Medical Presentations
Veterinary presentations by Dr. David Roy Hensen, DVM, drawing on 40+ years of expertise.
Browse and view the presentations below.
Presentations
What are monoclonal antibodies?
antibodies engineered with affinity for binding to a specific target, allowing a focused biological effect.
Why do monoclonals sometimes become ineffective overtime?
They are themselves foreign proteins, which can insight an immune reaction that destroys or mitigates the action of the therapeutic agent
What kind of adverse reactions can occur with monoclonal antibodies?
Anaphylactic forebody reaction
Adverse reaction related to the biologic process of the targeted site
What is the derivation of the ending part (suffix) of naming a veterinary monoclonal product? "vetmab"
Vet = veterinary
mab = monoclonal antibody
What are key points for Lokivetmab?
Trade name = cytopint
Target = Interleuken 31
Treats allergy especially atopy
Antipruritic
works within 24 hrs
last 4 to 8 weeks
2nd injection more effective
What are key points for Bedinvetmab?
Trade name = Librella
Target = canine nerve growth factor (NGF)
Treats canine osteoarthritis
Analgesis - inhibits pain neuro paths
Should have at least two doses. Monthly injections recommended
When is beninvetnab contraindicated?
Pregnancy and lactation
pre-existing neuroloogic disease
breeding dogs
What is the controversy with bendinvetnab?
rapidly progressive osteoarthritis (RPOA)
What are key points of Frunevetmab?
Trade name = Solensia
Target = feline nerve growth factor (NGF)
Treats feline osteoarthritis
Analgesic - inhibitis pain neuro paths
What are contraindications of frunevetnab?
contraindicated in cats that are pregnant, lactating, or breeding
What is canine parvovirus monoclonal antibody?
Treat and prevent Parvovirus
What is the dose of CPMA for treatment? for prevention?
Treatment = 0.2 ml.kg IV
Prevention = 0.1 ml kg SQ
How does CPMA affect puppy vaccines?
Must extend legnth of immunization > Needs one or two more vaccines
Is it ok to store CPMA in the refrigerator like other monoclonal antibodies?
No. It should be frozen,
What is Gilvetmab?
immune checkpoint inhibitor.
Prevents tumor-induced suppression of T-cell responses and supports the immune system’s ability to fight cancer.
What is gilvetmab used for?
Cancer
Mast cell tumor
Melanoma
How is Gilvetmab given?
10 mg/kg IV as an IV infusion over 30 minutes; repeat every 2 weeks for up to 10 treatments.
How effective is gilvetmab?
Not great. A little
What should be done pre treatment with gilvetmab?
Diphenhydramine - ward off anaphylactic reaction
Describe how did the author treat anal sacculitis
Emptied the anal sacs
Flushed anal sacs with physiologic saline
packed anal gland with antibiotic/steroid otic preparation.
Repeat every two weeks
What sedatives and analgesics did the author use?
butorphanol and dexmedetomidine
In what situations might you use systemic antibiotics when dealing with an anal gland issue?
Anal sac abscessation, particularly cellulitis extending into surrounding tissues
Rupture with significant surrounding cellulitis
Marked tissue inflammation extending beyond the sac
Fever, lethargy, or other systemic signs
Immunocompromise or other circumstances that make local treatment less likely to succeed
What nutritional recommendations would you make for recurrent anal sacculitis?
Add fibre to diet
Weight reduction diet if dog is over weight?
What can be done at home to benefit a dog with anal gland issues?
Weight loss (if dog is overweight)
Keep the perianal hairs clipped short
Short, five minute warm soaks help. Place the dog butt in a bathtub of lukewarm water and have the dog sit.
Moderate exercise
How is ondansteron classified pharmacologically?
5-HT3 receptor antagonist
amti emetic
anti nausea
What is the concern with oral ondansteron? Why?
Poor bioavailability.
Why --- extensive first-pass metabolism
If you really need an anti-automatic NOW, how should you use ondansteron?
Intravenous
Does ondansteron have a local effect? How?
Yes
peripheral 5-HT3 receptor antagonism within the GI tract
Name some other anti emetics that are used today? (not in article)
Maropitant (cerenia)
Metoclopramide (Reglan)
Ondansetron (Zofran) - very good anti nausea. Oncoloogist use this
Name some other anti emetics that have been used in the past but not so much today? (not in article)
Anticholinergics (e.g. atropine)
Antihistamines (diphenhydramine)
Phenothiazines (acepromazine)
According to the author, what percentage of anal gland tumors are detected incidentally during a rectal examination?
475
What paraneoplastic syndrome is common with anal sack tumors?
Hypercalcemia
T/F Most anal gland tumors are benign
False
The overwhelming percentage of anal gland tumors are malignant
Name some nonneoplastic anal gland disease
Anal sacculitis
Impacted anal gland
Anal gland abscess
Ruptured anal gland, abscess with cellulitis
What other clinical conditions can be suspected based on digital rectal examination?
lumbo sacral pain
Urethral mass
urethral stone
foreign material (sand, grass)
perineal hernia
Is there a DNA test for prosthetic or urothelial cancer?
Yes
Antech CADET BRAF offers a urine-based molecular test that looks for the canine BRAF mutation associated with urothelial carcinoma and prostatic carcinoma. It uses free-catch urine, making it noninvasive.
Would you sedate a dog just to do a rectal examination?
In most cases, I would NOT.
