Vet prep Power Pages Canine and Feline Flashcards
Itchy dog less than 1 year is likely what condition? What if it was around 1-3 years old?
<1 year is Food allergy whereas ages 1-3 years is likely Atopy (which is usually seasonal) they look the same as far as distribution of the lesions so beware (paws, face, ears, belly)
Atopy vs flea allergy lesions
Distribution of lesions:
FAD is caudal half of body and lumbosacral region and tail, butt, thighs NECK IN CATS
Atopy is usually paws, face, ears and belly
contact allergy dermatitis usually has these lesions _______
pruritic vesicles and erythematous papules
in cats beware of what two forms of skin reaction patterns?
Miliary dermatitis and eosinophilic (crusted papules diffusely) granuloma complex (4 types)
What are the 4 types of granuloma complex in cats?
indolent ulcer- most commonly seen as ulcerative symmetrical lesion on the upper lip
Eosinophilic granuloma- found in mouth or on body
Eosinophilic plaque- commonly seen as linear plaques on the caudal thighs
Flea allergy dermatitis of cats- caudal dorsal, symmetrical alopecia can be on face and neck
how long does it need to be on flea preventative and resolution of CS to say it was FAD?
2-3 months and be sure them bitches are cleaning because the larva hide from the meds in a cacoon
Why do we test the skin of the allergic animal with atopy?
NOT for a diagnosis persay but rather for a vaccine
normal dogs will also test + so this is not a diagnosis for atopy
Biopsy is the worst thing to do to try to diagnose it
Contact allergy is a type ___ hypersensitivity whereas Atopy is a type _____ hypersensitivity
And Flea allergy dermatitis is types…
Type 4 (cell-mediated) is contact allergy whereas Atopy is type 1 aka IgE mediated type of hypersensitivity; FAD is types 1, 4 and basophil hypersensitives
animal exposed to possible rabies animal and is vax vs unvax
is vax- redose RV ASAP and monitor for any CS for 45 days by owner
if not vax- vax immediately and quarantine for 4 months in dogs and cats and 6 months in ferrets
animal bites human and unknown RV hx
euth and send out for testing (IFA I think)
or if vax, quarantine for 10 days under supervision
Human unvax for RV and exposed
Human immunoglobulin + 4 RV (but if you have good titers then you just need 2 RV)
Poodle with waxing and waning GI signs, increased ALP and hyperkalemia that is PU/PD likely has…
Addison’s Disease
Addison’s disease is a deficiency in ____ and ____
mineralocorticoids (makes aldosterone– hold sodium excrete potassium) and glucocorticoids (makes cortisol)
Tx with oral pred daily or injectable drug monthly and increase dose like 4x for stressed patients
use what to tx Addison crisis?
0.9% NaCl, plus dextrose or sodium bicarb to throw the K+ back into the cells (since hyperkalemic), also give pred and use 60-90mL/kg/hour (shock dose) of IV fluids of 0.9NaCL
Itchy bugs in dogs and cats
Sarcoptes, fleas, dermatophytosis (ringworm), demodex gatoi which is one of the feline demodex mange mites and is contagioussss
What is the key cytokine that activates JAK/STAT and causes pruritus and the release of pro-inflammatory cytokines?
IL-31 is the key mediator cytokine that activates JAK/STAT and causes pruritus and the release of pro-inflamm cytokines
Both Apoquel and Cytopoint affect the same pathway but they act different bc _____ acts higher in the pathway
Cytopoint
MOA of Apoquel
MOA of cytopoint
Apoquel- JAK inhibitor Cytopoint- monoclonal antibody that binds to IL-31 which prevents it from binding/activating JAK/STAT pathway
how does cyclosporin help with itchy p?
calcineurin inhibitor that suppresses cytokine IL-2 which blocks the proliferation of T-cells and reduces inflammation and allergies
$$ so can use with ketoconazole
but beware bc cyclosporin can cause MDR1 interactions, and mess with insulin in diabetic p, hair growth (hirsutism), gingival hyperplasia- reverses when off the drug and can taper to minimize SE
what 3 skin drugs have quick onset of activity (24 hours)? What has a slower one of like a month?
Faster onset is Cytopoint, Apoquel, and pred. Slower onset is cyclosporine
Brachycephalic syndrome has one or all of the following characteristics…
Elongated soft palete, stenotic nares (sx-wedge resection), hypoplastic trachea (no tx), everted laryngeal saccules (this one is acquired as a result of increased airway resistence/inflammation and can be easily removed under anesth with allis tissue forceps and traction)
what is the risk with severe brachycephalic syndrome?
laryngeal collapse (toc would be permanent tracheostomy)
what are the possible causes of collapsing trachea? How to diagnose it?
can be result of weak or redundant dorsal tracheal membrane or if cartilaginous rings become hypoplastic or fibrodystrophic; diagnosis based on palpation of trachea causing honking coughing/spasms, can also see flattened trachea on rads or endoscopy showing bronchi collapsing
TX of collapsing trachea-
weight loss, anxiolytics if needed, bronchodilators
Sx-
-mild cases- can do dorsal tracheal membrane plication
-intratracheal stenting - 80% success rate
-external support- not very good option
Definition of DCM
a primary myocardial dz characterized by cardiac enlargement and impaired systolic function (seen in lrg breed dogs and cats without taurine in their diet)
CS of Dilated Cardiomyopathy (DCM)
fainting, ex. intolerance, lethargy, resp. distress from L sided heart failure or ascites from R sided failure
Diagnosis of DCM; Tx of DCM
echo and rads (echo will show systolic cardiac dysfunction bc poor contractility and shortening fraction);
TX is ACE inhibitors and/or Pimobendan (Vetmedin) or beta blocker if more severe like in heart failure (these meds end in olol)
Boxer dogs get what cardiac thing?
Familial arrhythmic cardiomyopathy aka arrhythmogenic right ventricular cardiomyopathy of boxer dogs
causes acute rapid VPC’s, may be asymp, have syncope, or have systolic dysfunction and heart failure (tx like a dog with DCM and give L-carnitine supplement)
What do you use in a boxer dog with syncope?
It likely has Familial arrhythmic cardiomyopathy aka arrhythmogenic right ventricular cardiomyopathy of boxer dogs so tx with sotalol (beta blocker) +/- mexilitine (Class I anti-Arrythmigenic)
What 3 drugs are cytotoxic?
Chlorhexidine and aminoglycosides and tetracyclines
TPLO eliminates what but not what?
tibial thrust but not cranial drawer of the stifle
Tx options for CCL tear?
TPLO, extracapsular repair aka lateral suture (small dogs), or TTA
what is the function of the cranial cruciate ligament?
Prevent cranial drawer,
-patellar translocation, excessive hyperext. and internal rotation
Always do urine culture in diabetic p like 1x/year because…
their urine is usually more dilute since pu/pd even with diabetes controlled and that makes it hard for the UA machine to detect some bacteria so culture will really let u know also if they have sugars leaking into their urine its a perf environment for bacteria to grow
What does this pet have?
PU/PD, polyphagia but losing weight, plantigrade stance (cat) and cataracts (dog)
diabetes mellitus
what is wrong with this patient:
Anorexia, vomiting, weak and has metabolic acidosis that is severe with BG >500mg/dL
Diabetic ketoacidosis (DKA)
A cat is super stressed but you wanna run a BG curve bc you suspect diabetes. what should you do instead?
Run a Fructosamine which will tell you what the BG has been for the past 2 weeks or teach o how to check at home
A dog presents for PU/PD, minor weight loss, elevated liver and cholesterol. What is on your ddx?
Diabetes Mellitus
what is the veterinary oral hypoglycemic drug used to decrease insulin requirements or insulin resistance?
Glipizide (Glucotrol) works similar to metformin in humans
What does a diet need to be in a dog with DM? How about a cat?
Dog- high fiber, low fat
Cat- high protein, low carb
DKA tx
aggressive IV fluids 0.9% with potassium and phosphate supplementation, regular insulin (fast acting as CRI or every 6-8 hrs), Bicarbonate therapy if meta. acidosis is severe or not getting better with IV fluids
Potassium Notes— Insulin causes the intracellular movement of potassium into muscle cells by binding to its receptor on skeletal muscle. About two-thirds of patients will develop hypokalemia in the course of treatment for DKA
Cats with diabetes can come off their insulin unlike dogs after they are regulated and is called “clinical remission” T/F
True!!!
What is the most common cause of pruritus in dogs and in cats?
Flea allergy dermatitis (FAD)
What is the most common flea for dogs and cats?
Ctenocephalides felis
(can carry Bartonella which is cat scratch fever, Dipylidium caninum which is tapeworm, and Yersinia Pestis which is the Plague)
what is the average time for a lifecycle in fleas?
