EDUCATION Education is learning what you didn’t even know you didn’t know. -Daniel J. Boorstin DISEASES OF THE PARATHYROID GLANDS HYPERPARATHYROIDISM HYPOPARATHYROIDISM Thyroid/Parathyroid glands 2 glands for each thyroid lobe 1=normal thyroid gland 2 and 3=parathyroid gland 4=enlarged thyroid gland Parathyroid gland • Secretion: Parathyroid hormone (PTH, Parathormone) • Function: ↑ plasma Ca2+ concentration – 1. ↑ osteoclast activity – 2. ↑ Ca++ absorption from GI tract – 3. ↑ Ca++ reabsorption from kidney tubules • Hyperparathyroidism → ________________ • Hypoparathyroidism → __________________ 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 Signalment: 7-11 yrs; Keeshoondren 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 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) Hyperparathyroidism Client Info 1. Most hyperparathyroid animals show no signs when first diagnosed 2. Run _____________ chem panels on all normal, older animals 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 Hypercalcemia • Tests – Elevated serum calcium levels – Low to low-normal phosphorus concentrations Hypercalcemia • Treatment – Fluids: 0.9% NaCl • No Ca2+ containing fluids – Diuretics (furosemide): dilute urine – Steroids • Complications – Irreversible renal failure – Soft tissue calcifications 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 http://www.thepetcenter.com/gen/eclampsia.html#The_video 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 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 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 LIFE ―Nobody can go back and start a new beginning, but anyone can start today and make a new ending.‖ -Maria Robinson DISEASES OF THE PANCREAS DIABETES MELLITUS (DM) INSULINOMA EXOCRINE PANCREATIC INSUFFICIENCY (EPI) 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 => ___________________ Pancreas Pancreas: beta cells 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 Insulin/Glucagon Balance Endocrine Pancreas • Hyperglycemia – Definition: Excessively high blood glucose levels • Normal in dogs: _________________ mg/dl • Normal in cats: __________________ mg/dl 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 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) 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 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 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 Diabetes Mellitus • Clinical Signs: – ____________________ – ____________________ – Weight loss (esp. cats) – Dehydration – Cataract formation-dogs – Plantigrade stance-cats Diabetes in Cats: Plantigrade posture Plantigrade posture Diabetic neuropathy Diabetes: Cataracts Increase in sugar (sorbitol) in lens causes an influx of water, which breaks down the lens fibers 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) 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 _______________ 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 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 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 DM Rx: INSULIN AND DIET!!! Table 1. Traditional insulin outline. Insulin types Concentration Duration/onset category Rapid acting Regular (Humulin R) U-100 (100 units/ml) (emergency) Intermediate acting NPH (Humulin N) U-100 Lente (Vetsulin® by U-40 (40 units/ml) Intervet) NO LONGER AVAILABLE* Long acting PZI (Idexx) U-40 Ultralente NO LONGER U-100 AVAILABLE* Glargine insulin analog U-100 Diabetes: Insulin therapy 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) 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 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. Diabetes Mellitus: Monitoring Find an ear vein Prick the ear to get Place drop of blood blood sample on green tip; readout in a few seconds Diabetes Rx: Urine glucose Diabetes monitoring: Urine glucose DM: monitoring 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 Endocrine Pancreas • Hypoglycemia – Definition: Low blood glucose levels – Causes • Neonatal and juvenile • Septicemia • Neoplasia • Starvation • Iatrogenic – insulin overdose • Portosystemic shunt • Many others Insulin Shock Causes: 1. Insulin overdose (____________ syringe) 2. Too much exercise 3. Anorexia Signs: Weakness, incoordination,_______________, coma 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 Insulinoma • CAUSE: ______________ of beta cells, secreting an excess of insulin • SIGNS: prolonged ______________________ →weakness, ataxia, muscle fasciculations, posterior paresis, brain damage, seizures, coma, death, 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 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 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 12-24 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 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 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 Testing and treatment for EPI • TLI (trypsin-like immunoreactivity) – Detects trypsin and trypsinogen – Usually want ____________________ in dogs to be diagnostic • Canine 5.7-45.2 • Feline 12-82 • Treatment includes enzymatic supplement – ___________________ powder (Amylase, protase, lipase) – Raw ox or pig pancreas Client considerations • Usually life long treatment. • Can be very expensive. • Can be well controlled. • Should not breed animal that has EPI.
Pages to are hidden for
"Thyroid replacement hormone levothyroxine sodium"Please download to view full document