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Applied Clinical Veterinary Nursing > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

What are some surgical conditions of the thyroid?

A

Functional (producing thyroid hormones) / non-functional
Benign e.g. adenoma, adenomatous hyperplasia, cysts
Malignant neoplasia e.g. carcinoma, adenocarcinoma

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2
Q

Describe benign thyroid masses in dogs vs cats.

A

Dogs = typically small, non-functional, rarely diagnosed
Cats = typically functional, cause hyperthyroidism

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3
Q

What pre-op considerations should we have for thyroidectomy patients?

A

ASA status - systemic effects of hyperthyroidism, BCS/MCS
Metastasis?
CVS / renal / ocular / co-morbidities
Medical stabilisation
Complications

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4
Q

Describe a thyroidectomy.

A

Wide clip, dorsal recumbency
Ventral midline approach to neck
Unilateral / bilateral thyroidectomy +/- parathyroidectomy
Sometimes reimplanting parathyroid tissue will allow for neovascularisation

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5
Q

What complications of a thyroidectomy can we see?

A

Surgical technique and skill
Haemorrhage
Seroma formation
Laryngeal paralysis (if recurrent laryngeal nerves damaged)
Horners (damage to sympathetic trunk)
Hypocalcaemia - iatrogenic hypoparathyroidism
Recurrence

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6
Q

Describe the parathyroid.

A

2 pairs of parathyroid glands - intracapsular (caudal) and extracapsular (cranial)
Secrete PTH - increases blood calcium

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7
Q

What is primary hyperparathyroidism?

A

Parathyroid tumour produces excess PTH
Other parathyroid glands stop functioning normally - risk of hypocalcaemia post-op before they begin functioning again

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8
Q

How do we treat primary hyperparathyroidism?

A

Medical - ethanol injection/heat ablation
Parathyroidectomy

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9
Q

What pre-op considerations should we have for parathyroidectomy patients?

A

ASA status - systemic effects of hyperparathyroidism (hypercalcaemia), co-morbidities
Medical stabilisation e.g. diuresis, renal support
Complications

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10
Q

Describe a parathyroidectomy.

A

Wide clip, dorsal recumbency
Ventral midline approach to neck
Almost always going to remove one of four parathyroid glands
If intracapsular, likely to remove associated thyroid

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11
Q

What are some possible complications of parathyroidectomy?

A

Haemorrhage
Seroma formation
Laryngeal paralysis
Horners
Hypoparathyroidism - hypocalcaemia

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12
Q

What post-op care should we provide to parathyroidectomy patients?

A

IVFT
Analgesia - avoid NSAIDs
Monitor for complications - renal function, hypocalcaemia

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13
Q

Describe the risks of iatrogenic hypoparathyroidism associated with unilateral thyroidectomy.

A

Removes 1 of 2 thyroids
Removes 1 of 2 caudal parathyroids, but cranial may be damaged
Low risk hypocalcaemia
Low risk hypothyroidism

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14
Q

Describe the risks of iatrogenic hypoparathyroidism associated with bilateral thyroidectomy.

A

Removes 2 of 2 thyroids
Removes 2 of 2 parathyroids, but cranials may be damaged
Higher risk hypocalcaemia
High risk hypothyroidism

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15
Q

Describe the risks of iatrogenic hypoparathyroidism associated with unilateral parathyroidectomy.

A

Removes 1 of 2 thyroids
Removes 1 of 2 parathyroids, but cranials may be damaged/already suppressed
Highest risk hypocalcaemia
Low risk hypothyroidism

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16
Q

What are the clinical signs of iatrogenic hypoparathyroidism?

A

Within 2-3 days - inappetence, weakness/lethargy, ptyalism, pawing at face
Advanced - muscle fasciculation, tremors, tetany, seizures, coma/death
Only treat hypocalcaemia if clinical signs present!

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17
Q

How can we treat hypocalcaemia?

A

Oral vitamin D pre-op (takes 24-48hrs to have an effect)
Oral calcium (takes 1-3 days to work)
IV calcium - if clinical signs / VERY low blood calcium levels

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18
Q

Which pancreatic conditions are surgical?

A

Endocrine - insulinoma
Exocrine - exocrine pancreatic neoplasia
Pancreatic abscessation
Pancreatic cysts

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19
Q

Describe insulinomas.

A

Malignant carcinoma
Often metastasise to LNs and liver

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20
Q

What are the clinical signs of an insulinoma?

A

Lethargy
Tremors, seizures, collapse
Peripheral neuropathy
Extreme hypoglycaemia (<2mmol) in an upright dog!

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21
Q

How do we diagnose an insulinoma?

A

Bloods (insulin/glucose ratio)
Imaging

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22
Q

How do we manage insulinoma patients pre-op?

A

Feeding - q4-6hrs, diabetic food
Gentle, regular exercise
Manage hypoglycaemia - intervene if needed

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23
Q

How do we manage a hypoglycaemic crisis?

A

Give oral glucose first e.g. jam!
One-off IV glucose
Glucose infusion
Stop once start to improve

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24
Q

How do we carry out a partial pancreatectomy for an insulinoma?

