Textbook of Veterinary Internal Medicine by Feldman, Edward C. -- Read -- Imperial Library of Trantor

Index

TEXTBOOK OF VETERINARY INTERNAL MEDICINE OBSERVING THE PET AND MEETING THE CARETAKER: THE HISTORY INITIATING THE PHYSICAL EXAMINATION COMPLETING THE PHYSICAL EXAMINATION ALGORITHMS HOW DO WE DEAL WITH INFORMATION AND WHEN? WHAT MAKES A GOOD DECISION TREE OR ALGORITHM? POINTS TO PONDER BEFORE CHOOSING TO USE DECISION TREE ANALYSES

How to Use Decision-Making Trees How to Use the Algorithms in This Textbook

BEYOND ALGORITHMS—THE SOAP CLUES IN PEOPLE CLUES IN COLLABORATION CLUES IN TANGIBLES INTRODUCTION THE CANINE GENOME

Genome Features

DOGS HAVE ROUGHLY 20,000 GENES

Other Features in the Genome Population Genetics and its Effect on the Genome

History Suggests Long Haplotypes within Breeds and Short Haplotypes across Breeds Arrays for Genome-Wide Association Mapping

THE FELINE GENOME APPLICATIONS TO VETERINARY CARE THE ELEMENTS OF GENE THERAPY VECTOR SYSTEMS VECTOR DELIVERY VECTOR TARGETING TARGET DISEASES

Monogenic Deficiency Diseases Cancer

Corrective Gene Therapy Destruction of Cancer Cells through Delivery of “Suicide Genes” Gene-Directed Immunotherapy Delivery of Chemoprotective Genes The Use of Replication-Competent Viral Vectors Miscellaneous Approaches to Cancer Gene Therapy

Other Disease Targets

Infectious Diseases Inflammatory Disease Cardiac Disease

SAFETY CONSIDERATIONS IN GENE THERAPY CONCLUSION WHAT IS CLINICAL GENOMICS? CLINICAL GENOMICS IN VETERINARY MEDICINE

Cost of Veterinary Health Care Diagnostic Screening for Genetic Disease and Cancer in Animals

Genetic/Diagnostic Testing

HYPP in horses Freemartinism in cattle Genetic testing for canine diseases

Cancer Cytogenetics

EMERGING APPROACHES TO CLINICAL GENOMICS SUMMARY SCREENING TESTS DIAGNOSTIC TESTS USEFUL CHARACTERISTICS OF DIAGNOSTIC TESTS

Accuracy and Precision Gold Standards Sensitivity and Specificity Positive and Negative Predictive Values

OTHER CONSIDERATIONS

Reference Standards Interfering Factors

PATIENT PREPARATION CONCLUSION CONSIDERATIONS WHEN PERFORMING HOME EUTHANASIA PROCESS OF HOME EUTHANASIA HOME EUTHANASIA OF CATS THERMOREGULATION HYPERTHERMIA

True Fever

Exogenous Pyrogens Endogenous Pyrogens

Inadequate Heat Dissipation

Heat Stroke Hyperpyrexic Syndrome

Exercise Hyperthermia Pathologic and Pharmacologic Hyperthermia

BENEFITS AND DETRIMENTS OF HYPERTHERMIA

Benefits Detriments Clinical Approach Fever of Unknown Origin

NONSPECIFIC THERAPY FOR FEBRILE PATIENTS MAINTANENCE OF NORMAL BODY TEMPERATURE DEVELOPMENT OF HYPOTHERMIA

PREVENTION AND TREATMENT

Passive Warming Active Warming

NEUROPHYSIOLOGY AND PATHOPHYSIOLOGY OF PAIN

Terminology and Definitions Neuroanatomy and Physiology of Pain Pathways Neuromodulation and Response to Pain

PAIN IDENTIFICATION AND ASSESSMENT

Pain Assessment by Proxy Current State of Assessing Pain in Animals Physiologic (Objective) Assessment of Acute Pain Behavioral (Subjective) Assessment of Acute Pain Types of Acute Pain Scales

Preemptive Scoring System Semiobjective Scales

Visual analog scale Simple descriptive scale Numerical rating scale

Behavior-Based Scales

Combined behavioral and physiologic response scale

University of Melbourne Pain Scale

Behavioral response scale

Definition of Expressions Used in Glasgow Composite Pain Tool for Dogs

Posture Comfort Vocalization Attention to Wound Area Demeanor Mobility Response to Touch

Composite behavioral pain scale

Assessment of Chronic Pain

CLINICAL PAIN MANAGEMENT CONCEPTS

Pain States Therapeutic Modalities

Pharmacologic

Opioids NSAIDs Local anesthetic agents Alpha-2 agonists NMDA receptor antagonists (methadone, ketamine, dextromethorphan, amantadine) Other analgesic agents (tramadol, gabapentin, acetaminophen)

Nonpharmacologic Analgesic Modalities

FUNGAL DISEASES PROTOZOAL DISEASES ALGAL DISEASES VIRAL DISEASES BACTERIAL DISEASES IMMUNE MEDIATED DISEASES NEOPLASIA ENDOCRINOPATHIES ALOPECIA SECONDARY TO PRURITUS NONPRURITIC ALOPECIA

Inflammatory Alopecias Noninflammatory Alopecias

Hair Cycle Review Abnormal Hair Growth Hair Cycle Abnormalities

HISTORICAL FINDINGS

Signalment Speed of Hair Loss Epilation Distribution of Alopecia

DIAGNOSTIC PLAN

Minimum Dermatology Database Histopathology Endocrine Testing Advanced Diagnostics

PROGNOSIS PATHOPHYSIOLOGY DIAGNOSIS SIGNALMENT

Age Breed Sex

HISTORICAL FINDINGS

General History

Diet Environment and Exposure Other Household Pets Human Contacts

Specific History

Site, Onset, and Progression Intensity Seasonality or Pattern (Predictability) Response to Previous Therapy

PHYSICAL FINDINGS DIAGNOSTIC PLAN

Skin Scrapings Surface Cytology Fecal Examination Skin Biopsy Fungal Culture Elimination Diets Intradermal Testing Allergen-Specific IgE Serology (Enzyme-Linked Immunosorbent Assay [ELISA] or Radioallergosorbent Test [RAST]) Environmental Restriction

RESPONSE TO TRIAL THERAPY COST CONTAINMENT GOALS OF THERAPY CLINICAL AND HISTOPATHOLOGIC DEFINITIONS CAUSE AND PATHOPHYSIOLOGY DIAGNOSIS PROGNOSIS TREATMENT Canine Diseases

Infectious Fungal Parasitic Metabolic Neoplastic Physical, Chemical Immune-Mediated/Autoimmune Miscellaneous

Feline Diseases

Infectious Metabolic Neoplastic Physical/Chemical Immune-Mediated/Autoimmune Miscellaneous/Idiopathic

APPROACH TO THE DIAGNOSIS Axillary/Inguinal Focal/Multifocal Facial Mucocutaneous Generalized/Extensive INFECTIOUS CAUSES OF EROSIONS AND ULCERS

Viral Diseases Bacterial Disease Fungal Disease

OTHER CAUSES OF EROSIONS AND ULCERS

Parasitic Infections Metabolic Disease Neoplasia Physical and Chemical Diseases Immune-Mediated and Autoimmune Diseases Miscellaneous Diseases

FOLLICULAR LESIONS

Bacterial Pyoderma Demodicosis Dermatophytosis

NONFOLLICULAR LESIONS

Impetigo Sarcoptic Mange Cheyletiellosis Otoacariosis Neotrombiculosis (Harvest Mite) Hypersensitivity (Fleas, Contact Hypersensitivity, Atopic Dermatitis) Immune-Mediated Dermatitis: Pemphigus Foliaceus (PF) Neoplasia

PATHOPHYSIOLOGY SIGNALMENT

Species Age Breed

HISTORICAL FINDINGS PHYSICAL EXAMINATION

Lesions Distribution

DIAGNOSTIC PLAN TREATMENT HYPOPIGMENTATION

Hereditary Hypopigmentation

Albinism Piebaldism Waardenburg-Klein Syndrome Canine Cyclic Hematopoiesis Chédiak-Higashi Syndrome Graying Vitiligo Nasal Hypopigmentation (Dudley Nose, Snow Nose)

Acquired Hypopigmentation

Postinflammatory Drug-Related Hypopigmentation Nutritional/Metabolic Neoplasia Associated Idiopathic

HYPERPIGMENTATION

Hereditary Hyperpigmentation

Lentigenes Canine Acanthosis Nigricans Acromelanism

Acquired Hyperpigmentation

Postinflammatory Endocrine Related Papillomavirus Associated Pigmented Tumors and Tumorlike Lesions

DIAGNOSTIC TESTS LIFE CYCLE OF THE FLEA FLEA ALLERGY FLEA CONTROL MAIN GENITAL DERMATOSES IN THE HUMAN BEING GENITAL DERMATOSES IN THE DOG DIAGNOSIS TREATMENT CONCLUSION FAMILY DEMODICIDEA FAMILY SARCOPTIDAE FAMILY PSORPTIDAE GENUS Lynxacarus FAMILY CHEYLETIELLA FAMILY IXODIDAE FAMILY ARGASIDAE ORDER PHTHIRAPTERA PHYSIOLOGY AND PATHOPHYSIOLOGY THERAPY COMPARATIVE ASPECTS WITH NECROLYTIC MIGRATORY ERYTHEMA AND THEORIES OF PATHOGENESIS CLINICAL PRESENTATION DIAGNOSIS MANAGEMENT DEFINITIONS ETIOLOGY AND PATHOGENesIS THRESHOLD PHENOMENON AND SUMMATION OF EFFECTS CLINICAL SIGNS AND DIAGNOSIS TREATMENT OF DERMATOSES that ARE RELATED OR SECONDARY TO ATOPIC DERMATITIS

Treatment of Microbial Infections Treatment of FAD Management of Food Reactions Treatment of Keratoseborrhoeic Skin Disease Treatment of Otitis Externa Treatment of Pyotraumatic Dermatitis

SPECIFIC TREATMENT

Allergenic Eviction Allergen Specific Immunotherapy (ASIT)

SYMPTOMATIC TREATMENT

Glucocorticoids Nonsteroidal Topicals Antihistamines Essential Fatty Acids Cyclosporine Other Nonsteroidal Systemic Antiinflammatory/Antipruritic Agents

CONCLUSION: COMBINATION THERAPY CASE MANAGEMENT DEFINITION PREVALENCE RISK FACTORS PATHOLOGIC CONSEQUENCES PATHOGENESIS OF OBESITY-ASSOCIATED DISEASES EFFECTS ON LONGEVITY DISEASE ASSOCIATIONS MEASUREMENT OF OBESITY IN COMPANION ANIMALS TREATMENT

Dietary Management Pharmaceutical Therapy and Weight Loss Lifestyle Management Monitoring of Weight Loss

PREVENTION HISTORY Dietary History—Inadequate Dietary History—Adequate PHYSICAL AND LABORATORY FINDINGS DIAGNOSTIC PLAN THERAPY PATHOPHYSIOLOGY Small Stature and Poor Body Condition Small Stature and Good Body Condition

Genetic Abnormalities of Bone Growth Deficient Nutrient Intake Caloric or Nutrient Loss Abnormal Metabolism

HISTORICAL FINDINGS

Duration of the Problem Diet Concurrent Clinical Signs

PHYSICAL EXAMINATION FINDINGS DIAGNOSTIC PLAN TREATMENT SEPTIC ARTHRITIS IMMUNE-MEDIATED POLYARTHRITIS EROSIVE POLYARTHRITIS NONEROSIVE POLYARTHRITIS ARTHROCENTESIS AND JOINT FLUID ANALYSIS GROSS EXAMINATION CYTOLOGIC EVALUATION ADDITIONAL TESTING PEOPLE, PETS, VETERINARIANS, AND THE BODY ODOR ISSUE PATHOPHYSIOLOGY CLINICAL APPROACH Normal Pets without Skin Disease Skunk Odor Urine, Fecal Matter, and Odors Associated with “Rolled in Something Dead” Pets with Odor and Skin Disease

Malodorous Pet with an Obvious Cause

Oral Diseases Respiratory Diseases Dermatologic Diseases Metabolic Diseases Gastrointestinal Diseases Neoplasia Dietary Grooming Behavior

Malodorous Pets with Obvious Systemic Illnesses Malodorous Pets with Skin Disease

SURFACE OCULAR DISEASE

Eyelids Conjunctiva Cornea and Sclera Keratoconjunctivitis Sicca

UVEAL TRACT LENS FUNDUS

Optic Nerve and Retina Vascular and Hematologic Disease

Cornea Aqueous Humor Lens Vitreal Humor ABNORMALITIES RESULTING IN BLINDNESS Retinopathies Retinal Detachment Syndromes Chorioretinitis VISUAL ASSESSMENT

Motion Detection Obstacle Course Menace Response Visual Placing and Postural Reactions Pupillary Light Reflexes

SPECIAL DIAGNOSITIC TESTS ABDOMINAL DISTENSION PERITONEAL EFFUSIONS INCLUDING ASCITES AND PERITONITIS DIAGNOSIS PERITONITIS TREATMENT SPECIFIC MECHANISMS AND DISEASES

Metabolic Diseases Electrolyte Disorders Acid-Base Disorders Inflammatory Conditions Infectious Diseases Immune-Mediated Diseases Anemia Endocrine Diseases Cardiovascular Disease Blood Pressure Respiratory Diseases Neuromuscular Diseases

Brain Spinal Cord Disease Neuropathies Myopathies Neoplasia

Physical and Psychologic Stress Pain Nutritional Derangements Drugs

VAGINAL-VULVAR DISCHARGE

HISTORY PHYSICAL EXAMINATION CYTOLOGY Vaginal-Vulvar Examination

PREPUTIAL DISCHARGE

HISTORY PHYSICAL EXAMINATION OTHER DIAGNOSTIC TESTING

PHYSIOLOGY OF WATER METABOLISM DIAGNOSTIC APPROACH TO POLYURIA, POLYDIPSIA, AND OTHER ABNORMALITIES IN URINATION

CENTRAL DIABETES INSIPIDUS (CDI), NEPHROGENIC DIABETES INSIPIDUS (NDI), AND PSYCHOGENIC (PRIMARY) POLYDIPSIA (PP) ANATOMY AND PHYSIOLOGY OF THE URINARY BLADDER CONTROL OF MICTURITION MICTURITION DISORDERS (Figure 38-1)

Neurogenic Causes

Lower Motor Neuron Disorder (Detrusor Areflexia with Sphincter Areflexia) Upper Motor Neuron Disorder (Detrusor Areflexia with Sphincter Hypertonus) Detrusor-Urethral Dyssynergia Dysautonomia

Nonneurogenic Causes of Micturition Disorders

Detrusor Atony from Overdistention or Overflow Incontinence Urinary Incontinence (Table 38-1)

Neurogenic causes (Figure 38-2) Nonneurogenic Causes

Urethral sphincter mechanism incompetence (USMI) Detrusor hyperspasticity (instability, urge incontinence) Ectopic ureter(s)

HISTORY AND DIAGNOSIS TREATMENT (Web Table 38-1)

Lower Motor Neuron Bladder Upper Motor Neuron Bladder Detrusor-Urethral Dyssynergia Dysautonomia Urinary Incontinence/Urethral Incompetence Urge Incontinence (Detrusor Hyperreflexia) Ectopic Ureter(s)

OUTCOME NORMAL URINE DISCOLORED URINE

Pale Yellow Urine Red, Brown, or Black Urine Milky White Urine

METHODS OF DETECTION AND INTERPRETATION OF TEST RESULTS ORIGIN OF PROTEINURIA DIAGNOSTIC APPROACH TREATMENT MONITORING CAUSES TREATMENT PHYSIOLOGY HISTORY PHYSICAL EXAMINATION DIAGNOSTIC PLAN MANAGEMENT ANATOMY OF THE PERIODONTIUM PATHOBIOLOGY OF PERIODONTAL DISEASE

Microbiology Interactions of Microbes with the Host and Immune/Inflammatory Response

CONTRIBUTING FACTORS

Genetics Calculus Tooth Crowding/Malocclusion Iatrogenic Factors Xerostomia Radiation Therapy Gingival Enlargement Systemic Health

PERIODONTAL PATHOLOGY

Gingivitis Periodontitis

The Periodontal Pocket Bone Loss Patterns

EFFECT OF PERIODONTAL DISEASE ON SYSTEMIC HEALTH DIAGNOSIS TREATMENT

Phase I Therapy

Scaling and Root Planing Antimicrobials

Systemic antimicrobials Local antimicrobials

Host Modulation

Nonsteroidal antiinflammatory drugs Bisphosphonates Subantimicrobial-dose doxycycline

Treatment of Contributing Factors

Phase II Therapy

Reconstructive Periodontal Surgery

Osseous grafting Guided tissue regeneration Combined techniques

Prevention and Adjunctive Therapies

Mechanical Plaque Removal

Toothbrushing Professional scaling and polishing

Dietary Methods of Plaque Removal Rinses, Gels, and Water Additives Barrier Dental Sealants Vaccination

DEFINITION ETIOLOGY AND PATHOGENESIS CLINICAL SIGNS DIFFERENTIAL DIAGNOSES DIAGNOSTIC STEPS HISTORY HISTORICAL SIGNIFICANCE

Age of the Patient Acute versus Gradual/Chronic GI Signs

PHYSICAL EXAMINATION DIAGNOSTIC TESTS TREATMENT CONCLUSION NORMAL PHYSIOLOGY GAGGING DYSPHAGIA

CLINICAL SIGNS HISTORY

Obstructive Lesion (Anatomic or Mechanical) Pain Neurologic Disorders Neuromuscular Disorders Endocrine

DIAGNOSIS TREATMENT

REGURGITATION

CLINICAL SIGNS DIAGNOSIS

Esophageal Disorder Alimentary Disorder Neurologic Disorder Neuromuscular Disorder Infectious Immune Mediated Endocrine

TREATMENT

PATHOPHYSIOLOGY CAUSES Metabolic/Endocrine Disorders Intoxicants Drugs Abdominal Disorders Dietary Causes Gastric Disorders Disorders of the Small Intestine Disorders of the Large Intestine CLINICAL APPROACH DIAGNOSTIC PLAN TREATMENT DIAGNOSIS TREATMENT MELENA

DEFINITION DIAGNOSIS TREATMENT

HEMATOCHEZIA

DEFINITION DIAGNOSIS

Rectum and Colon Anus and Anal Sacs

TREATMENT

DEFINITIONS PHYSIOLOGY OF THE LARGE INTESTINE CONSTIPATION

Clinical Evaluation

HISTORY SIGNALMENT PHYSICAL EXAMINATION DIAGNOSTIC EVALUATION

TENESMUS AND DYSCHEZIA

Clinical Evaluation

HISTORY SIGNALMENT PHYSICAL EXAMINATION DIAGNOSTIC EVALUATION

FECAL INCONTINENCE

Clinical Evaluation

HISTORY PHYSICAL EXAMINATION DIAGNOSTIC EVALUATION

PATHOPHYSIOLOGY CLINICAL EXAMINATION FINDINGS MANAGEMENT DISEASES CAUSING CNS SIGNS

Hypoxia from Systemic Disease Hypertension Endocrine/Metabolic Causes

Hepatic Encephalopathy Renal Encephalopathy Hypothyroidism Hyperthyroidism Hyperadrenocorticism Hypoglycemia Thiamine Deficiency

Electrolyte Abnormalities

Hypercalcemia Hypocalcemia Hypernatremia/Hyponatremia

Neoplasia Hyperthermia

DISEASES CAUSING PNS SIGNS

Hypoxia Metabolic/Endocrine Disorders

Hypothyroidism Hyperthyroidism Hyperadrenocorticism Hypoadrenocorticism Diabetes Mellitus Renal Failure

Electrolyte Abnormalities

Hypokalemia Paraneoplastic Syndrome

CLINICAL EVALUATION SPASTICITY MYOTONIA TETANY EPISODIC FALLING IN CAVALIER KING CHARLES SPANIELS SCOTTIE CRAMP CONTINUOUS MUSCLE FIBER ACTIVITY TETANUS MYOCLONUS ENCEPHALOMYELITIS DYSKINESIA DANCING DOBERMAN OTHER ABNORMAL MOVEMENTS DEFINITIONS PHYSIOLOGIC TREMOR PATHOLOGIC TREMOR

Type Distribution

LOCALIZATION OF THE PACEMAKER PREDOMINANCE OF CLINICAL SIGNS DISORDERS IN WHICH TREMBLING IS ACCOMPANIED BY OTHER SIGNS

Metabolic Disorders Intracranial Diseases Hind End Weakness

DISORDERS IN WHICH TREMBLING IS THE PREDOMINANT SIGN

Corticoid-Responsive Tremor Syndrome Orthostatic Tremor Hypomyelination Spongy Degeneration

TREMORGENIC TOXINS IDIOPATHIC HEAD TREMOR IDIOPATHIC TREMOR OF THE HIND LEGS ATAXIA

Types of Ataxia

Vestibular Ataxia—Peripheral Vestibular Ataxia—Central Cerebellar Ataxia Proprioceptive Ataxia Diffuse Lower Motor Neuron Signs C1-C5 Spinal Cord C6-T2 Spinal Cord T3-L3 Spinal Cord L4-S3 Spinal Cord Lumbosacral Region (Cauda Equina) PARESIS AND PARALYSIS DEFINITIONS PATHOPHYSIOLOGY APPROACH TO THE PATIENT WITH STUPOR OR COMA

Mental Status and Level of Consciousness Neuroophthalmologic Signs

Pupillary Reactions Ocular Movements

Alterations in Respiratory Pattern Skeletal Motor Responses

DIAGNOSTIC PLAN TREATMENT GOALS PROGNOSIS THE BRAIN IS SIMILAR TO OTHER ORGANS IN THE BODY BE CERTAIN THAT EPILEPTIC SEIZURES HAVE OCCURRED IDENTIFY THE ETIOLOGY ALWAYS TREAT THE UNDERLYING DISEASE START TREATMENT EARLY IN THE COURSE OF DISEASE START WITH THE APPROPRIATE AED BE PROACTIVE RATHER THAN REACTIVE ADJUST THE DOSE ACCORDING TO DRUG CONCENTRATION CONFIRM COMPLIANCE IN DOSING AND MONITORING KNOW WHEN AND HOW TO ADD OR CHANGE MEDICATIONS CN II—OPTIC NEURITIS HORNER’S SYNDROME CN V—TRIGEMINAL NEUROPATHY CN VII—FACIAL PARALYSIS CN VIII—PERIPHERAL VESTIBULAR DISEASE CN IX, X, XI—DYSPHAGIA, MEGAESOPHAGUS, AND LARYNGEAL PARALYSIS NORMAL SLEEP DIAGNOSTIC APPROACH REM SLEEP BEHAVIOR DISORDER SLEEP-DISORDERED BREATHING OR SLEEP APNEA GERIATRIC CHANGES IN CIRCADIAN RHYTHM NARCOLEPSY (NARCOLEPSY-CATAPLEXY)

Pathophysiology of Narcolepsy-Cataplexy Forms of Primary Narcolepsy CLINICAL SIGNS OF NARCOLEPSY DIAGNOSIS TREATMENT PROGNOSIS

CLINICAL SIGNS LABORATORY STUDIES NEUROBIOLOGIC BASIS TREATMENT OPTIONS SUMMARY CANINE BEHAVIOR PROBLEMS

Aggression

Aggression to Humans Living in the Household Possessive Aggression Territorial Aggression Aggression between Dogs Predatory Aggression

Separation Anxiety Fear Hyperexcitability Canine House Soiling Canine Urine Marking Stereotypies and Compulsive Disorder in Dogs Cognitive Dysfunction Syndrome

FELINE BEHAVIOR PROBLEMS

Inappropriate Urination and Defecation Feline Marking or Spraying Territorial Aggression, Intercat Aggression Petting Aggression Redirected Aggression Play Aggression Compulsive Behavior and Stereotypies

PREPURCHASE COUNSELING NEW PET-OWNER COUNSELING FOR PROBLEM PREVENTION APPROPRIATE HANDLING OF YOUNG ANIMALS SPECIFIC PROCEDURES FOR PROBLEM PREVENTION PUPPY CLASSES KITTEN CLASSES OBEDIENCE CLASSES BEHAVIOR WELLNESS APPOINTMENT BEHAVIORAL INTERVENTION SENIOR BEHAVIORAL EXAM SENIOR DOG CLASSES GRIEF COUNSELING Allergic/Inflammatory Physical/Traumatic Factors Neoplastic Cardiovascular Infectious DIAGNOSTIC APPROACH

Signalment and Historical Findings Nature of the Cough Physical Examination Radiographs Further Diagnostics Treatment Goals

DEFINITIONS INITIAL APPROACH TO THE DYSPNEIC PATIENT PHYSICAL EXAM FINDINGS

Upper Airway Small Airway Pleural Space Lung Parenchyma

GENESIS OF INNOCENT HEART MURMURS DIFFERENTIATION OF INNOCENT MURMURS FROM PATHOLOGIC MURMURS ASSESSMENT OF MURMURS THAT MAY BE PHYSIOLOGIC OR PATHOLOGIC TRANSIENT HEART SOUNDS

The First (S1) and Second (S2) Heart Sounds The Third (S3) and Fourth (S4) Heart Sounds Ejection Sounds, Systolic Clicks, Opening Snaps, and Pericardial Knocks Cardiac Murmurs Timing Location and Radiation Intensity (Loudness)

Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6

Pitch (Frequency) Shape

SYSTOLIC HEART MURMURS

Mitral Insufficiency Tricuspid Insufficiency Aortic Stenosis Pulmonic Stenosis Ventricular Septal Defect Atrial Septal Defect Physiologic and Innocent Murmurs

DIASTOLIC HEART MURMURS

Aortic Insufficiency Pulmonic Insufficiency Mitral Stenosis

CONTINUOUS MURMURS AUSCULTATION AND BEYOND ARTERIAL PULSES VENOUS PULSES DEFINITION CLINICAL SIGNS DIAGNOSTIC EVALUATION TRANSUDATES AND MODIFIED TRANSUDATES SEPTIC AND NONSEPTIC EXUDATES HEMORRHAGIC EFFUSIONS CHYLOUS EFFUSIONS NEOPLASTIC EFFUSION TREATMENT AND PROGNOSIS CLINICAL PRESENTATIONS

Stertor Reverse Sneezing Nasal Discharge

DIAGNOSTIC APPROACH

Signalment History Physical Examination

DIAGNOSTIC PLAN

Skull Radiographs Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Rhinoscopy/Nasopharyngoscopy Nasal Biopsy

TREATMENT/OUTCOME SYNCOPE CAUSES OF SYNCOPE

Cardiac Arrhythmias Structural Cardiac and Pulmonary Causes Reflex-Mediated Syncope (Neurally Mediated, Vasovagal, Vasodepressor, Neurocardiogenic Syncope) Orthostatic Hypotensive Syncope Cerebrovascular Disorders Severe, Acute Hypoxemia

DIAGNOSTIC WORKUP TREATMENT PROGNOSIS EVALUATION DIAGNOSTIC TESTS DEFINITIONS PATHOPHYSIOLOGY CLINICAL SIGNS DIAGNOSTIC TESTS THERAPEUTIC AND PROGNOSTIC CONSIDERATIONS PHYSIOLOGY AND PATHOPHYSIOLOGY INITIAL EVALUATION/CLINICAL SIGNS DIAGNOSTIC PLAN TREATMENT DIAGNOSTICS TREATMENT

Prehepatic Hyperbilirubinemia Hepatic Hyperbilirubinemia Posthepatic Hyperbilirubinemia Primary Treatment of Hyperbilirubinemia

EPISTAXIS

SIGNALMENT HISTORY

Characterization of Epistaxis

PHYSICAL EXAMINATION DIFFERENTIAL DIAGNOSIS

Extranasal (Systemic) Causes of Epistaxis Intranasal (Localized) Causes of Epistaxis

Systemic Conditions Causing Epistaxis (“Extranasal” Causes) Localized Conditions Causing Epistaxis (“Intranasal” Causes) DIAGNOSTIC PLAN

