Term
| How does Hyperthyroidism occur? At what age do cats tend to develop hyperthyroidism? |
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Definition
-It occurs due to hypersecretion of thyroid hormones due to hyperfunctioning nodules of the thyroid gland. Can be caused by idiopathic benign tumors of the thyroid glands (2% malignant).
-Tends to occur in middle-aged to older cats (9-10yrs), with no predilection of breed or sex. |
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Term
| Besides an increased Metabolic rate, what other signs/conditions occur in hyperthyroid cats? |
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Definition
-Weight Loss
-Increased Appetite
-Loss of Muscle Mass
-Not heat seeking
-Thicker nails and haircoat
-Agitated and Hyperactive
-Vomiting and diarrhea
-PU/PD
-Retinal Detachment
-Hypertension
-Hypertrophic Cardiomyopathy, tachycardia, and increased force of contraction in the heart |
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Term
| Name 3 diagnostic tests for hyperthyroidism? What is the prognosis of hyperthyroid cats that are relatively healthy otherwise? What would the prognosis be if the cat had heart, renal, or any other diseases unrelated to hyperthyroidism? |
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Definition
TESTS:
-Elevated serum Total T4 levels
-Free T4 or T3 suppression test to confirm
-Planar thyroid scintigraphy
PROGNOSIS OF HEALTHY:
-Excellent with treatment
PROGNOSIS WITH DISEASES:
-Less favorable |
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Term
| What are some treatment options for hyperthyroid cats? What other health concerns do we have when picking our treatment of hyperthyroidism? |
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Definition
-Anti-thyroid drugs (work by blocking thyroid hormone synthesis, come in pill, liquid, or patch form)
-Surgical Excision
-Radioiodine
-Hills y/d diet (iodine restrictive diet shown to lower circulating thyroid hormones)
OTHER CONCERNS:
-Age of the Cat
-Renal/Heart issues
-Hidden Renal Failure (hard to detect renal failure in cats with PU due to diluted BUN levels) |
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Term
| Explain what is done pre-op and during surgery for a surgical excision of the thyroid? What post-op complications can occur? |
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Definition
Pre-op: pretreat cat with methimazole typically
During: either removal unilaterally or bilaterally of gland
Post-Op Complications:
-low blood calcium levels due to removal of the parathyroid. 1-3 days post-op the cat should remain hospitalize to be monitored. |
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Term
| Explain to process of Radioiodine Treatment? |
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Definition
-Treatment of choice (also called 131 I treatment)
-No pretreatment (you want to keep the overactive cells so they can be targeted during therapy)
-Intravenous or oral dosage of radioactive iodine is given -> Taken up by the thyroid gland -> radioactive material kills the abnormal tissue in the gland and spares the normal tissue
- The parathyroid glands get to be spared
-Hospitalized for 7-10 days after treatment
-Elimination of radioactive material in urine/feces for next 2-4 weeks
-Restriction of cat to house, decreased contact with humans, and careful disposal of litter box waste is strongly recommended
-Thyroid/kidney blood work at 1 and 3 months post treatment
-Reoccurrence of hyperthyroidism is rare
*Note* - Let any waste from cat sit in a garbage bag in the back of the garage for 3 months till radiation goes away |
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Term
| What information should be given to the client on drug treatment of hyperthyroidism and how it should be monitored? |
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Definition
-Takes 1-3 weeks to reach normal levels again
-Dosage must be titrated and must be given for the rest of the life of the cat
-Serum T4 concentrations must be monitored
-Side effects include anorexia and vomiting
-Client must be diligent in monitoring pet for signs of reoccurrence of hyperthyroidism |
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Term
| What is Hypothyroidism? What type of animals tend to develop hypothyroidism (age, species, sex)? |
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Definition
-The clinical condition that results from inadequate production and secretion of T3 and T4 by the thyroid gland. Results in a decrease in cellular metabolic activity.
-Tend to see it in Dogs, middle-aged (4-10), More common in spayed and neutered animals (2.5:1). Certain breeds are more prone than others cockers and goldens). |
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Term
| Explain the physiological process of the Thyroid Gland (involvement of T4 and T3)? |
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Definition
-T4 is manufactured and stored in the thyroid gland inactive form. T3 is the active form of thyroid hormone. Activation is by removal of an iodine molecule and occurs in the cell.
