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Diseases of Digestive System. Chapter 2. Oral Diseases: Periodontal Disease. Periodontal Disease is plaque-induced inflammation of gums Progressive Includes gingivitis, gingival hyperplasia, peridontitis with vertical bone destruction, and peridontitis with horizontal bone destruction

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oral diseases periodontal disease
Oral Diseases: Periodontal Disease
  • Periodontal Disease is plaque-induced inflammation of gums
    • Progressive
    • Includes gingivitis, gingival hyperplasia, peridontitis with vertical bone destruction, and peridontitis with horizontal bone destruction
    • The end result is loss of tooth
  • Periodontal means “around the tooth”
    • Etiology
      • Food particles, bacteria collect around gum line and form plaque
      • Minerals in saliva collect in plaque and harden to form tartar (calculi) which adheres to teeth
        • Called gingivitis
        • 3-5 d to harden
        • Causes bad breath
oral diseases periodontal disease1
Oral Diseases: Periodontal Disease
  • Calculus builds up under gums
    • Separates teeth from gums to form ‘pockets’, which encourages more bacteria to accumulate and grow
      • Bacteria secrete toxins/enzymes that cause detachment of tooth from bony socket
      • WBC’s invade area and release their enzymes to destroy bacteria
        • These enzymes also cause detachment of tooth from bone
      • Pockets get deeper and deeper
        • Weakens bone
        • Can cause pathologic fractures
  • Other sequellae
    • Bacteria enter blood stream
      • Can cause micro-abscesses in liver, kidneys
      • Cause endocarditis on heart valves
oral diseases periodontal disease2
Oral Diseases: Periodontal Disease
  • Periodontitis—irreversible condition:
    • Alveolar bone resorption
  • Gingivitis—reversible; earliest signs of Periodontal Disease

Mild tartar more tartar severe tartar >50% bone loss

Mild gingivitis more gingivitis gum receding tooth is loose

No bone loss min bone loss moderate bone loss should be pulled

oral diseases gingivitis
Oral Diseases: Gingivitis
  • Gingivitis—earliest signs of Periodontal Disease
    • Involves only the soft tissues of the gums
    • Reversible inflammation of gums
    • Gingival hyperplasia (may also be breed- or drug-related)
    • Cause—accumulation of tartar on teeth
      • Tartar is conducive to bacterial growth
      • Enzymes produced by bacteria damage tooth attachment and cause inflammation
oral diseases gingivitis1
Oral Diseases: Gingivitis
  • Signs
    • Halitosis
    • Reluctance to chew hard food
    • Pawing at mouth
    • Oral pain; personality changes
    • Sneezing; nasal discharge
    • Increased salivation
    • Facial swelling; tooth loss
  • Dx
    • Complete oral exam
    • Presence of tartar (plaque) on teeth
oral diseases gingivitis2
Oral Diseases: Gingivitis
  • Rx
    • Dental scaling
      • with ultrasonic scaler
    • Root scaling/planing (below gum line)
      • with thin ultrasonic tip; curette
    • Gingival curettage
      • with curette against inner surface of gums (gingival pocket’s diseased soft tissue inner surface)
        • rationale is to convert chronically inflamed ulcerated lesions into a clean surgical wound to promote healing
    • Polishing to remove any missed calculi
    • Irrigation to remove diseased tissue and plaque
oral diseases gingivitis3
Oral Diseases: Gingivitis
  • Client info
    • Good oral hygiene is necessary for all pets
      • Brush teeth daily
      • Routine dental cleanings performed at veterinarian’s
      • Treat gingivitis early before irreversible lesions occur
    • Extractions are sometimes necessary to clear up infections
    • Hard, crunchy food may promote better dental health by removing tartar before it calcifies
      • Once it calcifies, tartar must be removed professionally
oral diseases periodontal disease3
Oral Diseases: Periodontal Disease

Without intervention, gingivitis progresses to:

  • Periodontitis—irreversible condition:
    • Loss of gingival root attachment (receding gums)
    • Alveolar bone resorption
    • Loss of teeth

alveolar bone

lip fold dermatitis
Lip-Fold Dermatitis

Often seen in breed with pendulous upper lips (spaniels, setters, St. Bernard, bulldogs, bassets)

