Reproduction, Neonates & Geriatrics Flashcards
Common bacterial isolates in neonatal sepsis
Staphylococcus
Streptococcus
E. coli
Klebsiella
Enterobacter
Salmonella
Clostridium
Pharmacological considerations in neonates
- decreased renal excretion and hepatic metabolism
- Avoid oral administration
- Intestinal flora very sensitive to antimicrobials
- BBB more permeable
- Rely on HR to maintain CO so avoid cardio depressant drugs
- Opiods good as reversible
- Avoid hep saline
Antimicrobials preferred for neonates
b-lactams (12 hourly not 8 hourly)
Metronidazole for giardiasis and anaerobic infections
Normal MAP of 1 month old puppy or kitten
49mmHg
Most accurate method to monitor overhydration and underhydration
Body weight
(Can use PCV/TS)
- Skin turgor not effective measurement
Lactate is ______ in neonates
Higher
What is considered hypothermia for puppies and kittens
25.6-34.4
Fluid resuscitation in moderately dehydrated/hypovolaemic neonatal patients
30-40ml/kg bolus
CRI 80-100mL/kg/day
Preferred fluid for neonates and why
LRS - utilise lactate for metabolic fuel particularly if hypoglycaemic
Why does hypoglycaemia occur in neonates
Poor hepatic gluconeogenesis
Inadequate hepatic glycogen stores
Glucosuria
Inefficient counter-regulatory hormone release (clinical signs harder to identify)
Treatment of hypoglycaemia in neonates
1-3mL/kg 50% glucose (1:3 = 12.5%), repeat as required
CRI 2.5-10% through central line
Carnitine 200-300mg/kg PO q24 (max. glucose utilisation)
Autonomic NS doesn’t mature until what age in neonates?
8 weeks
Normal weight gain for neonates
Should double their weight in first 10 days
5-10% BW gain each day
- may be slower in formula fed neonates
- should weigh multiple times daily
- can lose 10% BW in first 24h after birth
Normal HR of neonates
Puppies 200
Kittens 250
Normal temperature of neonates
35.2-37.0 by week 4
True or false: puppies and kittens can have an innocent murmur <12 weeks of age
True`
Why do neonates have higher fluid requirements compared to adults?
Higher body water % compared to body fat
Increased metabolic rate
decreased renal concentrating
Neonatal resuscitation in the neonate should include which of the following?
a. Gentle suction with a suction bulb
b. Doxapram administration
c. Swinging the neonate in a nose-down orientation
d. Calcium gluconate administration
A
Which of the following is true regarding eclampsia?
a. Bitches carrying large litters should be supplemented with calcium through gestation
b. It is most common in giant breeds due to large numbers of large feti
c. Clinical signs include tetany, hyperthermia, ataxia, and muscle tremors
d. All of the above
C
What is the inability of the male dog to retract the penis into the prepuce called?
a. Priapism
b. Phimosis
c. Paraphimosis
d. Paraphilia
C
Which of the following species is an induced ovulator?
a. Canine
b. Feline
c. Equine
d. Avian
B
he gestation of the canine is how many days?
a. 63 days
b. 42 days
c. 330 days
d. 76 days
A
Pyometra typically develops in what time frame in relation to estrus?
a. One month prior to estrus
b. During estrus
c. Three months post estrus
d. There is no correlation between
C
Delivery of the fetus occurs in which stage of labor?
a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
B
Active labor should not be allowed to continue for longer than what length of time before medical attention is sought?
a. 15 minutes
b. 1 hour
c. 4 hours
d. 12 hours
B
Uterine inertia can result from which of the following abnormalities?
a. Hyperkalemia
b. Hypolactatemia
c. Hypoglycemia
d. Hypercalcemia
C
Which of the following is not related to secondary uterine inertia?
