Final Exam

Feline Renal and Urinary Disease:

Inappropriate Elimination:

  • Number one cause for surrendering cats to a shelter, often leads to euthanasia as being “unadoptable”

  • Does NOT mean a urinary system problem

  • Conduct a physical examination to look for things like skin lesions, orthopedic issues, or spinal pain

  • Make sure cat is getting correct litterbox accommodations:

    • 1 litter box more than number of cats in home & one litter box per floor

    • avoid boxes near food and water sources, or facing each other

    • AAFP recommends a box that is 1.5x the length of the cat from nose to tail base

  • Make sure litter is a fine, sand-like, non-scented, clumping material that is a least 1.25 in deep

  • Treatment:

    • address any medical concerns

    • mitigate stressors with medications or pheromones

    • optimize accessibility

Feline Idiopathic Cystitis (FIC):

  • Previously called Pandora Syndrome

  • Most common cause of FLUTD (Feline Lower Urinary Tract Disease)

    • FLUTD is a collection of diseases that yield similar clinical signs, including:

    • Hematuria (blood in urine)

    • Stranguria (difficult urination, potentially mimicking constipation)

    • Periuria/Inappropriate elimination

    • Urinary obstruction

    • Behavioral Signs: Perineal hypergrooming

  • FIC is a defect in how cats handle stress

    • Physiological Mechanism: The lining of the bladder contains Polysulfonated Glycosaminoglycans (PSGAGs), which, under stress, can become patchy, allowing urine to contact bladder tissue directly.

  • Diagnosis: There is no specific diagnostic test available for FIC.

  • Treatment: Historically, treatment focused primarily on managing crystalluria, urine pH, and enhancing the PSGAG lining.

  • Emphasis on preventative measures, particularly stress minimization, though this is less effective during acute FIC episodes.

    • Diet should be focused on dissolution off crystals and altering pH

  • Treatment can also include increasing hydration, pheromones, or pain medications

Urinary Obstruction:

  • Urinary obstruction is potentially the most common emergency situation in male cats.

    • Causes of obstruction may include:

    • Conglomerates of mucus, crystals, or small urinary stones in the urethra.

    • The urethra's narrowness means that partial or complete obstruction can occur with minimal material.

    • Diagnosis Method: Typically diagnosed with abdominal palpation leading to identification of a large, turgid bladder.

    • Possible to digitally express some urine during examination.

  • Obstructions hinder the kidneys' ability to remove toxins from the bloodstream, presenting a risk of death.

  • Most Notable Complication: Hyperkalemia (elevated blood potassium levels).

    • Potassium levels are critical for nerve conduction and establishing appropriate concentration gradients.

  • Elevated potassium causes cardiac arrhythmias indicated by:

    • Absence of P-waves on ECG.

    • Presence of tall T-waves on ECG.

    • Normal ECG Parameters for Comparison: T-waves, QRS intervals, and rhythm assessments are used to differentiate between healthy and hyperkalemic states

Urinary Obstruction Treatment:

  • The primary goal in treating urinary obstruction is alleviating the obstruction itself and placing a urinary catheter.

  • Address hyperkalemia potentially before catheterization.

Treatment Options for Hyperkalemia

  • Possible treatments include:

    • Dextrose: Intravenous (IV) infusion that induces a natural release of insulin, promoting glucose absorption via the glucose/sodium symporter.

    • Insulin: Administered exogenously, usually in combination with dextrose to prevent hypoglycemia.

    • Calcium: Known as a "cardioprotective" agent that aids the SA node in the atrium to initiate action potentials.

    • Bicarbonate: Functions similarly to glucose, utilizing a bicarbonate/sodium symporter.

Monitoring and Post-Care

  • Monitor fluid intake and output post-catheter placement and during IV fluid administration.

    • Post-obstructive diuresis can occur, leading to potential dehydration if hydration is improperly managed.

  • Regular blood sampling should be performed to evaluate for resolution of azotemia and hyperkalemia; this monitoring process may take several days.

  • Develop FIC treatment plans for long-term management, including:

    • Pain management.

    • Stress management (using pheromones).

    • Prescription diets.

  • Important Note: Treatment does not ensure that obstruction will not recur, which may necessitate surgical intervention (perineal urethrostomy).

Perineal Urethrostomy

  • Surgical intervention for recurrent urinary obstruction.

    • Procedure involves amputation of the distal penis to create a larger urethral diameter, thus reducing the risk of urinary obstruction.

  • Post-Operative Risks: Increased risk for dehiscence (wound reopening) and urinary tract infections following surgery.

Urinary Tract Infections (UTI)

  • UTIs are a common issue seen in veterinary practice.

    • Notably more prevalent in female cats compared to males.

  • Sample Collection Considerations: The method of obtaining a urine sample can significantly impact diagnosis:

    • Naturally voided ("free catch")

    • Catheterization

    • Cystocentesis

  • Urinalysis Findings: Key findings indicative of UTI include:

    • Pyuria (presence of white blood cells in urine).

    • Bacteriuria (presence of bacteria in urine).

    • Isosthenuria (low urine concentration).

  • Gold Standard Testing: Urine culture and sensitivity testing provide the most definitive diagnosis.

    • Appropriately select antibiotics based on results, including frequency and duration of treatment.

    • Failure to treat adequately can lead to ascending infections and kidney infections (pyelonephritis)

Chronic Kidney Disease (CKD)

  • CKD is considered one of the "Big 3" diseases affecting senior cats, alongside Diabetes Mellitus and Hyperthyroidism.

    • It represents a degenerative process where 75% of functioning nephron population has been lost.

  • Signs: Presenting signs include renal azotemia; urinalysis will reveal isosthenuria or hyposthenuria (indicating low urine specific gravity).

  • Leads to renal atrophy, characterized by shrunken kidneys.

  • Staging of Disease: CKD is staged from I-IV based on blood and urine parameters:

    • Stage-dependent electrolyte disturbances (Calcium to Phosphorus ratio).

    • Anemia may occur due to decreased erythropoietin production.

    • Potential for protein loss and gastrointestinal upset.

    • Other extrarenal issues can include uremic encephalopathy and uremic ulcers.

  • Management: CKD is not curable but accommodates management strategies.

    • Dialysis and renal transplantation exist but are rare and less practiced due to availability limitations.


Canine Renal and Urinary Diseases:

Kidneys

  • Description:

    • Special filtering system for the body.

  • Functions of Kidneys:

    • Removal of Waste Products:

    • Cleansing the blood by filtering out waste.

    • Producing urine as a byproduct of this filtration process.

    • Blood Pressure Regulation:

    • Assists in maintaining the body's blood pressure.

    • Hormone Production:

    • Produces hormone Erythropoietin (EPO) that stimulates the production of red blood cells (RBCs).

Key Urine and Blood Test Parameters

  • BUN (Blood Urea Nitrogen): A measure of urea nitrogen in the blood which indicates kidney function.

  • Creatinine: A waste product from muscle metabolism that also reflects kidney function.

  • SDMA (Symmetric Dimethylarginine): A biomarker for kidney function.

Acute Kidney Injury (AKI)

  • Definition:

    • Abrupt decline in kidney function.

  • Common Causes:

    • Nephrotoxins:

    • Ethylene glycol

    • Raisins

    • Rodenticides

    • Other causes include trauma, shock, infections (e.g., leptospirosis).

  • Clinical Signs:

    • Lethargy

    • Vomiting

    • Dehydration

    • Renomegaly (enlarged kidneys)

    • Recent polyuria (increased urination) and polydipsia (increased thirst)

    • Oliguria (decreased urination) or anuria (absent urination)

    • Oral (uremic) ulcerations

    • Possible kidney pain

  • Diagnosis:

    • Bloodwork:

    • Indications of azotemia (elevated waste products in blood).

      • Azotemia defined as elevated levels of nitrogenous wastes in blood.

    • Hyperkalemia (high potassium levels), especially if oliguric or anuric.

    • +/- Hypocalcemia (low calcium), particularly in ethylene glycol toxicity.

    • +/- Hypercalcemia (high calcium), commonly seen with rodenticides.

    • Urinalysis:

    • Isosthenuria (non-concentrated urine).

    • Radiographs:

    • Indication of renomegaly.

  • Treatment:

    • Administration of IV fluids to address dehydration and support urine production.

    • Measurement of patient "ins and outs" (input and output of fluids).

    • Blood pressure monitoring.

    • Additional treatment based on identified underlying cause.

Giant Kidney Worm (Dioctophyme renale)

  • Description:

    • The largest known nematode, reaching lengths of 103 cm!

  • Transmission:

    • Contracted when definitive host ingests encysted larvae found in raw fish or frogs.

  • Clinical Signs:

    • Hematuria (blood in urine)

    • Pollakiuria (small, frequent urination)

    • Weight loss

    • Renal pain or abdominal pain

  • Diagnosis:

    • Presence of eggs noted in urine sediment.

    • Ultrasound revealing hydronephrosis (fluid-filled kidney).

    • Exploratory surgery as needed to confirm.

  • Treatment:

    • Unilateral nephrectomy (surgical removal of one kidney).

Bladder Anatomy

  • Functions of the Bladder:

    • Stores and excretes urine.

  • Anatomical Regions:

    • Apex

    • Body

    • Neck

  • Location of Ureteral Opening:

    • Dorsal wall of the bladder.

  • Associated Structures:

    • Urethra (including prostatic urethra, membranous urethra).

Bladder Stones (Uroliths)

  • Definition:

    • Formation of stones within the urinary tract due to crystallization of minerals in concentrated urine.

  • Types of Stones:

    • Struvite

    • Calcium oxalate

    • Urate

    • Cystine

    • Calcium phosphate (CaPO4)

    • Silica

  • Clinical Significance:

    • Cystine and urate stones are not visible via standard radiographic techniques.

Struvite Stones

  • Characteristics:

    • Commonly associated with urinary tract infections (UTIs), mainly those caused by Staphylococcus bacteria.

  • Breeds Predisposed:

    • Miniature Schnauzer

    • Shih Tzu

    • Miniature Poodle

    • Cocker Spaniel

    • Lhasa Apso

  • Clinical Signs:

    • Often asymptomatic; may see hematuria, pollakiuria, stranguria (straining to urinate), and possibly painful bladder.

  • Diagnosis:

    • Abdominal radiographs showing radiopaque stones, typically smooth and round in shape.

  • Treatment:

    • Cystotomy (surgical opening of bladder to remove stones) and specialized dissolution diets requiring 2-3 months for effectiveness.

    • Assessment for concurrent UTI and appropriate antibiotic treatment.

Calcium Oxalate Stones

  • Characteristics:

    • The second most common type of urinary stones.

  • Breeds Predisposed:

    • Miniature Schnauzer

    • Lhasa Apso

    • Yorkshire Terrier

    • Bichon Frise

    • Shih Tzu

  • Clinical Signs:

    • Similar to other stone types.

  • Diagnosis:

    • Abdominal radiographs demonstrating radiopaque stones with varying shapes.

  • Treatment:

    • Cystotomy.

    • Dietary treatment options ineffective for dissolution.

Urate stones:

  • Typically due to defect in uric acid metabolism

    • uric acid is an end product of purine metabolism in the liver

  • Seen in young to middle aged dogs

  • Breeds affected include: Dalmatians (genetic disposition) and English bulldog

  • Diagnosis: Abdominal ultrasound or radiographs

  • Treatment: cystotomy, dissolution diet (low purine diet), allopurinol (helps dissolve stones and prevent recurrence)

Transitional Cell Carcinoma (TCC):

  • bladder tumor

  • Cancer of epithelial origin arising from the bladder parenchyma, most commonly occuring in trigone region

  • seen in older dogs

  • Diagnosis: abdominal ultrasound (mass in trigone region and bladder wall thickening), Cadet BRAF testing (non-invasive urine tests for b-raf mutation in cells found in TCC

  • Treatment: Chemotherapy (Piroxicam), surgery not typically recommended

Urinary Incontinence:

  • Involuntary lack of urine control

  • seen in older, spayed females; due to urethral sphincter mechanism incompetence (USMI) (lack of sex hormone resulting in a weak urethral sphincter muscle)

  • Can also effect young dogs (due to congenital disorders such as ectopic ureters)

  • Clinical signs: Urine dribbling, “puddles” during rest

  • Diagnosis: diagnosis of exclusion, cystoscopy, CT scan, Contrast study to visualize ectopic ureters

  • Treatment: Phenylpropanolamine (proin) (increases internal urethral sphincter tone, Estriol (Incurin) (short acting estrogen compound that increases sensitivity of the urethral sphincter muscle to increase tone)

Canine Toxins:

CHOCOLATE

  • Toxic Component:

    • Methylxanthine

    • Primarily Theobromine

    • Secondarily Caffeine

  • Absorption and Distribution:

    • Theobromine and caffeine are absorbed in the gastrointestinal (GI) tract and are widely distributed throughout the body.

