Exam 1 Flashcards

Question

Difference between crystalloid & colloid fluids? Provide Examples of each. \*\* Learning Objective\*\*

Answer 1

**1. _Crystalloids_:** Solutes (electrolytes & non-electrolytes) that **can move freely around the fluid compartments**. Divided into groups based on tonicity (ability to shift water across semipermeable membranes) =Hypotonic, hypertonic and isotonic. **2. _Colloids_:** Larger molecular weight. **Remain in intravascular space** & keep fluid in intravascular space. Compare to crystalloids which end up in interstitial spaces. Natural: plasma, whole blood Synthetic: hetastarch, dextran, pentastarch, ‘oxyglobin’

Answer 2

* **Hypotonic:** Lower osmolality than intravascular fluid so **draws fluid into cells**. * Ex. 0.45 % NaCl, 5 % dextrose in water * **Hypertonic:** Higher osmolality than blood cells and plasma. Will draw fluids from interstitial & intracellular spaces into intravascular space. * Ex: 7.5 % NaCl solution, 5% dextrose in following: Normosol M, 0.45 % NaCl, 0.9% NaCl, **LRS**, Plasmalyte 56 . * **Isotonic:** Same osmolality as blood cells and plasma so fluids will neither exit or enter cells. Used for perfusion support & volume replacement. * Ex: 0.9 % NaCl, Ringer’s solution, LRS, Normosol R, Plasmalyte A, 0.45 % saline with 2.5 % dextrose

Answer 3

Hetastarch

Answer 4

Isotonic crystalloids LRS

Answer 5

1. correct dehydration 2. expand vascular space in shock 3. correct electrolyte/acid-base imbalances

Answer 6

Synthetic Colloids: hetastarch, dextran, pentastarch, ‘oxyglobin’ **Hetastarch** is most commonly used!

Answer 7

**Peripheral edema** Since crystalloids are freely permeable to enters cell membranes. 2/3 enters interstitial space. Most common if too much, too rapidly and if the patient has low albumin or heart condition

Answer 8

* **_fluid replacement_ -** Na concentration is **close to normal plasma Na** of about 140 mmol/l * Can give rapidly! * Designed to replace fluid loss * K is similar to that as plasma * Ex. Ringers, LRS, Normosol R, 0.9 % saline, PlasmaLyte * **_fluid maintenance_** - Na conc is **close to normal total body conc** of about 70 mmol/l * DONT give rapidly * Designed to replce daily Na losses without Na overload * Poor at explanding blood volume and thus often combined with colloids in patients with low albumin * Some lack K, so you should add it * Ex. Normosol M, 0.45 % NaCl with 2.5 % dextrose, PlasmaLyte 56

Answer 9

Switch from replacement to maitenance after 24 hours If used for longer periods, patient may become hypernatremic which can lead to swelling of the brain and then CNS signs. If replacement fluids are used for maintenece , you should add K and should monitor serum Na.

Answer 10

**To save money**. You dont want to charge client for additional bags of fluids when they have not finished one. Also so the hospital does not have to stock as many types of fluids. Problems: **hypernatremic** patient --\> brain swelling --\> CNS signs. Should add K and monitor Na levels.

Answer 11

* **(1) _Natural_:** used when goal is to restore RBCs, clotting factors, AT III, or albumin * **Plasma:** if albumin, AT III, clotting factors needed * **Whole blood:** if RBCs needed -- only if animal is ANEMIC * **(2)** **_Synthetic:_** used when goal is t**o rapidly improve perfusion** in patient that does not have obvious blood loss or clotting problem. Often used in addition to regular fluid therapy. * **Dextran** -Polysaccharide * Adv: isotonic. Stored at room temp. Increases plasma vol 1.38 x the vol. infused. * Disadv: increase in BMBT, PTT but no clinical bleeding. Fibrinogen conc decreases. Blood glucose level may increase. * **Hetastarch**: most commonly used synthetic colloid in vet med

