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小动物 PBL 课件. 动物科技学院动物医学教研部 杨宗泽 2011 年 9 月. What is involved in a routine physical exam?.

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slide1

小动物PBL课件

动物科技学院动物医学教研部

杨宗泽

2011年9月

what is involved in a routine physical exam
What is involved in a routine physical exam?
  • Look in eyes, ears, mouth, nose, and throat. Fecal float, thoracic auscultation, abdominal palpation, urogenital palpation, and lymphatic palpation. Heart rate, respiratory rate, temp, color and consistency of feces, membrane color, capillary refill time, skin tent, body weight, body condition score, and heart worm test (maybe).
what is common vaccinology of puppies
What is common vaccinology of puppies?
  • Vaccinology of puppies
  • 6-8 weeks  parvovirus, distemper virus, adenovirus type 2, parainfluenza
  • 9-11 weeks  repeat
  • 12-14 weeks  repeat, with rabies
  • Leptospirosis included if 9 weeks or older
  • Committee for vaccine protocol recommends giving distemper, adenovirus-2, and rabies for puppies under 6 months of age with unknown vaccine history
what is the epidemiology of missouri
What is the epidemiology of Missouri?
  • Epidemiology of Missouri canines
  • Couldn’t find information on Missouri specifically, but one source listed distemper, infectious hepatitis, and congenital heart diseases as being prevalent in that area of the US.
zoonotic diseases especially between humans cats dogs and parakeets
Zoonotic diseases-especially between humans, cats, dogs, and parakeets
  • Here are the zoonotic diseases that I found common to dogs, cats, and parakeets:
campylobacteriosis
Campylobacteriosis
  • bacterial disease that causes mild to severe infection of the GI system; watery or bloddy diarrhea, fever, nausea, vomiting and rare complications with this bacteria can cause CNS damage. It is transmitted throughfeces, contaminated food, water, or milk.
cryptosporidiosis
Cryptosporidiosis
  • parasitic disease that causes infection of GI system; watery diarrhea, fever, nausea, and vomiting. It is transmitted by contact with soil, food, water, or surfaces contaminated with infected feces.
giardia
Giardia
  • parasitic disease that causes diarrhea. It is transmitted by swallowing the parasite in infected food, water, oranyway you can getit in your mouth!(Not common in cats)
salmonellosis
Salmonellosis
  • bacterial disease that causes diarrhea, fever, and stomach pain- (infection can spread to other organs and other symptoms occur). Most commonly transmitted in contaminated food, but can also be passed in feces.
what is puppy socialization
What is puppy socialization?
  • Puppy socialization is the process of introducing a puppy to its environment. Socialization consists of exposing a puppy to various stimuli including, people, places, and other animals. The primary socialization period for dogs starts at three weeks and begins to diminish at twelve weeks. If a puppy is not properly socialized to humans and other animals, it will act fearful and sometimes aggressive.
what are common diseases found in puppy mills
What are common diseases found in puppy mills?
  • Many diseases are common to puppies that are raised in close proximity of one another. These diseases include:
1 parvovirus
1.Parvovirus
  • a.Caused by canine parvovirus 2 (Parvoviridae), a DNA virus.
  • b.Seen most frequently in juveniles and newborns
  • c.Shed in feces for 2-3 weeks postinfection and can sometimes be spread in vomit and saliva.
  • d.Symptoms include: i. Severe diarrhea ii. Vomiting iii. Fever iv. Edema v. Tachycardia vi. Ascites vii. Depression viii. Dehydration ix. Hematochezia
2 canine distemper
2.Canine Distemper
  • a. Cause is a Morbilivirus (Paramyxoviridae)
  • b.Is spread by aerosol droplets and other fomites. Once the disease enters the conjunctiva it is spread through the lymph system and progresses to the central nervous system. Incubation period is 3-7 days.
  • c.Puppies that are immunodeficent can develop neurologic problems such as encephalomyelitis or peripheral neuropathies. Older dogs develop demylination and and sometimes encephalomyelitis.
  • d.Symptoms include: i. Coughing ii. Conjunctivitis iii. Convulsions iv. Edema v. Fever vi. Ocular discharge vii. Tachycardia viii. Incoordination ix. Ascites x. Anorexia
3 canine coronavirus
3. Canine Coronavirus
  • a.Caused by an RNA virus (Coronavirus)
  • b.Most common in newborn and juvenile dogs
  • c.It is spread by oral ingestion of contaminated feces. It spreads to the small intestine causing diarrhea and malabsorption.
  • d.Canine parvovirus infection is more severe than coronavirus infection
  • e.Symptoms include: i. Diarrhea ii. Anorexia iii. Fever iv. Tachycardia v. Vomiting vi. Depression vii. Dehydration
4 canine hepatitis
4. Canine Hepatitis
  • a. Cause is canine adenovirus 1 (Adenoviridae).
  • b.Most commonly found in juveniles
  • c.Virus normally enters the oropharynx and progresses to the tonsils, lymph nodes, kidney and liver. Can cause glaucoma and corneal edema
  • d. Symptoms include: i. Diarrhea ii. Anorexia iii. Edema iv. Fever v. Tachycardia vi. Ascites vii. Vomiting viii. Blindness
5 infectious canine tracheobronchitis kennel cough
5. Infectious Canine Tracheobronchitis (Kennel Cough)
  • a.Can be caused by Canine parainfluenza type 2 virus, canine distemper virus, canine adenovirus 2 or Bordetella bronchiseptica.
  • b. Transmitted primarily through direct contact with infected animals or the secretions of infected animals. Incubation is 6 days.
