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Endocrine Flashcards

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1
Q

describe the anatomy of the thyroid gland

A

paired
bilobed
may or may not be joined by an isthmus

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2
Q

where is the thyroid gland typically located?

A

caudal to the larynx
ventrolateral to the trachea

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3
Q

which of the thyroid glands is more cranial?

A

right

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4
Q

at the level of what tracheal rings is the thyroid gland located?

A

5th - 8th

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5
Q

what structures are found surrounding the thyroid glands that are of surgical significance?

A

neurological structures
highly vascular

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6
Q

is thyroid tissue found only within the thyroid glands themselves?

A

no - ectopic tissue seen

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7
Q

where is ectopic thyroid tissue located?

A

midline from the tongue to the abdomen

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8
Q

what structure does the oesophagus sit in contact with?

A

left thyroid gland

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9
Q

what are functional thyroid conditions?

A

those where thyroid hormones are produced

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10
Q

what size are benign thyroid masses often in dogs?

A

small and rarely diagnosed

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11
Q

are benign thyroid masses in dogs functional or non-functional?

A

non-functional

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12
Q

are benign thyroid masses often seen in cats functional or non-functional?

A

functional and cause hyperthyroidism

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13
Q

what are the causes of 95% of all feline thyroid masses?

A

benign adenoma or adenomatous hyperplasia

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14
Q

in what species are malignant thyroid masses more common?

A

dogs

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15
Q
A
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16
Q

what are the common benign masses seen in the thyroid?

A

adenoma
adenomatous hyperplasia

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17
Q

what types of malignant neoplasia are seen in the thyroid?

A

carcinoma
adenocarcinoma

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18
Q

how many hyperthyroid cats have functional malignant tumors?

A

<5%

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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

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20
Q

what are the main systemic effects of hyperthyroidism?

A

BCS/MCS
presence of metastasis
CVS
renal
ocular

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21
Q

what are the CVS effects of hyperthyroidism?

A

tachycardia
hypertension

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22
Q

what are the renal effects of hyperthyroidism?

A

pre-renal azotemia due to hypertension

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23
Q

what are the ocular signs of hyperthyroidism?

A

retinal detachment seen secondary to hypertension

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24
Q

what comorbidities are often seen in hyperthyroid patients?

A

CVS
renal
increased ASA grade
cachexia
arthritis

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25
Q

what has a major impact on thyroidectomy anaesthetic and outcome if a patient has a functional mass?

A

success of pre-op medical management

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26
Q

how can HR be decreased before thyroidectomy in patients with a functional mass?

A

antithyroid meds

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27
Q

how can hypertension be managed before thyroidectomy if patient is hyperthyroid?

A

atenolol

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28
Q

what is involved in stabilisation of a patient with a functional mass before thyroidectomy?

A

decrease HR
treat hypertension
support renal function
increase body weight

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29
Q

what may affect ASA grade of thyroidectomy patients with a non-functional mass?

A

BCS
metastasis
co-morbidities

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30
Q

what effect may non-functional thyroid masses have on BCS?

A

PNS/cancer may be having an impact

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31
Q

is medical stabilisation of patients with non-functional masses required pre-op?

A

no as non-functional

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32
Q

how can a thyroid mass be made more or less difficult to remove?

A

easier - discrete/mobile
harder - fixed, inflitrative

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33
Q

what will post op management of the non-functional thyroid mass patient involve?

A

depends on surgery (uni or bilateral)
discuss with vet

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34
Q

what clip is required for thyroidectomy?

A

level of the jaw to the thoracic inlet
out to jugular groove

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35
Q

what position should patients be in for thyroidectomy?

A

dorsal recumbency
neck kept straight
sandbag under neck to elevate

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36
Q

what must be considered when choosing to remove the thyroid gland?

A

is the parathyroid gland (s) going to be removed too

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37
Q

what can be done with the parathyroid gland if it is removed during thyroidectomy?

A

can be re-implanted into the surgical site to allow for neovascularisation

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38
Q

what are the risks associated with re-implanting parathyroid tissue?

A

tumour may be seeded

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39
Q

what is the advantage of modified extracapsular technique for thyroidectomy?

A

reduced risk of recurrence

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40
Q

what is the disadvantage of modified extracapsular technique for thyroidectomy?

A

increased risk of post op hypocalcaemia

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41
Q

what are the complications of thyroidectomy which are unrelated to surgical technique?

A

GA
unmasking of CRF
hypothyroidism

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42
Q

why may CRF be umasked following thryoidectomy?

