Term
| Differentiate between large and small bowel diarrhea |
|
Definition
Large bowel diarrhea is characterized by greatly increased frequency of BM, small volumes of semi-formed feces, tenesmus, mucus, +/- hematochezia
Small bowel diarrhea may be accompanied by weightloss (esp. if chronic), normal to slightly increased frequency of BM, large volumes of loose cow pie feces, +/- melena |
|
|
Term
| What are the major differential diagnoses for infectious colitis in small animals? |
|
Definition
helminths (trichuris, ancylostoma, heterobilharzia)
protozoa (giardia, tritrichomonas)
bacterial (brachyspira, campylobacter, clostridium, e. coli, salmonella)
oomycetes (pythium)
algea (prototheca)
fungal (histoplasmosis) |
|
|
Term
| What breed is the poster child of histoiocytic ulcerative colitis? |
|
Definition
boxers
*** has also been reported in french bulldogs, mastiff, malamute, and doberman pinschers |
|
|
Term
| What is the pathogenesis of histiocytic ulcerative colitis in dogs (BOXERS!!)? |
|
Definition
| probs some genetic component --> vascular abnormalities of colonic mucosa and abnormalities in histiocytes result in accumulation of histocytes within the lamina propria --> secondary bacterial invasion serves to exacerbate mucosal inflammation and ulceration |
|
|
Term
| What are the two major underlying pathogeneses of IBD? |
|
Definition
Immune responses: generic inflammatory response involves cells (B,T, plasma, macrophage, and dendritic), secretomotor neurons (Ach, VIP, substance P), cytokines and other inflammatory mediators
Motility changes: Loss of normal gut segmentation due to suppression of the migrating motility complex (inflammation alters amplitude and duration of smooth muscle action potentials) and trigger (via substance P) of giant migrating contractions --> malabsorption, diarrhea, cramping |
|
|
Term
| What are the eight principles of therapy for inflammatory bowel disease? |
|
Definition
NUTRITION (novel proteins, hydrolized diet, fiber supplementation (for dogs)) <-- b/c inflammation may be incited by ingested food antigens
EXERCISE (helps restore normal segmental properties of the gut)
ANTIBIOTICS (some cases of IBD are incited by enteric pathogens, others are complicated by SI bacterial overgrowth)
PROBIOTICS (living organisms that boost innate and acquired immunity in the host, for dogs Enterococcus faecium <-- be wary of commercial veterinary product label claims, quality control appears deficient at this time.)
ANTI-DIARRHEAL AGENTS (prostaglandin synthase inhibitors, mu and delta opioid agonists, 5HT3 serotonin antagonists +/- alpha adernergic antagonists)
RESTORATION OF NORMAL MOTILITY (loperamide - opioid agonist- stimulates absorption while inhibiting colonic propulsive motility) <-- for difficult or refractory cases
ANTI-INFLAMMATORY/IMMUNOSUPPRESSIVE THERAPY (sulfasalazine <- salicylate (asprin) toxicity in cats, keratoconjunctivitis sicca in dogs. Also metronidazole, glucocorticoids and azathioprine)
BEHAVIORAL MODIFICATION (abnormal personality traits (separation anxiety, submissive urination) and environmental stressors have been associated with IBD in dogs) |
|
|
Term
| What is the difference between constipation and obstipation? |
|
Definition
constipation is defined as infrequent and difficult evacuation of feces without permanent loss of function.
Obstipation implies permanent loss of function and should only be applied after several consecutive treatment failures. |
|
|
Term
| What are the three most common etiologies for feline constipation? |
|
Definition
IDIOPATHIC (62% of cases)
ORTHOPEDIC (pelvic canal stenosis, manx sacral spinal cord deformity, malunion pelvic fracture etc.)
NEUROLOGIC
***also important to consider neoplasia, foreign bodies, metabolic/endocrine disease (obestiy, hypothyroidism), pharmacolgic interactions, and environmental/behavioral factors |
|
|
Term
| What are the four major principles of therapy for feline constipation? |
|
Definition
isolated mild cases are self limiting and resolve without therapy
moderate or recurrent episodes can be managed on an outpatient basis with dietary modification (wet food), water enema, oral/suppository laxatives and/or oral prokinetic agent
severe cases often require brief hospitalization to correct metabolic derrangements and evacuate impacted feces (water enema +/- manual extraction)
surgical intervention in the form of subtotal colectomy (obstipation or idiopathic dialated megacolon)for patients refractory to medical management or pelvic osteotomy (pelvic canal stenosis or hypertrophic megacolon). |
|
|
Term
| Which laxatives are most effective against feline constipation? What contraindications or side-effects are associated with these treatments? |
|
Definition
HYPEROSMOTIC (lactulose) and STIMULATIVE (bisacodyl) laxatives are most effective for recurrent chronic constipation in cats
for ALL laxatives patient should be well hydrated prior to administration to achieve greatest impact. DO NOT give bisacodyl daily --> damaged myenteric neurons with chronic use
*** lubricant, bulk forming (fiber) and emollient laxatives may be useful in mild, acute cases of constipation |
|
|
Term
| What are the three types of colonic prokinetic agents that can be used to treat feline constipation? What are some side-effects associated with these drugs that should be monitored? |
|
Definition
5HT4 SEROTONIN AGONISTS (cisapride) stimulate motility from the GE sphincter to the descending colon are are effective in cats with mild to moderate constipation. Cisapride alters cardiac muscle conductivity can can cause ventricular arrhythmias in humans (these effects have not been reported in vivo in dogs and cats) <-- off market, can get from compounding pharmacies. Tegaserol is another serotonin agonist that has been shown to stimulate colonic motility in dogs but has not yet been studied in cats
PROSTAGLANDIN E ANALOGUES (misoprostol): initiate giant migrating complex motility pattern, useful for dogs and cats with severe refractory constipation, very safe
H2 HISTAMINE ANTAGONISTS (ranitidine and nizatidine) inhibit acetylcholinesterase --> accumulation of AcH at motor endplates--> stimulate contractility in vitro |
|
|
Term
| T/F enteroplication is the best technique for preventing recurrence of intusuception |
|
Definition
FALSE
enteroplication has not been reported to reduce recurrence but has been associated with serious complications that require further surgical managment
*** no procedure reduces risk of recurrence, owners should be aware that there is a significant risk (11-20%) of recurrence regardless of treatment modality |
|
|
Term
| What is the preferred method for diagnosis of intussusception? |
|
Definition
ABDOMINAL ULTRASOUND (target like mass with two or more hyper and hypoechoic concentric rings on transverse, multiple hyper and hypoechoic parallel lines on longitudinal ****also look for associated masses)
*** survey rads are rarely diagnostic...what a surprise |
|
|
Term
| What is the treatment for intussusception? |
|
Definition
surgical --> either reduction or restection + anastamosis (if ischemic/necrotic)
**** important to provide supportive crystalloid and colloidal fluid therapy as post-obstructive secretory diarrhea may persist following surgical resolution of the intussusception |
|
|
Term
| What is the most common direction and location for intussusceptions in small animals? |
|
Definition
most commonly move antegrade (aborad --> towards the butt)
most commonly occur ileocolic |
|
|
Term
| What is the most common eitiology of intussusception in small animals? |
|
Definition
IDIOPATHIC
****also associated with parasites and linear foreign bodies (intraluminal mechanical linkage of non-adjacent segments), peritoneal adhesions (extramural mechanical linkage of non-adjacent segmenets) and massess and viral enteritis (flaccid or hardened segments of bowel result in inhomogeneity between adjacent bowel segments) |
|
|
Term
| What are the major tumor types that affect the colon in dogs? What is the general biologic behavior of colonic neoplasia in dogs? |
|
Definition
lymphoma, adenocarcinomas and GI stromal tumors (esp. leiomyosarcomas) are most common.
Although most colon tumors are malignant in dogs local invasion occurs at a relatively slow rate and metastasis is generally uncommon (vs. feline - high rate of metastasis). Malignant transformation of adenomatous polyps to carcinomas has been documented. |
|
|
Term
| What are the major tumor types that affect the colon in cats? What is the general biologic behavior of colonic neoplasia in cats? |
|
Definition
adenocarcinoma is most common followed by lymphoma and mast cell tumors.