  • c. The disease seems to linger because the organism adhere very well to the cilia cells in the respiratory tract and also the inability of systemic antibiotics to reach high enough concentrations in the lungs to clear the infection.
  • d.Common symptoms include: i.Cough ii.Conjunctivitis iii. Nasal discharge iv.Ocular discharge v.Fever and anorexia vi.Tachycardia
can puppies get heartworm disease
Can puppies get heartworm disease?
  • Yes, with lower larvae stages, but can be treated with preventative as long as they are under 6 months of age because adult worm takes longer to develop.
upper respiratory tract diseases
Upper Respiratory Tract Diseases
  • Nasopharyngeal—rhinitis; sinusitis; nasopharyngeal foreign body or tumor; tonsillitis; tonsillar tumor
  • Laryngeal—inflammation; foreign body; injuries; tumors
  • Tracheal—inflammation (inhalation of irritating substances and heat); infections (viral and bacterial); foreign body; tracheal collapse; tumor
lower respiratory tract diseases
Lower Respiratory Tract Diseases
  • Bronchial—inflammation; infection (viral, bacterial, and parasitic); allergy; foreign body; tumor
  • Pulmonary—inflammation; infection (viral, bacterial, and fungal); aspiration pneumonia; pulmonary edema; tumor
  • Pulmonary/vascular—heartworm disease; thrombosis or embolism; CHF; pulmonary hypertension; tumor
  • Other Diseases
  • Esophageal—inflammation; foreign body; tumor
  • Pleural—inflammation; infection (bacterial and fungal); hernia; tumor
what causes distended abdomen
What causes distended abdomen?
  • In a puppy, there are many things that cause a distended abdomen, such as cardiovascular problems, sinple bloat, parasites in the GI tract.
what is available for flea prevention in puppies
What is available for flea prevention in puppies?
  • The most common products include: Frontline, Advantage, K9 Advantix, and Revolution. These products come in a liquid droplet form that can be applied between the shoulder blades. Capstar is a pill that can be used more for infestation than preventative.
at what age can puppies be given flea prevention products
At what age can puppies be given flea prevention products?
  • Frontline-8 weeks
  • Advantage-7 weeks
  • Advantix-7 weeks
  • Revolution-6 weeks
what are the daily energy requirements for a 4 month old puppy
What are the daily energy requirements for a 4 month old puppy?
  • A puppy weighing 3 kg should be consuming around 450 kcal per day. They should stay on growth food at least until about 6 months of age and should be eating between 50-80% of their estimated adult body weight at 4 months.
what types of food are available
What types of food are available?
  • A variety of canned and dry growth foods are available through Iams, Hills, Purina, ect.
what main ingredients should be in a healthy growth diet
What main ingredients should be in a healthy growth diet?
  • A healthy growth diet should contain:
  • About %50 digestable carbs for energy
  • About %30 protein for building strong bones and muscle
  • About %10 fat
  • Crude fiber, high carnitine for fat metabolism, super antioxidant formula, vitamins and minerals, calcium, and daily dental protection
what is a healthy weight for a 4 month old miniature poodle
What is a healthy weight for a 4 month old miniature poodle?
  • An average 4 month old miniature poodle should weigh between 6-7 kg. An average adult weighs 12-14 kg.
what is a da2lpp with corona vaccine
What is a DA2LPP with corona vaccine?
  • Distemper, Adenovirus 2 (Hepatitis), Lepto, Parainfluenza, and Parvovirus. Coronavirus separate
what are the symptoms and diagnostics of hepatitis signs
What are the symptoms and diagnostics of Hepatitis SIGNS
  • Depend on immunologic status of host and degree of initial cytotoxic injury
slide30
Peracute—fever; CNS signs; vascular collapse; DIC; death within hours
  • Acute—fever; anorexia; lethargy; vomiting; diarrhea; hepatomegaly; abdominal pain; abdominal effusion; vasculitis (petechia, bruising); DIC; lymphadenopathy; rarely, nonsuppurative encephalitis
slide31
Uncomplicated—lethargy; anorexia; transient fever; tonsillitis; vomiting; diarrhea; lymphadenopathy; hepatomegaly; abdominal pain
  • Late—20% of cases develop anterior uveitis and corneal edema 4–6 days postinfection; recover within 21 days; may progress to glaucoma and corneal ulceration
cbc biochemistry urinalysis
CBC/BIOCHEMISTRY/URINALYSIS
  • CBC—schistocytes; leukopenia during acute viremia, followed by leukocytosis with reactive lymphocytosis and nucleated RBCs
  • Biochemistry—liver enzyme activity high initially, begins declining within 14 days; low glucose and albumin reflect fulminant hepatic failure, vasculitis, and endotoxemia; low sodium and potassium levels reflect GI losses; hyperbilirubinemia
  • Urinalysis—proteinuria reflects glomerular injury; granular casts reflect renal tubule damage; bilirubinuria
other laboratory tests
OTHER LABORATORY TESTS
  • Coagulation tests—reflect severity of liver injury and DIC
  • Serology for antibodies to CAV-1—fourfold rise in IgM and IgG; vaccine-induced antibodies confuse interpretation
  • Viral isolation—anterior segment of eye, kidney, tonsil, and urine; difficult in parenchymal organs (especially liver) unless first week of infection
imaging
IMAGING
  • Abdominal radiography—normal or large liver; poor detail due to effusion
  • Abdominal ultrasonography—may observe hepatomegaly, hypoechoic parenchyma (实质)(multifocal or diffuse pattern), and effusion
how do you diagnosis bordetella
How do you diagnosis Bordetella?