3 MONTHS
What do you do to tx a cat or dog with FAD?
Short term glucocorticoids to dampen the inflammation, flea control, clean house/tx yard, treat secondary infections!!!
Low TLI in dog or cat means…..
EPI
Elbow dysplasia in dogs–
umbrella term for one of the following conditions:
- ununited anconeal process (UAP)
-OCD of humeral condyle
-Fragmentation of the medial coronoid process
-Elbow incongruity
Elbow dysplasia CS/Diagnosis
usually by 4 months to a year of age, will have pain on elbow manipulation and may be bilateral so def check the other leg, take rads in the flexed lateral position
Tx of ununited anconeal process in dogs
NSAIDs, excision of the anconeal process works but could do Lag screw fixation and proximal ulnar ostectomy instead
OCD of the humeral condyle definition
Abn endochondral ossification resulting in thickening of the articular cartilage
OCD of the humeral condyle CS
bilateral 80% of the time, diagnosis with lesion on the MEDIALLLL aspect of the humeral trochlea with subchondral bone defect and surrounding sclerosis with osteophytosis
what is the tx of choice for OCD of the humeral condyle
sx to remove the flap and debride- excellent results, do it with arthroscopy
Medial fragmented coronoid process Diagnosis and TX
rads showing sclerosis of the subchondral bone along the trochlear notch of the ulna and adjacent to the proximal radioulnar articulation near the lateral coronoid process
TX is surgical removal with arthroscopy for removal of the fragment
Elbow incongruity
poor alignment of the elbow jts, predisposes to elbow dysplasia and tx is ulnar osteotomy but may not be super effective
Once fungal spores enter the body from inhalation or a wound, they convert to _____ and spread thru the body.
Yeast
what fungal orgs are most common in southern western US?
Coccidiomycosis aka Valley Fever
What fungal spore is most common in mid US moving east? (Midwest of MS river!!!!)!!!!
Histoplasmosis
What fungal spore is more prevalent eastern and northern US?
Blastomycosis
What fungal orgs is more prevalent in like Cali and some in Washington and colorado?
C. gattii cryptococcosis
Histoplasmosis
Midwest and Mississippi river
soil fungus spread via bat and bird feces- inhaled- dog or cat will have GI signs, resp. signs and nodular skin lesions with swollen joints
Diagnosis- anemia, leukocytosis, thrombocytopenia, nodular interstitial patter, pleural effusion, serum, CSF or urine antigen testing (cannot do fungal culture bc risk to lab workers)
TX- itraconazole and go 1 month past CS
Blastomycosis
hunting dogs!!!
Ohio river and east of MS river, soil fungus- bird and bat feces- inhaled- lots of URI signs and lymphadenopathy with snowstorm chest rads +/- draining tracts in skin showing thick walled budding yeast on cytology, lymphopenia, eosinophilia, mild anemia, monocytosis, hypoalbuminemia, hyperglobulinemia
Can do urinary antigen test or PCR to test
Tx Itraconazole 1-2 months past resolution of CS
Cryptococcus
cats more likely to get it- transmission through in soil via pigeon feces- pacific northwest- resp signs, ocular changes, neuro issues, cutaneous lesions like Roman Nose
Diagnosis- round purple or blue with VERY THICK MUCOID LOOKING CAPSULE short based budding
Tx- Amphotericin B 3x/week, +/- Fluconazole, tx is 2 months past resolution of CS so like 5 months to a year…..
what labwork do we need to pay attn to with a patient on an antifungal like ketoconazole or itraconazole?
Liver values, P450 cytochrome metabolism
Coccidioides immitis aka Valley Fever
Southern western US after heavy rain or earthquake that brings spores to the surface, inhaled- whole body systems affected- diagnosis with culture ZOONOTIC SO BE CAREFUL, will see spherules with double walls and will be full of endospores on cytology of a draining tract- Tx is ketoconazole 2 months past CS and itraconazole tx 6 months to a year can add amphotericin B (beware bc with -azole meds you need to keep an eye on liver values but also Ketoconazole can cause cataracts if used for more than 1 year…)
What classifies hip dysplasia???
Loss of articular cartilage, fibrosis, bone remodeling and loss of function
CS and Tx of a dog with hip dysplasia
Bunny hopping gait, ortolani sign, less than 50% of coverage of femoral head, osteophytes present, Morgan Line
Tx- JPS, THR, TPO, FHO and conservative tx
what is a “Morgan Line”
With Hip dysplasia, osteophyte formation at the insertion of the joint capsule
OFA hip-
performed in an effort to screen for hip dysplasia, 7 point grading scale, need to be at least 2 y/o and is SUBJECTIVE
Penn HIp-
Can do as early as 16 weeks BUT best results are at 1 year, distraction index is a good indicator of jt laxity (more objective than OFA hip)
Juvenile Pelvic Symphsiodesis sx
done at 14-20 weeks old, preventative as it allows for more acetabular coverage but still predisp to DJD bc pelvis was cut at the growth plate
Triple pelvic osteotomy (TPO) surgery
3 cuts- pubis, ischium, ilium and placement of the special plate on the ilIum to rotate the pelvis
do at ages 6 months to 12 months
if already has DJD, DO NOT do
Total Hip Replacement (THR)-
placement of prosthetic acetabular femoral component like in humans
super good success rate
can do anytime jt plates are closed, can already have hip dysplasia and DJD
Femoral Head and Neck Ostectomy (FHO)
remove head and neck, may have non painful lameness bc you shortened the leg, great results, salvage procedure in cases of severe hip dysplasia
Osteoarthritis (OA)
progressive, chronic, most common/impt in dogs and horses, steroids C/I… selective inhibition of COX-2 receptors with NSAIDs is the mainstay of medical mgmt
Bone and cartilage changes of OA:
Collagen fibril disruption (basically loss of CT), loss of articular cartilage, sclerosis of subchondral bone, osteophytes and enthesophytes (a bony spur forming at a ligament or tendon insertion into bone) with synovial inflammation
Why are steroids C/I with OA?
Into the joint, steroids inhibit the production of matrix metalloproteinase activators like plasmin and can cause thinning of the cartilage and fibrillation
What does heat stroke lead to in the final stages?
Thromboembolisms, SIRS, renal, neuro and GI dysfunction and eventually DIC with cardiovascular collapse
the temp of heat stroke is about ___ or higher but heat stroke p can present with subnormal or normal temps on presentation…
106 degrees F
what are some causes of heat stroke besides the obvious?
Toxins, eclampsia (placental issue causing hypertension), seizures, upper airway obstruction/lar par
when should cooling efforts be stopped in a dog that is hyperthermic?
When the temp reaches 103 degrees to avoid vasoconstriction
(use room temp water to cool the p and use fanning)
the most common cause of hypercalcemia in cats is…
Idiopathic
what regulates calcium in the body?
Parathyroid hormone (PTH), vitamin D (calcitroil) and calcitonin
what does PTH do?
causes increased Phosphorus and calcium mobilization from the bone and allows Phosphorus to be peed out and calcium to be retained by the kidneys (will cause increased Ca and decreased Phosphorus in the body)
What does calcitriol do?
increases calcium absorption from intestines and results in increased Phosphorus as well
what does calcitonin do?
Reduces calcium levels by inhibiting osteoclastic bone resporption
Signs of hypercalcemia–
pu/pd, anorexia, GI signs, seizures or muscle tremors, arrhythmias, weakness
DDX of hypercalcemia-
HOGS IN YARD
Na:K ratio < 27: 1 is suggestive of what disease?
Addison’s Disease
hypercalcemia and hyperglobulinemia are suggestive of what?
Myeloma or lymphoma
What diuretic can be given to well hydrated p with hypercalcemia to help promote caliuresis (urinating out calcium)?
Furosemide
what do we use to tx hypervitaminosis D causing hypercalcemia?
Bisphosphates or can use calcitonin
what do we use in emergency cases with hypercalcemia?
Sodium bicarbonate
dogs have ____ pancreatitis whereas cats get _____ forms
acute; chronic, subacute
canine pancreatitis is almost always ____ with cause unknown but factors include…..
Sterile; factors include fatty meals, endocrine diseases, inflammation or trauma, drugs (azathioprine, cyclosporine, L-asparaginase, tetracycline)
Diagnostic test of Pancreatitis in dogs and cats-
PLI and U/S but def diagnosis is pancreatic biopsy which is Gold Standard but is like never doneee.
pancreatitis meds-
fluids if needed, pain meds (not T3 or T4 because can cause worsening pancreatitis so use Gabapentin, stay away from NSAIDs bc stomach already upset), H2 blockers, anti-emetics, probiotics and dogs and CATS may need abx bc their pancreatitis is usually not sterile like in dogs, also low fat diet
EPI in dogs and cats
polyphagia, weight loss, young animal
What is the most common cause of EPI in dogs?
