VETS3009 EOS Exam

URINARY - Lower Urinary Tract Diseases

Upper Urinary Tract

kidneys, ureters

Lower Urinary Tract

bladder, urethra

Lower UT d symptoms

• dysuria: ABNORM pee

• stranguria: STRAIN

• pollakiuria: INCREASED FREQUENCY

• haematuria: BLOOD

• change in stream/flow

• incomplete bladder emptying

• overflow incontinence (too full - leak - LARGE BLADDER)

• inappropriate urination

• urinary incontinence (constant leak - SMALL BLADDER)

Cystitis

inflamed bladder (usually associated with infection)

(dysuria, stranguria, pollakiuria, malodorous urine (SMELL))

UTI

especially female dogs - shorter urethra (closer to anus)

males - longer urethra - no narrowing for bacteria to travel (from perianal region - e.coli, staph)

old cats over 10 and poor renal function

HOST DEFENCE: norm pee (flush out), anatomy (sphincter close), mucosal barrier, urine antimicrobial properties, IS

PREDISPOSE: diabetes mellitus, hyperadrenocortism, CKD, hyperthyroidism, immunosupress/chemo - pred

—> dilute urine, PUPD - bacteria prolif (immunosup)

INF ROUTES: ASCENDING, urinary catheters (want closed system, measure urine production and ensure running at all times)

DIAG:

• URINALYSIS (cystocentesis, urinary catheter - males, free catch = bac)

• URINE CULTURE (ID bac and susceptibility testing)

• BLOODS (lower UT d, should be normal, abnormal = also upper ut d.)

TX:

Uncomplicated: 7-14d empirical antibiotherapy - first line ab

Complicated: (immunocomp, kidney inf, (pyelonephritis), urolithiasis, prostatisits) 4-6wks and culture 1wk after stop

Cranberries - (avoid bac touch mucosa)

UT Stones and Symptoms

uroliths

Nephroliths - kidney stones, cystoliths - bladder, urethroliths - urethral, utereroliths - uteral

SIGNS: stranguria (OBSTRUCT = DIE), pollakiuria, haematuria (abrasive), concurrent UTI

MALE DALMATIONS PREDISPOSED

UT Stones Diag and Types

Diag: abdomen and pelvic x-rays, abdomen u/s, urinalysis (many crystals), stones analysis once removed

Types: Struvite, Calcium Oxalate, Urates

Struvite

INF based, DIET AND AB = DISSOLVE, COFFIN LID CRYSTALS, ALKALINE PH

mg ammonium phosphate, on x-ray, smooth-large, EVERY dogs and cat

(rectangle crystal, large and small smooth balls)

Calcium Oxalate

NOT INF, NOT DIET DISSOLVE, PICKET FENCE CYRSTALS ACID-NEUTRAL ph, BREEDS: yoki, schnauzer, pom, shih tzu, maltese

on x-rays,

(square crystal, lumpy balls)

Urates

SOMETIMES INF, SOME DIET AND MEDS DISSOLVE, THORN APPLE CRYSTALS, ACID URINE

with: liver dysfunction, BREEDS: Dalmatian, bulldogs

not on x-rays,

(spikey crystals, weird shapes)

Stone Tx

• Surgery

• Meds - dietary dissolution (struvite and urate) Hills S/D or U/D

• Removal - SEND STONES FOR ANALYSIS

Urethral stone: retrograde urohydropropulsion - push stone back into bladder

Bladder stone: cystotomy, VUHP (voiding unhydropropulsion), Lithotripsy (laser)

Stone Prevention

long-term manage (unless infection based)

monitor urine: pH, conc, infect

x-ray and u/s

increase water = dilute urine (WATER FOUNTAIN, WET FOOD (add water), FLAVOURED STOCK

Acute Obstruction

stabilise, bloods, fluids, pain relief, cystocentesis, catheterise (flush stone back into bladder then SURGERY), reoccur = urethrostomy

can’t excrete toxins = HIGH BUN AND CREATININE

HIGH POTASSIUM (over 6.5 = bradycardia (no p vales))

