Exam 3 Flashcards
Specific periods of the pediatric period
Neonatal period: birth - 2 weeks
Transitional period: 2 - 4 weeks
Socialization period: 4 - 12 weeks
Juvenile period: 12 weeks - puberty
Three most common neonate issues
- Hypothermia
- Hypoglycemia
- Sepsis
At what age do neonates become more like “small adults”?
4 weeks
Normal neonate temperature, pulse, respiration rate
96 - 96 F, 100 F by 4 weeks
Pulse: >220 bpm
RR: 15-35 bpm
Normal weight gain in neonates
Weight should be doubled by 2 weeks of age
Puppies: gain 2-4 g/day/kg of adult weight
Kittens: ~100g at birth, gain 10-15 g/day
How are neonates grouped at 24 hours old?
- Majority group: weight gain at 12 and 24 hours
- Portion of group: weight loss of <10% of birth weight
- Critical group: weight loss of > 10% of birth weight
Why can’t skin turgor be used to assess hydration in neonates? What should you use instead?
Neonates are 75% water and have non-cornified skin
Use MM dryness
Use USG as they age (can’t concentrate urine yet)
When do neonates’ eyes open? Menace present? Vision normal?
Eyes open: 10-14 days
Menace: present by 21 days, fully developed by 2-3 mo
Vision normal: 3-4 weeks
When are neonates’ ear canals open? What is the best way to assess hearing?
Ear canals open by 14 days
BAER best way to assess hearing but should not be done before 6 weeks of age
Is sinus arrhythmia normal in neonates?
No, they should have a normal sinus rhythm
What murmur is commonly heard in neonates?
Functional, soft murmur at left cardiac base
Why will atropine during bradycardia not be effective in increasing the heart rate of a neonate?
Their autonomic nervous system is not well developed so they have minimal response to vagal stimulation
By what age should testicles be descended in puppies?
Normally by 4-8 weeks, 16 weeks at the latest
By what age are postural reactions developed in puppies/kittens?
6-8 weeks
Non-visual placing: 2-3 days
Visual placing: 2-3 weeks
Extensor postural thrust: 3 weeks
Walking: 3-6 weeks
By what age do puppies/kittens have a righting response? Air righting response?
Righting response - birth
Air righting response - kittens 21-30 days
How are puppies/kittens assess on the Neonatal Viability Scoring System?
Activity/muscle tone, pulse/HR, reflexes, MM color, and RR assessed
Can earn up to 2 points per parameters
0-2 = weak vitality 4-6 = moderate vitality 7-10 = normal vitality
How does PCV of neonate compare to adult? USG?
PCV is higher than puppy or adult (42%)
USG = 1.018 because they do not fully concentrate urine
Why does radiography technique need to be adjusted for neonates?
Needs to be adjusted because of
- Partially mineralized bones
- Thinness of soft tissues
- Amount of water
Use high detail intensifying screens
Decrease kvp to 1/2 adult at same thickness
The most common cause of problems for neonates?
Husbandry issues
poor nutrition, hypothermia
Ideal ambient temperature for orphan neonates?
86-90 F for first week
Gradually decrease over next 3 weeks to 75 F
Causes of sepsis in neonates?
Often gram negative bacteria that enter bloodstream via
GI and peritoneal infection
Respiratory infection
UTI
Skin/wound infection
Clinical signs of sepsis in neonates?
Sudden death Crying, restlessness, weakness Hypothermia Dehydration Diarrhea Altered respiratory rhythm Cyanosis
What should you look for if you suspect a neonate is septic?
Check the umbilicus and look for puncture wounds
Treatment for sepsis in neonates?
Keep warm Fluids (IV or IO) Antibiotics (B lactam) O2 Glucose Monitor weight 2-3 x day
What is fading puppy/kitten syndrome?
Death within first 1 - 12 weeks
Most vulnerable periods: In utero At time of birth Immediately after birth - 2 weeks Post-weaning
Causes of fading puppy/kitten syndrome?
Congenital defects Teratogenic effects Malnutrition Low birth weight Trauma Neonatal isoerythrolysis Infectious disease
Diagnosis of fading puppy/kitten syndromes relies heavily on
Necropsy
Have the necropsy discussion prior to whelping
At what point should an owner of a neonate call the vet because the neonate is sick and will decline rapidly?
- Neonate crying for more than 20 minutes in presence of littermates and/or mother
- Neonate refuses to nurse or is not interested in nursing
Most common cause of chronic renal failure in pediatric patients?
Renal dysplasia
What primary lesions are suggestive of renal dysplasia in pediatric patients?
- Fetal or immature glomeruli/tubules
- Persistent mesenchyme
- Persistent metanephric ducts
- Atypical tubular epithelium
- Dysontogenic metaplasia
Most common liver disease seen in pediatric patients?
At what age do clinical signs manifest? What are the clinical signs?
Congenital PSS
As early as 6-8 weeks of age
CS (puppies):
Intolerance to anesthetic agents or tranquilzers that are metabolized by the liver
Intermittent neurologic abnormalities associated with eating high protein foods
Ammonium biurate crystals or uroliths
CS (kittens):
Hypersalivation Seizures Ataxia Tremors Depression Small body stature, think, unkempt
Most reliable and consistent way to diagnose PSS in pediatric animals
Fasted pre- and post-serum bile acids
Treatment of PSS in pediatric animals
Medical management:
Low protein diets in frequent, small meals
Antimicrobial agents
Lactulose
Causes of inflammatory pancreatic disease (affecting only the exocrine portion) in animals <6 mo old
Trauma
Infection (Parvo, FIP)
Effects of drop in body temperature on neonates
Heart rate drops
GI ileus more likely to occur
Less ability for lymphocyte transformation
Mother rejects neonate with cool skin
Single most important predictor of neonatal survival
Birth weight
Toy breeds: 100-200 grams
Large breeds: 400-500 grams
Giant breeds: 700 grams
Kittens: 100 grams
PSS seen in which cat breeds?
