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What are the three different types of rectoanal diseases?
- perineal hernia
- perianal fistula
- perianal gland tumor
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What is a perineal hernia?
protrusion of a hernial sac in the perineal area
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Which animals are more prone to getting perineal hernias?
intact male dogs over 6 - 8 years old
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What are the clinical signs of a perineal hernia?
- reducible perineal swelling
- pain on defecation
- irregular bowel movements
- constipation
- rectal deviation
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How do we diagnose a perineal hernia?
- history and physical exam
- rectal exam
- radiographs (will see a soft tissue mass in perineal area)
- barium enema (rectal deviation)
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How do we treat a perineal hernia?
- surgical: herniorrhaphy or neuter
- medical: stool softeners, enemas, manual extraction of feces
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What kind of client education do we need to provide about perineal hernias?
- keep stool well formed but soft to decrease straining
- neuter to decrease size of prostate and eliminate testosterone
- recurrence is possible
- if surgery is done, watch for infection at the surgery site
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What is a perianal fistula?
single or multiple ulcerated sinuses (draining tracts)
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Which animals are more prone to getting a perianal fistula?
large breed dogs
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What are the clinical signs of a perianal fistula?
- onset is insidious and goes undetected
- excess licking of perianal area
- fecal incontinence
- tenesmus
- constipation
- perianal hemorrhage
- foul odor and thick discharge
- personality change
- pain on raising tail
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How do we diagnose a perianal fistula?
- history and physical exam
- breed of dog
- rule out anal sac disease and tumor
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How do we treat a perianal fistula?
- immunosuppression
- cyclosporine, azathioprine, prednisone - may resolve completely
- surgical correction with concurrent anal sac removal
- tail amputation
- antibiotics
- fecal incontinence is a possible sequellum to surgery
- may recur
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What kind of client education do we need to provide about perianal fistulas?
- these animals are painful
- be careful to avoid bites when treating
- keep area clean and dry
- long term antibiotics
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What are the different types of perianal gland tumors?
- perianal ademona
- benign androgen dependent tumor
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Which animals are more prone to getting perianal gland tumors?
older, intact male dogs
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What do perianal gland tumors look like?
- ulcerate
- hemorrhage
- infection
- large tumors can be obstructive
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What are the clinical signs of perianal gland tumors?
- excess licking of perianal area
- masses around anus, tailhead, inguinal regions, prepuce
- masses ulcerated, bleeding
- incidental finding
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How do we diagnose a perianal gland tumor?
- appearance and location of mass
- fine-needle aspirate
- histopathology of excised mass
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How do we treat a perianal gland tumor?
- neuter, excision
- radiation therapy (effective but expensive)
- cryosurgery
- estrogen therapy if unable to survive anesthesia
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What kind of client education do we need to provide about perianal gland tumors?
- most respond well to neutering alone especially if the tumors are small
- suspect adenocarcinoma if tumors fail to regress
- neutering at a young age can prevent the problem
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What do hepatocytes do?
- produces bile to emulsify or break down fat
- gluconeogenesis
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How many functions can the liver carry out?
1500
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Is the liver able to regenerate?
yes
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The injury to a liver must be _____ before lab tests reveal a disease.
severe
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What are the different types of liver diseases?
- acute toxin induced liver disease
- chronic toxin induced liver disease
- infectious canine hepatitis
- hepatic lipidosis
- hepatic neoplasia
- congenital portosystemic shunt
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With acute toxin induced liver disease, acute failure happens when _____ of functional mass is injured.
70 - 80%
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Why is the liver most susceptible to ingested toxins?
due to portal venous blood from the stomach and intestines
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What is an acute toxin induced liver disease usually due to?
a drug overdose
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What are some drugs that can cause acute toxin induced liver disease? (don't need to memorize the list).
- acetaminophen
- phenobarbital
- antifungals
- anabolic steroids
- NSAIDs
- diazepam (cats)
- caparsolate
- diethylcarbamazine
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What are the clinical signs of an acute toxin induced liver disease?
- acute onset of signs
- vomiting, diarrhea, constipation
- PU/PD
- jaundice
- melena, hematuria
- CNS - depression, ataxia, dementia, blindness, seizures, coma
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How do we diagnose acute toxin induced liver disease?
- history of drug administration or accidental ingestion
- painful liver, hepatomegaly
- increased ALT, ALKP, bilirubin, bile acids, ammonia
- hypoglycemia
- coagulopathy
- radiographs
- ultrasound
- liver biopsy (beware of coagulopathies, run clotting profile prior to biopsy)
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How do we treat acute toxin induced liver disease?
- antidotes if available
- induce vomiting
- activated charcoal PO
- supportive therapy - aggressive fluid therapy, glucose, vitamin K, antacids, antibiotics, nutritional support
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What drugs can cause chronic toxin induced liver disease? (don't need to memorize the whole list)
- anticonvulsants
- glucocorticoids
- diethylcarbamazine
- methimazole
- antifungals
- NSAIDs
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What are the clinical signs of chronic toxin induced liver disease?