Complete Blood Count Including Platelet Count Chemistry Profile Urinalysis Hemostatic Studies Serology Imaging Rhinoscopy Nasal Swabs, Flushing, and Biopsy Nasal Culture Blood Pressure Exploratory Rhinotomy

TREATMENT

HEMOPTYSIS

SIGNALMENT HISTORY

Nature of the Expectorated Material

PHYSICAL EXAMINATION DIFFERENTIAL DIAGNOSIS

Pulmonary Cardiovascular Systemic

DIAGNOSTIC PLAN GOALS OF TREATMENT

PATHOPHYSIOLOGY

Thrombocytopenia Thrombopathia Von Willebrand Disease Vascular Disorders

PATIENT HISTORY AND PHYSICAL EXAMINATION DIAGNOSTIC APPROACH TREATMENT TERMINOLOGY AND NORMAL PHYSIOLOGY HYPERNATREMIA

ETIOLOGY

Pure Water Loss (Normovolemia) Hypotonic Fluid Loss (Hypovolemia) Sodium Gain (Hypervolemia)

CLINICAL SIGNS TREATMENT

HYPONATREMIA

ETIOLOGY

Low Plasma Osmolality Normal Plasma Osmolality (Pseudohyponatremia) High Plasma Osmolality

CLINICAL SIGNS TREATMENT

HYPERKALEMIA

Recognizing the Problem DIFFERENTIAL DIAGNOSIS (Figure 78-1)

Hypoadrenocorticism (Addison’s Disease) Urinary Tract Disorders Gastrointestinal Disease Acidosis, Pancreatitis, and/or Trauma Pleural Effusions Miscellaneous Disorders Iatrogenic and/or Nonadrenal Drug Therapy Adrenocortical Destruction Secondary to Mitotane (o,p′-DDD) or Trilostane Therapy Artifact (non-Akita) Artifact (the Akita)

TREATMENT

Background Specific Therapy for Hypoadrenocorticism Nonspecific Methods for Decreasing Serum Potassium Concentrations

HYPOKALEMIA

Recognizing the Problem DIFFERENTIAL DIAGNOSIS AND EVALUATION TREATMENT

CALCIUM

Normal Regulation of Calcium Metabolism Assessing Ionized Calcium Concentrations Disorders of Hypercalcemia

Nonpathologic Conditions Transient Conditions Pathologic Conditions

Disorders of Hypocalcemia

Causes of Severe Symptomatic Hypocalcemia Causes of Mild Asymptomatic Hypocalcemia PHOSPHORUS

Phosphorus Metabolism Hyperphosphatemia Hypophosphatemia

MAGNESIUM

Magnesium Metabolism Hypomagnesemia Hypermagnesemia

VENIPUNCTURE CEPHALIC VEIN VENIPUNCTURE

Lateral Saphenous Venipuncture Medial Saphenous Venipuncture Jugular Venipuncture Arterial Puncture

THROUGH-THE-NEEDLE CATHETERS MULTILUMEN CATHETERS JUGULAR CATHETERIZATION

Supplies and Patient Preparation for All Catheters Through-the-Needle Catheterization Technique Multilumen Catheter Technique

CENTRAL VENOUS PRESSURE MEASUREMENT BY WATER MANOMETER

Supplies Needed for Central Venous Pressure Measurement Procedure

INDICATIONS FOR TESTING TYPES OF TESTS: PROS, CONS, AND LIMITATIONS SAMPLE COLLECTING, HANDLING, AND SUBMISSION COLLECTING AND STORING FECAL SPECIMENS GROSS EXAMINATION OF THE FECAL SPECIMEN FECAL SMEAR FECAL FLOTATION TECHNIQUES FLOTATION SOLUTIONS Magnesium Sulfate Zinc Sulfate Sodium Nitrate Sodium Chloride Sheather’s Sucrose Solution (SG=1.27) CENTRIFUGAL FLOTATION VERSUS STANDING FLOTATION? STANDING FLOTATION CENTRIFUGAL FLOTATION PROPER EXAMINATION OF THE COVERSLIP FECAL SEDIMENTATION BAERMANN PROCEDURE FECAL CULTURE FOR TRITRICHOMONAS FOETUS IMMUNOLOGIC AND MOLECULAR TECHNIQUES POLYMERASE CHAIN REACTION (PCR) MULTIPLEX PCR NESTED PCR QUANTITATIVE REAL-TIME PCR DIAGNOSTIC RESOURCES CAPILLARY BLOOD SAMPLING WITH CONVENTIONAL LANCET DEVICE CAPILLARY BLOOD SAMPLING WITH VACUUM LANCING DEVICE ENTERAL FEEDING ACCESS DEVICES

Nasoesophageal Tubes Esophagostomy Tubes

Technique Using Curved Carmalt, Mixter, or Schnidt Forceps Percutaneous Feeding Tube Applicator Technique Percutaneous Needle Catheter Technique

Gastrostomy Tubes

Percutaneous Endoscopic Gastrostomy (PEG) Technique Blind Percutaneous Gastrostomy Technique

Jejunostomy Tubes Esophagostomy, Gastrostomy, and PEG-J Tube Removal Gastrostomy and Esophagostomy Tube Replacement

COMPLICATIONS OF ENTERAL FEEDING

Gastric Pressure Necrosis Feeding Tube Displacement Tube Obstruction Leakage through Ostomy Sites Aspiration Diarrhea

THYROID SCINTIGRAPHY

Introduction and Basic Techniques Indications for Performing a Thyroid Scan Image Acquisition Interpretation and Analysis Radioiodine Therapy for Feline Hyperthyroidism Thyroid Scan and Canine Thyroid Disease Radioiodine Therapy for Canine Thyroid Carcinoma

PORTAL SCINTIGRAPHY

Background and Basic Techniques Indications for Performing a Portal Scan Image Acquisition Interpretation and Analysis

BONE SCINTIGRAPHY

Background and Basic Techniques Indications for Performing a Bone Scan Image Acquisition Interpretation and Analysis Neoplastic Disease Nonneoplastic Disease Three-Phase Bone Scanning

QUANTITATIVE RENAL IMAGING (GFR SCANS)

Background and Basic Techniques Indications for Performing a Glomerular Filtration Rate (GFR) Scan Image Acquisition Interpretation and Analysis

DIGITAL RADIOGRAPHY DIGITAL RADIOGRAPHIC SYSTEMS INTRODUCTION TO DICOM, PACS, AND HIS IMAGE DISPLAYS INTERVENTIONAL ENDOSCOPIC PROCEDURES

Percutaneous Endoscopic Gastrojejunostomy (PEG/PEJ) Tube Placement Balloon Dilatation of Esophageal Strictures Removal of Gastrointestinal Foreign Bodies

INTERVENTIONAL IMAGING PROCEDURES

Image-Guided Sample Collection Choledochal Tube Stenting for Extrahepatic Biliary Obstruction Nitinol Stent Placement for Tracheal Collapse Amplatz Duct Occlusion for Canine Patent Ductus Arteriosus

PHYSIOLOGIC EFFECTS INDICATIONS IN HUMAN MEDICINE CONTRAINDICATIONS COMPLICATIONS IN HUMAN MEDICINE COMPLICATIONS IN VETERINARY MEDICINE HYPERBARIC CHAMBERS TREATMENT PROTOCOL SUMMARY CASE EXAMPLE Evaluation of hemostasis DETERMINATION OF THE BMBT COMPLICATIONS FROM EAR FLUSHING EAR FLUSHING TECHNIQUE MYRINGOTOMY

FOLLOW-UP

GETTING THE MOST FROM SKIN SCRAPINGS

Superficial Skin Scrapings

Indication Procedure Interpretation

Deep Skin Scrapings

Indication Procedure Interpretation

GETTING THE MOST FROM A SKIN BIOPSY (Web Box 93-1)

Site Selection Surgical Technique Wedge/Ellipse versus Punch Biopsy

Punch Biopsy Sampling Excisional/Incisional Sampling Fixation of Tissue Shave Biopsies

Interpretation—Making a Diagnosis

REQUIRED EQUIPMENT PROCEDURE FOR SAMPLE COLLECTION

Samples from Solid Masses or Fluid-Filled Lesions Liquid Samples Semisolid Samples Samples from Mucous Membranes of the Vagina, Conjunctiva, and Mouth and from Fistulous Tracts

COMMON MISTAKES TO AVOID IN COLLECTION AND PREPARATION OF CYTOLOGY/FLUID SAMPLES DETERMINING THE CHOICE OF CYTOLOGY OR BIOPSY ULTRASOUND PHYSICS TISSUE CHARACTERISTICS PERFORMING THE COMPLETE ABDOMINAL ULTRASOUND EXAMINATION

Preparation Getting Started Region 1: The Liver Region 2: Left Pancreatic Limb, Spleen, Left Kidney Region 3: The Left Adrenal Region 4: Urinary Bladder, Prostate/Uterus, Sublumbar Lymph Nodes Region 5: The Right Kidney, Duodenum/Right Pancreatic Limb Region 6: The Right Adrenal Region 7: The Mid Abdomen

CONCLUSION INDICATIONS MATERIALS TECHNIQUE

Patient Preparation Specific Biopsy Sites

CONTRAINDICATIONS AND COMPLICATIONS patient preparation SURGICAL SCRUB REQUIRED CONSCIOUS SEDATION LOCAL ANESTHESIA REQUIRED ABDOMINOCENTESIS DIAGNOSTIC PERITONEAL LAVAGE CATHETER PLACEMENT FOR DPL EQUIPMENT INDICATIONS FOR LAPAROSCOPY TECHNIQUE LAPAROSCOPY-GUIDED LIVER BIOPSY LAPAROSCOPIC SURGERY BONE MARROW ASPIRATION BONE MARROW BIOPSY ADDITIONAL SOURCES OF INFORMATION ON TECHNIQUES FOR BONE MARROW ASPIRATION AND BIOPSY ASPIRATE COLLECTION AND PREPARATION THORACIC ORGAN CYTOLOGY

Pulmonary Aspirates Heart-Based Tumors Thymus

ABDOMINAL ORGAN CYTOLOGY

Liver Spleen Intestinal Tract Kidney

ARTHROCENTESIS ARTHROSCOPY LYMPH NODE CYTOLOGY TECHNIQUES LYMPH NODE INCISIONAL (NEEDLE-CORE) BIOPSY TECHNIQUE INDICATIONS ANATOMY NASAL FLUSH (Figure 103-2) MODIFIED NASAL FLUSH (Figure 103-3) RHINOSCOPY AND BIOPSY PATIENT SELECTION INDICATIONS FOR BLOOD PRESSURE ASSESSMENT

Cats Dogs Hypotension

CHOOSING A BLOOD PRESSURE MEASUREMENT TECHNIQUE

Acute Diagnostic Blood Pressure Measurement Continuous Blood Pressure Monitoring: Conscious Patients Continuous Blood Pressure Monitoring: Anesthetized Patients

BLOOD PRESSURE MEASUREMENT TECHNIQUES

Arterial Puncture or Arterial Cannulation (“Invasive” or “Direct” Technique) Oscillometric Technique Doppler-Ultrasonic Technique (Doppler Sphygmomanometry)

PRINCIPLES CLINICAL USES

Measurement of SpO2 Measurement of Pulse Rate Measurement of Blood Pressure

COMPLICATIONS

Inaccurate Readings Burns

TRANSTRACHEAL WASH BRONCHOSCOPY THORACOCENTESIS PERICARDIOCENTESIS THORACOSTOMY TUBE PLACEMENT FINE NEEDLE ASPIRATION and biopsy LUNG BIOPSY COMPLICATIONS LEAD SYSTEMS

Standard Bipolar Leads Augmented Unipolar Leads Unipolar Precordial Chest Leads Modified Orthogonal Lead Systems

ELECTROCARDIOGRAPHIC RECORDING PRINCIPLES OF ULTRASOUND PHYSICS EQUIPMENT TECHNIQUE THE NORMAL ECHOCARDIOGRAM: IMAGE ACQUISITION, STANDARD VIEWS AND SEQUENCE 2-D ECHOCARDIOGRAPHY COMMON 2-D ECHOCARDIOGRAPHIC POSITIONS M-MODE ECHOCARDIOGRAPHY DOPPLER ECHOCARDIOGRAPHY

Spectral Doppler Pulsed Wave Doppler Continuous Wave Doppler Color-Flow Doppler

ARTEFACTS SPECIAL ECHOCARDIOGRAPHIC TECHNIQUES

Doppler Tissue Imaging (DTI) Transesophageal Echocardiography (TEE) Three-Dimensional Echocardiography (3-DE) Contrast Echocardiography

EVALUATION OF CARDIAC STRUCTURES AND FUNCTION

Cardiac Size and Chamber Dilation Systolic Function

Fractional shortening Velocity of circumferential fiber shortening Left ventricular volumes Stroke volume Ejection fraction E-point to septal separation LV dP/dt Systolic time intervals Cardiac output Diastolic Function

NORMAL VALUES CYSTOCENTESIS URINARY BLADDER CATHETERIZATION UNBLOCKING TECHNIQUE AND INDWELLING CATHETER PLACEMENT PERITONEAL DIALYSIS CATHETERS DIALYSATE SOLUTIONS EXCHANGE PROCEDURE COMPLICATIONS DISCONTINUING DIALYSIS BLOOD PURIFICATION MODES OF OPERATION ANTICOAGULATION BLOOD ACCESS INDICATIONS FOR USE PATIENT CARE SUMMARY PROCEDURE CONCLUSION ENDOSCOPIC PROCEDURES ENDOSCOPIC EQUIPMENT ENDOSCOPIC TECHNIQUE

Upper Gastrointestinal Endoscopy Proctoscopy and Colonoscopy

DESCRIPTIVE ENDOSCOPIC TERMINOLOGY TISSUE SAMPLING CONTRAINDICATIONS COMPLICATIONS CYTOLOGIC PROCEDURES CEREBROSPINAL FLUID COLLECTION

Spinal Needles Sample Stability

COLLECTION TECHNIQUES

Collection Sites Cisternal Tap Lumbar Tap Risks and Complications

MYELOGRAPHY EPIDUROGRAPHY DISCOGRAPHY MUSCLE BIOPSY

Selection of Muscle Open Muscle Biopsy Procedure Percutaneous Muscle Biopsy Procedure Specimen Processing and Transport

NERVE BIOPSY

Selection of Nerve Nerve Biopsy Technique (Common Peroneal) Nerve Specimen Processing

ELECTROMYOGRAPHY MOTOR AND SENSORY NERVE CONDUCTION STUDIES MOTOR AND SENSORY NERVE ROOT STUDIES OPEN BRAIN BIOPSY STEREOTACTIC BRAIN BIOPSY

Handling the Intraoperative Specimen

SELECTING THE EXAMINATION

Radiography Cross-Sectional Imaging

TECHNICAL CONSIDERATIONS

T1 and T2 Pulse Sequence and Anatomic Planes Windowing and Leveling

summary AI TECHNIQUES IN THE DOG

Palpation of the Cervix

VAGINAL INSEMINATION INTRAUTERINE INSEMINATION USING THE SCANDINAVIAN CATHETER INTRAUTERINE INSEMINATION USING ENDOSCOPIC VISUALIZATION OF THE CERVIX INTRAUTERINE INSEMINATION USING SURGERY INTRAUTERINE INSEMINATION USING LAPAROSCOPY ANATOMY EQUIPMENT AND METHODOLOGY BASIC ACID-BASE PHYSIOLOGY ACID-BASE DISORDERS OXYGENATION INITIAL SURVEY IMMEDIATE TREATMENT ANALGESIA SIGNALMENT AND HISTORY PHYSICAL EXAMINATION DIAGNOSTIC TESTS DIAGNOSTIC PERITONEAL LAVAGE THE DECISION TO GO TO SURGERY ONGOING CARE ARRHYTHMIAS HEART FAILURE PERICARDIAL EFFUSION ARTERIAL THROMBOEMBOLISM DEFINITIONS PREPAREDNESS RECOGNITION OF CPA BASIC LIFE SUPPORT ADVANCED LIFE SUPPORT

Drug Administration and Access Electrocardiography (ECG) Fluid Therapy

MONITORING DURING CPCR PROLONGED LIFE SUPPORT OLD CONTROVERSIES AND NEW RECOMMENDATIONS FOR CPCR

Open- versus Closed-Chest CPCR Epinephrine Dosage Vasopressin versus Epinephrine Hyperventilation and Interruptions during CPCR

PATHOPHYSIOLOGY

Primary versus Secondary Injury Intracranial Pressure and Cerebral Perfusion Pressure

PATIENT ASSESSMENT THERAPEUTICS AND PATIENT CARE

Extracranial Stabilization Intracranial Stabilization Ancillary Therapeutics and Patient Monitoring

DISTRIBUTION OF FLUIDS ALBUMIN POOR PERFUSION (SHOCK) BLOOD VOLUME DEHYDRATION AND INTERSTITIAL VOLUME FLUID TYPES

Crystalloids Colloids Hemoglobin-Based Oxygen Carriers Human Albumin Natural Colloids

ADMINISTRATION FLUID PLANS FLUID ADDITIVES RESUSCITATION: EARLY GOAL-DIRECTED THERAPY HYPOTENSIVE RESUSCITATION REHYDRATION CALCULATING DAILY REQUIREMENTS FLUID OVERLOAD MONITORING THE PATIENT FLUID THERAPY PRECEPTS PATHOPHYSIOLOGY OF KETOACIDOSIS DIAGNOSIS

History and Physical Examination

DIAGNOSTIC EVALUATION TREATMENT

Fluid and Electrolytes Insulin

COMPLICATIONS HYPERGLYCEMIC HYPEROSMOLAR SYNDROME PATHOPHYSIOLOGY DIAGNOSTIC EVALUATION TREATMENT PRIMARY SURVEY RESUSCITATION SECONDARY SURVEY TESTS MEDICAL INTERVENTION SURGICAL INTERVENTION RECOVERY PRIMARY SURVEY BLOOD OXYGEN CONTENT TISSUE PERFUSION CENTRAL NERVOUS SYSTEM AND URINARY TRACT SECONDARY SURVEY MONITORING SUMMARY PATHOPHYSIOLOGY CLINICAL SIGNS LABORATORY CHANGES TREATMENT PROGNOSIS HEPATIC AND SPLENIC EMERGENCIES ASSOCIATED WITH HEMOPERITONEUM

Splenic and Liver Lobe Torsion Splenic Infarction Hepatic and Splenic Abscesses Rupture of the Biliary System Acute Hepatic Failure

INDICATIONS GOALS OF OXYGEN THERAPY TECHNIQUES

Flow-by Oxygen Mask Oxygen Elizabethan Collar Nasal Prongs Nasal Oxygen Catheter Transtracheal Oxygen Oxygen Cage Positive Pressure Ventilation Humidification

MONITORING OXYGEN TOXICITY

Guidelines for Oxygen Administration

ACUTE KIDNEY INJURY ACUTE RENAL FAILURE CLINICAL SIGNS TREATMENT MONITORING DIALYTIC THERAPY OUTCOME REPRODUCTIVE EMERGENCIES OF THE DAM REPRODUCTIVE EMERGENCIES OF THE SIRE PATHOGENESIS CLINICAL ASPECTS DIAGNOSIS TREATMENT PROGNOSIS TYPES HOST RESPONSE STAGES AND CLINICAL SIGNS TREATMENT AND MONITORING PATHOGENESIS CLINICAL MANIFESTATIONS DIAGNOSIS TREATMENT TRAUMA-ASSOCIATED PLEURAL SPACE PATHOLOGY TRAUMA-ASSOCIATED PULMONARY INJURIES TRAUMA-ASSOCIATED THORACIC WALL INJURIES

Penetrating Thoracic Injury Rib Fractures

TRAUMA-ASSOCIATED MYOCARDIAL INJURY

Arrhythmias Pericardial Effusion

TRAUMA-ASSOCIATED MEDIASTINAL INJURY

Pneumomediastinum Tracheal Avulsion

TRANSFUSION IN ANEMIC DOGS AND CATS PRETRANSFUSION TESTING IN ANEMIC DOGS AND CATS TRANSFUSION FOR BLOOD LOSS ANEMIA TRANSFUSION FOR IMMUNE-MEDIATED HEMOLYTIC ANEMIA TRANSFUSION FOR ANEMIA OF ERYTHROPOIETIC FAILURE ADMINISTRATION CONSIDERATIONS IN TRANSFUSION FOR ANEMIA POSTTRANSFUSION MONITORING IN DOGS AND CATS TRANSFUSED FOR ANEMIA ADVERSE EVENTS ASSOCIATED WITH RED BLOOD CELL ADMINISTRATION POTENTIAL LONG-TERM PROBLEMS AFTER TRANSFUSIONS FOR ANEMIC DOGS AND CATS TRANSFUSION IN COAGULOPATHIC DOGS AND CATS PRETRANSFUSION TESTING IN COAGULOPATHIC DOGS AND CATS ADMINISTRATION AND MONITORING OF PLASMA PRODUCT TRANSFUSIONS TRANSFUSION FOR SPECIFIC COAGULOPATHY POSTTRANSFUSION MONITORING IN DOGS AND CATS TRANSFUSED FOR COAGULOPATHY ADVERSE EVENTS ASSOCIATED WITH TRANSFUSION FOR COAGULOPATHY TRANSFUSIONS IN PATIENTS WITH DECREASED COLLOID OSMOTIC PRESSURE ADVERSE EVENTS ASSOCIATED WITH TRANSFUSION FOR DECREASED COLLOID OSMOTIC PRESSURE TRANSFUSIONS IN PATIENTS WITH MISCELLANEOUS DISORDERS

Failure of Passive Transfer Immune-Mediated Disorders

EIGHT MAJOR CATEGORIES OF RESPIRATORY DISTRESS RADIOGRAPHY ADDITIONAL DIAGNOSTICS CONCLUSION CASE HISTORY STABILIZING THE PATIENT TOXICOLOGIC VERSUS NONTOXICOLOGIC FOOD-RELATED ILLNESS DIAGNOSING A FOOD-RELATED ILLNESS REQUIRES AN ADEQUATE DIETARY HISTORY AND A SAMPLE OF THE SUSPECTED FOOD OBTAIN ALL AVAILABLE CLINICAL, LABORATORY, AND PATHOLOGIC DATA IDENTIFY COMPOUNDS OR CLASSES OF COMPOUNDS THAT HAVE BEEN REPORTED TO CAUSE CLINICAL, LABORATORY AND PATHOLOGIC FINDINGS CONSISTENT WITH THE INFORMATION AVAILABLE TEST THE FOOD TO CONFIRM THE PRESENCE OF THE SUSPECTED COMPOUND AND TO CONFIRM THE DIAGNOSIS CROTALIDS (PIT VIPERS) ELAPIDS (CORAL SNAKES) Latrodectus spp. (WIDOW SPIDERS) LOXOSCELIDAE (RECLUSE OR BROWN SPIDERS) TICK PARALYSIS HYMENOPTERAN STINGS (INSECT BITES) HELODERMATIDAE LIZARD (GILA MONSTER) PLANTS KNOWN TO CAUSE SERIOUS SYSTEMIC EFFECTS

Lily (Lilium spp. and Hemerocallis spp.) Oleander (Nerium oleander), Lily of the Valley (Convallaria majallis), Kalanchoe (Kalanchoe spp.) Azalea (Rhododendron spp.) Sago Palm (Cycas spp.) Jequirity Bean (Abrus precatorius), Castor Bean (Ricinus communis) Autumn Crocus (Colchicum autumanale), Glory Lily (Gloriosa spp.) Yew (Taxus spp.) Yesterday, Today, and Tomorrow (Brunfelsia spp.)

PLANTS WITH LESS SERIOUS SYSTEMIC EFFECTS

Oxalate-Containing Plants

Insoluble Crystals

Stomatitis and glossitis Ocular Systemic

Soluble Crystals

ORNAMENTAL HOLIDAY PLANTS BULBS CHINABERRY TREE Dracaena spp. IVY NETTLE SOLANINE-CONTAINING PLANTS MINOR OUTCOMES

Zinc Oxide Ointment Corticosteroid Ointments and Solutions Antibiotic Ointments

MODERATE OUTCOMES

Tea Tree (Melaleuca) Oil Nicotine Transdermal Patches

MAJOR OUTCOMES

Fentanyl Transdermal Patches

SALICYLATES (ASPIRIN, OIL OF WINTERGREEN, ETC.)

5-Fluorouracil (5-FU)

DRUGS OF ABUSE: PRESCRIPTION DRUGS AND ILLICIT DRUGS PRESCRIPTION DRUGS

Amphetamines/Amphetamine-Like Compounds Sedative/Hypnotics Opioids Ketamine

STREET DRUGS

Marijuana Cocaine Heroin Club Drugs Hallucinogens

SOLVENTS AND ALCOHOLS

Acetone Isopropanol and Ethanol

ACIDS AND ALKALIS BLEACHES SOAPS, DETERGENTS, GENERAL CLEANERS, FABRIC SOFTENERS

Soaps Laundry and Automatic Dishwashing Detergents Liquid Fabric Softeners and Disinfectants Dryer and Fabric Softener Sheets

PATHOPHYSIOLOGY OF TARGET ORGAN DAMAGE

Overview Ophthalmologic Changes

Hypertensive Retinopathy Hypertensive Choroidopathy Hypertensive Optic Neuropathy

Neurologic Changes Renal Changes Cardiovascular Changes

BLOOD PRESSURE ASSESSMENT DEFINITION OF NORMAL VALUES APPROACH TO PATIENT GROUPS

Overview Apparently Healthy Patients Patients with Clinical Signs of Ocular or Neurologic TOD Patients at Risk for Hypertension without Evidence of Ocular or Neurologic TOD

ANGIOTENSIN-CONVERTING ENZYME INHIBITORS CALCIUM CHANNEL BLOCKERS ADRENERGIC BLOCKING AGENTS OTHER ANTIHYPERTENSIVE MEDICATIONS

Diuretics Other Drug Therapy

ADJUNCTIVE THERAPY MONITORING THERAPY CLINICAL MANIFESTATIONS PATHOGENESIS Decreased Preload

Hypovolemia Decreased Venous Return

Decreased Cardiac Function Decreased Vascular Tone MEASUREMENT OF BLOOD PRESSURE TREATMENT DIAGNOSTIC PLAN BACTERIAL SUSCEPTIBILITY TESTING

Usually Susceptible Bacteria Problem, or Resistant Bacteria

Staphylococcus Gram-Negative Bacteria

BACTERIAL SUSCEPTIBILITY TESTING

MIC Determination

PENETRATION TO THE SITE OF INFECTION

Diffusion into Tissues

Barriers to Diffusion

LOCAL FACTORS THAT AFFECT ANTIBIOTIC EFFECTIVENESS PHARMACOKINETIC-PHARMACODYNAMIC (PK-PD) PRINCIPLES

Aminoglycosides Fluoroquinolones β-Lactam Antibiotics Other Time-Dependent Drugs

EMPIRICAL TREATMENT BASED ON TISSUE SITE

Skin/Soft Tissue Infection Urinary Tract Infection Respiratory Infections Intracellular Infections, Flea- and Tick-Transmitted Infections Sepsis and Fever

Oral Drugs Injectable Drugs

AMPHOTERICIN B AZOLE DERIVATIVES GRISEOFULVIN

5-Flucytosine

ALLYLAMINES IODIDES ECHINOCANDINS ANALGESICS ANTIHISTAMINES (H1) ANTIDIARRHEALS LAXATIVES, CATHARTICS, AND ENEMAS ANTIEMETICS EMETICS ANTITUSSIVES GASTRIC ACID REDUCERS TOPICAL DRUG THERAPY CONCLUSIONS PHYSIOLOGY Metabolic Effects Dermal Effects Cardiovascular Effects Gastrointestinal and Hepatic Effects Renal Effects Neurologic and Muscular Effects Endocrine Effects Hematopoietic Effects Inflammatory and Immunologic Effects Miscellaneous Effects PHARMACOLOGY CLINICAL UTILITY

Low-Dose Dexamethasone Suppression Test High-Dose Dexamethasone Suppression Test Physiologic Replacement Therapy Antiinflammatory Therapy Immunosuppressive Therapy Antineoplastic Therapy Miscellaneous Therapeutic Uses

ADVERSE EFFECTS GLUCOCORTICOID REDUCTION PROTOCOLS PHARMACOLOGY ADVERSE EFFECTS GENERAL CONSIDERATIONS INDICATIONS FOR NSAIA ADMINISTRATION

Postoperative Pain Inflammatory Conditions Miscellaneous Conditions Osteoarthritis

PYREXIA CONTRAINDICATIONS FOR THE USE OF NSAIAs NSAIAs NOT APPROVED FOR USE IN VETERINARY PATIENTS (OFF-LABEL USE) NSAIAs OF THE FUTURE CONCLUSION REGULATORY ASPECTS GENERAL GUIDELINES FOR DIETARY SUPPLEMENT SELECTION ANTIOXIDANT NUTRACEUTICALS OF CURRENT INTEREST

Antioxidants and Free Radical Damage Vitamin E Beta-Carotene Antioxidant Combinations

OTHER NUTRACEUTICALS OF INTEREST

Chondroprotective Agents Polyunsaturated Fatty Acids

VETERINARY COMPOUNDED DRUGS: REGULATIONS UNDERSTANDING RISKS VERSUS BENEFITS WITH COMPOUNDED DRUGS

Pharmaceutical Issues Transdermal Delivery of Drugs in Organogels

COMPOUNDING BY THE VETERINARIAN AND PHARMACIST: ROLES AND RESPONSIBILITIES CLASSIFICATION INCIDENCE DIFFICULTIES IN DIAGNOSIs IDENTIFICATION FACTORS THAT INFLUENCE TYPE A ADRs PHARMACOGENETIC DIFFERENCES TYPE B ADVERSE DRUG REACTIONS (HYPERSENSITIVITY) PSEUDOALLERGIC DRUG REACTIONS FERMENTED DAIRY PRODUCTS Gastrointestinal and Hepatic Respiratory Urogenital Dermatologic Miscellaneous POTENTIAL USE OF PROBIOTICS IN DOGS AND CATS STABILITY IN STORAGE AND HANDLING SAFETY AND POTENTIAL ADVERSE REACTIONS CONCLUSION WHAT IS NUTRITIONAL GENOMICS? HOW IS GENE EXPRESSION CONTROLLED? APPLICATION OF NUTRIGENOMICS TO VETERINARY PRACTICE SUMMARY TAKING A DIET HISTORY PATIENT ASSESSMENT SPECIAL CONSIDERATIONS REGARDING ASSISTED FEEDING MONITORING NUTRITIONAL INTERVENTIONS BODY WEIGHT BODY CONDITION SCORE CACHEXIA SCORE MORPHOMETRIC MEASUREMENTS DILUTION TECHNIQUES

Total Body Water (TBW) Extracellular Fluid (ECF)

BIOELECTRICAL IMPEDANCE ANALYSIS (BIA) DUAL-ENERGY X-RAY ABSORPTIOMETRY (DEXA) SUMMARY NUTRITIONAL REQUIREMENTS FOR IMMUNITY

Fuel and Cell Division Antioxidants

EFFECTS OF MALNUTRITION ON IMMUNITY

Obesity

EFFECTS OF IMMUNE RESPONSES ON NUTRITION

Recommendations for Feeding in Severe Inflammatory Diseases

NUTRITIONAL MODULATION OF IMMUNITY

Polyunsaturated Fatty Acids Genistein, Carotenoids, and Arginine

DEFINITION

HOW IS OBESITY A DISEASE?

