Fundamentals of clinical practice 2 Flashcards
What are the different sections that can be seen in this panel?
What is being assessed in a blood panel?
Red cell mass
Evidence for effective and apt erthyropoeisis
Red cells size and variation
Red cell haemoglobinisation
Red cell shapes and inclusions
What are the goals of packed cell volume, red cell count and Hgb?
PCV (Hct), RBCC and Hgb
All three are measures of red cell mass and oxygen carrying capacity
Usually interpret them as a block
All equally affected by haemoconcentration
Will usually increase and decrease in line with one another
When they are discordant find out why – “rule of three”
How is PCV calculated?
PCV = MCV x RBCC
When may PCV be incorrect?
PCV may be wrong if…
RBC’s miscounted
Mistaken for platelets
Aggregated into pairs and triplets
MCV misleading
Cell shrinkage or swelling
Transport, tube filling
Osmotic effects in machine
What does high MCHC suggest?
misleading results
Not physiological to cram more Hgb into red cells than they will take
Haemolysis (sample handling or intravascular)
Lipaemia
Polycythaemia
Implies increased number of several haemopoetic cell lines in humans
In dogs and cats with polycythaemia vera ususally have normal neutrophil and platelet counts
How can MCV cause misleading PCV result?
Swelling of transport
Misidentification
Cell shrinkage or expansion in sample
Will impact PCV/HCT
How can the rule of three be used in haematology?
How is anaemia classified?
Based on MCV and MCHC
Blunt measure
Microscope visible findings may not be sufficient to push parameter out of the reference range
Machine dot=plots and histograms more sensitive
What are the classifications of anaemia?
Normocytic normochromic
Macrocytic hypochromic
Microcytic hypochromic
Properties of normocytic normochromic anaeamia
Often anaemia of illness or pre regenerative or occasionally non regenerative
Properties of macrocytic hypochromic anaemia?
Classic highly regenerative
Sometimes can be due to swelling of transport
Properties of microcytic hypochromic anaemia?
Classic iron deficiency- chronic external blood loss
Without anaemia- portosystemic shunts
How is polycytheamia detected on a panel?
Increase in PCV, Hgb concentration and RBCC
What are the properties of relative polycythaemia on a panel?
Apparent increase in RBC due to a decrease in fluid in circulation (often inc total protein and albumin)
What are the properties of absolute polycythaemia on a panel?
True increase in RBC mass due to increased RBC production and release
(usually polychromasia, anisocytosis and reticulocytes)
What is primary polycythaemia?
rare myeloproliferative disorder
Abnormal response of RBC precursors
Normal EPO levels
What is secondary polycythaemia?
Chronic tissue hypoxia of renal tissues due to heart lung diseases, high altitude, thrombosis, constriction of renal vessels
Renal tumor or cysts (increased intra capsular pressure)
Increased EPO
What are reticulocytes and how can they be visualised?
Young immature erythrocytes prematurely released to blood from the bone marrow in regenerative anaemias
Visualise using New methylene blue precipitation demonstrates RNA protein complexes (ribosomal RNA and mitochondria)
Clinical applications
- evaluation of erythropoeisis in bone marrow
- differentiation of regenerative and non regenerative anaemia
Reticulocyte count?
Species variation in reticulocyte response?
What red cell variations are there within dog breeds?
macrocytosis in some poodles
Akitas have unusually small erythrocytes and high potassium content
Greyhounds have high PCVs
Poikilocytosis
What red cell inclusions can be seen?
What are the key components of a haematology report in veterinary medicine?
Red Blood Cells (RBC), Hemoglobin (Hb), Hematocrit/PCV, Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin Concentration (MCHC), White Blood Cells (WBC) and differential, Platelet count.
How is red cell mass evaluated and what does it indicate about erythropoiesis?
Red cell mass is evaluated using PCV/Hct, RBC count, and Hgb levels. It provides evidence for effective and appropriate erythropoiesis based on size, color (MCV, MCHC), and reticulocyte count.
What does MCV and RDW indicate in red cell size and variation assessment?
MCV indicates the average volume of red cells, suggesting their size, while RDW measures the variation in red cell size, indicating anisocytosis.
How is anemia classified based on red cell parameters?
Anemia is classified based on cellular characteristics such as normocytic, normochromic, hypochromic, and macrocytic, which helps in determining the underlying cause and type of anemia.
Differentiate between relative and absolute polycythemia.
Relative polycythemia is due to a decrease in plasma volume without an increase in RBC mass, often from dehydration. Absolute polycythemia is a true increase in RBC mass due to increased production/release of RBCs.
What are reticulocytes and their significance in diagnosing anemias?
Reticulocytes are immature, non-nucleated erythrocytes released prematurely from the bone marrow during regenerative anemias. Their count helps evaluate bone marrow response and differentiate between regenerative and non-regenerative anemia.
What does a high RBC count indicate in animals?
It may indicate polycythemia, which is an increased number of red blood cells.
Why are reticulocyte counts important in veterinary diagnostics?
They indicate the bone marrow’s response to anemia, helping differentiate between regenerative and non-regenerative types.
How does dehydration affect PCV (Packed Cell Volume) readings?
Dehydration can artificially raise PCV readings by reducing plasma volume, making it seem like there are more red cells than there actually are.
What are the primary functions of white blood cells in disease diagnosis?
To aid in the diagnosis of disease through their characteristics, including type and concentration in the blood.
List the different types of white cells found in the blood.
Neutrophils, lymphocytes, monocytes, eosinophils, and basophils.
How do white cell counts vary among different species?
There is significant species variation in the relative value and distribution of white cells, with specific reference intervals for dogs, cats, horses, and cows.
What is leukocytosis and what can cause it?
Leukocytosis is an increase in the number of white blood cells in the blood, caused by conditions like infections, inflammation, and stress.
Explain the significance of neutrophilia and its causes.
Neutrophilia is an increase in neutrophils, often indicating inflammation, infection, or stress. Causes include bacterial infections, tissue necrosis, and reactions to steroids or epinephrine.
Describe the process and significance of cells leaving blood vessels (marginalisation, adhesion, migration).
This process allows white blood cells to exit the bloodstream and enter tissues where they can engage pathogens or damaged cells. Factors influencing this include epinephrine, glucocorticoids, and infection.
What are the implications of a left shift in a white blood cell differential?
A left shift, where immature neutrophils (bands) outnumber mature ones, indicates an active response to infection, inflammation, or stress.
Define eosinophilia and its causes.
Eosinophilia is an increased concentration of eosinophils, typically due to allergic reactions, parasitic infections, or certain diseases.
What does lymphocytosis indicate?
An increase in lymphocytes, often seen in viral infections, chronic inflammation, or in young animals as a response to vaccination.
Discuss the significance of monocytes in blood analysis.
Monocyte levels can indicate chronic inflammation, with an increase suggesting ongoing immune response to infection or tissue damage.
What does a “left shift” in neutrophils mean, and why is it important?
It signals an increase in immature neutrophils, indicating a vigorous bone marrow response to infection or disease.
In what situations might eosinophil levels increase, and what does this tell a veterinarian?
Elevated eosinophil levels can indicate allergic reactions, parasitic infections, or certain autoimmune conditions, guiding diagnostic and treatment strategies.
What are the primary goals of routine cytological sample examination?
To determine the adequacy of the sample for diagnosis, identify the type of cells present, and assess the presence of inflammation, infection, or neoplasia.
What factors should be evaluated during the low power review of a cytological sample?
Sample quality, presence and preservation of cells, background characteristics (e.g., hemorrhage, protein matrix, debris), and predominant cell types.
How do you assess cells at high magnification during cytology review?
By examining cell organization, population (single or mixed), cell size and shape variation, and nuclear characteristics including size, shape, and any abnormal mitoses.
What criteria are used to determine if a sample is inflammatory, and how do you identify its type?
Based on the presence of specific cell types (e.g., neutrophils) and characteristics such as septic versus non-septic inflammation.
What are the key features to differentiate between benign and malignant neoplasia in cytology?
Cellularity, degree of differentiation, presence of mitotic figures, and cellular atypia.
How can cytological examination help differentiate between epithelial, mesenchymal, and round cell tumors?
By assessing cell shape, arrangement, and other morphological features specific to each cell type.
Why is it important to match the cytology findings with the known normal cell population of a tissue?
To determine if the sample reflects normal tissue architecture or indicates pathology, such as neoplasia or inflammation.
“Known tissue approach”
What steps are involved in writing an in-clinic cytological report?
: Assessing sample adequacy, describing findings (cell types, inflammation, neoplasia), and providing a diagnosis or differential diagnoses.
How are reference intervals for biochemical panels determined, and what challenges are associated with their creation?
Reference intervals are ideally determined using data from 120 clinically normal animals to account for variability across age and breeds, but this is rare. In practice, they’re often based on smaller samples or extrapolated data. The central 95% of a healthy population defines these intervals, acknowledging that a small percentage of healthy animals will have values outside this range due to biological variability and measurement limitations
Explain the statistical basis for determining what constitutes a “normal” result in a biochemical panel.
The “normal” range is defined as the central 95% of a healthy population, calculated as mean ± 2 standard deviations for normally distributed data or the 2.5th to 97.5th percentiles for skewed distributions. This accounts for natural biological variation but also means that approximately 5% of healthy individuals will have results outside this range by chance alone.
Discuss the significance of abnormal results when multiple tests are performed. (biochem panel)
With each additional test performed, the likelihood of encountering at least one “abnormal” result in a healthy animal increases due to statistical probability. For example, running 15 tests might result in abnormal results 54% of the time purely by chance. This highlights the importance of interpreting test results within clinical context and considering the possibility of compound statistical anomalies.
How should veterinarians approach the interpretation of borderline biochemical panel results?
Borderline results, especially those near the limits of reference intervals, require careful consideration of analytical variation. For instance, a result slightly outside the reference range might fall within it when measurement imprecision is accounted for. Clinicians should consider the entirety of clinical evidence, potentially retesting to confirm findings.
What factors should be considered when evaluating the plausibility of lab results?
Assessing result plausibility involves considering pre-analytical and analytical factors such as sample handling (e.g., hemolysis, lipemia), the potential for contamination, and the limits of the testing technique. Unusual values that don’t fit clinical expectations may necessitate reevaluation or additional testing to rule out artifacts.
Why is understanding the distribution of test results critical for interpreting individual values?
nderstanding the statistical distribution helps clinicians to interpret how individual results relate to the overall health status of the population. It provides a framework for assessing the likelihood that a result reflects a true physiological deviation versus a statistical outlier or measurement error.
How do leakage enzymes like ALT and AST differ in indicating organ damage compared to function indicators like bile acid for hepatic function?
Leakage enzymes (ALT, AST, CK) increase in serum due to cell damage allowing their escape, reflecting organ damage. In contrast, function indicators (bile acid, ammonia for hepatic function; creatinine, USG for renal) assess the organ’s performance in executing its physiological roles. Understanding both provides a comprehensive view of not just the presence of damage but also the affected organ’s functional capacity.
Why is alanine aminotransferase (ALT) considered liver-specific in dogs and cats, and how does its half-life influence monitoring liver health?
ALT is liver-specific in dogs and cats, making it a reliable marker for hepatic damage when elevated. Its half-life (40-60 hours in dogs, 3.5 hours in cats) dictates the timing for retesting to evaluate ongoing or resolving hepatic insult. Early and higher level increases post-damage allow precise monitoring of liver health and recovery.
How does enzyme induction by drugs or endogenous compounds like glucocorticoids affect the interpretation of biochemical panels?
Enzyme induction refers to increased enzyme activity without direct organ damage, often triggered by drugs (glucocorticoids, barbiturates) or pathological states. This distinction is crucial as elevated enzyme activities may not always signify organ damage but could reflect adaptive responses to external stimuli, complicating the diagnosis and necessitating careful evaluation of potential inducers in the patient’s history.
How do tests for hepatic function, such as bile acid and ammonia levels, differ in their diagnostic utility compared to liver damage enzymes?
