Unit 1 Flashcards
(379 cards)
1
Q
PCV
A
packed cell volume
2
Q
neutrophils
A
most common; respond to bacterial infections and inflammatory response
3
Q
lymphocytes
A
infection, chronic inflammation, long term immune response
4
Q
monocytes
A
bacterial, viral, fungal infections (VF), autoimmune conditions
5
Q
basophils / eosinophils
A
produce histamine, respond to allergens and parasites
6
Q
how can you determine anemia in a patient?
A
pcv, hematocrit, MCV and MCHC
7
Q
normocytic
A
MCV is normal
8
Q
MCV
A
size of RBCs
9
Q
MCHC
A
concentration of hemoglobin
10
Q
normochromic
A
MCHC is normal
11
Q
leukocytosis
A
increased WBCs, infection/inflammation
12
Q
leukopenia
A
decreased WBCs
13
Q
stress leukogram
A
neutrophilia, lymphopenia, and monocytosis
usually as a stress response
14
Q
thrombocytopenia
A
decreased PLT, due to loss, destruction, or lack of production
could be false due to clumping
15
Q
thrombocytosis
A
rare, usually as a result of stress
16
Q
ALP
A
alkaline phosphatase
enzyme, primarily in liver, that helps break down proteins
17
Q
what does the liver do?
A
filters toxins
produces bile acids to break down food
18
Q
ALT
A
aminotransferase
primarily liver, also kidneys, heart, muscle, pancreas, spleen, and lungs
catalyzes interconversion of AA’s and oxoacids by transfer of amino groups
19
Q
GGT
A
gamma glutamyl transferase
primarily found in liver
transfers glutamyl moiety to other acceptors for glutathione recycling, aiding in glutathone production and protection from oxidative stress
20
Q
AST
A
aspartate aminotransferase
in liver and other vital organs/muscle
catalyzes reaction between AAs aspartate/glumamate
important for AA metabolism
21
Q
TBIL
A
total bilirubin
byproduct of liver breaking down hemoglobin
excreted in bile, ONLY in liver
22
Q
what do the kidneys do?
A
filter toxins through urine
23
Q
BUN
A
blood urea nitrogen
urea is produced by liver as a byproduct of protein digestion and is removed by the kidneys
24
Q
CREA
A
waste byproduct of wear/tear of muscles and protein digestion
removed by the kidneys
25
SDMA
AA produced by protein breakdown
increased SDMA = decreased GFR
26
LYTES
K, Na, Cl
27
total proteins
ALB and GLOB
28
ALB
protein made by liver to move small molecules through blood (bilirubin, Ca, progesterone, meds)
29
GLOB
helps make up antibodies, liver function, inflammation, clotting (a,b,g)
30
what is the most radioopaque material?
metal
31
signs of FB obstruction
profuse vomiting, inability to keep anything down
diarrhea + blood
painful/hunched posture
inappetence
polydipsia
lethargic
weight loss (usually after 7 days)
bloated/rigid abdomen
32
reasons an O brings in pt for poss FB
O saw pt eat object (not always)
consistent v/d for days
ADR (painful, inappetent, lethargy)
33
PE findings of a GIFB
attitude can be BAR or QAP
painful upon abd palpation
pale gums in severe cases
tachycardia/tachypnea
34
why would a possible GIFB present with pale gums?
the object may press down on the intestines, damaging vessels and sending the animal into shock
35
other differentials for poss GIFB
pancreatitis, gastroenteritis, bacterial/viral GI infection, liver disease, diabetes mellitus, kidney disease, Addison's, intussusception, neoplasia (cancer)
36
initial diagnostics for possible GIFB
cbc/chem, radiographs
CPL, UA to determine diabetes, AUS
37
barium
radiopaque liquid material safe for ingestion that helps map GI tract
38
barium study
if an obstruction is present, barium gets stuck in the area and highlights in rads
do pre administration rads, 30 mins post, then q1hr until barium is in colon
39
why do you have to be careful with barium?
if aspirated, it will NOT be absorbed and cause permanent damage (lungs)
40
partial obstruction
some material too big to pass out of stomach, moves in/out of way of material moving into duodenum
fabric/hole-y material allows some water/stool to pass
41
full obstruction
no ingesta can pass through stomach/SI
causes significant damage to stomach lining and SI- if severe, intestines can become necrotic
42
linear obstruction
pt eats linear object (string) that gets caught on something in GI tract, impeding movement, but intestines attempt to move it along
causes plication (appears like stretched out fabric)
43
radiographic finding of a GIFB
gas distention in stomach OR before where object is in SI
plication- c shaped SI loops
44
treatment for a GIFB
1. conservative management: hospitalization and IVF
2. endoscopic removal: if object is still in stomach and isn't fragile/dangerous to esophagus, less invasive than sx
3. sx
45
surgery for GIFB
IVC and IVF started
pre-meds, induction, gas anesthetic maintenance
shaved/cleaned on ventrum from xiphoid process to groin
incision from cranial to umbilicus to just cranial of pelvis
all abd explored, intestines ran from stomach to colon to find FB, palpate stomach
small incision made into stomach or intestines, careful to avoid major blood supply
material removed and incision closed
abd flushed w/ sterile saline then closed
46
complications of GIFB
object may be too dangerous for surgeon to remove
necrosis in area hard to resect
object (linear) may require multiple incisions
dehiscence can lead to septic peritonitis
incisions damage blood supply and later cause necrosis
pet unstable for sx
47
anastasmosis
joining 2 sides of intestine, blood supply, or other body channels
48
anastasmosis
joining of 2 sides of intestine, blood supply, or other body channels
49
dehiscence
opening of incision/wound
50
enterotomy
surgical incision into intestines
51
gastrotomy
surgical incision into stomach
52
ileus
lack of movement of GI tract
53
necrosis
process of cells/tissues dying due to trauma, disease, or lack of blood supply
54
plication
folding of the intestines, usually due to linear FB
55
GDV
gastric dilatation and volvulus
56
dilatation
stomach enlarges due to gas distention
57
volvulus
turning of stomach into abnormal position
58
what is the mortality rate of GDV?
