VMED 152 LE1 - Classifications of Pyrexia

o Acute inflammatory process

Problem Oriented Approach of Diagnosis
o FUO (fever of unknown origin)
3 methods to arrive at a diagnosis
▪ Obscure, unexplained fevers
- Systems based
• Due to chronic inflammatory process
- Species based
- Mixture of both • History of medication
Limiting factor: these methods arrive at diagnosis by pattern recognition ▪ Diagnosis
• Medical history, geography & history of travel
Methods • PE and routine laboratory test
1. Pattern recognition ▪ Clinical signs
Looking at the pattern of clinical signs • Lethargy, depression, shivering, appetite loss, vomiting,
Most useful in diseases with: coughing, nasal discharge
- Typical presentation ▪ Common causes:
- Unique pattern • Infection
- Few diagnostic possibilities ▪ Dogs: Fungal infections, Rickettsial infections, bacterial
- Extensive vet experience infections
2. Fishing expedition (Relying on blood work) ▪ Cats: Viral infections
Blood test has been very useful tool in diagnosis • Immune mediated (diseases & vaccination)
Understand clinical conditions
• Neoplasia
Results may not confirm with diagnosis
• Toxins
3. Problem oriented approach (POA)
▪ Diagnosis
Logical and pathophysiologically sound approach to diagnosis and
• Thorough medical history
management
• Complete physical exam
- What is the problem(s)?
o Look for the obvious
- Construct a problem list
- Identify the problems and prioritize o Done systemically
- Identify what system is involved • Laboratory tests
- Identify the location o Test should be safe, simple, inexpensive & easily
- Identify the lesion interpreted
- Think pathophysiologically o Minimize overlooking any rule outs
• Plan
Polysystemic problems o Should evolve as results are available
- Affecting or relating to more than one system o Easily understood and higher compliance rate
Pyrexia (Fever) Treatment
- Appetite loss - Swelling - Paresis - Paracetamol (acetaminophen) 10mg/kg BID PO
- Obesity - Anemia - Vomiting o Hepatotoxic and highly toxic if given at high dose
- Bleeding - Weakness o CS: vomiting, seizures, incoordination and discoloration
- Pathologic increase in the body temperature o Antidote: acetylcysteine
- Disruption in the regulation of body temperature o CI: Cats
- Temperature control mechanism - Ibuprofen: 5-8 mg/kg q12h
o Too cold → temp increasing mechanisms → peripheral o Nephrotoxic with a very narrow margin of safety
vasoconstriction, piloerection, increased muscle activity o CI: cats; animals with existing kidney dysfunction
(sympathetic stimulation) - Aspirin: 10-20 mg/kg q12h
o Too hot → temp decreasing mechanisms → peripheral o Damages the cartilages & joints; blood thinner
vasodilation, panting, decreased muscle activity (parasympathetic o CI: cats; animals with existing bleeding disorder
stimulation) - Cool, sponge bath
- Regulation of body temperature o Applicable if temp is lower than 40 C
o Heat loss: conduction/convection, radiation, evaporation - Stay hydrated
o Heat production: food processing, catecholamines & sympathetic o Small amounts of water on a regular basis
stimulation, extra rate of metabolism, metabolism & increased o Fluid therapy
chemical activity of cells - Treatment of the underlying cause
- Types of fever: - Apply alcohol at the paws
o Intermittent: interval where temperature is elevated for several Pug
hours followed by an interval when temperature drops back to - Problem in thermoregulation
normal - Brachycephalic airway syndrome
o Remittent: temperature does not touch the baseline and remains o 4 conditions that contribute to BAS: brachycephalic breeds,
above normal and fluctuates more than 1 ˚C within 24 hours elongated soft palate, stenotic nares, everted laryngeal saccule
o Septic: due to infection - Exposure keratopathy syndrome
o Relapsing: recurring - Prolapse of nictitans glans
o Hyperpyrexia: more than 41.0, seen in heat stroke - Legg-Calves Perthes syndrome: disruption of blood flow to the head
- Pyrogens of the femur → osteonecrosis/avascular necrosis
o Protein & protein breakdown products Pyrexia
o Lipopolysaccharide toxins Pros Cons
▪ Pyrogenic disease → hypothalamic sensors → resets the set Still uncertain
point (increasing) → activates temp raising mechanism → Permanent intracellular changes
Response to disease & infection
Cell membrane instability
promotes heat conservation and increases heat production ▪ Inhibit growth
▪ Organ dysfunction
▪ Pyrogens → phagocytosis (leukocyte, macrophage, (microorganism)
▪ Brain damage (prolonged
lymphocyte) → releases interleukin 1 → leukocyte ▪ Increases antibody activity
increased temp)
pyrogen/endogenous pyrogen → hypothalamus → ▪ Slow down the growth of
prostaglandin → elevate temp set point → temp raising some tumors
mechanism → vasoconstriction → shivering
Disturbances of food intake - Clinical signs:
- First signs observed when an animal is ill o Gradual wasting, despite voracious appetite
- Good appetite = good health o Frequent defecation
- Not definitive of a specific disease/condition ▪ Greasy, voluminous, yellowish to grayish stool
▪ Intermittent diarrhea
Hunger: need
- Treatment
Satiety
o Enzymes
Appetite: want
▪ Pancreatin (1tbsp/cup dry food, 3/4tbsp/cup wet food)
Hypothalamus: Hunger center at the lateral area ▪ Room temp
Satiety center ventromedial area o Diet
▪ Low fiber diet; highly digestible diet
Food intake regulation
▪ Feed 150%
- Nutritional regulation
▪ Do not restrict fat (if you have enzymes)
o Glucose & Amino acids
▪ Smaller more frequent meals
o Fat metabolites
- Alimentary regulation Pica
o Short term physiologic stimuli Consumption of non-food items
o “busog pa” Develops into a compulsive behavior
