ALWAYS LOOK FOR THE POSTIVE

1
ALWAYS LOOK FOR THE POSTIVE

• When it is dark enough, you can see the stars.
• -Persian proverb

2
Diseases of Digestive SystemOral
cavityEsophagusStomachSmall BowelLarge
BowelLiverPancreasRectumAnus

• Chapter 2

3
GI system

• GI tract mouth -gt anus
• Accessory structures
• Teeth, tongue, salivary glands, liver pancreas,
  gallbladder

4
Diseases

• Oral cavityEsophagusStomachSmall BowelLarge
  BowelLiverPancreasRectumAnus

5
crown is covered by a thin veneer of enamel
root is covered by a thin layer of cementum
6
Oral Diseases Periodontal Disease

• Periodontal Disease is plaque-induced
  inflammation of gums
• Progressive
• gingivitis, gingival hyperplasia, peridontitis
  with vertical bone destruction, and peridontitis
  with horizontal bone destruction
• The end result is loss of tooth
• Periodontal means around the tooth
• Etiology
• Food particles, bacteria, saliva, rbc and other
  bacterial components collect around gum line and
  form plaque, when this hardens it forms tartar or
  claculus
• Causes gingivits
• Minerals in saliva collect in plaque and harden
  to form calculus (tartar) which adheres to teeth
• 3-5 d to harden
• Causes bad breath
• Protects the bacterial environment

7
Oral Diseases Gingivitis

• Gingivitisearliest signs of Periodontal Disease
• Involves only the soft tissues of the gums
• Reversible inflammation of gums
• Gingival hyperplasia (may also be breed- or
  drug-related)
• Causeaccumulation of tartar on teeth
• Tartar is conducive to bacterial growth
• Enzymes produced by bacteria damage tooth
  attachment and cause inflammation

8
Oral Diseases Periodontal Disease

• Without intervention, gingivitis progresses to
• Periodontitisirreversible condition
• Loss of gingival root attachment (receding gums)
• Alveolar bone resorption
• Loss of teeth

alveolar bone
9
Normal Gingiva
10
Oral Diseases Periodontal Disease

• Periodontitisirreversible condition
• Alveolar bone resorption
• Gingivitisreversible earliest signs of
  Periodontal Disease

Mild tartar more tartar (lt25 loss) severe tartar
(25-50) gt50 bone loss Mild gingivitis more
gingivitis gum receding tooth is
loose No bone loss min bone loss
moderate bone loss should be pulled
11
Oral Diseases Periodontal Disease

• Calculus builds up under gums
• Separates teeth from gums to form pockets,
  which encourages more bacteria to accumulate and
  grow
• Bacteria secrete toxins/enzymes that cause
  detachment of tooth from bony socket
• WBCs invade area and release their enzymes to
  destroy bacteria
• These enzymes also cause detachment of tooth from
  bone
• Pockets get deeper and deeper
• Weakens bone
• Can cause pathologic fractures
• Other sequellae
• Bacteria enter blood stream
• Can cause micro-abscesses in liver, kidneys
• Cause endocarditis on heart valves

12
Oral Diseases Periodontal Disease
Iatrogenic mandibular fracture resulting from
excessive force extraction of a lower molar tooth
13
Oral Diseases Periodontal Disease

• Signs
• Halitosis
• Reluctance to chew hard food
• Pawing at mouth
• Oral pain personality changes
• Sneezing nasal discharge
• Increased salivation
• Facial swelling tooth loss
• Dx
• Complete oral exam
• Presence of tartar (plaque) on teeth
• Dental radiographs

Application of Peridontal Probe into
Interproximal Space Sulcus. Note the Probe Reads
Seven Millimeters.Visual Appearance does not
Always Indicate the Degree of Bone Loss
14
Intraoral Radiography
Horizontal bone loss
Standard Radiograph Unit 100 MA, 1/10 SEC, 55 KV
for 25 lb. Dog Tube head set at 16
Maxillary Molars
Image-Vet 70 Plus Dental Unit (AFP Imaging)
Maxillary Incisors
15
Oral Diseases Periodontal Disease

