Vet Prep/ Soft tissue Flashcards
A 1-year old female spayed Doberman Pinscher has presented after being hit by a car. Initial chest radiographs show mild contusions, and the patient appears to be otherwise stable. A right mid-shaft long oblique femoral fracture has been identified. Routine pre-operative blood work is unremarkable. A buccal mucosal bleeding test (BMBT) is elevated at 6 minutes. What will you administer prior to surgery?
Desmopressin acetate
A dairyman’s favorite cow was bred by a new bull a few weeks ago and now his cow has pyometra. What agent is most likely responsible for causing the cow’s pyometra?
The correct answer is tritrichomonas foetus. This organism is commonly associated with a post-coital pyometra in addition to causing early embryonic death. Campylobacter is a cause of early embryonic death but does not usually result in pyometra. Brucella will result in late term abortion. Leptospirosis is a cause of mid- to late-gestation abortions and not post-coital pyometras.
You perform a low-dose dexamethasone suppression test on a dog you suspect has Cushing’s syndrome. The 4-hour blood cortisol level and 8-hour blood cortisol level are approximately equally elevated above the normal range. What can you conclude from this information?
The correct answer is you should run a high-dose dexamethasone suppression test. Elevated blood cortisol concentration 4 hours and 8 hours post low-dose dexamethasone administration is diagnostic for hyperadrenocorticism, but it does not allow differentiation between PDH and a cortisol secreting adrenal tumor. Dexamethasone is more rapidly metabolized in dogs with either type of hyperadrenocorticism (approximately 4 hours to metabolize as opposed to 30 hours in normal dogs). In PDH animals, the 4-hour post-cortisol concentration may sometimes be suppressed, whereas cortisol from adrenal tumors will not be suppressed after administration of a low dose of dexamethasone. A high-dose dexamethasone test will suppress a larger percentage of PDH patients (up to 75% will be suppressed, showing a decrease in cortisol after 4 hours). Less reliable tests to differentiate PDH from an adrenal tumor include endogenous plasma ACTH concentration or abdominal ultrasound.
You are examining a 7-year old Thoroughbred gelding for a 5-day history of anorexia and jaundice. Which of the following enzymes would you consider to be liver specific in the horse?
Sorbitol Dehydrogenase (SDH) and Gamma Glutamyl Transferase (GGT)
A dog presents to your clinic for fever and lymphadenopathy. You perform an aspirate and see large, bipolar staining coccobacilli. The owner mentions that he saw his dog eating a rat a few days ago. What is causing the dog’s illness?
The correct answer is Yersinia pestis. In order to make this determination remember that Yersinia pestis is usually transmitted to cats and dogs as a result of ingesting infected rodents or via bites from the prey’s fleas. Dog and cat fleas are poor vectors of Plague. Dogs usually recover and you may lance the “buboes” and flush it, but dispose of organic material properly.
You are starting insulin therapy for a newly diagnosed diabetic feline patient. Blood glucose is 520 mg/dl (60-120 mg/dl). Urinalysis shows 3+ glucose and is negative for ketones with a trace of protein. Which of the following tests should this patient and all diabetic patients receive upon initial diagnosis?
All newly diagnosed diabetic patients should have their urine cultured. Diabetics are prone to getting urinary tract infections due to the chronic presence of glucose in their urine. Any underlying infection can lead to insulin resistance and make regulation of diabetes difficult to achieve.
Blood pressure and ECG are good tests for all patients in general but aren’t necessarily tests that are directly related to diabetes regulation.
A thyroid level should be checked in all older cats, for general health screening, but hyperthyroidism is not associated with diabetes mellitus. If a patient has diabetes which is difficult to control, concurrent hyperthyroidism should be ruled out.
Fructosamine level is helpful in trying to determine if a cat actually has diabetes if their glucose level is elevated and also as a follow up to determine regulation. Cats that have markedly elevated glucose levels, glucosuria, and clinical symptoms of diabetes do not necessarily need to have a fructosamine checked at the time of diagnosis.
You have encountered white muscle disease in a large commercial flock of sheep, and wish to examine the selenium status of the flock. You decide to collect samples. What samples should be collected in order to accurately assess the selenium status of the flock?
Whole blood from 20 random sheep to determine selenium levels
A relative calls you to ask how she can stop her 4-year old Cockapoo from begging for food at the table. You advise her not to pay any attention to the dog when it is showing this behavior. What behavioral principle is this?