A

hypertension caused by hyperthyroid resolves and as a result GFR is no longer adequate

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43
Q

what are the complications of thyroidectomy that are related to surgical technique and skill?

A

haemorrhage
seroma
laryngeal paralysis
horners
hypocalcaemia
recurrence

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44
Q

what type of thyroid mass often leads to haemorrhage during surgery?

A

canine invasive masses

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45
Q

how can laryngeal paralysis be caused during thyroidectomy?

A

damage to recurrent laryngeal nerve

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46
Q

how does horners syndroms occur following thyroidectomy?

A

damage to the sympathetic trunk

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47
Q

what are the signs of horners syndrome?

A

anisocoria
nictating membrane visible

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48
Q

how is hypocalcaemia caused following thyroidectomy?

A

deliberate or inadvertent damage to normal parathyroid tissue resulting in iatrogenic hypoparathyroidism

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49
Q

what can cause iatrogenic hypoparathyroidism?

A

arterial spasm
damage to tissue (deliberate or inadvertent)

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50
Q

what may be given pre and post operatively to support patients undergoing thyroidectomy who are at risk of hypoparathyroidism?

A

pre-op oral vitamin D
post op oral calcium

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51
Q

what does recurrence of thyroid tissue following thyroidectomy depend on?

A

presence of ectopic tissue
technique used
malignancy

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52
Q

where is ectopic thyroid tissue mostly seen?

A

chest

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53
Q

what are the most common thyroidectomy complications?

A

hypocalcaemia
recurrence

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54
Q

what is the parathyroid made up of?

A

2 pairs of parathyroid glands

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55
Q

what are the 4 parathyroid glands?

A

left extracapsular
right extracapsular
left intracapsular
right intracapsular

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56
Q

what parathyroid glands make up the cranial portion of the gland?

A

left and right extracapsular

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57
Q

what parathyroid glands make up the caudal portion of the gland?

A

left intracapsular
right intracapsular

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58
Q

what is secreted by the parathyroid gland?

A

parathyroid hormone

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59
Q

what is the role of parathyroid hormone?

A

increases blood calcium levels

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60
Q

in what animals is primary hyperparathyroidism seen?

A

dogs but uncommon

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61
Q

how can primary hyperparathyroidism be managed medically?

A

ethanol injection
heat ablation

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62
Q

how can primary hyperparathyroidism be managed surgically?

A

parathyroidectomy

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63
Q

what must be monitored for in the post op period following parathyroidectomy?

A

hypocalcaemia

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64
Q

why is hypocalcamia a risk following parathyroidectomy even if only one gland is removed?

A

hypercalcaemia seen prior
other glands atrophy due to over production by one - need time to recover and function normally

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65
Q

what is the prognosis for primary hyperparathyroidism?

A

95% if benign, functional adenoma

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66
Q

what may affect ASA grade of patients undergoing parathyroidectomy?

A

systemic effects of hyperparthyroidism
comorbidities unrelated to hyperparathyroidism

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67
Q

what organ system is affected by hypercalcaemia?

A

kidneys

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68
Q

how may hyperparathyroid patients be medically stabilised?

A

diuresis with furosomide
IVFT to dilute calcium
renal support

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69
Q

how should patients be clipped for parathyroidectomy?

A

jaw to thoracic inlet
out to jugular groove on either side - as for thyroidectomy

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70
Q

what position should patients be in for parathyroidectomy?

A

dorsal recumbancy
sandbag under neck to keep anatomy level

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71
Q

what is likely removed alongside caudal (intracapsular) parathyroid?

A

associated thyroid gland

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72
Q

what are the complications of parathyroidectomy which are unrelated to surgical technique?

A

GA
hypothyroidism

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73
Q

what are the complications of parathyroidectomy that are related to surgical technique?

A

haemorrhage
seroma
laryngeal paralysis
horners
hypoparathyroidism

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74
Q

what does risk of seroma following surgery relate to?

A

size of mass

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75
Q

why is hypoparathyroidism likely to be more severe in patients following parathyroidectomy?

A

3 remaining parathyroids function is suppressed by functional mass so there is a delay in the recovery of their function and hypocalcaemia can occur

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76
Q

what is involved in post op care for parathyroidectomy patients?

A

IVFT
analgesia
monitor for complications

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77
Q

what analgesia should be avoided following parathyroidectomy?

A

NSAIDs until kidney function known

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78
Q

what procedures pose highest risk of iatrogenic hypoparathyroidism?

