EXAM 2 Review

This is an acute disorder of dogs and cats. It can be seen in the spring, summer, and fall. It causes nystagmus, loss of balance, and vomiting. There is no effective treatment. We just provide supportive care.

Idiopathic Vestibular Disease

How long does a typical seizure last?

1-2 minutes

After a seizure is over, the animal can be disoriented and occasionally blind. True or False

true

What medication is used as a maintenance therapy for idiopathic epilepsy patients?

Phenobarbital

Status epileptics is classified as continual seizures over a prolonged period of time. How long is considered prolonged?

5 minutes

Status epilepticus is considered a medical emergency that can lead to irreversible coma an death. True or False

true

Facial Nerve Paralysis is a condition that has been reported in adult dog and cats that are over 5 years of age. The prognosis for complete recovery is excellent. Theses animals will return to normal within 2-3 weeks. True or false

false

This is a disease that begins with a weakness noted in the hind limbs then paralysis that progresses rapidly to flaccid systemic tetraplegia. There may be a history of an encounter with a raccoon, and the clinical signs appear 7-14 days after the exposure to the raccoon.

Polyradiculoneuritis (Coonhound Paralysis)

This is a condition where there is a lack of effective peristalsis that results in the dilation of the esophagus and regurgitation of undigested food. Treatment requires the use of a bailey chair when feeding and feeding a soft diet in small meals.

Megaesophagus

The next patient is here for sudden loss of voice. We are suspecting laryngeal paralysis based on signalment and clinical signs. However, what else should you be thinking about when you go in to perform your physical? What should you do before your PE?

You should suspect rabies anytime there is a voice change. Because of this, you should put on gloves before examining the animal

Degenerative meylopathy is another term used for hip dysplasia. True or false

False

This is when bacteria or fungi affect the bones of the vertebral column. It is seen in both dogs and cats, but it most commonly seen in large and giant breeds. It can be caused by penetrating wounds, paravertebral abscess or infection.

Discospondylitis

This is seen most often in young toy and miniature breed dogs. The trauma to the spinal cord is due to the cranial portion of the axis is displaced into the spinal column.

Atlantoaxial subluxation

Which type of IVDD describes the following: The extrusion occurs over a longer period of time; and it produces less severe and gradual clinical signs.

Type II

When talking about idiopathic epilepsy, which are signs seen in the aura phase?

hiding, vocalize, seeking comfort

Brain tumors are most commonly seen in younger animals, and they have not metastasized by the time of diagnosis. true or false

false

The most common cause of hypocalcemia that is related to the parathyroid gland is accidental removal of the parathyroid during removal of the thyroid. True or false

true

What is the hallmark clinical sign of primary hyperparathyroidism?

hypercalcemia

What test is only good as screening test for Hyperadrenocorticism (Cushing’s)?

Urine cortisol/creatinine ratio

When trying to evaluate a patient for Cushing’s, we run an ACTH stimulation test to confirm the disease, and follow with a high-dose dexamethasone suppression test to determine if the disease is adrenal or pituitary dependent. True or false

true

What do we look at on the serum chemistry when we suspect Addison’s?

Sodium Potassium Ratio

Hypoadrenocorticism (Addison’s disease) is classified as a decrease in glucocorticoids and mineralocorticoids. Hyperadrenocorticism (Cushing’s Disease) is classified as a hyper secretion of cortisol. True or false

True

When diagnosing insulinomas, we can use the demonstration of Whipple's triad to help. What are the components of Whipple'S triad?

• CNS clinical signs of hypoglycemia. or

• Glucose administration relieves CNS signs

• Fasting blood glucose less than or equal to 40 mg/100ml

What can owners do to by time en-route to the clinic with an animal in insulin shock?

Rub Karo syrup or oral glucose paste on their gums

A patient in ketoacidosis will have all the classic signs of diabetes; however they will physically ill as well . True or false.

True

What are the classic signs of diabetes mellitus?

Polyuria, polydipsia, polyphagia

Most all dogs with diabetes have _____________.

Type I

Most all cats with diabetes will have ___________.

Type II

Hypothyroidism is found more often in the dog, and hyperthyroidism is found more often in the cat. True or false.

True

What type of insulin will a sick diabetic animal that is not eating and is in the hospital?

Short acting (regular, crystalline)

What type of insulin will a healthy diabetic need?

Intermediate acting (lente, nph)

Levothyroxine is used to treat what?

Hypothyroidism

I-131 is used to treat what?

Hyperthyroidism

Lysodren (mitotane) is used to treat what?

Hyperadrenocorticis

What is idiopathic vestibular disease?

