Medical Nursing Flashcards
what is the process of a lameness workup?
signalment and presenting complaint
history
gait exam
physical exam
differential diagnosis
diagnostic plan
aids to diagnosis
arthrocentesis
why is signalment and presenting complaint important in lameness work up?
indicates possible conditions
signalment can make conditions more likely
what history should be taken for lameness cases?
current medications
duration of lameness
onset
progression
continuous or intermittent
effect of exercise and rest
effect of ground surface - if feet affected
which limb
activity levels
concurrent issues
what is assessed in stance for lameness cases?
asymmetry
weight bearing
angular limb deformity
weight shifting - to thorax if hindlimbs
what are the types of angular limb deformities?
varus - distal medial
valgus - distal lateral
how do you perform gait evaluation?
walk and trot
stairs
circles
stride length
head nodding - down on sound
scuffing nails
ataxia
paraparesis
paraplegia
bunny hopping
lateral sway
how is lameness graded?
out of 10
what is lameness grade 0?
sound
what is lameness grade 1?
occasionally shifting weight
what is lameness grade 2?
mild lameness at slow trot
what is lameness grade 3?
mild lameness while walking
what is lameness grade 4?
obvious lameness when walking
places foot when standing
what is lameness grade 5-8?
degrees of severity of worsening lameness
what is lameness grade 9?
places toes when standing
carries limb when trotting
what is lameness grade 10?
unable to weight bear
what is the benefit of lameness grading?
consistency between care and assessment
why is physical exam important in lameness pateints?
may have more severe injuries
what are you feeling for when palpating lameness cases (done on standing)?
asymmetry
swelling
muscle atrophy
joint enlargement
abnormal conformation
compare limbs, may have bilateral disease
what can be seen in patients with joint disease?
swelling
joint effusion
pain
instability
decreased range of motion
crepitus on manipulation
how should you examine joints?
lateral recumbency
examine unaffected limbs first for comparison
what can be seen in patients with limb disease?
swelling
muscle atrophy
pain
why is neuro exam useful in some lameness cases?
neuro issues may be causing lameness
how is neuro exam in lameness cases performed?
palpate spine
screening neuro exam of proprioception and reflexes
full neuro exam if concerned
how is cranial drawer test performed?
under sedation/GA
lateral recumbency
hold tibia and femur and try to move tibia cranially to see if CrCL ruptured
how is tibial thrust test performed?
hold femur with finger on tibial tuberosity
flex hock to see if tibial tuberosity moves forwards if CrCL ruptured
can be done awake
how do you test for patella luxation?
stifle extended with quads relaxed
shift patella medially and laterally
how is ortolani test performed for hip laxity?
dorsal recumbency
subluxate hips by pressing down
abduct femurs to reduce hips
adduct femurs to subluxate hips
what aids to diagnostics can be used for lameness work up?
US
x-ray
CT
MRI
arthocentesis
EMG if neuro or muscular issue
what is an arthrocentesis?
fluid obtained from the joint to diagnose disease
when is joint tap indicated?
persistent or cyclical fever
lameness in joint localised
how do you determine which joint to tap?
systemic lameness - multiple joints
one joint affected - one joint, possibly next one along
how do you prep for arthrocentesis?
GA patient
lateral recumbency
strict asepsis - gloves, drape
clip and prep area
prepare equipment
guide with bony landmarks
list equipment for arthrocentesis
20-25G needles - solution quite viscous
5/8th-2.5 inch needles - joint dependent
2.5-5ml syringe - create negative pressure
what are characteristics from arthrocentesis fluids when abnormal?
larger volume
less viscous as diluted with plasma and serum
abnormal colour
why is it important to release negative pressure before drawing out needle for arthrocentesis?
contaminate with blood from tissue
what should you do with fluid samples from arthrocentesis?
EDTA for cytology and smear
smear most important
plain if enough for protein
plain for culture if possible infection
give info on volume, viscosity, contamination
what should synovial fluid look like?
clear
viscous
small volume
define tap
to obtain
define arthrocentesis
surgical puncture and aspiration of joint
what equipment is needed for scapulohumeral joint tap?
radiograph - assess needle length
5ml syringe
1.5-2.5 inch, 20-21G spinal needle
how is scapulohumeral joint tap performed?
palpate acromion
needle inserted distal and directly perpendicular, slightly dorsal and medial
gentle traction to open shoulder joint
what equipment is needed for elbow/cubital joint tap?
5ml syringe
1-1.5 inch, 23G needle
how is elbow/cubital joint tap performed?
elbow flexed to 45 degrees
needle inserted at level between anconeal crest and epicondyle, perpendicular to epicondylar crest alongside anconeal process
what equipment is needed for carpal joint tap?
2-5ml syringe
5/8th, 23-25G needle
how is carpal joint tap performed?
flex carpus to 90 degrees to open joint space and avoid NV bundle
insert needle perpendicular to skin
aspirate all joints
what equipment is needed for MCP/MTP/IP joint tap?
1-2ml syringe
5/8th 25G spinal needle
how is MCP/MTP/IP joint tap perfromed?
hard if no aspiration
short bevel needle so whole needle tip is in the joint and avoid contamination
what equipment is needed for coxofemoral joint tap?
5-10ml syringe
1.5-2.5inch 20G spinal needle
how is coxofemoral joint tap performed?
VD radiograph to measure needle length
needle inserted craniodorsal to greater trochanter, angled medially and caudoventrally
hip abducted and internally rotated to open up joint
what equipment is needed for stifle joint or femoropatella joint tap?
5ml syringe
1-1.5inch 21-23G needle
how is stifle joint tap performed?
stifle partially flexed
needle inserted lateral to patella ligament midway between patella and tibial tuberosity
angled caudomedially until hits bone
goes through fat pad
how is femoropatella joint tap performed?
stifle extended
needle inserted at angle between patella and femur towards proximal
what are benefits and risks of femoropatella joint tap?
benefits - avoids passing through fat pad which can impede aspiration
risks - iatrogenic damage to articular cartilage possible
what equipment is used for tarsal joint tap?
