Internal Med Rotation Flashcards
What is the function of cortisol
Regulates blood pressure, vascular tone, carbohydrate and fat metabolism
What does ADH do?
Regulates sodium
Cortisol is an insulin _ hormone
antagonist
What is the most potent stimulant for cortisol production?
ACTH
For dogs, they can have primary hypothryoidism. What are the two most common causes?
Lymphocytic thryoiditis and idiopathic atrophy
What are the signs of hypothryoidism in dogs and signalment?
Middle age, pure breed dogs.
Signs -> decreased metabolic rate, lethargy, weakness, obestiy and exercise intolerance
What routine lab tests can we do to detect hypothryoidism?
We can see hypercholesteremia, sometimes mild non regenerative anemia
-Clinical signs, routine chemistries, specific thyroid function tests, response to treatmetn
What is the standard typically for testing hypothryoidism
Serum total T4. Low T4 not specific for hypothryoidism .
-Low T4 and clincial signs adeqaute for diagnosis .
Decreased thyroid hormones _ TSH
increases. Will see elevated TSH.
-Test is not very sensitive
What can we see on CBC for early hypothroidism
Elevated TSH and low or normal T4
What do we use to treat hypothroidism?
Levothryoixine
How do we monitor dogs with hypothryoidism?
-recheck in 6-8 weeks, clincial resonse and post pill testing.
-see good clincial resonse is most importnat.
What CS can we see related to hypercalcemia?
generalized weakness, PU/PD, lethargy, anorexia, vomiting,
How do we treat diseases with hypercalcemia?
- Rule our spurious hypercalcemia.
- if repeateable, measure an ionized calcium. If azotemia is present, could be induced renal failure. If normal ionized calcium then its renal failure induced hypercalcemia.
- History and Cs
- Look at CBC and chem.
What is the most common type of cancer that causes hypercalcemia?
lymphoma
What Cs relate to hypocalcemia?
muscle tremors, facial rubbing, stiff gait, behavior changes, and seizures
What diseases tend to have mild or severe hypocalcemia?
primary hypoparathryoidism ,ecclampsia, malabsorption
How do we go about diagnosing hypocalcemia?
- Rule out hypoabluminemia.
- History and Cs.
Type 1 vs Type II diabetes mellitus
- Aboslute hypoinsulinemia. loss of Beta cells. Occus via immune mediated destruction. Requires insulin injections for the rest of its life.
- Relative hypoinsulinemia. Impairment of Beta cells. Concurrent insulin resistance. Also called non-insulin dependent. Can only occur in the cat, cna manage with diet sometimes.
What drug can cause an increase in insulin?
corticosteroids
What are the CS of diabetes mellitus?
-glyosuria and polyuria
-PU/PD
-weight loss
-polyphagia
What can we see on serum chemistry with diabetes mellitus?
Hyperglycemia, Increased liver enzymmes, Hyperchoelsteremia and triglycerides
How do we diagnose diabetes mellitus?
CS, persistent fasting hyperglycemia, persistent fasting glucosuria.
What test do we use to differentiate between stress hyperglyemia and diabetes?
fructosamine
What additional signs of diabetes mellitus can we se in dogs?
bilateral cataracts, dry haircost, abdominal distension
What are clinical signs of feline hypothryoidism?
-weight gain, decreased appetite, lethargy,
How do we diagnose hypothroidism?
Low T4,
What is happening with hyperthroidism?
Excess roduction of T3 and T4
Signalment and Cs of hyperthryoidism?
Cats usually over 8 year, weightloss with good appetite, PU/PD, vomiting, unkept haircoat, thryoid nodule or slip,
CBC of hyperthyrodisim
-elevated ALT and ALP,
How do we diagnose hyperthroidism?
elevated thryoid hormone with CS,
-fREE t4 WITH TOTAL t4
What do we do with animals that are PU/PD?
Determine if they are truly PUPD
-can do multiple urinary specific gravity determinations
-quantify how much water they drink at home
PU pd
-in tact female
-muscle weakness
-peripheral lymphadenopathy
-weight loss with good appetite
-truncal alopecia, distended abdomen, thin skin
-pyometra
-hypokalemia
-hypercalcemia
diabetes in a dog or hyperthryoidism in cats
-hyperadrenocortisim
What is the most common cause of cushings?
pituitary dependent. due to excess ACTH secretion
CBC and chem of cushings?
