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Applied Clinical Veterinary Nursing > Endocrinology > Flashcards

Endocrinology Flashcards

(75 cards)

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1
Q

What are some surgical conditions of the thyroid?

A

Functional (producing thyroid hormones) / non-functional
Benign e.g. adenoma, adenomatous hyperplasia, cysts
Malignant neoplasia e.g. carcinoma, adenocarcinoma

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2
Q

Describe benign thyroid masses in dogs vs cats.

A

Dogs = typically small, non-functional, rarely diagnosed
Cats = typically functional, cause hyperthyroidism

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3
Q

What pre-op considerations should we have for thyroidectomy patients?

A

ASA status - systemic effects of hyperthyroidism, BCS/MCS
Metastasis?
CVS / renal / ocular / co-morbidities
Medical stabilisation
Complications

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4
Q

Describe a thyroidectomy.

A

Wide clip, dorsal recumbency
Ventral midline approach to neck
Unilateral / bilateral thyroidectomy +/- parathyroidectomy
Sometimes reimplanting parathyroid tissue will allow for neovascularisation

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5
Q

What complications of a thyroidectomy can we see?

A

Surgical technique and skill
Haemorrhage
Seroma formation
Laryngeal paralysis (if recurrent laryngeal nerves damaged)
Horners (damage to sympathetic trunk)
Hypocalcaemia - iatrogenic hypoparathyroidism
Recurrence

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6
Q

Describe the parathyroid.

A

2 pairs of parathyroid glands - intracapsular (caudal) and extracapsular (cranial)
Secrete PTH - increases blood calcium

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7
Q

What is primary hyperparathyroidism?

A

Parathyroid tumour produces excess PTH
Other parathyroid glands stop functioning normally - risk of hypocalcaemia post-op before they begin functioning again

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8
Q

How do we treat primary hyperparathyroidism?

A

Medical - ethanol injection/heat ablation
Parathyroidectomy

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9
Q

What pre-op considerations should we have for parathyroidectomy patients?

A

ASA status - systemic effects of hyperparathyroidism (hypercalcaemia), co-morbidities
Medical stabilisation e.g. diuresis, renal support
Complications

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10
Q

Describe a parathyroidectomy.

A

Wide clip, dorsal recumbency
Ventral midline approach to neck
Almost always going to remove one of four parathyroid glands
If intracapsular, likely to remove associated thyroid

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11
Q

What are some possible complications of parathyroidectomy?

A

Haemorrhage
Seroma formation
Laryngeal paralysis
Horners
Hypoparathyroidism - hypocalcaemia

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12
Q

What post-op care should we provide to parathyroidectomy patients?

A

IVFT
Analgesia - avoid NSAIDs
Monitor for complications - renal function, hypocalcaemia

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13
Q

Describe the risks of iatrogenic hypoparathyroidism associated with unilateral thyroidectomy.

A

Removes 1 of 2 thyroids
Removes 1 of 2 caudal parathyroids, but cranial may be damaged
Low risk hypocalcaemia
Low risk hypothyroidism

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14
Q

Describe the risks of iatrogenic hypoparathyroidism associated with bilateral thyroidectomy.

A

Removes 2 of 2 thyroids
Removes 2 of 2 parathyroids, but cranials may be damaged
Higher risk hypocalcaemia
High risk hypothyroidism

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15
Q

Describe the risks of iatrogenic hypoparathyroidism associated with unilateral parathyroidectomy.

A

Removes 1 of 2 thyroids
Removes 1 of 2 parathyroids, but cranials may be damaged/already suppressed
Highest risk hypocalcaemia
Low risk hypothyroidism

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16
Q

What are the clinical signs of iatrogenic hypoparathyroidism?

A

Within 2-3 days - inappetence, weakness/lethargy, ptyalism, pawing at face
Advanced - muscle fasciculation, tremors, tetany, seizures, coma/death
Only treat hypocalcaemia if clinical signs present!

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17
Q

How can we treat hypocalcaemia?

A

Oral vitamin D pre-op (takes 24-48hrs to have an effect)
Oral calcium (takes 1-3 days to work)
IV calcium - if clinical signs / VERY low blood calcium levels

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18
Q

Which pancreatic conditions are surgical?

A

Endocrine - insulinoma
Exocrine - exocrine pancreatic neoplasia
Pancreatic abscessation
Pancreatic cysts

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19
Q

Describe insulinomas.

A

Malignant carcinoma
Often metastasise to LNs and liver

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20
Q

What are the clinical signs of an insulinoma?

A

Lethargy
Tremors, seizures, collapse
Peripheral neuropathy
Extreme hypoglycaemia (<2mmol) in an upright dog!

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21
Q

How do we diagnose an insulinoma?

A

Bloods (insulin/glucose ratio)
Imaging

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22
Q

How do we manage insulinoma patients pre-op?