  • You must culture a sample from the trachea in order to diagnose. Sample may be obtained by endoscopy, bronchoalveolar lavage, transtracheal wash, and guarded swabs introduced directly through the mouth or through an endotracheal tube.
how do you treat kennel cough
How do you treat kennel cough? ?
  • It is a self limiting bacteria and so it is usually not treated. Several factors must be considered before selecting an antibiotic. They include the antimicrobial sensitivity of the Bordetella that was cultured from the swab, how well the drug penetrates(穿透) into secretions, and the penetration of the drug into host cells.
  • Usually cough suppressants(镇咳) are given
would a cbc or chem panel be altered by bordetella
Would a CBC or chem panel be altered by Bordetella?
  • Any infection will cause a rise in Neutrophil counts and this can also cause a rise in monocyte counts.
how do you rule out salmonella
How do you rule out Salmonella?
  • Most direct way to ID salmonella is to culture the feces, or contaminated substance. A stained fecal smear can be used to ID leukocytes in the feces which points to salmonella, but does not directly ID it.
what causes dark waxy otic discharge
What causes dark, waxy otic discharge?
  • Ear discharge is usually from one of three sources: earmites, bacterial infection or a yeast(fungal) infection
what causes a bounding femoral pulse
What causes a bounding femoral pulse?
  • “Bounding” femoral pulse simply means “strong” or “water-hammer” (descriptive terms), however this is most commonly seen with PDA (动脉导管未闭)and the degree of bounding of the pulse can be used to estimate the severity of shunting of PDA
how to characterize murmurs
How to characterize murmurs:
  • Murmurs are sounds of longer duration than the normal heart sounds. Heart murmurs arise from turbulent blood flow (vibrations) created when the normal, quiet, laminar flow is disrupted. This is caused by blood flowing between cardiac chambers or through stenotic or insufficient valves, or by alterations in blood viscosity or vessel diameter.
slide45
There are six features that characterize cardiac murmurs: Timing, Location, Intensity (Loudness), Shape, Pitch(音高) or Frequency, and Radiation.
1 timing
1. Timing
  • Murmurs can be divided based upon their timing during the cardiac cycle into: systolic, diastolic, or continuous types. Systolic murmurs begin with or after the first heart sound and end with or before the second heart sound. Diastolic murmurs begin with or after the first component of the second heart sound and end prior to the first heart sound. The duration of the murmur within the cardiac cycle may be further modified by terms such as: holo- and pansystolic; proto(early), meso-(mid) or tele(late) systolic; proto-, meso-, and holodiastolic and presystolic.
2 location
2. Location
  • The location of the murmur relates to the cardiac valve area where it is heard loudest( point of maximal intensity). Location helps identify the specific valvular lesion.
3 intensity loudness
3. Intensity(Loudness)
  • The intensity of a murmur is described using the six grades of Freeman and Levine. A grade 1/6 murmur is the faintest murmur that can be detected and is heard only with particular effort. A grade 2/6 murmur is a faint murmur clearly heard after a few seconds’ auscultation by an experienced examiner. A grade 3/6 murmur is moderately loud and easily heard. A grade 4/6 murmur is a loud murmur that doesn’t produce a palpable vibration. A grade 5/6 is a very loud murmur that produces a palpable vibration but is inaudible when the stethoscope is removed from the chest wall. A grade 6/6 murmur is a very loud murmur that produces a palpable vibration still audible after the stethoscope is removed from the chest.
4 shape
4. Shape
  • Murmurs are described in terms of their profile during the cardiac cycle. This corresponds to their shape on a phonocardiogram. Terms that are commonly used include: “plateau” or “band-shaped” for those murmurs of nearly equal intensity throughout their duration, “decrescendo” for those murmurs that gradually taper off from an initial peak, and “diamond-shaped” or “crescendo-decrescendo” for those murmurs that build to a peak and then gradually diminish.
5 pitch or frequency
5. Pitch or Frequency
  • Murmurs may also be described as: high-, medium-, or low- pitched or of mixed frequency. High-pitched murmurs are heard best with the stethoscope diaphragm, but the low-frequency murmurs are heard best with the bell. Some terms that describe the pitch are: harsh, blowing, or musical.
6 radiation
6. Radiation
  • Murmurs radiate in the direction of blood flow responsible for the murmur. The pattern of radiation is important in some lesions. For example: the murmur of congenital subaortic stenosis(主动脉基部狭窄) radiates widely- craniodorsally, apically and to the head; so it can be heard loudly at the right cardiac base.
continuous murmurs
Continuous Murmurs :
  • The characteristic murmur of a PDA is a continuous systolic and diastolic “machinery-like” murmur that is best heard over the aortic and pulmonic valve regions. The continuous murmur of a PDA waxes and wanes during the cardiac cycle and reaches peak intensity near the time of the second heart sound (is heard best at the aortic and pulmonic valve areas). It is best heard at the left heart base but radiates widely in some animals. The distinctive continuous murmur occurs as blood flows from the high-pressure aorta to the low-pressure pulmonary artery, producing turbulence.
normal electrocardiogram
Normal Electrocardiogram
  • When the cardiac impulse passes through the heart, electrical current also spreads from the heart into the adjacent tissues surrounding the heart. A small part of the current spreads to the surface of the body. If electrodes are placed on the body skin on opposite sides of the heart, electrical potentials generated by the current can be recorded; this recording is an Electrocardiogram.
