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What is the common clinical presentation of canine parvovirus?
Diarrhea (usually bloody)
What are the tests of choice and results for diagnosing canine parvovirus?
1. CBC: neutropenia and lymphopenia
2. Fecal ELISA: parvo antigen (recent vaccination will yield a false positive)
3. Fecal flotation: rule out concurrent helminthiasis
4. Abdominal rads: avoid missing foreign body, intussusception
What are the general treatments for canine parvovirus?
1. Isolate parvo suspects
3. Treat and prevent sepsis
4. Correct potassium, glucose, normalize BP
5. Stop vomiting
6. Pain control
7. Nutritional support
What are the treatments for acute canine parvovirus?
1. Admit, isolate, and place IV catheter
2. Start antibiotics (Cefazolin or Ampicillin)
3. Check Hct/TP/glucose
4. IV crystalloids if hypovolemic
5. In the first two hours calculate fluid needs and give 1/4-1/2 of fluid needs in first 2 hours
6. After first two hours give the rest of the fluids over the next 10 hours
7. After about 4-5 hours start to feed
8. Metaclopramide, pain control, and abx
What is the prognosis for canine parvovirus?
Good with treatment
What is the prevention for canine parvovirus?
1. Vaccination: MLV
2. Disinfectants: virus is extremely resistant, use bleach or quarternary ammonium cleaners
When does fecal viral shedding of canine parvovirus occur?
4-5 days after exposure, BEFORE the onset of clinical signs
Why would you perform a fecal float and abdominal rads on a suspected parvo dog?
To rule out GI parasites and foreign bodies/intussusception as causes for clinical signs
What findings would you expect on a CBC of a parvo puppy?
What are 3 preventative measures to control parvovirus in dogs and in an animal hospital?
1. Bleach, quarternary ammonium disinfectants
2. Limit environmental access of puppies until fully vaccinated
What are 2 risk factors for canine parvovirus?
1. Common in warmer, wetter seasons like Spring
2. Unvaccinated, intact males are higher risk
What are the classic signs in a dog with distemper?
Young dog with lethargy, ocular and nasal discharge, poor haircoat, dehydration, cough, vomiting, and diarrhea
At what age do most dogs contract distemper?
True or false: brachycephalic breeds are more prone to die from distemper than dolichocephalic breeds?
What signs come first in a dog with distemper?
Respiratory and ocular: ocular and nasal discharge, cough, loud breath sounds, keratitis, conjunctivitis, uveitis
What signs come second in a dog with distemper?
GI signs: inappetence, diarrhea, vomiting
What signs come third in a dog with distemper?
CNS signs: seizures, ataxia, vestibular symptoms, cerebellar symptoms, paresis, myoclonus (rhythmic twitching of the head, neck, and one or more limbs)
What might survivors of distemper develop?
1. Hyperkeratosis of the footpads and nasal planum
2. Enamel hypoplasia
3. Old-dog encephalitis (ataxia, compulsive walking, head pressing, hypermetria) - Myoclonus
4. Chewing gum fits
True or false: distemper can be spread via the placenta in pregnant dogs and the puppies that survive will develop neurological signs by 6 weeks of age.
What are the clinical signs of ferrets that contract distemper?
Papular chin dermatitis, cheilitis with swelling and crusting, perineal dermatitis, anorexia, depression, pyrexia, photophobia, pruritus, mucopurulent oculonasal discharge
What are differentials for distemper?
1. Canine infectious tracheobronchitis
2. Parvoviral enteritis
4. Infectious canine hepatitis
5. Rocky Mountain spotted fever
6. Organophosphate or lead toxicosis
7. Influenza in ferrets
What are the diagnostics for distemper?
1. Presumptive diagnosis based on young, unvaccinated dog with oculonasal discharge
2. CBC: absolute lymphopenia
3. Rads: interstitial pattern in lungs
4. Fluorescent antibody test: cytologic smears of conjunctiva, tonsils, CSF, bone marrow, urine sediment
5. RT-PCR: buffy coat, conjunctiva, preputial or vaginal swabs
6. KCS on ophthalmic exam
How do you treat distemper?
Supportive care, antibiotics for secondary infections, anticonvulsants, corticosteroids for optic neuritis and encephalitis WITHOUT systemic disease
What is the prognosis for canine distemper in dogs?
Guarded to poor - worse prognosis with CNS signs
True or false: ferrets have a good prognosis for canine distemper?
