Midterm 2 Flashcards
1
Q
If an animal has a high relative erythrocytosis, what may be occurring?
A
- Hemoconcentration
2. Splenic contraction in horses
2
Q
If an animal has a high absolute erythroctysosis, what may be occurring?
A
- Physiological response to chronic hypoxia
2. Neoplastic production
3
Q
What are the clinical sign of anemia?
A
- Pale mucous membranes
- Lethargy/obtunded
- Anorexia
- Exercise intolerance
- Tachycardia
- Tachypnea
- Systolic murmur
4
Q
What are the necropsy findings of an anemic large animal?
A
- Pale tissues
- Thin blood
- Scenic contraction/splenomegaly
- Centrilobular hepatic necrosis
5
Q
What are the causes of anemia?
A
- Loss of RBCs from hemorrhage
- Destruction of RBCs due to intra or extravascular hemolysis
- Decreased production of RBC’s
6
Q
What will you see with RBC morphology when looking at regenerative anemia in ruminants?
A
- Anisocytosis
- Polychromasia
- Macrocytosis
- Basophilic stippling
- Reticulocytes
7
Q
What would auto-agglutination suggested on RBC morphology?
A
Immune Mediated Anemia
8
Q
What do Howell-jolly bodies on a blood smear suggest?
A
RBC regeneration except in a horse
9
Q
What do Heinz bodies suggest on a RBC smear?
A
Oxidative damage (red maple or onion ingestion )
10
Q
What common hemoparasites can be evident on a blood smear in large animals?
A
- Babesia bovis
- Babesia caballi (Equine)
- Anaplasma marginale
11
Q
What are some unique features of the equine erythron (RBC)?
A
- Unstable PCV due to scenic contraction
- No peripheral signs of regeneration aka no macrocytosis, polychormasia, or reticulocytes
- Rouleaux formation
- Icteric plasma
- Howell-holy bodies as a normal morphological characteristic
12
Q
How can non-regenerative anemia be characterized?
A
Evaluation of the iron status through:
- Serum iron concentration
- Serum ferritin
- Total iron binding capacity (TIBC)
13
Q
What would a normal ferritin level in a horse suggest?
A
Bone marrow dysfunction
14
Q
A horse has a low total iron binding capacity (TIBC) level with a low serum iron concentration..what does this suggest?
A
Anemia of chronic disease
15
Q
What would iron deficiency anemia looks like on a iron panel?
A
Low serum iron concentration and high total iron binding capacity (TIBC) OR
A low serum iron concentration, normal TIBC, and low ferritin levels
16
Q
If a horse presents with a normal TIBC, a low FE, and a low ferritin level, what does this suggest?
A
Iron deficiency
17
Q
A horse presents with low Fe values, normal ferritin, and normal TIBC, what does this suggest?
A
Anemia of chronic disease
18
Q
A ruminant presents with anemia, there are immature RBC’s present and the TP is low…what does this suggest?
A
Acute blood loss anemia
19
Q
What parameters would be abnormal in a ruminant with hemolytic anemia?
A
There would be immature red blood cells present indicating regeneration and the TP levels would be normal.
20
Q
What type of anemia will a ruminant likely have if there are no immature red blood cells present and the TP is low?
A
Acute blood loss anemia that needs to be reevaluated in 72 hours.
21
Q
A cow presents with anemia. There are no immature RBC’s present,the TP is normal, and there is no evidence of hemolysis ..what is going on?
A
A non-regenerative anemia
22
Q
What are the steps in the diagnosis when an animal is anemic?
A
- CBC
- Urinalysis
- Feces for occult blood
- U/S or PE of body cavities
- Coomb/s test/flow cytometry
- Coggin’s test if a horse
- Bone marrow aspirate or biopsy
- Coagulation assays
- Evaluation of bleeding time
- AT-III levels
23
Q
If a large animal has non-regenerative anemia of chronic disease, what will be on the CBC?
A
Neutrophilic leukocytosis due to stress or inflammation
24
Q
What tests can be used to evaluate hemorrhage in an animal with anemia?
A
- Urinalysis with a dipstick, microscope to look for RBCs and to distinguish between hemoglobin and myoglobin
- Feces for occult blood
- Body cavities with U/S
25
What tests can be used to evaluate hemolysis in a large animal with anemia?
1. Coombs test with flow cytometry
| 2. Coggins test (horse)
26
If a horse has a positive coggins test, what does this mean?
Equine Infectious Anemia
27
If a large animal has a positive coomb’s test, what does this mean?
Immune mediated anemia
28
What is needed to demonstrate a regenerative anemia response when the M:E ratio is normal (1:1 to 2:1)?
Bone marrow aspirate or biopsy
29
What is the M:E ratio when a large animal has a regenerative anemia?
< 0.5:1
30
What tests are part of a coagulation assay in large animals?
1. PT
2. APTT
3. ACT
4. Fibrin/fibrinogen degradation products
31
What are the steps in treating anemia?
1. Control hemorrhage
2. Treat underlying cause
3. Support tissue oxygen volume with IV fluid therapy
4. Reasses and determine is blood transfusion needed
32
What is the main indication in an anemic large animal for a blood transfusion?
1. 10 L blood lost ( more than 25%)
| 2. PCV < 15% and Lactate > 4mmol/L
33
What is the universal blood donor for horses?
Aa & Qa negative
34
Which diseases should a donor horse/ruminants blood be free of?
1. EIA
2. EVA
3. BLV
35
How long will transfused RBC’s stay in a recipient for?
2-4 days
36
You need to do a blood transfusion in a horse, but there is no universal donor and the patient has received a previous transfusion..what do you do?
Do a major and a minor cross match
37
What is the difference between a major and minor blood cross match?
Major: Donor’s RBC’s with recipients serum
Minor: Recipients RBC’s with donor serum
38
What is the safe blood donor volume from an adult large animals?
1.6% donor BW
39
How do you determine the blood volume needed in a patient?
Patient BW x 0.08 x (desired PCV-receipent PCV/Donor PCV)
40
What is the target PCV for a large animal needing a blood transfusion?
15-20%
41
What premedication should be administered prior to a blood transfusion?
1. Antihistamine
| 2. NSAIDS
42
What is the rate at which you should give a blood transfusion in large animals and what steps are involved ?
1. Start slow at 0.1ml/kg/hr
2. Monitor TPR, attitude and watch for hives
3. Increase rate gradually every 5-10 min if no Rxn
4. Limit to 20ml/kg/hr
43
When and why does a tranfusion reaction usually occur?
Due to donor-recipient blood group incompatibilities and can occur during the first transfusion
44
What are the clinical signs of a blood transfusion reaction?
1. Tachypnea
2. Tachycardia
3. Urticaria
4. Pyrexia
5. Pulmonary edema
6. Colic
7. Shock/collapse
45
What are the steps when dealing with a blood transfusion reaction?
1. Slow/stop transfusion and give crystalloid fluids instead
2. NSAIDS or antihistamines
3. Dexamethason/prednisone
4. Epinephrine if there is anaphylaxis
46
What are some blood substitutes that can be used in a blood transfusion?
1. Oxyglobin
47
What is TRALI and when does it occur?
Transfusion-associated lung injury occuring 1-2 days after a blood transfusion
48
What are blood transfusion reactions that can occur “late”?
1. TRALI
2. Hemolysis
3. SIRS
4. Serum hepatitis (Theiler’s diease )
49
What disease in horses is commonly associated with the administration of tetanus antitoxin given 4-6 weeks before clinical signs occur?
Theiler’s disease ( serum hepatitis)
50
A horse is suffering from anemia...other than a blood transfusion, what can you treat with?
1. Iron supplements
2. Vitamin B12
3. Copper glycinate
4. Anabolic steroids
5. Oral therapy with RED CELL
51
What are some important causes of acute hemorrhage?