Himalayan
Persian
Mixed breeds
Localization of lesion with discolored urine AND stanguria? Without stranguira?
Stranguria -> lower urinary tract
(bladder, urethra, prostate)
No stranguria -> upper urinary tract
(kidneys, prostate, systemic disease)
How to differentiate between hemoglobinuria and myoglobinuria?
Look at plasma color
Pink -> hemoglobinuria
Clear -> myoglobinura
When is an antibiotic trial okay to do for a patient with suspected bacterial cystitis?
Dog with LUT signs (first occurrence)
Owner declines UA and culture
When is an antibiotic trial NOT okay to do for a patient with suspected bacterial cystitis?
Dog is acting systemically sick or seems obstructed
Cat -> more likely to have an inflammatory cystitis or may be obstructed
Difference between polyuria and pollakiuria?
Polyuria: daily urine output greater than 50 ml/kg/day
Pollakiuria: increased frequency of urination (but not necessarily increased volume)
What factors control thirst?
Osmotic factors:
Dehydration stimulated osmotic receptors in the hypothalamus
Non-osmotic factors: Fever Pain Drugs Hypovolemia
What factors control the secretion of ADH?
Hyperosmolarity (dehydration) Hypovolemia Hypoglycemia Stress Pain Fever Exercise Angiotensin Drugs
Ddx for PU/PD in young patients
Congenital renal abnormalities PSS HyperCa (malignancy, vit D intoxication) Pyelonephritis DI
Ddx for PU/PD in adult patients
CKD DM Hepatic failure HyperT4 Cushing's Addison's HyperCa (malignancy, 1 HPT, renal 2 HPT, Vit D, granulomatous dz) Pyelonephritis Neoplasia DI Pyometra
MOST CAUSE 2nd NDI
What type of diets may cause PU/PD?
High salt (treats -> pig ears)
Low protien
Vit supplementation
When should you perform water deprivation test?
ONLY when remaining ddx are CDI, primary NDI, and psychogenic polydipsia
Pathophysiology of secondary NDI
Osmotic diuresis or chronic PU/PD ->
Renal medullary solute washout ->
Impaired response to ADH
Normal bilirubin metabolism
Heme -> biliverdin -> unconjugated bilirubin (bound to albumin)
Unconjugated bilirubin goes to liver -> conjugated bilirubin
Conjugated bilirubin goes to bile -> SI -> LI -> converted to urobilinogen -> urobilin (yellow) and sterobilin (brown) -> excreted in feces
Small portion of urobilinogen reabsorbed by liver, some excreted by kidneys
What type of bilirubin is freely filtered by the kidneys?
Conjugated
Causes of pre-hepatic, hepatic, and post-hepatic icterus
Pre-hepatic:
‣ Hemolysis
Hepatic:
‣ Hepatitis, hepatic lipidosis, neoplasia, cirrhosis, toxins/drugs, sepsis
Post-hepatic:
‣Pancreatitis (most common cause in dogs)
‣Biliary neoplasia (most common cause in cats)
‣Cholangitis
‣Cholecystitis
‣Choleliths
‣ GB mucocele
Lab findings with pre-hepatic cause of ELE
Moderate to severe anemia, hemolyzed serum, spherocytes, heinz bodies
When can you detect icterus in serum and tissues?
Serum bilirubin > 1.5 mg/dl
Tissues - bilirubin > 2.0 mg/dl
What factors can artifactually cause elevated bilirubin?
Iatrogenic hemolysis
Lipemia
Elevated bilirubin with normal liver enzymes may be an indicator of
Sepsis
Acholic feces are seen with what type of disease
Chronic bile duct obstruction
Cellular origin of ALP, GGT, ALT, AST
ALP: membrane associated, inducible
GGT: membrane-associated, inducible
ALT: cytosolic, seen with necrosis/inflammation
AST: cytosol and mitochondria
What is important to know about ALP in cats?
Short-half life means this enzyme should go back to normal very quickly. Persistent elevations in the cat is always significant
No steroid-induced isoenzyme
ALP»_space; ALT is indicative of
Cholestasis
ALT»_space; ALP is indicative of
Hepatocellular disease
Pros and cons of liver sampling techniques
FNA:
Pros: good for specific masses or diffuse neoplasia, vacuolar changes
Cons: poor for inflammatory conditions
Biopsy
Pros: will provide better answers than cytology
Cons: more invasive, has a greater risk for hemorrhage, and usually requires heavy sedation or anesthesia
What is hepatocutaneous syndrome?
Crusting, ulcerative lesions on paws/footpads seen with liver disease
Common CBC finding with liver disease?
Microcytosis
What pattern of liver enzyme increase indicates hepatic lipidosis in cats?
Increased ALP with normal (or near normal) GGT
ALP significantly higher than ALT
What is Protein C used for?
Used to help differentiate PSS from portal vein hypoplasia
If normal, probably not a shunt
Low protein C activity common in shunts, but not present with portal vein hypoplasia
Does a normal appearance of the liver on ultrasound exclude hepatobiliary disease?