- Cephalic regulation May indicate: nutritional imbalance or boredom
o Commonly seen in ruminants (regurgitation) Causes:
Anorexia - Normal behavior or curiosity
- Primary Anorexia - Compulsive disorder
o Direct result of a disease process - Grass and soil eating
o Common in humans
o Psychologic disorder Coprophagy
- Secondary Anorexia Eating or ingesting of feces
o Occurs outside the brain Presence of undigested articles of food in the feces
o Major cause of anorexia in animals Common in mothers with newborn
o Commonly associated with nausea and vomiting
o Causes Diagnostic plan
▪ Pain Identify the underlying cause
▪ Endocrine disorders Thorough physical examination
▪ Intra-abdominal disorders Systematic
▪ Neoplasm Abdominal palpation
▪ Toxins Laboratory test
▪ Miscellaneous causes (change of diet, malnutrition, stress)
- Pseudo-Anorexia Treatment
o Inability to ingest food - Antibiotics: Metronidazole, amoxicillin, oxytetracycline
o Frequently painful (refusal to eat) - Probiotics
o Mass, tumor of tongue, fracture of mandible, epulis - Vitamin B
o Conditions that only hinder animal from ingestion. Animal has
appetite. Management
- Provide appropriate things for food, chew and play
Polyphagia: Consumption in excess of normal estimated food
o Interactive play (behavior)
Usually owner induced
- Provide better quality feed
Physiologic - Exercise
Pathologic o Physical
Psychologic: Common in humans o Mental
- Monitor and verbal discouragement/encouragement
- Primary
- Conditions that destroy/disrupt satiety center in the hypothalamus
- Neoplasia, trauma, infection
- Rare
- Feeding habits, genetics → overfeeding → obesity
- Secondary
- Increased metabolic rate
o Hyperthyroidism
o Low ambient temperature
- Catabolic disorders
o Hyperadrenocorticism
o Diabetes mellitus
o EPI (exocrine pancreatic insufficiency)
o Malabsorption syndrome
o Hypoglycemia
o Low calorie diet
- Drug induced
o GCC
o Anticonvulsants
EPI (exocrine pancreatic insufficiency)
- Inability to secrete the enzyme necessary for digestion (amylase,
lipase, trypsin & proteases)
- Trypsinogen → trypsin → trypsinogen 65
Common Canine & Feline Behavior
It is neither inherited nor acquired
Developed under combined influences of hereditary and environment
- Investigative: sense of smell
- Allelomimetic: tendency to mimic other animals, related to learning
- Epimeletic: Aka giving care or attention
Highly developed in dams feeding their pups
Aka nursing and regurgitation of food to feed their young
Regurgitation: passive act, partially digested/undigested
Vomiting: active act, partially digested/fully digested with acid
& bile
- Et epimeletic: attention seeking behavior in pups or dogs
Ability to establish close bond of relationship with a dog
Observable signs include: whining, yelping, tail wagging,
licking, touching with paws
- Eliminative: subordination, aggression due to territoriality
- Conflict or agonistic: happens when both animals show aggressive
behavior
- Ingestive: tendency towards rapid ingestion of food
Also, the ability to go without food and water for longer periods
of time
Signs: Lapping, tail out and down
Chewing and swallowing
Gnawing and holding food or treats with paws
Grass eating
Sucking
Continuous regurgitation → megaesophagus
Control: Smaller frequent meals
Specialized bowls that prevent from ingesting too fast
Remove possible competitor
- Pica: ingestion of non-food items
- Contactual: Maintaining of body contact with other animals
Usually seen in puppies
Signs: cuddling
Of praise and punishments…
- Majority of canine training is conducted using the principle of “praise
& punishment”
- A “praise” is also known as positive reinforcement
- A “punishment” is a negative reinforcement
Remember…
- Socialization produces a well-balanced and well-adjusted dog
- Dogs, like humans are individually different
- One method of training may work for a dog, but may fail for another
Ataxia, Seizure, Head Tilt & Otoacariasis
Causes
Ataxia: Sensory dysfunction that leads to incoordination of the limbs,
Ear injury/trauma
head and/or trunk
- Inflammation of the ear canal
Three types:
Brain disease
- Sensory (Proprioceptive): eyes; due to the slow compression of the
- Atrophy of vestibule
spinal cord
Metabolic disease
o Misplacement of the limbs and progressive weakness
Neoplasia
o Common in dachshund (original name: teckel hund)
Nutritional deficiencies
o Overweight → pressure in spine - Vit E deficiency
o Needle tests to isolate which region of spine is affected - Vit b complex deficiency
- Vestibular: ears; CN VIII (vestibulocochlear) - Anemia
o Changes in the head and neck position (head tilt) - Hypoglycemia
▪ False movement and deafness Toxicity
▪ Leaning, tipping, falling, rolling over - Lead poisoning
o 2 forms: - Avermectin poisoning
▪ Central (drowsiness, stupor, coma) Upper respiratory tract infection
▪ Peripheral
- Inflammation including respiratory tract → pushes/pressures CN VIII
o Diagnosis: Check ears: otoscope → inflammation
▪ Visualize inflammation in ear canal Otoacariosis: Otodectic mange (Otodectis cyanotis)
▪ Distinct otitis smell Inhabits the ear canal
- Cerebellar: brain; uncoordinated motor activity of the limbs and neck Clinical Signs: - Discomfort & intense itching
o Large steps, odd steps, head and body tremors, swaying of torso - Development of otitis externa
o Rabies, distemper, mass/tumors, Toxoplasma gondii o Vertical & horizontal canal erythema
General Clinical Signs - Presence of dark brown, ceruminous otic exudate
- Weakness of the limbs - Stumbling, falling Diagnosis: Age: younger → probability is lower, except for epilepsy
- Tilting of the head - Drowsiness, stupor Breed: Spaniel, GSD, Collie
