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263 Cards in this Set
- Front
- Back
Functions of the cerebellum
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Coordinate voluntary movements
Maintain posture and equilibrium Modulates msucle tone and movement via influences on UMN systems DOES NOT initiate any movement |
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Region of the brain in which the cerebellum is located.
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Dorsal metencephalon
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3 peduncles of the cerebellum that attach it to the brainstem
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Rostral
Middle Caudal |
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3 neuronal layers of the cerebellar cortex
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Molecular
Purkinje Granular neuronal layer |
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Four major clinical signs of cerebellar dysfunction
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Postural abnormalities
Gait disturbances Tremors Vestibular signs |
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Goal directed or intention tremor is a clinical sign of injury to this region of the brain...
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Cerebellum
|
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DAIM can arise from disorders of any of these:
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Skeletal muscle
Peripheral nerves CNS |
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Tremors may be connected to either of these neurologic conditions
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Cerebellar disease
Disorders of autonomic involuntary movement |
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Persistent, sustained muscle contraction with delayed relaxation
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Myotonia
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Myotonia is caused by a disorder of...
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Skeletal muscle membrane conductance disorder
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Is myotonia congenital or acquired?
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Either
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Acquired myotonia (pseudomyotonia) is a complication of...
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Hyperadrenocorticism
|
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Describe the EMG for a pseudomyotonic case
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Does not wax and wane
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Persistent, wavelike undulating muscle contraction caused by hyperexcitable motor axons
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Myokymia
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Persistent muscular contraction resulting in stiffness or collapse
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Neuromyotonia
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These two similar conditions are idiopathic in terrier breeds and are caused by hyperexcitable motor axons
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Myokymia
Neuromyotonia |
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Intermittent state of sustained muscle contraction; usually extensor rigidity
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Tetany
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Persistent sustained muscle contraction without interspersed period of relaxation.
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Tetanus
|
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Two metabolic causes of tetany
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Hypocalcemia
Hypomagnesemia |
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Two toxic causes of tetany
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Clostridium tetani toxin
Strychnine poisoning |
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Trauma to any of these three regions may cause tetany.
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Rostral cerebellum
Midbrain Thoracolumbar spine |
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This DAIM is typically presented with a sawhorse stance, intermittent contraction of antigravity muscles, and may affect limbs, face, and multiple muscles. Common causes are hypocalcemia and hypomagnesemia
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Tetany
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Limb and facial grimace and opisthotonous are seen in a young lab puppy. What genetic disease should you test for?
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Familial reflex myoclonus of the lab
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What causes familial reflex myoclonus of the lab?
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Reduced spinal cord glycine (inhibitory) receptors
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Treatment for familial reflex myoclonus of the lab
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None
|
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Prognosis for familial reflex myoclonus of the lab
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Poor
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Familial reflex myoclonus is not actually muoclonus, but...
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Tetany
|
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Toxin responsible for tetanus
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Tetanospasmin toxin
|
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How does tetanospasmin toxin work?
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Blocks release of glycine and GABA inhbitory neurotransmitters
|
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Treatment for tetanus
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Debride wound
Antitoxin Metronidazole/penicillin Supportive care |
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Prognosis for tetanus
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Good: Recovery in weeks to months
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What is they mechanism of action for strychnine?
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Glycine antagonist in the CNS causing tetany and seizures
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Treatment for strychnine
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Gastric decompression
Diuresis Anticonvulsants Supportive care |
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Which toxin crosses the blood brain barrier: Tetanospasmin or strychnine?
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Strychnine
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Sudden contraction of a muscle group followed by immediate relaxation.
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Myoclonus (tremor)
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Sporadic tremors are often a manifestation of...
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Seizure
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Three classifications of repetitive tremor.
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Resting (postural)
Action related Persistent |
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Diffuse action related myoclonus is also called:
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White Shaker's DIsease
|
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Onset of diffuse action-related myoclonus
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Acute
|
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Signalment of the typical case of diffuse action-related myoclonus
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Middle aged small and toy breeds
|
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Treatment for diffuse, action-related myoclonus
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Prednisone, immunosuppressive dose for several weeks then tapered off.