No
How to distinguish between small vs large bowel diarrhea
Small bowel
‣ Normal- increased volume
‣ Mucus rare
‣ Melena
Large bowel
‣ Normal-decreased volume
‣ Mucus common
‣ Hematochezia
‣ Urgency and tenesmus common
Causes of small bowel diarrhea
Malabsorptive
‣ Dietary responsive
‣ Parasites (Giardia)
‣ Antibiotic responsive
‣ IBD
‣ Neoplasia
‣ Fungal
PLE
‣ Lmphangiectasia
‣ Lymphoma
‣ Severe IBD
‣ Fungal
‣ GI hemorrhage
‣ Massive hookworm/whipworm infection
Causes of large bowel diarrhea
Dietary responsive Fiber responsive IBS Parasites (tritrichomonas) Bacterial disease Fungal IBD Neoplasia
How does a patient’s clinical status affect diagnostic evaluation of chronic diarrhea?
Patients that are anorexic, cachexic, or hypoproteinemic are not good candidates for therapeutic trials as this may result in significant morbidity and mortality from delayed treatment if the therapy is incorrect
What is the cytological difference between Giardia and Tritrichomonas?
Giardia
‣ Small number trophozoites
‣ “Falling leaf” movement
Tritrichomonas
‣ Undulating membrane
‣ Larger numbers
Utility of diagnostic imaging in patients with chronic diarrhea
Ultrasound most helpful
‣ Rarely gives definitive diagnosis
‣ Allows for lesion location prior to endoscopy
‣ Focal lesions for aspiration
Contrast study and radiographs
‣ Rarely helpful
What are the pros/cons of endoscopic versus surgical liver biopsy?
Endoscopic
‣ Advantages
• Less invasive
• Requires little recovery time (outpatient procedure)
• Allows visualization of mucosal surfaces
• Less expensive than surgery
‣ Disadvantages
• Limited evaluation of the GI tract (essentially the whole jejunum is off limits)
• Only being able to biopsy the mucosa (not full thickness biopsy)
• Not being able to evaluate other organs/structures
Surgical
‣ Advantages
• Allows evaluation and full-thickness biopsy of the entire GI tract as well as other intraabdominal organs.
‣ Disadvantages
• Invasive procedure
• Usually requires 2-3 days of hospitalization post-operatively for recovery
What is the treatment approach to antibiotic responsive diarrhea?
Broad-spectrum antibiotics effective against aerobes and anaerobes for minumum of 2-3 weeks
‣ Tylosin (20-40 mg/kg PO q12h)
‣ Amoxicillin (22 mg/kg PO q12h)
‣ Metronidazole (15 mg/kg PO q24h) + enrofloxacin (7 mg/kg orally every 24 hours)
Severe cases:
‣ Tetracycline (22 mg/kg PO q12h)
Can also try:
‣ Probiotics
‣ Fecal transplantation
Use of immunosuppressives for treatment of IBD
Corticosteroids Prednisone/prednisolone Methylprednisone Dexamethasone Busesonide Cyclosporine Azathioprine Chlorambucil
Treat 2-4 weeks beyond resolution of clinical signs, then start to taper 25% every 2-4 weeks
Treatment of EPI
Supplement pancreatic enzymes (Pancreazyme, Viokase)
Supplement cobalamine
Treat dysbiosis (antibiotics)
+/- low fat diet
What is the role of diet in treatment of lymphangiectasia?
Because low fat diets lack long-chain fatty acids, they prevent intestinal lacteal engorgement and protein loss
What fraction of seropositive cats shed coronavirus?
1/3
Do seronegative cats shed coronavirus?
No
except for in non-domestic felids
What kind of cat is most at risk for developing FIP?
Young (<2 years old)
Purebred (Persian and Birman)
Male
Live in multi-cat environment
Clinical signs of FIP
Antibiotic unresponsive fever Rapid weight loss Icterus Anorexia Depression Body cavity effusions Abdominal masses Neurologic signs Uveitis
How is FIP associated with intestinal obstruction?
Focal granulomatous lesion of colon or ileocolic junction
Lab findings for patient with FIP
Neutrophilia +/- mild L shift Nonregenerative anemia Lymphopenia Hyperproteinemia Hyperglobulinemeia Hyperbilirubinemia ELE
MAY ALL BE NORMAL
What is the rivalta test?
8 ml distilled water + 1 drop acetic acid + 1 drop effusion
Mix thoroughly
If effusion congeals -> positive for FIP
FIP effusion analysis
Modified transudate with pyogranulomatous inflammation
Color: clear, straw, yellow
Consistency: viscous, frothy when shaken, may clot in cold
Protein: >3.5 g/dl, low A:G ratio <0.45
Cellularity: <5000/uL, non-toxic neuts, macrophages, lymphs
FIP CSF analysis
Extremely high protein (>200 mg/dl)
Extremely high nucleated cells (>100/ul)
Risk of herniation during CSF collection
Necropsy findings FIP
White plaques on serosal surfaces
Adhesions of omentum, mesentery
Lymphadenopathy
Pyogranulomas
Vasculitis
Are adult cats more at risk for developing FIP if they live/lived with a cat that was diagnosed with FIP?
Adult cats not at risk
Seronegative kittens - yes
Treatment of FIP
Prednisolone
Maybe antiviral and immunomodulating drugs (UC Davis study)
How can healthy cats be screened for FIP?