Hepatic function tests, including measurements of bile acids and ammonia, evaluate the liver’s ability to perform essential metabolic processes, such as detoxification and synthesis. Unlike enzymes that leak from damaged cells, these function tests provide insight into the liver’s capacity to metabolize substances, with abnormalities indicating compromised liver function rather than structural damage. These tests are particularly valuable in diagnosing liver insufficiencies that may not yet have caused significant cellular damage.
What is the difference between organ damage and organ function indicators in veterinary biochemistry panels?
Organ damage indicators (e.g., leakage enzymes like ALKP, ALT, AST, CK, troponin I for cardiac damage, and PLI for pancreatic damage) are substances that leak into the bloodstream when cells are damaged. Organ function indicators (e.g., bile acid, ammonia for hepatic function; creatinine, USG for renal function; NT-proBNP for cardiac function) measure the ability of an organ to perform its physiological functions.
How are different biochemical parameters assessed and interpreted in veterinary practice?
Biochemical parameters are assessed based on their location (e.g., within the liver, other tissues, or cells), persistence in serum, degree of change, and their relation to disease or dysfunction. For example, enzyme activities (ALT, AST) indicate liver health, while creatinine and USG assess renal function. Parameters must be interpreted in the context of the animal’s overall health and specific condition.
What do elevated levels of ALT and ALKP indicate in dogs and cats, and how are they interpreted?
Elevated levels of ALT (alanine aminotransferase) and ALKP (alkaline phosphatase) in dogs and cats can indicate liver damage or dysfunction. ALT is more liver-specific, especially in dogs and cats, and increases earlier and to a higher degree following hepatic damage. ALKP can be induced by impaired biliary flow and medications, and is not liver-specific due to iso-enzymes present in bone and intestinal tissues.
How is renal function evaluated in veterinary medicine, and what does an elevated urea with normal creatinine suggest?
Renal function is evaluated using creatinine levels, urine specific gravity (USG), and the presence of proteinuria. Elevated urea with normal creatinine suggests pre-renal effects like dehydration or post-prandial states. A USG less than 1.030 in dogs or 1.035 in cats with azotemia suggests inappropriate dilution, indicating renal dysfunction.
Why are different biochemical indicators used in different veterinary species, and give examples?
Different species metabolize and respond to substances differently, necessitating species-specific biochemical indicators. For example, ALT elevations are more concerning in cats than in dogs due to their shorter half-life in cats. Urea is not a reliable renal function indicator in equidae and ruminants due to GI tract and other clearance mechanisms. Acute phase proteins and electrolyte balance also vary significantly among species, influencing test selection and interpretation.
What signifies organ damage in a biochemical panel?
Enzymes like ALT and AST leaking into the bloodstream indicate cell damage.
How do you differentiate between liver damage and liver function tests?
Liver damage is indicated by enzymes like ALT, while function tests involve bile acids and ammonia levels.
Why is creatinine important in assessing renal health?
Creatinine levels reflect the kidney’s ability to filter waste from the bloodstream.
How does species affect the choice of biochemical indicators?
Metabolic differences across species dictate which tests are relevant for assessing organ health.
What does an elevated ALKP level indicate in a dog or cat?
It can indicate liver damage or dysfunction, but it’s not exclusively liver-specific due to other sources like bone growth.
5-year-old English Springer Spaniel presented with acute onset of weakness. The patient has severe anemia, leukocytosis with neutrophilia, hyperglycemia, prolonged PT/aPTT, and hypoalbuminemia.
Immune-Mediated Hemolytic Anemia (IMHA)
Internal bleeding
Coagulopathy, possibly due to rodenticide toxicity
10-year-old cross-breed dog presented with a history of vomiting and anorexia. Bloodwork shows elevated ALP, ALT, GGT, hypercholesterolemia, and bile acids.
Hepatic neoplasia
Acute hepatitis
Drug-induced hepatopathy (considering meloxicam use)
A 12.5-year-old Old English Sheepdog presents with anorexia. Significant findings include severe leukocytosis with marked neutrophilia and band neutrophils, hypoalbuminemia, and elevated creatinine levels.
Pyometra
Septic peritonitis
Severe systemic infection leading to sepsis
A dog was accidentally exposed to a skin cream. Clinical pathology findings include hypercalcemia, hyperphosphatemia, and azotemia, indicative of potential renal involvement.
Toxicological exposure to calcipotriene (a vitamin D analogue) or other topical medication containing steroids, leading to acute renal failure and hypercalcemia.
History: 12-year-old Warmblood cross mare, refusing to move post a 40Km trail ride. Gluteal muscles hard, discomfort signs (lip curling, pawing), heart rate 48 bpm, respiratory rate 20 bpm, rectal temperature 38.2°C, dark brown urine.
Biochemistry Highlights:
Creatinine: 222 µmol/l (↑)
AST & Creatine Kinase: Above max detection limit
Total protein: 85 g/l (↑), Albumin: 40 g/l (↑)
Differential Diagnoses: Exertional rhabdomyolysis, dehydration, acute renal failure.
Treatment Options: IV fluids for rehydration, analgesics for pain management, and careful monitoring of renal function and muscle enzymes.
History: 5-year-old Thoroughbred mare, lethargic for 2 days, decreased appetite, not drunk for 12 hours, slightly increased respiratory effort, heart rate 52 bpm, respiratory rate 28 bpm, rectal temperature 38.5°C, mucous membranes pink and moist, capillary refill time <2 seconds.
Biochemistry Highlights:
Urea: 14.9 mmol/l (↑)
Creatinine: 141 µmol/l (↑)
Total protein: 58 g/l (↓), Albumin: 21 g/l (↓)
AST: 4.6 µkat/l (↑), Creatine Kinase: 6.5 µkat/l (↑)
Differential Diagnoses: Acute renal failure, dehydration, sepsis, electrolyte imbalances.
Treatment Options: IV fluids to address dehydration and renal function, antibiotics if sepsis is suspected, monitor electrolytes, supportive care.
History: 18-year-old Arabian gelding, off feed for 24 hours, lethargic, mild colic signs, heart rate 44 bpm, respiratory rate 16 bpm, rectal temperature 37.8°C, pale mucous membranes, capillary refill time 3 seconds.
Biochemistry Highlights:
Total Bilirubin: 34 µmol/l (↑)
AST: 12.5 µkat/l (↑)
GGT: 45 U/l (↑)
Albumin: 25 g/l (↓), Globulins: 55 g/l (↑)
Differential Diagnoses: Hepatic disease, hemolytic anemia, intestinal parasitism.
Treatment Options: Supportive care including IV fluids, nutritional support, possibly corticosteroids for liver inflammation, anthelmintics if parasitism is suspected.
History: 3-year-old Holstein Friesian cow, decreased milk yield, off feed for 48 hours, isolated, lying down more than usual, heart rate 88 bpm, respiratory rate 32 bpm, rectal temperature 39.4°C, mucous membranes pale.
Biochemistry Highlights:
Total Calcium: 1.75 mmol/l (↓)
Phosphorus: 1.9 mmol/l (normal)
Magnesium: 0.8 mmol/l (↓)
Differential Diagnoses: Hypocalcemia (Milk Fever), hypomagnesemia (Grass Staggers).
Treatment Options: IV calcium borogluconate for immediate relief, oral calcium supplements for maintenance, magnesium supplementation if necessary.
History: 4-year-old Aberdeen Angus, recently purchased, coughing, nasal discharge, heart rate 70 bpm, respiratory rate 40 bpm, rectal temperature 39.7°C.
Biochemistry Highlights:
Not specified in detail but indications of respiratory infection and stress.
Differential Diagnoses: Bovine Respiratory Disease Complex (Shipping Fever), parasitic lung infections.
Treatment Options: Antibiotics for bacterial infection, anti-inflammatories, supportive care, and stress reduction strategies.
What is haemostasis and its primary objective in vascular injury?
Haemostasis is the process by which blood clots form at sites of vascular injury to prevent excessive bleeding. Its primary objective is to seal damaged blood vessels through a series of events involving platelet aggregation and the coagulation cascade, which are divided into primary, secondary, and tertiary stages.
Describe the three traditional stages of haemostasis.
The three traditional stages of haemostasis are: 1) Primary haemostasis, where platelets aggregate to form a plug at the site of injury; 2) Secondary haemostasis, where the coagulation cascade stabilizes the platelet plug with fibrin strands; 3) Tertiary haemostasis (fibrinolysis), where the clot is dissolved after it has served its purpose.
What are the key components and inhibitors of primary haemostasis?
Primary haemostasis involves the adhesion, activation, and aggregation of platelets, facilitated by endothelial cells and von Willebrand factor (vWF). Key inhibitors include aspirin and NSAIDs, which inhibit thromboxane production, and clopidogrel, an ADP receptor antagonist, affecting platelet function.
What are the clinical signs and tests for evaluating primary haemostasis disorders?
Clinical signs include petechiae, ecchymosis, and purpura, indicating ineffective platelet function. Evaluation tests include platelet count, plateletcrit, Buccal Mucosal Bleed Time (BMBT), and assays for vWF antigen and activity for specific breed-related conditions.
What are the causes and types of thrombocytopenia and thrombocytosis in primary haemostasis disorders?
Thrombocytopenia can result from decreased production, immune-mediated destruction, consumption (e.g., DIC), sequestration, or loss, while thrombocytosis can be reactive (secondary to inflammation, neoplasia, or GI disease), drug-induced, or due to increased platelet production. Both conditions can be inherited or acquired.
What are the three stages of haemostasis and their basic functions?§
The three stages are primary haemostasis (platelet plug formation at a damaged vessel wall), secondary haemostasis (coagulation cascade forming fibrin strands to hold the plug together), and tertiary haemostasis or fibrinolysis (dissolution of the clot after it served its purpose).§
What key components can be measured from a clinical pathology perspective to assess haemostasis, and what do they indicate?
Clinically measurable components include platelet count and function, coagulation factors, and fibrin degradation products like D-Dimers. These measurements help evaluate the body’s ability to form and dissolve blood clots.
What are the cellular components and key events of primary haemostasis?
Primary haemostasis involves platelets and endothelial cells (producing vWF) in events like adhesion (platelets to exposed matrix proteins), activation (promoting platelet recruitment and shape change), and aggregation (mediated by fibrinogen).
What clinical signs and tests are used to assess primary haemostasis?
Clinical signs include petechiae, ecchymosis, and purpura. Key tests include platelet count, plateletcrit, Buccal Mucosal Bleeding Time (BMBT), and assays for von Willebrand factor (vWF) antigen and activity.
What are the types and causes of thrombocytopenia and thrombocytosis?
Thrombocytopenia can be inherited or acquired due to decreased production, destruction (e.g., immune-mediated), consumption (e.g., DIC), sequestration, or loss. Thrombocytosis can be primary or secondary, caused by increased platelet production or decreased clearance.
Describe thrombopathia and von Willebrand Disease (vWD) in terms of occurrence, diagnosis, and clinical signs.
Thrombopathia, an abnormal platelet function, is uncommon and difficult to diagnose, with normal or mildly reduced platelet count. vWD is the most common inherited disorder of haemostasis, characterized by deficient or abnormal vWF, diagnosable through vWF antigen concentration tests and BMBT.
What are the intrinsic, extrinsic, and common pathways in secondary haemostasis?
The intrinsic pathway is activated by contact with collagen, the extrinsic by tissue factor (TF), and both lead to the common pathway, where factor X is converted to thrombin, which then forms fibrin.
How is secondary haemostasis evaluated clinically and what tests are used?
Clinical signs of hypo- and hypercoagulability include haematoma, haemorrhage, and thrombosis. Tests include Prothrombin Time (PT) for extrinsic and common pathways, Activated Partial Thromboplastin Time (aPTT) for intrinsic and common pathways, and Activated Clot Time (ACT) for a quick in-house screening.
Discuss the types of disorders affecting secondary haemostasis.
