PU/PD

Polyphagia

PantingPanting

-Pendulous abdomen

-Thin skin

3 types of the disease:

>Pituitary Dependent Hyperadrenocorticism (PDH)

>Adrenal Dependent Hyperadrenocorticism (ADH)

>Iatrogenic

• PU/PD

• Increased appetite

• Weigh loss

• If ketoacidosis: vomiting, inappetence, lethargy

Diagnosis:

• Serum chemistry profile: Hyperglycemia , hypercholesterolemia

• UA: Glucosuria, ketonuria, low USG

Treatment:

• Insuline (NPH, Vetsulin)

• Diet change: Higher fiber diet, prescription diabetic diet

• If ketoacidotic: Hospitalization for IV fluids, anti-emetics, other supportive care for symptoms.

Prognosis:

• Fair to good

-Marijuana: Prolongued sedation, hypotension, bradycardia, hypothermia, mydriasis, hyperexcitability. Rarely lethal

-Foxglove: Cardiac glycosides, arrhythmias, lethargy, GI upset, hyperkalemia. Highly lethal

-Oleander: Cardiac glycosides, arrhythmias, lethargy, GI upset, hyperkalemia. Highly lethal

-Yew: Vomit, diarrhea, hypotension, bradycardia, tremors, seizures. Potentially lethal

-Cholecalciferol (Vit D3): Hypercalcemia and hyperphosphatemia lead to metastatic mineralization of soft tissues, following signs of renal, cardiac, and GI damage

-Raisins and grapes may cause acute renal failure

-Griffonia simplicifolia: Can cause serotonin syndrome. It is used as an antidepressant in Africa, contains 5-hydroxytryptophan causes seizures, tremors, hyperesthesia, ataxia, vomiting, diarrhea, hyperthermia, transient blindness.

-Ma Huang: Hyperthermia, tachycardia, tremors

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-Arsenic toxicosis: Ant baits. GI hemorrhages (check renal damage). Tx. Succimer or penicillamine as chelator

-Amitraz: Component of tick prevention collar. Reverse with Atipamezole

-Tricyclic antidepressants: Treat with Sodium bicarbonate.

-Ethylene glycol: Antifreeze. TX 4-methilpirazole (fomepizole 4-MP). Acute renal failure

-Zinc oxide: is a component of baby diapers. Normal attitude but vomit and diarrhea due to GI irritation

-Zinc toxicosis: By ingesting US pennies, batteries, car parts, paint, zinc-oxide sunscreen creams, screws, galvanized metals

-Chocolate: Methylxanthines caffeine and theobromine are the toxic components in chocolate, the darker the more harmful. Tx Methocarbamol, anticonvulsants, anti arrythmics. Decontaminate (emesis, activated charcoal)

-Doxorubicin: Nephrotoxic for cats, cardiotoxicity for dogs. Be aware of age and chronicity.

-Fenbendazol: Whipworm, Trichuris

-Imidocarb: Babesia spp (parasite anticholinergic)

-Levetiracetam: Anticonvulsant indicated when portosystemic vascular liver disease, is not metabolized by liver

-Phenobarbital: Anticonvulsant

-Finasteride: Androgen inhibitor, used in prostatic hypertrophy to decrease prostate size

-Selegiline: To treat Cognitive dysfunction syndrome

-Oclacitinib: FDA-approved for allergic skin diseases, such as atopic dermatitis. Increases risk of infection as it inhibits proinflammatory cytokines

-Pimobendan: common to treat heart disease and myxomatous Mitral Valve Disease MMVD. Vasodilator. Contraindicated with arrhythmias

-Sulfa trimethoprim: Relation with keratoconjunctivitis sicca

-Timolol (Beta blocker): Glaucoma. Adverse effects: eye discomfort dryness irritation, systemic lower pressure, bradycardia, allergic

-Dorazolamyde (carbonic anhydrase inhibitor): Glaucoma, decreases aqueous humor production

-Misoprostol: Prostaglandin E1 analog, decreases the risk of GI ulceration associated with NSAIDs

-Latanoprost (prostaglandin): Glaucoma, increase aqueous humor drainage

-Carprofen: NSAID commonly for arthritis, side effect GI upset, hepatopathy (rare)

-Apomorphine in conjunctival sac: to induce emesis with hypotension risk, when xylazine is not indicated since causes first brief hypertension but results in hypotension

-Vitamin K (Phytonadione): for coagulopathy secondary to decreased enteric absorption