·        Acute disorder that affects dogs and cats

·        Loss of balance, nystagmus, disorientation, ataxia, vomiting, anorexia

·        Happens out of the blue (won’t see any trauma)

When is idiopathic vestibular disease seen?

·        Seen most often in the late spring, summer and early fall

How do we treat idiopathic vestibular disease?

• Supportive care and force-feeding if needed

• Treatment is usually not recommended

  • It does not seem to change the course of disease

• Clinical signs usually resolve within 3-6 weeks and the animals will stabilize rapidly

What is idiopathic epilepsy?

·        This is a syndrome that is characterized by repeated episodes of seizures

·        There is no apparent cause for the seizure

When does idiopathic epilepsy begin?

·        The seizures usually begins around 1-3 years of age

How long do the seizures associated with idiopathic epilepsy last?

1-2 minutes

What changes could the owner notice before and immediately after the seizure?

·        After the seizure is over, the animal is disoriented and is occasionally blind

·        Seizures consist of three parts (will be asked on the test; will need to explain each phase):

·        1) The pre-ictal phase (aura) is a period of altered behavior in which the dog may hide, appear nervous, or seek out his owner. He may be restless, nervous, whining, shaking, or salivating. This may last a few seconds to a few hours.

·        2) The ictal phase is the actual seizure itself. This lasts from a few seconds to about five minutes. During this period, all of the muscles of the body contract strongly. The dog usually falls on his side and seems paralyzed while shaking. His head will be drawn backward. Urination, defecation, and salivation often occur. If it is not over within five minutes, the dog is said to be in ‘status epilepticus’ (medical emergency) or prolonged seizure. Don’t put anything in their mouth because they could clamp down and injure you because their muscles are contracting.

3) During the post-ictal phase, there is confusion, disorientation, salivation, pacing, restlessness, and/or temporary blindness. There is no direct correlation between the severity of the seizure and the duration of the post-ictal phase

Explain the pre-ictal phase of seizures (YOU WILL HAVE TO EXPLAIN THIS ON TEST)

The pre-ictal phase (aura) is a period of altered behavior in which the dog may hide, appear nervous, or seek out his owner. He may be restless, nervous, whining, shaking, or salivating. This may last a few seconds to a few hours.

Explain the ictal phase of seizures (YOU WILL HAVE TO EXPLAIN THIS ON TEST)

The ictal phase is the actual seizure itself. This lasts from a few seconds to about five minutes. During this period, all of the muscles of the body contract strongly. The dog usually falls on his side and seems paralyzed while shaking. His head will be drawn backward. Urination, defecation, and salivation often occur. If it is not over within five minutes, the dog is said to be in ‘status epilepticus’ (medical emergency) or prolonged seizure. Don’t put anything in their mouth because they could clamp down and injure you because their muscles are contracting.

Explain the post-ictal phase of seizures (YOU WILL HAVE TO EXPLAIN THIS ON TEST)

During the post-ictal phase, there is confusion, disorientation, salivation, pacing, restlessness, and/or temporary blindness. There is no direct correlation between the severity of the seizure and the duration of the post-ictal phase.

When do we start treatment for seizures?

·        If there is a primary disease found, it should be treated

·        If there is seizure activity more than once a month, treatment should be started

·        Phenobarbital  (2-3 times a day)

·        bloodwork is needed to rule out hypocalcemia, hypoglycemia, infection, hepatic encephalopathy (a worsening of brain function that occurs when the liver is no longer able to remove toxic substances in the blood), lead posioning

·        *radiographs are needed to rule out trauma to the head and hydrocephalus(Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain. )

·        *CT/MRI to rule out space occupying mass in the brain

·        *phenobarbital will take 7-10 days to reach therapeutic levels in the body, if the animal continues to have seizures after this time period, the concentration of the medication needs to be measured 2 hours before and after the medication is given

o   if the level is less than 20 micrograms/ml then the dose needs to be increased slowly until the concentration reaches 20-30

What is status epileptics?

·        This is seen in animals that are prone to have seizures

·        This is a medical emergency

·        Continual seizures over a prolonged period (greater than 5 min) can lead to an irreversible coma and death*

·        Owners with animals who experience seizures should be told about this condition and told to seek emergency assistance if this condition develops

·        *greater than 5-10 minutes and if they are not treated aggressively the animal can die

What are the components of immediate treatment for status epileptics?

·        Diazepam*, pentobarbital ( works faster), establish airway and start oxygen, place IV catheter and start fluids, blood work to check glucose, calcium, and other metabolic causes (correct if needed), monitor body temp (greater than 105 Fà cool bath), mannitol and prednisolone sodium succinate can be given if cerebral edema is suspected

What drug is used for maintenance of epilepsy?