  • Mechanism of Toxicosis:

    • Behavioral changes and central nervous system (CNS) stimulation.

    • Cardiovascular abnormalities.

    • Increased cardiac and skeletal muscle contractility.

    • Death may result from cardiac arrhythmias, respiratory failures, or hyperthermia.

  • Common Clinical Signs:

    • Vomiting

    • Diarrhea

    • Polydipsia

    • Restlessness

    • Agitation/Nervousness

    • Tachycardia

    • Hyperthermia

    • Cardiac arrhythmias

    • Ataxia, Tremors, Seizures

    • Onset of Signs: 6-12 hours post ingestion.

  • Diagnosis:

    • Based on recent exposure history.

  • Treatment:

    • Decontamination: induce vomiting.

    • Activated charcoal to decrease toxin absorption.

    • For CNS signs: Methocarbamol (muscle relaxer); Diazepam (mild sedative/seizure medication).

    • For cardiac arrhythmias: Beta-blockers, Lidocaine.

  • Prognosis:

    • Generally good with quick response.

    • Guarded to poor if seizures or cardiac arrhythmias develop.

    • Signs may resolve in 12-72 hours.

RAISINS/GRAPES

  • Toxic Component:

    • Tartaric Acid

  • Dose to Response Relationship:

    • Not known, but doses affecting dogs:

    • Grapes: More than 5 grapes in an 8 kg dog.

    • Raisins: More than 0.03 oz/kg (4.5x more concentrated than grapes).

  • Mechanism of Toxicosis:

    • Renal tubular necrosis.

    • Mineralization of kidneys, gastric mucosa, myocardium, lungs, and blood vessels.

  • Clinical Signs:

    • Dehydration

    • Possible abdominal pain

    • Vomiting (within 12 hours of ingestion)

    • Lethargy (within 24 hours of ingestion)

    • Anorexia (within 24 hours of ingestion)

    • Oliguria/Anuria

    • Onset of Signs: Within 6-12 hours post ingestion; can cause acute kidney injury (AKI).

  • Diagnosis:

    • Bloodwork: Azotemia, increased BUN and creatinine, increased phosphorus.

    • Urinalysis: Low urine specific gravity (USG) < 1.030.

    • Radiographs: Abnormalities uncommonly seen; may show renal enlargement (renomegaly).

  • Treatment:

    • Decontamination: induce vomiting, activated charcoal.

    • IV fluids for supportive care.

    • Close monitoring of renal function.

  • Prognosis:

    • Varied; not all dogs develop AKI.

    • Guarded with oliguria, anuria, ataxia, weakness.

GARLIC & ONIONS

  • Toxic Component:

    • Thiosulfinites (primarily Dipropyl Sulfides)

  • Source:

    • Plants from Allium spp. such as garlic (3-5x more toxic) and onions including leeks, scallions, shallots, and chives.

  • Mechanism of Toxicosis:

    • Oxidizes red blood cell membranes resulting in hemolysis.

    • Poisoning may result from ingestion of raw, dried, powdered, or cooked forms; cooking or drying does not inactivate the toxic principle.

    • Most dogs would need to consume at least 5% (5g/kg) of body weight to develop toxicosis.

  • Clinical Signs:

    • Lethargy

    • Weakness

    • Pale mucous membranes

    • Tachycardia

    • Hemoglobinuria (reddish-brown urine)

    • Onset of Signs: Within 2-5 days post ingestion.

  • Diagnosis:

    • Bloodwork: Anemia, Heinz body formation, methemoglobinemia (brown serum).

    • Urinalysis: Hemoglobinuria, reddish-brown color.

  • Treatment:

    • Decontamination: induce vomiting, activated charcoal, +/- blood transfusion.

  • Prognosis:

    • Generally good.

    • Guarded with severe anemia.

SUGAR-FREE GUM/XYLITOL

  • Toxic Component:

    • Xylitol

  • Common Sources:

    • Gum, candy, baked goods, peanut butter, and liquid gabapentin.

  • Toxic Mechanism:

    • Xylitol causes a rapid, dose-dependent insulin release, leading to hypoglycemia.

    • Doses > 75-100 mg/kg associated with hypoglycemia; > 500-1000 mg/kg can cause hepatotoxicity.

  • Clinical Signs:

    • Lethargy

    • Vomiting

    • Weakness

    • Disorientation, ataxia

    • Seizures

    • Onset of Signs: Within 30 minutes to 12-18 hours post ingestion.

  • Diagnosis:

    • Bloodwork: Hypoglycemia, increased ALT, hyperbilirubinemia, thrombocytopenia.

  • Treatment:

    • Decontamination: induce vomiting, activated charcoal.

    • IV dextrose to manage hypoglycemia; Denamarin for liver protection.

  • Prognosis:

    • Good with control of hypoglycemia.

    • Guarded if hepatic necrosis and coagulopathy develop.

MEDICATION TOXINS

MARIJUANA

  • Toxic Component:

    • Cannabinoids, specifically THC

  • Mechanism of Toxicosis:

    • THC acts on a unique receptor in the brain, responsible for CNS effects.

    • Clinical effects often seen at low doses.

  • Clinical Signs:

    • Dilated pupils

    • Ataxia

    • Tremors

    • CNS depression

    • Onset of Signs: Within 30 minutes post ingestion.

  • Diagnosis:

    • Based on history of ingestion and clinical signs.

    • +/- urine drug tests.

  • Treatment:

    • Decontamination: induce vomiting, activated charcoal.

    • Supportive care including IV fluids and a dark, quiet room.

  • Prognosis:

    • Excellent.

HUMAN NSAIDS

  • Common NSAIDs:

    • Ibuprofen, aspirin, naproxen.

    • Most commonly affecting the GI tract or kidneys.

  • Toxic Mechanism:

    • Inhibit cyclooxygenase enzyme, blocking production of prostaglandins, which are crucial for GI protection and renal blood flow.

  • Clinical Signs:

    • Mild to moderate toxicosis: abdominal pain, vomiting, diarrhea, lethargy, anorexia, melena (dark stool), hematemesis (bloody vomit).

    • Severe toxicosis: dehydration, pale mucous membranes, icterus, bruising, ataxia, seizures.

    • Commonly causes GI ulcers.

  • Diagnosis:

    • Bloodwork: Anemia from GI hemorrhage, azotemia, elevated ALT, bilirubin.

  • Treatment:

    • Decontamination: induce vomiting, activated charcoal.

    • Gastroprotectants, IV fluids, and supportive care.

  • Prognosis:

    • Excellent with mild to moderate irritation/ulceration.

    • Guarded to poor with GI perforation; renal and liver effects are usually reversible if discovered and treated early.

OTHER TOXINS

RODENTICIDES

  • Toxic Component:

    • Multiple!

    • Warfarin → bleeding.

    • Bromethalin → neurologic effects.

    • Cholecalciferol → calcification.

    • Always obtain the active ingredient from the product a dog has consumed.

WARFARIN

  • Mechanism:

    • Interferes with blood clotting.

  • Clinical Signs:

    • Depression

    • Loss of appetite

    • Pale mucous membranes

    • Bleeding from eyes, nose, GI tract

    • Weakness

    • Panting/rapid breathing.

  • Treatment:

    • Decontamination

    • Vitamin K1 for 2-4 weeks.

BROMETHALIN

  • Effects:

    • Causes neurologic signs.

  • Clinical Signs:

    • Muscle tremors

    • CNS depression

    • Seizures

    • Ataxia.

  • Treatment:

    • Decontamination

    • Time and wishes.

CHOLECALCIFEROL

  • Effects:

    • Produces excess calcium in the blood, causing calcification of soft tissues throughout the body.

  • Clinical Signs:

    • Depression

    • Loss of appetite

    • Passing large amounts of urine

    • Extreme thirst.

  • Treatment:

    • Decontamination

    • Low calcium diet.

BATTERIES

  • Toxic Component:

    • Alkaline chemicals such as potassium hydroxide and sodium hydroxide.

  • Mechanism of Toxicosis:

    • Causes corrosive injury upon contact to tissues through a process called liquefaction necrosis.

  • Clinical Signs:

    • Abrasions/ulcerations on the tongue, cheeks.

    • Drooling

    • Lethargy

    • Anorexia

    • Vomiting.

    • Onset of Signs: Within 12 hours after exposure.

  • Diagnosis:

    • Radiographs: metal opacity.

    • Endoscopy to assess for GI ulceration.

  • Treatment:

    • Administer water or milk immediately after exposure to corrosive material.

    • Do NOT induce vomiting as it may cause additional exposure to corrosive material.

    • Endoscopy or exploratory surgery if obstructive.

    • May pass through, but requires aggressive GI protectants and supportive care.

    • Pain medications for oral ulceration.

Feline Toxicology:

Signs of Toxin Exposure

  • Factors Affecting Symptoms:

    • Vary based on the toxin and route of exposure.

  • Gastrointestinal Signs:

    • Drooling

    • Lack of appetite

    • Vomiting

    • Diarrhea

  • Neurological Signs:

    • Hiding

    • Excitability

    • Incoordination

    • Tremors

    • Seizures

    • Lethargy

    • Coma

  • Respiratory Signs:

    • Coughing

    • Sneezing

    • Difficulty breathing

  • Skin Signs:

    • Redness

    • Inflammation

    • Swelling

  • Liver Failure Symptoms:

    • Lack of appetite

    • Vomiting

    • Dehydration

    • Jaundice

    • Diarrhea

    • Weight loss

  • Kidney Failure Symptoms:

    • Lack of appetite

    • Vomiting

    • Halitosis (bad breath)

    • Increased drinking and urination

    • Decreased drinking and urination

    • Weight loss

  • Onset of Toxicity:

    • Usually presents with acute onset of clinical signs but may have chronic toxicities as well.

Treatment Strategies

  • Pollution Dilution:

    • The principle that "The Solution to Pollution is Dilution!"

    • Focus on minimizing exposure to the toxin.

  • Inducing Vomiting (when appropriate):

    • Use of Apomorphine (subconjunctivally or intravenously) for dogs.

    • Use of Xylazine or Dexdomitor for cats.

    • Note that inducing vomiting is usually most effective for toxins ingested within the last 2 hours.

  • Binding the Toxin:

    • Administer activated charcoal to bind the toxin.

  • Counteracting Mechanisms of Action:

    • Example: Antifreeze and high-proof alcohol can outcompete toxic actions.

  • Dermal Toxins Treatment:

    • Best handled by bathing the affected area.

    • Flush mucous membranes if affected areas include eyes or mouth.

  • IV Fluids:

    • Important for support in many toxic situations.

Common Toxins

  • Plants:

    • Sago Palm

    • Lily

    • Poinsettia

    • Azalea

    • Chrysanthemum

    • Rhubarb

  • Other Toxins:

    • Acids/Bases

    • Essential Oils

    • Drugs (e.g., NSAIDs)

Sago Palm Toxicity

  • Plants Included:

    • Coontie palms

    • Cardboard palms

    • Cycads

    • Zamias

  • Toxic Component:

    • Cycasin (hepatotoxic)

  • Clinical Signs:

    • Vomiting

    • Melena (dark, tar-like feces)

    • Icterus (jaundice)

    • Increased thirst

    • Hemorrhagic gastroenteritis

    • Bruising

    • Coagulopathy (blood coagulation disorders)

    • Liver damage

    • Liver failure leading to death

  • Treatment Options:

    • Induce vomiting

    • Administer activated charcoal

    • Provide IV fluids

    • Support liver health with Vitamin K and Denamarin.