A

Dextrose infusion throughout, glucose monitoring
Gentle technique to reduce pancreatitis risk
Small nodule <1cm in diameter, can be difficult to find!
Check liver for micrometastasis

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25
Q

What post-op care should we provide to insulinoma patients?

A

Feeding - as pre-op, +/- feeding tube
Exercise - as pre-op
Hypoglycaemia - if not normalising, indicates presence of missed micrometastasis
Drugs - IVFT, analgesia, steroids, chemo for residuals

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26
Q

What are the possible complications of insulinoma removal?

A

Persistent hypoglycaemia
Transient hyperglycaemia
Pancreatitis
Can develop Diabetes Mellitus

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27
Q

What are some adrenal gland surgical conditions?

A

Adrenal mass - benign/malignant, primary/secondary
Secondary adrenal enlargement (pituitary-dependent!)

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28
Q

What are the clinical signs of adrenal gland disease?

A

None
Functional - overproduction from cortex/medulla
Haemoabdomen

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29
Q

What are the clinical signs of overproduction from cortex in adrenal disease?

A

Conns syndrome - mineralcorticoids e.g. aldosterone
Cushings - glucocorticoids e.g. cortisol
Masculinising syndrome - androgen e.g. testosterone

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30
Q

What are the clinical signs of overproduction from medulla in adrenal disease?

A

Phaeochromocytoma - catecholamines e.g. norepinephrine/epinephrine (intermittent hypertension)

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31
Q

What pre-op considerations should we have for adrenalectomy patients?

A

Systemic effects e.g. hypokalaemia, endogenous steroid, excess adrenaline/noradrenaline
Co-morbidities
Medical stabilisation
Unilateral vs bilateral

32
Q

How do we manage adrenalectomy patients peri-op?

A

Monitoring ECG for arrhythmias, BP, electrolytes
Drugs as needed

33
Q

What are some possible intra-op complications with an adrenalectomy?

A

Tumour rupture
Haemorrhage
Tachycardia/arrhythmias - may need propranolol/lignocaine
Hyper/hypotension
May need supplementation of gluco/mineralocorticoids - dexamethasone, electrolytes

34
Q

What post-op complications can we see with adrenalectomy patients?

A

Electrolyte abnormalities
Hyper/hypotension
Adrenal insufficiency - iatrogenic Addison’s
Delayed healing
Pulmonary thromboembolism

35
Q

Describe feline hyperthyroidism.

A

Most common endocrine condition in cats, usually over 10yrs old
Benign tumour that secretes excess thyroid hormone (uni/bilateral)
Often concurrent disease e.g. HCM, CKD, hypertension

36
Q

What are the clinical signs of feline hyperthyroidism?

A

Polyphagia
Weight loss
Tachycardia
Palpable enlarged thyroid gland

37
Q

How do we treat feline hyperthyroidism?

A

Anti-thyroid drugs, iodine-restricted diet (lifelong)
Thyroidectomy
Radioactive iodine

38
Q

What medications can be used to treat hyperthyroidism?

A

Drugs block synthesis of thyroid hormone
Methimazole / carbimazole
Normally euthyroid in 2-3 weeks

39
Q

What are some common side effects of anti-thyroid drugs?

A

Vomiting, anorexia, lethargy
Usually minor and transient

40
Q

What are some rare side effects of anti-thyroid drugs?

A

Persistent GI signs
Bone marrow suppression
Facial pruritis
Hepatopathy

41
Q

What nursing considerations should we have for cats with hyperthyroidism?

A

Careful handling - often fractious, concurrent disease, consider gabapentin?
Senior cat clinics - look for clinical signs/measure T4 in bloods
Treatment monitoring every 3-12 months - bloods, urinalysis, BP

42
Q

Describe dietary management for feline hyperthyroidism.

A

Iodine-restricted (iodine required to synthesis thyroid hormone)
Must be fed as sole food, lifelong
Can be euthyroid within 3 weeks

43
Q

What causes canine hypothyroidism?

A

Destruction of thyroid tissue
Middle-aged dogs

44
Q

How can we treat canine hypothyroidism?

A

Oral synthetic T4 - sodium levothyroxine

45
Q

What nursing considerations should we have for dogs with hypothyroidism?

A

Weight management clinics and dermatological clinical signs
Treatment monitoring every 6-12 months (6-8 weeks after starting, 2-4 weeks after dose adjustment)

46
Q

What hormones control calcium balance?

A

Parathyroid hormone - from parathyroid gland
Calcitriol (vitamin D) - from kidney
Calcitonin - from thyroid gland

47
Q

What are the clinical signs of primary hyperparathyroidism?

A

Neuro - weakness, lethargy, exercise intolerance
GI - reduced appetite, nausea, vomiting, constipation
Urinary - PUPD, urolithiasis, UTI
CVS - hypertension, arrhythmias

48
Q

How do we diagnose primary hyperparathyroidism?

A

Often elevated calcium is an incidental finding
High total calcium does not necessarily mean elevated ionised calcium
If elevated iCa then measure PTH

49
Q

How can we treat primary hyperparathyroidism?