• Rx
• Dental scaling
• with ultrasonic scaler
• Root scaling/planing (below gum line)
• with thin ultrasonic tip curette
• Gingival curettage
• with curette against inner surface of gums
  (gingival pockets diseased soft tissue inner
  surface)
• Polishing to smooth the tooth surface and prevent
  tartar buildup
• Irrigation to remove diseased tissue and plaque

16
Oral Diseases Periodontal disease
DOXIROBE GEL controls infection and promotes
rebuilding of periodontal structures
contains Doxycycline, an antibiotic
17
Oral Diseases Periodontal Disease
Plaque prevention gel
Applied once a week
18
Oral Diseases Periodontal Disease

• Client info
• Good oral hygiene is necessary for all pets
• Brush teeth daily
• Routine dental cleanings performed at
  veterinarians
• Treat gingivitis early before irreversible
  lesions occur
• Extractions are sometimes necessary to clear up
  infections
• Hard, crunchy food may promote better dental
  health by removing tartar before it calcifies
• Once it calcifies, tartar must be removed
  professionally

http//www.youtube.com/watch?v-qnbJZWycdgfeature
PlayListp480B67A7E8907594playnext_fromPLplay
next1index5
19
Oral Trauma

• Causes (many)
• Falls, fights (bites), burns, blunt trauma (HBC)
• High-rise syndrome in cats
• Fractured hard palate, mandibular symphysis
• Tongue injury from biting own tongue, dog fight,
  eat from tin can in garbage, FB(Foreign body)
• Cats playing with needles, thread strangulate
  tongue
• Electrical, chemical burns
• Gunshot wounds, fish hooks
• Bones lodged in teeth

Fx mandiblecat HBC
20
Oral Trauma

• Signs
• History or signs of head trauma
• Increased salivation
• Inability to close mouth due to
• Pain
• Fracture/dislocation
• FB
• Reluctance to eat (same reasons)
• Presence of foreign object
• Dx
• PE of oral cavity
• X-ray to r/o embedded FB

21
Oral Trauma

• Rx
• Depends on type of trauma
• Control bleeding
• Provide supportive care
• IV fluids
• pain relief
• Insure adequate airway
• Repair/extract damaged teeth, fracture
• Client info
• Like kids, if animals can get into trouble, they
  will
• Discourage chewing on electric cords
• Dont leave caustic/toxic chemicals out
• Keep pets in fenced yard or on leash when outside
• Animals still eat well without entire tongue

22
Oral Neoplasia

• Relatively common in cats and dogs malignant
  melanoma and squamous cell carcinoma most common
• Signs
• Depend on location and size of growth
• More common in males
• Abnormal food prehension
• Increased salivation
• Tooth loss
• Oral pain
• Dx
• Histology of mass
• X-rays to r/o metastasis
• Biopsy of LN to r/o metastasis

Squamous cell carcinoma (Upper R 3rd
incisor) Bone loss around lesion Rostral
maxillectomy was curative
23
Oral Diseases Oral Neoplasia

• Benign neoplasia
• Papillomas
• Epulides

Papillomas
24
Oral Diseases Oral Neoplasia
A gingival (buccal mucosa) melanoma involving a
dog's caudal mandible and temporomandibular
joint region.
Above An invasive feline oral squamous cell
carcinoma (courtesy of Jon Slattery)
25
Oral Neoplasia

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

26
Oral Diseases
http//veterinarydentistry.posterous.com/
27
Salivary Mucocele

• Accumulation of excessive amounts of saliva in SQ
  tissue
• Most common lesion of salivary glands in dogs
  rarely seen in cats (following trauma)
• Cause is unknown (tight collar, choke chain??)
• Signs
• Slowly enlarging, nonpainful, fluid-filled
  swelling on neck or under tongue
• Reluctance to eat
• Difficult swallowing
• Blood-tinged saliva
• Respiratory distress

