SA13 Medical Nursing Flashcards
What is an incision wound?
- Clean cut
- Caused by sharp object
- Glass, scalpel blade, etc
- Profuse bleeding, especially in deep/larger wounds
What is a laceration wound?
- Tearing of tissue
- Uneven edges
- Barbed wire, etc
- Less sever bleeding than incision
- Contaminated
What is an abrasion wound?
- Superficial wound
- Doesn’t penetrate full skin thickness
- Contamination with dirt and foreign material
What is a puncture wound?
- Small external wound
- Often with significant deeper damage
- Dog/cat bites
What is a contusion wound?
- Blunt blow
- Ruptured capillaries below surface
- Can have deeper injuries
What is an avulsion wound?
- Wound with skin flap
- Skin flap becomes necrotic
- Delays healing if not removed
What is a fracture?
- Break in bone
- Can be classed as open if wound present
What is a rupture wound?
- Injured organ
- Causes internal bleeding
- Life threatening
- Liver, spleen, etc
What is a haematoma?
- Blood filled pocket
- Aural, organ (liver, spleen)
What is a clean wound?
- Surgical wound
- Made under aseptic conditions
What is a clean contaminated wound?
- Surgical wound
- Made under aseptic conditions
- With mild contamination
What is aetiology?
Unknown cause
What is a contaminated wound?
- Fresh traumatic wound
- Surgical wound with major break in asepsis
What is a dirty wound?
- Traumatic wound over 6 hours old
- Any wound where ongoing infection in present prior to surgery
How can wounds be classified?
- Open/closed
- Clean/dirty
What is ischaemic?
Restriction in blood supply
What different degrees of damage are there in wounds?
- Resolution
- Regeneration
- Organisation
What is resolution in terms of wounds?
- No tissue destruction
- Very minor inflammatory phase
- Tissue returns to original state
What is regeneration in terms of wounds?
- Complete replacement of damaged tissue
- Connective tissue and blood supply must be intact
What is organisation in terms of wounds?
- Formation of scar tissue
- As unable to heal by regeneration
- Often results in loss of normal function
What are the stages of the healing process?
- Haemostasis
- Inflammatory
- Proliferative
- Remodelling/maturation
What is the haemostasis stage of wound healing?
Clots form to stop blood loss
What is the inflammatory stage of wound healing?
- Blood clot attracts neutrophils
- Clear up bacteria, necrotic tissue, foreign material
- Macrophages (monocytes) perform final debridement
- Exudate, swelling and redness seen
- 24-48 hr for clean surgical wound
What is the proliferative stage of healing?
- Fibroblasts lay new tissue
- Endothelial cells lay new blood vessels
- Epithelial cells migrate over wound to replace epidermis
- Granulation and wound contraction seen
What is the golden period to treat an open wound?
- Optimal time of treatment of open wound
- Within 0 - 6 hours
What happens 6 - 12 hours after an open wound is caused?
- Bacteria multiplies
- Early stages of infection
What happens 12 hours + after an open wound is caused?
- Tissues will be infected
What is granulation tissue?
- Bright red, vascular
- Seen 3-5 days in large wounds
- Can take weeks-months to fully develop
What is the remodelling/maturation stage in wound healing?
- Scar formation
- Strengthening and hair regrowth
- 7-10 days in clean surgical wound
What are labile cells?
- Epithelial, lymph, etc
- High ability to regenerate
What is first intention healing?
- Rapid healing can take place in incised wounds
- Only occurs if edges of wound are held together
- Only happens in clean wounds
What is second intention healing?
- Granulation
- Slower healing
- Happens where tissue is lost or presence of foreign material or infection
- Epithelial tissue tissue grows across to close wound
- Speed of this growth determined by wound environment
- Warm, moist environment encourages epitheialisation
Do wounds need surgical intervention immediately?
- Some wounds can be managed as open wound
- Once granulation is established can have surgical secondary closure
- Wounds without surgical closure must be dressed and bandaged appropriately until full healing
- Can take weeks-months depending on tissue deficit
How long does wound healing take in tendons and muscles?
- Several weeks
- Gradual reintroduction to exercise
How long does wound healing take in GI, urinary and reproductive tissues?
- 3-4 days
- Urinary bladder heals fastest
- Colon heals slowest
What factors can delay wound healing?
- Movement
- Infection
- Impaired circulation/perfusion
- Patient/client interference
- Poor nutrition
- Systemic disease
- Poor wound management
- Surgical factors
- Drug therapy
What is erythema?
