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Presentation!
Acute 12 hrs)
g81
- Like alcohol . toxlcation
- Trembling
>
"0"
****
***
**
Rare
(once a lifetime)
Treatment
- Activated charcoal
20% Ethanol IV (vodka or
the like)
"4-methylpyrazole (4-MP)
SUpportive care:
rL
...
..,.,;-::~-p
Prognosis:
Poor if renal
First page
ti
Prevention:
Use new antifreezes that don't contain
ethylene glyCOl
I
Proper disposal of ethylene glyco
DDx:
5 t u~_,-n
____-,
an example
~ :~=~I=gen
Induce emesis, gastric lavage
Urinalysis
- Protelnu .
Ca oxe Ie crystals
- Hematuria
-Isosthenuric (1.010)
Blood values
- t BUN, creatinine
- Stress leukogram
Ultrasound: hyperecholc kidney
- Dystrophic caldflcatlon "
Necropsy: birefringent crystals
on Impression smears of
kidney. polarized light
Page e
Treatment
~
tailure~,
"f
lT~X~:lE~m~e~rDe~n~c~-J2~O~O/~.E~lh~a~n~O~II~V~.~-~M~P~____L-___
""')
Diagnosis
Hx (antifreeze), C
convulSions
- Vomiting, nausea
- Anorexia, PUIPO
- labored breathing
Ataxia, Depression
- Coma/Death
Stage 2: 12-24 hours
- Nondescript- seems to be
recovering
Stage 3: 24-72 hours
- Renal signs (uremia)
Severe depreSSion
Oliguria/anuria
Anorexia & vomiting
Oral ulcers (common) ,
Death
Sequela: Acute renet
Antifreeze - Deadly
sJuaJUOO SO a,qe,L
See page ii
Presentation/CS: clinical
References:
"u",
t'rfC!)
'6-1
90-100%
65-89%
35-64%
11-34%
1-10%
(95%)
(75%)
(50%)
(25%)
(5%)
Drooling 31
Dry mouth 31
Dwarfism 682
Dysphagia 30
Dyspnea 174
Dystocias 412
Dysuria 329
Encephalitis 490,518
Eosinophilia 303
Episodic weakness 535
Estrus 435
Exercise intolerance 175, 535
Eye position 491
Facial asymmetry 491
Fainting 175
Fever 711
of unknown origin 712,713
Gag reflex loss 491
Glycosuria 334
Granular casts 335
Head tilt 506
Heart enlargement 181
Heart rate disturbances 252
Hematemesis 43
Hematuria 334, 335, 393
Hemolysis 282, 730
Lymphedema 323
Lymphocytosis 301
Lymphopenia 301
Malabsorption 76
Mandibular reflex loss 491
Megacolon 74
Megaesophagus 37
Monocytosis 300
Mononeuropathy 557
Motility disorders 44
Mucous membrane color 177
Myopathies 584
Neck pain 569
Neonatal infections 419
Neutropenia 298
Neutrophilia 299
Nonregenerative anemia 284
Obesity 710
Obstructive upper airway 128
Oligospermia 455
Oliguria 328
Osteopenia 613
Pain: neuromuscular 569, 584
Paralysis 532
Paresis 532
PD/PU 670
Peritonitis 106
Persistent anestrus 437
Persistent estrus 439
Sinusitis 122
Small from large intestine
disease 53
Sperm low or no 455
Specific gravity 332
Spinal column tumors 549
Spinal cord disorders 528
Splenomegaly 321
Stomatitis 19
Stupor 490
Syncope 175
T waves large 272
T4 levels low 675
Thrombocytopenia 291
Tiring 175, 535
OOx
-----_._-------_
..
Guide to
Small Animal Clinics
Tschauner's
ODr--------------------
SUDZ
PUBLISlllNG
1222 S. Hwy. 377
P.O. Box 1199
Pilot Point. TX
76258
ph # (940) 686-9208
Fax (940) 686-0164
ISBN 0-9623114-4-8
Table of Contents
2
8
10
12
14
15
17
108
167
327
394
479
596
651
685
717
750
756
769
797
798
799
Complete References
Smin
C12T/C11T
Cat
CM
OOx
Ox or Dx-L
Derm
D-CT
D-Mi
OVC
O-Sy
Ehb
E
Emrg
EndolE&RM
FH
F31M1F21M
FN
W"G;;I-----.:y;:e:te::r:;:in::a;:Ory::-:G;:'a::s::,:::ro::e::n::':::f!!r::it::js---:2::"n-d'".-:N"V-:-:A:-n-:d:-e-rs-o-n-.-L-e-a""'&
Febiger 1992
The 5 Minute Veterinary Consult. Canine & Feline. LP Tilley,
GIS
Strombeck's Small Anima! Gastroenteritis _ 3rd edition.
FWK Smith. Williams & Wilkens 1997
WG Guilford, SA Center, DR Strombeck, DA Williams, DJ
Kirk's Current Veterinary Therapy in Small Animal Practice
Meyer. WB Saunders Co. 1996
H3B1H2B
lruIXl. JD Bonagura. WB Saunders Co. 199511992
Handboqk of Small Animal practice - 3rd/2nd edition. RV
Cat piseases and Clinical Management - 2nd edition. RG
Morgan. Churchill Livingston Co. 1997/1992
Sherding. Churchill Livingston 1994
HF
Canine and Feline Cardiology PR Fox. Churchill Livingston
Canine Medicine - 4th edition. EJ Catcatt. American Veterinary
1988
Publishing 1979
HTIM
Manya! pf Canine and Feline Cardiology - 2nd edition. MS
Clinical Signs & Diagnosis in Small Animal practice. RB FOrd.
Miller, LP Tilley. Lea & Febiger 1995
Churchill Livingston 1988
HT
Essential of Canine and feline Elestrocardiology - 3rd
Small Animal Medical piagnosis - 2nd edition. MD Lorenz, LM
ednion. LP Tilley. Lea & Febiger 1992
HPic
Cornelius. JB Lippincott Ce. 1993
Color Atlas of Veterinary Cardiology. PG Darke. JD
Myller & Kirk's Small Animal Dermatology - 5th edition. DW
Bonagura, DE Kelly. MosbyWolfe 1996
IA
Scott, WH Miller, CE Griffin. WB Saunders Ce. 1995
Atlas of OphthalmOlogy in Dogs and Cats, I Walde, EH
Cyrrent V$rinary Dermatology: the Science and Art of
Schaffer, RG Kastlin, Be Decker Inc. 1990
10
IlltrIJn!CE Griffin, KW Kwochka, JM MacDonald. Mosby 1993
Magrane's Canjne Ophthalmology - 4th edition. LC Helper.
Veterinary DermatOlogy: Macroscopic and Microscopic TL
Lea & Febiger 1989
Gross, PJ Ihrke, EJ Walder. MOSby 1992
IG
Veterinary OPhthalmology - 2nd edition. KN Galatt. JB
Veterinary Clinics of North America. Advances in Clinical
Lippincott Co. 1991
Dermatology, DJ DeBoer. WB Saunders Co. 1990
Ihb
Manyal ofSmallAnjmalOphthalmology. MWyman. Churchill
Canine and feline Dermatologv: A Systemic Approach. GH
Livingston 1986
IP
Nesbitt. Lea & Febiger 1983
Atlas of Veterinary Ophthalmology. KC Barnett, Williams &
pocket Companion to Textbook of Veterinary Internal Med i.
Wilkens 1990
l<i!l. SJ Ettinger. WB Saunders Co. 1995
IS
Fyndamentals of Veterlnarv Ophthalmology - 2nd edition.
TeJCtb99k of Veterinary Internal Medicine - 4th edition. SJ
D Slatter. WB Saunders Co. 1990
12M11M
Ettinger, EC Feldman. WB Saunders Ce. 1995
Small Anima! Interna! Medicine-2ndl1 st edition. RW Nelson,
Veterinary Emergency and Critical Care Medicine. RJ Murtaugh,
CG Couto. Mosby 199811992
PM Kaplan. Mosby 1992
IMWW
Sma" Animal Intemal Medicine D Shaw, S Ihle. Williams &
Veterinary Endocrinology and Reproduction - 4th edition. LE
Wilkens 1997
Inl
McDonald, MA Pinerda. Lea & Febriger 1989
Manual of Small Anjmallnfectigus DiSeases. JE Barlough,
Diseases of the Cat J Holzworth. WB Saunders Co. 1987
Churchill Livingston 1988
Consultations in Feline Internal Medicine - 3rdl2nd edition. JR
InlG
Infectioys piseases of the Dog and Cat. CE Greene. we
August. WB Saunders Ce. 1997/1994
Saunders Co. 1990
Feline Practice. GO Norsworthy. JB Lippincott Co. 1993
Lab-S
Laboratory Profiles of Small Animal Dileases. CH Sodikoff,
Mosby 1995
1986
NSO
NSPa
NSW
00
OL
PaR
Pa-T or Pa
PysC
RM
RR
ertslnc.1986
canine & Feline Endq<;rjooloqy & RePCOduction - 2nd edition.
EC Feldman, AW Nelson. WB Saunders, 1996
Veterinary "EndocrinQlogy & Reproduction - 4th edition. LE
R&EM
McDonald, MA Pineda. Lea & Febriger 1989
Small Animal Medicine. DG Allen. JP Lippincott 1991
SAM
Saynder's Monuai of Small Anima! practice. SJ Birchard, RG
SAP
Sherding. WB Saunders Co. 1994
Sx481Sx38
Cyrrent Techniques In Small Anima! Syrgery - 4th13rd edition.
MO Bojrab. Lea & Febriger 199811990
Atlas of General Small Anima! Syrgery, DO Caywood, AJ
Sx-G
Lipowltz, lIIus: ME Finch, Mosby 1989
Briner paermllftei & Flo's Handbook' of Small Animal OrthoSxOP
pedics & Fractyre Repair - 3rd edition. DL Permattei, GL Flo,
lIIus: FD Giddings, AM Fritzler. WB Saunders Co. 1997
Textbook of Small Animal Surgery - 2nd edition. D Slatter. WB
SxS
Saunders Co. 1993
Pocket Companion to Textbook of Small Animal Surgery, D
Sx-S-hb
Slatter. WB Saunders Co. 1995
Small Anjmal Surgery, J Haran. Williams & Wilkens 1996
SxWW
Canine Surgery - 2nd edition. 0 Slatter. American Vet Pub 1974
SxA
Clinical and Diagnostjc Veterinary Toxicology. GO Osweiler et
Tox
al. Williams & Wilkens 1996
Toxicology. GO Osweiler. Williams & Wilkens 1996
ToxWW
Poisonous Plants of the United States and Canada. JM
PP/uSAIC
Kingsbury. Prentice Hall 1964
PPIM, PP/O, PP/A POisonous plants/MontaDB,Qklahomaor Alabama. printed
by Extension Service of each state
Radiographic Techniques in Veterinary practice - 2nd edition.
Xp
JW Ticer. WB Saunders Co. 1984
Radiographic Interpnrtation for the Small Animal Clinician. JM
XRP
Owens, lIIus: J Tennant. Ralston Purina Co. 1982
Textbook of Veterinary Djagnostic Radiology - 3rd/2nd edition.
X3T/X2T
DE Thrall. WB Saunders Ce. 199811994
Atlas of Radiology Anatomy of the Dog & Cat. H Schebitz, H
Wilkens. WB Saunders/Paul Parley Pub 1986
R&EF
~r---------------------
INTRODUCTION
Tschauner's MiniGuide to Small Animal Clinics is a quick reference guide for veterinarians and
veterinary students.
Fashioned after Heidi Tschauner's Senior Veterinary Student's Guide to Small Animal Clinics and a
direct continuation of the Guide to Bovine Clinics, Guide to Equine Clinics and Guide to Equine Lameness, it
helps quick assessment of cases until a more thorough reference can be located. This is not meant to replace other
texts, but encourage veterinarians & students to read something for every case and to use other references by
keying each condition to commonly used veterinary texts. Except for very generalized conditions of the eye and/or
skin, the chapter on the integument (i.e. the eye and dermatology) has been omitted. These two categories have
become so specialized that they are books within themselves, hopefully to be completed as such at a later date.
This guide is set up in table form to mimic class notes. The first column gives the "condition" and any
synonyms for it. Under the condition's name are the abbreviations and pages where that condition may be found in
commonly used veterinary textbooks. The second column, "Facts/Causes", gives pertinent information, incidence,
breed predisposition and pathophysiology of the condition. The "Presentation/CS" column outlines how the animal
presents with the condition and possible future sequelae. The "Diagnosis" column outlines how to use the history,
presenting signs and further procedures to make a diagnosis. The last column, "Treatment", outlines treatment,
prevention & prognosiS. Differential diagnoses, the key to diagnosis, are highlighted in rounded boxes for most
conditions. The box in the lower left briefly summarizes key words from each of the columns to provide a quick
handle for each condition.
Stars under the references are rough indications of the prevalence of each condition. Four stars indicates
that in a normal clinic you can expect to see the condition at least once a week, whereas one star indicates you may
see it only once a lifetime.
Prognosis is divided into Excellent, Good, Guarded, Poor or Grave. These correspond to the percentage of
cases that have a favorable outcome. Guarded indicates that roughly half of all cases of a certain condition either
has a favorable or unfavorable outcome (i.e, 50/50 chance), thus you must be guarded when giving a prognosiS.
Boldface type allows skimming Facts/Causes, Presentation/Clinical signs, Diagnosis and Treatment. More
in-depth information is given in lighter print and smaller print. Other texts keyed under the condition allow for quick
references; while the cartoons hopefully add life and help page recognition.
The inside of the front cover contains a quick index and Quick References and their abbreviations.
The inside of the back cover has normal laboratory values.
Chris Pasquini
(95%)
(75%)
(50%)
(25%)
(5%)
**** ***
** *
Disclaimer: the authors do not assume any responsibility for any results obtained from the procedures, treatment, drugs,
and/or dosages used; nor shall the authors be held liable for any misinformation or errors that may have
been obtained inadvertently by any persons or organization using this book.
Acknowledgment: Special thanks to the authors of the books to which this guide is keyed. Hopefully the guide will
encourage the student to use these more often.
~r---------~~--------
numbers along the left hand side, skipping a line between numbers. Continue this onto the next pages until all the pages in the
notebook have two corresponding lines in your table of contents.
As you fill out the pages in the notebook, name them after their
contents and record them in your table of contents. This will be
invaluable as you try to find vital information you wrote in the
notebook last week.
Cases: Label the four pages following the table of contents
"CASES'. As cases are passed out, draw an opened box at the
start of a line. Follow this with the case number, animal's name.
Later when the diagnosis is made, write it on the same line in bold
BLOCK LETTERS. This will obviously give you a list of all the
cases seen. If you move to another rotation before the animal is
discharged, the open box will help you follow the case through (an
important thing to do!). Ask the clinician in charge what happened
or go look up the chart with the case number. Check the box off
when the animal is discharged or necropsied. An open box
indicates an unfinished learning experience.
Information, confusion, drugs, cases, etc.: The pages following
the CASES pages are for the mass of information that will be
coming towards you. For your own case give yourself enough
pages to cover it (3 or 4 pages per case). For all cases write the
case number, animal's name, owner's name, clinician's name and
assigned student. Later write the diagnosis in bold BLOCK
LETTERS enclosed in a box.
For all cases write down the history, signalment, etc. Be sure to write down all the
instructions preceded by open boxes for you
to check off as things get done. As you read
up on the condition, jot down notes and organize your thinking. Write down things to ask
the clinician. As lab data, radiology and other
information comes in, write it down. If you run
into another case's pages, write: continued
on an open page and continue on that page.
Miscellaneous: Fluidtherapy, drugs, clin-path,
etc. may need to be reviewed. Write down
pertinent information for you to use in other
cases and put page number in the table of
contents.
Things to do! On the last page list the things
to rememberto do as they come up. Put a box
on the left hand side and write down what task
to do. When each task gets done, check it off.
.:(
-I
L-C.._ _
Optional: Draw case animals, trying to characterize their clinical signs. These can be
stick figures or cartoons. They will help you
observe the animal and remember it in the
future.
103
,rlules
~ .... h ...
16 weeks
Vaccination:
6 weeks
==='~."("l';"f.=:: ~e~~~@)
FVRCP-CSQ
- Rabies 1M (semimembranosus/semitendinosus)
or SO if appropriate vaccine
w.i
~~~
qrc
-
9 weeks
Vaccinatio,1: FVRCP-C sa
- Optional: Test FeVL & 1st FeLV vaccination
Fecal/deworm (pyrantel pamC'ate)
(l
12 weeks
Vaccination: FVRCP-C sa
- Optional FeLV booster
- Optional FIP vaccination
Fecal/deworm (pyrantel pamoate)
"FVRCP-C refers to feline rhinolracheltis virus, callcMrus, parvovi
rus (panleukopenia) vaccines & mayor may not come with Chlamy
dia pslttacivaccine; FlP: feline In'ectiouSperilon!tls~c.cine: FeLV:
felloe leukemia virus vaccine: sa to subcutaneous injection
t FVRCP-C sa: associated with fibrosarcomas (Injection sarcomas)
no) 1
"'7J ."
'>- ;
{--.I "--
i-,;
~t:4r
- ~
Summary
.J)
6 weeks
/~
\ \.
",.
.--!-~~
20 weeks
RottweilersiDobermans
- Vaccination: DA2PLP sa
r-:e:::.
~<"'-===::::j'-C;::
____
:::::==((0)0
Vaccination: DA2PLP. sa
Rabies 1M or sa
Fecal, deworm if + and flea control
Heartworm test (Knott's or Occult)
Check heartworm preventative dose
General physical exam
Vaccination: DA2PLP sa
Fecal/deworm (pyrantel pamoate)
Start heartworm prevention or check dose if started at 6 weeks
Summary
9 weeks
Vaccination: DA2PLP sa
Fecal (check deworming)
Check heartworm preventative dose
16 weeks
Vaccination: DA2PLP sa
Rabies 1M (hamstring muscles) or sa,
Fecal (check deworming)
Check heartworm preventative dose
12 weeks
16
Abdominal distention 71
Acute abdomen 68
Adenitis 33
Algae 61
Anal
sac disease 85
sac tumor 87
sacculitis 85
tumors 87
Anodontia 24
Anorectal diseases 82
Antibiotic associated
colitis 50
Ascariasis 64
Atresia ani 82
Bacillus 60
Bacterial overgrowth 72
Biliary problems 99-101
Brachiognathia 28
Branchial cyst 37
Campylobacteriosis 60
Candida 20, 61
Canine distemper 26, 54,
686
Carcinomatosis 105
Caries/cavities 26
Carnassial abscess 27
Cecal inversion 50
Cecal-colic volvulus 75
Chemical mouth burns 21
Cholangiohepatitis 100
Cholangitis/Cholecystitis 100
Chronic colitis 49
diarrhea 52
inflammatory bowel diz 62
Cirrhosis 98
Cleft palate 18
Clostridial enteritis 59
Coccidiosis 67
Colitis 48, 50, 62, 63, 73
Colon - perforation 84
Constipation 80
Copper - hepatitis 97
Coronavirus enteritis 54, 56
Cricopharyngeal achalasia 31
Cryptosporidia 67
Cyst 37
Dens in dente 24
Dental problems 24-28
Diarrhea 46
bacterial 59
chronic 62
fungal 60
viral 54-57
Dilatation of esophagus 37
Drooling 31
Dry mouth 31
Dysphagia 30
Enamel hypoplasia 26
Endodontic disease 27
Endotoxemia 88
Enteritis 46, 47, 63
Eosinophilic gastritis 41
gastroenteritis 62
granuloma 18, 22
Epulis 24
Esophageal problems 34-37
fistula 36
foreign bodies 35
inflammation/esophagitis 34
tumors 36
Extrahepatic obstructive biliary
disease 101
Fecoliths 84
Feline hepatic lipidosis 95
hypereosinophilic 62
infectious peritonitis 107,
688
r
Irritable bowel syndrome 73
Islet cell neoplasia 104
Labial granuloma/ulcer 18
Large bowel diarrhea 66
Leptospirosis 92
Linear foreign body 79
Lip fold dermatitis 18
Liver acute failure 90
chronic failure 96
disease 88
fluke infection 100
rupture 95
Lymphangiectasia 73
Lymphocytic-plasmacytic
bowel diz 63
gastritis 40, 41
Lymphoma 51
Malabsorption syndrome 76
Malignant melanoma 23
Malocclusion 28
Megacolon 74, 80
Megaesophagus 37
Mesothelioma 105
Motility disorder 44
Gastrointestinal System
Mucocele 32
Mycobacterial enteritis 60
Mycotic stomatitis 20
Neck lesions (teeth) 26
Necrotizing gingivitis 21
Obstipation 80
Obstruction 78, 44, 101
Obstructive biliary disease 101
Oral papillomatosis 23
Pancreatic disease 102
Panleukopenia 57, 690
Papillomatosis 23
Parasites 64-67, 100, 104
Parvovirus 55
Perforated colon/rectum 84
Perianal dermatitis 86
gland tumors 87
hernia 84
fistulae 85
Periodontal disease 25
Peritoneal hernia 105
Peritonitis 106
17
Salmonella 59
Short-bowel syndrome 72
Sialocele 32
Spastic colon 73
Stomatitis 19
Strangulating obstruction 78
Tapeworm 66
Tetracycline staining 26
Tongue trauma 22
Tonsillitis 29
Trichuris 66
Typhlitis 66
Tyzzer's disease 60
Ulcers - gastric 43
Umbilical hernia 105
Vascular ring anomalies 36
Villous atrophy 77
Volvulus 45, 75, 79
Vomiting 38
Whipworms 66
Xerostomia 31
Yersiniosis 60
GI
Harelip
. See Resp pg 120 - Occasionally seen, often associated wI cleft palate. Tx: Surgically join
-L~i~p~in:':j~u-r-i-e-s---+-~-,
, _ , ' Commonly from b~es or biting an electrical cord
<( i
***
Chronic lip
fold dermatitis
Cheilitis
M8k 278; E-hb 433: Mk 125;
SAP 348; H2B 334; IM-WW
Noxious odor
Hx (breed). CS
eOroolingfrom lower lip Physical exam: inspect lip fold
Pawing at mouth
~~'"
,..
Labial granuloma.
Indolent ulcer,
Rodent ulcer
M8k 713; Mk 126, Ehb 434;
H3B 305; H2B 951; IMWW
**
I . Uremic halitosis
t In size graduany
Hx, CS
Physical exam
Biopsy (chronic ulcerative dermatitis wi PMNs, plasma cells, mononuclear cells & some eosinophils)
Stomatitis,
Glossitis,
Gingivitis
MSK279, 136; Mk 127; Smln
72, 160; GI-S 190: H3B 299;
H2B 333, E-hb 434: 1M 320:
IM320;IM-'N'N245;SAP622;
CI2T 568(1): Cat 1123: 1129;
Neo 133
**
~\ _
~),(lJ-:
@!J (lilt
$=:7
- Dental plaque #1
- Idiopathic
- Infectious dizs (1 or 2)
- Metabolic dizs
- Physical/chemical trauma
- Drugs & toxins
- Immunemediated dizs
- Nutritional deficiency
Pathophysiology: unclear, see individual
Variable
Anorexia or Inappetence
Excessive salivation
Exaggerated chewing
- Halitosis
Dysphagia (difficult
swallowing)
Pawing at mouth
Vomiting or retching
\k'{}
__--..L.~; J'
DDx:
Oral neoplasia
,/
, \
t:ff ~
l'
Hematology:
')
~)
..,..,..-~
Prognosis: Good
Labial ulcer,
DDx:
Steroid
Chronic granulomatous
eosinophilic
granuloma,
l&
\ . Periodontal disease
lx:
:t.r
St. Bernards
**
/7
-f.\L..
Vb
a:).LD---1.._...l.)_-)
Prognosis: guarded
to good for control
Stomatitis - Causes
_Feline cailcivlrus
foreign material)
_Protein-calorie malnutrition
_Viral rhlnotracheitis
_Feline panleukopenia
- Electric cord bites
Recurrent ulceration In Silver.
_Feline leukemia (FelY)
- Caustic substance ingestion
gray Collies wI cyclic hematopoiesis d '
~
~
l.f:--J1(
d)'-
U1
.
CS:
Ox:
es, PE
Dental plaque #1
:t
dfJ
19
dJ
GI
Stomatitis
FactS/Causes ~
Condition
LM-Y"':C::O~t~i:!:C::':'--+'-:D:-o-g---::s&:":c"'aO::ts===~-
Overgrowth of
Candida albicans
Oral candidiasis Cause:
M8k 261; Mk 128: SAP 623:
Associated wi other oral dizs
E-hb 434; H3B 299; H2B 333
_ Long term antibiotic therapy
Immunosuppression
stomatitis;
**
Presentation/CS
Creamy white plaques
('thrush") on tongue or
mucous membranes
- Peripheral reddening
- May coalesce in time
- May spread to pharynx
Underlying tissue red or
ulcerated
Treatment
Diagnosis ~
Hx, CSt PE
'
~. Tx any underlying systemic diz
Culture organism
~". Ketoconazole (Nizoral) (BID) until
Biopsy:
,resolves
- Identify yeast hyphae
.
'ftl;=="',#,
- Periodic acid-Schiff stain
re;:;==;:;:CTI
l~;;l1 ~~i~
=ff @!)f;
DDx:
L
Ulcerative stomatitis
'V
Bullous autoimmune skin dizs Prognosis: Good; guarded if predis-
-tIk--\
~~~~~$~.
~.ll~x,-:~K~e~to~c~o!!n!!a~Z~o~le::.JP~x~:c.!G~O~O~d~_ _ _ _ _ _J...____...l.2:=====:;-;;-=~
Plant awn stomatitis Commonly to tongue and gingivae of incisors & canines
Dx: Salivation, physical exam (PE)
Tx: Heals rapidly once removed
***
:::;.
a.
f!!~
0'1
Cause: many
- Immunemediated, bacterial,
stomatitis,
viral
- Idiopathic: Fusiform bacilU & spirogingivitis.
Acutenecrotiztngulcerative
chetes: normal inhabitants out of control
gin gi v i t I sIs tom 8 I i Ii s.
suggested, Bacteroides melanlnogeniCus
Vincenfs stomatitis,
suggested
Idiopathic stomatitis,
Malteseterriers may be predisTrenchmouth
posed to ulcerative stomatitis
MB1<281,Mk. 129; GI-S 192.
~,-,...
190, SAP 623. 12M 411.FN
'~'2..
: : p,.r? 10 r:M-=-a-n-y-c.lau-s-e-s--~)_
cs: Ulcers
v,~
Ox: RIO
i"I~b
lx: Hygiene, ABs, Soft diet 0
Mouth burns
MB1< 279; Mk.127; SAP 622;
E-hb 433; IM-WW 245
**
'
jjj
Sequela: pneumonia
Hx. es
Examine oral cavity
- Tissue destruction
- Ulcerative or gangrenous
stomatitis
r::::--:-:_:-'-_-:-_________.1--.,Necrosis
Electrical bums
Chewing an electric cord in
puppies & kittens
Excessive salivation
Hesitant to eat or drink
Mouth shy
Mild: temporary discomfort
Severe: serious
Electrical cord
CS: Salivation, Mouth shy
Ox: HX,CS,PE
lx: Water, Soft diet until heals' Px: Good
Chemical
mouth burns
SAP 622; H2B 335; IM-WW
245
Excessive salivatIon
Hesitant to est or drink
Mouth shy
0-....;.
"::"..,.~<~-::-:7
Ulcerative
':',\'-
.Hx, CS
Examine oral
cavity
~,f}-
.....m?::i
~
W
Teeth cleaning
~
Mechanical & chemical (2-5%
"
silver nitrate) debridement
~\
ASs for 36 weeks (amoxiclllln,
.
ampicillin, cllndamycin, cephalosporins) .
Mouth rinses (0.2% chlorhexidlne or 3%
hydrogen peroxide dUuted 1:1 wI water)
Steroid (prednisolone) for weekS for
granulationtissuelesions-mayrespond
Soft diet. pharyngostomy tube
~~"
Ii
""U '
I. . . . ,
Steroids
i&'J.J!.J
".d-
~f
-VI
;0 . / )
'I .
Ii
GI
Mouth
Diagnosis
Presentation/CS
FactS/Causes
Condition
Treatment
Pu/PO (polyuria/polydipsla)
See Urinary guide
Uremia
Depression, lethargy
Retention
of
protein
by~prod~
IM481;H2B572,119,86;
C12T951, 966,971 ;C11T ucts in blood resulting in toxic Anorexia, weight loss
GI: vomiting, bleeding
846;GI-S192; Sx-s 1401; condition
Pa-T 211; H-TIM 321
- Stomatitis/oral ulcers
- Associated wI renal failure
Respiratory distress
- Gerialric pets
CNS/encephalopathy
Pathophysiology constellation of CS
Metabolic acidosis & uremic toxicily, anemia Osteodystrophy
r. & fluid overload, GI complications
**
.Hx, es, PE
ECG abnormalities
t BUN, creatinine,
phosphorus
. NonregeneraliVe anemia
- Phosphate binders
Urinalysis: isosthenuria
@! 'fu6##'4O
1.010)
Tongue congenital anomalies Rarem"Bird tongue" (ankylogloSSIa): abnormal developmental narrowing of tongue, 2
Tongue
trauma
M81<126;E-hb435,E1091
**
-(~V
N
/-----)
CS: Inability to nurse, die wlln days of birth; SUNivors: difficulty eating & drinking
Lingual swelling
Drooling of blood-tinged
saliva
Pawing at mouth
[I..
* .Rare;Vegetative
All breeds, especially Siberian
Cause'? - hypersensitivity suspected, hereditary, Males 3 yr old most commonly
tesions wi superfiCial ulceration tongue, drooling, halitosIs, oral bleeding, dysphagia, anorexia (pain), weight loss
huskies,
<
Canine oral
eosinophilic
granuloma
MI< 126; SAP 624; SX-WW
116
Ox Hx, CS, PE, RIO underlying systemiC disorders; Blopsy/hlsto collagen degeneration, eosinophilic & hiStiocytiC cellular Inflltrallon, palisading granuloma
ODx Neoplasia (mast cell tumor), MycotiC Infection, Foreign body reaction
Tx 1sl wi steroids (glucocorticoid [prednisolone]), frequently cause regreSSIOn In 10-20 days, leSIOns ml regress spontaneously, laser surgery
.Px Guarded
Malignant
oral
neoplasms
M81< 282; MI< 130; E-ho
431; H3B 308; H2B 341;
12M 409; 1M 319; IM-WW
247; E 1084; C12T 691;
~ i~44A;F-~ :~n;Sx-
**
"'_...)..
~ ~f%
-n-
of
~ ~
m~t:ommonmalignanltumor
. GingIVae & tongue
"
Highly invasive & readily metastasize
- Fibrosarcoma: locally invasive
~i~~-~
<&f''
(I
Benign tumors
papillomatosis, Papovavirus
COP
~
r;J;;..~
~pMa~WWT'Eg1~: ~
**
II
___
I_~_~
'/!
~
~
T~lymphocytes
~ra:J-'
Othertumors
- Mast cell tumors
- AdenocarCinoma of minor
,,"'"~ ~ands
. Adamantinoma
Hemangiosarcoma
Lymphosarcoma
Granular cell tumor
- O'cocyloma
~
' "-
~.-.
?~~-~
If
n
~ ~_~) I~~
Canine oral
Steroids
Feline
See Systemic; Retrovirus -Lentivirus, male> female (fights), Destroys
immunodeficiency CS: Recurrent infections, multiple systems: oral (> 50%) stomatitis, gingivitis, periodontitis
virus,
Ox: Hx, CS, PE, ELISA: in-office screening
'.)
Tx: Incurable, supportive Px: can live for years before CS, die wlin 1 year of diagnosis
Prognosis: Guarded to poor
FIV
~(
t "ffj
~
Hx, CS
"'C'ff11J Dogs:
Mouth exam for growths
- Malignant melanoma: surgical resection can
Impression smears
extend survival time
Fine needle aspiration
- Nontonsillar sec: aggressive surgical resec Biopsy usually required for deflnltion &lor radiation Tx
tive Ox
- Tonsillar SCC: poor Px because aggressive
Metastasis: evaluate reF'b
P
- I rosarcoma: poor x, moderately radiosen?iBo,nOapISlyymph ~~d~~
~ lungs sitiv9, recurrence common following resection
Cat: SCC: Px poor, local tumor removay\
_Chest rads ~ ':J _
by hemimandulectomy possible
sec: commonly in
gingivae or tonsils....
....
'
<;])1'
I
Lymphosarcoma - tonsil
OOx:
' ~_
Chronic nonhealing ulcers
Dogs: Malignant melanoma, SCC, Fibrosarcoma
~
. Sublingual foreign bodies
Cats: SCC
II!)
Eosinophilic granuloma
OX: Aspiration, Biopsy, Metastasis
Other tumors
Tx: + Sx & radiation, Px: Guarded to poor
Abscess
)
.
7~,""'''-
l')""l1
G<c.~
Cause:
'ii<= _
~~}
Masses of oral mucosa & Hx&CS (young dog wI oral Spontaneous regression in 1-3 month so Tx
commissures of lips usually
masses)
~ unnecessary
- Palate, oropharynx, lips,
Biopsy lor OOx
",:
~ E1ectrosurglcal debulldng if interierence
occaslonally
' I . SUrgical removal of one or more may InlUale regresslon
- Not in skin or genital mucosa
CommerCial autogenous wart vaccines are disappolntfng
Signs occur If interfere wI eating
Bleeding if dog Chews on them
OJ
8~)
::::(t"'
.
I" OOx:
Transmissible venereallumor
r---
I I 23
.so"'"'',",
""" ","'oorna
Fibromatous epulis
"..
- .
Prognosis: Good
t>'---.1
> ........ , (/
c@ ~
f~ 41
/"
"?
Teeth
GI
Condition
Epulides,
Diagnosis
Presentation/CS
Facts/Causes
Periodontal
epulis,
Fibromatous
epull's,
F"b
~:~S,;~~':
cm691:
~'; 16
Hx, CS
Wide surgical excision of fibromatous &
Deep biopsy: contains epithe- ossifying epulides if causing discomfort
lium, bone & cementum
Surgical excision of acanthomatous epulis
~-==(l:=::>:""d!lilI'
- Remove all involved tissue &lor bone to avoid
8
:
bleeding
===:{)
--I -
co
--==-_____--,
[ )"
P~, Biop~~
~'-
~.. Deciduous
~
P
t
Anodontia
665
Abnormal shapes
SAP 608, E 1210, Sx-S-hb 769, Sx-S
2316 C12T 686
recurrence
0X
Solitary or multiple
-Acanthomatous(lnvasive-tissue&bone). Signs if interfere wi eating
Gingival hypertrophy
/111
Cause: unknown
~oral papillomas
6
Id
Odontogenic
tumor
or
cyst
1f;"l1
- > yr 0 (any age can be affected)
~
\> '" ,
Boxers & English Bulldogs mlb
S.quamous cell carcinoma
~Ww
Prognosis: Good
predisposed
~ .., " ._F:::'b::.ro~s::a=r:.co::.m.:...::a:..&:;:o.:st::e..:o..:s..:a..:rc..:o..m
..aL_________
- OSSifying (noninvasive)
Impaction
Treatment
~
l
ermanen
= 42
= 30
======================'
,.,?
too many teeth, congenital defect, less common than loss of teeth
~
Bread predilection (Spamels, Hounds, Greyhounds, BUlldog, Boxer); Occasionally seen In cat
""" ::!.
-Odontomas rarely cause large number of formed or partly fonned teeth
~&~
Tx ff crowd other teeth - remove, Cosmetics, Braces are also used
. /"
'",IOpm",'
Rare, Failure to erupt oul of alveolar bone, rarely recognized in dogs or cats
CS: Nasa! discharge, orthodontic problems, pain
Ox: Radiology
Tx: Extraction if causing problems Prognosis: Good
.'
' '-
.~
f..(((..C y nIT).
(jjC~{~'
rr T1?1T1DJl.
i
-m\
Cv ~OO'
1).
r
Periodontal
diz
M8k 136; Mk 117;
615, 607; E-hb
439, IM-WW 249; E
1102; H3B310; H2B
344; Sx-S-hb 776;
Sx-s 2332; C12T
686; Cat 1125; F31M
55, 58; F-N 438;
Sx38 166: Neo 131,
SAP
140
***
#1 cause of oral
infection & tooth
loss in dog
Hx, CS
Arrest plaque stage with prophylactic care:
PE: Plaque
1. Crown scaling to remove plaque & calculi
- Periodontal probe into
- Ultrasound dental scaler, high speed rotating
periodontal pocket (space
burr or hand scaler
between tooth & gum)
2_ Root planing (removal of plaque & calculus from rool
Normally: 3 mm in depth
below gum margin in periodontal pocket)
Mild diz: 46 mm
- Periodontal curette
- Do not use ultrasound or damage of soft tissue (sublingual)
Moderate: 7-9 mm
3. Subgingival curettage to remove inflammatory soft
Severe: > 10 mm wi
tissue of inner lining of periodontal pockel (periodontal, curette)
mobility of tooth
4. Polish all tooth surfaces: rubber prophy cup, fine
- Radiographs: loss of lamina
grade prophypaste (pumice), retards accumulation of plaque &
dura (edge of alveoli) & bony
calculus
support of affected teeth
Gingivectomy; resection of unsupported gingival tissue
- Eliminate periodontal pockets> 5 mm deep
Open flap curettage: to treat periodontal
pockets extending beneath level of alveolar crest
Antibiotics, depending on severity
- Sequelae:
- Periodontal abscesses
Apical abscesses / _ _ _"-_ _ _ __
DOx
- Tooth loss
- Recurrent
Gingival inflammation from
transient
immunodeficient state (FeLV, FIV)
bacteremia
- Primary gingivitis
(,~
Prevention:
~
.. Home dental care
- Plaque removaholt wot
tooth brush or gauze sponge
- Rawhide chew toys
- Dry pet food or dog bones minimally effective
Annual oral check ups P-~f 7~
('i
l"
iCJ
Teeth
GI
Facts/Causes
Condition
Presentation/CS
Diagnosis
**
Enamel
hypoplasia/
Canine
distemper
_ _
stammg
Canine
Permanent
&
enamel
. _ ..
discoloration ~.,
'.,
.-:::,-,:-:-:-7."-c:cc:--,,-------+------
cavities/
Caries
Oral pain
: :oa:~:
PathophySiology: bacteria liberate acidic byproducts which degrade enamel, may continue
Ihrough the dentin to pulp cavity, resulling In
pulpltls & apical abscesses
Common sites: pits of occlusal surfaces of
premolars & molars
Cats ;, 6 yr old
Treatment
C\..
_ .",.,.//
Hx, CS, PE
..-I
fJ~~~::~ra!lr~n~~defect of enamel
Penaplcal abscess CS
\> .m
;~' (l
(
./
')
.,
I'
_.f
~ ... ,
DDx:
Teeth fractures
Xerostomia (20 canes)
'-
~'\l..1: I
~
..r-G-7"',1 (
--=~
**
'f!
\ ;tI ~
No treatment
Bleaching successful in humans
- Head shyness
I~) -.
r ,", , ,-:-;,-'-'- ~'-'- ~- O-'-'- "-'-P-(-PU-I-p-al-h-Y-P-e-re-m-i-a- - '-~F~ -c-t-u-red~c-r-o-w-n- - - - '- .-H-x,-C-s- - - - - - - - - -r.-T-e-e-th- e-~-r-ac-t-io-n- - - - - inflammation of pulp)
diz,
PuJpitis,
Pulpal hyperemia
M8k 137; Mk 119; SAP
607; H2B 346; E-hb 442;
CI2T 689; Sx38 172
**
~
I ,,_
_.
/" I
.............. _ /
Periapical
abscess,
- Painful, salivation
Palpate over root ends for
Oral pain
abscess
pulp wI pressure necrosis & ab- t sensitivity of tooth to touch Dental probe fordelects In enamel
scessation
Discoloration of tooth (dark gra Radiographs for periapical
Cause:
purple)
- #1: Tooth fx wI pulp exposure
Sequela:
- Invasion of pulp by caries
- Periapical abscess
-Trauma affecting blood supply
- Periodontal lesions extending
- Osteomyelitis
Into penaplcal region
- Sepsis
Pathophysiology
-Trauma &lor bactena wlln pulp cavlty
resulting In pulpltls (Inflammation)
Diz of pulp - tooth Ix
- Swelling results In IsChemic necrosIs of
surrounding pulp tissue & dentin
CS: Fractured tooth, pain
- Infection spreads out aplcalloramen to
Ox: PE,probe, Rads
perlap-cal tissue In lime
**
Carnassial
abscess,
Malar abscess,
Facial sinus
M8k 139; SAP 608; H36
313; H2B 347: Mk 119;
IM-WW 249: Sx-S-hb
420; Sx-S 1248; Sx-WW
117; E-hb 437: E 1097
Prognosis: Good wi
appropriate Tx
7i "Z
Teeth, Pharynx
Condition
GI
Facts/Causes
Presentation/CS
Diagnosis
Treatment
~o~e-n~ta~l~a~tt~r~it7io-n~&--+-.~c~a-us-e-s~:~~==~---~;
.A~S-y-m~~~o~m~m~ic~u~su~al~ly-----t.~H~X-,~P=E~~~~-----1-.-N-o-n-e-r-eq-U-i~re~d~if~P~U~IP~--abrasion,
- Normal we~r of aging
y.
t~ ,b,r,~
Dental probe: central
cavity remains sealed
Rock chewing
.
\
':i..i..J (,
occlusal surface, if hard
If pulp cavity exposed: root
Rock chewers , -Pathophysiology:
~" "..:::J ",,,..,"
2 dentin is protecting pulp cavity
canal therapy or extraction
l
Worn teeth
***
\..
***
,V
-:----:---"--:----::---,
Usually
- ,p
')1
asymptomatic
Mouth exam
t:::J' ~
t,.,I
)1
~~
~;'~11
~~f
'ili'
;~~-~
Prognosis: Good to
l~~;p.
guarded wi appropriate Tx ~
- ,Oto"m,;,
COptop"'9Y
Pharyngeal
trauma,
Foreign bodies,
Retropharyngeal
abscess
Retch
Cough
Inappetence
Malaise
Fever
~f
@b
Prognosis: Excellent if removed
early; guarded if present> 1 yr-old
**OJt
-2IO
, C,,;lUti,
hronic vomiting or regurgitation (megae-
~~
Malocclusion
Clinically insignificant usually Oral exam
Orthodontics: movement & reposi- Cosmetic
tioning of teeth to a more normal oLower canine displaced lingually
,~
M8k 139, 126; Mk 120; E-hb
position. Only to alleviate traumatic maloc- - Palatine defects
441; SAP 621; H28 334; F-N
clusions resulting in pain or inability to eat or
301; Sx-S-hb 783:
function. Not to correct cosmetic or genetic
Sx-S 2349;
dental defects
Neo 127
Cause (etiology):
- Genetics
- Retained deciduous teeth
oTypes:
- Prognathia (mandibular teeth rostral to
maxillary)
- Parrot mouthlbrachiognathia (maxilMalocclusion: prognathia, brachiognathia
lary teeth rostral to mandibular teeth)
CS: Clinically insignificant usually
- Lingually displaced mandibular canines
Inflammation of tonsils
Common in dog, less frequent in cat
Young small dogs
Usually bilateral
Types
Modify behavior
Orthodontic diz,
Malocclusion
Tonsillitis!
pharyngitis
:(
~r ...)
Retained
deciduous
teeth
Hx, CS
Mouth exam: visualize
tonsils in their crypts
1-i:1
y . . . . . :.
~
CC)"b
.r~------
", ~'--<111
'/-("lff~.1!"
7
~;'~11
;;
/-:-:::---7.'"' . --:---:::--'----.
Inflammation of tonsils
CS: Cough, Inappetence, Fever
Ox: Mouth exam
Tx: ABs Px: Good
Pyrexia
Anorexia
Pain & swelling of
pharyngeal region
~ ~\
Prognosis: Good
.Hx, CS
Mouth exam: try to visualize any foreign body
ABs
Remove foreign bodies
Surgical drainage of abscess
- Radiographs
- Surgical
exploration
Pharyngeal
neoplasms
*. Most pharyngeal
tumors are
.
<t -
~
~
Prognosis: Guarded
Tonsillar neoplasia Squamous cell carcinoma (SCC) TonSillar crypt In dogs, locally Invaslve. metastasizes to lymph nodes & lungs, Lymphosarcoma
,....._ - -..
~ oCS Dysphagia, anoreXia, emaclallon, coughing, retching, dyspnea, cramal cervical mass
,/ "';;- "
...
Ox PE Visualization, biOpsy, Rads lor metastaSis
~;;...............
"-.
oTx Euthanasia,SCC RIO metastasis-chemotherapy +fadlatlon; Extensive eXCIsion (heml"
mandlbulectomy or total mandlbulectomy greatest success) + radiotherapy
.".......--......
0 PrognosIs: Grave: < 9 mo. survival wI Sx or radiotherapy
0
29
Mouth
GI
Facts/causes
Difficulty
in swallowing
Dysphagia
E-hb 58; SAP 632, 646; E Clinical sign, not a diz
Condition
<>~
d!/ffi
Presentation/CS
Diagnosis
Drooling
Nasal discharge
Cough from aspiration
RIO causes
Treatment
Sequela:
~I~ __--------L--~A~sp~i~ra~t=io~n~pn~e~u~m~o~n=ia~-L----------------__
/'\ ~
Dysphagia - Causes SAP 633
Nonneurological
~
Neurological
- Oral dysphagia if @
- eNS or cranial nn. 9, 10
. Cleft palate
1l~'.' '1
Rabies, other viral,
Dental diz
IJb
\
bacterial, protozoal or
Oral foreign body /,
Oral neoplasia
'j I
fungal infections
_Trigeminal neuralgia
Persistent frenulum
_Hypoglossal nerve problem
Severe stomatitis/glossitis
_ Brainstem disorders: trauma,
Skeletal disorders
tumors, hemorrhage, edema
TMJ ?IZ (tem~romandibular joint)
- Myopathies or myositis
}~ A .. Cranromandlb~lar osteopathy
Masticatory myositis
}.:'" :I{ j .. Fractured hyoid ap~aratus
Immune polymyositis
Pharyngeal dysphagIa .
Hypothyroidism
~
\ Cncoph~ryngeal achalasia,
_ Neuromuscular diz
b..
\
dysphagia
Myasthenia gravis c;r If;
~ . Neoplasia: pharynx, tonsils, ret Botulism
.I I \ ~
rophaoyngeallymph nodes
Difficulty in swallowing
Acute polyradiculoneuritis
. Tonsillitis/Pharyngitis
CS: Drooling, Cough
Retropharyngeal abscess
Ox: Hx, CS, PE, RIO
Iatrogenic short soft palate
Tx: Supportive therapy, Food
Esophageal hypermotility
**
Supportive therapy:
- Nasogastric or pharyngostomy tube
- Syringe inserted in buccal vestibule (liquid
diet)
Corticosteroid
.1/ ~b
' (f.--.
"J -
-tA-' -
Pharyngeal
'
paraI
YSIS
Rare; Myopathy or neuropathy 01 glossopharyngeal, vagus or trigeminal nerves; Cause: Trauma & Idiopathic (unknown)
CS: Dysphagia
/"I' ..
I~~
/. -?
~~(do.
to
~
I
"
1.-----
.~.
Cricopharyngeal
achalasia!
dysphagia
H3B 339; M8k 276,
128; Cat 1174;
SxWoIo/ 12;
PaT 18
'11
H2B 339
Tx: Supportive, Pharyngostomy tub.~ feeding .
Prognosis: Good if temporary condition, Grave II permanent ____________________________
I
"
! -__________-L~~~~~~~~~~~~~
~____
~
,'
I![ljj
oDx:Hx,CS
Hypersialism,
"Drooling" ,
Hypersialosis,
Ptyalism
Hx, CS
Endoscopy
Barium swallow or fluoroscopy
'Co"""'P,";"'SP"""'~'
spaniel, Irish setters;
<!~'.U""M';9hl
~
'EMG
Rare condition
'II'
'II.
C~
***
~'
...,
(parOliddeuct~)
C
W rotidgland
0
Rabies
Other causes of dysphajla
\,~~
t~J:,?Wf
,.~)
(~
,{\
/~~(~-..
((I!
$=:7
I~
Depends on cause
.1 0 disease of parotid
_Anticholinergic drugs to alleviate drooling
10,,\\
short term
_ L_____----== -"'1\; f' 'iJ .Glycopyrrolate 0,01 mg/kg SO PRN
Esophagitis
CC!.-~
DDx Drooling
D
- Malformation of lips in giant breeds - Glossitis
- Cats:
- Oral foreign body
- Anxiety
Pharyngeal or esophageal obstruction
- Apprehension
Viral diz (distemper)
Oral neoplasia
- Contentment
Anticipation of feeding or injections - Organophosphates
-Inflammation of oral
- Portosystemic shunt (especially in cat)
- Gingivitis
AitB
DDx:
~.
I'i~J
!
I ~?
C-:==aa=::=s:;~,=/
//// S"':7
Guarded, depends on cause
Xerostomia,
Aptyalism,
Dry mouth
M8k 264; Mk 252:
IM-WW2SO
**
mouth
- Drugs (atropine)
- Dehydration or pyrexia
- Anesthesia
Immune mediated (accompanying
keratoconjunctivitis sicca)
- Diz of
Treat cause
Mouthwashes
r
l.EJ
Salivary Glands
Condition
Sialocele,
Mucocele,
Ranula
Causes:
~
~
0....
mastication
- Pain if traumatized
- Obstruction of duct
- Tumor invaSion
Hereditary factors
- Spontaneous
Pharyngeal:
- Swallowing difficulty
.,~.,~",,",.~.-, - Dyspnea
"'0" moodlbul.,,, ,,"omatic 9lood, 0' doc' Retrobulbar: Exophthalmos
Rarely in parotid gland or duct
"'..
~r=:."
l
salita w/in1issue
---
~ "'L
Penetrating wound
camasslal tooth abscess
Iatrogenic (surgery)
Sialolithiasis
H38 321; H2B 257; SxWW
121; PaT 5
*
I of
salivary glands
MSk 283; Mk251; H3B321:
H28 358; SAP 627; Ehb
436; E 1092; Cat 1150; FN
446; SxWW 121
*
Adenitis,
Sialoadenitis
M8k284; Mk251; SAP 627;
H38 318; H2B 352; IMWW
250; Ehb 435; E 1092
**
mucus
RadlologySialography: difficulllO
perform so rarely done
II
&I')r\~
C>'.
4~
JI
Abscess
Hematoma
Branchial cyst
Thyroglossal duct cyst
Coo",
IDDx:
M8k283;Mk250; Ehb436;
H2B 356; IM-WW 250; SxWW 121; SxShb 190; Sx
S 515; Nee 142
~te~
(submandibular)
Treatment
Diagnosis
Ranula: sublingual
- Mechanical intelierence wI
- Cranioventral cervical
~.~'~
- Ranula:
GI
Presentation/CS
Facts/Causes
OOx:
Drain fistula or forelg" body
- Chronic Infection & cellulitiS
4~
III! $:o:@J
~
~
Prognosis:
Good wi surgery, recurrence rates < 5%
ligation of parotid duct
Identify duct by 2-0 colored nylon suture per os
Into duct
//(i
S=
Prognosis:
Good: transient swelling then
atrophy & loss of function
- Fistula heals in a few days
:7
~;;11
1~\
/iii
,=
'7
i : Good
Rare
Usually malignant
Types:
. Adenocarcinomas most commonly
. Mixed tumors, mucoepidermoid carcinoma &
acinic cell tumor
Parotid or mandibular glands usually
- Benign tumors only documented in cat
Metastasis common 10 regional lymph nodes,
but slow to develop
"
- Sequela: mucocele
-CS,PE
- Fine needle aspiration
-Incision or exclsional biopsy
- Tumors should be staged(?)
c==~aZ~::~S~=o~7~@~
Ii)
OOx:
Salivary abscess
Salivary adenitis
- Neoplasia in loeallymph nOdes
Myxosarcoma of face or orbit
;7
Hx, CS
Palpation for pain
DDx:
Salivary abscess
Salivary neoplasia
Salivary mucocele
Other cause of
retrobulbar diz
Excision of gland
- Parotid removal difficult because of anatomy
Radiation therapy adjunctive Tx
Chemotherapy trials not reported
Conservative Tx recommended
- SystemiC ABs
- Drainage of abscess
Zygomatic gland abscess, drain
into oral cavity
- Wann compresses
Surgical treatment not recommended
Esophagus
GI
Facts/Causes
Condition
r2
/l
'\\\ r
**
1\
.
...
\'
Endoscopy wI biopsy:
Gastric reflux or vomiting
- Cimetidlne (Tagamet): Histamine-2antagodefinitive Dx
niSIS to reduce gastric acids, do not use wi antacids
Radiology:
- Sucralfate (Carafate): binds to & protect mucosa
- Survey films - normal
Antacids (Mylanta)
~.
- Contrast: normal m/b
Metoclopramide (Reglan): Regla'n --. Adherence of barium to mucosal ero-
."'5
A.
. Thickening of wall
Sequelae (rare)
~I
.1.---
~~~~~~::!::t::~":::,
:
-:~(~;;'7;n body)
?~~~bstruction
1\
**
;;;p ~;.'f!
{~~)J@i
Prognosis:
Dysphagia
Bones, fish hooks, needles
Complete obstruction
Common locations ~
-Immediate regurgitation
- Thoracic inlet
!
of solids & liquids
- Over base of heart
~ Partial obstruction
-In front of diaphragm
V(~-RegUrgitationofSOlidfood
Sequelae in 33% of FB
(fluids pass)
- EsophagitiS
Chronic obstruction
- Esophageal perforation
- Anorexia & weight loss
- Mediastinitis
Perforation
- Esophageal diverticulum
- Pleul1tis
- Febrile & anorexic
- Perforation wI abscessation & fistula
- Local abscesses
-Stricture
Dyspnea if impinges on airway, pleural effusion or pneumothorax
eaters)
........~
,,~,
2diz
j"causes rare
CS: Regurgitation, Drooling
Ox: Endoscopelbiopsy
Tx: ABs, Diet, Cimetidine, Sucralfate, Antacids,
Metoclopramide, Chlorpromazine
Trauma
Dogs cats (cats more discriminate
~
Gastroesophageal intussusception
Hiatal hernia
megaesophagus
- Thermal insult
- Trauma
- 2 to megaesophagus
. Spirocerca lupi (rare)
MSkZT7; Mk220;SAP636;
12M 417; 1M 324; IM-WW
255; E-hb 451; 5min 562;
H3B331;H2B369;E 1137;
C1IT 577; GI 314; Cat
1156; Sx-WW 123; Sx-Shb 194; Sx-S 534; Sx4B
187; Sx3B 201; Neo 147;
Emrg321
'\ )/
Stricture
PRAA (persistent right aortiC arch)
disinfectants)
Esophageal
foreign
bodies
q~
=- <Y W
Remove in cervical
stomach
- Don't move an immovable object or may periorate
Gastroesophageal intussusception
Hiatal hernia
Esophagitis:
@)'b '~'"
~ <i:J
1~\ _.
-:::-_::_
Prognosis:
Good if removed & no perforationI l"-~,_~--.
A~
Guarded to poor if perforation
f{
}
~~~~~~~~~~~~~~T!X~:~R~e~m~o~V~e~,!A~B~S~__________JL~~~==============~~______
Esophageal diverticulum
~~
*.
Esophageal
stricture/catrix
M8kZT7;Mk231;SAP638,
651; E-hb 452; 5min 566;
H3B 332; H2B 364, 12M
417: IM-'WW 256; 1M 324;
GI 322; Cat 1163; ClOT
904; Sx-WW 124: Sx-S-hb
196
~...--
it
Esophagitis
:Apb"~t",.,
""
il possible wi an instrument
- Esophascope & alligator forceps or grasping instrument
- Caution in removing sharp objects or pushing them into
.N;i;~mffi"~p"tP,"~,,at;oo
, ~
'" -
tJ1;{~'
Hx, CS
Endoscopy definitive
Extemal palpation of cervicaf FB
Radiology:
- Dilation proximal to obstruction
- Radiopaque: easily seen
- Radiolucent hard to see
- If perforation: pneumomediastinum,
MegaesophaguS/PRM
.....
Caustic agents:
NO emesis if caustic agents
- Acids: neutralize w/ milk of magnesia
- Caustic alkalis: vinegar or lemon juice
- Sucralfate (intestinal protectant)
- Rest esophagus: nothing PO 24 hrs
- ABs (as above)
- Steroids (as above)
FB (foreign body) remove: if severe trauma:
ABs, steroids & sucralfate
~
Hiatal hernias: Sx repair
~
All of above:
- Soft bland diet, frequent, small,
Gastrostomy tube
cs: Regurgitation
~ "~,~ v~=-.~~,~'~
~~r
Tagamet
Hx & CS
Treatment
Tx cause
Regurgitation
Diagnosis
Presentation
~(Y
M8k 128; SAP 640, 651; E 451; IM-WW 257; 5min 564; H3B 326; H2B 360; GI321; Sx-WW 123; Sx-S-hb 198, Sx-S 545; Neo 153
Sacllke dilation of esophagus, Congenital (rare) or acquired pulsion: strictures, FB, Inflammation, hiatal hernias, Dogs:> cats
CS: Gagging & retching, regurgitation; Sequelae: aspiration, perforation
Ox: Contrast rads (food-filled pOUCh) '" esophaacopy
Tx: Small: feed upright, eoft diet, liquids to lIush food through esophagus, Surgical resection if large
Complete obstruction
- tmmedlate regurgitation of food
Partial obstruction, only fluids pass
Similar to FB
Salivation, retching
OOx:
\
, "
FB
Esophagitis
Tumor
Cause:
-It 1: 2to routine Intubation, especially if
head lower than abdomen during Sx
- Chronic esophagitis
- FBltrauma
- Spirocerca/up/
- Tumors (rare)
- Periesophageal
obstruction
./ \
_*-=~J~:--~'~~~-L
__________~~V~)~__
\..
'r=""ill~" --,-;-:--,.,---,:--:-:-:--c-------'-''''''--
Hx, CS
Endoscope
Survey rad
_ Normal
- Dilation cranial
to stricture
Contrast radiographs:
_ Narrowing of esophagus, repeatable on
many films or fluoroscope
-Irregular mucosa & thickened wall
~3~5~L-________________-L_P'~~~"OO~'~"~P~~'________
-L____________
Esophagus
Condition
GI
Presentation/CS
Facts/Causes
Vascular ring
anomalies,
Persistent
right aortic
arch, PRAA
M8kl28;SAP641,646;IM
323; IM-WW255; E-hb452;
5min936;H3B69;H2B68;
Gr 319; C12T 696t: Cat
1165; Sx-WW 123: Sx-Shbl96,202;Sx-S538:Neo
~r.~~1
Diagnosis
Treatment
Hx, CS
Sx: ligate & cut restricting liga Congenital defect: persistence of 1 of - 1st noted when puppy weaned onto solid Radiographs:
mentum arteriosum
the aortic arches, entraps the esophagus
fOOd,
_ Dilation of thoracic esopha- Double ligate because 10% patent (opened)
- Persistent right aortic arch ~ ~~~~nt~~~, :~~~~
gus cranial to base of heart Frequent gruel feeding 6 wks, head
most common (nOrmaIlYleft~rSiSIS) Aspiration pneumonia - coughing
(contrast study)
elevated
~
-Lesscommonvascularanomalies.double
-Ventral displacement of trachea
/
aortlcarch,aberrantsubclavlanaa.m/cause
~'_ Aspiration pneumonia in crap
~
same problem
/
~'.
.
.\ \ :-. All have same signs & treatments
DDx:
'\.A
mal & middle lung l o b e s \ " , ; )
.Genetic:Ger.shepherd,lrish
Stricture
~~~
~ (
setters, Boston ter~er
Diverticulum t:J (
B , o k Prognosis: Poor, Sx helps all ~
Causesextralumtnal
.FBobstruction~f
~
10% cured
~@'
fi
)Izf
,*45
_ ,~ f--_e_s_o_p_h_a_g_e_a_'_O_b_s_t_ru_ct_io_n__
~~.=M=e=g=a=e~S=o=p=h=a=g=u~s:.._.Ll-.::'entraIlY,PUlmonarya.onleft&ligamentumarteriosum
re.E~"'~P~h~'9~"~'~'~"~"O~"~'~d'~d~by~aO~~~'~',"~h~tO~h9~h~t,~b~"~'~O~fdorsally
~h~"~rt~t!7.\-I ~50~'l\~'~in~t~e~rm~itt~e~n~t~r~e~g~u:r~g~it~at~io;n~~x~
40% continue severe sians
t:)
>E:m-
W"Z.
r
*.
0
~~
Esophagobron- Rare In dog & cats, congenital or acquired (FB)
o CS: Respiratory dysfunction: coughing associated wI drinking: regurgit~tion; Aspiration pneumonia
/'_
chial fistula * Ox: Rads - survey: pulmonary consolidation, pleural fluids; contrast defiOillve; Esophascopy & bronchoscopy
L .... . . . . -:
SAP 640, 650; H3B 329; Tx: Surgical correctlon; Broad spectrum ASs Px: Guarded wi successful surgery, Grave wfoul {chronic bronchopneumonia} ~
H2B364, Ehb451; Gt321
Megaesophagus,
Congenital: hereditary
Acquired: Usually idiopathic:
unknown I" neuromuscular dysfunction
~
r'-..J'r:
History
Treat underlying cause (usually
Pressure to abdomen rnI cause ballooning
not determined)
at thOracic inlet, difficult to see
Symptomatic (can't be cured)
1 dogs
Radiology: survey films
- Elevate dish so eat while standing (gravity), maintain standing lor 51 0 min after eating
- Semiliquid diet at frequent intervals
:
small portions, high calorie liquid or gruel diet,
t
diaphragm
occasionally canned food better
- Ventral displacement of trachea
Cisapride (prokinetic drug more potent than
Causes: megaesophagus Toxins
. Aspiration pneumonia (cranial &
metoclopramide, available in Canada)
Congenital
Botulism
middle lung lobes)
Myasthenia gravis
Neuromuscular
Chronic organophosphate
Contrast: esophageal dilation,
- Pyrldostlgmlne, neostigmine
- Steroid: Prednisolone
Idiopathic - #1
Lead
..r"'~
little barium into stomach
Various drugs tried, usually
Myasthenia gravis
_Tetanus
--~. Endoscopy
ineffective (clsaprlde, metoclopramide)
SLE
_Thallium
Fluoroscopy motility
Polymyositis
M'
II
~
';;;
Neuromuscular:
Permanent gastrotomy tube
Isce aneous
.'"
- Myasthenia gravis: measure antibodies
P0 Iyneuropathy
- Esophagitislfistula
~ to acetylcholine receptors. Tensilon Tx aSPi~tiOn pneumonta
- Polyradiculoneuropathy
Hypothyroid
test if systemically weak
(Coonhound paralysis)
. Add'tS '
- Electromyography
on s
Immune-mediated diz markers, ANA
Dermatomyositis
Thymoma
(antinudear antibody, serOlogy)
CNS diz (Caud. brain stem)
. PRAA (persistent rt. aortic arCh)
Thyroid stimulation (TSH) test
+
Tick paralYSIS
M d' sf 'I'
H20
-- Labrador
Giant axonal
neuropathy
:
[cat]
myopathy
Dilatation
d:JQj
18
**
Dye~~t~~~~la
'---------,-(-;;:==== ~" l !
'--, ~j
r----- ..~---'-----.DDx:
Chronic esophagitiS t
\
Dilated esophagus
~~~
-""I ~
Gastroesophageal intussusception
CS: Regurgitation, Aspiration
Obstructive dizs (FB, Ring anomalies,
Ox: Hx, Rads
stricture, diverticula, neoplasia)
Tx: Elevated dish, Semiliquid diet
Htatal disorders
Periesophageal
obstruction
-.J
tr
lLlll
Mechanical obstructi~n of esophagus from surrounding tissue, may lead to stricture: mediastinal masses, thymomas, hilar
Iymphaden~pa~hy, foreign bo,dy abs~esses, tumors, mediastinal masses, fungal granulomas, heart base tumors, cysts
SAP 644; GI322; C10T904; Sx-S-hb CS: Regurgitation, CS associated With mass & location
198; Sx-S 544; M8k 127; Cat 1166
Dx: Contrast radiographs, esophagoscopy
Branchial (or lateral cervical) cyst M8k 127
Tx: Treat cause of mass
Thyroglossal cyst M8k 127
i
fI~
Prognosis:
,I
-roo- Grave to poor - rarely cure
- EspeCIally If aspiration pneumoma
-Mostcontinueto regurgitate, but may improve wI
upright feeding
. ~~
;
- Aspiration always possible
~'-.!f Congenital: good, normal when mature
Regurgitation - Vomiting
GI
Facts/Causes
Condition
Presentation/CS
Diagnosis
Regurgitation
or Vomiting
't'
- Dermatomyosl~s (Collies)
,
Myopathy
_ Fecal exam for paraSItes
P~rslstent ~oml Ing
Congenital vascular ring anomaly
Hiatal hernia
Metabolic
_ Dietary trials before extensive diagnostic tests
Foreign body
_ Diagnostic workup
Caustic agents
- Hypothyroidism
. if symptomatic Tx ineffective
Stricture
Megaesophagus (neuromuscular) _ Hypoadrenocorticism
Radiographs (pl~~n): intestinal ObstructIon,) FB, masses,
Neoplasia (carcinoma, sarcoma from
Congenital megaesophagus
pancreatltls or peritOnitiS (ground glass, free gas
Spirocerca lupl!
- Idiopathic
- Other
.....
Contrast radiographs: gastric outflow obstruction
Extraesophageal compression
Lea~
. '
_Hemogram, serum biochem. (electrolytes, Ca, glucose, hepatic
- Myasthenia gravis
- Thyroid carcinoma
Acquired megaesophagus
Camne distemper ~~
enzymes [ALT & ALPj, BUN, creatinine, albumin, amYlas.e, lipase)
- Pulmonary alveolar cell carcinoma Neuropathy
Dysautonomia (cats) -- .. ~
Urinalysis
- Anterior mediastinal mass (cats)
- Giant cel! axonal
Chaga's diz I d'
d
~. FeLV (feline leukemia
virus) & FIV (feline immunodeficiency virus)
Gastroesophageal intussusception (rare)
- Gang!iOradiculltls
Pharyngea Isor ers
'd
nt f
- Polyradiculoneuropathy
Rabies
_Serum thyrol conce ra Ion
Functional obstruction of esophagus
Cricopharyngeal achalasia (rare)
Immune-mediated
Foreign body
H(DeartwnOtrrn"nuetedstbeIOW)(r.r~:l::J:~rt:ll-~)
Esophageal diverticulum (rare)
- Polyneuritis
Other obstructions
x co
~
___
Esophageal atreSia (rare)
- Polymyositis
protein)r
****
"_.oJ
~,\~
---:~_______
....---->;----.-.
Vomiting - Causes
Motion Sickness
Overeating
Drugs (almost any) ..-
'T~"""uoes~1 ~~"
~a
Canine distemper
Canine Corona, PaIVo
& ICH
- Bacterial & Rickettsia
Leptospirosis
Salmonellosis
- Intestinal obstruction
- Foreign body
Torsion/volvulus
Intussusception
- Stricture
Neoplasia
- ErythromYCin
~
. Adriamycin
~
- Digoxin
":-\,
- Cisplatin ':::~'3
Neorickettsia
Nervous
Pancreatitis may have normal amylase & lipase
- CyClophosphamide
Serum thyroid concentration (feline hyperthyroidism may
- Parasitic
- Vestibular dlz penpheral &
Toxins
Ascarids
central ,
have normal thyroxine earty)
- Blood-borne toxins
Giardiasis
- BehaVioral disorders
~_ Consider less common cause
- Heavy metals
Abdominal Inflammation
- Epilepsy
~\.... ~ -_Occuh CNS dlzs
- Pesticides
- Inflammatory bowel diz
- Psychogenic ~
~~ IdiopathIc gastriC hypomotility
- Solvents, etc.
- Enteritis ~ - CNS dlz
-~...,.. Limbic epilepsy
Systemic diseases
- Gastritis
'\ U.I
- t Intracranial pressure
Feline heartworm diz (seen in 50% of cases)
- Pancreatitis
- Colitis
Trauma
- Pyometra
- Pancreatitis
Tumor
Treatment of regurgitation
- Hypoadrenocorticism
- Peritonitis (septic,rupturedbowel,
Hydrocephalus
_ Remove initiating cause
- Diabetic ketoacidosis
bile duct or urinary tract)
- Encephalitis
_ Minimize chances for aspiration
- Renal failure/uremia
GI obstruction
- Hypoxia of vomiting center:
_ Maximize nutrition into GI tract
- Liver disease
extreme anemia or blood loss
_Check & correct dehydration, electrolyte
- Stomach outflow
- Cholecystitis
Foreign body
Miscellaneous:
imbalances or sepsis
- Hypercalcemia
- Postsurgical nausea
Px: Obstruction: Guarded
- Gastric dilation/volvulus
- Splenic disease
Pyloric stenosis
- Idiopathic hypomotility
depending of severity & duration
Infectious diseases
- Feline heartworm diz
Mucosal hypertrophy
_ Megaesophagus: Poor
- Viral:
Infiltrative diz (phyoomycosls) - Feline hyperthyroidism
_ Esophagitis: Guarded to good
Feline panleukopenia
Neoplasia (rare)
- Idiopathic
Ji-U. .\.
"
~~--------~_)D
es, not diz
Other es clues to cause
Ox: Differentiate
Tx: Symptomatic 1st
--
Tx: vomiting
- Treat symptomatically if no cause determined
Fluids & electrolytes if necessary
Dietary trials before extensive diagnostic tests
- Diagnostic work up if symptomatic Tx ineffective
"---
GI
Gastritis
Treatment
Diagnosis
Presentation
Facts/Causes
Vomiting
Hx, CS
Mild gastritis - self-limiting
Dog (indiscriminate eaters) > cat
Acute
oLow-grade inflammation wi shallOw erosions of Depression
Mild CS:
- NPO for 12-24 hours to rest stomach
mucosa
Abdominal pain
- No diagnosis necessary
- If no vomiting then ice cubes or sm.
gastritis PathOphyslology:
damage to mucosa -HCI into
(restlessness, crouching)
- Response to Tx is diagnostic
amounts of water
wall; stimulates vomiting center (brain stem)
M8k 294; Mk 236;
SAP 658; E-hb 455; E
Anorexia or depraved appetite - Fecal
- Bland diet at 24 hrs if no vomiting
Causes:
acute
gastritis
, 151;5min;H3B335;
(chew dirt, eat grass)
~
Serious:
(lId, cottage cheese + rice, tofu + rice)
H2B375: 12M420; 1M
Idiopathic #1
Ih'~1
SO fluids
~
326: IM-WW 258, 260;
Dehydration
CSC, protein
f h" b II
Dietary indiscretion (overeating.
Severe enlentls also
_ Fecal
- Cat: treat or air a s . ,
_ Antiemetics:
obstruction, FB & parasites
Sequela to gastric torsion
Chlorpromazine (Thorazine) (vomit
Assoc wI metabolic diz
k DDx:
center)
.
~~ GI parasites
Pylonc obstruction
Metoclopramlde (local GI & CTZ Ichamo.
~~1S~~~t oEarlychronlcGldlz
/)
. .
receptive trigger zone. brain!)
Gastnc ~IZ ~ulcers, p~.OriC dysfunction, tumor~) .
_ Follow wI diagnostics as needed
Metabolic dlz: V?~T1Itlng (pa~cre~tills, hepatiC ~IZ, renal - H2 blockers
diz, hypoadrenocomclsm, OKA [diabetiC ketoacidoslsD
~_
-:'0
.
Idiopathic, "Garbage gut"
Condition
/li;U -
Ex,.,,,,,,,
sa
****
./ -/, b .
~ '/ I
II '
~~~
Toxins/poisons
NPO
~~
~ ~
_II
P
~"E
II nt
rognosls: xce e
Good:
parasites
- _~
Tx: i/d diet, Steroids 0 Px: Guarded
Causes:
CS i1I~defined & mlb obscure
Usually in good condition wI
- Lymphocytic/plasmacytic
gastritis (LPE), most common
little weight loss or diarrhea
. Thought to be immune-mediated
Intermittent vomiting (not In all)
- Internal parasites: Ollulanus
_ Periodic exacerbation
Mk 236; SAP 663;
tricuspis, Gnathostoma
W "hi"
H3B 336, 373; 12M
h"I"
.
elg toss, anorexia
421;IM327;Cat1195
- Eo~inop II~ gastntls
Abdominal pain
H~lrbalis (tnchobezoars)
Chronic belching
Cats:
Chronic
gastritis
**
...... -
i~ ~..ll)
Dogs:
Chronic
gastritis
M8k 294; Mk 236;
SAP 663; E-hb 457; E
1154; 5min 618, 620.
622. 624; H3B 336;
H2B376; 12M421; 1M
327; IM-WW263; PaT28
**
Uncommon
Chronic inflam. of gastric wall
Most never diagnosed: idiopathic
Histological types - biopsy
- Chronic superficial gastritis (most
common)
- Atrophic gastritis
- Chronic hypertrophic gastritis
- Eosinophilic gastritis
- Granulomatous gastritis
- Lymphocyticlplasmacytic
it
-- 1
~(~ 1~
~~'
-} ,
), ! ~d~
II
Histotypes
CS: Intermittent vomiting, Ulcers
Ox: Difficult to Ox & Tx, Biopsy
Tx: Symptomatic, Steroids
::(l
41
4j[]
I'
f]l
Usually no Ox
~ ,
Symptomatic Tx if no biopsy __ :I
- 1. Dietary control for 3-4 wks to rule in
or out food allergies or intolerance
Bland. hypoallergenlc diet (hi CHOS)
.. 110 or DID, COttage cheese or tofu & rice
.. Small frequent meals
~2. Histamine H2-receptor blockers
ClmeUdine (Tagamet), AaniUdlne (ZantaC)
Inhibit add secretion; may help many
Contraindicated In atrophic gastritis
- 3. Deworm even if negative fecal
- 4. Sx if pyloric obstruction
.If no response: biopsy & treat
according to biopsy ~
- 1-4 above
SterOids + ~ '11
~ 5: Steroids + diet
~
~,
If immune mech. is suspected (see
lympholplasma cells in biopsy or eoslnophiis)
Steroid (prednisolone)
Contraindicated if lymphoma
If continued vomiting
~ 2 gastric motility disorder
Metoclopramide (Reglan) 30 min
before meal, or q6h-q8h. Central antiemetic & promotes gastric emptying, but flO
effect on F chronic gastritis
o Py!hiOSiS: complete surgical excision only cure,
,.,;"""1 to 8Om,,",,1
~
f:I
I
''''9'
Tagamet
Prognosis: Variable
Superficial: good
o
\':-."'11
~)~f
Immune-mediated: good
>v Eosinophilic: good dog, poor cat?
Pythiosis: grave
Stomach
GI
Condition
Gastric
foreign
body
Diagnosis
Presentation
Facts/Causes
Common in dogs cats
Radiopaque (metallic, needles,
Extremely variable CS
Some asymptomatic
'11
l'
_;-
****
(tentative)
Palpate object
Radiology (definitive)
- Radiopaque easily seen
Contrast: radiolucent
Filling defect or retain barium
when stomach empty (fabriC)
" Endoscope: difficult if food In stomach
.
f),u
loss of condition
Behavior change: eat 2 bites ravenously I ~-----then loses interest
DDx:
Rabies
Gastritis
'1..'
:"
Gastric ulcers
PylOric canal obstruction
Dogs> Cats, Hairballs: Cats
Gastric tumors
CS: Variable - Vomiting
,,/ 'Ii /,
Pancreatic diz
Ox: Rads
V CI
Vit. & mineral deficiency
..I
L:~:;;;~J.
History & PE
1t
Gastritis:
Treatment
~~4;
)11
-::~o _ Dog, Lympho _ Cat
DDx:
Chronic gastritis
Gastric ulcers
"Gastric FB
Pyloric canal obstruction
Phycomycosis
Po-T 34
Ox: Rads
,
8~
'
Gastric
ulcers!
Erosions,
Glbleeding
M8k 299; Mk 118, SAP
660; 12M429;IM330;; IMWlN261; E-hb458;GI348;
E 1155; 5min 610; H3B
338, 366; H2B 362, 412;
CatI199;CI2T706;Cl1T
, 32; Sx-S-hb 207;
Dogs cats
Pathophysiology:
- Damage to gastric mucosa
- HCI diffuses backwards
further damage
@)
All.
I"
&
Causes
Hematemesis
GI ulceration
(see above)
fS
Coagulopathy (uncommon):
- DIC
Clotting factor deficiency
- Thrombocytopenia
43
/, i &'.
__ .2
prog:~~~O~~~Y<~~"ill
Hematemesis
None:
Chronic vomiting
Asymptomatic
/1((
-'b
Prognosis: Good if removed ~
& no septic peritonitis from
perforation of GI tract
Tx: Remove
Gastric
tumors
_ G ______ _
~-
Stomach
Condition
Facts/Causes
Presentation/CS
Pyloric
canal
obstruction,
Causes:
- Pyloric stenosis (benign hypertrophy of muscles 01 pylorus) congenital &
acquired, brachiocephalic dogs (Boxer,
Boston terrier), Siamese cats
~ Pyloric neoplasia
- Hepatic & pancreatic abscesses,
neoplasia or inflammation
Gastric histoplasmosis & phycomycosis
- FB, gastric ulcers, antral polyps
-=-- Pyloric spasms _
GastriC distention
Vomiting following meals
(undigested food)
Projectile vomiting
(stenosis)
Vomiting lood > 8 hr after meal
Chronic - weight loss &
dehydration
Excellent appetite
Gastric outlet
obstruction
**
CS: Vomiting
lx: Pyloroplasty
Idiopathic
gastric
hypomotility,
Motility
disorder
**
Syndrome
CS: Vomiting hour'S after eating
Ox: RIO DDx, Fluoroscope, Rads
lx: i1d diet, Raglan Px: Good
torsion,
GDV,
Bloat
M8k291: Mk234; SAP674,
6n; 12M 426; 1M 329; IMWW260;E-hb463:E 1161;
5min 608; H3B 345: H28
389: G136t, 396; Sx-5-hb
209: Sx-S 580: Sx-WW
129: SX4B 223: 5x3B224;
Neo 162; Pa-T 22; X-T 527
**
DDx:
;'....-.q))
Gastritis
Gastric ulcers
i)
GI
Treatment
Hx (breeds), CS
Correct any electrolyte imbalance
Lab: metabolic alkalosis (lossotgastricaCid) Pyloroplasty better than pyloromyotomy:
Radiology: definitive
- Enlarged stomach
- Narrow canal1n
C"'::=:2?2Z=:::::~~!:/
/111 " ' = ; >
. "Beak-sign"
ooo,,,st
t>' :'.'
-:
A(
(!
.f9 \
V!J
t~f
Gastric FB
Gastric tumors
Motility disorders
..'
Cisapride
& domper1done jnew drug that mf help
DDx: Motility disorders
those not respondIng to metoclopramide)
Gastric outlet obstruction
Infiltrative bowel diz
Inflammatory bowel diz (parvovlrus, gastritis, ulcers)
&om Organ failure: Renal, Adrenal, Hepatic
"'IlL)
~
~;2) Neurological disorders (stress, trauma, pain, surgery, psychogenic)
PrognosiS:
Metabolic disorders (hypokalemia, uremia, hepatic encephalopathy, hypothyroidism)
Good if respond to metoclopramide
Drugs: anticholinergics, narcotic analgesiCS
Poor if doesn't, but still mlb an ac-
Gastric
dilatation!
volvulus -
/"-----~"
Diagnosis
Regl~
ceptable pet
Medical & surgical emergency Inconsistent depending on de- Simple dilatation indistinguishable EMERGENCY usually
High mortality
gree of rotation, 2' shock & toxemia on CS from dilatation! volvulus
1 st gastric decompression & treat
Dilatation: all small animals due 10
Retching, but can't vomit Percuss tympanic abdomen
shock SimUltan~~G
swallowed air, overeating
Pain, restlessness, excessive
Treat for shock & decompress before
- Decompress
.~
Volvulus (twisting) common, rOlates salivation
d
h
Trocharize 16-18-g needle, then
-" . occluding esophagus & pylOrus
D,'stended cr. abdomen
ra iograp y
cIOw.Wlse
- Narrow & deep-chested meT'
-ShockwJtime(tachycardia,weakperipheral
Stomach tube
- ympamc
pulse, pale mucous membranes, cold extremities,
- Lavage stomach
diumto large breed dogs (Great Cyanosis
depressed capillary refill weakness)
- Fluids, isotonic saline IV 90mllkglhr
Dane, Doby, St. Bernard)
Depression wi time
Rads plain: right lateral recumbency
. Steroids
Cause: unknown
Dyspnea wi hyperpnea
- Distend gas or fluid filled stomach
- Banamine (flunixin meglumine) 1 dose
Partial volvulus: intermit- - Soft tissue line ("shelf") across
- Hereditary
.
.
.
for toxemia
- Large meals/Quantities 01 water
tent episodes of partial bloat
twiSted stomaCh, not in Simple distention
. Splenic engorgement & rotation
- ECG monitor constantly
- Pyloric sphincter dysfunc~on~\
& vomiting ~~ - Pylorus displaced
Surgically correct volvulus
<)
~~\
_Spleen not in normallocationJorien_ - Orcumcostal gastropexy to
- Postpran~lal exercl~,
- Aer?~ha~la (swallOWing air)
(
tatlon in lat & VDIDV views
- Motility dlso~ers
_ Paralytic gas ileus
prevent recurrence
PathophYSiology:
_Enlarged spleen, mlb displaced to the right
- Post surgical Tx critical
- Distention precedes volvulus
- Small heart & caud. vena cava (hypovolemia)
ECG for 48-72 hrs - arrhythmias
" Udocaine, procainamlde &lor quinidine
- Volvulus ml obstruct stomach
Sequelae:
Contrast rads helps see
. .
Progressive distention
Hypovolemic shock
: g:~~::I~~I~~,~I~r~~~I~~~.hl~.a!~::~ranl
Obstructs portal & cranial vena - DIC
Lab:
caval blood flow
- Gastric necrosis (greater
-Acidosis US.ually
". I
. . . Hypokalemia common
Hypovolemic shock
curva,~re rupture wI ~r1tonltIS
Postmortem (PM):
.. En<iotoxic shock & death
- Cardiac arrhythmias
- Atonic, large stomaCh
_Torsion of spleen
- Death in a few hours 11 volvulus! Hype:emi~, ven,ousengor~ement, splenomegaly,
Prevention:
torsion
gas filled Intestines, gastnc mucosa lesions
Difficult because unknown cause
DDx:
Small meals wi low fat to promote
_~
Simple dilation
gastric emptying
Minimize exercise after eating
0~'
lJ~~.sPI~ni~~orsion
....
~
PeritOnitis
Minimize water after exercise
Pleural effusion
Train clients to recognize signs & come in
,.----------~--=:, Small intestine volvulus
;mm,dI.",y
,.~
Narrow & Deep-chested
Diaphragmatic hernia
CS: Pain, Shock
Acute abdomen syndrome
Dx: Percuss, Decompress
Prognosis: Grave to guarded
Emergency: Decompress & lx shock
depending on how Quickly diagnosed & treated
~-2~
(2:'1
B&~
-'--c="====..=..=-..=--=-==,-,,=-_
._._~
__
Diarrhea
GI
Condition
Facts/Causes
IM-WW
~~~:~6~35i: duration
Diagnosis
Presentation/CS
Treatment
.
~~~~~3i
. __e_l_ife_._th_r=e_a_te_n_in~g
if
'~2'~'~;~~~=e~_._s_o_m
____----1------~~.~
~ 11~~)1 _t~icc-p_rOC__ed__u~r~e_s____~______+-~-:lnt:~e:n:s~iv_e_d~i~a~g_n~O~s_ti_c~p_r_OCc-e~d~u_re_s__to~f=in~d__
****
-Extensive diagnostic procedures
399: Cat'
"t
Chronic
Mild, acute
diarrhea,
Idiopathic
diarrhea,
Acute
enteritis
Mk 225; 5min 46; 12M
434; 1M 335; 1M-WoN
270; E-hb468; E 1178;
GI 163, 400, 405; Cat
1213; DDx273; C12T
701;NB10.17
****
Common
Dogs & cats, especially kittens &
puppies
Acute or chronic inflam. of rnu-
Severe
acute
diarrhea,
Idiopathic
diarrhea,
Severe
acute
enteritis
Mk 225; 5mln 46; 12M
434; 1M 335; E-hb468;
E 1178; GI 163, 400,
405; DOx 273; C12T
701; N810.1?
***
Diarrhea
Vomition
Initially borborygmi
(sounds In gut)
- Acidosis
_ Dehydration
_ Electrolyte depletion
NPO
1.A
Ox (see below)
Mild acute diarrhea: Causes similar to enteritis
Idiopathic (frequently cause unknown)
Overeating, spoiled foods
FB (bones, hair, etc.)
Associated wi infectious diz (distemper, viral hepatitis,
Campylabaetsf sp,)
~,
~ ~tf~e
Prognosis: Good
Common
Same as mild, but more Comprehensive Dx
Symptomatic (unknown cause)
Severe, bloody or systemic signs
severe
Rehydrate: Ringer's sol
!1Flil'I
Lab:
(fever, depression & dehydration) Bloody diarrhea (dark &
- Neutropenia
- > 8-10% dehydration IV fluids (sunken ~
foul smelling, m/b black jf bleeding hi
eyes, fast, weak puIS.s, marked depression)
~
- Requires more thorough Dxthan
- Hemoconcentration (dehydration)
up, or frank blOOd if down low)
Add K (potassium) ,
mild diarrhea
- Virologic testing
Vomition (If proXlmal duode, ELISA for canine parvovirus
H.o~e oral rehydration
Pepto-Bismol i
num & stomach Involved)
. Serology for FsLV & FIV viruses
Antidiarrheal: make home care
.
i
Systemic signs
- Fecal cultures (Salmonella,
more acceptable in severe diarrhea
- Fever
campylobacter)
- Pepto-Blsmol (bIsmuth subsalicylate)
- Depression
Blood glucose (hypoglycemia)
controls diarrhea in mild to moderate cases
(antienterotoxln, antisecretory & antiinflammatory)
- Dehydration
Serum electrolytes (fluid therapy)
Use wI caution in cats: subsallcylate intoxication,
Complications
Blood gases
lonunately cats seldom need
- Dehydration
Radiology:
- Opiates: dlphenoxylate (Lomotli)
11
needed
for more than 3-5 d, reassess patient carefully
Electrolyte depletion
- Mechanical disorders
- Avoid anticholinergics
- Acidosis
- Obstructive disorders
Antiemetics: chlorpromazine (Thorazine),
Septic shock
metoclopramide (Raglan) or prochlorperazine/isopropamide
Hypoglycemia (kittens &
(Compazine'oarbazine) - inhibits voml~ng
Only in well hydrated patient, may causes hypotension
puppies esp,)
1/::.!!J/;,
_
Prognosis
Good
Guarded for emaciated, ~ung
& heavily parasitized } :~11
@>(
20% dextrose IV
Septic shock: steroids
(,n"e
Disinfect
area wi
,,"'" w'te'i
.:
Ch~~,
) _~0'~
~-?=
r
Colitis
GI
Diagnosis
Condition
Facts/Causes
Presentation
Treatment
Hx (young, debilitated, garbage), es
Specific Tx for underlying cause
Acute,
nonspecific
inflamma
Acute
large
bowel
diarrhea
Acute
tion of colon
Symptomatically if idiopathic
Semiformed to liquid feces RIO Trichuris 1st, #1 cause
colitis, Common in dog. less frequent in cats - Fresh blood (hematochezia) PE: dehydration, nonlocalized
- Withhold food for 24 hours, free choice water
it not vomiting
abdominal pain
Proctitis Young or debilitated animals (es- - Mucus
- Bland diet: 2nd day small frequent bland
pecially infectious dlzs, garbage scavengers)
Rectal exar... fresh blood,
- t Frequency of defecation
M8k 260: Smin
diet if Signs resolve (baby food, bOiled hambu,;g;;,,:;:;;~
466: H3B 377; Pathophysiology: inflammation
mucous, FB
- Straining to defecate (tenesmus)
or poultry wI rice & cottage cheese, Hill's lId) 'Ir
- Mucosal damage: bleeding, diarrhea
12M460:IM-WW
CBC:
t
PCv,
t
TPP,
stress
Ietlkogram,
- Painful defecation (dysChezia)
- Mucous secretion: mucoid stools
281: H2B 419:
- Fluid: Lactated Ringer's sOl. + potassium
I
leukopenia, eosinophilia
Water & SOdium absorption =watery
Vomiting
E-hb 491: E
Fecal exam:
ABs: broad spectrum:
"'1'\_1,'1
1233;C12T696t
diarrhea
Dehydration, depression
Ampicillin IV, 1M, SO, 010, esp. Clostridium .11'
- Flotation, repeat 2-3 x if negative
- Colonicstimulales + t frequencyofdeleca, Chloramphenicol po, Yerslnia, E. coli
-CytOlogy: saline smears: motile, S-shaped
Fever
lion, straining, pain
TetraCYCline PO, Yerslnla, E. coli
rods (Campylobacter)
Metronidazole, Clostridium
- Stained Wright's or new methylene blue
CausesJDDx: Acute colitis
Norfloxacin PO, Salmonella
- Fecal cultures
- Motility-modifying
Radiography to RIO other disorders
Garbage gut
Narcotic analgesics: only for 3648 hrs,"
CoIo",,",opy ~5r ",u.lly oot iodi",too
Bacterial
frequency of bowel movements," pain & tenesmus,"
- Clostridium perfringens
fluid secretion; contraindicated for infecUous enteritis
- Escherichia coli
(salmonellosis), not for cats; side effects: constipation,
- Salmonella spp
blOating, sedation
Diphenoxylate Hel (Lomotil) PO TIO
- campylobacter jejuni
Loperamide (Imodium) PO TID
. Yersinia enterocolitica
.. Paregoric PO TID
Parasites
\>J://.<. I/
O-ox-: Anticholinergics-antispasmodics: maxi- Tricuris vulpis
Acute gastroenteritis
mum of 2448 hrsor ileus; blocks acetylcholine on smooth
- Coccidia spp
mm.; for tenesmus & pain. Contraindicated In obstruc- Hemorrhagic gastroenteritis
tions, infectious enteritis, glaucoma, obstructive uropathy
- Ancylostoma caninum
- Viral gastroenteritis
.. Propantheline (Pro-Banthine) PO TID
Feline panleukopenia virus
Early chronic colitis
.. Dicyclomine (BentyJ) PO TID
Food-induced allergic colitis
Antisecretory drugs containing bismuth subpoorly documented
salicylate: may cause dark-colored feces, effect on cats??
Pepto-Bismol PO, 010
.. Corrective mixture of paregoric PO 010
/
Inflammation of colon; Dog> Cat, Young or Debilitated
CS: Acute large bowel diarrhea; Vomiting
Pepto-Bismol ~
'HoI
(s)!~~
"'~~
Chronic
colitis,
Idiopathic
chronic
colitis
H26 421; IMww 283
-+
Motility-modifying
-+
Hx CS
RIO Trichuris.
1st
-+-.
PE: dehydration,
caudal abdominal
pain
Rectal exam: pain, stimulates
tenesmus, roughened mucosa,
blood, mucus
esc: usually normal
Hypoalbuminemia
Fecal exam:
_StainedfecaVrectal smear: RBCs
OOx:
Small bowel diz
Eosinophilic colitis
Infectious colitis
Neoplasia
Cecal inversion
Irritable bowel syndrome
':;,
Prognosis:
Most resolve in 4-6 wks
Some long term - guarded
Relapses common
--
,
Colitis
GI
Condition
Facts/Causes
Pseudomembranous
colitis,
Antibiotic
associated
colitis
Diagnosis
Presentation/eS
Treatment
- Hx (ABs + CS)
Colonoscopy: erythematous, friable, mucosa wI
adherent, plaque like pseudomembranes
Biopsy: pseudomembrane of inflammatory cells,
mucin, fibrin & epithelial debris; mucosal necrosis
Definitive: C. diffic1le toxin wi ELISA or tissue
cultures (3 cases?)
H38427
DDx:
- Other causes of acute colitis
- Other causes of chronic colltis
*
ABs associated colitis
CS: Colitis
Ox: ASs + es, Colonoscopy
Tx: Stop ABs, Fluids, ABs
Cecal
inversion,
Cecocolic
intussusception
H2B 435; SAP 720;
Smin 430; 12M 461;
IMWW284
o Infrequent in dog
Inversion of cecum into colon
Potentially partial or complete lower bowel
obstruction
Causes unknown
Predisposing factors
- Trichuris infections
Prognosis:
- Usually prompt response to Tx, relapses occur prolonged Tx
=andotoxlc
Infrequent, Trichuris
CS: Intermittent hematochezia, Weight loss
Ox: Hx, CS, Barium enema
Tx: Fluids, Surgical removal
Intestinal
neoplasia
Benign tumors:
- Adenomatous polyps
- Adenomas
M8k 295; Ehb 489, 494; SAP
- Leiomyomas
713; 12M 460, 461; 1M 353; 1M
WIN 281, 285; H38 368, 380; Malignant neoplasms:
H2B 415; GI 453; Cat 1255;
- Adenocarcinoma
F31M 99; Cl1T 595; SxWIN
- Lymphosarcoma
m,'
/~~::~~~::=::2rtZ::::S:"'~::::"
00"
/'//{
..... = ; : >
-TrichuriasiS ' it0
-.
- Polyps
- Chronic colilis
- Neoplasia
-ileocoliC intussusception
Hx, CS
Abdominal palpation: abdominal
CS
mass, thickened intestinal loops, or
- Diarrhea
mesenteric lymphadenopathy
- Intermittent vomiting
Rectal palpation: stenosis or polypoid
Weight loss
rectal masses
Melena, hematemesis
Adenomatous rectal polyps: expose
136; Pa-T 64
Lesscommon: carcinoid tumors, leiomyo- Anemia, fever, icterus, abdomiby everting rectal mucosa
sarcoma, librosarcoma, mastocytomas,
na/ effusion, anorexia, lethargy Lab:
hemangiosarcoma & anaplastic sarcoma
Colonic polyps & tumors
- Blood loss anemia, neutrophilic leu(same cs as Inflammatory colitis)
Adenocarcinoma
kocytosis wI left shift, hypoproteine- Hematochezia
Locally Invasive & slow-growing
mia, elevated liver enzymes
- Older animals
Dyschezia
Radiologyl barium contrast
Dogs: most common in duodenum, ileum & terminal colon
- Tenesmus
- Mucosal irregularity
Cal: most common in ileum & distal jejunum
- Mucoid diarrhea
Forms:
-Napkin ring" sign (luminal narrowing)
Infiltrative: thickened stenotic region of bowel - obstructs lumen
- Intramural (wall) infiltration, thicken- Ulcerative: deep wI raised edges
Sequelae:
ing or nodularity
- Proliferative: lobulated, expal'lding mass
- Malabsorption
- Ulceration frequent, melena & blood loss anemia
- Thoracic radiography for metastasis
-locally invasive (mesentery, omentum, regional lymph nodes,
- Protein-losing enteropathy
Abdominal ultrasound: delineate
more widespread metastasis may also occur
Blood loss anemia
mass lesion
- Intestinal obstruction
Surgical excision or biopsy
Lymphoma
- Intussusceptions
- Definitive diagnosis
Arise Irom B lymphocytes 01 gut'associated lymphoid tissue
-Intestinal petforation & peritoni(GALT)
- Endoscopic biopsy: stomach, duode- Most common extranodai lymphoma in dogs & cats
tis
num or colon are accessible
- Gats: over 8 years Old, FeLV {+ )(feline leukemia virus) although not
- MetastaSis to liver & kidney
all viremic
**
- Types:
- Diffuse lymphoma: diffuse infiltration of lamina propria &
submucosa - Malabsorpbon & deep ulceration
- Nodular lymphoma: expanding Intestinal mass often in
illocecocollc region - ProgreSSive luminal obstruction
- Metastasis to regional lymph nodes & other organs
-=:;:;O'::~~~~'~~':~"'!; ~ ~
~~~n
c
/II(
' SF?
:7
on~==:J(FF=-
hI
~idi
""-0-
c:0 -
.;,I"...,.,
Prognosis:
Grave to poor for malignant
Guarded to good for benign
neoplasia
GI
~
.'}
Chronic Diarrhea
- Palpate abdomen (liver, intestine)
- Rectal palpation (foreign bodies, masses,
\" l ~~
~
...
00
- Fecal biochemistry
- Occult blood valuable
- Other tests impractical
00
resolve diarrhea
- If resolves need to go no further
Biopsy
",c-===~=ut==~~ar:fjJ
#3a: RIO malabsorptionlmaldigestion, bacte- Combined large & small bowel diz
coma, chronic inflammatory bowel dlz, histoplasmosis)
rial overgrowth if small bowel problem
(lymph""'"
PE (physical exam)
- Look for underlying systemic diz
Fever, wt. loss, malnutrition, dehydration
Weakness or depression (acid-base or
electrolyte imbalances)
Pallor (anemia, blood loss)
Edema or effusion (hypoalbuminemia)
fungal)
'r'<"L"",-
Feces
Volume/defecation
Steatorrhea
Undigested food
Color
Melena
Hematochezia
(bloody stool)
Mucus
Urgency
Frequency
Dyschezia
(painful evacuation)
Tenesmus
Others
Weight loss
Vomiting
Flatulence
Borborygmus
Halatosis
:(mald,g/malabs~ !odJJ~
(maldig.lmalabsb.)
Variation
Usually no
Rare
No - usually
2-3 x normal
No
Variations rare (blOod mlb)
No
Frequent
No
Frequent
Usually
> 3x normal
. dis!. colonic or rectal
No
Frequent
(maldigJmalabsb.)
(inflammatory dizl
Rare
Uncommon (coIiHs)
(maldigJmalabsb.)
No
No
No
((ma1dlg.lmalabsb.)
(maldlg./maJabsb.)
Eosinophilia......
t PCV .............................................Dehydration
+PCV.............................................Anemia
.~
exam
Direct Sudan stain Undigested fat (steatorrhea)
-Indirect Sudan stain Stains digested fat (steatorrhea)
Lugol's iodine stain Undigested starch
New methylene blue Leukocytes
- Sanne smears
Protozoa
53
- Pancreatic insufficiency
- Malabsorption
- Pancreatic insufc. or
- Exudative inflam. bowel dlz
Virus - Enteritis
GI
Presentation/CS
Diagnosis
Treatment
Tx
like
any
acute
diarrhea
Definitive
lab
confirmation
not
Minor
cause
of
enteritis
Acute
contagious
diz
of
dogs
Canine
- Supportive therapy (fluids & electrolytes)
needed because mild & nonfatal
Epitheliotropic virus - invades en- Most subclinical
coronavirus
terocytes of the villus tips, but Some: anorexia & depression diz, treated by support
------'1'1'i"'$'f ~
Prevention:
enteritis,
Mild to moderate diarrhea 7-10 Should be distinguished from
spares cells of crypts
Vaccination optional part of vaccination program
serious parvovirus
days
- ConSidervacclnation for high risk dogs (show, field
- Sloughing of villus tips = villous
CCV
& kenneled dogs)
CCV
has
no
fever,
leukopenia,
atrophy
Mk 229; Ehb 478;
Afebrile ("~
Facts/Causes
Condition
***
cal
Definitive Ox:
Electron microscope 01 fresh leces early
- Serology only retrospectiVe Ox
.-.~
'.~~-.~-~
Em~~ttJ
***
Clinical significance?
kf
;",0'00,
::"'l~
ELISA
f.[,if
Prognosis:
~
Excellent: most recover rapidly wI Tx
Some: diarrhea persists for 3-4 weeks
Fatalities reported, but rare
Tx like any acute diarrhea
- Supportive therapy (fluids & electrolytes)
No vaccine
~f
~'"
Prognosis:
Excellent: most recover rapidly wI Tx
~
.~
~.LP.:ro:g:on.:o:s:is:.:.:G:u:a:.rd:e:.d=,.:m.:,.:rt.:.'~"-,-'":.m.:.,_~t
_;M
~~'l.2lC!X~:!.A~B~Sl.';:S~~t~o~m!!!!a!!ti~c,-l~x~'!P!.x, ":.!G~u~a~r~d~e:!d!. .:.'!P.!.r: ev.:.e~nt! i! o! ne.:.!V:!:a: :c: :c: :in~a~Ii~o~n!!.l
-,. :o .:.': .,_
**
)!'
-. ct'
Severe, Contagious
,\
:1
!:~
'-"'~"''''il
,( (
.;
***
Pathophysiology:
- Destroys rapidly dividing cetls. Intestinal crypt ePithelium
. Bone marrow cells
- Excrete virus In feces
. Cardiomyopathy in puppies < 2-4 weeks,
oarn
Predisposition:
- Rottweilers
- Oobermans
Sequela:
Endotoxic shock
- DIC
- Death m/b in 1-2 days
if untreated
- P~ bulls
- Labrador retrievers
Hemorrhagic gastroenteritis (t PCV)
Salmonetlosis
Campylobacteriosis
Canine distemper
Canine coronavirus
Contagious, GI
CS: Severe diarrheaNomiting/Dehydration
lx: Fluids & ABs
Vac: No guarantee
Prevention:
Vaccinations - highly recommended
- No Vac program guarantees protection (maternal immunity)
more effective against vaccine virus than street virus
5-6 wks-old MLV (modified live) (not dunrg pregnancy)
- Revaccinate 2-3 week intervals
- Lasts between 14-16 wks (maternal Immunity mI block up to 18 wks)
No MLV vac. before 5 wks old or if has distemper
Inactivated vac. booster to dogs living wI infected dog (in
case incubating parvo) or pregnant animals
CEV strain 154 vaccine may overcome matemal antibody Interference problems
Recent vaccination (wlin 10 days) may produce false positive ELISA
55
Prognosis:
Good: most dogs survive
if supported long enough
Worse for Dobennans & Rottwellers
Guarded for septic ShOCk~_
or hemorrhagic diarrhea
.Surviv~1 gives prolonged
Immuntty (mf not be lifelong)
llJ
:Lt/ .
Viruses
Condition
Feline enteric
coronavirus,
FECV
GI
Facts/Causes
Ubiquitous virus endemic in
catteries
Villous atrophy & malabsorption
Oral route of infection
Presentation/CS
Young kittens
- Mild enteritis
- Diarrhea
Dia nosis
Treatment
Hx, CS
positive FIP results
Feline
astrovirus
**
Hx, CS, PE
EM (electron microscope)
Prevenlfon
No preventative measures available
Feline
panleukopenia,
Persistent
vomiting,.
Rebound
Seukocytosis
wI
marked
It.
J..
FPV,
**
..:!':..b..
./ a
("
GI
Diarrhea
Presentation/CS
Facts/Causes
Condition
Neor;ckettsia helminthoeca
Rickettsial
diarrhea,
Vomiting
Diagnosis
Treatment
-Hx (NW),CS
Operculated eggs in feces (direct
Isolate
Tetracycline or doxycycline IV to kin
Nasal
discharge
(serous
to
Very
common
in
dogs
of
Pacific
Mebendazote (TelmintiC)
poisoning
mucopurulent)
Northwest
M8k 321; Mk 242; Eho 481;
- Fenbendazole (panacUl~.
SAP 126, 690; 12M 439; 1M Transmission: ingesting raw Hypothermia
Supportive fll;lids, electrolytes :
338; 'M-WW 275; G1428; Infsalmon containing metacercaria of the Generalized
B 245; PaT 61
fluke N. sa/mincola
lymphadenopathy
TetraCYCIiq!
_ Fluke matures in 5 to 7 days (life cycle 3
(Regional)
10
PrognosIs:
~ ~
hosts: snail, fish & dog or bird)
Rickettsial agent it carnes causes clinical Most die if not treated
Good wI appropriate Tx
signs
- Wlo Tx 50-95% die
~
_Incubation period 5-21 days
~UN
* ***
l@)
Hemorrhagic
gastroenteritis,
\.
**
kl. - V I
Clostridial
enteritis
Prevention:
Keep dogs from eating infected fish
Freeze or thoroughly cook fish
Isolate infected dogs
- Hx (peracule), CS
Shock: prolonged capillary refill
time
Fresh blood in feces & vomitus
PCV of 50 to 80% wfo comparable
level of clinical dehydration (j
(IV,
90 mllkglhr until capillary reiilltime
& PCV normal, then continue on
maintenance rate)
Steroids initially if shock
appears refractory to fluids
DDx:
Parvovirus (has fever)
Toxicity
Bacterial gastroenteritis
Foreign body
Intussusception
Prognosis: ??
If shock: fluids
.
>
2-3
spores
('safety-pin')
per
high
power
C11T602;Cat1223; !nf-B 193;
Responds well to symptomatic therapy
011 abnormal
Emrg 346; Pa-T 57
Cc:t~
~' Assay for specific cytotoxin
& diarrhea spontaneously resolves in
2104 days
Acute bloody, explosive
normal flora).
~~~~~naIlY c~,ro~ic;,,'1
**
??
E. coli
E-hb 481; H2B 402; 12M 441;
Cat 1232; GI 426; Emrg 345
Salmonella
Escherichia coli, Normal bo_1 ftora of ileum & large bowel, Systemic illness (septicemia) in neonates
CS: Endotoxlc shock (depression, CNS deficits, anorexia, diarrhea, weakness, cyanosis, hypothermia & death); severe fatal hemorrhagic gastroenteritis
Tx: Aggressive supportive therapy, ABs (gentamicin & ampiclllln), Banamine or corticosteroids mIb indicated
Px: Tx often unsuccessful in endotoxlc shock
**
Trimethoprimsulfa
Support - fluids & electrolytes
Hygiene: prevent spread to animals & humans
@) ~
Prognosis:
Good for most animals
Diarrhea
GI
FactS/Causes
Condition
Presentation/CS
Diagnosis
Treatment
Campylobacteriosis
M8k 117: Ehb 480; SAP 702;
H2B 402; H3S 356; 12M 439;
1M 138; IM-WW 274: G1424;
ltt
Inf-B In: Emrg 344
Ve rsi niosis
Yers/nla entarceo/aties, Y. pseudotuberculOSis, Gram negative rod, May be found In asymptomatic dogs & cats
Causes invasive gastroenteritis in man & dogs: transmission from animals & food sources"
9
~.....,
-= __=====:::=-T-::::::::-:::::-:::::::::=
*'~M='WW..::~=2=75~:=S=-AP_i_2_9_t._+:_~c~s~:~u~,~"~a;"y~,~a~,~'i";;i"~"~,'~;m~"~,,~g~Jd;~a~rr~ha~a~;~O~d~O~g~~"L--:--:_~::::==
.
ill"
Ox: Culture
Bacillus
,.
.
plllformls,
Tyzzer's diz
{..\'
T
58 F-H 295; Inf-B 187; Pa1234;
'
;:v
:7'
. Alimentary tuberculosis
:~AP129;~~~'Bi:;;~~~i~~.~::::;~t~Y~:;;:;:"hY
};;-___
l/"'\
rhlJ.l-
D=
;.. l..
"- ~
c::> __
-=r.'===/
-A
---'X...--'
Prognosis: Grave
-I--::---::-c--:----..:::~==".~
)~~'~'~"':-:::::::;;::::::;:_:;===/::-~-----G~==:::;;:;:~;;:;:;; Usually subclinical
Vomiting
Diarrhea (loose, malodorous)
Anorexia
tr
,'"
chloramplt:!!!l:
Rare
e~~col
_ __
~
,
-~~5,t~~~i~~~tughiog~1,r~
PubliC
hea~h:
;'jj;
w~o~tru~oo _-::;/
,)e;::;:
OOx:
Euthanasia is recommended
due to zoonotic concern
Notify Health officials
~
~
"t
Prognosis: Grave
#,.. .......
.....------------
..,.,.. ,,~-, ..
Histoplasma
capsulatum
E-hb 488; SAP 133, 690; H2B
405; H3B 358; 12M 442; 1M
340; 1M-WIN 551;GI445;Cat
1234; F-H ;342; Inl-8 327; Pa
T64
ada",athy ~
Pythiosis,
Zygomycosis,
Phycomycosis
E-hb4BB,463; SAP 703; H2B
405; 12M431; IM332; IM-WW
263; H2:B 379, 948, 953: E
1226; Cat 1235: FH 347
~ (Regional)
~.~.
Hx (area), CS
Organisms in monocytes or PMNs on blood smears
- Delayed xylose absorption, t fecal fat
Palpable thickened intestines
Radiology: Intestinallorm: irregularities ot mucosa &
thickening 01 bowel wall
Serology: complement lixation titer of 1:16 strongly
suggestive, false negatives & false poSitives
- Blopsy/cytOlogy: fine-needle aspiration & exfoliatiVe
cytology
- Intestine: smears or fecal mucosal scrapings, Impression smears orendoscopic biopsies, fine needle
aspirates 01 lymph nodes, bone marrow~
Histopathology - special fungal
......,,
stains (periodic acid-Schiff [PAS],
....)
Grocotl-Bomori methenamine silver
nitrate, or Gridley)
CUlture: Sabouraud's media: difficult to iSolate & requires 10-14 days Ibr growth
Intractable vomiting & diarrhea (bloody mIb)
Hx, CS
Anorexia, depression, progressive weight loss
PE: palpable enteromesenteric masses
May produce bowel obstruction
Radiology:
Anorexia
~
- Abdominal mass
Colon (less common than cranial GI):
~
Barium contrast: thickened, stenosed segment of
tenesmus, hematochezla, constipation
bowel
Usually chronic
~:-, I
Biopsy: to conlirm (nonseptate or sparsely septate
sa lesions (less common)
"';z:..
hyphae)
Feline (ulcerallve GI)
DDx:
~ - StomaCh, intestine, a~o~lnally~ph nodes
Histoplasmosis (see above) -Gridley'sormethenamlnesllversialns, Romanowsky
Sequela: Obstruction Lymphosarcoma
stains: "ghosts" (don't stain)
f@)a -I
Granulomatous enteritis
lE:f
________~~~
__~~~~____~-~p~rn~g~oo=.~,,~p~~~--:-~~______~
Prototheca
",~~~
(algae), Intestinal
protothecosis
:__hB~br~4i~:~:~ _S~:_~ 2_~ 72~ ~3=~_H=:_~ M_B:i.=2_~;_:~ ~ .o=, :~: _~_:n_:'l _"_:o_;_,d_a",._'Y_;_O'c_o~_~_a,__ <~i
Algae, Large bowel
[lJ:
~ ,...
:Q=
~-.......
'~n:y
~'\
~)-:~~~~~~~
fA
Ii
Itraconazole (DOC)
Ketoconazole
Amphotericin B, Of a combination
,
1,11
Itraconazole
11\"
Completesurglcal excision only
"'"
I'll!
~
..._
Itraconazole .
,-~
II.
__--:-~___~--:-_
7'
_ . i
____~
$",,=,
one reported
PrognOSiS: Grave
IBD
Condition
Facts/Causes
Chronic inflammatory
bo I d" IBD
we IZ:
Presentation/CS
~reatment
Diagnosis
_"
-
- colitis,
~
-
EGE;
Feline
hypereosinophilic
syndrome
E-hb 487; GI429, 431 (f); GIS477: SAP707, 708; IM-WW
278,284; H2B424; H3B 363:
5min 5S2; 12M 451; 1M 347;
Cat 1239; F-N 413; Pa-T38
Histiocytic
ulcerative colitis,
Boxers
o Bacterial enterocolitis
o Cause: idiopathic?
"I -
Neutrophilic
(suppurative)
Feeding lrial
oSteroids (prednisolone), sullasalazine, Olsalazine, metronidazole; sIngle-agent or combination as for Iymphocytlc-plasmacytic COliti~
- LHellme therapy needed
Steroids
o Highly digestible diet rather than high-fiber
Prognosis; Guarded tor effective control
enterocolitis
SAP 709;
lM-WW 284
oHx,CS
o Colonoscopic biopsy
- Infiltration 01 PMNs (predominantly)
- Variable mucosal ulceration, necrosis or
crypt abscesses
oTests to exclude bacterial enteropathogens
o Feeding lrial
o ASs (Irimethoprim-SUlfa, enrofloxacln IBaytril1)
"Sulfasalazine, olsalazine, metronidazole, or prednisolone single-agent or combination as for lymphocytic-plasmacytic colitis
owe
18 D
IZ,
**
bowel diarrhea
Exclude paraSitic
cause of IBD
food hypersensitivity
lab & radiographs; unremarkable
Endoscope - intestinal biopsy definitive
- Intermittent or persistent
- Histo: diffuse infiltration of mu-II severe; protein-losing enteropathy
cosa wI mature lymphocytes &
(ascites, hydrothorax, edema)
Colitis:
plasma cells ~
- Chronic large bowel diarrhea
-tVolume
""::':::-------t Frequency
DDx:
- Tenesmusfdyschezia
Dietary hypersensitiVity
- t Mucus, Hematochezia
Bacterial overgrowth syndrome
- Weight loss & vomiting
uncommon
Interstitial lymphosarcoma
~
Intestinal lymphangiectasia
~~-. Otherchronic inflammatory bowel diz
.
.
- Steroid: prednisolone PO
" 5~aminosalicylic acid
Hyperallergenic diet:.
"
::so
~.
Parasites
Ii
antigens
- Genetic: Basenji, Softcoated Wheaton terrier,
Shar Pei
tero~
mS~
&
~'~
(~::t;)
,I" i.;P
Prognosis: Guarded
'
Persistence or recurrence
likely despije Tx
Co V
e1
&
Tx
Anti-inflammatory Tx:
5-aminosalicylic acid (5-ASA, Mesalamine drugs)
-1st chOice for dogs w/lBD of colon
Steroids
GI
Parasites
Parasites of - Common cause of diarrhea
Young, aged or debilitated aniintestines mals at greater risk
Incidence depends O~j
geographic location
~'
(e.g., uncommon in
~I.~'
Colorado to very, very\ ~
common in Florida)
~
:~*~
r!i
cats worldwide
Roundworms Dog: Toxocara canis >>> T. leonina
M8k 317; Mk 237; Ehb
Cats: T. cat; & T. leonina
475; SAP 695; Smin
1047; H3B357;H2B403; Infection by 4 routes
- Pr9l1atal: transplacental
migration in only T. canis
- Milk bom: transmammary
migration (T. canis & T. catQ
- Ingestion of host
***
Hx (age), CS
-IICS
......_
-Vomiting
- Potbelly
Abdominal discomfort
(whimpering & groenlng)
Stunted growth
Dull coat, unthriftiness
Worms passed in feces &
vomitus
~ ----
***
446;
IM343;
GI 412;
Pa-TIM-WW272;
47
cutaneous
_Migrate inroute
circulation & lungs, then to adult
Strongyloides
c:;;;J
;0 ;0,"";"
- Eggs
hatch in gut, 1st-stage larvae passed
in feces - develop into infectious stage or
Iree living adults
&Ii
(~l _
Prevention:
Milbemycin
~1
Heartguard:
Prognosis: Good to excellent wI
proper Tx & sanitation
~~
~~
.~
;..,...
Public heaHh:
;;;:.~
J"1!,~ ~ 1
Strongid-T
".",
~'-"
~-
- Hx, CS
Fecal flotation (Strongyloid ova)
- Iron deficient anemia
Eosinophilia
Intestinal ulcers
Tarry (melena) or bloody
diarrhea
Pallor, weakness
Emaciation & dehydration
Acute death in neonates possible
Pruritic dermatitis occasionally due
to penetraHon 01 skin
Adults: usually
asymptomatic
8 weeks
Other drugs: lenbendazole, febantel, butami$ole HCI,
mebendazole & dlchlorvos
Severely anemic
- wtIole blOOd transmission
- Iron supplementation
- Supportive therapy
Prevention:
Good sanitation
Oxibendazole & milbemycin: preventative
Sanitation
Hx (pups) CS
Initiate Tx as early as 2 weeks-old
Fecal flotation - ascarid eggs
- Repeat every 2 weeks (maturing life stages
_ Shed about 3 weeks or age &
unlile weeks old)
Hookworm,
- Diarrhea
""
,::=:;::;~;.-
'@)
Usualty asymptomatic
Ascariasis,
Diagnosis
PresentationlCS
Facts/Causes
Condition
l>,o'~-1'7
? 6& (
Prognosis: Good
f~
J!~
7:i~
Panacur~
Prognosis: Good
UJJillI
"-......'Y'"
J
GI
Parasites
- Mucoid
- Urgency & hematochezia
Transmission: Ingestion
Direct life cycle - 3 months
- Adults in cecum & colon
ding of eggs
Coionoscopy visualization in bowel lumen
(fresh blood)
M8k319;Mk241;E-hb
476; SAP 698; H2B Dogs of all ages infected
404.427; 5min 1160;
12M 444; 1M 341; 1M
WoN 282; C12T 713;
Cl1T628(f);Emgr347;
PaT68
**?
Panacur;'"
Fecal flotation (Strongyloid ova) Anthelmintics:
- Panacur (fenbendazole) or ~
- Brown, bipolar, operculated,
_ Vercom (febantel) for 3-5 days
football-shaped ova
Whipworms,
Tricuris,
Trichuris
colitis
ODx:
Ancylostoma caninum
Acute or chronic colitis
Eosinophilic colitis
Cecal eversion
Tapewonn,
Cestode
, Dipylidium caninum:
& cats
T. pisiformis: dogs; T.
taeniaeformis: cats
- Ingestion of cysticercus-infected
tissue (rabbits, rodents, sheep, ungulates)
Rare cestoCles: Echinococcus, Multiceps,
Mesocestoides & Spirometra
~
---
Ova in feces
D. caninum proglOtl"ldes barrel shape &
- Oroncit (praziquantel)
- CesteX (epsiprantel)
"""'- ~7
Prognosis:
,-l---=-:-::~~
Dipylidium (flea); Taenia
Coccidiosis
V. "'~~r'
,,,,,itiOh'"
Giardiasis
II
~~'\fJ
Worldwl de
dlstn"b utlon
-Hx,CS
Cysts
- Weight loss
Ii'
- Steatorrhea
;;.
'f
I""
..
'
Valbazen (albendazole)
Atabrinee (qulnicrine): 100%
Furoxone (furazolidone) PO BID suspension good
in cats
J~=- i
~L
g~
&j
;;;;
Balantidiasis
BslBntidlum coH, ciliated protozoan. 10 infects swine & humans, infrequently in dogs, not reported in cats; Associated wf Trichuris infection
CS: Rare cause of chronic ulcerative coll~s In dogs (persistent hemorrhagic diarrhea, depression, anorexia, dehydration)
Ox: Fecal smear: large, oval, brown, rapidly swimming, Ci1!ated trophozoites wi prominent macronuclei, Protozoal cysts in zinc
sulfate or sedimentation preparation of feces
Tx: Ragyl (metronidazole); eliminate contact wf swine, chec!c & treat Tricuri$
"
"
Other parasites
* .
I(
Rare in USA, Entam08ba hlstolyt/ea, primarily human pathogen, tropical & subtropical countries wf poor sanitation & high population density
CS; Rarely cause amoebic colitis (bloody mUCOid diarrhea) in dogs & cats', asymptomatic
Ox: Direct fecal smear: amoeboid trophozoites wI pseudopodiar movements, Amoebic cysts in zinc sulfate flotation, Colon biopsy (diagnostic reliable mucosafulcer
Tx: F1agyl (metronidazole), Furazolidone (FuroxOne), dehydroemetine. Public health
Cryptospondlosls: M8k 145, 12M 447, H3B 1173; Cat 1236; F-H 366; PaT 45; Rare In dog. cat & horses
~'
i .:..-.
Albon
Infects humans
Public Health:
__ "'''OO''_''~_'"~~''''
_"'
~
~
only. CS' 0,
Amebiasis
M8kI40;SAP700; H28
428; lMNffl 282: FH
398; PaT 67
?{1
Sulfonamethoxine (Albon)
Trimethoprim.sulfa (Tribrissen)
Trichomonads Pentatrichomonas hominas, mOlile. pear-shaped, flagellated protozoa. colon of dogs & cats
Ehb 497; SAP 700: F CS: Pathogenicity unproven
Ox: Salina fecal smears: trophozoites wI characteristic wavelike motion of an undulating membrane & a constant turning & rolling motion
H 397
Tx: Flagyl (metronidazole)
'I1f-"-'-----
&
scavenging control
death
PaT 46
Toxoplasma. No Eimeria in dogs orests
!
Ule cycle: ingesMn feces or infected tissue Protozoan, Asymptomatic, OocystS Tx: None
Giardia,
~1
Prevention: predation
.,---._-. ~-- ~
"Coccldl" ""ooozoon .......
Droncit
Excellent ~
CS: Harmless
Ox: Flotation: Eggs
Tx: Droncit, Flea & lice control Px: Excellent
Prognosis: Good
Relatively harmless
M $I ubtle decline In bodycondltion
Taenia spp:
*** .
dogs
.tQ _
Treatment
Diagnosis
Presentation/CS
Facts/Causes
Condition
r<:
---- =
::::.
Flagyl
;;.....---
--
"-
Acute Abdomen
Acute
abdomen,
Abdominal
pain
GI
not a condition
Pain: Classic finding defining
abdominal process producing syndrome
Anorexia
severe diz
- Hypovolemic &lor septic shock
Vomiting/retching
Symptomatic/supportive Tx while
aggressive diagnosis
Tx shock & stabilize first
- Decompress gastric dllatation/Volvuius
bowel
Collect samples before or early in therapy
Ff
_Abdominal mass
_FB
- Gl obstruction
- Pneumoperitoneum
Medical therapy
_ Monitored closely for response to Tx
_ Poor response indicates further diag-
Lab analysis
If above doesn't apply delay surgery
Medical conditions
Gastroenteritis: bacterial, viral, toxic
Cholecystitis
Pancreatitis
Pyelonephritis
Acute prostatitis
s=
IIII
- Parvoenteritis
- Peritonitis
- Continually monitor & treat symptomatically
SUrgery if deterioration, persistent pain,
unresponsive to T x or Ox indicates
Dyschezia
Dehydration
Lethargy/collapse
Fever (pyrexia)
Dysurialstranguria
Abdominal distension
"
Diarrhea
- Sepsis
12M 364; 1M 276; IM- Severe pain
WW 33; H3S 425;
**
I=~~'-ft~
(continued below)
ACUTE ABDOMEN
~-
J,
Initial PE
J;
/,J
(1,'/
'"
Shack
Gastric diila""ion/v,olv'JIU;,--q71
J,
t
DecompressiTx
Tx & stabilize
'""}
& stabilize
Thorough PE
,k
Obvious Sx
Not obvious
Abdominal mass
t
Abdominal radiographs
Obvious Sx
Abdominal mass
Intest obstruction
Spontaneous pneumoperitoneum
Sx not obvious
Clin path
'"
1
;J,
Not obvious Sx
TX
Obvious Sx
Abdominal fluid
J,
Fluid analysis
".--,-1_-:1"
Septic
Tx
supportive!
symptomatic & monitor
I
Impvement
supportive!
symptomatic
& monilor
im~rovemenV
No
deterioration
Nonseptic
----'7--,!c-+--No improvement
deterioration
Improvement
~IA-c-u~te-A7b~d~o-m--en--------------I~
Interpretation of abdominal fluid
(J
12M 364
Indication
Finding
Hemorrhage
- Clotted blood
Not clotted
- + Platelets
- Unreadable through newsprint
Cytology (centrifuge & slides)
_Organic debris
_ Bacteria (free or wlin WaCs)
_ WBCs > 500-1.000 cells/j.1l
Ongoing hemorrhage
Significant blood
GI perioration
Septic peritonitis (Indication for laparotomy)
Significant peritonitis
Toxic or degenerative PMNs
Peritonitis
Biochem ieal tests: compare concentrations of albumin/protein, amylase, bilirubin, creatinine, or BUN in lavage
to peripheral blood serum
-CBC
Anemia
Leukocytosis
Left shift w/o leukocytosis
Leukopenia
Biochemical tests
t Plasma proteins
+Plasma proteins
-. BUN, creatinine
- Electrolytes: deranged
Reported or viewed
RIO acute abdomen (gastric dilatation/Volvulus, septic peritonitis) Treat cause
CS, not a diz
distended abdomen
- May be associated wI acute
Physical exam: palpation
~-"":i
abdomen
- RIO pregnancy & obesity
~
~l
12M 366; IM278; IM-WW
Plane radiographs:
".
- Usually separate problem from
39
- Spontaneous pneumoperitoneum
acute abdomen
Take dienfs word about disten- Sx indicated (GI tract rupture or septic peritonitis)
tion until proven othelWise
- Gas in hollow organ: obstruction (Sx) or ileus
Fluid analysis or free abdominal fluid
Causes: (see box)
.- - Tissue
. . .Biopsy of abdominal masses mlb (I
_ - Fluid
Ultrasound
- f f . ACTH stimulation or low-dose dexamethasone
- Gas
Abdominal
distention
**
-Fat
- Weak abdominal muscles
r
iJJ
~______________________~IL-_
Abdominal distention
Tissue (organomegaly)
Pregnancy
Renomegaly
- Infiltrative diz
- Hydronephrosis
- Neoplasia
- Compensatory hypertrophy
Hepatomegaly
- Neoplasia
Upidosis
- Infiltrativelinflammatory diz
Splenomegaly
- Neoplasia
- lnfiltrativelinflammatory diz
Granuloma
Phycomycosis
Other neoplasia
/oj
~,.
...
-~
suppression test
- Weak muscles, Cushing's diz
~->__-L_'_L_ab__to_l_o_ca_l_iz_e_S_ys_t_e_m_i_nV_O_IV_ed________
00)
Prognosis: Guarded;
~__v_a_ne_s_w_/_c_a_u_se
(IM278)
Fluid
Fluid inside organs
- Intestines/gastric (obstruction, ileus)
- Congestion: torsion, rt. heart failure
Liver
Spleen
- Hydronephrosis
- Cysts
Fluid free in abdomen ~~""Z'
- Transudate
'S-....~.):
- Modified transudate
{,~ ~~"\
- Exudate
Y)
-Chyle
{\,~ \ } (
0. } \
-Blood
~j
Gas
Inside organs
- Intestines - obstruction
- Stomach - dilatation/volvulus
Free inside abdomen
- Rupture - GI tract/reproductive tract
- Spontaneous pneumoperitoneum
Peritonitis - bacterial metabolism
- IatrogeniC - post Sx
Fat
Obesity
Lipoma
Weak abdominal muscles
Cushing's diz
GI
Intestine
Over proliferation of microflora
in proximal intestine
Small
intestinal
bacterial
overgrowth
Results in malabsorption
Diagnosis
Presentation/CS
Facts/Causes
Condition
mucus)
Weight loss
Steatorrhea
**
,-==
>
II!
-~
,
)
~
Hx (bowel resection surgery
CS (small bowel diarrhea)
I bs ti
- Lab' maa orp on b rpti
-..:..
- Abnonnal xylose a so on
- Marked steatorrhea
-...
_Abnormalbentlromldetest
_ Positive urine nltrosonaphthol tast
0 Moderate non regenerative nonnochromlC"
Spastic colon,
Stress colitis
E-hb 495; SAP 710; 12M 454;
1M 350: H38 379; H28 431:
5mln 746; ell T
804; GI 468;
GI-S532
**
oRnaa""d,o""'O~canemla
Intestinal
lymphangiectasia
Ehb 487; SAP 710: 12M 453;
1M 349; IM-WW2BO: 5min 788;
G1439; Neo 169; Pa-T 40
_ Constipation
RIO
- Abdominal cramping
./:..-.....
' )
~J$
_
,ct,""
[IBDJ)
,.._
"
~
r R ~
~~
~~L
...
_ '~
oHx,CS
o Radiology
- Local gas ileus
- Local or general loss 01 peritoneal
detail due to effusion
- Exploratory laparotomy
wid
I-
- Lab:
- Hypoalbuminemia, hypoglobulinemia,
lymphocytopenia, hypocholesterolemia & hypocalcemla
- DOx from liver: liver function tests
- Urine protein determination - OOx renal diz
-Abclominocentesis:transudate, chyJousascites
& chylothorax occasionally
- Radiology Ascites & pleura! effUSIOn
laparotomy/endOScoPY wI biopsy definitive
Mood modification:
Light sedation during stress (acetyl promazlne, chlorpromazine or phenobarbital In nero
vousdogs)
- AnticholinerglcCNS depressant, drug
ThiZ~
lJj
M1... ;}1
Sudden anorexia
-Vomition
oBowel evacuation (m! contain blood)
- Abdominal pain
-MW/~Idlet d'f'
'
Pro-Banthine
~
ODx:
Non-enterIC hypoproteinemia liver failure, Renal dlz
Cardiac dlz - lymphangiectasia
- Exocrine pancreatic deficiency
Oth"
d;, - Iymph~""ma, h;"apl"m,,", LPE
Dietary modification
- Add dietary fiber (unprocessed
wheat b~an) (1-5 tbsp/meal)
\l9.
(J
v,,~
agents (Cholestyra,,mine)
I No identifiable lesions
Ro.',"
~~~~~JLs~x~r~e:m~o~v~a~l~o~f~s~m~a~I~I~i~n~t~e:s~t~in~e:s~L-__________~___'_~_m_a_'h_-_to_-~--~_"_t,_a'_'_'t_t1_m_'----____~~p~,og~"~~~;'~'~P~a~ac' (CS)-----
syndrome,
Mesenteric
thrombosis
Irritable bowel
ab""""all"..
inflammat~~ lesi~ns)
Short- boweI
syn drome
indirect evidence
- Response to ABs
diarrhea
Tx underlying disorder
Difficult to document
&
Treatment
combo
i"'d,""m-'hola"'""po",~,~."><))
}i:s.~
~
((I?
Prognosis: Guarded
Megacolon
GI
Condition
Facts/Causes
Presentation/CS
Megacolon
564
**
Treatment
Diagnosis
Hx (history)
Mild: Oral laxatives: DSS (Colace), bisacodyl
hypomotil~y
CS (clinical signs)
(DulcolaX)
Uncommon
PE: dehydration
Severe - initially
-Cats> dogs
Abdominalpalpation:dis- Fluids: polyionic solutions + potassium chloride
Pathophysiology:
tended, firm colon
(40 mEq/L)
- Fecal impaction, colonic
Digital rectal
- Remove fecal material:
dilatation, chronicobstruc Plain films - megacolon,
Multiple warm enemas (mild soap or DSS
pelvic fxS, vertebra/lesions
tion
[dioctyl sodium sulfosuccinatel to hydrated pet)
Colonic bacteria &
Lubricate rectum & distal colon: water soluble
enterotoxins
lubricant in large, catheter tipped syringe & a
- t Intraluminal pressure =
feeding tube
mucosal wall problems
Small sponge forceps to break up & remove
fecal concretions (sedation or anesthesia)
- Tx cause:' Sx for strictures, obstruction, idiopathic megacolon
Causes: Megacolon
Medical management:
-Idiopathic megacolon in cats (#1 cause)
- Oral laxatives: DSS (Colace), bisacodyl (Dul Acquired megacolon: 2 to any cause ofobstruction
colax)
& chronic constipation
- Diet: moist food + psyllium (Metamucil) or bran
Foreign bodies: bones, string, hair
fiber to soften feces
Neoplasia (lymphosarcoma in cats)
- Periodic enemas in mild constipation
Strictures, pelvic fractures
- t Exercise, weight loss in obese, clean litter pan
Terminal spinal cord lesion (Manx cats)
Subtotal colectomy: for nonresponsive cats!
Cats: dysautomia or Key-Gaskell syndrome
.? Congenital myenteric ganglion cells problem In humans; not well
idiopathic megacolon (see below)
-+
~)I!."" ~
/I-~
Cat> Dog
CS: Recurrent constipation
Ox: Rads
~~
Tx: Conservative, Sx
Prognosis: Guarded
Idiopathic
megacolon
H3B 371; H2B 430; SAP
777,719; 12M 468, 371;
1M 357; E-hb 49B; 5min
B08; E 1257; cat 1256;
F3rM 104; F-N 416; SxWW 135; Sx-S-hb 223;
Sx4B 272; Pa-T 65; X-T
564
I AcluH cats
constipation
Depression
Anorexia
Weight loss
Vomiting
Cecal-colic
volvulus
Sx-WW 136; Pa-T 66
Rare
Cecum, ascending colon & transverse colon rotated around cranial
mesenteriC root
Rare
CS: Tenesmus, Diarrhea, Vomiting
Ox: Hx, 'CS, Rads
Tx: Surgical correction
cS
term use
Adult cat
CS: Chronic & recurrent constipation
Ox: Hx, Plain films
Tx: Conservative, Subtotal colectomy
Px: Sx -Good
r Hx (adult cat)
~)N
///1
Prognosis:
$"
'
C::7
jl_ .
Conservative: Guarded
Sx: .Good, 65% complete resolution,
20% decrease frequency of signs
Depression
Abdominal distention
Tenesmus
Diarrhea
Vomiting
Dehydration & shock
C~
Malabsorption
GI
Presentation/CS
Condition
Facts/Causes
Malabsorption
syndrome
- Exocrine pancreatic
11t
'/
insufficiency (EPI)
IM-WW 15; H2B407; Pa-T39 Malabsorption
558: GI 437: 12M 449; 1M 345:
***
Insidious onset
Chronic small boweltype
diarrhea, persistent or intermit,r lent
I
. - t Va ume
- Normal - frequency
- Melena
- Steatorrhea
& electrolytes)
- VO~ltlng .
.
Abdominal distention wI or
w/o ascites
g~~
Cause -malabsorption
Lymphangiectasia
Eosinophilic enteritis
Exocrine pancreatic
insufficiency (EPI)
Plasma cell enteritis
Lymphosarcoma
Chronic parasitism
Histoplasmosis
Steatorrhea
Mastocytosis
Villous atrophy
Wheat sensitivity
Lactase deficiency
atrophy
SAP 711; Gl 449; Cat
1254; Pa-T 39
Diagnosis
Hx (breed predilection)
Biopsylhistopathology required
Fecal flotation (parasites)
Wheat withdrawal from diet test
Eliminate paraSite &: caloric prob-
lems
Serology:
q
.
rM
- Trypsin-like immunoreactivity
(TLI) for EP' (exocrine pancreatic insufficiency)
Tx parasites
Calories
Wheat withdrawal from diet test
Pancreatic insufficiency
- Oral pancreatic enzymes
- Diet low fat high protein
- Only 112 patients improve
Lactase deficiency
- Remove milk & milk products from diet
Undifferentiated malabsorption
protein-losing enteropathies
- No response to specific Tx
Contrast radiographs
- Ulcerative or nonulcerative thickening of wall
- Constriction or dilation of bowel lumen wI
normal mucosal pattem
- Distal Ileum maybe more distended than rest
of small intestine
Prognosis:
~
~
:'~Volume ~'
- N- t Frequency
..
or bacterial overgrowth
other gluten-containing diets
Endoscopy
Idiopathic villous atrophy
Duodenalfj8junal biopsy required
- Dietary: (did diet. Hill's) glulen-restrlcted
- Melena
hypoallergenic diet sometimes beneficial)
- Characterize morphological & bio- Steatorrhea
- Vitamin Tx: folate (5 mg daily PO) &
chemical abnormalities
- Weight loss (chronic), while Sometimes InfiltratiOll of lymphocytes & plasma
cobalamin (SOO~g monthly, 1M for 6 months)
Primary torm
- Wheat-sensllive enteropathy
- Idiopathic canine villous atrophy (G. shepherdS)
Secondary forms:
- Sequelae of diffuse infiltrative dizs
Chronic inflammatory bowel diz
_lymphoma
- Sequelae of enteric infections
Viruses (coronavirus, rotavirus)
Bacteria (overgrowth sv,ndrorr,el
Parasites (Giardia)
eating
- Vomiting
Abdominal distention wI
/--:0':-:-..;-i
or wlo ascites
Peripheral edema, muscle wastin9
Rare
Primary form 01 villous atrophy
- Partial vlllous atrophy
- Deficiency or delayed development
Mk 121; SAP 711: Neo 173;
of microvillus enzymes
Gl 451; H3B 353
- Dietary sensitivity to wheat
- ASSOciated wI malabsorption & chronic
dlarmea
~:-o;~;;:~;.;.~'n:::Sh Setters in Great Britain
Insidious onset
Chronic small bowel-type
diarrhea
tVolume
- N- t Frequency
- Melena
- Steatorrhea
Weight loss (chroniC)
-Vomlling
Weight loss (while eating)
Persistent or Intermittent cflarrhea
Abdominal distention ascites
in Gr Br, Malabsorption
villous atrophy
Idiopathic
Wheat-sensitive
enteropathy
Treatment
Hx (breeds predilection)
Biopsy - jejunum: Villous atrophy
Wheat Withdrawal from diet test
jI-~
i.~~
&Oi
Prognosis: guarded, often diarrhea &
weight loss continues despite Tx
Eliminate wheat Be other gluten containing diets
- Hili's did & i/d diets & Science Canine Growth
Diet, lams (ChunkS, Plus & Eukanuba)
- Wheal restriction for life
Breeding discouraged
PrognOSiS: poor
,
Intestinal Obstruction
Intestinal
obstruction
M8k 296; Mk 252: Ehb
482; SAP 713: H3B 367:
H2B413: 12M455; IM3S0;
IM-WW 276; <31173, 370;
E 1212; Sx4B 245; sxWW 133; Emrg 341; Neo
174; Cat 1262; 5 min 742;
X4T 540. 560; Pa- T 34
-Uncommon
Acute or chronic
- Abdominal pain
- Anorexia, depression
- Weakness
- Dehydration (rapid electrolyte water loss)
Distal small bowel obstruction
- Tolerated longer than proximal
obstruction
- Extramural compression
Complications
- Intestinal rupture
- Peritonitis
- Endotoxic shock
**
GI
- Nausea
- Vomition of bile
- Vomition feces-like
Onset of dehydration & weakness delayed
Abdomen distends Slowly
- Gas & fluid-filled loops of bowel palpated
- Tender abdominal mass
- Intussusception sausage-shaped palpated
Partial obstruction
- Vomition
- Prolonged or intermittent signs
- Reduced food & water intake
- Chronic weight loss
- Remain alert
- Feces fluid, bloody & putrid
- Transient response to previous AB Tx
Strangulating obstruction (vascular
compromise)
- Rapid progressive toxemia
Surgical emergency:
Hx, CS, common in young dogs
to relieve obstruction
History (FB): vomiting & dehydration
Palpation of dilated gut or FB suggestive - Meperidine (Demerol)
(relieve pain)
- Sausage in abdomen (Intussusception)
- IV fluids & electrolytes priorto
- Gas-filled loops prox. to obstruction
& during surgery
Borborygmi in distended loops
- Balanced electrolyte sol (if blood gas &
Radiology ~ plain
pH data not available)
~ Broad spectrum ABs, IV
- Gas or fluid ileus common wi complete
obstruction, prox. to obstruction
-Wholebloodorplasmatrans- Degree of ileus depends on duration of obstruction
fusions if circulatory shock
& location
- Postoperative ABs & fluids
- Partial obstruction mlb no ileus
continued
Contrast radiographs
1-3 days oral intake of fluid &
- Complete obstruction
Delayed transit time prox. to obstruction bland, low residue diet
5-6 days begin to return to
- Barium in ileus, proximal
regular diet
- Partial obstruction
Intestinal transit time & appearance distal to
obstruction usually nonnal
Filling defects
Lab: fluid, electrolyte, & acid-base
derangement
- t WBC & septic abdominal effusion,
ischemia or perioration wi peritonitis
- Shock
Blockage
CS: Vomition, Depression
Dx:Hx,CS,PE,Rads, Lab
fluids, ABs' Px: Good
Tx: Sx,
- Death
In general: the more proximal (orad)
the obstruction, the sooner vomi~
tion occurs after ingestion
Physiologic obstruction
Intestinal volvulus, Mesenteric volvulus
Dogs > cats, No known predilection
Rapidly progressive diz fatal unless surgery early
Intestinal FB
From segment~1 ileus due to peritonitis, surgery, metabolic disorders or neurological diz.
Ox: Survey radiographs: distended bowel loops + Contrast films: no obstruction
Tx & Px: depends on cause
(I....." body)
Intussusception
Young > old dogs & cats
Diagnosis:
Radiographic plain films
- Radiopaque objects easily to 10
- RadiOlucent m/b surrounded by gas or contain gas
- Unear FB bunChed or gathered bowel
:~
_~--.............~
~
Diagnosis:
Plain films: Localized ileus
- Sausage-shaped bowel in mid to caudal abdomen
Contrast rads: Obstructive ileus proximally
- Thin line of barium into intussuscepted segment
"coiled spring" appearance
Barium enema:
- Dx only if ileocolic or colon or cecum
- Filling defect within colon (ileum into cecum)
tumors
~~$
<
~~ ~
Constipation
***?
titr~~tieh
~~'''~~
Severe constipation
(enemas
rLa::;'x~a;;tj,iv~e;s~-:-e;n~e~m~a~s~---l.--------lf;;;;~;;':~
Causes of constipation
Intraluminal obstructIon
SAP 778
' I
Dietary:
Rectocolonic stricture, tumor,
Orallaxativeslcathartics:
_ Ingested foreign material (hair, bones,
inflammation, foreign body
- High fiber bulk-forming laxatives: added to lood
cloth, cat Jitter, rocks, plants)
Rectal diverticulum
Promotes soft leces (hydrophiliC) & normal coloniC motility
_ Inadequate water intake
Perineal hernia
AII~Bran (Kellogg cereal), Canned pumpkin,
Environmental/psychological:
Neuromuscular dysfunction:
Metamusil (psyllium), 15 tbsp/day
- I d- wid Hill's
Change in habitat or daily routine
- Lu
~cra I spina IZ
_ Unsanitary litter box
~
Deformity (Manx cats)
- lubricants--Iaxatives; soften & lubricate to lacililate evacuatio,,'===
_ Hospitalization
~~~B>-:. Intervertebral diz
Laxatone (white petrolatum)
t::"'M~:n
(:;[
'~D'
. Mineral oil
~
- Prolonged activity
...... ...
'9/
' . egeneratl~n, injury: ~eoplasia
Idiopathic megacolon
~.). Bilateral pelVIC nelVe Injury
- Emollient laxatives: promote water inlo leces (oral & enema)
Painful defecation:
(
~~,\
- Dysautonomia (ANS - cats)
Celace (dioctyl sulfosuccinate sodium), Suriak (dioctyl
_Anorectal obstruction:
C
- Hypothyroidism
sulfosuccinate calcium), Oialose (dioctyl sulfosuccinate
Anal sac impaction/abscess
Idi,opathic megacolon
potassium)
- Saline laxatives:
Anorectal foreign body, stricture, tumor FIUI d & eI~ t roIyte ab normalities:
Fly maggot infestation (myiasis)
- Dehydratlo~
Milk of Magnesia (magnesium hydroxide)
Bite wounds, cellulitis, or abscess
- Hypokalemia.
- Osmotic laxatives: soften by pulling water into lumen
Pseudocoprostasis (Ieces malted in
- Hypercalcemia (Hyperparathyroidism)
Duphalac syrup (Iactulose)
Dialose
perIneal hair)
- Chronic renal failure
.. Excellent safe, all-purpose laxative for dogs & cats
- Orthopedic disorders: limiting positioning
Drug-induced:
Colyte, GelYTELV (polyethylene glycol)
lor defec:a~on
- Adrenergic blockers & calcium
Milk (lactose)
Spinal dizlinjury
channel blockers
- Stimulant laxatives: t propulsive motility of bowel
Dizs of pelvis, hips
_Antihistamines
Contraindicated in obstructive leSion & not for long term use
Rectocolonic obstru~ion: h_~ _ Anticholinergics
Dulcolax (blsacodyl)
- Extramural compression ~d)
Aluminum hydroxide
Castor 011 goOd for clinic use to prepare lor radiographs & endoscopiC procedures
Prostati~ .hypertrophy
~l
_ Barium sulfate
Enema .& su~positories soften hard, Impacted leces & promote evacuation
.. Prostatitis
\ _ Diuretics
- Warm IsotonIC tap water or saline (5-10 mlkg) mild soap
.. Tumor
-Iron
- Colace (dloctyl sullosucclnate sodium) emollient
, Paraprostatlc cyst
- Overuse of laxatIves ~~J$~) Mineral O~I: IUb~cant, do not mix wI Colace
PelviC fractures
_ Opiates & opioids
- Fleet (Children s) enema (sodium phosphate) sOftening, fI)
PelVIC collapse _nutritional bone disease
Phenothiazlnes & tricycliC ~
bulk-produclng & Irnlatlng effect) only sale In medium to large dogs
~
Perianal tumor
wI normal renal function
~~-"~
antidepressants
, Never In small dogs or cats! (may cause dangerous
Pseudocoprostasis
- Sucralfate
hypernatremla, hyperosmolility. hyperphosphatemla & hypocalcemia)
I Oi
II
diet
mbo
--
I!
_. ----"- -._.- -- --
-'-----~---~--.-
Rectum Anus
Condition
Imperforate anus,
Anal atresia
.
.
AtreSia an I,
Atresl'a recti'
GI
Facts/Causes
Rare, congenital
Rectum ends blindly
Atresia ani: absence of an anal opening
Atresia recti: rectal pouch cranial
to membrane overlying anus
Presentation/CS
Tenesmus
Abdominal pain & distention, retention
of feces
Absence of anal opening
Sequela: Anesthetic risk
Diagnosis
No anal opening
RaCfobgy:
01',,-",
Treatment
Constriction of rectum
Rectal &
Cause:
anall
- 2 to chronic inflammation
(perianal fistula, chronic anal sac)
anorectal
- Anorectal trauma
- Adenocarcinoma of rectum
stricture
- Anorectal surgery
M8k 149; Mk 132:; E-hb
540; SAP 783, 788; H2B
475; 12M 465; 1M 357; GI
491; Gl-S 513; Sx-S-hb
227; Sx-S627; 5min 104;
Cat 1275
**
Rectal
prolapse,
Anorectal
prolapse
M8k 150; Mk 130; E-hb
540; SAP 787; 12M 461;
1M 354; IM-WW 287; H38
422; H28478; GI 499; GIS512; Sx-S-hb 228; Sx-S
628; Sx3B 259; SX-WW
139; Neo 181; 5min 1010
**
Contrast radiography
Dyschezia
Hematochezia
11_
'"~~J~'_'_
Rectovaginal
fistula
MBk
Tenesmus
Prognosis:
Poor: if due to adenocarcinoma
Guarded: if due to inflammatory process
~--~~~----------~
Cause: Rectal prolapse
ParaSites & straining #1
Enteritis
Rectal foreign body
Lacerations
Diverticula
Neoplasia
Urolithiasis
Urethral obstruction
Cystitis
DystOCia & prostatic diz
Perineal hernia
- Foul odor
.':~ ~=:::,
@{y'
Prolapsed rectum!
1 cause
Insert thermometer or finger be- Replace viable prolapse (wI finger)
tween prolapsed tissue & anal
-Sugar solution (50% dextrose or70% mannitol)
sphincter
relieves edema to help replacement
-If no resistance met: intussuscep- Stop straining
- Stool softened & moist diet
tion of ileum or colon
- Antispasmodics (dlcyclomine !8entyl])
Contrast radiographs for extent of
-Hydrocortisone retention enema (Cortenema)
prolapse
- Mesalamine retention enema (RowASA)
- Mild sedation
Anal purse string for 5-7 days maybe
required If continuous straining
DDx:
- lOW-fiber diet while suture In place
Prolapsed ileocolic intussus Resection & anastomose if necrotic
ception (probe around, in rectal pro Colopexy: for recurrent prolapse
lapse cant go far)
- Abdominal approach, pull on colon to reduce,
scarify colon & abdominal wall, appose scarified areas (2-0 or 3-0 monofilament
nonabsorbable suture
s=== :>
III!
/I
Prognosis: Guarded
Clip hair
Cleanse underlying irritated skin
Topical antibiotic ointment
Correct impaction if present
4~~, ~
.SeqUelae:~~'
Anus matted closed
CS: Obstruction
Tx: Correct
- Underlying dermatitis
- Myiasis (fly maggot Infestation)
-Impaction
,~
1~;~11
{ @;) (
t1" J
~
GI
Anal Region
Condition
Perineal
hernia
Diagnosis
Presentation/CS
FactS/Causes
Protrusion through perineal wall
Constipation
Obstipation
Dyschezia
_Tenesmus
M8k 149; Mk 132; E-hb Cause:
Stranguria il urinary
_ Weakness of pelvic diaphragm
539; SAP 782; H3B 418;
bladder hemiated
___
}1;
(levator ani & coccygeus muscles)
H2B 476; 1M 355; 12M
r
~)
463;IM-WW287;Gt493;
- Tenesmus (constlpatlon,
GI-S 512; SX-WW 141;
prostatomegaly, urethral calculi)
5min 928; Cat 1274
PathOgenesis: poorly understood
./'<'
_Male hormones? rare in castrated dogs
Bilateral or unilateral (predOminantly
rl9ht sided)
Contains rectum usually, retroperitoneal fat, prostate, rarely abdominal organs
(urinary bladder, intestine) ~))
"~~~/\:
fN
**
~/ r---'L~
P rf rated
eI0 I
CO on
rectum
Sx-S-hb 224
Anal sac
diz,
AnaJsacculitis
M8k 147; Mk 131; E-hb
541; SAP7S4; H3S421;
H2B 479; 12M 464; 1M
355;IM-WW288; G1497;
GI-S 513; SxB 283; SxS-hb 231; Sx-S 640;
Sx3B 270: SX-WW 140;
Cat 1275
~~pa:on
., -a -
also
Classification/contlnuum of dtz process
- Impaction: distended sac, mildly
painful on palpation
- Anal sacculitis: moderate to severe
pain on palpation, purulent fluid
- Anal sac abscess: marked distention
(pus, cellulitis, erythema, lever)
- Rupture draining fistulous tract
'L
{1
/""
Rectal palpation
lfif,1J
{L.J
I
.-H-'-,-C-s----
Anal
furunculosis
M8k 148; Mk 131; E-hb
541; SAP 784, 769; 12M
463; IM355; IM-WVV2SS;
H3B 419; GI 495; GI-S
513; SxB 276Sx-S-hb
228; $x-S 629; SX-WW
140; 5min 922
**
ment, infection
& abscesses
De~xail,~sone~"1
lavage - microscope
Hx, CS. PE
- Tail chasing
Malodorous perianal drainage
Change in temperament
Sequela: self-inflicted dermatitis
. Wound infection
(r:
Remove
rectal palpation
SedationFaorby
anesthesia
m1b nece~~
- Proctoscopy may be needed
PrognoSis: Good
dependin on cause
!\,~11f
rL~-'
I:e
--~~
.
~lU-"
, ' S , ")
--
=-
.J..._.L_ _ _ _ _ _ _ _ _ _ _--L________________~_
Anal discomfort
- Scooting
- Tenesmus
- Licking & biting anal, perineal,
& tail base regions
discharge
. Fecal
R,d.1 p,ol.p"
Incontinence
organ
Radiographs loss 01 abdominal Sroad spectrum ASs
detail, pneumoperitoneum
Exploratory celiotomy as soon as possible
'***
Perineal
fistulae,
Prognosis: Good if Sx
\.
,I
)10
~
~~
R'~'II'ce,.'O"'~'
: 2"
\ '\
~
4..../"
To
Painful
smdefecation (dyschezia)
prostatomegaly
.
-_r"-_r__~_-J, ~~:;:rua~:e!~~i~:~r;gi~~e~~~~~~~~:t:C:~~
'_i__
l~\
__
tal d6jf:f6cts
.
.------:~
Colon ic/Anorectal foreign bodies
& fecoliths
Causes
Treatment
>
- Perianal cleansing
wi antiseptic solution
/(I!
5=
7'
- Fecal incontinence
- Recurrence can occur
-lncisional dehiscence heal by 2 intention
~
tC:;J
,,,
ii/if
r
GI
Rectum - Anus
Presentation/CS
Diagnosis
-Irritation of perianal region Examine perianal region
Facts/Causes
Condition
Perianal
dermatitis
Treatment
Treat cause
-Topical Tx
**
- ....
Anal irritation
CS: Licking & biting
Ox:PE
Tx: Cause, Topical Px: Good
E-hb 540; SAP 781;
H2B 477;
IMC11T616;
G1S12
Ii>
Hemalochezia
~~'i.I
*
.'1
Sessile, raised or
pedunculated, Single
or mulbple
<
----------r.~R~oe::::ta~'~,,~.=""::;-,,=";::,=ocarclnoma .1
M8k 150; E-hb539; Sx-S-hb230;
Diarrhea
D h . I Inful
d~~~r
Passage of blood &
mucus w/feces
SX-WW 141
Tenesmus
Malignant
anorectal tumors
Lymphosarcoma
m.
~
1
coma; technique depends on location (abdomlnal colorectal resection & anastomoses, dorsal
perineal approach, r~~ pull-through)
Lymphosarcoma: initially wI chemotherapy
:::0,
tumors
Malignancies:
- Perianal (circumanal) gland adenocarcinoma see pg 86 above
- Apocrine gland (anal sac, anal gland) adenocarcinoma
- Other malignant tumors (squamous cell carcinoma, melanoma, lymphoma, mast cell neoplasia)
**
,~,
Perianal adenocarcinoma
Perianal fistula
~~
't7lV"<'I~ ~"
palpation
EXcision bIOPSY
-~
~.:5
PUfPD
~,1~1
'1!1.J
Adenoma: excellent wI Sx
Hypercalcemia
Rectal (anal sac)
87
l'~~.J.
~) ~~I Prognosis:
.~~
l' ..,-J7
'(.
III! S:-=@J
4"fc.\
JL____~.:A:n:a:l:sa:c::a:d:en:o:ca::r:c:in:o[m:a~
)$::I )11,
.J;/b
J
r-______________________
odicallybleed
Beagle, G. Shepherd)
SiiL?
Excision (TOC)
Anal sac
tumor
Ita
~--,--,-~=====
~.
Surgical removal best lor aU except Iymphosar-
Perianal
(circumanal)
gland tumors
>=:::::>"
II!l
'---_
PrognoSis: good
~~--~----------~~--~~
Anorectal
polyps
1~f
Tenesmus
Dyschezia (difficult defecation)
Diarrhea
olntlammation 01 rectum
Proctitis
U1([
-~..---\..Ti:'
'i
(")
lJil
~ ~\] H
be needed for
(Ill
Prognosis guarded
$=?
,.it;.).
~W
GI
Disease
Diagnosis - see below:
Treatment:
Jaundice
" Hepatic blood flow
' Hepatic encephalopathy
~r Treat inciting cause (see following conditions)
Prevent or manage complication of liver failure -\!s~~.Jj,?:C-2>--':::?
diz
. Protein, carbohydrate & Depression
~r;:::::
M8k 326, 130;
fat metabolism
- Hypersalivation
s
:;3. Drugs: consider if metabolized or excreted by liver
~
. Hepatotoxic drug: thiacetarsamlde
Mk 138, 1170; _ Detoxification of drugs &
- Behavioral changes
. Worsen hepatic dizs; methionine-containing products,
A
1207; SAP 722;
E-hb 599; 12M
toxins
- Altered consciousness
tranquilizers, sedatives, diuretics, aspirin & corticosteroids
~. ~.
487;IM369,379;
_ Formation
- Motor disturbances
Supportive therapy:
. ~
IM-WW 297;
bile
_Seizures & coma
- Maintain normal fluids
~
_ Avoid alkalinizing agents (lactate In lactated Ringer's solution,
~;:'6;~~~1~~ _ Thus clinical & lab
- CS wax & wane wI interspersed normal periods
C12T 736; E
abnormalities are diverse Ascites from hypoproteinemia, portal hypersodium bicarbonate augments ammonium Into eNS)
"""
1261; F31M 68; Acute or chronic
tension & renal sodium & water retention
Nutritional support
Sx38 291: Sx Excessive bleeding (occasionally) vii K
_Bulk of calories as carbohydrates, avoid high'protein diets, need adequate protein though
WW 143; X-T
)
426; Neo '89:
Achoic (gray-colored) feces (cholestasis
_ Gastrotomy or, ph~ryngostomy tube
~'
- \.,;
",
Pa-T 82
" , . Nonspecific signs
Control complications:
~1 )
*?
Vom~ing (common signs)
- Hepatic encephalopathy
r J l-:t'. ,
s;t:::
Hematemesls suggest ulcers
, Restrict protein intake
c!/
, ASs (neomycin, metronidazole) to. urease-producing bacteria of colon
- Anorexia
Lethargy
, Lactulose (synthetic disaccharide) cathartic & colonic acidifier
. .
.
_ Weight loss (chronic)
_ Control any GI hemorrhage: fresh, not stored blood for transfusion (less ammonia)
Clinical approach: acute vs chrome
_ Diarrhea occasionally (small bowel)
- Ascites & edema
, Hx" PE, Lab, Radiology & US may
" PU/PD
Restrict sodium in diet
suggest acute or ~hromc
.. .
_ Pigmented urine (bilirubinuria) ctlolestatic
Diuretic
Biopsy often reqUired for definitive Ox
liver diz & hemolytic diz
Plasma transfusions or volume expanders (hetastarch or dextran)
Acute:
Acute
ffi
- Coagulopathy & anemia
. Cause: toxic, infectious are common
Chronic
~
" Vit K1 parenterally
~
_ T~: intensive supportive care to allow
)) )
Prevent DIG
time to regenerate
_Gastrointestinal ulceration
_Prognosis: good if survive initial stages
#../
, H2 blocked (Ranitidine or cimetidine)
Chronic:
Sucralfate (mucosal protection)
.-...r_ Irreversible changes (cirrhosis more
-Infection & endotoxemia
likely)
,ABs (penicillins, cephalosporins or aminoglycosides [eliminated by kidney))
_ Prognosis: poor for long tenn
_ Renal failure: fluid to avoid prerenal azotemia
_ Cholestasis: may use choleretic agent (ursodial)
Liver
Liver functions
:#!::?
~
7((,'
l'e-:
fJ
Diagnosis:
~-~ glutamic oxaloacetlc transaminase) nonspecific for liver
disturbances)
History:
' r
~
Uverlnjury tAST & AlTw/normal CK
Abdominal flu,'d analys,'s
ri\}
Muscle Injury: fAST & CK
- Age (young - P?rtocaval shunts) '" ~
ALP/alkaline phosphatase nonspeCific - bone,
lIl~ifllfn
Transudate: 2 0 to liver diz & hypoalbuminemia
.
glucocortlcos!erolds or liver
It''
- Modified transudate (protein> 2.5 gm/dl) hepatiC
- Acute vs chroniC
Chronic; weight loss & ascites
- GGT! gamma glutamyltransferase nonspecIfic
venous congestion (vena caval obstruction) or cardiac causes
" Exposure to damag,'ng substances
Biochemical tests
- S'II e per,Iomtls:
: . ' . biliary tract rupture (bilirubin, yellOW to green,
_Intoleranceto substances (anesthesia intolerance) - Hypoalbuminemia: nonspecific -liver,
mixed Inflammatory infiltrate
_ Vaccination status (ICH, leptospirosis & FIP)
urinary, GI
Radiology:
, Physical exam:
- Hypoglycemia: insensitive, poor prognostic factors
" Change in size (hepatomegaly, microhepatica)
- Hypocholesterolemia - rare in liver dlz
Jaundice
- Hypercholesterolemia nonspecific
- Mineralization (choleliths)
_ Abdominal palpation
Liver function tests
- Radiolucencies (abscesses)
, Liver hard to palpate in normal animal, edges
sSA/serum bile acid concentrations: t when loss
- Abdominal effusions
of hepatic function. Fasting serum bile acid concen- Thoracic films if hepatic neoplasia suspected
sharp & not rounded normally
Hepatodynia (pain on palpation of liver)
tration (FsBA): 12 hr fast, sensitive, specific mea- US/ultrasound
Abdominal effusion
sure of liver function
- Detect focal parenchymal abnormalities
_ Neurologic exam if eNS signs
,Normal values < 10 Ilmol/liter
- Biliary tract (obstruction, calculi)
_ Fecal: melena & achoic feces
. > 30 J,lmoll1 warrant liver biopsy
- Vascular lesions
Skin & mucous membrane for bleeding
. Postprandial serum bile acid (PPSBA) concentration
- Percutaneous liver biopsy
.. High lat diet, take blood sample 2 hrs after feeding
, L,"ver b,"opsy (
esc (comp Iete blood count)
Normal values < 25 IlmOIll , > 30 Ilmol/l warrant Uver biOPSY
hemostasis screen prior to biopsy)
Anem (bl d I
h d" )
- Fine needle biopsy (diffuSEllesions)
la 00 OSS, C romc IZ
- BAl blood ammonia concentration for hepa~c encepha- Blind percutaneous neeale biopsy (diffuse)
- RBC microcytOSIs - shunts
..........
lopathy, but stlU can be nonnal wI encephalopathy
- Ultrasound-guided biopsy
Target cells & ancanthocytes
~
- ATT/ammonla tolerance test not as good as bile acids
- Keyhole needle biopsy (general anesthesia)
UA (unnaIYSls):
Homeostasis parameters (coagulation factors
- Laparoscopy (direct visuaUzation)
_ Isosthenuric or hyposthenUriC speCifiC gravity II PU/PD
synthesized In liver)
- Laparotomy (il surgically correctable diz suspected)
_ Bilirubinuria (sensitive & preceeds jaundice)
- PTlprothrombln time: extrinsic coagulation system
Biopsy analysis:
samples
in 10% buffered fonnalin 24 hrs
-- Monitor
lor bleeding
after biopsy
- Urobilinogen (absence & jaundiced. bile duct obstruction)
- APTTI activated partial thromboplastin time: for
- Ammonium biurate crystal-portosystemicshunls&normal
intrinsic coagulation system
animals
- ACT/activated coagulation time: rapid screening
Liver enzymes - not specific - screening tests
test for intrinsic system
(do not evaluate liverlunction, nonnal enzymes& liverdlzorabnonnal - Thrombocytopenia: splenic sequestration 01 platelets assoc.
enzymes & no liver diz possible)
wI portal hypertension, DIC, liver diz
ALT: liver specific
- ALT: liver specific - magnitude correlates wI
- DtC suggested by combination of prolonged PT & APTT, low
Bile acids: t wlliverdamage (N = <1 0)
injured hepatocytes (I OOx nonnal wI hepatocellular necrosis
plasma fibrinogen. increased fibrin degradation products, lrag& inflamma~on, 20-40x in cholestasis) AlT/SAlT '" serum alanine
mented RBCs & thrombocytopenia
PTH: extrinsic coagulation
aminotransferase lormeny called SGPT '" serum glutamic pyruviC Blood gas analysis: abnonnalities may occur 2 to liver diz (resp.
transaminase
alkalosis, metabOlic alkalosis, metaboliC acldosls &mixed acid-base
APTT & ACT: intrinsic coagulation
- AST (aspartate aminotransferase, fonnerly called SGOT/serum
@"
-- -
-;::.-
- -
--
GI
ure
Acute
Often nonspecific
_ Sudden severe insult that compromises
Acute
70--80% of liver
Anorexia
Causes (complete table below)
- Lethargy
_ Hepatotoxins (industrial chemicals, or- Vomiting
ganic solvents, pesticides, heavy metals,
M8k 326; Ehb
Diarrhea
&
biologic
toxins)
509; SAP 732;
Hx (toxin exposure)
Acute
hepatic
failure
***
CS (clinical signs)
Lab:
-tALT, t ALPm.yb.
- HyperbilirUb,inemia*
. t Serum bile acid'"
to regenerate
- Fluid, electrolyte & acid-base
Correct hypokalemia
IJ'
- Hypoglycemia*
OtherCS
- PU/PD
- Drugs:
- Hyperammonemia*
- Jaundice
- Excessive bleeding
- Hepatic encephalopathy
- Coagulopathy
thy, endotoxemia)
(9
findings
Compromise 70-80%
CS: Anorexia, Vomiting, Diarrhea
Ox: Hx, Lab (bile acids, hyperbilirubinemia), Coagulopathy
Tx: Supportive, Tx cause
Prognosis:
_ Supportive Tx m/ allow for hepatic
regeneration
Hepatotoxins
Chemical toxins:
_ Arsenic
_ Carbon tetrachloride
_ Chlordane
- Antimicrobials:
Trimethoprim/Sulfa
_ Chlorinated biphenyls
_ Chloroform
_ Copper
Griseofulvin
Ketoconazole
Chlortetracyclines
_ Dieldrin
_ Dimethylnitrosamine
- Heavy metals (copper, iron, lead,
mercury)
_ Hydrocarbons -$
- Naphthalenes
Primidone
- Valproic acid
- 'Antineoplastics (methotrexate)
. ErythromYcin~
' Isoniazid
'7
Itraconaz~le
Sulfon~m~des
- Anthelmlntlcs:
l ')
Jhl':::. .
dV/\])j ..
Mebendazole
_Phosphorus ~--(~
_ Selenium
- Tannic acid
Drugs _ toxic:
_ Steroids:
Glucocorticoids
Androgenic anabolic steroids
.. Methyltestosterone
Mibolerone
\
_ Analgesics'
Acetamin'ophen
_Salicylates
Phenylbutazone
_ Anticonvulsants:
Phenobarbital
Phenytoin
-Ca~in~herp~svirus
- Viruses:
- A~n~~lne
- Ghplzlde (cats)
- Meg~strol acetate (cats)
- Methlma:zole (catsw/hyperthyroidism)
AnesthetiCS:
- Halothane
- Methoxyflurane
- Biologi~ Toxins:
~ Aflatoxlns
~ Blue-~reen algae
- Amanita mush~oom
- Cycads (cycaSin)
- Pyrrolizidine alkaloids
- Pennyroyal oil
~:~
, Thiacetarsamide,
Diethylcarbamazine
O~i~ndazole + diethylcarbamazine
I L I,
wd\...\~~,
'I
- Others
- Protozoa:
- Toxoplasma
_ Babesia
- Dirofilaria
"?
I'
'<--""
(
?,~~~=~:~. . _j.,-"'::::::j
Systemic conditions:
Acute pancreatitis
Hemolytic anemia
Heat stroke
Inflammatory bowel dizlcoiitis
Sepsis & extrahepatic infections
Shock, congestive heart failure
Surgical hypotension/hypoxia
r~~~
-Trauma
Feline hyperthyroidism
~~Z~Y
91
--
-~-~----
----------
GI
Liver
Facts/Causes
See Urinary pg 351 & Systemic
pg695
Leptospirosis icterohaemorrhagiae, L. canicofa, L. grippotyphosa
Condition
Leptospirosis
MSk 336; SAP 128; E-hb
186; H2B 1207; G1517;
GIS 681; E 373; Inf-B
143; Pa-Y 98
**
Diagnosis
Presentation/CS
Subclinical in vaccinated dogs
all cats
& :
Treatment
_Thrombocytopenia
fI
(kldoe,)
- Icterus
- DIG (petechial & ecchymotic hemorrhages,
melena, hematemesis, epistaxis)
Occasional manifestatiOns
.t
...
DIG
ABs
(antiblo~CS)
tosplruna,
. .
- .oXYCYC Ine f
oriep
dlhydro~treptomycln
~oo~otIC - h~giene eS~iall~ re.gard-
cO
00
Serology:
. .
_ Microscopic agglutination (MA)
Preve~tlon: .
_ 4 fold. in paired sera'"
VaCCination.
.
.
- Part of most polyvalent canine vaccmes
. Single titers ne~er diagnostic b.ut ~ .
_Vaccinate at 9. 12, 15 wks (3 doses
1:300 suggestive, ~ 1:1000 highly I~n- required)
dlcat~I' G (ELISA)
Revaccinate annually (endemic areas
.19M g
;.:
every 4-6 months)
. CUlture: difficult to grow & identify
'"-
Dogs, Unvaccinated; PH
CS: Renal failure & Hepatic diz + Jaundice
Ox: Serology & CS
Tx: Support, Pen, Doxycycline
Vaccinate
jY
Prognosis:
: ,
Hepatic abscesses E-hb 5t6, SAP 737, H3B 387, 12M 544, G151S. GIS 677, 751; InfG 147, Sx-5-hb 233, Sx-WW 147, Sx4B 289, SxG 190, Nee 208, Pa-T 97
I Rare In dog & cat, Common In ox, Cause hematogenous spread, penetrating wounds, umbilical Infections, Immunosuppression
~
~:r
;;~,
\"\
CS Sepsis. Inflammation & hepatlc dysfunction anorexia, fever & vomiting, Rupture 01 absceSS (peritonitis, septic shock & death)
Ox Hx, CS. t PMNs wi left shift, t ALT, hyperolllnJblnemla, hypoglycemia, septiC abdominal effusion, Radiology (radiolucent areas),
Ultrasound. Biopsy (culture), exploratory laparotomy
Tx surgical eXCision of affected liver lobe. Broad spectrum ABs 68 weeks
C
/II(
s~
cysts
:.
::::,: ,..
out(ruo~)
In :;'b~;' ~::;~;~~,;;;~~~;~;:~::~.:~_ :~~~~:::' ~:~n~"~~~l~:~""_ :~~:~:~l :~~;;~~l;:~~:~~ .olit", cysts
Congenital or acqUifed
194
Infectious
canine
hepatitis,
ICH
M8k 335; Mk 138, 418;
H2B 1189; H3B 1129,
1130; 12M 532; IM-WW
304; E-hb 199; E 402; Gl
515; GI-S 675; Inf-B 11;
Inf-G 242; Pa-T 96; Neo
209
**
--r
'\.! \.-
cent structures
Most inapparent,
0
< 1 yr
Pathophysiology:
- Exposure to virus (urine, feces,
to tonsils
- viremia
coyote,
& eye
& bear
are infected w/out developing diz
- Fox, wolf,
skunk
Oiz of unvaccinated
CS: Subclinical
Ox: Hx, CBC, t ALT
Tx: Time
0
**
"
Hx (unvaccinated), CS
Symptomatic
Lab:
~ Thrombocytopenia usually
-+
"",.
Lymphosarcoma (hematopoietic)
~ Hypoglycemia
--
----
C-:==ZZ:=:s::;;-;~:::.
1III $ = >
'it1Jj
sizes)
Ultrasound:
focal, multifocal or diffuse
Exploratory Sx
i:q{)
Biopsy: definitive
- Large mass: laparotomy (excision
can be performed at same time)
Focal or diffuse: ultrasound-gulded biopsy
-B!indpercutaneousneedlebiopsyfordiffuse
93.
- ---
)'_~_l")
d
jj1(
solitary tumor
Chest X-rays for metastasis before Sx
- Evaluate abdominal cavity for metastasis & biopsy hepatic lymph nodes
ChemOltierapy: questionable efficacy in
dogs & cats
::::::oIoc!
r:-..
(>
changes
m~st r~ver
Hx (older). CS + Hepatomegaly
Abdominal distention
Other signs (PUlPO, Jaundice. diarrhea,
excessive bleeding)
eNS dysfunction due to encephalopathy,
hypoglycemia or eNS metastasiS
Metastatic
CS: Vague, Hx, Lab, Biopsy
Tx: Sx Px: Poor
Prognosis:
Good:
Distemper
.-/.'
Histoplasmosis
Fever
LeptospiroSiS
loss [cachexia])
CAV2 preferred)
Jill-
DDx:
- Pancreatic carcinoma
Adenocarcinomas (epithelial)
Hemangiosarcoma (mesenchymal)
Complications:
Glaucoma
Pyelonephritis
DIC (diSSeminated intravascular coagulation)
- Peracute death
19
of liver
Puppy immunity. by 9-12 weeks
(may recur)
~c:on:g~'~"'~te:l:"'~I':":"'~':d:"~W:/~dl~I.~"~,":o:t~'~""~':-~l______________L--~~;;~~~==:=::~
_h'P""b'I~'Yt"'lmO"likel'to'hoW"9",
'--- /111 $ = 7
primarily
saliva)
tlj"
Prognosis:
IDrug-induced
Liver
hepatitis
E-hb512; E 1320
**
Condition
Anticonvulsants, Analgesics, Gas anesthetics, Antimicrobials; Antihelmintics, Steroids (see Acute hepatitis
for ful11ist pg 91)
_\
_'
auses
Treatment
Diagnosis
Presentation
t frequency of seizures
vulsant therapy
Prognosis: ?71
83<'(( -
hepatopathy
.'
Steroid
hepatopathy
**?
dogs
Healthy dog
_Cats resistant
-Cause hepatic glycogen
Ba~~;~:ti;;:e:jb:~~~~i6n,
do not
mistake It lor serious hepatiC disorder
Spontaneous hyperadrenocorticism
glucocorticoid Tx)
~fra'~.
.., ..,
1..)
- CS of hyperadrenocorticism
ACTH stimulation or dexamethasone suppression test
Dramatic + in ALP, but normal
or slightly t liver specific ALT
Steroids _
t ALP ALl
;j
flr~~
"1 ~
Ster ods
~ \.....l.../
*,
---~
11:1
Mebendazole (TelmintiC): dewormer; Thiacetarsamide (Caparsolate) heartworm adulticide (small margin of safety); OXibenma(
"?
zole (FilaribitS): hookworm-heartworm preventative, Diethylcarbamazine (DEC): heartworm preventative
CS: Jaundice, Vomiting, Coagulopathy
Ox:
ALP, AL T, hyperbilirubinemia, Liver biopsy (centrilobular necrosis)
'. ;..
Tx: Supportive care for acute hepatic failure (fluids)
l<.
'c::::!.~
Feline
idiopathic
hepatic
lipidosis,
**1
0;
:t
-+
.FIP
. Neoplasia
NO-C-S-i-n-d-0-9~-r.;....-....:.:~%-C-..J'~
Liver rupture/
trauma
-+
DDx:
Cholanglohepatitis
~~-z,...
51 \}
Echogenicity
Liver biopsy: definitive
- Fine needle aspirate, do clotting
profile 1st
- Floats in formalin
- Oil red 0 stain for excess fat
. Cytology foamy & vacuolated
hepatocytes
o Blunt trauma
CS: Asymptomatic, hemoperitoneum (II laceration, hemontlage)
. HX,Cantesis; Radiology: local loss 01 peritoneal detail (margin 01
7",1C(
<,&
Prevention:
~.)
, ....
~''Jt
~~
Prognosis:
~'
~
I
~x:
~~'
~~~~~~~:~
hverneartrauma),Effusion~aceration)
,
) .'~.~"
~
Sx-S-hb233:
Sx-S645; Sx-WW
~ ---, \
147
*
.
Tx: laceration: aurglcal emergency, may require lobectomy
~____~______________~~95~~
__-___
' ______________
Liver
Condition
Facts/Causes
Chronic
hepatitis
91
**
opathy
.. ~
Pa-T 104
***
- PU/PD
- Ascites
- Weight loss
- Icterus/jaundice
Copper
associated
hepatitis of
Bedlington
terriers,
Westies,
Dobies,
Sky terriers
M8k 339; E-hb 518;
SAP 745, 748; H2B
442; H3B 394; 12M
531; 1M 413; IM-IfoIW
306; C12T 757;
GI525,743,
749;
GIS 597,
743;
Pa-T 90,
Tox-X 187
(~,
-MetaboHtcMtectc.uafngaccumulatfon
of copper In 11V8\"
Bedlington: hereditary (autosomal recesslve Inability 10 excrete copper in bile).
High incidence in braeo', stress may lead
to acute liver failure (e.g.) whelping may
Dring on
West Highland White: advanced before
signs
Dobie: hereditary? immune? shows signs
late in diz, advanced before signs
Skye terriers: chronic, genetic
ProgreSSive accumulation of copper &
chronic liver diz
-necrosis,
> 2000 flg/9
hepatic
injury (focal
hepatic
chronic
hepatitis,
cirrhosis)
- Necrosis of hepatocytes
_ Fibrosis usually
~ 1Il_
I -?
Immuno ogle.
,~
CS: Nonspecific, Icterus/Jaundice
OX: Lab, Difficult
Tx: SterOid, + Imuran, Supportive .Px: Variable
Nonspecific
- Depression
- Weakness
- Anorexia
- Vomiting
- Hepatic encephal-
535;IM-WW305;
E-hb520;
- Coagulopathy
<I-~
fS \.
a,.
GI
Treatment
Diagnosis
Presentation/CS
II
~ (DDX:
See above
I
00
00
- Supportive therapy
- Re-evaluate (lab, bile acids) for hepatic failure
- Try to discontinue all in 4-6 months, relapse may
occur
rn--1i%~==lF=="'"
UJ-J..1F
$; :
\)7~
0co~
;,.
~_ ~
,II!
IIl I
,I
Cuprimim
*
Metabolic defect = Copper in liver
CS: Asymptomatic to liver failure
Ox: Hx;tALT, ALP, BA; Biopsy
Tx: Supportive, Chelate
Px:
Good; Doby: Poor
dissecting
hepatitiS
SAP 748
cell hepatitis
E-hb 516; SAP 748
DDx:
Von Willebrand's diz
(bleeding in Dobies)
Prognosis:
- Bedlington: Good if mild to moderate failure -usually responds, can
live out life, Poor if fulminating hepatic failure
Doberman: Poor, Tx usually unsuccessful, most die in weeks to
months. More favorable If Ox In early stages
GI
Cirrhosis &
fibrosis
E-hb 511; SAP 749; H2B453;
H3B 1129; 12M 163; IM-WW
308:GI533;GI-S718: E 1317:
Sx4B 288
Hepatic encephalopathy
Preceded by nonspecific liver
diz CS: anorexia, lethargy,
sion
perpetuating
**
Jaundice
Ascites
Lab:
- t Serum liver enzymes usually,
but less than in active hepatitis
-+Serum bilirubin, ammonia & bile
acids
- Hypoalbuminemia
- Low BUN
a;;:Z:=:I:iIIJ
- Idiopathic #1
Infection (ICH)
- Hepatotoxins (copper, ant!convuls.~nts)
- Immunologic injury (chromc hepatltlS~
.. .
- Chronic cholestasis (chronic cholanglohepatltls In cats)
- Hyperglobulinemia sometimes
- Hemostatic abnormalities may reflect ole
Radiology:
- Microhepatica in dogs
- Hepatomegaly in cats wI biliary
cirrhosis
Ultrasound: t echogenicity (fibrosis) & ascites
- Mixed hyper & hypoechoic pattern (nodular hyperplasia)
[Jt~~~
spironolactone (Alkdactone)
~
transfusion
- Tx gastric ulcers: Cimetidine,
Sucra~ate (Carafate)
- Slow progression if specific cause
diagnosed
- Adjust anticonvulsants drugs
- Copper-positive biopsies
Chelatingagents( D-penicillamine)
- Chronic hepatitis - immunosuppressive drugs
- Ursodiol: choleretic & immunomodulatlng
oColchicine (antifibrotlc drug) benefits not proven
in dogs
o D-penicillamine; also antifibrotlc
~~~;~,o::"~~'ri":;';'"";"
",-,II. \
''''~"'~m,y 00'
-~~
hI
anomalies,
Portosystemic
shunts, PSS
pro~~;siS:
Guarded;
(HE)
iJ
~ill
belo~
**
WI" i'" 11
dMY7l
Ilt-
Hepatic
arteriovenous
(A V) fistula
~~
:a
=---
'
Prognosis: Guarded
Bile
Cholangiohepatitis
& cholangitis,
Feline suppurative
cholangiohepatitis
~ i""ah.p"i,~"",SI.m
**
Treatment
Diagnosis
Suspect in any cat wI fever & Systemic ABs (culMe & sensitlvity)
Presentation/CS
Facts/Causes
Condition
GI
Lab:
& Radiography:
- Hepatomegaly
bleeding uncommon
- Cholelithiasis
DDx:
Hepatic FIP
HepatiC lipidosis
GI, Fever
Neoplasia
Cholecystitis
M8k 344; E-hb 538; SAP 740,765; lM-WW
303,312; G1558; GI-S865; Sx-5-hb 234;
Sx-S 647; Sx3B 299; Sx- 196;
**
~\j
of gallbladder
'Hx,CS
Lethargy
Lab:
Cause: unclear
- Enteric aerobic 9ram (-) bacteria
Jaundice
Gall bladder
r
Cholecystectomy
Extrahepatic
**
biliary obstructive
diz, EBOD
~~~
i~~~~~~;;9~~I~~521~'
n
IP.
Asymptomatic usually
Occasionally: anorexia, wei9htloss,
diarrhea, vomitln9, jaundice,
hepatomegaly, abdominal distention,
& death
Icterus
Vomiting
Anorexia
o Welghtlosslemacialion
Abdominal pain
o Depression
Dehydration
Excessive bleeding (' Vit K
absorption)
Diarrhea & steatorrhea (tan-
/-;:::-- ,
~
Cholelithiasis, Calculi,
Gallstones
Often asymptomatic
,vag'.
- Cranial abdominal pain
In gall bladder
Mib assoc wI diabetes mellitus
May rupture & cause bile peritonitis
'"
Emphysematous
cholecystitis
- PynOOa
- Anorexia
-Vomiting
11
~~';S~B300 ~~c
~v
"
?i"."
??
K1 prior to surgery
4-6 weeks
Fluids & electrolytes
- ASs
ids, cholesterol
_ Inllammatory PMNs wI left shift
c:-
///t
S=
Prognosis:
& culture
Hx (location)
operculatad egg In feces (formalin-ether
technique)
Laparotomy or necropsy often no visible
abnormalities
_ Smalladulll1ukes 12 mm)
oHx,CS
Dron~
I,
&lor lipase
wI pancreallc diz
c
UA (urinary analysis)
- Absence of urobilinogen
- Bilirubinuria
Radiology - frequently nondlagnostlc
- Enlarged gall btadcler
- Radiopaque calculi readily seen
Ultrasound: normally ducts are not seen,
dilation allows then to be appreciated
Exploratory laparotomy - definitive
Radiology: radiopaque calculi
Ultrasound for radiopaque & radiolucent
differentiate from liver calcification
Nothing if asymptomatic
Sx removal (cholecystotomy)
.
k
Cause:
Acute peritonitis
- Blunt or sharp traums (hit by car)
- Abdominal pain 1st 48 hrs
- Penetrating wound, gunshot
- Anorexia, depreSSion, !ever
- Pathologic rupture ~ to inflammation,
- Abdominal distention
neoplasia or cl101eliti"ls
-Icterus
- Percutaneous liver biopsy
- Shock
(
""1
Blunt trauma to biliary duct develop
- Abdominal surgm~
much slower sgns & may be over
)
,.
shadowed by other traumat<c Injunes
~D
Prognosis:
:"
,;'
- .:"
:~~~~~
(pred?ls010n~): empirically
~~-dtF
............-:
General support
_ Fluids, nutrition, vitamin supplementation
Lab:
oo~~.'~)
wi
Steroids
'I
I ft
- Hyperbilirubinemia
Exploratory
./ j
Anorexia
Abd~~inal pa~w
Vomiting
' :..
uncommon
Liver fluke
infection
& cat:
Diarrhea
crG~_
Dogs
rFiiil.