But I also believe that 75% of the dogs we see our big enough tolerant enough to do a rectal. It's a lot easier in most cases than doing a pedicure. (my opinion)
What are the most common drugs used to stimulate appetite and Companion Animal medicine?
mirtazapine
capromorelin
cyproheptadine
How does mirtazapine work?
Causes enhanced noradrenergic and serotonergic transmission.
In what conditions should the dose of mirtazapine be decreased?
Renal - sid > q2d
hepatic - sid to q2d or q3d
geriatric
Is mirtazapine also an anti emetic?
Yes
What are some adverse effects or concerns of mirtazapine?
Serotonin syndrome (especially when used together with other drugs that increase serotonin)
cutaneous contact reaction (with topicals)
What is the dose of mirtazapine in dogs?
0.6 mg/kg PO every 12 hours
Half-life is shorter in dogs than in cats.
.
What is the common name of Capromorelin and how does it increase appetite?
Entyce
ghrelin-receptor agonist that causes the sensation of hunger and stimulates feeding behavior.
triggers pituitary release of growth hormone
hepatic release of insulin-like growth factor 1 (IGF-1), which reduces growth hormone
What are adverse effects of capromoreline in dogs?
hypersalivation,
GI upset
abdominal discomfort
What are adverse effects of capromoreline in cats?
hypersalivation
GI upset
behavior changes (eg, lethargy, hiding)
transient decreases in heart rate and blood pressure, which may be clinically significant in older or debilitated cats.
What are contraindications or cautions to use of? capromorelin?
Acromegaly
Diabetes mellitus
Why is propofol not used over a long period of time, even though it does increase appetite immediately postop
It must be given intravenously, which is not practical
What our concerns with using benzodiazepines such as (Valium) in cats?
Hepatic necrosis
When might one use glucocorticoids and megestrol acetate?
Palliative care
They do increase appetite, but there are many side effects.
What are characteristics of feline skin fragility syndrome?
Rare
acquired
thin skin that easily tears following minimal trauma.
dermatologic emergency.
minimal bleeding
difficult to manage.
Demodex cati may be present.
Does skin tear easy with FSFS?
Yes!!!!
What are differentials?
Endocrinopathy
hyperadrenocorticism ± diabetes mellitus,
Iatrogenic (topical or systemic glucocorticoid, progestogens, phenytoin)
Infectious (FIP),inflammatory/infectious (cholangiohepatitis),
Metabolic (anorexia ± hepatic lipidosis),
Neoplastic (cholangiocarcinoma and multicentric lymphoma)
What should be done to facilitate a diagnostic work up?
Sedation
What is the prognosis?
Grave
What is the difference between a Robert Jones bandage and a modified Robert Jones bandage?
Robert Jones is bigger, heavier, bulkier. It has more layers of cotten.
A modified Robert Jones has less cotton, but frequently uses a splint as additional support and to immobilize the injury
What are the three layers of a modified Robert Jones bandage and what is his main purpose?
Primary - contact skin / wound
Secondary - soft, absorbent layer. Usually roll cotton and gauze
Tertiary - rubberized taoe to hold interior layers in place
Why should a limb undergoing surgery not be clipped on placing a modify Robert Jones bandage?
It can damage the skin and lead to postoperative infection.
If changing a Robert Jones daily is part of the plan, should you remove the stirrups and replace with a new one?
No. This can irritate the skin..
Best to cut the end near the toe tip and place a new stirrup over it.
What are complications that placing a modified Robert Jones bandage?
Tourniquet effect
Slippage
Irritation / damage from unequal pressure
Should the bandage be conical or cylindrical?
Cylindrical
How high should the bandage extend?
Above the joint of interest
Usually above the stifle or elbow
What is supination?
movement in which a limb rotates so that the palm (or paw) faces upward/anteriorly.
Think - "holding a bowl of soup".
How many layers of cast padding to use for support?
Six to eight
How should conforming gauze be placed? - direction
Distal to proximal
At what point do you use the stirrups?
Place over ther conforming gauze.
Why is the distal toe left open?
To monitor for e xcessive swelling and discharge.
What can be said of the general appearance of cardiac cases?
They tend to lose weight, particularly in the terminal stages.
Puppies with congenital heart issues do not thrive intend to be small
Describe retinal changes that accompany hypertension
What kind of heart disease leads to cyanosis?
Right to left shunting
reverse patent ductus arteriosus,
atrial septal defect
ventricular septal defect
What is differential cyanosis and what condition is most often associated with it?
Caudal mucosa is cyanotic (not oxygenated)
Cranial mucosa is pink
Reverse patent ductus arteriosis
Why should tracheal palpation always be done?
Dogs that get myxomatous mitral valve disease also tend to get tracheal disease. Most importantly, tracheal collapse.
What is the cutoff respiratory rate that differentiates good for bad?
30 breaths per minute
What lung sounds are heard with pulmonary edema, plueral fluid and allergic bronchitis?
pulmonary edema - crackles
plueral fluid - muffled lung soounds
allergic bronchitis - wheezes
What is the most common reason for tachycardia in a dog or cat veterinary visit
Stress and nervousness
What conditions in dogs are associated with a bounding pulse?
aortic regurgitation
patent ductus arteriosus
severe bradycardia
hyperthyroidism
fever
anemia.
What conditions are associated with pulse deficits and why does this happen?
Tachycardia
fast atrial fibrillation
ventricular premature beats
Pulse deficits can occur with cardiac tachyarrhythmias in which beats occur so rapidly that the ventricle does not have time to fill with an adequate amount of blood before ejection
How wide should a blood pressure cuff be when obtaining blood pressure?