Pancreatic acinar atrophy
what is the most common cause of EPI in cats?
Chronic pancreatitis
pica means…
eating things out of the normal like soil, mulch, bark, etc.
Dog or cat with small bowel diarrhea with yellow to gray feces and polyphagia weight weight loss and pica= what diagnosis most likely?
Exocrine Pancreatic Insufficiency aka EPI
what does it mean if TLI or PLI is low?
EPI
what is the TOC for EPI?
Exogenous pancreatic enzyme supplementation
can also do cobalamin (vit B), vit K and Vit E supplements orally with highly digestible low fiber diet
osteosarcoma forms at the ____ site of bones and is away from the elbow in toward the knee in big dogs but is usually where in smaller dogs (less common)?
Where do primary bone tumors form? What about secondary?
metaphyseal; axial skeleton (jaw, scapula, ribs, pelvis, spine) in smaller dogs but this is not common
mandible has the best prognosis of any other osteosarcoma site with 1 year survival with sx alone
Primary bone tumors go to metaphysis but SECONDARY goes to the diaphysis!!!
what is the TOC for osteosarcoma?
Amputation of the limb which is the most effective way to get rid of pain and is palliative but 90% of dogs still develop mets (chemo can extend MST to 10-12 months)
where does osteosarcoma like to spread when it mets?
LUNGS, but can also go to LN and other bones
Does osteosarc cross jt lines into other bones?
nopeee
pulmonary mets will be visible in ___% of osteosarcoma cases at time of diagnosis but will still develop later on in most cases
10%
what on lab work of a lame dog will tell you it may be osteosarcoma?
elevated ALP (Alkaline phosphatase) on chem panel- associated with worse prognosis
Osteosarc but mets in the lungs and sx not an option tx-
Chemo and radiation and put the p on Bisphosphates bc they are osteoclast inhibitors and will help palliate pain in p where sx is not an option
Osteosarcoma MST
amputation alone 4-6 months but with chemotherapy 10-12 months
if presence of mets then 1-3 months
What is the most common malignant oral tumor in dogs? What are the overrep breeds?
Oral melanoma
Breeds overrepresented are chows, goldens, poodles, and cocker spaniels
___ of oral melanoma tumors are amelanotic so they do not have any melanin pigment
1/3
What % of oral melanomas are metastatic?
up to 80% and they frequently met to the LN and then the lungs
oral melanomas are the most common but what are the other sites for melanoma to develop?
Cutaneous (usually benign on dogs), nail beds (1/2 are malignant and 1/2 are benign)
how is the oral melanoma vax used?
Xenogeneic human DNA vaccine made from tyrosine which is a protein found in melanocytes and melanoma cells that allows the immune system to recognize it and form antibodies against it used to tx oral melanoma AFTER it has developed, and will NOT prevent the disease from developing like a normal vax
Oral melanomas less than ___ cm have MST of __ months
<2 cm have MST of 17 months
oral melanoma tumors more than 2 cm have MST of how long?
5.5 months
dogs with the tumor more caudal in the mouth obvs have poorer prognosis than if it was more rostral
TOC of oral melanoma
wide sx excision +/- rad and chemo
What are the most common dermal malignancy in dogs?
Mast cell tumors
what breeds are predisposed to MCT?
Boxers, Pugs, Boston Terriers, and other brachycephalic breeds (usually lesser grade MCT tho)
MCT release what substances when they degranulate? What can this cause?
Histamine, heparin, proteases, and cytokines that can cause GI ulcers/bleeding, poor wound healing, anaphylaxis (hypotension, vasodilation and collapse etc.)
What is the grading system used for MCT in the US?
The Patnaik system which evaluates the cell differentiation, mitotic figures, and invasiveness in surrounding tissues and predicts likelihood of recurrence and mets (1 is least aggressive and 3 is most aggressive)
Sx for MCT
excision with 2-3 cm lateral margins and 1 fascial plane deep and is TOC (radiation needed if you do not get good margins)
if mets present, then the TOC is chemotherapy
Supportive care for MCT
Glucocorticoids (cytotoxic to mast cells and reduces inflammation from the tumor), H1 blocker like diphenhydramine (Benadryl– NEVER give IV), H2 blocker like famotidine or ranitidine or cimetidine
what is the first FDA approved drug for tx of canine cancer in the US?
Tyrosine Kinase Inhibitor Palladia
Laryngeal paralysis is usually idiopathic in older dogs and can result in dyspnea and death and can be unilateral or bilateral..T/F
Trueeee!!!
What are the CS of lar par?
Voice changes, inspiratory stridor (high pitched wheeze sound), dyspnea and at risk for aspiration pneumonia
what muscle is responsible for the abduction of the arytenoid cartilage that opens the airway?
Cricoarytenoideus dorsalis muscle
What nerve innervates the cricoarytenoideus dorsalis muscle?
Recurrent laryngeal nerve
What is def diagnosis of lar par?
Laryngeal examination under light anesthesia using Doxapram to stimulate respiration and visualize arytenoid function
TOC for lar par, what are the risks? what if the p has lar par and megaesophagus?
Tie back sx AKA cricoarytenoid lateralization sx; risk of aspiration pneumonia; if the p is at an extreme risk for aspiration pneumonia like it also has megaesophagus then do permanent tracheostomy
A dog presents to you for weight gain, alopecia, pyoderma, and skin changes. What is the disease?
Hypothyroidism
How do we diagnose hypothyroidism?
Baseline T4 but confirm with cTSH and free T4 by equilibrium
What is the tx for hypothyroidism?
Synthetic thyroid hormone (levothyroxine) orally daily
What is the most common cause of hypothyroidism?
lymphocytic thyroiditis
why is hypothyroidism sometimes missed?
Euthyroid sick syndrome which is where the hypothalamus-pituitary stimulation of the thyroid is dampened because of illness
what hormones does the thyroid gland synthesize?
Thyroid hormone thyroxine (T4) and triiodothyronine (T3)
CS of hypothyroidism
lethargy, weight gain, alopecia, pyoderma, hyperkeratosis, seborrhea, hyperpigmentation, bradycardia, weak pulses
What will you see on cbc chem with hypothyroidism in dogs?
Mild non-regenerative anemia and hypercholesterolemia
Serum T4 level will be low (but make sure you confirm with cTSH or free T4 by equilibrium before tx)– hypothyroid dogs have increased cTSH and low free T4)
What will the labwork be that slam dunks hypothyroidism on cTSH and free T4?
Increased cTSH and low free T4; hypothyroid dogs should have low T4 even after TSH stimulation
What does this patient have: Bradycardia with severe dehydration but USG low, Na:K ratio <27, episode started when patient was stressed
Hypoadrenocorticism aka Addison’s Disease
what is the test of diagnosis for addisons?
ACTH stim test (suspected if baseline cortisol <2)
what is the tx for addisons?
Rapid infusion of 0.9% NaCl as shock dose (60-90ml/kg) and tx hyperkalemia with dextrose or sodium bicarbonate, steroids
Addisons disease is the deficiency of ____ and ____ and most commonly occurs because of what?
it is usually a deficiency in mineralocorticoids (makes aldosterone) and glucocorticoids (makes cortisol) and most commonly occurs from the idiopathic adrenocortical atrophy
Mineralocorticoids produce aldosterone which does what??
allows the body to retain sodium and excrete potassium
What is the sex predilection for addisons?
70% of females get it
What does hyperkalemia look like on ECG?
Tall tented T waves and diminished to absent P waves with prolonged P-R interval and wide QRS complex
what might you see along with addisons in terms of other anatomy?
Small adrenal glands, megaesophagus, micro cardia
post ACTH stim test below ____ ug/dL is consistent with Addisons disease
What steroid will not interfere with this test?
<2 ug/dL; only dexamethasone will not interfere with this test
longterm tx for Addisons disease:
Glucocorticoid- prednisone tapered but give 2-4x maintenance dose at times of stress or can
Mineralocorticoid- fludrocortisone daily or injectable DOCP every 3-4 weeks (Percorten I think)
Cushings occurs in ___ and ___ (species)
dogs and horses
A dog presents for pu/pd, panting, polyphagia, pendulous belly and pyoderma with thin skin?
Cushings disease
most cases of cushings are what and how are they tx?
Most cases are pituitary-dependent (PDH) and are treated medically with Lysodren or Trilostane
what is seen in horses with cushings?
Hirsutism which is abnormal long wavy coat
What will you see on labwork with cushings disease?
stress leukogram (SMILED), elevated ALP (alkaline phosphatase), hyposthenuria (USG less than 1.010)
What is the most impt diagnosis for test for cushings disease?