Inherited disorders include haemophilia A (factor VIII deficiency) and haemophilia B (factor IX deficiency), while acquired disorders include anticoagulant rodenticide toxicosis and conditions affecting coagulation factors like liver disease.
How does vitamin K inhibition affect coagulation, and what are the clinical implications?
Vitamin K is essential for synthesizing coagulation factors II, VII, IX, and X. Inhibition (e.g., rodenticide toxicosis) leads to prolonged PT and aPTT, mimicking factor deficiencies and indicating significant liver pathology or dysfunction.
What is fibrinolysis, and how does it relate to conditions like Greyhound Delayed Bleeding Syndrome?
Fibrinolysis is the process of dissolving blood clots, primarily through the action of plasmin converting fibrin into fibrin degradation products like D-dimers. Greyhounds may experience delayed bleeding post-surgery due to premature or excessive fibrinolysis, suggesting that clots formed are weak or dissolved too quickly. Treatments like tranexamic acid or epsilon aminocaproic acid (EACA) can be effective in preventing or reducing plasmin formation, thus improving the condition.
Discuss the pathology of the mammary gland.
Mammary gland pathologies include mastitis in farm animals, caused by various pathogens (bacterial, viral, mycoplasma), and mammary tumors in small animals. Mammary tumors can be benign (often adenomas with a benign histological appearance) or carcinomas (with a wide range of types, grading based on factors like differentiation, tubule formation, and mitotic rate).
What are the key pathological conditions of the uterus and external genitalia?
Conditions include congenital lesions (like segmental aplasia), inflammatory disorders (endometritis, metritis, pyometra), and neoplasms (leiomyoma, endometrial carcinoma). External genitalia may also be affected by neoplasms like squamous cell carcinoma and transmissible venereal tumors.
What is a granulosa cell tumor, and what are its characteristics?
Granulosa cell tumors are the most common type of sex cord-stromal tumor, typically benign, and can occur in any species. They feature a variety of histopathological patterns, including solid sheets, islands, and Call-Exner bodies, and may present with both solid and cystic areas, sometimes including areas of hemorrhagic necrosis.
Describe the main pathological conditions affecting the ovary.
Ovarian pathologies include ovotestis, cysts (follicular, luteinized, cystic rete ovarii, cysts of the subsurface epithelial structures), and neoplasms (sex cord-stromal tumors like granulosa cell tumors, tumors of the surface epithelium, germ cell tumors like teratoma and dysgerminoma, and rare tumors like yolk sac tumors).
What are disorders of sexual development (DSD), and how are they classified?
DSDs are conditions involving atypical development of chromosomal, gonadal, or anatomical sex. Classification is based on karyotype (XX, XY, or variations) and includes true hermaphroditism, male and female pseudohermaphroditism, with diagnoses often requiring assessment of sex chromosomes, gonadal type, and genital phenotype.
Disorders of Sexual Development (DSD)
Conditions involving abnormal development of chromosomal, gonadal, or anatomical sex. Classified based on karyotype and includes true hermaphroditism and pseudohermaphroditism.
Ovotestis
A rare condition where both ovarian and testicular tissue are present in the same individual, often associated with true hermaphroditism.
Granulosa Cell Tumor
A type of sex cord-stromal tumor originating from the granulosa cells of the ovary, often hormonally active and potentially malignant.
Pyometra
A serious reproductive condition in females characterized by the accumulation of pus within the uterine cavity, often secondary to infection.
Mastitis
Inflammation of the mammary gland, typically due to bacterial infection, leading to swelling, pain, and reduced milk production.
Leiomyoma
A benign tumor of smooth muscle origin, commonly found in the uterus (uterine fibroids) and sometimes in the external genitalia.
Endometrial Carcinoma
A type of cancer that originates from the lining of the uterus (endometrium), more common in older females.
Chimerism
A genetic condition where an individual has cells from two different zygotes, leading to mixed genetic profiles within the body.
Mammary Tumors
Neoplasms occurring in the mammary glands, ranging from benign (adenomas) to malignant (carcinomas), with varying prognoses based on type and grade.
What are the main categories of disorders affecting the testis and epididymis?
: Developmental anomalies, degeneration, inflammation, and neoplasia.
What is cryptorchidism and its implications for testicular health?
Cryptorchidism is the incomplete descent of one or both testes, often leading to hypoplasia and an increased risk of tumor formation.
Describe testicular hypoplasia and its common causes.
Testicular hypoplasia is characterized by underdeveloped testes, often due to congenital or pre-pubertal factors like nutrition, genetics, or endocrine abnormalities, leading to absent or incomplete spermatogenesis.
What causes testicular atrophy/degeneration and its typical histological appearance?
Caused by factors like infections, increased scrotal temperature, and nutritional deficiencies, it’s characterized by a reduction in testicular size with firm consistency and microscopic findings similar to hypoplasia, possibly with fibrosis.
How does epididymitis differ from orchitis in its impact on the male reproductive system?
Epididymitis, often caused by ascending infection, primarily affects the tail of the epididymis and can lead to secondary testicular degeneration/atrophy, while orchitis involves direct inflammation of the testes.
What condition describes undescended testes and its risk?
Cryptorchidism; increases tumor risk.
What is a key feature of testicular hypoplasia on microscopy?
Absent/incomplete spermatogenesis with hypoplastic tubules.
Main cause of testicular atrophy in adult males?
Infections and environmental factors leading to decreased size and firmness.
Primary site affected by epididymitis in males?
Tail of the epididymis, often leading to secondary testicular issues.
What’s a common histological finding in testicular degeneration?
Similar to hypoplasia, potentially with fibrosis.
What are the two main pathways for infectious diseases to affect the kidneys?
Haematogenous (descending) and urinary (ascending).
List some viral, bacterial, and parasitic agents causing kidney infections in animals.
Viral: Canine herpesvirus, Canine Adenovirus. Bacterial: Leptospira, E. coli. Parasitic: Toxocara canis, Leishmania spp.
Differentiate between non-suppurative and suppurative interstitial nephritis.
Non-suppurative involves lympho-histiocytic inflammation, while suppurative involves pus formation and can lead to embolic nephritis or pyelonephritis.
What causes acute and chronic interstitial nephritis, and how do they appear macroscopically?
Causes include various infectious agents. Acute shows kidneys swollen and pale tan, chronic shows fibrosis.
What is the primary cause and outcome of non-suppurative tubulointerstitial nephritis in dogs?
Primarily caused by acute leptospirosis, leading to lympho-histiocytic inflammation.
Describe the pathogenesis and causative agents of suppurative embolic nephritis.
Caused by bacteremia with agents like Actinobacillus equuli, leading to septic emboli and possibly abscesses or infarcts.
How does pyelonephritis typically begin, and what are its microscopic findings?
Begins with ascending infection, showing necrotic epithelium, neutrophil infiltration, and in chronic cases, severe fibrosis.
What are the primary pathways for the development of lower urinary tract infections?
Descending (leading to nephritis or pyelonephritis) and ascending.
Compare ureteritis, cystitis, and urethritis in terms of occurrence and associated factors.
Ureteritis is rare without cystitis, cystitis is the most common lower UTI, and urethritis is often linked to obstructions.
What is the most common cause of kidney infections in animals?
Bacterial agents like Leptospira and E. coli.
How does suppurative nephritis differ from non-suppurative nephritis?
Suppurative involves pus formation, non-suppurative involves immune cell inflammation.
: What is the hallmark microscopic feature of pyelonephritis?
Necrotic epithelium with neutrophil and bacterial infiltration.
What leads to lower urinary tract infections most frequently?
Ascending infections from the urethra.
How can urinary tract infections affect the kidneys?
Through ascending infection leading to pyelonephritis or descending infection causing nephritis.
Define triage and its primary goal in veterinary emergency settings.
Triage is the process used to prioritize patients based on the severity of their condition, aiming to do “the greatest good for the greatest number” by directing therapy where it’s most needed.
What constitutes effective triage in emergency veterinary medicine?
Effective triage means timely and appropriate prioritization, influenced by experience, a clear plan, stress management, leadership, and agile decision-making.
What are key methods to optimize triage in veterinary emergencies?
Optimization methods include practice, developing and following algorithms, and leveraging experienced triage officers supported by their team.
What are the drawbacks of using mnemonics like ‘ABCDE’ and ‘ACRASHPLAN’ in triage, according to the lecture?
: The drawbacks include the challenge of remembering what each letter stands for and the lack of incorporating point-of-care ultrasound (POCUS), which is crucial for immediate assessment.
Describe the algorithm approach to triage for a patient with RTA, haemoabdomen, and pulmonary contusions.
The algorithm includes assessing hypovolaemia through symptoms and diagnostics like ultrasound for blood loss, POCUS for pulmonary contusions, and evaluating reduced perfusion with oxygenated blood through blood pressure, lactate, and blood gas analysis.
Importance of POCUS in triage?
Allows immediate assessment of trauma or internal bleeding.
Compare the uses and limitations of isotonic crystalloids in fluid therapy.
Isotonic crystalloids like Hartmann’s and 0.9% saline are used for fluid resuscitation in hypovolemia and dehydration due to their rapid equilibration across membranes. However, their effect on intravascular volume expansion is short-lived, necessitating repeated administration or alternative therapy for sustained effects.
Explain the clinical applications and risks of using hypertonic saline versus hypotonic saline in veterinary medicine.
Hypertonic saline (7.2%) is used for rapid volume expansion and managing raised intracranial pressure with minimal volume, but risks inducing hypernatremia. Hypotonic saline (0.45%) can correct hypernatremia but may cause cerebral edema if hypernatremia is corrected too rapidly, leading to serious neurological complications.
Detail the specific clinical indications for the use of whole blood, packed red blood cells, fresh frozen plasma, and albumin in veterinary fluid therapy.
Whole blood is used for significant blood loss when packed red blood cells (pRBCs) aren’t available, targeting anemia. pRBCs are selected for anemia with no donor. Fresh frozen plasma addresses coagulopathies and supports oncotic pressure, while albumin is used in severe hypoalbuminemia to manage anaphylaxis and prevent acute kidney injury.
Discuss the role of colloids in managing hypoalbuminemia and the risks associated with their use in critically ill patients.
Colloids, like hetastarch and geloplasma, are used to improve oncotic pressure in hypoalbuminemia and vascular leak conditions. However, their use can exacerbate interstitial edema and minimal volume expansion due to vascular leakage, with potential risks including acute kidney injury and coagulopathy. Their use is cautioned against unless no alternatives are available.
Outline the approach to fluid therapy in hypovolemia, dehydration, and the endpoints for fluid resuscitation.
For hypovolemia, initial therapy involves micro boluses followed by larger boluses (10-15ml/kg for larger animals, 5-10mls/kg for cats), potentially including hypertonic saline. Dehydration correction prioritizes hypovolemia first, aiming for weight gain equivalent to the deficit over 24 hours. Endpoints for resuscitation include improved oxygen supply, mentation, blood pressure, lactate levels, and POCUS findings indicating improved volume status.
Why are isotonic crystalloids like Hartmann’s used in fluid therapy?
For rapid equilibration in hypovolemia and dehydration, despite short-lived vascular expansion effects.
When is hypertonic saline preferred in fluid therapy?
For rapid volume expansion in large animals and managing raised intracranial pressure, with careful monitoring to avoid hypernatremia.
Role of fresh frozen plasma in fluid therapy?
Addresses coagulopathies and supports oncotic pressure in hypoalbuminemia.
What complicates colloid use in critically ill patients?
Risk of exacerbating vascular leakage and interstitial edema, with potential for acute kidney injury.
Key considerations in monitoring fluid therapy effectiveness?
Monitoring involves assessing mentation, blood pressure, lactate levels, and volume status via POCUS, aiming for specific clinical improvement endpoints.
How do you calculate the initial fluid bolus for a 9.1kg dog showing signs of hypovolemia due to vomiting and diarrhea after ingesting mushrooms?