A

bilateral thyroidectomy
unilateral parathyroidectomy

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79
Q

what is the risk of iatrogenic thyroid/parathyroid damage in patients undergoing unilateral thyroidectomy?

A

low risk hypocalcaemia
low risk hypothyroid

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80
Q

what is the risk of iatrogenic thyroid/parathyroid damage in patients undergoing bilateral thyroidectomy?

A

higher than unilateral risk of hypocalcaemia
hypothryoid due to complete thyroid resection

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81
Q

what is the risk of iatrogenic thyroid/parathyroid damage in patients undergoing unilateral parathyroidectomy?

A

highest risk of hypocalcaemia
low risk hypothyroid

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82
Q

what will influence risk of hypocalcaemia post thyroid/parathyroid surgery?

A

is function surpressed, normal or raised pre op

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83
Q

when should iatrogenic hypoparathyroidism be treated?

A

only if clinical signs seen

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84
Q

what are the initial signs of hypoparathyroidism?

A

inappetance
weakness/lethargy
ptyalism
pawing at face

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85
Q

what are the more advanced signs of iatrogenic hypoparathyroidism?

A

tremors
muscle fasiculation
tetany
seizures
coma
death

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86
Q

when are clinical signs of iatrogenic hypoparathyroidism seen following surgery?

A

within 2-3 days

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87
Q

how can post parathyroidectomy hypocalcaemia be avoided?

A

vitamin D administered 24-48 hours prior to surgery

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88
Q

when should vitamin D be administered to parathyroidectomy patients?

A

24-48 hours pre op

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89
Q

what is the role of vitamin D pre-op for parathyroidectomy patients?

A

increases calcium absorption from the GI tract
reduces calcium losses through the kidneys

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90
Q

what calcium value must be measured following parathyroidectomy?

A

ionised calcium as is unbound and so usable by the body

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91
Q

why should you wait for clinical signs rather than just blood results to treat hypocalcaemia?

A

calcium needs to drop below normal to encourage the other parathyroid glands to work
exogenous may suppress action even further

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92
Q

when should calcium levels be checked post op?

A

definitely 2-3 days following surgery

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93
Q

what are the treatment options for hypocalcaemia?

A

vitamin D
oral calcium
IV calcium

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94
Q

what is the purpose of giving oral vitamin D before parathyroid surgery?

A

prepares the body for a drop in calcium so can stimulate PT glands to work

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95
Q

how long does oral calcium therapy take to work?

A

1-3 days

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96
Q

how is calcium usually given?

A

oral - sent home with patient

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97
Q

what is found within oral calcium?

A

elemental calcium

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98
Q

in what form is calcium given IV?

A

10% calcium gluconate

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99
Q

how should IV calcium be given?

A

over 10-20 mins

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100
Q

when is IV calcium gluconate given?

A

if clinical signs
if levels of calcium VERY low

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101
Q

what monitoring is needed when patients are receiving calcium IV?

A

ECG

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102
Q

what may be seen on ECG when giving calcium gluconate?

A

arrhythmia
bradycardia

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103
Q

what types of IV fluids should be avoided if calcium gluconate has been given?

A

bicarbonate
lactate
phosphate

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104
Q

why should bicarbonate, lactate or phosphate containing fluids be avoided in patients receiving calcium gluconate?

A

precipitate calcium

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105
Q

should calcium gluconate be given IV?

A

no recommended - skin may slough

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106
Q

is pancreatic anatomy the same in cats and dogs?

A

cats sometimes have a second accessory duct

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107
Q

where is the right limb of the pancreas located?

A

next to duodenum

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108
Q

where is the left limb of the pancreas located?

A

next to spleen

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109
Q

where does the body of the pancreas sit?

A

close to pancreatic ducts and common bile duct

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110
Q

what are the main pancreatic surgical conditions?

A

insulinoma
exocrine pancreatic neoplasia
pancreatic abscessation
pancreatic cysts

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111
Q

what is the main endocrine surgical condition of the pancreas?

A

insulinoma

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112
Q

what type of tumour is an insulinoma?

A

malignant carcinoma

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113
Q

what are the main indications of insulinoma?

A

hypoglycaemia (<2 mmol/L) in a standing dog
lethargy
tremors
seizures
collapse
peripheral neuropathy

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114
Q

what level of hypoglycaemia is associated with insulinoma?

A

<2 mmol/L

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115
Q

how is insulinoma diagnosed?

