Small Animal Final

Blood gases, respiratory disorders, urinary tract disorders

• pH

• PO2

• PCO2

• HCO3

• O2 sat.

• BE

• pH: 7.35-7.45 (< 7.35 acidosis, >7.45 alkalosis)

• PO2 80-600

• PCO2 35-45mmHg (<35 alkalosis, >45 acidosis (LA 45-55)

• HCO3 20-24 mEq/L metabolic (<20 acidosis, >24 alkalosis) (LA 22-30)

• OS >95%

• be -5-5

Hydrogen

• necessary for enzyme function and cell structure

• body needs to keep it constant

• Get from: water, base excess/bicarb

pH

• measures hydrogen ions

• buffer: donate or accept H+

• goal is to minimize pH changes

Hydrogen and pH have what relationship

• inverse

• hydrogen is acidic

• low pH: acidic

• high pH: alkalotic

  • low pH means high H

  • high pH means low H

Bicarbonate (HCO3)

• main buffer of extracellular fluid

• basic

• pH follow HCO3

  • high HCO3, high pH

  • low HCO3, low pH

• metabolic indicator

• bicarb made by kidneys in the body

Metabolic acidosis

low bicarb and pH

metabolic alklaosis

increased bicarb and pH

CO2

• combines with water to make an acid; acidic

• decreased CO2 = increaased pH = alkalosis

• increased CO2 = decreased pH = acidosis

• located in lungs in body

• respiratory indicator

• panting = expelling mroe CO2

respiratory alkalosis

breathing out CO2

respiratory acidosis

breathing in CO2

What is the most common disorder under anesthesia?

respirtory acidosis; pH <7.35, pCO2 >45mmHg

Respiratory acidosis can be caused by

• CNS depression from anesthetic drugs

• lung atelectasis

• pneumothorax

What is the body’s response to respiratory acidosis?

excrete hydrogen, retain bicarb

low hydrogen = increase pH, bicarb = basic

Respiratorty acidosis treatment

• increase ventilation

• fix function imapirment

pH > 7.45, pCO2 < 35mmHg

Respiraotry alkalosis

what can respiratory alkalosis be caused by?

• hyperventilation

• hypoxia

• incorrect mechanical ventialtion

respiratory alkalosis treatment?

• decrease ventilation

• address pain body’s response in to slow down excretion of hydrogen to try to build up concentrations of acid

What is the most common disorder in blood gases?

Metabolic acidosis

pH < 7.35, HCO3 < 18-20 mEq/L

metabolic acidosis

what can ccause metabolic acidosis?

• renal failure

• DKA

• lactic acidosis from shock/poor perfusion

• diarhhea/vomiting

Metabolic acidosis treatment

• sodium bicarbonate (HCO3)

• postassium shifts out of cells in exchange for hydrogen and hyperkalemia may result

body’s response to metabolic acidosis?

increase in respiratory rate

metabolic alkalosis

• pH > 7.45, HCO3 >24-26mEq/L

• loss of acid, increase in buffer

• decrease of chloride levels

• hypokalemia may result

Metabolic alkalosis treatment

• ddecreasing gastric refulx

• correcting hypokalemia - add KCL to fluids

• crystalloid therapy

• supplement calcium gluconate

Body response to metabolic alkalosis

decrease resp rate (hold in CO2 = increase pH)

pH follows the trend of

primary distrubance

Effects of acidosis

• decreased cardiac contractility

• decreased response to catecholamines

• antagonism of insulin

effects of alkalosis

• muscle spasms

• stupourus mentation

• hypokalemia

• hypocalcemia

Full compensation is indicated by

• normal pH

• lungs can adjust CO2 quicker than kidneys can adjust HCO3 which takes hours to days

Partial compensation indicated by

• HCO3 and CO2 are opposites but pH is not normal

No compensation is indicated by

• one value is normal, pH and the other value are not

Respiratory anatomy is based on

• location in the respiratory tract (upper vs lower)

• function within the respiratory tractg (conducting zone vs respiratory zone)

The upper airways/RT consist of

• nasal passages

• sinuses

• pharynx

• larynx

• trachea

the lower airways/RT consist of

• bronchi

• bronchioles

• lung parencyma

  • functions take place here

  • instersitial tissue

  • alveoli

Ventilation

mechanical movement of air through respiratory tract

Respiration

• physiologic and takes place within the cells and alveoli

• chemical change: inhale )2 exhale CO2

• how the cells are able to utilize the nutrients then have to awste to take out of cell