Reddening of tissue
Where does movement especially delay healing?
Over joints
How does infection delay healing?
- Bacteria destroys healing tissue
- Causes inflammation and pus
How does impaired circulation and poor perfusion delay healing?
- Tissue dies at wound edges
How does poor nutrition delay healing?
- Decreased vitamin K (affects clotting)
- Insufficient protein intake (affects cell growth and repair)
What systemic diseases can delay healing?
- Hypothyroidism (Decreased metabolism, slow cells)
- Cushings (Increased cortisol, slows healing)
- Renal (Increased toxins, weakened clotting)
- Hepatic disease (Reduced clotting factors)
- Diabetes mellitus (Increased blood glucose, slows healing)
- Severe cardiovascular disease (Poor perfusion, WBC can’t get to wound effectively)
How can poor wound management delay healing?
- Inappropriate primary dressing
- Poor bandage technique
- Unprotected bandages
- Infrequent bandage changes
- Patient interference
What surgical factors can delay healing?
- Wound infection
- Tight sutures
- Inappropriate suture material
- Poor suturing technique
- Poor aseptic technique
- Lack of drainage
What is delayed primary closure?
- Closed after 1 - 3 days
- Contaminated so need to be managed as open wound to begin with
What is secondary closure?
- Closed after 3+ days
- Heavily contaminated so needs to be managed as open wound for longer
What drugs can delay healing?
- Corticosteroids
- Chemotherapy
- Radiotherapy
Fluid build up in surgical wound?
Seroma
What is the primary dressing layer?
- In contact with the wound
- Can debride wound, absorb fluid, stimulate granulation tissue, promote epithelialisation, contract wound
What are the functions of a wound dressing?
- Absorption of exudate
- Analgesia
- Protection
- Prevention of infection
- Promotion of wound healing
- Maintaining correct humidity for healing
What is the secondary dressing layer?
- Wool and conforming bandage
- Absorbant
- Easy to apply
- Apply in spiral with even 50% overlap
- Conforming bandage compresses wool
- Holds primary layer in place
- Provides padding and stability
What is the tertiary dressing layer?
- Elastic and cohesive
- Apply in even 50% overlap
- Protection from soiling and mutilation
When can casts be used?
- Stable fractures
- Greenstick, simple, spiral fractures
- Fractured bone is close to in-tact bone
- Can be used post operatively
- Arthrodesis, internal fixations, tendon repair
What is another name for casts?
External coaptation
What are the properties of cast materials?
- Comfortable
- Easy to apply
- Strong/hard wearing
- Radiolucent
- Lightweight, not bulky
- Easy to remove
- Water resistant, breathable
- Economical
What are some examples of cast materials?
- Polypropylene impregnated with resin (Dynacast)
- Fibreglass impregnated with resin (Vetcast Plus)
- Thermoplastic polymer mesh (Vet-lite, Runlite SA)
- Plaster of Paris
What are some important things to remember when applying a cast?
- Apply in close proximity to bone for optimal support
- Too much padding causes slippage
- Too little padding causes decubital ulcers
- Joints above and below fracture must be included
How is a cast applied?
- Cover wounds with non-adherent dressing
- Apply stockinette to avoid creases
- Apply cast padding with 50% overlap
- Pad bony areas with ‘doughnuts’
- Immerse one roll of cast into water and squeeze several times
- Squeeze excess water and apply to limb with even pressure and 50% overlap
- Repeat until cast complete
- Leave pads and toes of digits 2 + 3 exposed
- Leave 1-2cm of padding exposed at top and bottom
- Turn stockinette and padding edges over ends of cast once hardened
How should a cast be cared for?
- Replace if excessively chewed or damaged
- Replace every week if animal young
- Administer medication as prescribed
- Cover bottom when taking patient outside
What should be monitored for when casts are used?
- Swelling of limbs and toes
- Chafing
- Staining with discharges
- Foul odour
- Slippage
- Chewing shows signs of discomfort
- Collapse or bending
- General patient demeanour; appetite, lethargy, depression
How should a cast be removed?
- Take radiographs to assess healing
- Sedate or GA if using oscillating saw
- Can use plaster shears to cut cast fro, distal to proximal ends
- Two cuts make a cutting line
- Saw cuts through cast, not padding
- Remove padding once cast removed
- Blade can become hot, caution must be taken
What are the aims of managing chronic wounds?
- Prevent further contamination
- Decontaminate as much as possible
- Debridement of necrotic tissue
- Infection control
- Healthy wound bed allows healing
What causes congestive heart failure?
