Endocrinology - Patient Management Flashcards
what are the clinical signs of feline hyperthyroidism?
Polyphagia, weight loss, tachycardia, palpable enlarged thyroid gland
what medical treatment can be done for feline hyperthyroidism?
anti-thyroid drugs
how can diet treat feline hyperthyroidism?
iodine restricted diet
what surgery can be done to treat feline hyperthyroidism?
thyroidectomy
what other curative method of treatment can be done for feline hyperthyroidism?
radioactive iodine
what does medical management do in terms of giving drugs?
they bloxk synthesis of thyroid hormones, more T4 is produced if an adenoma continues to grow
what are examples of drugs that can treat feline hyperthyroidism?
methimazole or carbimazole
when will a cat with hyperthyroidism be euthyroid after being given medical management?
2-3 weeks
what are the common side effects of anti-thyroid drugs?
- Vomiting, anorexia, lethargy
- Usually minor and transient * 10-20% of cats
what are the rare side effects of anti-thyroid drugs?
- Persistent GI signs
- Bone marrow suppression
- Facial pruritis
- Hepatopathy
- Rare (1-5% of cats) but serious- stop treatment
what are the nursing considerations for feline hyperthyroidism?
- Careful handling
- Often fractious!
- Concurrent disease- cardiac disease, arthritis
- Gabapentin?
- Senior cat clinics- look out for clinical signs of hyperthyroidism as common
in older cats - Often T4 measurement included in senior cat bloods
what treatment monitoring can you do for feline hyperthyroidism?
- Treatment monitoring- often dose increases required over time
- Recurrence, concurrent disease (CKD particularly)
- Every 3-12 months
- Clinical signs
- Blood tests- T4, haem, biochem
- Urine and BP
what dietary management can be done for feline hyperthyroidism?
- iodine restricted
- must be only food they eat for rest of their life
- less effective than other options
what are the disadvantages of feline hyperthyroid diet management?
- Not suitable if severely hyperthyroid
- Not suitable if other dietary requirements- IBD, CKD
- Not suitable for euthyroid cats in household
what is canine hypothyroidism?
- Destruction of thyroid tissue
what are the clinical signs of canine hypothyroidism?
- Weight gain, lethargy, bradycardia, endocrine alopecia, myxoedema
coma
what are the nursing considerations for canine hypothyroidism?
- weight management clinics
- treatment monitoring
- T4 bloods 6-8weeks after starting treatment
- 6-12 months reviews
what is calcium necessary for?
- Muscle contraction and nerve conduction
where is calcium found?
- Mostly stored in bones (with phosphate)
- Found in three forms in blood:
- Ionised- free, biologically active
- Complexed- inactive
- Protein-bound- inactive
what are the hormones of calcium balance?
parathyroid hormone
calcitriol (vitamin D)
calcitonin
what is primary hyperthyroidism?
- One or more parathyroid glands become hyperfunctional and secrete
excess PTH - Usually due to solitary benign tumour
what are the neurological signs of primary hyperparaythyroidism?
weakness, lethargy, exercise intoleracne and trembling
What are the gastrointestinal signs of primary hyperparathyroidism?
reduced appetite, nausea, vomiting and constipation
what are the urinary signs of primary hyperparathyroidism?
PUPD, urolithiasis, UTI
what are the cardiovascular signs of primary hyperparathyroidism?
hypertension and arrythmias
how is primary hyperparathyroidism diagnosed?
- elevated calium often accidental
- blood gas or extenal lab testing
- measure PTH is elevated ionised calcium
how do you treat primary hyperparathyroidism?
surgery
- ultrasound guided glandular ablation by heat or ethanol injection
what is secondary hyperparathyroidism?
chronically low calium leads to eleveated parathyroid hormone leading to renal failure
what are the nutritional causes of secondary hyperparathyroidism?
- dogs and cats fed diet with little or no calium or deficicne tin vitamin D
- high PTH causes calium to be metabolised from bone
- home-made diets can cause this
what is hypoparathyroidism?
low or absent PTH despite low calcium
what causes hypoparathyroidism?
surgical excision of the parathyroid, trauma, idiopathic, immue-mediated, others
what are the clinical signs of hypoparathyroidism?
seizures, muscle fasciculations/ twitching/ cramping, weakness, ataxia, anorexia, vomiting, facial rubbing
how is hypoparathyroidism diagnosed?
meaure ionised calcium, phosporous and parathyroid hormone
how would you treat severely affected hypothyroidism?