40% the circumference of the limb or tail
What cause S1 (1st heart sound) and S2 (2nd heart sound)?
S1 - closing of mitral tricuspid valves
S2 - closing of aortic and pulmonic bounds
What causes a systolic click?
Dogs with chronic valvular disease
Vibrations that occur when chordae tendineae and the mitral leaflets suddenly resist further stretching and protrude into the left atrium
How would you describe a sinus arrhythmia?
The heart rhythm is faster on inspiration and slower on expiration
Why are there pulse deficits with premature cardiaccontractions?
The ventricles don't have time to fill
Less blood pumped into the arterial system
Smaller pulse
What conditions produce a diastolic murmur (S2 > S1)
Aortic regurgitation
Pulmonic regurgitation
Mitral stenosis
Endocarditis
What condition is most commonly associated with a continuous heart monitor?
Patent ductus arteriosus (PDA)
What is the point of maximum intensity? (PMI)
The valve area at which the murmur is heard loudest
In the grading system of heart murmurs at what point can one palpate a thrill?
5/6
What causes a physiologic heart murmur
Change in blood viscosity, most commonly anemia
What abdominal condition can occur with right sided heart failure?
Ascites
• What approaches are there to eye enucleation?
Transconjunctival
Transpalpebral
• What accessory is useful to position the head for a nucleation?
Baloon pillow
How would you administer local anesthesia?
Retrobulbar
splash block
irrigate gelfoam with lidocaine or bivipocaine
How close to the island margin should the incision be made?
2 mm
• What vein do you need to be aware of and where is it located?
Medial ocularis
How is the eyeball globe removed?
excise conjuctiva with blunt dissection
cut muscular attachments
cuct optic nerve
• Should you clamp the optic nerve prior to incising it
No
• How is hemorrhage controlled after the globe is removed?
Pack with gauze or gelfoam for three minutes
What is the empty space packed with?
Gelfoam
How many layers to close the surgical site?
Two
conjunctival
skin (cut eyelid margin)
What is an important final step to do?
Elizabethean collar for two weeks
• What is the most common clinical sign of feline arterial thromboembolism.
Lameness – usually hind limb, but can be front limb
• What would be lines likely indicate if they have been found in this cat
Pulmonary edema
What are the ACVIM stages of heart disease?
A. Predisposed, but no evidence of cardiomyopathy
B1. Cardiomyopathy present, no clinical signs, low risk
B2. Cardiomyopathy present, no clinical signs, higher risk
C Current or previous CHF or ATE Has had a clinical complication, even if currently controlled
D Refractory CHF
How did they treat to prevent additional thrombus
clopidogrel or Plavix (18.75 mg/cat PO administered in the morning every 24 hours)
rivaroxaban or Xarelto (2.5 mg/cat PO administered in the evening every 24 hours)
What is the common name of rapamycin?
rapamycin = sirolimus
How does rapamycin work?
Slows disease progression by targeting the underlying pathogenic mechanisms
Describe a cat that is a good candidate for rapamycin?
cats with subclinical, nonobstructive hypertrophic cardiomyopathy.
Catsa that are NOT in CHF.
Do you think the client will keep Drew on three medications lifelong?
This is an opinion question.
But my experience, very few owners will keep a cat on medication's forever in which they feel the cat is doing well. So I totally agree with the recommendation. It is appropriate medicine. But my expectation is that the owner will not do this forever.
How does rivaroxaban work as a "blood thinner"?
Rivaroxaban is a factor Xa inhibitor that prevents conversion of prothrombin to thrombin during the clotting cascade.
How many days prior to a planned surgical procedure should anti-platelet drugs be temporarily discontinued
5 to 7 days
What is better to diagnose, congestive heart failure, radiography or echocardiography?
Radiography
What are echocardiographic signs of congestive heart failure?
B lines
plueral fluid
pericardial fluid
elevated left atrial filling pressue
What drug did the author suggest to calm fractious feline cardiac cases?
Butorphanol
Hypertrophic cardiomyopathy results in concentric or eccentric hypertrophy?
Concentric
The wall thickening is inward obliterating the left ventricular space. Importantly, this is not seen with radiography.
What is the common name of Pimobendan?
Vetmedin
What is pimobendan used for?
Treat congestive heart failure in dogs
Stave off congestive heart failure
In what conditions is pimobendan contraindicated
Hypertrophic cardiomyopathy
Basically anything that produces concentric hypertrophy. This can include aortic stenosis two
What are adverse effects of Plomondon?
GI upset
Potential increased risk for arrhythmias
What are drug interactions that should be avoided?
Calcium antagonists (eg, verapamil, diltiazem)
β antagonists (eg, propranolol, atenolol) can lessen pimobendan-induced increases in heart contractility
Should pimobendan be given on an empty stomach
Yes
Why was the vertebral heart score established
As an objective way of diagnosing cardiomegaly via thoracic radiography.
In dogs with a heart murmur, but not in congestive heart failure, how often should they have chest radiographs?
Once a year
What condition is common in cats and makes it difficult to get a BHS?
Pelural fluid
Are VD or DV radiographs OK for ventricular heart scores?
Lateral is preferred
What is the range of normal heart scores in dogs?
9.4 to 10.3
What dog breeds am higher VHS values?
Boxer
bulldog (French and English)
Boston terrier
Cavalier King Charles spaniel
Labrador retriever
Pug
Pomeranian
Whippet
What is the normal range of VHS scores for cats?
