Internal medicine Flashcards
Types of Jaundice
- Pre-hepatic: release of Hg due to RBC lysis
- Hepatic: dysfunction of hepatocytes or intrahepatic biliary tree
- Post-hepatic: obstruction or rupture of biliary tree, with impairment of excretion of conjugated Br into SI
Prehepatic Jaundice DD
- Immune-mediated hemolytic anemia
- Toxic: snake, onion/garlic, paracetamol, zink
- Transfusion reaction
- Erythrocyte parasites
- Cats: Mycoplasma haemofelis, FeLV-anemia, FIP, FIV, Hypophosphatemia-induced hemolytic anemia, Acetaminophen toxicity , Neonatal isoerythrolysis
- Dogs: Heartworm (caval syndrome) , Leptospira
Hepatic Jaundice DD
-Toxic hepatopathy: plants, mycotoxin
-Inflammatory: hepatitis, cholangiohepatitis, lipidososis
-Neoplasia (primary or metastatic)
-Hepatic amyloidosis
Cats:
-Suppurative or lymphocytic cholangiohepatitis
-Idiopathic hepatic lipidosis
-FeLV-associated diseases (esp. lymphosarcoma)
-Feline infectious peritonitis
-Toxoplasmosis
-Acetaminophen toxicity
Dogs:
-Chronic hepatitis
-Copper storage diseases
-Leptospirosis
-Infectious canine hepatitis
-Hepatic fibrosis/cirrhosis
-Thiacetarsamide
Posthepatic Jaundice DD
Biliary tract obstruction: biliary stones or mucocele
-Pancreatitis (acute or chronic) with compression of the bile duct
-Neoplasia (intestinal, pancreatic or hepatic) with bile duct compression
-Cholelithiasis or inspissated bile
-Duodenal FB (blocking duodenal pappillae)
Biliary Rupture:
-Traumatic rupture of bile duct or gall bladder
Azotaemia and types
Elevated conc. of BUN or Crea
- Pre-renal: no direct parenchymal damage
- Renal: direct parenchymal damage
- Post-renal: failure to remove urine from the body
Uraemia
Comb. of presence of azotaemia and CS of illness
-CS: lethargy, inappetence, weight loss, vomiting, diarrhoea, stomatitis
Pre-renal azotaemia DD
- Due to reduced renal perfusion: hypovolaemia (shock, dehydration, hemorrhage), cardiogenic
- Due to increased protein catabolism: necrosis, starvation, infection, fever
Renal azotaemia DD
- Tubular disease: toxins (NSAID´s, Ace-inhib., Lilium spp., antifungals, Gentamicin, Ethylene Glycol, grapes, pigmenturia, hypercalcaemia), renal ischemia (hypovolaemia, hypotension, heart disease)
- Interstitial disease: pyelonephritis (e.g. Lepto)
- Glomerular disease: immune complex deposition due to infections, immune-mediated disease or severe inflam.
- Hereditary disease
Post-renal azotaemia DD
-Rupture or obstruction of ureters, bladder or urethra
+/- Large painful bladder, inability to urinate, abdominal pain, uroabdomen
Chronic kidney disease DD
- Glomerulonephritis
- Secondary to AKD
- Infectious: bacterial, viral (e.g. FIP), fungal, rickettsial
- Metabolic kidney disease: hypercalcaemia, amyloidosis, drugs and toxins (grapes, NSAIDs, anti-freeze)
- Tubular disease
- Neoplasia
- Polycystic kidneys, renal dysplasia and other inherited diseases
Acute VS Chronic kidney disease
- Acute should not have: non-regen. anaemia, history of loss of condition and PU/PD
- AKD: acute onset anorexia and lethargy +/- vomiting, +/- painful kidneys, reduced water intake, good body condition, oliguria
- CKD: chronic anorexia, lethargy, vomiting, +/- small, irregular kidneys, poor body condition, chronic weight loss, PU, PD, +/- anaemia (non-regen.)
