Exam 1

Question 1

Answer 1

Idiopathic Megaesophagus

*Extreme form of Megaesphagus

*4 year Old Border Collie- Not Likely to be Congenital Megaesophagus. This is an Acquired form of Megaesophagus

*Prognosis is Poor, Particularly if there is Aspiration Pneumonia

Question 2

Answer 2

False

*Only 1/3 or Cats with Acute Pancreatitis will show Abdominal Pain

Lack of Abdominal Pain does NOT rule out Pancreatitis

Question 3

Answer 3

ALKP is Liver Specific for the Cat and Silkworm has Hepatic Lipidosis

*Half Life for ALKP is very Short- the Fact that we see it is Significant. Cats do not have Enzyme Induction!!! When we see ALKP in a Cat we know it is more Liver Specific.

ALKP is an Indication of Hepatic Lipidosis in Felines- KNOW THIS

Question 4

Answer 4

Surgical Debulking with Radiation

*Side Note: What if it had been a 10 Year Old Cat diagnosed with Nasal Lymphoma? Surgical Debulking with Chemo would be a better choice. Lymphomas are Sensitive to Chemo Drugs

Question 5

Answer 5

*Chronic Hepatitis leads to Coagulopathies- Liver is Responsible for the Synthesis of all Coagulation Factors

Question 6

Answer 6

Pancreatic Hyperechogenicity

*Pancreas becomes Hypoechoic because of Edema

Question 7

Answer 7

Esophageal Stricture

*2-3 Weeks after a Dog being in Dorsal Recumbancy for a Spay Operation. This Dog now has a Stricture that is Leading to Esophageal Regurgitation

Question 8

Answer 8

Airway filled with Fluid that Snaps Open

Question 9

Answer 9

Spirocercosis

*Geriatric Pit Bull with Shifting Forelimb Lameness

Enlarged Mandibular Salivary Glands- Caudal Esophageal Distention

Question 10

Answer 10

Pancreatic Acinar Atrophy

*End stage Chronic Pancreatitis will lead to EPI and Diabetes

Pancreatic Acinar Atrophy- Autosomal Recessive Disease that presents at a young age and is Immune Mediated

Question 11

Answer 11

Recheck in 3-5 Days, Ensure it decreses by 50%

Start on SAMe, Ursodiol, Liver Supplements

Recommend Liver Function Test

Recommend Abdominal Ultrasound

When you see a Mild Increase in ALT, we should NOT disregard it unless we have a specific cause. We need to recheck in 3-5 Days to make sure that the ALT is Decreasing

Should be worried about Chronic Hepatitis- Demonstrates that the concentration of ALT is NOT indicative of Prognosis

*Labradors- Commonly get Chronic Hepatitis that can be Copper Induced

Question 12

Answer 12

False

*Cats will show Triad of Clinical Signs including Cholangitis and Enteritis, but this is not a similar Clinical Sign in Dogs. Dogs rarely have Accompanying Inflammatory bowel Disease

Question 13

Answer 13

Biopsy the Liver after a PT/aPTT Screen

Question 14

Answer 14

Bacterial Pneumonia

*Feline Asthma = Feline Idiopathic Bronchitis

*Bacterial Pneumonia- Causes a Leukocytosis: WBC’s and Neutrophils

Question 15

Answer 15

Ammonia Tolerance Test

*Chronic Hepatitis and Mild Hypoalbuminemia as a Result- This is more likely to be a Chronic Hepatitis because the Liver is Small.

In this case we are worried about Parenchymal Liver Disease- Superior Diagnostic Test for this would be an Ammonia Tolerance Test

*Side Note- Minature Schnauzers can be diagnosed with Portosystemic Shunt when they are 5 years or older, but it is not common or reported in other Breeds

Question 16

Answer 16

Ciliary Dyskinesia

*Animal Responded to Antibiotics but the signs Recurred

*Coughing- Either Cardiogenic or Non-Cardiogenic. No Sign of Heart Disease. Could not Elicit a Cough on Tracheal Palpation. Therefore the Coughing is due to a Disease in the Lungs

Crackles Heard on Auscultation- Fluid in the Airways

*Cannot be Pneumonyssus Caninum because the Patient is on Heartworm Prevention, which would Prevent Nasal Mites as well

Question 17

Answer 17

Chronic Pancreatitis

Question 18

Answer 18

Gall Bladder Rupture

*High Lactates, Low Blood Pressure (Hypotension) and Anemia are associated with Poor Outcome in Biliary Mucoceles