6.7-8.1
How is a vertebral heart score determined
1. Using the calipers, measure the long axis of the heart from the carina to the apex of the heart at its most ventral point.
2. Starting at the cranial aspect of the fourth thoracic vertebrae (T4), transfer this measurement (ie, heart length) to extend caudally along the thoracic vertebrae.
3. Measure the heart at its widest point (ie, the short axis) perpendicular to the line drawn for long axis.
.
4. Starting at the same point on T4, transfer this measurement to extend caudally along the thoracic vertebrae at mid-body position and add the number of vertebrae it traverses
5. Add these two measurements. This is your VHS.
What non-cardiac factors can affect teal heart scores?
Hemivertebrae (common in Bulldogs)
Anemia
Pericardial fluid
What is normal pulmonary arterial pressure?
<25 m. Hg
When do clinical signs of pulmonary hypertension start?
>50mm Hg
At >100 mm Hg they become severe and life-threatening
What are signs of pulmonary hypertension? (PHTN)?
Exercise intolerance
Respiratory distress
Syncope
What breed is prone to secondary PHTN and why?
West Highland White carriers
They get pulmonary fibrosis
What causes pulmonary hypertension in dogs?
Left sided heart failure
Chronic pulmonary disease (fibrosis, bronchitis)
Heartworm disease
Polycythemia
What is typical signalment?
Older dogs
Dogs living at high altitude - >6000 feet
Recognized more with widespread use of echocardiography
What are clinical signs of PTHN?
A split or, less commonly, loud S2
mild-to-moderate tachycardia.
Signs of right-sided heart failure (eg, jugular venous distension, hepatomegaly, ascites).
What are echocardiographic signs of PTHN?
Speed (m/sec) of the tricuspid or pulmonary regurgitant jet and calculation of PAP using Bournulli equation.
Paradoxical septal motion
enlarged right heart
volume-underloaded (small) left heart.
.
Describe laboratory abnormalities with PTHN
Laboratory testing is typically unremarkable
How may CT scan help with PTHN cases?
Evaluate lung parenchyma
Determine if pulmonary thromboembolism is present.
How may abdominal ultrasound help in cases of PTHN?
Evaluate liver for hepatic Venus congestion, which is suggestive right sided heart failure
Search for other conditions
What is the mainstay of emergency treatment for pulmonary hypertension?
Oxygen
What is the most common drug used to treat pulmonary hypertension?
sildenafil (1-3 mg/kg orally 2 to 3 times a day)
Why is fluid therapy contraindicated?
Volume overload of the right side of the heart
What commonly used cardiac medications are contraindicated in treating pulmonary hypertension?
Furosemide
Nitrates (Nitroglycerin) - may lower systemic blood pressure without adequately reducing pulmonary vascular resistance.
What is the long-term prognosis with pulmonary hypertension?
Poor
Pulmonary hypertension is relentless and ultimately proves fatal.
What can be done at home to treat pulmonary hypertension?
Exercise restriction
Carry small dogs up and downstairs
Supplemental oxygen - easy for people. Not so easy for dogs.
How do paws look in cases of allergic pododermatitis?
erythema
salivary staining - ruust colored
What are the differentials for hypotrichosis of the tail base?
Endocrine (Hypothyroid)
Demodex
Pyoderma
Atopy
What clinmical sign points towards allergy?
Pododermatitis - presumably, the dog is allergic to something it's walking on like grass or carpet
What questions would you ask when getting a history?
onset
severity of pruritus
whether pruritus preceded lesion development,
seasonality
indoor/outdoor lifestyle
ectoparasite prevention status for all animals in the home
whether any other animals or humans in the home have similar lesion
concurrent medications
known diseases
travel history
dietary history.
How do you determine if the enlarged lymph node is inflammatory or neoplastic?
Aspirate and cytology
What is acanthosis?
abnormal thickening of the skin’s outer layer (epidermis)
What are the key points to treat
Break the itch cycle
Take care of infection
Barrier - physically prevent dog from self mutilation
Psychogenic - address compulsive disorder with appropriate drugs
What is Periodic acid–Schiff and Grocott’s methenamine silver staining used for
Visualize bacteria and fungi,
Is topical antibacterial therapy helpful?
Yes
Is fluorescent light therapy helpful?
Yes
Is Surgery to remove the lesion helpful?
No
How would you characterize dyspnea of pulmonary perenchymal origin?
Mixed - both expiratory and inspiratory
The clinician did not do fecal examination or heartworm test question. What do you think of it?
I would've done these. First of all it's part of routine wellness care. Secondly you generally get the results faster than with bronchoalveloar lavage with interpretation.. At least this is the case with most primary care facilities
How did the clinician make a definitive diagnosis of histoplasmosis?
Urine antigen test
What is the best treatment for histoplasmosis and how is it dosed?
Itraconazole 5mg/kg sid x 2 to 6 months
What is the logic of using corticosteroids?
In cases with severe respiratory distress, it decreases inflammation, making it easier for the lungs to function. However, the steroid, usually prednisalone, should be taper rapidly
What was the main adverse effect the clinician was concerned about?
Hepatoxicity
What is something that could have saved money and managing this case?
I always like to get three views of the chest on initial radiographic examination. However, I'm not so strict when it comes to monitoring, to see if things are improving. In this case, I think one view would've sufficed. I would've chosen VD.
Off the record suggestion: when it comes to radiographic monitoring, you could take three views, but only charge for one. With Digital radiography it's not that hard.
What is the most common category of infectious pneumonia in cats?
Viral
What is the most common category of infectious pneumonia in dogs?