A

bloods for insulin / glucose ratio
imaging

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116
Q

how can patients with insulinomas cope with such low blood glucose levels?

A

adjustment over time as decreases slowly

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117
Q

how should insulinoma patients be managed pre-op?

A

feed diabetic food
feed every 4-6 hours
gentle and regular exercise

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118
Q

how often should insulinoma patients be fed pre-op?

A

every 4-6 hours

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119
Q

how should hypoglycaemic crisis due to insulinoma be managed?

A

oral glucose where possible

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120
Q

what is the issue with using IV glucose for insulinoma patients in hypoglycaemic crisis?

A

can cause mass to produce even more insulin as placed directly into the blood vessel

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121
Q

how is an insulinoma hypoglycaemic crisis managed?

A

oral glucose
one off IV 50% dextrose
glucose infusion

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122
Q

how is insulinoma treated?

A

partial pancreatectomy

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123
Q

what glucose supplementation is required during partial pancreatectomy for insulinoma?

A

5% dextrose infusion

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124
Q

what is essential when handling the pancreas?

A

gentle to reduce pancreatitis risk

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125
Q

where can insulinomas metastasise?

A

liver

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126
Q

what is the impact of micrometastasis from insulinoma?

A

patient will continue to be hypoglycaemic

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127
Q

how should post-op insulinoma patients be fed?

A

as pre-op
Q4-6h
diabetic food

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128
Q

how should post-op insulinoma patients be exercised?

A

as pre op initially

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129
Q

what drugs may insulinoma patients be on post op?

A

IVFT
analgesia
steroids
chemo

130
Q

what is the role of steroids following insulinoma removal?

A

increase glucose levels

131
Q

why may insulinoma patients need chemo?

A

for residual tumor and any mets

132
Q

what are the complications seen with insulinoma?

A

persistent hypoglycaemia
transient hyperglycaemia
pancreatitis
DM

133
Q

what intervention gives better outcome for insulinoma patients?

A

surgery better prognosis than medical management

134
Q

where are adrenal glands located?

A

close to kidneys, vena cava and renal vessels

135
Q

what are the 2 segments of the adrenal gland?

A

outer cortex
inner medulla

136
Q

where is the cortex of the adrenal gland located?

A

outer portion of the gland

137
Q

where is the medulla of the adrenal gland located?

A

inside of the cortex

138
Q

what are the typical masses found in the adrenal cortex?

A

adenoma
adenocarcinoma

139
Q

what hormones are affected by cortical masses?

A

androgens
mineralocorticoids
glucocorticoids

140
Q

what medullary adrenal masses are seen?

A

phaeochromocytoma

141
Q

what hormones are affected by medullary masses?

A

catecholamines (e.g. adrenaline)

142
Q

what are the main adrenal gland surgical conditions?

A

primary adrenal mass
secondary adrenal enlargement due to pituitary mass

143
Q

how is secondary adrenal enlargement treated?

A

need hypophyscetomy as enlargement is due to pituitary dependent hyperadrenocorticism

144
Q

what are the main signs of adrenal gland disease?

A

often none
functional signs
haemoabdomen

145
Q

what is essential before surgery if the patient has a functional adrenal mass?

A

patient must be stabilised pre-operatively

146
Q

what is seen if overproduction is coming from the adrenal cortex?

A

cushings
Conns
masculinising syndrome

147
Q

what is over produced by the adrenal cortex that leads to cushings?

A

glucocorticoids (e.g. cortisol)

148
Q

what is over produced by the adrenal cortex that leads to conns syndrome?

A

mineralocorticoids (e.g. aldosterone)

149
Q

what is over produced by the adrenal medulla if there is a functional mass?

A

catecholamines (e.g. adrenaline)

150
Q

what can overproduction of catecholamines lead to?

A

intermittent hypertension

151
Q

why do some adrenal masses present with haemoabdomen?

A

some will spontaneously bleed due to location near renal vessels and cranial vena cava

152
Q

how are adrenal masses diagnosed?

A

CT

153
Q

what are benign adrenal enlargements known as?

A

adenomas

154
Q

what type of tumor are most malignant adrenal masses?

A

adenocarcinoma

155
Q

are phaeochromocytomas benign or malignant?

A

can be either

156
Q

what is commonly seen alongside malignant adrenal tumors?

A

tumor thrombus within the vena cava

157
Q

what should happen to all adrenal mass patients before surgery?

A

stabilisation

158
Q

what affects ASA status of adrenal mass patients?