Constant moisture in the folds from saliva causes bacterial growth

Food, hair, moisture cause irritation, erythema, and fetid odor

  • Signs
    • Halitosis
    • Collection of debris in lower lip fold
  • Dx
    • Clinical signs
  • Rx
    • Dental cleaning
    • Clip hair
    • Clean out folds (food)
    • Diaper rash cream
    • Sx is permanent Rx
lip fold dermatitis1
Lip-Fold Dermatitis
  • Client info
    • Keep lip folds dry (for the rest of animal’s life!!)
    • Flush/clean lip folds with 2.5% benzoyl peroxide shampoo
    • Drying agents like corn starch several times a day
    • Good dental hygiene will help prevent it
oral trauma
Oral Trauma
  • Causes (many)
    • Falls, fights (bites), burns, blunt trauma (HBC)
    • “High-rise syndrome” in cats
      • Fractured hard palate, mandible
    • Tongue injury from biting own tongue, dog fight, eat from tin can in garbage, FB(Foreign body)
    • Cats playing with needles, thread; strangulate tongue
    • Electrical, chemical burns
    • Gunshot wounds, fish hooks
    • Bones lodged in teeth

Fx mandible—cat; HBC

oral trauma1
Oral Trauma
  • Signs
    • History or signs of head trauma
    • Increased salivation
    • Inability to close mouth; due to:
      • Pain
      • Fracture/dislocation
      • FB
    • Reluctance to eat (same reasons)
    • Presence of foreign object
  • Dx
    • PE of oral cavity
    • X-ray to r/o embedded FB
oral trauma2
Oral Trauma
  • Rx
    • Depends on type of trauma
    • Control bleeding
    • Provide supportive care
      • IV fluids
      • pain relief
    • Insure adequate airway
    • Repair/extract damaged teeth
  • Client info
    • Like kids, if animals can get into trouble, they will
      • Discourage chewing on electric cords
      • Don’t leave caustic/toxic chemicals out
      • Keep pets in fenced yard or on leash when outside
      • Animals still eat well without entire tongue
salivary mucocele
Salivary Mucocele

Accumulation of excessive amounts of saliva in SQ tissue

Most common lesion of salivary glands in dogs; rarely seen in cats (following trauma)

Cause is unknown (tight collar, choke chain??)

  • Signs
    • Slowly enlarging, nonpainful, fluid-filled swelling on neck or under tongue
    • Reluctance to eat
    • Difficult swallowing
    • Blood-tinged saliva
    • Respiratory distress
salivary mucocele1
Salivary Mucocele
  • Dx
    • Clinical signs
    • Paracentesis shows thick, blood-tinged fluid
  • Rx
    • Aspirate fluid
    • Surgical drainage
    • Remove salivary gland; insert Penrose drain x 7 d
  • Client info
    • Cause is unknown; trauma may be involved
    • Without removal of gland, excess fluid will continue to accumulate
    • Some cases may resolve spontaneously

Removal of mandibular salivary gl

oral neoplasia
Oral Neoplasia

Relatively common in cats and dogs; malignant melanoma and squamous cell carcinoma most common

  • Signs
    • Depend on location and size of growth
    • More common in males
    • Abnormal food prehension
    • Increased salivation
    • Tooth loss
    • Oral pain
  • Dx
    • Histology of mass
    • X-rays to r/o metastasis
    • Biopsy of LN to r/o metastasis

Squamous cell carcinoma (Upper R 3rd incisor)

Bone loss around lesion

Rostral maxillectomy was curative

oral neoplasia1
Oral Neoplasia
  • Rx
    • Surgical excision
    • Partial removal of mandible/maxilla if bone is involved
    • Radiation therapy
    • Chemotherapy
  • Client info
    • Px for malignant tumors is guarded even with aggressive therapy
    • Benign lesions have good Px
    • Animals (esp cats) with bone removed may need nutritional support (feeding tube)
esophageal disease
Esophageal Disease
  • Esophageal obstruction

Ingestion of nondigestible object (bones, play objects)

Degree of damage depends on size, shape, time in esophagus

Surgical removal is least desirable → stricture formation

    • Signs
      • Exaggerated swallowing movements
      • Increased salivaiton restlessness
      • Retching
      • Anorexia
      • Hx of chewing on foreign objects

