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EDUCATION. Education is learning what you didn’t even know you didn’t know. - Daniel J. Boorstin. DISEASES OF THE PARATHYROID GLANDS. HYPERPARATHYROIDISM HYPOPARATHYROIDISM. Thyroid/Parathyroid glands. 2 glands for each thyroid lobe. 1=normal thyroid gland

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education

EDUCATION

Education is learning what you didn’t even know you didn’t know.

-Daniel J. Boorstin

diseases of the parathyroid glands

DISEASES OF THE PARATHYROID GLANDS

HYPERPARATHYROIDISM

HYPOPARATHYROIDISM

thyroid parathyroid glands
Thyroid/Parathyroid glands

2 glands for each

thyroid lobe

1=normal thyroid gland

2 and 3=parathyroid gland

4=enlarged thyroid gland

parathyroid gland
Parathyroid gland
  • Secretion: Parathyroid hormone (PTH, Parathormone)
  • Function: ↑ plasma Ca2+ concentration
    • 1. ↑ osteoclast activity
    • 2. ↑ Ca++ absorption from GI tract
    • 3. ↑ Ca++ reabsorption from kidney tubules
  • Hyperparathyroidism → ________________
  • Hypoparathyroidism → __________________
hyperparathyroidism
Hyperparathyroidism
  • Causes:
    • 1º hyperparathyroidism— ___________________________
    • 2º hyperparathyroidism—poor diet; low Ca intake
  • Clinical signs:
    • Many animals show __________________________
    • signs occur as organ dysfunction occurs
      • urinary/renal calculi (high plasma Ca++)
      • cardiac arrhythmias, tremors (Ca++ necessary for normal muscle contraction)
      • Anorexia, vomiting, constipation
      • weakness
hyperparathyroidism1
Hyperparathyroidism

Dx:

  • Routine chemistry panel
    • ↑ blood Calcium (normal: ~ _____________ mg/dl))
    • +/- ↓ blood Phosphorus (normal: ~2-6 mg/dl)
  • PTH assay
    • normal PTH: dogs ~20 pg/ml, cats ~17 pg/ml
    • In a normal animal: if blood Ca++ is high, PTH is low (neg feedback)
    • 1º Hyperparathyroidism: ______________________________
  • Ultrasound of neck – enlarged glands, abdomen - uroliths

Dff: neoplasia (LSA), Addison’s, rodenticide toxicosis, ARF

hyperparathyroidism2
Hyperparathyroidism

Tx:

1. _________________________ of diseased parathyroid (generally 4 lobes are imbedded in thyroid gland)

Other options:

2. Ultrasound-guided chemical (ethanol)

3. Ultrasound-guided heat (laser) ablation

Post-Op Care:

1. Hospitalize for 1 wk; ↓PTH may predispose animal to hypocalcemia

2. _____________________ (oral tabs, liquid)

3. Vit D supplements (promotes Ca intestinal absorption)

hyperparathyroidism3
Hyperparathyroidism

Client Info

  • Most hyperparathyroid animals show no signs when first diagnosed
  • Run _____________ chem panels on all normal, older animals
hypercalcemia other causes
Hypercalcemia: Other causes
  • Causes
    • Neoplasia (lymphoma, perianal gland tumors)
    • Renal failure
    • Hypoadenocorticism
    • Vitamin D rodenticide
    • Drugs or artifacts (ex lipemia)
  • Clinical signs vary with cause
    • PU/PD, anorexia, lethargy, vomiting, weakness, stupor/coma (severe), uroliths
hypercalcemia
Hypercalcemia
  • Tests
    • Elevated serum calcium levels
    • Low to low-normal phosphorus concentrations
hypercalcemia1
Hypercalcemia
  • Treatment
    • Fluids: 0.9% NaCl
      • No Ca2+ containing fluids
    • Diuretics (furosemide): dilute urine
    • Steroids
  • Complications
    • Irreversible renal failure
    • Soft tissue calcifications
hypocalcemia
Hypocalcemia

Causes:

  • Parathyroid disease
    • Inadvertent removal of ____________________ during thyroidectomy (most common cause
    • 1º Hypoparathyroidism (uncommon in animals)
  • Chronic renal failure—
    • may cause ↑ serum P, which can result in ↓ serum Ca (Ca:P __________________)
    • Vit D normally activated in kidney
    • Protein-losing nephropathy results in loss of albumin-bound Ca
  • Puerperal Tetany (Eclampsia)—late gestation thru post-partum period
    • Improper prenatal ______________________________________
    • Heavy lactation
    • Inappropriate Ca++ supplementation
    • Post-partum and late gestaion

http://www.thepetcenter.com/gen/eclampsia.html#The_video

hypocalcemia1
Hypocalcemia

Clinical Signs:

  • Restlessness, muscle tremors, tonic-clonic contractions, seizures
  • ______________________ with excitement; __________________ in severe cases (Ca++ is necessary for proper muscle contractions)
  • Hyperthermia
  • Stiffness, ataxic
hypocalcemia2
Hypocalcemia

Dx:

Total serum < ______________ mg/dl

Tx:

  • IV infusion of _______________________ solution (monitor HR and rhythm during infusion)
  • ___________________ (IV) to control seizures
  • Oral supplements of Ca (tabs, caps, syrup)
  • Improve nutrition
hypocalcemia3
Hypocalcemia

Client info:

  • Well-balanced diet; increase volume as pregnancy progresses
  • Signs in pregnant animal is _____________; call vet immediately
  • May recur with subsequent pregnancies
  • Early weaning is recommended
slide18

LIFE

“Nobody can go back and start a new beginning, but anyone can start today and make a new ending.”

-Maria Robinson

diseases of the pancreas

DISEASES OF THE PANCREAS

DIABETES MELLITUS (DM)

INSULINOMA

EXOCRINE PANCREATIC INSUFFICIENCY (EPI)

review of pancreas functions
Review of pancreas functions
  • Long flat organ near _________________ and stomach
  • Exocrine function (the majority of the pancreas):
    • ________________ enzymes
  • Endocrine function – islets of Langerhans
    • Alpha cells => _______________
    • Beta cells => ___________________
    • Delta cells => ___________________
review
Review
  • Insulin
    • Moves glucose into ___________ to be used for energy (glycolysis)
    • _______________ blood glucose
  • Glucagon
    • _________________ blood glucose
      • Stimulates liver to release glucose
      • Stimulates gluconeogenesis
    • Other hormones from other glands perform similar functions (hyperglycemic effect)
      • Growth hormone
      • Glucocorticoids
endocrine pancreas
Endocrine Pancreas
  • Hyperglycemia
    • Definition: Excessively high blood glucose levels
      • Normal in dogs: _________________ mg/dl
      • Normal in cats: __________________ mg/dl
diabetes mellitus
Diabetes Mellitus
  • Definition: Disorder of carbohydrate, fat and protein metabolism caused by an absolute or relative ___________ deficiency
  • Type I – Insulin Dependent DM – very low or absent insulin secretory ability
  • Type II – Non insulin dependent DM (insulin insensitivity) – inadequate or delayed insulin secretion relative to the needs of the patient
diabetes mellitus1
Diabetes mellitus

Incidence:

Dogs: ~100% Type I (Insulin dependent)

Cats: ~ 50% Type I and 50% Type II

-non-insulin dependent cats

can sometimes be managed with

diet and drug therapy

Causes:

Chronic pancreatitis

_______________________________

-beta cell destruction

Predisposing/risk factors:

Cushing’s Disease

Acromegaly

Obesity

Genetic predisposition

Drugs (steroids)

diabetes mellitus2
Diabetes mellitus
  • Age/sex:
    • Dogs: 4-14 yrs, females 2x more likely to be affected
    • Cats: all ages, but 75% are 8-13yrs, neutered males most affected
  • Breeds: Poodles, Schnauzers, Keeshonds, Cairn Terriers, Dachshunds, Cockers, Beagles
slide29
DM
  • Pathophysiology
    • Insulin deficiency => impaired ability to use glucose from ______________, __________________ and _______________
    • Impaired glucose utilization + gluconeogenesis => hyperglycemia
    • Clinical signs develop when:
      • Exceeds capacity of renal tubular cells to reabsorb
      • Dogs – BG > ________________ mg/dl
      • Cats - BG > __________________mg/dl
    • Glycosuria develops
      • Osmotic diuresis
      • Polyuria/polydipsia
slide30
DM
  • SYSTEMS AFFECTED:
    • Endocrine/metabolic: electrolyte depletion and metabolic _________________
    • Hepatic: liver failure 2° to hepatic lipidosis (mobilization of free fatty acids to liver leads to hepatic lipidosis and ketogenesis)
    • Ophthalmic: __________ (dogs) from glaucoma
    • Renal/urologic: UTI, osmotic diuresis
    • Nervous: peripheral neuropathy in cats
    • Musculoskeletal: Compensatory weight loss
diabetes mellitus3
Diabetes Mellitus
  • Clinical Signs:
    • ____________________
    • ____________________
    • Weight loss (esp. cats)
    • Dehydration
    • Cataract formation-dogs
    • Plantigrade stance-cats
diabetes in cats plantigrade posture
Diabetes in Cats:Plantigrade posture