- Hearing deficiency/deafness - Behavior changes Environment: malnutrition, stressors
- Appetite loss Vaccination
Description of ataxia, seizure or head tilt
Causes History of trauma: recent/past
Cerebellar - Abiotrophy (degeneration) Medical history & PE
- Congenital underdevelopment (panleukopenia) Exposure to other dogs
- Toxicity & poisoning Lab test - Complete hematology
Vestibular - Inflammation o Bacterial: higher WBC count
- Infection o Viral: lower WBC count
- Trauma - Serum chemistry & electrolyte panels
Spinal cord - Degeneration o Elevation in Calcium
- Trauma - Urinalysis
- Mass - ECG
Metabolic - Anemia Imaging: Radiography → trauma; CT scan, MRI
- Electrolyte imbalance CSF analysis
Seizures: Disturbance of the brain function - Sedate except for depressed patient
Sudden, uncontrolled discharge of neurons - Clear → any discoloration means inflammation
Primary vs Secondary - Insert needle between atlas and axis
Causes: Trauma, exposure to toxins, tumors, genetic abnormality/breed Biopsy
predisposition, hematolymphatic issues, idiopathic Otoscopy: direct or video
Phases Microscopy (Light microscopy/Stereomicroscope)
- Pre-ictal: altered behavior, restlessness, apprehensive, attention Treatment: SSS (specific, symptomatic, supportive)
seeking, salivating Ataxia
- Ictus: seizure episode, may or may not lose consciousness, change - Always specific/extent of the condition
in mental awareness Seizures
o Status epilepticus: continual seizure activity - more than 1 in a month
- Post-ictal: returns to normal confused, restless state, maybe ataxic, - more occurrence of cluster seizures
blind - Prolonged & severe grand mal seizures
- Classifications of seizures For head tilt
o Partial: low blood glucose levels - Etiology
o Generalized
Anticonvulsant drugs: give at higher dose → prevents resistance
▪ Petit mal: smaller, short lived seizures including the whole body
Phenobarbital 2 – 3 mg/kg PO
▪ Grand mal: spastic and erratic of whole body
Bromide 120 mg/kg (90 mg/kg as loading dose; 20 - 30 mg/kg
• Tonic: rigid, unable to move
as maintenance) for 5 days taper to 24 mg/kg per day (PO)
• Clonic: jerking movement Diazepam 0.1 – 0.4 mg/kg (intrarectal)
o Focal: generalized: seldom encountered
Oxygen therapy
Head tilt: Most common indication of imbalance Calcium gluconate: tonic spasms, unable to move/stiff, milk fever
*With the limbs trying to maintain balance Ice bath: controlled, relaxes muscles
Commonly affects the vestibular system (CN VIII) Fluid therapy
Also seen in old/senior dogs and cats Nutritional support
Clinical Signs:
Abnormal head carriage Erratic eye movements
Head tilt to either side Circling
Ataxia Nausea & vomiting
Paresis & Paralysis Feline infectious enteritis: Most severe and destructive disease
Paresis: partial loss of function All members of the Felidae family is very much susceptible
Paralysis: total loss of total function (neural or muscular) Disease is caused by the Feline Panleukopenia virus
Parvovirus: ssDNA
UMN Resistant to most disinfectant
Lesions within the CNS to the grey matter Transmission: Direct contact
LMN Infected cats, infected puppies
Lesions within the peripheral nerves (affecting limb) Indirect contact
Central grey matter (origin of the nerve) Contaminated objects
Vertical transmission
Maybe associated with: Transplacental
Transection of muscle Vectors
Static compression (organs, FB) Ectoparasites
Dynamic compression Clinical Signs
Concussion (trauma) General: Depression, anorexia, pyrexia, vomiting, diarrhea, severe
Degeneration dehydration, electrolyte imbalance
Vascular disease Pregnant/reproducing: Embryonic death, mummification, abortion, still
Infection births, early neonatal death
Inflammation Neonates: Locomotor dysfunction, circling, ataxia, incoordination
Neoplasia (primary & secondary)
Pathogenesis
Nutrition (seldom; common in milking dam)
Contact → lymphoid tissue infection → viremia → small amounts of virus
Age & breed
survive → persistence & shedding or strong immune response
Acute/insidious & slowly progressive
neutralize virus → persistence & shedding
Difficulty in movement
- Jumping/climbing the stairs Diagnosis
- Moving the neck Presumptive: History, Clinical signs, Leukopenia
- Forelimb involvement Confirmatory: Necropsy: brain: hemorrhage, inflammation, hypoplastic
- Systemic disease or CNS signa cerebellum; stomach: congested, hemorrhagic, thin mm, bile
Abdominal discomfort & spinal pain stained including duodenum
Continent Viral isolation
Tail function
Treatment
Supportive & symptomatic: Fluid therapy, antibiotics (cephalexin,
Physical Exam:
enrofloxacin – chewable), anti-emetics
Check for plegia (complete loss of voluntary motor skill):
Prevention: Vaccination, sanitation & disinfection
Monoplegia (one limb)
Management: Supplements, stress management
Paraplegia (both front or both hind)
CAV: Acupuncture, massage, hydrotherapy
Hemiplegia (both left or both right)
Quadriplegia (all limbs)
Rabies: Viral neurological disease
Check for:
Afflicts all warm-blooded animals
Proprioception (perception of position and movement of the body)
There is no known treatment for clinical rabies
Ataxia
Bats serve as reservoir
Dogs are the main host (Philippines)
Rabies virus = lyssa virus = rhabdoviridae
Deactivated easily by soap, acetone, formaldehyde, extreme
temperature, acidity
Transmission: Common: Animal bites
Licking of open wounds
Inhalation
Exposure to infected tissue
The virus is shed in the saliva
Most recorded animal bite cases are pet dogs because pet
dogs are monitored and positively identified
Replicate in muscle: Centripetal vs Centrifugal
7 Rule: Clinical signs appear in 7 days, 7 weeks or 7 years (humans)
Incubation: 10 days to 6 months