Esophageal endoscopy

esophageal obstruction
Esophageal Obstruction
  • Dx
    • Endoscopy
    • Radiography
  • 6-mo old St Bernard
  • What is your diagnosis?
esophageal obstruction1
Esophageal Obstruction
  • 3 mo kitten
  • What is your diagnosis?
esophageal obstruction2
Esophageal Obstruction
  • 2 yr old cat
  • What is your diagnosis?
interesting stuff
Interesting stuff
  • 7 mo old Pug
esophageal obstruction4
Esophageal Obstruction
  • Rx
    • Prompt removal is important
    • NPO x 24 h to allow for healing
    • Resume feeding with soft foods
  • Client info
    • Limit access to bones and small objects
    • Strings and needles are hazards for cats
    • Px is good if serious damage to esophagus can be prevented
stomach diseases
Stomach Diseases
  • Acute Gastritis
    • Commonly seen in dogs (cats to lesser degree)
      • Spoiled food
      • Change in diet
      • Food allergy
      • Infections (bacterial, viral, parasitic)
      • Toxins (chemicals, plants, drugs, organ failure)
      • Foreign objects
    • Signs
      • Anorexia
      • Vomiting (maybe dehydration)
      • Painful abdomen
      • Hx of diet change, toxin ingestion, infection, parasites
acute gastritis
Acute Gastritis
  • Dx
    • Hx and PE
    • CBC, Chem Panel to assess dehydration, metabolic imbalance, organ failure
  • Rx
    • NPO until vom stops
      • 4-6 sips of water q1h until watered out
      • Fluid therapy (SQ or IV)
    • Gradually start feeding after watered out
      • Bland food (Hill’s I/D, boiled chicken/rice)
    • Antiemetics
      • Chlorpromazine (Thorazine)
      • Metoclopramide
    • Coating agents
      • Kaopectate
      • Pepto-Bismol
    • Antibiotics—often prescribed, rarely needed
acute gastritis1
Acute Gastritis
  • Client info
    • Avoid abrupt changes in diet
      • Gradually mix new food in with old (1 wk)
    • If pet vomit 2-3 times, NPO x 24 h; if it continues see vet
    • Dogs and cats do not need variety
    • Avoid objects that can be swallowed (treat like a baby)
immune mediated inflammatory bowel disease enteritis colitis
Immune-Mediated Inflammatory Bowel Disease (Enteritis, Colitis)

Seen in cats, less common in dogs

Accumulation of inflammatory cells in lining of stomach, SI, LI

  • Signs
    • Chronic vomiting, wt loss
    • Diarrhea, straining to defecate, mucus in stool
  • Dx
    • Fecal to r/o parasites; culture to r/o bacterial infection
    • CBC, Chem panel to r/o metabolic disorder
    • FeLV, FIV to r/o those diseases
    • Endoscopy and biopsy for definitive diagnosis
immune mediated inflammatory bowel disease enteritis colitis1
Immune-Mediated Inflammatory Bowel Disease (Enteritis, Colitis)
  • Rx
    • What is the Rx for any Immune-mediated Disease?
    • Azathiaprine—immunosupressant (organ transplants)
    • Cyclophosphamide—inhibits immune system response
    • Sulfasalazine—a sulfa drug with anti-inflammatory effects
      • Most effective against colitis
    • Hypoallergenic diet
      • Free from preservative, additives
      • Highly digestible protein (rabbit, lamb, tofu, chicken)
      • Homemade diets with rice base
      • Some commercial diets are available
    • Client info
      • Life-long condition (special diet, frequent medical monitoring)
      • Immunosupressive drugs have side-effects (PU/PD/PP, wt gain, skin/urinary infections)
      • Use lowest dose that provides effect
gastric ulceration
Gastric Ulceration

Usually a result of long-term NSAIDs

  • Signs
    • Vary from asymptomatic to vom blood
    • Anemia, edema
    • Melana
    • Anorexia
    • Abdominal pain
    • Septicemia if perforation occurs
  • Dx
    • X-ray using contrast medium (Ba) to show ulceration in stomach lining
    • Endoscopy
gastric ulceration1
Gastric Ulceration
  • Rx
    • Fluid therapy for dehydration
    • NPO (as before)
    • Coating agents/antacids
    • Cimetidine—H2 antagonist (↓ HCl production)
    • Omeprazole—↓ HCl production (proton-pump inhibitor)
  • Client info
    • Do not use NSAIDs without veterinary supervision
    • Give NSAIDs with meal
gastric dilation volvulus
Gastric Dilation/Volvulus