////
Hx (trauma)
PE - Achoic leces
AbdominocenteSis: bile-stained modified
transudate. Bile higher in abdomen fluid
than in serum
Lab:
()jJ i
J)
_'
s=> --;
--------------~----~~'~--~~----~~j---~--------------~~-------------
GI
nts
Cirrhosis &
fibrosis
Ehb511; SAP 749; H2B4S3;
H38 1129; 12M 163; IM-WW
308:GI533; GI-S 718: E 1317;
Sx4B 288
elrreversibleendstageofphronic
hepatitis
- Hepatocyte death & repair by
fibrosis & nodular regeneration
- Processes compromise adjacent
perpetuating
**
,CS
Jaundice
Ascites
Hepatic encephalopathy
Lab:
-t
sion
acids
tto
- Hypoalbuminemia {1
!
- Low BUN
- Hyperglobolinemla sometimes
_ Hemostatic abnormalities may reflect DIG
Infection (ICH)
Radiology:
- Microhepatica in dogs
- Hepatomegaly in cats wI biliary
cirrhosis
Ultrasound:
echogenicity (fibro-
&
hypoechoic pat-
ID
0=
~:~,","~I~
-~,
hI
---
anomalies,
Portosystemic
shunts, PSS
systemic
liver parenchyma
- Encephalopathy from inadequate
clearance of toxins (ammonia, mercaptans,
short-chain FA, gamma aminobutyric acid)
- Urate urolithiasis: a complication
MBk332,130;E-hb521:SAP
751,763; H2S437: H3S3B3:
12M 523, 539; 1M 407,420; IM- Uncommon: dogs, cats
WW 309: GI-S 650, 802: GI Types: single intrahepatic or ex541; E 1340: Sx-S-hb 237;
trahepatic or multiple extrahepatic
Sx-s 660; Sx4B 292: Sx3B
295: Sx-WW 151: Sx-G 202: Congenital usually: < 1 yr old
CI2T 743 (f): PA-T 87; Neo
- Large breeds: single intrahepatic (doby,
195
Irish wolfhound, Golden, Lab, Samoyed)
- Small breeds & cats extrahepatic (Yorkshire terrier, Dachshund, miniature poodles)
- Domestic shorthaired> purebred cats
- Patent ductus venosus:
(intrahepatic) large breeds, connects portal
to caudal vena cava through tlver
Single extrahepatic connect portal or left
gastric or splenic v, with the caudal vena
cava cranial to phrenlcoabdominal veins or
azygos vein (small breeds)
Acquired due to dizs (cirrhosis &
chronic hepatitis causing portal hypertension)
- Usually multiple extrahepatic
**
i) ~-
Prognosis: Guarded;
grave for long term
'iJ
-+
urinary tract
Pu/PD
I":'
- Positive-contrast portography
procedure of choice
. Isolate of loop of jejunum through a ventral
midline incision, Inject contrast agent as a
bolus into a jejunal vein
'I~eedlle biopsy often unremarkable, hepatocyte atrophy wI small or absent ponal veins,
increased hepatic iron deposits
Ultrasound
- Small tlver, normal or .. intrahepatic veins
- Intrahepatic shunt from
porta to caudal vef''i cava
Ilh
Tx:
Hepatic
arteriovenous
(A V) fistula
sys-
1f=:'-o
-------------
=-:c;
"f,;;"ill
i$J;f) {'
Cholangiohepatitis
**
Suspect in any cat wi fever & Systemic ABs (culrure & sensitMty)
Aerobic gram +: ampicillin, amoxlCillin, cephajaundice &Jor GI signs
losporins, chloramphenicol & aminoglycosides
Liver biopsy - definitive
_Anaerobic: metronidazole, clindamycin, chlor
!fit
& cholangitis,
. -<:?
Cat, Bile duct
Jaundice, GI, Fever
in dogs
Dehydration
Encephalopathy, ascites
-Lab:
&
bleeding uncommon
- Cholelithiasis
DDx:
Hepatic
Hepatic lipidosis
FI P
'-' Neoplasia
'"
Cholecystitis
M8k344; E-hb 538; SAP740, 765; IM-WW
303,312; G1558; GI-S 865; Sx-S-hb234;
sx-s 647: Sx3B 299; Sx 196;
**
Vomiting
Jaundice
.., ~
**
biliary obstructive
diz, EBOD
General support
FluidS, nutrition, vitamin supplementation
Control complications (ascites,
hepatic encephalopathy, bleeding)
Prognosis:
??
- '.. '
- Fluids
& electrolytes
c:-
///t
5,==
Prognosis:
& culture
Hx (locaHon)
o operculated egg in feces (formalin-ether
technique)
o Laparotomy or necropsy often no visible
abnormalities
_ Small adult flukes 12 mm)
-Vomiting
Anorexia
o Weight loss/emaciation
Abdominal pain
Depression
Dehydration
Excessive bleeding (+ Vlt K
absorption)
o DiarrtJea & steatorrhea (tancolored from I
01 bile pigments)
Lab:
- Marked t ALP. chotesterol, bile acids
& bilirubin
- Moderately t ALT
- t serum bilirubin (1 conjugated)
- Prolonged PT, APTT & active clotting
time (ACT)
- t Amylase &lor lipase
,
wI pancreatic diz
c
UA (urinary analysis)
- Absence of urobilinogen
- Bilirubinuria
Radiology - frequently nondiagnostic
- Enlarged gall bladder
- Radiopaque calculi readily seen
Ultrasound: normally ducts are not seen
dilation allows then to be appreciated '
laparotomy - definitive
o Often asymptomatic
Jaundice, vomiting, anorexia,
weight loss & dehydration
o Achoic feces indicates
complete tHle duct obstruction
Radiology:
Ultrasound lor
difterentlate
Nothing if asymptomatic
Sx removal (cholecystotomy)
Radiology:
Gallstones
g."aml",
wi ""my",,,
Steroids (prednisolone): empirically
Asymptomatic usually
_Occasionally: anorexia, weight loss.
diarrhea, vomiting. Jaundice,
hepatomegaly, abdominal distention,
& death
J+
'lao '/
Hx,CS
~
Lab:
_ Hyperbilirubinemia
Exploratory
Gall bladder
\
Cholecystectomy
Abd~minal pa~Q
.....
Diarrhea
CP'G~.
Liver fluke
infection
Treatment
Diagnosis
Presentation/CS
Facts/Causes
Condition
P,.Tl05(I)
GI
l100r
'---'
Bile
Dron~
Ii,
i ,
Chotecystoenter08tomy:
or re-establishflow
- Cholecystoduoclenostomy: anastomoses gall
bladder to duodenum
- Cholecysto/ejunostomy: anastomose gall bladder to jejunum
108
Emphysematous
cholecystitis
SAP 759; Inf-G 151
tract rupture
~6';;S'4; v~c
~~
In gall bladder
Mib assoc wI diabetes mellitus
o May rupture & cause bile peritonitis
Cause:
- Blunt or sharp trauma
by car)
to Inflammation,
Acu1e peritonitis
- AbdOminal pain 1 st 48 hrs
- Anorexia, depression, lever
- Abdominal distention
-Icterus
- Shock
Blunt trauma to biliary duct develop
much slower signs & may be over
shadowed by other traumatic In/uri'"
//(t
Hx (trauma)
o PE - Acholc feces
o Abdominocentesis: bile-stained modified
transudate. Bile higher in abdomen fluid
than in serum
Lab:
!
)
- t Total serum bilirubin
-t Uver enzymes (ALP, ALT)
RadlologylUltrasound: Peritoneal effusion
.Exploratory laparotomy to confirm, culture
abdominal fluid
(}jl
GI
Pancreatitis
Hx, es, severely
Emergency; do not wait for lab work
PE: Abdominal pain
NPO (nothing per os) 3-4 days to prevent
Lab:(i:
ff]i)
pancreatic stimulation
_ Hyperlipemia
Fluid: critical (enough to cause mild diuresis
_t Serum amylase & lipase so pancreatic perfuSion good)
Pancreatitis
***
amlkaCln II no renallallure
iting
right (pyloric antrum displaced to left, _ IV feeding (not orally, so pancreas not stimulated) In acute
proXimal duodenum displaced right)
cases, NPO until 3.5 days after vomiting stops
- Sequela: Chronic pan- - Static gas pattern 01 proximal duode- _ Nursing care, monitor for renal failure
num & the transverse colon
creatitis{see EPI) dia- .CalCificatlonwllnpancreas(uncommon) - Antiemetics: phenothiazines (Chlopromazine)
betes mellitus
Contrast rads: Barlum
Heparin (mlnlmizethrombosis&intravascularCOagulation)(DIC)
:~~~~!~~~ ~~~=~:~~
left
Sx indications:
formation
Intestinal obstruction (Irom adheslons & strictures)
t~~e
PathophYSiology of pancreatitis:
of
Demerol
i
Prognosis:
_ Guarded depending on severity, poor if septic
shock, DIG, acute renal failure or bowl infarction.
of
J:ir~....
Complications
pancreatitis Hypocalcemia
.
,..,
.) ~
Acute renal failure
Cardiac arrhythmias
Act~vatJon of tryPSin. activates pancreatic proenzymes & vasoactive amines
~~\. DIG
Pulmonary insufficiency
.....
-?
Peritonitis
Activated ~anCrea!iC e~zymes & vasoactive amines
Chronic sequelae
- Pancre~tJc autocltgestlon (w.I resulting release 01 more enzymes, viCiOUS cycle)
~5"
Septicemia
Fibrosis
_Liver diz
- Systemic effect: hypovolemia (due to capillary vasodilation, venous pooling &Iossotfluid into intravascularspacell I
- Exocrine pancreatiC
- Damag.e to abdominal organs (liver, intestine, peritoneum, etc.) & other organs (heart~~
~
ExtrahepatiC bile duct
insufficiency (EPI)
lung~, kidney, et~.) due 10 leakage of enzymes into abdominal cavity & into blood
~.. \ obstruction
Diabetes mellitus
ChronIcally: fibroSIS of pancreas & no enzymes to release (Diabetes metl~us)
I j--", '
Cat: aSSOciated wI FIP or toxoplasmosis
"A - - , - - - - - - - - - - - - - - - - - '
.::::J
(b
Exocrine
pancreatic
loss + ap:":p:-:e::t;;ite-:-l-'-H-i-n-"-Ud-d-ie-t-,-T-ID-fe-e-d-i-ng-S-,-h-'9-h,-,-di9-"-Ub-'.-,-'ow-"-.-,,
acinar cells
organ destroyed
low fat
- .. Digestive enzymes
- Weight loss, mild to moder- - Routine lab test not helpful
Enzyme replacement: dried pancreatic enzymes
insufficiency, _ Results in failure of absorp- ate
- Serum amylase & lipase are
(Viokase, Pancrezyme) mix 12 tsp per meal lor me,
tion
-Polyphagia (t appetite)
not t
titrate to minimum dose when diarrhea stops & anima! gaining
EPI
Cause:
- Coprophagia & pica
-Sudan & iodine stained fecal
weight (1 tsp In 2 meals per day usually enough)
Ph'
t
Medium chain triglycerldes (MeT Oil)
M8k313; E-hb534; H2B
_
Pancreatic
acinar
atrophy
(PAA):
oor
air
coa
smearforsteatorrhea
(excess
**1
DDx:
103
Other cause of
chronic diarrhea
Pancreatitis
Facts/Causes
Condition
~'&
_....,-
~5
I'
H3B 413
Gastnnoma,
.,
Treatment
Diagnosis
Presentation/CS
Pancreatic
exocrine
neoplasia
GI
Difficult, DDx from liver or GI ab- Nothing very effective
struction
Palpate mass in rt. cranial quadrant
t ALT & SAP indicating liver diz
t plasma amylase & lipase & SSP
liver function test may help point at
pancreas & not liver
Radiology:
- Pancreatectomy
but never curative)
_ Cholecystojejunostomy or gastrojejunostomy if
~U
-'
lJ ()
00
0
Prognosis: Grave
ill
--"'-,-
M8k 398; E-hb 603; H2B 380; 412; SAP 661, 662: 1M 586, 297, 331: tM-WW 410; E 1597; CllT 370; E&R-F 442, Cat 1464; Sx-WoN 189; Sx-G 206
Insulinoma, Islet cell neoplasia; Beta cell neoplasia, Pancreatic neoplasia, Beta cell carcinoma, Islet cell adenocarcinoma--,",~_'-,
**
M8k 397; H2B 548; E-hb 572; E 1501; SAP 257; 1M 562; Cat 1464; E&R-F 422; E&R-M 198: Phys-B 872; Lab-S 332; Pa-T 279; OX 553; Sx-S-hb 515. 683, 756; Sx-S 1536: SX-WW 188
~
.
Karo syrup.
____ ~
Carcinomatosis,
Mesothelioma
H3S 199, 430, 432: 12M
471: 1M 362: E-hb 39; E
"*
"
See Endo pg 669; Old dogs, Malignant beta cell tumor, Hypoglycemia; metastasizes to liver
CS: Episodic, Seizures, CNS ( proprioceptive deficits, atrophy)
Dx: Whipple's triad (1. spontaneous hypoglycemia, 2. CNS signs, 3. Glucose resolves), Hi insulin wI low glucose
Tx: Emergency: Karo syrup, Medical or Sx (remove 1/2 of pancreas); Phenobarbital for seizures. Px: Poor
). Rare
olllfldespread dissemination of cancer to perttoneal surfaces (omentum, mesenteries, parietal peritoneum)
02 causes > 1
o Assodated wI metastasis of:
- Hemangiosarcoma
- Pancreatic carcinoma
- Ovarian carcinoma
j) ~'nteStinal carcinoma
DOx:
Bowel perforation
o Peritonitis
o FIP (not usually nodular)
locs
Radiographs
-Ground glass" appearance: generalized loss
of peritoneal detail (fluid), indistinct serosal
detail
Blotch appearance in cranial & mid abdominal, small metastatic nodules (5-10 mm)
- Pneumoperitoneogram: remove fluid & inject
air to see masses
o Abdominocentesis: nonseptic exudate or modified transudate
- HI specific gravity protein, RBCs
- CytOlogy: neoplastic cells usually not found
('Signet ringO cells - glandular neoplastic cells,
anaplastic epithelia cells)
o Exploratory laparotomy uaually needed to
diagnose
/.< s-::;:>
<
***
~
.
((
..
."7
.~
<'
~-~~;;p
1$)
1."\
=()I
Id
- Umbilical hernia
- Femoral or inguinal hernia
- Peritoneal-pericardial hernia
- Scrotal hernia
Acquired: trauma
- Diaphragmatic
- Ventral or lateral abd. hernias
- Mesenteric hernia
- Perineal
study
abdominal cavity
Reducible or irreducible
Strangulation: pain, vomit- Pneumoperitoneography
Positive contrast peritoneography
ing & depression
stra. ngulated: piece of gut, may cause
obstruction & may cut off blood supply to
Urethrocystography
hernTal contents
Intravenous urography
Parts of a hernia: ring, sac &
contents
DDx:
Hematoma
Prognosis:
Good if uncomplicated
Guarded to poor if strangulated
GI
Peritonitis - FIP
Facts/Causes
Condition
***
....c......='-".. . . . . . -'-'--------i
Causes - Peritonitis:
GI perforation or rupture '1 cause
Rupture: stomach, bowel, urinary
r bladder, uterus, gall bladd er
Presentation/CS
Abdominal pain (stiff walk,
tachycardia, tactlypnea)
_Praying mantis posture
Tucked up appearance
Fever
Anorexia
" Gut stasis, paralytic ileus
Vomiting
Abdominal distention
No feces
Shock (loss of fluid, endotoxemia)
Icterus (if bile peritonitis)
CS of 10 illness if present
" (e.g., intussuSC,eption)l1:'l
) \
Sequelae.
, ;.. ~
.
- Toxemia
Diagnosis ~
Hx & CS.
., ?
- A~mmal pain
~
- StasIs of gut
~
Palpation for pain, adhesions
AbdominocentesiS!
Cfagnostlc peritoneal lavage
- PMNs (> 5OO/~1)
,
- Bacteria in macrophages: septic
- Absence of bacteria: sterile
- Cytology & cutture
- PMNs toxic PMNs/neutrophils
- Left shift: more significant infection
- Degenerative left shift (more bands then
segmented PMNs) Indicates overwhelming, life
threatening innammation
Serum chemistry: many altered depending on
6");
i'
cause
Radiology:
- "Ground glass" appearance, loss of
.
v
organ detail, local or general
- Peritoneal exudate
- Gas- & fluid-filled loops of bowel
(loss of. flUid~)
/O.v1
- Serosal detail not seen ~
AdheSions 'I'"/'
~
- Free gas: rupture 01 viscus
Small amounts 01 gas undetectable
71.., ~ J J
Horizontal beam: gas between
liver & diaphragm
Hepatitis
~"\
. Serosat surfaces more distinct
Ruptured (abd/liver/prostate) abscess
~
- Contrast studies: urethrography,
Infection (E. coli, Staph., Strep., Nocardiosis, Mycobacterium spp.)
If"
2::\ \ cystog!"Phy &lor IV pyelography if
"I
' (S) d h'
' I
:::.-\. .
uropentoneum suspected
atrogemc X, e ISCenCe, surglca sponges
........'":\
. AvOid barium illeakage suspected
Ultrasound: detect fluid
Inflammation, Local or generalized
- Valuable for pancreatitis
- Soft tissue masses or abscesses
CS: Pain, vomiting, Distention, Shock
Exploratory laparotomy
Ox: Abdominocentesis, Rads, US, Sx
C
(1/1
~
lx: Support & correct cause, ABs, 'V fluids & feed, Lavage, NPO
Gastroduodenal ulcers
'-.Pancreatitis
Strangulation
, Incarcerated hernia
Volvulus & rupture
\ Neoplastic ruptures
FIP (feline infectious peritonitis) 10
~~~~emia
.... t.
Treatment
Support & correct cause
Medical or surgical?
Medical:
- Broad spectrum ABs immediately,
pending culture & sensitivity
- IV electrolytes & fluids (lactated
Ringer's sol., supplemented wI potassium,
plasma or whole bloOd (for cardiac output)
- Lavage & drainage (very important)
Treat cause
- Repair ruptured viscus
- Peritoneal lavage (streptomycin)
- Postop: continue IV antibiotics, frequent peritoneal lavage
Pain (Meperidine [Demerol])
Withhold food until improves, then slowly
reintroduce
IV feeding, including vitamins
a'
~
11
Demerol
AS
"'=
,~~::::;::::;:-:;;:-=::;;;--~;-;;;;;;;:::=~~---,----Feline
See Systemic d;zs pg 688
"nfect'"ouS Progressive & fatal systemic immune-mediated diz
'
peritonitis,
" Cats & wild cats
FIP
Coronavirus
Initially nonspecific
(fever,
mia])
Hx, CS
Lab: unspecific - strong circumstantial
evidence
()
No Cure
-------------------------------------------------
108
Cervical cysts 137
Chlamydia pSittaci 39
Chylothorax 156
Cleft palate 120
Clinical signs 111
Collapsed trachea 135
Congenital anomalies 129
Conjunctivitis 139
COPD 141
Coronavirus 144
Cough 111
kennel cough 138
suppressants 114
Coupage 142
Cysticlbullous disease 153
Cysts of mediastinum 164
Dental disease rhinitis 126
Diagnosis 112
Diaphragmatic hemia 159
Distemper 144, 689
Dyspnea 111
Edema of larynx 129
Elongated soft palate 130
Embolectomy 160
Emphysema 142
Eosinophilic pneumonitis 150
Everted laryngeal saccule 130
Expectorants 114
Infectious
peritonitis 144
tracheobronchitis 138
Lung
contusion 158
diseases 118
flukes 149
lobe torsion 157
sounds 112
worms 149
Lymphomatoid granulomatosis 150
Lymphoplasmacytic rhinitis 127
Lymphosarcoma 165, 315, 692
~==============================================~
Respiratory System
expiratory diseases 117
inspiratory 116
Oronasal fistula 120
Parasitic
lung disease 149
rhinitis 124
tracheitis 137
PCP 163
Pectus excavatum 159
Penta 163
Physical exam 112
Pleural effusions 113, 154
Pneumomediastinum 163
Pneumonia
allergic 150
bacterial 146
inhalation 148
parasitic 149
toxoplasma 149
uremic 344
verminous 149
Pneumonitis 150
Pneumothorax 161
Polyps nasopharyngeal 128
Pulmonary
edema 152
infiltrates wi eosinophilia 150
thromboembolism 160
Pyothorax 157
Radiology 113
Rales 112
Respiratory distress syndrome
111,152
Rhinitis 122
Rhinotomy 124
Rib fractures 159
Shock lungs 152
Sinusitis 122
Smog 163, 725
Smoke 163, 725
Soft palate 130
Solitary lung lesions 153
Space occupying lesions 164
Spasm of larynx 129
Staphylectomy 130
Stenosis
trachea 134
nares 120, 130
109
History/signalment:
Species - predispositions do oc~cr:
- Canine: collapsed trachea
General
respiratory
dizs:
History
Yl-::.
I":"A """,,--
.
.
Breed predilections
Afghan:
-?~
\\
( \~ Boston terriers
~. Bouvier des Flanders
~./. Boxer
Laryngeal collapse
Laryngeal paralysis, Anomalies of larynx
Lung tumor
--1>
Brachiocephalic breeds
~~
~. ) '1
- 8u~1 terrier
~-
~~
Ci~~~i1.~l
-?-it
~~
I
. - Rottweilers
_ Toy poodle
- West Highland White t.
Ciliary dyskinesia
Tracheal collapse; Chronic bronchitis
Pulmonary alveolitis
~
I Yorkshire terrier
General respiratory
dizs,
.~.,'"
."
~jlYl~l-
~onO$")t-3 ~
'r'~,\
'\ .\ .
.Ii.~
.
- Infection
- Pulmonary edema
- Change In vocalization
Viral (distemper. pal'Slnfluenza (dogs]
- Left atrial enlargement causing bronchial compreSSIon
'~
herpes & callCIIIII\IS (cat])
- Mediastinal diz (cauSing airway compreSSlon)~
. Bacterial (Bordatalla bronchlsapt/ca)
- Lymphosarcoma (esp. cats)
~) ~
. Parasitic (Fllaroldes. Capiliana sp)
Thymomas
-~
..;.:::.
- Tracheobronchial lymphadenopathy
~S J
Sne~ing.
Presentation!
Clinical Signs
Tracheal collapse
~/ ~J'
d.I1J
(.4
I.::
t~ -
Product~ve coug~
1i)~ .
r~'
~~
I
Fast & Shallow
No obstruction
(exercise. low 02, lever. etc.)
I
Miscellaneous 2
breathing pattern
Miscellaneous 1
breathing pattern
+Inspiratory effort
+Expiratory effort
I
Obstruction
upper airway
Obstruction
lower airway
DIAGNOSIS respiratory
Physical exam (PE):
~~'17
Respiratory diagnostics:
Radiology of the respiratory tract:
- Nasal cavity & sinuses: done under general anesthesia
Views: lateral, dorsoventral occlusal, ventrodorsal open mouth
& anterior-posterior frontal sinus
- Pharynx, larynx, trachea & hyoid apparatus
Cervical soft tissue radiographs
Lateral & VD projections
- Thoracic radiographs (lateral & DV)
___________
- Contrast radiography
~
Bronchogram
r::!-.. c)
Pulmonary arteriogram ==rU'~
Fluoroscopy:
w"",,"--
'1:r"""'='~""~
Vascular pattern:
- Abnonnal pulmonary vasculature
- Enlarged or smaller; or
- Loss of symmetry between veins & arteries
Pleural effusions:
- Scalloped or leafing of lung borders
- Fluid lines in lung fissures
- Loss of detail
fA
""""",.om,
Alveolar pattern
Soft
Hyperinflation
Emphysema
Pleural effusion
Pneumothorax
Diaphragmatic hernia
Maximum Intensity
Significance
Peripheral lungs
Trachea, thoracic inlet
Normal
Normal
Abnormal Sounds
Adventitious:
Usually inspiration
Crackles
Usually expiration
Wheezes
Inspiration
Stridor
Friction rub
Inspiration or expir.
Occluded airways
Usually pulmonary
Pulmonary &lor trachea Narrowed airways
Larynx
Laryngeal stenosis
Chest wall
Inflamed pleura
Sounds
Phase
Respiratory endoscopy:
Rhinoscopy, Pharyngoscopy, laryngoscopy, Tracheoscopy, Bronchoscopy
Description
Always accompany air movement (nonnal)
Added sounds, superimposed on breath sounds
Nonmusical, interrupted
Musical, continuous
fi:J)5()
. Serology:
i~
?'~6
~ ~ . Fungal: histoplasmosis, blastomyCOSiS, cryptococcosis,
"
Transtracheal wash/aspiration
(TIW)
coccidioidomycosis, aspergillosis
Occult heartwonTI
. Vlra!: F.VR, FCV, FeLV, FIV, FIP, CD, CA2V, PI, etc.
Ehrllchla
-= . _
04'
111
'
, .
.. _....
. 0
Mean
Range
pH
pO, (mm Hg)
pCO, (mm Hg)
[HCO;] (mEq/L)
0, content (m1/1oo ml)
02 saturation (%)
7.40
100
7.37-7.42
S0-110
40
35-45
24
22-26
18-22
20
95
93-{)S
.
may b~ curatl~e, palh~tlve, or an
_ Terbutaline (Brethine): beta 2
1. Supportive Tx: maintain & promote homeostasis adjunct to medical therapy tn respiratory dlzs
agonist, PO, same side effects as Iheophyillne
2. Symptomatic Tx: relieve clinical signs
-Isoproterenol (Isupr~): beta 3 agonist
Theo-Our
3. Specific Tx: directed at eliminating or
- Combo theophylline + terbutaline{,~:::;t;:;~
Medical therapy - objectives:
for those that can1 tolerate either alone
controfJing a definitive cause
1. Reduce intensity/severity of coughing
- Weight reduction: obese patients
(especially nonproductive coughS)
Supportive Txlcare:
2. Promote removal of airway secretions
Controlling Inflammatory/allergic responses:
integral & essential
3 . Airway resistance
- Steroids (corticosteroids): most popular drugs
- Good nursing care:
::::...<::===-....::r::.._~ 4. Control inflammatory or allergic responses
Prednisone or prednisolone; strive to find the
5. Maintain or improve oxygenation
can determine ultimate response to therapy
lowest beneficial dose; also has cough reduction effect
- Hydration &. electrolytes:
6. Treat infection
- Non,steroidal antllnflammatory drugs (NSAIOs): ~
1. Considerable fluid & electrolytes (Na', K', ct", etc.) may
.. Aspirin not commonly used
....
accompany respiratory dlz with compromised ventilation (hyperp- Cough suppressants-antitussive therapy:
.. Flunlxln meglumlne (Banamlne)
I
nea, tachypnea & open mouth breathing)
- Antihistamines: 01 limited value
Steroid
2. Intravenous therapy wI Isotonic electrolyte solutions Is often - Rule of thumb: suppress a cough only if nonproduc.. Diphenhydramine (Benadrylti)
\
tive. Contraindicated if lobar pneumonia
warranted
iv,
- Hycodan (hydrocodone): narcotic antilu,,,ive, Maintainlimprove oxygenation:
3. Fluid reQuirements in milliliters/day are essentially eQual to or slightly
higher than the energy requirements in calories/day for the patient.
central acting; titrate to lowest effective dose
- Facemask: 100% 02 short-term therapy only!
- Nutrition:
Use with caution in cats
- Oxygen cage: achieve 40-60% 02 levels, adequate
1. Energy & nutrient requirements t wi severe illness - Butorphanol (Tortlutrol): controlled drug (tv),
- Nasal catheters
fjf
less potent for reducing cough
-> 1.5 X's resting energy requirement-1.5 up t02 for dogs, & 1.25
- Intratracheal administration
111
up to 1.5 for cats, times the Resting Energy Requirement (RER) in - Dextromethorphan (Benylin)
(12-16 g needle)
Kcal = 30 X Body Weighl (kg) + 70
Expectorants: removing airway secretions:
- Tracheotomy: can be lifesaving
2. Adequate nutrition can seldom be maintained by - Maintain patient's normal hydration
oral means when severe respiratory diz is present _ Geocolatd (guaifenesinlglyceryl gulacolate):
Oral therapy, used in combination with antiltlsslves
3. Nutritional support warranted when severe illness
Promotes serous secretions of airway, which liquefies contents
& anorexia are present> 2-4days, especially in very _Water nebullzertherapy: effective expectorant 11 droplets proper sizes
(0.5-5 microns diameter)
young or debilitated animals, geriatriCS & cats
Ultrasonic nebulizers
(prone to hepatic lipidosis syndrome)
_
Acetylcystelne
(Mucomysl): a mucolytic agent
Parenteral feeding: central vein must be used & Is expensive
- Enteral feeding: nasogastric tube, pharyngostomy
Respiratory treatment:
:~w
==---'"',----
Bacterial infections:
- Antibiotics (ABs): bactericidal drugs
whenever possible & base therapy
on culture & sensitivity (C&S) when
.available
Full therapeutic dosages & avoid prolonged
therapy 'Nitti broad-spectrum ASs. unless
clinical dlz warrants it (resistant organisms)
. ReCIJlture if no quick response (72 hours)
- Empirical choice wlo Culture & Sensitivity
~~il3~~
II
~I
B s..
Parasite infections
- Fenbendazole (Panacur); effective lor most lung
nematodes, but may reSUlt In a rapid parasite kill & intense (Iatal)
InlJammatory reaction
- praziquantel: fluke Infections
Common parasites in dOQs and cats: Filaroldes sp, Cspillaria
aerophil/a, Paragonimus kellicotti, Aelurostronglylus abstrusus
(cat only)
- Tx recommendations: change constantly as better anthelmlntlcs
become available; consult aveterinary parasitologist or the current
literature
pang
Organism
Drugs of Choice
Principle pathogens
Staphylococcus
Penicillins, cephalosporins
Streptococcus
Penicillins, cephalosporins
Bordetella
Tetracycline, chloramphenicol
Mycoplasma
Tetracycline
Bacteroides
Clindamycin, metronidazole
Fusobacterium
Penicillin, clindamycin
Less-common pathogens
Klebsiella
Gentamicin
Pseudomonas
Gentamicin
E. coli
Cephalosporins, tetracycline
Pasteurella
Trimethoprimsulfa, amoxicillin
Actinomyces
Penicillins
Nocardia
Trimethoprim sulfa, sulfonamides
Mycotic infections:
- Amphotericin B: fungistatic & fungicidal
Very nephrotoxic
- Ketoconazole (Nizoral): antifungal, PO
- Itraconazole (SporanoX): relatively nontoxic,
expensive $$$
Most effective as a sole agent & has fewer side
effects (anorexia)
Fluconazole (Oillucan): imidazole (antifungal) (cryptococcus)
- Ketoconazole &. fluconazole in conjunction w/or
following Amphotericin B, Itraconazole
- Fluorocytosine: potentially nephrotoxic
- Common organisms, dogs & cats: Blastomyces
dermatitis, Histoplasma capsulatum, CoccidiOIdes
fmmitis, Aspergillus sp., Cryptococcus neoformans
(lal' "
I~
Keloconazo~
""IJ.'-_---'J
161"""
. ,.''.. .". . . . . . . . .'... ,'.'"' . . ,,', ""',11
,..... . ' "
~
IIjj~II1"~"g'~_ft"t:a'
%"H'i!III"."''''''''~'lelVl:
Dizs of upper
airways,
Obstructive!
Inspiratory pattern
Upper airway disorders
Presentation/CS
May incl~d. any of the following:
/~'
Coughing:
I,I~
\
- Usually abrupt & hacking in nature '-It?
Facts/Cause
t. External nares
2. Nasal cavity
3.
4.
5.
6.
Nasopharynx
Laryngopharynx
Larynx
CelVical trachea
Nasal cavity
- Stenotic nares
- Occlusive disorders
Infectious (bacterial, viral, fungal or parasitic)
=--
Hemorrhage
Nasopharyngeal polyps
Neoplasia
Pharynx ... larynx
fh,\
:2~J
-Coo,oo'aldl"roaffi
---..
Laryngeal paralysls
Laryngeal hypoplasia
Subglottic stenosis
{;/
-~
- Edema
-Trauma
- Nasopharyngeal polyps (cat)
.- __
- Foreign bodies
~
- Neoplasia
- Brachiocephalic syndrome
Elongated soft palate
.
.
laryngeal paralysis
"--1......1
Everted laryngeal saccules (stenotic nares)
- Acquired laryngeal paralysis (non-brachycephalic)
,0..
Dizs of lower
airways,
Obstructivel
~.~
~
...
Upper airways
Obstructive breathing pattern
Normal to Fast & Deep
t Inspiratory effort
"2.
'.
- Congenital disorders
Primary ciliary dyskinesia
Tracheal hypoplasia
'''!L
-C"""cal ..
/1)
'\'
) '
I
Lower airways:
- Thoracic trachea
- Bronchi
- Bronchioles
7
).
M~1
Cough:
Honking
- Wheezing (smoker's cough
- Productive
Abnormal secretions:
- Hemoptysis
. Mucopurulent
Obstructive breathing pattern (dyspnea)
- Expiratory dyspnea: intrathoracic lesion
,~-
~:~i~:~~:':P::':""gal"
:
,,,.sllI,)
- Tracheal collapse or compression (thymic or
~" ~
-Trauma
~~
- Osteochondral dysplasia
~.
- Foreign body
- Neoplasia
~
Mediastinal diz - compression
,)
f)
pattern
'
Normal to Fast & Deep breaths
t Expiratory effort
1~-~f7~
SY'IA~21S
{jo' 6)
Serology:
,
- Helpful in some mycotiC disease (CryPtococcoss)
- Seldom diagnostic
Rely more heavHy on culture, cytology & biopsy
'" (
-;
c...,.,r
'1'1r
~~~:~r~i;;::~r;a~hing
._-
'\
Diagnosis
Transtracheal aspirate:
(culture & cytology)
:::'\
,"
Cytology may identify: allergic,
'" w
bacterial, parasitic, inflammatory
)
disease or neoplasia
- Tracheoscopylbronchoscopy (I!exlble fiber optic equipment)
Medium-sized to large dog inspected to the level of
tertiary bronchi
Direct visualization, cuhure, cytology & biopsy
Foreign bodies can often be removed
Bronchography (outline tracheobronchial tree)
- Intraluminal masses, demonstrating bronchiectasis
Fluoroscopy (tracheobronchial dynamics)
to I
breathing:
Dizs of lungs,
mediastinum &
pleural spaces
Vel Mad 130, Feb 1994
~;-,--~I
- Pleural spaces
compliance, thus
restricting ability to
inflate (shallow)
Compensate by t rate
(fast)
- Trauma
- Aspiration pneumonia
~'\
~ _
Pulmonary aspirates:
- Pneumomediastinum
- Mediastinitis
- Neoplasia
Disorders of diaphragm
1 ~
,-~..:i).~
- Congenital defects
- Pulmonary edema
- Pulmonary contusion
- Pulmonary laceration
- Bleeding disorders
Pleuroperitoneal hemia
Thoracotomy: Identity lesions, detennine extent of dlz, resect lesions, place
drainage tubes, tissues for histopathology
Peritoneopericardial hemia
Hiatal hemia
- Acquired diaphragmatic hernia
Disorders of thoracic wall, sternum
- Congenital defects
Rib abnormalities
Pectus excavarum
Flat pup syndrome
- Acquired disorders
Rib or stemum fractures
Flail chest
Tumwald GH, Hoover JP.
- Other disorders
Lungs, Mediastinum & Pleural spaces
Restrictive breathing patterns.
dD~~d
- Foreign bodies
- Pulmonary cavitary lesions
- Neoplasia
- Respiratory distress syndrome
Disorders of pleural cavity
- Pleural effusion
- Pneumothorax
Disorders of mediastinum
- Trauma
. Shock
- Effusion
Miscellaneous
breathing
patterns 1 & 2
-Cough
- "Restrictive" respiratory
distress
- Shallow, rapid breathing
- Hyperpnea: gasping or
"air hunger"
_Orthopnea: positional dyspnea
Cyanosis
+Exercise tolerance
Examination
- Inspection: respiratory abnormalities
- Palpation: few, if any, abnormalities
Auscultation: adventitious sounds of
pulmonary origin usually
Percussion: regional or diffuse
abnormalities (dullness)
~~
-.~'
f 0,0~ ~\\
'..:\:
)
( I
.~
~:~~~roke
-Metabolic acidosis
. Ketoacidosis
. Renal diz
. Ethylene glycol poisoning
. Hean failure
Myelopathies
'f
..
Stenotic
nares
PE Direct inspection
~f~~~:ng or~~
Brachycephalic
CS: Obstruction
Dx:PE
Ix: Surgical Px: Good
Cleft
palate,
Oronasal
fistula,
opening
~~
Surgical
- Alar fold resection
- Nasal wedge resection
Jt J]
//
s= ..,.
. Good
Ineffective nursing
Nasal discharge
Nasal regurgitation
Hx, CS
PE: Direct inspection of hard palate
Hare lip
Defect, Brachycephalic
CS: Ineffective nursing, Nasal discharge
Ox: Direct inspection
Ix: Surgery
Px: Good
Prognosis: Good
"$
"
====~~~==~==~======~~==~~~~~----------Neoplasia
ot nasal cavity & paranasal sinuses 1% of all tumors in dogs & cats "..:,:tF:/
~i\ ~---------
~.~M~a~li~g-n-a-n~t-eLn~d-o-na-s-a~l-n-e-o-p~la-s~i-a------1-.~U=R=T-o~~~t-ru-~~io-n-----------,.~H~X-,C~s~- ~~\0
**
I '
Lymphosarcoma:
Cat
E 782;
E-hb
262; Cat 637,
766,853;
5min 1078;
80% Malignant
CS: URI obstruction
Ox: Rads, Rhinoscopy, Biopsy
Tx: ? Px: Grave
7t.-
-7
Prognosis:
Grave: wI surgery & or chemo~
therapy, recurrence to be expected
w/in 3 months
Poor to guarded wI radiation Tx,
dependin9 on de9ree 01 involvement
/.
--==:;910===~ill
**
#1 Endonasal tumor - cats
ro
..-J
- Sneezing
- Obstruction (upper airway)
- Inspiratory dyspnea
Acute or chronic
M8k 1122Mk 767; H3B
- Open mouth breathing
Often rhinitis & sinusitis occur t09jther
139;H28163,SAP 574,
" Stertorous breathing. snoring
Causes (see box)
rl\_/} I)))
525,541; E-hb 260; E
- Nasal discharge:
557; 12M 235; 1M 169;
IMWW212;5mln1036;
" Serous: foreign body. allergic, viral
Caf9SB, 1095; FN 268;
- MucopurulenVserosanguinous: infecSx4B 346; Sx-WW 65;
tion, prolonged FB, chronic EhrlichioPa-T 124
Sis (dogs), neoplasia
- Hemorrhagic: trauma, chronic infection
- Foodstuff: oronasal fistula
- Swelling & asymmetry of face: fungal,
RhinitiS/Sinusitis - Causes
trauma
Viral
- Rhinosporidium seeberi: rare
- Pain
- Salmon poisoning: rickettsial - Ocular discharge: nasolacrimal inflam" Canine
Lymphoplasmacytic rtlinllis (rare)
mation or obstruction
Parainfluenza
Allergy (hypersensttivity)
- Ulcerations of external nares: nasal as Herpesvirus
- Foreign bodies (grass awns)
pergillosis
Distemper
-Trauma
Accompanying systemic signs
Adenovirus-2
- Hit by car
- Anorexia, especially in cats
" Feline
- Bite wounds
- Fever, lethargy. weakness,
_Feline herpesvirus
- Gunshots
_Calicivirus virus
- Dental diz (Tooth root abscess)
FelV/FIV
- Ornonasal fistula
~
"7"
- 2 Bacterial
- Neoplasia
v "Z..~
"\
- Bordetella
Parasites (rare)
1\ I Chlamydia psiffasi
_Cuterebra spp.
- Unguatala ssrrata (tongue worm)
/ c;;::J
Fungal
- Pneumonyssus (Pneumonyssoides)
<... \ ' ~1-......::,
Aspergillosis: dog
canlnum (nasal mites)
'=' - PeniCilliosis: dog
- Gapillaria aerophilia (usually lower
respiratory tract
J
icat
Rhinitisl
Sinusitis
Infection or inflammation of
nasal cavity/sinuses
****
v-
'"1:C>
iI,
'I \ \
.::.....---;-::/:-//~
c:C/
~~-=<l'1"&::St'
(lJ@)
p~cz~~
- Palpation (symmetry)
(J
.....fi:..-)
I
,-~
'\
- RhinOSCOPY/naSOPharyngosc~py
,
- Serology, especially for fungal
- AGIO, DIE, ELISA
_ Surgery for histopathology ,
J
- Trephination
- Rhinotomy wI bone flap (greater exposure)
Il1--
C:::=~/tZt"I.?2!==:sS~~~"7
- Treat cause
- Supportive: nursing care
- Parenteral feeding & fluid therapy for anorexic animals
- Elizabethan collar (self mutilation)
- Repeat diagnostiCS
Multiple problems wlin nasal cavity of same animal
. FB & 2 bacterial infection
~ Bacterial & fungal infection associated wI neoplasia
- Bacterial infections:
- Oral ASs (culture & sensitivity) 2-4 weeks, avoid prolonged use (fungal overgrowth)
_ Decongestant: pediatriC Afrin nasal drops sid-bid 4 days on 4 days off
~
- Surgery for refractory or poorly managed cases
- Sinus trephination (remove exudate & irrigate sinus & nasal passages)
- Viral rhinitis:
II11
~
- Supportive care: sa fluids, Afrin, ABs for 2" bacterial infections
KetocoAazOI.r......."Y'
Bs
J.
- Vaccine 10 prevent
I .,
01
Upper airway
CS: Inspiratory dyspnea,
Sneezing, Nasal discharge
Ox: Hx, CS, PE
Tx: Treat cause. Px: Variable
=FI~
U
A
Prognosis:
) ;'~"(j
- Good:
~ (
- Bacterial
fWf.!i.!J1
- Respiratory viruses
:.U..r
" Trauma
. Foreign body
'~-P
- Some hypersensitivity
~
- Poor:
~ "" J
" Neoplasia
. FolV, FIV
~
l);;t1~
- Guarde.d:
" Mycotic
f ~ ~CO\
- ChroniC rhinitis
r@f~J
'-.7
Physical exam
*.-0.1~ ukSf~==:j1F~=?"'='""""'"
~
.!li:.J -
'Hx,CS
::?
.,
~
~
Y\~A-;.
~
.......,.
L_-_C_hr_Orn_ic_n_as_a_1
diiZ-;S;-;mI;;;;:JrO_Q_"_ir_e_10_n_9_-t_e_rm_th_e_ra_p_y_'
,re_-_0_va_I_"a_t_e...:at;tf2..,W,e_e-,k_i_nt_e_lV_a_IS_"_n_t_il_C_s_r_o_so_I_VO_----'
- Surgical patients
evaluate weekly until healed
*,,:' .
123"\
Bacterial
rhinitisl
sinusitis
M8k 1122; Mk 767;
**
-Hx,CS
Acute or chronic
-Sneezing
Physical exam:
Nasal discharge: mucopurulent/se- - Oral cavity (dental mirror)
Canine:
Oral ABs (culture & sensitivity) 2-4 weeks
- Avoid prolonged use (fungal overgrowth)
Decongestant
- Palpation (symmetry)
rosanguinous
~ Pediatric Afrin nasal drops SID-BID 4
Upper airway: inspiratory dyspnea, Laboratory: cee, chem & coagulation
(systemic dlzl
days on 4 days oil
open mouth breathing
CytOlogylbloPSY: aggreSSive nasal wash or Surgery for refractory or poorly managed cases
endoscopic retrieval of tissue
- Sinus trephination (remove exudate & irrigate
Pain
sinus & nasal passages)
Stertorous breathing snoring (obstruction) Culture: only valuable if endoscopic or surgical
curettage (because of nennal flora)
2" pneumonia rare - aggressive therapYi
Accompanying systemic signs
__h
Pasteurella multocida
Hunting dogs
596
Viral
rhinitisl
sinusitis
Prognosis:
W
Good if 1 & acute in dogs &
FeLVlFIV negative in cats
Guarded: chronic or
dog" cat
Pneumonyssus caninum (nasal mites), Adult pale yellow body, transmission unknown
- CS: Usually wlo or wI only mild signs, sneezing, serous nasal discharge
- Dx: most incidental finding at necropsy
-Tx: Drive out mites with noxious gases or chemical (ether~ Inhalant anesthetics & dichlorvos), Questionable efficacy & safety: Ivermectin
C~terebra spp" larva of rodent or rabbit botlly, TransmiSSIon: ingestlon, respiratory, or skin lacerations; Incidental parasites of dogs & cats, lesion of skin of neck & chest
Lmguata/a sefrata (tongue worm):
- CS: Severe rhinitis (coughing & violent sneezing, blood stained discharge)
-Tx: Physical removal only certain method of Tx
CSpillaria seroph/IIs: Rare; (usually lower respiratory tract) have been found in nasal cavity, parasite of frontal sinus, trachea, bronchi & rarely nasal cavity of foxes' Tx: ,.._:::--
Very common
Viral infection
2 bacterial infection
~ Dolichocephalic breeds
(Irish wolf hounds)
Mk 767; H2B 163;
E-hb 260; E 557;
~ 1 herpes virus wI 2
SAP 525, 542, 574;
Bordetella bronchiseptica &
12M235: 1M 169;lMPasteurella multocida involveWN212;Smin1036
****
Supportive care
Hx, CS
Sneezing
~ SO fluids
Physical
exam
Serous nasal discharge (bilateral)
~ Decongestants
Ubratory: CBC, chem & coagula~on (systemic
URT obstruction
diz)
- Vitamins
- Inspiratory dyspnea
Broad spectrum ASs
~ Open mouth breathing
for 2 bacterial Infections
~ Stertorous breathing, snoring
Turbinectomy in cats
Accompanying systemic signs
wI chronic rhinitis
- Anorexia especially in C8ts';.-_ _L _ __
- Fever, lethargy, weakness Viruses _ rhinitis
Sequela: Chronic rhinitis
Canine
- Parainfluenza
~ Herpesvirus
~ Distemper
~ Adenovirus~2
Viral + 2 Bacteria
CS: Sneezing, Serous, URT obstruction
Ox: Hx, CS, PE
Tx: Support, ABs
Foreign
body
rhinitis
Feline:
Conservative
Decongestant (Afrin)
~ Broad spectrum ABs 2~4 weeks
~ Once chronic low cure rates
Surgery:
- Remove infected & diseased tissue tor
obstruction & drainage
- Sinus trephination & drainage
- Rhinotomy wI turbinectomy
- Frontal sinus obliteration "'''4 ~/f
rill! ..
Parasitic
rhinitis
~ Reovirus
Feline
- Feline herpesvirus
~ Calicivirus virus
FeLVIFIV
_. (1
---<tl:S:~~
Pro nosis: Good If FeLVlFIV negative
Remove w! rhinoscopy
Hx,CS
Foreign bodies (grass awns) Violent sneezing
Rhinotomy may be necessary
Radiology:
vegetable
material
doesn't
show
Head-shaking
&
nose
pawing
Seldom lodge in nostril
Treat 2 infectionlinflammation
Most find their way into ventral Serous nasal discharge (unilateral) wI Rhinoscopy/otoscope under general
anesthesia
time mucopurulent, hemorrhage
nasal concha & meatus
- May be dislodged
URT obstruction:
~ Inspiratory dyspnea
~ Open mouth breathing
- Stertorous breathing snoring
Prognosis:
Good wI removal
rhinitis!
sinusitis
M8k 1122: H3S 139;
H2B 163; Ehb 261;
SAP 525, 542, 574;
12M 232; 1M 167; IMWW 210; 5mln 1036;
~~ww
65; NB 18.3
Dog> cat
Aspergillosis: 10 in dog
- Young to middle aged
- Dolichocephalic dogs >
brachycephalic (hunting dogs)
Cryptococcosis neoformans:
- Older cats, other body systems
Dental diz
rhinitis
Aspergillosis/penicilliosis - Dog
Sneezing
Nasal discharge (bilateral)
- Mucopurulent
- Hemorrhagic (destructive)
Swelling & asymmetry of face
Pain
URT obstruction
Inspiratory dyspnea
- Open mouth breathing
- Stertorous breathing, snoring
Ulceratlons of extemal nares: aspergillosis
Accompanying systemic signs
- Anorexia, especially in cats
- Fever, lethargy, weakness
sue
un----
Ij
Aspergillosis/penicilliosis:
Ketoconazole PO BID, eliminates in 50% if used
for 6-8 weekS
Itraconazole: more effective
Thiabendazole, success rate very low
Topical enilconazole: administrated
through surgical placed tubes
Surgery: open nasal cavity & sinus
technique
///f
S"'C?
'Hx,CS
Physical exam: crowns for damage
Radiology (oblique [teeth]: loss of lamina dura:
tooth root abscess
Enilconazole
q)!:rJ
ffii ~
Itraconazole ~
"'-----'
Nasal cryptococcosis:
Low-dose combined Tx in cats
- Ketoconazole
~
- Flucytosine
KetocoriaZcile
Continue Tx for 12 weeks
'Itraconazole (Sporanoxe)
~
l JI.
RhinosporidiosiS:
Cannot be treated medically
SUrgical removal only choice
- Recurrence likely
Prognosis: Poor to guarded:
depending on chronicity
//((
S---L>
Radiology:
- Asymmetry: prolonged fungal
C
Signs of periodontal diz
Oronesal fistula
.Nasal discharge: serous to mucopurulent
- May be unilateral or bilateral
DIfficult eating (mastication)
Weight toss
Hx, CS
Percussion: dull paranasal sinuses
Rare, Reported
CF=iJ1==;:C:::=....n~
CS: Sneezing; Nasal discharge (serous, mucopurulent & hemorrhagic)
"\,
4.J~
~~
Ox; Hx (CS wi no Improvement wI ASs), Nasal biopsy (lymphocytes & plasma cells infiltration)
OOx: Infectious nasal diz (fungal: aspergillosis or penicilliosis); Neoplasla
Tx: Immunosuppressive dosea of steroids (prednisone), gradually reduce dosage over 46 weekS (positive response expected In 2 weeks; If no response:
Add azathioprine (Imuran) to regime, may need long term Tx at lowest dose possible. If CS continue stop Tx & re-evaluate
Prognosis: Not known because to few cases
Allergic
rhinitis
H3B 139: H2B 168;
12M 236; 1M 170; IMWW213;NBI8.3;Pa-
"*
,,_"_If"
: ' : 7'('
_ ---:::/
_____/
***
.../""
::5
~C ______+-~
Nasal
trauma
L__
pr:::::;:lrin@)4
day~:~r:d@!
____~~__________-4________________~____+-______________________-+~u~nl~;k~e~[y__________________
Trauma:
- HBC (hit by car)
- 5 point landing in cat fall
- Fractures
Necrosis of conchae if infected
a ,oogy:
'\J
""",om"",,
- Topical epinephrine
I, ~
1:100,00) nasal
4.......
drops to stop
hemorrhaging
Broad spectrum ABs 20 bacterial
Severe: pressure pack nasal
~~~~~ry
malformation of septumjj
- Sequestration & osleomyelltlS
- Sinus mucocele
//(1
S=ate
>
Obstructive
upper airway
dizs
Inspiratory dyspnea
Others acquired
SAP 548; H2B 173; 12M 335; 1M
- Middle-aged & older dogs
Stertorous - snoring
158; SX-WW 64
**
Brachycephalic syndrome
~
...J i
( 00
. J
~
Nasopharyngeal polyps
Exercise intolerance
Laryngeal paralysis
Sequelae:
- Aspiration pneumonia
- Heat prostration
Nasopharyngeal polyps
URT obstruction
Tx: Cause Px: Guarded to poor
Nasopharyngeal
polyps
Benign masses
Obstructive breathing pattern
Tx depends on cause
~~~
Hx. CS. PE
Auscultation: localize obstruction at
loudest area ~ =
Palpation ~~
Neurologic exam
Laryngoscope (light anesthesia)
Radiology: rarely diagnostic
- Dilated saccules
- Soft tissue swelling
- Elongated soft palate
Fluoroscopy
Electromyography
Thyroid stimulating hormone test (TSH) for
laryngeal paralysis
Prognosis
Guarded to poor: tends to be
progressive wI most causes (degenerative dlzs)
Hx,CS
Surgical excision through oral cavity
- Pull soft palate out of way; grab polyp wI
Retract soft palpate to expose
Allis forceps -steady traction until removed
Radiology: soft tissue density in
Rhlnotomy lor complete removal, occasionnaso-pharynx or radiodensity ally
of osseous bulla (cats)
Ventral bulla osteotomy
Rostral rhinoscopy
III!
7
Biopsy & histo (Inflammatory tissue,
fibrous connective tissue & epithelium)
,=
=-I
Excellen~
Prognosis:
Regrowth if all not removed
1IU,...............z-n
. .~~~----------------------------------------------------------------------,. . . .-----------------------------
"
* .
Hx (young)
CS PE
'~L.arYngou,,~ope
--~~~------r-------------~~~~------~-----------
ITrauma:
- #1 bite wounds (fights)
- Choke chain trauma
- Gunshot wounds/projectiles
- Anything in cat
Causes laryngeal edema
URT obstruction
- Inspiratory dyspnea
- Open mouth breathing
-Noisybreathing (rasptostridor)
Voice changes(hoarsenessorloss)
Choking, gagging, coughing
~ 5)
Laryngeal
spasm
H2B 173;.
E-hb 266,
Cat 968
***,
Laryngeal
edema
~ ~
i./
'---'
<
Hx (cat intubation)
Direct visualization w. hile
intubating
~
Laryngoscope
Hx, CS
URT obstruction
Visualize: Layngoscopy
~ Deep breathing
- Inspiratory dyspnea
- Open mouth breathing
- Noisy breathing: stridor A>""""'~
Possible emergency
Tracheotomy if obstruction
Wound debridement
Establish drainage
i-~,~
~~.EI"t"'myog"Ph' ~
Hx, CS, PE
Auscultation: localize obstruction at loudest area
Palpation
.g",,_ _~~
" Neurologic exam
Laryngoscope (light anesthesia)
Radiology rarely diagnostic
-Soft tissue swelling
Prognosis:
Poor to good depending on severity
Possibly delayed signs 01 recurrent nerve
injury & subsequent obstruction
Prevent:
- Spray local 1-2% lidocaine
(only) anesthetic into
pharynx or swab on laryngeal
opening (auditls) belore
manipulation
~
7i'1{
~og" lojedloo
Int~~~e if severe
1lJi)
~
,
Stero~ds
Prognosis: Guarded
syndrome
SAP548, 549; H36139; H26
173; Ehb 263; 12M 246; 1M
1n; IM-WW 215; 5mln 400;
Sx-WW 64; Sx-S-hb 262:
Sx46 357~'P,;;'..;.T.:...~..
***
Hx, CS
Laryngoscopy - saccules of lateral
ventricles prolrude into laryngeal lumen
- Edema of the saccules
Histopathology of excised tissue may
indicate edema & fibrosis
pulls saccules
Obstructive respiratory
Brachycephalic breeds
Part of brachycepahlic syn- dyspnea (URT obstruction)
- NormaVlast & deep breathing
drome
SAP551: H2B173;Sx4B358
- Rattling stridor
May worsen wI ex,erc,isE',/'<'-.
Brachycephalic breeds
excitement,
Elongated
soft palate
**
Hx, CS
Inspect soft palate (override the
epiglottis &lor occlude the glottis), laryngesCO!"
Radiography: Overriding of
palate, thickening of tissue
///(
5-=
~'11
y~(
Goodw/
.M~:;';~'::~'~~I!~~Zl
.
dexameltlasone
,.d=~1
\~
Prognosis
Good wI successful surgery
Excessive removal - aspiration
"
~'!
k..-.
~--------.---------------.-~~--~-------r----------------,------------------
Laryngea'
Anatomical conformation
**
URT obstruction
Treat predisposing factors
Hx, CS
- Brachycephalic & other
- Inspiratory dyspnea
Laryngoscope: opposed or over "Brachycephalic syndrome"
collapse
breeds: Boston terriers, pug,
- Open mouth breathing
lapping arytenoid processes
Surgical excision or "tie back" of
H26175;SAP548,550,554:
pekingese, dachshund, Amer.
- Noisy breathing (owner may not
No abduction of arytenoids on
offending tissues
Sx-S-hb 262; Sx-WW 74;
know abnormal)
. Excise everted saccufes
Sx46 358
cocker spaniels
inspiration
-Unilateral excision of arytenoid cartilage, aryeplProcesses of arytenoid carti Stertorous "gurgling" sound- Surgical correction of
glottic fold & vocal cord for laryngeal collapse
lage(comlculate&cunellorm) overelongated soft palate
"brachycephalic syndrome"
- Partial resection of soli palate If elongated
lap causing collapse
... Exercise tolerance
- Corticosteroids lor postop edema
wI continued problems
May be seen in chronic end-stage upper Gagging (elongated soft palate)
Permanent tracheostomy if signs
airway diz also
persist after surgical correction of
Predisposing factors predisposing problems
"Brachycephalic syndrome"
- Stenotic nares
- Everted laryngeal saccules
- Elongated soft palate
.~
Laryngeal
I'
para YSIS
**
~2:57;
N-L 1",
I.ft.) \
Prognosis: Poor
Hx, CS, PE
Emergency tracheostomy
Laryngoscope: hyperemla& edemaS Steroid - reduce edema - earty
failure of abduction of vocal folds
Surgical enlarging glottic cleft for
TSH stimulation
moderate to severe CS
EMG (electromyograms) & NCV (nerve
- Unilateral arytenOid lateralization
conduction velocities) are abnormal
Hislo: mild to moderate type 1 & 2 myoflber - Partial laryngectomy per os
Cough during eating or drinking
atrophy
- Castellated laryngofissure & vocal
VOm!l Ing
l
fold resection
Lifelong thyroid hormones for proven
Voice changes ~_ b
')
"'0."'000'"''
- Inspiratory dyspnea
Open mouth breathing
_ Noisy breathing
_Stertorous "gurgling. (snOring) sound
Exercise intolerance
If
'=
~~
~
I.~) :':1
Prognosis: Poor
\(:J
Facts/Cause
Condition
Laryngitis
Inflammation of larynx
**
Presentation/CS
Diagnosis
Cough, gagging, dysphagia
Hx,CS, PE
Voice change (horse bark)
- Pain on palpation
Anorexia, malaise, fever
Laryngoscope: rigid or f!exlble
Other signs or upper rasp.
endoscope
Definitive Dx
tract infection
. Ocular & nasal discharge,
Edematous, inflamed mucosa
sneezing
Causes: Laryngitis
- Viruses
. Dog: adenovirus, Kg distemper
. Cat: rhinotracheitis, calicivirus
Smoke inhalation, irritating gases
Trauma (tracheal intubation)
Toxic causes
- Foreign body
Chronic barking
(butorphanol tartrate)
~~~~.
DDx:
Obstructive laryngeal dizs
Laryngeal neoplasia
Tracheobronchitis
J~J~
Prognosis:
URT obstruction
Inspiratory dyspnea
- Open mouth breathing
- Stertorous breathil'l9 snoring
Heat & exercise intolerance
Voice changes
oHx,CS
o Laryngoscope
Biopsy of granulomatous lesions
- Platelet count & activated clotting time
prior to biOpsy
Culture & sensitivity
**
,...,....-"""':-i~
stero~
I]J::
Neoplasia of
larynx
~~
Guarded to good
SO fluid if anorexic
,,'
Treatment
ABs for 2 bacterial infection
Steroid: dexamethasone if trauma
Humidified air
Clean, wann confinement
Avoid dust
Cough suppressants: Hycodan
(dlhydrocondeinone bitartrate). Torbutrol
lpi
URT obstruction
Hx, CS
Radiology: distortion, t soil tissue
Inspiratory dyspnea
denSity. laryngeal space ~._
. Open mouth breathing
Laryngoscope:
Noisy breathing stridor
swelling or mass
Exercise intolerance
Biopsy definitive diagnosis
Change in voice
- Alligator biOpsy forceps. needle or
Loss of bark
bronchoscopiC biopsy forceps
Coughing due to local irrita
~=""::;=([Jt:::="",a:1lJ
tion or aspiration
~.~
il't
=01
Surgical excision c
/.r({
>-e:::;::.
Curative for benign
~ Only palliative for malignancy
Radiation therapy: beneficial in some
(squamous cell carcinomas, mast cell
tumors, lymphoma)
Chemotherapy: rarely reported
---.-~~f:
a&k :E~~~~~~~~rdnoma
~ ~ ~.,
AeoPlasms of larynx
Squamous cell carcinoma
Lymphoma
Osteosarcoma
~
Melanoma
'~ .
Mast cell tumor
Adenocarcinoma
Metastatic tumors In doge
Thyroid carcinoma
Lymphoma
Pharyngeal rhabdomyosarcoma
Unilateral polyps
Exarcise Intolerance
oCollapse
*
\
P_
Hx, CS
Radiology: cervical & thoracic: soft tissue
denSity or decrease in lumen size
Bronchoscopy: tracheal mass
Biopsy & hlsto - diagnostic
nw (transtracneal wash) sometimes
.~
Cyanosis
Tumors of trachea
Malignant tumors in dogs
- Osteosarcoma
- Chondrosarcoma
- Lymphoma
- Mast celltumOf
- Adenocarcinoma
Malignant tumors In cats
- Adenocarcinoma
Lymphoma
- Squamoua cell carcinoma
Prognosis:
.1
Neoplasia
of trachea
DO.:
cats~_...J_ _ _ _-'--,
Oncocytomas
133
~'b
Surgery:
- Benign may be cured wI surgical resection
- Tracheal reconstruction (wedge resection. sidete-side anastomoses, telescoping. end-to-end
anastomosiS)
Chemotherapy (post surgery)
- Lymphoma: cyClophosphamide. vincristine &
prednisolone may prolong survival
///t
Prognosis:
Guarded: benign tumors
Poor: malignant
tracheal
hypoplasia
Sequela:
- Heat prostration
Collapsed
trachea
Dorsoventral flattening of
cervical or thoracic trachea
Signalment
H38 156;H2B 180; SAP
- Middle-aged to older
546, 556; E-hb 339; 12M
- Often obese
287; 1M 208; 5min 1112;
Cat 973; Sx-WW 75;
- Toy & miniature breeds
Sx48 3n; Pa-T 131; X.Toy poodle, Yorkshire terrier,
RP92; X-Gr144;NB 18.7
Pomeranians, Chihuahua
- t Inspiratory effort
- Open mouth breathing
- NoiSy breathing (lOud stridor over trachea)
Cough ~oud, harsh & unproductive)
CyanosiS, syncope wI exercise
Exercise intOlerance
Diet
Hx (young, brachycephalic), CS
DDx:
Tracheal neoplasia
Chronic bronchitis
Chronic heart diz
1 parenchymal diz
Tracheal stricture
Noisy breathing
.Cough
Tachypnea, dyspnea cyanosis
sa emphysema (crackling under skin)
Sequelae:
- Pneumothorax
L:---.1...:.!~~~~---,
Aspiration for FB
Acute allergic bronchitis
Other causes of
emphllsema
sa
//1/
Prognosis:
Poor wlo surgery
.Guardedwl,surgery
PostoperatlVEl
complication
common
.
Tracheal hypoplasia
-Stenotic nares
- Elongated soft palate
Obstructive I
Inlectious
sa emphysema
-..r-
Sequela:
- Heat prostration
CS:
Tx:
None
Transtracheal wash/aspirate:
- Chronic infection/inflammation usually
- Culture indicated
Segmental
tracheal
stenosis
accidents (HBC)
No known procedure
Control obesity
Intermittent ABs for 2 infections
Bronchodilators
OOx:
Rigid
rings, Bull dogs
CS: URT obstruction
Ox: Rads
Tx: None' Px: Guarded
***
Hx (young, brachycephalic), CS
Physical exam
- Palpable small, rigid trachea
Auscultation: noisy referred
airway sounds. ~
>h
- Pulmonary crackles
Radiology: small diameter
trachea entire length - normal: 3x
~:-a
~;f
f~)
.
.
\61
(
I I
- OccasiOnally split S2
Radiology: expiratory & inspiratory
- Narrowing of tracheal lumen
Collapse Of mainstem bronchi
- t Bronchial pattem
Fluoroscopy: dynamic airway collapse
Transtracheal waSh (TTW)
TracheoscoPy wI extreme caution
marked sinus arrhythmias
Tall, peaked p waves (p pulmonale)
._-
1J
t::::::J
"
Grading of
Grade 1: slight
membrane ventrally
Grade 2: < 1/2 normal lumen loss
Grade 3: 112 normal lUmen lost
Grade 4: > 112 normal lumen lost
PrognOSis
Hy -.,
--.r Guarded: progressive diz, complications frequent
Good for acceptable control wi medical Tx
(decreased coughing 75-90%)
Poor w/
Cage rest only may be enough
Temporary tracheostomy
Endoscopy: removal of FB
Primary closure of tracheal
injuries
~
sema, swelling
Radiology: peritracheal, intraemphysema &
muscular,
pneumomediastinum
Tracheoscopy
Surgical exploration
sa
Proolnos'.:
I
~",
T'al1ea..
.....c:. . . . . . .
Facts/Cause
Condition
Tracheitis
Presentation/CS
Inflammation of tracheal
mucosa
H3B258; H2B182; E
hb 338; E 756; SAP
575t. 532; PaT 131
I@-~.
{ i
***
~~
L
Coughing #1
Usually unproductive initially
I~
Sequela:
Pulmonary parenchymal diz
Bronchitis
- Bronchopneumonia
L------------_I
Causes or tracheitis
Infectious dizs
Noninfectious or irritative
- Canine parainfluenza virus - Prolonged barking
- Coughing assoc. wI collapsible
- Canine adenovirus 1 & 2
trachea or cardiac diz
- Canine reovirus
- Inhalation of smoke or noxious
- Canine herpesvirus
gas
- Mycoplasma
- Parasite infestation: Filaroides
- Bordetella
. Allergies
- Postanesthetic intubation
Inflammation
CS: Cough
Ox: CS, TTW
Tx: ABs, Antitussive Px: Good
Tracheal
foreign
bodiesl
mass
Uncommon
Usually small enough to pass
tracheal bifurcation
Large object at tracheal carina
(bifurcation~~
Diagnosis
-Hx,CS
~")
~d:!; ~
- ~~;u~~~=fi_\tress or 2
'-v-'
Treatment
Broad spectrum ABs 710 days
Cough suppressants (antitussive)
- Hycodan (hydrocodone)
- Contraindicated WlObar pneumonia
- Torbutro1 (butorphanol) less potent
fI
infection
l-"~
...
~~-( ~
t,CB
~>
,prevention
1-----------,('
~ ~ . Vaccinate for respiratory viruses &
DDx:
Pulmonary parenchymal diz
Primary cardiac diz
Collapsing trachea
Bordetellosis
--~t'-1"I*~@
f-..;.'11
['-5
~
~;;.?!
[~).
~
Remove
Obstructive breathing pattern
Hx, CS
- Fast, nonnaVfast respiration
Unresponsiveness to symptom- - Hold animal upside down & shake
- Stridor & loud wheezes (rattling in atic treatment
Bronchoscopy & snare
throat)
Radiology: soft tissue or mineral- - Thoracotomy & removal
dense objects wlin tracheal lumen
Chronic cough
- Atelectatic lung lobe
Sequela: obstruction & pulmonary Bronchoscopy
abscessation (inhalant pneumonia)
;~).
. . L~
**
~------~----~~
Abscess or granuloma
Hx,PE
~
Reflect underlying cause
ABs, antifungal agents
Auscultation ~~-="8S
Asymptomatic
- Surgical drainage or excision
- Displaced cardiac apex beat
Cough
Neoplasia:
Radiology
URT &lor LRT obstruction
- Lymphosarcoma: chemotherapy
- t ExplratoryeHortorgasplng It intrathoracic - Densities in mediastinum
. t Inspiratory effort II cervical
Gr 144; X3T 266~..L_ _ _ _ _ _ _ _ _ _ _ _-J
- Surgical excision
- Compression &Jor displacement
Dysphagia, drooling
Radiation therapy adjunctive
of
trachea,
heart
or
esophagus
Edema of neck, face & forelimbs
Space occupying lesion
Cysts: Extrathoracic drainage
- Esophagram
Dog: thyroid hyperplasia & neoplasia (vena cava syndrome)
t
er3 Ul
Cat: Cranial mediastinal masses
Laryngeal paralysis (upper airway obstruc- Ultrasound
'Cytology, culture & sensitivity (C&S)
Abscess or granuloma
tlon: stridor & voice changes)
Homer's syndrome
Serology for infectious diz
Mediastinal lymphadenopathy
Bronchoscopy (exam, culture or lavage)
Neoplasia
Mediastinoscopy
Cysts (uncommon)
See mediastinal masses
Extra.Trachealobstruction,esophaluminal
compression geal &lorvenacavalcompresSAP 549; H3S 161;
sion
H2B 231; X-RP 95; x
Ii
'Thom~sy~
Tracheal
parasites,
Lung worms
M8k 1066, 1117; H3S
159; H2B 183; Ehb
339; 12M 295, 301; 1M
219; IM-WW 225;
5min 1024
**
AsymptomatiC
Uncommon, Greyhound
Coughing: productive or
kennels
nonproductive
Parasites
- Filaroides osler; (Osleurus
oslen) (lung worms): Larvae in
nodules (granulomas) in trachea & bron
chi & rarely in lungs
- F. milks! & F. hirtht larvae In lungs
Aelurostrongylus sbstrusUS". cats
. Crenosoms vulpis. rare
- Cspillaria serophilis: unusual finding in
dogs, but is known to occur in cats
. Requires severe infestation to produce
signs
~~
Radiology:
- Occasionally nodular tracheal & bronchial
pattern for FilaroiCles os/eri
. t Bronchial & Interstitial pattem wI ottlers
~;p
1," ~
Prognosis: Poor to guarded
\!:J
Filaroides osleri
- Drug therapy usually effective
.Ivermectin PO once, caution in
Collies
. Thiabendazole PO
_Levamisole PO 810
- Surgical removal of nodules
Tracheoscopy/bronchoscopy
~fi?~. 5"~~
~- '~~
"..
~:2:%.J'
~~
'\....C.
Prognosis'
Good: usually resolves
i
Hx of exposure 5-10 days
Time, supportive care if CS mild
Very contagious respiratory Usually mild, self-limiting
(5-14 days)
before CS
- Don't excite or excessively exercise
disease of dogs
- Loosen collar
Lasts days to weeks & may recur Dry, harsh, hacking cough # 1 Physical exam (normal lung sounds,
(especially when exdted)
no fever)
- Confine to drafHree, dry area
Cause: 1# of organisms lsolaled
- Appears to be choking
- Cough elicited on light
_ Consider cough suppressants
- Bordetella bronchiseptica#l
- Paroxysm of coughing, mIb followed by
Canine
infectious
tracheobronchitis,
1 .
Kennel
cough,
Canine upper
respiratory
infection
complex
M8k 1123: Mk 769: H3B
1158: H28 1215: Ehb
339: 12M 285: 1M207: 1M
WW 218; 5min 32, 1114;
Pa-T 166: NB 18,6
r.:::J
cUoSnUta,"nlluYe
~'1M
-~,terstltlalpattemlnconcurrentdlstem..~
to eat
Feline
upper
respiratory
infection
complex;
URI
****
~~~ 1-
7'p~1
~:~~~~~:e;s~sc~:~yell~:~d
~ :~::~EMjwead~:ts
:1, unUSUal~'Y~""_fe"
Sequela: "Chronic snuffier" (Intermittent sneezing, mucopurulent nasal discharge & gingivitis)
,
_Liquid bleach (sodium hypochlorite, 1 parts to 30 parts H20) all cages ('0 minute
Dx: Hx, CS
"",'I-1l"L' -., -1
contact) & leave vacant for 2 days (right!)
lx'. Self limiting , Support #1 , ABS~./;:'
~
"> -12alrexChangeslhourminlmum
.... ~ ,r= )~.washhands&Change
smocks after handling Infected cats
'"
"c-~_'--_
.<\-0 '77
139
(f)
"
...--.-
"~
- '
E'>..) ".:: /""I(
r
_,'
{I
.f ~ f
fW
i
"
.....
Prognosis:
Good: most self limiting in 5-14 days
-May develop bronchopneumonia (1020%)
Support #1
Ii
~.
"
?H['
@
'
or ultrastructure
middle ear, sperm)
Only reported I dog & man
Palhophys.: impalred ~mucociliary
escalator H , chronic airway inflammation
- Predisposes to airway & lung bacteriall
Primary ciliary
dyskinesia,
immotiie cilia
syndrome,
viral inJections
Kartagener's syndrome
H3B164;H2S1S7,191;
WW22'
Acute
bronchitis
Sequela:
- Bronchiolitis, bronchiectasiS
- Bronchopneumonia ( fever,
***
Hx, PE, CS
Palpation of trachea often elicits
cough
,~""cl,~atjon:c)ccasjjon,al inspiratory
& expiratory wheezing
Radiographs: normal or peribronchial inliltrates
(esp. in cat)
Laboratory: generally unremar1cable
Bronchoscopy: mar1ced erythema of tracheobronchial mucosa
Transtracheal wash or bronchial lavage
- Cytology: PMNs maybe
- Culture may be positive for aerobic
bacteria or Mycoplasma spp.
I'
......
~~,\P
i ,,\
td
PrognOSis
Poor: most succumb to chronic infections early in life
Ae,
\ I
!'
treatment
Hx young
Auscultation
ventrocraniatly
- Inspiratory crackles & expiratory wheezes
Radiology: bronchitis, bronchiectasis or
bronchopneumonia
- Sltus Inversus in Kartagener's syndrome
Transtracheal washlbronchial wash culture
Bronchoscopy
Biopsy III EM (electron microscope) of ciliary
structure - delinllive Ox
- Sperm motility can also be checked
Abnormal sperm (motility), Usually sterile
~
?;;;fl
@3 f Sto","
DDx:
Foreign body
Tracheobronchial trauma
Collapsing trachea
Prognosis: Good
C
--h-r-o-n-,-C--"TC:p-e-rs-:j-st-e-n-t-:jn-:f-:la-m-m-at-:;o-n-O-:f'-.-:C"'o-u-g-:h-!-H-.-h-a-n-m-a-rk---T'-;-H::-x-:(-=-ag-=-e:;)-,;;C;;s----w~c ~
bronchial tree, 2~3 months
. Adult small or medium-sized
bronchitis
dog
CO PD
-
M8kl053; Mk768;SAP
561; H3B166;H2B 189;
E-hb 344; 12M 293; 1M
212; IM-WW 220; Smin
406;X-RP94, 106; X-Gr
14'
***
~
~ .::::?'t...,.., ~
,..----------'----:::
Bronchitis>
t"
DDx:
Chronic infectious tracheobronchitis 1 yr-old)
CHF (weight loss)
Pneumonia
Bronchopulmonary neoplasia
Extratlloracic tracheal collapse
Heartworm diz
The;i
HYcOOa~
~
possi~le.
.
.Ste~old: prednlsoloneorp~m.sone:
mainstay ofTx,especialiyforeo5lnophiliC bronchills
_Taper to reach lowest effective maintenance dose
Supportive:
Nutritional & hydration support .
_ Humidify air (vaporizer or nebulizer)
_ Dental hygiene
_Removeany underlying causes (s~oke,
paras"es)
Il
lothin,enrofloxacln
(Baytri1) or tetracyciine
_Avoid prophylactic or long-Ierm Tx, bacteria resistant strains
'0',
~teroid~
1;9
~l
~J....:sJ
T:;r
tl
a.
..:J
Cd
Hy
Prognosis: Guarded ~ cure is rare,
but significant improvement is possible,
progressive diz generally
Hemoptysis
RP 94; X-Gr 144
chltls; Rare disorder in cats
Systemic signs of infecCongenital or acquired
Clearance of airways distal to tions: fever, anorexia, halatosis, general debilitation
dilation, 2 0 infection common
- Enlarged lymph nodes
Causes:
1n bronchial infection (viral, bacterial, fungal)
2 n Infection as seen wi 1" ciliary dyskinesia
Obstructive airways (neoplasia, FB, inspissated
mucus)
Chronic inflammation (aspiration of noxious
substances, chronic pulmonary diz)
\~
Congenital bronchiectasis: reported in dog, wI
other congenital abnormalities iKartagener's
syndrome])
__
**
Hx, CS
Auscultation: + airway
sounds, especially
over affected bronchi/lung
Purulent bronchial secretions
- Radiology required for diagnosis
- Big airways, don't taper
- Bronchography if surgical
resection contemplated
;1
,
nw l"aOS1"Che~M,f;;ir
"U_U~~
~ ~__N_O_~~_'_~
DDx:
"
~
I
i
promote removal by cough reflex
- ASs (culture & sensitivity) 1421 days
. Repeat at first sign of exacerbation
Bronchodilators
Postural drainage: position in left, right. slemal
& dorsal recumbency & rotate at 30 minute intervals
- Percussion ("coupage"): series of cupped
hand thumps to chest to dislOdge secretions
Surgery (partial lobectomy) if severe localized diz
Theo-Our
ii~
t~)~
t.l)
Prognosis:
Poor long term: incurable, usually temporary
response to Tx, progressive diz
Treat underlying bronchial dlz
Bronchodilators
Oxygen (2840%)
[, [JJ~ ~.
Respiratory distress
oHx,CS
~ - Emergency Tx asthma attack
02 + rest + steroid usually stabilizes
-Coughing
Physical exam
. Oxygen cage rest until stabilized (40%)
~ Wheezing
- Auscultation: loud bronchial
Steroids: prednisolone or prednisone (Solu
- Expiratory dyspnea
sounds, expiratory wheezes &
DeltaCortef)
crackles in advanced cases
. Followed by oral prednisolone
- Gagging or vomiting
(expectoration)
Percussion: hyperresonant thorax
- Bronchodilator:
Radiology:
. Theophylline (Thee Dur) slowly IV over 3060 min
- Sneezing
Normal bronchial pattem (classically) or
followed by oral Tx; or
- Asthma: acute episodes,
Interstitial or pulmonary hyperinflation
. Ephinephrine, 1:10,000, 1-2 ml sa
asymptomatic between
(liattened diaphragm, peribronchial in
.Atroplne, ifstillnoresponse 1M (' cholinergic tone)
- Chronic bronchitis
Cyanosis in some
Laboratory: inconsistent
Complications:
Eosinophilia < 113rd
. Hyperglobulinemia In some
- Intermediate & long term Tx, some only
_ Bacterial infection
Fever
. RIO parasites: Heartworm, fecal flota
when exacerbation, others need chronic Tx
tion & fecal sedimentation
- Treat cause if found
. Eliminate dust, smoke, powders
- Pneumonia ~;.;: ~ _ nw (Transtracheal wash)
Emphysema /
1 - C&S (culture & sensIUvlty): In bacte . Indoor cats
4Y .}
rial bronchitis or 2" (Pastsurella multo'
Diet for fat cats
Y..c1.L..'-::,;6
ada), Mycoplasma
. Fenbendazole (Panacur) if eosinophilia
/~b'.:Y'
+Mucus,eosinophils,PMNs - Bronchodilators: Theo-Our tablets
-----'----------------'-------~,
& mucus: allergic pulmonary
(theophylline}(monitorj or Brethine (terbutaline):
monitor for anxiety, taChycardia, hypotension
diz or paraSites
. CombInation of Brethlne & Theoour for
__ -..... '\ . Eosinophilia not diagnostic f~rasthma
refractory cases
- Nonrespiratory cause of panting Acute viral respiratory infection
(normals ml have 25.%, eosmophlls)
_ Steroids: prednisone PO bid; use chroni
(fear, excitement, hyperthermia, Pulmonary parasites
_ Nasopharyngeal POIYP~~ ~
-.J for paraSitiC larvae
cally, not intermittenlly; taperto lowest altemateday
fever, anemia)
Laryngeal diz
~fJJ
(Ael~ro~trongylus). or ova
therapy; side effects: insulin resistant diabetes melll
Congestive heart failure (CHF)
o
Major
airway
obstruction
)
(Capiliana,
P.aragonlmus)
tus
Pneumonia
/""'
"J f b T l
- ABs il bacteria or mycoplasma cultured or
Cat asthma,
Cats
Types
Feline
- Asthma: acute brond'loconstriction
bronchitis,
Acute or chronic bronchitis
Feline chronic
Cause: unknown?
~ Hypersensitivity
bronchial asthma,
- Environmental pollutants
Allergic bronchitis
M8k 575; SAP 567; H38
- Genetic predisposition (Siamese?)
170; H2B 193; Ehb 342;
-Infectious agents (bacteria, mycoplasma,
12M 289; 1M 210; IMWW
viruses)
219; 5mln370;CaI1019;F
N231; F3IM303;XRP 103; o Pathophysiology:
X-Gr 144
- Acute bronchial constriction &
t mucus, proliferation of goblet
cells, inflammation, smooth muscle
hypertrophy
- Recurrent bronchopulmonary
infection
**
-r
bG
1\
~J
I"A-I-le-r':g==Y=?=B=r=o=n=c=hIo=c=o=n=s=tr=ic=t=io=n=,=.=M=U=C=U=s====r-----
CS: Respiratory distress
Ste~},i,~,frslaITIheo-~Iur D-?~
-FTI
W
~~
/,~'.MU""".~d.ma&
t m,,,,, ',I'",""Ohl'"
~,-1. Th~ St.~IO,,;d .
('
,2.;
Ii
Canine
distemper
**
/~~
lx:
Px:
Ox elusive: Hx, CS
Feline
infectious
peritonitis,
Radiology/Ultrasound
- Rare remissions in mildly affected or only
_ Confirm body cavity effusions
ocular involvement
_ Organ infiltration (lungs)
Supportive Tx, may improve quality 01 life
Fluid analysis: strongly supportive
None - Fatal
Straw colored, thick & visible
fibrin strands
Vaccination: Intranasal (IN) vac_ Hi specific gravity> 1.018,
cine (Primucell FIP) 2 doses 34
Risk factors (crowding, FeLV or FN conctJrocular.
eNS,
etc.
protein>
4
gldJ
rent 'Infections)
weeks apart at 16 weeks of age or
Combination of both wet & dry forms Serology: nol definitive (FIP & non-FIP corona
older, Annual boosters 78%
Catteries
~- All forms progressive & fatal
virus)
xt'-n$:~
'~
- Fundic exam
CS: Mul.ti.syst~ms: Fev~r, Dry & Wet
~
~ oHistopathology,biopsyornecropsy:
Ox elUSIve: FlUId analysIs
~. ("\\
L~nIY definitive tests
.
r:.. .~
:-3-(""'.,)?:I)
Prognosis: Grave
lxlP x: Fat a I, IN vaccme
"-~/...> ()
. ~_ _ _ _ _ _ _ _ _L~:":':=-':::":~~~c::'-_
Ati
0\
"ff'
(!j'"J
~~,_ _ _
tt--=~_ _ _ _ _ _ _ _ _ _ _ _ _ __ _
Mycobacterial
'. Neoplasia
. Severe nontuberculoos bacterial pneumonia
Mycotic pulmonary dlz
Mycotic!
fungal
lung diz,
M8k 1065; H3B 178:
H2B 202,1175; E-hb
350; IM216; 12M 300;
IM-WW 2124; 5min
954; Pa-T 166; XAP
100: X-Gr 144
**to***
- Fungal or fungal-like
pulmonary infection
Uncommon to common depending on
location of practice
lung involvement in disseminated fungal
infection common
- 1 pulmonary in cats, 1 0 GI in
dogs, but any organ system
Cryptococcus neoformans: Cat 10 in nasal
cavity, nasal sinuses, skin, or brain
- Pulmonary in 50% 01 cat cases
-Dog:1CNS
AspergillUs flaws
-::,~(J~i~jlJ:',,::""f')eot,;OO Of;mm~
~(!
1,'
DDx:
- Pulmonary neoplasia
Bacterial pneumonia
- Parasitic pneumonia
- Eosinophilic lung diz
Prognosis:
Grave for true pathogenic TB
Guarded for saprophytic forms
ZoonOSis possible, but not reported
Hx, CS
- Auscultation: crackles on inspiration
&
pleural effusions
o
Radiotogy (thorax)
- Combination of amphotericin B
- Disseminated, nodular intersti
& itraconazole or ketoconazole
tial pattern
Blastomycosis
- Hilar lymphadenopathy (tracheo Histoplasmosis
bronchia/lymph nodes)
- CocCidioidomycosis
- Cavitary lesions
~~
~
Ketoconazole
"J.l
145
_._-
Euthanize: zoonotic
Long term therapy'1: Isoniazid (Laniazid),
Rlfampin (Rifadin), Isoniazid combined wi
rlfampln (RHamate), Streptomycin, Etham
butol (Myembutol)
Saprophytic mycobacterium: Kanamycin, Ami
kaCin, Mlnocycllne, Doxycycline, Trimethoprim
sulfadiazine, Amoxlcillinlclavutanate
Surgical excision of large granulomas or consolidated lung lobes
15~t
Bacterial
pneumonia,
Bronchopneumonia
M8k 1121; Mk 766; SAP
577; H3B 176; H2B 200;
Ehb 348; 12M 297; 1M
214; IM-WW 223; 5min
952; Cat 1028; Pa-T 145,
166,168; X-RP 97; X-Gr
144
- Bordetella bronchiseptica
- Gram positive: Streptococcus
zooepidemicus, Staphylococcus,
***
Mycoplasmas spp.
Gram negative: Pasteurella spp, Klebsiella
spp, E. coli, PseudOmonas
Anaerobes: Actinomyces, Nocardia,
Bacteroides, Fusobacterium, Clostridium
- Pathophysiology: overwhelm
ingorcompromising normal de,--""=" fense mechanism
Cilia clearance, phagocytic cells,
mucous membrane barrier
- Restrictive breathing
Fast & shallow
- Fever
- Mucopurulent nasal
discharge
- Productive coughing
_ Exercise intolerance
_ Anorexia, depression,
listlessness
- Chronic: weight loss
- Enlarged lymph nodes
- Cyanotic gum
lactor)
- CS, Physical exam
- Auscultation: t lung
sounds, crackles
Percussion: dull sound
- Laboratory - inflammation
- t wecs wi neutrophilia (PMNs)
t1bO
- Radiology
.
(r
(
- t Lung density:
Alveolar = air bronchograms
Interstitial (initially)
- Cranioventral distributior.
~
.
..
""
- Fluids - hydration
- Vigorous ABs (C&S Important)
- Minimum 3 weeks, wen beyond duration 01
.'"
-.fA
Alveolar
~/
,.~~;;::===1>~\) -Immunosuppressionlimmunity
status
. Virus (FeLV, FIV, canine distemper, palVovirus)
OOx:
- Infectious
Viral (usually upper)
Fungal & parasitic
- Noninfectious
_ 10 neoplasms
Metastatic neoplasms
Thoracic lymphosarcoma
~I
es:
~1
:"r~
.
-Technique:
Percutaneous Dog
Long, through needle catheter (1014~)
.
through tracheal rings
Advance catheter into lower airway near carina
Transtracheal: dog & cat
Place an openend urinary catheter through a sterile
endotracheal tube & advance near carina (tracheal bifurcation)
Inject warm, sterile saline (cats & small dogs: 6 ml; large
dogs: up to 20 ml); can repeat in 5 min 12 Xs
Retrieve fluid by aspiration (suction < BO mmHg)
- Cytology, culture & sensnivity (C&S)
- Fluid remaining is rapidly absorbed by lymphatiCS
,.::::'"
l'--
Bronchoscopy &
bronchoalveolar lavage
- Especially useful in alveolar
interstitial diz & dyspnea w/o cough
- Technique:
Flexible fiberoptic bronchoscope into bronchial tree
Visualize diseased area & wedge bronchoscope or
catheter via biopsy channel wlin bronchus
- Inject 20-30 ml of warm saline (30# dog)
" Retrieve fluid (mild suction < 80 mmHg)
Cytology or quantitative cell counts, culture & sensitivity
Aspiration,
Inhalation,
Gangrenous
pneumonia
M8k 10S6; Mk 709; H3S
179; H2B 203; 12M 303; 1M
**
History, CS - presumptive Ox
CS dysphagia, presence of FB
Dyspnea varies from mild tachypnea l'Ausc,ult,'ti,)n:. crackles & wheezes
to marked inspiratory dyspnea wi
over effected lung lobes
~~_..""
orthopnea
~
Silence due to consolidation
- Tachycardia ~
Laboratory (repeat in 24-72 hours)
'on
~ -~
- Hypotens,
-:ed)
- Dramatic leukocytosis wI left shift
'
h'
.
- Wh eezlng, coug lng, gaggIng
Radiology (repeat 24-72 hours alter
-Causes:
-Ingesta:
Pharyngeal abnormalities
Following laryngectomy
Vomiting
Recumbencyorunconsciousness
Gastric reflux
- Foreign material:
Aerosolization: asbestos, lime
dust, chemical, noxious gas
Iatrogenic:
Intubation: barium, mineral oil,
&
shallow)
- Cyanosis
- DepreSSion, anorexia
- Exercise intolerance
- Fever, malaise
foodstuffs
Oral medications
Surgery: removing intubation tube
too soon
JL-~F
0
DDx:
Hematogenous pneumonia
k~-<'~~"
diz,
Verminous
pneumonia,
Lungworms,
Lung fluke
Mk 763; SAP 576; H3B 135;
H2B209; E-hb 350; 1M 191;
1024;
Pulmonary edema
r--------r~~~:;~~"
I
~
CS depend on parasite
Nonnal phase of parasite develop Mild cases: asymptomatic
ment or aberrant migration
Young animals < 2 yrs - CS
Clinical cases
- Cough
- Weight loss
- Exercise i
Number of respiratory parasites:
j}}
fu"
S'"
Ancylostoma caninum
- Uncinaria
- Toxocara canis
- Toxocara cati
- Tricuris
- Dirofilaria immitis - arteries or granuloma
or aberrant migration
Asymptomatic, Cough
Dx:
nw, Fecal
Panacur
Toxoplasmosis,
Toxoplasma
pneumonia,
Protozoal
lung diz
H3B 179; H2B
203; SAP 141,
578; E-hb 192;
12M 300; 1M 191;
5mln 1024; F-H
369; Pa-T 167;
X-RP 167
---------------~--
~--L._ _---'::::::-
DDx:
Chronic bronchitiS
Pneumonia (bact., viral, lungal, protozoal)
EosinophiliC lung diz
NeoplaSia
NonparaSitic bronchogenic
cysts & granulomas
Moat 8symptomatle
Aeute neerotlzing pneumonia
have been Infected), can occur in dogs
- Restrictive breathing (shal!ow & rapid)
-Multisystem protozoal (often subclinical in cats)
- Fever
Predispose:
- Immune deficient diz or concurrent infections Multisystem
-CNS
(FeLV & canine distemper)
- Anterior uveitis, chorioretinitis
Pulmonary diz more common wi acute than
- HepatitiS
chronic toxoplasmosis
Generalize lymph node enlargement
Hx,
~i -~,
~
~~~.;:",....
Prognosis:
Grave to guarded
~
- Grave with acid or particulate
material (necroSis or granulomatous
pneumonia)
- Guarded wI neutral or Ii
Fenbendazole (Panacur):
generally salest for all
Albendazole
Tetramisole filaroides
Thiabendazole - filaroides
LevamiSOle (Riperco!) - aleurostrongylus,
fllaroides
- Pooriy tolerated in cat
Ivermectin dog PO once
Droncll Paragonlmlasls
Oral ivermectln Filaroldes (os/erus) os/sri
Panacur
Prognosis: Good
Guarded to poor: granulomatous diz
Superinfection may develop In parasites wf
direct life cycles
~~,~~'~:;:ih~~';:~:~~
result
from Tx
of worms &may
intense
inflamma-
_,..
No treatment Is eonsistantly
Clindamycin TOe
(Tx of choice)
Clindam
Publle health:
Pregnant woman should avoid contact wf
soil, cat litter & raw meat (ocular lesion in
newborn child)
Transmission by petting cat unlikely
Allergic
pneumonia,
Pneumonitis
(hypersensitivity)
PIE, Pulmonary
infiltrates wI
eosinophilia,
EOSinophilic
bronchial patterns
Response to corticosteroids
RIO (rule out) all known causes of
pulmonary eosinophilia
M8kl119,1120;Mk765:
SAP 590; E-hb 353; H3B
188; H2B212; 12M 305; 1M
223: IM-WW 228; Gat
1042; F-H468; sx-wweo;
Pa-T 169; X-RP 103; X3T
382; X-Gr 144
***
Hx, CS
o Serology for systemic mycosis (aspergillosis or
cryptococcosls)
o lung fluids: eosinophils & PMNs & reactive macrophages
o lung biopsy (thoracotomy): definitive, thoracotomy
Hllar lymphadenopathy
- Pulmonary Infiltration & pulmonary parenchymal
lesions
o Radiology: Interstitial pattem+ multiple, Ill-delined
nodules of varying sizes
~..., ~~'Heartw'm'... ~
Granulomas in lung
CS: Systemic & Lung
Ox: Hx, CS, biopsy, Rads
Tx:
Px: Guarded
Neoplasia of
the lungs
------..
- Eosinophilia usually
pneumonitis,
Lymphomatoid
granulomatosis
(immunosuppressive doses)
pulmonary disorders,
(CGS)
Hx, CS
Cough!!!!!
Uncommon
-Idiopathic: resembles pulmo- Weight loss
nary hypersensitivity in humans Fast RR (tachyp,nea)
Pulmonary infiltrate & 20 lung
dysfunction
:{]
~~~cultation:
1j]
- HemoptySiS (blood)
---_-..
~-~
il't
=0'
Prognosis:
Guarded for eosinophilic,
lymphomatoid & Idiopathic
pulmonary granulomatoSis
- Good response In some wI aggressive therapy
Cyanosis
Radiography usually diagnostic
S-=iiL:?
(VO, rlght & left lateral)
Metastatic pulm" neoplasms +Exercise tolerance
" 10% missed on plain films due to: small lesions, Chemotherapy: may be benellclalln some
Less
common
signs
(ar10rexi,a.1
0
More common than 1
hidden, pleural fluid, atelectasis 011 or more lobes
- Lymphomatoid granulomatosis:
- Tumor emboli spread by lym- fever, Weiigg~ht:~II~O~S:s~'ti~~~Pha!lia'l - Patterns vary tremendously:
vomiting,
re
prednisolone, vincristine, cyclophatics or blood vessels
" Solitary or multiple nodules
phosphamide
Older animals >10 yrs
" Diffuse pattern: alveolar, interstitial
Sequelae:
- Malignant histiocytosis in Bemese
- Except lymphomatoid granulomatosis:
or
bronchial
- Lameness: hypertrophiC
young dogs 1-6 yrs
mountain dogs: doxorubicin, cycloosteopathy a pa"aneol,la:'tic - Hypertrophic pulmonary osteopathy
Boxers & Bemese mt. dogs
phosphamide, vincristine
of extremities
syndrome
- Complete or partial response re,
" Other radiographic signs
ported for metastatic tumors jheman Pleural effusions
c:
///(
Metastatic>
CS: Respiratory
Ox: Rads, Biopsy
Tx:Sx
- Sarcoma (uncommon)
. lymphoma
Fibrosarcoma
Hemangiosarcoma
Osteosarcoma
- Lymphoid granulomatosis
- Malignant histiocytosis (Bemese mt. dog)
_Pleural thickening
_Thoracic lymphadenopathy
Calcilication & cavlta~on of masses
Right Side & caudal lung lobes most
common site in dog 10
_lelt lung In cats
Prognosis:
Poor - >75% of 10 tumors inoperable
Survival> 1 year small 5 em, 2") solitary lQ
tumor wlo metastasis or malignant effusion
Survival> 6 months large lobar mass wI excision
Facts/Cause
Condition
Presentation/CS
Diagnosis
Treatment
Noncardiogenic edema
Restrictive breathing pattern Auscultation:
Pulmonary
Treat underlying condition
#1: left-sided heart failure
- Rapid & shallow
- Inspiratory fine crackles
edema,
- Oxygen: cage or nasal oxygen or
#2: over infusion of
Coughing only if fulminate
Mucus membranes: dusky or
mechanical ventilation
crystalloid fluids
alveolar edema
cyanotic
Noncardiogenic
Maintain patent airway
Cats: sternal recumbency/
Radiology:
pulmonaryedema,NCPE Noncardiac pulmonary edema
~ Stop or minimize IV fluids
Adult or acute
- t Lung density or interstitial &
(NCPE)
abducted elbows
- LasiX (furosemide)
respiratory distress
- #1 Injury in pulmonary capil
. Dogs: reluctant to lie down,
alveolar nature
- Morphine In dog or acepromazine In cats
syndrome,
lanes; other causes controversial ~Sit Up w/ neck extended
. Heart failure perihilar
if sedation is needed
NCPE: diffuse. but often dorsal -? Steroids: consider 1 shock dose
Shock lungs
& peripheral
of prednisolone
SAP 572; H3B 173, 182: H28 197,
/
- Lag of 12-24 hrs between onset Bronchodilators (TheoDuti!l)
206: E-hb 356; 12M 310: 1M 226;
5min984, 1022;Cat 1036;Pa-T137;
- Correct metabolic acidosis
!~
of CS & radiographic changes
X-RP 101
- ASs prophylactic (consider)
,
_____
..
_____~L-~E~C~GL(_~_h~_'_ro_;o_'~_P_hY_lt_o~_o
__
h'_a"__~
failure
Cardiogenic pulmonary edema:
see Circulation: 02, Lasix. thoraCauses of pulmonary edema
- Snake bite
cocentesis, etc.
SAP 572; 1M 227
- Toxins
High-capillary pressure
Pulmonary infection
- Left-sided heart failure
Lymphatic insufficiency
- Over infusion of crystalloid fluids
- Pulmonary neoplasia
Pulmonary capillary permeability
Undetermined or multiple origin
- Sepsis
- Neurogenic
Shock
. Seizure
- Pulmonary thrombocytopenia
. Head trauma
DIC (disseminated Intravascular coagu~pathy)
. Electrocution
- Inhalation of smoke/noxious gases
Theo-Our
- Upper airway obstruction (brachlocephallc)
Aspiration of gastric juices
- Ae-expansion lung edema
- Uremia
(rapid removal of pleural fluid or air)
- Near drowning
- Drug-induced (ketamine, narcotic
CHF> NonCHF
- Immunologic reactions
over dosage)
cs: Restrictive breathing
- Pancreatitis
~
.
***
Prognosis: Poor
Loss of consciousness
Respiratory distress
~ t Inspiratory effort, or
~ Respiratory arrest (apnea)
Hypothermia
C ~
Hypoxemia, acidosis, shoc!<,
I--"""'-",.-~~"""~< --.; ......_ - " cardiac arrest ~~ ~
Near drowning
~ Fresh water
- Salt water
Near
drowning
**
:,~5'
Solitary lung
I .
&
wi radiolucent center
eSlons;
Cysticlbullous
diz
/=-...l.___________--..I
OOx for solitary lung lesions
Bullae & blebs (destruction of alveolar wall)
Abscesses:
. Focal pneumonia
- Foreign body, punctures
- Chronic bronchitis or bronchiectasis
~ 1 mycotic or parasitic infections
Neoplasia
r77""O'77rm7n'7n""= Parasitic lesions
- Dirofilariasis
- Aleurostrongylus (rare)
- Paragonimiasis (flukes)
- Eosinophilic lung diz
Chronic eosinophilic pneumonia
H38180; H2B 205;
E-hb 357
**
(cats)
Granulomatous diz - dogs
Focal pneumonia
Bronchogenic cysts
nw
Hx, CS
thoracic radiography
Radiology:
-Dyspnea: fastRR(tachypnea) - Thick-walled lesions wi gas &
- Cough
fluid densities
Fever from Infection or necrosis
Abscesses
Systemicsigns: lethargy, mal Cavitation of a neoplasm
aise, anorexia, exercise intoler Infarcts (rare)
ance
- Thin-walled w/ usually normal
adjacent parenchyma
-Sequela:
Hypertrophic pulmonary
osteoarthropathy
<)
~~~:~:::~~~~~:"~~um
.
",.
~
.,'
Artificial resuscitation
Bronchodilation
Fluid therapy for shock
.St"old"o't'~~~
Guarde~
Px:
Cysts, bullae & blebs
- No immediate treatment
- Monitor for spontaneous
pneumothorax
ABs, antifungal, anthelmintic:
culture, Cytology or histology
Surgical:
Most solid lung lesions, persistent localized infection of a suspected abscess
: ~~!:
Neoplasia
. Pneumatoceles
k...~..-t - Persistent pneumothorax
. Confirm bullous lesions
.
wall & no fluid density
. Suspected or confirmed foreign
o/O>--!J'y
~~~:~~nct
. Loculated pneumothorax
Bronchoscopy-airwaysecretions
- Cytology for infec. or' neoplasia
~. Ultrasound: evaluate or guide biopsy
Exploratory thoracotomy
Repeat radiology at 1 & 6 months
r--.
., 1l\. \
r-:'):.{t).J(,'<..
T
D
Hx (near drowning)
Radiology
if asymptomatiC
body
0011'
-~II
~~
Prognosis:
Guarded to good
'7$
J;i;t;o,...
t~ . ~
-Abnormalaccumulalionoffluid Variable
Pleural
effusions
in pleural space
Normally just a small amount of
fluid for lubrication
Causes (see box)
- Changes in hydrostatic & oncotic
pressures
- t Vascular or lymphatic penneability
- Lymphatic obstruction
***
recumbency
cause
Prognosis:
Grave to guarded
Neoplasia: grave
Trauma: guarded
Radiology:
Coughing (uncommon)
Jugular venous distention!
pulsation
costodiaphragmatic angles
- Widening mediastinum
~~~~~~h________~..::..memj
branes)
"
Hx, CS, PE
jI'. -
of lung
borders
wall by fluid density
- Separation
Horizontal beam
views
to seefrom
fluid thoracic
line"
- Underlying CS (cardiomegaly, intrapulmonary lesions,
~
diaphragmatic hernia, lun.g lobar torsion, thoracic trauma)
~v
Ultrasound (do before fluid removal)
- Cardiac function (cardlogenlc vs noncardlogenic effusions)
~
Causes of pleural effusions t Vascular/lymphatic permeability or
obstruction
- Valvular lesions
.
";:,..
SAP 581
t Hydrostatic pressure
- Infectious pleuritis (bacterial, viral, fungal)
- Congenital cardiac abnormalities ~~
~
- Congestive heart failure (cardiomy- - Noninfectious pleuritis (uremia, pancreatitis)
- Pericardia! effusion
.:. ~
..:::::::
opathy, valvular diz, pericardlal effusion)
- Foreign body penetration
- Mediastinal & cardiac masses
- ~D ,.
- Over infusion of fluids
- Hemorrhage
Thoracocentesis
"=-- Intrathoracic neoplasia
- Diaphragmatic hernia
- Fluid analysis characterize effusion (see box)
... Oncotic pressure (due to
- Lung lobe torsion
Ether clearance test: rapid screening test for chyle
hypoalbuminemia)
- PUlmonary~hromboembOllsm
Tnglyceride concentration In fluid> than In serum In ChY~OUS
- Protein losing enteropathy
- Neoplasia
~
Exploratory thoracotomy
- Liver diz
Mediastinal lymphosarcoma
--...........
M'
. f . bod'
~ )"<" ~
Metastatic neoplasia
I 7\
- Igratlng orelgn
les
) ~
- Protein losing nephropathy
Primary lung tumor
- Biopsy of lung or mediastinal lesions
-~~
(nephrotic syndrome)
Mesothelioma
:.-- Tx of pyothorax or chylothorax
::=::iZ;L:~S:;~:::::7
- Chylothorax (Idiopathic or 2" to pnmary dlz)
//11
Ss==:;o:>
~
~~~==~~~2/
CO
ia
' -__
__________
Modified
transudate
Hemorrhagic
Nonseptic
exudate
Septic
Chylous
exudate
exudate
Yellow/pink
Yellow/red-brown
Mifkywhite
Red
Color
Turbidity
Clear
Clear/Cloudy
Clear/cloudy
Cloudy/opaque
Opaque
Opaque
Protein (g1dl)
< 1.5
1.5-3.0
2.5-6.0
3.0-7.0
2.5-6.0
> 3.0
Variable
Fibrin
+ Bacteria
Bacteria
Fibrin
Fibrin
Fibrin
Trigtycerides
Triglycerides
Nucreated cells/lJ.l
< 1000
1000-5000
1000-20,000
Cytology
Mesothelial cells
Macrophages &
Mesothelial cells
NeoplastiC cells mlb
Nondegenerate
Degenerate PMNs
PMNs, macrophages Macrophages
Neoplastic cells mlb
Oiz associations
Hypoproteinemia
5,000- 300,000
Chronic CHF
FIP
SeptiC pleuritis
Neoplasia
(pyothorax)
Neoplasia
Diaphragmatic hernia Diaphragmatic hemia
Lung lobe torsion
500-20,000
As in peripheral blood
Lymphocytes
RBCs& WBCs
PMNs&
macro phages
Chylothorax
- Obstructed duct
- Ruptured duct
-CHF
- Neoplasia
- Heartwonn
;--
Hemothorax
-Trauma
- Hemostatic disorders
- Neoplasia
Pleural EffiJ$iQI'l$
Facts/Cause
Condition
Chylothorax
M8lI1 054; SAP 584; Ehb
**
Diagnosis
Presentation/CS
Accumulation of chyle in
pleural space
Escapes from thoracic duct
Orthopneic
.? Fever
.? Cough
Cause:
- Idiopathic?
- Trauma: HBC (M by car), sur-
cardiomyopathy
OOx:
See pleural effusions
- Thrombosis
- Heartworms
- Mediastinal lymphoma
- Congenital in Afghan
~[~~~f':::::i~::~. '~.~~-.
Radiography:
- Fluid line
- "Leafing" of lung lobes
- Cough
- Congestive heart failure!
Treatment
Hx, CS
Palpation: usually normal
Auscultation: pulmonary &
.<
/~~
:;..--........ ,
.::Jc::::c::::c::::c::::c::::c::::c:::::::::____~ Thoracocentesis:
Chylous effusion
- Milky white, Opaque
Thoracocentesis as
~
needed: remove
~~......,
effuSion; chest tube
installation & suction
~
e,..,.~, \~
- LOW-fat diet
Hill's rId or wId, or
Homemade diet: 1 cup boiled rice or potato,
oatmeal or pasta + 1 cup low-fat (2%) cottage
cheese + 1 vitamin/minerai tablet + 112 tsp. cal
clum carbonate (TumS) & 1S ml MCT (medium
& short chained fatty acids 011/1 S Ib dog)
Surgery if above fails in 1-4 weeks
- Lobectomy: resect torsed lung lobe
- Ligate thoracic lymphatic duct
- Fenestration of the diaphragm, etc .
Passive pleuroperitoneal shunting: holes in silastic
sheeting covering a defect in diaphragm
Active pleuroperitoneal or pleurovenous shunting:
pump connecting thorax & abdomen or vein
- Pleurodesls: IPtetracycline tocause adhesions, not
recommended?
Prevent recurrence of effusion
~IHliit\
~E'!b,R\f'
Exploratory thoracotomy
~ .:.l!.
---.:~
jg/d
/1/(///!lIv..IJ,
g~rtll~
Hydrothorax
Causes:
- Cardiac diz
- Lung torsion
- Pancreatitis
Hemothorax
Cause: Trauma
-...
c...
~~~
~
....-."_....
----1
1IIIif..........................-="=~~~-""-----------------------------------------------------------------------------~;
Pyothorax
SAP 586; E 879; Ehb
365; 12M 324; 1M 240;
IM'NW 234; H3B 195:
Smfn 1002; Cal 1063; FN454
**
Weight loss
Medical emergency
Treat underlying cause
Indwelling thoracic tube
(pleural drainage)
Thoracic lavage
Systemic ABs (culture & senSitivity) for
minimum of 3-4 weeks
Protein 3.9-7.0 gldl
While waiting for C&S, panic/illn
Fibrin -.present
Bactena
~. Surgery in refractory cases (explore for
intrapleural foreign bodies, break down intrapleural
Cells - 5000-300,000, mostly
adheSions)
degenerate PMNs,alsomacrophages
Lobotomize severely diseased
- C&S (culture & senSitivity)
Drain abscesses~?,__
(aerobic & anaerobic)
Gram stain: rapid assessment
Hx. CS
Radiology: pleural effusion
Thoracocentesis necessary
- SeptiC exudate
Yellow to red-brown, cloudy to opaque,
flocculent
&
i\.~
J;!,
Exploratory
<t~~
C:::=:::,.;iizZ([:~SS:;:;",,<::::7:>
Prognosis: Poor
ID
Surgical
resection TOC (Tx of choice)
eluded= lobe expansion or atelectasis)
inspiratory effort
sence of lung sounds
60; Ehb 367; Smin 780;
- Remove affected lung lobes
. Copious bloody effusion
~
- Cyanosis
Plain radiographs
Cat 1082; Sx-G 101;
Higher incidence of respiratory arrest on induction
Mechanism: unknown
'l" . Cough hemoptySiS
- Pleural effusion: remove (thoracocentesis)
Sx4B 400; SxWW 81
Postoperative indwelling chest tube 2472 hours
Spontaneouslidlopathlc ~ HypotenSIon & collapse
- Repeat plain film
ThoraCIC surgery
~
~ SystelTliC signs fever, depreSSion,
. Lobar consolidation or atelectasis
Trauma
~"3-< ~ weakness
~... Displacement of cardia toward atelectatic
.2" 10 pleural effUSIon
()
lung
Pleural effUSion & atelectasis of cr & rt
I ( \
Air bronchograms early, resorbed late
middle lobes may prediSpose to torSion
. Rounding of lung edges as expands
Dogs cats
DDx
Misplacement of bronchus maybe
Large deep chested breeds. Afghan
Contrast radiographs/bronchogram may
Resulls in leural effusion
Causesof bloody plaural effusion
enhance
Rare
Pulmonary parenchymal or
Thoracocentesis: Copious bloody pleural
pleural mass
.z;g
CS: Restrictive breathin~
Diaphragmatic hemia
::~~eXPloration to
~ _I?....
Prognosis:
OX: Rads, thoracocentesIs
Pneumonia
confirm
t.~'\.~ Good: wI surgical correction
Tx: Sur ieat resection
Pulmonary contusion
~ Grave: w/o surgical correction
Lung lobe
torsion
L(
...
r.
157
-Cause:
Restricted breathing pattern
- #1 automobile accident
wi hemothorax (rapid & shallow)
- Kick, falling from heights t Inspiratory effort wI
- Penetrating trauma
pneumothorax
Lung
. Gunshot
Anxious or distressed
contusion
SAP 593; E-hb367; 12M
Sharp instrument
Hypovolemic shock
308; 1M 224; 1M""""""
Ese'DtlaDeai penetration
Heart rate
231; 5min 980; Cal
- Weak peripheral pulse
1039; Sx-1/MI81; SxS-hb 152; Sx-S374; X- Cold extremities
- Pale mucous membranes
103; X-Grl44r<'J~;>-,
- Depressed or stuporous
***
Thoracic
trauma,
RP
-+
Radiology:
Full severity of pulmonary contusion may not be
apparent on radiographs for 1-2 hours
May take 6-12 hours for fluidlhemorrhage to reach
peak levels
Evaluate:
Cardiac silhouette (narrowed - hypovolemia)
- Pleural space: fluid, air or abdominal
drn.
/1? ~~ ~
"-..::)-:JI-8n--..;;I
_
~
I _
""00
~~'-;1!5
Respiratory: restrictive
breathing (wheezing, exercise intol-
11
t;_.1J
~\:,-.,
~~<t~~
permanently
o Analgesia. intrapleural Infusion & intercostal nerve blocks
'oepaio
-: - Prognosis: Guarded
thorax
erance)
in upright position (dog sitting)
Hx, CS
~. TraUmatic: delay repair until stabilized
Auscultation: gut '%OUilds in chest
- Surgical repair: ventral midline abdominal
Radiology:
incision
_ Gas or barium-filled intestines in Congenital: surgical repair as soon as
Ultrasound:
_ Discontinuity of diaphragm may be
detected
Cardiac arrhythmias
Liver most commonly hemiated
Hydrothorax (entrapment &
venous ocdusion)
., ( I
.
m
~~~~~~---4~~~----~~-----+~~~~~~~~~~
Congenital:
Mostopencommunicationbetween
pleuroperitonealmembrane&peri-
**
*_
227;
289,X-G"44
ThOracocentesis:
- RBCs & protein for hemorrhage
- Centrifuge - bacteria. degenerate PMNs &
organic matter (perforation)
Blood: PCV & PPC for basellne of hemorrhage,
Arterial pH & Blood gas tension
ECG (electrocardiography): Serial to check for
arrhythmias associated wI myocardial Injury
#1 HBC
CS: Dyspnea, Shock
Ox: Tx shock 1st, Hx, PE, Rads
Tx: ABC
Rib**
fractures,
Flail chest
sa
Hx (trauma)
- Heart displacement
Percussion: for t or. resonance
AC'''''''''c->J
Modify to situation
Maintain at least 1 IV catheter, severely
Pectus excavatum5min916;Sx4B424;Sx-S374;X-RP113;X3T292
Congenital, Dorsal displacement 01 the sternum
.
,...
CS; Incidental finding on radiographs or respiratory dislress & collapse
Ox: Palpation, Radiology, usually Inddental findlng
Tx: SurglcallntervenUon not recommended
f:\~...A,....
l ) '" .' v;{ ;,p.
~
~
~;'\~;
.~~ ,~.,,,,
""'
\~ ~
{~1fi3>
~ :.c;;
Prognosis: Guarded
Re-expansion pulmonary edema:
complication following surgery
160
FactslCause
Presentation/CS
Diagnosis
Treatment
Nonspecific
Hx (vague), CS (nonspecific)
Occlusion of pulmonary
#1 Treal underlying cause ::
vessels by a clot
t Depth & rale (hyperpnea) Auscultation: crackles (rare)
Supportive care:
- t lung (airway) sounds
Oxygen supplementation
Pathophysiology: may cause pul - t Inspiratory effort
Split 2nd heart sound due to hypertension
monary hypertension & result in
- t Rate (Iachypnea)
Strict cage confinement
Radiology
pleural effusion
Careful parenteral fluid Tx
Cough (hemoptysis occasionally, esp. Normal
H3S 180: H2B 211: EwI heartworm)
"'90
hb366; 12M308;IM225; t Incidence where heartworm
- Diminution or loss of peripheral Anlicoagulanllherapy
- Coumadin (Warfarin or coumarin derivatives)
IM-'NW 230; Cat 1083;
prevalent
vessels
- Heparin (rapid onset, short-term effects)
Sx-$-hb 22: Pa-T 138
- t Size of central pulmonary a.
- Aspirin -. platelet function ("thins blood")
Mild right heart enlargement
- Prednisolone may be better choice in cats wi
Mild pleural effusions
heartworm diz
FibrinolytiC
therapy: lack selectivily, extremely
Arterial blood gas analysis
expensive
$$$
(!
I
! [til
- Hypoxemia
Causes - pulmonary thromboembolism
- Streptoldnase, urokinase, tissue plasminogen
- Hypocapnia, hypercapnia in severe diz
Cardiac diz
activator
Embolectomy:
- Respiratory alkalosis 2 to tachy Heartworm diz
High
mortality risk
pnea & hyperpnea
- Heartworm adulticide Tx
- Only considered for central pulmonary artery
Electrocardiography: depends on heart diz
- Dilative cardiomyopathy
obstruction
ST segment abnormalities - hypoxia
- Chronic mitral valvular insufficiency, endocarditis
Sinus bradycardia ~ to pulmonary
Neoplasia (lymphosarcoma, bronchoalveolarcarcinoma,
hypertension
pancreatic carcinoma)
/ __' -________,
Pulmonary angiography
DIC (disseminated Intravascular coagulation)
- Definitive antemortem Ox
Sepsis
OOx:
- Positive: filling defect or sudden termination of
Hyperadrenocorticism
Airway obstruction
blOOd flow
Renal dlz (amyloidosis, glomerulonephritis)
Other forms parenchymal diz Nuclearperiusion scintigraphy: sale & sensitive
PancreatlUs
nonspecific test
Eosinophilic lung
Pulmonary hypertenSion
Air emboli (rare)
Immune-mediated diz (autOimmune hemolytic anemia)
Iatrogenic: indwelling vascular catheters, transfusions
Idiopathic causes
~1
I
Condition
Pulmonary
thromboembolism
**
~w
ro
<6'>--
'v:;J
,, __ ifjP
~-~
~:cJ
Prognosis:
Poor (caIS) to guarded (dogs)
Recurrence possible, especially if cause not resolved
Guarded for central pulmonary artery obstruction
"nEtIl~()~----r~G;:.:s~o=r~a~i~r~in~p~le=u=ra:;ls:p:a:c:e:---~.~~E;xt==e:rn:a~l~w=o:u=n:d:-------"T:~H~x~(~'r=a~u=m~a~)-,C~sc-------~--~--c.~s~p=o==nl~a~n~e~o~u~s~r~e~c~o~v~e~ryC---------thorax
Causes:
Severity depends on amount Auscurtation: 'ig~_=",~ Mild: cage rest until resorption
#1 trauma (bile, puncture, carlrauma)
Ribfxs., puncture of chest wall,
333, 317, 336; 1M 233,
trachea, lung, esophagus
245; lM-WW 234; 5min
- Spontaneous: occurs in absence
956; CallOS3; Sx-ww
of Hx of trauma
82; Pa-T 171: X-RP 112;
. Rupture of air containing space: bulla,
X3T 329
bleb
AssoCiated wI underlying pulmonary diz
.. Neoplasia, granulomatous lesions,
pneumonia, fungal Infection, parasites
- latrogen,"c
Diagnostic procedure (pulmonary
aspirate, TTW, bronchoscopy)
" Surgery
Types of pneumothorax
1 Closed a" t
ped" th
: Ir rap
10 orax
'k~~"
/?-~. Open: air out of thorax through
wound
3. Tension pneumothorax: flap of
tissue allows air in thorax, but
stops escape
~;B~~55;i~b~~~;i:~
**
",..
OO_~_.. ___
of air
emphysema
Restrictive dyspnea
. Shallow & rapid (tachypnea)
_t Inspiratory effort & depth
sa
-+
--_...~_______
I'-~ [!.-~;"~:"
~,-~-w:n
O-J
~\
DDx:
&-~
Pleural effusion
Diaphragmatic hernia
Pulmonary contusion
Thromboembolism
Pneumonia
Asthma (cat)
r,1t;6!;111 l'---~~-.../
l%
~~-..~ r-;.~.'l1
&~~'
l@;j(
L.". f
Prognosis:
=~ >
Good if seals & air removed ~~,~
Poor if air leaking from
pulmonary or esophageal lesions
162
Facts/Cause
Condition
Mediastinitis
Presentation
Inflammation 01 mediastinum
H3B 206: H2B 230: Ehb 370: Acute: usually bacterial
5min 807
- Strep., Staph. & E. coli
Hx, CS, PE
t Inspiratory &Jar expiratory Radiotogy:
effort
- Initially: maybe no findings
- Anaerobic important if
- Widening of mediastinum wI loss
Dysphagia
esophageal perforation
- Thoracic pain
of detail
- Diffuse or localized (abscess/es) - Fever
- Air in mediastinum if esophageal
rupture
Chronic: usually fungal
- Concurrent pneumothorax or
- Histoplasmosis, coccidioidomyhydrothorax
- Deviation of trachea or esopha~
cosis, blastomycosis &
Edema of neck, head &lor foregus abscesses or granulomas
cryptococcosis
legs (cranial vena cava syn- Contrast to evaluate esophagus
- Bacterial also may cause (Actlnomyces,
drome)
- Concurrent pneumothorax or
Nocardia & Corynebacterium spp.)
hydrothorax
- Commonly abscess or
Fine needle aspiration (cuhure &
granulomas
sensitivity, cytology)
Surgical biopsy (mediastinoscopy,
thoracotomy)
Re-radiograph weekly for bacterial
- Esophageal rupture or perforation
diz, 2-3 weeks for fungal diz
**
~~
~l J
.J
"'-_LJ
Bacterial or Fungal
CS: Dyspnea, Dysphagia, Edema
Dx:Rads
Tx: ABs or Antifungals
. 2 to foreign bodies
Trauma
-~=:I(i::::::~b:~n:::py)
tissue
- Tube thoracostomy
- Thoracic surgery
DDx:
Mediastinal masses - neoplasia
Mediastinal hemorrhage (surgery,
trauma, coagulopathies, thymic
vascular disruption
Mediastinal edema (infection, trauma)
j,-__-::-___-:---:_____,I
Causes: Pneumomediastinum:
Penetrating wound of head, neck, or cranial
thorax, Air dissects through thoracic inlet
Airway or alveolar rupture
. Iatrogenic (bronchoscopy, nw, Tracheo.
stomy)
. External trauma
- Esophageal rupl1Jre (FB, trauma, ulceration &
perforation, neoplasia)
- Abdominal surgery
- Mediastinoscopy
Gas producing bacteria (rare)
bacteria) 36 weeks
Treat cause
Medicine
- Broad spectrum ABs (suspect
.~.-""
Bite wound
Migrating foreign body (grass awn, needle)
Pneumomediastinum,
Mediastinal
emphysema
Treatment
Diagnosis
Prognosis: Guarded
o Hx, CS
o Physical exam (PE)
Radlofogy:
Visualization of structures not nonnally
seen (cranial vena cava, azygos vein, brachlo :=~:Ve dyspnea (t inspiratory effort,
cephalic trunk, right subclavian & carotid ar
shallow & rapid)
terles, esophagus & tracheal wall)
SO emphysema
If severe: orthopnea (position breathing),
Facial
planes of neck visible
open mouth gasping
- Concurrent pneumothorax, pneumoretro
Ballooning of thoracic Inlet on expiration if
peritoneum, hydrothorax
severe
Pneumopericardium (rare)
- Sequelae to elevated mediastinal pressure
. Pneumothorax, Hypotension, Ventilatory
failure, Diminished venous return, En
gorged neck veins
Asymptomatic
0 SO emphysema mild to profound
0 Pneumothorax: Dyspnea & coughing
0 Esophageal rupture: thoracic pain, fever &
-Esophag'~FB
dJ}~
<~ ~
0U
Toxicology - Respiratory
Pentachlorophenol; Pressure wood treatment (fungicide), Rare since EPA restricted use In 1980's, livestock
lick "leaky" wood, t02 demand; Irritating to skin & respiratory tract; Not street dust see pg 737
CS: Gasping; Nervousness; Rapid pulse & respiration; Weakness, Muscle tremors; Fever; Convulsions - Death
Ox: Rapid rigor mortis; Blood
Tx: No specific therapy, Auids to flush kidney, Bath, Activated charcoal & support; Anticonvulsants. Px: Guarded
PCP, penta
M8k 2097; Mk 1696; Tox 239;
ToxWoN 273
*
Hydrogen sulfide
See Tox pg 725: Toxic gas, "Ronen egg" small, Agitation of liquid manure holding pita, Irritant to eyes & respiratory system
CS: Pulmonary edema, Hyperpnea, Apnea, Asphyxia
Tx: Fresh air, Artificial respiration
Px: Guarded to poor depending on severity
Smog S02
H2S
SmOke.
Zn P
__
q"
___________
~r
~:4...f ( ,
, ~
~ ---- -
- ~
'--""L.A...--V
~)
Rare: (atphaNaphthylthioureaj; Use declining because of more effective rodentlcldes, bread or sausage baits; t permeabilityotpu!monarycapillarles,
Strong emellc (protects some animals that vomit), rodents unable to vomit
0 CS: Pulmonary edema: ~drowns in own fluid-, sits wi forelegs extended & elbows out, head & neck extended to breath, Ataxia, low temp, Death
0 Tx: No specific Tx: Emetics early before edema, n-amyl mercaptan or Na thiosulfate; + 02; Mannitol; Atropine; Nebulization
~
~ - Px: Grave, better prognosis if sulVlve beyond 12 hours
3 2
M8k 2147;
H2B 1310
__
."..,...-;-J
. . .. '{" /f.
ANTU *
M8k 2143;
H2B 1309
_~
..1
f #)
Zinc phosphide; Kilra\, GophriOXl, Release of phosphine gas on contact wi water (more rapid at low pH), Odor of rotted fish, Emetic
- CSlDx: Exposure, Running & yelping fits, Rapid death, Dyspnea, Garlic smell to stomach
Tx: No specific Tx, Gastric lavage, oral bicarbonate,
NPO for 24hours, symptomatic Px: Guarded
163
1
..s'
Ii
~
.-.,...;
~i
~.
cause
Ultrasound:
differentiate
abscess,
way obstruction; stridor & voice
- Radiation therapy adjunctive
changes)
cyst or tumor
Cysts:
Horner's
Radioisotope for ectopiC thyroid tissue
- Extrathoracic drainage via needle
Cytology, culture & sensitivity
aspiration
- Lung, lymph node aspiration,
Mediastinal lymphadenopathy
- Surgery if fails
pleural fluid or biopsy
- Infectious
**
.'
~
I
,'
Neoplasia
- Lymphosarcoma
Bacteria (mediastinitis, pyothorax)
Anterior mediastinal- cat
Fungal (Coccidioidomycosis, his Multicentric - dog
toplasmosis, blastomycosis, cryp Lymphomatoid granulomas
tococcus)
- Metastatic neoplasia
Mycobacteria (rare In USA)
- Thymic tumor
Cysts (uncommon)
- Tracheal tumor
- Pleural, lymphatic, bronchogenic &
Abscess or granuloma (bacterial or fungal)
thymic; usually benign, ventral compartment
- SystemiC diz
Noninfectious granulomas wi
- Bite wound or esophageal perforation
eosinophilia
Compression
CS: Asymptomatic, Cough, Obstructive/Restrictive breathing
Ox: Rads
Tx
anterior
mediastinal
III!
DDx:
Lung masses l!o.:~='\&,,,,,,-s-..J
Cardiac masses
Diaphragmatic hernia
**
...
DDx:
Ectopic thyroid tumor
Heart base tumors
Thymomas
Pulmonary Ilyn'ptlon,atoic[
Hx, CS
Physical exam:
noncompressible
""ff""
cranial ~ediastinum
~
AuscultatIon 9
~
-. Bronchovesicular sounds
-Wheezes
- Displacement of pulmonary sounds to cau
dal thorax
M~
""
I,
t:i
FeLV+
'..
>
k\)
:a;
/J./~J!jJ!-
"w:t:t~-:;~l---
(~
Pulmonary
alveolitis &
interstitial
fibrosis
Dog
Mk 759; SAP 569
**
Ster~
~
~.
causes:
- Often early form of effusive dlz
- May be present 'NIlen effusive dlz resolves
effusion)
- Shallow & rapid breathing (pain)
Lethargy (reluctance to move)
o Fever
o Anorexia
III:~
Pleuritis,
Pleurisy
Tx frustrating, no cure
Hx, CS
Auscultation: bilateral, ventral, end-in- Eliminate smoke, dust or fumes
spiratory & early-expiratory crackles Control obesity
(most evident on lull Inspiration)
Trial bronchodilators
- Advanced cases crackles audible wlo stethoscope
- Sustained release theophylline,
Forced exercise: tachypnea or gasping, cyanosis
Aminophylline or oxtriphylline
Radiology: usually mild, diffuse interstitial
Steroids (CCS) initially: prednislung density
olone (immunosuppressive), then taper; may
- Retraction 01 lungs, nat diaphragm
'~;~;~;;.~~;~~;~J:~. ft~,~~". ~
Few
any. ~thOloglC
- No iflung
Diagnosis by ruling
Ultrasound: picks
Thoracocentesls:
- Cytology, Culture & SenSitivity (include anaerobic)
- Gram stain for tentative bacteria
.CI.u.;n,,,,t.of~~
~~
, ttloracocentesis
IJ
lIt '
.~:i"o'~""~)
=-0'
~-.---=~-------------
CIRCULATORY SYSTEM
Abbreviations Used in the Circulatory System
APCs
ASD
AV
CHD
CM
CO
CPA
DCM
DDx
DV
Echo
ECG
FUS
HCM
HR
HWD
LVA
MI
PDA
PMI
PPDH
PRAA
PS
Q
RAE
RCM
RVE
SAS
SV
TE
TF
TI
VD
VPCs
VSD
Mini Index
168
Accessory spleens 322
Anemia 274
Anterior mediastinal
lymphosarcoma 311
Antiarrhythmic drugs 192, 252
Aortic stenosis 197
Aortic valvular insufficiency 219
APCs 261
Arrhythmias 253
Arsenical toxicity 209
Atherosclerosis 237
Atrial fibrillation 229, 262
flutter 251, 262
premature contractions 261
septal defect 199
standstill 250, 257
tachycardia 261
Atrioventricular block 259
Atropine challenge test 258
Auscultation of thorax 178
Autoimmune hemolytic
anemia 279
Babesiosis 281
Bacterial endocarditis 218
Birman cat neutrophilic
anomaly 297
Bleeding disorders 288
Bradyarrhythmias 250
Hemophilia 293
Hemorrhage 277
Hydrothorax 183
Hypercalcemia 240
Hypereosinophilic syndrome 303
Hyperkalemia 238
Hypertension 243
Hypertrophic cardiomyopathy 223, 224
Hypocalcemia 240
Hypokalemia 239
Immunemediated hemolytic
anemia 279
thrombocytopenia 292
Intraventricular septal
defect 198
Iron deficiency anemia 285
Junctional premature
cpntraction 251
Junctional escape 259
Leukemia 315
Leukocytosis 296
Leukopenia 296
LSA 308
Lymphadenopathy 324
Lymphedema 323
Lymphocytes 301
CIRCULATORY SYSTEM
Lymphoid hyperplasia 324
Lymphoma 308
Lymphoproliferative 315
Lymphoreticular neoplasm 308
Lymphosarcoma 308, 310
Macrophages 300
Malignant hyperthermia 239
Mean electrical axis 186, 189
Mixed hemostatic defects 294
Mobitz type 1 & 2 258
Monocytes 300
Murmurs 179, 212
Myelodysplastic syndrome 316
Myelofibrosis 317
Myeloproliferative 315
Myocardial diseases 234
Myocarditis 234
Neutrophilic anomaly 297
Neutrophils 298
Nonregenerative anemia 284
Normal sinus rhythm 254
Nutritional myodegeneration 237
Oleander 245
Oncology 304
Osteosclerosis 317
Patent ductus arteriosus 200
Pelger-Huet anomaly 297
Pericardial disease 230
Peritoneopericardial diaphragmatic
hernia 230
Persistent right aortic arch 199
Physical exam 176
PMI heart valves 178
Polycythemia 317,325
Postcaval syndrome 208
Preleukemic syndrome 316
Pulmonary edema 182
hypertension 242
infiltrate wi eosinophilia 206
Pulmonic stenosis 196
Radiograph - heart 180
Restrictive cardiomyopathy 226
Rhythms 250, 251
Right AV valve dysplasia 199
AV valve insufficiency 217
congestive heart failure 208
ventricular enlargement 270
Rupture of chordae tendineae ~16
169
CIRCULATORY SYSTEM I
- Cardiomyopathy
Dilated cardiomyopathy
.. Idiopathic dilated cardiomyopathy
. Taurine delc (cats)
. camlline defc (dog)
- 2 myocardial diz
Myocardial trauma
Thyrotoxicosis
Hypertension (renal failure)
Myocarditis (paIVo)
Chronic anemia
Doxorubicin toxiCity
Enterotoxemia
Cardiac arrhythmias
- Tachyarrhythmias
Atrial arrhythmias (tachycardia, flutter &
fibrillation)
Ventricular tachycardia
- Bradyarrhythmias
Hyperkalemia
.. Iatrogenic
.. FUS (cat)
.. Hypoadrenocorticism
Sick sinus
SA block/arrest
Silent atrium
Pericardial dizs
- Pericardial effusions
Idiopathic
Infectious
- Constrictive pericarditis
CardiaClparlcardiai neoplasia
- Shock
Other organ systems:
- Brain
- GI: gastric dilatation & volvulus (GOV)
- Kidneys: hypertension
- Lungs: cor pulmonale & hypoxia
- Pancreas: necrotizing pancreatitis
- Endocrine:
Hypothyroidism (dog)
Hyperthyroidism (cat)
Hypoadrenocorticism
IHistory - Ox
Z:f{
~t
<
tV
CIRCULATORY SYSTEM I
History (obtain as much as possible)
Questions to ask:
Breed predilection
Beagle
Bichon Frise
Boston terrier
Boxer
---P-S'-AV-dY-SP-'~'~
-.L-abr-ado-r
PS; VSD
PDA
PRAA
OCM, SAS, ASD, TF, Sicksinus, neoplasms,
Newfoundland
myocarditis
~ Mahase
Brachycephalic breeds SA block
,. r(\,
Middle to large dogs
Bull mastiff
OCM
Miniature poodle
Bull terrier
SAS, AV dysplasia
Miniature schnauzer
Cavalier King Charles AV diz (Mitral AV), BE
Outdoor ~og
Chihuahua
PDA, PS, AV dysplasia
Pomeranian
Cocker spaniel
POA, SA block, AV diz
Poodle
Collie
PDA
Pug
Dachshund
SA block, Sick sinus, Tricuspid AV
Rottweiler
Dalmation
SA block
Samoyed
Doberman
OCM, Digitalis sensitivity, ASD
Shetland sheepdog
Eng. bulldog
PS, VSD, AV dysplasia; TF
Shih Tzu
Eng. springer spaniel POA, SA standstill,
~ Small dog
Eng, sheepdog
SA standstill
~. Standard poodle
Fox terrier
PS
/ {"
~ S1. Bemard
Golden retrievers
SAS; VSD
.
Temers
G, shepherd
PDA, SAS, AV dysplasia; PRAA, BE,
Toy & small breeds
Toy poodle
HCM, DCM, Pericardiai effusion
G. shorthaired pointer SAS
Weimaraner
Great Dane
AV dysplasia, OCM
Wirehaired terrier
VSD, PRAA
Yorkshire terrier
Irish setter
DCM
Irish wolfhound
PDA, VSD, TF
Keeshond
-".....-:.~
'~i:.~V
c~~
___
CIRCULATORY SYSTEM I
Fainting
Tiring
(syncope)
(exercise intolerance)
Cardiogenic:
- Pulmonary edema wi left heart failure
Cardiogenic:
~ Left atrial enlargement
- Pulmonary artery enlargement
- Pulmonary edema
Noncardiogenic:
- Airway disease
- Pulmonary fibrosis
Weight loss
Lameness:
Noncardiogenic:
- Pulmonary edema
Respiratory distress syndrome
- Alveolitis
Electrocution
- Neoplasia
Brain trauma
Pi:~:~effUSion
Inflammatory
Class 2:
Class 2
Class2a
Class 3:
Class 3
Class 3a
- Class 4:
Class 4
Class 4a
Class 4b
~~fZ:!lJ
Neoplastic
(.\ '-"
- Pneumothorax: spontaneous & traumatic
- Upper airway obstructions
Elongated soft palate
Laryngeal paralysis
- Lower airway obstructions
Fibrosis
Asymptomatic
~"t+
:0...\
Infectious
Class 1:
,e:
, ....
Cardiac causes:
- Bradycardia (AV blocks. Sinus arrest, Sicksinus syndrome, Atrial standstill)
- Tachyarrhythmias (paroxysmal atrial or ventricular tachycardia,
reentrant supraventricular taChycardia, atrial fibrillation or flutter)
(pulmonic stenosis,
subaortic stenosis)
- Acquired ventricular outflow obstruction (heartworm, hyperirophic
obstructive cardiomyopathy, thrombus, tumor)
- CyanotiC heart diz (tetralogy of Fal!ot, reversed PDA)
- Pericardial effusionltamponade
Constricllve pericarditis
- Pulmonary hypertension
Metabolic or hematologic causes:
- Hypoglycemia
- Hypoadrenocorticism
- Electrolyte imbalance (potassium, calcium)
- Anemia
- Sudden hemorrhage
Neurological causes:
- Seizures (aura, ictus & postictal signs)
- Neuromuscular diz
- Cerebrovascular accident
Narcolepsy, cataplexy
DDx - Lameness
Cardiogenic:
- Thromboembolism
l~
Noncardiogenic
GI
- Resp
. Neoplasia. etc.
1):
~V""
(r
. Cardiomyopathies (cats)~
. Septic embolism
(bacterial
")-;:
endocarditis (dogs)
Noncardiogenic:
- Orthopedic
~ Trauma
,1
'-;'-~~
/
ICardiology
CIRCULATORY SYSTEM I
Heart rate:
Fluid accumulations
Ballottement of abdomen, percussion of chest
& palpation of dependent skin areas
ICS '" Intercostal space
t CCJ '" CostOChondral Junction
Hyperemic
- Palpation for tracheal masses or collapse
Abdominal palpation: hepatomegaly, splenomegaly
& ascites (ballottement)
Pulse
-Weak pulse
Cardiac examination:
Jugular vein distension/pulsation
(pulsation higher than 113rd of the.-,!f\>~:<'.w.-<!!(y~~
way up neck)
Altered arterial pulse: (normal
cal pulses can be difficult to palpate)
Excessively strong (hyperkinetic)
Findings
.~::::-~
'-
- PDA
Aortic insufficiencies
Hyperthyroidism
Anemia, etc.
(hypokineUc)
.. ObeSity, pleural or pericardial effusion. masses, or pneumothorax
Pulse deficits
Atrial fibrillation
Ventricular premature contractions
-~
.. ~~--------------------------------~.~
OOx - Jugular vein
distention/pulsation
1M'
Distention alone
- Dilated cardiomyopathy
- Pericardial effusionltamponade
- Right atrial mass/inflow obstruction
- Cranial mediastinal mass
- Jugular vein/cranial vena cava thrombosis
Pulsation distention
- Right (tricuspid) AV regurgttation
_Cardiomyopathy
. Congenital
. Endocardiosis
- Pulmonic stenosis
,II
. Pulmonary hypertension
. Premature ventricular contractions .....
- Heartwonn diz
- Complete 3rd heart block
1M'
Pale - pallor
- Anemia
- Poor cardiac output
- Shock (hypovolemia,
bradycardia, etc.)
Displacement of heart
- Mass lesions
- Lung atelectasis
- Chest deformity
- Right ventricular hypertrophy
Weak pulses
- Dilated cardiomyopathy
- Subaortic stenosis
- Shock
- Hypovolemia
Strong pulse
- Excitement
- Hypertrophic cardiomyopathy (cat)
- Hyperthyroidism
- Fever/sepsis
Very strong. bounding pulse
- PDA (patent ductus arteriosus)
- Fever/sepsiS
Pulse deficits
_Atrial fibrillation
- Ventricular premature contractions
~/{.
f
I
1)
. -------""--0
~
1"
'-.)
b___\=~
j
,\
L
IAuscultation Ox
Auscultation of thorax
IM-WW 139: 12M B: Cat 822: H-Pic 24: H-T/M 9;
CIRCULATORY SYSTEM I
pAM
34 5)
--'111111'--------' 1,1-
Valvular dizs
Endocardiosis
Congenital aortic stenosis
Congenital pulmonic stenosis
Congenital AV valve dysplasia
Bacterial endocarditis
AV valvular regurgitation
due to cardiomegaly
R
Q
Heart sounds
Normal
- 81 (Iub): closure 01 AV valves (start of ventricular systole)
- 82 (dub): closure of semilunar (aortic & pulmonic) valves
(start 01 ventricular diastole)
54
- Pulmonic valve
- Aortic valve
Valve dysfunction
Stenosis: obstruction of flow (usually congenital)
Regurgitation (insufficiency): incomplete closure
of valve (congenital or acquired)
ECG
Phono
r----'-.::::O:':::.=:::::::::.::..:::::::::::.:::l!::::..:::..:.::::::..:..:=-,
82
Plateau, regurgitant
(Lt. apex)
- Aortic stenosis
- Pulmonic stenosis
- Rt. AV regurgitation
Right side
Left side
Left side
Atrial septal defect, pulmonic regurgitation, Tetralogy of Falro! are rare causes of murmurs
179
1'1\
"
Continuous (machinery)
- Patent ductus arteriosus
IRadiography
CIRCULATORY SYSTEM
Radiographs - Heart:
12
j. Oescending aorta
X4T 335; X-Ger 144, 234(1); cat 826; F31M249; IMWW 144; H-Pic 32
h. Aorta
n. Trachea
3
h.Aorta
12
k. Cr. waist
11
4
LATERAL VIEW
a. Cranial ~na cava: ventral edge seen
b. Caudill vena cava: between heart & diaphragm
.:--e. Right sfde heart: 6 to 11 o'cloCk - cranial aspect
c. Righi atria fRA): upper part of the cranial heart
d. Right ventricle (RV): 610 9 o'clock -lower cranial heart
e. Pulmonary trunk (main pulmonary arterylMPAlto radiologists):
nol seen on lal. view (superimposed)
t-g. Lett heart: 1 10 6 o'clock caudal aspect
t. Lett alrium: 1 to 3 o'cloCk upper, caudal heart
g. Lett ventrleSe: 3 to 6 o'Clock - ventral, caudal heart & apex
g'. Apex: S o'dock
h. Aortic arch: 11 10 12 o'clock - out of heart base
I. Brachlocaphallc trunk & It. subclavian a.: not seen, unless
pneumomediastinum
j. Deacendlng aorta: high againsllhe vertebrae
k. Cranial waist: 9 o'clOCk between the cranial vena cava & right
atrium
I. caudal waist: 3 o'dock - coronal)' groove
m. Slemopericardiac ligament: pericardium to stemal noor
n. Trachea
n' "Carina": bifurcation of traChea
~
MPA
./'
10
5
6
m. Stemophrenic ligament
9-
DVVIEW:
a. Cranial vena cava: not seen
.b. Caudal vena cava: right heart to diaphragm
~.......----c. Right atria: 9to 11 o'clOCk
V
d. Right ventricle: 6 to 9 o'clock
=
( Q
e, Pulmonary lrunk (MPA): 1 to 2 o'clock
8
t. Lett atrium: 2 to 3 o'clock, superimposed unless enlarged
g. Lett ventricle: 2 to 6 o'Clock
g'. Apex: S o'dock points to the left
h. Aortic arch: not 11 1 o'clock position
b. Caudal vena cava
i. Descending aorta: lett edge seen
j. Phranicopericardiac ligament: left mediastinal margin
_~lc--~-------------------------------~.~
2/5-3/5 rule: Draw a line from the "carina" 01 tM
trachea to heart apex (latera! view)
> 21Sth of the heart In back of the line II. heart
enlargement
> 3J5th of Ihe heart In front altha line Infers rt. heart
enlargement
Any chamber
RAE
RVE
RVE
RVE
LAE
LAE
LVE
RVE
<s ",",,,,,,""'..L.l..
DVview
- 9 to 11 o'clock bulge
- BaCkwards '0' . 6-9 o'clock
- Apex to lett
"Cowboy legS" (main bronchi)
3 to S o'dock bulge
Apex to right
RAE
lat view
DV view
RVE
LAE
RAE
RVE
RVE
LAE
LVE
LVE
RVE
(Rt. ventricular
enlargement)
I~
~~
LAE
LVE
Major vessels
Enlarged aortic arch
- Findings:
lat.: elongated cardiac silhouette, protrusion of cranial heart border 11-1 o'clock
DV: widened aortic arch 11-1 o'clock
- Causes
Patent ductus arteriosus
Aortic stenosis
Aortic aneurysm
v---....
LVE
<;;~""'~~
181
~IR-a-d-io-g-ra-p-h-y------------~~
Radiographs - Chest & Abdomen
XRP 101, 109, 123; X-T 353; 12M 30
Interstitial pattem
Chest is evaluated for air & fluid in lungs & fluid in pleural space
Abdomen is evaluated for ascites (peritoneal fluid) due to right heart
failure & back up of fluid into abdomen
CIRCULATORY SYSTEM
Pulmonary circulation
Under circulation (hypovascularity)
- Findings: more radiolucent lung fields
<';/I;'(}fJ?l'//J;
{-I1IIIL'
Pulmonary arteries smaller than veins r (
- Gauses:
Pulmonary edema
UsuaJly caused by congestive left heart failure - fluid backs up into the
pulmonic circulation, may also have noncardiogenic causes
Types of pulmonary edema
Alveolar pattern
Interstitial edema - fluid in lung tissue (parenchyma)
Vessels fuzzy, but evident
I ( t I (
/.
Overcirculation
- Findings
Arteries larger than veins
Mf1J!!!!1h
r"'(,~
Memory aid :
Veins are ventral & central
-Infection
- Toxic (smoke, endotoxins, venom,
ANTU)
- Allergy, anaphylaxis
-Trauma
- Uremia
- Over transfusion
- Lymphatic obstruction
- Venous obstruction (tumors masses)
- Hypoalbuminemia (nephroSiS, liver failure. enteropathies)
- Neurogenic (head trauma, encephalitis, brain tumors)
+Tissue density, not fluid mistaken for edema
- Interstitial fibrosis
- Interstitial pneumonia
- Atelectasis
- Allergic conditions
- Lung worms
IEchocardiography
CIRCULATORY SYSTEM
Echocardiography
(Cardiac UltrasoundlUS/Echo)
ff~.4
M-mode
rw
~~~~~W~;L2Z;z;a;*";;;~i~
H-T/M eo, 474; H-hb 31; 1M 30; SAP 448, 501; 12M 40; Cal 835;
IM-WW 146; H-Pic 43
'''S~
LV~
'L-I/.w
U<'j~=~"""=""'"
~/?~~
0- I
Apex
Fi;B Lt AV valve
- //
Chamber size
Cardiac contractility
::.
_
(Le., fractional shortening)
~ Common M-mode views
Va/ve in motion
~ r.sD
~
e2D (two--dimensional) or grey scale
~ [c7~
- -Pie section" view of heart
""""""'~~~~~
- Both real time & static images
- Uses:
AMV Anterior septal mitral valve cusp
Overall impression of cardiac chamber size &
Ao
Aorta (M)
motion
APM Anterior papillary muscle
IVS IntelVentricular septum
Valvular structure & function
Doppler: uhrasonic cinetoarteriography
- Compares frequency of transmitted ultrasound wi received
US of moving cells (blood cells), cells moving towards
transducer have higher frequency than those moving away
- Used to estimate velocity of blood flow
....,....--,,,:
LA
LC
LV
LVW
NC
PMV
PPM
PV
RA
RC
RVW
TV
1W
Left atrium
Left cusp of aortic valve (20)
Left ventricle
Left ventricular wall
,,
20
20
Dimensionallong-axis
echocardiographic views
Dimensional short-axis
echocardiographic views
185
ECG
CIRCULATORY SYSTEM
Electrocardiography, ECG
Normal dog & cat ECG values (1"60) Speed: 50 mmisec, Sensitivity: 1 mv
=10 mm
SAP 412; H-TIM 47, 474; H2B 72; 12M 13; IM-WW 140; CAT 837; H-HB 17;
HF 43, 113; H-T 8; H-Plc 37; Pys-B 142, 159, VC-Ox 217
ECG analysis: evaluate from left to right In basic limb leads (I. II,
~~--
......--""'_...
"",
Rhythm
Pwave
Height
Width
Canine
Feline
120200 bpm
Sinus rhythm
Sinus arrhythmia
Wandering pacemaker
Sinus rhythm
~ 0.4 mV 4 boxes)
0.04 sec 2 boxes)
PR interval
QRScomplex
Height
Width
0.2 mV 1 box)
S-Tsegment
Depression
Elevation
Q-T interval
Twave
Positive or negative
Electrical axis
+ 40 to + 1000
0.9 mV
(~9)
None
None
-_. ._ - - - - - - _ . _ - -
--.
3 seconds
I
r---6Boxes
Calculate
sro control
(calibrate stylus)
Marker button
(marks on paper)
Sensitivity switch
IIIII
HR (heart rate)T44
Irregular rates
- Count R-R intelVals in 3 seconds (2 sets of time markers at 50 mmlsec)
Multiply by 20 ............................................................. 6 complexes x 20 =120
Regular rates
- Count number of large boxes in 1 R-R intelVal
Divide into 600 ........................................................... 600/6 = 100
~ Count number of small boxes in one R~R intelVal
Divide into 3000 ........................................................ 3000/27 = 111
(contrast of tracing)
II
Paper speed
Stylus position
srD button
IECG
CIRCULATORY SYSTEM
0.02 sec
CAT 837
P wave:
P-R Interval:
Depolarization 01 atria
Delay of Impulse through AV node & bundle
of His
Ventricular depolarization
Depolarization of septum
Depolarization of left ventricle
Depolarization of right ventricle
Interval of ventricular systole
Repolarization 01 ventricles
Ventricular depolarization & repolarization
ORS complex:
wave:
- R wave:
- 8 wave:
SoT segment:
T wave:
Q-T Interval:
-a
0.5 nV
0.1 mVlbox
QAS complex
SoT segment
QT interval
T wave
A
Q
......-...
HA
~)
(20m...,)
~
~
0.1 mV
~~~~-A ~
L
r / "'
...
SoT
V-
I"'.
\I
T
I
QfS
rp-R-"*f'----Q-T--~')
interval
interval
I
complexes to calculate
"".".""".~'""..~..~...~-'-'---------------------------------------------------;;;:;;;~
-~
90'
_30 0
180' 1------'-2~:-'----__I
+180
Right axis
deviation
Lead system
Left axis
~0 deviation
~
Right axis
deviation
Chest leads
- Lead V10: over dorsal spinous proceSS of 7th thoracic vertebrae
- rV2 (CV5AL): rt 5th ICS' near sternum
- V2 (CV6LL): It 6th ICS near sternum
V4 (CV6LU): It 6th ICS at costochondral junction
Minimum leads to be recorded for dog & cat : 3 standard leadS & 3 augmented
unipolar leads
Lead selector switch to select different combinations
Other lead systems used for specific conditions
- Chest leads not needed for every patient
. Useful when ECG complexes In limb leads are small & difficult to evaluate
& to evaluate right heart enlargement
ICS _ intercostal space
E3:-
+1500
'tr
_90 0
.90
Left axis
deviation
Normal axis
30'
-180 0
+1800
00
0'
Normal axis
ii.,..
II
CIRCULATORY SYSTEM I
III
-,08
8'50.
.180
0 f.:\
.,ao
f------'-all<'-'------i o. ~
0
aVR
aVL*
aVF
+150 .
.90
1\ is positive to axis
Therefore MEA is +60 (a normal axis)
35-45 mm Hg - normal
< 30 mm Hg - inadequate cardiac output
< 25 mm Hg - overt failure
- Medication serum levels (e.g. digitalis)
Urinalysis (pretreatment): renal function & prerenal
azotemia
Heartwonn: occult (serologic), microfilaria
Auid analysis (pleural effusion or hydroperitoneum)
- Chemistries, cell numbers & types, cuhures & serology
to characterize type of fluid (transudate, modified transudate, exudate, hemorrhage, etc.) or identify etiologic
agents (infectious or neoplastic).
Thyroid/adrenal: T41evels & TSH stimulation/Dexamethasone suppression & ACTH stimulation
::::i::~:::~ydUreS ~~M=:::tti""-_.~~~,y
~~
~-....
""'ymy""",",Id"
'z.
"- .:-~.
,_
<!.11'"
CIRCULATORY SYSTEM I
Stages of Congestive
Heart Failure
Treatment summary
Class 1:
- No CS of failure, murmur
None necessary
Consider low Na diet
Class-2:
- CS wI exercise
l1I-,- .
-1I
Treatment
Glycopyrrolate (Robinul)
0.9% NaCI fluid IV
Pacemaker
None
Class 3:
- CS wI normal activity
l!
-- J '
or at night
-.JWoI
:~~;;'~~:~ne,
eJ
.~
Class 4:
- CS at rest
<.~
~ DIgoxin
I~'
Inderal
':'h/d
- ---
Pro-Banthine
Stop dig,it,aliS
None 10 Tx underlying cause
--: '
Propantheline (Pro-Banlhine)
Pacemaker
Digitalis
Digoxin
Digoxin
\I! Ill!
Enacard
Rest + 3 Os
- Rest (exercise restriction)
- Diuretics (LasiX)
- (Vaso)Dilators (enalapril)
- Diet - low sodium
Antiarrhythmics &
antitussives
Bronchoclilators Digoxin
Rest + 3 Os +
- Strict rest
- Diet: low sodium
- Diuretics
- (Vaso)Dilators: (enalapril)
Oxygen
11+ contractility (Echo)
- Positive inotropes
(Digoxin)
~I III[
LJ
1lI-~
,~_
Hypertrophic cardiomyopathy
- NO digoxin (not a contractile problem)
- Dittiazem (Cardizem) to cause
relaxation ( t ventricular filling)
Bacterial endocarditis (BE) & infective
myocarditis (Lyme dlz, trypanosomiasiS)
- ABs (Antibiotics), months for BE
Nutritional dilative cardiomyopathies
Taurine (cats) & carnitine (dogs) supplementation
a:---- .
_
rd'
[lID
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ti .
lV__-_I,
._, .
rmJ~
ri
/1/1
$=
CIRCULATORY SYSTEM
Congenital
heart diz,
CHD
***
which can be
hereditary (genetically linked) or originate during gestation (in
utero fetal dlz)
_Mostly associateclw/lt-lo-rtshuntorCHF
pulmonIc stenosis)
km.-
{,.I-:::
~~
(\\
~~.-;~~
____ ./
Auscultation
- Murmur In puppy or kitten may Indicate congenital diz or be Insignificant
-.~
.( J
IZ:"'':::';~I '~~II
~'"/~""
- Mucous membrane
ps.
....
Often normal
Weak (hypoklnetlc): II ventricular ouUlow obstruction or CHF
Bounding (hyperkinetic) - POA or aortlc Insufficiency
Most asymptomatic
Stunted growth
....r..r--.
Thoracic radiographs:
Echocardiography (US)
- Some anatomic abnormalities visualized (ASD. VSD. SAS)
- Cardiac enlargementlhypertrophy
- Saline ejection (contrast) into peripheral vein; rito-It shunting
- Doppler echocardlography: anatomical detail, blood flow
Information, intracardlac pressure estimates
~ .
i;
;
'"'"
$)
Uncommon defects
Vascular anomalies (dog & cal: 6%)
- Aortic Interruplionlhypoplasia (dog)
- Aortic stenosis (valvular) (dog)
- Aortlcopulmonary window (dog)
- Anomalous pulmonary venous retum (dog)
Atrial malfOlfTlaUon (cat)
Arteriovenous fistula (dog)
Coarctallon of aorta
Cor triatriatum
- Double aortic arCh
- Double chambered right ventricle
- Double outlet right ventricle (dog & cat: 4%)
Ebsteln's anomaly of It AV valve
Endocardial cushIOn diz (dog)
Endocardial flbroelastosls (dog)
OsIll1I1l secundum atrial septal defect (dog)
PulmonIc valve insufficiency (dog)
- Retroesophageai subclavian artery (dog)
oSinus Inversus (dog)
Truncus arteriosus (cat)
Taussig-Sing complex (cal)
Murmur
Nonnal
Innocent murmur
PhysiOlogic murmur
- Fever, anemia
Mild congenital defect
Abnonnal
Systolic
Cyanotic
/
Acyanotic
- Pulmonary hyperienslon
(reversed PDA, VSD, ASO)
- Tetralogy of Fallot
Lt~Rt.side
ps
-ASD
-SAS
- Lt AV dysplasia
oVSD
-ECO
AI AV dysplasia
Systolic + diastolic
-S
~
Continuous
" ') .
l1k
...
Tocalnlde, Propranolol
'-~
T 0 & f ro-soft
SAS + aortic Insufficiency
VSD + aortic Insufficiency
I'
,Enac~,.rd
7:1;'
'Wl'
Arrhythmias
.ps
(I" L.;!~M
~--------------------------------'
Treatment:
Asymptomatic - none may be required - monitor
Surgical- definitive Tx, often not practical or not done
PDA - Sx - TOC: ductus ligation, not if reversed
- Pulmonary stenosis: patch graft
- VSD, ASD: refer, variable success, requires bypass
- Persistent rt aortic arch: cut ligamentum arteriosum
Medical:
- Reversed PDA: rest, phlebotomies
- Tetralogy of Fallot: palliative (resl, beta blockers), Sx not attempted
- AV valve dysplasia: manage heart failure - 3Ds
- Subaortic stenosis: Sx not attempted, Inderal
rt95J
el-- ,_
DigOXIn
PrognosIs:
PDA: excellent wI surgery
~
Reverse PDA: grave
VSD & ASD, small: gOOd; large: grave
~_
~
--.
Lidocaine
'I
CHD - Stenosis
Condition
Pulmonic
stenosis,
PS
CIRCULATORY SYSTEM
**
Diagnosis
Facts/Cause
Presentation/CS
#2 CHO (congenital heartdelect, lIIay be asymptomatic
in dog
Fainting (syncope)
- 20% of CHO In dog, 10% In cat Tiring (exercise Intolerance)
-May becomblned w/tetralogy of Fallot Labored breathing
- At. AV often also malformed
Stunting
B",eds: Eng. bulldog, Fox
~~
Treatment
Hx (breed, age), CS
Physical exam: jugular pulse
Auscuhation:
- Systolic murmur (PllAI) al low left 3rd les
~~
~~~/
~~~
Sequelae:
- Right-sided congestive heart
Failure (CHF)
- Sudden death
ECG:
------
Deep S waves
~
- P pulmonale (RAE)
Radiograph:
"
- RVE: reverse -D" in DVND view
- RAE (right atrial enlargement)
- .. Pulmonary vascu larity
- "Pulmonary knob- (1 o'Clock): post stenotic
/111
aI~
Angiocardiography:
lasiH
Blood pressure:
- Difference between pulm0"'\8.ry artery & right
ventricular systolic pressures
> 70 mm Hg difference hdlcates severe lesion
Prc-g IlOsis:
~ If;~l1
~~l
~ili'
~
.&7
Subaortic
stenosis,
SAS,
$=?
Variable CS
Asymptomatic
Left congestive heart failure
- Weakness
_ Fainting (syncope), collapse
CS~. ~
Hx (breed),
No generally accepted Tx
PE: weak pulse
~-~.
W~. Mild (aortic gradient < 50 mm Hg)
Auscultation:
'
~
'If)()~ - None required
.
f't(iP Propranolol (lnderal) (Beta blocker)
- Systolic murmur
Crescendo-decrescendo
'I
minimize 02 demand of It. ventriCle
Aortic stenosis
ejection (diamond-Shaped) "'t}-_
Vasodilator,ACEinhibitore.g.,Enala
Sudden death - dysrhythmias
PMI _high II. 4th lCS
M8k 70; Mk 36; H-TfM 284:
~~
pril (Enacard) to decrease.afterload (restsInduced by myocardial ischemia
H2B63; Ehb391; F31M269;
Murmur at thoracic inlet & over carotid arteries
tance) and Na (H20) retention
oRarelylungcongestlon(cough,dyspnea)
H-Pic 71; 12M 152; 1M 120;
Palpation:
Calcium channel blocker: diltiazem
IM-WW 168;5min356; SAP
_ Thrill: thoracic & carotid arteries
(Cardlzem) to. afterload (resistance) & di501t, 503t; Cat 694, 871; E
late coronary arteries
923; C12T 822; H-F 143,
- Weak femoral pulse (hypo kinetic) 'pulsus Severe: consider surgery - refer
369,400; Sx-G 130; Sx48
parvus'
IIIII11I1
Prophylactic ABs before proce688;SX-S-HB300; 312; Sx ECG:
"'"Ir-'v-"\.--J~~.
S870, 915; Sx-WW 88; X-T
dures (e.g., dentistry)
LVE
(It.
axis
deviation,
tall
R
wave)
311.343: X-RP 126; Pa-T
183; NB 3.35
- Dysrhythmias (ventricular tactlyarrhythmias)
- Myocardial ischemia (S-T segment depression)
-----Ind~ral-y
Radiograph:
~~- Left ventricular enlargement (LVE)
- Left atrial enlargement (LAE)
Sequela:
- Enlargement of aorta (loss of cranial waist- Aortic bacterial endocarditis
lal. view, widening of cranial mediastinum VD view)
"'il Cardize
~Enacard
- Enlarged aortic arCh
(trauma predispose)
:
'I'
I.
Echocardiography (US):
- LVE - It wall thickening
COx:
/!({
- Attenuation of aortic outflow tract
Pulmonic stenosis
valve
motion
Abnormal
aortic
Txcongestiveheartfailure: Rest
Ventricular septal defect
Anglocardiogram (cardiac catheterization)
+ 3 Os, Cig'oxin (Diuretics,
-LVE
[vasoIDlialion, Diet. Digoxin)
-- Dilated aorta (post stenotic> 1.5 times)
Subvalvular narrowing
Arrhythmias
Blood pressures: difference between leftventricu- - Ventricular tachycardia: Procainamlde,
Tocainlde, Lidocaine. Propranolol
lar & aorllc pressures:
- 10-30 mm Hg: mild
~
~:;l1
- 30-70 mm Hg: moderate
lll (
Subvaivular
~
- > 70 mm Hg: severe
L+. Prognosis:
CS: Asymptomatic, Sudden death ~'
"> _
Good if mild
Guarded to poor if left-sided
Ox: Hx, Systolic murmur, LVE
. 1_.
congestive heart failure present
Tx:None
:;>
**
/0'\
M/{1J!!!!};
\I\(~
197
~,
Ventricular
septal
defect, VSD,
**
Diagnosis
defect
-?~~~~~:;:~7:~:~~~~~ur~~~;~~tlon
enlargement)
i!J)
Left AV
(mitral)
valve
oUAVdiz
malformation
Dog (2"10 of CHD)
dysplasia
M8k 73; 1M 122: IM-WW
t72; H-TIM 293; E-hb
393; SAP 5011, 5031; E
928; H-F 144, 384, 398;
SXS-HB299; Sx-S869,
916
Similar to degenerative
Pathophysiology:
Radiology:
Left atrial
enlargement
(lL~ Enaca~ 1m
:r':~ : ~..~
rio/ ~
~
'....
Atrial fibrillation
~~
- Digoxin, Propranolol
(beta blocker), diltiazem
(Cardizem)
. Combination of above
~.
~ \~.
(l--
>;""
.r.:,.::d
~
iL"'~J(1
.~
Di ;-in
M8k 71; Mk37; H-T/M275: 12M 156; 1M 121; IMWW 171: H2B66; H-pic91; Cat 663; F31M269; E-hb 369; 5min 378; SAP 501t, 503t;
E 910; H-F t4t. 378, 397; Pa-T 182; Sx4B 691; Sx-S-hb 292; Sx-S 659, 916; Sx-WW 92; PaT 182 ~18 3.33
o Opening between atria (e.g., Patent foramen ovale), Cats (4%, dogs 1% of CHD);
Samoyed, Boxer, Doberman: cause: 1; Left-to-right shJnt usually = right heart over~oad
CS: Usually asymptomatic (small), Rarely right-sided CHF
Ox: PE: generally norma!, Auscultation: soft systolic (holosystolic), ECG, Rads, US
o DDx: Pulmonic stenosis, VSD
o
o
+3Ds
- Rest! exercise restriction
- Dluretlcs (furosemide JLasiX\!)])
- Dietary sodium restriction: hid
- Vasodilation: enalaprll
<'g~
~:/
"'S::'p
Tiring, Tx HF
Prognosis:
- Good: 10r small defects
- Varies with size 01 lesion & 2 cardiac changes
Cat,
....1
Physical exam
Insufficiency usually
Large breed: Great Dane, G. shepherd, Bull
terrier, Eng. bulldog, Chihuahua
o Male> female
o cause: may result/rom a combination 0/
defects which cause the affected valve to
leak during systOle:
- Abnormal chordae tendineae
- Abnormal Insertion of valve leaflets
- Abnormal location of AV valve annulus
O~~:,a~"~~,i~.~.:V:~;lmnn~ro Merye!3f'~rdl,"9
\~.,in.~ature
L..::
L-.
~--r
). "
Holosystolic mUrmur:
./I!1
~~!
;i
Treatment
AsYmptomat~'C
F!!i '-:H-::X:-(;:"y=o:-un=-g=-,-:b=re=-e"d;;)"',C;;S;;:::::"'-~"'~::::---+'-:T:-x-n-ot-r-e-q~U~ire~d~in.!:!.!m!..o-st--_.J
Tiring
.,
> dogs (7% of CHD)
-Cyanosis
Breeds: Eng. bulldogs, Beagle, Keeshond.
- Mild respiratory (cough,
Poodle, terriers, Golden retriev~er,
Irish
shortness of breath)
setter
d:<- (V
- Respiratory failure - rare
Cause: unknown
~'
Pathophysiology
- Subaonic or high defect In the ventricular
septum (75% in membranous part)
Intraventricular septal
**
~Ih
CIRCULATORY SYSTEM
Presentation/CS ~.~.
Facts/Gause
.\ ~
(!
I!A9
-,
__~~~~_ _~~~~::'.-;;_ __
-~_
t;;; _
M8k74; 12M 157; 1M 122, F31M266; E-hb396: 5min 380; H2B 65; SAP 5011,.5031; C12T813; E 952; H-F 144, 384, 398; Sx-S 869, 916 *~/,l
-Insufficiency: leak during systole (abnormal chordae tendineae, insert10n o~ valve le~flets & !ocatlon of AV valve annulus, Great Dane, Weimaraner,
~~"
Lab, G. Shepherd, Males> females; Pathophysiology: volume overload to nght ventncle = right CHF
=
CS: Initially asymptomatic, Tiring, aSCites, dyspnea, weight loss
\.J
-.........\
o Ox: Hx, CS, ?E (jugular vein distentionJpulsation, systolic regurgitant, ECG ( tall P wave), Rads & US: RVE. RAE; Cardiac catheterization
~ (
~
o DDx: Degenerative valve dlz (old), Perlcardial effusion, Dilated cardiomyopathy
.)~ .,.:)
f i ./\
o Tx: Manage as signs of heart failure" arrhythmias (LasiX, exercise restriction, salt restriction)
~
1 (
i';
\..$"JI
Tetralogy of Fallot TF M8k 72; Mk 38; H-T/M 291; 12M 158; 1M 123; F31M 270; 5min 1096; H-plc 92; H2B 68; E-hb 392; Cat 873; SAP 501t; E 935; H-F
M it
."
,
142,380,401; SxS-hb 299,310; Sx-S 868; 908; X-T 311, 343; X-R? 126; Pa-T 183
o Multiple cardiac defect: 1. VSD (high ventricular septal defect), 2. Pulmonic stenosis, 3. Overriding aorta, 4. 2 0 Rt Ventricle hypertrophy
Rare (dog: 3"10 of CHD, cal: 6"10);'1 cause of congenital cyanotic heart diz in dog" cat; Eng. bulldog, Keeshond, Pathophys: Rlght-Io-Ieft shunt bypasses lungs Cyanosis
o CS Weakness, fainting, TIring, stunted growth, dyspnea, Cyanosis wI exercise, Sequelae conges~ve heart failure rare
~
o Dx Hlc (breedS), CS, PE (SystoliC murmur), PCV, ECG, Rads (RVE, hypovasculanty), US Angiocardiography
~
~_
r
o DDx Pulmonic stenOSIS, ASD, VSD
~
o Tx Medical: only palliat1ve (rest, beta blockers, phlebotomy; Surgery rarely attempted
co Px Varied see if tolerate
Vascular ring
anomalies
Persistent right
aortic arch
,
PRAA
SoB 509;
X-T127;
Pa-T 184
* -'
..-
0
0
0
Hx (young), CS
..,:::::::t!::____~~.:::~~""~:..
~')
oSx: ligate" cut res~rictlng arc.-=:h:::!rz::=t
...
'y\
. Ugamentum artenosum <" eM 5<7
,)1L
!1/(!t?t!7//
j f Jit/. .
rt t l l \ l (
Prognosis:
- Poor, Sx helps all
-10"10 cured
- 50"10 intermittent regurgitation
40% continue severe signs
Patent
ductus
arteriosus,
Facts/Cause
CIRCULATORY SYSTEM
Presentation/CS
PDA
**
Diagnosis
reversal,
Reverse
PDA,
Rt to Lt shunt,
Eisenmenger's
physiology
Mk 35; 1M 124; E-hb
388;H2867;Cat685;
E 966: X-T 308; Sx-S
860
**
:;:::~",o;~&,""",
J; .
Palpation
- Lt precordial thrill often present- U3rd intercostal space (LI3)
"Water hammer" (boundingthyperkinetic) arterial
~~
ti I -
Respiratorysigns: cough,
d s nea or ortho nea
y p
p
~
~Jl}
Sequela:
- Death from CHF if not
- Neuter (hered~ary)
- 1.5% recanalize in 2 mo.;
divide & suture
Auscu~tatlon:
J5t,1
Radiology:
Over vascularization
(hypervascularity) of lun9s
- Classic: all 3 bumps (1-3 o'clock OV)
_LVE, LAE (3 o'cloCk)
. "Ductus bump~ of descending aorta
(pathognomonic) (1 o'clock DV view)
treated
~)
ovvle~'$.
Echocardiology (US)
-
Shortness of breath
.Hx, CS
--f~ ~
Excellent
right shunt)
E.
wI surgery (left to
Avoid stress
-RVE
- Deceased peripheral lung vasculature (hypovasculature)
"Ductus bumpM of descending aorta
_ Pulmonary (artery) trunk knob sign (VO or OV view)
Angiocardiography: (nonselective angiogram)
_Simultaneous opacification of pulmonary trunk & aorta
ECG: RVE (right axis deviation)
~
Echocardlogram (US)
-RVE
_Anatomical defect
Itt.
Blood pressures:
- Rlght-to-Ieft shunt
. Right ventricular pressures Increased &
artery pressure exceeds aortiC pressure
portion of systole
Prognosis:
Enforced rest
Limited exercise
Radiology:
Sequela:
_Right congestive heart failure
uncommon
. 2' myocardIal failure or Left AV
insuHiciency
rflll
....
collapse
Fainting (syncope) esp wI exercise
or exCitement
Seizures
Differential cyanosis (PDA)
- caudally, not cranially
- Intrathoracic shunts - cyanosis
throughout body
. Cough & hemoptysis (spitting blood)
!}--.1,1
.:'
- - Ide~tlfy. P D A . .
~oppler: I~enllfy shunt Higher oxygen In pulmonary artery vs
nght ventncle
Angiocardiography: shunting from aorta to pulmonary artery
Blood pressures: RV&pulmonaryarterypressures increased,
but not equal to aortic pressure
1st diagnosed
~
r:-=~~----::-:----1~1
Pulmonary
hypertension
& shunt
Treatment
"blowout" lungs
_Open ductus arteriosus acts as a "popoff'valve
If duct closed - 'blowout" lung
- --P
--
V- .~
.
-. :
'\. t$)J;: ~
~
'-.(f;;:~~
hI
1~L
c> -
/3'"'=1 ')~
Right-to-Left shunt
CS: Caudal cyanosis
~~ ~
Ox: Hx, CS, Rads, Continuous murmur stops
Tx: No Sx, Rest & Bleeding
201
Prognosis: Grave
Endocardial fibroelastosis
H-F 402; Cat 700; C11T 651; Sx-S 860
Rare: Thickened endocardium, esp. in the left
ventricle, Hereditary in Burmese cats, it is progressive to symptoms at 2 monthS of age.
Heartworm Diz
CIRCULATORY SYS
FactS/Cause
Condition
Heartworm
diz, HWO,
Presentation/CS
Many asymptomatic
Indeflnitelv (lightly Infected)
.CS in 1-2years
(cumulative Infection)
Weight loss
------,-L-~-~
-
-.......:: ~
i R.\ I'
- Coughing (nOnproductive)r--..!?~)
br-~'
- Hemoptysis (thromboembolism)
- Fainting (syncope) (hypertension)
- Congestive heart failure
Jugular pulse
Ascites (abdominal distension)
~ _
__
,/\
Life cycle of DlrofilafiB Immltis:
Camage arterial endothelium (caudal lobes)
J . Mosquito gets a blood meal from a dog wi
Interstitial & alveolar lung dlz
circulating microfilariae (L1)
Pulmonary thromboemboli cause parenchymal lung dlz
Larvae develop In mosquito & Infective wlin 2.5
Right ventricle dilatation (Cor pulmonale):
.
weeks (L3)
Obstruction of pulmonary arteries - hypertension
L3 deposited by mosquito in canine through bite
,t Right ventricular afterload
wound
Migrate through tlssues for 100 days during
Large numbers of adult worms In right ventricle may" ventricular capacity
which they moult to L4 & then L5 stage larva. L5
& stroke volume
laNa enter venous circulallon & reach the small
Compensation Is by ventricular dilatation & hypertrophy & t heart rate
pulmonary art&ries In 3-4 months
finally results In" cardiac output & systemic venous congestion
As numbers increase' lill rt ventricle, then rt
Uver failure syndrome (vena cava syndrome)
atrium & finally vena cava
- Worms In rt heart & caudal vena cava, interfere wi rt AV valve - systemic
venous congestion
Microfilaria appear wlin blood;;?: 6
Glomerular nephritis (protein losing nephropathy)
months after infection
DepoSition of immune complexes
~--',\
pulmon~ry signs
- Dyspnea
***to****
e
,op.'mo..", .,"
Adult filarial worms cause pulmonary arteritis:
.~
-Anorexia
~
I'
,I
Q -=-
Sequelae:
J
- Nephrotic syndrome (occasionally);
ascites, peripheral edema, variable azotemia
Pulmonary eosinophilic granulomas
- Allergic pneumonitis
- Pulmonary thromboembolic diz
. Post caval syndrome
- Chronic hepatic congestion
- Aberrant worm
- DIC
OOx:
Pulmonary thrombosis
Pulmonary neoplasia
10 chronic respiratory diz
Microfilaremia (other filarial species)
~
. Enlarged caudal lobar arteries (normally < width 01 the9lh rib OVview),
Routine yearly screening for microfilaria (via Knott's, etc.) recommended
( _ ~~
cranial lobar arteries (normally < 4th rib -lateral view)
Physical examination: normal to rightsided CHF, CS
Ii
't~' Tortuous & blunted lobar pulmonary arteries ~
Auscultation:
1. 1(p
rprunlng" effect) (DV view)
V
t Lung sounds on auscultation (crackles & wheezes)
~ f \\
- t Interstitial, alveolar pattern due to emboli, Infarction
~\\, .,.,
Infiltration, fibrOSIS, etc (caudal or accessory lung lobes)
%"
Cardiac murmur < 10% of cases
I.
Split second heart sound (52)
"l
- Hepatomegaly
\
Holosystollc murmur tricuspid (rt AV) regurgitation
\..~. Clinical pathology: no pathognomonic findings /"
Unrelated murmurs due to mitral insufficiency or atrioventricular (AV) valve endoca iosis
- Eosinophilia B5-95% of infected animals
Microfilaria detection (occult infections: 20% no circulating MF [microfilaria])
- Basophilia 50-70% of infected animals; Monocytosis. Combination
_ Blood smear or wet mount; if negative do Knott's
of alf 3 strongly suggestive, however, eosinophilia & basophilia may
Concentration test
~ fi\rNs
be present wi Dipetalonema infections
--:;;;;;:;;;;k::::I"~
. Neutrophilla
20-75%, left shift
~
Knott's test or modified Knott's ($O.Olltest)
_
M -:=
. Piatelets tend to be lower in infected animals
Millipore filter test (Difil test) ($O,BOltest)
. Anemia (normocytic, normochromic-mildly decreased PCV (27-36%) 10% of cases
II negative, do Immunodiagnostic test
t Liver enzymes - SGPT (ALT) & SAP
Poor correlation between # of microfitarla & adult heartwonn burden
L r
re:o~.~f
SAP> lOX may indicate inability to tolerate adulticidal Tx
Differentiation of D. /mmltls from Dipetalonema recondltum
~
;:,;;;:;:~
.lmmunodiagnosislSerodiagnosis - occult heartworm diz:
- Azotemia
BUN & creatinine mildly t in < 5% of cases
- Antigen (Ag)aELlSA: detects circulating antigens of adult heartworms
Nephrotic syndrome contraindication to Tx
00
Canine Assure CH, DiroCheck & UNI-TEC; Snap & PetChek
. Bromsulphalein (SSP)t retention in < 20% 01 cases
aD
Still have false negatives
. Increase in Total protein
Radiographic signs present In 60-90% cases (determine severity 01 diz)
Urinalysis:
a Bulging of main pulmonary artery (MPA) or "pulmonary
- Proteinuria (albuminuria) in 20-30% of cases due to
knob" sign 6570% of cases (OV view)
+glomerulonephritis or associated amyloidosis
Right ventricular enlargement (RVE) 60-70% 01 cases
Fixed specific gravity (1 ,007-1.017) I
leE ' =,,!!~_D ,
Pulmonary arteries larger than veins
0 = ~lY :
_
if compensated renallnsulliciency exists
_ !V'-----,
~
;;;. Hemoglobinuria (post caval syndrome). hyperbilirubinemia
Electrocardiogram:
- Often normal & of minimal value
Dirofilaria immitis, Mosquito, All USA
Right ventricular enlargement (RVE) - wi right-sided CHF
, Rt axis1:leviation > 103
CS: Asymptomatic, Wt loss, Dyspnea, Cough, Fainting
S waves in leads I, II & III
Sequelae: CHF, Renal, Thrombi, etc.
. Premature complexes
_ Atrial fibrillation (severe pulmonary arterial diz or CHF)
Ox: Yearly screening, Serology, Knott's; If CS: Rads, Chem, etc_
Echocardiogram (US):
Tx: Tx cardiovascular diz
~4
- Rt ventricular enlargement
- Adulticide: Caparsolate, Imiticide?
~ '(
- Worms detected
Q.
y.
5)
;j) -.
Ar'"'-----
=..
IJ
- Microfilaria: Ivermectin
Prevention: Heartgard, Interceptor
(fJ.!
Treatment - Heartworms
Treatment heartworm cardiovascular diz:
Older dogs: may be nonprogressive
- Aspirin a/one m/b reasonable ahemative
Supportive therapy:
- Severe heartworm diz - CHF, nephritis, etc.
e-
Heartworm-induced CHF
- Rest
- Furosemide (LasiX): diuretic
- Low sodium diet 12 mglkg/day)
- Aspirin (5-10 mglkgl SID)
CIRCULATORY SYSTEM
Adulticidal therapy: prior to microfllaricidal Tx
'I
Aspirin
A"'i:'
""
- Note: Digitalis reserved for unresponsive severe CHF cases (class IV)
Melarsomine (Immiticide):
- Mild to moderate cases: 2.5 mglkg deep 1M (3rd-SIh lumbar vertebrae), 2 doses, 24 hours apart
- Severe cases: 2.5 rngr1<g deep 1M, walt 1 month & give 2.S mgkg deep 1M, 2 doses, 24 hours apart
- Not recommended for post caval syndrome
2: 90% effective against adults & LSI
Greater riSk of thromboembolISm (faster kill)
Contraindications-adulticideTx:
Less nephrotoxic & hepatotoxic
Renal failure - azotemia BUN> 120
Postadulticidal therapy:
mgldl w/out concentrated urine (specific grav- Strict rest 2: 4 weeks
ity < 1.030) or nephrotic syndrome
. Pulmonary thromboembolism 7 & 21 days (S - 30 days) after Tx
- Cage rest
- Oxygen therapy
Postcaval syndrome
Surgical removal:
Pulmonary artery: benefit to risk ratio very low
Pulmonary failure
Vena cava (post caval syndrome): alligator lorceps into jugular vein
NOTE: No Dichlorvos (Task) & other organophosphates In canines> 6 months of age that may have adult heartworm
infection because causes rapid kill with thromboembolISm or aberrant migrations of adult worms - circulatory failure with
hepatic congestion & centrilObular hemorrhage & necroSis
-BUN
- SGPT(ALT)
- Urinalysis
- Radiographs - especially If cough or dyspnea
( .,
.I ~
,,~... I
\WJ.
~
Most effective, but not FDA approved; fewest complications & easiest to use
Highly effective (> 98%) in killing microfilaria
_Give In moming & monitor lor exceSSIve salivation, anorexia, vomiting, depression, etc.,
maybe seen In approximately S% of pallents 12 days poslTx. Tx wI fluids &prednisolone
Check for microfilaria in 3 weeks
If poSitive repeat Ivermectln protocol & recheck in 3 weeks for MF
.. 11 poSitive repeat adullicidal Tx
, If negative start heartworm preventative
Ivom~
Ii.
DDx
Dirofilaria immitis
Dipetalonema reconditum
Wet mounts
Mobility
Stationary - undulate
Mobile
Straight body
324 (> 310) Ilm
Similar to canine RBC
CUlV9d body
2n 290)llm
Smaller than canine RBC
Concentration tests
Shape
Length
"'dth
Prevention:
Microfitaricidal (L 1) therapy:
Shape
Length
WIdth
Prognosis:
Tapered head
Btunt head
Straight body
Tapered tail
> 290 11m Knott's
> 240 Ilm Filter
6.17.2IJ.1T1Filter
>81lm Knott's
CUlV9d body
Button-hooked tall
< 27S)1m Knott's
< 240 Ilm Filter
4.7-5.8)1m Filter
< 811m Knott's
infiltrate wI
eosinophilia (PIE)
H-T/M240;SAP491;12M171;IM
132; IM-WW 178; Ct2T879, 267,
CIRCULATORY SYSTEM
Presentation/CS
Facts/Cause
Condition
Diagnosis
Treatment
Complication in 10-15% of
Progressively worsenoccult infection
ing cough
-Immune response against circu- Dyspnea & orthopnea
lating microfilaria
- Cyanosis
- AntibodylWBC trap microfilaria Exercise intolerance
Weight loss & anorexia
in lungs
(I
**to***
00
"pe"""9
region
I\ ~
"'
-----..
alveolar infiltrates
- Hypersensitivity reaction
C11T658,81S:Elr::;:;:H-F531
~;;~\
~
('
it?
r~
~
~
Laboratory (
! CD
- Eosinophilia, basophilia
& hyperglobulinemia
Serologic heartworm test usually pOsitive
Tracheal lavage cytology - eosinophilia
Response to Tx - improves in 2 days Prognosis:
Fair to good
Heartworm,
Pulmonary
thromboembolism/
Parenchymal
diz
H-TIm 241;
Fever
Coughing
Hemoptysis
Tachycardia
Dyspnea, tachypnea
Anorexia
Collapse, shock &
death
ollen
SAP 492;
1M 132
**
Hx (aduHicide Tx), CS
Auscultation
~
"
- Pulmonary crackles ~~ 3-10 days (anti-Inflammatory)
- Area of muffled lung sounds (local Cough suppressants (sedation)
-Torbutrol
lung consolidation) (J
(
t)
Laboratory:.