Phenobarbital

o   Epilepsy is an incurable disease

o   Even with treatment, the animal can have seizures, and the goal of treatment is to decrease the frequency of and severity of the seizures

o   Spaying and castrating animals will help prevent hormonal influences of the seizure activity

o   Medication will be needed for the life of the animal and missing doses or stopping medications can cause a seizure

o   Most animals can live a fairly normal life as long as they are managed properly

o   Periodic monitoring of the serum anticonvulsant concentration is required

o   Animals that remain seizure free for 6 to 9 months may be able to have their medication slowly decreased

What drug is used for emergency treatment of seizures?

Diazepam

What are the two types of IVDD?

·        Type I: acute rupture of the annulus fibrosus and extrusion of the nucleus pulposus into the spinal canal (this is common in younger dogs)

·        Type II: the extrusion occurs over a longer period of time, and produces less severe and gradual clinical signs

Which of the 2 is more common to see in younger dogs?

Type I

The severity of the injury caused by disk herniation depends on what?

·        The severity of the injury will depend on the speed that the disk material herniates, the degree of compression, and the duration

·        Clinical signs will depend on the location of the lesion

Spinal cord trauma has a very sudden onset, and it is related to… what???

·        Its onset is very sudden and is related to the velocity of the compression of the cord, degree of compression, and duration of the compressive force

Paresis VS Paralysis

Paresis: weakness (haven’t lost function just weak)

Paralysis: complete loss of function

What is Schiff-Sherrington?

·        *Schiff-Sherrington: this is when the animal displays rigid hypertonicity of the front legs and hypotonicity of the rear legs due to spinal cord trauma, has normal reflexes, and has pain perception usually L1-L7 if where the lesion would be

·        The absence of deep pain for more than 24 hours has a poor prognosis, and the worsening of clinical signs is also an indicator of poor prognosis

what is a panniculus reflex?

·        The cutaneous trunci reflex (also known incorrectly as the “panniculus reflex”) is a shrugging or flinching of the skin over the thorax when it is stimulated by light touch or by pinching. Tap the skin with an extended thumb (in adult horses) or with a hemostat.

What is Wobblers Syndrome?

·        This is a cervical spinal cord compression due to the caudal vertebral malformation or misarticulation occurs in large breed dogs

Who is Wobblers Syndrome seen in?

o   Large breed dogs; Great Dane and Doberman

What ages does Wobblers Syndrome usually affect?

o   The onset of clinical signs usually occurs before 1 year of age in the Great Dane and after 2 years in the Doberman

What is atlantoaxial subluxation?

·        This is seen most often in young toy and miniature breed dogs

·        The trauma to the spinal cord is due to the cranial portion of the axis is displaced into the spinal column

·        This displacement can be caused by a congenital or developmental abnormality, trauma, or combination of the 2

Who is atlantoaxial subluxation seen in?

·        Young toy and miniature breed dogs

When positioning the patient for radiographs for atlantoaxial subluxation, what position do we need them in?

·        *radiographs- lateral view with the neck in slight ventriflexion; anesthesia should be avoided if possible; the decrease in muscle tone may result in further Subluxation and spinal cord damage

What is Discospondylitis?

·        This is when bacteria or fungi affect the bones of the vertebral column

·       It is seen in both the dog and cat, and it is most commonly seen in large and giant breeds

What causes Discospondylitis?

·        The cause is unknown

·        This can be caused by penetrating wounds, paravertebral abscess, infection, surgery on the vertebral column, or migration of grass awns

Conductive deafness is the result of… what?

·        Conductive deafness is the result of chronic otitis, rupture of the tympanic membrane, or damage to the middle ear

What are the causes of Acquired Laryngeal Paralysis?

·        Acquired laryngeal paralysis can occur from lead posioning, rabies, trauma, and inflammatory filtrates to the vagus nerve*

The hereditary form of acquired laryngeal paralysis is seen in dogs of what age?

·        Animals with the hereditary form- 4 to 6 months

The acquired form of acquired laryngeal paralysis is seen in animals of what age?

·        Animals with the acquired form- 1 ½ years to 13 years of age

The animal is at higher risk for what after surgical correction for acquired laryngeal paralysis?

·        Tie back surgery puts them as a higher risk for aspiration pneumonia

What is megaesophagus?

·        With this condition there is a lack of effective peristalsis, which results in the dilation of the esophagus and regurgitation of undigested food

When is the congenital form of megaesophagus noticed?