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Prognosis for diffuse action related myoclonus
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Excellent but relapse possible
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Breeds predisposed to head bobbing
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Doberman, Bulldog, Boxer, Boston terriers
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Treatment for episodic postural repetitive tremor of the head and neck
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Anticonvulsants (variable response)
Usually just let it be |
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Course of episodic postural repetitive tremor of the head and neck
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Unpredictable intermittent episodes that are non-progressive
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Postural repetitive tremor of the pelvic limbs is a benign essential tremor seen in...
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Geriatric dogs
|
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Cause of postural repetitive tremor of the hind limbs
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Unknown
|
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Ruleouts with postural repetitive tremor of pelvic limbs
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Painful orthopedic diseases of pelvic limbs and lumbar spine
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True or false: Postural repetitive tremor of the pelvic limbs is non-progressive.
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False. May progress to thoracic limbs but will not typically intervene with the animal's quality of life.
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Treatment for postural repetitive tremor of the pelvic limbs
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None needed
|
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Does postural repetitive tremor if the pelvic limbs occur while at rest or in motion?
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Only at rest
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Difficulty in swallowing
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Dysphagia
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Phases of swallowing
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Oral
Pharyngeal Cricopharyngeal Esophageal Gastroesophageal |
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Esophageal and gastroesophageal dysphagia presents as...
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Regurgitation
|
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Deficit in bolus accumulation, difficulty lapping water or prehending food, excessive salivation and chomping, and loss of food from mouth are all signs of what form of dysphagia?
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Oral phase
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Weight loss, failure to thrive, loss of food from mouth, food reflux through nose, and adpiration pneumonia may all result from what form of dyshagia?
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Pharyngeal phase
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Weight loss, failure to thrive, loss of food from the mouth after attempting to swallow, repeated swallowing attempts, food reflux from the nose, aspiration pneumonia are all CS of this form of dysphagia.
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Cricopharyngeal phase dysphagia
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Basic cause of functional dysphagia
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Neuromuscular issue
|
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Basic cause of structural dysphagia
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Obstructive mass
|
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List some specific causes of structural dysphagia
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Trauma
FB Gingivitis/stomatitis Neoplasia Granuloma Ranula/ pharyngeal mucocele Nasopharyngeal polyp |
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Deficits in these areas may cause functional dysphagia
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Mucosal receptors fro swallowing
Cranial nerves 5, 7, 9, 10, 11 Medullary swallowing center NMJ Striated muscle |
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Type of musclulature in the pharynx
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Striated muscle
|
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Another word for cricopharyngeal dysphagia
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Achalasia
|
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In what age group is cricopharyngeal achalasia evident?
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Young dogs soon after weaning
|
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How is cricopharyngeal achalasia diagnosed?
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Radiography
|
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How is cricopharyngeal achalasia treated?
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Cricopharyngeal myotomy
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Describe cricopharyngeal myotomy.
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Cutting of the cricopharyngeal sphincter to relax it
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Prognosis for cricopharyngeal achalasia
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Good unless there are pharyngeal and esophageal motility defects
|
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Decreased esophageal motility may result from any of the following:
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Striated muscle
NMJ Medulla Peripheral nerves |
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Idiopathic disease of the esophagus often results from...
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Abnormalities in esophageal compliance and response of esophageal mechanoreceptors
|
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Myasthenia gravis causes esophageal problems at this level...
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NMJ
|
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A normal meal should be removed from a healthy canine stomach within...
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6-8 hours
|
|
Clinical signs of delayed gastric motility...
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Chronic vomiting, delayed up to 6-8 hours after eating. May be projectile.
Weight loss Post-prandial abdominal distension and discomfort |
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Possible causes of pyloric outflow obstruction
|
Pyloric hypertrophy
FB Gastric/duodenal neoplasia Extraluminal neoplasia (pancreas, liver) |
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Diagnosis of pyloric outflow obstruction based on...