Starts with the hypothalamus (stimulated by environment, stress, nervous system) -> Anterior Pituitary -> Thyroid Gland -> release of T4 -> goes to all tissues -> in the cell cytoplasm T4-Iodine = T3 -> T3 travels to the nucleus -> In the nucleus, if shifts how nutrients are used by the body
With Hypothyroidism all this is disrupted and causes weight gain, heat seeking, muscle atrophy, skin/hair issues, possible Horner's Syndrome (droopy face), Megaesophagus, laryngeal paralysis. |
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Term
| What are some clinical symptoms that can occur with Hypothyroid? |
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Definition
-Lethargy and mental dullness
-Alopecia/excessive shedding
-Dry, scaly hair coat
-Hyperpigmentation of skin
-Pyoderma
-Weight gain (despite lower food intake)
-Cold intolerance |
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Term
| What are some diagnostic tests we can performed to test for hypothyroid? |
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Definition
BASELINE T4:
-Most common
-If positive, other tests used to conform low levels
BASELINE T3:
-used instead of T4 (but not as common)
FREE T4 BY EQUILIBRIUM DIALYSIS:
-More expensive and must be sent to appropriate lab
TSH LEVEL:
-level will be elevated; while baseline T3 and T4 will be low
TSH STIMULATION TEST:
-Done by injecting TSH into the veins. If baseline T3 and T4 are low after appropriate time. This may be performed to confirm hypothyroidism. |
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Term
| What is the prognosis of Hypothyroidism? How can treatment aid in hypothyroidism? |
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Definition
PROGNOSIS:
- is excellent with treatment and treatment is affordable but also lifelong
TREATMENT AND HOW IT HELPS:
-Daily synthetic thyroid hormone
-Mental alertness and activity should increase in 1-2 weeks after therapy has started
-Skin/hair issues resolve slowly, about 1-4 months before hair coat starts to come back (due to the rest of body getting healthy first)
-Weight loss regimen
-Monitor serum concentrations (at 1 month post initial dosage and q4 weeks until levels appropriate)
-Adjust drug dosage accordingly |
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Term
| Explain and describe more about Iodine deficiency? |
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Definition
-It is uncommon
-May occur in young animals in any species when dietary intake is inadequate
-In addition to the classic signs of hypothyroidism, there is enlargement of the thyroid (Goiter)
-Goiters occur because there is no T4 being produced yet the pituitary gland is still sending TSH to the thyroid gland |
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Term
| What is Megaesophagus? Is it more common in cats or dogs? What is the difference between breeds predisposed and those who are congenital to it? What are the idiopathic causes of Megaesophagus? What is PRAA? |
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Definition
-Generalized enlargement of esophagus with a decreased or absent peristalsis (musculature fails).
-More common in dogs
-Predisposed: genetically more prone to developing (certain breeds)
-Congenital: develops within 4 months with poor prognosis
-Idiopathic causes include:
Distemper
Myasthenia Gravis
Thyroid
Addisons
Esophageal tumor
Foreign body in Esophagus
-PRAA: Persistent Right Aortic Arch, seen in puppies and is repairable |
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Term
| What are some symptoms of Megaesophagus? |
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Definition
-Vomiting (within 20mins of eating) or Reguring (within 5mins)
-Shape of expelled material, Presence of undigested food, Length of time btw ingestion and expelling, Posture and behavior of animal
-Cachexia
-Poor Growth
-Extreme hunger or lack of appetite
-Swallowing difficulty, exaggerated and/or frequent swallowing
-Sour and/or foul smelling breath
-Increased respiratory sounds (rattles)(secondary pneumonia), nasal discharge, cough (aspiration) |
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Term
| What are some ways we can diagnose Megaesophagus? How do we treat it? |
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Definition
DIAGNOSIS:
-History
-Clinical Signs
-Bloodwork - normal unless secondary pneumonia, hypoglycemia, or other decreased enzymes from lack of nutrition
-Radiographs (Upper GI and/or Fluoroscopy)
-Esophagoscopy
TREATMENT:
-Determine underlying cause
-Treat any aspiration pneumonia or esophagitis
-After that, there really is no treatment, only management for the rest of their lives |
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Term
| Explain some ways we can help manage Megaesophagus? |
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Definition
FEED AND WATER IN VERTICAL POSITION:
-Baily Chair
-Allow gravity to do the job
-Keep position for 15-30mins post meal
LOW-FAT OR LOW RESIDUE CANNED FOOD:
-Thick milkshake consistency or small meatballs
MULTIPLE FEEDINGS:
-3 to 4X a day recommended
MEDS:
-Acid reducer
-Motility drugs
-Esophageal bandage
WATCH FOR SIGNS OF ASPIRATION PNEUMONIA |
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Term
| What is Megacolon? Is it more common in cats or dogs? What is the difference between Congenital and Acquired Megacolon? |
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Definition
-Functional disorder; dilation of the colon; leading to infrequent and difficult defecation and constipation
-More common in Cats
-Congenital: lack of normal smooth muscle function