How do you prevent canine distemper in dogs?
1. MLV from 6-16 weeks of age, then annually
2. Isolate infected animals from one another
3. Disinfect all potential fomites
True or false: canine distemper virus is a fragile virus and is susceptible to most disinfectants?
How long should you separate a dog with distemper from a healthy dog?
2 weeks after disappearance of clinical signs
True or false: there is a vaccine for ferrets against canine distemper virus?
True: PureVax Ferret distemper vaccine
True or false: canine distemper virus is highly contagious through aerosol, transplacental, and direct contact routes
When does viral shedding begin and how long does it persist?
Begins day 7 after infection and may persist up to 90 days
Where does canine distemper virus replicate within the dog?
Upper-respiratory epithelium tissue macrophages, tonsils, and retropharyngeal LNs
What are three possible complications that can occur with a MLV for distemper in a Weimaraner under 1 year old?
1. Hypertrophic osteodystrophy (HOD)
2. Juvenile cellulitis
3. Corticosteroid-responsive neutrophilic meningitis/arteritis
What is a classic presenting complaint for a dog with cranial cruciate ligament disease?
Overweight, pelvic limb lameness that gets worse with exercise, hold up affected limb when standing still
What are the risk factors for developing cranial cruciate ligament disease?
2. Autoimmune disease
3. Cutaneous asthenia
What are common clinical signs of cranial cruciate ligament disease?
1. Variable pelvic limb lameness (unilaterl or bilateral)
2. Holds up affected limb when standing or non-weightbearing
3. Stifle externally rotated, increased flexion when walking
4. Improvement with rest, worsens with exercise
5. Joint effusion and thickening of the joint capsule (most pronounced over the medial aspect of proximal tibia - medial buttressing)
6. Asymmetry while sitting - affected stifle abducted
7. +/- Cranial drawer sign
8. +/- Cranial tibial thrust
9. +/- Meniscal click
What are differentials for cranial cruciate ligament disease?
1. Patella luxation
2. Lumbosacral disease
3. Hip dysplasia
4. Iliopsoas strain
5. Bone neoplasia
8. Immune-mediated arthritis
9. Caudal cruciate or collateral ligament damage
10. Long digital extensor tendon avulsion
11. Isolated meniscal injury (almost only in Boxers)
What would you see on a PE of a dog with cranial cruciate disease?
Palpable stifle effusion
+/- Cranial drawer sign and cranial tibial thrust
True or false: if you see questionable findings of cranial cruciate ligament disease, you should test the contralateral limb to compare?
What would you see radiographically on the lateral and craniocaudal stifle projections of a dog with cranial cruciate ligament disease?
1. Fat pad compression in cranial joint
2. Effusion in nearly all patients
3. DJD in chronic cases - trochlear ridge, caudal surface of tibial plateau, distal pole of patella
4. Static drawer - cranial displacement of the tibia relative to the femur
True or false: you could perform arthroscopy to diagnose cranial cruciate ligament disease?
What are the medical treatment options for a dog with cranial cruciate ligament disease?
1. Physical rehab
3. Disease-modifying osteoarthritis agents: polysulfated glycosaminoglycans, pentosan polysulfate, glucosamine, chondroitin sulfate
What are the surgical options for a dog with cranial cruciate ligament disease?
1. Intracapsular fascia lata or patellar tendon autogenous graft
2. Extracapsular suture stabilization - femoral condyle or fabella to tibia
3. Fibular head transposition - advances insertion of lateral collateral ligament
4. Tibial plateau leveling osteotomy (TPLO) - changes tibial plateau angle from 20-26o to 5-10o
5. Tibial tuberosity advancement (TTA)
6. Triple tibial osteotomy (TTO) - combination of TTA and TPLO
True or false: you should always inspect the medial meniscus in dogs with cranial cruciate ligament disease?
What is the prognosis in a dog with cranial cruciate ligament disease with only conservative management?
<10 lbs: 50% do well
>10 lbs: 20% do well
What is the prognosis in a dog that undergoes surgical management for cranial cruciate ligament disease?
85% of all sizes do well regardless of chronicity
What percent of dogs will have contralateral cranial cruciate ligament injury?
40% (increases to 60% if radiographic changes are seen in the uninjured leg)
What is the best way to prevent cranial cruciate ligament disease?
How old are most large breed dogs when they are diagnosed with DCM?