Obesity and Low-Grade Inflammation Obesity, Insulin Resistance, and Type 2 Diabetes Mellitus Obesity, Insulin Resistance, Dyslipidemia, Coronary Heart Disease

Dyslipidemia Cardiac Failure Hypertension (HT)

Obesity and Osteoarthritis Obesity-Related Kidney Disease Obesity and Cancer Miscellaneous PATHOPHYSIOLOGY Frequency Risk Factors Energy Balance

The Principles of Energy Balance Overestimation of Energy Expenditure and Requirement

Dysregulation of Food Intake Quality of Dietary Intake

NUTRITIONAL TREATMENT

Level of Energy Restriction Modification in Nutrient Content

Low-Calorie Diets Low-Calorie Diets: Low-Fat and High-Fiber Low-Calorie Diets and Essential Nutrients Low-Calorie Homemade Diets

Special and Nutraceutical Ingredients

Lipase Inhibitors Green Tea Catechins, Thermogenic Ingredients Factors Affecting Metabolism and Nutrient Partitioning

Pharmaceutical Aids

Tetrahydrolipostatin, a Lipase Inhibitor Dirlotapide and Mitratapide, Inhibitors of MTP

Rationing in Practice

Dietary History Clinical Examination Selection of Food Energy and Food Allocation Additional Advice

NUTRIENTS: THE IMPORTANCE OF PROTEIN AND AMINO ACIDS IN CATS NUTRIENTS: THE DIFFERENCES BETWEEN CARBOHYDRATE AND FAT METABOLISM FELINE NUTRITION ESSENTIALS: VITAMINS AND MINERALS WATER FELINE FEEDING BEHAVIOR AND PREFERENCES FELINE NUTRITION: WHAT IS AN APPROPRIATE AMOUNT OF FOOD? PERIODONTAL DISEASE, THE SINGLE MOST IMPORTANT DISEASE IN THE MOUTH OF DOGS AND CATS DENTAL PLAQUE AS THE CAUSE OF PERIODONTAL DISEASE INFLUENCE OF DIET COMPOSITION INFLUENCE OF DIET CONSISTENCY (“HARD” VERSUS “SOFT” DIETS) PERIODONTAL DISEASE CONTROL THROUGH DIETARY MEANS

Brushing Teeth Effect on Calculus Accumulation Effect on Plaque Accumulation Effect on Gingivitis (Periodontal Disease Development)

FOOD INTAKE AND PALATABILITY GENERAL FEEDING RECOMMENDATIONS MEETING ENERGY NEEDS PROTEINS AND AMINO ACIDS MINERALS AND VITAMINS

Minerals Vitamins

TAURINE ESSENTIAL FATTY ACIDS OTHER NUTRIENTS AND NUTRACEUTICALS FEEDING THE PUPPY FEEDING THE KITTEN REARING NURSING PUPPIES AND KITTENS NUTRITIONAL SECONDARY HYPERPARATHYROIDISM CLINICAL AND RADIOLOGIC EXAMINATION DIFFERENTIAL DIAGNOSIS THERAPY RICKETS CLINICAL AND RADIOLOGIC EXAMINATION TREATMENT DEVELOPMENTAL ORTHOPEDIC DISEASE CANINE HIP DYSPLASIA CLINICAL AND RADIOLOGIC EXAMINATION OSTEOCHONDROSIS CLINICAL AND RADIOLOGIC EXAMINATION DEVELOPMENTAL ORTHOPEDIC DISEASE TREATMENT TERMINOLOGY FOOD ALLERGENS FOOD INTOLERANCE CLINICAL FEATURES

Dermatologic Responses in Dogs Dermatologic Responses in Cats Gastrointestinal Responses in Dogs and Cats

DIAGNOSIS

Homemade Elimination Foods Commercial Elimination Foods Performing an Elimination Trial in Patients with Dermatologic Disease Performing an Elimination Trial in Patients with Gastrointestinal Disease

TREATMENT GENERAL GUIDELINES ROLE OF CONSISTENCY, FREQUENCY, AND MEAL SIZE DIET COMPOSITION PROTEIN FATS AND FATTY ACIDS CARBOHYDRATES/DIETARY FIBER NUTRITIONAL DEFICIENCIES RESULTING FROM GASTROINTESTINAL DISEASE METABOLIC ENERGY AND PROTEIN REQUIREMENTS IN CHRONIC HEPATIC DISEASE NUTRACEUTICALS IN HEPATIC DISEASE COPPER-RESTRICTED DIETS VITAMIN AND MINERAL SUPPLEMENTATION NUTRITIONAL INTERVENTION IN HEPATIC ENCEPHALOPATHY HEPATIC LIPIDOSIS IN CATS DIABETES MELLITUS

Using Fiber to Minimize the Rapid Absorption of Glucose Using a Low-Carbohydrate Food to Minimize the Absorption of Glucose Low-Carbohydrate Foods and Dietary Fat Intolerance Using Foods with a Low Glycemic Index to Minimize the Absorption of Glucose Weight Management in the Diabetic Patient

HYPERADRENOCORTICISM AND HYPOTHYROIDISM FELINE IDIOPATHIC HYPERCALCEMIA OPTIMAL WEIGHT MAINTENANCE

Cachexia Obesity

MODULATION OF SPECIFIC NUTRIENTS

Protein and Taurine

Protein Taurine

Fat Minerals

Sodium Potassium Magnesium

Vitamins

B Vitamins

Other Nutrients

Carnitine Antioxidants Coenzyme Q10

PRACTICAL ASPECTS OF FEEDING THE PATIENT WITH HEART DISEASE UROLITHIASIS GENERAL MANAGEMENT OF UROLITHIASIS

Stimulate Diuresis Effect of Dietary Sodium on Blood Pressure and Renal Function Adjusting Urine pH

UROLITHIASIS

Struvite Uroliths Calcium Oxalate Uroliths Calcium Phosphate Uroliths Urate Uroliths Cystine Uroliths

MISCELLANEOUS UROLITHS IDIOPATHIC DISEASE CONCLUSION OVERVIEW NUTRITIONAL ASSESSMENT GOALS OF NUTRITIONAL SUPPORT THE NUTRITIONAL PLAN CALCULATING NUTRITIONAL REQUIREMENTS NUTRITIONAL SUPPORT PARENTERAL NUTRITION

Types of Parenteral Nutrition

COMPONENTS OF PARENTERAL NUTRITION PARENTERAL NUTRITION COMPOUNDING PARENTERAL NUTRITION ADMINISTRATION COMPLICATIONS MONITORING SUMMARY TWO-STEP PROCESS OF DOGS AND CATS WITH RENAL DISEASE

Assessment Phase

Assess the Patient Assess the Diet

Energy Fatty acids Antioxidants Water-soluble vitamins Electrolytes Acid-base balance Moisture Protein Minerals

Assess the Feeding Method

Initiation and Monitoring Phase

Selection of Diet

Energy Fatty acids Antioxidants Water-soluble vitamins Electrolytes Acid-base balance Moisture Protein Minerals Clinical studies of dietary modification in dogs and cats with chronic renal failure

Selection of Feeding Method Monitoring Patient Response

PATHOPHYSIOLOGY CLASSIFICATION CLINICAL FEATURES DIAGNOSIS MANAGEMENT CONCLUSION RATIONALE FOR ENTERAL NUTRITIONAL SUPPORT PATIENT SELECTION FOR NUTRITIONAL SUPPORT CALCULATION OF NUTRITIONAL REQUIREMENTS DIET SELECTION NUTRITIONAL ADEQUACY METHODS FOR EVALUATING NUTRITIONAL ADEQUACY OF HOME-PREPARED FOODS ADDITIONAL CONCERNS WITH RAW FOOD FEEDING INDICATIONS FOR HOME-COOKED DIETS CLINICAL CLUES IN THE HISTORY AND PHYSICAL EXAMINATION FINDINGS

Historical Clues Suspicious Physical Examination Findings

PROBLEM-ORIENTED APPROACH TO DIFFERENTIAL DIAGNOSIS Generalized Pustular Eruptions and/or Crusting Dermatoses (Involving the Body, Head, Face, or Feet) Focal Pustular Eruptions and/or Focal Crusting Mucocutaneous and Mucosal Ulcerations Nonmucosal Ulcerations (Axillae, Inguina, Pinnae, or Other Haired Areas) Depigmenting Skin Diseases Miscellaneous Skin Biopsy Antinuclear Antibody Testing Direct Immunofluorescence Testing Indirect Immunofluorescence Testing THE SPECTRUM OF IMMUNE-MEDIATED DISEASE ETIOLOGY, PATHOGENIC MECHANISMS, AND THE ROLE OF INFECTION Direct antiglobulin (Coombs’) test Antinuclear antibodies Rheumatoid factor Antiplatelet antibodies Antineutrophil antibodies Thyroxine (3,5,3′,5′-tetraiodothyronine; T4), 3,4,3′-triiodothyronine (T3), and thyroglobulin autoantibodies Acetylcholine receptor autoantibodies 2M myofiber autoantibodies Central Nervous System Musculoskeletal System Gastrointestinal tract Fluid and Electrolyte Balance Metabolic Endocrine Immune System Methotrexate Cytosine arabinoside (cytarabine) Leflunomide Mycophenolate mofetil Levamisole Practical guidelines for therapy Problems and solutions in therapy of immune-mediated disease BACTERIAL INFECTIVE ARTHRITIS (SEPTIC ARTHRITIS, SUPPURATIVE ARTHRITIS) LYME ARTHRITIS BACTERIAL L-FORMS AND ARTHRITIS MYCOPLASMAL ARTHRITIS FUNGAL ARTHRITIS RICKETTSIAL ARTHRITIS PROTOZOAL ARTHRITIS VIRAL ARTHRITIS IMMUNE-MEDIATED ARTHRITIDES

Erosive Immune-Based Arthritides

Rheumatoid Arthritis Periosteal Proliferative Polyarthritis

Nonerosive Immune-Based Arthritis

Systemic Lupus Erythematosus Polyarthritis/Polymyositis Syndrome Polyarthritis/Meningitis Syndrome Sjögren’s Syndrome Familial Shar-Pei Fever Polyarthritis of the Adolescent Akita Polyarteritis Nodosa Drug-Induced Arthritis Vaccination Reactions Idiopathic Polyarthritis TREATMENT

CANINE

ETIOPATHOGENESIS PATHOLOGY

Molecular Events in Osteoarthritis DIAGNOSIS

History and Clinical Signs Diagnostic Imaging Laboratory Findings TREATMENT AND MANAGEMENT OPTIONS

General and Supportive Measures and Lifestyle Changes

Obesity Exercise

Passive movement Active assisted exercise Active resisted exercise Controlled voluntary movement

Other Physical Therapies

Medical Treatment of Osteoarthritis

Nonsteroidal Anti-Inflammatory Drugs Corticosteroids Pentosan Polysulphate

Nutritional Supplementation

Chondroitin Sulphate Glucosamine Glucosamine and Chondroitin in Combination

Which product to use?

Essential Fatty Acids

Viscosupplements Multimodal Drug Therapy Other Treatments Surgical Treatment of Osteoarthritis

FELINE PREVALENCE ETIOPATHOGENESIS CLINICAL FEATURES DIAGNOSTIC IMAGING

Elbow Joint Hip Joint Stifle Joint Shoulder Joint Hock and Carpus TREATMENT Supportive Measures Environmental Enrichment NSAIDs Nutritional Supplements CONCLUSION

REGENERATIVE BONE MARROW RESPONSE IMMUNE-MEDIATED HEMOLYTIC ANEMIA

PATHOPHYSIOLOGY

Infectious Neoplastic Inflammatory Drugs/Toxins

PATIENT PRESENTATION

Signalment, Seasonality of Presentation, and Possible Association with Recent Vaccination CLINICAL PRESENTATION

DIAGNOSIS

Complete Blood Count, Serum Biochemical Profile, and Urine Analysis Saline Agglutination Test Detection of Antierythrocyte Antibodies Diagnostic Imaging Ancillary Testing

THERAPY

Supportive Care and Transfusion Therapy Immunosuppressive Therapy Thromboprophylaxis Chronic Disease Management PROGNOSIS

Feline IMHA

OTHER HEMOLYTIC ANEMIAS

Alloimmune Hemolysis: Transfusion Reactions Alloimmune Hemolysis: Neonatal Isoerythrolysis Infection-Associated Hemolysis Erythrocyte Metabolic Defects

Oxidative Damage: Heinz Body and Eccentrocytic Hemolysis Hereditary Hemolytic Anemias Hereditary Hemolytic Anemias: Membrane Defects

Stomatocytosis Increased osmotic fragility

Hereditary Hemolytic Anemias: Erythroenzymopathies Hypophosphatemia

Microangiopathic Anemias Envenomation Histiocytic Disorders Blood Loss Anemia Chronic Blood Loss and Iron Deficiency

PRIMARY HEMOSTASIS

Platelet Physiology Platelet–von Willebrand Factor Interaction

DIAGNOSIS OF PLATELET DISORDERS

Clinical Signs of Primary Hemostatic Defects Screening Tests Testing for Quantitative Platelet Defects Thrombocytosis Platelet Function Tests

SPECIFIC PLATELET DISORDERS

Thrombocytopenia Acquired Platelet Dysfunction Hereditary Platelet Dysfunction von Willebrand Disease Disease Classification Diagnosis of von Willebrand Disease Inheritance and Expression

TREATMENT OF PLATELET DISORDERS AND VON WILLEBRAND DISEASE

Nontransfusion Therapy Transfusion Therapy

PATHOGENESIS

Effectors Genetics Environmental Factors Drugs Infectious Agents

CLINICAL FINDINGS DIAGNOSIS SPECIFIC TESTING

LE Cell Test Antinuclear Antibodies Autoantibodies

Antibodies to DNA Extractable Nuclear Antigens Antihistone Antibodies Antiphospholipid Antibodies

MANAGEMENT PROGNOSIS IN VETERINARY PATIENTS CLINICAL SIGNS OF ANEMIA SYMPTOMATIC TREATMENT DIFFERENTIAL DIAGNOSIS

Detection of Regeneration

Clerical and Laboratory Error Subtle or Elapsed Regeneration Inappropriate Regeneration

Delay in Regeneration (Preregenerative Anemia) Destruction of Bone Marrow

Cytotoxic Drugs, Toxins, and Radiation Infectious Diseases Bone Marrow Necrosis

Deficiency of Nutrients Required for Erythropoiesis

Iron Deficiency and other Causes of Microcytic Hypochromic Anemia Folate and Cobalamin Deficiency Starvation

Development Dam Deep in the Bone Marrow

Nonregenerative Immune-Mediated Hemolytic Anemia Feline Leukemia Virus Infection

Diversion of Hematopoietic Cells

Acute Myeloid (Myelogenous) Leukemia (AML) Myelodysplastic Syndrome (MDS)

Displacement of Erythroid Tissue (Myelophthisis) Depression by Disease (“Anemia of Chronic Disease”)

Anemia of Inflammatory Disease (AID) and Cancer-Associated Anemia Feline Immunodeficiency Virus (FIV) Chronic Liver and Kidney Disease Endocrine Disorders Critical Illness

Dilution (Pseudoanemia)

Fluid Therapy Pregnancy

Drugs

VITAMIN K DEFICIENCY LIVER DISEASE NEOPLASIA DISSEMINATED INTRAVASCULAR COAGULATION THROMBOSIS ACQUIRED ANTICOAGULANTS OVERVIEW OF LEUKOCYTE PRODUCTION AND KINETICS NEUTROPHILS AND THEIR DISORDERS EOSINOPHILS AND THEIR DISORDERS BASOPHILS AND THEIR DISORDERS LYMPHOCYTES AND THEIR DISORDERS MONOCYTES AND THEIR DISORDERS INTERPRETING THE LEUKOGRAM LEUKOCYTE MORPHOLOGY OR FUNCTION ABNORMALITIES

Canine Leukocyte Adhesion Deficiency Chédiak-Higashi Syndrome Cyclic Hemopoiesis Neutrophil Anomaly of Birman Cats Pelger-Huët Anomaly Neutrophil Function Defects Lysosomal Storage Diseases Infectious Agents as Inclusions in Peripheral Blood Leukocytes Miscellaneous Leukocytes and Leukocyte Morphology

PREVALENCE CLINICAL MANIFESTATIONS DIAGNOSTIC APPROACH

Abdominal Radiography Abdominal Ultrasonography Fine Needle Aspiration Splenic Biopsies/Splenectomy Other Diagnostic Tests

COMMON CAUSES OF SPLENOMEGALY IN DOGS AND CATS: NEOPLASTIC DISEASES

Malignant Tumors of the Canine Spleen

Hemangiosarcoma DIAGNOSIS AND CLINICAL STAGING TREATMENT

Nonangiomatous, Nonlymphoid Sarcomas of the Spleen

Histiocytic Sarcoma

Benign Tumors of the Canine Spleen Metastatic Tumors of the Canine Spleen Malignant Tumors of the Feline Spleen

Mast Cell Tumor Feline Splenic Hemangiosarcoma Other Malignant Tumors

Benign Tumors of the Feline Spleen Metastatic Tumors of the Feline Spleen

COMMON CAUSES OF SPLENOMEGALY IN DOGS AND CATS: NONNEOPLASTIC DISEASES

Congestion Splenic Infarction Splenic Hyperplasia/Extramedullary Hematopoiesis Nodular Hyperplasia/Hematoma Inflammatory Splenomegaly

PATIENT WITH A SPLENIC NODULE GENERAL MANAGEMENT OF A PATIENT WITH SPLENIC DISEASE BONE PATHOPHYSIOLOGY

Structural Organization of Bone Bone Growth and Development

Modeling of Bone

Normal and Pathologic Bone Remodeling

DIAGNOSIS OF BONE DISEASE

History and Signs Physical Examination Radiology

Bone Loss Bone Production

Nuclear Imaging Computed Tomography Magnetic Resonance Imaging Chemistry Hematology Biopsy and Histopathology Cytology Microbiology

CONGENITAL BONE DISORDERS Osteochondrodysplasias (Abnormalities of Cartilage, Bone Growth, and Development) Primary Metabolic Abnormalities Dysostoses with Malformation of Individual Bones, Singly or in Combination

Hemimelia, Phocomelia, and Amelia Syndactyly Polydactyly Ectrodactyly Segmental Hemiatrophy

DEVELOPMENTAL AND GENETIC BONE DISORDERS

Osteopetrosis Osteogenesis Imperfecta Mucopolysaccharidosis Dwarfism

Nonendocrine Endocrine

Skeletal Dysplasias (Osteochondrodysplasias)

Alaskan Malamute Chondrodysplasia7,72 Beagle Multiple Epiphyseal Dysplasia7,72 Bull Terrier Osteochondrodysplasia73 English Pointer Enchondrodystrophy7,74,75 Great Pyrenees Chondrodysplasia7,72,76 Irish Setter Hypochondroplasia77 Labrador Retriever Ocular-Skeletal Dysplasia7,78 Miniature Poodle Multiple Enchondromatosis79,80 Miniature Poodle Multiple Epiphyseal Dysplasia72 Miniature Poodle Pseudoachondroplasia7,72 Newfoundland Osteochondrodysplasia81,82 Norwegian Elkhound Chondrodysplasia7,72 Samoyed Ocular-Skeletal Dysplasia7,83,84 Scottish Deerhound Pseudoachondroplasia (Osteochondrodysplasia)85,86

Pituitary Dwarfism Congenital Hypothyroidism Retained Cartilage Cores Craniomandibular Osteopathy Multiple Cartilaginous Exostoses

IDIOPATHIC BONE DISORDERS

Enostosis Metaphyseal Osteopathy Calvarial Hyperostosis Multifocal Osteopathy Avascular Necrosis of the Femoral Head Secondary Hypertrophic Osteopathy Medullary Bone Infarction Bone Cyst Aneurysmal Bone Cyst Subchondral Bone Cyst Fibrous Dysplasia Central Giant Cell Granuloma

METABOLIC, NUTRITIONAL, AND ENDOCRINE BONE DISORDERS

Nutritional Secondary Hyperparathyroidism Rickets Renal Osteodystrophy Hypervitaminosis A Other Endocrine and Nutritional Bone Disorders

Primary Hyperparathyroidism Humoral Hypercalcemia of Malignancy Hyperadrenocorticism Hypogonadism Hepatic Osteodystrophy Anticonvulsant Osteodystrophy Hypovitaminosis A Hypervitaminosis D Zinc-Responsive Chondrodysplasia

Copper Deficiency

Lead Poisoning Overnutrition in Growing Dogs

NEOPLASTIC BONE DISEASE176 BONE INFECTION PATHOPHYSIOLOGY DIAGNOSIS TREATMENT ORGANISM DETECTION

Culture Cytology and Histopathology Fecal Examination Immunologic Techniques Nucleic Acid Amplification Techniques

ANTIBODY DETECTION

Serum Antibodies Antibodies in Body Fluids

VACCINE TECHNOLOGY

Inactivated Vaccines Modified-Live (or Attenuated) Vaccine Recombinant Vaccine DNA Vaccine

CORE VACCINES

Canine Initial Vaccination Series Canine Adult Vaccination Canine Adult Primary Vaccination Canine High Exposure Risk Feline Initial Vaccination Series Feline Adult Vaccination Feline High Exposure Risk

NONCORE VACCINES

Canine Bordetella bronchiseptica and Parainfluenza Leptospirosis Borrelia burgdorferi (Lyme Borreliosis) Feline Leukemia Virus Feline Immunodeficiency Virus Chlamydophila felis (formerly Chlamydia psittaci)* Bordetella bronchiseptica

MISCELLANEOUS VACCINES

Crotalus atrox Toxoid Porphyromonas Vaccine Virulent Systemic Feline Calicivirus (VS-FCV) Vaccine

VACCINES GENERALLY NOT RECOMMENDED NEW VACCINES ETIOLOGY EPIDEMIOLOGY PATHOGENESIS DIAGNOSIS SIGNALMENT AND HISTORY CLINICAL SIGNS CLINICOPATHOLOGIC DATA IMAGING SPECIFIC TESTING IDENTIFICATION IN TISSUE TREATMENT PREVENTION LEPTOSPIROSIS IN CATS PUBLIC HEALTH CONSIDERATIONS ETIOLOGY PATHOGENESIS CLINICAL SIGNS DIAGNOSING LYME DISEASE

Bacterial Culture Serology Western Blot Interpreting the Results of Lyme Testing in a Dog with Clinical Signs Screening Nonclinical Dogs for Borellia Infection TREATMENT Treating Nonclinical Dogs PREVENTION

LYME NEPHRITIS BORRELIOSIS IN CATS PUBLIC HEALTH CONSIDERATIONS TUBERCULOSIS

CLINICAL BACKGROUND

Epidemiology and Etiopathogenesis Predisposition Clinical Signs

MAC Infections

DIAGNOSTIC TECHNIQUES

Nonspecific Tests Specific Tests Correct Handling of Biopsy Material Gross and Histopathology

MANAGEMENT

Interim Management Treatment of Choice Prognosis

FELINE LEPROSY

CLINICAL BACKGROUND

Epidemiology and Etiopathogenesis Predisposition Clinical Signs

DIAGNOSTIC TECHNIQUES

MANAGEMENT

Interim Management Treatment of Choice Prognosis

CANINE LEPROID GRANULOMA SYNDROME (CANINE LEPROSY)

Epidemiology and Etiopathogenesis Predisposition Clinical Signs Diagnosis Treatment and Prognosis

DISEASE CAUSED BY NONTUBERCULOUS MYCOBACTERIA (NTM)

CLINICAL BACKGROUND

Epidemiology and Etiopathogenesis Predisposition Clinical Signs

DIAGNOSTIC TECHNIQUES

Cytology and Histopathology Culture

MANAGEMENT

Interim Management Treatment of Choice Prognosis

ETIOLOGY PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION BRUCELLOSIS IN CATS PUBLIC HEALTH CONSIDERATIONS ETIOLOGY PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PROGRESSION AND PROGNOSIS PREVENTION ETIOLOGY PATHOGENESIS CLINICAL SYMPTOMS DIAGNOSIS THERAPY PREVENTION DISEASE MANIFESTATIONS SEROPREVALENCE DIAGNOSTIC CONSIDERATIONS TREATMENT PREVENTION PUBLIC HEALTH CONSIDERATIONS EPIDEMIOLOGY PATHOGENESIS CLINICAL FINDINGS DIAGNOSIS

Clinical Laboratory Findings and Pathologic Findings Bacterial Isolation Serologic Testing Nucleic Acid Detection THERAPY PREVENTION

PUBLIC HEALTH SUMMARY GENERAL CONSIDERATIONS THE EHRLICHIOSES

Ehrlichia canis

ETIOLOGY AND EPIDEMIOLOGY PATHOGENESIS AND CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION AND PUBLIC HEALTH SIGNIFICANCE

