Transcript ADVERSITY - Dr. Roberta Dev Anand

ADVERSITY
“Adversity causes some men to
break, others to break records.”
-William A. Ward
Liver Diseases
High regenerative capacity; damage must be severe for
signs to appear
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Drug/Toxin induced Liver Disease
◦ Acute liver failure requires >70% of liver to be
affected
◦ Susceptible to toxin ingestion (portal circulation)
◦ Some drugs have a Hx of liver toxicity
 Acetaminophen
 Phenobarbital
 others
Drug/Toxin Induced Liver Disease
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Signs
◦ Acute onset
◦ Anorexia
◦ vomiting/,
diarrhea/constipation
◦ PU/PD
◦ Jaundice (maybe)
◦ Melena, hematuria, or
both
◦ CNS signs (depression,
ataxia, dementia, coma,
seizures)
Drug/Toxin Induced Liver Disease
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Dx
◦ Hx of drug administration
◦ Painful liver on palpation
◦ Chem panel
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↑ ALT (alanine aminotransferase)
↑ Total bilirubin, ↑ blood ammonia
↑ Serum bile acids
Hypoglycemia, coagulopathy
◦ Radiographs show enlarged liver
◦ Liver biopsy (unless coagulopathy suspected)
Drug/Toxin Induced Liver Disease
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Rx
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Antidotes
Induce vomiting
Activated charcoal
IV fluids
Vit K for clotting
Antibiotics
Special diets (Hill’s k/d or u/d)
Liver Tumors
Metastatic tumors are more common
than primary tumors of liver
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Signs
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Dx
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Anorexia, lethargy, wt loss
PU/PD
Vomiting/diarrhea (?)
Abdominal distension,
hepatomegaly
◦ Jaundice
◦ Anemia
◦ Chem Panel
 Abnormal liver enzymes and
liver function tests
Liver tumors
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Dx
◦ X-ray: Heptomegaly, Ascites (?)
◦ Biopsy of liver
◦ Abdominocentesis may show tumor cells
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Rx
◦ Surgical removal is preferred treatment
 Single masses have good Px
 Multiple nodules/Diffuse disease have poor Px
◦ Chemotherapy doesn’t help primary tumors;
better for metastatic lesions
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Client info
◦ Guarded to poor Px generally
◦ Survival time: 6 mo-3 y
THINGS THAT MAKE
YOU GO HMMMMMM…..
“Is it good if a vacuum
really sucks?”
Portosystemic Shunts
Shunts form between portal circ and systemic circ
allowing blood to bypass liver; Function of liver—detox
blood
Congenital or acquired
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By-passing liver, allows many toxins into
systemic circulation
CNS is most affected by the circulating toxins
Portosystemic Shunts
Portosystemic Shunts
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Signs
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Dumb/numb, lethargic, depressed
Ataxia, staggering
Head-pressing (against a wall)
Compulsive circling, apparent blindness
Seizures, coma
Bizarre behavior (esp cats)
Signs often more pronounced shortly
after a meal
Portosystemic Shunts
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Dx
◦ Chem panel
 ↓ serum protein, albumin (liver is usually small)
 ↓ BUN (liver converts ammonia → urea)
 ↑ ALT (alanine aminotransferase), ALP (alkaline
phosphatase)
 ↑ blood ammonia
◦ X-rays
 Small liver
 Contrast material
◦ Inject into splenic vein
◦ By-passes liver
Portosystemic Shunts
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Rx
◦ Medical management seldom very successful
 Low protein diet
◦ Sx
 Ligation of shunt
◦ Total ligation often causes ↑ liver BP
◦ Partial ligation may be more practical
◦ A second Sx can be performed after few months to close off
shunt totally
◦ Client info
 Px often very good following ligation
 For best results, Sx should be performed before 1 y
old
 Collateral circulation may develop, with relapse of
signs
Feline Hepatic Lipidosis
Idiopathic (IHL) – cause unknown
 Most common hepatopathy in cats
 Obese cats of any age, sex or breed
 Stress may trigger anorexia
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Diet change,
Boarding
Illness,
Environmental change
IHL
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Anorexia prolonged for 2 weeks causes
imbalance between breakdown of
peripheral lipids and lipid clearance
within liver
◦ Lipids accumulate in liver
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Other mechanisms proposed
Early diagnosis and aggressive
treatment important
◦ 60-65% of cases => complete recovery
IHL
IHL
IHL
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Clinical Signs
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Anorexia
Obesity
Wt loss (as much as 25% of body weight)
Depression
Sporadic vomiting
Icterus
Mild hepatomegaly
+/- coagulopathies
IHL
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Diagnosis
◦ CBC - stress
◦ Biochem panel – Increased ALP, ALT,
bilirubin, Low albumin, Increase serum bile
acids
◦ X-rays – mild hepatomegaly
◦ US liver hyperechoic
◦ Liver biopsy – severely vacuolized