30% with treatment
59
who is most @ risk of GDV?
extra large breed with deep/narrow chest
2x more likely in males
2x more likely in dogs that eat SID
5x more likely in fast eaters
60
how does a GDV develop?
air accumulates in stomach and is unable to escape
as stomach fills, it begins to flip on itself
spleen and stomach share blood vessels, spleen goes with stomach in flip, cutting off blood supply to both
stomach and spleen necrosis if not corrected
stomach may also rupture
61
clinical signs of GDV
severely lethargic
unproductive retching
sudden bloating/bouncy abd
abd pain
restlessness
unable to stand
hypersalivation
pale gums (shock)
tachycardia/tachypnea
62
PE for a GDV
depressed, painful upon abd palpation, tachycardia/tachypnea, "ping" on abd, pt whining or retching
63
diagnostics for poss GDV
radiographs, fluid therapy, pain meds as hypovolemia is likely due to constricted blood vessels
BW can evaluate organ function and severity of hypovolemia
64
which pain meds should be used for a poss GDV?
opioid butorphanol (cardiac friendly), fentanyl or oxymorphone
65
what are initial tx for a GDV?
fluid bolus to correct hypovolemia and shock, decompress stomach using trocarization or OG tube
66
OG tube
pt sedated, measure equine NG tube from nose-cranial last rib, push down L side
67
trocarization
find most tympanic location on L side, clip/clean, use large needle to stab into area and relieve air
68
what do radiographs look like for GDV?
"popeye's arm", gas bubble
69
what will BW show for a GDV?
HCT/PCV low due to hypovolemia
CK elevated due to striated muscle damage
K elevated due to cell damage
ALT/AST elevated due to hypoxic damage
LAC high due to hypotension/inflammation
70
tx for GDV
surgery only
71
surgical procedure for a GDV
prep and initial incision for major abd sx
isolate stomach once open
tech @ head with a bucket for drainage
stomach drains through OG tube
rest of abd examined and closed
72
gastropexy
stomach tacked to side of abd wall to prevent GDV (GD can still occur)
73
3 techniques for surgical gastropexy
circumcostal: relies on gastric seromuscular tissue flap passed through tunnel created behind last full rib and sutured to back of stomach
belt loop: seromuscular flap passed through soft tissue tunnel in abd wall
incisional: most common; relies on healing/fusion of edges of gastric seromuscular incision to edges of vertical transverse abd muscle incision
74
post surgical care for GDV
monitored closely for several hours (greatest concerns are blood clots and shock)
fluid maintenance (electrolytes)
pain medication CRI
PCV/TP, MM, pulse, urine
NPO at least 2 days
75
complications of GDV
delayed necrosis of stomach/spleen
blood clots w/ secondary embolisms
persistent hypotension secondary to hypovolemia
cardia arrythmias (VPCs or atrial fibrillation)
aspiration pneumonia secondary to retching
myocardia depressive factor can cause acute cardiac arrest
severe inflammation leading to multiple organ failure
76
what is the likelihood of GDV for patients with a gastropexy?
4%
77
how can we prevent GDV?
1. gastropexy
2. reduce stress (esp food related)
3. feeding and drinking habits
78
atrial fibrillation
irregular/rapid heart rhythm that can lead to blood clots in heart
79
azotemia
elevation of nitrogenous products (BUN), creatinine in blood, or other secondary waste products within the body
80
CK
creatinine kinase; an enzyme mostly in heart and skeletal muscle, small amounts in brain
81
crystalloid fluids
fluid that is an aqueous solution of mineral salts and other small, water-soluble molecules
82
DIC
disseminated intravascular coagulation; serious disorder where proteins that control blood clotting become overactive, usually after injury/cancer/infection
83
embolism
obstruction of an artery, typically by clot of blood or air bubble
84
gastrectomy
removal of all/part of stomach
85
hypovolemia
decreased volume of circulating blood in the body
86
hypoxia
deficiency in amount of oxygen reaching tissues
87
lactate
biproduct constantly produced in body during normal metabolism and exercise; if high --> impaired tissue oxygenation or shock
88
lower esophageal sphincter
muscle ring between esophagus/stomach that controls when material will enter the stomach
89
MDF
myocardial depressive factor; low molecular weight peptide released from pancreas into blood during shock
90
pyloric sphincter
muscle ring between pylorus of stomach and proximal duodenum that controls when material will leave the stomach
91
seromuscular
relating to the serous (surface tissue) and muscular layer of an organ
92
trocarization
procedure where side of abd is prepared and a large needle is inserted directly into stomach to allow air to escape
93
VPC
ventricular premature complexes; extra heartbeats beginning in one of heart's ventricles, disrupting regular heart rhythm
94
what anatomy makes up the upper GI tract?
mouth, esophagus, stomach, duodenum
95
what anatomy makes up the lower GI tract?
jejunum, ileum, cecum, colon
96
what part of the GI tract is used primarily for fermentation?
cecum
97
what are the 5 anatomical sections of the stomach?
1. lower esophageal sphincter
2. cardia
3. fundus
4. pylorus
5. pyloric sphincter
98
what are the 4 layers of the stomach?
1. lining - mucosa
2. submucosa
3. muscularis externa
4. serosa
99
what are the 4 parts of the SI?
duodenum, jejunum, ileum, cecum
100
duodenum
first section of SI, attached to stomach, proximal duodenum entrance point for pancreatic and common bile ducts; neutralizes stomach acid, mixes enzymes to help break down chyme, and absorbs nutrients
101
jejunum
second section of SI, absorbs sugars, FAs, and AAs
102
ileum
third section of SI, absorbs bile acids, fluids, and B-12
103
cecum
small pouch extrusion between ileum and colon, stores food material where bacteria can break down cellulose
104
villi
folds of intestinal mucosa and submucosa
105
microvilli
finger-like projections on villi and source of nutrient absorption
106
crypts
a gland found between villi in intestinal epithelium; produces stem cells to help repair damaged epithelium
107
colon
ascending, transverse, and descending
removes water, nutrients, and electrolytes from partially digested food
excretes feces out of body
108
E coli
gram (-), rod shaped, normal flora but has some toxigenic types
109
Salmonella
gram (-), rod shaped, with flagella
110
Clostridium
gram +, most anaerobic, rod shaped, can form endospores
111
Campylobacter
gram (-), microaerophilic, S shaped, can be normal flora
112
how does E. coli cause disease?