2.5-5ml syringe
5/8th-1 inch 23-25G needle
how is tarsal joint tap performed?
joint partially flexed
manipulate joint to feel articulation
angle needle perpendicular to skin into the joint
take fluid from craniolateral or caudolateral aspect of the joint
push effusion for easier access
what is CKD?
gradual, progressive, irreversible nephron loss
functional or structural disease over 3 months
how common is CKD?
most common kidney disease
3x more in cats than dogs
how does therapeutic management of CKD help patients?
slow progression of disease
maintain quality of life
what is the goal when managing CKD?
reduce workload of nephrons and prevent further damage
why is most CKD subclinical?
kidneys have considerable reserve function
what is seen in 50% nephron loss (one kidney or 50% reduced function overall)?
subclinical disease
what is seen in 67% nephron loss?
lose concentration ability
USG <1.030 dogs
USG < 1.035 cats
what is seen in 75% nephron loss?
azotemia
what is seen in 75-100% nephron loss?
decreasing quality of life to incompatible with life
what is the pathogenesis of CKD?
chronic interstitial nephritis (inflammation of renal interstitium)
what should be ruled out in CKD cases?
treatable or reversible causes:
pyelonephritis - inflammation of kidney and renal pelvis
ureterolithiasis
infection
FIP
FIV
describe the disease process of CKD
reduced GRF
initial compensatory hypertrophy of remaining nephrons
over time their increased workload leads to progressive nephron loss
progressive reduced GFR
list effects of CKD
loss of water and electrolyte regulation
PUPD
dehydration
hypokalaemia
loss of acid base regulation
acidaemia - vomiting, inappetence
azotaemia
hyperphosphatemia - vomiting, inappetence, secondary hyperparathyroidism
anaemia from lack of synthesis of erythropoietin
hypertension
end organ damage
describe common presentation of CKD patients
older cats
young if congenital disorder - polycystic or malformed kidneys
long term illness
incidental finding
what can you ask to screen for CKD in geriatric cats?
weight or condition change
PUPD
appetite
demeanour
activity
V or D
hypertension - blindness, neuro signs
ability to give meds
what assessments do you make in cats with CKD?
hydration
weakness
uraemic ulcers
uraemic halitosis
hypertensive retinopathy
small and irregular kidneys
rubber jaw (from renal secondary hyperparathyroidism)
how is CKD diagnosed?
USG
urine protein : creatinine
serum creatinine and urea
GFR - most sensitive test
SDMA/symmetric dimethylarginine
US
radiography
UOP
what indicates early CKD?
low urine conc
BW change
what confirms reduced renal function?
azotaemia with inappropriately concentrated urine
SDMA bloods
how is structural kidney disease diagnosed?
US - size and structure
x-rays - ureteroliths
how is hypertension associated with CKD?
CKD complication
makes CKD worse
what is the effect of hypertension in CKD?
blindness
neuro signs
organ damage
what is the goal for systolic BP in CKD patients?
140mmHg
how can you reduce stress when taking BP for cats?
minimal restraint
gaba
feliway
calm and patient
cat friendly
headphones on doppler
how does renal secondary hyperparathyroidism occur in CKD?
CKD increases serum phosphate as kidneys fail to excrete phosphate
more PTH secreted to low phosphate but also increased calcium
fails as kidneys cant excrete excess phosphate
progressive increase in phosphate and PTH
PTH causes bone resorption and rubber jaw
when is renal secondary hyperparathyroidism most commonly seen?
renal dysplasia
what causes hypokalaemia in 20-30% CKD cats?
inappetence
GI losses
urinary losses
what are the effects of hypokalaemia in CKD?
muscle weakness
inappetence
how is hypokalaemia in CKD cats managed?
supplementation
how does proteinuria in CKD occur?
protein leaks from the blood to urine when glomerulus damaged
more common in dogs
how is proteinuria measured in CKD?
urea to creatinine ratio
what causes anaemia in 30-65% CKD cases?
lack of erythropoietin production
reduced RBC lifespan
GI losses
what is the effect of anaemia in CKD?
weakness
lethargy
inappetence
what is monitored in CKD cats?
3-6 months when stable
appetite
drinking
GI signs
weight
BCS
BP
retinal exam
PCV
urea
creatinine
phosphate
calcium
electrolytes
urinalysis
how is iris staging for CKD used?
after diagnosis to treat and monitor CKD appropriately
once reversible problems addressed - creatinine, proteinuria, BP
what is stage 1 CKD?
non-azotemic renal abnormalities
mild SDMA increase
what is stage 2 CKD?
mild increase of creatinine
mild azotaemia
SDMA increase
what is stage 3 CKD?
moderate azotaemia
clinical signs
increased SDMA
what is stage 4 CKD?
increased clinical signs
azotaemia
increased SDMA
how can you manage CKD cats?
maintaining hydration
renal diet
supportive therapy
why is managing hydration so important in CKD cats?
dehydration advances CKD
what is a renal diet composed of?
low protein - toxins produced as by product of protein
low phosphate
good antioxidants and fatty acids - blood flow and reduce inflammation
high potassium
high bicarb - prevent acidosis
what supportive therapy can be done for CKD?
calcium channel blockers to open blood vessels and manage hypertension - amlodipine (cats) or ACE inhibitors (dogs)
renal diet and phosphate binders for hyperphosphatemia
renal diet and potassium supplements for hypokalaemia
renal diet, ACE inhibitors, omega 3 PUFAs, antiplatelets for proteinuria
what is a senior cat?
11-14yo
what is a geriatric cat?
15yo +
list common conditions affecting older cats?
hyperthyroidism
hypertension
CKD
feline cognitive dysfunction
dental disease
DJD
DM
intestinal lymphoma
IBD
list signs of hyperthyroid in older cat
PUPD
increased appetite
weight loss
list signs of hypertension in older cats
vision issues
neurological changes
systolic BP over 160mmHg
list signs of CKD in older cats
lethargic
unkept
weight loss
azotemia
generalised illness
hypertension
how prevalent is feline cognitive dysfunction?
55% cats over 11yo
80% cats over 16yo
list signs of dental disease in older cats
gingivitis
periodontal disease
tooth resorption
list signs of DM in older cats
increased urination
increased appetite
weight loss
what is seen in intestinal lymphoma in older cats?
digestive issues
what may be included in pre-assessment forms for screening geriatric cats?
behaviour changes
interactions with other pets
household changes
current medications
what is a sign of IBD in older cats?
ravenous as cant absorb food
how is disease detected in older cats in nurse clinics?
pre-assessment
history
parameters
diagnostics if concerned
clinical exam
what history should be taken in geriatric cat clinics?
parasite control
vaccination status
diet
confirm signalment
describe structure of geriatric cat clinics
done by same person ideally
patient dependent
history
weight
BP
clinical exam
diagnostic tests as needed - urinalysis, bloods
recommendations - vet referral, minor changes
summarise
arrange follow up
how should hydration be managed in geriatric cats?
always available
encourage to drink
measure intake every 6 months for any change
what are features of feline senior diets?
reduced energy and fat - less active
reduced calcium and phosphorus - manage possible kidney issues
increased fibre - increase digestion, support weight loss
wet - better support of hydration
how are condition scores used for geriatric cats?
ensure consistent weight
calculate % weight changes
BCS and MCS
<5% not significant
5-10% significant
>10% big concern
why is maintaining hydration in older cats so important?
maintain acid base balance
maintain osmoregulation
list effects of hypertension
retinal oedema
retinal haemorrhage
retinal detachment
left ventricular hypertrophy
progressive renal failure
bleeding into the CNS
ataxia
disorientation
seizures
coma
death
why is it important to monitor BP in older cats?
secondary hypertension common as a result of CKD, hyperthyroidism, other endocrine disorders
what can cause hypotension (<120mmHg) in geriatric cats?
heart failure
shock
hypovolaemia
what is normal SBP in cats?