Urinary Incontinence

Overflow incontinence = LARGE BLADDER

* detruser atony

True incontinence = SMALL BLADDER

*urethral sphincter mechanism incontinence - sphincter at bladder neck cannot close

spayed dogs (20%), large breeds, 3yrs old, med or sx (last resort, colposuspension, hydraulic occluder - artificial sphincter)

Phenylpropanolamine (PPA)

sympathomimetic, a2 agonist (Propazine) BID or TID (safer, work better)

stim urethral sphincter

(-) excite, increased hr and bp

spay = decrease oestrogen - harder for sphincter to stay tight

replaces oestrogen

Oestrogen

economical

(-) BM suppress

Detrusor Atony

STRETCHED BLADDER - WON’T/CAN’T URINATE (FLUTD or recumbent)

LARGE bladder, incomplete empty, poor urine stream

TX: empty bladder - urinary catheter (2-3d to repair), meds, palpate bladder - should be small after urination

FLUTD

Obstructive: stones

Non-Obstructive: FLUTD, interstitial cystitis (stress)

SIGNS: stranguria (vocalise, posture), inapprop urination, blood in urine, obstruction = VERY UNWELL = VERY BIG BLADDER (hypothermic, bradycardic, lateral recumbency

FLUTD - Obstructed

stabilise

Fluids - NaCl - NO POSTASSIUM!

catheter and Ecollar - flush with warm sterile saline

FLUTD - Non Obstructed

SMALL Bladder

resolve on on - interstitial or bac cystitis

1. urinalysis, increase water intake, change diet - hilld CD, mod behav and enviro (less stress), analgesia

2. no resolve = urinalysis, abdom x-ray, tx

3. abdom u/s, contrast imagine, perineal urethrostomy

UPPER URINARY TRACT DISEASES

kidneys and ureters

Kidney Role

excrete toxins, molecules: H, K+, NH4+, hormones, meds (abs, anti-seizure, anaesthetic, anti-nausea)

water balance and acid/base balance

electrolyte and bp maintenance (RASS - water/sodium excretion/retain - affecting cardiac output, angiotensin II = vasoconstriction = peripheral resistance) (Bp = CO x PR)

INCREASE BP = INCREASE EXCRETION OF NA AND WATER

hormone synthesis (erythropoetin (EPO) (if renal o2 low, stim BM produce more RBCs - increased 02 carrying capacity)

3 steps in urine formation

1. glomerular filtration - in bowmans capsule

2. tubular reabsorption - in renal tubule

3. water conservation - in collecting duct

Kidney Disease

SYMPTOMS: early d = none THEN PUPD, poor appetite, decrease bw, vom, lethargy

EXAM: norm, small (chronic) or large (acute) kidneys - painful, dehydrated, poor BCS, uraemic breath and oral ulcers (toxic waste not elim)

DIAG:

Biochem

• BUN - Blood Urea Nitrogen (INCREASES - also with dehydration) - fluids first

• CREATININE - from muscles (INCREASED) - renal doesnt excrete (high in muscled male)

• ELECTROLYTES

Urinalysis - USG urine conc ESSENTIAL, urine protein high if UTI, pH, Sediment exam - crystals, diag UTI, cells - cancers

Isosthenuria 1.008 - 1.013 *SUSPICIOUS OF KIDNEY D

Hyposthenuria <1.008 (dilute - not kidney d)

Hypersthenuria > 1.013 (minimal conc. ?)

