Small Animal Disease Flashcards
1
Q
(T/F) A majority of the blood volume of the liver and about half of its oxygen supply is supplied by the hepatic arteries.
A
(F, portal vein)
2
Q
What is the definition of hepatic vascular anomalies?
A
(Conditions in which the portal blood bypasses the liver and enter systemic circulation)
3
Q
(T/F) Hepatic vascular anomalies are always congenital.
A
(F, can be acquired too)
4
Q
Acquired portosystemic shunts are a sequela of what?
A
(Chronic portal hypertension)
5
Q
Portosystemic shunts can be intrahepatic or extrahepatic, are acquired versus congenital shunts intrahepatic or extrahepatic?
A
(Acquired - extrahepatic, congenital - either)
6
Q
Of extrahepatic and intrahepatic portosystemic shunts, which occurs more frequently in small and toy breeds?
A
(Extrahepatic shunts)
7
Q
What is the term for primary hypoplasia of the portal vein without portal hypertension that is a microscopic malformation of hepatic vasculature?
A
(Microvascular dysplasia)
8
Q
What two things does portal vein hypoplasia result in?
A
(Portal hypertension and multiple acquired shunts)
9
Q
What disorder causes a majority of the clinical signs seen in patients with portosystemic shunts?
A
(Hepatic encephalopathy)
10
Q
What type of uroliths cause the urinary signs (hematuria, stranguria, pollakiuria, and urethral obstruction) typically resultant of portosystemic shunts?
A
(Ammonium biurate stones)
11
Q
Do you expect your MCHC or MCV to be decreased on a CBC of a dog/cat with a portosystemic shunt?
A
(MCV → microcytosis)
12
Q
What white blood cell abnormalities do you expect to see on a CBC of a dog/cat with a portosystemic shunt? Two answers.
A
(Leukocytosis and neutrophilia)
13
Q
Do you expect bilirubin to be abnormal in a patient with a portosystemic shunt?
A
(No, usually normal)
14
Q
Is the increased ALP that is usually found on a chem of a dog/cat with a congenital portosystemic shunt related to the fact that they have a portosystemic shunt?
A
(No, could be increased bone isozyme d/t young age)
15
Q
Bile acids will be increased or decreased in a dog with a portosystemic shunt?
A
(Increased)
16
Q
What test can be done to distinguish between a portosystemic shunt and portal vein hypoplasia/microvascular dysplasia?
A
(Protein C testing)
17
Q
How does the use of antibiotics decrease ammonia absorption?
A
(Decreases number of bacteria that produce ammonia)
18
Q
GI ulceration is very common and potentially life threatening with intra or extrahepatic shunts?
A
(Intrahepatic shunts)
19
Q
How long should medical management be pursued prior to considering surgery for portosystemic shunts?
A
(2 weeks)
20
Q
What is the preferred surgical technique for closing portosystemic shunts to reduce the risk of postoperative complications such as portal hypertension?
A
(Gradual occlusion)
21
Q
How does the development of postoperative seizures in portosystemic shunt surgery patients impact the prognosis?
A
(Prognosis is poor in animals with postoperative seizures after portosystemic shunt surgery)
22
Q
What is the most common chronic complication of portosystemic shunt attenuation?
A
(Recurrence of clinical signs)
23
Q
(T/F) Localized splenomegaly is more common in dogs and diffuse splenomegaly is more common in cats.
A
(T)
24
Q
Extramedullary hematopoiesis causes (diffuse or localized) splenomegaly and occurs in response to what condition?
A
(Diffuse, anemia)
25
What two things can cause congestion of the spleen which leads to diffuse splenomegaly (there are more than two things but Dr. DeMonaco has two on her ppt)?
(Sedation/anesthesia and splenic torsion are on her PPT slide, in the notes she mentions thrombosis, right sided heart failure, and portal hypertension as well (so those are all acceptable answers))
26
Clinicopathology of a splenomegaly case typically will show anemia, will the anemia be regenerative or not?
(Regenerative)
27
Dogs with what neoplasm of the spleen are more likely to present with a hemoabdomen?
(Hemangiosarcoma)
28
You are presented with a dog with a hemoabdomen and focal splenomegaly both of which are confirmed via ultrasound, what next step would you take to rule in/out if this is a malignant cause of splenomegaly?