Bacterial
How many kinds of pulmonary parenchymal disease can you think of?
Infectious pneumonia
Non-infectious pneumonia
Neoplasia
Interstitial disease
Pulmonary edema
Pulmonary thromboembolism
Itraconazole is the drug of choice for treating histoplasmosis. One might you choose fluconazole instead?
Neurological involvement
Ocular involvement
Who has better penetration to these anatomic sites?
How often should the urine antigen test be done?
Every three months
In dogs, what percentage of malignant tumors metastasize?
50%
Where is the most common metastatic site in dogs?
local lymph nodes
Lungs
What percentage of memory tumors in cats are malignant?
> 80%
How should radical mastectomy proceed in Katz?
One side at a time. Give 2 to 4 weeks for this to heal and do the other side..
Doing both at the same time result in difficult heal (excessive tension on neutral line), Pain, and respiratory distress
Can a cat have a benign tumor and a malignant tumor at the same time?
Yes
Why is peri-operative pain management important
Humane - animal welfare
improve immune function and limit tumor spread
What local technique can provide analgesia for 72 hours
Bupivacaine liposome injectable suspension along incision
When doing a Mamectomy how deep should the surgeon go?
All tissue should be removed down to the rectus fascia
The rectus fascia and muscle should not be removed.
Describe how one would do a unilateral mastectomy
An elliptical incision is made from the most cranial nipple to the most caudal nipple so that the medial extent of the ellipse is at midline and the lateral extent of the incision is equidistant on the lateral side of the nipple line
What is an advantage of ultrasonography over radiography in detecting cystolith?
It will pick up ready loosen stones, like cysteine and urates that will be missed by radiography.
What cases are treated with perineal urehtrostomy
recurrent episodes of idiopathic urethral obstructions,
caudal urethral strictures
obstructive uroliths that cannot be retropulsed (blocked cat)
What condition is common in cats and makes it difficult to get a BHS?
Pelural fluid
Describe a PU to lay person
anastomosis of the naturally wider postprostatic portion of the urethra to the skin to make a new urinary stoma.
Reduces the risk for recurrent urethral obstructions
most cats have an excellent quality of life postoperatively
What anatomical structure serves as a landmark for PU Surgery? Where is this located?
Bulbourethral glands
Located it on either side of the urethra on the dorsal aspect
What are the structures that attach to the urethra?
ventral penile ligament
ischiocavernosus muscles
retractor penis muscle
Once these are dissected way, the urethra can be pulled out much more easily
Once the urethra is freed from attachments, describe how it is in size
Insert 1 blade of an iris scissors into the urethral opening, and cut on the dorsal midline cranially to the level of the bulbourethral glands. This is a longitudinal cut.
If a catheter is inserted into the urethra, a scalp plate can be used to in size
How can trauma to the urethra be minimized?
Take bites of the urethral mucosa that are less than one-third of the diameter of the urethra.
Use cotton-tipped applicator to gently remove any blood
Use small needle holders (eg, Castreviejo, Derf) for suturing.
If grasping urethral mucosa directly, use fine tissue forceps (eg, DeBakey).
What are the most common complications of PU
Stricture (5%-12%)
bacterial UTIs (23%)
Does PU surgery eliminate the primary cause of FLUTD in cats?
No. And I only keep some from getting obstructed.
What percentage of bandaging in cats result in complications?
A lot - 68.4%
How much worse is a bandage with splint or cast then just soft bandage immobilization?
The complication is 3.42 times that with just soft material
If you do use bandaging techniques, what is essential to do?
Monitor very close
Clients frequently like bandaging or splints as an option because it is less expensive and perceived as less invasive.
In managing acute diarrhea in dogs, how important is it to get an exact etiology?
Not very. Symptomatic treatment is essentially the same, and the vast majority of cases resolve.
I often consider acute diarrhea, a human social disease. People don't like it, particularly if they have company coming over. But more often than not - the dogs can care less.
Why is Pepto-Bismol ( Bismuth subsalicylate ) best to avoid in cats?
Concern for salicylate intoxication
Why are NSAIDs best to avoid?
Effect on the intestinal mucusal border
Or antibiotics indicated for acute diarrhea?
Usually not.
The only exception is in cases of sepsis, which is rare, and the dog would be very sick
Make dietary/nutritional recommendations
Spread meals out
Highly digestible, low fiber
Moderate fiber
Probiotics and probiotics added
What does VOHC stand for?
Veterinary Oral Health Council (VOHC)
What is the significance of VOHC?
Products that meet preset standards of plaque and/or tartar control in dogs and cats. Basically a seal of approval determined by experts qua;ified tyo make this call.
How many trials are required to get VOHC approval?
Two. And they must be done by independent groups.
If a product label for tarter control does not have the VOHC Seal does this mean that it is bad?
No. It just means it hasn't proven itself yet.
If a client is diligent about home dental care for their pet and uses only VOHC approved products does this mean it will never need in hospital dental care?
No. Periodontal disease is relentless. Diligent home care will slow down the destructive periodontal process, but it will not stop it. Nothing will.
The lesions may be described as vesiculobullous to ulcerative. Where do they tend to occur?
Friction points
Would you expect alterations in the CBC/chemistry or UA?
No
What test was used to determine systemic inflammatory response
C reactive protein
What cytology abnormalities were found?
Nondegenerate neutrophils
sparse, mixed, mostly free (rather than phagocytosed) bacteria within a granular eosinophilic background.
No acantholytic keratinocytes were found.