-stress leukogram (mature neutrophilia, lymphopenia, and eosopenia)
-thrombocytosis
-hyperglycemia, incrase liver enzymes
How can we diagnose this?
urine cortisol:creatinine ratio
-meaure urine cortisol and creatinine. above range possible
low dose dexamethasone test. measure blood sample at 0, 4 and 8 hours. if lower than reference range then its normal .
Can do ACTH stim test. measure cortisol .You give cosyntropin
What is addisons disease?
-deficiency of cortisol or cortisol and aldosterone
What are the CS of addisons?
PU/PD, hypvolemia shocka nd bradycardia ,
What does the CBC and chem look like?
non regenerative anemia, lack of a stress leukogram, azotemia, hypercalcemia, low sodium and high potassium
What does the chme look like for addions?
renal failure and hepatic insufficiency or protein losing enteropathy
How do we test for addisons?
baseline cortisol- > If less than 2 possibly has addisons.
ACTH stim test -> administer cosyntropin, If less than 2 the dog has addiosn .
How do we treat addisons?
if an an addisonian crisis -> IV fluid therapy, ACTH stmi test, corticosteroid replacement
If not
What are CS of esophagela disease?
-Regurge, drooling, repeated or painful swallowing, failure to thrive, coughing
How do we treat esophagitis?
-sucrulfate, proton pump inhibitors, metaclopramide, feeding tube placement
small vs large bowel diarrhea
large -> increased frequency, decreased fecal volume, mucus, frank blood, tenesmus
small -> normal to slighly increased frequency, increased fecal volume, melena, vomiting and weight loss
Hemmorhagtic gastroenteritis
-Cause is unknown,
-small breed dogs
-rasberry jam, bad odor
-severe dehydration and hypovolemia shock
-abdominal pain and discomfort
treatment ->
-supporitve treatment
Giardia
-mild, self limiting or severe acute diarrhea. Chronic small bowel diarrhea and weight loss.
Treat with fenbendazole or metronidazole
IBD
-most common ->lymphoplasmacytic enteritis
-chronic smlal bowel diarrhea/ mixed.
diagnose-> biospsies
treat with prednisone
Food responsvie enteropathy
2 week minimum diet trial
Intestinal neoplasia
chronic small bowel diarreha, weight loss, variable appetite
-diagnose -> biopsy
treat ->prednisone in cats
chemotherapy for lage cell
Exocrine pancreatic insufficiency
-weight loss with ravenous appetite
-voluminous pulpy feces, yellow to orange
-young to middle aged GSD and collies
-diagnose with finding a low TLI
Treat -> pancreatic enzymes
Chronic idopathic hepatitis
Insult to liver that initates immune response.
-biopsy required for diagnosis
Copper hepatopathy
-see increases in ALT and ALP
primary -> centrilobar
secondary -> periportal
Pre renal vs renal
greater than 1.030 for dogs and greater than 1.035 for cats
1.008-1.012
What do you do with the different stages in kidney disease?
pre-renal ->rehydrate and verify if azotemia resoles
if post renal ->correct obstruction, provide fluid therapy, veryify if resolves
What are clincial signs of acute kidney disease or failure
oliguria or nauria
letharygy, loss of appetite, vomiting, weighloss, diarrhea
What are the CS of chronic kidney disease?
PU.PD,
letharyg
dehydration
poor appetie, vomting,
constipation in cats
How do we diagnose and treat chronic kidney disease?
Stage 1 and 2 ->ID and treat the primary disease processes and disease
2 AND 3 ->slow disease progresswion with renoprotectivetreatment
3 and 4 -> alleivate symptoms
Acute pancreatitis
-activation of digestive enzymes within the pancreas
-abomdinal pain, vomting, anorexia, diarrhea
-AMS greater than 10x
-lps INCREASED
ALP> ALT
ALT>alp
cholestatic
hepatocellular