28
Salivary Mucocele

• Dx
• Clinical signs
• Paracentesis shows thick, blood-tinged fluid
• Rx
• Aspirate fluid
• Surgical drainage
• Remove salivary gland insert Penrose drain x 7 d
• Client info
• Cause is unknown trauma may be involved
• Without removal of gland, excess fluid will
  continue to accumulate
• Some cases may resolve spontaneously

Removal of mandibular salivary gland
29
Lip-Fold Dermatitis

• Often seen in breed with pendulous upper lips
  (spaniels, setters, St. Bernard, bulldogs,
  bassets)
• Constant moisture in the folds from saliva causes
  bacterial growth
• Food, hair, moisture cause irritation, erythema,
  and fetid odor
• Signs
• Halitosis
• Collection of debris in lower lip fold
• Dx
• Clinical signs
• Rx
• Dental cleaning
• Clip hair
• Clean out folds (food)
• Diaper rash cream
• Sx is permanent Rx

30
Lip-Fold Dermatitis

• Client info
• Keep lip folds dry (for the rest of animals
  life!!)
• Flush/clean lip folds
• with 2.5 benzoyl peroxide shampoo
• chlorhexidine
• malaseb pledgets (chlorhexidine miconazole)
• Drying agents like corn starch several times a
  day
• Good dental hygiene will help prevent it

31
ORAL MOA CS DX TX PROGNOSIS
Periodental disease Gingivitis Periodental Halothisis
Trauma Falling Bleeding
Neoplasia
Salivary mucocele
Lip fold dermatitis




32
Esophageal Disease

• Esophageal obstruction
• Ingestion of nondigestible object (bones, play
  objects)
• Degree of damage depends on size, shape, time in
  esophagus
• Surgical removal is least desirable ? stricture
  formation
• Signs
• Exaggerated swallowing movements
• Increased salivation restlessness
• Retching
• Anorexia
• Hx of chewing on foreign objects

Esophageal endoscopy
33
Esophageal Obstruction

• Dx
• Endoscopy
• Radiography
• 6-mo old St Bernard
• What is your diagnosis?

34
Esophageal Obstruction

• 3 mo kitten
• What is your diagnosis?

35
Esophageal Obstruction

• 2 yr old cat
• What is your diagnosis?

36
Esophageal Obstruction

• 8 yr male cat

37
Interesting stuff

• 7 mo old Pug

38
Esophageal Obstruction

• Rx
• Prompt removal is important
• NPO x 24 h to allow for healing
• Resume feeding with soft foods
• Client info
• Limit access to bones and small objects
• Strings and needles are hazards for cats
• Px is good if serious damage to esophagus can be
  prevented

39
Go through differences in small bowel vs. large
bowel diarrhea
40
Mucosa -gt muscularis -gt serosa
41
Stomach Diseases

• Acute Gastritis
• Commonly seen in dogs (cats to lesser degree)
• Spoiled food
• Change in diet
• Food allergy
• Infections (bacterial, viral, parasitic)
• Toxins (chemicals, plants, drugs, organ failure)
• Foreign objects
• Signs
• Anorexia
• Vomiting (maybe dehydration)
• Painful abdomen
• Hx of diet change, toxin ingestion,
• infection, parasites

Figure 23 Typical appearance of reflux gastritis
with a radial pattern of erosions on the antral
folds.
42
Acute Gastritis

• Dx
• Hx and PE
• CBC, Chem Panel to assess dehydration, metabolic
  imbalance, organ failure
• Rx
• NPO until vomiting stops
• 4-6 sips of water q1h
• Fluid therapy (SQ or IV)
• Gradually start feeding
• Bland food (Hills I/D, boiled chicken/rice)
• Antiemetics
• Maropitant (Cerenia)
• Metoclopramide (Reglan)
• Coating agents
• Sucralfate
• H2-blockers (famotidine, ranitidine, cimetidine)
• Proton pump inhibotor Omeprazole
• Antibioticsoften prescribed, rarely needed