A

Feeding - q4-6hrs, diabetic food
Gentle, regular exercise
Manage hypoglycaemia - intervene if needed

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23
Q

How do we manage a hypoglycaemic crisis?

A

Give oral glucose first e.g. jam!
One-off IV glucose
Glucose infusion
Stop once start to improve

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24
Q

How do we carry out a partial pancreatectomy for an insulinoma?

A

Dextrose infusion throughout, glucose monitoring
Gentle technique to reduce pancreatitis risk
Small nodule <1cm in diameter, can be difficult to find!
Check liver for micrometastasis

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25
What post-op care should we provide to insulinoma patients?
Feeding - as pre-op, +/- feeding tube Exercise - as pre-op Hypoglycaemia - if not normalising, indicates presence of missed micrometastasis Drugs - IVFT, analgesia, steroids, chemo for residuals
26
What are the possible complications of insulinoma removal?
Persistent hypoglycaemia Transient hyperglycaemia Pancreatitis Can develop Diabetes Mellitus
27
What are some adrenal gland surgical conditions?
Adrenal mass - benign/malignant, primary/secondary Secondary adrenal enlargement (pituitary-dependent!)
28
What are the clinical signs of adrenal gland disease?
None Functional - overproduction from cortex/medulla Haemoabdomen
29
What are the clinical signs of overproduction from cortex in adrenal disease?
Conns syndrome - mineralcorticoids e.g. aldosterone Cushings - glucocorticoids e.g. cortisol Masculinising syndrome - androgen e.g. testosterone
30
What are the clinical signs of overproduction from medulla in adrenal disease?
Phaeochromocytoma - catecholamines e.g. norepinephrine/epinephrine (intermittent hypertension)
31
What pre-op considerations should we have for adrenalectomy patients?
Systemic effects e.g. hypokalaemia, endogenous steroid, excess adrenaline/noradrenaline Co-morbidities Medical stabilisation Unilateral vs bilateral
32
How do we manage adrenalectomy patients peri-op?
Monitoring ECG for arrhythmias, BP, electrolytes Drugs as needed
33
What are some possible intra-op complications with an adrenalectomy?
Tumour rupture Haemorrhage Tachycardia/arrhythmias - may need propranolol/lignocaine Hyper/hypotension May need supplementation of gluco/mineralocorticoids - dexamethasone, electrolytes
34
What post-op complications can we see with adrenalectomy patients?
Electrolyte abnormalities Hyper/hypotension Adrenal insufficiency - iatrogenic Addison's Delayed healing Pulmonary thromboembolism
35
Describe feline hyperthyroidism.
Most common endocrine condition in cats, usually over 10yrs old Benign tumour that secretes excess thyroid hormone (uni/bilateral) Often concurrent disease e.g. HCM, CKD, hypertension
36
What are the clinical signs of feline hyperthyroidism?
Polyphagia Weight loss Tachycardia Palpable enlarged thyroid gland
37
How do we treat feline hyperthyroidism?
Anti-thyroid drugs, iodine-restricted diet (lifelong) Thyroidectomy Radioactive iodine
38
What medications can be used to treat hyperthyroidism?
Drugs block synthesis of thyroid hormone Methimazole / carbimazole Normally euthyroid in 2-3 weeks
39
What are some common side effects of anti-thyroid drugs?
Vomiting, anorexia, lethargy Usually minor and transient
40
What are some rare side effects of anti-thyroid drugs?
Persistent GI signs Bone marrow suppression Facial pruritis Hepatopathy
41
What nursing considerations should we have for cats with hyperthyroidism?
Careful handling - often fractious, concurrent disease, consider gabapentin? Senior cat clinics - look for clinical signs/measure T4 in bloods Treatment monitoring every 3-12 months - bloods, urinalysis, BP
42
Describe dietary management for feline hyperthyroidism.
Iodine-restricted (iodine required to synthesis thyroid hormone) Must be fed as sole food, lifelong Can be euthyroid within 3 weeks
43
What causes canine hypothyroidism?
Destruction of thyroid tissue Middle-aged dogs
44
How can we treat canine hypothyroidism?
Oral synthetic T4 - sodium levothyroxine
45
What nursing considerations should we have for dogs with hypothyroidism?
Weight management clinics and dermatological clinical signs Treatment monitoring every 6-12 months (6-8 weeks after starting, 2-4 weeks after dose adjustment)
46
What hormones control calcium balance?
Parathyroid hormone - from parathyroid gland Calcitriol (vitamin D) - from kidney Calcitonin - from thyroid gland
47
What are the clinical signs of primary hyperparathyroidism?
Neuro - weakness, lethargy, exercise intolerance GI - reduced appetite, nausea, vomiting, constipation Urinary - PUPD, urolithiasis, UTI CVS - hypertension, arrhythmias