Feline colonic tumors have a HIGH rate of metastasis (vs. canine have a low rate of metastasis and slow local invasion) |
|
|
Term
| How does the blood vessel anatomy of the the large intestine impact healing as compaired to the small intestine? |
|
Definition
| blood supply the the large intestine is not as good --> slower healing time and great risk of dehisence compaired to small intestinal surgery |
|
|
Term
| What type of enemas should be avoided when attempting medical management for feline constipation? |
|
Definition
| avoid pre-packaged hypertonic sodium phosphate enemas ---> can cause hyperphosphatemia which binds serum calcium resulting in hypocalcemia (can progress to tetany ie. muscle spasm) |
|
|
Term
| what is the definitive treatment for idiopathic megacolon in cats? |
|
Definition
subtotal colectomy
** either enterocolostomy (resection of cecum --> less tension on the anastamosis but worse diarrhea) or colocolostomy (more tension on closure and more likely to reobstipate) |
|
|
Term
| How long after performing a subtotal colectomy should owners expects soft stool and diarrhea? |
|
Definition
soft stool is forever, diarrhea in the first 4-6 weeks post op
*** remember worse diarrhea with enterocolostomy (resection of cecum) but less tension and less risk of reobstipation |
|
|
Term
| Why is there a higher risk of complications with large intestinal surgery as opposed to small intestinal surgery. |
|
Definition
high bacterial content -> peritonitis
poor blood supply -> ischemic necrosis and dehiscence
slower healing -> dehiscence |
|
|
Term
| When performing an ileocolonic anastamosis how do you deal with the huge lumen diameter discrepancies between the two sections of gut? |
|
Definition
| place simple interrupted sutures around the entire circumference of the ileum, the remaining opening in the colon is then closed straight across with simple interrupted sutures |
|
|
Term
| What percentage of the colon can be removed without any post-op clinical signs? |
|
Definition
70%
*** you can safely remove 90% of the colon but the patient will forever after have soft stool, and you should expect diarrhea for the first 4-6 weeks post-op |
|
|
Term
| what are the four surgical approaches to the rectum? |
|
Definition
“Split” pelvis
Dorsal perineal
Lateral perineal
Rectal pull through |
|
|
Term
| What is the most important complication associated with rectal surgery? |
|
Definition
incontinence
***other complications include tenesumus, hematochezia, stricture, reobstruction, dehisence, abscess, and peritonitis |
|
|
Term
| How can you differentiate a rectal prolapse from ileocolic intussusception with protrusion through the anus? |
|
Definition
| place a blunt prob between the protruding segment and the anal sphincter. If the probe can be passed cranial to the pubis then it's an intussusception. |
|
|
Term
| What is the treatment of choice for all odontogenic tumors? |
|
Definition
| surgical resection with adequate margins is curative for ALL of these tumors |
|
|
Term
| What are the most common locations in the mouth associated with odontogenic tumors? |
|
Definition
|
|
Term
| Why should all regions of missing teeth be evaluated with intra-oral dental radiographs? |
|
Definition
| unerupted teeth can progress to form dentigerous cysts which destroy alveolar bone and adjacent teeth. With expedient identification, extraction, and surgical debridement of the offending tooth this condition can be prevented. |
|
|
Term
| T/F most oral tumors in dogs are non-odontogenic |
|
Definition
TRUE
*** most common oral K9 oral tumors are malignant melanoma, squamous cell carcinoma and fibrosarcoma
*** exception, odontogenic epulides are also quite common (20-30% of all k9 oral neoplasms) |
|
|
Term
| What is the most common oral tumor of dogs? of cats? |
|
Definition
dogs --> malignant melanoma
cats --> squamous cell carcinoma |
|
|
Term
| Which non-odontogenic oral tumors have a high rate of metastasis? |
|
Definition
malignant melanoma and squamous cell carcinoma (esp. lingual or tonsillar)
*** oral fibrosarcoma is locally invasive but doesn't tend to metastasize |
|
|
Term
| What is the most common lingual tumor in small animals? |
|
Definition
squamous cell carcinoma
*** Because rostral lesions are noticed more quickly, and in a location more amenable to resection this location is associated with a better prognosis <-- dogs can function really well with most of their tongue removed, cats not so much but it can be done with supportive care (tube feeding and help grooming) |
|
|
Term
| Which type of oral tumors present with more clinical signs odontogenic or non-odontogenic? |
|
Definition
non-odontogenic --> often present with halitosis, ptyalism, hemorrhage +/- maxofacial deformation
*** exception is acanthomatous ameloblastoma (odontogenic in origin) which is very locally invasive |
|
|
Term
| All oral masses should be biopsied. Describe the location and technique that should be employed to obtain the safest most diagnostic sample? |
|
Definition
biopsy should be obtained within the clinical margins of the tumor with out disrupting any of the clinically normal appearing tissue <-- otherwise you could disrupt tissue planes necessitating wider curative resection
take a sample from deep within the tumor keeping in mind that the surface may be covered with inflammatory cells or hyperplastic gingiva and that there may be necrotic regions of the tumor as well |
|
|
Term
| Which lymph nodes must be assessed for accurate staging of maxillary tumors? |
|
Definition
maxillary lymphatics drain to parotid and medial retropharyngeal LN. Metastasis may be present without any neoplastic cells in the mandibular LN.
**** stage via US guided aspirates or surgically approached biopsies |
|
|
Term
| What is the gold standard to clinical staging (esp. prior to surigal resection) for oral tumors? |
|
Definition
| advanced imaging (CT/MRI) |
|
|
Term
|
Definition
ANY tumor of the ginigiva
*** can be benign (focal fibrous hyperplasia aka. fibrous epulis) or malignant (acanthometous ameloblastoma) |
|
|
Term
| What are some of the radiographic characteristics of benign oral tumors? |
|
Definition
Tend not to invade bone
Tend to displace teeth
Slow boney changes
Well defined area of lysis
Distinct margins
Uniform periosteal reaction |
|
|
Term
| What are the radiographic changes associated with malignant oral tumors? |
|
Definition
Invade Bone
Teeth often floating
Rapid bone changes
Multiple areas of lysis
Indistinct margins
Wide reactive zones and periosteal
layers of opacity |
|
|
Term
| What are the two most common post-op complications after surgical excision of oral masses? |
|
Definition
hemmorrhage (infraorbital, mandibular, palatine, and maxillary arteries, nasal turbinates) <-- always cross-match and prepare for transfusion when planing major facial surgery
wound dehiscence --> most occur distal to the canine teeth |
|
|
Term
| How many pairs of salivary glands do carnivores have? |
|
Definition
4 pairs of salivary glands (parotid, mandibular, sublingual, zygomatic) in addition to salivary tissue distributed throughout the buccal submucosa
**** cats also have a lingual molar salivary gland |
|
|
Term
| What are the major functions of saliva in dogs and cats? |
|
Definition
major role of saliva in carnivores is to lubricate food and protect the oral mucosa
*** saliva has MINIMAL digestive activity in carnivores |
|
|
Term
| T/F When performing salivary gland surgery it is important to warn the owners that xerostomia is a significant risk following the loss of one or more glands |
|
Definition
FALSE
*** due to abundant buccal salivary tissue dogs and cats rarely experience xerostomia following the loss of one or more salivary glands |
|
|
Term
| Which of the salivary glands in the carnivore produces primarily serous secretions? |
|
Definition
parotid salivary gland is the only one that produces just serous secretions