- same as acute but happening over a longer period of time
- vomiting, diarrhea, constipation
- PU/PD
- jaundice
- melena, hematuria
- CNS signs
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How do we diagnose chronic toxin induced liver disease?
- history of long term drug use
- increased ALT, ALKP, bile acids
- decreased albumin, cholesterol
- liver biopsy
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How do we treat chronic toxin induced liver disease?
- stop administering the drug
- low protein diet
- supportive therapy
- antibiotics if needed
- feeding tube if needed
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What is infectious canine hepatitis?
canine andenovirus 1 - hepatic necrosis in dogs
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How do dogs get infectious canine hepatitis?
- oronasal transmission
- virus replicates in the tonsils and lymph nodes
- localized in the liver
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What are the clinical signs of infectious canine hepatitis?
- usually in dogs under 1 year old
- fever over 103
- petechial hemorrhages
- hepatomegaly
- corneal opacities in blue eyes
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How do we diagnose infectious canine hepatitis?
- CBC - will see thrombocytopenia
- increased ALT
- serum titer increased and going higher
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How do we treat infectious canine hepatitis?
- supportive therapy
- force feeding
- blood transfusion
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What is cholangiohepatitis and which animal is most common in?
- bile duct and liver inflammation
- common hepatobiliary disorder in middle age to older cats
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What do we commonly see with cholangiohepatitis?
pancreatitis
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What are the clinical signs of cholangiohepatitis?
- vomiting, diarrhea
- anorexia, weight loss
- fever
- icterus
- hepatomegaly
- many patients present in end-stage disease
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How do we diagnose cholangiohepatitis?
- increased ALT, ALKP
- normal to increased bile acids
- hypoalbuminemia
- late stage - decreased BUN
- radiographs - will see hepatomegaly
- liver biopsy is a definitive diagnosis
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How do we treat cholangiohepatitis?
- long term antibiotics
- ursodeoxycholic acid
- prednisone
- fluids
- nutritional support
- vitamin therapy
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What kind of client education do we need to provide about cholangiohepatitis?
- prognosis variable
- treatment may be prolonged
- may be permanent liver damage
- repeat biopsy to assess response
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What is the most common hepatopathy in cats?
hepatic lipidosis
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What is thought to be a trigger of hepatic lipidosis?
stress in adult, obese cats
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What is hepatic lipidosis?
accumulation of fat within the hepatocytes
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What does hepatic lipidosis result in?
hepatic failure
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What can hepatic lipidosis be caused by?
prolonged caloric restriction in obese cats
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Do we know the exact cause of hepatic lipidosis?
no
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What are the clinical signs of hepatic lipidosis?
- anorexia
- obesity, weight loss of more than 25% of body weight
- depression
- icterus
- hepatomegaly
- salivation
- concurrent pancreatitis
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How do we diagnose hepatic lipidosis?
- increased ALT, ALKP, bilirubin, bile acids
- hypoalbuminemia
- radiographs - will see mild hepatomegaly
- ultrasound
- liver biopsy is a definitive diagnosis
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How do we treat hepatic lipidosis?
- often reversible
- fluid and electrolyte therapy
- aggressive nutritional support (parenteral nutrition, nasogastric/gastrotomy tube, force feed)
- high protein, caloric dense diet
- six feeding per day until the stomach adjusts to food and then decrease to three feedings per day
- antiemetics
- diazepam, metoclopramide to stimulate appetite
- when the cat is eating well on its own, pull the feeding tube
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What kind of client education do we need to provide about hepatic lipidosis?
- prevent obesity
- avoid stress in obese cats
- early intervention is best
- cats do not do well with frequent diet changes
- cure rate is 60 - 65%
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How do portosystemic shunts work?
- vascular communication between the portal and systemic circulation
- blood bypasses the liver
- blood that carries toxins from the GI tract will bypass the liver and not be detoxified
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What does the liver look like in portosystemic shunts?
liver is small and atrophied
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What are the two different types of portosystemic shunts?
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When do clinical signs of a portosystemic shunt usually show up?
by 6 months of age
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What are the clinical signs of a portosystemic shunt?
- behavior change
- depression, stupor, coma
- blindness, seizures
- head pressing, circling, pacing
- poor body stature
- underweight, retarded growth
- neurologic changes are due to systemic toxins
- hepatic encephalopathy
- may be worse after a high protein meal
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How do we diagnose a portosystemic shunt?
- low serum proteins
- increased liver enzymes
- decreased BUN
- increased bile acids
- hyperammonemia
- radiographs (will see small liver, portography to see the shunt)
- rectal scintography
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What is a rectal scintography?
- radioactive material is placed in the colon
- crosses the mucosa into the portal circulation
- quantify the amount of blood shunting away from the liver
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How do we treat a portosystemic shunt?
- surgical ligation
- medical therapy - lactulose, oral antibiotics, dietary modifications, high quality proteins, increase dietary fiber
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What is the prognosis for a portosystemic shunt?