48
How do we diagnose primary hyperparathyroidism?
Often elevated calcium is an incidental finding High total calcium does not necessarily mean elevated ionised calcium If elevated iCa then measure PTH
49
How can we treat primary hyperparathyroidism?
Most common and effective = surgery OR ultrasound-guided glandular ablation by heat/ethanol injection
50
What can cause secondary hyperparathyroidism?
Chronically low calcium leading to elevated PTH Renal failure Nutritional - diet with little/no calcium or deficient in vitamin D
51
What can cause hypoparathyroidism?
Low or absent PTH despite low calcium Surgical excision of parathyroid Trauma, idiopathic, immune-mediated etc.
52
What are the clinical signs of hypoparathyroidism?
Seizures Muscle fasciculations/twitching/cramping Weakness, ataxia Anorexia, vomiting Facial rubbing
53
How do we diagnose hypoparathyroidism?
Measure iCa, phosphorous, PTH
54
How do we treat hypoparathyroidism with mild clinical signs?
Oral calcium supplements and calcitriol (vitamin D)
55
How do we treat severe life-threatening hypoparathyroidism?
IV calcium - bolus/CRI Close monitoring essential (HR, ECG) Administer slowly
56
Describe hyperadrenocorticism (Cushing's disease).
Excess production of cortisol from adrenal gland Mostly dogs, very rare in cats Pituitary-dependent (PDH) vs adrenal-dependent (ADH) Or iatrogenic (admin of glucocorticoids)
57
What are the clinical signs of hyperadrenocorticism?
PUPD, lethargy Endocrine alopecia Pot-belly, thin skin Poor wound healing Panting, polyphagia Calcinosis cutis
58
How do we treat hyperadrenocorticism?
Trilostane (blocks synthesis of cortisol) Suitable for PDH and ADH Monitor - clinical signs and ACTH stim Side effects uncommon - GI signs, iatrogenic hypoadrenocorticism, sudden death
59
What nursing considerations should we have for hyperadrenocorticism?
Senior clinics - look for clinical signs Treatment monitoring (10 days after starting, then 4 weeks, 12 weeks then every 3 months) Iatrogenic hypoadrenocorticism causing Addisonian crisis
60
Describe hypoadrenocorticism (Addison disease).
Lack of adrenal hormones (glucocorticoids and mineralocorticoids) Young to middle-age dogs, rare in cats Often vague, waxing and waning illness
61
What are the clinical signs of an Addisonian crisis?
Collapse Hypotension Weakness Bradycardia Severe dehydration and hypovolaemia
62
How do we diagnose hypoadrenocorticism?
Electrolyte abnormalities ACTH stim test
63
How do we treat an Addisonian crisis?
Fluid resuscitation Correct electrolytes - IV glucose and insulin if severe hyperkalaemia Start ACTH stim ASAP
64
How do we treat hypoadrenocorticism long-term?
Glucocorticoid replacement (low dose prednisolone) Mineralocorticoid replacement (Desoxycortone pivalate, injection every 4 weeks for life)
65
Describe pancreatitis.
Disease of exocrine pancreas Inflammation of pancreas - idiopathic / dietary indiscretion, trauma, surgery Pancreatic enzymes prematurely activated - start digesting pancreas
66
What are the clinical signs of mild pancreatitis?
Anorexia Vomiting Abdominal pain Dehydration Lethargy
67
What are the clinical signs of severe pancreatitis?
Generalised inflammation DIC Renal/multiorgan failure Death
68
How can we treat pancreatitis?
Supportive care - IVFT, monitoring for systemic signs, analgesia Nutritional support essential - anti-emetics, tube feeding, low fat highly digestible diet
69
Describe diabetes mellitus.
Failure of pancreas to produce insulin Middle-aged to older, dogs and cats Dogs require insulin injections, cats may not
70
What are the clinical signs of diabetes mellitus?
PUPD Polyphagia and weight loss Cataracts (dogs) Peripheral neuropathy (cats) Diabetic ketoacidosis (DKA) - vomiting, collapse, dehydration Persistent hyperglycaemia
71
How do we treat diabetes mellitus in cats?
Insulin injections Diet - low carb, high protein, calorie-controlled Cats can go into diabetic remission - so monitor for hypoglycaemia!
72
How do we treat diabetes mellitus in dogs?
Insulin injections Diet - high fibre high carb, calorie-controlled, consistent schedule Exercise
73
What are the signs of hypoglycaemia?
Weakness, ataxia Depression Altered behaviour Muscle twitching, seizures
74
What nursing considerations should we have for diabetic patients?
Must use correct syringes for type of insulin administered Correct storage of insulin BG measurements - take samples from same location Consistency in lifestyle is key! Extra care when undergoing GA
75

Applied Clinical Veterinary Nursing (40 decks)

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