120-160mmHg
what can cause SBP to be slightly elevated in cats at 160-180mmHg?
stress
what can cause hypertension (>180mmHg) in geriatric cats?
CKD
hyperthyroidism
endocrine disease
what should be assessed in clinical exam in geriatric cats?
slowly and cat friendly
head to toe
assess gait
auscultate
observe resp
check thyroid
examine muscles
what are common conditions that geriatric cats may have?
ear infections
neurological conditions
trauma
infections
tumours
what bloods are common in geriatric cats and why?
biochem
haem
BG
thyroid
assess organs and systems
what urinalysis is commonly done in cats?
SG
dipstick
UPC ratio
what are considerations for restraining geriatric cats?
temperament
disease
injury
preference
age
DJD
push not pull limbs
towel wrap
minimal
define dyspnoea
difficult or laboured breathing
define tahcypnoea
increased rate of respiration
define orthopnoea
upright position with extended neck to create space in chest to aid breathing
what is normal awake and sleeping RR?
awake <35, panting normal in dogs
sleeping <25
list causes of tachypnoea and dyspnoea
stress
pain
excitement
exercise
hypoxaemia
hypercapnia
respiratory disease
cardiac disease
what is localisation for upper airway disease?
nasal passages
pharynx
larynx
trachea
list signs of upper airway disease
inspiratory dyspnoea (difficulty breathing in)
stertor or stridor
abnormal sounds heard without touching patient
list causes of upper airway disease
laryngeal paralysis
BOAS
FB
neoplasia
polyps
inflammation
tracheal collapse
how is upper airway disease initially managed?
GA and intubation if obstructed
care for rapid decompensation
what is localisation for lower airway disease?
bronchi
bronchioles
list signs of lower airway disease
quick short inspiration
prolonged expiration
harsh lung sounds on auscultation
wheezes due to broncho constriction
crackles from secretions blocking airways
what can cause lower airway disease?
asthma
bronchitis
smoke inhalation
bronchopneumonia
COPD
list signs of lung parenchyma disease
expiratory and inspiratory components
list causes of dyspnoea caused by lung parenchymal disease
pulmonary oedema - cardiac or non-cardiac
pneumonia
infection
fibrosis
haemorrhage
contusion
neoplasia
thromboembolism
parasites
how do lung parenchymal disease appear on x-rays?
fluid is white
can see masses or pathologies
list signs of pleural space disease
restrictive breathing pattern
increased RR
reduced depth of inspiration - lungs cant expand
list causes of pleural space disease
penumonia
pleural effusion
masses
diaphragmatic hernia
pneumothorax
heamothorax
list causes of pleural effusion
haemorrhage
infection
neoplasia
heart failure
chylothorax
what changes in lung auscultations with pleural effusions present?
muffled heart sounds
muffled lung sounds dorsally
how is pleural effusions and pneumothorax diagnosed?
physical exam
thoracic radiographs
US
why are US favoured for pleural effusion and pneumothorax diagnosis?
quick to diagnose
can do conscious
dont have to position patient
how do you stabilise patients with pleural effusion or pneumothorax?
thoracocentesis
how do you do a thoracocentesis?
sedate
prep area
collect samples for cytology, culture, biochem
drain space
what is the clinical approach when presented with respiratory emergencies?
oxygen
clinical exam
upper or lower disease
RR and effort
MM
HR and heart abnormlaities
pulses
minimise stress
what is the goals of oxygen in respiratory emergencies?
increase oxygen content in arterial blood
increase oxygen delivery to tissues
what determines oxygen delivery to tissues?
haemoglobin concentration
blood oxygenation
CO
list methods of oxygen supplementation
flow by - inefficient but fine if nothing else
mask
nasal prongs
nasal catheter - further in so more secure and better delivery
collar - fine for temporary
oxygen cage
intubation
ventilation
what are considerations for using oxygen cages?
care for temperature, humidity and carbon dioxide
cages can control this but are expensive
what are considerations when giving respiratory patients oxygen?
is it needed
oxygen toxicity
correct rate
list goals of oxygen supplementation in respiratory patients
resolve life threatening hypoxaemia
relieve resp distress
when can oxygen toxicity occur?
100% o2 for 12-24 hours
how do you prevent oxygen toxicity in resp patients?
give less than 60% if long term
aim for lowest oxygen level can tolerate
what should be monitored in resp patients?
physical exam
arterial BG
pulse ox
RR and effort
MM
hydration
HR
pulses
stress/anxiety
why is it important to measure arterial BG in resp patients?
partial pressure of oxygen
gold standard for arterial oxygenation
how do you take arterial blood samples for BG?
dorsal metatarsal or femoral artery
keep in airtight and specific syringe
apply pressure after sample
what affects PaO2?
oxygen
barometric pressure
what is normal PaO2 on room air and 100% oxygen?
100mmHg - room air
500mmHg - 100% oxygen
what values are seen in hypoxaemia?
PaO2 <80mmHg
<95% saturation
what is the goal for PaO2 and saturation for resp patients?
