Patient Care

Memorise the conditions noted

What is Hyperthyroidism and what does it cause?

• Hyperthyroidism is an overactive thyroid gland, 98-99% of the time caused by a benign adenoma (tumour), but 1-2% caused by a malignant adenoma.

• Causes the overproduction of Triiodothyronine (T₃) and Thyroxine (T₄) which increases the metabolic rate and can result in multisystem disease such as Grave’s Disease and Cardiovascular Disease.

Name the clinical signs of Hyperthyroidism.

• Palpable enlarged thyroid

• Polyphagia (excessive appetite) with weight loss/emaciation

• Aggression and hyperactivity

• Hypertension (High BP)

• Heart murmur and tachycardia

• Polyuria (excessive urination)/Polydipsia (excessive thirst)

• Blindness with retinal detachment

• Vomiting and diarrhoea

How would Hyperthyroidism be diagnosed?

• Blood Tests/ Haematology & Biochemistry (+ T4 which measures Thyroxine levels in the blood)

• Thyroid Scintigraphy (nuclear imagine of the thyroid via injection and a gamma detection camera)

How should a patient with Hyperthyroidism be nursed?

• Monitor vital and clinical signs (heart rate and blood pressure)

• Assist with the VS diagnosis tests

• Reduce stress (keeps the heart rate and blood pressure low)

• Fresh water availability

• Comfort observations (pain scoring)

• Suitable diet

• Prescribed VS medications

• Radioactive protocol (barrier nursing/lead lined equipment)

• Peri/Post - operative care

What is Hypothyroidism and what does it cause?

• Hypothyroidism is an underactive thyroid gland, normally caused by an auto-immune destruction of the thyroid gland.

• Causes a decrease in the production of Thyroxine (T₄) and decreases the metabolic rate.

Name the clinical signs of Hypothyroidism.

• Lethargy/Exercise Intolerance

• Obesity

• Bradycardia

• Rear limb oedema (Equine)

• Dermatological abnormalities (alopecia, seborrhoea, hyperpigmentation, pyoderma)

How is Hypothyroidism diagnosed?

• Blood Tests / Haematology & Biochemistry

• T₄ and Thyroid Stimulating Hormone assay

How should a patient with Hypothyroidism be nursed?

• Monitor vitals and clinical signs

• Assist VS with diagnostic tests

• Fresh water availability

• Comfort observations

• Medication given under VS direction

• Lifelong supplementation with Thyroxine

• Feed a suitable diet (Vegetables and lean proteins)

What are the 3 types of Hyperadrenocorticism (Cushing’s)?

• Pituitary dependent hyperadrenocorticism

• Adrenal-based hyperadrenocorticism

• Iatrogenic Cushing’s

What is Pituitary dependent hypoadrenocorticism?

• The over-secretion of ACTH by the anterior pituitary gland (found at the base of the brain).

• ACTH is a hormone that stimulates the adrenal gland to produce glucocorticoids (these increase blood pressure).

What is Adrenal-based hypoadrenocorticism?

• Adrenal tumour causes the over-secretion of cortisol.

• Adrenal tumours are responsible for around 20% of cases of Canine Cushing’s Disease.

What is Iatrogenic Cushing’s?

• Caused by giving an animal a high dose of steroids.

• The symptoms will go away once the steroids have been stopped.

• Iatrogenic: Symptoms of illness brought on by medical treatments.

Name the clinical signs of Hypoadrenocorticism.

• Polyuria/Polydipsia

• Polyphagia

• Loss of muscle tone

• Potbelly

• Panting

• Bilateral alopecia/Skin changes

• Skin and other infections

• Lethargy

• Neurological signs

How is Hypoadrenocorticism diagnosed?

• Abdominal ultrasound

• Abdominal radiography

• MRI or CT (of the pituitary/adrenal areas)

• The urine cortisol/creatine ratio

• General blood tests

What is Atopic Dermatitis?

• A chronic, inflammatory skin condition

• Normally caused by inhalation and ingestion of antigens

• Normally causes itchiness

What is Contact Dermatitis?

• Inflammation caused when the body makes direct skin contact with a substance.

• Causes pruritis (Itchiness) and self-trauma

• Treatment is usually to find the cause and use topical corticosteroids to reduce the inflammation

• Most common allergens likely to cause this are dust mites, pollen, mould and fungi.

What is Urticaria (AKA Hives or reaction bumps)?

• Allergic reaction which causes the formation of many reddened erythema or oedema, these are normally pruritic.

• Often appearing 24-72 hours of the initial exposure to the allergen.

• The oedema (swelling) is normally only within the superficial layer of the skin, but can be rooted deeper into the dermis layers of the skin.

• This tends to be a temporary reaction.

Name the causes of Urticaria.

• Drug sensitivity

• Insect bites

• Bee/Wasp stings

• Environmental allergens

• Feed/Supplements

• Topical reactions

• Normally long haired animals don’t make direct skin contact with things so short-haired animals are more prone.