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Endoscopy (food retention after fast)
Radiography (delayed gastric emptying, enlarged ingesta-filled stomach, intramural mass) Abdominal ultrasound 3 view thoracic radiographs |
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First diagnostic test for chronic vomiting
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Abdominal ultrasound
|
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Usual signalment of dog with chronic hypertrophic pyloric gastropathy
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Middle aged small breeds of dogs
|
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What special pre-anesthetic considerations should be made when an animal with chronic hypertrophic pyloric gastropathy is undergoing anesthesia?
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Increased risk of aspiration pneumonia so prolong the fast to 24+ hours
|
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On abdominal rads you see a "beak sign" in the stomach. THis is a sign of...
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Pyloric hypertrophy
|
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With chronic hypertrophic pyloric gastropathy will the duodenum be normal or abnormal?
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Normal
|
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Diagnosis of pyloric hypertrophy is best made with...
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Endoscopy and FNA
|
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How is pyloric hypertrophy treated?
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Surgical correction of obstruction
|
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List some possible causes of abnormal gastric motility
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Idiopathic
Sympathetic stimulation Hypokalemia Anticholinergics Gastritis |
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How does the endoscopic exam for abnormal gastric motility differ from that of delayed gastric emptying?
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Still see retention of food but no obstruction seen
|
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How do the survey radiographs for abnormal gastric motility differ from that of delayed gastric emptying?
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Look the same: Distended full stomach
|
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How is abnormal gastric motility treated?
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Correct underlying defect
Metoclopramide Cisapride (more effective prokinetic than metaclopramide) |
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How does cisapride work as a prokinetic?
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Causes release of ACH from enteric nervous system.
Noncholinergic effect on feline colonic smooth muscle Causes smooth muscle contraction |
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What feeding modifications should be made with an animal having delayed gastric emptying?
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Small frequent meals, restrict fat to speed emptying
|
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Two most common Salmonella serovars seen in small animals
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S. typhimurium
S. anatum |
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Is Salmonella in the dog and cat a zoonotic disease?
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Possibly. We treat it as if it is.
|
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Increased incidences of canine Salmonella carriage occur with...
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Raw diets, possibly
|
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Clinical signs of Salmonellosis in dogs and cats
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Vomiting and diarrhea (D > V)
Acute onset Pyrexia Septicemia Neutropenia Debilitated, stressed, immunosuppressed animals |
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How is Salmonellosis diagnosed?
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Fecal culture
Blood culture BAL |
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How is GI Salmonellosis treated?
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Supportive care (hydration, probiotics, etc.)
(Abx may prolong carrier state!) |
|
How is Salmonella septicemia treated?
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Antibiotics based on C/S for 10 days
Amoxicillin Choramphenicol Gentamicin TMS Enrofloxacin |
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How common is it to have an asymptomatic canine carrier of Campylobacter jejuni?
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Common
|
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Incidence of clinical C. jejuni is highest in...
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Immature dogs
Sheltered/kenneled dogs |
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Which diarrheal disease is seen more commonly in dogs: Campylobacter or Salmonella?
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Campylobacter
|
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Percentage of dogs with C. jejuni who show no CS
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50%!
|
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CS of Campylobacter
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Acute diarrhea
Acute vomiting Fever Anorexia Depression |
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How is Campylobacter diagnosed?
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Direct saline fecal exam: See highly motile spiral bacteria
Fecal cytology: Seagull shaped bacteria Bacteria culture |
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Significance of seeing Campylobacter jejuni on a fecal smear.
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Not diagnostic but suspicious. Confirm with culture but begin treatment right away.
|
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Special considerations for submitting a Campylobacter culture.
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Needs special transport and culture media.
|
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Oxygen requirement for Campylobacter.
