Exam 1 Flashcards
Idiopathic Megaesophagus
*Extreme form of Megaesphagus
*4 year Old Border Collie- Not Likely to be Congenital Megaesophagus. This is an Acquired form of Megaesophagus
*Prognosis is Poor, Particularly if there is Aspiration Pneumonia
False
*Only 1/3 or Cats with Acute Pancreatitis will show Abdominal Pain
Lack of Abdominal Pain does NOT rule out Pancreatitis
ALKP is Liver Specific for the Cat and Silkworm has Hepatic Lipidosis
*Half Life for ALKP is very Short- the Fact that we see it is Significant. Cats do not have Enzyme Induction!!! When we see ALKP in a Cat we know it is more Liver Specific.
ALKP is an Indication of Hepatic Lipidosis in Felines- KNOW THIS
Surgical Debulking with Radiation
*Side Note: What if it had been a 10 Year Old Cat diagnosed with Nasal Lymphoma? Surgical Debulking with Chemo would be a better choice. Lymphomas are Sensitive to Chemo Drugs
*Chronic Hepatitis leads to Coagulopathies- Liver is Responsible for the Synthesis of all Coagulation Factors
Pancreatic Hyperechogenicity
*Pancreas becomes Hypoechoic because of Edema
Esophageal Stricture
*2-3 Weeks after a Dog being in Dorsal Recumbancy for a Spay Operation. This Dog now has a Stricture that is Leading to Esophageal Regurgitation
Airway filled with Fluid that Snaps Open
Spirocercosis
*Geriatric Pit Bull with Shifting Forelimb Lameness
Enlarged Mandibular Salivary Glands- Caudal Esophageal Distention
Pancreatic Acinar Atrophy
*End stage Chronic Pancreatitis will lead to EPI and Diabetes
Pancreatic Acinar Atrophy- Autosomal Recessive Disease that presents at a young age and is Immune Mediated
Recheck in 3-5 Days, Ensure it decreses by 50%
Start on SAMe, Ursodiol, Liver Supplements
Recommend Liver Function Test
Recommend Abdominal Ultrasound
When you see a Mild Increase in ALT, we should NOT disregard it unless we have a specific cause. We need to recheck in 3-5 Days to make sure that the ALT is Decreasing
Should be worried about Chronic Hepatitis- Demonstrates that the concentration of ALT is NOT indicative of Prognosis
*Labradors- Commonly get Chronic Hepatitis that can be Copper Induced
False
*Cats will show Triad of Clinical Signs including Cholangitis and Enteritis, but this is not a similar Clinical Sign in Dogs. Dogs rarely have Accompanying Inflammatory bowel Disease
Biopsy the Liver after a PT/aPTT Screen
Bacterial Pneumonia
*Feline Asthma = Feline Idiopathic Bronchitis
*Bacterial Pneumonia- Causes a Leukocytosis: WBC’s and Neutrophils
Ammonia Tolerance Test
*Chronic Hepatitis and Mild Hypoalbuminemia as a Result- This is more likely to be a Chronic Hepatitis because the Liver is Small.