slide54
The normal EKG is composed of a P wave, a QRS complex, and a T wave. The QRS complex is often 3 separate waves, the Q wave, the R wave, and the S wave, but not always.
slide55
The P wave is caused by electrical potentials generated when the atria depolarize before atrial contraction begins. The QRS complex is caused by potentials generated when the ventricles depolarize before their contraction. So, both the P wave and the QRS complex are depolarization waves. The T wave is caused by potentials generated when the ventricles recover from the state of depolarization. The T wave is known as a Repolarization wave.
slide56
During depolarization, the normal negative potential inside the fiber is lost and the membrane potential becomes slightly positive inside and negative outside. During repolarization, positivity returns to the outside of the fiber, and negativity to the inside.
slide57
So, the P wave occurs at the beginning of contraction of the atria, and the QRS complex of waves occurs at the beginning of contraction of the ventricles. The atria repolarize less than a second after the P wave. This occurs just at the instant when the QRS complex is being recorded in the EKG. So, the atrial repolarization wave, known as atrial T wave, is usually hidden by the much larger QRS complex.
slide58
The ventricular repolarization wave is the T wave of the normal EKG. Ventricular muscle begins to repolarize in some fibers about 0.20 second after the beginning of the depolarization wave (the QRS complex) but in many other fibers not until as long as 0.35 second.
slide59
Thus, the process of repolarization extends over a long period. The T wave in the normal EKG is often a prolonged wave, but the voltage of the T wave is considerably less than the voltage of the QRS complex, partly because of its prolonged length.
slide60
The time between the beginning of the P wave and the beginning of the QRS complex is the interval between the beginning of the P wave and the beginning of the QRS complex is the interval between the beginning of electrical excitation of the atria and the beginning of excitation of the ventricles.
slide61
This period is called the PQ interval. Sometimes this interval is called the P-R interval because the Q wave is frequently absent. Contraction of the ventricle lasts almost from the beginning of the Q wave to the end of the T wave. This interval is called the Q-T interval.
slide62
Cardiac impulse first arrives in the ventricles in the septum and then spreads to the inside surfaces of the remainder of the ventricles. The average current flow occurs with negativity toward the base of the heart and with positivity toward the apex. During most of the depolarization process, current continues to flow in this direction as depolarization spreads from the endocardial surface outward through the ventricular muscle mass.
slide63
Just before depolarization has completed its course through the ventricles, the average direction of current flow reverses, flowing then in the direction from the apex toward the base because the last part of the heart to become depolarized is the outer walls of the ventricles near the base of the heart.
slide64
Therefore, in the normal heart ventricles, current flows from negative to positive primarily in the direction from the base of the heart toward the apex during almost the entire cycle of depolarization except at the very end. So, if a meter is connected to the surface of the body, the electrode nearer the base will be negative, whereas the electrode nearer the apex will be positive.
slide65
There are three bipolar limb leads, which are electrical connections between the patient’s limbs and the electrocardiograph. The term “bipolar” means that the EKG is recorded from 2 electrodes located on different sides of the heart, in this case on the limbs. So, a “lead” is not a single wire connecting from the body but a combination of 2 wires and their electrodes to make a complete circuit with the electrocardiograph.
slide66
Lead I- the negative terminal of the electrocardiograph is connected to the Right Arm and the positive terminal to the Left Arm. Lead II- the negative terminal of the electrocardiograph is connected to the Right Arm and the positive terminal to the Left Leg. Lead III- the negative terminal of the electrocardiograph is connected to the Left Arm and the positive terminal to the Left Leg.
how do you treat coccidia and hookworms
How do you treat coccidia and hookworms?
  • Hookworms:
  • Pyrantel Pamoate or Fenbendazole
  • Coccidia:
  • Sulfadimethoxine
how do you calculate a drug dose
How do you calculate a drug dose?
  • mg/kg of your desired dosage times body weight in kg of patient
  • mg/kg calculation times mg/ml (tablet, ect) of medication using
  • Will give you the mls, tabs, ect of medication to give patient
where do you locate drug dosages
Where do you locate drug dosages?
  • Drug dosages can be located in many veterinary drug guides such as Plumb's Veterinary Drug Handbook. Another place to find dosages is on VIN.
can albon and pyrantel pamoate be given together
Can Albon and Pyrantel Pamoate be given together?
  • Yes, according to Plumb's Veterinary Drug Handbook these two medications can be given together with no side effects.
is panacur safe for puppies
Is Panacur safe for puppies?
  • One of the adverse effects of Panacur(苯硫哒唑) is antigen release as the parasites die, and vomiting may occur in dogs. Because Billy is so emaciated and vomiting already, the decision was made to use Pyrantel Pamoate(双羟萘酸噻嘧啶). Pyrantel Pamoate can cause some vomiting but it is less frequent than Panacur.
what is pda
What is PDA?
  • Patent Ductus Arteriosis; a shunt between the aorta and pulmonary artery
what are polygenic traits
What are polygenic traits?
  • These are traits that are dependent upon the interactions of several different genes in the DNA. They may or may not be on the same chromosome.
what does basilar murmur mean
What does basilar murmur mean?
  • A murmur detected on the base-end of the heart
what are standard radiograph views
What are standard radiograph views?
  • Standard view for a thoracic radiograph is VD and Left Lateral.
can tracheal collapse be seen on xrays
Can tracheal collapse be seen on xrays
  • radiographs are a common way to visualize tracheal collapse. The x-ray must be done exactly on inspiration and expiration to see the trachea collapse. Therefore two x-rays are needed because the collapse occurs in the cervical or intrthoracic trachea.
what could cause enlarged tonsils
What could cause enlarged tonsils?