1. Coagulopathies
2. Thrombocytopenia
3. DIC
4. Guttural pouch mycosis in horses
52
What are some important causes of chronic hemorrhage?
1. Coagulopathies
2. Thrombocytopenia from EIA and BVD
3. GI loss
4. Internal parasites
5. Aromas always ulcers in ruminants
6. Caudal vena cava syndrome in ruminants
7. Jejunal hemorrhage syndromes in ruminants
53
How would you diagnose guttural pouch mycosis?
Endoscopy
54
How is guttural pouch Mycosis treated?
Surgically, as there is not time for medical treatment since it can take 6 months
55
What is the main clinical sign of vena caval thrombosis and in what species?
Bilateral epitaxis in cattle
56
What is the pathogenesis behind vena cava thrombosis ?
Ruminal Acidosis- lliver abscess-thrombus in the caudal vena cava -metastatic pneumonia- erosion of pulmonary veins
57
How is vena canal thrombosis diagnosed and treated?
Endoscopy and U/S
It is fatal
58
A high producing dairy cow presents with hyperglycemia, hypermagnesemia hyponatremia, hypochloremia, hypokalemia along with anorexia, tachycardia, and hypothermia. She is bleeding from her rectum. What may be going on?
Jejunal hemorrhage syndrome
59
What causes jejunal hemorrhage syndrome?
Poor diet and management
60
What will jejunal hemorrhage syndrome look like on ultrasound?
Distended loops of intestine
61
How is jejunal hemorrhage syndrome treated?
Surgery , but prognosis is guarded
62
What are the most common causes of hemoperitoneum in large animals?
1. Spleen trauma in mares
2. Reproductive tract injury with uterine artery rupture
3. Neoplasia
63
What clinical signs are seen in a horse with hemoperitoneum?
1. Anemia
| 2. Colic
64
How is hemoperitoneum diagnosed?
1. Swirling echogenic fluid on U/S
| 2. Abdominocentisis
65
How is hemoperitoneum treated?
1. Fluid therapy
2. Blood transfusion
3. Antifibrinolytics and procoagulant agents
4. Restricted physical activity
66
What is a signal that a horse will have a poorer prognosis with hemoperitoneum?
Prepartum hemorrhage
67
What is the prognosis for a large animal with hemoperitoneum?
Fair with 54 to 74% survival rate
68
What large animal species is more susceptible to nematode infection?
Goats
69
What type of abomasal ulcer is most often associated with anemia in cattle?
A grade 2 ( bleeding,non-perforation)
70
What are the causes of a anemia causing ulcer in cattle?
1. Lymphosarcoma
71
How are abomasal ulcer diagnosed?
Fecal occult blood tests
72
What it’s the treatment for abomasal ulcers?
Treat the underlying disease that is leading to ileus, feeed more fiber and less grain, and don’t used oral gastroprotectants as they don’t work
73
What causes hemophilia A?
It is a sex linked recessive traits affecting males that involves a factor VIII deficiency
74
What diagnostic signs will you see with hemophilia A?
Prolonged PTT dues to the intrinsic pathway being compromised from a factor VIII deficiency
75
What diseases are associated with vasculitis in horses?
1. Equine Purpura hemorrhagica (EPH)
2. Equine Viral arthritis (EVA)
3. Equine Infectious Anemia (EIA)
4. Equine Anaplasmosis
5. Idiopathic
76
What disease are associated with vasculitis in ruminants?
1. Malignant catarrhal fever (cattle)
| 2. Bluetongue (sheep)
77
What is the definitive diagnosis for vasculitits?
Full thickness punch biopsies at least 6 mm of the skin analyzed with histopathology
78
What is the cause of purpura hemorrhagica?
Type III hypersensitivity response to bacterial/viral antigens
79
What are the clinical signs of purpura hemorrhagica?
1. Limb edema
2. Purpura
3. Myositis
4. Colic
5. Reluctance to move
80
What bacteria/viruses can cause purpura hemorrhagic in horses?
1. Streptococcus spp.
2. Corynebacterium
3. Influenza virus
4. Strangles vaccination
81
How is purpura hemorrhagica treated?
1. Treat underlying cause
2. Corticosteroids for 2-4 weeks
3. Treat edema
82
What is the cause of Equine anaplasmosis?
Anaplasma phagocytophilum
83
Where does anaplasma replicate?
Granulocytes- neutrophils
84
What are the clinical signs of equine anaplasmosis?
1. Vasculitis with fever and limb edema
| 2. Secondary IMHA
85
How is Equine anaplasmosis treated?
1. Oxytetracycline
2. NSAIDS
3. IV fluid therapy
86
T/F: Equine anaplasmosis patients have the ability to spontaneously recover in 2-3 weeks
True
87
How is anaplasmosis diagnosed?
1. Morulae in neutrophils after 3 days of fever
2. PCR positive for three weeks
3. Seroconversion after 12 days
88
What is the vector for equine anaplasmosis?
Ixodes Pacificus
| I. Scapularis
89
What are the 3 mechanisms of thrombocytopenia?
1. Abnormal sequestration
2. Shortened platelet survival
3. Decreased/absent platelet production
90
What are the clinical consequenes of thrombocytopenia?
1Petechial hemorrhage and bruising
91
What are the causes of Immune-mediated thrombocytopenia?
Primary causes are idiopathic. Secondary:
1. Penicillin or ceftiofur administration
2. Lymphosarcoma
3. EIA or BVD infections
4. Alloimmune in foals
5. Autoimmune
92
A patient has thrombocytopenia and the platelet level is < 40,000/ul, what does this indicate?
Hemorrhage in response to trauma
93
A patient has thrombocytopenia and the platelet level <10,000/ul , what does this indicate?
Spontaneous bleeding
94
How is immune mediated thrombocytopenia diagnosed?
1. CBC- Platelet counts <100,000/u, mild anemia, and hypoproteinemia
2. Coagulation panel: prolonged bleeding time with normal PT, PTT and fibrinogen
3. Bone marrow biopsy: megakaryocytic and erythropoietin hyperplasia
4. Flow cytometry: Ig on platelet surface
95
What is the gold standard diagnosis for immune mediated thrombocytopenia?
Flow cytometry with Ig on platelet surfaces
96
What is the treatment for immune mediated thrombocytopenia?
1. Stop triggering medications and treat underlying disease
2. Immunosuppresion with corticosteroids ( dexmethasone/prednisone)
3. Blood transfusion
97
How long would you treat a horse with immune mediate thrombocytopenia with corticosteroids
10-21 days with a platelet count normal for at least 5 days
98
What would you see on a bone marrow biopsy with immune mediated hemolytic anemia?
Megakaryocytic and erythyroid hyperplasia...aka a regerative response
99
What infectious agents are likely to cause immune mediated thrombocytopenia in large animals?
1. Type II BVD in cattle
2. Equine infectious anemia in horses
3. Anaplasma phagocytophila in horses
4. Enzootic lymphosarcoma in cattle
100
What are the clinical signs of DIC?
1. Generalized thrombosis and/or hemorrhage
| 2. Multiple ischemia organ failure (MODS)
101
How is DIC diagnosed?
1. Thrombocytopenia
2. Prolonged PT, PTT, reduced fibrinogen and elevated D-Dimers
3. Clinical signs
Need 3 or more lab changes and C/ S to diagnose
102
What is the cornerstone of treatment for DIC?
manage/treat the underlying disease
103
Besides treating the underlying cause of DIC, what other treatments can be used?
1. IV fluid therapy
2. NSAIDS like flunixin meglumine
3. Heparin for At-III
4. Whole blood/plasma transfusions
104
What toxin is a common cause of DIC in large animals?
Moldy sweet clover
105
What is the toxic principle of moldy sweet clover?