In this case we are worried about Parenchymal Liver Disease- Superior Diagnostic Test for this would be an Ammonia Tolerance Test
*Side Note- Minature Schnauzers can be diagnosed with Portosystemic Shunt when they are 5 years or older, but it is not common or reported in other Breeds
Ciliary Dyskinesia
*Animal Responded to Antibiotics but the signs Recurred
*Coughing- Either Cardiogenic or Non-Cardiogenic. No Sign of Heart Disease. Could not Elicit a Cough on Tracheal Palpation. Therefore the Coughing is due to a Disease in the Lungs
Crackles Heard on Auscultation- Fluid in the Airways
*Cannot be Pneumonyssus Caninum because the Patient is on Heartworm Prevention, which would Prevent Nasal Mites as well
Chronic Pancreatitis
Gall Bladder Rupture
*High Lactates, Low Blood Pressure (Hypotension) and Anemia are associated with Poor Outcome in Biliary Mucoceles
*Does NOT give dogs a Poor Prognosis if you Diagnose Rupture at the time of Diagnosis. These dogs will pull through fine if you give them the Appropriate Supportive Care
Thoracic Radiographs
*6 Week Old GSD- Commonly get Congenital Megaesophagus and Persistant Right Aortic Arch
*Hematology and Biochemistry- Not necessary in Acute Presentation if the Patient is not Debilitated
Broad Spectrum Antibiotics
*Strong Evidence of Cystalloid Resuscitation- Increases Pancreatic Perfusion
Fentanyl CRI- Indicated and Recommended pain Control
Maropitant- Anti-Emetic of Choice
Phenobarbitone
*Dog is showing Classic Signs of Pharyngeal or Cricopharyngeal Dysphagia- Odynophagia and Ptyalism
*Irrespective of the Pathology in the Salivary Gland, If you have Odynophagia and Salivary Gland Hyperplasia then Phenobarbitone is the Treatment of Choice
An Abdominal US Exluding EHBO is Sufficient to Confirm Liver Dysfunction
*This dog has Onion Toxicity, which causes Heinz Body Anemia- that leads to Hemolytic Anemia.
The most Important thing that we need to do is make sure there is no Extrahepatic Biliary Obstruction. In the Face of Icterus, if there is No Extrahepatic Biliary Obstruction, then we have Confirmed Liver Dysfunction
It would NOT be Indicated to perform a Bile Acid Stimulation Test- It is redundant, we know there is Liver Failure
E. Tiger Lily- Nephrotoxic!
A. Blue Green Algae- Hepatotoxin
B. Aflatoxin- Hepatotoxin
C. Cycads- Hepatotoxin
D. Amanita Mushrooms- Hepatotoxin
Recommend Liver Function Testing and US/biopsy
*Phenobarbitol is Responsible for Enzyme Induction-Specifically ALKP. This is allowable within a Certain Range. If ALKP is
If Enzymes are Significantly Elevated, such as this case, we are concerned there may be Phenobarb Toxicity. There could be Liver Failure- Ultrasound and Run Liver Function Tests
*Immediate Discontinuation of Phenobarb could Cause Seizures- Needs to be Tappered
True
False
*Ultrasonography is not as Helful in Feline Species
Low Fat Diet Prescription Diet
We do not recommend any type of Perscription Diet in Patients with EPI
*In EPI we recommend a Cobalamine Supplementation, Pancreatic Enzymes, Metronidazole if we suspect Bacterial Overgrowth, and we can use Antacid to increase gastric pH
Pancreatic Abscess
Pancreatic Abscess- Chronic Sequela to Acute Pancreatitis that can occur 6 weeks or more after Acute Pancreatitis. But is also responsible for Pancreatitis. Surrounding tissue will Become inflammed and Cause Acute Abdomen
*Terriers are predisposed to both Acute and Chronic Pancreatitis. He has presented with Acute Abdomen.