- Pooling blood in venous system
- Due to damming back effect
- Due to cardiac disease
What does left sided congestive heart failure cause?
- Congestion of vessels in lungs
- Fluid leaking causes pulmonary oedema
What does right sided congestive heart failure cause?
- Congestion of venous circulation
- Particularly vessels returning from abdomen and chest cavity
- Results in ascites and pleural effusion
What clinical sign can cats show with either side congestive heart failure?
Pleural effusion
What are the clinical signs of congestive heart failure?
- Dyspnoea
- Tachypnoea
- Exercise intolerance
- Cough
- Syncope (collapse)
- Weight loss
- Pale/bluish MMs
- Ascites
- Dull breath sounds with effusion
- Increased breath sounds with pulmonary oedema
Why can coughing occur in congestive heart failure?
Oedema or cardiomegaly pressing on main stem of bronchi
What is a foramen oval?
- Opening in septum between right and left atria and ventricles
- Blood bypasses lungs and passes from right ventricle to left
- Should close shortly after birth
- Seen in neonates
What is Ductus Arteriosa?
- Connects pulmonary artery and aorta
- Blood bypasses lungs from right to left
- Closes shortly after birth as lungs expand
- Seen in neonates
What is Ductus Venosus?
- Venous shunt within liver
- Connects umbilical vein to caudal vena cava
- Blood bypasses foetal liver
- Mothers liver already metabolised nutrients
- Seen in neonates
What differences are seen in neonatal circulation?
- Foramen Ovale
- Ductus Arteriosa
- Ductus Venosus
What is PDA?
- Patent Ductus Arteriosus
- Failure of Ductus to close after birth
What are the signs of Patent Ductus Arteriosus?
- Often detected as machinery type murmur as first vaccination
- Often no clinical signs at that stage
What are the long term effects of Patent Ductus Arteriosus?
- High resistance in systemic circulation
- Blood passes from aorta to pulmonary artery
- Leads to over circulation to lungs and left side of heart
- Ultimately leads to left sided heart failure
What is the treatment for Patent Ductus Arteriosus?
- Surgical closure
- Treatment for congestive heart failure if diagnosed late
What are artial and ventricular septal defects?
- Failure of foramen ovale to close
What are the clinical signs of atrial and ventriculare septal defects?
- Similar to PDA
- Systolic murmur is heard
- Bigger hole = quieter murmur
What is the treatment for atrial and ventricular septal defects?
- Symptomatic treatment for congestive heart failure
- Open heart surgery
- Surgery requires heart bypass, is very expensive and not commonly done
What is aortic stenosis?
- Narrowing of the outflow (valve) of the left ventricle?
What are the signs of aortic stenosis?
- Typically a left sided murmur
- Output failure leads to fainting/collapse
- Congestive heart failure
- Sudden death due to cardiac dysrhythmias
What is the treatment for aortic stenosis?
- Symptomatic treatment with anti dysrhythmic drugs and beta blockers
- Mild cases may not require treatment
What is pulmonic stenosis?
Narrowing of pulmonary valve or artery leaving the heart
What are the signs of pulmonic stenosis?
- Typically right sided murmur
- Congestive heart failure
What is the treatment for pulmonic stenosis?
- Severe cases require dilation of artery
- Symptomatic treatment in non-surgical cases
What is mitral/tricuspid dysplasia?
Underdevelopment of the mitral or tricuspid valve
What is tetralogy of fallot?
- 4 heart defects
- Pulmonic stenosis
- Ventricular septal defect
- Abnormally positioned aorta
- Often have more than one congenital defect
What is myocarditis?
Inflammation of heart muscle
What causes myocarditis?
- Parvovirus in puppies
What are signs of myocarditis?
- Acute heart failure
- Death
What is dilated cardiomyopathy (DCM)?
- Thinning of myocardium
- Leads to loss of contractility
- Enlargement of heart chambers
What causes dilated cardiomyopathy?
- Common in Dobermans
- Often idiopathic
- Seen in taurine deficiency
- Was common in cats
What are the signs of dilated cardiomyopathy?
- L+R congestive heart failure
- Ascites and pulmonary oedema in dogs
- Pleural effusions + pulmonary oedema in cats
What is the treatment for dilated cardiomyopathy?
- Symptomatic treatment for congestive heart failure
- Taurine supplementation
What is hypertrophic cardiomyopathy (HCM)?
- Thickening of cardiac muscle
- Reduction in heart chamber size
- Most common cardiac disease in cats
What does stenosis mean?