Diagnosing jaundice
- Pre-hepatic: anaemia - PCV, TP, icteric serum, spherocytes, autoagglutination
- Hepatic: Incr. Br, ALT +/- incr. ALP, GGT, AST, US: liver pathology
- Post-hepatic: Incr. Br, ALP, GGT +/- ALT, US: biliary tract congestion, biliary stones, mucocele, pancreatitis
SI acute diarrhoea DD
- Diet: indiscretion, diet change
- Parasites: hookworms, roundworms, Giardia, Coccidia
- Virus: parvo, corona, rota
- Bacterial: Campylobacter, E.coli, Salmonella, Clostridia
- Toxic: NSAIDs, Organophosphates
- HGE
- Structural obstructions: FB, intussusception, torsions
- Extraintestinal: pancreatitis, liver/kidney, Addisons, ischaemic (e.g. heat stroke)
LI acute diarrhoea DD
- Diet: intolerance, hypersensitivity
- Parasites: Giardia, roundworms, hookworms, Coccidia
- Bacterial: ABE/SIBO, Campylobacter, Clostridia, Salmonella
- Fungal: Histoplasmosis, Pythiosis
- Infiltrative: IBE, lymphangiectasia, neoplasia
- Breed-related enteropathy (GS, Basenjis)
- Structural obstructions: FB/intussusception
- Extraintestinal: pancreatitis, EPI, liver/kidney disease, Addisons, structural obstructions (FB, intussusceptions, volvulus), Addison´s, hyperthyroidism (cats)
Haematochezia DD
- Inflammatory: IBD, Histocytic ulcerative colitis (Boxers), polyps
- Parasites: hookworm, whipworm, Giardia
- Bacterial: Clostridia
- Virus: Parvo
- HGE
- Trauma and coagulopathy
- Neoplasia: lymphoma, adenocarcinoma
- Anal gland disorders
- FB
Seizsure DD
- Intracranial: inflam. (meningoencephalitis, granulomatous/steroid responsive), Distemper, Metabolic (storage disease), Neoplasia, Coagulopathy, Hypertension, Idiopathic epilepsi, hydrocephalus, trauma
- Extracranial: Hepatic Encephalopathy (liver failure, PSS), Toxic (plants, lead, anti-parasitic (pyrethroids, organophosphates, carbamate) metaldehyde, rodenticide, strychnine, chocolate, caffeine, ethylene glycol
Common DD of seizures in dogs
< 1 y/old: PSS, Inflammatory, Distemper, Hydrocephalus/Storage disease, Toxins
1-5 y/old: Epilepsy, Cerebral Neoplasia, Toxins, Inflammatory
> 5 y/old: Cerebral neoplasia, Toxins, Inflammatory, Metabolic, Epilepsi, Vascular
Common DD of seizures in cats
(not as common as dogs)
Neoplasia, FIP, FIV, FelV, Cryptococcus, Toxoplasma, Toxins, Traumatic
Treatment of seizures
- Status epilepticus: O2 tx., IV catheter, Diazepam 0,5-1mg/kg (x3) -> Midazolam -> Propofol -> Phenobarbitone
- Chronic tx.: Phenobarbital, Potassium Bromide, Levetiracetem, Zonisamide, Imepitoin
- At home: Diazepam (rectal+oral+intranasal), Clonazepam, Levetiracetem
DD of pruritus in dogs
Dog: FAD and Atopic dermatitis (90%)
- Allergy: Flee (FAD), Atopic dermatitis, Food AD, Mosquito bite hypersensitivity, Contact dermatitis
- Parasitic: Flee (FAD), Demodicosis, Sarcoptic mange (scabies)
- Bacterial: Surface pyoderma (hot spot, skin fold), Superficial pyoderma, Deep pyoderma (Furunculosis), Abscess/Cellulitis, Atypical (GS pyoderma cellulitis)
- Fungi: Malassezia dermatitis, Ringworm (Dermatophytosis)
DD of alopecia
Either pruritic, or non-pruritic:
- Hormonal: Hypothyroidism, Cushing´s, Hyperestrogenism (cystic ovaries, Sertoli cell tumour, Granulosa cell tumor)
- Neoplasia: Sertoli cell tumour, Granulosa cell tumor
- Immunological (rare): Drug eruptions, Juvenile cellulitis, Pemphigus foliaceous, Lupus erhytematosus
Dermatology diagnosing
- Flee comb
- Skin swab
- Skin scrape: supf. (scabies, other supf. mites), deep (Demodex)
- Sticky tape impression and smear (bacteria, yeast, ring worm)
- Hair pluck/Trichogram: microscope (ring worm, Demodex), fungal culture (ring worm)
- Wood lamp (ring worm)
- Biopsy (punch/wedge)
- Blood: T4, baseline hormones
- Food trial
- Allergy testing (IgE serological, intradermal skin test)
Dermatology tx.
- Cephalexin + clorhexidine shampoo: bacterial (except deep), 2nd bacterial infections: FAD, atopic dermatitis, contact allergy, food allergy, fungal, parasitic
- Prednisolon (anti-inflam. + immunosup.)
- Miconazole shampoo: fungal (ringworm systemic: Griseofulvin, Itraconazole) (malassezia systemic: Ketoconazole dog, Itraconazole cat)
- Cyclosporin (immunosup.)
- Apoquel: Oclanitib
- Cytopoint: Lokivetmab
- Isoxazoline parasiticide, Amitraz wash: Demodex, Sarcoptes
DD of pruritus in cats
Cat:
- FAD (60%)
- Food Allergy dermatitis - fish protein allergy (30%)
- Atopy, feline eso. granuloma complex, mites (10%)
DD of alopecia in cat
Clinical presentations:
- Bilat. symmetrical alopecia: FAD, food allergy, feline atropy, mosquito bite hypersensitivity, ringworm, psychogenic alopecia
- Head and neck pruritus (mild alopecia): same + Notoedric mange, Otodectic mange, Demodecosis, autoimmune (Pemphigus foliaceus)
- Feline miliary dermatitis: FAD, food allergy, feline atropy, mosquito bite hypersensitivity, parasites (Notoedric mange, Otodectic mange, Demodecosis), ringworm, pyoderma, nutritional disorders (FA def.), idiopathic, neoplasia (MCT)
DD of hyposthenuria
< 1.008 (actively diluting)
- Cushing´s
- HyperCa
- Hyperthyroidism
- Pyelonephritis
- DI
- Pyometra
- Liver disease
- Psychogenic PD
- Diuretics
- IV fluids
- Normal
DD of isosthenuria
- 008-1.013
- Same as hypo + kidney disease
DD of hypersthenuria
- 014-1.029: min. conc.