Calculate the initial bolus using the formula: patient weight in kg x 10 mL/kg. For a 9.1kg dog, the initial bolus would be approximately 91 mL, adjusted on the drip pump to ensure precise delivery over 15 minutes.
After administering an initial fluid bolus and observing slight improvement but persistent hypovolemia (e.g., elevated heart rate and low blood pressure), how do you adjust the fluid therapy plan?
Increase the bolus to 15 mL/kg over 15 minutes based on patient response, with continuous monitoring of vital signs and lactate levels to guide further adjustments.
How do you transition fluid therapy from treating hypovolemia to addressing dehydration in a dog that has stabilized?
Calculate the total fluid deficit based on the difference between the current and previous healthy body weight, subtracting the volume already administered. Adjust the ongoing fluid rate to cover the deficit plus maintenance needs over 24 hours.
In a case of AKI with polyuria, how do you adjust fluid therapy to prevent further kidney damage while ensuring adequate hydration?
: Increase the fluid rate to account for ongoing losses plus maintenance, continuously reassessing urine output and adjusting the rate accordingly to prevent fluid overload.
How do you adjust fluid therapy to prevent fluid overload in a patient recovering from AKI with evidence of peripheral edema?
Gradually reduce the fluid rate based on urine output and clinical signs, aiming to maintain a stable weight without causing hypervolemia. Consider additional diagnostics to assess for complications like hypoalbuminemia or vascular leak syndrome.
Upon noticing peripheral edema in a recovering AKI patient, what steps do you take to identify the cause and adjust treatment?
Investigate potential causes of edema, such as hypoalbuminemia or reduced oncotic pressure, through diagnostic tests like biochemistry and urinary protein:creatinine ratio. Adjust the fluid therapy accordingly, possibly incorporating nutritional support and physiotherapy to manage edema.
What is assisted feeding and when is it required in veterinary medicine?
Assisted feeding refers to providing nutritional support to animals unable to meet their daily nutritional requirements due to inability to eat normally or absorb nutrients from certain GI tract sections. It’s needed when animals cannot consume enough nutrients on their own.
Compare enteral and parenteral nutrition in terms of administration route and indications.
Enteral nutrition involves using the gastrointestinal tract for feeding, preferred for its physiological benefits and lower infection risk. Parenteral nutrition, including TPN (Total Parenteral Nutrition) and PPN (Partial Parenteral Nutrition), is administered directly into the venous circulation, indicated when the GI tract is not functional or cannot be used.
Describe the decision-making process for choosing between enteral and parenteral nutrition.
The decision is based on the animal’s ability to use its GI tract, the nutritional status, and the specific health condition. Factors include GI tract functionality, risk of aspiration, and the need for immediate nutrition without GI involvement.
What are the different types of feeding tubes and their placement?
Types include naso-oesophageal, naso-gastric, oesophagostomy, gastrostomy (including PEG tubes), and enterostomy tubes, each chosen based on the patient’s condition, required feeding duration, and specific nutritional needs.
How do you calculate the amount of food for enteral feeding?
Calculate the Resting Energy Requirement (RER) using the formula RER = 30 x (body weight in kg + 70). Determine the caloric density of the chosen diet (Kcal/ml) and plan the feeding regimen to match the animal’s energy needs within clinic working hours, ensuring not to exceed 50ml/kg/feed.
Identify common issues with feeding tubes and their solutions.
Problems include blockages, tube dislodgement, trauma, infection, and over-granulation. Solutions involve regular tube flushing, careful handling to prevent dislodgement, maintaining good surgical site hygiene, and addressing infections promptly with antibiotics.
Discuss the considerations and challenges associated with parenteral feeding.
Parenteral feeding is complex, requiring meticulous calculation of nutrient needs and monitoring for complications like infections at the catheter site. It’s chosen when enteral feeding is contraindicated but requires careful balance to avoid metabolic disturbances.
Define hypovolaemic shock and its primary causes.
Hypovolaemic shock is a condition of inadequate organ perfusion due to acute loss of intravascular volume, leading to a critical drop in cardiac preload and negative consequences for tissue metabolism. Causes include traumatic blood loss, haemorrhage, and fluid loss from severe vomiting, diarrhoea, or polyuria.
What are the clinical signs associated with hypovolaemic shock?
Clinical signs include tachycardia (increased cardiac output), peripheral vasoconstriction (pale mucous membranes, prolonged capillary refill time, poor pulse quality), and reduced mentation due to decreased cerebral oxygen supply.
How is hypovolaemic shock diagnosed?
Diagnosis is based on clinical signs, history, low blood pressure, elevated lactate levels, and point-of-care ultrasound findings like a collapsing caudal vena cava and a poorly filling heart.
What is the treatment approach for hypovolaemic shock?
Treatment focuses on restoring volume with isotonic fluids and transfusions (blood/plasma) as needed. Speed is crucial to prevent rapid onset of hypoxia and potential brain death.
Define distributive shock and its primary causes.
Distributive shock is a state of relative hypovolemia resulting from pathological redistribution of intravascular volume, often due to loss of vascular tone regulation or disordered permeability. Common causes include sepsis/SIRS leading to vasodilation and increased vascular permeability.
What are the clinical signs of distributive shock?
Signs include vasodilation (injected mucous membranes, shortened CRT, bounding/hyperdynamic pulse, tachycardia), and increased permeability (peripheral oedema, pulmonary oedema, cavitatory effusions).
How is distributive shock diagnosed?
Diagnosis involves clinical signs, history, low blood pressure, elevated lactate, POCUS findings (collapsing caudal vena cava, poorly filling heart, septic focus, evidence of vascular leak).
What is the treatment focus for distributive shock?
Treatment targets vascular tone and permeability, requiring volume support (fluid bolus), vasopressor support (e.g., noradrenaline or dopamine), and ensuring adequate oncotic pressure (checking albumin levels, considering plasma transfusion, starting feeding).
Define cardiogenic shock and its causes.
Cardiogenic shock is a reduction in cardiac output due to myocardial failure (e.g., dilated cardiomyopathy), arrhythmias, or valvular disease, leading to systemic hypoperfusion.
What are the clinical signs of cardiogenic shock?
Signs include poor pulses, pale mucous membranes, prolonged capillary refill time, reduced temperature, with heart rate variations based on the underlying cause.
How is cardiogenic shock diagnosed?
Diagnosis is based on clinical signs, history, low blood pressure, elevated lactate, point-of-care ultrasound showing a poorly contracting heart, and ECG findings of arrhythmias.
What is the treatment approach for cardiogenic shock?
Treatment depends on the cause and may include managing hyperkalemia, splenic disease, and providing positive inotrope therapy (e.g., pimobendan, dobutamine).
Define obstructive shock and its causes.
Obstructive shock results from physical obstruction of the heart or great vessels, such as cardiac tamponade, pulmonary thromboembolism, or severe aortic stenosis, leading to reduced cardiac output.
What are the clinical signs of obstructive shock?
Similar to cardiogenic shock, with additional signs depending on obstruction location, including distension or compression of the vena cava and reduced diastolic filling.
How is obstructive shock diagnosed?
Diagnosis involves clinical signs, elevated lactate, and point-of-care ultrasound findings indicative of specific obstructions like pericardial effusion or pulmonary hypertension.
What is the treatment approach for obstructive shock?
Treatment focuses on relieving the obstruction (e.g., pericardiocentesis for cardiac tamponade, thoracocentesis for tension pneumothorax) and supportive care, including fluid therapy and oxygen.
What is the origin and primary purpose of POCUS in emergency settings?
POCUS was initially developed to help ER doctors quickly diagnose severe abdominal trauma by identifying free abdominal fluid, primarily blood, without the delays of traditional imaging. Despite being less sensitive than CT for detecting false negatives, it significantly speeds up the identification of severely bleeding patients.
How has the application of POCUS expanded in clinical settings?
POCUS use has expanded beyond its original purpose to include fluid detection in other cavities with Thoracic FAST scans and lung disease assessment with the Bedside Lung Ultrasound Examination (BLUE). Its use now also encompasses basic echocardiography and specific vessel assessments, such as the inferior vena cava.
What is the Global FAST approach in veterinary medicine, and what does it entail?
The Global FAST approach, developed by Gregory Lisciandro, involves a comprehensive assessment of both thoracic and abdominal cavities in small animals. It combines VetBLUE for lung examination, TFAST for thoracic assessment, and AFAST for abdominal evaluation, aiming for a holistic view of the patient’s condition.
Describe the FLASH protocol and its significance in equine patients.
FLASH (Fast Localised Abdominal Sonography of Horses) is a 7-point scan designed to assess abdominal and thoracic free fluid and small intestinal loops in horses. It has shown high sensitivity and specificity for diagnosing small intestinal obstruction, highlighting its importance in equine emergency care.
Summarize the critical role of POCUS in emergency veterinary medicine.
POCUS is crucial for rapidly assessing severe conditions in emergency veterinary patients, aiding in decision-making. It requires familiarity with a specific protocol to ensure consistent, speedy, and accurate examinations. A global assessment approach is recommended for thorough evaluation.
What is the key benefit of POCUS in emergency settings?
It allows for the rapid identification of critical conditions, such as internal bleeding, without the need for traditional, time-consuming imaging techniques.
: How does the Global FAST approach benefit small animal emergency care?
It ensures a comprehensive assessment of both the thoracic and abdominal areas, facilitating a more accurate and quicker diagnosis.
Why is the FLASH protocol important for equine emergency care?
It enables the effective detection of abdominal and thoracic fluid and intestinal issues, crucial for diagnosing and managing equine emergencies.
How has the use of POCUS evolved in clinical practice?
Initially focused on detecting abdominal trauma, POCUS now includes assessments of thoracic conditions, lung diseases, heart function, and blood vessels, making it a versatile tool in emergency medicine.
What is the significance of learning and using a single POCUS protocol?
Consistency in using a specific POCUS protocol enhances the speed, accuracy, and reliability of emergency assessments, improving patient outcomes.
Why is nutrition considered an essential component in managing critically ill veterinary patients?
Critical illness induces physiological stress and inflammatory responses, leading to protein catabolism and impaired healing. This results in poorer outcomes and increased complication rates, making nutrition a pivotal part of patient management.
How do you assess the nutritional status of critically ill veterinary patients?
Assess nutritional status using body condition score (focusing on fat stores) and muscle condition score (focusing on lean mass, which is probably more useful in critical illness). Repeat assessments daily and consider measuring muscle belly size with a tape measure for a more accurate evaluation.
When should nutritional support be initiated in critically ill veterinary patients?
Begin nutritional support at the latest by 3 days of anorexia or 7 days of hyporexia. Early intervention is always better, and immediate nutritional support is crucial for hypoalbuminemic patients, such as those with sepsis.
How can specific nutrients modulate disease processes in critically ill patients?
Omega-3 fatty acids have anti-inflammatory properties and may benefit early sepsis, though human studies show mixed results. Antioxidants can address oxidative damage but may cause harm in some cases. Glutamine offers anti-inflammatory and antioxidant effects, but veterinary literature is minimal. Probiotics have weak evidence for benefits in critically ill patients and concerns about antibiotic resistance.
Why is monitoring nutritional status critical in ECC patients?
To identify and mitigate the adverse effects of critical illness on the body, such as muscle wasting and impaired healing.
What is the significance of early nutritional intervention in ECC patients?
Early intervention can prevent further nutritional decline and support the body’s healing process, potentially improving patient outcomes.
How does nutritional support vary based on the patient’s clinical status?
Nutritional plans are tailored based on the patient’s condition, including the urgency for intervention (e.g., hypoalbuminemia) and specific needs (e.g., omega-3 for inflammation).
What role do omega-3 fatty acids and antioxidants play in critically ill patients?
They may modulate inflammation and oxidative stress, though their efficacy varies by case and existing literature.
How are body and muscle condition scores used in managing ECC patients?
They help assess nutritional status and guide the development of a targeted nutritional intervention plan.
What are common causes of head trauma in animals?