Narrowing
What are the signs of hypertrophic cardiomyopathy?
- Congestive heart failure
- Sudden death
What is the treatment for hypertrophic cardiomyopathy?
- Drugs to slow heart and improve chamber filling
- Congestive heart failure treatment
What is myxomatous valvular disease (MVD)?
- Mitral valve disease
- Degeneration of atrio-ventricular valves
- Most common in mitral valve
- Faulty valve function
- Blood leaking through valves when closed
- Common in CKCS
What are the signs of myxomatous valvular disease?
- Progressing murmur
- Congestive heart failure
What is the treatment for myxomatous valvular disease?
Symptomatic treatment
What is pericarditis?
- Inflammation of pericardium
- Causes pericardial effusion
What is pericardial effusion?
- Fluid accumulation inside pericardial sac
- Prevents heart filling during diastole
- More often in dogs (Golden retrievers)
What are the causes of pericardial effusion?
- Idiopathic
- Secondary to tumours or infection
What are the signs of pericardial disease?
- Lethargy
- Dyspnoea
- Muffled heart sounds
- Weak pulses
- Pale MMs
- Jugular distension
- Ascites
What is the treatment for pericardial disease?
- Drainage of fluid around the heart (pericardiocentesis)
- Removal of part of the pericardium (pericardectomy)
What is auscultation?
LISTEN FOR
- Heart rate and rhythm
- Murmurs
- Dullness
- Respiratory sounds
What is ECG?
- Measures electrical conductivity of the heart
- Gives info on rate and rhythm
- Gives crude indications of cardiac chamber size
What is the wave in an ECG?
P
- Depolarisation of the atria
- Starting from SA node
QRS WAVE
- Depolarisation of ventricles
- From AV node
T
- Repolarisation of ventricles
What positions are the ECG leads attached to the patient?
- RED = Right
- YELLOW = Left
- GREEN = Below sun
- BLACK = Right hind
How should the patient be positioned for an ECG?
- Non-conductive table cover (vetbed)
- Dogs in right lateral
- Cats sitting or standing
- Turn off other electrical equipment in room
- Apply conductive gel/spirit to pads/clips
- Don’t allow leads to touch
- Reduce patient movement and purring
- Keep patient as calm as possible
- Avoid chemical restraint
How can radiography be used to look at the heart?
- Shows size and shape of heart
- Can show congestion signs
- Always take DV view first
- Followed by lateral view (usually right)
- Sedation required
- Forelegs out of way
- Take standard inspiratory views
What is the most common haemopoietic disease seen in practise?
Anaemia
What is erythropoiesis?
Formation of erythrocytes (RBCs)
What is lymphoid tissue?
- Found in lymph nodes and spleen
- Matures agranular leukocytes
- Lymphocytes + monocytes
What is myeloid tissue?
- Found in red bone marrow
- Forms erythrocytes and granular leukocytes
- Neutrophils, esinophils, basophils
What is serum?
- Plasma minus clotting factors
- Does not have fibrinogen or prothrombin
What is anaemia?
- Reduced number of erythrocytes (RBCs)
- Reduced haemaglobin concentration
What does anaemia lead to?
- Reduced circulating oxygen
- Causes hypoxia in tissues
How is anaemia classified?
REGENERATIVE
- Bone marrow responds to erythropoietin from kidneys
- Releases RBCs and reticulocytes into circulation
NON-REGENERATIVE
- Lack of erythropoietin or bone marrow doesn’t respond
- No RBCs or reticulocytes released
What causes regenerative anaemia?
HAEMORRHAGE
- Internal/external loss
- Sever trauma
- Organ rupture
- Clotting disorder
- Neoplasia
- Haemorrhagic gastroenteritis
- Sever ectoparasite infection
- Surgery
- Epistaxis
HAEMOLYSIS
- Immune-mediated
- Blood parasites (mycoplasma haemofelis)
What causes non-regenerative anaemia?
- Bone marrow hypoplasia
- Iron deficiency
- Renal disease
- Leukaemia
- Lymphosarcoma
- Lead poisoning
What are the clinical signs of anaemia?
- Pale/jaundice MMs
- Evident blood loss
- Bounding, weak pulses
- Tachycardia
- Lethargy
- Hypotension (if losing whole blood)
- Inappetence
- Dyspnoea/Tachypnoea
- Exercise intolerance
- Collapse/syncope
How is anaemia dianosed?