Extinction of operant conditioning
Negative reinforcement occurs when a behavior is followed by the removal of an aversive stimulus thereby increasing that behavior’s frequency. An example is a loud noise continuously sounding until a lever is pressed, upon which the loud noise is removed. This will encourage the behavior of pressing the lever.
Negative punishment, also called punishment by contingent withdrawal, occurs when a behavior is followed by the removal of a favorable stimulus, such as taking away a child’s toy following an undesired behavior, resulting in a decrease in that behavior.
Avoidance learning is when a behavior results in the cessation of an aversive stimulus. For example, holding your ears to shield them from a loud, high-pitched sound helps avoid the aversive stimulation of that obnoxious sound.
Noncontingent reinforcement is the delivery of reinforcing stimuli regardless of the animal’s behavior. This causes that behavior to decrease because it is not required in order to receive the reward.
You finish a spay procedure on a young kitten and she regurgitates upon recovery after her endotracheal tube cuff was deflated. You wipe out her mouth and she appears to recover uneventfully. The surgery otherwise went well. Two days later she presents with a temperature of 103.4 F (39.7 C), she is a little lethargic, and she has a mild increased respiratory effort. You suspect she may have aspirated and now has pneumonia post-operatively. You perform chest radiographs. Which type of lung pattern is most typical of aspiration pneumonia?
Pneumonia is most commonly characterized by an increase of pulmonary densities with a patchy or lobar pattern. Aspiration usually involves the right middle and cranial lung lobes.
One study indicated that the aspiration pneumonia distribution patterns depend on patient position at the time of aspiration. In ventrodorsal, dorsoventral and standing dorsoventral positions, the right cranial, middle, and left cranial lung lobes are prone to aspiration pneumonia.
Pleural effusion is fluid around the lungs which is not a pattern for pneumonia.
Caudodorsal pulmonary edema, also known as neurogenic pulmonary edema, is characterized clinically by a rapid onset of respiratory difficulty after a central nervous system insult. The four major causes recognized include head trauma, seizures, electrocution, and upper airway obstruction.
Bronchiolar pattern in cats is most typical of airway disease such as asthma; perihylar lymphadenopathy is more typical of fungal disease or neoplasia.
Immune-mediated hemolytic anemia is classically associated with which type of hypersensitivity reaction?
ype I (aka immediate) hypersensitivity reactions occur when re-exposure of an antigen results in an allergic reaction. The antigen is presented and causes B cell production of IgE antibodies.
Type II (aka cytotoxic) occurs when an antigen on a cell surface binds with an antibody and is then recognized by the body as being foreign. The antigen on the cell may have been a normal feature of the cell or it may have been acquired, such as a drug binding to the cell. Macrophages or dendritic cells then recognize the cell and “present the antigen” which then causes B cell proliferation and production of IgG and IgM antibodies. The antibodies bind to the cell and activate the complement cascade which results in cell lysis/destruction.
Type III (aka immune complex) occurs when there are more antigens than there are antibodies. The antigens float around in the circulation and multiple antigens may bind one antibody, thus forming an immune complex. Large complexes can be cleared by macrophages, but smaller ones may evade the macrophages.
Type IV (delayed type hypersensitivity) takes several days to occur and rather than being antibody-mediated, it is actually cell-mediated. Cytotoxic CD8+ T cells and CD4+ helper T cells recognize antigen that is in a complex with major histocompatibility complex 1 or 2. This results in proliferation and activation of the cells. Activated CD8+ T cells then destroy the antigen containing cells while activated macrophages release hydrolytic enzymes.
What is the holding layer of the stomach?
the submucosa. Use monofilament, synthetic, absorbable
Where should you incise the stomach?
An avascular area away from the pylorus
How should the stomach be closed?
Two layer - mucosa and submucosa with a simple appositional pattern, simple or continuous fine.
Then second layer : muscularis and serosa with an inverting pattern.
What is the normal size of the fundus? how can you tell if the stomach is distended?
Normal fundus 6 icsp suspect pathology
Which way does the stomach usually rotate in GDV?
Clockwise rotation
90 to 360 degrees
Pylorus moves ventrally and to left,
Fundus moves to right.
How do you confirm gdv?
cannot identify pylorus on a right lateral, fundus distended.
What is an incisional gastropexy?
Antrum anchored to the body wall, which prevents pylorus moving. incise seromuscular layer of pylorus and transverse abdominus muscle and suture incision edges together.
What are the clinical signs of intestinal foreign bodies?