hepatocytes
IHL
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Treatment
◦ High protein, calorie dense diet
◦ Feeding tube usually required
 NG tube for short term liquid
diets
 Gastrostomy tube best
 Esophagostomy tube
◦ Tubes can remain in place
For up to 3-6 weeks
IHL
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Treatment
◦ IV fluids
◦ Metoclopramide SQ 15 min prior to feeding
◦ Monitor weekly
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CE
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Avoid stress in obese cats
Early intervention is essential
Any cat that stops eating is at risk
Cats do not respond well to frequent diet
changes
Pancreatic Dysfunction (Exocrine)
Main function of Exocrine Pancreas → secretion
of dig enzymes
 Located along duodenum
 Dig enzymes secreted in an inactive form to
protect pancreas tissue
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Pancreatic Dysfunction (Exocrine)
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Pancreatitis—Inflammation of pancreas
May be chronic or acute
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Develops when dig enzymes are activated within gland →
autodigestion
More common in obese animal; high-fat diets may predispose
animal to it
Unpredictable results; some recover well, others worsen and die
◦ Signs
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Older, obese dog or cat with Hx of recent high-fat meal
Depression, anorexia, vomiting
± abdominal pain
Shock, collapse may develop
Often seen post-holiday
◦ Table scraps of ham, gravy, etc
Pancreatitis
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Dx
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Rx
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Client info
◦ CBC, Chem panel
 Leukocytosis
 ↑ PCV
 Hyperlipidemia
 ↑ serum amylase, lipase
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IV fluids, electrolytes
NPO 3-4 d
Antibiotics
Butorphanol for pain
Start back on low fat diet 1-2 days after vomiting
stops
◦ Avoid obesity/overfeeding
◦ Feed low-fat treats
◦ Px is difficult to assess
Exocrine Pancreatic Insufficiency
The pancreas stops making dig enzymes
May occur spontaneously (GerShep) or due to chronic
pancreatitis (cats)
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Signs
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Wt loss
Polyphagia
Coprophagia, pica
Diarrhea, fatty stool
Flatulence
Dx
◦ Normal CBC
Exocrine Pancreatic Insufficiency
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Rx
◦ Supplement pancreatic enzymes with each
meal
 Pancrezyme
 Viokase-V
◦ Low fiber diet
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Client info
◦ EPI is irreversible; life-long treatment
◦ Pancreatic enzyme replacement is expensive
◦ With enzyme replacement, dog will regain
weight, diarrhea will stop
◦ Must be given with every meal
Perineal Hernia
Intact male dogs; atrophy of levator ani muscle; rectum
herniates
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Signs
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Reducible perianal swelling
Tenesmus (feeling of full colon)
Dyschezia (difficult defecation)
Urethral obstruction
 If bladder is herniated
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Dx
◦ Rectal palpation reveals hernia sac
Perineal Hernia
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Rx
◦ Stool softeners (Colace)
◦ Enemas
◦ Surgical repair
 Castration
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Client info
◦ Keeping stool soft may help reduce straining
 True for all dogs
◦ Castration recommended testosterone is
suspected as a predisposing factor
Perianal Fistula
Exact etiology unknown; thought to start as an
inflammation of sweat and oil glands around anus
Bacteria grow well in the moist, warm region of these
glands
Infection invades into deeper tissues
Most commonly affects G Shep (84% of dogs diagnosed)
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Signs
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Intact male, older (>8 y)
Tenesmus
Dyschezia, pain on exam
Fecal incontinence
Bleeding, foul odor of perianal area
Perianal Fistula
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Dx—PE to r/o anal sac disease/perirectal tumor
Rx
◦ Medical—usually not successful
 Clip hair, keep clean
 Flush with saline
 Antibiotics
◦ Surgical—difficult because of nerves/blood vessels
 Remove infected tissue
 Cryosurgery
 Laser surgery
 Cautery
◦ Client info
 Painful—be cautious of biting
 many complications of Sx
◦ Fecal incontinence
◦ Anal stenosis
Perianal Gland Adenoma
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Signs
◦ Intact male, older
◦ Single or multiple masses that may ulcerate
 Not metastatic
◦ Pruritis in anal area
◦ Bleeding
◦ Firm nodules in perianal skin
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Dx—PE, biopsy
Rx
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Client info
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Surgical removal
Radiation
Cryosurgery
Castration—causes regression of tumors
◦ Gently cleanse area daily with baby wipes
◦ Castration at early age helps prevent it