- Haematology; complete blood count, fresh smear, reticulocyte count
- Biochem to check organ disease; kidney disease
- Agglutination test; check for autoimmune haemolytic anaemia
- FeLV/FIV testing in cats
- Coagulation profile
- Imaging; radiographs of thorax, abdomen, ultrasonography, CT scan
What does epistaxis mean?
Nose bleed
How is anaemia treated?
TREAT UNDERLYING CAUSE
- Identify + control haemorrhage
- Treat immune mediated diseases (steroids)
- Treat infections (Tetracyclines for mycoplasma haemofelis)
- Erythropoietin if renal disease
- Treat coagulopathy; vitamin K and frozen plasma in rodenticide poisoning
- Treat underlying neoplasia
- Iron supplementation in chronic blood loss (Bleeding tumours into gut)
- Fluids (crystalloids, packed red cells, plasma, less commonly colloids)
- Supplementary oxygen may be indicated
What are the nursing considerations for aneamia?
- Monitor vital signs
- Pain scoring
- Monitor hydration status
- Encourage eating
- Monitor fluid intake and output
- Monitor excretions
- Assess exercise tolerance
What type of fluids are least likely to be required in anaemia treatment?
Whole blood
What are the congenital coagulopathies?
- Von Willebrand’s Disease
- Haemophillia A
What is Von Willebrand’s Disease?
- Inherited disease
- More common in certain breeds (dobermans)
- Lack of certain clotting factor (VW factor)
- Causes impaired platelet function
- Platelets needed for start of clotting process
What are the signs of Von Willebrand’s Disease?
MILD
- Excessive haemorrhage at spay/castration
SEVERE
- Die young of acute haemorrhage
SIGNS
- Epistaxis
- Bleeding post oestrus
- Petechial/ecchymotic haemorrhage
- Bleeding into pleural/peritoneal cavities
- Signs on anaemia
How is Von Willebrand’s Disease diagnosed?
- Biochem and haematology
- Clotting profile
- Activated clotting time
- Von Willebrand factor
- Platelet function test
CARE WHEN BLOOD SAMPLING - Lots of pressure post venepuncture
How is Von Willebrand’s Disease treated?
- Desmopressin synthetic ADH (DDAVP)
- Leads to increased levels in VW’s factor and factor VIII
- Cryoprecipitate from pet blood banks - source of factor VIII, fibrinogen, VW factor
- Mainly used prior to elective surgery
How can Von Willebrand’s Disease be detected in breeding programs?
- Von Willebrand’s factor levels can be measured
- Important in breeding
What are the nursing considerations for Von Willebrand’s Disease?
Same as anaemia
What is Haemophillia A?
- Lack of clotting factor VIII
What are the signs of haemophillia A?
- Haemorrhage into joints
- Haematoma formation
What is the treatment of haemophillia A?
- Cryoprecipitate from pet blood bank; source of C factor VIII, VW factor and fibrinogen
- Mainly used before elective surgery
- Can be used in mild cases
What are the nurse considerations of Haemophillia A?
- Same as anaemia
What are the acquired coagulopathies?
- Immune-mediated thrombocytopaenia
- Anticoagulant rodenticide poisoning
- Sever liver disease
What is immune-mediated thrombocytopaenia?
- Immune system damages and destroys platelets
- Leads to spontaneous bleeding
- Can be idiopathic, from infection or inflammatory disease
What are the signs of immune-mediated thrombocytopaenia?
- Bruising
- Epistaxis
- Haematemesis
- Haematuria
- Pale MMs
- Tachycardia
- Tachypnoea
- Anorexia
- Lethargy
How is Immune-mediated thrombocytopaenia diagnosed?
- Biochem and haematology
- Platelet count
- Clotting profile
- Thorax + abdomen radiographs
- Ultrasound
- CT
What is the treatment for immune-mediated thrombocytopaenia?
- Immunosupressive therapy (steroids)
- Blood transfusion
- Treat underlying cause
What is anticoagulant rodenticide poisoning?
- Rodenticides impair vitamin K production
- Vit K required for some clotting factor functions
What are the signs of anticoagulant rodenticide poisoning?
- Severe haemorrhage
- Especially into body cavities
How is anticoagulant rodenticide poisoning diagnosed?
- Biochem and haematology
- Clotting profile
- Toxicology
What is the treatment for anticoagulant rodenticide poisoning?
- Induction of emesis
- Activated charcoal
- Supplementary vitamin K
- Frozen plasma
- Supportive therapy (packed RBC transfusion)
What is sever liver disease?
- Clotting factors reduced
- Lack of production in liver
What is the treatment of sever liver disease?