A

systemic effects of mass
co-morbidities unrelated to mass

159
Q

what systemic effects can Conns syndrome cause?

A

hypokalaemia

160
Q

what is the impact of cushings on surgery likelihood?

A

endogenous steroids make patient poor surgical candidate

161
Q

how can adrenal mass patients be medically stabilised if they are hypokalaemic?

A

K+ supplementation

162
Q

how can adrenal mass patients be medically stabilised if they have cushings?

A

Trilostane to stabilise

163
Q

how can adrenal mass patients be medically stabilised if they have phaeochromocytoma?

A

alpha adrenergic blocker 2-3 weeks pre op to stabilise BP and HR

164
Q

how does presence of unilateral or bilateral adrenal masses affect prognosis?

A

bilateral likely palliation and euthanasia

165
Q

what is a significant risk with adrenalectomy?

A

haemorrhage
thromboembolism
very challenging

166
Q

what monitoring is needed for patients undergoing adrenalectomy?

A

ECG for arrythmia
BP
electrolytes

167
Q

what are the main intraoperative complications seen with adrenalectomy?

A

tumor rupture
haemorrhage
tachycardia
arrhythmias
hyper/hypotension

168
Q

what may need to be supplemented during adrenalectomy surgery?

A

gluco and mineralocorticoids
dexmethasone
electrolytes

169
Q

what are the main post op complications seen with adrenalectomy?

A

electrolyte abnormalities
hypertension
hypotension
adrenal insufficiency
delayed healing
pulmonary thromboembolism
SIRS/sepsis

170
Q

what is the most common endocrine condition in cats?

A

hyperthyroidism

171
Q

what causes hyperthyroidism?

A

benign tumor which secretes excess thyroid hormone - either unilateral or bilateral

172
Q

what diseases are often seen along side hyperthyroidism?

A

HCM
CKD
hypertension

173
Q

what are the signs of hyperthyroidism?

A

polyphagia
weight loss
palpable goitre
tachycardia

174
Q

how is hyperthyroidism diagnosed?

A

measure blood T4

175
Q

what are the main treatment methods for hyperthyroidism?

A

antithyroid drugs
iodine restricted diet
thyroidectomy
radioactive iodine

176
Q

what hyperthyroid management should be tried first?

A

medical management
also serves to stabilise before surgery

177
Q

what organ function must be tested once patients are euthyroid on medical management?

A

kidneys

178
Q

what is the role of antithyroid drugs?

A

block synthesis of thyroid hormone

179
Q

why may dose increases of antithyroid drugs be required?

A

if adenoma continues to grow then more T4 is produced and more drug required

180
Q

what drugs are used for hyperthyroid management?

A

methimazole
carbimazole

181
Q

how long after starting antithyroid medication should patients be euthyroid?

A

2-3 weeks

182
Q

when should T4 be checked?

A

3 weeks after treatment starts or any dose change

183
Q

what are the common side effects of antithyroid drugs?

A

vomiting
anorexia
lethargy
usually minor and transient

184
Q

what are the rare side effects of antithyroid drugs?

A

persistent GI signs
bone marrow suppression
facial pruritis
hepatopathy

185
Q

what should be done if rare antithyroid drug side effects are seen?

A

stop treatment

186
Q

what are the main nursing considerations for hyperthyroid patients?

A

careful handling
often fractious
consider concurrent disease (e.g. OA/cardiac)
look for signs in senior cat clinics
monitor treatment efficacy

187
Q

how often should hyperthyroid patients be rechecked?

A

3-12 months

188
Q

what is involved in hyperthyroid treatment monitoring?

A

look for recurrence
concurrent disease
bloods
urine
BP

189
Q

what is found in hyperthyroid diets?

A

iodine restricted - must be sole diet

190
Q

why is an iodine restricted diet of benefit with hyperthyroid patients?

A

iodine required for thyroid hormone synthesis

191
Q

if on dietary management for hyperthyroidism how quickly can patients become euthyroid?

A

within 3 weeks

192
Q

when is dietary management of hypothyroid cats not suitable?

A

if severe hyperthyroidism
if patient has other dietary requirements
if there are euthyroid cats in the house

193
Q

what causes canine hypothyroidism?

A

destruction of thyroid tissue

194
Q

in what animals is hypothyroidism commonly seen?

A

middle aged dogs
doberman
boxer
malamute

195
Q

what are the signs of hypothyroidism?