Plantigrade posture

Diabetic neuropathy

diabetes cataracts
Diabetes: Cataracts

Increase in sugar (sorbitol) in lens causes an influx

of water, which breaks down the lens fibers

diabetic ketoacidosis
Diabetic Ketoacidosis

2 metabolic crises:

↑ lipolysis in adipose tissue → fatty acids →ketone bodies →ketoacidosis →coma

(insulin normally _________________ lipolysis)

↑ hepatic gluconeogenesis (in spite of high plasma glucose levels)

(insulin normally ____________________ gluconeogenesis)

diabetic ketoacidosis1
Diabetic Ketoacidosis
  • Definition: True medical _______________ secondary to absolute or relative insulin deficiency causing hyperglycemia, ketonemia, metabolic acidosis, dehydration and electrolyte depletion
  • DM causes increased lipolysis => _________ production and _______________
diabetic ketoacidosis2
Diabetic Ketoacidosis
  • Diagnosed with ketones in urine or ketones in blood
    • Can use urine dip stick with serum.
  • Clinical Signs
    • All of the DM signs
    • Depression
    • Weakness
    • Tachypnea
    • Vomiting
    • Odor of acetone on breath
diabetic ketoacidosis3
Diabetic Ketoacidosis
  • IV fluids to rehydrate 0.9% NaCl
    • K (potassium) supplement
  • Regular insulin to slowly decrease BG
  • Monitor BG q 2-3 hrs
  • When BG close to normal and patient stable switch to longer acting insulin
slide38
DM
  • DIAGNOSIS:
    • CBC: normal
    • Biochemistry panel:
      • Glucose > ________mg/dl (dogs), > _____________ (cats)
    • UA
      • ____________________!!!!
      • ______________________
      • USG – low
    • Electrolytes may be low due to osmotic diuresis
    • Blood gases (if ketoacidotic)
    • Fructosamine levels – mean glucose level for last 2-3 weeks (dogs)
      • Ideal to test for regulation checks
dm rx insulin and diet
DM Rx: INSULIN AND DIET!!!

Table 1. Traditional insulin outline.

dm insulin therapy
DM: Insulin therapy
  • INSULIN
    • Beef-origin insulin is biologically similar to cat insulin
    • Porcine-origin insulin is biologically similar to dog insulin
    • Dogs and cats have responded well to human insulin products
  • INSULIN ADMINISTRATION:
    • ALWAYS USE THE ______________________ INSULIN SYRINGE! (U-40 vs. U-100)
      • Insulin is given in units (insulin syringes are labeled in units, not mL)
dm dietary management
DM: dietary management
  • DIET
    • DOGS: high _____________-, complex carbohydrate diets
      • Slows digestion, reduces the post-prandial glucose spike, promotes weight loss, reduces risk of pancreatitis
      • Hill’s R/D or W/D
    • CATS: high _______________, low carbohydrate diets
      • Cats use protein as their primary source of energy – blood glucose is maintained primarily through liver metabolism of fats and proteins
      • Purina DM, Hill’s M/D
      • Often a diet change in cats can dramatically reduce or eliminate the need for insulin
        • This is particularly true for type II
slide43
DM
  • Oral hypoglycemics (cats NIDDM)
    • Sulfonylureas – Glipizide
      • Direct stimulation of insulin secretion from the pancreas
    • Alpha-Glucosidase Inhibitors – Acarbose (dogs)
      • Delays digestion of complex carbohydrates and delays absorption of glucose from the intestinal tract.
diabetes mellitus monitoring
Diabetes Mellitus: Monitoring