Dicoumarol from improperly cured hay or silage
106
How does moldy sweet clover cause DIC?
The toxin is a vitamin K antagonist with interferes with production of factors II, VII, IX, and X
107
How is moldy sweet clover poisoning treated?
1. Stop feeding clover
2. Administer vitamin K1
3. Whole blood/plasma transfusion as required
108
What diseases in large animals are caused by RBC loss?
1. GP mycosis
2. Vena Caval Thrombosis
3. Jejunal Hemorrhage syndrome
4. Hemoperitoneum
5. Intestinal parasites
6. Abomasal ulcers
7. Hemophilia A
8. Purpura hemorrhagica
9. Equine anaplasmosis
10. EIA
11. IMTP
12. Moldy sweet clover poisoning
13. Warfarin toxicosis
109
Which diseases in large animals are associated with intravascular hemolysis?
1. Equine Piroplasmosis
2. Bovine Babesiosis
3. Bacillary hemoglobinuria
4. Leptospirosis
5. Heinz body anemia’s
6. Copper toxicity of ruminants
7. Water intoxicating of calves
8. Post-parturient hemoglobinura
110
What disease in large animals are associated with extravascular hemolysis?
1. Immune-Mediated hemolytic anemia
2. Equine infectious Anemia
3. Anaplasmosis in ruminants
4. Mycoplasma haemolame in camelids
111
What anemia in large animals are associated with decreased RBC production?
1. Depression anemia
| 2. Anemia of chronic disease
112
What are the causes of depression anemia in large animals?
1. Vitamin/mineral deficiency
2. Inflammatory chronic disease
3. Renal or hepatic failure
113
What vitamin/mineral deficiencies can cause depression anemia in large animals?
1. Iron
2. Copper
3. Cobalt (B12)
114
Hemoglobinemia and hemoglobinuria are associated with ________ hemolysis, while hyperbilirubinema is associated with ________ hemolysis.
Intravascular
Extravascular
115
What causes equine piroplasmosis and how is it transmitted?
1. Babesia caballi
2. Theileria equi
Both spread by tick vectors
116
What is the equine piroplasmosis infectious agent that is reportable?
Theileria equi
117
What are the clinical signs of equine piroplasmosis?
1. Fever
2. Obtunded
3. Anorexia
4. Incoordination
5. Nasal/ocular discharge
6. Hemoglobinemia/Uria
118
On blood smears, what is seen with babesia caballi versus theileria equi?
Large piroplasms with B. caballi and small piroplasms with T. Equi...the piroplasms are in RBC’s
119
How is Equine piroplasmosis treated?
Imidocarb
120
Which infectious agent that causes equine piroplasmosis is harder to clear and has more severe Clinical signs?
T. Equi
121
Wher does bovine babesiosis occur?
Not in the USA
122
What is the other name for bacillary hemoglobinura and what clinical signs are seen?
Red Water
1. Sudden death
2. Port wine urine form hemoglobinuria (intravascular hemolysis)
3. Fever
4. Bloody nasal/rectal distract 5. Palor/icterus
123
What causes bacillary hemoglobinuria?
Clostridium hemolyticum B toxin
124
What parasite is bacillary hemobloginuria associted with?
Faciola hepatica
125
How is bacillary hemoglobinuria treated?
1. Penicillin or oxytetracycline IV or IM
| 2. Blood transfusion
126
How is bacillary hemoglobinuria diagnosed?
1. Post Mortem with necrotic hepatic infarction with clostridium overgrowth
127
What are the clinical signs of leptospirosis infection in large animals?
1. Hemorrhage in the kidney, eyes, reproductive tract and lungs
2. Abortion
3. Uveitis
128
What two lepto serovars are associated with acute hemolytic syndrome?
1. L. Pomona
| 2. L. Icterohaemorrhagicae
129
What are the causes of Heinz body anemia?
1. Phenothiaine tranquilizers
2. Toxic plants
3. Selenium deficiency
130
What type of hemolysis does Heinz body anemia cause?
Intra and extravascular
131
What clinical signs are seen with Heinz body anemia?
1. Methemoglobinemia
| 2. Hemoglobinemia
132
What toxic plants can cause Heinz body anemia?
1. Red maple (equids)
2. Brassica spp.
3. Wild onion
133
What is the toxic principle of brassica and wild onion toxicity?
S-methylcysteine sulfoxide metabolize to dimethyl disulfide which causes RBC oxidation
134
How is Heinz body anemia treated?
1. Remove toxic source
2. Activated charcoal
3. Methylene blue in ruminants
4. Vitamins C
5. IV fluid therapy
6. Blood transfusion
7. Don’t give NSAIDS if kidney disease an can cause colic
135
Why would you want to be careful giving an NSAID in an animal with Heinz body anemia?
It can cause colic and kidney issues
136
What can cause primary copper toxicity in ruminants?
Excessive ingestion/injection of copper
137
What can cause secondary copper toxicity in ruminants?
1. Molybdenum deficiency
| 2. Hepatotoxic plants
138
Which large animal species is most susceptible to copper toxicity?
Sheep
139
How is copper toxicity diagnosed?
High serum and liver copper levels
140
If a sheep is in the acute hemolytic phase of copper toxicity, how it is diagnosed?
Non-regenerative anemia with high serum/liver copper levels
141
If a sheep is in the pre-hemolytic phase of chronic copper toxicosis, how it it diagnosed?
Elevate liver enzymes and high copper in liver biopsy
142
How is copper toxicity treated?
1. Measure copper levels in liver
2. Identify/ remove sources of copper
3. Supplement with zinc and iron and decrease molybdenum
143
A calf presents with serum hypo-osmolarity, mild anemia, and hemoglobinemia/nuria..what is likely going on?
Water intoxication
144
How does water intoxicating lead to clinical signs in calves?
Rapid ingestion of water causes osmotic lysis of RBC’s
145
A dairy cow presents with hypophosphatemia and hemoglobinemia/uria 1 month after calving..what is going on?
Post-parturient hemoglobinuria
146
What may post-parturient hemoglobinuria be associated with?
Copper and selenium deficiency
147
What can cause secondary immune mediated hemolytic anemia?
1. Penicillin
| 2. Lymphosarcoma
148
What are the clinical signs of immune mediated hemolytic anemia?
1. Fever
| 2. Tachycardia with pallor-anemia
149
How is immune mediated hemolytic anemia diagnosed?
1. Saline agglutination test
2. Direct Coomb’s test
3. Flow cytometry
150
How is immune mediated hemolytic anemia treated?
1. Treat underlying cause
2. Dexamethasone
3. Blood transfusion if needed
151
This disease is lifelong in horses, causes extravascular hemolysis, is transmitted via blood and is caused by a lentivirus...what is it?
Equine infectious anemia
152
How does a persistent infection of equine infectious anemia occur?
The virus persists in monocytes
153
T/F: Equine infectious anemia is reportable.
True
154
What are the c/s of equine infectious anemia?
1. Vasculitis
2. Glomerulonephritis
3. Hepatitis
4. Thrombocytopenia
5. Anemia in subacute to chronic cases
155
What is the difference between acute and chronic equine infectious anemia?
Acute occurs within 7-30 days while chronic is > 30 days. Acute has no anemia.
156
How is EIA diagnosed?
Coggins test with AGID and ELISA
157
When can EIA be diagnosed via a coggins test?
10 days post-infection (seroconversion)
158
What is the treatment for EIA?
None, must be euthanized or permanently quarantined
159
How do ruminants become infected with anaplasmosis?
The blood of carrier animals taken up by tick or flies
160
How does anaplasmosis in ruminants cause clinical signs?
Auto-antibody production leading to extravascular hemolysis
161
What are the different phases of anaplasmosis in ruminants ?
1. Acute
2. Convalescent
3. Chronic carrier
162
How is anaplasmosis in ruminants diagnosed (acute versus chronic phase) ?