Multiple Hypoechoic Lesions on Ultrasound with thickened Capsule
Pancreatic Pseudocyst- Appear Anechoic and Do Not have Capsule
Cysts are usually Benign and not associated with Clinical Signs
Insulinomas and Carcinomas are commonly Hyperechoic on US
Influenza Type A H3N8
*If the Canines are dying, you should be thinking Canine Influenza. Also these patients cough up blood
Laparotomy/Laparoscopy
Laparotomy- Allows you to Control Hemorrhage and you get a much better quality sample
*Non Neoplastic- not a Focal Area, which would be great for Fine Needle Aspirate. A Fine Needle aspirate will not be Helpful
Not Infiltrative- Not Lymphoma or Hepatic Lipidosis
Endoscopy with Cytobrush for Cytology
*Cytobrush of the Greater Curvature of the Stomach is the test with the Highest Sensitivity and it can be Conducted Immediately
Antibiotics
There is no association with Infection or Bacteria with the Development of Chronic Pancreatitis- No need to Antibiotics in the Treatment of Chronic Pancreatitis
*Treatment for Chronic Pancreatitis- Supportive Care. Need to Address Diet, Pain, and if necessary control the Trigger
We can use steroids at immunosuppresive Doses
Analgesia is very important in Patients that show Pain
Pancreatic Supplement is a Possiblity. In dogs with Chronic Pancreatitis feeding the supplement can reduce Postprandial Pain
Chronic Pancreatitis
*Elderly cats will develop EPI
Pithiosis
*Pylorous Wall is Thickened and its Lost its Layering. Considering the Signalment- Lab with Projectile Vomiting. Must be a Gastric Outflow Obstruction and the most likely cause is Pithiosis
Sliding Hiatal Hernia
*Juvenile Shar Pei- Caudal Esophageal Soft Tissue Opacity
Corticosteroids
*Corticosteroids do NOT Induce Acute Pancreatitis
B. Muscle Enzymes
*This dog has much Higher AST than ALT. More likely that the dog has Polymyositis
ALT and AST are NOT liver Specific
Pseudocyst
*Acute Complications: Pleural Effusion, Hypocalcemia (Soaponification of Fat). DIC/Coagulopathy can be an Acute Complication of Acute Pancreatitis
Chronic Complication of Acute Pancreatitis- Which occurs 6 weeks after an Episode of Pancreatic Necrosis: Pseudocyst
cPL
*Abdominal Radiographs, Amylase, and Lipase are USELESS in Diagnosing Pancreatitis in Dogs
Abdominal Ultrasound and cPL are the BEST
FNA and Biopsy are the GOLD STANDARD but because of the Patchy Distribution of Acute Pancreatitis it is difficult to Diagnose by these Methods
Eurasian
*Eurasian- Predisosed to Pancreatic Acinar Atrophy (Exocrine Pancreatic Insufficiency)
ECS = English Cocker Spaniel
AP = Acute Pancreatitis
All of the Above
*We are not going to recommend and Exploratory Surgery with Biopsy at this Stage- there are too many diseases occuring. To perform an Invasive test is not Clinically Appropriate and may Increase Morbidity
This Dog has Acute Pancreatitis- the Pancreatitis MAY Increase TLI
The sensitivity of cPL in Chronic Pancreatitis is very Low. using the cPL will not be helpful to confirm the Pancreatitis
Acute Suppurative Cholangitis
*Neutrophilic Infiltrate into Periportal Not beyond Limiting Plate!!!
Hepatocellular Carinoma
*PU/PD- Associated with Liver Failure. Very Common in Hepatocellular Carcinomas
Increase in Liver Enyzmes and Associated Hypoglycemia
Ultrasound Change for Hepatocellular Carcinoma- Hyperechoic
False
*SNAP- Good Sensitivity but POOR Specificity. Need to Follow up with an Abdominal Ultrasound or Spec PLI to Improve Specificity
Antral Pyloric Stenosis
*Projectile Vomiting- Main Clinical Sign of Antral Pyloric Stenosis
Ion Trapping
*Lactulose has an Ion Trapping Effect and Acidifies the Intestine and thus the Ammonia will be in a Non-Absorbable form
Bile Acid Stimulation
*Dog that seems to Have Hepatic Encephalopathy and Ammonium Biurate Crystalluria- he has a Portosystemic Shunt.
We want to do a Liver Function Test- Bile Acid Stimulation
Both A and B are Correct- Ammonia Tolerance test is more Labor Intensive and a Bile Acid Stimulation test works as well as the Ammonia Tolerance Test
L-Carnitine
Arginine- Important in the Urea Cycle and a Deficiency could Manifest in Hepatic Encephalopathy
Taurine- Important for Conjugated Bile Acids
L-Carnitine- Shunting Mechanism for moving Fatty Acids into the Mitochondria for Beta Oxidation
Low Fat Diet
*Ultra Low Fat Diet- Best
Acute on Chronic