·        The congenital form is seen at weaning time when the puppies are started on solid food

What are some diseases that are seen with the acquired form of megaesophagus?

·        The acquired form is seen in animals of any age and symptoms can include metabolic neuromuscular disease, distemper, tick paralysis, lead poisoning, polymyositis

After doing a barium study, how long should the patient be held up to prevent aspiration pneumonia?

·        Animals that have a dilated esophagus with barium in it are at risk for aspiration pneumonia, so the animal needs to be held in a vertical position for 5-10 min after the procedure

What does tick paralysis cause in the dog?

·        The female tick produces a neurotoxin

·        The neurotoxin produces a flaccid, afebrile, ascending motor paralysis

o   Starts in the back end and then works toward the front

o   Gradual development of hind limb incoordination that progresses to a flaccid ascending paralysis

What causes the tick paralysis?

·        Female tick produces a neurotoxin

How do we treat tick paralysis?

·        Remove all ticks from the animal

·        Tick product to kill hidden ticks (Ex: frontline)

·        Supportive care

Cervical Spondylomyelopathy vs Atlantoaxial Subluxation

Atlantoaxial Subluxation

• ¨This is seen most often in young toy and miniature-breed dogs

• ¨The trauma to the spinal cord is due to the cranial portion of the axis is displaced into the spinal column

  • This displacement can be caused by a congenital or developmental abnormality, trauma, or combination of the 2

Cervical Spondylomyelopathy

• ¨This is a cervical spinal cord compression due to the caudal vertebral malformation or misarticulation occurs in large breed dogs

• ¨The onset of clinical signs usually occurs before 1 year of age in the Great Dane and after 2 years in the Doberman

• ¨The signs are normally progressive involve hind-limb ataxia

• ¨Propriception will be abnormal

• ¨The neurological exam will be abnormal when the postural reactions, hopping, and proprioception is evaluated

What is Coonhound Paralysis?

·        The disease can affect an animal of any age or breed

·        Usually seen in a dog that has been exposed to a raccoon

·        Thought to have an immunologic pathogenesis

·        Not all cases involve a raccoon bite

when do clinical signs for Coonhound paralysis appear?

·        The clinical signs appear within 7 to 14 days after exposure to the raccoon

o   The weakness begins in the hind limbs with paralysis that progresses rapidly to flaccid, systemic tetraplegia

o   There may be an absence of spinal reflexes, loss of voice, labored breathing, and inability to lift the head

o   Animals may die of respiratory paralysis

How long does the Coonhound paralysis last?

·        The paralysis may last 2-3 months

o   The animals may require long term nursing care

o   Some animals may regain total function, but severely affected animals may not regain function

What animals are most often affected by Facial Nerve Paralysis?

·        Idiopathic, acute facial nerve paralysis has been reported in adult dogs and cats that are 5 years and older

Does complete recovery occur in those affected by facial nerve paralysis?

·        Complete recovery does not usually occur

What condition can develop in the eye of a facial paralysis patient?

·        May experience development of KCS (Keratoconjunctivitis sicca)

What is the difference in hypothyroidism and hyperthyroidism?

• Hypothyroidism

  • Primary acquired hypothyroidism is the most commonly seen in the dog

  • It usually follows atrophy of the thyroid or lymphocytic thyroiditis

  • Thyroid profile for T3 and T4

• Hyperthyroidism

  • This is the most commonly seen endocrine disorder in cats , it is seen rarely in dogs (neoplasia)

  • Overacting thyroid

  • Total T4- increased (total T3 is less accurate)

  • Free T4- more accurately reflects true thyroid secretory status (not to be used alone as a screening test)

  • Treatment:

    • Surgery- removal of the thyroid gland (preserve parathyroid glands during removal)

    • Radioactive iodine-131: treatment of choice; this results in the destruction of the tissue; cats remain hospitalized until their wastes are below hazardous radiation levels

    • Antithyroid drug therapy- Methimazole (tapazole): inhibit the synthesis of thyroid hormone

Clinical signs for hypothyroid patients?

·        Weight gain with no diet change, bilaterally symmetric alopecia, loss of hair on the tail

·        Lethargy, mental dullness, dry hair coat, hyperpigmentation, cold intolerance, recurrent skin infections

Clinical signs for hyperthyroid patients?