Vomiting, loss of appetite, abdominal discomfort, poss diarrhoea, poss melena.
Where should you incise the intestine?
Antimesenteric surface. relatively avascular. Not over FB. - distally in healthy bowel.
What is the holding layer of the intestine?
Submucosa.
What is the common cause of intussuception?
in young animals - common, spontaneous, link to enteritis/worm burden.
In mature animals - uncommon, usually secondary to other pathology such as masses or peritonitis.
What is the common site for intussuception?
Jejunocolic at ileocaecocolic junction common.
What are the most common bacteria types found in the colon?
Gram negative anaerobes. Perioperative antibiotics indicated.
Which sort of patient can a subtotal colectomy be recommended for?
Extremely successful for management of feline megacolon. removes 90-95% of the colon & removes the ileocaecocolic junction. DOGS DO NOT TOLERATE THIS SURGERY. Post operative diarrhoea is inevitable. manageable within 12 weks usually.
What signalment is usually present with apocrine gland adenocarcinomas?
90% FEMALE.
Where should you perform a cystotomy?
Ventral - readily accessible, visualise the trigone well, no increased risk of leakage. Prior to incision, perform cystocentesis to reduce spillage.
what breeds is urethral prolapse more common in ?
Young male dogs, sexually intact, brachycephalip breeds, tx- reset prolapse and castrate.
What is the most common cause of congenital urinary incontinence in dogs?
Ectopic ureters
What are the causes of urge incontinence?
Unsuppressible urination as bladder fills - due to inflammation, reduce bladder volume or polyuria, e.g cystitis, urolithiasis, neoplasia, systemic causes of polyuria.
What is sphincter mechanism incontinence? Which patients does this affect?
Majority of patients are neutered female dogs. it responds to oestrogen supplementation. Many affected patients are obese. Early spay more common. Common in dobermans, setters, rottweilers. continent for most of the day but urine passively leaks when lying or sleeping. continuous dribbling of urine is uncommon. May have concurrent UTI - exclude. A -adrenergic agonists used as tx.
What is juvenile smi?
Sphincter mechanism incompetence seen in female entire bitches, before first oestrus. it is often associated with ectopic ureters. but 50% resolve after first oestrus. Treat concurrent UTI.
What is colposuspension ?
Repositions the bladder neck forwards, incraeses pressure at bladder neck. used to treat SMI. This is performed even in patients that do not have intra pelvic bladder with effect, the mechanism of action is not fully understood. The cranial vagina is anchored to prepubic tendon.
what is the typical presentation with ectopic ureters?
Females > males. Retrievers, poodles, huskies. typically incontinent since birth. occasional adult onset presentations. there is continual dribbling of urine. may have urine scald. if unilateral may be able to pass a stream of urine. if bilateral may have no bladder filling.
What are the signs of prostatic disease?
Faecal tenesmus Constipation Alteration in faecal shape Dysuria Stranguria Haematuria Urethral discharge Urinary incontinence
What signalment is prostatic neoplasia common in? what is the prognosis?
Neutered males.
Aggressive, locally invasive, early metastasis.
Grave prognosis
Why should you give antibiotics when doing liver surgery?
Anaerobic (clostridial) residual population, may proliferate in ischaemic liver tissue.
What are the possible systemic effects with portosystemic shunts?
stunting, failure to thrive, hypoalbuminaemia, hepatic encephalopathy, dullness, aggression, failure to house train, seizures, PUPD, urate crystalluria, Liver dysfunction on biochemistry and high postprandial bile acids.
What type of shunt are small breed dogs predisposed to?
extrahepatic
What type of shunt are large breed dogs predisposed to?
Intrahepatic
What are the possible complications with a Total ear canal ablation and lateral bulla osteotomy?
Facial nerve damage, vestibular disease, horners syndrome, deafness, altered ear carriage, para aural abscess,
What is a cholesteatoma?
An epidermoid cyst lined by keratinised epithelium containing keratin debris.
What suture material should you use for ovarian pedicles?
synthetic, absorbable, e.g PDS
What are the land marks for flank ovariohysterectomy in cats?
Wing of ilium, greater trochanter, spay site - triangle
What bacteria is usually involved in a pyometra?
E coli
What does blood in the urine stream reflect?
Blood at the start of urination may relflect urethral, vaginal, penile or preputial disease, whereas blood at the end may reflect renal, ureteric or bladder disease, blood throughout the stream may be present with upper or lower urinary tract disorders. Dogs with prostatic disease may drip blood independent of urination.