Ehrlichia chaffeensis Ehrlichia ewingii

ANAPLASMOSIS

Anaplasma phagocytophilum

ETIOLOGY AND EPIDEMIOLOGY CLINICAL SIGNS DIAGNOSIS AND TREATMENT PUBLIC HEALTH SIGNIFICANCE

Anaplasma platys

NEORICKETTSIOSES

Neorickettsia helminthoeca Neorickettsia risticii

TICK-BORNE RICKETTSIOSES

General Considerations Rocky Mountain Spotted Fever

ETIOLOGY AND EPIDEMIOLOGY PATHOGENESIS AND CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION PUBLIC HEALTH ASPECTS

Feline Ehrlichioses

ENTERIC PROTOZOAL DISEASES POLYSYSTEMIC PROTOZOAL DISEASES COCCIDIANS

Hepatozoonosis Neosporosis Toxoplasmosis

FLAGGELATES

Leishmaniasis Trypanosomiasis

PIROPLASMIA

Babesiosis Cytauxzoonosis

Clostridium perfringens PATHOGENESIS DIAGNOSIS THERAPY Clostridium difficile PATHOGENESIS DIAGNOSIS THERAPY Campylobacter spp. PATHOGENESIS DIAGNOSIS THERAPY Salmonella spp. PATHOGENESIS CLINICAL SIGNS DIAGNOSIS THERAPY PATHOGENIC Escherichia coli ENTEROTOXIGENIC E. coli (ETEC) ENTEROPATHOGENIC E. coli (EPEC) ENTEROHEMORRHAGIC E. coli (EHEC) (ALSO CALLED VEROTOXIGENIC E. coli) CLINICAL SIGNS DIAGNOSIS THERAPY GRANULOMATOUS COLITIS OF BOXERS (HISTIOCYTIC ULCERATIVE COLITIS) ZOONOTIC IMPLICATIONS FOR ENTERIC BACTERIA

Clostridium perfringens Clostridium difficile Campylobacter spp. Salmonella spp. Escherichia coli

INFECTION CONTROL IN THE HOSPITAL ETIOLOGY AND EPIDEMIOLOGY PATHOGENESIS CLINICAL SIGNS AND LABORATORY ABNORMALITIES DIAGNOSIS TREATMENT PREVENTION MULTIDRUG RESISTANT BACTERIA

Staphylococci Enterococci Enterobacteriaceae Pseudomonads Acinetobacter Other Bacteria

DIAGNOSIS AND TREATMENT OF NOSOCOMIAL INFECTIONS CONTROL STRATEGIES FOR NOSOCOMIAL INFECTION

Hand Hygiene Isolation or Barrier Nursing Environmental Cleaning Antimicrobial Stewardship

EPIDEMIOLOGY PATHOGENESIS DIAGNOSIS PREVENTION

Considerations for Animal Shelters MANAGEMENT

EPIDEMIOLOGY PATHOGENESIS

General Bone Marrow Disorders Neoplasia Secondary Infections Miscellaneous Disorders DIAGNOSIS PREVENTION MANAGEMENT

DIAGNOSIS

Laboratory Changes Analysis of Effusion Fluid Analysis of Cerebrospinal Fluid Antibodies Polymerase Chain Reaction (PCR) Antibody Antigen Complex Detection Immunofluorescence Staining of FCoV Antigen in Macrophages TREATMENT AND MANAGEMENT Prognosis Symptomatic Treatment Immune Modulators Antiviral Chemotherapy PREVENTION Management of Cats after Contact Management of Multicat Households with Endemic FCoV Vaccination

FELINE VIRAL RESPIRATORY DISEASE CAUSATIVE AGENTS CLINICAL SIGNS DIAGNOSIS TREATMENT EPIDEMIOLOGY PREVENTION AND CONTROL INFLUENZA IN CATS FELINE PANLEUKOPENIA/FELINE PARVOVIRUS (FPV) INFECTION BORNAVIRUS DISEASE (FELINE “STAGGERING DISEASE”) POXVIRUS INFECTION FELINE FOAMY VIRUS (FELINE SYNCYTIUM-FORMING VIRUS) INFECTION ASTROVIRUS FELINE REOVIRUS INFECTION ROTAVIRUS HANTAVIRUS INFECTION TOROVIRUS INFECTION CAUSE AND EPIDEMIOLOGY EXPOSURE AND RELATED CONSIDERATIONS CLINICAL SIGNS PATHOGENESIS DIAGNOSIS TREATMENT PREVENTION CANINE PARVOVIRUS

ETIOLOGY AND EPIDEMIOLOGY TRANSMISSION PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

CANINE DISTEMPER VIRUS

ETIOLOGY AND EPIDEMIOLOGY TRANSMISSION PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

CANINE ADENOVIRUS TYPE 1

ETIOLOGY AND EPIDEMIOLOGY TRANSMISSION PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

CANINE ADENOVIRUS TYPE 2 AND PARAINFLUENZA VIRUS

ETIOLOGY AND EPIDEMIOLOGY Transmission PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

CANINE INFLUENZA A SUBTYPE H3N8 VIRUS

ETIOLOGY AND EPIDEMIOLOGY Transmission PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

CANINE RESPIRATORY CORONAVIRUS

ETIOLOGY AND EPIDEMIOLOGY Transmission PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

CANINE ENTERIC CORONAVIRUS

ETIOLOGY AND EPIDEMIOLOGY TRANSMISSION PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

CANINE PANCYTOTROPIC CORONAVIRUS

ETIOLOGY AND EPIDEMIOLOGY TRANSMISSION PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

CANINE ROTAVIRUS

Etiology and Epidemiology TRANSMISSION PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

CANINE HERPESVIRUS

ETIOLOGY AND EPIDEMIOLOGY TRANSMISSION PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

CANINE PAPILLOMA VIRUS

ETIOLOGY AND EPIDEMIOLOGY TRANSMISSION PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

RABIES VIRUS

ETIOLOGY AND EPIDEMIOLOGY TRANSMISSION PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

PSEUDORABIES VIRUS

ETIOLOGY AND EPIDEMIOLOGY TRANSMISSION PATHOGENESIS CLINICAL SIGNS DIAGNOSIS TREATMENT PREVENTION

OTHER VIRUSES OF INTEREST

West Nile Virus Bornavirus

Differential Diagnosis for Nodular Skin Disease

Bacterial Skin Disease Mycotic and Miscellaneous Infectious Skin Disease Noninfectious Pyogranulomatous Skin Disease Neoplasia Miscellaneous Diseases

Differential Diagnosis for Chorioretinitis, Exudative Retinal Detachment, and Panophthalmitis

Fungal Neoplasia Miscellaneous Infectious Causes

ANTIFUNGAL AGENTS

Amphotericin B

ORAL AZOLE ANTIFUNGAL DRUGS Flucytosine ALLYLAMINES Glucan Synthase Inhibitors SPECIFIC SYSTEMIC MYCOSES

Blastomycosis PATHOPHYSIOLOGY CLINICAL SIGNS DIAGNOSIS TREATMENT PUBLIC HEALTH SIGNIFICANCE Histoplasmosis PATHOPHYSIOLOGY CLINICAL SIGNS

Large-Intestine Disease

Diet-Associated Colitis Idiopathic Colitis Parasitic and Protozoal Colitis Bacterial Colitis Candidiasis

Small-Intestine Disease

Idiopathic Inflammatory Bowel Disease Intestinal Lymphosarcoma DIAGNOSIS TREATMENT Sporotrichosis PATHOPHYSIOLOGY CLINICAL SIGNS DIAGNOSIS THERAPY PUBLIC HEALTH SIGNIFICANCE Candidiasis Pythiosis PATHOPHYSIOLOGY CLINICAL FINDINGS DIAGNOSIS THERAPY Lagenidiosis CLINICAL FINDINGS DIAGNOSIS TREATMENT Zygomycosis CLINICAL FINDINGS DIAGNOSIS TREATMENT

PATHOPHYSIOLOGY CLINICAL SIGNS DIAGNOSIS TREATMENT HISTORY AND MYCOLOGY PATHOPHYSIOLOGY AND EPIZOOTIOLOGY DIAGNOSIS THERAPY MYCOLOGY AND EPIZOOTIOLOGY LOCALIZED (SINONASAL) ASPERGILLOSIS PATHOPHYSIOLOGY DIAGNOSIS THERAPY DISSEMINATED ASPERGILLOSIS AFRICAN HORSE SICKNESS FLAVIVIRIDAE BUNYAVIRIDAE FOOT AND MOUTH DISEASE HEPATITIS E VIRUS MELIOIDOSIS ANTHRAX CANINE BABESIOSIS FELINE BABESIOSIS AFRICAN TRYPANOSOMIASES SARCOCYSTOSIS HYALOMMA TICK BITE NECROSIS Cordylobia anthropophaga SPIROCERCOSIS SOURCE OF INFECTION: FECES SOURCE OF INFECTION: PARTURIENT FLUIDS/URINE SOURCE OF INFECTION: SALIVA/RESPIRATORY/SCRATCH SOURCE OF INFECTION: SKIN/FUR SOURCE OF INFECTION: EXTERNAL PARASITES VETERINARY STANDARD PRECAUTIONS GENERAL CONCEPTS DISEASES OF THE PINNA NONPRURITIC PINNAL ALOPECIA

Canine Pinnal Alopecia Periodic Alopecia of Miniature Poodles and Siamese Cats Pattern Baldness Congenital Hypotrichosis

CRUSTING AND SCALING DERMATOSES

Mange Fly Strike Dermatitis Actinic Dermatitis and Squamous Cell Carcinoma Frostbite Vasculitis Hyperkeratosis Nutritional Dermatoses

DERMATOSES CAUSING PAPULES AND NODULES

Tick Infestation Neoplastic Lesions Granulomatous Lesions

DERMATOSES CAUSING PUSTULES, VESICLES, AND BULLAE CONCAVE PINNAL DERMATOSES

Atopy Allergic Contact Dermatitis Defects in Keratinization Juvenile Cellulitis Proliferative and Necrotizing Otitis Externa

AURICULAR CARTILAGE DISORDERS

Aural Hematoma Auricular Chondritis

DISEASES OF THE EXTERNAL EAR CANAL: OTITIS EXTERNA

NORMAL ANATOMY AND PHYSIOLOGY

DIAGNOSTIC PRINCIPLES

History Physical Examination Cytologic Examination Culture and Susceptibility Testing Radiology, Ultrasound, Computed Tomography, and Magnetic Resonance Imaging PATHOPHYSIOLOGY Primary Factors

Hypersensitivities

Atopy and food hypersensitivity Contact hypersensitivity and irritant reaction

Ectoparasites Foreign Bodies Keratinization Defects Idiopathic Inflammatory or Hyperplastic Otitis Other Primary Factors

Predisposing Factors

Anatomic Changes External Environment

Perpetuating Factors

Secondary Bacterial Colonization/Infection Malassezia pachydermatis Chronic Anatomic Changes Otitis Media Treatment Errors, Undertreatment, and Overtreatment

GENERAL PRINCIPLES OF MANAGEMENT

Ear Cleaning Topical Therapy Systemic Therapy

THERAPY FOR SPECIFIC DISEASES OF THE EXTERNAL EAR CANAL

Ectoparasites Idiopathic Inflammatory or Hyperplastic Otitis in Cocker Spaniels Excessive Moisture (Swimmer’s Ear) Chronic Bacterial Otitis Refractory or Recurrent Yeast Infection Neoplasia

ROLE OF SURGERY IN THE MANAGEMENT OF OTITIS EXTERNA DISEASES OF THE MIDDLE AND INNER EAR

NORMAL ANATOMY AND PHYSIOLOGY Otitis Media Neoplasia of the Middle Ear Inflammatory Polyps Primary Secretory Otitis Media Otitis Interna Prognosis for Otitis Media Interna Ototoxicity Idiopathic Vestibular/Facial Nerve Diseases Deafness

Diagnostic Principles

Impedance audiometry/tympanometry Brainstem auditory evoked response

Acquired Late-Onset Conductive Deafness Acquired Late-Onset Sensorineural Deafness Congenital Sensorineural Deafness

Congenital Acquired Sensorineural Deafness

FUNCTIONAL CONSIDERATIONS

Functional Anatomy Regulation and Conditioning of the Inspiratory and Expiratory Airflow Mucosal Cleaning Olfaction HISTORY AND CLINICAL SIGNS PHYSICAL EXAMINATION

SPECIAL DIAGNOSTIC PROCEDURES

Radiography Cross-Sectional Imaging Rhinoscopy Olfactory Tests

CONGENITAL DISEASES INFLAMMATORY DISEASES

Viral Rhinitis Bacterial Rhinitis Mycotic Rhinitis Neurogenic Rhinitis Specific Rhinitis

TUMORS OF THE NASAL PLANE, NASAL CAVITY, AND FRONTAL SINUS

Tumors of the Nasal Plane Tumors in the Nasal Cavity Tumors of the Frontal Sinus

TRAUMA TO THE FRONTAL SINUS AND THE NOSE

Trauma to the Frontal Sinus Trauma to the Nose

EPISTAXIS GENERAL ANATOMY AND PHYSIOLOGY HISTORY AND PHYSICAL EXAMINATION DIAGNOSIS

Diagnostic Imaging Pharyngoscopy and Laryngoscopy Miscellaneous

DISEASES OF THE PHARYNX

Nasopharyngeal Polyps Nasopharyngeal Stenosis Pharyngeal Foreign Bodies Pharyngeal Mucoceles

SOFT PALATE ABNORMALITIES

Neoplasia Tonsillitis and Pharyngitis Oropharyngeal Dysphagia

DISEASES OF THE LARYNX

Laryngeal Paralysis Laryngeal Neoplasia Laryngeal Collapse

LARYNGITIS OBSTRUCTIVE INFLAMMATORY DISEASE Benign Oral Lesions Malignant Oral Lesions ORAL EXAMINATION AND DIAGNOSIS CLINICAL STAGING TREATMENT MALIGNANT MELANOMA MELANOCYTOMA FIBROSARCOMA HISTOLOGICALLY LOW-GRADE, YET BIOLOGICALLY HIGH-GRADE, FIBROSARCOMA SQUAMOUS CELL CARCINOMA OSTEOSARCOMA EXTRAMEDULLARY PLASMACYTOMAS ODONTOGENIC TUMORS EPULIDES PAPILLOMATOSIS SALIVARY GLAND TUMORS LINGUAL TUMORS NONNEOPLASTIC MASSES SIGNALMENT GENERAL MEDICAL HISTORY PHYSICAL EXAMINATION DIAGNOSTIC TECHNIQUES LABORATORY DIAGNOSTICS

DIAGNOSTIC IMAGING

Radiography

Bronchial Pattern Interstitial Pattern

Nodular Hazy and Unstructured

Alveolar Pattern

Diffuse Localized

Ultrasonography Nuclear Imaging Alternative Imaging

SCOPING PROCEDURES RESPIRATORY SAMPLING TECHNIQUES THORACOTOMY AND BIOPSY PULSE OXIMETRY AND ARTERIAL BLOOD GAS ANALYSIS PULMONARY FUNCTION TESTING ADDITIONAL DIAGNOSTICS CONCLUSION

ANATOMY AND PATHOPHYSIOLOGY HISTORY AND PHYSICAL EXAMINATION DIAGNOSTIC TESTS

Radiography Tracheoscopy and Bronchoscopy Tracheobronchial Culture, Cytology, and PCR Testing Clinicopathologic Studies

SPECIFIC TRACHEOBRONCHIAL DISEASES

Noninfectious Tracheitis

ETIOLOGY CLINICAL SIGNS AND DIAGNOSIS THERAPY

Infectious Tracheobronchitis

ETIOLOGY CLINICAL SIGNS AND DIAGNOSIS THERAPY

TRACHEAL PARASITES

Lungworm (Oslerus osleri; Filaroides osleri)

ETIOLOGY CLINICAL SIGNS AND DIAGNOSIS THERAPY

Cuterebrosis Tracheal Hypoplasia

ETIOLOGY CLINICAL SIGNS AND DIAGNOSIS PROGNOSIS AND THERAPY

Segmental Tracheal Stenosis

ETIOLOGY CLINICAL SIGNS AND DIAGNOSIS THERAPY

Collapsing Trachea ETIOLOGY CLINICAL SIGNS AND DIAGNOSIS THERAPY Obstructive Tracheal and Bronchial Masses

ETIOLOGY CLINICAL SIGNS AND DIAGNOSIS THERAPY

Tracheal and Bronchial Trauma

ETIOLOGY CLINICAL SIGNS AND DIAGNOSIS THERAPY

CANINE CHRONIC BRONCHITIS CLINICAL SIGNS DIAGNOSTIC EVALUATION TREATMENT PROGNOSIS BRONCHIECTASIS PHYSICAL EXAMINATION AND PRESENTATION DIAGNOSIS TREATMENT AND PROGNOSIS FELINE BRONCHIAL (LOWER AIRWAY) DISEASE CLINICAL PRESENTATION TREATMENT ACUTE TREATMENT CHRONIC THERAPY PRIMARY CILIARY DYSKINESIA (IMMOTILE CILIA SYNDROME) HISTORY AND PHYSICAL EXAMINATION TREATMENT AND PROGNOSIS BRONCHOESOPHAGEAL FISTULA BRONCHIAL MINERALIZATION PATIENT SELECTION RINGS OR STENTS? BRONCHIAL COLLAPSE EXPECTATIONS/RISKS STENTING

Stent Selection Stent Material Foreshortening Reconstrainability Stent Sizing

Stent Length Stent Diameter

STENT PLACEMENT TECHNIQUE

General Anesthesia and Preparation20 Stent Placement

POSTOPERATIVE CARE AND FOLLOW-UP DEALING WITH LONG-TERM COMPLICATIONS PROGNOSIS OTHER SPECIES AND NEEDS FOR TRACHEAL STENTING MANIFESTATIONS OF PULMONARY PARENCHYMAL DISEASE DIAGNOSTIC EVALUATION OF PULMONARY PARENCHYMAL DISEASE

Oxygenation Screening Tests

Complete Blood Count Serum Chemistry Profile Urinalysis

Natriuretic Peptides Imaging Studies

Alveolar Infiltrate Bronchiolar Infiltrate Interstitial Patterns Vascular Pattern

Invasive Tests

SPECIFIC PULMONARY DISORDERS

Infectious Diseases of the Lungs

Pulmonary Parasites

Pulmonary parenchymal parasites

Paragonimus kellicotti Filaroides

Airway parasites

Aelurostrongylus abstrusus Crenosoma vulpis Oslerus osleri Eucoleus aerophilia

Other parasites of relevance to the lung

Dirofilaria immitis Angiostrongylus vasorum

Bacterial Pneumonia PRESENTATION TREATMENT

Severe, Unstable Disease Moderate, Stable Disease Mild, Stable Disease

Unique pathogens causing bacterial pneumonia

Bordetella bronchiseptica Streptococcus equi subspecies zooepidemicus Mycoplasma Mycobacterial pneumonia Yersinia pestis pneumonia (plague)

Viral Pneumonia Influenza Virus Protozoal Pneumonia Mycotic Pneumonia Aspiration Pneumonia

Pulmonary Edema PRESENTATION TREATMENT

Lung Cancer

Metastatic and Special Lung Cancers

PRESENTATION TREATMENT Pulmonary Lymphoma Pulmonary Lymphomatoid Granulomatosis Malignant Histiocytosis (Disseminated Histiocytic Sarcoma) Primary Lung Cancer PRESENTATION TREATMENT

Interstitial Lung Disease

Lymphocytic Interstitial Pneumonitis (LIP) Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) Pulmonary Alveolar Proteinosis (PAP) Sjögren’s Syndrome Silicosis and Asbestosis

Eosinophilic Pneumonia Lipid Pneumonia Idiopathic Pulmonary Fibrosis PRESENTATION TREATMENT

Physical Lung Injury

Thoracic Trauma Drowning Smoke Inhalation

Miscellaneous Lung Disease

Atelectasis Cavitary Lung Lesions

Abscesses Pulmonary blebs, bullae, and emphysema

Lung Lobe Torsion PRESENTATION TREATMENT Pulmonary Thromboembolism

ANATOMY HISTORY AND CLINICAL SIGNS DIAGNOSTIC EVALUATION

Survey Radiography Ultrasonography Computed Tomography Further Diagnostic Evaluation

DISEASES OF THE MEDIASTINUM

Pneumomediastinum Mediastinitis Mediastinal Edema Mediastinal Hemorrhage Mediastinal Cysts Nonneoplastic Mediastinal Masses Mediastinal Neoplasia

DISEASES OF THE THYMUS

Thymic Hemorrhage Thymoma

DISORDERS OF THE DIAPHRAGM

Anatomy of the Diaphragm Radiographic Signs as an Indicator of Diaphragmatic Disease or Dysfunction Diaphragmatic Paralysis Diaphragmatic Hernia

Traumatic Diaphragmatic Hernia Peritoneopericardial Diaphragmatic Hernia

DISORDERS OF THE THORACIC WALL

Chest Wall Trauma Pectus Excavatum Thoracic Wall and Sternal Neoplasia

PLEURAL EFFUSION

ANATOMY AND PHYSIOLOGY ETIOLOGY CLINICAL SIGNS AND PHYSICAL EXAMINATION Thoracocentesis and Pleural Fluid Evaluation Biochemical Parameters and Additional Fluid Evaluation Radiography and Ultrasonography Pyothorax Chylothorax Hemorrhagic Effusion Neoplastic Effusion Eosinophilic Effusion Idiopathic Effusion Pneumothorax

Traumatic Pneumothorax Spontaneous Pneumothorax

PULMONARY HYPERTENSION PULMONARY PHYSIOLOGY CLASSIFICATION OF PULMONARY HYPERTENSION SIGNALMENT CLINICAL SIGNS AND PHYSICAL EXAMINATION DIAGNOSIS TREATMENT OUTCOME PULMONARY THROMBOEMBOLISM

ETIOLOGY/PATHOPHYSIOLOGY CLINICAL SIGNS AND DIAGNOSTIC TESTS TREATMENT

Heart Failure Resulting from Impeded Cardiac Filling

Pericardial Disease with Restricted Filling Valvular Inflow Obstruction Intrinsic Myocardial Disease with Impaired Diastolic Function

Heart Failure Resulting from Increased Resistance to Ejection

Increased Resistance to the Ejection of Blood (Afterload)

Heart Failure Resulting from Impaired Ejection or Volume Overload

Primary and Secondary Myocardial Disease with Impaired Systolic Function Misdirected Blood Flow Resulting in Volume Overload Chronic High-Output States

Heart Failure Resulting from Arrhythmias and Conduction Disorders

Sustained Tachyarrhythmias Chronic Bradyarrhythmias

HEMODYNAMIC ALTERATIONS IN HEART FAILURE DETERMINANTS OF CARDIAC PERFORMANCE DIASTOLIC HEART FAILURE NEUROHORMONAL AND CYTOKINE ALTERATIONS IN HEART FAILURE

Renin-Angiotensin-Aldosterone System Natriuretic Peptides Endothelin Arginine Vasopressin Adrenomedullin Cytokine and Integrin Signaling

CARDIAC REMODELING CHANGES IN ENERGY METABOLISM IN HEART FAILURE SUMMARY CARDIAC CONDUCTION SYSTEM AND ELECTROCARDIOGRAPHY NORMAL ELECTROCARDIOGRAM

Technical Aspects of the Electrocardiograph Evolution of the Electrocardiogram with Age Diagnostic Manipulations with Electrocardiography

Vagal Maneuver Atropine Response Test

Ambulatory Electrocardiography

CARDIAC RHYTHM DISTURBANCES

Clinical Impact of Rhythm Disturbances Identification of Rhythm Disturbances Disturbances of Excitability

Disturbances and Alterations of Sinus Excitability

Respiratory (normal) sinus arrhythmia Wandering pacemaker Sinus bradycardia Sinus tachycardia

Disturbances of Atrial Excitability

Premature Atrial Complexes Supraventricular Tachycardias

Atrial flutter Atrial fibrillation Atrial dissociation

Disturbances of Ventricular Excitability

Ventricular extrasystoles or premature ventricular complexes Accelerated idioventricular rhythm Ventricular tachycardia Ventricular flutter Ventricular fibrillation Torsade de pointes Ventricular parasystole

Disorders of Conduction

Atrioventricular Block

Bundle branch blocks

Atrial Standstill (Silent Atrium) Electromechanical Dissociation

Complex Disorders Involving Abnormalities of Both Excitability and Conduction

Cardiac Effects of Systemic Potassium and Calcium Abnormalities

Hypokalemia Hyperkalemia Hypocalcemia Hypercalcemia

Preexcitation Syndromes Sinus Node Dysfunction

Electrocardiographic Leads Mean Electrical Axis Precordial Leads Combining Mean Electrical Axis and Electrocardiographic Leads: Understanding the Direction and Force of Electrical Activity in a Heartbeat Confounding Factors WHAT IS A “BIOMARKER”? Myocyte Stress Inflammation Oxidative Stress Extracellular-Matrix Remodeling Neurohormones Myocyte Injury New Biomarkers MARKERS OF MYOCYTE INJURY

Cardiac Troponins in Disease

Noncardiac Causes Cardiac Causes NATRIURETIC PEPTIDES AND OTHER MYOCYTE STRESS MARKERS

Natriuretic Peptides

Natriuretic Peptides in Disease

Adrenomedullin ST2

NEUROHUMORAL MARKERS

Endothelin

Endothelins in Disease

Arginine Vasopressin

MARKERS OF INFLAMMATION CONCLUSION CLASSIFICATION OF HEART DISEASE AND HEART FAILURE EVALUATING THE EVIDENCE FOR EFFICACY AND SAFETY GUIDELINES FOR DIAGNOSIS AND TREATMENT OF CVHD

Diagnosis for Stage A

Consensus Recommendations:

Therapy for Stage A

Consensus Recommendations:

Diagnosis for Stage B

Consensus Recommendations: Consensus Recommendations: No Consensus:

Small breed dogs: Larger breed dogs:

Diagnosis for Stage C

Consensus Recommendations:

Acute (Hospital-Based) Therapy of Stage C

Consensus Recommendations: No Consensus Was Reached on the Following Acute Care Stage C Issues:

Home-Based (Chronic) Therapy for Stage C

Consensus Recommendations: No Consensus Was Reached Regarding the Following Home-Based (Chronic) Treatment Strategies in Stage C:

Dietary Therapy for Stage C

Consensus Recommendations for Dietary Therapy for Stage C: No Consensus Was Reached on the Following Dietary Therapy for Stage C:

Diagnosis for Stage D Acute (Hospital-Based) Therapy for Stage D (Refractory Heart Failure)

Consensus Recommendations: No Consensus Was Reached Regarding the Following Acute Care Stage D Recommendations:

Home-Based (Chronic) Stage D Therapy

Consensus Recommendations: No Consensus Was Reached Regarding the Following Chronic Stage D Therapeutic Recommendations:

Home-Based (Chronic) Dietary Therapy for Stage D

Consensus Recommendations:

INTRODUCTION INOTROPIC MECHANISMS INOTROPES

Digoxin

Mechanism of Action Indications Dosage Cautionary Notes

Digitoxin Dobutamine

Mechanism of Action Indications Dosage Cautionary Notes

Dopamine

INODILATORS

Milrinone

Mechanism of Action Indications

Pimobendan

Mechanism of Action Indications Dosage Cautionary Notes

Levosimendan

SUMMARY BACKGROUND Canine Feline BB IN CANINE DILATED CARDIOMYOPATHY BB IN CANINE CHRONIC DEGENERATIVE ATRIOVENTRICULAR VALVE DISEASE BB IN FELINE CARDIOMYOPATHIES PRACTICAL RECOMMENDATIONS REGARDING β-BLOCKADE IN HEART DISEASE AND HEART FAILURE (Box 239-2) Start Low Go Slow Aim High General DOSAGES OF BB (Table 239-1) POTENTIAL ADVERSE AFFECTS ASSOCIATED WITH BB CARDIAC EFFECTS VASCULAR EFFECTS SPECIFIC AGENTS CLASSES