PaO2 80-120mmHg
95-100% saturation
what does a pulse ox do?
measure partial oxygen saturation
calculates haemoglobin oxygen saturation
continuous and non-invasive monitoring
when does pulse ox work best?
moist, non-pigmented skin with adequate perfusion
what heart failure is normally seen in dogs?
left or right sided congestive heart failure
what heart failure is normally seen in cats?
biventricular failure
what are the commonly seen left sided heart failure in dogs?
myxomatous mitral valve disease in small dogs
dilated cardiomyopathy in large breeds (systolic dysfunction)
what is a common cause of right sided heart failure in dogs?
pericardial effusion
what heart failure is common in young dogs?
congenital heart failure
what heart failure is commonly seen in cats?
hypertrophic cardiomyopathy (diastolic dysfunction)
describe left sided congestive heart failure
backwards failure
pressure in the heart increased so pressure in pulmonary veins entering the heart have increased pressure
fluid cant enter pulmonary capillaries in due to pressure in vessels
fluid collects in pulmonary tissues
what are the effects on the body of left sided congestive heart failure?
pulmonary oedema
tachypnoea
dyspnoea
coughing due to enlarged heart pressing on receptors in trachea and bronchi
describe presentation of left sided heart failure
heart murmur - not always present or an indicator of this disease
tachypnoea
dyspnoea
tachycardia
pale MM
slow CRT
arrhythmia
weak pulses
pulse defecits
describe clinical approach to left sided heart failure cases
history
physical exam
stabilise before diagnostic tests - fragile and may decompensate
how do you stabilise patients with left sided heart failure?
minimise stress
sedate with low dose butorphanol
oxygen
furusamide IV if pulmonary oedema
pimobendan PO or IV to improve myocardial contractility
how does furusamide help with pulmonary oedema?
reduces circulating volume so reduces pressure in heart and reduces fluid not in circulation
how is left sided heart failure diagnosed?
echo
throacic radiography
ECG
BP
bloods
how does echo help diagnose heart failure?
diagnosis and severity of disease
how does x-rays and CT help diagnosis of heart disease?
identify pulmonary oedema
see heart size
find neoplasia
why are ECGs used in diagnosis of heart disease?
identify arrhythmia
why are BP measurements used in diagnosis of heart disease?
identify hypotension caused by low CO
why are bloods done in heart disease diagnosis?
electrolyte and renal parameters
diuretics can lower K, cause dehydration and azotaemia
what is seen on x-rays in the progression of cardiogenic pulmonary oedema?
begins in dorsal region, spreads caudal then ventral
list monitoring for left sided congestive heart failure pateints
RR and effort
less than 40 breaths per min
SBP above 80mmHg
HR
pulse quality
EGC if arrhythmia
x-ray if pulmonary oedema not improving
when is the patient seen as improving in left sided CHF?
RR and HR decreased
how is left sided CHF managed once stabilised?
lifelong therapy
feeding to prevent cardiac cachexia
bloods week after meds started or changed
3 monthly bloods, echo and other tests as needed (patient dependent)
describe right sided congestive heart failure
backwards failure
increased pressure in the vena cava causing effusions to form around organs as fluid cant re enter the circulation
what is the effect on the body in right sided congestive heart failure?
distended peripheral veins and jugular
ascites
pleural effusion
tachypnoea
dyspnoea
what are causes of right sided CHF?
pulmonic stenosis
tricuspid dysplasia
pericardial effusion
neoplasia
how is right sided CHF diagnosed?
history
physical exam
echo
thoracic x-ray
US
ECG
CT
describe a pericardial effusion
increased fluid in pericardium leading to tamponade as right atrium collapses due to external pressure
right side of heart filling impaired
what can cause left side of heart filling to be impaired in pericardial effusion?
septum can move with filling of the heart and breathing which can impair the left side
what is the impact of pericardial effusion?
decreased CO
what are common causes of pericardial effusion?
neoplasia
idiopathic
how is pericardial effusion stabilised?
pericardiocentesis
IVFT - counteract lower pressure in heart to improve filling and CO
what do you see post-pericardiocentesis?
HR pulses and demeanour improved
how do you manage patients following pericardiocentesis?
12-24 hour hospitalisation to monitor for arrhythmia
effusion can recur at any point
describe reduced cardiac output
forwards failure
left or right sided failure causing weak peripheral pulses and tachycardia leading to low SV
when is reduced CO commonly seen in heart disease?
DCM - reduced systolic function
end stage heart disease
what is the most common cause of feline cardiac emergencies?
HCM
can be caused by stress or anaesthesia
how do cats with cardiac disease present?
murmur
gallops
tachypnoea
dyspnoea
open-mouth breathing
tachycardia
bradycardia (more severe than tachy)
weak pulses
hypothermia
older overweight males more prone
when does arterial thromboembolism tend to have poor prognosis in cats?
when presenting with HF
what are signs of arterial thromboembolism in cats with HF?
sudden onset hindlimb paralysis/paresis
pain
pallor/cyanosis of pads and nail beds
pulselessness
poikilothermy/cold leg
poor hindlimb perfusion
how should you manage feline cardiac emergencies?
history
physical exam
stabilisation - fragile and easily decompensate
tests once stable
how should you stabilise cats with cardiac emergency?
avoid stress
oxygen
furusomide for pulmonary oedema
drain pleural effusion
gentle warming
analgesia for ATE
how do you diagnose feline cardiac emergencies?
history
exam
stabilise
echo - POC until stable
thoracic x-ray
ECG
BP
bloods
how do you manage feline cardiac patients in hospital following diagnosis?
adjust therapy to lowest effective dose
feed
manage thromboembolism - warm soft bedding and physio
home as soon as possible
manage stress
what is long term management for feline cardiac patients?
food intake to prevent cardiac cachexia
repeat bloods and echo
owner monitor RR and effort, signs of embolism
what is prognosis for feline cardiac patients?
guarded
may suddenly die
what is normal HR of dog?
60-120
what is normal cat HR?
160-220
what is a bradyarrhythmia?
HR lower than normal range
what is a tachyarrhythmia?
HR above normal parameter
how do patients with arrhythmias present?
syncope (collapse)
weakness
exercise intolerance
CHF
abnormal HR
weak pulses
pulse deficits
how are arrhythmias diagnosed?
ECG
define hyperpnoea
deeper breaths without dyspnoea
how do you triage a patient?
assess most life threatening concern
CV, resp and neurological
what are important considerations for dyspnoeic cat?
fragile
keep low stress
provide oxygen where possible
what should be examined in dyspnoeic cat?
RR and effort and pattern
clinical exam
auscultate
percussion
cranial rib spring
assess oxygenation
what can cause inspiratory dyspnoea?
dynamic extrathoracic upper airway obstruction
what can cause expiratory dyspnoea?
intrathoracic upper airway obstruction
lower airway disease
what does rapid shallow breathing indicate in dyspnoiec cats?
pleural space disease
parenchymal disease
what is meant by adventitious lung sounds?
abnormal respiratory noises
what can you hear on auscultation in respiratory disease?
breath sounds
wheezes
crackles
stertor
stridor
what can you palpate for in respiratory disease?
thoracic compressibility
percussion
what can cause URT obstruction?