43
Acute Gastritis

• Client info
• Avoid abrupt changes in diet
• Gradually mix new food in with old (1 wk)
• If pet vomit 2-3 times, NPO x 24 h if it
  continues see vet
• Dogs and cats do not need variety
• Avoid objects that can be swallowed (treat like a
  baby)

44
Immune-Mediated Inflammatory Bowel Disease
(Chronic gastritis, Enteritis, Colitis)

• Seen in cats, less common in dogs
• Accumulation of inflammatory cells in lining of
  stomach, SI, LI
• Signs
• Chronic vomiting, wt loss
• Diarrhea, straining to defecate, mucus in stool
• Dx
• Fecal to r/o parasites
• CBC, Chem panel, urinalysis to r/o metabolic
  disorder
• FeLV, FIV to r/o those diseases
• Endoscopy stomach SI and colon, and biopsy for
  definitive diagnosis

45
Immune-Mediated Inflammatory Bowel Disease
(Enteritis, Colitis)

• Rx
• What is the Rx for any Immune-mediated Disease?
• Azathioprineimmunosupressant (organ transplants)
• Cyclophosphamideinhibits immune system response
• Sulfasalazinea sulfa drug with
  anti-inflammatory/ antibacterial effects
• Most effective against colitis
• Metronidazole
• Prednisone
• Hypoallergenic diet
• Free from preservative, additives
• Highly digestible protein (rabbit, lamb, duck,
  chicken)
• Homemade diets with rice base
• Some commercial diets are available

46
Inflammatory Bowel Disease

• Client info
• Definitive dx is through biopsy
• Life-long condition (special diet, frequent
  medical monitoring)
• Immunosupressive drugs have side-effects
  (PU/PD/PP, wt gain, skin/urinary infections)
• Use lowest dose that provides effect

47
Gastric Ulceration

• Usually a result of long-term NSAIDs (aspirin,
  ibuprofen, phenylbutazone)
• Signs
• Vary from asymptomatic to vomiting
• blood
• Anemia, edema
• Melena
• Anorexia
• Abdominal pain
• Septicemia if perforation occurs
• Dx
• X-ray using contrast medium (Ba) to show
  ulceration in stomach lining (caution if
  perforation is suspected)
• Endoscopy

48
(No Transcript)
49
Gastric Ulceration

• Rx
• Fluid therapy for dehydration
• NPO (as before)
• Coating agents/antacids
• CimetidineH2 antagonist (? HCl production)
• Omeprazole? HCl production (proton-pump
  inhibitor)
• Client info
• Do not use NSAIDs without veterinary supervision
• Give NSAIDs with meal/antacids

50
Gastric Dilatation/Volvulus

• Primarily a disease of large, deep-chested dogs
  (2-10 yrs)
• Dilationgas filled Volvulustwisted along
  longitudinal axis
• Food/exercise? Anatomic predisposition, ileus,
  trauma, primary gastric motility disorders,
  vomiting, and stress
• Signs
• Abdominal pain/distension
• Weakness, collapse, depression,
• nausea, salivation
• Increased HR, RR may lead to
• arrhythmias
• Dx
• PE shows dilation, poor perfusion (? cap refill)
• X-rays show air filled stomach- double-bubble
• ECG may show vent arrhythmia or sinus tachycardia
• CBC and Chem panel necessary to assess
  electrolyte levels

51
Gastric Dilatation/Volvulus

• Great Dane, Weimaraner, Saint Bernard, German
  Shepherd, Irish and Gordon Setters, Doberman
  Pinscher
• Reported in cats
• Sharpei, Basett Hounds

• normal dogs, the pylorus is located ventral to
  the fundus on the lateral view, and on the right
  side of the abdomen on the dorsoventral view.

52
Gastric Dilatation/Volvulus

• normal dogs, the pylorus is located ventral to
  the fundus on the lateral view, and on the right
  side of the abdomen on the dorsoventral view.