Low dose dexamethasone suppression test to diagnose and ACTH stim test to monitor after diagnosing and treating
· ___is a LEAKAGE ENZYME THAT TELLS YOU ABOUT LIVER DAMAGE NOT NECESSARILY LIVER FUNCTIONING
ALT
Cushings vs. Addisons disease diagnosis
Cushings- Low dose dexamethasone suppression test- will tell you at 4 hrs if it is adrenal or pituitary and you will get results of cushings or not at 8 hours
Recheck labwork after treating with Triolstane if it does have cushings with ACTH stim test
Addison’s disease- do baseline cortisol and if under 2, then do ACTH stim test
horses tx of cushings disease–
Peroglide, trilostane or cyproheptadine
Hemangiosarcoma is a malignancy of what?
Endothelial cells that normally line the blood vessels
Hemangiosarcoma likes this organ the most
spleen (but others are right atrium, liver, retroperitoneal space, and subcutaneous tissues)
Hemangiosarcoma is highly mets and MST is ___
<1 year regardless of treatment
what is the most common tumor to met to the brain?
Hemangiosarcoma
What might you see in patient with Hemangiosarcoma on cbc?
Anemia, thrombocytopenia, schistocytes (fragmented part of the RBC)
Hemangiosarcoma cutaneous forms–
induced with chronic sun exposure, usually dogs with fair skin and thin hair that sunbath on their back, about 1/3 of them met and are invasive and advanced but MST is longer (> 1 year)
What stones can be seen in the bladder on rads?
Struvite and calcium oxalate
___ stones form with UTI because bacteria produces ammonia and ureases which increases the pH
struvite
What is the most common urolith in dogs and cats?
Struvite and calcium oxalate (can see both on rads)
Medical dissolution of urolith is possible for most stones besides which one?
Calcium oxalate
What diet do we use for tx of cystine and urate stones?
alkalinizing diet
what do we use to tx for struvite stones?
Acidifying diet
what is the urolith that most commonly requires sx?
Calcium oxalate
what med binds to cystine uroliths to form a soluble compound?
2-MPG (also use a urine alkalizer like potassium citrate or oral sodium bicarbonate), also reduce protein and restrict sodium
Urate stones are in what breed? How to tx them?
Dalmatians; t with reducing protein and use a urine alkalizing agent like potassium citrate or oral sodium bicarbonate, allopurinol
what does allopurinol do for urate stones?
decreases uric acid inhibition of conversion of hypoxanthine to xanthine to uric acid but beware bc giving Allopurinol without a reduced protein diet may lead to formation of xanthine stone
What is the only disinfectant for parvovirus?
Sodium hypochlorite aka Bleach
Confirming parvovirus diagnosis:
ELISA fecal or Cite test
Parvovirus destroys rapidly dividing cells in intestinal ____ and causes secondary ____ ___
crypts; secondary villous atrophy
what suture type do we use for tendon or ligament reapirs or jt capsule or fascial closures where prolonged strength is needed?
Polypropylene aka Prolene which is monofilament that is nonabsorbable
what type of suture lasts like 2 years and is known to have high tissue reactivity?
Silk which is multifilament
when does cardiac tamponade occur?
when the intrapericardial pressure equals or exceeds that of the right atrial pressure
where is the pericardial space?
between the parietal and visceral layers of the serous pericardium of the heart– this is normally small amounts of fluid here but not a lot so if there is more than normal it is pericardial effusion
what happens with pericardial effusion?
the heart tries to pump against the pressure from fluid and causes impaired cardiac function secondary to decreased diastolic filling
CS of pericardial effusion
non specific/sick animal to dyspnea, peripheral edema in large animals and abdominal distension (ascites) in small animals and colic in horses
will have muffled heart sounds and jugular vein distension from increased right atrial pressure and poor peripheral pulse quality (weakened pulses) with elevated HR and RR
what is pulsus paradoxus and why might a p have it?
Blood pressure decreases with inhalation
It’s most common in people with acute asthma, COPD exacerbation, and cardiac tamponade
what is the gold standard for diagnosing pericardial effusion?
echo
tx of pericardial effusion-
pericardiocentesis- know complications are ventricular premature contractions (VPC’s), laceration of the coronary artery, sudden death
polydipsia by definition is more than ____ ml/kg/day; polyuria is more than ___ ml/kg/day
> 100ml/kg/day; > 50ml/kg/day
how can you differentiate between diabetes insipidus and psychogenic polydipsia?
water deprivation test but can be a huge risk in p if not done properly – if it can concentrate its urine when fluids are withheld then it is psychogenic polydipsia but if it cannot then it is diabetes insipidus
What is the test of choice for ruling in/out central diabetes insipidus (CDI)???? I
For central diabetes insipidus (CDI)- trial therapy with vasopressin but beware that it can take days to weeks to overcome medullary washout of the kidneys before it works
when should you NEVER do a water deprivation test?
on patients that are sick, dehydrated, have endocrine disorders, azotemic, or hypercalcemic!!!!!!!
__ trauma occurs in 40-60% of HBC patients
thoracic trauma
what are the most common thoracic trauma conditions?
Pneumothorax and pulmonary contusions
suspect pneumothorax, do what ASAP (even before rads or anything)
thoracocentesis
severe pneumothorax can cause collapse of the ___ ___ and cause decreased venous return and impairment of CO with shock
vena cava
what are pulmonary contusions? How do they form?
impact -compression on chest and lungs- elastic recoil causes shearing forces on the blood vessels and hemorrhage into the alveoli and pulmonary interstitium- causes ventilation/perfusion mismatch and hypoxemia
What anatomical structure is usually open when a diaphragmatic hernia occurs?
open glottis causing low pressure in the lungs and large pressure in the space surrounding the lungs
what is the most common structure herniated into the chest with a diaphragmatic hernia?
Liver
usually takes ____ hours for lung contusions to show themselves. What do they look like on rads?
24 hours; they look like patchy/diffuse interstitial to alveolar pattern but may look n at first
where do we do a thoracocentesis for pneumothorax?
7th-9th intercostal space cranial to rib and dorsal 1/3 of chest
tx for flail chest (two parts of chest broken and moving independently)
opioid +/- Lidocaine +/- Ketamine CRI and intercostal nerve block with local anesthetic
oral ulcers, think ___ _virus which is spread aerosol in cats
Calicivirus (can cause lameness in cats so know that too!!)
most cocker spaniels have this neurologic diseases, what is it and what does it mean?
Chiari malformations (CM) which are structural defects where the lower part of your brain presses on and through an opening in the base of the skull and cerebellum into the spinal canal. The cerebellum is the part of the brain that controls balance
what is syringomyelia?
most common in cocker spaniels (along with Chiari like malformation) and occurs a result of the development of the fluid cavities within the parenchyma of the SC because the CSF mvmt through the foramen mangum is abnormal “head or ear scratcher disease”
what is the most common site for tumors in the dog?
cutaneous tumors
Squamous cell carcinoma (SCC)
malignant neoplasm of keratinocytes and is locally invasive but slow to mets and assoc. with sun exposure
in dogs, what tumor is the most common cause of tumor on the digit (BUT NOT THE CASE FOR CATS– likes the head on cats)
SCC
what tumor is benign and is said to be like reactive hyperplasia that is langerhan cell in origin and is common in dogs but RARE in cats
cutaneous histiocytoma (single well circumscribed mass in young dogs and tumors usually regress on their own in like 3 months but may get realll ugly before they go away for warn owners)
what vaccines are most associated with fibrosarcoma?
FeLV and RV
what is the holding layer of the abdomen?
rectus abdominus fascia sheath
what tumor type is common in cats but uncommon in dogs and most are benign, usually found on the head, neck, and thorax and are solitary and well circumscribed?
Basal cell tumor
What tumor is T lymphocyte in origin and is malignant with variable pigmentation?
cutaneous lymphoma
skin tag aka ____ _____
fibrovascular papilloma
what is a portosystemic shunt?
abn bf that results in deviation of the blood that is meant to go to the liver from the portal circulation into systemic circulation
congenital or acquired, single vs multiple, intrahepatic vs extrahepatic
what is the most common type of PSS?
Single, congenital and extrahepatic
anatomy involving pss-
all blood from the GI tract drains into the portal vein for detoxification in the liver- the liver gets about 2/3 of its blood flow from the portal circulation
cat with cooper colored iris usually has _____
PSS
small dogs get ___ shunts for PSS more commonly and larger dogs get _____ shunts
small dogs get extrahepatic “because they are so extra” and large dogs get intrahepatic usually but not always
bloodwork suggesting PSS-
Liver enzymes will be variable but ALP usually elevated
the following may be normal to decreased :
-BUN
-Glucose
-Albumin
-cholesterol
WHICH ARE THE LIVER FUNCTION TESTS
bile acids > 200 means shunt
can also do fasting ammonia test (do this if
are elevated)
how does PSS happen physiologically?