**** mandibular, sublingual and zygomatic (and molar in the cat) produce mixed seromucous secretions |
|
|
Term
| Where does the parotid papilla exit? |
|
Definition
| apical to 4th maxillary premolar |
|
|
Term
| Where does the mandibular papilla exit? |
|
Definition
|
|
Term
| Where does the zygomatic papilla exit? |
|
Definition
caudal to the parotid papilla
*** remember, parotid papilla is apical to the 4th maxillary premolar |
|
|
Term
| Where does the molar (cat only) salivary gland exit into the mouth? |
|
Definition
| lingual to the 1st mandibular molars |
|
|
Term
| What are the four potential etiologies for sialocele? What is the most commonly affected salivary gland? |
|
Definition
idiopathic (probs secondary to an anatomic defect of the duct system) is most common, can also arise secondary to trauma, iatrogenic or obstruction
sublingual salivary gland is most commonly affected (sublingual sialocele is also called a ranula) |
|
|
Term
| How do you diagnose sailocele? |
|
Definition
aspirate a sample of the fluid from the non-painful fluctuant (some may be firm) mass --> thick yellow to blood tinged fluid +/- PAS stain can be used to identify mucin in the fluid (most commonly affected gland is sublingual --> mixed seromucuos)
*** DDX include neoplasia, migrating FB, abcess, cervicofacial actionomycosis |
|
|
Term
| What are some clinical signs associated with pharyngeal sialocele? |
|
Definition
airway obstruction --> dyspnea and inspiratory stridor
dysphagia --> aspiration |
|
|
Term
| Although sublingual sialoceles (ranulas) are most common sialoceles can occur in association with any of the salivary glands. What clinical signs are associated with zygomatic sialoceles? |
|
Definition
exophthalmus
pain on opening mouth
swelling in the pterygopalatine fossa
*** DDX oropharyngeal penetrating FB |
|
|
Term
| What are some challanges associated with the use of sialography for diagnosis of sialoceles? |
|
Definition
requires general anesthesia, canulation of the ducts can be challenging, false negatives are possible
*** can usually diagnose based on FNA and cytology +/- PAS stain (identify mucin) |
|
|
Term
| What is the treatment for sialocele? |
|
Definition
removal of offending salivary gland and duct with aspiration of accumulated fluid (benign neglect is also an option as accumulated fluid will be slowly reabsorbed)
**** always inform owner that multiple salivary glands may be affected (or if it's a midline lesion it's challenging to determine which side is affected) and that a second surgery may be necessary if the sialocele persists |
|
|
Term
| Which type of sialocele can resolve spontaneously and rarely requires surgery? |
|
Definition
ranulas (aka. sublingual sialocele)
*** remember, sublingual salivary gland/duct is most commonly affected with sialocele |
|
|
Term
| What is the hypothesized etiology for sialolith? |
|
Definition
dystrophic mineralization
*** sialoliths are uncommon but if present they can obstruct salivary ducts resulting in sialocele formation |
|
|
Term
| What is the clinical presentation and etiology of sialadenosis? |
|
Definition
uncommon, non-painful, non-inflammatory, bilaterally symmetric swelling of the salivary glands
etiology is not completely elucidated but thought to arise from elevated parasympathetic tone associated with limbic epilepsy --> tx with phenobarbitol |
|
|
Term
| How can you differentiate sialadenosis from necrotizing sialoadenitis on PE and cytology? |
|
Definition
sialadenosis is non-painful and non-inflammatory, cytology will reveal adenomatous hyperplasia
necrotizing sialoadenitis is associated with firm painfully swollen salivary glands and systemic illness. Cytology will reveal inflammatory cells and lobular necrosis of glandular tissue |
|
|
Term
| How can you differentiate between necrotising sialoadenitis and necrotising sialometaplasia? |
|
Definition
both present on PE with painful swollen salivary glands and systemic signs of illness. Differentiate on cytology or histopath:
necrotising sialoADENITIS --> inflammation and lobular necrosis
necrotising sialoMETAPLASIA --> necrosis and squamous metaplasia with variable inflammatory cell populations and preservation of lobular morphology (histopath) |
|
|
Term
| What is the treatment for necrotising sialometaplasia (variable inflammation, squamous metaplasia, and preservation of lobular morphology)? |
|
Definition
surgical excision of affected glands
*** necrotising sialometaplasia generally non-responsive to medical therapy |
|
|
Term
| What are the six differentials for inability to close the mouth? |
|
Definition
TMJ luxation (mouth only slightly open)
TMJ dysplasia w/coronoid (mouth wide open)
zygomatic arch fracture (can also result in patients that cannot open their mouth)
neoplasia (zygomatic or coronoid)
idiopathic trigeminal neuritis
neurogenic atrophy of masticatory muscles |
|
|
Term
| What are the eight differentials for inability to open the mouth? |
|
Definition
retrobulbar or maxillofacial abscess/cellulitis (can open the jaws if the patient is anesthetized)
masticatory myositis (cannot open jaw even if anesthetized)
zygomatic mucocele
neoplasia
craniomandibular osteopathy
TMJ ankylosis
zygomatic arch fracture (can also result in patients that cannot close their mouth)
tetanus
OA of TMJ |
|
|
Term
| If you are presented with a patient that cannot open or close it's mouth what diagnostic approach should be followed? |
|
Definition
minimum database (CBC/Chem/USA)
sedated/anesthetized oral exam to evalute range of motion
Masticatory muscle biopsy for histopath and blood for type 2M muscle fiber antibody test (want to diagnose and tx masticatory myositis during acute phase otherwise muscle fibers become fibrotic) |
|
|
Term
| T/F When a patient presents with inability to open the mouth it is ideal to initiate treatment with immunosuppressive doses of steroids because masticatory myositis should be treated as expediently as possible |
|
Definition
FALSE
*** before starting immunosuppressive steroid therapy R/o retrobulbar abscess/cellulitis by performing a sedated oral exam to assess range of motion. Immunosuppression when the patient has cellulitis or an abscess can lead to severe regional or systemic disease |
|
|
Term
| How many teeth does an adult dog have? cat? |
|
Definition
|
|
Term
| What are the three hard tissues of the tooth? |
|
Definition
enamel (crown only)
dentin (root and crown)
cementum (root only) <-- attaches to periodontal ligament |
|
|
Term
| What cells produce dentin? |
|
Definition
| odontoblasts --> dentin is produced throughout the lifetime of the animal |
|
|
Term
| How is the tooth anchored in the jaw? |
|
Definition
| periodotium (which is made up of the ginigiva, alveolar bone, periodontal ligament, and cementum) |
|
|
Term
| What are the four components of the periodotium? |
|
Definition
gingiva, alveolar bone, periodontal ligament (attaches to bone), and cementum (attaches to PDL)
*** remember the periodotium anchors the tooth in the jaw |
|
|
Term
| How many premolars and molars do adult dogs have? |
|
Definition
maxillary --> 4 premolars, 2 molars
mandibular --> 4 premolars, 3 molars |
|
|
Term
| How many premolars and molars do adult cats have? |
|
Definition
maxillary --> 3 premolars, 1 molar
mandibular --> 2 premolars, 1 molar |
|
|
Term
| T/F a comprehensive oral exam with accurate assessment of periodontal disease, fractured teeth, and other oral pathology can only be performed on an anesthetized patient |
|
Definition
|
|
Term
| How many deciduous teeth does a puppy have? kitten? |
|
Definition
puppy --> 28
kitten --> 26 |
|
|
Term
| What is the rule of 4s and 9s? |
|
Definition
canine teeth always end with a 4
molars always end with a 9
*** using the modified triadan system |
|
|
Term
| How are the permanent teeth and deciduous teeth labeled via the modified triadan system? |
|
Definition
labeled from the patient's right to left.