Lily Toxicity (Lilium and Hemerocallis species)

  • Toxic Component:

    • Unknown; suspected metabolite is nephrotoxic.

  • Clinical Signs:

    • Vomiting

    • Lethargy

    • Drooling

    • Loss of appetite

    • Polyuria

    • Kidney failure

  • Treatment Options:

    • Induce vomiting

    • Bathe to remove pollen

    • Administer activated charcoal

    • Support with IV fluids

    • Possible dialysis for severe cases.

Poinsettia Toxicity

  • Toxicity Level:

    • Rarely to mildly toxic.

  • Toxic Component:

    • Diterpenoid euphorbol esters found in sap.

  • Clinical Signs:

    • Drooling

    • Licking lips

    • Vomiting

    • Diarrhea

    • Skin irritation (redness, swelling, itchiness)

    • Eye irritation.

  • Treatment:

    • Usually, does not require treatment unless signs are severe.

Azalea Toxicity

  • Toxic Component:

    • Grayantoxin, which affects sodium channels.

  • Clinical Signs:

    • Vomiting (not in horses)

    • Diarrhea

    • Weakness

    • Cardiac failure

    • CNS depression

    • Tremors

  • Treatment Options:

    • Administer activated charcoal

    • Provide IV fluids

    • Cardiac support

    • Sedation for seizure/tremor management.

Chrysanthemum Toxicity

  • Toxic Component:

    • Contains the largest concentration of toxins including

    • Sesquiterpenes

    • Lactones

    • Pyrethrins and other irritants.

  • Clinical Signs:

    • Vomiting

    • Diarrhea

    • Drooling

    • Incoordination

    • Anorexia

    • Itching

    • Erythematous skin (reddened skin)

  • Treatment Options:

    • Induce vomiting

    • Administer activated charcoal

    • Provide IV fluids.

Rhubarb Toxicity

  • Toxic Portion:

    • The leaf of the plant.

  • Toxic Component:

    • Soluble calcium oxalates as oxalic acid.

  • Clinical Signs:

    • Kidney failure

    • Tremors

    • Salivation

  • Treatment Options:

    • Induce vomiting

    • Administer activated charcoal

    • Acid reduction treatments

    • Provide IV fluids.

Acid Exposure

  • Common Sources:

    • Toilet bowl cleaners

    • Drain cleaners

    • Batteries

    • Metal cleaners.

  • Exposure Types:

    • Usually through accidental ingestion or dermal contact.

  • Injury Factors:

    • Depends on pH, specific acid, concentration, volume, and time of contact.

  • Severity:

    • pH 2-4 may cause mild irritation.

    • pH <2 can be corrosive.

  • Consequences of Corrosion:

    • Can cause gastrointestinal perforation and septic peritonitis.

    • Dermal contact results in corrosive injury.

    • Inhalation may cause irritation, pulmonary edema, and corrosive injury.

Acid Treatment

  • Immediate Actions:

    • Flush skin/oral membranes for 20 minutes.

    • Important: Do NOT induce vomiting!

  • Binding Issues:

    • Charcoal does not bind to corrosive agents.

    • Neutralizing agents may cause exothermic reactions and thermal burns.

    • Gastroprotectants for oral ingestion:

    • Sucralfate: functions as a "stomach band-aid."

    • Pantoprazole ("IV Prilosec").

  • Supportive Care:

    • Consider injectable medications for quick response.

    • Nutritional support may be necessary (possibly parenteral).

    • Provide analgesia and antibiotics for full gastrointestinal injury and infection risk.

    • Fluid/Blood support may address blood loss and protein loss.

Base Exposure

  • pH Effects:

    • pH 10-11 may cause mild irritation.

    • pH >11-12 results in corrosive injury.

  • Common Sources:

    • Bleach

    • Oven cleaners

    • Dishwasher detergents.

  • Risks:

    • Corrosive injury potential with risks of gastrointestinal perforation and septic peritonitis.

Base Treatment

  • Immediate Actions:

    • Flush skin/oral membranes for 20 minutes.

    • Important: Do NOT induce vomiting!

  • Binding Limitations:

    • Activated charcoal does not bind to corrosive products.

    • Neutralizing agents are ineffective.

  • General Treatment:

    • Treatment is essentially the same as for acid ingestion.

Essential Oils Toxicity

  • Absorption:

    • Lipophilic and well-absorbed across mucous membranes.

  • Pharmacokinetics:

    • Not well defined; effects vary by oil:

    • Clove Oil: Affects hepatobiliary system.

    • Citrus Oil: Affects GI, musculoskeletal, and nervous systems.

    • Peppermint Oil: Affects GI and nervous systems.

    • Wintergreen Oil: Affects GI, blood, hepatobiliary, and respiratory systems.

  • Caution:

    • Many essential oils contain cationic surfactants that are irritating and can cause corrosive injuries to skin and mucous membranes.

Essential Oils Treatment

  • Immediate Actions:

    • Bathe with mild soap if skin contact occurs.

    • Irrigate eyes if they have been exposed.

  • Oral Ingestion:

    • For non-caustic exposure: induce vomiting followed by activated charcoal.

    • For caustic exposure: dilute with milk or water.

  • Supportive Measures:

    • Fluid support

    • Gastroprotectants

    • Hepatoprotectants

    • Antiemetics for nausea and vomiting.

NSAID Toxicity

  • Sensitivity:

    • Cats are particularly susceptible due to decreased liver glucuronidation and longer half-life elimination of NSAIDs.

  • Affected Systems:

    • Gastrointestinal (GI): Can lead to ulcers.

    • Renal: Risk of Acute Kidney Injury (AKI).

    • Hemic: Can cause anemia and platelet loss.

    • Nervous: Can lead to depression and seizures.

  • Treatment Options:

    • Induce vomiting

    • Provide fluid/blood support

    • Administer activated charcoal; may need multiple doses for enterohepatic recirculation.

    • Use gastroprotectants and hepatoprotectants

    • Provide antiemetics for symptomatic relief.

Spays, Neuters, and Reproductive Diseases:

NEUTER

NEUTER - WHEN?

  • Felines:

    • Recommended age: Around 6 months of age.

  • Canines:

    • Small breeds: 6 months of age.

    • Reach skeletal maturity around this age.

    • Medium to large breeds: 1 – 1.5 years.

    • Hormones are important for joint development.

NEUTER - WHY?

  • Felines:

    • Eliminate unwanted litters.

    • Possibly decrease risk of inappropriate urinations/spraying.

  • Canines:

    • Eliminate unwanted litters.

    • Decrease running away and unwanted male behaviors.

    • Decreased occurrence of prostatic disease.

ORCHIECTOMY (NEUTER)

  • Definition: Complete removal of testicles.

  • Canines: Suture closed post-procedure.

    • Closed or open castration technique may be used.

  • Felines: Left open to heal by second intention (natural healing without closure).

SPAY

SPAY - WHEN?

  • Felines:

    • Recommended age: Around 6 months of age.

    • Induced ovulators.

  • Canines:

    • Small breeds: 6 months.

    • Medium to large breeds: 1 - 1.5 years.

    • First heat cycle around 8 months of age.

    • Dogs go into heat every 6 months.

    • Recommended to spay 2-3 months after experiencing the last heat cycle.

SPAY - WHY?

  • Felines:

    • Decreased chances of mammary cancer.

    • Prevent unwanted litters.

    • Eliminate behavioral changes from heat cycles.

    • Possibly decrease chances of inappropriate urinations.

    • Decreased chances of pyometra, a potentially life-threatening infection.

    • 1 in 4 chance that a dog reaching age 10 years will develop pyometra.

  • Canines: Same benefits as in felines listed above.

OVARYHYSTERECTOMY (SPAY)

  • Definition: Traditional spay procedure for canines and felines.

  • Procedure involves removal of:

    • Ovaries and majority of the uterus.

  • As an alternative: Ovariectomy can be performed, which is the removal of only the ovaries.

LAPAROSCOPIC SPAY

  • Description: Ovariectomy procedure involving:

    • Two small incisions (less than 1 cm) for instruments and camera.

    • Provides great visualization during the procedure.

  • Advantages include:

    • Average operating time is minimized.

    • Total scar length is reduced.

    • Lower blood loss compared to traditional spay.

    • Average blood loss for traditional spay: < 8 ml.

    • Average blood loss for laparoscopic spay: < 2 ml.

RABBIT SPAYS - WHEN AND WHY?

WHEN?

  • Ovariectomies conducted at 6 months of age.

WHY?

  • Uterine adenocarcinoma is the most common cancer in rabbits.

  • 60% chance of developing uterine adenocarcinoma in females over 3 years of age.

  • All breeds of rabbits are at risk.

  • Life expectancy is only 1-2 years after onset of clinical signs.

REPRODUCTIVE DISEASES

DYSTOCIA

  • Definition: Difficulty birthing.

  • Higher incidence in brachycephalic (short-nosed) breeds.

  • Caused by:

    • Fetal head/birth canal size mismatch.

    • Increased risk in large litters.

  • Clinical signs include:

    • Contractions for over 1 hour without producing a puppy or kitten.

    • Visibly stuck neonate in the vaginal canal.

DYSTOCIA - TREATMENT

  • Medical management consists of:

    • Calcium gluconate to help with strength of uterine contractions.

    • Oxytocin to increase frequency of uterine contractions.

    • Note: Often unsuccessful.

  • Surgical management involves Caesarean section:

    • Often performed in brachycephalic breeds scheduled in advance to prevent possible dystocia.

PYOMETRA

  • Definition: Pus-filled uterus.

  • Types:

    • Open pyometra:

    • Symptoms include mucoid, purulent, or hemorrhagic vulvar discharge, with or without systemic signs.

    • Closed pyometra:

    • Minimal to no vulvar discharge but presents systemic signs; usually occurs a few weeks to months after the last heat.

PYOMETRA - CLINICAL SIGNS

  • Common symptoms include:

    • Anorexia.

    • Vomiting.

    • Lethargy.

    • Polyuria (excessive urination), polydipsia (excessive thirst).

    • Abdominal pain.

    • Vulvar discharge.

PYOMETRA - DIAGNOSIS

  • Diagnostic tools include:

    • Bloodwork showing leukocytosis.

    • Radiographs indicating a distended, enlarged uterus.

    • Ultrasound revealing an enlarged fluid-filled uterus.

PYOMETRA - TREATMENT

  • Surgical removal is imperative, especially for closed pyometra.

  • Medical management with antibiotics is applicable ONLY for open pyometra.

MAMMARY CARCINOMA

DEFINITION

  • Mammary gland tumors affecting middle-aged to older age dogs and cats.

  • Timing of spay is critical and directly related to the risk of developing mammary cancer.

FELINES - MAMMARY CANCER RISK

  • Spay timing impact on risk of developing mammary cancer:

    • OHE (ovariohysterectomy):

    • < 6 months: 9% risk.

    • 7-12 months: 14% risk.

    • 13 - 24 months: 89% risk.

    • > 2 years: No benefit in reducing risk.

    • OHE before 1st heat: 0.5% risk.

    • OHE between 1st and 2nd heat: 8% risk.

    • OHE between 2nd and 3rd heat: 26% risk.

    • Intact females spayed after 2 years have a 7 times higher risk of mammary cancer.

CANINES - MAMMARY CANCER

CLINICAL SIGNS

  • Firm mass in mammary gland(s).

  • Multiple tumors are common in dogs.

DIAGNOSIS

  • Diagnosis methods include:

    • Biopsy.

    • Histopathology.

    • Fine needle aspirate, though this is not helpful for determining malignancy.

TREATMENT

  • Options include:

    • Surgical excision.

    • Partial or full mastectomy may be required in stages if both mammary chains are affected.

    • Chemotherapy might be indicated in some cases.

CRYPTORCHIDISM

DEFINITION

  • Failure of one (unilateral) or both (bilateral) testes to descend into the scrotum.

  • Considered an inherited trait.