What is the main state for immunosuppressive therapy?
High-dose glucocorticoids and mycophenolate mofetil
Why was omeprazole, sucralfate and maroptant given?
To protect the gut from anticipated side effects of the immunotherapy
What gender tends to epidermolysis bullosa more?
Male
What is Zenalpha?
medetomidine and vatinoxan hydrochlorides injection
sedative and analgesic in dogs
How is Zenalpha characterized pharmacologically?
alpha 2 agonist-antagonist
medetomidine alpha 2 agonist that crossed blood brain barrier
vatinoxan - alpha 2 antagonist that crossed blood NOT brain barrier
How can melatonin be reversed?
Antisedan - atipamezole HCL
What are advantages of Zenalpha?
• Zenalpha® has a shorter time to onset (5-15 mins) and a shorter duration of sedation in most dogs
• Patients recover more rapidly
• There is minimal vomiting with Zenalpha®
• Zenalpha® resulted in fewer severe cardiovascular side effects
What are contraindications to use Zenalpha?
cardiac disease
respiratory disorders,
shock
severe debilitation
hypoglycemia
stressed due to extreme heat, cold or fatigue.
How much Zenalpha would you give a 50 pound dog?
1.6 ml IM
What alpha-2 agonist-antagonist preceded Zelpha
Xylazine (Rompun)
Dexmedetomidine (Dextomidor)
Name five potential uses of Zenalpha
• Radiographic examination
• Diagnostic imaging
• Ear examination and treatment
• Eye examination and treatment
• Dermatological examination
and procedures
• Dental examination
• Dental biopsy
• Minor tooth extraction
• Nail trimming
Fine needle aspiration/
superficial biopsy
• Anal sac treatment
• Minor surgery to remove
dermal masses
• Seroma or abscess drainage
• Intravenous catheter placement
• Coat grooming
• Venous blood
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https://www.youtube.com/watch?v=hOIV200BivM
What is a super mutt?
Dog has ancestry from multiple different breeds, but the amount of DNA inherited from those breeds is very small - small that it can no longer be confidently assigned to any one particular breed.
Can a purebred dog have a DNA analysis that reflects different breeds?
Yes
Genetic ancestry and purebred status are two different things.
Does genetic screening affect a patient’s pet insurance?
No
Genetic predisposition is not the same as pre-existing condition
How can embark estimated dogs age?
By measuring their DNA methylation
What kind of sample does the gut health check require?
Fecal
DNA sequencing of the bacteria in the feces to characterize the intestinal microbiome and compare it with their healthy-dog reference population.
Is the embark test for veterinarians the same test pet owners have access to?
No. The veterinary report is more detailed and provides information for which action can be taken or at least suggested.
How often are the embark DNA results of real value?
Approximately three (3) out of four (4) dogs will have a notable result or be carriers of a genetic disease and roughly one (1) in four (4) dogs will be at an increased risk for a genetic disease.
Why is DNA testing potentially so valuable?
Genetic testing has the potential to let you know about a disease risk before symptoms arise which blood work cannot do.
If an embark DNA test shows that a dog is partly or holy American pitbull terrier can that impact home health insurance?
For New York
Embark result saying a dog is partly or predominantly American Pit Bull Terrier cannot, by itself, be used by a homeowners insurer to deny, cancel, nonrenew, or increase the premium for the policy.
Is it OK to give a dog a treat prior to taking a cheek swab?
No. We want to get a sample of the dogs DNA not the DNA that might be in the treat. The dog should eat. Nothing for 30 minutes prior to the test.
How long does it take to get the test results?
Up to eight weeks for the health check.
What is the common name for hypoadrenocorticism?
Addisons disease
What are the three layers of the adrenal cortex?
zona reticularis (inner)
zona glomerulosa (outer zone)
zona fasiculata (middle)
Is there a genetic component to hypoadrenocorticism?
Yes
What is atypical hypoadrenocorticism?
Glucocorticoid secretion is absent but serum sodium concentration ([Na]) and potassium concentration ([K]) are normal prsumably indicating sufficient aldosterone.
What are the most common causes of iatrogenic hypoadrenocorticism?
Mitotane -- o,p′-DDD (mitotane)
Vetoryl -- (trilostane)
What is secondary hypoadrenocorticism?
pituitary or hypothalamic failure which can lead to impaired secretion of pituitary adrenocorticotropic hormone (ACTH) or hypothalamic corticotropin-releasing hormone (CRH).
What is the typical signalment of canine hypoadrenocorticism?
Female
Young to middle age.
What are clinical signs of? hypoadrenocorticism?
Weakness
Anorexia
Weight loss
Vomiting
Diarrhea
collapse
PU/PD
What are physical examination abnormalities associated with hypoadrenocorticism?
dehydration
hypotension
bradycardia
weak pulses
weakness
underweight body condition
abdominal pain
hypovolemic or hypotensive shock
What is the definitive test for Addison's disease?
ACTH response test
What are common CBC abnormalities with Addison's disease?
Lymphocyte > 2.0
High eosinophils
Higj neutrophils
What are serum chemistry abnormalities?
Azotemia
Hyperkalemia
'Hypokaelima
Hypochloremia
Acidemia
Hypercalcemia
ALP and AST elevation
Why is the urine specific gravity low even though the dog may be dehydrated
High urine Na drags water with it
Reduced kidney Na gradient
What is the main thoracic radiographic abnormality of Addison's disease?