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Microaerophillic
|
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Treatment for Campylobacter
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Based on C/S
Usually erythromycin for 7-10 days |
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Number 1 side effect of erythromycin in dogs and cats. What special consideration minimizes this CS?
|
Vomiting (GI irritant). Give with food.
|
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List some differential diagnoses for chronic SI diarrhea.
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Parasites
Dietary indiscretion/ Fiber-responsive/ Dietary sensitivity Pancreatic exocrine insufficiency Feline hyperthyroidism FeLV/FIV Stagnant loop syndrome |
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Initial diagnostic plan for chronic SI diarrhea
|
3 fecals for intestinal parasites
Saline fecal smear Fecal cytology Correct DI/fiber responsive trial STLI Therapeutic deworming FeLV/FIV T4 |
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Possible causes of abnormal abdominal palpation in an animal with chronic SI diarrhea
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Stagnant loop syndrome
Nodular neoplasia FB Intussuception IBD Diffuse SI lymphosarcoma |
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What % of chronic small bowel diarrhea cases will have abnormal abdominal palpation?
|
1%
|
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Diagnostic plan for chronic SI diarrhea with abnormal palpation
|
Survey abdominal rads
Abdominal US 3 view thoracic radiographs FNA/ percutaneous biopsy +/- barium UGI Exploratory laparotomy |
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A cat has chronic SI diarrhea and its bowel loops feel thick, distended, and similar to a garden hose. What would be the best diagnostic tool to pinpoint the cause and why?
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Endoscopy, b/c full thickness biopsy will not heal well in these cases
|
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Typical diagnostic route when investigating abnormal palpation in a chronic SI diarrhea case.
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Rads, ultrasound, exploratory surgery and biopsy.
|
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Syndrome that involves partial SI obstruction leading to intestinal stasis and SIBO.
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Stagnant loop syndrome
|
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Most common causes of stagnant loop syndrome
|
Intestinal tumor or FB
|
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Normal SI flora count
|
<100,000 cfu/mL
|
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CS of stagnant loop syndrome
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Chronic SI diarrhea
Wt loss Chronic vomiting if high obstruction Dehydration Dilated bowel loop Abdominal mass |
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How does SIBO cause diarrhea?
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Bacteria ferment CHO (osmotically active particles)
|
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Endoscopic findings in an animal with SIBO.
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Normal
|
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Significance of abnormal palpation in a case of chronic SI diarrhea
|
Need further investigation
|
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Prognosis of SIBO
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Varies with underlying disease, length of affected SI, and degree of dilation
|
|
Syndrome resulting in loss of protein in the SI lumen
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Protein losing entropathy
|
|
Two causes of PLE
|
Damaged mucosal barrier
Dilated and obstructed lymphatics |
|
List some causes of PLE
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Lymphagiectasia
IBD Diffuse lymphoma Histoplasmosis Parvovirus HGE Hookworms Acute idiopathic enteritis |
|
Two main signs of PLE
|
Chronic SI diarrhea
Weight loss |
|
Hypoalbuminemia from PLE may cause these CS...
|
Chronic vomiting
Abdominal distension/ascites Peripheral edema Dyspnea and pulmonary edema, pleural effusion |
|
Lab findings associated with PLE
|
Low albumin, globulin, Ca
Possible lymphopenia, cholesterol |
|
Pathophysiology of PLE
|
GIT is site of plasma protein breakdown
Mucosal capillaries have large fenestrae Plasma proteins enter SI--> Usually digested, absorbed, recycled Increased loss with increased permeability, inflammation, erosion, ulceration, venous congestion, lymphatic obstruction Excessive loss exceeds absorptive ability of GIT |
|
Liver can increase protein synthesis by how much in the event of PLE?
|
2X normal
|
|
Hypoproteinemia may be seen with any of the following diseases:
|
PLE
Glomerulonephritis Hepatic failure Chronic hemorrhage Starvation/Malabsorption Burns |
|
With glomerulonephritis, what protein levels will you find on bloodwork?