  • Advisory note: Do NOT breed dogs or cats with this condition.

UNILATERAL CRYPTORCHIDISM

  • The retained right testicle is 2 times more likely to be retained compared to the left.

  • A retained testicle has a 10 times greater chance of developing testicular neoplasia (tumors).

CRYPTORCHIDISM - CLINICAL SIGNS

  • Observation of one or no testicles during palpation.

CRYPTORCHIDISM - DIAGNOSIS

  • Can be noted as early as 8 weeks of age.

  • Definitive diagnosis is achieved by 6 months of age.

CRYPTORCHIDISM - TREATMENT

  • Surgical removal of BOTH testicles is necessary.

  • Commonly found in the inguinal region (~75% of cases).

BENIGN PROSTATIC HYPERPLASIA (BPH)

DEFINITION

  • Enlargement of the prostate gland due to sterile, non-neoplastic causes.

  • Affects adult intact male dogs more frequently than cats.

  • Increased risk correlates with increased age:

    • 50% prevalence by 5 years old.

    • 95% prevalence by 9 years old.

BPH - CLINICAL SIGNS

  • Include:

    • Tenesmus (frequency urge to defecate/straining).

    • Secondary thin, ribbon-like defecations.

    • Bloody urethral discharge not always associated with urination.

    • Enlarged, usually painful prostate on rectal exam.

    • Possible abdominal pain.

BPH - DIAGNOSIS

  • Diagnosed through:

    • Prostatomegaly detectable on rectal examination.

    • Ultrasound can help rule out other causes of prostatomegaly, such as cysts or masses.

    • Abdominal radiographs showing an enlarged prostate.

BPH - TREATMENT

  • Neuter is curative for BPH.

  • Additional treatments may include antibiotics to address secondary infections, anti-inflammatories, and stool softeners if needed.


Orthopedic Diseases:

HIP DYSPLASIA

  • Definition: A congenital disease involving abnormal growth and development of the hip joint.

  • Common in large and giant breeds.

  • Characteristics:

    • The acetabulum of the pelvis is shallow.

    • The head of the femur is not held tightly in place.

  • Implications:

    • Predisposes to hip luxation.

    • Increases the likelihood of earlier onset of arthritis.

HIP DYSPLASIA (continued)

  • Clinical Presentation:

    • Some patients may present with complaints of discomfort.

    • Others may present later in life when hip instability leads to osteoarthritis.

    • Severity of disease varies; size of the patient affects presentation and manifestation.

    • Signs may include:

    • Decreased activity

    • Difficulty rising/sitting

    • Hip swaying and bunny hopping.

DIAGNOSING HIP DYSPLASIA

  • Methods of diagnosis include:

    • Gait examinations to observe movement abnormalities.

    • Radiographs to reveal:

    • Shortened femoral neck

    • Irregular/non-rounded femoral head

    • Shallow acetabulum

    • Ortolani Test:

    • A test designed to attempt to subluxate the hip joint.

    • A positive result is characterized by a "clunk" sound as the femoral head falls back into the acetabulum.

HIP DYSPLASIA GAIT

  • Gait analysis is a crucial part of the diagnostic process for hip dysplasia.

HIP DYSPLASIA INTERVENTIONS

  • Management strategies include:

    • Appropriate nutrition and feeding regimen; studies show optimal nutritional requirements are lower than for small breeds.

    • Maintaining a lean body weight.

    • Consideration of timing for ovariohysterectomy (OHE) and orchiectomy (OE).

    • Joint supplements to support joint health.

    • Surgical intervention in severe cases.

    • Long-term interventions are focused on arthritis management.

SURGICAL INTERVENTION

  • Types of surgical intervention:

    • Femoral Head/Neck Ostectomy:

    • Recommended for severe cases.

    • Juvenile Pubic Symphysiodesis:

    • Performed in puppies less than 5 months old; prematurely seals the pubic symphysis.

    • Total Hip Replacement:

    • Indicated in severe cases or when degenerative changes have established.

LEGG-CALVE-PERTHES DISEASE

  • Also known as: Avascular necrosis of the femoral head and neck.

  • Cause: Disruption of blood supply to the femoral head and neck, usually due to trauma but suspected to have a genetic component.

  • Most commonly seen in small breed dogs.

LEGG-CALVE-PERTHES DISEASE (continued)

  • Diagnostic Radiographs:

    • Show necrotic/destructive changes to the femoral head.

  • Clinical signs:

    • Joint pain and lameness associated with bone and cartilage deterioration.

  • Surgical intervention:

    • Femoral head and neck ostectomy is inevitable.

FEMORAL HEAD AND NECK OSTECTOMY

  • Procedure involves removal of the femoral head and neck (the "ball" of the ball-and-socket joint).

  • Outcome: Creates a false joint.

  • Important to manage pain both preoperatively and postoperatively.

HYPERTROPHIC OSTEODYSTROPHY

  • Definition: An auto-inflammatory disease typically seen in puppies usually between 7 weeks to 8 months of age.

  • Pathophysiology: Decreased blood flow to bone parts adjacent to the joint.

  • Commonly affects long bones of the limbs.

  • Often involves multiple limbs, with relapses lasting up to 20 months.

  • More prevalent in large and giant breeds.

HYPERTROPHIC OSTEODYSTROPHY (continued)

  • Clinical signs:

    • Symptoms vary from mild limping to severe cases with fever (up to 106°F) and anorexia.

    • Involves swollen, warm, painful bones and unwillingness to stand.

  • Treatment:

    • Suppressing the inflammatory response with NSAIDs or steroids for up to one year.

    • Additional analgesics may be needed.

    • Some cases resolve without intervention.

OSTEOCHONDROSIS DISSECANS

  • Definition: Development of a cartilage flap over bone joint cartilage leading to inflammatory response.

  • Commonly affected joints:

    • Shoulder joint (most common)

    • Elbows, knees, and ankles

  • Typically seen in fast-growing large breed dogs; more common in males than females.

OSTEOCHONDROSIS DISSECANS (continued)

  • Clinical presentation:

    • May present soreness after heavy activity; can progress to limping/lameness.

  • Diagnostic radiographs:

    • Reveal defects.

    • If the flap completely tears and mineralizes, known as a "joint mouse."

  • Treatment options:

    • Activity restriction and pain management.

    • Surgery for cartilage removal and/or plugging may be required.

    • Expected recovery time is 2-3 months.

CRANIAL CRUCIATE LIGAMENT RUPTURE

  • Description: CCL rupture is synonymous with ACL injuries in humans and is the most common knee injury in dogs.

  • Function of the CCL:

    • Prevents cranial displacement of the tibia.

    • Prevents hyperextension.

    • Prevents internal rotation.

  • Injury implications:

    • Usually associated with strenuous activity, leading to instability, inflammation, and discomfort.

    • Clinical sign includes acute lameness, often characterized by a "drawer sign."

    • Tests for diagnosis:

    • Cranial drawer test

    • Tibial thrust test

  • Risk Factor:

    • Increased risk of tearing the opposing CCL within one year of the initial injury.

CRANIAL DRAWER AND TIBIAL THRUST TESTS

  • Cranial Drawer Test:

    • Technique: Place one hand with the index finger on the stifle to stabilize and the thumb on the fabella; the other hand's index finger is placed on the tibial tuberosity with the thumb on the fibular head.

  • Tibial Thrust Test:

    • Technique: Stabilize the femur with the index finger over the patellar ligament and the tibial tuberosity; flex the hock and check for cranial movement of the tibia.

SURGICAL INTERVENTION FOR CCL TEARS

  • Types of surgical intervention:

    • Extracapsular: Surgery occurring outside the joint capsule; suitable for small dogs.

    • Lateral Stabilization: Heavy nylon or wire suture placed to function as a false ligament.

    • Intracapsular: Surgery occurring within the joint capsule.

    • Tibial Plateau Leveling Osteotomy: A technique to normalize the mechanics of the stifle joint.

    • Tibial Tuberosity Advancement: Technique to improve stability.

  • Note: Arthritis remains a risk even after surgical interventions.

  • Importance of pain management and a gradual return to physical activity post-surgery.

OSTEOSARCOMA

  • Definition: The most common bone tumor in dogs, significant in young (usually large to giant breeds) and older dogs.

  • Tumor Characteristics:

    • Dogs predominantly have appendicular tumors.

    • Common sites include the carpus, shoulder, and stifle – "away from the elbow and near the knee."

    • In cats, tumors are more likely to be axillary.

OSTEOSARCOMA TREATMENT

  • Diagnosis made with radiographs revealing bone lysis/destruction.

  • Concurrent chest films are necessary to assess for metastatic tumors.

  • Recommended treatment:

    • Amputation of the affected limb followed by chemotherapy, which improves survival rates.

    • Life expectancy of ~6-12 months with amputation and chemotherapy.

    • Amputation without chemotherapy results in a life expectancy of 3-5 months.

    • Without surgery and chemotherapy, euthanasia usually occurs 1-2 months post-diagnosis due to pain and risk of pathologic fractures.

  • Limb-sparing procedures are also available, using a bone graft to remove just the tumor.


Ophthalmic Diseases:

Entropion

  • Definition: A condition where the eyelid rolls inward, causing hairs and eyelashes to rub against the cornea.

  • Underlying Causes:

    • Primarily genetic or breed-associated:

    • Macroblepharon: Refers to having large eyelids.

      • Affects breeds like Hounds, Great Danes, and Shar Pei.

    • Brachycephalic breeds: Bulldogs, Shih Tzu, Persians.

    • Can also occur secondarily due to:

    • Dehydration

    • Eyelid trauma

    • Neurologic changes

  • Symptoms:

    • Corneal injury or ulceration

    • Epiphora: Excessive tearing

    • Blepharospasms: Squinting

    • Photophobia: Light sensitivity

Entropion Management

  • Protect the cornea using hydration products.

  • Treat any secondary infections.

  • Check for corneal injury by staining.

  • Surgical Treatment: Ultimately, a modified Hotz-Celsus procedure is needed for correction.

Cherry Eye

  • Also known as: Prolapsed nictitans.

  • Mechanism:

    • Weak tissue fibers fail to hold the gland of the third eyelid in place, leading to protrusion.

    • Protrusion results in poor blood flow and eventually swelling of the gland.

    • Can cause altered tear production.

  • Breeds Commonly Affected: Boston Terriers, Beagles, Cocker Spaniels, Bulldogs.

  • Importance: The gland of the nictitans produces up to 50% of the eye's tears.

  • Warning: DO NOT remove the gland, as this can lead to iatrogenic dry eye.

Cherry Eye Surgery

  • Procedure: Pocket imbrication surgery involves replacing the gland back into position during surgery.

  • Note: Ensure the incision is not completely closed to allow for tear drainage to lubricate the eye.

Corneal Ulcers

  • Description: The cornea is a clear tissue due to continued hydration from tear production.

    • The outermost layer is the epithelium, and the innermost layer is the endothelium, with Descemet's membrane above it.

  • Characteristics:

    • Corneas are avascular and receive nutrients from the aqueous humor and tear film.

    • Injury leads to the formation of blood vessels.

  • Causes of Corneal Ulcers:

    • Varied and can include:

    • Trauma (e.g., cat nails, ocular foreign bodies, facial rubbing, entropion).

    • Drying of the cornea (such as dry eye, neurologic disease, eyelid malformations).

  • Presentation:

    • Ocular pain, epiphora, corneal edema, and corneal vascularization.

  • Nerve Supply: The outer third of the cornea contains the nerve supply; resolution of pain does not necessarily indicate healing.

  • Potential Progression: Can lead to a descemetocele, necessitating surgery.

Corneal Ulcer Diagnosis

  • Method: Fluorescein staining is used for diagnosis.

  • Mechanism: The epithelium and endothelium of the cornea are hydrophobic and do not absorb the stain, while the stroma is hydrophilic and absorbs it, revealing the ulcer.

Corneal Ulcer Treatment

  • Management: Most ulcers are treated with topical ophthalmic medications.

  • Important Note: DO NOT USE STEROIDS as they worsen the ulcer.

  • Healing Timeline: All corneal cells are replaced in one week; thus, ulcers should heal within that timeframe.