(Take thoracic radiographs to look for metastasis, if you see metastasis → malignant, no metastasis → may be benign or malignant without metastasis so should consider splenectomy now)
29
Can you use ultrasound to differentiate between a benign and malignant splenomegaly?
(No)
30
What is the most common indication for a splenectomy?
(Splenic masses)
31
Is a splenectomy indicated in a spontaneous splenic rupture?
(Yes)
32
Is a splenectomy indicated in a traumatic splenic rupture?
(No)
33
What are the two reasons that FNAs are not used for cavitated masses of the spleen?
(Can iatrogenically rupture and are typically nondiagnostic even if they don’t rupture in the process)
34
What major gastric arterial supply branches off of the splenic artery?
(The left gastroepiploic artery)
35
Where does the venous drainage of the spleen go?
(The portal vein)
36
What is the term for the splenectomy technique in which you ligate the vessel distal to their branches to the stomach, so distal to the left gastroepiploic artery and distal to the short gastric arteries?
(Hilar resection technique/terminal branch ligation technique)
37
What is the term for the splenectomy technique in which you ligate distal to the branching of left gastroepiploic artery but otherwise entirely transect the other vessels to the spleen?
(Modified splenic artery ligation technique)
38
(T/F) The splenic artery ligation technique, in which the splenic arterial supply is transected entirely with no preservation of the left gastroepiploic artery, is not suggested because it can lead to gastric necrosis.
(F, this has been proven wrong)
39
Why should the mesentery not be untwisted in a splenectomy of a torsed spleen?
(Will allow free radicals and other inflammatory molecules that have built up in the spleen and splenic vessels to enter circulation)
40
You just removed the spleen of a patient who had a splenic mass. You’ve completed an entire abdominal exploration and found no other lesions. What else should you biopsy while you still have them open and under anesthesia?
(The liver)
41
What type of arrhythmias can dogs who undergo a splenectomy for a splenic mass develop up to 48 hours after surgery?
(Ventricular arrhythmias)
42
What is the most common neoplasia of dogs undergoing a splenectomy?
(Hemangiosarcoma)
43
In what two ways/routes can a hemangiosarcoma metastasize?
(Hematogenous and local tumor seeding after rupture)
44
What is the most common splenic disease of cats?
(Splenic mast cell tumors)
45
Cholestatic disease is more likely to affect ALP or ALT?
(ALP)
46
Hepatocellular disease is more likely to affect ALP or ALT?
(ALT)
47
What is indicated if you have similarly increased ALT and ALP?
(Indicates mixed hepatobiliary disease)
48
What two organ systems are affected by leptospirosis?
(Renal +/- hepatic)
49
What drugs stimulate glutathione synthesis, detoxify hepatotoxins, and are free radical scavengers, one being oral and one being injectable?
(SAM-e and N-Acetylcysteine)
50
Acute neutrophilic cholangitis is a sequela to what other disease process?
(Bacterial infection of the GI tract)
51
Chronic insults of cholangitis/cholangiohepatitis are more common in dogs or cats?
(Dogs)
52
Both liver enzymes will likely be increased with cholecystitis but one may be more elevated than the other, which liver enzyme is more likely to be greatly elevated in a case of cholecystitis?
(ALP)
53
What is the most significant biliary disease in dogs?
(Gallbladder mucocele)
54
What would you do to medically manage a gallbladder mucocele that was an incidental finding, so no sign and no concurrent infection, and the owners have declined surgery?
(Put the dog on ursodiol and +/- start a low fat diet)
55
Why should you avoid using LRS when administering fluids to a hepatic disease patient?
(Lactate metabolized in the liver)
56
For hepatobiliary disease patients, a high quality protein and highly digestible food is recommended except in one specific case, what is that exception?
(Hepatic encephalopathy → restrict protein initially and then add in slowly)
57
What is the term for an insult to the liver that initiates an immune response to the hepatocytes?
(Chronic idiopathic hepatitis)
58
What type of infiltration is present on histopathology in chronic idiopathic hepatitis?
(Lymphocytic)
59
In what two ways does liver disease cause ascites?
(By not producing albumin and by inducing portal hypertension)
60
What is indicated if you see a small, irregular liver on abdominal ultrasound?