*Does NOT give dogs a Poor Prognosis if you Diagnose Rupture at the time of Diagnosis. These dogs will pull through fine if you give them the Appropriate Supportive Care

Question 19

Answer 19

Thoracic Radiographs

*6 Week Old GSD- Commonly get Congenital Megaesophagus and Persistant Right Aortic Arch

*Hematology and Biochemistry- Not necessary in Acute Presentation if the Patient is not Debilitated

Question 20

Answer 20

Broad Spectrum Antibiotics

*Strong Evidence of Cystalloid Resuscitation- Increases Pancreatic Perfusion

Fentanyl CRI- Indicated and Recommended pain Control

Maropitant- Anti-Emetic of Choice

Question 21

Answer 21

Phenobarbitone

*Dog is showing Classic Signs of Pharyngeal or Cricopharyngeal Dysphagia- Odynophagia and Ptyalism

*Irrespective of the Pathology in the Salivary Gland, If you have Odynophagia and Salivary Gland Hyperplasia then Phenobarbitone is the Treatment of Choice

Question 22

Answer 22

An Abdominal US Exluding EHBO is Sufficient to Confirm Liver Dysfunction

*This dog has Onion Toxicity, which causes Heinz Body Anemia- that leads to Hemolytic Anemia.

The most Important thing that we need to do is make sure there is no Extrahepatic Biliary Obstruction. In the Face of Icterus, if there is No Extrahepatic Biliary Obstruction, then we have Confirmed Liver Dysfunction

It would NOT be Indicated to perform a Bile Acid Stimulation Test- It is redundant, we know there is Liver Failure

Question 23

Answer 23

E. Tiger Lily- Nephrotoxic!

A. Blue Green Algae- Hepatotoxin

B. Aflatoxin- Hepatotoxin

C. Cycads- Hepatotoxin

D. Amanita Mushrooms- Hepatotoxin

Question 24

Answer 24

Recommend Liver Function Testing and US/biopsy

*Phenobarbitol is Responsible for Enzyme Induction-Specifically ALKP. This is allowable within a Certain Range. If ALKP is

If Enzymes are Significantly Elevated, such as this case, we are concerned there may be Phenobarb Toxicity. There could be Liver Failure- Ultrasound and Run Liver Function Tests

*Immediate Discontinuation of Phenobarb could Cause Seizures- Needs to be Tappered

Question 25

Answer 25

**True**

Question 26

Answer 26

**False** _**\***Ultrasonography is not as Helful in Feline Species_

Question 27

Answer 27

**Low Fat Diet Prescription Diet** _We do not recommend any type of Perscription Diet in Patients with EPI_ \*In EPI we recommend a Cobalamine Supplementation, Pancreatic Enzymes, Metronidazole if we suspect Bacterial Overgrowth, and we can use Antacid to increase gastric pH

Question 28

Answer 28

**Pancreatic Abscess** _Pancreatic Abscess- Chronic Sequela to Acute Pancreatitis that can occur 6 weeks or more after Acute Pancreatitis. But is also responsible for Pancreatitis. Surrounding tissue will Become inflammed and Cause Acute Abdomen_ **\***Terriers are predisposed to both Acute and Chronic Pancreatitis. He has presented with Acute Abdomen. Multiple Hypoechoic Lesions on Ultrasound with thickened Capsule _Pancreatic Pseudocyst- Appear Anechoic and Do Not have Capsule_ _Cysts are usually Benign and not associated with Clinical Signs_ _Insulinomas and Carcinomas are commonly Hyperechoic on US_

Question 29

Answer 29

**Influenza Type A H3N8** **\***If the Canines are dying, you should be thinking Canine Influenza. Also these patients cough up blood

Question 30

Answer 30

**Laparotomy/Laparoscopy** Laparotomy- Allows you to Control Hemorrhage and you get a much better quality sample \*Non Neoplastic- not a Focal Area, which would be great for Fine Needle Aspirate. A Fine Needle aspirate will not be Helpful Not Infiltrative- Not Lymphoma or Hepatic Lipidosis

Question 31

Answer 31

**Endoscopy with Cytobrush for Cytology** _**\***Cytobrush of the Greater Curvature of the Stomach is the test with the Highest Sensitivity and it can be Conducted Immediately_

