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EDUCATION Education is learning what you didn’t even know you didn’t know. - Daniel J. Boorstin.

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Presentation on theme: "EDUCATION Education is learning what you didn’t even know you didn’t know. - Daniel J. Boorstin."— Presentation transcript:

1 EDUCATION Education is learning what you didn’t even know you didn’t know. - Daniel J. Boorstin

2 DISEASES OF THE PARATHYROID GLANDS HYPERPARATHYROIDISM HYPOPARATHYROIDISM

3 Thyroid/Parathyroid glands 1=normal thyroid gland 2 and 3=parathyroid gland 4=enlarged thyroid gland 2 glands for each thyroid lobe 2 glands for each thyroid lobe

4

5 Parathyroid gland Secretion: Parathyroid hormone (PTH, Parathormone) Function: ↑ plasma Ca 2+ concentration – 1. ↑ osteoclast activity – 2. ↑ Ca++ absorption from GI tract – 3. ↑ Ca++ reabsorption from kidney tubules Hyperparathyroidism → ________________ Hypoparathyroidism → __________________

6 Hyperparathyroidism Causes: – 1º hyperparathyroidism— ___________________________ – 2º hyperparathyroidism—poor diet; low Ca intake Clinical signs: – Many animals show __________________________ – signs occur as organ dysfunction occurs urinary/renal calculi (high plasma Ca++) cardiac arrhythmias, tremors (Ca++ necessary for normal muscle contraction) Anorexia, vomiting, constipation weakness

7 Signalment: 7-11 yrs; Keeshoondren

8 Hyperparathyroidism Dx: Routine chemistry panel – ↑ blood Calcium (normal: ~ _____________ mg/dl)) – +/- ↓ blood Phosphorus (normal: ~2-6 mg/dl) PTH assay – normal PTH: dogs ~20 pg/ml, cats ~17 pg/ml – In a normal animal: if blood Ca ++ is high, PTH is low (neg feedback) – 1º Hyperparathyroidism: ______________________________ Ultrasound of neck – enlarged glands, abdomen - uroliths Dff: neoplasia (LSA), Addison’s, rodenticide toxicosis, ARF

9 Hyperparathyroidism Tx: 1. _________________________ of diseased parathyroid (generally 4 lobes are imbedded in thyroid gland) Other options: 2. Ultrasound-guided chemical (ethanol) 3. Ultrasound-guided heat (laser) ablation Post-Op Care: 1. Hospitalize for 1 wk; ↓PTH may predispose animal to hypocalcemia 2. _____________________ (oral tabs, liquid) 3. Vit D supplements (promotes Ca intestinal absorption)

10 Hyperparathyroidism Client Info 1.Most hyperparathyroid animals show no signs when first diagnosed 2.Run _____________ chem panels on all normal, older animals

11 Hypercalcemia: Other causes Causes – Neoplasia (lymphoma, perianal gland tumors) – Renal failure – Hypoadenocorticism – Vitamin D rodenticide – Drugs or artifacts (ex lipemia) Clinical signs vary with cause – PU/PD, anorexia, lethargy, vomiting, weakness, stupor/coma (severe), uroliths

12 Hypercalcemia Tests – Elevated serum calcium levels – Low to low-normal phosphorus concentrations

13 Hypercalcemia Treatment – Fluids: 0.9% NaCl No Ca 2+ containing fluids – Diuretics (furosemide): dilute urine – Steroids Complications – Irreversible renal failure – Soft tissue calcifications

14 Hypocalcemia Causes: 1.Parathyroid disease a.Inadvertent removal of ____________________ during thyroidectomy (most common cause b.1º Hypoparathyroidism (uncommon in animals) 2.Chronic renal failure— a.may cause ↑ serum P, which can result in ↓ serum Ca (Ca:P __________________) b.Vit D normally activated in kidney c.Protein-losing nephropathy results in loss of albumin-bound Ca 3.Puerperal Tetany (Eclampsia)—late gestation thru post-partum period a.Improper prenatal ______________________________________ b.Heavy lactation c.Inappropriate Ca ++ supplementation d.Post-partum and late gestaion

15 Hypocalcemia Clinical Signs: 1.Restlessness, muscle tremors, tonic-clonic contractions, seizures 2.______________________ with excitement; __________________ in severe cases (Ca ++ is necessary for proper muscle contractions) 3.Hyperthermia 4.Stiffness, ataxic

16 Hypocalcemia Dx: Total serum < ______________ mg/dl Tx: 1.IV infusion of _______________________ solution (monitor HR and rhythm during infusion) 2.___________________ (IV) to control seizures 3.Oral supplements of Ca (tabs, caps, syrup) 4.Improve nutrition

17 Hypocalcemia Client info: 1.Well-balanced diet; increase volume as pregnancy progresses 2.Signs in pregnant animal is _____________; call vet immediately 3.May recur with subsequent pregnancies 4.Early weaning is recommended

18 LIFE “Nobody can go back and start a new beginning, but anyone can start today and make a new ending.” -Maria Robinson

