Medical Nursing Week 3

• Mouth
• Teeth
• Salivary glands
• Esophagus
• Stomach
• Small and large  intestine
• Liver- bile
• Pancreas

• Digestion and Absorbtion
• Detoxification
• Protective Barrier
• Hydration

• Dysphagia- difficult swallowing
• vomiting
•     Digested material
• Regurgitation
•    Undigested material
• Diarrhea
• Icteric
•    Jaundice
•    Yellow discoloration
•     Liver
• Weight loss
• PU/PD

• Dysphagia- difficulty swallowing, dental disease
• Dyschezia- Difficult or painful defication
• Melena- Bloody Feces, black in color, Indicates upper GI Bleed
• Hematamesis- Blood in Vomit
• Bile- Vomiting yellow bile reflux due to an empty stomach
• Anorexia- not eating and emaciation
• Pyrexia- fever
• Borgorygmus- bowel sounds, gas
• Tenesmus- Straining in pain for defication or urination

• Blood Panel- Leukocytes, infections
• Pancreas- Elevated Amylase and Lipase
• Liver- Elevated Bilirubin, SGOT, SGPT, Alkaline Phosphate, GGT, bile acids
• Elevated PVC
• Maldigestion test
•     Trypsin- Like Immunoreactivity (TLI)
•      Folate and Cobalamine test
• Fecal- Parasites
•   Malabsorption- sudden strain
• Fat Droplets

SGOT:     Serum glutamic  oxaloacetic transaminase, an enzyme that is normally  present in liver and heart cells. SGOT is released into  blood when the liver or heart is damaged.

SGPT: Serum glutamic pyruvic transaminase, an enzyme that is normally present in liver and heart cells. SGPT is released into blood when the liver or heart are damaged

• Radiographs
•    Stomach shape
•        Obstruction (foreign body)
•        Neoplasia
• Upper GI- Barium Study
•     Used for foreign body or transit time
•      Intussusception- intestine going into intestine
• Endoscopy
•     Stomach, Duodenum and Colon
• Visualization for ulcers and neoplasia
• Tissue biopsy
•    Noninvasive
• Biopsy and cultures
• Ultrasound
•   Liver size and gall bladder
• Shunts
• Ultrasound guided biopsy
• Lymph nodes
•  Intussusception

• Vomiting
• Loss of appetite
• Salivating- Nausea
• Abdominal Pain
• Melena
• Polydyspsia

• Inflammation caused by continuous damage to gastric mucosa
• Infections
•      Parvo Virus
•      Distemper
•      Viral
•      Fungal
•     Bacterial
• Toxins
•     Ethylene glycol- antifreeze
•     lead
•    arsenic
•    Plants and fertilizer
• Foreign objects
•   Rocks
•   Balls
•   Plastic
•    String
• Drugs
•   NSAIDS
• Dietary indiscretion
• Hepatic
• Renal
• Neoplasia

• Radiographs
• Blood panel
• Viral Screens
• Endoscopy
• Barium Study

• Dietary
•    NPO for 8-12 hours
•    Bland diet if no vomiting in a 12-24 hour period
• Antibiotics
• Antiemetics
•    Reglan- metoclopramide
•    Cimetidine (Tagamet)
•    Ranitidine (Zantac)
• Protein Pump inhibitors
•    Most potent agent to decrease stomach secretions and acidity
•     Omeprazole (prilosec)
•            0.7 mg/kg PO SID
• Misoprostol
•    NSAID ulceration prevention
•     2-5 mg/kg PO TID

• hepatogastric
• hepatoduodenal

A disease of the kidney. Also called renopathy

swelling of the kidneys when urine flow is obstructed

• Distended abdomen
•   Gas filled (ping)
• Dry heaves and salivation
• Grunting
• Collapse
• Hypotension and shock
• Arrhythmias
•    Myocardial Ischemia

• Dogs and Cattle
• Diet in Cattle
•    No evidence in dogs
•    Running or playing after eating (postprandial exercise)
•    Cattle
•        High protein diet
•            gas production (alfalfa)
• Genetic Tendency
•    Deep chested dogs
•        Great danes, Rottweilers, Chows, Golden Retrievers, Akita, etc.
• Laxity of hepatogastric and hepatoduodenal ligament

• Radiographs
•    Bloat
•    Double bubble appearance
•    Gas distention
•     Spenomegaly
• EKG
•    arrhythmias
• Blood Panel
•    Acidosis
•     anemia

• Shock Treatment
•    Fluids
•    Corticosteroid
• Decompression
•    Stomach tube
•    Trocarization
• Surgery
•   Gastrology
•    Splenectomy
• Antibiotics
• Antiarrhythmics
•     Lidocaine
•     Procainamide
•     Mexiletine  (mexitil)
• Prokinetic Agents (Ileus)- enhances gastrointestinal movement
•     Reglan
•     Cisapride