53
Gastric Dilatation/Volvulus

• Rx hypovolemic and endotoxic shock
• Goals
• Decompress stomach
• Pass stomach tube
• 18 gauge needle
• Stabilize patient
• (fluids, electrolytes,
• ECG)
• Rx for shock
• IV fluids
• Corticosteroids
• Antibiotics
• Prepare for Sx
• SxASAP

54
Gastric Dilatation/Volvulus

• right lateral view of a dog with GDV, the pylorus
  lies cranial to the body of the stomach and is
  separated from the rest of the stomach by soft
  tissue (reverse C sign).
• On the dorsoventral view, the pylorus appears as
  a gas-filled structure to the left of midline.
  Free abdominal air suggests gastric rupture and
  warrants immediate surgery

55
Gastric Dilatation/Volvulus

• Sx Laparoscopic correction and surgical
  correction
• FYI
• Post-Op
• ECG
• Blood pressure
• Pain management
• Monitor urine output
• Antibiotics
• Maintain fluids (oral, IV)

56
Gastric Dilatation/Volvulus

• Client info
• Avoid large meals
• Limit exercise after meals
• Feed high-quality protein diet
• Tack-down procedure not 100 preventative

57
Gastric Neoplasia

• Most common malignant neoplasia in dogs is
  adenocarcinoma in cats lymphoma
• Signs
• Wt loss
• Vomiting w/ or w/o blood
• Obstruction
• Usually seen in older animals
• Dx
• Endoscopy and biopsy for diagnosis
• X-ray with Barium contrast

58
Gastric Neoplasia

• Rx
• Surgery is TOC (treatment of choice)
• Many tumors are too far advanced (inoperable)
• Chemotherapy
• Radiation less successful for gastric tumors
• Client info
• Px is poor gastric neoplasia is a fatal disease
• Supportive care, control of vom, good nutrition
  are needed for these animals

59
Winning (success) takes work!

• The will to win is not nearly as important as
  the will to prepare to
• win.
• -Bobby Knight

60
Diseases of SI

• Often involves impairment of absorptive surface
  of SI (what is that?)
• Acute Diarrheaone of the most commonly seen
  types of diarrhea
• Causes(often accompanies acute gastritis)
• Diet change
• Stressful situations
• Drug therapy
• Signs (Duh?)
• Acute onset
• vomiting
• Normal appearance otherwise
• Dx
• Fecal to r/o parasites
• CBC (dehydration), Chem panel to r/o metabolic
  diseases

61
Acute Diarrhea

• Rx
• Fluids for dehydration, electrolyte imbalance
  (SQ, IV, PO)
• NPO x 24 h water OK if no vomiting
• Intestinal absorbants/coating agents
• Loperamideopiod receptor inhibitor that slows
  gut motility
• Antibiotics (?)
• Bland diet after 24 h
• Hills I/D
• Boiled chicken/rice

62
Parasite Diarrhea

• Signs
• Diarrhea
• Wt loss
• Poor hair coat
• Listlessness
• Dx
• Fecal exam
• Tx
• Anthelmintics for parasites Fenbendazole/pyrantel
  
• Antiprotozoal medication for Giardia, Coccidia

63
Giardia
64
Viral Diarrhea

• Parvovirus
• Canine distemper virus
• Coronavirus
• Feline panleukopenia virus

65
Parvovirus

• Seen mainly in young, unvaccinated puppies
• Signs
• Diarrhea, usually with blood
• Vomiting
• Febrile
• Anorexia, depression
• DxELISA (enzyme-linked immunosorbent assay) test
• Rx
• IV fluids
• Antidiarrheal therapy
• Antibiotics (Gram neg)
• Keep warm
• Anticonvulsants

66
Parvovirus

• Client info
• Sick animals will infect other unprotected
  animals
• Parvo can be fatal
• Vaccinate for protection

67
Diseases of LI

• Function is to reabsorb water, electrolytes
  store feces
• Inflammatory Bowel Disease (IBD)
• Signs
• Diarrhea with wt loss
• ? frequency of defecations, ? volume
• Tenesmus
• ? mucus
• Dx
• Fecal to r/o parasites
• Chem panel to r/o metabolic causes
• Biopsy of LI wall
• ? lymphocytes and plasma cells