The acquired from occurs with one of two things
Either the ductus venosus fails to collapse at birth and remains intact and open after the fetus no longer needs it
Or a blood vessel outside of the liver develops abnormally and remains open after the ductus venosus closes
PSS are usually ______ but sometimes the shunts are acquired from liver disease like _____
congenital; cirrhosis
what are some signs of PSS in a dog or cat?
stunted growth, poor muscle development, GI signs, Microhepatica on rads because “if you dont use it, you lose it”, disorientation, seizures, staring off into space, head pressing, urinating often and drinking a lot and vomiting, diarrhea
Usually signs after a high protein meal and take a while to wake up from anesthesia
also cooper colored iris in cats
Diagnosis of PSS
will likely have (microcytosis), low BUN, albumin and increases in liver enzymes (ALT and AST)
UA- will have low USG, may be evidence of an infection, urine may have spiky crystals called ammonia biurate crystals present
Bile acid test- take a baseline, give fatty meal (a/d) and measure two hours later
–> If the bile acids are mildly increased, or if the dog seems clinically normal despite the test results, the test can be redone in 3-4 weeks
–> If bile acids are more than 100 is it probably PSS
If ALT is above 200 it may be PSS and you should run a bile acid test in house
what is more difficult to repair sx, intrahepatic shunt or extrahepatic shunts?
intrahepatic shunts are more challenging
for either one we use the ameroid constrictor which results in gradual occlusion of the shunting vessel
tx of PSS
Lactulose changes the pH in the large intestine which decreases the absorption of ammonia and other toxins that makes the intestinal environment unfavorable for toxins
Also use abx and diet changes (low protein and only high-quality protein diets)
what urine crystals might you see in a p with PSS?
Ammonium biurate crystals “urate crystals”
rodenticide toxicities–
the most common type is anticoagulant types which inhibit vitamin K1 epoxide reductase
CS of rodenticide toxicity
hemorrhage and shock, abdominal distension, resp. distress, usually occurs 3-7 days after ingestion
will have prolonged PT (extrinsic pathway) FIRST because factor 7 has the shortest half life and is vitamin K dependent for its coagulation abilities
PTT will be elevated like 3-5 days later (intrinsic)
Tx of rodenticide toxicity–
emesis if happened within 4 hours AND only if PT is normal
Vitamin K supplementation orally for 4 weeks, check PT 1-2 days after completing vitamin K therapy for 4 weeks
if dog is in hemorrhage secondary to coagulopathy then do plasma transfusion with RBC initially, vitamin K1, isotonic crystalloids and/or colloids for volume support, vit K1 subQ
(if hemothorax, do thoracocentesis with U/S guided technique and auto transfuse it WITH A FILTER back to the patient)
what tumors are composed of many tumors derived from mesenchymal cell origin
soft tissue sarcomas and are all locally invasive while their potential for mets can be determined by histologic grade
Bromethalin rodenticide is not like warfarin toxicity but is still toxic, what is its MOA and how to tx its toxic effects?
inhibits oxidative phosphorylation and ATP esp. i neurons and causes loss of osmotic gradients so cerebral edema and increased intracranial pressure (ICP)
will see seizures and tremors, can be days to weeks after ingestion and tx with seizure meds, mannitol and/or furosemide to reduce the cerebral edema and keep patient inclined to promote venous pressure return
Cholecalciferol rodenticide toxicity MOA, CS, and tx
converts to vitamin D after ingestion and results in increased intestinal absorption of calcium and mobilization from bones. leads to severeeee hypercalcemia, hyperphosphatemia and organ injuries.
tx with saline diuresis bc too much calcium harms to kidneys and steroids to reduce intestinal Ca absorption and bisphosphates to inhibit osteoclast activity/bone absorption
prognosis shit once renal failure occurs
Ethylene glycol toxicities
antifreezes
metabolized by alcohol dehydrogenase, glycolic acid and oxalic acid (and some irrelevant others)
will see calcium oxalate crystals in the urine, p will have ataxia and vomiting, act drunken and pu/pd, if progresses, they will go into CV failure and renal failure and death
Tx- Fomepizole (4-MP) which is a competitive inhibitor of alcohol dehydrogenase and must be given within 8 hours of ingestion of eythlene glycol and dose every 12 hours for 1-2 days ($$)
could also use 20% ethanol like grain alcohol but need every 6 hours for 5-6 tx and can worsen acidosis and kidneys
hemodialysis or peritoneal dialysis
house hold cleaner ingestion that are acid based or gas consumption-
administer oral milk or water, DO NOT ENDUCE VOMITING, GI protectants for several days
Moldy garbage ingestion toxicity–
“Garbage Git” is ingestion of moldy food with penitrem A which is a neurotoxicant caused by Aspergillus species and raises resting membrane potential, thus causing depolarization and fine motor tremors, panting, restlessness, tonic spasms, ataxia and eventually seizures
Moldy garbage ingestion toxicity “Garbage Git” TX
emesis if not neurologic and if it happened recently, activated charcoal, methocarbamol, seizure meds if needed, GI protectants like H2 blocker and sucralfate
Bromethalin rodenticide is not like rodenticide toxicity but is still toxic, what is its MOA and how to tx its toxic effects?
inhibits oxidative phosphorylation and ATP esp. i neurons and causes loss of osmotic gradients so cerebral edema and increased intracranial pressure (ICP)
will see seizures and tremors, can be days to weeks after ingestion and tx with seizure meds, mannitol and/or furosemide to reduce the cerebral edema and keep patient inclined to promote venous pressure return
Cholecalciferol rodenticide toxicity MOA, CS, and tx
converts to vitamin D after ingestion and results in increased intestinal absorption of calcium and mobilization from bones. leads to severeeee hypercalcemia, hyperphosphatemia and organ injuries.
tx with saline diuresis and steroids to reduce intestinal Ca absorption and bisphosphates to inhibit osteoclast activity and bone re-absorption
Ethylene glycol toxicities
antifreezes
metabolized by alcohol dehydrogenase, glycolic acid and oxalic acid (and some irrelevant others)
will see calcium oxalate crystals in the urine, p will have ataxia and vomiting, act drunken and pu/pd, if progresses, they will go into CV failure and renal failure and death
Tx- Fomepizole (4-MP) which is a competitive inhibitor of alcohol dehydrogenase and must be given within 8 hours of ingestion of eythlene glycol and dose every 12 hours for 1-2 days ($$)
could also use 20% ethanol like grain alcohol but need every 6 hours for 5-6 tx and can worsen acidosis and kidneys
hemodialysis or peritoneal dialysis
toxocara species aka _____
roundworm
Toxocara (roundworm) migration and human risks
the larvae migrate through the liver and lungs and are carried up the mucociliary apparatus where they are swolled into the small intestine; it is important to know that Toxocara canis is associated with visceral larval migrans in humans and all toxocara sp. are zoonotic
Toxocara canis and cati are the ones that can affect humans
where do toxocara (roundworms) live in the dog and cat? Transplacental and/or transmammary transmission in cats or dogs????
in the small intestine and transmitted by transmammary AND transplacental in dogs but ONLY transmammary in cats or ingestion of the paratenic host or eggs, diagnose on fecal floatation
what species of toxocara does not migrate outside of the GI tract?
Toxoplasma leonina does not migrate outside of the GI tract and is not transplacental and/or transmammary (unlike T. canis and cati)
Ancyostoma aka ____
hookworm
Ancylostoma are associated with what risks in humans?
cutaneous larval migrans and high risk of zoonosis
what is the cat form of the Ancylostoma aka hookworm called (the dog is canis but the cat is different)
Ancylostoma tubaeforme
Ancylostoma tubaeforme has cats as the DH and has no transplacental or transmammary transmission T/F
True!!!!
Ancylostoma canis in dogs has ____ transmission
transmammary (unlike cat which does not have transmammary or transplacental transmission)
what is the hook worm affecting BOTH dogs AND cats?
Ancylostoma braziliense which has transmammary ANDDD transplacental transmission
Trichuris aka ______
whipworm
Trichuris infection can look like what disease?
Addisons disease
what worm can persist for a while and lives for a long time in the environment?
Trichuris
where does Trichuris live mainly in the body?
Cecum
what GI parasite of dogs and cats needs a high specific gravity fecal float or centrifuge?
Trichuris aka whipworms (look like a football under the microscope)
Dipylidium caninum aka _____
tapeworms
transmission and migration of Dipylidium caninum aka tapeworms–
ingestion of infected fleas/lice- gravid proglottids are voided in the poop and they release egg packets- then the next IH ingests the egg packets and the tapeworms go to the SI
Tx of Dipylidium caninum
praziquantel
Taenia species is another tapeworm form that can include what two animals as IH?
rabbits and rodents as the intermediate hosts
what is the most common Taenia subspecies?