Answer 12

Used in cases that need **oncotic support but don’t need clotting factors** Increases plasma volume by 1.37% of volume infused Most commonly used synthetic colloid- last longer than dextran in circulation. Ex: Cases with low albumin (vasculitis, PLN, PLE, liver failure, sepsis, etc) **Contraditions:** heart failure & cats get restless and/or salivate

Answer 13

Heart failute Some cats get restless and/or salivate

Answer 14

Fluid overload and pulmonary edema Coagulopathy Renal failure Human albumin: could cause life threatening allergic reaction in dogs

Answer 15

Isotonic Replacent fluids which can be given rapidly

Answer 16

Because **most patients with functioning kidneys** will simply **increase renal sodium loss** to compensate when hypernatremic. big problems occur when impaired kidney function and if **Na \>170** --\> Salt toxicity--\> swelling of brain --\> CNS signs

Answer 17

YES! But remeber.... * **Colloids are not used to replace dehydration deficits** because you need crystalloid to get into interstitial and intracellular spaces * Colloids are helpful to **keep fluids in intravascular space** so used in cases with **low albumin or vasculitis or those with peripheral edema or ascites.** * By combining both you decrease the amount of crystalloid you have to use and restore the fluid deficit of intravascular space more rapidly.

Answer 18

* Start **replacement crystalloid** to correct for dehydration * **Piggy-back a colloid** (plasma would be good choice, but could use hetastarch if you didn’t have plasma). * Once you calculate the mls of colloids you will be using, subtract that number from the calculated dehydration deficit. By using colloid, you decrease the amount of crystalloid you have to use. * If you gave only replacent fluids you run the risk of those fluids causing **peripheral edema/ascities/pleural effusion** because of the low oncotic pressure from low albumin

Answer 19

* **Beware of using high Na-containing fluids (replacement fluids)** to patients with known or suspected cardiac disease. * The high sodium load can unmask pre-clinical congestive heart failure, as water follows sodium, and volume overload can result. * The ‘classic’ fluids for a cardiac patients are **0.45% NaCl** (as opposed to 0.9%) and are **made isotonic through the addition of dextrose.**

Answer 20

**0.45% NaCl** that is made isotonic through the **addition of dextrose.**

Answer 21

Due to obligate renal K loss, patient who are not eating will become hypokalemic within dats. The amount added is based on the patients existing K levels and the "sliding scale of scott" \*\*NEVER give more than 0.5 mEq/kg/hr (Kmax)\*\*

Answer 22

Chart/Table that helps detemine how much K to add to a liter of fluids based on the patient's current K levels. If have only 1/2 a bag of fluids, just add half as much that is indicated! Never give more than the Kmax = 1/2 of the animals body weight= 0.5 mEq/kg/hr

Answer 23

**0.5 mEq/kg/hr** half of the body weight (kg) Never give more due to life threatening hyperkalmia can result in death

Answer 24

(1) large dogs that are in shock due to **gastric dilatation-volvulus;** (2) patients that should not receive large volumes of fluid , e.g. those with **head trauma or cerebral edema** Hypertonic saline pulls fluid into vascular spaces from interstitial and intracellular spaces (short lived). Used to replace volume deficit with less fluid in hypervolemic shock and improves blood flow. It is useful in patient that need to recieve a large amount of fluid quickly. Hypertonic saline is normally diluted with a colloid solution to 7% (Ex. To achieve a 7.5% dilution, add 17 ml of 23% hypertonic saline solution to 43 ml of a colloid solution in a 60 ml syringe.) Never give to a dehydrated animal!

Answer 25

* _Indications of hypertonic saline_: * Cases of hypovolemic shock that do not have dehydration or hypernatremia * Head trauma cases * _Contraindications of hypertonic saline:_ * Dehydration * Hypernatremia * _Side effects_ * Rapid administration may cause **bronchoconstriction, bradycardia & hypotension** * Dose: Over a 20-minute period, dogs should receive 4 to 7 ml/kg; cats ½ this dose.