Clinical forms of rabies:

Furious: Aggressive, restlessness, seizures, incoordination, ascending
paralysis
Dumb: Profuse salivation, ataxia, incoordination, death → asphyxiation

Most reliable signs: behavioral & unexplained paralysis

Diagnosis: Complete history & clinical signs

Lab: FAT, rapid rabies enzyme immunodiagnostics,
immunohistochemistry, mouse inoculation test, virus
isolation, PCR
Control: Vaccinate
Spay & neuter
Education
Quarantine
Breeding Soundness Examination (BSE) Physical Exam: Male
When we do it? Physical exam of the external genitalia
On a regular basis along with PE Semen collection & evaluation
Reasons Libido assessment
- Determine suitability for breeding
- Determine cause of breeding failure Penis & prepuce
- Predict the fertility of the animal - Check for congenital malformations
o Using laboratory & clinical evaluations - No crackling over the os penis
Steps in BSE - No abnormal enlargement
- Complete PE - No pain
- Thorough pre-breeding examination
o History of successful breeding Scrotum & scrotal contents
o History of failed/successful pregnancy - Two fully descended testicles
o History of medication - Consistency & location
- Assessment of heritable conditions - Size & shape
o Cryptorchid - Rabbits: can hide their testicles within abdominal cavity
o Abnormalities Prostate gland
o Hip dysplasia - No enlargement or pain
o Deafness - Ventral recumbency and perform digital rectal exam
o Retinal detachment Libido assessment
o Congenital = usually heritable - With or without female
- Diseases with breed predilection - Semen collection facilitates assessment
- Difficult when animal is scared, unfamiliar with place/female dog, too
Who can be bred?
familiar with place/female dog
Young, unproven ones
Semen collection & evaluation
Older, unproven animals
Done by
Mated bitches or queens that failed to get pregnant
- Manual manipulation
Purchased or sold for breeding purposes
o Extrude penis
Intended AI
o Make sure it is clean
Done periodically
o Manipulate penis until the dog starts to hump
Prior to breeding
o Place latex funnel
After whelping or queening
o Let the penis be until it dissipates
After weaning
- Electro-ejaculation
A complete medical history - Teaser bitch
Previous health status & diagnosis - Pheromones
Results of diagnostic test previously performed Seminal content
Drugs & medications Urethral Slightly cloudy 0.5-2 ml
Breeding profile pH 6.3
Length of ownership, rearing & management Sperm rich Milky
0.5-3 mL
*Animal with the longest delayed implantation: sea lions (2 months) pH 6.1
Prostatic fraction Crystal clear fluid
Physical Examination 2-20 ml
Note abnormalities that may adversely affect breeding: pH 6.4
Identify heritable characteristics (bite, eye color, dewclaw) Semen evaluation
Out at elbow Volume: 1 to 6 ml
Fiddle front Color: milky
Loose elbows Progressive motility: >70%
Barrel hocked Morphology: >80% normal
Cow-hocked Concentration: 100-500 M/ml
Narrow hindquarters - Count using Neubauer slide
Straight vs sway - Multiply by volume
hindlegs Causes of abnormalities
Cat foot - Severe stress
hare foot - Testicular hypoplasia (feminizing effect: Sertoli cell tumor)
splay foot - Hypothyroidism
Dip in the back - Toxicity
Hollow back - Nutrition
Overbuilt - Obstructive lesion (urolithiasis)
Roach back - Acute immune disorder
Serologic testing
- Brucella canis free
o Rapid card test sera
o Tube agglutination test
o 2-mercaptoethanol tube agglutination test
o Blood culture
- Others:
o E. coli (may be contracted from dog vagina)
o Proteus vulgaris
o Streptococcus sp.
o Staphylococcus sp.
Physical Examination: Female Optimizing male & female reproductive performance
Males
History of cycle - High-quality, nutritionally balanced, protein rich diet
Behavior during estrus - Sperms are made up of proteins
Dates & methods of previous insemination - Maintain excellent body condition score and anatomic soundness
Fertility of the studs used - Ejaculated sperm viability up to 7 days
Events following breeding Females
History of abortion, other diagnosis & treatment - Maintain pregnant bitches on the best plane of nutrition and continue
Examination of the mammary glands: regular exercises
- Number, size & consistency o Healthy reproductive system
- Character of secretions ▪ Healthy ova
- Examine for masses & abnormalities ▪ Maintain pregnancy
- Un-voided milk → milk hardens in glands → sour milk → milk out and ▪ Prevent congenital defects and abortion
check for bacteria → if bacteria is present, milk out manually. Do not ▪ Support lactating puppies
feed to pups. o For healthy fetuses and puppies
- Too much calcium may lead to excess milk production, calcium tetany - Nutrition of pregnant bitch
Inspection and palpation of the genital organs o 1st trimester: 132 kcal of ME
Structural abnormalities of the vulva o 3rd trimester:
▪ Increase energy intake by 10% per week
Character of vulvar discharge ▪ Total energy:
Type of Etiology Diagnosis • 25-30% is protein (30-40% animal origin)
discharge • 25-65% is lipids
Bloody Pro-estrus Hx of CS, vaginal cytology ▪ ~5% fiber
Estrus Hx & CS vaginal cytology, ▪ No need to supplement carbohydrates
progesterone level, LH testing
o Feed high in calories & protein in multiple small boluses
Placental sub Hx of recent whelping
o Avoid excessive calcium or vitamins during pregnancy to prevent
involution
eclampsia and dystocia
Severe PE & vagina culture, UTZ,
vaginitis or vaginoscopy - Inappropriate timed breeding
cystitis o Most common cause of infertility in bitches
Greenish black Separation of Hx of pregnancy or abortion o Thus, know stage
or dark bloody placental sites
Post-partum Hx of whelping within the 6-8
lochia weeks
Reddish brown, Open cervix Hx intact bitch in diestrus, CBC
yellow thick pyometra with elevated neutrophils, radio
malodorous & UTZ, culture & chemistry
panel (azotemia)
Metritis Hx of illness 2-7 days post
whelping, purulent vaginal
discharge & poor mothering
Straw colored Estrus Hx & CS, vaginal cytology,
progesterone levels, late
pregnancy or puppy vaginitis