adult teeth --> 100 + 200 (maxillary)/
400 + 300 (mandibular)
deciduous teeth --> 500 + 600
800 + 700 |
|
|
Term
| Which limb of the pancreas is larger and more mobile, therefore more ammenable to surgical manipulation? |
|
Definition
|
|
Term
| What is the etiology of periodontal disease? |
|
Definition
|
|
Term
| How is gingivitis different from periodonditis? |
|
Definition
gingivitis is reversible (with dental prophylaxis and home oral heal care)
periodontitis is NOT reversible however the progression of the disease can be halted with dental cleaning and home oral health care |
|
|
Term
| How is calculus different from plaque? |
|
Definition
plaque is a thin film of bacteria that initially forms on the teeth
Calculus occurs when plaque is not removed and becomes mineralized. The rough surface of calculus provides an ideal substrate for further plaque accumulation and progression of periodontal disease |
|
|
Term
| What is the normal probing depth of the ginigival sulcus in dogs? in cats? |
|
Definition
dogs --> 0-3 mm
cats --> 0-2 mm |
|
|
Term
| T/F periodontal debridement and dental cleaning will reverse the process of ginigival recession |
|
Definition
FALSE
**** only gingivitis is reversible with dental prophylaxis, for all other periodontal diseases prophylaxis will halt progression but not reverse the disease process |
|
|
Term
| What is the only way to detect alveolar bone loss associated with periodontal disease? |
|
Definition
| intra-oral dental radiographs |
|
|
Term
| Teeth should be extracted if they are associated with what degree of alveolar bone loss? |
|
Definition
50% or more
**** teeth may not be mobile! Need to assess bone loss with intra-oral dental rads |
|
|
Term
| What are the stages of periodontal disease? |
|
Definition
stage 1: marginal gingivitis, minimal plaque and calculus, no attachment loss
stage 2: moderate gingivitis, plaque, and calculus esp. accumulated in gingival sulcus, up to 25% attachment loss on dental rads
stage 3: periodontal pockets and attachment loss of 25-50% +/- vertical bone loss on dental rads
stage 4: pockets >9mm, attachment loss >50%, teeth are very mobile, severe halitosis and generalized stomatitis |
|
|
Term
| Which teeth tend to sustain the greatest calculus accumulation? |
|
Definition
maxillary 4th premolars
**** remember the parotid and zygomatic salivary ducts emerge apical to PM4 |
|
|
Term
| T/F professional periodontal cleaning is NOT an elective procedure and MUST be done under general anesthesia |
|
Definition
|
|
Term
| Inadequate plaque removal from which region of the tooth will render the entire periodontal cleaning ineffective? |
|
Definition
inadequate removal of plaque and calculus subgingivally from the cementum (attaches root to periodontal ligament) will render the entire cleaning ineffective
*** remember, cementum is very porous and a great substrate for plaque accumulation |
|
|
Term
| What two mechanisms are employed by ultrasonic scalers to clean the teeth? |
|
Definition
mechanical kick (effect of metal tip contacting the surface of the calculus)
cavitation (water spray hitting the vibrating tip) |
|
|
Term
| What are some characteristics of the two most common ultrasonic scalers? |
|
Definition
magnetorestrictive: elliptical oscillation energized by electromagnetic energy --> magnetic component needs to be replaces q 6 months
Piezoelectric: linear oscillation energized by a quartz crystal (brittle --> can be more easily damaged), used with variously sized tips which need to be replaced q 1 year |
|
|
Term
| What are the three most common ultrasonic scaler tips and what are they used for? |
|
Definition
beaver tail --> wide, supragingival scaling ONLY
universal --> slender tip, can be used for both supra and subgingival scaling
periodontal --> more slender and curved, used for deep subgingival scaling or periodontal debridement. Less vibration and water flow to protect subgingival soft tissues make this scaler ineffective above the gum line (ie. less cavitation capacity) |
|
|
Term
| What type of scaling is the most sensitive method for removing plaque and calculus from all tooth surfaces (enamel and cementum)? |
|
Definition
hand scalers and curettes
*** remember, DON'T use scalers subgingivally |
|
|
Term
| What is the difference between root and periodontal debridement? |
|
Definition
| both refer to removal of subgingival plaque and calculus however root planning is accomplished with hand scaling while periodontal debridement is done with the ultrasonic scaler |
|
|
Term
| What is the difference in form and function between a scaler and a curette? |
|
Definition
scalers have two cutting edges and therefore can only be used supragingivally.
curettes have a single cutting surface and can be used both supragingivally and subgingivally (aka root planning) |
|
|
Term
| What is the ONLY hand instrument that can be used below the gum line? |
|
Definition
| curette (has only one cutting edge) |
|
|
Term
| Why is it important to polish teeth after ultrasonic and hand scaling? |
|
Definition
scaling creates microetches in the enamel which can act as a nidus for plaque and calculus accumulation. Polishing smooths away these small scratches creating a slick even surface that is harder to plaque to adhere to.
*** always polish at a reduced rotational speed and avoid leaving the polisher on the tooth for more than a few seconds, otherwise you could cause heat damage to the pulp |
|
|
Term
| What is the most effective means of preventing plaque and calculus build up in between professional dental cleanings? |
|
Definition
daily tooth brushing
*** advise the owners to hold the mouth shut and insert the brush between the lips and the buccal surfaces of the teeth to prevent the pet from biting at the tooth brush |
|
|
Term
| What are six indications for using regional nerve blocks for dental procedures? |
|
Definition
tumors requiring biopsy, resection +/- reconstructive surgery
oral trauma (laceration, FB, jaw fractures)
Fractured teeth
palatal defects requiring soft tissue repair
severe periodontal disease
tooth resporption or caudal stomatitis in cats requiring multiple extractions |
|
|
Term
| Which drug is used for regional dental nerve blocks? What is the toxic dose of this drug in dogs and in cats? |
|
Definition
bupivicaine (marcaine)
toxic dose in dogs --> 2 mg/kg
in cats --> 1 mg/kg |
|
|
Term
| Which nerve block is used to anesthetize the rostral aspect of the maxilla cranial to the 3rd premolar in the dog? |
|
Definition
infraorbital
*** infraorbital foramen is located apical to the distal root of the third maxillary premolar |
|
|
Term
| How is the clinical impact of the infraorbital nerve block different in the cat vs. the dog? |
|
Definition
| the infraorbital nerve block only anesthetizes the teeth rostral to the third premolar in the dog, but will anesthetize ALL ipsilateral teeth in the cat due to the smaller size of their jaws |
|
|
Term
| Because the infraorbital nerve block doesn't anesthetize structures caudal to the 3rd maxillary premolar in the dog, which additional block can be used for the caudal maxilla? |
|
Definition
caudal maxillary block - just insert the needle caudal to the 2nd maxillary molar
*** remember, infraorbital block will anesthetize ALL ipsilateral teeth in the cat (due to it's smaller jaw) |
|
|
Term
| Which nerve block can be used to anesthetize ipsilateral mandibular incisors in large breed, non-brachycephalic dogs? |
|
Definition
middle mental
**** located at the medial root of the second mandibular premolar, lingual frenulum should be overlying the foramen. |
|
|
Term
| Because the middle mental nerve block is technically challenging and if correctly performed will only reliably anesthetize the ipsilateral incisors, which nerve block can be used to anesthetize the mandibular entire arcade? |
|
Definition
inferior alveolar block
***** angle the needle towards the contralateral canine in the mucosa just lingual to the 3rd mandibular molar |
|
|
Term
| 3/4 inch needles are usually used for dental nerve blocks; however, which block often requires a 1 inch long needle (esp. in larger dogs)? |
|
Definition
inferior alveolar
*** remember, this block anesthetizes the entire mandibular arcade |
|
|
Term
| What anatomic structure can be damaged when performing the inferior alveolar block in the cat? |
|
Definition
the lingual molar salivary gland
*** located immediately adjacent to the mandibular molar (remember, cats have only 1 molar on the mandible and 1 molar on the maxilla) |
|
|
Term
| What are the oral structures the can be assess using parallel beam intra-oral radiography? |
|
Definition
| caudal mandibular teeth in dogs, entire mandible in cats, the nasal cavity |
|
|
Term
| What are the oral structures that can be assessed using the bisecting angle intra-oral radiography technique? |
|
Definition
| maxillary teeth (including canines), mandibular and maxillary incisors, some portions of the mandible (ex. assessment of jaw fractures) |
|
|
Term
| What liver function tests are reported on normal serum chemistry profiles? |
|
Definition
bilirubin
BUN
glucose
albumin
cholesterol |
|
|
Term
| What RBC morphologic abnormality is associated with hepatic disease? |
|
Definition
acanthocytes
(irregularly spiculated, "thorn apple") |
|
|
Term
| T/F serum liver enzymes are NOT indicators of liver function |
|
Definition
TRUE
*** liver function indicators include bili, glucose, BUN, cholesterol, albumin, clotting factors and bile acids |
|
|
Term
| Which liver enzyme is most liver specific and associated with hepatocellular necrosis? |
|
Definition
ALT
*** magnitude of serum elevations is NOT prognostic |
|
|
Term
| What are some examples conditions that will elevate liver enzymes in the absence of primary liver pathology? |
|
Definition
| hypoxia (anemia, pulmonary dz, CHF), hypotension, bone abnormalities, non-hepatic neoplasia, GI disease (esp. pancreatitis), and drugs (glucocorticoids, anticonvulsants, ketoconizole etc.) |
|
|
Term
| What is the mechanism of elevated ALP. Elevations in this enzyme are more specific to the liver in which species, dogs or cats? |
|
Definition
ALP is an inducible enzyme that arises secondary to cholestasis rather than hepatocellular necrosis (ALT, AST).