Answer 26

Used in mild dehydration ONLY IF the GI function is normal (no vomit), airway is controlled and if mental status is ok. Common in large animals

Answer 27

In pediatric and/or severly dehydrated patients. Usually femur (trochanteric fossa) or humerus (greater tubercle)

Answer 28

For dehydration and shock

Answer 29

Most commonly in chronic renal failure or parvo puppy that cannot pay to stay in hospital. DONT swab with alcohol or use fluid with glucose Will want to warm isotonic fluids in warm water before giving.

Answer 30

cutting the skin over a vein so you can see it...

Answer 31

Perfusion parameters: **HR, CRT, MM, Pulse pressure, temperature, blood pressure** **\*\* KNOW THESE\*\*\***

Answer 32

1 pound = 500 ml Weight is a good indication if you are correctly/keping up with fluid loss.

Answer 33

Fluid loss from intracellular &/or interstitial spaces; occasionally the vascular space (in that order). Loss of total body water _Causes_: inadequate water intake, excessive fluid losses from vomiting, diarrhea, polyuria without compensatory polydipsia, peripheral edema **_Sign_**s: – Decreased skin turgor – Tacky or dry mucous membranes – Sunken eyes

Answer 34

Subclinica- undetectable

Answer 35

Mild dehydration = 5-7% (7%) Subtle loss of skin elasticity tacky mucous membranes

Answer 36

Moderate dehydration = 10% Prolonged skin tent Tacky MM Signs of volume depletion Proloned CRT (CRT \>2 sec)

Answer 37

Severe dehydration = 13% Skin tent stands in place Tacky MM Sunken eyes \>2 sec CRT depressed Maybe signs of shock (tachycardia, poor pulse)

Answer 38

_Dehydration_: fluid loss from **intracellular & /or interstitial space**; sometimes vascular space if severe dehydration _Hypovolemic shock_: fluid loss from **vascular space**. Results in inadequate oxygen delivery to tissues.

Answer 39

Fluid deficit in liters = % dehydrated x body weight in kg – Ex: 10 % dehydrated x 10 kg = l liter needed

Answer 40

Some differences in formulas. 40-60 mL/kg/day (dog high end; cat low end). During fever, the maintenance rate increases an extra 15-20 mL/kg/day (total 55-80 ml/kg/day) Has to be given over 24 hours, even if the patient wont be there the whole time

Answer 41

Estimate of losses that occur from diarrhea, vomiting, polyuria, or ‘third space’ sequestration. Some use the same number as daily maintenance and then just double it.

Answer 42

Give 50% of the dehydration deficit over 4-6 hours. Then give the remaining 80%-100% of the remainder of the dehyration deficit fluid over the next 6 ish hours. Maintian daily maitnance and ongoing fluid loss rates on a 24 hour basis.

Answer 43

Give 50% of the dehydration deficit fluid amount over 4 hours. Re-asses, then give the remainder of the dehydration deficit fluid amount over the remaining 20 hours (if no changes upon re-assesment) Keep maitnance and on-going loss amounts on 24 hours basis.

Answer 44

1L or 1000 ml | (ideally over 24 hours)

Answer 45

_Dehydration deficit_ Fluid deficit in liters = % dehydrated x body weight in kg Can give over 6-24 hours. Re-asses as needed. _Daily maintenance_: 40-60 mL/kg/day (dog high end; cat low end). During fever, increase an extra 15-20 mL/kg/day. Give over 24 hours _Ongoing fluid losses_: – Measure the losses (catheter, measure the vomit, weigh pee pad) --or-- estimate by doubling maintenance. Give over 24 hours. Re-asses as needed.