binds to intestinal lining, produces Shiga toxin, disrupting protein synthesis in epithelial cells, leading to cell death, sloughing of lining
leads to bloody diarrhea
113
how does Salmonella cause disease?
adheres and invades epithelial cells in mucosa and submucosa
attaches specifically to endocytic cells in Peyer's patches to create inflammation
secretes endotoxin and exotoxin, forces cells to create ethanolamine (food source)
replicates in macrophages
inflammation impairs absorption
diarrhea
114
how does Clostridium cause disease?
produces a spore once in SI or LI
spore produces enterotoxin (+ others)
damages intestinal lining cells
inflammation and sloughing of tissue
115
how does Campylobacter cause disease?
attaches to enterocytes on mucosal lining, releases enterotoxin/cytotoxin
IgA production
increases inflammation and permeability of interstitial fluids into the lumen
116
what are the clinical signs of bacterial diarrhea?
acute diarrhea, +/- blood
mild-severe lethargy
painful abdomen
inappetence
+/- fever and vomiting
117
what does black/tarry blood in diarrhea indicate?
damage is to stomach
118
what does frank blood in diarrhea indicate?
damage to LI/SI
119
PE for bacteria diarrhea
BAR=QAR, lethargic, painful on abd palpation, v/d in room, +/- delayed CRT due to dehydration
120
how is bacterial diarrhea diagnosed?
rule out other causes of diarrhea with fecal float for parasites, rads for abd mass or FB, CBC/CHEM for hepatic/renal/metabolic/endocrine diseases
fecal smear
GI profile (PCR sent out)
121
how is bacterial diarrhea treated?
antibiotics, fluids
- Erythromycin
- Sulfa-Trimethoprim
- Enrofloxacin (aerobic bacteria only)
- Metronidazole
122
irritable bowel syndrome or irritable bowel disease
severe inflammatory response of the submucosal lining in SI/LI
may be idiopathic caused by chronic food allergies/intolerance, bacterial, or parasitic infection
more common in cats
123
what is the most common type of IBS?
lymphocytic plasmacytic enteritis, when lymphocytes infiltrate into submucosa, damage mucosa, and increase permeability, leading to loss of interstitial fluid
124
what are the clinical signs of IBS?
chronic intermittent vomiting +/- diarrhea
lethargy
weight loss
PU/PD
stomach noise (borborygmus)
halitosis and flatulence
125
PE for IBD
BAR-QAR
+/- lethargy
bloating/mild ascites buildup palpable
+/- ropey intestines on palpation
poor haircoat due to impaired absorption
126
diagnostics for IBD
CBC - hypoproteinemia, hypocalcemia, neutrophilia
fecal float/smear to rule out other
AUS - thickening of intestinal wall
exploratory sx with intestinal biopsy (only way to definitively diagnose)
127
what is the tx for IBD?
diet- less carb/lactose/fat, high quality protein
Prednis (ol) one: steriod; BID for 1mo, then decrease by 50% q14 days
Azathioprine: immunosuppressant, must monitor CBC every 2 weeks
Metronidazole: BID for 2-4 weeks then SID
Intestinal protectants: sucralfate, cimetidine
Vitamin therapy: A, D, K, B
128
hemorrhagic gastroenteritis (HGE)
idiopathic, severe, bloody diarrhea, possibly due to hypersensitivity to Clostridium
causes significant damage to intestinal epithelial lining, leads to necrosis of tissue and secondary loss of fluids, proteins, and blood into intestinal lumen
129
clinical signs of HGE
profuse hemorrhagic diarrhea, vomiting, lethargy, anorexia, pale gums
130
PE for HGE
QAR-obtunded
delayed CRT
+/- abd pain on palpation
profuse bloody diarrhea
tachycardia
131
diagnostics for HGE
CBC/CHEM: severe hemoconcentration, neutrophilia, hypoproteinemia, +/- hypoglycemic
LYTES: low
Rads: diffuse ileus and fluid filled loops of bowel
132
tx for HGE
stabilization on IVF or bolus
IV abx, none PO
supportive meds
133
what is the pancreas?
major exocrine organ in mesentery, close to proximal duodenum
2 lobes, each with duct attached to duodenum for enzymes to be released into GI tract
134
how is the pancreas structured?
exocrine - acini
endocrine - islets of Langerhans
135
acini
cluster of epithelial cells in the pancreas that synthesizes, stores, and secretes digestive enzymes
136
what are the 3 cell types in the pancreas?
beta, alpha, and delta cells
137
beta cells
secrete insulin (70%)
138
alpha cells
secrete glucagon (20%); works opposite to insulin, encourages increase in BG concentration
139
delta cells
secrete somatostatin (hinders release of other hormones) and pancreatic polypeptides
140
how is insulin produced and carried into beta cells?
produced in Golgi apparatus, packaged into granules, then carried into beta cells by GLUT2
141
what happens after insulin enters beta cells?
intracellular concentration increases, beta cell membrane depolarizes due to Ca2+ influx, exocytosis of granules
142
what role does epinephrine play in insulin production?
it shuts it down; we want glucose to be free/used, not stored
143
how does insulin work?
insulin allows glucose to be taken up by insulin-dependent tissues (muscle and adipose/fat)
144
describe what insulin does in response to hyperglycemia
insulin is secreted by beta cells
binds to tyrosine kinase (insulin receptors) on surface, leading to phosphorylation
GLUT4 vesicles are released into exc space
GLUT4 binds to glucose and brings it into the cell
145
Diabetes Mellitus
metabolic condition where body does not take up glucose from blood, leading to hyperglycemia
146
what is a normal BG for cats/dogs?