A

weight gain
lethargy
bradycardia
endocrine alopecia
myxoedema
coma

196
Q

how is hypothyroidism diagnosed?

A

measure T4 and TSH

197
Q

how is hypothyroidism treated?

A

oral synthetic T4 - sodium levothyroxine

198
Q

when can hypothyroidism be picked up?

A

weight management clinics

199
Q

why can it take time to find ideal sodium levothyroxine dose?

A

bioavailability and absorption vary between patients

200
Q

what affects bioavailability of sodium levothyroxine?

A

food - consistent dosing crucial

200
Q

what should be measured when monitoring hypothyroid patients?

A

T4 only
TSH not needed

201
Q

when should T4 be measured in relation to tablet time?

A

3h post pill for peak conc
when due for lowest

202
Q

when should T4 bloods be done after starting sodium levothyroxine treatment?

A

6-8 weeks

203
Q

when should T4 bloods be done after altering sodium levothyroxine dose?

A

2-4 weeks

204
Q

long term how often should T4 be measured in hypothyroid patients?

A

every 6-12 months

205
Q

what is calcium required for?

A

muscle contraction
nerve conduction

206
Q

where is calcium stored?

A

in bones with phosphate

207
Q

what are the 3 forms of calcium found in the blood?

A

ionised
complexed
protein bound

208
Q

what is the biologically active form of calcium?

A

ionised

209
Q

what is usually measured on biochemistry when checking calcium?

A

total calcium - combination of all 3 forms within the blood

210
Q

what is the role of parathyroid hormone?

A

increases calcium resorption in kidneys and bone
increases calcitriol formation

211
Q

what is calcitriol?

A

vitamin D

212
Q

where is calcitriol / vitamin D released from?

A

kidney

213
Q

what is the role of calcitriol / vitamin D?

A

increases calcium reabsorption in kidneys
increases calcium absorption in the gut

214
Q

where is calcitonin released from?

A

thyroid gland

215
Q

what is the role of calcitonin?

A

inhibits osteoclasts and so reduces calcium release from bone

216
Q

what hormone is released in response to hypocalcaemia?

A

PTH release

217
Q

what is caused by PTH release?

A

increased calcium reabsorption in kidneys
calcium and phosphate mobilised from bone
activation of calcitriol

218
Q

what is triggered by hypercalcaemia under normal circumstances?

A

PTH blocked from release
calcitonin released

219
Q

what is the role of calcitonin?

A

increased calcium storage in bone
increased calcium excretion in kidneys

220
Q

what are the main parathyroid diseases?

A

primary hyperparathyroidism
secondary hyperparathyroidism
hypoparathyroidism

221
Q

what occurs during primary hyperparathyroidism?

A

one or more parathyroid glands become hyperfunctional and secrete excess PTH

222
Q

what breed has a genetic predisposition to primary hyperparathyroidism?

A

Keeshonds

223
Q

is primary hyperparathyroidism seen in cats?

A

very rare

224
Q

what are the main clinical signs of primary hyperparathyroidism?

A

neurological
GI
urinary
CVS

225
Q

what are the neurological signs of primary hyperparathyroidism?

A

weakness
lethargy
exercise intolerance
trembling

226
Q

what are the GI signs of primary hyperparathyroidism?

A

reduced appetite
nausea
vomiting
constipation

227
Q

what are the urinary signs of primary hyperparathyroidism?

A

PUPD
urolithiosis
UTI

228
Q

what are the CVS signs of primary hyperparathyroidism?

A

hypertension
arrhythmias

229
Q

how is primary hyperparathyroidism diagnosed?

A

often incidental elevated calcium
ionised calcium then checked
if elevated check PTH

230
Q

what must be done when collecting calcium samples?

A

check with the lab as special sampling and storage requirements

231
Q

what is the treatment used for primary hyperparathyroidism?

A

surgery
US glandular ablation

232
Q

what is used to perform US guided parathyroid gland ablation?

A

heat
ethanol injection

233
Q

what are the issues associated with US guided glandular ablation of the parathyroid gland?

A

damage to recurrent laryngeal nerve possible

234
Q

what are the signs of recurrent laryngeal nerve damage?

A

bark change
coughing
laryngeal dysfunction

235
Q

what is the only indicator of true hypercalcaemia?

A

elevated ionised calcium

236
Q

what is the cause of secondary hyperparathyroidism?

A

chronically low calcium leading to elevated PTH

237
Q

what can cause secondary hyperparathyroidism?