- some patients have a normal life expectancy
- normal hepatic function may not return even with surgery
- prognosis is highly variable without surgery
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What are the two functions of the pancreas?
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What are the endocrine functions of the pancreas?
- insulin: causes glucose in blood to be absorbed into body cells and lowers blood glucose
- glucagon: opposite effect to insulin - raises blood glucose
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What are the exocrine functions of the pancreas?
- secretes digestive enzymes into the duodenum (amylase, lipase, protease)
- secretes bicarbonate to neutralize stomach acid
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Amylase and lipase leak from the _____ into the _____ and are cleared by the _____.
- pancreas
- bloodstream
- kidneys
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What are pancreatic enzymes used for?
to measure pancreatic health
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What are some common problems with the pancreas?
- pancreatitis
- exocrine pancreatic insufficiency
- inflammation of the pancreas (acute or chronic)
- pancreatic autodigestion
- inflammation causing tissue damage in multisystemic involvement which often leads to death
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What type of animals is pancreatitis more prevalent in?
obese animals
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What kind of diets cause pancreatitis?
high in fat
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What kind of drugs can cause pancreatitis?
- furosemide
- azathioprine
- sulfonamides
- tetracyclines
- prednisone
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Is pancreatitis predictable?
no
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What is the prognosis of pancreatitis?
some recover and some die
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Is pancreatitis painful?
yes
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What are the clinical signs of pancreatitis?
- history of fatty meal
- vomiting
- depression
- anorexia
- dehydration
- fever
- abdominal pain (right cranial)
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How do we diagnose pancreatitis?
- no single test is definitive
- history and physical exam
- lab tests
- ultrasound
- radiographs may be normal or may have a "ground glass" appearance to right cranial abdomen
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What kind of lab results will we get with pancreatitis?
- increased ALT, ALKP
- increased bilirubin
- increased amylase, lipase, but they could be normal
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What are the treatment goals with pancreatitis?
- maintain fluid, electrolyte balance
- maintain integrity of circulatory system
- reduce pancreatic secretions
- relieve pain
- manage complications
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How do we treat pancreatitis?
- eliminate predisposing factors such as drugs
- fluids, electrolytes as needed
- antiemetics
- NPO for 48 - 96 hours
- restrict fat when eating again
- analgesics
- pancreatic replacement enzymes for 1 - 2 months
- may reduce drive on pancreas to secrete
- may reduce pancreatitis induced discomfort
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What kind of client education do we need to provide about pancreatitis?
- most mild cases do well if high fat foods are avoided
- yorkies are at high risk
- increased risk of severe pancreatitis: diabetes mellitus, obesity, cushing's, hypothyroid, GI tract disease, epilepsy
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Do cats typically get "classic" pancreatitis?
no
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What are the clinical signs of pancreatitis in cats?
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How do we diagnose pancreatitis in cats?
- ultrasound may be most useful
- TLI - trypsiniogen-like immunoassay
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How do we treat pancreatitis in cats?
- fluids
- nutritional support of hepatic lipidosis
- may be treated with pancreatic enzyme replacement
- antibiotics
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What does EPI stand for?
exocrine pancreatic insufficiency
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What is EPI?
progressive failure to secrete adequate quantity of digestive enzymes
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When do clinical signs occur with EPI?
occur when 85 - 90% of the secretory capacity of the pancreas is lost
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What can EPI be associated with?
pancreatitis (especially in cats)
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What does reduced secretions due to EPI lead to?
malabsorption
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EPI causes a failure of digestion in the _____.
small intestines
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What does EPI affect?
small intestines mucosa
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What are the clinical signs of EPI?
- occurs under 2 years old
- predominantly german shepherds
- BAR
- history of weight loss, ravenous appetite
- poor quality hair coat with oily shine on perineum
- diarrhea
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What kind of diarrhea does EPI cause?
- voluminous, soft, rancid odor
- semi-formed to cow pie
- may resolve when fasted or fed a low-fat diet
- flatulence, borborygmus
- abdominal discomfort
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How do we diagnose EPI?
- serum TLI - trypsinogen-like immunoassay - most reliable and commonly used
- sensitive and specific for EPI
- detects trypsin and trypsinogen
- levels will be decreased
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How do we treat EPI?
- replace digestive enzymes
- strict dietary routine
- low fat, highly digestible food
- vitamin supplementation
- antibiotic for bacterial overgrowth - metronidazole
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What kind of client education do we need to provide for EPI?
- monitor body weight weekly
- EPI may never be adequately controlled
- life long treatment
- may fail to regain full body weight though diarrhea and polyphagia is resolved
- enzyme treatment (may be expensive and must be given with every meal)
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What is EPI in cats usually due to and what else may it cause?
- usually due to pancreatitis
- may accompany diabetes mellitus
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How do we treat EPI in cats?
- pancreatic enzyme replacement
- antibiotics for bacterial overgrowth on intestines
- life long therapy
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