It is a more specificindicator of cholestasis in cats than in dogs, but due to its short half life in cats it is less sensitive
*** remember in dogs elevated ALP can also be secondary to bone lesions and glucocorticoids |
|
|
Term
| Elevations in which liver enzyme is more consistently appreciated in cats with liver disease? |
|
Definition
GGT
*** but remember, if hepatic lipidosis (most common liver disease of cats) ALP > GGT in most cases |
|
|
Term
| How can jaundice be further classified? |
|
Definition
pre-hepatic (hemolysis)
hepatic (hepatocellular - parenchymal disease)
post-hepatic (cholestasis and/or obstruction) |
|
|
Term
| When a patient is icteric it is important to determine if the cause of hyperbiliruminemia is hepatic or post-hepatic by evaluating liver function. Which liver function test is not diagnostically valuable in icteric patients? |
|
Definition
|
|
Term
| How should you respond to mild bilirubinuria in a dog? in a cat? |
|
Definition
in a dog --> small amounts of bilirubin can normally be present dog urine, integrate with clinical signsand urine specific gravity (ie. bilirubinuria is more significant if the urine is dilute)
in cat --> pathologic! Healthy cats NEVER have bilirubinuria |
|
|
Term
| What are the two major pathologic mechanisms for hyperbilirubinemia is patients with hepatic disease? |
|
Definition
impaired hepatic perfusion
regurgitation of bile acids back into the systemic circulation |
|
|
Term
| What is the most sensitive test of liver function? |
|
Definition
bile acids
**** remember, bile acid values in patients with hyperbilirubinemia DO NOT give you any information about liver function |
|
|
Term
| What are some pathologic mechanisms that can contribute to hypoalbuminemia other than decreased liver synthesis? |
|
Definition
| renal, GI, or third space losses, acute phase response, anorexia |
|
|
Term
| How much of the liver must be non-functional before its synthetic capacities are affected? |
|
Definition
|
|
Term
| What can you differentiate hepatic for post-hepatic disease base on coagulation cascade abnormalities? |
|
Definition
| PT will not normalize after vitamin K1 supplementation if the cause of the prolonged clotting time is due to decreased synthetic capacity secondary to parenchymal disease, but WILL IMPROVE if the problem is secondary to EXTRAHEPATIC OBSTRUCTION |
|
|
Term
| What type of sample is most applicable for histologic evaluation of liver parenchymal disease in dogs? in cats? |
|
Definition
dogs ---> biopsy (usually have chronic hepatitis)
cats --> FNA (usually have hepatic lipidosis) |
|
|
Term
| What are some liver diseases that can present as acute liver failure (aka fulminant hepatic failure)? |
|
Definition
drugs/toxicities
leptospirosis
hepatic lipidosis (cats)
various forms of hepatitis (esp. dogs)
neoplasia |
|
|
Term
Why is it challenging to achieve the goals of treatment for acute hepatic failure (eliminate causative agents and potentiating factors, provide optimal conditions for
hepatic regeneration, manage complications)? |
|
Definition
| often we cannot achieve all of these goals because the etiologic agent is often not known, most therapies are symptomatic and supportive with the hope that this will allow the liver to regenerate, and there have been virtually NO clinical trials to assess the efficacy of hepatic disease therapies |
|
|
Term
| What four supportive measures should be taken as soon as a patient with hepatic disease is identified despite lack of an etiologic diagnosis? |
|
Definition
address any fluid, metabolic, or electrolyte derangements (hypovolemia secondary to GI and 3rd space losses <-- may need to give colloid + crystalloid)
assess coagulation capacity (fresh frozen plasma if active bleeding, vit K1 SQ if cholestasis)
hepatic supportive care (antioxidants --> N-acetylcystine, S-adenosylmethionine, milk thistle, vit e)
treat hepatic encephalopathy if present (lactulose, low protein diet, oral non-absorbable antibiotics, +/- flumazenil or propofol if seizuring) |
|
|
Term
| What are the two hepatic disease where a commercial liver diet is an appropriate therapy? |
|
Definition
hepatic encephalopathy (low protein --> ammonia is a breakdown product of proteins)
copper associated hepatitis (these diets are also low in copper while most commercial diets over-supplement Cu) |
|
|
Term
| Chronic hepatitis is common in which species and rare in which species? |
|
Definition
| common in dogs, rare in cats |
|
|
Term
| If you identify some elevations in serum liver enzymes on a serum chemistry of a patient that is clinically healthy what is the next diagnostic step you should take? |
|
Definition
| re-test serum chem in 1 month, elevations in ALT 5x reference range for a duration > 4 weeks warrants further investigation (bile acids, biopsy) |
|
|
Term
| Which drugs are commonly associated with hepatopathy in dogs? |
|
Definition
phenobarbitol
carprofen
trimethoprim-sulfa
azathioprine
ketaconazole |
|
|
Term
| What is the histologic distribution of copper granules in cases of copper associated hepatitis in dogs? |
|
Definition
|
|
Term
| What is the most common primary hepatopathy in dogs? |
|
Definition
idiopathic chronic hepatitis
*** second most common is copper-associated hepatitis <-- this can be treated and reversed so ALWAYS stain for copper on liver biopsies!!!! |
|
|
Term
| What is the most common cause of increased ALT in dogs? |
|
Definition
| non-specific reactive hepatitis |
|
|
Term
| What is the treatment and prognosis for copper associated hepatitis in dogs? |
|
Definition
great prognosis with appropriate therapy --> low copper diet (commercial liver diets, avoid eggs, liver, nuts etc.)