Primarily a disease of large, deep-chested dogs

Dilation—gas filled; Volvulus—twisted along longitudinal axis

  • Signs
    • Abdominal pain/distension
    • Weakness, collapse, depression, nausea, salivation
    • Increased HR, RR
  • Dx
    • PE shows dilation, poor perfusion (↑ cap refill)
    • X-rays show air filled stomach
    • ECG may show vent arrhythmia or sinus tachycardia
    • CBC and Chem panel necessary to assess electrolyte levels
gastric dilation volvulus1
Gastric Dilation/Volvulus
  • Rx
    • Goals
      • Decompress stomach
        • Pass stomach tube
        • 18 gauge needle
      • Stabilize patient (fluids, electrolytes, ECG)
        • Rx for shock
          • IV fluids
          • Corticosteroids
        • Antibiotics
      • Prepare for Sx
    • Sx—ASAP
    • Post-Op
      • ECG
      • Blood pressure
      • Pain management
      • Monitor urine output
      • Antibiotics
      • Maintain fluids (oral, IV)
gastric dilation volvulus2
Gastric Dilation/Volvulus
  • Client info
    • Avoid large meals
    • Limit exercise after meals
    • Feed high-quality protein diet
    • Tack-down procedure not 100% preventative
gastric neoplasia
Gastric Neoplasia

Most common malignant neoplasia in dogs is adenocarcinoma; in cats lymphoma

  • Signs
    • Wt loss
    • Vom w/ or w/o blood
    • Obstruction
    • Usually seen in older animals
  • Dx
    • Endoscopy and biopsy for diagnosis
    • X-ray with Ba contrast
gastric neoplasia1
Gastric Neoplasia
  • Rx
    • Surgery is TOC
      • Many tumors are too far advanced (inoperable)
    • Chemotherapy
    • Radiation less successful for gastric tumors
  • Client info
    • Px is poor; gastric neoplasia is a fatal disease
    • Supportive care, control of vom, good nutrition are needed for these animals
diseases of si
Diseases of SI

Often involves impairment of absorptive surface of SI (what is that?)

  • Acute Diarrhea—one of the most commonly seen types of diarrhea
    • Causes—(often accompanies acute gastritis)
      • Diet change
      • Stressful situations
      • Drug therapy
    • Signs (Duh?)
      • Acute onset
      • ± vomiting
      • Normal appearance otherwise
    • Dx
      • Fecal to r/o parasites
      • CBC (dehydration), Chem panel to r/o metabolic diseases
acute diarrhea
Acute Diarrhea
  • Rx
    • Fluids for dehydration, electrolyte imbalance (SQ, IV, PO)
    • NPO x 24 h; water OK if no vomiting
    • Intestinal absorbants/coating agents (Kaopectate, PeptoBismol)
    • Loperamide—opiod receptor inhibitor that slows gut motility
    • Antibiotics (?)
    • Bland diet after 24 h
      • Hills I/D
      • Boiled chicken/rice
parasite diarrhea
Parasite Diarrhea
  • Signs
    • Diarrhea
    • Wt loss
    • Poor hair coat
    • Listlessness
  • Dx
    • Fecal exam
  • Tx
    • Anthelmintics for parasites
    • Antiprotozoal medication for Giardia, Coccidia
parvovirus
Parvovirus

Seen mainly in young, unvaccinated puppies

  • Signs
    • Diarrhea, usually with blood
    • Vomiting
    • Febrile
    • Anorexia, depression
  • Dx—ELISA (enzyme-linked immunosorbent assay) test
  • Rx
    • IV fluids
    • Antidiarrheal therapy
    • Antibiotics (Gram neg)
    • Keep warm
parvovirus1
Parvovirus
  • Client info
    • Sick animals will infect other unprotected animals
    • Parvo can be fatal
    • Vaccinate for protection
diseases of li
Diseases of LI