Vestibular mucosa
- Visual inspection
- Digital inspection
Clitoris
Uterus
- Transabdominal palpation
Vaginal cytology & culture
Digital examination
Vaginoscopy

Vaccination & parasite control

Vaccinations in the breeding bitch should be current (within 3 years)
Can be vaccinated early in proestrus
Deworming during pregnancy
Vaccination leading to fever disrupts estrus cycle
Safe during pregnancy: febantel, praziquantel
Case Presentation 1
Chummy
Vomiting
Recent estrus cycle, no mating/pregnancy
Appetite loss, vomiting, lethargy, vaginal discharge
PE
Weak lethargic
Enlarged abdomen
Vulvar & perineal area soiled with hemorrhagic mucoid discharge
LN palpable
Bilateral nasal discharge/lacrimal secretion
Swelling vulva
Increase hemorrhagic mucopurulent discharge from the vulva
Lab (+) gram positive
50, 224 tWBC

Differential diagnosis
Estrus cycle: values should be normal range/no infection, pain is present
TVT: no cells found, no history of exposure, no gross lesion, vulvar
discharge should be bloody
Metritis: no recent whelping (animal never pregnant/mated)
Pyometra: working diagnosis

Pyometra: Infection of the uterus

Involve hormonal and structural changes in the uterus
Estrus (high prog levels) → diestrus (2-10 weeks) →
suppression of the leukocyte response → decreased
myometrial contractility → stimulation of the endometrial
glands (mucus produced is good for bacteria) →
proliferation of bacteria (ascending infection from anus) →
bacterial infection → pyometra
Predisposing factors Middle aged (2-8 years)
Infrequent or irregular cycle (polycystic)
Had episodes of false pregnancies → body thinks it’s
pregnant
Nulliparous (never been mated)
Two types
Open: Characterized by presence of a foul smelling sanguineous to
mucopurulent vaginal discharge; cervix is open
Clinical signs: Presence of foul-smelling vaginal discharge
Lab results Elevated PCV
tWBC range of 900 to 75, 000 cell/ul
Radiography show enlargement of the uterus
Ultrasonography

Open type pyometra may be medicated:

- PGF2 alpha
- Prolonged antibiotic therapy
- This treatment is only indicated for open type pyometra, however,
70% of cases is expected to have a recurrence in 2 years
- Use vit c (500mg, SID) & vit e (800-1000 IU SID) → causes
endometrial contractions as well (no literature)