19 DISEASES OF THE PANCREAS DIABETES MELLITUS (DM) INSULINOMA EXOCRINE PANCREATIC INSUFFICIENCY (EPI)

20 Review of pancreas functions Long flat organ near _________________ and stomach Exocrine function (the majority of the pancreas): – ________________ enzymes Endocrine function – islets of Langerhans – Alpha cells => _______________ – Beta cells => ___________________ – Delta cells => ___________________

21 Pancreas

22 Pancreas: beta cells

23 Review Insulin – Moves glucose into ___________ to be used for energy (glycolysis) – _______________ blood glucose Glucagon – _________________ blood glucose Stimulates liver to release glucose Stimulates gluconeogenesis – Other hormones from other glands perform similar functions (hyperglycemic effect) Growth hormone Glucocorticoids

24 Insulin/Glucagon Balance

25 Endocrine Pancreas Hyperglycemia – Definition: Excessively high blood glucose levels Normal in dogs: _________________ mg/dl Normal in cats: __________________ mg/dl

26 Diabetes Mellitus Definition: Disorder of carbohydrate, fat and protein metabolism caused by an absolute or relative ___________ deficiency Type I – Insulin Dependent DM – very low or absent insulin secretory ability Type II – Non insulin dependent DM (insulin insensitivity) – inadequate or delayed insulin secretion relative to the needs of the patient

27 Diabetes mellitus Incidence: Dogs: ~100% Type I (Insulin dependent) Cats: ~ 50% Type I and 50% Type II -non-insulin dependent cats can sometimes be managed with diet and drug therapy Causes: Chronic pancreatitis _______________________________ -beta cell destruction Predisposing/risk factors: Cushing’s Disease Acromegaly Obesity Genetic predisposition Drugs (steroids)

28 Diabetes mellitus Age/sex: – Dogs: 4-14 yrs, females 2x more likely to be affected – Cats: all ages, but 75% are 8-13yrs, neutered males most affected Breeds: Poodles, Schnauzers, Keeshonds, Cairn Terriers, Dachshunds, Cockers, Beagles

29 DM Pathophysiology – Insulin deficiency => impaired ability to use glucose from ______________, __________________ and _______________ – Impaired glucose utilization + gluconeogenesis => hyperglycemia – Clinical signs develop when: Exceeds capacity of renal tubular cells to reabsorb Dogs – BG > ________________ mg/dl Cats - BG > __________________mg/dl – Glycosuria develops Osmotic diuresis Polyuria/polydipsia

30 DM SYSTEMS AFFECTED: – Endocrine/metabolic: electrolyte depletion and metabolic _________________ – Hepatic: liver failure 2° to hepatic lipidosis (mobilization of free fatty acids to liver leads to hepatic lipidosis and ketogenesis) – Ophthalmic: __________ (dogs) from glaucoma – Renal/urologic: UTI, osmotic diuresis – Nervous: peripheral neuropathy in cats – Musculoskeletal: Compensatory weight loss

31 Diabetes Mellitus Clinical Signs: – ____________________ – Weight loss (esp. cats) – Dehydration – Cataract formation-dogs – Plantigrade stance-cats

32 Plantigrade posture Diabetic neuropathy Diabetes in Cats: Plantigrade posture

33 Diabetes: Cataracts Increase in sugar (sorbitol) in lens causes an influx of water, which breaks down the lens fibers

34 Diabetic Ketoacidosis 2 metabolic crises: ↑ lipolysis in adipose tissue → fatty acids →ketone bodies →ketoacidosis →coma (insulin normally _________________ lipolysis) ↑ hepatic gluconeogenesis (in spite of high plasma glucose levels) (insulin normally ____________________ gluconeogenesis)

35 Diabetic Ketoacidosis Definition: True medical _______________ secondary to absolute or relative insulin deficiency causing hyperglycemia, ketonemia, metabolic acidosis, dehydration and electrolyte depletion DM causes increased lipolysis => _________ production and _______________

36 Diabetic Ketoacidosis Diagnosed with ketones in urine or ketones in blood – Can use urine dip stick with serum. Clinical Signs – All of the DM signs – Depression – Weakness – Tachypnea – Vomiting – Odor of acetone on breath

37 Diabetic Ketoacidosis IV fluids to rehydrate 0.9% NaCl – K (potassium) supplement Regular insulin to slowly decrease BG Monitor BG q 2-3 hrs When BG close to normal and patient stable switch to longer acting insulin

38 DM DIAGNOSIS: – CBC: normal – Biochemistry panel: Glucose > ________mg/dl (dogs), > _____________ (cats) – UA ____________________!!!! ______________________ USG – low – Electrolytes may be low due to osmotic diuresis – Blood gases (if ketoacidotic) – Fructosamine levels – mean glucose level for last 2-3 weeks (dogs) Ideal to test for regulation checks

39 DM Rx: INSULIN AND DIET!!! Table 1. Traditional insulin outline. Duration/onset category Insulin typesConcentration Rapid acting (emergency) Regular (Humulin R)U-100 (100 units/ml) Intermediate actingNPH (Humulin N)U-100 Lente (Vetsulin® by Intervet) NO LONGER AVAILABLE* U-40 (40 units/ml) Long actingPZI (Idexx)U-40 Ultralente NO LONGER AVAILABLE* U-100 Glargine insulin analogU-100