Taenia pisiformis
why does uremia occur with CRF aka CRI (chronic renal insufficiency )?
the inability of metabolic byproducts leads to buildup of urea (and other uremic toxins) and contributes to CNS depression, anorexia, vomiting, halitosis (bad breath), gastritis, and other CS
diet therapy for p with chronic renal failure–>
low protein (so urea does not sky rocket and cause uremia), high moisture, minimize acidosis state, reduced phosphorus
CS/Diagnosis and tx of feline asthma
expiratory dyspnea (expiratory push) and wheezing +/- coughing, acute onset
rads show bronchial pattern
Tx- oral and/or inhaled steroids and bronchodilators
what does a bronchial pattern look like on rads?
“train tracks and doughnuts” which are thickened bronchial walls
tx (more in depth info) for feline asthma–
inhaled bronchodilator like albuterol inhaler, long-term corticosteroids (once a response is seen, use inhaled steroids and taper from the oral steroids), +/- O2, bronchodilator, sedation if an ER presentation
why does a spacer need to be used when cats need an inhaler for their asthma?
it prevents them from needing to inhale on command so they can just breath in and out normally and let the meds flow into their airways
What is the most common cause of hyperthyroidism in cats?
adenomatous hyperplasia of the thyroid glands (but can also be due to functional thyroid carcinoma but that is less common)
what are the key CS of a cat with hyperthyroidism?
weight loss, polyphagia, vomiting, hyperactivity
may have thyroid nodule on palpation “thyroid slip” and have tachycardia, heart murmur or gallop
what is the diagnosis for hyperthyroidism in cats? What is toc?
serum T4 levels; TOC is oral methimazole, or surgical thyroidectomy, or radioactive iodine I-131
what is the function of the thyroid?
it synthesizes thyroid hormones (T4) and tri-iodothyronine (T3)
most common urinary stones in the dog and cat?
struvite and calcium oxalate
most common urinary stones in the dog and cat?
struvite and calcium oxalate
what abn bloodwork might you see on a hyperthyroid patient?
Increased ALT, ALP, AST, erythrocytosis, hypertension and high serum T4
What is the screening test of choice for hyperthyroidism in cats?
Total T4 levels
If abnormal, then do Free T4 by equilibrium dialysis
what is a common comorbidity of hyperthyroidism in cats?
renal disease
what medication may cause fascial excoriations?
Methimazole
What do you tell an o if they are thinking about doing the radioactive iodine I-131 tx for their hyperthyroid cat?
It is a single dose but the p has to be in hosp for like 1-2 weeks and possible side effects are Iatrogenic hypothyroidism requiring T4 supplementation life long and non-resolution of CS so need for redosing the tx
FIP-
a disease developing in cats usually 6 months to 2 years old and is a mutation of the feline enteric coronavirus (FECV) and nearly all cats are exposed to the coronavirus but only some will develop FIP and cats over ten years old are basically immune
How is FIP transmitted?
fecal oral transmission, the virus may persist in the enviornment for up to 2 weeks unless detergents are used
what is the effusive form of FIP?
characterized by vasculitis, leaking of proteins and fibrin rich fluid into pleural and peritoneal cavities
Do fluid analysis to diagnose, will have a dark yellow sticky and viscous high protein fluid
What is the dry form of FIP
granulomatous reactions in tissues, may involve nervous system, kidneys, eyes, LN and other sites. More difficult to diagnose
will have mature neutrophilia, lymphopenia, non-regenerative anemia, and hyperglobulinemia
gold standard diagnosis is histopathological exam of biopsy with seeing perivascular pyogranulomatous inflammation
Diagnosis of wet FIP and dry FIP–
Dry form– will have mature neutrophilia, lymphopenia, non-regenerative anemia, and hyperglobulinemia
gold standard diagnosis is histopathological exam of biopsy with seeing perivascular pyogranulomatous inflammation
Wet form– Do fluid analysis to diagnose, will have a dark yellow sticky and viscous high protein fluid
what about the FIP vaccine?
Is available for kittens over 16 weeks old but still can be infected after maternal antibodies wean off at 4-6 weeks, the current vaccine can result in false positive FECV titers
injection site sarcomas (ISS)
extremely locally invasive with fingerlike projections and mets rate of about 20%
occurs in 1 out of 10,000 vaccine injections but is not always associated with vaccines
what are the two vaccines with the highest incidence of injection site sarcomas?
Rabies and FeLV
compared to other sarcomas, ISS histologically has …..
more necrosis, inflammation with lymphocytes and macrophages and mitotic figures
What is the 1, 2, 3 rule
biopsy is indicated if a vaccine site lump fits the following criteria:
- Continues to grow after 1 month post vaccination
- larger than 2 cm
- still presents after 3 months
What is the TOC for injection site sarcomas in cats?
Radical excision with 3-5 cm lateral margins and 2 fascial planes deep, amputation if its a limb
+/- radiation/chemo
where to give cat vax
as low as possible
RV on right HL
FeLV on left HL
FVRCP on right Leg
FeLV and FIV are _____ that are transmitted only through ____ and should be considered in almost any sick cat
retroviruses; saliva
FeLV is a ____ test and FIV is a ____ test
FeLV is an antigen test (and is more reliable) and FIV is an antibody test (can be complicated in young cats and vax cats)
Up to ___% of cats may develop FeLV but only some develop a transient infection but cats with progressive forms of the infection die within ___ years
98%; 3 years
What is the “friendly” cat disease? What is the “unfriendly” cat disease?
Friendly is FeLV (contracted by intimate contact, grooming, licking)
FIV is the unfriendly diseases and is transmitted from biting
CS of FeLV and FIV
can be asymptomatic or lymphadenopathy, many oral lesions, neutrophilia, fever, development of infections, severe emaciation, lymphoid depletion
Testing for FeLV–
ELISA- detects antigen and confirm with a positive test by immediate IFA testing to differentiate between actual vs transient infection or can re-test in 1-3 months because up to 98% of cats infected with FeLV will have self limiting infection and develop antibodies and become antigen negative
Testing for FIV–
ELISA and western blot tests are used and are both antibody based
Do not test kittens under 6 months because it interferes with maternal antibodies
are FeLV and FIV vaccines core vaccines?
Nope they are considered based on risk factors and the risk vs. benefit immunization
core vaccines for cats
Panleuk, feline herpesvirus, rhinotracheitis, feline calicivirus (FVRCP) start as early as 6 weeks, booster every 3-4 weeks
RV given as early as 12 weeks
what feline disease can cause a positive test result from the vaccine?
FIV- the vaccine results in production of antibodies that interfere with all FIV antibody based diagnostic tests
what is the most common giardia in dogs? What is the TX for giardia?
Giardia duodenalis is the most common; the TX is fenbendazole, metronidazole, or both together tho no approved tx exists directly for dogs and cats
what is the transmission of giardia
route is fecal to oral and occurs via ingestion of cysts
what are the diagnostic options for giardia?
direct smear using saline or fecal float using centrifuge or fecal giardia ELISA test for antigen detection
PCR available to recheck
be sure to mention intermittent shedding makes it hard for def diagnosis and sometimes you have to repeat the test(s)
_____ is not considered a true parasite in dogs and cats
Eimeria
Lar par in dogs tx
o Crycoaryteniod lateralization surgery (Tie-Back) is the TOC but 10-28% of p will get aspiration pneumonia after this
o Partial laryngectomy- 50% complication rate bc of laryngeal webbing
o Permanent tracheostomy- best for p with increased risk of asp. Pneumonia like megaesophagus p
o Reinnervation of the laryngeal musles- may take a long time for laryngeal function to come back so not practical
o Castellated laryngeofissure- assoc. with severe post-op bleeding/edema and not usually done
lar par notes
- Its usually an idiopathic disease of older dogs which can result in severe dyspnea and death, older labs and goldens are predisposed
- May have voice change, inspiratory stridor, dyspnea
- The cricoarytenoideous dorsalis muscle opens the arytenoid cartilage which opens the airway and is innervated by the recurrent laryngeal nerve
- The acquired form is most common and is usually idiopathic, could be due to nerve issues, a mass in the region and/or hypothyroidism
- Def diagnosis is laryngeal examination done under very light anesthesia with Doxapram which stimulated respiration (when the p inhales, you would see abduction of arytenoids in a n patient)
what breed type is predisposed to developing nasal aspergillosis?
Dolichocephalic
what does each drug treat/is primarily used for:
- Drontal/Droncit
- Revolution
- Strongid
- Metronidazole
- drontal/droncit used for tapeworms
- revolution used for fleas, HW, hookworms, roundworms, and ear mites
- strongid used for roundworms and hookworms
- Metronidazole primarily used for anaerobes/colitis and giardia
how are dogs and cats exposed to coccidiosis (Eimeria and/or Isospora species)???
ingestion via sporulated oocysts from contaminated environments
what are the two subspecies of coccidosis in dogs and cats?