Can’t, no screening tests
What are the most reliable confirmatory tests for FIP?
Rivalta test
Effusion analysis
Biopsy
How is FIP spread from cat to cat?
Coronavirus spread fecal-oral route
How can FIP be prevented?
Decrease stress Pedigree analysis (don't breed cats that have had or produced kittens with FIP)
Vaccination is NOT recommended
Cardiac arrhythmias seen with hyperkalemia
No p waves
Spiked T waves
Bradycardia
When should you consider supplementing calcitriol in patients with CKD?
Used to reverse secondary hyperparathyroidism
Only if serum phosphorous < 7 mg/dl
Cannot use in conjunction with Epakitin (phosphate binder)
IRIS staging for AKI
Grade 1: Cr <1.6 mg/dL, non-azotemic, oliguric or anuric
Grade 2: Cr 1.7 - 2.5 mg/dL, documented AKI and azotemic, oliguric or anuric
Grade 3: Cr 2.6 - 5.0 mg/dL, increasing severity of azotemia
Grade 4: Cr 5.1 - 10.0 mg/dL
Grade 5: > 10.0 mg/dL
IRIS staging for CKD
At risk: history of toxin exposure, breed, infectious dz, old age
Stage 1: Cr <1.4 (dogs), <1.6 (cats), nonazotemic, inadequant concentrating abilty, abnormal renal palpation or imaging, proteinuria, increasing Cr
Stage 2: Cr 1.4 - 2.0 (dogs), 1.6 - 2.8 (cats), mild azotemia, absent or mild CS
Stage 3: Cr 2.1 - 5.0 (dogs), 2.9 - 5.0 (cats), moderate renal azotemia
Stage 4: Cr > 5.0 increasing risk of systemic clinical signs and uremic crisis
Clinical signs acute vs chronic kidney disease
Acute: oral necrosis, bradycardia, hypersalivation, large kidneys, normal BCS, severely depressed, seizures, coma, oliguric (except AG)
Chronic: retinal detachment, pale MM, oral ulcers, murmurs, hypersalivation , small kidneys, decreased BCS, renal osteodystrophy, polyuric
Treatment of metabolic acidosis and electrolyte imbalances in AKI
Ca gluconate
Dextrose
Bicarb
Treatment for persistent oliguria/anuria
Furosemide
Mannitol
Dopamine
Fenoldopam
(Controversial, none shown to improve outcome but some vets still use)
Goals of AKI treatment
Reverse anuria/oliguria
Keep up with fluid losses
Enteral nutrition if possible
Wean off fluids slowly
IRIS staging - UPC
Proteinuric =
> 0.5 dogs
0.4 cats
When is SDMA relevant?
A persistent increase in SDMA about 14 ug/dL suggests reduced renal function
May be a reason to consider a dog with Cr <1.4/1.6 mg/dl as IRIS stage 1
What is azodyl?
Probiotic/prebiotic used for it’s propensity to metabolize urea, creatinine, uric acid, various carcinogenic amines, guanidine and indole metabolites and phosphate
“Intestinal dialysis”
Little clinical evidence
When should you consider dialysis for renal failure?
Acute, anuric renal failure due to toxin or infection
For CKD, to improve condition prior to transplant
What is pre-renal proteinuria?
Proteinuria due to abnormal plasma content of proteins (hemoglobin, myoglobin, bence-jones proteins, globulins)
What is renal proteinuria?
Proteinuria due abnormal renal loss/handling of normal plasma proteins
Functional - due to altered renal physiology secondary to a transient extra-renal cause (strenuous exercise, fever)
Pathological - due to structural or functional renal lesion (glomerular, tubular, or interstitial)
What are the three types of pathological renal proteinuria?
Glomerular - due to lesions that alter the permselectivity properties of glomerular capillary walls
Tubular - due to lesions that impair tubular resorption of proteins that would be expected to cross the normal glomerular capillary wall
Interstitial - results from inflammation that causes exudation of proteins into urine (proteins come from peritubular capillaries)
What is post-renal proteinuria?
Due to protein that enters urine after the renal pelvis
Urinary - hemorrhage or exudation from urinary tract
Extra-urinary - hemorrhage or exudation from genital tract or external genetalia
How can you differentiate if proteinuria is urinary post-renal or renal?
Clinical signs of patient
If patient does not have fever -> more likely urinary post-renal
If fever present -> renal
What magnitude of different in day-to-day proteinuria is considered clinically significant?
Dogs: difference of at least 40%
Cats: double
Localization of lesion if UPC is > 2?
Most likely glomerular (pathologic)
UPC levels of animals for which an underlying disease should be identified and should be treated for PLN
Azotemic dogs with UPC > 0.5
Azotemic cats with UPC > 0.4
Non-azotemic dogs/cats with UPC > 2.0
Etiologies for glomerular disease
Membraneoproliferative glomerulonephritis (MPGN)
Membraneous nephropathy (MN)
Immunoglobulin A nephropathy
Amyloidosis
Hereditary nephritis
Minimal change disease
Treatment for glomerulonephritis
ACE inhibitors (enalapril, benazepril)
Angiotensin receptor blockers (losartan, telmisartan)
Renal diet
Control hypertension
Thromboprophylaxis (asprin, clopidogrel)
Control hyperkalemia
Breeds of dogs with familial glomerulopathies
Amyloidosis - beagle, sharpei, english foxhound
Hereditary nephritis - bull terrier, cocker, dalmatian, samoyed
Mesangiocapillary GN - bernese mt dog
Glomerulosclerosis, cystic glomerular atrophy - dobies, corgi, newfoundland
Glomerular vasculopathy and necrosis - greyhound
Atrophic glomerulopathy - rottweiler
Infectious agents associated with membraneoproliferative glomerulonephritis (MPGN)
Borrelia
Babesia
Leishmania
HW
Is it normal for protein to be found in the glomerular filtrate in Bowman’s space?
