Term
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Definition
| Non-measurable info/observations. |
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Term
|
Definition
| Measurable specifics and facts |
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Term
|
Definition
clinical symptoms (not a diagnosis)
S + O, opinions |
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Term
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Definition
| Actions that will be taken, Dx,Rx, Tx, discharge instructions |
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Term
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Definition
| Name, Age, Sex, breed, reproductive status, ID number |
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Term
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Definition
Temp 101 - 102.5
Pulse 80-120 bpm
Respiration 20-40 bpm |
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Term
|
Definition
Temp 101-102.5
Pulse 160-180 bpm
Resp 20-40 bpm |
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Term
| Should normal observations be included in the SOAP? |
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Definition
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Term
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Definition
| The clinical condition that results from inadequate production and release of T3 and T4 from the thyroid gland, resulting in an overall decrease of cellular activity. |
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Term
| Why is hypothyroidism more common in spayed or neutered dogs? |
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Definition
| Estrogen/testosterone help regulate metabolism |
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Term
| Signalment for hypothyroid dogs |
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Definition
Middle aged (4-10 yrs)
Mostly S/N
Golden retriever, dachshund, miniature schnauzer, cocker spaniel |
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Term
| Most common reason for low thyroid hormone levels |
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Definition
| atrophy of the thyroid gland. cause unknown |
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Term
| why else might there be low thyroid hormone levels? |
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Definition
| autoimmune destruction of the thyroid gland, or iodine deficiency |
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Term
| What is T3 and T4, and how is T4 converted into T3? Where does this occur? |
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Definition
T4 = thyroxine, inactive
T3 = triiodothyronine, active
Activation is by removal of an iodine molecule from T4. This occurs inside the cell. |
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Term
| Where is T4 manufactured and stored? |
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Definition
|
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Term
| Why might there be an iodine deficiency? What classic symptom does it cause? |
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Definition
| young animals, dietary intake inadequate. it causes goiter |
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Term
| What serum chemistry value is used to diagnose thyroid conditions? |
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Definition
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Term
| When treating hypothyroidism, why is T4 used and not T3? |
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Definition
| Cells are allowed to decide when to take in T4 and increase metabolic rate. If T3 is given, the patient is overdosed because it automatically goes to the nucleus and causes an increase in metabolic activity, now causing hyperthyroid symptoms. |
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Term
| Explain to the owner why the animal is lethargic, gaining weight, and heat seeking. |
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Definition
| Abnormal nutrient utilization. Normally, Fat is burned while carbohydrates are spared and stored as glycogen. In this case, fat is being stored instead of burned (no thyroid hormone to mobilize it.) No fat burn = no heat produced. |
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Term
| Explain why there is muscle paralysis and hair loss. |
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Definition
| Normally, thyroid hormone allows cells to build and maintain body protein. Body protein includes muscle, skin, hair, and the nervous system. |
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Term
| Mental alertness and activity should return within ___ weeks after start of treatment. |
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Definition
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Term
| How fast do skin and hair regrow? |
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Definition
| Takes 1-4 months, may actually worsen in the first month of treatment |
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Term
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Definition
| weight loss and serum concentrations. |
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Term
| when should serum samples be drawn? why? |
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Definition
| 4-8 hours post administration (same amount of time after administration each time)This is important for accurate comparison, as serum concentrations rise and fall throughout the day |
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Term
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Definition
| Pathologic, sustained high metabolism due to high circulating concentrations of thyroid hormone |
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Term
| Signalment for hyperthyroid cats |
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Definition
| Middle aged to older cats (13 yrs.) No breed/sex predilection |
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Term
| Why are there high levels of circulating thyroid hormone? |
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Definition
Hypersecretion of thyroid hormone due to hyperfunctioning nodules of the thyroid gland.
In this case, the anterior pituitary and hypothalamus are not functioning in the normal negative feedback loop. The high levels of the hormone are NOT shutting off the production of TRH/TSH. |
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Term
| Hyperthyroidism occurs commonly in ___, and rarely in ___ and ____ |
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Definition
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Term
| name the symptoms caused by increased metabolic rate (4) |
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Definition
NOT heat seeking (abnormal for cats!)