- _.
Aspirin 2-4 weeks
- Regenerative leukocytosis
Bronchodilators: aminophylline or
_ ~ theophylline (sustained release)
- Thrombocytopenia
Radiology:
~ .IV fluids + steroids if shock exists
Oxygen therapy (40%) (Pa02 < 70
- Severe pulmonary arterial diz
_Pruning of pulmonary arteries
mm Hg)
- Periarterial parenchymal diz
ASs (trimethoprlm-sulla, cephalosporlns,
, Patchy alveolar infiltrate wi a~r enrolloxaCin empmca1ly [pneumonia])
bronchograms - o f t e n : r l
peripheral lung
~: Prognosis:
Guarded
I.,'. 02 (1]--
1Ia~,-=~------------------------------------------------------~~
Heartworm
Eosinophilic
granulomatosis
SAP 491; 1M 133; H-F 531
*Heartworm Severe
pulmonary
arterial diz
SAP 492; 1M 133; H-F 535
**to ***
Rare complication of occult heartworm diz, some affected heartworm negative, Heartworm fragments nidus for eosinophilic granuloma
development, tumor-like behavior, Eosinophilic inliltrates of trachea, liver, spleen, kidneys, Intes~nes & lymph nodes
CS: Cough, Dyspnea
Ox: Hx (occult heartworm), CS: Lab: Eosinophilia & basophilia; Intrathoracic lymphadenopathy always; Rads: single or multiple
pulmonary nodules (1/4-4-), mixed interstitial & alveolar (bronchograms) pattem mediastinal lymphadenopathy
Tx: Combo chemo: prednisone + azathioprine (Imuran) 7-10 days, then altemate days (Indefinitely), Lung lobectomy
Px: Poor: relapse is common
(regional)
Sequela:
- Thromboembolism
Hx (HWdiz), cs ~
adulticide Tx
Use wi caution il hemoptysis
- Adulticide Tx
- Low salt diet for overt right-Sided CHF
- ABs
Likely in chronic HW
CS: Cough, dyspnea, Tiring
Dx:Hx,Rads,Lab
Tx: Sx removal of worms
207
/111
Ss-:
Prognosis:
Surgery: highly effective in
experienced hands
Conservative: Good - 70-80% survIVal
rate wi aCiulticlde Tx (40-50% if no adulticide Tx)
Heartworm
Condition
CIRCULATORY SYSTEM
Presentation/CS
Facts/cause
Right
congestive
heart
failure
Treatment
Dia nasis
H-Pic 5
ABs
Vasodilators (enalapril)
*to**
(regional)
Vena caval
syndrome,
Postcaval/acute
hepatic/liver
failure
Severe rt AV (tricuspid)
regurgitation
syndrome,
Dirofilarial
hemoglobinuria,
Vena cava
ww
* to ** (regional)
. ole
. Anemia
Immune complexes
'W'"
'~
vena cava
- Rt ventricular dilation
Nephrotic syndrome
fLO
(I
- Anabolic steroids:
Positive protein balance
Stimulation of erythropoiesis
Glomerulonephritis:
Mk73:SAP487;E-hb402;
1M 126; H2B 137: E 1046;
H F 537 NB 3 23
**
( aL)
Ii
Ca ir~late
~~\
\I
\flW
Renal insufficiency
- Free choice water
- Restrict protein & phosphorus
Arsenical
toxicity
;
Prognosis:
re
Immune complexes
CS: Nephrotic syndrome
Ox: BUN, Proteinuria
Tx: Diet, H20, Fluid, Steroids
- Isosthenuria
- Proteinuria (+ hypoalbuminemia)
PU (polyurea)
>
CapirsC;late
- Hypoalbuminemia
Peripheral edema
'=
/111
Hx, CS
Lab:
-I!
n
I dJ'
~~~~,~-.~/~~.
- Supportive fluids
- Thiacetarsamide{Caparsolate)
Tx when patient has stabilized
Aspirin before & after Tx
Broad spectrum ASs
- Microfilaria
- Azotemia: elevated SUN, creatinine
- Increased liver enzymes - SGPT
Radiology: Rt heart & pulmonary
artery enlargement
~
ECG: At ventricular enlargement
Echocardiogram
- Mass of worms in rt atrium & caudal
"""'"
~ -:;t:
Initial Tx of choice
- Jugular venotomy
Long foreeps or endoscopic basket'retrleval
device
Goal retrieve 3550 worms
(RBClySiS)
complicated by:
Metabolic acidosis
rS--h-O-Ck---Ii-k-e-,VV--o-r~m-s--in-v-e-n-a--ca-v-a--------~~
Laboratory
(
!
!
(!]
- Bilirubinuria, hemoglobinuria
- Hepatic congestion
- W/o Tx most die in 24-72
hours from:
- Cardiogenic shock
Surgical removal
Sequelae:
c:;:;
embolism
H-TIM 242; H-F 534; SAP
492, 12M 172; 1M 134; IM178; SxWW 97
Heartvvorm
- Renal diz
Prognosis
Poor to guarded
~
'
response
..i"-2P~ . Death
.L-----
. Perivascularinfiltrationofthiacetarsamide
Hx (aduhicide HW Tx)
,
Lab:
- Azotemia - may continue therapy if ~~
BUN lowers to < 50 mgldl with fluid
therapy/diuresis
(common,
Ii: -
~?':-
ifA~
U' I .
nna YSls
Bilirubinuria prior to 2nd, 3rd or 4th
(O!
cC=:::I=I:Oa:Jl1)
~dM
~~
Discontinue arsenical Tx if
toxicity
- Rule of thumb: stop Tx if 2 toxicity
signs coexist: depression, vomiting, anorexia, fever or diarrhea
- Supportive
- IV fluids to promote diuresis
- Feed high-CHO & low fat diet for 4
weeks
- ? SAL (Dimercaprol) if azotemia
is present, but questionable value
- Aepeat thiacetarsamide series of 4
in 2-3 months if toxicity interrupts
after 1st or 2nd Tx
210
Heartworm
Condition
Heartworm
Hepatic
diz
HT/M 247; H-F 537; 1M
135
*to **(regional)
Facts/cause
Presentation/CS
Phlebitis/phlebosclerosis of
hepatic veins resulting in fi~
brosis of veins
Chronic passive congestion
wI rt-sided heart failure orvena
caval syndrome resulting in
enzymes)
DIG
H-T/M 242; 1M 135
Aberrant *
heartworm
lesions
Spontaneous
pneumothorax
H2B216
. I.
Diagnosis
.~(-(~
I'~'Ii
00
Physical exam
(contraindication for
Treatment
co
Gastrointestinal signs
thiacetarsamide Tx)
-Icterus (contraindication loruse of Elevated serum liver enzymes
arsenicals)
Signs 01 severe pulmonary arterial diz
- Dyspnea
~~~
,
A
~'~
'
.-
\\\~ ~J'
Fibrosis of veins
CS: Asymptomatic, ASCites, Icterus
Ox: Hx, CS, SAP, Bilirubinuria
Tx: Supportive ~iet
Heartworm Disseminated
intravascular
coagulopathy,
CIRCULATORY SYSTEM
Urinalyses:
Bilirubinuria prior to 2nd, 3rd or 4th
Tx cause for concern (precedes icterus)
@J~
Imma"'. wo'"" may <.m~' I, "', & sa """". 0< mig"" 10 eNS. """",,, arteri" (.....ally
<e",
~~
I, ., \
\6J
(.g::::U
Excessive intravascular cloning or parasH. lysis 01 RBCs, initiated & perpetuated by: intravascular hemolysis (vena caval
syndrome), endothelial damage (adult worms), stagnant lung & hepalicblood flow; FOPs & constJmptlOll of coagulation components
Inhibits coagulation
CS: subclinical DlC generally accompankts adultlcfdal Tx, Petechiae & ecchymoses, bloodless - hemolysis or hemoptysis
Ox: Hx (HWD), CS, thrombocytopenia -monitor platelets, t bleeding time & activated clotting times (> 120 seconds) & FOP (> 1:20
dilution), Hemoglobinuria
Tx: Aspirin BID, Low dose heparin sa, transfusions for clotting factors, Vincristine IV, If severe thrombocytopenia
~~
Prognosis:
Poor If icterus & severe pulmonary arterial dlz
t:.
Hepa n
Inflammatory lesions may be due to: meChanical injury (intraocular), or immune-mediated response (aoSinophinc or pyogranulomatous) to the adult worms
SUrgical excision of granuloma from the anterior chamber of eye, spinal cord, skin or subcutiS
Px: Guarded, depends on location of lesion
Vincri!
h
i\
Bronchopleural fistula may devatop with severe Infections or aberrant heartworm migrallon
Tx: Rest + sedation, Asplr1n, BronChodilators, Cough suppressants, Corticosteroids, Antibiotics
Surgical: Chest drains for pneumoltlorax, Thoracotomy to repair bronchopleural fistulas
\~
~-----------------.--------------------------~.~
Feline
heartworm
disease
M8k96; H-TIM2SO;H38
129; H2B 137; SAP487;
12M 175;IM 126;IM-WW
179; 5min637; H-F 551;
Cat 495
** (regional)
Males> females
Resistance to infection:
complications
Asymptomatic: Tx not warranted
. hemoptysis (spitting blood)
Microfilarial tests < 20% of cats positive SymptomatiC: consider Tx
- Dyspnea (50%), thrombo Tx severe lung involvement first!
Serology
(
(
!
Steroids (discontinue before adu!ticide Tx)
embolism
CJ'~ Positive ELISA (antigens) (Canine Assure
Ascites
~
Bronchodllators
CH & DlroCheck)
GI signs
~.,o
Lass sensitiva than in dog (false negatives)
_Furosemide
- Episodic vom~lng(50%) Fecal examination (flotation & Baermann)
Oxygen may be indicated
common in cats
RIO other parasites (respiratory & Gl) Thiacetarsamide (Caparsolate) IV
Anorexia & Weight loss
BID (8 hours minimum between Txs) lor 2 days
Radiography always required in cats,
, Feed 1/2 hour balore Tx
Diarrhea
useful screening test
Strict rest for 4 to 6 weeks
eNS signs (aberrant migration)
- Postpone In a dyspneic cat, stress may be fatall
(thromboembol!sm 1-2 weaks after Tx
- Caudal lobar pulmonary artery
Seizures
(sudden deathsl)
enlargement wi or wlo tortuosity or pruning
Blindness
- Aspirin therapy 2 x a weak for 4 weeks
Right heart enlargement
Avoided in dyspnic cats (bronchoconstriction)
~
- Depression
Microfilaricides: usually not required
Alveolarlinterstitial densities
- Lethargy
Complications of Tx( < 40% of cases)
Ascites
Angiography - pulmonary vascular pattem
Thromboembolism (more than in dog)
Sequelae:
Echocardiology (US): especially uselul in cats
.. CS: Sudden death, fever, cough, dyspnea, he Pulmonary
- Cough (50%)
hyperglobulinemia (inconsistent)
(CD
(>80%)
Shorter life span of adult worms in
cats 2.5 years) than in dogs (5-7
Yffi)
Pathogenesis:
- Simllar to canine infections, but:
Exaggerated pulmonary
inflammatory response
Often severe pulmonary
thromboembolism
- 5-6 worms produce severe disease
Average cat infection - 3 adult worms
Li!a cycle (see dog)
C!:::,~
~~~~:~~~lism~lm~
P
CHF
V;
<@,_L~tl
Less than dogs, Regional
CS: None, Cough, Vomiting, CNS
Ox: ELISA, Rads, Echo
1&1~
Tx: Tx or not? Complications
Prevention not recommended
'ew
I!
"
because Ox difficult
Electrocardiography:
Often nonnal
.
Deep S waves in V2 & V3: 0.7 mV
S waves in leads I, 11, III, aVF: 0.5 mV
Transtracheal aspirates - eosinophilia
Postmortem: may be Incidental finding
DDx:
Feline asthma
Eosinophilic pneumonitis
Verminous pneumonia (Paragonimus,
Capillaria or Aleurostrongylus)
Cardiomyopathy
GI diz (inflammatory bowel disease)
caparsola~~1
Prevention:
'- ~
Prophylactic medications not recom
mended for routine use in cats
/f
Ji:S-~
Prognosis:
Guarded ~
Good in most if stJrvive acute pulmonary diz
CIRCULATORY SYSTEM
PMI
(poim of maximum
Valves of heart
space)
Normal function
lar systole
++-
Semilunar valves close at start of ventricular dias101e, 2nd heart sound (S2 - "dub")
Valve dysfunction
- Usually congenital
Valvulardizs
Mitral stenosis
Anemia
Fever
Anxiety
Kittens & u
--rJll'r"'r~
VVVYvPr'i
~D~iz__~~__________~F~a~ct~s________~CS~____________~D~x________________~T~x____________
Congenital
- PS (pulmonic stenosis)
- AS (aortic stenosis)
- AV dysplasia
Acquired
- Regurgitation
Endocardiosis (MI)
_ Ruptured chordae tendinae
Bacterial endocarditis
- Stenosis 2" to bacterial endocarditis
H2B 102
#2 congenital
Subvalvular
#1 cat
Fainting, tiring
Asymptomatic, HF
Tiring, HF
Sx (patch graft)
Controversial
TxHF
11 AV, #1 CHF
Sequela: MI
Systemic infection
Rare, Rt AV
Cough, tiring
CSofMI
Fever, vomiting, CHF
Tiring, cough
Murmur,
Murmur,
Murmur,
Murmur,
3 Os for HF
Rare
Narrowing of It AV opening:
Causes
Congenital
- Bacterial endocarditis
Associated with It atrial dilation, cardiac arrhythmias
& II atrial mural thrombi
Asymptomatic if mild
CS mIb related to underlying diz
(bacterial endocarditis)
Moderate to severe stenosis
- Tiring (exercise Intolerance)
-Cough
- Episodic weakness
Tachypnea, dyspnea
DOx:
Rad, Echo
Echo
Echo, + culture
Echo, Rads
Hx, CS
Physical exam
AUSC1.Jltatlon - murmur
- Early diastole
- Diastolic rumbling murmur S3 & 54
RadiOlogy:
LA enlargement
- Pulmonary venous distension
- Pulmonary edema
- Rt ventricular enlargement
- Prominent main pulmonary arteries
ECG:
- Increased or prolonged (> 0.4 mV, > 0.05 sec)
- Arrhythmias common
RVE changes
Echocardiogram (US):
- Left atrial enlargement
None
ABs, 3 Ds
No effective Tx
No effective Tx
Restrict exerCise
"-
--~~~
p- It
~
tI, ~
L
Prognosis: Poor
Pulmonic
insufficiency
~..
Rare, Generally not hemodynamically significant: Cause: 2 to heartworm disease, PDA wi pulmonary hypertension, trauma to pulmonic valve lea/lets, congenital malformation,
tricuspid insufficiency, bacterial endocarditis: Pathophysiology: regurgitation 0/ blood from pulmonary trunk to rt ventricle during ventricular diastole, Concurrent pulmonary hypertension
or stenosis, Volume overload of rt heart, At sided heart failure
CS: Asymptomatic, generally not significant, II conctJrrent pulmonary hypertension or stenosis (exercise intolerance, weight loss, ascites, jugular pulse)
Ox: Hx, CS, Auscultation (Split heart sounds, Diastolic murmur. low in 4th leS), Radiology: Enlarged rt ventricle, Pulmonary artery bulge at 1 o'ctock, Enlarged caudal vena cava
ECG (PII waves> 0.35 mV, > 0,05 sec, PR Interval> 0.14 sec, R wave changes in leaels, S wave changed, QAS > 0.06 sec, Arrhythmias uncommon), Echocardiogram ( Dilation of rtventricle,
pulmonary trunk & main pulmonary artery) Abnormalities of pulmonary valve
DDx: Dlrofllariasis, Bacterial endocarditis, isolated diastolic murmurs, AortiC insufficiency, TrlctJspld stenosis
Tx: None if asymptomatic usually, Diuretics furosemide (LasIX), Low sodium diel, Nitrates for pulmonary hypertension, Cardloglycoside usage is Quesllonable
CIRCULATORY SYSTEM
Condition
Endocardiosis,
Chronic AV valvular diz,
Left AV (Mitral)
valve diz,
Mitral regurgitation,
Presentation/CS
" I I
trans f ormatIon va vu ar
diz, Mucoid valvular
degeneratlon;
fibrosis
M8k 62, 87; 12M 133; 1M 107, 122; IM-
***
. Largedogs: dilatedcardiomyopathymorecommonthanendocardiosis
Pathology:
~~
- Fainting (syncope)
rr/~
~~..)
Sequelae:
- Pulmonary edema
Pulmona~ hypert~nSiO~D
MY~~
-~
rlJr
~(f
PMI
Lt AV (mitral) valve -
.Drr,..
~~~
~jl
m;d
to low
It 56th ICS
~. _ _ _ _ _-,C-_ _ _ _ _ _ _ _ _ _ _ _ .~-_.-----------___,,;j
- Left-sided CHF
Diagnosis:
~)
1
Hx (age. breeds)
Physical exam:
"~.
' .
~
-+
Radiology:
- LAE & then LVE (atrial & ventricle enlargement)
acard)
t Lung density
Dilated pulmonary veins venous congestion
progresses into pulmonary edema
"
:~~~P~:~v~~O::~~~dlneae
#1 CHF, Degenerative, ?, Lt A V
CS: LHF (Tiring, Dyspnea, Fainting)
Ox: Murmur, Rads, Echo
1$'.
to diz ~g
& complication caused by extracardlac dizs &
drugs (diuretics)
a
1Il
La
Echocardiogram (US)
Treatment considerations:
Class 1 (asymptomatic):
- Low salt & high quality protein diet
- Prophylactic digitalization
NOT recommended
Class 2 (early signs):
Sodium & caloric intake
Reduce exercise & excitement
- Diuretics
Class 3 & 4 (advanced signs):
- Rest + "3 Os"
Diet: restriction of sodium
Diuretics (mainstay of Tx)
(Vaso)dilators: (ACE inhibitors enalapril (En
j:L
~"
;;
-.:.::~
51 H
- - -
flD~
~
Prognosis:
Good for years if properly treated
Poor for long term if CS, Sudden death may
develop at anytime despite Tx, atrial fibrillations, biven
trlcular failure
Tricuspid Insufficiency
Condition
CIRCULATORY SYSTEM
Facts/Cause
ft
COx:
Chronic congestive heart failure
Rupture of chordae tendineae
Pericardial diz
Acute form (w/in 12-24 hours)
- Severe congestive heart failure (CHF)
"Respiratory distress (edema -lungs)
- Cyanosis
Marked venous engorgement
- Death (frothy blood-tinged fluid from
mouth & nose)
- Stand wI forelimbs abducted & head
& neck distended
Subacute. chronic form indistinguishable from tt AV regurgitation
see MI (mitral insufficiency)
OOx:
Volume overload of It heart
o Left atrial tear or rupture
Bronchopneumonia
Electrical shock
Heat prostration
Pulmonary distress syndrome
Pulmonary edema (toxic, infectious or
CNS)
~-
Treatment
Hx,CS
~=
Auscultation
~
~
- HoioSYSlolic murmur in caudal sternal region
Radiography
- Moderate to greatly enlarged heart silhoueHe,
globular In both vlews
ECG same as chronic It AV valve diz
- LAE (P milrale) & LYE (R waves)
- Atrial fibrillation 01 APes (atrial premature
contractions)
Echocardiogram
~_ _ _ _ _ _ _ _--'--. Pericardia! effusions
*
Rupture of
chordae
tendineae
Diagnosis
Presentation/CS
Left atrial
rupture,
-~D:t'.
None
Pericardiocenlesis, but hemormage is
likely to occur, not done if complete tear
is suspected
None
Prognosis:
Grave: TX usually unsucceSSful due to
rapid develOpment of cardiac
tamponade
Hx(MI)
~
Precordlalthnll, Jerky pulse
Jugular engorgement
~
Auscuttation
- Harsh helosystollc murmur
~
Left caud sternal border
Radiates & loud
- Armythmlas
Rapid HR
- loud respiratory sounds
- Gallop mythm (VOlume overload of It atrium)
Radiographs (don't take if worsens respiration)
- Pulmonary alvoolar edema (moWed of peripheral
lung fields)
+
- Left alrial enlargement
~y--- EchQcardiogram (US)
~
" "Railing" (eversion of mitral valve during systole)
ECG (in any position dog is comfortable)
- Sinus mythm (normal) or
sinus tachycardia
- P mitrale (wide P) or
P pulmonale (tall P)
o
Prognosis:
Poor: most rapidly develop Itsided CHF
(pulmonary edema) refractory to Tx
- -----------------------------------::::iiI;;j
Right AV
(Tricuspid)
valve
insufficiency,
TI
Dogs
Usually due to endocardiosis
(chronic valvular dlz)
- Majority concurrently wI left AV
valve
endocardiosis
Dachshund
&
(100%?)
Cocker Spaniel
Pathophysiology:
- Rt heart volume overload
" Regurgitation
into rt
atrium
**
Chronic valvular
diz (andocardiOSis) #1
Dirofilaria
See CMI
" RH F
- dyspnea
Hepatomegaly, splenomegaly
Jugular dIstention! pulse
Ascites: abdominal "water wave" or ballottement"
sign on palpation
~.
'"
l'
,I
PUlPD
_
,\
Anorexia, weight loss
~
Vomiting & diarrhea r/
- Pleural or pericardial
J
effusions
- Edema - peripheral & dependent
cardiac cachexia
Bacterial endocarditis
Dilated cardiomyopathy
Congenital cardiovascular anomalies
- Ebstein's anomaly
- Tricuspid valve dysplasia
- Common atrioventricular canal
/
Elevated rt ventricular pressure
- Pulmonary hypertension
Mitral valve insufficiency
Pulmonary diz
U to rt congenital shunt
- At ventricular outflow obstruction
Congenital anomalies
Pulmonary infarctslthrombosis
- Intrinsic or extrinsic masses
Chronic MI wI radiation to rt \I1oracic wall
Rt atrial neoplasia
Heartworm disease
Endocardiosis
CS: Lt side failure usually
Ox: PE, ECG, Rads
Tx:30s+
1 0 abdominal lesions
CongenHal defects: VSD of PS in
young & middle aged
Cardiomyopathy in larger breeds
Concurrent
Physical exam:
(P"9''''';''
ase;!es)
- Peripheral
venous
engorgement
- Ascites
History
CS: CMI (lell AV insufficiency)
(1_-
mlb necessary
Auscuhation:
.p
Dilators
- Holosystolic murmur
PMI: rt 4th ICS
ft
'"
~
Las j H
_
Radiology: CMI.+
- Moderate to massive
RAE (rt atrial enlargement)
Dorsal displacement of trachea & cranial vena cava
RVE (rt ventricle enlargement)(increased sternal
contact Ilat], backwards "0" [OV viewll
_ Difficult to distinguish from chronic Ml wI ~ cardiac
changes
- Hepatomegaly & enlargement of
wI congestion
& pericardial effusion
Diffj
abdominal organs
- Pleural
" Ascites
Ascitic/pleural fluid - modified transudate
"-Prognosis:
Guarded
al Endocarditis
Endocardial diz,
Bacterial
endocarditis
fection
Middle aged & older dogs:> cats, :> 4 112
BE,
Infectious
endocarditis,
Vegetative
endocarditis,
"Great imitator"
,."S
- Cavalier King Charles spaniel,
G. shepherd, Boxer
Routes of infection
- Wounds, local abscesses, pyoderma
- Pyometra, prostatitiS, pyelonephritiS
- Dental & other surgeries
IV catheters
Predisposing factors
- Immunosuppressive drugs
- Injudicious use 01 ABs
- Prior valvular diz (mitral insufficiency,
aortic stenosis)
Pathophysiology:
Bacteria from other infections passes in
CIRCULATORY SYSTEM
Nonspecific
- Fever
Hx (dental Sx),
(systemic signs of embolism)
Long term antibiotics imme Physical exam:
diately, minimum;::; 6 weeks (3- Water-hammer or bounding arterial pulse 6 months)
. Lethargy
(hyperkinetic)
- Vomiting
- Check other organs systems (retinal hemor Weight
rhages, ~taxls, cold extremities, lameness, CNS)
Sequela:
Auscultation:
~
- Congestive heart
- Cardiac murmur (#1 finding)
failure more common in aortic
Lt (mitral) valve - systolic PMI- It. low 5th IC
valve infections
endocardium of valves
-tt AV & aortic valves most commonly,
then rt AV & pulmonic
- Insufficiency murmurs (valves don1
close & blood regurgitates backwards)
. Large vegetations rnJ cause stenosis
- Septic or nonseptlc emboli: seeding of
other systems, lungs, kidneys & joints
- Can progress to CHF
Radiology'
..: .
- Nonspedflc - chamber enlargement & CHF signs '.
Echocardiogram (ultrasound) (2 dimensional)
- Hematu"ri,a,",,,',;,;,.~,----____ .
- Retinal,~,
_ Epistaxis
_CNS signs
--~,.~~
Aortic
valvular
insufficiency,
Bacterial
endocarditis of
aortic valve
E-hb 354; H2B 103; Smin
382; SAP 460; Sx-S 882; XT 346; NB 3.28
.,"-
**
Bact. endocarditis, Diastolic regurgitation
CS: Tiring, Cough, Fever
Dx: Thready pulse, Diastolic murmur, Echo
Tx: Long term ABs, "3 Ds" for CHF
1;.., ..
I.
Postmortem:
~
Vegetations on valves, shaggy,
nodules,
Laboratory:
((
(rfD
- Leukocytosis (PMNs) (80% of cases)
- Anemia (50-60%) Mild normocytic, normochromic
endocarditis)
ill.
@l;k.!~~(""c",iJ=O,)
Bacteria involved:
Streptococcus spp
Staphylococcus spp
E. coli
Corynebacterium spp
Aerobacter aerogenes
Pseudomonas aeruginosa
Erysipelothrix
""W_-'
",
A'!I{:
- t BUN (embolization)
I.
I'
:~u~r~in~~a~IY~:S~:i~S::~~~p:yuria,
& proteinuria
I I septic orhematuria
nonseplic inflammation
Prophylaxis:
Ampicillin & gentamicin 1 hour before &
Prognosis:
i.
~ ~7'
Grave to poor
Bacterial i i i pyometra, prostatitis, renal infections, abscesses, peritonitis, pancreatitis, septiC polyarthritiS, pyothorax
Septicemia
.Immune-mediated diz (SLE, Rheumatoid arthritis, autoimmune anemia)
SystemiC infections (mycosis, rickettsial, FIP, infectiou.s myocarditis)
Drug reactions - fever (disophenol, halothane, ketamine, tetracycline [cats],
AB hypersensitivity)
Bacterial endocarditis Tx
- ABs, support
(rises & falls sharply)
~ Heart failure Tx If necessary
Auscultation:
~
~
- 3 "Os" (Diet, Diuretics & Dilators)
_ Digoxin: if weak ventricle (Echo)
- Decrescendo diastolic murmur High It 4th ICS
. Blowing, high frequency sound of low intensity
Antiarrhythmics II Indicated
Hx, CS
PE: Thready or water-hammer pulse
eCG:
- P mltrale (wide P wave - atrial dilatation) & LVE
- Ventricular arrhythmias
Radiology: NOndiagnostic in uncomplicated cases
- May see LVE & LAE (elevated trachea)
- Occasionally aortic dilatation
Echocardiography (US)
Sequela:
- Emboli (see bacterial
F! -
- Arrhythmia
(polypnea, dyspnea)
_Jugular distention
sa edema
Ascites
Fainting (syncope)
Sudden death
Cough
~Bs
6.I\~
.
Prognosis:
Varies with severity; minimal
regurgitation is fair, severe is
grave: progressive diz
Cardiomyopathy
CIRCULATORY SYSTEM
Presentation/CS
Condrtion
FactsiCause
Cardiomyopathy
***
.. Cats
dog
i~;;:;;~s:eed)'~:~11'~
@i
(JI La~
~
~
~~r
... c."
Diastolic fUllng problem
- 2 dilated cardiomyopathy
Toxins (e.g., doxorubicin)
Infections (e.g., canine parvovlrus)
. Inflammation {e.g., physical agents)
(J,
.~
~.~r:.;;~_~~
(CO)
~-~~
Forms
Right-sided failure
_ 1 0 (idiopathic) cardiomyopathy
Dilated congestive CM
.. Taurine deficiency
Hypertrophic CM (HCM)
.. Most common form
Restrictive eM (RCM)
- 2 0 dilated cardiomyopathy
Toxins (e.g., doxorubicin)
Infections
Inflammation (e.g., physical
agents)
Idiopathic
Abdominal distention
- Venous distention
SQedema
Guarded at best
'.
Effective Tx requires
accurate diagnosis
Cage rest, aVOid excessive
Hx (diel), CS
PE: pulse, jugular pulse, apical beat
Auscultation
handling dyspnic cat
Radiology: not definitive for form
LasiX for all (pulmonary
because of overlap in findings
Echocardiography ~ definitive
Angiography (differentiates fonns): use if
echo not available
- Lethargy, depression
_Anorexia & weight loss
IItw ~
~-">
Prognosis:
ECG
NonspecifiC CS
+contraction
supraventricular tachycardia
(tachyarrhythmia, & t stroke
volume & cardiac effidency
- Sudden death
eM,
~--
OCM: digoxin to
strength, slow rate if
***
~~~~~
DiC:}
Radiology:
- Cat: not definitive
- Chamber enlargements
Angiography (differentiates forms)
Sequelae:
fractional shortenlng
RCM (cat)
Normal LV wall
Normal chamber
Normal contractility
OCM
ThIn wall
Large ventricle
Weak contractions: moderate to marked
In fractional shortening
.' II
~~ ~~F~ "~~~
. -_ _ _ _ _ _---'_ _ _---,
3 Forms - DCM, HCM, RCM
Dog: Dilated #1
Ji:)~
Cat: Hypertrophic #1
CS: Dyspnea, weakness
Ox: Hx,CS, PE,Rads, US
Tx: Correct Ox needed
Treatment
Diagnosis
Sequelae:
- Heart failure
- Cardiac arrhythmias
- Systemic embolism
~t.~;
.....,
1i:!.!.
Vasodilator (enalapril)
to all ( .. water retention)
Ena ard
Aspirin to all (.emb,oli)
~ 11'\
~",
. Hindlimb paralysis
.~
It.
~ft~"?
2S!~
Cause
? - Taurine deficiency
Pathophysiology
Diastolic dysfunction
Diastolic dysfunction
(Filling defect - pressure)
Systolic dysfunction
(Contractile problem)
Enlarged heart
Enlarged heart
Thin wall
Contractiiity
Diltiazem
Diltiazem
Digoxin
Dilated CM
Restrictive CM
Hypertrophic CM
Thick LV wan
Small chamber
Treatment
Large chambers
Contractions
Canine Cardiom
CIRCULATORY SYSTEM
Condition
Facts/Cause
Canine dilated
(congestive)
cardiomyopathy,
PresentationlCS
**
Arrhythmias common
(further depress
ventricular function)
I
1Af(
f
~{'<
-.
TREATMENT:
, SeptiC, neoplastic or Thromboembolic dizs
- Hypothyroidism
- Pheochromocytoma
- Diabetes mellitus
- Muscular dystrophy (Springer spaniels)
cardiac tumors
Traumatic myocarditis
- Brain injury ("brain-heart" syndrome)
- Infections
, Canine parvovirus (rare now)
Bacterial
Lyme diz
Trypanosoma cruzi, T. gondii, Neosporum
caninum, Hepatozoon canis
- Fungi, rickettsiae & algae-like organisms (rare)
Atypical forms
Boxer cardiomyopathy:
- Older male Boxers
.....---
Radiology:
- Huge, round heart (elevated trachea, Incr.
sternal & diaphragmatic contact, rounding of borders)
Pulmonary edema + pleural effusion: perlhllaror diffu$&
alveolar (air bron~ograms) & interstitial pattem (incr. opacity)
Obscured heart Silhouette, Pulmonary veins> arteries
Hepatosplenomegaly, AscIles (hazy abdomen)
gh)"
Myocarditis
Pelicard'f
I IS
Chronic valvular diz
Heartworm diz
-_ ~.
Cardiac tumor
.
.
Bactenal endocarditis
Causes cardiomyopathy:
unknown cause
, ,
Lt AV &lor rt AV regurgItatIon
10 cardiomyopathy:
Sudden death
Spitting blood (hemoptysis) (Doberman)
DDx:
"Os"
aI
"Os" + rest
- Exercise restriction
B
LIIIIM
1'~
:--
Enacardil:
I:
Aminophylline 1M
Oxygen (40-50%)
Cage rest
- CS - 3 categories
'-"'.' ,
... -
~-
I'
~
-
ocamiline
-"""""'-
I,II,mm,'ooj (aminophylline)
Bron?~odl1ators
- Lethargy, depression
- Anorexia & weight loss
Poor hair coat
Collapse
_~..J._____
<-
~I
- SO edema
_"",00
/) ,
- Jugular pulse
Chest wall heave
Nonspecific CS
standing)
- Cough ("gagging")
- Fainting (syncope)
- Tiring (exercise Intolerance)
OCM,
0_;"_.,
Hx (breed), CS
Physical exam'
Giant breed
cardiomyopathy; Pump
failure, Systolic failure
996; HPlc 98, 4; H-F 146, 467; SxS 885; X-T 347, 314; X-AP 129; PysB 170; Pa-T 194
Diagnosis
I
.~-
I :
:l
Digoxin
Morphine
Thoracocentesis if indicated by pleural effusions
Intractable
CHF - euthanasia ~)
~~J....?Y ~
Prognosis:
* .
(J
HeM
223
------"=-
Feline
hypertrophic
cardiomyopathy,
HeM,
CIRCULATORY SYSTEM
Facts/Cause
Persians
Cause: unknown (idiopathic)
Idiopathic
cardiomyopathy,
CM
M8k90; Mk8, 51: 12M 117; 1M 99;
IM-WWl62;H-TIM182;H3S107;
H2B 114: Smin 420: SAP 465: E
hb 415; Cal a89, 712; Cl2T786,
854; ellT 766; E 1017: HPic
***
- Hyperthyroidism?
- Coogenllal subaortlc stenosis?
Diagnosis
Presentation/CS
Similar to OeM
CHF (cong. heart failure)
- Labored breathing (pulmonary edema or
effusion)
- Rapid respiratorY rate (tachypnea) >
4O/min
- Sternal recumbency
- Open mouth breathing
- Cyanosis
- Fainting (syncope)
Lethargy. weakness, depression
Anorexia, vomiting
Jugular pulse
Some asymptomatic
Sequela:
- Aortic embolism
Hindlimb paralysis
Relentless crying
Physical exam
- Subnormal temp 1000 F)
'
.
~
- Pulmonary crackles
- Gallop rhythm (atrial gallops, 54)
- Tachycardia
Harsh bronChovesicular sounds
ECG: may be normal
- LVE: Lt axis deviation, tall R waves In leacllt
- Sinus tachycardia, atrial fibrillation, deep S waves
P - mltrate (wide P) RAE
Radiology: can't DDx different forms
- LAE - "valentine heart" (DV view)
,Elev. traChea, round heart silhouette (Iat.)
U atrial bulge 13 o'dock
Elongated heart
- Pulmonary edema (mottled lung pattern)
- Pleural effusion
Angiography - definitive
- Small LV lumen, thick wall
- Dilated atria, normal or enlarged aorta
Echocardiogram (US):
~
- Thickened It ventricle free wall & septum
- Ventricular volume
C:::=::J=:::J=llO[j)1)
Laboratory: variable
-Azotemla
Test T4 levels to RIO hyperthyroidism
- Urine analySis: protein
DDx:
Pathophysiology:
Hyperthyroidism
- Not a contractile dysfunctionl
Systemic hypertension
- Diastolic filling dysfunction (high pressure filling)
Acromegaly
Small LV chamber size
Congenital aortic stenosis
Stiff, nondistensible ventricular wall (unrelaxed)
.. Possible outflow obstruction If septal wall thicker than LV wall
(asymmetrical) - functional subaortic stenosis
CO (cardiac output) compensation
.. t HR, contractile strength
Lt (mITral) AV regurgitation
Atrial dilation & hypertrophy leads to:
~
Pulmonary hypertension, edema & pleural effusion
~
Tachycardia
~'?"
-AlileadingtoCHF
~
~
- n"ombl rna, 1o",," la. atria
a
.
l::=53-8~
Treatment:
:g~;?~~~~~:~~:~n)
WID ~~
II
[]jfJm
La;,.
GI
:~;~~~:ytr;];opranOIOI)
prOgnOSiS:~
225
{~
- Furosemide (LaslX)
... ;~W
!;:-II:I
(resolve pulmonary edema & CHF)
...
- Thoracocentesis: Significant pleural effusion (21-23 g butterfly needle In each hemithorax)
- Wann environment (prevent heat loss)
- Diltiazem (cardIzem) relaxes heart & slows rate
Fluids after edema controlled or effuSion aspirated
Tx thromboembolism
~ Long term therapy (after acute CHF controlled): 3 Os + rest
- Diuretic: Furosemide (LasiX) titrate to PO small dose 2-3Jweek
'
~
. Prevent recurrent pulmonary edema & pleural effusion
- Diet: low sodium (Hill's hId diet)
~.,
-.
- Dilator: enalapril (Enacard) (ACE Inhibitor) Cardizem
.. water retention & a vasodilator
- Aspirin (1 baby aspirin everY 3 days)
I.
,
- Diltiazem (Cardizem) (Ca channel blocker) or
- Propranolol (lnderal) (beta-adrenergic blOCker)
~
slows heart rate to 130-150 bprn
~
Digitalis not indicated - may worsen condition
Periodic thoracocentesis wi refractory pleural effusions Ind~r;l
I
'
~~
Feline Cardiomyopathies
ReM,
Presentation/CS
Diagnosis
Physical exam:
- I.aaa . .vera algnll than DCM ot.ijgM
-SubnOnnallemp 100~F)
~""
- Pale mucous membranes
~~
- Weak lemoral pulses
::.
~t
AuSCUltation'
~....
-lung sound often muffled
'f!!;;>
.50% murmuri (systOliC) difficult to localize
Gallop rhythm (83) hard to hear because of
last rhythm
- Harsh bronchovesicular sounds
- Endocardial fibroaislthlckening
=t LV stiffness
- Excessive moderator bands bridging LV
Intermediate
cardiomyopathy,
Intergrade
cardiomyopathy
Treatment
Facts/Cause
Least common type 01 cardiomyopathy
Reported In cats
6 to B year old males
Difficult to distinguish from HeM or OeM
cause: unknown
Pathogenesis:
Condition
Restrictive
cardiomyopathy;
CIRCULATORY SYSTEM
pressure)
=Pulmonary edema
orHCM
Acute onset
Lethargy, Anorexia
Acute heart failure
- Acute dyspnea
-labored breathing (pulmonary
edema or effusion)
- Fast breathing (tachypnea)
(> 4OImln)
Lethargy, weakness, depression
ovomillng
Radiology:
- Generalized cardiomegaly
LA often enormoua
- Nonselective angiography (after cat stabilized)
. Dilated RV & RA, LA lumen very Irregular wI
tilling dafacta (large papillary mUSCles)
Sequela:
- Aortic embolism
Hindlimb pain or paralysis
Flabby heart
~ ..
**
cause:
- Taurine deficiency In most
(reversible)
Single commercial diet, offbrand diet
Feeding only turkey. chicken, etc.
- Idiopathic in some
Pathophysiology:
- Poor contractility
, Systolic dysfunction
Dilation - weakening & thinning
- Decreased CO (cardiac output)
Compensation dilation, water & Na+
retention (renal, hormonal)
AV (mitral & tricuspid) regurgltatlonllnsuffiCiency
- Systemic & pulmonary congest10n
(edema & effusion)
, CHF
~ ~
(b,,,n!n,,'.. ,ru'~.o 1,
\l>~
-+.J.c-o-n-tr-ac-t-il-ity-,~
r"-F-Ia-b-by-'-'.-T-a-u-ri-n-e-,
Labored breathing
(pulmonary edema or effusion)
- t RR (tachy"",.) (> 4Ofmin)
Lethargy, weakness,
depress,ion
Vomltlng
W~
';jjl..'r' '\
Anorexia
IV ~
Jugular distention
Some asymptomatic
"'
~~~
Sequela:
_Aortic thromboembolism
1
~I
gil.
Taur~
II.
PrognOSis:
Poor: survival
of 6 months to 1 year
Feline dilated
congestive
cardiomyopathy,
OeM,
M8k 89; Mk S1, 8; 12M 125; IM-WW
161; H-T/M 188, 197; H3B 105; H2B
109; 5mln416, 1093; SAP469, E-hb
414; Csi 883, 70S, 151; NB 3.40;
C10T 251; E 1013; H-Pic 98; H-F
437,451; Sx-S 883; XT 347,314;
Pa-T 194
Echoeardlogram - definitive
- Enlarged RV, RA & LA
- LV slightly dllaled - rigid wI
papillary muscle projecting Into
chamber
- Prominent moderator banda
ECG:
- LAE P mltrala (wide P waves)
LVE lall R waves or wide QRSs
- LAE, LVE, ventricular or
supraventricular arrhyttlmias
"Aspirin
hid Diet, sodium restriction
Taurine supplementation (In case it is DCM)
" Vasod11ator (enalapril)
';'~ iii) L~
02 caga therapy
Enforced cage teSt
DlureUcs - high doses
Dlltlazem (Cardizem)", ,",-:ll==
relaxes ventricle lor better 1IIIIng
Hx (Taurine dele), CS
~'"
Physical exam:
~~
- 5ubno,"",1 temp 100' F)
- Pale mucous membranes
~ Weak femoral pulse, absent if embOlus
- Hyperreflective retinal areas
Auscultation:
50% Murmurs (systolic, blowing,
decrescendO)
. AV (mitral &lor tricuspid munnur)
effusions
_;~~aIYSiSOfrearo,'"",,"mbs ~_
. Jugularpulse~
[ij)
Aminophylline or theophylline
Fluid therapy
,~Jlff1!!) ~
"
:A~ ~~E.:;:cf;~;:r~ea~rt
'~l'~ ~- ~
J ~-- -P=;':I-:;~;'~~'dape,
L-:'H
41
DDXfi'
(pseudochylous) common,
Digoxi
".'
1,7
infiltrate wI eosinophilia)
Musculoskeletal diz
Neurological dizs
Poor contractility
mI
:---
"
Prognosis:
...":#!.
Laboratory:
- Taurine level :s; 20 nmollml (taurine
dele)
Pi'
(QJl
_Prerenal azotemia (J
- Measure T41n cats older than 7 years
"
Theo-D~r.
I I
' .
r!l
month generally
Good if due to taurine
deficiencies
Thromboembolism - grave
228
Thromboembolism
Obstruction of vessel wi
emboli carried in blood
Thromboembolism, TE,
Saddle embolus,
Aortic thromboembolism
Causes:
~
- Complication of heartworm
diz & treatment
Embolize to various sites
- #1 - Terminal aorta at
bifurcation of iliac arteries
"Saddle thrombus" - 90%
of cases
- Also brachial artery
**
~
I\.
~
Jlt ~ '7-
..i
'
CM - Atrial
fibrillation
SAP 474
**
(claudication", lameness)
- Relentless crying
Brachial artery
- Monoparesis of front limb
Renal: renal failure
Mesentery: colic (gut Ischemia)
-Death
'"~
00_\
Sequelae:
Kidney
Mesentery
~~~~
<>.
/i
Diagnosis
lot'""""""
~coagulopathy)
DDx:
j..,
Bacterial endocarditis
Posterior paresis
-Trauma
- Intervertebral disc diz
- Spinal lymphosarcoma
- Fibrocartilaginous infarction
- Myasthenia gravis
- Diabetic neuropathy
Paroxysmal (recurnng)
effusions
dipyrimadole, sutfinpyrazone
I
prognOSiS:~~
Laboratory:
- Elevated skeletal muscle
enzymes - LDH, CPK &SGOT Euthanasia
(wid",...,
cell,'" "m'9')
- Dehydrated
- CoagulatIOn profiles - DIC
.
c
,",'
CS of HCM or RCM
- Labored breathing
Weakness
(!;~~_Ab"""'"'9'1a"~ot
_
~
AA Interval
-> -~
CM - Pleural
effusion
SAP475; X-AP I 09; H2B 218; 5min
946
**
caVil!es (2)
- Visceral pleura covers lungs, supplied
by pulmonary circulation
- Parietal pleura: covers walls
mediastinum & diaphragm of
tho racic cavities, supplied
_
4J::1:;
CS: Dyspnea
Ox: Rads, Echo, Centesis
Tx: Lasix, Enalapril
:::-...
""'OPS~
~.
_
Cardizem
Di~
It.
ms:w
buprenorplline (Buprine),$)
~
"
,
Radiographs:
- cardiomegaly (LAE, LVE)
- Pulmonary edema & pleural
TorbUgesic
Bulorphanol (TorbugesiC),
Initial Tx of
Hx, CS
- Diltiazem (Cardizem)
Auscuhation
. Ca channel blocker
~.
Fast heart rate
C - m
ECG:
Ii.
~
- "t waves" (no P waves)
Persistence:
- Normal QRS complexes
_Digoxin +diltiazem (Cardizem)
- Rapid irregular ventricular rate
. Goal: ventricular rate < 200/min
~'!7"'"
(> 320/min)
Thoracocentesis If pleural effusion
Rapid, disorganized
depolarization of atria +
irregular AV conduction
More common wI hypertrophic & restrictive forms of
eM (cardiomyopathy)
Pathophysiology:
_Disastrous to cats wI stiff
ventricles
'ECG
- Supraventricular arrhythmia
- LAE, LYE
Jl
Treatment
-ManageCHF
Analgesics for pain
CIRCULATORY SYSTEM
Presentation/CS
Facts/Cause
Condition
------
()?
.............
~-'- r'~
~~~~
~La8
Thoracocentesis:
- Transudate to mf:~il~i~,';:~~~:~i
. Transudate: :=: 1.5
< 1000 cellsl}.il
Modified transudate:
gldl, 1000-5000 cellsflll
Ultrasound (US)
,I
Enacfj
i
i".
~<.
Pericardia I Disease
Pericardial
diz
**
CARDIAC SYSTEM
- Peritoneopericardial hernia
- Pericardlal defects
Abnormal development
Asymptomatic for years
o Hx,CS
Physical exam (PE)
- Communication of pericardia I Respiratory
- Unremarkable, or
& peritoneal cavities
- Labored breathing (dyspnea)
//(1
- Diminished or displaced cardiac sounds
- Herniation of abdominal organs - Cough
- Audible systolic murmur (cat)
- Empty abdomen
into pericardial sac
- Restrictive breathing pattern
PeritoneopericardaJ
Radiology - confirm
- Most diagnosed 1st yearor asymptomatic for
(rapid & shallOw) (taChypnea)
diaphragmatic
Prognosis:
several years
GI signs
~~
- Abdominal organs in
hernia, PPDH,
- Rarely causes compressive tamponade or
Excellent wI surgery
pericardium
compromises
cardiac
lunctlon
Vomiting
Diaphragmatic
~-~'-- Gas or fecal filled bowel wlin
- Diarrhea
: ;peritoneopericardial - Dogs & cat
cardiac shadow
DDx:
- Weimareiner
Colic (liver or small bowel strangulation)
hernia, DPPH,
- Contrast radiographs
Pericardlal effuSion
Cause:
unknown
("2:"'~~;"dii;",";
Weight
loss
Sternal
deformities,
no
xyphold
process,
10 cardiac diz
PDH
pericardial
hernia,
**
~;1'1
Sequelae- cardiac
~ ")
(rare)
s-=
:7
Echocardiography ( U S .
m,913
- Rare: incidental finding on necropsy
Clinically Insignificant
Mk 52; SAP 481; H38 113; H2B 127: 1M 147; E 1035; Eo 1135
Pericardial cysts
Constrictive
pericarditis
HaB 119; He 128; E-hb
420; SAP 481; 12M 189;
1M 147; IM-WWl83;Smln
927: H-Pic 124; H-F 511;
Sx-G 116; Sx48 676: SxB528; Sx-WW94
Cause: unknown (abnormal mesenchymal tissue development or Incarceration 01 omental tissue from a PDH)
Clinically significant - Pericardial effusions
Ox: Echocardiography or pneumopericardiography
Tx: SUrgically remove cyst + partial pericardiectomy
'--_
Prognosis: good wI surgery
PrognosiS
~
'~~~
(remove
nelVe
epicardial fibrosis
6'
~
-Effuslons
Pericardlocentesis & fluid analysis
Pericardial
masses!
neoplasms
////
page)
- Weakness, Labored breathing, Fainting,
r;;;;;;;;;;;;;;;;;;;m....
;;;;.';------L-- Dog (rare)
Hemangiosarcoma (It atrial origin)
- Heart base tumor: Chemodectoma, thyroid
carcinoma
_ Mesothelioma (pericardia' serosa)
_Rare tumors (lymphosarcoma, fibrosarcoma,
metastatiC tumors, myxosarcoma)
- Granuloma: ActinomycOSIs, Coccldlomycosls
- Ab.....
- Perlcardlal cyst
Cat (rare)
- lymphosarcoma
- Mesothelioma
- Heart base 1U~'''oh''mc..
- Metastatic tumors hemangiosarcoma, mammary & pulmonary
carcinomas
- Other neopIaslic messes (very
rare)
,,,,oall
RadiOgraphs:
_ Enlargement or distortion of heart shadow
_Hemangiosarcoma - protrusion of right or
cranial border
ECI'Iocardlography (US): most specific
(2-D localizes mass if perlcardial effusion)
Pneumoperlcardiography: if US not available
_Outlines mass lesion 75% of the time
Pericardlocentesls:
_Often fails to distinguiSh idiopathic hemorrhagic from neoplastic effusions
_Neoplastlc cells look 'Ike reactive
mesothelial cells
laboratory:
Anemia or nucleated AB'''' '.11 ~
hemangiosarcoma
l:2.~com~m~o~,~~!:,~~~~~~~~~,
Ii
Causes:
-idiopathic (most common)
Infections
- Bacterial (Actinomycosis)
- Fungal (Coccidioidomycosis)
Metallic pericardlal foreign bodies
Neoplasia
- Heart base tumor
- Mesothelioma
Recurrent idiopathic, hemorrhagic pericarditis
- Hemangiosarcoma - dog
- Repeated centesiS
_ Sx considered for small tumors (poor Px)
- Heart base tumor
_ Repeated centesis If surgery refused
- Resection If accessible
- Palliative parietal pericardiectomy
Resection of mass
_Thoracotomy, pericardiectomy or
pericardiectomy
Chemotherapy: experience limited
///1
s=> >
Pericardial Effusions
Condition
Pericardial
effusion &
tamponade
CIRCULATORY SYSTEM
Facts/Cause
Presentation/CS
Diagnosis
- Uncommon in dog
Rare in cat
=+
=.
'\~~
f'
Exudate (pericardHis):
Infection bacterial, fungal
Sterile serosanguinous
- Idiopathic, uremia, other Inflammatory dlzs
Hemorrhage (hemopericardium):
Neoplasia
Trauma external iatrogenic
cardiac rupture, esp. It atrial with Ml (mitral
insufficiency)
- Idiopathic
1\
ECG (electrocardiography):
....--..
Treatment:
Pericardiocentesis TOC (Tx of choice)
- Temporary or emergency measure
-Idiopathic hemOrrhagic pericarditis (50% respond)
Idiopathic
~~
- Pericardiocentesis
~, \. ~
- Broad spectrum antibiotics
~
- Steroids if culture negative <efficaC7unknown>
- Refractory - subtotal pericardiectomy
Surgery: subtotal pericardiectomy
- Idiopathic hemontlagic pericarditis . [t
- Constrictive pericarditis
Resection: pericardial masses or heart base tumors
Tx underlying causes - CHF, infection
Euthanasia considered for hemangiosarcoma
Chemotherapy for neoplasia (few cases reported)
Dog
- Idiopathic perlcardHis
cardiac or extracardlac neoplasma wI
In perlcardum
Hemangiosarcoma
Heart based tumor
Mesothalioma
- Ruptured left atrium (It AV regurgitation)
Inlectlous
-cat:
- Falin. infectious peritonitis
- Bacterial Infection
- Neoplasia
~ ~ I~
. t heart rate
/
- Pulse paradoxes (exaggerated t &
- Cough
In arterial pressure w/ expiration & inspiration)
- Shock: pallor, slow capillary relill
- Jugular pulse/distension
- Abdominal distention (ascites) Auscuhation
- Diminished, but otherwise normal heart sounds
- Fainting (syncope) on exertion
- Fast RR (tachypnea), Pericardlal frictfon rub rare, Arrhythmias
Fever II infectious
(-. ~~
Prognosis:
Fair to good: idiopathic & pericardial cysts wI Tx
Poor to guarded: infective pericarditis &
~
A
resectable heart based tumors
\>;'~' (!
Grave: hemangiosarcoma or nonresectable ~ ~ }
heart based tumors
T'j
Idiopathic: in 50% effusions recur
~
4.:.. "-
CIRCULATORY SYSTEM
Presentation/CS
Facts/Cause
- Inflammation of myocardium
- CS of 10 diz usually overshadows
cardiac CS
- Myocardial diz 2 0 to
.2
- Infectious ~ fever
~ Systemic, predisposing diz
myocardial
- 2 0 myocardial involvement
. Hyperthyroidism (cals)
~ Weakness
Cardiovascular abnormality
dizs,
- Labored breathing
2 myocarditis Forms of cardiomyopathy
- Unexpected heart failure
Mk 50; HTIM 295; H38 - Trauma
- Fainting (syncope)
- Ischemic injury
109; H28 l1B; 1M 93.103;
H-Plc 115; Cat 8B3. 90B; - Toxicity
- Sudden dealh
SAP 464. 475. 110; Ehb
-Initially
rnlb
an
incidental
finding
413: Ct2TB42; E 1011: H
- May become important & possibly
F 459: Pa-T 193.195
lead to death
- Dogs & cats
- Pathophysiology:
10 diz effect on myocardium: Necrosis, Ischemic injury, Degeneration
- May cause dilative cardiomyopathy
- Arrhythmias wi 20 cardiac failure
- Acute orchronic pulmonary congestion: pulmonary effusions & edema,
pericardial effusions
Condition
Systemic diz
**
- Sequela:
- CHF (cong. heart failure)
Toxoplasma gondil
Neosporumcanlnum
Hepatozoon canis
- Uremia
_ Hyperadrenocorticism
- Pheochromocytoma
_ Hypercalcemia
_ Hypocalcemia
-NHeoyppelargs.,laYCemia
.~
.~
- Physical exam:
~~
//I//Ilt)1.1LJ11
-Mucousmembranes (
,
f''1,(ft' u'ltt~
- Femoral pulse
~ ~
(
- Auscultation:
~
Murmurs, irregular heart rate
- Radiology:
I ~
- Gardiac chamber enlargement
- Lung involvement
.
J.;t.
KJ
...;;J:
ECG:
- ST segment alteration
Arrhythmias & conductive abnormalities
VPCs, ventricular tachycardia
,,~~;j~~~
. Atrial arrhythmias & AV block
~
Chamber enlargement
Echocardiography (US):
Myocardial function
- Heart anatomy
- Valvular vegetation
- Effusions
.
- Laboratory:
g~
- CSC (complete blood count)
- t Serum muscle enzymes (LDH. AST, CPK)
- Serum chemistries (endocrine or metabolic diz)
-Thyroidtesls(T3&T4) C (
I rf7) ~
-Sloodcultureslffever
. - - ~"""'"-,,-===- Serological testing for infectious causes in selective cases
(toxoplasmOSis. neosporosls. Lyme dlz, Rocky Mt spoiled fever. etc.)
Biopsy: specific test. but rarely done
-+
Trealmenl:
_ Treat 10 diz
- Treat cardiomyopathy
- Supportive care
- Manage arrhythmias
~
_Tx cardiac failure: Rest + "3 Os" (diuretics, diet/low
~.
salt & dilators)
I'
.,-0/
Iti I
1
;("~...o. Steroids for refractory arrhyth~mias
(traumatic or postvira myocard s
/
a \C;i
.'~~~~~~;;IS
::il
- -
...
~.
C~;~~C~IItOXiC
_ Dlgitahs
_Doxorubicin
_Oleander, foxglove. Illy of the valley
. Halothane (anesthetics)
- Chocolate toxiCity
. Sodium fluoroacetate
Carbon monoxide
_Toad toxicity
_ Genetic
_ Hypertrophic cardiomyopathy
_ Dilated cardiomyopathy (DCM)
_Duchenne-type cardiomyopathy.
canine X-linked muscular dystrophy
e~--------~==~~
L~
~_!"_
EnaC8'I rd
Steroi~
~
-===-___________
L_______
11
~
I
!I
i,
, ,
t
{
O---a."'~~
aI
(L;---':::J)..
_ Immune-mediated dizs
Lupus erythematosus
_ 2" to bacterial inlectlon (Immune.medlated)
-Physical:
- Trauma (contusions) - "HBCs"
- Heat stroke
Environmental
Malignant hyperthermia
_ Neurological trauma of cerebrum
_ Metabolic/endocrinology
- Hyperkalemia
Hypoadrenocortldsm
- Hypokalemia
- Other electrolyte imbalances
- Hypothyroidism
_Thyrotoxicosis (hyperthyroidism)
. Diabetes mellitus
Dia nosis
- Difficult to Ox, biopsy only specific test, but rarely done
_ 10 diz - identify
_Hx(ldiz)
_ ...,
i./i1,..
~~:-"'/r
Jr~
YI\/\~
<}"
~
236
Secondary Myocarditis
Neurogenic
cardiomyopathy.
ated wI
myocardial
except cat
Brain-heart
lesions, all
species,
_.....",. Pathophysiology:
Lesions of endocardium & subendocardium
Degeneration, necrosis & mineralization-
MI
,"\""/
___
__
release of catecholaminas?
Feline
myocardial diz,
#1
hypertrophic
th
1/ ~ 1 t
~v / (.1 ~
k
~~.
~<~.t
Q 110:/
'4 _
~
I,
'Ji:i.)'
<'-<71];'
10:;
r')?
d-/~
c1.1'
~
r'
Multisystems
CS:
Radioactive iodine
"1
#1
.'.
o
o
VPCs (2%),
Conduc~on
Common in humans
-"
)l\
.'
::>
'f
ai W
Prognosis:
Uncomplicated cases: Good
After correction of hyperthyroid state
Good: hypertrophic cardiomyopa-
.
Evidence of efficacy of TY for diz lacking
Tx primary disorder (often none for MIMI)
o General care
_Hospitalization & cage rest
_ B adrenergic blockers to lower heart rate &blood
pressure
Nitroglycerin
..
_Avoid digoxin if clear cut evidence of Ischemia or
infarction
_ Heat stroke: reduce body temperature, steroids
& mannitol for cerebral edema
o Tx concurrent cardiomyopathy
Prognosis:
Good for MIMI
o Guarded for MI
underlying dlz
Diagnosis difficult
~ oo Tx
Presumptive myocardial infarction
Hx (diz causes)
Oxygen
Hypercholesterolemia (suspect)
Nitroglycerine ointment
o ECG _ Ischemia, Ventricular arrhythmias
o Beta blockers (propranOlol [Inderal]) protect by
~_ _ _ _ _ _ _----'_ _,
Severe S-T segment elevation
decreasing 02 demand
Causes:
Presumptive because coronary
Oiltiazem (Cardlzem) vaSOdilator & decrease
Endocardiosis (Chronic valwlar dlz)
angiogram & myocardial enzyme
HR
o Congenital subaortlc stenOSiS
analysis rarely done in animals
Diabetes mellitus
Hypertrophic cardiomyopathy (cat)
o Canine hypothyroidism
Prognosis: unknown
o CS of complicated cardiac
disorders
- Respiratory distress
neration NMD
Se & ViI. E are antioxidants, protect from free radicals, dete destabilizes Iysosomes - autodigestion of muscles
'
g~:. ~:I~:~co~m:~~I~t _ puppy), EMG (fibrillation, myotonic disc~~rges), Muscle biopsy (necrosis wi calcification), Elevation of musCle enzymes
5=
Ql
/1(1
Necropsy: myocardial necrosis assoc. wI cardiovascular diz, MIMI common in older dogs
e~
. N
"
d,I,'" (10%)
"R" waves
Atherosclerosis
--
Difficult to Ox
oHXWCS)
o ECG of Ischemia/infarction
- ~T segment slurring
_ MIMI: notches or shoulders on down slope of
Weakness
Tiring
'"_M
Hypertrophic cardiomyopathy
~o/ 'SinustaChycardia(70"!.~)
/1
??tf~ ~. Large R waves (30%), APCs
~->
~'IAtriaifibriliatiOn(IO"k).
.
Thin, FrantiC
.no....
Echocardiology
chronic antithyroid Ox
I .Weakness, dyspnea,~
Myocardial
ischemia &
infarction,
MI
Methimazole [Tapazo)el
L
- I hy rtr h (70~)
~i.~
tventrlcu ar
pe op y
0
~lt1lt
. Thick ventricular septum (40%)
\ U ) . Lt atrial dilation (70%)
~~
41~
I,
Antiarrhythmics
~7'
Cardiac involvement
GI,
cardiomyopathy (HCM)
-Congestiveheartlailure
(15% 01 hypom,,,;d ca") (15%)
. . /"
":?
Twa",b..",mantl"
909
** -***
eNS,
" t:W
-----'iiI
'-
Pathophysiology - heart
T4fT3 direct effects on heart (t HR, &
contractility)
f
t sympathetic ANS: t heart activity
comp lea Ions
0 Indirect elfects: t
demand on heart (t
Hypertension
metabolism)
~
~. Hypertrophic
car d lomyopa y
Mk284;Cl1T756,334; H-TI
M 295; SAP 221; E-hb 552,
389; E 1023; 1M 552; H-F
734,255, 459, 565, Cat 723,
ECG
fortunately uncommon
l:;t'S~
Cardiac involvement
Treatment
Hx (eNS trauma); CS
/~
{~41
'\
- eNS neoplasia
,k"<:3> . Encephalomalacia
Diagnosis
CIRCULATORY SYSTEM
Presentation/CS
Facts/Cause
Condition
237
DOx:
Emboli of bacterial endocarditis
Hyperkalemia
CIRCULATORY SYSTEM
Presentation/CS
FactS/Cause
Condition
432,845,418,802,S12,519t:
H2B 75,87,532,571: E-hb
153: 1M 620; H-F 71, 573
***
Depression
Neuromuscular
Pathophysiology
- Bradycardia (conduction distur- weakness
banea) -+CO
- Difficulty
repolarizing myocardial
~-,~'
Hx, CS
Physical exam
~~
~
-+Renal clearance
Bums
Translocation f l i t
.
_rom ~ s 0 serum
- Metabolic aCidosIS
Diabetic ketoacidosis
- Tissue damage
Sequelae
- Fatal rhythm
disturbances
Pathophysiology:
Effects resting membrane potential
. Less sensitive to stimuli
. Neuromuscular function of skeletal, cardiac
& GI smooth muscle
- Abnormal cardiac con(lucllon
- Lower motor neuron paralysis
~
Prognosis: varies wI cause & severity
Good to excellent wi Tx if moderate to
mild
Grave to poor if severe wi or
w/oTx
CS of hypoadrenocorticism, renal
failure, ett.
K+, Bradycardia
CS: DepreSSion, Weakness
Ox: Spiked T waves
Tx: Saline fluids, Insulin + Dextrose
Hypokalemia
mineralocorticoids
glucocorticoids
0.9% saline
-""-:n'
_ Hypoadrenocorticlsm
J.
- Prolonged PR interval
- Wide & flat QRS complex
- Bradycardia
- Sinoventricular rhythm & atrial
Potentially fatal
- Uroabdomen
-+
~ ~._ Q-3-ti~
Cause: Hyperkalemia
t Intake.
Treatment
Dia nasis
J.
Laboratory
Tx if CS & low K+
- Hypokalemia
Potassium supplementation
. Dog: < 4 mlEqil
- Per os (PO) whenever possible
I ~. To avoid IHe threatening hyper Cal: < 3.6 mEqlL I
ECG
. ~ kalemia
Potassium gluconate elixir (Kaon Elixer)
- Depressed T wave amplitude
Potassium gluconate (TumllK)
- Depressed S-T segment
_ Parenteral K+ If vomiting or anorexia
- Prominent U wave
Potassium chloride
Added to fluids
_Prolonged Q-T interval
.. Initially wI normal renal function
Arrhythmias
.. 20 mEqlUday if fluid rate Is 40 mllkg day or
0.5 mEq/kglday
- . supraventriCUla~
.. Don't exceed 0.5 mEqlkglhr of K+
-" Ventricular
Monitor wI serum values (BID), ECG
e~ _ _---....
ODx - Hypokalemia
Common causes
Gastrointestinal
- Vomiting
- Diarrhea
- Gastric dilation/volvulus
Renal insufficiency
Diabetic ketoacidosis
2 hyperaldosteronism
- Liver insufficiency
- Congestive heart failure
- Nephrotic syndrome
Iatrogenic
- Fluid Tx
-Insulin Tx
- Bicarbonate Tx
- Loop (LasiX) or thiazide
diuretics
- Enemas
Uncommon causes
Low dietary intake
10 hyperaldosteronism
Hyperthyroidism
Hypomagnesemia
NeuromuscularleNS diz
Pseudohypokalemia
- Hyperlipidemia
- Hyperproteinemia
- Hyperglycemia
- Azotemia
Cardiac arrhythmias:
_Hypokalemia reduces efficacy of
antiarrhythmic drugs (lidocaine,
~".~.~
Prognosis:
Good: CS resolve in 1-5 days following correction
Chronic oral supplementation may be
needed to prevent recurrence
CIRCULATORY SYSTEM
Calcium
See
Endo
pg
681
Asymptomatic
to
severe
Hx,
CS
~
Eliminate
cause
Hypocalcemia
neuromuscular dysfunction PE: weak femoral pulse
~. Crisis
H-T/M 313; 1M 626, 541; E-hb Low serum Ca++ < 6.5 mg/dl
Muffled heart sounds
'.
- Supportive Tx, pending diagnosis
277; SAP 234, 72; H2B 1384, Clinically significant hypocalce- Tremors, twitches, tetany
518,1277; C11T301; H-F 577
mia uncommon in dog & cat
- Ataxia, Seizures
- Tachyarrhythmias
- Calcium gluconate slow IV
cardiac abnormalities
Behavior changes
Laboratory:
~,_
. Toxicity signs: bradycardia
Common causes:
_ Restlessness, aggression,
Serum calcium < 6.5 mgldl
& Shortening ofO-T In~lVal
- Puerperal tetany/eclampsia #1
panting, facial rubbing
If normal serum albumin/protein
ca gluconate may be given SO
**
- Hypoparathyroidism
Bradycardias
Neuromuscular excitability
CS: Tremors, Tetany, Panting
Ox: Hx, CS, PE, < 6.5 mg/dl, ECG
Tx: Calcium, Eliminate cause
Hypercalcemia
**
PU/PD
CNS depression, seizures
GI: anorexia, vomiting,
constipation
Muscular weakness
Fine muscle fasciculations
Sequelae:
- Cardiac arrhythmias (rare)
ECG
_ Prolonged Q- T interval
_ VPCs (ventriCUlar premature
-l
- Oral calcium
- Vitamin D supplementation
Maintenance: so injection of Ca
I~rr' '~~'-'--'J'
.:II
Oral Vit D
+ calcium
..
Hypercalcemia
~
Prognosis: Guarded
Lymphosarcoma - Guarded to
good; Cherno Tx
hypertension
Uremic heart
diz
***
- sa
.+
~rc"&
~trAf)J
~"'.i'}
1Ji.~
r!.1lJ
vn (6 &
hypoxia lanemiaJ, acidosis)
:;&'-
No cure, palliative
Avoid stress
' 1N
Fluid therapy
~
_ Check renal failure in cardiac patients before
fluids & diuretics
_ Rehydrate carefully wI low-sodium fluids (half
strength saline & dextrose)
_Reduce dose or avoid cardiac drugs eliminated
by kidney
, Monltorkidney function & electrolytes frequently
If using ACE inhibitors (enalapril) or digoxin
. Digitoxin can be substituted for digoxin
. Hydralazine & nitroglycerine can besubstituted
for ACE Inhibitors
Diet kid: restrict proteins & phosphorus, gradually restrict sodium (hypertension)
Phosphate binders: aluminium hydroxide (Amphojel), aluminum carbonate (Basaljel),
calcium carbonate (CamaloX)
Anemia: androgens, transfUSion
Hypertension: maintain systolic pressure at
120-160 mmHg & diastollc al60-100 mmHg
Mu~iple
ci,~::,
fPl
E~thanaSia ,oo."~
@
Prognosis: Poor to guarded, resolutionof
uremia may Improve ECG abl'lOnnalities or may
001
Hypertension
Condition
Pulmonary
hypertension,
Cor pulmonale
Mk49;SAP496,448t; H2B
155; 1M 126, 124; IM-WW
184,200; Cat 925; E 1023;
C9T313;H-Plc 147; H-TIM
413; H-F 578
**to***
(HWarea)
CIRCULATORY SYSTEM
Presentation/CS
Facts/Cause
Dia nosis
Treatment
Auscultation:
ment dueto pulmonary -hypertension"
- Diuretics: LasiX
Munnurs
(loud
or
split
2nd
PathophySiology:
- Vasodilator drugs, less effective on
heart sound, llicuspid regurgitation)
- Pulmonary vascular dlz or vasoconstriction
pulmonary arteries, best if left to right Shunt
- Abnormal lung sounds (cracjdes)
Heartworm: embolic dead heartworms
(VSOor POA)
, Pulmonary diz
Radiology:
- Phlebotomy (rarely needed or documented)
, Alveolar hypoxia (cat asthma)
- Right heart enlargement
:~p
~~
Sequela:
- CHF (congestive heart failure)
- Polycythemia
- Reverse PDA
~l'(
(I La) E~acg
-~ I,:""""r,
Pulmonary diz
- Pulmonary embolism
- Chronic pulmonary fibrosis
_ Chronic bronchial diz
- Pulmonary parenchymal diz/alveolar hypoxemia
- Reactive pulmonary vasoconstriction
-Idiopathic (1 0 pulmonary hypertension)
[Do:IesU
Sterol
I.
Theo.D~r
II
I!
Prognosis:
See underlying dizs
Hypertension
- systemic
SAP 496; E-hb 49; H2B
155; 12M 193; 1M 126, 30,
49; IM-WW 200; 5min 706;
E 1023; CI1T 310; H-Plc
134; H-F57B; F'ys41 0,424,
473; F'ys-B 190
**
Often missed
Hx (chronic renal diz), CS
Eye exam
Renal problems
- PU/PD
_. Appetite
_ Weight loss
Pathogenesis:
- iJ~ in~
Causes - hypertension
Secondary:
- Renal Diz (dogs & cats):
. Particularly glomerular diz
_ Endocrine
Auscultation:
_ Systolic & diastolic murmur in
cat (mitral regurgitation) & atrial (54)
gallOP (ventricular Stiffness) - cat
'
Cushing'siHyperadrenocorticism (dog)
Hyperthyroidism (Cats)
_Hypothyroidism (Dogs)
_Hyperparathyroidism (hypercalcemia)
, PheOChromocytoma: catecholamlnes
Old
age
- CNS disorders: pain, anxiety or stress
-
t BP,2 Diz
CS: CNS, Blind, PUIPD
Dx: Fundic exam, BP (indirect)
Tx: Low Na diet, Rx (DIuretics, Cllrdlzam, ACE Inhlb, Propranolol)
- Ca channel blockers
(diltiazam [CardizemJ) vasodilation
_Angiotensin-converting enzyme
(ACE) Inhibitors (enalapril) =dilation & Na+
& H2O elimination
Emergency Tx
_ Na nitroprusside (Nipride) IV
extremely hypotensive, cyanide toxicity, carefulln hepatic or renal dizs
Monitor Tx:
_ Hypotension: weakness, depression, syncope, acute renal failure
. Reduce dosage if CS
DDx:
Eye dlz
Other causes of cerebrovascular Injuries
Other causes of heart murmurs
Other causes of epistaxIS
Nipride
~;il
Enaca~dl!
I,
hid or kid
Prognosis:
--~ ~
Depends on cause
Expect gradual response to Tx: days
to weeks
Toxicity
Condition
Digitalis
intoxication
SAP 438; Ehb 379; 1M 56; H2B 75,
78; HF 192; PysF 156; Tox-WW
162,391
**
CIRCULATORY SYSTEM
Facts/Cause
Intoxication
Diagnosis
Hx (digitalis), CS
Auscultation ~
Gastrointestinal CS
-Ren:~?=:J
~-~~~~~
Toxic, Cat & Doby
,/
CS: Vomiting, Weakness, CNS
Ox: Hx, CS, Slow HR, Arrhythmias
Tx: Stop Tx, Phenytoin for arrhythmias
Cardiac
glycosides:
Oleander,
Foxglove toxicity
Presentation/CS
- Anorexia
- BorborygmuS(rumbllnggu!SOundsj
- Vomiting (nausea)
- Diarrhea
Cardiac CS (arrhythmias)
- Weakness
- Short, shallow breathing
- Fainting ~~
'CNS
- Depression,
lethargy
- Arrhythmias
~
ECG: arrhythmias
- Sinus bradycardia
- Sinus arrest
olCS
Reinstitute digitalis at reduced
level (50% usually)
Lidocaine or phenytoin
(Dilantin) for ventricular
arrhythmias (aggressive Tx)
Quinidine contraindicated
Antldigoxln & antidigitoxin antibodies cost
prohibitive $$$
arrhythmias
- Slow ventricular response to
atrial fibrillation
- Restlessness
Digitoxin
- Pericardial diz
Found dead
Oeprassion, dizziness, weakness
Mydriasis (dilated eye), blurred vision
GI abdominal paIn, nausea~
Vomiting
\.
Diarrhea
....""" J
- salivation
Respiratory distress
Terminal convulSIons, coma
Qflrt.
Treatment
Stop digoxin II toxiCity suspected
Supportive care until resolution
Hx (exposure)
Prognosis:
Fair to good for supraventricular arrhythmia;
Guarded: ventricular arrhythmia
To late!
I
!!.
Iii
Atropine
Sources
_Glycoside containing plants
Oleander (Nerlum oleander) jApocynaceaej)
.. #1 - Omamenlal shrub
Milkweeds (ASClepias spp)
Uly-ol-the valley (Conva//arla mala/is)
Laurel or azalea (Rhododendron sp)
Dogbane (Apocynum)
Yellow oleander
Foxglove (Digila/is purpura)
Taxine alkaloids
Japanese yew (Taxus cusp/data)
European yew (Taxus baccata)
Prognosis: Poor
Toxicity
CIRCULATORY SYSTEM
Condition
Carb.on
monoxide
H3B 1300; Smln 415; cat
243; H-T/M 330; Tox 374;
Tox-WWI71,172,22
Diagnosis
Presentation/CS
Facts/Cause
cs
Physical exam:
- Disorientation
globin
Treatment
HX(exposuretofum~1
Cardiac hypoxia
- SUdden death
Brain hypoxia
- Convulsion
-Coma
Ustless & weak
-Twitching
~ ()
oECG:
- S-T segment changes (slurring - hypoxia)
- Conduction abnormalities
- Arrhythmias
~:
~'
Prognosis:
Good If treated eariy
..
Mouth Irritation wi hypefsalivatlon
Emesis. diarrhea
.cardlacimtgUlariti8S~
Toad (Buto)
toxicity
- Cyanosis
"""i
_DepresSion
<i>
- Weakness, COllapse
- Pulmonary edema
- Convulsions, seizures
Death in 30 minutes
Digitalis'like toxin
CS: Vomltion, Diarrhea, Weakness
Dx: Hx, CS, ECG
Tx: Flush mouth, Propranolol
- Arrhythmias
1 ')
Hx (playing wi toad)
CS
p..s
AuscultalionlECG
_Cardiac irregularities leading to ventricular
fibrillation
Monitor wi ECG
Necropsy
_Toad parts in stomach
DDx:
cardiac glycoside plants (Olea~der)
Iatrogenic digoxin
, ({ ?
Snakebite
Carbon monoxide
~ '(. ~
~ cardiac diz
_GastriC torsion, anemia, shock, pancreatitis
Dilative cardiomyopathy signs
- TIring
- Dyspnea & cough
- Distended abdomen
Anorexia, welghtIOSS~.
'
) <; I (
COld extremitlEls
Anemia
~,
GI toxicities
~
Urticaria
Alopecia
Sudden death
Refractory to treatment
Hx (treatment), CS
ECG:
_Armythmias (ventricular, supraventricular &
None
conductive abnormalities)
~
_Atriai/Ventricular enlargement
S-T segment & T wave changes
- f QRS voltage
Radiology
_Cardiomegaly, pulmonary edema & pleural
efltJsions
._~
Echocardiology
~~
- f Contractility
_t Lt ventricular end-systolic intemal dimen- Prevention:
Monitor doxorubicin Tx wi EGG
sIOns & f Fractional shortening
~~
iI'
Anticancer drug
cs: Dilated cardiomyopathy
Dx: Hx,CS, ECG,Rads, Echo
Tx: Refractory
Halothane
HB 118
PrognoSIs:
Poor
~I----~~~~~-------
CIRCULATORY SYSTEMl
l Cardiac Arrhythmias
Cardiac arrhythmias,
Dysrhythmias, Ectopia
M8It63; Mk42; H-TIM 59, 371: SAP421; r2M69'IM
59; IMWW 187; HSB 77, 63; H2B 71; H-hb 28: HF 73. 269; H-Plc 154; Cat 925: Pys 142, 152 '
-1--,-p1~1--~
tG?~
'?t
Su.praventricular arrhythmias:
S
b
_ ~nus. radycardialtachycardia
_ Sick SinUS syndrome/sinus arrest
_Atnal premature complexes (APes)
_AV blocks
.
vc
2) -
--\
~_--...J
Ventricular arrhythmias:
_Ventr'.lcular
premature contractions (VPCs)
V
_ entncular tachycardia
_Ventricular fibrillation
Atrial standstill
~r--l
oPath...nes;.,
etc
Reentry (unldlrectlonal block)
. Increased or decreased excitability:
,Bectrolyte
Imbalance hyperlcalemia
,Acidosis, acidemia
,lsChemlahlypoxia
- Changes
in: resting potential
, Membrane
, Refractory penod (absolute or effective)
, Duration of each phase Of depolarization
, Repolarization
. Arrhythmogenic agents
, Digitalis
necrOSIS, fibrosis,
Mechanisms of arrhythmogenesls
@
B
Classification of arrhythmias:
r.--JI
P-R
Frequency: Bigeminy
Trigeminy
Paroxysmal (~3-5 recurring)
Continuous
Supraventricular
Origin:
Ventricular
Bradycardia (slow rate)
Rate:
Tachyca,rdia (fast rate or irregular)
Conduction abnormalities
R
p
VPC
Causes of arrhythmias:
Primary (cardiogenic):
Hereditary (rare in cats):
_ Sinoatrial (SA) node defects
Sick sinus, sinus block (SA arrest)
_Atrioventricular (AV) node block
_ Bundle of His
_Ventricular pre-excitation syndrome
(Wolf Parkinson White syndrome _cats)
~_
.
Acquired (cardiogenic):
- Conduction system diz
_Trauma or surgery
'~ ~
_Valvular diz
-, ~
_Atrial diz
_ Myocarditis
_ Cardiomyopathy (hypertrophic or dilated)
_ Ischemia
_ Neoplasia
_ Pericardial effusionltamponade
r;.
Secondary (noncardiogenic):
Dysautonomias (autonomic nelVous system)
_Vagal tone increase (parasympathetic)
Respiratory disorders (primarily dogs)
Gastrointestinal diz
_ Sympathetic tone: tachycardia
Excitement, exercise, pain, fever
_OrganiC brain diz: parasympathetic/sympathetiC
Metabolic disturbances:
_ Ischemia/hypoxia: hypotension or
hypoperfusion! anemia or respiratory diz
Presentation/CS
Benign & clinically insignificant
Clinical signs of poor cardiac output
- Episodic weakness
- Fainting (syncope)
- Depression
- Pallor
- Dyspnea
Sequelae:
- Malignant arrhythmias
- Heart failure
- Sudden death
!Rhythms - Summary
Normal rhythms
~Jl
CIRCULATORY SYSTEM
_- ~ ....~ Atrial standstill (hyperkalemia): HR: Dog < 60 bpm; Cat < 90 bpm
..-
Hyperkalemia, No P waves,
Junctional or Venlrlcularpacemaker
No P waves
Long P-R
,-0
Wandering pacemaker: P wave alterations - Often normal (dogs)
P wave alteration
-.JI.,-"JI..,.--..JVc.Jl.,f.-_~'''~
Mobitz II:
Dropped ORSs
(bigeminy or trigeminy)
P-R intervals are constant
Complete (3rd degree) AV block: Many Ps, few ORSs (ventricular escape)
No association between Ps & ORSs
Sinoatrial block (arrest): Pause of 2 or more R-R intervals. Clinically insignificant
Dropped QRS
~,
,r
PVC (QRS)
Atrial APCs: Premature P-ORS-Ts wI a pause, Isolated - clinically insignificant
Conduction disorders
Intraventricular conduction blocks: ORSs
prolonged, MIMI (microscopic intraventricular
myocardial infarct)
lOx - Arrhythmias
~J----=C=IR:-:C:-::-U--L-A=TO-RY-S-Y-ST-E-M---'I
Diagnosis of arrhythmias
1M 60; Pys 152
History (Hx)
- Digitalis toxicity common cause olarrhythml88
CS 01 arrhythmias: episodic weakness, fainting, CHF
Physical exam:
- Other signs of cardiac diz? or other dizs or abnormalities?
Pulse deficits
t
{[d
A",,,ltatlon,
- Heart sounds of varying Intensity?
1---
Drugs
u,.,
Mechanism
+ Na conduction
:.....-:'"'"
sympathetic tone
~
Su~~.ven. & ventricular arrhythmias~
Beta blockers
::
Group 4 Drugs
Diltiazem (Cardizem)
(atrial fibrillation)
I. ,.
L-_______________
~
)II
NOllTlai
Normal
Normal or pathological
Usually insignificant
Female min. schnauzer
Hyperkalemia? breed?
Asymptomatic
Prolonged PR interval
None
Propantheline (ProBanthine)
Pacemaker
Pacemaker
Propentheline. Stop digitalis
None
Tx underlying cause
Coursefs
Very rare
Atrial fibrillation
Enlarged atria
Junctional tachycardia
Accessory palhways
E1
,M
None
Digitalis
Digoxin
Fine
wavesl no "P" waves
Irregular irregular HR
Negative P waves
Digoxin
Delta waves
I'l
m
~------
Normal
Dog. normal respiration
Pacemaker shift
Exercise normal
Cardiacdiz
I.
ECG
Complete bl:k
AV junctional impulses
Cardizem
Supraventricular tachyarrhythmias
Facts
- Alrial flutter
- Ventricular preexcitmenl
WPW syndrome
.-
Group 1 drugs
Lidocaine
Quinidine (QuinideX)
Phenytoin (Dilantin)
Group 2 Drugs
Propranolol (Inderal)
Atenolol (TenollTlin)
, . -_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Normal rhythms
Sinus rhythm
Sinus arrhythmia
- Wandering pacemaker
Bradycardia
- Sinus bradycardia
Sinus arrest
- Sick sinus syndrome
Atrial standstill
- AV blocks
.1st degree AV bl:k
2nd degree
.. Mobitz 1
.. Mobitz 2
3rd degree
Junctional rhythm
Branch blocks
.RBBB
_LBBB or AFB
Tachycardia
Sinus tachycardia
- Atrial tachycardia
Antiarrhythmic Drugs
L -_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Arrhythmias
$\
--J~
H-TIM37'
r:k
&It:!
Treatment of arrhythmias
Sustained
1M 60
Digoxin
Udocaine
Cardiopulmonary resuscitation
CPR
No~.'
sinus ****
rhythm
I
~
Facts/Cause
.._
In dogs & cats
'"
**** fC I
I i III
...~'_
Regular rhythm
I 1111 III
'\"...-r-
.~
a!J)jt:s,
- Atropine eliminates
(vagal in nature)
PathOlogical conditions wI sinus arrhythmia
- Pronounced In dogs & cats wI respiratory dlz
- Sinus arrhythmia assoCiated wI sinus bradycardia may suggest digitalis toxicity
Wandering pacemaker
- Variation of sinus arrhythmia
dog
'--'~ ~
' . W'
'""Y'
11!!I[UII~jll!~
II II I
~"!ll
rhythm
- Abnormal in cat
~.,8;;:
of normal sinus
Treatment
1111
~-~"-)tH
Ito
I I
Variation of
wandering
pacemaker
Presentation/CS
CIRCULATORY SYSTEM
Diagnosis
"
Normal
sinus
arrhythmia
254
I
I
I I
II
111I
*1
Asymptomatic
- Normal finding
'i I'
,.~~il
***
Sinus
bradycardia
MBk 78; Mk 43; H-TIM
64, 379; SAP 423; H3B
67; H2B 73; 12M 77; 1M
66; IM-WW 188; E 978;
5mln 302; Cal 928; H-T
133, 213; H-F 74, 295;
Sx-WW95;NB3.14;Pys
471
**
II
I I
Heart rate:
- < 70 in dogs 60 In giant breeds)
- ~90 bpm resting cat 120bpm in
Causes:
nonresting)
vagal tone - may be normal variation
Atropine response test, then ECG in
Normal in athletic dogs
Cardiomyopathy
Respiratory arrest
Sick sinus syndrome
Hypothermia
Prognosis:
Hypothyroidism
Guarded to
-Toxemia
Hypo- or hyperkalemia, hypocalcemia
Slow heart rate: Dog < 70 bpm; Cat < 90 bpm
Increased intracranial pressure
CS: Weak, faint
CNS lesions
_ Drugs: digoxin, beta blockers, Ca channel blockers,
Ox: HR, Normal P-QRS-T, Atropine response test
morphine derivatives, xylazine, anesthesia
Dysautonomia
Tx: None, Glycopyrrolate
'~.~
I!
,.
Robinul
--.
. ::z-
rrrauTnmia - Br<!:ll,tu"<!:IIr'ltia
Sinus
arrest;
Sinoatrial
block,
Prolonged
CIRCULATORY SYSTEM
_1 disorder of SA node
Brachycephalic breeds
o Sinus bradycardia
o Nonconclucted (APCs)
-SA
syndrome
impulse
Female miniature schnauzer
- Other breeds reported: Pug. Boxer, Dachshund,
Cocker spaniel, Doberman
- Middle aged or older (geriatric)
Extremely rare In cat
Episodicweakness,Btaxla Hx (breed). CS
Pacemaker Toe (Tx ofChoiC&)
Fainting (syncope)
ECG - one or more offollowlng rhythms olf pacemaker not feasible
- Glycopyrrolate
- Sinus bradycardia
Confusion
- Propantheline (Pro Banthine)
w StokesAdam's seizures
- Sinoatrial block (pauses)
- Sinus arrest
Sequela: CHF
AHernating brady & tachy
cardia
standstill,
Persistent
atrial
standstill
H-TIM 66; HT 166, 182,
240; SAP 432; H3B 71;
H2B 74; 12M 78; 1M 67; 1M
WN 193; Smln 286; cat
935; E 981; HPic 154; HT 166, 182, 240; H-F 61,
296; NB 3.15; Sx-V'N/ 96
**
Bradycardia
Impulse not generated in SA node &
poorly or not conducted through atrial
tissue
_ Junctional or ventricular escape
rhythm controls heart
Cause:
- Hyperkalemia
Hypoadrenocorticism
Acute renal failure
Urinary obstruction
Diabetes ketoacidosis
Dilated cardiomyopathy (cat)
- Digitalis toxicity
_ Muscular dystrophy (Springer spaniels)
Dog; extremely rare in cat
Breed: English springer spanielS, Shih tzu, Old
Eng. sheepdog (correlated wI muscular dystrophy
[Silent atrium])
~-----
pacemaker,
CS: Weak, Fainting, Shock, Death
Ox: No P waves in any lead, Bradycardia
Tx:
for
NaCI
Weakness
Hypovolemic shock
CHF
Sudden death
Prognosis:
Poor for long term survival
o Extension of life possible wI pacemaker or drugs
If hyperkalemia suspected
Emergency Tx rpush K+ into cells)
. 0.9% saline, 40-90 m1/1(g/l'U until hyperkal Bradycardia: < 60 bpm . dog
emia & hypovolemia corrected; plus:
< 90 bpm cat
. 2 mEqlkg sodium bicarbonate Slowly IV (be Rhythm regular or irregular
ware of paradoxical cerebral acidosis); or
.. 0.5 UJkg of regular insulin slowly IV
_ No P waves in any lead
If life threatening condition
- ORS complexes normal or
_ Calcium gluconate (1 ml of 10% SOlution{
bizarre
Hx (breed). CS
ECG:
0.9% NaCI
.~
PrognosIs:
Hyperkalemia: good if corrected
Silent atrium - Grave: progressive
myocardial failure usually develops
AV Blocks - Bradyarrhythmias
Condition
Incomplete
(1st & 2nd
degree)AV
heart block
MBk 7B; Mk 43; H-TIM 67,
382, 393; T 74, 169, 231;
SAP 433; Cat936; E-hb 404;
12M 79; 1M 67; IM-WW 193;
H3B 72; H28 75; E 981; H-T
74,169,231;H-F61,295;HPic 154; ~'c., 20; SxWW 96
**
CIRCULATORY SYSTEM
Presentation/CS
Diagnosis
Partial block of impulse in AV
Type 1 usually none
Heart rate variable
node or AV junction
Type 2
1st degree block
Rare in cat
- Weakness
- Regular rhythm unless other arrhythmias
Types:
- Fainting (syncope)
~ Prolonged, constant P~R interval
- 1st degree AV block
- Congestive heart failure
Dog: > 0.14 sec
- Mobitz type 1 (2nd') AV block
Cats
Cat: > 0.08 sec
. More advanced degree of block - Asymptomatic, may toterate
Normal P wave & ORS complexes -1:1 ratio
_-1~2~"~d~&~3'~d~d.~g~'~~bI~~~~
2nd degree block
Digitalis #1 caUSe
,
causes:
- Normal P waves & ORS complexes
-p
Normal aging phenomena (type 1)
-Mobitztype1 (Wenckebach)AVbloc
Increased
vagal
tone
'I ),
_P-R interval gradually prolonged
- BrachlocephaMc breeds
- Respiratory dlz
before QRS dropped
-Gldlz
Rhythm: regularly irregular
- Neurological dlz
- Mobitz type 2
DigiUllis toxidty ('1 cause)
Sedatives (xylazlne, acetylpromazlne)
P-R interval not prolonged
Antiarrhythmic drugs (propranolol,
ORS absent after repeated P wave
quinidine, procalnamide &)
stimulation
- AV nodal dlz
- Heartworm
.. Bigeminy: 2 P waves to 1 ORS
- Bacterial endocarditis
complex (2:1)
- Cardiomyopathy
.. Trigeminy: 3:1 pattern
- Myocarditis
- Hypertrophic cardiomyopathy
Atropine challenge test:
Facts/Cause
-Idiopathic fibroSis
Mobitz type 1- p
QRS
Atrioventricular
block,
"Stoke-Adam's"
syndrome
MBk 7B; Mk 43; H-T/M 68,
382, 394; SAP 433; Ehb
404; H3B 72; H28 75: 12M
79; 1M 07; IM-WW 193; Cat
936; 5mln 290; E 981; H-T
74,175,235; H-F63,295; HPic 154; Sx-S BB2, 913; SxWW96;Pys471;Pys_B 156;
NB 3.20
**
not required
- Stop digitalis or other "causing"
drugs
Some Mobitz 1 & MObitz 2: Tx
depends on CS (weakness, syncope)
- Short term:
Glycopyrrolate (Robinol)
Propantheline (Pro Banthine)
Dobutamine (DobutreX)
, Isoproterenol (Isuprel)
- Permanent pacemaker(TOC)
Prognosis:
1 = good
0
2 = guarded
3 0 = poor to fair
_111-.11.'11
(3rd degree)
AV Block,
Treatment
1st Mobitz type 1 (2nd): Tx
'II I
Hx,CS
Permanentcardiac pacemaker
Normal P waves with a normal atrial rate (long term) lor symptomatic animals
Stop digitalis therapy II the cause
of 70-80 beats/min
over by accessory pacemaker tis- - Weakness
Short term Tx
ORS complexes - slower rate: escape
sue uunction or ventricle)
- Fainting (syncope)
- Glycopyrrolate (Robinul)
beats - bradycardia
Junctional escape: 40-60 bpm
- Congestive heart failure
Isoprotetenol (Isuprel)
- Dog < 52 bpm
- Dobutamine (Oobut~)
- Ventricular escape: 20-40 bpm
- Cat < 64 bpm
- COrticosteroids
No association of P wave & QRS
Causes:
complexes (many Ps & few ORSs)
Digitalis toxicity
ORS looks aberrant (wide & bizarre)
Cardiomyopathy
- Called ectopic beats (originate from
AV node disease
accessory pacemaker tissue)
See cause of type 1 & 2 blocks
Atropine challenge test
AV conduction dizs (infarction,
(see above)
inflammation, neoplasia)
Congen~al disorders (AS, VSD,
AV block)
till
Robinul
"
lI
-"'"'
DDx:
Advanced 2 AV block
Atrial standstill
Ventricular tachycardia
.:.f~
Prognosis: Poor
I II
I I I I 259
I II III
I
II
II
iI
Supraventricular Tachyarrhythmias
Condition
Sinus
tachycardia
Mk 44; H-T/M 64, 380;
C12T 807; SAP 426; Ehb 400; 12M 76; 1M 64;
IM-WW 188; H3B 74;
H2B n; C12T 807; H-T
133, 213; H-F 74, 298;
5min 303; Cat 929; pys
154; NB3.14
CIRCULATORY SYSTEM
Facts/Cause
Presentation/CS
o High rate rhythm from SA
Usually no symptoms
(asymptomatic)
node wI consistent 1:1 AV
Shortness of breath
conduction
Usually normal physiologic weakne~ss
.:::
response to exercise
-f'
.'Ii' /
Diagnosis
Heart rate - rapidly regular
Dog> 160-180
- Puppies> 220
- Col> 240
All other ECG featUres normal
Ocular pressure will decrease heart rale (vagal
maneuver)
""
_ _- L_ _ _ _,
****
APes! APDs
285;NB3.16
III
Paroxysmal atrial
tachycardia,
Sustained
supraventricular
tachycardia
M8k 79; Mk44; H-T/M 65,
383; T 142, 217; C12T
807; SAP 427; E-hb 400;
H3S 76; H2B n; 12M 76;
IM-WW 189; Smin28S; E
969; C12T 807; H-T 142,
217; H-F 77, 298; HPi(:
155; Pys 154, 170; NS
3.16
node
- Isolated. pairs, runs (3 in
succession) or paroxysmal
supraventricular tachycardia
(4 or more in a row) or
sustained supraventricular
tachycardia
~
ECG:
No Tx required
- APes (premature P-QRS-T com- Infrequent APCs mlb normal
plexes followed by pause)
Digitalis if correlated wI CHF
Irregular rhythm
Stop digitalis if cause
~ ,tP
- Abnormat P (P')followed by normal
QRScomplex
- P wave may be hidden in T wave of
proceeding beat
- P-R intervals constant
Prognosis:
Good, mlb normal
. .'.
,..,t---=~~_.,.
**
II I I
l~r
W
***
Atrial
tachycardia,
Prognosis: excellent
Oog - HR = 11 complexes (3 sec) X 20 '" 220 bpm
Regular mythm
sec
Supraventricular
premature contractions
Mk 44; IMWW 188; H-T!
M 64, 380; T 140, 215;
SAP 426; H2B n; H-T
140,215; H-F 76; 5min
DDx:
Paroxysmal tachycardia
Atrial flutter
Ventricular tachycardia
50 mmlsec,;prc)per speed
Faster rate
III
Atrial premature
contractions/
complexes!
depolarizations
Treatment
No Tx required if normal physiological
response
261
- Hypoxia
-Anemia
- Orug toxicity
Digitalis
- Dopamine
- Oobutamjne
- General anesthesia
- HypoItalemla
-Toxemia
Increased sympathetic tone
- Hyper1hyroldlsm (cat)
E1
DigitaliS if CHF
Digoxin
If Ineffective
. Dlltiazem or propranolol
!!1t
=0/.
Prognosis: guarded
Di~
1262
Atrial
;,' ;',;,;;';;;;;;
:~;i;;;
::~':'~~:h'''hJ~jnIO
"
)w",,"
"
(HF)
- Weakness
- Fa'nting (syncope)
fibrillation or back to
Accelerated
atrioventricular
rhythm
.HR>160bpmdog
~
- Atrial rate 600-700 bpm
response
.p
CIRCULATORY SYSTEM
. I
YSIO ogy:
at op
Reduced cardiac output due 10:
iIJ
+ stroke vo Iurne
,
..u..:.....,\
**
~c~ !F\
DiO
~In~
'-~
Px: Guarded in small animals ~6J
r;
'-'
FRaPid
Icli;
III
I II
I I
._---------,
Junctional
rhythm
~~
tYr~ ~
~. ~
Dt~italis
~,P
l'
./
Weakness
('""7)7~"Cles
3"*9~
**
r
~~~~~ope
/Cause:
Digitalis toxicity
Sick sinus syndrome
Myocard~is
DDx:
Atrial standstill
Slow atrial tac,,:h,v,I::anjia I
I.
Ventricular
preexcitation
H3B 83; H-TlM 67, 71:
HT 160; Gal 936; SAP
434; E 972; C12T 807
**
II~I'IIII
Cause: unknown
Congenital In dogs & cats wI or w/o other
congenital defects (atrlai septal defect,
valvular dysplasia, hypertrophic cardiomyopathy)
finding
-P
/in
C'
~~~
,p waves
,- HR 60-tO
Junctional
1
11"'1' III! 111 11 11,111
Ventricular pre-excitation
us~Hf..;
Prognosis: ???
IIIII11111
"",
Stop Digoxin
if cause, 1'1
P waves normal
k,"g
;'';'~rt
r2s3l "~f
~
III
II
INone
I III
Misce"aneous
WolfParkinsonWhite (WRW)
syndrome
IM-WW193; Ca1746; Smin
306; HTfM 68, HT 179,
*~.e
__~ ---..
Bundle
branch block
(Right or Left),
Intraventricular
conduction
blocks
IM-WW 194; H-T/M6a; HF 64; E 984; H2B 86; Smln
VPCs,
Ventricular
tachycardia
CIRCULATORY SYSTEM
Cats
WPW syndrome
Congenital: rare
- Acquired
- Feline hypertrophic cardiomyopathy
- canine chronic valvular diz
i-:c~=r=.ye
DDx:
AV ;";;::~;~:~:~hyca~,a I
o
**
pr&SSlJre}
Atrial
Ventricular tachycardia
Shortened P-R interval
Fever
- Hyperthyroidism
- Anemia
~~~ri~~::~~~~b';';!Ck
b~undles
'.;--l.C\~ ~.
-=
-causes
- Occasionally in normal dog (RBBB)
- Cardiomyopathy (AFB cats & LBBB dOgs)
- Congenital defects
- Tumor or trauma
- Myocarditis
- Canine chronic valvular fibrosis
- Heartworm & other pulmonary dizs
I
- Life threatening
- Ventricular fibrillation can - Sequelae:
- Hypotension
easily follow
- Myocardia ischemia
Paroxysmal
or
sustained
M8k80; Mk 44; H-TIM 69,
ft
P waves unrecognizable
QRS complexes: normal. wide or bizarre
Ventricular pre-excitement
Impulse uses accessory pathways
to bypass AV node
Activate portions of ventricle
*** =r
premature
contractions!
apolarization
~~"""'mias
____________-L-________
-i'---
~~~
- Electrolyte disturbances
- Altered serum potassium
- Altered serum calcium
- AHered blood pH
- Autonomic changes
- Hypoxia
- Systemic disturbances: Pyometra,
Pancreatitis, Fever, Excitement, Uremia
,'W-
/v\\
DDx:
- Sinus tachycardia
- Atrial tachycardia
- Atrial fibrillation wi conduction
\. disturbance (branch block) ../
s'~~~rti:e care
-Oxygen
-IV fluids
- Potassium
if needed
~'
SUPpiementatlOn~,.
' .
IL'
Inderal'
-W~
265
ili
Ventricular Fibrillation
Condition
Ventricular
fibrillation
IM-WWl92; H-T228; HF
82,304; Cl2T 171; SAP
431; H3BS3; H2B90;5mln
304; E-hb402; H-Pic 156;
Pys-B 155; NB 3.18
CIRCULATORY SYSTEM
Facts/Cause
Chaotic, asynchronous
impulse originating in the
Presentation/CS
Diagnosis
ventricles
#1 arrhythmia associated wI
cardiac arrest
- Unconsciousness
**
~~;;~~.rres~~
.
/C~.-u-se--:----~--~
Myocardial ischemia
Electrolyte imbalance
Hypoxia
Increased automaticity
ANS imbalance
Slow conduction
Drug toxicity
Unstable ventricular
Treatment
EMERGENCY SITUATION
- Cardiopulmonary resuscitation
Physical exam
- Weak or absence of palpable
(CPR) immediately
pulse
Steps to follow:
- A = airway (intubate, etc.)
- Dishwasher gray or cyanotic
mucous membranes
- B = breathing: 10-12 breaths/minute
- C = intrathoracic cardiac massage in
- Auscultation
animals> 15 kg; extemal chest com~ Bradycardia or absence of
pression if < 15 kg ("thumpg version)
heartbeat
- Defibrillation equipment if available
ECG (electrocardiogram)
~ No Pwaves
- D = DrugslElectrocardioconversion
- Intracardiac lidocaine occasionally
- No recognizable CRS complexes
successful
- ContinOous, chaotic & bizarre
positive & negative oscillations
Oscillation coarse (large) or fine
(small)
arrhythmias
~1 el.
JJ72.
Prognosis:
-Very grave
III
Cadqx.inoIBy
arrest,
CPA,
Ventricular
asystole
12M 93: IM-WW 195: smln
26,306; H-T/M 71. 72, 391.
**
'A'"
-1-,(jf;
'iJ
=IJO:(71D
No heart activity
CS: Unconsciousness, Dilated pupils, Loss of tone
Ox: No pulse or heart beat, ECG
Tx: Emergency CPR
DDx:
- ECG artifact (ECG not on proper lead
or connected improperly)
CIRCULATORY SYSTEMI
EMERGENCY Cardiopulmonary
resuscitation (CPR)
Causes of CPA
Hypoxia
- Respiratory failure
Steps 10 follow:
- A = airway (intubate, etc.)
- B = breathing: 10-12 breaths/minute
- C = intrathoracic cardiac massage in animals> 15 kg; external chest
compression if < 15 kg ("thump" version)
- Defibrillation equipment if available
- D = DrugsJElectrocardioconversion
- Intracardiac lidocaine occasionally
successful
Anesthesia
eNS trauma
Toxemia
Arrhythmias
Epinephrine:
Sodium bicarbonate
0.2 mg/kg IV
0.5-1.0 mEq/kg initial
dose up to 8 mEq/kg
I I
II
Advanced shock
Trauma
.
TREATMENT - CPA:
EMERGENCY SITUATION
Cardiopulmonary resuscitating
(CPR) immediately I!
A = airway (intubate endotracheal)
- Tracheostomy If necessary
~
.
I--
{f
~ ~~~~~~~~::~:~~~achine,
{ j .
oxygen line. mouth to tube
(approximate normal chest expansion)
Simuhaneously wI, chest massage~.
.,.;"
(t per 5 compressions)
--l>: _"
,
C = circulation - cardiac massage
- External chest compression (80-12OJmin)
Right lateral recumbency
Compression over 5th rib using heels of hand
below &
~::---...
above chest
~ \\......-./II..n
One hand compression
~
(thumb on 1 side & fingers
~j
on other) for small dogs & cats :::. ..........
Simuhaneous compression & ventilation (02)
Good for small & medium dogs & cats, inadequate for dogs over 20 Ib
Effective massage = detectable
femoral or arterial pulse &
improved color (membranes)
tJ
.::
.........
[]
I ...
.. Inst~ute
OJ:: ~~O:~~!el~ShOCk
.
(i .
Prognosis: Grave???
~r------~C~A~R~D~IA~C~S-Y-S-TE-M~I
ECG pattern
Right axis deviation
-009>+1000
ECG pattern
- Cat> + 1600
Deep S wave in leads I, II, 111 & aVF
Deep Q waves
- Pulmonary hypertension
90"
- Tricuspid insufficiency
- Chronic respiratory diz
-180 0
"80"
- Pulmonary stenosis
t-----':;Bj!i;:-----ioo0" f.:\
Q
17
S
Q
R
Left atrial enlargement
ECG pattern
- Wide notched P waves (notch nOI abnormal
unless also wide)
(> 2
boxes)
Mitral insufficiency
'- Cardiomyopathies
Patent ductus arteriosus
- Subaortic stenosis
Ventricular septal defect
..J
..----=-----------..
ECG pattern
-WideQRS
Dog> 0.06 sec
_Cat 0.04 sec
- Tall R waves
(lead II)
- Left axis deviation
Dog <+ 40
Dilation
Mitral insufficiency
Subaortic stenosis
- Dilated cardiomyopathy
.Cat<O
ST slurring or coving
HypertrophiC cardiomyopathy
Subaortic stenosis
-90"
~/S
~~
~~:~ ~ ;:~~~~~- :: 8
.,50.\AV
.30"
-I--I--I--\--l--I-1-+--+l-+s-.T+-s-+lu-r-rii-n-g+-I
Normal
/' /:XIS
p
.120"
8
I'
/@
.60'
/ "
"
QRS widening
I
271
-.
/
\
/O-O-X-:-L-.-rg-e-T-w-.-v-e-.------
"'
~~
-Normal variation
Myocardial hypoxia
Ventricular enlargement
r.- Hypothermia"-'
Hyperkalemia
- Addison's diz
Urinary obstruction
-Intraventricular conduction abnormalities
Metabolic diz
Respiratory diz
Cardiac drug toxicities
Large T waves
H-T 92, 120', H-F 69; SAP 418
CARDIAC SYSTEM
I I
I
~'
.~
:,
Tented T waves
H-T245;SAP418
Hyperkalemia
- Addison's diz
..
Elevation of S-T segment
H-T84,118,SAP417
Cardiac trauma
Digitalis toxicity
.2 changes
.2 changes
- Ventricular hypertrophy
- Ventricular hypertrophy
-VPCs
-VPCs
- Conduction disturbances
- Conduction disturbances
Digitalis toxicity
Prolonged
Q-T interval
SoT
Artifact
conduction disturbances
2 to prolonged QRS
Ethylene glycol toxicity
CNS problems
Bradycardia
Artifact
Short R waves
SAP417;H-T82
Pleural effusions
Pericardial effusions
Hypothyroidism
Q-T
Pulmonary edema
Obesity
Pneumothorax
HypoaJbuminemia
Severe myocardial damage
Loss of cardiac muscle mass
Shortened
Q-T interval
SAP418
Cl-T
,
......
273
./
Anemia
Anemia +02-carrying capacity of blOOd
-+ RBCs &lor hemoglobin content or
**,**
Pathophysiologic causes:
peg
1. Blood loss
2. Hemolysis (increased RBC destruction)
3. Inadequate RBe production (bone marrow)
Regenerative or responsive anemias
Reticulocytes (new RBCs) in circulation
__
_+
-=-~~~~c-
MCV (11)=
i.
r@
_ _ _ _ _~(~!~;;~~[[(~)
~~p.
~.
~
DDx - Anemia (large type Indicates common causes, small type less common)
Drugs
Blood loss
~ . Splenic torsion
/ ~ . Acetaminophen
- Acute hemorrhage
. Vena caval syndrome
Antineoplastic drugs
_ Chronic blood loss
- Extravascular hemolysis
.. Antiarrhythmics
Anticonvulsants
-Internal hemorrhage
Autoimmune hemolytic anemia
. Antiinflammatories (nonsteroidal)
Trauma
', Red cell parasites (Hemobartonella,
. Benzene
.
)
B b . Cyt
. )
Benzocaine
Tumors (h emanglosarcoma
a eSla,
auxzoonosrs
Chloramphenicol
Occult blood loss
. Heinz body hemolytic anemia
Cimetidine
Intestinal parasites
Drugs (propylthiouracil, gold salts)
. Gold salts
Ectoparasites (lice, ticks)
Modified live virus vaccines
: ~::~:~
Gastric ulcers
Heartworm
. Methimazole
Tumors
. Pyruvate kinase deficiency
. Methionine
_Platelet abnormalities
. Phosphofructokinase defiCiency
. Methylene blue
Factor deficiencies
. Leptosplrosls
. Metronidazole
_ Immune-mediated thrombocytopenia . Fragmentation hemolysrs.r::?i'l ~
. PeniCIllin & cephalosporlns
. Snake venom
/&
~ ~--:::3' Phenothlazlnes
;:J.","':"
- DIC (disseminated Intravascular coagulatiOn)
. Zinc toxIcity
~~ .,..~~
I \.. ~~ . Propylthiouracil
- Warfarin poisoning
~
~ . Sulfa derivatives
- Hemophilia A or other congenital factor delc
_ Nonregenerative anemia
. Thlacearsamlde
- . Trlmethopnm-sulfa
HI.
~ r::.
- Mye Iophlh ISIC anemia
. Vitamin K
_ emo YSIS
~:::, ~. Lymphosarcoma
. ZinC
Intravascula~
_ . Myeloproliferative leukemia
_ Hormones, chemicals
RBC p~ras es
.
~
Lymphoproliferative leukemia
Estrogen (endogenousorexogenous)
Acetaminophen/onion tOXICity
FeLV anemia #1 cause in cats
Lead poisoning
>
if.
r.) .
r..y ..-
~.
____
_________________
Diagnosis - Anemia:
i:ti:!It'--Mh'-
;-
_________________
r -.;:'
ff'
_______
TREATMENT:
1st collect all blood samples
Stabilize patient
Determine if regenerative or
nonregenerative
- Regenerative (blood loss or
hemolysis) requires more aggressive Tx than nonregenerative
Treat underlying cause
-t
\~ ~
- Deficiency syndromes
Iron deficiencieS
Hypothyroidism
. Folate or 912 deficiencies (rare)
- Renal failure
- Chronic inflammatory diz
- Canine ehrlichiosis
~ Idiopathic RBC aplasia
- Radiation toxicosis
- Idiopathic aplastic anemia
- Hypoadrenocortlcism
- Osteopetrosis
~L-
- History'
- Deworming?
- Diet (young> old - iron deficiency)
qjl~'!Jii'f,j
- Drugs or recent vaccination?
- Geography (ehrlichiosis, heartworm, 8abesiosis)?_
- Immune-mediated anemia (last Coggins' test)
- Travel history (Babesiosis)?
~
- Past illness (chronic anemia)? (.~~~
fj'
Clinical Signs
- Asymptomatic
- Lethargy
" I
-Weakness
-Anorexia
- t HR (tachycardia)
.
- Dyspnea, t RR (tachypnea)
- Reduced exercise tolerance
- Depression
- Poor grooming in cats
- Pale mucous membranes
Icterus
- Fever
Lymphadenopathy
(lymphoma)
Collapse if severe
275
PrognosiS
Regenerative better than nonregenerative
Goodforacuteorchronicblood
loss If cause removed
CIRCULATORY SYSTEM
Presentation/CS
Facts/Cause
Dia nosis
Treatment
N....
Hx(age)
Don't breed carriers
PCV 15-30% When 1st diagnosed
- Progressively declines over next 1-3 years to
* -
dea~
h'
JTi.rn~
't7-
PrognosIs:
die In 1-4 years
Grave:
"'''--
Hx (spaniel)
Avoid overexertion
Chronic hemolytic anemia
Nonnal or mildly PCV, but reliculocyles (7-23%)
Splenomegaly
Definitive: spacial RBC assay
(PFK)
deficiency
PrognOSis: good
Brown 10 pink teeth a bonea
Rare
Autosomai dominate trait -affect heme synthesiS PhotosaneWzation
MeChanism of hemolysis unknown
Feline
porphyria
'~"k""~~7
*
Stomatocytosis
~~~f{J
Lab 39
recessive trait
Aleskan Malamutes assoclated wI chondrodysplasia
Defects: to cell membrane or of ion transport
leading to Increased water content & large cells
-None
Avoid exposure to sunlight
Don't breed carrier animals
Prognosis: 711
Hx (Malamute)
None. do not breed
Mild hemolytic anemle &Sllghl reticulocytosis (2%)
RBC numbers reduced. but PCV nonnal due 10
enlarged RBCs
Morphology -RBCs appear to have mouthlike area
of central pallor
Hereditary - eutosomal
. ..-..1
~~
Blood if extemal
Hx (trauma). CS
-ro-S-to-p-h-.-m-o-rr-h-.-g-.--- Large volumes must be lost to
Occult in internal bleeding
- Check bleeding: wound, multiple sites
- External- suture or pressure bandages
effect PVC or RBC numbers
Acute:
- Coagulation disorders
- Intemal
- Internal or external bleeding
_ Signs of anemia: lethargy.
- Capillary refill time
Monitor for shock
Acute: 2-3 days for rageneration
weakness, anorexia, tiring
Bone marrow responds in 5 days
Tx hypovolemic shock
- Initially PVC & RBC normal
M8k 13;Mk26;E-hb684;
_Anemia shows asfl uid shifts into vascLiar space
-Massiveloss=hypovolemic CBC:
()!
(U U
- Balanced electrolyte soln to
SAP 149; H2B 722; 12M
. Appears nonregenerattve for 2-3 days then
shock
- Acutely PCV & TP normal (declines
replace estimated blood loss
1164.1171; 1M 899; IMrellculocytes In blood
_Tachycardia
in 24 hours due to mobilization of PCV < 15-20% consider whole
WoN 508; 5min 200. 256;
- Hypovolemic shock if severe
Cal 703; Pa-T 289; lab Chronic blood loss:
_Tachypnea
extracellularfluidto maintain volume)
blood transfusions
31.40- .. Iron stores. resulting in" RBCpro_Cold extremities
- Reticulocytes In 2-4 days as bone marrow
duction
_cardiovascular collapse
responds.
~
- Plasma protems
- Regenerative until iron stores are
- Renal damage ~~ _Coagulation tests if clotting problem su. spacted
depleted
- Bleeding
~"~ Chemistry:
._
For other organ function ,#0 -.
Ch~ntC..
_Total protein
c....
- Signs or anemia
Radiographs:
_ Blood in cavities
- Gradual onset
- Source of bleeding obvious
or source of
(fleas) or obscure (internal
bleeding
bleeding)
Other tests;
_ _ _ _ _ _ _ _ _ _ _...L0:..N:::::o..:ict:::.::ru::s:..--------l _ Fecal flotation, fecal occult blood.
urinalysis. cytologic of body cavity
Intestinal parasites
Blood loSS
fluids
(hookwOrms)
- Acute hemorrhage
DDx:
Ectoparasites (lice, ticks)
Trauma (lacerationVsurgery
Regenerative anemias
Gastric ulcers
Splenic rupture
- Immune-mediated hemolytic
Tumors
- Chronic blood loss
anemia (dog)
Coagulation
disorders
-Internal hemorrhage
- Hemobartoneffosis & Heinz
Factor deficiencies
_Trauma
DIC (dissemlneted intravascular coagutatlon)
body anemia
_Tumors(hemangiosarcoma)
Thrombocytopenia/platelets
- Nonregenerative anemias
- Occult blood loSS
- Warfarin poisoning
Blood loss
anemia,
Hemormage
***
..
/0-/ -
~l--~~--
~tb~
Prognosis
Anemia
CIRCULATORY SYSTEM
Condition
Facts/Cause
Presentation/CS
Diagnosis
Treatment
Asymptomatic
Hx (Drugs, Geography [ehrlichlosls, BabesjoslsJ) Dog: if cause not found:
Pallor
- Tx for IHA (Immune hamolytic
PE (physical exam)
Icterus (50% of cases)
anemia) willie walt lor test results
- Pale mucous
~(,
orPCV
M8k 14; Mk 21, 428; E-hb
Lethargy, weakness
membranes
Remove from drugs
685,217,58,220; SAP147; Hemolysis (excessive RBC
Anorexia
Steroids prolongedllile time Tx
- Icterus
H2B715;12M 1164;IM895;
destruction)
Cyclophosphamide (cytoxan)
HR (tachycardia)
- Splenomegalylhepatomegaly
IM-WW 509, 552, 344; Cat
Azathioprine (Imuran)
- Extravascular: RBCs destroyed by mono- Dyspnea,
706; F31M 471; Pa-T 289;
RR (tachypnea)
Blood smear: usually sufficient for regeneration Cat: look for drug or HemoLab 31, 40
nuclear phagocytic cells In spleen, liver & bone Reduced exercise tolerance
- Reticulocyte count: Normal dog '" 0-1 % barton ella cause
marrow
- .P
(0-60,0001).11); cat", 0-0.4% (0-40.0001).11)
-Intravascular: RBCslysedbyantibody, comp1e- Depression
, Regenerative If> 1%. may take 3 days to Show up If cause found treat
Fever
~ l'
,....0 ment, drugs, toxins or fibrin strands
- RBC morphology: Size (anisocytosis). shape
- Drug, infection, gastric pen Regenerative anemias
(polkilocytosls), color (polychromasia), nucleated
nies
RBGs, basophilic stippling
y "" Dogs: IMHA #1
Remove cause
- Spherocytes -Immune mediated hemolysis
cats: drug & hemobartonellosis most
Supportive Tx
) -_______________( /
- Heinz bodies or brown bIOod:
.
- Hemobartonellosis, ehrlioxidant toxiCOSIs or drugs
( ' ")
Cause - Hemolytic anemia
Drugs - hemolysis
chiosis:tetracyclineordoxy- RBC parasites
.
lnt(Elvascular
Acetominophen
cycline
Agglutination test (drop 01 blood onslide at
- RBC parasites
Antiarrhythmics
room temperature & at 4Q C: suggests immune- Acetaminophen/onion toxicity
anemia)
mediated
Anticonvulsants
CBC (complete blood count) (1
! ILl)
- Splenic torsion
Benzocaine
- Vena caval syndrome
- PCV reduced (normal canine - 40-55%,
Gold salts
feline - 30-45%)
- Drugs
Methimazole
- Pink plasma (IV hemolysis)
Extravascular hemolysis
Methionine
Coombs' test: positive indicates Immune- IMHA #1 in dog
Methylene blue
mediated anemia (autoimmune hemolytic anemia,
- Red cell parasites
Metronidazole
drug-lnduced hemOlytic anemia, neonatallsoeryth(Hemobartonella, babesia)
not needed If autoagglutination
rolysis)
Penicillin & cephaJosporins
- Pyruvate kinase deficiency
FeLV test for all anemic cats???
Phenothiazines
Urine analysis: occult blood: hemoglo- Heinz body hemolytic anemia
Propylthiouracil
binuria (from IV hemolysis) or myoglo- Drugs (propylthiouracil, gold salts)
Sulfa derivatives
'
binuria (myopathy)
- Modified live virus vaccines
TrimethopJim-sulfa
- Fragmentation hemolysis
Prognosis:
V;tamin K
- Ehrlichiosis
Regenerative betterthan non Zinc
- LeptospiroSiS
regenerative
capacity of blood due
Hemolytic to02-carrying
hemolysis
anemia
-+RBCs &/or hemoglobin content
1ri1
~
(!J
common~
eI
Stero~
~
J~-W
...
Immunemediated
hemolytic
anemia,
IMHA,
Autoimmune
hemolytiC
anemia
M8k 14; Mk 21, 248; E-hb
685; SAP 171; H2B 720;
12M 1166; 1M 901; IM-WW
509; 5min 344; Cat 708;
Pa- T 298; Lab 34
~
ff
Hx,CS
.(,
#1 cause of hemolytiC anemia - dog Vague:
- Rare in cat 1/2-314 associated wi FelV, other
- Sensnivily to cold
Physical exam
causes: HemobartonetlosiS & lymphoma
- Anorexia, listlessness
- Pale mucous membranes
Anti-RBC antibodies attach to anti- - Weakness
- Tachycardia (fast heart rate)
genson RBCs
- Systolic heart murmur
- Depression
- Antibody-coated RBC destroyed by:
- Hepatomegaly or splenomegaly
- GI (pica, vomiting, diarrhea)
Extravascularphagocytosis in spleen
(extravascular hemolysis)
Acute:
- Lymphadenopathy
:..--& liver, or
- Exercise intolerance (tiring)
-Jaundice
Intravascular hemolysis: induced
- Hyperpnea (fast breathing) Agglutination test (drop of blood on slide at
compliment activation
- Fever
room temperature & at 40 C: suggests immooe0
0
Type 2 hypersensitivity - 1 or 2
(
{O]
- Icterus (Intravascular hemoly mediated anemia) (
Cause: most Idiopathic - primary
'CBC
'OJ
- Secondary: antibOdies Initiated by:
- Severe anemia regenerative
Viral, bacterial or protozoal Inlectlons
- Marked reticulocytOSiS (polychroma Propylthiouracil In cats
LymphoprofileraUve disorders
sia), nucleated RBCs
Autoimmune hemolytic anemia uncommon
- Spherocytes - definitive (small globu Neonatal isoerylhrolysis (antibodies In colostrum):
Complications:
~-------------------.(.
DDx:
Other regenerative anemias
- DIC
- Sepsis
- Acute thromboembolism
- Renal failure
- Persistent hemolysis
Concurrent diz
-lmmune-mediatedthrombocytopenia
- SystemiC lupus erythemato-
Response to steroid Tx
Slero',~
If 20 - treat 10 cause
- Remove from drugs
Steroids (dexamethasone IV;then
prednisolone lor maintenance 3-6
months)
- Prolongedllife time Tx
- Consider cimetldlne to prevent
ulcers
Danazol (DanOCrlne) to prevent
phagocytosiS of RBCs
Other immunosuppressive
drugs il steroid alone Ineffective
- Cyclophosphamide
(Cytoxan)
Not If platelets < 3O,OOO/J.!.1
- Azathioprine (Imuran)
Heparin
Blood lransfusjon only If lile threaten-
;""
Splenectomy (beneficial?)
Manltor PVC, total sollds& autoagglutination bid-qid, reticulocyte count,
spherocytes lor 72 hours
- Periodic hemogram 1-2 wks then
monthly to detect recurrences (com
mooJ
- Wean oft steroids slowly & monitor
. 213 require lifelong Tx
~~~.~
~1~~
~~
Prognosis:
Poor: death in 30-40%
desp~e Tx
cats worse than dogs
CIRCULATORY SYSTEM
Facts/Cause
Condition
Feline
infectious
anemia; FIA
A type of
immune-mediated anemia
Icterus
r "'l
L. -\ . . . .-
. Organism in RBCs
.,)
- Intravascular
. n
hemolytic compone:a
-T~OSf~::::y@
c!l~~
pressed dogs
Pathophysiology: parasitized
RBCs removed byphagocytes: extravascular hemolysis
Treatment
Hx, CS
T"5~
Diagnosis
Lethargy, weakness,
f.:":
Urinalysis: bilirubinuria
Splenomegaly
esc: regenerative anemia
DDx:
St
'd
erol S
~-'
hemolysis rare
....
~'
,
. ..
' ".
..'
I\~~
Prognosis????
Ehrlichiosis
' Rickettsial diz, Ehrlichia canis, Transmitted by ticks (brown dog tick)
E.hb 689, 181, 284; SAP 154: CS: Depression, lethargy, anorexia. weight loss, fever, lymphadenopathy, bleeding tendencies, edema of limbs &
H2B 1219, 740, 7{j8'
';
scrotum, eNS, eye, joint, kidney & liver CS
Pa-T 303
Ox: Hx, es, esc: thrombocytopenia & mild to moderate anemia, Laue; Hyperglobinemia as a polyclonal gammopathy;
*1
(!
(II
/l!
Bone marrow: acute - normal cellular to hypercel1ular; late: hypocellular wI fat replacement
Tx: Tetracycline, Doxycycline, Chloramphenicol, Imidocarb dipropionate; Supportive: Fluids, transfusions; Tick control
~,canine transfusions
Blood
('L-.-:J
transfusions
M8k 19, E-hb 739, 5mln 398,
SAP 149
Babesiosis
M8k 23; Mk 69, 71; E-hb 687;
SAP 151; 5min 385; H2B 717,
12321; IM900; 1M-WIN 51 1: Pa-T
292
'Feline transfusions
ehrlichiosis
1t====-lIlii
Tetracycline
Protozoa, Tick
CS: Lethargy, Anorexia, Icterus
Ox: Organism in RBCs
Tx: Tetracycline
Cytauxzoonosis
=~~~tlon
:
Lethargy
Gradual fever
Progresses rapidly
-Icterus
- Death wIIn days to weak
r~--..,_
\_~.~
Recovery if Tx'd early
Hx CS
r~
"s,.'::) ;
- Thrombocytopenia
\~
Postmortem - usually
- Histo: large schizonts in endothelial cells of
'-?':' :':':':::::-i
structures in ReCs terminally
cp/c&,/I' .....
P'09 00$;'
- Grave: all reported cases fatal
Hemolytic Anemia
Condition
Facts/Cause
Oxidative
injury to RBCs,
(unknown cause)
Heinz body
anemia
M8k 1208; Ehb 687: SAP 151:
H2B719; 1M 898: F31M469; 5min
342; Cat 707
.--........
in/n_o-rm-al-ca-ts-&-"----~.
~
CS~ _
threatening
Emetics if recent ingestlon of toxin
appreciate
Urinalysis (UA)
**
/7
Prognosis: ????
~~
['8' ,
tOXI
I (a t)
cfJp
:z;g'R
(unknown cause)
Causes hemolysis
- Hemoglobinuria (rare)
- Bilirubinuria
Snake venom
::-::::::::=:===:=::=:====,--1' -Chemistries
+Total bilirubin (I
r:
Hemoglobin precipitates
I.
- Hemoglobinemia
. . x . For Tylenol toxicity
_Acetylcysteine (Mucomyst)
- Moderate t~ sever~ anemia
. Regenerative - retlculocytes
- PMN leukocytosis & t protein
Heinz bodies: Romanowsky-stained
blood smear
- Cat: single, large pale area in RBCs
- Dog: small & multiple more difficult to
Phenazopyridine
Propylene glycol
Vitamin Ks
DL-methionine
Topical benzocaine
(Cetamine) (larynx spray)
Hx (exposure),
Physical exam:
splenomegaly
CBC-
those bodies
wI a variety
~
- Heinz
foundof illnesses that
don't cause clinically significant
hemolysis
Gauses: see above
DDx:
Other regenerative anemias
Cats: concurrent diz wI Heinz bodies
Methemoglobinemia
6?J
Treatment
Dia nosis
causes: hemolysis
Methylene-blue (cats)
Spontaneous Heinz bodies in cats
Hemolysis &
methemoglobinemia
**?
CIRCULATORY SYSTEM
">..("""'_ .
C _.
Chocolate blood
Prognosis: ???
Hx (snake bite), CS
SpecifiC venom antidote
CBC: regenera~tive
anemia
Anti-inflammatories
Coagulation abnormalities
Antibiotics
~
_,~
:inc toxicity
~
_.
+.-'v-ho-m-O-'y-,,-'-'O-d-09-'-----'----+-.'""'-o-"'-"C"a--------t,-:H-:-,-:(-:zin-,-,-",,-o-,,-,-:.)-
Source
Ehb 161: SAP 152; H2B 719,
-Galvan!zedwire
12921
_ Kennel cage nuts
_-----~_~
-Pennies> 1985
vomiting
~
_
.-" ~~ -"I"~~""""'-
""'"
".~ ?
'"
283
Regenerative anemia
.Radiograph-metallicforeignbodies
Coombs' negative
l-'-R-'-m-o-"-'-O"-'-"-b-y-"-"-:"'~=O" :'O-dO-'-"'-P-y
Calcium EDTA
-~
,--Ca EDTA
~r--------=B~LO==O~D--~O~N-C-O-LO-G-Y~I
IAnemia
Nonregenerative anemia
M8k9; 12M 1168: IM-WW 512:
-~
-'~~=~Y
"-
Facts/Cause
~~~' )~'"
~
....
")<
Chronic diz, Mechanism?
Tx: Tx 1 diz
Nutritional
anemia;
Iron deficiency
anemia;
Microcytic,
hypochromic
anemia
- Phenylbutazone
Deficiency syndromes
- Iron deficiencies
- Hypothyroidism
- Folate or 812 dele from chronic Intestinal dlz (rare)
Renal failure
Chronic diz
canine ehrlichiosis
Idiopathic RBC aplasia
- Immune-mediated destruction of RBCs
Diagnosis
Treatment
~~
[f~-'~
1(
rg;
- Chronic inflammatory or
infectious process
- Chronic renal diz
I~
- Chronic liver failure
Cancer: anemia most common cec abnormality of cancer
- Neoplasia
Immunohemolylic anemia; associated w/lymphoproliferatlve malignancies (lymphoid leukemia)
- Necrosis
Hemormaglc anemias: Invaslon of tumors
Disturbance of iron metabolism
Aplastic anemias: excessive production of estrogen by testicular tumors
' ' \l .
\'
~.
~I""
.... :"
a~
-d%
crocytic cells
M8k 12: E.hb 685: 12M 1171:
Causes: iron detc anemia
Smin 346: Gat 705: SAP 154;
- Chronic blood loss
~:8 727; Pa-T 301
_ Severe flea infestation
"'~
,Hookworms
rl .... ~~. Bleeding GI neoplasms
J("1 /1 . Extemal hemorrhage
Coagulopathles
"i
OVerused blood donor
.J-
- Lymphosarcoma
- Myeloproliferative leukemia
- Lymphoproliferative leukemia
FeLV anemia #1 cause in cats
HOlTTlones. drugs or chemicals
- Cytotoxic antineoplastic drugs
- Chloramphenicol
- Estrogen (endogenous or exogenous)
- Benzene
Presentation/CS
- #1 cause of nonregenerative
anemia in dog & man
- Pathogenesis not understood: abnormal
Anemia of
inflammatory diz
A1mrr,
A>;
'<4..t
Condition
Secondary
anemia of
chronic
inflammation,
=r"
f~::n neon
- Microcytic anemia
Thrombocytosis 50"10 of dog cases
Low serum iron levels dog: < 80 ~gldl, Gat:
< 60 l1g1dl
"-.~~;..--;::::
~
>
DDx:
Other nonregenerative anemias
Other cause of microcytic, hypochromic anemias
Ferrous
Prognosis
1~ln~d~i:c~at~e:s::c~h~ro~n~i~c~b~IO~O~d~IO~S~s~~I~______________~~-~C~o~pp~e:r~d~e~k~,~V~it~B~6~d~e~k~,~le:a:d~i~n~to~x~ic~a~tio~n~~~~~~~~~ _~_?~?~?~?~?~?_____________
Cobalamine
(Vlt.
B12) deficiency,
* '
Drugs (may impair absorption or production): Anticonvulsants (phenObarbital, primldone), SUlfonamides (sullasalazine,
trlmethoprlm.su1fa), Antineoplastic agents (methotrexate); Pathophysiology: Hypoplasia 01 bone marrow, GlOSSitis
CS of inciting problem, Glossitis
Hx (drug exposure of concurrent diz): GBG: Macrocytic anemia (cat); Serum folate levels may be measured to confirm
Treat cause, Oral folate supplementation (FoliC acid [Folvite1)
117
Anemia
Condition
m'rn
..
Signs related to
Drugs associated wI reduced
erythropoiesis & aplastic ane- thrombocytopenia
& neutropenia take
**?
precedence over
chronic anemia
Estrogen
"--~
)"...-1
Q I
Neclofenamic acid
~~
~I/~t:
l
0
Thiacearsamide
Quinidine
~
Lead poisoning
Levamisole-induced immunohemolysis
Chloramphenicol
toxicity ~
E-hb 690; SAP
. \\
155; H2B 725 / , -
*?
(endogenous or exogenous)
Benzene
Phenylbutazone
Trimethoprim-sulfa
..
----......:::
-~
CIRCULATORY SYSTEM
Presentation/CS
Facts/Cause
Diagnosis
Treatment
Hx (drug), CS
Stop drug or toxin
- Recovery begins in 1 month
CSC:
- Initially anemia, thrombocytopenia wI Supportive care
leukocytosis (PMNs)
- Blood transfusions
- Later: pancytopenia
- Anabolic steroid\.
- Antibiotics
~~.+
Sequela:
- OVerwhelming
sepsIs
~
J8
....,.
~~tI,J
~
r;P
~
.
Estrogen
~~=:=--""/
.
C
////
CS of thrombocyte733
penia & neutropenia
Testicular Sertoli cell or ovarian
more pronounced
granulosa cell produce estrogen
than mild anemia
Exogenous:
Exercise intolerance
- Diethylstilbestrol
- Estradiol cyclopentylpropionate Sertoli cell tumor
- Alopecia
- Treatment of mismating. infertility, urinaryincontinence& peri- Feminization,. . . .....
. ;.
_
anal adenomas
.'ll)
- Depends on dose & age of
animal (worse in older dogs)
~ ~Ii.....
~t&.i17
Myeloaplasia,
Aplastic anemia,
Idiopathic erythrOid
hypoplasia/aplasia,
Hypoproliferative
anemia,
Bone marrow
00)
;.~
':;'
+ ".
Prognosis:
Depends on severity & offending toxin
Pancytopenia: poor to grave
Stop drug - reverses toxicity
~
,"'-4
Prognosis: ????
~
='
'=
Hx (drug exposure),
Supportive care
PE: Cryptorchidism,
i
- Blood transfusion if life threat CBC: Moderate to severe anemia
ening thrombocytopenia
- Thrombocytopenia: w/in 2-3 weeks
- Anabolic steroids; unknown ef- Leukopenia wlin 4 weeks
ficacy
Bone marrow: early. megakaryocytes,
granulocytic hyperplasia
- Late: generalized hypoplasia/aplasia
Surgical removal of tumor + recovery from
anemia
Lethargy
Weakness
Anorexia
Fever & infections
Bleeding disorders
'~~~OP~"J..__-:-----,__
,,),,""-'-Y
DDx:
Other causes of pancytopenia
& aplastic anemia
./
Hx (exposure), CS
CNS depression
!
!
CBC: Mild anemia ()
GI signs
- Not bone marrow aplaSia as in humans
- Neutropenia
Anorexia (vomiting, diarrhea)
Cats especially susceptible
Thrombocytopenia & neutropenia
Weight loss
- If use, limit to smallest dose &
~
precede anemia
shortest duration possible (when
would you ever do this?? &
why??)
Do not use in dogs or cats wI
S~
nonregenerative anemias
7U
"J
Hyperestrogenism
-.'i!
//((
See
>
CBC
No specific Tx
- Cytopenias: non regenerative anemia, Symptomatic & supportive until
neutropenia, thrombocytopenia ~
body can take overlrecover
Marrow aspiration:
Broad spectrum ABs
- Severely reduced or absence
Transfusion
fh
!
--:-_l.-.:...':o~e""m~at~o~po~ie~ticl':e~nelim('l<e,.nts
Steroids for thrombocytopenic
- Hypocellular fat
hemorrhage
failure
MBk 12; E-hb 689; SAP 153; H2B
g:~~~t:~~~b~osjs
*?
:
Lymphoproliferative disorders
" -
---~
ABs
Prognosis
Repopulation possible
I
f
Mechanical
of RBCs,
Pathic hemolytic diz,
Microangiopathic
hemolytic diz
E-hb6BB; 12M 1171; SAP 152
"
Coagulation Disorders
CIRCULATORY SYSTEM
FactS/Cause
Condition
PresentationlCS
Coagulation
disorders
MBk 40; Mk 55; 12M 1192;
IM-WW299; Ehb713;SAP
164; 1M 926; cat 704, 739:
PaT312
Sequelae:
thromboembolism
Petechiae
Hematoma
Bleeding
Venipuncture
Thrombocytopenia
Gommon
Rare
Mucous membranes
Multiple sites
Immediate bleeding
-;."_"': 'rJ/,t7
.>
'- -
1 ("
J.
Delayed bleeding
,. Cf'. . . . /
I
~_
'
~ I
..
ct)
V
L
Platelets, Warfarin
CS: Spontaneous or excessive bleeding
Ox: Cage side, Bleeding, APTT, PT tests
Tx: Proper Ox & Tx
- -(- \
.'\
---
'---,I--------------,------------~
t-}.,..~.,?,~~,-r
In
- ThrombosIs &
. Organ failure
,--'--------------'---'--'-"-'--="-'--
**?
it
Diagnosis
Disorders of
hemostasis,
Vii K deficiency
IJj::
. Anticoagulant rodenticides
-Decreased absorption
(normal time to form clot in dog: 60-120 sec, cat 60-70 sec,)
Prolongation in hemophilia, Warfarin poisoning, DIC & vWF
2 ml of whole blood into diatomaceous earth (gray topped lube)
- FOP (fibrin degradation products) test (Thrombco Wellco test)
- Increased wI DIC (commonly) & occaSionally in warfarin toxiCity
- Bleeding time tests: wound & measure time until bleeding stops
Buccal mucosa bleeding time (BMBT): 2 incisions in mucosa
of upper lip; normal 2-3 minutes
.. Prolonged: platelet dysfunction (aspirin Tx & vWD)
.. Normal in coagulation factor deficiencies & some DIC
O"tLl"
DIC
Liver diz
Cal: retrovirus-induced bone marTQw disorder
(Dx continued)
~
Toenail bleeding time (TBT)
~
.. Guillotine toenail clipper to bleeding _ ~~
Treatment:
Proper treatment depends on accurate diagnosis
Aggressive Tx because potentially life threatening
Nursing care: feed soft food; avoid neck leads, 1M injections & exercise
- Vitamin K sa
@P====:===================
I
i289l
ACT test
FOPs
( aL)
(I
SimplalelI
ACT
Plalelel counl
V
OSPT, APTT. Fibrinogen, AT III
(short lived)
_ Secondary plug due to intrinsic & extrinsic hemostatic pathways forming fibrin
_ Excessive clotting prevented by fibrinolytic pathway, antithrombin (AT) III
Il::========~
JlB
,....:;...
ViI K
Drug therapy:
_ Initiating pending test results, only helps K deficiency states, not for
DIG, vWF, inherited factor defc & nonobstructive liver diz
. Anticoagulants rodenticides (Warfarin) - reverses in 24-48 hours
Hormonal Tx for vWD associated wI endocrine disorders
- Hypothyroidism (l-thyroxine supplementation)
- Desmopressin acetate (DDAVP): for vWD, a vasopressin analog
Heparin Tx - DIC causing vessel thrombosis or embolism
~~~
Venipuncture wI smallest needle posSible (25 g), apply pressure for 5 minutes + pressure
bandage
Never collect urine by cystocentesis
Normal hem'ostasis
<
FOPs
'dlL]
Thrombocytopenia
CIRCULATORY SYSTEM
Presentation/CS
Facts/Cause
Platelets
Petechiae
or ecchymotic
Thrombo Types of thrombocytopenia
hemorrhages (mucous memcytopenia
- t Platelet destruction (#1 in branes or skin)
M8k 43; Mk 56; SAP 160:
dog)
Epistaxis, melena, hematuria,
E-hb 720; H2B 760: 12M
hyphema
- t Consumption
1197: 1M 931: IM-WW 523:
5min 278, 1100: cat 703,
Prolonged bleeding from
- Sequestration
748: Pa-T311
- -J Production (#1 in cats, ret- wounds/injection sites
rovirus - bone marrow disor- CS or inciting condition (infection, neoplasia or splenoders)
megaly)
Immune-mediated #1 in dogs
- Sepsis: fever, poor perfusion
Condition
**1
Dia nosis
Treatment
Hx (assume drug related until proven other- Treat cause
Immune mediated-steroids
wise)
- Ehrlichiosis - tetracyclines
Physical exam: for site of hemorrhage,
hepatosplenomegaly. infection or neoplasia Supportive
- Fresh transfusions (wlin 8
Cage side test - blood smear (Diff-Quick)
hours of collection) if both
- Normal platelet numbers: oil immersion
RBCs & platelets low
microscope: >12-15 platelets/field in dog
- If only low platelets - platelet
or 10-151field in cat
rich plasma
-If < 2 or 3/lield suspect thrombocytopenia
~af
CSC:
- Thrombocytopenia: < 1OO,OOO/~'"
(
Clinical bleeding at < 20,OOO/~1
I......_J__......I.I.~
Stop any drug & reevaluate in 2-6 days
Spherocytic hemolytic anemia if concurrent IHA (Evans syndrome)
- Combs test
Bone marrow aspiration & core biopsy: check megakaryocyte numbers
- Hyperplasia of megakaryocytes: peripheral destruction/consumption/sequestration of platelets
-Infiltrative or dysplastic bone marrow ~
cats: FeLV & FIV tests
Clotting profile: PT, APTT usually normal unless DIC
von Willebrand factor assay
Assays for canine ehrlichiosis, Rocky mountain spotted fever, cyclic thrombocytopenia, Hemobartoneliosis
Urine & blood cultures if sepsis suspected
RIO DIC wI hemostatic screen
Antiplatelet antibody tests are unreliable - RIO other clause
Radiographs: splenomegaly 10 or 20
Positive response to steroids for IMT
Tetracycline & steroids if ehrlichiosis or IMT suspected until serology returns
~~:y ;::=-::;=:::;;:::-:;;;---
rQ)
DDx - Thrombocytopenia
Selected causes of thrombocytopenia ~
Platelet production
- Immune-mediated megakaryocytic hypoplasia
- Idiopathic bone marrow aplaSia
Infectious see Systemic
-Drug-lnduced megakaryocytiC hypoplasia (estrogen, butazolidlne) antineoplastic
- Ehrlichia canis, E. plarys, E. equi
( (cisplalin, cyclophosphamide, Chlorambucil, doxorubicin, hydroxyurea)
- t Platelet activation & consumption
\;
- MyelophthisIc thrombocytopenia
- CystIc thrombocytopenia
- Ox: Hx (tick), positive serology, bone marrow:
~ ;
. Congenital thrombocytopenia cyclic hematopoiesis - gray collie
megakaryocytic hyperplasia in acute phase
~
-Infectious agents (canine distemper, parvovirus, FeLV & EhrlichiOSis canis)
Platelet destruction/consumption
Infectious cyclic thrombocytopenia
...
Immune-mediated thrombocytopenia (IMT)
SAP 125: H2B 1220; E-hb 190; E 380
' - ...
- Live viral vaccine - distemper
- Drugs
Ehrlichla platys, Gulf coast, lOw morbidity & mortality
- Mlcroangiopathy
Acelamlnoptlen
CS: asymptomatiC, InCidental finding
-DIC
, Antineoplastic drugs
Ox: Thrombocytopenia at 1-2 week intervals in asymptomatic dogs,
- Hemolytic uremic syl1drome
, AnliafThythmlcs
IFA testing or organism in platelets (Giemsa-stained blood smear)
- Hemorrhage
, Anticonvulsants
Tx: Tetracycline or doxycycline. Px: excellent wi Tx
- Vasculitis
, AntJinflammatories
(nonsteroidal)
- Endotoxemia/ sepsis
, Benzene
Live viral vaccine
- Ehrlichia canis, E. plarys, E. equi
Benzocaine
- Acute hepatic necrosiS
- Canine distemper vaccine: 1 week post-vaccine
, Chloramphenicol
-Neoplasia (immune mediated, microangiopathy)
Transient - up to 3 weeks
,Cimetldine
- Bleeding
GOld salts
Rarely Significant unless surgery during low platelets
Sequestration
Griseofulvin
Splenomegaly
(sequestration)
Levamisole
Hemorrhage: can consume platelets
Methimazole
- Splenic torsion
Methionine
- Bleeding alone or in association w/ bacterial or viral infections
- Hepatomegaly (rare)
Methylene blue
- Endotoxemia from gram negative bacteria cause endothelial damage &
Metronidazole
? ~
platelet activation
_PeniCillin & cephalosporlns
, Phenothiazlnes
~
<) (
J *;:.,~
Dx: Hx, PE, Cytology, hlstopath, culture
Propylthiouracil
, Sulfa derivatives
.-." .,~ ~< )
, Thiacearsamlde
Trimethoprim-sulfa
~ ';:I
~
Splenomegaly: causes sequestration of platelets in spleen
_Vitamin K
, . ~'"
- Ox: enlarged spleen w/o eVidence of other causes of thrombocytopenia
. Zinc
/
- little clinical significance if benign enlargement
~';>-~ ~
.>
'------,,-----------
jl[h'~"_
L ~--.---------------------------------~
Thrombocytopenia
Condition
Immunemediated
thrombocytopenia
MBk43; Mk56; SAP 160; Ehb 720; 12M 1199; 1M 933;
IM-WW 523; 5mln '100
Facts/Cause
CIRCULATORY SYSTEM
Presentation/CS
Oia nosis
Treatment
- Lifelong Tx required
Remission: adjust until platelets normalize
- Physical exam: for site of hemorrhage,
splenomegaly
- Immunosuppressive dos(1
-CBC
age of steroids (prednisolone)
- Thrombocytopenia: < 100,000/1'1
_Clinical bleeding at < 20,000/1'1
- Single dose of cyclophos- Anemia depending on degree of bleeding & concurrent
phamideto induce remission
IHA
Maintenance:
steroid + aza- leukocytosis wI left Shift
thioprine (Imuran)
- IHA (immune-mediated hemolytic anemia) + IMT =
Evan's syndrome
Danzol: androgenic ste- Coombs' positive anemia wI spherocytes
roid?
- Bone marrow aspiration & core topsy: check
- Fresh transfusions (wlin 8 hOurs
megakaryocyte numbers
of collection) If both RBCs & platelets
- Hyperplasia of megakaryocytes usually
tow
-II only low platelets- platelet rich plasma
- RIO infiltrative or dysplastic bone marrow
- Tetracycline & steroids if ehrliChiosis or
Bleeding time - prolonged
IMT suspected until serology retums
Clotting profile all noonal: PT, APTT, ACT, Refractory IMT
FOPs & fibrinogen
- Vinca- loaded platelets,
Radiographs: splenomegaly
danazol or splenectomy
Urine & blood cultures if sepsis suspected
- RIO ole wI hemostatic screen
- RIO ehrlichiosis (assay), drugs, infections,
r--..!/tI1,(/ j
II,
clotting abnormalities before diagnosis
Platelets
Petechiae or ecchymotic - Diagnose by ruling out other causes
#1 cause of spontaneous hemorrhages (mucous mem- Hx (rule out drugs 1st)
bleeding in dogs
#1 cause of thrombocytopenia
- Middle age females
- Breeds: Old Eng. sheepdog,
toy breeds
Extremely rare in cat
branes or skin)
Superficial bleeding
Epistaxis, melena. hematuria, hyphema
Prolonged bleeding from
woundsJinjection sites
Asymptomatic or collapse
depending on degree of
bleeding
- Vomiting
rto
Stero~
#1 Spontaneous bleeding
CS: Bleeding
Ox: RIO other causes
Tx: Lifetime steroids
Inherited
clotting
factor
deficiencies;
Hemophilia
MSk 40; Mk 54; E-hb 716;
~1749ir
Von
Willebrand's
diz, vWD,
Hereditary
thrombocytopathies,
Inherited platelet
dysfunction
M8k 45; Mk 54; E-hb 716;
SAP 164; H2B 769; 12M
1200; 1M 934; IM-WW 525;
F31M494; 5min 1158; Pa-T
317
l~;l1
,jj(
l~j
Prognosis ~
Good for most dogs, but
requires lifelong Tx
Asymptomatic
Spontaneous hemorrhage
- Bleeding from tooth eruption, dewclaw removal or tali docking
Prolonged bleeding aller surgery or
trauma
Deep bleeding into cavities, jointS &
musdes
sa hamatoma fonnation (lumps)
-lameness due to bleeding into Joints
No petechiae or ecchymoses
- Fading puppy syndrome
- Prolonged umbilical cord bleeding
t
J?
~'
/D-D'-.--~----~
'-
Prognosis
Suggestive: blaeding &. normal platelet count
Physical exam (PE): lor specific sites
BT (blaeding time) tests (cuticle bleeding time> 6 min)
Platelets normal
Homeostasis screen usually normal (ATPP, PT)
Specific vWF assays
- vWF antigen (vWF:Ag) most common
Test lor hypothyroidism in all vWD
I,
????
,WF
Hypothyroidism (L -thyroxine supplementation) Shortens BT
Do not breed
DDx:
.,
lilt
Prognosis: ????
Anemia
Condition
Facts/cause
CIRCULATORY SYSTEM
PresentationlCS
Diagnosis
Treatment
DIC,
..-~
~~
Vitamin K
deficiency,
Anticoagulants
(Warfarin,
coumarins)
~~~~1~~~r,~:O;1:~h~
-~
~l
~/
,;
"- ..:;;
~
_
enough
No consensus on Tx
Supportive Tx to combat shock
& maintain tisstle perfusion
IV Iluids
Blood transfusion
Antiplatelet Tx: aspirin
Heparin Tx may be tried ,(releases Inhibition on dotting factors &
platelet function If sufficient AT III)
f i,
,,
--..J
8:'11
ASf,i
~ Ji
a~
Prognosis:
Grave: high mortality even wi
treatment
Depends on underlying diz
sa
lJI.'
'1
f
.p~~
..ate(n:yVi,~".~ CS: Dyspnea, Bleeding
-_ /
<
.-
0/
l'@Jf
Prognosis:
oGoodifearlyDx&promptVit.K1
Px: Good
,....,---===---,-
jpg./'-&.
0""
(I;,",
I.')
. .-;:..
Leu
CIRCULATORY SYSTEM
Leukocytes
M8k 48, 1206; Mk 59;
12M 1173: IMWW515,
Cal 721; Pa-T 304: Lab 43;
RP-CBC28
****
Lymphocytosis
Monocytosis
Eosinophilia
Basophilia
Decrease in various types of WBCs
- "-penia" or "cytopenia"
Leukopenia
Neutropenia
Lymphopenia
Monocytopenia
Eosinopenia
Basopenia
I
~
Cyclic neutropenia,
Cyclic hematopoiesis
Lab 71
Pelger-Huet
anomaly, Chediak-
Pelger-Huet syndrome
MSk 54; Mk 64; E-hb 691,725; SAP
156; H2B 736; 1M 913; 5mln 917;
Gal 733, Lab 70
*
Feline Chediak-..J.,.
Higashi
S ndrome
y
~es
:~~~:~
.-.
DDx:
\. H, I ..., 00111..)
1C
_t
~'--
neutropenic cyCles)
left shift
Photophobic
Cataract formalion
~.'
00)
'HX, CS
!
!
'CBC
- Blood smear: toluidine blue stain
_Coarse, reddish granules in PMNs, 8OSinophlls & basophils
. Lympho~es: granules or vacuolation
\' .
.:~-;,
~
-
(...1
Granulocytopathy
.
syndrome In Insh
setters
No treatment
Spinal decompressive surgery
Euthanasia if progressive
Experimentally: bone marrow transplantation
Do 00' "oed
"',
Recurrentbacterial inlectionsstarting
In puppyhood (dermatitis, glngMtlS, os-teomyellUs, omphalophlebitiS
0 Lymphadenopathy "'II extreme leukocytoSis
12971
.
-~
~'"
PrognoSis:
Poor. euthanasia if progressive
l !.
'.
Prognosis: 11
;:fa
Symptomatic
.,'
-_:-,-':-,_..
tnHammation wI
'
;,;r
.J':'
, ,
. ,":, ,'-
-Nu.o.,,,,,mbl,,,"""s,
..---~!!::tf
,,,,, G...., m",' dlo w', 6 moot"'
'O!, .
F
~
Lab71
~.- ~--"-
~:
Mucopolysaccharidosis;
Feline storage dizs,
---
-"-~
- Platelet dysfunction
- Melanin in skin abnormal
Lelhal, autosomal receSSive condiUon
4r~'0"'>
12d+'i
f
I
\
.. _,
-50,OOO100,OOOWBCI~wlleftshitttobands,
metamYelo~es&myelocyteSI":'"
_
t "''j;:,-I~'
', . .'Jt,~.
Nonregeneratlve anemia in
chronic cases
Hypergammaglobulinemia
Difficult to confirm because
PMNs morphotoglcally normal
.;;;~
.... ;-"--_.,.
h1
l.~)
~
PrognosIs:
Poor/grave: most die at a few months old
c: -- -------Itrl'.."h
,0
ils
g'
CIRCULATORY SYSTEM
Neutrophils,
PMNs ****
M8k 49; Mk 59; E-hb 691;
Neutropenia
>'t
A. -
Circulating PMNs
***
DDx - Neutropenia
Infectious neutropenia
_ Overwhelming bacterial infection
Gram negative septicemia or endotoxemia
_ Mycosis (disseminated histoplasmosis)
_ Protozoal infections (Toxoplasmosis)
_Viruses (FeLV, FIV, feline panleukopenia, canine parvovirus,
canine hepatitis)
- Start ABs
. Inillal: IV gentamicin + cephalosporin
, Modify according to culture
Immunosuppressive doses of prednisolone if immune-mediated
I
Vaccination (panleukemia ~ cat, palVO - dog)
Endotoxins (gram negative sepsis) transient
Immune-mediated
Bone marrow necrosis or aplasia
Myelofibrosis & osteopetrosis
Myelophthisis (space occupying lesion in bone marrow)
- Neoplastic & myelodysplastic diz
_Ehrlichia canis
. Leukemias (granulocytic, lymphocytic, myelomonocytic),
Toxic/drug neutropenia
lymphoma, myelodysplastlc syndromes)
_ Drugs: estrogens, chloramphenicol, sulfonamides, tetracy- Cyclic neutropenia or cyclic hematopoiesis of
clines, cancer chemotherapeutics agents (cyclophosphamides, gray collie, cyclophosphamide Tx, FeLV)
chlorambucil, busulfan, melphalan, cisplatln, cytoSine arabinoside, methotrexate, Anaphylaxis (+thrombocytopenia)
vincristine, doxorubicin, hydroxyurea), cephalospOrins
Irradiation
Prognosis:
Guarded
~."--Neutrophilia
tCireulating PMNs
oCBC:Neutrophilia>II,500/~ r~
Signs or cause
~~~~=::~=.,
Physiology neutrophilia (epinephrine)
~.
- Stress, Fear, Strenuous muscular exertion
Corticosteroid induced
- Steroid Tx
SterOIds
l\v~
_Cushing's diz
Drugs: epinephrine & estrogen (earlY).
Inflammatory neutrophilia
- Infectious
Bacteria
Rickettsia
Viruses (canine distemper, feline minotracheitis)
Fungi
Severe abscessation (pyometra)
Parasites: Toxoplasma, Hepatozoonos;s
- Blood loss: hemorrhage or hemolYSIS
- Noninfectious
Tissue necrosis
.. Necrotizing pancreatitls
.. Muscle necrosis
.. Uver necrosis
.. Neoplasia
Neoplasia/malignancies
Thrombosis
Bums
Immune-mediated reaction :",tom,'CI,,,,. AIHA, ",lym!(OS"".
polyserositis)
Granulocytopathy syndrome (congenital) Irish setters
Paraneoplastic syndrome (fibrosarcoma, renal tubular carclnoma)
Neutrophilic leukemia
'r\
Ii
/~o
Monocytes
M8k 51; Mk 59; E-hb 700; SAP 158;
Monocytosis
Mk 59; E-hb 700; SAP 158;
H2B 744, 1M 919; E 915
~,
t
ijf]) Treat 10 diz
Acute or chronic diz (tra- Look for septiC cause
ditionally described primarily wI Hx (steroid induced have concurrent lymphopenia,
chronic diz)
eosinopenia & neutrophilia), PE
o Cytology & histopathology
/ ~
_ .............. RIO Immune-mediated
.
.. '.- ArthrocentesIs or other Immune tests
t Circulating monocytes
- Dog: > t ,350 I~I
- Cat: > 850 I~I
/7
.
DDx - Monocytosis
':
Corticosteroid-induced
- Steroid therapy
,
- Hyperadrenocorticism
._
----
'.. r':
. ,. .~.I i .
~".
"
.......
', ":i
.'
:.fl?~:'.! '
Antigenic stimulation
__
41'r..0 7
L-~~~~~~==~~~ ~~========r===============:J=================-'---~~
Lymphocytes
M8k 51; Mk 59; SAP 159; H2B
743:E-hb701;12MI181,1185:
IM914; IM-WW518;5min242;
cat 732; E 1915; Lab 62-67
Lymphocytosis
***
Lymphocytes: 2nd most common wec in healthy blood (dog & cat) Function: host defence & immune system component
- Retain ability to mitose & recirculate
Small cells wI round nucleus
- T-lymphocyte (T-killer celiS) - cell mediated immunity
_ B-lymphocytes (plasma cells - antibodies) - humoral immunity
.tCirculating lymphocytes
- Dog: > 5,OOO/j.l1
- Young age
Lymphopenia
****
~__~~
CS of cause
~D-D-x---Ly-mphocytosis
Young age
Epinephrine-induced (cats): Severe exertion, Physiological stress, Vaccination
Infectious - antigen stimulation: FeLV, Chronic Ehrlichia canis, Rickettsia rickettsia
& systemic fungi (blastomycosis)
Modified live vaccines (dog)
Neoplastic: Metastatic lymphoma in 20'% of lymphoma cases, Acute or chronic lymphoid leukemia
Hypoadrenocorticism 20%)
&~
ilia
Basophils
M8k 51; E-hb 704; 12M IISO,
28
Basophilia
- Basophilia
Any cause of eosinophilia
- GI diz
- Respiratory diz
- Neoplasms
Mast cell tumors
Lymphomatoid granulomatosis
Basophilic leukemia (dog) rare
Hyperadrenocorticism
Hyperlipoproteinemia (Diabetes mellitus, nephrosis,
chronic liver diz)
t
Basopenia: not clinically significant
iJ
Eosinophils
Eosinopenia
+
Eosinophilia
SAP 158; H2B 744; Ehb 702;
12M 1180, 1183 cat 731; 1M
918; IMWW 516; E 1919; Rp
CBe28
Presentation
Related to 10 disorder
Common causes
- Parasitic diz (skin, respiratory or GI
tract)
- Hypersensitivity (Pathophysiology: IgE
causes mast cell degranulation which in tum attracts
eosinophlls)
DDx - Eosinophilia
Stress or corticosteroids
- Stress leukogram
- Exogenous: steroid or ACTH therapy
Eosinopenia in few hours which normalizes in a day
Hyperadrenocorticism
Acute infection - 2 0 to steroid release
Treat 1Q disorder
RIO parasitic diz 1st
- Fecal exam, tracheobronchial
- Tx parasttes
washes, thoracic radiographs & - Hypersensitivity: eliminate alheartworm serologic or concentralergen + antihistamine & stetion tests
roid
Then check for other causes
- Remove tumor
- Tracheal wash: pulmonary infiltrates
- Hypereosinophilic syndrome
- Endoscopic biopsy: eosinophilic gas Poor response, steroids,
troenteritis
Megestrol acetate or
- Hypersensitivity testing
hydroxyurea (anecdotal success)
- Tumor removal- normalization or
- Hypereosinophilic syndrome in cats
DDx: Eosinophilia
Parasitic
- Ancylostoma spp, Trichuris vulpis, Toxocara canis, Dirofilaria
immitis, Dipetalonema reconditum, lungworms (Aleurostrongylus
abstrusus, Capillaria spp, Filaroides spp), Paragonimus kellicotti
Hypersensitivity reactions &lor inflammation
- Anaphylaxis
- Fleas, Food, Grasses, Nonspecific allergens
- Feline asthma
- Allergic dermatitis/Staphylococcal dermatitis
- Eosinophilic pneumonitis
Hypereosinophilic syndrome in cats
- Eosinophilic gastroenteritis
- See GI pg 62 - Uncommon, infiltration of eosinophils into many
Eosinophilic granuloma
organs (GI, liver, spleen,lymph nodes, lungs)
Para neoplastic syndromeltumor associated
- Cause: idiopathic, difficuh to differentiate from eosinophilic leukemia
- Fibrosarcoma
- CS: anorexia, weight loss, fever, vomiting, diarrhea & lymphadenopathy
- Anaplastic mammary carcinoma
- Ox: CS, Hx, eosinophil count: 4O,000/~1 (3-130,000)
- Mast cell tumor
- DDx: Indistinguishable from eosinophilic leukemia
- Lymphoma
- Tx: poor response, steroids, Megestrol acetate
Eosinophilic leukemia
or hydroxyurea (ancedotal success)
Hypereosinophilic syndrome in cats
- Prognosis: Poor to guarded usually fatal, death from organ
Neoplastic/metastatic carcinoma
dysfunction caused by tissue infihration
Chronic inflammation of skin, GI, Respiratory or urogenital
Hypoadrenocorticism
1((Atfl
-
~~
Oncology
Cancer,
Tumors,
Neoplasia,
Oncology
Ehb 223; H2B 799;
SAP 185; 12M 1091;
1M 833; Cal 755; E
466: FN 425; NB
14.1
***
CIRCULATORY SYSTEM
Definitions:
~-,
- Oncology: the study of tumors
;?
~
- Tumor: swefling; new, uncontrolled &
r~ ~
d)
progressive growth of tissue cells
- Neoplasm: any new & abnormal growth
_ Cancer: a cellular tumor - fatal
- Malignant: progressive to death
Anaplasia: loss of differentiation of cells & of their orientation
to one another
Metastasis: spread to distant sites (e.g., lung,liver)
_ Benign: nonmalignant; not recurrent; favorable for recovery
- Incidence of all cancers
J:.
- Dog: 411,000 (> human frequency)~,
_ Cat: 1.5/1,000 human frequency)
t'!...
_ Malignancy
_ cat: 80%
_ Dog: 35%
- Age: peak at 6-14 years
V-2J
t2
- Young animals
Canine: cutaneous hlstlocytoma. papilloma. osteosarcoma
Feline: lymphosarcoma, fibrosarcoma (FeLV associated)
Sex factors: few instances 01 difference
rlY::"'-;J~
Mammary
~
.. :,. \
Prostatic rumors
'S'
Congenilallumors are rare in the dog & cat
Embryonal nephroma
r.
- F,,,,,,,,kemia "'"' 08' be t",'sm~,d ,~g,","aJly to the "born let",
~~=~:highest
lj
. /7j'i'
' tj~
Causes of Cancer
. Environment
I~~
Cf~..
incidence oftumofS
_ Great Dane & S1. Bemard _osteosarcoma i f CQJ
- Osteosarcoma: giant breeds 60 x small breeds of dogs
_Melanoma: Boxer, Scottish terrier
Mastocytoma: Boxer, Bulldog, Boston t e r r i e f 8
Hemangiosarcoma: German shepherd.
---:--___-'
J( ~~.,
~(;(?I
~
"'-:'\
t PI'
reva ence In pets due to
~ t Life expectancy
'-----
~1/(~
<.).
1. Epithelial neoplasm
(e.g., skin, gastrointestinal tract)
- Adrenocortical adenoma
- Adrenocortical carcinoma
- Gastric polyp
- Gastric carcinoma
2. Connective tissue neoplasm
(e.9., bone, fat, muscle)
-Osteoma
- Osteosarcoma
- Fibroma
- Fibrosarcoma
)jl'/~\
:/.~
,-----'-~. -,
Characteristics
Benign
Usually encapsulated
Usually noninvasive
Highly differentiated
Rare mitoses
Slow growth
Little or no anaplasia
No metastasis
"~j1-\ ~
~~4
~
-iJ"~
Malignant
Nonencapsulated
Invasive
Poorly differentiated
Mitoses relatively common
Rapid growth
Variable anaplasia
Metastasis
/(~.'~
fj0/:\
~''r1 ""-
Clinical signs
- Asymptomatic
Cachexia (ill health & malnutrition)
-Anorexia
Fever
-. Resistance to infection
Client/OWner
- Stages of grief
- Denial of truth
- Anger (towards bearer of bad news)
- Grief
- Resolution: acceptance of what you cannot change
305
ril/'-'
.~
__ , "
ti
IOncology
_CDd ....
~y
_ Detect metastasis
_ Determine bone involvement
~.
- Examples:
[]:t-u=
, Fine needle aspirate (FNA)
- localize tumor
- Contrast: GI, genitourinary
Ultrasound:
- Closeness to large vessels
- Cavitary or cystic nature of mass
Nuclear medicine (scintigraphy): radiodetectable
tumors have >10,000,000 cells
CAT scans (computed axial tomography)
Endocrine assays
Treatment - Neoplasia:
Treat the patient & tumor
Euthanasia: immediately or as an option if other
treatment fails - inform owner of all variables - cost
Most cancer patients also have systemic disorders
- Treat (e.g., supportive & nutritional therapy)
Therapy may increase the pet's quality of life by:
- Decreasing or alleviating pain & suffering
~ Controlling the cancer
// spoe>""
- Rarely curing the cancer C
~'
@
_-,.,,/~
__
Lb I
,...__
...,
~_
:g
_
~_____________
Radiology:
~:=====~-
-Indications:
:...1.... .
@t:
~ ~l
ONCOLOGY I
Client counseling:
_ Set goals & expectations of client
--C:I:in~ic~ia-n--:h-as-n~g~ht-:&:-O~b:liga-ti:-o-n-t-o-q-u-e-S-:ti-o-n-:t=he--;:::B::io::PSY:::::::::th::e::co::::m::::ers::::to::n::e::o::f::d::ia::g::n::o::si::S======~
Radiation Therapy
local & regional neoplasia
Control vs cure
Increasing availability
- Often combined with other modalities
Investigational: Immunotherapy (biological modifiers), hyperthermia,
photodynamic etc., very ear1y In development & understanding
I'
..
Adrlam ~Jn
Chemotherapy
Few cancers are chemosensitive (lymphoid
neoplasia most sensitive)
Nonlymphoid tumors are only moderately
sensitive & rarely is life extended wI
chemotherapy alone
Used alone or in combination wI surgery, radiation,
hyperthermia
IndIcations:
Systemic neoplasia (e.g. lymphosarcoma)
Metastatic neoplasia or likely to metastasis
- Cytoreductlon
Nonresectable neoplasia
Contralndlcatlons: severe under1ying multiple
organ dysfunction
Tumor cells can develop resistance
Normal cells able to repair damage whereas cancer cells can't
Therefore need to lime drug doses to allow normal celts to repair
Complications of chemotherapy:
Myelosuppression & infection
Hypersensitivity (e.g., L-asparaginase)
phamide)
Vinblastine (Velban)
Hormones
- Prednisone
Ste~
I,
- Diethylstilbestrol
- Tamoxnen (NolvadeX)
Miscellaneous
- Asparaginase (Elspar)
- Dacarbazine (DTIC-Dome)
Lymphosarcoma
Condition
CIRCULATORY SYSTEM
Facts/Causes
Presentation
Lymphosarcoma,
LSA,
Lymphoma,
Uncommon
Lymphoid malignancy originating from solid organs
(e.g., lymph nodes, liver, spleen)
- Differentiates from lymphoid leukemia which originates
from bone marrow (malignant celiS In the blood & bone marrow)
Malignant
Gause:
lymphoma,
- Feline: feline leukemia virus (FeLV)
Reticulum cell
- Canine: unknown - virus-like particles?
sarcoma,
- Genetic
lymphomatosis,
- Carcinogenic agents
lymphoreticular
Incidence:
- Cat: 30% of all tumors
neoplasm
M8K 37, 53, 555; Mk 39, 32; E-hb
Peak at 1-3 years - 70% FeLV positive
235,709; H2B 785,1197; SAP 82,
Second peak - 7-8 years most FeLV negative
193,816: 12M 1123; 1M 861.954;
No breed or sex predisposition
IMWW 529: 5mln 792(F), 794; Cat
776, 680; Derm 1064: D-Sy 130,
Pedigree cats at risk at a younger age because of cattery
202; DMi 476; F-N 427: NB 14.4;
- Canine
Pa-T 324
5-10% of all neoplasms
Middle-age to older - 5.5-9 years (mean of 7 yrs)
~ Breeds: Boxer, Scottie, Basset, S1. Bernard, Airedale,
('
Bulldog & Lab
Intact females appear at decreased risk
~I
**
./-----"'!!w_=_ -
ClassHicalloniAnalomic localion
Dog
Multicentric (84%)
Anterior mediastinallthymic (2%)
Alimentary (7%)
Cutaneous (6%)
Miscellaneous extranodal sites 1%)
- CNS, heart, bone, nasal cavijy,
ocular structures
Fe LV
lymphoid Solid organs
CS: Depend on anatomical form
Ox: Hx, CS, PE, Lab, UA, FelV, Rads, Aspiration
Tx: Chemotherapy - Remission
",,00';"
,_,~"
D.
' : ' _ ._ _
~j~~
J~V\
iJ'O
'_'~.~.b
~-------,
Cal
Mediastinal& multicentric: 80'%
Renal: 50%
GI: 30%
Skin: minority
UnnalySI~.
.
.
- Low ~nn~ specrfic graVlty
. := Protelnun~ may occur
~ l Virology (feline)..
..
..
FeLV: 77% positive (80% .mec:llastlnal.& ~ultrcentnc.
50% renal, 30% Gl, minority of sldn) An effective Immune
World Health organization In 1979
response to FeLV doesn' 9uarantee protection from LSA
Each stage Is subclassified Into a (without systemic signs) & b
(with systemiC signs).
_ Positive test not diagnostic for LSA
_ FIV
Radiography: varies wi type
~
_Chest & abdominal films: organomegaly (hepatomegaly,
_
splenomegaly, renomegaly), lymphadenopathy
_50% of LSA dogs _ enlarged sternal & sublumbar lymph nodes, spleen & liver
..
_Chest films for masses & recommended for dogs wi hypercalcemia of unknown ongm
_Clinical staging (extent of involvement)
Contrast: most GI LSA abnormal
__
.
Ultrasonography: changes in echogemcity of parenchyma & size changes of organ
Aspiration biopsy/cytology: confinnation in 90% of dogs & 75% of cats, especially for
extranodal, mediastinal & GI forms
_ Lymph node aspiration: popliteal or prescapular preferred Sites
_Avoid very large or soft nodes (necrosis distortion) & submandibular if
dental diz is present .
.
.
DDx: Lymphadenopathy
- Mostly i~ature Iy,!,phoid ~ells suggestive. histologiC for conclusive Ox
_Other tISsues: liver, kidney, lung, spleen
[nfections (bacterial. viral, rickettsial. para_ Cytology over histology _cheaper
sitic & fungal
Excisionai or incisional biopsy: if aspiration questionable
Immune-mediated dizs (e.g., sys
Thoracocentesis: mediastinal if hydrothorax present
temic lupus erythematosls)
Other hematopoietic tumors: leuke_ Neoplastic lymphocytes or chyle (thoracic duct
mia, multiple myeloma, mast cell neoplasia.
invasion) _mediastinal form
malignant histiocytosis
Sta diz (CBC bone marrow aspiration, chest &
Metastatictumors to lymph nodes:
ge.,
malignant melanoma, mammary adenocarabdomen films)
)
cinoma, osteosarcoma. perltecta! adenocarcinoma. prostatic adenocarcinoma. soft tls__ro_ps
__
sue sarcomas, squamous cell carcinoma
- Neoplastic lymphocyte infiltrate _________________._N_ec
_ 0
Others vary wi site of LSA
Q-
L~-~~t:M~y~e~,o~id~:~e~~h~ro~i~dm;l~io~~=11..:.,..
[l:ts;;c==IO-F;===-h
y~====~_____
ILymphosarcoma
'-"""- 6"-I
.
ri -
Treatment of lymphoma
Incurable in both cats & dogs
Goal: prolong & improve quality of life
- Some cures are obtained
'
Thoroughly inform client about nature of doz,
including prognosis, cost & side effects
Cyto~:''
",-
onci
,1';:;-;
Stero~
1(,
cytox~'
, onc~vinl
",,','
""";.;;
II!~III
' ','
, "
Monitor carefully:
~-
~'~~.
on maintenance:
- Most cats can1 be rescued
- 70% of dogs can be rescued from 1-4 times
- COAP if good initial response
- ADIC ij COAP poor (Adriamycin [doxorubicin].
OTIC [dacarbazine]
Extranodal or solitary lymphomas
_ Controversial
_ Chemotherapy (induction, maintenance & rescue)
surgical resection &lor radiation
'~
I.
\
-~
CIRCULATORY SYSTEM
~.-('''''
di'
--
Remission rates
, Dog: 80-90%
p;;
, Cat: 65-75%
--/" ~
Staging important for prognosis
- Dogs: advanced cases (stages 4 & 5) grave (rarely
survive longer than a few weekS while lesser stages may sUlVive 2
years or more)
Rescue once remission relapse: 1-4x In dogs, rare in cat
- Chance & length 01 new remission about half 01 previous Tx
Dogs: most complete & lengthy remission - good quality ollile
Cures rare, remission of varying lengths common
Bone marrow involvement decreases long term $ulVlval
Y7-
:=:':::-'::::'::::':--:@:l
Response to therapy -stages
6
- Dogs - stage 1: 90% remission rate for 15 months
.1 -Y
Stage 4: < 50% remission rate lor 5 months
"'t. cats: lower than dogs
80% with lymphosarcoma & 27% with leukemia 015 months
Thymic form appears to respond best to therapy
Cat: $500-800
Dog: $t200-1800
- - - ----,----,- - - - ----
Facts/causes
Condition
Treatment
Diaanosis
Presentation/CS
Physical
exam
of
presentation
80% FeLV positive
- Noncompressible cranial thorax Inform client: diz, Px, cost & side
mediastinal
Average age of cats 2.5 years Dyspnea
effects
Enlargement of the thymus, Cyanosis
or Thymic
Chemotherapy: mainstay of Tx
Auscuhation: muffled heart sounds
anterior mediastinal lymph Dysphagia (regurgitation)
bronchoveslcufar
Induction of remission
Homer's syndrome - unl- Decreased
lymphosarcoma nodes, or both
8OUnda, displacement of lung
- Cats: COP (cyClophosphamide, Oncovt~,
M8k 555: Mk 39; E-hb 371: SAP Restrictive or obstructive pul- or bilateral (cat > dogs)
8Ound. to doraocauclal thOl'llx
prednisone)
Hypercalcemia (dogs)
193: H2B 785; 12M 1124, 1120;
monary
diz
due
to
hydrothorax
Percussion:
dull
ventral
thorax
PUlPD
- Dog: COAP
IM861; IM-WW530(f),532; 5mln
Anorexia,
weakness
Remission:
> 85% dogs & 75% cats
Blood
values:
(I
I
!
trll
or
airway
compression
respec792; Cat778; Sx-WW 109; Sx-G
95; X-RD 107: X-T 309
- variety of nonspecific abnormalities - Rarely Intensification: helps stimulate complete
lively
remission
diagnostic
Characterized by mediastinal Sequela:
- L-asparaginase (Elspar) for dogs
- CBC abnormalities from neoplastic bone marChylothorax
(erosion
of
LSA wi or wlor bone marrow
row infiltration or Immune-mediated abnormall- Doxorubicin ( (Adriamycin)) in cats
thoracic duct)
involvement
ties (thrombocytopenia [rare in cat), anemia)
Maintenance: LMP/,Iump (Leukeran,
_Hypercalcemia 50% of LSA dogs, rare In cats
methotrexate, prednisone). All given PO
Virology (feline) 77% FeLV.
- Maintains remission for 3-6 months
Radiology:
Rescue (reinduction of remission):
Cost of chemotherapy (1992)
- Anterior mediastinal mass
- Most cats can't be rescued
f- Cat: $500-800
- Dorsal displacement of trachea
Dog: $1200-1800
- Pleural effusions
"
Ultrasound
,' ''" Steroi
Thoracocentesis:
- Immature lymphocytes in pleural
effusion
- Histology/cytology
DDx:
Fine needle aspiration cytology:
Adrlam cin
Ectopic thyroid tumors
easy diagnosis
Heart base tumor
?h-~
Thymoma
Prognosis:
- '
Pulmonary lymphomatoid
Grave: wI out Tx die in 4-6 weeks
granulomatosis
I
Poor for long term survival over 1 year
Blastomycosis
Cats, FeLV.
w/ Tx, Cat life expectancy 6-9 months
CS: Dyspnea
Cats FeLV positive: grave (usually
anemic & die within afew weeks). FeL V negative
Ox: Hx, PE, Rads, Biopsy
cases tlve longer.
Tx: Incurable - Chemo
.~..
**
.....e:::
<.::-~
~~
~~<
'
~ o.i ~
,
C,-.
~
...:~
a-If}
~
I
,
1311
"~,
I~
Lb /
LL_Y--':=~=i~"'io,,-n
_S_a+r_C_O_m_a-'-Fa=ct::::sJ:.::Ca=u:::s:::es=---_ _
LSA _
Alimentary
M8k 557; Mk 39, 32; SAP
193; 12M 1124; 1M 861; 1M
Site:
_ Anywhere
-_~_'m
**
f-----'p-"re:::s"'en"'ta"'tio:o:nI:.::C:o:S_-+_---,-,~--'D"'ia"'g"'nO=sisiRCULATOR~a~!STEM
d"~.
)
Mass
~~
Sequelae:
_ GI obstruction
_ Peritonitis (rupture 01
( mesenteric lymphadenopathy or
lymphomatous mass)
Radiology:
50"")
abdominal lymphadenopathy
. Mid-abdominal masses
- Positive contrast: usually positive
,Mucosal Irregularities
"CJ
DDx:
Lymphocytic plasmacytic enteritis
Other GI tumors
Granulomatous bowel diz
Hypereosinophilic syndrome
Mycosis
fungoids
~"I\.L
,\\'
Generalized
lymphosarcoma
M8k 555; SAP 193; 12M
1124; IM861; IM-WW530.
531; H2B 785; E-hb 708;
5min 972; Cat 782: Pa-T
324
**
ill'.
",
I,
."
ncovin
I' -
,I~.
..
Conb'Oversial
Chemotherapy (induction, maintenance &
rescue)
Surgical resection &lor radiatiOn
// . _ -
-DDx:
Infectious dermatitis
-Immune-mediated disorders
Parasitic skin dizs
Other skin neoplasia
Multicentric
lymphoma,
"
~!'.......
.:~ ~
ulceration, alOpecia
Steroids
Mk32;SAP193;12M 1125;
IM861; IM-WlN531 (f),532;
H2B 785; Derm 1064; DSy130, 202: D-Ml 476: Cal
785; Pa-T 507
_"
_Plain films
~'
t ',Cyt'oxan
HepaIomegaIy, spIenomegaIy
Cutaneous
Chemotherapy: mainstay of Tx
-Induction of remission
COP (Cydophosphamlde, Vincristine [On-
.Organomegaly
Covinj,CytOSinearabinoside,prednlsolone)
Virology (feline) 70% FeLV negative ABs: Sulfadiazine-trimethoprim
CBC - Chern
(1
I
! 00)
(Tribrisseo)
~'
- Azotemia, liver enzymes
Monitor carefully
I '
- Occasionally kidneys
-Hx, CS
Palpation
- Generalized lymphadenopathy
Chemotherapy: mainstay of Tx
- Diffuse splenomegaly
Induction of remission
- Gums for pallor (BM Involvement)
- Cals: COP
Icterus,
oral
ulcers
- Dog: COAP
(lymph nodes), spleen, liver, kid- - Anorexia
~'
Ii
_ RemiSSion: > 85% dogs & 75% cats
CBC - chemistry
t
! :4.])
- Weight loss
I
neys or any combination of these
Intensification:
_ Hypercalcemia 20% of LSA dogs
- Lethargy
sites
- L-asparaginase (Elspar) for dogs
-Anemia
~
- Bone marrow involvement, es- Hypercalcemia (dogs)
- Doxorubicin in cats
Kidney
&
liver
~
,
_
PU/PD
pecially as diz progresses
Maintenance: LMPl"lump~ (Leukeinvolvement ~
Renal: uremia & renal failure
ran, methotrexate, prednisone): all given PO
.80% FeLV positive
- Urinary incontinence
_ Maintains remission for 3-6 months
_
Radiography:
varies
wi
type
Liver (anemia, jaundice,
Rescue (reinduction of remission):
_
Abdominal
films:
organomegaly
weight loss, vomiting)
- Most cats can't be rescued
(hepatomegaly, splenomegaly. renomegaty),
Eye 33%: uveitis, ocular
ABs if severe leukopenia (WBC
lymphadenopathy (mesenteric or iliac)
hemorrhage
< 2,500) or sepsiS develops
- 50% of LSA dogs - enlarged sternal
& sublumbar lymph nodes, spleen Blood transfusions & anabolic steroids
Anorexia 40-50% of cats from cyclophOsphamide
& liver
_ Cyproheptadine (Periactin): anti-serotonln,
- Chest films for masses & recomstimulates appetite
mended for dogs wi hypercalcemia Monitor carefully
of unknown ongin
Client: monitor pet's appetite & activ_Tracheobronchiallymphadenopathy,lnterstiity level, palpate lymph nodes, rectal
tial, bronChOalveolar or mixed pulmonary Infiltrates, pleural effusions (rare)
temperature (rises wI neutropenia & sepsis)
Ultrasonography changes In echogenlclty 01 parenchyma & size changes of organ
Aspiration biopsylhistology
-7
.(
~~~J
#1 LSA in dogs
CS: Varies wi sites
Ox: Hx, CS, PE, Rads, FeLV, Biopsy
lx: Incurable - Chemo Px: Poor
..-.~.-.-]
~,",
cyt~on~~,"
Prognosis:
stW
I,
'1jJ ~
Lymphosarcoma
CIRCULATORY SYSTEM
Facts/Causes
Presentation/CS
Diagnosis
'HIt,CS
- Physical exam
- Palpation
- Evidence of different organ involvement
- Stage dlz (CBC, bone marrow aspiration, chest &
abdomen films)
- Important to see if part of more common multicentricfonn
Condition
Extranodall
LSA
SAP 194; 1M 861: IM-WW
RetrobUlbar mass
Third eyelid mass
- Comeallnflltrallon
,'"
Treatment
Extranodal or solitary lymphomas
- Controversial
- Chemotherapy (Induction, maintenance &
rescue) surgical resection &lor radiation
c:
///!
s~
7'
Lymphangioma
HB784
~-.