- Supportive + supplementary vitamin K
- Frozen plasma
How long does clotting process take in healthy patients?
3-5 minutes
What is hypercoagulation?
Abnormal clotting
What is IMHA
- Immune-mediated haemolytic anaemia
- Immune system attacks RBCs
What is evans syndrome?
IMHA with immune-mediated thrombocytopoenia
Why are plasma and transfusions used with vitamin K in treatment for anticoagulant rodenticide poisoning?
- Vitamin K takes time to work
- Plasma gives clotting factors immediately
What are the signs of sever liver disease?
Same as anaemia
When would coupage be contraindicated?
In patients with lung injury
What is dysuria?
Difficulty urinating
What is Polyuria?
Increased urination
What is Oliguria?
Reduced urination
What is Anuria?
Not urinating
What is Pollakiuria?
Frequent urination in small amounts
What is cystitis?
Inflammation of the bladder
What is Tenesmus?
- Straining
- Urine or faecal
What is Stranguria?
Small dribbles
What is Haematuria?
Blood in urine
What is Incontinence?
- Lack of control of urination
- Not aware
Feline lower urinary tract disease
Where does each endocrine gland sit?
Pituitary gland - base of brain
Thyroid gland - Lateral to trachea
Parathyroid gland - next to TG
Pancreas - along proximal duodenum
Ovaries - next to kidneys
What is hyperadrenocorticism?
- Cushsings syndrome
- Production of excessive amounts of cortisol from the adrenal gland
What is iatrogenic?
From excessive steroid administration
What is cushings disease?
- Hyperadrenocorticism
- Production of excessive amounts of cortisol from adrenal glands
What can hyperadrenocorticism be caused by?
PITUITARY TUMOUR
- Usually benign (PDH)
ADRENAL TUMOUR
- Can be benign or melignant
- (ADH)
What are the clinical signs of hyperadrenocorticism?
- PU/PD
- Polyphagia
- Pendulous abdomen
- Liver enlargement
- Lethargy/poor exercise tolerance
- Muscle weakness
- Alopecia/skin changes
- Persistent anoestrous
- Testicular atrophy
- Calcinosis cutis
- Hypertension
- Neurological signs
What is hepatomegaly?
Enlarged liver
What is calcinosis cutis?
Thickened, hard skin from calcium deposits
Why can hyperadrenocorticism cause a pendulous abdomen?
- Weakened abdominal muscles
- Redistribution of abdominal fat
What skin changes can be seen with hyperadrenocorticism?
- Alopecia
- Comedomes
- Thinning skin
- Lack of elasticity
What diagnostic tests should be completed first when testing for hyperadrenocorticism?
- Must have compatible signs and results before specific endocrine tests
- Haematology (neutrophilia + lymphoaenia
- Biochemistry
Stress leucogram??
What are the 3 parts of the vomiting reflex?
NAUSEA
- Hypersalivation + increased swallowing
- Anti-peristalsis of duodenum and jejunum
- Decrease gastric tone
RETCHING
- Diaphragm, intercostal and abdominal muscle spasms
- Overcome gastroesophagus sphincter pressure
VOMITING
- Food forced out of relaxed stomach by abdominal muscles
What is the difference between vomiting and regurgitation?
- Regurgitation is ejection of undigested food from larynx or oesophagus before reaching the stomach
- Vomiting is from the stomach
What is regurgitation from the pharynx?
- Immediate
- Undigested, neutral pH
- Multiple swallowing attempts
- Poor ability to drink
- Dysphagia present
- Can see dyspnoea and coughs
- Food consistency can aggravate this
What is regurgitation from the oesophagus?
- Few seconds delay after eating
- Undigested, neutral pH, can be tubular
- Multiple swallowing attempts
- Normal to poor ability to drink
- Dysphagia present
- Can see dyspnoea and coughs
- Food consistency and exercise can aggravate this
What is vomiting from the stomach and proximal small intestine?
- Minutes to hours delay after eating
- Partially digested, may see bile, pH < 5
- Single swallowing attempts
- Normal ability to drink
- Dysphagia not present
- Hypersalivation, abdominal pressure, excess swallowing
What can cause acute vomiting?
- CNS disorders
- Gastric/intestinal disease
- Infections
- Gastric foreign bodies
- Intestinal foreign bodies
- GDV (
- Gastric mobility disorders
- Inflammation
- Haemorrhagic gastroenteritis
- Metabolic disease
- Acute pancreatitis …
What CNS disorders can cause vomiting?