• Lethargic
• Vomiting and diarrhea
• Anorexia
• Fever
• Icterus
• Seizures
•    Hepatic encephalopathy- brain disorder, seizures
•         Elevated Ammonia
• Lactulose- sythetic, non digestible sugar

• Infections
•    Bacterial
•     Viral
•     Fungal
• Autoimmune
• Neoplasia
• Idiopathic- unknown
• Chronic disease- failure
• Toxicity

• Blood panel
•    elevated liver enzymes
• Bile acids
• Radiographs
•    Neoplasia
• Ultrasound
•    Biopsy
•   

• Antibiotics
•     Amoxicillin
•     Cephalosporines
•     Metronidazole
• Nutritional support
•    PEG tube or nasal gastric tube
•    low protein diet and low fat (K/D)
•    B Vitamins
• Corticosteroid

• Vomiting and diarrhea
• Abdominal pain
• Fever and Anorexia

• Diet- pica (pattern of eating non-food materials)
•     High fat diet
•     Table scraps
• Liver Disease- pancreas
•    Inflammation to pancreas
• Infections
• Trauma
• Schnauzers- high fat
•    Due to idiopathic hyperlipidosis

• Blood Panel
•    elevated Amylase and Lipase
•    Leukocytes
• Radiographs
•     Hazy cranial abdomenal and peritonitis
• Ultrasound
•    Thick pancreas

• Fluid Therapy
• Antibiotic therapy
• NPO for 72 hours
• Antiemetics
•  Bland Diet
•     Low Fat- I/D

• Caused by loss of fluids
• Bloody vomit and diarrhea
• Fever
• Lethargic
• Dehydration

• Unknown
• Stress
• Diet Change
•  Possible clostridium
• Breeds
•   Primary in small dogs
•      Toy Poodles, Dachsunds, Etc.

• Blood Panel
•    Elevated PCV
•        50-80%
• Parvo Test
•    Negative results
• Radiographs
•      Normal

• Fluid Therapy
•    Treat dehydration and hemoconcentration
• Antibiotics
• Bland diet

• A group of gastrointestinal disease of stomach, small intestines and colon that are charactersitized by inflammatory cellular infiltrates in the lamina propria of these structures.
• Effects both dog and cats of any age or sex

• Abnormal mucosal immune response to certain causative factors and antigenic stimulation
•    Food Allergy
•    Dietary
•    Stress and behavioral
•    Heredity
•    Idiopathic

• Diarrhea
•   Chronic or acute
•   Continual or intermittent vomiting
• Vomiting
•   Chronic or acute
•   Continual or intermittent
• Anorexia and weight loss
• Tenesmus (or  feeling that you constantly need to pass stools) hematechezia

• Blood profile
•    High wbc count and low proteins as albumin
• Radiographs
• Fecal
• Endoscopey and tissue biopsy
•      Definitive test
• GI Blood Panel- canine or feline specific lipase

• Chronic long term treatment can control disease process, but cannot cure
• Each case may require different combinations of medication and diet control
• Control diet- bland diet as I/D or D/d
• Prednisolone 1-2 mg/kg BID, then taper after one month
• Aziothioprine 2mg/kg PO SID x 7 days, then q EOD
• Sulfasalazine 25-50 mg/kg m²
• Cyclophosphamide 50 mg/kg m2
• Amoxicillin 10-25 mg/kg PO BID
• Reglan- antiemetic
• Carafate- gastric ulcer
• Famotadine- H2 blocker
• Metronidazole- anaerobic bacteria and antiinflammatory
• Budesonide- local acting corticosteroid to GI tract

• Kidney
• Ureters
• Bladders
• Urethra
•    Penis
•    Vagina

• Filter and dispose Nitrogen waste
• Acid base regulation
• Chemical excretion
• Electrolyte, mineral, glucose and protein regulation

• PU/PD
• Vomiting and diarrhea
• Uremic breath
• Anorexia
• Incontinence
• Weight loss
• Urias
•     Oliguria
•     Hematuria
•     Anuria
•     Pollakiuria
•     Stranguria

• Anuria- Not urinating
• Stranguria- straining to urinate
• Oliguria- diminished urine production
• Pollakiuria- Frequent urination
• Hematuria- Bloody Urine
• Azotemia- High BUN and Creatanine
•                    Refers to renal disease
• Urolith (urolithiasis)
• Urinary calculi or stone
• Dysuria- Painful Urination