Head trauma in animals commonly results from crushing injuries, such as running into a tree, being hit by a vehicle, or experiencing a major fall.
What are the first and second considerations when assessing an animal with head trauma?
The first consideration is whether the animal can breathe, assessing for crushed nasal bones or soft tissue damage. The second consideration is the condition of the brain, looking for evidence of traumatic brain injury or skull fractures.
How do you assess and manage breathing in an animal with head trauma?
Assess the respiratory rate, effort, signs of cyanosis, and pulse oximetry. For emergency therapy, provide oxygen if the airway is patent, or perform rapid induction and intubation if not. Have suction available to clear the airway and consider emergency tracheostomy if intubation fails.
What are primary and secondary injuries in TBI, and their impacts?
Primary injuries include concussion, contusion, hematoma, and laceration, leading to increased intracranial pressure (ICP). Secondary injuries result from the neurological tissues’ excitation, causing ATP depletion, pro-inflammatory state, neuronal damage, and disruption of the blood-brain barrier, making the brain sensitive to peripheral blood pressure changes.
How can TBI be identified in animals?
Through neurological assessment of mentation and eyes, including observing the pupillary light reflex (PLR) and checking for signs like bilateral miosis or unilateral mydriasis, which indicate varying prognoses.
What are the main considerations in treating TBI in animals?
The main considerations include reducing the intracranial pressure (ICP) and normalizing perfusion. This can involve the use of hypertonic fluids like hypertonic saline or mannitol and managing blood pressure to maintain normal MAP.
What are the two main types of thoracic injuries and their consequences?
Thoracic injuries can be blunt (causing bruising, contusions, lung rupture, diaphragm rupture, or orthopedic injuries) or penetrating (causing direct injury to lungs, airways, major vessels, the heart, external contamination, or esophageal injury).
What is the initial step in evaluating an animal with head trauma?
Assess if the animal can breathe properly.
What is the significance of the pupillary light reflex (PLR) in head trauma assessment?
PLR helps in prognosticating the outcome based on the response.
How is increased intracranial pressure (ICP) managed in animals with TBI?
Through the administration of hypertonic saline or mannitol.
What is the importance of maintaining normal MAP in TBI patients?
It helps in preventing further neuronal damage by ensuring adequate cerebral perfusion.
What differentiates blunt from penetrating thoracic injuries?
Blunt injuries are primarily concussive, while penetrating injuries directly damage internal structures.
What are the two main types of abdominal injuries, and how do they differ?
Abdominal injuries can be blunt, causing concussions, contusions, swelling, and possibly organ ruptures, or penetrating, which may directly injure organs or major vessels and lead to external contamination.
What role does POCUS play in diagnosing abdominal trauma?
: POCUS (Point-of-Care Ultrasound) is crucial for triaging abdominal trauma, as it helps in identifying free fluid and guiding further diagnostic procedures like abdominocentesis.
How is haemoabdomen managed in the case of blunt trauma?
Management usually involves conservative measures such as fluid therapy, potentially using hypertonic saline and blood products if necessary. Surgical intervention is rare unless an organ has ruptured.
What is the role of tranexamic acid in managing trauma, and what are the considerations for its use?
: Tranexamic acid is an anti-fibrinolytic that stabilizes clot formation. It has shown a survival benefit when administered within 3 hours post-trauma in humans, with veterinary studies indicating its utility in reducing bleeding during surgeries, though with varying outcomes in non-surgical case
What is pneumoperitoneum, and how is it managed?
Pneumoperitoneum, usually resulting from blunt or penetrating trauma, indicates gastrointestinal tract damage. It often requires surgical intervention, with diagnosis challenging via POCUS and management including antibiotic cover and exploratory laparotomy.
What are the primary concerns and management strategies for uroabdomen?
The main concern is hyperkalemia, treated with glucose and insulin, alkalinizing fluid therapy, and potentially draining the abdomen and placing a urinary catheter to allow healing before any necessary surgery.
How is spinal trauma diagnosed and managed?
Spinal trauma diagnosis requires careful radiographic examination with orthogonal views, and management includes supportive care, pain relief, nutritional support, and physiotherapy, with surgical intervention considered based on the severity and type of injury.
When is tranexamic acid beneficial in trauma cases?
Within 3 hours post-trauma to stabilize clot formation.
What indicates pneumoperitoneum, and how is it confirmed?
Free gas in the abdomen indicates damage, confirmed by radiography.
What is the primary threat in uroabdomen, and initial treatment?
Hyperkalemia is the primary threat, treated with glucose, insulin, and alkalinizing fluids.
When is oxygen therapy indicated based on SpO2, PaO2, and lactate levels?
Oxygen therapy is indicated for SpO2 <93%, PaO2 <70mmHg, and lactate >2.0mmol/l, signaling reduced oxygen supply to tissues and the potential need for anaerobic respiration avoidance.
What conditions exemplify the need for oxygen therapy?
Conditions include ventilation/perfusion mismatch, pleural space pathology (e.g., pneumothorax), lung pathology (e.g., pneumonia), perfusion abnormalities (e.g., hypovolemic shock), distributive shock (e.g., sepsis/SIRS), anaemia, acid-base disturbances affecting the Hb/Sat curve, and right to left shunts.
What are the pros and cons of using flow-by, mask, tent/cage, nasal prongs, nasal catheter, and intubation for oxygen therapy?
Each modality has unique benefits and limitations. For example, flow-by is non-invasive but less efficient, while intubation offers direct oxygen delivery but requires sedation or anesthesia and carries a risk of complications.
Name two conditions that may require oxygen therapy due to impaired oxygenation.
Pneumothorax and pneumonia.
: What is the main advantage of using a nasal catheter for oxygen therapy
It provides precise oxygen delivery directly to the airways.
Why is monitoring important during oxygen therapy?
To ensure adequate oxygenation without causing oxygen toxicity.
How does acidosis affect hemoglobin’s oxygen affinity?
Acidosis reduces hemoglobin’s affinity for oxygen, increasing oxygen offloading to tissues.
What are the consequences of fluid overload and deficit in veterinary patients?
Fluid overload increases interstitial fluid, impairing oxygen and nutrient diffusion, adversely affecting renal and lung function. Fluid deficit impairs perfusion and promotes catabolism, insulin resistance, and cellular stress.
How does hypoalbuminemia affect fluid distribution, and what are its management strategies?
Hypoalbuminemia leads to poor oncotic pressure, causing fluid loss to the interstitial space, hypovolemia, peripheral and pulmonary edema. Management includes increasing protein intake, plasma transfusion, and careful use of synthetic colloids due to the risk of acute kidney injury.
What are common electrolyte disturbances in critically ill patients and their management?
Hypokalemia and hyponatremia are common, leading to weakness and mentation disturbances. Management involves fluid supplementation and careful correction, especially for sodium due to the risk of osmotic changes.
: Why is monitoring mentation crucial in inpatient management?
Mentation assessment provides clues about perfusion status and potential intracranial issues, utilizing tools like the Modified Glasgow Coma Scale for standardization.
How are cardiac issues identified and managed in inpatient care?
Cardiac issues like bradycardia and arrhythmias indicate systemic or myocardial disease. Monitoring includes ECG, and management may involve anti-arrhythmics, positive inotropes, and assessing cardiac output via POCUS.
How does blood pressure assessment guide inpatient management?
Blood pressure measurement helps identify hypovolemia, distributive shock, or poor cardiac contractility, informing the management approach.
What are the implications of hypo- and hyperthermia in critically ill patients?
Hypo- and hyperthermia result from various causes like anesthesia or inflammation, respectively. Management focuses on gradual temperature correction and addressing the underlying cause.
How is respiratory function monitored and managed in inpatient care?
Monitoring includes mucous membrane color, respiratory rate, and pulse oximetry, with advanced tools like blood gas analysis. Management involves oxygen therapy and addressing any identified respiratory issues.
Why is monitoring immune status important in critically ill patients?
Critical illness can weaken the immune response, heightening secondary infection risk. Management includes identifying infection sources, sampling for culture, and appropriate antibiotic use.
What is the mechanism of action for local anesthetics (LAs) in veterinary medicine?
Local anesthetics work by interacting with receptors within the Na+ channel close to the cytoplasm in their ionized charged form. This blocks nerve conduction by preventing sodium ions from entering the nerve ending, thus inhibiting the initiation and propagation of nerve impulses.
How are local anesthetics classified based on their chemical structure?
: Local anesthetics are classified into two main types based on their chemical link: amides and esters. Amides are metabolized by the liver, whereas esters are broken down by plasma cholinesterases.
Compare the speed of onset, duration, and toxicity between procaine and lidocaine.
Procaine has a rapid onset with a duration of 40-60 minutes and moderate toxicity. Lidocaine also has a rapid onset, but its duration is longer, lasting 1-2 hours, with similar toxicity levels.
What is the significance of using adrenaline with local anesthetics?
Adrenaline (epinephrine) is added to local anesthetics to prolong their duration of action. It causes vasoconstriction, which reduces blood flow in the area, slowing the absorption of the anesthetic and extending its effects.
How is lidocaine used in different local anesthetic techniques?
Lidocaine is versatile and used in various applications like spray for cat intubation, cream for skin numbing, eye drops for cornea anesthesia, and as part of infiltration techniques for surgical sites.
Describe the technique and benefits of intratesticular blocks.
Intratesticular blocks involve injecting a local anesthetic directly into the testicle, targeting the spermatic cord and associated structures. This method provides intraoperative pain relief and postoperative analgesia, particularly effective during castrations.
What are the indications for using lumbosacral and sacrococcygeal epidurals in veterinary medicine?
These epidurals are indicated for surgeries in the tail, perineal, and genital areas, including tail amputations, perineal urethrostomies, and anal sacculectomies. They provide effective analgesia for procedures in these regions.
How does the femoral nerve block compare to epidural anesthesia in terms of benefits?
Femoral nerve blocks offer an alternative with a reduced risk of urine retention and lower postoperative opioid consumption. They also tend to have less impact on mean arterial blood pressure, suggesting a potentially lower risk of hypotension during anesthesia.
What are local anesthetics, and how do they work?
Local anesthetics are drugs that cause temporary loss of sensation in a specific area. They work by blocking nerve signals in the body.
What’s the difference between amide and ester local anesthetics?
Amide local anesthetics are metabolized by the liver, and ester local anesthetics are broken down by plasma cholinesterases.§
Why is adrenaline added to some local anesthetics?
Adrenaline is added to prolong the effect of local anesthetics by slowing their absorption through vasoconstriction.
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What is an intratesticular block, and when is it used?
It’s a technique of injecting anesthetic into the testicle for pain relief during and after procedures like castrations.
How do peripheral nerve blocks benefit veterinary patients?
They reduce the need for systemic opioids, minimize postoperative pain, and can lower the risk of certain anesthesia-related complications.
What is the primary goal of equine regional anaesthesia?
To provide localized pain relief during and after surgical procedures on horses, minimizing systemic medication use.
What is the mechanism of action for local anesthetics (LAs) in veterinary medicine?
Local anesthetics work by interacting with receptors within the Na+ channel close to the cytoplasm in their ionized charged form. This blocks nerve conduction by preventing sodium ions from entering the nerve ending, thus inhibiting the initiation and propagation of nerve impulses.
How are local anesthetics classified based on their chemical structure?
Local anesthetics are classified into two main types based on their chemical link: amides and esters. Amides are metabolized by the liver, whereas esters are broken down by plasma cholinesterases.
Compare the speed of onset, duration, and toxicity between procaine and lidocaine.
Procaine has a rapid onset with a duration of 40-60 minutes and moderate toxicity. Lidocaine also has a rapid onset, but its duration is longer, lasting 1-2 hours, with similar toxicity levels.
What is the significance of using adrenaline with local anesthetics?
Adrenaline (epinephrine) is added to local anesthetics to prolong their duration of action. It causes vasoconstriction, which reduces blood flow in the area, slowing the absorption of the anesthetic and extending its effects.