- Vestibular disease
- Epilepsy
What gastric and intestinal diseases can cause acute vomiting?
What is collitis?
- Inflammation of colon
- Often results in LI D+
- Can confuse tenesmus + increased frequency with constipation
What is osmotic diarrhoea?
- Most common
- Unabsorbed solutes increases faecal water
What is secretory diarrhoea?
- Increased secretion of fluids and ions
- Or decreased absorption
- Cause by bacteria, toxins, viruses and some laxatives
What is permeability diarrhoea?
- Increased permeability of epithelial cells and tight junctions
- Blood / protein loss if severe
- Caused by R sided heart failure, portal hypertension, imflammatory bowel disease, neoplasia, infections and toxins
What is constipation?
- Failure to pass faeces
- Resulting in impaction
What are the clinical signs of constipation?
- Failure to pass faeces
- Tenesmus
- Hard faeces +/- blood
- V+
- Dyschezia
What is Dychezia?
Pain while passing faeces
How can constipation be diagnosed?
- Physical/rectal exam
- Radiography
- Ultrasonography
- Proctoscopy
What is proctoscopy?
What is the treatment for constipation?
- Enemas
- IVFT if dehydrated
- Dietary changes
- Lactulose
- Bulking agents
- Obstruction removal surgery
- Increased exercise
What are the causes of collitis?
- Chronic inflammation
- Infections secondary to SI fat maldigestion
- Neoplasia/polyps
- Motility disorders
- Local irritation; prostatitis, peritonitis
What are the diagnostic tests for collitis?
- Clinical and rectal exam
- Faecal analysis
- Biochem + haematology
- Radiography/ultrasonography
- Biopsy
- Protoscopy
What is the treatment for colitis?
- Hypoallergenic (hydrolysed) diet
- Increased soluble + insoluble fibre
- Dietary omega-3 fatty acids
- Dietary changes often enough to control colitis
What is cirrhosis?
Scarring
- Occurs in liver when 70-80% cell damage
What is prostatic disease?
- Common in older entire male dogs
- Prostate tends to increase in size as as dog ages
- Due to hormonal stimulation; benign prostatic hyperplasia
- Bacterial infection from urethra
- Cysts, abscesses, tumours may develop
- Prostatitis (inflammation)
What are the signs of prostatic disease?
- Faecal + urinary tenesmus/constipation
- Flat faeces
- Haematuria from infection/neoplasia
- Dysuria/incontinence
- Abdominal pain
How is prostatic disease diagnosed?
- Rectal examination
- Ultrasonography/radiography
- Prostatic wash + cytology
- Urinalysis
- FNA/biopsy
How is prostatic disease treated?
- Ypozane tablets - benign prostatic hyperplasia
- Inhibits testosterone uptake by prostate; 7 day course lasts 6 months
- Suprelorin
- Castration
- Antibiotics and analgesia
- Drainage/removal of cysts
- Palliative care for neoplasia
What are the nursing requirements for prostatic disease?
- Prevent urine scalding
- Monitor urine + faecal output
- Pain scoring
- Post op surgical care
What are testicular tumours?
- Most common; sertoli cell, interstitial cell (leydig cell)
- Most important; sertoli cell
- Usually related to retained testicle
What are the signs of testicular tumours?
- Feminisation; increased oestrogen
- Alopecia
- Gynecomastia; mammary development
- Pendulous prepuce
- Bone marrow suppression
How are testicular tumours diagnosed?
- Clinical signs and exam
- Are they castrated?
- Blood test; oestrogen concentration
How are testicular tumours treated?
- Surgical removal
- Chest radiographs needed to check for metastases
What is pyometra?
- Cystic endometrial hyperplasia
- More common in bitch than queen
- Cause by progesterone staying high post oestrus
- Endometrium thickened and gland numbers increase
- Excess fluid in uterus
- Can be induced by progestogens and oestrogens
- Bacteria leaks into blood stream
- Commonly seen 5-6 weeks post season
What are the signs of pyometra?
- More common in middle age/older bitches
- Signs start few weeks post oestrus
- PU/PD
- Lethargy
- Anorexia
- V+
- Vaginal discharge if cervix open
- Abdominal pain
- Shock
How is pyometra diagnosed?
- Clinical signs
- Abdomen palpation
- Radiograph/ultrasonography
- Vaginal swab
How is pyometra treated?
- Ovariohysterectomy
- May need medical stabilisation
- IVFT and antibiotics
- Aglepristone treats medically to empty uterus if open
- Medical treatment can lead to complications
What is false pregnancy?