- Cushing´s + Addisons
- Kidney disease
- Liver disease
- DM, renal glycosuria
- Normal - 030-1.045: max. conc.
- Dehydration
- Normal
- Acute kidney injuiry
DD of proteinuria
- Hemorrhage: trauma, inflam., neoplasia, urolithiasis, FLUTD, coagulopathy
- Inflam. in UT: inflam., neoplasia, infection
- Kidney disease: primary glomerular disease (Amyloidosis, GN), primary tubular diseas
- Pre-renal proteinuria: fever, cardiac disease, shock, muscular exertion, seizures
DD of urinary incontinence
- Consider first: 2nd. to PU/PD, submissive/cognitive behaviour, can´t walk
- Urethral sphincter mechanism incompetence
- Paradoxical urinary incontinence: prostatic dis., neoplasia, uroliths, FLUTD
- Ectopic ureter
- Inflammation: bacterias, uroliths, FLUTD, neoplasia, prostatitis
- Neurological dysfunction: UMN (large, distended), LMN (soft), Detrusor atony
DD of liver diseases
- Acute hepatopathy/hepatitis
- Chronic hepatopathy/hepatitis
- Cholangiohepatitis
- Feline hepatic lipidosis
- Feline inflam. liver disease/Cholangitis
- Hepatic Encephalopathy
3 endocrine diseases causing hyperglycemia
- DM
- Cushings
- Hypothyroidism
Cause of smaller liver
- Fibrosis/Cirrhosis
- CPSS
- HMD
Tx of liver disease
- Supportive: IV fluids, electrolytes, Maropitant, Omeprazole, Sucralfate, Famotidine
- Coagulopathy: serum + vit.K inj.
- NS: reduce NH3 -> lactulose/psyllium, AB (Metronidazole), diet (low P, high BV, high carb., mod. fiber content, small meals freq.)
- Immunosup.: Prednisolon +/-Azathioprine
- If bact. inf: AB (Metronidazole, Ampicillin)
- Anti-fibrotic: Colchine
- Antioxidants: Vit.E+C, SAMe, NAC-N-acetylcysteine
- Cu-chelation: D-penicillamine, Zink acetate
- Choleretic: UDCA (Ø bile obst.)
- Ascites: Spirolactone, +/-Furosemide, abd.centesis
- Cat lipidosis: NE/G-tube! High P. Gradually incr.
DD of coughing
- Laryngeal: paralysis, collapse, laryngitis, FB
- Brachycephalic Airway Syndrome
- Infectious tracheobronchitis - Kennel Cough (harsh hacking)
- Tracheal collapse (goose honk)
- Ca chronic bronchitis (hacking)
- Fe bronchial disease (chronic cough)
- Pneumonia (soft, rarely in cats)
- Pulm. oedema (non-cardiogenic) (soft)
Types of resp. sounds
- Crackling: fine/coarse (pneum., chronic bronchitis, heart failure, asthma, COPD)
- Wheeze: narrowing airways (asthma, COPD, heart failure)
- Rhonchi: obstr. trachea, bronchitis, pneum.)
- Pleural friction rub: pleural inflam., pericarditis
DD of dyspnoea
= shortness of breath
- Nasal cavity: tumors
- Tracheal: collapse, hypoplasia, parasites
- W/Ø resp. origin (Kussmaul): mets, gastric dilation, metabolic acidosis
- Ca chronic bronchitis (obst. exp.)
- Fe bronchial disease/asthma (obst. exp.)
- Pneumonia
- Pulm. oedema, neoplasia
- Lung lobe torsion
- Mediastinitis
- Pleural effusion
- Pneumothorax
- Diaphragmatic hernia
- Congenital cardiac disease
- AV-valve dysplasia
- Pericardial effusion
- Heart worm disease
- Oesophagitis, FB, spirocercosis,
- Hypoxia due to inhal. of toxic gases, severe anaemia
- Pancreatitis, acute hepatitis, goitre, acromegaly, HSA, hyperthermia, tetanus
Tx. of resp. diseases
- Acute: SpO2 and O2 therapy, sedation, +/-intubation, active cooling if required,
- Anti-inflam.: Dexamethasone, Prednisolone, inhalers: Fluticasone puffers, budesonide nebuliser
- BCAS: Rest, cool environment, surgery (Ø for tr. hypoplasia)
- Bacterias: Doxycycline/Amoxiclav
- Antitussives: Codeine, Tramadol (Ø syst. ill)
- Nebulization, coupage
- Bronchodilator: Terbutaline, Salbutamol inhaler