Dehydrated >1.047 (very concentrated)

Norm: 1.035 cats, 1.025 dogs

CHECK USG BEFORE FLUIDS

Imaging

SUMMARY: elevated BUN and Creatine, isothenuric urine, proteinuria, abnorm kidneys, consistent clinical signs

Azotemia

Elevated BUN and Creatinine BIOCHEM

Pre-Renal: DEHYDRATED/SHOCK - no kidney blood supply, low bp, NSAID?ACE use (high pcv/tp, high USG (>1.045)

Renal: infection, nefrotoxin, immune d/cancer (norm pcv/tp, USG: 1.008-1.013)

Post-Renal: OBSTRUCTION/RUPTURE (norm pcv/tp, USG: >1.025)

Uremia

Elevated BUN and Creatinine CLINICAL SIGNS - vom, lethargic, anorexic

Normal Urine Output

1-2 mls/kg/hr

anuria = none

oliguria <1ml/kg/hr (less production)

polyuria >2mls/kg/hr (more production)

Kidney Disease Types

kidney stones

pyelenophritis (kidney inf)

glomerulonephritis (protein loss)

renal neoplasia (cancer)

congenital kidney d (renal dysplasia)

AKI - acute kidney injury

SUDDEN, good BCS, no anaemic, norm to large kidneys

sudden dam, rapid kidney decline, REVERSIBE?, fatal if no tx. (accum toxins, no reg of fluids, acid/base/electrolytes)

appetite loss, vom, PD, decreased UO

• Prerenal (dehydration), Renal (neoplasia, inf), Postrenal (obstruction)

CAUSES: toxins (ethylene glycol, lilies, grapes/rasins - dogs), meds (genatmicin, ACE inhib, contrast agents), Inf (lepto, pyelonephritis)

TX: iv fluid to excrete waste (not too much urine - nasal d/c, inc RR, weight inc), want UO >1ml/kg/hr, monitor bw and central venous pressure (CVP), FRUSEMIDE, MANNITOL

MONITOR: intense, bw × 2 daily, bloods and electrolytes daily, urinary catheter, OVERHYDRATION RISK

OUTCOME: 50-60% die

CKD - chronic kidney disease

PUPD, progressive weight loss, poor BCS, anaemia, small irregular kidneys

CAUSES: PERMANENT RENAL DECLINE, >3m, remaining nephrons compensate

EFFECTS: PUPD, anorexia, nausea, weight loss, halitosis (bad breath), stomatitis, intestinal ulcers, altered behav, m. wasting, m. tremors

DIAG: 50% loss of renal function → USG decreases

66% loss renal function —> urine isothenuric

75% loss renal function —> azotaemia (high BUN and CREATINE)

Iris staging (1-4 (bad)) - bp >180mmHg = high risk, 130mmhg = low risk, 150, 160, proteinuria >0.5

TX: manage signs, hydrate, decrease toxin prod

• DIET: phosphate restriction, omega 3 and antioxidants (decrease inflamm), protein restriction (decrease uremic episodes) 70% red - START AT IRIS STAGE 2, PROTEINURIA

• MEDS: Phosphate binders (decrease P) , H2 blockers (famotidine), anti-nausea (maropitant), ace inhib (for proteinuria), anti-hypertensive (amlodipin) want 120-169mmHG, EPO - darbopoetin fluids, SC fluids (750-150mls - 24-72hrs)

Cat Prognosis

IRIS 2 - 3 years

IRIS 3 - 2 years

IRIS 4 - 1 month

CLINICAL PATHOLOGY

Plasma

everything including clot

Serum

everything except clot (no coagulation proteins - fibrinogen) (from clotted blood) IRREVERSIBLE

Microhematocrit

3 layers

1. serum/plasma

2. buffy coat

3. packed rbcs

yellow = jaundice and increased bilirubin

red = haemolytic anaemia (RBC breakdown)

Haematology

anticoagulated whole blood

EDTA: Purple top - good morphology, Ca IRREVERSIBLY bound

Citrate: blue top - REVERSIBLE coag (snake blood clot test)

Heparin: green top - NATURAL anticoag non-mammals (less RBC breakdown)

Biochemistry

serum - protein electrophoresis, ALP, lipase

plasma - EDTA (no ca, potassium - binds and gives inaccurate results), heparin- lithium and sodium innaccurate

Endocrinology

serum, rarely plasma

Culture and Sensitivity

NO EDTA (bacteriostatic - no bacteria grow in tube)

sterile container

Sample Labelling and info

• patient name/identifier

• date

• time

• sample type

signalment (species, breed, age, sex), fasting status, venipuncture site, time of sampling, repro status, current therapy.