Loss of muscle mass
Increased appetite
Weight loss |
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Term
| Normal thyroid hormone levels promote growth and maintenance of skin, hair, CNS, PNS, and muscle. Name the corresponding clinical symptoms seen with higher than normal thyroid levels. |
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Definition
Thick haircoat and nails
Agitated, hyperactive
Vomiting and diarrhea
Hypertrophic cardiomyopathy, tachycardia, increased force of contraction->
Hypertension -> PU, then PD and retinal detachment |
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Term
| Why are cats especially prone to loss of muscle mass? |
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Definition
| They are obligate carnivores, who get most of their energy from gluconeogenesis. |
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Term
| Diagnostic test for hyperthyroidism |
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Definition
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Term
| Why is concurrent renal disease only seen after the start of thyroid hormone therapy? |
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Definition
| decrease in BP decreases filtration of blood in the kidney, and BUN and creatinine levels in the blood are then allowed to rise |
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Term
| Name the three treatments for hyperthyroidism |
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Definition
1) Anti-thyroid drugs
2) Surgical excision
3) Radioactive iodine treatment |
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Term
| What anti-thyroid drug is used? What exactly does it do? |
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Definition
methimazole (tapazole.)
Blocks thyroid hormone synthesis. |
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Term
| Disadvantages of anti-thyroid drugs |
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Definition
inconvenient
Possibly stressful to owner and animal
expensive |
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Term
| How long does it take to reach normal T4 levels? |
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Definition
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Term
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Definition
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Term
| Before surgical excision of the thyroid, why is pretreatment with methimazole recommended? |
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Definition
| get vitals back to normal for anesthesia - hydration status, HR, BP, etc. |
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Term
| Possible post-op complications |
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Definition
| low blood calcium levels. recommend 3 day hospitalization to monitor blood calcium levels |
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Term
| With radioactive iodine treatment, why must methimazole treatment be stopped 2 weeks prior? |
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Definition
| So that the radioactive iodine is allowed to seek out and destroy the abnormal parts of the thyroid gland |
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Term
| radioactive iodine is given what route? |
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Definition
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Term
How long must the cat be hospitalized for?
How long will it eliminate radioactive waste? |
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Definition
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Term
| What might you tell the client when it goes home? |
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Definition
| restrict contact with humans and animals as much as possible, do not let outside, careful disposal of litterbox waste |
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Term
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Definition
| An endocrine disease caused by excess levels of glucocorticoids in the blood |
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Term
| average signalment for a cushing's patient |
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Definition
middle aged to older dogs or horses.
rarely seen in cats. |
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Term
| common breeds with cushing's |
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Definition
| poodles, beagles, dachshunds, miniature schnauzers, and boston terriers |
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Term
| Whether it is an anterior pituitary or adrenal gland tumor, which one causes the release of excess cortisol? |
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Definition
| adrenal gland - adrenal gland releases cortisol |
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Term
Name the cause for each of the following symptoms.
Pyoderma and UTI |
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Definition
| Excess cortisol alters the membranes of neutrophils, monocytes, and their lysosomes. Neutrophils and monocytes are less sticky, so they stay in the blood rather than moving into tissues. Lysosomal membranes are stabilized. These factors decrease the efficiency of immune response. |
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Term
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Definition
| Cortisol stimulates lipolysis and redistribution of fat to the abdomen. |
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Term
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Definition
| cortisol interferes with antidiuretic hormone, causing decreased recovery of water. Increased body water loss in the urine stimulates the thirst center. |
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Term
| Alopecia, thin skin, muscle loss |
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Definition
| Cortisol increases gluconeogenesis, which causes increased mobilization of amino acids from skin and skeletal muscle, and decreases the amino acids available to grow hair. |
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Term
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Definition
| cortisol stimulates the appetite center. |
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Term
Name the reason for each of the following diagnostics.