Eimeria and Isospora species
what is the tx for coccidiosis (Eimeria or Isospora species)?
Only approved drug is Sulfadimethoxine but other options are Ponazuril, TMS
Feline tritrichomonas infection is most commonly caused by Tritrichomonas _____
blagburni (which is formerly known as T. foetus)
Feline tritrichomonas infection domestic small animal host is ___ and location of infection is ____ and _____
cats; in the cecum and colon of cats
what is the diagnostic test available for Feline tritrichomonas infection? What is the tx?
Direct fecal smear, PCR, or culture
note that Giardia often looks similar on direct smear but they move differently– Tritrichomonas moves jerky and random but Giardia moves like a falling leaf
Tx is ronidazole,
what is the tx for Feline tritrichomonas infection??
No approved tx exist but use Ronidazole
Toxoplasmosis gondii- what are the domestic small animal hosts and what does transmission look like?
Cats; transmission can include either acquired or congenital modes
Acquired- ingestion of infected oocysts or infected tissues containing bradyzoites (like with Neospora caninum)
or
Congenital- passage of tachyzoites from the dam to the offspring with transmammary or transplacental transmission
what is the diagnosis for toxoplasmosis gondii?
fecal flotation showing oocysts but may not be seen, can also do serological testing with IFA or ELISA (A rise in IgG over a 2-3 week period or high IgM can help suggest an active infection!!!!!)
PCR
What is a good diagnostic test to indicate an active shedding of Toxoplasma gondii infection in a cat?
Serological test involving IFA or ELISA showing a rise in IgG over a 2-3 week period or high IgM
what is the TOC for toxoplasma gondii infection?
clindamycin is the TOC
Toxoplasmosis can cause congenital abn of human fetuses if pregnant woman is infected T/F
T
cryptosporidium- TOC
Nitazoxanide
blocked cats usually present with what metabolic derangements?
Azotemia, hyperkalemia, metabolic acidosis, hypocalcemia, and hyperphosphatemia
what do you see on ECG With hyperkalemia?
Bradycardia, tall tented T waves, widened QRS complexes, decreased to absent P waves and prolonged P-R intervals
tx hyperkalemia in dogs and cats–
IV fluids 0.9% NaCl (or can do LRS if that is all you have but Ringers solution is better)
IV calcium gluconate to re-establish normal depolarization but does not help decrease potassium (K+)
Give IV dextrose AND regular insulin NEVER GIVE INSULIN ALONE IN THIS CASE (this combo moves the potassium back into the cells)
sodium bicarbonate to shift potassium back into the cells as pH increases
where do escape beats come from?
from the AV junction or purkinje fibers
what is the difference of escape beats and VPC’s ?
They look the same but escape beats come from AV junction or purkinjie fibers and happens after a long pause whereas VPCs are from the ventricular and do not necessarily happen after any pauses
What does it mean if there is a normal QRS complex that is too close to the previous one BUT normal? What if it is abnormal looking?
Atrial premature beat; ventricular premature beat if QRS complex is abnormal
what is the difference between Atrial tachycardia and Atrial Fibrillation?
A-tach is continuous string of atrial premature beats as HR regular just fast but A fib is rapid depolarization of the atria which irregular rhythm (same with ventricles with V-tach and V-fib)
AV blocks 1st-3rd degree
1st degree- prolonged P-R interval
2nd degree- not every P followed by a QRS and heart beat dropped on auscultation
3rd degree- no conduction between sinus node and ventricles, profound bradycardia/escape rhythms, tx with pacemaker
VSD (most common in cats whereas PDA is more common in dogs) has ___ to ___ shunting
left to right shunting of blood
what do positive inotropes do for the heart?
Increase contractile strength (Pimobendan aka VetMedin)
Grades of periodontal disease-
Grade 1: healthy
Grade 2: mild periodontitis→ erythematous and inflamed gingiva, plaque and
calculus, gums may bleed but pockets are minimal
Grade 3: moderate periodontitis→ deeper periodontal pockets, gingival
recession, up to 50% loss of bone (technically diagnosed via radiographs only)
Grade 4: advanced periodontitis→ more than 50% bone loss, severe dental
disease
what is the most common gastric tumor in dogs?
adenocarcinoma
What is evan’s syndrome?
IMHA and thrombocytopenia
Cauda equina syndrome
Compression of nerve roots at the caudal end of the cord disrupting motor and sensory
pathways to the lower extremeties. Often caused by herniated disc
Dx: CT myelography or MRI
Tx: surgery or steroids
Cognitive dysfunction
Age related disease that has progressive accumulation of beta-amyloid in the brain
CS: inattentiveness, pacing, walking in circles, sundowning, vocalization, becoming lost
Brain atrophy on MRI
Degenerative myelopathy
Degeneration of axons and myelin starting at the thoracic SC, associated with mutation in SOD-1 gene, progressive but non-painful and is seen in GSD, corgis, and boxers mostly. No tx, PT may help, what that dog at Greenbriar had (was the GSD in PT)
Fibrocartilaginous emboli
Microscopic pieces of fibrocartilage occlude spinal cord vessels
that causes focal spinal cord ischemia→ infarct
Deficits are often asymmetric
Treatment:
-Supportive care and physical therapy, about 85% affected p make functional recovery but can take 3-4 months for recovery
Granulomatous meningoencephalitis
immune mediated form of MUO (meningocephalitis of unknown origin) that is usually intracranial but can be in SC as well, tx is LONGGGGGG tapering dose of Cytarabine (Cytostar)
what is the 30/30/30 rule for Granulomatous meningoencephalitis?
30% wont leave hospital, 30% leave but don’t live, 30% do well with long term
therapy
What are the types of Intervertebral disc disease?
Hansen type 1: nucleus pulposus (inside portion of the disc) extrusion, chondrodysplastic breeds (dachshunds), acute/painful, often younger dogs
Hansen Type 2: Annulus fibrosis extrusion (outer ring of the disc), chronic +/- painful, non-chondrodysplastic breeds, often older dogs
Deficits and localization for IVDD
*C1-5: UMN tetraparesis or paraparesis
* C6-T2: LMN forelimb, UMN hindlimb
* T3-L3: N FL, UMN hindlimbs
* L4-S1: N FL, LMN hindlimbs
deep pain-not the withdrawal reflex, must show signs of pain
-LMN diseases have decreased tone while UMN diseases have increased tone
what is the most common agent cultured from meningitis in dogs/cats?
Cryptococcus (fungal) and canine distemper virus and FIP (viral)
Myasthenia gravis
Born with too little ach receptors
dx: acetylcholine receptor antibody titer
Tx- ANTI-acetylcholinesterase (Neostigmine or pyridostigmine) (can see SLUD signs)
Immunosuppressive therapies may be needed
Vestibular disease rules to know:
Head tilt towards side of the lesion
* Nystagmus fast phase away
* Intact proprioception does not rule out central lesion
* ALWAYS localize to side of proprioceptive deficits (if it doesn’t match its paradoxical)
What is the most common cause of peripheral vestibular disease in the dog and cat? what is the second most common?
first most common is otitis media/interna; second most common is canine idiopathic vestibular disease: older dogs, ataxia,
head tilt, nystagmus, vomiting, usually resolves in 2 weeks but head tilt often lifelong
what is the most common cause of cataracts in dogs?
Genetics
how do you differentiate between cataract and nuclear sclerosis?
on retroillumination with a slit lamp, you cannot see through a cataract but you can see through nuclear sclerosis!!
why do diabetic dogs sometimes get cataracts?
excessive glucose overwhelms the hexokinase pathway and leads to sorbitol build-up which draws water into the lens
what are the different types of cataracts?
Incipient: <15% of lens
Immature: best time for surgery, 15-90% lens
Mature: 100% of lens
Hypermature: lens resorption, wrinkled lens capsule, sparkly appearance
what is lens induced uveitis?
when proteins of the lens leak into anterior chamber due to cataract formation causing uveitis
what sx technique do we use for the cherry eye (DO NOT cut out!!! will result in lifelong dry eye)
Morgan pocket technique
what is the NUMBER ONE cause of conjunctivitis in dogs?
KCS
corneal ulceration
Blepharospasm, conjunctival hyperemia, excessive lacrimation, ocular discharge, corneal
edema, corneal vascularization
Underlying causes: distichiasis, KCS, foreign body, entropion, ectopic cilia
Dx: fluoroscein stain-does not adhere to epithelium, stains exposed stroma
Uncomplicated heal within 3-7 days
descemetoceles: repels stain so will have fluoroscein stain around ulcer but not at the center giving donut appearance→ refer bc usually surgical
what test do we do if we suspect corneal perforation?