Quality Advances for Reference Lab

quality management system

dedicated staff (trained)

more expensive instruments - faster, larger volumes, better performance

Factors Influencing Lab Results

Biological: inter and intra individual

Analytical: pre-instrumental, instrumental, post-instrumental

Inter-individual factors

SPECIES VARY

species (pcv, reference interval)

age (young = higher ALP - bone remodel)

sex (repro female)

birds (ca from egg or cancer)

breed (akitas low MCV - mean corupuscular vol (small blood cells)

Intra-individual factors

SAME VARY IN INDIVIDUAL

time of day, stress/excite, fasting, drugs, repro status, sampling site

Pre-Instrumental Factors

LARGEST SOURCE OF ERROR

Sample qual (haemolysis (ammonia, GGT, AST), icterus, lipaemia (electrolytes, bicarb)

small sample size (inaccurate anticoag ratio)

Storage conditions and time (blood smears at time of collect, longer 24hrs)

Transport conditions

Instrumental Factors

EQUIP RELATED - NOT VERY COMMON

Personnel, method, lab factors (small error)

Post Instrumental

Transfer of info to client - interpret accurate results

Archiving of result - for record keeping

Storing Specimen - for repeat testing

Reference Intervals

healthy: in middle 95%

limitations: not sensitive enough, pre-analytical issues, lab and method specific

units: SI or conventional

2.5$ percentile and upper 97.5%

GI MEDICINE

Ptyalism

increased saliva - can’t swallow or over production

Origin: oral cavity, salivary glands (inflam = overproduce), oesophagus (blockage - pain), GI tract (blockage), neuro, metab, inf, immune-med d, drug rxn, (PSS cats - toxins bypass liver = neuro issues and salivate)

Signs: drooling (if purulent or blood = local d in oral cavity)

Hx: toxins, meds, GI signs, Urinary signs - blocked = abdominal pain = organ pain = drool

Diag: Mouth —> inspect oral cavity (sedation or GA), Foreign body —> thoracic radiographs (oesophagus foreign body, gas/fluid filled, pyothorax), Organ d. —> CBC, Biochem, Urinalysis (liver d, sepsis)

Dysphagia

Diff or painful swallowing (obstruction, motility disorder, pain)

3 Swallowing Phases: (b and c - regurg) - abnormalities = dysphagia

a) Oropharyngeal

b) Oesophageal - oesophagus move

c) Gastroesophageal - bolus to stomach

Regurg

PASSIVE, NO PRODROMAL, EAT or slight after

cricopharyngeal, oesophageal or gastroesophageal d. OESOPHAGUS OR PHARYNX D.

thick mucous

REGURG D

MOTILITY: Megaoesophagus, congenital, acquired

OBSTRUCTIVE: foreign body, stricture (common after foreign body removal), vascular ring anomaly (vessels dont dissapear when they mature properly), neoplasia

INFLAMM LESIONS: gastroesophageal reflux, esophagitis

Other: hiatal hernia, gastroesoph intusseption

Megaoesophagus

dilation of oesophagus due to lack of peristaltic activity

Causes: congenital (mini schnauzers, fox terriers - after weaning 10wks

acquired (idiopathic - can’t ID caue, some secondary megaesophagus (cause found) - neuromuscular disease - tick paralysis, lead toxicity

Diag: preliminary work-up (thorax radiographs - eval for secondary aspiration pneumonia (cloudy in cranioventral lung), rule out foreign body/obstruction IF NONE secondary tests

Tx: if d found - treat - reverse megaoesophagus otherwise manage - nutrition (feeding tube, high cal diet, small meals, little dogs upwright for 10mins post feed, larger dog bailey chair), some like liquids some like meatballs

NO MEDS

Oesophagitis

inflamm of the oesophageal lining

Causes: reflux oesophagitis (like acid) - MOST COMMON (following long GA), vom, forgiegn bodies, irritating/caustic substances (toxins)