Question 32

Answer 32

**Antibiotics** _There is no association with Infection or Bacteria with the Development of Chronic Pancreatitis- No need to Antibiotics in the Treatment of Chronic Pancreatitis_ \*Treatment for Chronic Pancreatitis- Supportive Care. Need to Address Diet, Pain, and if necessary control the Trigger We can use steroids at immunosuppresive Doses Analgesia is very important in Patients that show Pain Pancreatic Supplement is a Possiblity. In dogs with Chronic Pancreatitis feeding the supplement can reduce Postprandial Pain

Question 33

Answer 33

**Chronic Pancreatitis** **\***Elderly cats will develop EPI

Question 34

Answer 34

**Pithiosis** _**\***Pylorous Wall is Thickened and its Lost its Layering. Considering the Signalment- Lab with Projectile Vomiting. Must be a Gastric Outflow Obstruction and the most likely cause is Pithiosis_

Question 35

Answer 35

**Sliding Hiatal Hernia** _\*Juvenile **Shar Pei**- Caudal Esophageal Soft Tissue Opacity_

Question 36

Answer 36

**Corticosteroids** _**\***Corticosteroids do NOT Induce Acute Pancreatitis_

Question 37

Answer 37

**B. Muscle Enzymes** _**\***This dog has much Higher AST than ALT. More likely that the dog has Polymyositis_ _ALT and AST are NOT liver Specific_

Question 38

Answer 38

**Pseudocyst** \*Acute Complications: Pleural Effusion, Hypocalcemia (Soaponification of Fat). DIC/Coagulopathy can be an Acute Complication of Acute Pancreatitis _Chronic Complication of Acute Pancreatitis- Which occurs 6 weeks after an Episode of Pancreatic Necrosis: Pseudocyst_

Question 39

Answer 39

**cPL** _**\***Abdominal Radiographs, Amylase, and Lipase are USELESS in Diagnosing Pancreatitis in Dogs_ **_Abdominal Ultrasound and cPL are the BEST_** _FNA and Biopsy are the GOLD STANDARD but because of the Patchy Distribution of Acute Pancreatitis it is difficult to Diagnose by these Methods_

Question 40

Answer 40

**Eurasian** \*Eurasian- Predisosed to Pancreatic Acinar Atrophy (Exocrine Pancreatic Insufficiency)

Question 41

ECS = English Cocker Spaniel AP = Acute Pancreatitis

Answer 41

**All of the Above** \*We are not going to recommend and Exploratory Surgery with Biopsy at this Stage- there are too many diseases occuring. To perform an Invasive test is not Clinically Appropriate and may Increase Morbidity This Dog has Acute Pancreatitis- the Pancreatitis MAY Increase TLI The sensitivity of cPL in Chronic Pancreatitis is very Low. using the cPL will not be helpful to confirm the Pancreatitis

Question 42

Answer 42

**Acute Suppurative Cholangitis** _**\***Neutrophilic Infiltrate into Periportal Not beyond Limiting Plate!!!_

Question 43

Answer 43

Question 44

Answer 44

**Hepatocellular Carinoma** _\*PU/PD- Associated with Liver Failure. Very Common in Hepatocellular Carcinomas_ Increase in Liver Enyzmes and Associated Hypoglycemia _Ultrasound Change for Hepatocellular Carcinoma- Hyperechoic_

Question 45

Answer 45

**False** _**\***SNAP- Good Sensitivity but POOR Specificity. Need to Follow up with an Abdominal Ultrasound or Spec PLI to Improve Specificity_

Question 46

Answer 46

**Antral Pyloric Stenosis** _**\***Projectile Vomiting- Main Clinical Sign of Antral Pyloric Stenosis_

Question 47

Answer 47

**Ion Trapping** **\***_Lactulose has an Ion Trapping Effect and Acidifies the Intestine and thus the Ammonia will be in a Non-Absorbable form_

Question 48

Answer 48

**Bile Acid Stimulation** \*Dog that seems to Have Hepatic Encephalopathy and Ammonium Biurate Crystalluria- he has a Portosystemic Shunt. We want to do a Liver Function Test- Bile Acid Stimulation _Both A and B are Correct- Ammonia Tolerance test is more Labor Intensive and a Bile Acid Stimulation test works as well as the Ammonia Tolerance Test_

Question 49

Answer 49

**L-Carnitine** Arginine- Important in the Urea Cycle and a Deficiency could Manifest in Hepatic Encephalopathy Taurine- Important for Conjugated Bile Acids _L-Carnitine- Shunting Mechanism for moving Fatty Acids into the Mitochondria for Beta Oxidation_

Question 50

Answer 50

**Low Fat Diet** _\*Ultra Low Fat Diet- Best_

Question 51

Answer 51

**Acute on Chronic**