- SUrglcaf removal
Marsupialization if removal not poSSIble
- Allow lymph to drain 10 outside
-Hx. CS
/II!
Sequelae:
- Obstruction of organs possible: interfereswl muscle function, breathIng, urination or GI function
DOx;
Abocesses
- Enlarged lymph nodes
-Neoplasms
- Congenital cysts
-----L,
Benign tumor, SQ mass, Surgical removal
~ E:::n~g.
Diagnosis:
T
tment, when debilitated ~
_ ...
Euthanasia
Ox may be straightforward or difficult
ReIer to an oncologist
Hx (acute or chronic), CS
ML
Physical "ndings
Myeloproliferative syn rome,
,
. " . Asymptom,,"
~
- Splenomegaly, Hepatomegaly
Acute:
_ Unrewarding, remission rare
_ Slight lymphadenopathy or enlarged tonsils
Lymphoproliferative syndrome,
I' lethargy
weight
'ill
_Chemolllerapy; different protocols
- Pale mucous membranes
MSk 53, 37; Mk 39; E-hb 704; SAP 197; H2B 745; 12M 1135,
"- -~
Anorexia
CLl
Prednisolone, cytosine arabinoside,
_ Icterus (liver infiltration)
1140(f); 1M 871, 876; IM-1,NW 517; E 1923; 5mln 770; Cat 789,
-....: .......
Persistent fever
chlorambucil, busulfan & hydroxyurea
- Fever & emaciation
500,509: Pa-T 307; Lab 72, 94 . ~ ~\\..,.,
Dyspnea
Romanovsky's- staining of blood or bone marrow Supportive therapy includes blood transfusions,
~)V~
Vomiting & diarrhea
antibiotics. fluids, corticosteroids & vitamins
smears for well
~
Shifting limb lameness
differentiated cells
_ Leukemia: malignant neoplasms originating from bone marrow
CNS
CytochemiCal stains for undifferentiated cells
Chronic leukemias
_Encompasses all hematopoietic cell lines: RBCs. WBCs & platelets
CHRONIC
- None If asymptomatic
Electron microSCOpe <s
,
_Myeloproliferative syndromesfmyeloid leukemia, ML:
Asymptomatic 50%
_SymptomatiC or organomegaly. or blood
Blood
. Proliferation of bone marrow constituents (nonlymphoid) Also see
Prolonged Hx of vague
abnonnalities
.' Nontymphoid: granulocytes, monocytes, RBCs.
pg 165, 692 signs
Chemotherapy CLl: Prednisolone,
Abnonnal (leukemiC) cells
.r....
megakaryocytes. mast cells
Chlorambucil (leukeran) & vincriStine
Cytopenias in most
_ Lymphoprollferative syndromellymphocytic leukemia, LL:
Sequelae to tissue Infiltration
CML: Hydroxyurea PO bid
Total WBC (mean - 300.000l~1)
LymphOid cells: lymphocytes & plasma celIS
- Infections
.. No Tx for blast crisis
Anemia in most
.. _ '
_ Acute or chronic
- Severe anemia
Thrombocytopenia (most)
_ Acute: aggressive behavior (rapid death wlo Tx), immature
'
, :
- Hemorrhage
_cat: Fel Y 3. FlY
Complications: increased susceptibility to
(blast) cells In bone marrow &lor blood
- Organ dysfunction
_ Bone marrow aspirate to evaluate extent of diz
infections after chemotherapy
. Myelogenous leukemia, erythernic myelosis.
"-, - Death from any of above
.Cytochemlcal stains if blasts present to dlfferentiacute megakaryoblastic leukemia
~
_Chronic: protracted course. adult cells (cell lines can be recognized)
ate Ml from Ll
Leukemia.
MPD
LL~'
dJ
Rapid
ross,'
-Aou" ',"k,m',
.=::~~:~;.~~~;:,~~~::~~~~~:~"m!;
e 8''
~.'
.
A------'
" ( ) ~ Refe r
II)
~ ,~
-~
315
(~
h'
IT'i~
Prognosis:
- Acute
;:;::":i
-Grave
_ Untreated die in 3 weeks
..... " --....;:_
_ Remissions rare, , survival rarely over
3 months
_ALL: better than AMl, but worse than
lymphOma
- RemiSSIons 20-40%
Chronic leukemia sulVIval Cll > 2 years
Tr
Leukemia
Acute
lymphoblastic
leukemia,
ALL
LATORY SYSTEM
c;;A
F!l
CS: Lethargy, ill, Bleeding
Ox: Hx, CS, FeLV, Blood & BM
Tx: Poor
- Chemo
Acute:
-F~er
- Euthanasia??
- Chemotherapy - Immediately because rapid dlz
- Transfusion
- Monitor. If granulocyte count < 1,0001111 stop
- Chronic: Don't treat unless symptomatic
- Prednisolone 8. Chlorambucil (LeUkeran)
- Prednisolone & Chlorambucil & vincristine
- Monitor for relapse
Ste~
II.
~ Ii
I:~~~:~~~~:::~~:pmom",~,','"m-
.:!~."""".",
(lJ
Prognosis:
Acute:
Grave: mean survival
.
~~
JJ
~~
1...!.
.(
;7
~~
'/-1
\
(
(".,
Separate diz fro~ Iymphosarc?ma because it's a lymphoma originating in the bone marrow, not in the organs
- In LSA, marrow Involvement IS often a late manifestation - 10% in dogs & 30% in cats
Types:
Occurrence: Dog - uncommon; 10% of all lymphatic tumors
lympl\atic leukemias
- Chronic lymphocytic leukemia
Cat - may constitute up to 33% of feline lymphoid neoplasms (other lymphoma)
IMWW519; E-hb738, 758;
Acute lymphoblastic leukemias
Currently
considered
part
of
LSA
(Hardy)
SAP 197; H2B 745
Lymphoid
leukemia,
,-----
I~ ~- cyto~-~
~ Alk~1~
~
Myelofibrosis &
osteosclerosis
Ehb 738; SAP 155; H2B
755; Cat 794, 505
Rare leukemia, Plasma cells: synthesize immunoglobulins (Ig); Multiple myelOma (MM) most common PCN; Aged dogs (Germ.
_ CS: NonspecifiC (anorexia, listlessness, PU/PD); Hypervlscosity; Epistaxis, CNS; Infections (fever, pneumonia); lameness (pathologic fractures)
Sequelae: Kidney failure, Sepsis - infections; t Incidence of other tumors; Amyloidosis
Ox: 2 of the following: Monoclonal gammopathy; plasma cells in bone marrow; Bence-Jones proteinuria; Osteolytic lesions (dors, spinous vertebral processes)
Tx: Combo _antlneoplasllcs: Melphalan (Alkeran), Cyclophosphamide (CyIo~), Prednisolone; Surgery for fractures; Supportivelherspy (A8s; Diuresis; Furosemide)
Px: Short-term usually good, Long-term remission the rule about 12 months
Megaka!)'ocytic
leukemia, ~ "tjI".,;'
Essential
thrombocythemia
I'l.,p
Polycythemia
vera, PV,
Polycythemia rubra
vera,
ErythrocytOSiS
E-Ilb 705; SAP 163; H2B
731; 1M 909, 123; IM-WW
513; Cat 794, 504, 511
I.
U'" ~.'
~
."". :
o Rare type of leukemia, Reported In dog & cat; Megakaryocytic leukemia - Bizarre platelets; Essentlallhrombocytopenla: proUleralion
IJ
':,
': '
...""a\
,:'
, ...;;
...
"- "
of platelets
- CS: Bleeding, Thrombosis
o Ox: Thrombocytosis (platelet> 1 miltionllll, Splenomegaly)
o Prognosis: survival of 1-14 months
Chronic MP
diz,
Steroi
Bone marrow replaced with fibrous tissue (fibroblasts), Cause: FelV, 2" to myeloproilierauve diz, Inflammation, necrosis, neoplasia,toxlc agents,
Erythroleukemia complex in cats, ErythrOid myeloprolnerative diz, Reticuloendotheliosis, Acute erythroleukemia, Erythremic myelosis,
E-hb 705; SAP 163; HB
753; 1M 872; Cat 793
@Y.-
0 Dark skin
Hx, CS
POIPU
0 Physical exam
Neurologic disorders (behavior,
- Dark,. brick-red mucous
motor or sensory changes) 50%
membranes & skin
0 Neuromuscular disorders
- Splenomegaly
Blood values
.~emOrrhage
~._", - Polycythemia (65-80% PCV)
ODx:
Primary PV
.
iPJ
Prognosis:
o May be managed for many months wI periodic phisbotomies
Splenomegaly
r-~--~c-o-nd~i-tio-n~~--~----~F-act--~~c~a-u-se-s---------;----~p~re-s-e-m-a-t~io-n------;---------~D~ia-g-n~o=s~iS~~
Splen ic
mass,
Locall"zed
SpIenomegaIy
Neoplastic:
I1D -
- Hemangiosarcoma (I'
- Hemangioma (rare)
**
tumor)
- Fibrosarcoma
- leiomyoma
;..
- Leiomyosarcoma
.
Lymphoid neoplasm
..- k
_Uposarcoma
& (;
- Malignant fibrous histiocytoma
- Osteosarcoma
- Chondrosarcoma
- Rhabdomyosarcoma
- Myxosarcoma
- Undifferentiated sarcoma
- MetastatiC tumors - rare
- Nonneoplastic
- Hematoma (#1)
- Abscess (rare)
"Nodularhypeiplasia(common)
- Pu/PD
- Abdominal effusion
-Hemangiosarcoma: weak-
T~mment
~ +-----~~~------~
,j
."
myelohpo.m~
rt
- DIC - prolonged prothrombin time &I - UppO lVe care:
or activated partial thromboplastin
- Stabilize before surgery
time
. . . IV fluids, corticosteroids
Wh I bl od
stu
Thrombocytopenia ~---
0 e 0
tran SlOns
Hypofibrinogenemia ~ .
- ABs if sepsis or abscesses
S
- Fibrinlfibrinogen degradation
- Radiology: abdominal mass
ness, dyspnea, collapse, _ Chest film for metastasis
shock
~
/::
- Ultrasound
~
- Not recommended percutaneous fine
needle aspiration IV S
/ //
- Exploratory laparotomy & splenecr;J
tomy: Histopath, biopsy other organs
<
?~~sient
71
splenomegaly
- Hepatomegaly
Abdominallymphadenopalhy
- Other organ enlargement
Prognosis:
- Hemangiosarcoma: grave to
poor
- Hematoma: good if doesn't
rupture
Focal enlargement
Ox: Hx, PE, Rads, US, Laparotomy
CS: Asymptomatic, Nonspecific to collapse
lx: Cause, Splenectomy, Supportive
---------~---------~----------r.~----~~
-~
~I'I'Y'V'n!:ll Hemangiosarcoma: #1 splenic _ Abdominal distention" - Hx, CS
...
Splenectomy, complete
- Only palliative for sarcomas
Hemangioma
neoplasm
because of metastasis
-" E
- Common in dog, rare in cat
- Progressive anorexia,
201
MS'704 ; SAP1SO,
; H20 , ....; - Supportive care
hb 710; 12M 1143; 1M 947; lM-WW -Hemangioma: rare
lethargy" weakness
- Stabilize before surgery
533; 5mln 646; Cat6B7; F-H 799; Pa- - Both arise lrom vascular endothelium
_ Intermittent weakness wi
t327; NB 14.4; E1938; Sx-S-hb329; _ Site: spleen, heart, skin
IV fluids, corticosteroids
spontaneous recovery
SX S 951 S 40 707 S BS44 S
Whole blood transfusions
G200: s~-:w 203; ~_~~ 168i x:x,: - Very invasive, fast growing
_ Acute collapse, shock
hemopericardium
- ABs if sepsis or abscesses
461
- Metastasis common
_ Dyspnea (hemothorax lrom rup Nonclotting fluid
Middle-aged or older
ture of metastatic tumor)
Reactive mesothelial cells
- Chemotherapy: vincristine
(Oncovlnl!ij, doxorublcln (AdriamYCin),
- Medium to large breeds, espe- Vomiting" diarrhea
CSC:
cyclophosphamide (Cytoxan) may
cially German shepherds
_ Weight loss
- Anemia
prolong survival time
PUIPD
" Nucleated RBCs, poikilocytosis,
_Periodic radiographic or US of thorax &
abdomen for metastasis
Hemoperitoneum (common)
acanthocytes, schistocytes
- DIC: prolonged prothrombin time &Joractlvated _Periodic check lor OIC & anemia
partial thromboplastin time
- Sequela: DIC (disseminated Intravascular coagulation)
Thrombocytopenia
Hypofibrinogenemia
Fibrinlfibrinogen degradation prod.
DDx:
- Radiology: Chest film for metastasis
Transient splenomegaly
Ultrasound
Hepatomegaly
- Fine needle aspiration for cytology
- Abdominal lymphadenopathy
- Ultrasound guided or laparotomy
,;",1,
:for biopsy 110 hlstopath (' coagula
Other
organ
enlarg:~~
Dog> Cat, Metastasis
Prognosis:
tion 1st - PT, PTT, platelets)
CS:Vague
- Grave to poor:
- Death common due to metastaSis,
Dx: HX,CS,PE,CBC, Rads
even II not evident at splenectomy
c--=-".=>
I_._~-."'"
**
pain
-Physicalexam:
_ Palpate cranial abdominal mass
- Pale, icteriC mucous membranes
- Body cavity aspiration
_ Hemoperitoneum, hemothorax, or
~~-?lJJ
~!~~
~~ ~=z:s~
"1 ~
-+
ill
+.f
:~~
lx: Grave Px
Splenic
hematomas
E-hb 762; H2B 795; Sx-S-hb 330;
Sx-s 954; Sx-B 544; Sx-G 209; Sx4B 707; X-RP 167; X-T 461
**
0,0
I"
o~'
,--"
0
II
Splenectomy is curative
- Radiographs- splenic mass
Ultrasound (m/ nol be able to differentiate from
splenic neoplasia)
Prognosis:
- Good if doesn't rupture
'&
~
Splenomegaly
Splenomegaly
Ehb 710; SAP 178; H.2B 791;
IM943; Sx-S-hb328; Sx-S9S1
***
Presentation
1 diz
0
Nonspecific
- Abdominal distention
- Abdominal pain
- Anorexia
- Lethargy & depression
- Vomiting & diarrhea
- Weight loss
- PUlPD
- Depression
Splenic torsion: collapse,
shock, pain, vomiting, depression
- Congestivesplenomegaly: impedes
flow through the spleen
- Hyperplastic: t lymphocytes &
plasma cells & splenic mass due to
immunological stimulation & t phagocytosis due to blood-bom antigens & RBC destruction
- Inflammation: cell infiltrates (relatively uncommon)
- Extramedullary hematopoiesis: dizs
stimulating splenic production
- Infiltrative: neoplastic or nonneoplastic
Splenomegaly _ Causes
Congestion
- Splenic torsion wi or wlo gastric torsion
_ Portal hypertension
Chronic diffuse liver diz
.. Hepatic cirrhosis
.. Hepatitis
.. lipidosis
Rt. sided congestive heart failure
Obstruction of vena cava
Neoplasia
.. Heartworm diz
- Barbiturate, tranquilizers & inhalants
Infiltrative:
- Neoplastic:
Primary neoplasms
Diagnosis
Treatment
Asymptomatic
Hx, CS (01 different conditions)
Vague, usually related to Physical exam
- Pathophysiology:
__
Ii
CIRCULATORY SYSTEM
Facts/Causes
Condition
d~I!)1
"
\,.-
-CBC
Anemia, thrombocytopenia, leukopenia
Abnormal RBC morphology
- Spherocytes, Helnz bodies
Erythroparasltes
Neoplastic WBCs
Biochemical abnormalities are fare
Hypercalcemia lymphoma or multiple
myeloma
Hyperglobulinemia
Bone marrow: Neoplasia
Hemoglobinemia/hemoglobinuria
(lysis of RBCs)
Radiology: splenomegaly
Ultrasound
Fine needle aspiration for cytology
Ultrasound guldedllaparotomy lor biopsy &
histopath, Check coagulation first (Platelets,
PT & PTT
Exploratory laparotomy
- t % of reticulocytes
- Target cells
- Acanthocytes
- Schistocytes
- Howell-Jolly bodies
- Thrombocytosis
.. Myeloproliferative dizlleukemla
. Trypanosomiasis
.. Systemic mast cell dlz (mastocytosis) (cats)
. Cytauxzoonosis
.. Multiple myeloma
-Histoplasmosis
.. Malignant histiocytosis (rare)
Inflammatory:
. MetastatiC neoplasms - rare
- Bacterial:
- Nonneoplastic:
. AmyloidOSiS
Penetrating wounds
RE hyperplasialhyperfunction
Foreign bodies
- HemolytiC anemia
Hematogenous infection
. Immunemediated anemia
Septicemia
. Heinz body
Septic peritonitis
. Babesiosis
Pyometra
.
_Toxoplasmosis
. Pyruvat e klOase defIClency
- Systemic lupus erythematosus
Salmonellosis
- Chronic bacteremia
Canine brucellosis
. Canine brucellosis
Mycobacterium (TB)
. Bacterial endocarditis
- Protozoal diz:
- Canine ehrlichiosis
Haemobartoneilosis
- Viral dizs:
Infectious canine hepatitis
Feline infectious peritonitis
. Mycotic:
Histoplasmosis
Blastomycosis
SporotriChOSIS
Hypereosinophilic syndrome (cats. rare)
- Canine ehrlichiosis
Extramedullary hematopoiesis:
Infiltrative bone marrow Olz
Chronic hemolytic anemias, AIHA
-Chronic
_Pyometrainflammatory dizs
l}
~""---7-i ...,
L '--,
I'
..
~~~
~,-___L_y_m_p_h_o_s_a_~r-0m~a~~__~-c____~_._P_~~t~_'_~_~_i~_~r~_iO_~__________________r_~_i_~_U:;_~_i_~._~_._t~_pa_"_o_oom__iM__i'_.____~,-~~~-~___~~~--~---
Splenic
torsion
H28 791; SAP 180;
**?
SxS-hb
--cw
Collapse, shock
HX(usuallyaCtJte,mlbseveralweekS), CS Stabilize:
Anorexia
Physical exam:
- If gastric dilatation, decompress,
Vomiting
- Palpation: splenomegaly
treat shock
Depression
- Pale mucous membranes
- IV fluids, steroids whole blood
Tense, painful abdomen - Tense, painful abdomen
- Stabilize
Anemia, thrombocytopenia, leukopenia Exploratory celiotomy, untwist &
He, T.oglobinemialhemoglobinuria check for thrombosis
(lysis of RBCs)
Splenectomy it thrombosis
Radiology: displaced C-shaped
spleen
Palpation splenomegaly
MIb rotation of stomach -gastriC vOlvulus
Ultrasound (distended splenic veins)
~1~$;r~71
jrv.~
1-;':;'
321
Spleen
CIRCULATORY SYSTEM
Facts/Co ~f)
Condition
.5
Splenic
Cause
trauma!
rupture
:
~~
-. Underlyin~
**
i:t:;'~iC
'-
,,\l1
Splenic
abscessJ
inflammation
SAP 180: H2B 795
Presentation
Hemorrhagic shock
Vague signs of abc!~mi-
~1A~
- -
-~
wi other
1 dlz
- Abdominal pain
- Abdominal distention
- Vomiting
- Depression
**
Radiographs
Splenectomy
Surgical repair
C
///( s"='::=:>"
Prognosis: shock & death if
Treatment
Hx, CS
nal discomfOr1~'
Asymptomatic -:
/~\
~lf:
.. . - -----_'-'
/-
Diagnosis
""ji
Palpate:
enlarged spleen
Treat 10 cause
Radiographs
Systemic antibiotics
- Locally or generalized enlargement
- DystrophiC calcification if chronic infac.
- Gas forming bact. air In splenic parenchyma or
wi
In ",I,nl, ""'~'-:U
~r
~
Ultrasound
Serum biochemical
abnormaliUes rare
.--'~
~
"' -
~~~~~____________-L___ ~ ______L -_ _ _ __ _
AcceSSOrYH2B 797;
Sp Ieens
F-H 799:
S<4B 707
Splenosis
SAP 180: H2B 797
Prognosis: Guarded
Postsplenectomy
3% 01 splenectomized dogs
Hx (splenectomy)
~. es sepsis
Prognosis:DeadC
Lymphedema
H2Bn9
**1
///1
s-L;>
sa
;;,
Contagious
streptococcal
lymphadenopathy
E-hb 707
Puppy
strangles,
Juvenile
cellulitis,
Juvenile moist
pyoderma
SAP 371; H2B 958
- Arteriovenous shunts
Both forelimbs
- Thrombosis of cranial venal cava
- Compression of cranial vena cava by mediastinal mass
.. Btl8tral hindlimb
- Obstruction of sublumbar lymph nodes (neoplasia)
-All 4 limbs
- Hypoproteinemia
Prognosis:
Congenital: guarded, may improve spontaneously or become
permanent
doses of steroids
~V~
}
(1
! ttl)
---..-
Jki':J
41
Prognosis:
Good If responds in 4-5 days
Lymphadenopathy
Condition
Lymphadenopathy
E-hb 706: H2B n9: SAP 195; 1M
941; E 1930
***?
Enlargement
CS: Variable
Ox: Aspiration
Tx: Tx cause
Erythrocytosis,
Polycythemia
SAP 156; 1M 909: E-hb 705,103;
Facts/Cause
Lymph node enlargement
CIRCULATORY SYSTEM
Presentation/CS
Diagnosis
Treatment
- Enlarged superficial
lymph nod.(s)
Variable
- Systemic (systemic mycosis, salmon poisoning, Rocky
Mountain spotted fever, eMichlosis, Leishmaniasis, acute
leukemia)
- No systemic CS: chronic
leukemias, most lymphomas,
vaccination reaction
-Vague:
- Anorexia
- Weight loss
- Weakness
- Vomiting, diarrhea
- PU/PD (if hypercalcemia)
- AsymptomatiC
- RIO dehydration (relative erythrocytosis 1st)
Dark red gums
Erythrogram retums to nonnal after fluid replacement
- Retake PCV after patient relaxes (if suspect splenic
- Paroxysmal sneezing
contraction)
(viscosity of nasal mu- Hx (stress or fluid loss), CS
cosa)
- Physical exam
- CNS (behavior, motor
~ Dark red mucous membranes
or sensory changes)
- Slow capillary refill time
- Cardiopulmonary CS
- Relative
- Correct causes
Absolute
- Remove inciting cause:
nephrectomy
. Phlebotomy
Polycythemia rubra: hydroxyuria
(Hydrea)
. Phlebotomy
-eBC
Relative - dehydration
CS: Dark red gums
Ox: RIO, Hx, PE,
PVC
Tx cause
Erythropoietin
abnormalities
H2B 546; C12T 14351, 3451: C11T
484
-. PVC
Types 01 erythrocytosis
- Relative: t plasma proteins
Relative erythrocytOSiS (common)
Hypoxia: lung diz or rt-to-It shunts
~ Dehydration or hemoconcentration
- Transient splenic contraction from excitement, fear Renal dizlneoplasia: urinalysis, radiography, US, Biopsy, azotemia
- Greyhounds
Erythropoietin levels not readily available
Absolute erythrocytosis
_10 erythrocytosis (polycythemia vera)
Low serum erythropoietin
Defect in Intrinsic stem cell defect (leukemiC)
2" erythrocytosis: overproduction of erythropoietin
Hypoxia (chronic pulmonary dlz, high altitudes, cardiac dlz wI right)
to-left shunts)
~
, Erythropoietin-producing tumors
,~
(renal lymphoma, renal carcinoma,
//!~
nasal fibrosarcoma
~
r",
. Renal dlz (pyelonephritis)
g~"
Hyperadrenoconicism - dogs
~
Hyperthyroidism cats
\
- Erythroleukemia in cats - rare
t'
..
:.;t
.:' ,. .
Glycoprotein hormone: regulates normal erythopoiesis of bone marrow; Origin? juxtaglomerular apparat in kidney? Renal
hypoxia: major stimulus for secretion
~. Erythropoietin: ChroniC renal failure, Polycythemia vera (myeloproliferative disorder, t RBCs negative feed back on
erythropOietin, 10 polycythemia(high PCV)). Tx: renal failure (fluids, kid HiII'odiet, erythropoietin [Epogen]) or polycythemia vera
- Normal t: Right to left cardiovascular shunts, High altitude, Hemoglobinopathy, Respiratory center depression
-Inappropriate t: Tumors secretion (renal carcinoma, hepatoma, urinary leiomyoma, ovarian carcinoma, pheochromocytoma,
adrenocortical neoplasms, renal lymphosarcoma, nasal fibrosarcoma). Parenchymal renal diz: renal cysts, hydronephroSiS,
polycystic kidneys), Hormonal stimulation: androgen therapy, high dosage of adrenocortical steroids. Tx cause
326
Acute renal failure 348
ADH (antidiuretic) test 332
Aminoglycoside toxicity 353,
726
Amyloidosis 361
Antidiuretic hormone test 332
Antifreeze toxicity 352
Arsenic 353, 735
Azotemia 328, 331,340
Bacteriuria 392
Bilirubinuria 334
Blood chemistries 331
BUN 331
Capillariasis 353
Capsular hydronephrosis 356
Casts 335
CBC 331
Chronic renal failure 342-347
Clinical signs 328
Compulsive water drinking
379
Congenital
renal disorders 355
urachus 387
urethral 369
urinary bladder 367
Creatine 331
Crystals 335, 373
Cystic calculi 372, 374
Cystogram 336
Cystinuria 354
Cystitis 364, 365, 389
Cytoxan 365
Detrusor atony 388
Detrusor hyperreflexia 389
Detrusor sphincter reflex 385
Diabetes insipidus 378
Diagnosis - renal disease 330
Differential diagnosis 328, 329,
334337
Dioctophyma (worm) 353
Diuresis 338
Dysuria 329
Ectopic ureters 387
Elimination problems 390
Emphysematous cystitis 365
Ethylene glycol toxicity 352
Faconi's syndrome 355
Ketonuria 334
Leptospirosis 351
Lower
motor neuron bladder 384
urinary tract disorders 329
Micturition disorders 380
Mycoplasma UTI 365
Neoplasia 357 359, 367
renal 359
ureteral 357
urethral 370
urinary bladder 367
Nephrotic syndrome 361
Neurogenic
diabetes insipidus 354, 378
incontinence 384
Obstruction related incontinence 388
Oliguria - DDx 328
Over distention 388
Overflow incontinence 384
Parasites 353
Paradoxical incontinence 388
Paralytic bladder 384
Urinary System
Patent urachus 387
Pelvic bladder 365
Perirenal pseudocysts 356
Peritoneal dialysis 338
Phenylsulfophalein test 331
Physical exam 330
Polycystic kidneys 356
Polypoid cystitis 365
Polyuria 328, 376
Primary renal glucosuria 354
Prostatic disease 329, 469
Proteinuria 334, 391
Pseudocysts 356
Pseudohermaphrodite 389
Psychogenic polydipsias 379
PU/PD 376
Pyelonephritis 350
Pyuria 335, 392
Radiographs 336
Renal
azotemia 328, 340
biopsy 338
cysts 356
disease 328
dysplasia 355
glycosuria 354 (1 '), 355
failure 328, 342, 348
acute 348
chronic 342-347
hypertension 345
hyperparathyroidism 346
hypoplasia 355
neoplasia 359
pain - DDx 328
trauma 358
tubular acidosis 354
Ruptured bladder 366
Stress incontinence 386
Submissive urination 387
Trauma
renal 358
ureteral 358
urethral 371
urinary bladder 366
Treatment 338-339
Upper
motor neuron bladder 385
urinary tract infection 350
Uremia 328, 344
Ureteral
obstruction 357
trauma 358
tumors 357
Urethral
calculi 372, 374
congenital 369
discharge 329
fistulas 369
incompetence 386
neoplasia 370
prolapse 360
stenosis 370
trauma 371
Urethritis 368
Urge incontinence 389
Urinalysis (UA) 332, 333, 334
Urinary
bladder 337
DDx 337
incontinence 384
rupture 366
incontinence 380
tract disorders 328, 362
tract infection 328, 362
Urine specific gravity 332
Urine sediment 335
Urine spraying 390
Urolithiasis 372, 374
Water deprivation test 332,
377
327
"--"--"-
--~
Pu/PO (polyuria/polydipsia - t
amount! t drinking)
Urinary problems:
- Renal & ureter
Renal pain
"
-~ ...
____~_
/.
''2
Hyperadrenocorticism '. f
;;;;ii
-,.-.
,J:\I,
~ ~I
-"'"
c: .:~
_Neoplasia
- Dioctophyma renale (kidney worm)
- Accidental ligation of ureter when spaying
- Inflammation & stricture of ureter or urethra
- Extra-urinary lesions - abdominal masses
- Congenital causes:
. Torsion or kinking of ureter due to displacement
.' ~L >
Hypoparathyroidism
'Sc.5
Hyperthyroidism
~~
Lymphosarcoma
)l"-:
?~ 3.-
/'@
fir)
! fr
dJ .
~
l'
tv'
Clinical signs:
Often asymptomatic
Dysuria
Urinary incontinence
Urethral discharge
No fever usually
"1.<;/1! )
1{Jdj ~
'"
~~ t-r,r
~?1i:Jd)
Prostatic diz
Constipation, tenesmus
"Ribbon" stools
". '~
I>
Hypoadrenocorticism
Primary hyperparathyroidism
both kidneys
---
~. Liver diz
).
-::--4,
tr.:::
(UUT):
Physiologic polyuria #1
.~~
~ (Cushing's syndrome)
Renal diz
~f~,
~,
Jnr
~
Pollakiuria (t frequency)
Dysurialstranguria (painful)
-Incontinence (no control of unnatlon urge)
.~r
~
URINARY SYSTEM
DDx - Dysuria
=difficult micturition
~:
Preputial discharge
Urethritis
Urethral trauma
Urethral neoplasms (rare)
- Transitional cell carcinoma,
leiomyoma & squamous cell carcinoma
- Secondary tumors - transmissiblevenereal sarcoma & malignant lymphoma
Bacterial prostatitis
Prostatic cysts
<~
?~?
Diagnosis
URINARY SYSTEM
Questions to ask client (history)
Acute or chronic?
As a veterinarian, answer the following questions:
Progressive or nonprogressive?
- Primary renal diz?
Previous drug treatment?
- Predominantly glomerular, tubular, interstitial or a
- Aminoglycosides, ,
.
amphotericin B, thiacetarsamide, NSAIDs?
combination?
- Extent or severity?
Heartworm treatment?
- Acute or chronic?
Previous trauma?
- Reversible or irreversible?
Antifreeze changed recently?
- Progressive or nonprogressive?
Urination habits: change in frequency, volume, or
- Azotemic? Prerenal, renal or post renal?
color? Painful urination?
Urinating during the night?
History: may help, but often nonspecific & renal diz Reluctance to move?
Age?
may not be suspected
Breed?
-Age:
Water intake: diminished, normal, increased?
- Young - congenital, infectious or toxic causes
- Normal water intake = < 100 mllkg/day
- Old - degenerative or neoplastic disorders
E-hb 648; 1M 466, IM-WW 324; E 1706
Physical exam
Ehb 648; E 1706: IM-WW 324
;Jf
1\1
.,
Abdominal palpation
Changes in urination
Normal urine volume = 25-40 mV kg/day
for dog, & 20-30 mllkg/day for cat
Anuria: no urine
Oliguria: < 1.0 to 2.0 mllkg/hour
Polyuria: > 50 to 60 ml/kg/day
Blood chemistries
- Normal BUN:
(glomerular
filtration rate): more specillc indicator of GFR than BUN (variations
have little effect on creatinine filtrallon)
Plasma Proteins:
'-'
UA (Urine an lysis)
M8k 1128; E-hb 636; H38 494; 1M 469; IM-WW 324;
- Catheterization
(greatest risk 01 contamination to animal)
L
It_
-Color:
- Colorless - light yellow - normal- low SpG
- Darker color - nennal or abnonnal - high SpG
- Pink, red, brown or black hemoglobinuria or myoglobinuria
- Blue or green bilirubinuria or stored urine
-Clarity
- Turbid - epithelial cells, blood, WBCs & bacteria or cooling
URINARY SYSTEM \
DDx: LowSpG
1" renal insufficiency
2" disorders
- Diabetes insipidus
- Pyometra
- Hyperadrenocorticism
- Diuretics
- Corticosteroid Tx
- Psychogenic polydipsia
..
_-=~~""==========""'~
p=r--=
- 1.008-1.012 - isosthenuria
(same as plasma/glomerular
flltrate)
Unable to concentrate or secrete water
Do a 2nd test or a water deprivatiOn test if there are no signs of
dehydration or azotemia
1f1
lW
Changes in urination
Normal urine volume =
Dog:
Cat:
- Anuria:
- Oliguria:
- Polyuria:
Urinalysis - Values
Parameter
Dog
Color
Light yellow
Turbidity
Clear
Specific gravity
1.015-1.045
Osmolality (mOsm/kg) 500-2400
24-40
Volume (mllkd/d)
WBCs
< 5lhpf
Semiquantitative tests
Negative
Protein
Ketone, glucose
Negative
Negative
Urobilinogen
Trace
Bilirubin
5.D-7.0
pH
Quantitative tests
Creatinine (mg/dl) 100-300
Urea g/dl)
1.0-2.5
Protein (g/dl)
0-300
Sodium (mEqm
20-165
Potassium. (mEq/l) 20-120
Calcium (mEqIl)
2-10
Phosphorus (mEq/l) 50-180
Amylase (SU)
50-150
Cal
Yellow
Clear
1.015-1.060
500-2800
22-30
Melecat
Negative
Negative
Negative
Trace
5.0-7.0
110-280
1.0-3.0
0-20
3-120
>
__~G________________________~~~____________________________
URINARY SYSTEM
Proteinuria:
DDx: Proteinuria
- Glomerular diz
- Glomerulonephritis
- Amyloidosis
- Fanconi's syndrome
- Nonmalignant & malignant
hyperglobulinemias
- Plasma cell myelomas
(Bence-Jones proteins)
- Congestive heart failure
- Inflammation of urinary tract
- Stress
- Fever
- Exercise
- Hyperthermia & hypothermia
- Use for all high (3+) proteinuria in absence of inflammato~ urine sediment to determine significance of
protein
.
'Cv-,,:--
pH
~. Interpret wi caution if inflammatory urine sediment
- pH 5-7 normal in dogs & cats
~
- Normal values:
Varies wi diet: high meat lowers (acidic), vegetable
. Dog: < 1.0 0.2)
diet - alkaline. urolithiasis diets - acidic
Cat: < 0.5
Some bacteria split urea to produce alkaline urine
_Guidelines for interpretation (dogs)
and thus can be used to monitor treatment
. PrlCr < 5: glomerulosclerosis or atrophy
Note: pH tends to increase over time; measure on
. PrlCr = 5-13: nonamyloid glomerulopathy
fresh sample
Pr/Cr> 13: severe glomerulopathy or amyloidosis
if.
~
Glucose
00
- A.A - normaIIy
00
- > 0.0 requires further evaluation
0
- Indicates blood values
> 180 mgldl (renal threshold)
-Intermittent glycosuria: R/Opre-diabetic
state by Hxofstress or 1-hour-fed plasma
DDx - glycosuria
- Diabetes
- Transient
- Stress (cats> dogs)
- After eating
- Hyperadrenocorticism
+ pre-diabetic state
I~~~~~~~==~~~r~~~~~~~::~~~~~
Ketones: Dipstick
Bilirubin
- Dog: Trace to 1+ - normal
DDx- Ketonuria
cg
- Diabetic ketoacidosis 0
- Starvation
- Persistent fever
-Impaired liver function
-Hypoglycemicsyndromes
DDx - Pyuria
- Infection ~
Uroltths ~.,.~
-Trauma
~,
- Tumors ,-_.' "W':
_Toxins
\_f::':
~-,~
,'
~-l'''~
,
k;r:...
Epithelial cells
-Occasionally squamous, transitional or renal tubular cells
seen in normal urine
- t Numbers in inflammation or
neoplasia
- Hematuria
- Transfusion reactions
- Immunological reactions
- Infections
- Renal or postrenal bleeding
-Trauma
- Coagulopathy
-Infection
-Inflammation
- Urolithiasis
- Neoplasia
UTI
Casts
trophoresis
Urine sediment
WBC: pyuria
Occult Blood
Dipstick: does not differentiate hematuria
from myoglobinuria or hemoglobinuria
- To differentiate hematuria: presence of
d'
intact RBCs on se Iment exam
- To differentiate myoglobin from hemoglobin: ammonium sulfate precipitation, elec-
DDx Crystals
_ Small numbers normal in concentrated &
refrigerated urine
_Struvite (triple phosphate) crystals: significant
if inflammation or radiodense uroliths
_ Oxalate or hippurate crystals
Ethylene glycol toxicity
- Absence doesn't rule out anlilreeze toxiclty
335
Microorganisms
- Bacterial: best in cystocentesis samples
_ > 10,000 Iml for bacilli or > 100,000 Iml cocci
Can1 always be cultured
~
- Fungi are uncommon
...-.-~
- Microfilaria if heartworm microfilaremia
_ Dioctophyma renaJe ova - dog
- Gapillaria plica eggs dog & cat
4f1i.
~~~
~~0!Miscellaneous:
_ Fat droplets common in nonnal
feline urine; distinguish from RBCs
(float, refractile & vary in size)
- Spennatozoa
- Contamination: pollen~
plant materials
j(~
~~~
'0
Cystine
""0'"
'0" . -.'
,-
Uf$
~~ A
urate~~
~~
Oxalate
IRadiographs - Urinary
URINARY SYSTEM
E-hb 638, 1M 471; 12M 594.IM-WW 327; eM 431; E 1717; X-RP 173; X-
function (GFR)
Procedure:
- Iodinated contrast agent IV
,If abnormal renal function (t BUN & creatine) need more contrast agent
- Radiograph immediately, at 5 min & 10-15 min, 20-30 min If delayed
excretion
- Oblique radiographs may help to evaluale distal ureters & uterovesicular
Junctions
- Abdominal compression may help to maximize filling & visualization of renal
dlvertlcull & pelvis
PrecautlonsiContraindicatlons:
- Animals with reduced renal function may take 10ngerUme & need a higher
dose of contrast agent to yield adequate study
- Renal failure1insuHiclency: this procedure can decrease GFR for several
days afterwards. Use JdW1iIID.lf compromised renal function & be sure to
provide adequate pre- & post-diureSis
- VO (ventrodorsal) view
Size ...
.. Dog: 2.5 to 3.5 times length of L2
.. cat: 2.4 to 3.0 times length of L2
liver
Both kidneys should have smooth borders & be the
&
extraluminat
- Bladder defects
Procedure:
- catheterize bladder & remove urine
- Cystogram: distend bladder wi iodinated contrast medium
- Pneumocystogram: distend bladder wi room air or C02
- Double contrast cystogram: infuse 2-5 ml 01 undiluted Iodinated contrast &
follow wi distention of bladder wI air
Urethrogram 1M 472
Indications:
Normal kidney
All dlzs, except aplasia
Bilaterally
- Acute nephritis
- Acute nephrosis
- Hydronephrosis (uncommon)
- AmylOidoSis - irregular contour
- Polycystic kidneys - irregular contour
- Lymphosarcoma or metastatiC rumor
- Feline infectious peritonitis (FIP)
- Perirenal mass/cyst
- Subcapsular hematoma (rare)
Unilateral
- Compensatory hypertrophy
- Subscapular hematoma
- Primary or metastallc renal neoplasm
- Renal cyst
- Hydronephrosis
- Visualization
of
location, contour
integrity of urethra
&
Angiography
Indications:
- Evaluate architecture of renal
vascular supply
.. Dirofilaria Immit/s
.. Adenovirus - infectiOUS hepatitis
.. Ehrllchia canis
Congenital malformations
Primary vascular diz
TecI1nlque - 3 phases
- Arterial phase: 0.5-3.0 sec after injection
- Nephrogram: Immediately after arteria! phase
- Venous phase: 2-4 sec after injection
~::a(smO~hl
Vaginogram - urinary
Indications:
- Visualization of integrity, size
& location
of vagina
Pneumoperitoneogram
Indications:
- Visualization of visceral surfaces of kidneys, ovaries,
& other
organs
Procedure:
- !ndwelnng cannula placed in peritoneal cavity
, CO2 or nitrous oxide (n;ected Into peritoneal cavity
Right & left lateral, dorsoventral & ventrodorsal radiographs are taken
~ ..
DOx -
t Renal density
Nephrocalcinosis
- Hyperadrenocorticism
- Hyperparathyroidism
- Hypercalcemia
- Ethylene glycol poisoning
- Renal tubular defects
- Idiopathic
Renal calculi
Bladder obstruction
- Urethral calculi
- Urethral compreSSion by intrapelvic mass
- Urethral & urinary trigone neoplasms
Neurogenic atony
- Spinal cord compression of transection
- 2 to long-standing dysuria & urine retention
External compression
- Uterine enlargements
- Prostatic enlargement of paraprostatiC cysts
- Uterine stump abscess or granuloma
- Colonic neoplasm
Infiltrative diz wlin bladder wall
- Chronic cystitis
- Previous surgery & scar
- Neoplasia of bladder wall
- Urethral dlvertlcull
integrity of
- Urachal remnants
same size
Ureters are not normally seen (small, retroperitoneal location)
&
Cystitis
Congenital anomaly
Herniation into perineal, femoral or abdomlnallocaUons
Bladder rupture
Recent voiding?
Biopsy & Tx
URINARY SYSTEM
Antibacterial drugs for renal
Renal biopsy
Ehb 638; SAP 821; 1M 472; 12M 601; 1M 327; IMWW 327: 5mln 1018; E 1718;
Indications:
Only after less invasive tests used
- 'NIlen outcome of biopsy may alter therapeutic
hydronephrosis, coagulopathy, single kidneyorqueslienable function 012 very small marginal kidneys
-Types:
- Percutaneous biopsy: via ultrasound guid-
",,,
- Laparoscopy
Technique:
- Evaluate bleeding time & estimate platelet numbers
- Direct through long axis of kidney, solely through
cortical tissue
- Brisk fluid diureSis after procedure to prevent clot
formation in renal pelvis
- Send to pathologist
Complication: Hemorrhage - subscapular
common, macroscopic hematuria less common, severe hemorrhage into peritoneal caVity rare
lIt I'
Fluid therapy
M8k 1129; SAP 64; 1M 515; IMwwa29
Peritoneal dialysis:
1.5-4% glucose & balanced electrolyte solutions most
often used
- Use potassium-free dialysate if hyperkalemia
Mildly distend abdomen
Allow equilibration for 30-60 minutes & then remove
Repeat dialysis according to signs shown by patient
- Indications:
- Acute renal failure
- Chronic renal failure
- Overhydration
- Intoxications
Contraindicated:
- Ruptured diaphragm or extensive intraabdominal adhesions
11
& lower
urinary tract infection (culture & sensitivity)
Chloramphenicol
Tetracyclines
Penicillin & derivatives
Fluoroquinolones: enrofloxacin,
norfloxacin, ciprofloxacin
Streptomycin
- Carbenicillin
- Erythromycin
- Furadantin
- Cephalosporins
- Trimethoprim
- Suffonamides
Diuresis:
- Rehydrate first
-10% glucose IV TID (osmotic diuresis)
- Check for glycosuria & reasonable urine
flow (2-8 ml/minute)
- K+ (approx. 20 mEq/liter fluids)
- Can use 0.9% saline for diuresis
Rehydration:
- Estimate degree of dehydration
- Replacement (ml) = % dehydration x BW (Ibs) x 500 ml
- Isotonic fluids: Ringer's solution, lactated Ringer's, saline.
5% dextrose
- Maintenance: insensible water loss & urine flow
Lactated Ringer's or Ringer's IV
Approximately 30 millb/24 hours or maintenance chart
- Evaluation of replacement therapy:
Weigh frequently - once rehydrated, animal should not show marked gains
or losses
_Monitor BUN: rising BUN implies inadequate urine flow
Monitor urine flow: failing kidney cannot conserve water or excrete heavy
water load
Metabolic Acidosis: plasma bicarbonate < 12 mmolll or blood pH < 7.2
- NaHCOa (sodium bicarbonate)
Oral sodium bicarbonate initially 8-12 mglkg TID (maintain al CO2 at 18-24 mEqlJ)
.. Baking soda can also be used (1g = 12mEq NaC02)
Evaluate by blood gases or add 10-15 mEq NaHCOa per 250 ml fluid
Or kg body weight x 0.6 x (25 - patient's bicarbonate in mEq) = mEq
bicarbonate (give slowly over 24 hour period)
- Ca lactate may be given for acidosis if it is not desirable to add Na to Tx
schedule
- Hyperkalemia:
- Occurs in obstruction - follow by serum electrolytes
- ECG for signs of cardiotoxicity (spiked T waves)
- Severe hyperkalemia:
- 10-25 mEq NaHC03 IV over 30-45 minutes
- 0.35 units of insulin per pound of body weight. IV
. Follow insulin with dextrose (2 gm dextrose/unit insulin) - give 25% IV
Azotemia
URINARY SYSTEM
Condition
Presentation/CS
Facts/Gause
Treatment
Dia nesis
Prerenal azotemia
470; Pa;;-rT:2~"~;
~NiBh
21.22
I/-
Renal Azotemia
Postrenal azotemia
r---------------------------~
DDx: Azotemia
. Trauma
. Infection
. Toxemia
- Fractional reabsorption of urea as with dehydration
glomerular CS of cause
- Anuria, oliguria
- Results in. BUN &Jor creatinine in blood Sequela:
stream
- Urine concentration ability remains nor- - Renal diz
mal (tubular function remains nonnal)
- Renal failure
- If decreased perfusion corrected rapidly
kidney will return to normal function
If not corrected: renal ischemia & kidney
destruction
***
Causes-prerenalazotemia
Dehydration
-Shock
Hypoadrenocorticism
- Heart failure
Renal
(n
azotemia
***
~fJ'~
IJjlr-~\
~)
)/ -J'.r
liht:s>~
,~
~;"11
cLJ
< 1.017
Ethylene glycol
Aminoglycosides
Heavy metals
- Hypercalcemia
- Infections (leptospirosis)
- Others
- Chronic renal failure
Pastrenal
azotemia
***
- Oliguria
- Straining
Abdominal discomfort
'4I'J
- Tumor block
- Entrapment. of urinary tract (hernia)
- Trauma, stncture
- Iatrogenic: surgery or catheterization
Ruptured urinary tract
p"Jill
~~%J
(i
341
11" ,
> 1 030
/") ]
Kidney normal
- Restore circulating fluid volume & renal
perfusion
- Correct electrolyte abnormalities
Treat cause:
- Dehydration: fluids
- Shock: fluids, steroids
- Hypoadrenocorticism: fluids
- Heart failure: ????
~.:::
'~
- Acute:
- Support until repair itself
Fluids, Tx hyperkalemia & acidosis
_Initiate urine flow (Lasix, mannitol)
- Chronic:
- NO cure, palliative
- Fluids
- Diet: restrict proteins & phosphorus (Hill's
kid
-[!!- J'
revers~
kid I
Prognosis:'
)~
\'
Acute: may be
- Chronic: irreversible
Hyperkalemia - priority
- Unblock animal
- Cystocentesis if can't immediately unblock
- Fluid therapy
Sodium bicarbonate: 0.5-1 mmoVkg by slow IV
over 15 min
U regular insulin
per 3 9 dextrose
up
,~-itz1
"".
;:JJ... .:0..------t9
~~
.
Prognosis:
Good if corrected
- Guarded if renal lesions
***
URINARY SYSTEM
Facts/Cause
Presentation/CS
Condition
Diannosis
GI (ur?~11Ia)
~I~
(; '/13~
- VO~itlng
~--'! scleral injection (toxiC)
~(bf
c
')
~ Diarrhea
_ Oral ulcers (uremic stomatitis) d
- Oral & GI ulcerations
_Check hydration
-'
Nonspecific
_ Retinal changes (hypertension)
? _
_ Palpation: small, firm, nl umpy bumpy" kidneys or enlarged
- An~reXia.letha~rgy
+
+
- Weight loss
- Dehydration
Cardiovascular
~ {' '7 ~
~\ ~
dJ fiI..
Lf._
.,1
aD
00
j~
rJ'r)
eque.:
OOX PUIPO:
~fect~ons -
~.
"!
R d'
ype enslon
~
_ Contrast (excretory urography) often reduced excretion
Diabetes insipidus
d~:
limits this technique)
Diabetes mellitus
Osteoporosis, osteodystrophy
Pyometra
: : ; r . Ultrasound (US): hydronephrosis, polycystic diz, uroliths
Pyelonephritis wlo renal failure
Renal biopsy: cautiously in rare cases
Hyperadrenocorticism
Hypertension (t systemic blood pressure) (> 50%)
- Dog: > 180 (systolic) & > 100 (diastolic) mmHg
~
Adrenal insufficiency (also vomits & azotemic)
_Cat: > 200 mmHg (systoliC) > 120 (diastolic)
!~
t:'""1
tH
Acquired - CRF
Infectious (CIN)
- Pyelonephritis
~~:
~1
'1ij~
"\ . '
I),
- LeptospirosIs
- FIP (feline infectiOUS peritonitis)
- Lymediz
Chronic obstruction
Glomerulonephritis
- 2 0 to other organ diz
- Immune complex deposition
Nephrotoxins - chronic exposure
- Ethylene glycol
- Aminoglycoside ABs
- Hypercalcemia
TREATMENT - CRF
Immunological disorders
- Glomerulonephritis
- Systemic lupus
- Vasculitis (FIP)
- Amyloidosis
Neoplasia
- 1 0 renal adenocarcinoma
- Lymphosarcoma
- Metastatic diz
Fibrosis follOWing acute renal fallure
Bilateral hydronephrosis
Parasite: Dioctophyma renale
Infarction
- DIG (disseminated intravasc. coagulation)
- Emboli - bacterial endocarditis
: !~~y~~trr!~~~~~~
Glomerular atrophy
Tenlanglectasia
Tubulointerstitlal fibrosis
Glomerulosclerosis
Idiopathic polycystic diz
~~~nl~rrier
Amyloidosis
Abyssinian cat
Progressive - months-years -
Patient monitoring:
Mild renal failure (azotemia, impaired concentrating ability) evaluate every 3-4 months
Moderate 10 advanced CRF: evaluate
every 1-2 months
:
~~::~~~~~~;::~~~~~~:!i,ol:tal
kid '
C02, UA)
Blood pressure
~~A~~~I~~ress
Irrever~
CS:PU/PO,GI,Heart
Ox: Hx, CS,1,008-1,012, BUN
lx: NO cure - manage: diet, fluids
" . .
.\);
..
))) --:
? '" ::-:-.,
J 343 I
J'
. '
, - - I.
_____________________--'''--j
~~~=-..jprognOsis:poorIOng-term
~"::
.~:c--_._--
=i
,._._-
Uremia
Condition
URINARY SYSTEM
Facts/Causes
Presentation
PUlPD
(pOlyuria/polydipsia)
Uremia:
retentJon
of
protein
by-prodUremia,
ucts in blood & resulting toxic con- Depression, lethargy
Uremic syndrome
Anorexia, weight loss
dition
1M 481, 754; IMWW 323,
462: H2B 263, 572, 575,
- Generally associated wI renal failure GI complications
119,86; E-hb 117, 134;
- Vomiting (dogs> cats)
- Not uncommon in geriatric animal
Smln216; C12T951, 966,
- GI bleeding
All
uremic
patients
are
azotemic,
but
971; Cl 1T 846; NS-C 75,
Diagnosis
--.
Treatment
- Conduction defects
or arrhythmias
- Stomatitis/oral ulcers
not all azotemic patients are uremic
Laboratory:
161,188,226; NS-O 264;
NS-L 79Sx-S 1401; Pa-T Pathophysiology: constellation of CS Respiratory distress (dys_ t BUN, creatinine
211; H-TIM 321
_Metabolicacldosls &uremictoxicl\y, anemla& fluid
pnea, tachypnea) from uremic
phosphorus
.
over1oad
~
'-1 P!"9umonills & metabolic acido- " Nonre gene~al'Ive anemta
- GI complications
)1
SIS
. t .or .. ~tasslum & calcium
- cardlov~ular: myocardiallrrltablilly
~. CNS/encephalopathy:
- Systemic hypertension (CRF) .
~
.
Behavioral alterations
- A~ldOSI~,
.
- Pulmonary edema to pneumonltls:'~
D
r dr'
Uri nalysts: tsosthen urla
_Anemia
- emen la, e mum
tJ)
j _
'Jj!I -
- E""'ph~opathy
- Acidosis
- t or ... & Ca" serum level (ECG)
Cause: Renal failure. Postrenal disorders (urethral obstruction, urinary bladder rupture)
"f'~
t
ffin1rg;
~~)
@)"'f ~
(1.010)
@tl
~~
- Coma
o
Osteodystrophy f
C~
~c
"--~
/ I I
-@
em
\\r~.
,--->'--2/
III
bI'1;.
~"A-0(~
r-T-ox-ic-,R-e-na-If"--ai-Iur-e--------.
CS: PUIPD, dyspnea, vomiting
Ox:
_+
***
....-""-
- Parenteral fluids
- Diet restriction of protein & phosphorus
)~~.~r _~r
~ )~,-Y- : =~L~r.\: :\: :\
, ",
+ BUN, creatinine
... -
~:;iX))
?~J
Prognosis:
---------Renal
hypertension,
Glomerulosclerosis
SAP 496; E-hb 644; H28
155; 1M 478, 489; 5min
875;El023;Cl1T310; H
F 578; Pys8 190
***
Renal problems
- PU/PD
- Appetite
/l.
Often missed
Hx (chronic renal diz). CS
PE: Eye: retinal changes:
hemorrhage, papilledma, detachment
Auscultation: systolic & diastolic murmur in cat (mitral regurgitation) &atrial (S4) gallop (ventricular
stiffness) - cat
It ventricular hypertrophy
- Radiology. echocardiology & ECG
Proteinuria, azotemia (BUN)
Pressures measurements
- Dog: > tBO-185 mmHg Systolic & > 100 mmHg diastolic
- Cat: >200 mmHg systolic;
>100-130 mmHg diastolic
- Direct cannulation of artery
y\.
~~-Y;Jr,\~\,
'i7i;;;;;:;;;;;;;;;;;;;R?
_Hypothyroidism (Dogs)
_Hypetparathyroidism (Ca+)
""'==-'_
PIleochromocytoma: catecholamines
Acromegaly
- Anemia
- Old age
- CNS disorders
Minipress
u
Prognosis:
Depends on cause
Expect gradual response to Tx: days to
weeks
~----.~~
CRF
URINARY SYSTEM
Facts/Gauses
Condition
Presentation
**
-. Vit 0 =
gut calcium absorption
- PTH secretion t to maintain serum
Dia nesis
Treatment
GI signs
Hx (history), CS (clinical signs) CRF therapy: fluids + protein
restricted diet (kid or uJd) + vn c
- PUIPD, vomiting, oral
Blood values:
& B + avoid stress
ulcers
- Hyperphosphatemia
Hyperphosphatemia
Calcium can be nonnal, or t
Bone demineralization
- Early: protein-restricted diets are
- Osteopenia & potential Azotemia (t BUN, creatinine)
Nonregeneratlve anemia
also phosphorus-restricted (kid)
pathologic fractures
t PTH + azotemia
-Intestinal phosphorus binders
- "Rubber jaw"; replacement or Cross products Ca x P (normal < 5070)
+ dietary restriction
bone by fibrous tissue
Urinalysis:
. Aluminum hydroxide (AUema- Isosthenuria - low SpG
Sequela:
GEL), aluminum carbonate, calcium car- Proteinuria ~ -c..----....,.."
bonate (TumS, TitralaC), calcium ac- Neuropathy
Radiology: ~
etate
- Bone marrow suppression
Small irregular kidneys
- Vit 03 (calcitriol) &for calcium
- Mineralization of soft
- Soft tissue mineralization
supplementation cautiously
tissues
Only when phosphorus reduced or serum
- Myopathy
calcium x phosphorus < 50-70
- Insulin resistance
_ Pruritus
~j=~!g"
<!i::
f"' )
_~:
~\ )
.~K
~.
~ d~
'~C&B
/'
~,/
Prognosis: poor~
CRF - hyperphosphatemia
**oJ
nn",,\ 8
P+ ~\.
CRF-GI
Mk 835; SAP 804; 1M 491; H3S
513;H2B575,5mlnl019; E-hb
643; E 1734
***
Clinical signs
Vomiting
Diarrhea
Oral ulcerations
Discoloration & necrosis of
tongue
Gl hemorrhage
Cause of vomiting & diarrhea
in CRF not clear & probably
multifactorial
- Uremic toxins may alter GI mucosa &
trigger chemoreceptor zones in brain
High serum gastrin (impaired renal
excretion) - gastric hyperacidity
- Uremic gastric irritability
- Vascular local ischemia
(} -
avoid stress
Antiemetic
-Trimethobenzamide (Tigan)
~ Metoclopramlde (Reglan) DOC
- Chlorpromazine (Thorazlne) alpha b
lockers on Iy if others are ineffective
H2 antagonist: stomach acid &
vomiting, Clmetidine (Tagamer-), Raritldine (ZantaC)
Sucralfate (Carafate) protects mucosa
Oral ulcers
Local chlorhexidine
r-...c""l::-'J
CRF - Acidosis
Mk 835; SAP806; 1M 489; H2B 575; Ehb 644; E 1734; C11T 845
***
CRF hypokalemia
Mk 835; SAP 806, 70; 1M 487; H2B 575, 1281; E-hb
645; E 1734
***
Occurs in 30% of cats wi clinical renal
diz & CRF, uncommon in dogs
Renal loss exceeds intake, fluidsforCRF
PresentationlCS
Generalized muscle weakness
- Drooping, ataxia & ascending paralysis
- Ventral flexion of neck (cat)
PUIPD
Anorexia. lethargy
Mild cardiac rhythm disturbances
CRF - Anemia
Treatment:
CRF therapy: fluids + protein-restricted diet
(kid) + Vit C & B + avoid stress
Hypokalemia < 3.5 mEq/I
- Oral route safest
- Potassium supplementation, oral
- Potassium chloride solutions
- Potassium elixirs
- Potassium gluconate powder
~~
**
1f11::J
CS:
Weakness
Lethargy
Dyspnea
~/~
~
,( \
URINARY SYSTEM
Condition
Facts/Gause
Presentation/CS
Acute renal
failure,
- Anorexia, depression
Dehydration
Good flesh & condition
usually
- Oral ulcerations
GI signs
- Diarrhea
- Vomiting
Depression
Oliguria or anuria,
occasionally polyuric
Hypothermia
Fever if infective
Death
ARF
MBI< 1136, 1134; Mk878;
SAP 799; H2B 569; H3B
508,503: 5mln I 016, 572,
640; Ehb 639; 1M 482;
12M 614; IM-WW 327; E
1720; CM455; CI2T943;
CI1T 829; Sx-S-hb 471;
Sx-S 1398; X-T 450; X-Gr
134; NB21
**
~tj
.y.
~~~~
t
~j}
(ffD
((
W
j)
-:
. . . .'t
UA (urine analysis)
-SG 1.007-1.017 (isosthenuric) hallmark, inabilitytoconcentrate
usually (DDx prerenal azotemia - concentrated urine)
- Casts (tubular pathology), wec casts: Infecllon :,~'"
Ca oxalate or hippurate crystals - ethylene glycol :: .i''}'
,,-, ~
- Proteinuria
. r" .: !'fa
. '~" , :", C;;J.l
- Glycosuria
- Pyuria, bacteriuria
~~
/'/'
- Darkfleld If suspect leptospirosis ~
.. _:"/~
- Urea:creatlnlne < 0,08
I
Urine culture: all cases - by cystocentesis to RIO urinary tract infection
Serology: if lepto" ehrlichiosis or Rocky Mt. spotted fever
Radiology:
- Renal size, radiopaque uroliths
- Contrast: rupture or obstruction
~
Urtrasou.nd: Uroliths. renal parenchymal diz
1..,
. .
Renal biOpsy mIb necessary to determine
~ ~~Jr
severity,extent&cause
~~~
I"----~-------.
Dia nasis
Monitoring patient:
- Body weight & hydration BID
- Hematocrit SID
Serum electrolytes, BUN, creatinine SID
- If severe hyperkalemia or metabolic acidosis as
needed
- Fluid in susceptible patients to over hydration (CHF)CVP &lor "ins & outs"
- Urine output (urinary catheter) in oliguric or anuric
TREATMENT - ARF
- Supportive to allow repair
- Tx cause (il known)
- Stop any nephrotoxic drugs
, Emesis or gastric lavage if ingested toxins' recent
. Activated charcoal & sodium sulfate
- ASs for infections
Ethylene glycol: Ethanol 20% ,4-methylpyrazole,
Diuretics &lor NaHC03 may be Indicated
Arsenic: Dimercaprol (BAle)
- Fluid: Lactated Ringer's for all until stabilizes
- Monitor for hyperkalemia, hypokalemia or acidosis
- Diuresis: promote urine flow if less than 20 mtlkgld
:
'
a~'~.'.'
---~
rF=-IU-'-id':"th-e-r .L
py-:
nir~ ..
URINARY SYSTEM
Infectious Diz
Condition
Facts/Causes
Pyelonephritis,
Chronic interstitial
nephritis? ,
Presentation
@if.
Upper urinary
tract infection
M8k 1133; Mk 873; Ehb 589;
SAP 807, 562; H2B 562; H3S
500; 5mln 994; 1M 494; IMVo/W
328,339; E 1775; CM456, 479;
DOx5S4; Sx-S 1437; X-Gr 134;
PaT 234
***
or chronic
JjT\-'-
bladder wall
- Urolithiasis
- Immunosuppression
.t
- Diabetes mellitus
.)
'\.
- Hyperadrenocorticism
._ '-" \- Infectious canine hepatitis
Suppurative necrosis with healing
~ by replacement fibrosis
...----'-------
-~'
~
(g'
_
-...
DDx
Any cause of fever
Ascending
~. Any cause of leukocytosis
CS: fever, pain, PUIPD
.
'.
Any cause of acute abdomen
Dx: CS, PE, Pyuria, Rads
Lower urinary tract infection
Tx: ASs min 4 weeks
Nephro- or ureterolithiasis
,1,
//~ _
Leptospirosis,
Interstitial nephritis
M8k 1134; Mk 874: Ehb 186,
516; SAP 128; H2B 1207, 561,
910; H3B 498; 5mln 768, 142;
IM417:CM456; CI1T829: NSL 84, DDx 553
**
Subclinical in vaccinated
dogs & all cats
Peracute
- Fever, myalgia, vomiting
Leptospira inte"ogans: all
- Shock, vascular collapse
pathogens
- Bleeding diathesis
L. icterohaemorrhagiae
- Death
- L. canico/a
Acute to subacute
- L. grippotyphosa
- Fever, anorexia
Filamentous, motile spirochete
- Depression
Spread in urine: months - years
- Vomiting, dehydration
- Penetrates skin or mucosa
- Aeluctance to move (pain:
- Wild animal reservoir (rodents)
kidneys, muscie Of meningitis)
- Leptospiremia in 4-12 days
. Stiff gait wi severe muscle or
lumbar pain
Targets kidney (chronic in- Acute renal failure
terstitial nephritis) & liver
. Oliguria or anuria
DIC (disseminated vascular coagulation)
- Icterus
Latent or acute
- Petechial & ecchymotic
Endemic areas
hemorrhages (melena, heDDx:
Sequela
- Chronic renal failure
_PU/PD
Dia nosis
Treatment
Difficult to differentiate from Antibiotics for minimum of 4 wks
(based on oo1ture & sensitivity)
lower urinary tract infection
- Broad spectrum In abSence of culture, guesses
Hx, CS
possible from gram slalns:
_Ampicillin, amoxlclilln, trimethoprimfsullas, cepha Palpation: Acute: painful &Jar
10spoTins, Chloramphenicol, aminoglycOSides, fluoenlarged kidneys
Blood values:
- Leukocytosis (PMNs w/
Jeft shift) - acute
fi! **""+"AP
- Proteinuria
<::j;~.t
roquinolones
._ . coli, Enterobacter - trimethoprim-sulfa
.. Proteus, Staph., Strep - ampicillin
., Klebsiella - cephalosporlns
.. Pseudomonas - tetracycline
, Gram positive: amplclliinlamoxicillin
, Gram negative: trimethoprlm-sulfa, enrofloxacin
(Baytrii)
- Re-cullure In 3-5 days & continue same drug or
change depending on culture, Re-culture In a further 3-5 days
~ Re-culture 5--7 days after antibiotics stopped
. If + look for predisposing causes & treat it
- Bacteriuria
Radiographs:
~~
Hx. CS
Serology in conjunction wi CS
Physical exam: congested mucosa
Blood val ues
( [ ! ~)
- Leukocytosis (PMNs wi left shirt)
(J,
- Thrombocytopenia, fibrinogen
products
~-a
-Pyuria
(MA)
,,,,at
Prognosis: Guarded
Antibiotics (ABs)
- Penicillin G 1M,
&\
il1ir
d;'~~C.)
AS
acute Infections
Supportive Tx
- Fluids: shock, dehydration, renal failure
- Rehydrate & establish urine flow,
LasiX anuria/oliguria
- DIC: blood transfusion
Monitor renal function
Immunize after recovery
Zoonotic - shed in urine
therefore good hygiene
(8etadine )
Renal Toxicity
URINARY SYSTEM
Condition
Diagnosis
Treatment
Medical emergency
FactS/Causes
Presentation
Relatively common
Ethylene glycol,
Antifreeze
- Fall
drained
toxicity
If w/in 6 hours
- Induce emesis, gastric lavage
- Activated charcoal
20%
- PU/PD
- Labored breathing
- Isosthenuric (1.010)
toxic
""f Blood values:
(hyperpnea).
~ - t BUN, creatinine &
5 tablespoons (dog), 1 tbsp (cat)
- Dehydration
<l0ln.. phosphorus hyperglycemia,
of 50% radiator fluid can be lethal
- Ataxia
'-..::)~~ hypocalcemia
Oxidized by liver alcohol dehy- Depression
()
- Hypo- to normochloremic metadrogenase
Coma/Death (if enough)
bolie acidosis wI t anion gap
- Severe renal tubule necrosis
. Azotemia in 36-72 hours (dog),
- Renal pain
_ Stress leukogram
12-24 hrs (cat)
Stage 2: 1~-24 hours
Ultrasound: hyperechoic kidney. Ca oxalate crystals may form in kidney
dystrophic calcification
- Nondescnpt - seems to be
- Newer types of antifreeze non-
n?
**
recovering
Supportive care:
- Fluids & electrolytes to maintain
urine output
- Bicarbonate
o'"
~.-i
~
~tI
.
AN'fl--'r: \
"'F~"
.... ~. ""''''-'''''' _
...
~ ~...
~D~~er
=- .
,-.?
~
causes of
acu-te---~
I'ifib'
. Ketoacidotic diabetes
failure
renal failure
-: .
Antifreeze - deadly
.d ,1'1
/
CS: Drunk, Uremia
""-~
Ox: Hx, CS, UA (oxalate crystals)
Tx: Emergency: 20% Ethanol IV , 4-methylpyrazole-.....
Gastroenteritis
?~~
"3--. Garbage
intoxication
~
CNS d' ref
ISO
ers
Co., Milwaukee, WI
-.--------.----
A* rsen~.
c ,
~ r~~~ ~~~U~:,ed;;~:cs~~~:~r:J:~~~:u:n~,p~~i~~ ~ea:~:i~~n:i~i~=y&d~~r:O~:i:dlpc:::zy',;.I,nh~'.:elludlar re,hSPiratiOn ~ ~)
Sequela; Shock, Renal failure
,1 ')
------
til
Aminoglycoslde
toxicit
**
Gentamicin
/" ~
~a-T237
Dioctophyma renate,
A-mp,om",,
'-"al'Y
u,~..
Heavy infection
_Dysuria from CystitiS
- Hematuna
C\--.::~~
.F
""'" \
.Earthwormparate:cah;~t
~..
JIf.
~.
I,
'~
SA
P"':::-"~~ ~
\~
~\,
' - - - - -__
T
xnotalwayanaeded
- Spontaneous loss of paraSite in 12 weeks
~:::.~~!~~", ''''''d(f;,}(not':''ij'COlJlec:'I'
_
f.~
DO"
Asymptomatic usually
No renal failure If unilateral
"""" 1
Prognosis;
Good: spontaneous remission often
No medical Tx effective
~
..
A\~
~'-~
-S.,",,,
f{'"' Jr
CS: asymptomatic
Dx: Operculated egg
Tx: ? _ Ivermeclln
Giant kidney
worm
- aa
/J'--"\':?!
anasls
- ....... "a
~) (~
, - OtotOXICity: penpheral vestIbular signs: ataxia, incoordination. nystagmus
n';-,
Dx: Hx, CS, UA
~ aD
Capillaria,
Capi
.l
Tx: Stop
~~ ~;~~~-~~~~'
::---:::-:-_,.-
'II "
"
Nephrectomy or nephrotomy
Exploratory surgery if peritonitis - remove
worms
III!
-~
Tubular/Metabolic Disorders
Renal tubular
acidosis, RTA
Rare
Proximal RTA (type II): bicarbonate washout, partol Fanconi's syndrome in certain
breeds & reported in gentamicin toxicity
337: E 1602
Cystinuria
Nephrogenic
diabetes
insipidus, NOI
Primary renal
glucosuria
URINARY SYSTEM
Facts/Cause
Condition
Diagnosis
Presentation
PUlPD
Anorexia
COx:
Urease + infections
Lethargy
TdJ' ,
/7-'"!*~
~
\'
hallmar1<
UA: isosthenuria, pH > 6.0 in distal (type 1)
Hx,CS
(I
I ( 00
UA: cystine crystals (colOrless, hexagonal), considered abnormal in all dogs & cats
Stranguria, dysuria
Hematuria
..0: :0
See
CS:
1.001-1.006;
Treatment
''.. 6~.0'"
,,.
Water deprivation
+ AOH
. ; ; ;,"pp"m'g""'~""
~'hypok~a"mia
\'3-'..l~
HCO .'
n
./.
Prognosis: Guarded
ul
< 1.025
COngenital (rare): Unlimited water, Low sodium & protein diet, Chlorothiazide (Diuril) diuretics
*.
Benign condition
Defective proximal tubular transport of
glucose, enzymatic defect in active glucose resorption
M8k 1139; Mk 881; SAP 812; H2B Norwegian Elkhound predisposed, seen
564; IM-WW 337;
in other breeds, Scottish terriers & mixed
E 1801;
breeds
2027;
Pa-T215
~.P
Asymptomatic
PU/PO
Stuntad ."'~
'1 I'
'-
" '--
Prognosis: Good
Fanconi's
syndrome,
Renal glucosuria
MSk 1139; Mk 881; E-hb 665; SAP
812; H2B 564; 5min 582; IM-WW
336;E
Pa-T215
Hx (breed), CS
UA: Low urine speCific gravity: 1.001-1.018
- Persistent glycosuria
Blood values
- Normsl blood glucosa
- Hypophosphatemia
Hypokalemia
Renal clearance test: excessive loss of protein, amino acIdS, glucose, bicarbonate,
phosphate & potassium
~,~"ri~R' ~_
HC03
Px:
Poor
El
Monlto,'" ,.do_,.
hypoka'~'~O;-'
or deClining renallunctlon
'fI'
..~~
Congenitalsc------I:~~~~~~~~~~~~~;;~~~~::~~~:_~==~~~~~~~~_:~~----~~~'~h~~~"~.~'~~~"~'~"u~~~o'~p~a~p'~"a~~~~~~~
Uncommon, Cause: unknown Chronic renal failure
Hx (young), CS (CRF)
No definitive Tx
renal
disorders
M8k 1130; Mk 871; H2B 559; Smin
1014; E 1794; C12T 977; Sx-ww.
154; Sx-S 1428; Pa-T 213
**
I.
'57
**
& salt)
.--rotJJ
d;,OOS;';oo o.
Renal cortical
hypoplasiaJ
dysplasia
0Jj/"-{Y
Amy'o'd"',, '"
PUIPD
Uremia
-+
t;n=r_=
no cure
:~i~~d~U~ b;ca,bo"~
Prognosis: Poor" CRF
URINARY SYSTEM
Renal Diz
+-__---,Pccre~se~n~t~at~io~n
!I-
L_~c~o~n~d~iti~o~n_ _ _f-__-,F-"a,:ct~s~/C~a~u=s~e~s_ _ _ _
Renal cysts;
oOilatednephronsegments,.ogle
Pit"
o ycys Ie
k" d
I neys,
Congenital cystic
kidneys
Hereditary
or multiple (polycystic)
- Normal at birth
-Mayinvolveglomerularcapsule oranypart
_~
~~~=o Hx, cs
Diagnosis
of renallubules
i.dJ
urogram
_Radiolucent Iilling defect
Ureteral
obstruction,
Acute
hydronephrosis,
Obstructive uropathy
Mk 879; E-hb 687; SAP 819, 823;
H2B 606, 572, 579, 588; H3B
528; 5min 688; CM 461; Sx-WW
162; Sx-S 1435, 1448; Sx-B369;
Sx-G 222, 230; X-Gr 134; X-RP
178; X-T 453, 450; Pa-T236
**
DDx:
----
~~~~~::s
of renomegaly
- HydronephroSis
- Congenital cysts
Other causes of cranial abdominal
or retroperitoneal masses
.t ____
V
h
\..
'---
-)
(
....\ / )
I~ .FI"@oa"'!'_~';at:t"O'"'ate)
-- .
t ~\ _~
--.....J
~_"~
- Chloramphenicol, dlndamycln,
,,~
erythromycin, tetracyclines,
.....
--1-' ~
Palhophysiology:
- Partial or complete obstruction of ureter
- Urine retention"" t pressure
- Dilation of rena! pelvis & atrophy of renal
parenchyma
- Accumulation of waste products
- Bilateral destruction before big change uremia & death
- Unilateral: no signs for long perled of time
if unaffected kidney functional
- If bilateral dies before atrophy of kidney
Stranguria, Dysuria
Hematuria
Abdominal pain
Renal failure, rapidly
, I;:
~%
//(!
Ss-p
;>
~~
Prognosis:
Poor for bilateral progressive polycystic dlz
Good for unilateral non progressive diz
Surgical drainage & resection of cyst wall
7~~
Hx,
Palpation for pain
- Unilateral goes undiagnosed
- Vomiting
- Dehydration
- Hypothermia
- Severe depreSSIon
fj"
trlmethoprim better
,I: .
- Ampicillin & amlnoglycosldes poor
);'
Treat RF If present: fluids & diet
Nephrectomy II unilateral & other kidney confirmed to be functional
r-
Dilation of renal pelvis associated with atrophy & cystic enlargement of kidneys
Polycysticdlzprogresslve& no spec:ifictherapy
problem getting antibiotic Into
Infection:
Rare
Progressive abdominal enlargement
Accumulation of fluid extemal to renal
only sign
parenchyma (between parenchyma &
capsule or outside capsule)
5 reported cats, all male, > 8 years old
~
Cause unknown
,.....--""'
~
Not true cysts (not lined wi ePlthellum)~
=-
DDx:
Neoplasia
Hyperplasia
Pyelonephritis?
Capsular
hydronephrosis
Palpation: abdominal
- Abdominal enlargement
(renomegaly) .2-6 weeks
- Most kittens died of uremia
**
Feline perirenal
pseudocysts,
Treatment
~\,
bicarb
added to correct acidoSis & hyperkalemia
Dextrose or insulin + dextrose: if
severe hyperkalemia & arrhythmias to drlve
potassium into cells
fluids
- Contrast (intravenous urogram) Unilateral nephrectomy often re Renal pelvis dilated & dis- quired (check other kidney first!)
torted. MIb only corlical rlm of renal
tissue
.,----~~~~'U~~!!!~E!t.~!....J:- Ultrasound ~
III!
Ss-:
7'
Hydronephrosis: causes
Acquired causes
- Urinary calculi
- Neoplasia
- Dioctophyma rena/e
- Accidental ligation of ureter when spaying
- Inflammation & stricture of ureter or urethra
- Extraurlnary leSions: abdominal masses
- Blood clot
Ureteral tumors
MSk 1137; H2B 591; SAP 919; E
1799; Sx-G 232; X-Gr 134
Prognosis:
- Poor if bilateral
Kidney damage reversible if corrected in < 1 week
Malignant: Leiomyosarcoma
- Extension of bladder or prostatic tumors
Transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma
Rhabdomyosarcoma
Benign tumors: leiomyoma
*
~~~
~--
Congenital causes
- Ectopic ureter
Asymptomatic
t Persistent or recurrent hemarurla
Vague abdominal pain
Sequela: Hydronephrosls (Obstruction)
- Abdominal distention
Physical exam:
Urinalysis; hematurla,
uria, neoplastic cells
Radiography: renomegaly, ureteral mass
-Contrast excretoryurography: hydronephroSis/obstruction
~
- Chest radiographs for metastasis ,
Ultrasound: hydronephroSis
Exploratory laparotomy
;
[TOC)
i
renal function tests at 1,3,5 & 30
days after Sx. is remaining kidney functional?
- Monitor for metastaSiS at 3 & 6 months
cell carcinomas
Ureter
URINARY SYSTEM
Facts/Causes
Condition
RenaUureteral
trauma
**
fights)
Renal
neoplasia,
Kidney cancerl
tumor
MSk 1140; Mk882; E-hb 660; SAP
816,823; H2B580; H3B 520; 5min
330; IM-WW 354; IM-WW 354; E
1788;Cl1T919;CM463;Sx_WW
159; Sx-B 367; Sx-S 1440; X-Gr
134; X-RP 178; Pa-T 239; OOx
:51:
Presentation
CS of body trauma
Renal SC usually mild &
self-limiting
Hematuria
Pain
Dia nosis
Hx (HBC). CS (hematuria)
~\~
Treatment
>Z. ~w. Usually mild & self-limiting
\)
--.............
Injury
.. Laceration
of capsule or parenchyma
- Partial nel*irectomy IIInJuryon1y at pole
flrstl)
Sequela:
- Retroperitoneal space- Abdominocentesis
- Urine - creatine> 2 x serum (Inl~ally)
blood & urine
_Cellulitis & pain
Radiography:
- Blood or urine - retroperitoneal
- Sterile peritonitis
uroperltoneum)
Asymmetry, displacement obscure
_Abdominal discomfort
renal shadow
_Fever
Displaced colon
_Uremia (urine in abdomen) - Peritonitis: "ground grass", loss of detail
__ Abdominal enlargeto abdomen
- Excretory urography:
ment & pain
Extravasation of contrast if rupture
of parenchyma, pelvis or ureters
_ Contrast under renal capsule parenchymal injury wi intact capsule
_ Nonvisualization of kidney if avulsion of renal vessels
Ultrasound
;JI
DDx:
Trauma to back
Urinary tract trauma
Other retroperitoneal dizs (hemangiosarcoma)
Prognosis:
Good if mild, or if other kidney ok &
nephrotomy
Hx, CS
Physical exam
- Palpation tor renomegaly, cranial
. mass
- CheCk lor tumors & masses in other locations
Blood values
- Polycythemia (carcinoma, fibrosarcoma) erythropoietin -;;.. 60%, RBC;;.. lOx lOS
- Anemia
- Bilateral renal failure: azotemia (BUN, creatinine),hyperphosphatemia,especiallyincatswl
lymphosarcoma
__
Urinalysis
~_(R! J;)
Sequelae:
- Respiratory dlstressmetastasis
- Hypertrophic osteopathy
"8
ifj0
J.'
'UI=,=~phY
~O!l.'
r :l L=c:c:\ll
Chemotherapy:
- Lymphosarcoma
. COP: Cytoxan, oncovin, prednisone (gold
standard) doxorublcln (Adriamycin)
Nephrectomy TOC (Ix of choice) for all, but
lymphosarcoma
- Evaluate contralateral kidney function 1st
(excretory urogram)
- Thoracic films for metastaSis
- Remove kidney & ureter, perineallat & reglonallymph nodes
_ Submit all for hfsto
0
C::=~~~Z=:::;S:~~=7
/1(1 S!== 7'
,,~
:. I - I
<...
.....
'.
~Steroids
yt,:,xan.
. ' "~.
On7~vi
II.
::P
Prognosis:
!--...
Iff/;~
Poor for malignant renal neoplaSia
Poor If metastasis
Mean survival time after nephrourectomy
:;t:}
D-'
visua~l:icroscoPIC appe:-r::::~:i:~I:ogs
'!!':
Glomerulonephropathies
Condition
Glomerulonephropathies
M8k 1137; Mk 680; E-hb 649;
SAP 808; H2B 566; H3B 504;
Smin 637; 12M 605; 1M 474; IMWW 333; CM 448; C11T 823,
827; Pa-T 224; DDx 555
**
Associated conditions - causes
Idiopathic
Familial - Doberman pinschers?
Infectious
- Bacterial endocarditis
- Infectious canine hepatitis
- Brucellosis
- Ehrllchlosis
- Pyometra
- Oirolilariasls
- Borreliosis (lyme dlz)
- Systemic myCOSis
- Feline leukemia virus infection
- Feline InfectiOUS peritonitis
Miscellaneous
- Hyperadrenocorticism
- Chronic glucocorticoid treatment
- Bacterial endocarditis
- Mercury Intoxication
Neoplasia
- lymphOsarcoma
- Mast cell tumor
- Others
Inflammatory/immune mediated
- Systemic lupus erythematous (SLE)
-Chronic pancreatitis
- Chronic pyoderma
- Polyarthritis
Glomerulonephritis, GN,
Immune complex
glomerulonephritis
MSk 1138; E-hb649; SAP808;
H2B 566; H3B 507; 12M 605;
1M 474; IM-WW 334; E 1769;
CM450
**
Amyloidosis
MSk 1138; E-HB 649; SAP
809; H2B 568; Smln 338; IMWW 335; 12M 607; IM-WW
334: E 1763; CM 448: C11T
823; Pa-T 229
URINARY SYSTEM
Presentation
Facts/Causes
Diagnosis
Some asymptomatic wI
proteinuria
CS of predisposing illness
PU/PD more severe late In diz
Weight lOSS.
ilf'r...
V'/'~
J,l'/vt
11'-
Blood values:
- Nonregenerative anemia
_Hypoalbuminemia/hypoproteinemia
Hypercholesterolemia
1{ll
-Metabo~ic acid~is
Sequelae:
. .
UA (unn.lysls)
5
- uremla ..11 >7d % 01 neP.hrons effected
_ Persistent proteinuria (hallmark): dipstick
Anore.xla, epresslon
_In absence 01 pyuna or hematuria
Vomiting
~.....
_Specific graVity vanable, often able to concentrate urine
Diarrhea
n~}, - Unremarkable ~Iment findings a~d pH,. hyaline castes, RBCs
t!J'
Assess magnitude of proteinuria
Oliguria or anuria
Oral ulcers
- - - U Pr:Cr ratio (urine protein creatinine) alternate to 24 hr collection
_ Pulmonary thromboembo U Pr:Cr > 1 abnormal
lism. hypercoagulable states (loss 01
.. 1-5 - chronic interstitial nephritis; 3-40 glomerulonephritis; 10-40 - amyloidoSlS
antithrombin 3)
Panting
- 24 hour loss of protein in urine
Acute dyspnea
. Abnonnal: dog: > 30 mglkgld; cat: > 35 mglkgld
- Nephrot~c ~yndrome I~m pro- ~~~g:~~~o t~~~:n=elVemenl
longed proteinuna & hypoalbuminemia
_Hypoproteinemia. hypoalbuminemia or dilute urine
Edema
~_ - Hypercholesterolemia
..
Ascites
)
-Hypertension
@):~~
_ Hypertension
If renal lailureldecre~ GFR
.\
. Hyperglobulinemia
V
~
Blindness
. Azotemia (BUN)
_ Glomerulosclerosis
. Hyperphosphatemla If RF
- low specillc gravity
Renal biopsy only way to differentiate glomerulonephritis from
GN or amyloidosis to nephrotic syndrome
amyloidosis, Do only wI caution
======r.=F."'i)"'
ITreatment:
Difficult & oiten unrewarding
~
kld
:i
t2
Lasix
Amyloidosis
- No specific treatment proven effective - most terminal
- DMSO & Colchicine mentioned in addition to above Tx
Glomerulonephritis: often unrewarding, but may be
reversible as apposed to amyloidosis
r~=:~~==~======~~~~~~~~~==~C===~=X=CC======7====~p~ro~g~n~o;s~~~:~po~o~r==~
Nephrotic
syndrome;
NS
~-~~
I_ _ _ _
II
d,....
Prognosis:
($ )
11
Glomerulonephritis: Guarded ~ 01
Amyloidosis: Poor, diz relentlessly progressive to
CRF & uremia
,_ _...,'"~OO
Urina
URINARY SYSTEM
Tract Infection
presentat~.on
.
Diagnosis
Asymptomatic
,
,
Localize - RIO prostate or upper urinary tract
Hematuria
Hx (long term steroids, hypoadrenocorticism, OM)
Dysuria
CS: dysuria, hematuria
if~
U
Stranguria
Palpation:
t Frequency urination (pollaklurla) -Thickening of bladder wall
').,7
M8k 1132; Mk 872, E-hb 653,
Incontinence
- Pain on palpation - kidney
f.'4J
673; SAP826; H2B 596; H3B
_
_ _
- Kidney for pain, enlargement, asymmetry. contour
532; 5mln 776; 12M 632; 1M
- Ascending up urethra most common
Inappropriate urination lin house- Recta! exam: masses, prostatic diz
494,450;IM-WN339;EI775, - Descending or hematogenous
tralned animal - can't walt, ~~1~ - Catheterize if obstruction expected
1833;CllT909;Grl58,169; Location of infection affects Dx, Tx & Prognosis:
PU/PD
~~:;, - If pain (walking or PEl Nauro & O.rthOPedIC exam ~ ,
CM 472; X-T 459; X-Gr 138;
bladder & urethra majority
Normal temperature :
141J -W~tch urln~tlon
~
DDx 556
- Pyelonephritis: inflammation of kidney
Alert & active
~?
UrinalysIs
W or upper UT
, ~-
.
\1.
_
Cystocentesls
for
bladder
...
_
I,,'
- Cystitis: inflammation of bladder
Systemic Signs are rare
_Voided specimen for urethral problems
,
- Urethritis: inflammation of urethra
~
~ Bacteria (indicates Infection)
,
- Prostatitis: inflammation of prostate
Sequelae'
h~}~ pH may be alkaline (urease-splitting bacteria - Staph. au~us.
. ..
, d"
proteus, Ureaplasma) normal urine is acidic from lasted animal
Acute: Uncomplicated UTI starts as cystitis usually
- Septlcemla
J
- Pyuria (> 5 WBClhpf-) suggestive of lITl
@
~
CHRONIC (complicated UTI):
- Discospondylitis
_
- Proteinuria
1'('\ e"
~
- Complicated UTI: chronic inlection, recurring Infections,
I
h'
.
Hematuria
~
..2)
C
I
I
a
cu
I
uro
it
laSlS
_
Epithelial
cells
(:::;/
..
involvement of kidney & prostate, other complications (calculi,
- Incontinence
_No cellular casts in lower UTI (ODx from upper)
..
neoplasia, anatomic abnormalitles, .. host resistance)
- Prostatitis
Urinary culture: all animals wI dysuria, pyuria,
. All UTls of intact male dogs considered compli- Pyelonephritis
bacteriuria & Hx of steroids (Cushing'sliatrogenic)
cated (assume prostate involved)
- Renal failure
Blood values: usually normal ~
- Recurrence due to relapse or reinfection
- Bladder neoplasia & polyps
- Azotemia not expected in lower UTI
~~
Predisposing factors:
_ Chronic infection
- Rule out systemic diz (diabetes or Cushing's)
- Urinary stasis/retention (obstruction, urinary disorders, pain)
Radiology: bladder small or normal
- Micturition disorders
Recurring infections
- Defects in bladder wall (urachal remnant)
- Double contrast cystogram
-Inflammation: calculi, neoplasia
Acute mlb normal bladder
- Immunosuppression: decreased host resistance
Chronic - bladder waJlthickened & irregular
- Corticosteroids (Iatrogenic or hyperadrenocorticism)
. Calculi
- catheterization (iatrogenic)
Urachal diverticull vary In size & shape
- PU - polyuria (lowers osmOlarity)
Prostatic fluid analysis: cytology & culture to RI~
- Diabetes mellitus (glycosuria, pu, Immunosuppresslon)
Bladder
biopsy: nol routinely done, masse~ ~
DDx:
- Prostatic dlz
Laparotomy
~'t..
Prostatic diz
Upper or lower
urinary tract infection
Facts/Gauses
Condition
Urinary
tract
infection, UTI
Xt
i#6EiIfILOSJ
****
Jj
. . . "'""
Susceptibilities Bacteria
E. coli
Staphylococcus
Stfeptococcus
Proteus
Pseudomonas
Klebsiella
Recurrent UTI
UTI
Antibiotic
Sulfonamide-trimethoprim, cephaJexin
Ampicillin, penicillin
Ampicillin, penicillin
Ampicillin, cephalexin
Tetracycline
Cephalexin
Fluoroquinolone (enrofloxacfn)
Treatment:
Correct predisposing factors
Treat asymptomatic if significant bacteriuria
since sequelae independent of signs
~
Uncomplicated UTI: usually easily treated
~
- Antibiotics for ~ 2-3 weeks based on culture & sensitivity by cystocentesls
, Btoad spectrum antibiotics If no culture & sensitivity (chloramphenicol, lrimethoprlm-sulfa, ampicillin)
, Culture 5-7 days after ABs stopped
, If positive restart ABs for:2: 2-3 more weeks & reculture as above
Complicated UTI (Le., concurrent prostatitis or failure of above Tx)
- Antibiotics for 4-6 weeks
Reculture 3 days after therapy stopped
.. If + restart ASs for 4-6 weeks & reculture as above
If + after 2 therapy regime
" ASs 1/4 dose for another 4-6 months
~
,Reculture:if+
~_~--,-===~~
., Check for complication - prostatitis, pyelonephritis
Lifelong antibiotics mlbe required
Urinary acidifiers (less favorable environment for bacterial growth) not If on cld or sid diets
Acid urine enhances activity of penicillins, tetracyclines, furadantln, & methenamine
, Ammonium chloride (NH4CI): acidifler of choice 21-30 days PO
Monitoring unne pH (~ 6.5) 23x1day to adjust dose
~
Other acldifiers: 0, L-Methlonlna (Odorlroli8), Ascorbic acid (Vii. C), Ethylenediamine dihydroChlOride
- Urease inhibitor
" .
:JI
Manderin~
~
. San in diet, water in food, clean litter box, walking dog, etc.
363
II
Sal+
~~
URINARY SYSTEM
Cystitis
Facts/Causes
Condition
Cystitis
MBk 1132; MIc: 873, E-hb
653; H2B 596; H3S 532;
Sminn6;I2M573; IM494,
450;Cl1T909;Grl60; Pa-
Asymptomatic in many
Hx, CS
Hematuria. especially atend of Palpation:
urination
~ Thickening of bladder wall
. '
Dysuria
- Pain on palpatIon I1f
_ Idiopathic: cat
Frequent urination
(pollakluria)
***
Diagnosis ~~.
Presentation
Route of infection
urination
preferred to catheterization
- Bacteria (Indicates Infection)
'~, _ Pyuria
_ Proteinuria
Incontinence
Treatment
X"f
like pyelonephritis
4J .Antibiotics
for 3 ~eekS'rl::...j..,,;n
@>
dPrP
~~
~..;~
--l..'~
~~f'
'~
If . then stop
"
If + reevaluate for
Acute or chronic
Alert & active
'\ I.
_ Hematuria
..
predisposing causes
Common etiologic agents:
)
~
_ Dog: E. coli, Staph, Proteus, Klebsiella, Strep
- Epithelial celis
Antibiotics for
"'"" _cat: E. 00//, Pasteurella, Prot9lJS, Staph, Strep. Sequ~lae: .
.:0
;;. I
May be normal
~
6-8 weeks
~- - Polymlcrobes (multiple isolates common 8%
- Septicemia
~. Urine culture: only reliable
"'" "L-Ionns or "proto~asts - bacterial variants
D'
dyAtis
f UTI (
, t )
'NhiChareresistanttomanyantibiolics&arenot
- Iscospon
evidence 0
quant'la Ive
identifiable by routine culture methods)
- Urolithiasis ~'2,' Blood values: usually normal
Infec. ascend urethra to bladder
- Incontinence
,./
- Azotemia not expected In Lower UTI
~
_Ruleoutsystemlcdlz(diabeteSorCushing'S) Re-cutture 3 days after
Predisposing factors
- Prost ILlS..
J
Radiology
J
~
- if +
'/(:PrO$bltitis
- Pyelone~hrttls
_ Plainfilms:~ ~_
- Antibiotics 1/4 dose
: ~:~I:!I:arders
- Renal failure.
Bladder small or normal ~
for 4-6 months
- Acquired or congenital defects in bladder wall
- Bladder neoplasia
Calculi
Bs
r;. -
fi
at
- Urolithiasis
Immunosuppression
Assoc wI prostatic d,z & or cystiC calculi
Cyclophosphamideinduced cystitis,
Cytoxan.
Sterile hemorrhagic
;1 ,
i-rdJ
r '
t)
'
t."::::
EmPhysecrf
I'
matous '"
cystitis
*
H2BS97
In cranioventral aspect)
.UraChal
dlvertlcull vary In Size & shape
'~
'Ultr:~:;~plasia
~,,',a",g rula
~'---
Hematuria
Dysuria/stranguria
Pollakiuria
May resolve if drug stopped
Anorexia (mainly cats)
-a
:::::....:::::..- J-.....-v
~?f
C1c
I
u~nary
H2B596
Candidal UTI
Endoscopy
cystitis
E-hb 682; SAP 634; 1M .~~ Cause;
- Cyclophosphamide metabolite (acrolein) conH2B 805; E 1859; COx 557
tact wI bladder mucosa
. Causes hemorrhage, edema & necrosis
- May lead to fibroSIS, necrosls& rarely neoplasia
Mycoplasma
*
UTI
~ ~ :~CkemnglocaIOrgeneral(IoCalcommon
~::4
AlkyJaling drug
- Commonly used antineoplastic &. immunosuppressive drug (cancer - immune-mediated)
Causes sterile hemorrhagic cystitis aiter prolonged use (8 weeks)
- Prevalence of 7% after 22 weeks of therapy
- May occur after single injection
Cyto~
_ Contrast _d bl
trast ""stog,am
ou e con
~~
~. Acute m/b normal bladder
'\.~
Bladder atonyl
Pelvic bladder
. Causes
A Bs .
be requlfed
Prognosis:
.Acute = good,
Chronic = guarded
1"}-;;11
~~(
.J--------~.
DDx:
T:.A~= :e:~erizatlo~,
CS' Cystitis
Ox Double contrast cystography
Tx Surgical removal, long term ASs 68 weeks
PrognoSiS: Good If Tx early
Neurological (LMN, UMN, dysautomia) Muscular (Inflammation, muscle weakness dlzs, intrapelVIC bladder lperlneal hernia])
CS. Urine retention more common than Incontinence; Complication. azotemia, Infection
Ox: Palpation. PE; Lab; Radiography & ultrasound, Contrast radiography, Excretory urogram (cystogram)
Tx: Treat,O disease. complication; keep empty, alpha-adrenergic
antagonists (p'lenoxybenzamine), muscle relaxants
(Vallum), cholinergic drugs ( bethanechol)
Lifelong antibiotics ml
Prognosis: Good
M'l.
ChroniC bacterial cystitis, fold, vll!us-like or polypold projections 01 bladder mucosa, core of connective tissue & mononuclear c e u
ls
~w
Re-culture: if
:;.4
**
Prevention:
Restrict use of drug when possible
- Small daUy doses Instead of weekly dosing
Diuretics: LaSiX or thiazide
Concurrent corticosteroids
}'
Promote diuresis (salt added to food) )
Encourage frequent urinations
W {
H2B 596
Tx stopped
1/4 ABs
- Recurrent UTI
U"
@C7
W
~
oW;;'
URINARY SYSTEM
Trauma - Neoplasia
Trauma of
urinary
bladder,
Diagnosis
Presentation
Facts/Causes
Condition
Cause:
Nonspecific
- Hematuria
- Iatrogenic: catheterization, sur- Anuria
gery, excessive abdominal palpation (rare)
- Dysuria
High lalls
Ruptured bladder
- Spontaneous rupture
-Abdominal distention (ascites)
Urolithiasis - obstruction
- Abdominal discomfort
Neoplasia
(peritonitis)
Necrotizing cystitis
- Uremia
Atony
Depression & vomiting
Fundic portion most common site
Other signs of trauma
Pathophysiology:
- Lameness, abrasions,
- Self-limiting mucosal hemorrhage
shock,~~
most common
- Small rent in bladder may seal
spontaneously, urine readily re Sequela: Death in 2-4
sorbed
days of bladder rupture
- Sterile perkonitis: continual urine
w/oTx
into abdomen:
Postrenal azotemia: urea & creatine &
electrolytes absorbed into plasma
Creatine absorbed slower than
Ruptured
bladder
SAP 832, 840; E-hb 676;
H2B 607; H3B 542; CM
492; Sx-WW 166; Sx-S
1455; Sx-S 1455; X-Gr
138; X-T 459
**
V;~
Treatment
Tx life threatening problems first
Can be very difficult to Ox
(hemorrhage, shock, respiratory insufficiency)
Hx (HBC), CS
- Fluids IV
RIO rupture for any abdominal or pelvic trauma
Impalpable bladder after fluid therapy No Tx if mild hematuria or pollakiuria & no tears
suggestive of rupture
Marked persistent, gross hematuria &
Physical exam:
- Evaluate/stabilize-trauma patient 1st no tears in bladder
- Atraumatic: catheterize bladder &
- Examine for bruising in inguinal region
lavage wI very cold water to slow
Abdominal palpation
~I-.".a. hemontlage
, Painful If ruptured
. Impalpable bladder suggestive
~
Small bladder tear/ no peritoneal fluid
Rectal palpation
-Indwelling catheter to keep bladder
. Pelvic Ixs, hematomas, perineal
empty while heals
hernia containing urinary bladd!lr
Observe urination: normal urination Uroper;toneum in stable animal
- Surgically repair & lavage abdomidoesn't RIO bladder trauma
nal cavity
-If dysuria: catheterize urethra&bladderto
rule out obstruction, bladder avulsion or tearS4 Uroperitoneum in an unstable animal
- Remove fluid before repair
Urinalysis:
@
Urethral bladder catheter
Hematuria
- Urine SpG
- .-LZJ
Penrose drain or peritoneal dialysis
eBC & chemistries:
C:::J
catheter to drain peritoneal cavity
- POSIrenal azotemia (t BUN & hyperkalemia fol_If hyperkalemic: isotoniC saline
lowed by t creatinine in time if uroperitoneum)
Broad spectrum antibiotics
- Metabolic acidosis
- Hyponatremia, hypochloremia, hyper1talemia
Peritoneal hernia of urinary bladder
Radiology:
~
- Decompress bladder w/ urethral
- Survey: normal to ~~
catheter
peritoneal effusion (ground glass)
- Surgical repair when animal stable
- Positive contrast cystogram best: see
contrast in abdomen if open rupture
St=:::;> ::>
/111
Abdominocentesis:
- Creatine in abdomen 2x serum
Prognosis: Good if early Tx; guarded
uroperitoneum
if unstable at Sx
-;v.
;j.
Neoplasia
of urinary
bladder
>
azote'imt"j=:r:m
Palliative
~~.
" Euthanasia
Partial cystectomy if:
- Small tumor
No metastasis
-Trigone &neck not Involved
-Take lymph node biopsy
Otherwise not much works
CisplaUn for transitional cell carcinoma
r=-
Prognosis:
Generally poor, low 6 month survival despite Tx
_Late diagnosis, high rate of metastaSis
- Involvement 01 tri90~",,\'g-..::rave~..
.. ... _ _
Congenital
urinary
bladder
defects
.U
*Wr",.
~..
development of CRF
[3@
URINARY SYSTEM
Urethritis
Condition
Facts/Causes
Urethritis,
-Inflammation of urethra
Urethrocystitis
H2B 621: H3B 559: IMWW 339: Gr 160: Sx-S
1463: XT 475; Pa-T 243
- Cause:
- Noninfectious
w/o
infections
polypropylene catheters
~~ rr:
~
wI or Stranguria, dysuria
#1 catheterization (Iatrogenic)
. Polyvinyl - less urethritis then
***
7 ""\
r, rt\ ( I~
.: ~:"st~:~i~~king
RareIy
r' J'
. I
an ISO ate
ing (female)
- Rectal digital palpation: prostate,
r,
.
-{t..,J
~_~v
)---"""''---..
DDx ~...
I .,
-Anatomic abnormalities
St .ct
c Imca
n ure
- Masses
- Uroliths
- Prostatitis
;:J~""
~-'';,.-
f:'v'''/---~
TI~~-;)
r-7
qrl
,
~
M"'""'"Own
*
Y-'\....J -~~
c(I
N'~~~ -U","", '9''''''S
Imperforat.e urethra
- Hypospadia
CS
Examine urethral, penis & prepuce (male), vulva,
vagina. urethral opening (female)
- Rectal digital palpatiOn
Urinalysis & culture by cystocenlesis - UTI
Urethral discharge: neutrophils & bacteria
-Contrast cystography
@tL-..
Urethral
prolapse
E-hb 675; H38 609: H28
670.620: E 1835; CI2T
1027: CM 496: RM 550:
E&R 694: Sx38 391; SxG 308: Sx-S 1463; X-T
475; DDx 373,559
':)
- Severe urethritis
- Antispasmotics or
antiinflammatory Tx
Prevention:
- Limit indwelling catheters to relief
01 obstruction, urine retenlion & urine measurement in critically ill animals
- Polyvinyl catheters for indwelling
=:::~::
mi-
as short a
Good
time as
Ll
_lei
- Urethrorectal fistula
- Urethral stenosis
- Hennaphrodltlsm & pseudohemaphroditism
Congenital,. acquired
Urethrorectal fistula
Hx (history), CS (clinical signs)
- Urethrorectal fistulas
~ - Hematuria
Urethral catheterization dlfftculVimpossible
- English bulldogs / l _/.
- Dysuria 2" to UTI
Vaginal speculum
1
- Urine Irom anus & urethra
Contrast retrograde urethrography or voiding
~
CS noted at weaning
cystourelhrography
Urinary inCOntinence~ - Excretory urogram to evaluate kldney, ureter &
\
.-z..
ectopic ureters
Urinalysis of UTI (cystocentesls)
Hypospadia
t
.
";~~oIA~
____L_'~_:'_O 9_'C_'~_:_IiU_o~_~_h;_; ._"_sm_'_'"_m_' ' '_'_SW_'_' _' ' '_'_' _"_.C_-.L~"~"~' ' =~ ~ I'=;e=' 'r~i~="=id=~I S'c: .:-,-~_:'.;~_'a:_.-__
1U
"')-
Stranguria. dysuria
t frequency of urination
Dribbling of blood
Ucklng prepuce, vulva
Obstruction In cat; poorly documented in
dog
Remove catheter
catheters
- Catheterize for
~~~:J~~;::;;;;::;;;;;;::;--=--- ,r"'~=======""~""
c:=
Vag,",tos~([/
: ~~~:::~~iSCharge ",Woph'.&baC~ria
?... C
- Cys~it~~
,~P (,~),
Catheterization
Urethral fistulas,
Urethrorectal
fistula
-:/1
" -( \
.
IdiopathiC~,
~ -Urinalysis&cuhurebycystocenteslslosee
entity
Associated wI catheterization
""'"
ties - surgery
Remove uroliths
rI
'1
Treatment
Hx (catheter). CS
Physical exam
- Examine urethral, penis & prepuce
Infectious:
Diagnosis
Presentation
~d)
tJr
Ra..
Prolapse 01 male urethra out external
urethral orifice
Young Intact Eng. bulldogs, Boston terrier
cause: idiopathic (unknown): excessive
sexual excitement & mastulbation or urethral calculi? infection
9 months - 3 years
Not reported in neutered males
Jr':tJ .
Urinary incontinence
Odd outle! lor urine
Cutaneous urine scald"lng at opening
excessive licking of opening area
Complication:
-Incomplete penis & prepuce, cryptorchidism, unilateral renal agenesis, persistent Mullerian structures
-UT'
Surgical correction
Manage UTI
/1((
$=;>
e#?5i)
Prognosis:
Guarded: persistent Incontinence
Hx (young), Cs
Observe extemal genitalia & urination
Calheterizallon 01 urethra
Urinalysis: un
~
Radiology:
- Intravenous urography (UTI
&!-=-=
i 01
;U
.--~
<
Asymptomatic
Hx. CS
Small pea-shaped mass at end of penis Physical exam of prolapse
Further workup lor underiying urinary diz
Stranguria
Urinary catheter passage, urinalysis & culture
Discomfort
- Abdominal radiographs
ExceSSive licking 01 penis
- Rectal exam prostate
Bleeding from tip 01 penis
- Cystogram & urethrogram
- Increase in presence 01 estrous bitch
DDx:
Urethral & penile tumors
TransmiSSible venereal tumors
\lITi~
~-~
~r
COS,",, ,II
"if
. ~
POO9oo,"
Urethra
j
URINARY SYSTEM
Urethral
neoplasia
CS indlstingulshllblefrom UTI
Asymptomatic
Dysuria
Hematuria
Urinary Incontinence
May temporarily respond to ABs
Sequelae:
- Bacterial infections common,
compromised defenses
- Obstruction- uremia' depression &
vomiting'
Physical exam:
~""~'".r
urinary tract
involvement
Eurethrocystogram
xcretory urogram for
& positive
contrast
Urethral endoscopy: access urethral mucosal Involvement & guided biopsy
~ @;;i;rr::-t!;;;;;:illc~1~i.l
Urethral
stenosis or
stricture
E-hb 676; SAP 851; H2B
620: eM 493: Sx-s 1471:
X-T 47S: OOx SS8
**
-Hx, CS
- Catheterize
- Dysuria
- Gause:
MSurgery, trauma, removal of MStranguria
MHematuria
urethroliths, inflammation, forM
eign bodies, etc_
- Incontinence
- Congenital condition: unknown cause
- Ureterocele
- Urethral prostheses - male cats
, Use of shunts not recommended
- PhysiOlogic urethral stenosi1':: rAflAX dvs-
- Surgical correction
MSurgical repair
MPrescrotal urethrostomy Mdog
Perineal urethrostomy Mcat
MUrinary diversions in proximal
urethral stenosis
Sequelae:
MHydroureter
MHydronephrosis
MBladder distention
Dysuria, Incontinence
CS, Catheterize
correction
Asymptomatic In some
_ Dysuria (il partial obstruction)
_Fractures of pelvis
Hematuria
. Fractures of os penis
- Urinary incontinence
- Catheterization #1 but less
Large lacerations
severe
- Anuria (complete obstruction)
- Bite wounds, gunshot
SAP 846; E-hb 676; H2B
- Foreign bodies
MDepression (uremia)
623; H3BS62: eM 493: Sx- Urolithiasis
MAbdominal, inguinal, perineal
WW 168; Sx-s 1469; X-T #1 location: near junction wI
swelfing & bruising
475; DOx558
bladder
Urethral
trauma,
Ruptured
urethra
**
Cause:
HBC (hit by car) most severe
M
Sequelae:
- Post renal azotemia
MObstruction
Urethral stricture
, Periurethral hematoma/Inflammation
_ Urethral cutaneous or rectal fistulas
(raw)
e~~?-
,,:t.
Hx (trauma HBe)
Urinalysis: inflammation
Radiography:
-,~C:::.:::~.,.j cystostomy for t 0-'4 days
- Peritoneal effUSion
ASs if contaminated
MPositive contrast urethrogram to Ox &
rule out bladder trauma
Abdominocentesis: check abdominal &
serum creatinine for uroperitoneum
eBC & chemistries
MFor systemically ill or not responding
to Tx
2~
(I
(((9
5:
~/~~
::;::;;;;==:::=====;;;;===~======:;;:;;:;;~I;;;;;:;;_
I
~
~......-1\
.--_-----'__ ~r::v----./
~~~D~:~~:,e~:~~~~ria ~
Ox: Hx, PE, Rads, Centesis
Tx: Sx, Stent
,)
~_
,
~ _
_
, ____ '
-Prevention:
Use of flexible catheters,
gentle manipulation & a~ptic
technique
-Immobilize pelvicfx as
soon as possible
~\~-S~rognOsis:
~~V~)
Guarded, may
develop stenosIS
Urolithiasis
Condition
URINARY SYSTEM
Facts/Causes
Urolithiasis Dog
*** '
'" I"
V
d!~
>
~
J(IdJI:::-"J"V-I,., ..
7'
Presentation
Variable depending on size, #
& location of urolithS
Asymptomatic in some:
Lower UTI (cystitislurethritls)
Dysuria (painful)
Pollakiuria (frequent)
Bloody (hemat~ria)
Strong ammOnium odor
Lumbar pain
Partial obstruction:
_ Dribbling or urine
_ Stranguria
Ob t cti
~ r~ on - males:
una
- Fr~quent attempts to
unnate
.
- Reduced force & Size of
urine stream
- Uremia: vomiting, anorexia, Depression
.tn
Neoplasia of bladder
" FUS
- Coagulation disorders
~~:I'
- - ----;-
d:")l-.l
Facts/cause
~
c-/2
Prevention:
5-50% recur
/11/
0-
..:0
Rads
4+
CalCinuria (hyperparathyroidism,
exceSSIve Vit D intake, osteolytic
neoplasm, hypercalcl!onism &
prox. renal tubular damage)
~~
9OO~i'"
Prognosis: Guarded 10
calculi & owner/dog dietary compliance
"@
4+
Metabolic disorders
Excessive Ca & P diet, renal
tubular acidoSis, Hyperparathyrddlsm
Caphosphale
(apartite)
"Dog Only
.. .
Cystine
..
0 _Genetic defect/metabolism
(amino acid cystine) ~'-. '. 0.":'<2%, 1.5-4years
0: :
12+
. O~ ~ _ "'
Rare < 2%Many breeds (Germ. Shepherd)
Diet: com gluten, soybean hulls
24+
Diagnosis
Treatment
Prevention
pH: alkaline
UTI - urease bacteria (UA)
Smooth, rounded or faceted
Control UTI
cld Hill's diet (low-protein, Ca. P)
UTI
Hypercalcemia
pH: variable
Rough, quartz-like
Sx removal
UTI
pH: neutral - acidic
Smooth, round, oval
- Jack-stone
Hypercalcemia
Smooth, round or
faceted
Sx - removal
pH: acidic
Urinary cystine
Smooth, small round
to oval
UTI
pH: neutral - acidic
Jack stone
15%
373
//(1
$=
:7
/111
Med:
u/d diet
Potassium citrate (alkallnlzes)
D-penicilJamine or MPG
Sx: those that don't dissolve or obstruct
Sx - removal
/111
u/d diet
Potassium citrate (alkalinize urine)
D-Penicillamine
&?on't breed males >pH ~
fiii
<
:>
'"
$=
..,.
Monitor monthly for dissolution ofuroliths: Complete urinalysis & radiOgraphs; ASs -culture & sensitivIty if UTI. If not dissolved after 2 mo. consider surgery
Breeds:
Struvite: Females>males: Miniature Schnauzer, also Welsh Corgis,
DachShunds, Poodles, Pugs, Pekingese, Beagles, Scottish terriers
~. Oxalate: Males- Miniature Schnauzer, Miniature POOdles, Yorkshire
terriers, l..hasa Apsos, Shih Tzus & Dalmatians
Mixed
- Silica calculi
M-
~~
- Oxalate
(Ca, Mg, & ammonium)
Treatment
Types of stone
- Dogs & Cats
- Struvite (magnesium
ammonium-phosphate)
Hx, CS
' ,' Palpation: bladder & ur~hra
Blood values (1
(
(a L)
_CBC usually normal leukocytoSiS if UTI
- Post renal azotemia: in obstruction
" Urinalysis (UA): UTI
- Hematuria
III __4
- Pyuria/Bacteriuria
1
Urease- producing - Staph. sureus
-struvite
\ - Crystalluria - 10 usually same as
urO/lths, not always
- pH: see chart
Urine culture & sensitivity
.Radiographicdensity(seechart)
_Kidneys, ureters & urethra for calcun
0 :; not visible
1+ = barely visible
2- 4+ = readily visible
Ultrasound
Uroliths analysis _ quantitative
.'fassoCiatedw.~/~pyeIOnePhntIS(rare)
(crystallographic)
- Fever & hematurta
~
CommerCIal kits not recommended
)
Hepatic function tests if urate
L.Ji?'?2'":--'
.<7((/
uroliths (except in Dalmatians)
A '7l "
I:v~
(:1_ "~'y(iJd)
Diagnosis
FUS
Condition
Facts/Causes
Presentation
Variety of lower urinary tract disorders Calculi w/o obstruction (females &
Feline
urolithiasis
- Cystitis
- Urethritis
~~ri~bling of urine
Dia nosis
CS (straining to urinate)
Physical exam - palpation
_ Obst ct d
t
ars think trying to defecate)
ru e ca
FUS
- Obstruction:
stenosis
- Frequent urination
(pollakiuria, own-
(!j--:>
--oc-::>
/
~
{1l c?
Obstruction
- Emergency: life-threatening hyperkalemia, acidosis,
postrenal azotemia or ruptured bladder
IV catheter (draw blood for electrolyte & acid-base)
~- - Unblock cat (see box) (before giving fluidS), sedate
~ '7
. Massage penis or catheterization
~_~~?~.(Y~t{J
. Cystocentesis if can~ immediately unblock
~~:f"
: Indwelling catheter 1-3 days to prevent re-blocking
, Routine use not recommended. remove as soon as possible (12-36 hours)
Fluids to stabilize cat & lor life-threatening hyperkalemia & acidosis
, Saline + unblocking will quickly' potassium
- Antibiotics 7-10 days
~~- Polyuric renal failure otten ensues following relief of obstruction:
~ -~
,Hyponatremia: Salt tablets: 1gm tid iOilially PO, normal saline IV to correct
~ f
.HypOkalemia: K+ elixirs PO, K+ salts in parenteral flUids 20 mEq/hour)
".' -
~ti
r-.
::J
"
-Monitorforre-blockage
~
, I
.,;---;
~;.
, ~/
1I c:J
- EU,.betha",lIac If ",If".,m,
-Atonic
bladder from over distention: manually express 1-3 days Is/~\
. Bethanechol (Urechollne) if detrUsor atony
'
.I
ABs If Infection
Surgery:
/111
$=
>
~
375
Prevention:
Tends to recur in 70% of cats
Low Mg diet (Hili'S c1d diet or homemade) <2 0 mg of magnesium/100 kcal
Canned food over dry, Mix water wI food
Sa" food lightly (not n SID diet)
Encourage exercise, free choice water
Urinary addifiers: methionine, ammonium
chloride added to diet if not on cld or s/d
Prednisolone considered for persistent hematuria & urethritis
Clean litter box often
URINARY SYSTEM
Presentation
Facts/Causes
Dia nasis
***
iJ) iY
JJ[)J:
mone)
- Renal response 10 ADH Is to concentrate urine requiring
1/3rc1 functioning nephrons &a hypertonic renal medullary
interstitium
Other tests
- Lymph node biopsy
-==::::::--1
-z
DDx - Polyuria/Polydypsia
~
d
7
(lymphoma)
- Low dose dexamethasone suppression lesl (hypoadrenocorticiSm)
Provocative tests to differentiate normal psychogenic polydipsia,
. _ ? \. \ _
~~
~
"--
~I:Prima~renalgIYCOSUria
../1/
Fancom's Syndrome
. Acute renal failure
u____ \____
It--
Isosthenuria:
Hyposthenuria:
_\n __
=========~==========~
Determines il:
1. AOH released In response 10 subclinical dehydration
2. If kidneys can respond to ADH & concentrete urine
Contraincflcations (potentially dangerous - death):
- Dehydration
Azotemia (BUN, creatinine)
- Hypercalcemia
Terminate test when:
- Urine concentrated> 1.025
- > 5% weight loss
- Azotemia
- DehydratiOn
Abrupt water deprivation t&s1
Normal animal concentrate USG to 1.075 - cats; 1.045 - dogs: >
1.025 considered adequate lor test
- Negative result (Iailuretoconcentrate - USG < 1.025) w/o renal diz
or other laboratory abnormalities Indicates neurogenic or nephrogenic diabetes Insipidus &Jor medullary washout (001)
__~,
cz~
(low BUN)
Liver diz
AOH test
- For psycgenic polydypsia wi medullary waShout (can1 concentrate on abrupt test). allows gradient to be reestablished
"'- 't1
J,
- USG < 1.025
-J"
AOH test
usr
1.025
Evaluate for
hyperadrenocorticism
Norm~
Psychogenic
polydipsia
Abnormal _.
Hyperadrenocorticism
(medullary washout)
(COl)
01
URINARY SYSTEM
Pu/PD
Diabetes
insipidus
MBk 412, 1734; H2B 502, E-hb
85, 549; Dx-L 39
Nephrogenic
diabetes
inSipidus, NDI
**
_.
Jj
~;
., --,
/
'.
-'
Hx (no
trauma).
- Same as pituitary diabetes insipidus except
for challenge test
Blood values normal
- Urine SpG: 1.001-1.006; Normal
kidney> 1.025 unless madullary washout
_ Water deprivation + AOH tests
USG < 1.025 (tubules unresponsive)
,_ ~l' t <--,----'
Bi~_~~~
CS: PUIPD
Dx: No response to water or ADH tests
lx: lx cause, Unlimited H20
- Endocrine
. Hyperadrenocorticism
. Hypoadrenocortlcism
Hyperthyroidism
. Hypoparathyroidism
Metabolic disorders
Hypercalcemia
. Hypokalemia
- Drugs
. Corticosteroids
. Anliconvulsants
. Diuretic
eCongenltal1 NOI (rare)
Prognosis:
- 2 0 NOI: depends on response of
under1ying cause
_1 No[ (rare) guarded to poor
* .
Pituitary
diabetes
insipidus,
7 --Z ?
Th
,,'"
1;:;/
Lack of ADH
CS: PU/PO, eNS
OX: + AOH tests
Tx: Unlimited water, Oru s
Psychogenic
'Cause:
ing in 10 PD
'PUIPD
IJJI1!L.-J
'Nothing
1_001-1.003 Gradual water restriction to re'Water deprivation = concen- store renal hypertonic medullary
1:'''5'). Urinalysis:
USG
water drinking
M8k412, 1734; E-hb 85; IM459;
anticonvulsants
_2 Polyuria to rid excessive H20
____,l
Prognosis:
W
Good for idiopathic or congenital COl usually
become asymptomatic wfTx
~"'"' Guarded il trauma-induced
~
Graveiftumor
- Behavior problem
- Pharmacologic agents: salt, di
uretics, glucocorticoids, fluids,
idS:
1~1
Darbazine-
Primary polydipsia,
Dipsogenic diabetes
insipidus, Compulsive
~*:*BL~;~2;
5min(J)~)Ii
C~._.,.
_/_
_ Kidney is usually functional
fo
A-~~~:~~~~'I~r:~:c
.
t;-.
~esmOP~J~
Dlu"l;
DDx:
Nephrogenic diabetes insipidus
Psychogenic polydipsia
Other causes of PU/PO
- Disorderofthirstcenters, result-
polydipsia,
'-1
~
~I'''h
d ! aD
r:--':'==-:-:=-
df
trated urine
interstitium
-Abruptwaterdeprivation:diag- - Behavior modification (diazepam
noses 213rds of cases
(vauum), chlorpromazine (Thorazlne)
'" .~~
fl
V.,.m
-'f!"/,
~;'~11
~~{
l ____________J______D~[L--L--.-:0:~~J~-~..!::::~~:-:'~,~,:)_JP~ro~g~n~O~s~iS~:~E~x~c~e~I~le~nt~_~W~~'_
Incontinence
Micturition
disorders,
Urinary
incontinence
M8k 1141; Mk 884; E-hb
88;SAP858; 1-126611,613t;
H3S 545; 5mfn 82, 86; r2M
659,579; 1M 456, 517; IMWW349;Cl2T 1018;C11T
875; eM 486: Pys-R 197;
DDx 565; Sx-WW 169; SxShb 474; SX'S 1404; DOx
565; Dx-L 345
URINARY SYSTEM
Clinical signs
Urinary incontinence
- Dribbling of urine
- Loss of voluntary control
- Urine-scalding dermatitis
Abnormal micturition
- Inability to urinate
- Disruption of urine stream
Definitions:
- Micturition: voiding of urine
2 stage process: passive storage & active voiding
-Incontinent: loss of voluntary control of micturition
(dyssynergia)
- StrangurialDysuria
-Abdominal pain/discomfort
____---tm~
V N>/~)..,
***
Causes: Incontinence
Nonneurogenlc
- Hormone-responsive incontinence
l. \.
1
- Stress incontinence, urethral incompetence~.
.
\
a:J!J d.J
- Pelvic bladder
~
- Urachal r e m n a n t l (~
L.._:,\"I.."'=".:.r--=130::::::::x~
Normal micturition
Storage (filling) phase
L-_ ~- - Sympathetic (ANS): relaxes bladder detrusor muscle & increases internal
urethral sphincter tone
- Somatic: external urethral sphincter (urethralis muscle)
Stretch of bladder wall: sensory fibers to reflex & brain
Voiding (emptying) phase
- Parasympathetic (ANS): contraction of detrusor muscle
- Inhibition of sympathetic & somatic urethral sphincters
DDx:
Causes of polyuria
Causes of pollakiuria
Causes of stranguria
Causes of nocturia
Blood values
- + BUN & creatinine - renal function
Urinalysis in all incontinent animals
- Urine culture (cystocentesis)
RIO Polyurialpolydipsias which can result in urge incontinence
- Diabetes mellitus, pyometra, hyperadrenocorticism & hypercalcemia
@t!
~
..
$..
__ ....
Physical exam:
'. ~
~_~
- Examine perineum for urine scalding
~
- Palpation of urinary bladder before & after urination
Radiography:
Small bladder: bladder hypercontractility or + urethral resistance
- Survey: for obvious abnormalities of
Distended bladder: t urethral resistance or
bladde:r~\'........-~ bladder, urethra, pelvis or spine
contractility
X~ Contrast radiographs
Evaluate distention, tone, ease of expression
~
Excretory urogram
.. UMN - diffic41t
~
Positive contrast vaginogram
.. LMN - easy
tt'-<f)
. Vaginourethrography or retrograde urethrography
- Neurogenic exam: check integrity of sacral reflex arc (pudendal
.
nerv~ [sensory & motor] & sacral cord segment)
~~. Vagrnoscopy wi ~r wlo new methylene blue dye (dogs); visualization of
Penneal reflex: pinch perineum = contraction of anal sphincter &
contrast for ectoprc ureter
-< .
- Check for: urachal diverticulum, bladder wall thickening, calculi, prostatic
ventroflexion of tail
Bulbospongiosus reflex: squeeze distal peniS or vulva =
enlargement, urethral strictures, pelvis bone abnormalities
constriction of anus
- Rectal exam: prostate gland, anal tone, pelviC diaphragm, pelviC
I~
Urodynamic studies for micturition disorders
urethra, trigone of bladder
!
- Cystometrogram: bladder tone & volume, detrusor reflex
- Urethral pressure profile: intra-urethral resistances
- Observe urination: Measure residual volume after urination ~{ >t'
(catheterization) normal < 0.4 ml/kg
A: ~
Electromyography (EMG): coordination of detrusor &
381 urethral sphincter by checking anal sphincter
'-___________________- .
7 .
======'"
URINARY SYSTEM I
IUrinary Incontinence
Incontinence
c:"r "Box
Reflexes present
I
Small bladder
Large bladder
I
UA
Hormonal
therapy
Young animal
Difficult to express
(Infection
or inflammation)
Easily expressed
HL - flaccid paresis
PE - urine from
umbilicus
Hormonal
responsive
incontinence
Tx UTI or
FUS
Stops
I
Urge incontinence
UTVFUS
Urogram: calculi
Spastic
paresis
HL
Contrast urogram
I
Obstruction
Vaginal stricture
Incontinence
co nfn
I Uas
Reflex dyssynergia
""<~r
I
RIO Neoplasia, chronic cystitis,
polyps, uroliths, or urachal remnant
?~~
.~~
.. -----------------------------------------------~
Condition
Neurogenic
LMN - atonic bladder
Cause
Clinical signs
DiagnOSIs
Treatment
~
-
~M!-
No effective Tx
Manually express tid
Trauma - LMN
Continuous dribbling
UMNlautomatic
bladder
Trauma - UMN
Intermittent incontinence
Involuntary
Hindlimb: spastic paresis
D-U (rellex)
dysynergia
Trauma - ANS
Older, spayed
female
Voluntary control
Intermittent dribbling
Hx, Tx response
Normal reflexes & bladder
Urethral
incompetence
Stress
Voluntary control
Stressful incontinence
Hx, Tx response
Normal reflexes & bladder
Urge incontinence
Atony
over distention
Obstruction
Remove obstruction
Indwelling catheter
Bethanechol (Urecholine)
Paradoxical
incontinence
Partial
obstruction
Remove obstruction
Indwelling catheter
Ectopic ureters
Young
Continuous dribbling
Voluntary urination
".,,",",,~
Nonneurogenic
Hormone-responsive
incontinence
No perineal reflex
Involuntary
Large, expressible bladder
Hindlimb: flaccid paralysis
'-("-.'..,~
Intermittent catheterization
+Alpha sympathetic tone
- Phenoxybenzamine (Dibenzyline)
- Bethanechol (Urecholine)
Diethylstilbestrol
Phenylpropanolamine (TriaminiC)
Phenylpropanolamine
/i'
(TriaminiC)
C(
}~,
--=;?~
~ ,_.,m.__ ~'
r3ii3l
{-
.~
at
CIfT'BoX
Neurogenic Incontinence
Neurogenic
incontinence
Micturition reflex:
Detrusor muscle in bladder wall Internal bladder sphincter
"""<
CM490;
DDx 565;
Condition
Facts/Causes
Causes:
- 10 lesion of bladder (long distention, severe
inllammation 01 neoplasia)
- 2 to damage to sacral spinal cord
segments or pelvic nerve
_intervertebral disc dlz (rare in lumbar area)
_Gauda equina syndrome
-Sacroiliac luxations
- Sacrococcygeal fractures/separation
Tumors (spinal lymphoma)
- Sacral nerve roots, or both pelvic & pudendal
nerves
Bohd
& h" ct
II"
LMN/Lower
motor neuron
bladder.
Paralytic
bladder
Dx-l34.'4"",::L
Overflow Incontinence,
Atonic bladder,
URINARY SYSTEM
fI-
MBk1141'SAPB58-H2B
,.
613; 12M 664; IM519;
IM-WW 350; Sx-S
(
1404; Sx-S-hb 474;. '
E-hb 8;
eM 490;
- 1
DDX~?"~~~~~
D,L34
l' ~..;> _ _...L_ _ _,
<
Presentation
No attempt to urinate
Hx, CS
Dribbling of urine
Palpation:
Paralysis of tail
- Full bladder easily exLMN signs in pelvic limb pressed manually
Flaccid pareSis/paralysis
- Dribbling wI full bladder
- Decreased reflexes
- Loss of sensation to perineum perineal & bulbospon Sequelae:
giosus reflexes
- Urine scaJding
Cystometrogram: no detrusor
- Decubital ulcers
- Recurrent UTI (urinary tract
***
...,.~~~
~---r~~--~----------,
Above sacrum
CS: Automatic bladder, Spastic paresis
Ox: Hx, CS, PE
Tx: Catheter & empty tid, TLC
Detrusor -
sphincter reflex
dyssynergia,
Detrusor-urethral
dyssynergia
M8k 1141; Mk 884; SAP B59; H2B
614:1M 520: IMWW 350: CM 490:
**Over distention
DDx:
Urge incontinence caused by UTI
~A;-~~
i~
urination~
Prognosis: Poor
""'fJ
Qt'1J
tid-qid
Long-term therapy not successful
Bethanechol may increase detrusor
contractions
- Urinalysis weekly
-ABsif UTI
_Petroleum jelly
Prognosis:
Poor with sacral cord lesions
Good ?? better or guarded?
with root lesions
UMN/Upper
motor neuron
bladder, Detrusor
Automatic
bladder
'-,~~~
Sacral or Pelvic n.
CS: Dribbling, flaccid paralysis
Ox: Hx, CS, PE, Neuro - neg.
Tx: Time, Express tid-qid
hyperreflexia,
Treatment
Diagnosis
cL)
v~cr~~~:1
urinalri.:3~
Prognosis:
~
Guarded: some worsen
making Tx ineffective
URINARY SYSTEM
Incontinence
Condition
Diagnosis
Presentation
Facts/Cause
Treatment
,
Diethylstilbestrol
(DES) for
Hx, CS (Intennlttent - neutered)
Normal voluntary
females
urination
- Physical exam: small bladder
- Estradiol cypionate not recommended
-Involuntary-dribbling when - Urinalysis
~
(bone suppression)
animal is relaxed or asleep , Cyst~is
- Reduce slowly to lowest possible dose
ExclUsion of other causes of incon- - Phenylpropanolamine
tinence
(TriaminiC) or ephedrine (Mudrane) as
Sequela:
Response to Tx
alternate or in addition to estrogen
- Urinary tract infection
Testosterone cypionate - males
(exacerbates incontinence)
'\'-~~
if
')jJ
~~f
~
Prognosis:
- Excellent
*** .
Intermittent incontinence
under stress
cause
- Similar to female human stress - Able to urinate voluntarily
Sphincter hypotonus,
incontinence: involuntary release
Stress
of urine when increased abdomiincontinence
nal pressure (sneeze)
M6k 1141; MK 6B4; SAP 659; Cause: urethral smooth muscle inH2B 616; H3B 545; 5min 86;
IM-WW349; IM-WW351; E-hb competence or urethral malposition
66; CM 486; DDx 565; Dx-L
incompetence,
P'x,es"'",.Ih"I'~O""
_"
Trl.aml.nl.c
345
Submissive
urination
1M 519;CM 487; DDx565;
****
S"G 234
,?,-_~I
SC: Dribbling
v-a.lg-in-a~
Tx:Sx
/~
--:t.
\.~
~~~
........-
'~o:n:l
S,~COld
Ectopic
ureters
Young female -
~~al
~.
:::::::"
-Incontinence:
(D'
-,
" , _ ' ,',
continuo-u-s-o-r+'':H=:x=:(y-o-u=n~g=)''-,-'c''s:=--------I-,-s':::u:rg~i~c::.:I-tr-a-n-s-po-s-it-io-n-o-f--
intern'iittent dribbling
- Ability to urinate voluntarily
- Urine-soaked skin
_ Dysuria
:~:;:H;':~~:e [i;3},~
~~,
""'"'~ c:::.
' Sequela:
, Vaginitis
"'-J
~
- Urinary tract infection (UTI) '-0' ~
- Urethral incompetence
~~
Patent
urachus
'~~:;~~~f.!P~~:d~.~:::~"
nists) If urathral incompetencel
/tl!
S--L7
"
Dexatrlm/
Prognosis: Good????
/"
- Surgical resection
'=~'
**
CD
:&? '
TOfranii.
Prognosis
-?Good?
owners
**
387
Prognosis:
-Good???
==
Incontinence
URINARY SYSTEM
Condition
Paradoxical
incontinence
M8k 1141; Mk 884; H2B 617;
**
<l.
Facts/Cause
-SlmiiartooverflOWinconlinencefromdetrusor
~:~I~ia
Detrusor atony,
Over distention,
Detrusor areflexia
M8k 1141; Mk 684; SAP 859,
H2B 616; 12M 666; 1M 517; IM-
r:
\l)I1
difficultlimpossible to express
Radiography
DDx:
Detrusor atony
Urethrostomy - ureteritis
cult
! Urinalysis
~{{~~-( '~/
Treatment
Hx, CS
Relieve partial obstruction
Palpation: large turgid bladder - - Retropulsion - calculi
r"
,------.
.
.
:
y.
- Urethritis
Obstruction related
incontinence,
M-
Diagnosis
Presentation
/.z.
J)
~-
severe urethritis
W
I!'I~~=~~;~=~':~~L=========:::>
~A'
...
- Longer duration
c:::::::
~J
Urecholine
~XYbenzamine
l L . " . . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ---------1
Urge
incontinence,
Detrusor
hyperreflexia,
Cystitis, urethritis
or prostatitis
incontinence
SAP 859; H2B 616. 613t; 12M
665; 1M 517; Ehb BB. eM 4B6;
OOx 565
***
Pro-Banthine
~
UTI irritation
CS: Pollakiuria, Spraying
Ox: Hx, CS, PE, UA
Tx: Tx UTI or FUS
~--~------~----~---~~( \.,..A)
Pseudohermaphrodite
~. See Repro pg 459: Rare congenital abnormality of cats & dogs In which gonads are of one sex, but
E-hb 8B
, '\
!a89l
________---t.=-L-~8=9.J------------
d~<
(~K\
"I
-'.~
'<Ii
L
.J.
--
Hematuria Proteinuria
Condition
URINARY SYSTEM
Presentation
Facts/Causes
Dia nosis
Treatment
"
Behavioral therapy
Male urine marking his territory Spraying in standing posture, Hx, CS
.
Reduce
number
01
cats
in
house
1!
occasionally
while
squatting
RIO
urinary
problems:
- Hormones: intact tomcats more
- t or .. lime outside
.->:
- Tail held stiffly up & twitches
urinalysis, urine culthan castrated & intact females
- Place food or toys where spraying occurs
l.~
- Cover windows
~I ,
- Not generally accompanied by ture. radiographs
more than anestrous queens
. Introduce new cat Into closed room for a few weeks
- Stimulated: territorial, sexual.
Cat2, 171, 1475,2;Ehb
scratching as it does in normal
~-"
98; H28 1261; Sx-S-hb
Seeing other cats out window;
urination
1If \~ Castration: reduces In 90% of cases no matter age
476; Sx-S 1409; Dx-l390
Drug therapy
new cats, visitor or baby into
- Valium (dlaz8pam~. suppresses in 70% of cats (DOC)
-smaliamAounts
DDx:
household.
- Progestin: Ovaban (megestrol acetate) or medroxyprogesterone acetate (Depo-Provera)
-, It)
'\P":' Cystitis
. Reduces spraying In 30"k, many side etrects (mammary
hypertrophy, C\Jshingoid appearance, or diabetes mellilus,
Pu/PD (Diabetes mellitus
increased appetite, increased affection
Neurogenic incontinence
Behavior modification is rarely effective,
Tomcat, territorial
')1[Jd)
Diabetes insipidus
cat will spray when owner not around ~ ~
CS: Spraying, standing ~(t'/
Litter box aversion
Leave outside, cull
_
Ox: Hx, CS; RIO urinary problems
Location preference
.
Valium Ovaban
PrognosIs: guarded to good
~ I
Tx: Castration, Valium, Ova ban Px: Fair
Urine
spraying Cat
~~
*lL
"'-
1Y~
Sl_'O>.;
&-'7
'-'f)~
~
Elimination
problems
_____
***
Causes _ Proteinuria
Physiologicltransientlfunctional:
_ Strenuous exerc"tse
_Seizures
iI
~.r ~
.......\ \,-
- Fever
- Hyperthermia or hypothermia
- Stress
- Decreased activity
Pathologic:
Urinary - nonrenal:
Cystourolithiasis
UTI - bacterial cystitis
Traumalhemorrhage
Tumor
Cyclophosphamide cystitis
- Urinary - renal:
Glomerular diz (glomerulonephritis, amyloidosis)
Abnonnaltubular resorption (Fanconl's syndrome)
Parenchymal inflammation or hemorrhage (neoplasia or pyelonephritis)
- Nonurinary/overload proteinuria
Bence-Jones proteins (plasma cell myelomas)
Hemoglobinuria/myoglobinuria
Hyperproteinuria
Congestive heart failure
Genital tract inflammation (prostatitis, metritis)
.1)
Prognosis: Good
'~~~~:"'=".:r='BO~y
Treatment:
Diagnosis:
Evaluate significance of proteinuria in relationship to urinary Transient proteinuria usually
resolves, recheck urine
sediment & serum total protein & urine specific gravity
- Hematuria & pyuria: may be associated with either upper or lower urinary tract
Mild. persistent, isolated
Detected proteinuria usually by dipstick (semiquantitative)
proteinUria (clinical significance
Is uncertain)
Always recheck by repeating urinalysis after several days
- Sulfosalicyclic acid test (turbidity) (semiquantitative) for 2nd check or - Conservative
to check on 2nd positive dipstick
Evaluating patient every 3 If 2nd urinalysis confirms proteinuria: further diagnostic tests
6 months for presence of
Check urinary sediment:
proteinuria or progression
Treat cause of moderate or
Occult blood - hematuria (check causes)
)1 - Nonactive sediment 8 waCs/hpf) - glomerular diz
severe proteinuria
- Active urinary sediment (> 8 WBCs/hpf) (pyuria) - UTI
- UTI - Tx & recheck urine
Treat & recheck urinary protein once UTI controlled
- Glomerular diz: difficuh &
, If glomerular diz suspected (proteinuria + nonactive sediment)
often unrewarding
- U Pr:Cr ratio (urine protein:creatlne raijo) tor quantitative protein loss:
. More convenient than 24 hour urine collection
"l~ij\1ln
Normal values: Dog: < 1, Cat: < 0.5; Guidelines for dogs: IIPr:Cr < 1
normal or nonglomerular diz
Pr:Cr < 5
glomerulosclerosis or atrophy
nonamyloid glomerulopathy
Pr:Cr = 5-13
Pr:Cr> 13
severe glomerulopathy or amyloidosis
- Check for hypoproteinemia (glomerular diz)
Check for edema & ascites (nephrotic syndrome)
- Check for hyaline casts (glomerular diz)
Urine Pr:Cr ratios may be used to monitor therapeutic response
pathophysiology:
- Renal
_Glomerulus nonnally keeps large protelns out of urine
_Smaller proteins moslly reabsorbed by renal tubule
_. Transport maximum: above which get proteinuria
, Kidney Inflammatory exudate or discharge
_Lower urinary tract hemorrhage or Inflammatory (ureters,
urinary bladder &Jor urethra) may add protein 10 urine
- PhysIOlogy causes result in transient penneabillty of glomerulus
Hyaline casts
Bacteriuria - H
Bacteriuria
E-hb 653; SAP 827, 800;
H28597,1381; IM450,470,
497; ellT 910, 913t
~"~
~
-~
:@'.
. '.
, .... ,.
,I
.p,'1
... ~,r
URINARY
ertension
normal micturition
-Anatomic defects aJlowing ascent of
organisms
Immune deficiencies
-Inadequate eradication procedures
for established infection
~_-,====~:.:c~h~r;o;n;ic;p~r:;o:;sta~tn~i~S~(r;e;c;u;rr=en=t_U_T-"I)
c:::::::=
..-----------,
Bacterurialpyuria - Causes
Urinary tract infections
- Cystitis
- Urethritis
_ Pyelonephritis
Catheterization
Steroid therapy
Urolithiasis
FUS usually sterile
Genital diz
_Prostatitis
Metritis
_Genital diz
i' ca
Pyuria
SAP 826: H28 597; 656
DIFFERENTIAL DIAGNOSIS
Renal hematuria
SystemiC signs (depression, lethargy, anorexia,
vomiting, diarrhea, weig,t loss, abdominal pain)
PE (physical exam)
_Kidney palpation
, ,
- Observe Urination
---::-=-_..,.,-.L_--:-___---,,,...-., ----.....
. No dysuria - kidney or systemic
~
UA (urinalysis)
Causes - Hematuria
Kidneys
~~t~; ~,
~
Location throughout urine stream
~ I
RBC casts
- Renal parenchymal diz
- Dioctophrr:'s rens/s (rare)
,{
- Dystrophic RBCs
Lower unnary tract
~ (...
. Abnormal cystocentesls (alSo bladder, ureters or prostate)
Bladder: Infection, calculi, trauma, neoplasia
. Proteinuria glomerular dlz rlf massive", ANA lE prep,
_Urethra: infection, calculi, trauma, neoplasia
electrophoresis" renal biOPSY
Extraurinary
Blood & chemistry
_Prostate: infection, abscess, cysts, neoplasia
~ creati~ine, BU~ w/o obstruction
_Uterine: infection (pyometra), tumors (TVT)
- Le~kocytosls, anemia,
_Vagina tumors, trauma
RadlologylUltrasound: size & contour
_Preputial: tumors, trauma
- IV pY,elogram: tumors, calculi, obstruction, polycystic dlz
20 to systemic diz
- Artenography
- Bleeding disorders
Lower urinary tract/prostate
Hemolytic anemia (associated wi hemoglobinUria)
CS: Dysuria, straining (prostate), vaginal or ure Coagulation disorders
thral discharge
- Hypercatabolic states
PE: palpate bladder - distension, ease of expression,
_Fever
calculi or masses
Chronic heart failure
- Rectal exam: prostate, urethra & uterus
_Exercise-induced hematuria
- Observe urination
Dysuria pollakiuria: bladder, urethra or genitals
Dripping of blood independent of urination: vagina,
uterus or urethra of female/penis, Sheath, urethra or prostaleof male
- Location in urine sl~eam
Only at beginn'lng: urethra
Nonspecific sign
;#')
__M
). .
> --
~------~~r--------------------------
;- Bacteriuria - H
Bacteriuria
E-hb 653: SAP 827, BOO;
H2B597,I3Bl;IM450,470,
497; C11T910, 913t
~"~
.
.~
'.
.
. ...
, ...'."
"'~
ertension
URINARY
1l"_~::::::::::::==~:':C:h~r~o~n;ic;p;r:;o:;stat~n~i~S~(r;,ec~ur;r;en:t~U_T~I)
= ~
c:=:
~----------,
Bacterurialpyuria - Causes
Urinary tract infections
- Cystitis
- Urethritis
r-----------------~==::=:::::,
Lrl
Pyuria
SAP 826; H2B 597: 656
Pyelonephritis
Catheterization
C a t . Steroid therapy
Significant bacteriuria
Dog
General rule:
> 100,000 (lOS) bacterialml
Urolithiasis
Cystocentesis:
> a (>1Q4/ml definite)
>a
_ FUS usually sterile
Catheter
> 100,000
> 1,000
Genital diz
Voided midstream
t
>10000
-Prostatitis
Negative urine culture doesn't rule out infection ~'
_ Metritis
t 1Q3-105/ml question & repeat, il similar or greater: signillcant
I
Genital diz
CC
Contamination from prepuce
Leukocytes (WBCs) in large numbers in urine
or vaginalvulva
Suggestive of infection or inflammation
Unrefrigerated urine
Pyuria in absence of bacteria indicative of inflammation or nonbacterial infection (virus, fungal)
Pyuria (> 5 WBClhpf) is suggestive or UTI
A midstream catheterization, midstream voided or cystocentesis specimen with greater than 105 organismsiml
is indicative of infection rather than contamination
DIFFERENTIAL DIAGNOSIS
Radiographs/Ultrasound
- Survey & contrast studies: bladder, prostate, calculi
- Prostatic fluid (massage or ejaculate)
Bleeding disorders, fever or systemic diz
PE: check mucous membranes
- Normal micturition
- Auscultate heart & lungs
- CBC & chemistry:
- Platelet countlfunc1ion tests (thrombocytopenia)Clotting profile: prothrombin time, partial thromboplastin time, activated clotting time (coagulopathies)
Lower urinary tract/prostate
CS: Dysuria, straining (prostate), vaginal or ure- - Von WiUebrand's diz
- Cardiac evaluation
thral discharge
- PE: palpate bladder - distension, ease of expression,
calculi or masses
394
Abortion 422
Agalactia 475
Anestrus 396, 436
Anovulvar cleft 446
Artificial insemination 449
Asthenozoospermia 455
Atresia of vulva 446
Azoospermia 455
Balanoposthitis 468
Benign prostatic hyperplasia 471
Birth control 406
Brucellosis 424
Castration 453, 458, 473
Cesarean section 415
Chromoscmal defects 459
Clitoral hypertrophy 444
Conception 400
Chondyloma 447
Contagious venereal
tumor 447
Contraception 406
Crying - neonates 417
Cryptorchidism 458
Cyst
ovarian 440
prostatic or paraprostatic 469
Cystic endometrial
hyperplasia 408
Delayed puberty 434
Delivery of fetus 405
Diagnosis of pregnancy 403, 404
Diphalia 465
Dysgerminomas 441
Dystocia 412
Eclampsia 421
Ectopic pregnancy 410
Ectopic testis 453
Endometritis 408
Epididymitis 460
Estrogen 407, 733
Estrous cycle 396, 398
Estrus induction 437
Estrus suppression 406
Extra-abdominal ectopic testis 453
Fading kitten 410, 426
Fading puppy 410
Failure of erection 454
of passive transfer 419
to cycle 436
to permit breeding 432
False pregnancy 411
Fibroadenomatous hyperplasia
475
Fracture of the os penis 467
Galactorrhea 475
Galactostasis 474
Granulosa cell tumors 441
Hernia - scrotalflnguinal 457
Hypocalcemic tetany 421
Hypoglycemia 418
Hypoluteoidism 425
Hypospadias 465
Hypothermia - neonate 417
Induced abortion 407
Induced ovulator 398
Infantile vulvas 446
Infectious sarcoma 447
Infertility 428, 430, 452, 454
Inflammation of penis 468
Inguinal hernia 457
Interestrus interval 396
Intersex 459
Interstitial (Leydig) cell 463
Juvenile mammary hypertrophy
475
Juvenile vaginitis 445
Ketonemia 421
Klenefelter's syndrome 459
Lack of libido 454
Length of pregnancy/gestation 404
Leydig cell 463
Libido 448
Liter size - cat 398
Lochia 416
Lumpectomy 477
Luteal insufficiency 425
Luteinizin g hormone 398
Luteomas 441
Mammary problems 474
Mastectomy 477
Mas@s 474
Masturbation 467
Mating 400, 401
Metritis 420
Mllbolerone 406, 732
Mismating 407, 409
Neonatal problems 415-419
Nerd queen 435
Nymphomania 438, 440
Oligospermia 455
Orchttis 460
Os penis deformity 465
Ova ban 4060varian cysts 440
Ovarian failure 425
Ovarian remnant 441
Ovarian tumors 441
Ovulation failure 433, 435
Ovulation induction 437
....,..
Reproductive System
Papillomas 468
Paraphimosis 466
Paraprostatic cysts 469
Parturition 403, 404
Penile diseases 464-469
Periparturient hypocalcemia 421
Persistent anestrus/estrus 436,
440
Phimosis 466
Placenta 405
Placental delivery 403
Polyps - vaginal 447
Population control 406
Postpartum endometritis 420
hemorrhage 414
Pregnancy 403, 404, 407
Prepuberal gonadectomy 453
Prepuce diseases 464
Priapism 466
Prolapse
urethral 467
uterus 442
vagina 444
Prostatic diseases 469-473
Prostatomegaly 471
Prostoglandin 407,733
Pseudocyesis 411
Pseudohermaphrodite 459
Pseudopregnancy 411
Puberty 398, 401
Puerperal tetany 421
Puppy vaginitis 445
Pyometra 408
Recurrent estrus 438
Refusal to breed 432
Remnant syndrome 441
Reproductive cycle 396, 398(f)
Resuscitation 415
Retained placenta 416
Retrograde ejaculate 455
Rupture - uterus 442
Scrotal problems 456
Season 396
Semen collection 448
Seminoma 463
Senile atrophy 461
Sertoli cell tumor 441, 463
Short estrus 435
Short interestrous 438
Silent heat 434, 435, 436
Sperm granuloma 458
Split heat cycles 434
Stages of parturition 405
Sticker tumor 447
Stillbirth complex 422
Stump pyometra 409
Subinvolution 416
Superfecundation 439
Superfetation 439
Superovulation 439
Teratomas 441
Teratozoospermia 455
Testicular problems 458
Thecomas 441
Toxoplasmosis 426
Transmissible lymphosarcoma 447
395
.. ~
....
E-hb605; 1M 633: E 1604; SAP 932; H2B 637; 12M 838; R-M453, 463; RR 676, 411: Endo320; DDx 377: Sx-S-hb 440: Sx-S 1294: NB 19.5, 19.6
Bitch: monestrous: 1-3 cycles per year
Independent of season of the year in most breeds
Basenji: 1 season annually, in the spring (m/b slecl-dogs also)
German Shepherd will cycle every five to six months
-Interestrus interval: time betw. 2 consecutive estrous cycles
7 months (4-13), variable within bitch (can't predict next interval);
smaller breads - shorter cycles than large breeds
_ Duration 75
days
(60-90 days)
fJfP
Vaginal cytology'
- .
"" - Vaginal cytology:
~
Sequence of estrous cycle: bitch
Early proestrus: > 60% non cornified cells
,,,
Dlestral shift - 1st day: sudden
e "
_ Proestrus (swelling & bleeding)
Late proestrus: > 70% cornified cells
marked decline in cornified cells
tJ 11
E
(
RBCs throughout proestrus
& retum of small intermediates. parabasal &
- strus accepts male)
. waCs decrease in number
WBC cells (parabasal & intermediate cells
- Metestrus/oiestrus (abrupt loss of cornified celis)
. Extracellular bacteria throughout proestrus & estrus
...
outnumber comified cells)
Anestrus (lOW progesterone levels)
Record: retrospective indicator time of LH peak
_ "Heat" or "season". proestrus & estrus (follicular phase Estrus.: acceptance of male
& ovulation &. when will whelp (7-9 days after the
dlapedeslsIRBCs)
.
.
l
'!f. BehavlOral changes
- End of diestrus. partuntlon or false pregnancy
f:tc ..
0-
t .
~
} mj .
~
. Start:
acceptance of male;
,lC
End- refusal
-i)
CZ5
. .
1\ -
~l..u~.L
._"--'-'--'
i
-.
-e
: .... :A=.:::.::::I=
__ __.-_..
.\.::J
',-
,I
Estrus
Diestrus
9 d (3-21d)
Physical changes
Vulva swelling
Bleeding
Behavioral changes
Attracting males
Refuses copulation
Endocrine profile
Estrogen: gradually increasing
Progesterone (P4): baseline,
initial rises at end (> 2 ng/ml)
Vaginal cytology
~
Early: > 80% intermediate & parabasal
Late: > 70% cornified cells
r::::?)
RBCs, decreasing WBCs, Bacteria
Acceptance of male
metestrus
Anestrus:
Not apparent
None
397
Relum of WBCs
RBCs
--
13J~
~~
@e>
E-hb 628; 12M 842; 1M 636; E 1690; F 303; Cat 1855, 1847; F-N 458; A
A 698, 411; R-M 795; E&R 741; Endo 3.20; DDx 381; Sx-S-hb 441
Seasonally polyestrous
sexual receptivity
""
~IIflJ
r.
~~.j
\JiY\...J....!li
lactation
Cycles: anovulatory
t~o
e~sure OVUlatiO;. ,
L"II
I
2 5 k"t!
I normal
er s Ize:
I ens s
--.-.~
-:fi5.J~
Reproductive hormones:
Luteinizing hormone (LH): mating necessary for release
Progesterone (P4)
_Cycling queen: basal concentrations
_Pregnant queen: increases 3-4 days after breeding & peaks at day 21
of gestation. then gradually decreases during gestatiOn
. 4 - 5 times basal levels just prior to parturition
_Pseudopregnant queen: persists for 30-50 days: levels parallel pregnantqueen & droptonearbasalconcentrationbyday 50 post breeding
Estradiol (E): elevated during estrus
:~~: my~:sC~i:;~mlliibreeding
~ '-......
{{1-f~'-J\
I( (
V\:;'6
.
I
~'-J l A..r--
./
-'"-.
-.~.,--
.-
-.j.~.
---,-
Estrus
9 d (3-21)
Physical changes
Very little
Very little
Behavioral changes
Vocalization
Estrual posturing
Breeding
Metestrus 75 d (60-90)
diestrus
Anestrus:
Endocrine profile
Estrogen: gradually increases
None
399
r:h'\,
~""i
;0 ~
394
Abortion 422
Agalactia 475
Anestrus 396, 436
Anovulvar cleft 446
Artificial insemination 449
Asthenozoospermia 455
Atresia of vulva 446
Azoospermia 455
Balanoposthitis 468
Benign prostatic hyperplasia 471
Birth control 406
Brucellosis 424
Castration 453, 458, 473
Cesarean section 415
Chromosomal defects 459
Clitoral hypertrophy 444
Conception 400
Chondyloma 447
Contagious venereal
tumor 447
Contraception 406
Crying - neonates 417
Cryptorchidism 458
Cyst
ovarian 440
prostatic or paraprostatic 469
Cystic endometrial
hyperplasia 408
Delayed puberty 434
Delivery of fetus 405
Diagnosis of pregnancy 403, 404
Diphalia 465
Dysgerminomas 441
Dystocia 412
Eclampsia 421
Ectopic pregnancy 410
EctopiC testis 453
Endometritis 408
Epididymitis 460
Estrogen 407, 733
Estrous cycle 396, 398
Estrus induction 437
Estrus suppression 406
Extra-abdominal ectopiC testis 453
Fading kitten 410, 426
Fading puppy 410
Failure of erection 454
of passive transfer 419
to cycle 436
to permit breeding 432
False pregnancy 411
Fibroadenomatous hyperplasia
475
Fracture of the os penis 467
Galactorrhea 475
Galactostasis 474
Granulosa cell tumors 441
Hernia - scrotalflnguinal 457
Hypocalcemic tetany 421
Hypoglycemia 418
Hypoluteoidism 425
Hypospadias 465
Hypothermia - neonate 417
Induced abortion 407
Induced ovulator 398
Infantile vulvas 446
Infectious sarcoma 447
Infertility 428, 430, 452, 454
Inflammation of penis 468
Inguinal hernia 457
Interestrus interval 396
Intersex 459
Interstitial (Leydig) cell 463
Juvenile mammary hypertrophy
475
Juvenile vaginitis 445
Ketonemia 421
Klenefelter's syndrome 459
Lack of libido 454
Length of pregnancy/gestation 404
Leydig cell 463
....... - - - - - - - - - - - - - - - - .,...,
Libido 448
Liter size - cat 398
Lochia 416
Lumpectomy 477
Luteal insufficiency 425
Luteinizing hormone 398
Luteomas 441
Mammary problems 474
Mastectomy 477
Masttlis 474
Masturbation 467
Mating 400, 401
Metritis 420
Mllbolerone 406, 732
Mismating 407, 409
Neonatal problems 415-419
Nerd queen 435
Nymphomania 438, 440
Oligospermia 455
Orchitis 460
Os penis deformity 465
Ovaban 4060varian cysts 440
Ovarian failure 425
Ovarian remnant 441
Ovarian tumors 441
Ovulation failure 433, 435
Ovulation induction 437
- - - ,
Reproductive System
Papillomas 468
Paraphimosis 466
Paraprostatic cysts 469
Parturition 403, 404
Penile diseases 464-469
Periparturient hypocalcemia 421
Persistent anestrus/estrus 436,
440
Phimosis 466
Placenta 405
Placental delivery 403
Polyps - vaginal 447
Population control 406
Postpartum endometritis 420
hemorrhage 414
Pregnancy 403, 404, 407
Prepuberal gonadectomy 453
Prepuce diseases 464
Priapism 466
Prolapse
urethral 467
uterus 442
vagina 444
Prostatic diseases 469-473
Prostatomegaly 471
Prostoglandin 407,733
Pseudocyesis 411
Pseudohermaphrodite 459
Pseudopregnancy 411
Puberty 398,401
Puerperal tetany 421
Puppy vaginitis 445
Pyometra 408
Recurrent estrus 438
Refusal to breed 432
Remnant syndrome 441
Reproductive cycle 396, 398(f)
Resuscitation 415
Retained placenta 416
Retrograde ejaculate 455
Rupture - uterus 442
Scrotal problems 456
Season 396
Semen collection 448
Seminoma 463
Senile atrophy 461
Sertoli cell tumor 441, 463
Short estrus 435
Short interestrous 438
Silent heat 434, 435, 436
Sperm granuloma 458
Split heat cycles 434
Stages of parturition 405
Sticker tumor 447
Stillbirth complex 422
Stump pyometra 409
Subinvolution 416
Superfecundation 439
Superfetation 439
Superovulation 439
Teratomas 441
Teratozoospermia 455
Testicular problems 458
Thecomas 441
Toxoplasmosis 426
Transmissible lymphosarcoma 447
.,.0_----=-=::::--,-
396
Estrous/Reproductive cycle - Bitch
E-hb 605; 1M 633; E' 604; SAP 932; H2B 637; 12M 838; R-M 453, 463; RR 676, 411: Endo320; DDx 377; Sx-S-hb 440; Sx-S 1294; NB 19.5, 19.6
.. Other target tissues: growth of mammary ducts & tubules; proliteralion of oviductal fimbria; elongation of uterine horns; thickening of
oviduct & uterine lining; diapedesis of RBC through endometrium;
enlargement of cervix; elongation & edema of the vagina
0-
End: refusal
~
Anestrus: period of sexual qUiescence, follows di
{
"
estrus & stops wi next proestrus (bleeding & swelling)
Standing heat (stand firmly with
-i~
- Endometrium sloughs repa'r ale
d
It
_
hindquarters & vulva In a lordoSIs-like position)
--z
?
&150d
..... '
It eS,12O aysa ernonpreg
"FI
I
..
."
nan cyc es
ays .",er pregnant eyc e
agg ng (deVlatetalilolheslde)
~i"~ . Duration: average 4.5 months variable
~&
to help intromission
Physical & behavioral changes: not apparent
Endocrine profile:
'
Endocrine profile:
.
0
, LH surge usually at onset of behavioral estrus
. P4: basal concentratlon.s
.
"e
I I
2 d
(
d
) It
- E17B levels lIuctuate with waves of folhcular development
vu at on
ays 1-3 ays a er LH surge
- Mechanisms for termination of the anestrus phase & initiating a new
P4.contlnues rise started at end of proestrus
follicular phase is unknown
It'
'0. _
1\ -
-.
._'._._.
k.
__ .
- Vaginal cyto.logy:
' 90% Cornified cells (superficial & anuclear squamous cells)
. No neutrophils (~MNs) & dear background
. RBGs & bacteria (normal)
__.-
:
;
"-e
'-_. __. .
C1J
~ 'jt ..
}
~
~
Proestrus begins wnen vulvular swelling
& bleedIng 1st noted, ends when bitch IS
(
receptlVEltomale
.......
D
f .9 d
)
- ura Ion.
aYS(3-17days)
->I
- PhYSical changes
't'
V.ulvular swelling, bleeding (SangUineous)
discharge)
I,
Vaginoscopy: vaginal folds enlarged, rounded & edematous
rJ
_Behavioral changes:
Start: bitch sexually attractive to, but rejects
.t.::J
.:::C-.-
....~
Duration
Proestrus: 9d(3-t7)
Physical changes
Vulva swelling
Bleeding
Behavioral changes
Attracting males
Refuses copulation
Endocrine profile
Estrogen: gradually increasing
Progesterone (P4): baseline,
Initial rises at end (> 2 nglml)
Vaginal cytology
@e>
Early: > 80% intermediate & parabasal
Late: > 70% cornified cells
r::3(3)
RBCs, decreasing WBCs, Bacteria
Estrus
Acceptance of male
Standing heat. Flagging
90% cornffied
None
Stage
9 d (3-2t d)
Diestrus
75 d
metestrus
Anestrus:
397
cells
~~
I3>gl
--
GJ~
@e:>
398
r<-'P
E-hb 628; 12M 842; 1M 636; E 1690; F 303; Cat 1855, 1847; F-N 458; R
A 698, 411; RM 795; E&R 741; Endo 320; DDx 381; Sx-S-hb 441
Seasonally polyestrous
- United States: Jan-Oct = cycling
(~
days"
("'
-10% of pregnant cal~ will show estrus behavior & mate during 3rd &
6th weeks or gestation
. This may result in superfetation
.
.
Puberty: first estrus: 7 (5-12) months of age
-~.
~ puberty :
Duration.
1-10 days
Vaginal cytology'. generally not used In the queen
Factors ""e
...,lng start v'
~
. vanes:
.
't
'
F~wPhYSlcal
l[JJ
;11i:t-~~0'
~~
.
~_
_ Does not occur in nonovulatory queen
_ Ovulation w/o fertilization (spontaneous rare, sham
, ) I
./~'-JlA
. 'J'--
-"-.-
~1
---
J-
.---:'
"'---.-
Duration
Proestrus: 0.5-3 d
Physical changes
Very little
Behavioral changes
Affection, rubbing, treading
Refuses copulation
Estrus
9 d (3-21)
Very little
Endocrine profile
Vocalization
Estrual posturing
Breeding
Metestrus 75 d (60-90)
diestrus
Ea~y:
Anestrus!
Non.
P4 increases to day 25
399
Mating - dogs
E-hb 60S; 12M 840; 1M 633; IM-WW 417; SAP 932; H2B 639t: 5min 24; E
1605; R-M461, 465; E&A 544, 547; C12T 1043; Sx-S-hb440; Sx-S 1294;
N6l9.S
~
~lr6'
males)
Management failure to breed animals at right time
#1 cause of infertility (failure to become pregnant)
hetp, but don't tet them make you miss -standing estrus animals
usually know best
If there is a Infertility problem or artificial insemination is practiced other
estrus detection methods become mOl'e important
Conception:
-Insemination during proestrus & diestrus rarely fertile
- Maternal age effects conception rate & litter size
- Beagles: greatest between 2-3.5 years of age; decreases after 5years
to predict
't
r\"
- Maximum
angulation
wl"'.""colil.
occurs at oocyte
~~~:;~:~;:"g"",y ~ '(
flattened & blotchy
red & white
'"l.
!',
~(
1Hf
'\:
Breeding
Mating:
t . -,
~::~~s
Estrus
Slide Preparation:
Direct impression: allow to dry
- Swab technique: Roll cotton swab onto slide lighUy, 23 times
Bulb Pipettetectmique: Drop asmall amount offluid onto slide & allow
to dry
Staining:
Diff Quik: slides must be dry before staining
- New Methylene Blue: slides may still be wet; drop small amount of
stain onto slide, cover with a cover slip
~~~~~~~~~~~~~~~~':~:a~;~Blls'~ ~ 0 c1J~
_-
tl:J
Interpretation of cytology
,/40/7
G)~
- Cornified cells: here used to denote superficial (pyknotic nuclei) & anuclear cells
e;e>
(superficial cells, for the purest, are not comified because they have a nUCleus). Most common cells when ~
uterus has reached maximum comification to protect female from penis trauma: proestrus & estrus
Z.
- WBCs (leukocytes)
~
Maybe see in anestrus, eerly proestrus & again in metestrus
WBe in metestrus don't indicate infection unless they have toxic changes. These characteristically reappear 7-9 d ailer the lH surge
- Bacteria: normally in the vagina. If present along with toxic neutrophits, suspect infection
- RBGs: characteristically during proestrus, but may be during estrus & metestrus. Caution must be used when evaluating the presence of RBCs
c::3;
401
Breeding Cat
E-hb 628; 1M 636; 5min 24; E 1290; F 303;
Cal 1849; R-R 703; R-M 812; DDx 381
Breeding Practices
Rule for breeding
r \
Mating. cats
~~
\ -d....!:.
~
- Proestrus queen may become aggressive 10 the Tom or 10 the handler if mounting
attempted
- Estrus: Queen "caJr to the Tom, rub on objects, roll on fioor &
. Separate if fight
. See if quaen in heat
tt: ')
indication 01 adequate
: Mature tom can be used 3 x times a,week, or daily 10.r 4 - 5 days i~ a row
\':J' .
Postcoital reaction: lemale's pupils dilate, she rolls around, splay forelimbs wI nails
exposed & kneading (orgasm?). She will licks her vulva & resist Tom for a variable
period.
'2
Va~nal swabs can be taken to d?Cument mating il mating not observed (sperm)
:-w
:r
'
Pregnancy - cat
Mk 640; F 313; 1M 672; SAP 901; H2B 697; Cat 1856,
F-N 463; C12T 1043; R-R 32, 686, 705; R-M 813; E&R 752;
Sx-S-hb 448; Sx-S 1317; NB 19.10
Length of Pregnancy/gestation:
- 66 days (64-69) of fertile mating in cat
- 63 days from ovulation
- Parturition prior to 60 days is considered premature
- Prolonged if queen stressed
- Shortened with large litters
Diagnosis of Pregnancy
-Increased body weight, appetite, mammary development or milk production not diagnostic as these can
occur in the normal or pseudopregnant bitch
Impending parturition
- last week, slows down & investigates quiet places: put out a
parturition box (put her in it often, she may still pick her own spot)
Stage
2:
403
~I
Pregnancy - Bitch
~~
SAP 901; 12M 881; 1M 672: H2B697, lOt; RM 491; Sx-S-hb 447: Sx-S
1316; NB 19.10
Uterine changes:
- Implantation occurs 17-22 days after ovulation
Almas: equal distribution of fetuses in the 2 horns
ft:
'-..-
- 21 days: liquid filled fetal membranes form distinct oval swellings of the
uterus (1/2'/1.2 1.5 em)
28 days: round swellings (1"12.5 cm)
\
\..
Diagnosis of pregnancy
, ..- - _ . SAP 933; 12M SSI; 1M 671; HaBSSI; R-M 494; R-R32, 104, 683;
26-35 days:
~ ~
"-
fJ
~O;.'"
.~_. ~~}I
!W1 _
O'~
;; "u
.~
-Impending parturition
- Within 24 hours of transient temperature
drop (monitor-bid) in bitch, not cat
-10-14 hours after serum progesterone drops below 2 nglml (dog)
-1224 hours: nesting behavior
- Several days: r&sUessness. seeks seclusion, may not eat
- 1-2 weeks: mammary turgidity & secretion of milk
.-_'
B!
li "
\'"
Bitch break or licks off the fetal membranes & licks the puppy to
stimulate breathing
Bitch may eat the membranes
50% of pups are bom breach
-).
_.)
r-
.... ~
~~
St-J
Length of Pregnancy/gestation:
...,."..
- Cat: 66 days (64-69) from fertile mating~~~
- Dog
Q)
~
fii.::.
,
'>
~~
-:>
~~
Ovariohysterectomy
castration
&
LUlalyse
~:.:::. ~
CEH, Cystic
endometrial
hyperplasia!
- CEH:
dehYdratiO~'~":\
***
~~1-J'
:z.
pyometra~)
Treatment:
f!;-?
\']O",I:J ~
~~;II
Ii
)}(1
~-@~:
Stump Pyometra
409
Prognosis:
Surgery: Good if no peritonitis (mortality 10%)
Medical:
- Closed: poor (25-40%) low response rate & rupture or retrograde peritonitis;
- Open: good for short tenn return to reproductive function, 76-93%
success, 1/3 need 2nd series of injections
- Recurrence as high as 75% long term (so breed at next estrus to insure a fItter)
- 40-75% of successfully treated bftches wI1elp at least 1 litter
Lab:
size of litter. parturition & milk production
weeks & during lactation
"Fading puppy" or Ufading kit- - Hematocrit < 37%,
Cause:
- Feline reproduction & growth diet
ten"
syndrome
hemoglobin < 12 g/dl,
- Insufficient nutrients
Throughout pregnancy, especially last 3 weeks
- Normal appearance at birth
- Not. amount in late pregnancy & lactation
total plasma protein < 5.5 gldl
& during lactation
Fading
&
dieing
variable
time
after
birth
- Unbalanced diet
Fail to gain weight
No supplements (meat, milk, calcium, phos- Maintenance diel
Malnutrition
pregnancy
& lactation
H2B 1291; C11T 971; FN 562
**
- Ineffectual nursers
phorus or vitamins)
Feeding regimes:
- First 5-6 weeks or pregnancy: same
amount as normal
- Gradually + towards end of gestation so eating 15-25% more calories at birth
Free choice or BID
1SE::;~l:j
feeding: expect maintenance of
optimum weight & steady weight
gain in neonates
.~
Excellent
Rare in cat, but more common than in other species: Pregnancy other than In uterus
True extrauterine pregnancy: fetus wI nutritive connection wI tissues other than endometrium
Humans: ovarian & tubal pregnancies may occur, true abdominal pregnancies rare
Extrauterine ~ - No authentic cases or true extrauterine pregnancies reported In domestic species
. . \J
Secondary extrauterine pregnancies: escape of recognizable fetus from uterus to abdominal cavity or vagina
pregnancies
CS: Asymptomatic as apposed 10 In humans, unless rupture of uterus due to trauma
E-hb 609: A-R 141:
Ox: Usually InCidental finding, mummies
R-M 814; Cat 1860
Tx: Surgical removal, Spay
pregnancy,
False
pregnancy,
**
ban)
recurrence
- Not all bitches show the clinical - "Mothenng" - nesting mammate objects
signs of pseudopregnancy
Physiology: queen
Sequela, Mastitis
- Causes: sterile mating, sham
copulation, spontaneous ovulation, embryonic death, hormonal therapy
Note: can be seen clinically in queens
shortly following OVH
Pathophysiology: require sterile mating to
cause ovulation & corpora lutea formation;
CL persists only 30 days
DO.;
True pregnancy
Mammary gland disorders
(mastitis, neoplasia)
Hypothyroidism
prognosis: Good
Recurrence common in subsequent
estrous cycles in bitches
No
in fertility
412
Dystocia,
Difficult
Rare in cat
> 70 days
> 24 hours since prepartum drop in
Hx
- Gestation> 70 days
- Stage 1 > 24 hours
***
Ixs
History of previous dystocia
rC"us,e~DD:K: Dystocias
Physical examination:
- General physical examination
- Rectal temperature
- careful palpation of abdomen
- Digital vaginal exam (aseptic)
for fetus in canal & tone
- Mammary gland for colostrum
Abdominal radiographs:
- Number, size & viability of
pups (intraletal gas pattems, overlap-
Fetal dystocia:
- Large neonate - oversized
- Monster pups/kitten
of pelvis (Scottish terriers, Sealyhams)
- Nonviable fetus
- Abnormal position/presentation/ Old pelvic fractures
posture (usually not a problem in cats be- Vaginal mass - neoplasia
cause limbs are so short (breech normal in Developmental abnormalities: vagicat, 40-50%)
nal stenOSis, vulvar hypoplasia,
- cat 2 kittens wedged in canal, monsters
persistent hymen, persistent Mul Malposition usually nol a problem
lerian duct
- Uterine torsion (cat> dog)
- 2 uterine inertia
- Primary uterine inertia
- Metabolic disturbances
**
tions
/6i;J,
.
~~I
01:.:
[(
~Il-D
Hypocalcemia
See above
Uterine inertia
Uterine
dystocial
inertia
; .
Cesarean
section indicated if no
Abdominal radiographs:
hour
response to oxytocin in 1-4 hours
- Number, size & viability 01 pups (intrafetal
- Pup stuck in birth canal for> 2 hours
20: stage 2 labor stops: progas pattems, overlapping skull bones)
/111
- Nonattentive bitch to pups already
Ultrasound for tetal viability
longed efforts to deliver fetuses
(myometrial exhaustion& subclinical hypocaldelivered
prevention: in problem bitches, have
."'I:-_~,cemia/hypoglycemia)
- Labor appears to stop before entire
/.
owners monitor rectal temperature, If longerthen
24 hours after temperature drop do Csection
litter delivered
cl
,(e
I'
-"",,--..
dystocia
cephalus, chondrodystrophy)
Abnormal position/presentationl
posture
~ Presentation: cranial & caudal normal,
transverse abnormal
Position: dorsal position normal
Prognosis: Guarded
Dystocia
Fetus in birth canal
(Scottish terriers, Boston terriers, English Prolonged gestation> 70 days
bulldogs, Sealyham terriers & Pekingese)
Stage 1 > 24 hours
- Large sire, single fetus or small
Stage 2 > 4 hour wlo birth
liters, 1st born of a litter or pro > 1 hours between births wI active
longed gestation
straining
Malformed pups (cannot fit through the
Pain or depression aslw/labor
pelvic canal)
Nonviable fetus (fetal edema, hydro-
'=
*!
**
Ace
Hypoglycemia
r-D-D-X:---~
Healthy animal
- Digitally feather dorsal vagina
- Tranquilization: lor nervous ~
Maternal Dystocia:
- Narrow or obstructed birth canal
Congenital: brachycephalic breeds
& terriers (flattened dorsoventral diameter
Hypocalcemia
. Lubricate wi KY Jelly
hour
Pup stuck in birth canal for> 2 hours
Hypoglycemia
Cesarean section
Normal
"--01
""'=--- -
Nervous dystocia
NB 19.17
Prognosis:
Good - earty
Guarded late
Uteri ne
torsion
nancy or paJ1urition
Cause:
Emergency: exploratory
abdominal mass, pain
-l...
or~ove,
It
'\1J
eel ill
-'
.p-
51
~~~~~~:;~~~~~~~~;::.c~.~":d:.:~~do:m:in:a:'~'":m:'l'~~~~~;;~~~~~~.~-~~~G~~~d~n~~f~~~~~~~~'~"~~~~~ru~':~G~~~v~ef:lf~~~~
* . Rare
""o--C------t-o------Tear: lesion through endometrium & part 01
tear or
rupture
=:---
Postpartum
hemorrhage
Dystocia
Hx, CS, PE
Abdominal radiographs
- For size, number & position oj remaining
fetuses
~ Uterine rupture _fetus In abdominal cavity
Ultrasound: tor fetal viability
Exploratory laparotomy
Hx, CS
Physical exam
Lab: Normal PCV =
___--L-------.:.----_.J.
754
755
Emrg
**
30% at
lactated
ABs
Penrose drainage ventral drainage
Broad spectrum a~tlblotlcs 2 weeks
"
--C
/If(
so.....
~1
:.
>
parturition
.~
-~
I Jill
Oxytocin
\\\
- DIC
- Placental site problems
Guarded
Cesarean section
SAP 908; R-R 321; R-M 502, 819 (F); Cat 1902; C12T 1085; Sx4B
496; Sx3B404: Sx-S-hb450, 762; Sx-S 1322, 1325,2300; NB 19.12
III!
Indications:
_ Dystocia not correctable by
medical treatment
_ Systemic ill full term bitch
Dead puppies
Breeds predisposed to dystocia:
Chihuahua, English bulldog
~
1~
I
r;;I!
\'_
young
[ii5J
Resuscitate neonates
E-hb 611; E 1623?; SAP 909; Sx-S-hb 450; Sx-S 1324
Establish airway w/in 1-3 min of birth
- Remove placental membranes, meconium, suction
or swab oral cavity & trachea
- Swing pup head first downward path while supporting
rest of head & body repeatedly to clear airway
Stimulate breathing: briskly massage thorax & face wI
warm towel
02 by mask if cyanOSis persists
Monitor heartbeat (thoracic palpation/auscultation)
- External cardiac massage if none detected
glucose)
- Glucose if colostrum not consumed
- Karo syrup orally
- Dextrose 5%
sa
&
Facts/Cause
Condition
Lochia
Presentation/CS
Diagnosis
E-hb610;E1618
Subinvolution
of placental
sites, SIPS,
RadiOlogy,
US, abdominal palpation
Cause: unknown
Test lor Brucella canis to RIO
-Fetal trophoblast cells invade endometrium
& myometrium & may prevent involution
- Lack of thrombosis in endometrial blood J---------------l
vessels results in bleeding
OOx: Postpartum hemorrhage
Injuries during lYhelping
Bleeding dlsordersICoagulopathies
Vaginal masses
Placental necrosis
Metritis
Retained fetal or placental tissues
Trauma/neoplasia to genital tract
Chronic vaginitis
Normal lochia
Persistent decidual
reaction
E-hb 610; SAP 896; H3B 641;
H2B 701; 12M 887; 1M 676; IMWoN424; 5min 1090;E 1618; R-M
513; R-R 742, 354; E&R 586,
756(f); Sx-S-hb 443; NB 19.13
**
Retained
placenta
Rarely asymptomatic
Postpartum discharge
Fever
Anorexia
Depressed
Lactation stops ~
/,
..
~-'b
Prognosis:
Good, does not usually recur with luturewhelping
.~~~~
~ ~~~ .s,q""a,ce~
~
Treatment
Normal: greenish, brick red, brownish, then serosanguinous vaginal discharge which has no odor &
decreases in amount & diminishes after 4-6 weeks
Prognosis
Oxytocin
II ~
Good if treated eany <24 hours
Guarded II metritis develops
Neonatal
problems
1M 681
***
Hypoglycemia
Infection
Trauma
Hypothermia . c-__ / " \
.. :-....~
/"~
"'\ o
--f
+Activity
- +NurSing
Treat problem
Support: warmth, fluids, nutrition
Supplemental tube feeding
Fostermothe~
.+
>-
c5'
Neglected
~~1)IJ
Prognosis:
Poor if loss of 10% of birth weight
Grave if muscle tone
Worse than similar signs in adult because of rapid progression in neonates
Should have pink mucous membranes, be round & sleek wI good muscle tone
Respiratory rates: 15-35 breaths/min
Heart rate: over 200 beats/min for 2 weeks
Temperature: 96-97' F (35.6-36.1' C) at birth
- 100' F (27.8' C) by 1 week old
- Neonates unable to regulate temperature for 2 weeks
Nonnal birth weight: Kitten: 100 10 g
Puppy: 100-750 g
Puppy: 5-10% of birth weight/day
- Weight gain:
Kitten: 7-10 gJday
- Kitten weight at 6 weeks = 1 Ib (500 g)
- Puppy at 10-12 days should weigh twice birth weight
Hypothermia neonate
Hypoglycemia,
Malnutrition
- neonate
***
adults
- .. Activity
- .. Nursing
- Respiratory distress
it
~~~'=
......-c...-....~
'-.~.
- Constant crying
- .. Body tone & strength
--J)
CauseslDDx Hypoglycemia
<..
.
- Lactation dysfunction
MetntlS, mastitis, or undeveloped mammae
- Hypothermia (decreased digestion)
- Septicemia
Ci-
,,,.....
e7
GJ:I ~
5
U
~. Tube feeding
- Convulsions
- Bradycardia
- Weight gain
~
I
'- Puppy licks off lips
.L:""--)~ ..),:;;, -Slowly transfer to eating from a bowl
~~;;r
Decrease amount 01 water gradually until only solid food -lid
.
I-
------~II----~~~~pr~ev=en7tioLn:----------~---~~u
Common cause of neonatal death
Make sure neonate nurses in first 12 hours ~ J1l
for colostrum
--------------~--
Neonatal
infections
***
Persistent crying
+Activity
+Nursing
Failure to gain weight
Dry, rough hair coat
Muscle tone
f
'f' dO
SIgns 0 Specl IC IZS
~
~~,
~
-F-a-j-IU-r-e-O-f-p-a-S-S-j-y-'-etransfer
E-hb611;MkI519;R-R45,46,213
AcqUired Immunodeficiency
Failure to nurse wAn 12-24 hours of parturition
5% 01 immunoglobulins occur between matemal &fetal blood
Not as emphasized as much as in ruminants &equine medicine
colony
~...,~
v,?G:
\../)
~~
'
I't
\L. --'--~
~./ Prognosis.
Bacterial
Parasitic
- E coli
- Toxocara
- Hemolytic & nonhemolytic strep - Ancyclostoma
- Staph
- Giardia
- Bordetella
Coccidia
- Pasteurella
r:~- - Crytosporidium
- Salmonella
, / V-d
W../"'"7
- Brucella
,..,~ \.
~- 6
~ - Campylobacter ("""\ ;. ~
I ,
-=--------t-___________'-_-_-_T'--_-_-_~d,tft%- I
i'" -
<:.....~\.:.
Queen -
Postpartum rejection of part or all of litter, not always due to recognition of congenital defect
Hysterical
mother
Environmental insecurity: moves kittens to a more secure area (under bed, closet)
- Common 35 days after queening, + Protective behavior, aggression, fear
~hb610;F323
*=---.
0\'\:==-_______
~
--....
J):..1.
'-~-Y
Condition
Metritis,
Postpartum
endometritis
M8k 1035; Mk 6n; SAP
895,931; Ehb 610; H38
640; H2B 700; 12M 886;
1M 676; 1M-WoN 424; 5min
828: A-M 505; A-A 384;
E&A 586, 756(1); Sx-Shb 444; NB 19.13: Emrg
Cause:
- #1: Infection postpartum (ascending)
Retained placenta
, Dystocia trauma
, Obstetric manipulation
, Normal parturition
Post insemination
: ~::
421
~~~~~~n~
omltlng
~~~&:::~,oo-i~
~
'"
'"
- Fever
- Depression, lethargy
_ Anorexia
**
Dia nasis
Hx (postpartum), CS (vaginal
discharge postpartum)
.Coplouspurulentvaglnaldls- Physical exam: fever or hypothercharge (foul), Normal lochia: redmia, dehydration
dish brown & persists for 2-6 weeks
Palpation: doughy uterus
Systemic illness
Laboratory:
~Y).
;JiJ
- Dehydration
-Sepsis & toxemia (rapidprogres-
Radiologyl US (ultrasound)
- Enlarged uterus
- Check for retained fetus or placenta
Cytology & culture (guarded cranial vaginal
culture)
- Vaginal discharge (septic: PMNs, bacteria,
end~etrial ~ens)
.