Function of the respiratory tract

• supply the body with oxygen

• ddispose of carbon dioxide

• transport respiratory gases (diffuse O2 from lungs to rest of body)

• internal respiration: exchange between blood and tissue cells

• pulmonary ventilation: moving air in and out of lungs

• external respiration: oxygen loading, CO2 unloading, occurs at the alveoli

Veins vs arteries

• veins carry deoxygenated blood back to heart (except for pulnoary veins)

• arteries carry oxygenated blood to rest of body (except pulmonary artery)

Patterns of respiration

• rate and depth

• inspiratory effort (usually upper airway) vs expiratory effort (usually lower airway)

Abnromal sounds

• stridor: continuous high pitch respiratory sound

• stertor: coarse snorting

• coughing

Phsyical exam

• MM color

• auscultation

• examination of chest wall

• nasal airflow

Respiratory diagnostics

• radiographs, advanced imaging

• blood gases

• laryngeal exam

• rhinscopy

• BAL

• fecal exam

• HWT

Diseases of nose and sinus clinical signs

• sneezing

• nasal discharge

• facial deformity

• inappetance

• stertorous breathing

• herpes virus/calicivirus

• common in young, multi-cat households

• clinical signs:

  • nasal discharge

  • sneezing

  • ocular and oral lesions

• vaccination reduces severity and incidence

• can flare up during stress

• supportive tx

• wear gloves

Feline viral rhinotracheitis/viral rhintis

• causative agents:

  • cats: cryptococcus

  • dogs: aspergillus - commone in hunting dogs and dolichocephalics

• clinical signs:

  • epistaxis, purulent or serosanguinous discharge

  • facial deformity

• diagnostics:

  • skull radiographs, CT the head

  • rhinoscopy

  • fungal culture, serolgoical testing

  • rule out coagulapathy

• tx:

  • focal disease with nasal flush

  • trephine sometimes needed

  • oral medication if needed

Fungal rhinitis

• often unilateral hemorrhagic discharge

• common in older animals

  • dogs: adenocarcinoma

  • cats: lymphoma

• locally invasive

• radiation therapy

• palliative therapy

• rule out:

  • trauma

  • foreign body

  • nasopharyngeal polyps (esp. in young cats)

nasal/sinus neoplasia

Lower airway disease clincial signs

• coughing

  • productive vs non-productive

• dyspnea

• tachypnea

Obstruction outside of the chest:

inspiratory dyspnea; airways inside chest expand and outside collapse

obstruction insde chest =

expiratory dyspnes; airways inside chest collapse and outside expand

• congenital disease of lower airways

• components:

  • stenotic nares

  • elongated soft palate

  • hypoplastic trachea

  • everted saccules

• tx; surgery, weight control, symptomatic therapy (sedatives, weight loss, reduce exercise

Brachycephalic obstructive airway disease

• signalment: large breed dogs (labs), middle-old age

• clinical signs:

  • change in bark, excercise intolerance, stridor

  • inspiratory distress

  • heat stroke, cyanoiss, collapse

• spring and summer time common

• dx: laryngeal exam, can’t use sedatives (propofol drug of choice)

• surgery recommended (tie back, can lead to aspiration pneumonia)

Laryngeal paralysis

• signalment: puppies, dogs with recent grooming or barding hx

• causative agents:

  • virus complex perdispose for bacterial infection

  • adenovirus, parainfluenza, bordatella, mycoplasma

• clinical signs:

  • dry, hacking cough

  • nasal discharge

  • secondary pneumonia

• incidence reduced by vaccination

• most resolve without treatment, isolate infected animals; cage rest!

Infectious tracheobronchitis (kennel cough)

• common in small-toy breeds (Chis, Yorkies)

• pathophysiology:

  • degeneration of tracheal cartilage rings leading to dorso ventral flattening of the trachea and alxity of the dorsal tracheal membrane

  • can be intra and/or extra thoracic

• clinical signs:

  • dyspnea

  • collapse

  • paroxysmal honking cough

• dx: inspiratory/expiratory films, ± fluoroscopy

• tx:

  • severe and respiratory crisis: stabilize first, sedation, O2

  • chronic: weight management, cough supressant, harness, interventional stent (variable efficacy)

Collapsing trachea

• etiology:

  • infectious (lungworm, heartworm)

  • allergic (smoke, etc.)