SEVERE AND ONGOING => STRICTURE FORM

Signs: regurg, discomfort whilst swallowing, anorexia from pain, salivation

Diagnosis: hx (worming, foreign body, anaesthesia), radiographs/endoscope to rule out stricture/foreign body and examine severity

Tx: NO oesophageal rest (DON’T FAST!), gastric feeding tube, ANALGESIA, atacids, site protectants (sucralfate), metacloprimide/cisapride (increase sphincter tone), antimicrobials

Vomiting

active, prodromal (unsettled, lick lips, won’t eat, nausea, retch, abdominal contractions), bile-staining (yellow) - Receptors in pharynx, heart and abdominal viscera - CTZ trigger zone - vestibular apparatus, CNS

Causes

• Extra- GI: organs (liver, pancreas, kidney brain, CTZ - drugs, toxins) RULE OUT FIRST

• GI: Diet (sudden diet change, foreign material ingestion, food intolerance/allergy) Stomach disorders (obstruction, chronic gastritis - inflamm, parasites, gastric ulcers, gastric neoplasia, gastric dilation)

IF NOT IN STOMACH

• SI: parasites, enteritis (inflamm), obstruction, IBD, neoplasia

• LI: colitis (inflamm), obstipation-sever constipation (cats)

Diag: confirm not regurg - fresh blood (bleeding/ulcers), yellow/green (bile from duodenum), 12hrs after meal, projectile vomit (gastric outflow obstruction), prayer posture (pain: ulcers, pancreatitis, foreign body)

Acute Vomiting

Causes: diet, viral or bac inf, parasites

RARELY GET DEFINITIVE DIAG

Spontaneous resolution: FLUIDS, ANTI-EMETICS, Para tx (fenbenazole, milbemycin, febantel, BLAND DIET

Diag: phys exam, ALL NEED ABDOMEN RADIOGRAPHS!!!!!! discontinue contributing drugs, parvovirus antigen (faeces) - young/unvacc, faecal float (maybe giardia ELISA)

VERY UNWELL: blood and urine tests, abdom ultrasound, pancreatic lipase immunoreactivity

Chronic Vom

no response to tx in 2-3 wks

Causes: inflamm d (IBD/gastritis, para, diet intolerance/allergy), chronic pancreatitis, chronic partial obstruction, feline hyperthyroidism, CKD, Hyperadrenocorticism (addisons d dogs), liver d, GI neoplasia

Diag: hx and physical exam, status (other problems), discontinue drugs, rule out para (faecal float, faecal smear/ELISA - giardia - EVEN IF NO PARA DEWORM - FENBENDAZOLE 50MG/KG SID PO 3-5 DAYS) REGARDLESS OF THE RESULT, rule out extra GI (blood and urine tests, pancreatitis blood test, abdom u/s (UPPER GI BARIUM CONTRAST, endoscopy and GI biopsies, exlap and biopsies), abdom x-ray, diet trial (HYDROLYSED/NOVEL PROTEIN - croc/venison 4-6wks)

Diarrhoea

faeces with excess water (increase liquid and weight), SI vs LI

osmotic, secretory, exudative, abnorm motility

SI Diarrhoea

• LARGE vol

• WEIGHTLOSS ±

• VOMIT maybe

• watery, normal frequency, no mucus/fresh blood

LI Diarrhoea

SMALL vol

HIGH FREQ

MUCUS/BLOOD -+

no weight loss or vom

Acute Diarrhoea

Causes: diet, viral or bac inf, para

RARE DIAG (fluids if dehydrated, anti-emetics if vom or anorexia, para tx, bland diet (boiled chicken and rice, hills I/D low fat)

Diag: exam, faecal float - giardia elisa, faecal smear - giardia, campylobacter, parvovirus antigen

VERY UNWELL: bloods, faecal culture, abdom u/s

Chronic Diarrhoea - SI

no response to tx in 2-3wks

SI:

• Maldigestion (lack of digestive enzymes - from pancreatic failure)

• Malabsorption (food intolerance/allergy, IBD, neoplasia)