. ~ot diagnostic but .gulde '?f ABs
Vagmoscopy for location of discharge
- Mastitis
/D-D-X:-----L--~
Postpartum
CS: Sick mom, Vaginal discharge, Crying kittens
Ox: Hx, CS, PE
lx: ABs, Fluids, OVH or Med? Px: Guarded
Eclampsia,
Hypocalcemic
tetany,
Periparturient
hypocalcemia
Mk 457: Ehb 610; SAP
234; H38 639: H2B 699;
cat710; 12M 885; 1M 675:
IM-WN 423; 5min 535; E
1618; R-M 511, 821 (F):
RR 372; E&A 587: NB
19.13; Emrg421
***
Life threatening
Bitch> queen (rare)
Toy breeds, 1st 4 wks postpartum
Small, hyperexcitable primiparous bitches, rare in larger dogs & cats
"I
~
J:il~~
Prognosis:
Retained fetuses
Normal lochia & slight fever
Guarded because of
progression to toxemia & sepsis
Hemorrhage
Systemic diz
Mastitis
Nursing bitch
Initial signs:
- Restlessness
- Panting, whimpering
- Salivation, facial pruritus
Hx (lactating), CS
PE: 108 P temperature
(weao;,,)
t
t
Predisposing factors:
0
- Sfff
I , a aXlc g~1
_ Unbalanced diet
- Hyperthermia
-Inappropriate dietary supplementation
- Tetany: tremors & relaxation
Aeduced appetite
. .r-periods
- Stress of lactation
- Seizures: opisthotonus
- Calcium supplementation during gestation
- Ca+ loss in milk
Sequelae:
- Alkalosis
- Hyperthermia
Rare if nutritious, well balanced diet
- Flaccid paralySiS
Hypomagnesemia may be present & if not
- Cerebellar edema
corrected, calcium therapy will not work
- Shock & death if untreated
Pathophysiology: Hypocalcemia alters
membrane potentials - spontaneous discharge
of nerve fibers & tonic contraction of skeletal
muscles, dliferent than in cow where we see
paresis instead of tetany
Retained placenta
15
Cause:
- Excessive calcium loss in the milk
1-4 weeks postpartum most commonly
- 20 days prepartum to 45 days postpartum
r~
Laboratory:
- Hypocalcemia
<7
mal> 8.5 mgldl )
mgldl (nor-
+ Ca+
rt!J1lJ
C,
o Wean neonates If recurs during same lactation
o Balanced lactation diet wi additional oral calcium
DDx:
Hypoglycemia
Toxicities
Epilepsy
Irritability & hyperthermia
- Metritis
- Mastitis
Gestational
hypoglycemia
& ketonemia
sion possible)
- Chronic metritis - infertility
- Pyometra
110.
Hypocalcemia,
Puerperal
tetany,
Treatment
Presentation/CS
Prevention:
F\ ca+~
b:J l
.~1f.
~
o Extremely rare; Bitches on carbOhydrate-deflcient diets during advanced pregnancy; 7x dead puppies at birth, High mortality among puppies wI hypocalcemia,
Aesult in failure to respond to calcium Tx
es: .. food Intake & activity, vomiling, rapid respiration, abdominal straining, prostra~on, acetone breath, weakness, depression, seizure, coma
Ox: Hx (tast gestation), es, acetone breath, ketonuria, serum glucose levels < 7 mgldl, response to Tx, check for concurrent hypocalcemia (sImilar Hx & CS)
oOOx: Hypocalcemia
~
Tx: IV glucose in normal saline solution (respond Immediately & not affected again), frequent feeding, parturition or cesarean section alleviates problem
) Prevention: proper nutrition throughout gestation, monitor glucose
periodically until puppies weaned
Glucose
421
Incidence ?: difficult to assess because no reliable Vary: cause & time of gestation /i--~
environmental changes, drugs,
method of confirming pregnancy eariy in gestation
Early abortion
~ dietary supplementation, new animals in colony), CS
Fetal
- Death early in gestation = resorption
No CS
~ Physical exam:
~
- Death later in gestation results in abortion
resorption,
- Infertility (failure to conceive)
~
- Digital vaginal exam
Queen: abortion generally occurs between
Stillbirth
- Bitch continue to appear pregnant
- If systemically ill do CSC,
~
50-58 days of gestation
(mammary gland development & weight gam)
chemlstnes & urinalysis
complex
- Queens: appearance of pregnancy
- Consider pyometra
SAP 898, 932; H3B 628; H2B
S8S, 706; 12M 8S0: 1M 678; Esubsides
I
Difficult unless fetal tissue found c...::
hb608; CttT925:5min2,4;
Fetal
tissue
=
diagnosis
.
R-M 834; A-A 206, 21 0; E&R
574. 62S, F 757; DOx 375;
Submit
fetal
tissue,
placenta
&
iC======~~~
NB 19.12
vaginal swabs from bitch
t":>
:iJ
anorexia
Ultrasound: diagnose pregnancy after 16 days & also to confirm
Late abortion:
viability of fetuses, or retained fetus
- Vulvar discharge
Radiographs: for death or nonviability
_Fetal material (Jive or dead)
- After 45 days: collapse or decalcification of skeleton,
. Restlessness & abdominal contractions associintrafetal gas, or abnormal fetal position
ated wI impending abortion
Brucella serology in all bitches
(r::: r -- (-00)
Systemic illness (anorexia, lethargy,
- Slide agglutination Test (ASAn: screening for positives (negative
diarrhea, vomiting) during pregnancy
almost certainly free from infection)
- May indicate recent of pending abortion
- Retest positives wI TAT, remove positives -:,::==:~5:
HerpeS virus: vesicular or follicular le- FeLV, FIV & FIP serology
sion of vaginal mucosa
Fetallplacental tissue for bacteriology & virology
LosS of premature fetuses does not Karyotyping fetus if no matemal evidence (rarely done)
Toxoplasma paired titer
mean the entire litter will be aborted
Queens rarely show listlessness or an- Thyroid stimulating hormone (TSH) test
Low plasma progesterone 2 nglml) indicate hypoorexia
luteoidism, monitor next pregnancy if no diagnosis
Sequela: infertility
Abortion,
If"
It
Incidence?
OVH,
i .
Treatment:
Canine"
~. ~~~::~~YCOSideS
- Fetal defects:
~
_Amphotericin-B....
Chromosomal abnormalities
~ (~
- Ciprofloxacin
Anatomical abnormalities
Enrofloxacin
- Maternal factors:
.
~
: *:t:~~II~~~
- Systemically ill
_Chloramphenicol
.
- Metronidazole
" Uterine diz (chronic endometritis, cystic endometrial
hyperplasia, uterine adhesions)
- Doxycycline
Exogenous glucocorticoid therapy
- Oxytetracycline
.Infectious agents Brucella, E coli, streptococcus, harp- Nonsteroidal antllnflammatones
esVlrUS, "ptosplrOSls, canine parvOVlrus, camne distemper Hormones
- Androgens
Virus, mycoplasma, CampylObacter sp
_ Bromocnptme
"" Canine herpesvirus infection (CHV) & bru_Estrogen
cellosis Important because of Impact on breeding pro- ExceSSive ~hy~d
grams
t\
- ~IUCtO~~OldS
ToxoplasmOSIs (dOg not cat)
(~\ An;~t!~!n n
! y
_Barbiturates
" Hypothyroidism
cr
IB!
7'ffd:
-->
'"
- Antibiotics
...
Oxytocin
Attempts to pre~entJng [mp~ndlng .
abortion/resorption usually ineffective
Treat underlying cause If possible
_ Incidental bactenal infection: antibiotics from culture & sensitivity
Pyometra best treated wi ovariohysterectomy,
.....
but may be managed medically In some wlo severe Illness
_Brucellosis: no effective cure: cull positive ammals
.Translently elimination somewhat effective wI ABs, but recurrence can occur
'
'
Repeat aborter
- Changing studs or
Invasive reproductive evaluation (biopsy)
Il]
G:'U
Prognosis:
.Goodlm,oylsolatedevent&
subsequent breedings uneventlul)
.c:--'
~~:
~~.
i i
,...--:->-
'- ..(7
"/
'7
j,
~
I
rd
~~~
,
C
/ ;
/.
_ ~
I ',
'c
:...----,.....
-........,.....,
.
A.J
Facts/Gause
Condition
Canine
brucellosis
M8k 1043; SAP 1291,
130,879,898,926; E-hb
608,621, ISS, 106; H2B
1203; 12M 928; 1M 713;
5min 408; E 37; C12T
1094; ell T 925; R-M
467, 470, 544; R-R 728;
E&R 664, 626, 683; OOx
-~
Diagnosis
PresentationlCS
- #1
Hx, CS
- Mild lymphadenopathy, sple- - Rapid slide agglutination test
nomegaly
(RSAT): good screening test b.
Asymptomatic, usually
- Fever
bitch
Cause: Brucella canis (gram negative
coccobacillus)
-localizes in lymphOid & mononuclear system,
prosiate & testes, gravid uterus (infertility, abortion), rarely in eye, kidney or inteNertebral
discs
Transmission: penetrates any mucous membrane from infected material (aborted fetus)
- Oronasal, conjunctival or venereal routs (semen)
-Intrauterine (abortion)
- Milk & urine
- BetweEln same sex housed together does not
easily occur
- Time from exposure to bacteremia
21 days & can last up to 4 years
Anterior uveitis
Intracellular bacteria
Treatment
Euthanize all positive animals
recommended
No effective cure: none guaranteed
-Intracellular location of Brucella makes AB Tx
difficult & all infected animal considered potential carriers for life
Advise not to breed & neuter all infected dogs
before ABs
Transiently elimination somewhat effective wI
ABs, but recurrence can occur
- High levels of minocycline + streptomycin)for
14 days weeks may eliminate the bacteremia
phase, very expensive
- Tetracycline: 2 courses reculture & retreat if.
- These animals should not be used for breeding => relire or destroy
olf owners choose to treat, must advise strongly
of public health risk
~-
Prevention:
/G&'
Prognosis:
Poor for positive animalS, relapses
often occur, diz spreadS
& devas-
Herpesvirus
& cats
infection,
Canine
herpesvirus
infection
CHV,
Feline
herpesvirus
1, rhinotracheitis)
Prevalence
- CHV: 15% in house pets, up to 85%
in kennels
Once infected - infected for life
.Transmission: venereal, transplacental. via contact by the neonate during
birth, or through respiratory tract
-.#V-~
Neonates:
<2
weeks old
genitalia), CS
Serology
*?
:::::--)
- Vidarabine
[ ~.
None
~
~
'''~-~~~.~ i~:~ ;':'$~ ':f"~ ~d:;:;d~;
(!j!})
<b
& hemorrhage
--
4~
Aborlion(day44-51whenlnecte on ay
30), Premature birth - weak pups, Some
pups In a litter may be unaffected
.. ;-0-:-'
~ -
,J----
DDx:
I ___T /~
Prevention
No CHV vaccine
FHV feline rhinotracheitis vaccine
Hygiene
illf.
Prognosis:
Canine brucellosis
Neonates: grave
Adult: recrudescence
wI stress
*.
425
,. Unaffected/asymptomatic
See SystemiC dizs
FeLV causes spontaneous neo- .Immunodeflciency: 2 infections
"Fading
kitten"
FeLV,
Feline leukemia
virus Infection,
Feline
lymphosarcoma,
Feline leukemia
*** -----....,.:
Hx, CS
Physical exam: marked enlargement of lymph nodes
Wasting dlz
Lymphoma: anterior mediastinal; GI form, Vaginoscopy: for vaginal disKidney, liver (anemia, jaundice, weight loss,
charge or vesicles
vomitlng)
Laboratory: Anemia, Chemistries
Bone marrow myeloproliferative
FeLV: ELISA (Probe-Combo EUSA
diz
test (Iests for FeLV & FIV)
Eye, CNS, Cutaneous dizs
Necropsy of any stillborn or
Reproduction system
crborted fetuses: infectious
-Inappetence & listlessness
agen1!
- "Fading kittens
- Infertility
- Stillbirths & abortions
tently viremic
iA
~(.~~~7~
---<C::t~~
Prevention:
Vaccines available: efficacy <100%
-MLVs recommended for cats at risk of exposure
(outdoorlindoor cats, multicat households) 2
initial doses & annual boosters
Eradicate test & removal from cattery
Prognosis: Poor
***
(sneezing,
na8lX)Cular diSCharge,
fever)
Other CS
Abortions
Fetal infections: born w/ generalized infection (fatal encephalitis or focal necrotizing
hepatitis) or asymptomatic &
develop CS shortly after birth
Good
Toxoplasmosis
FN 472;
R-M 837
Adults - subclinical
See Systemic pg 690
Contagious viral gastroenteritis Perinatal infection - neonate
panleukopenia PalVovirus: relatively rare now be- - Nonnal or weak
cause of vaccinations, occasionally seen In _Cerebellar damage at 3 wks of age
abortion,
unvaccinated kittens
,Hypennetria, intention tremors,
F-N 471; 1M 336; SAP 114, Destroys rapidly dividing cells
symmetrical incoordination, roil700; E-hb 149, 467; 5mln
_
Transplacental:
abortion,
tera592; E314; H2B I 194; R-M
ing & tumbling, ataxia persist
836; R-R 66, 211; INF 1:
tologic
for life - dancing kitten
E&R759
, Cerebellar hypoplasia in utero - Fading kitten syndrome
.Invaslon of thymus, thymic atrophy & early
neonatal mortality
- Retinal dysplasia ifinvades retina
Severe: older kits, like parvo in dogs
In utero infections
_Early embryonic resorption (infertility)
- Fetal death/mummification
~
FPV, Feline
**
Hx (unvaccinated), CS
PreviouS vac. doesn't RIO
Lab: Transient leukopenia
Necropsy of any stillborn or
aborted fetuses - infectiOUS
agents
~.".'(IJ
Bacterial
infections abortions
- History
E coli, Strep, Staph, salmonella, Mild anorexia & depression
Physical exam: systemic diz
Advanced
Vaginal
discharge
- Abdominal palpation
Chlamydial agents, mycobacte(open pyometra)
_ Vagina! digital palpation, not recomrium
mended in queen
Febrile
Dog> cat
vaginal discharge orvesic!es
_ Abdomen may be distended -Vaginoscopy:
_Hematology (left shifl wI aleukocytosis)
- POIPU
_Serum biochemistry (azotemia)
- Dehydration
Cytology & culture of vaginal
- Infertility only usually
discharge
~~
- Pyometra - discharge
-Urinalysis
t~~:=,==~
- FeLV test & FIV _Thyroxin In older queens >6 year old
Ultrasound (US): enlarged, nongravid
uterus If CEH, confirm pregnancy, fetal
viability
Exploratory: ulerlne biopsy & cultures
(CEH), ovarian cysls
- Radiography
~ mlD\
m
11m)
It
CLORO
Vaccinations:
\\'
.
Active immunization
_MLV vac (not for pregnant or cats < 4 weeks
old)
Inactivated vaccine: for pregnant
cats & kittens <4 wks-old or debilitated kittens
- - 1 .. ("5"'""ff~
Evacuate uterus
Prognosis:
Guarded
ClaSSification
Breeding
- Persistent anestrus: poor weight gain, poor Medical problems
- Failure to breed
coat, failure to socialize, failure to thrive (low on Housing & nutrition
disorders
Vaccinations
Ehb 630; H3B 645; H2B - Normal estrous cycle
social order)
Breeding record of queen, litters etc.
705; 1M 644; Smin 88; E
- Abnormal estrous cycle Silent heat - not detected
Male fertility
/
1695; Cl1T 947; Cat
PhYSical & reproductive exam: systemic diz L ~
Ovulation failure
1864; F31M581; RM829;
- Vaginal palpation not recommended in
RR 709", E&R 762; DOx
- Continues to cycle wlo luteal e' -., A
381
queen, visualization of vulva
( 1 ! 11-J)
Cystic endometrial hyperplasia
Vaginal cytology to see if cycling - estrogen cornification of cells
- Infertility only usually
Vaginoscopy: for vaginal discharge or vesicles
- Pyometra - discharge
Hormonal assay:
Resorption & abortion - FeLV
Serum estrogen: OOx anestrus for silent heat
- Asymptomatic - resorption - infertility
, Estrus: E>20 pglml; Anestrus & interestrus < 20 pglml (expensive)
- Sanguineous vaginal discharge
Serum progesterone: DOx pseudopregnancy form anestrus ~
Pseudopregnancy & pregnancy> 2 nglml
- Expulsion of fetus - abortion
Anestrus <1 ng/ml
,
- Inappetence & listlessness
Lab data base: CSC, chemistries
.-;:;.
Urinalysis (cystocentesis)
FeLV test & FIV
~
Thyroxin in older queens >6 year old
~
Ultrasound (US): enlarged, nongravid uterus if CEH
- Confirm pregnancy
- Fetal viability
Exploratory: uterine biopsy & Cultures (CEH), ovarian cysts
Necropsy of any stillbom or aborted fetuses infectious agents
Karyotyping in suspected
Infertility queen-
lj
***
kIB
('II!
------
~_u.:
Treatment:
- Consider OVH
~J
1.l'lt~rtHity
REPRQPUCl'JG>N
-Bitch
Condition
Facts/Cause
Presentation/CS
Diagnosis
Infertility bitch
~/I}
***
'.,.
~
[i iJO LL( Genitourina~
PE, RIO
Brucellosis
J~4
1.
Normal
estrus
cycleliow conception
-+
--Refusal to breed
~
PsychologicaVterritorial
Vulvar/llaginal strictures
t Vaginal hyperplasia/prolapse
Musculoskeletal
Occlusive lesions: inflammation, tumor
- Cystic endometrial hyperplasia
- Abortion/fetal resorption
Maternal infectious diz: B. canis, herpes, toxa-
fr
estrus cycle
Brucella canis
Canine herpes virus
Uteritis, Mycoplasma, Ureaplasma? others
_ Immunological causes (uncommon)
- Inherited infertility
~""t
- Old age
~
~.f'-
.......
.;'@....
NO estrous cycles/Anestrus
Pregnancy
P
d
seu opregnancy
Endocrine diz
. Ovarian dysfunction
:-~.~
i!Q~
c.C~
/
I. \
(
"'"b("e'Eder
~
.---------------,---~~---------------/
J'.
Intersex
II
__--\
OVH (spay)
Young (d I.~ b rtyJ
,
. e a1 ", pu e
Old bitches
Drug Tx
-Silent- estrus
IL - -
Hyper- or hypoadrenOCOtticism~
, Diabetes mellitus
, Hypothyroidism
Occutt neoplasia
_ Infectious:
.
.
- General past history (vaccination, e tJc . .
_Detailed history: cycles, breeding, pregnanCIes, pregnancy terrmnations, failure of neonates to survive, kennel history & pedigree
a:9' \
2. Abnormal
'-------------,---------------,~~
U'~
~~~~L-----~~~==~------~L-c~a~u:s~e~
Vulvar discharge
Mass protruding from vulva
./ C? " -
(lj
*" -
rnf:;('L-t:
/7 .
I_
Mycoplasmalureaplasma cultures
Toxoplasma serology
..
Karyotyping in suspected intersex conditions
Exploratory laparotomy
s__?
/1(
Prevent Infertility:
Breed young (2-6 years): maximum fertility
Screen all for B canis w! RSAT every 6 months
_ Check positives w/ TAT: eliminate positives
Remove all canine herpes virus animals
Petiorm breeding soundness on all potential sires,
use only fertile males
Concentrate on estrus detection:
_#1 let animals tell you when ready to breed & breed
_ Not start of proestrus
_ Vaginal cytology during proestrus & estrus
_ Progesterone & LH hOmlone assay
..
Routine health maintenance (deworming, vaccmatlons,
regular physical exams)
Avoid hormonal treatments
Adequate maintenance of bitch dur!ng pregnancy,
whelping & neonatal period = maximum neonatal
)~
survival
OVH recomm~nded for all
nonbreeding bitches
.~
(/Iv":"" _
'fl'~S-
/6'9>/7
?1
432
of
Female Refusal to
breeding
Chronic vaginitis
breed,
Sequela:
~ Problem breeder: even if the
disorder is corrected memolY: "it"
was unpleasant
- Chronic vaginitis
. Occurs because of uonary retention
& bacterial overgrowth
.. Excessive licking or attraction of
males
Failure to
permit breeding
Ehb 629; SAP 930; H38
627: H2B 687; 12M 850;
1M 648; Smin 88; R-M
468; E&R 647, 765 (F)
***
i
,CS
estrus
Physical exam: musculoskeletal
Physiological
Cytology: to see if in estrus while attempting - Make sure breeding pair compatible
breeding
If nol in estrus will normally refuse male
Digital examination (gloved & lubricated index
finger in all but the most miniature of dogs) during
estrus to determine presence of strictures or other
defects
- Vaginoscopy
Observe attempted breeding
Thyroid tests (T3 & T4 or TSH stimulation)
Ultrasound: defects
Laparotomyllaparoscopy
#1 Mismanagement
Difficulty breeding, Sequela: Problem breeder
Ox: Hx, es, PE, Cytology of estrus, Breeding, T3 & T4, US
Tx: Walt until in estrus, AI
es:
Breeding
management
#1 cause of Infertility
Infertility
Faulty estrus detection:
- Breeding at wrong time
. Missing 1st day of estrus
"let breed when will
- infertility,
.. Breeding short preestrus female on preSAP 932; H2B 687; H38
& every other day
cletermined clay (1 0 days after proestrus)
627; 12M 850; 1M 649;
until won't"
Breeding
after
start
of
diestrus
5min 88; F-N 467; E&R
(cytological change)
553, 623, 762(f)
- Breeding only once
- Breeding several times in short period (2
~ A'I"
days)
- Making breeding unpleasant for
animals
- Kennel hygiene & overcrowding
- Nutrition, vaccination & parasite
control
- Depending on science (cytology)
instead of dogs natural ability &
desire to breed at right time
*** -
ft
= Progesterone rise
= LH fragments in urine
= roughly> 90% cornified cells
won'
Examine bitch for pregnancy in 2530 days: abdominal palpation or ultrasound
- If not pregnant do progesterone
assay to see if above 2 ng/ml
Mismanagement:
Infertility
Breeding management history
Queen to Tom's territory, several
- Failure to identify estrus (-call")
- How long has female been housed w/ weeks before to allow adaptation
. Queen may need tom to show estrus
-1. Place pair together for short
tom?
- Not enough time for adjustment
periods & observe. Separate if fight,
~~HOW
many
matings
allowed?
to Tom's territory
See if queen in heat. Witness mating (labor
Witness mating? Ad libitum~ Harem?
Ovulation
intensive)
- Inexperienced Tom
failure
- 2. House queen & tom together - Only 1 breeding (needs multiple)
FN 468; E-hb 628; 1M
allow mating ad libitum wlo obser636, 649; 5min 88; E - MiSS timing
1290; F 303; OOx 381 Frequency of mating more imvation
- 3. Large breeding colonies: harem
portant determinant of ovulabreeding
tion in queen than day of cycle
,lor 2 toms housed wI many queens
on which mating occurred
.1 tom for each 4 - 5 queens best, up to 15
queensltom maximum
Multiple matlngs: at least 3/day x
3 day
Mature tom can be used 3 x times a week, or
daily for 45 days in arow with arest in between
Queen infertility
Management
{ <r q
~~~
***
~~'S
..
Silent heat
cycles,
i
Apparent anestrus
escape heat
Winter will delay coming into
estrus (photoperiod)
BitCh: fastidious wI minimal vaginal swelling or discharge & little
Delayed
puberty
Walt
mature {2 years:
Cat: failure to start cycling dog} before pursuing
by 13 months
History (age)
Physical exam: intersex ch,,,actenst:ics
Can be difficult to detect silent heat
- Bitch: owner check Vulva closely 2 x
weekly for swelling or bleeding &
present bitch to a male once weekly
DDx:
- EndOCrine test if can't wait 2 years
Poor heat detection
. Progesterone > 2 ng/ml indicates
Failure to cycle
cycled in last 60-90 days in bitches, &
- OVH (ovariohysterectomy)
estrus & mating in cat in last 40-50
- Ovarian hypoplasia/aplasia
- OVarian neoplasia
days
**
Causes (etiology):
- Androgenlprogeslins therapy
- Hypothyroidism
- Cushing's diz, steroid Tx
-Intersex
- Inadequate daylight- cats
- Breed variations
- Season
Poor nutritional status
" Parasitism
- Chronic diz
POOl'
]t~:;:;;
Pubertal bitches (young), can hap- Bitch: signs of proestrus: Hx (young bitch)
pen in any bitch on any heat
vulvar swelling, vaginal CS: signs of heat wlo breeding
- Estrus starts but ovulation or deveJopmentof
CLs fails
bleeding, attract mates
Vaginal cytology, breeding behavior, hor- Retums to standing heat 2 -12 weeks later &
- Usually no breeding
mone evalUation
hormonal events are normal
(no estrus)
P4 assays: low level indicate no ovula- Not shortened interestrous intervals
- Proestrus returns in 2-1 a tion or CL fonnation
- Final or true heat is fertile
- Rarely repeated in same bitch
weeks mayor may not
proceed to estrus
cycles,
False heat
E-hb606; SAP892; IM647;
IM-WW
H2B 688"
5min88;E
'
R-M 468;
A-A 713;
E&A 553,
632
**
from
repeated diestral progesterone influence
~1
(LI
~
Prognosis' Excellent
----~
Ovulation
failure queen
Frequency
of
mating
more
imovulation in some cats
~
portant to ovulation than day of
- HCG orGnRH (Cystorelin) lMon
~
cycle mating occurs in queens
1st 20 days of estrus
Delaysonset of next cycle, doesn't
Ii I I 11)
shorten present estrus
< Than 3 matings Tx: Vaginal stimulation
luteaIP;~
Jd:jJl
**
~~
I
*'
G.
';Jf!jJJ
Short
estrus
12M 655; 1M 649; Cat 1866
*
Silent heat,
Unexpressed
estrus
FN 467; R-M 832; H3B
645; H2B 705; E&R 764
**
/&:i>O
r"
-~
Estrus shorter than 3 days: bitch, < 1 day: queen; Invariably an error in observation; Causes: Poor heat
detection, Split estrus, Age & erratic estrus cycles, Nonnal individual variation
"""",
CS: infertility, perceived short estrus, failure to get pregnant
~C
Dx: Hx, CS; behavior, vaginal cytology, progesterone or LH assay
Prognosis: Guarded
Tx: Correct estrus detection (teaSing wI male, behavior, cytology, progesterone assay) Px: Good
~'"
""?"
'-.c~
--U
Change housing
Don't show estrus cycle, but are Not seen to come Into History ("Nerd queen")
- House "nerd queen" alone or
Physical & reproductive exams
heat
cycling
Vaginal cytology to see if cycling - estrawi either another cycling queen
"Nerd queens" in colony low on
gen comification of cells
social ladder
Serum estrogen: DDx anestrus from
Some queens require presence of
silent heat (expensive)
a Tom to show estrus
- Estrus: > 20 pg/ml
- Anestrus & interestrus < 20 pg/ml
~
Lab data base: CSC, chemistries
Px: Good
'Y:~//[j
~
~143s1
)i="1J
-r-;;}
anestrus,
Silent heat,
Prolonged
anestrus,
Prolonged
inter estrous
intervals
E-hb 606; SAP 928, 892; 12M
854; 1M 645; tMWW420; H38
628,645; H2B688; C11 T963;
E&R 632-3; E 1609; Cat 1865;
R-M 468; R-Fl712
***
Into heat
DDx;
Short interosseous interval
No heat
Ox; Walt 2. yrs, Hx; RIO OVH; PE, Lab, Cytology,
. B. cams, T3 & T4, Progesterone, Karyotyping
Tx. OVH, Estrus Induction
Treatment anestrus;
Cat. Causes: persistent anestrus
I\JJ'JU.........
Bttch: no safe estrus induction method, therefore reserve for pathological anestrus &
stimulate estrus in bitches treated wi androgens to prevent estrus (racing
greyhoundS given testosterone): there is a number of protocols
_ Give FSH (follicle-stimulating honnone/urofillitropin [Metrodin]) to induce estruS
_ Perform vaginal cytology 5 days after vulva swells (proestrus)
_ Breed when 80% superficial cells & give hCG (human gonadotropin
hormone, [Follutein]) to cause ovulation
_ Breed every other day until won't
Cat:
_t Light to 18 hours/day over 2 months, cat will cycle in 4-8 weeks
Housing wi cycling female or exposure to a tomcat helps
Breed when will, as often as will & every other day until won't
Hormonal induction can also be tried: FSH to bring on estrus, breed & give hCG to cause ovulation
, !
..
437
~:sj~
II
Short
interestrus
intervals,
Recurrent
estrus
E-hb 607; SAP 930; 12M
Infertility
Short interval between
estruses < 4 months
Dog
Interestrus Interval < 4 months
Prolonged
heat,
Prolonged
proestrus! estrus,
Nymphomania
E-hb 606; SAP 929; 12M
855; 1M 648; H3B 628; E
1609; Cat 1865; FN 468;
C12T 1073; CIIT 963; AM 468. 830 (f); A-A 714;
E&R63
-c<'i::::z:.1l
DropS[androgen])for3-4months
Suppress estrus for 6-9 months to allow
, :r~
".
_
,,r
Prognosis: Guarded: bitches usually remain subfertile even when eslrus delayed
Hx (signs or estrus obselV9d by owner)
RIO (rule oul) estrogenic treatment
Physical exam - general
- Swollen vuva & vuvar discharge
- Abdominal masses (ovarian tumor)
oVaginal cytology: comified cells confirm estrogen presence
oEndOCrineteSI$:estrogen>15pglmlsuggested
of proestrus or estrus
0Ultrasound: enlarged ovaries (cyst or neoplasia - granulosa cell tumor
.'
Sequelae:
- CEH (cystic endometrial hyperplasia)
CyStic mammary hyperplasia
ft~/_.L
m,asorfr;b;<!'~".d,'/r-:_v:;:"~7=~:;' ~
G_"_ital_fib_'_OI_.;_omyo
__
endometrium to recover
- Breed on next estrus because short interval
frequently resumes (estrus can begin immediately or up to 9 months after Tx stopped)
o Megestrol acetate (Ovaban) not recommended because of progestin effects on endometrium - pyometra
WI--jlj Ovariohysterectomy if nonbreedlng
nosis
**
Dog:
..
~
U- /~
~D!.~ .__ ~~
.."
Receptivity up to 45 days
Estrus lasting longer than 16 days
_Nymphomania (uncommon?)
Aeceptivity up to 45 days
_Aggressive, vicious
Prolonged
o Physiology.
" If bred rarely conceive
_
Normal
ovarian
cycle:
repeated
estrus
(folproestrus or
oCystic follicular degeneration
licular) phases of 7 day duration
Persistent estrus during seasonal anestrus
estrus,
. Intervening interestrus phase
period
_ If follicles form in overlapping cycles _ Weight lOSS. rough. thin hair coat
estrus may be continuous
o Persistent nonseasonal estrus
_ Cause: cystic follicular degeneration of
Cat 1865; F-N 468; E-hb
ovaries
630: E 342; H2S 70S; 1M
_Old. nulliparous queens
64B;IM-'NW 420; E 1695?;
SAP929; R-R714; R-Me3O;
E&R 765
Cat
Persistent
estrus
(..-
///(
/~o
DDx:
EstruS> 16 days
CS: Vicious> Nymphomania, Rarely conceive
Ox: Hx, CS, PE, Vaginal cytology, serum estrogen
Superfecundation F 310
Superovulation, Superfetation
~A
1( "
:;a7r--,~~,'j1\
_he,
F31O;F-N462
-}J
439
(
t"
~'-A
).,,:.'n \
~,,-:;!
)'~
'[)
Ovarian
cysts,
Cystic
ovarian diz,
N'y1 IIpl .... IlCi ia,
anestrusl
- Nymphomania
"'",sl
(Ovariectomy)
I
Attempt to luteinize cyst
- Bitch
-GonadOtropin-releasing hormone (GnRH
[Factrel]) once 1M
- hCG (human chorionic 90nadotropln [Follutel~l) once 1M
- Response expected in 2-3 weeks (Change in
vaginal cytology from comified to noncomified
cells) monitor for SO days after Tx lor pyometra
- Cat: Induce ovulation
. Vaginal stimulation wi thermometer or metall
glass prObe 4-Stimes at 5-20 minute intervals
-- Success indicated by copulatory cry
HCG or GnAH (Cystorelin?) 1M
estrus
,.
- Abnormal structures
FOllicular cysts
Luteinized cysts
Persistent
spay
Dogs> cats
-t
levels> 10 pglml
Interestrous interval
mal
Abdominal radiographs
Exploratory: definitive
/l1li
,) ),
/d2>ij
~~h<.,
~~
DDx:
& kidneys
Prognosis:
,--
Ovarian
tumors,
Uncommon in bitch
common
-/'
Neoplasia
peritoneal cavity
'II'
-CS
- US (ultrasound). radiology
Ovariohysterectomy (TOC)
- Avoid rupbJre of neoplasia on removal
- Chemotherapy may be added to OVH tor metastasis (only palliative)
- Cyclophosphamide
Exploratory - definitive
~~4!
~~----------~-----O!=rr
-.,
Ovarian tumors
- Epithelial tumors
Papillary adenoma: benign
Papillary adenocarcinoma: malignant, metastasize to peritoneal cavity (penloneal effusion), lymphatiCS & dIstant Sites
Cystadenoma: less common benign (cysts)
- Sex-cord stromal tumors
Granulosa cell tumors: #1-cat frequent In bItch
__ Large, unilateral, often palpable; Hyperestrogenism - persistent estrus
. Usually: malignant in cat. benign In dOQ; only 10-25% metastasize
Sertoll-Leydig cell tumors - thecomas & luteomas, rare
- Germ cell tumors:
Dysgerminomas: uncommon, large unilateral, 10-20% metastaSize
Teratomas: multiple tissue types, large benign unilateral tumors, mlb palpable & abdomInal distention
**~
.
rognosls:
~V;~~n--t~;;~~~~~~~~~;;,~~~~~~~::::::::::::::::::::::~~~;;~~~::~~~~~7
. Depends on .tumor
/,
Ovarian -Presenceoffunctional ovarian tissue In spayed - Bitch
Hx (spayed), CS
I~/? +--E-'-P~'O-"-'-O-"-Ia~P-.-'-o-m-y-,-.-,-O-Is-'O-'-O~'.
..-m-.-.-nt
remnant
bitch or queen
syndrome -
- Queen
- Vocalization, rolling, treading or lordosis
- Attract &lor accept tom
- Afopeda
OOx:
Vaginal neoplasia
Vaginitis
Uterine stump pyometra
Trauma
tissue
- Remanent easier to find if animal in estrus,look
caudal to kidney
I~T/~
_
~
/111
-Good"""""',u""
11J
~
L----"""-=..J....-------'------c::!.~------'--"==-=----
~::-
--
prolapse
MSk 1032; Mk 700; SAP
* j}'!</"oR!.'\
Part~1
cervix)
b\
- Vaginal discharge
caM'
- Abdominal pain
- Straining, restlessness
+/- Hx 01 dystocia
- Abnormal posture
Uterus through wlva
Mutilation
not a
Manual
If uterus viable
Requires epidural or general anesthe
sia
- Laparotomy reduction
- Oxytocin after reduction for involution
Systemic ABs for metritis
Amputation II necrotic& can' be reduced,
i I digital
~I~ ~
.....
tion
:4Ii
0'
Hemormagic Shock
form rupture of ovarian
or uterine artery
OOx:
Vaginal prolapse
NeoplaSia (TVT, sec, leiomyoma)
Pm"""""
Congenital
abnormalities
of uterus
Sx-s 442; R-R 720
Uterine
neoplasia
renal agenesis
Uterine torsion
Many asymptomatic
Abdominal distention
Tenesmt.lS
Dysuria
Hemorrhagic vaginal discharge
"-
Vulvar
discharge
12M 865; 1M 654; IMWW 417; H3B 603;
5mln 174, 1142: Dx-L
357
***
_p
"',CS
(f-J)'
l~
]I -'ItJ:.....
(U...
I I
'II'
~~'~'~
~l
see pg 414
OOx
oPalpat;oo
____
Radiographs or ultrasound
Exploratory exploration
Vaginal cytology rarely helpful
10b~~
LJLS
Vulvar diSCharg~:
~ /""'>.;.~. Determine origin of discharge: uterus Txcause
Normal & abnormal discharges
_ Licking
vs vagina & cause
Normal discharge
_ Pollakiutia
.
..,):. Hx, CS
- Proestrus & estrus
Not systemically ill:
Physical exam
- Outing parturition
_ Indicates disorder of vulva, Vaginal cytology: predominant compo_ Postpartum up to 6 weeks - lochia
vestibule, vagina or
nent
Less noticeable in queens
_ Normal
- Comified epithelial cells
Classify by predominant cytologic
- RBCs
, /r~-;
__ =",,""-_-~~/-~
Systemically ill: indicates
charactetistics
uterine disorder
- Pus/PMNs
~/L~
_ Comified epithelial cells
_ Malaise
- Mucus
Normal - proestrus & estrus
_Weight loss
. Cellular debris
Abnormal: estrogen, cysts. ovarian rumor
_ Vomiting
Vaginoscopy: where coming form - va- RBCs normal or abnormal
Normal: proestrus or estrus wtlere predOmi_ PU/PD
gina vs uterus
nant cytology of discharge is cornified cells
_ Fever, dehydration
If uterine disorder suspected
If RBC predominate; abnormal
_ Indicates uterine disorder
- Radiographs, ultrasound
- PUS - PMNs:
Other tests depending on findings
Considered septic il accompanied by bacteria
,,/\ r--.
\"""
~~
::t;: ~
ill
. -
!1~J ~ ~
~ g~e:;u~~~~~~((~~!)
I~\.
'~@' -Mucus
II
jf(:?>1
:~';e;~n:strus or
~_ ~' \~
.~
_ Normal lochia
I
\.
~~ .l'~,,'",Abortion
I=======~~--
Vaginal
edema,
Ii
Hx (proestrus or estrus). CS
Resolves wI end of follicular phase
- Painful mating
Digital palpation of mass just dis- of cycle C
1"/((
S""L;>
Protruding fleshy red mass tal to urethral tubercle
Ovariohysterectomy (TOC) in nonbreeding
Vaginal
r/J fh"
-,"i~"';~~;id,,~,';;sh;;:'~h';;.:;;"",d'.
"",_I' cers
.
Sequela:
Drying,for
fissures
& ul-e /
if protrudes
a tim
cfi>//I
~
cenlrations decline
DDx:
prolapse"
Prognosis:
Excellent wI OVH
Tends to recur each
estrus wlo OVH - 66%
Vaginal neoplasia
Benign vaginal polyps
Vaginal &Jor uterus prolapse
preventing recurrence)
.
.
Hx. CS
-'
vulva)
- Wlo hyperplasia - rare: dystocia, tenesmus,
forced sepafa~on during mating
. Most commonly in cow
(D-
*
*
hypertrophy
C~/Dx; Asymptom~tic;
~rotrusion
dischaf~:)e
--------.j
Inflammation of vagina
Common in bitch. rare in queen
Causes:
Vaginitis
adult
***
I..
/,~(
fV
-,~
,. L
I'"
Q!,,
,_
t~
' 0
I'
-.
B,tch, 2 to ~b~ormahtle~
I,
' ,
fl~
vaginitis,
Juvenile
vaginitis
Mk 681; E-hb 617; SAP
91.; 1M 658; Smlo 174; E
:Nm
0'~
Puppy
r~'"
.Transient. recur
IdiopathiC - 30%
_ Immunological
Sactena. E colt, Staph, Strep, proteus, Pas-
I" -
'-1
I~
.. '/
Sequela:
_ Infertility
"I
(\\
DDx:
~""s
,\
~~
Diestral discharge
~~
~
postpartum discharge
Vaginal neoplasia
Vag,nal hypelplasia
Subinvolution of placental sites
'. !",l(cA
p
Vulvar IiCking
IT
.......
~Al
~~~5
Hx 1 year-old)
CS (vulvar discharge
III!
Prognosis:
Good if correct underlying cause
Idiopathic: good most recover spontaneously but may take years
estrus~_
oj'",.---....,~
Uncommon
Cause:?
Hx. CS
Digital exam: stricture
Vaginal cytology: PMNs (various
stages of degeneration) +1- bacteria, wlo
J;7tJr.
.
(
~
~T_
r{ 6" . /
cosa
,,'
0,",,11"''''''.''"
'od''', "",'oal
neoplasia,
vaginal trauma
;f(
<l
11
Vaginal discharge
Vulvar licking (10%). scooting
Erythema of the vaginal mucosa
wlo blood
-=::.~
-TopICal dO""~;f (G)?~
',~ -.
Prognosis:
- -
446
Congenital vagina disorders: Asymptomatic
common in bitch, rare in cat
Breeding difficulties
stenosis,
Persistent
hymen,
Small vulva
Infantile
vulvas,
Cause:
- Prepuberal bitches, small
- Vaginal discharge
of urine (urine pooling)
DystOCia if pregnant
,/~Q
& in
- Excessive licking
2D vaginitis
Atresia of vulva
~~ \\~11
~~~~
Prognosis:
Excellent
cessed vulva
- Weight reduction - diet
Sequela:
Ascending urinary
tract infections
(3
**
Vulvar
Recurrent
enlargement
SAP 913; R-M 480
& smell
~
. A1
.
Asymptomatic
Urine pooling & perivulvar der
matitis
~vaglmtl~j1
Vulvar
Vaginoscopy
- Licking
**
- Dyspareunia/pain on
copulation
Chronic vaginitis
Vaginal congenital
abnormalities
Hx (young), CS
Digital palpation
t.
Vaginal
&
1.
(C
I I .....
~,/ ~s
Ifl
oHx,CS
Visual or digital exam (rectal 8< vaginal)
Vaginoscopy for cranial tumors
o vaginal cytology not usually helpful (don't
shed cells)
Exclsional biopsy
qP'
DDx::
10 vaginltls/VeStibulltis
Vaginal trauma, laceration
oTumors of distal urethra (sQuamous cell,
transitional cell carcinoma)
oVaginal edema & prolapse
~~1
~
",.
X
P".'''''@''
Excellent lor benign tumors & TVT
Poor for malignant tumors
JTh ?;,,,
pi
:~~~~w:~ata.tropical 8jjU_PI~;~rarely ~
In bite wounds
&
ft
~;> -
'j
r=------::--,--::--::--'
Temperate
climates, Coitus
L.:>3
J
Tx:
CytotoxiC hemotherapy
/clq--=_=::-___
>
rum"
I~
f ! .
,~1
:.:~~~~:;~I
~:~~~~~:tous
( f7h 1
~=gUlnous
,I
LJ
Histiocytoma
Lymphoma
lesions
discharge before tumor
EsI,""
. Urethritistcystltls
- prostatitis
onc~
~'":ethotr~
~,'.~
Cytox
"f-
rIb?1
of(
Male dog
Breeding soundness ex,aml~
SAP 934; H2B 692: Smin 90; R-M 539:
R-A 836, 869: E&R 673; NB 19.2
History:
- General health
- Rectal palpation:
Prostate gland: only accessory sex gland in dog, surroundsneck
01 the bladder
.. Located at cranial rim of the pelvis (may slip Into the caudal
abdomen if bladder distended). elevating the chest & using free
hand under abdomen to Ill! prostate facilitates exam
.. Palpable median septum separates the prostate into 210bes (dorsal
aspect) In all but the very large dogS
&
evaluation
Ehb 618; SAP 935; HSS 635; H2B 694; 12M 899;
1M 687; E 1649; CI2T 1060; Cl1T 938; AM 539;
A-A 836; E&R 674
Indication: artificial insemination, routine part of breeding
soundness exam, evaluate male infertility
Equipment: AV, graduated centrifuge tubes, pipettes, slides.
cover slips, gloves, microscope, cell counter, stains, teaser
bitch
- Daily sperm production: correlated with testicular weight
(large dogs produce more than small)
- Semen collection in cat not usually done In clinical
practice because usually requires general anesthesia &
electroejaculation
progression
- Morphology; stained semen slide smear oil immersion count
100-200 cells
Abnormal morphology: 1" defects of head, midpiece, & tail; ,2"
defects; detached heads, retained cytoplasmic droplets, bent tails
Artificial insemination, AI
E-hb 619; H3S 580; 12M 933; 1M 717; E 1652; A-A 869, 923;
NB , 9.8; E&R 549, 734
Indications:
- First examine (thawed) sample microscopically on a warmed slide for quality & number of
motile sperm
AI in
Cat
Infertility in
dog - male
***
t abnormal spermatozoa)
Presentation/clinical signs
Lack of interest in estral bitches
Preputial discharge
Underdeveloped extemal genitalia
Failure of conception
Small Utters
Abort"Ions
(normal breeding)
Cryptorchidism
Feminization?
Enlarged, hot or painful scrotum
Abdominal mass or pain
Abnormal ejaculate
Azoosperrrua .
or aspennia
. "
- Incomplete ejaculation
P
t
t d
Saln or a~ l;a e pain
tress or fI t
~
.. liver cirrhosis
'J
:
. " Diabetes mellitus
~
.. Metastatic neoplasia
.. Hypoadrenocorticism (testicular atrophy
_60%)
~
.. Hypothyroidism
cKetoCOl1,
azole
Imetl Ine
Cyclophosphamide
Vinblastine
AmphoteriCin B
IK .
Inexperienced dogs
- Retrograde ejaculation
" Rad"lat"lon
~(~...
Bitch not in heat
~
Behavioral problems (submissive, aggressive) - Congenital disorders ~. Heat
_ Inability to mount
. xxv syndrome
./\.
~
Defects of penis
. XX male syndrome
\.1:..;:
.. inflammation
.. Paraphimosis
. Testicular hypoplasia
-- Hernia
...
.. Persistent frenulum
- Acquired azoospennla
__ Environmental
.J
Vulva. or v~ginal disorders
. Drugs
__ Systemic dizs - prolonged fever
Erectlo.n ~allure
.. Antineoplastic, cytotoxic drugs
.. Orchitis orchiepididymitis
1~
i /
l'
Hypot~s.to~teronism
.. HYPopltUitansm
.. Hypothyroidism
.. Hyperestrogenism
.. Hyperadrenocorticism
.. Drugs
~
J -t.
.;
'
.. Diethylstilbestrol
.. Tamoxifen (NolvadeX) citrate
Glucocorticoids
.. Anabolic steroids
.. Anti-gonadotropin releasing hormone
analogues
fA"~
.. Spironolactone
No breeding or offspring
Ox: Hx, PE, B. canis, T3 & T4, Semen
CS: No libido, No conception, Cryptorchidism, etc.
Tx: Tx cause, Monitor semen .Px: Varies wI cause
Sexual overuse
Infertility wI sperm In ejaculate
- Oligozoospennia
- Teratozoospermia
_ Asthenozoospermia
Bruc~lIosls
.. Immune mediated
.. Scrotal dermatitis
. Duct occlusion/epididymitis
. Testicular tumors
Tumors of hypothalamus or pituitary
. Hormonal disturbances
. Endocrine dysfunction (pituitary dwarfism)
~')""_~ -------------------------~
---
~;-'.
i'\~'
Diagnosis - infertility:
CBC, chemistry, urinalysis: for
Honnone assay
underlyln~ systemic d~zs & specific repro dizs
. --- Serum te, sto, sterone concentration:
~
History: general health, management & breeding
B. cams screening for All dogs (male &
to differentiate from castration & cryptorchid
~
practices, past breeding periormance, previous dizs,
female) presented for reproductive problems
- Scrotal testes: >1,000 pgfml
drug administration
- Rapid plate agglutination test - accurate for negatives
- Cryptorchidism: 2()()..I ,000 pglml
- Retest positives - TAT
- Bilateral castratIOn: 25 pglml
- Systemic diz in last 6 months
- Eliminate all positives form breeding program if not from thiS earth
- FSH (follicular stimulating hormone) Indicator for spermatogenesis,
- Exogenous drugs (current & previous)?
Thyroid function (T3 & T4 levels or TSH stimulation)
pituitary-gonadal function, assays not readily avaIIC"~";"''T''''rf
Trauma, stress?
b
I"
h I
Normal"" 20-130 ng/ml
'
II ectlon: num er, motl ity, morp oogy
5
emen
CO
Active acute testicular degeneration = 130-250 ng/ml
- Breeding' practices: mating management
Nonnal1y
milky
white
~
Severe
testicular
damage
=
>250
ng/ml
thoroughly established before subjecting a
Green tin! Infection (wI or wlo clumps, clots or Hakes'
-lH (luteiniZing hormone) n5eS wI testicular dysfunction,
stud to ngorous & expenSive medical workup
Reel hemorrhage
take multiple samples 20 minutes apart
Past breeding performance
- Volume (for total sperm # calculation)
.... Radiography: for prostatic enlargement
.. LibidolBreeding behaviorlMating ability
.. Recently sired litters, litter size?
- Motility: >70% progressive linear motility
Ultrasound: for testicular neoplaSia, prostatiC btopsy
.. Previous semen evaluation?
- Morphology: >80% normal for fertility
Testicular biopsy if pefSlstent azoospermia or oligozoospermia
Mating protocol
- Numbers: > 200 million In ejaculate to be fertile Epididymal aspiration for obstructive leSions, Indicated If palpable
.. Ovulation & breeding timing technique - predetermine day of
-Infertility diagnosed only if several samples over 6
abnormality 01 epididymides
~
season? behavior? vaginal cytology? progesterone?
- Weigh against posSible sperm granuloma
O~- ~ ;:7Y
Breeding history of bitches that don't become pregnant?
months abnonn~1 for mOtil~ty, morphology or number
Facilities, housing?
Overuse of stud?
- Other tests on eJ.acul.ate. .
II
Treatment:
""
"~"
_:~_
Inferlility in related dogs?
~ . Cytology f~r epltheltal or.lnflamr:'atory ce s
Base treatment on specifiC dtagnosls --Elevated tOXIC wee - suggest IflflammatlOCl
..
.
Infertility in other dogs & bitches in kennel'~ti..~{
Physical exam:
0~t
Abnormal epithelial cells - prostatic neoplasia
Treat specifiC dlzS
- General exam: thorough & include all
~
. Aerobic bacterial culture & sensitivity (>10,000 suggest
Consider:
body systems (e.g., hip dysplasia, systemic diz)
genital infection < 10,000 suggests urethral contamination), not
- Surgical corrections (hernias, torsion)
_ Scrotum: dermatitis, adhesions. tumors
diagnostic for Infection.
..
.
- Thyroid supplementation
.. Culture of sperm rich fraction of ejaculate - for organisms
..
.
Measure scrotal width compare to body weight (E table 127-1)
originating in testes or prostrate: normally < 100 bacteria Iml
EmpIrical honnonal regimens often unhelpful or
- Testis: check for 2, size. symmetry & consistency
.. Cultureofprostatlcfractlonmorespeclficforprostaticorganisms:
deleterious, use only as a last resort after complete
Cryptorchid, orchitis, tumor, degeneration
+nO~alIY.< 100 ~acteria/ml . .
diagnostic evaluation
- Palpate epididymis, vas deferens & spermatic cord
. _ Virus Isolation for cantne herpes VIruS maybe
Monitor semen every 2-3 months
for abnonnalities shouldn't be painful
. MycoplasmalUreoplasma .cultures
.
_ Spermatogenesis requires 62 days
- Penis & prepuce: nonerect & erect: freely movable, pinkish,
. Semen pH - normally 6.3-7.0, for antibodies (basic AB for aCidic
d
smooth, nonpainful mucosa, mild discharge normal
prostatic fluid)
- Epididymal transit - 15 ays
Persistent frenulum, foreign bodies, trauma, neoplasia, folliculitis, Seminal alkaline phosphatase concentration:
- Requires abnormal spenn for 6 months to diagphimosis, discharge
marker for completeness of ejaculation
~
nose as infertile
- Os penis: palpate tor fracture, congenital deformity
- Normally 5-40,000 units/l, if <5,000 may not have
_ Rectal palpation & abdominal
completely ejaculated or obstruction distal to epididymis
+1_ Scanning electron microscopy: ultrastructure sperm defects
Prognosis: varies wI cause
Prostate gland: normal:symmetrical.smooth&firm,nonpainlul
Potentially reversible: drugs & toxins, high tempera, Pelvic urethra
ture, infections
L-,"_p_e~l~v~iS_ _ _T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Many poor to guarded despite appropriate treatment
J \
!:: a
e __ ...
--t
452
Infertility
-Unabletobreedorproduce
in tom
i
~.8'
Cal 1852; F-N 467; F
~~ :::9~~:;2:
" .
::;O~:-'
-Lackofinterestinestralqueens History:
breeding)
Small litters
Congenital defects in offspring
.,
.....". Underdeveloped
external geni-
.:::-=-~
.. Ubldo & breedin9 behavior
.
talia
Cryptorchidism
.. Mating ability
.. Recently sired IllIers
.. Number 01 kittens?
. Mating protocol
_
Sperm quality or quantity not
er\
Inexpenenced
/
Queen not in heat
Behavioral problems (submisSIVe,
aggresSive)
Stress
--efeed..
Caged tomcat
-Inability to mount & achieve
Intromission
Hair rings at base of penis
Vulva or vaginal disorders
- Poor libido
Behavioral problem
(incompatibility, dominant Queen)
Hair rings at base of penis
Frequent copulation doesn't decrease libido in cat
Cryptorchidism
Endocrine d,z not common
Hypothyroidism (infrequ nt)
Estrogen administration
Nutritional
/;
_ Malnutrition, obesity
- Hypervitaminosis A
_ High liver intake
Congenital defects
Prepuberal
gonadectomy
Sx4B496,511
Early age neutering before sexual maturity
lID/J2
Infertility in queen
Poor breeding management - timing
Castration/Orchidectomy in cat
Procedures:
- Dorsal recumbency, aseptic prep
- Incise skin & ventral abdominal wall from umbilicus to pubis, avoid
prepuce
Locate ectopic testicle by tracing one of following:
. Ductus deferens from prostate
. Testicular vessels from aorta & cauda! vena cava
- Double ligate testicular vessels 7 dUctus deferens & transect distally,
remove testis
- Routinely close ventral abdomen
- Submit testis for biopsy
& suture
SAP 883: C12T 1037: Sx-G 294: Sx-WW 178: Sx4B 58; Sx3B416; Sx-Shb 452
Procedure:
- Dorsal recumbency, aseptic prep prescrotal area
Avoid clipping or scrubbing scrotum (irritation)
- Incise pre scrotal skin on midline as push 1 testis toward incision
Incise sa & spermatic fascia to expose parietal vaginal tunic
- Exteriorize tunic covered testes & cut scrotalligamenVJigament. of tail
of epididymis
- Reflect fascia & fat up spermatic cord wI gauze sponge
- Closed technique:
Double-ligate intact spermatic cord & vaginal tunics wI a transfixing
absorbable suture (don't cut parietal vaginal tunic
Transect spermatic cord & cremaster muscle distailo ligature (thus
never opening vaginal/peritoneal cavity:
- Open technique:
Incise parietal vaginal tunic (thus opening the vaginal cavity which
connect to peritoneal cavity)
Double ligate spermatic cord wI transfixing absorbable suture
Ligate parietal vaginal tunic & cremaster muscle wI an encircling
ligature
Transect spermatic cord, parietal vaginal tunic & cremaster muscle
- Routinely close sa tissue (simple interrupted/absorbable) & skin
(simple continuous subcuticular pattern/absorbable or routine skin
closure/monofilament)
DDx:
- Testicular hypoplasia
- Segmental aplasia of epididymis
-_. . -
libido:
_Poor
Change
housing
~.~
I
'7
"7~....o."
J.
-Thyroid supplementation
. Queen's fertile
_.. Facilities, housing
':(
. Infertility in related cats
. Infe~hty In other toms or queens In kennel?
PhYSical exam
- General exam thorough & Include all body systems
_ Orchitis
-<
_ Effusive FIP infection of scrotum
...
_ _ _ _ _ _ _ _ _---"_ _ _ _ _ _ _ _ _,
rt
Base Tx on specific
Cat 1894; SAP 884; Sx4B 521; Sx-G 38: Sx-S-hb 452; Sx3B 420
Procedure:
_Position in dorsal recumbency at end of a table, let tail hang down
- Pluck hair of scrotum and aseptically prep perineum
- Incise scrotum over each testes & expose testis
- Incise parietal vaginal tunic (open) & excise it
- ligate spermatic cord
1. Separate ductus deferens from rest of spermatic cord & tie 2
square knots with ductus deferens & rest of spermatic cord or
2. ligate spermatic cord wI absorbable suture
_Transect spermatic cord & ductus deferens distal to knots
- Do nol suture scrotal incision
_Traction avulsion technique is used by many veterinarians because
of its speed, if you wish notto dofor your new boss become proficient
& speedy at other techniques
Testicular biopsy
SAP 882, 935: E-hb 621: Cat 1898; E&R 687
1()
Procedure:
Dorsal recumbency - septk prep of prescrotal area
- Incise skin just cranial to scrotum
- Incise parietal vaginal tunic& tunica albuginea of testis
- Excise bulging testicular tissue wI razor blade
Close tunica albuginea (absorbable suture) routinely Close skin
(nonabsorbable suture)
Bouin's or Zenker's fluid fixation
Postop complication: hemorrhage, infection, local
& atrophy
Infertility
Breeding
management,
Normospermic
infertility
SAP 933, 937; H2B
H38 631; 12M 90S. 909; 1M
692; R-M 832(1); R-A 789
***
**
Lack of
libido
Failure of
management
any management
problems
practices, past breeding performance, previous dizs,
drug administration
Check heat detection
~ Breeding practices: imperative mating management be thor- Switch partners
oughly established before subjecting a stud dog to rigorous & expen- Patience in retraining nervous dogs
sive medical workup see preceding page)
Past breeding performance (Ubiclolbreeding behavior/Mating ability)
Mating protocol: Ovulation & breeding timing technique
Breeding history 01 bitch?
Facilities. hOusing
Overuse of stud
- Assess libido:
Maximum in own
~ In foreign territory
~ Dominant female
Age
- Pain, stress
~ Inexperience or frightened
~ Hypothyroidism
Doesn't like
Prognosis: Good
Causes: prior castration, May be to young - prepubertal, Timid inexperienced dog, Testicular atrophy or degeneration, Intersex condition, Congenital
disorders (penile hypoplasia, hypospadias, persistent frenulum, preputial stenosis), Pain (orchitis, prostatitis, fractures of os penis)
~~
"<,-
erection
SAP 936; E&R 694
Hx (age, experience, timidity); Physical exam (check lor castration, genitals, & other causes): Endocrinetesting: testosterone concentration, Karyotyping
If intersex suspected, Testicular biopsy for atrophy or degeneration
__
Tx: Ensure female in heat, Ensure male mature, Correct
causes;
technique viewed so animals not intimidated
__ __
-=Erection wi
failure to
Cause: Pain causing loss of erection & interest in sex, Analgesia, as penis fracture, Retrograde ejaculation, Blockage of vas deferens
CS: Infertility, Erection wffallure to ejaculate
Hx: pain causing loss Of erection & interest in sex; Physical exam: RIO penile analgesia or os penis fracture; Exam(ne urine after breeding (If spermatozoa indicates retrograde ejaculation,
Elevated alkaline phosphatase suggest blockage of vas deferens: Testicular biopsy on azoospermlc dogs lor seminiferous tubule func~on assessment
Tx: Surgical correction of outflow obstruction; Retrograde ejaculation: Sympathomimetic agents (pseudoephedrine or phenylpropanolamine) Uttle data on success
axis;
wolflian duct system - atresia: Intersex
CS: Infertility
Ox: Hx: CS; PE of extemal genitalia (intersex); Karyotyplng; Gonadal biopsy: Ultasound: evaluation of Intemal genitalia; Laparotomy/laparoscopy
Tx: None
eiaculate
SAP 936
Congenital
infertility
12M 90S, 909: 1M 696
Oli
OS
Azoospermia
12M 907: 1M 69S, E-hb620,
H2B 691 R-M 552 833 (F)
RR 873: E&R 7 2 2 '
***
/i.
\
dog;::: 10 Ibs
~
Azoospermia: complete
absence of sperm
~
\2:
:-.
. Overuse
~ Incomplete
pathoIO~y:
collection _
(\
~\
Iii
dlscovere~
collection
- Never deem a dog mfertlle based on a Single evaluation
: > } . Collect males In presence of owner, In hiS own surrounding~
..J
- Reevaluation at several weekslnteJVat may be necessary
r. --
tf.\
pe
or
--]-
"~
J~
0fJ V
... -
r-J'~
--.....t::B.i~
\~-;.~
JiZ'f"l
(1'- ";\ ~)-. Laboratory: CBC, chemistries, urinalYSIS for meta~ Prognosis:
(-:J.
C0~~'
__........
.
bolic, endocrinopathies or infections
Guarded
~ AnaboliC steroids
Urinalysis after ejaculate for retrograde ejaculation Reevaluate every 2 months for year
~ SpermatogenesisJtesticular degeneration
Seminal alkaline phosphatase: if low, may indicate incomplete ejaculasince recovery form testicular insult
Heat (inflammation, fever, environmental tempera~
tion or. obstructi~n distal to epididymis
takes 62 days
ture, cryptorchidism, scrotal dermatitis)
Testicular bIOpsy: Int~rpretation m~st be done by an expert
Oligozoospermic males may be
Metabolic disorders/endocrinopathies
- Stem cells (spermatogonia) damaged In basal compartment of the
subfertile rather than infertile
I t
sive forward motility (#1 cause is toxic contamination: urine,
Damage at cOilectiorJhandling)
~ R etrograd e eJacu a e
water. detergents, lubricants, ethylene oxide or formalin);
.Abnormal motility often associated with defects 01 midpieceltait
~ ProstatiC diz ~ obstruction
congenital (Kartagensr's syndrome - immotile cilia)
Retrograde
.
I t
eJacu a e
1M 696; E&R 732
,0~~
\..~
<\.
_Cystocentesis better?
;:;(~\
-'-:::::::::-<l!ll'''-.:\'.'CY:'l;'-
/1
m~
'--::da4j
-1f. .u...
bladder rather than out the ure- Semen evaluation; Low number of sperm
@).?II ~ thra
Urinalysis: excessive sperm in urinary bladder after ejaculation
a MeMrl
Scrotal
dermatitis
SAPS77; H.3BS12; E&R710;
Sx-S-hb 456; DDx 369, 370
**
-Most
-Pain
-Swelling
Licking of scrotum
to scrotum
-Uncommon
Don't castrate dogs through
tes
Dermatitis (Brucellosis?)
Laboratory: CBC, chemistry, urinalysis:
for underlying systemic dizs & specific repro
d"IZS
Semen collection
- Motility: >70% progressive linear mo~lity
- Morphology
Scrotal
neoplasia
SAPS7S; E-hb632; E 1700;
Sx-S-hb456, 452; R-M 563;
E&R 71 0; DDx 370
*-**
Mass
Types
Ulceration
/~Z?
Highly malignant
CS: Mass, Ulceration
Ox: Impression, Biopsy
Tx: Surgical excision
Scrotal!
inguinal
hernia
SAP 877; E&R 709; Sx-S-hb
171; Emrg425
**1
Big scrotum
Tx: Sx & Neuter
Prognosis: Guarded
Sx correction immediately to
- Enlarged spermatic cord & _Physical exam of scrotum & sper~
oSee GI10S
avoid strangulation, Transfixing
matic cord
_ Herniation of abdominal orscrotal contents
ligation
of hernial sac
Manually
try
to
reduce
&
feel
hergans or omentum through the - Pain, swelling
nial ring, often unable to reduce Bilateral castration recommended
inguinal canal
to prevent recurrence
- Ultrasound
- Congenital or traumatic
- t Incidence of
testicular tumors
DDx -tScrotal size
lilt
SAP 937
-Inguinal hernia
- Testicular torsion
- Testicular neoplasia
Orchitis
- periorchitis
- Epididymitis
- Sperm granuloma
- Hydrocele
- Hematocele
- Scrotal abscess
7:~
~l
~ '~")'
-b
'~
Prognosis: Good
Hidden testicle
M8k 9S6; E-hb 62S; SAP 877,
sso; H2B 649; H38588; 12M
915; 1M 702; 5min 490; Cat
1851, 1896;A-M541 ,831 (F);
A-A821; Sx4B522; Sx38421;
Sx-WoN 175
ml/It
-Inguinal canal
Lateral to penis
."
V.
yJ \
.--:-_ _......_Sert_oli_ce,,_tum_ors_&t_orsi_on----L.-----,
It:,1~1
L.
Testicular
hypoplasia
tubular o Small:
Abnormal development of
ii
germinal epithelium
testicle at
Infertility
- Reduced sperm number & infertility
testicles
Purebreds predisposed: Yorkshire terrier, Pomeranian, miniature & toy poodles, smaller
breeds, boxers, Pekingese,
"",,,ny 'k'TIr.;
system
SAP877
Results In Impaired transport of sperm to urethra; Accumulation of sperm proximal to obstruction; "";,,~~, " ....'v,.!
CS: Sperm granuloma, Testicular degeneration
1'ttS8~:_.ddi::]~l
Tx: Neuter (spay/orchiectomy)
~
Intersexuality,
Intersex
__~~~__~
No curative treatment
Intersex disorders can lead normal lives
Medical: ointment for urine scalding, antibiotics for urinary tract infections
Surgical: for minor defects causing urine
scalding: clitoridectomy
'Neutertominimize riS\( of tumors & pyometra & abnormal behavior
~,
Abnormalities of phenotypic sex,
Pseudohermaphrodite
XXV
Prognosis: Good for life
XV
Chromosomal defects
xxv
XO
xxx
xx
Orchitis!
epididymitis,
- Pain, heat
- Swelling
- Licking of scrotum
- Anorexia, listlessness, reluctance to walk, fever, stiff or
**
Brucella canis
Direct trauma (puncture wounds, licking) #1
for acute
Compare size
Irregular surface, nodule or adhesions: chronic
inflammation. infection or neoplasia
Firm hard testicle: neoplaSia or acute orchitis
Pain: acute orchitis or testicular torSion
stilted gait
Chronic granulomatous orchitis:
Seamen .evaluation
Orchitis
testicle
~ Slow, progressive, low~grade,
nonsuppurative inflammation wI
fibrosis
Bacterial cultures:
&
DO.:
Testicular trauma
Testicular neoplasia
Immune mediated orchitis
Testicular torsion
Urethritis
Prostatitis
~ ----/
Dog> cats, #1 B.
CS: Pain, Heat, Swelling, Licking of scrOlUlm
Dx:Hx,CS,PE,Semen,Cultures
Breeding animals
- IV fluids, ABs
- Cold compresses
- Anti-inflammatory agent (corticosterOids,
aspirin)
- Unilateral orchiectomy to save unaffected
testis
Castration:
Wounds
- Brucella-positive dogs
- Sperm rich fraction of ejaculate - for
Self mul:ilalion~
~ Chronicity: atrophy. fibrosis
cosides
Cephalosporin or oxacillin for staph resistant
Ampicillin, amoxicillin, clavunate-amoxicillin, chloramphenicol
~ Castrate (ovariectomy) once stable
~~
~~ _~.
esc
Urinalysis (UA)
Biochemistries
Fungal cultures
Cytology: fine needle aspiration
- Differentiate purulent from
granulomatous inflammation
Castration & histopath
::-L
- Severe testicular abscesses &lor necrosis
- Nonbreeding animals
__
===~~~
~--=
__
~T_X_:_A_B_s~,c~a~s~t~ra=te~.=p=x=:G==ua=r~d=ed=-____-ll__~
______.~~_-=::::====::======~~~~~~::~ ~~
Immune
mediated
orchitis,
Autoimmune
orchitis
SAP 878; H3B 590; H2B
651;E-hb630
Hx (breeding)
Physical exam
- Palpate: size,
shape & consistency
- Compare size
- FIrm hard testicle: neoplasia or acute orchitis
Culture for B canis all males presented for reproductive failure, chronic scrotal dermatitis or orchitis
- Serum agglutination test for screening, conllrm wI
agar gel immunodiffusion test
Seamen evaluation
Cytology: fine needle aspiration
- Castration
No curative treatment avatlable
Immunosuppressive steroids lead to infertility
- Prednisolone, Cytoxan, Imuran
Evaluate related dogs for hereditary
1-'_T~
__ru_'_,,_a_lro_p_hY______/ "C3.~OOc~==~"4J=ft::====)5~~i4-ro
PrognoSis: Poor for fertility
Age related change in testicles due to cessation of sperm production
Cause: unknown
-Infertility
'H,
NO effective Tx
None
DDx:
Trauma or Infectious atrophy
Hypothyroidism
Hyperadrenocorticism
J;~i~Cles
-A~!~~~:
se~~i~r~s
~:~~!~~m~h~eriCin
*
I
es,
,"",so
0''''0.''0' 01
q""Ii~; I_tlt~
Condition
Facts/Cause
Presentation/CS
Trauma to
testicle
Diagnosis
Treatment
~X:;b452;DDX372
/j('>d,-'_ -
idymitis~(
I
'
q~
Endocrine
d iz -.
.
~i'~
, ~,i"
?<e:/~~7-':;
;:<;":.."
I ."._l
'if ~ht.l~Endocrin8diZ&testlCI8S
testicles
;;'P8"
=_-,-:""""'_
~ ~-.-.,.,~,
:~:o;~:;.~~~"'
ff!~:~
. HI" "".oortl,.", '. .
.'
~lOw
-.,~
.L.w.,hI,",M"",,,,""""".""''''''"
'
T esticul ar
torsion
'2:
(hyperadrenocorticism," ,hypoadrenocortlcism)
'I'
Skin disorders
~
".,
47
:~oS~~:i~~~~rease:
"m,".ma~ ~
~\'-,_
.Je\~t7.",,7{:."')~'
~"'ddf-:~"~
~~
~
~
'
;'
;-~-
r I~
Prognosis: Poor
Abdominal torsion
- Stabilize - fluids
-Immediately neuter (spay/orchieclomy)
Intrascrotal torsion: castration
OOx:
Scrotal torsion: acute orchitis, blunt trauma, necrosis of neoplasia
Abdominal tOrsion: other cause of abdominal pain
Partial or chronic torsion: testicular neoplasia
Prognosis: Good wI surgery
Testicular
tumors
.+
*- ***
_ Castration/orchiectomy unilateral or
bilateral:
- Usually complete response in 3 months
_ May not reverse myelosuppression of bone
marrow
Cases of metastasize are unusual
- Cytotoxic chemo: vinblastine, cyclophosphamide & metotrexate weekly - 50% tumor reduction - at least several months of Improved life
Monitor for hematological changes (CBC) & metastasize at 3, 6 & 12 months
- CS: feminization
Physical exam: palpation of mass
in testes, diffuse or discrete nodule
- Ultrasound of testes If not palpable
- Bone marrow depression:
Myelotoxlcosls (10-15%) anemia (erythrOid
hypqllasia), hemorrhage (thrombocytopenia)
& Infection (granulocytic hypoplasia)
CytOlogic aspiration (rarely done)
Stained preputial swab: epithelial cell
influenced by estrogen - comification
- Castration: excised testicle: appearance of tumor. Histopath: definitive
- Chest & abdomen radiographs for
metastasis
Prognosis:
- Serum levels or estradiol, _ Good for reversal of feminization
progesterone or testosterone
Poorfor bone marrow changes 30%
CBC for blood dyscrasias: anemia,
recover
thrombocytopenia
Metastasis: grave
--o:-~
~.~~
~--b
(l
Seminomas
Rarely metastasize 5-10% to regional lymph
nodes & abdominal viscera; Location: 75% in
scrotal testicle, 25% in abdominal testicle
***
:=~:~~~OSiS
~~
Mild glandularhypospadias -surgical reconstrucSAP 886; E-hb 628; H38 609; H2B 669; 1M 700; 5min 1058, 718; RM 549; E&R 691; SxShb 453; Sx48 529; Sx38 426; DOl( 372
tion of urethra
.Rarecongenltaldefect.but#1extemal Urethral opening ventral & caudal to oHx(young)
Severe deformities: urethrostomy & castration wI
genitalia anomaly
normal position
PIlysical exam (PE): incomplete prepuce ventrally
excision of rudimentary penis, prepuce & scrotum
Developmental failure of genital fold to - Mib found in perineal region
Catheterization of penis
C
{fif
5i> :>
ruse
Asymptomatic mlb
Associated defects
Cause: exogenous progesterone or Underdeveloped penis
Cryptorchidism
.: Diphalia
estrogens during pregnancy, (nad Incomplete prepuce ventrally
Incomplete scrotum &prepuce (ventral)
equate androgenic stimulation during Urinary incontinence &lor urinary scalding
1M 700; E&R 692
Persistent
Mullerian
structures
fetal development
of abdomen & perineum
Duplication of penis
Unilateral
renal
ageneSis
(~So
terrier
Prognosis: Good
Reported in 2 dogs
, Rare in dogs 8. cats
o Hx (young)
o None needed If no clinical signs
Penis Shorter than prepuce
Breeds: Great Dane, collie, cocker Asymptomatic
Surgical enlargement of preputial orifice if urine
Physical exam (PE): of penis. testes
spaniel, Doby
pooling
+1- Urine pooling in prepuce
Karyotype
Normally associated wi female
- Irritation &Infection of prepuce
Histopathology of gonadal Hssue
SAP 886; H2B 669; 1M pseudo hermaphrodites
Urinary incontinence &lor urinary scalding Serum H-Y assay (not generally available yet)
- 78- chromosome individual wI XX
700; R-M 549: E&R 691
of abdomen 8. perineum
karyotype
Dysuria, hematuria
81ateral cryptorchidism
Prognosis: Good (dog not concemed about size)
Hypospadias
Gll.'' .',
e.,".n
None needed
Persistent
penile
frenulum
SAP 886. 891: H3B 609;
H28 669; 12M 912; 1M
700; R-M 549; R-R 795;
Sx-8-hb 454; Sx4B 533;
E&R 691; DDx 373
**
Os penis
deformity
Uncommon congenital
defect
Band of connective tissue
from ventral tip of penis to
prepuce
- Normal ruptures by puberty
Breeds: cocker spaniels. miniature
poodles, mixed breed dogs. Peking-
'"
c~
Congenital
Deviation 01 peniS
Asymptomatic
Surgical correction
Hx (young)
- Cut wI scissor
Hindered extrusion of penis Physical exam (PE)
~ Control bleeding wI pressure
Deviation of penile tip ventrally - Hindered extrusion of peniS
- Deviatlon of penile tip ventrally or - Short acting anesthetic
or laterally
Unwillingnessorinabilitytocopulaterally.I~
$= ?
/,(,(!
late (pain of erection)
Inability to extend penis
Urine pooling in prepuce
Pain on urination
Urination on medial aspect of
hindlimb - scalding
Excessive licking of prepuce
Prognosis: Good for natural copulation
(:7~
;'jj
. jpY\
465
..
-------
Depends on severity
-None if non-breeder 8. doesn't cause paraphimo
sis or dysuria
- Severe: fracture & straighten
Phimosis
(can't protrude) MSk 1042: Mk 683; SAP 886, H3S 610; HB 671; 12M 913; 1M 700; Smin 989; RM 549; AA 793; E&A 692, 767 (F); Sx-S-hb 455; Sx4B 531; Sx3B 428: 5xG 304; DDx 372
**
Paraphimosis Can't retract penis into pre- Can't retract penis into
puce,commonlyoccursaftercopulationor
prepuce
(can't retract)
M8k 1042; Mk 683; SAP
semen collection
Pain of erection: won'l or can't male
888,890; H3S 610; H2B Causes:
670; 12M 913; tM 701;
5min 989; R-M 550; R-R
802; E&R 692, 767 (F);
Sx-S-hb 455; Sx4B 531;
Sx3B426; Sx-G306; DDx
372; Emrg 425
**.~I~,,'l:-<'__
I
Prognosis: Good ~
Hx (young), CS
Physical exam (PE): visualize
_ Palpate penis & os penis
Radiology: os penis defects
~
t,;
/ _ _ _ (,
"-- fl:):
......,
"
Phimosis
Abnormally short prepuce
Hematoma of penis
PnaplSm,
\f;~l1
t.,.j
; @',l (
*. Persistent
penile erection
sexual excitement
Persistent
~)
___
I!t>-t
~
Trauma to
penis &
prepuce
SAP 886, 887; H3B 614;
H2B 673; 12M 911; 1M
699; Cat 1652, 1892; RM550; H2B667; RR 775;
E&R 695; Sx-G 310; SxS-hb 454, 455; Sx-S
1341; Sx4B 527; Sx3B
38'1423; DDx ~73; Em r9
Causes:
- Falls, fighting injuries, blows,
hit by car, mating
- Strangulation (malicious rubber
bands amund penis, cat hair)
- Foreign bodies: Grass awns
Contusion, laceration or puncture wounds
Fracture of os penis (see below)
Bleeding
Swelling, hematoma, bruising
Dysuria, hematuria, stranguria,
anuria
Systemic depression
Balanoposthitis: perpetual discharge
Paraphimosis (inability to retract penis
into prepuce) rubber band
- 2 urethral obstruction
Excessive licking
425
"Cause: trauma
Sequelae:
- Urethral blockage
- Anuria
Urethral
problems
m. .
~
~t ~Y[,~
Common
CS: Bleeding, Swelling, Dysuria, Paraphimosis
Ox: Hx, CS: licking, PE
Tx: Stop
Clean, Suture, Prevent
Fracture of
the as penis
Prognosis:
Guarded
~idJ
~
urinary bladder
-Emergency cystocentesis
-Catheterization & lavage to prevent urethral stricture postoperatively; Antibiotics (ABs)
"Consider urethrotomy or urethrostomy -temporary
or permanently
t-. ..~
Amputation if severe
" Uremia
Radiology
Urinary catheterization or
retrograde urethrography
for urethral involvement
I!
Prognosis: Guarded
system
Mastui1Jciti(~l- ~
")
----
:;;:..-
Fistulas 369
Hypospadia 369
Urethral prolapse 369
_____
Neoplasia 370
StenOSiS or stricture~370
.
Trauma 371
f -z.
Urolithiasis 372
).r-';f):
FUS 374
I dJ
c!J!j
\Co'
01
- Papillomas
- CarCinomas
- Occasional tumors
in dog, Rare
- Transmissible venereal tumors
Hx, CS
Large: penile amputation,
- Physical exam (PE)
Biopsy: TVT: large round cells wI
scrotal ablation
numerous mitotic figures
Chemotherapy: Vincristine
(contagious)
(Oncovin)
**
Balanoposthitis,
Inflammation of
penis & prepuce
M8k 1042; Mk 682; SAP 886;
HSB6t1; H28671; 12M913;
Hx:
trauma, bleeding problems
Physical exam (PE): complete
- Small amount of green preputial
discharge normal
- Excessive: further investigation
- Penile mucosa: pinkish white, smooth &
nonpainful
- Rectal exam to RIO (rule out) prostatic &
urethra diz
charge
t----- Balanoposthitis
Yellow-green preputial discharge
- Small amount considered normal
- Excessive: further investigation
Excessive licking
*
Prostatic
neoplasia
M8k 1047; Mk696; E-hb626;
SAP865;H2B631; 12M 922,
924; 1M 709; IMWW 357;
Rare
- Adenocarcinomas & transitional cell carcinoma spreading from the bladder
-Old dogs
- Castration doesn't protect
o Metastasis is common
- Aggressive biological behavior
~~
:J/!}
.... /j
"'11'
'_~
V~~
r'pb
-oJ
4t
,,
-I
oHx,CS
Physical exam - rectal: enlarged, asymmetric
prostate, enlarged sublumbar lymph nodes
Cytology: malignant cells in urine sediment,
prostatic wash, ejaculate or needle aspiration
(usually only consistant wI inflammation)
- Radiography: prostatomegaly, sublumbarlymphadenopathy, calcification of prostate
- Check chest for metastasis
Ultrasound: hyperechoic
Biopsy - avoid if suspect abscess
- Perirectal approach
- Transabdominal approach
cysts
MBk 1047; Mk 652; SAP 865;
Congenital
Extension of cystic hyperplasia
Paraprostatic cysts
mIb assoc wI
Mullerian ducts (uterinus masculinus)
DDx:
Perineal hernia
.fkr;
-
J
Large, Congenital
CS: Prostatic enlargement CS
Ox: Rads - 2 bladders, US
Tx: Surgical removal, drainage, castration
~.
ill
u~"i ';O"Y;':ii:
~~
Hx, CS
Prostatic fluid - usually sterile
- Tenesmus
- Urine retention
Rads - 2 bladders
- Abdominal. distention
- Contrast to tell bladder
Constipation
J--/a~j-'~) from cyst
- Dysuria
~
~1
Ultrasound to determine ongln of cyst
- Push out on penneum
~
paraprostatic
**,
--------.-.
Penile lymphoid
hyperplasia
Prostatic
Tx
DDx:
Urethritis
Early penile or preputial
neoplasia, TVT
Preputial trauma
Prostatitis
;~~
'. ,
None if asymptomatic
.
s 711
Guarded
tialflora)
- Also herpesvirus, fungi (Candida & Blastomycetes)
***
///(
~.:.:,'''.
~ On ovln
Euthanasia
!.
rl':/'
J.,,;
~Prostatic massage:
t,
Prognosis:
Grave: mean survival < 4 months
Castration
1en )
""'~"
;~ ~tP
"" 01
Jj.,4
f..:I"fJ
----;
dizs
page also
160,I32;EI662;CI2T
unknown reasons
Simultaneous multiple diz
processes J: - sible
X-T 479
***
Tx
process
Benign prostatic hyperplasia;
- Tx only if clinical signs present
- Castration most effective Tx
- Antiandrogens
T
-l
Fecal tenesmus
"Ribbon- stool
Dysuria (urethral obstruction)
Urethral discharge (classic sign)
m","p;O;,.,;"
Bacterial prosta~itis:
"' Acute prostatitis
ASs 2-3 weeks
Supportive care
Castration recommended
- Chronic prostatitis:
Eliminate any predisposing factors
ASs- must penetrate prostatic/blood barrier4 weeks
.. 2 negative cultures
Castration for prevention of recurrence
Prostatic abscessatlon:
- ABs, long-term suppressive AB Tx
- Surgical drainage recommended
Prostatic neoplasia:
None effective euthanasia
Urinary incontinence
PeritonitiS or metastasis
. Caudal abdominal pain &lor lumbar pain &lor hindlimb stiffness
- Hypertrophic osteopathy
- Urethral obstrllCtion
- Infertility
~~::=~/'~'/~'
t t t./~'Z::
(../::'S~=~C::::,
__ ./
-- Excretory
urography neoplasia
Prostatic calcification
- Check chest, pelvic area for metastasis
Ultrasound: prostate consistency & guide biopsy
Prostatic aspiration - cytology & culture:
- Pass catheter to prostate Gudge by rectal palpation)
- Aspirate via syringe on catheter (usually only small sample
COllected) useful in very painful dogs who will not ejaculate
Needle aspiration: perirectal or transabdominal
routes (not for abscesses) for periprostatic cysts
Prostatic biopsy: percutaneous (closed) prostatic
biopsy - perirectaJly or transabdominally or during surgery
Ii
~I\
1'1:
~ r
Asymptomatic
(possible in all but
acute prostatitis)
Enlarged prostate
'-
Prognosis:
Benign hyperplasia: GOOd
wI Sx
Prostatitis: Guarded
Abscess: Guarded
Paraprostatic cyst Guarded
Neoplasia: Grave
- - - ------------.- - - Benign
prostatic
hyperplasia
Asymptomatic usually
Tenesmus (defecation~#'
Rectal palpation:
_ Constipation
.~
~ - Large, nonpainful,
in dogs -
BPH,
Cystic hyperplasia
M8k 1048: MK 696: Ehb 635: SAP 865: H2B
626; 12M 921; 1M 707;
IM-WW 348; 5min 389;
C12T 1033, 1103; R-M
556; R-R 851; E&R 71 I;
em 4.22; OOx 560; SxWW 196; Sx-G274; SxS-hb459: Sx-S 1353; X-
_ "Ribbon- stool
Hematuria
NO systemic signs
Healthy dog
perplasia
Aging prostate
~~.
, 11 I
,
:v47:~n~~
I
'*'
symmetrical prostate
i
' .+h
Ur nalysls. - ematuna
CBC & chem: normal
Radiology: prostatomegaly (dorsal displacement
of colon, cranial displacement of bladder)
Ultrasound: normal to diffuse hyperechoic
(parenchymal cavities/cysts)
.
"\..60% of dogs> 6 yrs +
- Urethral dtscharge
Usually no CS
l\:-m .
~s
~c
(.
'~
I
Old, intact dogs
CS: Asymptomatic
Ox: Hx, PE, Rads
~ ":.
\ :'"
'
*.
~.
_
Diarrhea
Prostatic hyperplasia
Prostatic cysts
Do
NOT
use estrogens
({trW
lilt
l.,..../'-
l'
Prostatic cysts
Cystitis
Prostatitis
3k:7,p,(ji'!'Y
~
DOx'
'
. ,
Chronic nephritis
" , .
Diarrhea
Prostatic hyperplasia
r _ _-,::in=m=a:le=d:o:9::S=:c===___
Jk4
\ i", ~
Ss=p
Pro~si'S: ~ ~r.ii~
~~ Good wI castration
Cystitis
'" P9 733
/I(!
l' ..1
DDx:
Chronic nephritis (both >6 yrs)
Rare
Red-tinged urethral discharge
Hx (estrogen), cs
Metaplasia of prostatic co!umnar
Hyperestrogenism signs
Nonpainful prostatomegaty
epithelium
- Alopecia
Abnorrnaltestes if Sartoli cell tumor
Cause: excess estrogen
- Hyperpigmentation
Prostatic fluid: t # if squamous epithelial cells
Sel101i cell tumor, see pg 463
- Gynecomastia
Presumptive dx: Hx, CS, histo of testes (if Sertoli)
- Iatrogenic (exogenous estrogen to
- Pendulous prepuce~.Prostatic biOpsy definitIVe dx
treat benign porstatic hyperplasia) CryptorchId
347;R-Fl852
('; }_.--?),
.
~
~J I'i/:!
Sequelae
- Partial urinary obstruction (rare)
, Dysuria
- Perineal hernia (occasionally)
Squamous
metaplasia
_ prostate
Prognosis: Guarded
Potentialty reversible
Hx, CS
Rectal palpation:
painful prostate,
normal to mildly enl,,,Oi3d
UA (urinalysis) - Gross & microscope
- Hematuria, bacterurla & WBCs
(pyuria)
- Do cystocentesis to OOx from cystitis I
t WBCs & PMNS +I-Ieft shift
Radiology essential:
- Survey & cystourethrogram to
eliminate cystitis
- Cystourethrogram
_Enlarged atonic bladder
- Prostatic ducts & abscesses
fill wi contrast
Prostatic massage not
recommended
LIfe-threatening
ABs 21-28 days (blood/prostate
barrier breaks down, mostABs will work)
culture & sensitivity
- Reculture 3-7 days after ABs stopped,
if + continue ABs for 3 months
Supportive care
Estrogen contraindicated
Castrate after resolution of infection,
diminishes recurrence
Large abscesses
- Surgical drainage (ventral
drainage) + ABs (ABs alone,
abscess will persist)
Concurrent septicemia or peritonitis
- Culture & sensitivity of abdominal fluid or blood
- Fluids & parenteral ASs
- Monitor for hypoglycemia
Chronic***
prostatitis
M8k 1046; Mk 697; E-hb
625; SAP 865; H2B627;
12M923;IM 708;IM-WW
347;GrI71;CI2Tl030,
1105;R-M557;E&A715;
DDx 560; Sx-WW 176;
Sx3B 393; x-T479
Guarded
.~sympt~matic,
n
i
often
Assume all males wi UTI have
prostatitis until proven otherwise, signs attnbuted to prostate
\:
even w/o CS
Recurrent cystitis: UT ~
Cause:
- Dysuria, stranguna
\
_Sequela to acute prostatitis, or
Urethral discharge (constant or
intermittent)
- Develops insidiously
'bb
t I
t'
_ 2 0 to prostatic problems (cysts, ConstIpa Ion - n on s 00
~
neoplasia squamous metaplasia
,
.
urolithiasis)
f ); .
UTI (assume prostatitis in intact
4
(
male wi UTI)
Sequela:
May lead to abscessation
_ Recurrent or chronic UTI
- Granulomatous prostatitis
-Associated wI blastomycosis & cryPt~mYCOSiS - Prostatic abscess
)\ "-rP
_""fj
1f,1
~
~
,>
.-.:.
AsymptomatiC
Acute prostatitis signs
Chronic prostatitis signs
Usually UTI signs
Urethral discharge:
'f
- Dysuria
.,~~
_Tenesmus
~3
Urethral discharge purulent or
hemorrhagic
Systemic signs may be prase, n,t
.
'
i~
DDx:
-Chronlcnephrills
- Diarrhea
- Prostatic hyperplasia
Prostatic cysts
-Cystitis
'
Prostatic
abscess
v Rectal exam
prostatic barrier
- Prostate: variable size, no pain
Long termABs-6wksminimum
CBC & chem,: usually normal
Aecultureurine&prostaticfluid3-7days
UA: pyuria, bacteruria, hematuria
& 1 month afterTx stopped.
.
_ UTI
- Gram +: e~hromycm, cllndamycl~,
oleandomycin, chloramphemcol or tn Prostatic fluid analysis essential for
methoprim-sulfa
diagnosis, but difficult to interpret
-Gram -: chloramphenicol, trimethoprim_ Ejaculate or prostate massage
sulfa or carbenicillin
lffails;ABsfor3months-trimethoprimInflammatory cells & bacteria
sulfa, or carbenicillin
- Quantitative culture
Castration
Definitive: prostatic biopsy
- Prostatectomy (difficult,
Radiology: calcification mlb
postop incontinence)
Ultrasound - hypereChol
tB -
~
b
Sequela:
'.
Rupture & peritonitis
'
- Fever, Pain, Vomiting .-'~
Icterus
473
~~
Hx, CS
Palpation: prostatic enlargement
-Asymmetrical wI varying consistency (cobblestones). fluctuations
- Pain (peritonitis more than abscess)
- Palpation causes urethral discharge
Prostatic fluid: septic, purulent,
bloody
CBC& chern: liver enzyme elevation
- PMN leukocytosiS left shift
Urinalysis: hematuria. pyuria, bacteriuria
Radiographs:
- Prostatic enlargement irregular contour
- Poor detail of caudal abdomen - peritonitis
- Retrograde urethrography: prostatic reflux
Ultrasound: normal to diffusely hyperechoic
with parenchymal cavities & asymmetric shape
Prognosis:
Guarded for cure based on
human medicine
Life-threatening: prompt &
aggressive Tx
ABs (antibiotics)
- Parenteral administration initially 'If ill
- Long term suppressive antibiotic
therapy may be indicated
Surgical drainage recommended
//((
Prognosis: Guarded
------~,
Acute mastitis
Bitch/queen poor mothering
lococci
Galactostasis
H3B 616: H2B 676; 12M
875;IM665; E-hb611; R
M508
***
- Cytology of milk:
Bacteria
WBCs >
3,OOO/1l1 (degenerative)
ABCs
- Gram stain for ABs
- Culture & sensitivity
- Hemogram
Neutrophilic leukocytosis
- +/- Toxemia
Infection of mammae
CS: Swollen, painful, reddened; Crying
Ox: Hx, CS, PE
Warm
Mammary
congestion,
-Hx, CS
- Sequela:
- Abscessation & gangrene
. Dark, cool &lor ulcerative
- Neonate illness
- Causes:
Nonnal in advanced pregnancy
& lactation
- Weaning of pups
- Pseudopregnancy
- Mastitis
- Heavy milking bitches on a high
level of nutrition
- Hx (weaning or pseudopreg
nancy) ,CS
- Milk is not infected
C~
Prevent:
Gradually wean offspring wI
modest .. In food Intake
~
Then gradually t amount
J ~,
offered to pre-pregnancy level
'\.YJ
i : Good
Agalactia
Ehb 611; H3B 617; H2B
677; RM 509, 820(1);
E&R590
**
- Lack of milk
- Failure of milk production is rare
Failure of milk letdown more
common
-Occasionally, primiparous bitches
have milk but will not let it down,
- Hx, CS
- Physical exam: mammary glands
- Response to treatment
Causes Agalactia:
Failure of milk letdown
- Premature parturition
Physical exhaustion
- Shock
Mastitis
Metritis
SystemiC infection
Endocrine imbalance
Ac~valium
parturition
Pathophysiology:
_ t Protactin release
- TRH stimulates prolactin release, hypothy
roiaanimals have increasedTRH secretion
~eo,"" ,,,' of
Mammary
~pid abnormal growth of mammary
tissue
hypertrophy! Hormonal depend~nt, dysplastic change of
.
mammary glands In cats
hyperplasia. . Fibroepithelial hyperplasia,fibroadenoma,
fibroadenomatosis
Seen in:
- Young pregnant intact queens most comFibroadenomatous
monly
hyperplasia,
. Intact & neutered males & female receiving
Juvenile mammary
progesterone Tx
hypertrophy, Mammal)'
PathophysiOlogy:
fibroadenomatosis,
Response to progesterone
Flbroglandular
Pregnancy
hypertrophy
Progesterone treatment ((megestrol acM8k 1037; cat 1874; FN
etateIOvaban, methylprogesterone)
463; 12M 876; 1M 666; Benign condition: differentiate from neoplasia
H3B 618: H2B 678; INF
368: E&R 757
cats,
Causes - galactorrhea
#1 false pregnancy in bitCh
OVH during diestrus
Cessation of progesterone Tx
(megestrol acetate & methyl progesterone)
Hypothyroidism
Pregnant queens
Hx (time), CS
- Mammary enlargement in first 2 weeks or Physical exam
pregnancy (normally late pregnancy)
BiOPsy if tumor suspected
Nonpainful, firm swelling in 1 or more mam
mal)'glands
OOx:
Profound enlargement & discomfort &
Mammal)' neoplasia
inflammation
Galactorrhea
Ulceration of underlying skin
No systemic illness
Fluid-tilled cysts
tod'ot
Bromocriptine
(Parlodei)
inhibits prolactin secretion
(not approved in USA)
Thyroid replacement Tx in
hypothyroid animals ~
Prognosis: Good
t. .
~_
..
.
.
. ..
Mammary
neoplasia
- 50150 benign/malignant
1702,1703;5minBOQ,
802; Cal 1904; CI2T
1098; Cat 635; R-M
509,521,833 (F); SxS-hb 711; Sx-$ 21 85;
Sx3B 454-
***
form malignant)
. Benign: fibroadenomas
. Malignant: adenocarcinomas
Palliative therapy:
- Antibiotics, hot packs, debridement of ulcerative leSions; Corticosteroids
- Metastatic pulmonary dlz: antitussive or bronchodllators
/ttt
Prevention:
Bitch: spay (ovariOhysterectomy) early is protective
- Spay: at or near 1st estrus (0.5% incidence), after 1st estrous (8%), after
2nd but before 4th estrus (26%), > 2.5 yrs or 4th estrus no difference
DDx:
Old intact bitch, #1Tumor in bitch
CS: Mass, 50150 benign/malignant
Ox: Biopsy, Rads
Tx: Excision
Prevention: Spay before 1 st heat
Queen: neutering
Glandular fibrosis
Chronic inflammation
Mastitis
Prognosis:
~--'D
ill"
Benign: Excellent
.I -Y
Metastasis to lungs: Grave
l'
Malignant: Poor to grave
- Inflammatory carcinoma: Grave, die soon after Ox; Sarcoma: grave
Cat: Grave; average survival of 8 months after Sx
Lumpectomy
+risk
Simple mastectomy
sa
Regional mastectomy
Complete unilateral mastectomy
477
t
Algae 555
Aminoglycoside 509, 579
Anisocoria 496
Anticholinesterase 576
Anticonvulsant 514
Arsenic poisoning 577,735
Ataxia 505
Atlantoaxial subluxation 544
Atrophic myositis 590
Aujesky's disease 555
Bacterial meningitis 551
Beagle polyarteritis 555'
Bee 579
Behavior disorders 494
Biotin deficiency 522
Blindness 498
Botulism 569
Boxer neuropathy 572
Brachial plexus 559
Brain 486
abscess 519
herniation 503
localization 487
tumors 527
trauma 524, 525
Brainstem lesions 502
Breeds predisposition 482
----
Encephalomyelitis 552,519
Epidermoid cyst 536
Epilepsy 512
Exercise intolerance 534
Exertional rhabdomyolitis 595
Facial paralysis 562
Feline infectious peritonitis 554
cerebral infarction 524
degenerative myelopathy 570
dysautonomia 583
infectious peritonitis 554
leukemia virus 554, 692
panleukopenia virus 554
stroke 524
Fibrocartilaginous embolism 543
Fibrotic myopathy 595
Forebrain 492
Ganglioradiculitis 573
Gangrene 594
Glycogen disorders 589,517
Head tilt 506
trauma 525
Heavy metals 579
Hepatoencephalopathy 523
Hereditary diseases 571, 575,
592, 593
Horner's syndrome 564
Hydrocephalus 51 0
Hypercalcemia 581, 676
---
Neuromuscular System
Manx cats 537
Masticatory muscle myositis 590
Meningeal cyst 543
Meningeal vasculitis 555
Meningitis 550
Meningocele 537
Metaldehyde 577
Molluskicides 577
Multiple cartilaginous exostosis
539,611
Myasthenia gravis 586
Myelodysplasia 536
Myoclonial congenita 575
Myopathies 584
Myotonia 593
Narcolepsy 516
Neoplasia 589
brain 527
cerebral 515
muscle 589
neuroepithelioma 549
spinal column 548
Neuroaxonal dystrophy 575
Neuropathy 572
Niacin deficiency 522
479
----c:======
dysraphism 533
shock 543
trauma 542
Spondylitis 541
Stroke 524
Strychnine 578
Suprascapular paralysis 560
Swimming puppies 583
Tentorial hernia 525
Tetanus 580
Thiamine/B1 deficiency 526
Tick paralysis 567
Toxicities 576-579
Toxoplasma 519
Tremor syndrome 568
Uremic syndrome 344, 522
Vasculitis - meningitis 551
Vertebra deformities 536
Vertebral osteomyelitis 541
Vestibular disease 506
Vision abnormalities 498
White dog shaker syndrome 568
Wobbler's disease 545
X-linked muscular dystrophy 592
~IN-e-u-ro-I-og~i-c-a-IE=-x-a-m-i~n-a=tio-n-----f~I-----::-N=E=U-:-::R=-O=M=-=-:U=-=S--=C:-:-U:7L--::A--=R=-S=Y:-::S=T=E=M:-='11
Neurological Problems
M8k889; Mk568; SAP 1110; 12M 942; 1M 725; IM-WW 451; E-hb228; E57S;
NS-W 9; NS-O 7, 55; NS-L 365; NS-hb 4; NS-C 25; Sx-S 984; NB 12.2
. Age?
.. Young: more likely congenital &
Objectives:
1. Neuro: confirm presence of neurological deficit
2. Localize: determine location & extent of the lesion
3. DDx: establish a differential diagnosis list
4. Dx: tentative diagnosis based on:
- Signalment, history & anatomic localization
5. Dx/Tx: diagnostic &Jor therapeutic plan
6. Px: determine prognosis
History: Questions:
-~
:-(
~.
-,
f0
~.~?
_ Duration?
Y
"i
- Symmetry?
<.
'\
1J
'
Primary complaint
(f!/..
"tr"""~
Location of lesion
~.
~1
~~ ~;~ ~h~
..
r,
(i .
1Pilir
!'
: :. -
r ~ , _~
~~
;,),.. "" / r_~ ~
*
Location
_ ';
Visual dysfunction .. ,.. ,....................... ,................. Optic n. & VIsual pathways, cerebrum'
Anisocoria ......................... ,................................ , Sympathetic, parasympathetic, oculomotor (3)
Strabismus .......................................................... Oculomotor (3), Trochlear (4), Abducent (6)
Dropped jav.: & head ~trophy ................. ,......... ,.. ,Tri.gem~nal (5), muscle
N~nnofacla~ sensatlon ......................... ,........... Tng~mlna1(5)
}~
FaCial pa,ralysls .......... ,....................... ,................ FaCial (7)
Dysphagia ............................................... " .......... Glossopharyngeal (9). Vagus (t 0)
Megaesophagus ..: .............................................. Vagus (10)
\l';~-p
\~
Laryngeal paralysis .................................... ,........ Vagus (10)
~ '/
ParalYSIs/deviation 01 longue .............................. Hypoglossal (12)
~y
Deaf ............... ,.... ,...... ,.................................... ,.. Vestibulocochlear (8)X~
1"'"
"'-1
:t
!./..
/A
c;..... :"-;..,.........
Toxic
Metabolic
Nutritional
~~
~_~_~_~_~la_a~_C---.J
, 481
----
_.
------
- .
._------
_.-
B=-r-ee-d-.-=pr-e-:d"...iS-p-O-S=it:-iO-n-------1~l-----:-cN=E=U=R:-::O::-::M=U'-:-:S=-CC
=U:7.L
:-A
"""""'R=-=S=Y=S=T=E::-=-1
M
'-::1
Afghan
Akita
< 6 mo
Basset hO~Ud
~ ~ adult
' ~...
3-6 mo
Beagle
,'), 6-9 mos
aduh
'<ZL aduH
Boston terrier
birth
young
adult
Bouvier
< 1 yr
612 wks
Boxer
>5yrs
<6mo
> 5 yr
Brittany
6wks
2-6 mo
--i'f
~~
~ ~~
adun
?
3-9 mos
Cairn terrier
Chihuahua
ChowChow
<1 yr
birth
~
.'
()
)\.l,7-,
~l \.
Collie
Corgi
Dachshund
birth
<12wks
12-15 mos
birth
3-6mo
aduH
adult
adult
birth-4 wks
Dalmatian
birth
3-6 mo
3-6 mos
2-9 mos
adult
> 5 yrs
":::'::2:>
fa
Egyptian mau
Eng_Bulldog
English pOinter
English Setter
Foxhound
Fox terrier
(smooth)
German shepherd
Cerebellar degeneration
Motor neuron diz
Globoid cell leukodystrophy
Hydrocephalus
Cerebellar hypoplasia
Myotonia
Dysmyelinogenesis
~:~;~~: ceroid_liPotUSCinOS~iS1;Bf------=;-Dermatomyositis
Intervertebral disc diz
Intervertebral disc diz
Neuronal ceroid-lipofuscinosis
Sensory neuropathy (long hair)
8-10 wks
Golden
Gordon setter
- - - - --- - - -
Great Dane
Hounds
'iY~' adult
Irish setter [5;l'
birth
\1-3yrs
I,
l AduH
Irish terrier
~~~ 8-10 wks
Jack RusSf:1I ~
3-6 rno
6-12 mo
Kerry blue terrier
6-12 mo
Lhasa apso
Juvenile
Maltese
Juvenile
Manx cat
birth
Pekingese
adult
Pomeranian
Juvenile
Poodle
< 1 yr
< 1 yr
< 1 yr
2-4mo
4-6 rno
6-9 mo
adult
adult
Pug
adult
Rhodesian Ridgeback
juvenile
Rottweiler
4-18 mo
2-3 yr
,II'
~'~'
t.\W
6'-.......)
l~CJj
?
Sheepdog
St. Bernard
birth
birth
1-3 yrs
adult
Myopathy
Cerebellar cortical abiotrophy
---
SChnauze~JJ
.3i:)6 mo~2 yr
3-6 rno
Megaesophagus
6 rno-2 yrs Cervical vertebral malformation
adult
Fibrocartilaginous infarcts
adult
Intervertebral disc diz
Harriers
Deafness
Dalmation leukodystrophy
Idiopathic vestibular diz
Narcolepsy
Cervical vertebral malformation
Cervical disc diz
MyositiS of head muscles
adult
adult
Dancing Doberman diz
Spongiform degeneration of CNS
cat
Sacrococcygeal malformation
birth
Hydrocephalus
<6 mos
Hemivertebrae
Variable
<6mos Sensory neuropathy
Smo
Neurogenic amyotrophy
birth
Deafness
Neuronal ceroid lipofuscinosis
3-6 mos
Hound ataxia
306mo
Hereditary ataxia
6-12 mo
Myasthenia gravis
1-6mo Idiopathic vestibular diz
Megaesophagus
3-6mo
Giant axonal neuropathy
15mo
adult
True epilepsy
Myositis of head muscles
adult
Fibrocartilaginous infarct
adult
Lumbar intervertebral disc diz
adult
Degenerative myelopathy
> 5 yr
3--6rno
Gangliosidosis
,r
myelo~athY
,p-
)1))~
r'\
True epilepsy
Intervertebral disc diz
"
Pug encephalitis
...
Meningocele. pileonidal cyst
Neuroaxonal dystrophy
Leukoencephalomyelopathy
Spinal muscular atrophy
Sacrococcygeal malformation
Deafness
True epilepsy
Fibrocartilaginous infarct
JI
"7
/}!
()-,
~
--
g~>8
oJ...,
-7
L~0
--------------------------~~~------------~--------~--
~lp~E~-~N~e-u-ro~lo-g-y------------~~~----~N=EU~R=O~M~U=S=C~U~LA~R~S~Y=ST=E=M~I
General neuro physical examination: lor all patients 12M 944: IM-WW 4S1: Cat 1507: NS-W 9: NS.c 41: NS3hb 8; NB 12.2
Check other systems for findings that may be pertinent to
neurological disorders
~tt
- Some Inflammation of eNS affects other systems
-gz~
.Ch"'''at;O;I;''foo''',';~,m''',to",'''m'';'&
Iym,h"a~,ma"
'yst,mlo
"";0,, ";;,, ;o',d;,", '''tonltl, (FIPI &";;ne I',kam;a (F,LVI ,'nlS" &
Reproductive system:
. External ear canal & ear drum: middle &lor inner ear infection
. Skin changes: endocrinopalhles:
. laceration & bruising: trauma
Tlok ,,,="0 b;to" ,;ok ,,,alys;,, a"to po'y",';"'"''"'''
- Skeletal system:
. Palpate for fractures, masses
'
'
~
,~of
III
;-,
,r
,
()
Observe
_ Mental status (BAR [bright alert & responsive] or otherwise)
_
ition.
'
Stan~e & head po~
. head tilt, wide based
_
~_
stan:e' head tremo~lbobbln9
~-.., ~-='
- Galt observation & strength
Testing
;~
_ Proprioceptive positioning (knuckling):
~
.,
(
.
.)
rest paw on it s dorsum or abduct limb or cross limbs
~
~
- Head
- _
Eyes: position, movements & pupil size
i~
Menace response
~~"\-?
~~
P ill
Ii ht reflexe ;7./
.. up ary g
s
.. FundiC exam
eJ'~<
I ,
Jaw tone
~
~
")
--:
10''''''~
~V
~j:;
~~
rrif-..
sW 1I0win
in
~
g, ~ 99 9
FaCial sensation
- Body: muscle atrophy (head
'""
I-"'~
f7 .
Mk 568; SAP lItO; fM 725; Ehb 267; E 578; NS-C 44; NSL 367; NS-O 7; NS3hb 47; NB 12.3
1. General observations: identify any neurological prOblem w/o specific localization (routine part of
normal physical exam PEl
- Mental attitude/consciousness, behavior, seizures: cerebrum & brain
stem
Stance & head position: head tilt, wide based stance; head tremorlbobbing
(cerebellum)
Gait & strength observation evaluates entire nervous system
- Gait observation/Abnormalities: proprioceptive deficits, pareslslweakness, circling, ataxia /loss of
coordination & dysmetria, scuffing, knuckling or atrophy
Clinical entities: cerebrum, cerebellum, brain stem, spinal cord, peripheral
nerves, or vestibular lesions
- Strength (push down on standing animal): weakness from cerebrum, brain
stem or spinal cord injuries (UMN or LMN deficit)
3. Postural reactions: neure screening tests: don't localize, but sensitive indicators of neurological disorders
- Proprioceptive positioning (knuckling): testsforconsdousperception of location of limbs
- Hopping: not routine part of PE, tests strength of the limb & integrity of the sensory & motorspinaltracts
& cerebellar input
- Hemistands & hemiwalks: not routine part of PE, tends to magnify a hemilateral deficiency
- Wheelbarrowing: not routine part of PE, test as in hopping
Other postural tests are less reliable than proprioception, hopping, hemistanding & wheelbarrowlng: Righting
reflex, Suspension righting, Tonic neck & eye reactions: Spinal sensory pathway tests: Tactile placing reaction,
Extensor postural thrust
Visual placing reaction is actually a test for vision, but can be done at this time
~'
~'0
lYJ- )
J
& limbs)
JT
re
2.
__ ~
~~ ~Ilj1J
J" (. }
..
-Integumentary system:
_ ...
- Eyes:
Aot";,,
.
"
- Urinary system:
'q
\.
--_.-
I-L-
Brain
NEUROMUSCULAR SYSTEM
Condition
Presentation/CS
Facts/Gause
Brain
SAP 1128; Ehb235;
12M 980; 5min 402;
Cat 1517; NS-hb 55;
NS-W 24,112; NS,()
WN271,279;XT66;
Pys82
**
Dia nosis
head tremorlbobbing
Area of lesion
Head
Brain
Cerebrum, brain stem or cerebellum
Forebrain (cerebrum & diencephalon)
Brain stem
Unilateral rostral midbrain
Unilateral caudal midbrain or lower
Vestibular system
Head tilt, circling, falling, rolling towards lesion
Horizontal or rotary nystagmus
Ataxia
DDx peripheral from central vestibular diz
.. Central: depression, weakness,
Hypothalamus (asymptomatic, endocrinopathies, behav& postural deficits, horizontal, roioral abnonnali!les, temperature regulation problems, appetary or vertical nystagmus
tite & thIrst disorders)
Cerebellum:
Brain stem:
. Incoordination w/o weakness
Cranial nerve 3-12 deficits
Head tremorslbobbing
Ataxia, vestibular signs
Unconsciousness
Dysmetria
Base-wide stance
Abnormal gait - UMN
Normal reflexes & posture
Weakness/paresis
Mental status normal- BAR
Postural deficits (proprioceptive)
Nonspecific treatment
- Anti-edema: Furosemide (LasiX), Mannitol
- Anti-inflammatory drugs: in absence of infection - to reverse inflammation
& alleviate 2 processes: edema, vasculitiS
- Pain control not usually needed in brain injuries
Surgical therapy
- Uncommon because of dlNicully of approach 10 brain
Decompression #1 surgery Clecompress or remove tumors, abscesses &
hematomas' usually poor results
~ ~
~;:p
I,?
J
CI
,);;, ff3
.<.";p
(,f/;.0'
~>
prognosis:
' I \
Anatomical location:
- Brain stem: poor
~
- Cerebellum: guarded - compensation possible
- Cerebral: better than brain stem, but worse than cerebellum
Severity of injury: mild better than severe (duh!)
Progression of diz important prognostically
c
Cerebellum
Posture
Movement/gait
Postural reactions
Cranial nerves
Normal gait
Slight weakness
Deficits
N
Deficits
Deficits
N ( awkward)
N to dysmetria
Normal ( blindness)
Thalamus - Cn2
N
N
Weakness, ataxia
Head tilt, falling Weakness, ataxia
Head tilt
N to ataxia
Normal
Tremors, dysmetria,
487
ataxia
CrN 3-12
CrN?CrN5&7
CrN8CrN7
N absent menace
~r---~~~~~",,~~~==~
(~.(/'A/\~(C<
1:\
A-
0!
CrN2
Cranial nerves
erN 2, brain, retina
erN 2, erN 3
""
""",.".
Pupils asymmetric
Eyes asymmetric
erN 3
erN 2, cerebellum
erN 2, erN 3, ANS
erN 3, erN 4, erN 6
erN 5, erN 7
1
d
I
ur----co
--.----------------------------------~
(~--
~~~/. erN 8
erN 1 Olfactory
Smell- nasal mucous membrane
CrN 2 Optic nerve Vision
<
erN 3 Oculomotor Motor: extrinsic eye muscles
ANS - parasympathetic: constrictor to pupil
CrN 4 Trochlear
Motor: dorsal oblique extraocular muscles
CrN 5 Trigeminal Major sensory to head & motor to masticatory muscles
Ophthalmic Sensory: eyeball, forehead area & medial canthus (eye)
Maxillary
Sensory: lateral canthus, upper jaw area, upper teeth
Mandibular Sensory: ear, mandibular teeth, lower jaw area
Motor: muscles of mastication
erN 6 Abducens
Motor: lateral rectus & retractor bulbi
CrN 7 Facial nerve Motor: muscles of facial expression
ANS - parasympathetic: glands of head including lacrimal
CrN 9,10
CrN 9
CrN 10
erN 11
CrN 12
L-c-r-a-n-ia-l-n-e-rv-e-s--e-x-a-~-a&-IC-~_e_,_~_~_,rn_a,,_1-:-~-:-:-:-'-O-"-d)------------------------------~~~
Nerve
CrN 2 (Optic)
CrN 3 (Oculomotor)
ANS
CrN 4 (troChlear)
CrN 5 (Trigeminal)
erN 513 (Mandibular)
CrN 6 (Abducens)
Test
Menace response
Pupillary light reflex
Pupillary symmetry
Eye position
Palpebral reflex
Mandibular function
Eye position
Checks
Cn2 & 7
erN 3 & 2
Symp, CrN 3
CrN 4,3 & 6
CrN 5 erN 7
CrN 5/3
CrN 3,4, 6
~~.
Ii~~
Vestibulocochlear
COChlear nerve
Vestibular
..
-'~
'.~~~
~ .~~~
Normal findings
Blinking of the eyelids (Cn7) or turning head away
Constriction of both pupils, can move eyes
Same size
Substitute ophthalmic exam if suspect
Closure of the eyelids
Ability to eat, no atrophy
CrN 6 abnormal - deviation of eye towards nose
CrN 3 abnormal - deviation down & out
CrN 7 (FaCial)
CrN7
Evaluate face for symmetry
Facial symmetry
Normal symmetry
erN 8 (COChlear)
Unseen, loud noise CrNB
React to sound
\ / Loud noise behind animal
Check for balance, nystagmus & head tilt No loss of balance & rOlling, head tilt, nystagmus
erN 8 (Vestibular)
Balance, nystagmus
CrN 98 CrN 10
Gag reflex
Finger in throat
~,~
Gagging
10
(Glossopharyngeal, Vagus) Cough rellex
CrN 10 (9)
Irritate larynx
Coughing
CrN 12 (HypoglOssal)
Tongue exam
CrN t2
Observe, fA'lI to test strength
Eating & retraction 01 tongue ~~
p}
g;~:, ~,u
Procedure
Threaten each eye with the hand
Bright local light through the pupil
Check that pupils are same size
Check both eyes look in same direction
Touch medial & lateral canthi
Open mouth, check atrophy
Check eyes are in same direction
r /;::t""
r=ID:-=D:-x---=B:-ra--=i-n-=S:-:-ig-n-s--------;~t-----:-:N=E::-:-U=R-=O-=-:M~U=-=S-=C:-:-U:-:-L-=-A-=R--=S=-=-y7.:S=-=T=E:=-=-1MI
DDx - Coma/stupor
DDx: Encephalitis
failure) - ammonia
- Endocrine dysfunction
DDx - Protrusion of
Hyper- or hypoadrenocorticism
NSO 520
- Cats
3rd
eyelid
Thyrotoxicosis or hypothyroidism
Brainstem disorders ~.. ~
_ FIP
NSL 122
Biochemical
imbalances
- Trauma.
\J~~
- Toxoplasmosis
Homers's syndrome (constant)
Acid-base abnormalities:
~
_Systemic fungus (cryptococcosis)
- NeoplasIa
Tetanus (briefflashingprotrusions)
Cerebral cortical disorders
_ Rabies
hypercapnia, acidosis or alkalosis
Cats w/ severe systemic diz
Tx
_ Pseudorabies
- Anomalous conditions
Severe atrophy of muscles of mas Osmolality changes; hyposmotic
Hydrocephalus
Bacterial (rare)
tication (myositis or CrN 5 nerve
states
(diuretic
Tx,
hyponatremia,
Lissencephaly
Dog
damage)
fluid Tx)
~
_Canine distemper
- Inflammatory diz
HyperosmotiC states: hypematremia,
Meningitis
.>- J -1
- Infectious canine hepatitis
hyperglycemia
Encephalitis
" IF
- Granulomatous
0
Electrolyte disturbances: hyper- or
- 1 or 2 brain tumors
C.
meningoencephalitis?
hypocalcemia
- External trauma
_ Systemic fungal diz
- Vascular disorders
- Toxoplasma, encephalitozoonosis, Nutritional: thiamine deficiencies
Toxins:
Feline ischemic encephalopathy
trypanosomiasis, babesiosis
- Exogenous neurotoxins
Canine vascular accident
- Neosporum caninum encephalitis
Metabolic encephalopathy
_Rabies
- Toxins: molds, sedatives, salicylate>r~----~- Hepatic diz
_ Pseudorabies
anticholinergics, ethylene glycol DDx _ Loss of balance
Hyperthermia; hypothermia
- Hypoglycemia
_Protothecosis
Peripheral vestibular diz
- Ehr1ichiosis, salmon poisoning
'\
- Severe uremia
- Otitis interna
- Hyperosmolal~y of diabetes mellitus
- Bacterial (rare)
~.' ~~~
,_
- Feline vestibular diz
- Heat stroke ~ Metabolic encephalomyopathies
_<
- Idiopathic vestibular syndrome (dog)
- Hypoxia
( - Energy depriving
- Trauma & hemorrhage in inner/middle
Intoxication ~~_
~
Hypoxia, ischemia - oxygen
ear
- Leads
c;:::--r ~
. Hypoglycemia _ glucose
Central vestibular (+ depression 3. wea~ness)
-lnsecticidesJrodenticides
- Endogenous neurotoxins
N"'-~~
- Distemper
- brainstem or cerebrum ~ 5)
~~
Infectious
S4r-.' ->.
Thiamine
Epilepsy deficiency
Narcolepsy/cataplexy
t
' ~r
_re_n_a_l_fa_il_u_re_,_u_r_in_a_ry_O_b-_l/:._=_~~
, __. struction
_u_re_m_i_a_:
. Hepaticencephalitis, hyper-ammonia (portosystemic shunts, liver
- Toxoplasmosis
- Neoplasm
- Brain stem trauma
- t Intracranial pressure - trauma
..
------~----------~
----fL-~(oox-
~~,
\\~ ~
Facial asymmetry
\,.'
OOx - Absence of menace response
OOx: Loss of pupillary light reflex
~
Injury to cerebrum (opposite side) yW\~
Distemper encephalitis
Lesion of Cn2
~'A:;")
Brain stem injury (same side)
I ~ 'l ~
Space occupying (bone or frontal lobe tumors)
Lesion of CrN 3 or brain stem
. Peripheral nerve (same side)
~\'
Post orbital abscesses
-". Facial nerve palsy
Y,
Posterior synechia or severe iris atrophy
Pituitary hypothalamic (neoplasm, abscess)
\
Hemifacial spasm
OptiC radiation & visual cortex
Keratitis secondary to inability to blink
- Neoplasm, abscess
Space-occupying lesions of
cerebellar-medullary angle
OOx _ Abnormal eye position (ocular)
- Trauma,. scarring, e t c . .
- TOXIC & Ischemia (lead, anesthetiC)
.
I
I . of CrN 3 4 6
Otitis intema-media
I ~~.o~
Brain stem eSlons - nuc el
, ,
P r
h I
Bell's Palsy
-c oloencep a oma aCla ;::::;.,r~:'"
_Tumors, edema, i intracranial pressure, he erebrum
~~
-Concussion
matomas
E
h IT
.
& granulomas
~ 'S/
- ncep ails
. :-""1T t
s
~~ ~
- Neoplasia
'"t
e anu,
~ ;,:
OOx - Loss of gag & cough reflexes
)
(HOmer s syndrome
_g/
_Toxicities - metabolic or exogenous
Dysphagia
- Rabies
- Pharyngitis
e:J'G'-
\..)';---?7"
~~~~anerve.
~'1
~(/
'u
:(Y-
<~
491
OO~
~\.
(.
NEUROMUSCULAR SYSTEM
Facts/Cause
Cerebrum
&
Thalamus;
Cerebral hemispheres
basal nuclei (telencephalon)
&
& mental
status
& audition,
& general sen-
- Interprets vision
Forebrain
proprioception
**
Dia nosis
Presentation/CS
~~"
. ~
4.
~~'
.
eY
Neuroexam
//
- Identify existence of a neurological problem
1. General obselValions: mental attitude/consciousness, behavior; seizures
2. Gait obselVation & strength: no appreciable
3. Postural reactions (proprioceptive positioning, hopping, wheelbarrowing)
- Localize neuro problem once identified:
. ~
"-t
,
CSF analysiS
- tndlcatlons: abnormal neuro exam, recurring fever, epilepsy, chronic pain, brain disorders
- Contralndlcations: recent CNS trauma, rapid declining Ie. vel of consciousness
.
-Interpretation
No change In CSF: degenerative, anomalies, metabolic, toxic & nutrition dizs
Neoplasja: usually Increased protein, increased pressure, cells usually normal
InllammaUon: Increased cell count & protein preSStJra elevation
, Trauma: ABCs & protein elevation
Toxicological screening: for cerebral affects
Treatment
~
)-
- Hydrocephalus
- Lissencephaly
- Immunosuppressive/antiinflammatory drugs
Many dlzldlopathlc: Immune-mediation suspected in some.
Inflammatory diz
- Meningitis
Encephalitis
0
brain
Nonspecoic treatment
..
?~
Lasix
- External
-I
; ;
Valium
Anomalous conditions
Tumors 1 or 2
Trauma
:;:::-:--
- Infarcts (rare)
Thiamine deficiency
Vascular disorders
~,
.....
\-. f/
i : ? r* ~
~ \
--,~L,../
C-..
"'--..-k4-
'{Z.,-J ~
& smell
-~
Hypothalamus
~'2~3~
d
.-
, -_ _ _ _..L_ _ _ _ _ _ _ _ _ _ _L _ _ _ _---,
1t
1 than cerebellum
-:--..-_ __... ~ Severity of injury: mild betlerthan severe (duh!)
information
t~
'
\'~
'.
~
:
\
)
::,m:!~a:~ndOCrlne abnormalities
Clinical signs:
<;'
"'..;-~"",.....
~t;~i? ~F
'...... "'-::i!
5',..
\..............-l.
~~
':-).
~~
?-
'")
<.
494
NEUROMUSCULAR SYSTEM
Presentation/CS
Facts/Cause
Condition
Diagnosis
Treatment
Behavior & mentation changes Differentiate behavior from neura problem Treat cause
Abnormal mental activity
Behavior &
- Hx (owner): animals normal behavior, onset
- Loss of recognition of owner
~ Cerebral cortex lesions: bepersonality
of signs?
havior, dementia, compulsive - Dementia
Physical exam:
- Aggressiveness, irritability
behavior
disorders,
- Identify a neura problem: mentation
- Passiveness, hypersexuality
- Brainstem lesions: depresAbnormal
changes + other neura deficits
- Compulsive pacing or circling
sion, stupor, coma + cranial
mentation
Seizures
nerve & postural abnormali- - Sleepiness, semicoma, coma
1M 747; NS.c; 133;NS-hb360,
Gait & strength: little change if cerebral
- Blind if occipital lobe affected
ties
364; NS-W 119. 219, 90;
+ Postural reactions deficits (contralateral
NS3hb 366
Behavior & personality chan ges Hypothalamus signs:
limbS if unilateral cerebral)
- Usually due to lesion of cere- - Polyuria, polydipsia, aphagia (no
Blind: oCcipital lobe damaged
eating), pica
brum or diencephalon
- Differentiate from brain stem diz
Brain stem: also depression, stupor & coma
.. Cranial nelVe deficits
.. Gait abnormalities + postural deficits
CBC: for infectious, metabo~c or toxic diz
Ancillary test
- EEG may help differentiate from psychological problems
- CSF: infectious or neoplasm
- Radiography: skull fxs or
neoplasms, bone changes
- MRI or CT scan
~~
); 1. Psychological problems
,.
2. Neurological problems
Cerebral cortical disorders
- Anomalous conditions
Hydrocephalus
ussencephaly
Lysosomal storage dizs
- Inflammatory diz
Meningitis
Encephalitis
_Tumors: 10 or 20 - brain
- Trauma: external or infarcts (rare)
- Thiamine deficiency
Vascular disorders
Feline ischemic encephalopathy
Canine vascular accident
Metabolic encephalopathy
- Hepatoencephalopathy
- Hypoglycemia
- Severe uremia
- Hyperosmolality of diabetes mellitus
- Heat stroke
- Hypoxia
Intoxication
- Lead poisoning - household toxins
- Insecticides
- Rodenticides
- Drugs
Disorders of brainstem
- Trauma
- Neoplasia
Intoxication
DDx:
Cerebral/diencephalon
Psychological problems
Brain stem
~
(;,
___
Iris - Anisocoria
Condition
NEUROMUSCULAR SYSTEM
Facts/Gause
DiagnOSi~
History, CS
size
Treatment
Eye exam
~\.( --~ - Symptomatic
- Pupillary light response ~ I - Indirect-acting meiotic agents
(echiothiophate iodide or
- Menace response to see if blind
FeLVtest
demecariumbromide)sldtomask
mydriasis
- Monitor for lymphosarcoma in future
Anisocoria - Causes
Afferent mydriasis
Efferent mydriasis (unitat. eN 3)
Sympathetic miosis
Feline spastic pupil syndrome
Homer's syndrome
Feline dysautonomia
Central blindness
-Intraocular diz - pupil dysfunction
- Iris atrophyltraUmaidevelopment
- Anterior uveitis/(miOSiSj
- Glaucoma (mydriasis)
- Synechia
- Corneal pain (keratitis): oculopupillary reflex
(erN 5-3) (miOSiS)
Idiopathic
Dilation (mydriasis)
Unresponsive to light in either eye
Constriction (miosis)
Dilates slightly in reduced light
Constriction (miosis)
Dilation (mydriaSiS)
Light in affected eye: no constriction in either eye; Light in normal eye, constriction of both eyes
Constriction (miosis)
Dilation (mydriasis)
Variable response to light
Constriction (miOSiS)
Unresponsive to light
Normal, OppOSite pupil dilated Responds to light in both eyes
Mydriasis:
afferent
anisocoria
H2B t t2S; I_S 470; I-G
717
*?
Further tests
DDx:
Efferent mydriasis
Central blindness
Intraocular dlz pupfl dysfunction
Iris atrophy, glaucoma, posterior synechia
Efferent
mydriasis,
Internal
ophthalmoplegia
H2B 1126; 1-5 453; NS
L 121, 291, 2911
*?
o Unilateral
Oculomotor nerve
Dilated & not blind
Dilation (mydriasis)
- Persistent Ipsilateral mydriasis wi
normal menace response
Anisocoria (pupils of different size)
accentuated In lighted room
of Drooping lid (ptosiS) (levator palpe
brae)
DDx:
Afferent mydriasis
Intraocular dlz
Abnormalities ot iris sphincter
-Glaucoma
Iris atrophy
lens luxation
Posterior synechia
Dysautonomia
497
Ophthalmoscope: for retinal thinning, optic neuritis, optic o Treat underlying cause
Antineoplastic
nerve atrophy
Anti-inflammatory
- Normal if no retinal or optiC nerve damage
Antimicrobial drugs
Prechiasmalleslons: loss of direct PRL & normal PLR on
No treatment it degenerative cause
affected sided
-Unilateral:
Partial dilation (mydriasis) In room light
Ught In affected eye: neither constrict (loss of direct In
affected eye & Indirect in unaffected eye)
Ught in unaffected eye: both eyes constrict (Normal
direct in unaffected eye & inqlrect in affected eye)
No menace response or vision In affected eye
Bilateral: complete mydrlasls& blindness (no menace or
PLR In either eye)
o Chiasmallesions: loss of both in & direct in both eyes
Bilateral dilated, unresponsive pupils (complete lesion)
Absent menace & PLR In both eyes
Normal fundus
o Optic tract lesions
Unilateral lesion
Hemianopia (deficit In half of visual field in both eyes)
Normal PLR In both eyes
Bilateral
Partial or complete visual deficit
Menace res onse absent in both e es
Eyaaxam:
Traat undel1ylng neurological condition if
- PLR: no response to direct or indirect PlR In affected eye,
possible
normal direct & indirect PLR In unaffeclM eye ~
Symptomatlc: indirect acting meiotic agents
- Normal menace response
~ sid to mask mydriasis
Lesion localization:
Preganglionic lesion
0.5% physostigmine test:
miosis of affected eye in 20 min ~
PI,--.
.0.1% pilocarpine test: no miosis
')
- Postganglionic:
~
~
Dog: short ciliary carry both para- & sympathetic fibers
Gat parasympathetic Innervation separate form sympathetic
.. Nasal Short ciliary innervate medial Iris: "O-shaped"
pupfl if right eye Involved; "Reverse 0' it left
.. Malar short ciliary Innervate lateral iris: "o-shaped" Prognosis:
pupil If lett eye involved; "Reverse D' if right
Topical parasympatholytic agents (alro'
Dog & cat
pine) wear off in 1-2 weeks
.. 0.5% physostigmine test: affected eye remQjns dilated o Bilateral midbrain lesion: grave
.. 0.1% pilocarpine: miosis in 20 min
Unilateral midbrain lesiOn: guarded
o Gaudal brain stem: grave
,,>."
\i '
Blindness
Condition
Vision
NEUROMUSCULAR SYSTEM
Facts/Cause
Presentation/CS
Diagnosis
Treatment
History (Hx)
No treatment for blindness
CS - partial or complete [ass of vision Treat underlying cause
PE: may be difficuh to detect in dogs &
- Antibiotics for infections
Blindness
cats - compensate; obstacle course
- Anti-inflammatory for inflammaH2B 1132; 12M 982; 1M
Lesion localization
tion
ww as; 5min 22; J-O 260;
- Ocular media opacities
"
- Antineoplastics for tumors
Sx-S-hb 433, Sx-S 1276,
. PLA: afferent defiCit
.
Degenerative conditions not
NS-L271 ,290, NS3hb274
. Menace response: reduced or absent
treated
f
. Ophthalmoscope: cloudy ocular
**1
- Occipital visual cortex ~ L
~A
media, cataracts
-'I
~
J
. ERG (electroretinogram: abnormal)
Causes Vision abnormalities'"
,
- Retinal lesion - affected eye
- Opaque ocular media
. Neoplasia
1~
.PLR: aHerent deficit
' Corneal opacities (pannus etc.)
. Trauma
'(~
S
.Menace response: reduced or absent
_JIJ'
. Ophthalmoscope: probable abnormalities
Cc. Cataracts
- [ntracranial diz
~
. ERG (electroretinogram): abnormal if photore Inflammation of anterior segment
. Optic tract lesions
l '-~ '\.
ceptor lesion
- Retinal diz
Inflammatory diz (canine distemper, etc.) - Ganglion cell & optic nerve lesions
Progressive retinal atrophy ! _
. Neoplasia
(aHected side)
Retinal detachment
"
.. Trauma
: ~~~~:%:o~~!~~educed or absent
Retinal dysplasia
- ' . LGB, optic radiation, visual cortex
. Ophthalmoscope: optic disc signs
Sudden acquired retinal degeneration .. Feline cerebral vascular diz
. VEERRG,(normal (PhkOI,orecePtors)OK)
.
.
VIsual evo e response abnormal
~
Gangho~ cell hypoplasl~.
.. Hydrocephalus .
~ Optic tract, KGB, occipital
~~
Congemtal stat~onary mght blindness .. Inflamm~tory dlz (canine distemper, GME, cortex (eye[sl affected)
Inflammatory dlz
toxoplasm?Sl5, abscess).
.
PLR
~
Optic nerve diz
Ischemlccerebral hYPoxia (apnea, cardiac
Optic tract dilated & unresponSive
Q.I
'~.
CN 2 atrophy
arrest)
LGB or visual cortex normal
".
... ..
.A I .
.. Metabolic storage dizs
. Menace response: reduced or absent
..
~
. p aSia .
.
.. Neoplasia
~. Ophthalmoscope: normal retina & optic disc
............ -.......
HypoplaSia
I
. . ../
\1::0....... ERG: normal (photo receptors OK)
<?;.~
... " p
f. . Glaucomatous cupping
... T entonal herniation
"
. Unilateral: contralateral hemiparesis
Prognosis:
I~'
~
O
.'
.. T r a u w m r . Bilateral: Tetraparesls & other neurological Guarded to poor for
1.
ptlC neuritis
..,..
.
deficits
VISion return if total loss
. Congenital lesions (retinal dysplasia, hypo .
plasla, cataracts)
Visually impaired animals make
Loss 0 I VISion
-Searchlngorwanderingnystagmus
.'..
acceptable pets, cats especially
(
Dx: Hx, CS, PE Lesion localization
Radiograph, CAT, MRI
~
compensate well, may not be able
Tx: Blindness: none, Tx underlying cause
i:i:~tal & intracranial
L
to notice blindness
abnormalities,
;r.
I~
e-
0 .-
6.
t'f\\
7".;)
<
<0
fi! .
~----
Retinal
detachment
n
y(
~E~~;'::~'Onn'tlOO
~I~","'
:
;''''0001,,,"'9'''" U,",I,,"oo 01
Traction 20 to healing hemorrhage or chorioretlmtls
2 to retrobulbar abscess or mass
, Ethylene glycol (cats)
--
--
..~--.-':-
ment
Surgery - refer
t-.-~~
I'}
J -
- L------------'-------~-'"'~"
Cause _ Retinal detachment
~
None if no symptoms
Treat underlying cause if possible
SystemiC steroids if Infection & hypertension ruled out
Systemic NSAIDs (avoid If intraocular
hemorrhage)
Mannitol if transudative detach-
I~J1'f
=-<Y
e
.~
Steroids
"
Prognosis:
Guarded: variable, some reattach
&in dog vision may return, rarely In
cat...
....
..... -.: :. ~ ; .. 1.
.;~:. '~:'-;\'.:;:"~'y~
,:".: :':"
\. -. ~ .....
.~.
-;.! ~
.; :,.::, .~ ~:~ ~
:
~
........ : ..
...; ::.:
"":t= ~
:; ';""':,~~
; ...::
-.;. ''';' ~:
,
4 .. : _
.': ........ .
,:;",:.;
-01 \ '
\n.
.:, \:~.
.,6. '
-'-f
........oo
-.
:".":'.
'.:oo':,"
~."
"r7':)
ttr,;.,'Q)"
\
Optic nerve
NEUROMUSCULAR SYSTEM
Condition
Facts/Cause
Presentation/CS
Treatment
No treatment
Asymptomatic - micropap/lla
Blindness
lack of pupillary light reflexes
~, :-.
*)"
@
Diagnosis
sponsa
Papilledema,
OptiC disc edema;
Papillary edema,
Choked disc
SAP 122~ 5mln 906: IP
172: I-A 202-204, 299(1);
1-0259; IG 518; NS3hb
Rare in dog
~~;eOj~..
Sequela:
- Blindness if damage to central
optic pathway or visual cortex
~D-D-,,---J
/-' -
~r-J
Optic neuritis
'-"'-"
r'-"
~ p~,"OO" ~t
71 .
wI
CNSlumors
Optic
neuritis
SAP 1228: H2B 10251.
8401: 12M 983: 5min 22,
681: I-S 468: I-P 173: I-A
204-205: 1-0 259; I-G 517:
I-G 517: I-hb 259: NS3hb
294,283; Neo 332
**?
."
~~
suspected
" ""
Optic nerve
atrophy
SAP 1229; I-S 470; I_P
173; 1-0257; I-G 518; I-hb
259; Neo 333
*1
I:s:-eq-ue:-l:-to-o:-t:-he-r-d:-iZJS-;B~I~in~d~ne~s~s~,~s~cc~p:e:',;:;N:o':;T:x:e;;ffe:ct~i:ve~-"1
~kt
Prognosis: ~ 0'
intra~.cranial
501
Ophthalmoscope:
w.rn
Brainstem
NEUROMUSCULAR SYSTEM
Diagnosis
Facts/Cause
Presentation/CS
Invariably serious
Cranial nerve 3-12 deficits, more presumptive: cranial nerve deficits wI
Brainstem (midbrain, pons
than one, often partial
any weakness or loss of mental status
Ataxia: vestibular signs
Nauro:
& medulla oblongata)
- Structural extension to
- Loss o! balance
~-;f< -Identify neurological problem
spinal cord
- Head tilt
~..?
1. Consciousness: depression, stu~ ~ por coma
- P~thologic nystagmu
- RAS, reticular activating
system: conscious level
l ' Head tilt, CirCling, loss of balance
- Circling _
Consciousness (RAS)___ .:
2. Gait&strength:proprioceptlvedefi- Heart rate, rhythm, & respiration centers (medulla)
~--~
cits, paresislweakness, ataxia
- Depression
- Stupor
'
''1 ~
3. Postural reactions (propriocep~ve, hop- Cranial nerves J.12 asso- Coma
"_____ ~
ping, wheelbarrowing)
ciated wi brainstem
- Localize neuro problem
- Walking (locomotor) re- .Abnormalgait-UMN( t reflexes,
rigidity)
4. Cranial nerves exam: deficits 3-12
flexes in midbrain
Weakness/paresis: UMN signs
. Ventrolateral strabismus (CrN 3,
Necessary for normal gait
Movement Initialed in higher cen- Postural deficits (proprioceptive)
. Dilated nonreactive pupil (CrN 3
. Vestibular eye movements, no normal nystagmus
ters -descending motor tracts cross
Decerebrate
rigidity:
op~thotOnus
wI
when move head from side to side
over in the midbrain
Condition
Brainstem
lesions
E-hb 273; 1M 731; H2B
239; SAP 1126; E 604;
Cat 1518; F? 1518; DOx
429; Sx-S 1001; NS-C
**
~~-~.
"7
,,-
}
)
~
ening injury
/ )I
=----
p.'
./r_- ~~~
_'
c-
I""" -
::?
1Io"'--------'----/{f))
~
s!lghtly decreased
Walking, RAS, CrNs, UMN
\()!
n ~ d'. ~ -~~~~d heart rate, mythm or altered respiratory pates, Ox: erN deficits + weakness or + mental statusffi~-:>}-8~ Radiography head trauma
"':,\t:
[-CSF.,.,,.,,
Tx: None
Prognosis: grave, usually fatal
Steroid IV (methylprednisolone)
for edema, In absence of infection - to
reverse inflammation & alleviate 2 processes: edema, vasculitis
- If improves slop steroids to avoid side
effects
- Mannitol: if no improvement (not if
shock)
If stuporous or comatose:
- Nutrients & fluids (stomacl1lube)
- Bladder & rectum evacuation
regularly
_ __ _
Stera!'J
I\.-
Prognosis:
~~
Brain stem: poor ~~
Sever: grave
~
Progression of diz important
II unconscious
OJ!!r~
- Airway (intubatian)- .. ~11l
-Oxygen
-
ABs
C. Localize to part of brain
Antineoplastic drugs
_"Head signs"; consciousness
- Nutritional Tx: Thiamine (Bl) can cause
_Gait + "head signs M
neurological diz
.. Paralysis or weakness of an 4 limbs Surgical therapy: if evidence of developil1g
r ~ \ ~/r::
Treatment
Midbrain
~5
- Cranial nelVes 3-5
'"":;11
- Abnormal consciousness
... -~
Pons
~
- Facial signs CrN 5 & 7
_ Gait & balance abnormalities (vestibular & tracts)
Medulla
_ Swallowing (CrN 9, to), or tongue function (CrN t 2)
- Abnormal balance & gait
- Heart rate rhythm & respiration
Intramedullary vs extramedullary
_ Extramedullary: cranial nerve signs more significant
than limb signs
_ Intramedullary: limb signs more significant than cranial
nerve signs
~~i:-~
'CiiGiiiP
_ _ _ _ _ _ _-r____....J
L -_ _
Tentoria! herniation
Delayed onset of signs
Progressive course
Unilateral dilation of pupils progressing to bilateral
Alert or apathetic progressitlg to coma
. '
Normal or weak, progressing to decerebrate rigidity & then to flaCCId paralYSIS
Often unilateral asymmetry
503
Cerebellum
NEUROMUSCULAR SYSTEM
Diagnosis
Treatment
Presumptive:
ataxia
wlo
weakness
Congenital:
no treatment,
-Incoordination(ataxia)w/oweak
Coordinates
movements,
Cerebellar
Euthanasia
rate & range, but does not ness: excessive range, rate & force of move- Hx, CS
Specillc Tx: depending on diagnosis
ment, accentlJated by circling or tuming
lesions**, initiate them
- Neurological exam for brain. diz
ABs (bacterial. protozoal & fungal)
SAP 1127; IM731, 743;
Vestibular system con- - Base-wide stance from balance defi- - Identify neurological problem
- tmmunosuppresslve/antllnl\ammatorydrugs
H2B 239: 5min 168; E
cits, not proprioception
1.
Stance
&
head
position:
head
tilt,
wide
- An~neoplastlc drugs
nectionsto help coordinate
604; Cat 1173; F-?
- Irregular, deviating gait, veering
- Toxin removal: lead
based
stance;
head
tremorlbobbing
1518; 00)(440,443;5)(balance & posture
from straight line
5 IDOl; NS-C56t,318f,
2. Gait & strength: ataxia, dysmetria surgical therapy: uncommon
- Proprioceptive fibers don't - Dysmetria (too long or too short moven; NS-hb 60, 216; NS,
but nonnal strength
pass through cerebellum
ments)
W 25, 120; NS-O 52,
3. Postural reactions: normal but may
Hypermetria (exaggerated response519; NSl 163, 376,
I
"'"
255; NS3hb 225, 61,
goose stepping, nose too far in water when
be exaggerated (dysmetria)
219,264: Pys 219
drinking)
- Localize neuro problem
Causes _cerebellar signs
- Swaying of trunk while stand4. Cranial nerves exam: No menace response
(mechanism unknown) animal is not blind
_ Congenital
ing, titubation
.
Pathological nystagmus (positional & vertical)
- Tremors: regular, rhythmic, os_ Feline panleukopenia
C_ Localize to part of brain
_Canine herpes virus
ciUating movements
- "Head signs": head tremors, BAR
_Cerebellar hypoplasia/dysplasia
Intention tremors: worsened by
- Gait + "head signs": incoordination
b II
voluntary movement (eating)
- Cere e ar abiotrophy
Postural tremor: fine tremor of head,
of gait or dysmetria
- Storage dizs
trunk, upper extremities when standing, - 5. Normal spinal reflexes
Acquired cerebellar diz
disappears when recumbent
- 6, Normal muscle tone
_ Inflammations: canine distemper,
- Normal strength & reflexes
- 7. Normal sensation (pain & proprioception)
Toxoplasma, Cryptococcus, granu Normal postural reactions
- Radiography: tumors, lesions of bone or cartilage,
Pathological nystagmus (positional head trauma
lomatous encephalitis, FIP, parasite
o CSF analysis: usually normal
migration
~ ~ \ & vertical)
- Neoplasms
l~bftl- Para~oxical vestib~la.r signs
OOx - cerebellar signs
-Injuryltrauma
~
L. . ...I (headtlit,nystagmus,clrcllngaway
Dlz causing seizures
Trauma
v'
from lesion) acquired lesion of
_ Lead
Hemorrhage
-Hexachlorophene,organophosphate
vestibulocerebellum
.
o Infarction
Loss of menace response, but not blind
Infectious Inflammatory dlz
(rare)
Granulomatous meningoencephalitis
~-~
Anisocoria: mechanism not understood
Incoordination
Neoplasia
Mental status normal - BAR (bright,
F7 .
CS: Ataxia, tremors wlo weakness
Congenital cerebellar hypoplasia
alert & responsive) because RAS not affected
Virus-induced cerebellar malformation
Ox: Ataxic but strong
Prognosis:
Cerebellar neuronal abiotrophy
-Guarded: compensation possible
Tx: Congenital - None
o Metabolic storage diz
Facts/Cause
Condition
Presentation/CS
a4<"If)
~~
- Treat cause
_ Staggering & irregular muscu- Hx, CS, PE
Uncoordinated gait
Differentiate form generalized weakness
lar movements
Cause:
12M 970; 1M 740; 5min
that can make gait look ataxic
- Proprioceptive ataxia: dis- Tendency to cross limbs
20; IM-WN 75; E 145;
NC-C 18,318,319,280,
ruption of proprioceptive Exaggerated or hypermetric move- Identify as a neurological problem
337, 343; NS-W 34;
1. Stance & head position: head tilt,
(position sense) pathways ments
NS3hb216,366;NS-hb
Prolongation
of
weight
bearing
wide based stance; head tremor/bob~-:'l>--.'"\--.~
in spinal cord or brain stem,
61,170,208
phase of walking - delayed probing, intention tremors
cerebrum
**1
traction of affected limb
2. Gait observation & strength
I.
- Cerebellar disorders
3. Postural reactions (proprioceptive)
-Vestibular disorders
Localize neuro problem to proprioceptive, cerebellar or vestibular
_ Check for asymmetry of ataxia: Yes in
f""""l')
vestibular, no in others usually
- Postural reactions:
.
'"
. Abnormal: proprioceptive ataxia &
central vestibular
~ ""A
- Head & intention tremors:
only
Head tih: in cerebellar & vestibular
/""""Vh
__- - - - - - L - - - - - - (r"'.:{,
- Weakness: not in cerebellar or periph(
OOx: Ataxia
vr~'
eral vestibular, often if brain stem inS' I
d d' #1
~ volved(centralvestibularorpropriocep-
Ataxia
j-h,
cerebellar~"
;!. \ .~
--====-
: P~~;~i:C':ptiV: ataxia
.r-JI
td \ . .
~~
~Cerebellardisorders
~~u
( ~..--: ( '~'~_ Vestibular disorders
~~~rt., ~
- Penpheral
~
- Central
J'
lf
'=
Dlfferenllate from generalized weakness
(('
~
tive ataxia)
DDx Ataxia
Vestibular
Cerebellum
Spinal cord #1
"f
~~
~--
505
Vestibular Diz
NEUROMUSCULAR SYSTEM
Condition
Dia nosis
Presentation/CS
Facts/Cause
Uncommon in dog & cat
Signs of both central & peripheral vestibular diz
Head tilt,
Vestibular system: control pos~
- Head tnt towards lesion
Vestibular ture in relationship to gravity & eye - Circling, falling. rolling towards lesion
movements in relationship to head
- Spontaneous nystagmus (last phase away from lesion)
diz
movements
E-hb274; 12M 1002; 1M
764. 731; SAP 1138, ~ Peripheral vestibular centers:
inner ear (labyrinth [semicircular
1248, 390; H3B 241;
change i t n
H2B 1162, 238t, 239,
canals, utriculus & saccule] re257,24:5mln1150,74;
ceptors
[cristaampullaris,
macula]
(deviation of eye) on side of lesion
IM-WW 93, 460, 490; E
& vestibular nerve (CrN 8)
723; Cal 1560; NS-C
- VomRing, salivation (motion sickness) J
269; NS-W 21, 224;
_No proprioceptive fibers or UMN Differentiate peripheral from central vestibular diz
NS3hb61 ,216,220; NSfibers
- Central: brainstem signs + common signs
hb56;NS-OS2,4Q,106;
364,198;NS-L238,246,
More common deficit
Depression, weakness & postural deficits
249; X-T 50; OOX 443; - Central vestibular system:
Nystagmus: horizontal, rotary or vertical, may
Phs 168: NB 12.19
change ([Iredion wi head position change
brainstem vestibular nudeL floc Recumbency, lesion side down, lean against wall
culonodular lobe of cerebellum,
Loss of perception of sensation
motor, sensory & proprioceptive
Multiple cranial nerve deficits: facial (7), trigeminal (5) & abducens
centers [brainstem] located in
~)
~)
area
Cerebellar signs (hypermelria, intention tremors)
Poorer prognosis
- Peripheral (inner ear) vestibular diz:
No UMN signs (no weakness), No depression
Nystagmus: horizontal or rotary, doesn't change direction wi head position change
Postural reactions normal if done slowly (ataxia because of loss of
balance, not due to proprioception)
Cranial nerve deficits: only facial (7) possibly, NO cerebellar signs
Total lack of nystagmus indicates bilateral vestibular
lesions
Peripheral or Central
Paradoxical vestibular signs: head & body tilts away
CS: Ataxia, Tilt, Circling, Nystagmus
from side of lesion: damage to flocculonodular lobe of
Dx: CS, PE, Neuro Exam, Rads
cerebellum & some unilateral space occupying brain
stem lesions
DDx: Central (depression, weakness)
::~f;~O~:t::~~::~::U:'
;;~
**
(central)
(9
. t..
Tx: Tx cause
Vertical nystagmus
Nystagmus & head position
Cranial nerve deficits
Horner's syndrome
Proprioception & posture
VVeakness
Cerebellar signs
Depression
Neoplasms
Trauma
Congenital vestibular diz
Peripheral idiopathic
- Geriatric canine vestibular syndrome
_ Feline idiopathic vestibular diz
Aminoglycoside ototoxicity (rare)
Peripheral
No
NO effect
7
May be
Normal
No
NO
NO
Central
Maybe
May change
5,6,7
NO
DeficRs
Weakness (UMN)
Yes
Treatment:
Peripheral: Tx cause
_ Idiopathic (canine & feline): None needed; spontaneous
recovery - so time
.
.
_ Neoplasia: surgical excision difficult because of InvaSive
nature, radiotherapy or chemotherapy
- Congenital vestibular diz: none
_Aminoglycoside toxicity: stop drug
..
_Otitis medialinterna: ASs, Steroids; Exposure keratitiS
Tarsorrhaphy, or
.
Ophthalmic ointments, pilocarpine eye drops qld
Central vestibular diz: Tx cause
~
iiiJ~~))
~~
Yes
~_,,::::~=tr!...DDx: Central
or Peripheral vestibular diz
Head tilt, circling in both
Prognosis
Head tilt may persist indefinitely
Peripheral: better than central
Idiopathic: excellent spontaneous recovery
- Neoplasia: poor
Congenital vestibular diz: may be acceptable pet wi
compensation
- Aminoglycoside toxicity: good
.
_Otitis medialinterna: guarded many become chroniC
- Trauma: good
Central vestibular diz: poor
M
Vestibular Diz
Condition
Geriatric
FactS/Cause
Kg
*?
vestibular
diz, Idiopathic
#2
'~
"1
60'
Injury - 'Stroke'
(30%)
" No Homer's syndrome (DDx from otills)
OOx:
~)
*?
Feline
vestibular diz,
IVD
1M 766; IM-WW 491; SAP
1138; E-hb 275; H2B 264;
Cat 1560. SxS 809; N$-C
268; NS-W.224; NS3hb222;
NS-hb215; NSO 364; NSL 247; SxWW 288
*?
nystagmus
H2B 1161: NS-L 252, IMWW491
G)
~(~
~~ 2>
~~
(9 ~
Prognosis:
"Excellent: spontaneous improvement in 2-3 days &
complete return to normal in 2-3 weeks
..
~.f\( l...:
Puppies: congenital, rapid, pendular nystagmus (abnormal eye movements; Usually spontaneously resolves in a few weeks, Cause: unknown
Cats: congenital nystagmus: most often in ocular albinism; Siamese: condition persists for life;
Chediak-Higashi syndrome cats also (pigmentation & melanin granules abnormal)
(;;)CX-'
Nasopharyngeal
Benign growths in kittens & young adult cats; Pink, polyploid growths often wI stalk; origin unknown; location:
polyps cat,
nasopharynx ~ base of auditory tubes, may extend to middle ear, pharynx & nasal cavity
Inflammatory
CS: Respiratory signs; Sequelae: vestibular diz/otitis externa (head tilt, nystagmus, Horner's syndrome)
polyps
DDx: Visualize; Radiographs: check tympanic bullae for middle ear infection, Biopsy/histo
vestibular diz
Tx: Surgical excision ~
1M 166. 769;H2B 1161; IM- Prognosis: excellent
WW 491; NS3hb 224
Neoplasia. vestibular
~~
a'
tll'"
p-:.--}2,
diz 1M 766. E-hb 274, H2B 1161, NS-C 299, NS3hb223, NShb216. NS-l249. 251
~t
Tf"
"''' -...::
Onset<3months atblrthorlstlew
months
oBreeds G shepherd,
Doby, Akita, cocker
o Cats: Siamese, Tonklnese
----~
252
Ammoglycosides
0 0
vestibular diz
Otitis media
~....--::::-..
.b_
~ :'1
Cause ? Inherited?
..
fl"
OXICI
**
-Headtllt,clrclmg,ataxia
"CompensatIon In time
Deafness
Nystagmus ~
stre~ln.
('..
)
G
None
Common cause of
N
one
II
d~~Oe:~::::fdo~n~u~~
COx:
Cerebellar abrotrophy
Oscillatory nystagmus 01 Siamese
Acquired dlz of mIddle ear
n~
~! ,dJ'
\~~) )
\ '
.'- )
- -_
Hx (ear trouble)
ABs from culture & sensitivity or
.
xl
I
anal &
cephalosporin, chloramphenicol
Otoscoplcexame ema earc
!interna
I
Bulla osteotomy
tympanic membrane abnorma tym-.
E-hb 274; SAP 390; H2B
f ,.
.
Exposure keratitis
1161; 1M 766, 796; IM-WW
- Extension 0 otitiS media CrN 7 (faCial)
panic membrane
T
rrh h
490 5 . 896 Cat 1560
to otitis interna (bacteria,
I
imation
Skull radiographs for fxs
- arso ap y, or
.W'
22ml~.,
NS-O
361
,488','
yeasts,
"o'othecosis)
acr
S
h'
t
t
st
(I
'
t'on
VII)
Ophthalmic
ointments, pilocarpine eye
NS
_ Facial paralysis (drooped ear & C Irmer ear e
acnma I
NSL 109; 248~.
- Neoplasia
lip, drooling, ptoSiS)
~
drops qid
NS3hb 22~;
r
~ Pathophysiology: Paralysis of _ Exposure keratitis (can't dose
~.
<:::
1\\\\
NS-hb 212,
. C 7)
(. -Z
-.......;;
Sx-WW288;
vestibuIOCOCh!ear(CrN8,faClal( n
eyes)
'f('/
-T5O
"Xl & sympathetiC pathway (Homer's
S
la'
~':.
! syndrome)
Prognosis:
Peripheral vestibular diz
ascends up nelVe to bram,
Guarded: many bacterial infections be
CS: Unilateral vestibular signs, CrN 7 ~_teSpeClaIlY In cats
come chronic & frustrating to Tx. Can be
Ox: Otoscope, rads, Schirmer tear test i.~
controlled wi long tenn therapy
lx: ABs, Bulla osteotomy, Eye drops ~
**
\).
-c ....
, ,J-\?
7
-:__.: . ____________
I
\
I'I
-~2>
~-=
-=2>
~ (i.~
,'\
~,.
oHx{age).CS
0 Normal CSF,
radlographs
~1
___ , 'k~
Trauma (hemorrhage In Inner ear, fractures): PrognosIs' usually good if limited to inner ear & pelrous temporal bone ~~
Congenital
@Ii
1};~f;I
~)
Prognosis:
Excellent for recovery - spontaneous
" Recurrence unusual, fare permanent head tilt
idiopathic
Congenital
Treatment
None required - spontaneous recovery
Support
Hx (old dog), CS
~~
NEUROMUSCULAR SYSTEM
Diagnosis
PresentationiCS
,if \."\. :.
-:!~~abscessOrmemngltlslf
509
\7
~.~
s.>
.""
510
Brain
Facts/Gause
Condition
NEUROMUSCULAR SYSTEM
Presentation/CS
Diagnosis
Treatment
Hydrocephalus Pathological
Types:
-Communlcatlng:lncreasedproductionoICSF
- External: decreased meningeal absorption
(arachnoid villi) 01 CSF
- Internal/obstructive or noncommunlcating:
obstruction of CSF flow
. BlockageSites: cerebral aqueduct or lateral
foramen of 4th ventricle
Breeds for 10 : toy breeds &
**1
_ Dementia
~G;-J
bility normal)
_ Dome-shaped calvarium
Radiographs:
E I
.20
hydrocephalus
_ Rapid progressive cerebral
dysfunction (InCreased cranial pressure)
.Depresslon,decreasedmentation, head
pressing, severe seizures, slowing of
postural reactions, limb weakness, &
hyperactive reflexes, blindness wI normal pupil responses
J 1f};'l'If!)
fPA
DDx:
Ussel1Cephaly
Metabolic encephalopathles"i
(rf
<,
'1
Hydranencephaly Mk 579; H2B 252; Pa-T 338; NS-O 197: cerebral hemispheres replaced by CSF
......
Otocephalic syndrome Rare, Beagles group of head abnormalities (hydrocephalus, short lower Jaw & others), Epilepsy & neuro s l g n s -
"Lhasa apso
smooth brain"
Cerebellar
hypoplasia,
Panleukemia
Cause:
**
:?'\.~
/~,
,;
~S,
Classical
Hx
RIO other dlzs
Necropsy - confirmatory
kitten
- Normal strength
"
Phenoba' r~ltal
u
f.~~,.--,~,,,)
U
"qt;l>
- :l l
~ CI
None available
needed
Anticonvulsants if seizures
(phenobarbital)
Phe,fiital
- Menace
",.:" ,: ',""',
DO.:
Cerebellar abiotrophy
(progressive)
lysosomal storage diz (CNS)
Normal at birth
Slowty progress6ve cerebellar diz signs
-Ataxia (hypermetrla. crossing
'death
of legs, stumbling)
Cerebellar malformations
Onset: few months after birth
- Tremors
& degeneration
Breeds: Kerry blue terriars, Gordon setters.
- Normal strength
M8k 901; E-hb280, 238; SAP
rough-coated Collies, Bordercollles, Bull mas- Decreased menace
1136; H3B 235; H2B 254; 1M
tifts & others
Slowly progressive 740; IM-WW 461; E 618; Cat Also reported In cats, not confirmed
symmetric throughout life
1527; Pa-T 368; N5-C 327; Pathophysiology: premature aging & death of
NS-W I 20; NS-K 117; NS-hb
Purkinje cells
Sequela: Eventually incapacltatin9
Hx (age), CS
RIO other causes
Diagnostic test normal: cerebellum normal In
size groSSly, Films, CSF & EEG
Prognosis:
for most, mildly affected:
Good:
functional pets
Not a progressive disorder & lunctionallmpairment usually mild, CS are static - pel may
improve as learns to compensate
. Euthanasia
None
if disability great enough
~
...
*.
__
Symptomatic
-Tremors
_ Ataxia: hypermetria, sw~y
Cerebe llar
abiotrophy
?~;;""'Ph"U'
-=---
(dull
Metabolic encephalopathies
- Hepatoencephalopathy
- Toxic encephalopathies: lead
- Hypoglycemia
\!)
in~'~f
??
Asymptomatic (some
litter affected, some not)
CS present at birth
V ~~~?l>
I "\
Prognosis:
- : : : - - : - - c : : - - - : - - - - - - - - - - - - - - ' - - - - - y~,
~~}
DDx:
Cerebellar hypoplasia
(nonprogreSSive)
lysosomal storage diz (CNS)
Encephalitis
Neuraxial dystrophy
.~1~
..
,';4~~
I 11 ~
tw.:);}
Cause: Unknown
Occipital dysplasia .Toybreeds usually (Yorkshire temers, PomaMBk 920; Mk 586; H3B 232;
ranlan, Maltese, Miniature & Toy poodles)
H2B253; SAP 51; NS-C 354; ~
NS-O 198; NS-l28; N5-hb ~
Asymptomatic usually
Vary from cervical pain to seizures
Tremor, ataxia: hypermetria,
Hx, CS
.
Radiography for abnormalities.
_F.M: abnorma~ly enlarged ~ .mlsshapened
- AbnormaI OeclPItcallantal JOint
Myelography: not necessary
Necropsy - definillve
"; .
~~'"
swaying, falling on turning -~/,.":!>b
Abnormal head posture e~~
Iventroflexlon 01 head) )
l
I
Mild atlirst, but may
)
\'
progress as repeated (~ trauma
~)
t5
\l
),
DDx:
Atlantoaxial luxation
Cerebellar hypoplasia
Cerebellar abiotrophy (progressive)
F
.....
"'~t
~~ )
lQ.
q"~<>o,.-..,.
...( ;~~_L______rL'[!'\.i:l!J-_\\_.J:'::::~~~'s:.:~P~~~~~t~II:~to;",~g~,~d="===~_~.:p~,og=":o.~,~,
.::::::::!~==-=___
5111
.
Meningoencephalitis
512
Seizures
Condition
NEUROMUSCULAR SYSTEM
Dia nosis
Presentation/CS
Facts/Cause
Physical
exam
j
of seizures: Abnonnal conscious Dog: 80% of cases
H2B 243; 12M 988, 987; 1M
,
761.752,416;IM-WW89;
ness, muscle tone, autonomic Neurologic exam - interictal
Cats: 50% of cases
5mln 144, sse; E 152; Cat
- Normal: Idiopathic, 1, acquired, metabolic & toxic epi Symptomatic epilepsy: if cause found
function, involuntary muscle
ISIS; F3M 389; DDx449;
lepsy & some structural causes
movement, altered sensation &
Extracranial causes
Sx-S 1124; NS..c 119, In;
If abnormal: a vigorous diagnostic evaluation inNS-W 95, 191: NSK 41;
behavior
Intracranial causes
NS3hb 313; NS-hb 296;
dicted
t
I
Acute symptomatic seizures: seizures wlin a week of known
Tonic clonic generalized moNS-0285, 123; NS-L326;
. Diffuse cerebral signs: altered consciousness, postural deliC~s wI normal
cause 01 seizure
tor:
t
muscle
tone
(tonus)
alterSx-WW 287; Pys 257
gait, cortical blindll9SS, placing/propulsive behavior
Remote symptomatic seizures: occurring weeks to months
nate wI relaxation (clonus)
.. MetabOliC encephalopathy, toxic, hydrocephalus, lissencephaly. inlecafter known cause of seizures
tiouslinllammatory diz, cerebral neoplasia
- Status epilepticus: seizure lasting longer - Postictus: period of neuronal re, Focal cerebellar? signs: contralateral proprioception & postural deficits,
covery - variable length usually
than 15 minutes or repeated seizures wlo
contralateral visual deficits, circling
<30min.
recovery to consciousness
.. Cerebellar tumors, vascular lesions, trauma, infection/inflammation
. Multifocal CNS signs: infectiouSiinflammalion
Behavior, weakness, dementia,
- Cluster seizures: 2 or more seizures occur Minimum data base:
pacing, blindness
ring in same 24 hour period
-ese
Facilitating conditions: drugs & physiologic
DDx:
- Biochemical profile, bile acids,
states that lower seizure threshold
Narcolepsy
fasting blood glucose
- Phenothiazine tranquilizers (acepromazine)
Syncope (fainting)
- Urinalysis
- Cyclic estrogen fluctuations
Behavior disorders
- +/- CSF (il highly suspected 01 Idiopathic epilepsy)
rr::
- Repeat data base belore Initiat!ng anticonvulsant treatment
Transient vestibular attacks
EEG (electroencephalography): interictal EEG abnor Neck spasms
malities eliminate idiopathic so vigorously pursue etiology
Myasthenia collapse
Skull radiographs: hydrocephalus, head trauma, ortumor
Idiopathic #1
rr-;.",,-:,:---/
Funduscopic exam: systemic illness or inflammatory diz
CS: Seizure (Aura, Ictus, Postictus)
Blood lead level in certain areas
Ox: Hx, CS
.
CT (computerized tomography) or M RI (magnetic resonance imaging)
#A
dJi)
**
Seizures - causes
.ldiopBthic (most common' K9 & calS)
Classification of seizures
_ Generalized seizure: bilaterally
Extracranial causes
unconsciousness, #1 In dog
toxins)
Hypoglycemia
Hypocalcemia
Eclampsia
Lymphocytic parathyroid ills
Hepatic encephalopathy
Uremic encephalopathy
~~~~~;~:;;~!;:~::~:;~~!!:'I~;~~'~;:~startlrom
locus
in cerebral
motor Almost
cortex.
progressato
generalized
seizure,
Hypoxia
Thiamine deficiency
Hypemalremla
"'IF?
Moldy loodstuH
Partial complex (psychomotor, temporal lobe, limbic)
Hypoparathyroidism
Renal failure
(~~,...-..~?:
seizures: alteration of consdousness + abnormal behavior (Running fit, Fly
Acute pancreatitis .c
catcher, Tail chaser, Rage syndrome {Springer Spaniel])
Hyperlipoprot9inemia
Acid base balance/electrolyte disorders
- Poisoning
6 mo - Syrold
Ethylene glycol
Lead
Idiopathic epilepsy
OrganophOsPhates
Causes < 6 months old
Inllammatorylinlectlous dizs
Carbamate
Juvenile epilepsy
Metabolic disorders
Chlorinated hydrocarbons
Inftammatory/lnfectious dizs
- Hepatlc-portosystemic shunlS
Metaldehyda (slug bait)
- Canine distemper
- Hypocalcemia
Mycoloxlns
-FIP
Viral encephalitis
Strychnine
Toxicities
Toxicity
Intracranial
Trauma
Trauma
- Primary epilepsy
In utero Insults (acquired epilepsy)
Acquired epilepsy
Trauma
_ Trauma, hypoxia at birth, metaboliC
Encephalitis
disorders, encephalitis
- Tumors 1" & ~ (metastatic)
Metabolic disorders
- Inflammatory dizs
- Hypoglycemia
Viral: Canine distemper (K9),
_ Hepatlc-portosystemic shunts
Feline infectious perHonitls (F)
Congenital
Bacterial - Brain abscesses
- Hydrocephalus
Polioence,*,alomyelltis (F)
- Ussencephaly
Toxoplasmosis
_ Lysosomal storage dlzs
Fungal (cryptococcosls)
Granulomatous meningoencephalitis
Pug dog encephalomyelitis
Rabies. Aujesky's dlz
Inlarctlon
Lysosomal storage diz
_Congenital: Hydrocephalus, Lissencephaly
00)
(!
Treatment:
Treat cause if found; if not, treat seizure
When to start treatment? Arbitrarily
_At least 3 seizures - make sure epileptic
_ > One seizure every 6 weeks
_Cluster 01 seizures once every 8 weeks
_Status epilepticus (any cause)
b;~11~~H'<':
@6t> ~
~~
Prognosis:
Guarded to good; 50-80% success of
antiepileptic Tx
Worse prognosis: complex partial seizures
2 generalization
514
Seizures
Condition
Facts/Cause
Idiopathic
epilepsy,
Cause: unknown
BS
name
implies
Primary
epilepsy
NS-L 3~
***
r~ 1; ~
.r...:. ~""
Juvenile
epilepsy
IM7S1;
H2B 244
Unknown etiology
- Severe form 01 Idiopathic epilepsy
< 16 weekS 01 age at onsel
Breed predisposed: Cocker Spaniel
~
.
oR"eoITh'mb:lhe~"e"ho"ppYI>1S
....
NEUROMUSCULAR SYSTEM
Diagnosis
Presentation/eS
.",11 "ue,"""
.I~~
,~
husky, Mlriature poodle, Wirehairedfoxterriers, Lab, Golden retriever, sporad"lc In all breeds
01 dogs & cats
Severe epilepsy: frequent seizures per week, to
status epilepticus
- Generalized tonic-clonic, no lateralizing signs
\.~
-=-
--=:.
~~7
~
<B
'
~~'
~a
Acquired
epilepsy
Treatment
-;: ;'
Prior insult (inflammatory, trau- Partial seizures only or partial sei~ Hx of previous insuH 6 Anticonvulsant - phenobarbital. No
months to 3 years before matler how bad II looks, attempt treatment as
matic, toxic, metabolic or vaszures that generalize
seizure, usually cause can't
cular)
H3B 220; H2B 243; 12M
- Alters a focus of neurons be determined
7-,~ : ,",
- - - -
998; 1M 761
spontaneous discharge - sei Neuro exam, blood tests,
iP \
~~
~
zure
CSF usually normal
~f~~""
ECG often abnormal (dif- Prognosis: may be better than '\ :
_~~~ In utero or perinatal insults
ferent from idiopathic)
for idiopathic in large breeds
~\'\:l"'1
~-----
q~
~_ A-- ~~
r
Status
Status epilepticus: seizure lasting Jongerthan 15 minutes or repeated
wlo recovery to consciousness
epl01 ept"ICUS seizures
_Specific causes of most unknown, systemic metabolic derangement & Inflammatory brain
OOx:
Vestibular diz
page, Rule out DDx
.,tlelno~'lrt'it;ar~
Narcolepsy
Catheterization -IV
I'"
& Cluster seizure
injuries may predispose
24 h
' d . Tetanus
Pentobarbital, check serum
SAP 1153; HaB 220', 12M - Cluster seizures: 2 or more seizures occurring in same
our peno
drug levels, if inadequate
Hypocalcemia
I
1001; 1M 757, 763; 5mn
S equeIa:
, 1 5 - 4 5 mgll) adjust dose
146;.NS-O 298; NS-L 337
_ Permanent neuronal damage if continuous seizure> over 20 min
Hypoglycemia
Initial Tx
~~ ~~ ~~_
_ _ Hyperthermia, lactic acidosis, hypoxemia, cardiac arrhythmias, pul Organophosphate
_ Thiamine (B-complex vitamins) & dextrose
~1-__/~.'.. '-.. ~
poisoning
~_./
monary ed ema, death
time epileptic
'< ,
J :-___
D: ..... .--
Meta60lic
#1
encephalo- Hypoglycemia: rare but metabolic seizures, Insulinoma: dog> years.old,""'~~/,:I,- .--,,_____
pathies
transient & recurrent juvenile hypoglycemia < 4-5 months old
SAP 1147-, H2B 245, NS-L
328; NS3hb 318; N5-hb
**
302
Inflammatoryl
infectious
dizs
H2B243,NS3hb318 NShb302
Hepatic encephalopathy
th
~
I~~'
- Phase 1
" ,"
.
',PE':\, Va
.. Diazepam short acting, PB~,
l:.
~i;~:~~~:~I~~~~O~I~V
dT)
yrol I IS
fI
"I
,~.:,.::
_Phase 2 p a :
Viral d1zs: Canine distemper, Felineinlectious peritonitiS; Protozoal dizS -toxoplasmoSis, Fungal dlzs; All subacute progressive dlzs
CS; Systemic Signs, Canine distemper: "chewing gum" seizures
.,
.
.
Ox: Hx, CS; Abnormalities on the phySical, neurological or funduscopiC examinations; cae, profile, U,~, Abnorm~1 CSF. t cells &
protein. organisms (cryptococcus), oUen normal in canine distemper; ECG; Serology: toxoplasmoSis. FIP, canine distemper
Treat primary etiology 6. apply symptomatic treatment for seizures
Prognosis: Guarded to poor
'~
Thalamocortical tumor, 1 gliomas Boxer, Boston terner; Meningioma nonbrachycephallc breeds. cats
"cs Seizures 6. behavior changes, Otl'1er cerebellar SIgns (contralateral conSCIous propnoceptlon &
neoplasia postural defiCits, galt often normal, contralateral visual defiCIt, altered conscIOus level Circling)
Ox Skull radiographs. CSF II1creased pressure & or protein wI normal WBC, neoplastiC cells rarely
seizure
seen, ThoraCIc radiographs for metastasis, CT (computer tomography) diagnostic
H2B243. NS3hb 318, NS. Tx Refractory to treatment
hb 302
"PrognoSis Grave
Cerebral
Maintenance phenobarbital
',' ,
started if seizure controlled by above
, If seizure continues at lower frequency:
I '''-'I'
,--~I
)6 . Ph~se 3: for r~ractory patients
* .
Diazepam drip
Valiu
Extracranial seizurogenic toxins Slug bait, SpOiled dairy products (mycotoxlns). Strychmne (rare), Lead poisoning
TOXICltl~es
. TOXin accumulated In the cerebrum causes the seizures, thus continuous seizure actMty until treatment Is applied
-........_~:;:.,::...5I
515
-
::.._______-'---__
--
--
--
-----
..--.
~
Narcolepsy
Condition
Narcolepsyl
Cataplexy,
Sleep
disorders
M8k 900; SAP 1154;
H3B228; H2B323;5min
867: E 157; DDx 451,
452; Cat 1561; NSO
299: NSL337, 88; NS
C 223: NSW 92, 119,
196;NS3hb325; NShb
308: Sx.l/o/W 287: pys
257
**
Facts/Cause
Presentation/CS
Cataplexy: sudden loss of muscle Sleep episodes at inappropritone resulting in collapse
ate times
- Motor Inhibition of short duration
- Completely reversible
- Initiated by: excitement (eating, playing, sexual
arousal)
NEUROMUSCULAR SYSTEM
Diagnosis
Treatment
(attacks stimulated by eat- -Incurable disorder
ing),CS
Drugs to reduce severity
Hx
Pharmacological tests
YOhimbinechallenge: positlve if 90% reduction of attacks (4 hours duration)
Imiptamine dtallenge-. improves arousal
Physostigmine Challenge: causes increase in
number & duration of episodes
Atropine response: marked .. in attacks
in other dogs
~)~
S pnnge
s aniel
p
NSL 323:
NSW 119
~;'~11
Prognosis:
Good: not a fatal dlz
Hypothyroidism
Chronic hypoxia
Obesity
Other metabolic Illnesses
) '); .. wi grazed appearance to eyes, few tremors in pelvic limbs; wag tail, growl & bite animate objects, crouching under table
-......
'. - Ox: Hx (spaniel), CS; no measurable abnormalities
.. ::i7
( 0 Tx: High levels of progestins (Ovaban) .. vigorous training program, but neither completely eliminate aggression,
(.{t;)\
r
Euthanasia
r;f,/
Poor lor complete elimination of aggression
~. CS: Episodic rages 01 seconds to few minutes, return to normallnbetween. Snapping & marked bllaterat mydriaSiS (dilation)
Prognosis:
~~l
Rage syndrome -\ Episodic rage behavior In Eng, sprlng~r spaniels; normally wellbehaved, Onset 1.5 years old, Cause unknown
YOhimbine~
Uff!!1
Narcolepsy
"
DDx:
Cataplexy
Myasthenia gravis
Hypoglycemia
HyPOCalcemia
Adrenal insufficiency
PolymyOSitis
Nonmotor epilepsy
Syncope
, Cardiac arrhythmias
Hypokalemia
Partial seizures
- Yohimbine (Yobine):current
..
'()'
Visual
loss
Bone
marrow aspirates
_Accumulallon of nonremovable substrates caus
_ Seizures
Aspirates of bone marrow, liver, lymph node
ing loss of function of affected cell
_ Behavioral chang88lmental status
abnormal storage material
- Autosomal recessive pattern
Multisystem (lIver, skin, hemopoietic)
- Necropsy histo; to. ;;:"~""fi"~,, Most likely In purebred dogs wI Inbreeding
'Failuretogrow,comealopadty'hepatosple--~
MSk 900, 907; Mk 582, Only single member of liHer effected
nomegaly, blunt-broad facial features
I
--ODx:
'\
_ Inflammatory CNS diz
591; SAP 1145: H3B Classification:
Udoses: defect in degradation of lipids
233; H2B 255, 279; 1M
'I:
HydrocephalUS
Leukodystrophies: defect In degradation of myelin
759, 744, 788; IMWW
V
Ussencephaly
Glycogen
storage
disorders:
inability
to
malabO
Cerebellar hypoplasia
.
460; Ehb 280; E 617,
r-______________
Cerebellar neuronal abiotrophy
lize glycogen
676, 70B; 675; 5min 87;
Cat 1527: NSC 139, Pathophysiology:
Rare, Progressive multifocal neuro dizs
r.,.... ~'r.
Lysosomes: packets of hydrolytiC enzymes
223: NSW 114,154,
CS: 1st year, Progressive, Multisystems
-J
Genetic enzyme defects w/ln Iysosomes
220, 224; NS-K 119,
Material builds up In tysosomes resulting in cell
124; NS3hb341; NShb
Prognosis:
death
285, 322; NSpa 214:
progressive & fatal
_ Grave: always progressive I: fatal
_ Neurons affected most because they don't divide
NSL 296, 271: NSO
185; Pa-T 341
Globoid cell leukodystrophy, Krabbe's diz
Sphingomyelin lipidosis, Nelrmann-Plck
.
See pg 573; Cairn lerriers, West Highland White terriers,
Sphingomyelkinase deficiency
. I.
'
Neuronal ceroid IIpofuscinosis
\
Beagles, Blue tick hOunds, Poodles
Siamese, DSH cats
'.
- English setters, OSF cats
Onset: 1130 weeks
.
.\'!fu~oOnset:3--6months.
~'(
-Onset: 141Bmonths
_ CS; Ataxia, intention tremors, dysmetria, pareSIS, ~
CS: Stunted growth, AtaXia, tremors
,
CS: Mental changes (dementia,
visual deficits, seizures, behavioral changes
Lesions: CNS, liver, lung, spleen, lymph
\,
depression), ataxia, tremors, paresis,
~~
lesions: CNS only
")
nodes, kidney,
visual deficits, seizures. behavioral changes
bone marrow, adrenal glands
\ lesions: CNS, lymph nodes, salivary
Ganglioside Gm1, NormaN.5-Landing da, Derry's d~'Z
glands, prostate, kidney
..
Beta galactosidase deficiency
Glucocere.broaidosis, Gaucher's diz
~,~ .oj,
Breed: Siamese, Korat. DSH cat;
Glucocerebrosidase deficiency
Cavitating leukOdystroPhy
io ;. ..
Lysosomal
storage
dizs, LSD,
Degenerative
diz
Rare
_____-,__-...
.'1
l....:..:..:.._-,
:t\.f! i
~:; ~~~~,S~I;'~~S
~~
diz~
...,J:........
('!cl0)0
r
-:i-
f\...A.
~:::~~. :~~~,~:edd,gs
"N J9$;~"f.
1 :~~:g~~~,::;le~W
{j~ j f J' : g~,:ti:_~
CS: Ataxia, hypermetria
Lesions: CNS, liver
(
MetaChromatic leukodystrophy
-Cats
Onset: 2 weekS old
/.
I/; "
~.
517
months
CS: Decreased vision, ataxia,
progreSSing to paresiS
- Lesions: CNS only
<~.
;:-:~I
Ence~halitis
518
Condition
Facts/Cause
Inflammatory
brain
disorders,
Infectious
encephalitis
-~~'ill
')1:J'
If'
/I.
Treatment
....
....
Toxoplasma, encephalitozoonosis,
trypanosomIasis, babeSIOSIS
~=-~ Pseudorabies
.-
Cats: Causes
~r$
~~
~
t
,~
corneal changes
Serology: test for antibodies
- Time limitation & less reliable than CSF
- OptiC neuritis: canine distemper CTIMRI: more helpful for mass lesIon than
- Extreme, erratic behavior: radisseminated Inflammallon
~
bies
Necropsy
r.t!
/~
Protothecosls
Bacterial (rare)
\-Lo
Di~osis
-Inflammation of brain tissue Acute multifocar neure diz, gen- Hx, CS (muhifocal)
ABs I~ ~c~ss blood brain barrier)
#1 disseminated brain
erally progressive
CSF: diagnostic test of choice
- AmplcllII" (initial drug olchoicej, pemciIdisorder
- Cerebral: seizures, dementia,
-Increased WBCs (highest in granulomatous &
lin G, chloramphenicol, celoxi!in, cefolaxime,
bacterial dlzl
Often associated wI meningitis
!rimethoprirn sulfa, metronidazole
visual deficits, weakness, interic- EOSinophilS: systemic fungal. protozoal or
Often also affects the eye (most
Antifungal: amphotericin B (Funglzone),
tal naure abnormalities
parasHic
Mk608,E-hb28O, Sap1140,
H3B23e, H2B260, 12M 1007,
1M 760,5mm544,NS-C 127,
NS-K 59; NS-Pa 102, 144
NSC 127; NSO 216, NS-L
381;NS3hb299;
~r
NEUROMUSCULAR SYSTEM
Presentation/CS
FIP
DDx:
Toxoplasmosis
Systemic fungus
- GME
~ v,
Pseudorabies
Bacterial (rare)
- CNS toxins
Sterol
I.
- Anticonvulsants: phenobarbital
If brain
- Diuretics, mannitol
t~~
/-
FfID
encepha~-
vasculitis
General supportive
- Fluids
~ I!l
(y
Prognosis:
Poor to guarded
\.:::;.
T,
Infectious meningitis
r
Encephalopathy
!Iue to sepsis
Sepsis
~.
tion
-
&
No
hemorrhage
serum
biochemical
Toxoplasma
encephalitiS,
of bacteria
* .
& WSCs
Rare
TOKOP'-SIfIII gondit ubiqultous proto-
".
Toxoplasmosis
)(
..
- Fever
- Shock
CNS:
- Acute
+ in consciousness
-~ur~~)~#
*~Jtj
r:c-;:~~~==~-L
So;,u...
f~\
(
systemic; Sequela:
--.-
. .
brain hermatton
I ;:,
I
II
~u
If'
t~-~:;p)
(=0;,
'~-q
)- ,
__________________l -__
Antemortem Dx difficult
MiCroscopic Idenllflcatlon
Serology: rising titers in paired sera or high
single sera
FeLV & FIV test In cats
Fecal exam for oocytes
(shed for only short time)
~ ~ 8S
~1~~lIngfO
Supportive therapy
..... _
..,9"bOdlas
Pathophysiology:
- Rapidly progressive mass lesjon
- Necrosis & edema of adjacent neural
ltl~~~'C-
__
Hx (septicemia), CS
(l
~~~~~
Brain
abscess
6~
Vhf:)./ '.
'~I ~;)Jfi
I
f"'/
DOx:
Trauma
Vascular Injury (not progreSSive),,~=- Tumors (not as rapid)
Granulomas
Aberrant parasite infections
Metabolic Encephalopathies
Condition
Metabolic
encephalopathies
2 impairment of eNS
ergy requirement)
Pathophysiology:
-Dis!urbldealenvironmentforCNSneurons
380, 131
Diagnosis
***~5
NEUROMUSCULAR SYSTEM
PresentationiCS
metrical
- Altered consciousness (con-
.....
tiff
g
encePhalitiS/Hyperammonia~~.
- Hepatic
(POrtosystemic shunts, liver failure) - ammonia
Endocrine dysfunction
..
J~v
tlclsm
..
- Hypoventllatlon: ethylene glycol coma
- Hyper- or hypoadrenocorticism
- Thyrotoxicosis or hypothyroidism
Biochemical i m b a l a n c e s . . . /
. .
- Osmolality changes:
Hyposmotic states' diuretic Tx hyponatremia fluid T x
' .
~'
Reticulosis;
** -
::s
h r
Chronic granulomatous mening08f1cep a 1-
tis
M8k 900; E-hb 284; SAP 1141; H3B Only reported In pugs
238; H2B 268; 12M 1011; 1M nl; IM- Cause: ? familial, immunosuppression?
WW 469 '. Sm', 9'9'. E 626'. I-G 862; - Patho''''''''''ology
"1NS-C 341, 157;
r:".
- Similar to GME but more malacia
NS-W 119; NS-hb ~','( ( (/I,g~,l,II. - Affects all brain regions
358t; NS-Pa 111;
4'"'(.r{ y. Young adults (9 months to 7 yrs)
NS-L 384;
~ <,'l.7 Callfomla & NE USA
NS-O
Only in pugs,
229..L..d..{:a
........