a. Exhaustion
b. Electrolyte disturbance
c. Dehydration
d. Dam conformation
D
CEH
Cystic endometrial hyperplasia
Usually precedes pyometra and is common in middle-aged, female entire bitches and queens
Endocrine disease occurring in diestrus when corpora lutea are present and progesterone is high
Can be sub clinical or life threatening
Basic pathophysiology of pyometra
CEH in its sub clinical stage involves proliferation and hyper secretion of endometrial glands leading to fluid filled cysts in uterine lumen (usually in diestrus). Once bacterial colonisation occurs there is accumulation of intraluminal purulent exudate and inflammatory infiltration into the endometrium and myometrium. Progesterone is high which stimulates endometrial growth and glandular secretory activity which diminishes immune function and increases bacterial adherence > pyometra
How do bacteria gain access in pyometra
Ascension of bacteria when cervical dilation in oestrus (E. Coli most common)
Diagnosis of pyometra
Enlarged uterus (uterine wall thickness, distension, cystic glands)
History of recent oestrus
Vaginal discharge
SIRS signs
Anorexia/inappetence
Lethargy
Painful abdomen
Degenerative neutrophilia with bands
Anaemia (NR, normocytic, normochormic)
Increased CRP
Increased globulins and proteins (dehydration, antigenic stimulation)
Hypoalbuminaemia
Prerenal azotaemia
Increased liver enzymes
Treatment of pyometra
- Stabilise
- Broad-spectrum antibiotics
- Progesterone receptor antagonists: closed to open pyo to enhance removal of exudate
- Surgery/OHE
- Medical management: PGF2a (increases contractility, luteolysis, increases uterine contraction)
When are small animals considered geriatric
When they have entered into the last 25% of there expected life expectancy
RBC, WBC production in geriatric animals
There is reduced ability for the bone marrow to produce new WBC and RBC as a result of reduced haemopoesis
The coagulation system shift to …. in geriatric patients
Hypercoagulobility
Respiratory muscle strength in geriatric patients
Reduced by about 25% and A-a significantly increases
Imaging changes in geriatric patients
More calcification of ribs and joints
Calcification in bronchial circulation may be mistaken for pulmonary disease
The liver may extend beyond costal arch
Cat hearts may lie more flat on the sternum and be mistaken for cardiac disease
Spondiolysis may be present
Fluid therapy in geriatric animals
Because geriatric animals have increased myocardial fibrosis, valvular malfunction and myocardial fibre atrophy they are highly dependent on their end-diastolic volume and thus more sensitive to fluid loss but also to too much fluid. They likely also have some degree of renal insufficiency
- balanced crystalloids ideal
- may require supplements of K, Vit B etc
Nutritional requirements of geriatric animals
Have higher protein requirements
Require a highly digestible diet high in fibre
Have decreased ability to digest fats > deficiencies in fat soluble vitamins
Antioxidants required to combat oxidative stress > minimise free radicals and production of NO
Probiotics and prebiotics helpful
Pharmacological considerations for geriatric patients
‘Start low, go slow’ (may change when emergent)
Oral absorption might be decrease due to reduced GI function
Decline in hepatic mass and function alter metabolism
15-20% estimated to have reduced renal function so careful for kidney elimination
Adjusted dose - norm dose X (Norm crea/pt crea)
Adjusted interval - norm interval (1/norm crea/pt crea)
Metritis
Similar bacterial infection to pyometra but occurs after parturition when PG is low.
Similar clinical signs to pyometra as well as reduced milk production and malodorous lochia
Unlike pyometra this is very treatable with medical management (PGF2a, amoxiclav, IVFT)
Normal parturition and timing
- Uterine contraction, cervix dilating, body temp drops, PG drops, 6-24h
- True labour, strong contractions, clear discharge before each puppy/kitten
- Passing of placenta with each birth
When is parturition an emergency
Failure to stage 2 within 24h
Full term without labour
Failure to deliver within a timely manor I.e. one puppy/kitten every 1-2h
Foetal distress <160
Still births
Maternal distress (lethargy, pain, green or copious discharge
Pex of dystocia
Treatment of dystocia
Address life-threatening shock
Oxytocin 0.25-0.4U/dog
C-section
+- ovariohysterectomy