Chummy 2 years later…

- Pain upon palpation
- Marked enlargement of abdomen
- No discharge
Diagnosed with recurrent pyometra
- Signs
- History of recent cycle

Close: Cervix closed; characterized by absence of the foul

mucopurulent vaginal discharge
It is more difficult to diagnose due to its insidious nature
Marked abdominal distention
Only treatment possible is surgery, then IV fluids & antibiotic
therapy & nutritional support post-op

Recommendation
Preventive: Spay
Case Presentation 2 Urinary disorders
Chief complaint: Swollen vulva, perineum, bloody vulvar discharge Urinary disorders
Diagnosis: Canine Transmissible Venereal Tumor (TVT) - Pollakiuria
- Dysuria
Co-amoxiclav 1.4 mL TID for 14d o Stranguria
Jetepar 5mL BID for 30d o Hematuria
Vitamin C 500 mg for 14d o Urinary incontinence
Vitamin E 400 IU for 14 days o Polyuria & polydipsia
Vincristine Sulfate 0.025 mg/kg
PU/PD
Low PCV Excessive urination and water intake respectively
Osmotic solution cannot be given May be observed in a number of diseases
Colloids Normal water consumption: 50-100 ml/kg/day
Normal urine production: 30-50 ml/kg/day
TVT: Sticker tumor *In disease conditions, urine output is important to monitor
High risk in young sexually active dogs In a normal setting…
- Diagnosis - Heavy exercise
o FNAB - High ambient temperature
o Impression smear - Dry or salty food
o Vaginal swab Increased urination:
- Treatment - High water content of diet
o Chemotherapy - Low environmental temperature
▪ Vincristine
• 0.025 mg/kg Clinical signs include:
• BW, IV, once a week - Nocturia
• Natural alkaloid - increased frequency of litter change
• Extracted from Vinca rosea plant - Drinking from alternative water sources
• Distribution in the circulation: 5-30 min post injection Diagnosis
• Does not cross the BBB - History of trauma or medications
• Elimination - Urinalysis & culture
o Feces (50%) Diluted urine → increased amount of urine → bacteria (UTI/cystitis)
o Urine Macromolecules:
Proteinuria → (+) protein → glomerulonephritis or early renal disease
• Low WBC
Hematuria → inc protein → may cause false positive
o Once a week
Glucosuria → (+) glucosuria → diabetes mellitus
o Make immune system better than just treatment
- CBC: leukocytosis, neutrophilia
o Radioimmunotherapy
- Blood chem: Elevated T4
o Immunotherapy
Hyperglycemia
o Surgical excision
Elevated ALT
o Supportive therapy
Elevated BUN
o Symptomatic therapy
Hypercalcemia
Hyperkalemia
- Diagnostic imaging
Abdominal radiographs
Ultrasonography
Case Presentation 3
Presentation: Hematuria, dribbling
Differential: Cystitis (elevated WBC, fever, lethargy, vomiting)
Cystolithiasis (palpable mass or bladder)
Nephrolithiasis
Acute renal failure
Laboratory: PCV 60
Total WBC elevated
Neutrophils elevated
BUN elevated
Creatinine elevated
Color amber → concentrated
Turbidity turbid
Protein (+) positive → hematuria
Bacteria 20-30
Diagnosis: Cystolithiasis
65-75% of the kidney is destroyed → renal failure
When the kidneys lose compensatory ability
Lower → renal dysfunction
Types of renal failure:
Acute renal failure (ARF)
Chronic renal failure (CRF)
Clinical signs
Acute: anorexia, dehydration, vomiting, diarrhea, lethargy, oral ulcers,
uremic breath, oliguria
Chronic: anorexia, dehydration, vomiting, diarrhea, lethargy, oral ulcers,
uremic breath, oliguria, PU/PD, weight loss, edema & ascites
ARF CRF
BUN Moderate to marked Mild to moderate
elevation elevation
Creatinine Moderate to marked Mild to moderate
elevation elevation
Phosphate Moderate to marked Mild to moderate
elevation elevation
Ca Normal to high Normal with 2
hyperparathyroidism,
hypocalcemia
K Moderate to marked Mild to moderate
elevation elevation
TP & dehydration Dehydration Isosthenuria
Normal to large Small, irregularly
kidney shaped kidney
Values higher than normal: ARF
Sudden plummet of values: CRF