FB
polyps
laryngeal tumours
how do you manage URT obstruction?
intubate
what can cause LRT disease?
asthma
bronchitis
bacterial infection
lung worm
FB
neoplasia
what can occur secondary to LRT disease?
pneumothorax
how do you manage general LRT disease?
bronchodilators
what causes feline asthma?
type 1 hypersensitivity to allergen
airway hyperresponsiveness
reverse bronchoconstriction
secondary inflammation
describe chronic bronchitis
airway inflammation
excess mucus production
airway narrowing
how is lower airway disease managed?
oxygen
minimise stress
bronchodilators
what are examples of bronchodilators given in cats?
terbutaline 0.015mg/kg IM/SC q4
salbutamol 1-2 puffs to effect
how is parenchymal disease managed in cats?
cage rest
oxygen
sedation as needed
furusomide
what can be the fluid in pleural effusion?
transudate
modified transudate
exudate
what are possible types of exudate in plural effusion?
pyothorax (septic)
neoplasia or FIP (non-septic)
chyle (CHF, trauma or idiopathic)
blood (trauma, coagulopathy, neoplasia)
what equipment is needed for thoracentesis?
clippers
sterile prep kit
sterile gloves
butterfly catheter
3 way tap
EDTA and plain tube
20ml syringe
procedures book helpful
describe thoracocentesis procedure
7-8th intercostal space, costochondral junction
EDTA for cytology
plaint tube for biochem and culture and sensitivity
IV antibiotics as needed
supportive care
what are examples of glucocorticoids in dyspnoic cats?
dexamethasone
fluticasone inhaler
when should you give furusomide to dyspnoeic cats?
if suspect HF
what is the action of the heart?
pump blood around the body and lungs
what is myocardium?
cardiac muscle that contracts rhythmically and autonomically without nervous input, controlled by electrical impulses
what is heartrate controlled by?
sympathetic and parasympathetic nervous systems
how does SNS control HR?
releases catecholamines adrenaline and noradrenaline to increase HR
how does PNS control HR?
PNS releases hormone acetylcholine to decrease HR
what are cardiac cells?
electrical cells and myocardial cells
what are functions of electrical cells of the heart?
conduction system of the heart in orderly fashion
spontaneously generate electrical impulses and respond to impulses
transmit electrical impulse along to next cell
what is the role of myocardial cells in the heart?
make up walls of the atrium and ventricles
responsible for contraction and ability to stretch
what needs to happen for the heart to function properly?
co-ordinated contraction
2 atria then 2 ventricles pushing blood to circulation and lungs
describe the conduction system of the heart
at rest cardiac cells are polarised
depolarise when stimulated by electrical impulse causing contraction
repolarise back to resting state to allow filling between contractions
what is the sinoartial node?
area of modified cardiac muscle cells in right atrium wall that initiates heart beat and controls HR influenced by PNS and SNS
how does the SA node initiate heart beats?
fires electrical impulses causing depolarisation to spread through atrial muscle cells causing atrial systole and blood to move to the ventricles
what is the atrioventricular node?
specialised group of muscle cells at the top of intraventricular septum that coordinates ventricular contraction with atrial contraction by its slow transmission of the impulse through it
why is it important the atrial and ventricular contraction is coordinated?
allows full filling of the ventricles before contraction
what is bundle of his?
bundle of nerve fibres running down the interventricular septum and divides into left and right bundle branches
what is the role of the bundle of his?
connects to the AV node to pass the impulse to the ventricles
what are purkinjie fibres?
network of specialised neurones organised into fine fibre branches connected from bundle of his going into the ventricles myocardium
describe ventricular contraction
begins at bottom of the ventricle and moves upwards causing ventricular systole and pushing blood out of the heart
what does an ECG do?
measures and records changing electrical activity of the heart using positive and negative electrodes
records changes in potential difference
describe how an ECG works
when parts of atria nearest SA node depolarise electrical potential difference is created with parts still in resting state
when negative and positive electrodes are placed either side of the heart ECG detects this depolarisation wave travelling across the heart and records as a wave deflection
when are ECGs used?
diagnose arrhythmia
triage
anaesthetic monitoring
general monitoring
critical patients
monitor idenitfied pulse defecits and arrhythmias
CPR to identify shockable rhythms
in patients with metabolic and electrolyte abnormlaities
pericardiocentesis and central line placement
hands off monitoring
where are the ECG leads placed?
red - right fore
yellow - left fore
green - left hind
black - right hind
what are the different types of electrodes for ecg?
crocodile clips directly to skin
pads on patients paws or thorax
what are general considerations for using ECGs?
remove interference sources such as mobiles
good skin contact
patient ideally in right lateral
list types of ECG machines and most important uses for each
multiparameter - continuous monitoring
paper trace - diagnosis
holter - long periods and can wear at home
telemetry - remote monitoring
list troubleshooting for ecg
check machine
check leads
minimise patient movement
ideally in right lateral
purring/panting interferes
check contact
clip fur
what is the p wave?
atrial electrical activity
positive deflection
small electrical change as small muscle mass of atria
what is the PR interval?
time between atrial and ventricular depolarisation
occurs during atrial depolarisation, wave depolarises AV node
what is the Q wave?
ventricular septum depolarises first following depolarisation wave passing bundle of his and purkinjie fibres causing small downwards wave on trace
negative deflection
what is the R wave?
majority of ventricular myocardium is depolarised causing depolarisation wave travelling towards positive electrode
large muscle mass so large deflection
positive deflection
what is the s wave?
after depolarisation of most of ventricles, final depolarisation occurs at base of the heart
small negative deflection
what is QRS complex?
waveform representing depolarisation of ventricles followed by ventricular contraction
what is the baseline on an ecg?
when atria and ventricles are depolarised there is no longer electrical potential difference before repolarisation
what is the t wave?
repolarisation of ventricles following complete depolarisation ready for next impulse
small positive deflection
why can the T wave be positive, negative or biphasic?
can be random repolarisation of myocardium
how should you interpret ECGs?
HR
complexes - present and normal
any arrhythmias
list types of arrhythmia
regularly regular
irregularly irregular
regularly irregular
bradyarrhythmia
tachyarrhythmia
intermittent
continuous
sinus
ventricular
supraventricular
what makes an arrythmia heart beat abnormal?
its rate, impulse conduction or ectopia (out of place)
can all cells in the heart generate electrical activity?
yes
what are types of sinus rhythms?
normal sinus rhythm
sinus arrhythmia
what is sinus rhythm?
normal PQRST complex
regular heart sounds
pulse on every heart beat
normal HR
regularly regular rhythm
what is sinus arrhythmia?
regular variation on HR coinciding with respiration due to PNS activity/vagal tone on SA node
normal P for every QRST
pulse for every heart beat
electrical impulse originates from SA node
regularly irregular rhythm
list bradyarrhythmias
sinus bradycardia
sick sinus syndrome
AV blocks
escape beats
hyperkalaemia
what is a sinus bradyarrhythmia?