• Functional disorders

Diag: hx and phys exam, SI vs LI, patient status (low albumin +- globulin, dehydrated, severe weight loss/cachexia

Deworm (fenbendazole), blood and urine tests, abdom u/s, specialised blood tests, diet trial, antimicrobial trials (Ab responsive diarrhoea -ARD), upper/lower GI endoscopy and biopsies, exlap and biopsies)

Diseases Causing Vom and Diarrhoea

Acute Gastritis/Gastroenteritis

TX: diet restriction (fast 6-12hrs, water/fluids)

6-12hrs later - food trial (low-fat, easy digest, hypoallergenic) - feed small amount 3-6times/day - return to normal diet over 2-3 days

Commercial: Hills I/D, R/C GI diet, Homemade: lean chicken and rice

ANALGESIA, ANTIEMETICS< AB (ONLY IF EVIDENCE OF MUSOCAL DAM) (concurrent diarrhoea with blood in faeces, febrile, high WBC - 5-7d, - otherwise disrupt flora, res)

Acute Pancreatitis (Dogs)

middle-aged, obese, sedentary, female dogs, most idiopathic (trats, high fat-diet)

Signs: lethargy, anorexia, vom, dia, jaundice, ab pain, pyrexia

Diag: bloods (leucocytosis (neutrophilia and left shift), high blood glucose, lipid, calcium, increased liver enzymes and jaundice (bile obstruction)

Spec lab tests (amylase and lipase - unreliable, pancreatic lipase immunoreactivity - more accurate)

Imaging - radiology LIMITED, u/s BEST - pancreatic enlargement, changes in echodensity, hyperechoic abdom fat)

Tx: traditionally -rest pancreas to reduce inflamm, NOW NUTRITION ASAP when vom subsides - feeding tubes, freuqnt small meals high in carbs, low in fat (dogs) - long term low fat food, IV FLUIDS, PAIN RELIEF, ANTIEMETIC

Prognosis: guarded, severe die with aggressive treatment, reoccurance common

Feline Pancreatitis

CHRONIC: More common - Liver/GI inflamm (anorexia, lethargy, fever/hypothermia, weight loss

NO VOM/ABDOM PAIN

ACUTE: shock signs, SEVERE - necrosis

LI Diarrhoea

Colitis and Proctitis

Phys exam normal

Causes: inf (whipworm, hookworm, giardia, tritichomonas, cryptosporidium

traumatic (foreign, cat hair), allergic (diet protein, bac), inflamm/immune

Tx: fast patients if acute (12-24hrs), hypoallergenic or novel protein in dogs with histopathologic inflamm, fibre supplement (poorly fermentable fibre - bran = increase bulk and improve contract), fermentable fibre (psyllium - short chain fa - healing and flora)

Constipation

• infrequent, incomplete or difficult defecation with passage or hard or dry faeces (hard/dry)

OUT

Common, cats mainly

Strain - small or no faeces, small amount of liquid or mucoid or blood, occasional vom, inappetence or depress

Exam: hard filled colon with faeces

Rectal Exam: mass, stricture, perineal hernia, anal sac d, foreign body or material, prostatic enlargement, narrowed pelvic canal

Causes: diet (bones, hair, excess fibre), enviro (lack of exercise, dirty litterbox, inability to walk), drugs (opioids = slow gut motility - dehydrated in colon, diuretics - dehydrated = dry poo), painful defecation (anorectal d), mechanical obstruction (extraluminal - healed pelvic fracture -narrow canal or prostatic enlargement - push on canal, intraluminal and intramural (colon/rectum) - colonic or rectal neoplasia, rectal stricture), neuromuscular disease (less motility), metabolic and endocrine d (debility - general m weak, Dehydration - CKD in cats and neoplasia, hypothyroidism - congenital in kittens)

Diag: hx, phys exam - rectal, neuro exam (neuromuscular d), CBC, biochem, UA), abdom x-ray (colonic/rectal foreign body/ass, prpstate enlarge, fractured pelvis), colonoscopy (mass, stricture)

Tx: microlax enema (ONLY IF MILD), warm water/saline enema with lube, ENSURE POOP!