80-120 mg/dL
147
type 1 DM
insulin dependent; requires insulin therapy
beta cells are destroyed due to trauma, autoimmune disease, inflammation, therefore no insulin is produced and no glucose uptake
148
type 2 DM
non insulin dependent; does not require insulin therapy
beta cells produce less insulin, insulin dependent cells respond less, and cells cannot uptake glucose
149
what type of diabetes will dogs get?
type 1
150
how does DM happen secondary to obesity?
cortisol (stress) leads to weight gain due to sugar production, reducing production of insulin, and beta cells are less likely to improve production
151
diabetic ketoacidosis (DKA)
after the body has been hyperglycemic for a long period, tissues are unable to get needed sugar for energy, has to turn to other energy sources
fat in liver is broken down, creating ketones, which decrease the ph of blood, making it acidotic
electrolyte imbalances, cardiac suppression/arrhythmias, renal insufficiency
152
clinical signs of nonketotic DM
PU/PD, weight loss, polyphagia (hunger), sudden cataracts (dogs), dehydration, plantigrade posture (cats)
153
clinical signs of ketotic DM
depressed/lethargic, weak and unable to walk, tachypnea, vomiting, sickly sweet breath, +/- diarrhea
154
PE for DM
BAR-obtunded
likely obese
lethargic
non painful
+/- cataracts
ataxia (cats) due to weakness
ADR
155
diagnostics for DM
CHEM:
elevated BG
+/- elevated K
elevated ALP/ALT/AST
+/- elevated Phos
Falsely low Na
CBC: NSF in nonketotic; if ketotic:
50% nonregenerative anemia
neutrophilia, thrombocytosis
UA: glucosuria, +/- ketonuria, pyuria, and hematuria
156
treatment for nonketotic DM
insulin therapy (regular fast-response, NPH/Vetsulin/Prozinc, or Glargine
food therapy
157
treatment for DKA
IVF (LRS) to correct dehydration
KCl as CRI
insulin therapy, usually IM q1 hr
158
how can you monitor diabetic patients?
Fructosamine level: measures avg BG for 2-3 weeks
BG curve: initial sample, insulin dose, then another sample q2-4 hours
Freestyle Libre: electronic device
Water intake
159
insulinoma
beta cell islet tumor that secretes excessive amounts of insulin, causing too much glucose to be taken in by cells, leading to significant hypoglycemia
25% of all ferret tumors
160
clinical signs of insulinoma
>2y, neurologic signs (ataxia, seizures, disoriented, collapse), musculoskeletal signs (weakness, twitching), or GI signs (nausea, vomiting)
161
PE for insulinoma
normal unless during an episode
tumors not palpable (may feel enlarged spleen)
alopecia (due to adrenal disease)
162
diagnostics for insulinoma
CBC/CHEM: severe hypoglycemia
Rads: rare to see mass, may see enlarged spleen, +/- metastatic nodules in lymph nodes, spleen, or liver
163
treatment for insulinoma
hospitalize if in episode, with fluid therapy and restricted activity
surgery to debulk nodules on pancreas, check other organs for metastasis, then measure BG q6-12 hours post surgery via urine
Prednisone or Diazoxide
164
Diazoxide
inhibits pancreatic insulin secretion and stimulates epinephrine release
165
prognosis for insulinoma
with surgery, the median euglycemic interval is 240 days, and median survival time is 483 days
166
acinus
small saclike cavity in a gland, surrounded by secretory cells
167
depolarization
cell membrane becomes less negative
168
endocrine
glands secrete hormones directly into blood
169
exocrine
glands secrete products through ducts opening into epithelium instead of directly in blood
170
exocytosis
contents of a cell vacuole are released to the exterior through fusion of vacuole membrane with the cell membrane
171
gastrin
hormone that stimulates the secretion of gastric substances into the bloodstream; secreted by stomach wall during digestion
172
islet of langerhans
groups of pancreatic cells secreting insulin and glucagon
173
adrenal glands
endocrine glands that produce hormones, located in the retroperitoneal space medial kidney; vascularized and innervated
174
what are the 3 layers of the adrenal glands?
capsule, cortex, medulla
175
what are the 3 layers of an adrenal gland's cortex?
zona glomerulosa
zona fasciculata
zona reticularis
176
zona glomerulosa
outermost layer of the adrenal gland cortex, produces mineralocorticoid hormones (aldosterone)
177
aldosterone
mineralocorticoid hormone
controls the balance of water/salts in the kidneys by Na+ retention and K excretion
178
zona fasciculata
middle and thinnest part of adrenal gland cortex, secretes glucocorticoids and has metabolic effects on several tissues, increasing glycogen synthesis, mobilization of lipids, and protein catabolism
179
glucocorticoids
natural form of steroids
180
zona reticularis
innermost layer of adrenal gland cortex
primarily produces androgen sex hormones
181
medulla
contains chromaffin cells, where norepinephrine and epinephrine are made; controlled by SNS
182
Renin-Angiotensin-Aldosterone pathway
hypotension --> kidneys produce renin --> angiotensin converted to angiotensin 1 --> ACE converts angiotensin 1 to angiotensin 2
angiotensin 2 leads to vasoconstriction and increases BP
183
How does angiotensin 2 cause vasoconstriction?
it triggers the release of aldosterone and vasopressin from the pituitary gland, causing the kidneys to retain Na+ and excrete K+, leading to water retention
increased blood volume and BP
184
vasopressin
antidiuretic hormone, causes kidneys to retain Na+ and excrete K+
185
Cortisol
stress hormone, produces in zona fasciculata
controlled by hypothalamus pituitary adrenal axis
counters insulin by encouraging higher BG and stimulating gluconeogenesis
helps with Na+/K+ excretion from kidneys to maintain pH
can cause immunosuppression
186
Addison's
hypoadrenocorticism- the adrenal glands aren't producing enough cortisol or aldosterone
usually due to immune mediated destruction of the adrenal cortex (or trauma, infection, neoplasia)
causes inability to regulate body ion concentration, kidney function, BG, and BP
187
clinical signs of Addison's
young-middle aged dogs
depression/lethargy
anorexia
vomiting/diarrhea/hematochezia
dehydration
shaking
weak pulse
hypothermia
painful abd
hypoglycemia
hyperpigmentation
alopecia
PU/PD
188
why would an owner bring in a patient with Addison's? (non crisis)
intermittent gastroenteritis (+/- blood)
slow weight loss
lethargy
189
Addisonian crisis
hypothermia, lateral, dehydrated, obtunded, weak pulse, hypotension, tachycardic, +/- painful abdomen
true emergency due to shock --> death
190
diagnostics Addison's
CBC: normal leukogram, anemia
Chem: low Na/K ratio, hypoglycemia, azotemia, hypochloremia, hypercalcemia, hypoalbuminemia
can rule out if resting cortisol is >2mug/dL
ACTH stimulation test
191
ACTH
adrenocorticotropic hormone
192
the results of an ACTH stim test came back as <2ug/dL for pre and post ACTH. what does this mean?