SA node impulse and depolarisation slower than normal
normal sinus rhythm and PQRST complex
slow HR
no pulse deficits
regularly regular rhythm
what can cause sinus bradyarrhythmia?
can be normal in giant or athletic dogs
issue with SA node
secondary to disease - causing increased vagal tone, hypoadrenocorticism, hyperkalaemia, BOAS, high ICP leading to cushings reflex, hypocalcaemia
hypothermia
hypoglycaemia
hypothyroidism
how do you treat sinus bradycardia?
treat underlying cause
give anticholinergic - atropine or glycopyrrolate
positive inotrope - dopamine or dobutamine
what is sick sinus syndrome?
SA node fails to discharge electrical impulse leading to severe bradycardia or periods of asystole
what causes sick sinus syndrome?
degenerative
common in WHWT, cocker, cairn, mini schnauzer
how is sick sinus syndrome treated?
pacemaker
poor response to atropine
what are downsides and risks to pacemakers?
last 5-10 years
expensive
infection
lead dislodgement
failure to place correctly
venous thrombosis
list nursing considerations following pacemaker
no waking for 48 hours
harness only walks
no neck restraint or jug samples
what is an AV block?
impulses from SA node delayed or blocked going through AV node, signal may fail to reach the ventricles
issue with conduction system in the heart
what can cause AV block?
disease process
drugs that effect AV node
what is the difference between AV block and bundle branch block?
AV affects AV node
bundle branch block affects left or right bundle branch
list signs of AV block
decreased CO
lethargy
syncope
collapse
how is AV blocks treated?
manage underlying condition
vagolytic drugs - atropine, glycopyrrolate
pacemaker for 2nd and 3rd
what is a first degree AV block?
delayed conduction through AV node
normal PQRST
prolonged PR interval
what is a second degree AV block?
longer conduction delay
some P waves wont have QRS, dropped beat
what is mobitz type I second degree AV block?
PR interval gets longer and longer until beat is dropped and then back to normal
what is mobitz type II second degree AV block?
PQRS complex normal
occasional P wave without QRS
what is a third degree AV block?
complete lack of conduction through AV node
multiple P waves without QRS complexes
some tall QRST complexes which are ventricular escape beats acting as rescue beats
usually slow HR
what are rescue beats?
electrical impulses occurring from random cells to keep animal alive
leads to bizarre and wide complexes with absent P wave
how does hyperkalaemia affect bradycardia?
as potassium increases, severity of bradycardias and arrhythmias increase
what is seen in hyperkalaemia arrhythmias?
reduced/absent p waves
spiked t waves
short QT interval
prolonged QRS complex
progression to atrial standstil, sine wave pattern, v fib and asytsole
what diseases can cause hyperkalaemia?
urethral obstruction
AKI
hypoadrenocorticism
how is hyperkalaemia treated?
calcium gluconate bolus to reduce risk of v fib and protect cardiac myocytes from high k
insulin infusion to move k into cells
dextrose as cells uptake glucose with k to prevent hypoglycaemia
list tachyarrhythmias
sinus tachycardia
supraventricular tachycardia
atrial fibrillation
ectopic beats
accelerated idioventricular rhythm
ventricular tachycardia
r on t phenomenon
what is sinus tachycardia?
SA node generates impulse at faster rate than normal
normal PQRST complexes
regularly regular rhythm
faster HR than normal
pulse for every beat
when can sinus tachycardia be normal?
pain
stress
exercise
hypovolaemia
anaemia
what is supraventricular arrhythmia?
atrial origin
occurs at point other than SA node then conducts via AV node to the ventricles
QRS normal but often narrower and taller
p wave abnormal
premature heart beat
irregularly irregular rhythm
what are other names for supreventricular arrhythmia?
atrial premature complex
premature atrial contraction
atrial premature beat
what is supraventricular tachycardia?
3 or more supraventricular arrhythmias
rapid HR
narrow and upright QRS, may or may not be with P wave
regularly irregular rhythm
what is seen in slow SVT?
normally no clinical signs
whatclinical signs is seen in fast SVT?
weakness
collapse
poor pulse quality
poor peripheral perfusion
pale MM
prolonged CRT
inadequate diastolic filling
what can cause SVT?
cardiac disease
systemic disease causing toxicity, hypovolaemia, electrolyte imbalance, ischemia
how is SVT managed?
lower HR
treat underlying disease
beta blockers
calcium channel blockers - IV then oral for maintenance
what is ventricular arrhythmia?
ventricular origin
normal conduction pathway not followed
QRS complexes wide and bizarre
what is an ectopic beat?
beat generated not from SA node but other cells in the heart
premature and interrupts normal rhythm before SA node would initiate other rhythm
abnormal PQRST complex
what are types of ectopic beats?
atrial premature complex
junctional premature complex
ventricular premature complex
supraventricular tachycardia
escape beats
what is atrial fibrilation?
supraventricular tachyarrhythmia
rapid and irregular arrhythmia of atria
pulse deficits common
irregular pulse
ventricles contract before filling
rapid irregular HR
fibrillating baseline
taller and narrow QRS
no visible p wave
irregularly irregular rhythm
how is atrial fibrillation treated?
decrease HR
increase CO
calcium channel blockers
beta blockers
digoxin
amiodarone
what is junctional premature complex?
ectopic beat arising from area in AV junction
ventricles activated normally
premature narrow QRS before P wave
what is a ventricular arrhtyhmia?
SA node no longer controls ventricular contractions
abnormal electrical impulse at ectopic site below AV node takes control of pacemaker role
complexes wide and bizarre
what can cause ventricular arrythmia?
underlying cardiac disease
complication of GDV, splenectomy, pancreatitis, anaemia
what is ventricular premature complex?
ectopic beat occurring before normal SA node depolarisation, begins in abnormal location in ventricles
no p wave
wide and bizarre QRS
weak pulses
pulse deficits
what is accelerated idioventricular rhythm?
3 or more VPC together
elevated HR
unlikely to effect CO, hypotension or haemodynamic compromise
how do you manage accelerated idioventricular rhythm?
monitor closely for progression to v tach
what is ventricular tachycardia?