Function is to reabsorb water, electrolytes; store feces

  • Inflammatory Bowel Disease (IBD)
    • Signs
      • Diarrhea with wt loss
      • ↑ frequency of defecations, ↓ volume
      • Tenesmus
      • ↑ mucus
    • Dx
      • Fecal to r/o parasites
      • Chem panel to r/o metabolic causes
      • Biopsy of LI wall
        • ↑ lymphocytes and plasma cells
inflammatory bowel disease
Inflammatory Bowel Disease
  • Rx
    • Sulfasalazine—a sulfa drug with anti-inflammatory effects
      • Most effective against colitis
    • Prednisone
    • Mesalamine—a metabolite of Sulfasalazine in LI (actions unknown)
    • Hypoallergenic diet
      • Hill’s d/d, c/d, i/d
      • Homemade diets
  • Client info
    • Treatment is often prolonged
    • Goal of Rx is to control symptoms, not cure disease
    • Animals with IBD need to be taken outside frequently for BM’s
intussusception
Intussusception

Cause usually unknown; can result from parasites, FB, infection, neoplasia

  • Signs
    • Vom/diarrhea with or without blood
    • Anorexia, depression
  • Dx
    • Palpation of sausage-like mass in cranial abdomen
  • Rx
    • Surgical reduction/resection of necrotic bowel
    • Restore fluid/electrolyte balance
    • Restrict solid food x 24 h after Sx; then bland diet x 10-24 d
  • Client info
    • Recurrence is infrequent
    • Px depends on amt of bowel removed
    • Puppies should be treated for parasites to prevent intussusception
megacolon
Megacolon

Uncommon in dogs, more common in cats

Associated with Obstipation

  • Signs
    • Straining to defecate
      • Must be distinguished from straining to urinate in male cats
    • vomiting
    • Weakness, dehydration, anorexia
    • Small, hard feces or liquid feces
      • With or without blood, mucus
megacolon1
Megacolon
  • Dx
    • Palpation of distended colon filled with hard, dry feces
    • Radiographs show colon full of feces
    • Rectal palpation assures adequate pelvic opening
  • Rx
    • Warm water enema
      • Animals can become hypothermic
    • Manual removal under anesthesia
      • Mucosal surface is delicate
    • Client info
      • Encourage water intake
        • Salt food
        • Always provide adequate supply
      • High-fiber diet
megacolon2
Megacolon

Surgical removal

Suture ends at arrows

liver diseases
Liver Diseases

Liver performs ~1500 functions

High regenerative capacity; damage must be sever for signs to appear

Vague signs early: anorexia, vom/diar, wt loss, PU/PD, fever

  • Drug/Toxin induced Liver Disease
    • Acute liver failure requires >70% of liver to be affected
    • Susceptible to toxin ingestion (portal circulation)
    • Some drugs have a Hx of liver toxicity
      • Acetaminophen
      • Phenobarbital
      • Thiacetarsamide (Caparsolate)
      • others
drug toxin induced liver disease
Drug/Toxin Induced Liver Disease
  • Signs
    • Acute onset
    • Anorexia
    • vomiting/, diarrhea/constipation
    • PU/PD
    • Jaundice (maybe)
    • Melina, hematuria, or both
    • CNS signs (depression, ataxia, dementia, coma, seizures)
drug toxin induced liver disease1
Drug/Toxin Induced Liver Disease
  • Dx
    • Hx of drug administration
    • Painful liver on palpation
    • Chem panel
      • ↑ ALT (alanine aminotransferase)
      • ↑ Total bilirubin, ↑ blood ammonia
      • ↑ Serum bile acids
      • Hypoglycemia, coagulopathy
    • Radiographs show enlarged liver
    • Liver biopsy (unless coagulopathy suspected)
drug toxin induced liver disease2
Drug/Toxin Induced Liver Disease
  • Rx
    • Antidotes—if available (ex: acetaminophen)
    • Induce vomiting
    • Activated charcoal
    • IV fluids
    • Vit K for clotting
    • Antibiotics
    • Special diets (Hill’s k/d or u/d)
liver tumors
Liver Tumors

