Revision notes Flashcards
What disease processes have a strong/high recommendation for the use of antithrombotics?
- IMHA
- Feline cardiomyopathy
- PLN
- > 1 disease/risk factor for thrombosis
What disease processes should antithrombotics be considered to be used in but not always recommended?
moderate risk or only really risk if in combo with others:
- pancreatitis (d)
- glucocorticoids (d)
- Cancer
- Heart disease (d)
- sepsis (d)
- HyperA
What type of thrombosis is usually seen with IMHA?
- PTE
What type of thrombosis is usually seen with feline cardiomyopathy?
- Arterial (minimal evidence for venous)
What type of thrombosis is usually seen with PLN?
- PTE >ATE> venous
What type of thrombosis is usually seen with pancreatitis (d)?
- splenic vein thrombosis
- ATE
- portal vein thrombosis
What neoplasias are most commonly associated with thrombosis?
- round cell
- carcinoma
- adrenal tumour
Are antiplatelet or anticoagulants recommended for venous thrombosis prevention? Give example of this
- Anticoagulant
PTE due to HE => heparin superior to aspirin.
Are antiplatelet or anticoagulants recommended for ATE prevention? Give example
- antiplatelet
Cats with FATE - clopidogrel
When is aspirin recommended?
- prevention of ATE in dogs and cats
When is clopidogrel recommended?
- prevention of ATE in dogs and cats
When should antithrombotic drugs be discontinued?
- if high risk of thrombosis, should not be discontinued for invasive procedures but if multiple agents used, then reduce to single antiplatelet drug
- for low to moderate risk of thrombosis, discontinue 5-7 days prior
- if the underlying cause and the thrombus has resolved.
restart as soon as possible post op provided not ongoing bleeding.
What antithrombotics should be weaned before discontinuation?
- UFH
- Direct Xa inhibitors.
What are other causes of feline pancreatitis apart from idiopathic?
> 95% = idiopathic.
- Infectious
- parasites (Toxoplasma gondii, Eurytrema procyonis, Amphimerus pseudofelineus)
- viruses (coronavirus, parvovirus, herpesvirus, calicivirus) - Trauma inc surgery or hypotension
- Neoplasia
- Toxins:
- topical fenthion
- KBr
- Phenobarb
- hypercalcaemia
- snake bite. - Autoimmune
- With concurrent disease:
- diabetes mellitus,
- chronic enteropathies,
- hepatic lipidosis,
- cholangitis,
- nephritis
- IMHA
What are u/s findings of acute pancreatitis in cats?
- equivocal or - pancreatic enlargement, - hyperechoic surrounding mesentery, - focal abdominal effusion - distension/corrugation of duodenum
What does a normal feline pancreas look like on MRI? and with pancreatitis?
Normal: T1 hyperintense and T2 isointense to hypointense
Pancreatitis:
- T1 hypointensity
- T2 hyperintensity of the parenchyma,
- enlargement of the pancreas,
- pancreatic duct dilatation
- contrast enhancement.
What is the PPV and NPV of Spec fPL in sick cats?
Specific and sensitive - better with more severe cases.
PPV 90%
NPV - 76%
How should a “normal” and “abnormal” snap fPL be interpreted?
- normal - unlikely to have pancreatitis
- abnormal - may have pancreaitis.
What is the difference in inflammatory cell types with acute suppurative vs chronic feline pancreatitis?
Acute - neutrophilic +/- necrosis, oedema
Chronic - lymphocytic or mononuclear + fibrosis or cysts
What are the treatment recommendations for feline acute pancreatitis?
- treat any inciting cause
- IVFT
- Antiemetics (maropitant/ondans)
- gastric prokinetics (metoclop may be contraindicated due to dopamine antagonism, but no clinical studies support this. otheriwse cisapirde ro erythomycin)
- analgesia - buprenorphine/methadone/fent, maropitant, tramadol or gaba
- appetite stim - mirtazapine or capromorellin + feeding tube if req
- Gastrointestinal diet.
Abs and corticosteroids not recommended for the pancreatitis but may be indicated if concurrent disease would benefit from them
What are the treatment recommendations for feline chronic pancreatitis?
- analgesia
- nutrition support (no specific diet recommended)
- antiemetic
- appetite stim
- cobalamin
- pred at antiinflam or immunosuppressant levels provided not hyperglycaemia. if so consider cyclosporine.
Abs not recommended
What are the 5 main phenotypes of feline cardiomyopathy
- HCM
- Diffuse or regional increased LV wall thickness with a nondilated LV chamber. - RCM:
- Endomyocardial form: prominent endocardial scar that usually bridges the interventricular septum and LV free wall, => fixed, mid-LV obstruction and often apical LV thinning or aneurysm;
+ LA or biatrial enlargement is generally present.
- Myocardial form Normal LV dimensions (including wall thickness) with LA or biatrial enlargement - Dilated cardiomyopathy (DCM)
- LV systolic dysfunction with
increase in ventricular dimensions,
normal or reduced LV wall thickness,
atrial dilatation. - ARVC:
- Severe RA and RV dilatation
+/- RV systolic dysfunction and RV wall thinning.
+/- left side affected
- Arrhythmias and RSCHF - Nonspecific phenotype/unclassified
- A cardiomyopathic phenotype that is not adequately described by the other categories
What proportion of cats have HCM?
what are the main clinical presentations?
- 15-30%
Presenation:
- asymptomatic
- CHF
- FATE
What are the following genetic abnormalities associated with and in which breeds:
- MyBPC3-A31P
- MyBPC3-R820W
MyBPC3-A31P: myosin binding protein C in HCM in Maine Coon cats. = 35-42
MyBPC3-R820W: myosin binding protein C in HCM in ragdolls/