|
Normal albumin, low globulin
|
|
Liver disease will result in low levels of these blood proteins
|
Albumin
Globulin |
|
Diagnostic plan for hypoprotenemia
|
Evaluate chronic SI diarrhea
If GI signs mild, R/O other causes protein loss (creatinine, UA, liver function) Fecal alpha1-protease |
|
Purpose of testing fecal alpha1-protease
|
Document enteric protein loss when kidney and liver problems are rules out and there is little to no diarrhea.
|
|
Purpose of alpha1-protease in the body.
|
Protects animal against premature activation of trypsin in pancreas
|
|
Alpha1 protease is normally found in...
|
The blood
|
|
Number of samples needed to test for fecal alpha1 protease
|
3 in one day
|
|
Therapy for PLE
|
Treat underlying disease
|
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Causes of SIBO include
|
Stagnant loop syndrome
PEI Malabsorptive disorders Idiopathic syndrome |
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Which animal is more tolerant of higher GI flora? Dog or cat?
|
Cat
|
|
SIBO occurs in what % of PEI patients?
|
80%
|
|
How is SIBO diagnosed?
|
Quantitative SI bacterial culture of duodenal juice. (Aerobic and anaerobic)
|
|
How relaible are the cutoff values for SIBO?
|
Controversial
|
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Diagnosis of SIBO may be made indirectly based on...
|
SUCA (Serum unconjugated cholic acid)
|
|
SUCA is normally reabsorbed in what part of the SI?
|
Jejunum
|
|
Serum bile acids are deconjugated by what process?
|
Bacterial breakdown in the SI
|
|
Purpose of conjugated bile acids
|
Carry fats to the SI mucosa for absorption
|
|
Diagnostic plan for SIBO
|
Evaluate primary SI disorder causing chronic SI diarrhea
Serum B12 and folate (nonspecific) Quantitative duodenal culture SUCA |
|
How effective are the present diagnostic tests for SIBO?
|
Not very. Usually just do abx trial.
|
|
Therapeutic plan for SIBO
|
Treat underlying condition
Abx therapy for 3 weeks (tetracyclines, ampicillin, MTDZ, tylosin, clindamycin) |
|
Are benign SI polyps more common in the dog or cat?
|
Cat
|
|
Clinical signs associated with SI neoplasia
|
Chronic SI diarrhea and vomiting (or mixed bowel diarrhea)
Wt loss Anorexia Anemia/melena Abdominal mass/lymphadenopathy SI obstruction Diarrhea may be minimal to absent |
|
Diagnosis for intestinal neoplasia is based on:
|
Ultrasound, 3 view thoracic rads
FNA Biopsy (Endoscopic, US, laparotomy) |
|
Treatment for intestinal adenocarcinoma
|
Surgical resection
|
|
Treatment for intestinal lymphosarcoma
|
Chemotherapy
|
|
Prognosis for intestinal neoplasia in dogs
|
Guarded
|
|
Which species as a group has a poorer prognosis for intestinal neoplasia: Dogs or cats?
|
Cats
|
|
Most common SI malignancy in dogs
|
Adenocarcinoma
|
|
Most common SI malignancy in cats
|
Lymphoma
|
|
Does adenocarcinoma present as a solitary mass or as an annular mass?
|
Either
|
|
CS of adenocarcinoma in dogs
|
Chronic small bowel diarrhea
Wt loss Anemia/melena Anorexia Abdominal madd Diarrhea can be minimal or absent |
|
True or false: SI adenocarcinoma is localized and benign.
|
False. It is invasive and metastatic
|
|
Diagnosis of SI adenocarcinoma is based on...
|
Ultrasound, 3 way TXR
Biopsy |
|
Treatment for SI adenocarcinoma
|
Surgical resection
|
|
Px for SI adenocarcnoma
|
Guarded in dogs
Poor in cats |
|
Why is endoscopy not always diagnostic for SI adenocarcinoma?
|
Endoscopy only reaches to the duodenum. Most tumors in jejunum or ileum
|
|
What is the relationship between SI LSA in cats and FeLV?
|
Believed that FeLV causes LSA, but most cats FeLV negative when LSA diagnosed.