  • Enlarged tonsils can be a result of many problems associated with coughing and throat issues. Since tonsils are simply lymphatic tissue, elargement or inflammation can result from infection or just irriatation of the tonsil area.
slide78
Enlarged or inflammed tonsils are very commonly associated with kennel cough because the dog continuously hacks and coughs which irritates the tonsils. Since "Billy"s tonsils were described as enlarged and not inflammed or worse (and his lymph nodes were normal) I think it is unlikely that he has tonsillitis or any serious infection of the tonsils
is vaccinating compromised animals ok
Is vaccinating compromised animals ok?
  • Risks of vaccinating compromised puppies
  • Hypersensitivity  usually with killed vaccines (like leptospirosis and rabies)
  • Local site reactions (especially in poodles)
  • For immunocompromised dogs, an illness can occur if the vaccine is incompletely attenuated or contaminated
  • Leptospirosis is the most allergenic vaccine compound, and if combined with other killed vaccines (like corona) can increase risk of anaphylaxis
what else does revolution treat
What else does Revolution treat?
  • It will prevent heartworms, kill adult fleas and also prevent their eggs from hatching, it treats and controls ear mites, it also treats and controls sarcoptic mange. It is one small tube that is applied monthly on the dog’s back.
are there any side effects to revolution
Are there any side effects to Revolution?
  • In some cases there have been irritation at the site of application, temporary hair loss, slight loss of appetite, drooling, vomiting, diarrhea, drowsiness, increased breathing and heart rate and some muscle tremors.
how do you treat mixed bacteria cocci and small rods in the ear
How do you treat mixed bacteria (cocci and small rods) in the ear?
  • Initial thorough cleaning of the ears are needed to remove debris and lipids. A ceruminolytic agent, such as Epi-otic, can be used. This is a good product because it also has a mild anti-fungal and anti-bacterial agent. Next, a cleaning and drying solution should be used; preferably one that contains acid to change the pH of the canal to make it less favorable for yeast to grow. Finally, a medication should be chosen
how do you treat yeast with malassezia sp in the ear
How do you treat yeast with Malassezia sp. In the ear?
  • See above list. The most common treatment is Otomax which contains a gentamicin (bacterial agent) a betamethasone (an analog of prednisolone which can act as an anti-inflammatory) and a clotrimazole (an anti-fungal). This medication is given twice daily. Some studies do not recommend giving this medication if the tympanic membrane is ruptured.
what are the cocci and rods
What are the cocci and rods?
  • Most likely a Pseudomonas infection. A common cause of otitis externa is Pseudomonas, a gram negative bacteria. Although there are several species of Pseudomonas, aeruginosa is the most common one isolated from infected ears. Pseudomonas favors moist areas and may cause ulcerations and subtle changes in the microanatomy of the ear canal. Therefore, dogs that have had a previous Pseudomonas otitis infection require ear maintenance therapy aimed at keeping the ear canal acidic and free from cerumen to prevent recurrence.
slide86
Furthermore, if the Pseudomonas infection does recur, it is usually much more resistant to antimicrobial agents than the original infection, making resolution more difficult and time-consuming. And the more chronic the Pseudomonas infection, the greater the chance that there is a concurrent otitis media. All cases of Pseudomonas cultured ear infections should be inspected for underlying causes of otitis externa.
what is mometomax
What is mometomax?
  • This is a derivative of the otomax that only has to be given once daily, therefore, decreasing the chances of the medication not being given properly.
slide88
To treat this problem, we used Epi-otic to clean the ears twice daily for ten days. After filling the ear canal with the solution, gently massage the ear canal to loosen any debris before allowing the dog to shake. Next, clean out any excess debris with cotton. This cleaning procedure removes excess wax and has some anti-bacterial and antifungal action.
slide89
After cleansing the canals, repeat the same routine with the ClearxEar Cleaning solution and then the ClearxEar Drying solution in order to create an environment less favorable for the yeast and bacteria-these products increase the pH of the ear; when the infection is cleared these two products are excellent for weekly preventitive cleaning. Finally, apply 2 drops of Mometomax to each ear once daily for 10 days after the pm cleaning routine. The ears should be checked in 10-14 days to be sure the medication is working against these species.
what is hyperemia and what does it have to do with the ears
What is hyperemia and what does it have to do with the ears?
  • Les and I pretty much attributed the hyperemia (excess blood) in the ear to him scratching because of the infection. we couldn't find anything significant on it.
can prednisone be given to puppies
Can prednisone be given to puppies?
  • In painful ear infections, an initial dose of prednisone is commonly given for 5-7 days before tapering the dose in order to tend to the underlying inflammation involved in yeast and bacterial infections. It can be given to puppies, however, since our case hasn’t shown outright signs of ear irritation and because predisone has been shown to retard growth in some cases we should hold off on giving it.
can predisone use adversely effect a puppy with a heart condition
Can predisone use adversely effect a puppy with a heart condition?
  • Prednisone is routinely used in healthy puppies with skin conditions.
slide93
Cardiovascular System: Glucocorticoids can reduce capillary permeability and enhance vasoconstriction. A relatively clinically insignificant positive inotropic effect can occur after glucocorticoid administration. Increased blood pressure can result from both the drugs' vasoconstrictive properties and increased blood volume that may be produced.
slide94
Hematopoietic System: Glucocorticoids can increase the numbers of circulating platelets, neutrophils and red blood cells, but platelet aggregation is inhibited. Decreased amounts of lymphocytes (peripheral), monocytes and eosinophils are seen as glucocorticoids can sequester these cells into the lungs and spleen and prompt decreased release from the bone marrow. Removal of old red blood cells is diminished. Glucocorticoids can cause involution of lymphoid tissue.
how does an echocardiogram work
How does an echocardiogram work?