AND
copper chelators (zinc if presymptomatic, penicillamine if clinical <- also has anti-inflammatory effect) both chelators increase synthesis of metallothionein which binds Cu --> excreted in feces, DO NOT use them together because their action is diminished in combination |
|
|
Term
| What is the difference in histologic findings associated with acute and chronic hepatitis? |
|
Definition
acute --> primarily neutrophils
chronic --> primarily lymphocytes and plasma cells |
|
|
Term
| What is the outcome of most cases of acute hepatitis? |
|
Definition
spontaneous recovery, some cases of acute hepatitis may progress to a chronic clinical course but remain primarily neutrophilic on histology
**** vs. fulminant acute hepatitis --> rapidly fatal |
|
|
Term
| What serum value should you assess prior to performing a liver biopsy in a patient with suspected hepatitis? |
|
Definition
| assess fibrinogen --> if <1g/dl treat with steroids for 1 week before taking the biopsy |
|
|
Term
| Although abdominal ultrasound may be unremarkable in patients with chronic hepatic parenchymal disease, what findings are negative prognostic indicators? |
|
Definition
| enlarged portal lymph nodes, ascites, microhepatica |
|
|
Term
| What histologic findings are consistent with chronic hepatitis in dogs? |
|
Definition
periportal inflammation (lympho-plasmacytic)
bridging necrosis with destruction of hepatic lobule limiting plate
+/- piecemeal necrosis |
|
|
Term
| T/F evidence of immunologic eitiology for chronic hepatitis in dogs is lacking |
|
Definition
TRUE
**** coirticosteroids are still the cornerstone of therapy for idiopathic chronic hepatitis due to their anti-inflammatory and weak anti-fibrotic acitivity |
|
|
Term
| What options are available for medical management of idiopathic chronic hepatitis in dogs? |
|
Definition
corticosteroids (ANTI-INFLAMMATORY + antifibrotic)
ursodiol (enhances bile flow, antioxidant, immunomodulator)
antioxidants (SAMe, silymarin, vit E)
+/- supportive care (fluid therapy, diuretics if portal hypertension + ascites, lactulose and low protein diet if hepatic encaephalopathy, GI protectant and antacids if ulcers) |
|
|
Term
| What finding is a negative prognostic indicator for patients with chronic hepatitis? |
|
Definition
cirrhosis (MST 1.3 months)
if no cirrhosis (MST 9.9 months!) |
|
|
Term
| The portal vein provides what percentage of the total blood flow and oxygen to the liver? |
|
Definition
80% of blood flow
50% of oxygen
**** the balance is provided by the hepatic artery |
|
|
Term
| What anatomic components make up a complete portal triad? |
|
Definition
bile duct, hepatic artery, portal vein
*** remember each hexagonal hepatic lobule also has a central vein in the middle |
|
|
Term
| what is the circulatory impact of a portosystemic shunt? |
|
Definition
| blood that is drained from the GI tract bypasses the liver and immediately enters systemic circulation (drugs and toxins aren't metabolized, bile acids aren't reabsorbed etc.) |
|
|
Term
| What is the etiology of acquired portosystemic shunt (20% of all shunts)? |
|
Definition
portal hypertension
most commonly secondary to chronic hepatitis with cirrhosis but can also occur secondary to portal vein hypoplasia (small or absent intrahepatic vein --> portal hypertension), neoplasia, hepatic arterio-venous malformation (fistula), and CHF |
|
|
Term
| What signalment is most commonly associated with extrahepatic shunts? What about intrahepatic shunts? |
|
Definition
extrahepatic --> small breed dogs (yorkies!) AND cats
intrahepatic -> large breed dogs (Irish wolfhound) |
|
|
Term
| For patients with congenital extrahepatic shunts (yorkies!) what is the most common destination for the shunt? |
|
Definition
portal vein to vena cava (45%)
*** 5% shunt to the azygous vein |
|
|
Term
| What is the most common sign of hepatic encephalopathy in cats? |
|
Definition
|
|
Term
| What clinical signs are associated with portovascular anomalies in dogs? |
|
Definition
hepatic encephalopathy <-- often episodic occurring after feeding
poor physical condition, urinary calculi +/- secondary UTI, anesthetic drug intollerance +/- chronic GI signs (not super common in cats) |
|
|
Term
| What abnormalities on minimum database are supportive of portovascular anomaly? |
|
Definition
hemogram: MICROCYTOSIS, +/- mild mature neutrophilia
chem: low albumin, BUN, cholesterol, glucose, potassium, 50% have elevated ALT
UA: ammonium urate crystaluria (if you see this in any breed other than dalmatians and English bulldogs think PSS!) |
|
|
Term
| What is the best screening test for portovascular anomaly? |
|
Definition
serum bile acids
*** ammonia tolerance testing is CONTRAINDICATED in patients with signs of hepatic encephalopathy and anyways, the test is fiddly to do and prone to falsely elevated results |
|
|
Term
| What non-invasive tests can be used to definitively diagnose portosystemic shunts? |
|
Definition
abd ultrasound (can often identify INTRAhepatic shunts)
scintigraphy (give radioisotope IV or rectally, any portovascular anomally (except microvascular hypoplasia) will have 67-87% of contrast bypassing the liver) |
|
|
Term
| If non-invasive techniques do not identify a portovascular anomaly, but suspicion is high based on laboratory and clinical findings, what additional tests are available for definitive diagnosis? |
|
Definition
exploratory celiotomy
+
liver biopsy (diffuse hepatic atropy, lobular collapse, indistinct or abscent portal veins)
+
portal angiography (can inject contrast into splenic pulp, or splenic or mesenteric vein to visualize extrahepatic shunts intra-op) |
|
|
Term
| What are the indications for medical management of portovascular anomalies and what are the treatments? |
|
Definition
to stabilize a patient prior to surgery, for inoperable shunts (esp. portal vein hypoplasia and aquired shunts), or for mildly affected individuals
tx--> minimize hepatic encephalopathy (low protein diet, lactulose, neomycin) and minimize ascites (spironolactone) |
|
|
Term
| What is the optimal treatment for portosystemic shunt? |
|
Definition
| complete or partial surgical ligation of shunt <-- extrahepatic are easiest |
|
|
Term
| What two complications are associated with surgical ligation of portosystemic shunts? |
|
Definition
Portal hypertension --> manifests as abdominal pain, ascites, bloody diarrhea, ileus, and/or shock, usually transient but can be treated with diuretics and hetastarch/plasma
seizures ---> etiology unknown, LIFE THREATENING (65% mortality despite aggressive therapy) |
|
|
Term
| What is the most common presentation of a cat with a portosystemic shunt (single extrahepatic is most common)? |
|
Definition
hypersalivation (secondary to hepatic encephalopathy)
*** armstrong was really pumped about copper colored irises as well..... |
|
|
Term
| What are the four categories of liver disease? |
|
Definition
Circulatory disorders (ex. PSS)
Biliary tract disorders (ex. cholestasis)
Parenchymal disorders (ex. hepatic lipidosis and hepatitis)
Hepatic neoplasia and hyperplasia |
|
|
Term
| Which hepatic diseases/disorders are common in DOGS but rare in cats? |
|
Definition
chronic hepatitis, copper associated hepatitis, and cirrhosis
steroid hepatopathy
portal vein hypoplasia |
|
|
Term
| Which hepatic diseases/disorders are common in CATS but rare in dogs? |
|
Definition
cholangitis
hepatic lipidosis
cystic liver disease in geriatric cats |
|
|
Term
| What is the pathogenesis of hepatic lipidosis? |
|
Definition
obesity coupled with anorexia results in intense peripheral lipolysis with massive amounts of free fatty acids (FFA) in the blood --> FFAs accumulate in hepatocytes disrupting normal cellular function
*** can be primary (healthy cat goes off feed from environmental stress, diet change etc.) or secondary to underlying disease that induces anorexia (ex. neoplasia, FB, CKD etc.) |
|
|
Term
| What is the common PE and laboratory findings associated with hepatic lipidosis? |
|
Definition
FAT and YELLOW!
most consistent chemistry abnormality is elevated ALP and bili (and normal GGT), but also commonly have elevated AST and ALP |
|
|
Term
| Why is ultrasound an important aspect of diagnosing hepatic lipidosis? |
|
Definition
| diffuse hyperechoic liver parenchyma is supportive of the diagnosis however, ultrasound is important to r/o underlying disease and perform guided FNA for cytology |
|
|
Term
| ultrasound guided FNA is the ideal method of diagnosing hepatic lipidosis. What would be some indications for collecting a liver biopsy from a patient with suspected hepatic lipidosis? |
|
Definition
presence of inflammatory cells on FNA (r/o peripheral blood contamination from hepatitis) or poor response to treatment after 1 week of therapy
*** screen for coagulation abnormalities first, if present pre-treat with vit K1 SQ (IV --> anaphylaxis!) 2-3x q 12 hours |
|
|
Term
| What is the cornerstone of treatment for hepatic lipidosis? |
|
Definition
expendient enteral nutritional support!