• Blood Panel
•    Azotemia
•    Hyperphosphatemia
• Urinalysis- UTI (Cystitis) Inflammation
• Radiographs- Contrast cystogram
•                      Stones
• Contrast cystogram
•          IVP
• Ultrasound
•    Prostate
•     Tumors
• Exploratory Surgery
•       Biopsy

• Pollakiuria
• Stranguria
• Hematuria
• Dysuria
• Febrile- feverish

• Infections
•    Bacterial
•    Viral
• Secondary pyelonephritis- kidney infection
• Bladder stones
• Urachal diverticulum

• Urinalysis 
•      Bacteria
•       Proteinuria
• Urine culture and sensitivity
• Radiographs and cystogram
•    Stone
•    Neoplasia
• Blood Panel
•    Kidney Disease

• Antibodies
•   7-14 days
•   May be needed 6-8 weeks

• Dysuria and Hematuria
• Stranguria
• Vomiting and Diarrhea
• Lethargic
• Not Eating

• Dietary
•  Infections
• Congenital (Anatomical)
•    Urachal diverticulum

• Urinalysis 
•     Cyrstals
• Radiographs
• Ultrasound
• Contrast cystogram and IVP
• Blood profiles

• Struvite
•   Magnesium Ammonium phosphate
•   Primate cats with FLUTD
•   Dissolve crystals in acid PH of Urine
•   C/D diet
• Calcium Oxylate
•   Most common urolith seen in dogs
•    S/D diet
• Urate
•   1.Dalmations- usually males with urethral obstruction
•   Due to incomplete oxidation of uric acid which forms urate crystals   Alkaline ph change to urine
• 2. Allopurinol- binds xanthine oxides to prevent uric acid production
• 15 mg/kg PO BID
• 3. U/D diet- Alkaline diet

• Antibiotics
• Dietary managment
•     C/D
•     Struvite (Alkaline
•     S/D
•     Calcium oxylate (Acidic)
•     U/D
•     Urate  (Acidic)
•   

• Cystotomy- surgical incision of the urinary bladder
• Nephrotomy- surgical procedure in which the kidney is cut

• Dysuria
• Hamaturia
• Pollakiuria
• Urinating
•   Abnormal areas
•   Frequent trips to the litter box
• Excessive licking of genitalia

• Diet
•   High in Magnesium and Ash
• Infections
• Alkaline PH urine
• Anatomical 
•     males
•       Due to penis anatomy

• Physical exam
•   Large painful and unexpressable bladder
•   Distended penis
•     Mucus plug
•     Blue discoloration
• Urinalysis
•    Struvite crystals
•         Triple phosphate
• Blood Panel
•    Azotemia
• Hyperkalemia
• Radiographs and Ultrasound
•     Double contrast cystogram

• Nonobstruction
•   Antibiotics
•    Diet management
•          C/D diet Acid PH urine dissolves crystals
• Propantheline
•   Anticholinergic
•   Reduces bladder spasms and urge and incontinance
•   7.5 mg/kg PO every 3rd day
• Phenoxybenzamine
•    Minimize reflex dysnergia
•    Urethral outflow problems

• Obstruction
• Urinary catheter
•     Retro pulse 0.9% NaCL
• Leave urinary catheter in for 2-4 days
•     Until hematuria has resolved
• Remove urinary catheter
•   Cat urinating well by itself
•    send home 24 hours later on antobiotics and C/D diet
• IV fluids
• Antibiotics
• E-collar
• Reccurring FLUTD
•   Surgery
•    Perineal urethromstomy (PU)

• P/U P/D
• Lethargic
•    Inactivity
•    Weakness
• Anorexia
• Weight loss
• Vomiting
• Oral Ulcerations
• Stomatitis
• Uremia
•     Retention of toxic waste materials
• Seizures and hypothermia
• Diarrhea

• Degenerative disease (aging)
• infections
• Neoplasia
• Congenital
•    Basenji nephropathy
•    Hydronephropathy
• Polycystic kidney
• Immune mediated
• Amyloidosis
•    Abyssinians and Shar Pei
• Toxicity
•   Ethylene glycol

• Blood Panel
•    Elevated BUN, Creatinine and phosphorus and anemia
• Urinalysis
• Specific gravity is <1.020
•     Isosthenuria or Hyposthenuria
• Radiographs
•    Evaluation of kidney size and shape
•    Nephrocalcinosis
•    Uroliths
• Ultrasound

• Fluid Therapy
•   Iv Fluids
•      Isotonic
•   SQ fluids
•      Cats
• Anemia
•    Erythropoietin
• Vomiting
•   H2 receptor antagonists
•        Cimetidine (Tagamet)
•        Ranitidine
•   Reglan
• Antibiotics
•     No Aminoglycosides
• Hyperphosphatemia
•        Amphogel (aluminum Hydroxide)
• Dietary Management
•    Low Protein
•       K/D