Loop Diuretics Thiazide Diuretics Potassium-Sparing Diuretics

COMBINATION THERAPY CONTROL OF BRONCHOMOTOR TONE METHYLXANTHINES BETA-ADRENERGIC AGONISTS ANTICHOLINERGICs THE HISTORY OF THE RENIN ANGIOTENSIN SYSTEM THE DEVELOPMENT OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS THE NEUROHORMONAL HYPOTHESIS OF HEART FAILURE THE RENIN ANGIOTENSIN SYSTEM IN DOGS AND CATS WITH HEART DISEASE ACTIONS AND COMPLICATIONS OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS

Enalapril Benazepril Adverse Effects Drug Interactions

WHEN TO INITIATE THERAPY—THE EVIDENCE FOR, AND AGAINST ACE INHIBITOR ADMINISTRATION

Animals with Congestive Heart Failure Animals with Cardiac Disease but without Congestive Heart Failure

VASODILATORS

Amlodipine Hydralazine Nitrates Nitroglycerin Isosorbide Mono/dinitrate

FUNCTION EFFECTS ALDOSTERONE ANTAGONISTS SPIRONOLACTONE EPLERENONE CLINICAL APPLICATION CLASSIFICATION SYSTEMS FOR ANTIARRHYTHMIC AGENTS CLASS I ANTIARRHYTHMICS CLASS IA DRUGS CLASS IB DRUGS CLASS IC DRUGS CLASS II ANTIARRHYTHMICS CLASS III ANTIARRHYTHMICS CLASS IV ANTIARRHYTHMICS DIGITALIS GLYCOSIDES ADENOSINE, EDROPHONIUM, PHENYLEPHRINE RADIOFREQUENCY ABLATION EXTERNAL RHYTHM CONTROL AND PACEMAKER THERAPY COUGH SUPPRESSANTS SEDATION OF THE CARDIAC PATIENT

Butyrophenones (Droperidol, Fluanisone) Phenothiazines Benzodiazepines (Diazepam, Midazolam, Zolazepam with Tilamine) Alpha-2 (α-2) Adrenergic Agonists (Xylazine, Detomidine, Ranitidine, Medetomidine) Opioids (Buprenorphine, Butorphanol, Codeine, Diprenorphine, Fentanyl, Methadone, Morphine, Naloxone, Nalbuphine, Pentazocine, Pethidine, Remifentanil, Sufentanil, Tramadol) Opioid Agonists Opioid Partial Agonists Combinations of Drugs

SEDATION OF THE CARDIAC PATIENT WITH SPECIFIC CARDIAC DISEASES

Mitral Regurgitation Dilated Cardiomyopathy Hypertrophic Cardiomyopathy Pericardial Effusions Patent Ductus Arteriosus and Ventricular Septal Defects Subaortic Stenosis and Pulmonic Stenosis Heartworm Disease Aggressive Dogs

PREOPERATIVE PATIENT ASSESSMENT SIGNALMENT HISTORY

Angiotensin Converting Enzyme Inhibitors Beta-Blockers Physical Examination Preoperative Diagnostic Evaluations

Electrocardiogram Noninvasive Systolic Blood Pressure Measurement Thoracic Radiography Echocardiography Biochemical Profile

Serum electrolytes (Na+, K+, Mg2+, Ca2+, Cl−) Renal parameters (BUN, creatinine, and phosphorous) Serum albumin Liver enzymes (ALP, ALT, AST) Serum thyroid hormone assessment Complete blood count Blood gas analysis

PREOPERATIVE ANESTHETIC PLAN

Optimization of Cardiac Output Desirable Manipulations of Cardiovascular Physiology

Fixed Stenosis Dynamic Stenosis Regurgitation Shunts

Left-to-right shunts Right-to-left shunts

Systolic Dysfunction

INTRAOPERATIVE PERIOD MONITORING

Physical Examination Central Venous Pressure Electrocardiogram Systemic Blood Pressure Urine Output Blood Gas Analysis Pulse Oximetry Capnography Echocardiography Rapid Response to Negative Trends

INDICATIONS FOR PACING

Atrioventricular Block Sinus Node Dysfunction/Sick Sinus Syndrome Atrial Standstill Less Common Uses for Pacing Therapy

TYPES OF PACEMAKERS AND HEMODYNAMICS OF PACING

Pacing Nomenclature Single Chamber

Ventricular-Inhibited Pacing (VVI) Atrial-Inhibited Pacing (AAI)

Dual Chamber

Atrial Synchronous Pacing (VDD) Dual-Chamber Pacing and Sensing with Inhibition and Tracking (DDD)

TRANSVENOUS PACEMAKER IMPLANTATION

Temporary Pacing Implantation of Permanent Pacemaker

PACEMAKER PROGRAMMING

Pulse Width and Voltage Amplitude Programmability Rate Programmability Sensitivity Refractory Period Special Features

PACEMAKER COMPLICATIONS

Infections DEFINITION CLINICAL APPROACH HISTORY AND PHYSICAL EXAMINATION

History Physical Examination

LABORATORY TESTS ELECTROCARDIOGRAPHY CARDIAC IMAGING

Radiography Echocardiography Other Imaging Modalities

CARDIAC CATHETERIZATION AND ANGIOGRAPHY

Hemodynamic Measurements Angiography Therapeutic Procedures

ETIOLOGY AND PREVALENCE

Etiology Prevalence CLASSIFICATION

DEFECTS CAUSING PRIMARILY VOLUME OVERLOAD

SYSTEMIC TO PULMONARY (LEFT-TO-RIGHT) SHUNTS

Patent Ductus Arteriosus

PATHOGENESIS PATHOPHYSIOLOGY CLINICAL FINDINGS

Left-to-Right Shunting PDA PDA with Pulmonary Hypertension (Right-to-Left Shunting PDA) NATURAL HISTORY CLINICAL MANAGEMENT

ATRIAL AND VENTRICULAR SEPTAL DEFECTS PATHOGENESIS PATHOPHYSIOLOGY

Atrial Septal Defect Ventricular Septal Defect Eisenmenger’s Syndrome CLINICAL FINDINGS NATURAL HISTORY CLINICAL MANAGEMENT

VALVULAR REGURGITATION

PULMONIC AND AORTIC VALVE INSUFFICIENCY

Pulmonic Insufficiency Aortic Insufficiency

ATRIOVENTRICULAR VALVE DYSPLASIA PATHOLOGY AND PATHOGENESIS PATHOPHYSIOLOGY CLINICAL FINDINGS CLINICAL MANAGEMENT

DEFECTS CAUSING PRIMARILY PRESSURE OVERLOAD

VENTRICULAR OUTFLOW OBSTRUCTIONS

Pulmonic Stenosis PATHOLOGY PATHOPHYSIOLOGY CLINICAL FINDINGS NATURAL HISTORY CLINICAL MANAGEMENT Aortic Stenosis PATHOLOGY AND PATHOGENESIS PATHOPHYSIOLOGY CLINICAL FINDINGS NATURAL HISTORY CLINICAL MANAGEMENT

ANOMALOUS DEVELOPMENT OF THE ATRIA AND COR TRIATRIATUM

LESIONS CAUSING RIGHT-TO-LEFT SHUNTING: CYANOTIC HEART DISEASE

PATHOPHYSIOLOGY

Mechanisms of Right-to-Left Shunting Effects of Hypoxemia Ratio of Systemic to Pulmonary Resistance Additional Circulatory Factors

CLINICAL EVALUATION OF THE PATIENT WITH CYANOTIC HEART DISEASE

Echocardiography Cardiac Catheterization

TETRALOGY OF FALLOT PATHOGENESIS PATHOPHYSIOLOGY CLINICAL FINDINGS CLINICAL MANAGEMENT OTHER CAUSES OF CYANOTIC CONGENITAL HEART DISEASE

Valvular Atresia Double Outlet Right Ventricle Transposition of the Great Arteries

MISCELLANEOUS CARDIAC DEFECTS VASCULAR ANOMALIES AORTIC ANOMALIES VENOUS ANOMALIES MYXOMATOUS MITRAL VALVE DISEASE

Occurrence Significance and Progression Pathology Inheritance and Breeding PATHOGENESIS PATHOPHYSIOLOGY CLINICAL SIGNS PHYSICAL EXAMINATION Electrocardiographic Findings Radiographic Findings Echocardiographic Findings LABORATORY FINDINGS DIFFERENTIAL DIAGNOSIS MANAGEMENT

Asymptomatic Disease Patients with Left Mainstem Bronchial Compression without Pulmonary Congestion and Edema Patients with Syncopes but without Pulmonary Congestion and Edema Patients with Pulmonary Edema Secondary to MMVD Mild to Moderate Heart Failure Recurrent Heart Failure Severe and Life-Threatening (Fulminant) Heart Failure Prognosis after the Onset of Chronic Heart Failure

Complications Associated with MMVD

Acute Exacerbation of Pulmonary Congestion and Edema Caused by Ruptured Chordae Tendineae Right-Sided Heart Failure Caused by Pulmonary Hypertension Acute Exacerbation of Pulmonary Congestion Caused by Tachyarrhythmia Left Atrial Rupture and Cardiac Tamponade

TRICUSPID VALVE INSUFFICIENCY CONSEQUENCES (PATHOPHYSIOLOGY) CLINICAL SIGNS PHYSICAL EXAMINATION

Electrocardiographic Findings Radiographic Findings Echocardiographic Findings MANAGEMENT

SEMILUNAR VALVE INSUFFICIENCY INFECTIVE ENDOCARDITIS PATHOLOGY ETIOLOGY AND PATHOGENESIS CASE HISTORY AND CLINICAL SIGNS PHYSICAL EXAMINATION

Blood Culture Obtaining Blood Cultures Electrocardiographic Findings Radiographic Findings Echocardiographic Findings OTHER LABORATORY FINDINGS DIAGNOSIS MANAGEMENT Management of Cases with Tentative Diagnosis of IE PROGNOSIS PREVENTION

CANINE DILATED CARDIOMYOPATHY CLINICAL PRESENTATION PHYSICAL EXAMINATION

Electrocardiography Radiography Echocardiography Biomarkers PATHOLOGY ETIOLOGY Breed-Specific Dilated Cardiomyopathy

Cocker Spaniels Dalmatians Doberman Pinschers Great Danes Irish Wolfhounds Newfoundlands Portuguese Water Dogs

Nutritional Cardiomyopathy

Taurine-Related Cardiomyopathy

Treatment of the Dog with Dilated Cardiomyopathy Treatment of the Dog with Occult Dilated Cardiomyopathy Treatment of the Dog with Dilated Cardiomyopathy and Congestive Heart Failure Treatment of the Dog with Ventricular Arrhythmias Prognosis for the Dog with Dilated Cardiomyopathy

ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY IN THE BOXER DIAGNOSIS TREATMENT MYOCARDITIS

Atrial Myocarditis

HYPERTROPHIC CARDIOMYOPATHY HYPOTHYROIDISM MYOCARDIAL INFARCTION HYPERTROPHIC CARDIOMYOPATHY

Genetics of Hypertrophic Cardiomyopathy PATHOPHYSIOLOGY Systolic Anterior Motion of the Mitral Valve Arterial Thromboembolism PATHOLOGY Patient History and Clinical Abnormalities Thoracic Radiographs Electrocardiogram Echocardiogram

Assessment of Diastolic Function Tissue Doppler Imaging Echocardiography

Circulating biomarkers

Advanced Diagnostic Imaging

Cardiac Magnetic Resonance Imaging DIFFERENTIAL DIAGNOSIS TREATMENT Treatment of Asymptomatic Cats with Hypertrophic Cardiomyopathy Congestive Heart Failure Anticoagulant Therapy PROGNOSIS

DILATED CARDIOMYOPATHY ETIOLOGY HISTORY

Clinical Abnormalities on Physical Examination Electrocardiogram Thoracic Radiographs Echocardiogram TREATMENT

Positive Inotropic Therapy Antiarrhythmic Therapy PROGNOSIS

Taurine Deficiency–Induced Myocardial Failure Taurine Deficiency–Induced Diseases

Assessment of Taurine Status Treatment of Taurine Deficiency–Induced Myocardial Failure

RESTRICTIVE CARDIOMYOPATHY

Thoracic Radiographs Electrocardiogram Echocardiography TREATMENT PROGNOSIS

UNCLASSIFIED CARDIOMYOPATHY DIAGNOSTIC TESTING TREATMENT ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY SIGNALMENT AND CLINICAL ABNORMALITIES

Thoracic Radiographs Electrocardiogram Echocardiography PATHOLOGY TREATMENT

STRUCTURE AND FUNCTION OF THE PERICARDIUM CONGENITAL PERICARDIAL DISORDERS

Peritoneopericardial Diaphragmatic Hernia PATHOPHYSIOLOGY CLINICAL SIGNS DIAGNOSIS TREATMENT Benign Intrapericardial Cysts CLINICAL SIGNS, DIAGNOSIS, AND TREATMENT Pericardial Defects

ACQUIRED PERICARDIAL DISORDERS

Pericardial Effusion

Causes

Neoplastic Infectious Metabolic and toxic Cardiovascular Traumatic Idiopathic PATHOPHYSIOLOGY CLINICAL SIGNS DIAGNOSIS TREATMENT Neoplastic Infectious Cardiovascular Idiopathic

CONSTRICTIVE PERICARDITIS CLINICAL SIGNS AND DIAGNOSIS TREATMENT CANINE HEARTWORM DISEASE

LIFE CYCLE PATHOPHYSIOLOGY CLINICAL SIGNS DIAGNOSIS

Microfilarial Detection Immunodiagnostic Antigen Tests Radiography Electrocardiography Echocardiography Clinical Pathology MEDICAL MANAGEMENT Prophylaxis Diethylcarbamazine Macrocyclic Lactone (Macrolide) Antibiotics Ivermectin Milbemycin Moxidectin Selamectin

ADULTICIDAL THERAPY

Melarsomine Microfilaricidal and Preventative Therapy in Heartworm-Positive Dogs Procedure Macrolides Exercise Restriction Surgical Therapy

ANCILLARY THERAPY

Corticosteroids Aspirin Heparin Therapy Doxycycline Microfilaricidal Therapy

COMPLICATIONS AND SPECIFIC SYNDROMES

Asymptomatic Heartworm Infection Glomerulonephritis Allergic Pneumonitis Eosinophilic Granulomatosis Pulmonary Embolization Congestive Heart Failure Caval Syndrome Aberrant Migration PROGNOSIS CONTROVERSIES

Yearly Testing

YEARLONG PREVENTION Macrolides as Adulticides ANTI-Wolbachia THERAPY

FELINE HEARTWORM DISEASE

LIFE CYCLE PATHOPHYSIOLOGY CLINICAL SIGNS DIAGNOSIS TREATMENT AND PREVENTION PROGNOSIS

BACKGROUND PATHOGENESIS CLINICAL SIGNS TREATMENT

Reduce Thrombus Formation Improve Blood Flow

Arterial Flow—Thrombolytic Therapy

Streptokinase Urokinase Tissue Plasminogen Activator (t-PA) Improve Collateral Flow Pain Management SURVIVAL PREVENTION Antithrombotic Drugs Antiplatelet Agents

Aspirin Clopidogrel (Plavix)

Anticoagulant Agents

Warfarin Low-Molecular-Weight Heparins Synthetic Xa Inhibitors

Diseases of Veins Diseases of Lymphatics Tumors of Peripheral Blood Vessels TECHNIQUES USED TO EVALUATE VENOUS AND LYMPHATIC DISEASE

Angiography Diagnostic Ultrasound

DISEASES OF VEINS DISEASES OF THE PERIPHERAL LYMPHATICS INFLAMMATORY LYMPHATIC DISORDERS (LYMPHANGITIS AND LYMPHADENITIS) LYMPHEDEMA

Primary Lymphedema Secondary Lymphedema

LYMPHANGIOMA, LYMPHANGIOSARCOMA BASIC NEURONAL ACTIVITY NEURON DOCTRINE IMPORTANT BODY FUNCTIONS ASSOCIATED WITH THE NERVOUS SYSTEM

Consciousness, Awareness, Cognition, and Behavior Posture and Movement Functional Concepts of Upper versus Lower Motor Neuron Movement Pain and Sensation Endogenous Modulation of Pain

VITAL FUNCTIONS OF THE BODY

Urinary Function Respiration Cardiovascular Functions Coughing Sneezing Hunger Drinking

NEUROLOGIC EXAMINATION

Sensorium and Behavior Posture and Gait

Posture Gait

Paresis

Ataxia

Postural Reactions

Postural Reaction Tests

Hopping Paw replacement, tactile placing responses Extensor postural thrust

Hemiwalking Wheelbarrowing

Muscle Mass, Tone, Spinal Reflexes, and Cutaneous Sensation

Muscle Mass and Tone Spinal Reflexes

Patellar reflex

Biceps and Triceps Reflexes Withdrawal-Flexor Reflexes—Thoracic and Pelvic Limbs Crossed Extensor Reflex Perineal Reflex Cutaneous Trunci Reflex Nociception (Pain Perception)

Cranial Nerves

Vision and Pupillary Light Responses (II, III, VII) Palpebral Fissure and Third Eyelid Symmetry (III, V, Sympathetic Nerves) Eyeball Position and Movement (III, IV, VI, VIII) Vestibular Function (VIII) Facial and Trigeminal Nerve Function (V, VII) Tongue and Laryngeal-Pharyngeal Function (IX, X, XII)

NEUROANATOMIC DIAGNOSIS

Prosencephalon Brainstem

Vestibular Disease

Cerebellum Spinal Cord Peripheral Nervous System

Lower Motor Neuron/Neuromuscular System Peripheral Sensory Nerves Multifocal Localizations and Diffuse Central Nervous System Disorders

RESPONSE OF THE BRAIN TO DAMAGE NEUROLOGIC EXAMINATION

History and Behavior Abnormal Movements Gait and Posture Postural Reactions Cranial Nerves

LOCALIZING THE LESION

Cerebellum Pons and Medulla Midbrain Forebrain DIFFERENTIAL DIAGNOSES DIAGNOSTIC APPROACH

PRIMARY BRAIN DISEASES

Congenital and Hereditary Diseases

Congenital Malformations Chiari-Like Malformations Hydrocephalus

Inborn Errors of Metabolism

Organic Acidurias Spongiform Encephalopathies Polioencephalopathies Neuroaxonal Dystrophy Leukoencephalopathies Lysosomal Storage Disease Ceroid Lipofuscinosis Movement Disorders

Hereditary Cerebellar Ataxia Multiple System Degeneration Dyskinesias and Dystonias Paroxysmal Dyskinesias Tremors

Encephalitis

Viral Encephalitis Encephalitis of Unknown Cause

Vascular Disease Brain Tumors DIAGNOSTIC PROCEDURES TREATMENT PROGNOSIS AND SURVIVAL

Specific Tumor Types

Meningiomas Neuroepithelial tumors Central nervous system lymphoma Secondary intracranial neoplasms Pituitary tumors

FUNCTIONAL NEUROANATOMY CLINICAL SIGNS

Head Tilt Vestibular Ataxia Nystagmus

Physiologic Pathologic Strabismus Cranial Nerve Deficits Nausea and Vomiting Change in Mentation Paradoxical Syndrome

NEUROLOCALIZATION DIAGNOSTIC PROCEDURES GENERAL THERAPY AND COMPENSATION IN VESTIBULAR DISEASES PERIPHERAL VESTIBULAR DISEASES

Otitis Interna/Media Nasopharyngeal Polyps Idiopathic Vestibular Disease Hypothyroidism Ototoxicity and Iatrogenic Trauma Others

Congenital Neoplasia

CENTRAL VESTIBULAR DISEASES

Inflammatory Diseases Infectious Diseases Noninfectious Diseases Neoplasia Vascular Toxicity Others

Thiamine Deficiency Anomaly Trauma Degenerative Diseases Postanesthetic Vestibular Syndrome in Cats

EPISODIC Degenerative Anomalous Metabolic Neoplastic Nutritional Inflammatory, Noninfectious Infectious Toxins Trauma INFLAMMATORY, NONINFECTIOUS DISORDERS OF THE BRAIN

Granulomatous Meningoencephalomyelitis Necrotizing Encephalitis

Infectious Disorders of the Brain

Bacterial Meningoencephalitis Fungal Meningoencephalitis Viral Meningoencephalitis Other Infectious Diseases

Degenerative and Anomalous Disorders of the Brain MECHANISMS OF DISEASE Diagnosis

Signalment History Physical Examination Neurologic Examination Problem List and Differential Diagnosis Minimum Database Ancillary Diagnostic Investigations

Noncontrast vertebral radiography Cerebrospinal fluid analysis Myelography Electrophysiology

CLINICAL SIGNS DIAGNOSTIC PLAN DEGENERATIVE DISORDERS METABOLIC DISORDERS

Diabetes Mellitus Hypothyroidism

NEOPLASTIC DISORDERS PARANEOPLASTIC NEUROPATHY INFECTIOUS DISORDERS

Protozoal Polyradiculoneuritis

INFLAMMATORY DISORDERS

Acute Polyradiculoneuritis Brachial Plexus Neuritis Chronic Inflammatory Demyelinating Polyneuropathy Sensory Polyganglioradiculoneuritis

TRAUMATIC DISORDERS

Brachial Plexus Injuries Femoral Nerve Injury Sciatic Nerve Injury Caudal Nerve and Tail Dysfunction

TOXIC DISORDERS AUTONOMIC DISORDERS

Dysautonomia Other Autonomic Neuropathies

MISCELLANEOUS IDIOPATHIC NEUROPATHIES CLINICAL OVERVIEW INFLAMMATORY MYOPATHIES

Immune-Mediated Polymyositis Masticatory Muscle Myositis Extraocular Myositis Dermatomyositis Infectious Polymyositis

NONINFLAMMATORY MYOPATHIES

Myotonia Congenita Muscular Dystrophy Inherited Myopathy of Great Danes (Formerly Central Core Myopathy) Centronuclear Myopathy (Formerly Hereditary Myopathy of Labrador Retrievers) (Table 264-1) Labrador Retriever Episodic/Exercise-Induced Collapse (see Table 264-1) Exertional Rhabdomyolysis Distal Myopathy of Rottweilers Nemaline Myopathy Fibrotic Myopathy (Gracilis/Semitendinosus Myopathy) Myositis Ossificans (Fibrodysplasia Ossificans Progressiva) Ischemic (Neuro)myopathy Traumatic Myopathy

METABOLIC MYOPATHIES

Primary Metabolic Myopathies Secondary Metabolic Myopathies

CLINICAL SIGNS DIAGNOSTIC PLAN GENERAL THERAPEUTIC CONSIDERATIONS TICK PARALYSIS BOTULISM ELAPID SNAKE ENVENOMATION MYASTHENIA GRAVIS

Acquired Myasthenia Gravis Congenital Myasthenic Syndromes

MISCELLANEOUS TOXINS AND DRUGS ORAL NEOPLASIA BENIGN NEOPLASMS MALIGNANT NEOPLASMS CLINICAL SIGNS, DIAGNOSIS, AND STAGING TREATMENT PROGNOSIS SELECTED ACQUIRED DISEASES OF THE LIPS, CHEEKS, AND PALATE SELECTED ACQUIRED DISEASES OF THE SALIVARY GLANDS NORMAL ANATOMY AND FUNCTION DIAGNOSIS OF ESOPHAGEAL DISEASES

HISTORY PHYSICAL EXAMINATION DIAGNOSTIC TESTS

CRICOPHARYNGEAL DYSPHAGIA CLINICAL SIGNS DIAGNOSIS TREATMENT ESOPHAGITIS CLINICAL SIGNS DIAGNOSIS TREATMENT ESOPHAGEAL FOREIGN BODIES CLINICAL SIGNS DIAGNOSIS TREATMENT ESOPHAGEAL STRICTURE CLINICAL SIGNS DIAGNOSIS TREATMENT MEGAESOPHAGUS AND ESOPHAGEAL HYPOMOTILITY CLINICAL SIGNS DIAGNOSIS TREATMENT VASCULAR RING ANOMALY CLINICAL SIGNS DIAGNOSIS TREATMENT ESOPHAGEAL DIVERTICULA CLINICAL SIGNS DIAGNOSIS TREATMENT ESOPHAGEAL FISTULA CLINICAL SIGNS DIAGNOSIS TREATMENT ESOPHAGEAL NEOPLASIA CLINICAL SIGNS DIAGNOSIS TREATMENT HIATAL HERNIA CLINICAL SIGNS DIAGNOSIS TREATMENT MISCELLANEOUS ESOPHAGEAL DISORDERS COMPOSITION OF THE NORMAL FLORA PHYSIOLOGIC MICROBIAL-HOST INTERACTIONS

Metabolic Functions Trophic and Protective Effects to Epithelia Host-Microbiota “Cross-Talk” at the Mucosal Surface

MUCOSAL RECOGNITION OF BACTERIA MICROFLORAL PERTURBATION AND ENTERIC DISEASE

Idiopathic Inflammatory Bowel Disease Antibiotic-Responsive Diarrhea Infectious Gastroenteritis

PROBIOTICS AND PREBIOTICS FUNCTIONAL ANATOMY

Regulation of Acid Secretion Gastric Motility Digestion and Assimilation of Nutrients Gastric Flora

DISEASES OF THE STOMACH SIGNALMENT, HISTORY, AND PHYSICAL EXAMINATION

Clinicopathologic Testing

IMAGING

Endoscopy Evaluation of Gastric Emptying Gastric Secretory Testing

ACUTE GASTRITIS CLINICAL FINDINGS DIAGNOSIS TREATMENT

Fluid Therapy Dietary Restriction and Modification Protectants/Adsorbents PROGNOSIS

GASTRIC EROSION AND ULCERATION CLINICAL FINDINGS DIAGNOSIS

Diagnostic Imaging TREATMENT Fluid Therapy

Reducing Acid Secretion and Providing Mucosal Protection Mucosal Protectants Antiemetics Antibiotics and Analgesia

GASTRIC DILATATION AND VOLVULUS

Diagnostic Features CLINICOPATHOLOGIC FINDINGS TREATMENT Fluid Support Gastric Decompression Adjunct Therapy for Endotoxic Shock and Reperfusion Injury Cardiac Arrhythmias Surgery PROGNOSIS PROPHYLAXIS

CHRONIC GASTRITIS

Histopathologic Features of Gastritis ETIOLOGY CLINICAL FINDINGS DIAGNOSIS TREATMENT Parasitic Gastritis Gastric Pythiosis Helicobacter-Associated Gastritis Chronic Gastritis of Unknown Cause Atrophic Gastritis Hypertrophic Gastritis

DELAYED GASTRIC EMPTYING AND MOTILITY DISORDERS Outflow Obstruction Defective Propulsion DIAGNOSIS TREATMENT GASTRIC NEOPLASIA

Benign Tumors Malignant Tumors

Adenocarcinoma Lymphosarcoma Leiomyosarcoma CLINICAL FINDINGS DIAGNOSIS TREATMENT

Gastrointestinal Disease Nongastrointestinal Disease Cardinal Sign Other Signs FUNCTIONAL ANATOMY OF THE SMALL INTESTINE

Normal Structure4,5,7-29 Normal Function

Digestion and Absorption4,5,30-89 Motility4,90-133 Absorption and Secretion of Water and Electrolytes134-141

SMALL-INTESTINAL MICROBIOME

Normal Bacterial Flora142-178 Bacterial-Dietary Interactions179-184 Bacterial-Mucosal Interactions185-190

GASTROINTESTINAL IMMUNE SYSTEM

Functional Anatomy of the Mucosal Immune System191-198 Cells and Molecules of the Mucosal Immune System

Lymphocytes199-218 Dendritic Cells219-225 Other Immune Cells204,207,226-232 Enterocytes226,233-238 Enteric Neurons239 Cytokines240-255

Homing of Lymphocytes in Gut-Associated Lymphoid Tissue204,256-263 Acquired Immune Responses of Gut-Associated Lymphoid Tissue210,264-266

Antigen Uptake and Presentation201,267-270 B Cell Responses248,265,271-275 Cytotoxic Lymphocyte Responses Mucosal Tolerance246,266,276-287 Bacterial-Epithelial Interaction189,288-316 Danger Theory317-319