1. Inclusion bodies in RBC’s on fresh blood smear (acute phase)
2. PCR
3. cELISA (chronic)
163
What are the clinical signs of an acute phase of anaplasmosis in ruminants?
1. Fever
2. Late term abortion
3. Severe anemia with no hemoglobinuria
164
What are the clinical signs of an chronic phase of anaplasmosis in ruminants?
1. Weight loss
| 2. Icterus
165
What age of ruminants will have more severe clinical signs when infected with anaplasmosis?
Older
166
Why does seroconversion not equal organism clearance with anaplasmosis?
The organism will no longer be visible in RBC’s but will still be in the animals body lifelong
167
How is anaplasmosis in ruminants treated?
1. Supportive
2. Blood transfusion
3. Oxytetracycline
168
A llama from Colorado presents with a moderate, poorly regenerative anemia, fever, and lethargy. There is evidence of extravascular hemolysis. What is the likely cause?
Mycoplasma haemolamae
169
How is mycoplasma haemolamae treated?
Oxytetracycline, but full cure unlikely
170
How is mycoplasma haemolamae diagnosed?
1. PCR
| 2. Fresh blood smear
171
How many RBC’s must be affected before clinical signs will be seen in acute anaplasmosis in ruminants?
> 1%
172
What is the most common form of anemia in large animals?
Depression Anemia
173
A ruminant presents with decreased serum iron and TIBC with normal bone marrow iron stores and ferritin levels. How would you treat?
You would NOT supplement with iron as this is anemia of chronic inflammation and this would cause there to be too much iron in the body due to the sequestration in the bone marrow.
174
What chronic disease syndromes can lead to depression anemia in large animals?
1. Liver abscess
2. GI abscess in small ruminants
3. Chronic pneumonia
4. Chronic BVDV
5. Johns disease
6. Neoplasia
175
What are tests you can use to measure B cell function in humoral immunity?
1. In vitro lymphocyte blastogenesis test
| 2. Response to a killed virus vaccine
176
How can immunoglobulin concentration be determined?
1. Total globulins by ELISA, ZNSO4, and RID or routine chem
| 2. Globulin fractions by protein electrophoresis
177
How can B cell concentrations in blood/lymphonodes be determined?
1. CBC w/ differential
2. Flow cytometry
3. HIstopathology
178
How can T cell function be tested in cell-mediated immunity?
1. In vitro lymphocyte blastogenesis test
| 2. Intradermal injection of phytohemagglutinin (PHA)
179
What are some clinical conditions in large animals that may indicate immunodeficiency?
1. 2 or more episodes of pneumonia in 1 year
2. Opportunistic organism infections
3. Multiple sites of infection
4. Recurrent pyodermatitis
5. Meningitis or osteomyelitis
6. 2 or more months on antibiotics with no effect
7. Failure to gain weight/grow normally
8. Recurrent infections with history or primary immune deficiency in blood line
180
What occurs if there is failure of passive transfer?
Inadequate humoral immunity
181
Why is passive transfer of IgG in colostrum and IgA in milk important?
The immune system is competetent but naive at birth and needs time for antigen processing and colonial expansion
182
How is failure of passive transfer treated?
Give colostrum within 3-4 hours of birth but no more than 24 hours. GIve plasma if it has been longer than 24 hours since birth.
183
What breed of horse is susceptible to sever combined immunodeficiency disease (SCID)?
Arabians
184
What occurs during severe combined immunodeficiency disease (SCID) that causes C/S?
Failure to produce function B and T lymphocytes due a autosomal recessive primary immunodeficiency
185
How does SCID progress in foals?
Normal for 2-3 months an then start to suffer from bronchopneumonia, enteritis, septic arthritis and/or omphalophlebitis. They die within 5 months.
186
How is SCID diagnosed?
1. Persistent lymphopenia <1000/ul on CBC
2. Low globulin concentrations ( IgM and IgG)
3. PHA intradermal test
4. Lymphoid/thymic hypoplasia at post-mortem
187
How is SCID treated/prevented?
No treatment, but prevented with genotypoing
188
An 8 month old foal presents with a history of chronic/recurrent infections and on serology, the persistence IgM levels are < 25 mg/DL...what disease is this?
Selective IgM deficiency
189
What type of immunity is deficient in selective IgM deficiency in horses?
Humoral due to a primary immunodeficiency
190
What age horses can be affected by selective IgM deficiency
All ages as there is juvenile (5 month to 2 years) onset and adult onset ( 2 to 5 years)
191
What is a common clinical presentation in a 3 year old horse with selective IgM deficiency?
1. Recurrent infections
| 2. Lymphosarcoma
192
How is selective IgM deficiency in horses treated?
1. Antibiotics and other supportive treatment
2. Plasma transfusions for IgM transfer
Prognosis is poor to grave
193
How would you distinguish common variable immunodeficiency (CVID) and Slective IgM deficiency in horses?
The main difference is in CVID, the IgM will be , 25mg/dL AND the IgG will be depleted eventually reaching <200mg/dL
194
A horse presents to you with variable lymphopenia, B cell depletion in bone marrow/lymphoid tissue, and has a lack of response to vaccination with tetanus toxoid due to low IgM and IgG levels and has recurrent fungal infections...what disease is this?
Common variable immunodeficiency of Horses (CVID)
195
How is CVID treated?
Supportive care and antibiotics short term, but long term prognosis is grave
196
Name the disease: A primary immunodeficiency of the innate immune system due to an autosomal recessive gene inherited in Holstein cattle.
Bovine leukocyte adhesion deficiency (BLAD)
197
Which cell is not able to migrate out of the vasculature in response to cytokines in a cow with bovine leukocyte adhesion deficiency?
Neutrophils
198
Wht are the 4 forms of bovine lymphoma?
1. Juvenile (calf)
2. Thymic (adolescent)
3. Cutaneous
4. Enzootic
199
At what age are cattle when they suffer from juvenile LSA?
< 1 year, usually between 3-6 months
200
Which two forms of bovine lymphoma have similiar clinical presentations?
1. Juvenile (calf) LSA
| 2. Enzootic
201
What are common clinical signs of juvenile and enzootic bovine lymphoma?
1. Symmetrical generalized lymphadenopathy
2. Poor growth/ Weight loss
3. Moderate anemia from bone marrow infiltration
202
What is the age of onset for thymic LSA?
6-24 months
203
What are the clinical signs of thymic LSA?
1. Dysphasia from esophageal compression
2. Dyspnea/cough from tracheal compression
3. CV insufficiency from blood vessels contraction
204
What causes clinical signs in Thymic bovine LSA?
Space occupying mass at the base of neck and cranial thorax ( thymus tumor)
205
What age cattle are infected with cutaneous bovine lymphoma?
1-3 years
206
Describe the type of tumor seen on cattle with cutaneous LSA..
2-3 cm w/ necrotic center that are raised, circular and ulcerated affecting the skin and very painful, tend to wax and wane and can spread to other organ systems
207
What virus is associated with Enzootic bovine lymphoma?
Bovine leukosis virus (BLV)
208
What is the age of onset for enzootic Bovine LSA?
> 2 years, most orient > 4 years
209
Why is enzootic bovine LSA not a huge problem for producers?
The majority of cattle infected are asymptomatic and there is no difference in economic performance
210
How is enzootic bovine LSA commonly transmitted?
1. Horizontal: Iatrogenic from reused needles/instruments
| 2. Vertical: Ingestions of infected milk/colostrum
211
What type of immune response does a BLV infection stimulate and why can it lead to enzootic bovine LSA?
Humoral response with antibodies that do not clear the infection
212
What percentage of cattle will develop persistent lympocytosis with a BLV infection? Enzootic LSA?