What is the primary purpose of equine regional anesthesia?
The primary purpose of equine regional anesthesia is to provide localized pain relief during surgical procedures or diagnostic interventions by blocking sensory nerve signals in specific areas of the horse’s body.
What are the main types of nerve blocks used in equine regional anesthesia?
Main types include peripheral nerve blocks (for limbs and tail), paravertebral blocks (for flank and thorax), and epidural anesthesia (for procedures involving the caudal part of the body).
How is a supraorbital nerve block performed, and what area does it desensitize?
A supraorbital nerve block is performed by injecting anesthetic near the supraorbital foramen to desensitize the forehead and the area around the eyes.
What are potential complications associated with equine regional anesthesia?
Complications can include inadvertent vascular injection, local anesthetic toxicity, and nerve damage, leading to temporary or permanent loss of sensation or motor function.
What factors influence the choice of anesthetic agent for equine regional blocks?
Factors include the desired duration of anesthesia, the specific area to be anesthetized, potential side effects, and any pre-existing health conditions of the horse.
Why is regional anesthesia important in equine medicine?
It allows for pain-free surgical and diagnostic procedures in a targeted area, improving animal welfare and procedural outcomes.
How do veterinarians decide where to administer a nerve block in horses?
Veterinarians choose the injection site based on the anatomical origin of the nerve supplying the area requiring anesthesia.
What is the role of ultrasound in equine regional anesthesia?
Ultrasound helps in visualizing the nerve and surrounding structures for more precise and safer administration of the nerve block.
Can equine regional anesthesia be used for chronic pain management?
Yes, it can be used for chronic pain management, especially in cases of limb lameness or other persistent pain conditions, by providing targeted relief.
What safety precautions should be taken when performing equine regional anesthesia?
Safety precautions include proper patient restraint, choosing the correct anesthetic agent and dose, and monitoring the horse for adverse reactions post-procedure.
Why are local blocks important in farm animal surgery?
Local blocks are crucial for performing surgeries on farm animals while they are standing, minimizing the stress and risks associated with general anesthesia. They provide targeted pain relief and allow for a variety of surgical and diagnostic procedures to be performed with the animal conscious but comfortable.
What are the key considerations when choosing local anesthesia techniques for farm animals?
Key considerations include the type of surgery or procedure, the specific area requiring anesthesia, the animal’s size and condition, potential side effects of the anesthetic agents, and the ability to manage any complications that may arise.
Describe the three main local anesthesia techniques for flank surgery in farm animals.
he three main techniques are the “Line” block, which involves direct injection along the surgical site; the “Inverted L” block, which creates an anesthetic field in the shape of an inverted L around the surgical area; and Paravertebral anesthesia, which targets the spinal nerves supplying the flank area, providing a wider area of anesthesia.
What are the local anesthesia options for foot surgery in farm animals?
Options include the “Ring” block, where anesthetic is injected in a ring around the top of the hoof to numb the entire foot, and Intravenous Regional Anesthesia (IVRA), where anesthetic is injected into a vein of the limb after applying a tourniquet, numbing the area distal to the tourniquet.
Which blocks are used for eye surgery in farm animals and what do they target?
The Retrobulbar block targets nerves behind the eye for procedures on the eyeball itself, the Peterson block is used for anesthesia of the deeper eye structures, and the Auriculopalpebral block is motor only, used to paralyze the eyelid muscles without affecting sensation.
How is local anesthesia achieved for teat surgery in farm animals?
Local anesthesia for teat surgery can be achieved through a “Ring” block at the base of the teat or through Intravenous Regional Anesthesia (IVRA) for more extensive procedures, with or without the use of additional local infiltration techniques.
Why is local anesthesia important in farm animal surgery?
It allows for pain management and stress reduction during procedures, improving animal welfare and surgical outcomes.
What is the difference between a “Line” block and an “Inverted L” block?
A “Line” block is a straight line of anesthesia at the surgery site, while an “Inverted L” block encircles the area in an inverted L shape for broader coverage.
How does Paravertebral anesthesia work in farm animals?
It involves injecting anesthetic near the spinal nerves to numb a large area of the body, such as the flank or abdomen, by blocking nerve signals to and from that region.
When might IVRA be preferred for local anesthesia?
IVRA is preferred for surgeries on limbs or teats where it’s necessary to numb the entire area below a tourniquet, providing a bloodless field and extensive numbness.
What are the key steps in managing complications from local anesthesia in farm animals?
Key steps include monitoring for signs of toxicity or allergic reactions, being prepared to support respiratory and cardiovascular functions, and knowing how to treat local anesthetic systemic toxicity (LAST).
What analgesic regime would you employ for a dairy cow undergoing a difficult calving due to foetal-maternal disproportion?
For analgesia during difficult calving, consider using epidural anesthesia with local anesthetics like lidocaine or bupivacaine to provide pain relief to the pelvic area. Also, systemic analgesics such as NSAIDs (e.g., flunixin meglumine) can be administered to manage pain and inflammation.
How can the cost of an analgesic protocol for difficult calving be justified?
The cost can be justified by comparing it to the overall value of the animal’s health, productivity, and welfare benefits from effective pain management. The cost of the protocol is often significantly less than the potential loss from complications arising from inadequate pain management.
What potential complications can arise from analgesic approaches in difficult calving, and how do they alter case management?
Potential complications include systemic effects of opioids, risk of infection with invasive procedures, and local anesthetic toxicity. Management alterations might include monitoring for adverse effects, adjusting dosages, and employing multimodal analgesia to minimize risks.
Describe the anaesthesia and analgesia protocol for a left displaced abomasum surgery via standing right flank approach.
The protocol includes local infiltration anesthesia or a regional block for the surgical site, systemic analgesics like NSAIDs for pain and inflammation, and potentially sedatives to maintain standing sedation. Specific medicines, doses, and routes should be selected based on the animal’s condition, the expected surgery duration, and legal regulations for drug use in food-producing animals.
What is an effective anesthesia plan for a 12-week old dairy calf undergoing umbilical hernia repair surgery?
An effective plan includes premedication with a sedative and an opioid for pain relief, induction with an injectable anesthetic agent suitable for young calves, maintenance of anesthesia with inhalant anesthetics via intubation if needed, and local infiltration at the surgery site. Post-operative analgesia should include NSAIDs and careful monitoring for recovery.
Why is pain management critical in veterinary procedures like difficult calving?
Pain management is crucial for animal welfare, reducing stress, and facilitating recovery, leading to better health outcomes and productivity.
What factors influence the choice of analgesia in farm animals?
Factors include the type of procedure, the animal’s health status, potential drug side effects, and regulations on drug use in food-producing animals.
How do veterinarians manage the cost of analgesic protocols?
By evaluating the benefits of pain management against potential losses from inadequate care and leveraging cost-effective drugs within legal guidelines.
What is multimodal analgesia, and why is it important?
Multimodal analgesia involves using multiple drugs and techniques to control pain, minimizing the risk of side effects while maximizing pain relief.
How do potential complications affect analgesic and anesthetic choices?
Potential complications necessitate a careful selection of drugs and techniques, balancing effective pain control with the risk of adverse effects.
How would you devise a sedation protocol for a 2-year-old colt undergoing standing castration?
A sedation protocol for standing castration in a colt could include the use of an alpha-2 agonist like detomidine or xylazine, combined with butorphanol for additional analgesia. Dosing should be calculated based on the horse’s weight (300kg), considering the specific drug concentrations and manufacturer guidelines. Administration is typically intravenous, using a suitable gauge and length needle for equine IV access.
What anesthetic protocol would you recommend for a mare requiring GA for bilateral stifle arthroscopy?
The protocol should include premedication with an alpha-2 agonist and butorphanol, induction with a combination of ketamine and midazolam to ensure a smooth transition to recumbency, and maintenance with an appropriate volatile agent like isoflurane or sevoflurane. Doses should be calculated based on the mare’s weight (480kg). Consideration for local blocks around the stifle may provide additional analgesia and reduce the need for systemic analgesics.
What are the benefits of combining midazolam with ketamine for induction in equine anesthesia?
Combining midazolam, a benzodiazepine, with ketamine provides muscle relaxation, reduces the dose of ketamine required for induction, and may result in a smoother induction and recovery phase. This combination can help mitigate some of ketamine’s dissociative effects and enhance patient safety during the transition to recumbency.
Are there any suitable local anesthetic blocks for a dog undergoing bilateral total ear canal ablations (TECA)?
For TECA, local anesthetic blocks such as the auriculopalpebral nerve block, which provides analgesia to the ear, can be used to significantly reduce intraoperative and postoperative pain. An appropriate volume of a local anesthetic like bupivacaine or lidocaine can be used, taking care to calculate the dose based on the dog’s weight and the maximum safe dose of the local anesthetic.
How can you provide effective analgesia for notably painful procedures like TECA in a small animal?
Effective analgesia can be provided through a multimodal approach, combining systemic analgesics such as NSAIDs and opioids with local anesthetic blocks. This approach targets pain at multiple pathways, offering more comprehensive pain control and potentially reducing the amount of systemic medication required.
Why is premedication important in equine anesthesia?
Premedication helps calm the animal, provides initial pain relief, and can make induction smoother and safer by reducing the doses of induction agents needed.
How do local blocks benefit surgical patients?
Local blocks provide targeted pain relief, can reduce the need for higher doses of general anesthetics, and help in postoperative pain management.
What is the role of multimodal analgesia in veterinary surgery?
Multimodal analgesia involves using different types of pain management strategies together to more effectively control pain, minimize side effects, and improve recovery outcomes.
Why calculate drug doses based on animal weight?
Calculating drug doses based on weight ensures the medication is effective while minimizing the risk of overdose and side effects.
How do you ensure safety during the induction of anesthesia?
Safety during induction is ensured by careful dosing, monitoring the animal’s vital signs, and preparing for emergency interventions if needed.
What are the main functions of breathing systems in anesthesia?
Breathing systems deliver oxygen and anesthetic gases, remove carbon dioxide from exhaled breath, and allow for patient ventilation if needed. They are categorized into non-rebreathing and rebreathing systems, chosen based on patient size and other factors.
Describe the characteristics and appropriate use of non-rebreathing systems in veterinary anesthesia.
Non-rebreathing systems are ideal for small patients (less than 10kg) due to their low resistance and reliance on high fresh gas flows. They are commonly used for their simplicity and efficiency in oxygen delivery.
What are the advantages of rebreathing systems, and when are they used?
Rebreathing systems are efficient for larger patients (over 10kg) as they recycle exhaled gases (after CO2 removal), reducing the need for high fresh gas flows. They warm and humidify the gas, making them suitable for longer procedures.
How do you calculate the appropriate fresh gas flow for a given patient using a non-rebreathing system?
Calculate the fresh gas flow (FGF) by multiplying the patient’s minute volume (MV) by the system factor (SF). For a non-rebreathing system like the T-piece, with an SF of 2.5, FGF = MV x SF.
Compare the T-piece, Bain, and Circle systems regarding their suitability for different patient sizes.
The T-piece is suited for very small patients (<10kg), the Bain system works for medium-sized patients (10-30kg) with its tube-within-a-tube design, and the Circle system is versatile for patients ranging from 2-150kg, featuring CO2 absorption capabilities.
Why is patient size important in choosing a breathing system?
Patient size determines the breathing system’s efficiency in delivering and removing gases, with smaller patients requiring systems that provide minimal resistance and larger patients benefiting from CO2 absorption capabilities.
How does a rebreathing system conserve gases?
By recycling exhaled gases (after removing CO2), reducing the need for continuous high fresh gas flow, making it more efficient and cost-effective for larger patients or longer surgeries.
What role does the system factor (SF) play in calculating fresh gas flow?
SF adjusts the calculation of fresh gas flow needed to ensure the patient receives enough oxygen and anesthetic gas while minimizing waste, tailored to the specific breathing system used.
How do you calculate and administer IM premedication of buprenorphine and acepromazine in a 42kg dog?