Which breeds are predisposed to polycystic kidney disease?
Persian cats BSH cats bull terriers WHWT Cairn terriers.
What are the signs of an acute renal infection?
PUPD, haematuria, lethargy, vomiting, anorexia, renal pain, pyrexia
What is a good empirical choice of antibiotic for pyelonephritis?
Amoxicillin-clavulanate - it is bactericidal, concentrates in urine and has a broad spectrum of efficacy.
What does PLE lead to? What is the name of these three signs together?
significant proteinuria will also progressively lead to hypoalbuminaemia and hypercholesterolaemia. This is known as the nephrotic syndrome and these patients may be hypercoagulable due to loss of antithrombin III in the urine.
Which breeds are predisposed to amyloidosis?
Sharpei, abysinnian siamese and oritental cats. In cats the amyloid tends to be deposited within the medulla so the degree of proteinuria may not be so extensive.
What is fanconi syndrome?
A primary tubular disorder - may be congenital in the basenji (most commonly affected dog), may also be acquire with infections such as leptospirosis. Renal tubular reabsorption is affected resulting in a loss of variable amounts of glucose, amino acids, bicarbonate and electrolytes in the urine. Fanconi syndrome may be suspected in a PUPD patient with glucosuria but not hyperglycaemia.
What is primary renal glucosuria?
May be congenital or acquired secondary to tubular damage. diagnosis is based on identifying persistent glucosuria in the absence of hyperglycaemia or loss of other substances in the urine.
What is renal tubular acidosis?
May be congenital or acquired.
Proximal renal tubular acidosis arises when the proximal tubules cannot reabsorb bicarbonate ions and is often part of fanconis syndrome. This results in mild acidaemia due to compenstatory ccid secretion by the distal renal tuules and a urine with a ph of 5.5-6.0.
Distal renal tubular acidosis arises when the distal tubules cannot secrete hydrogen ions. as this is a more significant factor in acid base homeostasis the metabolic acidosis arising is usally marked and the urine ph > 6.0
What are the common causes of AKI in veterinary patients?
Ischaemia during anaesthesia, hypotension, hyperviscosity
Infarction - thrombi and emboli
Toxins - ethylene glycl, lilies, grapes, raisings, heavy metals, organic compounds, haemoglobin, myoglobin, envenomation, melamine.
Infectious diseases - leptospirosis, pyeonephritis, borrelia burgdorferi, feline infectious peritonitis
Nsaids, aminoglycosides, amphotericin B, cisplatin, radiographic contrast agents, sulphonamides, tetracyclines, ACe inhibitors.
Rodenticides (calciferol containing), psoriasis creams, neoplasia all cause hypercalcaemia.
What are the clinical signs of AKI?
short history of signs such as anorexia, nausea, lethargy, vomiting, diarrhoea, weakness, altered mentation. PUPD not always present if patient is anuric/olgiuric. Uraemic breath and oral ulceration may be detected. Renal palpation may reveal painful & enlarged kidneys.
What does haematology/biochem show with aKI?
Anaemia more suggestive of chronic kidney disease
Phosphorus elevated. If calcium also elevated - suspiscious of vitamin D toxicity.
Potassium may be elevated
Frequently acidotic - inability of renal tubules to excrete hydrogen ions.
USG low.
Azotaemia
Glucosuria in the absence of hyperglycaemia is supportive of renal tubular damage, as is the presence of casts on urine sediment.
What can be given to a patient that is hyperkalaemic whilst waiting for fluid therapy to take effect?
Calcium gluconate may be given to stabilise the cardiac mebrane whilst therapies ot lower potassium take effect. fluid therapy will dilute hte potassium to a certain extent, and insulin and dextrose saline can be used to stimulate intracellular shift of potassium. sodium bicarbonate can also be given to encourage this or address severe acidaemia.
What UPC would classify as proteinuric in dogs and cats?
cats >0.4 (borderline 0.2-0.4)
Dogs >0.5 (0.2-0.5 borderline)
What management can be used to slow progression of chronic kidney disease?
Protein restiction - low/normal may be adequate for most patients.
Phosphate restriction.
Increased fat - calories if not willing to eat
Alkalinisation - potassium citrate or sodium bicarb.
Fatty acids - omega 3 and 6 fatty acids in dogs.
Atioxidants- oxidant damage to protein lipids and dna may play a role - so anti oxidants such as vitamin E , carotenoids or flavanoids may prove beneficial.