Leukocytosis, mature neutrophilia, and monocytosis |
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Definition
| Cortisol alters the cell membranes of neutrophils and monocytes, making them less sticky. they stay in the blood instead of moving into the tissues. |
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Term
|
Definition
| Cortisol stimulates lipolysis |
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Term
| Low urine specific gravity |
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Definition
| Cortisol interferes with ADH, causing decreased recovery of water by the kidney. More water is lost in the urine and it will be more dilute. |
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Term
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Definition
| cortisol increases gluconeogenesis |
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Term
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Definition
| Cortisol increases liver enzyme production |
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Term
| Which tests are aimed at answering the question: does this animal have cushing's disease? |
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Definition
Urine:Creatinine ratio
Low Dose Dexamethasone suppression test |
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Term
| Which test is aimed at determining whether the animal has an adrenal gland tumor or an anterior pituitary tumor? |
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Definition
| High Dose Dexamethasone Suppression Test |
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Term
| If it is a horse, what kind of tumor is it? |
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Definition
|
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Term
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Definition
Draw baseline blood sample
administer 0.01mg/kg dexamethasone
Draw second blood sample |
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Term
Name the results of an LDDS test for :
adrenal gland tumor
normal
anterior pituitary gland tumor |
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Definition
high levels of cortisol on first and second samples
Normal values, then low values
High values on first and second sample |
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Term
|
Definition
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Term
Results of HDDS for:
adrenal gland tumor
normal
anterior pituitary gland tumor |
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Definition
high levels on first and second sample
normal values, then low values
high values, then low values (decreased into normal range or cut in half) |
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Term
| What drug is used solely for an anterior pituitary tumor and why? |
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Definition
| Anipryl(L-deprenyl) - decreases ACTH output |
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Term
| Why won't anipryl work for an adrenal gland tumor? |
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Definition
| Excess cortisol levels in the blood will already be working to reduce the output of ACTH by the anterior pituitary. Lowering ACTH more will not do anything. |
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Term
| 3 drugs that work directly on the adrenal gland to reduce the release of cortisol |
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Definition
| Lysodren, trilostane, Ketaconazole |
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Term
Explain specifically how each of the following drugs work.
Lysodren |
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Definition
| causes progressive necrosis of glucocorticoid secreting areas of the adrenal gland. |
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Term
|
Definition
| decreases the production of cortisol. |
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Term
|
Definition
| suppresses release of cortisol |
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Term
| Patient monitoring for cushing's |
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Definition
| repeated disease specific tests to monitor therapy, monitor appetite closely, dispense prednisone, monitor very carefully with lysodren at first |
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Term
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Definition
| Hypoadrenocorticism. An endocrine disease resulting from the deficiency of glucocorticoids and/or mineralocorticoids. |
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Term
| signalment for addison's patient |
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Definition
dog, cat, horse
young to middle aged
In dogs, more likely a female
poodles, danes, rotts, westies |
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Term
The outermost zone of the adrenal cortex produces and secretes _____.
The middle zone produces and secretes ______. |
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Definition
mineralocorticoids (aldosterone)
Glucocorticoids (cortisol) |
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Term
| What controls aldosterone secretion? |
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Definition
| Angiotensin II, ultimately stimulated by osmoreceptors and baroreceptors in the kidney, stimulates the adrenal gland to secrete aldosterone. (nothing to do with anterior pituitary or hypothalamus.) |
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Term
Indicate whether the following increases or decreases with low aldosterone levels
sodium recovery
sodium in the blood
Potassium recovery
potassium in the blood
Water recovery
blood volume
blood pressure |
|
Definition
decreased
decreased
increased
increased
decreased
decreased
decreased |
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Term
| Clinical signs of aldosterone deficiency |
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Definition
| decreased blood pressure, decreased blood volume (dehydration,) polyuria, polydypsia, microcardia, bradycardia, weakness, trembling |
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Term
| What are the clinical signs of glucocorticoid deficiency? Why do these occur? |
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Definition
| Mental dullness, exercise intolerance. Decreased gluconeogenesis and glycogen mobilization |
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Term
| Test used to diagnose addison's disease |
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Definition
|
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Term
| steps of the ACTH stim test |
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Definition
baseline blood draw
administer ACTH
draw 2nd blood sample
cortisol levels are compared |
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Term
| positive and negative result of the ACTH stim test |
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Definition
positive = second sample will have the same values
negative = second sample should have higher values |
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Term
| What other diagnostic test is used? |
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Definition
Sodium:potassium ratio
should be more than 27:1 |
|
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Term
| how would you treat an acute addisonian crisis? |
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Definition
Rapid correction of hypovolemia using 0.9% NaCl.