(Cirrhosis)
61
Does a normal appearing liver on ultrasound rule out hepatic disease?
(No)
62
What is required for a diagnosis of chronic idiopathic hepatitis?
(Biopsy)
63
What are the two possible reasons for copper hepatopathy mentioned in the lecture?
(Dysfunction in copper metabolism (which occurs in the liver) and severe cholestasis)
64
How do you tell the difference between primary and secondary copper hepatopathy on histopath of a liver biopsy?
(Primary - copper build up is centrilobular, secondary - copper build up is periportal)
65
What is the term for the end-stage of inflammatory liver disease?
(Cirrhosis)
66
What can appear similarly to cirrhosis on abdominal ultrasound?
(Nodular hyperplasia)
67
(T/F) Metastatic hepatic neoplasia is more common than primary hepatic neoplasia in dogs.
(T)
68
(T/F) Malignant neoplasia of the liver is more common than benign neoplasms of the liver in dogs.
(T)
69
(T/F) Primary hepatobiliary neoplasia is more common than metastatic in cats.
(T)
70
What is the most common malignant liver tumor in dogs that has a generally good prognosis after treatment with surgical resection and a low rate of recurrence?
(Hepatocellular carcinoma)
71
What are the two reasons that increased corticosteroids cause an increase in ALP in dogs?
(ALP has a cortisol isoenzyme so when corticosteroids are present, ALP is released; and corticosteroids cause cells to swell d/t glycogen accumulation which induced release of ALP)
72
(T/F) Nodular hyperplasia requires no treatment.
(T, it is a benign asymptomatic old age change in the liver)
73
You did routine yearly blood work on a 13 year old mixed breed dog and notice that his ALP is moderately increased. He has no signs of liver disease so you perform an ultrasound and notice the shape of the liver is irregular, you plan to perform a biopsy but what do you suspect the biopsy will come back as?
(Nodular hyperplasia)
74
Why should you assess +/- BMBT, platelets, and clotting times prior to hepatic biopsies?
(Hemorrhage is the major risk for a liver biopsy so want to make sure they are normal before performing biopsy)
75
What three tests should be performed on a liver biopsy from a canine patient?
(Histopath, copper analysis, and culture)
76
You are empirically treating a patient with chronic idiopathic hepatitis, your meds are pred, ursodiol, and denamarin, would you choose to put them on a low protein diet to begin with, why or why not?
(No, protein is important for the liver to regenerate so unless that are showing signs of HE, no need to put them on a low protein diet just put them on a highly digestible, high quality protein diet)
77
What drug is used for copper chelation for treatment of copper hepatopathy in addition to restriction of dietary copper restriction?
(D-penicillamine)
78
In addition to increased liver enzymes, hyperbilirubinemia, and hypercholesterolemia, what else would you expect to see on a CBC in a dog with bacterial cholangiohepatitis?
(Inflammatory leukogram)
79
When is surgery indicated for cholecystitis?
(When medical management (abx and ursodiol) do not work)
80
What age group is more commonly impacted by gallbladder mucoceles?
(Older dogs)
81
What are the two suspected components of the etiology of gallbladder mucoceles?
(Mucus hypersecretion and dysmotility)
82
What age group of dogs is typically impacted by GDV?
(Geriatric dogs)
83
Is slow or rapid eating a risk factor for GDV?
(Rapid)
84
Is feeding (fewer, larger or more, smaller) meals a risk factor for GDV?
(Fewer/large meals)
85
What PE finding is the earliest indication that an animal is potentially going into shock (obviously in relation to other things, not all animals with this PE finding are going into shock)?
(Tachycardia)
86
What portion of the stomach does all of the moving in a case of GDV and how does it move?
(The pylorus moves ventral, cranial, and to the left)
87
How does portal hypertension result from GDV?
(The dilatation of the stomach presses on the portal vein leading to portal hypertension)
88
Why does an animal with a GDV go into shock?
(Decreased cardiac output due to decreased blood return to the heart due to the caudal vena cava compression by the dilated stomach)
89
What does the pancreas secrete in response to ischemia caused by GDV?
(Myocardial depressant factor)
90
How does sepsis result from GDV?