A

renal failure
poor nutrition due to diet deficient in vitamin D

238
Q

what is the effect of high PTH seen with secondary hyperparathyroidism?

A

causes calcium to be mobilised from bone

239
Q

how is secondary hyperparathyroidism treated?

A

balanced diet

240
Q

what is occurring during hypoparathyroidism?

A

low or absent PTH despite low calcium

241
Q

what are the causes of hypoparathyroidism?

A

iatrogenic through surgery
trauma
idiopathic
immune mediated

242
Q

what are the clinical signs of hypoparathyroidism?

A

seizures
muscle fasiculations
twitching
cramping
weakness
ataxia
anorexia
vomiting
facial rubbing

243
Q

how is hypoparathyroidism diagnosed?

A

measure ionised calcium
phosphorus
PTH

244
Q

how should severe hypoparathyroidism be treated?

A

IV calcium with bolus or CRI

245
Q

how should mild hypoparathyroidism be treated?

A

oral calcium
calcitriol (vitamin D)

246
Q

what can be caused by IV calcium administration?

A

arrhythmia
arrest
bradycardia even if given slowly

247
Q

what should be done if extravasation of calcium gluconate occurs?

A

infiltrate tissue with saline
wound management

248
Q

what causes hyperadrenocorticism?

A

excessive production of cortisol from adrenal gland which is either pituitary, adrenal dependent or iatrogenic

249
Q

what is iatrogenic hyperadrenocoticism caused by?

A

administration of glucocorticoids

250
Q

what are the clinical signs of hyperadrenocorticism?

A

PUPD
lethargy
endocrine alopecia
pot-belly
thin skin
poor wound healing
panting
polyphagia
calcinosis cutis

251
Q

how is hyperadrenocorticism diagnosed?

A

no single test accurate
ACTH stim
LDDS (low dose dexmethasone supression test)

252
Q

how is hyperadrenocorticism treated?

A

trilostane
surgery

253
Q

what is the action of trilostane?

A

blockage of synthesis of cortisol

254
Q

what types of hyperadrenocorticism is trilostane suitable for?

A

PDH
ADH

255
Q

how are patients on medical management for hyperadrenocorticism monitored?

A

clinical signs
ACTH stim
pre-pill cortisol

256
Q

what are the side effects of trilostane?

A

GI signs
iatrogenic hypoadrenocorticism
sudden death

257
Q

when should blood testing be performed after starting or changing doses of trilostane?

A

biochem and ACTH stim 10 days after

258
Q

how often is blood testing needed once patients on trilostane have been tested at 10 days?

A

4 weeks
12 weeks
then every 3 months

259
Q

when is it recommended trilostane be given?

A

in the morning

260
Q

when should ACTH stim be performed after admin of medication?

A

4-6 hours

261
Q

when is pre - pil cortisol measured?

A

when dose is due - if in the am don’t give in the morning and have earliest available appointment

262
Q

what can happen if patients are given trilostane overdose?

A

iatrogenic hypoadrenocorticism - can lead to addisonian crisis

263
Q

what are the signs of Addisonian crisis?

A

hypotension
weakness
bradycardia
severe dehydration
hypovolaemia
collapse

264
Q

what is hypoadrenocorticism caused by?

A

lack of adrenal hormones (glucocorticoids and mineralocorticoids)

265
Q

what animals is hypoadrenocorticism commonly seen in?

A

young to middle aged
female
rare in cats

266
Q

what are the signs of hypoadrenocorticism?

A

vague waxing and waning illness
V
D
weight loss

267
Q

how is hypoadrenocorticism diagnosed?

A

electrolyte abnormalities
ACTH stim

268
Q

how is addisonian crisis treated?

A

IVFT resuscitation
correct electrolytes (glucose and insulin if hyperkalaemic)
start ACTH stim test ASAP

269
Q

how is hypoadrenocorticism treated in the long term?

A

glucocorticoid replacement
mineralocorticoid replacement

270
Q

what drug is used to replace glucocorticoids?

A

prednisolone

271
Q

what drug is used to replace mineralocorticoids?

A

desoxycortone pivalate - Zycortal

272
Q

how is zycortal administered?

A

every 4 weeks injection

273
Q

is pancreatitis an endocrine disease?

A

no - exocrine

274
Q

what causes pancreatitis?

A

idiopathic
dietary indiscretion
trauma
surgery (hypoperfusion under GA)

275
Q

what is actually happening in the pancreas during pancreatitis?

A

pancreatic enzymes prematurely activated - pancreas is digested

276
Q

what are the signs of mild pancreatitis?