• disease of the bronchioles

• clinical signs:

  • coughing

  • dyspena

  • tachypnea

  • cyanosis

• PE: tachy/dyspnea, wheezes, coughing

• dx: radiology, ETW, TTW

• tx: depend on cause

Bronchitis and Feline Asthma

Diseases of lung parenchyma clinical signs

• dyspnea

• coughing

• crackles/harsh lung sounds

• primary infectious

  • viral, bacterial, fungal, parasitic

• secondary infectious:

  • aspiration pneumonia, foreign body

• dx: radiogrpahs, bronchoscopy, cytology and culture

• tx: underlying cause

  • nebulization

  • antimicrobials, antifungals

Pneumonia

What lung lobe is the msot common loaction for aspiration pneumonia?

right middle lung lobe

• etiology:

  • cardiogenic: heart failure

  • non-cardiogenic: electrocution, near drowing, airway obstruction, seizures

• clinical signs:

  • dyspnea/tachypnea

  • coughing

  • crackles on aus.

• tx: diuretics, cardiac meds, O2 supplementation, cage rest

Pulmonary edema

• primary or secondary tumors

  • primary; surgery

  • secondary: chemotherpay or supportive care

neoplasia

• obstruction within the blood vessles supplying the lung tissue

  • secondary to other disease processes

  • gas exchange can’t occur

  • mostly fetal

• etiology: secondary disease processes: IMHA, pancreatitis, neoplastic, HCM

• clincial signs:

  • acute dyspnea, cyanosis, coughing

• dx: may have normal radiogrpah, CT scan with angiograph

thromboembolic disease

Clinicals signs of the chest wall and pleural cavity

• rapid shallow breathing

• respiratory sounds decreased

  • pneumothroax - normal heart sounds

  • pleural effusion - muffled heart sounds

• often traumatic, can be idiopathic

• decreased lung sounds

• thoracocentesis - location

• tension penumo: air trapped in pleural cavity leading to progressive lung collapse

Pneumothorax

• thoracocentestis location: ventral

• treat specific problem

• types:

  • transudate

  • hemothorax

  • pyothroax

  • chylothroax

pleural effusion

Thoracocententesis

• 7-9th rib

• clip and surgical scrub

• butterfly catheter

• 3 way stopcock

• 30-60 ml syringe

• cranial to rib (blood vessles caudal)

• samples for cytology and culture

Thoracocententesis for a pneumothorax

• sternal position

• tap at highest point between dorsal and middle third

• worst side uppermost if lateral

Thoracocentesis for pleural effusion

• standing or sternal

• costochondral junciton (middle and ventral third)

• both sides if needed

What are possible causes for dysuria/pollakiuria in dogs?

• bacterial UTI

• urolithiasis

• neoplasia

• prostatic disease

what are possible causes for dysuria/pollakiruria in cats?

• idiopathic cystitis

• urolithiasis

• bacterial UTI

• neoplasia

up to ___% of UTIs are asymptomatic

80

signs of urinary related inflammation/irritation?

• dysuria

• pollakiuria,

• stragnuria,

• hematuria,

• odor

• licking

Cysitits is

• bladder inflammation

• often accompanied by urethritis (urethral inflammation)

• ± bacterial infection

• underelying cause

• abnormal bacterial colonization

• females > males, dogs > cats, intact male dogs > neutered, cats > 10 y/o

• recurrence vs resistance, uncomplicated vs complicated

• host defenses

  • natural micturition, anatommic structures, mucosal defense barriers, urine composition, immune rresponse

• causative agesnt:

  • e. coli, staphylococcus, streptococcus, proteus

UTI

FLUTD stands for

feline lower urinary tract disease

FLUTD is mostly ____ in origin

idiopathic (64% of cases)

FLUTD is more likely to impact

• overweight cats

• cats that eat a strict dry diet

• middle aged cats

FLUTD is

a general term for a range of conditions that can affect a cat’s bladder or urethra

• syndrome of younger, middle aged cats

• CS: pollakiuria, dysuria, stragnuria, hematuria

  • periuria - urinating around litterbox

• males and females

• exclusion diagnosis (if nothing else can be found)

• no proven prenventative therapy

• client education ccritical

Feline idiopathic cystitis

• calculi within excretory pathway

  • oversaturation - precipitation - solidificaiton

  • diet, pH, volume, inhibitors

  • genetic/breed dispositions (yorkies, shih tzus, mini poodles)