For buprenorphine at 0.02mg/kg and acepromazine at 0.03mg/kg, calculate the doses in milligrams, then convert to the volume based on the concentration of the drugs available. Ensure to adjust for micrograms if necessary.
What management strategy would you use for a pet goat with chronic degenerative arthritis?
Consider a multimodal approach, including NSAIDs for pain relief, physical therapy, and environmental modifications to reduce joint stress. Adjust the treatment based on effectiveness and the goat’s tolerance.
Describe the local anesthetic technique for examining a painful equine eye.
Use a topical anesthetic like proparacaine for initial examination. For more invasive procedures, consider a retrobulbar block to desensitize the deeper structures of the eye and an auriculopalpebral block to immobilize the eyelid.
What additional analgesia is appropriate for a horse with ongoing laminitis?
In the yard, consider NSAIDs, standing support wraps, and soft footing. In the hospital, more advanced pain management like regional limb perfusion with antibiotics or analgesics and systemic opioids may be appropriate.
Calculate the doses for premedication and GA induction for a 450kg horse.
For acepromazine (0.03mg/kg) IM, romifidine (0.08mg/kg), and morphine (0.1mg/kg) IV, calculate the total milligrams required. Then, for ketamine (3mg/kg) and midazolam (0.06mg/kg) induction, determine the volume to draw up based on the concentrations available.
Why is accurate drug dose calculation important in veterinary anesthesia?
Accurate calculation ensures the animal receives the optimal effect of the medication, minimising risks of underdosing or overdosing, which can impact the safety and effectiveness of anesthesia.
What considerations are important for managing chronic pain in animals?
Consider the type of pain, the animal’s overall health, potential side effects of medications, and the need for a multimodal approach to provide effective and sustainable pain relief.
How do local blocks aid in equine eye procedures?
Local blocks provide targeted anesthesia, reducing stress and pain for the animal, and allow for a thorough examination or procedure without the need for general anesthesia.
Why choose multimodal analgesia for conditions like laminitis?
It targets different pain pathways, offering more comprehensive pain control, improving patient comfort, and potentially reducing the need for high doses of any single medication.
What is the benefit of calculating drug doses based on animal weight?
This ensures that each animal receives a dose tailored to its specific needs, maximizing the efficacy of the medication while minimizing the risk of adverse effects.
How does environmental modification aid in managing chronic conditions like arthritis in animals?
Adjusting the animal’s living conditions to reduce strain on affected joints can significantly improve comfort and mobility, complementing medical treatments.
Why is patient monitoring crucial during and after anesthesia?
Continuous monitoring allows for immediate detection of and response to any physiological changes, ensuring the animal’s safety and facilitating a smooth recovery.
What role does client communication play in veterinary pain management?
Effective communication helps ensure that pet owners understand their animal’s condition, the rationale behind treatment plans, and their role in managing their pet’s pain at home, leading to better outcomes.
What initial fluid therapy is recommended for a young wild rabbit in shock due to cat-induced injuries?
Administer fluid therapy considering the rabbit’s weight, assessing for shock, and deciding between subcutaneous or intravenous routes based on the severity of dehydration or shock.
How should gut motility issues be addressed in a traumatized wild rabbit?
: Prescribe gut motility drugs to prevent gastrointestinal stasis, a common complication in stressed rabbits, ensuring the drugs are safe for rabbits.
: What analgesia strategy is appropriate for a young rabbit with traumatic wounds?
Provide analgesia suitable for rabbits, considering NSAIDs or opioids depending on pain severity and ensuring dosages are rabbit-specific.
Describe the dietary considerations for a young wild rabbit under emergency care.
Initiate feeding with easily digestible, high-fiber foods to support gut health, and consider critical care formulas if the rabbit is not eating voluntarily.
What antibiotic choices and monitoring strategies should be employed for cat-induced wounds in rabbits?
Choose antibiotics carefully to avoid those harmful to rabbits’ gut flora and monitor for signs of infection or adverse reactions to medication.
What fluid therapy is indicated for a wild buzzard after a collision trauma?
Calculate fluid needs based on bird’s weight and condition, choosing the route (subcutaneous, intravenous) based on severity of dehydration or shock.
How should analgesia be managed for a buzzard with a leg fracture?
Administer bird-appropriate analgesics, carefully dosed to manage pain without impairing recovery or causing toxicity.
What feeding strategy should be adopted for a recovering buzzard?
Provide a diet that meets the nutritional needs of a carnivorous bird, initially through assisted feeding if necessary, and ensuring the food is easily digestible.
Describe the initial monitoring and fracture management for a buzzard with a mid-shaft leg fracture.
Monitor the bird’s vitals, pain level, and response to treatment; stabilize the fracture minimally until further definitive treatment can be planned.
What environmental and further triage considerations are important for a buzzard in critical care?
Ensure a quiet, stress-free environment to promote recovery, with appropriate enclosure sizing and perch adjustments to accommodate the injury, alongside planning for further diagnostic tests or specialist referral for the fracture.
2-day-old foal presented with signs of weakness, lethargy, and failure to nurse effectively.
Differential Diagnoses: Neonatal sepsis, hypoxic-ischemic encephalopathy, prematurity.
Diagnostic Plan: Complete blood count, blood culture, IgG levels, ultrasound of the thorax, arterial blood gas analysis.
Treatment Plan: IV fluids for dehydration, broad-spectrum antibiotics for suspected sepsis, supportive care including warming and nutritional support.
Outcome and Prognosis Considerations: Prognosis depends on timely identification and treatment of underlying causes; monitoring for improvements or complications is critical.
“Adult cat with acute onset of vomiting and lethargy
Differential Diagnoses: Foreign body obstruction, pancreatitis, toxic ingestion.
Diagnostic Plan: Physical examination, radiography, complete blood count, serum biochemistry, abdominal ultrasound.
Treatment Plan: Fluid therapy, antiemetics, analgesics, and, depending on diagnosis, surgical intervention or specific antidotes for toxins.
Outcome and Prognosis Considerations: Early intervention can significantly improve outcomes; prognosis varies with the underlying cause and response to initial treatment.
Neonate presenting with signs of neurological distress, including seizures, lethargy, and poor feeding, following a difficult birth or oxygen deprivation event.”
Definition: Hypoxic-ischemic encephalopathy (HIE) is a condition resulting from inadequate oxygen and blood flow to the brain near the time of birth, leading to neurological dysfunction.
Differential Diagnoses: Sepsis, intracranial hemorrhage, metabolic disorders.
Diagnostic Plan: Clinical observation, MRI or CT scan to assess brain injury, EEG for seizure activity, blood tests to rule out metabolic causes.
Treatment Plan: Supportive care (maintaining normal blood glucose, temperature, and blood pressure), therapeutic hypothermia (cooling therapy) for eligible neonates to reduce neurological damage, seizure management with anticonvulsants.
Outcome and Prognosis Considerations: Prognosis varies; early intervention with therapeutic hypothermia has been shown to improve outcomes in some cases. Long-term follow-up for developmental and neurological assessment is essential.
Acute Respiratory Distress Syndrome (ARDS) in dogs is a serious respiratory condition. This syndrome is the failure of the respiratory system to perform properly because of the accumulation of fluid in the lungs. This leads to inflammation and is a life-threatening syndrome. This condition is also known as “shock lung”, as it is known to occur after a shock to the dog’s system, such as a traumatic injury. Plotting a graph of lung volume against trans-lung pressure can show hysteresis in patients with ARDS. In ARDS, there is collapse of the alveoli, such that higher pressures are required to inflate the lungs. What is meant by hysteresis in this case?
Hysteresis is the phenomenon whereby the individual curves for inflation and deflation are not the same
What are the two main objectives when learning to optimize ultrasonographic images?
The main objectives are to understand how to optimize ultrasonographic images by manipulating various machine settings and to be able to label and store images for future review.
Why is selecting the appropriate preset important before performing an ultrasound scan?
Selecting the appropriate preset (e.g., cardiac, abdomen, superficial structures) is crucial because using a mismatched preset, like a cardiac preset for an abdominal scan, will make it difficult to obtain a good image.
What steps should be taken before placing the transducer on the animal for an ultrasound scan?
Enter patient details, reduce ambient light if possible, prepare the animal appropriately, select the correct transducer type, and select the suitable transducer frequency.
What initial settings should be adjusted on the ultrasound machine before scanning?
Set an approximate depth of penetration (labeled as ‘magnification’ or with in/out arrows), and adjust overall gain and power settings (if available) to mid/low values.
How should the depth of penetration and focal zone be adjusted once the transducer is on the animal?
Adjust the depth of penetration so the organ fills the screen and adjust the focal zone to the middle of the organ.
What is Time Gain Compensation (TGC) and why is it important in ultrasound imaging?
TGC adjusts the gain at different depths to compensate for sound attenuation in deeper tissues, ensuring even echotexture and visibility throughout the image.
How does adjusting TGC affect tissue consistency in ultrasound images?
Adjusting TGC ensures that tissues have an even consistency across different depths, improving the diagnostic quality of the ultrasound image.
What are the different ways to move the transducer for optimal ultrasound imaging?
The transducer can be moved in standard and non-standard planes, slid in various directions, angled, or rotated to capture the best possible image.
What is knobology in the context of ultrasound imaging, and what does it involve?
Knobology refers to the skill of adjusting machine controls like frequency, depth, focal depth, and TGC to optimize imaging for different organs.
How can you ensure you capture and correctly label ultrasound images?
Use the machine’s freeze function to capture images, label them appropriately (e.g., orientation), and then store or print. For dynamic imaging, pressing ‘store’ during scanning saves a video clip.
How do ultrasound machines assist in making measurements on images?
Ultrasound machines provide cursors for measuring linear lengths, areas, or peripheries, and selecting a body system allows for specific measurements like ‘renal length.’
What functionality does calculation software in ultrasound machines offer?
It transforms measurements into biological values, such as estimating gestational age or predicting the date of parturition, enhancing diagnostic accuracy and planning.
What are the essential safety and preparation steps before an ultrasound exam?
Use appropriate personal protective equipment (PPE), ensure proper restraint of the animal, consider the need for analgesia or sedation, and adjust the examination setting based on the animal’s size and the area being examined.
How do you prepare an animal’s skin for ultrasound imaging?
Clip hair, clean the skin with alcohol, apply ultrasound gel, and ensure good contact between the transducer and skin to allow sound penetration.
What are the differences between linear and curved transducers?
Linear transducers emit parallel sound lines creating a rectangular beam for full cross-sectional images, requiring full contact. Curved transducers emit diverging sound lines for a larger cross-sectional image with a smaller contact area, useful for areas like between ribs.
Why and how are stand-offs used in ultrasound imaging?
Stand-offs, such as gel pads or extra gel, move superficial structures further from the transducer to reduce near-field noise, essential for imaging superficial structures like equine tendons.
How does frequency selection affect ultrasound imaging?
Higher frequencies provide better resolution but less depth penetration, suitable for shallow structures like the eye, while lower frequencies offer deeper penetration but lower resolution, used for deeper structures like sheep pregnancy detection.
Why use a stand-off in ultrasound imaging?
To improve imaging of superficial structures by reducing near-field noise and enhancing image clarity.
When should radiographs be taken, and what is crucial to obtain?
Radiographs should only be taken when there is definite clinical justification. It’s imperative to obtain a standard view for accurate interpretation.
What defines a Controlled Area in radiography?
Once x-ray equipment is switched on, the radiography room becomes a Controlled Area, permitting only authorized personnel to enter while radiography is being performed.
Describe the key components of radiography equipment and their purposes.
Key components include the tube head for generating x-rays, lead shutters for beam area control, a light beam diaphragm for positioning, cassettes for image capture, and a grid for improved image quality in deeper tissues.
What are key safety measures for operators during radiography?
Safety measures include staying at least 2 meters away from the primary beam, wearing PPE, using a personal dosimeter, recording all exposures, ensuring equipment is in good order, and avoiding radiography if pregnant.