(GDV causes GI tract ischemia which can lead to bacterial translocation → sepsis)
91
Why does an animal with GDV have a decreased tidal volume (which then leads to hypoventilation and eventual hypoxia)?
(Due to pressure on the diaphragm)
92
Which vessels are the culprit for the hemoabdomen that can be resultant of GDV?
(Short gastric arteries → stretch and/or tear due to dilation)
93
Which portion of the stomach is almost always the one that suffers from necrosis in a case of GDV?
(Fundus)
94
What arrhythmia will you find in a GDV patient?
(Ventricular arrhythmias → VPCs progressing to Vtach)
94
What is the term for a systemic inflammatory reaction to circulating endotoxin and free oxygen radicals that causes peripheral vasodilation and profound hypotension?
(SIRS → systemic inflammatory response syndrome)
94
What are the two purposes of taking radiographs in suspect GDV patients?
(Confirm your diagnosis and diagnose comorbidities)
94
What four treatments are the fundamentals of resuscitating/stabilizing a GDV patient prior to surgery?
(Fluids, decompression, oxygen, and analgesia)
94
What is the classical ‘shock dose’ of IV crystalloid fluids?
(90 ml/kg)
94
What is the classical ‘shock dose’ of IV colloid fluids?
(20 ml/kg)
94
What ‘space’ (extracellular, extravascular, etc.) do you want to keep fluids in within the body to be useful in treating the shock?
(Intravascular space)
95
Which of the decompression options, orogastric intubation or percutaneous decompression, which provides a more rapid and effective decompression of a GDV stomach?
(Orogastric intubation)
96
How do you find the safest area to insert a trocar for percutaneous decompression of a GDV stomach?
(Percussion → find that area of greatest tympany)
97
When you are derotating the stomach in a case of GDV, should you be pulling the pylorus left or right?
(Right)
98
When you are derotating the stomach in a case of GDV, should you be pushing the stomach ventrally or dorsally?
(Dorsally)
99
Why should you alert your anesthetist when you have confirmed that the stomach is back to a normal position?
(There will possibly be reperfusion injury and endotoxin release so that can affect the vitals)
100
The preferred method of gastropexy is incisional and what portion of the stomach should you be working on and which side of the body should it be attached to?
(Should be attaching the pylorus to the right side of the body, if you attach the fundus to the left side, you are not prevent GDV from happening again)
101
(T/F) Obstructive GI disease treatment will probably require surgery.
(T)
102
What are the five possible etiologies for obstructive small intestinal disease in small animals?
(FB, neoplasia, intussusception, hernia/torsion, stricture)
103
What is the pathophysiology of generalized bowel hypoxia that is resultant from a lodged foreign body?
(Dehydration (d/t vomiting, inability to drink and/or absorb fluid through GI, fluid loss from hypersecretion into lumen) leads to hypovolemia and body compensates by taking blood from intestines → generalized bowel hypoxia)
104
What fluid type should you use in your preoperative fluid plan for a patient with a small intestinal obstruction?
(Crystalloid replacement fluid)
105
What three electrolytes can/should be corrected as a part of your preoperative fluid plan for your SI obstruction patient?
(Potassium, sodium, and chloride)
106
You should limit your potassium supplementation to under what value?
(0.5 mEq/kg/hr)
107
Why is it important to perform a complete abdominal exploration in a foreign body surgical case?
(There are often multiple foreign bodies)
108
What are the ‘four P’s’ pertinent to assessing viability of bowel?
(Pink, palpation, peristalsis, pulses)
109
What are some things you can do to prepare for contamination in a foreing body removal surgery? List what you can.
(Perform clean procedures first, isolate the segment of intestine, use separate instruments/gloves, have suction ready, hold the segment off with atraumatic forceps after ‘milking’ chyme from the segment)
110
Which side of the intestine, mesenteric or antimesenteric, should you make your enterotomy incision?
(Antimesenteric)
111
Should you make your enterotomy incision orad or aborad to the foreign body you are removing?
(Aborad)
112
Describe the suture type and needle that you would use to close an enterotomy incision.
(Absorbable, small (3-0), monofilament with a taper needle that lasts > 2 weeks; Dr. Ganjei mentioned PDS)
113
Do you want your incision closure for an enterotomy to be inverting, everting, or appositional?