  • metabolic disorders

• primary or secondary to UTI

• urease producing bacteria

  • staphylococcus or proteus species

  • infection induced struvites

• crystalliuria is NOT the same thing as this condition

Uroliths

most uroliths are composed mostly of what crystal?

struvites

• monohydrate or dihydrate

  • acidic to neutral environment

• males > females

• breed dispositions: min/stan schnauers, min poodles, shi tzus, yorkies

  • himalyan, persian, burmese

• hypercalciuria

• no medical or dietary dissoluation

• high recurrence rate

calcium oxalate crystals

• magnesium ammonium phosphate

  • nuetral to alkaline envrionment

• sterile or infection induced

  • 85% occurs in female dogs (infection induced)

  • 85-95% of feline urethral plugs

• stahpylococcus and proteus

  • urease interacts with urea —> ammonium (NH4)

  • increased pH - struvite crystals adhere to proteins

  • stone forms

Struvite crystals

How are struvite crystals/plugs medidcally dissoluted?

• acidify urine with strict diet adherence

• goal: 6.0 USG, increase water consumption

• antibiotics

• monthy progress monitoring

• prevention

• arises from transitional cell epithelium

  • ureters, bladder, prostate gland, proximal urethra

  • commonly origniates in trigone

  • paipillary infimtrative

  • breed/age predispositions (Scotties)

  • dogs > cats

• highy metastatic

• high UTI incidence associated

TCC

• obstruction to low pressure urine flow in excretory pathways

  • ureteroliths, urethroliths, malignancy

  • partial or complete

• consequences:

  • postrenal azotemia, metabolic acidosis, hyperkalmeia, dehydration, bladder rupture, uremic death

• EMERGENCY SITUATION - decompressive cystocentesis first line

• postobstructive diuresis

Male cat obstruction

urinary cather nursing care

• collection system lower than patient

• clamp tubing when moving patient or emptying bag

• check tube patency hourly

• daily maintenance

• culture catheter urine at removal

• do not give antibiotics only to prevent infection

• inability to control urination

  • dogs more common than cats

  • females more common than males

  • can be acquired or congenital

• common causes:

  • USMI

  • ectopic ureters

  • neurologic disease

• differentiate from pollakiuria and PU and urge/overflow

urinary incontinence

what is the most common cause of urinary incontnence (lower)?

Urethral sphicnter mechanism incontinence

SApyed female dogs and spay incontenance

• diagnosis of exclusion

• varying degrees

• more common in large breeds than small

Response to tx for USMI

• stimulate smooth muscle recceptors

• alpha agonsits - phenylpropanolamine

• ± hormones - estriol (estrogen - tightens bladder sphincter)

• opens in area other than trigone

  • intra vs exrtamural

  • uni vs bilateral

• young female dogs more common than males

• constant to intermittent leaking

• breed disposition (english bulldogs, golder retrievers, labrador retreievers)

• may also have renal agenesis and USMI

ectopic ureter

• incoordination between bladder contraction and urethral relaxation

• middle age to large giant male dogs

• initiates stream then unable to continue to void

• pass catheter to rule out obstruction and measure residiual volume

• tx:

  • intermittent catherization

  • relax urethra

  • ± bladder stimuli

reflex dyssynergy

Kidney functions

• excrete

• secrete

• regulte

Kidney excretion

• filter out water base toxins from blood

• cellular metabolism produces water soluble products

• toxic if waste not eliminated

Kidney secretion

• hormones (EPO, Vitamin D)

• Renin - BP regulation

Kidney regulation

fluid, elevtrolytes, acid-base balance

• structural and/or functional abnormality

  • > 3 months to years

  • irreversible

• golmerular compensatory mechanisms

  • hypertension/hyperperfusion/hyperfilitration

• spontanoeus progression

  • spectrum of severity

  • 2/3 (75%) of nephrons lost

    • dilute urine (isothenuria)

  • 75% of nehprhons lost in both kidneys

    • proteinuria, hypertension, azotemia, uremic death

CKD

CRF common in

cats age 15+

What can cause CKD?

• calculi/obstructions

• familial renal disease

• congenital malformations

• idiopathic

Kidneys reabsorb

>99% of water enterin tubules

normal canine and feline USG

• canine: >1.030

• feline: >1.035