A

anorexia
vomiting
abdominal pain
dehydration
lethargy

277
Q

what are the signs of severe pancreatitis?

A

generalised inflammation
DIC
renal failure
multiorgan failure
death

278
Q

how is pancreatitis diagnosed?

A

blood tests not overly reliable
abdominal US

279
Q

how is pancreatitis treated?

A

IVFT
analgesia
anti-emetics
feeding ASAP - may need tube
appropriate diet

280
Q

what diet is appropriate for pancreatitis?

A

palatable
low fat
highly digestible

281
Q

what is the long term nutrition aim for pancreatitis patients?

A

low fat

282
Q

what causes diabetes mellitus?

A

failure of the pancreas to produce insulin

283
Q

what animals is DM more common in?

A

middle aged to older animals
burmese cats

284
Q

what increases the risk of DM?

A

obesity

285
Q

what are the clinical signs of DM?

A

PUPD
polyphagia
weight loss
cataracts
peripheral neuropathy (cats)

286
Q

what is a severe sign of DM?

A

DKA

287
Q

what are the signs of DKA?

A

vomiting
collapse
dehydration

288
Q

what indicates DM on tests?

A

persistent hyperglycaemia
glucosuria
fructosamine elevated

289
Q

how is DM commonly treated in cats?

A

insulin injections
diet
oral liquid - Senvelgo

290
Q

what insulin is used for cats?

A

Pro-zinc

291
Q

what diet is best for diabetic cats?

A

low carb
high protein
calorie controlled
wet food
grazing ok

292
Q

why is wet food best for diabetic cats?

A

improved glycaemic control

293
Q

what is the role of Senvelgo (liquid) in DM management?

A

blocks 90% of glucose reabsorption in the kidney so excess is excreted
still able to reabsorb some to prevent hypoglycaemia

294
Q

why is it important to monitor cats for hypoglycaemia?

A

cats may go into diabetic remission but will often become diabetic again in later life

295
Q

how are dogs with DM treated?

A

caninsulin injections
diet
exercise

296
Q

what is important about diet for dogs with DM?

A

high fibre
high carb
consistent schedule
calorie controlled

297
Q

how is insulin administered?

A

SC SID/BID depending on patient and insuline

298
Q

how often should patients with DM be fed?

A

BID

299
Q

when should insulin be given if giving BID?

A

feed every 12 hours and give insulin at the same time

300
Q

when should insulin be given if giving SID?

A

feed in am before insulin and then 6 hours later at nadir

301
Q

when should insulin be injected in relation to feeding?

A

after or during meal

302
Q

what is essential about food type and quantity if patients are on insulin?

A

type and quantity must stay the same at every meal

303
Q

how can glucose levels be monitored?

A

BG curve
freestyle libre

304
Q

how is a BG curve run?

A

BG measured every 2 hours
owner supplies food and insulin

305
Q

how does freestyle libre glucose monitoring work?

A

continuous
routine as normal

306
Q

how long does it take following insulin dose change for blood glucose levels to stabilise?

A

~7 days

307
Q

where is it recommended first insulin dose is given?

A

whilst hospitalised to monitor for hypoglycaemia

308
Q

what must owners of patients with DM be aware of?

A

signs of hypoglycaemia
and what to do if they suspect their pet is hypoglycaemic

309
Q

what are the signs of hypoglycaemia?

A

weakness
ataxia
depression
altered behaviour
muscle twitching
seizures

310
Q

how should owners manage hypoglycaemic patients if conscious?

A

offer food
if reluctant to eat put honey on gums
contact vet

311
Q

how should hypoglycaemic patients managed by owners if unconscious?

A

rub honey onto gums
phone vet

312
Q

how should hypoglycaemic patients managed by owners if seizuring?

A

phone vet

313
Q

what should be done if owners are unsure if their pet is hypoglycaemic?

A

feed as far safer to elevate blood sugar than risk hypoglycaemia

314
Q

what syringes must be used to give insulin?

A

correct pet specific ones

315
Q

how should insulin be handled?

A

follow manufacturers instructions
often in the fridge
mix gently before administering

316
Q

where should BG samples be taken from each time?

A

same location as capillary blood will have different glucose levels to venous

317
Q

what is key when managing DM patients?

A

consistency
keep diet, exercise and routine the same

318
Q

when is extra care needed for DM patients?

A

if undergoing GA

319
Q
A

Advanced Clinical Nursing Theory (36 decks)

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