Answer 46

Shock fluid dose: **90 ml/kg/hr dog**; **45-60 ml/kg/hr cat.** **Give 1/4 of the dose within 15 minutes then reasses**. Can calculate 1/4 of dose simply by adding a zero to the animals weight in _pounds_ to get the mls of fluid | (represent the total blood volume)

Answer 47

**Replacement crystalloids** Sometimes hypertonic saline in GDV or head trauma HBC patient. (NOT when dehydrated or if cardiac issues)

Answer 48

See Answer Key

Answer 49

See Answer Key

Answer 50

See answer key

Answer 51

Hypovolemic (hemorrhagic, non-hemorrhagic, redistribution) Cardiogenic Vasodilatory or Distributive Obstructive Combination of above

Answer 52

_Hemorrhagic_- blood loss (ususally **\>15%** of blood volume) _Non-hemorrhagic_ - vomit, D, wounds, burns, polyuria _Redistribution_- fluid shift to body cavitis, bowel, peripheral tissues.

Answer 53

Due to: (1) Acquired heart disease (myocardial trauma, myocarditis, pericardial tamponade, arrythmias) (2) Congenital heart disease (3) Anesthetic overdose

Answer 54

Obstruction to flow: GDV, pericardial effusion, venous thrombosis, tension pneumothorax USUALLY obstruction of venous return (as in GDV), but sometimes it is arterial obstruction (e.g. saddle thrombus) Rx: relieve obstruction and use IV fluids

Answer 55

_Dog_: GI and Liver _Horse_: GI and Lungs _Cat & Ruminants, Pig_: Lungs

Answer 56

THE BIGGEST AND SHORTEST ONE YOU CAN GET IN!! **18-20 g in CATS** **14-18 in DOGS** use intraosseous if no acess (femur, humeral shaft, tibial crest)

Answer 57

Patients with projectile vomiting or patients with a metabolic alkalosis 0.9% NaCl is more acidic than isotonic palanced pH fluids (ie normosol R, PlasmaLyte A, LRS)

Answer 58

YES! Piggy back colloids onto it.

Answer 59

Hypertonic saline helps draw fluid into the intravascular space - resulting in a rapid, but transient, increase in circulating volume. Concurrent colloid use allows hypertonic saline tostay in the vascular space for longer. Then follow with crystalloids at maintenance.

Answer 60

Transfusion of whole blood and packed RBC. Transfusion of oxyglobin Dog universal donor (DEA 1.1 neg) Recommend cross matching or typing in cats, if possible.

Answer 61

Binds to pulmonary O2 and carries it to tissues Able to pass through microcirculation _Indications_: severe anemia, hypovolemic shock caused by blood loss or maldistribution of blood Has vasoconstrictive effect (reduces needed volume) (NOT in USA =/)

Answer 62

* Fluid therapy as noted for hypovolemic shock * Broad-spectrum antibiotics based on suspected pathogen (do you remember the GI bugs?) * If peritonitis: surgical exploration/drainage * Cover for GI ulceration with what? * Heparin to improve efficacy to antithrombin III in neutralizing activated coagulation factors. * Oxygen via cage, nasal catherter, face mask, ventilator. * Vasopressor considered if: * Jugular vein distended * Crackles are heard on auscultation * CVP \> 10 cm H20 * All these parameters tells us that continued administration of IV fluids or blood/blood products is contraindicated (due to fluid overload) * Prognosis very guarded in these cases * Intestinve care needed * Vasodepressors: dopamine, dobutamine

Answer 63

* Oxygen * Minimal fluid therapy until caridiac function can be accurately determined * CHF = furosemide * Arrhythmias = manage appropriately * Vasodilators * Positive inotropes

Answer 64

Systemic Inflammatory Response Syndrome = Imbalance of pro-inflammatory (excess) & anti-inflammatory mediators (not enough) on a systemic scale in response to an insult. * Pro-inflammatory cytokine: TNF, IL 1, IL 6 * Anti-inflammatory cytokine: IL 4, IL 10, IL 13 * Other molecules that up-regulate inflammation: leukotrienes, prostaglandins, thromboxanes, nitric acid, platelet activating factor, free radicals Inflammation is a normal response to infectious and non-infectious insults, characterized by pain, heat, redness, swelling and loss of function. Usually inflammation in contained. SIRS results when inflammation is NOT CONTAINED

Answer 65

_Non-infectious causes of SIRS_ * Hypotension * Trauma & hemorrhage * Hypoxia & ischemia * Pancreatitis * Burns * Neoplasia