30%
1-5%
213
What 7 common organs can enzootic LSA infect in cattle?
1. Peripheral lymph nodes
2. Retrobulbar lymph nodes
3. Heart
4. Uterus
5. Abomasum
6. Spleen/kidney
7. Lumbar spinal cord
214
How is enzootic LSA diagnosed?
Demonstration of neoplasticism cells on cytology/histopathology of a biopsy/FNA/fluid sample
215
T/F: A diagnosis of BLV = a diagnosis of LSA.
False
216
What does a positive results on a AGID test for enzootic LSA tell you?
Confirms an infection of BLV, but not LSA
217
How is enzootic LSA treated?
1. L-asparaginase
| 2. Dexamethasone
218
How can enzootic LSA be prevented?
Since there are no BLV vaccines available, you must ID seropositive cattle and cull them. Minimizing iatrogenic transmission is helpful.
219
What are the types of equine lymphoma?
1. Alimentary
2. Thymic/mediastinal
3. Multi centric
4. Cutaneous
220
What is the most common primary tumor of horses?
Lymphoma, specifically the sarcomatous forms
221
What is the etiology of equine lymphoma?
Unknown, but it is sporadic
222
What is the average age a horse can develop lymphosarcoma?
5-10 years , except alimentary form less than 5 years (16 year average)
223
What parts of the horses body are commonly infiltrated with alimentary lymphosarcoma?
1. Small intestine
| 2. Intestinal and hepatic lymph nodes
224
What are the clinical signs of alimentary lymphosarcoma in horses?
1. Emancipated w/ good appetite
2. Recurrent colic
3. No peripheral lymphadenopathy
225
How is alimentary lymphosarcom in horses diagnosed?
1. Hypoalbuminemia on chem panel
| 2. Low glucose absorption test from intestinal malabsorption
226
What are the clinical signs of thymic/mediastinal lymphosarcoma in horses?
1. Respiratory signs like labored breathing
2. Ventral edema
3. Pleural effusion
4. Lymphadenopathy
227
How is thymic/mediastinal lymphosarcoma diagnosed?
1. U/S
| 2. Cytology of pleural fluid
228
What are the clinical signs of multi centric equine lymphosarcoma?
1. Emaciation
2. Severe depression
3. Lymphadenopathy
4. Anemia/leukemia
5. Organ dysfunction
229
What are the clinical signs of cutaneous lymphosarcoma?
1. Multiple SQ nodules that appear suddenly, then regress
| 2. Local LN involvement
230
How is equine lymphoma treated?
1. Corticosteroids for immune suppression
2. Chemotherapy
3. Supportive
231
What is the most common cause of acute hepatitis and failure in horses?
Idiopathic acute hepatitis (IAH)
232
What can cause idiopathic acute hepatitis in 20% of cases?
1. Equine serum products
| 2. Tetanus antitoxin
233
When will idiopathic acute hepatitis in horses typically manifest as disease?
4-10 weeks after administration of a biologic
234
What age and type of horse typically develop IAH?
1. > 2 years
| 2. Lactating mares 1-3 months post foaling
235
What are the clinical signs of equine IAH?
Acute progressive hepatic failure over 2-7 days with:
1. Jaundice
2. Photosensitization
3. Yawning with hepatic encephalopathy
4. Intravascular hemolysis
5. DIC
236
What viruses are associted with IAH?
1. Theiler’s disease flavivirus
| 2. Equine parvovirus
237
What is typically found on blood chemistry with IAH?
1. Elevated bilirubin
2. Elevated SDH, AST, GGT, and ALP
3. Low BUN and glucose
238
What will liver function tests looks like in a horse with IAH?
1. High bile acids
| 2. High ammonia
239
What can be used to diagnose IAH in a horse besides blood chemistry?
1. U/S
2. Biopsy/histo
3. Post mortem exam
240
What is seen on ultrasound in a horse with IAH?
Decreased parenchyma echogenicity and heterogenous
241
What is seen on biopsy/histo of a horse with IAH?
Diffuse necrosis and biliary hyperplasia ( are not very helpful)
242
What is see post-mortem in a horse with IAH?
Enlarged, pale, diffusely mottled liver OR
| Small “dishrag” LIver
243
How would you treat a horse with IAH?
1. IV dextrose and electrolytes
2. Plasma transfusion
3. Liver support drugs/ammonia reduction
244
What is the prognosis for IAH?
90% mortality, deat in 5 days or recovery in 7-10 that may not be complete..very expensive to treat
245
How an IAH be prevented in horses?
1. Give the toxoid for tetanus instead of antitoxin
2. Routine tetanus prophylaxis
3. Screen horses on property for subclinical infection
246
What is the cause of Tyzzer’s disease and what species does this affect?
Clostridium piliforme in foals
247
What does Tyzzer’s disease cause?
Acute and highly fatal bacterial hepatitis
248
How do horses become infected with Tyzzer’s disease?
It is sporadic and not contagious, but it is shed by healthy mares who are resistant
249
What are the clinical signs of tyzzer’s Disease?
1. Sudden death at 7-42 days old
2. Fever
3. Icterus
4. Seizures
250
What is the prognosis of Tyzzer’s disease?
Grave because fatal in 48 hours
251
How is tyzzer’s disease treated?
High dose penicillin and gentamicin with support
252
How is Tyzzer’s disease diagnosed?
Necropsy with mutlifocal hepatic necrosis and intracytoplasmic bacteria. Can also use PCR or fluorescent antibody
253
What is Black’s disease and what species are affected?
Infectious Necrotic hepatitis that infects small ruminants
254
What is the cause of Infectious necrotic hepatitis (INH)
Clostridium novi type B toxins
255
Why is infectious necrotic hepatitis called Black’s disease?
The clostridium toxin ruptures SQ vessels and causes dark skin
256
What parasite is associated with INH? Why?
Faciola Hepatica or magna..or a liver biopsy. The liver fluke cause hepatic damage and sets up for a clostridium infection.
257
How do small ruminants become infected with clostridium that causes infectious necrotic hepatitis?
Spores are found in the soil, bowel and liver of grazing animals that are consumed and then disseminated in the respiratory system to the liver
258
What are the clinical signs of infectious necrotic hepatitis?
1. Sudden death in late summer/early fall
2. Fever
3. Anorexia
4. Depression
5. Separation from the herd
259
What is a differential diagnosis for Tyzzer’s disease?
Equine Herpes virus
260
What is a differential diagnosis for infectious necrotic hepatitis?
Anthrax
261
How Is infectious necrotic hepatitis (INH) diagnosed?
1. Necropsy
2. Gram stain liver impression smears
3. Fluorescent antibody on impression smears
4. Specific exotoxins identification
262
What is the definite diagnosis of infectious necrotic hepatitis and why is it not used often?
Specific exotoxin identification, but not practical in the field
263
What is seen on necropsy in small ruminants that died of INH?
1. SQ hemorrhage
2. Blood tinged body cavity fluids
3. Swollen/congested liver with focal coagulative necrosis and fluke migration tracts
264
How do you treat INH in small ruminants?
Not usually indicated, but
1. Penicillin
2. Oxytetracycline
265
How is INH prevented in a flock?
1. Vaccinate
2. Mass administration of long acting antibiotics if herd member dies from it
3. Burn/bury/remove carcasses
4. Reduce fluke infestation
5. Commercial bacteria/toxoids
266
When vaccinating a herd against INH, what do you use and how should it be timed?
A commercial bacteria/toxoid that will have a 5-6 month effect and should be timed with fluke season with 2 injections 5 months apart in mild climates and 1 injection in harsh climates
267
What cause Bacillary hemoglobinuria?
Clostridium novyi Type D toxin
268
What are the clinical signs of bacillary hemoglobinura?