Sodium restriction generally not advocated as there is little evidence it contributes to hypertension.
Potassium levels are usually kept normal as patients may be hyperkalaemic or hypokalaemic. supplement if needed.
Use of a renal diet advocated from iris stage II onwards.
What can be used to reduce phosphate levels in CKD?
Phosphate binders in the diet which act within the GI tract to reduce absorption of phosphate - aluminium salts, calcium salts, sevelamer hydrochloride, lanthanum carbonate.
How can proteinuria be reduced in CKD?
Ace inhibitors;
Dilation of the efferent renal arteriole which reduces glomerular hypertension, reduction of angiotensin II which has an effect on systemic hypertension, may reduce pdocyte hypertorphy and reduce renal fibrosis, reduction of aldosterone which may reduce renal fibrosis, may increase appetite and feeling of well being, may cause an increase in azotaemia as a result of reduction in GFR. Proteinuria has been shown to be deleterious and associated with a poorer outcome as it may axercerbate tubulo interstitial damage.
What are the best treatments for systemic hypertension in CKD?
ACE inhibitors in dogs
Calcium channel blocker amlodipine besylate being used in cats. (can be combined with an ACE inhibitor)
Why do patients with CKD become anaemic?
Decreased erythropoietin production by kidneys
Increased blood loss form GI bleeding - uraemic gastritis
decreased life expectancy of circulating RBCs
Suppression of bone marrow by uraemic toxins such as PTH
Decreased precursor availability form anorexia
Options for treatment include erythropoietin, darbopoietin and blood transfusion.
What is the composition of struvite uroliths?
Magnesium ammonium phosphate hexahydrate.
List the most common urolith types in order.
Dogs - struvite, calcium oxalate, urate, silica, cysteine.
Cats - calcium oxalate, struvite, urate - the rest v uncommon.
What are the clinical signs of urolithiasis?
In the urethra - stranguria, dysuria, anura, abdominal discomfort, uraemia.
In the bladder - signs similar to UTI such as haemturia, dysuria and pollakiuria.
List the typical urolith radiopacity, in order of decreasing radiodensity -
Most radio dense and obvious on a radiograph > Struvite, calcium phosphate, oxalate, cystine, urate.
which types of stones typically respond to dissolution?
Struvite and urate.
Calcium oalate, calcium phosphate and silica are resistant to dissolution.
Why do dogs get struvite uroliths?
Struvite calculi usually follow infection with urease producing organisms such as staphylococcus, proteus or ureaplasma. urease is an enzyme that breaks down urea, causing the release of ammonium and bicarbonate ions into the urine. supersaturation with ammonium ions promots struvite formation, while bicarbonate ions alkalinise the urine, which further enhances the presence of alkaline urine. Attempted dissolution may be indicated in stable patients. Female dogs with radiodense uroliths, uti and alkalinuria usually have struvite urolithias.s Tx - antibiotics, dietary modification that reduces urine saturation of magnesium, and oral urinary acidifiers.
Why do calcium oxalate uroliths occur?
Urine must be supersaturated with calcium. Factors that may affect supersaturation of calcium include hypercalcaemia, and possibly a diet containing high protein, high calcium and a low vitamin B6. Diuresis > decreased urine concentration decreases the risk of Ca oxalate urolithiasis in people - e.g cats on high moisture diets have less risk. Nephrocalcin is a natural inhibitor of calcium oxalate crystal growth. Other potential inhibitors include citrate, glycosaminoglycals, tamm horsfall proteins. Treatment is usually by surgery. Prevention of reoccurence includes treatment of underlying hypercalcaemia., increasing water intake, lower protein.
Which animals are predisposed to urate uroliths?
they form because of increased excretion of urates or uric acid in the urine. dalmation dogs and bulldogs have a higher frequency of urate stone formation than other breeds. Breeds that are predisposed to portosystemic shunts are also predisposed.
Why do urate uroliths occur?
In normal animals, purines convert to hypoxanthine, which converts to xanthine which converts to uric acid which converts to allantoin which is a soluble end product excreted in urine. in dalmation dogs uric acid is not converted to allantoic resulting in urine that is oversaturated with uric acid. Other risk factors include increased renal excretion of ammonium, low urine ph, urinary tract infections with urease producing bacteria and other bacteria or mycoplasma. Animals with portosystemic shunts may develop ammonium urate uroliths because of impaired metabolism of uric acid and ammonia.