Maybe due to neutralizing response by body? |
|
Lymphosarcoma in cats involves these organs commonly...
|
Stomach, LI, liver, mesenteric LN, kidneys
|
|
Signalment of LSA in dogs and cats
|
Middle aged dogs, older cats
|
|
Is lymphosarcoma more common in dogs or cats?
|
Cats
|
|
How does LSA present in the SI?
|
Diffuse mucosal infiltration
SIngle or multiple masses Annular constricting mass |
|
CS of lymphosarcoma
|
Chronic SI (mixed) diarrhea
Chronic vomiting Weight loss Anemia/melena Anorexia Abdominal mass/ lymphadenopathy Diarrhea may be minimal or absent |
|
Lymphosarcoma is best diagnosed by...
|
Endoscopy and biopsy of duodenum
|
|
Treatment for invasive/infiltrative lymphosarcoma of the SI.
|
Chemotherapy
Cats: Prednisone and chlorambucil |
|
Two chemotherapeutic drugs used to treat SI LSA in the cat
|
Prednisone
Chlorambucil |
|
Treatment for a single mass of lymphosarcoma.
|
Surgical removal followed by multiagent chemotherapy
|
|
3 reasons to treat SI LSA surgically.
|
Obstructive mass
Risk of perforation Severe ulceration and bleeding |
|
Prognosis for lymphocytic LSA in the cat.
|
Good! 2 year survival with chemotherapy!
|
|
Prognosis for LSA in the dog
|
Poor to grave
|
|
Histoplasma is most common in this area of the US
|
Ohio and Mississippi River basins
|
|
Histoplasma spread is associated with...
|
Bird droppings
|
|
3 forms of Histoplasma disease
|
Acute
Chronic respiratory Disseminated |
|
How does Histoplasma infection become disseminated
|
Macrophages from the lungs
|
|
How is Histoplasma diagnosed?
|
Rectal cytology
Endoscopy/ mucosal biopsy Percutaneous FNA or tru-cut biopsy GOAL: Identify the organism |
|
Treatment for Histoplasma
|
Amphotericin B (quick-kill)
Ketoconazole Itraconazole (if stable) |
|
True or false: SI neoplasia tends to cause chronic SI diarrhea, wt loss, icterus, and anemia.
|
False--> all of these except icterus are signs of SI neoplasia. Icterus would result if the cancer spread to liver.
|
|
Two causes of ascites
|
Portal hypertension
Hypoalbuminemia |
|
Two possible causes of portal hypertension and ascites.
|
Distortion/obstruction of sinusoids
Increased portal blood flow volume |
|
Describe the under-filling theory of ascites.
|
Splanchnic pooling = decreased venous return to heart
Decreased cardiac output, activation of RAAS Increased circulatory volume Dilution of serum albumin from fluid retention |
|
Describe the over-filling theory of ascites
|
Primary renal retention of Na and water
Increased circulatory volume Dilution of serum and albumin |
|
Which is the current dominant theory of ascites etiology: Over-filling or under-filling?
|
Mixture of two
|
|
Toxins responsible for hepatic encephalopathy.
|
Amino acids
Ammonia SCFA's Mercaptans GABA Endogenous benzodiazepines |
|
How does hepatic encephalopathy occur?
|
Liver cannot remove toxic material produced in the bowel or unable to undergo normal metabolism. Abnormal concentrations of toxins in the blood.
|
|
Most potent inhibitory neurotransmitter
|
GABA
|
|
GABA is released when these two compounds bind appropriate receptors in the brain.
|
Benzodiazepines
Barbiturates |
|
Drugs contraindicated for treatment of seizures induced by hepatic encephalopathy.
|
Benzodiazepines
Barbiturates |
|
Why would flumazenil be a possible treatment for hepatic encephalopathy?
|
GABA antagonist, since liver may not be removing GABA effectively
|
|
Processes that lead to an increase in GABA in the CNS.