1. Sudden death
2. Fever
3. icterus
4. Blood nasal discharge/feces
5. Hemoglobinuria uncommon
269
What does bacillary hemoglobinuria do to the liver?
Causes localized hepatic necrosis
270
How is bacillary hemoglobinuria diagnosed?
1. Post mortem necropsy 2. History of animal from endemic area
3. Gram stain impression smears
4. Fluorescent AB on impression smears
5. Histopathology
271
What is seen on necropsy in a animals that died from red water?
1. Advanced decomposition
2. Bloody oriifices
3. Hemorrhage in SQ, serosa
4. Coagulative necrosis in liver
272
How is red water treated?
1. Supportive
| 2. Blood transfusion for intravascular hemolytic anemia
273
How is bacillary hemoglobinemia prevented?
1. Remove carcasses
2. Administer commercial bacteria/toxoid vaccines for 5-6 month protection
3. Control liver flukes
274
What is the pathophysiology of red water similiar to?
Infectious Necrotic Hepatitis
275
In what species are liver abscess most likely to occur in ? Why?
Cattle
Erosions of rumen epithelium from high energy diets inducing lactic acidosis
276
What bacteria is associated with liver abscess formation in Cattle?
F. Necrophorum
277
How do neonates typically form a liver abscess?
Extension of an umbilical infection
278
What concurrent disease and infectious agent puts goats at a higher risk for developing a liver abscess?
Caseous lymphadentitis
C. Pseudotuberculosis
279
What are the clinical signs of a liver abscess that span all species?
1. Weight loss
| 2. Fever
280
What are some differentials for a liver abscess in cattle?
1. Reticuloperitonitis
2. Parasitism
3. Malnutrition
4. Lymphosarcoma
5. Johne’s
281
What are some differentials for a liver abscess in horses?
Why?
1. Abdominal abscess
2. Cholelithiasis
They have intermittent colic
282
What are the primary complications that can arise from a liver abscess, especially in cattle?
1. Caudal vena cava thrombosis
2. Common bile duct compression
3. Peritonitis
283
How are liver abscesses in cattle diagnosed?
High risk feed ration ( high grain/limited forage and no adjustment period)
284
What will be seen on CBC and chem panel with a liver abscess?
1. Neutrophilia
2. Anemia
3. Elevated GGT and AST
285
T/F: You should biopsy a liver abscess.
False
286
How are liver abscesses treated?
1. Penicillin or ampicillin combined with rifampin
2. Metronidazole
But diagnosis usually made post-mortem
287
How can liver abscesses be prevented?
1. Adjust grain/feed change over 3-4 weeks
2. Feed a good fiber source
3. Administer approved feedlot antibiotics
288
Describe a good fiber source for cattle to prevent liver abscesses?
> 19 cm in length with 1kg/head/day with lactating diary cows recieving a 45: 55 roughage to concentrate diet and 2.3kg stem hay/day
289
What are some feedlot approved antibiotics that can be used to prevent liver abscesses in cattle ?
1. Bacitracin
2. Chlor or oxy tetracycline
3. Tylosin
4. Virginiamycin
5. Leukotoxin based F. Necrophorum vaccine
290
What are the clinical signs of chronic active hepatitis (CAH)?
1. Weight loss
2. Icterus
3. Depression
4. Behavior changes
5. Mild colic
6. Intermittent fever
7. Aseptic vasculitis (rare)
291
What is the liver enzyme profile in a large animals with chronic active hepatitis?
1. Marked increase in ALP and GGT
2. Mild increase in AST and SDH
3. Increased serum bile acids and conjugated bilirubin
292
When performing histopath on a liver biopsy in a horse with chronic active hepatitis, what will you see?
1. Mononuclear cell infiltration
2. Neutrophils is bacterial infection
3. Biliary hyperplasia
4. Hepatocellular necrosis
293
What diagnostics should be done to a liver biopsy in an animal with chronic active hepatitis?
1. Culture
| 2. Histopath
294
How is chronic active hepatitis treated?
1. Antibiotics if there is an infection for 4-6 weeks
| 2. Corticosteroids if there is lymphocytic plasmacytic infiltration
295
What antibiotics are used to treat chronic active hepatitis in large animals?
Antibiotics for enteric bacteria:
1. Ampicillin
2. Chloramphenicol
3. Penicillin + gentimicin
4. TMS
296
What corticosteriods can be used to treat large animals with chronic active hepatitis?
1. Prednisolone: better for longer treatment and higher doses
2. Dexamethasone: more potent, so better for short term and low doses
297
What is suppurative cholangiohepatitis?
Neutrophil accumulation within hepatic portal tracts and bile ducts
298
What is the sequelae to suppuratic cholangiohepatitis?
1. Cholelithiasis
2. Loss of hepatic function
3. Chronic active hepatitis
299
What are the clinical signs of suppurative cholangiohepatitis
1. Fever
2. Colic
3. Icterus
4. Weight loss
300
What liver enzyme is elevated on blood chemistry with cholangiohepatitis?
GGT
301
How is cholangiohepatitis diagnosed?
1. Elevated GGT
2. Elevated conjugated bilirubin
3. Inflammatory CBC
4. U/S
3. Biopsy
302
What is seen on U/S with cholangiohepatitis?
1. Diffuse increase in echogenicity
2. Hepatomegaly
3. Mild biliary distension/biliary wall thickening
303
What does a biopsy determine in a patient with cholangiohepatitis? What is seen on a biopsy?
Determines the severity of disease and degree of fibrosis
1. Nuetrophilic infiltrate
2. Hepatocyte nerosis
304
What bacteria are commonly cultured on a liver biopsy in a patient with cholangiohepatitis?
1. Salmonella
2. E.coli
3. Citrobacter
4. Aeromonas
5. Acinetobacter
305
How is cholangiohepatitis treated?
1. Antiobiotics for 4-6 weeks
| 2. Monitor liver enzymes serially
306
What antibiotics should you use to treat cholangiohepatitis?
Gram - and anaerobe effective:
1. TMS
2. Penicillin+gentimicin
3. Chloramphenicol
4. Enrofloxacin
5. Ceftiofur
307
What is cholelithiasis?
Stones in the left/right bile ducts or gallbladder
308
What is choledocholithiasis?
Stones in the common bile duct
309
What is hepatolithiasis?
Stones in the intrahepatic bile ducts
310
What large animal species tends to become clinical with cholelithiasis?
Horses
311
What is the most common cause of biliary obstruction in large animals?
Choledocholithiasis
312
What can cause acute biliary obstruction in horses and what will you see on blood chemistry?
Colonic displacements
Elevated GGT, bilirubin, serum bile acids and ammonia
313
What is the most likely reason for cholelithiasis?
Ascending inflammation or infection
314
What are equine bile stones made out of?
1. Bile salts
2. Calcium bilirubinate
3. Cholesterol
315
What is the triad of clinical signs in a horse with cholelithiasis?
1. Intermittent colic
2. Fever
3. Icterus
316
What age horse is most predisposed to cholelithiasis?
> 5 years
317
What would indicated that a horse with cholelithiasis has multiple stones or that the bile duct is completley occluded?
1. Photosensitization
2. Encephalopathy
3. Weight loss
4. Icterus (bile duct)
5. Coli (bile duct)
318
How is cholelithiasis diagnosed?
1. Elevated GGT, ALP, and bilirubin
2. U/S: hepatomegaly, dilation/thickening bile ducts, diffuse echogenicity, choleliths
3. Triad of clinical signs
319
On U/S, where is it most likely you will see choleliths?
Cranioventral right hepatic lobe between the 7-10th ICS
320
How accurate is diagnosis of cholelithiasis with U/S?
50-75%
321
What are differential diagnosis of cholelithiasis?
1. Chronic liver disease (other forms)
| 2. Causes of mild recurrent colic like verminous arteritis, internal abscesses, enteroliths, and neoplasia
322
How is cholelithiasis treated?