·        Weight loss, vomiting, polyphagia, tachycardia, thyroid is palpable (enlarged), aggressive behavior

·        Can see increased BP and blindness w/retinal detachment (can’t reverse blindness)

Who is more commonly affected by hypothyroid?

dog

Who is more commonly affected by hyperthyroid?

cat

What is the treatment for hypothyroidism?

levothyroxine (soloxine, Thyro-tabs; human approved- Levothroid, Synthroid)

o   DON’T SWITCH BETWEEN BRANDS

o   Oral supplementation is required for life

o   Daily dosing is required to maint concentrations

o   Excess medication can induce hyperthyroidism (increased thirst, urination, appetite ; nervousness, excess panting, weakness) if any of these are seen stop med ASAP and call the clinic

o   Routine blood test are required

o   Some drugs can decrease the thyroid hormone concentration- cortisone, aspirin, banamine, furosemide, phenobarbital

What is the preferred treatment of hyperthyroidism?

• Surgery- removal of the thyroid gland (preserve parathyroid glands during removal)

• Radioactive iodine-131: treatment of choice; this results in the destruction of the tissue; cats remain hospitalized until their wastes are below hazardous radiation levels

• Antithyroid drug therapy- Methimazole (tapazole): inhibit the synthesis of thyroid hormone

  • Surgery or radioactive iodine is the only cure hyperthyroid disease

  • The cause is unknown

  • Medical management produced side effects in many cats

  • Treatment to decrease thyroid hormone  [] may unmask concurrent diseases like renal failure

  • Concurrent diseases may need to be corrected before surgery

  • Bilateral removal of the thyroid glands may result in hypothyroidism

  • All animals with hyper should have their BP checked routinely if tapazole does not reduce the BP, then other hypertensive agents need to be added

What is diabetes insipidus?

• Very rare

  • Part of the job of the kidneys is to continually filter the blood that passes through them and to maintain the balance of the body's water by excreting or reabsorbing fluid as required.

  • Efficient re-absorption of fluids requires an adequate level of a hormone known as antidiuretic hormone (ADH) or vasopressin which is produced by the posterior lobe of the pituitary gland in the brain. If this hormone is not produced in sufficient quantities or if the kidney fails to respond to it, diabetes insipidus can occur.

• 2 forms:

  • Central – brain origin

    • Central and primary nephrogenic cases are rare

  • Nephrogenic – renal origin

    • Most of these cases are secondary to other diseases

Diabetes insipidus should be considered in patients with consistently low urine specific gravity of….?

·        At the end of the test, urine specific gravity is >1.025 in those animals with only a partial ADH deficiency or with antagonism to ADH action caused by hypercortisolism. There is little change in specific gravity in those animals with a complete lack of ADH activity, whether due to a primary loss of ADH or to unresponsiveness of the kidneys.

What test helps with diagnosis of diabetes insipidus?

·         water deprivation test should be done if the animal is not dehydrated and does not have renal disease. The bladder is emptied, and water and food are withheld (usually 3–8 hr) to provide a maximum stimulus for ADH secretion. The animal should be monitored carefully to prevent a loss of >5% body wt and severe dehydration

·        The patient will have consistently low urine specific gravity (hyposthenuria - <1.008)

o   If there is any evidence of kidney disease, we can’t do this

What is the name of the drug that can be used to manage some animals with central diabetes insipidus?

·        Some animals with central diabetes insipidus can be managed with desmopressin acetate (a synthetic vasopressin/ADH)

·        It is available in oral, intranasal, or ophthalmic drops

·        Other treatments needed will depend on underlying disease

What is diabetes mellitus?

·        The pancreas helps in regulating the concentration of glucose in circulation

•  The ß cells produce insulin which drives the glucose into the cells for glycolysis to occur

·        DM results when these ß cells stop producing insulin in adequate amounts or when the cells in the body become resistant to the insulin

CAT/DOG most commonly gets Type I and  CAT/DOG most commonly gets Type II

Most all dogs will have will have insulin-dependent diabetes (type I)

50% of cats will have non-insulin-dependent diabetes (type II)- does not require insulin therapy

• Can manage with weight loss and diet

What is Ketoacidosis?

·         PU/PD/PP (classic)(KNOW THESE THREE); weight loss, sudden cataract formation, dehydration, plantigrade posture in cats*

·        All of the above in a addition to : Depression, weakness, tachypnea, vomiting, odor of acetone on the breath

o   When they come in, they are sick

What are the classic signs of diabetes?

PU/PD/PP (classic)(KNOW THESE THREE); weight loss, sudden cataract formation, dehydration, plantigrade posture in cats*

Who is insulin shock seen in?

·        Seen in animals who have fluctuations in their diet, are allowed to exercise excessively, or have been given too much insulin

How do we prevent Insulin shock?

Feed the animal 1/3 of its total daily diet with insulin administration, maintain consistent feeding and medication schedule, avoid excessive exercise

o   Clinical Signs

• Weakness, restlessness, incoordination, seizures, coma