4-10 years old
What three breeds are the most common large breeds to have DCM?
Boxers, Dobermans, Great Danes
In what breed of dog is juvenile onset of DCM most common?
Portuguese Water Dog
What are the common clinical signs of a dog with DCM?
Basically signs of CHF
What are the differentials for DCM?
1. Primary respiratory disease
2. Non-cardiogenic pulmonary edema
4. Non-cardiogenic effusions
6. Myxomatous valvular heart disease
9. Cardiac tumor
10. Pericardial effusion
11. Diaphragmatic hernia
12. Pulmonary hemorrhage
13. Laryngeal paralysis
14. Collapsing trachea
15. Congenital heart disease
What might you hear on cardiac auscultation in a dog with DCM?
I-III/VI systolic apical murmur (mitral regurg)
Gallop sound (S3)
Abnormal lung sounds - dull ventral lung sounds (pleural effusion), increased bronchovesicular sounds (pulmonary edema), crackles
When would you want to perform a urinalysis in a dog with DCM?
Prior to treatment
True or false: you should run a taurine analysis in any dog or cat with DCM?
What would you find on thoracic and abdominal rads in a dog with DCM?
1. Left atrial or left ventricular enlargement
3. Pulmonary edema - perihilar, caudodorsal lung lobes in dogs
4. Pleural effusion
5. Pulmonary venous enlargement
6. Enlarged vena cava
7. Hepatomegaly d/t congestion
What would you see on a echo in a dog with DCM (gold standard test btw)?
LV eccentric hypertrophy
Normal wall thickness
Enlarged end diastolic dimensions
What might you see on an ECG in a dog with DCM?
Wide, tall, or low voltage QRS
True or false: in acute DCM presentation, IV fluids are indicated?
What are the treatments of choice in dogs with DCM?
1. Diuretics: reduce edema and effusion - Lasix
2. Dilators: ACE inhibitors - Enalapril; 2% nitroglycerin; Na-nitroprusside
3. Low sodium diet
5. O2 supplementation
6. Exercise restriction
7. Positive inotropes: Dobutamine, Digoxin, Pimobendan
8. Antiarrhythmics: Beta blockers - Atenolol; calcium channel blockers - Diltiazem
What are some of the etiologies of DCM in dogs?
4. Taurine deficiency - Cocker Spaniel, Golden, Boxer, Dalmation
5. Carnitine deficiency - Boxers
6. Infectious - Chagas myocarditis caused by Trypanosoma cruzi
7. Toxic - Doxorubicin
8. Volume overload
How old are dogs who present with idiopathic epilepsy?
1-5 years old
What is a common history of idiopathic epilepsy?
1. 1+ seizures usually about a month apart
2. Generalize tonic-clonic (30 seconds to 3 minutes) - loss of consciousness, sustained contraction of all muscles, paddling limb motions or rhythmic muscle contractions, fecal and urinary incontinence
3. Generalized seizures usually affecting only the face and jaws
How do patients usually present with idiopathic epilepsy?
Usually present normal at the clinic
May have temporary neurological deficits if present within 24hr of a seizure - ataxia, abnormal behavior, cortical blindness, hemiparesis
What are common differentials for idiopathic epilepsy?
4. Lead toxicosis
5. Metaldehyde toxicosis
6. Organophosphate toxicosis
10. Hepatic encephalopathy
13. Thiamine deficiency
14. Lyosomal storage disease
True or false: idiopathic epilepsy is a diagnosis of exclusion?
What does bloodwork help to rule out in the case of idiopathic epilepsy differentials?
Metabolic or toxic causes of seizures
What test would you run to rule out hepatic encephalopathy as a differential for idiopathic epilepsy?
What would an MRI or CT help rule out in the case of idiopathic epilepsy differentials?
Structural brain disease
True or false: CSF can be used to rule out encephalitis as a differential for idiopathic epilepsy?
How often should you monitor anticonvulsant blood levels?
2-4 weeks after starting meds or changing (3 months for KBr), then every 6-12 months
If there is poor seizure control
If concerned about anticonvulsant toxicity
How often should you monitor bile acids since anticonvulsant drugs can be hepatotoxic?
What are the acute treatment options for idiopathic epilepsy?
What are the common maintenance therapies for idiopathic epilepsy?
What should you do if a dog is not already on anticonvulsant therapy for idiopathic epilepsy?