  • Echocardiography: Ultrasound using Doppler imaging to produce a 2-D image of the heart. Echo uses a B-mode to produce a simultaneous real-time video stream and a M-mode to give graphical representation. Using a hand-held transducer, tests are performed by shooting sound waves through the thorax.
slide96
You can look to references to see the areas in which to place the transducer along the sternum in order to get the correct long axis and short axis recordings. Echocardiography is a vital instrument in diagnosing and isolating all types of cardiac problems. It is now commonly used during surgery to serve as imaging for non-invasive procedures.
slide97
Echo:
  • LVIDd 35* (9.2 – 21) Left Ventricular Diameter Diastole
  • LVIDs 21.5* (3 - 13.3) Left Ventricular Diameter Systole
  • AoD 12.8 (.6 – 14.5) Aortic Root Diameter
  • LA 23.3* (.9 – 16.3) Left Atrial FS 39% (33 – 46) Fractional Shortening
  • IVSd 5.9 (5.4 – 7.4) Interventricular Septum Diastole
  • IVSs 7.2* (8.2 – 10.3) Interventricular Septum Systole
  • LVPWd 4 (4.3 – 5.9) Left Ventricular Posterior Wall Diastole
  • LVPWs 7.1* (7.3 – 9.3) Left Ventricular Posterior Wall Systole
  • LA/Ao 1.84* (.83 – 1.13) Left Atrium / Aortic Root Diameter
  • Qp/Qs 2.41* (1) Pulmonary Flow / Systemic Flow
  • PDA Vmax >4.5 m/s
  • PDA 5mm
how do you follow catheter placement during embolization
How do you follow catheter placement during embolization
  • echocardiogram is most commonly used during the procedure to follow the catheter and coil placement
will the coil expand as the puppy grows
Will the coil expand as the puppy grows
  • Yes, it is a coil that will/can expand if the shunt expands
what are pda treatment drugs
What are PDA treatment drugs?
  • If PDA progresses to congestive heart failure, the most common drugs used to treat it are diuretics. I included a quick summary of these diuretics just in case he asks a random question about them.
  • Fluid that builds in the chest can be relieved by these diuretics:
slide101
Inhibitors of Na/K/2cl transporter: Furosemide, bumetanide
  • Furosemide is the most commonly used diuretic in veterinary practice. Minimum effective dose should be used in order to prevent dehydration and activation of the Renin Angiotension Aldosterone System. These diuretics reversibly inhibit the Na/K/2Cl co-transporter of the membrane of the epithelial cells of the thick ascending limb of the loop of Henle.
slide102
Inhibitors of Na/Cl cotransporter: Thiazides
  • Thiazide diuretics are also used, but can cause Hypokalemia especially when administered with furosemide. This diuretic works on the distal convoluted tubule. The blockade of this co-transporter decreases the ability of the kidney to increase free water clearance.
slide103
Inhibitors of epithelial sodium channels: amiloride, triamterene
  • The distal convoluted tubule contains contain sodium channels which allow reabsorption of sodium. These diuretics inhibit the Na+ conductance of these channels. This decreases the electrochemical potential for K+ secretion in the urine. Because of this, these diuretics are considered to be K-sparing.
slide104
Inhibitors of type I (mineralocorticoid / glucocorticoid) receptors: aldactone
  • The diuretic Spironolactone, competitively inhibits the binding of aldosterone to mineralocorticoid receptors in epithelial cells of the distal convoluted tubule and the collecting duct. This binding down-regulates the synthesis of membrane Na-channels and Na-K-ATPase. The secretion of K+ and H+ are inhibited. Sometimes hyperkalemia may result.
  • The dosages for these diuretics depends on the case. Furosemide is the most commonly used diuretic
what is lasix
What is lasix(呋塞米)?
  • Furosemide (lasix) is the most commonly used diuretic in veterinary practice. It increases the excretion of chloride, potassium, sodium, calcium, hydrogen, magnesium, water, ammonium, and bicarbonate. Lasix works by decreasing the absorption of electrolytes in the loop of Henle’s ascending part. This decreases the reabsorption of both sodium and chloride. It also affects the distal renal tubule by increasing excretion of potassium.
will stress alter bloodwork
Will stress alter bloodwork?
  • Yes stress will alter bloodwork. That was part of my neutrophil and monocyte stuff.
what causes increased leukocytes neutrophils and monocytes
What causes increased leukocytes, neutrophils and monocytes?
  • Infection/inflammation, stress, glucocorticoids, Bone marrow disease, hemolytic or hemorrhagic anemias, Chronic granulocytic leukemia, Granulocytopathy, and Cyclic hematopoiesis.
what is mature neutrophilia
What is mature neutrophilia
  • Large numbers of mature neutrophils circulating in the blood.
how do you distinguish between mature immature neutrophilia
How do you distinguish between mature/immature neutrophilia
  • Immature neutrophils are called Band Cells and have a horseshoe shaped nucleus. Mature neutrophils are round cells that measure 12-15 microns. They have pale pink cytoplasm with granules present. They have segmented nuclei that contain condensed chromatin.
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What causes an increase in Alkaline Phosphatase?
