
urinary
CVS
what are the neurological signs of primary hyperparathyroidism?
weakness
lethargy
exercise intolerance
trembling
what are the GI signs of primary hyperparathyroidism?
reduced appetite
nausea
vomiting
constipation
what are the urinary signs of primary hyperparathyroidism?
PUPD
urolithiosis
UTI
what are the CVS signs of primary hyperparathyroidism?
hypertension
arrhythmias
how is primary hyperparathyroidism diagnosed?
often incidental elevated calcium
ionised calcium then checked
if elevated check PTH
what must be done when collecting calcium samples?
check with the lab as special sampling and storage requirements
what is the treatment used for primary hyperparathyroidism?
surgery
US glandular ablation
what is used to perform US guided parathyroid gland ablation?
heat
ethanol injection
what are the issues associated with US guided glandular ablation of the parathyroid gland?
damage to recurrent laryngeal nerve possible
what are the signs of recurrent laryngeal nerve damage?
bark change
coughing
laryngeal dysfunction
what is the only indicator of true hypercalcaemia?
elevated ionised calcium
what is the cause of secondary hyperparathyroidism?
chronically low calcium leading to elevated PTH
what can cause secondary hyperparathyroidism?
renal failure
poor nutrition due to diet deficient in vitamin D
what is the effect of high PTH seen with secondary hyperparathyroidism?
causes calcium to be mobilised from bone
how is secondary hyperparathyroidism treated?
balanced diet
what is occurring during hypoparathyroidism?
low or absent PTH despite low calcium
what are the causes of hypoparathyroidism?
iatrogenic through surgery
trauma
idiopathic
immune mediated
what are the clinical signs of hypoparathyroidism?
seizures
muscle fasiculations
twitching
cramping
weakness
ataxia
anorexia
vomiting
facial rubbing
how is hypoparathyroidism diagnosed?
measure ionised calcium
phosphorus
PTH
how should severe hypoparathyroidism be treated?
IV calcium with bolus or CRI
how should mild hypoparathyroidism be treated?
oral calcium
calcitriol (vitamin D)
what can be caused by IV calcium administration?
arrhythmia
arrest
bradycardia even if given slowly
what should be done if extravasation of calcium gluconate occurs?
infiltrate tissue with saline
wound management
what causes hyperadrenocorticism?
excessive production of cortisol from adrenal gland which is either pituitary, adrenal dependent or iatrogenic
what is iatrogenic hyperadrenocoticism caused by?
administration of glucocorticoids
what are the clinical signs of hyperadrenocorticism?
PUPD
lethargy
endocrine alopecia
pot-belly
thin skin
poor wound healing
panting
polyphagia
calcinosis cutis
how is hyperadrenocorticism diagnosed?
no single test accurate
ACTH stim
LDDS (low dose dexmethasone supression test)
how is hyperadrenocorticism treated?
trilostane
surgery
what is the action of trilostane?
blockage of synthesis of cortisol
what types of hyperadrenocorticism is trilostane suitable for?
PDH
ADH
how are patients on medical management for hyperadrenocorticism monitored?
clinical signs
ACTH stim
pre-pill cortisol
what are the side effects of trilostane?
GI signs
iatrogenic hypoadrenocorticism
sudden death
when should blood testing be performed after starting or changing doses of trilostane?
biochem and ACTH stim 10 days after
how often is blood testing needed once patients on trilostane have been tested at 10 days?
4 weeks
12 weeks
then every 3 months
when is it recommended trilostane be given?
in the morning
when should ACTH stim be performed after admin of medication?
4-6 hours
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
what can happen if patients are given trilostane overdose?
iatrogenic hypoadrenocorticism - can lead to addisonian crisis
what are the signs of Addisonian crisis?
hypotension
weakness
bradycardia
severe dehydration
hypovolaemia
collapse
what is hypoadrenocorticism caused by?
lack of adrenal hormones (glucocorticoids and mineralocorticoids)
what animals is hypoadrenocorticism commonly seen in?
young to middle aged
female
rare in cats
what are the signs of hypoadrenocorticism?
vague waxing and waning illness
V
D
weight loss
how is hypoadrenocorticism diagnosed?
electrolyte abnormalities
ACTH stim
how is addisonian crisis treated?