  • In Severe Cases: Conjunctival pedicle grafts may be necessary.

  • Failure to Heal: May indicate the presence of an indolent ulcer.

Indolent Corneal Ulcers

  • Also known as: Boxer Ulcer, as Boxers are commonly affected.

  • Characteristics: A failure of the ulcer's leading edge to heal with deeper stroma involvement.

  • Treatment:

    • Debridement: Removal of the flap and performing a keratectomy.

    • Keratectomy: Involves creating micro-abrasions into the corneal stroma to facilitate epithelial tissue regrowth.

  • Technique: GRID KERATOTOMY using a 25-gauge needle.

Keratoconjunctivitis Sicca (KCS)

  • Also known as: Dry Eye.

  • Causes:

    • Commonly an autoimmune disease affecting tear glands.

    • Breeds affected include Cocker Spaniel, West Highland White Terrier (WHWT), Schnauzer.

    • Can also result from secondary ocular conditions.

    • Caution: Sulfa-containing antibiotics can lead to KCS.

    • More prevalent in black and tan breeds.

  • Effect: Decreased production of the water component of the tear film, leaving oil and mucus components, leading to mucoid discharge.

  • Symptoms: Corneal pigmentation may manifest in chronic cases.

Keratoconjunctivitis Sicca Diagnosis and Treatment

  • Diagnosis: Schirmer Tear Test; normal tear production is indicated by a paper wick of 15 mm in 1 minute.

  • Treatment:

    • Immunosuppressive eye medication for autoimmune causes.

    • Surgical correction for structural issues (entropion, cherry eye, eyelid agenesis, etc.).

    • Use artificial tear products to support cornea hydration.

    • Surgical relocation of the salivary duct to the eye for hydration.

Pannus

  • Also known as: Chronic Superficial Keratitis.

  • Prevalent Breed: German Shepherd is overrepresented.

  • Nature: An immune-mediated disease affecting the cornea.

  • Presentation:

    • Typically presents as a raised pink mass on the cornea, usually toward the lateral edge of the eye.

    • Usually bilateral; lesions may flatten and spread across the cornea, leading to blindness if untreated.

  • Exacerbating Factors: UV light and high-altitude environments can worsen the condition.

Pannus Treatment

  • Primary Treatment: Steroids or immunosuppressive medications.

  • Additional Care: Treat secondary infections with topical antibiotics.

  • Prevention: Use doggles to shield the eyes from UV exposure.

Uveitis

  • Definition: Inflammation of the uvea, which consists of the iris, ciliary body, and choroid.

  • Types:

    • Anterior involvement (iris and ciliary body)

    • Posterior involvement (choroid and retina)

    • Panuveitis (all uveal tissue)

  • Causes: Various origins, including:

    • Infectious

    • Neoplastic

    • Traumatic

    • Immune-mediated

    • Idiopathic.

  • Symptoms: Anterior uveitis results in red eyes, ocular pain, miosis (constricted pupil), blepharospasms, and photophobia.

  • Intraocular Pressure: Usually low intraocular pressure is observed.

Uveitis Management

  • Treatment: Focuses on addressing the underlying cause.

  • Medications: Anti-inflammatories and steroids are commonly used.

  • Risks: Untreated uveitis can result in blindness and secondary glaucoma.

Glaucoma

  • Definition: A condition characterized by increased intraocular pressure.

  • Symptoms: Causes ocular pain, buphthalmia (enlargement of the eye), mydriasis (dilated pupils), and in severe cases, blindness and potential eye rupture.

  • Cause: Typically arises from issues draining the aqueous humor, not from overproduction.

Glaucoma Diagnosis and Treatment

  • Diagnosis: Measured through eye pressure evaluation.

  • Management: Treatment may involve topical eye medications or surgery, which could potentially restore vision.

  • Severe Cases: In instances of non-responsive glaucoma, enucleation may be necessary.

Endocrine Diseases:

CANINE DISEASES

HYPERADRENOCORTICISM (HAC)

  • Also known as "Cushing's Disease"

  • A disease caused by excessive cortisol production

  • Cortisol: A natural body steroid

Forms of Hyperadrenocorticism:

  • Pituitary-dependent (PDH):

    • Accounts for ~ 80-85% of cases

  • Adrenal-dependent (ATH):

    • Accounts for ~ 15-20% of cases

  • Iatrogenic:

    • Caused by medications leading to prolonged steroid use

Adrenal Glands:

  • Described as the cortisol factories of the body

PITUITARY-DEPENDENT HAC

  • Caused by a benign pituitary tumor

  • Common in middle-aged to older dogs

  • Usually affects small breeds such as:

    • Beagles

    • Dachshunds

    • Poodles

    • Terriers

  • Physical effects: Bilateral adrenal gland enlargement

ADRENAL-DEPENDENT HAC

  • Caused by an adrenal tumor

  • Typically affects medium to large breeds such as:

    • German Shepherds

    • Labrador Retrievers

    • Poodles

  • Physical effects: Unilateral adrenal gland enlargement

CLINICAL SIGNS OF HAC

  • Symptoms Include:

    • Polyuria (excessive urination)

    • Polydipsia (excessive thirst)

    • Polyphagia (excessive hunger)

    • Pendulous abdomen

    • Panting

    • Alopecia (especially along the trunk)

DIAGNOSIS OF HAC

  • Methods Include:

    • Screening bloodwork showing:

      • Increased ALP (Alkaline Phosphatase)

      • Increased platelets

    • Urinalysis revealing low urine specific gravity (< 1.020)

    • Ultrasound for:

      • PDH: Bilaterally enlarged adrenal glands

      • ATH: Unilaterally enlarged adrenal glands

    • Low Dose Dexamethasone Suppression Test (LDDST):

      • Confirmatory test to differentiate PDH HAC vs ATH HAC

    • ACTH Stimulation Test:

      • Will not differentiate between HAC forms

      • Only test to identify iatrogenic HAC

  • Diagnostic Choice: LDDST is preferred

TREATMENT OF HAC

  • Goals: Lifelong management of clinical signs

  • For Pituitary-dependent HAC:

    • Trilostane (Vetoryl):

      • Inhibits cortisol synthesis

    • Mitotane (Lysodren):

      • Destroys glucocorticoid-producing zones of adrenal glands

  • For Adrenal-dependent HAC:

    • Adrenalectomy: Surgical removal of the affected adrenal gland

HYPOADRENOCORTICISM

  • Also known as "Addison's disease"

  • Caused by adrenocortical insufficiency

  • May occur due to:

    • Damaged adrenal gland or medication

  • Commonly seen in:

    • Young to middle-aged female dogs

  • Breeds affected include:

    • Standard Poodles

    • Portuguese Water Dogs

    • West Highland White Terriers

    • Rottweilers

    • Soft-Coated Wheaten Terriers

CLINICAL SIGNS OF HYPOADRENOCORTICISM

  • Symptoms are notoriously vague and fluctuate in presence:

    • Worsening of signs in stressful situations

    • Weakness

    • Lethargy

    • Anorexia (loss of appetite)

    • Vomiting

    • Can present as a life-threatening crisis with severe signs:

      • Mental depression

      • Bradycardia (slow heart rate)

      • Hypovolemic shock (reduced blood volume)

DIAGNOSIS OF HYPOADRENOCORTICISM

  • Methods Include:

    • Screening bloodwork showing:

      • Anemia

      • Absence of a stress leukogram

      • Hyponatremia (low sodium)

      • Hyperkalemia (high potassium)

    • ACTH Stimulation Test:

      • Confirmatory test revealing low serum cortisol concentration

    • Definitive Diagnostic Test: ACTH

TREATMENT OF HYPOADRENOCORTICISM

  • If in Addisonian crisis:

    • IV fluids

    • Glucocorticoids (injectable)

  • Chronic Management:

    • Glucocorticoid supplementation (e.g., Prednisone)

    • Mineralocorticoid supplementation (e.g., DOCP injections (Zycortal) every 25 days)

CUSHING'S DISEASE VS ADDISON'S DISEASE

  • Cushing's Disease:

    • Hyperadrenocorticism

    • Increased cortisol production

  • Addison's Disease:

    • Hypoadrenocorticism

    • Decreased cortisol production

HYPOTHYROIDISM

  • Condition characterized by decreased thyroid hormone from the thyroid gland

  • Most commonly due to atrophy of the thyroid glands

  • Seen in middle-aged dogs

  • Breeds affected include:

    • Any breed!

    • Boxers

    • Dachshunds

    • Doberman Pinschers

    • Golden Retrievers

MECHANISM OF THYROID HORMONE PRODUCTION

  • Process:

    • Hypothalamus releases Thyrotropin-Releasing Hormone (TRH)

    • TRH stimulates the pituitary gland to produce Thyroid Stimulating Hormone (TSH)

    • TSH triggers the thyroid glands to produce:

      • T3 (triiodothyronine)

      • T4 (thyroxine)

      • Calcitonin

CLINICAL SIGNS OF HYPOTHYROIDISM

  • Symptoms Include:

    • Unexplained weight gain

    • Lethargy

    • Mental dullness

    • Exercise intolerance/inactivity

    • Cold intolerance

    • Bilaterally symmetrical truncal alopecia (loss of hair)

    • "Rat tail" appearance

DIAGNOSIS OF HYPOTHYROIDISM

  • Methods Include:

    • Low Total T4 (TT4): Measures both free and protein-bound T4

    • Low Free T4 (fT4): More sensitive measure of metabolically available T4

    • Increased TSH

    • Confirmation: Hypothyroidism should always be confirmed with an fT4 + TSH

EUTHYROID SICK SYNDROME

  • A condition where thyroid hormone levels are low in patients with underlying systemic illness

  • Important to note: Low TT4 DOES NOT mean the patient is hypothyroid!

    • This syndrome is often a reason for over-diagnosis

    • Emphasis on treating the underlying disease is crucial

    • Thyroid supplementation is unnecessary in this case

TREATMENT OF HYPOTHYROIDISM

  • Management Approach: Lifelong treatment

  • Goal: Increase serum T4 levels to normal range and eliminate clinical signs

  • Medication:

    • Levothyroxine: Synthetic T4 supplementation

FELINE DISEASES

DIABETES MELLITUS

  • A disease characterized by decreased production of insulin by the pancreatic beta cells and/or decreased insulin utilization by peripheral tissues

  • Commonly affects older dogs and cats

  • Dog Breeds Affected:

    • Bichon Frise

    • Cairn Terrier

    • Miniature and Standard Poodles

    • Miniature and Standard Schnauzers

  • Cats: Obese cats are predominantly affected

CLINICAL SIGNS OF DIABETES MELLITUS

  • Symptoms Include:

    • Polydipsia (excessive thirst)

    • Polyuria (excessive urination)

    • Polyphagia (excessive hunger)

    • Weight loss despite increased appetite

    • Specific signs in dogs: Blindness from cataracts

    • Specific signs in cats: Poor hair coat/lack of grooming and plantigrade stance (walking on the flat of the foot)

DIAGNOSIS OF DIABETES MELLITUS

  • Methods Include:

    • Bloodwork showing hyperglycemia (high blood sugar)

    • Urinalysis revealing glucosuria (glucose in urine)

TREATMENT OF DIABETES MELLITUS

  • Management Approach: Lifelong care

  • Insulin Therapy: Given twice daily after meals

    • Medications:

      • Vetsulin for dogs and cats

      • Glargine for cats

  • Dietary Recommendations: High protein, low carbohydrate diets

CATASTROPHIC COMPLICATIONS OF DIABETES MELLITUS

  • Cataract Formation:

    • Common in dogs, will not occur in cats

    • Cats lack the enzyme aldose reductase responsible for diabetic cataract formation

  • Remission Possibility:

    • Dogs are considered Type I diabetics, therefore will not experience remission

    • Cats may experience some remission

HYPERTHYROIDISM

  • A disease of continued excessive secretion of thyroid hormones

  • Causes:

    • Benign thyroid neoplasia or hyperplasia involving one or both thyroid lobes

  • Commonly seen in older cats (typically > 8 years of age)

CLINICAL SIGNS OF HYPERTHYROIDISM

  • Symptoms Include:

    • Weight loss despite a normal to increased appetite

    • Polyphagia (increased hunger)

    • Vomiting ± diarrhea

    • Hyperactivity or changes in attitude (nervousness)

    • Decreased grooming activity leading to poor haircoat

    • Possible palpable thyroid gland

    • Palpable signs: Thyroid slip

DIAGNOSIS OF HYPERTHYROIDISM

  • Methods Include:

    • Screening bloodwork showing:

      • Increased ALT (Alanine Aminotransferase)

      • Increased Total T4 (TT4): Definitive diagnosis

TREATMENT OF HYPERTHYROIDISM

  • Medications:

    • Methimazole: Suppresses production of thyroid hormones

  • Procedures:

    • I131 therapy:

      • A radiation treatment that cures hyperthyroidism by rendering hyperfunctional thyroid tissues nonfunctional

ACROMEGALY

  • A disease resulting from chronic exposure to excessive growth hormone (GH) from an adenoma (tumor) of the pituitary gland

  • Leads to the overgrowth of connective tissue, bone, and internal organs

  • Commonly causes insulin-resistant diabetes mellitus

  • Typically observed in middle-aged to older males

CLINICAL SIGNS OF ACROMEGALY

  • Symptoms Include:

    • Polyuria (excessive urination)

    • Polydipsia (excessive thirst)

    • Polyphagia (excessive hunger)

    • Weight gain despite signs of diabetes mellitus

    • Large, prominent head

    • Gallop heart sounds, congestive heart failure (CHF)

    • Lameness

    • Neurologic signs

    • Thickening of oropharyngeal soft tissues

    • Enlargement of the lower jaw

    • Stridor/snoring

DIAGNOSIS OF ACROMEGALY

  • Methods Include:

    • Screening bloodwork showing:

      • Hyperglycemia

      • Mild elevations in ALT and ALP (Alkaline Phosphatase)

    • Radiographs showing oropharyngeal tissue hypertrophy and degenerative joint disease in multiple joints

    • Hormonal measurements showing increased growth hormone concentrations

      • Note: Increased GH can occur in other diseases as well

    • IGF-1 assay:

      • Hormone produced by liver in response to GH

    • CT or MRI of the pituitary gland

TREATMENT OF ACROMEGALY

  • Management Approaches:

    • If diabetic, adjust insulin dose to maintain glycemic control

    • No consistently effective treatment for long-term management

    • Radiation therapy of the pituitary tumor:

      • Best available option with variable and rarely permanent response


Cardiovascular Diseases:

Cardiovascular Diseases of Dogs and Cats

Heart Anatomy

  • Arteries: Blood flows away from the heart. This blood is directed towards the lungs for oxygenation.

  • Veins: Blood flows towards the heart. It consists of oxygenated blood, which is returned to the heart to circulate throughout the body.

  • Diastole: Phase characterized by the filling of the ventricles in the heart.

  • Systole: Phase characterized by the contraction of the ventricles in the heart.

  • Blood flow direction: Blood flows in one direction through the heart.

Main Components of the Heart

  • Cranial Vena Cava: Returns deoxygenated blood from the upper body to the heart.

  • Caudal Vena Cava: Returns deoxygenated blood from the lower body to the heart.

  • Right Atrium: Receives blood from the vena cavae.

  • Right Ventricle: Pumps deoxygenated blood to the lungs via the pulmonary artery.

  • Pulmonary Artery: Delivers deoxygenated blood to the lungs.

  • Pulmonary Veins: Return oxygenated blood from the lungs to the heart.

  • Left Atrium: Receives oxygenated blood from the pulmonary veins.

  • Left Ventricle: Pumps oxygenated blood to the body through the aorta.

  • Aorta: The main artery that carries oxygen-rich blood away from the heart.

  • Valves: Includes mitral valve, tricuspid valve, aortic valve, and pulmonary valve, ensuring proper blood flow direction within the heart.

Heart Sounds

  • Normal Heart Sounds: Described as “Lub – Dub.”

    • These sounds are produced by the opening and closing of the heart valves.

    • Best heard at the apical impulse, located on the left side of the thorax, around the 4th - 6th intercostal space.

    • Assessment should include listening to both sides of the chest.

Abnormal Heart Sounds

  • Heart Murmurs: The most common abnormal sound detected.

    • Suggest underlying heart disease; in cats, often associated with functional murmurs due to stress.

    • Can be differentiated using a Pro-BNP test.

    • Results from turbulent blood flow, creating vibrations detected with a stethoscope producing a “whoosh” sound.

    • Murmurs can be classified based on location, timing, and loudness.

    • Point of Maximal Intensity (PMI): The best location to auscultate murmurs.

Grading of Heart Murmurs

  • Heart Murmur Grades (from Grade I to VI):

    • Grade I: Very soft murmur, not immediately audible.

    • Grade II: Soft murmur, noted with careful auscultation.

    • Grade III: Moderate murmur, easily audible.

    • Grade IV: Loud murmur without accompanying thrill.

    • Grade V: Loud murmur with palpable thrill.

    • Grade VI: Murmur audible with the stethoscope off the chest wall.

Common Cardiovascular Diseases

Mitral Valve Degeneration (MVD)

  • Description: Most common cardiac disease in small breed dogs, characterized by the degenerative disturbance of mitral valve connective tissue.

  • Consequences:

    • Leads to mitral valve regurgitation, resulting in cardiac volume overload.

    • Can progress to congestive heart failure (CHF) if untreated.

  • Age Factor: Prevalence increases with age.

  • Breeds Affected:

    • Cavalier King Charles Spaniels

    • Papillons

    • Miniature Poodles

    • Yorkshire Terriers (Yorkies)

    • Chihuahuas

    • Dachshunds

    • Typically affects small breed, older dogs.

Clinical Signs of MVD

  • Heart Murmur: Typically a left-sided apical systolic murmur.

  • Respiratory Signs: Can include tachypnea (increased respiratory rate) or dyspnea (difficulty breathing).

Diagnosis of MVD

  • Methods:

    • Auscultation: Detection of murmurs.

    • Radiographs: To visualize heart size and structure.

    • Echocardiogram: Assess heart function, often showing left atrial enlargement and cardiomegaly.

Treatment for MVD

  • Monitor: Regular chest radiographs every 6 months for less severe cases.

  • Medications:

    • Pimobendan (Vetmedin): A positive inotrope that helps the heart pump efficiently and may slow heart size change.

  • Monitoring for CHF: Important to detect worsening of the condition.

Dilated Cardiomyopathy (DCM)

  • Description: Condition characterized by impaired systolic function of one or both ventricles leading to enlargement and possible CHF.

  • Dietary Associations:

    • Dogs: Linked to grain-free diets.

    • Cats: Historically associated with taurine deficiency (pre-1987).

  • Affected Groups:

    • Mostly dogs, but can also affect cats.

  • Typical Onset Age: 4-10 years; males are affected more than females.

  • Breeds Affected:

    • Doberman Pinschers

    • Irish Wolfhounds

    • Great Danes

Clinical Signs of DCM

  • Varying clinical signs (may be absent):

    • Potential for cardiac arrhythmias.

    • Syncope (temporary loss of consciousness due to low blood pressure).

    • Soft grade I-III systolic left/right apical murmur.

    • +/- signs of congestive heart failure.

Diagnosis of DCM

  • Methods:

    • Breeds: Diagnosis suspected based on breed predispositions with heartbeat irregularities or murmurs.

    • Radiographs: To check for cardiomegaly and enlarged atriums.

    • ECG: May show sinus tachycardia or ventricular tachycardia.

    • Echocardiogram: Confirm ventricular and atrial dilation and reduced myocardial systolic function.

Treatment for DCM

  • Medications:

    • Antiarrhythmics

    • Digoxin: Helps improve heart function.

    • Pimobendan (Vetmedin): Improves pumping ability.

    • ACE inhibitors: Used to lower blood pressure.

Hypertrophic Cardiomyopathy (HCM)

  • Description: Characterization of increased ventricular wall thickness, primarily the left ventricle, altering how blood is pumped.

  • Common in: Older cats, leads to risks such as thromboembolism and Feline Arteriothrombembolism (FATE), which can cause saddle thrombus leading to hind limb paralysis.

Clinical Signs of HCM

  • Often asymptomatic; may be incidentally found during exam:

    • Presence of systolic murmurs.

    • Potential for arrhythmias.

    • Signs of CHF may be present.

Diagnosis of HCM

  • Methods:

    • Pro-BNP Test: Assesses heart muscle damage.

    • Echocardiogram: Will show increased septal and left wall thickness, with potential left atrial enlargement.

    • ECG: May reveal ventricular premature complexes.

    • Radiographs: Indicate overall cardiomegaly.

Treatment for HCM

  • Medications:

    • ACE inhibitors: Help relax blood vessels.

    • Clopidogrel: A platelet aggregation inhibitor reducing clot formation risk.

  • Ongoing monitoring for signs of CHF is necessary.

Patent Ductus Arteriosus (PDA)

  • Description: An arterial shunt between the aorta and pulmonary artery that should close 24 hours after birth but may remain open (patent).

    • It is the most common congenital heart defect in dogs.

  • Age of Onset: Primarily affects young dogs.

  • Breeds Affected:

    • Maltese

    • Pomeranian

    • Shetland Sheepdog

    • Collie

    • Irish Setter

Clinical Signs of PDA

  • Often discovered incidentally during examination.

  • Heart murmur: Continuous in nature.

  • Additional signs may include exercise intolerance and failure to thrive, with possible signs of CHF.

Diagnosis of PDA

  • Methods:

    • Radiographs: To check for enlarged aorta and left heart side.

    • Echocardiogram: Confirms the presence of a patent ductus.

Treatment for PDA

  • Surgical Options:

    • PDA closure with a ductal occluder.

    • Vessel ligation via thoracotomy.

Congestive Heart Failure (CHF)

  • Description: Characterized by sudden onset of respiratory distress or fluid retention due to heart disease.

    • Pressure in capillaries increases to the point that vessels leak due to heart dysfunction.

    • Classifications include:

    • Right-sided CHF: Manifests as ascites and pleural effusion.

    • Left-sided CHF: Results in pulmonary edema.

Clinical Signs of CHF

  • Typical symptoms may include:

    • Tachypnea: Increased respiratory rate.

    • Dyspnea: Labored breathing.

    • Cough: Especially in dogs.

    • Presence of pulmonary crackles.

    • Difficulty exercising and restlessness.

    • Heart murmurs can also be noted.

Diagnosis of CHF

  • Methods:

    • Radiographs: Identify decreased serosal detail in right-sided CHF and pulmonary edema in left-sided CHF.

    • Left atrial enlargement can also be detected.

Treatment for CHF

  • Medications:

    • Furosemide: A diuretic for fluid retention.

    • Oxygen therapy: To support breathing.

    • ACE inhibitors: To assist in managing heart failure effectively.


Exotic Animal Medicine: Small Mammals

Ferrets

  • Classification and Characteristics
      - Ferrets are relatives of weasels, skunks, and otters.
      - Many ferrets in the United States are sourced from commercial breeding farms;
        - Common practices include spaying/neutering and descenting.
      - Average Life Expectancy: 6-8 years.

  • Terminology:
      - Intact male: Hob
      - Neutered male: Gib
      - Intact female: Jill
      - Neutered female: Sprite
      - Young: Kit
      - Group: Business

  • Diet:
      - Ferrets are obligate carnivores.
      - Their diet should comprise 30-40% protein and 15-20% fats.
      - Avoid cat food as it can lead to obesity and increase the risk of bladder stones.

  • Housing:
      - Multi-level enclosures are recommended.
      - To stimulate natural behaviors, provide tubular activity inserts like:
        - PVC piping
        - Cardboard tubes
        - Cat tunnels
      - Hammocks can serve as recreational areas.
      - Ferrets can be litter trained.

  • Preventative Care:
      - Vaccination against Distemper Virus and Rabies is crucial.
      - Administer diphenhydramine prior to vaccinations to mitigate risks of vaccine reactions.