Obstipation

• intractable constipation caused by prolonged retention of hard, dry faeces (Huge faeces in colon - compact - very dry as water reabsorb)

NOTHING OUT

Tx: iv fluids, manual remove of faeces under GA - FOR EVERYONE (aspiration risk high), ab (bacteriaemoa), initial enema (water/lube) to begin faecal softening - through feeding tube, transabdomen massage or instruments, anal instrument removal, x-rays to see if successful

DERMATOLOGY

1. Thorough Hx

anti-para meds, on any meds, O concerned?, how long? anything similar before? stopping them from eating/sleeping? certain times of year? any skin lesions (ringworm), breed (staffys, basset hound ears)

2. Distant Exam

skin lesions, where, itch signs/staining from saliva and contsant licking

3. Skin Exam

where: head to tail

Look like: red, hairloss, hives, d/c, elephant skin = thickened - chronic,

DESCRIBE:

• location and distribution - dorsal left paw

• number of lesions - multifocal

• size - calipers

single mass, dorsal aspect or R metacarpus, round and domed, size wide vs raised, alopecic, pink, non-pain on palpate, firm

4. Samples

• sticky tape impression smear (scale, crusting, erythema) - on slide, then 1 small drop purple diff quick - 3 nd look under microscope - bac/yeast inf

• Cotton Tips - MOIST skin d, any d/c (ears, hotspots - most dermatitis) (roll onto d/c then on slide, hairdryer to heat fix - diff quick stain - hairdryer to dry then look under microscope - inf, bac, yeast, wbcs, unstained = ear mites)

• Microscopsy (cytology) - malazzezia (yeast), rod (e.coli)

• Wood’s Lamp (ringworm) - fungal, zoonotic, touch spread (esp cuts), kittens —> hairloss, 50% of lesions glow, itchy

• FNA

• Histopathology (from biopsy)

INCISIONAL: section (challenging location and avoid seeding tumour)

EXCISIONAL: entire lump removal

Skin Scrape

5. Talk to O about tx plan

client compliance, clear plan and can do tx, easy for o (us give if possible), instruct how to avoid reinfestation

6. Follow-up/Revisit

• working and O comply, before meds finish, repeat 1-5 at each revisit, no improvement = specialist

Skin Lesion Types

Pruritus

itching

biting, chew, lick, scratch, rubbing skin

30-40% r derm consults

Alopecia

• absence of hair where normally present

• self induced from pruritis or hair follicle issue (demodex mites)

Wheals

• Hives or urticaria

• circumscribed, oedematous and raised lesions on skin surface

• ALMOST ALWAYS ALLERGEN EXPOSURE

• (allergy bumps testing)

Pigmentary Changes

• disruption of melanin pigment in skin

• hypopigmentation = reduced pigmentation

• hyperpigmentation = increased pigmentation (signs of chronic disease)

Rashes

• redness (erythema), and pimples (papules)

• indication of localised inflamm - inflamm cells accum in papules

Scaling and Crusting

Scale: superficial accum of loose skin cells (corneocytes) on the surface of epidermis LOOSE SKIN/DANDRUFF

Crust: accum of these dried cells along with exudate (serum, blood, pus) on the skin surface. + EXUDATE

Erosion and Ulceration

Erosion: partial loss of epidermis with the basement membrane left INTACT, SUPERFICIAL/SUBTLE LESION

Ulceration: loss of epidermis, DERMIS EXPOSURE, DEEP LESION, (can be caused by itching)

Change in Skin Thickness

Lichenification: thickening of skin associated with chronic inflamm

Hyperkeratosis: excessive keratin → nose, paw pads, skin thick and hard

Masses

inflamm (papules, pastules, abscesses)

neoplastic, malignant or benign

Allergic Skin D

hypersensitivity on re-exposure

IS over-reacts to enviro allergens (pollen, grass, dust, food proteins - chicken, fish, beef, eggs)

genetically predisposed (atopy) >6 months of age

Hx clues: maltese terrier, staffy, lab, golden retriever, poodles, 1-3yrs, duration (chronic wax and wane), favourable response to tx