hypoadrenocorticism, needing to be treated with mineralocorticoid/glucocorticoid
193
the results of an ACTH stim test came back as 2-6ug/dL for pre and 6-18ug/dL post ACTH. what does this mean?
normal
194
the results of an ACTH stim test came back as >22ug/dL for pre and post ACTH. what does this mean?
hyperadrenocorticism (cushing's), needing to be treated with high dose dexamethasone suppression
AUS
195
treatment for Addisonian crisis
correct shock via IVF +/- dextrose, monitor urine for renal failure
administer steroids (Dexamethasone)
196
treatment for Addison's
oral Prednisone BID then SID
Fludrocortisone acetate SID
DOCP q25-28d, with electrolytes rechecked after first few injections then q3-6mo
197
DOCP
Percorten-V; mineralocorticoid desoxycorticosterone pivalate
198
Cushing's
hyperadrenocorticism; adrenal gland produces too much cortisol and pituitary gland produces too much ACTH
due to either a tumor in adrenal (15%) or pituitary (85%) gland
199
clinical signs of Cushing's
7-12y old dogs
PU/PD
alopecia (flanks)
low distended abd
polyphagia (inc appetite)
hyperpigmentation
muscle weakness/wasting
poor wound healing
calcinosis cutis
200
calcinosis cutis
buildup of Ca+ in dermis/beneath skin, leading to firm bumps on skin
201
PE for Cushing's
BAR-QAR
pendulous abd
alopecia
dry skin with nonhealing wounds
usually coming for comorbitities (UTI, hepatitis, DM)
202
diagnostics for Cushing's
CBC/Chem: stress leukogram (leukocytosis with neutrophilia, lymphopenia, eosinopenia), thrombocytosis, increased ALP/CHOL), hyperglycemia
UA SG <1.020 and proteinuria
resting cortisol to rule out
rads/AUS to see enlarged adrenal glands
ACTH stim test and 3 sample DSTs
203
treatment for Cushing's
Trilostane (Vetoryl) to reduce the amount of Cortisol being produced (blocks the enzyme needed to make cortisol in adrenal glands)
must have ACTH stim test 10-14 days after starting/med change, then q3-6mo
204
what is the MST for Addison's?
4.7y
205
what is the MST for Cushing's?
900 days
206
what are the kidneys?
2 bean shaped organs, used to filter byproducts and excessive ions/metabolites out of body into urine; also produces hormones to regulate erythrocyte concentration and regulate BP
207
where are the kidneys?
it retroperitoneal space in mid lumbar area lateral to main vessels
208
renal capsule
tough, fibrous renal capsule envelopes each kidney and provides support for soft tissue
209
hilus
concave aspect of kidney where uteters attach
210
cortex
contains glomeruli and convoluted tubules
211
medulla
loops of henle and collecting tubules, making up renal pyramids
212
corticomedullary junction
junction between the cortex and medulla
213
nephrons
filtering units of the kidneys
corticomedullary and juxtamedullary
214
corticomedullary nephrons
excretory and regulatory functions
215
juxtamedullary nephrons
maintain osmotic gradient of interstitial fluid of medulla, from low --> high in outer to inner medulla
216
how do the kidneys work?
blood enters via peritubular capillaries, pressure gradient in glomeruli forces solutes out of blood
proximal convoluted tubule reabsorbs fluids and dumps into interstitial fluid
descending loop of henle allows free water passage
distal convoluted tubule secretes K and H, and Na, Cl, and HCO3 are absorbed
collecting duct reabsorbs solutes and water from the filtrate, forming dilute urine
217
AKI (acute kidney injury)
sudden damage to kidneys due to trauma, infection, autoimmune conditions, toxins
218
common causes of AKI
infections, such as leptospirosis, toxic plants, chemicals/medications, or shock inducing events
219
how does leptospirosis damage the kidneys?
bacteria causes Na+ transport disregulation and decreased aquaporin expression in medulla, resulting in polyuria and natriuresis
220
clinical signs of AKI
oliguria (sm amounts of urine)
polyuria
painful kidneys
v/d
anorexia
dehydration
fever
lethargy
mouth ulcers
ataxia
221
PE for AKI
dry/tacky gums with reduced CRT and exaggerated skin turgor
tachycardic
lethargic
reduced stimuli response
222
diagnostics for AKI
CBC: leukocytosis, neutrophilia, anemia, +.- lymphopenia
CHEM: renal azotemia (elevated BUN, CREA), hyperphosphatemia, hypocalcemia, hyperkalemia, metabolic acidosis
UA: significantly dilute or very concentrated, with active sediment
AUS: kidney size
223
tx for AKI
hosp on fluids, treatment with abx/antifungals, hemodialysis to flush system and prevent kidneys from further damage, correct shock
224
how does furosemide work?
pulls fluid from interstitium into the blood
225
chronic kidney disease (CKD)
chronic decline in the population of functional nephrons
GFR no longer adequate to maintain normal excretory function
more common in cats
226
what is the most common cause of CKD?