3 or more VPCs
rapid HR
bizarre and wide QRS complexes
absent P waves
large t waves
what are signs of v tach?
weak pulses and deficits
rapid irregular HR
low CO
hypotension
collapse
haemodynamic compromise
altered mentation
hypoperfusion
what can cause v tach?
primary cardiac disease
abdo pathology
inflammation
severe anaemia
abnormal autonomic activity
electrolyte disturbances
drug toxicity
neoplasia
list effects of v tach
decreased systemic tissue perfusion/cardiogenic shock
myocardial failure
malignant arrhythmia/v fib
sudden death
what is treatment aims for v tach?
convert to sinus rhythm
slow HR
improve CO and peripheral perfusion
how do you treat v tach?
manage underlying cause
lidocaine
beta blockers
amiodarone
procainamide
magnesium
how do you manage pulseless v tach?
emergency
start CPR
shock
what is r on t phenomenon?
VPC premature so superimposed on T wave of preceding complex
on sinus or ectopic beat
ventricles not fully repolarised before depolarising
what can be the consequences of r on t phenomenon?
v tach or v fib
list cardiac arrest rhythms
ventricular fibrillation
pulseless ventricular tachycardia
pulseless electrical activity
asystole
how does defibrillation work?
sends high energy electric shock to heart to reset electrical state of the heart and convert to sinus rhythm
which CA rhythms are shockable?
v fib
pulseless ventricular tachycardia
why is it important not to shock non-shockable rhythms?
can be detrimental for survival
what is v fib?
pre-terminal condition leading to patient death unless managed
no effective ventricular contractions
rapid ECG with irregular wavy baseline
no CO or pulses
can be coarse or fine
how do you manage v fib?
CPR and shock
what is pulseless electrical activity?
electrical impulses in the heart
no corresponding myocardial contractions
varied HR
normal complexes become wide and bizarre
no heart beat or pulses
can occur minutes after patient death
how do you manage pulseless electrical activity?
CPR
adrenaline
atropine
defib if converts to shockable rhythm
what is asystole?
flat line
most common arrest rhythm
no pulses or CO
associated with end stage disease caused by high vagal tone
how do you manage asystole?
CPR
shock if converts to shockable rhythm
what are the stages of a normal cell lifecycle?
interpahse - cell matures and DNA replicates
mitosis - prophase, metaphase, anaphase and telophase
prophase - preparation to split, chromosomes form
metaphase - chromosomes line up
anaphase - chromosomes split
telophase - chromosomes stretch out
cytokinesis - cell splits in 2
when do cells enter apoptosis?
after replicating a set number of times, depending on function and replication frequency controlled by the nucleus
what signals do cells responds to?
growth and environmental signals
what makes cancer a rare event?
processes in place to prevent it occuring
what is cancer?
phenotypic end result of whole series of changes that take long time to develop
how is cancer prevented?
cell cycle inhibited for repair or apoptosis
tumour suppressor genes
describe how cancer arises
accumulation of genetic mutations which eliminate cell constraints
very slow process and may not occur in lifetime of animal
what is one factor that is increasing the amount of cancer we see?
longer lifespan of animals as more mutations can accumulate
list environmental causes of cancer (not proven in animals but can assume as in humans)
chemical carcinogens
physical agents
hormonal causes
cancer causing/oncogenic viruses
(inherited cancer, not recognised in animals)
list types of chemical carcinogen
tobacco smoke
pesticides
herbicides
insecticides
cyclophosphamide (chemo drug linked with bladder cancer)
list physical agents that can cause cancer
sunlight
trauma
chronic inflammation
magnetic fields
radiation
surgery
implanted devices
asbestos
how can hormones effect cancer?
neutering can prevent some
neutering can increase risk of others such as lymphoma
how do oncogenic viruses lead to cancer?
indirect or direct action on causing cancer
list examples of oncogenic viruses
papilloma virus
FeLV
list mutations resulting in cancer
sustain proliferative signalling
evade growth suppressors
resist cell death - cant recognise DNA damage
enable replicative immortality - telomeres dont reduce on division (apoptosis when no longer present)
induce angiogenesis - new blood vessels
active invasion and metastasis
how many mutations are needed for cancer to occur?
5-6 critical mutations
what is a tumour?
benign or malignant neoplasm
define neoplasia
formation of abnormal growth that is not responsive to physiological control mechanisms
benign or malignant
define cancer
malignant neoplasms
define benign tumour
space occupying
can cause tissue distortion
define malignant tumour
locally destructive, may metastasise and cause death
how does chemotherapy work?
targets dividing cells
different drug classes work at different stages of DNA replication and cell division, or interfere with cell signalling
when can chemotherapy be used?
primary induction therapy - sole therapy
primary neoadjuvant chemo - before treatment
adjuvant chemo - mop up after surgery
consolidation chemo - haemopoietic chemo after remission
maintenance chemo - low intensity over long term
rescue or salvage chemo - failed response to previous chemo
palliative chemo - maintain quality of life, not cure
what are the benefits of multimodal chemo plans?
maximal cell kill in range of tolerable host toxicity
broader range of interaction between drugs and tumour cells
slows development of tumour drug resistance
what are considerations for using multimodal chemo plans?
only drugs with single use efficacy against tumour type
ideally use drugs without overlapping toxicity so dont have to wait for toxicity to settle before next drug
use drugs at optimum dose and schedule to lower resistance by tumour
use consistent intervals
list effects of chemo on cells
affects dna replication so go inot apoptosis
list types of chemo agents
alkylating agents
antitumour antibiotics
antimetabolites
antimicrotubule agents
corticosteroids
platinum
l-asparginase
target agents
what are examples of alkylating agents and how do they work?
cyclophosphamide, chlorambucil, lomustine
binds alkyl groups to cellular macromolecules cross linking DNA
what are examples of anti-tumour antibiotics and how do they work?
doxyrubicin, mitoxantrone
multimodal action of cellular toxicity
how do antimetabolites work?
inhibit use of cellular metabolites in cellular growth and division
what are examples of antimicrotubule agents and how do they work?
vincristine, vinblastine
interfere with cellular function and replication
what are examples of corticosteroids used in chemo and how do they work?
prednisolone
induction of apoptosis in haematologic cancers
what are examples of platinum used for chemo and how do they work?
cisplatin, carboplatin
bind DNA
how does L-asparginase work as a chemo drus?
induces apoptosis in tumour cells
what are examples of target agents for chemo and how do they work?
palladia, masivet
tyrosine kinase inhibitors, block receptors on cell surface
what is lymphoma?