""\
~o~.
~lIvatlon,
DDx:.
Diffuse enCephalitis.
- Encephalopathies. (polsonl~g, hyd,,?-
._Certain
Hydrocephalus
brain tumors
CS: Temp < 90F (32"C), altered mental at~tude, cardiac armythmlas
Tx: Blankets, warmed fluids, water bottles. electric heating pads may cause
peripheral vasodilation & intemal cooling
Other. see below & next pages
ca,...
~---, ......
~,
circling
Brain stem: loss of balance,
head tih, cranial nerve paralYSiS, blindness, facial
& tri-
geminal paralYSis
- Hemi or tetraparesis, nystagmus
o Meningitis, neck paln & fever
o intermittent fever
Ocular form: blindness, dilated
'1
nresponsive 10 light rarest
fou~ ~ ~I~west progression ~
DDx:
_ CNS lymphosarcoma (reticulosis)
Acute renal degeneration (toy breeds)
Infectious enC?phalitis
Other neoplasia
, Metabolic encephalopathies & toxins
~ce--~
_ Cerebralsl.ns: seizures, dementia, - Hx (pug), CS
head pressing
pleocytosis, eosinophilia
Histo: diffuse perivascular mononuclear
Infiltration & white matter degeneration
,'.' , b-' b'
- Postmortem: de Ilut ve, I<un opsy
_ Diffuse, degeneration of White & gray mailer
_ Large perivascular cuffs of lymphocytes &
hisllocytes
~.
----<'
,
~ , "'ph~",. ,.""od,s_m,,,, ,diopalh"
~.
TI"
epilepsy, .encephalltls
'(i1}
, I . 1 CNS disorders
Granulomatous
meningoencephalitis, GME,
~
..1
pulmonaryd~nctlon),metabolicaCidOSis(accumulationofaeids;shOck,diabetes
me!litus, uremia)
cs: Depression, delirium or coma
Tx: Correct underiYing dlz, bicarbonate given slowly
Alkalosis: When ph > 7.4; Cause: respiratory alkalosis (f carbon dioxide) or
meta.bolic alkalOSis
or sequestration. of body acids); most commonly from
~ chlonde loss from vomiting or sequestratiOn
1"\ CS: Less pronounced than acidosis: tranSient confusion, muscular weakness
Hyperthermia, heat stroke: high temperature may cause cerebral edema
"""\...
~"'
~ "".........
, . hyperglycemia
'.
hypematremla,
~1 i ~r::;:
~-
.. Hyperosmotlc
.
'
states:
~W
~;'~11
~l
-Seizures
Treatment
-Hx, CS
Physical/neuro exam
rahPi~IY PNrogreh""divel~~::~'g3ro:en~ks~eluctance
Prognosis:
Grave: generally progressively fatal
diz disseminate: 25% die in 1 week
Su~valtlme generally short 2-8 months
fJ'
- Corticosteroids - palliative
lor short periods
Anticonwlsants for seIzures
(phenobarbital)
- ASS ineffective
- EuthanasIa wI progression
521
_. ---------.- -
Prognosis:
.,,M.,.
Grave: invariably fatal, usually wlin few
weeks, maximum 6 months
A~"
II I
:-a-
"
;f:)
Uremic Syndrome
Condition
NEUROMUSCULAR SYSTEM
20/1;1
- Hx (renal failures) CS
Encephalopathy
Dementia delirium
~ <,
~.';;'-2-:
- Seizures may occur
( )
PE (physical exam)
- t BUN
/,1
m~'
JX==:-"'::'~ ::=~ 1W'
'"
I
,.
described in dogs
Pathophysiology of uremic encephalopathy: uremic blood has
toxic substances (organic acids)
that affect the brain
Acidosis
Pneumonitis
Osteodystrophy
Lab
wi terminal uremia
Treatment
Diagnosis
Presentation/CS
-t
Serum creatinine
- t.
Serum phosphorus
Sli
co
r.
~r
~ ); ~r.
~
~ /r:L ~
- -,
Prognosis:
Grave
~,-::;;;;:rt:::dL~dI;;;gt49~r
".GOOdl","~f'U"'."':::.~"'."d
Cavernous ~. Lesion of cavernous alnus: Cause: neoplasia (hemangiosarcoma, pituitary tumors, lymphOsarcoma); Infectious: FIP, fungal infections
~\
Sin US
Biotin defiCienCyo
H2B 1008t; 12811
~
_1~lf
,.
ru
Other deficiencies
&
~
_
A ..
oRare,Dagenerationofneuronsinbrain&spinaICOrd
cs: CNS (rear limb weakness, ataxia, cramping & convulsions): dry scaly skin, erythema,
a",m;'.",dd.'de"h h.UO$;' O$Sif".'ed""""f'.I\~
*
*.
convulsions
Hepatic
encephalopathy,
HE,
Hepatoencephalopathy,
Hyperammonia,
Portosystemic
shunts
M8k 900; E-hb 2n; SAP 722., 751;
H3B 246; H2B 437, 441; 1M 428. 407,
384,422; N5-0 261 , 131; NS-l329,
429; Cal 1534; F31M 377; NS-C
159,188,226; NS-W 92,116,202,
220; NS-K 131: NS3hb 348; NS-hb
328; NS-Pa 208
B2
"'~'~\~1
.~ \\----------
~~
\~~r~
,
" ~rr.
'i\,
u ='9 i- .....
':~~~_/
,"
Niacin deficiency: anorexia, weight loss, diarrhea, oral ulcerations & CNS signs (weakness, convulsions,
....
coma; Degeneration of nervous tissue
Pantolhsnlc ac:id: rare: CS: anorexia, hypoglycemia. hypochloremia & azotemia, eNS (conVtllsions, coma & death)
-f"'-
'--
{a
ascites
- HepatiC failure
portosystemic shunts
_ Cirrhosis, Hepatic lipidosis
Hepatotoxicity
Hepatitis
'$
Neoplasia
(,
Congenital urea cycle enzyme deficiency (mre)
'\
______
~ 0_~
Emergency
-IV fluids - diuresis (Ringers or
0.9% saline)
Restrict protein: kid diet,
multiple small meals
_ Lactulose
Hepatoencephalopathy - Causes:
- Ultrasound
**
~
'-'
(82) deficiency
Riboflavin
"z::=
\:~"o/
..
syn drome
/);"11 ill
t.~
f J .6;+
00
:::\
ri~
'"fl~
~~l"
Prognosis: variable???
R
tal do D fl encyof hepatic enzyme needed for converting ammonia to urea In liver
~
enzyme
: C~':"H con~i~n~n~p~io:'t~y. cerebrocortlcal dlz (seizures, stupor or coma, altered behavior), InterrMtent GI signs [vomiting, diarrhea], An0pre~,~' Stu~t~)ng
~-:;-'r
deficiencies ~o Ox' ~~Iprandlal hyperammoneml8., abnonnalammonia challenge test, Hypoalbuminemia, Other hepatic test usually nonnal (ALT, SA, e aCi s,
~
<:"
portography to RIO PSS, Uver biopsy
~
~-----U
H2B 441
OOx: PSS, AcqLired disorders of urea metabolism
0 Tx No apecHlc Tx available, supportive care similar to
PSS (low protein diet, oral ASs, lactulose)
~j.
Urea cycle
=--_
_______--_____-_-_____- ___
Brain Trauma
Condition
NEUROMUSCULAR SYSTEM
Facts
Hyper-
See Endo pg
aialOCUticisiil,
Cushing's
syndrome
& Cause
Presentation/CS
Diagnosis
Treatment
- Causes: 1. Pitultary dependent (65%), 2. Adrenal tumor 15% (AT), Iatrogenic: prolonged steroid Tx - adrenal atrophy
- CNS sequela: pituitary neoplasia
CNS signs: large pituitary tumor - dullness, seizures, somnolence, wandering, head pressing, ataxia, blindness,
anisocoria, Homer's syndrome, Cranial nerves
2, 3 & 4
involvement
path:
.-.,..,.
r..-:
~~9
~
"'-
Myotonic dimpling
~..::::. ~
Tx: Pituitary dependent: Mitotane, Lysodren (o,p'DDD), Ketoconazole (Nizoral) lifelong BID Tx
-....
--
Cranial
vascular
diz
SAP1133;H38247;
H28257; 1M 760; E
hb 239; E 607; Cat
1536; SxS 1029;
PaT351; N$-0244,
131; NSW 119;
NS3hb 29&. NS-hb
281; N$-Pa 244; SxWW 287; XT 75
"',
WO<Se
Prognosis:
Guarded 10 good if survive 48 hours &
no underlying diz
Cerebellar infarcts best, brain slem
E-hb 239; H38 247; 12M 996; 1M 760; 5mln 548; IM-WW 474; Cat 1537; NS-C 216, 231; N$-W 119, 222; NS3hb 296; NS-hb 282; NS-Pa 242;
Supportive care
- Steroids for edema & inflammation
- Moderate fluid restriction if not in
Shock
Monitor cardiac arrhythmias
Nutritional support
Specific therapy
- Treat cause if possible
Hx (cat), cs
CBC, chem., skull radiographs, & CSF usually
normal
EEG: abnormal
G~
L---
Brain
trauma,
Cause:
_ HBC (hit by car)
_ Blunt trauma, animal fight,
Craniocerebral
trauma, CCT,
Head
trauma
Ehb 273; H38 250;
12M 981; 5mln 402;
SAP1137;IM760; E
605; Cat 1539; F31M
406; Sx-S 1027, SxWW280; 1122; PaT 343; NSC 228;
NS-W 221; NS-K
147; NS3hb290; N$hb 275; N$-Pa 189;
NS-0303,470, 128,
NSL 356
Fractures:
Jr----"'k:.
.. Varies wI location & severity
-
,.0
- Motor activity:
. Nonnal to recumbency & no reflexes
Hx (HBC)
Signs
Physical exam:
& blindness
&
of
injury indIcate
""
CheCk airways
_Check tor shock & entire body for injuries
_RespiratIOn & pulse rate: ataxic RR & Slowing
pulse precedes respiratory arrest
responsive) to
'.
- Injuries to head
Oaceratlons, bruising), fractures
. Normal to bilateral/unresponsive
- Consciousness:
. BAR (bright alert
~
,-~
Neuro exam:
Consciousness level: BAR to coma
.
. Static, worsening or imprOVing
Hematoma (uncommon)
_t
. Brain swelling
. Tentorial herniation
lowing reflexes
- Limbs: tone, reflexes
****
lesion
r:-~~
US
.~ ~
.,'
Posttraumatic syndromes
Cerebral:
- Concussion: temporary loss of consciousness
- Wide circles toward lesion
_Proprioceptive deficits & mild weakness
- Decreased menlalion
- Seizure: al trauma or later (delayed)
Normal to Cheyenne-Stokes respiration
HBC
OX: Hx (HBC), CS, Neuro exam, Rads
CS: Depend on location
lx: If NO CNS CS: observe
If CS: Oxygen, Medical, Sx, Euthanasia
~~~~
-...::: 6?'
- Tentorial herniation:
Progressive deterioration ot conSCiousness
Decerebrale rigidity
Then flaccidity & failing respiration
Cerebellum
- Truncal ataxia
- Umb hypermetria
Head dysmetria
Nystagmus
Vestibular damage (peripheral better
than central)
- HeadtHt
Loss of equilibrium (swaying & falling to side)
- Wide based slance
- Horizontal nystagmus & downward strabismus
Weakness & proprioceptive deficits (cenlral)
_Loss of hopping reflex on same side (central)
If NO
CNS abnormalities:
observe
Unconscious: intubate
Oxygen
Medical
~
Steroid (melhylprednlsolone) for
vasogenic edema
Diuretics: mann'llol (osmotiC),
carbonic anhydrase inhibitors &
la$iX to reverse CNS edema
Diazepam (Valium) for seizures
Surgical management
Skull fractures & penetrating wounds
Those deteriorating wI medication
Supportive:
- Treat any shock: fluids
- Comatose animal
. Tum (ulcers), feed
Euthanasia: especially if
coma for
week
~i:al~
i'"
~Manni
.::'I
-"t- ,
Prognosis: Variable
48
hours
Thiamine - Tumors
Condition
Larval
migration,
Parasitic
meningitisl
myelitis!
encephalitis
Mk 603; E-hb 274; H2B
262; 1M 776; E 608, 624,
683,686; cat 1532; NS-O
241t, 242; NS-C 158, 146t;
NS-W 120; NS-hb; NS-Pa
NEUROMUSCULAR SYSTEM
Presentation/CS
Parasite migration
- Toxocara larvae
- Ancylostoma caninum
- Angiostongylu$ (Australia)
Dirofilaria immilis (heartworm)
- Cuterebra sp.
- Coenurus sp. (larvae of Taenia multiceps)
- CysticerCIJS cellulosae
_Acanttiamoeba .-:,---:_ _ _ _ _ _L _ _ _ _ _ _ _ _ _ _,
159
*~'
a"
Thiamine/B1
deficiency,
Pdoei iCEIj:A ebt I aIa:i:i,
Cerebrocortical
necrosis,
"Castek's
paralysis"
SAPII44;H2B264,1278;
1M 760; E-hb 2n; E 613;
Cat 1533; NS-C 163; NSW 120, 223; NS-hb 285;
NS-Pa277; NS-0271; NSL251.385
Rare
Water soluble Bl vitamin
Essential for aerobic metabolism
- Deflciency causes switch to glycolysis lactic
acid & neuronal dysfunction
- End result: hemorrhagic necrosis of CNS - mid-
brain
- Must be supplied in diet especially In cats
. Cats fed reddish fish (tuna, salmon) contains
thiamine -Inactivating enzyme (thiaminase)
may become deflC1~"'.
* ~~
Diagnosis
Treatment
Difficult antemortem
CSF tap: diagnostic test of choice
- Eosinophilic pleocytosis >51111 uncommon but
suggestive
- Elevated spinal protein >35 mg/dl
Peripheral eosinophilia
Definitive Ox: demonstrate parasite in CNS
- CSF toxoplasma tilers: dramatically high if
organism present
Fecal for eggs, supportive
::::::;:J
Microfilaria supportive
Necropsy,'/_ _ _ _ _--..
No therapy successful
Appropriate anthelmintics require specific
antemortem diagnosis
Do
DDx:
Brain abscesses
Focal encephalitis
-S;,
-<
"mo. U:~'
)-
..
--
"'-
RIO differential Ox
CS&Hx
All lab test normal
Serum assay for thiamine metabolites to confirm
Plasma pyruvate & lactate elevated
Response to thiaminase Tx
" ,I,
Prognosis:
Grave: all cases confirmed have ended in
death
Completely reversible wi Tx
Inject thiamine & correct diet
Vitamin supplementation PO
Avoid IV dextrose before thiamine therapyml exacerbate signs
THIAMINE
1-"
I:,'
DDx:
Inflammation
Toxic injuries
Vascular disorders
Hypoglycemia
Hepatoencephalopathy
Hypokalemic poIymyopathy of cats
Encephalitis
Polymyositis
PrognosIs
ExcelJentrf treated
Fatal If untreated
~
@
rBrain
tumors!
neoplasia
Mk 810; E-hb 275; SAP
1132; H2B269; 1M 759; E
610; Cat 1537; F31M 418;
NS-0278, 282. 136; NS-L
272; NS-C232; N5-WI16,
220; NS-K 79; NS3hb299,
255; NS-hb 282, 338; NSPa 355; Sx-S 1030; SxWW286; Sx4B82; X-T75
**
ltow
Sequela:
- Brain herniation
. Stupor & coma
~
=--.
..i...:i"
,7 _
~ "' , ...
DDx:
Hematoma/infarcts
Brain abscess (rare)
Vascular injuries
GME (granulomas)
Aberrant parasite migration
chondroid osteomas)
Phenobarbital if seizures
Euthanasia
~~
L
~
a>ii1~
c::.'i2>~
~-r
Prognosis:
"''' .....
Grave for all brain tumors
Brain tumors
- Glioblastoma
Ependymal tumors
Metastatic neoplasms most
- Choroid plexus tumors
common
- Ependymomas
- Prostatic tumors
Schwann cell tumors
- Mammary carcinoma
- Schwannomas
- Osteosarcoma
- Neurofibroma
- Hemangiosarcoma
Meningioma (#1 in dog & cat)
- thyroid carcinoma
Reticulosis (eNS lymphoma)
- Bronchial adenocarcinoma
CNS parenchymal tumors
Generalized (systemic) lympho- Astrocytoma
sarcoma
- Oligodendroglioma
NERVOUS SYSTEM
- Unilateral or bilateral
Pathophysiology: UMN II LMN clinical signs help differentiate peripheral from central
localize spinal cord level of Ihe lesion
" upper motor neuron (UMN): eNS neurons in descending motor tracts located in ventra! & ventrolateral white matter of
spinal cord. Functions:
. Transmit motor Information to body .. limbs (ExCitatory UMNs: iniliate & maintain consCiousness movements &
prOVides lone to extensor muSCleS [posture], they are inactive until needed)
c..
,'*',*',',*",',','N'.' S"2,,,579,
tJ.J
--'
c::tff:f,
L5-7
L4-LS
Sciatic nerve
S1-S3
LS-L6
Pudendal nerve
Caudal
L6
L
-_ _ _ _
______________
!T~raparesis/paralysi~.
..r:SZ
-&... (rl
..:::
t\ \$ )_ . ',.:I
f
_
- LMN signs to thoraCIC limbs ~
- UMN signs to pelvic limbs
Horner's syndrome
T 3- La, Thoracolum~r
UMN signs to rear limbs
Cutaneous trunci
Nonnal thoracic limb (+/- Schitf-Sherrington)
L4-S2: Lumbosacral & cauda equina
LMN signs to rear limb
Normal thoracic limbs
UMN signs: bladder, anus & urethra
':'-..
-:
dl
'
_Spastic paresis/paralysis
~
!.
_ t tone & reflexes
J
_
Slow, disuse atrophy
.
Proprioception & sensation loss in all 4 limbs
Homer's syndrome
Complete decrease or abSent cutaneous tn.mcl response
L7-S1.
<.. 7t
,
LMN 10 sciatiC nerve
- ) ~)~ - _ _
- Loss of withdrawal rellexes
:\: .,
;.
Normal femoral nerve
.h
- ..
_+ Patellar reflex & bears welg t
Normal thoracic 11mb
Anal reflexes & tone normal to Increased usually
1j;
.
S2- Cds Sacral region (cauda equina)
T 3- La. Thoracolumbar region
Normal thoracic & pelvic limb
UMN signs to pelvic li~bsJparaparesis
LMN signs _ bladder, anus & urethra'
F.
- Spastic paresis/paralyses, ataxia
~
_Flaccid paralysis of anus & tail
- t tone & reflexes
~
_No defecation
- Slow atrophy
_
_Loss of reflexes & sensation to tail, penIS, vulva & perineum
Cutaneous trunci absent 1-2 vertebrae caudally
. Distended, lIaccid bladder; incontinence; easily expressed
Normal thoracic limb
nUMN bladder": may occur wI lesions above S1
_ +/_ Shiff-Sherrington (serious sign)
Proprioception & sensation loss in rear limbs _ Paralysis wI loss of voluntary
control
Anal reflexes & tone normal to Increased usually (UMN)
_Initially urine retained (catheterize)
UMN bladder" (paralysis wI loss of voluntary control)
_Reflex urination occurs in 1week
:n .
529
.. _-----.
ophthalmic)
i
~
NEUROMUSCULAR SYSTEM
jjr:';;;M;;:in:im=u;;m:-:da:;:;ta~b:a::se:-;;(M::;D~B;-)
f;;o:r:a;;lI::n:eu:::r::o:;c:as:e:s;-r=:,,=:,,:,,:,,::(=::============:=:~:=.:.J
;:..'
DDx:
-<
- Serum biochemistries
:h"
Neuro exam:
\til
- First confirm neuro problem
l
J
Gait observation & strength
_ I
Postural reactions: proprioceptive positioning
reaction, Hopping, Hemi-stands & Hemi-walks,
Wheelbarrowing
- Second: try to localize
RIO disorder above foramen magnum
Mental attitude, Stance & head position are
normal (no vestibular & cerebellar problems)
Cranial nerves exam: normalw/cord problems
- Localization to peripheral nerves or spinal
cord: correlate UMN &Jor LMN signs found wI spinal reflex,
~E5ml J
\ A-
Urinalysis
_ Fecal analysis
@t--=I
~ -J,""""""""'....~
'??"""\\",
-Braindiz
IL.lI~
___
Neuromuscular junction
Ventral gray matter of cervicothoracic &
lumbosacral intumescences
r-
(J
4th also: Superficial pain loss: lost at the same lime as motor function
loss. 11 superficial paln Is perceived, so will deep pain. (A withdrawal reflex, DOES
NOT require paIn percepliOll)
- - - ----------1
Prognosis:
Infections
Antibiotics(trimethoprimMsulfacombinations, rifampin, metronidazole, chloramphenicol, Itraconazole - high penetrat
;ng ability); (Avoid aminoglycosides, amphotericin B, ketoconazole - poor penetration)
~~~~?ry9/rr.rr
.. Dlskospondylitis especially difficult may require surgery alSo
_ NeoplasialDegenerative disorders
Steroids: to slow degeneration & lymphosarcoma
Chemotherapy rarely ineffective in CNS neoplasia
Radiation
Intoxication
Tetanus: ABs (tetracycline, penicillin, metronidazole, Diazepam, barbiturates)
.
ttt.?
S~:>
Strychnine: stop absorption, aspiration of stomach, activated charcoal; Diazepam, barbiturates
Definitions
Surgical: for compressive extramedullary diz
Monoparesis/paralysis:
As SOOll as poSSible
It conscious deep paln gone tor hours to days Sx of little value
Paraparesis/paralysis:
Hemilaminectomy or dorsal laminectomy TL spine, Ventral
T etra-quadriparesis/paralysis:
slot decompression - cervical area
Hemiparesislhemiplegia:
Prophylactic disk fenestration
Fracture stabilization
Extensive postoperative physiotherapy (swimming, towel walk
ing, limb manipulation, muscle massage)
Nursing care required: evacuate bladder (q4-6h) padded clean
C:::~~/~~~,/~_/~==::~====~~~-L~o:s:s~m~d:e:e~p:pa:in::~g:m:v:e______________1
'I~
-~
531
'-lp~a-re-s~is------------------~~r----~N~E~U~R~O~M~U7.S~C~U~L~A~R~S~Y=S=T=EM~I
Paresis/paralysis
MSk 942; 12M 971; 1M 741; 5min 118; IMWW 69; NS3hb 129, 173; NS-C 16,43,398,433
Disturbance of initiating voluntary movement causes weakness (paresis) or paralysis, depending on severity & location of lesion
DDx; Paresis/paralysis
Unilateral/asians of cerebral cortex
Unilateral brainstem lesion
Cervical or cervicothoracic cord lesion
Thoracic or lumbar spinal cord lesion
Diffuse diz of peripheral nervous system
& neuromuscular dizs
~:::.:~:~:t::~:~:I~:i~:'s:~a:::t~:~:r:~:~so:p:i~a:dt:~:Z=&====:-;f1IE~d wea~~e:s
wI normal postural reactions, normal reflexes & absence of ataxia
/'
-r~'
L.
..." _( ) -,
\,\L
_ Dlskospondylltis
~_.. --, "
Acute nonprogressive
Chronic progressive '?'t?~~
- Trauma - fractures, luxatlons
_ Neo lasia
?--,,~
- Trauma - fractures, luxations - Wobbler
~
- Fibrocartilaginous embOllsm~
_HemO~rhaglC myelomalacia 1).) V'
. Fibrocartilaginous embOIIS~.
'\
- Type 2 disk diz
__
- TOXIC tetanus, strychnine
'\ ~Ch'
.
Toxic: tetanus, strychnine
.) J
Neoplasia
_caudal aortic embOli (cat)
I
romc progressive
_Myelodysplasia
~ .
- Myelodysplasia
~ - Type 2 disk d,z
- Hemorrhage
' ~ - ~a,~ln~ ~Is~mper tit .,.
. HemorrhaQ'
N
I
A t I
.} - e Ina In e...,ous pe onl IS
.
- eop aSia
cu e progressive
_Degenerative myelopathy (Gar. shephard)
Acutelprogr~ssrv~
_canine distemper
/~~
_ Type 1 disc diz
- HypervitaminoSis A (cats)
Type 1 dIsc dlz
- Feline Infectious peritonitis
~
_ Infectious inflammatory diz:
- Spinal dysraphism
- Infectious inflammatory diz:
- Degenerative myelopathy (Ger. shepherd)
M 1- .
Progressive in young animals
- Cauda equlna syndrome
ye rtrs
~ ..... ,
..
..
Myelltrs
-HypervitaminosiS A (cats)
<!'- ..
Meningitis
' A~
.Atlantoaxlall~xatlon (acute)
.
Meningitis
-Spinal dysraphism
~.
/, .... ,
C . - d' t
Neuronal abiotrophies & degenerations (chroniC)
_Canine distemper
Progressive in young animals
fr .f' \
: Ra:I~~ne IS emper
i.>. - Lysoso~al storage dizs (chroniC)
Rabies
- Neuronal abiotrophies & degenerations
;") ....~ . Parasitic myelitis
CongenitaVanomal?us (con~tant)
_Para.sitic m~elitfs
_
- Lysoso~al storage d i Z S .
_ Noninfectious inflammatory diz - V~rtebral a~omahes (Hemlvertebrae)
Granulomatous
- sPJn~ dysraph~s~
- Nomnfectlous inflammatory drz Congenital/anomalous (constant)
Vertebral anomalies ~.
.......... - CalCium depOSits In great Dane
G ranu Ioma t ous
-.
..
meningoencephalitis ~
- Multiple cartilaginous exosto~
meningoencephalitis
- Spinal bllida
.~I
. ..
. _.
_Cauda agenesis of Manx cats
} -~
. mmune menrngrtls
~
~\
- Im~une ~enlngttls . _
_Spinal dysraphism
_) plsi"
.Felina pOlioencePhalitis.
_
'
.
,..
Feline polioencephalitis
. ",m.l. oo.II.g,",", .,,51,.",
~
A .
?
0A -
j'}!;:> -
'ug,
(;(/-::1
___
- - - ----.-----'1
Treatment
Diagnosis
PresentationlCS
Facts & Cause
Conservative if only pain or mild motor
Hx, CS
Compression of terminal end Lumbosacral pain
deficits
Cauda
of spinal cord & nerves _ Reluctance to jump, run, sit or Lumbosacral pain on deep palpation
- Restrict exercise
or dorsal flexion of tail
_Analgesics (aspirin, PBZ (phenylbutazone)
climb stairs
(cauda equina)
equina
- Steroids: prednisolone
Breeds: instability: middle aged proprioceptive deficits in 1 or Radiographs
_Subluxation of L7-51
syndrome, Ger. shepherd, any breed
both pelvic limbs (50%)
Surgery if progressive, or moderate
- Bony stenosis
Lumbosacral
to severe motor deficits
Congenital stenosis: small- LMN to rear limb: lameness,
_ Ventral &Jor lateral spondylosis at
_Dorsal laminectomy & occasionally
weakness, hyporeflexia
stenosis,
breeds
L7-S1
_Sciatic nelVe paralysis w/o femoral n_
L7-S1 foramenotomy &Jor stabiliLumbosacral
Involvement possible
_ Erosions of end plates if concurrent
instability,
DDxlCauses: Cauda equina
. Loss of withdrawal reflex
diskospondylitis
. Hyperactive patellar reflex (UMN) _
Instability or stenosis of L7
Lumbosacral
spondylopathy
S1 intervertebral disk space Hyperesthesia or parestheSIa Epidurography
Myelography of limited value - subMSk 922; Mk 585; Ehb
Intervertebral diskdiz in area
of perineum & tail base
300, 743; 12M 1035; 1M
Fractures
Self-mutilation of tail,
481; E 673, F31M 381;
Diskospondylitis
NS-W 173; NS-C 450; NSperineum or pelvic limb
Granuloma, progressive
K 20S; NS3hb 158; NSspinal stenosis
hb 155; NS-L 74,82,363;
Sequela: Cystitis
NS-O 206; NS-Pa 433,
Congenital vertebral
454; XRP 81; Sx-WW
DDx:
malformation
298~Sx-B629Sx-S 1056,
Musculoskeletal disorders: coxofemorat dysplasia,
".'.
polymyosills, cruciate ligament, polyarthritis
.
~
Cauda equlna disorders: InfeCtions (neuritis,
diSkospondylitis), neoplasia. disk dlz, trauma, flbroPrognosis:
compression to caudal cord
j
cartHaglnous emboli
Surgery: good, not curative in all cases
Disorders ofT3-L3 (UMN): degenerative myelopathy,
CS: LMN rear limb, bladder, Mutilation
Conservative: many dogs become
neoplasia. type 2 disc protrusion
Ox: HX,Rads
refractory & require surgery
Condition
**
;~
~
,,"'If
10"
ff
~
Hx (birth, breed), CS
Normal patellar reflex
PelVic flexor reflex stimulates flexion
if both pelvic limbs
Myelography: obstruction of CSF
at foramen magnum
(2;'\}.~
..-~\~
p~",~ ,~tf
Not progressive so
E isodic Weakness
Condition
Episodic
weakness &
collapse,
Periodic
weakness,
Exercise
intolerance
ContEdI2(2)pgI41 Feb 1990;
1M 742; NS3hb 350; N8-C 389;
NS-W 189; NShb 332; NS'L
88; OOx 433
NEUROMUSCULAR SYSTEM
Facts/Cause
Many neurological dizs are
episodic
Episodic weakness prominent in a
large variety of dizs
Metabolic & cardiorespiratory
#1 causes
Syncope: faintingfloss of consciousness, usually due to inadequate 02 or glucose to cerebrum
Presentation/CS
Diagnosis
Treatment
Episodic weakness
Dffficult to diagnose
Treat cause
- Worsens wI exercise & im- Hx (important because vet may never see an episode): number of
proves wI rest
episodes? Is there a-pattern? What time of day? Any relationship of
- Waxes & wanes, normal in~ episodelo exercise? Feeding? Excitement? Prodromal seizure phase?
between
loss of consciousness? Describe episode: generalized motor sei- Varies form mild pelvic limb zure? Syncope? Pallor or cyanosis? Slowing orfast heart rate? length
ataxia to tolal collapse or syn- of episode? How is animal afterwards? Appetite? Thirst? Weight loss?
cope
Urination? Vomiting? Diarrhea? Exercise intolerance?
Normal when vet sees animal Physical exam: full general & neura exam on all animals
Form a differential diagnosis list - Rule out DDx
- Minimum data base
,
( "&-;)
***
'
~ ~J.
-'
I
:s:-
0-
.
.
'l.
'7.
Q!~ ~
~
.-_ _ _ _ _ _ _L _ _ _ _ _ _ _ _ _ _ _....J_-,
Large variety of dizs. Metabolic & cardiorespiratory #1
CS: Episodic weakness
Ox: Difficult to diagnose; Hx, PE, lab, test
Tx: Treat cause
I"'. ....
CSC.
f Cl
I]'
. UnnalYSls'
~
Fasting blood glucose, urea
. Serum electrolytes (Na, K, Ca, Mg)
Serum enzymes (muscle: CK, AST, liver: ALT, ALP)
SI.
Electrocardiogram ECG on all ,
f"1.\
1'
,00
L =-JIf-1
-Additional data often necessary'
iQ
Heartworm test: depending on geography
,Radiographs: to RIO cardiopulmonary dlz, other conditions suggested by PE
. Response to imipramine
. Edrophonium response test (Camsiolon, Tensiior0j:shortactinganliCholinest
erase used to diagnose myasthenia gravis improved ability to exercise
Muscle biopsy
fh.-,";;;;;;C=:::l:F'=="-"'"r.
. Liver function test - bile acids b
. ACTH stimulation test for Cushing's diz
Basal T4 for hypothyroidism
~
. Immunological tests: ANA for polymyositis,
antibodies to AcTH for myasthenia gravis
, Blood gas & acid base estimates@,":;;'"
CSFin some
EEG, nerve conduction & electromyograph
.
~
~~
,...;:::-.
~";t
IJ'
li
--n=
~r==-~~--~-'-------_+---~~-..- - - - - - L
:;iT
Tracheal collapse
- Hypoadrenocorticism
DDx - Episodic weakn~ess 1
_ pulmonary diz
- Hypothyroidism
Neuromus~ular ~isorders
,.
I
_ Pleural effusions
_Hypoparathyroidism ~.""~
- Myasthenia gravIs
-, ~
_Thoracic masses
- Pheochromocytoma
- Polymyositis
~
_Filaroides osleri
- Diabetes ketoacidosis
- Myotonia - Chow
. / . Hematologic disorders
Neurological dizs
~ __
- Hereditary myopathy in labs
_Bleeding hemangiosarcoma
- Cataplexy/narcolepsy
_
- Dermatomyositis In colhes
_Anemia, regenerative & nonregeneratlve
- Scottie cramp
- Episodic collapse
_Myeloproliferative disorders
- Epilepsy
"
- Hyperadrenocorticism myopathy
_Hyperviscosity syndrome~
- Thoracolumbar dISC dlz
-Feline hypokalemic polymyopathy
_Hemoglobmopathies
-V) ~- Spinal disorders
_Idiopathic pyrexia
j ,
- Wobbler syndrome
- Ischemic neuropathy (thromboembolism)
- Malignant hyperthermia
_polycythem'ia
l.....
-Cerebellar disorders
Metabolic disorders
(..~
- Vestibular disorders
- Mitochondrial myopathies
_Hypoglycemia (#1 metaboliC cause)
- Congenital disorders
~~
- Exertiona! myopathy
- Sex linked muscular dystrophy
_Hyperglycemia
. Hydrocephalus .
(
"
- Hereditary myopathy - Devon rex cats
_Hypokalemia
- Old dog encephalitis JA:-n-)
- Hereditary myopathies - Labs
_Hyperkalemialhypoadrenocortlcism
- Tu~o~s
.,.c:::::..t~~
Cardiovascular disorders
_Hypercalcemia
~
- ThIamine defICiency .
_Hepatic encephalopathy
("
- Lysosomal storage dlz
- Arrhythmias (bradycardia, tachyarrhyth mla)
- Congenital hear diz (shunts)
_Uremic encephalopathy
~ 7
~
- Progressive axonopathy (boxer)
- Acquired hear dlz
_Hypematremia
I.,--..\.
- Giant axonal neuropathy
- Congestive heart failure
_Hypocalcemia
- Botulism
, Valvular diz
~
_Hypermagnesemia
- Tetanus
($
. Myocardia
~ ~
- Hypomagnesemia
~~ i_Generalized
tremors
\
_ACIdOSIS
_Jack Russell ataxia
. Pericardium (cardiac tamponade)
- Heartworm diz
(
__ HSheocatkstroke (hyperthermia)"
- Episodic falling (Cavalier King Charles spaniel)
_Vasovagal syncope
_
Orthopedic disorders
- Aortic thromboembolism
Hypoxia
- Degenerative joint diz (hips & stifle)
Respiratory diz (s~vere)
Endocrine disorders
- polyarthritis
-Insulinoma
-laryngeal paralYSIS
_Upper respir. tract obstruction (brachi0C6phaiiC)
_Hyperadrenocorticism myotonia
- Severe coughing
It U
V
535
ne
Failure of 1 or more vertebral arches to
Spina bifida,
Spina cystica;
Myelodysplasia,
Myelorachisis
MSk 921; Mk 586; E-hb 307; E
NEUROMUSCULAR SYSTEM
; Cat
ges.
. Myelomeningocele - protrusion of the
spinal cord & meninges
Asymptomatic usually
Hx (breeds)
- Radiographs: incidental
radiographic finding il no CS
Myelography for meningocele
Prognosis:
Good: spinal bifida occulta
- Poor: spinal bifida manilesta + CS
Hemivertebra
160; NS-C 407; NS-W 149; NS-O 203; X-T 84; X-RP 74
of 2 or more vertebrae (bodies or arches alone or the whole
vertebra), cervicar or lumbar spine usually
CS: Asymptomatic. stable & rarely cause clinical signs
Ox: Radiographs (incidental finding)
DDx: Dlskospondylitis, healed vertebral fracture
Tx: None needed
: Good
Sacrococcygeal
dysgenesis of
Manx Cats
M8k 920; Mk 586; E-hb 306', 12M
1045: 1M 793; H3B 256; H2B
278; IM-WW 483; E 684; Cat
1589; F31M 439; NS-C 457; NSW 153; NS3hb 164; NS-hb 160;
NS-Pa 87; NS-O 200
Butterfly Vertebra
Transitional vertebrae
(.
<07$'"
~"~
Hx (tailleSS), cs
Palpation of lumbosacral abnormalities
Radiographs
Myelography: meningocele
No treatment
Incontinence: manual bladder expression &
lecal softening agents
Surgery lor meningocele
NoTx
Sequela:
_Recurrent urinary tract Infection
M'9acoIOO~
*
,.J~E2!
Congenital malformation, Tailless Manx cats
CS: Asymptomatic, Hind limb LMN signs, UTI
Ox: Hx (tailless), cs, PE, Rads, Myelography
Tx: No treatment .Px: Variable
<~
prognosis:
Depends on clinical signs
- Hemivertebra
_ Malunion vertebral fractures
_Vertebral luxation & fractures
IM-WW 452; NSPa 90, 200; NSL 190, 195; X-T 82; XRP 76
- Hemlvertebra
_ Malunion vertebra! fractures
_Vertebral luxation & fractures
- Muscle spasms
_ Abdominal pain causing arching 01 back
_Back pain from disk protrusion
----~~~--------------------------
Spinal Problems
Condition
Idiopathic
feline
polioencephalomyelitis,
Cerebrocortlcal necrosis
Mk 589; E-hb 294: H3S 240;
12M997: 1M 771; Smin 958;
E 626, 658; Cat 1558; I-G
BS8; NS3hb 3821; NS-C
NEUROMUSCULAR SYSTEM
Diagnosis
Presentation/CS
Difficult
RIO other muilifocal eNS dizs
- Incoordination/ataxia
- Paresis (weakness) hindlfmbs, letraparesls
Hypermetria
- Inleniion tremors of head
Seizures
localized hyperesthesia (pain)
Mentally alert
Treatment
Data laCking
Isolate
oHx, CS
Cranial nerves nonnal
Postmortem: only dellnitive
- Perivascular cuffing wI mononuclear cells,
Iymphocyticmeolngllis, glial nodules, with
degenerating & demyelination
NS-Pa 119
Calcinosis
circumscripta
Idiopathic
Circumscribed, single or
multiple calcium deposits
PeriartlCtJlar
Young, large breeds
(G. shepherd)
-~~~k~'
:". "
~?
Hx, CS
Rads & myelography: single, round, calcium mass pressing on dorsal spinal cord
&
\,
~"l:'
Spondylosis
deformans
M8k923: MkSS8; Ehb269:
E 690: H3B 262: H2B 293:
5min 1072; NS-C 427; NS
W 153: NSK 197; NS3hb
153; NShb 149;NS0205;
NS-L 191: X-RP84
***
Surgical removal if CS
Prognosis: Good wI Sx
None required
Incidental finding
Common degeneration of spine - Subclinicalalmostafways
olf hyperesthesia (rare)' analgesicsfsteroids
Spinal radiographs:
(no spinal cord compression)
Surgery rarely indicated
acquired wI age
Occasionallyimpingeon I ,V.foramina
- Spurs: small barely dlscemible nodules
_Osteophytes ("spurs") at interverte nerve root compression
to massive ankylosing bridges
bral spaces (periarticular) "bridges" Occasionally vertebral instability
. Separate centers of ossification in the
Independent of either inflammation or trauma
Sequelae:
Intervertebral protrus'lon & hemiation
_Traumatic fractures of spurs
DDx:
Iatrogenic - previous disc fenestration.
Previous vertebral fracture/dislocation.
Congenital anomaly.
Neoplasia
Spondylosis
Diskospondylitis
Hypervitaminosis
./(
II
.,
See Skeletal pg 611: Benign, proliferative dlz of bone & cartUage metaphyses, stops when growth plates fuse
< 18 months Cause:?; Transformation?
CS: Often a~ymptomatic, Firm, distinct swelling near metaphysis, Lameness (50%), Neurologic deficits
Ox'. H x, CS, RadIology {"Caul1flower-tike"), Biopsy, Myel~~raphy
Tx: Not necessary unless neurologic signs - SUrgical eXCISion &
Neutering recommended because of posslble hereditary
Prognosis:
Good, usually subclinical
540
Spondylitis
*
Dural
ossification,
'Pachymeningitis'
Mk 587: Ehb 294; E 657;
NS-WI49", NS3hbI51;NS-
NEUROMUSCULAR SYSTEM
Presentation/CS
Condition
Diagnosis
-Incidental finding radiographically
Treatment
Nona needed
::'~i~
Incidental finding - large breeds
Prognosis
CS: Asymptomatic
eo",',,'.,'n o.'g'd",
Hypervitaminosis A in cats,
Dystrophic
cats
Thoracic 11mb lameness, ataxia
oFeedingexcessive liver diet, cOd IiverOilsupple- Reluctance to move
calcification of
mentation
Lethargy, anorexia
skeleton
PathOphysiOlogy:
Postural changes:
_Extensive exoslosis in cervical & thoracic
marsupial-like, sitting
spina
wi front feet raised
M8k927; MkS91; E-hb296"
H3S 839; H2B 294, 1279;
- New periosteal bone at metaphases
~::-\ v
0
1 affects
0
0
- Spinal
gJ'?f-.-';\
~~
271; XRPn
<t>--~.~
G
Prognosl8~
CS (spinal pain)
Difficult & prolonged: relapses not
Palpation: spinal pain
uncommon
Fever of unknown cause
ABs 4-6 'Ior.!eks minimum: if miniSpondylitiS, Spondylitis: infection of vertebrae - Depression, lethargy
Leukocytosis
mal neurologic deficit
- Poor hair coat
Middle-aged large & giant breeds
Bacteremia, pyuria (50%)
_Staph._peniciUlnaseresistantABS- oxacilVertebral
_
Fever
or
unknown
cause
(Great Dane, German Shepherd,
CSF: usually normal, protein (chronic
lin,cloxacillin,Cepheliosporins(cephalexin
osteomyelitis, Airedale terrier), rare in cats
Kyphosis (hunchback)
compression) or WBC & protein (meningi(Keflex), cephradlne, cllndamycin,
tis, myelitiS)
methicillin, lrimettloprim sulfa, cephalosporin
.2:1 males:females, young to middle aged Spinal pain #1 (hyperesthesia)
Vertebral
Radiography: 1st signs in 4-6 weeks
- Streptococcus: (B-hemolytic) - ampicillin,
Stiff
gait.
reluctance
to
run
or
Jump
abscess
Mid thoracic, caudal cervical & lumin 2-4 weeks if negative)
amoxicillin, penicillin.
. Neurologic deficits (transverseo! (re-radlograph
_ Irregular lysis of vertebral end
- Brucella - 2 courses of ABs - tetracyclines +
M8k 923; E-hb 258; H2B bosacral spine usually
multifocal myelopathy)
streptomycin
284; 12M 1029; 1M 782; SAP Multiple disc spaces often affected
_Progressive paresis/paralyplates
. Neutering
1158,1161;5mln524;lM- -Cause:
_ Widening or collapse of disk
' Euthanasia (zoonotic potential)
sis caudal to lesion
WW 485; E 653; Gat 1550;
spaces
If no response in 5 days to ASs
F3IM447; NS-W 148, 173; - Hematogenous spread #1: skin,
NS-C 360; NS-K 200;
heart, bladder, testes, ovarian
reevaluate
_SclerosiS of vertebral end plates
Brucella infection: insidious
NS3hb 155, 387; NS-hb
t
t f
I
_Vertebral osteophytes
~ Surgery, curettage & culture or
107,151; NS-o 231; NS-L
sump, u enne In ectlons, rena
Staph: rapkt progression
190,204; Sx-S 1087; X-RP - 2" to disc fenestration/prior trauma (rare)
~ Fusion of vertebral bodies
different antibiotic
83
- Migrating foreign body (plant awn)
_ Reaction cross disk space
If significant neurologic signs ~ my~
2" to spondylitiS
Sequelae:
-E".m~wo"nds
_Scintigraphy (bonescan) forearlydiagelography
_ Meningitis &for myelitis
nesis
~ Hemilaminectomy, disc curettage
Causative organisms:
ri\
f Staphylococcus aureus (#1),
Myelography: if spinal cord com~
+ ASs
) II '
': ~ StreptococcuS, Brucella canis 10%); Mulpression suspected ~ Average treatment time - 4-6 months
tiple other organisms -rarely Involved (E. coli,
Blood cultures:
Reassessment + re-radiograph Nery 2 weeks
Corynebacteria. Pasteurella)
. .
initial1yttlen IX/month
_ positive In 75% cases
Clinical improvement occurs long betore radlo/-7-:>" - Fungal rare -PaecilomyCEls, Mucor, Fusarium
~ Urine culture positive in 25% cases
graphiC Improvement.
_Tube agglutination test for Bru~ Repeat blood cultures 2 weeks after treatment
ceUa (1 :200)
cessation
, ~ Bone cultures: aspiration under lIuorDDx:
escopy or curettage at surgery
Neoplasia (doesn't cross disk space)
~@H
Disk diz
Polymyositis
Spinal trauma
Prognosis:
Meningitis
Hematogenous, Staph
Good: most - mild to moderate CS
Polyarteritis
Guarded: moderate to severe signs
CS: Spinal pain, Stiff gait
_ Recurrence common with B_ canis
Ox: Pain, Rads, cultures
Systemic illness
Diskospondylitis, Diskospondylitis: infection of I_V. - Weight loss, anorexia
discs & adjacent vertebrae
**
)
~
ti;'~l1
542
Spinal Trauma
Facts & Cause
Condition
Spinal
trauma
NEUROMUSCULAR SYSTEM
Diagnosis
Presentation/CS
& cats
Acute
Treatment
Hx (HBC), cs
Causes:
UMN signs caudal to lesion
- Lacerations, abrasions
Mk 591; E-hb 308; SAP
a HBC (hit by car), Bullet, Falls
Varying degrees of weakness/pa- Neurological exam
1158,966; H38268; H28
- Vertebral fxs, luxations,
ralysis & ataxia
- Evaluate spinal reflexes
297; 12M 1019, 971; 1M
subluxation or collapse
729, 7S0, 778; IM-WW
- Access perception of deep
Hyperesthesia
486: E 687; cat 1547;
- Disc herniation
Progression in disc herniation or
pain
F3IM442; NS-G397, 55,
- Vertebral malformation &
spinal instability
- Do not test postural reactions
341: NSW 158; NSK
instability
158: NS3hb 142, 158,
- Palpate for mal alignment of
180; NShb 140, 154;
- Fibrocartilaginous emboli Sequela: Spinal shocks: transient
spinous processes
NSPa 189; NS'() 310,
<1 hours
myelopathy
Radiology: condition often worse than
280; NS-L359, 184;196,
Flaccid paralysis (LMN) caudal to lesion
radiographs
81; DDx 428: Sx-WW Caudal thoracic spine most
Atonia & arellexia caudal to lesion
299;291: SxSl031;Sx
- Evaluate whole spine
common site
B SOl; PaT 345: NS
- Fxs, displacement at time of film
Spinal
cord
12.13
Ci "." .
***
."
A- (
~ c:!J
DDx:
Pelvic fxs
- lMN to forelimbs
Muscle trauma
- Normal forelimbs
51-3: sacral spinal cord lesion
- UMN to perineum
Fibrocartilaginous
embolism!
infarct,
Ischemic
myelopathy
M8k 929; Mk 587; Ehb
300; H3S 265; H2B 285;
SAP 1159;12M 1027; 1M
781: IM'WoN 487; 5mln
596; E 671: N$-C 365;
N5-W 149; N5-hb 153;
NSPa 246: N5-L 81,
409,194,205:
NS.() 246;
SxWW300;
PaT 353
~
~
__
+ patellar reflex
- Normal forelimbs
~
~
to1
~
~~ Ug-l
.
/~
- . _ _ _ _ _.,,-_ _ _ _ _ __
~~
-----..
C0
~
Prognosis:
Guarded: 50% recover to be acceptable pets
Mild epiSOde: spontaneous recovery
.
Severe paresis/paralysis - if recovery to occur Improvement seen In 7-10 days
.
Good if retain deep pain perception in 11mb & tSlI & have
UMNsigns
0 Extensive lMN signs poor prognosis
.lossof deep pain very poorto hopeless prognosis -often
euthanasia
Decompression surgery does not help
-
L pt
LMN
543
(\~!t~ ~
/"/'[(
----
~ _~_
gY-d'-r
COnge
10 days
,
.
Goal reduce edema & inflammation
.
' d I No definitive antemortem diagnOSIs,
h
)
perae.ute (sudden) paresis/paralYSIS cau a
although MRI scan possible
_ Glucocortlcoids (Dexamet asone
10 lesion
. H (breed peracute wI no trauma)
,Clmetldlne for GI Side effects
- Asymmetric (hemlparesislhemip!egla)
~S' res~mptlve: acute, nonpalntul, Supportive care
During or immediately after exercise, (50%)
':n.trtc pareSis wI normal radlol- 0 Euthanasia if deep pain lost
asym
Initial cry at onset, then no beck pain
Nonprogressive after 1224 hours
ogY
normal
UMN or LMN dlz related to embolism location Plain radlog~phS' a1ln most cases
.
.
the cervical & CSF AnalYSIS - norm
- High % LMN Signs since
. Myelo raphy _often normal. Some spinal
cord !elling (thinning of dye column)
lumbar enlargements #1 sites of embolism
Homer's syndrome If ClT3
RIO (rule.out) diagnosis
localize lesion by CS (UMN & LMN CS)
-~
5=:7
---
I'llt
i\~:
. ,
- Refer: hemllamine~~:0:m~Y~'~"~f.2'~'.~d='"":O:.~S;;""'~d~'O:S::ta;bi'
.~i:rsing
Prognosis: varies
o Excellent only pain & reluctance to move with no abnormalities in motor function or perception
Good: if voluntary motor & deep pain sensation
Spinal shock
SteroiCi
I
I
- Normal forelimbs
- Normal femoral -
& ischemia
......
.L,.i"
?'
_ __
S inal Column
Condition
NEUROMUSCULAR SYSTEM
Presentation/CS
Diagnosis
Transverse myopathy C1-5 Hx, Cs
- Cervical pain (hyperesthesia)
Palpation: careful, avoid
. Extension & rigidity - neck
forceful flexion of neck
-cause: absence, malformation, - Motor dysfunction in all 4 - UMN signs in aU 4 limbs
failure to ossify or insufficient
limbs (UMN)
- Dorsal displacement of axis (C2)
ligamentous support of dens
. Varying degrees of paresis & Radiographs (very carefully):
Rupture of ligaments of dens
ataxia to paralysis
- Lateral - neck slightly ventroflexed or fracture of dens
body of axis displaced dorsally &
Breeds: congenital: toy &
l
cranially
miniature (rare In cat); wI trauma _
**
~
~j~
.;:;:t" -< -
any breed
- Pathophysiology:
- Compression of spinal cord
~-'
~-
~ft~
Treatment
--
tween CI-5
1'-.,.-
DDx:
t!4--/~
.rr<r~,I~
"
Cervical trauma
Menlngilis,tmyelitls
Neoplasia
Degenerative
'\.
c
'
(iR
!1
**
)?
""
\ I
Spinal cord tumor
,,- -Intervertebral disc diz
~,\
\il"
.Extradural compression
r;j"
vtJJ:f, n
fi.~
~<Cl.
~))
II
_
6
-::5= $g
' If
Great Dene puppies, Peliarticular calcium phosphate mineralization & bone deformity of axial & appendicular skeleton; Caudal cervical
canal stenOSiS due to dorsal displacement of C7 = compression, not related to Wobbler syndrome. Cause unknown, hereditary?
CS: Progressive incoordinetion & paralysis in 1-2 month old great Dane puppies
Ox: Hx (GO puppies). CS, Radiographs: dorsal displacement of C7
Treatment hasn't been Clescribed
!:i1~-;P
~-"'~
///!
PI
~)
Hx (breed), Cs
Steroids: prednisolone alone for mild
CNSsigns
Resistance to cervical manipulation
Abnormal hopping & conscious - Restrict exercise: cage rest - hamess
instead of collar
proprioception
Surgery - refer: if no improvement
Radiographs: flexed lateral
{&
or progression
- Subluxation of vertebrae
Dorsal or ventral decompression
- CS-6 & C6-7 most common sites
- Narrowed disk space if concurrent
herniation
- Abnormally shaped vertebrae, bony
stenosisofspinalcanal,hyperostosis
of laminae, asymmetry of articular
facets, degenerative joint diz of articular processes
Myelography necessary before Sx
for site & type of cord compression
lff\-::::'
. Canine distemper
')' "
/~
II'~ (. '"
W f@W
'-
~p
h,
Prognosis:
Good if voluntary motor function wI
conscious pain perception
Guarded for acute onset of tetraplegia
. ~~ ~
Wobbler's
diz,
{~ (
"(
"'i\
--; ~!
1~;;11 ~
~~
-~
Prognosis:
Extremely variable
Poor if tetra paretic patients
- Better if pain alone, paraparesis or
ambulatory tetraparesis
Disk Disease
NEUROMUSCULAR SYSTEM
Facts & Cause
Condition
Type 2
intervertebral
disk diz,
IVD,
none on
shepherd, Dobie, Labs)
_ Cervical disk diz ssen in Dobies
associated w/wobbler's
Hansen's type II
MSk421; Mk587; E-hb297;
H3B 258; H2B 286; 12M
1033; 1M 785; IM.WW 474;
5min 740; SAP 1158, 1163;
F3IM452;;N5-W147,154;
NSC 413; NSK 21; NShb
145; NS..Q 324, 416; NSPa
202; X4T98; XGr46; PaT
4S8;X-RP81;Sx-B601;Sx-
Presentation/CS
f
.Oldercats.:protrtJSion airlycommonbut rarely
causes clinical dlz
~~
-Cause:unknown
Pathophysiology"
_ Fibroid degeneration
I d'
'
common Not
"weanieSIl~.
14_9;_NS_~ ~_7;_N_S-_L~_;~
1
\
~~
chronicity before CS
Stero~
MyelitiS
myelomalacia,
PHM,Hematomyelia
Prognosis:
. Coxof.emoral osteoarthritis
thoracolumbar area
~~ .Diskospondylitis
~p
Degenerative myelopathy
hemorr haglc
~. Neoplasia
Progressive
rDDx:
i,'
Less
~~
......
Bulging
..
'
Hyperesthesia
WW295~'-Bulglngofannulusflbrosls
**"'
Diagnosis
Diagnosis
__________
Usually acute
o Spinal cord Signs depend on site
- Initially a transverse myelopathy between T3-L3
Severe deficits rear limbs' paraplegia
- Progressive diffuse myelopathy over
hours - 2 days
FlacCid paralysis In 1-2 days. Dia
phragmatic paralysis & bilateral
Homer's syndrome
Extreme pain
oHx,CS
o PMH: No effectlve~treatment
Rule out coagulopathles prior to Subarach- o Euthanasia
noid puncture for CSF
o Myelography: epidural hemorrhage
o
~ ~
~
~_)~
.
Prognosis
o PHM: grave: fatal In 710 days
(respiratory paralysis)
i ;t)
---'
Type 1
intervertebral
disk diz,
IVO,
Hansen's type I
M8k 921; Mk 587; Ehb 297;
H3B2S8; H28286; 12M 1021;
1M 779; IMWW 477; SAP
1158,1163; Cat 1547; F31M
452; NS-W 147, 154; NS.c
413; NS-K 21; NS3hb 132;
NShb 133; NS-O 321,416;
NS-l 82; NS-Pa 202; XRP
81; X4T 98; X-Gr 46; SxB
601; PaT 458; NB 12.17
Hx (breed - dachshund), CS
pain
& no neuro
signs
****
Location:
_ #1 Thoracolumbar: T11-12,
L1-2
fi"i
normal forelimbs
. Peracute to acute onset
Pain: reluctance to move,
arched back
. UMN signs if above l3: spastic paresis
& ataxia of hindlimb (paraparesis)
-lMN sign if lesion L3-4to L7-S1
- NO cutaneous reflex 2 vertebrae caudal to lesion
- Urinary
& fecal
incontinence
ll
dog,
T11-L2
(Robaxin) PO Ii'
OOx:
- Spinal trauma
Fibrocartilaginous emboli
oOiskospondyli\is
~
o Menlnglt.lsfmyelitis
~ ~ 1.\
NeoplaSia
1\
Atlantoaxial luxation
J
Acute polyradiculoneuropathies
o Dural ossification
Calcification of longitudinal ligament
Lateral spondylosis
Oblique radiographic projection
\l
Rupture, nWeanie
(I
Sterof@!
~
-Grave: I
hours, poor > 24
- Recurrence more common In nonsurgical cases
- Most that recover Show improvement wfln 2
weeks
NEUROMUSCULAR SYSTEM
Spinal
column
neoplasia
M8k.927,957; Mk.591,
6tO; E-hb 303; H3B
266; H2B 295; SAP
1157,1163,972; 12M
1031; 1M 784; IM-WW
484; 5mln 820, 822; E
6n; Cat 1550; F31M
455; NS-W 152; NS-C
367, 466; NS-K 99,
211; NS3hb 96, 147,
355; NS-hb 145; NS-O
280; NS-L 189, 194,
197; NS-Pa 386; Sx-S
1035; Sx-ww 299,
291; X4T93; X-RP 86
**
----~-.
Ji
Diagnosis
PresentationlCS
DDx:
Intervertebral disk diz
_ Spinal trauma
Vertebral osteomyelitis/diskospondylitis
Meningitis/meningomyelitis
Degenerative myelopathy
Fibrocartilaginous embolic myelopathy
Treatment:
Most impossible to treat once diagnosed
- Exception: lymphomas
- Some treatable If diagnosed prior to irreversible spinal cord damage
Medi~al:
_
'
Cort~c~sterold~: tempo~ary Tx of sp~nal co~ edema
, Palliative: steroids as adJunct to Sx or If tumor Inoperable
_ Chemotherapy for epidural lymphosarcoma
3
'?
- Surgery: remove tumor & decompress spinal cord
'
_ Intradural-extramedullary: if well encapsulated & diag.
~
nosed early - possible to remove
,-!.l___=_;:-__
- Extradural tumors: debulked or fully remove, rarely sucNeuroepithelioma
.
cessful
E-hb 2S5; 1M 784; NS-L 423; NS-O 2791, 282; NS-L 189
- Doesn't improve lymphosarcoma in cats
Neurofibromas: excision difficult - foraminotomy &
'1 intradural-extramedullary tumor
extensive laminectomy
-Thoracolumbar
Young dogs (6 months
- 3 years)
spinal cord
(T1o-t2)
Euthanasia: for intramedullary tumors
German Shepherd
Presentation:
Very vague signs weeks before neuro. sign onset
Pain is often the first sign (radicular or periosteal)
Often progression to paralysis, although pain loss unusual
Diagnosis:
- Hx (breed, age), CS
Plain radiographs
CSF Analysis: Normal to mildly Increased wec count,
Elevated total protein
Myelography: intradural-extramedullary
_Ancillary tests -EMG, SCERs, CT & MRI scanning
ThoraciC & abdominal radiographs for metastaSiS
Treatment
Glucocorticoids: occasionally temporary improvement
Surgery
///!
S'==
smro~
~t
~~
Prognosis:
Extradural: poor
. . ' , h)
- Lymphosarcoma remission < 9 months
-Intradural-extramedullary: guarded wI removal ,~
_ Immediate prognosis related to neurological deficits
Intramedullary: gravelhopeless
itt!.
Condition
Meningitis,
Menigomyelitis
M8k 946, 924, 903; Mk 608;
SAP 1141, 1158; 1M 769;
H3B 246; H2B 260, 281; Ehb288,291;12Ml009,1012,
818; 1M 782; IM-WW 464469; E 619. 641. 650: Cat
1530: NS-C 358, 356: NSW 93, 153; NS3hb 335,
383; NS-hb 106, 283, 316;
N5-0 230, 402; N5-L 204;
NS'Pal56;H3184
**
NEUROMUSCULAR SYSTEM
Menin itis
Facts & Cause
Not as common in dogs & cats as
in large animals
Inflammation of the meninges (pia
& arachnoid)
May be associated wI inflammation of underlying brain
(meningoencephalitis) or spinal
cord (meningomyelitis)
k,-----------..
Causes:
- Infectious (rare)
Bacterial (rare)
Fungal: cryptococcus neoforrnis
Viral (FIP) - rare
Protozoal rare
Rickettsial diz
Presentation/CS
Diagnosis
Cervical rigidity
Hx, CS
- Pain/Hyperesthesia - neck pain
~~~:!:i~~:SS
,CSF:
- t Protein (breakdown of BBB) (often> 100 mgldl)
- Turbidity n > 500 cellsl~1
~A
-::-r, _
- Steroid-responsive #1?
- Vasculitis
~7
-.;~
Complication:
- CNS edema
- Hydrocephalus
//7 ' #
~.
I.j, , .~
......-~,.~
- Thrombophlebitis
- Damage to cranial nerves & spinal
nerves
DDx:
Acute Type 1 disk extrusion
Polyarthritis
Diskospondylitis
Polymyositis
Cervical intervertebral disk diz
Meningeal Tumors
Granulomatous menigoencephalitus
Steroid'
ii"
Nocardia
St
..j.
Steroia
II.
Vasculitis - meningitis
Mk589; 608; SAP 1141, 1158; 1M 775; H2B281. 260; E-hb 253; N5W 150; NS-C 154; N5-K 68; NS-hb 107: N5-0238; N5-L 191.384; NS-hb 108; 1-8319
Fungallnllammalion of the meninges (pia & arachnoid) myelitis
.
_ Cryptococcus neoformis (most common). Nocardia, Blastomyces dermatltldls, Histoplasma
capsula\1Jm & Coccidioides immltls
Rare in cat & dog
Pfi - I '
w..ks
~ }~Iucyto'sine
~
Amphotericin
_ Extremely difficult to eliminate
-:1
Intrathecal amphotericin B recommended (poor CSF penetration)
Given at high doses IV (can be used intrathecaJly)
_ Rx of cryptococcosls Combination amphotericin B + Flucytoslne
_Ketoconazole - does not cross the BBB - used only as adjunctive treatment
_Rlfampin + amphoteriCin B & flucytosine for histoplasmosis & aspergillosis
Rickettsial: tetracycline
"d
ero.
H,
Steroid responsive
_ Corticosteroids IV Dexamethasone or oral prednisone for rem'lsslon
Bacterial
_ ABs (culture & sensitivity): for 3-4 weeks
following cessation of CS
Causes: Septicemia, Local invasion. surgery. migrating foreign body. Bite wounds,
Extension of nasal sinus, inner ear. spinal cord (myelitis) or osteomyelitis; Hematogenous (endOcarditis. prostatitiS. metritis, diskospondylilis, pyodenna. pneumonia)
Once infection established spreads rapidly
Fungal meningitis
-,
Treatment:
Emergency: fluids,
fever
ValiumlPentobarbital to prevent/control seizures
Bacterial meningitis
Ri.~po:setoanti~bi~iCS
or steroid ther~apy
i'~
f~i::i;:>.......,
~=p=rog==n=oS=i=S:====================== ~
Steroid sensitive: good, Recurrence common (50%)
Bacterial: guarded/poor despite therapy: recurrences common,
,.J'......_v-~J many die
Vasculitis: Guarded, some develop progressive brain & spinal
cord involvement despite Tx
552
Viruses
Condition
Canine
distemper
myelitis &
myoclonus,
Encephalitis in
immature animals
**
Vd .
c:..'i:....bL:
-~
&.
lesions
CSF not helplul in a high % of cases (normal) II abnormal - very variable
CSF/serum titers not very reliable
.
11 cs: pro~eln Is Incre~d - I- IgG With
speclilc antl-C~V activity .
Isolate animal
Euthanasia II severe, Incapacitating,
progressive neurologic signs
Prevention:
Distemper vaccination
..
..
.
~. Camne distemper VINS. neurotrop'c
\,
NEUROMUSCULAR SYSTEM
Presentation/CS
Diagnosis
Treatment
Facts & Gause
Hx of systemic illness: naso-ocular Antemortem onen OITTICUIt
Often unrewarding, no reliable
See Systemic Dizs pg 689
Hx (unvaccinated puppy), CS therapy for myelitis or myoclonus - my Severe, highly contagious multiM discharge, GI enteritis, pneumonia
elopathy Irreversible
eNS multifocal ordisseminated after Thorough neurologic exam
system viral diz
recover from systemic illness
Ophthalmic exam: chorioretini- Symptomatic corticosteroids
Myelitis: inflammation of spinal cord Myelitis signs reflect location 01 Infection
tis, hyperreflectivity, "medallion" Supportive/good nursing
T3-L3 affected most often
T3-L3 (#1) lransverse myelopalhy
~\
00'
"
..
E-hb 294, 1M m, H2B Rare, Young dogs < 6 months, Believed aSSOCIated wI MLV vaccines In combo wI parvo vacCine In pups less than 6-8 weekS old
1189, SAP 109, NS-O CS Sean wlin 1~2 weeks of vaccination anorexia, listlessness, CNS (behaVior changes [vIciousness] aimless wandenng, howling, Incoordination, terminal convulSions)
220, NS3hb 3731, '-B 59 Ox Hx, CS, abSence of InclUSions bodies, OOx furiOUS form of rabies
/>.
Tx Symptomatic ???, PrognosIs guarded
{,;!$~
--'l< ; , I
r
Prevention' Measles vaccine or MV-COV combo In pups <6-8 weekS old, then parvovacclne In 7-10 days AVOId MLV In Immunosuppressed pups or parvo Infected
t'lJl6J
' (if,/.
*
Old
dog
~'_
-::::;
6~
1.;r:,
encephalitis,
ODE, Disseminated encephalomyelitis in mature dogs, Subacute diffuse sclerosing encephalitis, Chronic dementia djstem(1pe~ _-.....,...,
IM-WN 465; NS-C 149;~ Extremely fare, a form Of canine distemper, Progressive disorder - fatal, > 6 years old
~~
NS-O 218; NS3hb 371t: t"' ~ I
CS: Initial: visual impairment& bilateral menacedeflcll; Progresses toCNSCS (mentally depressed, compulsive circling or head pressing,
~il
I-B 53;
'personality changea [stupor, dumb, falls to respond to owner or environment stimuli (dementia}])
Pa-T 366
Ox: Hx, cs, Necropsy (disseminated perivascular cuffing, degeneration, demyelination, diffuse sclerosis, cerebellum & brain stem)
~"!
Tx: unrewarding always latal Px: Grave - all die
~
lJi3J
~'-I\
'
Rabies,
Fatal
encephalomyelftls
M8k 966, 925; Mk 575,
588,619; E-hb 197, 183,
212,281;SAP117,1169;
H2B 1199, 265; 12M 1015;
IMn3;IM-WW464;5min
1008; E 622; Cat 1530;
NS3hb 3711: NS-C 151;
NS-W 118,221; NS-K62;
N5-Pa95; N5-0220; N$L 383; 1-839; I-G 365
st;r~
4-
10
6..
Rhabdovirus (Lyssavirus)
_ Worldwide, except some free islands
#1 important zoonotic diz because
of fatal encephalitis
DDx for all wI abnormal behavior
Progressive, fatal neurological diz of
warm blooded animals
Reservoirs: skunks & raccoons, bats.
foxes; less dogs & cats because olvaccinations,
cats more susceptible than dogs
_Impossible to eliminate in endemic aTeas
- Asymptomatic carriers
Pathophysiology:
_ Transmission - bites (in saliva)
- Migrates to eNS over peripheral nn.
_ Then antigrade over nelVes to salivary glands
_ Shed in saliva usually < 1 0 days after
CS (dies In dned saliva)
Incubation: 3-8 wk (mlb > 6 months)
wI
Polyradiculoneuritis
~ Certain toxicosis
.-
Pseudorabies
- Pseudorabies
Drooped head
- Hypersexuality, paraphimosis
- Die - laryngeal/respirator paralysis
Comatose or convulse, thrash wildly
before death in 2-7 days
Fonns can overl.lp & all rapidly fatal
553
Prevention: vaccination
-
--
.-
-,
"\;-1"
- - ..... ,.-..;:
Prognosis: Grave \
~ Toxoplasmosis
- Certain toxicosis
-~.-,
LMN paralysis
mestic animals
- FIP
- FIV
Notify authOrities
Almost always fatal in do-
Cat:
I Eut~anasia o~ ~uarantine
- Progressive
abnormal behavior
.' Dog:
CS - suspect
Submit head chillea on we! Ice In
leakproof container (do not lreeze)
- Notify authorities: postmor~
- Disorientation (dementia)
Paralytic phase, 2-4 days (dumb form)
- Severely depressed
DDx - anyth'Ing
J',
da,.
Prevention in humans:
15% of humans untreated humans bit by a rabid animal become infected
Once signs develop in humans latal (almost always)
Human diploid cell vaccine (HOCV): human immunization strongly recommended lor
veterinarians
.
Immediately notify local health department when animal bites a human or posSIble
contact wi rabid animal
Humans bitten by animal
-Instruct owner to quarantine healthy animal lor 10 days
_Euthanasia wlld, stray or rabid animals & examine tissue
_Vigorously scrub wound wI soap & water (EthanOf 70% & benzalkonium chloride 14% are rabidicidal)
. Contact health officials: dedde about postexpcsure prophylaxis
.. Previously Immunized humans: 2 dose 01 vaccine (on day 0 & 3)
.. Nonlmmunlzed humans: rabies Immune globulin & 5 doses 01 vaccine on day I,
3,7,14&28
. --.
_._.
----
.--~---
..-
_.._.
NEUROMUSCULAR SYSTEM
Viruses
Facts & Cause
Condition
Presentation/eS
Diagnosis
Treatment
Feline
FIP,
Pathophysiology:
Coronavirus
**
~
~
~
.?'
...
fatal~/),-
1:J.rJrf
."':-,.,
<Z1'...J y-&s
WBCs (especially
- Serology:poordistlnctionbetweenFIP
& enteric coronavirus
Prognosis
- Dry FIP should have a high titer (>
1:3200), although some cases of CNS - Grave: once clinical signs develop - nearly always fatal reFIP have negative or low titers
- Biopsy
gardless of treatment
4Et
ID[Jbts""c=:o-==I
r.
t,~~f"-~'"...~'"
..,..
Prevention:
- Vaccination in catteries: intranasal (IN) vaccine (Primucell
~~
FIP) 1991
- Herpes virus: acute puppy encephalitis: acute crying, diarrhea, dyspnea, abdominal tenderness, terminal
~
depression & death usually in 1-3 days; DIG; cerebellar hypoplasia
:
.(
-Infectious canine hepatitis: encephalitis (rare): Rapid, progressive tetraparesis, coma, seizures, &
SAP 91,110,120,121;
death; vomiting, fever, abdominal pain & jaundice
12M 1012, 1015; Cat
\.")
'1529; F31M 403; NS3hb - FeLV: Seizures, ataxia, blindness, behavior aberrations, motor deficits, etc.
225; NS-O 222, 224, 225, - FIV: Encephalopathy: behavioral changes, dementia, compulsive wandering, licking motions, facial twitching, seizures
397;1-611,198
- Feline panleukopenia virus: cerebellar hypoplasia: nonprogressive ataxia, hypermetria, falling to side, broad based stance & intention tremors
- Parvovirus encephalitis: Systemic: diarrhea, vomiting; CNS abnormalities
Other
Viruses
~!)
--?>.~
l~
Pseudorabies,
Aujesky's
diz,
Mad itch
,,,
(~\
(j
,/i -
OX:
DDx:
Rabies
..
fI)l
r
~~
i)~~
a'
Ji
..
.
..
IMnOE6n
Menl ngeal VaSCulitiS, Beagle polyart.entls, Polyartentls
adrenals, meninges (severe suppurative leptomeningitis
g
Rare polysystemlc .dIZ..
, necrot,lzln Iv=t~!)ofG~nk:n:~~e~~~rg~=~ _nL~9s u~al1Y spared; Breeds: Beagles, Burmese mountain dogs, Ger. shorthaired pointers
.:
- fibrinoid necro$Cs men ngea
" ,
.
I raron of mucous
1\
,
,
...
CS: Systemic signs (pyrexia, lethargy, vague pain, weightless): Organ system~ (linear skin ~\Ceratlon, u ce 1
, ' ...
membranes, nasal discharge, cardia & .renal fallu.re); Meningitis: cervical rigidity, spinal pain, fever
(,'~I~~
~ '),
Ox: Hx: CS; Lab: leukocytosis w/left shift & proteinuria
~
OOx: HypersensitMty angilis
:~J
Tx: Glucocorlicolds Mor cyClophosphemlde
C- V'
_ Prognosls: Guerded to poor
;.4.
M8k 924; E-hb 288, 242; 12M 1017: 1M 775; IM-WW 468; E 626; NS-C 158: NS-O 240; I-B 337; I-G ~09
.
Rare. Rocky mountain spotted lever (RMSF Rickettsia rickettsli) & ehrlichlosls (EhrliChla canis): Concurrent sys!eml.c dlz; Tick transmission
cs: eNS (30% _ depression, neck rigidity, pain, mental changes, ataxia, paresthesia, vestibular signs): Systemic signs fever,
."'---'
anorexia, depression, vomiting, oculonasa1 discharge, cough, lymphadenopathy
fij;3~
Ox: Hx, CS, PE - systemic dlz, Serum" CSF titers
.
Lesions: Rickettsia: necrotizing vasculitis, perivascular accumulation 01 PMNs & lymphoretlC~lar celll.nfiltrate In most tissues,
.
'I
Canine ehrlichiosis: generalized lymphoid & plasma cell accumulation in bone marrow, meninges, kidneys & other organs
.~
J
Tx: Tetracyclines: doxycycline: Chloramphenicol for young dogs
'--...:: _Prognosis: Neurological damage may be Irreversible
Rickettsial meningomyelitis
-, .
21
,(ft
--
.J
>
555
~
.
.
SterQlds
Peri
Nerve Dizs
NEUROMUSCULAR SYSTEM
Peripheral
nerves
dizs,
Common
neuropathies,
Pathology: 2 types
- Demyelination: slowing of conduction velocities in the nerve fibres. Myelin sheath is lost while the
axon remains intact. Remyellnalion of the demyelinated areas
commonly occurs. Axon intact so little neurogenic atrophy
- Axonal (Wallerian type) degeneration: degeneration of neuron from the lesion distally &
concurrent breakdown of the myelin sheath
. Regeneration of the surviving portion of the axon may occur
. "Dying back": degeneration begins at distal end & gradually
progresses to cell body
- Often demyelination & axonal degeneration
coexists but one fonn usually predominates
Neuropathy: pathologic changes &Jor functional disturbances in PNS (peripheral nervous system)
Types:
- Mononeuropathy: single peripheral nelVe
Neuropathies,
- Polyneuritis: affect more than 1 group of
Peripheral
peripheral nerves
Polyneuropathies
M8k 917; Mk 613; E-hb
316,79; SAP 1165; H3B
272; H2B 303, 311; 1M
794, 798: 5mln 930; E
148,701: Cat1591: NSC 337, 79; NSW 162;
NS-K 169: NS3hb 111;
NS-hb 113: NS-O 53,
145,353,493,507: NSL53,61,66,172:Sx-WN
303; Sx4B 73: Sx-B 50
***
Causes of polyneuropathy
Idiopathic #1
Coonhoun d paraIysrs
+ reflexes &
herds, Rottweilers
- Progressive neuropathies: Caim terriers
\\\.: - Axonopathles
cv...
~'CI
P
ssl
nopathY'boxers
Feline dysautomla
: P~~~~ h;::~~aIUria: d~estic shorthair cats
Myasthenia gravis
. Laryngeal paralysls-polyneuropathy: Dalma Caudal aortic thrombosis (cat)
tians
Polyneuropathy wi hyperchylomicronemia (cat) . Distal sensorimotor polyneuropathy: Rottweil Brach,al plexus avulsion
"-'''lism
r
J
- - ..
..
~-------
l ---..
[JtJ.~~a::==:l-jl=l=;==:J:!==-Ib::"
"'..tr'
support
Inherited polyneuropathies
- Inher~ed degenerative disorders
- Spinal
atrophy
in Brittanys.
Swedish
Laplandmuscular
dogs, English
pointers,
German
shep-
nk
Ie paralysis
cep 0
u.
Polyneuropathies
- Pelvic limbs usually affected 1 st
-Chronic, insidious course in most
Exception: subacute - coonhound paralysis,
acute: ischemia
_ ANS signs rare
-Cranial nerves not commonly affected
Exceptions (facial n. In coonhound paralys!s
~h~othyroldneuropathy,vagusdysphagla
In giant axonal neuropathy
Bladder control usually intact
Panniculus reflex usually intact
Mono- or poly-
&
~. Hx, CS
Treatment:
~_ _ _ _ _ _ _ _..J..._ _ _ _ _ _~. Key: find cause, Often not obvious
Supportive care
Waterbed or heaVlly padded sur-
h
INs
Penp era erve
Mk
613:
E-hb 316; SAP 1165: H2B 303:
NS-L
53; 166, 172
Peripheral nerves
-12 cranial nerves (CrN 1-12)
_36 pairs of spinal nerves
Types of nerve fibers
II bod . gray matter of spinal
- Mo~or/efferent fibers: ce
yin
'~
:.
"/l-J
~ 9
I~ ~
,
:>
~N
_
_S~m~a~lI~p~"~lm~=~r~a~re~-'______~~~~~~~~________-l!-________________
~!).
Mononeuropathy
M8k 917; Mk 613: E-hb
328: SAP 1170; H3B287:
H2B 317: 12M 1046: 1M
794: IM-WW 488: Cat
1557; F31M 380: NS-W
229: NS-C438; NS-Kl80:
NS3hb 111: NS-hb 113;
NS-O 53, 366, 493, 503,
513: NS-L 70: NS-Pa415;
Sx-WW 305, 303: Sx4B
74: Sx-B 52; Pys4B 94
***
....,./ ..l-_ _ _ _ _ _ _ _;
NEUROMUSCULAR SYSTEM
Diagnosis
Presentation/CS
Condition
Treatment
%:
~ .-:&1
~.
(>?
-Obturator
- Femoral
Peroneal
"b,~
"f~!':::::~:trelieve compression 01
!l 7.
Brachial plexus
Suprascapular
Musculocutaneous
Radial
Median
Ulnar
AXillary
/a. oSympathetlcANS
Lumbosacral plexus
fj(
If no improvement in 2-3
CS-T1
06-7
C6-8
CS-T2
CS-T2
CB-T2
e6-8
Tl-3
-7@,monthS
L..,::f
- Amputation
- Joint fusion
Amputation if self-mutilation
L4-S2
L4-6
L3-6
L5-S2
LS-S2
LS-S2
Prognosis:
Good for concussion, few
weeks to heal
Severance: poor/guarded
for reinnervation
- Over 12 inches - poor
W'
"
Avulsion of
brachial
plexus
its roots
**
Brachial plexus Rare, bllateral symmetric, dog & cats, Cause:? - allergy: all horse meat diet?
.
es'. ',uw thoracic limb weakness wI m or absent reflexes, tone, atrophy; fadal paresis: allerglceplsodes
neuritis
of facial edema & generalized urticaria initially
.
Ehb317; E704: Mk 614: Ox: CS; Electromyography: denervation potentials, absence of evoke muscle action potentials
SAP 1169; N$3hb 1921: Tx: Soma respond to steroids
NS-O 359; NS-L n; NSPa 427; Sx-WW 306
..
~_)
.....,
_ _ _ __
560
Facts
& Cause
NEUROMUSCULAR SYSTEM
Presentation/CS
Treatment
Dia nosis
Radial
paralysis,
& digits)
**
G""'"
_Knucklingoverofpaw(inabilitytoextendcarpus
i)Aw-----,---------
'V-L---
Prognosis
Good, contusion heal or
animal does well on 3 legs
Musculocutaneous paralysis
References see radial nerve above
'''5
C6-8: motor to the biceps & brachlalis i.e. the elbow lIexors
Sensory to cranlomedial antebrachium
CS: No gait changes, slight straightening of elbow joint
Ox: Reduced Wlthdrawal & biceps reflexes
1-"
Sciatic
paralysis,
Ischiatic
nerve damage
References - see radial
Peroneal!
fibular
paralysis
References - see radial
nerve above
**
~~
~
C6-S - motor to teres m. ajar & minor & deltoideus muscles & sensory
to the lateral aspect 01 the arm
cs: none (compensation by other local muscles)
Ox: Reduced shoulder flexion on withdrawal reflex
Tx: none needed
peroneal nerves
Branches: peroneal & tibial
arsus (hock
position sense
. I)
'fl
fAlexes.& 9rl""b""b''''1 '''th'
t11
Pain loss: below sll e except
taxlc I1m
e owes I e
medial limb (femoral n.lsaphenous)
Knuckling
of paw &
~. Loss of withdraw response
h
._"
dragged on 1 e grou"...
(reduced or abse~t)
Muscle atrophy
(.0( -?
(hamstrings, cranial &
t t
nerves
Damage - causes:
Hip surgery
~ 1M injections - hamstrings
Jg
i,
oL6-S1:molorlollexorsolhock
can be inJured
--.,,::.....~
maycausetransient
r--~YZ;:J
Femoral nerve damage
1\
._
!J!-
L~~:':O:I~~:drl~~:~::I':~:n:la:'~~;9:h:)o:s:'n:~_tl_o_n_1~
on madial1imb (saphenous)
____
Ox: CS, Patellar reflex Is lost, sensation loss:
medial 11mb (saphenous nerve zone)
....., _ _ , . _ _ _ _
~~~
:, ,
o Reduced to absent
hock flexion on
injuries
~ Amputation: 31egged dogs
((
dowell
~o-~oo
~
0
.
(G
", ) ' o
0
I IS para YSIS
References see radial nerve above
-!
~
7.~"
7>
ru~
i' '11
) ;.
~~
~=-______~=-____-J~_O_,"_'_H_'_I~L'9~h~;n~j'!~}'o_n_),_c_s____________________~__'
Tx: None, does fine
--=,
~~
<:-L-L~~~~L__,.__J __~
__
"o___
~
Prognosis: Good
_ _ _ _ _ _ ,_. _ ::.;-."',"-0."'';'''-._,,_
CS
I -
,.,
-Ifnoretumtofunction,watch
withdrawal reflex
Ox
'0
Prognosis: Good
"::-.::-".=::::::::.:::=
TOb I
I,"
"
'~
//
Hx, CS
----
lateralis
~l
~_\,"'1 . :?
__+--''-___-:_7'..:..~=_"'Z._
digits (pes)
G
G)
,JJJ
.~
() 7
I-
L6~ 7 & 81: motorlO hamstrings Can bear weight (can extend stifle _femoral n.) Hx, CS
Time: allow 2-3 weeks to see 11
& advance 11mb (hip Ilexed)
Loss of tactile placing reflex & paw
contusion heals
& thos e of tibial & common
If no return to function
d I
"~"'''''''
* r \,\
___
Axillary
nerve paralysis
References see radial nerve above
... __,.o:..::....=,'_~o...:..::..=.:::----'---="'---'
NEUROMUSCULAR SYSTEM
Condition
Facial
paralysis,
Idiopathic
facial
paralysis
M8k 913, 936; Mk 601;
E-hb 273, 319; SAP
1139; H3B 242; H2B
271; 12M 1049; 1M 795;
IM-WW 489: 5min 578;
E 609, 707; NSC 274:
NS3hb245; N5-hb231,
234; NSL 110: NS-o
38, 364, 368: DDx 427
**
Presentation/CS
Diagnosis
"".
~.
~~
Treatment
Acute or chronic
Treat primary cause
Hx, CS
Facial paralysis - inability to move Physical exam:
- Otitis media/interna: surgical drainmusdes of facial expresSion
age of bullae, ear flushing, systemic
- Otoscopic exam in all
Distortion of face
. Otitis external- abnormal tympanic memABs
brane or ruptured
Excessive salivation
- No treatment if idiopathic
- Neurological exam
Ear & lip droop
Treat dry eye, serious
Skull radiographs
Inability to blink eye
- Eye drops
0
Changes in tympanic bullae +Lacrimation, 2 corneal diz - chronic
- Transposition of parotid duct
Innammalion - increased thickness,
Prognoses:
Idiopathic: good - most return to
function in 1-2 months
Guarded if due to inner ear infections
of ear surgery
..
~c~ern--~ffia~CI-c8d-c--'-.-c-.mn---'c-.--n-mKti--~on--M-c~-~------------r.-c-on--t~---cU.-n-M--fac--'.-'--mu--8C.-on---f-.
-'-'-H-',-C-s----------------------,-.-.-000---.-.-,-,.-.-,.--------------------.
Spasm of facial nerve from hyperirritability or
lowered excitation threshold
Cause:
Sequela following lacial paralysiS
Idiopathic
Otitis medfallntema & tumors of middle ear
- Brain stem injuries
spasm
Idiopathic
trigeminal
neuropathy,
Dropped
jaw
syndrome,
<.
Prognosis???
Hx (normal except for paralysis of jaw), CS Recover In 1-2 weeks
Feed dog wI head elevated & manually place food
RIO differential diagnosis
In mouth, water In deep container (dogs usually can
Motor conduction velocities slowed in CrN 5
drink)
EMG - denervalion
Supportive care
Physical exam:
No masseter or temporalls mm. atrophy
Don't use steroids
Sensation to head normal
- Otherwise normal dog
Sequela:
- Aspiration pneumonia
St~
OOx:
Mandibular
paralysis
Rabies #1
Brain stem dizs
Trauma, tumors
Oral dizs
Common problem In humans (douloureux) rarely occurs in animals; Cause: foreign body (plant awn) lOdges near
perlpherallrigemlnal n. near base of ear, neuroflbrosarcoma. neurofibroma, neurinoma of trigeminal ear
V2 CS: Generalized facial pain, exceSSive salivation, coughing, dysphagia
I. PrognOSis: Guarded
~f
NEUROMUSCULAR SYSTEM
Horner's
Ii
Horner's
syndrome
&
periorbita
Causes:
- Idiopathic:
Hx
Diagnosis: 3 of 4 cardinal signs
- anisocoria in dark - classic (Cn3
relaxed by dam)
~
Constricted pupil (miosis) &
1% phenylephedrlne or (~ ,,\
anisocoria
0.1% epinephrine
sweating (anhidrosiS) in all animalsbul
- Postganglionic lesions dilate
, ~
.
horse, difficult sign 10?Mtobs8rv8 - Preganglionic
rapidly wlin 20 min
lesion - may
dilate In 40-60 min
(nictitans)
#1
in dog
'C\
**
DDx:
"'"' """"
Enophthalmos
fiP
- Dehydration
..
_ Debilitation
NIctltans protrusion
_ Enophthalmos
\tJ0
Prognosis
- Anterior uveitis
- Spastic pupil syndrome in cats
- Parasympathomimetic agents
- Organophosphate toxicity
- Central neurological
Sympathetic pathway
Sympathetic neurons arise
in hypothalamus, descend
cervical spinal cord to synapse in Tl-T3,
4 segments
- Preganglionic fibers pass over Tl-T3 spinal
nerves to sympathetic trunk in dors. thorax
- Pass through stellate (cervicothoracic) & middle cervical ganglia to pass
pathetic trunk to synapse in the cranial cervical ganglion
Postganglionic fi'Oars pass through middle ear into omillo
of the Iris, periorbital smooth muscles & periarteriolar
Tongue
paralysis,
Hypoglossal
paralysis
Cause of dysfunction:
Hypoglossal nerve dysfunction
_Trauma, rupture of hyoid apparatus
- Neoplasia
-Iatrogenic injury: bulla osteotomy orsublingual salivary gland removal
Brain stem (medulla)
-Trauma
_ Vascular (hemorrhage, edema or infarct)
Neoplasia
Hx, CS
Physical exam
Neuro exam:
_ Pull on tongue - weak retraction
_Jaw tone & ability to close mouth nonnally
_Unilateral- tongue protrudes toward lesion
. Bilateral (rare): tongue hangs out of mouth
_COx brainstem diz ordiffuse neuromuscular
diz
Dysphagia, megaesophagus, laryngeal
paralysis
Contrast radiography & fluoroscopy - diagnostic
_Pooling of contrast in mouth. inadequate
bOlus 'onnaUon, inconSistent induction of
swallowing reflex
prognosis:
Guarded? spontaneous recovery in some cases
DDx:
Inflammation of tongue
_Oropharyngeal neoplasia, foreign body
Fractured hyoid apparatus
_ Rabies
Trigeminal neuralgia
**
Laryngeal
paralysis,
**
Dysphagia*
lJ~
g;i ~:.g~:!"tion,
Tx:
Aspiration
See Resp PG
131:
Tracheostomy,
CCS, Sx
l.
It
=~~ '~\"")
I' . F '"
(
poor
Mastlca=t=o=~=m=y=o="=t.====::::=-_
:/'I
Megaesophagus
r,,;!;,, ____
~L_ _ _ _ _ _ _ __
\\).,:~~JA}
~r.,
.\
of oral cavity,
,If,
k.:
l."..~ ~ /, _ _
1.......
pharynx
& esophagus
(most
",","mj
, i
r::'--::"":::=;::::;::-:::=::;;;:-:;;::::~d;r.;iif;;:;;.t;;;'
Tongue paralysis rare wlo other e lei s
Tx:
,.",k ",
if
J'J
~U
~I
I 'II
\
~
"'b----
U-I
Coonhound - Tick
LAR SYSTEM
i
Coonhound
Best known canine peripheral Pelvic limb weakness (paresis) Hx (fight with a raccoon 7 to 16 Supportive! nursing: preventing
neuropathy - acute ascendiJ'lg paralysis
days ago) es, usually diagnostic
bed sores & urine scalds
- Flaccid
Cause: unknown
Ascends rapidly progressing to PE: wound
- Physical therapy, bladder
-7-10 days after contact wi a raccoon
paraparesis, quadriparesis & fre- EMG (needle EMG denervation potentials)
evacuation
Idiopathic no contact wI raccoon, not all
Diffuse spontaneous activity in most ap- Assist in eating & drinking
quently
to
tetraplegia
blnen dogs get dlz, some get diz w/o
paralysis
exposure to raccoons
- Extremely rare in cat
- Oiz doesn't confirm immunity
Genetic susceptibility?
Pathophysiology: degeneration: mild lymphocytic radiculitis, demyelination & axonal
degeneration (polyradicuioneuritis) 01 mainly
ventral (motor) roots 01 spinal nerves. Later,
peripheral nerves distal to the affected roots
may develop widespread degeneration
G)
E=;:~
hrs to a week
Prognosis:
Good: recovery starts in lsi week,
may take 4 to 5 months
- Some dogs never recover, complete recove/)'
- Decubital ulcers
.Px: Good
~.
"",,",'W""".
polyneur~is
No treatment effective
Hx, CS
Physical exam: spinal reflexes
CSF: usually normal (elevated protein, normal cells)
EMG: (mUSCle degeneration potentials,
slowed conduction velocftles)
Muscle biopsy
0
:=:~~
.",,'OS'" grave;
, most progressively worse
* .
oSeeToxp.=,RaM
Snake venom
Coral snake
- R d n ellow - kill a fellow
e 0 y
neurotoxin
E-hbl64,H28315,E321,
NS-C 386 NS-hb 3591
~~"D
-==:~~~~-:~
'.'
~
S
'F1accldquadnpareSls(generallzedweak- ~'
_
ness, petvlC > thoraCIC limbs))
~ _~
o
~
... ___ ~
G)'
t. ,
.
,
..
&
Paraneoplastic polyneuropathy
1_~:,a
...Jte).cs
-S-
' b l f Shock
Ehb 240, SAP 1168, 1175, H3S 286, H2B 313, E 714, NS-W 215, NS-hb 192, NS3hb 195, SxWW 306
th t It I nctlons of peripheral nerves PathophYSiology not understood
~I Some neoplasia may release a substance a a ~rs u I
I limbs) f Muscle to'ne'. Spinal reflexes Loss of tactile fa positioning reflexes
( I
: g~ ~:(~~~~I~~,I:)n~~~~:~~ ~ee:~~=: ~~x~:~~~:S,~~erve ~elocllies, Histo' demyelination, g~nglioneuriIlS, axonal atrophy
Tx Remove neoplaSia it possible Prognoss Guarded to poor
'h
CS due to location
Hx, CS
Compression &Jor destruction
Electrophysiology
.
.SchWannoma (neurinoma, neurilemoma)soh- .Usual1yslow growing -weeks- monthstorCS
- Oenervatlons potenllals EMG
tary
a Lameness of a limb
.
- NCVs (conductlon)
oNeurofibroma:usuallysolilary .
Brachial plexus
,~~)
't
Map sensory loss
aNeurofibrosarcoma:oltenonmultlple.nerves
_Lameness
. 'Biopsy
Lymphosarcoma (cat> dog) metastasIs
_Pain on moving limb
Cause: unknown
- Paresis & atrophy
Effects: single nerve (s), nerve toots
- Homer's syndrome & loss of panniculus
. - Brachial plexus (C6T2) most common site
rellex (il caudal brachial plexus)
.
- Trigeminal nerve (CrN 7, #1 cranial nerve
Lymphosarcoma above + signs of multlcan-
---,
oodf
.., (
0. _- -
vanab,!ls
flaCCid paralYSIS
\
_ 1 female tick sufficient to cause
clinical signs about 7 to 9 days
easternw
Ie
Hx (tick; LMN)
Rapid reversal of signs
..
after infestation
~-
Death from
respiratory paralysis in
1-5 days if tick not removed
.-::L----:--:-;:;-:::;=--;:N;;M~J---'--,
~
Derma cento~, blocks
CS: Flaccid paralysis ascending
{,,,
Ox: Hx, remove of tick
Tx: Remove tick Px: Good
"
'
567
,~,'
..--
a Coonhound paralysis
_.
"',
br~~~~~~osPhates
Snake bite
Urinate,
r.
. .
~
~'.d.~~~ecjat~e
~
~:::::Y,." ""~
.
,-
(hyperesthesia, atrophy)
Botulism (~everal a~lmaIS)
Myasthenia grav,s
1
I ted)/
2h
ours
_ Australian diz, may continue to deteriorate
alter removal olthe tick hyperimmuneserum
f
d
Dipped if suspected & tick not oun
24-7
~ .~_.~.,_
wI re~
moval of tick
Electrophysiological studies: EMG normal,
d ed
scl
tric diz
/IIL
Prognosis:'
0 POCK: even wI removal, recurrence
likely in 1-2 years
_PostStJrglcai metastasis reported (1)
**.
North American & Australia
TI-ck
?
Ticks: Dermacentor andersonii
k)
D
paralys is
(Rocky Mountain wood tic or ,
164t
.
. .
;>
'"z .
'';
Prognosis:
------- -
--
Tremors
NEUROMUSCULAR SYSTEM
shaker
syndrome,
torrler,
tremors
tremors
- Severe ataxia or gait
- Worse wI excitement. stress or exercise
- Chaotic eye movements (opsoclonus). 01-
, beagle
Cause: unknown
.? Inflammatory, neurotransmitterdeiect, dernyellnaJing disorder?
No specific treatment
Diazepam (Valium)
:E.;::--,
Corticosteroids (prednisolone)
=..-.
~;;:'~
- Hexachlorophene
fall)
'ttl;
'=" 0'
. load
-Organophosphates
_Butyrophenone
Metabolic tremors
_Uremia
Whnedogs
CS: Dfffuse tremors, Disappear wI
Ox: Hx,CS
I
///
Prognosis
Guarded: Spontaneously resolve in 1-3 months
after onset or
Continue for life (still make viable pets wI
sedalion or quiet
i
_ Hypocalcemia
_Alkalosis
.
Valium
,. 'Y/.
trem~r
syndrome; Associated wI abnormal myelination In puppies; Autosomal receSSive trait In Chow chow, other breeds are sporadically affected
I Dalmatlon, Australian silky terrier, Samoyed, SChnauzers)
in puppies; Seen when first walk; Worse wI exercise or excitement
I
In 1-3 monthS w/o treatment in most puppies
& 2 dalmatians
Autosomal recessive Iralt
- Disorder of serotonin neurons?
Spasticity syndrome: disturbance of myotatic
reflex mechanism
Onset: 6 wkS - 18 months
- Stimulated by exercise or excitement
Scotty
cramp,
Hyperkinetic
syndrome
M8k 905; Mk 582; E-hb
279; H38 243; H2B 266;
E 617; 5min 862: NS-C
315; NS-W 196; NS3hb
264; NS-hb 252; NS-L
148: NS-o 207
**
Hx (Scotties)
exercise" excitement
Increased stiffness & hyperflexion (goose
syrup
in Scottlel}
L:::=
Stimulated by exercise or excitement
CS: Cramping wi exercise - rear limbs
Ox: Hx, CS, Challenge test
Tx: Valium Px: Good
""".W'..l
Rare: Doga generally resistant to botulism _ LMN (lower motor neuron) detect
_ Mild weakness to progressive, symmetric.
_ Several reports of hunting dogs fed carascending weakness to Quadriplegia
M8k 916: Mk 328; E-hb
casses or offal
Raecid
paresisfparalysis: limb, factal, neck,
316; 12M lOSS; 1M 800;
- Not reported In cats
jaw, pharyngeal & laryngeal muscles, & ocH3B283; H2B313,1326: _ Cause: Ct. botulinum Iype C neurotoxin
caslonally respiratory muscles
_ Gram-positive spore-forming saprophytiC
iM-WW 493: E 702; Cat
- Hyporeflexla, hypertonia
1555; NS-C 385; NS-W
anaerobic rod (Soil)
- But no musde atrophy
_Neuromuscular blockade: inhibiting release
234; N5-K 190; NS3hb
- Stiff, stilted action
186; NS-hb 187; NS-O
0/ ACh al the neuromuscular junction
BAR:
mentally alert
_ LMN paralyaia - rapidly progressive
366; NS-L 67, 106; 1-8
Cranial nerve involvement (drool, cough,
196; Sx-WW 306 ~
Toxin:
dysphagia), mydriasis
~. AI,.''''' 0' """"" "'II, decompo,'"' ",,"" - Megaesophagus raTe
~ ('
p..ve""y"lhosl,o,,,..aseoIAChotNMJ
VOice loss
(LMN) : loss of muscle tone
_ No hyperesthesia, pain sensation OK
~
- No proprioceptive deficita
Botulism
1M 746,
NS3hb 333
paresis/paralysis of limbs
('~
.7
~.
ca?J'(
ri~
,
'"
/
Diagnosis:
Localize origination of pain
- Neck pain
Manipulate gently - resistance
Spinal radiographs
, CSFtap
, Myelography
- Other areas of spinal cord
' Pressure over vertebrae & lumbosacral area
, Resistance to abdominal palpation
" Dorsal traction on lal! - cauda eQUina syndrome
" Spinal radiograph
.CSFtap
Myelographs
Umb pain -localize to bone, muscle or joint
- Palpate muscles for pain
- Check for wounds (cellulitis)
_ Palpate Joint for range of motion
- RadiographS
- Joint taps
f5s9l
}~;;11
@ill
Prognosis
Good: most dogs recover in 1-3 weells wfonly
supportive care, if survive first 2 to 3 days will
recover
~~i~
BAR, Death
Pain- Neuromuscular
'\
DDx ~ Pain - neuromuscular
Neck pain
-Infectious & inflammatory diz of
eNS
Meningitis
- Vertebral instability
- Diskospondylitis
_ CelV"lcal intervertebral disk diz
Ischemic myopathy
- Bone pain
- Tumors - compression
10
Panosteitis
bone tumors
- Trauma
Osteomyelitis
- Generalized myositis
- Joint pain
- Disk diz
- Diskospondylitis
Infections
Immune mediated joint diz
- Neoplasia
- Cauda equina syndrome
._------_._----------------
Neuropathies
NEUROMUSCULAR SYSTEM
Presentation/CS
Condition
Neuronal
abiotrophies &
degenerations
H2B280; SAP 1157; 1M 788;
E619;NS-W158; NS-K158;
NS-hb 140, 154; NS-O 187
.. .
~= ~,
~ "'7F~
~~, ~
~
<:L!J
l,f)
Ox: RIO
d':-~
Prognosis:
Poor: although some are 'CI
'\J so slow that animal may be an
acceptable pet for a long time
degenerative .
myelopathy,
M8k 921; Mk 586; E-hb 292;
H3B 256; H2B 280; SAP
1157; 12M 1034; 1M 786; lMWW 481; E 650; NS-C 426;
NS-W 148; NS3hb 145; NShbI43;NS-OI93;NS-l192;
NS-Pa 319; Sx-WN296; PaT 370
Treatment
G. Shepherd
Diagnosis
Hx (older, large breed), CS (slow ataxia & oNone _euthanasia when nonfunctional In 30UMN weakness)
6 months
Physical exam: no spinal pain
- Support - prevent decubital ulcers
- Reported Tx: steroids, viI. B & E, exercise
RIO (rule outdia9nosis) excluding inflammaprograms, aminocaproic acid (EACA)
tory & compressive thoracolumbar dlz
. ';,';;';'" ",dlog,aph" CSF, myeIO~'taPh'no' Symplomallo, do, "'"
DDx:
~
..
~
oHipdysplasia
o Osteoarthritis
Type 2 disc diz
Sp'naleOfd
o Distemper myelitls
Chronic dlskospondylitls
Myelitis
Neoplasia
neop~.a
No Tx
~
,.....~~.-
__
..'
UMN (upper motor neuron): Onsal at 3-6 months old; Bllatera! symmetri.c spinal ~ord degeneratl~n ~red?m~na~~IY Involving the;, spin07re.~ellar.tracts
CS: UMN signs: weakness, rear 11mb incoordination, progreSSlng to ataxia of all 4 limbs & hypermetna, SWinging hindquarters, prancing pelVIC 11mb
gait, signs may stablllze
Tx: No treatment availabla
Prognosis: ?
*.
0
Hereditary
of Afghan hounds,
Afghan
M8k 903; Mk 585; E-hb 296; Genetic defect in myetin, 3-13 months old; Caudal cervical & thoracic cord demyelination of spinal cord axons (cavitation & necrosis)
H28 280; 12M 1041 t; 1M 789; CS: Bunny hop gait, Progressive paresis & ataxia of pelvic limbs, Thoraclclimb initially stiff progressing to paretiC, Pain perception impaired, UMN (LMN
E662; NS3hb 154; NS-C346;
CSlate)
NS-K 122; N8-hb 151; NS-O Ox: Hx (Afghan), CS
Tx: No Tx available
192; NS-l193; Pa-T 371
Prognosis: Grave, hopeless
Neuronal
Mk 582; H3B273t; H28304t:
12M 1043t Smin 930; 1M 790;
NS3hb 191; N8-hb 189; NSo 189: NS-L 84
Swedish
spaniel
Demyetination of the brain stem, spinal cord 8. cerebellum; Onsat - 6 weeks old; Cause: unknown
CS: Rapidly progressive; All 4 limb weakness, LMN rapid atrophy limb deformities & arthrogryposis
Ox: Hx, CS; RIO rule out other causes of cervlcal myelopathy; CSF, radiographs & myelography normal
Leukoencephalomyelopathy, Rottweilers
M8k 903; H3B 233; H28 280; 0 Hereditary; LMN; Onset at 5-7 weekS old, Neuronal deganaration of spinal cord ventral grey matter
12M 1041t; 1M 789: E 619, CS: LMN signs: rapid flaccid tetraplegia, sever muscular atrophy, Loss of spinal reflexes
672; N8-C 347; NS-W 150; .Ox:EMGdegenerativepotentlaIS
NS-O 192; NS-hb 378t: N8- 0 Tx: No traatment available
28
E 652;
Cat 1552
. tf)
\6J
572
NEUROMUSCULAR SYSTEM
Hypertrophic neuropathy in Tibetan mastiffs *
Neuropathy
Spinal muscular atrophy in
Rottweilers
*
12M 10431; 1M 791; H2B3041; NS-C 371; NS3hb 191:
NShb 189; NSPa 309
or
M8k90S, 911; Ehb 321; t2M 1043t; IM791; H3B274t; H2B3Q4t; SAP 1167;
E 709; Smin 930; NSCS71; NSW21 3; NS-K 174; NS3hb 1921: NS-hb 191:
NS-O 356; NS-L 78; NS-Pa 437
Hereditary, LMN (lower motorneuron); Onset - 7-1 0 weeks old: Extensive,
cAronlc demyelination
CS: LMN signs: rapid progressive weakness, loss of muscle tone &
hyporeflexia, pelvic limbs then thoracic limbs, recumbency wlin 3 weeks
Pain sensation normal, Cranial nerves normal
'
Ox: Hx, CS, NCV: slow conduction velocity due
::\.
to demyelination
' \ ~TX: No treatment available
.PrognoSis: Guarded
\...J."
~('fit?:
E-hb 320; 12M 10431; 1M 791: H3B273t; H2B304t: SAP 1167; Smin
930; E 708; N8-C372;NS-W213; NS-KI76; NS3hb 193; 1921; NShb 191; NS-O 355; NS-L 79 NS-Pa 444, 316
UMN; Ons~1 at 6 months old; Axonal degeneration & swelling of CNS, PNS demyelination & remyelination
CS: UMN signs predominate: slow, progressive severe rear limb ataxia, swaying hypermelric gail, front limb
Involvement late In diz
Ox: Hx (young boxer), CS; PE: loss of
proprioception, weakness, patellar
areflexia, normal flexor reflexes, intact
pain perception, normal bladder control,
.,
normal cranial nelVes; EMG: normal,
NCV: normal to"'; Nerve biopsy: ...
myelinated fibers, onion bulb fOnnation/,"j
Tx: No treatment available
Prognosis: So slow dog may be
demyelination
CS: LMN signs: progressive rear limb weakness
(paresis), proprioception defiCits, depressed
reflexes, alrophy of distal peMc 11mb
muscles, Thoracic limb normal,
Megaesophagus, Diminished
bark, Some dogs have a
curly coat
Ox: Hx, CS, Spontaneous
EMG activity in dislallimb,
Biopsy: Giant axonal swelling
Tx: No treatment available
Prognosis: Poor
({'.l
~~,-------=-,~"""----------------~1
Distal denervating diz
MSk 908: E-hb 320; 1M 790: H2B 303; SAP 1167: E 708; NS-C 139: NS3hb 1911, 344t;
NS-hb 3241; NS-O 526, 186t; NS-Pa 220, 458; Pa-T 363
oSee pg 517: Inherited lysosomal storage diz; West Highland White" Cairn Terriers, bluetick hounds,
cats; Onset: 4-6 months old: Demyelination CNS & PNS, enzyme deficiency accumulation of
S-galactocerebroside in CNS cells & macrophages (globoid cellS)
CS; LMN signs: progressive paraparesis &
~
paraplegia,quadriparesis,
Hindlimb dysmetria, Ataxia,
,..,
... Conscious proprioception & hyporeflexla,
J
C""""
Head/neck tremors; Behavioral changes,
--;r
Blindness, nystagmus, Cachexia,
........::.;;
Anorelda before death
"Z'
c-c'
;C
--.
I'
\.
"'_
~..
\.
~~
M8k 910; H3B279; H3B 310; SAP 1170; E 706; NS-W 213: NS-hb 191; NS-O 363; NS-L 77 NSPa420, 44
Degenerative neuropathy of distal motor axons; United kingdom: Dogs: Cause: unknown: Pathophysi
ology: ? toxic agent?
CS: Weakness all 4 limbs (tetraparesis) acutely, few days 10 4 weeks; Not affected: mastication,
swallowing, respiration, bladder control & tail wagging; Neck weakness loss of bark; Severe muscle
atrophy: proximal extensor muscles: Spinal reflexes depreSSed or absent (patellar reflex); Sensoryfunctlon
maintained; Cranial nelVe dysfunction infrequent (Co7)
Ox: Hx CS: Electrophysiology (EMG abnormalities,'" molor velocities
normal sensory velocities), Muscle biopsy: decreased
nerve fiber in intramuscular nelVe bundles,
neurogenic atrophy
DOx: Acute idiopathic polyneuropathyl
coonhound paralysis
Tx: Supportive care
Prognosis: Good - complete recovery in 4-6 weeks
'-
zC"'"'
\S
"IH~e-re-d=it~a-ry-=P~ro~b~l-em--s----------~~r----~N~E~U~R~O~M~U=S~C~U=L~A~R-=SY~ST-E-M~I
Sensory neuropathy, *
Sensory ganglioradiculitis
M8k 905, 912; Mk 582; 12M 10431; 1M 792; H2B 3041: SAP
,.......
MBk 905, 912; E-hb 282; 12M 1043; 1M 791; H2B 3041; SAP 1167:
Smin 930; NS-C 291; NS-W 212; N$-hb 191: NS-O 356; NS-Pa 443
Condition
~
Dysmyelinogenesis,
Myoclonial
congenita,
Congenital
hypomyelination
M8k 909, 901; E-hb 279;
H2B254; ES17; N5-K 124;
NS-hb 254; NS-O 190; NSL 149;Sx-S 1033: Pa-T363
Facts
NS-W230
~
Cals (Siamese) & dogs
Causes: Unknown
CS: Periodic, hysterical,lntense chewing
or licking 01 back, tail & rear limbs
Tx: Mixed success wi steroids, phenobarbital. diazepam, hormones
& Cause
Rare
MSk 903; E-hb 292; H2B 2801: E 652, 849; NS-O 190; N5-L 193,
Treatment
Presentation/CS
Diagnosis
Hx (puppies), CS
RIO (rule out diagnosis all physical & lab
tests normal Cranial nerves normal
Necropsy: confirm - histo - demyelination wI
normal ax:ons
<'. .
20~
No specific treatment
Supportive care - keep quiet
DDx:
White dog shaker syndrome' Metabolic disorders
Intoxication
- Uremia
_Hexachlorophene
Hypocalcemia
_Lead
- AlkalosiS
- Butyrophenone (Doble)
_ Organophosphate
-:--
~~
,
CS; Pelvic limb alalda, Hypermetrla, Frequ~nt flicking C7
t:~
movements of distal limbs when at tull fleXion
Tx: Acepromazlne may reduce episodes of
extensor rigidity; Phenobarbital may produce,-.
temporary improvement of signs
\ t
Prognosis: May improve wI age
g .\
&
575
77
~~L~3,
~'
Hound ataxia in
"'-
*
.....................
~t:~
r./
~
~
bloodhounds or 51. Bernards): NS3hb 191; NS-L 84; NS-O 190; N5-hb 189
- --p
v
Other Neuropathies:
Stochard's paralysis (crosses 01 Great Danes wI
. . & hyporeflexla
(especially shoulders)
Ox: Hx, CS, EMG: deneNation
\
Tx: No treatment avalleble
Px: Poor
-;::!>
E~,"mem"oc1 '''hy
Hypomyelinogenesis; failure to form myelin " ..........~ bmbs, head & body
Dysmyelinogenesls: formation of
_
'!>t:. - Wide based stance, hypermetria,
abnormal myelin
.;;.:.
...
head & body i.ntentl~n tremors
New u
, r Bunny hoPPing galt
cau!: Ps
~'Body ~remors more apparent when
_ Congenital; Dalmatians,
exerCise
Weimaraner, spaniel & chow
)), - Olsap~ear at rest or sleep
_ Sequela to in utero viral infection
- Rear limbs more severely affected
or thyroid disorders of pregnant dam
\)
-.r..ioted when start ambulating
-Idiopathic: Schnauzer, Australian silky
No weakneSS
Pathophysiology: abnormalities In myelin: m conduction velocity, conduction block, failure to conduct,
cross talk between adjacent axons, aberrant firing
Neurogenic amyotrophy,
Hyperesthesia syndromes,
/~j
Idiopathic hyperesthesia syndrome
_____.
..._
576
Poisonings
Condition
NEUROMUSCULAR SYSTEM
PresentationlCS
Acute (wlin an hour)
Organophospha1es, Major cause of poisonings
Commonly used - insecticides, Muscarinic effects:
OPs,
pesticides & anthelmintics (flea - "Slobbering" - salivation
Anticholinesterase
**
products)
-Trichlorfon, parathion, dichlorvos, malathion,
ronne!, chlorpyrifos,lrichlorlon; dimethoate,
crofomate, diazinon, lonolos, phosmet, diSulfoton, coumaphos, lamphur, phorate,
fenthion
Interaction wi phenothiazine tranquilizers,
succinylcholine, physostigmine, neostig-
mine, carbamatas
Similar to carbamate except
irreversibility
"'-'~"'=':::J -Irreversible inhibition of acetylcholinesterase (AChE), overestimations of parasympathetic
ANS, skeletal mm. & CNS
Dia nosis
Treatment
Hx wlin 48 hrs + parasympa- Emergency (rapid progression)
thetic signs tentative Dx of Prevent further absorption
OP's or carbamate
- Remove flea collar
- Lacrimation
Response to atropine
- Bathe if topical exposure
- Defecation, watery diarrhea
therapy
-Induce vomiting il ingestion witnessed
- GI hyperrnotility, abdominal pain - Analysis of stomach contents or hair
- Activated charcoal slurry lavage
AcetylchOlinesterase activity (abnor- Miosis, mydriasis
Atropine to effect (mydriasiS & absence
mal > 500 lUll)
_ Pallor, cyanosis
Reduced serum & RBC cholinester- of salivations), repeat every 3-6 hrs for 1-2
days (irreversible action of OP's)
ase levels
- Dyspnea
-,;
ASAP: 2 PAM (pralidoxime chloride)
- Vomiting (emesis)
t;/
IV every 4-6 hours
Nicotinic effect:
- Diphenhydramine (Benadryl): decreases
nicotine receptor overload
- Muscle tremors &: contraction
- IV Fluids
(faCial & tongue 1st then entire body)
OOx:
Respiratory support
- Ataxia & collapse, Paralysis
Strych
nine
Contraindicated: morphine, succinylcholine
& phenothiazine tranquflizers
- Tetany (sawhorse stance)
Compound 1080
eNS effects relatively rare
ANTU
Public health: wear gloves & aprons to protect
- Depression or hyperexcitability
Chlorinated hydrocarbon
people
- Tonic-colonic seizure
Metaldehyde
ci
. Inhibits muscarinic, nicotinic & Death: respiratory muscle paralysis, bronchoconstriction, pulmoneuromuscular synapse
nary edema
Common pOisoning
CS:
~
f.~
Bromethalln@~,:::_,_".'
II
- Oelayed onset of CS
. Predominanlly CNS signs
-Tremors, ataxia. depression
t:i
~T~x_:~E~m_e_r~g~e_n_C~y~,_A_t_ro~p~in~e~,~2~P~A~M~~__~-'~\~(~~_-t~~-~s~~~wn'o.'S~!M~!P~'~~~&~t'~'~24~WH~k'__~~~~~~~~~~~~7S~iS~&~T~X~-~w~e~e~k~s~ro~~~c~o~v~er~~
Carbamate,
- Insecticides (carbaryl)
1:z..,-
___--'"T"x::,:.:L:::ik:::e:..;O::p:...:'S:..;--=A:::tr::,o::p!:;i::;"::e".:.P.:x.:.:G=OO:::::::d____________...L______
.::~~__~____-.l-=-/'-t(~
7
Met:--a-=/d-=-e-=h-y-d-=e----cr.-:
l
::S"h"'."ke:C"&;:-;:b-=-ak;::e:;;--M=-o::"U-S-=ki-:--c'"'lde:-----,s.,-'u-,.g-::&--,S-:-n.-:-:i"b"'.-:-tt-:&-r.
JAVMA 205(3)p417, 1994; M8k
2074,2145; Mk 1676; H3B 1256;
H2B 1313; E-hb 161; Srnin 827;
1M 755; IM-WW 473; Cat 229;
3601; NS-O 265t; Tox 325; ToxWW 250, 73t, 821; NB 20.13
~1.___
**
-"
II
V--
Prognosis: 9 0 0 d @
\X-vfJ
"".u \
I'
.'
q-@
Sequela: Death
by respiratory failure
DDx:
""
Strychnine
Compound 1080
Chlorinated hydrocarbons
Organophosphates
/'C-:<..J",O
Molluskicides, geography
CS: "Shake & bake": ataXia, tremors, seizures
Ox: Hx, CS, Lab
Tx: Induce vomiting, Lavage, Charcoal, Relax
Arsenic
poisoning
~.~.")}
~)
.
CS: Acute GI (salivation, repeated vomiting, colic); Staggering, PU; Stupor, Death
Sequelae: Shock, renal failure
S~(r~._Pi_d_G_I_S_ig_n_S)_,_le_v_el_s_>_to_p_p_m_;_p_M-L~!J
Prognosis: ????
~(
) ")
~It~ _________~~~
Tx:. Absorption
(vomiting, lavage, charcoal); BAL; Fluid ______________________
.L_D_X:_H_X_,C
__
Px: Poor to guarded
...
__ .-::.:;
576
Poisonings
Condition
Organophospha1es,
OPs,
Anticholinesterase
M8k 916, 928, 2058, 2062; Mk
1665, 1669;E-hb1SS; H3B1252;
H2BI314,313; SAP1143, 1171t,
1172; IM\AIW 473; 1M 756; Smln
884; Cat 216; E 313; NS-W 228;
NS-C 386; NS3h267; N5-hb255;
NS-O 2651, 136; NSL67; NS-Pa
255; Sx-WW 306; PaT 356; Tox
298; Tox-\AlW231; NB 20.6
**
NEUROMUSCULAR SYSTEM
Presentation/CS
Treatment
Dia nasis
Hx wlin 48 hrs + parasympa- Emergency (rapid progression)
thetic signs tentative Dx of Prevent further absorption
- Remove flea collar
OP's or carbamate
Bathe if topical exposure
Response to atropine
- Lacrimation
therapy
-Induce vomiting if ingestion witnessed
- Defecation, watery diarrhea
- Activated charcoal sluny lavage
- GI hypermotility. abdominal pain Analysis of stomach contents or hair
AcetylchOlinesterase activity (abnor Atropine to effect (mydriasiS & absence
- Miosis, mydriasis
mal>
500 lUll)
_ Pallor, cyanosis
of salivations), repeat every 3-6 hrs for 1-2
Reduced serum & RBC chollnester
days (irreversible action of OP's)
aselevels
- Dyspnea
-.
ASAP: 2 PAM (pralidoxime chloride)
- Vomiting (emesis)
IV every 4-6 hours
Nicotinic effect:
Diphenhydramine (Benadryl): decreases
nicotine receptor overtoad
- Muscle tremors &: contraction
. IV Fluids
(faCial & tongue 1st then entire body)
DDx:
Respiratory support
- Ataxia & collapse, Paralysis
Contraindicated: morphine, succinylcholine
Strychnine
& phenothiazine tranquilizers
- Tetany (sawhorse stance)
Compound 1080
eNS effects relatively rare
ANTU
Public health: wear gloves & aprons to protect
- Depression or hyperexcitability
people
Chlorinated hydrocarbon
- Tonic-colonic seizure
Metaldehyde
fenthion
Interaction wi phenothiazine tranQuilizers,
succinylcholine, physostigmine, neostlg
mine, carbamates
Similar to carbamate except
irreversibility
""-..."~",,,,,,"C) -Irreversible inhibition of acetylcholinesterase (AChE), overestimations of parasympathetic
ANS, skeletal mm. & CNS
ct
V-
synapse
sis, bronchoconstriction,
pulmo. neuromuscular
'''~'.~"''' ._"
...- , - . "
"
Common pOisoning
CS:
nary edema
~
f.~
down
OX: Hx, Response to atropine
~c.-.
Bromethalln
. Delayed onset of CS
. Predominantly CNS signs
. Tremors, ataxia, depression
c
-....
LT
__x_:_E_m
__e_rg~e_n~c~y~,~A~t~r~orP~i~n~e~,~2~P~A~NI~____-1~pI~\~~~~,
__+:~~-~s~~~w~~~s~th~'~t~P';~~'~t;.fO~'2~4~~~:kS~L1~~~~~==~~~~~~~S~iS~&~T~x~.~w~e~e~k~S!to~re~c~o~v~e~r~~
Carbamate,
Insecticides (carbaryl)
-=:::::
f
. '~.... PH: protect people
;.,.)..
______1.T"x::;:C;L::;i:::k::e..:O::;P:...;:S:..-..:A:::tr::.::o:!:p:;:in:::e:..::P:..x:.::..G::::o:::o:::d'--____________L ______~~:.....__..:..______.L.:/~
~~-:--;--:---:----r.-:M::O-I:;IU.,.S:-:k"fc"'f"d.,.e--.,.s;:-,Uc:9-:&;:-s:::n:::ac:;il-;:ba-:c:ci,-:;&T.-;::S:;:hc:.;:ke=-=&-:b:::.:;k=e::----- ~.1J
JAVMA 2OS(3)p417, 1994; M8k
2074,2145; Mk 1676; H3B 1256;
**
,~L..
./
t("
"V
II
1.J...-....,1,
)"1;\1.(
Prognosis: good
-;Jj)
Sequela: Death
_____..:.. by respiratory failure
.............
DDx:
Strychnine
Compound 1080
Chlorinated hydrocarbons
Organophosphates
..-.,-,t,.J><.
Molluskicides, geography
~~FJ
Prognosis: ????
poisoning
~.~~D~X:~H~X~.C~s~(m~p=id~G~IS_lg_n_S_)._le_v_el_s_>1_0_p_p_m_;_PM-4~1J
)
~-
Arsenic
.
577
---- ---
____________________
----~~--
-~
~l
-~
_-===~
--
-~~---~
Toxicities
NEUROMUSCULAR SYSTEM
Diagnosis
- Hx (Ingestion). CS
- Hyperthermia
Acidosis
-Inducing seizures with loud hand clap is NOT
DIAGNOSTIC & can be lethal
-Induce vomiting - red or green bait
-Analysis of stOmach contents, liver, kidneys &
iurine
DDx:
High CPK & lactic
Tetanus
dehydrogenase
Hypocalcemia
Myoglobinuria
lead
Zinc phosphate
~~r.
.4-aminopyridlne
'iiiegal in USA
Vom;';"
0' ooNicotine
Caffeine
CS: Tetanic seizures
-II,
1\\ 'l",l./'
. . . . . '\
Compound 1080
xL
:F
I \\ r i o Sequela: Death due to hypoxia
~ "\ --. ~
CHC
"Hx,~, ab
_~'
20toresPiratOrymUSCleridlditY&~r~
Tx: Vomiting, Lavage, Charcoal, Valium .Px: Poor
20 renal damage
- - ........
Metaldehyde
Facts & Cause
_Alkaloid used lor burrowing rodents (ral, mold,
gopher) & coyote control
JAVMA 205(3)p416, 1994;
-Sweettastingcoallng or pellets, dyed purple,
M8Ic. 2156; Mk 1732; H3B
red or green
1250; H281305; E-hb 161; -No rationale tor its use! Sale iliegalln USA
SAP1143, 1158, 1162;5min - DIrectly affect the spinal cord like tetanus
1089; 1M 755; NS-C 310;
- Competitively blocks Inhibitory neuron (glyNS3hb262; NS-hb 250; NScine)
o 265t; Tox 345; Tox-WVO/ - Results In hyperexcitability. loss 01 "damp284~'
N820.12
ing" 01 spinal reflexes ~
olethal doses
@J_;
?\
~.
_Dog: 0.75 m g l k g '
-Cat: 2.0 mg/kg
~
Condition
Strychnine
..'
~({5
Presentation/CS
- Rapid onset- 10-20 min,
- Nervousness, apprehension, stiffnesseariy
- Abdominal Ii cervical rigidity
UrlControlled reflex activity:
- Violent tetanic seizures - spontaneous
or 2<' to stimuli (light, sound, touch)
-Generallzedexfensorrigidity- "sew horse
stance" -legs &body stiff. ears erect. lips
pulled back (risus sardonlcus)
-Opisthotonus
-Dilated pupils (mydriasis)&semicomatose
- Apnea (breathing stops), no paddling,
chomping or salivation
,J --://~\\~.Y~
ro:::-);
",e
Treatment
oPrevent lurther absorption
- Induce vomiting il not hyperesthetic or
conYUlsive
-Gastric lavage: 1-2% tannic acid or 1:2,000
potassium permanganate lollowed by
activated charcoal + saline cathartic
Control seizures
- Diazepam (VaUum) - effective?
- Phenobarbital
- Muscle relaxants PO: Glycerol guiacolate
(Geocolate). Methocarbamol (Robaxin)
- Inhalation anesthesia
- NO morphine or ketamine
Hasten elimination:
- Diuresis (normal saline wI 5% mannitol)
-Acidify urine wI NH4CI PO qid once diuresis
established. not If acidotic
Px: Guarded il early Tx, Good il controlled
- Poor If late Tx & seizures have occurred
Chlorinated
Use curtailed because of persis
tence in environment: only lindane,
hydrocarbons, endosulfan (Thiodan), methoxychlor. Chlor-
No specific antidote
Stimulate or depress CNS
Hx (Exposure)
Depression alternates wI C8: convulsive seizures &
Symptomatic TX
- Dermal exposure: copious
muscle activity
neuromuscular involvement
~ane & toxaphene approved lor use around
_ Head pressing
(twitching)
wash in soap & cold water
CHC,
livestock,
..
Ll'b'l'
I
h
- Ingestion (rare): activated charcoal slurry
Organochlorine
-Agriculture products: insecticides:
- Hypersensltrve:exaggerated
eves In rain, Iver, samac
lavage after seizures controlled
insecticides
..
.
,
response to stimuli
contents or
fat (glass contain
Control seizures:
M8k 2063;Mk 1666; H3B
DOT, TOE, dieldrin, aldnn, endnn,
- Vomiting, hypersalivation
only)
~.
chlordecone, edosuHan
.
-::::
- Diazepam (ValiUm) IV. Phenobarbital
1259; H2B 1315; Ehb 160; Recommended levels of spraying
- Continual chewing motion
- Fat biopsy,,; _ -r
'"
- NOT phenothiazlnes (lOwers threshold)
1M 755; IM-WV\I' 473; SAP
T 'h'
ff
&
k b d
-....JOJ-.J
'(,
I
1143; Cat 218; NS-O 265t,
usually safe
- wlte .ngo ace nec - 0 Y
- If;' iii l..oo.""h4(1 Remove stress from environment
13t;Tox286;Tox-wvo/237
A
I t ' t
(I t I bl )
(severe lasclculation & tremors, ataxia)
DOx:
t[~) )\l Maintain hydration & urine output
ccumu a e In Issue a so u e
_ Convulsive seizures (unlike
,~
v~
(CHC elimInated In urine - IV fluids or gastric
Cats especially susceptible
OPS): clonic-tonic. paddling & foaming at
Strychnine
- ./
tube)
~" Act,oo IIp'd'''',''e "","'ed IhlO",h ";0,
mo",h
\\... A
Compound 1080
""-dlffuseCNSs!imulantordepressant(causesa. Hyperthermia
ty'l,:~1)
Organophosphates
PH: protecl people wi gloves &
-,,-..:::
.1,
true cerebral encephalopathy)
f
\
Protracted course ~
Metaldehyde
aprons, proper authorities dispose -persIst
Persistence; Lindane, DDT
- distributed to lat
~. Lead
in environment
CS: Seizures & neuromuscular involvement
Comatose
~ I I~
Degenerative cerebellar diz
Dx: Hx, CS, Levels
Death during severe seizure or
Garbage intoxication
Prognosis: good wI early diagnosis & Tx - weeks to recover
Tx: Svmptomatic, Valium, Fluids. Px: Good
complete recovery
,,,
JJ
sa
**
4t
toxicity
Lead
I. Expos_ure to lead.in old paint, car
MBk 2072'Mk 1674. SAP
batterieS, motorod & grease, caulk155. 1143;' 5mjn 758; H3B
ing material, dry wall, fishing sink1271; H2B 1329. 1380; E-hb
ers
162; 1M 756; IM-WW 472; E _Dogs that dig orchew)n ground wI high lead
318; NS-C 162; NS-W 119;
levels (leaded gas)
NS3hb267; NS-hb255; NS_ Toxic doses: 10-25 mglkg lethal
0264, 136; NS-L 295; NSPa250,465; Pa-T3S4;Tox Pathogenesis:
107;Tox-WVO/I91;NB20.14
-Alterscerebralmetabollsmleadingtoedema,
hypoxia, cerebral necrosis
""C.J'"
- t RBC fragility & abnormal erythropoiesis
/
- Effects heme synthesis - maturation
p.'f- Usually young animals < 1 year-old
It:
Males> females
**
tY
fJ 0';--
;;e
~
~
8S -
ED~'
.
II
"
1)-;;11
i<'ll( 7'illI~
W~
10801/1081
See TOX.739: Highly tox,ie; rodenls & coyotes; licensed ~xterminators; Ar,P block
_
~
.
' C S : Rapid - Vomiting, Urination, Defecation, Dyspnea, Wild behavior, running fits, Seizures, Rapid rigor mortis;
~!
~
Sodium
Cat: above + vocalization
is'~ffi ~ ~/' (,
fluoroacetate~ Dx: Hx, CS, rapid rigor mortis (extensorrigidity), No hypersensilivily to slimuli
~ Q)
"j ' \ r----/\...
~~ Tx: EmeSIS, lavage, charcoal; Glycerol monacetate (Monacetin), 02, barbiturates
I~}
G>""i;
/
~
h)#
-.
__E
\
AI"~
," s;-s)l
.
- Drugs: antibiotICS (neomycin, streptomYCin, gentamicin, polymyxin e, tetracyclines, sullonamides), Organophosphates: axonal degeneration
PolyneuropathIes - Other chemicals: acrylanide, Tri-ortho-cresyl phosphate, carbon disulfide, CO, DDT, Lindane, pentachlorophenol
E-h~ 283; H3~ - Polyneuropathy; Venoms (coral snake, bee); radiation
285. H2B
Dx' presumptive on Hx CS
315; tM-WW
.
,
474; NS3hb
Tx: Removal of offending substance results in regeneration of peripheral nerves & often returns to normal
192t, 195, 36
Prognosis: Usually reversible: vincristine, OP's
intoxication, Irreversible: aminoglycosides, irradiation
579
\'
...---.
~
Tetanus
Condition
Tetanus,
Lockjaw
MBk 929, 447; Mk 590, 330;
Ehb 187; SAP 1291, 1158,
1162; H3B 1153, 1269; H2B
1211,1326, 1422t; 1M 745; E
374; I-B 193; I-G 521; NS-C
308; NS-W 162; NS3hb 260,
258; NS-HB 246, 248; NS-O
232; NS-L 141; Sx-WW 306
Dogs
**
I;
, J1 ,
'I'~I.
FIJ\
wound location
- "Pump handle" tail
~ d."o'op po'yoo",opol"o,
. ( ) "7
PathophysiOlogy: ? Neuronal metabolism;
.
11'0'0",
".
DDx:
ears)
- Prolapse
of 3rd eyelid
Strychnine
Rabies
- Occasionally seizures
Eclampsia
Meningitis
-td !
I
Organophosphate poisoning
Canine distemper
Carbonated hydrocarbons
Uremia
oHx,CS
Needle EM<:,.chan ~reased motor
nerve velOciIleS;:r=;:
-Thyro" ,tlm,'oIloo
'-z:t
test
i!
~--......
'"'S~.<
_~~
.,
',.
Diabetes mellitus
May cause fiber
- Proprioceptive deficits
- Depressed patellar reflex
tentials,
conduction velocities
Nerve biopsy: thinning of myelin
I I
yperosmo a ity
462
*.
'c
HypogJyceml
polyneuropathy
~~"~-.~
_.-
Pa246,472
Evidence
".'
of OM
Treat diabetes
sheath
see P9 663
_'~~.
_
wI control
glycemia
of diabetes
"-=,,
./C-L
~__
. -
JJ8
--
0
0
:iiIJ
_ _ _ _ __
1 )~
~r;r
Hyperkalemia
See Cardlo pg 238: Life threatening phenomena; Causes: oliguriC renal failure (failure 10 excrete) #1 cause, adrenocortical insufficiency, diabetes mellitus, severe acidosis; shock
Cause: ... Intake ort loss in GI & urine, diuresis (vomiting, diarrhea, excessive fluid therapy, or Insulin therapy); Loss of neur.omuscular function
CS: Muscular weakness, depreSSion, ileus, reduced renal concentrating abilities & abnormal cardiac conduction. LMN paralysis characteristic
Ox: Serum potassium
Tx: Supplementation easiest & safest by oral rout (hyperkalemia - heart problems),
if oral rout not possible (GI complications)
sa
~~~~~~----
Seizures #1 signs or
~. Hx, CS
hyperinsulinism
~ Lab
Weakness (paresIs or
- Low resting glucose levels, nay be normal
quadrlparesls) wI depressed
(resllng, fasting, after exercise)
patellar reflex
- Serum Insulin values usually high
DepresSion of all spinal reflexes
- Amended insulin glucose ration >30
Atrophy, collapse
r <- 1\, _ . ..-: ; 0Electrodlagnostic tests Ilbnllatlon ~
0 Visual Impairment,
~___
potentials & sharp waves
unilateral facial nerve
~
1!J
. .~
paralySIS, behavioral
" \
~
- Mild muscle atrophy
~rPlanti9radestancecommonincats
Generalized weakness
L..1.
I
7-
Polyneuropathy
Thyroid supplementation:
Sodium levothyroxine (T4)
-~,
',.~
~r
If survive 7
Hypocalcemia
})';'11
Prognosis:
degeneration
(mechanisms not understood)
Hyperglycemia!
Metaldehyde poisoning
Cats> Dogs
(I
Spinal trauma
limbs, Opisthotonus
Diabetic
M8k"913:E-hb318;SAP1168;
H3B 281; H2B 311; E 706;
polyneuropathy
pg 662
\)'~-
--
NEUROMUSCULAR SYSTEM
Massive
doses
of ABs: penicillin,
Hyperesthesia
Usually presumptive Ox
- Spores in soillfeces, gram-positive, ToniC/clonic muscle spasms
ampicillin, tetracycline or metron
Clinical
signs,
History
anaerobic bacteria
idazoJe
- Elictted wI slightest sound or Wound may not be evident (eS > 5-20 days
- World wide distribution
after wound)
Muscle relaxants, sedatives or
tactile stimuli
-Soil contaminated deep puncturewouncls
No reliable clinical test lor Ox (try to culture)
(anaerobic environment needed)
tranquilizers (phenobarbital, diazepam
- Masseter, neck, hindlimb & o Anaerobic culture for organism
\.~'
_""....,=c"'::"'__
*.
Hypocalcemia
E-hb 558; E 1457; SAP 234;
1M 754; H2B263, NS-W203;
NS3hb260, 350; NS-HB332:
NS-O 259
*
Hypercalcemia
Ehb 552; H2B 263; E 1437;
NS-W 203; NS3hb 352:
NS-hb 332
See Endo pg 681: Most common in cattle; Cause in dogs: hypoparathyroidism, renal diz, ethylene glycol toxicity, acute pancreatitiS, intestinal
malabsorption, hypoalbuminemia, nutrHlonal 20 hyperparathyroidism, Puerperal tetany/eclampSia
Pathophysiology: Ca essential for neuromuscular transmission, muscle contraction, membrane stability & Clotting process
CS: Tetany (neuromuscular excitability 1fasciculation, twitching tetany, muscle spasm, gait changes [stiffness & ataxia]), Occasionally seizures
(grand mal), weakness; BehaVioral changes (restlessness, aggression, panting, hypersenSitivity to stimuli, disorientation)
- 0" Low Ce. HI,h pho,phetom'" hypop...lhy,M,m. '0"" Ie",,". """"'0",' '" hyp'~e"lhyroldl",,: B,"Y""". hy"rtho,mle. PU/PO & 'om.h'~
t" ~
See Endo pg 676: Affects cellular function, Gl, renal, cardiac & neuromuscular dysfunction; weakness caused by membrane excitability
disturbances; Cause: 1 & 2" hyperparathyroidism, Pseudohyperparathyroidism (lymphosarcoma), hypoadrenocortlcism, chronic renal failure
CS: Depression, muscular weakness, fine muscle fasciculation
581
' . t~r
Aortic thrombosis
Condition
Aortic
thrombosis,
Ischemic
neuropathies,
NEUROMUSCULAR SYSTEM
- Feline cardiomyopathy
Bacterial endocarditis (dog)
. Originate lrom valvular vegetations
- Heartworm dlz & treatment
Saddle
embolus
- #1 - terminal aorta at
bifurcation of iliac arteries
."Saddlethrornbus" 90%olcases
Pathophysiology:
motor neuron)
- Dragging hindlimbs (can't
flex or extend hocks)
Intermittent lameness
(claudication = lameness)
- Relentless crying - pain
Brachial artery
- Monoparesis of front limb
**
Treatment
ManageCHF
Physical/Saddle thrombus
- Pallor of affected paws, paresthesia, cyanotic nail beds
- Absence of femoral pulse, cold
extremities
Euthanasia
initially
- Intact myotatic reflex
Sequelae: DIC
Diagnosis
Hx (cardiomyopathy)
?~~
Echocardiography (US)
EJevated skeletal muscle en-
Postelior paresis
Trauma
- InteNertebral disc dlz
- Spinal lymphosarcoma
- Fibrocartilaginous Infarction
- Myasthenia gravis
- Diabetic neuropathy
Torbugesic
/1
~~
Prognosis:
M8Ic 929; Mk 597,596; E-hb 319; SAP 1170; 12M 1056; 1M aOl; H2B 1130; 5min 531; E 707; Cat 1555, NS-W 85, 216; N-K 179; NS3hb 250, 192t, 283; NS-hb 239;
NS-O 365; NS-Pa 471
Hx (Britain), CS
Disorder of ANS - autonomic neNOUS sys- Rapid onset. progressing over 48 hours
o Physical exam
tem (sympathetiC & parasympathetic
Depression, vomiting, "retching,
- Dilated puplls unresponslve to light
United Kingdom, rare in USA
- Dry mucous membranes, nose
Cause: unknown ?toxlcology?
Dilated
,n...x;"pupils (mydriasis) anisocolia
- Bradycardia, hypotension
Rare incals < 3 years-old, reported In 6 dogs Dry nose, eye (keratoconjunctlva sicca)
- Proprioceptive deficits
PrOlapse of 3rd eyelid
- loss of anal reflexes
GI: dry mouth, anal areflexia
Postmortem
-lesions of ANS
Disorder of ANS, United Kingdom
Constipation
CS: Dilated pupils, Dry nose
Regurgitation - megaesophagus
~t"",
,J...----------,-,-----1
t:' J t",tr
o
Ox: Hx,
Tx:
CS, PE
Supportive.
't.:.J.:)'
~"'~""~}(;;.->_?'
Prognosis
Poor: mortality,. 70%, some cats recover spontaneously over years
Some that recover have '0 shaped pupils in left
eye, & reverse "D In right
Px: poor
---b~--~~~~~--,--.--7T~__,__~--,--.~--,--_r~~--------_r~~__,__.~~~~
Idiopathic
oCatsw/inherited hyperchylomicronemia Asymptomatic, most cats all dogs
Hx, CS
olowfat diet (rId or wId) to lower serum trlglycer-
hyperlipidemia,
Polyneuropathy wI
inherited
.......-...h........w-..-ia
- cats
Ii
.....
Swimming
puppies
Rare,
Not a
.Tx:
""
Px: Good~
<,t>-i"Z
Hobbles in adducted
position
Deep bedding
I r/dl ,
Prognosis:
" Depends on continual
attention Of owners
NEUROMUSCULAR SYSTEM
ii
Disorders of
skeletal muscles,
Neuromuscular disorders:
dysfunction of motor unit
Weakness: common to
Hx (history), es (clinical signs)
romuscular disorders
Physical exam including cardiovascular system
- Motor neuron (cell body & axon)
- Focal or generalized
Neuro exam:
Myopathies
- Neuromuscular junction
General
signs
- Evaluate strength - weakness #1 sign
E-hb 329; SAP 1124,1173; 1M
- Myofibrils innervated by nerve
- Gait abnormalities
. Gait, exercise, push on animal
803; IM-WW306; 5min 854, 864;
_ Paresis or paralysis
. Postural responses (Wheelbarrowing, hopping etc.)
E 727; Cl1t 573, 1029, 1043;
_Tiring (exercise related weakness)
Stlflness =inflammatory myopathies, myotonlas & MG
Cal 1574; NS3hb 195; NS-W228; Cause (see box): hereditary, ac
Ataxia:
(sensory sign) suggest neuropathetlc disorder
N-K 1812; NS-O 145, 376; NS-L
quired (autoimmune, metabolic, Other accompanying signs
. Palpation: muscle tone & spinal reflexes
66,69,84; Sx-WW 306;
_Masticatory dysfunction
Note atrophy or swelling
endocrine, neoplastic, infectious,
toxic & ischemic)
:~~::~:;;~~,~~:~,::~::~::~;:~:~:~ - Cranial
nerves:
weakness from
possible
w/o generalized weaknessY!
OlHerentlate
regurgitation
vomiting
elin path:
03?#:#$ ~
- cac, chemistries, & urinalysis for metabolic disorders
- Dysphonia & dyspnea (laryngeal - CK (serum craatine kinase) elevated if muscle damage, doesn't confirm a myositis
**?
I.
dysfunction)
Neck pain
- Diskospondylitis
- Cervical intervertebral disk diz
- Tumors - compression
- Cervical nerve root
- Trauma
Generalized myositis
- Polyarthritis (atlantoaxial joint)
Other spinal regions
- Disk diz
- Diskospondylitis
- Neoplasia
- Cauda equina syndrome
,.;;:
4,r;J)'"
Treatment:
~
Electrolyte imbalance
Hereditary disorders: selective breeding & prevention
~ Hyperkalemic periodiC paralysis
Acquired neuromuscular disorders
Mestinon
Hereditary
- Hypokalemia - cats
- Treat 10 cause: hypothyroidism, adrenal
- Canine X-linked muscular dystrophy
- Endocrine
dysfunction, electrolyte disorders, protozoal infections
~I
- Congenital myasthenia gravis (MG)
Hypothyroidism
Generalized MG
~ Familial canine dermatomyositis
Hypoadrenocorticism
_ Anticholinesterase drugs
r
- Hereditary myopathy of Labs
Hyperadrenocorticism
- Pyridostigmine bromide syrup (Mestinon)
- Hereditary myotonia of Chows
- Neostigmine (Prostigmin) 1M
,/., ; I
- Familial reflex myoclonus of Labradors _ Neoplasticlparaneoplastic
_Infectious muscular disorders
- ASs for any concurrent aspiration pneumonia
1~ i \~.~
Acquired muscular disorders
- Autoimmune
Generalized myasthenia graviS
Focal myasthenia gravis
Leptospira myelitis
Megaesophagus - feed in upright position
Masticatory muscle myositis
_Toxic
.~. _. Focal MG: pharyngeal & esophageal problems
~
Feline idiopathic polymyositis
Tick paralysis
Anticholinesterase 1 hour prior to feeding
Hypokalemia polymyositis
Bot r
'
- Feed in upright position & remain upright for 10 min after feeding
Polymyositis
Ulsm
P
t
t t
t b
Organophosphate
toxicity
- ercu aneous gas ro amy u e
- Metabolic muscular disorders
Dru s affecting neuromuscular
- F?r those not responding to upright feeding
.
Glycogen metabolism
g, .
Anticholinesterase drugs value not known, lower doses may be of benefit to prevent
transmission
regurgitation
Lipid metabolism
_Ischemia
Steroids (prednisone) if concurrent immunological dizs
Nutritional myodegeneration
_Feline myositis ossificans
Immune-mediated inflammatory myositis MMM
Enzyme deficiencies
_Local wound myositis
- Acute MMM inflammatory diz
Hyperthermia - malignant & exercise
_Fibrotic myopathy
- Immunosuppressive doses of corticosteroid then taper dose
- Exertional myopathy
- Chronic MMM fibrotic diz
- As for acute + (steroids)
SterOids
Manually open mouth
" .........' "
Polymyositis
~--.-"~-(""
- Immunosuppressive steroids
""""
- refractory cases: azathioprine or cyclophosphamide ~
Jktl
:~?E;~~:~: ~~'~
\$ () -:t~~;':~!~;~E::'::~~9:::~ro:::::,:;~,~::am~:ostigmln
t
:i
Neuromuscular
~J
--------_.
--
~~.(~
NEUROMUSCULAR
Acquired
myasthenia
gravis
M8k 915; E-hb 323:
SAP1123, 1174, lIn:
H3B278; H2B307; 12M
1057: 1M 801: IM-WW
494: 5min 83S; E 712:
Cat 1572, 1555: N-K
189: NS3hb 201: N5HB 197,228; NS-038S,
164t; NS-LS9, 89,106;
Pys 291
** 'r
Progressive muscular
weakness
- Episodic: exacerbated wI exercise & improves wI rest
- Gait: normal initially then progressivery
shorter (stiff stilted) tliliaysoown & refuses
to move, then moves after rest
, Postural tremor & crouching
stance before collapse
- Drooping face -Iacial nelVe
- Difficulty holding up head, closing mouth
- Dysphonia (voice changes - high)
- Generalized or predominantly In rear limb
or Thoracic limbs
Megaesophagus common
- Regurgitation
- Dysphagia (difficult swallowing)
- Salivation (sialosis -iiow of saliva)
- Regurgitation, gagging
Exacerbation of CS wi cold (shivering depletes ACh)
Muscarinic stimulation
- Salivation
- Miosis
- Vomiting/regurgitation
. Diarrhea
Hx (episodic weakness), CS
Physical exam/Neuro exam:
- MUSCle strength: gait at walk (strenuous
..wheelbarrow, hopplng & hemistepping tests, i
- Ataxia: conscious proprioception (paw POSition,:~ii:~~!I~~~~~'~i~~::~
-Palpate in lateral recumbency, muscte tone & bulk, pedal
I
- Palpation for mUscle/nerve pain & percussion for a hypotoniC dimple
No sensory problem
- Neuro: unremarkable besides weakness & dysphagia? eliminates most form of neuropathy
Cranial nelVe dysfunction, weak gag reflex, weak tongue, facial paralysis
~
Edrophonium chloride (Tensilon) challenge test IV
,~~"
- Presumptive Ox of generalized. MG
Tensi Ion il!
- Improves In 30 seconds, negative response doesn't rule out
Long acting antiCholinesterase neostigmine test {Prostigmin, Stlglirlj improve in 15-30 min
Atropine (0.04 mglkg, IV) should be given prior to antlchollnesterases to block their muscarinic
elfecfs
DDx:
Metabolic disorders
- Hyperkalemia
- Hypokalemia
Hypocalcemia
- Hypercalcemia
Hypoglycemia
Cardiovascular disorders
CHF
- Arrhythmias
Neuromuscular disorders
- Polymyositis
- Polyneuropathies
Megaesophagus
Polymyositis
- Some neuropathies
- Botulism
Hypothyroidism
Damage to muscle - polymyositis
Globoid cell leukodystrophy
IJl.
F==--t
lL
Treatment:
Anticholinesterase drugs (prolong ACh action on neuromuscular junction)
,~
- Pyridostigmine bromide syrup (Mestinon) PO
pro~in
. Dosage varies wI exercise, eXCitement or cold,
___ '>1\,
".-:2.'
adjusted according to response
Mestinon
. S;g"
~I
p"ma~ di'.
0....
,,~
-----~-
Prognosis:
Guarded: progressive course
Some dogs spontaneously remission
Poor if severe megaesophagus
Mestlnon questionable effectiveness with constant dosage Changes being very common
CorticosteroidS It concurrent autoimmune diz
Muscle
NEUROMUSCULAR SYSTEM
Condition
Congenital
myasthenia
gravis, MG
M8k 905; E-hb 330; SAP
t173; H3B 278; H2B 307;
12M t 057; IM-WW 494;
5min 83S; NS-W 198; NS0386; NS-lS9, 89, 100;
Focal
myasthen
ia
Similar to acquired MG
Episodic tiring, recovery wI rest
Noted when first walk
- less active than littennates
- Megaesophagus common
- Regurgitation
Dysphagia (difficult swallowing)
- Salivation (sialosis -flow of saliva)
- Regurgitation, gagging
- Dysphonia (VOice changes - high)
" Exacerbation of CS wI cold
gravis
Diagnosis
Presentation/CS
.. head,
Prog"".""
w"Jm,ss, pal,'c limbs to
to recumbency
Regurgitation due to megaesophagus
~~g~:~:::p":a;~~:~:;~~;~:tion, dysphagia
Dx: No generalized weakness, CrN, AChR antibodies
Tx: Feed upright Px: good
(,~."m_m,une
Tx) SterO~i'd'
_
- Repetitive
Be"fIt I'om
,"lIcholl",""asa
T,
nel'le
stimulation
~'
l'TI
~,~.
,~1
,iLl
~_~,
l ~:"______-l~:'lM!!""S",t,-:~~n~~'l!."""''''''''~''..::~=<J _
Jill.
..I
.
Treatment
Muscle weakness
Hx, CS
'umbrigidity/hyperextensionofaIl4IimbS
Proximal appendicular muscular hypertrophy
Classic signs of Cushing'S: PUlPO, hair
loss, pendulous abdomen, thin skin
OOx:
Hypothyroidism
e Myasthenia gravis
_Pathophysiology:
' ~~. 4
/ ; "-
Steroids..
/:....
#...l.~q'--
....c....
...,...,~
' ~
Ie
- Rarely In puppies
- Commonest In young ruminants
Nutritional deficiencies of vit E, selenium or both
e Puppies fed semisynthetic diet~
deflcienlln vit E & selenium
I
'V)
Pathophysiology: Vit E
protects antl-oxldative for
!
. __
unsaturated fatly acids,
destabilization of Iysosomes,
1;
">
OOx:
Infectious myopathy
- 'Swlmming puppy' syndrome
Breed- specific congenital myopathy
)/i1
tfi.
Prognosis:
-.;:::;.
Poor: for complete resolution of myopathy
Guarded: myopathy variable
- EMG findings persist even wI improvement
Hepatic glycogen storage diz: S-8 week old toy breeds: CS: Persistent lasting hypoglycemia - Ox: Hx, CS, IV glucagon or epinephrine - hypoglycemia, enzyme isolation
Glycogen
metabolism
Amyulo-1,6-glucosidase deficiency: young female German shepherds - CS: poor growth & weakness
disorders,
Glycogenosis
or enzyme
deficiency
MSk 90S; E-hb 320, 527,
413; SAP 1174; E 708
II 'L;-.,
_1 0
~'
-L
~ ~
~.
-l:ir:~ :~"?.....
~ ,~... - ' - - - - -
',..
;,' '-
':"
*
_
Neoplasticl
Association b~een neoplasia & neur~~u,scular disorders suspected but not proven
paraneoplastic
- Thyoma aSSOCiated
589
~ -
lffJ"'-'
...
'-...-...
~""_V""">
~J.-rJTf(
t~------~..-J
\ ~
~~
Myositis
NEUROMUSCULAR SYSTEM
Condition
Masticatory
muscle
myositis,
MMM,
Eosinophilic
myositis,
Atrophic
myositis, Cranial
myodegeneration
E-hb 330; H3S 856, H2B
907; SAP 1174; 12M 1059;
1M 803, 259; IM-WW 496:
Smin 854; N-K 164; NS3hb
196; NS-H8 193; NS-O
379; N$-L 85; Sx-1/No/308
**
Treatment
Acute:
Hx, CS
Acute inflammatory diz
~ Swelling of masticatory Physical exam:
~ Steroids: Immunosuppressive doses
of corticosteroid then taper dose
muscles (eyes bulge/exophthalmos)
- Presence of atrophy or swelling
. Monitor by ability to open mouth & serial
~ Salivate
Acute: resent manipulation of
serum CK levels
~ Fever, swollen tonsils & man~
mouth
. Long term low-dose alternate day Tx of
steroids because tends to return
dibular lymph nodes
- Inability to open mouth if chronic
~ + Azathioprine (Imuran)
~ Jaw drop
Laboratory:
~ Trismus (spasm of masticatory
eBC - neutrophilia & eosino- Chronic fibrotic diz
- As for acute (steroids) +
muscles, lockjaw)
philia
~ Jaw held partially open
- Muscleenzymes normal to slightly ~ Manually open mouth
(pseudotrlsmus), won~ open orclose mouth
~ Never paralYSis
temporalis, pterygoid)
Myofibers of masticatory muscles distinct from
limb muSCles
- Type 2M myofibers target of autoimmune
disorders
Diagnosis
Presentation/CS
- Variable fever
- Masticatory dysfunction
Chronic (more commonly recognized)
EMG, electromyography
- Positive waves, fibrillation potentials, electrical silence in areas of
fibrosis
Muscular biopsy (Iemporalis muscle)
- Necrosis&phagocytO$i$ortype 2M myofibers
masseter muscles
Prognosis:
Good: steroids - rapid clinical
remission
Recurrence common
Complete or partial response occurs
lM804; IM-WW496;NS-W
198; N-K 185; NS3hb 195;
NS-HB 193; NS-L 85; N$0380; Sx-1/No/308
Laboratory:
Polymyositis,
**
DDx:
Atrophy
Lethargy, depression
Stiffness
Regurgitation (megaesophagus -
Neospora caninum
esophageal dysluncllons)
myoclonus
oI Labs
H2B904
~
~
~
~ v ( 1 ('
Radiographs:
Megaesophagus
~ Pneumonia
~:;.,
II T I~
~
~ CBC (complete blood count) & Chem
~
t CK
Xi. t AST
~-=:rl---~
Steroid
Ik,
.~.~
Dysphagia
Familial
rellex
loss)
!f;'~l1
~f
Prognosis:
Good in absence of
t:::t:rI
aspiration pneumonia ~
Muscle relaxation at rest
Decerebrate rigidity II oplsthotonus when
handled or auditory atimUIi
Respiratory distress if severe
Muscle finn, not painful
Distortion of lacial musculature
No dysphagia
Hx (Lab, young), CS
Physical exarnlneuro exam: diHicult to perfonn: generalized stiffness when handled
EMG: Increased motor unit action potentials,
polyphasic MUAPs, multiple motor unit discharges to tactile stimuli, nonnal NCV
Nonnal muscle enzymes: CK, Aldolase, AST,
lOH
Nonnal muSCle biopsy & histochemical assay
No known treatment
Clonazepam& diazepam tittle effect
Euthanasias: because of severe galt abnorm.,tle,~
~~
Prognosis: Poor; usually puppies
euthanlzed
If)
\6!
NEUROMUSCULAR SYSTEM
*
X-linked
muscular
dystrophy.
Sex linked
myopathies, Golden
retriever muscular
-Rare
MaJeGolden retrlevers,lrish terriers, Samoyeds
&
2 male cats
Disorder of
dystrophy
MSk 906; E-hb 331, 413; SAP
1173; 12M 1064; 1M 807; H2B
905; Gl1T 786, 1028, 1042;
C9T 792; NS-o 378; NS3hb
myopathy of
labrador
retrievers
CSdog
Difficult swallowing (1st sign) dysphagia
Stiff galt, cervical rigidity
Stunting
Weakness
Muscular atrophy 01 most muscles
Hypertrophy hamstrings & tongue
Lumbar kyphosis (hunchback)
Motor unit
CS: DHficult swallowing
Tx: NoTx
CScat
Cervical rigidity
Adduction of hocks
_-'-- -,. Symmetricat enlargement of muscles
Lumbar kyphosis
Peculiar hunched gait
Reduced cardiac contractility & blventrlcular enlargement
Extremely rare
Onset: < 5 months old, labrador
DefiCiency 0ltype2 (fast-twitch/white) muscle
fibers & predOminance of type 1 fibers
Autosomal recessive trait
Mechanism: unknown
,_.1..._______
NS-HB256;
NS-0378
Hx (male, breed).
None available
-SeI_YO b'''d;/~
1ifI
Prognosis;
Poor: dlz
jf;'~11
\ ;<;::). (
(!.(!I I
"'-
Valium
_~:::::~:::,:;:,::" I"'JlBlik~',:G)
~;~:;'bm"'"
decremental)
Nutritional myoo'egeneration
Congenital myotonia
hyperthermia
(~
No known treatment
~~--~~==~~~~=-----~~~~--~~~----
Malig nant
~r- f
wi motUrity'
'f/
n'~~~~-------------
It'""'.to""
1:
H3B8S3;SAPI174;NS-W201,NS3hb
~NrnS~;_~;L~ Ne64:~ :~ ~:~:;: ~N~S: ~ : ;~Ii~ ~ ~ ~ ~ ~ ~]I~ ~ I ~ ~ ~ ~ ~ y:.a~,~0~ ~"~.a~ t~m~9~'~'~W~'~S;~ '~ ~m~ ~d~'~o~"~"~m~ba~,~p;.~,~ ~ ~ ~ : : ~ _-:-:-:-:-~ ~ "i.'l"i'Jr,,;> _-, muscle biopsy,
, for
Breeds:
Chows, Staffordshire bull terriers.
M8k905; E-hb331; SAP 1174;
Labs, West Highland white terrier, Samoyed
12M 1064; 1M 807; H2B 904;
5mln 661; NS3hb 262, 259; Autosomat recessive in chow
Pathophysiology: hyperexcitable muscle memNS-WI99; N~b.B7;
brane
,.-,,~.r,-'
2-6 months when first walking
Hereditary myotonia,
Myotonia congenita
NS03:"
._".:
Feline idiopathic
polymyositis,
Hypokalemic
polymyopathy
inflammatory myopathy
Polymyositis: reported In a few cats (1-13
years Old)
Hypokalemic: dogs & cats of all breeds
- Young Amer. pit bull
- Chronic renal lallure & those consuming
acidifying diets, Pu/PD 2 to hyperthyroidism & anorexic cats at more risk
Cause: unknown, viral?
-Immunological? response to steroids?
- Not clear il 2 syndromes or just one? Both
show same signs & are treated the same
Clinical features mimic mild thiamine defi-
thiamine deficiency
r;!/
Hx (breed), CS
Physical exam
Neuro: normal proprioception & mentation
Lab:
- CK &: AST elevated (muscle necrosis)
o EMG: Continuous insertional activity; bizarre high-frequency discharges - wax &
wane (dive bomber) - confirm Ox
'Myotonicdimple: local percussion ormanual
indentation results in furrow that persists for
31)..40 seconds
Muscle biopsy: rarely diagnostic alone
Hx (bite, Sx), CS
Antibiotics (C&S)
p,~~
Wounds
CS: Inflamed wound
Hx (bite, Sx), CS, C&S
lx: ABs
- Pronounced ventral flexion 01 neck
- Scapular protrusion (weakness)
- Exertlonal weakness, reluctance to walk
oHx,CS
PhyslcaJ/neuro exam
_Thoracic limbs weaker than P limbs
Laboratory
- Inability to Jump
1 ' \CBC (complete blood count) & Chem
Stilled, stiff front 11mb ga~ wI
- t CKlCPK(creatinlnephosphOklnase,250adduction of legs when walking ~
10,000 IU/dl normal 26-145 IUldl) & t
Muscle pain, Muscle atrophy
J,~
AST & aldolase (normal 5-17 IUldl), LDH
Anorexia, weight loss
~ I
_ Hypokalemia (serum potassium) <35
ungroomed hair coat
mEq/I
tv--' j - 70% of potymyositis cats " all of hy Sequela
I
u,....-;o:
pokalemic ones
DDx:
lectromyography muilifocal abnormalities,
Hypokalemic polymyopathy
bizarre high frequency waves, positive waves
Myasthenia gravis
Muscular biOPSY - definitive
Bilateral vestibular diz
- Polymyositis: lymphocyte inllammation &
Thiamine deficiencies
fibrosis, muscle necrosis
Inflammatory myopathies
- Hypokalemic polymyopathy: no histologi Thyrotoxicosis
cal lesions
Thiamine
Correct hypokalemia: potassium gluconste
elixir PO; parenteral potassium lor severe
weakness
Dopamine infusion IV in life threatening collapse
Spontaneous remission common - 30% 01
OlD
~~S
Steroid
Monitor potassium periodically
1-'
Potassium'
gluconate
elixir
Prognosis:
Good il remission
-------- ---
Muscle
NEUROMUSCULAR SYSTEM
Condition
Facts
~
I
&
* .
(Toxoplasma,
Hx (breed), CS
Do not breed
myositis
E-hb 192; H2B 910; 1M 806;
SAP 1175; NS-HB 192; NS-L
84; NS-O 383
?SteroiCls?
PrognOSiS:?????
~~
01
induced
Gangrene,
Myonecrosis
PaS 26, Ehb 329?
Muscle
2~1
Rare
Progressive painful, swollen weakness Hx, CS; Lab: t CK & AST & liver enzymes Clindamycln
- alanine aminotransferase
Toxoplasma gondii in dogs & cats, prOiozoa Atrophy of muscles
Sulfasalazlne & pyrimethamine
Generalized myositis
~. ProgreSSive rear limb weakness & rigid EMG: spontaneous activity
Most common in puppies wi or~ j! "> _
hyperextension in young
Toxoplasma titers
wlo meningitis or myelitis
. _~5
Rapidly progressive flaccid paralysis wi MuSCle biopsy - definitive
- Cystic lesions of tachyzoltes
hyporeflexia (LMN) - adults
Associated wi mmunosuppression
- Necrosis wI mixed Inflammatory infiltrate
in older dogs
CNS:seizures,stupor,coma,opticneuritis
CSF: mixed pleocytosis, high protein content
- Concurrent canine distemper infection
& ocular changes
- Exogenous sterolds"~C~h~'~m~o~Ih~,~,"",,U~I~;C-:-_ _ _--:::-:_ _ _ _--::-:-_ _-,-_ _ _~--_ _ _ _~--...J..:..:.:""-=":'-":~---::-'''-:-:-'.Illl1..,
:-_--,--,--,___
rG
r ed
-, T
~~,~~:"~.~;n
Neospora)
Treatment
Diagnosis
Presentation/CS
Familial
canine
dermatomyositis
Protozoal
& Cause
f~II \~~~ ~,
ill
~,~
-ti-
Necrotic tissue Invaded by air-bOm saprophytiC & usually putrefactive bacteria (gas bubbles If bacterial form gas)
- Moist gangrene: swollen, soft, pulpy & usually dark in color, putrefactive odor (common)
- Dry gangrene shrivelled & leather-llke usually of light color; Une of demarcation: separation of gangrene from adioining
tissue: swollen, reddiSh or bluish zone of hyperemia & Inflammation
- Sapremia: condition where saprophytic bacteria, that usually live only in dead organic matter, can survive In blood
Causes: necrosis & exposure to air born bacteria
Tx: Stop spread of necrosis, Amputating if sapremia eminent
t
Fitch. Cant. Ed 19(8)1997 pg
947; E-hb 331; H3B849, 857;
H2B910; Cat 1575; NS-0384;
Sx-5-hb 643; Sx-S 1996; Sxww 308
tnt
f
- Strain: very common, tearing to complete rupture, most commonly to musculotendinous junction
, Tx: Ice packs 1st 24 hours, Warm compresses after 24 hours, compressive wraps, antiinflammatories,
".
*** "':I;~-
1&
7l
dog'. RB : g~~~~:a~,:~~;' flexion & extension of joints. compare to opposite side if unilateral). Rads to rule out bone disorders
\.,
I
~ ,CS: Gait abnormalities: Infraspinatus (atrophy of muscle, outward rotation, elbow adduction, abduction of forepaw w carpal ''flip''),
quadriceps (from femoral fx, markrd extension of stifle), gracilis rupture (jerky gait - shortened stride wI external rotation of tarsus, medial
rotation
~
rotation of stifle); semitendinosus ribriotic myopathy (rotation - hock out, stifle in; backward slap of paw at end
of stride)
, Tx: Time,
surgical free up muscle & relieving adhesions may help. Quadriceps: maintain flexion
gait abnormalities, recurrence after surgery common
of stifle
Ox:
CK
wI 90-90 flexion
(j)
\
(?)
splint
~~(.
\
I
.
[.
\~
...,
Exertional
myopathy,
DO"
Monday morning diz in greyhounds
Tx: Baths, Rest
& massage
Hx (greyhound racer), CS
Lab:
Hemoglobinemia
MyoglobInuria
-- tt Muscle
Potassium & PhOSPhOru~
enzymes
....
_.-
596
Acromion fractures 625
Adequan 598
Apodia 635
Arthritis 598, 599, 600, 601,
602
Avascular necrosis 641
Bicipital tenosynovitis 624
Blastomyces dermatitidis 609
Bone cysts 612
Bone infection 609
Bony callus 616
Borreliosis 602
Breeds - predilections 649
Carpal problems 634
Chondrodystrophy 603
Chondrosarcoma 606, 608
Collateral ligament 646
Coxofemoral luxation 640
Cranial cruciate ligament 645
Craniomandibular osteopathy 612
Cruciate ligament rupture 645
Degenerative joint disease 598
Delayed union 621
Dewclaw removal 635
Dislocation 605
DJD 598
Dyschondroplasia 604, 626,
628, 642, 649
Elbow joint fractures 630
Enostosis 611
Erosive immune mediated joint
disease 600
Factory 8 deficiency 603
Feline chronic progressive
polyarthritis 600
Femoral fractures 643
Fibrosarcoma 602, 608
Fracture disease 617
Fragmented medial coronoid
process 629
Fungal bone infection 609
Greenstick 615
Growth deformities of radius &
ulna 633
Hemangiosarcoma 608
Hemarthrosis 603
Hemophilia A 603
Hip luxation 640
Hip dysplasia 638
HO 610
Humeral fractures 627
Hypertrophic pulmonary
osteoarthropathy 610
Hypervitaminosis A 603
Hypervitaminosis D 613
IdiopathiC polyarthritis 601
Infectious arthritis 599
Ischemic femoral head
necrosis 641
Jaw locking 623
Joint disease - septic 599
Joint trauma 605
Legg Perthes disease 641
Liposarcoma 602
Lobster claw 635
Luxation 605
carpal joint 634
coxofemoral 640
elbow Joint 632
hip luxation 640
mandibular 623
patellar 644
proximal intertarsal 648
sacroiliac 637
tarsal 648
TMJ jOint 623
Lyme disease 602
Malunion 620
Mandibular problems 623
Marie's disease 610
Meniscal problems 646
Metaphyseal osteopathy 610
Multiple cartilaginous
exostosis 611
Multiple myeloma 608
Muscular problems 584-595
Myopathies 584-595
Myasthenia gravis 586
Neoplasia
bone 606
chondrosarcoma 606, 608
fibrosarcoma 608
hemangiosarcoma 608
multiple myeloma 608
osteosarcoma 606, 607
plasma cell myeloma 608
synovial cell sarcoma 602
synovioma 602
Nonerrosive polyarthritis 601
Skeletal System
Nonunion 621
OC 604, 628, 642, 646, 649
OCD 604, 626, 628, 642, 646
Old age laxity of carpus 634
Onychectomy 635
Open fracture 618
Osteitis 609
Osteoarthritis 598
Osteoarthropathy 598
Osteoarthrosis 598
Osteochondritis 626
Osteochondritis juvenilis 641
Osteochondroma 611
Osteochondrosis 604, 626,
628, 642, 646, 649
common sites 604, 626,
628, 642, 646, 649
elbow 628
femoral head 642
shoulder 626
stifle 646
tarsal 649
Osteomalacia 613
Osteomyelitis 609
Osteopenia 613
Osteoporosis 613
Osteosarcoma 606, 607
Ostreochondritis juvenilis 641
Panosteilis 611
Patellar luxation 644
Pelvic fractures 636
Periosteal proliferative 600
Plasma cell myeloma 608
Polyarthritis 600, 601
Polydactyly 635
Pulmonary osteoarthropathy
610
Puppy carpal weakness 634
Radial & ulnar dysplasia 633
Reiter's disease 600
Retained enchondral cartilage
cores 630
Rheumatoid arthritis 600
Rickets 613
597
-
--
-------
598
Condition
Degenerative
joint diz,
DJD,
Arthritis,
Osteoarthritis,
Osteoarthrosis,
Osteoarthropathy
SAP 1101; H3B 819; H2B
869; 12M 1078; E-hb 74t,
738; 5min 364; IM-WW
439,441; CI2T 1196; SxWW238; Sx-S-hb618;SxS 1921; Sx-OP 176; SxOD27;X-TI71;Pa-T455,
453;
****
Facts/Cause
Presentation/CS
Progressive deterioration of
articular cartilage
- WI variable degrees of periarticular remodeling
- Synovitis first which results in
progressive degradation of cartllage
#1 joint disorder in dogs, rare
in cats
Common joints
Lameness
- EpisodiC
- May warm out of lameness wI
light exercise
- Strenuous exercise t severity
Stiffness, made worse by inactivity(Sleeplng orcage confinement)
Pain
Heat
Joint effusion
- Hip (dysplasia)
Slow progressive Hx
- Elbow jOint
- Stifle joint
- Shoulder joint
c...-------------
~
')
Malarticulations
Treatment
A~'
-tVolume(10-20x)
ht t
t'
- Ig
pro elns
- Cells < 3000/~I, rarefy above 500
.70-80% I phocytes 5% PMNs
sr
~
'...
-+VIscoslty
(hyaluroniC aCid - diluted
Septic arthritis
hit (
I f . I)
y::::::>
Immune-mediatedjointdiz Neoplasia
tl
wi trauma)
Postmortem:
- Cartilage loses luster yellow & soft
W . h d .
. Fibrillation (blistering), Thinning, Micro
- elg t re uctlon
fxs, Erosions
- Moderate & consistent exercise
. Cartilage fragments (detritus) into
. Swimming (nonweight bearing)
synovial fluid
Prevention:
- Synovia (inflamed): thickened, red or yel- Early diagnosis & treatment
DDx:
low tinged
Trauma L _ _-"-_ _- , r;;---.---',' Adequan may allow healing of cartilage
"
Trauma
- Joint instability (hip dysplasia
- Fxs, articular step defects
- Luxations
y~
I
_
AS
' I fl 'd J
ynov,a UI:
Diagnosis
Hx, CS, PE
~~
.. '
DJD wI radiographic changes:
Manipulation of jOint. L \
incurable, irreversible changes
~ Pain
Goal: reduce pain, slow
~;o,...
~-".\../
I
<I:#~
(~Jj )
0-'
Joint
effusion
.3.
Drainage mandatory if severe
Pathophysiology,
Infectious
Synovial fluid collection be_ Open drainage - arthrotomy. debride &
Rapid cartilage damage due Heat
arthritis,
fore ASs!
lavage: II fibrin oCCludes needles
to release of enzymes, hi Periarticular swelling
cellulitis (edema to fibrosis)
- C&S (culture & sensltivity) (aerObic &
Bacterial
Synovectomy (culture)
WBCs, fibrin & bacteria
Systemic signs: fever,
anaerobic)
Sterile bandages
arthritis
Invasion of bacteria - inflammation
Leave open: 'ingreSS-egress' drainage catl1eter most
Culture blood, urine or synovial memdepression, anorexia,
PMNs & fibrin, enzymes & proteinaHB3 820; H2B 870; E-hb
brane bioPSY
effective
.
739;5min36S',12M 1078',
ceousdebris
lymphadenopathy
_
Needle distention-irrigation: alternate infusion & aspiration
- Gram stain
Pannus (granulation tissue overgrowth
tM_WW444;C12Tlln;
through needle or catheter: least effective
Progresses
rapidly
of cartilage surface)
,WBCs 40,OOO2BO,OOO/~L
E 2362, Cat 608: Sx-S Rest cartilage
Open drainage
Loss of GAGs (protects cartilage)
hb 565; Sx-S 1690; Sx(mm')
Passive exercise (15 min BID) or swimming (20 min SID)
WW 242; Sx-OP 188;
- If draining, often not sore
PMNs
>
90%
suggestive
10-14 days
Sx-OO 29; X-T 178
Cause - Septic arthritis
(pressure of distension causes
Total Protein <! 4 gldl
Maintains good range of motion
pain)
Trauma: Penetrating wound bite
_Leash walk for 3-4 months for cartilage to strengthen
Low viscosity, turbidity, increased total
Extension from adjacent tissue,
volume, often bloody
NSAIDs for pain (buffered aspirin, PBZ)
_Complications:
. Bacterial or fungi (-) doesn't rule out
especially fungal (uncommon)
Corticosteroids contraindicated If infection
Rickettsial or mycoplasmal Infections
- Recurrence
_ Positive bacterial culture
Surgery for chronic case
~ Rocky mountain spotted fever
- DJD
diagnostic
_ Arthrodesis, excision arthroplasty, or ampu- Ehrlichiosis
_ Ankylosis
-lab: .. PCV & t WBCs, PMNs & TP
tation if joint destroyed & source of uncontrol Viral diz rare
_ Persistent pain
Radiology essential for base line
_Lyme diz (bOrreliosls)
lable pain
Ea~y:
Hematogenous
No bony changes
_Umbilical infection
- Pneumonia
Soft tissue swelling & widen_ Urinary tract infection
ing of joint space (variable)
- Endocarditis
_Dermatitis
~
- Definitive radiographic Ox
Otitis externa
after irreversible damage
- Periodontal diz
Periosteal proliferation
-_Prostatitis
DiSCOSpondylitis
DOx: Widening of jointspace (weight
SeptiC
arthritis,
Shifting lameness, 1 or
more joints
_Especially carpus & tarsus
**
~
J ~::::C"" ,0
~
Iatrogenic
-Joint injection (steroids)
- Joint Sx (20%)
~
I
Acute trauma
.DJD
~ .OCD
r~:~:--::-~t::=======:; tE',
Jo,'nt infection
. Immune-mediated arthritis
~
bearingorstressrads){Cartltagedamage)
I
Irregular subchondral bone or loss w
signs of osteomyelitis
Cystic subchondral radlolucenciesw/scleroslsaround{mottl-eaten)
.Synovialmembranebiopsy:C&S,histo
Search forseplicslte
,
."
- Rads of thorax, abd ome, 'pI
~:_~:.r~
G
ddt0 good ",
Prognosis: uar e
'-V
Good for survival
- F"nction: depends on severity of damage
...
c..) ~:-'11
}~r
==:::,=
-t~~~~!!t-~UI~"~"'~""~'d~I~U~S~1~",~a~rt_____L~t~o!a~rt;~,"~a~,~",:.:,:a~g,::....--_---.....
../
!..1"j
~
---------------------
'1
Erosive
polyarthritis,
Rheumatoid arthritis,
Erosive immunemediated jOint diz
HB3822;H28872: SAPll04: 12M
1085; IMWW446: 5mln960: CI2T
I I 88; E2313:T 130; Ehb 741: Sx189; SxOl230
-=
Immune-mediated
Periosteal
proliferative form,
Reiter's diz
H2B 873: 12M 1087; Ehb 741;
5min 960, IMWW447; E2368; X
T 180
Aspirin (pain)
,,00."-,0-'-, -
Trauma
Feline chronic
progressive
polyarthritis;
Hx,CS
Positive rheumatoid test
Joint lIuld analysis -In"am~atlon,
but doesn't RIO Infection
Poor mucin clot
j
- waCs t (3-30,0001)11)
- Nonregenerattve PMNs 2095%
Synovial biopsy:
C"""#f1lI
Sequela:
- Convoluted villous folds
- Luxation/subluxation
-,:,,""'.", thickened synovial lining
Angular limb deformities
- Necrotic foci
- Plasma cell & lymPhocytli
OOx:
infiltrate
Systemic lupus erythematosus
Radiology erosive
(test lor anUnuclear antibody)
- Synovial effuSion
Other infectious arthritides
- Subchondral bone destruction/cyst
OJD
fonnation: "punched out" appearance
Traumatic arthrilis
- Pericondylar osteolysis & erosion
Septic arthritis
- Narrowing of joint space
Idiopathic arth ntis In Gr9}'tloUnds
- "MUShrooming" of ends or metacarpi &
Juvenile polyarthritis in Akitas
metatarsi (collapse of subchondral bone)
Trimethoprim sutlas in RottweHers &
Joint luxation
Lameness (shifting leg)
Morning stiffness
Pain in 1 or mora joints
Joint swelling (soft tissue or fluid)
e~~
r--
\ ~~
_~_~~~-A
'''''-.::.3)
OX: Hx,
Hypertrophic osteopathy
Degenerative joint diz
" Septic arthritis
"traumatic arthritis
" Rheumatoid arthritis
Nonerosive arthritis
Laboratory:
Leukocytosis (PMNs)
t FibrinOgen, (Slighlly to
moderately)
FeLV poSlttve (5070%)
Steroid, Immune Rx
JIlL,
Aurothioglucose
- Stopped 1 month after normal Joint tap
- Weekly CBCs - stop if WBCs < 4000/)11
Periodic joint taps to monitor response
Supportive care:
I
- Body weight reduction
- Ughtto moderate exerciSe,.
,
tit?
AS~n
'<d 5te!l
~ ~
Prognosis: Poor: conSidered incurable &
relatively unresponSive to Tx: some mJ
respond temporarily, most don't
&I
dJi!
::'j
Aspirin (pain)
Steroid (prednisolone or
'
prednisolone) given il'ldefinltely
: '
Cytotoxic drugs:
I '
Cycrophosphamlde: urinalysis ~
stop If hemormaglc cystitis
Azathioprine (Imuraf'l!)) or 6
mercaptopurine (PurinethOl)
Cytotoxic drugs stopped 1 month after
nonnal joint tap
Weekly CBCs stop if WBCs <4000 1)11
Not Gold salls in cats: toxic
Periodic joint taps to monitor response
"Monitorfor clinical manifestation of FeLV
Euthanlze When poor quality of Ille
Hx, CS
E
I
Arthrocentesis
wac 4-70,000/)11 wI 25-99%
nondegeneralive PMNs
Fluid cloudy & yellow tinged
Radiology
Periarticular soft tissue swelling
- Periosteal new bone
Osteophyte bridging of joints
Coarsening of trabecular pattem
- Narrowed joint spaces (lysis)
Immunologic tests: negative
Rheumatoid factor test negative
---D-D'--~
topurine (Punnethol)
- Gold salts for persistent inflammation,
ty'"
~~y~s~t~e~nn~i~c~'~U-P--U-S---'~'~R~'~~=I.~,=.=~~~...
~~m~dog~'=O='=~=b=------'='W:=.,=1~0.~.=,,~"='"=.=,=0=u~==.=o==~0-------'7.~~~IO~I."'~~."'I.~.="=os~'='~~'S~L~Ec-------TO'=R=.m==ovo~~=Cu=..=.'vo=:.=.==ont-------
:f
Idiopathic
polyarthritis,
Uncommon
Nonerrosive
polyarthritis
**
yarthritis, peak
of
tEl'
Lameness, swollen
?~~~
V,J--_
_ _ _ _..L-----, DJD
Ir1mune, Nonerosive - #1 Polyarthritis
Infection arthritis
CS: Cyclic fever, Lameness
Rheumatoid arthritis
cs
nondegeneratlve PMNs
wac
(>80%)
pol-
Hx (history),
Synovial fluid: thin, t
(4,000-100,000) wI predominanlly
<l!:;oVPJ":a ~
painful joints
"Walking on eggshells": short
strides
Usually multiple joints (particularly small distal joints)
JJ
~O~~h .~:;o;:!~:~e~:!~~::~~!~~i~~s:
than ANA
. RF (meumatoid factor test)
.....
. Direct Immunofluorescence""
s~~g~~hrOpathy
\'ft
nonerosive polyarthritiS
M~j:o:~~~
~~t~
I,,"i~') 7~ ~
ster.o,' i,dO
DJ
mediated diz
ANA ~ rheumatoid factor
negatlv~e v'~,L',
~"'"' ~<'~'" ~:\""'.,
u
- ,
t.:eI
--
------
&Tx
Lymediz,
Borrelliosis
Multisystems
- Lameness
Recurrent, intennittent
nonerosive polyarthritis
- Fever
fld
- Lymphadenopathy
-Anorexia
documented in cals
I\
- Cardiac abnormalities
)1
\/~,
(\ ~
."-~
Kidney diz CS
Cardiac abnormalities
sarcoma,
Synovioma
HB3824; H2B875; E-hb 737; Smin
1091; E2052; SAP 201; Cat 1619;
TetraCYcli~~
~,
Prevention
Reduce tick exposure
Ascaricide sprays & daily tick removal
, Tick need to feed for 24 hours for
infection
Vaccine - efficacy not proven, but affects
Multisystems, Geographic
Asymptomatic, Multisystems (lameness, fever, lymphadenopathy)
Hx, CS, Synovial fluid & Tx
ABs (Tetracycline) Px: Good
#1 primary joint tumor
Tumor of synOVial cells
Rare: dog, 6B yrold (2-14); extremely rare: cat
Usually involves a major Joint: stifle or elbow
Aggressively & highly destructive to bone
- Crosses ioint (bone tumors do not)
- Metastasize to lungs (up to 50%)
,",o'ogl, ""'",'''",00
W'
~
Lameness
Pain
Radiology:
Initially soft tissue mass near joint
Galcified (Hazy & punctuated or linear
streaks)
Crosses joint (bone tumors do not)
Liposarcoma
SvnOl/ial chondrosarcoma
Lameness, Rads, Amputation
,....--------------------------------~.~
Hemophilia A,
Factory 8 deficiency,
Hemarthrosis
EHB 716, 718t; E23S9; H2B 769;
772; SAP 164; 5min64; CI2T 461t
Hx, CS
Laboratory: +PTT/ACT
Abnormal toe nail bleeding lime
Synovial fluid aspiration
Frank blood during hemorrhage,
xanthochromic wI t macrophages at
other times
Radiology:
Joint space (thinne<l cartilage)
Irregular subchondral bone
-OJD
Oefinltlvedlagnosis: LowFVIII:C actlvtty
boo.
Largerwaight bearing joints more likely to be
involved (elbow & stifle)
Larger active dogs more prone than sma\ler
~ --,
less active
Transfusion, Nursing
etc.)
& joints
History (cat), CS
Check diet for excess Vit A
Radiology:
- Bridging exostosiS of cervical vertebrae
C1T2
New bone formation on bone metaphysis of surrounding joints
Periarticular ankyloSis of limb joints
(elbOw)
~.,-"'-, ,. Frequently misdiagnosed as DJD
Lethargy, anorexia
Sit in marsupial-like position with front feet
raised
-Lameness
Cutaneous hyper or hyposensitivity
Neck or joint stiffness
Failure in endochondral
ossification
#1 shoulder joint (also elbow,
Osteochondrosis,
Dyschondroplasia,
Variable lameness
- 51 % bilateral
OeD,
Osteochondrosis
dissecans
Sequelae:
- Genetics
- Mineral imbalances
- Low copper diet +incidence
- Hormonal imbalances
-DJD
**-***
years
._Trauma
Deepest may
cartilage
cells
die
cause
dissecting
flap &
El
-:-------'--~
IIrtSteOci;o;idr.OSis=.iis.ec;;;;;~------- .DDx
Septic arthritis
0 t
S eoc on
OsteomyelitiS
Bona abscess
1IF~r~a~g~m~e~n~t~ca~n~c~a~IC~ify~&J~o~r~b~re~a~k~O~ff~-="~io~in~t~m~o~u~se~'~'~~-~n~u,~bo:'~'~C'~'~I
I
II
\\~\
\
PrognosIs:
Cartilage delects
Young, Fast growing, Large breed males
CS: Lameness, Swelling, Atrophy
Ox: Palpation, Rads
Tx:
Sx Px: Good
...-......