Microcardia - due to hypovolemia
What are ECG abnormalities of hyperkalemia
Bradycardia
PR prolongation
absent p waves
wide QRS complexes
Describe the ACTH test
Take a blood sample (T = 0 hr)
Administer cortrosyn (ACTH) IM or IV is ok. SQ is not good in a dehydrated animal.
Take post cortrosym sample in 1 hr
How long can cortrosyn be stored at -20degrees C.?
Up to 6 months
What is -20 degrees in Farenheit?
Describe the item or answer the question so that site visitors who are interested get more information. You can emphasize this text with bullets, italics or bold, and add links.How is ACTH interpreted?
Addison = No response or minimal response to ACTH injection
Normal - cortisol >2 mcg/dL (>55 nmol/L)
When might measuring a single cortisol level be useful?
A single value above 2 mcg/dL (>55 nmol/L) rules out Addison
What is the most important thing to do in treating acute Madisonian crisis?
IV fluids
Note: animals can be severely dehydrated, which makes IV catheterization challenging
What is the fluid of choice in treating Addison crisis and why?
0.9% saline
Best to avoid any solution that has potassium
What can happen if serum electrolytes (Na and K) are fixed too quickly?
Fatal osmotic fluid shifts in brain
There is severe bradycardia. Why might a clinician give dextrose?
Glucose causes the release of insulin. Insulin drives extracellular potassium into cells.
The serum potassium levels normalize, and this improves the arrhythmia
Why is prednisone or prednisone? The steroid of choice for Addison's?
At last 24 hours. Easy to make adjustments.
Describe how prednisone is given for maintenance of Addison
Start at a high dose (0.5mg/kg bid) and rapidly lower it to a physiologic dose (0.1-0.2 mg/kg q12-24h).
Once maintenance dose is reached (my opinion 10 days) instruct the owner that the dose should be increased when encountering stressful events (travel, thunderstorms, vistors, etc.)
Use clinical signs of steroid excess to help guide prednisone dosage
What is the starting dose of Percorten-V, Zycortal (DOPC)?
1.5mg / Kg by SQ injection once a month.
What is the ideal range of Na/K level?
28-30
Is Addison's disease fun to treat? Why?
Yes - grest fun.
You take an animal that is really sick and going to die and fix him or her essentially back to normal
Give me three other diseases that you will see in veterinary medicine that are fun to treat.
Pyometra (my favorite)
Dog or cat choking from obstruction so long as you remove obstruction in time
Feline infectious peritonitis (FIP)
Tick born diseases because they usually respppond rapindly to treatment
Removing a sticks lodged between the upper dental arcade. I was encoutered a dog screaming in pain that was rushed into my veterinary hospital. I noticed the dog had such a stick losgeed in his mouth. I grabbed a hemostat and was able to remove the stick. The dog immediately felt better and started licking my face. The people in the waiting room startd to applaud. I can't remember if I got paid.
Others
What is the of medication's called used to successfully treat FIP?
Antivirals > nucleoside analogues
Remdesivir — a prodrug of GS-441524
What are the grades of hepatic encephalopathy? (HE)
HE GRADE CLINICAL SIGNS
0 Asymptomatic
I Mild decrease in mobility, apathy or both
II Severe apathy, mild ataxia
III Combination of hypersalivation, severe ataxia, head pressing, blindness, circling
IV Stupor/coma, seizures
Can hepatic encephalopathy (HE) be mistaken for just "quiet dog"?
Yes
When are signs of hepatic encephalopathy most likely to occur?
2 hrs after a meal (especially high protein)
Is there a laboratory test that predicts hepatic encephalopathy?
No - it remains a clinical diagnosis.
Where does ammonia come from in the portal vein?
Intestine - enterocytes using amino acids especially glutamine
intestinal microbiome
How is ammonia levels controlled and eliminated? What organs?
Liver - converts ammonia to urea
Kidneys - eliminate ammonia through the urine
Does muscle mass act as a buffer for hyperammonemia
Yes
True or false - inflammation is relatively unimportant and inducing signs of hepatic encephalopathy. The important factor is ammonia levels.
False - inflammation does play a role in producing clinical signs
Are magnanese (Mn) low in cases of hepatic encephalopathy
No - they are elevated
What is the best treatment for hepatic encephalopathy (HE)?
Surgery if possible as in PSS.
In case cases due to hepatic parenchymal disease we need to do medical treatment.
How would you treat acute hepatic? encephalopathy (HE)?
If hypoglycemic give dextrose
If infection or inflammation, give appropriate antibiotics (e.g. UTI)
Enema to get rid of ammonia producing bacteria
How do you feel about using LRS in a dog or cat with hepatic encephalopathy (HE)?
Bad idea. Lactate is metabolized but liver, and we want to avoid having to use the liver.
How do disaccharides like lactulose help with hepatic encephalopathy (HE)?
Lead to short-chain fatty acids (SCFAs)
SCFAs favors more bacteria that utilize ammonia.
SCFAs can acidify colonic content, trap ammonia as non-absorbable NH4+, and provide an ammonia “sink.”
SCFAs act as osmotic laxatives, speeding removal of trapped ammonia, urease-producing bacteria, and nitrogen present in colonic content and in bacterial protein.
What percentage of hepatic blood flow comes from the portal vein?
Describe the item or answer the question so that site visitors who are interested get more information. You can emphasize this text with bullets, italics or bold, and add links.What are the three types of portal hypertension? Consider site of anatomic pathology.
Pre hepatic
Post hepatic
Hepatic
pre-sinuoidal, sinusoidal, or post-sinusoidal
What causes asccites with liver failure?