IVFT resuscitation
correct electrolytes (glucose and insulin if hyperkalaemic)
start ACTH stim test ASAP
how is hypoadrenocorticism treated in the long term?
glucocorticoid replacement
mineralocorticoid replacement
what drug is used to replace glucocorticoids?
prednisolone
what drug is used to replace mineralocorticoids?
desoxycortone pivalate - Zycortal
how is zycortal administered?
every 4 weeks injection
is pancreatitis an endocrine disease?
no - exocrine
what causes pancreatitis?
idiopathic
dietary indiscretion
trauma
surgery (hypoperfusion under GA)
what is actually happening in the pancreas during pancreatitis?
pancreatic enzymes prematurely activated - pancreas is digested
what are the signs of mild pancreatitis?
anorexia
vomiting
abdominal pain
dehydration
lethargy
what are the signs of severe pancreatitis?
generalised inflammation
DIC
renal failure
multiorgan failure
death
how is pancreatitis diagnosed?
blood tests not overly reliable
abdominal US
how is pancreatitis treated?
IVFT
analgesia
anti-emetics
feeding ASAP - may need tube
appropriate diet
what diet is appropriate for pancreatitis?
palatable
low fat
highly digestible
what is the long term nutrition aim for pancreatitis patients?
low fat
what causes diabetes mellitus?
failure of the pancreas to produce insulin
what animals is DM more common in?
middle aged to older animals
burmese cats
what increases the risk of DM?
obesity
what are the clinical signs of DM?
PUPD
polyphagia
weight loss
cataracts
peripheral neuropathy (cats)
what is a severe sign of DM?
DKA
what are the signs of DKA?
vomiting
collapse
dehydration
what indicates DM on tests?
persistent hyperglycaemia
glucosuria
fructosamine elevated
how is DM commonly treated in cats?
insulin injections
diet
oral liquid - Senvelgo
what insulin is used for cats?
Pro-zinc
what diet is best for diabetic cats?
low carb
high protein
calorie controlled
wet food
grazing ok
why is wet food best for diabetic cats?
improved glycaemic control
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
why is it important to monitor cats for hypoglycaemia?
cats may go into diabetic remission but will often become diabetic again in later life
how are dogs with DM treated?
caninsulin injections
diet
exercise
what is important about diet for dogs with DM?
high fibre
high carb
consistent schedule
calorie controlled
how is insulin administered?
SC SID/BID depending on patient and insuline
how often should patients with DM be fed?
BID
when should insulin be given if giving BID?
feed every 12 hours and give insulin at the same time
when should insulin be given if giving SID?
feed in am before insulin and then 6 hours later at nadir
when should insulin be injected in relation to feeding?
after or during meal
what is essential about food type and quantity if patients are on insulin?
type and quantity must stay the same at every meal
how can glucose levels be monitored?
BG curve
freestyle libre
how is a BG curve run?
BG measured every 2 hours
owner supplies food and insulin
how does freestyle libre glucose monitoring work?
continuous
routine as normal
how long does it take following insulin dose change for blood glucose levels to stabilise?
~7 days
where is it recommended first insulin dose is given?
whilst hospitalised to monitor for hypoglycaemia
what must owners of patients with DM be aware of?
signs of hypoglycaemia
and what to do if they suspect their pet is hypoglycaemic
what are the signs of hypoglycaemia?
weakness
ataxia
depression
altered behaviour
muscle twitching
seizures
how should owners manage hypoglycaemic patients if conscious?
offer food
if reluctant to eat put honey on gums
contact vet
how should hypoglycaemic patients managed by owners if unconscious?
rub honey onto gums
phone vet
how should hypoglycaemic patients managed by owners if seizuring?
phone vet
what should be done if owners are unsure if their pet is hypoglycaemic?
feed as far safer to elevate blood sugar than risk hypoglycaemia
what syringes must be used to give insulin?
correct pet specific ones
how should insulin be handled?
follow manufacturers instructions
often in the fridge
mix gently before administering
where should BG samples be taken from each time?
same location as capillary blood will have different glucose levels to venous
what is key when managing DM patients?
consistency
keep diet, exercise and routine the same
when is extra care needed for DM patients?
if undergoing GA