  • Heartworm Prevention:
      - Ferrets can be potential carriers for heartworm, ensuring preventive care is essential, though prevention methods may be off-label.

  • Ferret Adrenal Disease:
      - Age of Onset: 2-3 years; median age is 4.5 years.
      - Prevalence: 80% of ferrets over 5 years exhibit symptoms of adrenal disease.
      - Pathophysiology: Involves overproduction of sex hormones.
      - Etiology: Suggested connection between lack of sex organs and prolonged photoperiods.
      - Clinical Signs:
        - Hair loss, predominantly on the caudal body.
        - Vulvar swelling in females and prostate enlargement in males.
        - Potential urinary obstruction in males.
        - Pruritis.
      - Treatment Options:
        - Hormone Therapy: Hormone implant to suppress GnRH production for a duration of 12-18 months.
        - Surgical: Adrenalectomy (removal of adrenal glands).

Rabbits

  • General Information:
      - Rabbits serve multiple purposes:
        - Fiber/wool production
        - Meat source
        - Companionship
      - Average Lifespan: 6-10 years.
      - Physiologically, rabbits are post-gastric fermenters characterized by a large cecum and the practice of coprophagy.

  • Terminology:
      - Male: Buck
      - Female: Doe
      - Young: Kit

  • Diet:
      - Primarily hay-based, complemented with whole pellets and leafy vegetables.
      - Reserve alfalfa for lactating does and growing kits due to its high calcium content, which can pose a risk for bladder stones.
      - Avoid fruit as it may lead to high sugar intake and intestinal dysbiosis.

  • Husbandry:
      - Requires spacious areas for activity, promoting gastrointestinal and urinary health.
      - Social species that typically flourish in groups.

  • Preventative Care:
      - Vaccination against Rabbit Hemorrhagic Disease (RHD).
      - U.S. experienced outbreaks of RHDV-2 from 2020 to the present in the Southwest, characterized by fatal hepatic necrosis.
      - Vaccination for RHD is approved by USDA for emergencies.
      - Regular examinations for dental health are necessary.
      - Preventative measures against parasites should be routinely taken.

  • Encephalitozoon cuniculi:
      - An endemic intracellular microsporidian parasite primarily spread through urine or transplacentally.
      - Absorbed from the intestinal tract, entering the bloodstream, and affecting multiple organs.
      - Clinical Signs:
        - Many rabbits may remain asymptomatic.
        - Torticollis (Wry Neck).
        - Uveitis, often seen in cases of transplacental infection.
        - Nephritis.
      - Diagnosis:
        - Use of IFA (Immunofluorescent Antibody) antibody titers.
        - Seropositivity does not imply active infection; antibodies typically peak 3 weeks post-infection.
      - Treatment Options:
        - Some instances resolve spontaneously.
        - Administer fenbendazole (Panacur) for 28 days.
        - Provide support for motion sickness as needed.
        - Phacoemulsification or enucleation is indicated for cases of severe uveitis.

Rats

  • General Characteristics:
      - Average lifespan ranges from 2-3 years.
      - Nocturnal and omnivorous in nature.
      - Highly social animals that enjoy burrowing.

  • Terminology:
      - Male: Buck
      - Female: Doe
      - Young: Pups

  • Diet:
      - A balanced pelleted diet is recommended.
      - Obesity is prevalent amongst pet rats due to unhealthy selective eating patterns.

  • Husbandry:
      - Utilize deep-bedded multi-level cages, preferably metal wired for adequate ventilation over aquariums.
      - Offer various textures to support chewing behavior (e.g., paper, cardboard).
      - Observed floor time is essential, as rats may exhibit destructive behaviors.

  • Mammary Tumors in Rats:
      - Incidence: 30-90% in females, 16% in males.
      - Most tumors are benign fibroadenomas, while roughly 10% are adenocarcinomas.
      - Treatment:
        - Surgical removal is recommended.
        - Ovariohysterectomy is often necessary when masses ulcerate or impede mobility.

Hamsters

  • General Information:
      - Lifespan averages 2-3 years.
      - Nocturnal herbivores categorized as:
        - Males: Boars
        - Females: Sows
        - Young: Pups
      - Notable for their large cheek pouches for foraging.

  • Diet:
      - Optimal diet consists of rodent chow.
      - Seed-based diets can lead to vitamin E deficiencies.

  • Husbandry:
      - Require deep-bedded cages conducive to burrowing behavior.
      - Some species may be territorial; caution is necessary during introductions.

  • Wet Tail (Proliferative Ileitis or Tyzzer's Disease):
      - Symptoms: Foul-smelling diarrhea, unkempt fur, dehydration, weight loss, and potential death.
      - Often exacerbated by stress (e.g., overcrowding, humidity, shipping).
      - Commonly caused by Lawsonia intracellularis, but can also be attributed to other pathogens (Clostridium, E. coli, Helicobacter, etc.).
      - Condition primarily affects the small intestines, leading to malabsorption issues.
      - Treatment Options:
        - Recommend antimicrobial therapy, such as metronidazole.
        - Ensure fluid and nutritional support.

Guinea Pig/Cavy

  • General Characteristics:
      - Average lifespan is 6-8 years.
      - Crepuscular behavior.

  • Terminology:
      - Males: Boars
      - Females: Sows
      - Young: Pups (precocial).

  • Diet:
      - Strictly herbivorous; dietary components include:
        - Unlimited grass hay
        - Leafy vegetables
        - Pellets
      - Vitamin C is essential, as guinea pigs cannot synthesize it and require external supplementation.

  • Husbandry:
      - Prefer single-level enclosures equipped with huts and hiding spots.
      - It is detrimental to house them with rabbits due to the risk posed by Bordetella, which can be fatal to guinea pigs.

  • Malocclusion:
      - Defined as "bad close"; typically results from inadequate diet or genetic factors.
      - Their teeth are hypsodont, and the premolars/molars have an s-shaped alignment, which may entrap the tongue and lead to anorexia.
      - Treatment involves regular dental trims and nutritional support.

Hedgehogs

  • General Characteristics:
      - Nocturnal and omnivorous, commonly consuming invertebrates like mealworms, crickets, and in some cases, frogs and lizards in the wild.
      - Notable for their specialized mantle covered with hollow spines made of keratin, serving various functions:
        - Protection
        - Breaking falls
        - Thermoregulation

  • Diet:
      - Primarily insectivorous, favoring a hedgehog-specific diet over cat food to avoid obesity.

  • Husbandry:
      - Very active during the night; providing a wheel or saucer is recommended, although avoid wire wheels due to injury risks.
      - Deep bedding and hiding spots are essential for burrowing behavior.
      - Self-Anointing Behavior:
        - A unique behavior where hedgehogs lick a new object, produce thick saliva, and distribute it through their spines; the cause remains unknown.

  • Wobbly Hedgehog Syndrome:
      - A condition characterized by demyelination that leads to paralysis, with an incidence rate of approximately 10%.
      - Clinical Signs:
        - Falling
        - Tremors
        - Seizures
        - Muscle atrophy
        - Paresis
        - Progression to paralysis.
      - Currently, no known cause or cure exists.

ONCOLOGY

  • Definition: Oncology is the branch of medicine that specializes in the diagnosis and treatment of cancer.

  • Classification of Cancers: Cancers are identified and categorized based on the cell types present:
      - Carcinomas: Epithelial tumors.
      - Sarcomas: Mesenchymal tumors.
      - Round Cell Tumors: Specific category of tumors.

  • Categories of Tumors:
      - Benign Tumors: These are abnormal cells that do not metastasize (i.e., spread).
      - Malignant Tumors: Cancerous growths that invade surrounding tissues and can metastasize.

  • Diagnosis Methods:
      - Fine Needle Aspirate (FNA) & Cytology: A common method for obtaining tumor samples.
      - Histopathology: Requires biopsy or surgical excision to evaluate cellular structure and disease presence.

CRITERIA FOR MALIGNANCY

  • Characteristics of Malignant Cells:
      - Anisocytosis: Variation in cell size.
      - Anisokaryosis: Variation in nuclei size.
      - Prominent or Multiple Nucleoli: Increased visibility of nucleoli within the nucleus.
      - Variation in Nucleus to Cytoplasmic Ratio: Atypical ratios suggest malignancy.
      - Multiple Nuclei: Presence of more than one nucleus per cell.
      - Abnormal Mitotic Figures: Indicates abnormal cell division.

  • Diagnostic Role: This assessment is typically performed by a cytologist.

EPITHELIAL CYTOLOGY

  • Morphological Features:
      - Tumor cells are commonly cohesive and cluster tightly together.
      - Round cells possess round nuclei.
      - Source: eClinPath for cytological information.

MESENCHYMAL CYTOLOGY

  • Morphological Features:
      - Cells can vary in shape from round to spindle-shaped.
      - Cells have wispy cytoplasmic borders.
      - Nuclei can appear oval to round.
      - Reference: eClinPath.

ROUND CELL CYTOLOGY

  • Morphological Features:
      - Characteristic round cell shape.
      - Cells are arranged either individually or in sheets.
      - Exhibits good exfoliation properties, facilitating cytological assessment.

EPITHELIAL NEOPLASIA

  • Carcinomas: A type of malignancy arising from epithelial tissue.

APOCRINE GLAND ANAL SAC ADENOCARCINOMA (AGASACA)

  • Definition: Cancer arising from the glands of the anal sac, classified as epithelial neoplasia.

  • Prevalence: More common in dogs (especially those ≥ 10 years of age) and rare in cats.

  • Breeds Affected:
      - Cocker Spaniel
      - English Springer Spaniel
      - German Shepherd

  • Clinical Signs:
      - Perineal swelling.
      - Tenesmus: straining to defecate.
      - Biting or licking at the perineal area.
      - Scooting behavior.
      - Increased urination (polyuria).
      - Increased thirst (polydipsia).
      - Generalized weakness.
      - Vomiting.
      - Recommendation: Routine rectal exams on older dogs to detect signs early.

APOCRINE GLAND ANAL SAC ADENOCARCINOMA (AGASACA) Diagnosis

  • Diagnostic Methods:
      - Bloodwork indicates HYPERCALCEMIA.
      - Fine needle aspirate and cytology of anal gland.
      - Histopathology following removal of the anal gland as needed.

APOCRINE GLAND ANAL SAC ADENOCARCINOMA (AGASACA) Treatment

  • Treatment Options:
      - Surgical Removal: Most effective treatment involves surgical excision of anal glands.
      - Radiation Therapy: Utilized particularly if there is regional lymph node involvement.
      - Chemotherapy:
        - Cisplatin
        - Carboplatin
        - Doxorubicin
      - Source: WikiDoc for treatment guidelines.

APOCRINE GLAND ANAL SAC ADENOCARCINOMA (AGASACA) Prognosis

  • Normocalcemia: Approximately 18 months lifespan.

  • Hypercalcemia: Approximately 6-9 months lifespan.

MESENCHYMAL NEOPLASIA

  • General Overview: Sarcomas are tumors arising from mesenchymal tissues.

HEMANGIOSARCOMA (HSA)

  • Nature of Tumor: Highly metastatic tumor originating from vascular endothelial cells.

  • Species Affected: Can affect dogs and cats; higher incidence in dogs.

  • Common Age of Affected Animals: Typically occurs in dogs aged 8-10 years; uncommon in cats.

  • Breeds Affected:
      - Pitbulls
      - Dalmatians
      - Golden Retrievers
      - German Shepherds

  • Common Affected Areas:
      - Spleen
      - Right Auricle of the heart
      - Right Atrium of the heart
      - Skin

HEMANGIOSARCOMA (HSA) Clinical Signs

  • Clinical Indicators:
      - Mild exercise intolerance.
      - Decrease in appetite.
      - Weight loss.
      - Lethargy.
      - Weakness.
      - Tachypnea (rapid breathing).
      - Anorexia.
      - Abdominal distention or palpable fluid wave.
      - Acute onset of weakness or collapse.
      - Pale mucus membranes.
      - Weak pulses.
      - Presence of a palpable intra-abdominal mass.
      - Source: Vetscraft for detailed clinical signs.