What are the practical difficulties encountered in large animal radiography?
Radiographs are often taken with the animal conscious and standing, requiring multiple people (machine operator, plate holder, animal handler), and usually done at the client’s premises, demanding careful safety planning and technique due to the horizontal beam and large patient size.
What are the risks associated with horizontal beam radiography in large animals?
The risks include the potential for the beam to travel further, creating more scatter and requiring higher exposures than in small animals. This necessitates the use of protective clothing and adherence to the inverse square law for safety.
How can you ensure safety during large animal radiography?
Ensure correct machine settings, patient positioning, labeling, focal distance, beam centering, and collimation. Perform a final safety check to ensure everyone is correctly positioned.
What are the conventions for orienting radiographic images in large animals?
The cranial aspect of the animal should be on the left of the image, and the proximal aspect on the upper part of the image. Lateromedial views of specific areas like the tarsus are standard.
Why are oblique views used in large animal radiography, and what do they highlight?
Oblique views are used to provide additional perspectives on joints, highlighting medial and lateral aspects that may not be visible in standard projections, such as the dorsolateral-palmaromedial oblique view.
What is the basic structure of an imaging report?
An imaging report should detail the findings (‘What have you got?’), describe the observable details (‘What can you see?’), and conclude with the clinical significance (‘What does it mean?’).
How should abnormalities in radiographs be described in a report?
Abnormalities should be described using specific radiographic and ultrasonographic descriptors, such as “fluffy new bone on the distal patellar groove,” indicating mild osteoarthritic changes.
What are common pitfalls in interpreting imaging series?
Common pitfalls include overinterpretation, using wrong terminology, concluding without adequate observations and interpretations, and failing to provide or consider adequate context for the findings.
Why is sticking to the basic structure important when submitting reports for imaging series?
Adhering to a basic structure ensures clarity, comprehensiveness, and relevance, facilitating accurate diagnosis and appropriate clinical decision-making.
: Why is terminology important in imaging reports?
Precise terminology prevents misunderstandings and ensures clear communication among veterinary professionals.
How can overinterpretation be a pitfall in imaging analysis?
It may lead to incorrect diagnoses or unnecessary treatments, emphasizing the need for a balanced and evidence-based approach.
What role does the imaging report template play in veterinary diagnostics?
It standardizes reporting, ensuring all necessary information is conveyed and interpreted correctly for optimal patient care.
What are the two common views taken when radiographing a dog’s stifle?
Lateral (medio-lateral) view and caudo-cranial view.
How should the dog be positioned for a lateral stifle radiograph?
In lateral recumbency with the leg to be imaged against the table.
: How is the dog positioned for a caudo-cranial view of the stifle?
In ventral recumbency with the limb extended caudally.
How should the limb be positioned for a medio-lateral projection of the dog’s stifle?
The limb to be radiographed is flexed 90 degrees, with the upper limb moved cranially or laterally out of the way using a rope tie or sandbag.
What is a common error to avoid when positioning the limb for a medio-lateral projection?
Avoid pulling the leg too far cranially or laterally as it can rotate the pelvis and thus the lower leg and stifle.
What additional positioning aids are used for a lateral view of the stifle to ensure optimal radiographic quality?
A foam pad under the hock to keep the tibia parallel to the table and a sandbag to hold the hock in position.
What areas should be included in the exposed area for a lateral view of the stifle?
Include 50% of the femur and 50% of the tibia-fibula, with collimation centered at the stifle joint or slightly more distal.
What indicates a well-positioned stifle radiograph in the lateral view?
The femoral condyles should be superimposed and not rotated.
For a caudo-cranial view, how should the limb be rotated and where should the center of collimation be?
Rotate the limb so the patella is in the midline, with the center of collimation at the middle of the stifle joint.
What are key features of a well-positioned caudo-cranial radiograph of the stifle?
The femoral condyles are of equal size with the patella in the midline, ensuring no limb rotation and good visualization of the joint space.
What are the two primary radiographic views for examining a dog’s shoulder?
Lateral (medio-lateral) and caudo-cranial views.
What positioning is required for the lateral view of a dog’s shoulder?
The dog is placed in lateral recumbency with the leg to be imaged against the table.
Describe the positioning for a caudo-cranial view of the dog’s shoulder.
The dog is placed in dorsal recumbency, and the limb is extended cranially.
How is the limb positioned for a medio-lateral projection of the shoulder?
The limb is pulled into extension, the upper limb is moved caudally, and the neck is flexed dorsally to avoid superimposition over the shoulder joint.
What are the positioning details for a lateral view of the dog’s shoulder?
Use a foam pad under the chest for alignment, include the distal 50% of the scapula and proximal 50% of the humerus, and collimate around the shoulder joint.
What indicates a well-positioned shoulder radiograph?
Clear visualization of the joint space without overlying tissue from the neck, other limbs, or the cervical spine.
How should the limb be positioned for a caudo-cranial view of the shoulder?
The dog is in dorsal recumbency, limb extended and slightly away from the midline, with the head and neck slightly pushed away if needed for clarity.
Atopic dermatitis
Prurititc skin disease
Myasthenia gravis
Type 3 hypersensitivity
Equine recurrent airway obstruction
type 3 hypersensitivity
Canine blue eye
type 3 hypersensitivity
Type 4 hypersensitivity
Cell mediated not antibody mediated
Prolonged onset
Tuberculosis hypersensitivity
Type 4
Sensitised T helper cells
Lateral skin on neck in cattle for testing
What are the goals for treatment of type 4 hypersensitivity
What is a secondary immune deficiency?
SCID
Severe combined immunodeficiency is primary immune def
CLAD
Canine leukocyte adhesion deficiency
Primary immunodeficiency
How can antibodies be tested?
Indirect ELISA
Antibody on the plate is much more accurate than indirect
Capture may work better than indirect
What are some specialised lab test for ELISA?
Agglutination/haemagglutination inhibition
Singla radial haemolysis
Complement fixation
What are the pros and cons for infectious and non infectious vaccines?
Pros and cons of different vaccines
Type 2 hypersensitivity reactions to vaccines in COws
Bovine neonatal pancytopenia
Type 2 hypersensitivities to vaccines in cats
What type 3 hypersensitivities can occur with vaccines
What is the immediate response to a vaccine
IgM
Followed by IgG which is longer lasting and more effective with a higher affinity
Viruses
Dogs core viruses and vaccination schedules
Feline vaccination schedules
What are the common vaccines for rabbits and ferrets?
What are the common vaccines for horses?
Core vaccines for livestock animals
Split into cat 1 and cat 2 which are core and non core
What are the non core vaccines for livestock vaccines
What are the Cat 1 vaccines for sheep
What are the less common routes for vaccines?
What are the general considerations for who to vaccinate and when?
What are the considerations for vaccinating farm animals
What are the british horse racing authority rules for vaccinations?
What considerations should there be when vaccinating older cats?
How should a veterinarian approach booster vaccinations for a dog that has moved to a new area, especially considering boarding kennel requirements and previous vaccination history?
Course needs restarting as the time passed
Needs DHPPi as eurican
This practice only stocks canigen and therefore needs to restart
Adult restart means 2 doses of lepto 4 weeks apart ( animal is in kennels in 3 weeks)
DHPPI needs 1 injection as an adult
Kennel cough can also be given
Going to kennels in 3 weeks so potentially may not be able to go to the kennels
Vaccine lapse may affect insurance
Onset of immunity for kennel cough is 3 weeks so this may affect kennels
DHPPI and Lepto can be mixed in a syringe and given subcut
Immunocompromised people should stay away for 3 weeks as they are attenuated vaccines
How should a veterinarian determine a vaccination plan for a new equine import with unknown vaccination status intended for international competition, and a companion animal not previously considered for vaccination?
They should vaccinate both against Equine influenza, strangles (if mixing with other horses water etc), Tetanus vaccine
Equine influenza can be mixed with tetanus. Immunity is longer with tetanus so first use a mix and then less commonly. Just equine influenza following
Herpes vaccine can be administered- can cause abortions and the vaccine isnt always effective. Owner choice and assess repro health.
What issues arose with RHD2 vaccine for rabbits?
The backbone meant that rabbits that had been vaccinated once with RHD 1 may have an averse reaction to RHD2
Vax with inactivated type 2 and then vaccinated with type 2 followign
What is the incidence of FIV?
Describe FIV exposure
Feline Immunodeficiency Virus (FIV) affects cats by targeting their immune system, specifically CD4+ T lymphocytes. FIV binds to the CD134 (OX40) receptor on activated T cells during the initial stages of infection and subsequently uses the CXCR4 chemokine receptor to gain entry into the cells. This viral entry leads to the depletion of CD4+ T lymphocytes, which are crucial for mounting an effective immune response. The progressive depletion of these cells compromises the cat’s immune system, making it susceptible to secondary infections, chronic diseases, and a decrease in overall health.
What are the clinical signs for FIV and what is the treatment?
What are the common terms for inflammation of the female repro system
When is infection most likely to occur in the female reproductive tract?
How does uterine contamination occur post partum
How does uterine contamination occur at mating?
What can be seen in the image
Incomplete ossification of cuboidal bones
What can be seen?
a developmental joint disease
Osteochondrosis dissecans
The bone doesnt mineralise and instead turns into soft necrotic tissue
Osteoarthritis
Osteochrondral fragmentation
Canine immune mediated polyarthritis
what would be the aetiology of joint sepsis here
Traumatic wounds
What are the systemic treatment options for osteoarthritis?
systemic arent always the best options
What are the intra-articular treatment options for osteoarthritis?
anogenic or autogenic stem ells
PRP - platelet rich plasma
What are the different options for joint sepsis treatment?
Systemic
Intraarticular
Regional options
withdrawal times for races
: The horse was diagnosed with osteoarthritis in small tarsal joints bilaterally, with a racing event in 16 days, necessitating careful selection of treatment to comply with competition withdrawal times.
corticosteroid administered with shorter withdrawal time.
Arthrocentesis of the tibiotarsal joint revealed a nucleated cell count of 5x10^9 cells/l with 30% neutrophils and a total protein of 20g/l, indicating joint disease that requires a comprehensive diagnostic and therapeutic approach.
multiple joints affected. Intraarticular wouldnt work so corticosteroids would be the best option
Autoimmune disease
How does azathioprine work and what are its side effects?
Azathioprine works by damaging DNA, affecting rapidly growing bone marrow and immune cells. Side effects include myelosuppression, pancreatitis, and hepatotoxicity. It’s metabolized into 6-mercaptopurine and further processed by enzyme systems (TPMT) , with variations in metabolism affecting side effect likelihood.
What is mycophenolate mofetil and its effects?
Mycophenolate mofetil inhibits de novo purine synthesis, suppressing T and B cells. It’s fast-acting, with limited evidence for use in dogs or cats with immune-mediated diseases. Adverse effects include gastrointestinal toxicity and potential for hepatitis.
Explain the use and mode of action of ciclosporin.
Ciclosporin is a potent T-cell suppressor, used for atopic dermatitis in dogs and cats. It binds to cyclophilin, inhibiting calcineurin and reducing the activation of IL-2 and related cytokines, leading to reduced effector T-cell function.
What are the principle effects of steroids?
What are the metabolic effects of steroids?
How can glutamine be used for treating IMD?
How can arginine be used in treating IMD?
What are the mechanisms of IMD immunological damage?
How does pregnancy affect ADME of drugs?
What antibiotic susceptibility is important for treating Greasy Pig Disease?
Antibiotics susceptible to Staphylococcus hyicus should be selected based on susceptibility test results, considering what is licensed in the pig.
What considerations are important when assessing an equine wound?
Age of the wound, whether it’s clean/contaminated/dirty, exposure of bone/tendon/joint, signs of infection, and culture.
Clinical pathology of inflammation
The lactate story
Coagulopathy of sepsis
Degenerate vs non degenerate neutrophils
non degenerate on the left
What is an example of a sporadic disease in cats?
FIP
Common viral zoonoses