*** place a NG tube on day 0! Monitor potassium and phosphorus as insulin released in response to feeding can cause intracellular translocation and marked serum depletion of these ions |
|
|
Term
| Other than enteral feeding with monitoring of potassium and phosphorus what additional therapy is often necessary for patients with hepatic lipidosis? |
|
Definition
| vit b12 supplementation (40% of patients are deficient) |
|
|
Term
| How is the signalment for acute neutrophilic cholangitis different from chronic neutrophilic cholangitis? |
|
Definition
acute --> younger, male, febrile
chronic --> older, NO fever |
|
|
Term
| What are some differences in laboratory findings in acute vs. chronic neutrophilic cholangitis? |
|
Definition
acute --> marked neutrophilia with regenerative left shift, elevated ALT
chronic --> mature neutrophilia, elevated ALT and bilirubin |
|
|
Term
| What is feline "triaditis", what anatomic features influence the development of this syndrome? |
|
Definition
triaditis = IBD + pancreatitis + cholangitis
because the bile duct and pancreatic duct converge and enter the small intestine at the major duoudenal papilla inflammatory processes happening in any one of these organs can influence the other two |
|
|
Term
| How important are bacterial pathogens in inciting neutrophilic cholangitis? |
|
Definition
| enteric organisms have been isolated from ~25% of cases, helicobacter-like organisms have also been identified in biopsies from affected animals |
|
|
Term
| What is the treatment for neutrophilic cholangitis? |
|
Definition
if acute --> supportive therapy (fluids, nutritional, analgesics, vit K1, antioxidants (SAMe, vit e))
+ antibiotics (clavamox, cephalosporin or fluouroquinolones)
if chronic --> ab + prednisolone (either start 2 wks after initiating ab therapy, or concurrently if PMNs are noted on bx) |
|
|
Term
| What is the prognosis for neutrophilic cholangitis? |
|
Definition
| prognosis is the same for acute and chronic presentations --> 50% have prolonged survivial, 50% die/euthanized 90 days post initiation of therapy |
|
|
Term
| How much of the liver can safely be removed surgically? |
|
Definition
|
|
Term
| What vessel most commonly gives rise to extrahepatic (yorkie) portosystemic shunts? |
|
Definition
most commonly arise for left gastric or splenic vessels running along the lesser curvature of the stomach
*** remember 45% of PSS exit into the venacava, only 5% into the azygous |
|
|
Term
| What liver biopsy techniques are available for use following celiotomy? |
|
Definition
guilotine (for diffuse disease or lesions at the edge of a liver lobe)
wedge (for discrete lesions that cannot be optained using guillotine method)
punch (discrete nodules far from the periphery of a liver lobe <-- pack with gel foam for hemostasis) |
|
|
Term
| What are some indications for tooth extraction? |
|
Definition
severe periodontal disease with >50% alveolar bone loss or gross tooth mobility
fractured teeth with pulp exposure
retained deciduous teeth or supranumary teeth causing malocclusion
malpositioned teeth causing malocculusion or tissue trauma
tooth root resorption |
|
|
Term
| What characteristics of the oral cavity contribute to its excellent healing capacity? |
|
Definition
abundant blood supply, constantly bathed in saliva (rich antimicrobial properites)
**** so use absorbable suture (GUT) because oral incisions will heal much more quickly than skin incision |
|
|
Term
| When making ginigival flaps for extraction of multi-rooted teeth, what principle must be strictly followed? |
|
Definition
| always elevate the gingival mucosal to the point where they can be closed with absolutely NO TENSION |
|
|
Term
| What post-op complication is associated with extraction of upper canine teeth? What are the treatment recommendations should this complication occur? |
|
Definition
| oronasal fistulas can occur, esp. if the tissue surrounding the extracted canine teeth is unhealthy --> let the fistula drain and allow time for healthy epithelial tissue to develop, may resolve on its own or can surgically close the fistula once healthy tissue has regenerated |
|
|
Term
| What characteristics of deciduous teeth make extraction difficult? |
|
Definition
| deciduous teeth are long and slender with thin root walls making them prone to fracture during extraction --> care must be made not to damage permanent tooth buds when retrieving any root fragments |
|
|
Term
| What technique is used to extract single rooted or sectioned multi-rooted teeth? |
|
Definition
| press elevator into the periodontal space and apply rotational pressure for 5-10 seconds. Repeat this process circumferentially around the tooth until the tooth is loose. Place extraction forceps on the tooth as far apically as possible (minimize tooth fracture) and apply rotational force for 5-10 sec several more times until the tooth can be lifted out of the alveolar socket parallel to its long axis |
|
|
Term
| What should you do after extracting a tooth but before suturing the gingival flaps? |
|
Definition
| assess the alveolar crest for any edges or spicules and use a football diamond burr to smooth them down. Use a bone curette and chlorohexidine solution to remove and flush any remaining debris out of the socket |
|
|
Term
| What teeth have multiple roots in the dog? In the cat? |
|
Definition
dog -> maxillary PM 2,3,4 and M 1,2
mandibular PM 2,3,4 and M 1,2,3
cat -> maxillary PM 3,4 +/- M 1
mandibular PM 3,4 and M1 |
|
|
Term
| Why is it essential to section even severely damaged or infected multi-rooted teeth? |
|
Definition
| sectioning multi-rooted teeth is ESSENTIAL to prevent inadvertent fracturing of the tooth/roots |
|
|
Term
| T/F intra-oral dental radiographs should always be taken before and after performing extractions |
|
Definition
TRUE
necessary to minimize complications (retained root fragments) and document extent of disease (severe periodontal disease --> jaw fracture after extraction) |
|
|
Term
| What is the recommended post-op care following tooth extraction? |
|
Definition
pain meds (3-5 days)
antibiotics (7-10 days) <-- calvamox or clindamycin
soft diet for couple days to a week
recheck in 3-4 weeks |
|
|
Term
| Why is it so challenging to obtain a biopsy from the body of the pancreas? |
|
Definition
| many important structures are located here--> pancreatic duct within the parenchyma and the pancreaticoduodenal artery between the closely opposed parenchyma and duodenum make dissection in this region challenging! |
|
|
Term
| Which species does not always have an accessory pancreatic duct? |
|
Definition
cats
*** the accessory pancreatic duct when present acts to drain the left limb of the pancreas |
|
|
Term
| What is the blood supply to the right limb of the pancreas? left limb? What are the consequences of compromising either blood supply? |
|
Definition
right limb is supplied by the pancreaticoduodenal artery --> if transected the descending duodenum is devitalized
left arm is supplied by the splenic artery --> if transected the spleen and part of the stomach (not such a big deal, lots of collateral circulation) will become devitalized |
|
|
Term
| Which limb of the pancreas is larger and more mobile, therefore more amenable to surgical manipulation? |
|
Definition
|
|
Term
| Although surgically obtained biopsies of the pancreas are generally more diagnostic for assessment of pancreatic disease what less invasive procedure can be done percutaneously? |
|
Definition
ultrasound guided FNA
*** DO NOT use truecut biopsy needles on the pancreas, the needles are too large and the risk of damaging the pancreatic ducts is great |
|
|
Term
| What surgical approach should be used when collecting laprascopic pancreatic biopsies? |
|
Definition
Right lateral approach
*** the left limb of the pancreas is tucked up between the stomach and omentum, is smaller and less mobile |
|
|
Term
| What is the benefit of collecting a pancreatic biopsy via laparoscopy (right lateral appraoch) vs. celiotomy? |
|
Definition
| laprascopic biopsies can be collected with less direct manipulation of the pancreas and therefore are associated with a decreased risk of post-op pancreatitis |
|
|
Term
| Why might you want to avoid using the suture fracture technique of collecting a pancreatic biopsy in the left limb of the pancreas? |
|
Definition
greater risk of ligating the major pancreatic duct ---> will result in severe pancreatitis 24-48 hours post op
*** in general the suture fracture technique as associated with more inflammation than the dissection technique but it is quicker |
|
|
Term
| T/F total pancreatectomy is infrequently performed in vet med because it is a very challenging surgery associated with marked patient morbidity and mortality, and if successful requires intensive management for life |
|
Definition
|
|
Term
| When procedure should ALWAYS be done after performing any surgery involving the pancreas? |
|
Definition
lavage the region with copious amounts of warm sterile saline because manipulation is always associated with some degree of exocrine secretion
*** pack off the rest of the abdomen to prevent rinsing exocrine secretions into other regions of the abdomen. Closed suction drain can be placed as well (other drains are associated with secondary bacterial infections) |
|
|
Term
| What is a class 1 malocclusion? |
|
Definition
normal jaws but abnormal dental relationships
ex. lingouversed mendibular canines, mesioversed maxillary canines, crossbites, and crowded/rotated teeth |
|
|
Term
| What is a class 2 malocclusion? |
|
Definition
| arises from a genetically short mandible --> mandibular incisors are abnormally distal to maxillary incisors |
|
|
Term
| What is a class 3 malocclusion? |
|
Definition
genetically short maxilla
*** common in brachycephalic breeds |
|
|
Term
| T/F two teeth of the same type should NOT be in the same place at the same time |
|
Definition
TRUE
**** retained deciduous teeth should be extracted expediently as they can lead to the development of class 1 maloclusions |
|
|
Term
| What are the most common supranumerary teeth in the cat? |
|
Definition
associated with 308 and 408
**** second mandibular premolars |
|
|
Term
| At what age do puppy deciduous teeth erupt? |
|
Definition
| 3 weeks (incisors and canines) up to 12 weeks (premolars) |
|
|
Term
| At what age to kitten deciduous teeth erupt? |
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Definition