68
Inflammatory Bowel Disease

• Rx
• Sulfasalazinea sulfa drug with anti-inflammatory
  effects
• Most effective against colitis
• Prednisone
• Metronidazole, Tylosin
• Mesalaminea metabolite of Sulfasalazine in LI
  (actions unknown)
• Hypoallergenic diet
• Hills d/d, z/d, i/d
• Homemade diets
• Client info
• Treatment is often prolonged
• Goal of Rx is to control symptoms, not cure
  disease
• Animals with IBD need to be taken outside
  frequently for BMs

69
Intussusception

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

70
Intussuception
71
Megacolon

• Uncommon in dogs, more common in cats (mostly
  idiopathic)
• Associated with Obstipation (intestinal
  obstruction, severe constipation)
• Signs
• Straining to defecate
• Must be distinguished from straining to urinate
  in male cats
• vomiting
• Weakness, dehydration, anorexia
• Small, hard feces or liquid feces
• With or without blood, mucus

Greater than length of lumbar vertebrae
72
Megacolon

• Dx
• Palpation of distended colon filled with hard,
  dry feces
• Radiographs show colon full of feces
• Rectal palpation assures adequate pelvic opening
• Rx
• Warm water enema
• Animals can become hypothermic
• Manual removal under anesthesia
• Mucosal surface is delicate
• Client info
• Encourage water intake
• Salt food
• Always provide adequate supply
• High-fiber diet

73
Megacolon

• Surgical removal

Suture ends at arrows
74
ADVERSITY

• Adversity causes some men to break, others to
  break records.
• -William A. Ward

75
Liver Diseases

• High regenerative capacity damage must be severe
  for signs to appear
• Vague signs early anorexia, vom/diar, wt loss,
  PU/PD, fever
• Drug/Toxin induced Liver Disease
• Acute liver failure requires gt70 of liver to be
  affected
• Susceptible to toxin ingestion (portal
  circulation)
• Some drugs have a Hx of liver toxicity
• Acetaminophen
• Phenobarbital
• others

76
Drug/Toxin Induced Liver Disease

• Signs
• Acute onset
• Anorexia
• vomiting/, diarrhea/constipation
• PU/PD
• Jaundice (maybe)
• Melena, hematuria, or both
• CNS signs (depression, ataxia, dementia, coma,
  seizures)

77
Drug/Toxin Induced Liver Disease

• Dx
• Hx of drug administration
• Painful liver on palpation
• Chem panel
• ? ALT (alanine aminotransferase)
• ? Total bilirubin, ? blood ammonia
• ? Serum bile acids
• Hypoglycemia, coagulopathy
• Radiographs show enlarged liver
• Liver biopsy (unless coagulopathy suspected)

78
Drug/Toxin Induced Liver Disease

• Rx
• Antidotes
• Induce vomiting
• Activated charcoal
• IV fluids
• Vit K for clotting
• Antibiotics
• Special diets (Hills k/d or u/d)

79
Liver Tumors

• Primary and metastatic tumors are not uncommon in
  dogs and cats
• Metastatic tumors are more common than primary
  tumors of liver
• Signs
• Anorexia, lethargy, wt loss
• PU/PD
• Vomiting/diarrhea (?)
• Abdominal distension, hepatomegaly
• Jaundice
• Dx
• Anemia, usually non-regenerative
• Chem Panel
• ? serum albumin
• ? serum bilirubin, bile acids
• ? serum glucose
• Azotemia (? BUN, creatinine esp in cats)

80
Liver tumors

• Dx
• X-ray Heptomegaly, Ascites (?)
• Biopsy of liver
• Abdominocentesis may show tumor cells
• Rx
• Surgical removal is preferred treatment
• Single masses have good Px
• Multiple nodules/Diffuse disease have poor Px
• Chemotherapy doesnt help primary tumors better
  for metastatic lesions
• Client info
• Guarded to poor Px generally
• Survival time 6 mo-3 y