IV infusion of glucocorticoids (dex.)
IV infusion of 50% dextrose.
Maintain body temperature
Monitor patient |
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Term
| why is dexamethasone used and not prednisolone? |
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Definition
| prednisolone would interfere with an ACTH stim test because it cross reacts with cortisol |
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Term
| Treatment of chronic or stabilized acute patient |
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Definition
replace glucocorticoids with oral daily prednisolone.
Replace mineralocorticoids with oral fluorinef daily and IM injections of DOCP or Percorten given monthly. |
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Term
|
Definition
serum electrolyte concentrations - tested regularly and adjusted as needed
Increase glucocorticoid replacement during periods of stress.
Carry glucose snacks and medications. |
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Term
|
Definition
| an endocrine disease that results in the inadequate production of insulin. |
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Term
| 1 in every ___dogs and 1 in every ___ cats will be diagnosed with DM. |
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Definition
|
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Term
|
Definition
middle aged, ~8 yrs
female dogs, male cats
intact females
obese |
|
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Term
| why are intact females more prone to diabetes and what is the treatment for them? |
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Definition
| The corpus luteum is maintained for 9 weeks whether the dog is pregnant or not. It secretes progesterone, which stimulates the production of glucose. Treatment is spay. |
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Term
| How is insulin an example of receptor mediated communication? |
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Definition
| Insulin is the key that allows glucose into the cell. Glucose enters the cell by facilitated diffusion. |
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Term
| Three types of cells that do not need insulin for glucose entry |
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Definition
| RBCs, lens of the eye, and the brain |
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Term
What are the reasons for the following symptoms:
lethargic and dull |
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Definition
| high glucose concentrations, freely enter the tissue with no insulin. brain is sedated |
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Term
|
Definition
| glucose freely enters the lens - glucose and metabolites draw water into the eye. cataracts are formed |
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Term
|
Definition
| glucose freely enters RBC and attaches to hemoglobin |
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Term
|
Definition
| glucose attaches to protein molecules circulating in the blood |
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Term
| Why are there high glucose concentrations in the blood? |
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Definition
|
|
Term
Reasons for the following symptoms
Polyphagia |
|
Definition
| No insulin - no glucose into cells - cells are starving - stimulates appetite center |
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Term
|
Definition
| no insulin - no glucose into cells - cells are starving - mobilize protein and fat |
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Term
|
Definition
|
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Term
| Polyuric/polydypsic (and possibly dehydration) |
|
Definition
| hyperglycemia - stimulates thirst center and exceeds renal threshold - water follows glucose out with the urine - increased body water loss - stimulates thirst center |
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|
Term
Reasons for the following diagnostics:
High blood glucose levels |
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Definition
| Hyperglycemia - due to glucose not entering the cells, more glucose being made by gluconeogenesis (cell's attempt to get glucose from protein) |
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Term
|
Definition
| increased fat mobilization - cells attempt to get glucose because they are starving! |
|
|
Term
|
Definition
| excess ketones produced by beta oxidation of fatty acids. (cells attempt to get glucose from fat) |
|
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Term
|
Definition
| Glucose in the blood exceeds renal threshold and ends up in the urine. Bacteria thrive on the high levels of glucose here |
|
|
Term
| what routes may insulin be given in? |
|
Definition
|
|
Term
| What type of injections are used for long-term therapy, and what type is used for immediate effects? |
|
Definition
SQ used for long-term
IV and IM for immediate |
|
|
Term
| Most common concentrations of insulin |
|
Definition
U-100 and U-40
(U-100 means 100 units of active insulin per ml) |
|
|
Term
| different sources of insulin |
|
Definition
| beef, pork, beef/pork, or human recombinant(synthetic) |
|
|
Term
| why is it important that the animal remain on the same type and species of insulin? |
|
Definition
| may have different effects - animal needs to be gradually switched and dosage adjusted as necessary |
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|
Term
| What determines the schedule of insulin shots/feeding times? |
|
Definition
| onset of action, peak action, and duration of action of the insulin |
|
|
Term
| the onset of action should occur at what point in the glucose curve? what about the peak action? |
|
Definition
onset = 1st significant drop of blood glucose
peak = lowest level of glucose |
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|
Term
| how to manage weight loss |
|
Definition
should not begin at the time of diagnosis or beginning of treatment.