-Acquired: more commonly an idiopathic form. Feces chronically retained, fecal water completely absorbed = "concrete feces". Feces build up and cause dilation of colon. Smooth muscle can no longer contract or expand do to stretching. |
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Term
| What are some rule-outs we can come up with to better diagnose an acquired form of megacolon? |
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Definition
-Foreign body
-Lack of exercise
-Lack of litter box or clean litter box
-Painful defecation (anal sac abscess, stricture of anus, hip dysplasia, spine or disc problems)
-Narrowed pelvic canal (Fx of pelvis, intrapelvic fracture)
-Neurologic
-Dehydration
-Weight (overweight cats are more prone) |
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Term
| What are some clinical signs of Megacolon? What are some ways we can diagnose Megacolon? |
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Definition
CLINICAL SIGNS:
-Straining to defecate with small or no fecal volume
-Hard, dry feces
-Less frequent defecation, or Frequent but non-productive trips to litter box
-Lack of appetite
-Depressed
-Thin
DIAGNOSIS:
-History
-Dehydration
-Abdominal palpation (firms areas that may be moldable)
-Rectal palpation
-Radiographs |
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Term
| What are some ways we can treat Megacolon? What are some complication that can happen from surgical removal of the colon? |
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Definition
STABILIZE PATIENT:
-Fluids
-Electrolytes
CONSERVATIVE:
-Stool softeners and lubricating agents
-Cleansing enemas (may need anesthesia)
-Manual removal of stool
-Dietary modifications (increase fiber)
SURGERY:
-Remove the colon
-Attach ileum to rectum
SHORT TERM COMPLICATIONS:
-Peritonitis
-Straining to defecate 1st week
-Cramping of bowels
-Loose BM and increased frequency (improves in 2-3 months)
LONG TERM:
-30-50% have increased BM for rest of life
-Softer than normal stools
-Strict low-residue diet |
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Term
| What is EPI? What role does the Pancreas play, and what happens if that role is decreased or absent? Explain the Etiology behind EPI |
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Definition
-Exocrine Pancreatic Insufficiency (also know as Pancreatic Insufficiency or Maldigestion Syndrome)
-Pancreas has a huge role in digestion by producing and storing Trypsin, Chymotrypsin, Amylase, and Lipase
-Decrease or absence of digestive enzymes means that food passes through GI undigested. Animal is literally starving to death
ETIOLOGY:
-Chronic pancreatitis
-Congenital (happens >2years of age, Pancreatic cells just start decreasing in numbers)
-Pancreatic acinar atrophy (pancreas looks shriveled)
-Pancreatic Cancer
-About 90% of pancreas destroyed before we see symptoms |
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Term
| What are some symptoms with EPI? |
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Definition
-Rapid Weight Loss (loss of body fat, muscle atrophy)
-Poor hair coat
-Light yellow or clay colored chronic diarrhea (greasy)
-Flatulence (due to bacteria working overtime in gut)
-Borborygmus (tummy rumbles)
-Constant, insatiable hunger
-Coprophagia and pica
-SIBO: Small Intestinal Bacteria Over-growth (micro vili/brush border end up getting destroyed) |
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Term
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Definition
-History
-Clinical Signs
-X-rays - check for masses
-Fecal exam (fat and starch)
-Fecal Protease Test (FPT) (3 consecutive samples, soybeans)
-Serum Trypsin-like Immunoreactivity test (blood test looking for normal levels of trypsin like enzymes, animal with EPI have no detectable amount) |
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Term
| What are some ways we can treat EPI? |
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Definition
-Fairly easy, but expensive and life-long (need to replace animal's pancreatic enzymes)
-Only source is from the meat packing industry (Viokase-V, Pancrezyme w/ H2 blocker antacid)
-Highly digestible diet
-Vitamin B-12
-Antibiotics for "bad" bacteria
-Animal must stay on meds for the rest of life (symptoms return quickly)
-Most patients respond well within 1 weeks (begin gaining weight)
-1 out of 5 won't
-Most will always have low BCS |
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Term
| Explain Epilepsy? What species, sex, and age is it most commonly seen in? How does age play a role in seizure activity? |
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Definition
Neurological condition that occasionally occurs due to disturbances in normal electrical function of the brain (brain is structurally normal but functionally abnormal)
-Seizures are symptoms of Epilepsy
-Normal brain function deals with excitatory and inhibitory signals (when excitatory input is great than inhibitory, a seizure occurs "seizure threshold")
-More common in male dogs around the age of 6months - 5yrs
-Onset <2yrs of age, seizures are more likely to be difficult to control, the worse they tend to get, and the more damage they cause
-Onset of >2yrs of age, seizures are more likely to be easily controlled or may not require medication, they tend to also develop a consistent pattern |
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Term
| What etiologies can cause Seizures/Epilepsy? |
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Definition
ETIOLOGIES:
-Hereditary or Idiopathic
-Trauma or Tumor
-Infection (encephalitis, Distemper, Toxoplasma)
-Metabolic Disorders (hypoglycemia)