Treatment: Surgery
Diuretics: Furosemide (2-4 mg/kg IV): does not alter GFR but
may lead to loss of potassium
Mannitol (0.25-0.5 mg/kg IV): type of sugar, osmotic
diuretic → pulls fluids towards the renal tubules →
contraindicated in animals with heart conditions
Dopamine (25µg/kg/minute IV)
*ensure patency or urinary tract → catheter
Diet modification: aim is to acidify the urine
Regular monitoring of the BUN and creatinine
Regular urinalysis
Bacterial culture
Case Presentation 4 - Staphylococcus sp., Streptococcus sp., Proteus
Presentation: Stranguria, pollakiuria mirabilis, Pseudomonas sp., Escherichia coli,
Normal appetite, regular water consumption Klebsiella sp., Enterobacter sp.
Defecation not observed - Candida sp., Cryptococcus sp. (isolated in nasal
Updated vaccination cavity → faster spread of agent)
Updated deworming Treatment
Blood test: NSF Bacteria Antimicrobial agents
Urinalysis: diluted E. coli Trimethoprim/sulfa (TMS), Cephalosporins,
Differential: Leptospirosis (vaccination, no icterus) Gentamicin, Enrofloxacin, Clavamox
Uro/cystolithiasis Proteus mirabilis Penicillin (ampicillin or amoxicillin), TMS,
UTI Cephalosporins, Gentamicin, Enrofloxacin,
Pollakiuria & stranguria Clavamox
UTI (Cystitis): bacterial infection Staphylococcus sp. Penicillin (ampicillin or amoxicillin),
Diagnosis: Complete medical history, palpation, urinalysis, Cephalosporins, TMS, Chloramphenicol,
urine bacterial culture, ultrasonography, CBC & chemistry Gentamicin, Clavamox
Streptococcus sp. Penicillin (Ampicillin or amoxicillin), TMS,
panels
Gentamicin, Clavamox
FLUTD
Pseudomonas sp. Tetracycline, Gentamicin
Klebsiella sp. Cephalosporins (cephalexin or cefadroxil)
Urinary tract infection Gentamicin, Clavamox
*maybe much more common in females due to wider and shorter Enterobacter sp. Trimethoprim/sulfa (TMS), Clavamox
urethral dimensions compared to males Common antimicrobial dose
- the bacterial or fungal infection of the urinary tact Penicillin G 40 000 U/kg TID
- Aka cystitis Ampicillin 25 mg/kg TID
- More common in female than male dogs Amoxicillin 11 mg/kg TID
- More common in male than female cats Amoxicillin/Clavulanic acid 11 mg/kg TID
- Infection may be persistent Tetracycline 20 mg/kg TID
Types Chloramphenicol 33 mg/kg TID
Uncomplicated Cephalexin 5 mg/kg TID
- no identifiable underlying cause Cefadroxil 5 mg/kg TID
- no structural or functional abnormalities Trimethoprim/sulfa 2.2 mg/kg BID
Complicated Enrofloxacin 2.5 mg/kg BID
- have an underlying cause Gentamicin 2.2 mg/kg TID
- infection may be recurrent or persistent Amikacin 2.2 mg/kg TID
- commonly due to problems in client compliance Prescription & Client Education (June 28, 2012)
- inability to find drugs written in brand names (ALWAYS write Ciprofloxacin (10mgkg) 250 mg tab: ¼ tab PO q12h 14d
generic names) Ascorbic acid (500mg/day) 500mg tab: 1-tab po q24h 14d
- treatment may not be specific for that particular condition Nefrotec: 1-tab po q8h 14d
(shotgun treatment) Monitor: Water consumption & Urine output

Diagnosis: Complete medical history *Kaolin → stomach coating

Palpation (transabdominal, rectal) *Pectin: bulk former → concentrates fecal matter → firm feces
Urinalysis (high probability of diagnosis → pus/WBC) Refractory UTI
Urine bacterial culture - Occurs when there is treatment failure
Radiography - Common causes includes
CBC & chemistry panels - uroliths
Urine: Normally appear as varying shades of yellow to amber - bladder tumors, polyps
The color is affected by pigments - pyelonephritis
Endogenous: bilirubin, hemoglobin - prostatitis
Exogenous: food additives, metronidazole (maybe - ureterocele
nephrotoxic) - urachal remnants
*do not take grapes → slows down GFR → makes Treatment failure
metronidazole stay longer in the system → Relapse
nephrotoxicosis - recurrence with the same etiologic agent
Cystocentesis: saves times (no waiting time) and sterile - antibiotic related (problem with client)
- nidus for infection (maybe after surgery like suture material)
Clinical signs - underlying immune problem
- dysuria - PUPD - iatrogenic
- stranguria & pollakiuria - Atypical colored urine Recurrence
- urinary incontinence - Incessant licking → more common in - underlying immune problem
cats - iatrogenic

Diagnosis: History & PE What to do in cases of recurrence or persistence?