PATHOPHYSIOLOGIC MECHANISMS IN INTESTINAL DISEASE

Congenital Abnormalities320-329 Motility Disorders109,330-341

Functional Inflammatory Metabolic Neuromuscular Physical

Luminal Disturbances342-344 Villus Atrophy Enteroctye Dysfunction Microvillar Membrane Damage345-356 Brush-Border Membrane Disease55,357-362 Epithelial Barrier Disruption363,364

Luminal Aggressive Factors Endogenous Factors Intestinal Inflammation Intestinal Neoplasia Leading to Ulceration

Hypersensitivity365 Mucosal Inflammation312,363,366-374 Neoplasia Nutrient Delivery Failure

CLINICAL FEATURES OF SMALL-INTESTINAL DISEASE

Diarrhea375,376

Mechanistic Temporal Anatomic Pathophysiologic Etiologic Causal Clinical

Malabsorption377-384 Melena385-397 Borborygmi and Flatulence Weight Loss or Failure to Thrive Protein-Losing Enteropathy398-402 CLINICAL PRESENTATION399,403 DIAGNOSIS404

Endoscopy

Advantages Disadvantages

Laparotomy

Advantages Disadvantages TREATMENT

DIAGNOSIS OF SMALL-INTESTINAL DISEASE

DIAGNOSTIC APPROACH405-408

Patient Information Environmental History Past Medical History Clinical Signs

Fecal Examination

Direct Smear Fecal Concentration Methods409 Bacteriologic Examination410,411

Routine culture

Molecular Fingerprinting156-158,166,174-176,412

Virologic Examination413 Giardia Antigen414 Occult Blood387,415,416 Alpha1-Protease Inhibitor402,417-422 Fecal Calprotectin423-427 Rectal Cytology

Imaging

Plain Radiography428-433

Gas Ileus

Generalized Localized

Fluid Ileus

Generalized Localized

Contrast Radiography

Follow-Through Examinations434-436 Barium-Impregnated Polyethylene Spheres (BIPS)437,438

Ultrasonography330,439-485

Special Tests486-489

Tests of Intestinal Absorption490-496 Serum Folate and Cobalamin Concentrations* Intestinal Permeability491,514-537 Tests for Protein-Losing Enteropathy538,539 Breath Tests510,540-557 Unconjugated Bile Salts558-560 Miscellaneous Tests550,561-567 Assessment of Intestinal Motility*

Endoscopy386,389,394,572-585 Intestinal Biopsy586-598

Examination of Biopsies

Histopathology599-607

Crypt-Villus Unit Epithelium Lamina Propria Miscellaneous

Alternative examinations206,608-617

Duodenal Juice161,167,173,559,618-620

ACUTE SMALL-INTESTINAL DISEASE

DIAGNOSIS621 Treatment of Acute Diarrhea622

Fluid Therapy623-628 Diet38,629-636 Protectants and Adsorbents637 Motility- and Secretion-Modifying Agents638-641 Antimicrobial Therapy642-644 Probiotics and Prebiotics (Synbiotics)145,645-683

Etiologies of Acute Diarrhea

Acute Diarrhea Induced by Diet, Drugs, or Toxins Hemorrhagic Gastroenteritis635,684-686 CLINICAL FINDINGS DIAGNOSIS TREATMENT

Infectious and Parasitic Causes687,688

VIRAL ENTERITIDES

Canine Parvovirus689-711 CLINICAL FINDINGS693,712-729 DIAGNOSIS413,730-742 TREATMENT743-755 PROGNOSIS756 PREVENTION599,757-766 Feline Parvovirus (Feline Panleukopenia)767-773 Canine Coronavirus774-789 Feline Coronavirus790-794

Enteric Coronavirus Intestinal Feline Infectious Peritonitis795

Feline Immunodeficiency Virus796 Feline Leukemia Virus Miscellaneous Viruses797-803

BACTERIAL ENTERITIDES

Relevance of Bacterial Isolation804-807 Campylobacter spp.168,808-835 DIAGNOSIS TREATMENT PROGNOSIS Salmonella spp.171,813,836-867 CLINICAL FINDINGS849,868,869 DIAGNOSIS406,407 TREATMENT110,870,871 PROGNOSIS Clostridium spp.156,178,686,727,872-892 Escherichia coli354,411,893-902 Enteroadherent Organisms903-906 Yersinia pseudotuberculosis907,908 Tuberculosis909 Miscellaneous Bacteria785,910-918

RICKETTSIAL DIARRHEA (SALMON POISONING)919-937 ALGAL INFECTIONS938-942 FUNGAL INFECTIONS

Pathogenicity943-945 Candidiasis712,944 Pythiosis946-953 HISTORY AND CLINICAL SIGNS954-956 DIAGNOSIS957-961 TREATMENT AND PROGNOSIS962-964 Zygomycosis965 Histoplasmosis966

HELMINTHS

Importance807,967-972

Organism

Helminths Cestodes Trematodes Protozoa

Roundworm Ascarids EPIDEMIOLOGY973-981 CLINICAL FINDINGS982,983 DIAGNOSIS984-986 TREATMENT962,974,987-993 Strongyloides sp.973,979,985,986,994-999 Hookworms1000 CLINICAL FINDINGS DIAGNOSIS984-986 TREATMENT987 Tapeworms1001 CLINICAL FINDINGS DIAGNOSIS TREATMENT987

PROTOZOA

Trichomonads975,1002-1010 Coccidia

Isospora spp.819,1011-1017 Cryptosporidium spp.1016-1040 DIAGNOSIS1032,1038,1039,1041-1046 TREATMENT1005,1047 Giardia sp.

EPIDEMIOLOGY* PREVALENCE414,979,1068,1072-1076 CLINICAL FINDINGS1077-1080 DIAGNOSIS† TREATMENT673,1047,1089-1108 PROGNOSIS

CHRONIC IDIOPATHIC ENTEROPATHIES

Characterization of Chronic Enteropathies382,1109-1111 Management of Chronic Enteropathies1112

Antiparasiticides Dietary Management173,620,630,1113-1119 Antibacterials Immunosuppression

ADVERSE REACTIONS TO FOOD

Food Allergy (Hypersensitivity)1120-1123

Mechanisms1124-1130 CLINICAL SIGNS1131-1133

Systemic Signs Cutaneous Signs Gastrointestinal Signs

Food-Allergic Skin Disease Food-Allergic Gastrointestinal Disease DIAGNOSIS1134 Indirect Tests446,531,1135-1141 Dietary Trial Food Intolerance

Mechanisms

Food poisoning Pharmacologic intolerances Pseudoallergic mechanisms1142,1143 Metabolic reactions

CLINICAL SIGNS1144 DIAGNOSIS Dietary Trials for Adverse Food Reactions531,1145,1146

Preliminary Investigations Exclusion Trial1121,1147,1148

Traditional Exclusion Diet Hydrolyzed Diets1149-1154 Challenge Phase Rescue and Provocation Phases Maintenance Protocol TREATMENT Gluten-Sensitive Enteropathy1155-1170 PATHOGENESIS264,515,516,519,1171-1186 CLINICAL SIGNS1156,1161,1187 TREATMENT1188 SMALL-INTESTINAL BACTERIAL OVERGROWTH AND IDIOPATHIC ANTIBIOTIC-RESPONSIVE DIARRHEA

DEFINITIONS162,348,559,1189-1198 ETIOLOGY AND PATHOGENESIS348,1199,1200 Secondary SIBO1201-1204 Idiopathic ARD348,1199,1205-1222

CLINICAL PRESENTATION

Idiopathic Antibiotic-Responsive Diarrhea Secondary SIBO150,1192 DIAGNOSIS151,161,162,1193,1223 Indirect Tests for SIBO and ARD Serum Folate and Cobalamin Concentrations559,1224 Serum Unconjugated Bile Acids559,560 Other Biochemical Tests Breath Hydrogen Excretion Intestinal Permeability1225-1227 Lack of Histologic Changes on Intestinal Biopsy Empiric Response to Antibiotics

Identification of Idiopathic ARD559 Identification of Secondary SIBO

TREATMENT

Idiopathic ARD143,1190,1209,1228-1232

Antibiotics Ancillary Treatments*

Secondary SIBO

INFLAMMATORY BOWEL DISEASE

DEFINITION† CLINICAL PRESENTATION1242-1250 ETIOLOGY AND PATHOGENESIS* DIAGNOSIS599,1294,1295 Hematology1296 Serum Biochemistry1243 Fecal Examination417,1295 Folate and Cobalamin* Diagnostic Imaging439,449,478 Intestinal Biopsy† IBD Activity Index449,1243,1303-1307 Other Diagnostic Investigations* TREATMENT962,1275,1322-1324 Dietary Modification513,636,1152,1325-1327 Antibacterial Therapy656,667,1328-1332 Immunosuppressive Drugs Glucocorticoids1199,1328,1333-1339

Cytotoxic Drugs1340-1351

Probiotics and Prebiotics*

Novel Therapies for IBD1345,1349,1355-1362

Response to Treatment and Prognosis† Lymphocytic-Plasmacytic Enteritis1370-1374 PATHOGENESIS613 CLINICAL SIGNS DIAGNOSIS TREATMENT AND PROGNOSIS Basenji Enteropathy479,1375-1382 CLINICAL SIGNS DIAGNOSIS TREATMENT Familial Protein-Losing Enteropathy and Protein-Losing Nephropathy in Soft-Coated Wheaten Terriers* CLINICAL SIGNS DIAGNOSIS TREATMENT AND PROGNOSIS Eosinophilic Enteritis203,969,1385-1387 CLINICAL SIGNS969,1388,1389 ETIOPATHOGENESIS969,982,1390-1395 DIAGNOSIS1396 TREATMENT Other Forms of Inflammatory Bowel Disease

Granulomatous Enteritis1397-1402 Proliferative Enteritis1403,1404

LYMPHANGIECTASIA

DEFINITION AND CAUSE18,1405-1425 HISTORY AND CLINICAL SIGNS1413,1414,1426-1433 DIAGNOSIS422,456,459,480,1434-1436 TREATMENT1437

MISCELLANEOUS CAUSES OF PROTEIN-LOSING ENTEROPATHY

“Crypt Disease”28,29

INTESTINAL NEOPLASIA

Spectrum of Disease472,1438-1444 Intestinal Lymphoma (Lymphosarcoma)1445-1447 CLINICAL FINDINGS1445,1448-1459 COMPLICATIONS838,1460-1462 CLINICAL PATHOLOGIC FINDINGS1386,1463,1464 HISTOLOGIC FINDINGS* TREATMENT AND PROGNOSIS616,1366,1467,1477-1482 Extramedullary Plasmacytoma1483-1486 Intestinal Adenoma and Adenocarcinoma1440,1487-1497 CLINICAL FINDINGS AND DIAGNOSIS* TREATMENT AND PROGNOSIS1491,1500-1502 Smooth-Muscle and Stromal Cell Tumors1503-1516 DIAGNOSIS463,1517-1524 Laboratory Tests Diagnostic Imaging TREATMENT AND PROGNOSIS1525 Amine Precursor Uptake and Decarboxylation Tumors1526-1529 Other GI Neoplasms*

ADYNAMIC ILEUS AND INTESTINAL PSEUDOOBSTRUCTION

DEFINITION334-336,429,1541-1557 MANAGEMENT570,1546,1558-1566

INTESTINAL OBSTRUCTION*

Intussusception* Intestinal Strangulation Intestinal Volvulus1603,1616-1623

SHORT BOWEL SYNDROME1590,1624-1634 CLINICAL SIGNS DIAGNOSIS TREATMENT1635-1637 PROGNOSIS IRRITABLE BOWEL SYNDROME

DEFINITION AND DIAGNOSIS1638-1642 TREATMENT1643

NORMAL STRUCTURE AND FUNCTION

Macroscopic Anatomy Microscopic Anatomy

FUNCTION

Secretion and Absorption of Water and Electrolytes Mucus Motility Role of the Colonic Microflora Immune Surveillance

DIAGNOSTIC EVALUATION

HISTORY AND PHYSICAL EXAMINATION

Features to Assess and Score from Normal, Mild, Moderate, to Marked

Morphological Features Inflammation Laboratory Investigations

Neuromuscular Dysfunction Mechanical Obstruction Inflammation Metabolic and Endocrine Environmental and Behavioral

Molecular Diagnostics CYTOLOGY Imaging Colonoileoscopy

INFECTION

Helminths

Trichuris Heterobilharzia americana Balantidium coli Entamoeba histolytica Tritrichomonas foetus Giardia intestinalis

Fungi

Histoplasmosis

Pythium insidiosum

Prototheca spp.

Bacteria

Campylobacter spp. Clostridium perfringens Clostridium difficile Brachyspira pilosicoli

INFLAMMATION

Inflammatory Bowel Disease

DEFINITION PATHOPHYSIOLOGY AND MECHANISMS OF DISEASE Influence of Diet Effects of Inflammation on Colonic Function CLINICAL EXAMINATION AND HISTORY PHYSICAL EXAMINATION Ancillary Tests and Laboratory Investigation TREATMENT AND MANAGEMENT

HISTIOCYTIC ULCERATIVE COLITIS

DEFINITION PATHOPHYSIOLOGY AND MECHANISM Evaluation of the Patient

HISTORY AND PHYSICAL EXAMINATION LABORATORY INVESTIGATION AND TESTS TREATMENT AND MANAGEMENT

OBSTRUCTION

Neoplasia

BACKGROUND CLINICAL EXAMINATION DIAGNOSIS TREATMENT PROGNOSIS

Intussusception

DEFINITION AND BACKGROUND PATHOPHYSIOLOGY CLINICAL EXAMINATION DIAGNOSIS TREATMENT AND PROGNOSIS

HYPOMOTILITY AND DYSMOTILITY

Constipation

CAUSE PATHOPHYSIOLOGY CLINICAL EXAMINATION DIAGNOSIS TREATMENT Removal of Impacted Feces Laxative Therapy Colonic Prokinetic Agents Surgery PROGNOSIS

IRRITABLE BOWEL SYNDROME ANATOMY PHYSIOLOGY OF DEFECATION HISTORY AND PHYSICAL EXAMINATION DISEASES OF THE RECTUM

Proctitis Perineal Hernia HISTORY AND PHYSICAL EXAMINATION DIAGNOSIS PATHOGENESIS TREATMENT PROGNOSIS Rectal Neoplasia HISTORY AND PHYSICAL EXAMINATION DIAGNOSIS TREATMENT PROGNOSIS Rectal Prolapse HISTORY AND PHYSICAL EXAMINATION DIAGNOSIS PATHOGENESIS TREATMENT PROGNOSIS Rectal and Anal Stricture HISTORY AND PHYSICAL EXAMINATION DIAGNOSIS TREATMENT PROGNOSIS

DISEASES OF THE ANUS

Atresia Ani HISTORY AND PHYSICAL EXAMINATION DIAGNOSIS TREATMENT PROGNOSIS Perianal Fistula HISTORY AND PHYSICAL EXAMINATION DIAGNOSIS PATHOGENESIS TREATMENT PROGNOSIS

DISEASES OF THE ANAL SACS

Anal Sac Impaction, Sacculitis, and Abscess HISTORY AND PHYSICAL EXAMINATION DIAGNOSIS PATHOGENESIS TREATMENT PROGNOSIS Anal Sac and Perianal Neoplasia

Anal Sac Apocrine Gland Adenocarcinoma HISTORY AND PHYSICAL EXAMINATION DIAGNOSIS PATHOGENESIS TREATMENT AND PROGNOSIS

Other Perianal Tumors Fecal Incontinence HISTORY AND PHYSICAL EXAMINATION DIAGNOSIS PATHOGENESIS TREATMENT AND PROGNOSIS

LIVER BIOPSY EVALUATION OF VASCULAR LIVER DISEASES CIRCULATORY DISORDERS OF THE CANINE AND FELINE LIVER13

Primary Vascular Disorders Primary Hepatic Disease

MORPHOLOGIC CLASSIFICATION OF BILIARY DISORDERS OF THE CANINE AND FELINE LIVER29 MORPHOLOGIC CLASSIFICATION OF THE PARENCHYMAL DISORDERS OF THE CANINE AND FELINE LIVER44-46 Hepatocytes

Cytoplasmic Alterations Nuclear Alterations

Hepatic Stellate Cells Kupffer Cells Lipogranulomas Extramedullary Hemopoiesis MORPHOLOGIC CLASSIFICATION OF NEOPLASTIC DISORDERS OF THE CANINE AND FELINE LIVER55 LABORATORY EVALUATION OF HEPATOBILIARY DISEASE

Clinical Enzymology

Drug Induction Breed Related Endocrinopathies Hypoxia/Hypotension Nodular Hyperplasia Muscle Injury Neoplasia Bone Disorders Gastrointesintal Disease Miscellaneous PLASMA PROTEINS IN HEPATIC DISEASE

Albumin Globulins Coagulation Proteins

BLOOD AMMONIA SERUM UREA NITROGEN BILIRUBIN BILE ACIDS CARBOHYDRATE METABOLISM CHOLESTEROL AND LIPID METABOLISM URINALYSIS HEMATOLOGIC ABNORMALITIES HEPATIC BIOPSY ACQUISITION AND INTERPRETATION RADIOGRAPHY ULTRASONOGRAPHY PREBIOPSY CONSIDERATIONS FINE NEEDLE ASPIRATES ULTRASOUND-GUIDED BIOPSIES LAPAROSCOPIC BIOPSIES SURGICAL BIOPSIES DRUGS USED FOR TREATMENT OF LIVER DISEASES

Glucocorticoids (Prednisone and Prednisolone) Azathioprine Ursodeoxycholic Acid Antioxidants Vitamins C and E S-Adenosyl-L-Methionine Silymarin Antifibrotic Drugs Anticopper Medications Treatment of Ascites in Chronic Liver Disease Treatment of Hepatic Encephalopathy Hepatic Encephalopathy and Liver Lipidosis in Cats Dietary Therapies for Liver Disease

PARENCHYMAL LIVER DISEASES HEPATITIS IN DOGS

Acute Idiopathic Hepatitis Hepatitis and Necrosis due to Phalloidin or Acetaminophen Intoxication Leptospirosis Liver Abscess Chronic Idiopathic Hepatitis Copper-Associated Hepatitis Lobular Dissecting Hepatitis

DISEASES OF THE BILIARY SYSTEM

Destructive Cholangitis in Dogs Neutrophilic Cholangitis in Cats Lymphocytic Cholangitis in Cats

CHRONIC HEPATITIS FIBROSIS AND CIRRHOSIS

Bedlington Terriers Doberman Pinschers West Highland White Terriers Labrador Retrievers Dalmatians Skye Terriers Cocker Spaniels English Springer Spaniels Infectious Canine Hepatitis and Chronic Hepatitis

LOBULAR DISSECTING HEPATITIS DRUG-ASSOCIATED HEPATITIS CHOLANGIOHEPATITIS ACIDOPHIL-CELL HEPATITIS LEPTOSPIROSIS GRANULOMATOUS HEPATITIS LEISHMANIASIS BABESIOSIS CHOLANGITIS COMPLEX PATHOLOGY AND CLASSIFICATION

Neutrophilic Cholangitis Lymphocytic Cholangitis Mixed Inflammatory Infiltrates Cholangitis Associated with Liver Fluke

NEUTROPHILIC CHOLANGITIS

CLINICAL FEATURES DIAGNOSIS TREATMENT PROGNOSIS

LYMPHOCYTIC CHOLANGITIS

CLINICAL FEATURES DIAGNOSIS TREATMENT PROGNOSIS

MIXED INFLAMMATORY CHOLANGITIS EMBRYOLOGY ANATOMY/CLASSIFICATION HEPATIC ENCEPHALOPATHY DIAGNOSTIC EVALUATION

Signalment History Clincial Signs/Physical Examination CLINICAL DIAGNOSIS

Clinicopathologic Findings

Liver Function Testing Coagulation Profiles Abdominal Effusion Histology

DIAGNOSTIC IMAGING

Abdominal Ultrasonography Scintigraphy Computed Tomographic Angiography Magnetic Resonance Angiography Portovenography Differential Diagnoses

TREATMENT

Medical Management

Medical Management Alone

Presurgical Patient Management Surgery Extrahepatic Portosystemic Shunts Intrahepatic Portosystemic Shunts Complications Following PSS Attenuation Surgical Management of Feline Portosystemic Shunts

Surgical and Interventional Treatment of Hepatic Arteriovenous Malformations Prognosis Postoperative Care

INTRINSIC AND IDIOSYNCRATIC XENOBIOTIC HEPATOTOXICITY

Xenobiotic Hepatotoxicity: Morphologic Lesions Specific Hepatic Xenobiotic Toxicities (Box 280-1)

Antimicrobials

Commonly Reported Toxins Endotoxins and Enterotoxins

Anticonvulsants: Phenobarbital, Phenytoin, and Primidone Diazepam Oxibendazole and Mebendazole Methimazole Nonsteroidal Antiinflammatory Drugs

Carprofen

Acetaminophen CCNU Aflatoxin Xylitol Cycad Natural or Herbal Remedies General Treatment Recommendations

METALS AND LIVER DISEASE

Copper Hepatic Iron Retention

METABOLIC DISORDERS AFFECTING THE LIVER

Amyloidosis Feline Lipoprotein Lipase Deficiency and Hepatic Lipid Deposition Canine Hyperlipidemia Biliary Mucocele Canine “Steroid or Glycogen” Vacuolar Hepatopathy41 Feline Hepatic Lipidosis49

STORAGE DISORDERS INVOLVING THE LIVER

Lysosomal Storage Disorders

HEPATOBILIARY INFECTIONS Obstructed Bile Flow Impaired Hepatic Perfusion ± Oxidant Injury Compromised Immunocompetence Increased Translocation of Enteric Organisms Neonatal Visceral Larval Migrans Iatrogenic

Hepatic Involvement in Systemic Infectious Disease

Granulomatous Hepatic Inflammation

HEPATOBILIARY NEOPLASIA ANATOMY AND PHYSIOLOGY CHOLELITHIASIS

ETIOLOGY

CHOLEDOCHOLITHIASIS

CLINICAL SIGNS DIAGNOSIS TREATMENT

CHOLECYSTITIS

ETIOLOGY CLINICAL SIGNS DIAGNOSIS TREATMENT

EMPHYSEMATOUS CHOLECYSTITIS GALLBLADDER INFARCTION BILIARY NEOPLASIA

Biliary Cystadenomas Biliary Carcinomas (Cholangiocarcinomas) DIAGNOSIS TREATMENT

PARASITIC DISEASE OF THE BILIARY SYSTEM

ETIOLOGY CLINICAL SIGNS DIAGNOSIS TREATMENT

GALLBLADDER MUCOCELES

ETIOLOGY CLINICAL SIGNS DIAGNOSIS TREATMENT

GALLBLADDER TORSION PORCELAIN GALLBLADDER WHITE BILE PANCREATITIS

EPIDEMIOLOGY ETIOLOGY PATHOGENESIS CLINICAL PRESENTATION AND DIAGNOSIS

History and Clinical Signs Diagnostic Imaging Clinical Pathology Markers for Pancreatitis Cytology Pancreatic Biopsy THERAPY

Treatment of the Cause Supportive Care

Alimentation Analgesia Antiemetic Agents Plasma Antibiotics Antiinflammatory Agents Other Therapeutic Strategies Mild Chronic Pancreatitis

PROGNOSIS

PANCREATIC AND PERIPANCREATIC FLUID ACCUMULATIONS

Pancreatic Pseudocyst Pancreatic Abscess

EXOCRINE PANCREATIC INSUFFICIENCY

BACKGROUND ETIOLOGY PATHOGENESIS CLINICAL PRESENTATION DIAGNOSIS THERAPY

Key Points Dose Dosing Schedule

PROGNOSIS

EXOCRINE PANCREATIC NEOPLASIA

BACKGROUND ETIOLOGY AND PATHOGENESIS CLINICAL PRESENTATION AND DIAGNOSIS THERAPY AND PROGNOSIS

OVERVIEW OF FELINE PANCREATIC DISEASE

Acute Necrotizing Pancreatitis Acute Suppurative Pancreatitis Chronic Nonsuppurative Pancreatitis Pancreatic Nodular Hyperplasia Pancreatic Neoplasia Pancreatic Pseudocyst Pancreatic Abscess Pancreatic Atrophy

ACUTE NECROTIZING PANCREATITIS

ETIOLOGY

Known Associations Suggested Associations

Concurrent Biliary Tract Disease Concurrent Gastrointestinal Tract Disease Ischemia Pancreatic Ductal Obstruction Infection Trauma Organophosphate Poisoning Lipodystrophy Hypercalcemia Idiosyncratic Drug Reactions Nutrition PATHOGENESIS CLINICAL SIGNS

History Physical Examination Findings

DIFFERENTIAL DIAGNOSIS DIAGNOSIS

Laboratory Findings Special Tests of Pancreatic Function

Lipase and Amylase Activity Assays Trypsinlike Immunoreactivity Trypsinogen Activation Peptide Pancreatic Lipase Immunoreactivity

Imaging Findings

Radiography Ultrasonography Computed Tomography

Biopsy

THERAPY PREVENTION

Complications of Acute Necrotizing Pancreatitis—Chronic Nonsuppurative Pancreatitis Complications of Acute Necrotizing Pancreatitis—Exocrine Pancreatic Insufficiency Complications of Acute Necrotizing Pancreatitis—Hepatic Lipidosis Complications of Acute Necrotizing Pancreatitis—Diabetes Mellitus

GROWTH HORMONE ACROMEGALY

PATHOGENESIS CLINICAL MANIFESTATIONS DIAGNOSIS TREATMENT

PITUITARY DWARFISM

PATHOGENESIS CLINICAL MANIFESTATIONS DIAGNOSIS TREATMENT PROGNOSIS

VASOPRESSIN PATHOGENESIS CLINICAL MANIFESTATIONS DIFFERENTIAL DIAGNOSIS DIAGNOSIS TREATMENT PROGNOSIS Common Uncommon Uncommon to Rare PRIMARY HYPERPARATHYROIDISM AND HYPERCALCEMIA IN DOGS

CAUSE PATHOPHYSIOLOGY

Calcium-Parathyroid Hormone Feedback System Severe Hypercalcemia

SIGNALMENT

Age and Gender Breed Hereditary Disease

ANAMNESIS: CLINICAL SIGNS

General Renal: Kidneys, Bladder, and Urethra

Polydipsia, polyuria, or both Urinary tract calculi or infection

Listlessness, Lethargy, and Decreased Activity Weakness, Exercise Intolerance, and Muscle Wasting Inappetence Shivering, Twitching, and Seizures PHYSICAL EXAMINATION

Clinical Pathology: Hemogram (CBC), Serum Biochemical Profile, and Urinalysis

Complete Blood Count Serum Chemistry Profile8

Serum total calcium concentrations Changes in serum calcium concentration with time Plasma ionized calcium concentration Factors affecting the serum calcium concentration Blood urea nitrogen and serum creatinine Serum inorganic phosphorus (PO4) and its significance

Decreased Intestinal Absorption Increased Urinary Excretion Transcellular Shifts

Plasma protein Urinalysis Urine Sediment Electrocardiography Radiology Ultrasonography Assays: PTH, PTHrP, Vitamin D (Calcitriol) Radionuclide Scans Selective Venous Sampling New Methylene Blue Infusion Diagnostic Approach to the Hypercalcemic Dog or Cat

General

Hematologic Cancers Solid Tumors with Bone Metastasis Solid Tumors without Bone Metastasis

Review of the History and Physical Examination

FIRST STEPS SIGNALMENT HISTORY PHYSICAL EXAMINATION

Initial Data Base

Blood and urine Radiography and ultrasonography Lymph node and bone marrow evaluations Serum PTH and PTHrP concentrations

Acute Medical Therapy for the Hypercalcemic Dog

Primary Hyperparathyroidism versus Other Disorders

Primary hyperparathyroidism versus renal failure or vitamin D toxicosis Indications for aggressive therapy

Definitive Supportive

Initial Considerations Secondary Considerations Tertiary Considerations Future Considerations

Fluid therapy Saline diuresis Diuretic therapy Glucocorticoids Bisphosphonates Calcitonin Plicamycin EDTA Bicarbonate Dialysis Calcium receptor agonist therapy