Yes
What components of glomerulus aid in permselectivity of proteins?
Fenestrations in glomerular capillaries
BM (negative charge)
Podocytes
What is the screening test for proteinuria? Confirmatory tests?
Screening: dipstick
Confirmatory: SSA, microalbuminuria
Signs of anaphylaxiz post-vaccination
Vomiting, swelling, collapse, fever
Types of non-immunologic reactions post-vaccination
Cutaneous granuloma/vasculitis Systemic fever/malaise Febrile limping syndrome in cats Neoplasia Fetal resorption Vaccine associate disease of akitas and HOD and juvenile cellulitis in weimeraners
Types of immunologic reactions post-vaccination
Type 1: anaphylaxis
Type 2: IMHA
Type 3: blue eye or immune complex disease
Age of critical period of susceptibility to disease where there are not enough Ab to protect from disease yet still too many maternal Ab to allow for active immunization
6-16 weeks
Core vaccines for dogs and cats
Dogs - rabies, distemper, adenovirus, parvo
Cats - panleuk, herpes, calici, rabies, FeLV
Priniciples that should be used in assessing an animal’s risk and selecting proper vaccinations
Vaccinate the largest possible number of animals in the population at risk
Vaccinate each animal no more frequently than necessary
Vaccinate only against infectious agents to which individuals have realistic risk of exposure, infection, and subsequent development of disease
vaccinate only when the potential benefits of the procedure outweigh the potential risks
Do all adverse vaccine reactions need to be reported to the USDA Center for Veterinary Biologics and to the vaccine manufacturer?
YES
Where should vaccinations NOT be given?
Intrascapular space
What factors are triggers for disease outbreak recognition of and call to action?
Higher than expected number of cases
More severe or prolonged disease than expected
Failure of usual containment procedures to stop transmission
When should you pursue further diagnostic testing in a disease outbreak?
Many affected animals
Severe or complicated disease
Deaths
Unusual disease patterns
Quarantine time is directly related to what pathogen factor?
Pathogen incubation period
Isolation time is directly related to pathogen factor?
Pathogen shedding period
Largest amounts of pathogen shedding occur during
Preclinical incubation period
Most favored diagnostic test for respiratory pathogens?
PCR
What is the single most important step in managing disease outbreak?
Isolation of sick animals
How long should a sick animal be isolated during the management of a disease outbreak?
Isolate for the length of the contagious period/pathogen shedding
Why might an exposed animal not have clinical disease?
Infected but pre-clinical incubation period
Subclinical infection
Not infected due to immunity
ALL EXPOSED ANIMALS SHOULD BE QUARANTINED
How long should an animal be quarantined for?
Pathogen incubation period
How often should quarantined animals be monitored for clinical signs?
Twice daily
Treatment for Amanita poisoning
Silimarin (milk thistle extract)
Treatment for acetaminophen poisoning
Acetylcysteine
Treatment for copper or riron accumuationg in liver
Chelation therapy with penicillamine or trientene
Zinc (inhibits copper absorption)
Limit copper in diet
Treatment of hepatic lipidosis
E-tube
Feed high protein, high fat diet
Give slowly to avoid re-feeding syndrome
Treatment for vacuolar hepatopathy
Good diet including increased protein +/- melatonin, lysodren
Treatment of leptospirosis
Penicillin or ampicillin IV followed by doxycycline PO
Treatment of bartonella
Enrofloxacin, doxycycline, azithromycin
Treatment of Platynosonum concinum liver flukes
High dose praziquantel (20 mg/kg SC for 3 days or 20 mg/kg PO q 12 week)
What is ursodiol?
Hydrophilic bile acid that replaces hydrophobic bile acids such as chenodeoxycholic acid that are extremely toxic
Used as anti-inflammatory and to increase bile flow in the treatment of cholangiohepatitis/cholangitis
CONTRAINDICATED in full bile duct obstruction
Consequence of untreated bile duct obstruction
Cirrhosis
Treatment of emphasematous cystitis or GB mucocele?
Sx
Why is surgery the treatment of choice for liver tumors?
Chemo usually ineffective due to multiple drug resistance (MDR) gene that is constitutively expressed by liver tumor cells
Treatment for chronic hepatitis
Immunosuppressive therapy (widely used but controversial)
Colchicine (anti-fibrotic therapy)
Sylimain (extract of mil thistle)
What is choline?
Used in treatment of liver disease
Important in phospholipids so essential for exporting lipid from liver
What is included in supportive therapy for patients with liver disease?
Fluids Plasma Nutrition (increased demand for protein and calories) Folate Choline Vitamin C
What is SAMe?
S-adenyl methionine
Synthesized in liver from methionine
Liver damage reduces SAMe synthetase activity in the liver which is important in methylation reactions that synthesize nucleic acids, amino acids, phosphatidylcholine, polyamines, and glutathione
Need to give 1 hour before meal
Treatment for hepatic encephalopathy
Glucose Potassium Sarmazenil Protein-restriction Lactulose Neomycin, metronidazole Albumin (binds tryptophan, an aromatic AA precursor for false neurotransmitters)
How does lactulose work in the treatment of hepatic encephalopathy?