Pruritis, secondary inf (superficial pyoderma, ear inf, recurrent)

(atopy: ears, under arms, belly)

Cats and Allergies

Head and Neck Pruritus

Miliary Dermatitis

Eosinophilic Granuloma Complex

Symmetrical Alopecia

Head and Neck Pruritus

erosive type lesions

FLEA tx

lesions locations around head and neck

Miliary Dermatitis

multi-focal pinpoint papule lesions - millet seeds

progressive spread - inf - scabs

feel before see (unless alopecia)

Eosinophilic Granuloma Complex

Eosinophilic Plaque: well-defined, raise, red wound. Ventrum and thighs. EXTREMELY ITCHY

Eosinophilic Granuloma: raised, circular, yellow to pink nodules. Head and thighs.

Eosinophilic Ulcer: indolent ulcers, rodent ulcers. NO PAIN/ITCH, Well defined red skin ulcers. Upper Lip.

Symmetrical Alopecia

CATS: not inflamm alopecia - skin NORMAL

self-trauma due to pruritus

Causes of Allergic Skin D

• flea allergy dermatitis

• mosquito bite hypersensitivity

• contact allergy

• atopic dermatitis (atopy)

• food allergy

Flea Allergy Dermatitis

less common - prophylaxis

75% of canine allergies,85% of feline allergies

Tail base

Diag: wet paper test/cotton wool to skin - flea dirt will stain brown (digested blood)

Intradermal skin allergy testing - confirm reactivity to flea antigens,

strict flea control = IMPROVEMENT

Tx: min 3 months , adulticides (alfoxalaner: dogs, esafoxalaner: cats), bravecto (flurolaner), seresto collar (flumethrin, imidacloprid) = REPELS

tx all animals in the household, control enviro, and all areas visiting, wash bedding and dry in sun

*only takes 1 bite, flea prevention and when last applied

Mosquito Bite Hypersensitivity

Cats - scaling, cursing and alopecia of nose and ears

tx symptoms

Contact Allergy

ON NON HAIRED AREAS ONLY (no protection)

inguinal, paw underside, interdigital skin, muzzle

skin folds = protection (normal in fold)

Type 4 hypersensitivity (cell mediated not antibody mediated)

Causes: plant irritants

• buffalo grass, wandering trad (purple and green stripes), inch plant (green, white flowers), purple heart, moses in a boat (purple and green), scurvy weed (blue flowers), turtle vine (cacti looking)

Irritant chemicals (floor detergents, bleach)

Diag: contact elim (10d) - e.g. clothes, re-challenge for reoccurrence, patch test on skin

Tx: avoid (fence off, protect skin (clothes), remove, remove from skin (bath) ASAP)

Meds (steroids)

Atopic Dermatitis

• genetically predisposed - complex interact microbe, enviro, genetics, immunologic

Symptoms: pruitus and erythema of face, ears, perianal region, paws, ventrum, saliva staining - paws and anus, otitis externa (80%), secondary inf (malassezia or bac), recurrent conjunctivitis and sneezing

Diag: exclusion aetiologies - rule out para, inf, contact allergy, food allergy (8wks), intradermal skin tests

Tx: modify exposure for allergies, ATOPY = modify patients response

manage secondary inf first - cytology to ID and antimicrobial therapy

Symptomatic: apoquel, atopica, cytopoint, pred

Desensitisation: vacc, weekly (induction phase) then monthly (maintenance phase) with allergen (ID via intradermal testing first)

1/3 resolve, 1/3 more tx, 1/3 no benefit

Promote skin barrier: essential fa, omega 3 and 6 (+ steroids and antihistamines) - megaderm, regular bathing - removes allergens and rehydrates skin barrier - aloveen, prevent self trauma (e-collar/t shirts)

NOT CURABLE = GENETIC!!!!!