|
GI bacterial metabolism
GI hemorrhage Increased permeability of BBB in liver disease Glutamic acid--> GABA in CNS as result of ammonia metabolism |
|
Normal ratio of branched to aromatic amino acids in a healthy animal.
|
3:1
|
|
Liver disease causes a relative increase in the level of this type of amino acid.
|
Aromatic (3 fold increase)
|
|
Type of amino acid that crosses blood brain barrier
|
Aromatic
|
|
What effect do aromatic amino acids have in the brain?
|
Increase production of inhibitory and false neurotransmitters.
|
|
Mercaptans are a byproduct of...
|
Bacterial metabolism of sulfur-containing AA
|
|
How can "liver sparing" drugs contribute to hepatic encephalopathy?
|
If they contain mathionine, may be metabolized to mercaptans that can induce coma.
|
|
Why does SAMe not cause HE even though it is a form of methionione?
|
Methionine not available for bacterial metabolism, sent to liver whole
|
|
Mercaptans decrease the hepatic metabolism of...
|
Ammonia
|
|
The effect of SCFA's on the brain is similar to that of...
|
Barbiturates
|
|
Where do endogenous benzodiazepines come from?
|
Food
|
|
Liver diets should have low levels of...
|
Highly digestible proteins
|
|
Goal of protein restriction in liver diets
|
Reduce levels of ammonia
|
|
Purpose of suluble fiber in a liver diet
|
Decrease colonic pH and trap ammonia in LI
|
|
Three common hepatobiliary disorders
|
Vacuolar hepatopathy
Microvascular dysplasia Gallbladder mucocele |
|
Benign reversible vaculolar hepatopathy of dogs caused by exogenous or endogenous glucocorticoids
|
Steroid hepatopathy
|
|
How frequently does steroid hepatopathy lead to liver disease?
|
Rare
|
|
CS of steroid hepatopathy
|
Related to corticosteroid excess
|
|
This enzyme is greatly elevated with steroid hepatopathy
|
Alkaline phosphatase
|
|
True or false: Vacuolar hepatopathy is always linked to corticosteroid excess.
|
False.
|
|
Current hypothesis behind vacuolar hepatopathy
|
Stress of severe disease--> Hypercortisolemia--> Increased ALP--> vacuolar hepatopathy
|
|
Absence or dysplasia of terminal portal veins
|
Hepatic microvascular dysplasia
|
|
Hepatic microvascular dysplasia is inherited in...
|
Cairn terriers
|
|
CS for hepatic microvascular dysplasia resemble those for...
|
Portosystemic shunt
|
|
Often the only clinical sign of hepatic microvascular dysplasia
|
Elevated serum bile acids
|
|
Sign seen with portosystemic shunts that is not seen with hepatic microvascular dysplasia.
|
Microcytosis
|
|
Does HMD or PSS have a higher shunt fraction?
|
PSS
|
|
Prognosis for hepatic microvascular dysplasia
|
Good if asymptomatic
Dogs with CS can often be managed for years |
|
In a dog with elevated bile acids, how do you determine whether due to PSS or hepatic microvascular dysplasia?
|
Abdominal U/S (50-80% accuracy in shunt detection)
|
|
How can a symptomatic animal be treated for hepatic microvascular dysplasia?
|
Low protein diet
Lactulose Intermittent, nonabsorbable antibiotics like with hepatic encephalopathy |
|
Disease characterised by gallbladder distension with immobile bile, cystic mucosal hyperplasia, and a stellate pattern on U/S
|
Gallbladder mucocele
|
|
This breed may be predispoded to gallbladder mucocele
|
Cocker Spaniel
|
|
CS of gallbladder mucocele
|
Vomiting (M/C)
Anorexia Lethargy Abdominal pain Icterus Pyrexia Rupture--> Ascites and shock |
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True or false: Gallbladder mucocele may be an incidental finding
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True
|
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Treatment of gallbladder mucocele
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Emergency surgery if rupture
Scheduled surgery iof CS Medical management if subclinical (Ursodeoxycholic acid, recheck q 4-6 weeks) |
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Copper associated hepatitis is seen most frequently in this dog breed.