1. Long term antibiotics and anti-inflammatories
323
When is surgery indicated for cholelithiasis? What surgeries?
When there is choledocholithiasis..
1. Choledocholithotripsy
2. Choledochotomy
324
Which organ in te body is the first to encounter toxins?
Liver
325
What types of toxins are more problematic in cattle and sheep?
Chemical
326
What drugs can cause liver toxicity in horses?
1. Erythromycin
2. Rifampin
3. Diazepam
4. Sulfonamides
5. Aspirin
327
What do mycotoxins cause in the liver?
Megalocytosis
328
In what large animal species are mycotoxins more problematic and why?
Ruminants because they accept moldy feed
329
What toxin causes chronic megalocytic hepatopathy and chronic, delayed hepatic failure?
Pyrrolizidine alkaloid containing plants
330
How does pyrrolizidine toxicity occur when it is unpalatable?
If forage is sparse and animals are hungry, dried plants can get into hay/silage, seeds can be includes in the ration
331
What is the lethal dose of pyrrolizidine alkaloids?
200-250mg/kg BW
332
What species are resistant to pyrrolizidine alkaloids?
Goats and sheep
333
What common plants contain pyrrolizidine alkaloids?
1. Ragwort
2. Salvation jane
3. Common heliotrope
4. Lantana
334
How does pyrrolizidine alkaloids cause liver failure?
The toxic pyrroles crosslink double-stranded DNA blocking hepatocytes from dividing leading to chronic megalocytic hepatopathy. This change causes hepatocellular death which are replaced with connective tissue distrupting bloow flow and regeneration.
335
What are the clinical signs of pyrrolizidine alkaloid toxicity in horses? Cattle?
1. Weight loss
2. Icterus
3. Hepatic encephalopathy
4. Abortion
5. Photosensitization
6. Diarrhea
1. Diarrhea
2. Weight loss
3. Tenesmus
4. Proapsed rectum
5. Ascites
336
Pyrrolizidine alkaloid toxicity is chronic and subclinical until an acute presentation of hepatic failure with photosensitization and hepatic encephalopathy occurs..why does this all of a sudden occur?
Loss of hepatic mass reaches a critical threshold
337
What is a poor prognostic indicator in horses with pyrrolizidine toxicosis?
Bile acids > 50 umol/L
338
What do hepatic enzymes look like with pyrrolizidine toxicosis?
1. Elevated SDH, LDH< and FLDH if hepatocyte destruction occuring, will be normal if damage has been done
2. Elevated GGT and ALP
339
How can pyrrolizidine toxicosis be differentiated from other liver disease with a liver biopsy?
Megalocytosis with biliary hyperplasia and peri-portal fibrosis
340
What will a liver look like that has been damaged by pyrrolizidine alkaloids?
Small, firm and discolored
341
How is pyrrolizidine toxicosis treated?
1. Supportive with control of the hepatic encephalopathy
| 2. Low protein, high energy diet
342
What is the prognosis of pyrrolizidine toxicosis ?
If substantial fibrosis present (bridging), death will occur in 5-10 days once signs of liver failure start. If a horse retains appetite, they may recover. Can serial measure liver enzymes and bile acids to prognosticate.
343
How is pyrrolizidine toxicosis prevented?
1. Check dried feed
2. Adequate feed to pastured animals
3. Graze sheep on infested pasture
344
How could you treat abnormal behavior in a large animal suffering from hepatic disease?
1. Sedation: Low dose alpha 2's
2. Reduce ammonia production/absorption
3. Analgesia
4. Treat cerebral edema
5. Treat acute hypoglycemia
345
Why should you not use diazepam in large animals with hepatic disease?
Exacerbates hepatic encephalopathy through action on GAB, duration of action too short, and worsens ataxia
346
What are poor prognostic indicators in large animals with hepatic disease?
1. Hemolysis
2. Hepatic encephalopathy
3. Severe metobolic acidosis
4. Diarrhea
5. Bridging necrosis/fibrosis on biopsy
6. High serum bile acids
7. Long PT
8. Low albumin
347
Which large animal liver diseases involve supportive therapy as the main treatment and if there is no evidence of severe chronic changes/fibrosis, have a good prognosis?
1. Theilers
| 2. Cholangiohepatitis
348
What can ben used to reduce blood ammonia in large animals with liver disease?
```
1. acetic acid
2 lactulose
3. Oral neomycin
4. Metronidazole
5. Mineral oil
6. MgSO4
```
349
T/F: You can combine mineral oil and MgSO2 when reducing blood ammonia.
FALSE
350
Why is giving continuous IV fluids with 5% dextrose a good idea for liver disease patients?
1. Decrease effort/energy spend on gluconeogenesis
2. Decrease blood ammonia
3. Address dehydration/shock
4. Improve bile flow
351
When should metabolic acidosis be treated and how?
If pH is < 7.1 and use alkalinizing IV fluid like lactated ringers. If they doesn't work, use NAHCO2 (bicarb)
352
Why do animals with liver disease sometimes develop hypokalemia and how does this contribute to increased serum ammonia levels?
The anorexia decreases potassium intake. The low potassium increases production and absorption of ammonia from the kidney and enhances intracellular movement of ammonia.
353
What antioxidants can be used for therapy in hepatic disease patients?
1. DMSO: cholelith destruction
2. Mannitol: cerebral edema
3. Vitamin E
354
What anti-inflammatory can be given to hepatic disease large animal patients?
Banamine
355
What is pergolide?
A medication used to treat hyperlipemic ponies with pituitary tumors
356
What vitamins can you consider giving paraenterally on a weekly basis in hepatic disease large animal patients?
why would you give these?
1. B1
2. Folic acid
3. A
4. D
5. E
6. K1
Given is cholestasis limits their uptake
357
What medications may decrease hepatic fibrosis?
1. Colchicine
2. Cyclosporine
3. Pentoxyfilline
358
What herbs/alternative medicine can be used to treat hepatic disease?
1. SAME
2. Milk thistle
3. Acupuncture
359
What type of diet should large animal hepatic disease patients receive?
High carbohydrate and moderate protein rich in branched chain amino acids that is fed frequently in small portions.
Oat and grass hay best or 2 parts beet pulp: 1 part cracked corn in molasses
360
What are some proteins that are rich in branched chain amino acids?
Sorghum, milo, beet pulp and bran have leucine, valine and isoleucine
361
What diets should be avoided in large animals with hepatic disease?
High protein like alfalfa, legumes, spring grasses because can exacerbate signs of hepatic encephalopathy due to conversion of urea to ammonia.
362
What large animal species are suceptible to hyperlipemia/hyperlipidemia?
Ponies,
Donkeys,
Mini horses
363
How is hyperlipidemia/hyperlipemia caused?
A sudden drop of carbs in the diets either by starvation, anorexia, stress, weight loss or lactation leading to fat mobilization with hepatic accumulation
364
What is the difference between hyperlipidemia and hyperlipemia?
Hyperlipidemia is reversible with triglycerides still less than 500mg/dL and no evidence of hepatic dysfunction whereas, hyperlipemia has triglycerides above 500, there are severe dysfunctional signs along with insulin resistant hyperglycemia and a high mortality.
365
How is hyperlipidemia reversible?
If caloric intake is increased, fat will not be mobilized and stored in the liver.
366
Why are azotemic animals more likely to acquire hyperlipidemia?
Lipid removal from the blood is inhibited due to the inhibition of lipoprotein lipase
367
A minature horse presents with anorexia, depression, diarrhea, and a white coating of tongue, azotemia and myopathy. Triclyceride levels are over 500 ug/dL..what disease is this?
Hyperlipemia
368
Why do large animals die from hyperlipemia?