(Appositional)
114
How do the forceps you choose to use on your R&A differ for the portions to be resected and the portions to be anastomosed (so what kind of forceps do you use on those parts)?
(To be resected - use rochester-carmalts, to be anastomosed - doyen intestinal forceps)
115
What are the three phases of wound healing?
(Inflammatory, repair/proliferative, maturation)
116
What occurs in the inflammatory phase of wound healing?
(Neutrophils break stuff down)
117
What occurs in the repair/proliferative phase of wound healing?
(Fibroblasts build stuff back up)
118
What does GI incision dehiscence lead to that can ultimately result in death?
(Septic peritonitis → septic shock)
119
The chance for developing short bowel syndrome is more likely if what part of the small intestine is removed?
(Ileum)
120
You are beginning surgery on a cat who had segmented dilation of their small intestines on radiographs with multiple short, comma shaped portions of bowel, what is your first step?
(Check under the tongue and cut the probable linear foreign body anchored there)
121
What is the common term for palatoschisis?
(Cleft palate)
122
What is the common sequela of palatoschisis?
(Aspiration pneumonia)
123
What are the four possible vesicular stomatitis diseases in pigs?
(FMD, swine vesicular dz, vesicular stomatitis, and vesicular exanthema of swine)
124
What causes oral ulcers in non-human primates and fatal neurologic disease in humans?
(Herpes B virus)
125
What three diseases should be on your differential list when presented with a ruminant with ulcerative stomatitis, besides FMD?
(Bovine viral diarrhea virus, malignant catarrhal fever, and bluetongue)
126
What is the causative agent of necrotizing stomatitis?
(Fusobacterium necrophorum)
127
You are presented with a dog with bilaterally symmetrical tongue ulcers, what body system is failing to cause these?
(Renal failure → uremic ulcers)
128
What disease complex results in ‘rodent ulcers’ in cats, and it is suspected to be a hypersensitivity reaction?
(Eosinophilic granuloma complex)
129
What is the causative agent of woody tongue that is characterized by a pyogranulomatous glossitis and can affect cattle, sheep, horses, pigs, and dogs?
(Actinobacillus lignieresii)
130
Is contagious ecthyma, which infected animals (sheep and goats primarily) present with crusts on lips, face and feet, zoonotic?
(Yes → causes orf in humans)
131
What is the causative agent of candidiasis, which is a yeast-like fungus that causes mucosal thickening and hyperkeratosis?
(Candida albicans)
132
You are presented with a bird with proliferative oral stomatitis, what does your differential list contain?
(Candida sp., Trichomonas sp., avian pox virus, and vitamin A deficiency)
133
What is the most common oral neoplasia in dogs?
(Melanoma)
134
What is the most common malignant oral neoplasia in cats?
(SCC)
135
What is the 3rd most common oral malignancy in dogs that affects surprisingly younger, large breed dogs?
(Fibrosarcoma)
136
Where do fibromatous epulis arise from in the oral cavity?
(Periodontal ligament)
137
What is the causative agent of oral papillomas in dogs?
(Canine papillomavirus 1)
138
What is the causative agent of oral papillomas in cattle?
(Bovine papillomavirus 4)
139
What other locations in the body can bovine papillomavirus 4 cause lesions (in addition to the mouth)?
(Forestomachs and esophagus)
140
What cells do distemper target which are responsible for making enamel which can lead to enamel hypoplasia/dentin exposure/staining in distemper patients?
(Ameloblasts)
141
What disease is associated by a defect in hemoglobin metabolism that leads to red to brown discoloration of dentin and bones, ‘pink tooth’ disease?
(Porphyria)
142
You are performing a necropsy on a cow and notice linear ulcers in the esophagus, what does this indicate?
(BVDV)
143
What type of inflammation is induced by the presence of Spirocirca lupi in the esophagus?
(Granulomatous inflammation)
144
The failure of what leads to ruminal drinking?
(Failure of the reticular groove reflex)
145
What does uremic gastric mineralization occur secondarily to?
(Calcium:phosphorus imbalance due to renal failure)
146
Do gastric adenocarcinomas have a high or low rate of metastasis?
(High)
147
What two species can develop gastric squamous cell carcinoma?
(Horses and pigs)