-Alprazolam: For noise-related phobias

-Diltiazem: Atrial fibrillation

-Lidocaine: IV anti-arrhythmic

-Ivermectin

-Atropine: To treat organophosphate intoxication

-Benazepril: ACE inhibitor, can be used to treat protein loosing nephropathy

-Desmopressin acetate (vasopressin): To enhance surgical hemostasis in a patient with types I and II von Willebrand disease

-Clotrimazole: topical tx of nasal aspergillosis

-Lokivetmab: Tx of atopic dermatitis, a dog-specific monoclonal antibody, neutralizes interleukin 31

-Cephalexin: first choice Ab for acute mastitis pending culture results

-Amitraz: has been discontinued as causes sedation, hypothermia, hypotension, bradycardia, hyperglycemia, and GI stasis. Antagonist Atipamezole

-ACTH stimulation test

-High dexa test (differentiate PDH from ADH

-PDH: 75% will suppress

-ADH won`t suppress

Treatment:

Medical:

> Trilostane

>Mitotane

>Lysodren (cause neoplastic adrenal glands necrosis)

Surgical:

>Adrenalectomy

Prognosis:

Fair to Poor

DX: Total T4

Free T4 (most accurate as single test)

TSH normal doesnt rule out, high: highly supportive

TX: Levothyroxine

Euthyroid syndrome: Thyroid not underlying problem. Rule out other diseases

Acute:

>Hypovolemic shock

>Weakness

>Vomiting

Chronic:

>Non-specific

>Can be mistaken (GI disease/renal disease/pancreatitis)

>PU/PD

SX: Vomit, diarrhea, abdominal pain, anorexia

DX: Pancreatic lipase immunoreactivity

US: Enlarged hypoechoic pancreas with periferal hyperechoic fat

TX: Fluid therapy

Antiemetics: Ondansentron, maropitant

Pain control: Fentanyl, hydromorphone

DX: parvo fecal ELISA (false +: vaccination, false -: Fecal sample taken out of shedding time)

Blood chemistry: Leukopenia neutropenia, hypoalbuminemia, hypokalemia, pre-renal azotemia

TX: FLUID THERAPY-KLC/dextrose, additives colloid betstarch

ABS: Ampicilline, cephalosporines, metronidazol

ANTI EMETICS: ondansentron, maropitant

PX: Vaccination

Congenital: Persistent right aortic arch

Acquired: Myastenia gravis, addison (muscle tone loss)

DX: XR-esophagus distention

ACTH stimulation test: Addison

Acethylcholine receptor antibody titer: Myastenia gravis

TX: ADDISON- glucocorticoid & mineralocorticoid

MYASTENIA GRAVIS: Pyridostigmine (anticholinesterase)

*Prevent aspiration pneumonia

*Prokinetics: help speed gastric emptying

*Proton pump inhibitors: lower gastric acid

*Gastrotomy tube: lower regurgutation

Tx: Surgical excision with wide margins; Obtain as wide as possible margins.

If the tumor is in an area with limited tissue, consider adjunctive radiation therapy or amputation.

Tx: Stabilize the patient and consider exploratory laparotomy with splenectomy and chemotherapy.

Px: Guarded to poor

Maldigestion, weight loss/failure to gain weight, diarrhea, and polyphagia are caused by insufficient secretion of pancreatic digestive enzymes by the exocrine pancreas (acinar atrophy). 

Concurrent small intestinal dysbiosis and cobalamin deficiency are common. Dogs with EPI frequently have loose stools that are “antibiotic-responsive” due to small intestinal bacterial overgrowth. 

Diagnosis: Measure serum trypsin-like immunoreactivity concentration (<2.5 µg/L)

Tx: Oral enzyme replacement and cobalamin supplementation if deficient

: May trigger an autoimmune response against erythrocites

Sx: icterus, hepatomegaly, splenomegaly, discolored urine

Dx: blood smear: spherocytes, anisocytosis, poikylocitosis

        Saline slide agglutination: differentiates rouleux

       Urine: hemoglobinuria, bilirubinuria

       Coombs: aglutination +

Tx: immunosupressors: prednisone, azathioprine, cyclosporine, mycophenolate

       Anticoagulants: clopridogel, low dose aspirin

       Blood transfussion

Clinical signs: Depression, anorexia, fever, lethargic, PU/PD

Dx: US (image like multiple bladders)

Tx: Ovariohysterectomy

Prognosis: Depend on clinical signs or other organs involved (kidney disease).