Surgical Therapy for Primary Hyperparathyroidism

Assessing the Parathyroid Glands during Surgery

How many glands are involved? The solitary adenoma, hyperplastic nodule, or carcinoma Enlargement of multiple parathyroid glands Recurrence of PHPTH No parathyroid mass at surgery Results

New Therapies for PHPTH in Dogs

Percutaneous Ultrasound-Guided Radiofrequency Heat Ablation

Background Candidates Procedure Results

Percutaneous Ultrasound-Guided Ethanol Ablation

Background Candidates Procedure Results

Posttreatment Management of Potential Hypocalcemia

Background Presurgical Serum Calcium Concentration Less Than 14 mg/dL Presurgical Serum Calcium Concentration Greater Than 15 mg/dL Vitamin D Resistance

Pathology Prognosis

PRIMARY HYPERPARATHYROIDISM IN CATS

Differential Diagnosis for Feline Hypercalcemia Idiopathic Hypercalcemia of Cats Primary Hyperparathyroidism in Cats

HYPOPARATHYROIDISM AND HYPOCALCEMIA

BACKGROUND PATHOPHYSIOLOGY Clinical Features of Naturally Occurring Hypoparathyroidism—Dogs

Signalment Duration of Illness and Common Clinical Signs Seizures Facial Rubbing and Biting at Feet Physical Examination

Clinical Features of Naturally Occurring Hypoparathyroidism—Cats Diagnostic Evaluation—Dogs and Cats

Serum Calcium and Phosphate Concentrations Electrocardiogram Serum Parathyroid Hormone Concentration

Differential Diagnosis for Hypocalcemia (Box 286-6, Figure 286-10)

Parathyroid-Related Hypocalcemia Acute Renal Failure and Ethylene Glycol Toxicity Chronic Renal Failure, Hypoalbuminemia, and Pancreatitis Puerperal Tetany (Eclampsia) Nutritional Secondary Hyperparathyroidism Miscellaneous Causes of Hypocalcemia

Therapy for Hypoparathyroidism and Hypocalcemia

Emergency Therapy for Tetany Fever

Post-Tetany Short-Term Maintenance Therapy

Subcutaneous Calcium Repeating Intravenous Bolus Calcium Supplementation in a Continuous Intravenous Solution

Long-Term Maintenance Therapy

Vitamin D in General Vitamin D2 (Ergocalciferol) Dihydrotachysterol 1,25-Dihydroxyvitamin D (Calcitriol) Calcium

Initial approach to oral calcium Calcium supplements

Treatment Protocol

Parathyroid Histology in Primary Hypoparathyroidism Prognosis

PHYSIOLOGY AND METABOLISM CANINE HYPOTHYROIDISM

PATHOGENESIS EPIDEMIOLOGY CLINICAL SIGNS

CONGENITAL HYPOTHYROIDISM

Polyendocrinopathies CLINICOPATHOLOGIC CHANGES DIAGNOSIS OF HYPOTHYROIDISM

Patient Selection Basal Thyroid Hormone Concentrations

Total T4 concentration Free T4 concentration Total T3 concentration Reverse T3 and free T3 concentrations

Effect of Drugs on Thyroid Hormone Concentrations Effect of Systemic Illness on Thyroid Hormone Concentrations Basal Thyrotropin (TSH) Concentration TSH Response Test TRH Response Test Scintigraphy Thyroid Ultrasound

DIAGNOSIS OF THYROIDITIS

Antithyroglobulin Antibody Anti-T3 and Anti-T4 Antibodies Thyroid Biopsy

TREATMENT AND THERAPEUTIC MONITORING

Hypothyroidism Concurrent Nonthyroidal Illness

Cardiomyopathy Hypoadrenocorticism TREATMENT FAILURE PROGNOSIS

FELINE HYPOTHYROIDISM FELINE HYPERTHYROIDISM

Etiopathogenesis Clinical Features

General Features Gastrointestinal Features Cardiovascular Features Respiratory Features Apathetic Hyperthyroidism Palpable Goiter

Investigative Procedures

Diagnostic Imaging Electrocardiography Screening Laboratory Tests Thyroid Function Tests

Pathophysiology Basal circulating thyroid hormone concentrations Thyroid stimulating hormone response test Thyrotropin-releasing hormone response test Triiodothyronine suppression test Thyroid radionuclide uptake and imaging

Treatment

Antithyroid Drugs and Other Medical Treatments

Thioureylene antithyroid drugs Other medical treatments

Surgical Thyroidectomy Radioactive Iodine Other Therapies Effect of Treatment on Renal Function

THYROID NEOPLASIA AND HYPERTHYROIDISM IN DOGS CLINICAL FEATURES DIAGNOSIS TREATMENT PATHOLOGY PATHOPHYSIOLOGY HISTORY AND CLINICAL SIGNS PHYSICAL EXAMINATION DIFFERENTIAL DIAGNOSES DIAGNOSTIC EVALUATION TREATMENT PROGNOSIS INSULIN-SECRETING ISLET CELL NEOPLASIA IN THE CAT CLASSIFICATION AND ETIOLOGY PATHOPHYSIOLOGY SIGNALMENT ANAMNESIS PHYSICAL EXAMINATION DIAGNOSIS PATIENT EVALUATION Complete Blood Count Biochemistry Panel Urinalysis Ancillary Tests THERAPY

Goals of Therapy

Common Uncommon

Initial Insulin Recommendations Storage and Dilution of Insulin Initial Adjustments in Insulin Therapy Dietary Recommendations Exercise Identification and Control of Concurrent Problems Oral Hypoglycemic Drugs

TECHNIQUES FOR MONITORING DIABETIC CONTROL

History and Physical Examination Serum Fructosamine Concentration Urine Glucose Monitoring Serial Blood Glucose Curve Generating the Serial Blood Glucose Curve at Home Evaluating Aggressive, Excitable, or Stressed Diabetic Dogs

COMPLICATIONS OF INSULIN THERAPY

Hypoglycemia Stress Hyperglycemia Recurrence or Persistence of Clinical Signs

Insulin Underdosage Insulin Overdosing and the Somogyi Response Short Duration of Insulin Effect Prolonged Duration of Insulin Effect Inadequate or Impaired Insulin Absorption Circulating Antiinsulin Antibodies Concurrent Disorders Causing Insulin Resistance

Caused by Insulin Therapy Caused by Concurrent Disorder CHRONIC COMPLICATIONS OF DIABETES MELLITUS

Cataracts Lens-Induced Uveitis Diabetic Neuropathy Diabetic Nephropathy PROGNOSIS

CLASSIFICATION

Types of Diabetes Mellitus in Humans Types of Diabetes Mellitus in Cats

INSULIN, METABOLIC EFFECTS, AND DISTURBANCES

Insulin Synthesis, Structure, and Regulation Metabolic Effects Metabolic Disturbances

CLINICAL FEATURES

SIGNALMENT CLINICAL MANIFESTATIONS DIAGNOSIS AND WORKUP

THERAPY

Goals of Therapy

Reevaluation 1 Week after Diagnosis Reevaluation 3 Weeks after Diagnosis Reevaluation 6 to 8 Weeks after Diagnosis Reevaluation 10 to 12 Weeks after Diagnosis Further Reevaluations Every 4 Months Goals of Therapy

Initial Insulin Therapy Neutral Protamine Hagedorn Insulin (Isophane Insulin) Lente Insulins Protamine Zinc Insulin Long-Acting Insulin Analogs Insulin Choice and Dose and Owner Instructions

ORAL HYPOGLYCEMIC AGENTS

Sulfonylureas Meglitinides Metformin Thiazolidinediones α-Glucosidase Inhibitors Trace Elements Others

DIETARY MANAGEMENT CONCURRENT PROBLEMS GLUCOTOXICITY, LIPOTOXICITY, AND REMISSION OF DIABETES MONITORING OF DIABETES

Monitoring in the Hospital

Frequency of Reevaluations Serum Fructosamine Urine Glucose Blood Glucose Measurements and Serial Blood Glucose Curves Problems Encountered in Monitoring Blood Glucose in the Hospital

Monitoring at Home

Technical Aspects Introduction of Technique to Cat Owners Comparison of BGCs Generated at Home and BGCs Generated in the Hospital Long-Term Compliance with Home Monitoring Continuous Glucose Monitoring

PROBLEMS DURING LONG-TERM MANAGEMENT

Stress Hyperglycemia Hypoglycemia

PROBLEMS CAUSING PERSISTENCE OF CLINICAL SIGNS Step 1 Step 2 Step 3 Step 4 Step 5

Technical Problems Insulin Underdose Insulin Overdose and the Somogyi Effect Short Duration of Insulin Effect Prolonged Duration of Insulin Effect Impaired Absorption of Insulin Binding of Insulin by Insulin Antibodies

CONCURRENT DISORDERS CAUSING INSULIN RESISTANCE HYPOTHALAMUS–ADENOHYPOPHYSIS–ADRENAL GLAND AXIS PATHOPHYSIOLOGY

Pituitary-Dependent Hyperadrenocorticism

Functional Adrenocortical Tumors

Concurrent Pituitary and Adrenocortical Tumors Adrenocortical Nodular Hyperplasia Ectopic ACTH Secretion CLINICAL ASPECTS SIGNALMENT

Age Breed Gender HISTORY AND PHYSICAL EXAMINATION CLINICOPATHOLOGIC FINDINGS Hemogram Biochemical Profile Urinalysis

Thyroid Function Tests Diagnostic Imaging

Thoracic Radiographs Abdominal Radiographs Ultrasonography Computed Tomography and Magnetic Resonance Imaging

The incidentally discovered adrenal mass

ENDOCRINE TESTS

Tests to Diagnose Hyperadrenocorticism (Screening Tests)

Urine Cortisol–to-Creatinine Ratio

ACTH stimulation test Low-dose dexamethasone suppression test

Urinary Cortisol–to-Creatinine Ratio (Low-Dose Dexamethasone Suppression Test)

Differentiating Tests (Tests Used to Discriminate Pituitary from Adrenal Tumor HAC)

Low-Dose Dexamethasone Suppression Test High-Dose Dexamethasone Suppression Test HDDST Using a Urine Corticoid–to-Creatinine Ratio Endogenous ACTH

Ultrasonographic examination of the adrenal glands

Computed Tomography and Magnetic Resonance Imaging TREATMENT

Treatment: Pituitary-Dependent Hyperadrenocorticism

Overview Trilostane Mitotane

Standard protocol: initial induction or loading dosage Standard protocol: maintenance dosage Nonselective protocol Ketoconazole Selegiline hydrochloride Other drugs

Surgical Treatment of Dogs with Pituitary-Dependent Hyperadrenocorticism

Hypophysectomy Radiation Therapy in Dogs with Pituitary-Dependent Hyperadrenocorticism

Treatment of Functional Adrenocortical Tumors

Overview Adrenalectomy Medical Management of Adrenocortical Tumors: Mitotane Medical Management of Adrenal Tumors: Trilostane

Complications and Concurrent Diseases Associated with Hyperadrenocorticism

Large Pituitary Tumors Adrenal Tumors Hypertension Pyelonephritis Urinary Calculi Diabetes Mellitus

ETIOLOGY OF NATURALLY OCCURRING FELINE CUSHING’S SYNDROME IATROGENIC FELINE CUSHING’S SYNDROME SIGNALMENT CLINICAL FINDINGS

Diabetes Mellitus, Polyuria, and Polydipsia Appetite Obesity Dermatologic Changes Musculoskeletal Changes Hepatomegaly

ROUTINE CLINICAL PATHOLOGY TESTS

Urinalysis Complete Blood Count Serum Biochemistry

DIAGNOSTIC IMAGING ENDOCRINE FUNCTION TESTING

Screening Tests Tests to Discriminate Pituitary-Dependent Hypercortisolism from Adrenal Tumor TREATMENT MEDICAL MANAGEMENT SURGICAL MANAGEMENT Pituitary Radiation Therapy

ADRENAL PHYSIOLOGY CANINE HYPOADRENCOCORTICISM

PATHOGENESIS SIGNALMENT CLINICAL SIGNS CLINICOPATHOLOGIC CHANGES

Hematology Serum Electrolyte Abnormalities Na : K Ratio Other Biochemical Abnormalities

Imaging Studies Electrocardiography Endocrine Testing

Basal Cortisol ACTH Stimulation Test Endogenous ACTH Concentration Plasma Aldosterone Aldosterone-to-Renin and Cortisol-to-Adrenocorticotrophic Hormone Ratios

TREATMENT

Acute Management Maintenance Therapy

Glucocorticoid Therapy Mineralocorticoid Therapy Desoxycorticosterone Pivalate (Percorten V, Novartis) Fludrocortisone Acetate (Florinef, Squibb) Dogs without Electrolyte Abnormalities

Polyendocrinopathy PROGNOSIS Poor Response to Therapy Feline Hypoadrenocorticism

SUMMARY GASTROINTESTINAL ENDOCRINOLOGY GASTROINTESTINAL HORMONES

Gastrin-Cholecystokinin Family

Gastrin Cholecystokinin

Secretin-Enteroglucagon-Gastric Inhibitory Polypeptide Family

Secretin Enteroglucagon Gastric Inhibitory Polypeptide

Peptide Family

Somatostatin Motilin Ghrelin 5-Hydroxytryptamine

DISEASES OF THE GASTROINTESTINAL ENDOCRINE SYSTEM

Glucagonoma SIGNALMENT AND CLINICAL SIGNS LABORATORY AND IMAGING FINDINGS DIAGNOSIS

Glucagon Measurement Plasma Amino Acid Concentrations PATHOLOGY THERAPY PROGNOSIS

Gastrinoma SIGNALMENT AND CLINICAL SIGNS LABORATORY FINDINGS IMAGING FINDINGS ENDOSCOPIC FINDINGS DIAGNOSIS

Basal Gastric Acid Secretion Basal Serum Gastrin Concentration Secretin Stimulation Calcium Stimulation PATHOLOGY THERAPY Treatment Directed at Tumor Cells Somatostatin Analogues Adjunct Medical Therapy

Gastric hyperacidity

Histamine (H2) Receptor Antagonists H+/K+-ATPase Inhibitors Diffusion Barriers Synthetic Prostaglandins Somatostatin Analogs Amino Acid Supplementation

Gastrointestinal ulceration PROGNOSIS Intestinal Carcinoid Pancreatic Polypeptidoma

ETIOLOGY PATHOPHYSIOLOGY CLINICAL PRESENTATION DIAGNOSTIC EVALUATION DIAGNOSTIC IMAGING

Abdominal Ultrasound Radiography Computed Tomography and Magnetic Resonance Imaging Nuclear Scintigraphy

ARTERIAL BLOOD PRESSURE MEASUREMENTS HORMONAL TESTING ESTABLISHING THE DIAGNOSIS TREATMENT

Preoperative Medical Management Anesthesia and Intraoperative Complications Surgical Considerations, Postoperative Complications, and Outcome MEDICAL MANAGEMENT HISTOPATHOLOGY PROGNOSIS

THE ESTROUS CYCLE FOLLICULAR PHASE PREOVULATORY LUTEINIZATION AND OVULATION LUTEAL PHASE ANESTRUS BREEDING MANAGEMENT OF THE HEALTHY BITCH THE HISTORY CONCERNING THE REPRODUCTION DATA THE EXAMINATION OF THE BITCH ADDITIONAL EXAMINATIONS THE NORMAL CANINE ESTROUS CYCLE NORMAL VARIATIONS IN THE CANINE ESTROUS CYCLE

Delayed Puberty Silent Heat Cycles Split Heat Cycles Management Errors

PATTERNS OF ABNORMAL ESTROUS CYCLES

Prolonged Proestrus or Estrus Prolonged Interestrous Intervals Shortened Interestrous Intervals Hypoluteiodism Exaggerated Pseudocyesis (Pseudopregnancy)

PREGNANCY

Physiologic Changes and Clinical Monitoring Gestation Length Prediction of Parturition Day

DISORDERS DURING PREGNANCY

Early Fetal Loss and Abortion Infectious Agents

Brucella canis Toxoplasma gondii and Neospora caninum Canine Herpesvirus

Hypoluteoidism Insulin Resistance Hypocalcemia Hypoglycemia Premature Labor

NORMAL PARTURITION

Litter Size Physiology of Parturition Signs of Impending Parturition Stages of Parturition

First Stage Second Stage Third Stage

Interval between Births Completion of Parturition

DYSTOCIA

DEFINITION Frequency CLINICAL ASSESSMENT DIAGNOSIS Maternal Causes of Dystocia

Uterine Inertia

Management

Obstruction of Birth Canal

Fetal Causes of Dystocia

Oversized Fetuses Posterior Presentation Breech Presentation Lateral or Downward Deviation of the Head Backward Flexion of Front Legs Transverse or Bicornual Presentation Two Fetuses Presented Simultaneously Management of Fetal Malpresentations Outcome of Obstetric Treatment Criteria for Cesarean Section

POSTPARTURIENT CONDITIONS

Perinatal Loss Uterine Disorders

Hemorrhage Retained Placentas and Fetuses Acute Metritis Subinvolution of Placental Sites Uterine Rupture Uterine Prolapse Toxic Milk Syndrome

Mammary Gland Disorders

Agalactia Galactostasis Acute Mastitis

Miscellaneous Disorders

Puerperal Tetany Disturbances in Maternal Behavior

BACKGROUND ANESTHESIA PROCEDURES EFFECT OF GONADECTOMY ON BEHAVIOR EFFECT OF GONADECTOMY ON INCIDENCE OF NEOPLASIA

Mammary Neoplasia Prostatic Neoplasia Osteosarcoma Transitional Cell Carcinoma Hemangiosarcoma Reproductive Tract Neoplasia

EFFECT OF GONADECTOMY ON ORTHOPEDIC DISORDERS EFFECT OF GONADECTOMY ON OBESITY EFFECT OF GONADECTOMY ON URINARY TRACT DISEASE EFFECT OF GONADECTOMY ON ENDOCRINE DISEASE

Hypothyroidism Diabetes Mellitus Adrenal Disease

EFFECT OF GONADECTOMY ON NON-NEOPLASTIC REPRODUCTIVE TRACT DISEASE CONCLUSION CANINE

PERMANENT STERILIZATION

Female Male

TEMPORARY CONTRACEPTIVE TECHNIQUES PREGNANCY TERMINATION

Bitch

Mismate Drugs Abortifacients—Single Agents Abortifacients—Combination Treatments Abortifacients—Other Treatments Abortifacients—Dexamethasone

FELINE

QUEEN

Permanent Sterilization Termination of Pregnancy Estrogen Prostaglandin Prolactin Inhibitors Progesterone Inhibitors

SUMMARY

SIGNALMENT AND HISTORY ETIOPATHOGENESIS CLINICAL SIGNS

DIAGNOSIS

History and Physical Examination Imaging Laboratory Findings TREATMENT Ovariohysterectomy

Antibiotics Medical Therapy

General Prostaglandins Dopamine agonists Progesterone-receptor antagonists

RECURRENCE OF PYOMETRA AND FERTILITY UTERINE STUMP PYOMETRA CONCLUSION

INVESTIGATION OF INFERTILITY CLINICAL PRESENTATIONS OF INFERTILITY

Failure to Cycle

Introduction Delayed Puberty Prolonged Anestrus

Abnormal Estrous Cycles

Split Estrus Ovulation Failure Prolonged Proestrus or Estrus Ovarian Neoplasia

Normal Estrous Cycle with Failure of Copulation

Behavioral Problems Vestibulovaginal and Vestibulovulval Abnormalities Vaginal Hyperplasia Congenital Anomalies of the External Genitalia Vaginal Hypoplasia/Aplasia

Normal Estrous Cycle with Copulation and Conception Failure

Fertile and Fertilization Periods

Normal Estrous Cycle with Copulation Distant from Ovulation

Fertile and Fertilization Periods

Clinical/managemental assessments Hormone measurement Vaginal cytology Vaginal endoscopy Evaluation of cervical-vaginal secretions

Normal Estrous Cycle with Copulation Close to Ovulation

Infertile Male Uterine Disease Aplasia of the Tubular Genital Tract

Normal Estrous Cycle and Copulation with Pregnancy Failure

Short/Inadequate Luteal Phase Infectious Causes of Pregnancy Loss

Canine herpesvirus Brucella canis Canine adenovirus Canine parvovirus Canine distemper virus Toxoplasma gondii

Normal Vaginal Bacterial Flora

CONCLUSION ANATOMY

Embryologic Origins of the Posterior Reproductive Tract Anatomic Relationship of the Vagina and Vestibule

EXAMINATION OF THE VESTIBULE AND VAGINA

Vaginal Cytology Visual and Digital Examination of the Vagina and Vestibule Vaginal Bacterial Cultures

VAGINAL ABNORMALITIES

Vaginitis Anatomic Abnormalities Vaginal Fold Prolapse, Vaginal Hyperplasia, and Vaginal Prolapse Miscellaneous Vaginal Disorders

ANATOMY SPERMATOGENESIS BREEDING SOUNDNESS EXAMINATION

HISTORY PHYSICAL EXAMINATION Libido Collection Semen Examination Motility Morphologic Examination Volume and Concentration Semen Handling On-Site Vaginal Artificial Insemination Semen Preparation for Shipment

OPTIONAL ADDITIONS TO THE BREEDING SOUNDNESS EXAMINATION ANATOMY AND PHYSIOLOGY

Female

Vulva, Vestibule, and Vagina Cervix and Uterus Ovaries

Male

Penis Accessory Sex Glands Testicles

Sexing Kittens Puberty

NORMAL QUEEN

Estrous Cycle

Proestrus Estrus Interestrus (Postestrus) Diestrus Anestrus

NORMAL TOM

Reproductive Physiology Semen Collection Semen Evaluation

BREEDING MANAGEMENT

Natural Mating Behavior Artificial Insemination

PREGNANCY AND PARTURITION

Pregnancy Diagnosis Care of the Pregnant Queen Parturition Dystocia

CONTRACEPTION IN THE QUEEN AND TOM INFERTILITY IN THE QUEEN AND TOM

Infertility in the Tom Cat Infertility in the Queen

ABNORMALITIES OF THE TOM

Cryptorchidism Orchitis and Epididymitis Testicular Neoplasia Priapism, Phimosis, and Paraphimosis Trauma Prostate Disease Behavioral Abnormalities Congenital and Genetic Disorders Affecting Reproduction

ABNORMALITIES OF THE QUEEN

Ovarian Remnant Syndrome Ovarian Neoplasia Mammary Hypertrophy Mammary Neoplasia Pyometra Postpartum Disorders of the Uterus

CHALLENGES FACING THE FETUS AND NEONATE

Fetal Challenges during Late Pregnancy Challenges at Parturition Neonatal Challenges

CHARACTERISTICS OF NORMAL NEONATES OPTIMIZING NEONATAL SURVIVAL

Care of the Bitch before and during Pregnancy Care of the Bitch at Parturition Care of the Neonate Care of Older Neonates Artificial Rearing of Neonates

SICK PUPPIES

Known Causes of Mortality Unknown Causes of Mortality Clinical Signs of Sick or Fading Puppies Consequences of Disease in Canine Neonates Treatment of the Sick Puppy

Minor Disease Significant Disease

INVESTIGATION OF NEONATAL LOSS PREVENTIVE HEALTHCARE PROGRAMS CONCLUSION DEFINITIONS CLINICAL APPROACH

History Physical Examination Differentiation of Acute from Chronic Renal Failure

LABORATORY EVALUATION OF RENAL FUNCTION

Glomerular Function Blood Urea Nitrogen Serum Creatinine Cystatin C Creatinine Clearance Single Injection Methods for Estimation of GFR Iohexol Clearance Radioisotopes Urine Protein/Creatinine Ratio Microalbuminuria Bladder Tumor Antigen Test Tubular Function Urine Specific Gravity and Osmolality Water Deprivation Test Gradual Water Deprivation Fractional Clearance of Electrolytes

ROUTINE URINALYSIS

Physical Properties

Appearance Specific Gravity

Chemical Properties

pH Protein Glucose Ketones Occult Blood Bilirubin Leukocyte Esterase Reaction

Urinary Sediment Examination

Red Blood Cells

Urinary Tract Origin (Kidneys, Ureters, Bladder, Urethra) Genital Tract Contamination (Prostate, Prepuce, Vagina)

White Blood Cells Epithelial Cells Casts Organisms Crystals Miscellaneous

MICROBIOLOGY RADIOLOGY ULTRASONOGRAPHY RENAL BIOPSY DEFINITION ETIOLOGY

Prerenal Intrinsic Renal Failure Postrenal

PHASES OF ARF CELLULAR MECHANISMS OF THE PATHOPHYSIOLOGY OF ARF DIAGNOSIS

Clinical Presentation Laboratory Evaluation Imaging Renal Aspirate and Biopsy Specific Tests of Renal Function Tests for Specific Diseases

RISK FACTORS FOR ACUTE UREMIA MONITORING PREVENTION TREATMENT

Fluid Treatment

Sample Calculations without Fluid Pump Sample Calculations with Fluid Pump CONVERTING OLIGURIA TO NONOLIGURIA

Renal Replacement Therapy

TREATMENT OF URETERAL OBSTRUCTION TREATMENT OF SPECIFIC DISEASES TREATMENT OF UREMIC COMPLICATIONS

Potassium Sodium Metabolic Acidosis Calcium and Magnesium Phosphorus Hypertension Hematologic Disorders Gastrointestinal Disorders Nutritional Support Infections PROGNOSIS

CANDIDATE SELECTION DONORS PREOPERATIVE MANAGEMENT DONOR SURGERY RECIPIENT SURGERY PERIOPERATIVE MANAGEMENT AND COMPLICATIONS IMMUNOSUPPRESSION MONITORING COMPLICATIONS

Rejection Ureteral Obstruction Neurologic Signs Hypertension Infection Diabetes Mellitus Neoplasia Miscellaneous Complications

OUTCOME CANINE TRANSPLANTATION SUMMARY OVERVIEW DEFINITION Blood Markers Urine Markers Imaging Markers—Abnormalities in Kidney

Terms and Concepts Related to Kidney Disease, Kidney Failure, and Uremia Acute versus Chronic Kidney Disease Staging Chronic Kidney Disease Affected Population Causes

Familial or Congenital Kidney Diseases

Dogs Cats

Acquired

PROGNOSIS

CLINICAL CONSEQUENCES

Uremia

Clinical Signs of Uremia Pathogenesis of Uremia

Disturbed excretion of electrolytes and water Reduced excretion of organic solutes Impaired renal hormone synthesis

Gastrointestinal Consequences Impaired Urine Concentrating Ability, Polyuria, Polydipsia, and Nocturia Arterial Hypertension and Cardiovascular Consequences Neuromuscular Consequences

Encephalopathies and Neuropathies Myopathies

Hematologic Consequences

Anemia Hemorrhagic Consequences of Uremia

Renal Secondary Hyperparathyroidism

Incidence and Pathophysiology Clinical Consequences

LABORATORY FINDINGS

Metabolic Acidosis Azotemia Hyperphosphatemia Hypercalcemia, Hypocalcemia, and Hypermagnesemia Hypokalemia

SPONTANEOUS PROGRESSION

Progressive Character Pathophysiology of Progression Hypertension and Progression Proteinuria and Progression Tubulointerstitial Injury in Progression of Glomerulopathies Intrarenal Precipitation of Calcium Phosphate Other Factors

Lipids and Progression Uremic Toxins Metabolic Acidosis Chronic Hypoxia DIAGNOSTIC EVALUATION

Complications Comorbid Conditions Risk Factors for Acute Decline in Renal Function Risk Factors for Long-Term Decline in Renal Function TREATMENT

Overview of Treatment Dietary Therapy

Dietary Modifications

Diet phosphate Omega-3 PUFA and antioxidants Diet protein

Diet Therapy—Evidence from Clinical Trials Indications for Diet Therapy

Drugs—Medication Review and Dose Modification Phosphorus Retention, Hyperphosphatemia and Renal Secondary Hyperparathyroidism

Dietary Phosphorus Restrictions Intestinal Phosphorus Binding Agents

Dehydration Hypokalemia and Potassium Depletion Metabolic Acidosis Arterial Hypertension

Rationale for Treatment Indications for Treatment General Goals and Guidelines for Treatment of Elevated Blood Pressure in Patients with CKD