Answer 66

* Initial event primes the immune system (Ex: HBC trauma) * Second event occurs (loss of blood leading to hemorrhagic shock) * Second event can result in excessive inflammatory response because immune system has been primed

Answer 67

**Multiple Organ Dysfunction Syndrome (MODS)** * Altered function of 1 or more organs in an acutely ill patients such that homeostasis cannot be maintained without intervention * Mortality 50 + % * Can be progression of SIRS or septic shock * Respiratory failure, hepatic failure, GI bleeding, renal failure, etc. leading to hypovolemic, vasodilatory or cardiogenic shock and death.

Answer 68

SIRS-Systemic Inflammatory Response Syndrome

Answer 69

Secretory Malabsorptive/Maldigestive Osmotic They are clinically indistinguishable. In clinical practice, it is rare to have diarrhea as a result of only 1 mechanism.

Answer 70

1. Villous atrophy 2. Unabsorbed nutrients create osmoticcomponent to diarrhea 3. Colonic fermentation ensues 4. Production of D-Lactate(calves) 5. Toxin stimulates increased H2O and electrolyte secretionby gut epithelium (crypt cells)

Answer 71

Damage to the villus tips causes: 1) Proliferation of immature crypt cells 2) Relative increase in secretion

Answer 72

Voluminous, bulky stools with high osmolarity Steatorrhea With fasting, diarrhea usually abates

Answer 73

_Secretory, Maldigestive/Malabsorptive Diarrhea = Net losses of_: 1. Water and **_sodium_** 2. Potassium 3. Bicarbonate (metabolic acidosis) _Osmotic Diarrhea = Net losses of_: 1. Water 2. Potassium 3. Bicarbonate

Answer 74

mOsm of solute/kg of solvent (mOsm/kg) Determined by the **_number_** of particles in solution.

Answer 75

* **Ineffective osmoles**--Diffuse across membranes * **Effective osmoles--**_DO NOT_diffuse across membranes * Effective osmoles create an osmotic gradient and pull water across the membrane. * **Osmolality of ECF = 2(Na +K) + glucose/20 + BUN/3** * **Tonicity** = Effective osmolality

Answer 76

1) Hypertonic Dehydration 2) Isotonic Dehydration 3) Hypotonic Dehydration The name reflects the tonicity of the ECF after water is lost.

Answer 77

_Pathogenesis_ Increased solutes in the ECF --\>creates osmotic gradient --\> H2O moves from ICF to ECF to maintain volume _Biochemical changes_ PCV and TP increase Na+ and Cl-increase= hyperosmolality _Causes_ 1. **Osmotic diarrhea** * Nonabsorbable solutes accumulate in the gut lumen --\> H2O moves from plasma into the gut * Plasma becomes hypertonic 2. **Maldigestion/Malabsorption** * Damage to intestinal epithelial barrier * Disrupts absorptive pathways

Answer 78

1. Osmotic diarrhea * Nonabsorbable solutes accumulate in the gut lumen --\> H2O moves from plasma into the gut * Plasma becomes hypertonic 2. Maldigestion/Malabsorption * Damage to intestinal epithelial barrier * Disrupts absorptive pathways

Answer 79

_Pathogenesis_= Water loss = electrolyte loss * Decrease in ECF volume * _No_ change in osmolality, _no_ osmotic pressure * _No_ shift between the ICF and ECF _Biochemical changes_ * PCV and TP increase * Serum Na+and Cl-*_do not_ change* ** _Causes_ * Some diarrheas * Some renal diseases

Answer 80

Most Common, especially in diarrhea _Pathogenesis_ : Electrolyte loss \> Water loss * water shifts from vasculature to cells * volume depletion and cerebral edema _Biochemical Changes_ * PCV and TP increase * Na+ decreases = hypoosmolality _3 Causes_ * Secretory diarrhea (calf scours) * Vomiting * 3rd space loss (Displaced abomasum & GI atony)