~~." ~
anatomical sites
El
-......
,~,---------------------------~1
'\ -
Articular
fractures,
Joint trauma
H2B87S,Sx-OP187,21S
**~*
Palpation
3-legged la~me
AVOid nerve blocks & exercise
Swelling
) ~" Radiology
- 2 radiographs at right angles
Sequela:
(craniocaudal & laleral)
_ Obliques added, esp. il chip or
Immature animals physeal fxs
- DJD
(Salter 3 or 4)
- Premature closure of phyavulSion Ixs
Must be correctly Dxlorsurglcal reduction
SIS after Salter Ix correction (wAn
,\ .
2-3wks)
***
~~
"'fJW
r~rJtzz:6~~
>
(9
Time
Ice: ,reduce swelling
Aspirin pam relief
Rest
'"
_ .
-~
Aspirin
"
a
j",
Stretching or tearing
CS: Asymptomatic to lame
Luxation
\.
y.
Prognosis:
Good il anatomical reduction, delays mprognoSis
Segment shorten
Sprain
\l;;:::
PrognosIs:
Good to excellent
-:.:::::.
Subluxation:
partial
dislocaLocations
radiographically
- Immobilization of joint for 1-4 weeks de(dislocation) &
tion of a joint
Carpal pg 634
Subluxation: more difficult to Dx
pending on instability
subluxation Lass 01 integrity 01 one or more ligaments
E_hb737",HB3827",H2B861",
Elb
632
- Radiology: weight-bearing, Surgical repair of torn ligaments
863t, 877t; E 2049; Sx-OL - Avulsion Ixs of ligament attachments
: HiPo~4gg
simulated weight-bearing or
143:Sx-S-hb574,404,609;
stress views
S'-WW251.~
S'86'-OP
***
.-L-----------'---,
.~complete
or partial dislocation
n. r
A
Shoulder 624
Slifle pg 644
Tarsus pg 648
TMJ pg 623
(flexed
or
extended
positions)
Q~
l('
~
_ _ _ _ _~~T~x~:~R~e~d~u~~~t~-o~n~&~im~m~o~b~il~iza==ti~o~n~_ _ _ _ _~16~O~5~------
e-=
--
/'//
CC t
'S ~
_=_+~pr~o~gn~o~s-'s---------
- bone
E-hb 746: SAP 972,
1068: H3S 840: H2S
893; 5min 892; 12M
1145;E2097:Cat1623:
Sx-ww 225: Pa-T 447
Acanthomatous epulis
Bone scintigraphy
Classification of bone neoplasia
- Combine wI surgical excision
- Synchronous 1 bone tumors 10%)
Primary tumors:
Metastasis
- Monitor reds of local bone lesion & thorax
- Osteosarcoma #1 - 80% dog & cat
Biopsy: required for definitive Ox Hyperthermia: experimental
- Chondrosarcoma: 10% In dog, rare in cat
- Wedge or trephine
Euthanasia
- Fibrosarcoma
- Matrix type
-==C""=~
, Fibrous: osteosarcoma, chondrosarcoma,
- Hemangiosarcoma
fibrosarcoma
**
Pain, paresis
Altered function
Palpable mass
Lameness: mild to 3-legged lame
Localizing signs
Nasal discharge
Cranial nerve deficits
- Nerve root Signature
Tx:
Osteosarcoma
#1 bone tumor: dog (80-90%) &
**- ***
~ Cis:lat~
of life
Prognosis:
Surgical: palliative only: 1 0 neoplasia (osteosarcoma, hemangiosarcoma, metastatic
tumors, nonosseous invasiva neoplasia (malignant melanoma)
Lameness
Swelling
Fever & anorexia
Severe muscle atrophy
Respiratory compromise
~,
~~~I
~W'l~
seq~elae: c1f~
Hx, CS; PE
Radiology:
- Sclerosis & punctate lytic areas
- Periosteal proliferation (95%) - rough
& irregularly
. Sunburst periosteal reaction (33%)
- Metaphyseal region of long bones
- PathologiC fractures
- Subtle or explosive
Y"""'''''=='=''
Chest
rads
for
metastasis
(Osteomyelitis
Common sites
- Fibrosarcoma
doesn't metastasize), 3 views (At & Lt lateral &
> 80% appendicular
- Chondrosarcoma
VD)
~
- Hemangiosarcoma
- #1 Distal radius
Osteomyelitis
- Proximal humerus
- Mib places beSides metaphysis
- Proximal or distal tibia
Appearance similar
- Hx of direct contamination (Sx or trauma)
- Proximal or distal femur
- Draining tract
Distal ulna (dog) only site that
Doesn1 metastasize (X-ray chest)
- Grows slowly (re-rad In 2-3 wks)
_Crosses joints, tumors don1 usually
ay'
Mycotic osteomyelitis
_ Hematogenous- multiple sites
Metaphyseal region frequently
- Mf look radiographically like tumor
- Culture, Biopsy
~,
.'"
- Aggressive lesion
May look radiographically like tumor
- Biopsy
Sequela:
Metastasis to lungs
- Dog: ribs, nasal cavity, pelvis
(10%)
-Cat scapula, vertebrae, tibia, mandible
Good to
Fibrosarcoma
Surgical removal
i excision
Nasal chondrosarcoma:
radiotherapy wI or wlo surgery
6 yr (1-12 yr), medium & large breeds; Male,. female; Location: metaphyseal area of long bones (dis!. femur),
periosteal tumors - mandible or maxilla, Produces collagenous matrix but no neoplastic cartilage or bone; Slow rate of growth
E-hb 747; H3~B940: CS: Lameness, Swelling
H2~ 893; SAP 972;
Ox: Hx (age, breed, sex, site, dura~on, surgery); Rads: not definitive Ox (Similar to osteosarcoma" chondrosarcoma, imposSible to
5mln 599;
differentiate between 1" & metastatic tumors, periosteal proliferation eariy, erosions adjacent to tumor follows, soft tissue sweJling; Biopsy:
SX-W\N 226;
required for definitive Ox (matrix type: fibrous: osteosarcoma, chondrosarcoma, fibrosarcoma; Ox of fibrosarcoma or chondrosarcoma are
Pa-T 446
viewed wI suspicions for possible osteosarcoma
~-.,=====_
\\
II
Hemangiosarcoma Rsre, Dog' 7 yr; Medium & large breeds (G shepherd), Cat extremely rare,
C:=:;;3?:~0G2:=~S;;::;=~::::7~:;:>
LocatiOll prox & dlst one-third of long bones, pelvis, stemum, maxilla, Most disseminated by blood by time of Ox
~
E-hb 747, H38 8 4 0 ' s W CS: Lameness, Sequela pathologic fxs at site c o m m o n @ ,
H2B 893, 5mln 644,
~. Ox: Hx (age, breed, sex, Site, duration, surgery), Rads not definitive Ox, extenSive osteolYSIs. mottled -moth eaten" appearance, ~'
12M 1143,
((
confined to medullary cavity usually, pathologic fxs; Biopsy: definitive, Metastallc check thoraCIC rads & abdominal ultrasound
SX-W\N 227
Tx: Wide surgical eXCision, Adluvant chemotherapy (doxorubiCin, vlncnstine & cyclophosphamide), Euthanasia
Px Extremely poor
Multiple myeloma
Plasma cell myeloma
CS' Bone pain, pathologicaf fxs, neuropathy, Hemorrhage, anemia, Fever; Multiple organ failure (renal) lJrU'-IV-V'"
Ox CS, Plasma call infiltration of bone marrow + one of Bence-Jones proteinuria (not commonly done), osteOlYSIS, monoclonal proteins
Tx Combination cherno (melphalan, cyclophosphamide, prednisolone), SUpportive care, MonItor
I.
Px Guarded wI proper management, can result In spinal txs, paralySIS or nontreatable pain
~
*.
Osteomyelitis,
Bone infection,
Osteitis
t:s-"
r Inflammation or infection of
bone
- Bacteria; commonly consid-
-Pyrexia(fever),depres-
_ PathologiC fractures
_ Subtle or explosive
- Lymphadenopathy
- Muscle atrophy
tsr' -
... \
"
~~~'~~~~ft~~:ue
---'--:----,
DDx:
NeoplaSia (metastaSiS)
~(
~ ,
~'.
S'=:7
~
II
Ch
~='T';::;FT
..
_
~
m
Acute osteomyelitis
- ABs may be enough early
. Start on Cephalexin (KefleX)whllewaltlng 10rC&S
- Surgical if no clinical improvement in 72 hours,;1
abscess or forei9n body present
Dependent drainage C
r///
5-:::::7
Oebnde wound
Evaluate fx fIxation & add cancellous
bone graft, re-stabllize rf necessary
~
ASS 30-60 days
Chronic osteomyelitis
of
fracture stability
~~
, If unstable - stabilize
' I
t Loose
implants
remove seques rum
Benign bone cyst
s, urglca
Px: Guarded
* . ***
soft
mor
-Appearancesimilartoidentical to osteosarcoma
Fungal bone
infection
- Wound dehiscence
Chronic:
-Often previously treated
tissue infection
~ Rarely hematogenous spread
Acute:
- Pain, local swelling,
hyperemia
sion, anorexia
AB
***?
Tx:
///t
I" 10
H3B 835; H28 887; SAP 1091; Ehb 747; Smln 890; 12M 1260; C12T
1200; Cat 1640; Sx-WW 223; SxS-hb 562; Sx-S 1685; Sx4B 897;
Sx38906; Sx-OP 163; X4T 154; XRP 16; Sx-OD 14; Sx-OL 11; Pa-T
441
.---- '-~~
~~
.lS=2CJ
See Systemic diseases pg 702: Fungi, GeographiC locations for each affects incidence
, ,
_
,
- Coccidioides Immitis: disseminate fonn, #1 Ox, CS: lameness, painful swelling of long bones or JOInts (50%), draining tracts, weight loss, f~er, lethargy" other organ CS
- Blastomyces dermatitidis: systemic fungal Infection that disseminates to eyes, skin, bones & oth,er organs, CS: depends on organs; nonspeCIfic: fever, weight loss, cachelda,
inappetence & depression (50"10 of cases), P1Jlmonary CS In 86%, Osteomyelitis: periosteal r,eaction & soft tissue swellln9
_ Histoplasma capsuiatum: respiratory or GI, disseminated to liver, adrenals, spleen, CNS, skin & bone
_ C,>,ptDcoccu. "",,'onna.., A.".""flu.
fumi_.
.. .
CS: Depends on route of entry, localization or dissemination: asymptomatiC, acute sign of localized dlz, chroniC signs: chest. multiple organ systems
,
__
Tx: Ketoconazole (Histoplasmosis - TOG), Amphotericin e, F1ucytosine (Aspergillosis); Combo of flucyt~lne" amphotenCln B (Cryptococcosls);
"
Combo amphol.,','n B keto,o"",ol. (Bla~om_isl:
(alii: Rocon...'. (C~pto,o"o.sl
__
Px: Good to poor depending on seventy & response to meds
~_.1
_ __
Ox: Hx, biopsy, cytology, culture
01
"",,0..,0'.
609
'-
Diagnosis
FactslCause
Condition
Hypertrophic
osteodystrophy
Metaphysea
osteopathy
E-hb 745; SAP
1074; H3B 830;
C12T 1175;
SxWW220;
SX-OP721;
Sx-Ol213;
X4T 136; X-RP
22; NB 16.19
V\
Hypertrophic
pulmonary
osteopathy, HPO
Hypertrophic pulmonary
osteoarthropathy,
Pulmonary osteoarthropathy,
Marie'sdlz,
~ hypertrophic osteopathy
H3B 837; H2B 891; Ehb 745 ;
SAP 1075; IM-WW 568; 5mln
712;Cat 1643; Sx-WW227;SxOP 723; Pa-T 444; Sx-OL. 219;
X4T 181; X-RP 23, 103: NB
16.19
2 to
~(,.'~.~.L~/ejltOPhysiSi~_",,"",~e~taP,hYSiS)
y..
_/'
hyperthermia or acidosis
DDx;
Panosfeifis,
Enostosis
H3B 832; H2B 889; E-hb 744;
SAP 1073; 5min 904; C12T
1172: E 2089; Sx-OP 715; SxWW 221; O-L.209: X4T 136; X-
RPI6~
**
"1 lesion
~~
exostosis, Me
E,
Osteochondromatosis,
Osteochondroma
M8k 920; Mk 586; E-hb 304,
744; SAP 1077; H3B
253, 831; H2B 882;
E 681; Cat 1629;
NS-C 408; NSW
152; NS3hb 153;
NS-hb 150;
NS-Pa201;
NS-L. 189; X4T
139; XRP 20,
85
'""-'
Nutritional
<18 moot"'
:~~~~~~~~~~~~l~!~f~~:I~~I.
Cao,e'
l '\
reactions
wi time
f!;:!;i
\j
chondrosarcoma reported
/111
~;';"1'l
Lameness
Pain on palpation
RadiOlogy
- Radiopaque osseous metaphyseal densflies
of variable size
.~
(50%) if compression of
over lying neNes or tendons
Neurologic deficits if compress spinal
cord
~
~
-Cauliflower.like",radiolucentareasof
...
hyaline cartilage w/ln exostosis
.
fC/i\\0
'~~
""f~
610"y to
M ~o
h f
~-r' .~
I
_=-__1-=:'::'::::":"-'':::':::::':::::::''''
__
.NotnecessaryunJessneurolo..'cSi.os,
Often asymptomatic
:.
es, Rads
\;;J
~ {{
~
~
~~
2 Hyperparathyroidism
.~VitY if sev~
\(fjj.
Firm swelling
Pain
Symptomatic
- Pain relief (buffered aspirin)
DDx:
G
G)4
"";- ""
..... .
,(r:;-./i 1.(
P,ogoo,;"
I CS: Asymptomatic/Pain
>
Smp
"I
~1, A5i
(,j1JJ
- Steroids controversial
Radiology
Hypertrophic osteodystrophy
cartl aglnous
anorexia
Hip dysp(asla \\
Osteochonl" sis
Multi pie
Fever, malaise,
r.:-_ _:-'-'-'--'-,,....-l--:"::::b'~o~~~eli~tle"-'- - - - ,
\-,,1)
Prognosis:
Good if underlying dlz corrected
Some may have persistent lameness
Grave if 10 neoplasia can1 be treated
Nonspecific Tx
Spontaneous remission in mild or
moderately affected dogs
Correct dietary imbalance & m calories!
energy
NSAIDs for pain (buffered aspirin)
Prognosis: Guarded
Many dogs recover spontaneously but
permanent bone changes & physical
deformities may develop
May succumb to hyperthermia
DDx;
Panosteitis
Bone associated neoplasm
Hypertrophic osteopathy
~E~:~~~~:~~iS ~.r
Treatment
.rf
J13__
~
Bone cysts
oPsin
Hx; CS
446
Benign neglect
Chondrosarcoma
Osteosarcoma
Giani cell tumor
Craniomandibular
osteopathy
(CMO)
Cause: unknown
DDx:
NB 16.18
HypertrophiC osteodystrophy
Bone tumor
Osteomyelitis
Temporomandibular malformation
Myositis
**
f'.
A;i
~~;;=:bOny
~"t
1
0
Symptomatic
Pain: buffered aspirin
Nutritional support if can't eat
(feeding tube, soft food)
Surgery unsuccessful
Euthanasia If animal unable to eat or
recurrent, persistent serious episodes
changes are reversIble but many dogs have some Impaired mouth functions but can eat
Rarely show spontaneous reversal of
",
I Correct 10 cause
Symptoms of 1 0 dlz
Enforced cage rest to prevent
Palpation: "rubber jaw"
Bone density CS:
trauma (Ixs) until bone strength re- Extreme pain on palpation of fxs
- Lameness: weakened bone
turns
Radiology:
- Spontaneous/pathological fxs
_
Generalized
bone
density
"Rubber jaw"
~
~.....
<~
~~
Laboratory:
- Altered serum calcium, phosphorus & SAP reflect 10 diz process
- t BUN & creatine in renal failure
----=-----.L..-
Osteopenia - OOx:
--
Prognosis:
Depends on cause
61
Fractures (Fx)
SAP 1088; H3B 942; SX-WW 207,251; 5x-oP 24,676; Sx48 826; SxS-hb 537; Sx-S 1595; X4T 142; X-RP 12; Pa-T 430; NB 16.13
V0
Facture (fx) classification
f-----------"-------
h==-~~~~~--=]~~~~=======j potentialprognOSticvalue(dependlngoneffectongrowthplate).
Type 1 (I): fxs through the growth plate, adja-
Open vs. Closed: 1st step in fracture classification, directly affects prognoSis, treatment
& management. Open fxs require more aggressive initial Tx
''"''I
SO emphysema (radiology)
Closed fractures
Torus
l?
Direction of fractures
-Transversefracturefxline
perpendicular to long axis of
bone. The most dangerous
fx due to rotational instabU
ity, often overlooked by
DVMs!
Avulsion
Chip
Multiple
Comminuted
Oblique fracture
fx line other than
perpendicular to
long axis of bone.
Segmental
Stellate Fx
Impaction fxs
Compression fx
Pathological fx
2) Location:
delayed on nonunion
4) Type of fracture
tial)
- Poor apposition affects stabilization & callus formation
- Physeal fractures can effect germinal layer & result in growth deformities
5) Infection: no healing or delayed due to endotoxins
6) Age & condition: young heal wonderlully (2-4 wks) ,geriatric patients slowly
7) Nutrition, obesity, diabetes, etc. compromise healing
Fracture reduction
- Simple fxs require at least 50% contact of fragments
- Joint fx: require precise articular surface alignment, no "step" defect
Anatomical fragment alignment: as close to pre fx "normal" as
Orthopedic fixation device (AKA implants)
Evaluate if will be able to prevent movement during healing
Proper apposition of bone fragments"
Devices
-Intramedullary pins
~~""'"
q'/J::Z;
Sufficient size
.......
/j
Seated correctly
/)
, Not penetrate joint space!
(.I
- Kirshner-Ehmer apparatus (external fixator) useful asan adjunct to 1M pinslorrotation
stabilization of transverse fxs. 3 pins (2 in 1 fragment) best. Usually can be removed in 3-Sweekswhen
rotation stabilized by callus. Also used for highly unstable comminuted or open fxs.
_Properly angled
t'~ !;~:; ~
:..'~ ~. ~ ~,;
~,,-
C - Cartilage, joint
- Effusions suggest DJD
- Device into cavity
"' """'j...
.
. -,
-~
~.
1-
'-
0- Device
- Compare to previous films
- Check movement, bending,
breakage,
- Radiolucency of bone around the
device
- Motion of implant or fx fragments
- Osteomyelitis
- Bone necrosis due to heat of drill
S - Soft tissue
- 7-10 days emphysema & soft tissue swelling
from surgery should be gone or almost gone
- Emphysema or swelling indicate infection or
communication wI environment
Other complications
Osteomyelitis: not uncommon complication to surgery, rarely hematogenous spread
- Fever, local heat, swelling, pain
- Draining tract
Nerve damage: e.g., radial nerve wI spiral fx of humerus, sciatic wi pelvic fxs
Osteoporosis:
- Chronic disuse of limb
- Generalize opacity
- Coarse trabecular pattern over entire bone
Joint complications
- "Fracture diz": 1. stiffness, 2. pain, ROM (range of motion)
- Ankylosis
- DJD
- Soft tissue & capsular contracture
Sarcoma associated wI fractures
- Low incidence
- Years to develop
. (Femoral) diaphysis most common
Pulmonary metastases
618
Open
fxs
****
\ ...
l-
-lnall3types,ilwoundisignored
- Lavage wound
~,.
wI copious quantities of
lactated Ringer's soluijon
- Alcohol on skin surrounding wound but
avoid contact wI open wound
Culture & sensitivity (swab/remove
fluid), Gram stain
- Restrict activity
.... - Elizabethan collar if necessary
- Stage implant removal
- Radiographic & PE at appropriate times
Complication:
- Continued infection: necrotic soft tissue or bone,
unstable fx or unstable orthopedic implants
- Delayed healing
~.,(,',
~
Prognosis:
.
Good: if treated quickly & effectively
proper wound management, fJxalion & postoperatlve care
"-7
"'f',." / ~
non~iable ti~ue
~ I
Penrose drainage
I
Delayed or partial wound closure if severe ~/' I
(Betadyne) or dilute Nolvasan (hexachlorophene)
bacterial contamination
.:f:
)
/
I
,
supply
Rigid fixation: reduce risk & severity of wound infection
- No 1M pins: tends to spread
infection
- Bone plates
- External fixation recommended
if possible
Condition
Malunion
SAP 1099: Cat 1700; Sx-OD
13: Sx-OL 118; SX-WV'/209:
Sx-S-hb562: Sx-S lS84: X4T
154
**
Facts/Cause
Presentation/CS
Treatment
Diagnosis
Hx (fx repair), CS
Radiographs: characterize the
defonnity
- Axis of joint rotation should be
parallel to the weight bearing
surface
- Define area wI most deformity
Deformed Ix union
CS: Deformity, Asymptomatic
Dx: Hx, CS, Rads
Tx: None to Surgical repair Px: Good
....
~
@I
Prognosis: Good
IIILJ"
Hx,CS,PE
Delayed union: healing at a slower Persistent lameness
Radiology - serial evaluation
than predicted rate
_ Delayed union: continued
_Absolute union will occur eventually
Sequelae:
_Cause: usually age related, blood supply comhealing but slow
_
Disuse
muscle
atrophy
or
promises, but existent, Micromotion leads to
Persistent fracture line
Range
of
motion
&
large viable callus' union
(nonbridging callus)
stiffness
Nonunion: failure of a fx to heal
Opened marrow cavity wlo
_ Healing will not occur wlout addi- - Neuromuscular
(pseudoarthrosis)
significant sclerosis
dysfunction
tional surgery, bone grafting or both
SAP 109S: Cat 1700; Sx-WW
_Nonunion: no progression of repair
_
Limb
angulation
&lor
_> 6 mo for fxs of shah of long bones
209; Sx-OP 154, 710; Sx-S Smooth fx surfaces
hb559; Sx-S 1 S7S; Sx-S895;
shortening
_> few months for bes of metaphysis
Sx-OL 121; Sx-OD 9; X4T
Sealed marrow cavity
Cause: vascular (viable) or avascu154
False joint
lar (nonviable)
Implant instability
#1 cause: inadequate fixation &
Radiolucent halo around a
resulting instability
screws or wires, etc,
Factors associated wi delayed or
Change of position of imnonunion
plant on serial radiographs
" Fracture location
- Malposition
- F ractu re gap
Soh tissue interposition
Distraction (by fixation)
Bone loss (trauma or surgical removal)
_Soh tissue trauma (blood supply
loss, trauma or surgery)
Inadequate fixation - instability #1
Contamination, infection (trauma or
surgical)
- Neoplasia
Delayed
union
Nonunion
** .. ***
-+
~~
~~
#1 inadequate fixation
CS: Persistent lameness
Dx:Rads
Tx: Delayed union: ASs; t Stability
..
Nonviable nonunion: ASs; Debride lx, t Stablhty
Px:Good
bone plate)
.
.
Viable (vascular) nonumon: reqUires
compression only
.
_ t Stability (add 1M pins, external flxatar, bone plate under compressiOn)
Nonviable (avascular) nonunion: ,requires resection, graft & compression
_ Debride fx site to restimulate fx healing
, Remove fibrous connective tissue
(debridement, transverse ostectomy ,
_ Reestablish medullary continuity
(drill sclerotic bone)
,
_MSingle" or decorticate small C~IPS
of bone on either side of nonunion
_ Autogenous cancellous bone grah
_+Stability (bone plates only under compression)
- Close
, Suction drain if infection or dead space
, Leave open it grossly infected; 1c wound dosure wi
cancellous bone graft later
Postop: Physical therapy
_passive range of motion therapy
_Short walks & swims
_Encourage controlled weight bearing (improves
circulation)
- Open wound management~!D
, Change bandages daily
~ ...
, Keep bone & soft tissue moist
merus)
621
Prognosis: Good
,
Tolerates up to 20-30% loss in length before galt
abnorrnal\tles
, '
Healing will proceed if stable in presence of Infection
Cause: trauma
Fractures
of skull
- Fighting, gunshots
(mandible or m",ililll,)
;j!J
~2'
~
**
_-+_'
~~=
_ _ _ _~
Fractures of maxilla:
Extracranial Ixs:
Facts: Traumatic fxs of nuchal crest. sagittal crest, frontal sinus, usually
nondisplaced because of cranial muscle mass
Tx: Conservative: usually nondisplaced because cranial muscle mass provides
Intracranial fractures:
Facts: Usually closed fxs, may lacerate venous sinuses, meninges or cerebral
cortex
CS: CNS compromise, medical management of CNS trauma (concussion &
2 cerebral edema) prior to anesthesia for diagnostic procedure. If progressive
deterioration despite medical care - skull radiology
Tx: Sx: drill multiple small holes for elevation, elevate depressed calvaria fxs
wI small elevator, remove comminuted fragments that may cause laceration of
cerebrum, remove any hematoma. Temporalis adequate coverage for any
defect. Monitor post surgery: serial neurologic exams
Px: Good for cranial fx repair; Guarded: variable neurological recovery
, Hx (trauma) , CS
I Surgery: pass Intubation tube through a temporary tracheo Asymmetry of jaw
. . on
siomy so occlusion can be checked
Palpation: crepItatIOn
Nasa I oraI hernorrhage
_ Insure proper dental occlusion
.
Nasal obstruction
manipulation
_ Rigid fixation: earliest return to function,
'
' 'ty open I xs
Malocclusion
.._.
,
- High rise falls in cats Malon
_Tooth roots can interfere wi placement of fixation ""vlces,aVOl
_ Iatrogenic: tooth
Oblique radiographs
roots & mandibular canal
extract"on~. Sequelae: Malocclusion, Osteomy- Check for other fxs (maxilla)
_Mandibular body Ixs, conSider as open Ixs '" AS,S
,
I ' n, Impan
I t ,Do"" ''''
-m ...."e a tooth in a fracture nne If it stabilizes reduction,
elit,ls, Nonuni,on, Maum,o
exposed tooth roots al a Ix line promote nonunion
trauma
Mand,"bu.ar -Cause:
HBC (hit by car)
fxs
- Fighting, gunshots
SAP 945, Cat 1653; Sx
hb617, Sx-s 1912,Sx4B
977, 8x38890, Sx-ww
261 S, "4 S" OP659
'
S"-O'L1'O,',X"T"45,X-G,'
"
20, 154(1)
Uy
) __
la_ll_u_re_,_I_nl_e_ct_,_o_n_o_I_S_Oft_tl_s_su_e
___ ___---:----:_---::-::_ _
L
*** Mandibular symphyseal fxs ***.~ most separation of the cartilaginous joint; Wire stabilizatio~ - f~1I
cerclage (hypodermic needle guide for wire through skin). Soft food until wire remo.ved, heal by fibroSIS
Rostral mandibular body fxs: repair complicated by small amount of bone for Implants & common
'
~_
(r.~
mi.'~\
~
bilateral fxs
II F
'ht"
_Tx: Tape Muzzle: tolerated by most dogs; Cats. & ~rachycephalic breeds ~ot as we; Egure elg wIre.
for bilateral fxs; Cross pinning: Kwires or 1M pins 10 selected cases (avoid roots)
Central mandibular body fx
. '
_Tx: Plate fixation (TOG) , 2 screws at least on either side of fx; Sever~ly commln~ed fxs: extem?1 pin
fixation (pins, clamps & connecting bars; Stable fxs & tight teeth: Interdental wmng around fx hne &
figure eight around teeth; Tape muzzle
Caudal mandibular fxs:
- Tx: Tape muzzle: lor minimally displaced Ixs; Bone plates & interfragmentary wiring: lor displaced & unstable Ixs
Mandibularramus Ixs:
,
_Tx: Tape muzzle: enough for many espec~ally if high up; ~ow~r ramus fxs: small plates, Interfrag
mentary wiring, K-wire fixation in combination w/ orthopedic wire
Cond loid process fxs * usually are minimally or nondlsplaced, Evaluate TMJ JOint radiographically
;--r-::1
'
rv-"
__
Treatment open lilW as WIde as possible & push on bulge 01 condyloid process & then close jaw while continUing pressure
~__
Isolated Injury or associated wi other mandibular fxs; Cause: trauma, temporomandibular
~
TMJ/mandibular
dysplaSia, nontraumatic cause; Reported in Sf. Bemards, Basset, I. setters, Amer, cocker
luxation
Dx: Palpation & radiology
,
, "
Tx', Replace mandible via closed reduction: anesthetized In, dorsal re,cumbency,
~
SAP 950: Gat 1653; Sx-hb 618; Sx-S
T pencil orI f
SAP 950
**
1~~d::ow~e~1a:c~r~o~s~s~las:.r:t~m~o~l~a~rs:,~c~lo~s:e:m~o~ut~h~o~v~e!r~p_e_n_C_il_&_m_O_v_e_Ja_w_b_a_c_k_'n_p_la_c_e_,
_a_p_e_m_u_z_z_e_o_r_.::===--~~~.,.;
623
'&/'
__
Shoulder
luxation
H3B 814; E 2338; Cat
1689; Sx-S-hb 570; Sx-s
1710; Sx-WW 251, 252;
Sx-op 230; Sx4B 1075;
Sx3B 740; Sx-OL 170; Sx00132
**
of shoulder
Lameness
rffi~
Chronic
bicipital
tenosynovitis
JAVMA207{2)201,1995;
Sx4B 1074; Sx-oP 252
Unilateral:bilateral - 23:3
Cause:
-Idiopathic in most
-Trauma
Synovial sheath surrounding biceps tendon
is continuous with shoulder Joint
....
Intermittent
weight-bearing
-Worse after exercise
Atrophy of infraspinatus &
supraspinatus (15%)
II
Suprascapular
nerve injury
it
**
625
~~~
1Jl
~J
.
$=:>
Steroids
,,~
Prognosis:
A
Medical: guarded
1- May be due to chronic nature of dogs tested, acute?
: excellent
* . No gait change
I'll!
~l@)
~J.!v
~
@/
w>
",
~'OI)
~~~~~~~
626
Shoulder
#1
site
of
osteochondrosis
Dyschondroplasia,
_. wI exercise
. Subchondral bone changes m/lndicate
Osteochondritis Caudal aspect of head of humerus
cartilage damage
- Unilateral or bilateral (50150)
Swelling (distention of joint!
_ Flattening or cratering of
OGD,
synovitis)
subchondral bone
- Male:female - 5:1
Osteochondritis Breeds: Large & giant breeds, also - Pain on extension of shoulder
_ Subchondral bone sclerosis
dissecans
Brittanles, Bull terriers, Bordercollies, & Greyhounds ~~
(thickening)
SAP 1085; H3B862; Cause: unknown
~ifI.
_ n Joint mouse": floating piece of
Ehb 735; C12T _ 4-10 mo-olds, rapidly growing,
cartilage in Joint space (mIb calcified)
21173; 630;
E2042;Sx-S
Sx. Ioss 0 f
S-hb
large breeds
- Chronic: DJD (scI erOSIS,
1947; SxWW 221,
Overnutrition, genetiCS, low copper
"'\.::y
joint space, periarticular osteo243; Sx-OP 244;
Trauma (Umphasislast20y""'I:caUSlnQor
phytes)
Sx4B 1069; Sx3B
749; Sx-OL 185; Sxaffecting abnormal cartilage
Arthrography to see flap or "joint
00136; X-Gr 56
- Diet & trauma only factors that
s_eq..:.u-e-la-'-O-J-D-----.l::m~O~'rn,.,,,:OP,c;,
can be controlled
large patients
Pathophysiology:
I~
DO.:
- Cartilage outgrows its
Fragmented coronoid process
nutritional supply
Panosteitis
(synovial fluid)
. ..r- OCD of elbow
Deepest cartilage cells die
Ununited anconeal process
- Trauma may cause dissecting flap &
Hypertrophic osteodystrophy
joint mice in joint space
Bicipital bursitis
oe,
;JK:
***
D/
.
C
Osteochondritis:
Defect in articular cartilage
Osteochondritis dissecans:
Cartilage defects
Young, Fast growing, Large breeds
CS: Variable lameness, Swelling
Ox: Palpation, Rads
Tx: Conservative (Rest, NSAIOs); Sx
~~(I-.-
Prevention:
Don't over feed (controversial)
Check for mineral balancing diets
(copper/calcium/zinc) ~
- Breeding??
.-@)07
Prognosis:
Good wi surgery (75%
normal, 22% mild lameness)
Conservative - Poor
DJD: poor for Sx or conservative Tx
- 0\\
.~~-
..
~f)
Traumatized animal
").::
. 3-legged lame
..
628
Osteochondrosis,
Dyschondroplasia,
OeD,
Osteochondrosis
dissecans
SAP 1082; H2B 864; C12T
1173; SAP 984; 5min 888, 540;
Sx-WW 221, 243; Sx-OP 307;
Sx-5-hb631; Sx-S 1957; X-RP
35; X-Gr 62; X4T 132; Sx-OL
189; Sx-OD 159; NB 16.9
***
Fail~re i~ endochondral
Variable lameness Hx (young, large), CS (lame &
Surgery - arthrotomy
ossification of elbow
Swelling (distention of
joint distention)
- Debridement
Less common~han shoulder jOint joinVsynovitls)
f'.( .... Ma~ipulate for pain
- Curettage to good hemorrhagic bone, let
Tends to be bilateral
fl1.RadIOlogy (cartilage not seen)
fibrocartilage fill in defect
Medial condyle of humerus
l.~~\
Subchondralbonechangesmllndicate
_ Subchondral bone cyst (misno-"
cartilage damage
mer: not secreting membrane, rather a
~
~h~:al films 4-6 weeks apart before
wad of rIEIcrotic cartilage wi a sclerotic
...~-'.-up
(
layeraroundil)
~
-Subchondral bone lucency
Often accompanies ununited
in medial condyle (CrCa view)
anconeal process & fragmented
- Subchondral sclerosis &
coronoid process
~
calcification lormatl"
of flap
- Osteophyte
'"
V Cause: un 1mown
./""\/).I-<'
- 4-10 mo-olds, rapidly grow-~
- ~
,-
1$1,..
1. _
ing,
large
retriever,
Lab, breeds
Rottweiler)(Gold,"
- Overnutrition, genetics, low
copper?
, Pathophysiology:
~./~7-
'-;--',
.)
I ~.
'\.
h:
Prevention:
Do not over feed (controversial)
Check for mineral balancing diets
(copper/calclumfZinc)
Breeding affeded animals
Deepest cartilage
cells die
---
-~,
Hypertrophic osteodystrophy
~
~
":D
Ununifed
anconeal
process; UAP
SAP 1080; H3B 818; H2B 865;
5min 540; C12T1176;5min540;
Sx-WW 221, 247; Sx-OP 300;
Sx4B 1063; Sx3B 778; Sx-S-hb
638; Sx-S 1977; Sx-OL 193; Sx00160; X4T 132; X-RP 37; xGr16.9
**
Prognosis:
Good wi early Sx for soundness
DJD:
Bilateral in 30%
Felt to be related to OCD
Types:
- Cartilage retention nest
- Delayed union
- Nondlsplaced nonunion
- Displaced nonunion
D
..r---
OFAwillnowcertifyelbows
(flexed lat.fllm sent for evaluation)
.\I-~L::----.L:------:--:----------'lf
C .
..
COx:
artllage + Nut"tlon of Large breeds
oco 01 elbOw
CS: Intermittent lameness
;:\:::})
-
process
+anconeal
Exploratory
-
DJO
r-rttst-e
arthrotomy
to confirm
629
m~"7
(I
--~
DDx:
OCD of elbow
Fragmented coronoid process
Panosteitis
: ~~rirtroPhic osteodystrophy
132
'=::7
"Ununited coronoid
process"
H3B 815; H2B 865; 5mln 540;
CI2T 1174; Sx-WW 221, 247;
Sx-OP310; Sx4B1090;Sx3B
774; Sx-S-hb 635; Sx-S 1966;
Sx-OL 195; Sx-OD 159; X4T
\C:J
(I
CS: Lameness
,I
Variable degree of
Failure of anconeal process
lameness
to unjte wI ulna
- Worsens wi
- Separate ossification center
- Normally unites at 4-6 months
I
\"._.--::=:.-,--,,--L-,----Failure to unite wi ulna> 6 mo
~:d>
I,~}
-'g-'-
Jr
131
/111
$=
:;>
-~
@:j.-~;.:J
c. )
PrognosIs: \.Z;
Guarded
....... J
630
Incidantallinding
May interfere wI normal growth
01 ulna
~ /J
cartilage
cores
rc~
.s.q"e,a~
*
ulnar metaphysis, Large
to ulnectomy or ostectomy
Incidental finding, deformities
**-***
~!;,~y
Elbow jOint
fxs
- Forelimb deformities
. Valgus deviation, external
rotallon of carpus
. Cranial
of radius
Traumatized animal
3-legged lame
Cause: trauma
- HBC (hH by car)
- High rise falls
Anatomical reduction
required or OJD
Elbow joint articular fxs:
Hx, CS
Palpation
RIO thoracic trauma
Radiology
- To characterize fx
- Consider thoracic films
. RIO Pneumothorax, hemothorax, diaphragmatic hemia, rib f)(S, chylothorax. traumatic
pericarditis
(I
Radial &
ulnar fxs
Cause: trauma
Acute lameness
- HBC (hit by car)
Angular deformities
- Falling or jumping injuries
Often open
Anatomically impossibleto pass
an 1M pin retrograde in the radius from fx site, but can pass
***
-<--
~-----
----- ------"
**
Luxated elbow
Acute lameness, pain
Shortening of limb (proximal
Lateral, Trauma
CS: Lameness, Pain
Ox: HX,Rads
Tx: Reduce,
Post - reduction
Subluxalion of elbow
**
Growth
"-"1f~/{
I'@J\_
Prognosis:
Good: if uncomplicated & promptly treated
Guarded: if chronic wi severe cartilage
damage
excessive duration of
Lameness
Development abnormality due to
asynchronous growth rates of radius & Limb pain - variable
deformities of ulna due to:
Noticeable deformity
radius & ulna, - Total or partial fusion of growth plates: Manifestations
- Shortening of limb
Distal ulna or radius, or proximal radial
Radial & ulnar dysplasia
SAP 997; H3B 832; H2B 883; Pathophysiology: both radius & ulna
- Angulated forelimb
Sx-QL 127; Sx-OP 299, Sx4B
- Rotated forelimb
must grow synchronously or variable
1094;Sx3B 793; Sx-S-hb 580;
curvatures
Sx-s 1746
**
Distal ulnar physispremature closure
#1 growth plate disturbances
Immature dog: Ostectomize 1"
(2 em) of ulna, fill defect wi fat
graft, splint 1 month only if no
curvature in radius, if curvaturecorrect radius ASAP
Mature dog: deformities (bow
string (cranial & medial) of radius, limb shortening, carpal valgus w/ external rotation, elbow
subluxation
- External Kirschner device: transfixing pin distal radius parallel to articular suriace, transfixing
pin in proximal radius parallel to articular surface, osteotomy radius at maximum curvature,
cut ulna also. Connect bars between 2 transfixing pins so they parallel each other. Drive remaining transfixing pins. Cover device w/ light
padded bandage_
~~
(U I
<
'
<) '(
:
I.HX,CS
Radiology
- Deformity
- Elbow & carpal
subluxation
2' DJD
Cause:
- Trauma - major or minor fxs
- Hypertrophic osteodystrophy (bone bridging)
- Retained ulnar cartilage core
- Chondrodystrophic breeds
Inherited distal ulnar closure in Skye terriers
- Synostosis: bony union of radial & ulnar shafts
- Osteochondrosis of growth plate
~
.
~
'" .
_ __
Fxs of carpus
SAP 1000; Sx-OL 98; Sx-OD , 86; Cal
1665; SX-I/IIW 253; Sx-QP 351; Sx4B
1103,1276; X-Gr66, 184(1)
**
joint capsule
Medial or lateral
carpal instability
Rupture of media~or
.
lateral collateral
I
ligaments
E2339;Sx-WlN253:Sx4B1112
-Trauma
l~.....
Lameness
*
Flexion syndrome
CI2T 1177
***
Onychectomy, Declaw
SAP 1062; CAT 1702; Sx-G 328; Sx-S-hb 145; Sx-
A'
;J
~i.?
"'\::y
S 352
Acute, nonweight bearing Hx, CS ~. Me & Mt#3&4 must be aligned properly form
lameness ~ Palpat,on
Radiology
-Closed reduction & extemaJ coaptation splint or cast for 1 or
**
L _____________________
Surgical removal of
3rd phalanx & claw
i(~\'
"D
:::=:~~=:~;::;~~::7
/1/1
'" ~ ./
............
G~
Metabolic diz
Moderately t exercise
.T~rembli~g~ffr~nll:'m:b:'=.~.-.l_'_P_"_"'_'_'O_"_--'~~~::::::J~':c~;~~,~~~~t~~~~i~~~"~,:,,~,y~,,~::,~,,~".,.~"~~~~~;,~~~~g~t:~~:~O~'I
Weakness of carpus
Gradual weakness of carpus
Plantigrade stance
Old & obese dogs
Breeds: Doby, Collie, Sheltie,
Samoyed. Lab
carpus~
Puppies: 8-16 wks old; Several breeds: Doble & Shar pei; Cause unknown (taul flexor carpi ulnaris?)
C5: Rapid es, stand on flexed carpi, Inward deviation; buCkle & walk on lateral forepaw
Ox: Hx (puppy, breed). CS; PE (not swollen, painful or unstable); No radiographic SIgns, occaSIonally unilateral
Tx: Spontaneous recovery 2-4 weeks: if worsens or persists -light weight splint in slight extension (3-5 d Intervals
for 5-7 d: cui Insertion of ftaxor carpi ulnaris
Carpal instabilityl
E 2339
~~It;p~~~-----------r..~c~a~~W1DpaawWiinn(dfuir~e~ct~io~nno~-----
.>
***
weakness ~>- :x":~:
Puppy carpal
,;
~~~~:~~a\nc~e'-1-'-H-X-(-hi-g-h-r-is-e-fa-I-I),-C-S--~'-U-n-d-e-r-3-0-I-bs-:-e-a-rl-Y-ffi-d-u-ct-i-On--&-c-a--~
leads to ligament
#1 High rise fall wi limb
hyperextended
- Rupture of palmar ligaments &
E 2339
may be needed
Sprain, Luxation,
Subluxation:
carpal joint
Sx4B 1106; Sx-OP 348
Hx, CS
, ,
--
.-
Elective procedure
- Best perionned in neonate
Ectrodactyly syndrome,
Lobster claw
Neonates
Surgical scrub
- Grasp nall & cut away from attachment
to metacarpal bone wI a Scissor
- One absorbable suture in skin
- No bandage necessary
_ Older animal
Digital removal
SAP 1063; S:X-8-hb 145;
Sx-G 332; Sx-OP 386
IrD;::e~W;;:C::;I=aw;:;-:r:::e:::m:'-:O::v::a:-'I----::d;-:o:-:g:-:s----'
SAP 1063; SxShb 145: Sx-s 352: Sx-G 330;
Syndactyly
-=--7,,---------j
I :;::.:~~::::::.
II
~Yt.
--~
----,
--.
I.
claws
***
'
L-~~~~~~~~==~~~635~_____________________~=-
______
tnjured animat
***
Sequelae:
- DJD in acetabular fxs
- Narrowing of pelvic canal
Future dystocia
- Difficult urination or
defecation
- Sciatic nerve
Emergency Tx 1st - stabilize Conservative all that is needed for selected pets
Physical exam:
- Restricted cage rest for 4-6 weeks
Padded bedding
- Palpate pelvic bones
Fractures of ischium
Usually associated with other pelvic Ixs
Sx repair usually not necessary, especially if
any other fxs are reduced & stabilized
I
Fractures of acetabulum
Surgery (ABs)
Surgical reduction: TOC for all - Refer (technical expertise - errors abound)
- Caudolateral or dorsal approach (trochanteriC osteotomy or gtuteal tenotomy)
- Protect sciatic n., & caudal gluteal vessels & n
- Reduce fracture
Maintain reduction wi point-Io-point bone holding forceps (ASI F small reductlon forceps, Kern
bone holding forceps)
Precontoured bone plate, acetabular plate, small dynamic compression plate or pelvic reconstruction plate
.. Engage at least 4 cortices on each side of fracture
- Prognosis: Good wi anatomic
reduction, stability & no nerve damage
Guarded: wlo anatomiC reduction
'==:.
. . ..J
638
Hip
dysplasia
****
neuro signs
- Gait abnormalitie wlo neuro Ortolani sign Ooint laxity): click or pop heard
deficits
or felt as press hand on knee as abduct limb
- Chronic: more common - Radiology:
older dogs
- Hip subluxation Goint laxity) (worst sign)
- Severe form: young (5-12 mol
Shallow acetabulum, flattened
Pain (limited hip joint motion)
.. < 50%-60% of femoral head inside
Difficulty rising in pelvic limbs,
dorsal Tim of acetabulum
Loss of congruency (para/lei lines) between femoral head &
especially after exercise
acetabular cup, especially In cranial third
Muscle atrophy - pelviC limb
Sequelae:
- DJD, osteoarthrosis, osteoarthritis
- Luxation or subluxation of
the femoral head (worst sign)
OOx:
Degenerative myelopathy
Septic arthritis
Trauma
Immune-mediated joint diz
Ruptured cranial cruciate lig.
Scoring methods:
- OFA 7 point grading system: Excellent. Good. Fair,
Borderline, Mild HD, Moderate HD, Severe HD
- 3-point scoring scale: Normal, Borderline or Dysplastic
- Norberg angle (Europe), joint laxity, not accepted in USA
L-S instability
PanosteHis
(young) I'CiF.~~~iiontiHijpciv;;Pi8iiia~ie\;:ViiiP:e;cte;nci6cjOFA
dysplasia view: VD hip-extended
r-=-_-:-:~=~:::--:_~~C-:-_-:_~=J;:::;==:::;--IO
"
"I"Ity, I9 &"
" d
COxallnstabl
giant b ree d s, In herlte
Pull
caudally
& rotated sllghtty medially
Dog limbs
in dOrsal
recumbency
Femurs parallel
Patellas centered in trochlea of lemur (If not - see flattening of fovea capitis)
Superimpose lemur & ischiatic tuberosity
Include from below the stifle to Just above hlp bones
0 No rotation or acetabulum will appear of uneQual~dePth
.& 1 joint will look artificially worse)
\.
- Check
rotation: obturator foramen eQual.
<:
~
width of the wings of the ilium equal
~
o
{!
'==========================;;-\
Intertrochanteric osteotomy
Patient selection important
- Marked t in angle 0 f anteversion &I
or inclination
months)
Tx: Craniolateral approach, transverse
intertrochanteric osteotomy
- 2nd osteotomy to remove wedge of
bone & +angle, creating a coxa vera
- .. Angle of anteversion to normal by
rotating proximal femur caudally
- Rigid fix w/3.S mm hook plate or wi
standard bone plates
Post-op: restrict activity for 8 weeks
Prognosis: significant number pain free
wi normal mobility
vage procedure)
Most effective in dogs < 40 Ib
Craniolateral or ventral approach
~ Remove femoral head & neck
- Incise round ligament of the head of the femur
Postop: use limb in 3-7 days or passive range of
;0 .
\~
~
~
"If \
Treatment:
Conservative for mildly affected
- Restrict activity for inflammation to
subside
- Aspirin for pain
Don"t breed
" ... ~
;~ ~
fl!l:~)
01
Prognosis: Good
"'\.YJ
Hip
luxation,
Caudoventral
Open reduction: clean out acetabulum 1stthen reduce head into acetabufx; do under general anesthesia
lum then a stabilizing technique (a few are listed below):
Craniodorsalluxation
1. Joint capsule imbrication with retention suturing:
- Externally rotate femur (head over & away from ilium)
.. Cruciate or horizontal pattern if enough capsule on both sides remain
- Pull limb distally (head over acetabulum)
.. Through capsule on acetabulum & hole in greater trochanter if not enough
capsule on neck of femur
- Rotate femur internally (head into acetabulum)
.. Suture through hole in greater trochanter and to screws in acetabular rim
- Flexion sling (Ehmer), daily reexamine
2. Transacetabular pinning: a temporary intramedullary pin through proxi Caudoventralluxation:
mal femur neck and head & through the acetabulum into pelvic cavity (1 cm)
- Abduct limb (head from under
+ Ehmer Sling for 7-21 days - remove pin, rest 21 more days
hip bone)
Replace ligament of head of femur betweentoggJe pin in acetabulum and
- Externally rotate limb (head into
hole in proximal femur & head
acetabulum)
4. Translocate the greater trochanter caudally so gluteal muscles pull the
- Hobbles, daily reexamine
femoral head into acetabulum
If
luxates
- open reduction
Avascular necrosis of the femoral head, Ischemic/asceptic femoral head necrosis, Legg Perthes diz, Legg-Calve-Perthes diz, Osteochondritis juvenilis,
Coxa plana
H3B613; H2B868; Sx-Ol
207; Sx-OD 223; Sx-WW
222; Sx-oP 13; X4T 134;
Pa-T 440; NB 16.19
neck
o
oHx,CS
o Palpation: pain on abduction, extension
crepltance
Radiology - definitive
-Irregular areas of lysiS (dissolving) head
& neck
-Irregular density of femoral head & neck
- Widenln9 of articular space
Rattening &. collapse of subchondral
~~e_ ~,::gh~"
-~~
DDx:
j'
~V~~
~ &'('
o Hip dysplasia
Coxofemoral luxation
o Infectious arthritis
o Ruptured cruciate ligament
o Medial patellar luxation
o Inta-arUcular fxs
o Neoplasia
-'--"'-'
Condition
Facts/Cause
Femoral head
OC,
Osteochondrosis,
Dyschondroplasia,
Osteochondritis,
OeD,
Osteochondrosis
dissecans
PresentationiCS
-Intermittent lameness
Pain on flexion
Sequela: DJD
Diagnosis
Hx (age, sex, breed), CS
Manipulate lor pain
- Radiology:
-Subchondral defects of temoral head
OJD
Treatment
Conservative or surgical?
Conservative
- Rest (exerdse on leash only for 6 months)
- Restricted feed Intake
- NSAIOs (bullered aspirin or
PBZ for comfort)
: '
,,'
A!tf.'
- Surgery - arthrotomy
- Debridement, curetlage, rarely done in dogs
Femoral head & neck excision < 40 Ib
- Tolal hip replacement
- Postsurgery
, Enforced rest for 6 weekS (leash)
(I
?~-~.
,Keep patient thin
DDx:
Leg-Perthes diz
Hip dysplasia
Osteochondral Ix
Prevention
(.
Femoral
fxs
SAP 1022;Sx-OL56;Sx-OD
218, 256; Sx-OP 469; Sx4B
232;Ca11668,1678;S,WW
885,887,1040,1237; Sx3B
682; Sx-S-hb593; Sx-S1805;
X-Gr 92, 202(1)
#1 bone Ix in dog
Trauma: hit by car (HBC)
Healing faster in young animal
Prognosis: Good
Lameness
Traumatic induced
recumbency
~.
~:
''0r
~
***
~--~------~~Fractures:
Femur diaphysis
D-'
.......
Vi~ews
~( ~~~,
)--~----~~
- Fact: Femoral artery & vein on medial side, sciatic nerve caudal to lemur
- Tx: Cranlolaterat approach
Simple obUque Ix: 1M pin
Comminuted: build proximal & distal fragments Into 1-piece fx, combination
of Interfragmentary screws, ligure-8 wire, skewer pins. Save fragments wlo muscle
attachment In a blood soaked sponge & use il needed for stablllty.
. 2 or 3 piece Ixs wI long oblique Ix lines: cerclage wire + 1 or 2 normograde or
retrograde 1M pins, cancellous bone graft (flush area first)
Highly unstable comminuted fxs: add devices for stability (plating or 1M pin +
Kirschner-Ehmer device) & cancellous bone graft
Distal femur
- Distal femur: metaphysis, condyles, trochlea, Majority are physeal
Tx: Lateral, medial or cranial approach (tibial crest osteotomy may be added tor better
exposure), cross-pinning, multiple pinning & modified Rush pinning, Retrograde. flexion
sling, Postoperative (see above), except cage rest for 24 hrs only
Complication: Quadriceps tie-down (contracture): adhesions between fx callus & quadriceps, avoid
by using a flexion sling & eariy retum to exercise: OJO in intra-articularlxs wlo anatomical reduction;
Shortening of leg In Immature physeal fxs expected, < 20% dOeSn't produce clinical signs
Trochanter fx
_Tx: Craniolateral approach, Tension band (2 Kirschner wires + ligure-8 wire). Postoperative (see
above), except cage rest for 24 hrs only
Patellar txs (rare)
_Tx: Lateral approach, 2 Kirschner wires lengthwise + figure-8 wire around pin ends on cranial
surlace 01 patella. Postoperative (see above), except cage rest for 24 hrs only
Reduction fixation
- Intraoperative broad-spectrum ABs IV
(Induction & repeat il Sx longer than 2 hrs)
Post--op
- Cage rest 1-3 days
- Flexion (Ehmer) sling to prevent use
_Physical therapy (nonweight bearing)
- Continue ASs if open fx
- Leash walk at 4-5 days if fixation
stable, slowly over 4 weeks
~~ed"i'~
flt m~
644
Facts/Cause
Condition
Patellar
.on
luxatl
Dogs> cats
Rear leg lameness
Small breeds larger breeds -Intermittent to carrying limb
p .
terriers
CatI606;SI117:0-LI52:
QD254;Sx4BI232;Sx3B
aln
Congenital> aCQuired
~~ ~')
***
~
;(7):
( ,
;r;
~lJ
II, \\ \ \ \
~~
W~~,~
Meniscal injury
SURGERIES
Coxofemoral luxation
correction
- Number of procedures, most patients
require combination of techniques
Conservative il minimal es,
mature dog,. 1 yr-old
- Weight reduction
- Controlled exercise
- NSAIDs
- Usually Ineffective in clinically affected animals
wI surgery
manually returned
Grade 4 - Permanently luxated, can't be manually
repositioned
Stifle
&
jf growth plates
- Cranial cruciate
Grades of luxation
Grade
~
ate opened whether CS or not
- Persistent luxation immediate surgical
Surgery:
____
Treatment
Hx, CS
Palpation: extend limb
#0:. ~ _,
Leg-Perthes diz
,< 2yr-old
&
~
:\\' ' \
:::,:
';;;.~~bS~~.4;O~~" category
Medial> laleral;, ""'Y ,;,,""',' DDx:
o-Sx 272: RA 1
MPL:LPL - 7:1
r
Diagnosis
Presentation/CS
~~ . Severe traum~ required: rupture of cr. & ca. cruciate, medial & lateral collateral ligaments, menlscal attachments, popliteus & long digital extensor mm,
luxation
CS:
SAP 1039; Cal 1692; SxWN 256; Sx-OP 565; SxS-hb 604; Sx-S 1854
Cause:
Ruptured
cranial
cruciate
lorn"",
lig.
'3-pulley pattem
Ox: Hx, CS, Palpation: total laxity in all directions, lateral medial, cranial caudal & rotational Instability
Tx: Repair medial &. lateral collateral ligaments, popliteus &. long digital extensor mm. (locking tendon loop, '3-pulley pattern', Bunnell suture,
spike washer & screw or fascial reinforcement), Correct cruclate by intracapsular or extracapsular imbrication techniques, Suture menisci to periphery
or do a meniscectomy - Postop: Kirschner-Ehmer device or cast immobilization for 3-4 weeks; Then Robert-Jones bandage for 2 weeks.
***
g~~lg~;~!~~:!:::~~~ess
wI
exer-
cise
Chronic, persistent lameness
~~
Rest for
Radiology:
- DJD (degenerative joint diz)
Postop:
- Restrict exercise to hand
~ Joint effusion
Surgeries:
Pateliarlendon procedure (25-175Ib dogs)
_Cut a strip in fascia lata/quadriceps fascia, over patella & down patellar
ligament
- Converging saw cuts in patella
_Cut proximal end of strip, leaving distal end attached to tibial tuberosity
_Orill tunnel In the lateral femoral condyle in direction of cranial cruciate ligament
_Push graft through detect In patellar tendon, fat pad & tunnel (piece of patella
In tunnel)
_Postop: Robert-Jones bandage wI cranial fiberglass slab for 1 month (necessary)
. 4 month leash only exercise & no stairs
Fascial strip oveHhe~top procedure
\~ ()
~ ,~
.1~t;:;}ii;i;1;i~~E:.:':~~~::::::I~I~:~:"I~' ~
Imbrication
'-'
,Around fabellae through patellar ligament of tibial tuberosity
I
Extremely rare
_______________________
oCS:Acutehindlimblameness
Ox: Hx, CS, caudal drawer sign (tested at 90 of stifle flexion), Radiology (avulsion of bony attachments, caudal sag of proximal tibia in lateral view)
.
0
,c,~/-'I
L~--J: ~
'\.~'l g~
- Avulsion fx
au a crucla e Igam
3-4
es, history
-..:._-=-___.:..__.:...::._I[i:j<J.l:::...--J
~
l)
______ '\
10> 1-______________________-'''
"If
N\
(S \Jl - - -
nd
Meniscal
problems
Lameness
Hx, CS
Cranial cruciate Cranial drawer sign usually
damage usually
Click or clunk during
Treatment controversial
Preserve if grossly normal or
manipulation as femoral
Partial meniscectomy, completeltotal not advised
condyle slips over double'AIU"'-=CA unless both caudal & cranial horns damaged
- Arthrotomy approach (medial or lateral)
fold of meniscus
Correct cranial cruciate damage
- Remove caudal hom
***
limb
ligament
disruption
Hx, CS
Radiology.
stress
radiographs
ill
of collagen fibers
- 2ndo: partial tearing
'I
**
avulsion of
exercise
surgical repair & partial immobilization
- Complete ligament tear: Bunnell locking
loop or "3-pulley" suture for
/,(,(!
Prognosis:
Stifle
DC,
Osteochondrosis
OCD,
Osteochondritis
dissecans
SAP 1085; H28 a65:
5mlnaea: E234a: Q.L
la9; 0-0 260; Sx-Shb633;Sx-S 1961: SxWW 244; Sx-OP 56a
o
o
DDx:
Hlp dysplasia
Panosteitls
Sprain - ligament
Patellar luxation
Chronic CCl
1 repair
- R,,.
Good
if done early
(",e~", on
(I
Buffe~'~ed~"'~P~"~'==~~~~~R
patient thin,
Prognosis: Good
Prevention: Do not
I
diets
___
> ___
'W~M=
..-- .. ~_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~~
Tibial &
fibular
fxs
SAP 1041: Cat 1678:
Sx-OL 71: Sx-OD241:
Sx-4B 88a, 1050,
1263, Sx3B 722, Sx-
;~~~~06s8~~-;X~:;
Acute 3-legged
lameness
109
I
.
I t ' f ct
.
arge ImpN
s Ina
ra ure
n
SIte
~\
\
~~...
Hx (HBC). CS (3-legged)
Tx depends on variables
Physical exam;
- Palpation: swelling & crepitation
- Examine also for orthopedic injuries
_~~~c~~~nt
- Evaluate thorax
Neuroexam forsensorypercepllon &spinal cord
musculoskeletal injuries
. Should be able to support themselves on 3
Ii
1M
pins, cerclage
...
, J
Y:"
__
I .
Proximal
intertarsal
subluxation
or luxation
Subluxation luxation
Cause:
- Rupture of plantar
ligament (75%)
- Trauma to plantar
ligament (25%)
Hx,
Walks plantigrade
- Abnormal dorsiflexion
chronic cases
- Doesn't respond to
conservative Tx & splints
6+ yrs-old
Obese dogs
-'"'~ ~~o../ Breeds: Shetland sheepdog, Collie, Samoyed
Unilateral> bilateral
Luxation: ~~
Arthrodesis wI a bone plate
Curette cartilage 01 joint & add
cancellous bone
7 hole bone plate on lateral side
of tarsus
Plantar lig"
Lameness, Plantigrade Dorsiflexion
Ox: Palpation, Stress radiographs
Tx: Arthrodesis Px: Excellent
es:
Tarsometatarsal
subluxation
II
I
Signs 01 trauma
Resemble intertarsal subluxation
Moderate to severe semlweight-bearing lameness
Abnormal dorsiflexion
Thickening of joint capsule
in chronic cases
~I-
Arthrodesis
of proximal
tarsometatarsal
joints &,
- Pin & tension band
Pin (through calcaneus, T4 & into
distal 112 of Mt 4)
".OM ...
.~
"os......m........, iO;~
arthrodesis
- Remove cartilage from distal tibia & trochlea of talus,
inlertarsal & tarsometatarsal Joints
- Autogenous cancellous bone grafts
- Dorsal bone plate
Prosthetic sutures replacement of collatel'8lllgaments
- Coadaptation splint for 2-6 weeks
Tibiotarsal
subluxation or
luxation
Subluxation:
- Arthrodesis of proximal intertarsal joint
II~,---'--------------------~--------------~~
intertarsailuxation~~~
Fractures of
pes
Sx-S-hb 610; Sx-S 1883: Sx48
890,1252,1264,1283: Sx-OP
607: Sx-WW 257
Tarsal
DC,
\,
Osteochondrosis,
Dyschondroplasia,
Osteochondritis
Calcaneal fxs: common in racing greyhounds, rare in other breeds. Associated wI central tarsal txs or plantar ligament tears, resulting in plantar
- Tx: Steinmann pins, tension band wiring, lag screws, plates or cerclage Wires used
Talus fxs: rare
Central tarsal Ix: common in racing greyhounds, reported in other breeds. Right tarsus due to counterclockwise racetracks. Often with other tarsal fxs
- Fxs graded from 1 to 5 and fixation depends on grade -lag screw to external coapted. Px: variable wI grade
o Metatarsal fxs: Nonweight bearing lameness. Swelling, crepitus & pain
- Tx: Coaptation for 4-6 weeks, Internal fixation of severe displacement or multiple bones
Sesamoid bone fxs: primarily In greyhounds. CS: mild swelling & pain over plantar aspect of metatarsophalangeal jOint
- Tx: Remove fragments. Prognosis: good for return to racing
Dog problem, not In cat
Endochondral ossification failure
Medial & lateral trochlea of talus
- Less common than shoulder
_Unilateral or bilateral
- Male:lemala - 5:1
Breeds: Large & giant breeds
(Rottweller. Labrador)
cause- unknown
eJ
4-10mo-old,rapidly
growing, large breeds
LJ
* -
Lameness
Hyperextension of tarsocrural Joint
Swelling (distention of jolnV synovitis)
Pain on nexlon
Sequelae OJD
~
. Overnutrition,
.,rgenetlcs,lowcopper
~
, Trauma: causing or aHecting
abnormal cartilage
\ \
"\ I
Pathophysiology: cartilage o u t - '
grows its nutrltlon, cells die, trauma
~_-"7"(
% -
~
~
DOx:
Hlp dysplasia
Panostel\ls
: Sprain -ligament damage
Fracturelluxatlon
~~"""
~
r~
Conservative
- Rest (exercise on leash only for 6 months)
- Restricted feed intake
' : ,.
- NSAIOs (bufferEid aspirin or PBZ for comfort)
I
Surgery - arthrotomy
1\
- Debridement
A
- Curettage, scrape to good dean bone
- Remove' Joint mice"
:.r//.
_ Postsurgery
C
/. if- J~
. Enforced rest for 6 weeks (leash)
. Keep patient thin
(1]_'
8uffe~d~a:,~p,~";,::::~~~~~-r[)
~
'------'.
Panoste~is
~-",,\
7," \
~"I:,,,
____
650
Acromegaly 683
Addison's disease
canine 660
feline 658
Adenocarcinoma 677
Adrenal tumor 654,658
APUDomas 667
Beta cell carcinoma 669
Canine
Addison's disease 660
Cushing's syndrome 654
hyperadrenocorticism 654
hyperthyroidism 674
hypoadrenocorticism 660
hypothyroidism 674, 675
Catecholamine-secreting tumor 684
Cretinism 674
Cushing's syndrome
canine 654
feline 658
Dermatology-endocrine 682
Diabetes insipidus 670
Diabetes mellitus 662
Diabetic ketoacidosis 665
DI670
DKA 665
DM 662
Dwarfism 682
Ectopic vasopressin 659
Endocrine diseases 652
incidence 653
Erythropoietin abnormalities 325, 682
Euthyroid sick syndrome 675
Excess ADH syndrome 659
Feline
Addison's disease 658
Cushing's syndrome 658
hyperadrenocorticism 658
hyperthyroidism 672
hypoadrenocorticism 658
hypothyroidism 673
Gastrinoma 667
Gestational hypoglycemia 669
Hyperadrenocorticism
canine 654
feline 658
Hypercalcemia 676,678
Hyperchylomicronemia 671
Hypergastrinemia 667
Hyperglucocorticism 654
Hyperlipidemia 671
Hyperlipoproteinemia 671
Hyperparathyroidism 678
juvenile 679
nutritional 679
primary 678, 679
pseudohyperparathyroidism 677
renal 2' 346, 679
Hypersomatrophism 683
Hyperthyroidism
canine 674
feline 672
Hypertrophic cardiomyopathy 672
Hypervitaminosis D 677
Hypervitaminosis D3 677
Hypoadrenocorticism
canine 660
feline 658
Hypocalcemia 680,681
Hypoglycemia 668
malnutrition 669
gestational 669
.~/~----------------------------------~~
Endocrine System
Hyponatremia 659
Hypoparathyroidism 681
Hypopituitarism 682
Hyposomatotropism 684
Hypothyroidism
canine tumor 674
canine - adult onset 675
feline 673
juvenile 674
Induced hyperglycemia 664
Insulin resistance diabetes mellitus
666
Insulinoma 669
Islet cell adenocarcinoma 669
Juvenile
hyperchylomicronemia 671
hyperparathyroidism 679
hypothyroidism 674
panhypopituitarism 682
onsetDM 664
Ketoconazole 657
Lymphosarcoma 677
Metabolic bone disease 679
Multiple myeloma 677
NKHDS665
Nonketotic hyperosmolar diabetic syndrome 665
Nutritional 2' hyperparathyroidism 679
Pancreatic neoplasia 669
Panhypopituitarism 682
Pheochromocytoma 682
Pituitary cyst 682
Pituitary
dwarfism 682
gland tumor 655
hypofunction 682
Posthypoglycemic hyperglycemia 664
Post-insulin hypoglycemia 664
651
...
ne
Endocrine
diseases
M8k 380; H3S 435,
438; H2B 495; 12M
671; 1M 525; lM-WW
Generally nonspecific
Dysfunction of hormone's
C-
.:m
(1
001
. -
(most secreted
continuously, some fluctuate [weekly, monthly. circadian/diurnal rhythms})
- Hormone transport in blood (thyroid & steroid hormone bind to
plasma protein wI a little free hormone to bind to receptors)
- Immunoassay (radioimmunoassay, enzyme-linked assays{ELISAj)
Skin signs
signs
Physical exam
Concentration of hormone in blood stream
target organ
...::l--,.T
/~
~
Laboralory samples
,,"y '"
Time to ship
Mailing package
Refrigerated
2 day air
Refrigeration not required Regular mall
2nd day air
Refrigerated
Refrigerated
1-5 years
5-1Q years
More than
Hypoadrenocorticism
Hypercalcemia (lymphosarcoma)
Hypothyroidism
Diabetes insipidus
Diabetes mellitus
1 0 hyperparathyroidism
Cretinism
Hypoparathyroidism
Hyperadrenocorticism
lnsulinoma
Nutritional 2 hyperparathyroidism
Juvenile diabetes insipidus
COO," -
cf~
E'd~'M"~
/U~")
- '''''...."
t f::Z;'
~
I
Hypothyroidism
Juvenile hypothyroidism
Acromegaly
o Pituitary dwarfism
o Cretinism
Insulinoma
Oiabetes Insipidus
Hypercalcemia (anal sac tumor)
0 Juvenile hyperparathyroidism
.2 hyperparathyroidism - diet
.2 hyperparathyroidism renal
OM . Nonketollc hyperosmolar
diabetic syndrome
0 OM . insulln resistant
Hypoglycemia - Gestational
Pheochromocytoma
0
p" mooth
' 1 ' . Hyperthyroidism
~ DM - insulin resistant
_.:?_
__ ........
;'
---.".-" (~
~"
.:.,
~
~.
..
~~"
/
- ,,,",,,,
Rare" , p"Ulet;m.
Hyperadrenocorticism
gal
""rome dwariism
y
Pituitary
Cretinism
Hypoadrenocortlc~m
Hypercalcemia (lymphosarcoma)
Hypoparathyroidlsmlhypocatcemia
Hypothyroidism (adult & juvenile)
Insullnoma
Diabetes inSipidus
01 hyperparathyroidlsm
Hypercalcemia
02 hyperparathyroidism diet
.2 hyperparathyroidism. renal
OM Nonketotlc hyperosmolar diabetic
syl'ldrome
Hypoglycemia - Gestational
Pheochromocytoma (1 cat)
0
.-
Diabetes insipidus
"
Not reported in cat
oJuvenBe onset diabetes mellitus
Juvenile hyperparathyroidism
~-----.
ENDO
cism
Hyperadrenocorticism,
Cushing's
syndrome,
Cushing's diz,
Hyperglucocortlcoldlam
VetMed71Q, 1997; M8k 387,
407; Mit. 261, E-hb 565; SAP
240; H3B473; H28534; 12M
775; 1M 587; 5min 690, 40;
IMWW 404; Catl481; C12T
416,421,336,356,Cl1T396t,
345,349,1062,310; E 1538,
R&E-F 187; R&EM 216;
Oerm 635, OCT 273; [)'Sy
102, 151, 192, DMi 275;
PhysB 905, 956, 970; Lab-S
338; Lab-C 220: PaT 258;
SxS-hb503, 758; Sx-S 1496,
2293; Sx48 539: Sx38 431;
SxWW 181; NB9. 7
Causes:
1. PHuitary dependent (85%)(PDH): excessive
ACTH - hyperplasia
2. Adrenal tumor 15% (AT): excessive cortisol
3. Iatrogenic: prolonged steroid Tx - adrenal
atrophy
Breeds: PDH: Boxer, Boston terrier, Dachshund, Poodle, terrier breeds, all breeds can be
affected; AT: Ger. shepherd & toy poodle
***
Polyphagia (PP) (ravenous appetite due to developing OM, cortisol Interferes wI insulin at cellular level)
Dermatologic changes:
- Thin, wrinkled skin (atrophy of skin
due to catabolism, especially abdomen)
- Bilateral, symmetrical, nonpruritic alopecia
(thin, dry, broken hair)
- Hyperpigmentatlon (cause unclear)
- Calcinosis cutla: uncommon
Hematomas after venipuncture, bruising
Pressure necrosls
- Pyodanne (Immunosuppression)
Muscle weaknesslwasting 70% - trembling,
weak, atro~y r:llimb muSCles
Pathogenesis:
1 - PDHlPituitary dependent hyperadrenocorticism 80%
- Hypothalamic dysfunction
- Pituitary gland tumor: #1 Adenoma, 85% (90% mlcoradenomas,
<:
- Small dogs
2 Adrenal tumors 15% (ATs)
- 50/50 rule = 50% malignant (carcinomas: malignant, large locally invasive &
metastasizes); 50% benign (adenomas - smaller); < 15% mineralize on radiographs
- Secretes excess cortisol, independent of ACTH (autonomous)
-. ACTH due to negative feedback resulting in contralateral adrenal hypoplasia
- Usually unilateral
- Big dogs; female> Male
3 Iatrogenic: prolonged exogenous GCC (glucocorticoid) administration (2 to Tx for
atopy, immunological diz, eye. ear medicines)
- Bilateral adrenocortical atrophy
Hormones involved:
- CRH (corticotropin releasing hormone from hypothalamus) stimulates release of ACTH
- ACTH (from anterior pituitary): stimulates adrenal cortex to secrete glucocorticoids,
mineralocorticoids & androgenic steroids
Negative feedback on CRH
- Corticosteroids have negative feedback on ACTH
Steroid excess
CS: PUIPD, Pot bellied, Alopecia
Dx:CS,PE,Lab,Rads;Tests
Tx: Pituitary: Mitotane or Depranil
Adrenal: Adrenalectomy
DOx:
Diabetes mellitus
Liverdiz
Renal diz
Hypothyroidism
Hypercalcemia
Pyelonephritis
Diabetes insipidus
Hyperthyroidism
. Psychogenic pol'ydillsia
Acromegaly
_--.--/
Glucocorticoid effects
Diagnosis & treatment:
Gluconeogenesis
following
page
Lipolytic
Protein catabolic
Anti-inflammatory (suppresses phagocytoSis, lympholyUc & .. Ig)
EN
Diagnosis - Cushing's diz
Hx (steroid Tx)
aD
.+
f-
Treatment of hyperadrenocorticism
PDH
PDH
.+
;I
/111
'-
- Oxygen
- Anticoagulants
+ time
/'..A~
di!'.';~
Prognosis:
,p.
Tf~\~\
iII["1i" r
=- 01
Adrenal Function
Facts/Cause
Condition
Feline
Hyperadrenocorticism,
Cushing's
syndrome, CCS
Mk 261, E-hb 596: SAP 244,
373: E 1510; H2B534; 12M 792;
1M 587; 5mln 890; IM-WW 408;
F2IMI29; Cat1481, 1405;R&EF256; R&E-M216; Phys-B970;
Lab-G220: Pa-T358; Sx3B431;
Sx-S-hb 503, 758; Sx-S 1496,
2293; NB 9.7
*-**
Rare In cats
Chronic exposure to excess glucocorticoids
Strong correlation between Cushing's &
Diabelesmellitus: In most diagnoses after
documentation of Insulin-resistant Oiabetes mellitus
Insidious onset, Slowly progressive
Middle aged & older (10+ years old)
o Female> males
Causes-like dogs:
1. Pituitary dependent (70% of spontaneous cases):
- Excessive ACTH - excess cortisol adrenal hyperplasia
2. Adrenal tumor 20% (AT)
- Excess cortisol
3. Iatrogenic: uncommon
~-;-~.-~, -r;;.r~
ENDOCRINE SYSTEM
Presentation/CS
Diagnosis
Treatment
Hx (steroid TxJ, CS
PolyphagiaIPP (ravenous appetite due to de- -Insulin resistant DM common
Palpation: CS & hepatomegaly
valoping OM)
I
I
"Potbelly", pendulous abdomen
Blood values
- Stress leukogram nol consistent In cats
OermatolOglc changes
t
ALP
not
a
consistent
finding
In
contrast
to
- Thin pin, easily bruised
- Bilateral symmetrical alopecia
dog (alkaline phosphatase)
- t Blood glucose in 80%
Dull, dry hair coat
Pinnal alopecia
-t Cholesterol
o UA (Urinalysis)
Medial curtlng of ear tips
Glycosuria In 80% - OM
- Hyperplgmentation
- Skin Infections (demodicosis)
RadiOlogy:
- Hepatomegaly
Muscle weaknesslwasting
o Ultrasound
o Lethargy
o Presumptiva Ox: CS, PE, Lab & Rads
o Dyspnea/panting
oTeatstoestabiiahdlagnosis(ACTH, HDOST)
o ImmunosuppressiOn
- Recurrent bacterlallnlectlons
w/aimllar results to dog
o ACTH stimulation to diagnose Cushing's
o Sequela:
- POH & ATs usually exaggerated response
- Normal: nonnal increase cortisol
- Diabetes mallllu5 80% 01 cases
- Iatrogenic: blunted or no Increase
PUIPD & polyphagia
LDDST: not well standardized for cat & not
Insulin resistant
- Pulmonary thromboembolism
recommended
- CongesHve heart failure
HDDST: differentlate nonnal from Cushing's,
PDH not suppressed in cat as In dog so can't be
used to DOx POH from AT
PUJPD: 2" Diabetes mellitus
(ijX.L
___
""""
Rare
ADH '" antidiuretic hormone, vasopressin
Ectopic production of AoH despite low
serum sodium (hyponatremia), osmolal-
Ectopic vasopressin
syndrome,
Ity
Ectopic antidiuretic hor- Unable 10 secrete a dilute urine & therefore
mone production,
retain fluids
ExcessADH
syndrome,
Syndrome of inappropriate
secr.tion of antidiuretic
Pathophysiology:
- AOH Increases permeability to waler in
distal nephrons & collecting ducts
- Expansion of extracellular volume
- Hyponatremia (t secretion of Na,'
plasma osmolality, t urine osmolality)
hormone,
SIADH
Cause: StAoH
Paraneoplaslic diz
- Bronchogenic carcinoma
- Thymoma
- Leiomyosarcoma
- Pancreatic adenocarcinoma
- Mesothelioma
- Lymphoma
Anticancer drugs:
- Vincristine
- Cyclophosphamide
o Exogenous AoH administration
Adipsia,
Hypodipsia
SAP 270; IM-WW 386; CI2T
953; CllT 303t, 304,1002
I. Thrist:?
Asymptomatic
CS of Jow sodium 120 mEq/I)
-PUlPo
- Edema
- Anorexia. weakness
- Nausea, vomiting
- Confusion, stupOr
- Seizures. coma
o Sudden t body weight (water retention)
DDx: Hyponatremia
Vomiting & diantlea #1- GI loss
Hypoadrenocorticlsm
Renal Insufficiency (nephrotlc syndrome)
oCongestive heart failure
o Postobstructive diuresiS
Over hydration (1 polydipsia)
Edematous states
Iatrogenic
- DiJretics
- Fluid therapy - hypotonic fluids
Myxedema coma
Pseudohyponatremia
- Hypertipidemla
- Hyperproteinemia (> 10 gfdl)
- Hyperglycemia
- Mannitol therapy
OIz causing excessive release of AoH
Depresslonfstupor/coma
Absent or reduced thirst
o Cause: ? idiopathic, resetting of osmore- Personality change
ceptorthreshold or lesion of thirst center? Disorientation
Young < 1 year old in idiopathic & congeni- o Anorexia
o Weaknessflethargy
tal form
Irritability/seizures
Female miniature schnauzer
o PathophySiology:
- Normal: water loss, mild t in plasma osmolalitystlmulatesosmoreceptors in hypottlalamus to t drinking & ADH secretion
- Adipsia: no extra drinking - hypernatre-
/""":-:~~~~-:...,":"~
Si-
R&E-F 302; R&E-M216; Phys-B970; lab-C222; Pa-T2259; Emrg 224, 255; Sx-S-hb512, 758; SX-S2294; NB9.11
Rare. more being Ox lately, especially in insulin resistant diabetic cats; < 7 years Old, Iatrogenic: steroid or Dvaban Tx
~. CS: Similar to dog: lethargy. weakness, hypothennia
Ox: Sama method as dogs: PE (dehydration), Auscultation: Bradycardia: ACTH stlmulatlon ("Blunted" or no cortisol response);
ECG: depends on t 01 K; Radiology; Necropsy (small adrenal wI thin cortex)
oTx: Emergency: rapid IV normal saline (20-40 mgfkg), Dexamethasone (Azlum): then mlneralocortlcoids (Florinel
I
[lludrocortisone acetatel); Glucocortlcolds maintenance (cats don'! respond as quickly as dogs to fluids & steroids)
Hyponatremia,
.". _..-r ~
ster~
lfJjrru .
dJil
Rare,
excess
CAH (cortropin releasing honnone from hypothalamus) stimulates release of ACTH
00
CS: PUIPO, Pot bellied, Alopecia; OM ACTH (anterior pituitary) stimulates adrenal cortex to secrete glucocorticoids, mineralo00
corticoids & androgenic steroids
0
OX: ACTH, HOOST, Glucose
- Negative feedbaCk on CRH
Tx: ? Surgery ?
oCorticosteroids have negative feedbaCk on ACTH
Feline hypoadrenocortlclsm: Mk264; E-hb602; CI2T421; 1M 597; SAP 238; H28531; 5mln 716: IM-WW404; E 1591; F21M 129; Cat 1490;
I)
Prognosis:
Guarded to poor in cat
.@
tr
p:
-:a..:
';:' ~ ~-:;.O/
~~.
':,%~
a '
->
'--
cs
lob
- Hyponatremia - hallmark < 130 mEq/I
- Persistent high urine osmolality, hypematriuresis, & nonnat renal function
- Low plasma osmolality 275 mOsmlkg)
o Evidence of cancer or antlcancer drug
o Water loading test (give 20 ml of H20 by
stomach tube & measure urine osmolality,
should decrease to < 100 mOsmlkg In normal
- PoSitive if urine osmolality remains higher
ttlan plasma
Bioassay for rumor
o RIO outer cause of hyponatremia
Na < 130
'''-",\
~I
,.
oec,omi;~~
H20 test
~I
LithO~
Hx (miniture schnauzer); CS
opE: dehydration & altered mentation
o Lab:
- Hypernatremia (profound)
- Hyperosmolality (profound)
- Hyperchloremia, azotemia (mild), hyperalbu.
mlnemia (mild), hYPersthenu~
Rad;",.,h"
.~
"",Ily "otmal
,~:.
dany;~
ENDOCRINE
Addison's ** Uncommon endocrinopathy
+GluCQcorticoids &lor mindisease,
eralocorticoids from adrenal
Hypo-
cortex
adrenocorticism
Causes of Addison's
1: diz of ad renals (usually defe of both m;n,oalo- &
- Unknownlidiopathic #1
- Destruction of adrenals
Autoimmune
Granulomatous fungus
HemOrrhagellnfarction
Metastatic tumors
OVerdose of o,p'DDD (mineralOCOrticOidS usually normal)
2: Pituitary ACTH deficiency (glucocorticoid deflclency, min
eralocorticoids usually remain normal)
Iatrogenic - termination of steroid Tx: (sudden) pro
longed or hi doses of glucoconicoids (ACTH suppressed)
- Megestrol acetate (Ovaban$) Tx In cats
Destruction of pituitary or hypothalamus by tumors
- Idiopathic ACTH deficiency (rare)
","""_.1
til
7~
Rt.
- Megaesophagus (rare)
Prognosis:
leads to:
. Hypovolemic shock, +cardiac conduction &
OUlPU~ + blood press, + renal perfusion
. Muscle weakness & nausea, mineralocorticoid
deficiency
, Eariy: normal electrolyte levels, but can'l deal w/
~~;~i~;~~ ~~~~~~aline
- Microcardia
- Small aortic arCh
,',;,
Hypercalcemia 25%
- Maintenance
- Prerenallrenal azotemia (BUN)
Mineralocorticoids:
~
Mild acidoSis
DOCP 1M or SQ, monthly injections
- t Lymphocytes, eosinophils
- Anemia (normocytic, normochromic nonre Florinef tabletsDOC(dru9ofcholce)
generative)
GluCQCortlcolds maintenance not always
. PCV - dehydration
requlred: Cortisone or prednisolone
. Hypoglycemia (rare)
- Steroids on hand for crisis
UA: SpeCific gravity often increased, but mib
Monitor
decreased due to medullary Na washout
. Initially monitor serum electrolytes every 12
ECG: depends on t of K (see box)
weeks until pa~ent stable
. Once stable check Na, K, BUN every 3monlhs
Radiology:
~
ii~
J
_ _ _ _..1._
TREATMENT:
"",,,
Glucocorticolds (CCS) can be defident w/o aldos
Ventricularasloleorfibrillationw/severe
hyperkalemia
r~::.;====--........J
Diabetes
mellitus,
OM
M8k 394, 913; Mk
267; Ehb 576, 318;
SAP249,1168;H38
463, 281; H2B 523,
311; 12M 737, 734;
1M 563, 573(1), 595,
79B; IM-WW 394;
5min 520; E 1510,
706;Catl465,1459,
1555; Cl1T 311;
CI2T 393, 403, 390,
384; R&E-F 339;
R&E-M 194; NSC
383: NS-W202,216,
228; NS3hb 194,
351; NS-hb 192,
331;NS-03S2,270;
NS-L 79; NS-Pa
462;Phys-B 851;
Derm706;Pa-T276;
Sx-S-hb 756, 66; SxS2290,140;NB9,2
***
Types:
""'"
Complications:
- Hypoglycemia (Iatrogenic)
Cataracts (1'101 in cats)
Relative insulin deficit, Insulin antagonism, abnormal
carbohydrate metabolism, some function of 13 cells of pancreas
- Infections (especially urinary tract)
Cats 20%, less common in dogs
DKA (diabetic ketoacidosis)
Some Insulin secreted so mild hyperglycemia & ketoacidosis uncommon
Type 3 . 2 0 Diabetes: associated wI other dizs (pancreatic Lipidosis hepatic
diz, endocrine disorders. drug-Induced (steroids, megestrOl acetate). hy- Pancreatitis (dog, less common in cat)
peradrenocorticism. acromegaly)
Peripheral neuropathy (common in cat
(NIDDM)
Causes multifactorial
Uncommon sequelae: glomerulonephropathy,
glomerulosclerosis, retinopathy, gastric paresis,
r~'rY.""'3el,etiic, drugs (steroids, megestrol acetate), immune
diabetic diarrhea
mediated destruction of beta cells, amyloidosis, hor
monal abnonnalities (excess growth hormone), hypera
drenocorticism (rare), pancreatic diz, obesity & hi CHO
diets, infectious viral dizs
Pathophysiology:
-.Insulin
- t Hepatic gluconeogenesis & glycogenolysis
- .. Glucose uHllzation & impaired glycolysis
- Ketoacidosis (t ketone bodies due to underuse of glucose)
- Results in hyperglycemia & glycosuria (PUIPO [osmotic diuresis], polyphagia, weight loss, dehydration)
Insulin
Regular (crystalline zinc)
NPH (Iosphane), Lente
- Ultralente
Treatment summary
Insulin
Regular short acting
NPH, Lente ~ intermediate acting
PZI, Ultralente long acting
- Balanced diet, feed BID
Exercise ( Insulin requirement)
Home monitor: Keto--Diastix for
morning urine
- AdjuS1 dose (see box)
- Feed 1/2 of day's food
Feed other 1/2 in evening
Patient monitoring
Home monitoring by owner
Subjective evaluation of water intake, urine
output & nonnal body weight; good, not
ravenous appetite; vomiting, diarrhea,
anorexia, weight loss or weakness
Check urine daily for glucose & ketones
prior to evening meal (not in morning)
(TestTape, KetcrDiastix, Clinitest), urine
J'.
monitoring not necessary in cat
<1~ --~. ,N.eg~tive for glucose indicates correct response to
\;~?~
'\ - )
Injections
~ Persistent glycosuria: bring in for inhospital serial
blood glucose determinations
. ~ \ - Periodic serial blood glucose curves in hospital every 2
fJ 4 weeks to adjust insulin dose
' .
\ r
CJ d
Insulin defc
CS: PUIPO, Polyphagia, Weight loss, Caltar~lcts;"':
Ox: CS, Hyperglycemia + Glycosuria
Tx:
Insulin
UA (urinalysis)
(,Jf")
q:IL fl
Glycosuria (KetodiastiX) ~
Ketonuria (KetostiX, Ketodiastix) for DKA
I
10 renal glycosuria
Chushing's hyperglycemia (dog)
Stress hyperglycemia (transient
epinephrinlTinduced)
(no glycosuria)
OM
Balanced diet, feed BID
- Highfiber, highly digestible, complex carbohydrate
die1s (Hill's rid (reducing), wid diels)
Nibblers: Free choice + 2 small meals 01 canned
food; 2 meals for gluttons)
Obesity: gradually reduce over 2-4 monthS: Hill's rrd. Gaines cycle 3
PUIPD (polyurialpolydypsla)
PP (polyphagia)
- Weight loss, many obese until late in un-
ENDOCRINE
Diabetes mellitus
Thin dog & cats: highcaloric, low fiber diet (Vd or pld);
once ideal weight gradually change to high fiber
-Insulin: maintain blood glucose between 100-180 mgldl in noncataract dogs & 100250 mg/dl
in cataract dog & cat (> 80 mgldl glucose strip). Or, in cats, less then 200 mg/dl for 2: 80% of day
n~f ~~
GlucJ~rol ~
functional B cells) control glycemia in some NIDOM cats when used wI dietary Tx & obesity
correction (duration from weeks to > 1 year), wait a month to see improvement in blood glucose;
litHe use In dogs.
, - Discontinue & re-evaluate In 1 week If hypoglycemia or euglycemla (reinstitute if hyperglycemia
retums, Initiate insulin therapy If CS worsen or hyperglycemia over 2 months)
Post-insulin
hypoglycemia
E-hb 583: H2BS27; 1M 572:
C12T 385: R&E-F 198; Emrg
254
**
.
J
Asymptomatic in most
Weakness
Anxiety
Behavioral changes
Muscle twitching. ataxia
00
00
Head tilting
- Cats that regain ability to make Generalized seizures
insulin months after insulin therapy -Coma
started
1/2
(1 gm/dl)
Demonstrate hypoglycemia 65 mgldl)
followed by hyperglycemia (> 300 mgldl)
w/in
24 hours period following insulin
< 1 year old : keeshond & golden: not
in cat;
H2B 523;
CI2T 348
Transient
insulin
response
Evening
PUIPO
Weight loss
r:W
,
Hx (insulin Tx) + CS
Marked morning glycosuria
Hypoglycemicepisode 2-6 hours
after injection
Confirm wi blood glucose curve:
- Hyperglycemia> 250 mgldl wi
in 1Shoursorlessofinsulin Tx,
while lowest level> SO mgldl
OKA,
Diabetic
ketoacidosis
Mk 267; E-hb 579; SAP 249;
H3S 467; H28527; 12M 759;
1M 578; 5min 516; 1518; IMWW395,396; Cat 1470; CI2T
384,394; C11T359; E&R392;
Lab-S 330; Emrg 251
**
D
7,
- PUlPD
- Polyphagia
~ Weight loss
- Vomiting, diarrhea
- Acetone breath (JuiCy Fruit odor)
- Kussmaul respiration (slow,
deep breathing due to acidosis)
-Coma
I i3i
~j..j,~f
~
\
I-::-- f
arA
--=--
~
I
o$evere form of OM
Hyperosmolar blood, no ketones
- Pathophysiology: osmotic gradient between intracellular & extracellular com~rtments 01 brain
- Causes: cellular dehydration & dysfunction
~
.. :
'f
f
~
--,.
~
r - ()
-Early: PUIPO
_Weakness
}
_Vomiting
- Thirst may diminish even wI increasIng hyperglycemia
oCNSsigns
. Mental depreSSion
-Grand mal seizures
- Hemiparesis
. Hyperre""".
-Musciefasclculatlons
Ny".gm"
,
00
cO
2. Starvation/fasting
3. Dehydration
4. Diabetogenic hormones (Gce, gluca-
Cat
cemia
'-
- CS of hyperglycemia
- Continued PU/PD
- Weight loss
**
665
Emergency
Rehydrate & maintenance fluids
-:ai~ ~:!~~::~male~,,\>.11endl:a.c:b.,~
Physical exam:
- Dehydration
- Check for coexisting disorders
(acute pancreatitis)
oHx,es
- Physical exam: dehydration, hypotension
& mental depression
- Hyperglycemia often above 800 mglml
Serum osmolality> 350 mOsmll<g body
water (normal 290-310)
oMost have renal orprerenal azotemia (BUN,
creatinIne)
NO kalones, but may be aCidotic
OOx:
o DiabetiC ketoacidOSIS
tJf1f11
f
"\>
Prognosis:
Guarded to poor
..
ENDOCRINE SYSTEM
Diabetes mellitus
Condition
Insulinresistant
Diabetes
mellitus
Facts/Cause
Normal amounts of insulin result in
subnormal response
Presentation/CS
CS of diabetes
- PU/PD/PP
**
Diagnosis
Treatment
Tg'
/..:
Insulin
/I~
,/
Gastrinoma,
ZOllinger-Ellison
syndrome,
APUDomas,
Hypergaslrinemia
Mak 398; E-hb 603: H2B380;
412: SAP 661, 662: 12M 771:
1M 586, 297, 331; Smln 360,
614: IM-WW 410; E 1593:
C11T 370: R&E-F 442, Cat
1464: Sx-WW 189
Rare
Gastrinomas (Islet [APUDJ cell tumors of pancreas)
- Malignant, gastrin-producing tumor
- Most in right lobe & body of pancreas
- Small<2cm
- Metastasizes (75% of cases) to liver belore Ox
Signalment: female:male 2;1. older animals, rare in
calS (2 reported)
Pathophysiology:
- Excess gastrin, t hydrochloric acid (HCI) - gastriC
ulcers
. Gastric mucosal hypertrophy; delayed gastric emptying, esophagitis (renux): diarrhea & steatorrhea
Gastrin normally secreted by gastric & duodenal
mucosa
Suspect if severe ulcers + gastric mucosa hypertrophy, or responsive ulcers that relapse when Tx slopped
PE (physical exam) unremarkable
Persistent serum gastrin levels (each
lab has own normals) 3-100 x not routinely measured
Provocative stimulation
- High protein meal (Hill's pld)
- Normal: Double levels in 30 minutes,
little response If hypergastrinemia
Regen8fatlve anemia (50% of cases)
blood loss
Radiographs: contrast - ulceration,
esophagitis
Ultrasound: pancreatic mass
Endoscope: ulcer & mucosal hypertro-
fG'.
~::[]
;;;::;;;r:=~
Prognosis
Grave for long term - many highly malignant
Guarded to poor for short term
Hypoglycemia
Condition
ENDOCRINE SYSTEM
PresentationlCS
Facts/Cause
Diagnosis
Treatment
Treat
underlying cause
DDxlCauses - hypoglycemia
eNS, renal, liver, RBCs
- Surgery for hyperinsulinism
- Minute to minute BG controlled by:
- Juvenile-onset
Glucagon (alpha cells 01 pancreatic islets) - t BG
or extrapancreatic neoplasia
- Puppies (neonatal)
Insulin - f BG
- Chronic hypoglycemia
-Transient juvenile hypoglycemia
- Fasting:
- Portosystemic anomalies
- Constant calories: protein, fats & /
- Glycogenolysis (liver) maintains for 24 hr., then
- Glycogen storage dizs
complex carbOhydrates), avoid simple sugars
body protein (muscles) & glycerol from tat for
Adult
- Limit exercise
glycogenesis
- Insulinoma (common)
- Dogs & cats OK for days to weeks of tasting (unlike
- Steroids when diet no longer effective
humans), adaptation to wild
- Insulin overdose (common) iatrogenic
- Diazoxide (Proglycem)
Exception: puppies & toy breed
- Extrapancreatic neoplasia (esp. hepatic)
- Thiazide diuretics (potentiates)
dogs: hypoglycemia w/in hou rs7-=0-,-fL--'-, - Severe liver dlz
Insulinoma (see below)
fasling
See pg
***
fA
421,
418,
581,
669 also
J:Jtf
-/
neonaI e
*** -
'"
Gestational
hypoglycemia
**
Insulinomas,
Islet cell neoplasia;
Beta cell neoplasia,
Pancreatic neoplaSia, Beta
cell carcinoma, Islat cell
adenocarcinoma
M8k 397, 906; H2B 548; E-hb
572,321; IM-WW400; E1501;
SAP 257,1166; 12M 766; 1M
562, 745; cat 1464, 1535;
5min 734, 930, 162; R&E-F
422; R&E-M 198; NSW 202;
NS3hb 194, 353; N8-HB 192,
333; NS-O 269; NS-L 328, 89
NS-Pa 246, 472 Phys-B 872;
Pa-T 279; oox 553; Sx-S-hb
515,683, 756:Sx-S 1536;SxG206; Sx-WW 188
BG = blood glucose
Persistent crying
Weakness, activity
Decreased nursing
Respiratory distress
Convulsions, Coma
Weight loss of > 10%
Hx (failure to suckle), CS
Physical exam
~tj
See Repro pg 421: Rare; Bitch's diets deficient during pregnancy, hypoglycemic last of gestation; t in dead puppies at birth & 1st 3 days, hypocalcemia (failure to respond to Ca Tx)
CS: f Food intake & activity, Vomiting, Rapid respiration, Abdominal straining, Prostration, Acetone breath
~
Ox: Hx (last gestation), CS, Acetone breath, Ketonuria, glucose levels < 70 mgld!, Response to Tx, CheCk lor concurrent hypocalcemia
oOx: Hypocalcemia
Tx: IV glucose in normal saline solution, Frequentleeding, Parturition or cesarean section alleviates problem
Prevention: proper nutrition throughout gestation
**
Old dogs, Hypoglycemia
CS: Seizures, CNS
Ox: Hi insulin wI low glucose
Tx: Medical or Surgery?
Episodic in nature
- Weak in hind limbs to seizures
- See CS 01 hypoglycemia
Seizures (0.5-5 min) > syncope
com~ (see Ne~ P9 581)
- WeIght gam
CNS: proprioception deficits depressed reflexes
mu~le atrophy ~-l>
~ ,}
.!
Hydr~Diurii
669
:::=:2ra=:S;;;;::7
D.
Steroids
'.~
<fiil'
Diabetes insipidus
Facts/Cause
Condition
Diabetes
insipidus, 01
POIPU (pOlyurlalpoolydypsla)
~~
l(
~~
**
20
~-~"
DOx:
- Diabetes mellitus
- Hyperadrenocorticism
- Hyperthyroidism
- Hypertension (severe)
- Liver diz
- Hypercalcemia
- Chronic renal failure
- Pyelonephritis
- Hypokalemia
- Hyperviscosity
syndromes
Hyperlipidemia,
Hyperlipoproteinemia
M8k 1640; E-hb 543, 544, 151,
652,249; SAP 1199; H3B 481;
H2B543; IM-WW410; 5mln240,
725; E 1410,1414; 12M813; 1M
613,436
Diagnosis
Treatment
Central 01
Hx, CS (PUIPO)
PhySical exam: usually unremarkable, mlb
ENDOCRINE SYSTEM
Presentation/CS
- Water deprivation
unlimited water
Repositol vasopressin
(Pitressin tannate) 1M
Synthetic vasopressin (Desmopressin acetate DDAVP)
1 .025)
1.025)
out
val
Chlorpropamide (Diabinese)
+ ADH
ADH 1.025)
Carmustine (BCNU)
DI
- Nephrogenic
- Tx predisposing cause
- Not mandatory if unlimited water
- Psychogenic
- Nothing, behavior modification,
- Psychogenic: concentrate
(> 1.025)
- Central or Nephrogenic: no re-
slow restriction
sponse 1.025)
-Gradual H20 deprivation +AOH
- Central: concentrates (>
1.025)
- Nephrogenic: no response
1.025)
~@dd
Prognosis:
~;'~11
~ @i) r
idiopathic or congenital.
- Guarded if trauma Induced
- Guarded to grave: tumor
- Nephrogenic: depends on response of underlying cause
- 10 NOI (rare) guarded to poor
- Psychogenic: good
;::========"====::!'-________..J
DDxlCauses: Hyperlipidemia
- 2 to underlying
Obesity
- Late pregnancy
- 10
~'(l;
"1"'<
@J
Thyrotoxicosis,
Feline
hyper1hyroicIism,
Thyrotoxic
MBk 419; Mk 284; SAP 221; Ehb 561, 417; H38451; H2B511;
Smn708, 98; IM-WW 392', 12M
(history),
(clinical signs)
myocardial diz,
2 0 hypertrophic
cardiomyopathY,HeM
-Common CS
- Looks healthy
- Weight loss (95%)
- Polyphagia
Laboratory:
- CSC: stress response (leukocytosiS & eosinopenia), t PCV (50%)
- Frantic, anxious, aggressive t Resting T4 (multiple samples) (normal", 15-55 mmolll; 12-43 nglmt)
uncommon
(70%)
-t Free T4 in early cases
Cause:
o Nuclear imaging (technetlum-99 pertechnetate) taken up in thyroid shows thyrOid
-Thyroid hyperplasia/adenoma: func- eNS: hyperactivity. weakness
breathlessness
143; H-TIM 295; H-F 734, 255, Mechanism of PU: unknown
PUIPD (50%): renal
459,565; Cat 1416; R&E-F 118;
- Medullary washout &lorthyrotoxic GI: vomiting (40%). diarrhea
R&EM 274; Phys-B 902; Lab-C
334; F-N 401: F3rM 155; F21M
psychogenic polydipsia
222; PaT 266; Sx-S-hb508; SxS 1517; Sx-WW 183; Sx4B 542
&
<:(f)1!.
&if
A-~-~d-~
__
~--::-&'~
/r-=
OS",,,
/
r/
-.4,.'/ ~..--
~@I/?))rr ~
~~~
d-
C~
Pathophysiology - heart
HR&
contractility)
-Increased sympathetic ANS: t heart
activity
-Indirect effects: increase demand on
~k;1
~~s
~
heart (t metabolism)
il?i
~
UO'.J.Ut
,
'-
'~DDX:
~ia, i~f!ammation,
1,-r.-""',
.-
Cardiac complication
~~='=======t:==-~=======_
o Stabilize before above Tx
~
Arrhythmias
Propranolol (lnderaJ)
, f3 blocker fOr Sinus tachycardia, supraventricular or ventricular arrtlythmias
CHF clinical signs:
- Hypertrophic cardiomyopathy
Diuretic (furosemide [LasiXJ)
Diltlazem (C8rdlzame), digoxin or propranolol (Inoeral) carefully
- Dilatative (rare)
Furosemide (LasiX)
, Digoxin (contractlllty)
Thoracocentesis (effusions)
ACE Inhibitors (captopril [CapOIe] or enalapril [VasoteC])
.. Antithyroid Tx
:::>
e \\\\
Tapazole
insuffiCiency)
r:~~ ~\
~
pancreatic exocrine
- Hepatic diz
- Cardiomyopathy
Prognosis:
- Uncomplicated cases: good
- After correction of hyperthyroid state
Good: hypertrophic cardiomyopathy usually partially reversible
Poor: dilative cardiomyopathy usually not reversible
Feline hypothyroidism:
SAP 220; H38 447; H2B507; 5min 726; IMWW 390; 12M 719; Cat 1452; F31M 147; F21M 150; R&EF 111; R&EM 68; Phys8 935; Lab-G 227; PaT 266;
Extremety rare in cat, Cause: #1 Tx of hyperthyroidism (usually transient)
CS: Asymptomatic, dwarfism/cretinism,lethargy, mental dullness, seborrhea sicca, dry halrcoat, obeSity, bilaterally symmetrical alopecia does not occur
~
Ox: Hx, CS, subnormal resting serum T41evel that falls to respond to TSH stimulation
~ oTx:T4supplementation
~-:::;)-2f.~
Px: Adult good, CongenItal guarded
*
n?
_
"'V".
""'4
I
Hyperthyroidism
Condition
ENDOCRINE SYSTEM
Presentation/CS
Diagnosis
Treatment
Enlargement in neck
Goiter - ventral cervical mass
- Usually nonfunctional
Pressure or Infiltration of adjacent areas
Dysphagia (difficult eating), weight loss
Cough, hoarseness
- VOmiting, anorexia
- Dyspnea (difficult breathing)
- Precaval syndrome (edema of face, neCk,
forelimbS)
- Homer's synctrome
Rare: hypocalcemia if medullary carci
noma; usually eucalcemic
Rare: 10% hypel1unctlon (PUIPD, weight
loss, wI Increased appetite, weakness,
heat intolerance, nervousness)
Cardiac Signs - inSignlflcant compared to
tumor importance
Facts/Cause
Canine
Rare
Tumors large, invasive carCinomas
hyperthyroidism,
Usually not hypel1unction (no hyperthyroidIsm)
.90% malignant tumor
Metastasize to lungs
Mk 284; SAP 224; E-hb 567; 10-15% of all head & neck 1umors: dog
- Old - 9+ years
H3B454; H2B 514; 12M729; 1M
558; 5mln 708; IM-WW 394; E Cause: unknown, iodine deficiency?
1484; R&EF 166; R&E-M 74; PathophysiOlogy: malignant carcinoma (90%)
- 213rd unilateral, ectopic sites (cranial mediPhys-B 932, 945; Lab-C 227;
astinum base of tongue rarely, most in thySx-5-hb 509~;
Sx-S 1522; Sxroid gland)
WIN 183; Sx4B 542
- Locally Invasive, high metastases at lime 01
diagnosis (lungs, lymph nodes)
- Boxers, Old Eng, sheepdogs, Shelties,
Golden retrievers
Medullary carcinoma: rare
- Benign adenomas: less common, little cliniI
cal Importance, usually incidental finding at
necropsy: boxers - rare
fJ;rass, 90% Malignant
C5: Cervical mass
Thyroid
neoplasia
*~
s:,~
a.
Juvenile
Hypothyroidism,
Cretinism
Mk280: SAP 218; 12M 703: 1M
544; E-hb 568; 5min 726; E
1487; F31M 151; H-T/M 300;
Ne0243, 385;C12T346; Cl1T
310; Pa-T 266; SxS-hb 507;
~~
8,81515
6~~
Canine
Adurt onset
hypothyroidism
;i'~
***
~i
,~
r
'
- -
71--1L....
.,
<
....
Dullness, lethargy
1 of most over diagnosed dizs
Tiring (exercise intolerance)
Hx (history), CS (clinical signs)
"Heat-seekers": cold intolerant .Best:unresponsivenesstoTSH
Skin changes
stimulation test
Alopecia: symmetrlc~truncal
- Resting level, TSH stimulation, 4- 6 hr later
alopecia
level
G
'
'jfJil
-"Rattall",Flakes
_ < 2_0 J.l.gtdl t of T4
- Hyperpl9mentation
_ "Tra9Ic' facial expression (thickening of Very low resting T3fT4 with CS& no
skin on lace, puffy - myxedema [thlckenother Illness highly suggestive, but not diagIrg of dermis])
nostlc as other dizs & drugs can lower
Weight gain wlo increase in appetite
- 11 normal basal levels, not hYPothyroid
Reproductive:
- Differentiate from euthyroid sick
_ Male:" libido, testicular atrophy,
syndrome (lowT4) & T410wering drugs:
hypospermla, infertility
responct normally to TSH suppression test
- Female: anestrus, sporadic cycling, in- Biopsy: differentiate 10 from 2<' (histo)
fertility, abortion, poor litter sUlVival
UA: NSF (no significant findings)
- Galactorrhea (25% of intact bitches)
Blood values: ".bO$&f"'O::=ll"=_~
BleeCfng lisorders
,
lJ.I U
- Exacerbatlon 01 Von Witlbrand's diz?
- Anemia: nonregenerative
CNS penpheral neuropathy~are (normOChromiC, normocytic) 25-40%
- Draggln9 of front feet
(J 7
t Cholesterol (;;:: 75%)
- Lateral head tilt
- Trl91ycerldes
- FaCial nelVe paralySIS
- t CK (creatinine phosphokinase)
,,,,,,,
Other pttuitary signs
ObeSity
E
- xerclse Intolerance
response,
Tx: L.thyroxine
(T.)
- HypogonadIsm
->'
.'
gain, Low
Pyoderma pruritus
A,I
-~
~
I;
HyperadrenocortiCism
- Hypoadrenocorticistn
_Diabetes mellitus
.".
~~~~~~n~~~~~~!~:k~r:t;~~:~"
- Myxedema coma
Cardiovascular CS
Cretinism/dwarfism see congenital above
Eye (rare) corneal lipid deposits, Chronic
Bradycardta
uveitis, 2" glaucoma, KeratoconJunc\lva
Weak apical beat
-::-::-:::-"~~----=~'-----:'~-~Ji'_'~'~'~'-:--:-----::~___n~o~tJP:r~o::v~e:,:n'-Jf-
Pro9nosis:
Poor lor carcinoma or large masses (ma.iOrity
of cases) - sUlVlval < 12 months
Good for adenomas & small tumors (minority)
~~E~~!ratiVeanemia ~~
. ;- :~'Si_kln problems
.... ~
,< Ta , T4
DDx: I
,...,. ~
type,
Benign tumors
- Abscess
Granuloma
Salivary mucocele
- Thyroglossal duct remnants
Stunted growth
HJ: (neonate), CS (clinical signs)
Disproportionate dwarfism
Physical exam: goiter
- Broadened skull
Low T3IT4 before & alterTSH stimulation
- Protruding tongue (macroglossia)
- Normal: 15-25~gldl may be 1020x higher
- Lateral strabismus exophthalmos
than adult
t
,Q
- Distended abdomen
Radiography:
- Rare
Slows cellular metabolism
< 1 year old
Causes:
- Thyroid dysgenesis #1 in dog
Dyshonnonogenesis: rare cause In kittens
- Transport abnormalities
- Golterogens
- Severe iodine deficiency
Pathophysiology:
- .. Metabolic rate
- Growth plata problems
Prognosis:
Poor: most die before weaning
Mental retardation likely if Tx started after
3-4 weeks old
NelVous disturbances usually reversible, Skeletal malformations may be reversible if animal
treated aggressively before 8-10 months old
iL-thY~1~
Monitor Tx: CS of overdose
- PUJPD, nelVousness, WI. loss, t appetite,
panting, lever
Ox: Elevated T4 &Jor T3, amelioration of
CS by discontinuance of Tx
-Access 1-2 months afierTxstarted
Haircoat & body weight
Prognosis: Good
r::=---,-----:::::-:------:-~::l.<~=-___L_ _ _ _ _ _ _ _ _ _ _ __
't
\]
/Ili
Ox: Biopsy
Tx: Sx Px: Poor
~"
DO"
r.-f
. Cushing's
~~~;~~~IIi;~;""
~~~~;:~~:;~r.::'~::'1
..
-~
ENDOC
Hypercalcemia
PU/PD
eNS depression, seizures
Gl: anorexia, vomiting,
constipation
Muscular weakness
Fine muscle fasciculations
**
Sequelae:
- cardiac arrhythmias (rare)
see Cardio pg 240
- Soft tissue mineralization
- Renal tubular dam ge
Nonpathological conditions
- Young age
- Laboratory error, hemolysis, lipemia
Hyperproteinemia
- Hemoconcentration
Pathological conditions
- Malignancy
Lymphosarcoma #1
~.
.
.. (
.
/D
- Hypoadrenocorticism
~')
- Chronic renal failure ( mild hypercalcemia)
0
~
- 1 Hyperparathyroidism - parathyroid tumor #1 ~
Bone lesion: metastasis, sepsis, disuse osteoporosis
Acute renal failure
aJ)
Hyperparathyroidism
- No neoplasm found
- Chloride:phosphate ratio greater than 33
- Marked phosphaturia
- t PTH wI normal kidneys
- Hypervitaminosis 0
Cholecalciferol-containing rodenticides
.;;~ Q - ~
r:-"':::"'--~~.J_:::"=--.J_-, (Fl~rnp"ge" OuintoX, Rat-Be-Gone) ~
Malignancy - Lympho
House plants: Cestrus, jessamine, Solanum, Triestrum
ECG:
Treatment:
Pseudohyperparathyroidism: malignancy #1 cause 01
.,~t..._~ Aggressive Tx If azotemlC
hypercalcemia (paraneoplastic syndrome) in dogs & cats
IL~;:;.;):;:-'r"':' hyperpnosphatemla or dehydrated
Lymphosarcoma
~
- 0.9%% sodium chloride (NaCI),~~
#1 cause of hypercalcemia in dogs
volume expansion & diureSIS
I
Furosemide (LaslX) requires high
,. 20% of affected dogs
to
Increase
secretion
of
Ca
dosages
40% 01 lymphoma, hypercalcemia dogs have anterior mediastinal mass
. Thiazide diuretics contraindicated (f Ca excretlon)1
.. Biopsy of lymph node, organs or bone marrow to diagnose
- Steroids helps, but make definitive diagnosis difficult
- Sodium bicarbonate may help when combined wI diuresis
Documented in cats, but at much lower frequency
Lymphosarcoma: chemotherapy
Tx: steroids will lower serum calcium, but makes subsequent identification of lymphoma difficult
Hyperparathyroidism: surgical removal
Multiple myeloma: 15% hypercalcemic; Tx: chemotherapy, long term survival recorded
Nutritional PTH: confinement, diet
~ Adenocarcinoma (apocrine) of anal sac: old female dogs, 90% hypercalcemiC, usually malignant,
Multiple myeloma: chemotherapy
metastasized to regional lymph nodes at time of diagnoses
Adenocarcinoma of anal sac: surgical excision,
Tx: surgical eXCision, radiation & chemotherapy
radiation & chemotherapy
Prognosis: Poor for long term survival, tumor usually recurs - 2-21 months survival time
Hypervitaminosis 03: stop Ca
Hypervitaminosis 03: Causes: iatrogenic vitamin D intoxication (dietary supplementation, post-vitamin Rodenticide toxicosis: low calcium diet, phosphate
therapy for hypocalcemia); cholecalciferol-containing rodenticides (Rampage, OuintoX, Rat-Bebinders, avoid sunlight, IV fluids, furosemide, predGone): gaining popularity over anticoagulants because no resistance & no secondary toxicities it rodent
nisolone
ingested
Hypoadrenocorticism: supplement
CS: Vague, related to hypercalcemia, sequela: renal damage, duration weeks
Renal failure: kid diet,
- Ox: Hx of exposure, hypercalcemia often severe 1520 mgtdl, associated with hyperphosphatemia;
fluids, restrict Na
azotemia (renal damage)
- Tx: Stop supplementation ortherapy; Rodenticide toxicosis: low calcium diet (Hill's kid, u/d & sid, restrict
Prognosis:
milk products); phosphate binders that don't contain calcium (aluminum hydroxide [Amphojel)); aVOid
Lymphosarcoma - guarded to good
sunlight; if severe, aggressive IV fluids, furosemide, prednisolone &lor calcitonin for several weeks
.1 0 PTH: Good, most tumors benign
- Prognosis: Good if aggressive, complete recovery if early Tx
Multiple myeloma: Guarded, long term SUlVival recorded
Adenocarcinoma of anal sac: Grave for long term sUlVlval
Hypoadrenocorticism: 20% mild hypercalcemia 15 mgldl), ionized fraction usually normal
Hypervitaminosis 0: Good if early
- Prognosis: correction of hypoadrenocorticism resolves hypercalcemia rapidly
Hypoadrenocorticism: Good
Chronic & acute renal failure: see 2 0 renal hyperparathyroidism
Chronic renal failure: Poor
Nonpathological conditions:
- Young age: have a mild hypercalcemia 13.0 mgldl) due to skeletal growth
Laboratory error: hemolyzed or lipemic blood samples false I
Hi Ca of malignancy, 10 Hyperparathyroidism
Hi Ca + Low P =
Hi CA + Hi P + noma! BUN = ViI. D toxicity
Hi Ca + Hi P + Hi BUN =
10 renal failure
Hyperparathyroidism
Condition
Facts/Cause
Primary
hyperparathyroidism,
Hypercalcemia
M8K 401: Mk 481: Ehb 555,
558(F), 645; SAP 233, 236:
H3B 459; H2B519: 12M 693:
1M 537: 5min696,204: IMWW
288: E 1444: C12T 351, 963,
1000: C11T 376; Cat 1452;
R&E-F 455: Phys-B BSS, 894:
Lab-C 235: Pa-T 272; X-T 34.
25; Sx-S-hb 511: Sx-S 1527:
SX-WW 187: NB9,17
**
Presentation/CS
ca & P ab~rptioo
ENDOCRINE SYSTEM
Diagnosis
Many asymptomatic
Renal
Hx (older dog)
suspect in older dogs
wi
Treatment
hypercalcemia
evidence of malignancy
Physical exam:
- Urinary tract calculi CS
_Often normal In dog, no palpable mass
Listlessness, depression
. Calculi wlin urinary tract
Anorexia ~)
- Cat: palpable celVical mass - 50%
GI
~:. Blood values:
tS - ,
I
_ Pu/PD (ADH inhibition)
_Vomiting
"'i:
roid tumor
Prednisolone If nollymphosarcoma
.!
coma
- Lameness - stiff gait
.. Normal: hypoalbuminemia
.. ~creased: 1 hypoparathyroidism, eclamp-
_ H~~~~~:~~~~sphatemla
- Shivering
- Constipation, ObstiPatlO~j
, - - " hallmark
- Almost all solitary adenoma, check all 4
parathyroid glands 1st, tumor should be
- Pancreatitis (rare)
,
'. . Corrected for albumin: Ca + measured Ca _
large & others atrophied, making them
Neuromuscular
1,
albumin + 3.5 for dogs
,
hard to find
_ Muscle weakness
/.
~ . Ionized calcium (biologically active): ~c
~
Remove 3 of 4 glands in hyperplasia
b
d'
. Raised in 1 PTH&2"totumor
otJ
D
rOWSlneSS, 0 tun atlon,
. ornormal In renal failure
c
- Most will become hypocalcemia w/in 96
_ R~:~i~~ tViiO
- S~izures
..
-~temla (BUN, creatinine), tAL:, ALT
t Caleemia & norma! to. phOsphorus & : c:r~lovlascnUlar: ECG abnormalities
- High ~TH ~alues ~uggestlve, wlo
bone resorption
S eet~ (u ~ommon)
.
azotemIa _ diagnostic
.
...
- DemlnerallzalJon (maxilla & man
_Inhibits l19uromus~lar activity, dlrectceldibular lamina dura)
PTH low wI tumors
_Fibrosa osteodystrophy
. High PTH & azotemia PTH or renal lailurE!
lular toxl~lty (c:alc~um nephropathy), soft
tissue mlnerah7atl.on
~
_ Path I I II ct
~
Urinalysis (UA)
fiO-:1
-- g
, Renal damage In time
I
0 og ca ra ures ~
~
rJI'"
.
Facial swelling
<;.
- Low SpG <1.015 (Can interference wI AOH)
Causes:
7.
w - 2 bacterial cystitis/cystic calculi: hematuria,
#1: SOlitary parathyroid adenoma
\
Se~elae
.
~"j
I
pyuria, bacturia, crystalluria (uroliths - calcium
. all
'\
-2 Renalfatlure
phosphate, calcium oxalate or combo of two)
_ d
Cy"",a enoma: occaSion y In c a t ,
R d I .
II
I f
.
Parathyroid carcinoma ('nlreq 001)
a 10 ogy. usua y norma, except or po$SIble un.
I
U
nary calCuli
oPara~yroldhype~laSia(rare)
..,
~.
/"\...12
- Loss 01 lamina dura line around teeth
: Ectopl~ parathyroid adenomas. (usually cranial mediastinum)
f~
Rule out malignancy _hypocalcemia also
.), ~" Ultrasound: normal parathyroids not visualized, il
Hereditary neonatal parathyroid hyperplasia ( r a r e ) " /
adenomas> 5 mm seen
Solitary parathyrOid adenom~~7
I
I
RIO other causes, esp. malignancies
CS: None, PUIPD, Nervous
)
- cec. Chern, utA, radiographs, lymph node or
OX: Hi Ca+, PTH
~"....,
l.
bone marrow biopsy
Exploratory celVical surgery (IV methylTx: Surgery
ene blue to help find parathyroids)
oes,
~'/J
,_tZ
convulsion
IV or
sa CalCium treatment
Monitor
ProphylacticVit D3 calcium after surgery
if presurgery levels> 14 mgldl Ca
- Monitor Serum Ca bid: OK if above 8 mgldl,
most hypocalcemic between 26th day al
ter surgery, supplement until stabilized
then gradually withdraw
- May recur after surgery so periodiCally
Check Ca levels
/'(t<
"1;""
( a!J
Juvenile
hyperparathyroidism
CI2T351
0
Good,
hyperparathyroidism in cats E-hb 558, SAP 233: 5min 696;E 1456: R&E-F 494
~
Renal2 C
hyperparathyroidism
**
/111
Ox: Palpable parathyroid mass In 3 of 7 cats; Serum ca levels 11-23 mg/dl: Radiographs: thin cortices
Tx: Surgically remove parathyroids
Lameness
Weak bone & lax ligaments
_ Reluctanceto stand or move
_ Abnormal gait r v .. -~
.
\..boo ~
Skeletal pain
~ (!)
,
r-
IAII meatdietl
V '\ -
;.
"Tc"',"Yf~ct"~~f
Prognosis:
&
F\
bI
".
10-20% have mild hypercalcemia, the rest
have less or normal levels; associated with
hyperphosphatemla
Pathophysiology:
- Hyperphosphatemla Irom' renal excretion, inhibits Vit 0 lormation
- low Vit 0:::. gul Ca absorption
- Low Ca = t PTH secretion
Increased mobilization of Ca from bone
GeneralizedOSleoporO$is. commonly seen
in cancellous bones 01 skull
High phosphatemia + hypercalcemia leads to
soft tissue mineralization
- Exacerbates progression of renal failure
GI signs
- PU/PD, vomiting, oral
ulcers
Bone demineralization
- Osteopenia & potential
pathologic fractures
- -Rubber jaw": replacement
of bone by fibrous tissue
Sequela:
iI
,",""":::,~==r='=r'i'
Radiology
- Neuropathy
.
_ Small irregular ....i
- Bone marrow suppression
n,in,erali.za.tion
Mineralization of soft tissues ~~-'. - Soft tissue
- Myopathy
~1.
-Insulin reSistance
,
?"
- Pruritus
...f.
&
+ avoid stress
"'d)
.Intestinal phosphorus binders
Aluminum hydroxide (AmphoGel, Tums:)
Monitor serum P every 10-14 days until
normalized & then monthly as needed
oCalcitrioi/Vit D3 (Rocaltrol) to inhibit PTH,
(iiiD" reJ
Prognosis: Poor
Hypocalcemia
Condition
ENDOCRINE SYSTEM
Hypocalcemia
12M 698, 829; 1M 626, 540,
541; Ehb 277, 55B; SAP 234,
72:H281384,517,I277;5MIN
206; E 1457; CI2T 370, 378;
C11T301,305,376, 1062; HF
577: H-TIM 313; Cat 1463;
R&E-F 497; R&E-M 163, 173;
Sx-Shb8, 514, 509,558: SxS
1457
Diagnosis
Treatment
Hx
(hiStyory),
CS
(dinical
signs)
Eliminate
cause
Asymptomatic to severe
Physical exam: complete
Supportive Tx, pending diagnosiS
neuromuscular dysfunction
t
1 -4])
- calcium gluconate or
Neuromuscular excitability Auscultation 1
calcium chloride slow IV
- Tremors, twitches (face & ears) Serum calcium < 6.5 mg/dl
8.5-9.0 mgldl), if normal serum albu Toxicity signs: bradycardia &
- Tetany, muscle spasms
mirVprotein total & ionized if possible
shortening of a-T Interval
\...7)
- Stiff gait & ataxia
Asymptomatic 7.5-9 mgldl dog
ca gluconate may be given SO
/'
Presentation/CS
Facts/Cause
Low serum Ca .. < 6.5 mg/dl
Clinically significant hypocalcemia uncommon in cat
Protein bound & ionized fractions
- In hypoalbuminemia, the ionized fraction
is assumed to be normaf
- Adjust calculation In low serum total pro
tein or albumin concentrations
Severity of signs due to magnitude, rapidity
of onset & duration of low calcium
- Hypersensitivity to stimuli
**
- Disorientation
..-:-__--'=--:=::.._L"--,-,,.,-___,
Neuromuscular excitability
CS: Tremors, Tetany, Panting
)\
.C~~5~~~C!~dl
Behavior changes
- Restlessness, aggression,
panting, facial rubbing
* Bradycardias
(I .;:tjJ
PUIPD. vomiting
Ij
_
Hyperthermia ...-:
~
'S~'"I'd'
.bdom,L._
J?,
7,
,.,. "
in _
ij)
otCataracts
(!
Ow
or precipitatlon
g;~::::~'m;'&"ka~loslsmaY:aise!Y
ECG:
0;:
- Prolonged Q-T
- upp ernen
a or I e
-*oral
Phosphorus: kidney diet,
phosphate binders
2 hypoparathyroidism:
supplement until
resolves
- Maintenance
- Short term hypocalcemia & tetany
. so injection of Ca gluconate usually enough
- Prolonged state - hypoparathyroidism
. calcium
Ca gluconate every 6-8 hours until oral
& vit D~ supplements effective (mOllltor
Ca serum concentrations SID, stop SO once ca
- Acute pancreatitis
- Nutritional 2 hyperparathyroidism
- Dilution (P or Ca free fluids)
- Idiopathic hypocalcemia
- Hypovitaminosis D
Calcium chloride is
_ Hypomagnesemia
caustic outside vein
sa
> 8 mgldl
-Chronic maintenance Tx-idlopathic
hy!~arathyrOidiSm & bilateral thyroidectomy in
__________~Oc-~P~n~'m~a~~~re~n~a~l~d~i~Z~(~C~hro~";~'~o~'.~~~1~'~~~"~'~"~'~ilU~~~)====================~==========
. .;,..-
-sa
interval
4J~------1--
OOX - hypocalcemia
See also pg 240, Severe hypocalcemia
Puerperal tetany/eclampsia #1 wI CS
421, 581 & 681
_ Hypoparathyroidism
Spontaneous (lymphocytic parathyroiditls)
Iatrogenic _ bilateral thyroidectomy
~J
~~07
. I
,_._G__O_O_d~,=g_u_a_rd_e_d__if_s_e_v_e_r_e__~~~___
__ j~t-,-'-'~-----------------------------------------------~~
Hypoparathyroidism, Failure of parathyroid to pro- CS when Ca < 6-7 mgldl
PTH orfailureOftlssues to respond Episodic (hrs - days between)
Hypocalcemia toduce
PTH: psetJdohypoparthyroldlsm: not re- Nervousness
M8K 405; Ehb 558: SAP 234.
ported in dog & cat
Muscle tremors & twitching
235; H38457; H2B 517. 263; a Hypocalcemia & hyperphos Behavioral changes
12M 698; 1M 540, 754; 5min
phatemia wI normal renal func722.206; E 1457: C12T 370.
Pruritus (faciai rubbing, feet biting)
378; C11T305.376, 1062; Cat
tion
50%
1460; R&E-F299: R&EM 159; Female dogs, any age
- Aggression, disorientation
NSW 203; NS3hb 260, 350;
- Depression & listlessness
NS-HB 332; NSO 259; Phys- Small breeds of dogs (toy poodle,
min. sChnauzer, Lab. G. shepherd & terrier)
B 885, 895; LabC 237; Pa-T
Cramping
270; Sx5-hb 8. 514, 509: Sx-S Cats: young to middle aged
Lameness:
1457
Cause:
- Rigid limb extension (tetany)
- Neck surgeries - iatrogenic
- Stiff, hunched or rigid gait
.. Post-thyroidectomy: common
- Ataxia, leg pain
in cats, in 1 -5 days, may be transient
Grand mal convulsions 80%
Post - parathyroidectomy: dog
PUIPD
(parathyroid adenoma)
'P''''. Idiopathic/spontaneous: immunemedl- Panting
ated?
Vomiting & diarrhea
Lymphocytic parathyroidilis: destruction
Weight loss, anorexia
of parathyroid gland
Hyperthermia
Very La[.' dog & not reported In cat
**
Response to Tx
f
Sequela:
-
&\' \. \V
~(
~~~
~
681
- Dihydrotachysterol
tlli
""I
'''j''bmty&''''~"Y U~r-~
Low PTH " Neck surgeries
CS: Tetany
\
Dx: Low Ca+, Low P T H '
Tx: Vit D & Ca supplementation
6 mgldl)
DDx hypoparathyroidism
Hx (recent Sx), CS
PE: extensor rigidity
- Weak pulse
Blood values
- Severe hypocalcemia
dos,
Prognosis: Guarded
Dwarfism
Condition
Pituitary
hypofunction,
Hypopituitarism,
Pituitary
dwarfism,
Juvenile
panhypopituitarism,
Pituitary cyst
ENDOCRINE SYSTEM
FactS/Cause
Deficiency of pituitary hormones (cortisol,
T4, GH)
Young animals: deficiency of GH - pituitary
dwartism
Germ, shepherd, spitz, toy pinscher,
Carnelian bear dog, immunodeficient
weimaraners
Adult onset: 10 pituitary neoplasia
Rathke's pouch development
Presentation/CS
Dia nosis
Treatment
Sequela:
- 2 Hypothyroidism
0
- 2 Hypoadren.",,~ort~;'~;'~m_ _ _ _--.l________~
DDx - Dwarfism
Malnutrition
Maldigestion/malabsorption
Heavy intestinal parasitism
Congenital heart of kidney diz
Congenital liver diz (portosystemic
shunts)
Congenital hypothyroidism (cretinism)
Hyper- or hypoadrenocorticism
Diabetes mellitus
Metabolic storage diz
Skeletal dysplasia
Cretinism Guvenile hypothyroid)
Acromegaly,
Prognosis:
GH replacement usually eflective, repeat If
alopecia returns, expensive & unavailable
Short stature usually permanent because
growth plates closed soon after GH therapy
started
"f.
(somedogS&a1lcais)~9.~~
......
I'--'/=c..4~
Progesterone
Ji
'-'~~:.~J ~--L-=Skln=..""=.Y_---..
~.
<::'j-
~./
..
~_
(-' ......I
'1
DDx:
Other causes of inspiratory stridor
- Elongated soft palpate
- Laryngeal paralysis
- Upper airway neoplasia
- Foreign body
Simple Diabetes mellitus
Hyperadrenocorticism
~
683 .
,
- Orthokeratotic hyperkeratosis
:rn
-Dog'
- Withdraw progesterone
&Jor ovariohysterectomy
- GH concentration normalize & sofltissue
~~~b_1:
c~
~
Prognosis:
Cat: Good - short term: survival4-42 months
- Grave - long term: die or euthanlzed be
cause of CHF, renal failure or expanding
pituitary tumor
Dog: Good
Pheochromocytoma
Condition
Pheochromocytoma
MSk 421: Mk 288; H-T/M 311;
CIIT 307t, 310: H3S 478;
H2S1 19, 538: SAP 245; 12M
ENDOCRINE SYSTEM
Facts/Cause
Treatment
- Panting, tachypnea
PU/PD
~~."
Distended abdomen "'" 2~ r '
.
lethargy
~---------~,I. Sequelae:
COx:
Other causes of systemic hypertension
Diagnosis
PresentationlCS
Long-term alpha- & beta-adrenergic blockers if inoperable - control cardiac arrhythmias & hypertension
d Ir b
.o:::.=.';,-~- . ~ _. _~_'m'fr~.)~:)'~/~
....
- Neurologic disorder
- Pulmonary diz
Catecholamine
Prognosis:
Adrenal tumor
Poor if inoperable
- Guarded if operable
Tx: Adrenalectom
See Cardio pg 325: Glycoprotein hormone: regulates nonnal erythopoiesis of bone marrow; Origin? juxtaglomerular apparatus in
Erythropoietin
kidney? Renal hypoxia: major stimulus for secretion
abnormalities
1. Reduced erythropoietin, 2. Normal t (hypoxia), 3. Inappropriate t (tumors, renal diz)
CS: Chronic renal failUre or polycythemia vera, Cardiopulmonary diz, hypelViscosity; Neoplasia, renal diz
~~-----~-)I!t.c~,
Endocrinological conditions that are not covered in this text:
~~~ . ~~ )
t .~,
rii/!v''''~~~.
Hyposomatotropism,
Hyperand,09enism
~~iIl
'~
,,_,~
Acquired growth hormone responsive dennatosis
Atrophic hypogonadism
L1 )
en
n S
p
"_',.:.J-'~-.=.'-___Testosterone
E_st_'_o_9__'e_s__o_n-'
-si_ve_d_e_rm_a_l_iti_S
__________
M_a_le_'_e_m_in_iz_i_
9_y_n_d_'imbajance
o_m_e____l_
",,_'0
___
responsive
dermatitis
Adrenal
sex honnone
'-'1\'-_"
ri ______ H
b i"J-V
)l .... :lo ., -:
. . . . . . . ~~. .~k~'~jm~f"~&K~.~
.. ~__--__--------------------------------------------____________________________________________~~l
~~.
Systemic Diseases
Anaphylaxis 706
Anorexia 708
Anthrax 699
Asperg iIIosis 703
Blastomycosis 704
Cachexia 709
Canine distemper 686
Cat plague 699
Cerebellar hypoplasia 690
Circulatory shock 707
Continuous fever 711
Cryptococcosis 703
Distemper
canine 686
feline 690
Ehrlichiosis 700
Encephalitis - distemper
522, 687
Fading kitten syndrome 690
Feline panleukopenia 690
distemper 690
immunodeficiency virus 694
infectious peritonitis 688
leukemia 692
lymphosarcoma 692
panleukopenia 690
Parvovirus 690
FeLV 692
Fever 711
Fever of unknown origin 712
FIP 688
FIV 694
Francisella tularensis 699
Frostbite 715
Fungus 702-5
Heat stroke 714
Hepatozoonosis 696
Histoplasmosis 705
Hypersensitivity reaction 706
Hyperthennia 714
Hypothermia 715
Immunodeficiency virus 694
Infectious peritonitis 688
Leishmaniasis 698
Leptospirosis 695
Leukemia 692
Lupus erythematosus 699
Lymphoma 692
Malignant hyperthermia 714
Malnutrition 708
Multifocal encephalitis 687
Mycotic lung disease 704
Neosporosis 696
Obesity 710
Old dog encephalitis 522, 687
Pancytopenia 700
Panleukopenia 690
Parvovirus 690
Plague 699
Postvaccine canine distemper
Canine
distemper,
-/ t"7'v(j
~
.
~~~~~~~(~~~e~:;emeIY
**
J~ r
~<~~,v
~
(Z)
- Parvovirus
Cardiomyopathy
CNS
- Other causes of seizures
- Other causes of meningoencephalitis
Toxoplasmosis
/------ ---~
.......
")
'--____~------==c::..'c~
4,,,
Qi
1Yf.
:a~);
~
-
Postvaccine canine
distemper encephalitis
See Neuro P9 552: Rare, < 6 months; ? associated
wI MLV distemper + parvo vaccines in pups < 6-8
weeks old
CS: Wlin 1-2 weeks of vaccination:
~
anorexia, listlessness, CNS
Dx: Hx, CS, absence of inclusions bodies5.@., l..lM~
Tx: Symptomatic: ???
.,.....~ ~
Prognosis: guarded
c.~
Prevention: Measles vaccine
then parvo vaccine in 7-10 days
Multifocal encephalitis,
Encephalomyelitis
See Neuro pg 552: Chronic progressive diz 2 to
distemper virus, 4-8 years-old
CS: Incoordination, Weakness, Head tilt, Facial
paralYSis, Head tremors wI myoclonus, BAR, No
seizures or personality changes
Dx: Hx (age) CS; Necropsy
Tx: No treatment
Prognosis: Poor
/
-) ):
~OL
~~
~.~
Prevention:
Vaccinate bitch before breeding,
don't use MLV in pregnant bitch
- Passive matemal antibodIes
Protective for 9-12 weeks in puppies that received colostrum
.. Protects for 1-4 weeks If colostrum I'lOt received, 814 weeks If
colostrum received
Interferes wI response to vaccinations
Vaccination:
- MLV COV (modified live vaccine)
2 doses nearly 100% protective
- Normal puppies: vaccinate at 6-8 weeks of age
, Repeat every 3-4 weeks until 14-16 weeks old
Colostrum deprived puppies
Vaccinate at 4 weeks old, Repeat in 2-4 we&ks
- Dogs older than 16 weeks
Vaccinate twice 2-4 weeks apart
- Measles virus vaccine, recommended for 1st vaccine if puppy less
than 8 weeks old wI or wlo COV because it partially protects pups
In face of Interfering matemal antibodies, follow wI at least 2 COV
vaccInes later
- Annual boosters recommended
_tmmunlty IS solid & prolonged, but not necessarily lifelong
- MLV vaccInation wfin 4 days of exposure may be effective In
preventing dIstemper
Poslvaccmal complications
- Encephalitis associated wI MLVvaccmes
-
ness of vaccine
Concurrent parvo may reduce response
~~y!!~:~i::: e,"~..po..s"u..re.....~::~
..
- Auscultation; crackles
Blood count for WBCs
- Lymphopenia, early leukopenia
latertPMNs
()
(
{aO
Radiology for pneumonia
(interstitial or alveolar)
CSF analysis if neurologic CS
Virological techniques usually not necessary
or practical (Inctuslons In buffy coat - FA
rising
titers
diagnostic
L Serology:
___
_
_suggestive
_ _ _not
_
_ _ _ __
- Hyperkeratosis of foot pads
("hard pad" diz)
- Abdominal pustules/rash
- Transplacental: abortions, stillbirths, weak
puppies CNS signs
Old dog encephalitis
Multifocal encephalitis
0l'.1"
l
I'
r)..;'
...!JJ~ I
'l"r~~
d~,,'
_-
J
\
_ ...",//
Treatment:
No specific antiviral drugs
Broad~spectrum ABs for
2 bactenat infections
Humidification of airways
Pneumonia
- Expectorants
- Bronchodilators
GI (vomiting & diarrhea)
Antiemetics
- Antidiarrheals
Seizures:
- Anticonvulsants (phenobarbital)
Good nursing
- Keep eyes & nose free of discharge
- Nutritional support
~
- Clean, warm, dry
I
"
- Fluids
Vt B
- B-complex vitamins
I
Isolate animal
Euthanasia if severe, incapacitating,
progressive neurologic signs
~)
_-:.J(_~
Prognosis:
.........
Guarded: mortality from 1-100% depending
on virulence & age of animal
Pessimistic even for mild cases
Disease is often progressive despite therapy
- Some recover & then exacerbate
M
Feline
infectious
peritonitis,
Progressive & fatal systemic immune-mediated diz, cats & wild cats
FIP,
~'~",(,-::
Initially nonspecific
Chronic fluctuating fever (unresponsive to ABs)
Anorexia, weight loss, Inactivity
- Vomiting, diarrhea
~~_-.
:"-;S? \)
j,(
,~
DOx:
FIV infections
Pathophysiology:
H3S 1136; H2B '196;
HepatiC Oaundl~~)
,...., l
~ ~. Chylothorax
Smln 586; 12M 1290; 1M
- Systemic infection of macrophages
Pancr~as (vomiting) uncommon
~ --:--' Diaphragmatic hernia
n4, 981, 372, 231 ,410,
- Immune complex-mediated vasculi678, 214; IMWW 558,
Adhesions: large mass of guts~'
(
Chronic bacterial peritonitis
tis
effusions
223; jB 66; cat449. 333,
Pleuritis:
th?:acic
effusions
35%'"'c::._
..
Cholangiohepatitis comp!ex
833,1071; F-N 352; Pa- Necrosis & pyogranulomatous in Dyspnea, tlnng, sternal recumbency or sitting posture
Pansteatitis
:Y. ;:::
T173; NB 11.20
flammation
0,"'"
&
CNS
co"'
T
I
.
'f/
'.
Transmission: oral or respiratory
"Dry" form (noneffusive) (slow, insidious & smoldering)
oxop asmosl.s
~
),
I
.6 months - 5 years (all ages), Clinical
_ Pyogranulomatous lesions _organ-specific
CryptOCOCC?SIS
;;
~ 'jll
FIP < 3 yrs-old or > 11 yrs
Kidney - Pu/PD
TuberculosIs
. (It .J
\ ~='Y~:ot_~" Low morbidity (20%), but high mortal Icterus, hepatomegaly
,rr ./
ity (90%)
CNS: pyogranulomatous meningoencephalomyelitis: incoordination, posterior paresis, nystagmus,
Risk factors: crowding, FeLV or FIV
convulsions, intention tremors, cranial & peripheral nelVe paralysis, hyperesthesia, generalized
concurrent infections
ataxia, head tilt, behavior changes, urinary incontinence, tetraplegia
Incubation: days to weeks to months
Anterior uveitis - pyogranulomatous (iridocyclitis, chorioretinitis, comeal edema aqueous flare,
hypotony, irttis. hyphema, hypopyon)
S I
I
CNS:
p enomega y
More Irequent in dry (noneffusive) than wet form
Mesenteric lymphadenopathy
ProgressiVe focal, multifocal or diffuse involvement of
Pyogranulomatous pneumonia infrequent & dyspnea uncommon
spinal cord, brain, & meninges
Combination of both wet & dry fonn
Cats < 2 years & aged cats
~
Cattery diz, Fatal
"fll
All forms progressive & fatal
Rarely have abdominal or pleural jffuSlon { ""I
CS: Wet & Dry forms
(D
Reproductive - suspected: infertility, stillbirths, abortions,
Dx:Hx,CS,PE,Lab,Rads,Selrol,oc,,1
congenital malformations, fetal resorption, birth of weak or ''fading kittens"
<c:.._
"'r"
**
~< ~~'~~
~=#~<l~~'
<:!}/ / Ci'7J
Unrewarding
Grave
~~
?---.?
C~~
~
;""-.
Hx, CS (AB resistant fever)
\S~. ~\
Physical exam
~
Auscultation: muffled heart & lung sounds in 25% of wet form
\\
Palpation & percuSSIon of a fluid wave
.
Palpation of lymphatic. hepatomegaly, enlarged firm kidneys - dry torm (pyogranulomatous)
Fundic exam { flame- or boat-Shaped hemorrhages
Lab: unspecific - strong circumstantial evidence
- CBC anemia, leukocytosis, lymphopenia
- Chemistry: noneffuslve FIP to pin down organs involved azotemia, liver enzymes + bile acids
- UA: Proteinuria - kidney, bilirubinuria
Radiology & Ultrasound
- Confirm body cavity effusions
- Organ enlargement (kidney liver)
- Organ Infiltration (lungs)
Fluid analysis - strongly supportive (centesis)
Clots on standing- pale yellow. translucent
- High cell count-1QOO-l0,000 1)11, PMNs)
-TenaCious, sticky - fibrin
~
-;.-,~
-Foamy-high protein content4-10g/dl
\.
.
~
- Protein electrophoresis (gamma globulin::?; 32% of fluid proteln
Albumin < 48% 01 fluid protein
Albumin to globulin ration (AJG) < 0.81
~ Nonseptic exudate (pyogranulomatous) predominantly
nonregeneratlve PMNs & macrophages wI some plasma cells & lymphocytes
CSF or aqueous humor of eye: t WBCs (especially PMNs)
in neural & intraocular FIP, & elevated protein
Corona virus serOlogy FIP antibody often nondlagnostic
- Not definitive because doesn't differentiate F1P coronavlrus from
nonFIP coronavirus or distinguish between carrier & active infection
Use as a diagnostic aid not definitive diagnosis
Low titer - FIP possible
High or rising titer - FIP probable
Negative titer - F1P unlikely
SpecifiC ELISA, IFA, antlgenantlbody & DNA probe tests are being developed
Biopsy - only definitive Dx in live cat, valuable in some cats
Vasculitis & pyogranulomatous inflammation rn--""~==jJ===_~
Check FeLV
lIJ-l=
1}:
Postmortem: pyogranulomatous: multiple, gray-white nodular
masses of variable size on surface & in
W"'r-.\ '.g
Treatment:
NO
CURE
zM.
Prognosis:
Grave: Wet form: sUlVival from days to 2 months~
- Dry form: sUlVival time up to 1 year
Once clinical signs develop - nearly always fatal regardless of treatment
- Rare remissions in mildly affected or only ocular involvement
Prevention:
Vaccination in catteries
Intranasal (IN) vaccine (PMmucell FIP) 199t
. 2 dOSeS of 0.5 ml each intranasally 3-4 weeks apart at16 weeks of age or older
. Annual booster: survival of 7185% for vaccinates vs 17-20% lor unvaccinates when challenged
w/in 6 months
Cattery management
- Isolate cats wi F1P signs
- Control FeLV (vaccination, testing & removal)
- Replace only wI cats of negative FIPV-Ab titers
- Use only proven queens in breeding program
Good husbandry (hygiene, feeding & density)
IN Vaccination
FPV,
Feline
panleukopenia,
**
Adults - subclinical
_ Normal or weak
Lab:
- DIC
- Death in 1-2 d if untreated
n~lt.
~~~
DDx:
~l'JV~-I:-""""
Hx (unvaccinated), CS (gastroenteritis/
Treatment
Emergency - start treatment before lab results
SymptomatiC & supportive (as for canine parvovirus)
Aggressive fluids (IV catheter)
- Add K+ (potassium)
-Overzealous fluids mlb problem in severe hypoproteinemia, sepsis or intussusception
Broad spectrum ABs to control ~ bact. sepsis
- Gentamicin to hydrated patient 5 days
Prevent gram-neg. sepsis & endotoxemia
NPO (nothing per os) If vomiting until antlemetlcs drugs not needed
No anticholinergic antiemetics/antidiarrheal Rx (antimotility)
contraindicated, t risk of endotoxin absorption
Moribund or severe anemia or hypoproteinemia
- Plasma/whole blood transfusions form health donor cats
Check for ole 1st (Platelet & activated coagulation time)
?'v~~t~o~;:~itamin parenterally
=n<t.'-ct..g:-~
.m.
Prognosis:
Guarded to grave: young kittens (mortality 50-90%)
- Guarded until Impending recovery indicated by cessation of vomiting & diarrhea and
return of appetite
Cerebellar hypoplasia persists for life, (p8rtyentertainmen
is not a valid reason to keep alive, love lsi)
;;:::':i
Guarded for septic shock or hemorrhagic diarrhea
Survival may give long~standing (years) immunity
- - rl,..-.:;:
tr
~~~
-~, Anterior (eran.) mediastinal lymphosarcoma
euA. Hx, CS
A!!fl:'~~
0
-Radiology:
'~U~7~
leukemia,
FeLV
moo'
cat
***
- Demonstrated in
. Pleural effusions
Forms:
- Lymphoma:
- Palpation: abdomen
Radiology
Malabsorption
315
......
GI form:pg 42, 51
164, 165
Retrobulbar mass
- Third eyelid mass
_CorneallnllHralion
_?j
~'.L
Bone:
~
ELISA
"";;;;;;d:=:Idll
Cutaneous
form:
multiple
firm,
nonpainful
- Subclinical = immunity or persistently infected
Exploratory laparotomy
(contagious)
cutaneous nodules
Pathophysiology:
DDx
Anemia
Haemobartonellosis
- Immune-mediated hemolytiC anemia
Panleukopenia & panleukopenia like syndromes
L"",-I
'$
.-:,S;"~_=------
::--
Lymphosarcoma
- Chemotherapy can extend life,
- COP (Cytoxan, oncovin, prednisolone)
Myelosuppressive dizs
- Blood transfusions for nonregenerative anemia
- Steroids (glucocorticoids) may t life span, useful if thrombocytopenia
-Interferon
~;-i~~~
/111
Treatment:
'l -
~L~
y.
/111
S~O~
~
......
p'
\v~
<I'
CI!i
""'q----:::::====""-.t7l:).1",,:\, -
..',
Feline
immunodeficiency
virus,
IrTTTlUncx:leOCiercy
diz
M8k 586: SAP 91; E-hb 202,
285,697; H3Bl 139;H2BI19S:
5min 584; 12M 1294; 1M 955,
904,861; IM-WW 558: Cat433;
CI2T 280; Cl1T216, 244, 275,
1010,1069; E 411
..
..
'
......... ,', .
'
Facts/Cause
Presentation/CS
Diagnosis
Condition
FIV,
..........
Treatment
-Incurable (Infected for life) but asymptomatic cats can live for years before CS
up to years
Chronic: immunodeficiency
- Chronic recurrent infections,
waxing & waning, progresslvelyworsen over
months to years
- Chronic wasting (weight loss &
debilitation)
- Recurrent fever 01 unknown origin
- Antibiotics for
some~mes
bacterial infections.
dramatic response
Generalized lymphadenopathy
INo antiviral Tx I
--.I~------------------------------------~~
Leptospirosis Bacterial diz: dogs & humans
(I
(
(10
Subclinical in vaccinaled dogs & all cats Hx,CS
Serology in conjunction wI CS
Peracute: leptospiremia
Physical exam: congested
Leptospira interrogans:
- Fever
mucosa
- Shock, vascular COllaps~
L. icferohaemorrhagiae
- L. canicola
Blood values:
,
Death
,
- L grippotyphosa
- t WBC (leukopenia
o~
Acute to Subacute
Filamentous, motile
early), PMNs wI lett shill
DO
- Fever, anorexia
?
spirochete
- Thrombocytopenia
- Depression
- t Fibrinogen products
also pg 92'1:. Public health - zoonosis
- Vomiting, dehydration
Chemistry:
351, 592
Spread by shedding in urine for
- Azotemia - t BUN & creatine
- Thirst
I. months to years
. Hyperphosphatemia
- Reluctance to move (pain- kidneys,
- t Liver enzymes (ALT, AST, LDH) &
:..~ - Penetrates abraded skin or mucosa
musde or meningitis), myalgia (muscle ten
...
- Wild animal reservoir (rodents)
bilirubin
demess)
- Electrolyte imbalances (renal & GI ef- Acute renal failure
fects)
(,In
P
Oliguria or anuria
UA (urinalysis) ~
~
oeph01;,)
~~ "
- Acute hepatic failure
- Microscope of leptospires
. Icterus
(darkfield) ~
DDx:&liver
- DIC: petechial & ecchymotic hemorrhages
_ Culture
~
(melena, hematemesis, epistaxis, hemor- . Proteinuria
~
rhagic gastroenteritis) Bleeding diathesis (melena, epistaxis)
- Py~rla .
,,~.
Other causes of anterior uveitis
oOccasional manifestations
- C~.lInd.runa (g~anular casts)
_Abortion or stillbirths ? ~- Bilirubinuna (liver)
~ T I~
Other causes of persistent fever
Uveitis (Immunologic) 't,
. -Isosthenuria (SpG 1.010) . ~
Other causes of acute renal failure
_Meningitis
~!
Serology: microscopic
-;y.: '
- Ethylene glycol toxicity
Ch",,;, (mo".
agglutination test (MA)
Pyelonephritis
Fever, ~nten?r uveitIS
4 fold Increase in paired
- AnoreXia, weight. loss
sera over 2-4 weeks (to
,r~
-Toxins
- Frequently subclinical
.
differentiate from previous
"
...
Other causes of acute hepatitis
,j.'
Infection or vacCination)
'1"""'~
-Infectious canine hepatitis
Sequela:
I \i
. Single titers never diagnostic but 2:
~(
Toxins
_ Chronic renal failure
1:300 suggestive, 2: 1:1000 highly Indicative
')
\... - Bacterial infections
Pu/PD
_IgM-lgG (ELISA) titers -less available
I
Stom~titiS
~ _I
than MA
*_**
8j',
Isee
~
4. \..
~
\;='A\~ .T~i~~'f:'ki~~e~12d'YJ
;
(;,,,..,;,,,
~ff
~ -
Spirochete, Urine
""').1 y.r
) .
~~I;
(antibiotics)
i:
- Penicillin G 1M, sa BID - 2 wks
- Dihydrostreptomycin (once
azotemia resolved to eliminate carrier
state)
- Doxycycline, tetracycline
Supportive Tx
- Fluids: shOCk, dehydration, renal failure
- Anuria/oliguria: rehydrate & establish urine flow, LasiX anuria/oliguria
- DIC: blood transfusion
Monitor renal function
Immunize dogs aiter recovery to prevent
infection by a different serovar
Zoonotic - hygiene especially
regarding urine, Betadine(povi~
don;t
Prevention:
Vaccination: reduces Incidence & severity but doesn't prevent subclinical or
urine shedding
Bivalent Leptospira bacterin component
of most polyvalent canine vaccInes
-9,12,15wks(3dosesrElquired)
- Revaccinate annually (endemic areas
-~.,.. ~Urineorbloodcutture;definitive
every 4-6 months)
~
_
~
. ~~ but difficult & difficult 10 identify so use
~
I (-'
serology wI CS
I,:\- ~
oHlstoofsilverstainedbiopsyolk.idneyor Prognosis: Guarded If f .
)
liver
severe, renal & hepatiC
'~
damage may be permanent C-
"'\.J..:>
16951
-(
(f/;~:;;p
rf 0'
Neosporosis,
Neosporum infection
M8k482; E-hb 193, 608; SAP
145; 5min 870; H3B 1180; H2B
1235,910,260,11211,1080;
12M 1317; 1M 775, 738; IMWN 553; C1IT 283; Pa-T381
oHx,CS
oClindamycin, SlJlladiazine, trimeihoprim & pyrimethamine used, successful treatment not reo Positive serology & negative T. gondii
ported
serology
Neospora taCl1yzoltes or tissue cysts in
nervous tissue occasionally found
Abortion: organism in aborted letus or
paired sera of dam 2 weeks apart
c,,0o4[j
'i,
~~-j:>
/ ,,\
polyradlculomyositis, neuromuscular
Pro"""" Poo.
1r.l:J
ba~
OOx:
Causes of fever
oCauses of muscle hyperesthesIa
Periosteal reaction: Immune mediated polyarthrills, Immune mediated myosills, neoplasia, Infections
oLeishmaniasis, babesiosis, ehrlichiosis, endocarditis, Chagas' dlz
Toxoplasmosis
DDx:
Cats
Asymptomatic in most
Nonspecific: anorexia, depression, unresponsive fever,
weight loss
Respiratory: acute necrotizing pneumonia - progressive
dyspnea
Eye: anterior uveitis [iridocyclitis, chorioretinitis] - aqueous flare, keratic precipitates,
hypopyon orfundic lesions (rare
in dogs)
CNS: encephalomyelitis: seizures, ataxia, tremors, weakness/paralysis, cranial nelVe
deficits
Muscle: myositis - hyperesthesia, stiff gait, muscle atro-
protothecosis
Hx (History), CS
+Creatine kinase (muscle damage), + liver enzymes. bile acids, bilirubin. amylase or lipase
(pancreas); leukopenia or leukocytosis
Radiographs: diffuse interstitialtoalveolarpattem,patchy,
ascites, hepatomegaly
CSF: protein, lymphocytic
Sf?
--------..L-------- ~
r
VA='
~....
~~
J!-1
Antirobe~
lJllill
J
nosis difficult
Serum IgM antibodies for active
or recent infection ~ 1 :256
Prognosis:
Guarded, no Tx consistently effectiVe
60% recover wlo treatment
Mortality highest in neonates & immunosuppressed
Prevention in cats: no raw meat,
roaming, or eating cockroaches, flies
or earthwollTls (sure!)
I
Protozoan, Cat> dog; PH
-;;5iy~rf'.~
CS: Asymptomatic, multisystems ~tL~~
-__ ./1
Clindamycin (Antirobe)(DOC)fordogs
& cats
- Also used: trimethoprim-sulla, sulfonamides
Anterior uveitis: topical or parenteral
steroids
pleocytosis, PMNs
phy
Public
He.~h:
~
ples),adults(hyperexcitabltity,depres- ~r- to humans
sicn, tremors, paresis, paralySis, sel- /
()"""t ~ Positive toxoplasmosis antibody titer cat safer
"".,)
697
~r~~~~:~~~b~~i~~~~~a~I~~~~~~~vel
*?
sa
~!~:~::t:::,p:::e:x~:at~hY&
hep:t~sPle-
Prevention:
_ Control sand flies: insecticides & moisture control
a",,
..-- t
5
-::!
))Ql
'"
J.
(.~,--,-/o
I\~.~
ill
f; .
;:;."'--===--__________-,-______
es:
Systemic
lupus
erythematosus,
SLE,
Lupus
erythematosus
M8k 579; SAP 316; H38 791;
H2B 120, 839, E-hb n9,839,
107; 12M 1229; 1M 972; 5min
782; IM-WW 537; E 211;
Oerm 578, 574; D-Sy 117,
152,153; D-Mi 24, 145; DClin 64; O-hb 115; D-Plc 75;
D-Dx 166; Pa-T 226, 498
*
Cat plague
M8k 485; H3B 1152; H28
1210; SAP 1291; 12M 1273:
5min 942; Cat 533; F-H 294,
660
DDx:
cat fight abScess
Other causes of bacterial pneumonia
Other causes of sepsis
Acute or insidious CS
History
Often CS wax & wane
Heart murmur
Multi-organ diz: showing simultaneously or -Sldn blopsy:variable: leukocytoclastlcvasrandomly
culltis & mononuciear panniCIJlitis
- Thrombocytopenia, hemolytic anemia
Laboratory: variable depending on system
- Glomerulonephritis
involved: anemia, proteinemia, thrombo- Polyarthritis: gait abnormality #1 sign
cytopenia, leukopenia
. Stilted gait or shifting lam~eness DIT or peroxidase: deposition of Immune. Joint swelling
globulin or complement at basement mem- Fever, lymphadenopathy
...
brane
- Muscle pain
LE prep unreliable & not routinely used
- CNS signs
6 . ANA positive 85-90%
- cardiopulmonary (myocarditis, pleuritis)
Appropriate clinical signs
Variable pruritus
Direct immunofluorescence
Skin manHestations 20-50% of eases
PoSitive Coombs
Periorbital alopecia
IFA & IPS poSitive
- Seborrhea
smears are nondiagnostlc
- Oral ulceration (stomatitis)
- Mucocutaneous ulcerations
- Footpad ,e"ao''''nI''''''at;;'nl~
Canine ehrlichiosis
- Pann'lctJrltis (lupus profundus)
Multiple myeloma
- Urtlcaria, Purpura
Cats:
- Fever, anorexia, lethargy,lymphadenopathy
- Draining abscesses: submandibular&
limb Buboes i
swelling 01
I
tracts
hi,,.,,,,,,
- Splenic,
"'Ime,n,,, d;,
- Death In 7 days or
- Chronic emaciation
wI death in 2-4 .;,, <;~~.;:.-:~~
Dogs:
'Immunosuppressive drugs
.Prednisolone+azathloprine(lmuran)
. Every other day wI steroid
. Use cautiously in cats
Supportive care
Gold salts contraindicated (potential to
cause glomerulonephritis)
.Severeanemla&thrombocytopenla: splenectomy
.
-;-.;' '
.
Steroi~
~
;::--..
fll
'(
t\
.f"
Rare in cats, dogs relatively resist.ant: Franc/sella tularens/s gram-neg. coccobacillus; eating many dead, sic~ rodents or rabbits; tick born
CS: Anorexia, No diarrhea or vomiting, Lymphadenopathy, Draining abscesses, Rapid weight loss, Bacteremia, Fever, Death in 2-5 days
- Ox: Hx, CS, Autopsy: white foci on liver & spleen
Tx: isolate, no Tx successes reported, streptomyCin' Px: poor
Public health: circumstantially implicated, wear gloves, maskS & gowns
Rare, Carnivores resistant, eatIng infected meat
\'
Consider euthanasia?
ABs: streptomycin 1M (DOC), tetracyclines, chloramphenicol
Topical insecticides for fleas whether
present of not (5% carbaryl dust)
Protect humans: isolate, wear gowns
gloves masks, parenteral not oral ASs
Once r&covers animal no risk to humans
~
health officials
node aspiration: Gram's or Giemsa slains: small gram-negative, bipolar coccobacillus or direct liuorescent
antibody (IFA)
- Blood: neutrophilia wI left shift, culture
(liquid blood culture medium), serology
(convalescent-phase titers within 10-14
days)
- Thoracic radiographs recommended to
access possibility of aerosol transmission
to humans
~_
Streptomycin' I'
*.
muran
r~f~~'~S~':b[""r,",:e:b:a:~:e~":al:~~~~1~~~~~fu~~~;:~::
I~
I-
....
II
Tularemia, Rabbit fever, Deerfly fever, Market men's diz, M8k 494; H3B 1156t; SAP 1291; IM-WW 547; 12M 1336; F-H 296; Cat 532; 5min 1121; C11T 288, 286t
Ehrlichiosis,
Tracker dog diz,
Tropical canine
pancytopenia,
Canine
hemorrhagic
fever,
Canine typhus
M8k562; E-hb 189; SAP 124;
IM-WW 555; 12M 1282; H3B
1163;H2B1219;IM960;5mln
538; E378, 380; Cat 545; Pa,
T 303; NB 1
**
~
Obles
;;
Sequela: Sepsis
. 1/;>
~~-
Ox: Ticks,
Rocky Mt
spotted fever,
RMSF
M8k 564; 12M 1280; 1M 94,
962; SAP 125, 497; E-hb 188,
181,284; H3B1165: H261221;
5mln 1042; E376: NB 11.9
sial
Tick-born (Dog tick [Dermacentor variabilisj, wood tick
[D. andersom])
-3 hOSllicks: definitive -humans, dogs
& cats; reservoir rodents, rabbits &
dogs (purebreds: G shepherd, Siberian husky)
-Need to be attached for 520 hours to
infect host
Transmission also through blood transfUSions
-Incubation period 2-14 days (acute)
All USA; Endemicareas: east
coast, Midwest & plains
Spring, summer: tick season
April- September
Pathophysiology:
- Widespread vasculitis: organism invades & replicates In vascularendothelium =necrosis & vascular
permeability
- DIC/Dlssemlnated intravascular coagula~on
- Immune mediated
- Edema & vascular collapse
Multisystem dysfunction
OOx:
e I -(-\11
- Thrombocytopenia
- Nonregenerative anemia
L k
.
- eu openta
L
h d
th
- ymp a enopa y
S I
I
- p enomega y
I -.
I
-'---.-/
I
~~1:"~i~9~:~istaxiS,
~~;U~~Tni~Ckk,~su;m~m~e;'r,~~iffi~~~~~~
Fever, Multisystems (GI,
Lung, Lame, etc,)
Ox: Hx, es, Lab, IF, Tx
Tx: Doxycycline or Tetracycline, Support
?(
melena,
?;:;;;;;;;;;:-;;~;;;...L-'lturia, petechial to ecchymotic
Sequelae:
_ Myocarditis
_ DIC (disseminated
intravascular
eNS, Skin,
coagulation)
- Shock
'
Prevention: tick control In endemlc areas, low dose tetracycline or doxycycline PO for 6
h
~
mont s,
;; .. (';
PrognosIs:
~
Excellent w/ Tx unless ~
bone marrow severely hypoplastic
Poor In severely chronic Infections
o Infection doesn't
I.
h d
th
o SerOlogical 4 fold rlse in titer of antibody to
Lymp a enopa Y
confirm
Skin/mucous membranes
MlcroIFA (Immunofluorescent antibody)
- Rash, petechial & ecchymotiC hemorrhages 20%),
,. 1: 128 west, 1:1 024 east
common in humans, confers name to diz)
- 19M titers -acute infections
- Edema of limbs & face
Direct IF (DIF) . skin
-Gangreneof distal limbs, scrotum, mammary glandS, CNS nuld: elevated protein, PMNs ormononose or lips
nuclear cells
Eye: anterior uveitis & retinal hemor- Synovial nuid analysis - PMNs
,
~
_ _ _ _ _ _ _ _L-_ _--.,
0:/
~-....:.-----...l-.:::=---_
Rickettsia; Dogs; Tick; Acute, subclinical & chronic phases
CS: Fever, Bleeding, Dyspnea, eNS, Weight loss, Eye
hema-
~.)'
'2
DDx:
canine ehrlichiosis
Canine distemper
Other causes of
- Fever
- Splenomegaly
- Lymphadenopathy
- Other CS
\ \\
Doxycycline
Prevention:
Prognosis:
~. ~
$
Excellent jf early Tx,
recovery in 48-96 hours
Poor if delayed Tx, high fatality if
left untreated
If CNS signs may die wlin hours
immune for 6-12
for lifetime
Ehrlichiosis,
Tracker dog diz,
Tropical canine
pancytopenia,
Canine
hemorrhagic
fever,
Canine typhus
J-.....~ _
Sequela: Sepsis
. {( '
Px: ExceUent
Rocky Mt.
spotted fever,
days
questionable wI cytop~nias,
used in puppies < 5 months
Enrofloxacin (Baytril)
Imidocarb (Imzol) anllcholinesterase parasympathomimetic SC repeated
In 14 days effective In refractory ehrllchiosis (not available in USA)
Supportive: blood,
~.,,
flu'ds ASs steroids
, ~,
,
)
In Immune component.
~
i' .
Ii
(petechiae, ecchymoses,
'
'5\'
t I
epl axiS, re Ina
hemorrhages)
- Pallor
- Eye' anterior or posterior uve"fs
.
II
- CNS: (meningoencephalomyelitis)
- Signs of specific organ failure
(kidney, liver)
~
, I
\'.
P'
, k
I '
rev~ntlon: tiC contro In endemlc areas, low dose tetracycline or doxycycline PO for 6
months
~ __
j .... Co r;
Prognosis:
_~
Excellent wI Tx unless ~
bone marrow severely hypoplastic
Poor in severely chronic Infections
Infection doesn't provide Immunity
?(
c!J,J
RIckettsia
i8
I-
hll
~~~~~~;J
~'
/ )
~ .
DDx:
Canine ehr1ichios;s
Canine distemper
Other causes of
- Fever
- Splenomegaly
- Lymphadenopathy
- Other CS
I\t--~'-Hlil
'-.,./
\ \\
Doxycycline
Prevention:
Tick & rodent control in enzootic
a1iLY\/~
~? ~liJcf,~~
Prognosis:
" . =-:;
'J ~'
Excellent if early Tx,
recovery in 48-96 hours
Poor if delayed Tx, high fatality if
left untreated
If CNS signs may die w/;n hours
immune for 6-12
for lifetime
'\J:?,
immitis
Asymptomatic: common
. Soil: mycelialarthrospores
In tissue: large spheres releasing hundreds
of endospores
Transmission: inhalation arthrospores, cutaneous inoculation rare,
not contagious
M8k140;SAP136; H3Bl
Forms:
H2B 1175,202', 1M 217;
- Cutaneous: local inoculation
'NW549; Ehb 216: 5mln 460;
- Pulmonary: acute or chronic
Cat561; CI2T330; E 444; Pa
T166; NB 11.12
granulomatous pneumonia &
** -***
tracheobronchial lymphadenopathy
- Extra-pulmonary: chronic
- Fever, lethargy
- Lameness & painful swelling of
bones & joints,
Draining tracts
Metaphyseal end of bOnes
- Orchitis, prostatitis
-lymphadenopathy
- Ocular lesions
eNS signs
Abdominal organs
Heart & pericardium
Pulmonary form:
- Cough
- Fever & malaise
- Dyspnea
~(
Cutaneous form:
)~ ~1 - Painless,
~
~~
nodule
& I
v/
fiZ)
firm indurated
+ central
- Lymphadenitis
yr-olds)
ulcer
& Iymphad-
enopathy in area
- No pulm~nary signs
:t~
Ketoconazole
Desert - SW USA
CS: Asymptomatic, Disseminate; Pulmonary; Skin
Ox: Hx, CS, Rads, Serology
Good: Tx effective in
Cryptococcosis
MSk 145; H3B 1121; H2B
11S2, 202, SAP 137; E-hb
218;C12T330;5min488; 1M
'NW 550; 12M 1302; E 450;
Cat 554; Pa-T 385; NB 11.13
** -***
Asymptomatic
Nasal form (cat 50%, rare: dogs)
- Mucopurulent to bloody nasal dis
oCryptococcus neoformans: budding
charge
yeast w/ thick, protective capsule
CNS (dog: 50%, cat: 25%), seizures,
Forms:
circling, head pressing, blindness, CIe
-Nasal form in cats
mentia, ataxia, weakness, cranial nerve
- Disseminateform (extra-respiratory):
defiCits (2, 7, 8)
CNS (local extension through cribriform Eye (cats: 25%, dog: 50%): granuloplate granulomatous meningoencephamatous (exudative) chorioretinitis, an
litis or myelltls), Eyes, Skin
terior uveitis & optic neuritis
General geographic distribu- Skin (cat& dog: 25%): rapidlyenlarging firm nodules that ulcerate & ooze
tion, no true endemic areas
(head, near nose)
Infection: inhalation of soilborne
Others: peripheral lymph nodes (submandibular), pharynx, & oral cavity,
____.,-- kidney, liver, spleen, heart & skeletal
m.
Fever 25%)
Crlnlcal pulmonary diz rare but 50%
have lung lesion at necropsy
Aspergillosis
~:
Clinical signs
CBC: often normal
Radiology: nasal bone
lysis or tissue density
DD"
.-;,
JiilEJll
~\.....
'1
Fluconazole -)
~~
}i!!:t:t
('~
~
~
.
Asymptomatic
Systemic:
** -***
90%
Forms:
- Nasal most common in dogs
(medium to large dolichocephalic or
mesocephalic: large nasal cavities), occa
sionally in cats
- Disseminate form: rare & asso
ciated With immunosuppression (sterOid or
cytotoxic drugs) skin, pulmOllary, CNS,
eye, GI, bone or cardiovascular
- Cats: pulmonary & GI most fre-
.
invades brain case
~ .......
TIssue biOpsy: be~er than
Disseminate' -
oq
1:"
.
I
- S kIn
~'
- Bon~
..
- ~rdlovascular
Urinary
(?
)
703
lli.1IiiiiiiiiIi.,"===='O~_ _ _ _ _ _ _-------'
704
Systemic Mycoses
Facts/Cause
Condition
Blastomycosis,
Gilcrist diz,
llJ~
Diagnosis
Treatment
.... CS
esc:
SerOlogy:
agar
gel
diffuSion
not
often
used
mg/dl
tracts (13%)
because of acuteness of di% usually
- Monitor every 30 days &at3 &6 months after
- No pulmonary signs
Tx stopped
Eye: 41%, epiphora (tearing), pain,
anterior uveitis, cloudy comea, granulomatous retinitis, blindness 26%
Skin form: 26%, ulceration
& draining
/ " ) ' Bone: osteomyelitis,
**-***
rr---
SYSTEMIC DISEASES
'. . I
Chicago diz,
North Amererican
tis, bronchitis
blastomycosis
M8k 469; H3B 1113; H2B - Peripheral lymphadenopathy
11 n, 202, SAP13S; E-hb213;
60%
Smln 394; 12M 1305; IM-WW
548; C12T 330; E 439; Cat - Eyes, skin, bones & other or559; Pa-T 443,149,410; NB
gans
11.13
FungaVmycotic infection
River valleys of central USA
(Ohio, Missouri & Mississippi rivers & Great
lakes) similar to histoplasmosis
.1 nfection: ai rborne spores or skin
inoculation, discourage backyard
burial
Dogs (1-5yrs, > 40 Ib) > cats
Dogs lOx more frequently than
Presentation/CS
humans
t...
JJ...
~5
~ ----...
1\
-'" 1C!1
<1
Central USA
CS: Lungs, Eye, Skin, Bone
Ox: Hx, CS, Rads, Cytology
Tx: Amphotericin B +
ketoconazole
pe'"''''
;..-;--DDx:
~
J!\
KetoconaZole~
~
'.~
Lymphadenopathy
Bone leSions
- Lymphosarcoma
Pulmonary lesions
- 10 bone tumors
- Distemper
- Other systemic mycoses
- Bacterial, fungal or
- Other systemic mycosis
- Regional bacterial infecalgae osteomyelitis
- Diffuse pulmonary metasta~ tlons
~. Prostate enlargement
sis
Skin lesions ~
Bacterial prostatnis
Ocular lesions
- Many dizs
~~- Benign prostatic
- Other causes of uveitis
- Actinomycosis
~y
hypertrophy
- Other causes of retinitis
/
:'\
- Nocardiosis
I .
~
i&Jt
11-
Prognosis:
Poor: if untreated most die ~
Guarded in sever respiratory - frequently die in a few days
- Good if survive first week of Tx
Ocular: poor, less responsive, resuIting in enucleation
'1. -
"
~~=,-~.--------------------------------~~
c::J .
lap .
orm ogs_
Radiology:
y
- ~~ym:o~atlcc%:all )
- Diffuse interstitial
"
- ::rr e~ Intrl~ bl ~ _ _ - Hilar & mediastinal
. .rge. owe. 00 y mu
thy
COld dlarrhe~, tenes~us
_ Irregularities of mucosa &
thickening of bowel wall
. Small bo~el. watery dla~ea,
malabsorption, waterydlar(diffuse infiltrate)
rhea, weight lo~
_ Hepatomegaly splenomegaly
- Pulmonary signs: dyspascites'
,
nea, coughing, pale gums.
- Bone lesions are rare
fever
Cytology: organisms in mono ~~~:s~!~~ (wI or wlo lung Signs) cytesimacrophages
- Peripheral or abdominallymphaden- "Bone marrow aspirateslbuffy
opathy
coat smears of peripheral blood:
- Lameness associated wI proliferative
best for diagnosis
or lytic bone lesions
_Oral ulcers
. Lungs: transtracheal lavage, bronchoscoptic
-Peritoneum - masses, mesenteric ad
alveolar lavage, needle aspiration
hesions, nodutar or granular serosal . Intestine: smears or fecal mucosal scrapsurlaces
ings, Impression smears or endoscopic biop-Eyes -exudative anterior uveitis, mulsles
tifocal granulomatous chorioretinitis, . Uver, spleen, or lymph node aspirates
optic neuritiS
Abdominal or thoracic effusions
-CNS - ataxla~~ Skin lesion Impression smears
I seizures, etc
BlopslesforGI &tlverforms {perlodlcacld-ScMf
Systemic fungal diz" Central river valleys
I';7-f
stain (PAS),H&Estcun Round to oval bodies wI
f!J:;J
'pseudocapsule"
0
Cats: 1 pulmonary & disseminate diz
Culture hazardous, difficult, done whn 1hours
Dogs' frequently _ severe GI diz
of collection, Sabooraud's media, ~""
"
;.s-#, ~
10-14 days for growth
<lU4
Ox: Hx (area) CS, organisms buffy coat, Rads, biopsy ~
* - **
cs:
rn-
Tx: Itraconazole
705
Ijl-J
.:,
l}:
------..
Prognosis: Guarded
Grave: if untreated most die
Remission. not cures expected
DDx:
Other pulmonary fungal dizs
Bony: 10 bone tumors or other
fu
ngal dizs
Malabsorption: lymphocytic or
plasmacytic enteritis & infiltrative
bowel disorders
1::::::========:::'
Emergency: immediate Tx
Hx (exposure)
Acute, severe, systemic type 1
exposure
I,1~;~~:~~~:~~I~:a~ &lor
injec- CS: especially skin reac- If respiratory distress: patent airway &
hypersensitivity
Hypersensitivity Life-threatening
give 02
tions are suggestive
reaction
Radiographs: pulmonary Epinephrine IV (1 :10,000) 0.2-1.0 ml
Rare in dog
- Epinephrine 1M or subQ : for less acute cases or If
M8k571, 574; Mk423; H3B Extremely rare in cat
angioedema{morecommonthan
IV can1 be administered
787; H2B 835; E-hb 728,
edema~
actual anaphylactic shock)
- Epinephrine Injected into offending site
169, 724: 5mln 700, 398; Anaphylactic reactions - type 1
Salivation & lacrimation
Repeat 15 min - epinephrine at 20 min.
IM-WW 535; E2004
- Allergic reaction to allergen
intelVals if necessary
- Occurs immediately after introduc- Anxiety
Shock doses of IV fluids: 5% dextrosel
tion of an antigen (allergen) into circu- Tachycardia
water or lactated Ringer's 50-100 mllkghu for 1-2 h
Cat: Resp. distress, dysplation of a sensitized animal
Steroids: last acting-corticosteroids: DexamethaAnaphylactoid reactions: similar to anaphylaxis wi nea, stridor, cyanosis
sone (0.25 - 1 mglkg IV or 1M)
same treatment, but non-allergenic meChanism
Sweating
Antihistamine: Diphenhydramine (Benadryl)
1'1301:h rea'oti(m"_C8luse release of chemi- Piloerection
0.25 - 1 mglkg IV or 1M
cal mediators from mast cells & baso- Vomiting,
Ice on site
phils (histamines, serotonin kinins etc,)
- Alters vascular permeability, smooth
muscle contractions, compliment activation
Life threatening
Target organs: dogs differ from other
~~---lL:E~p~in~e~p~h~ri~n~e~IV~~
I
('
domestic species as the liver is main
DDx:
"'"
target organ; cat: splanchmc vascula Other causes of shock
~'I ture & smooth muscles of lungs; ___-l::::=::::::::,---,-----l.,
Certain toxicosis
\\ A
of anaphylaxis
Feline asthma
~~!
(parenteral Introduction usually not orally)
Canine hemorrhagic gastroenteritis
Venom (hornets, wasps, ants)
Urticaria & angioedema of
~
,,,\
Blood products: transfusions
non immunological causes
\
Tetanus & venom antitoxins
Acute type 1, Rare
: ; J'
i . Vaccine,
CS: Itching, GI, Resp.
v
~
Allergenic extracts
Dx: Hx, CS
c:I J
b
Drugs: ABs, local anesthetics, vit K,
Prognosis: Guarded,
Anaphylaxis,
""':i<Fl1llry
~1J
~-=_~'i~-------------------------~~
Acute severe Circulatory failure
Rapid, weak pulse
History, Clinical signs
- 02 & nutrients to vital organs
Heart sounds
Prolonged CRT (;' 3 sec)
Circulatory
- Removal of wastes
(capillary refill time)
Pale, cold & dry mucous
shock,
- Leads to progressive & possibly fatal membranes
CVP (central venous pressure)
- Water manometer in Jugular vein
derangement of organs
Cardiogenic
Muscle weakness,
Metabolic acidosis
MultjfactoriaJ syndrome
depressed
sensation
shock
Cold skin, espedally extremities Postmortem: widespread
M8k 1235; 12M 391; 1M 94, Severe insufficiency in capillary
hemorrhage /":_
302; H3B 1295; H2B 1353; perfusion
Oliguria or anuria
f
,!t:;J-..,
E-hb 150, 144; Smin 150;
b5- V
IM-WW107
. ,
Classification of shock
Cardiogenlc:
Hypovolemic: mal1ted depletion
- Myopathic:
of extracellular volume
Cardiomyopathy
- Fluid loss (exogenous)
Congestive heart failure
'.
_Hemorrhage (Intemal or external)
Myoca rd ~tIS.
.
- Vomiting
MyocardIal InfarctIon
Diarrhea
~'
- Valvular: _
__
Burns (massive)
_ '~
"-'~
, Vegetative endocarditiS?
,
Anaphylaxis
Ruptured chordae tendineae
,
Obstructive blood flow ~
- lntracardiac obstruction:
- Aortic embolism
";,
Intracardlac tumors
- Caval syndrome of heartworm diz
Hypertrophic obstructive cardiomyopathy
Aortic stenosis
- Oysrhythmias:
Vasculogenic; circulatory disturbances
Sustained ventricular tachycardia
of distribution
Prolonged atrialorsupraventriculartachycardia
Uncontrolled atrial fibrillatlonttlutter
- Endotoxemia (early sepsis)
Complete heart block or atrial standstill
- Peritonitis
Severe bradycardia
- Pneumonia
- Drug overdoses:
Vasodilators
- Septicemia/sepsis
Calcium entry blockers
- Anesthetic overdose
Badrenergic blockers
- Surgical trauma
- Extracardiac obstruction:
Pericardlal tamponade
rfu'
#1 Edt
. Heartworm dlz
L
OW t Issue pe slon n 0 OXIMS
~
, Massive pulmonary embolism
CS: Rapid pulse, Pale, Weak, Cold, Anuria,
,Othercausesofpulmonaryhypertension
Ox: CRT;' 3 sec, Acidosis
_,
~~_-.==.,
Tx: Ernerg.: Fluids, Steroids, ABs, Bicarb
J ' ~"~ 707
Shock,
***
1]5:::J
..
0,:1
-<
Emergency
Replace fluid volume
- Restricted volumes in
cardiac failure
- large volumes for others
- Lactated Ringer's (electrolyte solution)
. Dog: 40-90, cat 20-60 mllkg Initially
- Blood transfusion
- Plasma or plasma expanders
CardiovascularstimulantSllnotroplcsup'I port after flUid volume loading
_Dopamine (Introplrdl) sale
_Dobutamlne (DobutreX) safe
Vasopressors pel'Slstent low blood pressure
- Dopamine (Intropln), constriction dose
- Methoxamine (Vasoxyl) IV
_Phenylephrine (Neo--Synephrlne) IV
.02: nasal catheter, cage, face mask
Broad spectrum ABs for septic shock
Penicillin G + aminoglycosides???
Steroids alter fluid volume corrected lor early
hypovolemic shock
-Dexamethasone, prednisolone,ormethylprednisolone IV once
__-,_____________ \.
02
Weight
loss
t Nutrient demands
266
- Pathologic
Physiologic (colds,
weather, growth,
- Parasitism
Malnutrition, eating or not?
Dysphagia (difficult swallowing)
Fecal exam:
- Microscopic for parasites
- Deworming Hx
- Fecal occult blood for melena
Physical exam:
- CS of concurrent diz (diamea), fever, - Diarrhea
dysphagia (diHlcult swallowing), abnormal o Lab - CSC, pp (,I,sm, ''"te'''1 & fibrinogen _
dentition, melena, icterus, dyspnea, tachycar- - Inflammatory process (t WBCs, t PMNs,
. _,
dI,
t fibrinogen, f PP: fibrinogen ratio)
;.;.t':i
- Abdominal palpation
- Chemistry: hypoalbuminemia
- Weigh
Cats: FeLV antigen & FIV antibodies; T4
- Check for lice
Urinalysis, thoracic & abdominal radiographs
Analyze diet:
Serological tests: viral, rickettsial, fungal dirofilariasia,
- Adequate intake
ANA
- Inadequate intake
- Echocardiography, Ultrasound
. Adequate feed: anorexia due to 1Q dlz
- GI endoscopy
, Inadequate feed: malnutrition
- Exploratory laparotomy wI biopsies
Anorexia
5min 16
- Inappetence
- Causes similar to weight loss
1M 276, 276t;
ing practices
- Metabolic dizs
- Organ failure
_Kidney
~
. Renal
. Liver failure
./,?"~/I
- H~percalcemia
$I . cr~
- ToxIc agents
~
oAnosmia
~...~.