chronic interstitial nephritis (loss of tubules)
227
risk factors of CKD
other diseases include hypertension, hyperthyroidism, DM, Cushing's
high protein diet in cats
>5y old
228
clinical signs of CKD
weight loss, lethargy, PU/PD, lethargy, v/d, dehydration, unkempt coat, oral ulcers, halitosis
229
PE of CKD
depressed attitude, unkempt coat, emaciated, +/- heart murmur, kidneys palpable, retinal detachment, uremic oral ulcers (waste products build up in blood)
230
diagnostics for CKD
CBC: mild nonregenerative anemia
CHEM: elevated BUN, CREA, SDMA, hyperkalemia, hyperphosphatemia
UA: SG < 1.030
UPC: measures filtration ability of kidneys
AUS: can r/o neoplasia
231
treatment for CKD
slow down progression with kidney friendly rx diet
232
structure of bladder
thin walled, saclike organ in pelvic canal
connected to kidneys via ureters
expels urine via urethra
contains transitional cells on mucosa layer
apex, body, trigone regions
urethra
233
urethra
tube connecting bladder to exterior of body
234
cystitis
inflammation of UB
in cats, idiopathic
in dogs, bacterial cause
235
crystalluria
crystals in urine
236
uroliths
stones in UB
237
FLUTD cystitis
feline lower urinary tract disease (FLUTD)
unknown definitive cause, stress can make it worse
can be obstructive (ulcerative) or nonobstructive (non ulcerative)
238
risk factors for FLUTD
middle aged, overweight cats
indoor litterbox/no outdoor time
dry food
stressful environments
239
clinical signs of FLUTD
stranguria, pollakiuria, painful urination, excessive licking, inappropriate urination, hematuria, +/- lethargy
240
bacterial cystitis
affects ~14% of dogs in life
most commonly due to gram (-) bacteria: e coli, staphylococcus, proteus, klebsiella, pseudomonas
241
risk factors of bacterial cystitis
recessed vulva, disease like DM, cushings, CKD, neoplasia, back injuries
more likely in females
242
clinical signs of bacterial cystitis
stranguria, foul smelling urine, hematuria, cloudy urine, pollakuria, accidents, +/- lethargy and inappetence
243
crystalluria/uroliths
concentrates of minerals in urine
244
what are the 4 types of crystals/uroliths?
struvite, Ca2+ oxalates, ammonium biurate, cystine
245
struvite
magnesium ammonium phosphates; common in dog urine; significant formation due to UTI due to urease producing bacteria
246
Ca2+ oxalates
second most common type
due to high Ca2+, citrates, or oxalates in diet and acidic urine
risk factors are high carb diets and obesity
247
ammonium biurate
dalmation, eng bulldogs, spanish water dogs predisposed
animals with liver disease
248
cystine
rare and genetic predisposition
heavy excretion of AA cystine
249
clinical signs of crystalluria or uroliths
straining, hematuria, accidents, foul odor, crying, +/- lethargy and inappetence, polyuria
250
PE for crystalluria/uroliths
painful on palpation
sometimes stones palpable
urinating in room
otherwise NSF
251
diagnostics for crystalluria/uroliths
UA: proteinuria, hematuria, +/- elevated leukocytes, alkaline urine, +/- bacteria/crystals on sediment
Culture: helps identify most appropriate abx
CBC/CHEM: r/o other PU/PD conditions (in older pts)
rads: radioopaque stones in UB
252
tx for bacterial cystitis
abx: clavamox, enrofloxacin, cefpodoxine
253
tx for FLUTD
diet change, avoid stress
254
tx for uroliths/crystalluria
surgical removal, dietary change to reduce frequency of stone formation
255
urethral blockage
most common in male cats because of long urethra
bacterial/inflammatory/urolith blockage of urethra, preventing excretion of urine and causing backflow into ureters and kidneys
decreases backflow into ureters and kidneys, decreasing blood ph and leading to metabolic acidosis
256
risk factors of urethral blockage
young-middle aged cats
overweight
dry food
257
clinical signs of urinary blockage
lethargy, inappetence, +/- vomiting, painful abd, stranguria, oliguria or no urine, hematuria, crying
258
PE of urinary blockage
painfully firm abd w full bladder
hypothermia
penis red/purple
stranguria
tachycardia
259
dx for urinary blockage
rads: confirmation of bladder size and check for uroliths, loss of detail in abd presents concerns for ruptured bladder
CBC: nsf
CHEM: elevated BUN, CREA, hyperkalemia, hyperphosphatemia, elevated liver enzymes
UA: r/o bacterial/crystalluria (FLUTD)
ECG: hr and arrhythmias
260
tx for urethral blockage
fluids to correct metabolic acidosis
10% Ca2+ chloride if hyperkalemic
sedation, induction, and sx to alleviate obstruction
261
sx for blockage
feed ucath through urethra to bladder gently
drain bladder and flush with sterile saline
suture catheter into place hosp > 3 days with cath
262
recovery for blockage sx
IVF
pain medications- bup
prazosin to reduce urethral spasms
surgical perianal urethrostomy if cat continues to block
263
urethrostomy
reroutes urethra to another location to widen it
264
pyometra
emergency infection of uterus
closed: no discharge
open: discharge draining
usually ~1-3 months after heat cycle
265
risk factors of pyometra
middle aged- old dogs intact
266
clinical signs of pyometra
lethargy, PU/PD, inappetence, v/d, weight loss, vaginal d/c
267
PE for pyometra
QAR-depressed
bouncy/firm abd
+/- pale gums and fever
268
dx of pyometra
rads: large soft tissue in caudal abd
CBC: leukocytosis with neutrophilia
CHEM: hyperglobulinemia, elevated ALP/ALT/CREA/BUN
UA: proteinuria and bacteria on sediment
269
tx of pyometra
sx, with risk of septicemia
IVF to stabilize
pain medications
270
sx for a pyometra
remove entire uterus and inspect for any holes to suggest rupture
271
recovery for pyometra
hosp for 24 hrs on IVF and pain CRI
O to monitor for inappetence, v, abd distention (septic peritonitis)
272
prognosis for UTI
excellent with chronic care
273
prognosis for urethral blockage
improved if brought within 12-24 hrs
274
prognosis for pyometra
fair, dependent on age, other diseases, length of time, and if septicemia
275
what are the 3 layers of the heart?
pericardium (outer)
myocardium
endocardium
276
what are the 3 conduction nodes of the heart?