- Pseudopregnancy/pseudcyesis
- More common in bitches
- Unknown causes
- Usually worse after each season
What are the signs of false pregnancy?
- Signs seen 6-8 weeks post oestrus
- Mainly behavioural changes
- Nesting and mothering toys
- Mammary development and mastitis
How is false pregnancy diagnosed?
- Easily recognised from signs
- Must rule out pregnancy
How is false pregnancy treated?
- Can resolve spontaneously
- Drugs to suppress lactation
- Galastop for dogs, Kelactin for dogs and cats
- May need hormonal treatment
- Spay after clinical signs gone
What are mammary tumours?
- More common in bitches
- 50% are benign in bitches
- 80% are malignant in cats
- Mammary carcinoma is malignant
What are the signs of mammary tumours?
- Enlarged, lumpy mammary tissue
- Can become large and ulcerated if left
How are mammary tumours diagnosed?
FNA/biopsy
How are mammary tumours treated?
- Surgery
- Mammectomy; single gland
- Local mastectomy; affected and adjacent gland
- Radical mastectomy/mammary strip; all glands on affected side
- Radiography of chest to check for metastases
What is an antiprolactin?
- Cabergoline
- Manages pseudopregnancy
- Stops lactation
What is aglepristone?
- Termination of pregnancy
- Used up to 45 days post mating
- Medical treatment of pyometra
What is proligesterone?
- Synthetic progesterone
- Used for oestrus control
- Treats false pregnancy
What is delmadinone?
- Progesterone injection
- Used as chemical castration
- Reduced libido, not infertility
What is deslorelin?
- Chemical castrate implant
- Induced temporary infertility in healthy entire male dogs
- Takes 6 weeks for full effects
- Lasts 6 months
What is elbow dysplasia?
- Abnormal development of elbow joint
- Usually inherited
- Affects young giant and large breed dogs
What are the clinical signs of elbow dysplasia?
- Lameness
- Lifting head when affected leg put down
- Limping
- Arthritis in older age
How is elbow dysplasia diagnosed?
- Radiography
- CT scan
- MRI
- Elbow arthroscopy
How is elbow dysplasia treated?
- Weight management
- Physio/hydrotherapy
- Anti-inflammatory medication
- Stem cell treatment
- Total elbow replacement
How can cases of elbow dysplasia be reduced?
- BVA/KC elbow scoring scheme
- Assess predisposed breeds before breeding
- Aim to eliminate/reduce occurrence
What is patella luxation?
- Dislocation of patella
CONGENITAL - Anatomical deformities at birth
- Can be inherited
AQUIRED - Result of trauma
What are the clinical signs of patellar luxation?
- Inability to extend stifle joint
- Lameness
- Non-weight baring
- Deformity
- Small fractures
- Pain
- Abnormal gait (skipping)
How is patellar luxation diagnosed?
- Radiography
- CT scan
- MRI
How is patellar luxation treated?
- Depends on grade (1-4)
- Surgery required for 3-4; tibial tuberosity transposition
- Surgery not needed for 1-2 unless severe clinical signs
- Physio/hydro therapy
- Exercise modification
- Weight management
- Anti-inflammatory medication
What is the cruciate ligament?
- Normal stifle joint has 2 cruciate ligaments
- Form a cross to stabilise joint
- Menisci serve as shock absorber
How is cruciate rupture caused?
CRANIAL RUPTURE
- With medial meniscus damage
- Usually from trauma/exercise
- Femur slips onto tibia
CRUCIATE DEGENERATION
- Breed conformation
- Upright position of hind limbs make joint become unstable
What are the clinical signs of cruciate rupture?
- Acute onset lameness after trauma
- Pain
- Limping
How is cruciate rupture diagnosed?
- Manipulating joints to assess cranial draw
- Radiography
- MRI
- Exploratory surgery/arthroscopy
How is cruciate rupture treated without surgery?
- Anti-inflammatory medication
- Weight management
- Physio/hydrotherapy
- Dogs <15kg normally stabalise
- Dogs >15kg may require surgery
How is cruciate rupture treated with surgery?
EXTRASCAPULAR
- Place non-absorbable suture - Around lateral fabella and through hole in tibial crest
- Knot secured with metal crimps
INTRASCAPULAR
- Place strip of patella ligament through inside of stifle joint
- Secured with sutures
TPLO
- Tibial Plateau Levelling Osteotomy
- Change tibial plateau angle
- Allows movement without pain
- Ligament remains damaged
- Bone stabilised with TPLO plate and screws