A

Most common and effective = surgery
OR ultrasound-guided glandular ablation by heat/ethanol injection

50
Q

What can cause secondary hyperparathyroidism?

A

Chronically low calcium leading to elevated PTH
Renal failure
Nutritional - diet with little/no calcium or deficient in vitamin D

51
Q

What can cause hypoparathyroidism?

A

Low or absent PTH despite low calcium
Surgical excision of parathyroid
Trauma, idiopathic, immune-mediated etc.

52
Q

What are the clinical signs of hypoparathyroidism?

A

Seizures
Muscle fasciculations/twitching/cramping
Weakness, ataxia
Anorexia, vomiting
Facial rubbing

53
Q

How do we diagnose hypoparathyroidism?

A

Measure iCa, phosphorous, PTH

54
Q

How do we treat hypoparathyroidism with mild clinical signs?

A

Oral calcium supplements and calcitriol (vitamin D)

55
Q

How do we treat severe life-threatening hypoparathyroidism?

A

IV calcium - bolus/CRI
Close monitoring essential (HR, ECG)
Administer slowly

56
Q

Describe hyperadrenocorticism (Cushing’s disease).

A

Excess production of cortisol from adrenal gland
Mostly dogs, very rare in cats
Pituitary-dependent (PDH) vs adrenal-dependent (ADH)
Or iatrogenic (admin of glucocorticoids)

57
Q

What are the clinical signs of hyperadrenocorticism?

A

PUPD, lethargy
Endocrine alopecia
Pot-belly, thin skin
Poor wound healing
Panting, polyphagia
Calcinosis cutis

58
Q

How do we treat hyperadrenocorticism?

A

Trilostane (blocks synthesis of cortisol)
Suitable for PDH and ADH
Monitor - clinical signs and ACTH stim
Side effects uncommon - GI signs, iatrogenic hypoadrenocorticism, sudden death

59
Q

What nursing considerations should we have for hyperadrenocorticism?

A

Senior clinics - look for clinical signs
Treatment monitoring (10 days after starting, then 4 weeks, 12 weeks then every 3 months)
Iatrogenic hypoadrenocorticism causing Addisonian crisis

60
Q

Describe hypoadrenocorticism (Addison disease).

A

Lack of adrenal hormones (glucocorticoids and mineralocorticoids)
Young to middle-age dogs, rare in cats
Often vague, waxing and waning illness

61
Q

What are the clinical signs of an Addisonian crisis?

A

Collapse
Hypotension
Weakness
Bradycardia
Severe dehydration and hypovolaemia

62
Q

How do we diagnose hypoadrenocorticism?

A

Electrolyte abnormalities
ACTH stim test

63
Q

How do we treat an Addisonian crisis?

A

Fluid resuscitation
Correct electrolytes - IV glucose and insulin if severe hyperkalaemia
Start ACTH stim ASAP

64
Q

How do we treat hypoadrenocorticism long-term?

A

Glucocorticoid replacement (low dose prednisolone)
Mineralocorticoid replacement (Desoxycortone pivalate, injection every 4 weeks for life)

65
Q

Describe pancreatitis.

A

Disease of exocrine pancreas
Inflammation of pancreas - idiopathic / dietary indiscretion, trauma, surgery
Pancreatic enzymes prematurely activated - start digesting pancreas

66
Q

What are the clinical signs of mild pancreatitis?

A

Anorexia
Vomiting
Abdominal pain
Dehydration
Lethargy

67
Q

What are the clinical signs of severe pancreatitis?

A

Generalised inflammation
DIC
Renal/multiorgan failure
Death

68
Q

How can we treat pancreatitis?

A

Supportive care - IVFT, monitoring for systemic signs, analgesia
Nutritional support essential - anti-emetics, tube feeding, low fat highly digestible diet

69
Q

Describe diabetes mellitus.

A

Failure of pancreas to produce insulin
Middle-aged to older, dogs and cats
Dogs require insulin injections, cats may not

70
Q

What are the clinical signs of diabetes mellitus?

A

PUPD
Polyphagia and weight loss
Cataracts (dogs)
Peripheral neuropathy (cats)
Diabetic ketoacidosis (DKA) - vomiting, collapse, dehydration
Persistent hyperglycaemia

71
Q

How do we treat diabetes mellitus in cats?

A

Insulin injections
Diet - low carb, high protein, calorie-controlled
Cats can go into diabetic remission - so monitor for hypoglycaemia!

72
Q

How do we treat diabetes mellitus in dogs?

A

Insulin injections
Diet - high fibre high carb, calorie-controlled, consistent schedule
Exercise

73
Q

What are the signs of hypoglycaemia?

A

Weakness, ataxia
Depression
Altered behaviour
Muscle twitching, seizures

74
Q

What nursing considerations should we have for diabetic patients?

A

Must use correct syringes for type of insulin administered
Correct storage of insulin
BG measurements - take samples from same location
Consistency in lifestyle is key!
Extra care when undergoing GA

75
Q
A

Applied Clinical Veterinary Nursing (40 decks)

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