Week 7 Flashcards
1
Q
Calculate RER for a pregnant 30kg dog
(early stage pregnancy factor = 1.8)
A
2
Q
When should a pregnant bitches feed intake be increased?
A
during last 3rd of pregnancy when the foetuses rapidly put on weight
3
Q
How much additional weight should a bitch gain in percent between mating & whelping
A
15-25%
4
Q
What is the percentage increase in demand for Ca and P in the last 35 days of pregnancy and why?
A
60% increase due to rapidly developing skeletons of the foetuses
5
Q
What is the expected weight gain for a pregnant cat?
A
~40% of pre-pregnant BW
~5% per week
6
Q
Describe diet for a pregnancy cat into lactation
A
Normal diet first 2-3 weeks after mating
Increase energy requirement with ad lib kitten food for remaining pregnancy and lactation
supplement with taurine to prevent abortion
7
Q
What can be done to make transition from liquid to solid/semi-solid diet in puppies/kittens?
A
Dry food or canned food can be mixed with milk/milk replacer
8
Q
What is different in cat a renal diet compared to a normal diet
A
Reduced phosphorous to slow renal deterioration
Moderate protein restriction to reduce clinical signs caused by uraemia (but adequate to prevent breakdown of lean body mass for AAs)
Potassium to prevent hypokalaemia
Vitamin B for polyuria
9
Q
What is food aversion
A
Learned behaviour associated with negative experiences
e.g. GI upset, stressful experiences like force feeding)
10
Q
How can nutrition be maintained in animals that cannot eat?
A
supportive enteral feeding
Naso-oesophageal feeding
Oesophagostomy tube
Gastrotomy feeding
Liquid renal diets
11
Q
define oliguria
A
low urine output
12
Q
What dietary modifications can you use to prevent/treat urinary crystals
A
Reduce intake of minerals directly related to crystal type found
Adjust pH of urine to an uncomplimentary level for the crystal found
Control calorie intake to maintain healthy weight
Increase water intake and urine output
Calcium stones will need to be removed surgically
13
Q
What is the normal urination/defecation posture for cattle
A
standing
lift tail
hunched back
14
Q
How do dogs use elimination behaviour to signal breeding information
A
females urinate in presence of males
Males can tell if female is in heat by her faeces
15
Q
How do dogs use elimination behaviour for territorial marking
A
females & (esp.) males urinate on vertical objects
16
Q
What is the normal urination/defecation posture for dogs
A
defecate:
- squat, arch back & raise tail
urinate:
- males raise 1 leg
- females squat
17
Q
How do cats use elimination behaviour for territorial marking
A
spray urine containing their scent on walls
18
Q
What is the normal urination/defecation posture for cats
A
squat with raised tail to defecate
squat without raised tail to urinate
19
Q
Do cats have a preference for which sites to eliminate in
A
preferred substrate
litter tray separate from other social groups
secluded, quiet place
20
Q
How do horses use elimination behaviour to signal breeding information
A
stallions mark over mare’s faeces
females urinate in presence of stallion
21
Q
How do horses use elimination behaviour for territorial marking
A
males leave stud piles
mare’s urinate over other unknown mare’s faeces
22
Q
What is the normal urination/defecation posture for horses
A
urinate by standing, leaning forward with limbs extended backwards
defecate by standing with tail raised
23
Q
A
24
Q
What is middening behaviour in meerkats, badgers etc
A
use of communal latrines for territory marking/communication
25
What is renal clearance of drugs
volume of plasma containing the drug removed by the kidney per unit time
Cu = urinary concentration
Vu = rate of flow of urine
Cp = plasma concentration
26
What are the 3 fundamental processes in renal clearance of drugs
27
Describe the renal clearance of drugs
1. glomerular filtration of drugs
- Most drugs are small so can cross glomerulus freely
- Drugs bound to albumin cannot cross
2. tubular secretion of drugs
- Drugs can be transferred into tubular lumen by non-selective carrier systems:
* organic anion transporter (OATs) - acidic drugs against electrochemical gradient
* organic cation transporters (OCTs) - organic based drugs down gradient
3. passive tubular resorption of drugs
- Lipid soluble drugs are poorly excreted as they are reabsorbed
- Drug excretion is influenced by degree of ionisation and urinary pH:
* ionised drugs cannot cross plasma membrane
* acidic drugs are more rapidly excreted if urine is alkaline
* basic drugs are more rapidly excreted if urine is acidic
28
How can aminoglycosides cause nephrotoxicity
Cause tubular cell toxicity by:
- accumulating in lysosome of PCT epithelial cells
- impair mitochondrial function => increasing oxidative stress and free radicals
- interfere with tubular transport
29
Describe the interactions between NSAIDs & the kidney
Prostaglandins dilate afferent arteriole
NSAIDs (COX2 inhibitors) block prostaglandin production => decrease blood flow to kidneys => acute kidney injury
NSAIDs can induce an immunological reaction after a period of exposure => inflammatory cells infiltrate kidney interstitium => acute interstitial nephritis => AKI
30
How can a non-toxic drug cause toxicity due to dosage?