Primary and metastatic tumors are not uncommon in dogs and cats

Metastatic tumors are more common than primary tumors of liver

  • Signs
    • Anorexia, lethargy, wt loss
    • PU/PD
    • Vomiting/diarrhea (?)
    • Abdominal distension, hepatomegaly
    • Jaundice
  • Dx
    • Anemia, usually non-regenerative
    • Chem Panel
      • ↓ serum albumen
      • ↑ serum bilirubin, bile acids
      • ↓ serum glucose
      • Azotemia (↑ BUN, creatinine; esp in cats)
liver tumors1
Liver tumors
  • Dx
    • X-ray: Heptomegaly, Ascites (?)
    • Biopsy of liver
    • Abdominocentesis may show tumor cells
  • Rx
    • Surgical removal is preferred treatment
      • Single masses have good Px
      • Multiple nodules/Diffuse disease have poor Px
    • Chemotherapy doesn’t help primary tumors; better for metastatic lesions
  • Client info
    • Guarded to poor Px generally
    • Survival time: 6 mo-3 y
portosystemic shunts
Portosystemic Shunts

Shunts form between portal circ and systemic circ allowing blood to bypass liver; Function of liver—detox blood

Congenital or acquired

  • By-passing liver, allows many toxins into systemic circulation
  • CNS is most affected by the circulating toxins
portosystemic shunts2
Portosystemic Shunts
  • Signs
    • Dumb/numb, lethargic, depressed
    • Ataxia, staggering
    • Head-pressing (against a wall)
    • Compulsive circling, apparent blindness
    • Seizures, coma
    • Bizarre behavior (esp cats)
    • Signs often more pronounced shortly after a meal
portosystemic shunts3
Portosystemic Shunts
  • Dx
    • Chem panel
      • ↓ serum protein, albumen (liver is usually small)
      • ↓ BUN (liver converts ammonia → urea)
      • ↑ ALT (alanine aminotransferase), ALP (alkaline phosphatase)
      • ↑ blood ammonia (from protein)
    • X-rays
      • Small liver
      • Contrast material
        • Inject into splenic vein
        • By-passes liver
portosystemic shunts4
Portosystemic Shunts
  • Rx
    • Medical management seldom very successful
      • Low protein diet
    • Sx
      • Ligation of shunt
        • Total ligation often causes ↑ liver BP
        • Partial ligation may be more practical
        • A second Sx can be performed after few months to close off shunt totally
    • Client info
      • Px often very good following ligation
      • For best results, Sx should be performed before 1 y old
      • Collateral circulation may develop, with relapse of signs
pancreatic dysfunction exocrine
Pancreatic Dysfunction (Exocrine)
  • Main function of Exocrine Pancreas → secretion of dig enzymes
  • Located along duodenum
  • Dig enzymes secreted in an inactive form to protect pancreas tissue
pancreatic dysfunction exocrine1
Pancreatic Dysfunction (Exocrine)
  • Pancreatitis—Inflammation of pancreas

May be chronic or acute

Develops when dig enzymes are activated within gland → autodigestion

More common in obese animal; high-fat diets may predispose animal to it

Unpredictable results; some recover well, others worsen and die

    • Signs
      • Older, obese dog or cat with Hx of recent high-fat meal
      • Depression, anorexia, vomiting
      • ± abdominal pain
      • Shock, collapse may develop
      • Often seen post-holiday
        • Table scraps of ham, gravy, etc
pancreatitis
Pancreatitis
  • Dx
    • CBC, Chem panel
      • Leukocytosis
      • ↑ PCV (means what?)
      • Hyperlipidemia
      • ↑ serum amylase, lipase
  • Rx
    • IV fluids, electrolytes
    • NPO 3-4 d
    • Antibiotics
    • Butorphanol for pain
    • Start back on low fat diet 1-2 d after vom stops
  • Client info
    • Avoid obesity/overfeeding
    • Feed low-fat treats
    • Px is difficult to assess
exocrine pancreatic insufficiency
Exocrine Pancreatic Insufficiency

The pancreas stops making dig enzymes

May occur spontaneously (G Shep) or due to chronic pancreatitis (cats)