sinoatral node
atrioventricular node
bundle of his-purkinke fibers
277
structure of the pericardium
epicardium
pericardial cavity
perietal pericardium
278
pericardium
outermost, inelastic, collagen rich fibrous connective tissue surrounding the heart
279
parietal pericardium
outer layer of the pericardium, covered in parietal pleura and touching the lungs
280
pericardial cavity
middle layer of the pericardium, the space between outer/inner layer; contains serous fluid to reduce friction
281
epicardium
inner layer of the pericardium, firmly attached to outer surface of heart
282
myocardium
middle layer of the heart, has striated muscle that goes in 3 different directions
thickest part of the heart that allows pumping of blood
283
endocardium
innermost layer of the heart, a thin/smooth membrane that lines the inside of the heart and forms the valves' surface, for protection
284
tricuspid valve
between RA and RV, with 3 leaflets
285
pulmonary semilunar valve
between RV and pulmonary artery, with 3 leaflets
286
mitral valve
between LA and LV, with 2 leaflets
287
aortic semilunar valve
between LV and aorta, 3 leaflets
288
atria
thin walled sinuses at base (cranial) of heart
289
auricle
conical/ear shaped pouch that projects from each atrium
290
right atrium
receive blood flow through vena cava
291
left atrium
receive pulmonary veins
292
which ventricle of the heart is thicker?
left
293
pulmonary trunk
only oxygen poor artery in body
294
pulmonary veins
drain into LA
295
aorta
largest artery in the body that carries oxygenated blood to the tissues via circulatory system
296
sinoatrial node
first conduction node to start signal, has automaticity (spontaneous signaling), on lateral wall of RA
297
atrioventricular node
second conduction node, on atrial septum of RA
298
bundle of his-purkinje fiber system
last conduction node, node is in ventricular septum and fibers reach deep into apex
299
mitral valve insufficiency
myxomatous growths develop on the leaflets of the mitral valve, causing thickening and retraction of the leaflets, with small amount of space between atrium/ventricle
chordae tendinae can tear and cause leaflets to lose structure
blood backflows from ventricle to atrium (pressure gradient)
atrium expand due to inc volume
eventually can no longer expand, addl fluid drains into lungs
300
risk factors of mitral valve insufficiency
small breeds
~8y old
progression leads to signs of CHF
often no clinical signs present
301
dilated cardiomyopathy
ventricular muscles, esp left side, weaken and can no longer contract appropriately- ventricle becomes wider
renin-angiotensin-aldosterone system is set off
- poor blood pressure due to lack of ability to push blood into aorta
- kidneys work harder
- enlarged ventricles to compensate
pressure gets too high and backflows into lungs
302
arrhythmogenic RV cardiomyopathy
in boxers specifically, can cause fainting spells and sudden death due to significant tachycardia (400bpm), ending in v fib
303
risk factors of dilated cardiomyopathy
diets lacking taurine (grain free)
3-7y old
males more likely
cats
304
hypertrophic cardiomyopathy
abnormal thickening of ventricles, altering contractility/relaxation of the heart as it pumps blood
thick muscle leads to loss of lumen space for blood and force of pumping, leading to bp issues
305
risk factors for hypertrophic cardiomyopathy
rare in dogs, common in cats
avg 6.5y old
males predisposed 75%
306
congestive heart failure (CHF)
point of no return, prognosis is grave-poor
heart can no longer compensate for any changes, and fluid builds up in lungs, ending with pulmonary edema
animal is drowning in own fluids and has poor contractility to pump blood through heart
307
clinical signs of CHF
persistent, non-progressing cough
constant panting
resp distress
tachypnea
exercise intolerance
fatigue/lethargy
cyanotic gums
distended abd
coughing blood
collapse
308
PE for heart disease (any)
depends on severity, may be NSF other than heart murmur
309
left apical systolic murmur
often heart at site of mitral valve, but if louder can hear everywhere
310
right apical systolic murmur
tricuspid regurgitation
311
what are the stages of heart disease in dogs?
A- high risk
B1- murmur but no enlarged heart
B2- murmur with enlargement
C- clinical signs of heart failure, tx necessary
D- not responding to tx
312
grade 1 murmur
low intensity murmur heart in quiet, after auscultation of localized area
313
grade 2 murmur
low intensity murmur heart immediately
314
grade 3 murmur
murmur of moderate intensity
315
grade 4 murmur
high intensity murmur that can be auscultated over several areas without any palpable precordial thrill
316
grade 5 murmur
high intensity murmur with a palpable precordial thrill
317
grade 6 murmur
high intensity murmur with a palpable precordial thrill that can be heart without a stetchoscope
318
diagnostics for potential CHF`
radiographs, vertebral heart score
echocardiogram
- for cats, will identify structure changes
- for dogs, will indicate severity
319
treatment for CHF
Pimobendan, Clopidogrel, Enalapril, Furosemide, Spironolactone, Amlopidine
320
pimobendan
Ca2+ desensitizer with vasodilator effects to reduce preload (amount of flow into the heart)
321
clopidogrel
anti clotting medication for cats only
322
enalapril
ACE (enzyme to convert angiotensin 1 --> angiotensin 2) inhibitor and lower BP
323
spironolactone
k+ sparing diuretic
324
furosemide
loop diuretic that helps with hyperkalemia
325
amlopidine
ca2+ channel blocker used for hypertension
326
P wave
depolarization of atrial muscle, followed by return to baseline
327
QRS complex
activation of his-purkinje system and ventricular muscle contraction
- ventricles depolarize
- repolarization of atria at same time
328
t wave
ventricular repolarization
329
P-R interval
beginning of P wave to beginning of QRS complex; the time re
330
QRS duration
spread of impulses throughout ventricles, measure of intraventricular conduction time
331
Q-T interval
measured from beginning of Q to end of T wave, measure of ventricular systole and ventricular refractory period
332
what are 2 atrial abnormalities?
atrial fibrillation
atrial premature complex (APC)
333
what are 3 ventricular abnormalities?