Increases incorporation of ammonia in microbial protein
Lowers pH of colon and converts ammonia to ammonium.
Ammonium is less lipophilic, is not absorbed as readily, and is instead excreted into feces
Treatment for ascites associated with liver disease
Plasma (for hypoalbuminemia)
Salt restriction
Spironolactone
Therapeutic paracentesis
Causes of hepatic lipidosis in cats
Idiopathic - MOST COMMON
DM
HypoT4
Pancreatitis/tiaditis
Common causes of protozoal hepatitis and treatments
Leishmania: allopurinol
Toxoplasma: TMS, pyrimethamine
Hepatozoon: imidocarb
Fungal hepatitis most commonly caused by
Histoplasmosis
Tx with itra
Most common pathogen in bacterial cholecystitis?
E. Coli
What is idiopathic chronic hepatitis?
Unknown etiology, possible immune-mediated
Doberman, Cocker Spaniel, Westies
Biopsy will show bridging necrosis, lymphocytic-plasmacytic infiltration, progressing to cirrhosis
Treat with immunosuppressive therapy, colchicine, sylimarin
Prognosis very guarded
What is colchicine?
Microtubule inhibitor that inhibits collagen deposition, stimulated collagenase
Used as anti-fibrotic therapy and may decrease inflammation in patients with liver disease
No data on efficacy
What is sylimarin?
Milk thistle
Antioxidant, leukotriene, and TNF inhibitor
Inhibits P glycoprotein, affects P450 enzymes
Uncertain efficacy
Which supplements for liver disease act on methyl transfer?
Folate
B12
SAMe
Which antioxidant vitamins may be helpful in liver disease?
Vitamin E
Vitamin C
Causes of neurological signs with hepatic encephalopathy
- Ammonia from colon and kidney
- Inhibitory GABA receptor stimulation
- False neurotransmitters from aromatic amino acids
- Methionine/mercaptans
- Hypoglycemia
- Cerebral edema
- Hypokalemic alkalosis
- Dehydration
What is often the only way to monitor liver disease?
Repeat biopsy
What is the “triple therapy” for helicobacter infection?
- PPI
- Amoxicillin
- Bismuth
Almost all underlying causes of changes in gut motility that cause vomiting are due to
Low protein
When do you need to re-culture after treatment for UTI?
Complicated UTI
Culture 7 days after treatment started and 1 week after treatment has stopped
How are colony numbers estimated in urine cultures where colonies are TNTC?
Estimating percentage of total area of the plate that is covered with a confluent lawn of bacteria and then x 10,000
Most common pathogens in UTIs
More common: E.coli, proteus, staph, enterococcus
Less common: klebsiella, psuedomonas
Which antibiotics are first line for uncomplicated UTI?
Clavamox
TMS
What antibiotic is first line when suspecting pyelonephritis (and while awaiting culture results)?
Fluroquinolone
Duration of treatment for UTI (uncomplicated and complicated)
Uncomplicated: 7-14 days
Complicated: 4 weeks
Clinical signs of distemper infection?
Cough small intestinal diarrhea Hyperkeratosis “Chewing gum” seizures Dentine damage and cardiomyopathy (neonates) HOD? Uveitits
When can you get a weak false positive on parvo fecal antigen ELISA?
4-8 days after live vaccine
How long will a parvo fecal antigen ELISA be postivie after infection?
10-12 days
When is PCR for parvovirus most sensitive, how long will it detect virus post-infection, and does it detect vaccine?
Most sensitive at 10 days
Measurable as long as 54 days
Detects vaccine up to 14 days
Diagnosis of distemper is based on what?
Pattern of clinical signs Cytoplasmic inclusions CSF IgG vs serum IgG Immunocytology of antigen PCR Neutralizing Ab ELISA for IgM or IgG
What is a positive prognostic factor for parvo?
Higher C-reactive protein
Maintenance of WBC count during hospitalization
(Cholesterol lower in non-survivors)
Main negative prognostic factor for distemper
Neurological signs
Water requirements for animals being treated for parvo/distemper?
1 mL/lb/hr
Puppies need 2x
Major risk of modified live distemper vaccine
Vaccine-induced encephalitis
HOD
(Especially in weimeraner)
Which distemper vaccines give immunity >3 years?
Modified live
Recombinant canary pox vector vaccine
Environmental risk factors for lepto
High rainfall Flooding Standing water Working dogs Urban dogs exposed to rats Overcrowded kennels Contaminated water sources in dry areas Warm, moist alkaline soil
Serologic diagnosis of lepto requires:
Single titer > 800
4-fold increase or decrease in paired titers 1-3 weeks apart gold standard
Lyme borreliosis is transmitted by
Ixodes ticks
What percent of dogs are seropositive for lyme borreliosis? What percent show clinical signs?
75% are seropositive
5-10% have clinical signs
Pathogenesis of lyme borreliosis
OpsA aids in attacghment to tick midgut
When tick feeds on host, OpsC upregulated and causes migration of borrelia to salivary gland
Increase in VlsE as tick engorges, allows borrelia to evade host immunity
Dermal inoculation causes inc in OpsC and Salp15 -> dissemination
Clinical signs of lyme disease
Clinical signs occur 2-6 months after exposure
Polyarthritis, shifting leg lameness
Fever, anorexia, lethargy
Lymphadenopathy
Lyme nephritis (PLN caused by immune-complex deposition)
Can cats get lyme borreliosis?