Multiple repeated doses results in increasing plasma concentration and potentially toxicity
Decreasing dose frequency allows levels to return to normal
31
Why is drug clearance important consideration in elderly patients or those with renal disease
Drugs removed predominantly by renal excretion are liable to cause toxicity
Polar drugs remain in lumen and get progressively more concentrated - these drugs need special care in patients with renal dysfunction
32
What are diuretics
33
Why do we need diuretics?
34
What are the different groups of diuretics
Osmotic diuretics
Loop diuretics
Thiazides
Amiloride
Spironolactone
35
Describe the mechanism of action of osmotic diuretics
Indirectly act on cells of nephron:
- drug is filtered in glomerulus but cannot be reabsorbed
- increase the osmolarity of filtrate in PCT, descending limb & collecting ducts
- water is retained in urine to maintain osmotic balance
- => decreases concentration Na+ in lumen and decreases reabsorption of Na+
IV administration
36
What is the effect of osmotic diuretics if given orally
Will not be absorbed &
cause water to be retained in intestines => diarrhoea
37
What are the indications of osmotic diuretics (mannitol)
forced diuresis (intoxication, impending kidney failure)
Emergency treatment of acutely raised intracranial or intraocular pressure
38
What are the unwanted effects of osmotic diuretics (mannitol)
transient expansion of extracellular fluid volume
hyponatraemia (acute)
39
Describe the mechanism of action & use of Carbonic anhydrase inhibitors
1. Block reaction of CO2 with H2O
2. Thus prevents Na+/H+ exchange & HCO3- reabsorption in proximal convoluted tubule & Na+ absorption is also reduced
3. Increased HCO3- in filtrate opposes water reabsorption
Used for:
- glaucoma, idiopathic intracranial hypertension, altitude sickness
40
Describe mechanism of action of loop diuretics
Act from within the tubule:
- Na+, K+ and Cl- enter blood by a co-transport system
- loop diuretics act on NKCC2 symporter in the thick ascending loop of LoH
- inhibits Na, K and Cl reabsorption => diuresis
Interfere with tubular feedback control of GFR => no decrease of GFR
41
Describe pharmacokinetics of loop diuretics
Tightly bound to plasma protein:
- do not pass directly into glomerular filtrate
- secreted into tubule by organic anion transporters
- action reduced if proteinuria is present
Rapid onset of action - 30 mins after administration
42
What are the unwanted side effects of loop diuretics (e.g. furosemide)
excessive water loss
Na and K loss following long-term use
Hypocalcaemia
Adaptive changes in circulation - RAAS activation
43
What are the indications of loop diuretics (e.g. furosemide)
Oedema
heart failure
Forced diuresis (intoxication, renal failure)
44
Describe the mechanism of action of thiazides
Act from within tubule:
- bind to Cl- site of distal tubule Na/Cl co-transport system
- inhibit Na+ reabsorption
- inhibit water reabsorption
45
What are the unwanted side effects of thiazides
adaptive changes in circulation
K loss following long-term use
46
What are the indications of thiazides
oedema
heart failure
47
What is the mechanism of action of potassium-sparing diuretics (e.g. Triamterene and amiloride)
Act from within tubule:
- directly block epithelial Na+ channel
- inhibits Na+ reabsorption in collecting ducts
- promotes loss of Na+ and water without depleting K+
48
What are the unwanted side effects of potassium sparing diuretics
hyperkalaemia because K is retained
49
What is the mechanism of action of aldosterone antagonists (e.g. Spironolactone) (diuretics)
Act from within tubule:
- tubule cells are impermeable to Na+ in absence of aldosterone
- spironolactone competes with aldosterone at its receptor
- causes mild diuresis and potassium retention
50
Describe the pharmacokinetics of spironolactone (aldosterone antagonist)
Well absorbed after oral administration and extensively metabolised by the liver to active metabolite
Slow onset of action - effects peak after 2-3 days
51
What factors can exacerbate CKD?
52
How does hyperphosphataemia exacerbate CKD & how can we treat it?
