Medical Nursing Week 6

• Epidermis
• Ears
• Hair coat
• Glands

• Protection
• Temperature Regulation
• Behavior

• Alopecia- Hair loss
• Pruritis- Itching and scratching
• Pustule- Raised nodule with pus
• Lichenification- thick dlephant like skin
• Seborrea- greasy, oily dermitis

• Pruuitis
• Alopecia
• Fleas
• Foul smell and discharge
• Redness
• Scabs, crust and parasites

• Skin scrape and fungal cultures
• Blood profile- organ related problems will cause skin problems
• Allergy test
•    Intradermal
•    RAST (radioallergosorbent test) Not as accurate as Intradermal
• Skin Biopsy

Skin problems can also be caused by ie. Hypothyroid or diabetes

• Parasites- fleas and sarcoptes
• Allegic
• Irritation
•    Hair mats
•    Bite wounds

• Irritation casues itching and scratching
• Self induced trauma casues hair loss and exudation
• Lesions develop
• Secondary infection by staphylococcus occurs

• Red, moist skin with pus like exudate
• Hair loss
• Scratching and moist area
• Painful and febrile

• Clip and clean if localized (hot spot)
•   Clean with antiseptic
•        Chlorhexiderm
• Treat primary cause
•       Parasites, fleas, etc.
• Antibiotics
•      Cephalexin, baytril, amoxicillin and clavamox
• Short term corticosteroids
•     Prednisone
•     Vetalog
• E-collar to reduce chewing
• Medicated bedding
•       Nolvasan shampoo
•       Oxydex
•            Benzol peroxide
•            astringents
• Antihistamaines- not for cats
•      Benadryl (diphenhydramine) and Hydroxyzone (anthrax)

Deep suppurative infections- under the epidemis

• Mostly cats, from cat fight wounds
• Penetrating wounds
•      Bites, foreign body
• Self infliction
•      Skin infections
•      Dermatitis
• Trauma
•      HBC (hit by car)
• Aerobic organisms
•      Pasteurella- in their mounth, most common
•      Actinomyces
•      Streptococci
• Anaerobic organisms
•      Clostridium
•      Bacteroides

• Depression and febrile
• Anorexia
• Tissue edema and swollen region
• Ruptured purulent discharge

• Surgery
•    Debride necrotic tissue
•    Provide drainage with penrose drain
•    Drain stays in 2-3 days before removal
• Antibiotics
• Supportive Care
•     Fluids
•     Nutritional Support

Azotemia is a medical condition characterized by abnormally high levels of nitrogen -containing compounds, such as urea, creatinine

• Impactation
• Infection
• Abcess

• Large quantity thick secretion
• Infection
• Poor Grooming
• Small ducts

• Anal sacs become impacted
• Secondary infection
• Abcess and rupture

• Scratching, licking, or dragging anal region
• Tail chasing
• Tenesmus
•    Painful defication

• Palpate distended anal sacs
• Fluid normally clean tan or yellow
• Abcess seen

• Medical
•    Express anal sacs and flush with dilute nolvasan or betadine
• Topical anti-inflammatory
•    Panalog
•    Otomax
• Antibiotics
•  

• Abscess
• Reoccuring problem
•    Analsacculectomy

• Infection of keratinaceous structure (hair, nails, skin) by parasitic fungi
• Ringworm

• Microsporum canis
•     50-70% infection in dogs and cats
•     90-98% in cats
• microsporum gypseum
• Trichophytan metagrophytes

• Infection usually young and immunosuppred animals
• Highly contagious (zoonotic)
• Transmission is contact from spores to skin

• Pruritis
• Irregular or circular areas of skin with alopecia and scales

• Fungal Culture
•    Dermatophyte media (DTM)
•     Agar turns orange to red if positive
•              Dermatophyte causes PH change
•   Observe daily, can take up to a week to turn red
• Woods lamp
•    M. Canis fluresce 50-80% times
•    Not an absolute test
• Skin Biopsy

• Topical
•    Use antiseptic baths
•    2 times weekly
•    Ketoconazole or miconazole formulation
•    Local miconazole creams
• Systemic
•    Griseofulvin
•         10-30 mg/kg PO BId for 4-6 weeks
•         Side Effects
•                Hepatotoxicity
•                 Teratogen
•                 Cats extremely sensitive
• Ketoconazole
•     10mg/kg PO Sid for 3-4 weeks
• Intraconazole
•    10mg/kg PO SID for 3-4 weeks
• Treat 1-2 weeks post negative culture or clinical signs

• Transmission can occur from the mother to neonate during the first 2-3 days of life.
• Infects hair follicles and caused by immunosuppression
• Caused by demodex canis or demodex cati
• Demodex occurs in 3 forms
•     Generalized demodicosis
•                 Normally caused by immunosuppression on underlying disease
•                Juvenile onset
•                     3-12 months
•                Adult onset
•                 >1 year
• Pododemodicosis
•    Chronic interdigital disease
• Localized demodicosis
•    Animals < 1 year of age
•    Usually resolves spontaneously in 4-8 months