Treatment of Anemia

General Guidelines for Minimizing Anemia Anabolic Steroids Blood Transfusion Hormone Replacement Therapy

Calcitriol Therapy

Rationale for Calcitriol Therapy Guidelines for Using Calcitriol

Minimizing Progression MONITORING

NORMAL GLOMERULAR STRUCTURE AND FUNCTION CLINICAL FINDINGS

SIGNALMENT HISTORY

Systemic Disease (Glomerular Disease)

Infectious Inflammatory Neoplastic Miscellaneous Familial (see Table 312-1)

Idiopathic (A, G, MPGN, MN, MCD, P-E or M)

Systemic Disease (Glomerular Disease)

Infectious Inflammatory Neoplastic Miscellaneous Familial (MN)

Idiopathic (MN)

PHYSICAL EXAMINATION FINDINGS CLINICOPATHOLOGIC AND IMAGING FINDINGS HISTOLOGIC DIAGNOSES Procurement and Processing of the Renal Biopsy Specimen Evaluation of the Renal Biopsy Specimen

GLOMERULAR DISEASES

Membranoproliferative Glomerulonephritis CLINICAL FEATURES PATHOGENESIS HISTOPATHOLOGIC CHARACTERIZATION SPECIFIC TREATMENT PROGNOSIS Membranous Nephropathy CLINICAL FEATURES PATHOGENESIS HISTOPATHOLOGIC CHARACTERIZATION SPECIFIC TREATMENT PROGNOSIS Proliferative Glomerulonephritis CLINICAL FEATURES PATHOGENESIS HISTOPATHOLOGIC CHARACTERIZATION SPECIFIC TREATMENT PROGNOSIS Immunoglobulin A Nephropathy Amyloidosis CLINICAL FEATURES PATHOGENESIS HISTOPATHOLOGIC CHARACTERIZATION SPECIFIC TREATMENT PROGNOSIS Hereditary Nephritis CLINICAL FEATURES PATHOGENESIS HISTOPATHOLOGIC CHARACTERIZATION SPECIFIC TREATMENT PROGNOSIS Minimal Change Disease CLINICAL FEATURES PATHOGENESIS HISTOPATHOLOGIC CHARACTERIZATION SPECIFIC TREATMENT PROGNOSIS Glomerulosclerosis Tubulointerstitial Lesions Associated with Glomerular Disease

NONSPECIFIC MEDICAL MANAGEMENT OF GLOMERULAR DISEASE PATIENT MONITORING COMPLICATIONS OF GLOMERULAR DISEASE

Edema Formation Hypertension Thromboembolism Hyperlipidemia

PROGNOSIS DEFINITION OF CONCEPTS AND TERMS

Urinary Tract Infection Microburia Bacteriuria Funguria Pyuria Inflammation versus Infection

ETIOPATHOGENESIS

Normal Host Defenses Microbial Factors Microbial Isolates Routes of Infection

CLINICAL FINDINGS

Historical Information and Physical Examination Findings Laboratory Results Results of Imaging Studies and Endoscopy

DIAGNOSIS

Urine Collection Urinalysis Urine Culture

Qualitative Urine Culture Quantitative Urine Culture

Antimicrobial Susceptibility Testing

Agar Disk Diffusion Technique Antimicrobial Dilution Technique

TREATMENT

Prevention Eradication of Underlying Causes Evidence-Based Antimicrobial Use Antimicrobial Therapy

Uncomplicated Urinary Tract Infections Empiric Antimicrobial Treatment Complicated Urinary Tract Infections Recurrent or Relapsing Urinary Tract Infections

Relapse Reinfection Superinfection Prophylactic antimicrobial treatment

Ancillary Therapy

COMPLICATIONS OF BACTERIAL URINARY TRACT INFECTIONS

Polypoid Cystitis Emphysematous Cystitis Magnesium Ammonium Phosphate (Struvite) Urolithiasis Pyelonephritis

NONBACTERIAL URINARY TRACT INFECTIONS

Fungal Urinary Tract Infections Viral Urinary Tract Infections

ANATOMY PHYSIOLOGY AND PATHOPHYSIOLOGY DIAGNOSTIC EVALUATION

Semen Collection Prostatic Massage and Wash Brush Technique Fine Needle Aspiration

DISEASES OF THE PROSTATE

Benign Prostatic Hyperplasia PATHOGENESIS DIAGNOSIS THERAPY Acute Bacterial Prostatitis DIAGNOSIS THERAPY Prostatic Abscessation DIAGNOSIS THERAPY Chronic Bacterial Prostatitis DIAGNOSIS THERAPY Prostatic and Paraprostatic cysts DIAGNOSIS THERAPY Prostatic Neoplasia DIAGNOSIS THERAPY Prostatic Disease in Cats

Renal Dysplasia Primary Glomerulopathies Polycystic Kidney Disease Amyloidosis Immune-Mediated Glomerulonephritis Miscellaneous CLINICAL FINDINGS DIAGNOSIS SPECIFIC DISORDERS

Renal Dysplasia Primary Glomerulopathies Polycystic Kidney Disease Amyloidosis Immune-Mediated Glomerulonephritis Miscellaneous Conditions

CYSTINURIA CARNITINURIA HYPERURICOSURIA HYPERXANTHINURIA RENAL GLUCOSURIA FANCONI SYNDROME RENAL TUBULAR ACIDOSIS NEPHROGENIC DIABETES INSIPIDUS EVIDENCE OF ACUTE TUBULAR INJURY USING URINE BIOMARKERS INTRODUCTION AND EPIDEMIOLOGY FELINE IDIOPATHIC CYSTITIS

SIGNALMENT

PATHOPHYSIOLOGY

Histology Bladder Abnormalities Systemic Abnormalities Infectious Agents and Feline Idiopathic Cystitis Obstructive Feline Idiopathic Cystitis Summary Approach to the Patient

Diagnostics Radiography Urinalysis and Urine Culture Cystoscopy

Treatment of Feline Idiopathic Cystitis

Treatment Options for the Acute Episode Multimodal Environmental Modifications Dietary Therapy Pheromones Pharmacologic Therapy Conclusion

UROLITHIASIS

Overview Radiography and Other Imaging Techniques Removal of Cystic Calculi Principles of Stone Analysis Struvite and Calcium Oxalate Urolithiasis Management of Urolithiasis Management of Struvite Urolithiasis Management of CaOx Urolithiasis Urate Urolithiasis Dried Solidified Blood Calculi Cystine and Silica Urolithiasis Mixed Compounds Bacterial Cystitis Summary

ANATOMY AND PHYSIOLOGY CLINICAL SIGNS DIAGNOSTIC APPROACH

Diagnostic Imaging Cystoscopy Urodynamics

UROLITHIASIS

Urolith Kinetics—Formation and Growth of Uroliths Role of Matrix In Vitro Assessment of Urolith Formation Crystalluria Diagnosis Urolith Removal Techniques

Cystotomy Laparoscopic-Assisted Cystotomy Voiding Urohydropropulsion Retrograde Urohydropropulsion

Catheter-Assisted Retrieval

Stone Baskets Electrohydraulic Lithotripsy Laser Lithotripsy Extracorporeal Shock Wave Lithotripsy

CALCIUM OXALATE UROLITHIASIS EPIDEMIOLOGY ETIOPATHOGENESIS

Hypercalciuria Hyperoxaluria Water Source Modifiers of Calcium Oxalate Crystal System Concurrent Medical Conditions TREATMENT PREVENTION Role of Diet Medications Thiazide Diuretics Potassium Citrate Vitamins MANAGEMENT

STRUVITE UROLITHIASIS EPIDEMIOLOGY ETIOPATHOGENESIS TREATMENT

Medications PREVENTION Dogs with Calcium Oxalate and Struvite Urolithiasis

PURINE UROLITHIASIS EPIDEMIOLOGY ETIOPATHOGENESIS

Dalmatian Dogs Hepatic Dysfunction Non-Dalmatian Dogs Xanthine Uroliths TREATMENT Dietary Modification Xanthine Oxidase Inhibitors Portal Vascular Shunts Evaluating Response to Medical Therapy PREVENTION

CYSTINE UROLITHIASIS EPIDEMIOLOGY ETIOPATHOGENESIS TREATMENT PREVENTION CALCIUM PHOSPHATE UROLITHIASIS EPIDEMIOLOGY ETIOPATHOGENESIS

Inhibitors of Calcium Phosphate TREATMENT PREVENTION

SILICA UROLITHIASIS ETIOPATHOGENESIS TREATMENT AND PREVENTION UNCOMMON UROLITHS MIXED AND COMPOUND UROLITHS URETEROLITHS

DIAGNOSIS MANAGEMENT

URINARY TRACT OBSTRUCTION

Urethral Obstruction Ureteral Obstruction

URINARY TRACT TRAUMA

Ureteral Trauma

INFLAMMATORY CONDITIONS OF BLADDER AND URETHRA URINARY INCONTINENCE

Urethral Incompetence in Female Dogs Detrusor Instability and Urge Incontinence Urinary Incontinence in Male Dogs Ectopic Ureters

ANATOMIC ABNORMALITIES

Congenital Ureteral Abnormalities

Ureterocele

Urethral Prolapse Urethrorectal or Ureterovaginal Fistula Vesicourachal Diverticula and Persistent Urachus Pelvic Bladder

HARNESSING THE POWER OF “OMIC” TECHNOLOGIES

The Genome and Genomics Transcriptome and Transcriptomics Proteome and Proteomics Metabolome and Metabolomics

CONCLUSION TUMOR BIOLOGY IN CHEMOTHERAPY CHEMOTHERAPY STRATEGIES

Goal of Treatment Treatment Response Combination Chemotherapy Chemotherapy in Combination with Other Treatment Modalities Modes of Administration Chemoprotection Metabolic Dosing Dose Intensity Toxicity after Chemotherapy Chemotherapy Drug Resistance

PALLIATIVE INTENT TREATMENT CURATIVE INTENT TREATMENT STAGING AND HEALTH WHAT TUMORS TO TREAT WITH CHEMOTHERAPY CHEMOTHERAPEUTIC DRUGS

Drug Cost

WHEN TO GIVE CHEMOTHERAPY Induction Consolidation Maintenance Rescue

Timing

Primary Treatment Adjuvant Treatment

ADMINISTRATION OF CHEMOTHERAPY

Basic Chemotherapy Drug Handling Risks to Staff and Owners Route of Administration

MONITORING OF ANIMALS WITH CANCER

Gastrointestinal Toxicity Complete Blood Count Serum Chemistry Profile

THERAPEUTIC SUPPORT OF ANIMALS WITH CANCER

Antiemetics Appetite Stimulants Antidiarrheal Drugs Urothelial Bladder Wall Protection Prevention of Neutropenic Sepsis

SPECIFIC CHEMOTHERAPEUTIC AGENTS ANTITUMOR ANTIBIOTICS PLATINUMS ENZYME MITOTIC INHIBITORS KEY POINTS TUMOR IMMUNOLOGY

Cellular Components Immune Surveillance Immune Evasion by Tumors

NONSPECIFIC TUMOR IMMUNOTHERAPY

Biologic Response Modifiers Recombinant Cytokines, Growth Factors, and Hormones

CANCER VACCINES BIOLOGIC PRINCIPLES OF RADIATION THERAPY

Biologic Effect of Radiation Tissue Response Radiocurability

RADIATION THERAPY TECHNOLOGY

Overview Teletherapy Brachytherapy Systemic Radiation Therapy

CLINICAL RADIATION THERAPY

Treatment Goals Curative Radiotherapy Palliative Radiotherapy Clinical Role of Radiation Therapy Primary Radiation Therapy

Postoperative Radiation Therapy Preoperative Irradiation Sequential Combination of Surgery and Radiation Therapy Surgical Procedures Helpful for Radiation Therapy

Integration of Radiation Therapy, Surgery, and Chemotherapy for Inoperable or Metastatic Disease

ROLE OF RADIATION THERAPY IN THE MANAGEMENT OF CANCER PATIENTS LYMPHOMA ETIOLOGY CLASSIFICATION

Canine Classification Feline Classification

CLINICAL PRESENTATION AND SIGNS

Canine Multicentric Lymphoma Canine Lymphoma of Other Sites Feline Lymphoma

DIAGNOSIS

Physical Examination Hematologic Abnormalities Serum Biochemical Abnormalities Retroviral Status Imaging Cytologic and Histopathologic Diagnosis Advanced Diagnostic Techniques DIFFERENTIAL DIAGNOSIS THERAPY Systemic Chemotherapy in Dogs with Lymphoma Systemic Chemotherapy in Cats with Lymphoma Reinduction or Rescue Therapy Therapy for Extranodal Lymphoma

PROGNOSIS

Prognostic Factors in Dogs Prognostic Factors in Cats The Future of Lymphoma Therapy

LYMPHOID LEUKEMIA

Acute Lymphoblastic Leukemia Chronic Lymphocytic Leukemia

NONLYMPHOID LEUKEMIAS AND MYELOPROLIFERATIVE DISORDERS CLASSIFICATION CLINICAL PRESENTATION DIAGNOSIS THERAPY

Polycythemia Vera (Primary Erythrocytosis)

PLASMA CELL NEOPLASMS

Multiple Myeloma ETIOLOGY PATHOPHYSIOLOGY CLINICAL PRESENTATION AND SIGNS DIAGNOSIS DIFFERENTIAL DIAGNOSIS TREATMENT

Initial Therapy of Multiple Myeloma Evaluation of Response to Therapy Therapy Directed at Complications of Multiple Myeloma Rescue Therapy PROGNOSIS

SOLITARY PLASMACYTOMA CLINICAL SIGNS DIAGNOSIS THERAPY PROGNOSIS Epithelial Tumors Mesenchymal Tumors Round Cell Tumors Melanocytic Tumors GENERAL APPROACH

HISTORY AND PHYSICAL EXAMINATION DIAGNOSTICS Fine Needle Aspiration Biopsy

EPITHELIAL TUMORS

Papilloma Intracutaneous Cornifying Epithelioma Canine Squamous Cell Carcinoma

Canine Cutaneous Squamous Cell Carcinoma Canine Nasal Planum Squamous Cell Carcinoma Canine Digital Squamous Cell Carcinoma

Feline Squamous Cell Carcinoma

Feline Cutaneous Squamous Cell Carcinoma Feline Multicentric Squamous Cell Carcinoma in Situ (Bowen Disease)

Basal Cell Tumors (Basal Cell Epithelioma) Basal Cell Carcinoma Trichoepithelioma Follicular Stem Cell Carcinoma Pilomatricoma Trichoblastoma Other Follicular Tumors Sebaceous Gland Tumors Hepatoid Gland Tumors (Perianal Gland Tumors) Sweat Gland Tumors (Apocrine Gland Tumors) Ceruminous Gland Tumors Anal Sac Adenocarcinoma

ROUND CELL TUMORS

Lymphoma, Mast Cell Tumor, Histiocytoma, and Transmissible Venereal Tumors Plasmacytoma

MELANOCYTIC TUMORS

Melanoma

ETIOLOGY INITIAL CLINICAL EVALUATION BIOPSY CONSIDERATIONS GENERAL TREATMENT CONSIDERATIONS MANAGEMENT OF CANINE SOFT-TISSUE SARCOMAS MANAGEMENT OF CANINE SOFT-TISSUE SARCOMAS WITH UNIQUE CLINICAL FEATURES

Leiomyosarcoma/Gastrointestinal Stromal Tumors

MANAGEMENT OF FELINE SARCOMAS PREVENTION SUMMARY GENERAL FEATURES, PATHOLOGY, AND BIOLOGIC BEHAVIOR HISTORY AND CLINICAL SIGNS DIAGNOSIS AND STAGING T = Tumor (Primary Tumor) N = Node (Regional Lymph Nodes) M = Metastasis (Distant) TNM-Based Stages TREATMENT AND PROGNOSIS

Surgery Chemotherapy

1. A (Adriamycin/Doxorubicin) 2. AC (Adriamycin and Cyclophosphamide) 3. VAC (Vincristine, Adriamycin, and Cyclophosphamide)

Immunotherapy and Biologic Therapy Radiation

CANINE APPENDICULAR OSTEOSARCOMA SIGNALMENT DIAGNOSIS

Palliative Management Palliative Radiation Therapy Limb Amputation Limb-Sparing Surgery Radiation Therapy Chemotherapy Metastasis Prognostic Factors

CANINE APPENDICULAR CHONDROSARCOMA CANINE APPENDICULAR FIBROSARCOMA CANINE APPENDICULAR HEMANGIOSARCOMA CANINE AXIAL OSTEOSARCOMA

Skull Tumors Scapular Tumors Pelvic Tumors Rib Tumors Vertebral Tumors

OTHER CANINE AXIAL TUMORS

Multilobular Osteochondrosarcoma

FELINE APPENDICULAR OSTEOSARCOMA OTHER FELINE APPENDICULAR TUMORS FELINE AXIAL TUMORS METASTATIC BONE TUMORS CANINE JOINT TUMORS FELINE JOINT TUMORS OVERVIEW OF CANINE AND FELINE MAST CELL DISEASE INCIDENCE OF CANINE MAST CELL DISEASE BIOLOGY OF MAST CELLS BIOLOGIC BEHAVIOR OF CANINE MAST CELL TUMORS CLINICAL PRESENTATION DIAGNOSIS AND STAGING TREATMENT

Surgery Radiation Chemotherapy PROGNOSIS

FELINE MAST CELL DISEASE

Cutaneous Visceral Gastrointestinal

PATHOGENESIS OCCURRENCE AND CLINICAL PRESENTATION BIOLOGIC BEHAVIOR DIAGNOSIS STAGING AND GRADING TREATMENT OPTIONS

Surgery Radiation Therapy Chemotherapy

Electrochemotherapy

Immunotherapy Multimodal Therapy MONITORING

AN OVERVIEW OF CANINE HISTIOCYTIC DISEASES

Histiocytic Differentiation and Canine Histiocytosis Cutaneous Histiocytoma Complex

Metastatic Histiocytoma Langerhans Cell Histiocytosis Immunophenotypic Studies Regression of Histiocytomas

Histiocytic Sarcoma Complex

Treatment of Histiocytic Sarcoma Complex Morphologic Features of Histiocytic Sarcoma Immunophenotypic Studies

Reactive Histiocytosis

Systemic Histiocytosis Cutaneous Histiocytosis Treatment Options in Systemic Histiocytosis and Cutaneous Histiocytosis Microscopic Features of Systemic Histiocytosis and Cutaneous Histiocytosis Immunophenotypic Studies Pathogenesis Concluding Remarks

FELINE HISTIOCYTIC PROLIFERATIONS

Feline Progressive Histiocytosis

Morphologic Features Immunophenotypic Studies

Feline Pulmonary Langerhans Cell Histiocytosis

Morphologic Features Immunophenotypic Studies

Feline Histiocytic Sarcoma

Morphologic Features

Immunophenotypic Studies

KIDNEY URINARY BLADDER PROSTATE PENIS AND PREPUCE TESTICLE VAGINA AND VULVA UTERUS OVARY MAMMARY GLAND ENDOCRINE-RELATED PARANEOPLASTIC SYNDROMES

Hypercalcemia of Malignancy Hypoglycemia Ectopic Adrenocorticotropic Hormone Syndrome Syndrome of Inappropriate ADH Secretion Hyperestrogenism

HEMATOLOGIC PARANEOPLASTIC SYNDROMES

Anemia Erythrocytosis Neutrophilic Leukocytosis Eosinophilia Thrombocytopenia Thrombocytosis Platelet Hyperaggregability and Hypercoagulability Disseminated Intravascular Coagulation Hyperglobulinemia

CUTANEOUS PARANEOPLASTIC SYNDROMES

Feline Paraneoplastic Alopecia Superficial Necrolytic Dermatitis Nodular Dermatofibrosis

GASTROINTESTINAL PARANEOPLASTIC SYNDROMES

Cancer Cachexia Gastrointestinal Ulceration

NEUROLOGICAL PARANEOPLASTIC SYNDROMES

Myasthenia Gravis Peripheral Neuropathy

RENAL

Glomerulonephritis and Nephropathies

MISCELLANEOUS

Hypertrophic Osteopathy Fever

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Client Information Sheets

Acute Pancreatitis in the Dog and Cat Acute Renal (Kidney) Failure Addison's Disease Antifreeze Poisoning Arrhythmias and Antiarrhythmic Therapy Aspergillosis Bacterial Urinary Tract Infection Blastomycosis Blindness in Dogs and Cats Brachycephalic Airway Syndrome Brain Tumors Breeding Management of the Bitch Canine and Feline Cardiomyopathy Canine Atopic Dermatitis Canine Cushing's Syndrome Canine Demodicosis Canine Distemper Canine Hypothyroidism Canine Valvular Insufficiency and Congestive Heart Failure Care and Use of Feeding Tubes Chemotherapy Chronic Hepatitis in Dogs Chronic Kidney Disease Coccidioidomycosis Colitis Collapsing Trachea Congenital Heart Disease Congestive Heart Failure and Medical Therapy Degenerative Myelopathy Diabetes Mellitus Disk Disease Diskospondylitis Dystocia in the Bitch Echocardiography Elbow Dysplasia Endoscopy and Protoscopy Feline Asthma Feline Enteric Coronavirus and Feline Infectious Peritonitis Feline Immunodeficiency Virus Feline Leukemia Virus Vaccinations Feline Odontoclastic Resorption Lesions (FORLs) Feline Renal Transplantation Flatulence Fleas and Flea Allergy Dermatitis Food Hypersensitivity Gastric Dilatation-Volvulus Gastrointestinal Food Allergies Heartworm Disease Hemangiosarcoma Hepatic Lipidosis in Cats Hip Dysplasia Histoplasmosis Home Monitoring of Blood Glucose How to Read a Pet Food Label Hyperthyroidism in Cats Immune-Mediated Hemolytic Anemia and Immune-Mediated Thrombocytopenia Immune-Mediated Polyarthritis in Dogs Laryngeal Paralysis Leptospirosis Leukemia Liver Failure and Hepatic Encephalopathy Management Lower Urinary Tract Disease in Cats Lumbosacral Stenosis Lymphoma Mammary Gland (Breast) Tumors in Dogs and Cats Mast Cell Tumors in Dogs Megaesophagus Myasthenia Gravis Non-Neoplastic Infiltrative Bowel Diseases Normal Whelping in the Bitch Novel Antigen Diets Nutritional Management of Chronic Renal Disease Nutritional Management of Diabetes Mellitus Nutritional Management of Gastrointestinal Disease Old Dog Vestibular Disease o,p'-DDD Treatment of Pituitary Cushing's Syndrome Otitis Externa Panosteitis Parvovirus in Dogs Pneumonia Portosystemic Shunts Pregnancy Prevention Prostate Disease Pyometra Radiation Therapy Seizures Solar-Induced Squamous Cell Carcinoma in Cats "Steroid" Therapy The Fractured Tooth Tracheal Wash and Bronchoscopy Transitional Cell Carcinoma Urolith Management Vaccine-Associated Sarcomas in Cats von Willebrand's Disease Weight Management

Grand Rounds

Primary hyperparathyroidism in a mixed breed dog

"Wolly" History of several months Owner Diagnosis: Cushing's In-Hospital Evaluation

In-Hospital Evaluation Additional Findings?

Differential Diagnosis: Increased Calcium

Owner Discussion

Updated Problem List

Owner Discussion Demands from both parties

Radiographs Ultrasonography Tests Results for Hyperadrenocorticism? Additional Diagnostic Procedures Primary Hyperparathyroidism (everything consistent with "Wolly") Parathyroid Hormone Primary Hyperparathyroidism Wolly's Problem List Updated Yet Again Treatment Options for Primary Hyperparathyroidism in Dogs Plan

During surgery-dissecting to thyroid area (arrow tip on thyroid lobe) Thyroid Lobe with Parathyroid Mass (parathyroid mass is at tip of arrows) Normal Thyroid and Parathyroid

Postoperative Monitoring Wolly's Postoperative History

Wolly's serum calcium concentrations the next few days Next Several Months

Pertinent Past History Recent Veterinary Evaluation Treatment At That Time Initial Diagnostic Workup at Davis

CBC CHEMISTRY PROFILE Differentials for Hepatopathy Differentials for Acute Renal Failure Abdominal Ultrasound Thoracic Radiographs Additional Diagnostics

Treatments Post-Dialysis Evaluation

Repeat Abdominal Ultrasound Abdominal Exploratory Surgery Histologic Evaluation Postoperative Progress Postoperative Progress

Summary

Hyperadrenocorticism and aortic artery thromboembolism in a 14-year-old dog

History Physical Examination After Referral:

Fundic Exam

Problem List and Differentials Initial Diagnostic Workup

Marked Hypertension Chest Radiographs Neurologic Examination Abdominal Ultrasound Distal Aortic Thrombus

Working Diagnosis

Why Do Dogs with Cushing’s Syndrome Clot? Echocardiogram Continued Medical Management

Outcome

Repeat Neurologic Exam Initial Recheck Next Recheck, Following Week

Final Diagnosis Future Plans Post Mortem Exam

"Iowa" Hypothyroidism in a 5-year-old male intact golden retriever

Presenting complaint Physical exam

Cutaneous lesions

Problem list Differential diagnoses Diagnostic procedures Clinical diagnosis

Hypothyroidism-Etiology Diagnostic procedures

What about Iowa?

"YOFFI" Pseudallescheriasis in a 15-month-old female spayed Gordon setter

History Physical exam Problem list Diagnostic procedures Revised problem list Differential diagnoses Therapeutic plan (9/26/02) Diagnostic plan Tentative clinical diagnosis

Plan

Necropsy

Pseudallescheriasis

"Peekaboo": Pancreatitis and diabetic ketoacidosis in a 9-year-old female spayed domestic shorthair

History Physical exam Problem list

Differential diagnoses: Abdominal pain Differential diagnoses: Vomiting Differential diagnoses: PU/PD

Diagnostic plan

Abdominal ultrasound (4/24)

Clinical diagnoses Therapeutic plan

Transfer to internal medicine on 4/25 That morning's diagnostic results

Therapeutic plan

4/26 4/27-5/1 Hospitalization Assessment of condition on 5/1

Release from hospital on 5/3 Reevaluation-5/5

Physical exam Diagnostic procedures Therapeutic plan

Reevaluation-5/17 Reevaluation-5/27 Reevaluation-8/13

Assessment of Peekaboo on 8/13

Follow-up Diabetic ketoacidosis (DKA)

Treatment of sick cats with DKA Protamine zinc insulin (PZI)

Intestinal lymphangiectasia in a 1 yr old female intact Maltese "Kiki"

Presenting Complaint History

Therapy Prior to Referral Additional History

Physical Examination Problem List

Differential diagnoses-Vomiting Differential diagnoses-Small intestinal diarrhea Differential diagnoses-Ascites Differential diagnoses

Diagnostic plan Diagnostic results

Abdominal ultrasound

Revised Problem List Therapeutic plan

Perioperative management During surgery Abdominal exploratory Histopathology results H&E 5 X: Lipogranuloma H&E 10 X H&E 20 X: Lipogranuloma

Clinical diagnoses Therapeutic plan Follow-up

Update (9/14/04)

Intestinal Lymphangiectasia

Abdominal ultrasound Fecal α1-proteinase inhibitor (PI) Gastroduodenoscopy (GD) or abdominal exploratory? Treatment What about medium-chained triglycerides (MCT)? Follow-up Prognosis

Bronchial foreign body in a 2-year-old male castrated German shorthair pointer

Presenting complaint History Physical exam Problem list Differential diagnoses-cough Diagnostic plan

Results Thoracic radiographs Cervical radiographs

Plan

10/10/03: Bronchoscopy Results

Therapeutic plan

Acute uremia in a 5-year-old MC domestic shorthair cat

Presenting complaint History Physical exam Problem list Some differential diagnoses - acute uremia

Renomegaly

Diagnostic plan Diagnostic plan Therapeutic plan

7/15/03

Diagnostic and therapeutic plans

7/15/03

Therapeutic plan

7/16/03 Pre-nephropyelogram

Plan

100% dried solidified blood was the mass removed from the ureter.

Therapeutic plan post-op (7/16)

7/17-7/22 Creatinine and BUN (7/14-8/5) 7/22

Discharge First follow-up Second follow-up

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