Mechanism:
- GFR reduction reduces phosphate excretion (system copes initially due to PTH)
- Once overwhelmed Ca and P build up
- Mineralisation of tissues including kidney
- Mineralisation + PTH => worsens CKD
Treatment:
- restricted phosphate intake (renal diets)
- Oral phosphate binders
* Aluminium hydroxide
* Calcium carbonate
* Calcium acetate
- Calcitriol therapy
53
How does systemic hypertension exacerbate CKD & how can we treat it?
Mechanism:
- Renal disease predisposes hypertension:
* RAAS altered Na handling
* excessive SNS activation
- Kidney is main target organ of hypertensive damage
- Glomerular hypertension => glomerular sclerosis => proteinuria => progresses CKD
Treatment:
- Dietary sodium restriction (renal diet)
- Anti-hypertensive drugs
* ACEi (e.g. benazepril)
* Ang II receptor blockers (e.g. telemartizan)
* Dihydropyridine Calcium Channel Blockers (e.g. amlodipine besylate)
54
How does proteinuria exacerbate CKD & how can it be treated
Mechanism:
- protein processing by proximal tubular cells => increase in pro-inflammatory mediators
- Tubulointerstitial inflammation => structural disease
Treatment:
- reduced protein diet
- polyunsaturated fatty acids (PUFA) - calms inflammation
- Pharmacological reduction in GFR
* e.g. ACEi
55
How do hypoperfusion, hypoxia & ischaemia exacerbate CKD & how can they be treated?
=> inflammation, oxidative stress, increased damage
treatment:
- hydration
- PUFA
56
How can hypokalaemia caused by CKD be treated?
supplementation in renal diets
57
How can metabolic acidosis caused by CKD be treated?
prescription diets are alkalinizing
58
How can inappetance/nausea caused by CKD be treated?
H2 blockers (e.g. cimetidine)
Protein pump inhibitors (e.g. omeprazole)
Maropitant citrate (cerenia)
Appetite stimulators (mirtazepine)
59
what are the main attributes of prescription renal diets for CKD?
Low protein (high quality protein)
Reduced Na
Restricted phosphate
Alkalinising
PUFA (antioxidants)
60
61
How can AKI & pre-renal azotaemia be differentiated
Pre-renal azotaemia usually has hypersthenuria
62
What is acute renal failure
Result of AKI
Azotaemia with inability to concentrate urine
63
What is the treatment for AKI?
Aim: minimise damage & buy time for tubular repair
replace fluids to improve renal perfusion and reduce ongoing hypoxia/ischaemia
Monitor and correct electrolytes and acid-base
Maybe instigate controlled diuresis once hydrated
64
How do you treat struvites
Antibiotics
Urinary acidifiers (struvites like alkaline environment)
NSAIDs if signs of inflammation/discomfort
65
How do you treat calcium oxalate crystals
promote hydration
alkalinise urine via diet
66
describe urate stones in dogs & the treatment
due to Purine metabolism alteration => uric acid in urine
Treatment:
- xanthine oxidase inhibitors
- protein restriction
- promote hydration
67
What are treatment options for feline non-obstructive idiopathic/interstitial cystitis (FIC)
Opiates or NSAIDs for pain and inflammation
Diet, hydration and antibiotics for urolithiasis
Behavioural support
Surgery, chemotherapy or NSAIDs for neoplasia
68
Name some common causes of AKI
69
Why might general anaesthesia contribute to kidney injury
can cause hypotension & hypovolaemia which reduce renal perfusion & thus kidney function
drug reactions
70
Why do cats mark/spray?
Sexual behaviour - advertise presence and availability
Reactional behaviour - results of change in environment
- Anxious cat makes area smell like themself to reduce anxiety
71
Define pigmenturia
presence of component that causes abnormal color to urine
72
define periuria
urination outside litter box/ house soiling
73
What are the 5 pillars of a healthy environment for cats
1. provide safe place
2. multiple separated key resources
3. Provide opportunity for play & predatory behaviour
4. Provide positive, consistent & predictable human-cat social interactions
5. Provide environment that respects importance of cat's sense of smell
74
What are examples of medical issues are associated with latrine problems in cats?
Renal insufficiency
Hepatic disease with UTI
75
What are examples of medical issues related to spraying problems?
renal insufficiency
Idiopathic cystitis
diabetes
Urolithiasis
76
Where are feline latrine areas typically located?
periphery of territory
quiet or secluded area
different for urination and defecation
on soft rakeable substrates
77
Where are feline marked areas typically located?
areas of prominence/significance
separate to latrine areas
78
What are the principles of cleaning areas of house soiling?