HEMANGIOSARCOMA (HSA) Diagnosis

  • Diagnostic Tools:
      - Radiographs:
        - Observe for mass effect on spleen.
        - Identify decreased serosal detail due to abdominal effusion.
        - Enlarged, globoid cardiac silhouette may be noted.
        - Look for pulmonary metastasis.
      - Abdominal Ultrasound:
        - Splenic mass may be detectable.
        - Abdominal effusion assessment (abdominocentesis might indicate blood).
      - Echocardiogram:
        - Mass might be identified in right atrium or auricle.
      - Surgical Biopsy: To confirm diagnosis via histopathology.

HEMANGIOSARCOMA (HSA) Treatment

  • Treatment Options:
      - Surgery:
        - Splenectomy (surgical removal of spleen).
        - Removal of cutaneous masses.
        - Right auricular ablation as necessary.
      - Chemotherapy:
        - Doxorubicin
        - Piroxicam
        - Cyclophosphamide

HEMANGIOSARCOMA (HSA) Prognosis

  • Prognosis Based on Treatment Options:
      - Cutaneous with Complete Surgical Excision: Curative.
      - Non-Cutaneous, Surgery Alone: ~2-3 months survival.
      - Non-Cutaneous, Surgery + Chemotherapy: ~6 months survival.
      - Right Auricular Ablation Alone: ~42 days survival.
      - Right Auricular Ablation + Chemotherapy: ~5-6 months survival.

SOFT TISSUE SARCOMA (STS)

  • Definition: A group of tumors arising from various mesenchymal tissues, classified together based on similar biological behavior.
      - Types: Include fibrosarcoma, hemangiopericytoma, nerve sheath tumor, leiomyosarcoma, and liposarcoma.

  • Common Affected Population: More prevalent in middle-aged to older dogs and less frequent in cats except for injection sites.

  • Predilection: Occurs commonly in larger breeds.

SOFT TISSUE SARCOMA (STS) Clinical Signs

  • Clinical Features:
      - Patients often show a progressively enlarging mass.
      - The mass is often non-painful.

SOFT TISSUE SARCOMA (STS) Diagnosis

  • Diagnostic Processes:
      - Fine Needle Aspirate and Cytology: This is a preliminary assessment; may be challenging to differentiate tumor types.
      - Histopathology: A definitive diagnosis is made via biopsy or excision.

SOFT TISSUE SARCOMA (STS) Treatment

  • Treatment Methods:
      - Surgery: Complete surgical excision is ideal but may be limited; obtaining good margins is a goal.
      - Radiation Therapy: Used in some cases.
      - Chemotherapy: Particularly for high-grade tumors, including use of:
        - Doxorubicin
        - Mitoxantrone
      - Reference: Xstrahl for treatment options.

SOFT TISSUE SARCOMA (STS) Prognosis

  • Prognosis Factors: Prognosis varies depending on type, location, clinical stage, and tumor grade.

  • Higher Metastatic Rates Recorded In:
      - Leiomyosarcoma (smooth muscle tumor).
      - Splenic sarcomas.
      - Intestinal sarcomas.

  • Notably, soft tissue sarcomas tend to recur slowly if they do recur.

ROUND CELL NEOPLASIA

LYMPHOSARCOMA (LSA)

  • Definition: Also referred to as lymphoma; marked by uncontrolled and pathological expansion of lymphocytes – can be categorized as either T-cell or B-cell types.

  • System Affected: May affect any organ system.
      - In Dogs: Commonly shows generalized infiltration of lymph nodes leading to lymphadenopathy and involvement of lymphoid organs.
      - In Cats: Tends to present as single site disease, often gastrointestinal.

  • Breeds Commonly Affected:
      - Golden Retrievers
      - Boxers
      - German Shepherds
      - St. Bernard
      - Aging cats as well.

LYMPHOSARCOMA (LSA) Clinical Signs

  • Clinical Features in Canines:
      - Enlarged peripheral lymph nodes.
      - Weight loss.
      - Lethargy.
      - Anorexia.
      - Fever.

  • Clinical Features in Felines:
      - Chronic vomiting.
      - Chronic diarrhea.
      - Weight loss.
      - Anorexia.
      - Potentially palpable enlarged mesenteric lymph nodes.

LYMPHOSARCOMA (LSA) Diagnosis

  • Diagnostic Techniques:
      - Fine Needle Aspirate and Cytology:
        - In dogs, performed on peripheral lymph nodes.
        - In cats, typically ultrasound-guided.
      - Biopsy:
        - Dogs: peripheral lymph nodes biopsy.
        - Cats: gastrointestinal tract biopsy.
      - PARR Analysis:
        - Commonly used in canines to differentiate between B-cell and T-cell lymphoma.
      - Flow Cytometry:
        - Useful for differentiating between B-cell and T-cell lymphoma.

LYMPHOSARCOMA (LSA) Treatment

  • Treatment Options:
      - Chemotherapy:
        - CHOP Protocol (commonly utilized in dogs): Includes:
          - Cyclophosphamide
          - Doxorubicin
          - Vincristine
          - Prednisone
        - Prednisone Monotherapy: Available for both dogs and cats.
        - Chlorambucil: Used particularly for cats.
      - Radiation Therapy: Occasionally used based on clinical scenario.
      - Bone Marrow Transplants: Not commonly offered but noted in literature.
      - Source: Royal Veterinary College for comprehensive treatment guidance.

LYMPHOSARCOMA (LSA) Prognosis

  • Prognosis Outcomes:
      - Dogs:
        - CHOP Protocol and other chemotherapies: Approximately 8-12 months survival expectancy.
        - Prednisone Only: ~ 1-2 months survival.
        - No Treatment: ~ 4-6 weeks survival expected.
      - Cats:
        - Chlorambucil + Prednisone Treatment: Approximately 1-3 years survival.
        - Prednisolone Alone: ~ 1 year survival expectancy.

OTHER NEOPLASIA

PHEOCHROMOCYTOMA

  • Definition: A neuroendocrine tumor arising from the chromaffin cells of the adrenal gland.

  • Rarity: This tumor is uncommon, occurring in:
      - Dogs: Typically found in middle-aged to older dogs, approximately 11 years of age.
      - Cats: Common in older cats, around 14 years.

  • Breed Prevalence: No specific breed predisposition identified.

PHEOCHROMOCYTOMA Clinical Signs

  • Clinical Features Observed:
      - Intermittent weakness or collapse.
      - Increased urination (polyuria).
      - Increased thirst (polydipsia).
      - General lethargy.
      - Vomiting.
      - Anorexia or inappetence.
      - Notably, some may not exhibit any clinical signs at all.

PHEOCHROMOCYTOMA Diagnosis

  • Diagnostic Methods:
      - Bloodwork: May indicate elevated ALT and ALP levels.
      - Blood Pressure Measurement: Often reveals hypertension.
      - Abdominal Ultrasound:
        - May show unilateral adrenomegaly and potential invasion into the vena cava.
      - Histopathology: Necessary for definitive diagnosis, despite normal low-dose dexamethasone suppression tests (LDDST).

PHEOCHROMOCYTOMA Treatment

  • Treatment Options:
      - Phenoxybenzamine: Alpha1-antagonist used to control hypertension, typically given 1-3 weeks before surgery.
      - Atenolol: Beta-blocker used to control tachycardia.
      - Surgical Excision: A primary method for treatment.
      - Source: BMC Veterinary Research for further insight into treatment.

PHEOCHROMOCYTOMA Prognosis

  • Prognostic Expectations:
      - Tumors that are surgically excisable typically have a guarded to good prognosis.
      - If the animal survives the immediate postoperative period, the survival expectation is around 18-24 months.

Quality of Life and Euthanasia

Overview

  • Presented by Kara Schmidt, DVM.

Definition of Humane Euthanasia

  • Defined as a "Good death."

  • Intentional ending of life to eliminate pain and suffering.

  • Different types of euthanasia:
      - Quality of life (QOL)/palliative euthanasia.
      - Behavioral euthanasia.
      - Convenience euthanasia.
      - Disease control/population medicine.

  • The veterinarian acts as the advocate for their patient.

Quality of Life/Palliative Euthanasia

  • Involves evaluation of the pet's quality of life:
      - Determine if the pet enjoys favorite activities.
      - Assess the pet’s appetite.
      - Evaluate if the pet is comfortable.

  • Recommended practice for owners:
      - Keep a record of positive (good days) and negative (bad days) experiences.

  • Role of the veterinarian:
      - Provide guidance and support to owners in decision-making.

Behavioral Euthanasia

  • Considered one of the most difficult types of euthanasia.

  • Indicated when the pet's behavior adversely affects:
      - Its own quality of life.
      - The owners' quality of life.
      - Public safety.

  • Important assessment steps:
      - Rule out underlying causes for fear, anxiety, and aggression (such as pain).
      - Identify triggers and determine if they can be avoided.
      - Review the pet's biting history.

  • Legal and procedural considerations:
      - If a pet has bitten a person, a rabies sample must be submitted prior to euthanasia, within 10 days.
      - Consider the progression of aggression in decision-making.

Convenience Euthanasia

  • Refers to euthanizing a physically healthy animal.

  • Often requested by owners for their convenience:
      - Inability to physically care for the pet.
      - Inability to financially care for the pet.

  • Veterinarians retain the right to refuse convenience euthanasia.

  • Recommendations for veterinarians:
      - Consider options that serve the best interest of the patient:
        - Rehoming the pet.
        - Surrendering to a clinic or humane society.

Disease Control/Population Euthanasia

  • Conducted to protect the health of large populations of pets.

  • Commonly performed in shelter settings.

  • Example case:
      - Distemper outbreak in Columbus humane society in 2016.

  • Objective:
      - Shield a healthy population from being infected by an outbreak.

Religious Considerations

  • Awareness of varying beliefs regarding euthanasia in different religions.

  • Respect for these beliefs is paramount.

  • Veterinarians still hold a duty to support their patients' needs.

Euthanasia Process

  • Recommended practices:
      - Sedate the animal first to ensure comfort.

  • Various sedation options:
      - Telazol (IM or IV).
      - Acepromazine (IM or IV).
      - Propofol (IV).

  • Purpose of sedation:
      - To allow the patient to relax peacefully and comfortably, achieving unconsciousness.

  • Use of IV catheters:
      - Facilitates easy access for administering euthanasia solution.

  • Euthanasia solution is typically:
      - Pentobarbital, which leads to the cessation of breathing and heart activity.

Administration of Euthanasia Solution

  • Different methods of administration:
      - Intravenous (IV):
        - Preferred due to rapid, smooth, and painless effects.
      - Intracardiac (IC):
        - Requires sedation or anesthesia prior to administration.
      - Intraperitoneal (IP):
        - Absorbed more slowly and used when IV access is difficult or causes distress.

Allowing Owner Presence During Euthanasia

  • Owners may choose how involved they wish to be during the procedure:
      - Some may stay only for sedation.
      - Others may remain throughout the entire process.
      - Some may opt not to be present at all.

  • Importance of setting expectations for the owner about the process:
      - Explain possible physiological reactions such as agonal breathing, muscle twitching, dysphoria, urinations/defecations, and the inability to close the eyes.

  • Suggestions for memorializing pets post-euthanasia:
      - Fur clippings.
      - Pawprints.

Confirmation of Death

  • Required before disposing of animal remains:
      - Criteria for confirmation includes:
        - Absence of respirations and heart sounds.
        - Presence of fixed, dilated pupils.
        - No corneal reflex.
        - Graying of mucous membranes.
        - Rigor mortis (not a definitive indicator alone).

Support for Clients and Staff

  • Provide emotional support to clients during difficult times.

  • Mention of veterinary social workers in some veterinary hospitals to assist with support.

  • Respect for staff, as losing a patient can be equally challenging for them:
      - Some staff may choose not to witness certain euthanias.

  • Significance of self-care for veterinary professionals:
      - Acknowledge emotional challenges and allow oneself to grieve.

Aftercare Options

  • Owners are responsible for the remains of the euthanized pet:
      - Burial: Must comply with city ordinances.
      - Cremation Options:
        - Common cremation: multiple animals are cremated together, no ashes returned.
        - Private cremation: individual cremation with ashes returned to the owner.