In lab setting, yes
Not naturally
Criteria for lyme borreliosis
- History of exposure to ticks in an endemic area
- Typical clinical signs
- Specific Ab against B. Burgdorferi
- Prompt response to antibiotics
Drawback of ELISA for diagnosis of lyme borreliosis?
Cannot distinguish between disease and vaccination
What does the SNAP 4Dx specifically test for lyme borreliosis?
C6 antibody
VlsE (IR6) gene only expressed during infection and replication within mammalian host
Codes for C6 peptide
Vaccines do not induce false positives!
What is the lyme multiplex assay?
Test by Cornell that quantifies amounts of OspA, OspC, and Osp F
Should all dogs that test positive for lyme on SNAP test be treated?
No, only treat clinical dogs
Treatment for lyme borreliosis?
Clavamox
Doxycycline
Prevention of lyme borreliosis
Tick prevention
Vaccination (Osp A antibodies)
Wy is there controversy over vaccination for lyme borreliosis?
Most infections are subclinical
Disease responds to antibiotics
Questionable vaccine efficacy
Post-vaccinal Lyme-like syndrome
OspA can be inflammatory and cause lyme nephropathy
Can lyme for a dog be transmitted to a human?
No
Only serve as a sentinel for human disease
Vector and infected cell type:
E. Canis, E. Ewingii, A. Phagocytophilium, A. Platys
E. Canis: Riphicephalus, monocytes/macrophages
E. Ewingii: Amblyomma, granuloctes
A. Phagocytophilium: Ixodes, granuloctes
A. Platys: Riphicephalus, platelets
Cytologic finding with E. Canis
Morulae within macrophages
What causes the most common labwork abnormality found with E. Canis infection?
Thrombocytopenia
Due to:
Platelet consumption
Decreased platelet half-life (splenic sequestration, immune-mediated destruction)
Increased PMIF inversely proportional to platelet count
In which phase of disease is E. Canis most commonly diagnosed?
Chronic
What labwork abnormality found with E. Canis warrants distinction from lymphoma?
Granular lymphocytosis
Lab abnormalities found with E. Canis infection
Moderate - severe thrombocytopenia
Mild - moderate non-regenerative anemia
Granular lymphocytosis
Pancytopenia
Hyperproteinemia
Increased ALT and ALP
Protienuria
CSF - lymphocytic pleocytosis
Morulae on blood smear
Diagnosis of E. Canis
Serology:
Fluorescent Ab test gold standard
Point-of-care ELISA (IDEXX 4Dx SNAP)
Treatment for E. Canis
Doxycycline 21-28 days
Chloramphenicol for puppies <5 mo
Enro is NOT effective
How do you assess response to therapy in treatment of E. Canis?
Resolution of signs
Increased platelet count
(Should normalize within 2 weeks)
Clinical signs of E. Ewingii
Polyarthropathy Fever Splenomegaly Hepatomegaly Thrombocytopenia
Is erlichia zoonotic?
No reported cases
Needs vector for transmission
E. Canis DNA has been detected in humans with erlichiosis
(Use caution when handling ticks on dogs)
Cytology/lab findings found with Analplasma phagocytophiliuum?
Morulae within neutrophils
Mild to severe thrombocytopenia
Moderate non-regenerative anemia
Vector and target cells for rickettsia rickettsia
Dermacentor ticks
Vascular endothelial cells
How does rickettsia rickettsia cause thrombocytopenia
VASCULITIS
First and most consistent clinical sign of RMSF (rickettsia rickettsia)?
Fever
What percent of patients with RMSF (rickettsia rickettsia) have neurologic signs?
80%
Retinal hemorrhage is a clinical sign of which tick-borne disease?
RMSF (rickettsia rickettsia)
How can RMSF cause death?
Hemorrhagic diathesis
Thrombosis of vital organs
DIC
Meningioencephalitits
Cardiovascular collapse
Diagnosis of RMSF (rickettsia rickettsia)
Serology: > 4x increase in IgG titer, single titer < 1:1024
Direct FA of tissue (some false negatives)
PCR (whole blood or tissue)
Treatment of RMSF (rickettsia rickettsia)
Doxycycline
Enrofloxacin
Chloramphenicol
Zoonotic potential of RMSF?
No reported cases
Which species of babesia may have direct transmission between dogs?
B. Gibsoni
How does babesia cause a hemolytic anemia?
Direct RBC damage
Intravascular hemolysis
Extravascular hemolysis
Which species of babesia is endemic in SE greyhound kennels?
Babesia canis vogeli
Which species of babesia is known to cause a thrombocytopenia?
B. Canis
How can you diagnose babesiosis on serology?
Increasing titers over 2-3 weeks
What is the most sensitive and specific way to diagnose babesiosis?
PCR
Teatment of babesiosis?
Imidocarb
or
Azithromycin + atovaquone
Prevention of babesiosis includes:
Tick control
Blood donor screening
Don’t reuse needles
Sterile instruments
Control dog fighting
Treatment of symptomatic carriers
How is bartonella transmitted?
Cat flea, possibly ticks
Transmission via infected cat blood (cat scratch, animal bite)
What percent of healthy dogs are seropositive for bartonella?