Increase portal, hypertension
Overall increase in systemic vascular volume because of alterations in the renin aldosterone system
Hypoalbuminemia associated with liver failure
How would you manage chronic ascites associated with hepatopathy?
Aldosterone
Furosemide
Abdominocentesis
Are there alterations in hemostasis with hepatic disease.?
Yes
There can be both hemorrhage and thrombosis. Thrombosis occurs more often than hemorrhage, particularly in chronic cases.
What are clin path risk factors when planning hepatic biopsy
platelets <50,000 mcL
PT or aPTT >1.5 times upper limit
fibrinogen <100 mg/dL (<1 g/L),
vWF activity <50%,
BMBT >5 minutes
PCV <30% is also “high risk” due to the effect of anemia on platelet function and decreased resilience against hemodynamic instability if there is hemorrhage.
What blood product is the best source of clotting factors?
Fresh frozen plasma
What condition is most frequently associated with pre-hepatic jaundice?
Anemia - especially acute
What situation leads to acholic (chaulky white stools) and why
Complete Valerie obstruction.
Occurs because there's no bilirubin moving to the intestine that would otherwise be converted to the brown pigment stercobilinogen.
Training Title 3
Short description
What are the major prostatic diseases seen in Companion Animal medicine
Benign prostatic hyperplasia
Prostatic cyst
Prostatiic abscess
Prostatitis
Prostatic metaplasia
Prostatic Neoplasia
What are advantages of ultrasound in terms of evaluating prostate disease over traditional radiography?
Better internal images
Easier to see regional lymph nodes
Easy to see fluid pockets
What is the best way to prep a dog for prostatic ultrasound?
Empty bowel - NPO for 12 hours. Let dog defecate before exam..
Full urinary bladder, which access a landmark and acoustic window. Don't walk dog before examination.
In real practice, it may be difficult to tell the dog to defecate but not urinate
Do dogs need to be anesthetized to perform a CT scan or MRI scan?
Yes
What are pros and cons of CT scan versus MRI?
CT - faster than MRI. Less expensive.
MRI - better image quality (but not by much). Takes longer.
What are the sampling techniques to obtain prostate samples for further evaluation?
Semen collection
Prostatic massage
Traumatic urethral catheterization
FNA
Biopsy
In collecting semen for evaluation, what fraction of the ejaculate is primarily prosthetic fluid
Third fraction
With prostatic massage, the clinician collects two samples. Which sample has prostatic material?
The second.
With traumatic catheterization to collect prostate samples, how do you determine the location of the catheter tip?
Digitail rectal palpation
Can prostate cyst be drained, using ultrasound guidance?
Yes
What are some concerns with fine needle aspirate (FNA)?
Seeding tissue with bacteria orneoplastic cells
Describe prostatic massage
1. With an empty bladder, perform a sterile catheterization.
2. Flush the urinary bladder with sterile saline.
3. Aspirate it back to obtain the first sample
4. Retract the catheter to the level of the membranous urethra, guided by rectal palpation. Perform transrectal prostatic massage for about 1 minute.
5. Occlude the urethral orifice and slowly inject the second sterile saline to wash the urethra.
6. Advance the catheter into the bladder and aspirate the fluid back to obtain the second sample
Why is a urethral catheter placed during a prostatic ultrasound guided biopsy procedure
To visualize and avoid the urethra
Training Title 3
Short description
What are the major prostatic diseases seen in Companion Animal medicine
Benign prostatic hyperplasia
Prostatic cyst
Prostatiic abscess
Prostatitis
Prostatic metaplasia
Prostatic Neoplasia
What are advantages of ultrasound in terms of evaluating prostate disease over traditional radiography?
Better internal images
Easier to see regional lymph nodes
Easy to see fluid pockets
What is the best way to prep a dog for prostatic ultrasound?
Empty bowel - NPO for 12 hours. Let dog defecate before exam..
Full urinary bladder, which access a landmark and acoustic window. Don't walk dog before examination.
In real practice, it may be difficult to tell the dog to defecate but not urinate
Do dogs need to be anesthetized to perform a CT scan or MRI scan?
Yes
What are pros and cons of CT scan versus MRI?
CT - faster than MRI. Less expensive.
MRI - better image quality (but not by much). Takes longer.
What are the sampling techniques to obtain prostate samples for further evaluation?
Semen collection
Prostatic massage
Traumatic urethral catheterization
FNA
Biopsy
In collecting semen for evaluation, what fraction of the ejaculate is primarily prosthetic fluid
Third fraction
With prostatic massage, the clinician collects two samples. Which sample has prostatic material?
The second.
With traumatic catheterization to collect prostate samples, how do you determine the location of the catheter tip?
Digitail rectal palpation
Can prostate cyst be drained, using ultrasound guidance?
Yes
What are some concerns with fine needle aspirate (FNA)?
Seeding tissue with bacteria orneoplastic cells
Describe prostatic massage
1. With an empty bladder, perform a sterile catheterization.
2. Flush the urinary bladder with sterile saline.
3. Aspirate it back to obtain the first sample
4. Retract the catheter to the level of the membranous urethra, guided by rectal palpation. Perform transrectal prostatic massage for about 1 minute.
5. Occlude the urethral orifice and slowly inject the second sterile saline to wash the urethra.
6. Advance the catheter into the bladder and aspirate the fluid back to obtain the second sample
Why is a urethral catheter placed during a prostatic ultrasound guided biopsy procedure
To visualize and avoid the urethra
Training Title 3
Short description