-Heat stroke, visual/nasal stimuli, Temp over 108F |
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Term
| What are the classification of seizures? |
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Definition
1) Generalized or grand mal seizures
-Excitatory storm across the brain
-Clinical symptoms are obvious and severe
-Animal is unconscious
2) Focal Seizures
-Smaller area of the brain is affected
-Very mild or subtle clinical signs (fly biting/chewing gun, twitching of the facial muscles)
-Focal seizures may become generalized
3) Absence, or Petit mal seizures
-Abrupt, short-term lack of conscious activity
-Not common in dogs, however debate is whether the animal is conscious or not during the seizure |
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Term
| What are the 3 phases of Grand Mal Seizures? |
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Definition
1) Prodromal or Pre-Ictus, "aura"
-animal acts upset or anxious
-may hide or become clingy
2) Ictus (tonic-clonic)
-Period of seizure activity
3) Post-ictus
-Post seizure behavior (animal may still be on their side regaining consciousness)
-Least understood phase
* Most seizures occur when the animal is asleep or at rest |
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Term
| Explain the Ictus and Post-ictus stage of Grand Mals? |
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Definition
ICTUS:
-seizure begins with stiffening of muscles (tonic), then animal falls to the side with head back
-then tonic turns into clonic (rhythmic movements, biting motions, paddling legs, swaying head)
-animal is unconscious, and all actions are involuntary
-Most last 1-2mins, may be apneic for 20-30secs
-Cluster seizures (brief movements consciousness)
-Status epilecticus (continuous seizure lasting >30mins, series of multi. seizure with no consciousness in between
-Owner should stay calm, move furniture and other animals out of the way, don't touch the animal but be present to comfort animal after
POST-ICTUS:
-pet may lay quietly for a period od=f time
-it may be confused, disoriented and appear blind
-the animal may also be polyphagic, polydypsic
-infrequently, the animal is aggressive
-may take 1-2 days for animal to fully recover, but rare |
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Term
| What information should be in your history notes about the patients seizure activity? What are some diagnostics we can do? |
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Definition
HISOTRY NOTES:
-Critical that client describes the event
-Length, first signs, movements, episodes
-The client should keep a calendar indicating date, time of day, and related activities
-If possible, the client should videotape future events
DIAGNOSTICS:
-CBC, Serum Biochemistry profile
-Urinalysis
-CSF tap
-MRI or CT
-Radiographs |
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Term
| What are some in-hospital treatment we can provide for patients with seizures/epilepsy? What kind of information about the animals seizures can help us determine longterm treatment? |
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Definition
IN HOSPITAL TREATMENT:
-If presented in status epilepticus, place intravenous catheter and give diazepam (also rectally)
-Protect animal and yourself
-Consider well padded cages with bumpers
-Bell on collar
LONGTERM TREATMENT DECISIONS:
-Has > or equal to 1 seizure occurred per month and/or the owners object to their frequency
-Has the animal has a very severe seizure or a cluster of seizures
-The seizures increase in frequency or severity
-An underlying brain disease has been identified as the cause of the seizures |
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Term
| What are some drugs we can used to manage Epilepsy? What things should we know about each drug and their use? |
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Definition
PHENOBARBITAL:
-Oral or IV
-Oral reaches peak effects at 4-8hrs after ingestion, and may take several days for therapeutic levels to be reached
-Short half-life and clients must stick to daily regimen to be effective
-Metabolized by liver and hepatotoxicity may result
-Metabolism by liver induces enzymes so Alkaline phosphatase will be higher, and may increase ALT & AST
-Side Effects include polyphagia and obesity
POTASSIUM BROMIDE (KBr):
-Liquid or capsule
-Affects chloride channels in the brain and decreases excitability
-Long half-life (24days) so missed dosages aren't a problem
-Cleared by the kidneys (good for patients with liver disease)
-Competes with chloride at the kidney, which will result in polyuria/polydipsia
-Monitor salt intake cause as NaCl increases the chloride will win in the kidneys, so more bromide will be excreted and the effectiveness is reduced |
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Term
How should we monitor drug levels in Epilepsy patients taking these drugs?
What do we need to teach our clients about Epilepsy/seizures |
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Definition
DRUG MONITORING:
-Takes 2-3wks for phenobarbital to reach appropriate blood levels for evaluation
-Take KBr 4-6wks for evaluation
-Be certain that blood samples for drug levels are monitored at appropriate times post admin. for comparison purposes
CLIENT EDUCATION:
-Seizures are controlled not cured
-Meds are required for rest of life
-Animal doesn't die after seizures but can be life threatening with severe clusters or status epilepticus
-Protect themselves and dog from injury
-Spay/neuter (genetics)
-Avoid drugs that lower seizure threshold (Ace, Organophosphates) |
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