Start a loading dose of Phenobarbital IV or Keppra IV/SQ and then continue with maintenance therapy
What are the side effects of phenobarbital?
What is "safest" anticonvulsant drug?
Keppra - no drug interactions
What are three methods of preventing idiopathic epilepsy?
Spay females (estrogen can lower seizure threshold)
Do not breed affected dogs
True or false: the goal of treatment for idiopathic epilepsy is to decrease the frequency of seizure by 50%
What is the number of seizures a dog has to have to be considered "adequately controlled".
<2-3 seizures per month
What constitutes an emergency in regards to seizures and idiopathic epilepsy?
>3 seizures in 24 hours
A single seizure lasting >5 minutes
What are the Stage 1 clinical signs of ethylene glycol toxicosis (30 min-12 hr)?
CNS signs: lethargy, disorientation, ataxia, knuckling, vomiting, PU/PD, hypothermia, hypotension, seizures, coma, +/- muscle fasciculations
What are the Stage 2 clinical signs of ethylene glycol toxicosis (12-24 hr)?
Animal may appear to be improved, quiet, depressed, PU/PD
What are the clinical signs of Stage 3 ethylene glycol toxicosis (24-72 hours)?
Weakness, depression, anorexia, tachypnea/dyspnea
What are differentials for ethylene glycol toxicosis?
2. Cranial trauma
3. Intracranial neoplasia
6. Ketoacidotic DM
7. Renal failure
8. Raisins/grape toxicosis
What is the test of choice for diagnosing ethylene glycol toxicosis?
REACT ethylene glycol test kit
What drug may block a positive result on the REACT ethylene glycol test?
True or false: a serum osmolality of >20 mOsm/kg is strongly indicative of ethylene glycol toxicosis?
What are the treatments of choice for ethylene glycol poisoning?
1. Supportive care: IV fluids, NaHCO3-, CRI
2. Decontaminate and induce vomiting: activated charcoal
3. Prevent metabolism of EG: Fomepizole (inhibits alcohol dehydrogenase) or Ethanol (competes with ethylene glycol for alcohol dehydrogenase)
4. Hemodialysis or peritoneal dialysis: only options for pregnant animals
What are other diagnostics besides the REACT EG test and the serum osmolality test to diagnose a potential ethylene glycol toxicosis?
1. Chemistry: high anion gap, hypo- or hypercalcemia, increased BUN and Cr
2. UA: monohydrate calcium oxylate crystals (3-18 hours post ingestion), glucosuria, cellular casts, renal tubular cells
3. Wood's lamp: detects fluorescein stain in antifreeze
True or false: if treated within 5 hours, a dog has a poor prognosis with ethylene glycol toxicosis?
False, good prognosis
True or false: ethylene glycol itself is not toxic, its the metabolites that are dangerous?
True - glyoxalate, glycolate, and oxalate cause calcium oxalate crystal formation in the vasculature and renal tubules causing renal tubular damage, there is metabolic acidosis occurring, the citric acid cycle is inhibited, and phosphorylation is inhibited
What is the name of the hepatic enzyme that converts ethylene glycol into the dangerous metabolites?
True or false: is you start Pimobendan before the onset of CHF with DCM, it will delay the onset of CHF but won't prevent it from happening?
What are classic signs of GDV?
Large breed dog
Trying to throw up without success
What are some risk factors for developing a GDV?
1. Big breed dog
2. Nutrition/management: 1x/day feeding, elevated bowls, eating fast, exercise after eating, dry food with oil/fat as main ingredient
4. Fearful temperment
What are some differentials for a GDV?
2. SI volvulus
3. Splenic torsion
4. Diaphragmatic hernia w/stomach in chest
How do you diagnose a GDV?
PE and RADS!!
How do you treat a GDV?
1. Shock therapy: start IV fluids, pass orogastric tube carefully and decompress, trocarize in extreme cases
2. Surgical correction: derotate, gastropexy, +/- splenectomy
3. Medical therapy: hydration, blood pressure, electrolytes, acidosis, cardiac arrhythmia's
How do you prevent GDV?
1. Feeding management
2. Prophylactic gastropexy in appropriate breeds
3. DO NOT breed dogs that have had a GDV
4. DO NOT breed dogs with a relative history of GDV
What is the % mortality in surgical cases of GDV and what does it increase to if there is gastric necrosis?
15% in surgical patients, increases to 30% with gastric necrosis
When is a dog most likely to develop heat stroke?