40 Diabetes: Insulin therapy

41 DM: Insulin therapy INSULIN – Beef-origin insulin is biologically similar to cat insulin – Porcine-origin insulin is biologically similar to dog insulin – Dogs and cats have responded well to human insulin products INSULIN ADMINISTRATION: – ALWAYS USE THE ______________________ INSULIN SYRINGE! (U-40 vs. U-100) Insulin is given in units (insulin syringes are labeled in units, not mL)

42 DM: dietary management DIET – DOGS: high _____________-, complex carbohydrate diets Slows digestion, reduces the post-prandial glucose spike, promotes weight loss, reduces risk of pancreatitis Hill’s R/D or W/D – CATS: high _______________, low carbohydrate diets Cats use protein as their primary source of energy – blood glucose is maintained primarily through liver metabolism of fats and proteins Purina DM, Hill’s M/D Often a diet change in cats can dramatically reduce or eliminate the need for insulin – This is particularly true for type II

43 DM Oral hypoglycemics (cats NIDDM) o Sulfonylureas – Glipizide o Direct stimulation of insulin secretion from the pancreas o Alpha-Glucosidase Inhibitors – Acarbose (dogs) o Delays digestion of complex carbohydrates and delays absorption of glucose from the intestinal tract.

44 Diabetes Mellitus: Monitoring Find an ear veinPrick the ear to get Place drop of blood blood sampleon green tip; readout in a few seconds

45 Diabetes Rx: Urine glucose

46 Diabetes monitoring: Urine glucose

47 DM: monitoring

48 DM Client Education – ______________________ insulin replacement therapy – Insulin administered by _______________________________ – _____________________ insulin, mix _____________ (no bubbles), single use syringes – Cataracts common, permanent – Consistent diet and exercise – Recheck BG or curve regularly or fructosamine levels – Progressive – If animal _________________- NO INSULIN

49 Endocrine Pancreas Hypoglycemia – Definition: Low blood glucose levels – Causes Neonatal and juvenile Septicemia Neoplasia Starvation Iatrogenic – insulin overdose Portosystemic shunt Many others

50 Insulin Shock Causes: 1.Insulin overdose (____________ syringe) 2.Too much exercise 3.Anorexia Signs: Weakness, incoordination,_______________, coma

51 Insulin Shock Prevention 1.________________ diet (type and amount)/consistent exercise (less insulin with exercise) 2.Monitor urine/blood glucose at same time each day 3.Feed 1/3 with insulin; the rest 8-10 h later (at insulin peak) 4.Have sugar supply handy

52 Insulinoma CAUSE: ______________ of beta cells, secreting an excess of insulin SIGNS: prolonged ______________________ →weakness, ataxia, muscle fasciculations, posterior paresis, brain damage, seizures, coma, death,

53 Insulinoma: Dx Chem Panel – ↓blood glucose – Simultaneous glucose and insulin tests ____________ glucose, __________________ insulin => insulinoma Observations – Symptoms occur after _______________ or _________________ – when symptomatic, blood glucose< ______________ mg/dl – symptoms corrected with sugar administration

54 Insulinoma: Rx Surgical Rx: removal of tumor Medical Rx: Acute, at home: administer glucose (Karo); keep animal quiet, seek vet care Acute, in Hosp adm. glucose (50% Dextrose) Chronic care feed 3-6 small meals/day (high protein, low fat) limited exercise glucocorticooid therapy (antagonizes insulin effect at cellular level) Diazoxide (↓insulin secretion, tissue use of glucose, ↑blood glucose) Octreotide (Sandostatin) injections—inhibits synthesis and release of insulin by both normal and neoplastic beta cells

55 Insulinoma: Client info 1. Usually, by the time insulinoma is diagnosed, metastasis has occurred so prognosis is ______________________ 2. With proper medical therapy, survival may be mo 3. Always limit _____________ and _________________ 4. Feed __________, ________________meals throughout day; keep sugar source close during exercise 5. _________________________ on mm provides for rapid absorption of glucose into blood stream 6. Avoid placing hand into dog’s mouth during seizure to avoid being bitten

56 Exocrine Pancreas Insufficiency (EPI) Inability to process nutrients efficiently due to ____________ of production of enzymes from pancreas. – Pancreatic acinar atrophy Found most commonly in German Shepherds and Rough Collies through a recessive gene. – In cats, EPI is primarily the result of chronic pancreatitis

57 Diagnosis of EPI Not usually evident until ____________ % of pancreas is unable to secrete enzymes. – _________________ although no change in diet or appetite (appetite often increases) – Persistent tarry diarrhea. – Flatulence – Poor haircoat

58 Testing and treatment for EPI TLI (trypsin-like immunoreactivity) – Detects trypsin and trypsinogen – Usually want ____________________ in dogs to be diagnostic Canine Feline Treatment includes enzymatic supplement – ___________________ powder (Amylase, protase, lipase) – Raw ox or pig pancreas

59 Client considerations Usually life long treatment. Can be very expensive. Can be well controlled. Should not breed animal that has EPI.


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