Answer 81

* Volume* is regulated by adjusting **[Na]** * Osmolality* is regulated by adjusting **H20 balance**

Answer 82

*Volumeis regulated by adjusting [Na+]*= Influenced by changes in vascular pressure * Renin-Angiotensin-Aldosterone System (RAAS) * Aldosterone acts on the kidney to conserve Na and excrete K. Water will follow Na abck into the body. * ADH will also be released for hypovolemia * Osmolalityis regulated by adjusting H2O balance.* = Influenced by 1-2% change in osmolality * ADH release --\> Thirst & ↑ H2O resorption from the kidney

Answer 83

GI losses of Na, Cl, K, +/- HCO3 **in secretory diarrhea** * Loss of Na and H20--\> hypotonic dehydration BUT remeber, in **Osmotic diarrhea**... * Nonabsorbable solutes accumulate in the gut lumen --\> H2O moves from plasma into the gut * Plasma becomes hypertonic due to hypernatremia

Answer 84

[HCO3-] in intestinal fluid \> [HCO3-] in plasma because.... 1. Biliary and pancreatic secretions 2. Secretion of HCO3-in exchange for Cl-in the ileum

Answer 85

1. Loss of buffering system --\> acidosis --\> H+/K+ shifts 2. Loss of electroneutrality --\> kidney retains Cl- --\> ↑[Cl-]

Answer 86

K is lost in diarrhea but this loss may be masked when there is a loss of bicarbonate and thus an acidosis. This is because the excess H will enter cells in exchange for K, thus masking the total body deficit

Answer 87

* Will be Hyperchloremic due to the kidneys retaining Cl to replace the last bicarbonate * BUT somtimes will be normochloremic if the necrease in colonic pH leads to an increase in ***Lactobacillus spp.*** growth in the GI. This is because Lactobacillus spp. produces large amounts of **L & D Lactate** that will act as anions and contribule to the electroneutrality (thus reducing the need to retain Cl)

Answer 88

**Metabolic acidosis** (loss of HCO3-) **Hyperchloridemia** ( to Maintains electroneutrality) - -or-- * *Normochloridemia** (Increased lactate (unmeasured anion) = contributes to electroneutrality) * *Hyponatremia** (Secretory diarrhea) - -or-- * *Hypernatremia** (Osmotic diarrhea)

Answer 89

ETEC E. coli causes a secretory diarrhea (due to enterotoxin) that may lead to sepsis Diarrhea will be yellow and watery. Calf will be dull, weak, and have a **loss of palpebral reflex** Affects calves/piglets 2-3 days old Blood work: dehydration, hypoglycemia (due to sepsis = increase metabolisma and decrease production), low pH. hyper D/L lactatemia and maybe hyperkalemia. Lose H2O, Na+, Cl-, K+, and HCO3- Acidosis occurs due to (1) H production - hypovolemia and negative energy balance (2) H titration of depleted HCO3

Answer 90

Grey top! POC machines in office measure L-Lactate ONLY Wisconsin Vet Lab measured D- Lactate

Answer 91

Lactobacillus spp. produce abundant L-and D-Lactate L-lactate is cleared but D-lactate accumulates --\> Metabolic acidosis **D- Lactate** * D-lactate has direct neurotoxic effect * will cause the loss of palpebral reflex in ETEC calves * Mainly produced by microbial production * It is slowly metabolized by the mitochondria of mammals **L- Lactate** * Produced by mammalian cells in cytosol when O2supply is low * Concentration rises with: * Exercise, Shock & Hypoxia/Anoxia

Answer 92

Combined increase in: * 1. High anion gap metabolic acidosis * 2. Metabolic alkalosis Characterized by: * 1. Significant hyponatremia ↓↓Na+ * 2. Hypochloridemia↓Cl- * 3. Hyperkalemia * Fluid Imbalances and shock

Answer 93

Severe acidemia Hyperchloremic metabolic acidosis commonly found (43%)

Answer 94

1. Greater compensatory ability 2. Blood gas and electrolyte values usually WNL 3. Persistent low normal K+ values * Likely reflect whole body K+ deficit * Need for K+ supplementation