ventricular fibrillation
ventricular premature complex (VPC)
ventricular tachycardia
334
atrial fibrillation
lack of P waves and irregular ventricular rate
QRS complexes are normal-slightly different
rapid rate due to marked pulse deficit
can be due to other heart issues or during sx after giving opioids, GI/resp/neuro disease that elevate parasympathetic tone
335
clinical signs of atrial fibrillation
predisposed breeds- irish wolfhound, dane, newfoundland, doby
males
lethargic, weakness, exercise intolerance, sycope, coughing, dyspnea, ascites, anorexia
336
physical exam for atrial fibrillation
tachycardic and irregular heart rhythm
murmur if heart disease is present
pulse quality: normal-decreased
337
diagnostics for atrial fibrillation
ECG determines irregular ventricular rate
24hr holter vest
echo, cbc/chem, BP check, thoracic rads can r/o other causes
338
treatment for atrial fibrillation
heart failure meds
mainly for dogs showed hemodynamic issues (flowing blood)
Procainamide
339
APC
premature p waves, or differ from normal in size/configuration
usually occur secondary to structural heart disease (enlargement or atria stretch)
if young, usually due to accessory pathways
can result from electrolyte abnormalities, anemia, endocrine diseases, trauma
340
clinical signs of APC
atrial dilation
atrial myocardial disease
electrolyte/metabolic disturbances
hypoxia, anemia
fever
high sympathetic tone
males
labored breathing
exercise intolerance
weakness
collapse
341
PE of APC
irregular cardiac rhythm with decreased intensity at first sound
soft atrial sound
342
diagnostics for APC
ECG
24hr holter test
echo, T4, thoracic rads, cbc/chem for r/o of other
343
tx for APC
treat underlying cause first
anti-arrhythmic meds
- beta blockers such as Sotalol, Atenelol, Carvedilol
- Ca2+ channel blockers such as Diltiazem
344
ventricular fibrillation
terminal rhythm + nonexistent heart sounds, pulses, and BP
cardiac arrest
can be secondary to ventricular tachycardia, too deep under anesthesia, or resp arrest/ventilator failure
345
causes of v fib
hypoxia
aortic stenosis
heart surgery
drug reaction (anesthetics)
electrical shock
electrolyte imbalances
hypothermia
myocarditis
shock
346
clinical signs of v fib
systemic illnesses
previous hx of cardiac arrhythmias
collapse
death
347
treatment for v fib
confirm with ECG
CPR + defibrillator to return into normal rhythm
no medications needed
348
VPC (ventricular premature complex)
inverted QRS complex
can be caused by cardiac disease, abnormal serum levels of Ca2+ or K+, splenic/GI disease
can lead to hypotension, destruction of cardiac muscle tissue, sudden death
349
clinical signs of VPC
weakness
exercise intolerance
fainting
can be asymptomatic
cough or dyspnea if CHF involved
sudden death
350
causes of VPC
cardiomyopathy
congenital defects (subaortic stenosis)
chronic valve disease
GDV
traumatic inflammation of heart
digitalis toxicity
heart cancer
myocarditis
pancreatitis
351
PE of VPC
dyspnea
collapse
pale gums
abd pain
can happen under anesthesia, indicating pt cannot handle and needs to be woken up
352
diagnostics for VPC
ECG
thoracic and abd rads, CBC/chem, and echo to r/o
353
treatment for VPC
treat underlying cause
can use similar meds to APCs
hosp if cause is an electrolyte imbalance
354
ventricular tachycardia
rapid, regular, or irregular QRS rhythm (300-400bpm)
can be caused by primary cardiac disorders, electrolyte derangements, acid/base imbalances, hepatic/splenic disease, and pheochromocytoma (neuroendocrine tumor)
355
clinical signs of ventricular tachycardia
tachycardia
collapse
hypotension
syncope (fainting)
CHF
sudden death
356
risk factor of ventricular tachycardia
secondary to DCM in doby, and ARVC in boxers
structural damage to heart, heart failure, or myopathy
systemic disease- hypoxia, anemia, electrolyte/acid-based disturbances, hyperthyroidism
drug reaction
357
PE of ventricular tachycardia
lethargic
tachycardia +/- tachypnea
pale gums
collapse in exam room, difficulty getting up
358
diagnostics of ventricular tachycardia
ECG
echo, CBC/chem for r/o
359
medications for a dog with ventricular tachycardia
lidocaine, quinidine, procainamide
360
medications for a cat with ventricular tachycardia
propranolol with small dose of lidocaine
361
AV block first degree
longer spacing of P wave from QRS
362
AV block second degree
mobitz 1: longer spacing of p wave from QRS over time
mobitz 2: = abnormal spacing over time
363
AV block third degree
consistently dropping QRS complexes
364
cause of AV block
progressive fibrosis/degeneration of AV node
inflammation/infection of heart muscle or aortic valve, physical disruption of AV node secondary to myopathy, electrolyte abnormalities, or exposure to toxins/meds
365
clinical signs of AV block
bradycardia
dogs:
- lethargic
- exercise intolerant
- collapse
- sudden death
cats:
- labored breathing
- collapse
366
PE of AV block
BAR-depressed
bradycardic
pale gums
won't walk
367
risk factors of AV block in cats
primary cardiac diseases, systemic/metabolic disease, age-related fibrosis of AV nodal tissue
368
treatment for AV block
pacemaker
369
endocardial pacemaker
pacemaker lead fed through femoral vein into heart, lead in RV, once in place will feed wire up into jugular vein, jugular then tied off and lead is attached to battery that is placed under the skin
370
epicardial pacemaker
open thoracic surgery, using a ventilator
cut open pericardium to form. a window, place leads in proper location on heart, lead wire led out of chest and battery placed under skin
371
sick sinus rhythm
heart rhythm where sinus node does not discharge an impulse to trigger heart to contract
heart stops beating
372
risk factors for SSR
breeds: westies, dachsunds, schnauzers, boxers, spaniels
females
373
clinical signs of SSR
irregular bradycardia
weakness
lethargic
exercise intolerant
collapse
syncope
labored breathing
coughing
374
PE of SSR
BAR-depressed
irregular heart beat- arrest, bradycardic, tachycardic
limited movement
375
atropine response test
determines if a dog has SSR
atropine normally increases HR; an SSR dog will remain unchanged
376
treatment for SSR
pacemaker
medications:
- propantheline
- theophylline
- terbutaline
- hydralazine
377
Which bacteria is the most likely cause of a UTI?
E coli
378
what diagnostic test is used to diagnose Cushing's?
LDDS (low dexamethasone suppression test)
379
What 2 parts of the brain help with managing cortisol production?
pituitary gland and hypothalamus