What is the pathophysiology of Urticaria?

• Allergy reaction causes the immune defence reaction to trigger.

• Chemical signals are sent to the mast cells to release their histamines.

• Histamines are released into the capillaries and boost blood flow to the affected area which causes the inflammation.

• Additional chemical messengers respond to this.

• Blood vessels dilate and become leakier to allow WBC and other protective substances to fight back

• Extra fluid oozes into the surrounding tissues causing swelling and works with nerves to cause itchiness.

What is Flea Allergy Dermatitis?

• A hypersensitivity reaction to the proteins within flea saliva.

• Clinical signs are normally intense pruritis, loss of hair, irritability and restlessness, inflamed skin, hot spots and broken or crusty skin.

• In dogs typically seen in the base of the tail, belly and thighs

• In cats typically seen in neck back and head.

How is Flea Allergy Dermatitis treated?

• Strict, year round flea control

• Management regimes

• Steroids and Antihistamines

What is Pyoderma?

• A bacterial skin disease/infection

• Caused by various bacteria:

• Staphylococcus pseudintermedius -

• Proteus pseudomonas

• Dermatophilus congolenis

• Pastuerella (Commonly caused by cat bites)

What are the 3 types of Pyoderma?

• Surface Pyoderma - Skin fold dermatitis or acute moist dermatitis.

• Superficial Pyoderma - Impetigo (Bacterial skin infection) /Folliculitis (Inflammation of the hair follicles)

• Deep Pyoderma - Furunculosis (boils or infection of the hair follicles) /Pododermatitis (inflammation of a dog’s paw pads)

Name the clinical signs of Ectoparasites.

• Pruritis

• Papules and scabs

• Alopecia

• Dorsum/tail area most frequently affected

How are Ectoparasites treated?

• Treat the animals for fleas and the environment

• Treat skin infections antibiotics/corticosterioids

How can Ectoparasites be diagnosed?

• Skin scrapings - useful for mite infestations

• Hair brushings - useful for mite infestations and fleas

• Tape strips - useful for Oxyuris equi eggs (Pin Worms)

• Hair plucks - Indicated where there is hair loss, crust, broken hairs and scales. Useful for fungal culture and the identification of dermatophytosis

What is Dermatophytosis?

• Ringworm (fungal dermatitis)

• Round hairless patches of scabby or crusty skin which may be sore but do not cause any constant discomfort.

• Normally caused via a fungal infection (dermatophytes) in the Trichophyton or Microsporum families

How is Dermatophytosis treated?

• Isolate the patient from other animals

• Clip around any lesions to remove scabs or crust

• Antifungal shampoo’s

• Repeat treatments

• Exposure to air and sunshine

What is Dacryocystitis?

• Inflammation of the Tear Sac

• Usually caused by an obstruction of the Tear Sac (AKA Nasolacrimal Sac)

• This is usually due to a foreign body, inflammatory debris or a mass.

Name the clinical signs of Dacryocystitis.

• Increased lacrimation

• Recurrent conjunctivitis

What is Squamous Cell Carcinoma?

• A tumour which grows within the squamous cells of the epidermis layer of the skin.

• Most common type of tumour in horses.

Name the clinical signs of Squamous Cell Carcinoma?

• Thick, yellow ocular discharge

• The appearance of a fleshy mass

• Commonly found on the third eyelid or the eyelid margins

What is Conjunctivitis?

• Inflammation of the conjunctiva (the inner skin lining of the eyelids)

• This can be uni or bi-lateral

• The causes could be bacterial or viral infection, foreign body or insect hypersensitivity.

What is Cloudy Eyes?

• A hazy appearance to the pupil of the eyes

• Commonly caused by:

• Nuclear Sclerosis (aging)

• Cataracts

• Dry eyes

• Corneal ulcers/scratching

• Uveitis (Inflammation of the Uvea, the middle layer of skin within the eye)

• Glaucoma

What are Cataracts?

• A cloudy opacity in the lens of the eye that impairs vision and can lead to blindness.

• Caused by the clumping of proteins within the eye’s lens.

• Can be hereditary, diabetes or age related and can be due to trauma or nutritional deficiencies.

Name the clinical signs of cataracts.

• Cloudy appearance in the lens of the eye.

• Bumping into things.

What is Keratoconjunctivitissicca (KCS)?

• Dry eyes caused by a reduction in aqueous tear production from the lacrimal and third eyelid.

• Usually caused via immune-mediated disease, infection, medications, hyperthyroidism or head trauma.

Name the clinical signs of Kerotoconjunctivitissicca (KCS).

• Vascularisation (Blood shot eyes)

• Ulceration

• Opacity of the cornea

• Recurrent conjunctivitis

• Mucoid or mucopurulent discharge in or around the eyes.