Seidel test which is where concentrated fluorescein stain is used and will be spread diffusely across the cornea with a large area of green where there is aqueous humor
Spontaneous chronic corneal epithelial defects-
Aka Spontaneous chronic corneal epithelial defects (SCCEDs), also known as indolent ulcers, Boxer’s ulcers or nonhealing ulcers, are noninfected, epithelial defects with a redundant, nonadherent epithelial border
boxer dog predisposed
tx of superficial keratectomy has best success rate
Fluoroscein stain seeps under the ulcer margin, in this situation, the space between the epithelium and the stroma are not able to adhere together and heal properly
TX OPTIONS:
*Cotton tipped applicator debridement (50% success)
*Grid or multiple punctate keratotomy (only dogs, 70% success)
* Diamond burr debridement (70-95% success)
*Superficial keratectomy (~100% success)
* Medical therapy: NSAIDs, topical antibiotics to prevent infection,
recheck in 10-14 days
Chronic superficial keratitis (Pannus)-
Predisposed breeds: German shepherds, Greyhounds
o Incidence and severity increase at high altitude, increased UV light, cloudiness to the cornea which is the clear part of the eye
life long, more commonly affects younger dogs and is more severe and progressive
o Antigens to corneal proteins leading to hypersensitivity of corneal proteins
Dx- no stain uptake, starts at the ventrolateral limbus and is vascularized, non-painful and can progress to blindness
Tx -lifelong topical steroids or cyclosporine, sunglasses to protect from UV light
+/- radiation therapy
What is it called when there is pannus of the 3rd eyelid?
Plasmoma- occurs when plasma cells infiltrate the 3rd eyelid and causes thickening, depigmentation, and follicle formation
GSD predisposed
Tx is similar to chronic superficial keratitis (regular pannus)
Pathophysiology behind glaucoma:
Blockage of aqueous humor→ increased IOP→damage to retinal glanglion cells and optic
nerve→ blindness
What is the most common cause of glaucoma in cats?
Secondary to something else like uveitis or trauma (unlike dogs who get it mostly from having concurrent diabetes)
CS of acute glaucoma:
- Midrange pupil (often fixed), with sluggish PLR (other causes
of red eye do not usually present this way) - Pain
- Corneal edema
- Note: feline acute glaucoma causes mydriasis and buphthalmos
CS of chronic glaucoma:
- Corneal edema
- Haab’s striae (breaks in Descemet’s membrane)
- Buphthalmos: end stage disease, usually blind
what is the normal pressures of the eyes?
10-25mmHg (lower end for Doliocephalics and higher end for brachycephalics)
what is the normal pressures of the eyes?
10-25mmHg (lower end for Doliocephalics and higher end for brachycephalics)
tx for glaucoma:
Gentamicin injection for ciliary body ablation (only for blind eyes),
carbonic anhydrase inhibitors (Dorzolamide which decreased Aq. humor production), beta blockers (-olol which decrease Aq. humor production BUT NOT IDEAL for animals that also have heart issues LOL), Prostaglandin analogs (Latanoprost which increases Aq. humor outflow– use only for PRIMARY glaucoma and does not work at all in cats and do not use if there is secondary uveitis bc will make it worse!!!)
Keratoconjunctivitis sicca
▪ Most common cause of conjunctivitis in a dog
▪ Deficiency of aqueous portion of tear film
▪ Schirmer tear test: no proparacaine
* Normal >15mm/min
▪ Genetic predisposition, immune mediated, usually bilateral
▪ Lymphocytic-plasmacytic infiltrates in lacrimal gland respond to immunomodulatory therapy
▪ Can be caused by trauma, radiation, hypothyroidism, diabetes, and cushings disease
▪ Treatment: Cyclosporine A or Tacrolimus topically, artificial tears
▪ Surgical therapy: parotid duct transposition (may elect if no response to therapy after 6 months)
Uveitis
▪ Clinical signs: aqueous flare, hyphema, hypopyon, miosis due to pain, hypotony
Hypotony- low IOP
Hypopyon- accum. Of WBC causing a whitish film in the anterior chamber of the eye
Miosis is constricted pupil
Aq. flare occurs when the blood-aqueous barrier is compromised and is visualized when a small, direct beam of light creates a “headlights-in-the-fog” effect in the anterior chamber
▪ Causes of a red painful eye: KCS, corneal ulceration, glaucoma, uveitis, immune-mediated
▪ IOP<10 unless secondary glaucoma
Some Golden retrievers are predisposed (genetic)
▪ Treatment: antiinflamatories, mydriatic (atropine or tropicamide), glaucoma medications (do
not use latanaprost! Prostaglandin agonist-already have increased prostaglandins from
inflammation, will cause more inflammation!)
Cholangitis and cholangiohepatitis in cats–
Biliary system primary target of inflammation to liver in cats
CS: jaundice and hepatomegaly
In cats, bile duct and pancreatic duct join to form the common bile duct before emptying into major duodenal papilla
In dogs, adenocarcinomas mostly occur in the stomach but where do they like to go in the cat?
Jejunum and ileum
in cats- Lymphocytic plasmacytic stomatitis
▪ Inflammation of the oral mucosa including the buccal and labial mucosa, palate,
tongue, floor of the mouth and gingiva
▪ Extensive ulceration, gingivitis, excessive salivation, decreased appetite
▪ Seem to be plaque intolerant
▪ Often need full mouth extraction of teeth (60% remission)
▪ steroids
Megacolon in cats
Colon diameter 1.5 x length of L7 vertebra
Treatment:
-De-Obstipation
- dietary modification: high fiber or low residue, stool softeners, motility modifiers: Cisapride, or surgical options
what is the most common cause of anemia in cats?
Anemia of chronic disease
what are some examples of autoimmune hemolytic anemia for intra vs. extravascular?
Intravascular: hemoglobinemia, hemoglobinuria, may not see jaundice
Extravascular: hyperbilirubinemia, jaundice, bilirubinuria
Mycoplasma haemofelis in cats–
Transmission by ticks, transfusions, bite wounds and causes extravascular anemia
DX: blood smear and PCR
Tx: doxycycline 3 wks +/- prednisolone
what tumor type causes excessive insulin production?
insulinoma
what are causes of hyperestrogenemia?
Sertoli cell tumors (cryptorchid) and ovarian granulosa cell tumors
either one causes alopecia, feminization, bone marrow suppression
overproduction of immunoglobulin
hypergammaglobulinemia, causes can be: multiple myeloma, plasma cell tumors, lymphoma
Results in hyperviscocity, infection, polyuria, heart failure, bleeding, renal failure, seizures
what tumors (2) cause cutaneous flushing?
vasodilation of cutaneous blood vessels, possible causes are pheochromocytoma or mast cell tumor
CS: erythema, alopecia, crusting, variable pruritis along face, neck,
eyelids, what is this causative agent/diagnosis
Demodex infection
if generalized= underlying systemic disease
what is the feline mange mite that burrows in the skin and is highly contagious with direct contact? What is the feline walking lice midge/Mite?
Notoedres cati aka feline scabies mite; the feline walking mite is Felicola subrostratus
What ectoparasite is this:
Begins on ear tips, face eyelids, neck, distal extremities and is highly pruritic ZOONOTIC
Notoedres cati aka feline scabies mite
this is the feline chewing louse that causes itching and alopecia=
Felicola subrostratus
what are the causes for digital SCC in cats (not common unlike in dogs so do not get confused)
secondary to primary pulmonary carcinoma (feline lung digit syndrome) in cats ]
so cat with tumors/lesions on paws and not derm issue= TAKE CHEST RADS!!!
SCC is usually on the head and face of cats
bronchial pattern on chest rads in a cat is likely….
feline asthma
Blastomycosis is rare in cats but not in dogs. T/F
T
you have a cat that presents with draining tracts and coughing. You take a cytology of the draining tract and find spherules with double walls and are full of endospores. what is the diagnosis?
Coccidioidomycosis
what can cause protein in urine in cats and how is it managed?
hypertension (managed with ACE Inhibitors and other anti-hypertensives)
which of the following is least helpful in helping to diagnose atopic dermatitis in dogs?
skin biopsy
what is the effect of the barbiturate thiopental in dogs??
increase in the rate of cardiac arrhythmias
BIchon frise of twelve weeks of age, what do you tell the owners about her risk of mammary neoplasia??
Spaying after the first heat cycle will result in an approximately 8% likelihood of mammary cancer
what is the most predisposed breed to osteosarcoma?
Greyhounds
increased ALP in a dog with lameness, think-
osteosarcoma
all of the following are considered reservoirs for rabies except….
-bats
-foxes
-raccoons
-rats
-coyotes
-skunks
rats