1. Metabolic dysfunction
2. Liver rupture---> hemoabdomen
3. Laminitis
4. Lipid in liver, kidney, heart and skeletal muscle causing dysfunction
369
How is hyperlipemia diagnosed?
1. >500mg/dl triglycerides
2. White/yellow plasma
3. Elevated bilirubin
4. High TP on refractometer
5. U/S: Hepatomegaly/increased echogenicity/loss of architecture
6. Don't need a biopsy
370
How is hyperlipemia treated?
1. Correct primary disease to alleviate anorexia
2. Give palatable feeds in tube with IV dextrose 5%
3. Insulin
4. Wean foals
371
A ewe is in the final 2 weeks of gestation and presents with anorexia, weakness and depression, appears to be blind and is star gazing with tremors and ataxia. What diseases could this be?
1. Pregnancy toxemia
2. Mastitis
3. Hypocalcemia
4. Polioencephalomalacia
5. Enterotoxemia type D
6. Toxicosis
372
How is pregnancy toxemia diagnosed?
1. Hypokalemia
2. Hypocalcemia
3. Ketonuria
4. Metabolic acidosis
5. Elevated free fatty acids
6. Friable and fatty liver on necropsy
373
What large animals can suffer from pregnancy toxemia?
Ewes with more than 1 fetus and does with 3 or more fetuses in the 3rd trimester or if they are underconditioned
374
How does pregnancy toxemia occur?
The ewe/doe is unable to meet energy demands with rapid fetal growth and inadequate caloric intake
375
How is pregnancy toxemia treated?
1. Caesarian section/induce parturition with dexamethasone or PGF2
2. Continuous infusion of glucose
3. B vitamins
4. Transfaunation
5. Glucose precursors like propylene glycol
376
How is pregnancy toxemia prevented?
1. Provide excellent quality forage
2. Fetal sorting at day 45 to make sure ewe/does with more than 1/2 fetuses get the proper nutrition
3. Serial measurement of plasma BHB to asses nutritional adequacy
377
What is fat cow syndrome?
Mobilizaton of fat to liver of post parturient dairy cows stimulated by negative energy balance and hormonal changes of parturition
378
What are the clinical signs of fat cow syndrome?
Over-conditioned cow after calving has anorexia, weight loss, and depression of rumen motility and lactation
379
How is fat how syndrome diagnosed?
1. Ketonuria
2. Normal liver enzymes
3. Hypoglycemia (maybe)
4. Liver biopsy isn't helpful as lipidosis is present in normal post-parturient cows without disease
380
What percentage of liver fat values on a liver biopsy correlates to clinical signs in fat cow syndrome?
>34%
381
How is fat cow syndrome treated?
It has a 25% mortality, so you have to treat predisposing disease and address the negative energy balance and lipidosis
382
How is fat cow syndrome prevented?
1. Prevent obesity in late lactation with a 12-13 month calving interval with make changes before the dry period
2. Adequate protein in the dry period with good quality roughage with added grain 2-4 weeks prior to calving
383
What is the lancet fluke and where do adults reside/shed eggs and what does this cause?
Dicrocoelium dendriticum
| Bile ducts where is causes inflammation, cirrhosis, and hepatic insufficiency
384
What part of dicrocoelium infects the definitive host (goats, sheeps, and cattle) ?
Metacercariae in ants
385
What are the clinical signs of a dicrocoelium parasitism?
1. Weight loss
2. Depression
3. Anemia
4. Hypoproteinemia
5. Submandibular edema
386
How is dicrocoelium, faciola hepatic, and fascioloides magna diagnosed and treated?
1. Fecal sedimination exam
| 2 Albendazole
387
What are the set of differential diagnosis for a Dicrocoelium parasitism?
1. Chronic fascioliasis
2. GI helminthiasis
3. Johnes
388
What is the difference between fascioloides magna and fasciola hepatica?
Fascioloides magna occurs in greater numbers, has a broader geographic distribution, and is a variety of snail hosts.
389
How is the disease caused by fascioloides magna different in cattle versus sheep/goats?
Cattle: It is a dead end host where it rapidly gets encapsulated and only causes condemnation of the liver, but not real significant clinical signs.
Sheep/goats: Unlimited migration that can cause severe hepatic insufficiency
390
When does fasciola hepatica occur and where?
In late fall/winter in habitats that are wet for >6 months and >50F...it is very climate sensitive
391
What are the three syndromes fasciola hepatica can cause?
1. Subclinical disease and production loss
2. Anemia, ill thrift, and hepatic dysfunction
3. Acute illness and sudden death from Clostridium novyi and haemolyticum
392
What are the clinical signs of a cow with subclinical fasciola hepatica disease?
1. Reduced weight gain, feed efficiency, and lactation
| 2. Anemia, hypoproteinemia, bottle jaw
393
How is depression anemia and biliary hyperplasia caused by fasciola hepatica?
The flukes produce proline which causes the anemia and hyperplasia
394
How long do fasciola hepatica flukes survive and when does the body amount an immune response to them?
They survive more than 12 months, but an immune response occurs 5-6 months post infection
395
What species is most susceptible to fasciola hepatic disease? Why?
Sheep and goats
| Fluke entry to bile ducts can be fatal
396
What are the clinical signs of a bile ducts being invaded by liver flukes in sheep and goats?
1. Ascites (acute and chronic)
2. Hemoabdomen (acute)
3. Pallor (acute)
4. Icterus (acute)
5. Edema (chronic)
6. Emaciation (chronic)
397
What is seen on a blood chem and CBC in an ruminant with fasciola hepatica infection?
1. Depression anemia
2. Hypoproteinemia
3. Mild eosinophilia
4. Elevated hepatic enzymes
398
How do you distinguish fasciola hepatica from paramphistomum?
1. If albendazole doesn't kill off the adult liver flukes and some are still seen on sedimination, it is paramphistomum.
2. Paramphistomum has smaller, grey eggs
3. Necropsy
399
What medication can kill juvenile >6month fasciola hepatica?
High dose clorsulon
400
What disease that kills fasciola hepatica adults can only be used in lactating animals?
Albendazole
401
How should treatment for fasciola hepatica be timed?
Treat when flukes are older than 12 months after the transmission season ends and remove treatment while they are < 6 months old
402
What are common clinical signs signs that are very suggestive of liver disease in large animals?
1. Icterus
2. Hepatic encephalopathy
3. Secondary Photosensitization
403
What leakage enzymes in large animals indicate possible liver damage? Which are most commonly measured?
1. AST ( most common)
2. SDH (most common)
3. ALT
4. GLDH
5. LDH 5
404
If unconjugated bilirubin is increased in the plasma, what might this indicate?
1. Hemolysis
2. Decreased uptake into hepatocytes
3. Disturbed intracellular protein binding/conjugation
405
If conjugated bilirubin is high in blood serum, what might this indicate?
1. Disturbed secretion of conjugated bilirubin in canaliculi
2. Intra or extra hepatic bile obstruction
406
What can cause hypoglycemia in horses?
1. Liver failure
2. Strangulating colic w/ sepsis
3. Sepsis in foals
4. Paraneoplastic
5. Iatrogenic (insulin)
407
What are differentials for hepatic encephalopathy?
1. GI associated hyperammonemia (colic/colitis)
2. Trauma
3. Rabies
4. Viral encephalomyelitis
5. Leukoencephalomalacia
6. Brain abscess
7. Equine protozoal myelitis
8. Botulism
9. Heavy metal toxicity
408
In which species is hypoalbuminemia uncommon with hepatic disease?
Horses
409
What is sorbitol dehydrogenase (SDH) sensitive for?
Acute hepatocellular damage
410
Measuring ALP is heplful in _______, but not _________.
Horses; ruminants
411
What liver enzyme increases in young racehorses in training for unknown reasons?
GGT
412
What can GGT refelct?
1.