Biological/enzymatic cleaner
rinse off with water
Wipe with surgical spirit
allow to dry
DO NOT use bleaches or ammonia based detergents
79
Why might a cat be spray marking?
High arousal (sexual or reactional)
Stressors in environment
80
What are the treatment options for feline spray marking?
physical intervention (neutering)
Psychological therapies
Chemical therapies
Environmental manipulations:
- L-shaped litter box
- pheromonal products
- controlling the stressor
81
Describe causes of cat latrine behaviour issues
Medical disorders
Latrine aversion:
- litter box size
- substrate
- location
Substrate preference
Inadequate house training
Lack of indoor latrine
82
Describe treatment for latrine behavioural problems in cats
Restriction:
- ensure resources are available to all cats
- confine for short periods
Resolution:
- address cause e.g., stressor
- create attractive latrine area
- retrain
83
Describe possible medical causes of elimination problems in dogs
Neoplastic - bladder tumours
Metabolic disorders - diabetes
Dietary - obesity
Pain related
Infectious/inflammatory - urolithiasis
Neurological
84
Describe possible behavioural causes of elimination problems in dogs
Lack of or incomplete house training
Sexual signalling - marking
Social signalling
Arousal
Owner relater - seeking attention
Physical distress - fear, anxiety
Social distress - separation
Secondary to psychogenic polydipsia
85
What are separation related problem behaviours in dogs
Destructive behaviours
Vocalisation
Elimination
Anorexia
Psychosomatic/medical - diarrhoea, excessive licking
Over-activity
86
What are common differentials for elimination when alone:
1. when the dog displays no distress at owner departure
2. When dog displays distress at owner departure
87
Fill in the horse assessment of fluid deficit table
88
How does hypotonic fluid loss (water) affect the tonicity of remaining body fluid and blood volume?
increases tonicity of remaining body fluid
increases blood volume as water is drawn from cells into blood as blood is hypertonic so water is drawn from hypotonic cells
89
How does isotonic fluid loss (water & electrolytes) affect the tonicity of remaining body fluid and blood volume?
No effect on tonicity
Decreases blood volume
90
Describe the initial effect of water loss (hypotonic)
Loss of water from blood and interstitium increases ECF tonicity
=> osmosis and movement of water from ICF into ECF
=> cells lose fluid to plasma and interstitium
=> this compensates for volume loss in blood at the expense of cellular blood volume
LOSS OF HYPOTONIC FLUID LEADS TO DEHYDRATION INITIALLY
91
Describe the initial effect of water & electrolyte loss (isotonic)
No change in tonicity of remaining body fluids
No osmotic effect
No net fluid change between cells, interstitial space and blood
LOSS OF ISOTONIC FLUID LEADS TO HYPOVOLAEMIA INITIALLY
92
Fill in the table
93
What is the effect of a hypertonic saline bolus on a hypovolaemic patient
draws fluid from interstitial space and cells
acts in short term and cause temporary expansion of plasma volume
NaCl will redistribute over time reducing this effect so must be followed with isotonic fluid to restore total fluid deficit and maintain perfusion
94
What is the effect of administering sterile water intravenously in a hypovolaemic patient
dangerously hypotonic
likely result in major electrolyte disturbances
can cause RBC swelling and bursting
95
Describe the ultrasound procedure for diagnosing pregnancy in the bitch
1. animal can be standing or in R lateral recumbency
2. curvilinear transducer
3. apply transducer cranial to pubic brim (sagittal or transverse)
4. direct beam dorsally
5. find bladder and colon
6. uterus between bladder and colon
7. non-pregnant uterus hard to find
96
At what stage (days) of pregnancy is ultrasound of pregnant bitch best done?
28-32 days
97
What stage of pregnancy is this bitch
d22 (embryo just visible)
98
What stage of pregnancy is this bitch
d23
99
What stage of pregnancy is this bitch
d27
100
What stage of pregnancy is this bitch
d32
101
What stage of pregnancy is this bitch
d38
102
What stage of pregnancy is this bitch
d48
103
Why should rectal temp be measured twice daily in late pregnancy of bitch
to detect prepartum hypothermia that precedes parturition by 24-36 hrs (mediated by sudden progesterone drop)
temp drops from 39C to 37C
104
What are signs of bitch preparing for parturition
whelping nest (shredding and ripping up bedding)
restlessness
increased mucous discharge and swollen vulva
105
What are signs of onset of parturition in bitches
Uterine contractions
increasingly restless
pant and/or shiver
frantic nesting behaviour
refuse food or vomit last meal
allantoic fluid from vulva as foetus ruptures allantochorion
106
Fill in the table with changes in the vaginal smear of bitches