Dog left in car
Core Temp >105.8F
Which breeds of dogs are more likely to develop heat stroke?
Those with long, dark hair
What three historical events may increase the likelihood that a dog develops heat stroke?
Previous hx of heat stroke
What five things cause a heat stroke?
1. Excessive external heat/inadequate heat dissipation
2. Excessive muscle fasiculations
3. Endogenous pyrogens (sepsis, febrile neoplastic syndrome)
4. Medications (phenothiazines, opioids (cats), cardiac drugs)
What are the clinical signs of heat stroke?
1. Acute increase in core body temp >105.8F
2. Brick red mucous membranes
5. Respiratory distress
7. Diarrhea (bloody)
10. Ataxia/muscle tremors
12. Loss of consciousness
What are the differentials for heat stroke?
What are the tests of choice for diagnosing heat stroke?
Usually based on history and presentation
If the core body temp exceeds this amount, death is imminent.
What would you see on an ECG of a dog with heat stroke?
What would you see on a CBC in a dog with heat stroke?
Increased PCV and TP due to dehydration
What would you see on a biochemistry in a dog with heat stroke?
Increased CK due to muscle damage
What would you see on a blood gas in a dog with heat stroke?
Respiratory alkalosis from excessive panting
Metabolic acidosis due to decreased tissue perfusion (lactic)
What would you see on a urinalysis in a dog with heat stroke?
What would you see on a coagulation panel in a dog with heat stroke?
Prolonged ACT, PT, PPT (poor prognostic indicator), FDP
What would the blood pressure be like in a dog with heat stroke?
Hypotensive due to shock and dehydration
What are the treatments in order for a dog with heat stroke?
1. Stabilize: O2 supplementation, IV fluids
2. Aggressvie active cooling: use tepid water (NEVER COLD OR ICE) - apply soaked towels, shallow bath, fans
; lower core body temp to 103F and monitor every 5-10 minutes to avoid hypothermia
3. Prophylactic broad spectrum abx: GI sloughing/bacterial translocation
How can heat stroke be prevented?
Never leave animal in a car
Always provide access to shade and water
Avoid prolonged exercise especially for dogs with upper airway obstruction
What three things are CONTRAINDICATED in a dog with heat stroke?
1. Cold/ice water for cooling: causes extreme peripheral vasoconstriction and increases the inability to dissipate heat
2. NSAIDs: decreased renal perfusion and GI sloughing
3. Jugular venipuncture: unknown or abnormal coagulation status
What are the common presentations of a dog with heartworm?
1. No signs in most dogs
2. Coughing is a common complaint
3. Exercise intolerance
4. Weight loss
6. Ascites (right sided heart failure)
7 Dyspnea (pulmonary hypertension)
What are the differential diagnoses for heartworm?
4. Left-sided CHF
5. Primary bronchointerstitial disease
What are the diagnostic tests of choice to detect heartworm?
1. HW antigen test - detects adult female worms
2. Filter of modified Knott's for microfilariae
What are the three adulticide treatments of choice for heartworm disease?
1. Melarsomine: 3 doses
2. Exercise restrictionL 4-6 weeks after each dose of Melarsomine
3. Prednisone or NSAIDs: reduce Melarsomine injection site inflammation
What treatments would you start before the adulticide in a dog with heartworm?
1. Doxycycline: kills Wolbachia bacteria living inside HW larvae and decreases lung pathology associated with dead worms
2. Monthly heartworm preventative: usually started on asymptomatic dogs to kill the youngest larvae (<4 months old) because the adulticide won't kill those young larvae and they can re-infect the dog
What are the two options for microfilaricide drugs (heartworm preventatives used to kill young larvae)?
1. Slow microfilaricides: Ivermectin, Selamectin, Moxidectin - fewer adverse reactions because microfilariae die off slowly
2. Fast microfilaricide: Milbemycin - 10% of animals have adverse reactions from the fast die off of the larve - pretreat with dexamethasone and diphenhydramine and hospitalize for 8 hours after giving Milbemycin
How is heartworm disease prevented?
Monthly macrolides: Ivermectin, Selamectin, Moxidectin, Milbemycin
What would you see in a dog heavily infected with HW?
Caval syndrome: adults are obstructing the tricuspid valve and posterior vena cava - severe lethargy, dyspnea, pallor, weakness
How do you treat caval syndrome?
Surgical removal of worms or dog will die within 2 days
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