  • Signs
    • Wt loss
    • Polyphagia
    • Coprophagia, pica
    • Diarrhea, fatty stool
    • Flatulence
  • Dx
    • Normal CBC
    • ↓ total lipids
exocrine pancreatic insufficiency1
Exocrine Pancreatic Insufficiency
  • Rx
    • Supplement pancreatic enzymes with each meal
      • Pancrezyme
      • Viokase-V
    • Low fiber diet
  • Client info
    • EPI is irreversible; life-long treatment
    • Pancreatic enzyme replacement is expensive
    • With enzyme replacement, dog will regain weight, diarrhea will stop
    • Must be given with every meal
perineal hernia
Perineal Hernia

Intact male dogs; atrophy of levator ani muscle; rectum herniates

  • Signs
    • Reducible perianal swelling
    • Tenesmus (feeling of full colon)
    • Dyschezia (difficult defecation)
    • Urethral obstruction
      • If bladder is herniated
  • Dx
    • Rectal palpation reveals hernia sac
perineal hernia1
Perineal Hernia
  • Rx
    • Stool softeners (Colace)
    • Enemas
    • Surgical repair
      • Castration
  • Client info
    • Keeping stool soft may help reduce straining
      • True for all dogs
    • Castration recommended testosterone is suspected as a predisposing factor
perianal fistula
Perianal Fistula

Exact etiology unknown; thought to start as an inflammation of sweat and oil glands around anus

Bacteria grow well in the moist, warm region of these glands

Infection invades into deeper tissues

Most commonly affects G Shep (84% of dogs diagnosed)

  • Signs
    • Intact male, older (>8 y)
    • Tenesmus
    • Dyschezia, pain on exam
    • Fecal incontinence
    • Bleeding, foul odor of perianal area
perianal fistula1
Perianal Fistula
  • Dx—PE to r/o anal sac disease/perirectal tumor
  • Rx
    • Medical—usually not successful
      • Clip hair, keep clean
      • Flush with saline
      • Antibiotics
    • Surgical—difficult because of nerves/blood vessels
      • Remove infected tissue
      • Cryosurgery
      • Laser surgery
      • Cautery
    • Client info
      • Painful—be cautious of biting
      • many complications of Sx
        • Fecal incontinence
        • Anal stenosis
perianal gland adenoma
Perianal Gland Adenoma
  • Signs
    • Intact male, older
    • Single or multiple masses that may ulcerate
      • Not metastatic
    • Pruritis in anal area
    • Bleeding
    • Firm nodules in perianal skin
  • Dx—PE, biopsy
  • Rx
    • Surgical removal
    • Radiation
    • Cryosurgery
    • Castration—causes regression of tumors
  • Client info
    • Gently cleanse area daily with baby wipes
    • Castration at early age helps prevent it
feline hepatic lipidosis
Feline Hepatic Lipidosis
  • Idiopathic (IHL) – cause unknown
  • Most common hepatopathy in cats
  • Obese cats of any age, sex or breed
  • Stress may trigger anorexia
    • Diet change,
    • Boarding
    • Illness,
    • Environmental change
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IHL
  • Anorexia prolonged for 2 weeks causes imbalance between breakdown of peripheral lipids and lipid clearance within liver
    • Lipids accumulate in liver
  • Other mechanisms proposed
  • Early diagnosis and aggressive treatment important
    • 60-65% of cases => complete recovery
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IHL
  • Clinical Signs
    • Anorexia
    • Obesity
    • Wt loss (as much as 25% of body weight)
    • Depression
    • Sporadic vomiting
    • Icterus
    • Mild hepatomegaly
    • +/- coagulopathies
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IHL
  • Diagnosis
    • CBC – nonregeneratiave anemia, stress neutrophilia, lymphopenia
    • Biochem panel – Increased ALP, ALT, bilirubin, Low albumin, Increase serum bile acids
    • X-rays – mild hepatomegaly
    • US liver hyperechoic
    • Liver biopsy – severely vacuolized hepatocytes
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IHL
  • Treatment
    • High protein, calorie dense diet
    • Feeding tube usually required
      • NG tube for short term liquid

diets

      • Gastrostomy tube best
      • Esophagostomy tube
    • Tubes can remain in place

For up to 3-6 weeks

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IHL
  • Treatment
    • IV fluids
    • Metoclopramide SQ 15 min prior to feeding
    • Monitor weekly
  • CE
    • Avoid stress in obese cats
    • Early intervention is essential
    • Any cat that stops eating is at risk
    • Cats do not respond well to frequent diet changes