Answer 95

If diarrhea is the sole problem: Severe electrolyte and acid-base disorders are **_relatively uncommon_** in small animals

Answer 96

**Severe and protracted diarrhea** ## Footnote **& Diarrhea that is accompanied by vomiting**

Answer 97

**Absorption** occurs primarily in enteric villi **Secretion** occurs primarily within intestinal crypts.

Answer 98

Small intestines

Answer 99

Large Intestines

Answer 100

True In diarrhea the secretory processes predominate Different disease processes can convert some portion of the GI tract from an absorptive organ into a secretory organ.

Answer 101

1. Osmotic (Malabsorption/ Maldigestion) 2. Secretory 3. Increased permeability (exudative) 4. Altered motility

Answer 102

Develop when osmotically active molecules remain in the intestinal lumen (malabsorption). This promotes movement of water from the plasma to the intestinal lumen. (1) As a result, the absorptive capability of the small and large intestine are overwhelmed. Ex. GI overload (2) also occur when there is interference with digestion and therefore the absorption of nutrients “what is not digested cannot be absorbed” Ex. Exocrine pancreatic insufficiency in dogs and TGE in young pigs

Answer 103

Feces that are pale and full of fat Due to exocrine pancreatic insufficiency

Answer 104

Osmotic diarrhea due to villous attenuation/atrophy in the small intestines Aka TGE

Answer 105

Secretory diarrhea is a **active** process It is usually caused by a infectious adjant that adheres to the mucosa and distripts the secretion of the enterocytes. Certain bacterial toxins can also activate secretion of Na, Cl and other electrolytes

Answer 106

Loss of normal epithelial lining/cytokines --\> increased permeability --\> passive loss of fluid Ex. Rhodococcus equi

Answer 107

b. secondary due to stimulation of peristalsis by increased intraluminal volumes

Answer 108

Primary: Rhodococcus equi enterocolitis in foals Secondary: Excocrine pancreatic insufficiency, Renal disease (uremia induces vasculitis and mineralization of the mucosa)

Answer 109

**Acute**- usually self-limiting but in some it is due to systemic illness. Ex. dietary indiscretion, dietary intolerance, parvo, panleukopenia, salmonella, pancreatitis --- **Chronic-** diagnosis requires more extensive work-up, possibly a biopsy Ex. IBD, neoplasia, chronic parasitism/fungal infection

Answer 110

**Johnes Disease!!!** **Exudative diarrhea (increased permeability)** \*\*\* & Osmotic diarrhea (secondary) due to the diffuse granulomatous enteritis and proliferation of macrophages that will result in mucosal damage and inflamamtion. Loss of the normal epithelial lining / tight junction causes an increase in permeability and passive loss of fluid. Protein losing enteropathy Have diffuse granulomatous enteritis in the ileum/ ileocecal area as well as local lymph node involvement (enlarged ileocecal lymph node) Cattle are infected when they are younger than 6 months, then only a few present with the chronic condition. If in herd, you should test and cull carriers. In sheep/goats you will have a **granulomatous lymohangitis with lymphangiectasia** (prominant lymphatics vessels) Other DDx would be neoplasm of the GI tract

Answer 111

**Cryptosporidium**! - due to the agem CS, and **zoonosis** other DDx: **E. coli, rotavirus, salmonellosis, corona virus** **Osmotic /Malabsoption Diarrhea** (TGE is another good example of osmotic diarrhea in swine) If preform histology of a very fresh intestinal mucosa you will see protozoa (2-3 um) on the apical surface of the enterocytes * In snakes*, this causes a chronic disease of hypertrophic gastritis with prominant rugal folds (enlarged abdomen), weight loss, and inappetence. * In birds,* cryptodporidium will be found in the lungs, bile ducts and GI tract.