  • An increase is indicative of intrahepatic or extrahepatic biliary obstruction
  • Also due to hepatobiliary disease (esp. obstructive jaundice) and bone diseases with increased osteopblastic defomans and bone cancer, hepatic tumors, granulomas, and hepatic lipidosis (fatty liver  normal physiological response to lipolysis, obesity, or hepatotoxins)
  • Not liver specific – also occurs in bone, placenta, intestine, kidney, and leukocytes; however, only clinically significant (showing up on chem panel) for bone and liver
slide112
What causes increase in Creatine Kinase?
  • It is an organ-specific enzyme catalyzing the transfer of a phosphate group from phosphocreatine to ATP; has three isoenzymes found in the brain, myocardium, or both skeletal muscle and myocardium
  • Most commonly increased related to muscle damage and seen if muscle necrosis
what causes decreased creatinine
What causes decreased creatinine?
  • It is formed in the muscle, passes into blood, and excreted in urine.
  • Elevation in creatinine level in the blood indicates a disturbance in kidney function
  • Creatinine clearance would decrease – it is a measure of renal function based on the rate at which ingested creatinine is filtered through the renal glomeruli  indicative of renal failure
what causes increased phosphorus
What causes increased phosphorus?
  • Phosphorus is co-regulated with calcium (which is also slightly elevated)  this suggests renal failure, hypervitaminosis D or hypoadrenocorticism
do congenital heart defects stunt growth
Do congenital heart defects stunt growth?
  • “Many animals with CHD will have stunted growth”
are there contradictions with steriod use and heart conditions
Are there contradictions with steriod use and heart conditions?
  • Corticosteroid administration always has the potential to suppress endogenous production of cortisol. The dog is more sensitive to suppression of endogenous cortisol production than the cat. The likelihood and degree of suppression increases with the corticosteroid's duration of action. Even topical or inhalation therapy can suppresses cortisol production. The immunosuppressive effects of corticosteroids are related to dose, steroid potency, and dose interval, and can predispose animals to infectious disease.
slide117
Vaccination of animals receiving immunosuppressive doses of glucocorticoid is not recommended. Short-term anti-inflammatory doses of glucocorticoid are not considered to significantly interfere with antibody response to vaccination.
slide118
In dogs, anti-inflammatory doses of oral prednisone reduces baseline T3 while T4 is unaffected, and the thyroid becomes hyper-responsive to TSH after 2-4 weeks. With immunosuppressive doses of oral prednisone, T3, T4, and fT4 are decreased as early as 24 hr after initiating therapy, but response to TSH and TRH tests is increased, allowing the latter two tests to be used to differentiate primary hypothyroidism from changes due to prednisone administration.
slide119
Anaphylactic reactions may occur with parenteral administration of glucocorticoid. Acute hypotension may occur with rapid intravenous administration of formulations containing polyethylene glycol or propylene glycol as a carrier.
slide120
Gastrointestinal ulceration may occur with high doses or long term administration of glucocorticoid. Colonic perforation is noted as a sequella to neurosurgery, with the high doses of glucocorticoid commonly administered in the perioperative period.
  • Adverse effects of glucocorticoid agents are generally associated with long-term administration of these drugs, especially if give at high dosages or not on an alternate day regimen. Effects generally are manifested as symptoms of hyperadrenocorticism. When administered to young, growing animals, glucocorticoids can retard growth.
why do dogs cough in left heart failure
Why do dogs cough in left heart failure?
  • Cough is a common sign of heart disease in dogs. The cough is commonly associated with pulmonary edema because of the left-sided overload. The cough tends to be mild, grunting, and soft. Coughs normally associated with respiratory illness tend to be loud, hacking, dry, brassy, and precipitated by excitement
what are common broad spectrum antibiotics
What are common broad spectrum antibiotics
  • The penicillin derivatives are usually used as initial broad spectrum meds. Penicillins are usually bactericidal against susceptible bacteria and act by inhibiting mucopeptide synthesis in the cell wall resulting in a defective barrier and an osmotically unstable spheroplast. The exact mechanism for this effect has not been definitively determined, but beta-lactam antibiotics have been shown to bind to several enzymes (carboxypeptidases, transpeptidases, endopeptidases) within the bacterial cytoplasmic membrane that are involved with cell wall synthesis.
slide123
The different affinities that various beta-lactam antibiotics have for these enzymes (also known as penicillin-binding proteins; PBPs) help explain the differences in spectrums of activity the drugs have that are not explained by the influence of beta-lactamases. Like other beta-lactam antibiotics, penicillins are generally considered more effective against actively growing bacteria.
slide124
The main ones I researched included amoxicillin, ampicillin and unasyn (ampicillin/sublactum).
  • All 3 increase resistance to gram negative anaerobes and anaerobic bacteria. The only difference is unasyn will also get beta-lactamase producing bacteria making it cover a broader spectrum; however, it is usually used IV since it comes in a powder to be reconstituted. An empty stomach is ideal for these medications and adverse effects may include hypersensitivity and some GI effects.
slide125
Since we sent Billy home, we put him on a 10 day course of amoxi-drops. This is a powder that is reconstituted to a liquid droplet form and must be kept refrigerated; it must be discarded after 10 days of being reconstituted.
is there a broad spectrum antibiotic to cover bacteria yeast and kennel cough
Is there a broad spectrum antibiotic to cover bacteria, yeast and kennel cough?
  • The previous antibiotics would be the best bet since KC and the bacteria found in our ear cytology were gram negative. However, topical ear mediations will be much more efficient in treating the ear infection and a definite cure for kennel cough is still a debate.
what is the best low sodium diet for billy
What is the best low sodium diet for Billy?