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Term
| At what age does adult dentition emerge in dogs? |
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Definition
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Term
| At what age does adult dentition in cats emerge? |
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Definition
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Term
| What is the difference between gemini and fusion teeth? |
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Definition
gemini teeth have two crowns but a single radicular system
fushion teeth have two fused crowns with two individual redicular systems |
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Term
| What two therapies are available for treatment of a fractured tooth with pulp exposure? |
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Definition
| extraction or endodontic treatment (ie. root canal) |
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Term
| What should always been done on every fractured tooth? |
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Definition
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Term
| What is the difference between an uncomplicated and a complicated tooth fracture? |
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Definition
uncomplicated --> no pulp exposure
complicated ---> pulp exposure
***** do intra-oral rads on ALL fractured teeth regardless of pulp exposure |
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Term
| What is the etiology of tooth resorption? |
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Definition
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Term
| Where do resportive tooth lesions begin? |
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Definition
| lesions begin in the cementum and progress into the dentin and enamel of both the crown and the root |
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Term
| What is the clinical appearance of a tooth with supragingival resorptive defects? |
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Definition
| the resorptive lesions are associated with localized gingival enlargement of inflamed granulation tissue |
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Term
| What diagnostic test is required for proper identification and treatment of feline tooth resorption? |
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Definition
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Term
| What are the characteristics of the five stages of tooth resorption lesions? |
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Definition
TR1 -> mild hard tissue loss (cementum +/- enamel)
TR2 -> moderate hard tissue loss (dentin + cementum +/- enamel), does not extend into pulp cavity
TR3 -> deep hard tissue low (dentin + cementum +/- enamel), that does extend into the pulp cavity
TR4 -> extensive hard tissue loss, tooth has lost most of its integrity
TR5 -> hard tissue remnants are only visible on rads, complete gingival covering
TR3 |
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Term
| What are the types of tooth resorption lesions? |
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Definition
type 1 -> periodontal disease or apical periodontitis (endodontic disease) with normal root opacity
type 2 -> loss of lamina lucida with dentoalveolar ankylosis, root structure may no longer be discernable
type 3 -> one root is type 1 and one root is type 2 |
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Term
| Why is it important to determine the TYPE of tooth resorption lesion via intra-oral dental rads? |
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Definition
| type of lesion determines treatment options. All type 1 teeth must be extracted, type 2 teeth can be crown amputated |
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Term
| How can feline stomatitis be differentiated from periodontitis or gingivitis? |
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Definition
inflammation associated with feline stomatitis often extends beyond the gingival and mucogingival junction to involve the caudal pharynx, palatoglossal folds, palatal and buccal mucosa
while periodontitis and gingivitis only involve the gingiva and mucogingival junction
**** biopsy and histopathology is NOT useful in differentiating these conditions |
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Term
| What is the etiology of feline stomatitis? |
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Definition
immune dysregulation
*** pathogenesis is not completely elucidated but currently most popular theory is that plaque bacteria is the inciting cause. Viral shedding may contribute to increased patient morbidity |
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Term
| What is the recommended treatment for feline stomatitis? |
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Definition
full mouth extractions --> 60% have complete remission
*** professional periodontal cleanings and home dental care are NOT sufficient to control clinical inflammation and pain |
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Term
| If full mouth extractions do not completely resolve inflammation and pain associated with feline stomatitis what adjunctive medical therapies are available? |
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Definition
immunosuppression with cyclosporine or corticosteroids +/- SHORT TERM antimicrobial therapy
*** long term antibiotic monotherapy is NEVER indicated for ANY condition of the oral cavity |
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Term
| Why does being an obligate carnivore put cats at risk for developing pancreatitis? |
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Definition
Essentiality of dietary arginine
Low levels of hepatic ornithine
High dietary protein requirements
Lack of hepatic enzyme adaptation to low protein
Insufficiency of hepatic glutamate reducatase
Insufficiency of intestinal ornithine transcarbamylase
Differences in lipoprotein metabolism (HDLs)
Differences in orotic acid metabolism |
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Term
| What are some differences in clinical presentation of acute pancreatitis in dogs vs. cats? |
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Definition
dogs tend to present with the "classical" signs --> cranial abdominal pain, fever, vomiting, diarrhea
cats more commonly present with lethargy, anorexia, and hypothermia |
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Term
| What are some differences in laboratory findings in cats vs. dogs with pancreatitis? |
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Definition
cats: leukopenia + hypocalcemia (associated with a poorer prognosis)
dogs: leukocytosis + elevated serum lipase (ANP)
*** both tend to have anemia, elevated ALT, ALP, bili, glucose, and cholesterol |
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Term
| What are some differences in radiographic appearance of pancreatitis in dogs vs. cats? |
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Definition
dogs --> increased opacity in right cranial abdominal quadrant, left gastric displacement, right duoudenal displacement, gassy duoudenum and colon
cats --> hepatomegally and abdominal effusion |
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Term
| What is the ultrasonographic appearance of the pancreas with pancreatitis? |
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Definition
hypoechoic, enlarged or irregular
*** ultrasound is less sensitive in cats with pancreatitis than in dogs, same with survey abdominal rads |
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Term
| What therapies are indicated for the treatment of pancreatitis? |
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Definition
| eliminate any inciting agents if possible, short duration of NPO if sever vomiting (risk of aspiration), IV fluid therapy +/- plasma, analgesics and anti-emetics |
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Term
| What are some feline specific therapies for the treatment of pancreatitis? |
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Definition
if hypocalcemic --> supplement with calcium gluconate
H1/H2 antagonists and/or low dose dopamine (decrease microvascular permiability -> reduce risk of developing hemorrhagic necrosis)
broad spectrum ab (reduce effect of gut bacterial translocation)
surgical decompression of pancreaticobiliary duct (decreases ductal hypertension -> restores normal pancreatic blood flow and tissue pH) |
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Term
| What are the four major functions of the exocrine pancreas? |
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Definition
secretion of digestive zymogens (acinar cells) -> secreted into small intestine, trypsinogen activates trypsin, which then activates the other zymogens
secretion of anti-bacterial proteins (acinar cells) --> regulates small intestine microflora
secretes bicarbonate-rich fluid and H20 --> neutralizes stomach contents in the duodenum
secretes intrinsic factor --> facilitates vit B12 absorption in the distal ileum
**** dogs secrete intrinsic factor from both pancreas and the stomach, are not as reliably deficient in vit B12 as cats with exocrine pancreatic insufficiency |
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Term
| What three pathogenic mechanisms can lead to exocrine pancreatic insufficiency? |
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Definition
chronic pancreatitis (esp. cats)
atrophy (genetic in dogs esp. german shepherds, rare in cats)
neoplasia |
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Term
| How can you diagnose exocrine pancreatic insufficiency? |
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Definition
LOW serum TLI
ABSENT pancreatic specific lipase |
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Term
| How do you treat exocrine pancreatic insufficiency? |
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Definition
pancreatic enzyme replacement
GI acid suppression (HCL can degrade the pancreatic enzyme supplement)
supplement vit B12 and other fat soluble vitamins (A,D,E,K)
short term antibiotics with good anaerobe coverage (to suppress SI overgrowth)
diet (high digestibility, moderate fat to maintain caloric density, low fiber) |
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