- CNS dlz
'
~
=-=0
-=
~------------~-------,--------------,---~
Cachexia,
Cancer
cachexia,
Anorexiacachexia
complex
M8k 1638; H3B
765; H2B 817;
SAP191,447;E-
hb240;E513
- Regurgitationlvomiting
- + Fever ( t catabolism)
- Infections
- Inflammation
- Neoplasia: cachexia
- Toxins
ow/ofever
_ Metabolic disorders
. Renal
, Hepatic diz
. Cardiac diz
. Adrenal failure
- Cancer cachexia syndrome
- Loss of muscle mass
-Immune mediated neuromusculardiz
- Degenerative joint diz
- Exudative skin dizs
- Bums
- Pyoderma
- Lower motor neuron diz
- Loss of smell especially in cats
- Phenomenon of severely reduced or stopped eating = progressive emaciation & debility; cachexia with eating
wI severe metabolism alterations; common in cancer
- CS: Anorexia, cachexia/weight loss, anemia, debility
o Ox: HxlCS; Find neoplasm (PE, radiographs, cytology, biopsy)
- DDx: Starvation; Parasites; Endocrine (hypoadrenocorticism, hyperthyroidism, hypopituitarism), CNS (diencephalic syndrome); Chronic infectious dizs (FIP, systemic mycosis); Malabsorptionlmaldigestion syndromes
- Tx: Specific anticancer therapy; Dietary (special diets, tube feeding, parenteral nutrition, t palatability [warm,
flavor wI meat, fat, onion, garlic, multiple feedings],
diets; Appetite stimulants -cat (diazepam
[Valium], Oxazepam [SeraX])
Weight
gain,
Obesity
M8k 1641; E-hb2, 12M611;
IM612;E4;H3B 1237;H2B
1287; Cat 172; NB 13.2
****
(Q..
~
Fever,
Pyrexia
~..
- Rickettsia
Ehrlichia
Rocky Mt. spotted fever
Hemobartonella
- Parasites & protozoa
Babesia
Toxoplasma
Aberrant lalVa migrans
Dirofilaria thromboembolism
Leishmania
- HepatiC tumors
- Mastocytoma
- Plasma cell neoplasm
- Mast cell tumor
- Metastatic diz
- Any actively necrosing tumor
- Secondary infected neoplasn
~/U.U=\=m
~~T"
rl
- Fever: over 104F usually im- - Fever: clinicians assume fever - Nonspecific AB treatment,
portant
due to an infection until proven most respond promptly & no
- Dehydration
otherwise
lab work is periormed
- Anorexia
- Response to nonspecific AS - Monitor: temperature ..
Lethargy
treatment, most respond q12h
- Tachycardia
promptly & no lab work is per- Hyperpnea
formed
-Iffever persists see FUO below Prognosis: Good, most promptly
respond to nonspeCific ABs
- Other inflammatory processes
- Nitrofurantoin
- Endocrine & metabolic
- Inflammatory bowel diz
- Enrofloxacin
- Hyperthyroidism
Cholangiohepatitis
- Amphotericin B
- Hypoadrenocorticism)
- HepatiC lipidosis
- Barbiturates
rare)
- Toxic hepatopathy
-Iodine
- Pheochromocytoma
- Cirrhosis
- Atropine
- Hyperlipidemia
- Pancreatitis
- Procainamide
- Hypematremia
- Peritonitis
- Salicylates (high dose)
- Neoplasia
- Pulmonary thromboembolism
- Cimetidine
- Lymphoma
- Pleuritis
- Antihistamines
- Leukemia
- Granulomatous diz
- Heavy metals
- Myeloproliferative diz
- Hypertrophic osteodystrophy
-Vaccines
- Intracranial tumors
- Infarction
- Immune mediated
- Blunt trauma
- SLE (systemic lupus erythematosus)
- Pansteatitis
- Immune-mediated hemolytiC anemia
- Panniculitis
- Immune mediated thrombocytopenia
- Cyclic neutropenia
- Pemphigus
-Intracranial lesions (encephalitis, - Polyarthritis
trauma)
- Polymyositis- Vasculitis
- Drugs & toxins
- Hypersensitivity reactions
- Tetracycline (#1 in cat)
Transfusion reaction
- Penicillins (#1 dog)
- Infection 2 to immune defects
- Cephalosporins (#1 dog))
- Sulfonamide
Drugs
(tetracycline)
Blastomyces
'~
\
Survey bones: bone tumors, multiple myeloma, osteomyelitis,
- Yersinia (plague)
- Tissue necrosis
diSkospondylitls, panosteitis, hypertrophic osteodystrophy
\
Protozoal
- Mycobacteria (tuberculosis) - Hemobartonellosis
- Hyperthyroidism
Skull: dental abscesses, sinus infections, neoplasia
\~~~
Contrast: GI excretory urography: for neoplasia or infections
- Nocardia
- Blunt trauma
- Cytauxzoonosis
- Ultrasound:
- Actinomyces
Rare causes in cats
Neoplasia
Abdominal: guided FNA biopsy: neoplasia, abscess
\\,
- Immune disorders (polyarthritis)
- Brucellosis
or infection( pyelonephritis or pyometra)
- Lymphoma
- Endometritis
EChocardlography If murmur: endocarditis
- Localized abscesses of or- - Leukemia
- Endocarditis
~ Bone marrow aspiration (cytology & bacteriallfungal cultures)
gan or tissue
- Diskospondylitis
- Myeloproliferative diz
~ Biopsy any lesion or enlarged organ
Pneumonia
Pyothorax
- Intracranial tumors
- Prostatitis
- CSF tap if neurological signs
Abscess (liver, lung, kidney) - Plasma cell neoplasm
- Leukocyte scanning
Dental abscess
- Mast cell tumor
Exploratory laparotomy: last resort if not improving
Therapeutic trials: antipyretics, antibiotics, steroids
Fever of
unknown
origin, FUO
Treatment
- Vasculitis
Restrict activity
Recurrent bacteremia
- Steroid-responsive fever
High caloric diet
- Endocarditis
- Meningitis
Fluids: isotonic (lactated Ringer's or 0.9% saline)
Localized abscesses of organ or tissue
- Infection 2 to immune defects
Inform owner diagnosis can be
Abscess (liver, pancreas, prostate, lung,
- Immune mediated thrombocytopenia
extenSive, expensive & not always
kidney)
~ Pemphigus
definitive (10-15% never diagnosed)
Chronic prostatitis
- Polymyositis
Stump pyometra
- Hypersensitivity reactions
If definitive diagnosis treat specifically
- Transfusion reaction
Peritonitis (retroperitoneal space)
, Pyothorax
Neoplasia
Idiopathic (no definitive diagnosis) & al Chronic pyelonephritis
- Lymphoma
ready treated wI ABs
, Osteomyelitis
- Acute or chronic leukemia
- Steroid trial (warn owner death can occur
SeptiC arthritis
- Myeloproliferative diz
if undiagnosed infectious cause)
Diskospondylitis
. If Immune mediated or steroid responsive:
- Intracranial tumors
Meningitis
- Plasma cell neoplasm
fever resolves in 1-2 days; taper dose to
SystemiC infections (early, chronic or latent) - Mast cell tumor
every other day
~.
- Brucellosis
- Metastatic diz
....J'
- SystemiC mycoses (histoplasmosis, blasto- Necrotic solid tumor (liver, kidney, bone, lungs,
Steroids,
mycosis, coccidioidomycosis)
lymph node)
\1\- Ehrlichiosis
- Malignant histiocytosis
- Rocky MI. spotted fever
- Multiple myeloma
/-------L-J. No response to steroids: aspirin or con- Lyme diz
Miscellaneous
Most common causes tinuedABs
- Salmon poisoning
- Chronic granulomatous diz
- Aspirin [salicylates] & return
\
of UFO
- Chronic hepatic dizs
Protozoal
to clinic in 1-2 weeks (bid
:
Infectious diz
- HemobartoneUosis
- Metabolic bone disorders
in dogs, q3d in cats)
~ I
...
(viral #1 in cat)
- Babesiosis
(hypertrophic osteodystrophy)
. Other antipyretic drugs: dipyrone
A
Immune
mediated
~ Hepatozoonosis
:7 f1:j ~ Drugs (tetracycline, sulfa,
[NovaldlnJ, fJunixin meglumine
(rare in cat)
[BanamineJ, use wI caution,
- Chagas' diz
~
penicillins, enrofloxacin)
hypothermia, ulcerogenic, blood
Idiopathic
- Leishmaniasis
Tissue necrosis
cytopenias, nephrotoxic if dehydrated
MisceUaneous
Immune mediated
- Hyperthyroidism
- Continue ABs trials (cephalosporin + ami Neoplastic
- SLE (systemic lupus erythematosus)
noglycoside combo for minimum 015-7 days)
- Immune-mediated hemolytiC anemia
- Polyarthritis
Monitor: temperature q12h, CBC every 2
weeks forleukopeniaorsepsis, weigh weekly
-Idiopathic (1015%)
r
L- -
Ii
Heat stroke,
Hyperthermia
M8K 726; Mk 442, 631; H-TI
M 326; E-hb29; H3B 1311;
H2B 1369; 12M 991; 1M 974;
IM-WW 59; 5MIN 640
**- ****
regional
airway,~f.':
- Renal failure
Cause:
wave abnormalities
-Oxygen
- Diazepam
0'
Hypothermia
& Frostbite
M8k 727; Mk 443, 627; E-hb
17; SAP519t;H3B 1315;H2B
1373; 1M 681; 5mln 80, 163;
C12T 157; E 26; H-TIM 328
***
~.
Prognosis:
':%i
'" )
~~ \{f;J.
cool, Fluids,
Malignant
hyperthermia
foe
~~
"-''''''~I-Treat OlC
J'
time)
Sequelae:
muscle relaxants
'IJ~'.,;~~:;~~:X~;'~:
Vasodilation=hypotenpe~s!on:
Hx (surgery), CS
ECG
- Tachycardia (fast HRl
- SoT segment & T wave
abnormalities
myocardial
Prognosis: Guarded?
Consciousness
- Hx (cold), CS
Lethargy
Low body temperature - < 95
Shallow, infrequently
.~~~":~;~;~~
- Severe: < 82C 28 C)
respirations
Regional: greaterin Arz. than Alaska
Ataxia
Cause:
Stupor
- External cold
Shivering, disappears if se-
- Drugs
- Interference wI thermoregulatory
centers - anesthesia
'~
vere hypothermia
/~. . . , ~'-,
?i
-.-~
~\
(,. PrognosIs:
.
redness
L--~G~u~a~ro~ed~:~p~e~rn~is~te~n~t~c~ol~d~,p~a~le~,~in~s~e~n~si~tiv~e~
Hypothermia
- Intullate if unconscious, 02
~
;
__
- Warm patient
_IV catheter; rapid infusiOfl normal saline (warm to 104109F (40-43C In water bath or Incubator) +
Mild 10 moderate: warm water heating pad, water
bottle, electric heating pad (monitorforthermal bums),
immerse In warm water
Severe: internal (core) warming <90Fo 32 CO), prolonged hypothermia or unstable cardiovascular
.. Peritoneal dialysate (109F/43OC); rapidly infuse &
immediately remove, repeat until> 96F (>36q
_. Colonic lavage wI warm saHne
. L,
.. Gastric lavage wI warm saline
Supportive care
"-
- IV fluids (warmed)
- Ventilation, Oxygen
- Treat any atrial fibrillation & ventricular tachycardia
- Analgesia for painful thawing: molphlne sulfate, oxymorphone (Numorphan), buto'llhanol, pentazocine (Tal-
"'"")
D-
_0.
Monitor
~.
- [J.
'
Acaricides 740
Acetaminophen 731
Acetylsalicylic acid 731
Acid or alkali poisoning 721
Adriamycin toxicity 730
Aflatoxins 747
Algacide 742, 743
Algae 748
Alkali poisoning 721
Amanita phalloides 747
Aminoglycoside toxicity 726
Amitraz 740
Amphetamine 737
Amphotericin B toxicity 728
Analgesics 730, 731
Anemia 730
Angel dust 737
Anticholinesterase 740
Anticoagulants 295, 738
Anticonvulsants 730
Antibiotics 726
Antidotes 719
Antifreeze toxicity 352, 734
Antimony toxicity 736
Ants 722
ANTU 738
Arachnids 722
Aromatic hydrocarbons 721
Arsenic poisoning 735
Aspirin 731
Barium toxicity 736
Battery liquid 721
Benzene 721
Bleach 721
Bleeding heart 744, 745
Blue green algae 744,748
Boric acid 741
Bromethalin 759
Bufo toxicity 724
Bute 731
Cadmium toxicity 736
Caffeine toxicity 724
Carbon monoxide 246, 725
Cardiac glycosides 245, 746
Caustic agents 721
Central nervous system
depressants 737
Cheque toxicity 732
Chloramphenicol toxicity 727
Chlorinated hydrocarbons 578,
740
Foxglove 744
Chocolate toxicity 724
Chromium toxicity 736
Garlic 746
Citrus oil extracts 741
Gas anesthetics 730
Gasoline 721
Coat contamination 720
Cocaine 737
Gastric lavage 719
Compound 1080 739
Gastrointestinal
irritants 744, 746
Contact irritants 744, 747
Gentamicin 726
Copper - hepatitis 97, 734
Glucocorticoids 729
Corrosive agents 721
Glycoside plants 744,746
Corticosteroid 729
Coumarins 295, 738
Green algae 748
Halothane 737
Cytoxan 368
DEET 741
Heartworm medication 735
Heinz body anemia 282,
Detergents 720,721
Digitalis 244, 730, 744
730, 731
Hepatitis 94, 730
Diquat 743
Dishwasher granules 721
Herbicides 742
Hydrocarbons 721
Dishwasher soaps 720
Doxorubicin 247, 730
Hydrogen sulfide 725
Ibuprofen
731
Drugs 731
Drug & toxin - anemia 730
Insecticides 718
Emergency care 719
I ron toxicity 736
Kerosene 721
Estrogen toxicity 733
Ethylene glycol toxicity 352, 734 Ketoconazole toxicity 727
Lead toxicity 579, 734
Fire ants 722
Toxicology
Lutalyse toxicity 733
Lye 721
Marijuana 744, 745
Megestrol acetate 732
Mercury toxicity 736
Metaldehyde 577, 738
Mibolerone toxicity 732
Milkweeds 744
Mistletoe 744, 746
Molybdenum toxiCity 736
Mushrooms 747
Naphthalene 721, 741
Narcotics 737
Nephrotoxic plants 747
Nettles 744, 747
Nicotine 741
Nightshade 745
NSAIDs 731
Oleander 744
Onions 744, 746
Rattlesnake 723
Rhododendron 744, 746
Rhubarb poisoning 744, 747
Roundup 742, 743
Rotenone 740
Rodenticides 738, 739
Sago palms 744
Selenium toxicity 736
Smog 725
Smoke inhalants 725
Snakes 723
Sodium fluoroacetate 739
Solanum poisoning 745
Solvents 721
Spiders 722
Steroids 729, 730
Stinging nettles 747
Strychnine 578, 738, 742
Tetracycline toxicity 726
Thallium toxicity 734
TOXICOLOGY
n9
Toxicology, Toxicology: study of poisons (toxi- CS similar to
POisoning
JAVMA 205(3)p417,
1994; Tox-X 392; H2B
1301; C12T 210, 211;
%min 126; Cat 215;
NM 20.2; Tx 7, 660
**
cants)
cells
- Toxinslbiotoxins: poisons originating from biological processes
Owners frequently suspect poisonings, which usually are other
sicknesses
Relatively uncommon since:
- Pets, especially cats, are finicky eaters
- Vomit readily If harmful material ingested
- cats eat small portions
Dogs poisoned more than cats
History (exposure), CS
several illness
Physical exam
Pain
"'!::;:'X~-I Serum enzyme profiles:
Vomiting
i
or kidney damage
Diarrhea
Coagulation tests (PT & PIT)
Salivation
Urinalysis
0
-Slimy
-CSC
(l
( e.
Redness of mouth
- Electrolyte analyses
CNS
- Blood pH, bicarbonate,
- Trembling
anion gap db
i&
- Incoordination
Hair for chronic exposure
- Fits
Stomach contents
-Coma
Postmortem: lesions, or- Panting
gans & tissue samples in
- Abdominal pain
10% formalin
n) {
Chemical analysis: blood,
organs
Metaldehyde
Fertilizers
2%
cleaner, solvents, paint stripper)
Lead
wrongly used to clean a pet
Strychnine
Warfarin (8rodifaxoum)
Tylenol, Ibuprofen et al.
but uncommonly ~~~'!~,
Pyrethrins -
Often blamed
CS: Similar to several illness
Ox: Hx, CS, Lab
Tx: Induce vomiting?,
Chlorphyrifos
./ " ()
Organophosphates
tI
Petroleum distillates - ethylene glycol
Cholecalciferol
Re.mlPUn illl
Peritoneal dialysis
Gastric lavage: used when emesis In Ineffective or contraindicated. Must be perlormed In an unconscious or lightly anesthetized
animal
- Place an endotracheal tube to prevent aspiration
- Stomach tube, lavage warm water or saline be gravity flow, aspirate back alter a lew minutes repeat 10-15 times
Enterogastric lavage: "through & Itlrough enema' gastriC tube &
endotracheal tube in place. Give enema fluid gently until it comes
out gastric tube
452-7t65
Toxicjty
Acetaminophen
Anticholinesterase poisoning
Antifreeze (ethylene glycol)
Arsenic
Copper (hepatotoxicity)
Coumarin & indandione
anticoagulants
Cyanide
antidotes
Acetylcysteine
Atropine sulfate
PO
Ethanol (20%)
IV
4-methylpyrazole
Dimercaprol (BAL)
DL-6,B-Thioctic acid
Ascorbic acid
1M
1M
PO
Vit K1 (phytonadione
PO,
- Whole blood
sa
Sodium nitrite
Sodium thiosulfate
Lead
Calcium disodium EDTA
D-Penicillamine
Methemoglobinemia in cats
Ascorbic acid
Organophosphate insecticides Pralidoxime chloride
IV then SO
PO
PO
IV,SO
2-PAM
Snake (crotalid) venom
Zinc
CNS dysfunction
- Seizures: diazepam (Valium) for seizures IV,
phenobarbital IV if diazepam ineffective or prolonged Tx required,
pentobarbital IV if phenobarbital ineffective - lightly anesthetize
CNS excitation: doxapram (Dopram) IV
- Phenothiazine tranquilizers not recommended
Antivenins
Calcium disodium EDTA
IV
IV then sa
TOXICOLOGY
Presentation/CS
Facts/Cause
Condition
a pet or
Inadvertently contamination wI
toxic substances such as:
- Paint, paint remover, petroleum products, motor oil, bleach, disinfectant,
antifreeze or tar
May burn the skin or
Poison when licked off or
Burn mouth
Dermatitis (red)
Diagnosis
Hx (exposure), CS
arrhea, GI distention;
Depression, collapse,
seizure, coma
Dermatitis (red)
Hx (exposure), CS
JAVMA 205(4)p558,
1994; H2B 1332;Tox-WW
322,143
Corrosive &
caustic
agents,
Acid or alkali
poisoning,
Petroleum
products,
Aromatic
hydrocarbons,
Industrial &
commercial
toxicants
Treatment
agent)
CS
tbsp/10 Ibs)
- For lye: vinegar, lemon juice or
orange juice (2 tbsp Ibs)
- For petroleum products: vegetable or mineral (2 tbsp/10 Ibs),
poorly absorbed by charcoal
Respiratory failure
Degreasing solvents
Detergents: laundry,
dishwasher
Dinitroorthocresol
Dishwasher
granules
Disinfectants
Drain cleaner
Dry cleaning solvents
Ethane
Gasoline
Glues
Hexachlorophene
Kerosene
Clay pigeons (shooting) Lacquers
- Coal tar products
Lye
Creosote
721
Methane
Mineral seal oil
Mothballs
Naphthalene
Oven cleaner
Paint stripper
Paint thinner
- Paints
Petroleum distillates
Phenol
Pine tar
Plastics
- Polishes: furniture,
shoe,floor
- Polyurethane
Potassium hydroxide
Propane
Trichloroethylene (TCE)
- Turpentine
-Vamishes
- Wood preservatives
- Xylene
Arachnids,
Spiders
TOXICOLOGY
Facts/Cause
Diagnosis
Presentation/CS
Difficult to recognize probably under Acutely: bite very painful, little Difficult to diagnose
Hx, CS suspect,
swelling
diagnosed
Black widow (Latrodeetus mactans): red hourglass on Pruritus, erythema & local discomlon usually
later than snake bites
M8k:2155;Mk:1731; ventral abdomen; L. hesperus, SW & E USA
5min 1070;Cat231; , Venom: neurotoxin: causes release of neurotransmit Widow spiders
-Intense pain
ters at neuromuscular Junctions
EhbI65;SAP331;
Restlessness, anxiety, apprehension
C12T 631; Derm Brown recluse (Loxosceles reelusa): violin-shaped
- Salivation
443; ToxWW 438 mark on dorsal thorax
- Shock; rapid, shallow, irregular respiration
Venom: potent dermonecrotic toxin, vasoconstrictive,
- Painful musde rigidity - clonus, spasms
thrombotic, hemolytic & necrotizing properties
9 commonty on face. forelegs
Ascending motor paralysis
**
,re
Brown spider (fiddle backed)
- Delayed, may nalleei bite, indolent (causing little pain)
- Red (erythematous) area around bile,
blanched zone around red '" "bulls-eye"
- Necrotizing akin lesions, into muscles,
last for weeks If not treated
- Rarely fever, nausea. seizures
Sequelae:
- IV hemolysis
Renal failure
- Shock, death
Treatment
eDa-~
rr:::~~
Sterol s
.~
Prognosis: ~
Widow: good in dogs, guarded in cats
Recluse: good, may be delayed for week:s
D~
.
&
spraying
'-:A'"n--=t-s----,--;:F::-ir""e-'a""nt"s-:(""S"o"tec:n""OP",S"'iC"S"in-V""ic""ta-:)""S"".-:A-m-e""r.-:&""s"'WS,U-"S""A"":"p"r"'ed""a"c"e"o""us=-=-ca"m=iv"o=re"s""'li"k"e-!oV"'e=sp"id"s";7u"r::-ba:::n=-&;;-:::ru"cr"a"ls"e:;;tt"in"g='=s:-;A"'tt"'a"c:::h----'-Fire an:s
by jaws & pivot in a circle administering stings
Derm 462, E-hb CS: Initially painless, then redness, itching swelling, regress in 48 hours; anaphylaxis (hypersensitivity), death if large numbers
165;~1 Ox: Hx (ant exposure), CS
Cat 230
" . DDx: Mechanical punctures, snakebite, angioneurotic edema
Tx: None if mild; antihistamine &lor steroids if moderate to severe; Epinephrine if anaphylaxis
*___
"" ..,~
Snakes,
Massasauga
or
pygmy
rattlesnake
Physical
exam
&
rhage,
hematoma,
necrosis
Ehb164;$AP330,
Ice on site, toumlQuet controversial
Water moccasins (Agkistrodon)
152; H3B 1289;
Bite
wounds
sloughing
Fer-de-lance; true vipers: puff adder, Russell's viper,
- Antivenin: polyvalent crotalid (Micrurus) wlin 2
H2B 315; E 321;
- Vipers: Tachycardia
- Dyspnea, swollen nasal pascommon European adder
hr of bite, bind specifically to venom, poison control
5min 1066; Cat230,
Identification:
Pit
vipers
Elapines:
CNS
CS
sages or throat (head bite)
centers may help locate, 510 ml injected Into tis
260; Derm 873,
Pit
organ
between
eye
&
nostril
sue & rest IV
874A; ToxWW
Lab: hemoconcentration,
- Salivation
Broad triangular head, distinct neck:
Have epinephrine (1 :1000) lor anaphylactic shock
440: 57, 75t
hemolysis, t or coagu- Dilated pupils, shock
, Vertical elliptical pupils (round In nonpoisonous)
ready
, Prominent curving, hinged fangs, strik:e & Inject
lation times, DIC
2 clostridial infections
Diphenhydramine (Benadryl) reduces
venom, rattlesnakes: rattle
anxiety & helps prevent allergic reaction to antivenin
Toxic principle: hemotoxic, necrotizing & anticoagu Coral snakes:
Tracheostomy if dyspnea from swollen nose
lant, neurotoxic
- Small fang marks
No NSAIDs early (aggravate possible throm
ElapineS(Elapldaefamlly): SE USA, WTexas
bocylopenia) OK in later stages for pain & edema
- Pain & swelling minimal
- Coral snakes {Eastem or Texas coral snak:es (Micru
rus), Arizona or Sonoran coral (M/cruraides)
Antibiotics for 2 infections
- eNS: weakness, disorientation,
- Cobra & mamba: not Indigenous to USA
Treat shock: IV fluids (careful for pulmonary
paralysis, respirator failure
- Identification: coral snak:es:
edema)
Cranial n, paralysis of eyelids, eyeball
, Bands of yellow, red & black (yellow bands in con
Corticosteroids: controversial, may buy time
tact wi red bands)
- Parasympathetic CS: saliva, Short fangs (hang on & 'chew" venom Into victim)
tion, vomiting, defection or di "Pseudo- coral snak:es: black: bands bordering both
Coral snakes:
arrhea
sides yellow bands
- Antivenin: availability limited (get from hospital
-Toxic principle: neurotoxic: respiratory paralysis, suremergency room)
vivlng animals rarely have sequelae
DDx:
- Supportive care, anticonvutsants if
Dogs & horse> cats & cows
y
POl radiculoneuritis.r.:::--:-_-:::-::-_-:-::-:--::-::-_--\ necessary
Bitten on muzzle or legs (curiosity)
Tick paralysis
"Red on Yellow, kill a fellow
- Ventilation assistance
Spring & summer
Botulism
Atropine
More common in SW & SE USA
Myasthenia gravis Red on black, friend of Jack
< 50% cause envenomation & clinical
or venom lack"
Fracture
L-------,~-----IPrognosis:
signs
Abscesses
Pit vipers: depends on site of bite, size
Spider envenomation
Viperlnes (Pit vipers & Elapines)
of animal & amount of venom
Allergic reactions to insect bites or stings
-Acute phase (1 st 2hr): poor, usually die if notlreated
CS: Pit vipers: necrosis & sloughing
Nonpoisonous snake bites
- 1st day phase: good jf no shock or depresSon
Elapines: CNS
Convalescent phase (10 d): good lor lite
Ox: Hx, CS, Physical exam
Corral snake: envenomation rare, recovery expected if prompt aggressive Tx
Tx: Elapine: Antivenin, Supportive, Tetanus antitoxin
Venomous
snake bites
**
Chocolate
toxicity,
TOXICOLOGY
Facts/Cause
Theobromine toxicity,
Caffeine/coffee,
Theophylline/tea
toxicity
Presentation/CS
Dia nosis
CNS
- Excitement, hyperactivity
- Chronic movements (Involuntary,
jel1ty)
- Delirium, muscle twitching
- Seizures, tonic totetanic convulSion
cardiac arrhythmias: sudden death
Urinary Incontinence
Vomiting & diarrhea
Polypnea (rapid breatl'1ing & heart
beat)
Hyperthermia
"-..I~'~~
lUll
- Blindness or dlsonentation
-Convulslons,selzures
_ Deatl'1ln 30 minutes
**
Hydrogen sulfide,
H2S
C4
-DDx:
.:>ther cause of oral & facial bums
- ElectriC cord
- caustic chemicals
......),",..J~....<...:J'. .
~~~S;J..""'
Carbon
monoxide
Smog,so2,
~0~1~:~0~~:W~
-_ "\
"l
-=
-~~C
?
Atropine
--=---
History, CS
Brick red gums form CO
Auscultation
BronchoscopyfTranstracheaJ
wash: soot, damage
Bradycardia late
Radiographs: findings in 16lachypnea)
24 hrs, film every 12-24 hrs:
Cyanosis
patchy interstitial edema, dif Weakness, collapse
fuse peribronchial densities,
Shock, respiratory or caredema (interstitial & alveolar
diac arrest
patterns with air bron Sequela: pneumonia
chograms)
'..-::!:;;,,,,,,ii'I
- G..
Pulmonal)' edema
Hyperpnea
.Asphyxia follows if not immediate arti-
Smog, Sulfur oxides + H2SO4 smog major factor in air pollutants; dealhs of man & animal
Urban environments
Eyes - Respiratory
t~~
).-'-: ________-,
-)
~ =~
~ ~
Manure pits
CS: Asphyxia
Tx: Fresh air
127. ,..
Hx (playing wI toad), CS
Auscultation/ECG: Cardiac irregularities
leading to vantricular fibrillation
Monitor w/ ECG
Necropsy: Toad parts in stomach
!~
:~~~~~c
House fires
Pathophysiology: direct thermal injury,
& inhalation of noxious substances
- CO toxicity (carbon monoxide poisoning)
most common cause of death
Alveolar damage, interstitial edema,
hypoxia & 2 0 bronchopneumonia
~:,~~::g~~~~:1t)
.'~
~.Inderal~
lidocaine
Toad (Bufo)
toxicity
Smoke
inhalants
Theobromine
\~
CS: Excitement, Seizure, Arrhythmias
Ox: Hx, ECG
Tx: Symptomatic, Antiarrhythmics
Digitalis-like toxin
CS: Vomition, Diarrhea, Weakness
Ox: Hx, CS, ECG
Tx: Flush mouth, Propranolol
Treatment
Emesis, activated eharc081 every 3-4 hours
Eye Irritation
Salivalion
EmphySema,
Respiratory distress
PubliC Health
Antibiotics - Toxicity
Condition
Aminoglycoside
toxicity
E-hb 138, 170, 274; H3B 1291;
H2B 566, 1161, 1165, 1348,
1349; E 332; 1M 767; IM-WW
491; Gat 235; NS3hb 190, 225;
NS-hb216; NS-L249; Tox208,
212;Tox-WW153, 235, 84, 821
**
Facts/Cause
TOXICOLOGY
Presentation/CS
Diagnosis
Treatment
Gentamicin (Gentocin)
dination, nystagmus
acoustic nerve degeneration, cardiovascular de Tobramycin (Nebcin)
- Hearing loss
pression
Kanamycin (Kantrim)
Neuromuscular blockade: when aoministered
concurrently with certain anesthetic agents
Dihydrostreptomycin (Ethamycin)
Related to high doses & prolonged use \"" 7ds)
Amikacin (Amiglyde)
especially if impaired renal function
Neomycin (Biosol)
Predisposing lactors
Dehydration & hypovolemia
RenallnstJlficlency
MetaboliC aCidosis
Concurrent furosemide f"~~,~
(LasiX)TX
Severe sepsis or
eno'otoxemla
t{f-----r-.~---l!!_."'
..
~~
Deafness may persist
Tetracyclines
Prevention:
No tetracycline to
young growing dogs
::a
CNS depression
Broad spectrum antibiotic
- Reversible bone marrow suppression may oe- DehydratiOn & dull hair coat
GI signs
Anorexia (vomiting, diarmea)
- Not bone marrow aplasia as in humans
E-hb 690; SAP 155; H3B Cats &SpeCially susceptible
Weight loss
1291; H2B 725, 1348, 1349;
Death
-II use, limit 10 smallest dose &
5min 91; Cat 235; Tox 209
shortest duration possible
Do not use In dogs or cats wi
non regenerative anemias
Chloramphenicol: Chloromycetin,
Chloramphenicol
toxiCity
""
Ketoconazole
toxicity
-Stop drug
HX (exposure), CS
CBC: Mild anemia - Aplastic anemia
- Neutropenia
Thrombocytopenia & neutropenia
precede anemia
Bone marrow: vacuolation of hematopoietic precursors
(r
!Ill
Hx (taking drug), CS
+ ALT activity
NlZOraI
Cholestatic hepatopathy in dogs reported; acute onset of jaundice & + serum liver enzymes, Hypersensitivity?
Trimethoprimsulfadiazine Also: keratoconjunctivitis sica, gastroenteritis, pustular dermatitis, erythema multiforme, blood dyscrasias, hepatic
necrosis, seizures in cats
(Tribrissen)
E-hb 516; H3B 1291; H2B
1348
Drugs
TOXICOLOGY
Condition
"~
"'''~'
~ Hx {tasking
drug), CS
Facts/Cause
Fev~r.
Amphotericin B (Fungizone) IV polyene antibiotic, VomitIng
fungistatic & fungicidal, protect from light
Cl2T327; 5AP11351,139;IM
218; H2B 1348
Excellent for initial Tx of fulminating life threatening
Amphotericin
B toxicity
~
1/'
'T
Amphotericin B
.
~
\..v
7'--
infections
- Restrict to first few days of life threatening systemic
infections or unresponsive fungal infections
sodium-depleted animal
Oon't use In cats: more sensitive- toxicity
wi single dose, rare that amphotericin should be
used in cats sjnce new drugs
tB
00
Other bizarre effects reported for itraconazole: dermatitiS & 11mb edema
(due to vasculitis)
Prevention:
Monitor anorexia for toxicity
Monitor ALT activity monthly
duringTx
-=-:-----,c-::-------,,---------,---------:~~,
****
Steroid Tx excess
- Pu/PD
- PolyphagiaiPP
- Weight gain
~'~.1'
. ~
1
,/ ~IL
>
-Immunosuppression
. Infections
_ GI ulcers
_ Bizarre behavior changes
Abrupt stoppage of GCS
_ See Addison's above + Pu/
PO
Abortions, teratogenic
Hepatotoxicity see pg 94
eD
Steroids
"
enhance absorption
IJ
C12T329;SAP138; H28179;
,-
Stop treatment if CS or
BUN or creatinine stop Tx if > 3 mg/dl
Metoclopramide for vomiting
Potassium supplementation
preventi!,:
Rehydrate animal before giving
Dilute amphotericin B in 5% dextrose
-If normal renal function: dilute in 60-120 ml of 5% dextrose, give over 15 minutes
- If compromised renal function: dilute in .5-1 liter over 3-6 hr.
Measure BUN before each dose to prevent irreversible renal damage
- If BUN remains below 50 mgldl give amphotericin B every other day
- If BUN> 50 mgldl stop amphotericin B until :s;: 35 mg/dl
- If Creatinine stop Tx if > 3 mgldl
Other suggestions: mannitol concurrently, saline loading, furosemide, aminophylline, antihistamine diphenhydramine (Benadryl) 1M to prevent vomiting
Triazole
- Itraconazole (SporanoX): latest triazole, given wI food to
,'..
,/
Triazole
(itraconazole,
fluconazole)
toxicity
Prevention:
Hx (steroid Tx), CS
Stress leukogram (leukocytosis wi Avoid in pregnancy
neutropenia, eosinopenia, monocytosis) Avoid long term hi dose Tx
ALP (alkaline phosphatase
- Use alternate day Tx if long term
ti
Tdr '
Jjj1k
GCC
1)( required
____________L - - ,
Beneficial drug
. CS: Pu/PD? PP
Dx:Hx
Tx: Limit use, Alternate day Tx
Short acting:
Intermediate acting:
Triamcinolone (Vetalo~)
Long acting:
Dexamethasone (Azium)
Ultralong acting:
ccs
--
--
'-"",4 ~I+I II
Digitalis
_
_
_
Intoxlcatlo~n
**
_.
"talStop digoxin, Lidocaine or phenytoin, supportive; reinstitute 50% digitalis
"
D19l ~ Tx:
Px: Good to guarded
Doxoru (Cln
Drug oxidative
RBe
See Circ 282: Oxidation of RBCs causing hemoglobin denaturation - Methemoglobinemia (reversible) or
InjUry to
S,
Hemolysis &
methemoglobinemia,
,_~
~ _I Ii'
~
& toxin
induced **?
aplastic
anemia
"_J
See Cire pg 286: Nonregenerative reduced erythropoiesis & aplastic anemia: cytotoxic antineoplastic drugs,
Drug-induced
**
Ji
;
--_."
Tylenol,
See GI pg 94 - Anticonvulsants, Analgesics, Gas anesthetics, Antimicrobials; Antihelmintics, Steroids - see pg 91 for full list
CS: Usually acute hepatitis except in anticonvulsants & steroid
Ox: Presumptive diagnosis usually, cannot be proven
Tx: Withdraw drug, supportive care, no antidotes
Cat:
Hx (exposure), cs
- Anorexia, depression
Methemoglobinuria (choco~
- Salivating
late brown urine), hematuria
- Vomiting
Heinz body anemia, methH2B 1335,1347,1348;
Target organs: liver (dog) & RBCs - Sever cyanosis (dark gums) emoglobinemia,
PCV
SAP 1.52; 5min?12,
(I
I
(cat)
-Icterus in 2-7 days
t Hepatic enzymes & t biliruE323, Cat 233,
~
Tylenol Excedrin Anacin~3 Datril
_ Dyspnea
bin
Tox-WIN 303
1
" "
NB 20.5
'
Tempra, Paracetamol
- Swollen face & paw, itching Serum acetaminophen levels
Postmortem: dark, chocolate-colored
1 " Toxic metabolites~ii Death in 18-36 hrs
blood, mottled liver, centrllobular hepatic
I if"Y:.
Dog: depression, abdominal
necrosis, edema
NOT TO CAT!!!!
pain, anorexia,. vomiting, heDDx:
CS: Cyanosis, salivating, vomiting, icterus
npat'c necrOSIS, Icterus, wetght
Phenol comPounds. Phenacetin
H b0 dles, UA, L
loss & death (few days)
Detergents
Nitrobenzene
x. Hx, CS,emz
ab
Soaps
Sul!ites
Tx: Prompt, emesis, charcoal, Acetylcysteine, Vit C
Nitrites
acetaminophen
anemia
,~'"".,~ I-OO~"~';'~'._'"
**
~f)11;;I,"",
o-
:.I ~
c: . - )
Dx: Hx, CSt PE, Lab: methemoglobinemia: chocolate brown, Heinz bodies, Bilirubinuria
Tx: Stop any drug or toxin, supportive, Blood transfusions see pg 382
Prognosis: Good
Drug
hepatitis
E-hb 512; E 1320
11
6J
_
Heinz body
anemia
'(,..;7 .
<
, CS: Dilative cardiomyopathy (tiling, dyspnea & cough, distended abdomen), Anorexia, weight loss, Cold extremities, Anemia, Glloxicilies, Urticaria, Alopecia,
~~~~~ ~e;,t~CG. Radiology, Echocardlology
(Adriamycin)
cardiomyopathy
. .
- See Cardlo pg 247 - Dogs, cats resistant, anticancer chemotherapy; Cardiac toxicity relatively frequent & potentially IWe threatening
b' .
~I
7
,
See Cardio pg 244 - Heart medication: digoxin, digitoxin; + inotropes, narrow margin of safe.!y,
Cats & Dobies
,..,~~.
cs: GI (anorexia, vomiting, diarrhea); Cardiac (arrhythmias, dyspnea); CNS
.. /.,~,.
Ox; Hx (digitalis), CS, ECG; bradycardia, arrhythmias
_C>Igi~
11
In cats
Prognosis:
Grave if methemogtobin >50%
Prompt Tx can result in recovery
NSAI~sj
Aspirin,
Acetylsalicylic
acid
J
A V M A
205(4)557,'94;E- 11__~.1
hb 167, 145; H3S
1280; H2B 1336,
1347,1348; 5min
369: Cat232; Tox
395; Tox-WW
304; 74t, 174;NB
20.5
Vomiting
~" Hx (history), CS
Abdominal c r a m p s , Heinz body anemia, thrombo Depression
cytopenia
Inappetence
+ Hepatic enzymes
HypelVentilation
Azotemia
Ataxia, Stupor
Acidosis & hypokalemia
Fever (pyrexia)
Necropsy: gastric ulcers
Coma&death (in1 ormo~
DDx:
tBl,
..:::;;.......... -~
Other gastritis
. Other acidosis
Antifreeze
" NSAIDs
Drugs
TOXICOLOGY
Condition
Ovabanl
toxicity,
PresentationleS
Facts
Stop Tx if CS
Monitor urine glucose for diabetes
mellitus
Hx (given), CS
-Megestrolacetate{Ovaban):oral Polyphagia
drug that is widely abused in vet Cystic endometrial hyper- Glucose in urine
med
plasia
Megestrol acetate
Uses
toxicity
_Dog:
C12T1074, 1104,583: E-hb 612,
543,96t: H3B 1291; H2B 1348,
1349,702,12461, 1072, 930,338,
1263,1255,1259,1263;SAP893,
1205, 340, 869, 339, 340, 329,
914, 7351; 1M 651, 70B
Treatment
Diagnosis
Mammary hyperplasia/nec-
plasia
-Falsepregnancysignswhen
Tx stopped
Prevention:
Cat: warn owners, exhaust other
options before try, then every other
day Tx & wean to every 7-14 days
maintenance
Not recommend for estrus suppression in bitches intended for future
breeding
Diabetes mellitus
Acromegaly
Adrenocortical suppression in
- Feline:
II
I\
aggression,
urine spraying
ECG lesions
, Plasma cell gingivitis,
feline eosinophilic
k.eratitis
Miboleronel
Cheque toxicity
E-hb613; H3B 1291; H2B 1348,
1349,702,1263; SAP 930, 7351;
1M 651, 708; CI2T 14391; Cl1T
954,966, 1074
''jI"'l
'\'
'1
i'
to pregnant
Post Tx lactation in bitch
'
Estrogen
toxicity, ECP,
DES,
Hyperestrogenism
CI2T 1075; E-hb 613; SAP 899,
155;H3B 1291: H2B 725, 702; tM
6n,661:5min570;EI632,1075,
1079; Cat236: F-N 460,463; R-M
530,811 (F); R-R 691, 707, 715;
E&R 592; Tox-WW22, 134,2991,
'"
D~\
Prostaglandins
F2a toxicity,
Lutalyse toxicity
a .
~mr
Hx (estrogen given), CS
oPE: if testicular tumors: cryptorchidism, feminization
we""
- Leukopenia wfin
Fluids
Blood transfusion
Steroids for shock
o Surgical removal of tumor + recovery from anemia
/111
D -
History (Hx)
Clinical Signs (CS)
Heavy Metals
TOXICOLOGY
Facts/Cause
Condition
Presentation/CS
Thallium
~~
MSk 2146;
H2B 1308;
Tox-WW
207
\\
~,\\))
\'\j
charge)
Necrotizing GI (hematemeSiS, hemorrhagic
diarrhea, abdominal pain, anorexia)
"C,""S,.2:!m'lblil'\Q. ataxia, convulsions, paraly__ "
Brick red mucous membranes in 2-4 days
toxicity ~
__ :_-.
8:
Kidney damage
"~'::""~i(O';l.'~lc:::'h'~
~~
~~
~~~~~'~'"
,.' ,
'-../
\ \\
II
1 /' ))
'f
/'
;::tJ..
c:::~~.
---> c/,/
~-
See GI pg 97: Metabolic defect causing accumulation of copper in liver; Bedlington, West highland white, Dobie, Skye terriers
CS Asymptomatic until critical level reached, Depression, lethargy, Anorexia, Vomillng, Jaundice, HemolytiC anemia, Hepatic
encephalopathies; PUlPD in dobles Chronic: Weight loss, Ascites, Small liver
: Hx (breed), CS, Lab, Rads, Liver biopsy definitive
Tx: Supportive, Chelate copper (D-penicillamine or zinc)
- Doby: no effective treatment establishecl
(')
10
1(\ \ , \:'
See Neuro pg
Dithizone
@ "
_L..::~~~"~~~_---=;:~
See Urinary pg 352: Good sweet taste, Fall & spring, Nephropathy
CS Acute: drunk (ataxia, knuckling, depression), PU/PD, hyperpnea, death
- Stage 2: 12-24 hr: Nondescript - seems to be recovering
- Stage 3: 24-72 hr: Renal signs, depression, oliguria/anuria, anorexia & vomiting, oral ulcers, death
Antifree~B
**
Hx (exposure),
~::=::':..-+~-----:~-----:~''''-_
Ethylene
glycol,
cs
f}G' _.
Treatment
Dia nosis
,'\
'7
B'~\'
~'
....J!'~
'-"-" \l\;
579:
CS: GI (vomiting
0.4 ppm,
Nucleated/Basophilic RBCs
Zinc toxicity
IV hemolysis in dogs
- Anorexia
-Vomiting
Lethargy, diamea, icterus, red urine
Death if not treated
Source
Galvanized wire
Kennel cage nuts
Pennies minted after 1983
Fungicides, zinc oxide medications
- High copper or calcium diets
Hx (zinc exposure)
Remove source by surgery or endoscopy
- Regenerative anemia
Symptomatic III supportive for gastro Radiograph metallic foreign bodies
enteritis & anemia
Coombs' negative
Chelsting agents: Calcium disodium
Postmortem: gastroenteritis, kidney tubular necroEDTA or D-penicillamine
Sis, hepatocyte necrosis
Lab:
AP & bilirubin, zinc concentrations (metal
free blood wbes)
"}~r"~f"'ED~
II,
Prognosis: Excellent
Inorganic: insecticidas: ant & roaCh poisons;
herbiCides: crabgrass killer; preservatives for
Arsenic
poisoning;
Arsenicals
wood
MU'"
- Organic: Heartworm mecltcation {caparsolate), Filaricide {organic), siMsar 510, arsanllic acid (feed additive)
Use greatly reduced because of live stock
l0$$9s & environment persistence
Hazardous when used as recommended
Mechanism: binds to - SH enzymes - disturbs
-~
Repeated vomiting
. Dogs: vomit repeatedly & recover
. Cats: often die despite vomiting
- Whining, severe colic (abdominal
pain)
Anorexia, depression
" Bloody diarrhea wI mucosal tags
Weakness, trembling, ataXia, staggering
OligUria
Polyuna (PU) may precede anuria
ParaparesiS, stupor coma, death
~ "S~:::
DDx:
Thallium
- Renal failure
Lead poisonmg
Garbage intoxication
~_ ~~
~
Ethylene glycol
Hemorrhagic gastroenterltts
r:
Viral gastroententls
,~
T;J
>10 ppm
:-
=~'j<~~~'
<:r:>
' ....-=-j
. ... .'
; ,1:1)b
- r7
"Po"mortem '''''''' of
!!-
9tdl~~
~,,:-
~~
Prognosis:
Poor to guardacl for acute toxicosis
minerals M8k2073; Mk 1676; H281282t; Cat 239 Tox 121; Tox-WW 189,197
- Mercury
toxicity
Rare, mercurial salts & alkyl mercurials; Horses: Inorganic Hg containing blistering agents (if horse ticks or used wI DMSO),
Mercuric fungicide treated grains historically but banned for years
CS: Stomatitis, vomiting, diarrhea, dehydration, shock, death in hours, CNS, dermatitis, blindness, coma, death
-Antimony
toxicity
- Barium
toxicity
-Chromium
toxicity
Trivalent chromium essential nutrient, hexavalent is toxic; paints, leather tanning, wood preservatives
CS: contact dermatitis, gastroenteritis, nasal irritation
ffl8>~"l
<Qj
- Iron toxicity
.'
CS in small animals: anorexia, weight loss, hypoalbuminemia, death in excess given to young especially if vit E or selenium deficient
...
Central nervous system depressants H3B 1290; H2B 1347, 1348
Acetylpromazine
- Atypical behavior, aggression, urination, defecation, seizures, cardiac effects, injection site pain, hyperactivity (cat)
Halothane
- Cardiac effects, hyperthermia leading to myocardial damage, nystagmus, torticollis, vomiting, hepatitis, apnea ~ ~
Lidocaine
Ketamine
- Ineffective anesthesia, seizures, cardiac arrest, death (liver & kidney damage), apnea
Methoxyflurane
- Dog (cardiac arrest, renal damage, hepatic damage); Cat (ataxia, death)
Xylazin. (Rompun)
Prescription drugs,
Narcotics -
eNS
H281338
Tox-WW311
::...
PCP,
Pentachlorophenol
l4" -~
))
Cocaine
. HYP'''~h'~'
Analog of ketamina, nonbarbilurate anesthetic; taken off market in 1978 because of side effects: delirium, agitation, halluclnal\ons
CS variable, alternating eXCitation & depression, hypersalivatlon, mydnasls, tonlc-clonlc seizures, champing of jaws, Clrchng
Ox Hx (exposure) CS, tachycardia, arrhythmias, hypertenSions
~
Tx Rapid decontamination emeSIS, activated charcoal & cathartics
~~?
TID; keep cool & Isolated, diazepam (Vatlum) IV fluids, aCidify urine, diuresIS (furosemide)
~~.
l'
t!(;t ~
~
737
'\
~
__I~~\JJ
~_U'\.
Rodenticides
Condition
TOXICOLOGY
Facts
M t Id h d
& Cause
CS:
_~D_X~:~H~X~'~C~S~'~La~b~,~p~os~tm~ort~e~m~:I~o~rm'_ld~e~h_y_d_e_od~o_r~
Tx: Emesis
__
Strychnine
& Tx
____________________
~~
________
.~~~ ~~~~
_____
~~~,~
=- \:-.,.
____
__
~~
l. ~
J1;::::;:::'
~
**'
Treatment
e a j)1e
y e
**
c:::;
Diagnosis
Presentation/CS
Tx: Stop absorption, Control seizures (diazeparn/phenobarb), Hasten elimination (diuresis, NH 4Cr
/r_~" :~
JAVMA 20 513)p41,
6 1994;
M8k 2144; 5min 1156; Cat
II.I
,.-,
tissue
~~~rl
'iL';''I...:;
---=--=-,
**
Anticoagulants
See Circ pg 295 - #1 clotting factor deficiency; Source: Rodenticides #1 (warfarin), inhibition of Vito K
~ ~ ~
cs: Dyspne., Bleeding
~
-~ ~
Dx: Hx, CS, Response to vH K1, Lab (anemia)
;:~ ~~~~iC, remove source, Vitamin K1, Translusion~ ~ ______~
_
Vitamin K deliciency,
(Warfarin,
coumarins)
**
Vito
Other
-Alph-chlorophydrin: sold only to exterminators, uncommon in USA; CS: infertility in males; Tx: not described
- ~l~
rodenticides ANTU (alpha naphthyHhio urea): See Resp pg 163 - rarely used; Strong emetic (protects some animals that vomit), rodents unable to vomit, not used much
K ._
--
Cat 223:
Tox 332.
357:
Tox-~ 290
~. Vacor (Prldymethyl, PyrImilin): taken off market in 1979; but mI be on premises, Mech.: VII. B antagonism, destroys
.-
Zinc
phosphide
JAVMA205(3)p416, 1994:
MSk 2147: E-hb 161, Cat
225:TOX353;TOX-~282,
3t
~
r
CS: Pulmonary edema "drowns In own fluid", Death w/o convulsions, vomiting, salivation
_ Tx: Ineffective: emesis, lavage, steroids, diuretics, antibiotics
MSk 2143; Mk
1721; H2B 1309:
~ ~_ Pulmonary edema
I(
OOx:
I\.. Strychnine
B ro m eth a lin -New rodenticide bait for warfarln resistant rodents, PathOphysiology. neurotoxin - uncouples oxidative phosphorylation - hyperex-
Prognosis: Guarded
(/,(%
citability.(like strychnine) & lIlen depressiOll; Products: Vengeance, Assault, Trounce (green pellets). ~
:\,'\ ,;;(
- CS: Rapid, dose dependent;
'"
~(
- Hyperexcitability, ataxia, weakness, gran mal seizures, occasional paralysis, severe muscle tremors,
~
running fits, hind 11mb hyperreflexia, anisocoria, CNS depression, death In 1-3 days: ataxia
r
't
{(
- Vomiting, Diarrhea, Coma up to 12 days
- Ox: Hx (exposure), CS, No tests
"f
- DDx: Rabies, Strychnine, Organophosphates, DEET, Chlorinated hy<lrocarbons, Spinal chOrd Injurles, Cerebral edema
r:
&~
- Tx: Remove immediately: meal ... emesis; activated charcoal + cathartic TID for 3 days; Minimize cerebral edema: mannitol (20%)
/~'- L. .)
,
_-'
__ IV, dexamethasone early: Seizures: diazepam, or phenobarbital: Support, supplemental feedings
.,.../\/~
><.~. ~.....
Prognosis: Grave, once clinical Signs Tx ineffecttve
~~-""""
Sodium
fluoroacetate,
Hx (expoSlJre, rodent) CS
- Prevent absorption:
.
_ Lack of hypersensitIVIty to stimuli
- Emesis lIor gastric lavage (milk or lime
Hyperglycemia
water)
Detection of 1080 In tissue difficult (baits,
- Activated charcoal If early
stomach contents, & kidney)
- Block conv~rslon of 10S0 to toxic substance
Postmortem
- Monacatn~ (glycerol monoacetate) 1M
_ Racctd heart
~ hourly or
- Widespread cyanosis ~- ~
- 50% Ethanol PO & 5% acetiC aCid PO
- Rapid rigor mOrtis
r-- Supportive care
extensor rigidity
',/
r~\ ;:\)- Seizures - short acting barbiturates
- 02 & artificial resplratlOO for respiratory fall\
ure
ATP block
CS: Frenzy, Yelping, Seizure. Death
Ox: Hx, not hypersensitive
Tx: Monacetin, Emesis, Support
"-
to stimUli)
Chlorinated hydrocarbons
- Organophosphates
739
- Hypocalcemia
Garbage Intoxication
- Zinc phosphide
Monoacetate
~.
'
,~
.1rU.
III
Insecticides
TOXICOLOGY
Diagnosis
Presentation/CS
Facts & Cause
Condition
See
NS
pg
576:
Common
poisoning
insecticides,
pesticides
&
anthelmintics
Organophosphates,
Alike - carbamate: reversible OPs; irreversible
(OPs)& ~
CS: Slobbering, Dyspnea, Vomiting, Muscle tremors & twitching. eNS CS rare, Death
Carbamate, " ' Ox: Hx, Response to atropine
Anticholinesterase Tx: Emergency - stop absorption, Atropine, 2 PAM
Treatment
**
Chlorinated
hydrocarbons,
See NS pg 578: Persists in environment; Insecticides: DDT banned, only lindane & methoxychlor now;
Cats especially susceptible; lipid-soluble
CS: Vomiting, hypersalivation, Twitching & tremors, Convulsive seizures, Death
Ox: Hx, Conwlsive seizures & twitching, Levels
CHC,
Organochlorine
insecticides
**
Amitraz,
Acaricides
Px:: Guarded to
&
depression
Rotenone
'I'.
-;;y
Diarrhea
Pyrethroids
JAVMA205(3)p41S, 1994; Mak:
2065; E-hb 160; H38 1259; H2B
1316; Smin 1004: Cat 220; ToxWW241, N820.B
**
safe
Piperonyl butoxide: cytochrome
p.
&
~ \\.
'oJ;
Bradycardia
ports Ox
Cholinesterase inhibitors
'\)I
Pyrethrins
Detoxify
- Dermal: wash in soap & water
- Ingestion: emetics or gastric lavage if < 4
hrs & no seizures, Activated charcoal + saline cathartic
Supportive: Diazepam (Valium) or barbiturates (not phenothiazine tranquilizers) repeated as needed for seizures
- Dextrose IV if hypoglycemia
.:!7 _-
I :r
<I
,
Public health:
Home & garden sprays
Jr
Hx (exposure), CS
Hypersalivation
Dyspnea
Rabi~s
- Dermal: wash
age if
'
<4
hrs
- A_ charcoal
Organophospha!e tO,XICOSIS
&
water
& no seizures
+ saline cathartic
Death or recovery in
24-72 hours
Metaldehyde pOisoning
Strychnine
Supportive:
- Methocarbamol (Robax'II~) IV muscle
relaxant (not phenothiazine tranquilizers)
- Vii E ointment for dermatitis
Nicotine
Other
Insecticides
soap
NO atropine
hydrocar~on ,
Weakness, prostration
in
Chlonnated
dermatltis~ ~
DetOXify
Seizure _ hyperthermia
Contact
Detoxification
- Ingestion: emetics. activated
charcoal, cathartic
DOx:
. '
Pyrethrins,
HX, CS
\~ ~ ~
Vocalization
Seizures
~~"X
Depression
o Hypotension
o PU (polyuria)
Vomiting, anorexia
respiratory
';11=
weeks to recover
'25~v.w245
Meningitis
Lead poisoning
Prognosis: Excellent
unless overwhelming exposure
C11-a'
-/
f\
Citrus oil extracts (control of lice, ticks & Heas -limonene, IInalool), poisoning rare, cattrealed at dog dose
- CS: Ataxia, weakness, paralySis, depression, hypothermia
)..:~({ )
- Tx: Supportive: bath in warm soapy water & keep warm & well ventilated, Px: excellent
~
~
Boric acid: ant & roach baits, cleaning compounds
~)
I,.
I
\
M8k2061; H3B 1260,1281: H2B
- CS: Vomiting, diarrhea, weakness, ataxia, seizures, lremors, oliguria, anuria, depression
~
~
6
~
~ .~
1316,1317,131a,1337:Cat220;
- Ox: Hx (exposure), cs, UA, boric acid in urine
~
...
~
~
- Tx: Emesis, activated charcoal, fluids, Tx renal failure, peritoneal dialysis
~
DEET: N, N-dlethyltoluamlde, Insect repellent, flea control, neurotoxicity, hypotension
...
-,
if
\ '
_
CS: Rapid: Vomiting, anorexia, tremors, seizures, hypersallvatlon
~
~.:I J
b
;:... "":;:,",'"",,n
- Ox: Hx (exposure), CS, 20 ppm in serum diagnostic
~-f
- \'
- Tx: Detoxify: dermal: wash In soap & water, Ingestion: emetics or gastric lavage, activated charcoal + saline cathartic:
1 \ , (,
~
,
Supportive; diazepam or barbiturates, atropine sparingly for hypersallvation & GI hypermotility
~'
Naphthalene: coal tar of petroleum hydrocarbon, mothproofing products
.....
\\\
~\,
- cs: Vomiting, bad breath (mothballs), cataracts in neonates
~
\1
- Ox: Hx, CS, Methemoglobinemia, Heinz body anemia, hemolysiS, hemoglobinuria, hepatic damage & nephroSis
\. _,.....
- Tx: Emesis, activated charcoal + saline cathartic, ascorbic acid, fluids, bicarbonate, blood transfusions
Nicotine: alkaloid from tobacco plant (Nicot/ana tsbacum): tobacco leaves or insectiCide (Black Leaf 40),
~
darts for dogcatchers: stimulates sympathetic & parasympathetic systems
l.r
~-.'
P.uI
r'
tJ;Lt
b~
~,
\) ,
c:
'I,
?.
Herbicides
Condition
Herbicides
MBk 2042; H3B 1263; H2B
1321: Ehb 164; E 320; Cat
229; Tox-WW 257; Tox 261
TOXICOLOGY
Presentation/CS
Facts/Cause
Diagnosis
Treatment
Routinely sprayed on pastures Nonspecific signs, similar to all History (exposure),
Detoxify:
grazed by animals
herbicides
CS are nonspecific & Ox is diffi- Wash for dermal exposure
If used properly few toxic
cult
- Ingestion: Emesis, activated
problems
Rule out DDx before diagnosing
charcoal + cathartic
- Toxicities usually due to acciherbicides
. Ion trapping
dents
Chemical "analysis may help but Supportive: fluids, diuresis
Organic synthetic herbicides more
may not confirm
Protect people
commonly used than inorganic
L-'~
HYdroge~lJ
peroxide
Herbicides in dogs
Dipyridyl compounds
- Paraquat
- Diquat
Phenoxy herbicides
- 2,4-D
-MCP
- Silvex
Thiazines
Glyphosate
- Roundup
- Kleenup
.Algacide
- Monuron (Telvar)
- Dicholone (Phygon)
Dacthal
Dicamba
Dinitro compounds
Na Chlorate
-Atrazine
- Prometone
Px:Good
Phenoxy
herbicides,
2,4-0, ChlOrinated
phenoxy derivatives,
M8I!;2059; H3B 1268;ToxWW 261, 259t
Triazines
-Anorexia
Depression, weakness
Salivation
Dyspnea
Muscular spasms
Ataxia
Hx (exposure)
Lab: tAP, LDH, creatine for liver, kidney &
muscle damage
Detoxify:
- Wash for dermal exposure
- Ingestion: activated charcoal, Ion trapping
wI Na bicarbonate;
Supportive: fluids, diuresis
Protect people
Prognosis:
__
Exposure
Nonspecific CS so Ox dlfficult
Necropsy: enlarged, friable liver: pulmonary
edema & hydrothorax
(en".;,. , , , ,teO
Roundup
_Skin in"itation
Gastroenteritis: vomitln9 & diarrhea
CNS: depression, coma.....,r,,,,.-,
H3B 1265:
H2B 1323;
Cat 228
Dipyridyl
compounds,
Paraquat,
Diquat
M8k 2043; Mk 1656; E-hb
164: E 320; H3B 1264; H28
1322; Cat 228: Tox 260,
262; TOx-WW 263, 258t
~~l
ac~vated charcoal,
sodium sulfate cathartic
Hx (known exposure), CS
Emesis/gastric lavage
Activated charcoal + cathartics
Hx (known exposure), CS
Depression, lethargy
Gastroenteritis (vomiting & diarrhea)
Ataxia, hyperreflexia
Large doses: cardiac or respiratory arres1;
liver & kidney damage
Rare
Desiccant herbicide
Toxic effect - free radical damage to tissues,
mainly in dogs & cattle
Spot sprays for weeds
- Used as a mallcioua poisoning against
dogs
neal
Gastroenteritis (vomiting, diarrhea)
Respiratory (delayed dyspnea,
nia), death
!Jf.
~--
DDx:
Organophosphates
Garbamates
- Chlorinated hydrocarbons
ANTU
Allergic reactions
Ethylene glycol
Garbage toxicosis
Viral gastroenteritis
744
Poisonous Plants
Condition
Facts/Cause
Poisonous
plants
JAVMA205(4jp558,1994;
ous
Tox-WW 143, 10
*td
,
(i
iIP
common
,I
TOXICOLOGY
Diagnosis
Presentation/CS
stomach contents
cl
Taxine alkaloids
- Japanese yew (Taxus cuspidafa)
- European yew (Taxus)
Nightshade,
Solanum
poisoning,
Solanaceous
alkaloids
o
0
JAVMA 205(3)p417,
1994; Tox-WW 384;
PP/USA/C 123
JAVMA205(3)417, '94
to paralysis,
prostration,
~ unconsciousness shock
-ma'
""
'?I:';
.~....y~
)
--
Vomiting
Diarrhea, salivation
f)M(
))]..- .
0
. . '
:::?
Contact irritants
- Nettles: spurge, stinging, wood (Urtica)
- Poison ivy, oak & sumac (Toxicodendron)
Asparagus fern (Asparagus)
- - Trumpet creeper/cow itch (Campsis)
- Giant hogweed (Heracleuum)
II gressive weakness~
- Devil's ivy
Sorrel (Oxalis)
Dock (RumeX)
-:=---:--i---------f---'L.
Sago palms
toxicosis
Rhubarb (Rheum)
Beet tops (Beta vulgaris)
Mistletoe (Phorandendron)
Soluble oxalates
z:..
JAVMA 205(3)417,'94;
M8k212Ot; H3B 1286; H2B
1343; Tox-WW 370
--
~ ~_+.",.,,-
-,
Hx (exposure), CS
Plant parts In vomitus
__
=-:__-:,-__:-:"':::::=~~
Jr/
Remove GI contents
- Induce vomiting in a conscious pet
(apomorphine (dog), xylazlne (cat),
syrup of ipecac or hydrogen peroxide)
- Gastric lavage
- Activated charcoal: followed
in 30 minutes with:
- Cathartic (sodium sulfate or
70% sorbitol) to hasten removal
of toxicant-charcoal complex
Supportive & symptomatic care
Milk for GI signs
\.0
Marijuana,
Hemp plant
JAVMA 205(3)417,'94;
Mak 2100t; H3B 1282;
H2B 1338; cat 236; ToxWW 310, 368; PPfUSAIC
222
- Cathartic
POisonous
plants
Araceae family
- Dumbcane (Dieffenbachia sp)
- Split-leaf philodendron (Monstera sp)
- Dashine (Colcasia sp)
- Elephant ear (Alocacia sp)
- Jack-in-the-pulpit (Arisaema sp)
Nightshades (Solanum sp)
- Nightshades (Solanum nigrum)
- Jerusalem cherry (Solanum pseudocapsicum)
- European bittersweet (Solanum dulcamara)
Glycoside containing plants
Bleeding
heart
Treatment
sativa)
~,
I
___-:::;0'7"
'J
:.. J
t'~
b
,,--,._,r_, _/'"'"'~ ~~ ~
excitement of aggression
745
j'
- , '
ryE
~,{j
~~~~'~{
?TI
~("
~.-:7 (~~.
~
__
Muscle relaxants
P"90";" Good
~:-.:'0
Poisonous Plants
Condition
TOXICOLOGY
Facts/Cause
Diagnosis
Onions or
Garlic
JAVMA205(3)p417. 1994;
MBk 2122t; Tox-WW 397;
Hemolysis
-Icterus
Treatment
Blood' transfusions. fluids
Hx (exposure). CS
- ,
~~
*~~~~~~~--~==~~--.
cs
GI irritants,
*
Cardiac
glycosides
Remove GI contents
",..- Induce vomiting in a conscious pet (apomorphine (dog), xylazine (cat), syrup of ipecac or hydrogen peroxide
- Gastric lavage
- Activated charcoal, followed In 30 minutes with:
~,. - Cathartic (sodium sulfate or 70% sorbitol)
to hasten removal of toxicant-charcoal complex
Soluble oxalates
- Rhubarb (Rheum)
- Beet tops (Beta vulgaris)
- Devlr's Ivy
- Sorrel (Oxalis)
- Dock (Rumex)
Mechanism: absorbed into blood &
calcium
- May precipitate in renal tubules = blockage &
necroSis
Soluble oxalates,
Rhubarb
poisoning
MBk 20n; H3B 1269; H2B
1342; 5min 336; Cat 229;
Hx (exposure), CS
Plant parts in vomitus
Plant in stomach contents
Calcium oxalate crystalluria
Hyposthenuria
Prognosis: Good
Rompun
Remove GI contents
-Induce vomiting in a conscious pet: apomorphine (dog),
xylazine (cat), syrup of ipecac or hydrogen peroxide)
- Gastric lavage
- Activated charcoal: followed in 30 minutes with:
- Cathartic (sodium sulfate or 70% sorbitol) 10 hasten removal of toxicant-ci1arcoal complex
Supportive & symptomatic care
Kaopectate (kaolin + pectin) or Pepto Bismol
Ventricular arrhythmias; Anlian11ythmics: phenytoin, propranolol or lidocaine
Remove GI contents
-Induce vomiting: apomorphine (dog), xylazine (cat), syrup
of ipecac or hydrogen peroXide
- Gastric lavage wI activated charcoal or
- CalCium h~roxide (Hmawater) or calcium gluconate solution PO to precipitate oxalate as calcium salts
Cathartic (sodium sulfate) to hasten removal of toxicantcharcoal complex
Demulcents: Kaopectate (kaolin + pectin)
or Peplo Bismolto protect GI
Supportive" symptomatic care:
- Fluids ,(renal failure)
Hydrogen
- DiuresiS
- calcium solution IV for hypOcalcemia peroxide
- ;~~~g~
*~
:,..--~..-
--~-::::.-~
~,-~ ~
,
Contact **
irritants,
-.:.~
~-=
=-
Rumex
Mushrooms:
- Amanita phal/o/des. cholinergic: GI, CNS
5mln B34; H3B 1287; H2B
_ Gyromitrs spp.: hemolysis: liver, kidney, CNS
1344; E-hb 165; Cat 229;
_ Coprinus atramentarlus: arrhythmias & hyPP/USAIC 71, BB
potension
~ -Inocybe & Clitocybe spp; cholinergic eHects
Mushrooms
;~-\
H3B 12B7;
H2B 1344;
Cat 229;
Tox-WW376 ~4!!.7
PP/uSAIC 57,
e,~.
;rApomorphine
Nephrotoxic
plants,
Mistletoe (Phorsndandron)
GI irritant &
Mistletoe
Prognosis: Good
Muscarinic CS
Hx (exposure), CS
- Hypersalivation
Mushroom In stomach
- Vomiting & diarrhea
Ataxia, paralysis, coma
Uver & kidney damage
- Icterus, azotemia
Psychotic: ,"p'''"'', ",",",c;oo-I
lions, in
Remove Gf contents: induce vomiting, gastric lavage: potasslum permanganate. acllvated charcoal followed In 30
minutes with a caltlartlc (sodium sulfate)
. ItFiri
Physostigmine 1M
~
Propraoolol for cardiac an11ythmlas
Penicillin may reduce uptake by liver
' r
Supportive & symptomatic care
Hydrogen
Monitor liver function
peroxide ~,
9-:
Prognosis: ?
i
Depression
Weakness
Pu/PD (polyurialpolydipsias)
Diarrhea, (bloody)
Icterus
Prostration & death
po,,'''''' ....n.I
IIi
I I
Poisonous Plants
Condition
Toxic blue-green
algae,
Algae poisoning,
Algal poisoning
JAVMA205{3)p417, 1994: Mk 1636;
H3B 1268; H2B 1345:Tox451:ToxWW 364, 79t; PP/uSAIC 60
~
"
-~
TOXICOLOGY
Presentation/CS
FactS/Cause
Diagnosis
.::7"-:::..----,----,
Bloom on water
CS: CNS, GI, Death
-' Ox: Difficult
Tx: Emesis & support
"
'0"""'''0.'00& ".,h
"..-~~:
~;
_
,,",:::::::;:>,
"'-_
=-~~--~---T~~~~~--~--~---------
See Systemic Diseases
Hx, CS, PE
"Dog: Disseminated
'Green algae: unicellular, colorless, wi saprophy Lab: nonspecific
- Chronic large bowel diarrhea
tic, fungus-like mode of nutrition
Colonoscopy (thickened, corrugated mu- Weight loss
cosal/olds mlb friable or ulcerative)
- Prototfleea zopfii, P. wicerflamii
CNS: depression, atalda, pareSis, vesProtothecosis,
- Ubiquitous: found in sewage & animal wastes
'10 organism: CSF, recta! scrapings, rectal
tibular, seizures, deafness
- Ingesllon, wound contamination
biopsies
Opportunistic algae
Ocular: blindness, Intraocular inflamma- Immunosuppression potentiates
- Round, unicellular organism, 5-1S).lm,
lion, chorioretinitis, exudative retinitis wi
E-hb 498; SAP 703, 69Ot; H2B 1239;
"
Disseminate
diz
In
dogs
(Collies)
refractile capsule (bloOd agar,
retinal detachment, anterior weills, an426: 1M 341: CI2T 326,329; Cl1T
Sabouraud's dextrose media) Glemsa,
"Cutaneous
in
cat
terior
weills,
panophthalmitis
1067,1250
GMS, PAS
Rarely colonize GI:
- Skin: crusty exudates 01 trunk, limbs &
- Severe necrotizing or ulcerative
Oeltnitive: IFA testing at centers for Oiz
mucous membranes, draining ulcers
enterocolitis
Control
- Kidney: renal insuffiCiency
Disseminates widely to other
"Cats: skin - finn nodules on extremities, CSF: pleocytosis (lymphocytes or granulocytes), t protein
v~ceral organs, eyes, CNS (1)''l'!'%.U
feet & head
Prototheca,
Green algae,
Treatment
- No specific antidote, often animal dead
or dying before Tx
Emesis or lavage then
activated charcoal &
cathartic
Supportive care
DDx:
Eye&CNS:
- Distemper
- Systemic mycoses
Granulomatous meningoencephalitiS
Large bowel diarrhea:
- Histoplasmosis
- Trichuriasis
-Inflammalory bowel diz
- Neoplasia
None reported
Prognosis:
Disseminated: grave no reported successful Tx
Ocular: resistant to Tx
Skin: guarded may respond to months of
ketoconazole
~r---------------------D-R-U-G--S
AAAAA
Accutane: isotretinoin
Achromycin: tetracycline
Acta-Char: activated charcoal
GAGS 598
Adrenalin: epinephrine
Adriamycin: doxorubicin 307, 730
Aldactone: spironolactone
Aleve: naproxen 731
Cardrase: ethoxzolamide
Caricide: diethylcarbamazine citrate/DEC 205
Carrisyn: acemannan
Cefadyl: cephapirin sodium
Cefa-TabslCefa-DropS: cefadroxil
Cefotan: cefotetan
Centrine: aminopentamide sulfate
CephulaC: lactulose 523
CesteX: epsiprantel 66
Check Drops: mibolerone 411,406,438,732
Celesone: betamethasone
Charcodote: activated charcoal
Cheque: mibolerone 438, 732
Chlor-Trimetron: chlorpheniramine maleate
Chloromycetin: chloramphenicol 727
Choledyl SA: oxtriphylline
ChronulaC: lactulose 523
Cipro@: ciprof\oxacin 609
Citro-Mag, Citroma:magnesium citrate
Citro-Nesia: magnesium citrate
Claforan: cefotaxime sodium 609
ClavamoX: amoxicillin plus clavulanate 609, 727
Cleocin: clindamycin 727
Clinafarm-EC: enilconazole 703
Clin-Quin: quinidine sulfate
Cloxapen: cloxicillin sodium
Colace: docusate sodium/dioctyl sodium sulfosuccinate (DSS) 74,81
Colyte@: polyethylene glycol 81
Compazine: prochlorperazine 46
Corcid: amprolium 67
Cordarone: amiodarone
CorgardID: nadolol
Cortef: hydrocortisone
Cortenema: hydrocortisone retention enema 83
BBBB
BAL: dimercaprol, British Anti-Lewisite 735
Bactocilk: oxacillin
Bactrirn: sulfamethoxazole-trimethoprim
Bactrovet: sulfadimethoxine 67
Banamine: flunixin meglumine 114
Basaljel: aluminum carbonate gel
Baytril: enrofloxacin 60, 609, 701
8-complex vitamins: thiamine 515
Cortrosyn: cosyntropin
Cortroxyn: ACTH (corticotropin gel) 656
Cosmegen: actinomycin D
Crystodigin: digitoxin
Cuprimine: 0- Penicillamine 579, 735
Cystorelin: hCG or GnRH 406, 435
Cytobin: liothyronine (T3)
Cytomel: liothyronine (T3)
CytosarlCytosar-U: cytosine arabinoside
(cytarabine) 307
CytoteC: misoprostol 43, 667, 731
cytoxan: cyclophosphamide 279, 307
DODD
Danocrine: danazol 279
Dantrium: dantrolene sodium 385
Oaranide: dichlorphenamide
Daraprirn: pyrimethamine
Oarbazine: isopropamide 46
Datril: acetaminophen 731
DDAVF': desmopressin acetate 289
Deca-Durabolin: nandrolone decanoate 343
DeccoX: decoquinate
Declomycin: demeclocycline 659
Demerol: meperidine 46,102
Depakene: valproic acid
Depakote: divalproex sodium
Depo-Estrodiol: estradiol cyprilonate (ECP)
407, 733
Depa-Medrol: methylprednisolone acetate 729
Depo-Proveral: medroxyprogesterone acetate 390
DeprenyIlL-deprenyl: selegiline 657
r:7i1l
cccc
Calan: verapamil
Calciferoi: ergocalciferol (Vit 02)
Calciparine: heparin calcium
CamaloX: calcium carbonate 346,421
Canestran: clotrimazole 703
Canopar: thenium closylate
Caparsolate: thiacetarsamide 204
Capoten: captopril
Carafate: sucralfate 34
Cardioquin: quinidine polygalacturonate
Cardizem: dihiazem 193
Cardoxin: digoxin 193
------------------------~~~--------------------------
Equizol: thiabendazole
Estrumate: cloprostens (PGF analog) 407
Ethamycil1: dihydrostreptomycin 726
Ethrane: enflurane
Eulexin: flutamide
Excedrin: acetaminophen 731
Excenel: ceftiofur
FFFF
Factrel: gonadotropin-releasing hormone
(GnRH) 440
Feldene: piroxicam 731
Festal-II: pancreatic enzymes 103
FilaribitS: diethylcarbamazine citrate/DEC 205
Flagyl: metronidazole 67
Fleet children enema: sodium phosphate 81
Florinef: fludrocortisone acetate 661
Flucort@: flumethasone
5-Fluorouracil: fluorouracil
Fluothane: halothane
Fulvicin@: griseofulvin 727
Follutein: human chorionic gonadotropin 440, 437
Foivite: folic acid 285
Formula PluS: marine oil 671
DRu(~S
Fuller's earth: activated clays 743
Fulvicin: griseofulvin 727
Fungizone: amphotericin B 728
Furadantin: nitrofurantoin
Furoxone: furazolidone 67
GGGG
Gammune: human gamma-globulin
Gantanol: sulfamethoxazole
Gantrisin: sulfisoxazole
Gemfibrozil: lopid 671
Gentocin: gentamicin sulfate 726
Gentran-70: dextran-70
Geoci1lin: carbenicillin indanyl sodium
Geocolate: glycerol guiacolatelguaifenesin 114
Geopen: carbenicillin disodium
Glauber's salt: sodium sulfate 718
Glucantime: meglumine antimonate 698
Glucotrol: glipizide
Glyrol: glycerin
GoLYTELY: polyethylene glycol 81
Gravol: dimenhydrinate
Gris-PEG: griseofulvin 727
HHHH
Heartguard: iverrnectin 205
Hepalean: heparin sodium
Hetacin-K: hetacillin K 727
Hetastarch@: hydroxyethyl starch
HipreX: methenamine hippurate
Hismanal: astemizole
HSCAS: hydrated sodium calcium aluminosili
cate 747
Hycodan: hydrocodone 114
1111
ldamycin: idarubicin
Imaverol: enilconazole 703
Imizole: imidocarb Hel 281, 700
Immiticide: melarsomine 204
Imodium@: ioperamide HCL 63
Imuran: azathioprine 63, 279, 699
Imzol: imidocarb 700
Inderal: propranolol 192
Indocin: indomethacin 731
Inocor: amrinone lactate
Innovar-Vet: fentanyl citrate + droperidol
Interceptor: milbemycin oxime 205
Intropin: dopamine 707, 731
Isordil: isosorbide dinitrate
I~optin: verapamil
Isuprel: isosorbide dinitrateisoproterenol
Ivomec@: iverrnectin 205
KKKKK
Kantrim@: kanamycin 726
Kaon Elixir: potassium gluconate
Kaopectate: kaolin + pectin
Kefle><: cephalexin 609,727
Keflin: cephalothin 609, 727
Kefzol: cefazolin sodium
Ketalar: ketamine HCI
Ketofen: ketoprofen
Klonopin: clonazepam
LLLL
DRUGS
Proglycem@:diazoxide 669
PPPPP
Palosein: orgotein 598, 743
Panectyl: trimeprazine
Panmycirl: tetracycline
Periactin: cyproheptadine HCI
Par!odel: bromocriptine 407
Pavulon: pancuronium bromide
PBZ: phenylbutazone 598, 731
Pelamine: tripelennamine
Pentasa: mesalamine
Pentostarn: sodium stibogtuconate 698
Pentothal: thiopental sodium
Pepcid: famotidine 43, 667
Pepto-Bismol: bismuth subsaticylate 47
Persantine: dipyridamole
Phenergan: promethazine HCt
Phenetron: chlorpheniramine maleate
Phillip's Milk 01 Magnesia: Mg hydroxide 81
Pitressin: vasopressin 379, 670
Platinol: cisplatin 307, 606
Polyflex: ampicillin 727
Prilosec: omeprazole 667
Primaxin: imipenem-citastatin sodium
Prinivil: lisinopril
Principen: ampicillin 727
PriloseC: omeprazole 667
Pro-Banthine: propanthetine 192
Procan-SR: procainamide HCI
Procardia: nifedipine
SSSS
Prostaphlin: oxacillin
QQQQ
Quarzan: clidinium 73
Questran@: cholestyramine
Quinaglute: quinidine gluconate
QuinideX: quinidine 252
Quinora: quinidine sulfate
RRRR
Regitine: phentolamine mesylate
Reglan: metoclopramide 34
Regonol: pyridostigmine bromide 585
Retrovir@: zidovudine
Ridaura: auranofin (triethylphosphine gold)
Rifadin: rifampin
Rintal: febantel
Ritatin: rethytphenidate 516
Robaxin: methocarbamol 578
Robinul-V: glycopyrrolate 192
Rocaltrol: vito 03, catcitriot 346
~.~
. . -------------------------------------------------=.~
Surital: thiamylal
Suprax: cefixime
Styquil1: butamisole 66
SynanthiC: oxfendazole
Synthroid: L-thyroxine/levothyroxine NA (T4) 674
Syprine: trientine HCI
111111
Tagamet: cimetidine 34, 343, 667
Talwin: pentazocine
Tapazole: methimazole 673
Task: dichlolVOs 66
Tegison: etretinate
Tegopen: cloxicillin sodium
Telezol: tiletamine-zolazepam
TelmintiC: mebendazole 58, 66
Tempra@acetaminophen 731
Tenormin: atenolol 252
Tensilon: edrophonium chloride 586
Terramycin: oxytetracycline 726
TesteX: testosterone propionate
Theo Dur@: theophylline 114
Thorazine: chlorpromazine 34
Thytropai<B>: thyr01ropin (TSH)
Thyro-TabS: levothyroxine NA (T4) 674
Ticar: ticarcillin
Tigan: trimethylbenzamide
,TitralaC@: calcium carbonate 346, 421
Tofranil: imipramine 386, 516
Tonoca~ tocainide
TorbugesiC: butorphanol 114, 102, 582
Torbutrol: butorphanol102, 114, 582
Torecan: triethylperazine
Toxiban: activated charcoal
UUUU
Unipen: nafcillin sodium
Urecholine: bethanechol 388
Urocit-K: potassium citrate
Uroeze: methionine (L-/O, L-methionine)
VVVVV
Valbazen: albendazole 67
Valium: diazepam
Vancocin@:vanomycin
Vaseline: petrolatum, white
Vasoxyl: methoxamine 707
Vedco: ACTH (corticotropin gel) 656
Velban: vinblastine 307
Velosef: cephradine
Ventolin: albuterol syrup
Vercom: febantel 66
VermipleX: toluene
Versenate: calcium disodium EOTA 579
Vesprin: triflupromazine
Veta-K1: vitamin K1 295
Vetalog!): triamcinolone acetamide 722, 729
Vibramycir1: oxycycline 726
Viokase: pancreatic enzymes 103
Vitamin C: ascorbic acid 743
wwww
Wellcovorin: leucovorin calcium
Winstrol-V: stanozolol
yyyy
Yobine: Yohimbine 516
Yomesan: niclosamide
XXXX
Xylocaine: lidocaine HCI
zzzz
Trade Name:
generic name (cont.)
"
T_m_c_n_u_m
__:_~_m_c_ur_iu_m_b_e_~_la_t_e__________________________~~~______________________________________________
~r-----------------------d-r-u--gs
aaaa
acemannan: Carrisyn
acepromazine: acepromazine
acetaminophen: Anacin-3, Datril, Excedrin,
Tempra, Tylenol 731
acetazolamide: DiamoX
acetylcysteine (n-acetylcysteine): Mucomysl 282, 731,743
acetylsalicylic acid: Aspirin 731
ACTH (corticotropin gel): Vedco, Cortroxyn,
Actha/ 656
actinomycin 0: Cosmegen
activated charcoal: Acta-Char. Charcodote,
Toxiban
activated clays: Bentonite, Fuller's earth 743
atbendazole: Valbazen
albuterol syrup: Proventil, Ventolin
allopurinol: Zyloprim
antivenin 723
apomorphine HCI 719
ascorbic acid: Vitamin C 743
L-asparaginase: Eispar 307
aspirin: Aspirin 731
astemizole: Hismanal
alenolol: Tenorrnin 252
atracurium besylate: Tracrium
atropine
auranofin (triethylphosphine gold): Ridaura
aurothioglucose: Solganal
azathioprine: Imuran 63, 279, 699
bbbb
baclofen: Lioresal 385
betamethasone: Celesone@, Betasone
bethanechol CI: Urecholine 388
bisacodyl: Dulcolax 74
amiodarone: Cordarone
amitryptyline: Elavil
busulfan: Myleran
butamisole: Styquin 66
butorphanoJ: TorbugesiC, Torbutrol 102,114,582
cabergoline
calcitriol: Rocaltrol 346
calcium carbonate: TumS, TitralaC, CamaloX
346, 421
calcium chloride
calcium citrate
calcium disodium EDTA: Versenate 579
calcium gluconate
calcium lactate
captan
Gaptopril: Capoten
carbamazepine
carbenicillin disodium: Geopen, Pyopen
carbenicillin indanyl Na: Geocillin
carbimazole: Neo-Mercazole
carboplatin
carnitine (L-carnitine)
cascara segrada
castor oil 81
cefadroxil: Cefa-TabS, Cefa-DropS
cefazolin sodium: Ancef, Kefzol
cefixime: Suprax
cefmetazole sodium: Zefazone
cefotaxime sodium: Claforan 609
cefotetan: Cefotan
cefoxitin sodium: Mefoxin 609
ceftiofur: Naxel, Excenel
cephalexin: KefleX 609, 727
cephalothin sodium: Keflin 609.727
cephapirin sodium: Cefady1
cephradine: Velosef
.
T d N e
generic name: ra e am
diazepam: Valium
dich10rphenamide: Daranide
dichlorvos: Task 66
dicloxacillin: Dynapen
dicyclomine: Bentyl 83
diethylcarbamazine citrate/DEC: Caricide. Difil,
FilaribitS, Nemacide 205
diethylstilbestrol: DES 407, 733
digitoxin: Crystodigin
digoxin: Lanoxin, Cardoxin 193
dihydrostreptomycin: Ethamycin 726
dihydrotachysterol (Vit D): Hytakerol 681
dittiazem HCI: Cardizem 193
dimenhydrinate: Dramamine, Gravol
dimercaprol: BAL 735
dimethyl sulfoxide: DMSO 598
diminazene aceturate: Bemil 281
Qioctyl calcium sulfosuccinate (docusate calcium):
Suriak, Doxidan
dioctyl calcium sulfosuccinate (docusate sodium,
DSS): Colace 74,81
dioctyl surfosuccinate potassium: Dialose 81
diphemanil methylsulfate: Diathal
diphenhydramine HCI: Benadry1 114, 706,723
diphenoxylate HCI: Lomotil 47, 63
diphenylhydantoin
diphenylthiocarbazone: Dithizone@ 734
dipyridamole: Persantine
dipyrone: Novaldin
disophenol (DNP)
disopyramide phosphate: Norpace
dithiazanine iodide: Dizan 205
divalproex sodium: Depakote@
dobutamine Hcr: DobutreX 193, 707
------------------------~~~------------------------
~r------------------------d-r-u--gs
domperidone: Motilium@
dopamine HCI: Intropin 707, 731
doxapram HCI: Dopram 415,719
doxorubicin: Adriamycin 307,730
doxycycline: Vibramycin 726
DSS (dioctyl sodium sulfosuccinate): Colace 74,
75
eeee
ECP/estradiol cypionate: DepoEstrodiol 407
edrophonium chloride: Tensilon 586
epinephrine: Adrenalin
epsiprantel: CesteX 66
Epsom salt
ergocalciferol (Vit D2): Calciferol
erythromycin: many 727
erythropoietin: Epogen, Amgen 325, 347
esmolol: BrevibloC
essential fatty acids: EFA-Z-PluS
estradiol cypionate: Oepo-Estradiol, Diethylst
407, 733
ethanol 734
ethoxzolamide: Cardrase
etidronate disodium: Oidronel
kkkk
kanamycin sulfate: Kantrim 726
kaolin + pectin: Kaopectate
Kellogg cereal: AII-Bran 81
ketamine HC1: Ketalar, Ketaset
ketoconazole: Nizoral 115,657,727
ketoprofen: Ketofen
1111
etretinate: Tegison
ffff
famotidine: Pepcid 43, 667
febantel: Aintal@
febantel + praziquantel: Vercom 66
fenbendazole: Panacur 58, 65, 115
fentanyl citrate: Sublimaze
fentanyl citrate + droperidol: Innovar-Vet
ferric cyanoferrate: Prussian blue 734
ferrous sulfate: many
finasteride: Proscar
fluconazole: Diflucan 115, 728
flucytosine: Ancobon 703
fludrocortisone acetate: Flurinef Acetate 661
flumazenil: Mazicon
flumethasone: Flucort
flunixin meglumine: Banamine 114
\
fluorouracil: 5-Fluorouracil
fluprostenol: Equimate 407
flutamide: Eulexin
folic acid: Folvite 285
furazolidone: Furoxone 67
furosemide: LasiX 193
440
gonadotropin, human chorionic (HCG): Follutein
440,437
griseofulvin: Fulvicin, Gris-PEG 727
guaifenesin/glycerol guiacolate: Geocolate 114
hhhh
JU IT
~(~
A'5r,l
9999
~"
mmmm
magnesium citrate: Citro-Mag, Citroma, CitroNesia
magnesium hydroxide: Milk of Magnesia 81,718
magnesium sulfate: Epsom salt 718
mannitol: Osmitroi
marine oil: Formula PluS 671
marinelfish o~ 671
mebendazole: TelmintiC 58, 66
meclizine HCI: Bonine
meclofenamic acid: Meclomen, Meclofen.
Arquel
medium-chain triglycerides: MCT Oil 73
medroxyprogesterone acetate: Oepo-Provera@
megestrol acetate: OVaban 390, 406,732
meglumine antimonate: Glucantime 698
melarsomine HCI: Immiticide
melphalan: Alkeran 307
meperidine HCI: Oemerol 46, 102
mephenytoin: Mesantoin
6.mercaptopurine: Purinethol
mesalamine: Asacol, Mesasal, Pentasa
mesalamine retention enema: RowASA 83
metaproterenol sulfate: Alupent, Metaprel
metaraminol bitartrate: Aramine
methazolamide: Neptazane
methenamine hippurate: HipreX
halothane: Fluothane
HCG or GnRH: Cystorelin 406
heparin calcium: Calciparin8
heparin sodium: Liquaemin, Hepalean
hetacilJin potassium: Hetacin-K
human chorionic gonadotropin (HCG): FOllutein
437,440
human gamma-globulin: Gammune
hydralazine hydrochloride: Apresoline 193
hydrated sodium calcium aluminosilicate:
HSACAS 747
hydrochlorothiazide: HydroOiuril 669
hydrocodone bitartrate: Hycodan 114
hydrocortisone: Cortef
hydrocortisone sodium succinate: Solu-Cortef
hydrocortisone retention enema: Cortenema 83
hydrogen peroxide
hydroxyethyl starch: Hetastarch
hydroxyurea: Hydrea
hydroxyzine HCI: AtaraX
~~~~_
nnnn
L-thyroxine: Levothyroid, Synthroid 674
nadolol: Corgard
lactulose: CephulaC, ChronulaC 523
nafcillin sodium: Unipen
leucovorin calcium: Wellcovorin
nalorphine: Nalline
levamisole HCI: Levasole, Tramisol
naloxone: Narcan 719
levodopa (L-dopa); Larodopa
naltrexone HCI: Trexan
levothyroxine sodium (T4): Soloxine, Thyronandrolone decanoate: Oeca-Durabolin
Tabe, Synthroici 674
r:;;:Ql
1~~~o~ca~in~e~H~C~I~:X~y~IOC~~~ne::______________________________~~~______________________________________________
..,
~r------------------------d7r-u--gs
0000
omeprazole: PriloseC 667
ondansetron: Zofran
argotein: Palosein 598,743
osalazine: Dipenturn 63
oxacillin: Prostaphlin@. Bactocirl
oxazepam: SeraX 709
oxfendazole: SynanthiC
oxtriphylline: Choledyl SA
oxybulynin chloride: Ditropan@ 389
oxymetholone: Anadrol 343
oxymorphone HCI: Numorphan
oxytetracycline: Terramycin@ 726
pppp
pancreatic enzymes: Viokase, Pancrezyme,
Festal-II 103
pancuronium bromide: Pavulon
tttt
tamoxifen: NolvadeX
terbutaline: Brethine@, Bricanyl 114
terfenadine: Seldane
testosterone cypionate: Andro-Cyp
testosterone propionate: Testex, Malogen
tetracycline: Panmycin, Achromycirl
thenium closylate: Canopar
theophylline: Theo Dut, Sio-Bid 114
thiabendazole: Omnizole, Equizol
thiacetarsamide: Caparsolate 204
thiamine: B-complex vitamins 515
thiamylal: Surital, Bio-TaJ
thiopental sodium: Pentothal
thyrotropin (TSH): Dermathycin, Thytropar
thyroxine 682
ticarcillin: Ticar
tiletamine-zolazepam: Telezol, Zoletil
prochlorperazine: Compazine 46
promazine HCI: Sparine
promethazine HCI: Phenergan
propantheline: Pro-Banthine 192
propiopromazine: Tranvet
propofol: Oiprivan
propranolol: Inderal 192
prostaglandins F2a: Lutalyse 407,423,733
pseudoephedrine: Sudafed@l 455
psyllium: Metamucil
pyrantel pamoate: NemeX, Strongid T 64, 65
pyridostigmine bromide: Mestinon, RegonoJ 585
pyrimethamine: Oaraprim@
qqqq
quinicrine: Atabrine 67
quinidine: QuinideX 252
quinidine gluconate: Quinaglute, Ouraquin
quinidine polygalacturonate: Cardioquin
quinidine sulfate: Clin-Quin, Quinora
rrrr
ranitidine: ZantaC@ 43, 667
retinol: Aquasol A
rifampin: Rifadin
ssss
senna: Senokot
selegiline: Deprenyl, L-deprenyl, Eldepryl 657
sodium aurothiomalate: Myochrisine
sodium phosphate: Fleet children enema 81
sodium stibogluconate: Pentostam 698
sodium sulfate: Glauber's salt 578, 718
yyyy
xylazine: Rompun 719, 737
yohimbine: Yobine 516
zzzz
zidovudine: AZT, Retrovir
uuuu
urofollitropin: Metrodin 437
ursodiol: Actigall
vvvv
"~
"
v.
wwww
white petrolatum: Laxatone, Vaseline 81
______________________~17611
4>:~~
r.:.g
r-
-.
~~-----------------------
- - . . ,_ _
SliiIiliiiiiiiiiiiiii.Miiiiiiiiiiii;;;;;:e,;;;;;;;.,
Index
AAAAAAA
Abdominal distention 71
pain 68
Aberrant heartworm 210
Abnormal arterial pulse 177
Accordion pleating 79
ACE 193,343
Acetaminophen 731
Acetic acid 739
Acetylcysteine 731, 743
Acetylsalicylic acid 731
Acr
Ade
All
Acromegaly 683
Acromion fractures 625
Acrylanide 579
ACTH stimulation 656
Activated charcoal 576
Activated clays 743
Acute abdomen 68
bronchitis 140
colitis 48
enteritis 46
erythroleukemia 317
gastritis 40
gingivitis 21
hepatic failure 90,208
hydronephrosis 357
lymphoblastic leukemia 316
leukemia 316
necrotizing ulcerative
gingivitis 21
polyneuropathy 566
proctitis 48
prostatitis 472
renal failure 348
respiratory distress 152
Adamantinoma 23
Addison's disease
dog 660
cat 658
Adenitis 33
Adenocarcinoma 51,87,121
of anal sac 677
of intestines 51
of minor salivary glands 23
Adenoma 87
Adequan 598
ADH 332,379
ADH response test 377
ADIC 3tO
Adrenal tumor 654, 658
Adrenalectomy 684
Adriamycin 307
Adriamycin cardiomyopathy 247, 730
Adult respiratory distress
syndrome 152
Adventitious sounds 112
Adversive syndrome 492
Advil 731
Aleurostrongylus 137, 149
Agalactia 475
Agkistrodon 723
AI 449
Air bronchograms 113
Alachlor 742
Albendazole 67
Albon 67
Aleve 731
Algacide 742, 743
Algae 61, 555, 744,748
Aliphatic hydrocarbons 721
Alkali poisoning 721
Alkaline phosphatase 89
Alkalosis 520
Alkeran 307
Alkylating agents 307
ALL 316
All-Bran 81'
Allergic asthma 143
bronchitis 140, 143
pneumonia 150
rhinitis 127
Allium 744
Allopurinol 373
Aloa vera 744, 746
Alocacia 744
Alpha-1 ,4 glucosidase
deficiency 589
Alpha-adrenergic 740
Alpha-adrenergic blocker 385
ALT 89
Aluminum carbonate 346
Alveolar pattern 113
Amanita phalloides 747
Amaryllis 746
Amastigotes 698
Amikacin 726
Aminoglycoside toxicity 353,
509,579,726
Aminosalicylic acid 63
Amiodarone 252
Amitraz 740
Ammonium biurate 335
chloride 363, 578, 718
salts of fatty acids 720
AmphetamiQe 737
Amphotericin B 115
toxicity 728
Amprolium 67
Amyloidosis 361
ANA 699
Ana
Anabaena flosaquae 748
Anacin-3 731
Anal tumors 87
Anal sac disease 85
sac tumor 87
sacculitis 85
Analgesics 730, 731
Anaphylaxis 706
Ancobon 703
Ancylostoma 65
Ancylostomiasis 65
Androgen 343, 438
Anemia 88, 274
anticoagulants 295
aplastic anemia 287
babesiosis 281
blood transfusions 280
chloramphenicol 286
cobalamine deficiency 285
cytauzoonoSis 281
disseminated Intravascular
coagulation 294
drug & toxin Induced 286, 730
ehrllchlosis 280
folate deficiency 285
Inflammation 284
Heinz body 282
hemobartonellosis 280
hemorrhage 2n
hemolytiC 278
immune mediated 279
Iron deficiency 285
non regenerative 284
of chronic inflammation 284
oxidative injury 282
vitamin K deflclency 295
~r-----A-s-s---------------------A~va
Ani
Ant
Art
Antidiarrheal drugs 47
Arthritis 598
Ankyloglossia 22
Anodontia 24
Anorectal prolapse 83
stricture 82
tumors 86
Anorexia 708
Anovulvar cleft 446
Anterior mediastinal
lymphosarcoma 165, 311
Anthrax 699
Antibiotic 730
antitumor 307
associated colitis 50
renal diseases 338
respiratory 115
toxicity 726
Arthrodesis 598
carpus 634
tarsus 648
Arthrospores 702
Articular fractures 605
Artificial insemination 449
Aryl 720
Ascariasis/Ascarids 64
Aseptic femoral head
necrosis 641
Ascites 88
Asclepias 744
Ascorbic acid 363, 743
Aseptic meningitis 551
Asparaginase 307
Asparagus 747
Asparagus fern 744
Asparaginase 307
Aspergillosis 61, t 26, t 45,
703,747
Aspiration pneumonia 148
Aspirin 731
Assault 739
AST 89
Asthenozoospermia 455
Asthma 143
Astrovirus 56
Ataxia 505
Atenolol 252
Atherosclerosis 237, 671
Atlantoaxial instability 544
Atonic bladder 384
Atrazine 742
Atresia ani 82
Atresia of vulva 446
Atrial APCs 251
fibrillation 229, 262
flutter 251, 262
premature contractions 261
septal defect t 99
standstill 250, 257
tachycardia 261
Atrioventricular block 259
Atromid-S 671
Atrophic gastritis 41
myositis 590
challenge test 258
Aujesky's disease 555
Aura 512
Auscultation of thorax 178
Autoimmune hemolytic
anemia 279
orchitis 461
AutomatiC bladder 385
Autonomic polyganglionopathy 583
Avascular necrosis of
femoral head 641
Avulsion
brachial plexus 559
fractures 615
Axid 667
Axillary nelVe paralysis 560
Azalea 744, 746
Azathioprine 63
Azium 661, 729
Azoospermia 455
Azotemia 328, 33t, 340
Azulfidine 63
BBBBBB
Babesiosis 281
Bacillus piriformis 60
Baclofen 385
Bacteria
bordetella 124, 138, 146
bronchitis 140
campylobacler 60
clostridium 59
Drugs of Choice 115
esCherichia 59
franclsella 699
gram negative bacilli 59
gram positive bacillus 59
leptospira 92, 695
mycobacterium 145
pasteurella 124
principle pathogens 115
salmonella 59
streptococcus 146
urinary tract Infections 363
yerslnla 60, 699
~.l"-----";--~-~;~~;. . ="~~--------------------------~.
Bacterial
Ben
Bladder
Bra
infections 427
meningitis 551
overgrowth 72
pneumonia 146
prostatitis 472
rhinitis 124
sinusitis 124
Bacteriuria 392
BAL 353
Balan 742
Balanoposthitis 468
Balantidiasis 67
Balantidium 67
Banamine 114
Banzalkonium chloride 720
Barium toxicity 736
Basenji 355
Basophilia 302
Battery liquid 721
Beagle polyarteritis 555
Bedlington terriers 97
Bee 579
Beettops 744, 747
Behavior disorders 494
Benadryl t 14
Benazopril 343
Bendiocarb 742
Benifin 742
Benign fibrous polyps 121
hypertrophy of pylorus 44
prostatic hyperplasia 471
Bensulide 742
Bentonite 743
Bentyl 83
Benylin 114
Benzene 721
Benzethonium chloride 720
8ernil 281
Besnoitia 67
Beta 2 agonist 114
Beta blockers 252
Beta cell carcinoma 104, 669
Beta vulgaris 747
Betadine 420, 695
Betasan 742
Bethanechol 388
Bicipital tenosynovitis 624
Bigeminy 258
Bilirubinuria 334
Biopsy
intestinal 62
liver biopsy 89
muscle 584
oncology 306
renal 338
Biosol 726
Biotin deficiency 522
Bipyridyl compounds 743
Bird tongue 22
Birman cat neutrophilic
anomaly 297
Birth control 406
Bisacodyl 74,8t
Bladder atony 356
defects 367
herniation 84
neoplasia 367
problems 365-367
stones 372
trauma 366
Blastomyces 145, 609, 704
Blastomycosis 704
Bleach 721
Bleeding 70t
GI43
disorders 288
heart 744, 745
Blenoxane 307
Bleomycin 307
Blindness 498
Bloat 45
Block vertebrae 536
Blood
gas analysis 89
in vomitus 43
Blue green algae 744
Bone cement 609
cysts 612
infection 609
Bony callus 616
Bordetella 124, t 38, t 46
Boric acid 741
Borreliosis 602
Botulism 569
Bowel disease 62
Boxer central-peripheral
neuropathy 572
BPH 471
Brachial plexus neuritis 559
Brachiognathia 28
Bro
Bronchodilator 114, 193
Bronchopneumonia 146
Bronchoscopy 147
Brucellosis 424
Buboes 699
Bubonic plague 699
Bufo toxicity 724
Bulbs of tulips 744,746
Bullae t53
BUN 331
Bundle branch block 264
Burr cells 284
Butane 721
Butazolidin 731
Bute 731
Butorphanol 114, 582
Butterfly vertebra 536
cccccc
Cachexia 709
Cadmium toxicity 736
Caffeine toxicity 724
Caladium 44
Calcinosis circumscripta 538
Calcitonin 738
Calcitriol 346
Calcium acetate 346
carbonate 346
channel blockers 252
disodium 735
EDTA 579
gluconate 421
phosphate deposition 545
Cal
Carbon
Calculate HR 187
Campsis 744, 747
Campylobacteriosis 60
Cancer 304 (see tumor or
Cat
Cer
instability 545
Cesarean section 415
Cestex 66
Cestode 66
Cetylpyridinium chloride 720
Chattering 26
CHC 578, 740
CHD194
Check Drops 43S
Chediak-Pelger-Huet 297
Chelitis IS
Chemical analysis - UA 334
Chemical mouth burns 21
Chemotherapy 307, 310
Cheque/C. Drops 406,411
Cherry red blood 246
Chewing-gum seizures 686
Chicago disease 704
Chilled semen 449
Chimeras 459
Chlamydia psittaci 139
Chlorambucil 307
Chloramphenicol toxicity 727
Chlorinated aliphatic
hydrocarbons 721
hydrocarbons 578, 740
phenoxy derivatives 743
Chlorine bleach 721
Chloroflurenol 742
Chloroform 721
Chlorothiazide 379
Chlorphenothane 579
Chlorpromazine 343
Chlorpropamide 379
Chi
Chlorpyrifos toxicity 576
Chlortetracycline 726
Chocolate brown 730
Chocolate toxicity 724
Choked disc 500
Cholangiohepatitis 100
Cholangitis 100
Cholecystectomy 100, 101
Cholecysmis 100
Cholecystoduodenostomy 101
Cholecystoenterostomy 101
Cholecystojejunostomy 101
Cholestasis 88
Chondrodystrophy 603
Chondrosarcoma 606, 608
Chorioretinitis 686, 697
CHP 566
Christmas cherry 745
Chromium toxicity 736
Chromosomal defects 459
Chronic blclpitallanosynovitis 624
bronchial asthma 143
bronchitis 141
canine inflammatory hepatic dlz 96
colitis 49
dementia distemper 552
diarrhea 52
gastritis 40, 41
hepatitis 96
hyperplaSia of scrotum 456
hypertrophic gastritis 41
inflammatory bowel 62
inflammatory hepatic 96
mitral valvular fibrosis 214
myxomatous transformation 214
polyneuritis 566
progressive polyarthritis 600
proliferative pyogranulomatous
'"'-"""'----,
Chronic
laryngitis 132
prostatitis 473
relapsing polyneuropathies 566
renal failure 241, 325,342, 345,347
snuffier 139
superficial gastritiS 41
valvular disease 214
Chrysanthemum 741
CHV 425
Chylomicron (CM) test 671
Chylothorax 156
Circulatory shock 707
Circumanal gland tumors 87
Cirrhosis 98
Cisplatin 307, 606
Citrus oil extracts 741
Classification
arrhythmias 248
fractures 614
heart patients 174
Clavamox 727
Clay pigeons 721
Cleft palate 18. 120
Clindamycin 149, 696
Clitocybe 747
Clitoral hypertrophy 444
Clofibrate 671
Cloprostenol 407
Closed technique 453
Clostridial enteritis 59
Clostridium tetani 580
Cluster seizure 515
CM 221
CMO 612
CNS lymphosarcoma 527
Clo
Com
defects 294
Commercial toxicants 721
Common poisonings 718
Complete AV Block 250, 259
Complete blood cell count 331
Compulsive water drinking 379
Conception 400
Condyloma 447
Congenital
absence of ventral bladder wall 367
agenesls - renal 355
amyloidosis (ranal) 3S5
anomalies
larynx 129
nasal 129
renal 355
urachus 387
uterus 442
bladder wall diverticulum 367
cystic kidneys 356
ectopic uraters 387
epispadia 369
heart disease 194
hermaphroditism 369
hypomyelinatlon 575
hypoplasia - renal 355
hypospadia 369
Infertility 454
Imperforate urethra 369
Intra-abdominal urachal cyst 387
myasthenia gravis 5ee
nystagmus 508
persistent patent urachus 367
persistent urachal diverticulum 367
polycystic kidney 355
pseudohemaphrOditism 369
ranal disorders 355
syringomyelia 533
telangiectasia 355
tremors 568
Congenital
urachus 387
urethral agenesis 369
diverticula 369
duplication 369
stenosis 369
urethroractallistula 369
urinary bladder defects 367
urethral disease 369
Cor
Corcid 67
Comified cells 401
Coronavirus 54, 144, 554,
6SS
Corrosive agents 721
Cortical dysplasia 355
Cortical hypoplasia 355
Corticosteroid 729
Cottonmouth 723
Cough 111, 13S, 174
causes 111
heart disease 174
kennel cough 138
suppressants 114
Coumadin 160
Coumarins 295, 738
Couppage 142
Cow ITch 744, 747
Coxa plana 641
Coxofemoral luxation 640
CPR 267, 268
Crackles 112
Cranial cruciate ligament 645
myodegeneration 590
vascular disease 524
Craniocerebral trauma 525
Cream of tomato soup 583,
671
Creatinine 331
Creosote 721
Cretinism 674
CRF 241,342,347
Cricopharyngeal myotomy 31
Crotalids 723
Cro
Crown of thorns 744, 746
Crown scaling 25
Cruciale ligament 645
Crying neonates 417
Cryptococcosis t 26, t 45, 703
Cryptorchidism 456
Cryptosporidia 67
Crystals 335
Crystodigin 193
Cystic
ovarian disease 440
bullous disease 153
Cysticercus 594
Cystine crystals 372
Cystinuria 354
Cystitis 364, 389
Cystitis - incontinence 389
Cystogram 336
Cystorelin 435
Cytauxzoonosis 281
Cytoisospora 67
Cytosar-U 307
Cytosine arabinoside 307
CytotoxiC chemotherapy 447
Cytoxan 279, 307, 326, 365
Dda
Des
Desiccant herbicide 743
Desmopressin 289, 293, 379
Detergents 720, 721
Detrusor areflexia 388
atony 388
hyperreflexia 385, 389
363
735
Dacarbazine 307
Dacathal 742
Daffodil 746
Dalmatian 372
urate 372
leukodystrophy 575
Danazol 279
Dancing Doberman 573
Danocrine 279
Dantrium 385
Dantrolene 385
Dashine 744
Datril 731
DCM 222, 227
635
Deerily fever 699
DEET 741
Defibrination syndrome 294
Degenerative myelopathy 570
neurological disease 517
joint disease 598
Degreasing solVents 721
Delayed puberty 434
Delayed union 621
Delivery of fetus 405
Delta waves 251
Demeclocycline 659
Demyelination 575
Dens in dente 24
Dental attrition 28
disease rhinitis 126
enamel hypoplasia 686
fonnula 24
Depo~Estradiol 407, 733
Depo-Provera 390
Dermacentor 567, 701
Dermatomyositis 594
Dennoid sinus 536
Derris plants 740
Derry's disease 517
DES 386, 407, 733
Digitalis
Dir
Oms
Dwa
Dirofilariasis 202
Dishwasher granules 721
Dishwasher soaps 720
Disinfectants 721
Diskospondylitis 541
Dislocation 605
Disorders of hemostasiS 288
Disseminated intravascular
coagulation 294
Disseminated encephalomyeli~
tis 552
Distal denervating disease 573
Distal symmetric polyneuropa~
thy 573
Distemper
canine 144, 686
GI54
neurology 552
respiratory 144
feline 690
Dithiazanine iodide 205
Dithizone 734
Ditropan 389
Diuresis 338
Dizan 205
Diseases
of lower ailWays 117
of lungs/mediastinum/pleural
spaces 118
of peripheral nerves 556
upper ailWays 116
DJD 598
DKA 665
DM 662
DMSO 598
Dobutamine 193, 263
Dock 744, 747
Dog tick 701
Donuts 113
Dopamine 731
Doppler 184
Dopram 415
Double contrast cystogram 336
Douloureux 563
Doxapram 415
Doxorubicin 307
cardiomyopathy 247, 730
Doxycycline 700, 726
Drain cleaner 721
Droncit 66
Drooling 31
Dropped jaw syndrome 563
Dropped elbow 560
Drug ~ anemia 286, 730
Drug~induced hepatitis 94, 730
Dry cleaning solvents 721
Dry fonm 144, 688
Dry gangrene 594
Dry mouth 31
DSS 74,75
DTIC-Dome 307
Duchenne muscular dystro~
phy 592
Dulcolax 81
Dumbcane 744
Dural ossification 540
Dwarlism 682
Dyschezia 80
Dyschondroplasia 604, 626,
628, 642, 649
Dysgenninomas 441
Dysmetria 504
Dysmyelinogenesis 575
Dysphagia 30, 565
Dyspnea 111, 174
Dysrhythmias 248
Dystocia 412
Dystrophic calcification 540
Dysuria 329
Cushing's disease
000000
D,L~methionine
D~penicillamine
gia 385
urethral dyssynergia 385
Devil's ivy 744, 747
Dewclaw removal 635
Dex 279, 661, 729
Dexamethasone 279, 661, 729
Dexedrine 516
Dextroamphetamine 516
Dextromethorphan 114
Diabetes insipidus 378, 670
Diabetes mbllitus 662
Diabetic ketoacidosis 665
Diabetic polyneuropathy 581
Diabinase 379, 670
Diagnosis
anemia 275
arrhythmias 252
cardiology 176
differential 2
myopathies 584
neoplasia 306
oncology 306
pregnancy 403, 404
renal disease 330
respi ratory 112
spinal cord disorders 530
Dialose 81
EEEEEE
E. coli 363
Early embryonic resorption
690
Easter lilies 744
Eastern wood tick 567
EBOD 101
ECG 186
heart enlargement 270
Echocardiography 184
Eclampsia 421
ECP 407, 733
Ectopia 246
EctopiC antidiuretic hormone
production 659
cordis 201
kidney 355
pregnancy 410
Dia
Diaphragmatic hernia 159
peritoneopericardial
hernia 230
Diarrhea 46
acute 46
bacterial overgrowth 72
colitis 48
chronic Intractable 52
chroniC inflammatory bowel 62
enteritis 54
feline viruses 56
fungal & algal 61
idiopathiC 46
malabsorption 76
parasites 64
parvovirus 55
salmon poisoning 56
salmonella 59
short bowel 72
small vs large 53
spastic cOlon 73
villous atrophy 77
Diazoxide 669
Dibenzyline 385
DIC 294, 695, 701
Dicalcium phosphate 421
Dicamba 742
Dicholone 742
Dicyclomine 83
Dieffenbachia 744
Diestral endometritis 408
Diethylcarbamazine 205
Diethylstilbestrol 307, 386,
407, 733
Difil 203, 205
Dmucan 115
Dig~alis 244, 730, 744
glycoside 252
Ectopic
testis 453
ureters 387
vasopressin syndrome 659
Edema ~ laryngeal 129
Edrophonium chloride
challenge test 584
Efferent mydriasis 497
EGE 62
Ehrlichia platys 291
Ehrlichiosis 280, 700
Eisenmenger's physiology 201
Elapines 723
Elbow joint fractUres 630
Eldepryl 657
Electrical alterans 272
Electrocardiography 186
Electromyography 381
Elephant ear 744
EUmination 390
ELISA 692, 694
Elokomin fluke 58
Elongated soft palate 130
Elspar 307
Embolectomy 160
Emergency ~ toxicities 719
Emollient laxatives 81
Emphysema 142
Emphysematous cystitis 365
En block 477
Enacard 193
Enalapril 193, 343
Enamel hypoplasia 26, 686
Encephalitis 552, 687
Encephalomyelitis 552, 687
Enc
Eosinophilic
Encephalopathy 519
Endocardial splitting 216
cushion 195
fibroelastosis 201
Endocardiosis 214
Endocrine 650
diseases 652
incidence 653
pneumonitis 150
Ephedrine 386
Epidermoid cyst 536
Epididymitis 460
Epidural 415
Epilepsy 512
Epinephrine 706
Esop-~
diverticulum 35
foreign bodies 35
hiatus disorders 36
inflammation 34
megaesophagus 37
Eut
Euthyroid sick syndrome 675
130
Excedrin 731
Excess ADH syndrome 659
Excision arthroplasty 599
Excision of femoral head 639
Excretory urography 336
Exenteration 500
Exercise intolerance 175,
534
myopathy 595
Exertional rhabdomyolitis
595
Exfoliative cytology 400, 40t
Expectorants 114
Extensor damage 560
External root resorption 26
Extra-abdominal ectopic
testis 453
Extrahepatic biliary obstructive disease 101
Extranodal LSA 314
to cycle 436
obstruction 35, 37
persistent rt. aortic arch 36
stricture 35
tumors 36
Essential thrombocythemia
317
Estradiol 398, 407, 733
Estrogen 396
Estrogen toxicity 733
Estrous cycle 396, 398
bitch 396
queen 398
EstruChek 400
Estrumate 407
Estrus
bitch 382
cat 398
induction 437
suppression 406
Ethane 721
Ethanol 352, 734, 739
Ethylene glycol 352, 734
Ethylenediamine
dihydrochloride 363
Euphorbia 744, 746
European adder 723
bittersweet 744, 745
yew 744
Eurytrema procyonis 104
Endometritis 408
Endotoxemia 88
Enemas 81
English ivy 744, 746
Enlarged urinary bladder 337
Enostosis 611
Entamoeba 67
Enteritis 46, 47, 63
acute 46
chronic 62
parasitic 64
small vs large 53
Enterocolitis 62
Enuresis 380
Eosinophilia 303
Eosinophilic
gastritis 41
gastroenteritis 62
granulomatosis 18, 22,207
lung disease 150
myositis 590
oral 22
Epirubicin 247
Episodic weakness 534
Epispadia 369
Epogen 325, 347
Epsiprantel 66
Epulides 24
Epulis 24
Equimate 407
Equine tetanus antitoxin 580
Erection failure 454
Erlichiosis (sp) see ehrlichiosis
Erosive immune mediated
joint disease 600
Erythremic myelosis 317
Erythrocyte refractile bodies 282
Erythrocytosis 317
Erythroid myeloproliferative
disease 317
Erythroleukemia complex 317
Erythropoietin 325, 684
Esbilac 418
Esophag~is 34
Esophagobronchial fistula 36
Esophagopexy 36
Esophagus - catrix 35
dilatation 37
Feline
Femoral
Fit
For
hernia 105
nerve damage 561
Fenbendazole 65, lIS, 149
Fer-de-lance 723
Ferric cyanoferrate 734
Ferrous sulfate 285
Fetal dystocia 413
death 690
dystocia 413
resorption 422
Fever 711
Fever of unknown origin 712
FIA 280
Fibrin degradation products
288
Fibrinoid leukodystrophy 575
Fibrinolytic therapy 160
Fibroadenomatous hyperplasia 475
Fibrocartilaginous embolism
543
Fibroglandular hypertrophy
475
Fibromatosis gingivae 24
Fibromatous epulis 24
Fibrosarcoma 602, 608
Fibrotic myopathy 595
Fibrous polyps 121
Fibular head transposition
645
Ficam 742
Filaroides 137, 149
FI P 144, 554, 688
Fire ants 722
F~
Formalin 365
Formamidine insecticide 740
Formula - dental 24
Foxglove 245,744
FPV 427, 690
Fractures 614, 617,635
eM
221
degenerative myelopathy 570
dilated congestive cardiomyopathy
227
distemper 690
dysautonomia 583
enteric coronavirus 56
eosinophilic granuloma 18
fatty liver syndrome 95
heartworm disease 211
hepatic lipidosis 95
herpesvirus Infection 426
hypereoslnophilic 62
hyperthyroidism 672
hypertrophic cardiomyopathy 224
hypoadrenocortlclsm 658
hypothyroidism 673
idiopathic hepatic lipidosis 95
polymyositis 593
vestibular 50S
immunodeficiency virus 23, 694
infectious anemia 280
infectiolJS peritonitiS 107, 554, 6S8
leprosy 145
leukemia 165, 315, 426, 692
lower urinary tracl disease 374
lymphosarcoma 165, 692
panleukopenia 57, 427, 554,690
parvovlrus 690
perirenal pseudocyslS 356
plasma cell gingivitis 20
porphyria 276
rhlnotracheitis virus 139
stomatitis complex 20
storage disease 297
stroke 524
upper respiratory infection 139
urolithiasis 374
urologic syndrome 374
viral rhinotracheitis 426
512
FIV 23, 554, 694
Flabby heart 227
Flagging 400
Flagyl 67
Flail chest 159
Fleet children enema 81
Fluconazole lIS, 703
Fluconazole toxicity 728
Flucytosine 703
Fludrocortisone acetate 661
Fluid therapy 339, 349
Fluke 104
Flunixin meglumine 114
Fluoroscopy 113
Fluprostenol 407
FLUTD 374
Focal myasthenia gravis 588
FOCMA 692
Folate/Folic acid 285
Follicle-stimulating hormone
437
Follicular cystitis 365
Follutein 437, 440
Forebrain 492
Foreign body
esophagus 35
gastric 42
linear 79
pharynx 29
rectal 84
rhinitis ",25
Fai
Failure of erection 454
FFFFFF
acetabulum 637
carpus 634
elbow joint 630
femoral 643
humerus 627
ilium 636
mandibular 623
metacarpal 635
metatarsal 635
os penis 467
paw & foot 635
pelvic 636
pes 649
phalangeal 635
scapular 625
sesamoid 635
skull 622
tibial & fibular 647
165
astrovirus 56
bronchiUs 143
callcivlrus 139
cardiomyopathies 221
cerebral infarction 524
Chediak-Higashi 297
chronic bronchial asthma 143
chronic progressive polyarthritis 600
Fungus
bone infection 609
candida 20
COCCidioides 145,702
COccidioidomycosis 702
cryptococcosis 145,703
cryptococcus 145,703
drugs of choice 115
histoplasma 61, 145,705
histoplasmosis 61, 145, 705
lung disease 145
meningitis 551
mycotic Infections 115, 702-705
phycomycosis 61
pythiOsis 61
pythium 61
rhlnltls 126
sinusitiS 126
stomatitis 20
systemic 702-705
zygomycosis 61
Furazolidone 67
Furosemide 193
Furoxone 67
FVR 426
GGGGGG
GAGS 598
Galactorrhea 475
Galactostasis 474
GALT 51
Ganglioradiculitis 573
Ganglioside 517
Gangrene 594
Garlic 744, 746
Gas anesthetics 730
Gasoline 721
Gastric dilatation/volvulus 45
erosions 43
Gastric
Giant
foreign body 42
hypomotil~y 44
lavage 578, 719
outlet obstruction 44
ulcers 43, 88
Gastrinoma 104, 667
Gastroduodenoscopy 63
Gastrointestinal bleeding 43
diarrhea 46
irritants 744, 746
parasites 64-67
ulceration 43, 88
Gastropexy 36
Gaucher's disease 517
GDV 45
Gemfibrozil 671
Generalized lymphosarcoma
313
Gentamicin 726
Gentamicin impregnated
bone cement or beads 609
Geocolate 114, 578
Geriatric canine vestibular
disease 508
Gestational hypoglycemia
421,669
GI bleeding 43
diarrhea 46
irritants 744, 746
parasites 64-67
ulceration 43, 88
Giant axonal neuropathy 572
breed cardiomyopathy 222
hogweed 744, 747
Schnauzers 285
Giardia 67
Giardiasis 67
Gilcrisl disease 704
Gingivectomy 25
Gingivitis 19
--,...---"'"",--..."....
Gon
Ham
hormone 440
Hed
Hedara helix 744, 746
Heinz body anemia 282.730,
731
Hemangioma 319
Hashish 745
Hemangiosarcoma 23,319,
608
Granulocytopathy syndrome
297
Granulomatous gastritis 41
meningoencephalitis 521
pulmonary disorders 150
urethritis 368
Granulosa cell tumors 441
Great imitator - SLE 699
Great pretender 660
Green algae/scum 748
Green stick 615
Grey scale 184
Ground clay-based kitty liter
743
Growth deformities of radius &
ulna 633
Guaifenesin 114
Gurgling 131
Gyrom~ra 747
HHHHHH
H2 antagonist 343, 347
H2-receptor antagonist 43,
343,347,667
H2S 163, 725
Hair matted anus 83
Halothane 247, 737
'~~-~~"~'-
"
"."".-',,""'"
"'~""""-
Havolac 418
hCG 437
HCM 223
HDDST 656
HE 523
Head tilt 506
Head trauma 525
Heart enlargement 181
patterns - ECG 270
sounds 178. 212
Heartguard 205
Heartworm 202
allergic pneumonitis 206
disseminated intravascular
coagulopathy 210
renal disease 209
heart failure 208
hepatic disease 210
medication 735
parenchymal disease 206
pulmonary arterial diz 207
pulmonary thromboembolism 206
renal disease 209
right hea~ failure 208
Heat (estrus) 396
Heat stroke 520, 714
Heat-seekers 675
Heavy metals 579
Hemarthrosis 603
Hematemesis 43
Hematuria 334, 335, 393
Hemifacial spasm 563
Hemimandibulectomy 29
Hemivertebra 536
HemobartoneUosis 280
Hemolysis 278, 730
Hemolytic anemia 278
Hemophilia 293, 603
Hemon1'lage 277
Hemorrhagic enteritis 58
fever 700
gastroenteritis 58
myelomalacia 546
Hemostasis 289
Hemothorax 156
Hemp plant 745
Hepatectomy 93
Hepatic
arteriovenous fistula 99
drug induced disease 730
encephalopathy 523
failure - Lepto 695
lipidosis 95
Hepatoencephalopathy 523
Hepatotoxic drugs 88
.,
"
Hem
Hill's
Hyd
Hyp
Hyperparathyroidism 678
Hyperpnea 111
Hypersensitivity 140, 143
pneumonia 150
reaction 706
Hypersialosis 31
Hypersomatropism 683
Hypersthenuria 377
Hypertension 243
Hyperthermia 520, 714
Hyperthyroidism 672
canine 674
feline 672
Hypertrophic
cardiomyopathy 223, 224
gastritis 41
neuropathy 572
osteodystrophy 610
osteopathy 151
pulmonary osteopathy 610
Hypervitaminosis A 540, 603
Hypervitaminosis 0 677
Hyphosthenuria 377
Hypoadrenocorticism 581,
658,660,677
cane 660
feline 658
Hypocalcemia 240, 421,
581, 680. 681
circulatory system 241
eclampsia 421
hypoparathyroidism 681
neuromuscular 581
Hypocalcemic tetany 421
.,,",~,
..
,.-~
Hyp
Hypodontia 24
Hypoglycemia 418, 421,581,
668,669
gestational 421
neonate 418
neuromuscular 581
Hypokalemia 239, 339, 581,
593
FUS cat 339
polymyopathy 593
weakness 581
Hypoluteoidism 425
Hypomyelination 575
Hypomyelinogenesis 575
Hyponatremia 339, 659
FUS cat 339
Hypoparathyroidism 681
Hypopituitarism 682
Hypoplasia - tracheal 134
Hypopnea 111
Hypoproteinemia 331
Hyposomatotropism 684
Hypospadia 369,465
Hyposthenuria 332, 377
Hypothalamus 493
Hypothermia 417,520. 715
neonate 417
Hypothyroidism
canine - adult 675
feline 673
juvenile 674
myopathies 589
polyneuropathy 580
Hypoxia - cerebral 520
111111
Iatrogenic hematuria 393
IBD 62,63
Ibuprofen 731
Icagen 400
ICH 93
ICT 463
Ictus 512
Idiopathic chronic-tolitis 49
Idiopathic bowel disease 62
cardiomyopathy 224
chronic active hepatitis 96
chronic colitis 49
demyelination 575
diarrhea 46,47
epilepsy 514
facial paralysis 562
feline polioencephalomyelitis 538
hepatic lipidosis 95
hyperesthesia 574
hyperlipidemia 583
hyperlipoprotelnemla 671
inl!ammatory bowel 62
lower urinary tract 374
megacolon 7S
meningitis 551
polyarthritis 601
polymyositis 591
IFA 692
ILUTD 374
Imbrication 645
IMHA 279
Imidocarb 281
Imipramine 386, 516
Imizole 281
Immiticide 204
Immune
"mediated orchitis 461
Inf
Int
Infertility
bitch 430
breeding management 454
male/dog 450, 454
male cat 452
male dog 450
queen 428
tom 452
Infiltrative proliferative
lymphadenopathy 324
Inflammatory bowel diz 62
brain disorders 518
diseases 515
penis & prepuce 468
polyps - vestibular diz 508
reticulosis 521
Infraspinatus muscle contracture 595
Inguinal hernia 105, 457
Inhalation pneumonia 148
Inherited clotting factor
deficiencies 293
Inherited nonregenerative
anemia 285
Inocybe 747
Insulin 357
Insulin resistance diabetes
mellitus 666
Insulinoma 104, 669
Interestrus interval 396
Intergrade cardiomyopa1hy 226
Intermediate cardiomyopathy
226
Isc
Ischiatic nerve damage 561
Islet cell neoplasia 104, 669
Isospora 67
Isosthenuria 332, 377
Itraconazole 115, 126
Itraconazole toxicity 728
IVD 546
Ivermectin 204, 205
Ivomec 205
JJJJJJ
Jack-in-the-pulpit 744
Japanese yew 744
Jaw locking 623
Jerusalem cherry 744
Joint
arthritis 598
degeneration 598
fractures 605
luxation 605
osteoarthritis 598
osteochondrosis 604
septic arthritis 599
sprain 605
synovial fluid - septic 599
trauma 605
JPCs 263
Juglans nigrum 744
Junctional escape 259
premature contraction 251
rhythm 251, 263
Juvenile epilepsy 514
hyperchylomicronemia 671
Juvenile
hyperparathyroidism 679
hypothyroidism 674
mammary hypertrophy 475
panhypopituitarism 682
vaginitis 445
onset DM 664
KKKKKK
Kanamycin 726
Kantrim 726
Kartager's syndrome 140
Keflin 727
Kennel cough 138
Kerosene 721
Ketoconazole 115, 126, 657
toxicity 727
Ketonemia 421
Ketonuria 334
Key Gaskel syndrome 583
Kirby-Bauer disk 392
Kleenup 742, 743
Klenefelter's syndrome 459
Knott's test 203
Krabbe's disease 517,573
Kupffer's cells 300
Kyphosis 537, 541
LLLLLL
L-deprenyl 657
L-thyroxine 674
Labial granuloma 18
Labial ulcer 18
Lac
Lack of libido 454
Lacquers 721
Lactation 410
Lactescence 671
Lameness 175
Lamina dura 25
Lanoxin 193, 244
Large bowel diarrhea 66
Large T waves 272
Larval migration 526
Laryngeal paralysis 565
collapse 131
edema 129
paralysis 131
sacculectomy 130
spasm 129
Laryngttis 132
Lasix 193
Lateral ceNical cyst 37
Laundry soaps 720
Laurel 744
Lavage 147
Laxatives 81
Laxatone 81
Laxatone 81
LDDST 656
Lead toxicity 579, 734
Left atrial enlargement 271
atrial nJpture 216
AV valve dysplasia 198
AV valve diz 214, 215
AV valve dysplasia 198
ventricular enlargement 271
Legg Perthes disease 641
Lei
Leishmaniasis 698
Length of pregnancy 404
Lentivirus 694
Leprosy 145
Leptomeningeal cysts 543
Leptospira 92, 351, 592, 695
Leptospirosis 92, 351, 592,
695
liver 92
kidney 351
myelitis 592
systemic disease 695
Leukemia 165, 315, 692
myeloproliferative 315
Leukeran 307
Leukocytes 296
Leukocytosis 296
Leukoencephalomyelopathy
571
Leukomoid reaction 299
Leukopenia 296
Levamisole 205
Levo1hyroid 580,674, 675
Leydig cell 463
Lhasa apse smooth brain 510
Libido 448
Lidocaine 192, 252, 265
Lilium longiflorum 744
Lily-of-the valley bush 744
Lindane 578,579,740
Linear foreign body 79
Linguatala serrata 124
Loc
Lio
Lioresal 385
Lip fold dermatitis 18
Lipemia retinalis 671
Lipid-lowering drugs 671
Lipoma 602
Liposarcoma 602
Lissencephaly 510
Liter size - cat 398
Lithium carbonate 659
Lithotabs 659
Liver biliary' problems 100
biopsy 89
cirrhosis 98
copper associated 97
drugs 94
disease 88
enzymes 89
fluke infection 100
hepatic failure
acute 90
chronic 96
lipidosis 95
leptospirosis 92
neoplasia 93
rupture 95
shunts 99
LL 315
LMP 310
LMP treatment 310
Lobster claw 635
Lobular dissecting hepatitis
97
Local wound myositis 593
Lochia 416
Lockjaw 580
Lomadine 281
Lonchocarpus plants 740
Long-haired dachshund
sensory neuropathy 574
Loss of pupillary light reflex
491
Lotensin 343
Low dose dexamethasone
suppression test 656
Lower airway disorders 117
Lower motor neuron
bladder 384
signs 528
Lower urinary tract 329
Lown-Ganong-Levine
syndrome 264
LSA 308,312
LSD 517
Lumbosacral instability 533
spondylopathy 533
stenosis 533
Lumpectomy 477
Lungs
alveolitis 166
asthma 143
contusion 158
cystic disease 153
diseases 118
edema 152
emphysema 142
lIuke 149
f1Jngallnfections 145
granulomatosis 150
lobe torsion 157
neoplasia 151
pneumonia 146
Lungs
sounds 112
thromboembolism 160
torsion 157
worm 137, 149
Lym
Lymphocytosis 301
Lymphoplasmocytic rhinitis
127
Lymphoproliferative
syndrome 315
lymphoreticular neoplasm 308
Lymphosarcoma 23, 165,
30B,310,311,359,677,692
anterior mediastinal 311
diagnosis 309
feline 692
FeLV 692
hyperglycemia 677
intestinal 51
mediastinal 165
nasalcat 121
prognosis 310
renal 359
thymic 311
treatment 310
Lysodren 657
MM~MM
M-mode 184
Maalox 667
Macracanthorhynchiasis 67
Macracanthorhynchus 67
Macrophag6s 300
Macrozamia 744, 745
Mad itch 555
Magnesium hydroxide 81
Malabsorption syndrome 76
Malar abscess 27
Malformation
Malignant hyperthennia
592, 714
lymphoma 308
melanoma 23
Malnutrition 410, 669, 708
neonate 418
pregnancy & lactation 410
Malocclusion 28
Maltese terriers 21
Malunion 620
Mammary congestion 474
Mammary
fibroadenomatosis 475
hypertrophylhyperplasia
475
mastectomy 477
mastitis 474
neoplasia 476
Mandelamine 363
Mandibular fractures 623
luxation 623
Mandibular
symphyseal fractures 623
Mandibulectomy 29
Manx cats 537
Marie's disease 610
Marijuana 744, 745
Marine/fish oil 671
Market men's disease 699
Maroteaux~Lamy 297
Massasauga 723
Mast cell 23, 706
Mastectomy 477
Masticatory muscle myositis
590
Mastitis 474
Masturbation 467
Mating
dog 400,401
feline 402
MCE 539, 611
MCP 743
MCTOil73
MCV 274
MDS 316
MEA 166
Mean corpuscular volume 274
Mean electrical axis 186, 189
Median & ulnar paralysis 560
Mediastinal emphysema 163
form - FeLV 165, 692
inflammation 162
lymphosarcoma 165
mass lesions 164
Mediastinitis 162
Medipren 731
Med
Medium-chain triglycerides
73
Medroxyprogesterone
acetate 390
Megacolon 74, 80
Megaesophagus 37
Megakaryocytic leukemia 317
Megestrol acetate 390, 406;
444,660, 683, 732
toxic~y 732
Meglumine antimonate 698
Meiotic agents 497
Melarsomine 204
Melphalan 307
Menigomyelitis 550
Meningeal cyst 543
Meningeal vasculitis 555
Meningitis 550
Meningocele 537
Meniscal problems 646
Mercury toxicity 736
Mesalamine drugs 63
Mesalamine enema 83
Mesenteric volvulus 79
Mesothelioma 105
Mestinon 585
Metabolic acidosis 339
bone disease 679
encephalopathies 495,
515,520
Metachromatic leukodystrophy 517
Metaldehyde 577, 738
Metamusil 81
~."lIiiii;i';;;';;t~,~~---===-~-",=,~~~",~~~~~~~------------------------------------------------------------------~.~.==-=Met
Mil
Mot
Myc
Mothballs 721
Mothproofing 741
Motility disorder 44
Motor neuron disease 575
Motrin 731
Mouth bums 21
Moxidectin 205
MPD 315
Mucocele 32
Mucoid valvular degeneration
214
Mucomyst 731, 743
Mucopolysaccharidosis 297
Mucous membrane color 177
Mudrane 386
Multicentric lymphoma 313
Multifocal encephalitis 552,
687
Multiple
cartilaginous exostosis
539, 611
dew claws 635
myeloma 317, 608, 6n
Munnurs 179, 212
Muscle relaxants 578
Musculocutaneous paralysis
560
Mushrooms 747
Myasthenia gravis 586
Mycobacteria enteritis 60
Mycobacterial disease 145
Mycobacterium 145
Mycoplasma 138, 139
Mycosis
aspergillosis 61, 145, 703
blastomycosis 145, 704
bone infection 809
candida 20
coccidioidomycosis 702
cryptococcosis 145, 703
drugs of choice 115
fungal Infections 115,702-705
histoplasmosis 61, 145,705
lung disease 145
meningitis 551
phycomycosls 61
pythiosis 61
rhinitis 126
sinUSitiS 126
stomatitis 20
systemic 702-705
zygomycosis 61
Myelopathy
spinal muscular atrophy 572
NNNNNN
Naloxone 415
Nandrolone decanoate 343,
347
Naphthalene 721, 741
Napkin ring sign 79
Naprosyn 731
Naproxen 731
Narcan 415
Narcolepsy 516
Nasal mites 124
neoplasia 121
polyps 128
rhinitis 122
stenotic nares 120, 130
trauma 127
Nasopharyngeal polyps
128, 508
National Animal Poison
National
Control Center 719
Naxen 31
NDI354
Near drowning 153
Nearfar-far-near suture 595
Nebein 726
tis 21
Necrotizing vasculitis 555
Negative chronotrope 252
Neirmann-Pick disease 517
Nemacide 205
Neomycin 726
Neonate
care 415
hypoglycemia 41 8
hypothermia 417
infections 41 9
malnutrition 418
problems 417
resuscitation 415
Neuropathy
mononeuropathies 558
~ N.O.rt.h.A.m.e.ri~
...
Neoplasia
Neopl~
Neoplasia
leukemia 692
Leydig cell 463
biopsy 306
bone 606
brain 527
chemotherapy 307
chondrosarcoma 606, 608
circulatory system 304
circumanal gland 87
classification 305
clinical signs 305
condyloma 447
contagious venereal 447
COP 23
prostatic 469
renal 359
liver 93
lungs 151
rhabdomyoma 589
rhabdomyosarcoma 589
luteomas 441
salivary glands 33
scrotum 457
seminoma 463
Serteli cell 463
Sertoli-Leydig cell tumors 441
sex-cord stromal 441
seizures 515
spinal column 548
squamous cell carcinoma 23, 29,
133
31',359,677,692
Iymphorelicular 308
malignant characteristics 305
malignant melanoma 23
mammary 476
mast cell 23
meSOthelioma 105
metastatic tumors 359
s~ckef
stomach 42
synovial cell sarcoma 602
synovial chondrosarcoma 602
synovioma 602
mouth 23
cystadenoma 441
diagnosis 306
dysgerminomas 441
epulides 24
epulis 24
epithelial 441
esophageal tumors 36
feline leukemia 692
feline lymphosarcoma 692
FeLV 692
fibrosarcoma 602, 608
fibrous polyps 121
gastric 42
gastrinoma 104
germ cell 441
granular cell 23
granulosa cell 441
hemangiosarcoma 23, 608
histiocytoma 447
histogenic classification 305
hypergastrinemia 104
infectious sarcoma 447
insulinoma 104
interstitial cell 463
Intestinal 51, 79
islet cell 104
larynx 133
nephroblastoma 359
nerves 567
neuroepithelloma 549
odontomas 24
of larynx 133
of lungs 151
of periodontal ligament 24
of traChea 133
oncocytoma 23
oral 23
osteosarcoma 606, 607
ovarian 441
pancreatic 104
papillary adenocarcinoma 441
papillOmas 468
papillomatosis 23
penis & prepuce 468
perianal gland 87
pericardium 231
peripheral nerves 567
pharyngeal 29
pheochromocytoma 684
pituitary gland 655
plasma cell myeloma 608
plasma cell 317
teratomas 441
testicular 463
thecomas 441
thymic lymphosarcoma 311
thyrOid 674
tonsillar 29
trachea 133
transitional cell carcinoma 359
transmissible lymphosarcoma 447
reticulum cell tumor 447
venereal tumor 447,468
treatment 307
ureteral 357
urethral 370
uterine 442
uterus 442
urinary bladder 367
vaginal 447
venereal granuloma 447
vulvar 447
lymphadenopathy 324
NeoplastiC reticulosis 521
Neorickettsia 58
Oral
Ocu
Nor
sis 704
tumor 447
papillomatosis 23
Orchidectomy 453
Novantrone 307
NS 361
NSAIDs 731
Nuprin 731
Nutritional 2 hyperparathyroidism 679
myodegeneration 237, 589
Nymphomania 438, 440
Odontoclastic resorptive
lesions 26
Odontomas 24
Odortrol 363
Old age laxity of carpus 634
Old dog encephalitis 552,687
Oleander 245, 744
Oligodontia 24
Oligospermia 455
Oliguria 328, 330
Ollulanus 67
Olsalazine 63
Omeprazole 667
Onanism 467
Oncicola canis 67
Oncocytoma 23
Oncology 304
Oncovin 307
Onions 744, 746
Onychectomy 635
o,p'-DDD 657
Open fractures 618
Open fractures technique 453
Ophthalmoplegia 497
Opioid drugs 63
Opportunistic algae 748
OPs 576, 740
Optic nerve 500, 501
Oral candidiasis 20
eosinophilic granuloma 22
Orchiepididymitis 460
Orchitis 460
Organochlorine insecticides
000000
Obesity 710
Obstipation 80
Obstruction
biliary disease 101
intestine 78
pyloric canal 44
related incontinence 388
respiratory 116
ureteral 357
Obstructive
biliary disease 101
expiratory diseases 117
inspiratory diseases 116
respiratory pattern 116
upper airway diseases 128
uropathy 357
Obturator paralysis 561
OC 604, 628, 642, 646, 649
Occipital dysplasia 511
OCD 604, 626, 628, 642, 646
Nephrectomy 359
Nephroblastoma 359
Nephrogenic diabetes
insipidus 378
Nephrotic syndrome 361
Nephrotoxicity 726
Nephrourectomy 359
Nerd queen 435
575
Neuroepithelioma 549
Neurogenic amyotrophy 575
cardiomyopathy 236
diabetes insipidus 379
incontinence 384
Neurohypophyseal diabetes
insipidus 379
Neurological examination 480
NeuromUSCUlar blOCkade 726
Neuronal abiotrophies 570
ceroid lipofuscinosis 517
degenerations 570
Osteochondrosis
elbow 628
hip 642
shoulder 626
stifle 646
tarsus 649
Osteoclastic lesions 26
Osteomalacia 613
Osteomyelitis 609
Osteopenia 613
OsteoporOSiS 613
Osteosarcoma 606, 607
Osteosclerosis 317
Otitis media/interna 509
Ototoxicity 509, 726
Ovaban 18,390, 406, 660,
683, 732
toxicity 732
Ovarian cysts 440
failure 425
remnant syndrome 441
tumors 441
Ovariohysterectomy 406,
409, 441, 442, 444
Oven cleaner 721
Overcirculation 182
Overdistention 388
OVerilow incontinence 384
OVH 447
Ovulation failure 433,435
induction 437
Oxalate crystals 335, 372
Oxalis 744, 747
Oxybutynin 389
1111.6.04.'.6.2.6.'.62.8.'.6.4.2.'.64.611.~
11....111111................
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. -.. . .o.ct
..
re.o.tid.e. .
66.9. .
578, 740
Organophosphates 576, 740
Orgotein 598, 743
Oronasal fistula 120
Orthodontic disease 28
Orthopnea 111
Os penis deformity 465
Osleurus osleri 137
Osteitis 609
Osteoarthritis 598
Osteoarthropathy 598
Osteoarthrosis 598
Osteochondritis 626
Osteochondritis dissecans
Neo
Neospora 696
Neosporosis 696
Neostigmine 585, 587
Oxy
Oxytocin 41.2. 420, 423
pppppp
PAA 103
Pachymeningitis 540
Pain-neuromuscular 569
Paint 721
Palosein 598, 743
Panacur 65, 66, 115
Pancreatectomy 667
Pancreatic
acinar atrophy 103
exocrine neoplasia 104
neoplasia 104, 669
parasites 104
Pancreatitis 102
Pancytopenia 700
Panhypopituitarism 682
Panleukemia 511
Panleukopenia 690
Panosteitis 611
Pantothenic acid 522
Papilledema 500
Papillomas 468
Papillomatosis 23
Parabasal cells 401
Paradoxical vestibular
signs 506
Paragonimus kellicotti 149
Paralysis 532
bladder 384
coonhound 566
facial paralysis 562
Paralysis
hypoglossal paralysis 565
laryngeal 131,565
mandibular paralysis 563
obturator paralysis 561
Paramyxoviridae 686
Paraneoplastic polyneuropathy 567
Paraphimosis 466
Parasites
acanthocephalans 67
aleuroslrongylus 137, 149
ancylostoma 65
ancylostomiaSis 65
ascarids 64
balantidium 67
besnoitia 67
Capillaria 124, 137. 149,353
cestode 66
coccidia 67
cryptosporidia 67
cuterebra 124
cysticercus 594
cytoisospora 67
dermacentor 567
dioctophyma 353
dipetalonema 205
dipylidium 66
dirofilaria 202
Para ~r-----~P~a-ra-s~i~te-s-----------------P---bZ
entamoeba 67
epsiprantel 66
eurytrema 104
filaroldes 137, 149
fluke - pancreas 104
giant kidney worm 353
giardia 67
hammondia 67, 594
hepatozoa 594
hookworm 65
isospora 67
leishmania 698
linguatala 124
liver fluke 100
macracanthorhynchus 67
nanophyetus 58
nasal mites 124
of intestines 64
of lung 149
of meninges 526
of muscles 594
of nose 124
ollulanus sp. 67
oncicola 67
pancreatic parasites 104
paragonimus 149
pentatrichomonas 67
phlebotomas 698
physaloptera 67
platynosomum 100
pneumonyssus 124
protozoan 67
pshaslopiera 67
rhinitis 124
rhipicephalus 700
Rocky Mountain wood tick 567
sand !Hes 698
sarcocystis 67, 594
schistosomiasis 67
spirocerca 36
stomach worm 67
strongyloides 65
taenia 66
tapeworm 66
thorny-headed worms 67
ticK paralysis 567
Parasitic meningitis/myelitisl
encephalitis 526
myositis 594
rhinitis 124
Paresis 532
Parlodel 407
Paroxysmal atrial taChycardia 251, 261
Partial defects parietal
pericardium 230
Partial hepatectomy 99
Parturition 404
bitch 405
cat 403
stages 405
Parvovirus
dog 55
feline 690
encephalitis 554
enteritis 690
Pasteurella multocida 124
Patellar luxation 644
Patellar tendon procedure
645
Patent ductus arteriosus 200
Patent urachus 387
Periesophageal
tion 37
Perineal fistulae 85
hemia 84
hemiorgraphy 84
Periodic bleeding 534
Periodic weakness 534
Periodontal disease 25
epulis 24
ligament tumor 24
probe 25
Periodontitis 25
Periosteal proliferative form
600
Peripheral eosinophilia 150
Peripheral nerves 557
Perirenal pseudocysts 356
Peritoneal hemia 105
dialysis 338
hernia 105
Peritoneopericardial diaphragmatic hernia 105,
195,230
Peritonitis 106
FIP 144
Peroneal paralysis 561
Persistent anestrus 436,440
decidual reaction 416
erection 466
estrus 439
hymen 446
left cranial vena cava 195
patent urachus 367
penile frenulum 465
right aortic arch 36, 199
Persistent
urachal diverticulum 367
Pesticides 718
Petroleum products 721
PgF2 409,423
pH 334
Pharyngeal trauma 29
neoplasms 29
paralysis 30
Pharyngitis 20, 29
Phencyclidine 737
Phenol 721
Phenoxy herbicides 743
Phenoxybenzamine 385, 388
Phenylbutazone 731
Phenylpropanolamine 386
Phenylsulfophalein test 331
PhenytOin 244,252,730
Pheochromocytoma 684
Phillip's Milk of Magnesia 81
Phimosis 466
pHisoHex 720
Phlebotomy 317
PHM 546
Phorandendron 744, 746
Phosphofructokinase 589
Phycomycosis 41, 61
Phygon 742
Physaloptera 67
Physiologic obstruction 79
PIE 150, 206
Pilonidal cysVsinus 536
Pine tar 721
Pit vipers 723
Pitressin 379
Pit
Pneumonia
bacterial 146
Pituitary cyst 682
granUlomatous 150
diabetes insipidus 379
parasitiC 149
dwarfism 682
toxoplasma 149
gland tumor 655
verminous 149
hypofunction 682
Pneumonitis 150
adrenal function tests 656
uremic 344
Place packs 738
Pneumonyssus 124
Placenta 405
Pneumoperitoneogram 337
Placental delivery 403
Pneumothorax 161
Plague 699
Poison 716, see toxicity
Plant alkaloids 307
Polioencephalomyelitis
Plant awn stomatitis 20
81 deficiency 526
Plaque 25
idiopathic 538
Plasma cell gingivitis 20
Polishes 721
myeloma 608
Polyarteritis
neoplasm 317
Polyarthritis
pharyng~is 20
nodosa555
proteins 331
chronic progressive 600
stomatitis 20
idiopathic 601
Plastics 721
SLE 699
Platinol 307
Polycystic kidneys 356
Platynosomum 100
Pleural effusion 113, 154, 183, Polycythemia 325
Polycythemia rubra vera 317
229
Polydactyly 635
Plug 374
Polydipsia 328
PMI 212
Polydontia 24
PM! heart valves 178
Polyethylene glycol 81, 720
PMNs 298
Polyglycol ethers 720
Pneumomediastinum 163
Polymyositis 566, 591, 593
Pneumonia
protozoal 566
allergic 150
Polyneuritis
aspiration 148
brachial plexus 559
chronic 566
PBZ 731
PCN 317
PCP 163, 737
PDA 200
PDH 230
Pectineal tenotomy 639
Pectus excavatum 159
Pelger-Huet anomaly 297
Pelvic bladder 365
Pelvic fractures 636
Penicilliosis 126
Penicillium 747
Penile 464
hypoplasia 465
lymphoid hyperplasia 469
urethrostomy 375
trauma 467
Penta 163
Pentachlorophenol 579. 737
Pentamidine isethionate 281
Pentatrichomonas 67
Pentostam 698
Perforated colon/rectum 84
Perianal dermatitis 86
Perianal gland tumors 87
Periapical abscess 27
Pericardial cyst 230
disease 230
effusion & tamponade 232
masses 231
Pericardiectomy 233
Pericardiocentesis 191, 233
Pericardium 230
Periesophageal obstruc-
Polyneuritris
causes 557
Polyneuropathy 556,557,
566,567,573,581,583
causes 557
chronic relapsing 566
cranial 573
diabetic 581
distal symmetric 573
ganglioradiculitis 573
hyperlipidemia 583
hypoglycemic 581
hypothyroid 580, 675
miscellaneous toxins 579
paraneoplastic 567
peripheral nerves 556, 557
Polypnea 111
Polypoid cystitis 365
Polyps
anorectal 86
nasopharyngeal 128
vaginal 447
Polyradiculitis 566
acute 566
chronic relapsing 566
coonhound paralysis 566
protozoal 566
Polysulfated glycosaminoglycans 598
Polyurethane 721
Polyuria 328, 330, 376
Polyuria volume 330
Population control 406
Portal hypertension 99
Portal vascular anomalies 374
Por
Portosystemic shunts 523
Portovascular anomalies 99
Positive inotrope 193
Post-insulin hypoglycemia
664
PostcavaVacute hepaticlliver
failure syndrome 208
Postprandial hyperlipidemia
671
Postsplenectomy sepsis 322
permanganate 578
salts of fatty acids 720
Potbelly 654
Povidone-iodine 420
Pr:Cr ratio - urinary 391
Pregnancy
bitch 404
Pregnancy
cat 403
length 404
termination 407
Preleukemic syndrome 316
Prepuberal gonadectomy 453
Prepuce 464
Pre renal azotemia 328
Prescription drugs 737
Priapism 466
Pridymethyl 738
Primary epilepsy 514
hyperparathyroidism 678
polydipsia 379
renal glucosuria 354
Pro-Banthine 252, 389
Procedures
angiography 337
artificial Insemination 449
bronchoalveolar lavage 147
catheterize 375
collection of semen 449
cystogram 336
epidural 415
excretory urography 336
exfoliative cytology 401
Intravenous urogram 336
laboratory samples 652
liver biopsy 89
peritoneal dialysis 338
pneumopemoneogram 337
prostatic massage 469
reproduction - male 453
resuscitate neonates 415
scarification 469
semen collection & evaluation 448
testicular biopsy 453
transtracheal wash 147
tube feeding 418
unblock cat 375
urethrogram 337
Proc-
urinalysis 333
uterine infusion 420
vaginal cytology 401,431
vaglnogram 337
Proctitis 48, 86
Progesterone assay 431
Proglottides 66
Prognathia 28
Progressive
axonopathy 572
hemorrhagic myelomalacia
546
neurogenic muscular
atrophy 575
Prolactin suppression 407
Prolapse
rectal 83
urethral 467
uterus 442
vagina 444
Proliferative cystitis 365
Prolonged anestrus 436
heat 438
interestrous intervals 436
proestrus/estrus 438, 439
Prostoglandin
409,420,423
toxicity 733
Prostatectomy 469
Prostatic abscess 473
cysts 469
disease 329, 470
hyperplasia 471
massage 469
neoplasia 469
incontinence 389
Prostatitis incontinence 389
Prostatomegaly 471
Prostigmin 585, 587
Protein-losing enteropathy 73
Proteinuria 334, 391
Protothecosis 61, 555, 748
Protozoa
amebiasis 67
babesia 281
balantidium 67
entamoeba 67
cryptosporidiosis 67
cytauxzoon 281
giardia 67
hepatozoon 696
leishmania 698
neospora 566, 594, 696
other protozoa 67
toxoplasma 149,594,697
trichomonads 67
Prostaglandin 409
Prostaglandin PgF2 407,
Rad
Renal
Pro
or luxation 648
PS 196
Pseudocoprostasis 83
Pseudocytesis 411
Pseudoephedrine 455
Pseudoephedrine 455
Pseudohemaphroditism 389,
459
Pseudohyperparathyroidism 677
Pseudomembranous colitis
50
Pseudopregnancy 411
Pseudorabies 555
PU/PD 654
Puberty 401
Puberty - cat 398
Public heaHh
ascariasis 64
blastomycoSis 704
brucelloSis 424
brucellosis 424
chlorinated hydrocarbons 740
coccidioidomycosis 702
giardiasis 67
histoplasmosis 705
leishmaniasis 698
leptospirosis 695
mycobacteria 60
organophosphates 740
plague 699
Rocky Mountain spoiled fever 701
....
~.="- - - - - - - - - Protozoa
Rotenone 740
salmonella 59
toxoplasmoSis 697
Tularemia 699
150,206
knob 196
osteoarthropathy 610
thromboembolism 160, 206
Pulmonic insufficiency 213
stenosis 196
Pulpal hyperemia 27
Pulpitis 27
Pulse 176
Pump failure 222
Pump handle tail 580
Puppy carpal weakness 634
Puppy vaginitis 445
PV 317
Pyelonephritis 350
Pygmy rattlesnake 723
Pyloric canal obstruction 44
Pyloroplasty 44
Pyogranulomatous meningoencephalomyelitis 521
Pyometra 408
Pyo
Pyometra complex 408
Pyothorax 157
Radiograph 180
chest & abdomen 182
heart 180
Pyrantel pamoate 64
Pyrethrins 741
Pyrethroids 741
Pyrexia 711
Pyridostigmine bromide 585
Pyriminil 738
Pyruvate dehydrogenase
deficiency 589
Raglan 44
Pythiosis 61
Rales 112
Ranula 32
Rattlesnake 723
ReM 226
QQQQQQ
QATs 288
Quadriceps contracture 595
Quaternary ammonium
compounds 720
Quick drying paints 721
Quinidex 252
Quinidine 252
RRRRRR
rid diet 73
Rabbit fever 699
Rabies 553
Radial & ulnar dysplasia 633
Radial paralysis 560
Radiation therapy 307
sia 324
Rectal
exam - renal system 330
foreign bodies 84
prolapse B3
pelioration 84
Recurrent estrus 438
Refusal to breec 432
Reglan 44, 343
Regurgitation 38
Reiter's disease 600
Remittent fever 711
Remnant syndrome 441
Renal azotemia 328
biOpsy 338
cancer 359
carcinoma 359
conical dysplasia 355
hypenension 345
conical hypoplaslaldysplasia 355
cysts 356
disease 328
heanworm 209
failure 88, 328, 677, 695
glycosuria 355
hypertenSion 345
leptospirosis 695
neoplasia 359
osteodystrophy 679
pain 328
rickets 679
2 hyperparathyroidism 346, 679
tubular acld(lSis 354
trauma 358
tumor 359
Reproductive cycle
bitch 396
queen 398
Resection arthroplasty 598
Resins 721
Respiratory distress 111, 152
Respiratory sinus arrhythmia
254
Rest + "3 D's' 193
Restrictive breathing 118
cardiomyopathy 226
Resuscitate neonates 415
Retained deciduous teeth 28
enchondral cartilage cores
630
placenta 416
Reticuloendotheliosis 317
Reticulosis 521
Reticulum ce11 sarcoma 308
Retinal detachment 499
Retinal dysplasia 690
Retrograde ejaculate 455
Retropharyngeal abscess 29
Ret
Retrovirus 694
Reverse PDA 201
Rhabdomyoma 589
Rhabdomyosarcoma 589
208
to left shunt 201
Right
ventricular enlargement 270
Ritalin 516
RMSF 701
Robaxin 578
Robinul 192, 252, 255
Rocaltrol 346
SSSSSS
Sacrococcygeal dysgenesis
537
Sacroiliac fracture 637
Saddle embolus 228, 582
thrombus 582
Sago palms 744, 745
Saline cathartiC 578
Salivary gland fistula 32
Salmon poisoning 58
Salmonella 59
Salter-Harris fracture 614
Satts of fatty acids 720
San Joaquin Valley fever 702
Sand flies 698
Sandoff's disease 517
Sanitizers 721
Sapremia 594
Saprophytic mycobacterium
145
Sarcocystis 67, 594
Sarcoma 305, 308
Sardonic grin 580
Saw horse stance 580
sBAIserum bile acid 89
Scapular fractures 625
Scarification 469
Schistosomiasis 67
Sciatic paralysis 561
Sclerosis 598
Scoliosis 537
Scotty cramp 568
Scrotal dennatitis 456
hernia 105,457
neoplasia 457
swelling 456
Season 396
Seizures 512
Selective angiography 191
Selegiline 657
Selenium toxicity 736
Semen 449
Seminoma 463
Senile atrophy 461
Sensory mutilation syndrome 574
neuropathy 574
trigeminal neuropathy 563
Septic arthritis 599
Sertoli cell tumor 463
Sertoli-Leydig cell tumors 441
Serum progesterone 400
Serum progesterone ELISA
kit 400
Severe acute diarrhea 47
Severe pulmonary arterial
disease 207
Sex linked myopathies 592
Shake & bake 577, 738
Shampoos 720
Shark cartilage 709
Shark cartilage diets 709
Shock 707
Shock lungs 152
Short estrus 435
interestrous intervals 438
R waves 273
Short-bowel syndrome 72
Shortened Q-T interval 273
Shoulder luxation 624
Shoulder OC 626
SIADH 659
Sialoadenitis 33
SialoceleJSialolithiasis 33
Sick sinus syndrome 251,
256
Silent heat 434, 435, 436
Silica crystals 372
Silvex 743
Simazin 742, 743
Sinoatrial block 256
Sinoatrial standstill 257
Sinus arrest 256
wandering pacemaker 255
arrest 256
arrhythmia 254
bradycardia 255
rhythm 254
tachycardia 251, 260
trephination 124
wandering pacemaker 255
Sinusitis 122
SIPS 16
Sjogren's-like syndrome 19
Skeletal muscle relaxant 385
Sky terriers 97
SLE 699
SLE arthropathy 601
Sleep disorders 516
Small from large intestine
disease 53
Sol
Spl
Sti
Sub
Solvents 721
Somogyi overswing 664
Sorrel 744, 747
Space occupying lesions 164
Spasm - larynx 129
Spastic colon 73
Sperm granuloma 458
SpG 332
Spherocytes 275
Sphincter hypotonus 386
Sphingomyelin lipidosis 517
Sphingomyelkinase 517
Spica splint 624
Spiders 722
Spina bifidaJcystica 536
Spinal arachnoid cysts 543
column neoplasia 548
cord disorders 528
curvature defonnities 537
dysraphism 533
muscular atrophy 572
shock 543
trauma 542
Spirocerca lupi 36
Splenectomy 318
Splenic abscess 322
inflammation 322
mass 318
rupture 322
torsion 321
trauma 322
Splenomegaly 320
Splenosis 322
Split heat cycles 434
Subgingival curettage 25
Subgingival erosions 26
Subinvolution of placenta 416
Subluxation 605
carpal joint 634
coxofemoral 640
elbow 632
hip luxation 640
shoulder 624
stifle 644
tarsus 648
Submissive urination 387
Subtotal colectomy 74
Subtotal colectomy 75
Sulfasalazine 63
Sulfasalazine 63
Sulfonamides 519
Sulfonated hydrocarbons 720
Sulfonylurea agent 379
Sulfur oxide 725
Sumac 747
Superfecundation 439
Superfetation 439
Supernumerary teeth 24
Superovulation 439
Superoxide dismutase 743
Suppositories 81
Suppurative cholangiohepatitis 100
enterocolitis 62
Suprascapular paralysis 560,
624
Supraventricular arrhythmias
248
Rock chewers 28
Rocky Mountain
spotted fever 701
wood tick 567
Rodent ulcer 18
Rompun 719
Root canal 27
Root planing 25
Rosary pea 744, 746
Rostral mandibular body
fractures 623
Rotavirus 54
Rotenone 740
Roundup 742, 743
Roundworms 64
RSAT test 431
RSHP 346
RTA 354
Rubber jaw 346, 679
Rumex 744, 747
Ruptured bladder 366
chordae tendineae 216
uterus 442
Russel's viper 723
Scrot-~]-------::S:-:-h-o------------::S:-m-a
Sup
Supraventricular premature
contractions 261
Surfak 81
Surgeries
adrenalectomy 684
arthrodesis 598
arthrodesis proximal intertarsal joint
648
castration 453
cesarean section 415
cholecystectomy 100, 101
cholecystoenterostomy 101
cholecystojejunostomy 101
cholecystoduodenostomy 101
colopexy 83
cricopharyngeal myotomy 31
deepening trochlear groove 644
diaphragmatic crural opposition 36
embolectomy 160
en block 477
esophagopexy 36
excision arthroplasty 599
excision of femoral head 639
fascial strip over-the-top 645
fibular head transpos!tlon 645
gastropexy 36
gingivectomy 25
hemimandibulectomy 29
hepatectomy 93
hip replacement 639
Imbrication 645
Incise frenulum 22
Intertrochanteric osteotomy 639
laryngeal sacculectomy 130
lumpectomy 477
mandibulectomy 29
mastectomy 477
nephrectomy 359
orchidectomy 453
pancreatectomy 667
partial hepatectomy 99
patellar tendon 645
pectineal tanotomy 639
penUe urethrostom 375
Surgeries
pericardiectomy 233
perlcardlocentesls 233
perineal hernlography 84
phlebotomy 317
prepuberal gonadectomy 453
prostatectomy 469
pyloroplasty 44
staphylectomy 130
subtotal colectomy 74
surgical enlarging glottic cleft 131
tenodesis 624
lestiCtJlar biopsy 453
thyroidectomy 673
tieback 131
tooth extraction 27
total hip replacement 639
Sustained supraventricular
tachycardia 261
Suture: near-far-far-near 595
Sweeney 560, 624
Swimming puppies 583
Syncope 175
Syndactyly 635
Synovial cell sarcoma 602
Synovioma 602
Synthroid 674, 675
Syringomyelia 533
Ton
Tongue worm 124
Tonsillar neoplasia 29
Tonsillitis 29
Tooth extraction 27
Torbugesic 582
Torbutrol 114
Torsion
gastric 45
lung lobe 157
stomach 45
Total hip replacement 639
Toxic bluegreen algae 748
Toxic or drug induced
myositis 594
Toxic PMNs 298
Syr
Ten
Tenodesis 624
Tenormin 252
Tented T waves 272
Tentorial herniation 503, 525
Teratomas 441
Teratozoospermia 455
Terbutaline 114
Testicles - adverse drug
reactions 461
Testicular problems 458-463
aplasia of duct system 458
biopsy 453
cryptorchid 458
drugs 461
hypoplasia 458
neoplasia 463
orchitis 460
senile atrophy 461
trauma 462
torsion 462
tumors 463
Testosterone cypionate 386
Testosterone responsive
dermatitis 684
Tests
TTTTTT
T-lymphotropic virus 694
Tachyarrhythmias 251
Tachypnea 111
Taenia 66
Tamponade - pericardial 232
Tannic acid 578
Tapazole 673
Tape muzzle 622
Tapeworm 66
Tarsal problems 648-649
fractures 649
luxation 648
osteochondrosis 649
subluxation 648
Tarsometatarsal subluxation
648
Taurine 227
Taxine alkaloids 744
Taxus 744
Tay-Sachs disease 517
T8 meningitis 551
TE 228
Tea toxicity 724
Telvar 742
Tempra 731
Tenesmus 80
Toxicities
anticonvulsants 730
antibiotics 726
antidotes 719
antifreeze toxicity 352, 734
antimony toxicity 736
ants 722
ANTU 738
arachnids 722
aromatic hydrocarbons 721
arsenic poisoning 206, 735
aspirin 731
automatic dishwasher detergents
721
barium toxicity 736
battery liquid 721
bee 579
benzene 721
bleach 721
bleeding heart 744, 745
blue green algae 744,748
boric acid 741
bromethaUn 759
bufo toxicity 724
butane 721
bute 731
cadmium toxicity 736
caffeine toxicity 724
Caparsolate 209
carbamate 576
carbon disulfide S79
carbon monoxide 246, 725
carbon tetrachloride 721
cardiac glycOSldes 245, 746
cationic detergents 720
caustic soda 721
caustic agents 721
central nervous system depressants
737
Cheque toxicity 732
chloramphenicol toxicity 727
chlorinated aliphatic hydrocarbons
721
chlorinated hydrocarbons 578,740
chlorine bleach 721
chlorphenothane 579
Toxicities
chloroform 721
chocolate toxicity 724
chromium toxicity 736
Citrus all extracts 741
clay pigeons 721
coat contamination 720
cocaine 737
compound 1080 739
contact Irntants 744, 747
copper - hepatitis 97, 734
copperhead 723
corrosive agents 721
corticosterOid 729
cottonmouth 723
coumarlns 295, 738
creosote 721
crotalids 723
DEET 741
degreaslng solvents 721
detergents 720, 721
digitalis 244, 730, 744
dinitroorthocresol 721
dipyrldyl compounds 743
diquat 743
dishwasher detergenVgranules 721
dishwasher soaps 720
disinfectants 721
doxorubicin 247, 730
drain deaner 721
dNg 579, 731
drug & toxin - anemia 730
dry cleaning solvents 721
elapines 723
emergency care 719
EpiNbicin 247
estrogen toxicity 733
ethane 721
ethylene glycol toxicity 352, 734
fire ants 722
foxglove 744
garlic 746
gas anesthetics 730
gasoline 721
Thr
Tests
Tetanus 580
Tetrachloroethylene 721
Tetracycline 26, 280, 726
staining 26
Tetralogy of Fallot 199
Thalamus 492
Thallium toxicity 19, 734
Thecomas 441
Theo Dur 114,193
Theobromine toxicity 724
Theophylline 114, 193
toxicity 724
Thiacetarsamide 204, 209
Thiamine/B1 deficiency 526
Thiazide diuretics 669
Thiazines 742, 743
Thoracic trauma 158
Thorazine 343
Thomy apple 335
Thomy-headed worms 67
Thrombocythemia 295
Thrombocytopenia 290
Thrombocytosis 295
Toxicities
Toxicities
nightshade 745
nonlonic detergents 720
NSAIOs 731
oleander 744
onions 744, 746
organochlorine Insecticides 740
organophosphates 576, 740
Ovaban toxicity 732
oven cleaner 721
oxalates 747
paint stripper 721
paint thinner 721
paints 721
paraquat 742, 743
pcp 737
penta 163
pentachlorophenol 737
pesticides 718
petroleum products 721
phenol 721
phenoxy 743
phenylbutazone (peZ) 731
pine tar 721
pit vipers 723
plastics 721
poinsettia 744, 746
polson control center 719
poisoning 718
poisonous plants 744
polishes 721
polyurethane 721
potaSSium hydroxide 721
prescription dNgS 737
Prldymethyl 738
propane 721
prostaglandin toxicity 733
protothaca 748
pyrethnns 741
pyrlmlnll 738
quaternary ammonium 720
rattlesnake 723
resins 721
rhododendron 744, 746
rhubarb poisoning 744, 747
rotenone 740
Toxicities
roundup 742. 743
roden\lcldes 738, 739
sago palms 744
sanltizers 721
thiacetarsamide 209
thiazines 742, 743
toad (8ulo) toxicity 724
lrimethoprim-sulfadlazine 727
tri-ortho-cresyl phosphate 579
turpentine 721
Tylenol 731
vacor 738
vamlshes 721
Venomous snake bites 723
viperlnes 723
vitamin D rodentiCides 738
vitamin K deliciency 738
Toxicities
vomiting - induced 719
Don1 Induce vomiUng 721
warfam 295, 738
wood preservatives 721
xanthines 724
xylene 721
yew 744
zinc phosphide 739
zinc toxicities 735
zn3P2 163
Trau-~r-----~T~ru~------------------~U~nc
peniS & prepuce 467
peripheral nerve 558
renal 358
testicle 462
trachea 135
urinary bladder 366
TraUmatic peripheral
nerve injuries 558
Tremor syndrome 568
Trenchmouth 21
Trephination 124
Tri-ortho-cresyl phosphate 579
Triamcinolone 729
Triaminic 386
Triazole toxicity 728
Triceps contracture 632
Trichinella spiralis 594
Trichinosis 67
Trichloroethylene 721
Trichomonads 67
Trichuris colitis 66
TrichUris vulpis 66
Tricuspid valve dysplasia 199
Tricuspid valve insufficiency
217
Tricyclic antidepressant 386,
737
Trigeminal sensory neuropathy 563
Trigeminy 258
Trimethoprim-sulfadiazine 727
Tropical canine pancytopenia
700
Trounce 739
Urethral
Urt
stricture 370
trauma 371
Urethritis 368
Urethritis - incontinence 389
Urethrocystitis 368
Urethrogram 337
Urethrorectal fistula 369
Urge incontinence 389
Urinalysis 332, 333
Urinalysis values 333, inside
back cover
Urinary acidifiers 363
antiseptics 363
bladder atony 356
defects 367
herniation 84
neoplasia 367
problems 365-367
stones 372
trauma 366
incontinence 329, 380
Pr:Cr ratio 391
tract disorders 328
tract infection 362
Urination 330
Urine LH assay 400
sediment 335
Specific Gravity 332
spraying 390
volume 330
Urobilinogen 89
Urolithiasis 374
Urol.hs 372
Urologic syndrome 374
vvvvvv
Vaginal
UUUUUU
u/d diet 90
UA 332
Ulcerative colitis 62
Ulcerative keratitis 139
Ulcerative stomatitis 21, 139
Ulcers - gastric 43
Umbilical hernia 105
Umbilical urachal sinus 387
UMN neuron bladder 385
Unblock cat 375
Uncinaria stenocephala 65
Unclassified LSA 314
Unexpressed estrus 435
UNI-TEC 203
Unilact 418
Ununited anconeal process
629
Upper airway disorders 116
motor neuron
bladder 385
signs 528
respiratory infection 139
urinary tract infection 350
Urachal diverticulUm 387
Urate crystals 372
Urea cycle enzyme deficiencies 523
Urecholine 388
Uremia 22, 241, 328, 344
Uremic heart disease 241
pneumonitis 344
Ureteral obstruction 357
trauma 358
tumors 357
Urethral agenesis 369
discharge 329
diverticula 369
duplication 369
fistulas 369
incompetence 386
neoplasia 370,468
plug 374
prolapse 369, 467
stenosis 369, 370
Values
Ventricular
premature contractions
251, 265
septal defect 198
tachycardia 251, 265
Ventriculoperitoneal shunts
510
Verminous pneumonia 149
Vertebral deformities 536
abscess 541
osteomyelitis 541
Vestibular disease 506
Veta-K1 295
Veta-Lac 418
Vetalog 729
Vibramycin 726
Villous atrophy 77
Vinblastine 307
Vinca alkaloids 307
Vincent's stomatitis 21
Vincristine 307,659
Viperines 723
Viral Sinusitis 125
Viral gastroenteritis 690
Viral rhinitis 125
Viruses
astrOVirus 56
bronchitis 140
canine adenovirus-1 93
adenovirus type 2 138
coronavirus enteritis 54
distemper 54,144
herpes virus 138
parainfluenza virus 138
CAV-293
CCV 54
coronavirus 56, 107, 144, 688
FECV 56
Viruses
Vomiting
enteritis 54, 56
esophagitis 34
esophageal problems 34-37
fungal enteritis 61
gastritis 40
hypermotility 44
inducing 719
intestinal obstruction 78
megaesophagus 37
pancreatitis 102
panleukopenia 57
parasites 64
parvovirus 55
pyloric canal obstruction 44
salmon poisoning 58
vestibular disease 506
ulcers 43
feline astrovlrus 56
calicMrus 139
distemper 57
enteric coronavirus 56
immunodeficl&ncy virus 23
infectious peritonitis 107, 144
leukemia 692
panleukopenia 57
parvovlrus enteritis 57
rhinotracheitis virus 139
FIP 107,144
FIV 23
FPV 57
herpesvirus 139
papovavirus 23
VPCS 265
Vulvar enlargement 446
discharge 443
hypoplasia 446
stenosis 444
Vulvovestibular cleft 446
vWD 293
paramyxovlridae 686
parvovirus 55, 57
retrovirus 694
rhinitis 125
rotavirus 54
wwwwww
E - Selenium 237
K 289, 295, 738
Volvulus
cecal-colic volvulus 75
gastric 45
intestinal volvulus 79
mesenteric volvulus 79
Vomiting 38
acute abdomen 39
chronic bowel disease 62
Wei
Wheezes 112
Whipple's triad 104
Whipworms 66
Wh~e dog shaker 568
Winstrol 347
Wobbler's disease 545
Wolf-Parkinson-White (WRW)
syndrome 264
Wood nettles 747
Vel
Yersinia 60, 699
YerSiniosis 60
Yew 744
Yobine 516
Yohimbine 516
zzzzzz
Zinc toxicity 735
Zn3P2 163
Zollinger-Ellison syndrome 104
Zygomycosis 61
preservatives 721
tick 701
Worn teeth 28
WRW syndrome 264
xxxxxx
XMlinked muscular dystrophy
592
Xanthines 724
Xanthomas 671
Xerostomia 31
XOIXXXlXXY syndrome 459
Xylazine 719
Xylene 721
vvvvvv
Yanthomas 583
Yellow fever 145
~..
-- ----c;;;l
Measurements - Equivalents
MSk2196;Mk972:CI2T1417:H2B 13S6
Fluids
1 L (liter)
1 dl (deciliter)
1 ml (milliliter)
1 J.LL (microliter)
1 II OZ (Iluid oz)
1 pt (pint)
1 qt (quart)
1 gal (gallon)
1 cup
1 drop
1 tsp (teaspoon)
1 tbsp (tablespoon)
1 minim
= 1 qt (1.0567 L)
= 1000 ml (10' ml)
= 100 ml (102 ml)
= 0.001 L (10'L)
= 15 minims (16.23)
= 1 cc (cubic centimeter)
= 0.000001 L (10.6 )
= 30 ml (29.57)
= 500 ml (473.2)
= 16110z
= 1/2 L (473.2 ml)
= 2 cups
= 1.136 imperial L
= 1 L (946.4 ml)
= 4000 ml (3785.6) =4L
= 4.55 imperial L
= 4 quarts
= 0.833 imperial gal
=250 ml
= 8 II oz
= 1120 ml
=5ml
= 15 ml
= 0.06 ml (0.062)
\~
Length
1 yd (yard)
l' (ft/foot)
1" (in/inch)
1 m (meter)
= 91.44 cm
= 30 cm (30.48)
= 2.54 cm
= 40 " (39.37)
= 100 cm
1 cm (centimeter) = 0.4" (0.39)
1 mm (millimeter) = 0.04" (0.039)
=1m
= 1 yd
= 10mm
Weights
1 kg (kilogram)
1 mg (milligram)
1 9 (gram)
= 2.2 Ib (2.205)
=0.1 9 (10-' kg)
= 15 grains (15.43)
= 0.035 oz
1 J.Lg (microgram) = 0.000001 9 (10.6)
1 ng (nanogram) =(10')
=(10-12)
1 pg (picogram)
1 gr (grain)
= 65 mg (64.8)
= 30 9 (28.35)
1 oz (ounce)
= 1/2 kg (0.454)
1 Ib (pound)
= 1 part per million
1 J.Lg/gm
1 ton
= 2,000 Ib
1 metric ton
= 1,000 kg
= 1000 9
= 1/65 (0.015) gr
= 10 mg
= 0.065 9
= 16 oz
= 1 mg/kg
= 2,2051b
17g81
Abbreviations
a,aa
abd
abnorm
ABs
bact
BID
bilat
C&S
caud
CrN
conc
cran
CS
d(s)
decr
DDx
defc
degen
dist
diz
DJD
DOC
dors
Ox
elev
envir
~-
artery (ies)
abdomen
abnormal
antibiotics
bacterial, bacteria
twice/day
bilateral
Culture & Sensitivity
caudal
cranial nerve
concentrate
cranial
clinical signs
day, days
decrease
differential Ox
deficiency
degenerative
distal
disease
degenerative joint
diz
Drug of Choice
dorsal
diagnosis
elevated
environment
~~--
esp
ext
FB
Feds
fx, fxs
gen
hi
hr(s)
HR
hs
Hx
1M
IN
incr
infec
inflam
int
IP
IV
jt
lat
Ib
Ig
lig (ligg)
LMNs
In, Inn
It
especially
external
foreign bodies
Federal agents
fracture(s)
general
high
hour(s)
heart rate
at night
history
intramuscular
intranasal
increase
infection
inflammation
internal
intraperitoneal
intravascular
joint
lateral
pound
large
ligament(s)
lower motor neurons
lymph node (s)
left
m/
mlb
med
membr
metab
min
MLV
mo (s)
n, nn
neg
norm
PCV
perf
PM
PMNs
PO
pos
ppt
PRN
preg
prblm
prox
Px
q
010
repro
resp
may
maybe
medial
membrane
metabolic
minute
modified live virus
month, months
nerve(s)
negative
normal
packed cell volume
perforating
postmortem
neutrophils
per os/orally
positive
precipitate
as needed
pregnancy
problem
proximal
prognosis
every (as inq12 hrs)
four times/day
reproduction
respiratory
R/O
RR
rt
Rx
SID
sm
spec
SO
supf
Sx
thru
TID
TP
Tx
UMNs
usu
unilat
vac
ventr
v,w
w/
w/i
w/o
wk(s)
wt
yr(s)
Rule out
respiratory rate
right
drug(s)
once a day
small
spectrum
subcutaneous
superficial
surgery
through
three times/day
total protein
treatment
upper motor neurons
usually
unilateral
vaccination
ventral
vein(s)
with
within
without
week, weeks
weight
year, years
number or pound
-----_.--
".
Drug abbreviations
Uses
(1
rQJ-
Comments
[Resulting testing solution]
Routes of administration
PO
SO
1M
IV
IP
IN
IC
IT
Red (nothing)
Common chemistries
ISerum]
per os, by mouth or orally
Serology
Occult heartworm
subcutaneous injection
c-- (~
":\
intramuscular injection
~,.--~I-R-ed-&-b-Ia-ck------c-om-m-o-n-c-h-em-i-st-rie-s---[S-e-ru-m-]-------I
intravenous injection
~
(None, separator)
Serology
intraperitoneal (into peritoneal cavity)
Occult heartworm
intranasal
"Stat~ = Don~ have to wait for
"Stat" chemistries
Green (lithium heparin)
intracardiac
Hormone tests
clotting
intrathecal (into subarachnoid space)
Ammonia
[Heparin plasma]
Dosage ScheduleslTiming
q
SID
BID
TID
OlD
000
PRN
hs
at night
-=
Fibrin degradation
Gray (NaFI)
Glucose
IPlasma]
Urine culture
[Urine]
PT & PTT
Von Willebrand's diz
products (FDP)
(nutrients)
;:.
~:SA j}c? ~
~
-: :c~-' I: :(-r: :~, I-:~ ~ c:sc~s-_eacrtw:~o-' r n_- c_- _[E_D T_A p_la_Sm_a ] ~_~_1~
I-L_p-u_r_p-.l.le:(-E:D:TJA_)_________
J7991
____
Serology
v=-"1--,-
Enzymes:
SAP (Alk phos) lUlL
mgldl
Electrolyte:
Na (sodium) mEqlL
K (potassium) mEqlL
CI (chloride) mEqlL
Ca (calcium) mgldl
P (phosphorus) mgldl
Mg (magnesium) mgldl
Acid-base
pH
CO2 mEqlL
pHC03 (Bicarbonate) mEqlL
Dog
10-25
0.5-2.0
< 1.0
100-300
SO-11 0
5.0-7.0
2.3-4.0
0.8-2.0
150-200
Cat
1S-30
0.5-2.0
< O.S
100-200
70-120
5.0-8.0
2.7-4.0
0.8-1.5
150-200
140-155
3.5-S.0
100-125
9.0-12.0
2.5-S.0
1.5-3.0
145-1 SO
3.5-5.0
110-125
8.0-12.0
3.0-8.0
2.0-3.0
7.30-7.40
20-30
20-25
7.25-7.40
20-25
1S-22
Dog
20-150
10-115
Cat
10-100
15-50
10-50
20-120
1-10
10-90
3-10
< 1,000
<1
10-40
20-200
2-20
10-100
2-S
1,2000
<1
CPK
Dogs
PCV (hematocrlt) %
40-55
5-9
12-18
SO-75
19-25
30-36
0-1.5
120
200-500,000
5,000-17,000
3,000-12,000 (SO-70%)
< 300
(0-3%)
1,000-5,000 (12-30%)
S:s::=J 150-1,300
2]
Cal
100-1,000
Rare
(3-10%)
(2-10%)
5,000-20,000
3,000-12,000 (35-75%)
< 300
(0-3%)
1,500-7,000 (20-55%)
0-850
(1-4%)
100-1,000
(2-10%)
Rare
.
All Labs vary widely!!!
Rectal temperature
Dogs
102F (38.9C)
70-150
20 (16-20)
<2
Cats
101.5F (38.SC)
101-102"F
-.--::
~
i'!-'
r-
101.5-102.5F
150-200 (120-210)
25 (20-24)
<2
Urinal ysis
H2B 1383
Color
Pressure (mm H2O)
Cell counVJ.l1
WBCs (mononuclear)
RBCs
Protein (mg/dl)
Dog
Cat
Clear, colorless
< 100
< 170
<8
None
<25
<8
None
<20
Color
Turbidity
Specific gravity
Urine vol ume (mllkg/day)
Semiqua ntitative tests/dipstick
Protei n
_C
Manual clinical chemistry procedures
C12T 1401
(% M 30 m;,)
Dog
Cat
0-9
0-30
,,5%
15-25
~2.2
Blood
Gluco se
Keton es
Bilirubi n
Dog
Cal
Light yellow
Clear
1.015-1.045
25-40
Yellow
12.S
,,3%
15-25
pH
. Back Cover I
I Inside
1.015-1.060
20-30
5.0-7.0