Change diet slowly and gradually (every 2-3 weeks.)
Readjust insulin dosage as diet changes. |
|
|
Term
considerations for the rate of glucose absorption for:
canned food
high fiber foods
low carbohydrate, high protein for cats |
|
Definition
canned foods absorbed faster than dry
high fiber foods absorbed slower
slower glucose peak |
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Term
|
Definition
blood glucose curves
blood glucose checked (in-home monitors)
daily log of insulin given, site, food intake, water intake, and urination |
|
|
Term
| why would in home blood glucose monitoring be especially important for the cat? |
|
Definition
| stress causes hyperglycemia |
|
|
Term
|
Definition
| home monitor to clinic monitor, clinic monitor to machine |
|
|
Term
|
Definition
|
|
Term
|
Definition
can be used in conjunction with blood testing
time delay between blood glucose and urine gllucose
affected by how often the animal urinates - best to get first thing in the morning |
|
|
Term
| Why do we continue to test glycosylated hemoglobin and fructosamine? |
|
Definition
| Unlike serum proteins which have a short lifespan, fructosamine depicts the blood glucose environment for the past 2-3 weeks. GHb reflects the blood glucose environment for 60-90 days in the dog or 30-45 days in the cat, because of the RBC turnover time. |
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|
Term
| Occurrence of infection warrants ______ in insulin |
|
Definition
|
|
Term
| It is always better to be hyperglycemic than hypoglycemic. Therefore, when a patient is fasted for anesthesia.... |
|
Definition
| use only 50% of insulin dose |
|
|
Term
| Client education regarding time/money commitment |
|
Definition
lifelong monitoring and therapy
cost depends on size of the animal and severity of disease
all caretakers must be educated |
|
|
Term
| Client education regarding exercise |
|
Definition
Moderate, daily exercise recommended
maintain ideal BCS |
|
|
Term
| Why should insulin be given 15-20 min after a meal? |
|
Definition
| allow adjustment based on food intake, vomiting, etc. |
|
|
Term
| how should dose be adjusted if they vomit a little or don't eat as much? |
|
Definition
| reduce by 25%...have the client call if they aren't sure! better to be hyperglycemic than hypoglycemic! |
|
|
Term
| Top 5 causes of hypoglycemia in diabetic patients |
|
Definition
| not the right diet, vomited/didn't eat enough, insulin overdose, too little exercise, spontaneous remission in cats |
|
|
Term
|
Definition
insulin type and insulin syringe match.
gently roll to mix insulin
wipe top with alcohol
check for air bubbles |
|
|
Term
|
Definition
| pet and give a treat. give it in a different spot. warm the insulin in your hand first |
|
|
Term
| what the client can monitor for hypoglycemia |
|
Definition
| lethargy, weakness, trembling in hind limbs, acts drunk or confused, glassy-eyed, lip-smacking or licking in dogs, drooling in cats, aggressiveness, vocalizing in cats |
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