• Localized demodicosis
•    Non parasitic
•    Lesions on muzzle, head, ears, and forelegs
• Generalized demodicosis
•     Begins local and spreads
•     Diffuse, alopecia, scabs, and erythema
•     pyoderma and pruitis
•    Generalized lymphadenopathy
• Pododemodicosis
•     Digital and interdigital pain, erythema and swelling

• Skin scrape
•    Alligator- cigar shaped with six legs
• Skin biopsy

• Localized demodicosis
•    Bathing
•   Nolvasan shampoo
•    Amitraz (mitaban dip)
• Generalized Demodicosis
•    Mitaban dip
•       Body clip
•       Amatraz dip weekly
•       Skin scrap every 2-4 weeks
•       Continue dips 3-4 weeks following first negative scrape
• Ivermectin
•    0.4-0.6mg/kg PO SID for 1 month past negative skin scrape
• 0.2-0.3 mg/kg SQ of 2 weeks apart

• Pododemodicosis
• Mitaban dip- soad feet daily
•     Usually do not use mitaban dip in animals less than 4 months of age
•     Long term antibiotics
•    May use lime sulfur dips- very young animals only and cats

• Caused by sarcoptes scabei (scabies)
• Notoedres cati (feline scabies)
•   Primarily on head and neck
• Cheyletiella
•    Walking dandruff
•    Scotch tape test
•   Highly contagious and pruritic
•  Zoonotic
•   Burrowing mite
•   Transmission is by contact
• Mite causes intense pruritus by mechanical irritation

• Intense pruritus
• Alopecia
• Scabs, crust and pyoderma

• Skin scrape
•    50-75% of skin scrape may be negative

• Topical
• 1. Body clip and shave
• 2. Lime sulfur 2% dip every 2 weeks
•      Young animal
• 3. Mitaban dip every 2weeks
• Systemic
•    Ivermectin 0.2-0.3 mg/kg SQ every 2 weeks for 2 treatments
• Amatraz Dip

• Parasites
• foreign bodies
•   Fox tails, hair, dirt
• Atopy- allergies
•   >50% otitis externa
• Food allergy
• Neoplasia
• Conformation abnormalities
•    Cocker spaniels, labs, most spaniels
•     Have greater number of apocrine glands (sweat gland)and hair
•    Narrow ear canals
• Bacterial infection
•    Staphlococcus
•    Streptococci
•   Fungi
•   Malassezia pachydermititis (a yeast)
•        Gram stain= peanut shape

• Ear canal becomes inflamed and erythematous (redness)
• Sebacious and apocrine glandular activity is increased
• Combination of increased epidermal thickness and increased glandular activity leads to wax production and entrapement into cnal causing bacterial and yeast infection
• Chronic inflammation leads to permanent changes as calcification of auricular cartilage and stenosis (colliflower ears)

• Pruritus and head shaking
• Painful ear and head tilt
• Discharge or foul odor from ear

• Otoscope exam
•    Inflammation and discharge
• Ear culture
• Cytology of ear canal exudate
•    Wright- giemsa stain
•    Bacteria, yeast, fungal

• Ear cleaning
•   Clip and remove hair
•   Ear flushing and cleaning
•     Remove wax and pus
•     Nolvasan otic
•    Oto clens
•    Clean with ear loops or currettes
• Topical cleaning
•    Otomax
•    Panalog ointment
• Systemic therapy
•    Antibiotics
•    Corticosteroids
•    Antifungal
•       Ketoconazole for malassezia
• Surgery  
•    lateral ear resection
•   Total ear ablation and bulla osteotomy
• Water soluble only if tympatic is ruptured
• Auri flush

• Globe
• eye
• Eyelids
• Conjunctiva
• Nictating Membrane (3rd eyelid)
• Lacrimal Glands

• Vision
• Tears for defense mechanism

• Conjunctivitis- Inflammed red conjuntiva
• Chemosis- edema of conjunctiva
• Cataract- opacity of lens
• Canthus- angle at either end of the eyelid
• Ectropian- eversion and turning of the eyelid
• Entropian- inward inversion of eyelis
• epiphora- overflow of tears
• Glaucoma- increased intraocular pressure
• Hyphema- hemmorage in anterior chamber
• Keratisis- corneal inflammation
• Miotic- pupil constriction
• Myosis- pupil dilation
• Photophobia- abnormal sensitiation to light
• Ptosis- droopy upper eyelid
• Synechia- adhesion of iris to cornea or lens
• Uvea- entire vascular eye-iris, ciliary body and choroid
• Uveitis- inflammation of uvea
• Blepharospasm- inability to open eyelids/ closed eye (horses)
• Ciliary body- circumferential tissue inside the eye

• Ocular and nasal dishcarge
• Conjunctiviti and epiphora
• Keratitis
• Corneal opacity
• Ocular pain and swelling
• cataract
• Hyphema-blood in the front (anterior) chamber of the eye.