  • Hills offers g/d and h/d diets for heart failure and heart disease, which are very good nutritionally, but can not be offered for puppies.
  • Science diet has a puppy lamb meal and rice formula, which has low sodium. Comparing to the numbers with their heart diets (0.72% as fed, 0.78% dry matter, 174 mg/100 kcal) the lamb and rice meal’s sodium content is 0.37% as fed, 0.4% dry matter, and 92 mg/100 kcal.
  • With Billy’s weight of 2.9 kg (or 5.38 lb) he would eat 7/8 cup of dry a day, or 5/8 of a can.
  • The canned food has similar sodium contents, at 0.12% as fed, 0.4% dry matter, and 97 mg/100 kcal.
what are the pros cons of pda surgical ligation
What are the pros/cons of PDA surgical ligation?
  • The pros were that it is a relatively safe operation with a high rate of success. It is also relatively quick as far as surgeries go. The cons are that there are complications, including hemorrhaging, iatrogenic trauma, and others which could lead to death.
what kinds of fluids are used during surgery are fluids ok during pda surgery
What kinds of fluids are used during surgery? Are fluids ok during PDA surgery?
  • Surgery protocols typically call for fluid maintenance during most surgeries; PDA surgery fluid rate should probably not exceed maintenance. Maintenance fluid rate can be calculated in a variety of ways (ours was 60mls/kg/day of Normosol R).
slide130
Goals of fluid therapy:
  • Maintain normal hydration
  • Replace electrolytes
  • Maintain normal acid base status
  • Augment plasma oncotic pressure
  • Maintain intravascular volume(cardiac output)
  • Induction of diuresis
slide131
A crystalloid will be chosen. Crystalloids are water-based solutions containing low molecular weight electrolytes. The most common:
  • Lactated Ringer’s isotonic for fluid replacement, acidotic states, maintenance
  • Nomosol R isotonic for fluid replacement, acidotic states, maintenance
what are anesthesia protocols for pda
What are anesthesia protocols for PDA?
  • Anesthesia protocols for PDA must be compatible with animals that may have some degree of respiratory compromise. Cardiac arrhythmias require good dosage, induction, and maintenance of the anesthesia. Isoflurane is the preferred gas anesthesia because it is less prone to cause arrhythmias. The other Drugs used in our protocol are listed below.
slide133
Our anesthesia protocol:
  • Premeds:
  • Hydromorphone: IV .165mL
  • Midazolam: IV .132 mL
  • Induction:
  • Propofol: .99mL
  • Maintenance:
  • Isoflurane
what are anesthesia side effects
What are anesthesia side effects?
  • Anesthesia side effects are very diverse. They can include bradycardia, respiratory distress, hypotension, and arrhythmias. The side effect of each medication used in our anesthesia protocol is discussed in depth in another learner issue.
what causes hypothermia
What causes hypothermia?
  • Some causes of hyperthermia include exercise, being left in a parked car, a thick coat, short faces (such as with bulldogs and boxers), inadequate outdoor shelter, prolonged seizures, lung and heart diseases and a history of having hyperthermal episodes. The eating of hops can cause malignant hyperthermia. Macadamia nut toxicosis can also cause hyperthermia in dogs.
what does fractional shortening mean
What does fractional shortening mean?
  • FS is a measure of left ventricular volume in diastole vs. systole
  • FS%= LVDd – LVDs x 100

LVD

what is the normal fetal circulation
What is the normal fetal circulation?
  • The placenta is the site for the intake of nutrients, the elimination of wastes, and the exchange of respiratory gases. Blood rich in nutrients and oxygen and low in waste products enters the fetus through the umbilical vein. Most of this blood passes directly through the liver in the ductus venosus to enter the caudal vena cava, but there is some mixture of non-oxygenated blood in the liver. The oxygen-rich caudal vena caval blood passes through a valved opening in the interatrial septum, the foramen ovale, to enter the left side of the heart.
slide138
This blood is pumped into the aorta by the left ventricle. Oxygen-depleted blood returning in the cranial vena cava, with some admixture of blood from the caudal vena cava, passes through the right atrium into the right ventricle. Some of it goes to the lungs, but because the lungs are collapsed and offer resistance to blood flow, most of it bypasses the lungs via a ductus arteriosus and enters the aorta distal to the origin of the major arteries to the head and the arms.
slide139
As development continues, more and more blood flows through the lungs. At birth, the lungs fill with air, and pulmonary resistance to blood flow is less than that of the rest of the body. Blood returning from the lungs increases the pressure in the left atrium, the valve in the foramen ovale is held shut, and all the blood in the right side of the heart is pumped to the lungs. Then, the foramen ovale permanently closes and a depression is left, the fossa ovalis.
slide140
Blood in the left side of the heart, all of it has been through the lungs, is pumped into the aorta. Most blood continues to the body, but some in the aorta, because of the relatively low pulmonary resistance, flows through the ductus arteriosus into the lungs. Because of this temporary reversed flow through the ductus arteriosus, a certain fraction of blood circulates twice through the lungs.
slide141
Within few hours, the ductus arteriosus contracts. Its lumen is filled in with connective tissue, and the duct is transformed into the ligamentum arteriosum. With the loss of the placenta, the umbilical vein and arteries lose their function. The umbilical vein becomes the round ligament of the liver, which may have been seen in the falciform ligament. The proximal portions of the umbilical arteries remain as the proximal portions of the internal iliac arteries. Distal parts of the umbilical arteries supply the urinary bladder, and also some become the lateral vesical ligaments.
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