81
Portosystemic Shunts

• Shunts form between portal circ and systemic circ
  allowing blood to bypass liver Function of
  liverdetox blood
• Congenital or acquired
• By-passing liver, allows many toxins into
  systemic circulation
• CNS is most affected by the circulating toxins
• Dx at approximately 1 year of age, however
  clinical signs can occur as early as 6 weeks or
  as late as 8 years of age

82
Portosystemic Shunts
83
Portosystemic Shunts

• Signs
• Dumb/numb, lethargic, depressed
• Ataxia, staggering
• Head-pressing (against a wall)
• Compulsive circling, apparent blindness
• Seizures, coma
• Bizarre behavior (esp cats)
• Signs often more pronounced shortly after a meal

84
Portosystemic Shunts

• Dx
• Chem panel
• ? serum protein, albumin (liver is usually small)
• ? BUN (liver converts ammonia ? urea)
• ? ALT (alanine aminotransferase), ALP (alkaline
  phosphatase)
• ? blood ammonia (from protein)
• X-rays
• Small liver
• Contrast material
• Inject into splenic vein
• By-passes liver

85
Portosystemic Shunts

• Rx
• Medical management seldom very successful
• Low protein diet, lactulose (reduces amount of
  circulating ammonia)
• Sx
• Ligation of shunt
• Total ligation often causes ? liver BP
• Partial ligation may be more practical
• A second Sx can be performed after few months to
  close off shunt totally
• Client info
• Px often very good following ligation
• For best results, Sx should be performed before 1
  y old
• Collateral circulation may develop, with relapse
  of signs

86
Portosystemic Shunts

• Protein restricted diet
• The ideal diet should be
• highly digestible (little residue reaches the
  colonic bacteria)
• High biological value protein (high levels of
  branched chain amino acids and arginine and low
  levels of aromatic amino acids and methionine)
• Protein content Dog 14 to 17
• Protein content Cat 30 to 35
• highly digestible carbohydrate as the primary
  source of calories

87
Feline Hepatic Lipidosis

• Idiopathic (IHL) cause unknown
• Most common hepatopathy in cats
• Obese cats of any age, sex or breed
• Stress may trigger anorexia
• Diet change,
• Boarding
• Illness,
• Environmental change

88
IHL

• Anorexia prolonged for 2 weeks causes imbalance
  between breakdown of peripheral lipids and lipid
  clearance within liver
• Lipids accumulate in liver
• Other mechanisms proposed
• Early diagnosis and aggressive treatment
  important
• 60-65 of cases gt complete recovery

89
IHL
90
IHL
91
IHL

• Clinical Signs
• Anorexia
• Obesity
• Wt loss (as much as 25 of body weight)
• Depression
• Sporadic vomiting
• Icterus
• Mild hepatomegaly
• /- coagulopathies

92
IHL

• Diagnosis
• CBC nonregenerative anemia, stress
  neutrophilia, lymphopenia
• Biochem panel Increased ALP, ALT, bilirubin,
  Low albumin, Increase serum bile acids
• X-rays mild hepatomegaly
• US liver hyperechoic
• Liver biopsy severely vacuolized hepatocytes

93
IHL

• Treatment
• High protein, calorie dense diet
• Feeding tube usually required
• NG tube for short term liquid
• diets
• Gastrostomy tube best
• Esophagostomy tube
• Tubes can remain in place
• For up to 3-6 weeks

94
IHL

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

95
Pancreatic Dysfunction (Exocrine)

• Main function of Exocrine Pancreas ? secretion of
  dig enzymes
• Located along duodenum
• Dig enzymes secreted in an inactive form to
  protect pancreas tissue

96
Pancreatic Dysfunction (Exocrine)

• PancreatitisInflammation of pancreas
• May be chronic or acute
• Develops when dig enzymes are activated within
  gland ? autodigestion
• More common in obese animal high-fat diets may
  predispose animal to it
• Unpredictable results some recover well, others
  worsen and die
• Signs
• Older, obese dog or cat with Hx of recent
  high-fat meal
• Depression, anorexia, vomiting
• abdominal pain
• Shock, collapse may develop
• Often seen post-holiday
• Table scraps of ham, gravy, etc