• Opthalmic exam
• Tonometer
•    Pressure for glaucoma
• Corneal stain
•     Ulcer
• Shirmer Tear test
•   Dry eye
•   Decreased tear production
• Conjunctival scrape
• Biopsy- looking for cancer

Corneal damage or abrasion

• Trauma
• Infection
• Foreign body
• Chemical burn

Corneal Stain

• Antibiotics
•   Topical and systemic
• Atropine- stop ocular pain
• Surgery
•   3rd eyelid
•   Conjunctival flap

Inward inversion of eyelid margins causing conjunctivitis and corneal ulcers

• Congenital
• Breeds
•    Bradycephalic breeds
•   Chows, shar pei, rottweilers, english bull dogs

• Epiphora, conjunctivitis and chemosis
• Corneal ulcer and scarring
• Ulcerative keratitis

Ocular exam

• Medical
•   Ulcer treatment
•   Lubrication
• Surgery
•   Corrective entropion surgery preferred to prevent secondary eye damage

• Inflammation of ocular mucous membranes
• Red eye or pink eye

• Infectious- bacterial, chlamydia, virus
• Foreign body
• Trauma
• Irritants
•   Dust, distichia
• Immune mediated
•    Allergies
• Keratoconjunctivitis sicca KCS

• Ocular dishcarge and scleral congestion
• Chemosis and photophobia
• Epiphora

• History and eye exam
• Corneal stain
• Topical anesthetic
• Tear test
• cytology

• Treat primary disease
• Systemic drugs
•    Antibiotic
•    Corticosteroids
•         allergic, chemosis
• Topical
•    Cyclosporine (optimmune)
•        KCS
•   Antibiotic
•      Gentocin, bacitracin, and neomycin (BNP)
• Antiinflammatory combinations
•    BNP-HC, gentocin durafilm

BNP- made by your heart and shows how well your heart is working.

• Protrusion of gland of third eyelid
•    May be unilateral or bilateral

• Genetic and breed predisposition
•    Cocker spaniel, poodle, shar pei, bull dogs
•   Bradycephalic breeds
• Cats- Burmese

• Pink mass protruded from medial canthus
• Ocular discharge and conjunctivitis

• medical management provides only temporary relief
•   Systemic and topical therapy
•        antibiotics and corticosteroids
• Surgical repair is recommended
•    Removal of gland or securing gland down
•    Tack down
• Complete removal of gland can cause KCS

• Inflammatory and degenerative changes of the cornea and conjuctiva caused by reduced tear secretion
• KCS may be primary (Lacrimal secreation failure) or Secondary (failure of tear delivery)

• Primary
•   Infection
•   Immune mediated (genetic)
•      Cocker spaniels, shitzu, bull dog, Llasa apso
• Drug toxicity- sulfa products
• Truama
• Secondary
•    Infection
•    allergic
•    Chemical

• Conjunctivitis and ocular discharge
•  Corneal ulcer
• Neovasculariazation and corneal scarring
• Loss of vision

• Schirmer Tear Test
•   Diagnostic if low tear production
•     <21 mm/min
• Corneal stain
• Conjunctival scrape and culture

• Stimulate lacrimation
•        Topical cyclosporine
• Provide lubrication
•        Methylcellulose or polyvinyl alcohol
• Treat for bacterial infection
•        Antibiotics
• Reduce conjunctivis
•       Costicosteroids

• Elevation of intraocular pressure causing buphthalmos
• Normal intraocular pressure (IOP)
•    15-30 mmhg
• Glaucoma
•   Primary
•    Genetically determined
• Secondary
•   any ocular disease that results in the obstruction of aqueous outlfow

• Primary- unknown and genetic
• Secondary
•    Uveitis
•   Lens luxation
•   Tumors
•  

• Acute Glaucoma
•   Ocular discharge and pain
•   Conjunctivitis
•   Vascular congestion
•   Blindness
• Chronic glaucoma
•    Globe enlargement (buphthalmus)
•    Corneal edema- turns white
•   Lens luxation
•   Tapetal hyperreflexivity
•   Irreversible vision loss

• Measure intraocular pressure
•    Schiotz tonometer
• Gonioscopy

• Immediate control for pressures over 50mmhg
•   Hyperosmotic
•    Mannitol 1-2g/kg IV over 30-45 min.
• Carbonic Anhydrase inhibitors
•    Decrease aqueous production
•    Dichlorphenamide (Daranide)
•    dog 2-4mg/kg PO Bid- TID
•     Cat 1-2 mg/kg PO Bid- Tid
•    Methazolamide
•    Acetazolamide
• Topical autonomic agents
•     Timolol
•     Pilocarpine 2%
• Treatment for secondary ocular disease
• Long Term Treatment
•    medical
•     Carbonic anhydrase inhibitors
•     Pilocarpine
•     Rarely effective for long term
• Surgical
•   Laser cyclophotocoagulation
•      Destroys ciliary body, thus reducing aqueous production
•   Transscleral cyclocryotherapy
•    Freeze ciliary body
•  Enucleation
•    Salvage for pain
• Athropine never with an animal on Glaucoma