iv calcium bolus or cri
how would you treat mild hypothyroidism?
oral calcium supplements and calcitriol (vitamin D)
what should you monitor when giving calcium IV?
heart rate and ECGw
what can happen if you administer calcium IV too quickly?
can cause cardiac arrythmias and cardiac arrest
what can haappen if calcium IV is given too slowly?
bradycardia
if caclium IV has got onto the skin what should you monitor for?
irritation, necrosis
what should you do if calcium has got onto the skin?
infiltrate tissue with saline and manage the wound
what is hyperadrenocortisism also known as?
cushings
what is hyperadrenocorticism?
excessive production of cortisol from the adrenal gland
what types of hyperadrenocorticism are there?
pituitary depedent and adrenal dependent
what are the clinical signs of hyperadrenocorticism?
PUPD, lethargy, endocrine alopecia, pot-belly, thin skin, poor wound healing, panting, polyphagia, calcinosis cutis
how do you treat hyperadrenocorticism?
trilostane which blocks synthesis of cortisol
surgical
what are the side effects of giving trilostane for hyperadrenocorticism?
GI signs, iatrogenic hypoadrenocorticism and sudden death
what are the nursing considerations for a patient with hyperadrenocorticism?
- senior clinics look for signs
- treatment monitoring
- morning doses
what can happen if a patient overdoses on trilostane?
iatrogenic hypoadrenocorticism, full Addisonian crisis causing weakness, lethargy, anorexia, vomiting, diarrhoea and collpase
what is hypoadrenocorticism?
addisons disease, lack of adrenal hormones glucocorticoids and mineralcocorticoids
what patients are affected by hypoadrenocorticism?
young to middle age dogs, any breed more commonly female
what would you see with hypoadrenocorticism?
vague, waxing and waning illness, not quite right, vomiting and diarrhoea and weightloss
what would you see if a patient is in an addisonian crisis?
collapse, hypotension, weakness, bradycardia, severe dehydration, hypovolaemia
how would you treat addisonian crisis?
fluid resuscitation, correct electrolytes, start ACTH stim test
what long term treatment would you give to a hypoarenocorticism patient?
glucocorticoid replacement and mineralocorticoid replacement
what is pancreatitis?
disease of the exocrine pacreas which leads to inflammation of the pancreas, usually idiopathic, dietary indiscretion, trauma, surgery
what happens during pancreatitis?
the pancreatic enxymes are activated prematurely which leads to the pancreas staring to ingest itself
what are the clinical signs of mild pancreatitis?
anorexia, vomiting, abdominal pain, dehydration, lethargy
what are the clinical signs with severepancreatitis?
generalised inflammation, DIC, renal failure, muliorgan failure, death
what are the clinical signs of pancreatitis in cats?
jaundice
how would you treat pancreatitis?
IVFT, monitoring for systemic signs, analgesia, anti-emetics, feeding tubes, palatable, low fat highly digestible diet
what long term treatment would you provide for a patient with pancreatitis?
low fat diet for dogs
what is diabetes lmellitus?
failure for the pancreas to produce insulin
what are the clinical signs of diabetes mellitus?
PUPD, polyphagia and weightloss, cataracts (dogs) and peripheral neuropathy (cats)
what are the clinical signs of diabetic ketoacidosis?
vomiting, collapse, dehydration
how do you treat diabetes mellitus in cats?
insulin injections
low carb high protein diet that is calorie controlled, wet food and consistent feeding schedule
- oral liquid senvelgo
how do you treat diabetes mellitus in dogs?
- insulin injections
- diet - high fibre high carb, consitent schedule, calorie controlled
- exercise
how do yo give an insulin injection?
subcut either once of twice a day depending on the patient and the type of insulin
how often should a patient be fed on insulin?
if twice a day, feed every 12 hours at the same time as the insulin
if once a day feed in the morning before insulin and then again 6 hours later
how do you monitor diabetes mellitus?
- measure blood glucose every 1-2 hours using blood glucose curve
- if using freesytle libre this is continuous monitoring
how long does it take for blood glucose levels to stabilise following an insulin dose chage?
7 days
what are the signs of hypoglycaemia?
weakness, ataxia, depression, altered behaviour, muscle twitching and seizures
how would you treat a patient who is hypoglycaemia?
offer food, rub honey on gums if reluctant to eat, rub honey on gums if unconscious
what is impotant to rememebr when measuring blood glucose?
take samples from the same location, capillary blood has different glucose level to venous
what should you do before giving insulin?
mmix the bottle gently