97
Pancreatitis

• Dx
• CBC, Chem panel
• Leukocytosis
• ? PCV (means what?)
• Hyperlipidemia
• ? serum amylase, lipase
• SNAP cPL test
• Rx
• IV fluids, electrolytes
• NPO 3-4 d
• Antibiotics
• Butorphanol for pain
• Start back on low fat diet 1-2 d after vom stops
• Client info
• Avoid obesity/overfeeding
• Feed low-fat treats
• Px is difficult to assess

98
Exocrine Pancreatic Insufficiency

• The pancreas stops making dig enzymes
• May occur spontaneously (G Shep) or due to
  chronic pancreatitis (cats)
• Signs
• Wt loss
• Polyphagia
• Coprophagia, pica
• Diarrhea, fatty stool
• Flatulence
• Dx
• Normal CBC
• ? total lipids

99
(No Transcript)
100
Exocrine Pancreatic Insufficiency

• Rx
• Supplement pancreatic enzymes with each meal
• Pancrezyme
• Viokase-V
• Low fiber diet
• Client info
• EPI is irreversible life-long treatment
• Pancreatic enzyme replacement is expensive
• With enzyme replacement, dog will regain weight,
  diarrhea will stop
• Must be given with every meal

101
Perineal Hernia

• Intact male dogs atrophy of levator ani muscle
  rectum herniates
• Signs
• Reducible perianal swelling
• Tenesmus (feeling of full colon)
• Dyschezia (difficult defecation)
• Urethral obstruction
• If bladder is herniated
• Dx
• Rectal palpation reveals hernia sac

102
Perineal Hernia

• Rx
• Stool softeners (Colace)
• Enemas
• Surgical repair
• Castration
• Client info
• Keeping stool soft may help reduce straining
• True for all dogs
• Castration recommended testosterone is suspected
  as a predisposing factor

103
Perianal Fistula

• Exact etiology unknown thought to start as an
  inflammation of sweat and oil glands around anus
• Bacteria grow well in the moist, warm region of
  these glands
• Infection invades into deeper tissues
• Most commonly affects G Shep (84 of dogs
  diagnosed)
• Signs
• Intact male, older (gt8 y)
• Tenesmus
• Dyschezia, pain on exam
• Fecal incontinence
• Bleeding, foul odor of perianal area

104
Perianal Fistula

• DxPE to r/o anal sac disease/perirectal tumor
• Rx
• Medicalusually not successful
• Clip hair, keep clean
• Flush with saline
• Antibiotics
• Surgicaldifficult because of nerves/blood
  vessels
• Remove infected tissue
• Cryosurgery
• Laser surgery
• Cautery
• Client info
• Painfulbe cautious of biting
• many complications of Sx
• Fecal incontinence
• Anal stenosis

105
Perianal Gland Adenoma

• Signs
• Intact male, older
• Single or multiple masses that may ulcerate
• Not metastatic
• Pruritis in anal area
• Bleeding
• Firm nodules in perianal skin
• DxPE, biopsy
• Rx
• Surgical removal
• Radiation
• Cryosurgery
• Castrationcauses regression of tumors
• Client info
• Gently cleanse area daily with baby wipes
• Castration at early age helps prevent it

106
References

• Alleice Summers, Common Diseases of Companion
  Animals
• Dr. Jan Bellows. The Smile Book I, Common Dental
  Problems and Procedures. 1996
• http//www.walthamusa.com/articles/wf93lec.pdf
• Fossum, T.W. Gastric Dilatation Volvulus Whats
  new? World Small Animal Veterinary Association
  World Congress Proceedings, 2009
• http//veterinarycalendar.dvm360.com/avhc/article/
  articleDetail.jsp?id650420skdate0A090909
  pageID2
• http//www.vet.uga.edu/VPP/CLERK/west/index.php