Answer 112

**Black Head/ Histomoniasis** **Increased permeability/Exudative diarrhea** Vectored by **Heterakis** (chicken ascarid) More common in chickens, but the disease is less severe. You should not house chickens and turkeys together. **Lesion in the Liver and cecum**. Yellow multifocal to coalescing eosinophilic, granulomatous, necrotising hepatitis. Cecum is enlarged, yellow, and contains a course, fibronecrotic material in the lumen of the cecum, typhlitis. Secondary infections will increase the lesion severity.

Answer 113

blood supply

Answer 114

1. **Principle Nutrient Artery**: supplies medullary supply of the bone. 2. **Metaphyseal Artery**: Distal ends of the bone 3. **Periosteal Artery** Proximal end of bone

Answer 115

Epiphyseal and Metaphyseal arteries

Answer 116

OSTEO-INDUCTIVE FACTORS

Answer 117

Inflammatory

Answer 118

**Repair , granulation** Results in the formation of a *_solf callus_*, which provides a slight increase in mechanical strength

Answer 119

hard callus

Answer 120

**remodeling stage** it can last up to 6-9 year (in humans) and accounts for **70%** of the healing time

Answer 121

**compression** it is *_weaker_* than the convex area

Answer 122

**tension** It is stronger than the are of compression (concave).

Answer 123

**tension/convex**

Answer 124

remodeling

Answer 125

6-12 months

Answer 126

**Contact Healing** Cones travel at 50-100 micrometers/day

Answer 127

**Simultaneously** in contact **Seprately** in gap

Answer 128

perpendicular

Answer 129

2. heals by callus formation = FALSE Cancellous bone does NOT heal by callus formation

Answer 130

continued growth of physeal cartilage

Answer 131

endochondral ossification

Answer 132

**proliferation** Zone of hypertrophy is where condocytes differentiate, thus fracture WONT alter normal growth

Answer 133

factors that affect fracture healing

Answer 134

1. Anatomical reduction 2. Rigid fixation 3. Will compromise soft tissue to achieve

Answer 135

1. Restore overall length 2. Restore overall alignment 3. Limit surgical approach 4. Limit soft tissue disruption "look but do not touch" - it emphasizes the role of soft tissue integrity and th use of bone grafts

Answer 136

endosteal & medullary

Answer 137

**Cerclage wires and external fixators** **External captations** will also Not distrupt blood suuply

Answer 138

bone plates

Answer 139

**External coaptation** It distrupts no blood supply, but it not very stable and thus some fractures cannot heal this way

Answer 140

bone grafts

Answer 141

**bone grafts**

Answer 142

Autograft Allograft Xenograft

Answer 143

Cancellous Cortical Cortical-cancellous

Answer 144

**Osteogenesis** *cancellous autogenous and cortical-cancellous bone* grafts promote osteogenesis

Answer 145

**Osteoinduction** Cancellous and cancellous-cortical bone graphs promote osteoinduction

Answer 146

**osteoconduction** cortical\* and cancellous bone graphs are osteoconductive

Answer 147

Autogenous Cancellous

Answer 148

All of the above it is the only bone graft that is osteogenic

Answer 149

1. Mechanically weak 2. Increased surgical time 3. Limited storage time 4. Pain at donor site 5. Intraoperative blood loss

Answer 150

1. Available as frozen chips or powder 2. Decreased surgical time 3. Readily available 4. No donor site problems 5. Can mix with autograft to increase volume 6. Expensive 7. Lack osteogenic properties (only osteoinductive and osteoconductive)

Answer 151

* *Phase I – inflammation**(within hours) * *Phase II – revascularization and osteoinduction**(2 weeks) * *Phase III – osteoconduction**(3-4 weeks) * *Phase IV – mechanical support**(up to 12 weeks)

Answer 152

osteoconductive (they have no osteogenic activity and very little osteoinductive activity)

Answer 153

ribs, ulna, fibula, & ilial wing

Answer 154

Osteoclasts move into graft and resorb bone Osteoblasts follow and lay down new bone Mechanical strength of graft maintained. AKA "Creeping substitution"

Answer 155

Provides immediate mechanical support Promotes osteogenesis Osteoinductive Osteoconductive