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Bedlington Terriers
Also see in Westies, Skye terriers, Dalmatians, Labs, Dobermans |
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What defect causes copper-associated hepatitis?
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Autosomal recessive trait causing accumulation of copper within hepatocyte
|
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Why is copper associated hepatitis seen in Dobermans
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Propensity for chronic hepatitis--> Cholestasis--> Copper buildup b/c of reduced biliary clearance
|
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Forms of disease caused by copper-associated hepatitis
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Severe hepatic failure and death in young adult following stressful event
Chronic hepatitis Asymptomatic carrier |
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How is copper-associated hepatitis diagnosed?
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Excessive copper in biopsy specimen (> 1000 ppm)
|
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How is copper associated hepatitis treated?
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D-penacillamine or trientine to chelate copper, inhibit fibrosis and CMI.
Zinc acetatie (decrease absorption) Ascorbic acid (increase urinary excretion of Cu) May need to be treated for over 1 year! |
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Prognosis of acute copper associated hepatitis
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Grave
|
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Prognosis of chronic copper associated hepatitis
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Depends on fibrosis
|
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In an animal with primary copper associated hepatitis, is lifelong copper chelation therapy necessary?
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Yes although may be able to taper dose down to lower level
|
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List some hepatotoxic drugs.
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Phenobarbital
Diazepam Oxybendazole TMS Carprofen |
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How is a drug proven to be hepatotoxic in a given animal?
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Administer drug, reverse CS. Then challenge animal with drug again and get more CS again
Not often done |
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Median time to carprofen hepatotoxicity in susceptible animals
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19 days
|
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Biopsy findings in an animal with carprofen infuced hepatotoxicity
|
Hepatic necrosis
|
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How long after discontinuing carprofen do clinicopathologic findings return to normal?
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3-4 weeks
|
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Clinical signs associated with carprofen-caused hepatocellular necrosis usually resolve after...
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20 days once treatment stopped
|
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High incidence of carprofen linked hepatocellular necrosis seen in this breed
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Labradors
|
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Most common CS seen with carprofen-related hepatocellular necrosis in Labradors
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Anorexia
Vomiting Icterus |
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Elevations of these clinicopathological values seen with carprofen linked hepatocellular necrosis
|
ALT
AP Bilirubin |
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Primary histopathologic signs of carprofen-induced hepatitis
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Nonspecific necrosis and inflammation
|
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Treatment for carprofen-linked hepatocellular necrosis
|
Discontinue carprofen
IV fluids 1-7 days Antibiotics 3-14 days May use GI drugs or ursodeoxycholic acid as needed |
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How should a patient on carprofen be monitored for hepatitis?
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Blood chem panel before treatment, check liver enzymes after 3-6 months
|
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Is liver neoplasia more commonly metastatic or primary?
|
Metastatic
|
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Is liver neoplasia more commonly malignant or benign?
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Malignant
|
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CS of hepatic neoplasia
|
Asymptomatic
Abdominal mass Hepatomegaly Ascites (+/- tumor cells) Mild hepatic signs: Anorexia, wt loss, lethargy, occasional vomiting and diarrhea |
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Primary tumors that tend to metastasize to the liver
|
Mammary mass
Spleen Pancreas Stomach and/or intestines |
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Are biliary carcinomas more common in male or female dogs?
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Female
|
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Icterus is commonly associated with this hepatic neoplasm
|
Biliary carcinoma
|
|
Made from the union of methionine and ATP, being an essential metabolite for hepatocytes
|
SAMe
(S-adenosylmethionine) |
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Do endogenous levels of SAMe increase or decrease in liver disease?
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Decrease
|
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SAMe is a precursor of this antioxidant.
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Glutathione
|
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Three antioxidant nutraceuticals that may be beneficial in liver disease
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SAM-e
Vitamin E Milk thistle |