When do we culture? - medical history (drug history)
- animal is immune suppressed - CBC & chem panels
- concurrent infection - Bacterial culture
- chronic diluted urine - Antibiotic sensitivity test
- elevated bacteria observed - diagnostic imaging (radiography, ultrasonography)
- presence of wbc
- specific gravity is <1.015
- common isolates:
Case Presentation 5 Predisposing factors: Age: Occurs in animals 2-10 years old
Urolith formation Sex: Equal frequency in adults of both sexes
Diet and other factors: High crystal concentration Obstruction common in males
Adequate time in the urinary bladder Breed: Affinity to water (large breeds > small breeds)
Affects the urine pH: color change in urine Confinement and exercise
Decreases in crystallization inhibitors: Diet
- Citrates, Pyrophosphates, Glycosaminoglycans Struvite: Staphylococcal UTI
Supersaturation forms the urolith Contains Staphylococcus sp., Proteus sp.
Clinical signs: Pollakiuria Contains protein
Diagnosis: Medical history and physical exam Degrades urea
Urinalysis Produces CO2 and ammonia
Urine culture Increase the pH (alkaline)
Antibiotic sensitivity Increased ammonium and phosphate
Radiography Diagnosis: Medical history and physical examination
Ultrasonography Clinical signs
Meds of Patch did not work Smell the urine sample
Anuria is now present: CBC
2-3 days of anuria: Vomiting & inappetence occurs Urinalysis: USG > 1.030
Pushing of stomach by the bladder pH > 7.0
Palpable urinary bladder Normal value: 5.5 to 6.5 pH
Microbiology test was done: E. coli (pink) was present as well Microscopic examination
as possible Klebsiella, Enterobacter or Citrobacter (blue) Treatment: Surgical removal of the urolith
Shapes of urinary stones/crystals Recommended for small animals
Smaller stones
Voiding urohydropropulsion
Dietary management
Aims to decrease the formation of new struvite
Encourage drinking
Moderate levels of protein
Keep the pH to 5.5 to 6.5 pH
Dietary dissolution
Acidify the urine
May result in urethral obstruction
Best reserved for female dogs and cats
Control UTI
Bilirubin Struvite Keep the animal at a low dose antibiotic therapy
Longer time using ATB give 1/3 of the lower dose
Ca Oxalate: Increase incidence due to increased use of acidifying
diets
Stones that are formed with acidic urine
Two forms:
Monohydrate: Whewellite
Elongated, ovoid, flat
Dihydrate: Weddelite
Rhomboid
Treatment: Surgical removal of the urolith
Management:
Dietary dissolution: Diet with urine alkalinizer
Calcium carbonate Calcium oxalate dihydrate Dietary management: Aims to prevents formation of new uroliths
Diets that moderately restrict protein, calcium &
oxalate
Monitor: Serum level of phosphorus & magnesium
Prevent struvite formation if too low

Uric acid calculi: Most common urolith in dalmatians and some English
Bulldogs
Caused by heritable defect
Adenosine (purine) → hypoxanthine (very soluble) → xanthine
(xanthine-oxidase) not very soluble → uric acid (not very soluble) →
allantoin (very soluble)
Dalmatians lack enzyme (uriase) to convert uric
Calcium oxalate monohydrate Cystine acid to allantoin
Treatment: Surgical removal
Management: Dietary management: high quality, low protein
Definitive diagnosis: Complicated cystitis, identifiable cause: Uroliths Allopurinol supplement: Xanthine oxidase inhibitor
Urolithiasis: One of the most common cause of UTI Decreases amount of uric acid
Caused by the presence and effects of uroliths, calculi, To be given life-long: 10 mg/kg TID for 3 weeks
or excessive, amounts of crystals Maintain SID 10 mg/kg as supplement
These cause irritation of the lining of the urinary tract Avoid giving excess: risk of developing xanthine
Urinary bladder: transitional epithelium calculi
Amorphous substances in the urine: Epithelial cells
Case Presentation 6
Signalment: Intact male, indoor cat
Inappetence
Stranguria
History: Stranguria
Pollakiuria
Frequent licking of genitalia
Updated deworming & vaccination
Indoor cat
Diet: commercial cat food (Whiskas, Friskies)
Physical exam: depressed, inactive, unresponsive
Delay in CRT
Swollen & congested prepuce
Mucoid discharge
Firm & distended urinary bladder
Dull & dry coat
Easy epilation of the hair
Pale mucous membrane
Differential diagnosis: Urolithiasis
Urethral obstruction
Urinary tract infection
Feline urinary tract disease
Lab results: High WBC
Dehydration (no appetite)
Neutrophilia
Lymphopenia
Urinalysis
FLUTD: Common in cats
- A collection of the clinical signs that affect the urinary bladder & urethra
of cats
- A condition that has many possible causes, but generally exhibit
similar, recognizable signs
- Characterized by: Pollakiuria, hematuria, dysuria-stranguria,
inappropriate urination, partial or complete urethral obstruction → these
signs have been termed as feline urologic syndrome if cause is known
- Equally prevalent in males & females
- Overweight
- Indoor cats
- 2-6 years of age
- Possible causes: urolithiasis, anatomic abnormalities, trauma,
cystitis, behavioral abnormalities, neurologic abnormalities (trauma to
lumbar vertebrae), neoplasia
FLUTD (urolithiasis)
- Micro-calculi or crystal containing mucous urethral plugs
- Struvite & calcium oxalates are most common
- Clinical signs: pollakiuria, hematuria, dysuria, vocalizing, licking, &
urinating in inappropriate places
- Maybe obstructive or non-obstructive
- Diagnosis: Medical history
Physical exam: enlarged, turgid UB, thickened UB wall,
abdominal pain, penile congestion,
CBC & chem panels
Urinalysis & culture
Diagnostic imaging: radiography, ultrasonography
Catheter
Cystoscopy: least recommended, penis is too small
Only done if causative agent is still not found
- Treatment: Management of non-obstructive FLUTD
Often asymptomatic within 5-7 days
Sterile cystitis: no antibiotics needed, anticholinergics (reduce
bladder spasms)
Treat with appropriate antibiotics
- Treatment: Management of obstructive FLUTD
Unblock the cat: Cystocentesis, catheterization
Set up a close urine system
Administer IV fluids (make sure UB cath is working)
Antibiotics
Diet management
Urethrostomy with penile amputation
- Prescription:
Norfloxacin 200mg tablet – dissolve in 5ml distilled water, 0.4 ml to be
given PO BID containing……………..