diverse group of neoplasm of common origin from lymphocytes, lymph nodes, spleen, bone marrow
can affect all areas of the body
how does lymphoma present in cats and dogs?
cats - intestinal presentation
dogs - 80% have multicentric form, one of most common tumour in dogs
how is lymphoma treated?
consistent chemotherapy cycles
restrart chemo if leave remission
can live 2+ years with treatment
what is the CHOP protocol?
cyclophosphamide
hydroxydaunorubicin/doxorubicin
oncovin/vincristine
prednisolone
when is prednisolone given in the CHOP protocol?
if systemically unwell
how does the CHOP protocol work?
given over several months
discontinuous so stopped when finished and restart as needed
what causes chemo toxicities?
drugs targeting normally dividing cells
what is commonly affected by chemotherapy in the body?
bone marrow
GI
list side effects of vincristine
myelosuppression
peripheral neurotoxicity
GI
ileus
list side effects of cyclophosphamide
neutropenia
GI toxicity
haemorrhagic toxicity
list side effects of chlorambucil
myelosuppression
list side effects of epirubicin
anaphylaxis
myelosuppression
GI toxicity
cardiotoxicity - rare
what is a possible side effect of doxorubicin?
changes leading to CHF
list nursing considerations for chemo patients
feeding
toileting
barrier nurse
care pre-diagnosis, during treatment if ill and end of life care
list considerations for administering chemo
bolus or infusion, or orally for some
IV needs to be clean stick
check drug and dose
use PPE
correct protocols
correct disposal
what chemo drugs are group 1 vesicants?
vinchristine
epirubicin
how do you manage chemo admin gone wrong?
leave ICV in and aspirate
inject saline around area
heat compression
how do you manage excretions following chemo?
drug is excreted for 4-5 days
handle with gloves
double bag
urinate in low traffic areas and wash away
how can you support owners with chemo pets?
understand condition and treatment for discussion
understand owners needs
provide supportive care, curative treatment, palliative care, hospice or euthanasia as appropriate to help patient
keep owners involved
provide support as needed
what are the two types of dietary sensitivities?
non-immunologically mediated
immunologically mediated
what are the types of non-immunologically mediated dietary sensitivities?
repeatable food intolerances
non-repeatable dietary indiscretion - over eating, eating things shouldnt, gluttony
intoxication
contamination/poisoning
what are immunologically mediated food sensitivities?
repeatable
food allergy or hypersensitivity
define a food allergy
immunologically mediated adverse food reaction/AFR to dietary component
what is the most common dietary component causing food allergies?
proteins
what defence mechanisms does the body have against AFR?
constant exposure to foreign antigens
peristalsis
mucus layer
gut not designed to let large molecules through
protients hydrolysed before entering blood
oral tolerance is series of signalling and processing leading to tolerance of foreign antigens
body learns whats harful
when does AFR occur?
failure of bodys defence mechanisms against them
how do most AFR manifest?
delayed hypersensitivity/type 4
anaphylaxis in some cases
list the systems affected by AFR
dermatological
GI
list common food allergens in dogs
beef
dairy
wheat
list common food allergens in cats
beef
dairy
fish
what is canine epileptoid cramping syndrome?
severe muscle and intestinal cramps of short duration in border terriers as a result of gluten allergens
how is canine epileptoid cramping syndrome treated?
eliminating gluten
list cutaneous clinical signs of food allergies
pruritis
erythema
list GI signs of food allergy
vomiting
diarrhoea, usually LI
non-specific so need to differentiate cause
what is the systemic reaction to food allergies?
anaphylaxis
how do patients with food allergies present?
younger pets typically
derm signs
LI diarrhoea, GI signs
other causes of issues excluded
how are food allergies diagnosed and managed?
exclusion/limitation
challenge and rescue
provocation and rescue
maintenance
what is the exclusion/limitation phase of food trials?
feed novel protein or hydrolysed diet exclusively
what is the challenge and rescue phase of food trials?
feed original diet to confirm was the problem
return to elimination diet if problems return
key phase of diagnosis
what is the provocation and rescue phase of food trials?
adding individual foods to identify triggers and whats fine
what is maintenance phase of food trials?
continuing to feed whats okay and excluding triggers
when are blood tests not useful for food allergies?
when have GI manifestation
how long does it take to see improvement in food allergies when starting management?
GI signs - 6 weeks
derm signs - 10 weeks
what is chronic inflammatory enteropathies/CIE?
group of disease with chronic GI inflammation
any of vomiting, diarrhoea, dysorexia (abnormal appetite), weight loss of over 3 weeks duration
what needs to be done before diagnosis of CIE?
exclusion of other diseases such as exocrine pancreatic insufficiency, abdo organ inflammation, metabolic disease
how is CIE diagnosed?
everything else is normal and ruled out
biopsies indicate both inflammation and villi atrophy
what are advantages and disadvantages of intestinal biopsies via laparotomy?
adv - full thickness biopsies, full exploration of other organs
disadv - surgical, risk of dehiscence, peritonitis and sepsis
what are advantages and disadvantages of intestinal biopsies via endoscopy?
adv - minimally invasive
disadv - small mucosal biopsies, jejunum hard to access
list possible causes of CIE
food responsive disease/FRD
antibiotic responsive disease/ARD - common in breeds such as german sheperd
idiopathic disease
describe antibiotic responsive disease
gut flora prone to random changes causing diarrhoea and inflammation which leads to further changes in gut flora
how is antibiotic responsive disease managed?
metronidazole
describe idiopathic CIE
previously known as IBD
immunological disorder
loss of tolerance to mucosal flora
cycle of GI inflammation and shift in mucosal flora, each making each worse
list consequences of CIE
dehydration
protien malabsorption/protein losing enteropathy leading to hypoalbuminaemia leading to effusions and oedema and thromboembolic events as blood more viscous (lowers oncotic pressure)
hypocobalaminaemia/low b12
GI haemorrhage
anaemia
GI perforation leading to spetic peritonitis
describe supportive therapy for CIE
haemodynamic stability
fluid balance and electrolytes to manage hypovolaemia and hydration
manage diet
tube feed in severely effected patients
anti emetics
appetite stimulants
what therapy can be done for idiopathic CIE?
immunosuppression if immune mediated problem to allow gut to recover - preds at minimum effective dose
consider fenbendazole, metronidazole, vitamin b12, anti-platelet drugs as needed
describe what a diet trial is
exclusive feeding with food and water for upto 10 weeks
hypoallergenic not sensitivity diet
novel proteins
why may diseases other than food allergies respond to diet trials?
food is high quality and digestible