Find an ear vein Prick the ear to get Place drop of blood

blood sample on green tip; readout in

a few seconds

slide48
DM
  • Client Education
    • ______________________ insulin replacement therapy
    • Insulin administered by _______________________________
    • _____________________ insulin, mix _____________ (no bubbles), single use syringes
    • Cataracts common, permanent
    • Consistent diet and exercise
    • Recheck BG or curve regularly or fructosamine levels
    • Progressive
    • If animal _________________- NO INSULIN
endocrine pancreas1
Endocrine Pancreas
  • Hypoglycemia
    • Definition: Low blood glucose levels
    • Causes
      • Neonatal and juvenile
      • Septicemia
      • Neoplasia
      • Starvation
      • Iatrogenic – insulin overdose
      • Portosystemic shunt
      • Many others
insulin shock
Insulin Shock

Causes:

  • Insulin overdose (____________ syringe)
  • Too much exercise
  • Anorexia

Signs:

Weakness, incoordination,_______________, coma

insulin shock1
Insulin Shock

Prevention

  • ________________ diet (type and amount)/consistent exercise (less insulin with exercise)
  • Monitor urine/blood glucose at same time each day
  • Feed 1/3 with insulin; the rest 8-10 h later (at insulin peak)
  • Have sugar supply handy
insulinoma
Insulinoma
  • CAUSE: ______________ of beta cells, secreting an excess of insulin
  • SIGNS: prolonged ______________________ →weakness, ataxia, muscle fasciculations, posterior paresis, brain damage, seizures, coma, death,
insulinoma dx
Insulinoma: Dx
  • Chem Panel
    • ↓blood glucose
    • Simultaneous glucose and insulin tests

____________ glucose, __________________ insulin => insulinoma

  • Observations
    • Symptoms occur after _______________ or _________________
    • when symptomatic, blood glucose< ______________ mg/dl
    • symptoms corrected with sugar administration
insulinoma rx
Insulinoma: Rx

Surgical Rx: removal of tumor

Medical Rx:

Acute, at home:

administer glucose (Karo); keep animal quiet, seek vet care

Acute, in Hosp

adm. glucose (50% Dextrose)

Chronic care

feed 3-6 small meals/day (high protein, low fat)

limited exercise

glucocorticooid therapy (antagonizes insulin effect at cellular level)

Diazoxide (↓insulin secretion, tissue use of glucose, ↑blood glucose)

Octreotide (Sandostatin) injections—inhibits synthesis and release of insulin by both normal and neoplastic beta cells

insulinoma client info
Insulinoma: Client info
  • 1. Usually, by the time insulinoma is diagnosed, metastasis has occurred so prognosis is ______________________
  • 2. With proper medical therapy, survival may be 12-24 mo
  • 3. Always limit _____________ and _________________
  • 4. Feed __________ , ________________meals throughout day; keep sugar source close during exercise
  • 5. _________________________ on mm provides for rapid absorption of glucose into blood stream
  • 6. Avoid placing hand into dog’s mouth during seizure to avoid being bitten
exocrine pancreas insufficiency epi
Exocrine Pancreas Insufficiency (EPI)
  • Inability to process nutrients efficiently due to ____________ of production of enzymes from pancreas.
    • Pancreatic acinar atrophy
  • Found most commonly in German Shepherds and Rough Collies through a recessive gene.
    • In cats, EPI is primarily the result of chronic pancreatitis
diagnosis of epi
Diagnosis of EPI
  • Not usually evident until ____________ % of pancreas is unable to secrete enzymes.
    • _________________ although no change in diet or appetite (appetite often increases)
    • Persistent tarry diarrhea.
    • Flatulence
    • Poor haircoat
testing and treatment for epi
Testing and treatment for EPI
  • TLI (trypsin-like immunoreactivity)
    • Detects trypsin and trypsinogen
    • Usually want ____________________ in dogs to be diagnostic
      • Canine 5.7-45.2
      • Feline 12-82
  • Treatment includes enzymatic supplement
    • ___________________ powder (Amylase, protase, lipase)
    • Raw ox or pig pancreas
client considerations
Client considerations
  • Usually life long treatment.
  • Can be very expensive.
  • Can be well controlled.
  • Should not breed animal that has EPI.