10%
Clinical signs of bartonella in the dog
Fever
Endocarditis (B. Visonii)
Pyogranulomatous lymphadenopathy
Peliosis hepatis (focal blood filled spaces in liver)
Cavitary effusions
Clinical signs of bartonella in the cat?
Lethargy
Fever
Mild neurologic signs
Gingivitis/stomatitis
Why is serology problematic in the diagnosis of bartonellosis?
5-12% of cats infected with B. Henselae seronegative
IgG persists for prolonged period following clearance
How do you diagnose Bartonellosis?
Blood culture (Bartonella alpha-proteobacteria growth medium)
PCR
Treatment of bartonella
Enrofloxacin + doxycycline
What is cat scratch disease?
Zoonotic Bartonellosis, affects immunosuppressed people
Clinical signs of hemotropic mycoplasma?
Depression, inappetence, dehydration Weight loss Hemolytic anemia Splenomegaly Icterus Febrile or hypothermic
Lab abnormalities seen with hemotropic mycoplasma
Autoagglutination Regenerative anemia Erythrophagocytosis Elevated ALT Hyoerbilirubinemia
Main clinical sign of carrier phase of hemotropic mycoplasma
Relapsing anemia
Diagnosis of hemotropic mycoplasma
PCR good for detecting acute phase, but not carrier
Treatment of hemotropic mycoplasma
Doxycycline
Enrofloxacin
Pred (if IMHA)
Azithromycin is not effective
NO TREATMENT THAT COMPLETELY ELIMINATES ORGANISM
How is canine hemotropic mycoplasma transmitted
Brown dog tick
When do clinical signs of mycoplasma canis pop up?
If a dog has been splenectomized or immunsuppressed
How is hepatozoon transmitted?
Tick ingestion
Where does hepatozoon canis live in host?
Encysts in striated muscle
Lab abnormalities with hepatozoon
Severe leukocytosis Hypoglycemia Hypoalbuminmia Inc ALP Inc BUN
CPK is usually normal
Radiographic findings with hepatozoon
Periosteal proliferation along long bones
Similar to hypertrophic osteopathy
Which muscles would you biopsy to diagnose hepatozoon
Biceps femoris or semitendinosis
Treatment of hepatozoon
Triple therapy: TMS, Clindamycin, Pyrimethamine
Ponazuril
Decoquinate
No drugs eliminate all tissue stages of organism
Usually have shirt-lived remission 2-6 months before relapse
Reservoir host for cytaux
Bobcat
What are the main reasons cytaux causes clinical disease?
Blood flow obstruction and hemolytic anemia
Prognosis of cytaux
BAD
Rapid course of illness and frequently death in less than 5-7 days
How can you diagnose cytaux
Piroplasms on blood smear
PCR
Treatment for cytaux
Azithromycin
Atovaquone
How are FIV and FeLV spread?
FIV - fighting
FeLV - spread of bodily fluids
Best test for FIV/FeLV testing?
IDEXX SNAP
Confirm with PCR [or IFA (FelV) or DIVA (FIV)]
What type of dogs are candidates for being blood donors?
Dogs: > 50 lbs PCV > 40% Never been pregnant Never have had a previous blood transfusion DEA 1.1 and 1.2 negative
Cats: > 10 lbs PCV > 35% Never been pregnant Never had previous blood transfusion Indoor only
What is the anticoagulant of choice when collecting blood for blood transfusion?
CPDA
Advantage of plastic bag over glass bottle for collection of blood for blood transfusion
Bags have slightly les negative pressure so less likely to cause RBC damage
Bottles need to be vented so higher risk of bacterial contamination
Volume of blood transfused should not exceed
22 ml/kg/day
Calculations for blood volume to transfuse to achieve a given PCV
Donor blood (ml) = K x BW (kg) x [(Desired PCV - Recipient PCV)/PCV of donor blood]
2 ml of transfused whole blood per kg of BW rasies PCV by 1%
1 ml of transfused pRBC per kg of BW raises PCV by 1%
What factors does frozen (stored) plasma lack and what is it mainly used for?
Lacks 5 and 8
Used in anticoagulant rodenticides, hemophilia B, colloid support
What coagulation factors does cryoprecipitate have and what is it mainly used for?
VWF
Fibrinogen
Factor 8
Used in VWBD and Hemophilia A
Why would you ever need to give albumin to a patient?
Life-threatening hypoalbuminemia
Types of transfusion reactions
Hemolysis (immune-mediated and non immune-mediated)
Febrile, non-hemolytic reaction
Allergic reaction
Transfusion-related Acute Long Injury (TRALI)
Sepsis
What is that cause of febrile, non hemolytic transfusion reaction?
Cytokines produced by WBCs during storage of the blood
What is Transfusion Related Lung Injury?
Rare syndrome caused by WBC antibodies from donor plasma
Causes pulmonary edema, fever, hypotension, dyspnea, and hypoxia
What causes non-immune-mediated hemoticis transfusion reactions?
Problems in storage or administration of blood
Temperature fluctuations, using pressure bags, pumps, or small needles
What complications are associated with massive transfusion reactions?
Citrate toxicity (hypoCa) HyperK+ HypoK+ Hypothermia Coagulopathies
Primary indication for transfusing fresh frozen plasma?
Hypoprotienemia and coagulopathy
Will not maintain higher protein levels, still need to address underlying issue
Main indications for transfusing cryo-poor plasma?
Vit K rodenticide
Hemophilia B
The delay in resolution of icterus in patients which are clinically improving may be attributed to
Long half-life of delta bilirubin
